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Three Doors to Spiritual Reflection. Ethnographic Research on the Role of Emotion, Images and Sacred Texts in Spiritual Reflection done by non-chaplaincy Health Care Professionals CASC/ACSS April 15, 2011. Authors.

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three doors to spiritual reflection

Three Doors to Spiritual Reflection

Ethnographic Research on the Role of Emotion, Images and Sacred Texts in Spiritual Reflection done by non-chaplaincy Health Care Professionals

CASC/ACSS April 15, 2011


Thomas St. James O’Connor, ThDMichael Chow, MA, MDivElizabeth Meakes, MTS Janet Young, MTS Gary Payne, MDiv Myrta Rivera, MA Laura MacGregor, MSc Janet Howitt, MDiv/MSW

introductions of presenters
Introductions of Presenters
  • Michael Chow, M.Div, MA

Director, St. Joseph’s Health System, Diocese of Hamilton

Specialist & Teaching Supervisor (CASC)

  • Gary Payne, M.Div

Professional Practice Leader, Spiritual Care

St. Joseph’s Healthcare Hamilton

Specialist & Teaching Supervisor (CASC)

introductions of participants
Introductions of participants
  • Who am I?
  • Professional practice?
  • Special interest in this workshop …
our plan1
Our Plan
  • Stepping Back a Little
    • Overall Research Question
    • Review of Literature
    • Sources
    • Definitions
    • Findings and Discussion
  • Moving Forward
    • Role of Emotions, Images & Sacred Texts
    • Discussion
stepping back a little
Stepping Back a Little
  • Ethnographic qualitative study
  • 2 articles published
    • “In the Beginning: A Canadian Study on Sources and Definitions of Spiritual Reflection used by Health Care Professionals who are not Chaplains”

In Journal of Pastoral Care & Counseling, Vol 64, No 1 (2010)

      • Focus on Sources & Definitions
    • “Three Doors” Has been accepted for publication by Journal of Healthcare Chaplaincy, NY (March 2011)
      • Focus on Images, Emotions and Sacred Texts
overall research question
Overall Research Question

What are the practices of spiritual reflection

for health care professionals who are not chaplains

who provide spiritual care to their clients?

interview guide
Interview Guide

1) What are the sources you use for spiritual reflection?

2) How do you define spiritual reflection? Any spiritual authors you use?

3. How much time weekly on spiritual reflection?

4. Similarities & differences between prayer & spiritual reflection

5. Goal of spiritual reflection?

6. How important is spiritual reflection for identity?

7. Which groups-colleagues, clients, & other profession.?

8. Role of emotion and images in spiritual reflection? Is there an image or verse from a sacred text that describes spiritual reflection?

9. Give me an example of spiritual reflection from your practice

10. Image or verse from a sacred text and/or any other source that describes it.

11. Any other comments.

review of literature
Review of Literature

From “In the Beginning” publication:

  • No empirical research found on definitions, sources or methods of spiritual reflection used by health care professionals who are not chaplains.
  • Interviewees preferred “spiritual reflection”, whereas chaplains & pastoral counsellors also used “theological reflection”
lit review findings cont
Lit Review findings (cont)
  • Spiritual care and spirituality have become more important to many health care disciplines in the last thirty years
  • In the health care disciplines, there is an emphasis on reflective practice
  • Don Schon’s Reflective Practice is a common text used in many health care disciplines.
lit review findings cont1
Lit Review findings (cont)
  • Literature Review focused on three health care disciplines:
    • nursing,
    • social work
    • occupational therapy
  • Examining barriers to practice of spiritual care which includes spiritual reflection
barriers in nursing
Barriers in Nursing
  • Lack of conceptual clarity of “spirituality”
  • Frequent assumption that spiritual care is same as religious/faith based care
  • Demands placed on bedside nurses in terms of patient care
  • Lack of confidence in dealing with spiritual matters
  • Lack of education regarding spiritual care and reflection
barriers in social work
Barriers in Social Work
  • The notion that social work, like other health professions in recent decades, has distanced itself from religious belief
  • Increased emphasis on evidence-based practice
  • Lack of appropriate education in the realm of both spiritual care of clients and the role of spirituality as a health professional
occupational therapists a philosophical dilemma
Occupational Therapists:a philosophical dilemma
  • Canadian Model of Occupational Performance [CMOP], the model that describes the human participant in occupational therapy and the corresponding domain of concern for the profession, spirituality is placed at the central core of the person and model (Baptiste, 2005)
barriers for ot s
Barriers for OT’s
  • Debate within the profession:
    • How to define spirituality


    • Whether spirituality belongs in the centre of the occupational therapy model
  • Lack of training in spiritual aspects of care
  • The fear of intruding on another’s beliefs
barriers for ot s cont
Barriers for OT’s (cont)
  • Discomfort by the treatment team when professions explored spirituality
  • Confusion about the role of spirituality
  • Lack of time
  • Their role in terms of spirituality was to refer to pastoral care
  • An assumption that discussing spirituality with clients is taboo or inappropriate
  • Too emotionally charged
other findings
Other findings
  • In some cases, nurses & OT’s became more comfortable providing spiritual care with experience
  • That therapists who considered themselves religious were more likely to have positive attitudes regarding exploring spirituality in their professional life
  • Spiritual reflection has not been addressed nor has the methods and sources for reflection. Nonetheless, spiritual care requires some level of reflection
sample details
Sample details
  • 20 interviews
  • Occupational Therapists, Nurses, Social Workers, Physiotherapists, Music Therapist, Recreation Therapist, Physician, Psychologist
  • Faith groups included: United Church , Evangelical Christian , Christian Reform , Mennonite, Buddhist , spiritual but no faith group
  • Gender mainly females 17:3
  • Age: mainly over 40
brief check in
Brief Check In

For a few minutes please consider:

  • Is Spiritual Reflection part of your own practice?
  • What are some sources for Spiritual Reflection for you?
  • How do you define Spiritual Reflection?
research findings sources
Research Findings: Sources
  • Music 9/20
  • Sacred text esp. Bible 6/20
  • No sacred text mentioned 4/20
  • Personal & client experiences 7/20 - (much of this was personal journey)
  • Variety of spiritual authors used
  • Nature – 4/20
research findings definitions
Research Findings: Definitions
  • Connecting to Self & others…balance & grounded 9/20
  • Accessing & discovering the divine 8/20
  • Meaning and purpose 6/20
  • Related to daily life 6/20
unexpected findings
Unexpected Findings
  • Many mentioned no education in spiritual care/reflection
  • None mentioned receiving adequate education
comparison against study on theological reflection
Comparison against study on Theological Reflection

Sources for Theological vs. Spiritual Reflection

Chap/Past CounsellorOT, Nurses, SW

1. Sacred texts 63/75 1.Mus, Art, Lit 11/20

2. Pers. Exp. 50/75 2. Sacred text 11/20

3. Experience/Clients 42/75 3. Per/Prof Exp. 7/20

4. Faith Tradition 39/75 4. No sacred txt 4/20

5. Lit. & Soc. Sci. 26/75 5. Nature 4/20

discussion on definitions
Discussion on Definitions

Definitions of Theological vs Spiritual Reflection

Chap./Past. Coun. OT., Nurses, SW.

  • Both struggle to define
  • Meaning making Connecting with Self/Other
  • Discovering Divine Discovering Divine
  • Discipleship Meaning/purpose
three doors1
Three Doors
  • Role of Emotion, Images & Sacred Texts
  • In the process of Spiritual Reflection
  • By non-chaplaincy health care professionals who offer spiritual care
three doors2
Three Doors

Main Finding:

  • That emotion and images are main doors,
  • With sacred texts being a side door
5 minute check in
5 minute Check In

Please consider:

  • What has been your experience with Spiritual Reflection?
  • What are the roles of emotion, images and sacred texts in Spiritual Reflection for you?
  • Is there an image or verse from a sacred text that describes Spiritual Reflection for you?

Outcomes of Spiritual Reflection

  • Deeper sense of peace
  • Grounding and Letting Go

Some form of Transformation results from Spiritual Reflection

the 3 doors
The 3 Doors

“In our research, we found that emotion and images were the two main doors to spiritual reflection …

…A third door used by some was sacred texts but most participants acknowledged that they had little education in the sacred texts.

Sacred texts were more of a side door and not the main doors.

Also a consequence of this spiritual reflection … was transformation.”

role of emotion images and sacred texts
Role of Emotion, Images and Sacred Texts
  • Affirmed by many writers (Killen & de Beer, 2002; Kinast 1996; Whitehead and Whitehead, 1995)
  • Anton Boisen coined “Living Human Document” (1952)
  • Gerkin expanded and insisted on hermeneutics (1984)
from human sciences
From Human Sciences

Goleman, Emotional Intelligence (1995)

    • Cites work of Salovey & Mayer, 1990
  • 5 Domains

Fosha, Siegel & Solomon, 2009

  • Emotions facilitate integration & motivation
spiritual needs
Spiritual Needs

“… many healthcare professionals … believe that addressing the spiritual needs of clients and patients is within their scope of practice and part of holistic care.”

“Most research on spirituality and health is done by these non-chaplaincy professionals and researchers…”

is there a gap
Is there a gap?

“However with these professionals, there is a gap between research, the interest and the actual practice.”

“It is not known how much spiritual care is actually done by the non-chaplaincy disciplines.”

spiritual care therapy
Spiritual Care & Therapy
  • Spiritual Care & Therapy traditionally domain of chaplains and community clergy
  • Some are critical of these other professionals doing spiritual care when many have little education and training in this area (Sloan et al., 2000)
care involves reflection
Care involves Reflection
  • Spiritual Care involves Spiritual Reflection

(Schon, 1983; Mezirow, 1997; Mamede & Schmidt, 2004)

  • “Reflective practice is important in all health care disciplines. Spiritual reflection can happen in the midst of a visit with patient, in a prayerful time after or in conversation with a colleague.”
research lacking
Research lacking?

“However, there has been no empirical research on the role of emotion, images and sacred texts in spiritual reflection among non-chaplaincy health care professionals.”

rationale for study
Rationale for study
  • Given lack of empirical research, qualitative study employed
  • Descriptive and ethnographic
  • Goal is to understand and explore the role of emotion, images and sacred texts
secondary rationale
Secondary Rationale
  • Investigate if there are any similarities and differences between chaplains and other health care professionals in areas of spiritual and theological reflection
  • Research questions
  • Context
  • Sampling & Participants
  • Procedures and Analyses
  • Standpoint of Researchers
research questions
Research Questions
  • “What are the roles of emotion, images and sacred texts in Spiritual Reflection?”
  • “Is there an image or verse from a sacred text that describes Spiritual Reflection for you?”

Ethnography studies cultures within their contexts

  • 3 different Canadian health care institutions in Southern Ontario
    • Large teaching hospital in urban centre
    • Community hospital in different urban setting
    • Long term care facility in same city as community hospital
sampling methodology
Sampling Methodology
  • Varied health care disciplines represented
  • Purposeful sampling by invitation
  • Criteria:
    • Health care professional
    • Outside chaplaincy
    • Engaged in spiritual care and reflection as part of practice
  • Sampling ended when data saturation occurred after 20 interviews
participants description
Participants description

Interviewees fall into 3 groups of spiritual practice:

  • 9 identified as spiritual but not religious, using spiritual practices from Christian, Buddhist, Hindu and Muslim traditions
  • Another group of 9 from particular Christian denominations (3 United Church of Canada, 4 Evangelical, 1 Christian Reform, 1 Mennonite)
  • 3rd group: 2 Buddhists
  • Researchers made field notes and were participant observers
  • Ethical approval received from Research Ethics Board of Wilfrid Laurier University in Waterloo, Ontario, Canada
  • Interviews audio-taped & transcribed
  • Field notes also part of data
  • Data analyzed for themes using constant comparative method (inductive data analysis)
  • Then recorded under these emerging themes (deductive data analysis)
validity of analysis
Validity of Analysis
  • Increased validity through 2 types of triangulation: data and investigator
  • Multiple researchers were involved in designing, interviewing, coding and discussion
  • 6 researches interviewed participants and offered observations on cultures
  • Another researcher did literature search and involved in discussion of the findings relative to literature
  • Yet another researcher was an observer (no interviewing nor involved with literature search) coded data independently
  • Principal investigator also coded data and met with outside observer to discuss the themes that emerged
  • Consensus achieved, themes presented to wider research team for discussion
  • All researchers engage in either theological or spiritual reflection and value this practice
  • 4 researchers work as chaplains and/or pastoral supervisors in health care
  • 1 occupational therapist
  • 1 completed joint MSW/Mdiv degree
  • 2 family therapists and pastoral counsellors
  • Various Christian denominations and respectful of all faith groups
  • Emotion & imagination: 2 main doors
  • Transformation is outcome of reflection
  • Professionals led to spiritual reflection primarily based on their emotional response to patient or situation, including anger, awe, sadness, joy
  • Images brought out in session also primary as door to spiritual reflection
findings cont
Findings (cont)
  • Emotion and images linked, but not for all
  • However, 70% could not identify a sacred text that described process of spiritual reflection
  • For 30%, sacred texts were an avenue for spiritual reflection
  • Description of data
    • Emotion crucial part of spiritual experience and reflection for most (13/20)
    • Quotes (pp 7, 8)
critique of emotion
Critique of Emotion
  • Minority of health care professionals are critical of the role of emotions in spiritual reflection
  • “One has to be wary of emotions and one’s emotions might have nothing to do with the client or patient with you had a session.”
  • Quotes from study
  • Description of data
    • 14/20 mention that images lead to or are part of spiritual reflection
    • Quotes from #88, #76, #82, #79, #93 & 94
  • Some didn’t use images
    • Quotes: #83, #91
emotions images
Emotions & Images
  • “While there are some who don’t use images and some who don’t use emotions in spiritual reflection, the majority (11/20) use both emotion and images as their doors to spiritual reflection.”
sacred texts
Sacred Texts
  • Summary of data
    • 14/20 can’t remember or don’t use
      • Samples
    • 6/20 named sacred text (all from Bible)
    • Other sources include works of art, various songs, serenity prayer, various writers, poem “Footprints”
outcomes using emotion images and sacred text
Outcomes using Emotion, Images and Sacred Text
  • “Transformation in one form or another was the overall outcome of this use of emotion, images and sacred texts in spiritual reflection.”
    • Quotes:
      • #90 a music therapist
      • #86 recreation therapist & #79, #87 SW

“The transformation that takes place in some ways is beyond the control of the professional and in many ways paradoxical.”

  • “letting go of control” #77 SW
  • “paradox” “being comfortable with discomfort” #91 PT
discussion of findings1
Discussion of Findings
  • First purpose was to explore non-chaplaincy health care professionals’ use of emotion, images and sacred texts in spiritual reflection on provision of spiritual care
  • Several significant findings in this uncharted area
discussion of findings2
Discussion of Findings
  • Emphasis on emotion & images as 2 doors to spirituality and spiritual reflection
  • These invite reflection on the sacred without the use of sacred text
discussion of findings3
Discussion of Findings
  • Pargament 2007:
    • “search for the sacred”
    • “… humans in our contemporary society experience the sacred inside and outside of religion. For those outside of religion, the experience of the sacred which is most important is not usually connected to sacred texts.”
discussion of findings4
Discussion of Findings

“The experience of these health care professionals is that sacred texts are not a requirement for spiritual reflection.

However, emotion and images are required for spiritual experience and reflection.”

discussion of findings5
Discussion of Findings
  • Focus similar to Boisen and Gerkin re Living Human Document
    • Gerkin used Bible, systematic theology and is own tradition to interpret experience and understanding the living human document (O’Connor 1998)
  • Traditional spiritual care professionals agree
    • emotion and imagination essential (O’Connor & Meakes, 2008)
discussion of findings6
Discussion of Findings
  • Second purpose of study was to compare previous study on Theological Reflection (spiritual care professionals) with this study on Spiritual Reflection by non-chaplaincy health care professionals
theological vs spiritual reflection
Theological vs Spiritual Reflection
  • In the study on Theological Reflection:
    • Sacred texts are bigger than the 2 doors of emotion and images
    • Both studies found that the groups share the common components of emotion, images and sacred texts in reflection process
  • Could there be collaboration and mutual learning between chaplains and health care professionals on theological and spiritual reflection?
final thoughts
Final thoughts
  • Cannot generalize this research to all non-chaplaincy practitioners in health care
  • Sample too small
  • Other areas and cultures?
“One finding of the previous study on theological reflection is that the chaplains and other participants had gone beyond the methods and science of theological reflection that they had learned in their graduate studies into a creative and poetic imagination learned from experience, from the living human document.”
“We recommend, based on the current study, that the various health care professionals who engage in spiritual care collaborate with chaplains on further study of the role of emotions, images and sacred texts in spiritual and theological reflection.”
reflections questions
Reflections & Questions

We welcome your thoughts, comments…