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The Integrated SelfReview - The Integrated Self
A Holistic Approach to Spirituality and Mental Health Practice
by Louis F. Kavar
Psyche Books, 2012
Review by Lynne Trevisan
Oct 22nd 2013 (Volume 17, Issue 43)

The elements of health are mental, physical, emotional, social, financial, environmental, and spiritual. When a person is seen by a healthcare provider most of the focus is on the main reason the patient is in the office.  As part of that focus the practitioner must identify where a patient or client currently is on the health spectrum and then measure how far they are advancing during the treatment process.   Many practitioners reach a point where the patient or client doesn't advance to their best possibility.  What stops the process?  How can the provider help the patient overcome the barrier to further improvement?  What role might spirituality play in the patient's ability to overcome those barriers?  Does a belief in a Higher Power, or prayer, or meditation, or any spiritual practice, help a person heal faster and more completely?  

The book, The Integrated Self by Louis Kavar, Ph.D., explores the use of spirituality in treatments for patients.  He offers a definition of spirituality, provides case scenarios, addresses the cultural components, a sample assessment, and gives suggestions on how to handle situations from a practice standpoint. 

To begin, Dr. Kavar shares a definition of spirituality.  He states

Spirituality is about some kind of pure experience, or a positive feeling, or something that is a unique aspect of life events.  Religion, in turn, is defined in terms of institutional membership, dogma and beliefs, or ritualistic observances.  From this distinction, spirituality and religion are understood as unrelated to each other and comprise two separate domains (2012, p. 7).

Some scientists speculate there is a specific region of the brain that is engaged when a person is in the midst of a spiritual experience.  However, it has since been found that "religious and spiritual pursuits involve the various areas of the brain used for thought, analysis, and conjecture." (Kavar, 2012, p. 10)

Spirituality can take many different paths.  This can be the practice of religious rituals, or it can take another form.  People, pets, nature, and calming activities may all be experienced as a spiritual event because they allow the person to reach a meditative state.

Religious and spiritual belief systems have a major influence on the way people perceive illness, health and healing. (Young & Koopsen, 2011).   Let us consider someone who had surgery: after the doctors completed the operation the patient's body healed itself.  Will it ever be as good as it was when it worked properly?  Likely, it will not be.  A person's belief system comes into play in how they view the change in their health; they may get caught up in being a victim of their illness due to fear and resentment, or they may be accepting and at peace with the changes.

Have you ever heard "never talk about politics or religion?"  Are you uncomfortable talking about spiritual beliefs – your own as well as someone else's?  Maybe you were taught this is beyond the scope of practice expected of your profession.  But, now you are being told it is your responsibility to ask questions of your patients or clients in order to better serve them.  Isn't this a dichotomy?  Yes and no.  Understanding the purpose of why you are asking the information is a major part of the foundation you need to provide specific and appropriate professional services to your client.  There are steps you can take to approach this discussion with diplomacy and discretion.  This is where the five Rs come in to play.

The five Rs are: reason and reflection; religion; relationships; and restoration (Young and Koopsen, 2011, p. 147). Understanding the five Rs allows the care giver to guide the client in their healing.  Many people will get stuck in their grief, maintaining an attitude of victimhood for many years, possibly their entire lives.  As mentioned above, others just reach a barrier in their improvement and cannot surpass that barrier to reach their best outcome.  You may be able to lead the person to the resources they need in order to help themselves – each client is different so this is a judgment call and you need to consider your professional boundaries: does this action align with your professional duties?  Once you have shared the appropriate resources, it is their responsibility to take advantage of the opportunities in order to move beyond the barriers and on to gaining perspective on the incident(s), that there are lessons to be learned, and forgiving the person, people, and/or circumstances that caused their illness and/or pain. 

How can you make this process easier for your client?  First, you can make the process easier by understanding that Reason and Reflection are related to the patient's coping skills and how they view their spirituality.  Many people use religion as a coping skill.  Their spirituality fills their needs by allowing them to "form emotional reassurance, positively frame problems, accept limits of personal control, and guidance in problem solving" (Hall, Meador, & Koenig, 2008, p. 150).   Knowing that the client's actions are based on reason and reflection, this allows you to know their level of coping skills, whether they are in spiritual distress, determine any potential interventions, and gain an understanding of the client's world view to provide better service (Young & Koopsen, 2011, p. 149). In short, this lets you know the client's level of hope regarding their circumstances.

Learning a client's religious belief system guides you to contacting appropriate resources.   Clients often rely on their relationships with family and friends to provide support in times of great physical and emotional stress.  Knowing who the client trusts allows you to enlist their assistance in a successful outcome.  Restoration is a return to a healthy body, mind and spirit – or as healthy as possible.   Sometimes, acceptance of their current reality – whether it is a full return to health or the best it can be – is the greatest gift.

Why does cultural sensitivity in healthcare matter?  Typically, the same procedures will be used to treat the patient regardless of their beliefs and behaviors.  So, why does it matter in a healthcare practice whether or not the provider is aware and sensitive to the patient's beliefs?  Why is this issue even a concern?  "Provision of culturally competent healthcare has been an area of increasing focus in research due to increased mobility of individuals and increased ethnic and cultural diversity within the populations being served" (Vogler,  Altmann, & Zoucha, 2010, p. 6). When speaking of cultural competency in care-giving, few people can have a full understanding of another culture's behaviors, beliefs and practices.  Thus, it is important to focus instead on cultural understanding and support of that culture's practices.  It is far better to ask questions in a friendly and supportive way than to presume you already know the answer.  It is also important to remember that every person is an individual.  Just because they have a specific cultural or ethnic background does not mean they follow those practices. 

There is a "four-dimensional model of spiritual and religious belief and practice: 1) religious practices and rituals; 2) relationship to a superior being; 3) social support from a community sharing similar beliefs; 4) a sense of meaning derived from an existential perspective" (Hall, Meador, & Koenig, 2008, p. 146).  When working with children it is likely they do not fall into this model.  It is helpful to have a separate assessment prepared to rely upon when working with children who have a chronic or terminal illness.   If you are in a situation where you need to provide services for a child it is critical to understand the family's orientation as well as the individual child's preferences.  You should be prepared for differences between the two, especially when the child is in the adolescent age range.  According to Tanyi, "it is best to interview each individual in the family as responses on how to incorporate spirituality in their care would also add understanding to their unique spiritual needs. (2006, p. 290).  Assessing the primary family member's spiritual and religious beliefs, behaviors, and rituals will help guide you as you work with the child. 

When working with children the caregiver needs to remember the child typically knows far more than they let on with their parents.  You should be prepared to answer the questions "am I going to die?" and "what will happen to me when I do?" in children who have a terminal illness.  These are questions the child knows they cannot ask of their family.   If you have a thorough assessment, you have a better opportunity to answer the child's question in a way that aligns with the family's beliefs.

Caring for people of any age who are in the process of dying and people who are grieving is another area where having knowledge of the person's spiritual beliefs is vital.  This period is one of the most challenging changes in life for many people.  The provider's role can be multifaceted.  Comfort can be offered to the patient by sitting with the patient/client, talking, gentle care, and simply being present.  According to Young and Koopsen, "the place of death is not as important as the care, trust, compassion, acceptance, and love that are provided and shared at this time" (2011, p. 244).  Even if the patient is unconscious they know someone is with them. 

No assessment tool fits all scenarios.  As Kavar states, "it is vital that clinicians consider what role spirituality is likely to play in the treatment of clients and develop assessment strategies based on the unique client population and treatment provided" (2012, p. 53). Ultimately, "the goal of [treatment] is to improve an individual's functioning in the world" (Kavar, 2012, p. 27).

 

References:

Hall, D., Meador, K., and Koenig, H. (2008). Measuring religiousness in health research: review and critique.  Journal of Religion & Health. Jun2008, Vol. 47 Issue 2, p134-163.

Tanyi, R. (2006). Spirituality and family nursing: spiritual assessment and interventions for families. Journal of Advanced Nursing, 53(3).

Vogler, J., Altmann, T., and Zoucha, R. (2010). Native Hawaiian Attitudes of Culturally Sensitive Healthcare Provider Traits and Behaviors.  Journal of Cultural Diversity. 17(3):90-8.

Young, C. and Koopsen. C.  (2011).  Spirituality, Health and Healing: An Integrative Approach (2nd ed.). Sudbury, MA: Jones and Bartlett. 

 

© 2013 Lynne Trevisan

 

 

Lynne Trevisan, College of Health, Human Services, and Science, Ashford University


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Metapsychology Online Reviews
ISSN 1931-5716