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.

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.


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s