What you Don't Say Speaks Volumes: Spirituality in Social Work

As many of you know, I am not an expert in spirituality.  Maybe it is because I am not an expert that I clearly see the need to write this, because it is not facts or answers that we need but questions and discussions.  It seems that openness and inquisitiveness may be what is called for.

I was meeting with a group of Social Workers recently and I had an interesting experience that stuck with me.  We were processing several difficult topics including, sexual trauma, abuse, and addictions.  We discussed these topics clearly, comfortably, and professionally.  Then something happened that I just couldn’t forget.  A Social Worker leaned forward in her chair, dropped her voice, apologized and asked permission to discuss spirituality as it related to how she viewed her work with clients.

This struck me, hard.  As Social Workers we have difficult conversations all the time.  We had just finished having many of them.  The truth is, having difficult conversations is part of the job description for a Social Worker.  If we won’t have the hard conversations then who will? I found it unsettling that the one topic that was too hard to discuss was spirituality. 

In my experience as a Social Worker, teacher, therapist, and clinical supervisor I have found that many Social Workers shy away from examining the role of spirituality in their own lives and practice as well as in their dialogue with their clients.  They are not provided training or guidance in how to do this and they are afraid that they will do it wrong.  They fear offending or alienating a colleague or client, so they hide behind professionalism.  They choose what is safe. 

So following a whispered conversation about spirituality in Social Work, I asked myself what my role was.  What example will I set for my students?  What does it mean to teach Social Work at a religious institution?  How will I prepare students to work with clients and will it involve spirituality?  Who will teach them to ask questions about their own spiritual journey and how it intersects with their practice?  If we are unable to embrace the conversation how will we authentically encourage our clients to share their spiritual journey with us?  Won’t they know by our silence that this part of them doesn’t belong in the conversation?  What are we losing by being quiet?

The reality is that spirituality matters to many of our clients and not being able to talk to them about something important to them limits our work with them.  Research supports this.  Ninety percent of the world recognizes some type of spiritual practice (World Christian Database, 2001).  A large database of research also supports that spirituality is important to mental health (D’Souza, 2002; Konig, 1998; Teppers, Roger, & Coleman, 2001; Russinova, Wewiorski, & Cash, 2002; Zaza, Sellick, & Hillier, 2005).  Clients use it to cope, and identify it as something that sustains them (Konig, 1998).  Religious and spiritual practices reduce isolation and loneliness and support a sense of mean and purpose (Verghese, 2008).

My own work with complex trauma, attachment, and relational disruption also supports this.  When early caregivers are attentive, nurturing and secure; children learn that people can be trusted.  On the contrary when children experience abuse, abandonment, and relational disruption they learn that people cannot be trusted and are not stable.  I have found it impossible and inauthentic to fully restore trust in a child or adult that has experienced this loss.  When you explain to a young adult who was abandoned by their parents that they can count on people; you are telling them something that is fundamentally untrue.  They know in their very core that if their mother and father can leave them that anyone can.  So, how do you encourage them to risk attachment and connection despite the very real possibility that people may disappoint them?  The only way I have seen this occur is when an individual is able to rely on something consistent and steady.  They are able to use their spirituality to identify something larger than themselves that can be a stabilizing force.  The security of this unwavering “being” allows them to take the risks necessary for relationships and connection and allows them to weather the disappointments of human relationships. 

Like I said, I am not an expert in spirituality or a religious scholar.  I don’t have answers. I have questions.  Maybe it is not answers we need but questions?  So I hope that you will examine your work closely.  That you will pay attention to not only what you are saying when working with clients, but also what you are not saying.  I hope that you will embrace a bio-psycho-social-spiritual framework.  When you are doing an assessment I hope that you will not simply check a box on your clients’ religious identification but that you will explore what a higher power means (and doesn’t mean) to them. That you will give them room to share a personal narrative of spirituality, both what it is and what it isn’t to them.  Remember the power of the unspoken dialogue and remember that you are a Social Worker.  If you don’t embrace the uncomfortable conversations, who will?

D’Souza R. Do patients expect psychiatrists to be interested in spiritual issues?  Australasian Psychiatry 2002; 10:44-47

Koenig HG.  Religious beliefs and practices of hospitalized medically ill older adults. Int’l J Geriatr Psychiatry 1998; 13:213-224.

Russinova Z, Wewiorski NJ, Cash D. Use of alternative health care practices by persons with serious mental illness: Perceived benefits. Am J Pub Health 2002; 92: 1600-1603

Tepper L. Rogers SA. Coleman EM, et al. The prevalence of religious coping among persons with persistent mental illness. Psychiatric Services 2001; 52:660-665

Verghese, A. (2008). Spirituality and mental health. Indian Journal of Psychiatry, 50(4), 233–237. doi:10.4103/0019-5545.44742

World Christian Database.  Atheists/Nonreligious by Country. World Christian Trends, Barrett and Johnson (William Carey Library 2001), updated February 2007.  See website: http://worldchristiandatabase.org/wcd/ http://worldchristiandatabase.org/wcd/

Zaza C, Sellick SM, Hillier LM. Coping with cancer: What do patients do? J Psychosoc Oncol 2005; 23:55-73

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Grief

As a social worker we are many things.  We are advocates, we are policymakers, therapists, community organizers and we connect people to resources. We work in many settings.  We work in hospitals, hospice, child welfare, substance abuse treatment facilities, policy institutes, homeless shelters, adoption agencies, and psychiatric hospitals.  These lists are not all inclusive. The truth is social workers work everywhere and often do everything.  One of the most important roles we have is grief counselor.  This is easy to recognize in some settings such as hospice but it is true in all the settings we work.  

A social worker walks hand in hand with a client as they walk through grief.  As a community we recognize the grief of losing someone we care about to death.   We even hear talk about a divorce being like a death.  In truth grief encompasses much more.  Grief is a response to loss and human beings experience loss throughout their life.  As human beings we grieve the loss of relationships, jobs, communities, families, parents, security, home, and so much more.   Largely, we experience grief at the intersection of our vision and our reality. 

             

Each of us has a vision of our life.  The human struggle is to integrate the reality of our life with our vision.  We ask ourselves, “What did I expect out of life?” Our answers to this question vary.  For each of us there are different pieces of our vision that are dear to us.  One of us may easily transition from one career to the next while another can’t seem to let go of “how they thought it would be”.  

The process of moving through life transitions is the process of grief.  Throughout an individual’s lifetime they have many experiences that cause a disruption in the “normal”.  This can be anything that requires a shift in the picture, anything that requires them to adapt and create a “new normal”.  To create a “new normal” we must first grieve the loss of what we thought was “supposed to be”.  We must learn to live in a world that is in some way different from what we ever imagined. 

Many of us will be successful in grieving small changes to our life vision but we must also incorporate critical incidents.  Critical incidents are those moments in life that fundamentally change our trajectory.  They alter our path permanently.  Some critical incidents may be anticipated such as a marriage, birth, graduation, or empty nest.  But many will be unexpected.  Many will be moments we never anticipated.  Contingencies we couldn’t envision much less prepare for.  This is the moment when many of us say "I will not", "I cannot".  This is the moment we often must borrow from the strength of those around us.

When these critical incidents occur our tools and coping skills are often inadequate and are overwhelmed by the abrupt and sometimes violent shift from what we “thought” our world was to what it “must become”.  It is only natural that the skills that served us so well in our “normal” would be inadequate to face this “new normal” we never imagined.   

As a social worker we will often be called upon during these times to walk with someone as they grieve, accept, and learn to find hope in new things.   During this time someone will honor you with his or her story.  They will share their vulnerability.  As you honor this trust and create a safe place for them to struggle with integrating the new, you will see the beauty of human beings.  An angle of human beings that not everyone gets to witness, The moment when someone takes what was a shattered vase and pieces it back together bit by bit until it is a beautiful mosaic.  No, it will never be the vase it was.  It will be something so much stronger and more beautiful than anyone ever imagined.