Please join us in welcoming Kelly Arora to Mental Health News Radio. Our topic of discussion is Spiritually Integrated Therapy. We also asked Kelly to provide us with some additional information for our blog readers about her work, her role with the Samaritan Institute, and how she is working to broaden the reach of the Samaritan Institute.
Kelly, tell us about The Samaritan Institute and your role there.
The Samaritan Institute is a network of counseling centers across the United States and Japan. Our affiliated Centers distinguish themselves within their communities by being “spiritually integrated”—addressing the whole person as mind, body, spirit and community – within the context of the therapeutic relationship. The Samaritan Institute headquarters’ staff is based in Denver, and we also have 5 part-time Center Consultants who live and work throughout the U.S.
I’m in a new position in Denver as the Institute’s Vice President for Center Resources. My role is to support counseling Centers through education, leadership development and consultation. A key focus for me right now is to continue the development and implementation of Samaritan’s new Spiritually Integrated Therapy (SIT) curriculum.
What is spiritually integrated therapy?
Spiritually integrated therapy recognizes that spirituality can be an important component of a person’s healing process. Historically, the spiritual dimension has been marginalized in psychotherapy. Today there is more support for spiritual integration in health care in general and within mental health care specifically. In part, that’s due to the growing body of empirical research on the ways spirituality functions as both a source of struggle and as a positive coping resource in times of stress –which includes times when people experience mental health issues.
Therapists who are spiritually integrated are aware of how their own spirituality may affect their clinical practice. Awareness helps therapists recognize how they have the potential to impose their values and beliefs on clients and how they might avoid discussions about spirituality. Spiritually integrated therapists are also equipped to evaluate the healthy and unhealthy ways in which clients may engage their spirituality in times of stress—particularly in relation to the mental health conditions that bring them to a Samaritan counseling center. Spiritually integrated therapists are able to assess clients’ spirituality for the ways in which spiritual values, beliefs and practices function in life-giving and life-limiting ways, and then they help clients address those challenges and draw on helpful spiritual resources.
Why has the spiritual dimension been marginalized in psychotherapy?
There are a number of factors, beginning with the field’s roots in Sigmund Freud who saw religion as a problem to be fixed. Historically, a number of scholars have also contributed to narrow, secularized understandings of spirituality that don’t connect it with a search for and relationship with the sacred. As members of the psychology community tried to establish the field as a legitimate science, they intentionally avoided association with anything resembling superstition and magical healing, including spirituality and religion. Some psychologists view religion and mental health care as competing belief systems. Some religious groups have also contributed to this tension through their critical writings. More recently we see examples of the tension between psychology and spirituality reflected in the DSM III’s references to religion as being symptomatic of psychopathology, and in the limited references to religion and spirituality within major psychology and psychiatry textbooks and journals. I’m happy to say that since the 1990s we’ve seen tremendous growth in the number of studies on the relationship between spirituality/religion and health.
Tell us about Samaritan Institute’s new Spiritually Integrated Therapy training.
A few years ago, the Samaritan Institute wanted to address the gap in spiritual education for psychiatrists and psychologists. It put together a Training Advisory Board that includes Ken Pargament, Ph.D. (faculty at Bowling Green State University and author of Spiritually Integrated Psychotherapy), James Griffith, M.D. (faculty at the George Washington University School of Medicine and Health Sciences), James Lomax, M.D. (faculty at Baylor College of Medicine), and Carrie Doehring, Ph.D. (faculty at the Iliff School of Theology), as well as Executive Directors from the Samaritan Network. That group developed a curriculum outline, based on the work Ken Pargament has done and documented in his 2007 book on the topic. At that time, I was teaching spiritual care at Iliff School of Theology, and I also taught courses on the relationship between faith and healing at Regis University in Denver. I had developed a course called Faith, Spirituality & Culture for the Regis University School of Pharmacy’s doctoral students. That course required a similar synthesis of spiritual care with health care that has translated well in to the work I’m doing with the SIT curriculum. My initial involvement on the project led to full-time work with the Institute.
When I complete development of the SIT curriculum –which I expect to do by the end of 2015—the program will include 6 modules: (1) Introduction to SIT, (2) Roots of Spirituality, (3) Evaluating Spirituality, (4) Spirituality of the Therapist, (5) Assessing Spirituality, and (6) Addressing Spirituality. We recommend that all personnel in a counseling center participate in the Introduction to SIT module because we want to ensure that the entire Center practices spiritually-sensitive communication with clients. The wrong reaction from a receptionist might cause a client to hesitate bringing their spirituality into the therapeutic conversation. Modules 2-6 are more in-depth and are created for clinicians. These modules help Samaritan therapists understand how their own spirituality may affect their clinical practice, evaluate the healthy and unhealthy ways in which clients engage their spirituality in times of stress—particularly in relation to their mental health, assess clients’ spirituality within the context of the therapeutic relationship, and address clients’ spirituality in ways that enhance the integration of body, mind, spirit, and community.
What prompted your interest in the connection between health and spirituality?
I was diagnosed with rheumatoid arthritis (RA) 17 years ago. RA is an autoimmune disease where the body attacks the lining of the joints. It’s characterized by chronic joint pain and fatigue. I experienced my first symptoms of RA when I was a young mother with a 1-year-old and 3-year-old. As is often the case when a person finds out she or he has an incurable disease, this prompted me to ask the quintessential question “Why is this happening?” I looked for answers within my spiritual meaning making system – the system of beliefs that helps me make sense of how the world works and my place in it. I discovered that exploring these kinds of deep questions about my illness experience was as important to my overall well-being as my relationship with my rheumatologist, who focused solely on the physiological effects of the disease. My meaning making process included conversations with a counselor who was willing to take seriously my belief system. I also worked with a spiritual director (a person who companions others on their spiritual journeys) to help me find the best spiritual resources to cope with the ongoing losses and psycho-spiritual struggles I had in relation to the RA. Years later, when I considered the type of doctoral research I wanted to pursue, I knew I wanted to help others with the spiritual dimensions of chronic health conditions.
How do you define spirituality?
I think about spirituality in the broadest possible way: as the lived beliefs, values, practices and relationships that help people make meaning of the world and their purpose in it, including their search for and connection with that which is sacred. The sacred includes God, Allah, Brahmin, and other names for theistic understandings of a divine spirit or force, as well as nontheistic understandings of that which is transcendent or greater than the self – ways of thinking that might be described by people with Buddhist or secular spiritualties (for example, Ultimate Truth or the highest good).
How can spirituality help a person with a mental illness?
Many people rely on religious and spiritual beliefs and practices to cope with stressful life experiences, such as mental illness. Spiritual practices like prayer and meditation can help people cope with anxiety and pain, can help them maintain a connection to the sacred in their lives even as they face the unknown, and can help them frame their illness experiences in meaningful ways. Studies show that the ability to make meaning of an illness, to have some understanding of why it’s happening, helps people experience a better quality of life. Not everyone struggles to make sense of an illness (especially acute illnesses that quickly resolve), but research shows that health and well-being suffer when people who do experience spiritual struggles are not able to resolve them over time (say over the course of a year or two). We also know that stressful situations and spiritual questions can lead to positive spiritual growth. In fact, struggles can be an important part of spiritual growth and transformation. It’s when people “get stuck” pondering spiritual questions without finding satisfactory resolution, that health and well-being can be negatively affected. Spiritually integrated mental health care helps people with mental illnesses address those struggles (perhaps with the help of a person who specializes in spiritual care, such as, a member of the clergy). Spiritually integrated therapy can also help people draw on or discover spiritual resources to support them in the midst of their illness experiences. Research on religious and spiritual coping–relying on these kinds of beliefs and practices in times of stress—shows that having a “well-integrated” spirituality helps restore and promote well-being. “Well-integrated” means that a person’s spirituality is broad enough and deep enough to respond to the diverse stressors that face us over the course of our lifetimes. A well-integrated spirituality is also complex and flexible enough to handle multiple points of view and ambiguity, and it’s generally focused on goodness rather than punishment.
When is it appropriate for behavioral health care providers to ask or counsel patients about spirituality?
There has been debate in the broader health care community about the appropriateness of health care providers talking to patients explicitly about spirituality. The Samaritan Institute believes offering compassionate care to the whole person (mind, body, spirit and community) promotes balance in life and healing, especially when care providers respect the patient’s unique beliefs and practices without judging or imposing their own beliefs on the patient. It’s appropriate to ask a client about spirituality to learn how they frame what’s happening to them and to learn about the resources clients bring with them to the healing process. Spiritually integrated clinicians are also attuned to ways in which a client might hint at spiritual concerns or resources without explicitly calling them “spiritual.” It’s also important to ask questions that help the client explore this perhaps unnamed spiritual dimension of their health and well-being, especially if the client has questions or struggles they want to resolve.
Kelly Arora, PhD., is the Vice President for Center Resources at the Samaritan Institute in Denver CO. She is currently developing the Spiritually Integrated Therapy curriculum for the Samaritan Network of Counseling Centers. Kelly has been very active promoting the integration of spirituality in health care through presentations and workshops for diverse groups, including Spiritual Directors International, Hospital Sisters Health System, the American Academy of Religion, the National Nurse Practitioner Symposium, the Osher Lifelong Learning Institute, and the Society of Pastoral Theology. She has developed and taught numerous courses on spirituality and health care at the Regis University School of Pharmacy, Regis College, the University of Denver, and the Iliff School of Theology. Before she entered academia and the nonprofit sector, Kelly spent eleven years in the telecommunications industry and ten years developing and presenting programs on spiritual formation and church leadership.
Ph.D., Religious and Theological Studies, University of Denver and Iliff School of Theology Joint Ph.D. Program, 2011
M. A. Religion, Memphis Theological Seminary, 2005
B.S.Industrial Engineering, Kansas State University, 1984
Have questions about The Samaritan Institute?