Using Spirituality in the Treatment of Trauma
Journal Articles:
Popular Media:
Peter A. Levine PhD - Spirituality & Trauma
https://www.youtube.com/watch?v=8_pkgi-qdyQ
Do your spiritual beliefs help or hinder healing psychological wounds? Peter Gerlach
https://www.youtube.com/watch?v=fo7sM5DqNlU
Spirituality vs Religion ~ Eckhart Tolle
https://www.youtube.com/watch?v=e8LuFUJvcOU
Case Example:
Debra is a 60 year old female who is suffering from severe anxiety, severe depression and marital problems. She comes into counseling to learn how to be a better employee and a better spouse. A bio-psychosocial is completed by the therapist along with a depression inventory and an anxiety inventory. She scores off the charts for both. Later a PTSD inventory is also completed. The client is diagnosed with PTSD and a recurrent Depressive Disorder. Medical issues include high blood pressure, acid reflux, and overall undiagnosed body pain.
Client has a lengthy history of childhood abuse and abandonment. She spent six years in foster care, as a child, after her father died of an overdose, and her mother continued to use drugs. Client was sexually abused by her foster father from ages 8-12 and then was returned home after her mother gained custody. Client was then sexually abused by her step-father until she got pregnant, by her abusive boyfriend, and was married at age 16. Throughout her 12 year marriage she was sexually and physically abused by her husband. Several times she went to her minister to ask for help and she was told that she needed to become more submissive, and that since he was her husband, what she thought was sexual abuse wasn’t. She ended up in a domestic violence shelter after he allowed a friend of his to come home and rape her. They were divorced and she lived on her own for years. The church allowed him to remain and they asked her to leave because of the divorce. After 5 years of living alone she met her current husband and they have been married ever since.
As the stress at work has risen and she is not able to maintain a “perfect” home, she continues to get more and more depressed. Her husband is almost 15 years older than her, and due to health issues, cannot help in the home the way he did in the past. Client reports becoming verbally abusive towards her husband, due to stress, and this, in turn, causes both nightmares and flashbacks of past trauma. Due to the fact that she identifies with being a good Christian she feels tremendous guilt about her divorce and her current behavior. She also feels tremendous abandonment from God for having these awful things happen to her.
ACA Code of Ethics:
A.2.c. Developmental and Cultural Sensitivity
Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly (American Counseling Association, 2014).
State of Tennessee Counselor Rules and Regulations
0450-01-.13 PROFESSIONAL ETHICS. Copied from the State of Tennessee, Licensed Professional Counselor rules and regulations (CHAPTER 0450-01 General Rules for Professional Counselors, 2014).
All licensees and certificate holders shall comply with the current code of ethics adopted by the American Counseling Association, except to the extent that it conflicts with the laws of the state of Tennessee or the rules of the Board. If the code of ethics conflicts with state law or rules, the state law or rules govern the matter. Violation of the code of ethics or state law or rules may subject a licensee or certificate holder to disciplinary action.
(1) The certified professional counselor and licensed professional counselor and anyone under his supervision shall conduct their professional practice in conformity with the legal, ethical and professional standards promulgated by the Board under its current statutes and rules and regulations.
(2) Each applicant and certificate holder or licensee is responsible for being familiar with and following this code of ethics.
(3) A copy of the code of ethics may be obtained by writing the American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304.
(4) In the event an applicant, certificate holder, licensee, or other individual has a question regarding legal, ethical, and professional standards neither the Board nor its administrative personnel shall consider such questions unless presented with a proper petition for a declaratory order, subject to the requirements set forth in T.C.A. § 4-5-223.
(5) In addition to the other requirements of this rule, all licensees and certificate holders who practice counseling electronically shall comply with the Ethical Standards for Internet Online Counseling adopted by the American Counseling Association, www.counseling.org, except to the extent that they conflict with the laws of the state of Tennessee or the rules of the Board. If the standards for the ethical practice of internet counseling conflict with state law or rules, the state law or rules govern the matter. Violation of the standards for the ethical practice of web counseling or state law or rules may subject a licensee or certificate holder to disciplinary action.
Ethical Problem Solving Model:
There are many different aspects to this case and many moral delemas that need to be addressed. Stadler (1986) believed in her model that it is critically important that the counselor needs to conscientiously be aware to reduce the impact of their own values on the client. It is for this reason that Stadler’s model was chosen. Each step of the model will be addressed in this context.
American Counseling Association. (2014). 2014 ACA code of ethics. Retrieved May 15, 2014, from counseling.org: http://www.counseling.org
Bormann, J. E., Liu, L., Thorp, S. R., & Lang, A. J. (2012). Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD. International Journal of Behavioral Medicine, 19, 496-502. doi:10.1007/s12529-011-9186-1
Bowland, S., Edmond, T., & Fallot, R. D. (2012). Evaluation of a spiritually focused intervention with older tauma survivors. International Journal of Behavioral Medicine, 73-75. doi:10.1093/sw/swr001
Cervantes, J. M. (2010). Mestizo spirituality: Toward an integrated approach to psychotherapy for Latina/os. Psychotherapy, Theory, Research, Practice, Training, 47(4), 527-539. doi:10.1037/a0022078
Cottone, R. R., & Claus, R. E. (2000, Summer). Ethical decision-making models: A review of the literature. Journal of Counseling and Development, 78, 275-283.
Gerlach, P. (2011, December 18). youtube. Retrieved from youtube.com web site: https://www.youtube.com/watch?v=fo7sM5DqNlU
Levine PhD, P. A. (2012, August 5). youtube. Retrieved from youtub.com web site: http://www.youtube.com/watch?v=8_pkgi-qdyQ
Tolle, E. (2011, August 14). youtube. Retrieved from youtube.com web site: http://www.youtube.com/watch?v=e8LuFUJvcOU
Walker, D. F., & Aten, J. D. (2012). Future directions for the study and application of religion, spirituality, and trauma research. Journa of Psychology and Theology, 40(4), 349-353. doi:0091-6471/410-730
Wortmann, J. H., Park, C. L., & Edmondson, D. (2011). Trauma and PTSD symptoms: Does spiritual struggle mediate the link? Psychological Trauma: Research, Practice, and Policy, 3(4), 442-452. doi:http://dx.doi.org.libproxy.edmc.edu/10.1037/a0021413
Peter A. Levine PhD - Spirituality & Trauma
https://www.youtube.com/watch?v=8_pkgi-qdyQ
Do your spiritual beliefs help or hinder healing psychological wounds? Peter Gerlach
https://www.youtube.com/watch?v=fo7sM5DqNlU
Spirituality vs Religion ~ Eckhart Tolle
https://www.youtube.com/watch?v=e8LuFUJvcOU
Case Example:
Debra is a 60 year old female who is suffering from severe anxiety, severe depression and marital problems. She comes into counseling to learn how to be a better employee and a better spouse. A bio-psychosocial is completed by the therapist along with a depression inventory and an anxiety inventory. She scores off the charts for both. Later a PTSD inventory is also completed. The client is diagnosed with PTSD and a recurrent Depressive Disorder. Medical issues include high blood pressure, acid reflux, and overall undiagnosed body pain.
Client has a lengthy history of childhood abuse and abandonment. She spent six years in foster care, as a child, after her father died of an overdose, and her mother continued to use drugs. Client was sexually abused by her foster father from ages 8-12 and then was returned home after her mother gained custody. Client was then sexually abused by her step-father until she got pregnant, by her abusive boyfriend, and was married at age 16. Throughout her 12 year marriage she was sexually and physically abused by her husband. Several times she went to her minister to ask for help and she was told that she needed to become more submissive, and that since he was her husband, what she thought was sexual abuse wasn’t. She ended up in a domestic violence shelter after he allowed a friend of his to come home and rape her. They were divorced and she lived on her own for years. The church allowed him to remain and they asked her to leave because of the divorce. After 5 years of living alone she met her current husband and they have been married ever since.
As the stress at work has risen and she is not able to maintain a “perfect” home, she continues to get more and more depressed. Her husband is almost 15 years older than her, and due to health issues, cannot help in the home the way he did in the past. Client reports becoming verbally abusive towards her husband, due to stress, and this, in turn, causes both nightmares and flashbacks of past trauma. Due to the fact that she identifies with being a good Christian she feels tremendous guilt about her divorce and her current behavior. She also feels tremendous abandonment from God for having these awful things happen to her.
ACA Code of Ethics:
A.2.c. Developmental and Cultural Sensitivity
Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly (American Counseling Association, 2014).
State of Tennessee Counselor Rules and Regulations
0450-01-.13 PROFESSIONAL ETHICS. Copied from the State of Tennessee, Licensed Professional Counselor rules and regulations (CHAPTER 0450-01 General Rules for Professional Counselors, 2014).
All licensees and certificate holders shall comply with the current code of ethics adopted by the American Counseling Association, except to the extent that it conflicts with the laws of the state of Tennessee or the rules of the Board. If the code of ethics conflicts with state law or rules, the state law or rules govern the matter. Violation of the code of ethics or state law or rules may subject a licensee or certificate holder to disciplinary action.
(1) The certified professional counselor and licensed professional counselor and anyone under his supervision shall conduct their professional practice in conformity with the legal, ethical and professional standards promulgated by the Board under its current statutes and rules and regulations.
(2) Each applicant and certificate holder or licensee is responsible for being familiar with and following this code of ethics.
(3) A copy of the code of ethics may be obtained by writing the American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304.
(4) In the event an applicant, certificate holder, licensee, or other individual has a question regarding legal, ethical, and professional standards neither the Board nor its administrative personnel shall consider such questions unless presented with a proper petition for a declaratory order, subject to the requirements set forth in T.C.A. § 4-5-223.
(5) In addition to the other requirements of this rule, all licensees and certificate holders who practice counseling electronically shall comply with the Ethical Standards for Internet Online Counseling adopted by the American Counseling Association, www.counseling.org, except to the extent that they conflict with the laws of the state of Tennessee or the rules of the Board. If the standards for the ethical practice of internet counseling conflict with state law or rules, the state law or rules govern the matter. Violation of the standards for the ethical practice of web counseling or state law or rules may subject a licensee or certificate holder to disciplinary action.
Ethical Problem Solving Model:
There are many different aspects to this case and many moral delemas that need to be addressed. Stadler (1986) believed in her model that it is critically important that the counselor needs to conscientiously be aware to reduce the impact of their own values on the client. It is for this reason that Stadler’s model was chosen. Each step of the model will be addressed in this context.
- Identify competing
principles – There are many competing principles in this client’s history: sexual abuse, abandonment, being a “perfect
person”, and core religious values.
- Secure additional
information – Client needs time to process all of these issues and needs to
identify which area of her life she wants to address.
- Consult with colleagues –
May need to get information about the religious denomination that this client
identifies with and get facts about the beliefs about marriage, violence, roles
etc. Also may need support and feedback
from colleagues on an ongoing basis as the client processes her trauma.
- Identify hoped for outcomes –
Discuss with client what she wants the outcome of therapy to be, can this be
measured, and is this appropriate and attainable.
- Brainstorm actions to
achieve outcome – Small steps to achieve client’s outcome of therapy.
- Evaluate effects of action –
What will be the consequences of these steps and can she live with them.
- Identify competing nonmoral
values – Are there conflicting core value beliefs about this situation?
- Choose the course of action.
- Test the course of action –
How is the outcome measured?
- Identify steps, take action,
evaluate. Repeat?
American Counseling Association. (2014). 2014 ACA code of ethics. Retrieved May 15, 2014, from counseling.org: http://www.counseling.org
Bormann, J. E., Liu, L., Thorp, S. R., & Lang, A. J. (2012). Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD. International Journal of Behavioral Medicine, 19, 496-502. doi:10.1007/s12529-011-9186-1
Bowland, S., Edmond, T., & Fallot, R. D. (2012). Evaluation of a spiritually focused intervention with older tauma survivors. International Journal of Behavioral Medicine, 73-75. doi:10.1093/sw/swr001
Cervantes, J. M. (2010). Mestizo spirituality: Toward an integrated approach to psychotherapy for Latina/os. Psychotherapy, Theory, Research, Practice, Training, 47(4), 527-539. doi:10.1037/a0022078
Cottone, R. R., & Claus, R. E. (2000, Summer). Ethical decision-making models: A review of the literature. Journal of Counseling and Development, 78, 275-283.
Gerlach, P. (2011, December 18). youtube. Retrieved from youtube.com web site: https://www.youtube.com/watch?v=fo7sM5DqNlU
Levine PhD, P. A. (2012, August 5). youtube. Retrieved from youtub.com web site: http://www.youtube.com/watch?v=8_pkgi-qdyQ
Tolle, E. (2011, August 14). youtube. Retrieved from youtube.com web site: http://www.youtube.com/watch?v=e8LuFUJvcOU
Walker, D. F., & Aten, J. D. (2012). Future directions for the study and application of religion, spirituality, and trauma research. Journa of Psychology and Theology, 40(4), 349-353. doi:0091-6471/410-730
Wortmann, J. H., Park, C. L., & Edmondson, D. (2011). Trauma and PTSD symptoms: Does spiritual struggle mediate the link? Psychological Trauma: Research, Practice, and Policy, 3(4), 442-452. doi:http://dx.doi.org.libproxy.edmc.edu/10.1037/a0021413