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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