As part of the bio-psycho-social inventory, The Joint Commission and CARF require that spiritual care and the spirituality component be addressed. At the NASW National Association of Social Work Ohio 2015 Conference, presenters Mari Alschuler, Phd, LISW-S and Thelma Silver, PhD, LISW-S addressed the role of spirituality in social work practice. ‘It’s a matter of determining where the client is at,’ (in terms of their beliefs and the role of religion and spirituality in their lives). Spirituality is an important component of the 12-step in substance abuse counseling.
The speakers discussed a number of religions and the core beliefs within each. They asked how many of the audience were familiar with Hinduism. (About 20%) This is typical of the U.S. and yet by the number of adherents, this faith tradition is one of the top 5 in the world. In Islam, also among the top 5, mental illness might be seen (culturally) as a weakness and shameful. According to research, many Moslems consider the cause of mental health disorders to be an unbalanced lifestyle. In Judaism, there is the legacy of The Holocaust. The speakers covered the many different strands of Christianity. For instance, among an Appalachian population, fundamentalism is often the predominant Christian belief system and a strong reliance on more patriarchal approaches. There might be an emphasis on daily scripture reading and prayer. Hard work is valued and self-sufficiency, so adherents might not be as apt to seek help for mental and behavioral health conditions.
About 1/3 of Native Americans live on reservations (Sands 2012) and there are roughly 500 recognized tribal groups. Mental health therapy might be seen as intrusive. Neo-paganism and nature religions should not be confused with Satanism, but instead, like Wiccan traditions, are a nature based religion, reviving pre-Christian practices. Often the nature based religions embrace a duo-theistic philosophy with both male and female Deity/God figures. About 20% of Americans do not profess a belief, affiliation or practice any religion and consider themselves to be atheist (acknowledging no Divine presence) or agnostic (‘show me the proof’). And then, there is the SBNR group, ‘spiritual but not religious’ – which is neither atheistic or agnostic. This group believes in a higher spiritual reality, but outside organized religion, and may have been raised in a faith tradition they no longer actively practice or believe in.
Questions which might be asked in an assessment include: ‘do you have a religious affiliation?’ ‘Do you practice any type of belief system?’ ‘Do you have a religious or spiritual preference?” ‘Do you have a religious or spiritual support system?’ ‘What gives you a sense of purpose or meaning? ‘What gives you strength?’ ‘Is spirituality an important part of your life? ‘Does spirituality play a role in your life?’ ‘Is religion an important part of your life?’ ‘Who or what do you have faith in?’ ‘Was faith a part of the family you grew up in?’ ‘What spiritual or religious tradition did you grow up in and do you practice it now?’ (Why or why not?) ‘Are there any conflicts with/within your family of origin?’
The speakers explained that the diagnostic manual DSM 5 outlines culturally-specific syndromes. Religion and spirituality may be protective OR a risk factor. (Some beliefs that pass for religion or religious practice demonstrate pathology.) Beliefs can mimic psychiatric disorders, trigger disorders, promote a positive worldview, or provide a role model for dealing with life which can be tremendously supportive. There were three examples with a spiritual dimension to the diagnosis for audience members to discuss.
[photo credit: author- mobi/Dreamstime ID#6827645824]
For more information on Americans and Religious Practice see the PEWResearch Center