HOLISTIC PRACTICE “BORN AGAIN”: DOES SOCIAL WORK NEED A
SPIRITUAL PERSPECTIVE?
A Project
Presented to the faculty of the Division of Social Work
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
by
Kayleigh Ellen Lembke
SPRING
2012
HOLISTIC PRACTICE “BORN AGAIN”: DOES SOCIAL WORK NEED A
SPIRITUAL PERSPECTIVE?
A Project
by
Kayleigh Ellen Lembke
Approved by:
__________________________________, Committee Chair
Kisun Nam, Ph. D., MSW
____________________________
Date
ii
Student: Kayleigh Ellen Lembke
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library and credit is to
be awarded for the project.
__________________________________, Graduate Coordinator, _________________
Dale Russell, Ed.D., LCSW
Date
Division of Social Work
iii
Abstract
of
HOLISTIC PRACTICE “BORN AGAIN”: DOES SOCIAL WORK NEED A
SPIRITUAL PERSPECTIVE?
by
Kayleigh Ellen Lembke
Spirituality and religion are complex areas in any individual’s life. Research suggests that
most American’s have some affiliation with a spiritual or religious side of themselves.
The goal of this study was to explore the relationship of participants (CSUS college
students) with spirituality and/or religion in regards to stress. Research has shown stress
to be one of more predominate challenges of college students and an experience felt by
most if not all adults. Though the primary purpose of research for this project was to
identify the effects, if any, of spiritual and/or religious practices on the symptoms of
stress, the larger implications for the social work profession was explored in detail to see
how and if spirituality and/or religion might fit in accordance with holistic practice, the
values, code of ethics, and professional guidelines of social work. The findings of this
study support the inclusion of some form of spiritual/religious dialogue with clients for
the social work profession and practical ways of incorporating spirituality and/or religion
within practice.
____________________________, Committee Chair
Kisun Nam, Ph.D., MSW
_______________________
Date
iv
DEDICATION
“Give me a sharp sense of understanding, a retentive memory, and the ability to
grasp things correctly and fundamentally.”
~ St. Thomas Aquinas
I would like to dedicate this thesis project to my Higher Power. Without the
guidance and loving support of Him I would never have made it through. He took me
along the path through the twists, turns, thorns, and peaceful pastures. Without His hands
on mine this would never have been written. Without His inspiration and Holy Spirit I
know this project would not have made it to the page.
I also want to dedicate this thesis project for all those who have doubted
themselves, thought they weren’t good enough, couldn’t do it, or struggled to see and
embrace the amazing abilities, talents, insights, and gifts that they behold.
Finally, I dedicate this project to every homeschooler who has been told they
won’t make it in the “real world,” or in “real school.” Those who have been told they
aren’t good enough, they aren’t smart enough, they aren’t “this” or “that.”
This one made it, and you can too.
v
ACKNOWLEDGMENTS
I want to thank my Advisor, Dr. Kisun Nam; whose patience, support, and
guidance got me from start to finish. I want to thank my Independence High School
teachers: Mrs. Bertolucci, Mrs. Campbell, Mr. Goff, and Mrs. Latteri. Without whom I
wouldn’t have had the knowledge and skills to build upon to be successful through the
years. I want to thank and acknowledge my BSW practice teacher, John Davis. Who
helped me believe I could get a Masters.
I want to thank Cool and the Gang, otherwise known as Nathan, Kevin, Maureen,
Tiffany, and Emma. You guys have constantly supported me through the last two years
and I don’t know how I would have done it without all of you! To Kevin, my “unofficial”
thesis partner through endless bags of soda gummies, coffee dates, turkeys, and making
me work on thesis I thank you. Your support, humor, and friendship have meant the
world to me. I could not have finished without you making me.
To my family: my mom, Shelly, thank you for the endless proof reading and
foundational education that brought me where I am today; my dad, Bobby, who always
motivated me to do my best; my siblings, Roxanne, Josie, and Evan; “my roommates,”
Paige and Imogen; my boyfriend Nick (and “the boys,” Kodi and Aiden) who sacrificed
me to school day after day, year after year, and loved me anyway. Thank you for your
endless support and belief in me through all the tough and stressful times. I love you all
and am so thankful to be privileged to have you in my life.
Finally, I want to acknowledge and thank Him: my inspiration, my motivation,
and my Lord.
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TABLE OF CONTENTS
Page
Dedication ........................................................................................................................... v
Acknowledgments.............................................................................................................. vi
Chapter
1. THE PROBLEM ........................................................................................................... 1
Introduction ............................................................................................................. 1
Background of the Problem .................................................................................... 2
Statement of the Research Problem ........................................................................ 4
Purpose of the Study ............................................................................................... 5
Theoretical Framework ........................................................................................... 6
Definition of Terms................................................................................................. 8
Assumptions............................................................................................................ 9
Justification ........................................................................................................... 10
Limitations ............................................................................................................ 10
2. REVIEW OF THE LITERATURE ............................................................................ 14
Introduction ........................................................................................................... 14
Spirituality............................................................................................................. 15
Conceptualization of Spirituality ................................................................. 15
Distinction Between Spirituality and Religion ............................................ 15
Stress ..................................................................................................................... 17
vii
Conceptualization of Stress.......................................................................... 17
College Students and Social Work .............................................................. 17
Spirituality, Stress, and Social Work .................................................................... 24
Interventions Utilizing Spirituality on Stress ............................................... 24
Social Work and Spirituality........................................................................ 25
Summary: Spirituality Within a Holistic Framework ........................................... 31
3. METHODS/METHODOLOGY ................................................................................. 38
Hypothesis............................................................................................................. 38
Research Questions ............................................................................................... 38
Introduction ........................................................................................................... 38
Study Design ......................................................................................................... 39
Sampling ............................................................................................................... 40
Measurements Instruments ................................................................................... 40
Data Collection Procedures................................................................................... 41
Analysis Plan ........................................................................................................ 42
Protection of Human Subjects .............................................................................. 42
4. DATA ANALYSIS AND FINDINGS ....................................................................... 44
Introduction ........................................................................................................... 44
Demographic Information ..................................................................................... 45
Stress ..................................................................................................................... 45
Spirituality............................................................................................................. 52
viii
Religion ................................................................................................................. 55
Spirituality, Religion, and Stress .......................................................................... 57
Utilizing Spirituality/Religion in Practice ............................................................ 61
Conclusion ............................................................................................................ 66
5. SOCIAL WORK IMPLICATIONS ............................................................................ 67
Introduction ........................................................................................................... 67
Hypotheses/ Research Questions .......................................................................... 67
Interpretation of Results ........................................................................................ 68
Implications for Social Work ................................................................................ 69
Recommendations ................................................................................................. 73
Conclusion ............................................................................................................ 74
Appendix A Human Subjects Application ...................................................................... 76
Appendix B Informed Consent ....................................................................................... 82
Appendix C Interview Questionnaire ............................................................................. 84
References ......................................................................................................................... 87
ix
1
Chapter 1
The Problem
Introduction
The college years are new and exciting times for countless young students. For
many, it’s the first time they are away from home, having to cook for themselves, and
learning that “balancing a check book” is not placing it on the top of their finger while
trying to keep it from falling. In addition, many students are having to do their own
laundry, pay their own bills, and get one of those “planner things” they’ve seen used by
their parents. With the amassing responsibility of new college students one of the most
common ailments is stress (Ratanasiripong, Sverduk, Hayashino, Prince, 2010). Other
common concerns of students are depression, anxiety, adjustment disorder, and sleep
hygiene (Kraft, 2009). Though many of these factors work in tandem together, stress is
often the manifestation and root cause behind the increasing intensity of these factors. A
prevailing social construct within society is that a “college degree equals success”
(Zagier, 2010). The “college degree equals success” (2010) mentality, at its core, is an
encouragement for higher education as means to a successful and secure future as an
individual. College is viewed as way for students to gain life-skills, begin networking, or
even meet their future spouse—it is often referred to as “the best years of your life.”
However, along the path of “the best years of your life,” college students have been
bombarded with situations and circumstances leading to an increase in stress. An increase
in stress can lead to thoughts of “not being able to handle it,” or “maybe college isn’t for
me.” These thoughts can then lead to dropout. Through that same social constructionist
lens of “college degree equals success” (2010), dropping out of college would mean
2
failure. Failure in school, failure in being able to obtain a job, failure in securing one’s
future, failure at life in general. Luckily, this dim outlook does not have to be the future
for students. College campuses around the United States offer mental health counseling
services to students for low to no cost (Kraft, 2009). The students are able to see a
counselor for support with their concerns and take advantage of resources to add to their
repertoire of skills. Once a student has come to counseling, they may see a professional
from a variety of disciplines from social work to psychology. Within these various
disciplines are various methods of assessment; and despite differences, there is much
overlap. Counselors aim to identify areas of concern in their client’s life from
psychological, biological, and social perspectives. Though these perspectives are valuable
to assessing a client on a multi-dimensional level one perspective remains taboo—
spirituality. This area is so often overlooked and some thoughts behind exclusion of this
category are the potential to cross boundaries and lines between church and state, the
perception of a counselor trying to “convert” their client, or risk offending a client who
does not have any spiritual or religious affiliation. It could also cause issues of countertransference for a counselor. On the other hand, it could also be an extraordinarily
beneficial area of exploration with clients to open space and possibility.
Background of the Problem
Spirituality and religion are active factors in roughly 90% of Americans; the
remaining 10% list no affiliation with either spirituality or religion. However, despite the
lack of active participation, the 10% still have a relationship even in the absence of active
participation with spirituality and religion. As spirituality and/or religion could be a
3
factor in an individual’s life and is a factor in 90% of American’s lives. It would then be
fitting to have an exploratory discussion of spirituality and/or religion when working with
clients, and particularly for the purposes of this study, social work. It would be fitting on
the basis that social work practices from a holistic framework. A holistic framework is
looking at the whole person in their surrounding environment. Traditionally social work
degree programs barely cover aspects of spirituality and/or religion when working with
clients (Hodge, 2005). Yet, many clients have strong affirmative affiliations with
spirituality and/or religion (Gallup, 2011); and those that do not have affirmative
affiliations may benefit from the ability to voice their past experiences, negativities, or
struggles that come forth from not holding a particular believe. It has been thought that a
majority of social workers affiliate with spirituality or religion but do not maintain an
active practice and that may be a reason for not including spirituality and/or religion in
their work with clients (Hill, Pargament, Hood, Mccullough, Swyers, Larson, Zinbauer,
2000). Separation of church and state may be another sticking point keeping social
workers from exploring spirituality and/or religion. Regardless of the reason,
spirituality/religion has been shown to be an effective coping skill for many Americans
struggling with stress (Hill et al., 2000). In an effort to provide a comprehensive standard
of care, not only should social workers should include spirituality and religion in
assessment, interventions, and treatment planning but the social work profession should
educate those in degree programs on how to explore spirituality and/or religion in a
positive, respectful, non-combative, and neutral manner so that if a client requests a
4
discussion on spirituality/religion a social worker would be prepared to do so in a
sensitive and supporting manner.
For the purposes of this study spirituality and/or religion and the effects that it has
on stress are explored through the personal experiences of college students. Stress is the
number one prevailing concern of college students (Brougham, Mendoza, Miller, Zail,
2009). Stress is also highly prevalent among the general population of Americans
(American Nurse, 2001). In showing that spirituality and/or religion can be effective
coping mechanisms to manage the symptoms of stress through data collected from
college students, current research in the field, and social work holding that it practices
from a holistic framework; it can be said that spirituality and/or religion, and the possible
benefits should be generalized into assessment, intervention, treatment planning, and at
the very least be offered as a general discussion.
Statement of the Research Problem
Spirituality has not been adequately integrated into social work practice.
Spirituality and spiritual/religious competence is not explored in academia for social
work formation. Students are being accepted into bachelor and master’s level programs
without being adequately trained on how to explore the ideas of spirituality or religion
with clients. Without training in how to discuss spirituality or religion, recently graduated
social workers and those that have come before know little about how to address such
topics with clients (Knitter, 2010). In clinical settings, spirituality has not sufficiently
been considered in assessment or treatment planning. Spirituality has been seen as
“taboo” in the social work world even though social work aims to address an individual
5
through a holistic framework. A holistic framework means to identify every area of an
individual’s life; which would include spirituality and/or religion. Among college
students stress is by and large the most widely reported issue students are faced with
(Brougham, Mendoza, Miller, Zail, 2009). Spirituality has been defined as an incredible
asset for students in combating stress (Hill et al., 2000), yet, more is not done about the
topic in the training of practitioners through social work education or in clinical training,
assessment, or treatment planning. Due to these factors the following is hypothesized; (1)
spiritual or religious practices decrease the effects and/or symptoms of stress. (2)
Individuals do not mind being asked about their relationships, experiences, or preferences
regarding spirituality or religion. This research project will endeavor to gather
information in relation to the hypotheses while attempting to answer the following
questions; (1) do spiritual or religious practices decrease the effect and/or symptoms of
stress? (2) do individuals mind being asked about their relationship, experience, or
preferences regarding spirituality and religion?
Purpose of the Study
This study aims primarily to identify to what degree college students utilize
spirituality as means of coping with stress in their everyday lives. Secondarily, this study
aims to identify students’ thoughts on having spirituality and/or religion explored in
working with a counselor. Finally, this study aims to identify to what extent spirituality
should be included in training, assessment, and treatment planning in social work
practice.
6
Theoretical Framework
Several theoretical frameworks are applicable for this research study. However,
this section will give focus to General Systems Theory (Ashford, LeCroy, Lortie, 2006)
or Systems Theory. Systems theory holds that there is “a circular causality, in which all
elements of a system simultaneously are influenced by, and influence each other” (Walsh,
2010, p. 92). In short, the basic idea of the theory is that any interaction between two
things creates a system wherein then each thing or “part” then interacts and influences
one another (Walsh, 2010). Walsh states several main principles held within General
Systems Theory. The first being “connectedness:” the principle that all parts of a system
are interconnected, and changes in one part will influence the functioning of all other
parts” (p. 93). The connectedness of any part of a system with another is the basis for
understanding how two things can be so crucial to one another. For example, a child and
its mother–that is a system; one part being the child, and a second part being the mother.
As the two interact and are connected each influences the other on many levels. As the
child cries, hopefully the mother checks to see if the child is hurt, hungry, scared, or a
myriad of other possibilities. As the child ages the mother may call the child for a meal,
the child interacts with mother and comes when called. This is an example of two parts of
a system working, interacting, and being connected to one other. To continue with this
example the child also interacts with the father, which would be an addition to the
system. The child interacts with both parents and contributes to a third system and now
the three parts are interconnected and influencing one other in day-to-day life. The
mother interacts with child, as well as with the child’s father and in like manner the father
7
with the mother and child. This process continues in the immediate family, to any
extended family, neighbors, into the school system, and limitless numbers of parts that
now play a roll in the “system” of this young family. That same child will interact with
any immediate siblings they may have, extended family such as grandparents, cousins,
aunts, or uncles. The child will grow and begin to interact within their community
through neighbors, friends, teachers in schools, counselors, and maybe even churches.
That same child will also interact with national factors when voting or during exposure to
media; the child will interact globally through factors that influence their future job
market, their buying market, or their interaction with people from around the world.
Again, these are all parts of the child’s system. They all influence and play rolls within
the lifetime of that child. These systems are interconnected and multifaceted and a change
in one part influences and has an effect on all others.
Another principle of General Systems Theory is “wholeness” the idea that any
phenomenon can be understood only by viewing the entire system” (p. 93). With this
principle in mind, a connection is formed between the holistic framework of social work
and the importance of looking at a client as part of their system along with other “parts”
that influence and affect that system. In the example above, when the “child-system”
begins to interact with their community they may then be exposed to their family’s
spiritual or religious affiliations by way of their local church or participating in practices
related to their family’s affiliation. Walsh points out that “children usually develop their
early values and spiritual beliefs in the context of family life” (p. 104). As the child from
the example grows and matures they may begin to adopt their family’s system of beliefs
8
or begin to explore and adapt their beliefs into something of their own. This illustrates the
importance of examining a client’s system and the parts of that system, which have had
an influence in the client’s life.
The “feedback principle” [of General System’s Theory] states that a system’s
behavior affects its external environment, and that environment affects the system.”
According to a recent survey conducted by Gallup roughly 90% of Americans have some
spiritual or religious belief system from which they hale (Gallup, 2011). With such a
large majority of Americans reporting some form of spiritual or religious belief, an
assumption that spirituality or religion has played a part in a client’s system would be
appropriate. Furthermore, even with the 10% of Americans that do not report to affiliate
with spirituality or religion does not mean that spirituality or religion has not influenced
or affected their system at some point. The probability of spirituality or religion
influencing a client’s system at some point in their lives would then behoove the social
work profession to include an assessment, exploration, or discussion of spirituality or
religion in their interactions with a client in keeping with the feedback principle, the idea
of “wholeness,” and General Systems Theory.
Definition of Terms

Spirituality
o The belief in something outside oneself, a connection with the universe or
essence of being, “the quality or state of being spiritual” (MerriamWebster, n.d.).

Religion
9
o An institutionalized system of religious attitudes, beliefs, and practices
held by individuals that may meet together for group worship (MerriamWebster, n.d.)

Stress
o A physical, chemical, or emotional factor that causes bodily or mental
tension and may be a factor in disease causation (Merriam-Webster, n.d.).

College Student
o A student enrolled in a college or university (Merriam-Webster, n.d.).

Social Worker
o A professional working as a “social worker,” counselor, clinician, or
service provider concretely concerned with providing social services and
especially with the investigation, treatment, and material aid of the
economically, physically, mentally, or socially disadvantaged in any
number of social service agencies, or within agencies advocating for rights
and policies in favor of the previously mentioned populations (MerriamWebster, n.d.).
Assumptions
The assumptions that need to be considered for this study are first that by Eric
Erickson’s third stage of development, “initiative vs. guilt” (Ashford, LeCroy, Lortie,
2006, p. 79) when a child is between the ages of 3 and 5 they have an awareness of
spirituality or religion in some form. Second, that by the time an individual reaches
adolescence they have contemplated or interacted with spirituality or religion in some
10
form whether by their own accord or by exposure to their caregivers preferences. Third,
that spirituality or religion is positive, negative, neutral, or a combination in every
person’s life. Fourth, that an individual’s relationship with spirituality and religion is
fluid throughout their lifetime. Fifth, that spiritual or religious practice is beneficial in
dealing with stress. Sixth, that the terms “spirituality” and “religion” may be used
interchangeably at times, while maintaining that different definitions exist, that the
concept of both terms are more broad. Finally, by introducing spirituality or religion into
the practice of social work through assessment, interventions, exploration, and
discussion, therapists can provide a better quality of care and a more holistic approach in
working with clients.
Justification
This research project will provide valuable information on the effectiveness of
spirituality in coping with stress for college students. By providing evidentiary support
for spirituality’s inclusion within social work, this study will provide a framework for
application of spirituality in social work formation. Across disciplines, if social workers
are the only ones exploring and including spirituality with our clients it further sets us
apart as a profession and increasingly exemplifies our unique approach to clients and our
expertise within the field of social work.
Limitations
Several limitations to this study include: that this study will be based upon
qualitative research, and that findings will be produced from a sample size too small for
generalization across the larger culture. The research results will also be found through a
11
survey of college students roughly 18-26 years of age, which limits generalization across
all ages of the population. Though the study will provide a sound basis for further
research, while still providing valuable information for consideration, generalization
across the larger society cannot be assumed. A larger cross-sectional sample population
would be favorable to maximize generalized information and data. The data collection
will be done through an interview process, which lends to subjective responses on the
part of the participants. The questioner was self-created which could present a limitation
so that the questions are not nationally recognized or supported outside of this
researcher’s purposes.
In terms of validity the study was conducted by way of interview with a
predetermined questionnaire to identify participants’ thoughts on spirituality, religion,
stress, and use of such discussions in counseling. Possible threats to internal validity are
history, which pertains to outside events that affect the result of the study; maturation,
which refers to the physiological changes that take place in the participants during the
course of the study; testing, which is the implementation and interaction of the tests for
the participants; instrumental decay/instrumentation, which is the deterioration of the
instruments used; regression to the mean/statistical regression, where participants
answers gravitate towards the mean score; selection, which can become a threat where
“preexisting differences between study subjects may interact with the independent
variable and affect the outcomes of the study” (Terao, Schmidt, Yuen, 2009, p. 52); and
experimental attrition/mortality, where participants drop out of the study and choose to
no longer participate (2009).
12
Preservation of internal validity was maintained in regards to history due to lack
of outside events having any effect during the questionnaire distribution and data
collection. In terms of maturation, participant's were notified of the opportunity to
participate, contacted researcher, and were interviewed within a two-week span; too short
a time span for maturation to have any effect on the outcomes. Testing was not a threat
due to lack of testing in data collection/analysis process. Threats in conjunction with
instrumental decay/instrumentation where not of concern due to interview data being
recorded electronically, printed, and analyzed prior to any deterioration of data.
Regression to the mean, otherwise known as statistical regression, did not affect the
outcome of the data due to the fact that there was a single interaction of researcher and
participants where data was collected in one meeting and not multiple distributions of
measures. Randomization was utilized in an effort to maintain validity against the threats
of selection. Finally, all participants elected to stay in the study, therefore experimental
attrition or mortality were not concerns or threats to the study.
External validity poses limitations to the study in that the research is qualitatively
based, utilizing a small sample, with minimal age and ethnic diversity. Information
gathered would not be able to be generalized to the larger populous without a more
extensive and diverse sample of participants. While the study does allow room for
varying definitions of terms (i.e. spirituality, religion, stress), the ability to measure the
identical data amongst varying data sources is not possible.
One limitation to the study in terms of reliability was the ability to maintain
consistency of the questionnaire. At times during the data collection a participant would
13
ask for clarification of a question which would cause the researcher to initially state all
questions identically but some questions were repeated and asked a different way for
some participants and not others based on need. Due to this fact it may pose a slight
measurement error. The majority of questions in the interview questionnaire are openended and open for participant interpretation; the questionnaire would yield similar
answers though not identical if repeatedly distributed.
14
Chapter 2
Review of the Literature
Introduction
This literature review will be divided into three main sections of exploration: the
first being spirituality/religion, the second, stress, and the third, social work. With regard
to spirituality, the conceptualization, brief history, and differences between the ideas of
spirituality and religion will be explored to provide a foundational basis to build upon
with subsequent sections. In addition, consideration of stress in a general sense as well as
in conjunction with college students will be detailed to illustrate the correlation between
stress and college, considering that the sample population for this study is comprised of
college students. Current methods college students utilize to alleviate stress, both safe and
unsafe, will also be listed. Evidence for spirituality and its effects on stress will also be
detailed. Finally, social work as a profession will be explored to demonstrate the role it
plays in spirituality, in working with college students, and serving clients through a
holistic framework.
These areas were selected to provide the reader with a broad and encompassing
picture of research on the topic in order to give relevance to the study. Areas were also
chosen to provide the reader with an idea of the interconnectedness of all three areas. In a
holistic approach to social work, one must take a “balcony view” on every subject that
one comes across. In other words, without giving credence to an entire picture and
gathering history and background information, as well as current thoughts and ideas, one
cannot fully understand the extent of the issue and is certain to approach the situation
without some type of error. In the same way that dots on a page do not make a full picture
15
until one stands back to observe the whole, so too one cannot assess an individual based
on one or two areas of their lives. The “balcony” or view from above must be
implemented to fully serve a client or review literature on a given topic.
Spirituality
Conceptualization of Spirituality
Spirituality is a largely complex concept not able to be confined to one definition
(Hill et al., 2000). However, for this project, distinctions between spirituality and religion
will be drawn in an effort to provide some basis for comparison in the coming chapters
and data analysis. Hill et al. referred to Spilka’s (1993) “review of literature” (Hill et al.,
2000, p. 57) which lends to more “contemporary understandings of spirituality,” (p. 57)
disseminating spirituality into three categories of understanding, while providing a
multidimensional consideration for conceptualization. First, a “God-oriented spirituality
where thought and practice are premised in theologies, either broadly or narrowly
conceived,” (p. 57); second, “a world-oriented spirituality stressing one’s relationship
with ecology or nature” (p. 57); and third or to conclude, “a humanistic (or peopleoriented) spirituality stressing human achievement or potential” (p. 57).
Distinction Between Spirituality and Religion
Spirituality and religion “are complex phenomena, multidimensional in nature,
and any single definition is likely to reflect a limited perspective or interest” (Hill et al.,
2000, p. 52), and it would be “premature to insist on a single comprehensive definition of
either term” (p. 52). There is such a wealth of debate on the definitions of both terms that
it would be fair to suggest the adage, “to each his own.” Despite the varying degrees of
16
definitions, common themes arise around both spirituality and religion. To some,
spirituality is a broad term and religion is more succinct and specific. Knitter (2010)
notes that a “religious experience, whether it is described as the experience of a personal
God or of an enlightened state, communicates to the individual a sense, and assurance
that they are part of something larger. They are not alone; they are not an accident” (p.
267). Redman conducted a study that suggested spirituality referred to one’s ability to
have an awareness of one’s own nature, fueling a desire for “self-development, and selftransformation” (2008, p. 60), and discovering a personal meaning to life (Redman,
2008). Hodge (2005) draws a distinction between spirituality and religion by the
following: “spirituality is conceptualized as an individual’s existential relationship with
God (or perceived transcendence)…religion refers to a particular set of beliefs, forms,
and practices that have been developed in community by people who share similar
experiences of transcendent reality” (as cited in Hodge, 2001). Canda, Furman, and
Nakashima in 2004 found that,
Religion was defined as ‘an organized, structured set of beliefs and practices
shared by a community, related to spirituality’… and spirituality was defined as
‘involving the search for meaning, purpose, and morally fulfilling relations with
self, other people, the encompassing universe and ultimate reality, or however a
person understands it’ (as cited in Canda & Furman, 1999, p. 316; p. 28).
On an elementary level, Hill et al. found that, “the word ‘religion’ comes from the Latin
root religio which signifies a bond between humanity and some greater-than-human
17
power…[and] the word ‘spirituality’ is taken from the Latin root spiritus meaning breath
or life, with the Latin spiritulis designating simply a person ‘of the spirit’” (pp. 56-57).
These and other distinctions between spirituality and religion vary slightly,
however the overall guidelines of definitions can be said to contain the following:
spirituality generally consists of a larger sense of being and loose, informal relationship
with an unnamed entity. Religion is a more formalized set of practices taken part in by a
community of persons holding shared beliefs about a specific being or entity.
Stress
Conceptualization of Stress
Stress is defined as, “a physical, chemical, or emotional factor that causes bodily
or mental tension, and may be a factor in disease causation” (Merriam-Webster, n.d.).
Simply put, stress can manifest physically, chemically or emotionally, causing the body
or mind distress, and potentially leading to physical illness. Stress can be brought on by
any number of factors: a sick family member, project deadlines at work, financial
problems or, as in the case of college students—the demands of assignments and their
course load responsibilities (Ong & Cheong 2009).
College Students and Social Work
With economic downturn (Guo, Wang, Johnson, Diaz, 2011), escalating tuition
rates and ongoing competition in the workforce calling for higher degree standards,
students are choosing to rapidly increase the amount of courses they take each semester.
When students reach the maximum number of units at one institution they often enroll in
a second institution. Usually this second institution is a junior college allowing students
18
to add even more classes. A great deal of effort in an attempt to complete their education
faster and avoid spending copious amounts of student loan fees and time. With these
factors in mind it is no surprise that the predominate and prevailing concern of college
students is stress, with percentages rising with the passing of every year (Brougham,
Mendoza, Miller, & Zail, 2009; Ratanasiripong, Sverduk, Hayashino, Prince, 2010).
In their research, Brougham, Mendoza, Miller, & Zail (2009) found that the most
common stressors for college students were, “academics, social relationships, finances,
daily hassles (for example, parking and being late), and familial relationships” (p. 86). A
deeper look into details of the stressors reveals academics as leading the aforementioned
struggles, in particular while balancing assignments and course load responsibilities;
social relationships consisting of non-familial relationships such as significant others,
friends, classmates or coworkers; finances, including the ability to pay for room and
board, rent, groceries, a cell phone, tuition, parking pass, books, and other monetary
obligations; daily hassles, and in addition to the example could also include overbooking
oneself with additional responsibilities such as to a campus club or various study groups,
or personal disorganization as a whole; and finally, familial relationship stressors which
may be expanded to include maintaining relationships if a student is away from home for
the first time, student-family disagreements regarding choices, and/or homesickness.
Other areas of stress for college students with increased academic requirements and
responsibilities are first time diagnosis for learning disorders and “cognitive deficits (for
example, attention and concentration difficulties), illness, increased rates of depression
and anxiety, and decreased life satisfaction” (Brougham et al., 2009, p. 86).
19
In dealing with stress, students often utilize a variety of coping skills and
practices, both unsafe and safe or, according to Brougham et al. (2009), maladaptive and
adaptive strategies. Maladaptive strategies could also be contributing to ongoing stress in
a student’s life. Many students who reported elevated “levels of stress also consumed a
greater amount of ‘junk food,’ were less likely to exercise and less likely to obtain
adequate amounts of sleep” (p. 86). Liguori, Schuna, and Mozumdar (2011) also noted
that increased stress correlated with altered sleep patterns for college students. It is the
belief of Brougham et al. (2009) that coping strategies can be broken down into two main
categories, “problem and emotion focused strategies” (p. 86). Problem-focused strategies
consisted of “behavioral activities such as action and planning” (p. 86). For example, a
student under stress may enlist the use of a problem-focused strategy for a large
assignment rapidly approaching by planning out a detailed itinerary that breaks down the
assignment into “do-able” portions prior to the due date, instead of having one large
assignment looming over their head. While problem-focused strategies have been
associated with higher positive outcomes and reduced stress, some emotion-focused
strategies can be both negative and positive. The negative aspects of emotion-focused
strategies include avoidance (through procrastination or mental disengagement by
increased alcohol use), self-punishment, self-focused rumination and self-blame
(Brougham, et al., 2009). However, even though there are negative aspects to emotionfocused strategies, there are also many positive coping strategies associated with
emotion-focused strategies.
20
Among these positive strategies are “self-help, approach…expressing feelings,
seeking emotional support…acceptance…positive reframing…and accommodation” (p.
87). Self-help consisted of preservation of emotional well being through acquiring
informational texts or searching the Internet for different self-help tips or ideas. Approach
consisted of facing the issues causing the stress for the individual by making adjustments
or finding ways to minimize the problem through a schedule or a plan in order to break
down the issue. Expressing feelings was done through meeting with and talking to friends
or family about the experiences of the individual that were causing stress. Seeking
emotional support was also done through meeting with or talking to friends or family that
were able to support the individual during the negative experiences that they were going
through. Acceptance was also utilized by many individuals to the point where they were
able to accept the stress and continue with life while stressed, knowing that at some point
the stress would subside—after the semester’s end perhaps. Positive reframing was also
used to look at the stressful situation differently in an effort to offset the stress and create
a new perspective of the situation. Accommodation was simply accommodating the stress
through reframing and accepting the state which the individual was in at that time.
In regard to counseling, “a healthy mind in a healthy body” or “mens sana in
corpore sano” (a Roman ideal) was the intention and sought-after objective of the first
college health service (Kraft, 2009, p. 267). The emphasis and inclusion of counseling or
mental health services for students on college campuses is a relatively new phenomenon
less than one century old (Kraft, 2009). The beginning of social work’s role in colligate
life is even more recent.
21
The ideas of multidisciplinary integration for student support and counseling were
recommended in the early 1900s. Prior to the multidisciplinary approach, college
counseling first began in 1861 at Amherst College when Dr. Edward Hitchcock, MD was
appointed as Professor of Hygiene and also served as a physician for sick students.
Hitchcock gave personal counseling to student-patients that he was seeing, in addition to
medical treatment. Following Hitchcock, at Princeton University in 1910, the “first
dedicated mental health service for students” (Kraft, 2009, p. 267) was founded by
psychiatrist, Stewart Paton, MD.
In 1920 when the American College Health Association was founded, the need
and importance of “mental hygiene,” (Kraft, 2009, p. 267) or counseling services for
students, was not only recognized but subsequently established on many college and
university campuses nationwide. In the beginning of college mental health, psychiatrists
were the primary professionals working with students. After the inception of the
American College Health Association, other disciplines began to integrate in order to
serve students. In 1927 this included social workers when the Commonwealth Fund
sponsored a conference in New York City to discuss the implications for mental health
services on college campuses and the disciplines that would be incorporated. (Kraft,
2009).
Also in the 1920s at the first meeting of the American College Health
Association, four reasons in support of establishing a college mental health program were
brought forth by Frankwood Williams, MD. They were as follows:
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1) The conservation of the student body, so that intellectually capable students
may not be forced unnecessarily to withdraw, but may be retained [now called
Student Retention]. 2) The forestalling of failure in the form of nervous and
mental diseases, immediate or remote [now called Secondary Prevention]. 3) The
minimizing of partial failure in later mediocrity, inadequacy, inefficiency, and
unhappiness [now called Primary Prevention]. 4) The making possible of a large
individual usefulness by giving to each a fuller use of the intellectual capacity he
possesses, through widening the sphere of conscious control and thereby
widening the sphere of social control [now called Primary Prevention] (Kraft,
2009, p. 269).
Through these ideas and reasons, the college mental health realm found the sentiments to
be valid and placed emphasis on student retention, secondary prevention and primary
prevention as stated above, in order to continue to strive to support student growth,
mental wellbeing, and “mens sana in corpore sano.”
The ideals of college counseling for professionals went beyond just serving
students. An emphasis on working with college staff was also encouraged due to the need
for college professors to be able to refer students in need to services, as well as how to
work with students which may have needed special accommodations. Health services
staff, such as nurses, were also trained on how to identify emotional health needs in
students and how to work with counselors to meet such needs. The multidisciplinary
approach was introduced as a way to ease the tight budgets of the schools.
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Evidenced-based treatments and short-term therapy models were the primary
targets of interventions in the college sector of therapy. In the early years of college
mental health, one counselor was expected to carry upwards of 150 cases (Kraft, 2009).
One to 150 cases is a large caseload considering a 40 hour work week, not including time
for keeping documentation on clients in addition to added duties outside of the half hour
to hour, per case, per week. In addition, in 1947 the Third National Conference on Health
in College was held in New York City. Prior to the college conference, 550 psychiatrists
were polled on the student population and of those that utilized mental health services it
was found that “one-third [of students seeking services were seeking services] for
“urgent” problems, one-third for chronic psychiatric problems, and one-third for help
with improving “personality problems and patterns” (Kraft, 2009, p. 269). The students
represented in the 1947 poll, in addition to students throughout the century, have sought
services for anything from depression, anxiety, ADHD, and schizophrenia to eating
disorders, borderline personality disorder and bipolar disorder (Kraft, 2009).
The goal for all the professionals working with students was simple; for students
to succeed, graduate, and be as independent as possible. Interventions, medications and
suicide prevention programs to meet student need and provide support reinforced this
goal. In an effort to continue to support students in the best way possible, the “Journal of
American College Health” was created for “college mental health professionals, as well
as other college health professionals, to share data, research studies, and perspectives on
the field” (Kraft, 2009, p. 272). As an added support to professionals in this evergrowing, important population of students, the journal provided a network of support and
24
ideas from across disciplines in support of one another to the best of their abilities and to
aid student success in the college system.
Spirituality, Stress, and Social Work
Interventions Utilizing Spirituality on Stress
In a comprehensive study conducted by Hill, Pargament, Hood, Mccullough,
Swyers, Larson, Zinbauer in 2000, they found that spirituality has been proven to be
effective for many individuals in coping with life’s everyday trials and an aid in
alleviating many of the adverse affects of the stress which comes from life’s challenges.
Knitter suggests “meditation, yoga, silent prayer, mindful walks, [and] wordless music”
(2010, p. 269) as interventions based in spirituality. Hodge stated “rituals, such as
devotional reading, mediation, prayer, scripture study and worship” (2005, p. 289) could
be important interventions to support spiritual practices for individuals. Other possible
interventions for clinicians could be “making referrals to clergy…gathering information
on clients’ spiritual background…[or] more controversial methods, such as touching
clients for healing purposes and using prayer” (Canda, Furman, & Nakashima, 2004, p.
28) if the client requests or feels comfortable with such practices. More practices
associated with spiritually based interventions found by Canda, Furman, and Nakashima
were “prayer, meditation, visualization, guided imagery, and biofeedback” (2004, p. 31).
Biofeedback is the process of an individual “learn[ing] how to control various
physiological processes such as muscle tension, blood pressure, breathing, heart rate,
brain wave states, skin temperature, and skin conductance” (Ratanasiripong, Sverduk,
Hayashino, Prince, 2010, p. 2). In a study conducted by Redman, participants shared their
25
spiritual practices and possible interventions by social workers to alleviate client stress
which consisted of “attending religious services, engaging in rituals or activities constant
with their faith, or communicating with religious or spiritual leaders” (2008, p. 63). The
various interventions above have been found to be beneficial to clients in the alleviation
of symptoms associated with stress (Canda, Furman, & Nakashima, 2004;
Ratanasiripong, Sverduk, Hayashino, Prince, 2010; Hodge, 2005; Redman, 2008). In
addition, Hodge notes that “[spiritual] rituals…have been associated with a number of
positive outcomes, including the alleviation of isolation, anxiety and dread and the
promotion of a sense of being loved, appreciated, and secure” (as cited in Ellision &
Levin, 1998; Jacobs, 1992; Koenig, McCullough, & Larson, 2001; Perry, 1998;
Worthington, Kurusu, McCullough, & Sandage, 1996; 2005, pp. 289-290). Redman
found “that a spiritual outlook may engender a more optimistic orientation to life, thus
buffering stressors” (Redman, 2008, p. 49) that can cause anguish and turmoil in an
individual’s life. Redman also suggested that those experiencing stressful events in their
lives who have an affiliation with a spiritual or religious entity find solace by “plac[ing]
those events within a correspondingly monumental context” (p. 48). In addition to the
alleviation of many of the symptoms of stress, Hodge also mentions “spirituality and
religion are important assets that enable many people to cope with life challenges” (as
cited in Koenig et al., 2001; Pargament, 1997).
Social Work and Spirituality
Social work and spirituality have a long and complicated history. “Social work”
or “helping the needy” has long been seen as part of the duty of the church (Platt, 2000).
26
It could be said that wealthier citizens of earlier times would attempt to “buy” salvation
by giving alms or giving money to the poor (Katz, 1996). The true interpretation of the
ideals behind good works was apparently lost on some as they gave alms in “exchange”
for salvation, missing the overall ideal of giving as a gesture from the heart rather than
from fear. In addition to “the church” as a governing body giving aid to those in need,
France as far back as 1534, established a board comprised of “churchman, notables, and
merchants…whose [sole] responsibility [was] to establish a list of all needy persons and
provide relief and medical care” (Platt & Coorman, 2001, p. 92). In the United States in
the early 1890s, the Hull House movement began the true era of social work with Jane
Addams and Ellen Gates Staff (Sklar, 1985). The Hull House was a community-based
resource for women to gather support and aid in independently navigating the workforce,
raising children and reforming the limitations of political power in a true women’s
movement. Many of the women involved during the Hull House period were acting out
of a desire to educate (Costin, 1983) women regarding their own bodies and reproductive
hygiene and, at times, admonish (Wahab, 2002) those who were living lives in opposition
to what was considered moral. From these experiences, early social work and
spirituality/religion were tied in a way that was more controversial, judgmental and
frequently founded with ulterior motives. This contributed to the idea that spirituality
and/or religion, in connection with social work has been taboo, or almost forbidden for
fear of possible judgment or desire to “convert” individuals to the ways of the social
worker. To some extent the ability of the social worker to be objective, unbiased or nonjudgmental is still questioned or even thought to be completely lacking.
27
Conversely, though some of the intentions in the past of combining social work
and spirituality and/or religion may not have been entirely pure, non-judgmental,
unbiased, etc. Social work as a profession has come a long way since its early inception.
The National Association of Social Worker’s (NASW) Code of Ethics and professional
guidelines have been put in place to safeguard against the negative outcomes of the past.
In the preamble of NASW Code of Ethics it states that it is the duty of a social worker to
pay “attention to the environmental forces that create, contribute to, and address problems
in living” (Workers, 2008). This fundamental ideal of the profession can be applied to the
notion that spiritual or religious experiences of a client are tied to their environment. As a
component of an individual’s experience, whether it is a contributing factor or an avenue
to address problems or challenges in a client’s life, it is incumbent upon the social worker
to consider the role that spirituality and/or religion has played.
The NASW Code of Ethics also states that under Ethical Standard 1.05 (c) that
“Social workers should obtain education about and seek to understand the nature of social
diversity and oppression with respect to…religion” (Workers, 2008). This highlights the
importance of education on this issue so that social workers can be educated
professionals that make a new history in the wake of the past. Social workers are also
called to support the self-determination of clients under Ethical Standard 1.02, which
emphasizes client assistance with “identity” and “goals.” The duty of a social worker in
exploring spirituality or religion with a client in relation to their personal identity or goals
is clear when seen within the context that 90% of Americans actively affiliate with some
form of spirituality and/or religion (Gallup, 2011). For the 10% of Americans with no
28
affiliation, the duty of the social worker to explore that aspect of their lives ceases when
inquiry produces said result because at that point spirituality or religion, are not part of an
individual’s identity or goals or at least are not part of their identity or goals at that point
in time. Canda, Furman, and Nakashima also echo and expand supporting spiritual
assessments, indicating that they follow in line with the ethical standards of social work,
stating that spiritual assessments start “where the client is, [uphold] the dignity of the
person, cultural competency, and basing practice on carefully gleaned information”
(2004, p. 31) from clients on their spiritual or religious affiliations “with respect for client
self-determination” (p. 31). Redman (2008) also calls upon social workers to “be
particularly attuned to the roles that spirituality might play among those who have
experienced highly stressful life events” (p. 63). This juncture is recommended to social
workers to support clients and “proactively [explore] topics related to the potential
functions of spirituality [that] could be of benefit… [and]…represent a way of coping
with” (p. 63) life events that cause stress.
To exclude exploration of spirituality and/or religion would be inconsistent with
social workers’ responsibility to clients. The NASW Code of Ethics values a social
worker’s competence; not just in providing services but integrating cultural sensitivity
and awareness as well. One definition of culture is a “set of shared attitudes, values,
goals, and practices” (Merriam-Webster, n.d.). Spirituality and/or religion can be cultural
for many clients (Hill et al., 2000). Those that are spiritual generally ascribe to a set of
shared attitudes, such as acknowledgement of a higher power. Also shared are the values
of living life a certain way with regard to their higher being, goals for the way life should
29
be lived and practices for achieving those goals. If spirituality contains the necessary
characteristics to a culture, a social worker is to be culturally competent, and roughly
90% of Americans ascribe to some form of spiritual affiliation (Gallup, 2011). It
behooves the social work profession to not only reassess the training of new social
workers coming forth from the collegiate sect, but also the impediments mentioned at the
beginning of this section: separation of church and state, company policies against
exploring spirituality, clash of disciplines and ideals behind best practice and approach,
and long standing taboo formed through social construction in order to better serve
clients and advocate on behalf of social justice (Workers, 2008) for societal change.
As a whole, social work has lacked the ability to involve spirituality in the phases
of treatment: assessment, goal planning and intervention. Explanations for this deficiency
can be attributed to fear of separation of church and state, company policies against
exploring spirituality, clash of disciplines and ideals behind best practice and approach,
clinicians themselves not associating with a spiritual affiliation or identity (Hill et al.,
2000) or even “good ‘ole” traditional taboo from the past (Katz, 1996). Others have
speculated as to the reasons for the lack of spiritual and religious assessment and
intervention within the social work profession. Hodge suggests this may be due to the
“few spiritual assessment models” (2005, p. 287) that have been created and/or
disseminated into the field and the fact that “training in spiritual assessment has been
lacking” (as cited in Canda & Furman, 1999; Derezotes, 1995; Sheridan & Amato-Von
Hemert, 1999). Whatever the driving force, spirituality is left out of the loop when it is so
30
clearly beneficial to many clients (Hill et al., 2000). If it could be beneficial to one client
it, should be explored for all.
Greater numbers of social work students are graduating from their programs with
little to no training in spirituality (Hodge, 2005; Knitter, 2010). They have been versed in
their diversity classes and field practice experiences but have no inkling of how to
approach clients about thoughts on spirituality. That same resistance to opening the door
to exploration of spirituality also bleeds through and hinders the client’s ability to openly
speak about spirituality.
If therapists, counselors, clinicians, or by whatever name they are called, do not
challenge social stigma and taboo associated with discussing spirituality or religion how
then can best practice be achieved? Furthermore, the idea that a client may discuss any
issue that is of concern to them with a therapist is jeopardized. If a client senses a
therapist’s reluctance to explore spirituality or religion, how then can that client be
empowered to bring the up the topic? In such cases, open discussion of spirituality or
religion could be beneficial and meet the needs of the client, which, after all, is the
ultimate goal of therapy.
This also highlights the assumption that spirituality is validating and positive in a
client’s life. What if spirituality is not a positive area of a client’s life, but a point of
contention and trauma (Canda, Furman, & Nakashima, 2004)? Would a therapist not be
able to serve and support their client through their trauma because it’s attached to
spirituality? The ability of the therapist to support their client in whatever capacity or
purpose spirituality fits for them could be essential in continuing a strong therapeutic
31
relationship. This ability of a therapist to support clients through various, diverse,
traditional and alternative ways is at the root of holistic practice. It is social work’s
professional goal to serve “the whole person” (Aguilar, 1997, p. 83), and in valuing the
person and their “wholeness” (p. 83) also “nurturing the part that is [or could be]
spiritual” (p. 83).
Summary: Spirituality Within a Holistic Framework
The notion of “mens sana in corpore sano” (“a healthy mind in a healthy body”)
as stated at the beginning of this chapter, was a Roman ideal from centuries ago. Yet,
despite its age, this motto speaks to the holistic nature of the social work profession, the
connection of body and mind and the importance of health in both. It would appear the
Romans knew centuries before social work came to be that people are comprised of more
than their external parts and that there is need for balance between the visible and the
invisible.
It is this very balance that frames the parameters of a holistic approach to clients
for social workers. A holistic approach is looking at the whole person, and with that
design comes the “ecological approach” (Aguilar, 1997, p. 83), which is the identification
of a person and their influences and resources biologically, psychologically and socially.
Biologically, it behooves a therapist to identify if there are any areas of concern with a
client because of the impact biology can have for an individual. For example, if a client
has constant migraines due to a chemical imbalance and then abuses alcohol as a result to
ease the pain, and then drives while drunk, crashes into a light post, and is a mandated
client through the courts for driving under the influence; knowledge and history of the
32
biological forces affecting the client is beneficial to a social worker in order to best
support the client. The social worker can then make an appropriate assessment and
referrals for the client because of the background biological knowledge. The same is true
psychologically: a client with a history of severe attention deficit hyperactivity disorder
(ADHD) may not benefit from a traditional therapy model where they come to session
and sit for 50 minutes. Assessment of client to learn they have ADHD tendencies would
be able to prompt the social worker to then approach the client in an alternative way to
best support the client’s needs. The session may be held outside while walking around, or
the session may be more interactive, utilizing art or engaging in standing role play
activities to give the client a greater range of intervention and treatment options to best
support their concerns. To assess an individual on a social level, identifying who is in a
client’s social network through school, work and community can support the client in
areas that are lacking, or areas that might be helpful if they were to increase their
engagement.
With greater and greater emphasis being placed upon short-term therapy, not only
across clinical arenas, but also within the college community, “it is critical to identify risk
factors as quickly as possible” (Aguilar, 1997, p. 84). With the ecological approach and a
holistic framework in mind, there is still at least one area that remains undiscovered or
explored, and that is the spiritual. During a need to rapidly identify risk factors, the ability
to also assess any “indications of spiritual health” (Aguilar, 1997, p. 84) is needed to
continue to achieve best practice and due diligence for clients so that it can be said with
confidence that all areas were explored in order to meet the needs of each client. A
33
“holistic approach” which social work prides itself on and the ability to provide for
clients, is a criterion that sets social work apart from other disciplines and professions.
The profession must examine if “holistic” is truly the approach and position that social
work can identify with if spirituality is not assessed or taken into consideration. In
providing a holistic approach to treatment for clients, any and all areas should be assessed
and supported. Being able to draw on different areas of a client’s life and experiences is
also a way to identify, introduce, and promote “strengths and coping mechanisms”
(Aguilar, 1997, p. 84).
There can also be negative aspects of expanding spirituality and religion into
social work practice. In an effort to promote a spiritual or religious dialogue from an
already spiritual or religious social worker, Knitter cautions that “many religious people
are not very humble about what they think their religions tell them is true” (2010, p. 261).
Another aspect of spirituality and/or religion joining in social work is “inadequate
preparation of ‘religious dialogue’ with clients” (Knitter, 2010, p. 262). The skill of being
able to engage with clients and valuing the importance of human relationships is crucial
and monumental within the social work profession (Workers, 2008). Yet, there is still a
lack of education on how to engage with clients and facilitate or support human
relationships within the context of religious dialogue (Knitter, 2010). Additionally, if a
social worker associates with “secular humanism,” (p. 264) they may have their own
attitudes, biases and reservations to engaging in a dialogue with their client as to their
experiences or affiliations with spirituality or religion. The difficulty lies in the inability
of social workers to be able “to understand and empathize with [a client that holds]
34
religious [or spiritual] attitudes and feelings” (p. 264). This is understandable considering
that for an individual ascribing to humanistic secularism, an emphasis and importance on
religion or spirituality is “utterly foreign [to them]…because [they] know so little about it
[or they may know but]…not like” (p. 264).
On the part of the client or the individual there are several aspects of spirituality
or religion that could pose potential harm as well. In historical context,
spirituality/religion has been used to gain and abuse power and control, wage war and
“manipulate others for…self-serving purposes” (p. 264). Religious or spiritual beliefs can
also serve as a way for individuals “to run away from their problems or to justify their
actions” (p. 265) and utilize their belief systems as a “tool for avoidance or
rationalization” (p. 265) of negative or maladaptive behaviors. A belief that everything
that happens is permitted by God, or that an individual’s negative experiences are caused
by karma, can lead individuals “to ‘tolerate the intolerable’” (p. 266). These beliefs can
also impede further questioning as to whether their experiences were warranted, or can be
changed or adapted so that they might have a more positive experience in life. These
beliefs often result in a sense of “fatalism that squelches or prohibits any kind of
responsibility or initiative” (p. 266). The idea leading to feelings of being a “worthless
sinner still leaves [an individual] a worthless sinner” (p. 266) despite God’s love, and can
be detrimental to one’s self-worth or efforts to overcome challenges in individual’s lives,
addictions or “basic goodness” (p. 266).
These unfortunate possibilities can pose a quandary to a therapeutic relationship
and accomplish the opposite of the goal of incorporating spirituality or religion into the
35
frame of holistic practice. For these reasons, education within social work programs
(Canda, Furman, & Nakashima, 2004; Hodge, 2005; Knitter, 2010; Redman, 2008), more
mention or specificity in the NASW Code of Ethics (Canda, Furman, & Nakashima,
2004), and systemic or political adjustments to “ensure that all people have…access to
the resources,…services, and opportunities they require to meet their” (Workers, 2008)
needs on a complete and holistic (Aguilar, 1997) level need to be emphasized, supported,
and integrated within the social work profession as a whole.
In terms of areas that would benefit from inclusion of spirituality or religion,
though there are not many spiritual or religious assessment tools currently offered, Hodge
(2005) suggests utilizing a spiritual ecogram where one expands on history and current
relationship with spirituality or religion. In using the ecogram, strengths can be drawn to
inform future intervention techniques (prayer, meditation, spiritual reading), treatment
approaches (spiritually based cognitive behavioral therapy) referrals (to religious or
spiritual mentors) or even ease transition from therapy (2005) due to community or faithbased engagement.
In a field that prides itself on empowering clients, self-determination and cultural
competence, it hardly seems appropriate when there are still large gaps in the areas of
assessment and intervention that could lead to strong and supportive resources, social
network and potential for therapy and effective coping mechanisms. Empowering clients
is a means to instill and foster a sense of power in those “who are vulnerable, oppressed,
and living in poverty” (Workers, 2008). Not to be misunderstood, populations including
those “who are vulnerable, oppressed, and living in poverty,” (Workers, 2008) are not the
36
only populations deserving of empowerment. All clients should be empowered, and
through that empowerment clients should be encouraged and supported in a multilayered
assessment of all areas to determine relevancy or irrelevancy of a particular area. Just as
biologically there may be no concerns for a client it is “ruled out,” so too should
spirituality be given the same courtesy. The same is true for self-determination, which is
Ethical Standard 1.02 where clients are encouraged “to identify and clarify their goals”
(Workers, 2008). Without asking a client if spirituality is an area of importance, their
goals cannot be identified or supported. In regards to cultural competence, spirituality can
be embedded in a client’s culture ethnically and/or socially. If spirituality is part of a
client’s culture and the impact on that client due to those cultural considerations is not
explored, then cultural competence cannot be achieved. Exploring all possible areas of a
client’s life is a true holistic approach that can be offered and supported for client’s
process and time during therapy.
The inclusion of spirituality and/or religious affiliations, experiences or
preferences of clients is crucial to holistic practice and understanding the context of a
client and their lives (Hill, Pargament, Hood, Mccullough, Swyers, Larson, Zinbauer,
2000). Hill et al. point out that “noted psychologists” including “Allport, Jung, Fromm,
[and] Maslow” all “argue that religion or spirituality must be considered for a complete
understanding of the person” (2000, p. 53). When working with individuals, “the task of
helping [a client] discover…strengths is part of the role social workers…play” (Aguilar,
1997, p. 84). Up until now it would seem that a “profession that cares about all aspects of
37
the individual has a ‘dis-ease’…with speaking about the spiritual [or religious] aspect[s]
of [a] person” (p. 84) in their lives. It is now time for change.
38
Chapter 3
Methods/Methodology
Hypothesis
1. Spiritual or religious practices decrease the effects and/or symptoms of stress.
2. Individuals do not mind being asked about their relationship, experiences, or
preferences regarding spirituality or religion.
Research Questions
1. Do spiritual or religious practices decrease the effect and/or symptoms of stress?
2. Do individuals mind being asked about their relationship, experience, or
preferences regarding spirituality and religion?
Introduction
This study utilized an exploratory research design to examine and gain
information on spirituality and stress from the perspective of college students. The
general research study was conducted through an interview process with an interview
questionnaire comprised of open and close ended questions pertaining to the participants’
demographic information, spiritual backgrounds, practices, stress levels, and coping
strategies. Qualitative methods were pursued during this study to provide a rich
examination of personal accounts and thoughts of the participants. The example of
counseling within a general framework was posed to the participants in exploring their
thoughts on spirituality within the helping professions.
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Study Design
To aid in answering the preceding research questions and exploring the
hypothesis this project will be an exploratory in design and qualitative in nature. The
purposes of the exploratory design are to help in gaining familiarity and to develop a
better understanding of the given questions put forth by this project (Terao, Schmidt,
Yuen, 2009). The exploratory design will also provide an opportunity for further
refinement of the research questions and hypothesis to, in turn inform further research on
the areas of spirituality, religion, stress, social work, and holistic practice. The study will
be qualitative utilizing an interview questionnaire created and distributed by this
researcher. Utilizing qualitative means will provide for a rich and in-depth look into the
participants ideas and thoughts on spirituality, religion, and stress. The qualitative design
will allow for process-oriented data collection, and more subjective data given by the
participants. The study will examine a smaller college campus population and their
thoughts on spirituality, religion, stress, and utilization of spirituality and/or religion in
practice to provide a peek into the possibility of generalizing the usage of spirituality
and/or religion not just with stress, and not just in counseling but across the social work
profession as a whole. Robson (2002) suggests that qualitative study “allows for a truer
assessment of what is believed or thought by the participant” (Breedlove, 2005, p. 37). As
spirituality and religion are as unique as individuals that affiliate or do not affiliate with
them, being able to offer a medium of an interview process allows for participants’ voices
to be heard and their definitions and experiences to fuel the process.
40
Sampling
The population for this study will be current Sacramento State students. The
actual sample consisted of 10 participants. The participants were recruited through
purposive or judgmental sampling as this researcher conveniently chose a sample of 10,
but intentionally made the sample more diverse to properly reflect the student body of
Sacramento State. The participants were members of two student organizations on
campus, one of which this researcher had previously been a member. This researcher
interviewed the first five individuals that came forth from each organization to equal 10
participants. The advantage of using purposive sampling is that the approach ensured the
desired number (N=10) of students for the study and the students were a diverse
representation of Sacramento State’s student body. Limitations to the study method
include a bias due to only opening the study to participants that were current Sacramento
State students and also part of the two organizations chosen to sample from. However,
the two student organizations created the opportunity for a more diverse sample, 5 female
and 5 male participants, diverse ages, backgrounds, socio-economic status, majors, and
year in school.
Measurements Instruments
The instrument utilized for this study was an interview schedule. This researcher
met with each participant individually to administer an interview comprised of fourteen
main questions. Of those fourteen main questions were thirteen descriptive questions for
further clarification or explanation. The interview consisted of open and close-ended
questions and basic demographic questions. The interview questionnaire aimed at
41
identifying and exploring participants’ thoughts and experiences and to gain similar
though not identical answers to the questions. The interview questionnaire asked the
same questions of each participant but allowed room for participant interpretation and
expansion if they so chose. As the questionnaire gained the intended data and information
the face validity of the study is maintained.
Data Collection Procedures
The data was collected through an individual interview process with each
participant at a time and location of their choosing for their convenience. An informed
consent form (See Appendix B) was given to each participant, which they signed and
were given a copy of prior to beginning the interview. The consent contained details of
voluntarily participation and contact information for both the researcher and researcher’s
supervisor/project advisor. Following signature of consent form this researcher
interviewed each participant and transcribed the interview on the computer to accurately
portray the responses of each participants regarding the interview questions. The
interview questions (See Appendix C) were created by the researcher for the specific
purpose of gathering data on each participant’s demographic information; experiences
around spirituality, religion, stress; and thoughts on combining services and discussion of
spirituality or religion on the part of the practitioner when meeting with clients. The data
was collected orally from each participant, the interview questions were predetermined
and identical throughout the data collection process for all participants with exception to
more detailed questions asked by the participant if they needed further clarification to
answer a question. The interview process allowed for flexibility in gathering data from
42
participants, in addition to a detailed and in-depth description of the participants’
experiences and thoughts on the topic of the project. Constraints to the interview process
consisted of the researcher’s beginning skills of interviewing and skills in systematically
conducting each interview.
Analysis Plan
Following the conclusion of each interview, the transcripts of each interview were
reviewed for clarity of transcription and accuracy of participant responses. A content
analysis was then conducted on the responses given by the participants during the
interviews. This researcher explored common themes from the responses along with any
responses that appeared to be alternative to common themes. This researcher also
identified varying options to approach spirituality and/or religion based on responses
from participants of criteria for respectfully broaching the topic of spiritually and/or
religion with clients. Drawing common themes, alternative ideas, and options for
approaching spirituality and/or religion with clients was useful in summarizing
meaningful connections and possibilities for answers to the posed research questions and
hypotheses. Common themes and outcomes from interviews were then utilized within the
context of implications for the field of Social Work.
Protection of Human Subjects
Protocol for the Protection of Human Subjects (See Appendix A) was submitted
and approved by the Division of Social Work stating that research would pose no to
minimal risk for participants. The probability and magnitude of harm or discomfort
43
anticipated for participants were no greater than what might be encountered in daily life
or during the performance of routine physical or psychological examinations or tests.
The participants were provided with this researcher’s information for contact if
participant was interested in being interviewed for the study. Prior to the survey
questionnaire being administered, this researcher provided participants with a written
informed consent, which was collected after completion by this researcher. Informed
consent from all participants was obtained through a signed, written consent. All
participants were given a blank copy of the consent form for their records. The consent
form outlined the study’s purpose, procedure, risks, benefits, and confidentiality
concerns. The consent form also outlined that the participants’ involvement is strictly
voluntary and they were free to opt out of participation at any time they wished without
explanation or consequences.
The consent form informed the participants that their involvement was
confidential. Upon completion of the study all materials utilized during the study were
destroyed. The candidates, who agreed to participate in the study, upon accepting all
terms of the study, were asked to sign the informed consent form, and return it to the
researcher. The signed consent form and other data collected were stored separately, in a
locked cabinet in the researcher’s home. The participants were also informed of their
right to withdraw without any fear of penalty or repercussion.
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Chapter 4
Data Analysis and Findings
Introduction
Interviews were conducted with a total of ten participants who answered various
demographic and open-ended questions to shed light on the following hypotheses: 1)
Spiritual or religious practices decrease the effects and/or symptoms of stress. 2)
Individuals do not mind being asked about their relationship, experience, or preferences
regarding spirituality or religion. Data was gathered to also collect information to answer
the following research questions: 1) Do spiritual or religious practices decrease the
effects and/or symptoms of stress? 2) Do individuals mind being asked about their
relationship, experience, or preferences regarding spirituality and religion? The purpose
of the exploration of these research hypotheses and questions was to learn more about
individual experiences with spirituality, religion, stress and the relationship among the
three. In addition, this study aimed to identify the individual’s thoughts on spirituality
and/or religion and not only its place in practice but also how to broach the topic in a
professional setting.
Presentation of the data will consist of basic demographic information followed
by content analysis of the fourteen questions of the interview broken into five categories:
Stress; Spirituality; Religion; Spirituality, Religion and Stress; and Utilizing
Spirituality/Religion in Practice. Following the statement of each question the common
themes will be summarized, outliers (or responses that deviated from the majority) will
be identified, and anecdotal statements from participants will be included where needed.
45
Demographic Information
Basic demographic information for the participants are as follows: 50% of the
participants were male and 50% of the participants were female. The ages of participants
ranged from 19-24 years of age with a mean of 20.7 years of age. All or 100% of
participants identified as “white” or Caucasian. Year in school varied with 1 participant
identifying as a freshman, 3 sophomores, 3 juniors and 3 seniors.
Stress
The following five questions explored participant’s ideas for a definition of stress,
how stress manifested itself, how often participants felt stressed per week and per month,
when participants felt that they were most stressed and in what ways they coped with
stress.
“What does the word ‘stress’ mean to you?”
The participants identified several feelings to explain what stress meant in their
lives. The main feelings were described as being “overwhelmed,” “anxious” and
“worried.” “Overwhelmed” participants shared that they felt that they were “too busy”
with “not enough hours in the day” to complete the tasks they had at hand. Overwhelmed
was also referred to as not being, “within your ability to deal with [things] effectively or
easily.” A sense of being anxious was shared by 40% of the participants. Several
participants attributed anxiety to affecting a person both mentally and physically. One
participant explained anxiety in the following way, “Anxiety is a feeling that’s mental
and physical too. Many things going on that you don’t know how to deal with or are
having trouble processing.” Another participant described anxiety as being “caused by
46
problems and issues in your life—overload, hot mess—and is undesirable.” In expanding
on feelings of being “worried,” two participants noted that the onset of worry works in
conjunction to cause stress, stating that, “when something has to get done or a goal has to
be achieved and you are worried it cannot be done; then you begin to feel stressed.” An
additional participant equated the word “stress” with “hectic,” explaining that it was “the
first word that came to mind.” They indicated a sense of “a lot going on—busy, worried,
causing stress.” The word “stress” was difficult for the participants to define. Most were
able to describe stress and the feelings they associated with stress. One participant was
able to describe stress as, “late nights, early mornings and lots of coffee in between.”
Another person shared that stress was “anything that makes you think irrationally — and
almost in a desperate way. You just don’t know what else to do.” Yet another participant
shared their belief in differing levels of stress depending on the circumstances of that
time. Stress from school; studying for an exam or having a paper due; and another level
“Where you just want to pull your hair out.”
Stress was not a new term for any of the participants. Though they identified
different meanings of the word they shared commonalities in their experiences through
specific feelings, having stress be brought on through having a wide range of
responsibilities and similar ideas about stress often being a culmination and outcome of
various feelings added together.
“What does ‘stress’ look like for you?”
Stress manifested symptoms among the participants in a variety of psychological
and physiological ways. One participant chose metaphorical humor to explain their clues
47
to being stressed as they expressed with a chuckle, “I want to head-butt a bullet.”
Psychological symptoms of stress for many participants included heightened sense of
irritability, increased fatigued, lack of motivation, being “more emotional,” feelings of
helplessness, having a “day when [the] calendar just isn’t working,” and even not being
“a happy person.” Many participants shared that they have more negative interactions
with peers and family. Many of the interactions with others are either somehow limited or
pressured. Participants shared a difficulty in being able to hold their tongues if they
disagreed with someone, often losing their tempers with family or friends. A slight
personality change was also noted by several participants, one of which was described as,
“When I‘m stressed, I’m usually very quiet. I’m normally very bubbly and talkative.”
Another participant explained, saying, “[when] I keep thinking about something, it’ll
keep me up. When I can’t see past it, can’t see myself resolving it, [it] tends to consume
my mind all the time.” Another participant shared, “I act differently towards others
because of stress, I ‘b*tch’ about it,” and “I get cranky. I snap at people more than I
normally would.” Physiologically, they said that stress manifested itself by circles
underneath their eyes, lack of appetite, sleeping more than normal, an increase in the
intake of caffeine—usually coffee, as well as more acne breakouts. Physically, one
participant said, “I feel it in my shoulders.” However, despite the more negative effects of
stress, some participants indicated increased procrastination yielding an ability to
“Breathe and see things more clearly,” making more jokes than usual and an improved
focus that allowed them to complete tasks more efficiently.
“How often do you experience stress per week?”
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Range of experienced stress for participants during the week consisted of 30%
indicating a feeling of being “stressed at least some point every day.” Another 30% of
participants indicated feeling stressed 2-4 times per week, becoming more intense when
exams take place or when life starts “piling up.” An additional 20% indicated being
stressed 5-10 times per week and the 20% of participants said that stress was not
measurable per week. These 20% said that they began feeling overwhelmed during peak
times of the semester (midterms/finals); it was at this point they found themselves feeling
stressed. When participants found themselves feeling stressed during intensely busy times
during the school year, they recognized that during the rest of the year they did not feel as
stressed as they did during those busier times.
“How often do you experience stress per month?”
Range of “experienced stress” for participants during a month-long period of time
consisted of 10% of participants identifying feelings of stress approximately 50 times per
month. Another 40% indicated feeling stressed 20-30 times per month. One participant
described feeling stressed “a good majority of the month, at least every business day.” An
additional 30% indicated an average of 8-15 times during the month during which they
experienced stress. One participant differentiated that during the school semester they
experience stress more frequently than during winter or summer break. However, even
during periods of break or “vacation” time they still indicated feeling stressed at least 5
times per month. The final 20% of participants indicated feelings stressed on average less
than 2 times per month again indicated by feeling stressed only during peak, highly
concentrated portions of the school semester.
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“When do you feel you are ‘most’ stressed?”
Unlike identifying definitions of what stress is, participants had little difficulty
identifying the factors that contributed to their highest amount of stress. There were
several answers that each participant gave in examining what causes them the most stress.
Many participants had similar answers. Participants noted that when they are “most
stressed” they are “broke” (implying not enough funds to pay for things they need) and
40% of participants stated they felt most stressed when many assignments are due at the
same time, often getting caught in a cycle of negative thoughts. One participant
illustrated, “all I think about is the down side to everything.” Other contributors to stress
were not being as organized or prepared as one would like to be, and also feeling a great
deal of stress from procrastination of assignments building up.
Specific periods of intense stress reported by participants at the beginning of new
semesters, dead weeks (the weeks just prior to final examinations), and final
examinations themselves. The beginning of a new semester was declared as most
stressful by 20% of participants. One person indicated that, “in the beginning, if your
schedule is not set up, you have to worry about that— trying to get into classes, getting
the [most desirable] teachers, understanding the syllabus and just get all set up.”
Midterms and finals were identified as most stressful by 70% of participants. One
participant noted fears pertaining to midterm and final examinations by stating, “When I
have to try to cram everything, I start to get more stressed out. I think about failing and
how will I get out? Will I be here forever? Will I not get into the field I want to?”
Another participant reported that during midterms and final examinations that they felt
50
most stressed and they observed increased stress levels among people due to frequent,
“all-nighters, work and the process of finishing.” A great deal of emphasis was put on the
final exam or paper. One participant confessed, “Your grade is really dependent on your
final.” However, in the midst of the stress, some participants saw finals as “the gleaming
light at the end of the tunnel,” further stating that, “Even during finals it’s not as bad. I
know it’s the end. What has happened has happened, and what I do now would not really
change the outcome.”
This group of participants identified themselves as being involved in campus
activities, working and being full-time students, frequently having been all those at one
time. Many supported themselves financially by working, taking loans or having
financial assistance from their families. Though extra-curricular activities caused them all
a fair amount of stress, they still welcomed all of their options and avenues for
involvement on campus during these collegiate years.
“How do you deal with stress?”
Coping mechanisms listed by the participants consisted of a wide range of
approaches. Participants had amazing insight into their coping mechanisms and selfidentified their coping mechanisms as “negative” or “positive,” meaning that they had
engaged in coping mechanisms traditionally seen as maladaptive and/or not having
contributed positively to a decrease in stress levels. Many participants related adaptive
coping mechanisms that had been conventionally proven to decrease stress. The act of
“ignoring stress” was reported by 40% of participants, additionally keeping stress
“inside,” often yielded negative side effects (such as tension within interpersonal
51
relationships). One participant however, related that stress could take such personal toll
psychologically that by focusing on the stress they would “be freaking out. [I] can’t
concentrate, think or act on it, so I just [metaphorically] leave it and come back to it.”
Other participants self-identified the following: smoking cigarettes; drinking
alcohol; playing video games, playing with animals, or playing instruments; crying;
utilizing sexual outlets; sleeping; reading books; watching television; and meditating as
coping mechanisms. Talking to others either family or friends was listed by 20% of the
participants as highlighted by the following participant, “I just tell them what I’m feeling
and it shares the burden and I can hear their thoughts and hearing, ‘It’ll be fine,’ is a
reassurance of my own thoughts, even if I’m thinking that it’s hard to take it in.”
Conversely, another 20% found themselves coping with stress by isolating themselves
from others. Some form of exercise was reported by 50% of participants either by taking
a walk or going to a gym. One participant noted that by focusing on, “Working out
instead of thinking, ‘oh I have this and this to do’…gives my mind a break and exercise
frees my thoughts and regenerates my energy.”
Not doing much as a way of coping with stress was noted by 30% of participants
choosing to just “face it,” and complete whatever was causing them the most stress.
Another 20% of participants reported that they try and face the stress “head on” by
working on whatever is causing the stress. This same 20% also shared the importance of
providing ample time for breaks to recharge as indicated by one participant stating,
“taking an hour to myself is okay because the hour won’t put me behind.”
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Spirituality
The following two questions explored participants’ ideas for a definition of
spirituality, if they considered themselves a spiritual person, and what that answer meant
in their lives.
“What does ‘spirituality’ mean to you?”
Spirituality as the belief in a higher power was indicated by 70% of participants.
While 30% of participants noted that spirituality meant some form of religious belief.
Amongst the two ideological perspectives additional clarification was obtained for
expansion of what spirituality entailed. This higher power had an emphasis for
participants in being non-judgmental and comforting. Participants illustrated these beliefs
by stating the “higher power—or something—that you can confide in or talk to, [is]
someone there to listen without judgment,” a “higher power that comforts you.” The
higher power was also not one to control but rather “assist” one through life. Emphasis
was also placed on relationship as shared by one participant saying,
To me it means a little more of a relationship you have with God and the
spirituality that comes within and for some people that doesn’t have to be God, it
could be Mother Earth. Spirituality doesn’t have a tie to organized religion.
This sentiment led to the 60%, which identified spirituality as not needing a label to be
attached in order to be able to define the term.
The terms and ideas of “religion” and “belief in a higher power” were
interchangeable to 30% of participants. Another 20% of participants identified spirituality
as having more on an internal and personal focus on themselves explained by one
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participant as “finding a harmony in your physical, mental, [and] social life.” One
participant noted that the term spirituality “evolved” throughout their life and meant
different things at different times. In early childhood spirituality was more associated
with spiritual practices in an organized fashion. However, now the term was more
introspective and had higher importance on self-exploration. The tie to spirituality being
involved in thoughts of an afterlife was shared by 20% of participants.
One participant poignantly shared their thoughts of a higher power and spirituality
as simply,
The belief of something greater, [that] you don’t have to believe in something to
participate in, like an afterlife, but that people are just people, there’s more to a
person than their physical human existence—more to life than our daily routine.
“Do you consider yourself to be a spiritual person?”
In terms of identifying if a participant identified as spiritual, 10% reported not
being spiritual on any level, 20% were undecided, and 70% of participants considered
themselves to be spiritual. Of the 10% that did not indicate affiliating with spirituality
they expressed not being driven by any particular force, just that they “tend[ed] to do
things that make [themselves] or others happy, just things that make [them] feel good”
and not for any specific spiritual gain or reward. Of the 20% that were undecided, one
participant shared that though they held a belief in a higher power they were not the “type
of person to go to church or think that anyone or God will make everything better.” The
participant also shared they did not feel that “everything is always going to pan out just
because you believe in God.” Another participant expressed more neutrality in terms of
54
identification stating they “wouldn’t see it as a thing to help or hinder other than maybe
whatever I’ve worried about isn’t a big deal in the grand scheme of things.” The
participant identified being “pragmatic” and the lack of having “seen” religion led them
to a belief that “religion is not a practical approach to something.”
Of the 70% who identified as spiritual 40% indicated that they did not attend
church regularly. One participant stated,
I believe myself to be a Christian; I do believe in God, I struggle with it but a lot
of people do. I do not attend church regularity, but I think if you try to do the right
thing then you’re fulfilling---you’re doing what you’re supposed to do. Church is
an added bonus, like good job, but as long as you’re still a believer, you’re good.
Another participant explained, “I say prayers and stuff and I feel like I don’t have to go to
church to be spiritual and I feel like I can do it on my own time.” The topic of prayer was
not essential for the participants with 30% reporting prayer or conversation with God and
20% of participants utilizing meditation. The importance of prayer not just in hard times
but also good times was illustrated by one participant, “I always pray when times are hard
and remind myself I should pray when times are good… I like to think I have a running
conversation with God.” The absence of religion did not impede one participant’s
spirituality as they explained, “I’ve never been baptized or had a religion picked out for
me. I believe there is evil and good, in times of stress, I do pray.” One participant’s
experience of the effects of meditation were told in the following way,
I believe that mediating … helps you organize your own thoughts, and I believe
that there is something higher than me that sets down or shows me hints of things
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that I should be doing, gives me clues through my life to guide to where I should
be going.
Religion
The following two questions explored participants’ ideas for a definition of religion,
if they considered themselves to be religious persons, and what that answer meant for
them in their own lives.
“What does ‘religion’ mean to you?”
Religion, as with spirituality, and stress, yielded several definitions by the
participants. Many answers were overlapping and every participant had more than one
criterion to identify what religion meant. Religion as a leading moral code with predesigned beliefs or organization was defined by 50% of participants. One participant
shared that religion meant, “you go to church on Sunday, take communion, pray, and you
lead a good Christian life and participate in fellowship with your other church members.”
Religion as a means of directing people in their lives was indicated by 60% of the
participants. Religion being specific practices of spirituality was shared by 20% of
participants. The Bible as a direct distinction between spirituality and religion was
explained by 10% of participants. Another 10% of participants shared their belief that
religion was a “man-made thing to explain spirituality.” Stating that one “want[s] to
believe [they] don’t just die.” A final 30% of participants found no distinction between
spirituality and religion, the terms were interchangeable or went “hand-in-hand” together.
“Do you consider yourself to be a religious person?”
56
In terms of identifying with religion, 30% of participants did not share any
affiliation with religion, an additional 30% where undecided, and the final 40% affiliated
themselves as religious. Of the 30% who indicated no affiliation with religion their
remarks consisted of lack of interest, disagreements with religion held by the family of
origin, and a thorough distaste for anything related to religion. Contributing factors to
these beliefs were family of origin not placing a great deal of emphasis on high
participation; feeling that the family of origin were hypocritical between their beliefs and
day-to-day practices; and one participant shared that they felt religion was one of “the
biggest reasons for conflicts—people don’t understand each other.” The participant
suggested “abolishing religion would make the world much easier.” Of the 30% of
participants that were undecided, they reported being spiritual over being religious,
having a belief in a higher power and their own beliefs, but not necessarily following a
specific religion. The remaining 40% of participants self-affiliated as religious due to
having been raised within a particular sect, their definition of religion was religion being
a personal experience, or connecting religion and spirituality as one and the same.
Participants identified that though they do not always regularly participate in organized
and systematic practices they “would still classify [themselves] in a religion.” One
participant shared their feelings about church and religion in this way, “I don’t think you
have to go to church be religious person. I can connect with God in my own time in my
home or in my car, I don’t have to go to church to connect with God.” Another
participant reflected that the systematic practices of a church were a comfort when they
shared,
57
Church means more when you go through a hard time. I experienced that when I
was 16 [with various factors in my life]. That ties into the stress because my
church will always be the same every Sunday. The prayers literally will be the
same. Like a reboot button, I can be rebooted; church will always be there like a
rock even when life is crazy.
Spirituality, Religion, and Stress
The following three questions explored whether or not the participants had ever
utilized spirituality or religion in dealing with stress, and if they had, the effect that it had
on their general well-being, and finally if they thought it was important for others to
utilize spirituality or religion to cope with stress.
“Have you ever used spirituality or religion in dealing with stress?” and “If yes, how did
you feel after utilizing spirituality/religion in dealing with stress?”
When exploring participant’s own experiences with utilizing spirituality or
religion during periods of stress, 20% of participants stated they had not used either
spirituality or religion when feeling stressed. The majority of the participants (80%)
indicated utilizing spirituality or religion to deal with stress. Of the 80% who had used
spirituality or religion, 20% indicated using spirituality or religion rarely or in the past
but not currently. One of the participants that indicated not using spirituality or religion
contributed to having been a logical or rational thinker and explained it as, “to rely on
something that is more conceptual. It just has not been the way I do things.” The
participant that shared having utilized spirituality or religion in the past (but no current
use) reported that they though they prayed in elementary school and had previously gone
58
through counseling and that it “never seemed to work out.” The participant that indicated
rarely using spirituality/religion described using it as a means for entering into nature
through walking or taking time to “just think about things.” This same participant stated
that after using spirituality or religion, “I felt much better, I felt like afterwards I would
come to my senses; I now had a course of action, [a plan] on how to proceed with an
endeavor or an issue facing me at that time.”
Of the remaining participants that had utilized spirituality or religion in times of
stress, one participant reported receiving little or no benefit. They shared having prayed
in high school during times of stress and would pray in an effort to obtain “help.” The
participant reported that at times they felt better and other times they felt worse. When
they felt worse they explained feeling upset for not receiving assistance. However,
conversely when they did find relief they described, “If it does work, you feel good, [you
get] the feeling that spirituality is real [and] you get a better feeling in life.” The
remaining five participants found relief and benefit from their practices. The participants
shared praying in times of stress related to work, school, their personal selves, or people
in their lives. The participants also shared the idea of “positive thinking” and personal
accountability shared by one participant in this way,
I’ve always had the mentality that if I think good thoughts and hope that I’ll do
well, it’s always in God’s hand really—everything happens for a reason—if I
mess up on an exam I have to figure out what I did wrong and I have to do better
on the next one.
Another participant shared their experience of spirituality as,
59
When I start to really panic (which is how my stress accumulates) my stress
builds up a lot [I get a] panic feeling. I lay down, close my eyes and think, do
nothing but be in my own head, which summons the higher power, which helps to
ease that anxiety.
Still another participant shared they pray more often when they are stressed than when
things are “fine” and they are “content with life.”
After utilizing spirituality or religion all participants noted a shared relief and
“more peace with” themselves having “given it up to someone else” in spite of the fact
that it may “not be the answer you want or need but it gives you something, food for your
soul.” Some participants noted that it’s a struggle because it’s out of their hands but had
an understanding that whatever happens is “meant to be.” A sense of calm was also
shared by participants and noted by some as a “calming measure to help…ease a lot of
the stress.” One participant explained the thought of a presence of God when they shared,
I felt a lot calmer and not as stressed. I mean doing different activities [and]
taking breaks helps, but after I do everything and get everything done I feel so
much better and accomplished. I got through that hard time and God was with me
and helped me through it; [for me it’s] more of the presence of God and
awareness that He’s there.
“Do you believe it is important for others to utilize spiritual or religious practices in
dealing with stress?”
When participants were asked if they felt it was important for others to utilize
spiritual or religious practices, all participants shared the idea that spiritual or religious
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practices are important for others if it’s a benefit to others. Some participants offered,
“It’s their choice but if it worked for me I might suggest it,” based on personal
experience. Others stated a belief that individuals do “not always have look towards God
for help. They can do it their own way.” The idea of not “pushing spirituality or religion”
was also shared by all participants, with an emphasis on individuals coming into
spirituality or religion in their own way was the route most encouraged by participants.
Importance was not a factor for one participant as they explained,
It’s not so much important; but it does work for many people. For [example,]
those people who need more guidance and the idea that there is someone
watching over, protecting, [and] helping them to deal with their lives and their
troubles.
There was also differentiation between religious practices and spiritual practices
as noted by one participant,
I believe with spirituality there is no judgment, if any it’s yourself and it’s just
nice to know that somebody might be hearing [you] (maybe not answering) but it
somehow plays a role in your life, because there are some things you can’t
control. [Some people] need something to be able to look up to, or just believe in.
The idea of openness to spirituality and religion was a theme of some participants noted
by one saying, “I think that most people should…try it out” because one does not know if
it might be effective. As noted by another participant, “if it works for them, then you
know—if that’s the best option then go for it.”
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Utilizing Spirituality/Religion in Practice
The final four questions explored whether each participant had been to counseling in
the past, if spirituality or religion had been utilized by their counselor, if it was or would
have been helpful, their thoughts in general on counselors talking about spirituality
and/or religion with clients, and how a counselor could introduce the topic in a respectful
manner.
“Have you been to counseling before?”
When participants were asked if they had been to counseling before 30% reported
they had never been to counseling and 70% reported at least one time in their past they
had been to counseling. Some participants had been to counseling multiple times either in
elementary school, high school, or currently. The participants shared that they had been
seen by school counselors, church counselors, camp counselors, and private counselors.
Of the seven who had been to counseling before, one participant’s counselor had
explored spirituality or religion with them; the remaining six reported no discussion or
exploration of the topic. Of the six who had not had spirituality or religion discussed
during their time in counseling, three were undecided of whether or not exploration or
discussion would have been helpful, two thought it would not have been beneficial to
have explored, and one thought it would have been helpful for them.
The participant who shared that spirituality and/or religion had been explored
with them during their time in counseling shared the follow on reflection of their
experience,
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[It was] very beneficial because he was very personable and he did agree with
some of my own beliefs. I was not even sure of what I believed in at the time and
he said “that’s fine” because I was a kid and I would just figure it out eventually.
He said that [it] would be best without people influencing [me], just using [my]
own conscience. He gave no bias or anything.
The participant also shared their belief that “people need to know what’s out there. Not
just what’s right in front of their faces, or what they’re taught.”
The three participants who were undecided about exploration or discussion of
spirituality being helpful listed the following expansions on their thoughts: one
participant shared their mother was encouraging them to pray and a tie in with the
counseling would have been “weird.” Another participant shared that they may have
“laughed if a counselor” had attempted to broach the topic. However, upon further
reflection the participant stated,
I would probably try it if it were presented to me in a “legit” [meaning, legitimate]
way. It might be something I would think about trying, but I like facts. I want to
see if or know if it’ll work before I do it. It would be something I would think
about if it were presented in a professional way.
The third participant stated that exploring spirituality or religion would have “possibly”
been helpful. They shared,
I went to see a counselor my first year of college for depression and it probably
would have been helpful looking back now. It would have given me an alternative
way of looking at things. It would have been another way to deal [with my
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challenges]. I was at a point where I was having a hard time coming to terms with
things, disappointment, stuck at a college I didn’t want to go to, classes with
people I didn’t like, [and] still living in a home town I didn’t want to. Things that
were [just] disappointing.
The two participants that indicated their belief that exploring spirituality or
religion would not have been helpful attributed this to the age they were during the time
of counseling and the specific experiences they were going through. One participant
shared,
I was too young to fully understand spirituality or religion. Perhaps when I was at
least high school age with more developed mind and sense of how things work in
the world I would have been able to better understand it.
The other participant shared that, “it was more of me venting…and I didn’t have anyone
to talk about it.” The participant also shared they had taken a “spirituality class” and they
felt the class had been enlightening and took comfort in being more “free” to have their
own opinion. Due to the class they had taken they felt more of a general appreciation for
spirituality and its role in their life despite their counselor not approaching the topic.
The last participant that had been to counseling but not had spirituality explored
with them by their counselor had the follow-through to say if they thought it would have
been helpful,
It could have been, everything’s always worth a shot. Maybe see if they [the client
in counseling] are a believer without directly asking them. If they are [the
counselor] could bring it up but if they aren’t [the counselor] wouldn’t have to
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make them feel uncomfortable or disrespected for their beliefs. [The counselor]
could ask them if they’ve ever prayed about stress going away or if they think a
higher power could help them with their stress.
“What are your thoughts on counselors talking about spirituality and/or religion?”
In terms of practice and participants thoughts on counselors exploring spirituality
or religion with clients, participants had mixed ideas and approaches on the topic. Of the
participants 90% indicated they would be “fine” with counselors broaching the topic with
clients and 10% or one participant noted mixed feelings of the topic. The participant who
shared their mixed feelings thought that counselors would not be able to be neutral,
unbiased, and felt they would push their own agenda if they were to discuss spirituality or
religion stating, “as far as a counselor would go, I just don’t know. I feel like a counselor
would push it. They stick to one way of solving their patient’s problems: religion,
medication, random activity [just] to get results.”
The remaining 90% of participants who felt that exploring spirituality or religion
would be appropriate were split on how to approach the topic. The two methods offered
by participants were to “just ask” (40%) if the client had any spiritual or religious
background, or to “suggest/recommend” (50%) prayer, mediation, spirituality, or religion
as an option for clients. Participants shared the importance of the counselor being
unbiased, neutral, and not “pushing” spirituality or religion on clients. Some suggestions
of how to approach the topic consisted of saying, “have you ever thought about this,” or
“are you religious in any type of way,” or “here’s a way that helps many other people,
this something that you might consider trying.” The latter recommendation was in
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reference to providing a pamphlet that a client might view of various coping mechanisms
or an information sheet detailing the negatives and positives of utilizing spirituality or
religion in one’s life.
Some of the participants’ concluding remarks on the subject were,
I think it’s [spirituality or religion] something everybody should pursue to try it
out. I don’t think it’s a bad thing for someone to try out mediation or music, [it’s
just] another way for people to get away and [get] help with issues. I could see
how religion or spirituality could help other people. It can be a viable way to help
someone with his or her issues but may not for everybody.
Another participant shared, “may not be for everyone but [it’s] a good idea to share.”
Another participant stated,
I think it’s great! Everyone should have an open mind about trying new things,
and looking at things a different way. Counselors shouldn’t force it on someone
because it could make them upset but it’s good to have an open mind about it.
One participant made the point that if someone is seeking counseling they are seeking
support for challenges in their life they have been unsuccessful in and “if you’re getting
help [you should be] exploring all your options, you never know—it could change things
for you in a positive way.” When it came to how to broach the subject one participant
stated, “cut to the chase, don’t skirt around the subject, just ask” because as noted by
another, “it never hurts to ask anyone, it’s just a question, it’s just opening a new door to
talk.”
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Conclusion
In summary, this chapter aimed to explore, analyze, and discuss the data received
from participants who took part in the interview process for this study. The data was
collected, analyzed, and discussed in an effort to provide information to address the
research hypotheses (“spiritual or religious practices decrease the effects and/or
symptoms of stress” and “individuals do not mind being asked about their relationship,
experience, or preferences regarding spirituality or religion.”) and research questions (“do
spiritual or religious practices decrease the effect and/or symptoms of stress?” and “do
individuals mind being asked about their relationship, experience, or preferences
regarding spirituality and religion?”) presented in Chapter 1 and the basis for this project.
The final chapter, Chapter 5 will further explore the results of this study in relation to the
hypotheses, research questions, implications of this study for social work practice and
recommendations for further research.
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Chapter 5
Social Work Implications
Introduction
The purpose of this study was to explore what, if any effects spirituality or
religion had on stress, what experiences participants had with religion and/or spirituality,
and how the findings could implicate the social work profession as a whole. A total of ten
participants were interviewed, they varied in age, gender, and other demographic areas.
This chapter will explore the answers to the hypotheses and research questions,
interpretation summary of results from the interviews, recommendations for further
research, and implications for the field of social work.
Hypotheses/ Research Questions
The following hypotheses and research questions where presented to provide and
fuel the purpose of this study. As the findings from the data collected were presented in
Chapter 4, the hypotheses and research questions will be addressed below:
Hypotheses
The first hypothesis to be addressed is: “spiritual or religious practices decrease
the effects and/or symptoms of stress.” As noted by the findings of the participants that
utilized spiritual or religious practices one (14%) of seven felt little or no change and six
of the seven or roughly 86%, received benefit and relief from their practices. The second
hypothesis to be addressed, “individuals do not mind being asked about their relationship,
experience, or preferences regarding spirituality or religion.” As indicated by the
findings, 10% of participants were unsure of their thoughts on counselors broaching the
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topic of spirituality or religion and the remaining 90% of participants reported having no
problem if a counselor were to inquire about their spiritual or religious practices.
Research Questions
The first research question to be address, “do spiritual or religious practices
decrease the effect and/or symptoms of stress?” Based on the responses given by the
participants of the study who had utilized spiritual or religious practices, 86%
experienced some form of relief from their stress symptoms. The second research
question, “do individuals mind being asked about their relationship, experience, or
preferences regarding spirituality and religion?” Again, based on the responses given by
the participants 10% of participants were undecided as to their thoughts on counselors
exploring spirituality or religion based on the belief that counselors would not be able to
be unbiased or neutral. The remaining 90% of participants would not mind being asked
about their spiritual or religious experiences or preferences. In some instances
participants even championed the idea of counselors providing alterative options to
clients who were seeking support with their challenges.
Interpretation of Results
In summary of the results put forth from Chapter 4 many students tend to have
high levels of stress during the semester, especially around final examinations.
Participants shared that they may need support to decrease their stress. Spirituality and
religion tend to be viewed differently, and some participants have quite a negative
perspective on religion, while they view spirituality in a more positive way. Participants
emphasized that, while it may be possible to incorporate spirituality and/or religion into
69
their practice, counselors should do so with caution. In general, counselors may consider
the term “spirituality” over “religion,” considering the more negative connotation of
religion reported by the participants. Participants listed both maladaptive and adaptive
forms of coping such as “keeping it all inside,” or seeking support from friends and
family. Most participants identified as spiritual over religious, equating religion to
something more from their childhood than their present early adulthood.
The effectiveness of spirituality or religious practices may not be completely
significant due to participants typically wanting more substantial help to ease the stress,
especially during the exam time. Additionally, participants tend to perceive spirituality as
an “emotional” support, rather than physical/substantial help to address stress in the same
way that partaking in exercise might physiologically alleviate symptoms. Many
participants shared feeling a sense of anxiety. The “emotional” support received through
spiritual or religious practices may not remove all physiological symptoms of stress (for
example if one is feeling anxious) but provide psychological relief instead.
Implications for Social Work
The research outlined in this proposal yields results that can be applied
throughout the mental health field. The results though centralized through the data
collection with late aged teenagers and young adults in college, can be of importance to
clinicians on an introspective level, those working with clients of all ages, in agencies for
assessment and treatment protocol, in policy and advocacy, and finally for the social
work profession as whole that asserts a holistic approach to their work.
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The holistic approach embraced by the field of social work is one of the
profession’s signature values, and separates the field from other mental health disciplines.
The holistic approach to treatment considers all of the possible contributing factors that
may be impacting a client’s present state and challenges. Knowledge of the relationship
between spirituality and/or religion and mental health contributes to a holistic assessment
approach as knowledgeable social work clinicians are better positioned to ascertain and
utilize data regarding a client’s spiritual or religious ideologies. By expanding assessment
parameters to include information about spirituality and/or religion, current and future
social workers will be able to expand treatment options, providing clients with alternative
tools to manage or reduce undesirable challenges they face.
In social work practice and counseling the holistic approach of the profession
creates a viability in which spirituality and religion can be incorporated. In considering
the integration of spirituality and/or religion into practice social workers should be
conscientious of the approach they take when facilitating a dialogue with clients. Most
clients may not be expecting to be asked about their spiritual or religious experiences or
affiliations. A social worker should come from a place of curiosity, not knowing, and
allow the client to tell their story and examine the role that spirituality and/or religion
plays in their client system. If the client identifies spirituality and/or religion as
something that would beneficial for them in treatment and intervention it should be a
collaborative effort on the part of both social worker and client. Spirituality and/or
religion should be used in creating opportunities for client growth and success, evaluating
opportunities, and making accommodations or adjustments to support client self-
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determination in relation to their goals. The process of introducing a spiritual or religious
dialogue must be done so carefully, considering the historically negative connotation of
religion and spirituality. This research project sought to identify spirituality and religion’s
effects on stress in college students, however further research to expand on what other
areas spirituality and/or religion might serve client stills needs to be done. Through
incorporation of spirituality and/or religion into social work practice and more spiritual
and religious dialogues being conducted with clients further information and data can be
gained through field experience.
Practical options for implementation were listed in Chapter 4 from participants
themselves consisting of diverse experiences and affiliations with spirituality and
religion. One option from participants was to “just ask” if someone had any spiritual or
religious background. Another option was to “suggest/recommend” prayer, mediation,
spirituality, or religion as an alternative intervention or coping mechanism for clients.
Some participants suggested providing psycho-educational materials or pamphlets on
various coping mechanisms and having spiritual or religious practices listed. The
pamphlet would detail potential negatives or positives of utilizing spirituality or religion
in one’s life and give the client the opportunity to initiate a discussion. Phrases suggested
for beginning a conversation on spirituality or religion consisted of, “have you ever
thought about this,” or “are you religious in any type of way,” or “here’s a way that helps
many other people, this something that you might consider trying.” The latter
recommendation was in reference to providing a pamphlet that a client might view.
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As discussed in this proposal’s literature review, research indicates that
spirituality and/or religion may decrease the effects of stress on individuals who take
practice in some form of spirituality or religion (Hill, et al. 2000, Knitter, 2010). As
suggested in Chapter 2, social work clinicians are not being trained with knowledge on
spirituality or religion and are unlikely to gather information about a client’s experiences
or preferences in relation to spirituality or religion during the assessment process, or
consider spirituality or religion as a component of treatment planning (Knitter, 2010).
Social work clinicians who fail to assess this component of a client’s lifestyle and to
incorporate the data gathered in treatment planning may inadvertently restrict the
treatment options available to their clients (Workers, 2008). As a general rule, holistic
assessment encourages consideration of all bio-psycho-social factors; research suggests
that spirituality and/or religion should be considered among these factors (Aguilar, 1997;
Hodge, 2005; Knitter, 2010).
As current research and the findings from this project confirm that inclusion of
spirituality and/or religion in assessment, treatment planning, and intervention are areas
that clients are not opposed to being explored—and in many cases are of benefit—would
indicate the opportunity for improvements in social work coursework, service delivery,
policy, and the social work profession as a whole. Given that hypotheses from this
project hold true, it would be encouraged that social work bachelors and masters
programs, in addition to agencies where social workers are present to educate their
students and staff about the benefits of gathering information about clients’ spiritual or
religious preference during assessment, treatment planning, and intervention (Canda,
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Furman, & Nakashima, 2004; Hodge, 2005; Knitter, 2010; Redman, 2008).This may
include the incorporation of spirituality/religious practice-related questions on initial
client assessments, providing clientele with educational information about the effects of
spirituality and/or religion on stress, and helping clients to access spiritual and/or
religious resources themselves and/or their families (Hodge, 2005). This would also
apply to the macro or policy level, as social workers should advocate for the inclusion of
spirituality and/or religion for clients. Separation of church and state as mentioned
throughout this research project could be altered in support of inclusion and utilization of
spiritual and/or religious resources and potentially provide a source of funding for true
holistic comprehensive care for clients.
Recommendations
This writer would encourage agencies that support holistic practice and social
work educators to include information in their training or classroom curriculum about
spirituality and religion, specifically the importance that it could play in a client’s life, the
effect that it can have on mental health, suggestions for broaching the topic with clients,
and background on effectively incorporating spirituality and/or religion into assessment,
treatment planning, and intervention. Although it is beyond the scope of this research
study, further exploration in a larger sample population would be useful to examine the
usefulness of spirituality or religion in providing mental health services. A larger
interview population would be beneficial in gaining more generalizable data, in addition
to populations of participants that are not in college, more racially diverse, or participants
that have all been to counseling. Expanding the research questions to identify what other
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areas and ways spirituality and/or religion may be ineffective or effective for clients
would benefit from further research as well.
Conclusion
One of social work’s goals is advocacy for clients. As presented throughout this
project, research is growing in support of expanding the traditional ideas of holistic
approaches to treatment to include spirituality and religion. There is also a great deal of
confusion across disciplines, mental health agencies, and state and federal law concerning
placement and incorporation of spirituality and religion. As social work professionals we
are called upon to advocate for social change, client self-determination, and access to
opportunities for clients to meet goals. On a macro and advocacy level social workers
have a duty to see to the incorporation and implementation of spirituality and religion
into practice to serve clients through a holistic lens, and ensuring as many opportunities
for client success as possible. Whether that be through federal and state legislative
changes to blur the lines between “church and state,” within agency and company
policies, in social work educational programs, or on a personal level facing discomfort,
negative history, taboo, and the past of what has been and looking towards the future,
new history, hope and potential for client success.
As stated in the beginning of this research project, if social workers are the only
profession including spirituality and religion in depth with our clients in assessment,
treatment planning, and intervention it sets social work apart as a profession. This also
invites other disciplines to join in for more comprehensive care for clients. Client care
and success is the ultimate goal of the profession. Trailblazing the way for future
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professionals to support clients in the best way possible is advocacy, empowerment, and
highlights social work’s capacity “to enhance human wellbeing and help meet the…needs
of all people” (Workers, 2008). These are the values for which we stand.
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APPENDIX A
HUMAN SUBJECTS APPLICATION
77
Human Subjects Application
1.
Who will participate in this research as subjects (e.g., how many people, from what
source, using what criteria for inclusion or exclusion)? How will you recruit their
participation (e.g., what inducements, if any, will be offered)? How will you avoid
any conflict of interest as a researcher?
Answer: There will be a sample size of ten participants for the research study. The
participants shall be from Sacramento State’s Phi Sigma Sigma sorority chapter, a
member of the National Panhellenic Council, as well as Sacramento State’s Sigma
Phi Epsilon fraternity chapter, a member of the Interfraternity Council.
Permission to interview participants in these organizations has been received from
each organizations chapter advisor. Being a Sacramento State student is the only
inclusion criteria. The researcher will be using convenience sampling to gather
participants and no inducements for participate will be offered. Due to this
researchers religious and Greek-lettered affiliations (Phi Sigma Sigma) potential
conflicts of interest may arise. However, in an effort to promote and further
valuable unbiased research in these areas the researcher will clearly express to
potential participants the voluntary nature of their participation and their freedom
to discontinue participation at any time. In addition, interview participants will be
recruited during the organization’s weekly meetings. Each organization holds a
weekly meeting that allows a brief timer period for outside announcements. The
researcher will attend these announcement periods, announce the intent to gather
participants for interviews, and leave contact information for those wishing to
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participate.
2.
How will informed consent be obtained from the subjects? Attach a copy of the
consent form you will use. If a signed written consent will not be obtained, explain
what you will do instead and why. (See Appendix C in Policies and Procedures for
examples of consent forms, an example of an assent form for children, and a list of
consent form requirements. Also see the section on Informed Consent in Policies
and Procedures.)
Answer: An initial written consent form was mailed to the organization’s chapter
advisors to ask permission to survey members of each organization. Approval
from the chapter advisors has been received and submitted to the Human Subject
committee. Once approval from the Human Subject committee is confirmed
participants for the survey will be recruited through the organization’s weekly
meeting during announcements and convenience sampling. The participants will
be provided with this applicant’s information for contact if interested in
participating in the study. Prior to the survey questionnaire being administered,
this researcher will provide participants with a written informed consent, which
will be collected after completion by researcher. Informed consent from all
participants will be obtained through a signed written consent. All participants
will be given a consent form prior to the interview and the participants will
receive a blank copy of the consent form for their records. The consent form will
outline the study’s purpose, procedure, risks, benefits, and confidentiality
concerns. The consent will also outline that the participant’s involvement is
79
strictly voluntary and they are free to opt out of participation at any time they
wish without explanation or consequences. See attached consent forms.
3.
How will the subjects’ rights to privacy and safety be protected? (See the section on
Level of Risk in Policies and Procedures. For online surveys, also answer the
checklist questions at the end of Appendix B in Policies and Procedures.)
Answer: In regards to confidentiality, the consent will inform the participants that
their involvement is confidential. Upon completion of the study all materials
utilized during the study will be destroyed. The candidates, who agree to
participate in the study, upon accepting all terms of the study, will be asked to
sign the informed consent form, and return it to the researcher. The signed
consent form and other data collected will be stored separately, in a locked
cabinet in the researcher’s home. The participants will also be informed of their
right to withdraw without any fear of penalty or repercussion.
4.
Summarize the study’s purpose, design, and procedures. (Do not attach lengthy
grant proposals, etc.)
Answer: The purpose of this study is to gather information on currently enrolled
Sacramento State college student’s views on spirituality and its correlation with
stress levels and stress management. The study aims to be able provide
recommendations for social work practitioners in the areas of exploration of
spirituality with their clients. Approval will be first obtained by the Human
Subject Review Committee at Sacramento State through the submission of this
Human Subject Application. This study will utilize an exploratory research design
80
to examine and gain information on spirituality and stress from the perspective of
college students. The general research study will be conducted through an
interview with a survey questionnaire comprised of open and close ended
questions pertaining to the participant’s demographic information, spiritual
backgrounds, practices, stress levels, and coping strategies. Qualitative methods
will be pursued during this study. The participants who agree to participate in the
study upon acknowledgment of consent and confidentiality forms will complete
the interview process.
5.
Describe the content of any tests, questionnaires, interviews, etc. in the research.
Attach copies of the questions. What risk of discomfort or harm, if any, is involved
in their use?
Answer: The research will be conducted through interview consisting of openended questions, which will explore participant’s thoughts and personal insight on
stress and spirituality in the college realm. This study will also use close-ended
questions for demographic information. See attached questionnaire for specific
questions.
Risk of discomfort or harm involved in the use of interview and questionnaires
associated with this study are no greater than what might be encountered in daily
life or during the performance of routine physical or psychological examinations
or tests.
6.
Describe any physical procedures in the research. What risk of discomfort or harm,
if any, is involved in their use? (The committee will seek review and
81
recommendation from a qualified on-campus medical professional for any medical
procedures.)
Answer: Not applicable
7.
Describe any equipment or instruments and any drugs or pharmaceuticals that will
be used in the research. What risk of discomfort or harm, if any, is involved in their
use? (The committee will seek review and recommendation from a qualified oncampus medical professional for the use of any drugs or pharmaceuticals.)
Answer: Not applicable
8.
Taking all aspects of this research into consideration, do you consider the study to
be “exempt,” “no risk,” “minimal risk,” or “at risk?” Explain why. (See the section
on Level of Risk in Policies and Procedures.)
Answer: This study aims to identify the affects of spirituality on students’ stress
levels, thoughts on life stressors, and religious or spiritual affiliations and
practices. Due to this topic, students may experience a minimal level of
discomfort. However, the probability and magnitude of harm or discomfort
anticipated for participants are no greater than what might be encountered in daily
life or during the performance of routine physical or psychological examinations
or tests. In addition, participants are voluntary and the interview process focuses
on student perspective and beliefs. Taking all aspects into consideration this study
is anticipated to be no to minimal risk.
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APPENDIX B
INFORMED CONSENT
83
CONSENT TO PARTICIPATE IN A RESEARCH STUDY
Participant: please review, sign, and return this consent form if you elect to participate
in the research study described below.
The purpose of the research study is to gather information regarding the affects of
spirituality on students’ stress levels, thoughts on life stressors, and religious or spiritual
affiliations and practices. The information obtained will be analyzed for the purpose of
completing the interviewer’s thesis. Research will be conducted by CSU, Sacramento
Masters of Social Work student Kayleigh Lembke under the guidance of Dr. Kisun Nam
from the Division of Social Work at California State University, Sacramento. All data
collected will be held confidential.
Participation will involve the following:


Completion and submission of signed Consent to Participate form.
Participation in an individual interview conducted by Kayleigh Lembke.
Interview will take place at the participant’s choice on the California State University,
Sacramento campus and will require no longer than one-hour to complete.
Potential benefits of the research include:



Contributions within the field of social work practice.
Personal insight
Potential coping skill for stress
While participation in this research study is associated with minimal risk to participants,
should participants experience any level of distress as a result of their participation they
are encouraged to contact Sacramento County’s Mental Health Crisis Intervention
Hotline at (916) 732.3637.
Participants who wish to discuss their rights or who wish to seek clarification regarding
the research process are encouraged to contact Kayleigh Lembke at #-###-###-#### or
####@####.###. In addition, participants may contact faculty advisor Dr. Kisun Nam at
####@####.####.###.
-----------------------------------------------------------------------------------------------------------By signing below, I indicate my understanding of the research process and elect to
participate voluntarily. Furthermore, I understand that I will not receive compensation in
return for my participation and that I am entitled to discontinue my participation at any
time without the fear of repercussion.
Participant Signature:______________________________ Date:________________
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APPENDIX C
INTERVIEW QUESTIONNAIRE
85
Interview Questionnaire
1) Demographics
a. Gender
b. Age
c. Race/Ethnicity
d. Year in school (freshman, sophomore, junior, senior, other)?
2) What does the word “stress” mean to you?
3) What does “stress” look like for you?
4) How often do you experience stress:
a. Per week
b. Per month
5) When do you feel you are “most stressed”?
6) How do you deal with stress?
7) What does “spirituality” mean to you?
8) Do you consider yourself to be a spiritual person?
a. Please describe:
9) What does “religion” mean to you?
10) Do you consider yourself to be a religious person?
a. Please describe:
11) Have you ever used spirituality or religion in dealing with stress?
a. If yes, please describe:
i. How did you feel after utilizing spirituality/religion in dealing with
stress?
12) Do you believe it is important for others to utilize spiritual or religious practices
in dealing with stress?
a. If yes, please elaborate
86
13) Have you been to counseling before?
a. If yes, was spirituality or religion explored with you by your counselor?
i. If yes, did you feel it was beneficial?
ii. If no, would it have been helpful?
14) What are your thoughts on counselors talking about spirituality and/or religion?
87
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