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Article 44

Spirituality in Rehabilitation Counseling

Daniel J. Smith

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J. Ronald Gentile (1996), a noted educational psychologist, observed,

... consider what occurs when bad things happen to people unexpectedly—for example, when you get AIDS from a transfusion or a loved one, when you were mugged or raped, or when you are disabled from an accident.

Feelings will be associated with and conditioned to the situations and people involved, fight or flight (overcoming or helplessness) patterns will be induced, and, of course, perceptions, future learnings, and perhaps your whole life will become altered. Such learnings are neither active nor intentional; they happen to you. If they are constructive or metacognitive, it is only by retrospective analysis and they may or may not occur in social contexts. But I submit that these are the most meaningful learnings in people’s lives. They are currently explainable from Pavlovian (respondent conditioning) and Skinnerian (avoidance learning) but not by the cognitive constructivist definitions of meaningful learning....

As a Certified Rehabilitation Counselor (CRC), I refuse to leave the most meaningful learnings in people’s lives to be explained by behavioral psychologists in terms of either respondent conditioning or avoidance learning. I surmise that Carolyn Vash, Ralph Piedmont, and Ken Wilber might relate Gentile’s unexpected occurrences to opportunities for personal growth explained in terms of spiritual transcendence. Since these “unexpected occurrences” fall within the everyday realm of issues dealt with by Certified Rehabilitation Counselors, it is my belief that in order to serve the client dealing with such issues, it is imperative for rehabilitation counselors to be in touch with their own beliefs concerning spiritual transcendence, as well as be willing to deal with spiritually transcendent issues in a counseling session. Perhaps the research referred to in this article might influence the education process of rehabilitation counselors in terms of spirituality, increasing their effectiveness in relating to clients dealing with Gentile’s life-altering circumstances.

In the therapeutic service that rehabilitation counselors provide for their clients, scant research has been conducted concerning rehabilitation counselors’ personal spiritual beliefs and their willingness to incorporate spiritually transcendent concepts into counseling sessions.

Spiritual transcendence is defined in accordance with Piedmont’s (2004) definition:

Spiritual Transcendence represents the ability of an individual to stand outside of his/her immediate sense of time and place and to view life from a larger, more objective perspective. This transcendent perspective is one in which the person sees a fundamental unity underlying the diverse strivings of nature. People...believe that there is a larger plan and meaning to life, something beyond our mortal existence.

It has been argued that by ignoring or avoiding spiritual issues, a counselor not only endangers the therapeutic relationship but also disallows possible interventions in this area (Kelley, 1995). Spirituality implies belief in a transcendental reality which may or may not incorporate a formal religion (Shafranske, 2000). Byrd (1998) illustrated the distinction between religion and spirituality by indicating that “spirituality means openness to a higher power, and to one’s self and others. Religion, on the other hand, implies institutions, denominations, charges, and synagogues as well as doctrines, dogmas, and creeds” (p. 25). As this definition suggests, it is possible for a client to present as spiritual and not religious, religious and not spiritual, spiritual and religious, or neither spiritual nor religious. It becomes the task of the counselor to identify the degree of spiritual development and/or religious affiliation present in both the client and themselves and how this may affect the counseling relationship, process, and objectives. Survey data of counselors, educators and the general population show spirituality and religion to be therapeutically pertinent, ethically congruent, meaningful subject matter for counselors.

Counselors can expect that at least for some clients, spirituality and religion play a part in how the client feels and thinks about these issues and problems. As counselors explore the cognitive, affective, and unconscious elements of issues such as these, they can help clients by an alert openness to how spiritual and religious threads may be woven into such concerns and used in their resolution. (Kelley, 1995, p. 34)

Burke, Hackney, Hudson, Miranti, Watts, and Epp (1999) equated ignoring spirituality to showing insensitivity to client issues. Burke et al. further stated that should a counselor fail to examine his or her own spiritual values, the counselor might inadvertently impose those values in a therapeutic session. Burke et al. also believed that a holistic approach to counseling requires an examination of the spiritual and religious components of the therapeutic situation as a possible source of personal development for both client and counselor.

Carolyn Vash (1994) agreed, exhorting rehabilitation counselors to rethink the seeming disadvantage of disability, instead opting for the affirmative belief of opportunity by investigating spiritual and philosophical teachings. Her rudimentary suppositions were two: “consciousness is life viewed from the inside; life is consciousness viewed from the outside” (p. xxiii) and “adversity plays a powerful role in shaping our personalities... personalities shape our responses to adversity” (p. xxiii). Her purpose in writing was to induce in rehabilitation counselors a sense of urgency for a new paradigm incorporating spirituality in rehabilitation counseling. Vash nominated theories from various sacred traditions for the purpose of permitting readers the discretion of incorporating these unique psychospiritual responses into their own counseling technique. It should be noted that these theories also appear as various selected tenants of the psychospiritual philosophy of authors such as C. G. Jung (1969), Roberta Treischman (2001), and Ken Wilber (1995). The severest adversities are neither “awfulized” or trivialized but instead presented as the seeds for psychospiritual growth, that is, catastrophe drawing forth a reaction that awakens the soul. Vash postulated transforming adversity into extraordinary prowess, by a psychospiritual examination given that catastrophe interferes with our lives, interferes with social relationships, enforces rest or a halt to normal activity, and basically acts as an instigating experience in a right of transcendent passage.

Karasu (1999) cautioned counselors that perchance too much emphasis is placed on the professional practice of the therapist and not enough attention is given to personal or spiritual growth. He mentioned the possibility that the client can evolve only as much as the therapist him- or herself has developed. To Karasu, a therapist is a secular minister, tailoring his or her skills, theory, and spirituality to the therapeutic relationship and to whatever the client brings to that relationship.

Perhaps it is Nosek (1995) who presented the most convincing case for the professional consideration of each client’s spiritual expression. She lamented that her personal spirituality, as a seeker of God, was completely ignored in her lifetime of contact with the rehabilitation system, as a client, as a student, and even as a rehabilitation researcher. She spoke knowingly of spiritual crises being ignored or downplayed, despite the fact that for both Nosek and other clients with disabilities, spirituality is the underpinning of satisfactorily coming to terms with life with a disability. She contended that if it is possible to measure amorphous concepts such as self-esteem and positive or negative attitude, surely we must be able to deal with spiritual growth in the same fashion. She admonished those who criticize the deficiency of a common language of spirituality by addressing this lack of consensus as a counselor’s challenge to investigate personal spiritual beliefs as well as each client’s relationship with his or her own spirituality.

The purpose of this study is to accept the challenge of Margaret Nosek and Carolyn Vash and to investigate rehabilitation counselors’ consideration of spiritual transcendence (Piedmont, 2004) in their own lives and their willingness to address and introduce spiritual transcendence in counseling sessions. Willingness to introduce and/or deal with spiritual transcendence in counseling sessions is influenced by

1. the rehabilitation counselor’s ability to recognize spiritually transcendent issues in the course of counseling or counseling relationships;

2. the rehabilitation counselor’s self-confidence about his or her ability to adequately explore spiritually transcendent issues;

3. the rehabilitation counselor’s ability to focus a counseling session on issues of spiritual transcendence; and

4. the rehabilitation counselor’s belief about the therapeutic benefits (outcome expectations) of dealing with spiritually transcendent content in counseling sessions.

It was necessary to prepare a questionnaire to perform two tasks. It was important that the questionnaire both measure the respondents’ cognizance of spiritual transcendence in their own lives as well as appraise the respondents’ inclination to employ or access spiritual transcendence in counseling sessions. In order to accomplish the first task, Piedmont’s spiritual transcendence scale-revised (STS-R) renamed assessment of spirituality and religious sentiments (ASPIRES) in 2004 was used with Piedmont’s permission, composing the first nine items of the questionnaire (see the Appendix). The responses to the nine questions are measured on a five-item Likert scale, strongly agree, agree, neutral, disagree, and strongly disagree. To score the ASPIRES, points are assigned to the response for each item. For questions 1, 2, 3, 4, 7, 8, and 9, five points are assigned for strongly agree, four points for agree, three points for neutral, two points for disagree, and one point for strongly disagree. For questions 5 and 6 the point total is inverted with strongly disagree accruing five points and culminating with strongly agree earning one point. An average range of scores is introduced by Piedmont, each classified by gender and age. Also, concurrent with a total score for a respondent’s spiritually transcendent orientation, the ASPIRES also yields three subcategories, those being prayer fulfillment (the total for items 1, 4, and 8), universality (the total for items 6, 7, and 9), and connectedness (the total for items 2, 3, and 5). The subcategories are also presented in terms of the average scores for gender and age groups.

Concerning score analysis, if respondents score higher than average on the overall ASPIRES instrument, they are seen as “concerned with living a life that is in accord with values and meanings that originate with some larger understanding of the purpose of the universe” while those lower than average are seen as “focused on the tangible realities of daily living” (Piedmont, 2004). Respondents with average scores either for the overall instrument or any of the three subcategories are viewed as fluctuating between both the above average and below average perspectives. Those respondents scoring above average in the prayer fulfillment subcategory are seen as “find(ing) a personal sense of emotional satisfaction, strength, and support in their efforts to connect with some larger reality” while scoring below average shows a trend of non involvement in this area, with an average score connotating life at times interfering with employing such practices. Those respondents scoring above average in the universality subcategory “share a common belief that all of life is interconnected... seeing humanity as a single interrelated body,” while a low score signifies an autonomous characterization of humanity, “a collection of individuals, some... seen as more similar to self than all others.” An above-average score for connectedness indicates “a special sense of responsibility (and gratitude) for the many gifts received from those who came before. a need to grow those gifts through sharing with the others... and an obligation. to those who come after, whereas a below-average score indicates “difficulty to find a sense of belonging and meaning within any type of group or community.”

The remaining seven items were developed in order for rehabilitation counselors to self-report concerning their propensity to engage in spiritual transcendence in therapeutic sessions. In order to judge the validity of the seven items, a panel of experts was secured. A tentative list of six original items was originally e-mailed to Caroline Vash and John Benshoff, with Vash forwarding a copy for review Henry McCarthy. All three panel members are considered recognized experts in the field of spirituality and rehabilitation counseling. The panel members were asked to review individual items in terms of their ability to measure the willingness or disposition of rehabilitation counselors to introduce issues related to spiritual transcendence in counseling and add appropriate comments.

Various revisions were made based on panel feedback. Benshoff suggested language changes in four of the items, eliminating some ambiguity in the questions and focusing the respondent on the area of comfortability with accessing spiritual transcendence in counseling sessions. Vash’s feedback focused on succinct definitions of terms as well as the use of basic language granting the items a consistent interpretation by all respondents. McCarthy’s response clarified the differentiation between individual sessions and group sessions in terms of rehabilitation counselors accessing spiritual transcendence. The panel’s feedback also facilitated the formation of a seventh item focusing on a counselor extending psychosocial discussion with the client into the realm of spiritual transcendence. After consultation with the panel the seven items added to Piedmont’s ASPIRES were as follows:

Item 1. “I am willing to introduce spiritually transcendent issues in counseling sessions with my clients.” (1) Strongly Agree (2) Agree (3) Neutral (4) Disagree (5) Strongly Disagree

Item 2. “I believe that the integration of spiritually transcendent issues in a counseling session is therapeutically beneficial for rehabilitation clients.” (1) Strongly Agree (2) Agree (3) Neutral (4) Disagree (5) Strongly Disagree

Item 3. “I am able to discuss spiritual values with my clients in session.” (1) Strongly Agree (2) Agree (3) Neutral (4) Disagree (5) Strongly Disagree

Item 4. “When the client introduces a spiritually transcendent issue, I will encourage the client to discuss the issue.” (1) Strongly Agree (2) Agree (3) Neutral (4) Disagree (5) Strongly Disagree

Item 5. “I am willing to extend a psychosocial discussion with a client into the realm of spiritual transcendence.” (1) Strongly Agree (2) Agree (3) Neutral (4) Disagree (5) Strongly Disagree

Item 6. Which of the following best describes you: “In my role as a Rehabilitation Counselor, I integrate spiritually transcendent issues into my individual sessions:” (1) Nearly every session, allowing the client to either accept or reject the topic. (2) Whenever the client introduces a spiritually transcendent issue during the session. (3) Some of the time, usually when nothing else has helped a client adjust to a disability. (4) Never, I plan to use limited session time dealing with concrete issues. (5) Not applicable, I don’t conduct individual sessions.

Item 7. Which of the following best describes you: “In my role as a Rehabilitation Counselor, I integrate spiritually transcendent issues into my group sessions:” (1) Nearly every session, allowing each group member to either accept or reject the topic. (2) Whenever a group member introduces a spiritually transcendent issue during the session. (3) Some of the time, usually when nothing else has helped a client adjust to a disability. (4) Never, I plan to use limited session time dealing with concrete. (5) Not applicable, I don’t conduct group sessions.

A sample of convenience featuring Certified Rehabilitation Counselors engaged in clinical practice within the western New York area was selected. Fifty- one CRCs were personally contacted and e-mailed and faxed the survey. Thirty-five CRCs responded to the survey for a response rate of 68%. In other words, this research survey, a rudimentary 16 item multiple choice instrument, seemed to be favorably viewed by the CRCs responding, and might readily be duplicated either nationally or in multiple areas for a more universalized conclusion.

Responses to the STS-R items were entered into an SPSS data file, and T- scores were calculated for the total score and the three subcategories of the STS-R for comparison with the norm group. Responses to the seven items on counselor willingness were analyzed using descriptive statistics (frequencies, means, and standard deviations). Pearson correlations were calculated to investigate the relationship between the STS-R results and the items regarding counselor willingness/readiness to integrate spiritual transcendence into counseling sessions.

Recognizing both importance of spiritually transcendent issues in the field of professional counseling, particularly rehabilitation counseling (Bergin & Richards, 1997; Shafranske, 2000; Standard, Sandhu, & Painter, 2000; Vash, 1994) and the fascinating results of this pilot project, perhaps this research instrument might be utilized by the Commission for Rehabilitation Counselor Certification to investigate spiritual transcendence on a national level, awarding continuing education credits for the completion of the survey.