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Spiritually Integrated Psychotherapy:
A Partial Map of a Small Piece of the Territory for Pastoral Counselors and
Their Colleagues
Agenda
• Introduction, results, questions (45)
• Group conversation (5-7 people, 20 min)
• Responses from groups (20)
Rob Gonsalves“Unfinished Puzzle”
Met
hodo
logy
Exp
lain
ed
Grounded Theory
• Qualitative research
• Extension of ethnography (Strauss, Corbin, Charmaz)
• Constant-comparative method
• Construction of intermediate theory grounded in data (vs. testing a theory with data)
Procedures I• Proposal & MAP Grant in Collaboration with TSCTF
• Identifying general boundaries – Search of academic institutions with SI in description– Search of counseling agencies with SI in description– Search of counselors’ websites with SI in description– Defining “Pastoral Counselors and those who work with them”
• Sample– Maximum diversity frame (note limitations)– Email blast to all AAPC members asking to ID self and someone in community not AAPC
who practices SIP– Ed. Institutions selected from websites that met criteria– Counseling centers selected that met criteria– Individual practitioners from email blast & referred from email blast, center or ed.
Institution (you really should talk to…)
11%
9%
13%
18%9%
9%
4%
16%
11%
Age
26 - 3031 - 3536 - 4041 - 4546 - 5051 - 5556 - 6061 - 6566 - 70
44%56%
Gender
MaleFemale
Sample Characteristics
4%
16%
2%
78%
Race/Ethnicity
AfricanAfrican Amer-icanAsianEur/Amer
7%
38%56%
1st Degree
Sem MAUniv MAM.Div.
2%2%2%2%4%
18%
18%24%
27%
Term Degree
MSWDOMDUniv R PhDMA+Sem PhDD.Min.Univ. NR PhDNone
9%2%
13%
11%
11%2%
31%
4%
4%
11%
Prof ID
LPC
LPC & MFT
LPC & PC
MFT
MFT &PC
MSW & PC
PC
PC & Psychologist
Psychiatrist
Psychologist
2%4%
8%
13%
15%
15%
19%
25%
Work Location
Congregation
Hospital
Group Practice
Academic
Acad & Priv Prac
Acad/Priv Prac
Private Practice
Agency
2%2% 2%2%
4%
4%
4%
7%
9%
9%9%
9%
16%
20%
RelIGIOUS ID
Adventist Buddhist
Bud/Chris Episcopal
Black Baptist PC(A)
UCC Catholic
ABUSA Evang. Christian
PC(USA) UMC
Baptist Christ. NOS
27%
11%
16%13%
4%
7%
9%
2%
11%
Years of Practice
0 - 56 - 1011 - 1516 - 2021 - 2526 - 3031 - 3536 - 4040+
4%9%
11%
16%
22%
38%
Region
NECentralAtlanticWest/RMMidwestSE
6%
16%
19%
22%
38%
AAPC Rel
NoneFellowMemberDipClinical
Procedures II
• Interviews– Open questions; Recorded– Continuous coding using NVIVO; constant comparison in
scheduling interviews– Note limitations…diversity, Canada
• Interpretation of results (constant-comparison method)– Axial coding, building categories, using NVIVO– Model building using NVIVO– Now testing validity/truthfulness
Som
e Re
sults
Gen
eral
The
oreti
cal F
ram
ewor
k
Alternative Medicine
PC Traditional Prof.
SIP & Spiritual Direction
Phenomenological-Existential
Multicultural framework for
SIP
Faith Based Practice
Humanistic
Sacramental Assumptions
General Theoretical Frameworks for SIP
Black Church
Community
A Multiversal Construction Implicit/organic understanding of spirituality
PC Traditional
• Part of Christian ordained ministry & training• Rooted in religious community & hospitality• Strong theological training• CPE & Psychodynamic/conflict theories• Strong sense of counseling as sacred• Christian heritage (but not Christian Counseling)• Connects people to God• Not spiritual director, but open to big questions• SIP a new way to market PC
Faith-Based Framework• Religious people want religious counseling• God incarnated in therapist for salvation of others• Strong theological training• Salvation is health• Kerygma perspective• Spirit of God talks– What does God want for this person– Seeking God in each session
• Christ is active presence in therapy• Therapy grounded in human fallenness
Humanistic Framework
• Spirituality & therapy = self-discovery• Absolute client centered approach• Therapy helps client generate own theology• Therapy expresses grace in human
relationships• Human connection between therapist & client
is central
Phenomenological Framework
• Focus on mystical presence• Therapy empowers transcendence • Existential therapy—mindfulness, meditation• Sacred is revealed in therapeutic vulnerability• Self-transcendence is central
Multicultural Framework• Spirituality is one of many multicultural factors• Working with spirituality IS multicultural
counseling; one competency among others• Deals with differences• Attends to faith or faiths of “others”• Requires competency in multicultural counseling– Utilizes microskills
• Respectful of and conversant with various spiritual traditions
Spiritual Director & SIP Framework
• Therapy begins in spiritual direction• Spiritual direction as certified discipline used
throughout process of therapy• Focus on preventive care
Black Church Community
• SIP in the action of preaching in Black Church• SIP in the action of the community in Black
Church• SIP in the action of pastoral counselors
serving, often without license in Black Church• Black Church as therapeutic experience
“Sacramental”-- Mediating Variable*• God is present in sessions
– Christ’s active presence– Connects people to God– God-focused incarnation– God’s desire for people central
• TX Sacred safe space– Casts goodness – Rigorous self-exploration– People reveal selves– For the spirit to grow
• TX is process of surrender to Holy/God/Deity– Seeking God in each session
• Priestly dimension of TX– Ministerial identity– TX mediates forgiveness– Grace made real in TX
relationship– Grace linked to positive
psychology– Counseling as sacrament– TX empties self for client
• TX creates conditions for Holy Spirit activity– Spirit is motivating energy– Follows the spirit’s lead– The “glue” in personality & TX
*Mediating in the sense that it creates important connection between categories
Prac
tices
…..
Prac
tices
…
General Therapy-orienting Practices
Attend Carefully to
Belief System
Trust Therapist’s instincts & intuition
Use-refer religious
community
Create place of safety
Everything in therapy is spiritual
Use of religious symbols
Who initiates?
Client-Centered never
therapist
Therapist initiates
Loving the Client
Transcends Boundaries of Traditional TX
Specific Practices in
Therapy
Uses Spiritual-Religious Symbols
Assessment
Black Church Preaching-Communal Experience
Teach-use Xn Spiritual Practices
Proactively Raise
Spiritual Questions
ScriptureTeaches Spiritual Practices
Models Therapist’s
own Spiritual Practices
Assessment
Formal Methods-
Alternative Med
Therapist Language
Music as Spiritual Mediator
Prayer
Therapist Use of Self
Use of Self
Guided by Psychological
TheoryTherapy anchored in TX own Spiritual and religious life
Spirituality is the core connection between client &
TX
Priestly Presence/Action
Culturally Aware & Competent--
Bilingual
Questions for Groups (20 min.)
• How does this description/model fit your experience?
• Whose voices are we missing?
• What would you want the research team to know from your group’s discussion?
• What questions did we forget to ask?
Group Feedback…
Implications for PracticeEspecially with Strategic Plan’s Mandate in Mind
• Multiversal/polydoxy—not one model/not one truth
• Plurality of models requires contextual definition by clinicians– Claiming-defining location and meanings– Similar to identifying models of therapy used– Transparency for self, clients, supervisees and other clinicians
• Plurality of models requires consideration and research– Clarity—better description and definition of approaches/models– Contextualization—what model is appropriate for whom and in what context?– Contextualization—multicultural factors and religious plurality – Contextualization—models, intended outcomes and populations– How to communicate model/location– Generous listening
• Plurality of models points to care in PC training and collaboration– Plurality and defining terms– Clarifying procedures, practices and outcomes– Clarifying and contexualizing therapist use of self and resources– Generosity– Communicating model/location
Survey….
Assessment• No specific assessment or reference to assessment (30%)• Religious-Spiritual questions on intake form (25%)• Therapist intuition (17%)• Overtly asks clients in first session (13%)• Attend carefully in session (11%)• Fitchett’ assessment model (2%)• Pargament’s assessment sometimes (2%)• Center has them, don’t use them…
Teach-Use Christian Spirituality• Christian prayer (29%)• Scripture reading (10%)– Use for in-session reflection– Reciting scripture as homework– Useful examples from Christian tradition– Meditation
• Devotional practices (2%)• Fasting (2%)• Laying on hands (2%)• Meditation on Christian principles (2%)• Practices of Ignatius (2%)
Formal Practices-Alternative Medicine:Teaching and Using:
• Acupuncture• Biofeedback• Body work-Yoga &Tai Chi• Brainspotting • Breathing techniques• Cranial-sacral Therapy• Emotional Freedom
Therapy• Energy medicine• Guided Imagery
• Healing touch• Heart Math• Ignatius practices• Meditation• Mindfulness• Reiki• Rejects medical model• Relaxation • Spiritual Direction• Wellness & exercise
Prayer57 references to prayer by 23 respondents*
• Christian prayer as practice (6)• Always prays for clients & therapy (8)• Tells every client that she/he prays for them (3)• Never prays in or for therapy (5)• Encourages Centering Prayer (2)• Asks clients if they want to pray (2)• Prays with clients in session (4)• Prayer used as alternative medicine (2)• Ethical concerns about covert prayer (1)
*Numbers in parenthesis are higher than 23 due to Some respondents falling in more than 1 category
Priestly Presence/Action
• Use of self as ordained minister– Interpreting scripture, tradition, etc.– Sacraments, etc.
• Called to do what God did—incarnate presence with others
• Mediator of God’s grace through therapy• Counselor is a symbol of God’s grace• Counseling itself is sacramental presence/action
Therapy an Expression of Therapist’s Own Religious/Spiritual Life
• Genuineness about spiritual life• Personal theology and beliefs guide therapy• Therapist brackets personal beliefs and theology• Therapists trusts own instincts and intuitions • Therapists own spirituality is at the center of therapy
encounters• Uses own spiritual practices—teaches, models
Age Gender 1st Deg Term Deg Prof ID R/Ethnic Rel ID Wk Locat Yr Pract AAPC Rel Region
26-30 5 Female 20 Mdiv 25 None 12 LPC 4 African 2 ABCUSA 4 Ac & PP 7 0-5 12 Clin Memb 4 Atlantic 5
31-35 4 Male 25 Sem MA 3 Dmin 8 LPC & MFT 1 Af/Amer 7 Adventist 1 Acad/PP 4 six-10 5 Fellow 15 Central 4
36-40 6 Univ MA 17 MA+ 2 LPC & PC 6 Asian 1 Baptist 7 Academic 6 11-15 7 Dip 3 Midwest 10
41-45 8 MSW 1 MFT 5 Eur/Am 35 Black Bapt 2 Agency 12 16-20 6 Member 1 West/RM 7
46-50 4 DO 1 MFT & PC 5 Buddhist 1 Congreg 1 21-25 2 None 22 NE 2
51-55 4 MD 1 MSW & PC 1 Bud/Christ 1 Group Pct 4 26-30 3 SE 17
56-60 2 Sem PhD 8 PC 14 Catholic 3 Hospital 2 31-35 4
61-65 7 Univ NR PhD 11 Psychiatrist 2 Christ. NOS 9 Priv Prac 9 36-40 1
66-70 5 Univ R PhD 1 Psychologist 5 Episcopal 1 40+ 5
Pscyhol & PC 2 Evang. Christian 4
PCA 2
PCUSA 4
UCC 2
UMC 4
45 45 45 45 45 45 45 45 45 45 45
Sample Characteristics
Procedures• Proposal & MAP Grant in Collaboration with TSCTF
• Identifying general boundaries – Search of academic institutions with SI in description– Search of counseling agencies with SI in description– Search of counselors’ websites with SI in description– Defining “Pastoral Counselors and those who work with them”
• Sample– Maximum diversity frame (note limitations)– Email blast to all AAPC members asking to ID self and someone in community not AAPC who practices SIP– Ed. Institutions selected from websites that met criteria– Counseling centers selected that met criteria– Individual practitioners from email blast & referred from email blast, center or ed. Institution (you really
should talk to…)
• Interviews– Open questions; Recorded– Continuous coding using NVIVO; constant comparison in scheduling interviews– Note limitations…diversity, Canada
• Interpretation of results (constant-comparison method)– Axial coding, building categories, using NVIVO– Model building using NVIVO– Now testing validity/truthfulness