The Spiritual Environment

Rick Klimowicz, MDiv MHS OTR/LW1 Inpatient Behavioral Health Unit

The Hospital of Central CTNew Britain, CT860-224-5285

rickklimowicz@ymail.com

Objectives

Equip OT’s with religious/ spiritual considerations as a component of their practice

Explore and understand the behavioral health client’s worldview and identify interventions that may promote recovery

Become aware of our own religious/ spiritual context Review and critique Eagan and Philipps “The Spiritual

Environment” from OT in Mental Health: A Vision for Participation

Equip OT’s with Religious/ Spiritual Considerations

Spirituality is important to health and rehabilitation

Spirituality is a component of OT practice

The spiritual environment is within the heart, mind, and experience of every person

Meaning in life is to be found within this rich and mysterious environment

Explore and Understand the Client’s Worldview

The Place of Spirituality in Recovery For many, hope, meaning and identity are

derived from some spiritual source Religious coping methods appear to reduce

symptoms of mental illness Participation in spiritual practices is associated

with a reduction in mortality

Defining the Spiritual Environment The spiritual context includes action, ideas, feelings and

beliefs that affect a person’s daily life and relationships Addressing the spiritual component can contribute to a

practice that more fully addresses the needs of the individual.

Listen and appreciate that there is an enormous diversity of contexts, shaped by many factors

Comprehension is important—if not critical—when supporting someone in the process of recovery

The spiritual environment is “the experience of conscious involvement in the project of life-integration through self-transcendence toward the ultimate value one perceives.”

The spiritual context is “the fundamental orientation of a person’s life; that which inspires and motivates that individual”

Spirituality is seen as a source of meaning. It provides a sense of purpose and connectedness to the world and others.

As spiritual beings, all people are considered to have a spiritual context or environment, within which their spiritual outlook is formulated.

The spiritual environment provides a framework through which individuals attempt to do the following: Accept, make sense of, and find meaning in life. Resolve loss and grief issues. Understand and relate to oneself and others. Solve problems. Make life decisions

Cope with struggles. Embrace joys. Adjust to change. Find strength. Face fears. Become vulnerable. Dedicate oneself to something or someone beyond one’s

self.

OT’s contribute to the formation of a supportive environment through three interrelated processes:

1. They listen for the uniqueness of the person.

2. They study their own contexts to ensure that their ideas, feelings, and beliefs do not become barriers to clearly understanding who the other person is and what he or she is experiencing.

3. They work to develop and maintain practice structures that allow and encourage recovery.

OT’s listen for the uniqueness of the person.

Honoring what has often been devalued is critical to the healing process.

OT’s study their own contexts to ensure that their ideas, feelings, and beliefs do not become barriers to clearly understanding who the other person is and what he or she is experiencing.

Central to this spiritual environment is the person’s relationship with self, others, the world, and for some, the Transcendent.

An individual’s spiritual context is influenced by multiple elements, including…

Personal constitution, Background and personal history, Faith background, Personal spiritual experiences, and Socio-cultural context.

Sense of Self and Worldview

The development of a healthy sense of self allows the person to fully accept him or herself and to become as relational and functional as he or she is able to be.

A person’s ideological framework and outlook regarding “free will” can impact that person’s perspective as to how much influence he or she can actually have on the course that his or her life takes.

OT’s work to develop and maintain practice structures that allow and encourage recovery.

Identify Interventions that may Promote Recovery

Logos reasoning vs. Mythos reasoning

Improve the OT’s awareness of his or her own spiritual context

No matter how open and welcoming we feel, our contexts ensure there will be things we do not understand or even feel comfortable with. Move beyond our immediate circles, listen as other people speak, rephrase our routine questions in terms that are more likely to lead to a trust moment.

Reflective Questions by Emily Schultz

What are the most important underlying beliefs or values that guide your life?

How, if at all, do you establish and maintain a relationship with the Divine in your life?

How do your beliefs/ values influence the way you connect to yourself?

What activities do you do to maintain a positive relationship with yourself?

How do your beliefs/ values influence the way you connect to other beings?

What activities do you do to maintain a positive relationship with other beings?

How do your beliefs/ values influence the way you connect to the world?

What activities do you do to maintain a positive relationship with the world?

Describe a challenge that you have recently experienced in your life.

How, if at all, did a creative process help you to get through that challenge?

How, if at all, did a spiritual process help you get through that challenge?

In what ways, if at all, were the creative process and the spiritual process linked for you?

In what ways, if at all, did use your inner reflection to get through the challenge?

In what ways, if at all, did you use narratives to get through the challenge?

In what ways, if at all, did you take action to get through that challenge?

Given where you have come from and where you are now in your life, where would you like to be in the future relative to your relationship to the Divine, yourself, other beings, and the world?

Ensuring that Practice Structures Support Recovery

The way we work promotes wholeness and helps people to realize their full potential.

Working with clients in a real environment enables participation. When we use simulated occupations with our clients, we maintain dependence.

OT and Faith Communities

Occupational Therapists can work with faith communities to ensure that congregations are welcoming of persons in recovery.

Occupational Therapists with their knowledge of meaningful occupation and appreciation of spiritual issues, could provide an important service in bridging the gap between people in recovery and faith communities.

Occupational Therapists can be a resource to clients who are searching for a spiritual home by identifying existing faith communities that are supportive of individuals with mental illness.

Resources

Resources for Spiritual Discussionby Andre Waite HOPE QuestionsH—Sources of hope and other spiritual resources

O—Organized religion client participates in

P—Personal spirituality and helpful practices

E—Effects of client’s spirituality and beliefs on medical care

FICA QuestionsF—faith, belief, and meaning in life

I—Importance and Influence of spirituality on their life

C—Community of Support availabl;e to client

A—Addressing spiritual needs: How client wants you to address these needs

Religious/ Spiritual Interventions by Andre Waite

Use prayer, meditation, breathing exercises, or relaxation techniques as a way for client to self calm

Establish rapport through discussions about spirituality

Improve on client factors needed during spiritual practices: walking down an aisle or navigating pews, genuflecting, tall kneeling, dressing in proper clothing, preparing special foods, completing ritual actions or dances, etc.

Guide clients through pencil and papers tasks focusing on spirituality. Arrange the session so it is a cognitive task or a physical task.

Online Resources

Creating Caring Congregations, a DVD and a corresponding curriculum produced by Mental Health Ministries:

http://www.mentalhealthministries.net

The National Alliance on Mental Illness:

http://www.nami.org/namifaithnet

Comments

Mental Health and Addiction Services

Monday Tuesday Wednesday Thursday Friday

8:30am Community meeting & goal setting group

Community meeting & goal setting group

Community meeting & goal setting group

Community meeting & goal setting group

Community meeting & goal setting group

9:45 or 10:00 am

Group psychotherapy

with SW

Grouppsychotherapy

with SW

Grouppsychotherapy with

SW

Group psychotherapy

with SW

Grouppsychotherapy

with SW

10:45am Nursing or Recreation

Group

Nursing or Recreation

Group

Dietician, Nursing or Recreation

Group

Nursing or Recreation

Group

CBT/ DBT with SW

1:45pm Substance Abuse with SW

Relapse Prevention

group with OT

Substance Abuse with SW

Addictions group with OT

Substance Abuse with SW

2:30pm CBT/ DBT with SW

CBT/ DBT with SW

CBT/ DBT with SW

CBT/ DBT with SW

Self Expression group with OTI

3::30pm OT groupCoping Skills

OT groupExpressive

Media

OT groupWork/Productivity

Skills

OT groupLife Skills

OT groupLeisure Skills

W-1 Group Schedule

OT Groups

Coping Skills: Identifying healthy coping skillsGetting motivated and a better attitude Improving hope, optimism, and life

satisfactionMaking sound decisions and identifying

and solving problemsPreventing relapse into Mental Illness

Expressive Media & Self Expression: Building self esteem and clarifying values and

beliefs Expressing feelings assertively and resolving

conflict Obtaining emotional and/or spiritual support Finding and building healthy and responsible

relationships / dating Being an effective life partner Parenting or caring for a frail, disabled parent

Work or Productivity Skills: Considering a career, school or training, self-

employment, or volunteer work Receiving SSI and/or SSDI and working Managing retirement or disability Finding stable, full-time work; preparing

applications and resumes; learning interview skills

Holding down a job Leaving employment properly

Life Skills: Straightening out financial and/or legal matters Balancing a budget, using banking services, and

avoiding consumer fraud Obtaining and managing an apartment or room to

rent Considering transportation options Using community resources and support services Grocery shopping, planning healthy meals or

snacks and identifying emergency food sources Considering health and safety issues

Leisure Skills/ Substance Abuse: Developing social and pleasurable pursuits Balancing work, leisure, self and family care Getting organized / using time effectively Establishing life goals Developing a balanced exercise program Relieving some physical pain Preventing relapse and understanding addictions Adopting a sober lifestyle

Community Meeting/ Goal Setting: Identify feelings Establish short-term goals and healthy coping

strategies Demonstrate sound judgment and decision

making Consider reason for hospitalization, treatment,

and/or discharge plans

Some Coping Strategies

Take care of yourself (shower, brush teeth, shave, put on regular clothes) Set up a meeting with a community religious leader Call or write to family and/or friends Use breathing and other relaxation techniques Write in a journal Listen to soothing music Give yourself a massage – rub your temples, shoulders, and the back of your neck Exercise by walking the halls, stretching, or using an exercise mat Laugh, enjoy yourself Play cards or a board game / do a jigsaw puzzle Read a novel, newspaper, or magazine Watch TV or a DVD movie Color or complete a mind challenge Focus on ways to solve problems, rather than worrying Challenge negative thinking Relieve anxiety by visualizing positive outcomes Make a to-do list (housing, employment, etc…) After discharge: go to 12-step meetings, IOP, or counseling

Behavioral Health OT Treatment

Traditional

HandoutsSimple, structured tasks

BrainstormingRole plays

Arts and crafts

Innovative12 step or inspirational literatureJournaling and creative writing

Art, Poetry, and MusicHoliday activities

Cards and table gamesJigsaw puzzlesMind challengesPhysical activity

Mindful breathing and relaxationSelf soothing strategies

Bio-energetic movements New games

Journaling

What have I done that I wish I had not done, since my last journal entry? What have I left undone in my life work and relations? Who are the people in my life that I trust right now? Who has trust in me? Have I done harm to myself or another? Do I need to make amends? Do I need to worry less about yesterday or tomorrow? Do I need to celebrate a joy or to commemorate a sorrow? Have I given of myself, without undue expectation of something in return? How have I learned and grown, since my last entry? How can I be more happy and at peace with my life work and relations?

References:

Egan, M. & Phillips, S., The Spiritual Environment, In C. Brown & V. Schoeffel (eds), Occupational Therapy in Mental Health: A Vision for Participation (pp.453-463), Philadelphia: FA Davis

Shultz, E. Spiritual Occupation, In C. Brown & V. Schoeffel (eds), Occupational Therapy in Mental Health: A Vision for Participation (pp.755-763), Philadelphia: FA Davis

Waite, Andrew, How Spirituality is a Regular Part of Occupational Therapy Practice, In August 25, 2014 OT Practice (pp.13-16), Bethesda, MD: AOTA