Spirituality in Social Work
Abstract and Keywords
This entry addresses the topic of spirituality in the social work profession, with an emphasis on the American context. Toward that end, the history of the relationship between the profession and spirituality is traced from the profession’s origins, through secularization, to the present reemergence of spirituality as a legitimate subject in social work discourse. The diverse ways in which spirituality and religion are conceptualized are reviewed along with rationales that are advanced to support the inclusion of spirituality in social work. The topics of spiritual assessment and intervention are discussed and guidelines for using spiritual interventions in practice settings are presented with a brief review of the research on spiritual interventions from an evidenced-based perspective. Some of the organizations that help support and nurture spirituality in social work are delineated. The entry concludes with a summary of proscriptions for advancing spirituality to the next stage in its professional development.
This entry focuses on social work in the United States and, to a lesser extent, social work internationally. However, it also draws on content from medicine, psychology, and other academic disciplines. As illustrated in the following section, the trend toward incorporating spirituality in the social work profession is part of a larger movement that encompasses all of these disciplines. This movement stems from changes in philosophical systems of belief—in essence, societal meta-narratives—that transcends these disciplines. The result is a broad trans-disciplinary movement that affirms the importance of spirituality.
Accordingly, the emergence of spirituality in the social work profession reflects broader historical currents that have affected many academic disciplines. These larger philosophical shifts have shaped how the social work profession has understood spirituality over the course of its history. In turn, this history serves to frame and illuminate the profession’s present understanding of spirituality.
History of Spirituality in Social Work
The social work profession grew out of organized religion. Until at least the late 19th century, most social welfare was conducted in a religious setting or was animated by a spiritual impulse. For instance, around 370 AD, the Eastern Orthodox Church established the first major hospital, which was set among houses for the poor, buildings for people with diseases, homes for the elderly, and a special hospital for people with leprosy (Hanawalt & Lindberg, 1994; Koenig, King & Carson, 2012). If the history of welfare work in recorded human history was proportionally chronicled in a 100 page book, only the last 2½ pages would be devoted to the emergence of the social work profession in its present secular form (Marty, 1980). Thus, it is possible to understand the history of the relationship between the profession and spirituality in terms of three eras, which can be summarized under the rubrics of origination, secularization, and reemergence.
The philosophical basis for social welfare is primarily found in religious teachings. Philosophically, the notion of justice requires the existence of a transcendent moral standard (Smith, 1996). If the norms of a given culture are used to assess the culture, then it is not logically possible to posit that something is unjust. The existing culture cannot provide a frame of reference that allows it to critique itself. Without the ability to, in a certain sense, rise above the status quo, it is impossible to recognize injustice.
To posit that a situation is unjust requires a moral framework that stands apart from the culture. In turn, this framework provides individuals with the ability to assess the present culture in relationship to this framework. It provides an independent position from which to posit what a just society looks like. An independent moral framework provides a lens through which to evaluate a given culture, to determine whether or not a status (poverty) or action (slavery) is just or unjust.
Religious traditions provide such a framework (Stark, 2003). Religions affirm moral standards—formal or informal notions about what is right, just, and fair. In turn, they provide an external framework for assessing a given culture. To the extent that the status quo does not conform to the standard, action is implicitly called for to set things right. Put differently, religions provide a framework for envisioning the world as it should be. It provides a vision of a just society (for example, a society free of poverty or slavery).
Buddhism, Christianity, Hinduism, Islam, and Judaism all provide adherents with a distinctive moral framework for determining just and unjust situations. Although different religions affirm different notions of justice, there is wide agreement across faith traditions that poverty and suffering represent deviations from what ought to be. Consequently, religions typically affirm the moral importance of efforts to address such concerns. In Islam, for instance, one of the five pillars of the faith is the zakat, in which a percentage of one’s accumulated wealth and assets—usually 2.5% each year—is given to charity to address economic inequalities and to provide for the general welfare (Crabtree, Husain & Spalek, 2008).
Since the philosophical basis for social welfare is derived from religion, it is unsurprising that the earliest forms of organized social work were developed by spiritually motivated individuals in religious settings (Popple & Leighninger, 2011). Catholics, Jews, Muslims, and other religious believers have been providing assistance to disenfranchised people for centuries. As societies changed, new methods of service delivery were continually developed and implemented which, during a certain epoch, lead to the creation of the social work profession.
In the United States, the roots of organized social work can be largely traced to the work of evangelical Christians in the second half of the 19th century (Magnuson, 1977; Smith, 1957). As industrialization spawned new problems, such as widespread urban poverty, new and more systematic approaches were needed to address these emerging issues. Accordingly, evangelical Christians, who were prominent societal actors during this era, lead the way in developing new methods to deal with these problems. Included among these were innovations such as charity organization societies (COS), settlement houses, and organizational innovations such as foster care.
The first COS in the United States emerged in Philadelphia before the Civil War. By 1851, the city had been divided into sections that were assigned to 5,000 poverty relief workers, representing most of the 160 church-sponsored and 40 other charitable societies in Philadelphia. Through this systematic approach, assistance could be provided to virtually every family struggling with poverty in the city. In 1850, Phoebe Palmer founded what may be the first settlement house in the nation, the Five Points Mission in urban New York City. Emphasizing environmental factors in poverty, the Five Points Mission and House of Industry provided food, clothing, shelter, and employment. In 1853, Charles Loring Brace founded the Children’s Aid Society in New York City, as an alternative to sending orphaned children to institutions which were often overcrowded, impersonal, and ineffective in meeting the developmental needs of children. Through this Society, essentially first foster care agency in the nation, children were placed with families in the Midwest.
These three movements—the COS, settlement houses, and a broader movement that emphasized the development of institutions to deal with social problems—are widely considered to have provided the foundation for the social work profession as it presently exists in the United States. All of these movements expanded rapidly in the late 19th century, aided by efforts by Catholics and others who shared the same basic concern to alleviate human suffering. In turn, this growth led to the emergence of a distinct professional discourse. All three of these foundational pillars, however, grew out of the Christian church. In this sense, the church gave birth to the present day social work profession (Popple & Leighninger, 2011).
Despite the religious origination of social work, the profession experienced a rapid secularization process. Beginning in the late 19th century and continuing throughout the majority of the 20th century, religious and spiritual content was progressively eliminated from the profession’s discourse. By the middle of the 20th century, the profession had been largely secularized.
The relatively rapid transformation of the profession was part of a larger trend stemming from the acceptance of modernism among cultural elites. Although many factors contributed to the development of modernism, the Enlightenment, which originated in 18th century continental Europe, is widely considered to be the driving force behind modernism. A central tenet of the modernist meta-narrative is the privileging of human rationality over other ways of knowing (Gellner, 1992). Enlightenment thinkers rejected transcendent perspectives, such as Christianity, in favor of the notion of objective human reason. The application of rigorous, unbiased human logic was posited to lead to richer and more productive forms of human existence.
As modernist’s notions of reality were increasingly accepted across academic disciplines, secular values came to dominate academic discourse (Smith, 2003). In each discipline, the process of secularization was somewhat different. For instance, in social work, the desire to be viewed by other, more prestigious, academic disciplines as a genuine profession helped accentuate the rejection of religious perspectives in favor of secular perspectives (Holloway & Moss, 2010). Nevertheless, while the route toward secularization differed, the secular narrative affirmed by modernism was adopted across academic disciplines.
The affirmation of the secular narrative was apparent throughout the helping professions. Although neglect of religion was common, in many cases leading figures expressed direct animosity toward religion. Included among these were such influential individuals as Sigmund Freud and Albert Ellis.
Freud, the father of psychoanalysis, is perhaps the most influential person in the history of modern therapy. In the Future of an Illusion, Freud (1927/1964) posited that religion represents a form of “obsessional neurosis” or psychopathology. Ellis is widely viewed as founder of the modern cognitive behavior therapy (CBT) movement. In the Case Against Religion, Ellis (1980) argued that religion is a form of “emotional illness” that creates and maintains “neuroses and psychoses.” In short, devout spirituality was framed as a form of mental illness that helping professionals should actively attempt to discourage.
These trends were also evident in social work. In a seminal study, Cnaan and colleagues (1999) examined 35,000 abstracts listed in Social Work Abstracts, 1,500 papers presented at five Annual Program Meetings (APMs) of the Council on Social Work Education (CSWE), 50 social welfare course outlines posted at two APMs, 20 widely used social work textbooks on social policy and social welfare history, and all editions of the Social Work Yearbook and the Encyclopedia of Social Work. In every content area, analysis revealed that religion received little or no mention. The efforts of spiritually animated individuals to assist people in need were either ignored or delegitimized.
To be clear, Christian organizations such as Catholic Charities and the Salvation Army continued to provide services to the poor and disenfranchised during this era. Similarly, some social work programs existed in Catholic, evangelical Christian, and Jewish universities. Through more informal mechanisms, American Indians, Muslims, and other religious groups continued to offer assistance to people in need. At best, however, these actors operated at the margins of the profession. The professional mainstream showed little interest in religion or spirituality for the better part of the last century.
The late 20th century was characterized by a renewed interest in spirituality in the social work profession that has carried on into the present. This interest was not confined to social work, but transcends the social sciences. As was the case with secularization, broad philosophical influences provided the foundation for this shift. More specifically, the advent of postmodernism created philosophical space for spirituality in academic discourse.
Beginning in the mid-20th century, postmodernism has increasingly challenged modernism as the intellectual dominant worldview among cultural elites in western societies. Postmodernists posit that the events of the past century have undermined confidence in the notion of objective human reason (Lyotard, 1979/1984). The human reason that Enlightenment thinkers hypothesized would lead to the development of a secular, certain, universally applicable knowledge that would enhance humanity has not produced the promised results. Rather, it produced value informed narratives that reflected the interests of those with power. Instead of the salutary benefits posited by Enlightenment thinkers, the application of secular human reason lead to the creation of destructive meta-narratives such as the Marxism, National Socialism or Nazism, and French Revolution’s reign of terror (Gellner, 1992). Accordingly, the Enlightenment project is no longer intellectually creditable from the vantage points of postmodernists.
Although the fundamental principles of postmodernism are still in the process of being negotiated, a number of suppositions serve to demarcate postmodernism as a distinct worldview. Among these is the de-centering of human rationality in favor of a plurality of ways of knowing. Rather than a single, objective material reality, multiple realities exist, incorporating both material and spiritual dimensions. Human relationships and subjectivity are emphasized.
The acceptance of the postmodern worldview has legitimized the topic of spirituality in academic discourse. In social work, interest in spirituality has increased dramatically since the 1980s (Canda & Furman, 2010). A number of social work programs provide specialized courses in spirituality and religion and an even greater number incorporate content on spirituality into their curricula. A few programs offer certificates and/or focused training in spirituality. CSWE’s APM has a specialized track dedicated to spirituality and another dedicated to one specific religion: Islam and Muslims. More recently, CSWE convened a Religion and Spirituality Work Group in 2011 to promote ethical and effective practice in the area of spirituality and religion. Numerous books and articles on spirituality have appeared in the literature and prominent mainstream social work journals have devoted special issues to the topic.
Indeed, perhaps the best indicator of the reemergence of spirituality as a legitimate topic in academic discourse is the amount of content devoted to this subject in the peer-reviewed literature. Figure 1 depicts the results of a key word search (spirit* or religi*) of peer reviewed journals in Social Services Abstracts. As can be seen, the number of publications addressing spirituality and religion has increased exponentially over the last few decades. Beginning from a total of 13 articles in the 1950s, this increased to 48 in the 1960s, to 140 in the 1970s, to 337 in the 1980s, to 922 in the 1990s, and 2,937 articles in 2000s. As these data indicate, interest in spirituality has grown exponentially over the course of the past two decades.
In spite of these developments, spirituality remains controversial in some circles of the profession. Echoing Freud and Ellis, some individuals have continued to argue in favor of excluding spiritual perspectives, especially those of underrepresented groups such as evangelical Christians. The notion of spiritual diversity has been a particular source of contention. Some are willing to accept the inclusion of spiritual perspectives into professional discourse, but only those perspectives that are consistent with the values of the dominant secular narrative. In response, others have argued that the profession should expand its understanding of diversity in the area of spirituality—in the same way it has done with race, gender, ethnicity, and sexual orientation in the past—so the profession reflects the demographics of the increasingly multicultural society it is called to serve. These various tensions also animate conceptualizations of spirituality and religion, as well as understandings of the relationship between these two constructs.
Traditionally, spirituality has been understood as a dimension within religion. In other words, religion was viewed as the broader, more encompassing concept. Spirituality referred to a subset of individuals who were deeply committed to the precepts of their religious tradition. New, more postmodern forms of spirituality, such as the syncretistic spirituality movement or the New Age movement, are viewed as representing new religions.
In keeping with this understanding, international human rights protocols typically mention religion. For example, the United Nations' (1948/1998) Universal Declaration of Human Rights repeatedly mentions religion as a human right that should be protected. Conversely, spirituality is not mentioned. Rather, it is implicitly incorporated into the wider concept of religion.
Reflecting the ascendance of postmodernism, this ordering is frequently reversed in recent scholarship on spirituality and religion. Religion is understood to be one venue in which spirituality is expressed. In other words, spirituality is viewed as the broader, more encompassing concept. Postmodern forms of spirituality are often viewed as being distinct from religion.
Although no consensus has emerged regarding the relationship between spirituality and religion, fairly wide agreement exists that they are overlapping but distinct constructs (Derezotes, 2006). Each construct is also widely understood to be multi-dimensional. In other words, both spirituality and religion are complex entities comprised of different, intertwined components.
Generally speaking, spirituality is defined as an individually oriented construct, while religion is defined as a socially oriented construct. More specifically, spirituality tends to be conceptualized in more individualistic, subjective, and experiential terms. In addition, spirituality is frequently posited to incorporate reference to God, the transcendent, or the divine. Conversely, religion tends to be conceptualized in communal, organizational, or structural terms. In addition, religion is often understood to be related to, or mediates, spirituality.
Beyond this very general framework, little agreement exists. A wide variety of definitions has appeared in the social work literature. Spirituality, in particular, has been conceptualized diversely. For example, spirituality has been defined as an individual’s relationship with someone/something beyond the individual, the human search for meaning and purpose, and as a dimension of human personality/development. As implicitly reflected in these definitions, some scholars conceptualize spirituality as a unique aspect of human experience that is experienced by some individuals. Others define it as a universal dimension of human experience that is experienced by everyone (Crisp, 2010).
The lack of agreement, however, has not hindered the emergence of spirituality as a legitimate topic in the profession. Indeed, in many ways it has helped to advance the profession’s still somewhat tentative embrace of the concept. Regardless of the philosophical influences that animate various definitions, the respective scholars using these various definitions believe in their validity. In turn, arguments are marshaled in favor of including spirituality—variously understood—as an important aspect of social work’s professional conversation.
Rationales for Including Spirituality in Social Work Practice
At least five different rationales are commonly advanced to support the inclusion of spirituality in social work. These rationales are related to ethical standards, client self-determination, spiritual strengths, worldview knowledge, and policy requirements. Different authors articulate these rationales in different ways. Regardless of their specific formulation, these concepts are widely cited to support the importance of incorporating spirituality as a legitimate issue in social work practice.
It should be noted that these five rationales are highly intertwined and tend to overlap one another. For instance, respect for client self-determination is an important ethical standard or principle. As such, these rationales serve to reinforce one another in providing a philosophical foundation for recognizing spirituality in social work.
Professional ethics represent one reason why social workers should attend to spirituality. The National Association of Social Workers (NASW) Code of Ethics (2008) notes, “professional ethics are at the core of social work.” Ethics are at the center of the profession. Social work can be seen as emanating from, or driven by, professional ethics.
Professional ethics codes have many purposes. A primary goal, however, is to provide standards that guide professional conduct. As the NASW Code of Ethics (2008) states, the Code sets forth certain values, principles, and standards to guide social workers’ conduct. It enumerates specific ethical standards that should inform and direct social work conduct.
The NASW Code of Ethics (2008) refers to religion in numerous locations, either directly or indirectly. Spirituality is not explicitly mentioned. In this sense, the NASW Code of Ethics implicitly reflects the traditional understanding of religion being a broader, more encompassing construct than spirituality.
In the area of cultural competence and social diversity, the Code instructs social workers to obtain education about and to seek to understand the nature of diversity and oppression regarding religion (1.05c). When communicating with clients and colleagues, social workers should avoid unwarranted negative criticism, such as demeaning religious comments (2.01b). In a related standard, social workers are enjoined not to practice, condone, facilitate, or collaborate with any form of religious discrimination (4.02). In addition to these more micro-oriented standards, the Code also mentions religion in a macro context. For example, in the area of social and political action, social workers are called to prevent and eliminate religious discrimination.
As these ethical standards imply, social workers have an ethical responsibility to address spirituality. This includes both their work with individual clients and their efforts to promote a more equitable and just society. Fidelity to these ethical standards requires social workers to, for instance, fight against religious discrimination.
It is important to note that the ethical standards articulated in the NASW Code of Ethics are not unique to social work in the United States. The International Federation of Social Workers’ (2004) Statement of Ethical Principles also mentions spirituality. More specifically, social workers are called to uphold and defend each person’s spiritual integrity and well-being (4.1). In the area of social justice, social workers have a responsibility to challenge discrimination that stems from people’s spiritual beliefs (4.2.1). The Statement also emphasizes the importance of advocating for the human rights articulated in international protocols, such as the United Nation’s (1948/1998) Universal Declaration of Human Rights.
The Universal Declaration mentions religion in a number of places. For example, it prohibits religious discrimination (Art. 2, 16). Perhaps more importantly, however, the Declaration also lists religious freedom as a basic human right and then maps the terrain of this right. Article 18 stipulates that everyone has the right to change one’s religion, and the right to manifest one’s religion in teaching, practice, worship, and observance. This includes the right to manifest one’s belief in private or public space, either alone or in community with others.
It is also worth noting that social work is not unique in terms of its ethical stipulations regarding spirituality. Many professional ethics codes in the helping professions mention spirituality or religion in a similar manner (Miller, 2003). This professional agreement serves to underscore the ethical importance of attending to spirituality in professional practice. To be congruent with the vision of practice depicted in professional ethics codes, social workers must address spirituality in their practice of social work.
A second rationale for addressing spirituality is related to client autonomy. Self-determination is an important social work value. For instance, the NASW Code of Ethics (2008) calls social workers to respect and promote clients’ right to self-determination (1.02).
The salience of client preference is underscored by the evidence-based practice movement, which emphasizes the importance of incorporating clients’ preferences into the therapeutic dialogue. Effective therapy is predicated on the creation of a non-coercive atmosphere in which clients’ desires are respected. Tailoring therapy to incorporate clients’ desires leads to better outcomes.
Spirituality is a salient life dimension for many people. According to Gallup data, approximately 90% of the general population in the United States believes in God or a universal spirit (Newport, 2012). Forty-one percent are very religious and 28% are moderately religious. Although substantial variation exists among nations, at the global level, interest in spirituality and religion is increasing (Grim & Finke, 2010).
Many of these individuals want their spiritual values to be taken into account during service provision. To be clear, not everyone for whom spirituality is important wants to have their spiritual values integrated into service provision. Many, however, do. It is also important to note that spirituality tends to be even more salient among traditionally disenfranchised populations. For example, African Americans, Latinos, women, people who are poor, and the elderly tend to report disproportionately higher levels of spirituality (Newport, 2012). For instance, approximately 93% of older African Americans report that prayer is “very important” in dealing with stressful situations (Taylor, Chatters & Jackson, 2007). While social work is committed to assisting all people, it has a special ethical commitment to attend to the needs of people who are vulnerable, oppressed, and living in poverty (NASW Code of Ethics, 2008).
In short, numerous clients want to have their spiritual beliefs and practices incorporated into counseling and other forms of service provision. Social workers have an ethical obligation to respect clients’ desires in this area. Integrating clients’ spiritual values into service provision demonstrates respect for client self-determination, which, in turn, fosters better clinical outcomes.
A third rationale for addressing spirituality pertains to clients’ spiritual assets. Identifying and operationalizing assets, resources, and strengths is a central component of social work practice. Determining “what works” in clients lives typically plays a foundational role in ameliorating problems, facilitating effective coping, and promoting health and wellness.
In addition to being a key component of practice, the importance of strengths is also highlighted in the NASW Code of Ethics (2008). Social workers are called to recognize the strengths that exist in all cultures (1.05a). Once identified, these assets can be marshaled to help clients overcome the challenges they face.
Spirituality is often an important strength in clients’ lives. A relatively large and expanding body of research exists on this topic. The modernist hypothesis advanced by individuals such as Freud (1964 ) and Ellis (1980)—that spirituality is linked to mental illness—is no longer tenable. In aggregate, higher levels of spirituality are associated with higher levels of mental and physical health (Koenig et al., 2012). The breath of the research is extensive. Literally thousands of studies indicate that spirituality is related to a wide variety of positive health outcomes.
For example, spirituality is positively associated with quality of life (typically when facing major life-challenges), psychological well-being (for example, happiness, joy, life satisfaction), meaning and purpose, internal sense of control, social support, self-esteem, hope, optimism, and less loneliness. It is also related to positive character traits, such as altruism, forgiveness, and volunteering, as well as social capital, which are commonly understood as social networks that facilitate cooperative and mutually supportive relationships. In terms of personality traits, spirituality is associated with agreeableness, conscientiousness, cooperativeness, in tandem with less risk taking, irresponsibility, hostility, and anger.
Spirituality is inversely related to anxiety, substance abuse, delinquency, crime, and marital instability (for example, spirituality predicts less divorce and separation, spousal abuse, infidelity, and greater commitment to the marriage and martial satisfaction). It is also associated with less depression and faster recovery from depression, lower levels of suicidal ideation, attempts, and completions.
In addition to better mental health outcomes, increased spirituality also predicts better physical health (Koenig et al., 2012). For instance, spirituality predicts less likelihood of Alzheimer’s disease and dementia, cancer, heart disease, hypertension, and cerebrovascular disease (stroke). It predicts higher levels of immune functioning, self-rated health, and longevity.
To be clear, the relationship between spirituality and wellness is not universal (Koenig et al., 2012). Some studies report no or an inverse association between spirituality and health. Nevertheless, the state of the present research is such that it is no longer a question about whether or not spirituality is positively linked to health and wellness. Rather, the relationship between spirituality and wellness is so well established that research now tends to focus on understanding the mechanisms that explain the relationship.
One mechanism that tends to activate a spiritual response is major life challenges (Pargament, 2007). The salience of spirituality frequently becomes more significant during times of stress or difficulty, which may help explain why spirituality tends to play a more pronounced role in the lives of traditionally disenfranchised populations. For instance, people often turn to spirituality when coping with general medical illness, chronic pain, cancer, vision problems, HIV/AIDS, caregiving burden, psychiatric illness, bereavement, and end-of-life issues. Individuals wrestling with such problems tend to report that spirituality enhances their ability to cope and adapt.
Social workers often encounter individuals when they are facing major life challenges. To help clients deal with these challenges, they have an ethical obligation to identify all assets that may be relevant to this task. In many cases, spiritual assets can be marshaled to assist clients in ameliorating problems.
A fourth rationale is to understand clients’ worldviews. Successful practice is largely predicated upon understanding clients’ value systems. This is particularly important when working with those from different cultures, who are often hesitant to trust social workers. In such cases, developing some degree of empathetic awareness of the cultural worldview in play is critical to achieving optimal outcomes. This view is echoed in the NASW Code of Ethics (2008), which enjoins social workers to develop their knowledge of clients’ cultures and to provide culturally competent services that are sensitive to clients' cultural value systems (1.05b).
Interactions that are congruent with clients’ value systems typically enhance client buy-in and engender positive outcomes. Knowledge of clients’ worldviews helps practitioners to identify assets, respect client autonomy, and build therapeutic rapport. It helps social workers avoid interactions that impair the therapeutic alliance and facilitates the selection of culturally-sensitive interventions that are more likely to be adopted and faithfully implemented.
Spirituality frequently plays a fundamental role in shaping individuals’ worldviews. As noted above, spirituality is expressed in particular religions, which tend to engender culturally distinct value systems (Van Hook, Hugen & Aguilar, 2001). These value systems can affect beliefs and practices in many areas of significance to social workers including, for example, perspectives about animals, burial practices, child birth, child care, communication styles, coping practices, death, diet, finances, grieving, healing, health, marital relations, medical care, military participation, recreation, schooling, and wellness.
The United States is among the most religiously diverse nations in the world. As is the case with many other countries, the past few decades has witnessed substantial growth in a variety of culturally distinct traditions in which religion and ethnicity are comingled. Such groups include Asian Muslims, Hispanic Catholics, Indian Hindus, Korean Presbyterians, Latino Pentecostals, Punjabi Sikhs, and Soviet Jews. These groups supplement existing religious subcultures in America, such as evangelical Christians, Latter Day Saints, traditional Catholics, and hundreds of Native tribal groups.
With each of these populations, their cultural values can differ from those affirmed in mainstream discourse. For instance, in many American Indians tribes, mental health cannot be understood apart from the spiritual. Assisting a Native individual wrestling with a mental illness—within the context of a Native worldview—may require incorporating tribally specific spiritual interventions into treatment. In other situations, routine practices may be contraindicated as they conflict with Native spiritual values.
Ignoring the existence of these spiritual values in practice settings impairs service provision (Gardner, 2011). In some cases, the failure to take these values into account can engender negative affect. Accordingly, it is necessary to inquire about clients’ spiritual value systems. Learning how clients construct their spiritually animated worldviews assists social workers develop an empathetic understanding of rationales that inform their beliefs and practices. This knowledge allows practitioners to tailor service provision so that it engages, rather than conflicts, with clients’ values. In turn, this type of culturally congruent practice leads to better outcomes.
The final rationale for addressing spirituality is policy requirements. A number of agencies, professional organizations, and accrediting bodies stipulate that service provision should be tailored to incorporate client spirituality. In recognition of the importance of spirituality in practice, these entities explicitly address spirituality in their policy statements.
These policy recommendations serve to guide practice. The situation is analogous to the NASW ethical standards or the human rights of religious nondiscrimination and religious freedom reviewed above. In much the same way that professional ethical standards or the United Nation’s Universal Declaration informs practice decisions, the following policies serve to direct conduct.
To assist practitioners interact with clients, NASW issued a set of Standards for Cultural Competence in Social Work Practice (NASW Standards for Cultural Competence in Social Work Practice, 2001). These standards specifically mention the importance of spirituality and religion in the lives of clients. The standards also state that the term culture includes ways in which people from various religious backgrounds experience the world around them. Thus, the delivery of culturally competent services incorporates attending to clients’ spiritual value systems.
The CSWE Educational Policy and Accreditation Standards (2008) are designed to promote excellence in social work educational programs. These standards explicitly mention spirituality and/or religion three times. The explicit curriculum should include content designed to help future social workers engage religious diversity in practice (EP 2.1.4). Similarly, content regarding human behavior and the social environment should foster understanding of spiritual development (EP 2.1.7). In addition, programs should demonstrate their commitment to religious diversity in their larger educational environment (for example, demographic make-up of its faculty and selection of field education settings) (EP 3.1).
The Joint Commission, formerly known as the Joint Commission on Accreditation of Healthcare Organizations or JCAHO, is the largest health care accrediting body in the United States. It accredits most of the nation’s hospitals and thousands of other health care organizations. It recommends that services be tailored to take into account clients’ spiritual values. Similarly, at the local level, many agencies provide services that address spirituality as a matter of policy (Canda & Furman, 2010).
These various policies are not limited to organizations in the United States (Furness & Gilligan, 2010). For example, similar recommendations have been enumerated by various organizations in the United Kingdom as well as the World Health Organization (WHO). As an example of the former, the National Institute for Clinical Excellence (2004) recommends practitioners explore clients’ spiritual needs and assets. The WHO Expert Committee on Cancer Pain Relief (1990) makes similar recommendations regarding palliative care. WHO grounds these recommendations in the internationally recognized right to religious freedom.
As this grounding implies, these policies are often implemented because various organizations recognize the importance of the rationales discussed above. Professional ethical standards that require non-discrimination when dealing with religion, the internationally recognized human right of religious freedom, the importance of respecting clients’ spiritual self-determination, the salient role that spiritual assets can play in helping ameliorate problems, and the critical importance of tailoring services so they are congruent with clients’ spiritual value systems are all widely affirmed. In turn, these rationales often form the basis for various policy statements, either explicitly or implicitly. As such, these five rationales are interlinked and mutually reinforcing. Together, they provide a comprehensive foundation for services that address spirituality.
To tailor service provision to incorporate client spirituality, a spiritual assessment is commonly recommended. Such an assessment involves gathering and synthesizing information about spirituality into a framework that provides the basis for subsequent practice decisions. A spiritual assessment is typically conducted as a part of a larger bio-psycho-social-spiritual evaluation. This type of holistic assessment provides practitioners with a more complete understanding of relevant factors in clients’ lived realities.
The assessment focuses on understanding how spirituality informs clients’ value systems. Social workers do not attempt to determine the veracity of clients’ spiritual beliefs, an endeavor that lies outside the purview of their professional training and risks violating clients’ spiritual autonomy. Rather, the aim is to understand how clients’ spirituality shapes their worldviews with the goal of tailoring service provision accordingly. For instance, a strengths oriented practitioner might attempt to understand how various spiritual practices function as assets with an eye toward leveraging those assets to help clients ameliorate problems.
Assessment is typically conceptualized as a two-stage process. Initially, a brief assessment is administered. The fact that this initial assessment entails a minimal time commitment means that it is possible to administer such an assessment to all clients. The purpose of the preliminary assessment is two-fold: (a) to determine the relevance of spirituality to service provision and (b) to ascertain whether a comprehensive assessment is needed.
As alluded to above, the use of a two-stage model helps to conserve practitioners’ time for those individuals whose spirituality directly intersects service provision. In some cases, spirituality may be a marginal or non-existent dimension in clients’ lives. Alternatively, spirituality may be personally important, but unrelated to service provision. In such instances, a brief assessment is typically sufficient.
A brief assessment also helps to legitimize the topic of spirituality in practice settings. Some clients assume that social workers are secular and/or hostile to spirituality. Such individuals are unlikely to broach the topic with practitioners unless first asked, and even then may exhibit considerable hesitancy in discussing spirituality. An assessment helps meta-communicate that the spiritual dimension of existence plays an important role along with the biological, psychological, and social dimensions.
If the brief assessment suggests the client’s spirituality might intersect with service provision, then a comprehensive assessment is administered. A number of comprehensive assessment tools have appeared in the literature, some of which have undergone preliminary validation for use with specific populations, such as American Indians (Hodge & Limb, 2011). Perhaps the most popular approach to assessment is conducting a spiritual history, a process that is analogous to conducting a family history. Other conceptually distinct assessment approaches include spiritual lifemaps, spiritual genograms, spiritual eco-maps, and spiritual ecograms. Each approach is characterized by a certain set of advantages and limitations, allowing practitioners to select an assessment approach that best fits the unique needs of each individual client in a given clinical context.
A comprehensive assessment provides a vehicle to elicit clinically salient information that can be used to promote wellness. For example, medical social workers developing discharge plans might use the information obtained in an assessment to link patients with the spiritual supports needed to process the existential concerns that emerged during hospitalization. Similarly, school social workers might use the information to help a child who is bullied because of her spiritual values. A spiritual assessment also provides practitioners with the necessary knowledge to consider the use of spiritual interventions.
Spiritual interventions are clinical strategies that incorporate a spiritual dimension as a primary component of the intervention. Research suggests that many social workers use spiritual interventions. According to a number of studies, the majority of NASW affiliated practitioners utilize an array of spiritual interventions in their work with clients (Canda & Furman, 2010; Sheridan, 2009). Research also indicates that many practitioners in the UK and other nations also regularly employ spiritual interventions (Furman & Benson, 2006).
These same studies indicate that most social workers report receiving little, if any, training in spirituality during their educational training. This may be an artifact of the relatively recent emergence of spirituality as a legitimate topic in social work discourse. Nevertheless, concerns have been raised regarding the widespread use of spiritual interventions with minimal training.
Guidelines for Using Spiritual Interventions in Practice
To help practitioners use spiritual interventions in an ethical and effective manner, four guidelines have appeared in the literature (Hodge, 2011). These guidelines, which are drawn from the evidence-based practice movement, can be summarized under the following rubrics: client preference, clinical expertise, cultural competency, and research evaluation. First, client preferences should be respected. Assuming an assessment reveals an interest in utilizing spirituality in clinical situations, the use of possible interventions is explored and informed consent obtained for any intervention selected. Informed consent is understood to be an ongoing process with practitioners monitoring clients throughout the implementation process to ensure that they remain fully supportive of the intervention.
A second factor to consider in the use of spiritual interventions is the practitioner’s degree of clinical expertise. Spiritual interventions should typically be used only when sufficient training has been received to ensure that the intervention can be implemented in an ethical and professional manner. Some proficiency with the intervention under consideration is required. Practitioners ought to have some degree of training and experience using a given intervention.
A third consideration is cultural competency. Cultural competency is required to select and implement spiritual interventions within the context of clients’ cultures. An intervention that is effective with a mainline Christian client may not be effective with a Hindu client. In order to implement an intervention effectively, practitioners require some knowledge of clients’ spiritual value systems.
Finally, the research on spiritual interventions that are relevant to the presenting problem should be evaluated. Interventions should only be used if research suggests they will be effective with a given problem. It is widely recognized that epistemological assumptions influence understandings of what is considered to be good evidence. Nevertheless, some empirical rationale should exist if an intervention is to be considered in a clinical context. In other words, some empirical evidence ought to suggest that the intervention will be effective in addressing the client’s presenting problem.
Research on Spiritual Interventions
A limited, but growing, body of research exists on spiritual interventions (Koenig et al., 2012). Using various types of experimental designs, a number of spiritual interventions have been evaluated. Included among these are 12-step programs, Buddhist-based mindfulness, forgiveness therapy, generic spiritual meditation, Hindu-based meditation, mantra-chanting, spiritual teaching, spiritual coping therapy, spiritually-focused therapy, and spiritually modified cognitive behavioral therapy (CBT). In aggregate, the use of these spiritual interventions has yielded generally positive outcomes.
Among the more effective interventions is spiritually modified CBT. In this therapeutic modality, standard CBT treatment protocols are modified with spiritual beliefs and practices drawn from clients’ spiritual value systems. The cognitive restructuring strategies and the behavioral assignments are similar to those used in the traditional secular CBT pioneered by Ellis. However, once unproductive beliefs and behaviors are identified, they are replaced with salutary schema and actions that resonate with clients’ spiritual values.
Although the evidenced-based practice movement remains controversial in some social work circles, it is notable that spiritually modified CBT meets the criteria for an efficacious treatment in at least one context. Specifically, it is an effective treatment for devout Christians coping with depression. Other outcomes that have been examined include anxiety disorder, bereavement, bipolar disorder, compulsive disorder, neurosis, perfectionism, schizophrenia, and stress. In addition to Christianity, this approach has been used with Buddhism, Taoism, Islam, and a generic form of spirituality. As implied above, outcome research using this modality has typically produced positive results.
Reflecting the broad cross-disciplinary acceptance of spirituality sparked by postmodernism, most of the research on spiritual interventions has been conducted outside the field of social work. Social workers have, however, contributed to the larger empirical knowledge base on spirituality. These contributions have frequently been facilitated by various organizations, networks, and journals.
Spiritually Animated Social Work Organizations
The social work profession is home to a number of spiritually animated organizations. These groups vary in size and reflect the diverse expressions of spirituality within the profession. Accordingly, their foci and purposes vary. Among the more prominent are the North American Association of Christians in Social Work (NACSW) and the Society for Spirituality and Social Work. Many smaller groups exist that also play vital roles including, for example, the Islamic Social Services Association (ISSA) and Integral Social Work network.
The oldest of these various organizations is NACSW, which was established in 1954 in the midst of the secularization era. The mission of this ecumenical organization is to equip its members to integrate Christian faith and professional social work practice. Toward this end, it sponsors annual conventions, provides CEUs, publishes books, as well as a quarterly academic journal—Social Work & Christianity.
The Society for Spirituality and Social Work was founded in 1990 by Ed Canda, at the cusp of the postmodern influenced era that witnessed the accelerating reemergence of spirituality in the profession. The vision of the Society is to create connections and mutual support among social workers of many contrasting spiritual perspectives. It also sponsors an annual conference on spirituality in social work, typically in conjunction with the Canadian Society for Spirituality in Social Work, a sister organization that is oriented to professional social work in Canada.
The Islamic Social Services Association (ISSA)—established in 1999 by a group of Muslim social workers—split into two independent organizations in 2003: one in the US and one in Canada. The founders’ vision was to develop a network of Muslims in the human services to address the mental health, family issues, and other social welfare concerns that impact Muslims.
The Integral Social Work network is comprised of social workers interested in the application of Integral Theory to social work. Integral Theory was originally developed by Ken Wilber. Influenced by transpersonal psychology, it is a post-disciplinary meta-framework that incorporates the insights of diverse philosophical systems.
There are many other initiatives housed at various social work programs. For instance, the social work program at the Catholic University of America (CUA) is home to the Center for Spirituality and Social Work, which seeks to increase awareness of the role of both religious and non-religious expressions of spirituality in all aspects of life. CUA has also played an important role in the development of the quarterly academic periodical: The Journal of Religion & Spirituality in Social Work: Social Thought, another disciplinary social work journal devoted to disseminating scholarship on spirituality.
As implied above, these organizations are not limited to the US. In addition to the Canadian groups mentioned above, organizations also exist in other parts of the world. For instance, in the UK, the Social Work Christian Fellowship (SWCF) was founded in 1964. In manner analogous to the other groups listed above, it provides professional and spiritual support to its members through a variety of national and local events around the UK.
Social workers also participate in a myriad of spiritually animated groups hosted in other disciplines. These various groups, both inside and outside the profession, help support and nurture spirituality in social work. They also help equip social workers to tackle challenges and chart the future directions of the nascent spirituality movement.
The past few decades have witnessed considerable advancement in terms of the profession’s acknowledgement and understanding of spirituality. Nevertheless, spirituality is still a relatively new area of academic interest in social work. In keeping with the recent appearance of spirituality in the professional conversation, this emerging movement faces a number of challenges as it seeks to develop and mature.
Many individuals have contributed to the emergence of spirituality as a valid topic in social work discourse. Among those who have played a major role in this process are the following seven individuals. As scholars whose efforts have helped create space for spirituality in social work discourse, they have been asked to share their perceptions on the critical steps required to advance spirituality in social work to the next stage in its professional development. Although articulated by individuals, these prescriptions reflect currents of thought affirmed by many social workers invested in spirituality.
In light of the ongoing problems regarding religious discrimination in the profession, Cnaan (2006) recommends research to assess the magnitude of the problem with the aim of ensuring that the basic human rights of spiritually motivated people are respected in social work. Ai (2006) highlights the need for rigorous, controlled outcome research on spiritual interventions with different religious groups. Drawing from transpersonal psychology, Derezotes (2006) suggests developing a third, spiritual methodology that bridges quantitative and qualitative approaches while simultaneously incorporating transrationale ways of knowing.
Russel (2006) emphasizes the need to integrate spirituality content comprehensively into social work education so that practitioners are prepared to work competently with clients. Furman and Benson (2006) stresses the need for large-scale quantitative and qualitative studies to understand the role of spirituality in direct practice and education, both in America and elsewhere. Graham (2006) proposes increased international collaborations between the Global North and Global South to enrich and diversify understandings of spirituality. Finally, to address the problems spawned by globalization, Canda (2005) calls for the continued growth in professional efforts to nurture appreciation for spiritual diversity in nations around the world.
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