Integrating Spirituality into Therapy
Integrating Spirituality into Therapy
Categories: RECENT RESEARCH
Stephen Wright, M.A., LCPC, RDDP
There have been numerous studies validating the positive impact spirituality has on mental health and well-being (Brown, Carney, Parrish, & Klem, 2013; Galanter, Dermatis, Post, & Sampson, 2013; Starnino & Canda, 2014). Spirituality has been shown to both insulate against the development of mental illness as well as aid in the recovery from mental illness (George, Larson, Koenig, & McCullough, 2000). This article will conceptualize the journey of spiritual growth through the lens of Christianity and explore how mental health issues can impact and impede that process. Then it will discuss ways to integrate spiritual development into the lives of individuals whose spiritual development has been affected by mental illness.
To begin with, spiritual development (or we can use the term “spiritual maturity”) can be conceived, in part, as a journey from an egocentric perspective of life to that of a more altruistic one. In essence, a mature believer is one who thinks less about oneself and more about others (Philippians 2:3-4). Scripture indicates that the defining characteristic of a mature believer in Christ is one who “loves” others. This “agape” love in the New Testament is less a feeling and more an attitude accompanied by altruistic behavior. In essence, then, maturely developed Christian faith is characterized by a radical paradigm shift in one’s worldview away from self-focused immaturity toward a healthy hetero-centricity.
In general, most individuals begin their journey in Christian faith focused on the self. This egocentric perspective is the starting place that is changed through an encounter with, or understanding of, Christ’s sacrifice. Gratitude plays a fundamental role in leading an individual to accept the gift of salvation and allowing him or her to begin the relationship with Christ, which ideally and progressively leads to maturity.
As Paul puts it, mature Christians are to: “Do nothing out of selfish ambition, or vain conceit, but, in humility consider others better than yourselves” (Philippians 2:3-4, NIV). Thus, it is this altruistic consideration or love of one another that indicates a person of faith is maturing. The words of Jesus sum it all up: “My command is this: Love each other as I have loved you. Greater love has no one than this: to lay down one’s life for one’s friends” (John 15:12-13).
There is a difference, however, between healthy, mature altruism and self-preservation motivated, or co-dependent, “people-pleasing.” Many individuals suffering from mental illness find it difficult to value themselves, as they suffer from the shame and stigma of the disorder (Mashiach-Eizenberg, Hasson-Ohayon, Yanos, Lysaker, & Roe, 2013) and, therefore, do not establish and maintain appropriate boundaries. Looking for external validation, these individuals tend to try to please others in their lives in order to experience some sense of value that they find difficult to generate internally. The result is that they “give of themselves” from their perspective, sometimes believing they are acting altruistically. However, the reality is that their motivation is much more self-oriented even though their behavior is other-centered. Their hope is that the validation of others in response to their behaviors will result in feeling better about themselves. In other words, whether on a conscious or unconscious level, these individuals are deferring to people in their lives in order to receive external validation because they lack, at some level, the ability to generate intrinsic validation.
In order to integrate spirituality into therapy, one may consider that a client’s mental illness acts as a hindrance in spiritual development toward a more altruistic, and therefore meaning-filled, life. Clients struggling with mental, emotional, and/or physical difficulties are people in pain. It is difficult to think of others when one is in pain. The suffering which one experiences tends to turn his or her thoughts inward. A person who is struggling with this type of pain and introspection often focuses on stopping the pain rather than working through it. He or she will tend to incorporate unhealthy behaviors, such as addictions or various forms of self-injuriousness, in a subconscious effort to alleviate that distress.
There is a preponderance of research evidence that living a life of meaning and purpose helps insulate and inoculate a person from mental illness (McKnight & Kashdan, 2009; Bronk, 2013; Schaefer, et al., 2013). Furthermore, incorporating meaning and purpose into one’s life can support his or her recovery from mental and emotional difficulties (Schaefer et al., 2013). From a Christian perspective, there is an intrinsic, godly direction of the development of meaning and purpose; therefore, a hetero-centric perspective is the natural outgrowth of that meaning and purpose. In other words, it is being proposed here that, if clients can be helped to develop and understand their reasons for being apart from the pain and suffering they are experiencing, they can develop the capacity to manage their distress more effectively and experience a higher satisfaction in life that is not so egocentric.
Purpose and meaning are crucial factors in this discussion. We can consider altruism as the expression of meaning and purpose in a person’s life because altruistic behaviors are an outgrowth of an individual’s purpose, which creates meaning for their experience. Having purpose may have great, positive impact on mental health, including personal longevity, fewer health problems, a stronger sense of well-being, positive social impact (McKnight & Kashdan, 2009), and recovery from trauma and negative events (Schaefer et al., 2013).
From a Christian perspective, purpose and meaning are easily understood as an outgrowth of the relationship one has with God through Christ. The Christian worldview is one that focuses on caring for others, loving one another, and bearing each other’s burdens. These altruistic behaviors are intrinsic to Christian life and are consistently expressed throughout the New Testament. A number of books have been written correlating the development of purpose and meaning in life with Christian faith (Boot, 2003; Bronk, 2013; Warren, 2012). For the purpose of this article, it is sufficient to state that the natural course of the Christian life tends to lead toward altruism, which is an expression of purpose as stated above.
Consequently, it is reasonable to assume that mental health clients could benefit from introducing and incorporating the spiritual exercise of gratitude and development of a more other-centered perspective. What follows is a possible path toward helping clients along the journey of integrating spirituality into their lives and assisting them to move forward toward a more spiritually mature, meaning filled, and purposeful life.
In order to help facilitate that transition, many believe that the spiritual growth journey really begins with gratitude. We can define gratitude as biblical “thankfulness.” Emmons and McCullough define gratitude in their book, The Psychology of Gratitude, as a “Moral Affect” (Emmons & McCullough, 2004). They go on to elucidate how gratitude functions:
Gratitude has three functions that can be conceptualized as morally relevant: (a) a moral barometer function (i.e., it is a response to the perception that one has been the beneficiary of another person’s moral actions); (b) a moral motive function (i.e., it motivates the grateful person to behave prosocially toward the benefactor and other people); and (c) a moral reinforcer function (i.e., when expressed, it encourages benefactors to behave morally in the future) (Emmons & McCullough, 2004).
According to Emmons and McCullough, when an individual experiences gratitude, the result is that one’s focus moves away from self (Emmons & McCullough, 2004). The person who experiences gratitude as a result of an altruistic act directed toward him or her will be more likely to choose to reciprocate with altruistic behavior… not only toward the benefactor, but also toward others in general.
It has also been shown that intentionally experiencing gratitude can have a positive impact on one’s sense of well-being (Sheldon & Sonja, 2006; Emmons & McCullough, 2004). Having clients develop a “gratitude journal” is one way to help focus on, and experience, gratitude, which may, in turn, give them a sense of turning their eyes outward toward others instead of inward toward themselves.
Once a client has developed the capacity to experience gratitude, a three-stage process can be entered into by the clinician with the client in parallel process with other interventions. The clinician can incorporate spirituality and guide clients along a spiritual development path in tandem with other appropriate interventions within the framework of their existing therapeutic modality. What follows is a three-stage process that can be incorporated into one’s clinical approach with hurting people.
First, the clinician can help a client recognize and normalize that he or she is self-oriented. As Scripture repeatedly points out, this fleshly focus is our default setting due to our fallen, sinful nature. It is important to gently reflect this reality in a non-judgmental way through unconditional positive regard (Rogers, 1951). The clinician can validate a client’s pain and point out that it is only natural that anyone in pain is first and foremost thinking about him/herself in a defensive, yet self-preserving, manner.
Second, the clinician can help the client incorporate gratitude and develop understanding that his or her immature, selfish, and sinful behaviors inevitably impact others. Clients are often affected negatively by regret when faced with the reality of how people in their lives have been shaken by their likely unintentional, yet nonetheless egocentric, behaviors toward others. During those discussions, it is helpful to reframe that regret into motivational or “godly” sorrow (2 Corinthians 7:8-11) by encouraging the client to consider, “My behaviors have impacted the people in my life by causing pain or distress; therefore, I am going to do everything in my power to avoid hurting them again in that way.”
The discussion about gratitude can occur along more religious lines if the client self-identifies as having Christian faith… or along more general lines if not. From the Christian perspective, helping clients connect with the grand concept of Christ’s death for our sins because of His love for us can have a powerful impact. However, in both cases, identifying areas of gratitude helps clients positively. Bartlett and DeSteno showed that gratitude can help foster relationships “by encouraging individuals to accept short-term losses in order to reap longer-term rewards…” (Bartlett & DeSteno, 2006).
Third, clinicians can help clients identify their potential positive impact on the world. This can be done by helping clients identify their personal strengths, reframe their difficult experiences, and develop an awareness of their passions. In the spiritual growth process, it is most helpful to see these three steps as successive developmental phases the client moves through, building on the stage before.
In summary, having conceptualized the developmental aspect of a client’s spiritual journey as moving from being immaturely self-oriented to maturely other-centered, the clinician can understand how the pain of suffering from mental health problems tends to interrupt and impede spiritual growth and maturity by pulling the attention of the individual toward the self and away from others. That immature preoccupation with the self can obscure an individual’s sense of purpose and meaning. If one considers the development and maintenance of meaning and purpose as spiritual outcomes and that mental illness tends to interrupt that process, he or she can conclude that guiding a person toward a more other-centered perspective can be beneficial to the healing process. The discussion led to the strategy of incorporating gratitude into therapy as a means to begin helping the client move toward an outward and other-centered perspective. This spiritual growth process culminates in a progressively sequenced model of helping clients identify purpose and meaning in their lives and, therefore, being capable of experiencing a greater and more mature sense of well-being and mental health.
Steve Wright, M.A., is a therapist at Timberline Knolls Residential Treatment Center located in the Chicago area. He served for more than 25 years as a minister working in churches with youth, families, and as a senior pastor. As a counselor, he worked in residential treatment as a therapist, supervisor, coordinator, and program director first in the substance abuse field and then in the eating disorder discipline. Steve holds a bachelor’s degree in Biblical Studies from Central Bible College in Springfield, Missouri, as well as a Master of Arts in Teaching from Olivet University and a Master of Arts in Community Counseling from the Illinois School of Professional Psychology in Chicago.
Bartlett, M.Y., & DeSteno, D. (2006). Gratitude and prosocial behavior: Helping when it costs you. Psychological Science, 17(4), 319-325.
Boot, J. (2003). Searching for truth: Discovering the meaning and purpose of life. Captain Fiddle Publications.
Bronk, K.C. (2013). Purpose in life: A critical component of optimal youth development. Springer Science & Business Media.
Brown, D.R., Carney, J.S., Parrish, M.S., & Klem, J.L. (2013). Assessing spirituality: The relationship between spirituality and mental health. Journal of Spirituality in Mental Health, 15(2), 107-122.
Emmons, R.A., & McCullough, M.E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377-389.
Emmons, R.A., & McCullough, M.E. (2004). The psychology of gratitude. Oxford University Press.
Galanter, M., Dermatis, H., Post, S., & Sampson, C. (2013). Spirituality-based recovery from drug addiction in the twelve-step fellowship of narcotics anonymous. Journal of Addiction Medicine, 7(3), 189-195.
George, L.K., Larson, D.B., Koenig, H.G., & McCullough, M.E. (2000). Spirituality and health: What we know, what we need to know. Journal of Social and Clinical Psychology, 19(1), 102-116.
Mashiach-Eizenberg, M., Hasson-Ohayon, I., Yanos, P.T., Lysaker, P.H., & Roe, D. (2013). Internalized stigma and quality of life among persons with severe mental illness: The mediating roles of self-esteem and hope. Psychiatry Research, 208(1), 15-20.
McKnight, P.E., & Kashdan, T.B. (2009). Purpose in life as a system that creates and sustains health and well-being: An integrative, testable theory. Review of General Psychology: Journal of Division 1, of the American Psychological Association, 13(3), 242-251.
Rogers, C.R. (1951). Client-centered therapy. Boston: Houghton-Mifflin, pp. 560. Journal of Clinical Psychology, 7(3), 294-295.
Schaefer, S. M., Morozink Boylan, J., van Reekum, C. M., Lapate, R. C., Norris, C. J., Ryff, C. D., & Davidson, R. J. (2013). Purpose in life predicts better emotional recovery from negative stimuli. PloS One, 8(11), e80329.
Sheldon, K.M., & Sonja, L. (2006). How to increase and sustain positive emotion: The effects of expressing gratitude and visualizing best possible selves. The Journal of Positive Psychology, 1(2), 73-82.
Starnino, V.R., & Canda, E.R. (2014). The spiritual developmental process for people in recovery from severe mental illness. Journal of Religion & Spirituality in Social Work: Social Thought, 33(3-4), 274-299.
Warren, R. (2012). The purpose driven life: What on earth am I here for? Zondervan.