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Article 50

Doctoral Students’ Perceptions and Competencies Regarding Spiritual Strategies in Counseling

Hannah B. Bayne, Radha J. Horton-Parker, & Christine A. Ward

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The importance of integrating spirituality within counseling is currently supported by a variety of research (Cashwell & Young, 2011; Steen, Engels, & Thweatt, 2006; Young, Cashwell, Wiggins-Frame, & Belaire, 2002; Young, Wiggins-Frame, & Cashwell, 2007). Several studies (e.g., Steen et al., 2006; Young et al., 2007) stress the influence of religion and spirituality in the lives of clients, as well as the positive impact of addressing spiritual or religious issues in the counseling process. As a result, the relevance of spirituality and religion to counseling is now fairly well established, and the focus of current research has shifted to examining counselor competency and training in the application of these issues (Robertson & Young, 2011; Young et al., 2002).

Professional associations and accrediting bodies further support the importance of integrating spirituality and religion in counseling by outlining clinical competencies to be addressed within counselor education programs (Association for Spiritual, Ethical, Religious, and Values Issues in Counseling [ASERVIC], 2009; Cashwell & Watts, 2010; Council for Accreditation of Counseling and Related Educational Programs [CACREP], 2009; Robertson & Young, 2011). Despite these efforts, it is unclear how well programs have been able to integrate spiritual competencies within coursework, particularly when many faculty perceive themselves as only moderately competent in their ability to address these areas in their teaching (Young et al., 2002). There is often great variance among programs in the degree to which spiritual competencies are addressed and assessed, suggesting that the level of counselor preparation in these areas may vary (Cashwell & Young, 2011; Dobmeier & Reiner, 2012).

Previous research suggests that an individual’s religious/spiritual background influences his or her willingness and comfort with addressing religious and spiritual issues in practice, though overall neither counselor educators nor clinicians feel fully prepared to address religious and spiritual issues in their work with clients (Robertson & Young, 2011; Walker, Gorsuch, & Tan, 2004; Young et al., 2002; Young et al., 2007). One area not yet addressed is whether doctoral students, who represent the future counselor educators and clinical leaders for counselors-in-training, feel competent including spirituality and religion when teaching and supervising counseling students. Therefore, this exploratory study examined doctoral students’ perceived competency in utilizing spiritual counseling strategies as well as their perceived ability to promote these strategies within teaching and supervision roles. The FACE-SPIRIT model (Horton- Parker & Fawcett, 2010) was used to structure survey questions, as this model was based on some of the ASERVIC competency areas and includes both implicit and explicit strategies for the inclusion of spiritual practices in counseling.

The FACE-SPIRIT Model

Horton-Parker and Fawcett (2010) developed the FACE-SPIRIT Model to address the need for specific strategies practitioners might use to integrate spirituality into professional practice and thereby meet a number of the ASERVIC competencies. Though these ASERVIC competencies provide a general framework for addressing spirituality and religion with clients in a broad sense, the competencies do not detail specific strategies to accomplish these goals, which may be needed for the teaching and supervision of counseling students (Dobmeier & Reiner, 2012). The FACE-SPIRIT model thus provides examples of specific strategies, organized as either implicit (done within one’s self without the client’s awareness) or explicit (performed outwardly with the client; Horton-Parker & Fawcett, 2010). In this model, the four implicit strategies were grouped under the acronym FACE and the six explicit strategies were placed under the acronym SPIRIT.

FACE

“Implicit integration” of spirituality in therapy includes practices that the helping professional conducts within himself or herself, often before clients arrive (see Figure 1). The acronym FACE stands for the following four strategies: Focusing on the Present, Asking for Guidance, Compassion Cultivation, and Existential Empathy (Horton-Parker & Fawcett, 2010). Focusing on the Present (F) captures the need to be fully present in the moment in order to achieve an authentic and genuine connection to facilitate the change process (Cashwell, Bentley, & Bigbee, 2007), and may include strategies such as mindfulness. The strategy of Asking for Guidance (A) involves opening oneself to the possibility of receiving guidance from a higher source, such as one’s own unconscious, chi energy field, or higher power (Breslin & Lewis, 2008). In the Cultivation of Compassion (C), counselors can prepare for client sessions by visualizing the well-being of their clients through loving-kindness or other meditative strategies (Leary, Tate, Allen, Adams, & Hancock, 2007). Finally, Existential Empathy (E) consists of listening for the spiritual yearning of the client and hearing the deeper longing behind the ordinary details that are conveyed through the client’s stories.

Figure 1

The FACE SPIRIT Model.

SPIRIT

The explicit integration of spirituality into psychotherapy involves openly and directly addressing clients’ spiritual and religious issues as part of the therapeutic process. SPIRIT represents the following six explicit interventions: Simile and Metaphor, Prayer, Interpretation of Sacred Texts, Rituals, Imagery, and Transgression Relief (Horton-Parker & Fawcett, 2010).

The S in SPIRIT refers to the use of Simile and Metaphor, which can help clients work through spiritual concerns that they may find difficult to express (Horton-Parker & Fawcett, 2010). Clients can be asked to think of situations, characters, or narratives from their faith traditions that might relate to their own life challenges, and then consider how they can serve as similes and metaphors for their own lives (Horton-Parker & Fawcett, 2010). Although controversial, Praying (P) with clients can be beneficial in secular counseling (Frame, 2003; Hodge, 2007; Wade, Worthington, & Vogel, 2007). Prayer should only be considered if it is likely to serve the best interests of the client (e.g., to instill hope) and if there is a low risk of it causing harm or creating dependency (Horton- Parker & Fawcett, 2010). Discussing and Interpreting Sacred Texts (I) can also serve as a positive resource for a client by harnessing the language and stories contained within his or her faith tradition. Counselors may ask clients to bring in passages that seem relevant to them, or, in some cases, encourage clients to consider alternate interpretations to clear up any textual misinterpretations that may be causing them pain (Frame, 2003). Rituals (R) can be highly efficacious in helping clients to achieve their goals by creating “protected space” and “sacred time” (Horton-Parker & Fawcett, 2010; Imber-Black & Roberts, 1992). The benefits of ritual therapy in counseling include helping clients to heal, change, and relate to others (Horton-Parker & Fawcett, 2010). Therapeutic guided imagery (I) assists the client in visualizing positive images and has been effective in treating anxiety and pain (Goodwin, Lee, Puig, & Sherrard, 2005), as well as depression, fatigue, mood disorders, and alcoholism (Sandoz, 2006). Finally, Transgression Relief (T) is a term coined by Horton-Parker and Fawcett (2010) to refer to forgiveness. By placing the emphasis on relief the concept is reframed in a way that highlights the positive psychological benefits to the person who has been wronged, rather than on extending mercy to the wrongdoer (Enright & Fitzgibbons, 2000; Horton-Parker & Fawcett, 2010).

The FACE-SPIRIT model, then, offers a framework for integrating spirituality into counseling, both in terms of direct implementation with clients as well as in the personal practices of the counselor. Therefore, this model was selected to provide structure for survey development in this study, measuring perceived competencies through the lens of actual practices and degree of comfort in implementing these practices within counseling and instructional settings.

Purpose

This study examined doctoral students’ self-perceptions of their abilities to incorporate spiritual competences within their teaching and supervision. The study examined differences between doctoral students with varying career interests and of different religious or spiritual backgrounds on indicators of incorporation of spiritual/religious strategies within personal and professional roles, as well as self- perceptions of their abilties to teach and supervise spiritual competences.

Research Questions

The following research questions were developed to examine doctoral students’ use and understanding of spiritual strategies and their abilities to incorporate these strategies in their teaching and supervision practice.

1. Based on their intended professional roles (i.e., counselor educator identity, counseling practitioner identity, or both counselor educator and clinician/other identities), are there significant differences between doctoral students’ a) incorporation of spirituality in their personal lives or professional counseling practice, b) attitudes towards spiritual strategies, and c) perceived abilities to teach and supervise using spiritual strategies?

2. Based on their religious identities (i.e., organized religion, atheist/agnostic, or new religion/spirituality), are there significant differences between doctoral students’ a) incorporation of spirituality in their personal lives or professional counseling practice,

   b) attitudes towards spiritual strategies, and c) perceived abilities to teach and supervise using spiritual strategies?

3. Do doctoral students’ incorporation of spiritual strategies in their personal or professional lives and attitudes about spiritual strategies predict their perceived abilities to incorporate spiritual strategies in their teaching and supervision?

Method

An analysis of survey responses from counselor education doctoral students at CACREP-accredited doctoral programs was conducted to examine students’ use of spiritual strategies and their self-perceived abilities to incorporate these strategies in their teaching and supervision practice.

Participants

The target population included doctoral students at CACREP-accredited institutions. The total number of counselor education doctoral students who fit these parameters is unknown. To recruit participants, an e-mail was sent to the program leaders of each CACREP-accredited doctoral program with a request to distribute the survey to current students. E-mails were also distributed to counseling honor society members at each institution. Finally, to increase participation, an e-mail was sent to a listserv for counselor educators. After a two month period of repeated attempts to obtain participants, a total of 127 participants had accessed the survey, with additional requests for participants yielding no new submissions. After examining the data for complete cases, 125 participants provided valid, usable data and were included in the analysis.

Participant frequencies demonstrate that 55% of respondents were between the ages of 26 and 35 (n = 68). Participants were also predominately female (n = 96; 77%), and Caucasian (n = 94; 75%). Participants self-reported their spiritual or religious affiliation and were then grouped into categories for ease of analysis. Within these categories a majority of participants identified as part of an organized religious group (n = 80; 64%), some identified as spiritual or “other” (n = 34; 27.2%), and others identified as atheist or agnostic (n = 11; 8.8%). Most participants were in their third to sixth semester of study (n = 41.7; 43%), and most reported full-time enrollment (n = 96; 78%). Slightly more than half of respondents reported being licensed as professional counselors (n = 66; 53%). Many respondents provided the name of their institution, which demonstrated that participants represented over 40 programs across the country, including private, public, and online programs. Though reports were inconsistent and prevent comparative analysis, a review of the reported institutions suggests that a majority of respondents study in the South Atlantic region. The highest number of participants from any one institution was nine, demonstrating that no one institution dominated representation in the data.

Instrumentation

The survey used for this study was developed by the researchers and was based on the FACE-SPIRIT model (Horton-Parker & Fawcett, 2010). Though other methods of assessing spirituality and spiritual competencies exist (Kass, Friedman, Leserman, Zuttermeister, & Benson, 1991; Robertson, 2010), none assess each component of the FACE-SPIRIT model. Thus, a measure was developed to examine degree of perceived comfort and competency within each level of the FACE-SPIRIT framework.

The FACE-SPIRIT instrument consists of three primary sections: Incorporation of spirituality into personal and professional life (Incorporation of Spirituality); attitudes about the importance/utility of using spiritual strategies in counseling sessions (Attitudes Toward Competencies); and perceptions of abilities to teach or supervise the use of spiritual strategies (Abilities to Teach/Supervise). Each section was comprised of ten questions, which participants rated on a 5-point Likert-scale. Overall scale reliability for the FACE-SPIRIT instrument was found to be very good (30 items;  = .88). For this preliminary study, validity of the instrument has not yet been established.

The first section of the survey, Incorporation of Spirituality, was comprised of questions concerning participants’ incorporation of or adherence to spiritual practices or mindsets in their personal lives and work with clients ( = .73), such as: “I practice mindfulness or centering exercises to focus myself on the present moment before or during counseling sessions.” The second section of the survey, Attitudes Towards Strategies, was comprised of ten questions gauging participants’ attitudes about the use of spiritual strategies in counseling sessions ( = .73), such as: “Interpreting or referring to passages from the sacred texts of clients’ spiritual or religious traditions can help them draw strength and insight into their issues.” The third and final section of the survey, Abilities to Teach/Supervise, was comprised of questions examining participants’ perceptions of their abilities to instruct or supervise counseling students to incorporate spiritual competencies in their practice ( = .86), such as: “I am able to teach students methods for the ethical and appropriate use of prayer with clients in counseling sessions.”

Data Screening

All data from the survey were downloaded into SPSS 20.0 for screening and analyses. No variable had more than 5% missing cases. Data were screened for statistical outliers using Mahalanobis’ Distance on the grouped dependent variables. Five cases were identified as outliers and eliminated from the analyses. Next, the Kolmogorov- Smirnov test of normality indicated that the three dependent variables (Incorporates Spirituality, Attitudes Towards Strategies, and Abilities to Teach/Supervise) were normally distributed for the grouped career variable as well as for the grouped religious identification variable. Additionally, Levene’s test of homogeneity of variance indicates that equal variances can be assumed for the grouped career variable and the grouped religious identification variable.

Results

Research Question 1

Multivariate analysis of variance (MANOVA) was used to analyze research question one, which investigated the difference between participants’ beliefs about their incorporation of spirituality in their personal lives or professional counseling practice, attitudes towards spiritual strategies, and perceived abilities to teach and supervise using the spiritual strategies among doctoral students with varying professional identities (counselor educator, clinician, or both). The assumption of equality of variance was satisfied, Box’s M = 15.61, F = 1.19, p = .287. MANOVA results indicate that professional identity does not significantly affect the combined dependent variables (Wilks’  = .932, F(6, 240) = 1.428, p = .204, η2 = .034).

Table 1

Subsection Means by Religious/Spiritual Identity

Research Question 2

MANOVA was also used to analyze research question two, which investigated the difference between participants’ beliefs about their incorporation of spirituality in their personal lives or professional counseling practice, attitudes towards spiritual strategies, and perceived abilities to teach and supervise using the spiritual strategies among doctoral students with varying religious identities (condensed into three categories: organized religion, atheist/agnostic, and new religion/spiritual). The assumption of equality of variance was satisfied, Box’s M =12.46, F = .998, p = .447. MANOVA results indicate that religious identity does not significantly affect the combined dependent variables (Wilks’  = .980, F(6, 240) = .412, p = .871, η2 = .010). While not significant, subsection means among various religious/spiritual categories indicate variance among scores. Subsection means broken down into specific religious/spiritual categories are presented in Table 1.

Research Question 3

Standard multiple regression was conducted to determine whether doctoral students’ incorporation of spirituality in their professional and personal lives (Incorporates Spirituality) and their attitudes about spiritual strategies (Attitudes Towards Strategies) accurately predict their perceived abilities to teach or supervise the spiritual strategies to others (Abilities to Teach/Supervise). Average scores from the three sections of the FACE-SPIRIT instrument were used. Regression results indicate that the overall model significantly predicts perceived abilities to teach and supervise the spiritual strategies to others, R2 = .263, R 2adj= .251, F(2, 122) = 21.772, p < .001. This model accounts for 25.1% of the variance in perceived abilities to teach and supervise spiritual strategies. Post-hoc power analysis was conducted using G*Power software and was determined to be greater than .95 for this regression model. A summary of regression coefficients is presented in Table 2 and indicates that both predictor variables significantly contributed to the model

Table 2

Coefficients for Overall Model Variables

As a follow-up, two separate forward multiple regression analyses were used to examine research question three. The first analysis examined which of the items from the Incorporates Spirituality section of the FACE-SPIRIT instrument were predictors of doctoral students’ perceived abilities to supervise or teach the spiritual strategies. Regression results indicate that an overall model of three items (using similes and metaphors in counseling, using sacred texts during sessions, and helping clients develop symbolic actions or practices to facilitate healing) significantly predicted doctoral students’ perceived abilities to supervise or teach the spiritual strategies, R2 = .280, R2adj=.261, F(1, 117) = 5.217, p < .05.

The second follow-up forward multiple regression analysis examined which of the items from the Attitudes Towards Strategies section of the FACE-SPIRIT instrument were predictors of doctoral students’ perceived abilities to supervise or teach the spiritual strategies. Regression results indicate that an overall model of two items (attitudes about using similes/metaphors in counseling and attitudes about doing practices to generate compassion toward others prior to seeing clients) significantly predicted doctoral students’ perceived abilities to supervise or teach the spiritual strategies, R2 = .192, R2adj = .179, F(1, 117) = 4.469, p < .05.

Discussion

Results indicate that there are no significant differences among doctoral student participants in their incorporation, attitudes, and perceived teaching competencies of spiritual strategies, regardless of professional goals or religious/spiritual identities. As a whole, mean scores show that participants rated their perceived competency in incorporating spiritual considerations in their teaching as “adequately prepared” (4) or “unsure” (3). These findings indicate that doctoral students feel at least somewhat competent in integrating spiritual strategies in counseling and teaching, which may demonstrate a slight improvement from previous research indicating lack of preparedness or perceived competency among counselor educators as well as practitioners (Robertson & Young, 2011; Young et al., 2002; Young et al., 2007; Watkins van Asselt & Senstock, 2009).

Though not groundbreaking, the finding that an individual’s incorporation of spiritual strategies in his/her personal life and attitudes about using the strategies in sessions predicts his/her perceived ability to supervise and teach the strategies to others does have implications for the preparation of counselor educators. Focusing on self- reflection and encouraging the development of personal practices among students could be useful, given its predictive value in this study.

One somewhat surprising finding is that attitudes regarding the use of similes and metaphors and actual incorporation of similes and metaphors in counseling were the top predictors of ability to teach/supervise spiritual competencies. It could be that simile and metaphor provide a non-threatening and universal language to discuss broader spiritual/religious themes in ways that both clients and students can identify (Ahammed, 2010; Prest & Keller, 1993). Counselor educators may in turn feel more comfortable by utilizing simile and metaphor to introduce concepts without applying personal bias to class discussions (Prest & Keller, 1993). Doctoral student training could therefore include learning about what already exists in spiritual/religious philosophies, as well as brainstorming how to create new associations to reframe client issues.

Other strong predictors in this study, such as reading sacred texts and generating compassion towards clients, demonstrate personal practices of doctoral students that correlate with their perceived ability to teach and supervise others. It is unclear whether participants restricted their reading of sacred texts to only those associated with their own faith, or whether they were familiar with multiple texts from different religious or spiritual movements. This distinction could be examined in future research and provide a better clarification of the contribution of sacred texts to perceived teaching ability. Furthermore, it is unclear whether participant compassion was linked to their own beliefs of interconnectivity and spiritual philosophy, or whether it stemmed from more secular notions of empathy and positive regard. Further research into this construct could also yield a better understanding of the connectivity between compassion and counselor educator preparedness.

Limitations

There are several limitations worth noting, all of which can provide direction for future research. First, the final pool of 125 valid participants was not substantial enough to ensure adequate power of the statistical tests and therefore increases the likelihood of finding false results. Further research should utilize a greater sample size for enhanced reliability of findings.

Additionally, in order to examine the preparation of future counselor educators, the focus of this study was restricted to doctoral students and did not measure master’s- level competencies or current faculty practices. Previous research has suggested that current faculty feel unprepared and/or hesitant to incorporate spirituality in their teaching (Young et al., 2002), and thus this study was meant to expand on current research by studying future faculty-in-training. Results indicate general perceived competency levels, although additional research is needed to confirm perceived competency levels across professional roles.

Furthermore, as with any survey research, the issue of selection bias is salient. Although participant demographics demonstrated a range of participant spiritual/religious practices, respondents were primarily Protestant Christian (36%) or Catholic (24%). This may be an indicator of normal population distributions among current doctoral students, but it could also be true that Christian and Catholic students were more inclined to participate in the survey. Additionally, it may be that only those students who already had some propensity or training towards using spiritual/religious strategies decided to participate in the study, thus explaining the lack of significant differences within the sample.

An additional point of consideration is that participants may have answered the questions based on what they felt they should be able to do, and the survey did not specify whether they actually intended to incorporate these spiritual strategies in their future teaching practice. Therefore, participants could have felt that they had the ability to incorporate these strategies in their teaching, but may not have the intent of doing so. Furthermore, perceived ability may be different from actual effectiveness of teaching. Future research may be needed to distinguish among these points.

Finally, though the FACE-SPIRIT instrument was found to have strong reliability within this study, it has not been validated and thus results should be interpreted with caution. The FACE-SPIRIT model was used to provide a structure and theoretical model to guide survey questions. However, future testing of the model and survey instrument is needed in order to establish validity of the constructs and the theoretical basis of the instrument.

Conclusion

Based on the results of this study, personal practice of and attitudes towards both implicit and explicit spiritual strategies significantly predict doctoral students’ perceived abilities to integrate these strategies in teaching and supervision. Insignificant results across groups suggest that many doctoral students feel at least somewhat competent addressing issues of spirituality and religion within their future teaching and supervision of counseling students, regardless of personal faith or career aspirations. Though this study has limitations which caution wide application of the data, it does suggest that future counselor educators may feel adequately prepared and willing to integrate spiritual strategies in teaching.

Further efforts to validate the FACE-SPIRIT model are needed. An advantage of this model is that it provides a structure for conceptualizing strategies for integrating spirituality in counseling and thus could also be used to structure classroom instruction. The development of more specific teaching modules or strategies would be beneficial to encourage curriculum integration. The results of this study indicate that simile and metaphor, inclusion of sacred texts, and compassion cultivation may all be beneficial for counselor educator preparation. Future research could determine if these same indicators also predict student learning and skill development.