The American Psychological Association (APA) recently adopted new multicultural guidelines for psychologists (Clauss-Ehlers et al., 2019). Within these guidelines, psychologists are charged with delivering culturally adaptive and strengths-based approaches to interventions. However, possibly a byproduct of the field’s reliance on Cartesianism, spirituality is often overlooked as an important area of cultural competence and ingredient in the therapeutic process. Many clinicians also receive little training in spiritual competency (Bartoli, 2007), which may decrease the likelihood a clinician will include it in the therapeutic process and possibly even lead to undervaluing this domain. Yet spirituality is consistently identified as an important resilience factor in the face of mental health challenges (e.g., see reviews Bockrath et al., 2021; Haney et al., 2020), is important to people’s lives (Vieten et al., 2013), and many clients report wanting to address it in treatment (Rose et al., 2001).
Although many definitions of spirituality exist, one most relevant to this discussion is “an aspect of a person or group dealing with a search for meaning, moral frameworks, and relationships with others, including ultimate reality” (Canda & Fuman, 1999, p. 44). Many have characterized trauma as a spiritual or soul wound (e.g., Comas-Diaz et al., 2019; Park et al., 2017; Shay, 2014), perhaps in acknowledgment of what makes trauma traumatic—the violation of trust a person can experience about right and wrong, basic goodness, safety and justice. Although certainly complex and multifaceted, perhaps one of the most critical processes of healing trauma involves meaning-making (e.g., Fischer et al., 2020; Park, 2013). Across all forms of trauma, ranging from life-threatening illness, war, sexual abuse and natural disasters, individuals must confront: How do we make sense of tragedy, harm, betrayal and loss? What does it mean that humans cause deep suffering to each other? These are inherently spiritual questions (Kusner & Pargament, 2012), regardless of whether a client practices Hinduism or nihilism.
In large part due to the recent proliferation of both moral injury and psychedelic-assisted therapies in psychology, spirituality in the therapeutic context has re-emerged as an important ingredient and approach for trauma-related healing (e.g., Griffiths et al., 2018; Coady, Hawkins, Chartoff et al., 2021; Smother & Koenig, 2018). More treatments have been developed (e.g., Harris et al., 2018; Pearce et al., 2018), competencies have been proposed (Vieten et al., 2013), and interdisciplinary treatment models pairing spiritual-psychological services have been developed (Cenkner et al., 2020). In several studies using various psychedelic-assisted therapies, participants reporting the most significant gains in reductions of posttraumatic stress disorder (PTSD), depression and anxiety were those who also reported having greater spiritual significance and personal meaning of their experiences (Cox et al., 2018; Davis et al., 2020; Griffiths et al., 2006, 2008; Williams et al., 2021). These collective findings highlight the clear link between spirituality and healing. Spirituality is too important to the psyche, the Greek root of which means soul, to continue to be left out.
About the Author
Dr. Amanda Khan is a licensed clinical psychologist and researcher specializing in the assessment and treatment of trauma sequelae. Dr. Khan is a staff psychologist at Sage Integrative Health, a Bay Area holistic psychedelic clinic. She is Co-Chair of the Moral Injury SIG for ISTSS.
References
Bartoli, E. (2007). Religious and spiritual issues in psychotherapy practice: Training the trainer. Psychotherapy: Theory, Research, Practice, Training, 44(1), 54–65.
Bockrath, M. F., Pargament, K. I., Wong, S., Harriott, V. A., Pomerleau, J. M., Homolka, S. J., Chaudhary, Z. B., & Exline, J. J. (2021). Religious and spiritual struggles and their links to psychological adjustment: A meta-analysis of longitudinal studies. Psychology of Religion and Spirituality. Advance online publication. https://doi.org/10.1037/rel0000400
Canda, E. & Furman, L. (1999). Spiritual diversity in social work practice. New York, NY: The Free Press.
Cenkner, D. P., Yeomans, P. D., Antal, C. J., & Scott, J. C. (2020). A pilot study of a moral injury group intervention co-facilitated by a chaplain and psychologist. Journal of Traumatic Stress, 34(2), 367-374.
Clauss-Ehlers, C. S., Chiriboga, D. A., Hunter, S. J., Roysircar, G., & Tummala-Narra, P. (2019). APA Multicultural Guidelines executive summary: Ecological approach to context, identity, and intersectionality. American Psychologist, 74(2), 232–244.
Coady, A., Hawkins, L.T.C.L., Chartoff, R., Litz, B., & Frankfurt, S. (2021). Trauma, spirituality, and moral injury: Assessing and addressing moral injury in the context of PTSD treatment. Curr Treat Options Psych. https://doi.org/10.1007/s40501-021-00252-0
Comas-Díaz, L., Hall, G. N., & Neville, H. A. (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue. American Psychologist, 74(1), 1-5.
Cox, K., Lancelotta, R. L., Barsuglia, J., & Davis, A. K. (2018, November). 5- MeO-DMT and subjective improvements in post-traumatic stress disorder [Poster presentation]. Annual Convention of the Maryland Psychological Association.
Davis, A. K., Averill, L. A., Sepeda, N. D., Barsuglia, J. P., & Amoroso, T. (2020). Psychedelic treatment for trauma-related psychological and cognitive impairment among US Special Operations Forces veterans. Chronic Stress, 4, 2470547020939564.
Fischer, I. C., Shanahan, M. L., Hirsh, A. T., Stewart, J. C., & Rand, K. L. (2020). The relationship between meaning in life and post-traumatic stress symptoms in US military personnel: A meta-analysis. Journal of Affective Disorders, 277, 658–670.
Griffiths, R. R., Johnson, M. W., Richards, W. A., Richards, B. D., Jesse, R., MacLean, K. A., Barrett, F. S., Cosimano, M. P., & Klinedinst, M. A. (2018). Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitude and behaviors. Journal of Psychopharmacology, 32(1), 49-69.
Griffiths, R. R., Richards, W., Johnson, M., McCann, U., & Jesse, R. (2008). Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. Journal of Psychopharmacology, 22, 621–632.
Griffiths, R. R., Richards, W. A., McCann, U., & Jesse, R. (2006). Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance. Psychopharmacology (Berl), 187, 268–283.
Haney, A. M. (2020). Nonsuicidal self-injury and religiosity: A meta-analytic investigation. American Journal of Orthopsychiatry, 90(1), 78–89.
Harris, J. I., Usset, T., Voecks, C., Thuras, P., Currier, J., & Erbes, C. (2018). Spiritually integrated care for PTSD: A randomized controlled trial of “Building Spiritual Strength.” Psychiatric Research, 267, 420-428.
Kusner, K., & Pargament, K. I. (2012). Shaken to the core: Understanding and addressing the spiritual dimension of trauma. In R. A. McMackin, E. Newman, J. M. Fogler, & T. M. Keane (Eds.), Trauma therapy in context: The science and craft of evidence-based practice (pp. 211–230). American Psychological Association.
Park, C. L., Currier, J. M., Harris, J. I., & Slattery, J. M. (2017). Trauma, meaning, and spirituality: Translating research into clinical practice. American Psychological Association. https://doi.org/10.1037/15961-000
Park, C. L. (2013). Trauma and meaning making: Converging conceptualizations and emerging evidence. In J. Hicks, C. Routledge (Eds.), The experience of meaning in life. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6527-6_5
Pearce, M., Haynes, K., Rivera, N. R., & Koenig, H. G. (2018). Spiritually integrated cognitive processing therapy: A new treatment for posttraumatic stress disorder that targets moral injury. Global Advances in Health and Medicine, 7, 1-7.
Rose, E. M., Westefeld, J. S., & Ansley, T. N. (2001). Spiritual issues in counseling: Clients’ beliefs and preferences. Journal of Counseling Psychology, 48(1), 61–71.
Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31, 182-191.
Smother, Z. P. W., & Koenig, H. G. (2018). Spiritual interventions in veterans with PTSD: A systematic review. Journal of Religion & Health, 57(5), 2033-2048.
Vieten, C., Scammell, S., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2013). Spiritual and religious competencies for psychologists. Psychology of Religion and Spirituality, 5(3), 129–144.
Williams, M. T., Davis, A. K., Xin, Y., Sepeda, N. D., Grigas, P. C., Sinnott, S., & Haeny, A. N. (2021). People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences. Drugs, 28(3), 215-226.