Integrating Spirituality Into Recovery Requires Ethical Approach

Spirituality has been found to play a positive role in recovery when it is integrated with other treatment modalities. But in order to do so, ethical obligations and provider-patient boundaries must be understood.

On Friday at the Rocky Mountain Symposium for Addictive Disorders, Jack Perkins, DMin, LADC, CSAC, CCLC, founder of Psuche Education, Counseling & Coaching Services in Fort Gibson, Oklahoma, presented a session on the integration of spirituality and psychotherapy. Ahead of his presentation in Denver, Dr Perkins spoke with Addiction Professional to discuss integrating spirituality within holistic care, ethical guidelines for integrating spirituality and psychotherapy, and key tenets for establishing a model in which spirituality and psychotherapy work together.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: How can integrating spirituality within holistic care help improve patient outcomes? What are some of the benefits?

Perkins: Research has shown that integrating spirituality into patient care enhances the wellbeing of patients. Holistic comes from the Greek word ὅλος, holos, an adjective meaning “the whole.” The 5 areas of human development (i.e., spiritual, cognitive, emotional, social, and physical/physiological) are integrated and have a synergistic relationship.

Spirituality is a core component of healthcare, especially when looking at the research demonstrating positive outcomes for patients. Harold Koenig’s (2013) research highlighted the positive outcomes of integrating spirituality into patient care, (1) those with acute emotional problems have better mental health, (2) patients cope better with illness, have less depression, and recover more quickly, and (3) those with severe and persistent mental health disorders cope better and have fewer exacerbations requiring acute hospitalizations.

AP: What ethical issues and guidelines should providers be aware of when integrating spirituality with psychotherapy?

Perkins: Healthcare professionals should practice cultural sensitivity when attempting to incorporate spirituality into patient care. They should review ethical guidelines related to the role spirituality should have in providing care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Commission on Accreditation of Rehabilitation Facilities (CARF), and other accrediting agencies provide guidelines related to integrating spirituality into patient care. Providers must be sensitive to ethical issues such as integrity, blurred boundaries, dual relationships, respect, and competence.

Remembering 5 key principles will help healthcare providers avoid ethical issues:

1. We don’t all come from the same cultural background.
2. Patients are often in distress, including spiritual distress, and are in a vulnerable position.
3. Be aware of limitations in training and experience when addressing spiritual issues.
4. Refer to those trained in spirituality when dealing with complex and difficult situations.
5. It is not our role to convert consumers to our faith perspective.

Ethical integrity is as important when integrating spirituality into treatment as when using other methods of treatment.

AP: What are the key tenets of a model in which spirituality and psychotherapy can work together?

Perkins: First, meet patients where they are. During the assessment process, assess the role of spirituality as a strength or weakness. This may be reflected on treatment plans.

When healthcare providers are integrating spirituality into patient care, it requires professionalism; this includes elements like well-respected knowledge and skills that reflect the same integrity as used when using other models of treatment. Healthcare providers are to have the same attitude toward spirituality as other components found in the biopsychosocial model.

AP: Is there anything else you would like to mention that we have not touched on?

Perkins: Psychology and spirituality have often been polarized, each reacting against the other. On one side is extreme humanism, devoid of an understanding of healthy spirituality. On the other side of the continuum is what I call extreme religiosity. When proponents of each side begin to create dialogue, they will discover psychology and spirituality are integrated.

Psuche (ψυχη), the word I use, in Greek is translated as the sensory-self, soul or life. It is the root of the English word psychic and psychology. The soul represents “the breath of life” and is rendered “heart” in sources like the Bible. Healthcare providers should strive to integrate spirituality in patient care.

Reference

Perkins JH. The integration of spirituality and psychotherapy: ethical obligations, boundaries, and creating a holistic setting for change. Presented at: Rocky Mountain Symposium on Addictive Disorders. Aug. 5-7, 2022. Denver, Colorado.