Furthering holistic approaches to clinical care.

FURTHERING HOLISTIC APPROACHES TO CLINICAL CARE

Sperry, Len. (2001).

Spirituality in clinical practice: Incorporating the spiritual dimension in psychotherapy and counseling. Philadelphia, PA. Brunner-Routledge. Paper. vii + 192 pp. $24.95. ISBN 1-58391-067-0.

Len Sperry, M.D., Ph.D. is Clinical Professor of Psychiatry at the Medical College of Wisconsin and professor of Health Services Administration and Psychology at Barry University. He is board certified in psychiatry and clinical psychology, a fellow of Division 36 (Psychology of Religion) of the American Psychological Association, and a member of Committee on Psychiatry and Religion of the Group for the Advancement of Psychiatry.

Sperry's report of recent Gallup poll statistics showing prevalence rates of belief in God (94% of Americans surveyed) and preference rates of patients wishing to have practitioners address religious or spiritual beliefs as part of care (81% of Americans surveyed) provide cultural and contextual support for the importance of this dimension of human experience. Although the DSM-IV (1994) lists Religious or Spiritual Problem (V62.89) as an area that may be the focus of clinical attention, and the Ethical Principles of Psychologists and Code of Conduct (2002) includes religious diversity as a human difference about which psychologists should be knowledgeable and competent, a lack of emphasis exists in this area within graduate training programs (Miller, 1999; Richards & Bergin, 2000). Spirituality in Clinical Practice: Incorporating the Spiritual Dimension in Psychotherapy and Counseling takes an important place among resources designed to better prepare practicing clinicians and clinicians-in-training to address the religious and spiritual dimension of their clients' lives.

The topic is approached from a broad perspective, supporting a spirituality that is respectful of diversity, drawing from teaching of the Christian tradition and weaving into it wisdom of the contemplative and Eastern traditions, feminism, and the findings of contemporary psychology. Spirituality is understood as a reflection of one's core values, one's direct and personal experience of the sacred, and one's search for meaning and belonging.

The book is organized into four parts and includes some unique components compared to others like it in the field. Offering developmental perspectives that integrate spiritual and moral dimensions of experience and growth, exploring the interface of spiritual development and personality functioning, and providing perspectives on spiritual practice and tradition from theoretical schools such as object relations, self psychology, and transpersonal psychology are all volume distinctives. Additionally, brief personal narratives from the lives of practicing clinicians provide the reader with an inside look at applied and practical examples of holistic care.

In Part I, Sperry provides an overview of models of care and compares and contrasts what he terms spiritually-attuned psychotherapy and counseling with traditional contemporary approaches to psychotherapy as well as spiritual direction and pastoral counseling. Spiritually-attuned psychotherapy is described as follows:

It is based on a developmental rather than a pathological model of
health and well-being, and it views growth in a holistic fashion
including the psychological, moral, and somatic dimensions as well as
the spiritual dimension ... The specific goal of spiritual counseling is
in promoting the process of transformation or ongoing conversion in all
its spiritual, psychological, moral and somatic dimensions. (p. 14)

In Part II, the author provides "a detailed description and discussion of several developmental models and perspectives regarding the spiritual dimension and the process of spiritual growth and development" (p. 21). Five dimensions of human experience are posited: psychological, social, moral, somatic, and spiritual, with spiritual located at the center. Also offered in this section are theoretical perspectives of spiritual development (based on the dimensional categories); these include object-relations, transpersonal, and self psychology. In addition to these theoretical perspectives, other dimensional perspectives on spiritual growth include ethics, character formation, and conversion theory. Developmental models that have a direct or indirect bearing on spiritual growth are also a highlight of this section, and the author reviews psychosocial development (Erikson), moral development (Kohlberg), faith development (Fowler), self development (Kegan), spiritual development (Helminiak), spiritual growth (Wilber), and the spiritual journey (Keating), highlighting how each of these frameworks contributes to an understanding of spiritual growth and development. The final chapter in this section addresses spiritual crises or emergencies that might arise in therapy because of a particular client's personality structure and presenting issues.

In Part III, Sperry turns his focus to practical and applied methods of providing holistic care. The author begins with a discussion of engagement and assessment strategies. Sample intake questions, frameworks for thinking through ethical issues, and practical approaches to client assessment are just some of the significant strengths of this section. Step-by-step suggestions are provided on how to conduct a spiritual assessment (including how to structure the nature and extent of it) and also how to think through questions about whether or not to pray with clients. Spiritually-oriented interventions are the focus of the next chapter in this section and include treatment strategies for working with individuals and couples. The discussion begins with indications and contraindications of offering such interventions. Theoretically informed spiritually-oriented interventions are also discussed from cognitive behavioral, psychoanalytic, experiential, and relational perspectives and case examples are included. Incorporating spiritual disciplines into therapy is the focus of the last chapter, and Sperry advocates the potential inclusion of healing prayer, medication, fasting, reading sacred writings, forgiveness, moral instruction and service as therapeutic interventions. Suggestions for how these might be integrated in treatment planning and process are offered.

The final section of the book, Part IV, provides detailed narratives by six clinicians who incorporate spirituality into their personal and professional lives. A range of levels of incorporation is posited, from a minimum level in which a clinician performs a brief spiritual assessment of a client, to an intermediate level in which a clinician would engage in some measure of processing spiritual material in therapy and might make a referral to a spiritual care-giver, to a maximum level of integration, which would include in-session engagement, assessment and intervention, as well as incorporation of the centrality of the spiritual dimension in the clinician's personal life. This section provides a rare inside look into the spiritual lives of clinicians and the ways in which they bring spirituality into the therapy hour.

Written in a highly accessible style, Spirituality in clinical practice: Incorporating the spiritual dimension in psychotherapy and counseling is a valuable resource for clinicians who are interested in developing greater competency in addressing the spiritual needs of their clients. The book is both theoretical and practical. Due to the inclusion of perspectives on spiritual growth and development from within key developmental and clinical theoretical frameworks, the work has particular utility for clinical courses in graduate training programs. The graduate curriculum of any program would be enhanced by including this book along with others that address intake, diagnosis, case conceptualization, treatment planning, and intervention, thereby training students to consider the spiritual lives, needs, and desires of clients from the very start of the clinical encounter. Addressing this important area of diversity and central aspect of human experience (as posited by the author based on survey and empirical data) will prepare students and clinicians to address the full range of needs and concerns of 21st century clients.

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D. C.: Author.

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Washington, D. C.: Author.

Miller, W. R. (Ed.). (1999). Integrating spirituality into treatment: Resources for practitioners. Washington, D. C.: American Psychological Association.

Richards, P. S. & Bergin, A. E. (Eds.). (2000). Handbook of psychotherapy and religious diversity. Washington, D. C.: American Psychological Association.

Reviewed by THERESA C. TISDALE, Ph.D.