Spirituality & Recovery:
Using Spiritual Interventions in
the Process of Transforming
Persons in Christ
Ana Wong-McDonald, Ph.D.
The Salvation Army – Haven
11301 Wilshire Blvd., Bldg. 212, 3rd Fl.
Los Angeles, CA 90073
(310) 478-3711, x43653
ana.wong-mcdonald@usw.salvationarmy.org
Presentation Outline
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Introduction: Research on spirituality
and mental health
Example: Results of a 3-year spirituality
group
Application: Spirituality interventions for
transformation into Christ-likeness
Questions & Discussions
Important Notice
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Spiritual interventions do NOT replace professional
treatment for people with severe mental illness.
Mental illness is a brain disorder (see handout
posted on conference website from last year).
Effective treatment = medication + therapy
Best treatment = medication + therapy + spiritual
interventions
Introduction
What do research studies show about the
relationship between spirituality and
mental health?
Beneficial Effects of Spirituality/Religion
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Research in the last 2 decades have
evidenced that spiritual and religious
practices contribute to better physical
health, psychological adjustment, and
lower rates of problematic behavior
(Miller & Thoresen, 1999; Mulligan & Mulligan, 1999;
Richards & Bergin, 2000; Seybold @ Hill, 2001).
Beneficial Effects of Spirituality/Religion
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Many people with mental illness see spiritual
activities as an important part of their
recovery processes.
They believe that spiritual concerns should be
discussed with their counselors and mental
health providers (Mulligan & Mulligan, 1999; Quackenbos,
Privette, & Klentz, 1985; Rose, Westefeld, & Ansley, 2001;
Tepper, Rogers, Coleman, & Malony, 2001; Worthington, Jurusu,
McCullough, & Sanders, 1996).
Beneficial Effects of Spirituality/Religion
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On individuals with
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Depression
Anxiety
Substance addictions
Schizophrenia
Impact of Spirituality on
Persons with Major Depression
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Religiosity is associated with
decreasing levels of depression
(Catipovic, Ilakovac, Durjancek, & Amidzc, 1995; Cosar, Kocal,
Arikan, & Isil, 1997; Plante & Boccaccini, 1997),
especially for people with intrinsic
religiosity or faith based on internal
beliefs (Mickley, Carson, & Soeken, 1995; Watson, Milliron,
Morris, & Hood, 1994).
Impact of Spirituality on
Major Depression
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Lower levels of depression among
those who held a belief in an afterlife
(Alvarado, Emper, Bresler, & Dobson, 1995).
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Depression less likely among religious
individuals with medical illness or
religious surgical patients as
compared with their less religious
peers (Richard & Bergin, 2000).
Impact of Spirituality on
Major Depression
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Church attenders are half as likely to be
depressed as non-attenders (Koenig et al., 1997;
Thearle, Vance, Najman, Embelton, & Foster, 1995).
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In a 10-year longitudinal study, maternal
religiosity and maternal-offspring
concordance of religiosity were found to be
protective agents against depression for
offspring (Miller, Warner, Wickramaratne, & Weissman,
1997).
Impact of Spirituality on
Persons with Anxiety Disorders
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Positive mental outcomes noted for
people with anxiety disorders who are
intrinsically religious and among those
who use religious and spiritual coping
mechanisms (Jahangir, 1995).
Impact of Spirituality on
Anxiety Disorders
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A normal healthy religious life is a protective agent
against anxiety disorders. Intrinsic religiosity is
associated with lower levels of general anxiety
(Lotufo-Neto, 1996; Mickley et al., 1995; Richards & Bergin, 2000).
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Death-anxiety among terminally ill patients with
HIV/AIDS was decreased with use of religious and
spiritual coping (Woods et al., 1999), specifically with
the use of prayer (Kaplan et al., 1997).
Impact of Spirituality on
Substance Addictions
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Intrinsic religiosity is related to low levels of
substance use (Fischer & Richards, 1998), while the
likelihood of using or relapse include a feeling of
disconnectedness with one’s religion (Gills & Mubhashar,
1995).
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Higher levels of religiosity or spirituality among
individuals recovering from substance abuse are
associated with enhanced coping, greater resilience
to stress, an optimistic life orientation, greater
perceived social support, and lower levels of
anxiety among inpatient and halfway house
substance abusers (Pardini, Plante, & Sherman, 2001).
Impact of Spirituality on
People with Schizophrenia
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Religious coping methods have positive effects
on persons with schizophrenia and with their
families (Wahass & Kent, 1995).
For the individual with schizophrenia, religious
worship with the family or with a congregation
may integrate the person into a greater
community when s/he feels isolated. For the
family, religious worship with the individual with
schizophrenia serves as a means of feeling
connected with the individual who has lost touch
with reality (MacGreen, 1997).
Example
Results of a 3-year spirituality group
(Wong-McDonald, 2007)
Article is posted on conference website.
Group Description
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The spirituality group (SG) was an optional
group at a psychosocial rehabilitation
program (psych rehab) at a community
mental health center.
48 persons with severe mental illness
participated in psych rehab: 20 chose to
participate in SG (with signed informed
consent), 28 did not.
Of the 20 clients in SG, 18 professed to
some type of Judeo-Christian faith while 2
were open to all faiths.
Group Description
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The recovery process based on treatment goal
attainment is compared between those in SG and
those not in SG.
Examples of treatment goals include:
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Wellness (e.g., lowering frequency of panic attacks,
losing weight, decreasing hospitalizations, overcoming
agoraphobia)
Socialization (e.g., making a new friend, going out on a
date, saving money to go on a vacation with friends)
Vocational/education (e.g., obtaining a driver’s license,
earning a high school diploma, returning to college,
transitioning from volunteer to paid employment)
Outcome
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For a 3-year period (April 2003-April 2006)
All 20 clients (100%) in SG achieved their
treatment goals, as compared to 16 out of 28
(57%) clients not in SG who attained the goals.
Result is significant (p < .0001).
Chi square tests were used to determine if the
difference was due to ethnicity, attendance, yrs of
education, diagnosis, type of goal, history of
substance abuse, age, and housing arrangement.
Results were all not significant.
Reports from Clients in SG
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Spirituality is very important in their recovery.
Sensing God’s presence lessens feelings of sadness.
Their faith helps them to feel calmer from fears/anxieties.
Their faith helps them to forgive.
They feel more confident to pray.
They are more able to resolve things from a spiritual
perspective.
They believe that there is always hope because God is
always there.
Application: Use of Spiritual Interventions
to Transform Persons into Christ-Likeness
What?
 Who?
 How?
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What?
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Spirituality refers to the lived experience of
God in all aspects of life, that is rooted in the
revealed word of God and grounded in the
community of faith (Stevens, 2004).
Intervention refers to any action a counselor
takes to move the counselee toward health,
well-being, and Christ-likeness.
Scriptural Basis
Colossians 1:28-29
We proclaim Him, admonishing and teaching
everyone with all wisdom, so that we may
present everyone perfect in Christ. To this
end I labor, struggling with all His energy,
which so powerfully works in me.
Galatians 4:19
My children, with whom I am again in labor
until Christ is formed in you.
Spiritual Formation
Non-Christlikeness
Christlikeness
Every intervention (e.g., becoming clean & sober,
forgiveness & reconciliation, taking responsibility,
seeking God, prayer) should move counselee
toward Christlikeness.
Purpose of Spiritual Interventions
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Affirm spiritual identity & divine worth
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Many do not know who they are in Christ
Understand problems from an eternal
spiritual perspective
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Give biblical teachings on trials & suffering
Purpose of Spiritual Interventions
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Modify erroneous spiritual beliefs
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Many have false notions about what the
bible says
Seek guidance and strength from God
to cope and heal
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Sometimes just a reminder that God is
present in their troubles will help them to
go on.
Purpose of Spiritual Interventions
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Emotionally forgive & heal from past
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Some are stuck in the past and ruminate about
wrongs done to them.
Accept responsibility
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Taking responsibility for one’s life is the first step.
They may not be responsible for the past (i.e.,
abuse that was done to them) but they are
responsible for their present & future.
Purpose of Spiritual Interventions
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Obtain (and offer) support from (and to)
their religious community
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Being a contributing member gives a sense of
well-being and belonging
Grown in faith & commitment to God
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All spiritual interventions should point the
way to Jesus.
(Richards & Bergin, 1997)
What?
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Two types of spiritual interventions
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Implicit
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Explicit
(Tan, 1996)
Implicit Interventions
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They are covert.
Counselor does NOT openly or directly use
spiritual resources like prayer or Scripture.
Example: Counselor praying silently for the
counselee.
Example: Counselor becomes Christ’s presence
for the counselee by modeling the love of God in a
way that can be experienced interpersonally.
Explicit Interventions
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They are more overt.
Counselor directly and systematically deal with spiritual
issues.
Counselor uses spiritual interventions like prayer,
scripture, spiritual writings and music, and may refer/help
counselee connect with a church.
Example: Counselor gives counselee a list of biblical
passages to read/study that are applicable to the
counselee’s situation.
Example: Counselor opens the session with prayer and
may include prayer during the session at specific
moments.
Who?
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Implicit – Can be used with anyone
Explicit – For counselees who agrees to
accept spiritual interventions and who
can benefit from them. (For
psychotherapists, this involves obtaining
informed consents from clients.)
Who?
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Explicit interventions are contraindicated for
the following counselees (Richards & Bergin, 1997):
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Those who make it clear that they do not want
such interventions.
Those who are psychotic (i.e., out of touch to
reality) or delusional (e.g., believe that God gave
them powers to control the weather).
Implicit/Explicit Interventions
Used in Spirituality Group
SPIRITUALITY GROUP
 Psychosocial rehabilitation
(e.g., skills training, CBT)
 Implicit interventions (e.g.,
silent prayers, counselor as
presence of Christ)
 Explicit interventions (e.g.,
open prayer inviting Spirit of
God, reading Scripture,
listening to spiritual music)
 RESULT: 100% attained
treatment goal; change in
relationship with God & with
neighbor.
NO SPIR GROUP
 Psych rehab
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Implicit
interventions used
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Explicit interventions
not used
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RESULT: 57% attained
txt goal; some change
in relationship w/others
from learning social
skills and appropriate
boundaries.
What?
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Spiritual formation sits on 3 legs as its
foundation; these 3 legs also form the
basis for the spiritual interventions:
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Spirit of God
Word of God
People of God
(See separate table posted on conference website for
definitions and examples of spiritual interventions.)
Spirit of God
Psalm 127:1
Unless the Lord builds the house, its
builders labor in vain.
Spirit of God
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Spiritual assessment/discernment
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Counselor prayer
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Continuous (overlap with counselor prayer)
Sometimes the Holy Spirit will direct counselor to a specific
group topic (like a pastor is led to a sermon topic)
Listening (one ear is listening to the people, & the other is
attuned to God)
Before (to prepare both counselor and counselee, ask for
Holy Spirit to lead session), during (can be silent to seek
guidance from Holy Spirit or vocal to model for counselee),
and after session (release counselee to God)
Counselee prayer
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Encourage counselee to seek help from God
Spirit of God
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Joint counselor & counselee vocal prayer
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Spiritual relaxation & imagery
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Particularly useful for counselees who are unsure
about how to pray
Ask counselee to picture in their mind a soothing
situation (such as them resting in the arms of Jesus)
Spiritual meditation
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Ask counselee to ponder on a scriptural passage or
biblical story that relates to their situation
Word of God
Hebrews 4:12
For the Word of the Lord is living and active, sharper
than any double-edged sword. It penetrates even
to dividing soul and spirit, joints and marrow; it
judges the thoughts and attitudes of the heart.
Isaiah 55:11
My Word that goes out from My mouth: It will not
return to me empty, but will accomplish what I
desire.
Word of God
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Reference to Scripture
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Teaching spiritual concepts
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Many are ignorant of what the bible says
Need to explain certain passages/concepts
(e.g., what does being salt & light mean?)
Spiritual confrontation
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Point out incongruence between counselees’
beliefs/behavior and what the bible teaches
Word of God
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Religious bibliotherapy
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Giving counselees spiritual literature to read that
relates to their problem
Memorization of Scripture
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Encourage counselees to memorize scriptures
relevant to their situations. Have them memorize a
few “life” verses (i.e., promises that they can cling
to during difficult times). May use hymns to aid
memorization.
People of God
1 Corinthians 12:27,26
Now you are the body of Christ, and each one of
you is a part of it. If one part suffers, every part
suffers with it; if one part is honored, every part
rejoices with it.
Galatians 6:1-2
...if someone is caught in a sin, you who are
spiritual should restore him gently...Carry each
other’s burdens, and in this way you will fulfill
the law of Christ.
People of God
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Use biblical community
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Pray & support one another
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Encourage counselees to connect with other believers.
May start by creating a loving community in the group.
Encourage outside meetings & mutual support without
counselor. May end session by asking: “Who will pray
for Mary this week?”
Spiritual self-disclosure
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Counselor shares what God taught them in a relevant
situation to model and encourage.
People of God
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Encouraging forgiveness
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Spiritual confrontation
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Need to define and help counselees understand what
forgiveness means; share/model how to do this
There are times when a caring community will loving
confront a member.
Service to others
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Encourage (may create) loving acts to others in group
and in community (e.g., volunteering at a board & care
home)
How?
The following approach was used in the Spirituality Group with
people who have mental illness, but can be adapted into
other settings.
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Start from ground zero
Use material that is fairly easy to read (no higher
than high school level)
Go slower. Use repetition. Some have cognitive
deficits. Use handouts and visual aids.
How?
The following approach was used in the Spirituality Group with
people who have mental illness, but can be adapted into
other settings.
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Watch attention spans. Vary modality with music,
lecture, reading aloud, discussion, and video.
Do NOT “dumb” down the content
Do NOT accept less accountability than “normal”
people
Process of Transformation
1.
Knowing
Faith comes by hearing, and hearing by the Word of
God (Romans 10:17).
2.
Being
I desire to do Your will, O my God; Your law is within
my heart (Psalm 40:8). The fruit of the Spirit is love,
joy, peace, patience, kindness, goodness,
faithfulness, gentleness and self-control (Galatians
5:22-23).
3.
Doing
Faith by itself, if it is not accompanied by action, is
dead (James 2:17).
Case Examples
Sharon: History of domestic violence and involvement
w/aggressive impulsive males
 Knowing: Learned biblical principles, healthy boundaries,
job skills
 Being & Doing: Took responsibility to grow; returned to
church and saw pastor regularly; started leading group on
boundaries in domestic violence shelter; graduated from DV
program, moved into own apartment; stopped dating
aggressive male when she noticed warning signs; today she
is employed by the Dept. of Mental Health as a peer
counselor helping other clients
Case Examples
Ricky: Bipolar Disorder, history of risky sexual
behaviors
 Knowing: Learned what the Bible says
about appropriate and healthy sex
 Being & Doing: Stopped these behaviors for
over a year; donated money that he would
have used on prostitutes to charity;
channeled energies into returning to school
Goal of Spiritual Interventions
Ephesians 4:14-16
Then we will no longer be infants, tossed back and
forth by the waves, and blown here and there by
every wind of teaching and by the cunning and
craftiness of men in their deceitful scheming.
Instead, speaking the truth in love, we will in all
things grow up into Him who is the Head, that is
Christ. From Him the whole body, joined and held
together by every supporting ligament, grows and
builds itself up in love, as each part does its work.
Questions & Discussions
Thank you!