Spiritual Care as an Integrative Practice with Common Factors Theory

“People don’t care how much you know until they know how much you care.”
– John Maxwell

There are a lot of different kinds of Psychotherapy out there. Some modalities have been subjected to careful empirical study; some have long histories of clinical practice backing them up; and some live on the fringes of mainstream practice – either due to the biases and fashions that plague any shared human pursuit, or because the modality is indeed a bit wacky.  In choosing a therapy, different people make different choices for a variety of reasons. Sometimes it is because they feel a given modality is particularly apt for addressing a particular condition, but more often it is because a given modality is well suited to their own personality, and “makes sense” to them as individually.

My own practice, which includes both work in a hospital setting and work in private practice, is rooted in the CPE training that informs hospital Spiritual Care Providers (aka chaplains*).

[*Labels are in flux right now, particularly in Canada.  Personally I only use ‘chaplain’ for faith-based care, i.e. the chaplain mediates between a person and a tradition, or works with people in the context of their shared tradition. Conversely, I use ‘Spiritual Care Provider’ for a clinically trained professional who facilitates a person’s meaning making and coping on that person’s own terms (irrespective of similarities or differences in belief). This tidy split is not typical, especially in the U.S., rural regions, and geriatric environments, but I find it useful.  Along the same lines, I would also love to see CPE change from Clinical Pastoral Education to Clinical Psycho-spiritual Education, since the shepherding metaphor is not strongly present outside of Christianity.  However, there are a wide variety of opinions in the profession regarding labels, and mine should not be seen as wholly representative nor wholly unique.]

The practice of Spiritual Care overlaps with various other modalities including, but not limited to emotion-focused, acceptance and commitment, narrative, and story therapies; and often has a Rogerian tone. This overlap is enhanced because the training itself encourages exploring other psychotherapeutic modalities and personality theories.

As an Integrative Psychotherapy (though it may not be clearly named as such) Spiritual Care relies heavily on facilitating the client’s awareness of their own emotions, their own story, and the beliefs and assumptions they have around their story with an emphasis on finding or developing meaning, purpose, and connection with what is significant or sacred to them.  As my clinical supervisor often says, “The spiritual care journey can involve three key elements: Self-awareness, Understanding personal beliefs, Purpose and meaning.” and “Emotions don’t lie. A client’s fear is real, even if a particular belief behind it may not be. We try to help clients unpack those emotions and underlying factors; we give them permission to talk about things.”

Also, since no two people hold exactly the same things as significant or sacred, or exactly the same perception of those things, CPE trained Spiritual Care Providers facilitate a process of discovery and affirmation rather than religious authority. And while we are are all trained to comfort and facilitate individuals and families through times of grief, trauma, and shock; this supportive role is complemented by insight-oriented roles that popular depictions of our profession have often failed to represent.
[Again, this is part of the reason why the language and labels are in flux, since a Spiritual Care Provider is a clinician whose practice should not be confused with a visit from a “friendly vicar”.]

How is a Spiritual Care Provider defined?
The Scope of Practice for Spiritual Care Providers in Canada states: “Spiritual Care and Counselling Specialists seek to improve the quality of life for individuals and groups experiencing spiritual, moral and existential distress related to changes in health, maturation, ability, and life circumstances.  They utilize a holistic, relational approach to assess the nature and extent of the concerns; collaboratively develop a plan of care; provide therapeutic interventions to promote, maintain, and restore health and/or palliate illness and injury; and evaluate the implementation of the plan of care to ensure its efficacy and adequacy.”

And, in Ontario, where Spiritual Care is included in the controlled act of Psychotherapy, we should also add, “In the course of engaging in the practice of psychotherapy, a member is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to treat, by means of psychotherapy technique delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.” (See Psychotherapy Act, 2007, section 4)

As an Integrative Psychotherapy, Spiritual Care relies not only on techniques which happen to be present in various other psychotherapeutic modalities; it relies heavily on Common Factors Theory (though it may not be clearly named as such).  Common Factors are not the assumptions, techniques, and ‘tricks of the trade’ of this or that particular modality, Common Factors are personal and relational. They consist of the working alliance; that is the bond between participants; shared goal for client; agreement on tasks/process; etc. “Except for the initial severity of the client, there is no other variable that has been assessed early in therapy that predicts final outcome better than alliance.” However we only see verification of this fact in more recent studies since previous measures tend to focus on procedure not person of the therapist. (B. Wampold, The Basics of Psychotherapy: An Introduction to Theory and Practice, 2007, p95-102) I think it is important to note that these Common Factors – i.e. the working alliance, shared goals, and agreement regarding the task or process; along with the maintenance of health boundaries as well as safe and effective use of self – are clearly articulated in the definition of Spiritual Care Scope found in the Scope of Practice quoted above, and are also laid out in the Competencies of the profession, found elsewhere in the same document.

In journeying with a client, in creating a therapeutic space for their story, their emotions, their assumptions about themselves and the world, benefit comes in what could be loosely likened to what Hinduism calls Darshan: the sacred moment of truly seeing and being seen. And while s/he is certainly no deity or guru, a good clinician can help co-create the right environment and circumstance for clients to experience themselves more deeply.

Postscript:
If this has left you wondering about “What Spirituality?” or “Where’s the Spirituality in this?”, I’d invite you to look at my previous blog post, An Introduction to Spirituality.

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Grit, Resilience, and Balance

It’s not glittery memes and “positivity porn” that helps a person achieve their goals; it’s grit.
Angela Lee Duckworth says, “Grit is passion and perseverance for very long-term goals. Grit is having stamina. Grit is sticking with your future, day in, day out, not just for the week, not just for the month, but for years, and working really hard to make that future a reality. Grit is living life like it’s a marathon, not a sprint.”

.

Here are three articles about resilience, grit and balance from folks who get things done when the going gets rough.

A Navy SEAL Explains 8 Secrets To Grit And Resilience

US Navy SEALS conquer fear using four simple steps

Mindfulness-based stress reduction finds a place in the military

What is the difference between Psychotherapy and Coaching?

Sometimes, there seems to be a bit of confusion between Psychotherapy and Coaching, and depending on the professional, their practice, and even where they practice, there may actually be different degrees of overlap.

That said, here is a quick chart of general difference distinguishing Psychotherapy and Coaching (there are likely more and some exception may apply):

Psychotherapy

Coaching

·        About addressing disturbance or
dysfunction as well as enhancing function
·        Solely about enhancing function
·        Inner work / Awareness oriented
(though action may be an outcome)
·        Outer work / Action oriented
·        Addresses underlying concerns ·        Addresses external concerns only
·        Brings unconscious material to
consciousness
·        Only works with conscious mind
·        Enhance insight and self-awareness ·        Clarify goals and enhance motivation
·        Focused on past, present, and future ·        Primarily focused on present and future
·        Focused on personal outcomes ·        Focused on concrete worldly outcomes
·        Focus on whole person ·        Acknowledges whole person but focuses
on specific tasks or activities
·        May have an educational component,
but no advice-giving.
·        May have a mentoring or consulting
elements, depending on the client’s goals
and the coach’s expertise.
·        In some places, like Ontario,
Psychotherapy is a legally regulated
profession overseen by a professional
college. (Check your local laws.)
·        Coaching is an unregulated profession,
though various organizations do exist to
provide the option of training,
certification, and oversight.

And here are some of the ways they are similar:

  • Each has a variety of sub-specialties based on certain theories or techniques.
  • Each has many practitioners who use integrated approaches rather being limited to a given sub-specialty’s theory.
  • Both may involve insights, or shifts in meaning-making, albeit in different ways.
  • Both may involve ‘homework’; not everything occurs in the session.
  • You, as the client, must do ‘the Work’ – just like a physiotherapist can facilitate certain exercises, but can’t do them for you; a psychotherapist and/or coach can facilitate certain processes, but what the client gets out of the process is related to what she or he puts into the process.
  • Both hinge on the openness and trust of the client/practitioner relationship; so finding a ‘good fit’ is vital to the success of the work.

So, if your challenge is an addiction, trauma or PTSD, anxiety, depression, bereavement, the natural stresses that go with certain transitions in life, or the deep work of understanding yourself better, you may require a psychotherapist.

However, if you’re looking to enhance performance or meet certain personal or career goals, you may want a coach.

I am both a registered Psychotherapist as well as a certified Coach.  In my own practice aspects of either service can come into play depending on the client and the client’s needs.  However, even here, it is very important to clearly identify what scope of practice is being leveraged. This keeps the work transparent and maximizes the clients opportunity and agency in our work together.