Has the Time Come? A Recommendation for Culturally Congruent Therapy Interventions

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ABOUT THE BLOG: Sofia University has been training clinicians, spiritual guides, wellness caregivers, and consultants who choose to apply transpersonal principles and values in a variety of settings for over 40 years. Our students, alumni and faculty have a wealth of information to share. Please enjoy this topic that highlights some of the teachings featured at Sofia University.

Shamanic techniques as a model for Earth-based psychospiritual interventions

PsyD graduate student David Christy wrote a scientific scholarly paper about shamanic techniques as a model for Earth-based psychospiritual interventions. Spiritually oriented psychology seeks to foster mental health and overall wellbeing using techniques derived from clients’ faith traditions (Richards & Worthington, 2010). Most of the research in this field has focused on interventions rooted in Abrahamic traditions or on increasing spirituality in general (Hook et al., 2010). This paper argues that culturally congruent psychospiritual interventions are needed for people witAAEAAQAAAAAAAASyAAAAJDdiMjc3ZmE0LWVkM2EtNDBiNS1iODMyLTk1ZWY5M2NhNWRlYQh earth-based belief systems. It then presents shamanic techniques as examples of interventions well suited for psychotherapy with these populations. This paper provides (a) an introduction to spiritually oriented psychology; (b) proposes that there is a need for earth-based psychospiritual interventions; (c) examines shamanic techniques and associated health outcomes; (d) overviews psychological mechanisms that may underlie these practices; (e) examines areas for future research; and (f) discusses ways these techniques could be integrated into a spiritually oriented therapeutic practice.

According to Gallup (2002) polls, the U.S. population is becoming increasingly spiritual and religious: approximately 95% of the United States population reported belief in God, and more than half believe in an after-life. The religious and spiritual beliefs of the public are also becoming increasingly eclectic – 24% of the overall public indicated they sometimes attend maxresdefault.jpgreligious services of a faith different from their own, and nearly half of the public has reported having had a religious or mystical experience, up from 22% in 1962 (Pew, 2009). Psychologists have studied the roles religion and spirituality (R/S) play in people’s lives for some time; recently the field has begun to pay greater attention to how R/S can positively impact mental health and facilitate growth. In an early article arguing for this scientific examination of R/S, Miller and Thoresen (2003) linked R/S variables with health outcomes, discussed how to operationalize the terms and advocated for further research into this area of psychology.

Miller and Thorsen (2003) described spirituality and religion as distinct but related constructs, characterizing religion as a primarily social phenomenon and spirituality as an individual’s engagement with the sacred. Miller and Thorsen’s article presented an objectivist approach to studying R/S. This approach assumes that the phenomena studied (e.g. religious and spiritual beliefs) can be examined as external objects independent of the observer. The approach also assumes that a systematic analysis of R/S phenomena will lead to universal conclusions. Objectivist approaches are often contrasted with constructivist approaches. Constructivist approaches study human behavior within the contexts and relationships in which it occurs, assuming that that the phenomena studied cannot be separated from the observer (Parks, 2003). Many authors have advocated including construJosep_Benlliure_Gil43.jpgctivist approaches to working with spiritual and religious issues, especially when working with people from religious and ethnic minority groups (McCabe, 2007; Parks, 2003; Yeh, Hunter, Madan-Bahel, Chiang, & Arora, 2004). Harley (2006) discussed the need for health care models that embrace both paradigms, noting that the biomedical model is “not well equipped to analyze the experiential or political dimensions of health, especially those of indigenous healing knowledge embedded in alternative epistemologies” (p. 436).

Therapists working with these populations, or with clients holding earth-based and eclectic R/S beliefs need to be able to provide culturally congruent  interventions. Counselors should be aware that clients who embrace shamanic techniques may also utilize other spiritual practices, rituals, and work with faith healers as a part of their healing. Therapists who wish to understand the belief systems of such clients might look to the theoretical framework of participatory empiricism as a way of understanding how energy work, rituals, or shamanic journeys done by others may help their clients in their healing process.

Research is beginning to show that using these techniques on their own can result in increased health outcomes. To date the studies examining the efficacy of these techniques have been small and these findings should be seen as tentative until more research has been conducted.

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In Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer, What Factors Account for the Benefits?

By John Rettger, Kathleen Wall, Diana Corwin, Alexandra N. Davidson, David Lukoff  and Cheryl Koopman*

images.jpegPSIT is an integrated psychotherapeutic approach explicitly targeting treatment of the whole person. CAM approaches described in the literature for breast cancer patients typically address the dimensions of thought, body, and emotions; most do not specifically aim to integrate spirituality, with few exceptions. PSIT specifically addresses physical, psychological, existential, and spiritual factors. Preliminary studies of PSIT have shown promise in promoting health and well-being among breast cancer survivors.

PSIT is both an approach to psychotherapy and a spiritual practice focused on a lived spirituality. As such, PSIT supports breast cancer patients seeking meaning and purpose as well as deepened spirituality. PSIT integrates psychotherapy and spiritual practices in order to help clarify and fulfill the individual’s life purpose and to build skills for resolving obstacles in life transitions, including cancer survivorship.

PSIT is non-sectarian, relying on a personal sense of the sacred, and is therefore potentially acceptable to people of most religious/spiritual orientations as well as to people who do not identify as religious/spiritual but who embrace the pursuit of inspiration and life meaning in coping with cancer and other life challenges.

This study sought to add to the body of qualitative research describing the relationship between spirituality, SWB, and QL. A multiple case analysis design was chosen to allow deeper inquiry into how and why changes in SWB and QL occur during the PSIT group intervention.

Four participants’ experiences were investigated in detail to understand how spirituality is or is not promoted and to further explore the relationship between spirituality and QL. Through this qualitative analysis, we sought to identify both individual participant and PSIT intervention factors that contributed to positive or negative changes in SWB and QL.

Describing individual factors associated with greater or less benefit may identify potential moderators of treatment efficacy for future research on PSIT. Similarly, describing PSIT components associated with greater or less benefit may identify potential mediators of treatment efficacy for future research. Exploring the relationship between spirituality and QL in this context may generate insights about how PSIT can enhance QL through its focus on spirituality.

meditation-567593_960_720.jpgThe FACT-B uses a 37-item self-report scale to measure multidimensional areas of quality of life for breast cancer patients. Participants rate the veracity of the statements using a Likert scale. It includes questions about physical well-being (e.g., “I have a lack of energy”), social/family well-being (e.g., “I feel close to my friends”), emotional well-being (e.g., “I feel sad), and functional well-being (e.g., “I am able to enjoy life”). Pre and post quality of life scores for all participants were assessed using this scale.

Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-Ex). The spiritual well-being of the participants was assessed through the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-Ex). The FACIT-Sp-Ex is a 23-item instrument that yields scores on two sub-scales, Meaning/Peace and Spirituality, as well as a total score of Spiritual Well-Being (with a possible range of scores of 0–92).

Higher scores on these sub-scales indicate greater meaning/peace and spirituality, with possible score ranges of 0–32 and 0–16, respectively. Sample questions include “I have a sense of purpose in my life” and “I find comfort in my faith or spiritual beliefs.” For this study, improvement was operationalized by calculating change scores for spiritual well-being (SWB) from the baseline and post-treatment scores obtained with this scale.


These findings suggest that there is a relationship between changes in SWB and changes in QL, with the women experiencing the greatest changes in SWB also showing the greatest improvements in QL. Furthermore, participant changes in SWB and QL in the context of the PSIT intervention appear to be related to participant characteristics including spiritual and religious backgrounds, doubts, and trials as well as the application of metacognitive psychological skills.

Other benefits of PSIT stemmed from use of core components of the intervention. Participants reported they benefited by clarifying an aspirational life purpose and by developing mindful non-judgmental witnessing of the personal factors that helped and hindered the actualization of that life purpose. These processes lead to cognitive restructuring and developing alternative perspectives. In a group setting that emphasized inner processing, participants reported learning a set of skills useful in dealing with cancer survivorship and other life stressors.


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16 Spiritual and Religious Competencies for Psychologists


By Cassandra Vieten (Institute of Noetic Sciences and California Pacific Medical Center Research Institute); Ron Pilato ;Kenneth I. Pargament (Bowling Green State University); Shelley Scammell (Institute for Spirituality and Psychology); Ingrid Ammondson (Institute of Noetic Sciences); David Lukoff (Sofia University)




It is clear from polls of the general public that religion and spirituality are important in most people’s lives. In addition, the spiritual and religious landscape is becoming increasingly diverse, with nearly a fifth of people unaffiliated with a religion, and increasing numbers of people identifying themselves as spiritual, but not religious. Religion and spirituality have been empirically linked to a number of psychological health and well-being outcomes, and there is evidence that clients would prefer to have their spirituality and religion addressed in psychotherapy. However, most often, religious and spiritual issues are not discussed in psychotherapy, nor are they included in assessment or treatment planning.

Not Just Religious, but Spiritual


There is a need not only for religious competencies, but also for spiritual competencies. Although the words have historically often been used interchangeably, spirituality and religion are increasingly being viewed as distinct yet overlapping constructs (Kapuscinski & Masters, 2010; Piedmont, Ciarrochi, DyLiacco, & Williams, 2009; Schlehofer, Omoto, & Adelman, 2008; Zinnbauer et al., 1997). Though the term spirituality is notably missing from the APA Ethical Principles for Psychologists and Code of Conduct (2010), in 2011 the APA Division 36 Psychology of Religion was renamed the Society for the Psychology of Religion and Spirituality, and their journal is titled the Psychology of Religion and Spirituality (Piedmont, 2009).

Pargament (2007) has defined spirituality as “. . . the journey people take to discover and realize their essential selves and higher order aspirations” (p. 58), or a “search for the sacred” (Pargament, 2007, p. 52), whereas religion has been defined as “the search for significance that occurs within the context of established institutions that are designed to facilitate spirituality” (Pargament, Mahoney, Exline, Jones, & Shafranske, 2013, p. 15).

Hill et al. (2000) define spirituality as thoughts, feelings, and behaviors related to concern about, a search for, or a striving for understanding and relatedness to the transcendent. Spirituality has also been defined as an individual’s internal orientation toward a transcendent reality that binds all things into a unitive harmony (DyLiacco, Piedmont, MurraySwank, Rodgerson, & Sherman, 2009). Kapuscinski and Masters (2010) found that “communion with the sacred, or a search for the sacred” (p. 194) was included in 67% of studies that provided a definition of spirituality. The word sacred most commonly referred to God or to the transcendent, and the authors propose that this focus is what differentiates spirituality from other psychological constructs such as meaning, purpose, or wisdom.

Spiritual and Religious Competence as a Form of Multicultural Competenceaware-1207669_960_720.jpg

Three basic activities of multicultural competence are as follows: (1) to engage in the process of becoming aware of one’s own assumptions about human behavior, values, biases, preconceived notions, personal limitations, and so forth; (2) to attempt to understand the worldview of culturally different clients without judgment; (3) to implement relevant, and sensitive intervention strategies with culturally different clients (Arredondo et al., 1996; Sue,1998). These capacities clearly extend to cultural differences involving religion and spirituality.



Both quantitative ratings and qualitative feedback informed the revision of provisional items. This process resulted in the following 16 proposed spiritual and religious competencies for psychologists, three in the area of Attitudes, seven in the area of Knowledge, and six in the area of Skills.


1) Psychologists demonstrate empathy, respect, and appreciation for clients from diverse spiritual, religious, or secular backgrounds and affiliations.


4) Psychologists know that many diverse forms of spirituality and/or religion exist, and explore spiritual and/or religious beliefs, communities, and practices that are important to their clients.    


11) Psychologists are able to conduct empathic and effective psychotherapy with clients from diverse spiritual and/or religious backgrounds, affiliations, and levels of involvement.

To read all 16 competencies and see the full article, click here.