Discussing Trauma, Addiction and Spirituality - Brill
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Discussing Trauma, Addiction and Spirituality
Peter Bray
Abstract
The following chapter outlines a series of discussions held over a twelve month
period with a group of New Zealand mental health professionals. The clinicians are
associated with a residential unit and they work with clients who have alcohol and
substance addictions. As most of the participants work as counsellors in settings
that are influenced by the medical model, they wanted to discover how far their
utilisation of, and interest in, spiritual orientations of professional practice might be
recognised and developed as an aid to therapy. Naturally they were concerned to
explore how they might work in this way in a perceived atmosphere of institutional
judgement. As the group freely explored their own spirituality in the context of
their professional relationships with clients and the institution, it highlighted the
positive benefits of their own non-denominational spirit-led practices. As they
discussed addiction as originating in an act of self-medicating survival that
supports the individual to overcome behaviours which originate in trauma, they
began to consider recovery as a spiritually inspired self-actualising process.
Although the initial aim of the group was to explore the significance of spirituality
in clients’ presentations and to identify similar principles and beliefs that might
underpin their own professional practice, a central theme began to emerge that
resonated deeply with the group’s participants. It suggested that the experience of
trauma significantly disrupts, or wounds, human beings’ tendencies to actualise,
forcing them down less effective pathways to achieving or recovering the capacity
to reach higher levels of consciousness. Addiction was therefore conceived not
only as a false or unwelcome outcome of the struggle to meaning, a detour in the
human journey into actualisation, but also as an adaptive process of recovery. In
this context, counsellors saw themselves working with clients in a spiritual quest to
reconnect their clients with their lost potential.
Key Words: Addiction, counselling, co-existing problems, competence, growth,
mental health, recovery, self-actualisation, spirituality, trauma.
*****
1. Introduction
There is an undeniable link between trauma and addiction.1 It has been
estimated that there is a higher incidence of alcohol and substance addiction in
individuals who have been impacted by stressful life events, such as histories of
physical and/or sexual trauma, than those in the general population who have not.2
There is also strong evidence to suggest that individuals with co-existing mental
health problems (CEP) use drugs and alcohol to avoid and/or to suppress the
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access138 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
distressing effects of trauma and that a substance abusing lifestyle may predispose
them to experience further traumatic events.3 As a result, many clients seeking
treatment for substance addiction require trauma treatment services and vice versa.
Research also suggests that certain types of trauma can cause existential and
spiritual crises and that addressing them can improve psychological and
behavioural health.4
Spirituality also has a significant part to play both in the prediction of recovery
and in improving addiction treatment outcomes. In cases where individuals have
recovered successfully and positively maintained their changes, increases in the
levels of spirituality between treatment entry and graduation have been noted.5 It
also appears that a significant aspect of recovery from addiction, arguably a
parallel to post-traumatic processes, is that over time individuals manage behaviour
changes that depend upon successfully addressing struggles with existential
meaning and the construction of durable narratives that incorporate new beliefs and
goals. Thus, interventions that utilise personal spiritual resources can provide
support to manage or resolve addiction, traumatic responses and other CEPs.6
Although interventions that involve spiritual beliefs are difficult to evaluate those
that incorporate non-denominational approaches are effective at reducing trauma
symptoms.7
The following presents the context and points of view of nine therapists at an
addictions centre in New Zealand.8 A series of ten ninety minute conversations was
facilitated with the group in which they discussed their experiences of trauma and
spirituality work with clients affected by alcohol and substance addictions. This
chapter incorporates some of their reflections on spirituality and its relevance to
their practice.
2. A Special Interest Discussion Group on Spirituality
A. The Group
How do we identify spirituality in the medical model? Name it as
part of our practice . . . normalise it amongst our peers? We’ve
talked about our own spirituality and the client’s and how that
comes together in a collaborative therapeutic partnership. Now
we are talking about what we do in addictions and how
spirituality fits into that. How our spiritual journey has led us to
this moment and how we can become a vehicle for our clients’
spiritualties and raise their awareness.9
Coming from an eclectic practice base the discussion group all agree that
‘addiction is a chronic relapsing brain disease characterized by compulsive
behaviour’10 that causes psychological and physical harm to individuals, their
families and communities. They also recognise that in the process of recovery,
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 139
__________________________________________________________________
forms of spiritual rehabilitation are useful in penetrating their clients’ complex
psychological defences.11
Almost all of their clients have mental health CEPs, particularly post-traumatic
stress, ‘PTSD and Axis II disorders,’12 many derived from traumatic wounding in
childhood. Their clients present with active mood, anxiety, personality, and eating
disorders, and PTSD characterized by persistent maladaptive symptoms related to
the trauma, including blunted emotional responses, hyper-arousal, and
flashbacks.13
As our conversations ranged around spirituality, addictions, and trauma it was
clear that the group members wanted to examine the impact of their spiritual
experiences on professional practice. Their concern to address these issues
corresponds to a developing trend in mental health and addictions recovery
literature.14 Consequently, discussions involved a good deal of self-reflection that
recognised the importance of spirituality in client work.15 The group’s comfort
with their own spirituality and enthusiasm for examining spirituality in action was
deeply encouraging and contradicted studies where health professionals have been
‘lukewarm’ about spiritual interventions and regarded them as ‘pertaining more to
the private than to the public dimension of their own approach to the treatment of
“addictions.”’16
Correspondingly, the group was anxious not to be identified or regarded as
psychologically similar to their clients in case they might be seen to be
contradicting the professional and clinical expectations of their funders. As one
group participant put it, ‘How much of ourselves, the person and the clinician, are
we to acknowledge and accommodate in our future discussions? I fear disclosing
my spiritual side to the institution, to judgement.’ Whilst recognising that using
spirituality as an intervention works in their therapeutic practices, ‘It is still an
uncomfortable fit with the medical model’ and not an accepted or demonstrable
part of their practice with clients.17
B. The Mental Health and Addictions Treatment Centre
Over an eight week residential programme the centre works with clients who
meet the Diagnostic and Statistical Manual of Mental Disorders definition for
substance dependence: ‘a pattern of repeated self-administration that can result in
tolerance, withdrawal, and compulsive drug-taking behaviour.’18 Acknowledging
the relationship between substance use and trauma-related mental health problems,
clients are those that have committed to being substance-free, and ‘who don’t have
healthy environments to grow up in, are unable to make healthy choices, or are
afflicted by external traumatic events which have disempowered them.’19
What we are really trying to get to are the behaviours that guide
clients’ addictive behaviours. Looking at the cause as well as the
effect . . . We don’t often talk about drugs and alcohol but we do
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access140 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
talk about behaviour and the things that led to substance use -
these are just as much a part of the addictive behaviours as using
the substances.
C. Pathways to Recovery
Looking for a pathway that both respects the intangible nature of clients’
experiential styles and responds to the expectations and constructions of the
medical institution is a genuine challenge. ‘Either we are accused of being too
cautious or unclear in our assessments or we only tick the boxes that enable us to
be accountable.’ In such cases the difficulties entailed in using value-laden
vocabulary like ‘faith’ or having a ‘Higher Power’ are clearly challenging when it
comes to completing conventional medical assessment documentation.
Counsellors provide a number of structured activities which include regular
individual and group counselling, psycho-educational training, skills development,
and recovery reviews. Currently, ‘Spiritual and Cultural’20 is a designated reporting
area in their clients’ Recovery Action Plan, and the group were particularly
interested about how they might tackle this in a more pro-active manner.
Previously counsellors had interpreted this quite narrowly with clients and our
discussions permitted them to step outside their clinical remit and reinterpret their
clients’ ‘church and religious activities in broader spiritual terms.’ Strongly
influenced by the medical model of practice they suggested that the only areas
where it seemed acceptable to deal with a client’s spirituality were when discussing
formal Christian values and Mäori culture, which meant that they had to ‘work
covertly with one eye watching our backs.’21 The discussion group provided safe,
‘nurturing and self-care to support each other to safely articulate spirituality within
the medical model.’
In conventional 12-step groups the connection between spirituality, substance
misuse, and intoxication are well established.22 Likewise whilst these helpers
informally accept the inherent wisdom of using spirituality as a tool for recovery,
the centre only minimally refers to it by name in documentation.23 Anecdotally,
there is resistance here to the 12-step doctrine suggesting that the fellowship’s rigid
one-size-fits-all approach does not align with the unique requirements of their
clients.24 However, frequently borrowed elements like ‘making amends,’
‘surrendering,’ and being ‘powerless to your addiction’ are successfully included
in the therapists’ work.25
3. Talking About Trauma and Spirituality
A. What is Spirituality in Counselling and Addictions Work?
The literature suggests a beneficial relationship between spirituality, religion,
and recovery from substance use disorders. Also coming to this conclusion the
group defined ‘spirituality’ as a relationship or consciousness nested in a larger
context of meaning, and through their discussions began to bring together a
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 141
__________________________________________________________________
number of concepts previously captured by the American Counseling
Associations’ Summit on Spirituality. They described spirituality as an actualising
tendency, one that directs an individual ‘towards knowledge, love, meaning, hope,
transcendence, connectedness, and compassion . . . creativity, growth, and the
development of a values system.’26 However, acknowledging the difficulty, bias,
and ambiguity generated by distinctions, and rather than seeking specific
definitions, the group chose to surrender personal definitions and to work within
those existing traditions already formed by professionals working in an addictions
and mental health service roles. Arguably this is a limitation but it also reveals in
some measure the participants’ hesitancy in offering a hitherto private aspect of
themselves for scrutiny within the potentially judgemental shadow of the medical
institution.
Constrained by life experiences, knowledge and values, or the particular
theories that underpin their practices, and the context and disposition of clients,
counsellors and other health professionals generally find it difficult to consider
integrating spirituality into their professional practices.27 Studies suggest that
although individuals recovering from addictions frequently cite spirituality as a
supportive influence, ‘clinicians’ perceptions of their clients’ spiritual needs have
sometimes appeared alarmingly inaccurate.28 Similarly in addictions work, clients
and their counsellors who bring spiritual, religious, or mystical experiences and
beliefs to their work are not always sympathetically received or understood when
they coexist with symptoms of substance misuse. Arguably, the language of
‘transformation from addiction to recovery is best explained by recovering addicts
themselves.’29
B. Spirituality and Addictions Work
Nearly half the discussion group professionals were recovered addicts, and/or
had experienced difficult life events or trauma. Although nervous about disclosing
the spiritual dimensions of their private and professional lives or being judged
severely by their peers, the group agreed that increasing their personal awareness
must enhance their capacity to work competently with their client’s spiritual
experiences.
The group made two overarching assumptions: clients and counsellors bring a
level of spirituality to their work; spirituality is a positive resource for clients
managing the trauma of addiction.30 Subsequently, the group aimed to explore the
ways that they positively admit spirituality into their clinical settings, therapeutic
relationships, and practices. They also identified how it impacts upon their work in
the institution and conceptualised how their approaches to practice might be
integrated into a working model.
The ten sessions proved to be a journey of self-discovery; members took
spiritual inventories, sought intra-psychic connection, considered spirit-centred
interventions, and generously shared spiritual experiences that deepened their
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access142 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
working relationships. Alongside deeply moving disclosures, models and
interventions that placed trauma and spirituality at their centre, either as mutual or
singular outcomes of addiction, as triggers, or as processes of psychological
development and personal growth were carefully discussed.31
Raising the point that some trauma or crises leave unexplained and
‘consciously withheld’ experiences, one group member disclosed that she is aware
of a permanent parallel dream-like thread of consciousness that accompanies and
informs her day-to-day living and her practice like a continuous sense of déjà vu. ‘I
am not mad but I have these experiences.’32 This opportunity to bring these
‘aspects of ourselves as professional people’ was warmly welcomed.
It was agreed that clients want their counsellors to see them as whole people
with resources that inform their wellbeing and provide healing.33 Spirituality as a
core component of a client’s life experience, may either be viewed as a positive
resource for coping or one that has the capacity to negatively contribute to mental
pathology, making it important for the group to ‘to know who we are before we
help others to address their spiritual natures.’34 Here a significant point emerged
concerning professional training. One of the group stated that she had been
traumatically ‘dismembered’ by counselling training had ‘been in recovery ever
since . . . Being so fragmented comes with a price but allows us to also be more
fully exposed and known.’ Whilst another explained how she ‘knew’ that she
couldn’t be a counsellor unless she undertook her own journey. Discussing suicide
and other traumatising aspects of her life, she explained that she had ‘had just
walked on from . . . I hadn’t done my grieving,’ emphasising there were things that
had to be done if she was going to be of use to others.
As drug use and spirituality are not antithetical, the group regard their work as a
sensitive balancing act that holds quite contradictory notions for both counsellors
and clients. For example, in order to fulfil a desire for wholeness, a relationship
with Creation, human beings seek sacred and spiritual experiences, and for many
spirituality and drug use are not incompatible.35 Spiritual experience may be
quickly achieved through the use of substances or through deliberate training.
However, personally traumatic and alienating experiences do disrupt these
meaningful attachments and subsequently become the drivers for behaviours that
support addictions and create further isolation. In short, there is a significant link
between the temporary fulfilment of addiction and the desirability of surrendering
to spiritual wholeness.
Although it was agreed that counsellors do not generally indulge in delusory
‘“benefit-finding” or looking for “silver-linings” where there are none,’ they were
wary about ‘rationalising suffering and pain by positively projecting upon client
experiences spiritual explanations.’
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 143
__________________________________________________________________
C. Admitting Spirituality into Practice
The group agreed that as clients and counsellors do not have two dimensional
existences a key factor in therapy is how to effectively identify and align spiritual
orientation within the therapeutic relationship. It was suggested that spirituality is a
relational connection. One counsellor recounted her experience of being with a
suicidal client who ‘had lost the ability to carry on,’ and identified her client’s
spirituality as a ‘thread that might help her to survive.’ In this case the counsellor’s
role was to hold and nurture that fragile ‘piece . . . Until they [clients] are ready to
pick it up again.’ Considering the Jungian collective unconscious, another clinician
discussed possessing psychological radar that, using intuition or a higher level of
consciousness, taps into the ‘energy that permeates everything and everywhere.’36
Another described her intimate ability to receive client data in terms of graphic
impressions; ‘I get things [pictures] in my head that don’t belong to me.’ Another
counsellor suggested that the spiritual experience of counselling was derived from
empathic awareness, whilst another freely introduced the notion of determinism by
suggesting that the encounter could be regarded as pre-designed.37
It was agreed that spirituality permeates all practice either as it is introduced by
the therapist or provided by the experiences of the client.38 ‘Positioning with our
client’s consciousness is about awareness and accommodation’ and ‘expanding our
consciousness.’ To regard spirituality as a private area even to counselling would
be to ignore or diminish the significance of client belief and the power of their
spiritual capacity.39 Reflecting on the group’s carefulness around disclosing
spiritual experience, it was assumed that the same reluctance and resistance might
be experienced by clients.
Although spiritually-sensitive or spirit-centred approaches to counselling
allowed group participants to put their ‘spiritual eyes on’ and to ‘feel genuinely
more connected’ they confessed to not having had any formal training in working
in this way with clients.40 Relying on their own convictions to guide their work,
they were critical of ‘linear, clinical, and cold’ training programmes that by
omission deny a spiritual dimension of existence.41 In addition they noted with
some caution that the influence of addiction psychiatry, originating in the
Kraeplinian model of mental disorders with its bias toward bio-organic causes,
holds little regard for spiritual experiences and those that espouse them.42
Participants seemed to have quite independently experienced the restrictions
caused by the institutional requirements of a medical framework, being
undervalued and feeling vulnerable to professional misinterpretation. An example
given of a local psychologist’s removal because of his unconventional beliefs
about spiritual guardians was particularly telling and emphasised the impediments
to communication caused by a zealously policed and sanitised bicultural and
ethical practice. They suggested rather, that the counsellor’s role is to include the
spiritual material that clients present, appreciate its positive contribution to healthy
mental and social functioning, and learn to recognize when it begins to activate and
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access144 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
shape pathology rather than resolving it.43 The group identified their trauma
survivors as engaged in an actualising process that develops resilience and includes
a growing familiarity with a spiritual component.
They have more experience of distressing circumstances –
developed spiritual muscles - and therefore have pushed to the
line between the natural and the supernatural . . . they have gone
to places that have prepared their psyches to connect with the
numinous.
4. Conceptualising Trauma and Spirituality
One of the group’s initial aims was to consider a common-sense model of
spirit-led practice that corresponds to the clinicians’ experiences of spirituality in
trauma and addiction recovery work.44 They began by conceptualising recovery as
a survival process that equips the individual to overcome behaviours, in this case
addictions, which originate in trauma. Later they incorporated self-actualisation in
the survival process and suggested that it is fuelled by spirit and facilitated in a
spiritual dimension. Their ideas suggest that trauma significantly disrupts or
wounds the human organism’s natural tendency to actualise and creates less
effective pathways to achieving or recovering the capacity to reach, higher states of
consciousness. Thus the group conceived of addiction as the false or unwelcome
outcome of a struggle to meaning in a disrupted journey, and the process of
recovery as a spiritual quest to recover and reconnect the client with their lost
potential. It was also agreed that even though the identification of spiritual
resourcing may be difficult it seems to have a place in the process of recovery
likened to a ‘shamanic’ journey beyond trauma.
You have come through the pain. You have come through the
experience and you have come back with the word and the
knowledge and you know that there is a door – you know that
there is a way out. You know the route.
The clinician’s role as a guide is to assist the client in this integrative process of
reattachment and realignment ‘so that the journey can continue.’ This rupture is
used as a ‘space where informed choices are being made and actions are tentatively
taken, disruptions are being challenged, and meaning and learning is happening.’
The group agreed that for some this space was more complicated than for others, ‘I
experience the clients here as the more sensitive souls in the world.’ Subsequently,
less vulnerable and in recovery, clients find it easier to look back upon their
experiences as necessary and valuable, ‘Clients are grateful for their addiction
journeys because they can’t hide from the insights they provide about themselves,
who they once were, and how to relate again to the world.’ For the client,
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 145
__________________________________________________________________
. . . the real struggle is to accept that they will need to be
abstinent for the rest of their lives . . . That they can never use
substance again as a coping mechanism - is the real trauma.
These counsellors hold the tense space between the institutions of our society
and their clinical obligations to honour and work with their client’s experiences.
They recognise that the ‘addict’ is not the totality of the client, or merely a broken
part searching to fulfil its seemingly insatiable appetites. They understand that
there is something greater going on. Human beings have the need to be whole, to
be all that they can be and this is only finally resolved in nurturing relationship
with others in their communities and through life affirming and meaningful
activities. Unfortunately, many recovering addicts return to the places where their
traumas began and where their greatest challenge is to continue with their abusers
and those they have abused who may need as much help as they do. Nevertheless,
in spite of the deficits of our society counsellors and their clients continue to do
their work to reintegrate the needy and vulnerable parts of the clients’ with the
whole. Together they engage in meaningful relational processes that draw upon
profound personal resources to facilitate recovery and transformation. ‘That is
spiritual . . . that’s a miracle!’
Notes
1
Center for Substance Abuse Treatment, ‘Anxiety Disorders’, Assessment and
Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug
Abuse. Treatment Improvement Protocol [TIP] Series 9, DHHS Publication No.
SMA 95-3061 (Rockville: Substance Abuse and Mental Health Services, 1994),
viewed on 6 August, 2014.
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hssamhsatip&part=A30236;
Office of Applied Studies, Substance Abuse and Mental Health Services
Administration (SAMHSA), ‘Mental Health Screenings and Trauma-Related
Counseling in Substance Abuse Treatment Facilities,’ The N-SSATS Report,
September 30, 2010; Center for Substance Abuse Treatment, Trauma-Informed
Care in Behavioral Health Service: Treatment Improvement Protocol (TIP) Series,
No. 57 (Rockville: Substance Abuse and Mental Health Services Administration,
2014).
2
Louise Langman and Man Cheung Chung suggest that the incidence falls within a
range of 15-55% higher than the general population. Louise Langman and Man
Cheung Chung, ‘The Relationship between Forgiveness, Spirituality, Traumatic
Guilt and Posttraumatic Stress Disorder (PTSD) among People with Addiction,’
Psychiatry Q 84 (2013): 11-26; Lori Keyser-Marcus, et al., ‘Trauma, Gender, and
Mental Health Symptoms in Individuals with Substance Use Disorders,’ Journal of
Interpersonal Violence nv (2014), viewed, 29 July, 2014.
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access146 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
http://jiv.sagepub.com/content/early/2014/05/06/0886260514532523.
3
Martina Reynolds, Gillian Mezey, Murray Chapman, Mike Wheeler, Colin
Drummond, and Alex Baldacchino, ‘Co-Morbid Post-Traumatic Stress Disorder in
a Substance Misusing Clinical Population,’ Drug and Alcohol Dependence 77
(2005): 251.
4
Alan N. Baroody, ‘Spirituality and Trauma During a Time of War: A Systemic
Approach to Pastoral Care and Counseling,’ Families Under Fire: Systemic
Therapy With Military Families, eds. R. Blaine Everson, and Charles R. Figley
(New York: Routledge, 2010), 165-190; Peter Bray, ‘A Broader Framework for
Exploring the Influence of Spiritual Experience in the Wake of Stressful Life
Events: Examining Connections Between Posttraumatic Growth and Psycho-
Spiritual Transformation,’ Mental Health, Religion and Culture 13 (2010): 293-30.
5
Adrienne J. Heinz, Elizabeth R. Disney, David H. Epstein, Louise A. Glezen,
Pamela I. Clark, and Kenzie L. Preston, ‘A Focus-Group Study on Spirituality and
Substance-Abuse Treatment,’ Substance Use Misuse 451/2 (2010): 134-153.
6
Langman and Chung, ‘The Relationship between Forgiveness,’ 12; Lawrence
Calhoun and Richard Tedeschi Calhoun, eds., Handbook of Posttraumatic Growth:
Research and Practice (London: Lawrence Erlbaum Associates, 2006).
7
Center for Substance Abuse Treatment, Trauma-Informed Care, 104-105.
8
Stanislav Grof, and Christina Grof, eds., Spiritual Emergency: When Personal
Transformation Becomes a Crisis (New York: G. P. Putnam’s Sons, 1989).
9
It was agreed that a recording might be made for future/further discussion and
dissemination. In the following group notes, extracts, and commentary have been
included where appropriate but not specifically referenced throughout the rest of
the chapter.
10
Benita Walton-Moss, Ellen M. Ray, and Kathleen Woodruff, ‘Relationship of
Spirituality or Religion to Recovery from Substance Abuse,’ Journal of Addictions
Nursing 24.4 (2013): 224-225.
11
Harold E. Doweiko, ‘Substance Use Disorders as Symptoms of Spiritual
Disease’ Addiction and Spirituality a Multidisciplinary Approach, eds. Oliver J.
Morgan and Merle Jordan (St. Louis: Chalice Press, 1999), 51.
12
Information confirmed by a local unpublished report, ‘2014 Matua Raki
Workforce Innovation Award’:10; Ingo Schafer, et al., ‘Childhood Trauma and
Dissociation in Patients with Alcohol Dependence and Drug Dependence, or Both:
A Multi-Centre Study,’ Drug and Alcohol Dependence 109 (2010): 87-88.
13
Marian L. Logrip, Eric P. Zorrilla, and George F. Koob, ‘Stress Modulation of
Drug Self-Administration: Implications for Addiction Comorbidity with Post-
Traumatic Stress Disorder,’ Neuropharmacology 62 (2012): 552-564.
14
Since 2009 the American Counseling Association, the ACA has required its
members to satisfy nine ‘Competencies for Addressing Spiritual and Religious
Issues in Counseling’ that assist them to develop a practice framework that allows
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 147
__________________________________________________________________
them to understand and work effectively with clients’ spiritual and religious lives;
J. Scott Young, Marsha Wiggins-Frame, and Craig S. Cashwell, ‘Spirituality and
Counsellor Competence: A National Survey of American Counselling Association
Members,’ Journal of Counseling & Development 85 (2007): 47–52; The
competencies address four domains of counselling practice: knowledge of spiritual
phenomena; awareness of one’s own spiritual perspective; understanding clients’
spiritual perspectives, and spiritually related interventions and strategies;
Currently, the American Spiritual Ethical and Religious Values in Counseling
(ASERVIC) has 6 areas of spiritual concern with 14 competencies. Viewed on 17
May 2014. http://www.aservic.org/resources/spiritual-competencies/; For a British
perspective read John McLeod, The Counsellor’s Workbook: Developing a
Personal Approach (Maidenhead: Open University Press, 2010); William West,
Psychotherapy and Spirituality (London: SAGE Publications, 2001), 17-18.
15
Julie Savage and Sarah Armstrong, ‘Developing Competence in Spiritual and
Religious Aspects of Counseling,’ Handbook of Multicultural Counseling
Competencies, eds. Jennifer A. Erickson Cornish, Barry A. Schreier, Lavita
I.Nadkarni, Lynett Henderson Metzger, and Emil R. Rodolfa (Hoboken: John
Wiley, 2010), 379-413.
16
Valeria Zavan and Patrizia Scuderi, ‘Perception of the Role of Spirituality and
Religiosity in the Addiction Treatment Program among Italian Health
Professionals: A Pilot Study,’ Substance Use & Misuse 48 (2013): 1157-1160.
17
The ‘medical materialism,’ articulated by William James as psychology’s
inability to fully explain religious experiences, nearly a century later has the
capacity to influence therapeutic practice at a grass-roots level. William James, The
Varieties of Religious Experience (New York: Modern Library,1929).
18
American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders, 4th Ed. (Washington: American Psychiatric Association, 2000), 192.
19
Center for Substance Abuse Treatment, ‘Anxiety Disorders.’
20
Mental Health and Addictions Service, ‘Recovery Action Plan,’ (Unpublished
document): 1-5.
21
A majority of the centre’s clients are drawn from Mäori, Aotearoa/New
Zealand’s indigenous population. Mäori recognise the physical realm as immersed
in the spiritual realm, so wairua/spirituality significantly influences people’s
relationships with the living, the dead, and the environment. Fraser C. Todd, Te
Ariari o te Oranga: The Assessment and Management of People with Co-existing
Mental Health and Substance Use Problems (Ministry of Health: Wellington,
2010); read also, Rangimarie Pere, Te Wheke: A Celebration of Infinite Wisdom
(Gisborne, New Zealand: Ao Ako Global Learning New Zealand, 1997); Mason
Durie, Whaiora: Mäori Health Development (Auckland: Oxford University Press,
1994).
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access148 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
22
Herbert Spencer, Appendix II ‘Spiritual Experience,’ Alcoholics Anonymous:
The Story of How Many Thousands of Men and Women Have Recovered from
Alcoholism (New York: A. A. World Services Inc., 2001), 568; Ralph L. Piedmont,
‘Spiritual Transcendence and the Scientific Study of Spirituality,’ Journal of
Rehabilitation 67 (2001): 4-14.
23
The following may provide a useful context for further discussion on this point:
Marc Galanter, Helen Dermatis, Stephen Post, and Cristal Sampson, ‘Spirituality-
Based Recovery from Drug Addiction in the Twelve-Step Fellowship of Narcotics
Anonymous,’ Journal of Addiction Medicine nv (2013): 1-8; Robert Walker,
Thodore M. Godlaski, and Michele Staton-Tindall, ‘Spirituality, Drugs, and
Alcohol: A Philosophical Analysis,’ Substance Use & Misuse 48 (2013): 1233-
1245.
24
Robert Walker and colleagues analysed four problems that they believe required
satisfactory resolution before the applicability of spiritual practices in the 12-step
method could be accepted. Walker, Godlaski, and Staton-Tindall, ‘Spirituality,
Drugs, and Alcohol.’
25
The American Psychological Association summarise the steps as a six phase
process:
1. Admitting that one cannot control one’s addiction or compulsion;
2. Recognizing a higher power that can give strength;
3. Examining past errors with the help of a sponsor (experienced member);
4. Making amends for these errors;
5. Learning to live a new life with a new code of behaviour;
6. Helping others who suffer from the same addictions or compulsions.
Gary R. VandenBos, APA Dictionary of Psychology, 1st ed. (Washington, DC:
American Psychological Association, 2007).
26
Geri Miller, ‘The Development of the Spiritual Focus in Counseling and
Counselor Education,’ Journal of Counseling and Development 77 (1999): 498-
501.
27
For a more detailed discussion read; Peter Bray, ‘Naming Spirituality in
Counsellor Education: A Modest Proposal.’ Special Issue on ‘Counsellor
Education in Aotearoa New Zealand,’ New Zealand Journal of Counselling,
(2011): 76-97.
28
Atheistic denial of sacred realities, and a defensiveness in their presence and
usage, a determined rejection of all but one’s own authentic spiritual path without
recognising or appreciating the diversity of others, or an inability to accept that
individuals may construct their own spiritual meanings might lead to a view that
spirituality is beyond the purview of the counselling professional; read, Brian J.
Zinnbauer and Kenneth I. Pargament, ‘Working with the Sacred: Four Approaches
to Religious and Spiritual issues in Counselling,’ Journal of Counseling and
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 149
__________________________________________________________________
Development 78.2 (2000): 162-171; Heinz, et al., ‘A Focus-Group Study on
Spirituality,’ 134-153.
29
Mary Hansen, Barbara Ganley, and Chris Carlucci, ‘Journeys from Addiction to
Recovery,’ Research and Theory for Nursing Practice: An International Journal,
22.4 (2008): 256-272.
30
West, Psychotherapy and Spirituality; Bray, ‘Naming Spirituality,’ 76-97.
31
Developed from a model of post-traumatic growth proposed by Lawrence
Calhoun and Richard Tedeschi and combined with Stanislav and Christina Grof’s
Holotropic framework of psycho-spiritual growth. Bray, ‘A Broader Framework,’
293-30.
32
Ideas that corresponded perfectly with Ronnie Janoff-Bulman’s work on
shattered assumptions, Ronnie Janoff-Bulman, Shattered Assumptions: Towards a
New Psychology of Trauma (New York: Free Press, 1992).
33
Eugene W. Kelly, ‘The Role of Religion and Spirituality in Counselor
Education: A National Survey,’ Counselor Education & Supervision 33.4 (1994):
227-237.
34
James M. Nelson, Psychology, Religion, and Spirituality (New York, NY:
Springer 2009); Harold G. Koenig, ‘Research on Religion, Spirituality, and Mental
Health: A Review,’ Canadian Journal of Psychiatry 54.4 (2009): 283; Johanna
Leseho, ‘Spirituality in Counsellor Education: A New Course,’ British Journal of
Guidance & Counselling 35.4 (2007): 441-454.
35
Christina Grof, The Thirst for Wholeness: Attachment, Addiction, and the
Spiritual Path (New York: HarperOne, 1993).
36
Pavel Rican and Pavlina Janosova, ‘Spirituality as a Basic Aspect of Personality:
A Cross-cultural Verification of Piedmont’s Model,’ International Journal for the
Psychology of Religion 20.2 (2009): 2-13.
37
Spirituality is at the centre of Carl Rogers’ conceptualisation of the empathic
relationship and his core counselling conditions permit the counsellor to respond to
the client’s deep need for universal attachment and tendency to actualise; Carl R.
Rogers, A Way of Being (New York: Houghton Mifflin, 1995), 134.
38
West, Psychotherapy and Spirituality.
39
Carl Rogers, confesses that he had ‘underestimated the importance of this
mystical, spiritual dimension.’; Rogers, A Way of Being, 130.
40
Keith Morgen, Oliver J. Morgan, Craig Cashwell, and Geri Miller, ‘Strategies
for the Competent Integration of Spirituality into Addictions Counseling Training
and Supervision’, Counseling Outfitters, (2010); 1-10. Viewed on 12 August 2014
from http://counselingoutfitters.com/vistas/vistas10/Article_84.pdf.
41
West, Psychotherapy and Spirituality.
42
Galanter, ‘Spirituality and Addiction,’ 287-288.
43
Koenig, ‘Research on Religion,’ 289.
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access150 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
44
The group were presented with a draft process pathway to recovery that
originates in trauma and continues into developing post-addiction opportunities.
Linear in presentation the pathway is a complex synthesises drawn from the
author’s earlier work; Peter Bray, ‘A Broader Framework.’
Bibliography
Bray, Peter. ‘A Broader Framework for Exploring the Influence of Spiritual
Experience in the Wake of Stressful Life Events: Examining Connections Between
Posttraumatic Growth and Psycho-Spiritual Transformation,’ Mental Health,
Religion and Culture 13 (2010): 293-30.
———. ‘Naming Spirituality in Counsellor Education: A Modest Proposal.’
Special Issue on ‘Counsellor Education in Aotearoa New Zealand.’ New Zealand
Journal of Counselling nv (2011): 76-97.
Calhoun, Lawrence and Richard Tedeschi, eds. Handbook of Posttraumatic
Growth: Research and Practice. London: Lawrence Erlbaum Associates, 2006.
Doweiko, Harold E. ‘Substance Use Disorders as Symptoms of Spiritual Disease.’
Addiction and Spirituality a Multidisciplinary Approach, edited by Oliver J.
Morgan and Merle Jordan, 33-53. St. Louis: Chalice Press, 1999.
Durie, Mason. Whaiora: Mäori Health Development. Auckland: Oxford University
Press, 1994.
Galanter, Marc. ‘Spirituality and Addiction: A Research and Clinical Perspective.’
The American Journal on Addictions 15 (2006): 290.
Grof, Christina. The Thirst for Wholeness: Attachment, Addiction, and the Spiritual
Path. New York: HarperOne (1993).
Grof, Stanislav and Christina Grof, eds. Spiritual Emergency: When Personal
Transformation Becomes a Crisis. New York: G. P. Putnam’s Sons, 1989.
Janoff-Bulman, Ronnie. Shattered Assumptions: Towards a New Psychology of
Trauma. New York: Free Press, 1992.
Nelson, James M. Psychology, Religion, and Spirituality. New York: Springer,
2009.
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessPeter Bray 151
__________________________________________________________________
Rogers, Carl. A Way of Being. New York: Houghton Mifflin, 1995.
Savage, Julie and Sarah Armstrong. ‘Developing Competence in Spiritual and
Religious Aspects of Counseling.’ Handbook of Multicultural Counseling
Competencies, edited by Jennifer A. Erickson Cornish, Barry A. Schreier, and
Lavita I. Nadkarni, 379-413. Hoboken: John Wiley, 2010,
Schafer, Ingo, Willemmien Langeland, Johanna Hissbach, Christel Luedecke,
Martin D. Ohlmeier, Claudia Chodzinski, Ulrich Kemper and Peter Keiper.
‘Childhood Trauma and Dissociation in Patients with Alcohol Dependence and
Drug Dependence, or Both: A Multi-Centre Study.’ Drug and Alcohol Dependence
109 (2010): 84-89.
Spencer, Herbert. Alcoholics Anonymous: The Story of How Many Thousands of
Men and Women Have Recovered from Alcoholism. New York: A. A. World
Services Inc., 2001.
Tedeschi, Richard and Lawrence Calhoun. ‘The Posttraumatic Growth Inventory:
Measuring the Positive Legacy of Trauma.’ Journal of Traumatic Stress 9 (1996):
455-471.
Walton-Moss, Benita, Ellen M. Ray, and Kathleen Woodruff. ‘Relationship of
Spirituality or Religion to Recovery from Substance Abuse.’ Journal of Addictions
Nursing 24.4 (2013): 217-226.
West, William. Psychotherapy and Spirituality. London: SAGE Publications,
2001.
Acknowledgements
I would especially like to thank my colleagues whose permission, support,
transparency, and enthusiastic participation in our Spirituality Special Interest
Group has made this chapter possible. You do more than you know, and your
knowing is rich with common-sense and caring.
Peter Bray is a Senior Lecturer in Counselling in the Faculty of Education and
Social Work at the University of Auckland in New Zealand. He has been widely
published in scholarly peer-reviewed journals and has recently edited a number of
books that seek to positively reframe the institutional position and treatment of
individuals exposed to crises and to trauma. His current research considers the
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free access152 Discussing Trauma, Addiction and Spirituality
__________________________________________________________________
relational and spiritual dimensions of experience in counselling for both the
practitioner and the client.
Peter Bray - 9781848883727
Downloaded from Brill.com01/31/2021 04:55:43AM
via free accessYou can also read
