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Spiritual Attributes Within Crisis Intervention

发布时间:2017-04-25
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Abstract

Research reveals that spirituality is highly valuable to many people in times of crisis, trauma and grief. The relationship between coping with trauma and the use of various spiritual beliefs is well established. In this paper, I will be addressing the need for counselors to address the spiritual and religious needs of their clients. I will also include ways to promote the spiritual beliefs within the counseling session.

Spiritual Attributes

Within Crisis Intervention

Crises occur in the lives of normal, average individuals who are just having difficulty coping with stress. There are three essential parts of crisis that give a trilogy definition. The three parts of a crisis are these: a precipitating event, a perception of the event that causes subjective distress; and the failure of a person's usual cooping methods, which causes a person experiencing the precipating event to function at a lower level than before the event. A crisis event is seldom anticipated. By its very nature, a crisis represents an unanticipated event during which coping mechanisms are temporarily compromised and adaptive living is jeopardized.

The foundation of crisis intervention is the development of rapport - a state of understanding and comfort - between client and counselor. As the client begins to feel rapport, trust and openness follow, allowing the interview to proceed. Before delving into the client's personal world, the counselor must achieve this personal contract. The counseling relationship is unique in this regard; before any work can be done, the client must feel understood and accepted by the counselor (Kanel, 2006).

In crisis psychiatry, individual spiritual needs are often overlooked, yet spiritual beliefs are where most gain their reserve personal strength in times of crisis. D'Souza (2002) completed a study on mental health consumers and found that 67% felt their spirituality helped them cope with psychiatric issues. Recent research (Larson, 2002) found that those reporting a religious response to the question "How do you cope with stress?" were likely to have a significantly shorter length of hospital stay than those with any other response. Those requiring inpatient mental health care are certainly in need of all available personal resources, and spirituality is one important consideration.

Dr Harold Koenig (2002) explains there are 5 reasons counselors should address the spiritual and religious needs of their patient: (1) many patients are religious and their beliefs help them to cope, (2) religious beliefs may influence medical decisions, (3) religious beliefs and practices are related to better health and well-being, (4) many patients would like medical care providers to address their spiritual needs, and (5) addressing spiritual needs is rooted in the long historical relationship between religion, medicine, and healthcare. As counselors, we are always interested in a patients' medical history; it provides vital information in making life and death decisions. Research has also shown that addressing the spiritual dynamics of a patient is vital for the patient in "facing" life and death realities.

Religious and spiritual practices are traditional ways through which many people develop personal values and their own beliefs about human meaning and purpose. The experience of psychological trauma shatters an individual's sense of order and continuity of life. Questions of meaning and purpose emerge as a person experiences a loss of control over his or her future. Widely respected clinical scholars, including Herman (1992), Lifton (1988), and Van der Kolk (1987), have indicated that traumatic events often bring about a 'crisis of faith'. Figley (1989) has noted that, in order to answer the question of 'Why did it happen?' the traumatized often turn to faith and spirituality.

Studies investigating the roles of religion and spirituality in the facing of traumatic experiences have found that personal faith and religious communities are primary means by which people cope (Weaver et al., 1996). Weinrich et al. (1990) studied the effects of stress, in the wake of the terror and destruction caused by the class IV Hurricane 'Hugo' in South Carolina, on 61 nursing students and 10 faculties involved in disaster relief. After three weeks of disaster relief work, three quarters of those in the study reported that religion was a primary positive coping strategy. In a similar vein, a study of Jewish teenagers in Israel, who were facing the threat of missile attack during the 1992 Persian Gulf War, found they used religion and prayer to positively cope with traumatic stress (Zeidner, 1993).

Other researchers investigated religious coping methods used by individuals who experienced the devastating impact of a major midwestern flood. Frequent prayer and worship attendance were associated with better mental health (Smith et al., 2000). It is possible, of course, that individuals with better mental health are more likely to engage in religious activities.

There is increasing evidence (Baetz, Larson, Marcoux, Bowen, & Griffin, 2002) that spirituality/spiritual practices enhance one's mental health in areas such as feelings of depression, length of inpatient stays, satisfaction with life, and substance abuse. Koenig, Larson, and Weaver (1998) found, in a sample of 455 older patients, that those who attended church at least once a week were less likely in the previous year to have been hospitalized. The researchers also concluded that older adults who attend religious services at least once per week were hospitalized on the average of 11 days per year compared with 25 days per year for the unaffiliated.

Spirituality also appears to be beneficial with mental health consumers with substance abuse issues. Carter (1998) studied the importance of spiritual practices in relation to recovery from substance abuse. Two cohorts were compared, one with alcoholics with more than 1 year of sobriety and one with less than 1 year of sobriety. A questionnaire based on the values stressed in 12-step recovery programs assessed spiritual beliefs and practices. This study concluded that individuals with more spiritual practices had fewer relapses and longer-term sobriety. It should be noted that embracing spiritual beliefs alone was not enough. Participation in spiritual practices was shown to enhance recovery and offer early interventions that may help prevent relapse.

A well-designed investigation of persons grieving the loss of a family member or very close friend discovered a strong link between the ability to make sense of the death through religious belief and practice and positive psychological adjustment (Davis et al., 1998). In a third study, fathers of children being treated for cancer in a hospital clinic were asked about various methods of coping. Among 29 separate strategies used, prayer was both the most common and most helpful according to the fathers (Cayse, 1994).

Research suggests that some people exposed to traumatic events perceive benefits coming as a result of their difficulties, including an increased appreciation for being alive (Janoff-Bulman & Frantz, 1997). Among survivors of a cruise ship sunk at sea, more than 7 in 10 indicated that they enjoyed each day of their life to the fullest as a result of the traumatic experience (Joseph et al., 1993). Other studies have found that survivors often rely upon their faith for help in crisis situations, leading to increased meaning and purpose in life (Pargament, 1997).

The Christian tradition recognizes the importance of health, wholeness, and healing. A relationship based on faith in a caring God can provide health in all its fullness including during crisis. Gary Gunderson (1997) stated the following: "Faith needs the language of health to understand how it applies to life, health needs the language of faith in order to find its larger context, its meaning". Health integrates our spiritual, physical, intellectual, emotional and social lives. Therefore, health can be experienced in relationships with God and others; health involves a willingness to change; and health is a choice.

Promotion of clients' health must begin with the "do no harm" approach. Safety and common sense should guide all decision regarding the allowances of personal spiritual practices. Overt religious delusions that may involve potential harm to the patient or another should be discouraged through reality orientation as warranted. Benign religious practices (e.g., continuous prayer) that appear to offer relief and/or comfort should be promoted. Each case should be evaluated individually as events commence for safety and promotion of patients' positive outcome. Counselors should ask questions regarding spiritual history to facilitate patients' individualized care.

GWISH (2002) identifies itself as a "leading organization on educational and clinical issues related to spirituality and health." The director of this institute, Christina M. Puchalski, developed a spiritual history tool called FICA (Table 1), an acronym designed to help practitioners structure questions when taking a spiritual history. The HOPE approach (Anandarajah & Hight, 2001) is another example of a spiritual assessment tool developed to help practitioners take a spiritual history (Table 2).

Table 1. FICA

F is for questions of faith. Some examples of questions to ask would include the following: Do you consider yourself a spiritual person? What gives your life meaning?

I represents the importance of this resource in the client's life. Assessment questions might include, how often do you attend worship services? Do your beliefs largely influence your decisions with regards to your medical practices?

C is for community. Are you actively involved with a church community, and do you use this as a support?

A is for the practitioner to address these concerns with the patient, such as to ask, how would you like me to address these issues in your health care?

Table 2. HOPE

H addresses spiritual resources such as hope, without direct focus on religion or spirituality.

O represents importance of organized religion in their lives; the spiritual door is open.

P represents inquiry with regards to personal practices.

E is to remind the practitioner to work with the patient to discuss end-of-life issues, such as living wills.

Direct therapy-related interventions should be cognitive in nature and focus on positive, future, and goal-oriented directions. This helps remove the negative correlative from past experiences and refocuses from current stressor of decompensation to helping promote hope for the future. For example, an involuntarily admitted patient who recently lost custody of his or her children would likely be devastated by such a personal loss and be inclined to focus on this, openly worsening the client's condition. The counselor's focus at this stage is to help the patient bring his/her loss into perspective through immediate grief counseling and, dependent on the history or severity, antidepressant agents may be indicated. This would be a time one might want to access spiritual resources and should be encouraged to do so.

Following the initial grief period, the practitioner would help the patient shift focus to things he/she could do now and in the future. Directing the focus to goal-oriented behaviors promotes drive and satisfaction. Individual practitioner practices vary greatly, dependent on their choice of therapy styles, and each must seek his/her own ways to incorporate spirituality into practice. By doing this, counselors can help patients identify strengths, beliefs, and practices that are essential to health and well being (Laughlin, 2004)

Traditionally, Christian prayer has been understood as 'dialogue with God' (James, 1963). Prayer is shaped by historical, personal, denominational and cultural variables (McGrath, 1999). However, within such variables, prayer involves some sense of connectedness with 'otherness'. The definition of prayer is thus determined by how the concept of 'otherness' is understood. The working definition of prayer has emerged as follows: 'Prayer is "I" connecting with, or communicating with, "other", where "other" relates to a non-physical object or being, e.g. God, Higher Being, Inner light, Spiritual Self, etc.' This definition of prayer is inclusive of both personal and traditional concepts of 'the spiritual' and 'the divine'.

Prayer can be used as a support mechanism for the client and brings a lightening of the load and a feeling of relief for the counselor. Prayer can also been seen as an expression of hope for the client. It can also be a process of handling the client over 'in trust' between sessions, the expression of a desire for something else to reach the client which is over and above what other relationships can provide, an acknowledgement of struggle, and a plea for guidance. Silence was also identified as prayer - those moments when 'being' is more productive than 'doing'. Silence has been regarded as a prayerful and spiritual space (Gubi, 2002).

Inner healing prayer consists of "a range of 'journey back' methodologies that seek under the Holy Spirit's leading to uncover personal, familial, and ancestral experiences that are thought to contribute to the troubled present" (Hurding, 1995). In inner healing prayer, the counselor's knowledge of scripture is used as the backdrop or grid through which to interpret what occurs as the client's describes the 3xperience of inviting Christ to come into the memory. Perceived occurrences out of line with Jesus' character are quickly addressed.

Sides (2002) recommends that appropriate Biblical passages would be assigned following a successful implementation of this prayer form to ground the experience in the Word of God and continue the healing process. Overt incorporation of the Word of God following the prayer helps maintain a balance between affective experience and continuing growth from the experience through its interpretation via the Bible. While some question the legal and ethical ability to use some forms of inner healing prayer in psychotherapy (Entwistle, 2004), others believe they can be used in clinically sensitive manner as part of treatment (Tan, 2002; Garzon, 2005).

Many doctors and nurses believe in the power of prayer. Even in these days of separation between church and state issues, doctors are rediscovering the power of prayer in a patient's healing; some medical schools even include classes on how to talk with patients about their faith. The churches are not mandating doctors to pray with their patients; however, from the doctor's personal faith experience and from the patients' desire for prayer, flows the healing comfort and power of a healer's prayer for his or her patient. Many studies indicate that prayer makes a difference in a person's recovery (Long, 2004).

Most Americans turn to their faith to cope with trauma (Schuster et al., 2002; Weinrich et al., 1990), they are also turning to clergy to help them do so. In this way, the clergy are perhaps the first traumatologists. Members of the faith community have a long history of helping in times of grief, crisis and trauma. Clergy are most often called upon in crisis situations associated with grief, depression, or trauma reactions, such as personal illness or injury, death of a spouse or close relative, divorce or marital separation, serious change in health of a family member or death of a close friend (Weaver et al., 1999; Weaver et al., 2002).

When disaster happen, they affect not only those directly involved but others who suddenly feel that their security is threatened. To function during an emergency situation, people must put their feelings and normal human reactions arise. This state of denial allows individuals to act in order to survive. If this initial shock did not exist, people would be so overwhelmed with feelings that they could not function at all. After the emergency is stabilized, those involved can come to terms at an appropriate pace with what has happened (Kanel, 2006).

Crisis intervention usually involves quick actions to restore a victim's equilibrium to safe and predicable living. As such, crisis intervention is usually an immediate and temporary intrusion into the life of a person (Rosenbluh, 2002), with referral to after-care remediation if needed. Typically, the focus of crisis intervention is directed to such personality factors as coping mechanisms and individual resilience, as well as to such environmental factors as the sources of emotional support.

Yet, the cultural context of crisis events is often neglected, despite the subtle influence of culture upon the appraisal of victims and circumstance. In this regard, helping the victims of trauma requires crisis interveners to become aware of their own cultural assumptions; demonstrate an ability to communicate an understanding, acceptance and appreciation of cultural differences; and identify available resources from the victim's culture to assist with crisis resolution and aftercare.

There are many issues victims of trauma and violence will face as they are confronted with their own mortality: despair, hope, sin, eternity, love, guilt, shame, fear, etc. As counselors, we may be unable to address all of these issues in an effective manner. But by acknowledging and respecting the real dynamics of a client's faith and belief system, we can better meet the holistic needs of our critical clients and their family members.

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