Understanding Spirituality in Spiritually Integrated Psychotherapy

1. Understanding Spirituality in Spiritually Integrated Psychotherapy Kenneth I. Pargament Department of Psychology Bowling Green State University kpargam@bgnet.bgsu.edu Presented at Samaritan Annual Conference Spiritually Integrated Psychotherapy Denver, Colorado August 8, 2009

2. Cindy Videoclips

3. Reductionism • Freud – religion as a means of anxiety reduction • Durkheim – religion as a source of social solidarity • Geertz – religion as a source of meaning • Kirkpatrick – religion as an evolutionary by-product

4. Searching for the Sacred at an Early Age “Dear God, How is it in heaven? How is it being the Big Cheese?” Young Child (Heller, 1986, p. 31)

5. Children as Spiritual Beings • The capacity for spiritual experience and knowledge • The capacity to think about God as unique rather than humanlike • The capacity to conceive of an immaterial spirit and an afterlife • The capacity to experience spiritual emotions

6. A Definition of Spirituality • Spirituality is a search for the sacred.

7. Sacred Core God Divine Transcendent Reality

8. Sacred Ring Place Meaning Sacred Core God Soul Divine Transcendent Reality Children Marriage Nature Time

9. Sacred Qualities • Transcendence • [There is an] ‘otherness’ [to religious experience. It is] ‘wholly other. . . quite beyond the sphere of the usual, the intelligible and the familiar, which therefore falls quite outside the limits of the canny” (p. 26).

10. Sacred Qualities • Transcendence • Boundlessness “To see a World in a grain of Sand; And Heaven in a Wild Flower; Hold Infinity in the palm of your hand; And Eternity in an Hour” (William Blake)

11. Sacred Qualities • Transcendence • Boundlessness • Ultimacy

12. Nature as a Sacred Resource(Ahmadi, 2006) • “Whatever happens in the world to me or others, nature is still there, it keeps going. That is a feeling of security when everything else is chaos. The leaves fall off, new ones appear, somewhere there is a pulse that keeps going. The silence, it has become so apparent, when you want to get away from all the noise. It is a spiritual feeling, if we an use that word without connecting it to God, this is what I feel in nature and it’s like a powerful therapy” (p. 134).

13. Nature as a Sacred Resource(Ahmadi, 2006) • “Whatever happens in the world to me or others, nature is still there, it keeps going. That is a feeling of security when everything else is chaos. The leaves fall off, new ones appear, somewhere there is a pulse that keeps going. The silence, it has become so apparent, when you want to get away from all the noise. It is a spiritual feeling, if we an use that word without connecting it to God, this is what I feel in nature and it’s like a powerful therapy” (p. 134).

14. Sacred Aspects of Life • Psychological attributes (e.g., virtues, meaning) “The things that come from God are the highest things that we look for in life; peace and joy and love and beauty and health and vitality and strength and wisdom and creativity and abundance and the whole cookie factory. . . God gives these resources to us like the sun gives light” (interviewee).

15. Sacred Aspects of Life • Psychological attributes (e.g., virtues, meaning) • Cultural products (e.g., music, literature) “We have so much misery and suffering here. So much difficulties and pain. But soccer is our gift from God. Our healing grace so that we Brazilians can go on” (Rev. Filiho, Washington Post)

16. Sacred Aspects of Life • Psychological attributes (e.g., virtues, meaning) • Cultural products (e.g., music, literature) • People (e.g., saints, cult leaders)

17. Manifestations of God in People “God has a deep raspy voice – God is a jazz singer. She is plush, warm, and rosy – God is a grandmother. He has the patient rock of an old man in a porch rocker; He hums and laughs, he marvels at the sky. God coos at babies – she is a new mother. He is the steady, gentle hand of a nurse, the cool reassurance of a person pursuing his life’s work, and the free spirit of a young man wandering only to live and love life” (McCarthy, 2006).

18. Perceptions of Sacredness: Results of a National Survey • “I see evidence of God in nature and creation” (78%) • “I see God’s presence in all of life” (75%) • “I sense that my spirit is part of God’s spirit” (68%) • “I experience something more sacred in life than simply material existence” (76%) • “I see my life as a sacred journey” (55%)

19. The Search for the Sacred Discovery Socio-Cultural Context

20. A Direct Encounter with the Divine • One night, in the middle of one of my depressions, I heard a voice I’d never heard before, and haven’t heard since. The voice said, ‘I love you, Parker.’ This was not a psychological phenomenon, because my psyche was crushed. It was ‘the numinous.’ It was ‘mysterium tremendum.’ But it came to me in the simplest and most human way: ‘I love you, Parker.’ That rare experience taught me that the sacred is everywhere, that there is nothing that is not sacred, therefore worthy of respect. (Palmer, 1998, p. 26)

21. Encountering the Sacred Indirectly • “You really want to know who raised me? It was a peppertree with a short trunk. . . It had a great nest inside that was like a womb. . . You could sit in that womblike space and look out at the world without the world seeing you. . . I felt safe and loved and protected in that tree. It was my link with God/creation – with what was stable and real. . . that tree was a sacred presence in my life, and it taught me more about God and love than I ever learned in all the years I went to Sunday school” (Anderson & Hopkins, 1991, pp. 35, 37).

22. The Sacred as a Product of Internal and External Forces • “One half of ‘God’s stuffing,’ comes from the primary objects the child has ‘found’ in his life. The other half of God’s stuffing comes from the child’s capacity to ‘create’ a God according to his needs” (Rizzuto, 1979,p. 179).

23. The Sacred and its Implications • The sacred as magnet • The sacred as reservoir • The sacred as emotional generator • The sacred as guiding light

24. The Sacred as an Organizing Force “ If the foot shall say, Because I am not the hand, I am not of the body; it is therefore not of the body? If the whole body were an eye, where were the hearing? If the whole were hearing, where were the smelling? . . . But now are they many members, yet but one body. And the eye cannot say unto the hand, I have no need of thee, nor again the head to the feet, I have no need of you. Nay, much more those members of the body, which seem to be more feeble, are necessary” (I Corinthians 12: 15, 17, 20-22).

25. The Search for the Sacred Discovery Conservation Socio-Cultural Context

26. Spiritual Pathways • Ways of Knowing (Bible study, science) • Ways of Acting (ritual, quilting)

27. Nontraditional Way of Acting “By simple definition, quilting is merely sewing pieces of fabric together into a whole. But as spiritual discipline, it is a careful attention to the details of my life. Quilting as spiritual discipline is entering the sensual richness of the universe, creating order out of chaos, beauty out of the simple, wholeness from the scraps, and in the midst, being transformed” (Bushbaum, 1999, p. 236).

28. Spiritual Pathways • Ways of Knowing (Bible study, science) • Ways of Acting (ritual, quilting) • Ways of Relating (shared worship, loving relations)

29. Love as a Way of Relating “Love releases us into the realm of divine imagination, where the soul is expanded and reminded of its unearthly cravings and needs” (Thomas Moore, 1992, p. 81).

30. Spiritual Pathways • Ways of Knowing (Bible study, science) • Ways of Acting (ritual, quilting) • Ways of Relating (shared worship, loving relations) • Ways of Experiencing (prayer, meditation)

31. The Search for the Sacred Discovery Conservation Conservational Spiritual Coping Threat, Violation, and Loss Socio-Cultural Context

32. 9/11 as a Desecration • Students in Ohio and New York City coping with 9/11 • About 50% agreed that attacks were “An offense against both me and God.” • About 30% agreed that “Something sacred that came from God was dishonored.” • Perceptions of desecration are linked to: • Emotional distress • Anxiety • Depression • PTSD • Poorer physical health • Extremist reactions and desire for vengeance

33. Ways of Spiritual Coping • Benevolent Spiritual Reappraisal • Seeking Spiritual Support • Seeking Support from Clergy/Congregation Members • Spiritual Helping • Spiritual Purification

34. Benevolent Spiritual Reframing Child either positively reframes a situation or God’s response to a situation by imbuing religious/spiritual meaning or significance. “God allows me to have this illness so I can be challenged more in this life. I will be more happy because I am more fulfilled. Having to cope with Cystic Fibrosis will allow me to progress further in my next life.”

36. Ano and Vasconcelles Meta-Analysis(2004, Journal of Clinical Psychology) Number of Studies Cumulative Confidence Effect Size Interval Positive Religious Coping with Positive 29 .33* .30 to .35 Health Outcomes Positive Religious Coping with Negative 38 -.12* -.14 to -.10 Health Outcomes

37. The Search for the Sacred Discovery Conservation Conservational Spiritual Coping Spiritual Struggle Transformational Spiritual Coping Threat, Violation, and Loss Spiritual Disengagement Socio-Cultural Context

38. Dangers of Religious and Spiritual Life • Don’t let worry kill you -- let the church help • Thursday night -- Potluck supper. Prayer and medication to follow • At the evening service tonight, the sermon topic will be “What is Hell?” Come early and listen to our choir practice.

39. Three Types of Spiritual Struggle • Interpersonal • Intrapersonal • Divine

40. Interpersonal Spiritual Struggles • Negative interactions among congregation members: • Gossiping • Cliquishness • Hypocrisy • Disagreements with doctrine • “They get off in a corner and talk about you and you’re the one that’s there on Saturday working with their children and washing the dishes on Sunday afternoon. They don’t have the Christian spirit” (Krause et al., 2000).

41. Intrapersonal Spiritual Struggles “Is Christianity a big sham, a cult? If an organization were to evolve in society, it would have to excite people emotionally, it would have to be self-perpetuation, it would need a source of income, etc. Christianity fits all of these. How do I know that I haven’t been sucked into a giant perpetual motion machine” (Kooistra, 1990, p. 95)?

42. Struggles with the Divine “Many times I wonder how there can be a God – a loving God and where he is . . . I don’t understand why He lets little children in Third World countries die of starvation and diseases. . . I believe in God and I love Him, but sometimes I just don’t see the connection between a loving God and a suffering hurting world. Why doesn’t He help us -- if He truly loves us? It seems like He just doesn’t care. Does He?” (Kooistra, 1990).

43. An Illustration of Spiritual Struggle “I am told God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.”

44. Spirituality and Health Study • Participants • 1629 participants • Age: Mean = 49.1 years, SD = 17.76 • 75.3% Christian • 56.2% Attend religious services “almost every day” or “every day” • 55.3% Engage in private prayer “almost every day” or “every day” • 59.9% “Very religious” or “fairly religious”

45. Spirituality and Health Study • Measures • Mental Health: Symptom Assessment-45 Questionnaire (Davison, Bershadsky, Bieber, Silversmith, Maruish, & Kane, 1997) • Anxiety • Depression • Hostility • Interpersonal Sensitivity • Religious Struggle: Negative Religious Coping Subscale of Brief RCOPE (Pargament, Koenig, & Perez, 2000) • Social Support: Six items adapted from previous research (Zimet, Dahlem, Zimet, & Farley, 1988) • Obsessive-Compulsive • Paranoid Ideation • Phobic Anxiety • Somatization

46. Spirituality and Health Study • Procedure • Sample recruited from sampling frame maintained by Survey Sampling International • Sampling frame reflects demographics of 2000 U.S. census • Contacted 8,500 individuals • 1,895 completed the survey (22% response rate) • 266 surveys excluded due to missing data

47. Spirituality and Health Study • Statistical Analyses • Regression • Criterion measures: SA-45 subscales • Model 1: Age, gender, education, ethnicity, income, marital status, frequency of prayer, frequency of church attendance, social support, occurrence of personal illness/injury • Model 2: Religious struggle • Model 3: Interaction of religious struggle and personal illness/injury

48. Spirituality and Health Study • Summary • Religious struggle positively associated with various forms of psychopathology • Relationship between religious struggle and psychopathology stronger for individuals with recent illness or injury

49. Measures (Pargament, Koenig et al. 2004) • Number of Active Diagnoses • Subjective Health • Severity of Illness Scale (ASA) • Activities of Daily Living (ADL) • Mini-Mental State Exam (MSE) • Depressed Mood • Quality of Life • Positive Religious Coping and Religious Struggle • Global Religious Measures (Church Attendance, Private Religiousness, Religious Importance) • Demographics

50. Consequences of Religious Struggles • Study of medically ill elderly patients over two years (Pargament, Koenig, Tarakeshwar, & Hahn, 2004) • Struggles with the divine predicted increases in depressed mood, declines in physical functional status, declines in quality of life after controls • Struggles with the divine predicted 22-33% greater risk of mortality after controls • Struggles also predict stress-related growth