NUMBER 524 • 9 JUNE • SPIRITUALITY
In a Journal of the American Medical Association (JAMA) article, Astin (1998) offers three theories as to why clients choose alternative treatment options, including spiritual options: dissatisfaction, control, and philosophy. Dissatisfaction stems from ineffectiveness of traditional healing techniques, through either cost or adverse effects. Control and autonomy are returned to the client through alternative treatment methods. Finally, these treatments may be more compatible with a client's view of the world, personal beliefs, or philosophy.
In nursing, McSherry (2000) suggests that religion and spirituality are actually polar opposites on the same continuum. The fact that spirituality is so ambiguous and subjective may be one reason it is not addressed within the confines of nursing education. Educators cannot hope to teach a concept that is so universal, personal and broad in a realistic manner, yet nursing students are reporting they do not feel trained to handle the spiritual needs of their patients (McSherry, 2000).
An intriguing question for nursing educators is what is actually creating all of this interest in spirituality, and McSherry (2000) argues that it may never be addressed if the emphasis in nursing continues to be on audits and performance. If spiritual aspects are incorporated into training programs simply to allow those programs to label themselves as holistic, then students and educators may not take spirituality training seriously (McSherry, 2000).
Within the discipline of occupational therapy (OT), spirituality is considered to be an important aspect in the rehabilitation process for clients (Engquist, Short-DeGraff, Gliner, & Oltjenbruns, 1996). Knox (1992) conducted a pilot study survey examining occupational therapists from Colorado, in order to determine their ideas, beliefs and spiritual practices both within their personal lives and work. Even though 98% of the respondents felt that spirituality was an important aspect related to recovery from illness and disability, only a little over a half (54%) supported addressing spiritual issues within their profession. Thirty-seven percent reported that they were unsure what their specific role was in respect to addressing this topic. Several respondents (75%) felt that clients should be referred to another profession to deal with spiritual needs, whereas 33% reported that these issues should be addressed within their profession (Knox, 1992). For some in the field of occupational therapy, work can bring a sense of purpose and meet one's own spiritual needs (Christiansen, 1997). However, this is not a unique concept. In the 17th century debate arose around the concepts of spirituality, government, and the field of science, and religion. Due to the strong influence of medicine on OT, addressing spirituality became inappropriate (Christiansen, 1997). This may have laid the foundation for current occupational therapists' views to not incorporate spirituality into work situations. Other possible reasons for feeling other professions should deal with the client's spiritual needs may be due to the fact that occupational therapists are confused with their role regarding this issue (Knox, 1992), and the difficult nature of attempting to separate spirituality and religion (Christiansen, 1997).
As with other helping fields, professionals in the field of rehabilitation counseling report that spirituality is an important aspect of the rehabilitation process yet it is not a concept that is being well integrated into the client's treatment process (Kilpatrick & McCullough, 1999). This may be due to the lack of training that rehabilitation professionals are receiving in this area, or because spirituality and religion are sensitive personal topics, not amenable to easy discussion and discourse (Kilpatrick & McCullough, 1999).
In recognition of the importance of spirituality in counseling, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) recently released the 2001 Standards asserting that knowledge and skill regarding spiritual issues relevant to different counseling programs is required of all students in CACREP accredited programs. Religious and spiritual values are mentioned within the social and cultural diversity section of the eight CACREP common core areas in which students ate required to demonstrate knowledge. Program area standards specifically mentioning spirituality include: career counseling, college counseling, community counseling, gerontological counseling, marital, couple, and family counseling, and mental health counseling. The program area standards for school counseling make no mention of spirituality. Each counseling program area standard states that students must be able to demonstrate knowledge and skill which, for the above mentioned programs, consists of "implications of social, cultural, spiritual, diversity and equity issues relevant to ... counseling" (p. 14). CACREP has introduced these Standards, however no specific guidance is given as to how spirituality is seen as relevant to the counseling program, nor is any rationale given explaining methods a counselor can employ to effectively deal with spiritual issues (CACREP, 2000).
Spirituality is a major component of drug and alcohol treatment and many rehabilitation counselor training programs include concentrations or specialties in drug and alcohol treatment (Benshoff, Janikowski, Taricone, & Brenner, 1990). Since treatment notions derived from the disease model dominate drug and alcohol treatment, most drug and alcohol treatment programs embrace and teach the spiritual concepts of Alcoholics Anonymous (Matthews, 1998), but the logic is perplexing ... who is teaching (or taught) the teachers? In treatment, as well as in counselor education programs, it seems to be assumed that counselors know what spirituality is or have somehow "picked it up" in either their academic or home training. No universal standards have been set, so there is no way to know how spirituality concepts are being communicated to clients or if those programs incorporating spirituality are doing so in an effective manner.
Carroll (1999) writes, "The importance of the spirituality to the AA program cannot be overstated" (p. 57). She goes on to quote the AA Big Book that asserts that if an individual is "alcoholic", he or she "... may be suffering from an illness in which only a spiritual experience will conquer" (Alcoholics Anonymous, 1976, p. 44). In part this is simply linear logic. A basic belief of Alcoholics Anonymous is that alcohol has assumed an all-powerful, deified role in the life of the alcoholic. Connectedness to self, others, the environment and simple tasks of daily life are overshadowed by the power of alcohol. Recovery means the individual must develop new life skills, and the entire thrust of the 12 steps is incrementally towards developing a sense of spirituality. For example, the first several steps and many AA writings and sayings urge the newcomer to find inner peace; the process culminates in the 11th and 12th steps which urges the recovering person to use prayer and medication to establish a relationship with a higher power, and to carry this "spiritual" awakening to others. (Benshoff & Janikowski, 1999).
Green, R. L.(2001). Spirituality in Rehabilitation Counselor Education: A Pilot Survey. Journal of Rehabilitation, July-Sept, 2001
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Astin, J. A. (1998). Why patients use alternative medicine: Results of a national study. Journal of the American Medical Association, 279, 1548-1554.
Benshoff, J. J., & Janikowski, T. P. (1999). The rehabilitation model of substance abuse counseling. Pacific Heights, CA: Brooks-Cole.
Benshoff, J. J., Janikowski, T P., Taricone, P. F., & Brenner, J. (1990). Alcohol and drug abuse rehabilitation: A content analysis of the rehabilitation literature. Journal of Applied Rehabilitation Counseling, 21 (4), 9-12.
CACREP. (2000). http://www.counseling.org/cacrep/main.htm
Carroll, J. J. (1999). Compatibility of Adlerian Theory and practice with the philosophy and practices of Alcoholics Anonymous. Journal of Addictions and Offender Counseling, 19, 50-61.
Christiansen, C. (1997). Acknowledging a spiritual dimension in occupational therapy practice. The American Journal of Occupational Therapy, 51 (3), 169-172.
Engquist, D. E., Short-DeGraff, M., Gliner, J., & Oltjenbruns, K. (1997). Occupational therapists beliefs and practices with regard to spirituality and therapy. The American Journal of Occupational Therapy, 51 (3), 173-180.
Kilpatrick, S. D., & McCullough, M. E. (1999). Religion and spirituality in rehabilitation psychology. Rehabilitation Psychology, 44(4), 388-402.
Knox, L. A. (1992). Spirituality and occupational therapy: A survey of therapists' beliefs, opinions and practices. Unpublished master's thesis, Colorado State University, Fort Collins.
Matthews, C. O. (1998). Integrating the spiritual dimension into traditional counselor education programs. Counseling and Values, 43(1), 3-19.
McSherry, W. (2000). Education issues surrounding the teaching of spirituality. Nursing Standard, 14(42), 40-44.