Rehabilitation counselor willingness to integrate spirituality into client counseling sessions.

... consider what occurs when bad things happen to people unexpectedly-for example, when you get AIDS from a transfusion or a loved one, when you are mugged or raped, or when you are disabled from an accident. Feelings will be associated with and conditioned to the situations and people involved, fight or flight (overcoming or helplessness) patterns will be induced, and, of course, perceptions, future learnings, and perhaps your whole life will become altered. Such learnings are neither active nor intentional; they happen to you. If they are constructive or metacognitive, it is only by retrospective analysis, and they may or may not occur in social contexts. But I submit that these are the most meaningful learnings in people's lives. (Gentile, 1996, p. 38)

These "unexpected occurrences," with all their meaning laden consequences, often refer to the onset of disability and fall within the everyday realm of Certified Rehabilitation Counselors (C.R.C.) while the "most meaningful learnings" recurrently reference spirituality (Vash, 1994; Nosek, 1995; Wilber, 1995; Piedmont, 2004b). Alston, former editor of The Journal of Rehabilitation stated "Spirituality and religion were subjects that had been virtually taboo in counseling and professional circles for years, yet ... the relationship of spirituality and disability has been linked frequently in the literature" (2001, p. 3).

Vash (1994) proposes that disability or experiences that disturb our lives, that cause us pain, can be seen as part of one's heroic spiritual voyage of life. She encourages therapists to rethink the seeming disadvantage of disability, instead opting for an affirmative belief, that of granting clients opportunities for personal growth that may be explained in part by spirituality defined as Spiritual Transcendence. In keeping with Vash's explication, the terms spirituality and Spiritual Transcendence will be used interchangeably throughout this commentary. Spiritual Transcendence may be best understood in accordance with Piedmont's definition:

   Spiritual Transcendence represents the ability of an
   individual to stand outside of his/her immediate sense of
   time and place and to view life from a larger, more
   objective perspective. This transcendent perspective is
   one in which the person sees a fundamental unity
   underlying the diverse strivings of nature. People ... believe
   that there is a larger plan and meaning to life,
   something beyond our mortal existence (Piedmont,
   2004a, p. 4).

Therefore, it seems critical for rehabilitation counselors to be in touch with their own beliefs concerning Spiritual Transcendence, as well as being willing to deal with Spiritually Transcendent issues in a counseling session while engaging clients dealing with life altering circumstances (Vash, 1994). In the therapeutic service that rehabilitation counselors provide for their clients, scant research has been conducted concerning rehabilitation counselors' personal spiritual beliefs and their willingness to incorporate Spiritually Transcendent concepts into counseling sessions (Vash, 1994).

Survey data of counselors, educators and the general population show spirituality and religion to be therapeutically pertinent, ethically congruent, meaningful subject matter for counselors (Bergin & Richards, 1997; Shafranske, 2000; Standard, Sandhu, & Painter, 2000). It becomes the task of the counselor to identify the degree of spiritual development and/or religious affiliation present in both the client and counselor and how this may affect the counseling relationship, process, and objectives. Kelley comments on the relationship between the issues raised by life altering occurrences and spirituality in a counseling session.

Counselors can expect that at least for some clients, spirituality and religion play a part in how the client feels and thinks about these issues and problems. As counselors explore the cognitive, affective and unconscious elements of issues such as these, they can help clients by an alert openness to how spiritual and religious threads may be woven into such concerns and used in their resolution. (Kelley, 1995, p. 34)

Burke et al. (1999) equates ignoring spirituality to showing insensitivity to client issues and that, should a counselor fail to examine his/her own spiritual values, the counselor might fail to explore these issues in a therapeutic session. Burke also believes that a holistic approach to counseling requires an examination of the spiritual and religious components of the therapeutic situation as a possible source of personal development for both client and counselor. Vash (1994) agrees, and encourages rehabilitation counselors to rethink the seeming disadvantage of disability, instead opting for the affirmative belief of opportunity by investigating spiritual and philosophical teachings. She offers rudimentary suppositions: "consciousness is life viewed from the inside; life is consciousness viewed from the outside" (p.xxiii) and "adversity plays a powerful role in shaping our personalities ... personalities shape our responses to adversity" (p.xxiii). Her foremost purpose in writing is to ignite in rehabilitation counselors a sense of urgency for a new paradigm incorporating spirituality in rehabilitation counseling. Vash nominates theories from various sacred traditions for the purpose of permitting the reader the discretion of incorporating these unique psychospiritual responses into his/her own counseling approach. It should be noted that these theories also appear as various selected tenants of the psychospiritual philosophy of authors such as C.G. Jung (1969), Roberta Treischman (2001), and Ken Wilber (1995). The severest adversities of disability are neither "awfulized" nor trivialized but instead presented as the seeds for psychospiritual growth, that is, a "catastrophe drawing forth a reaction that awakens the soul" (Vash, 1994, p.27). Vash further postulates that disability or adversity transforms the soul by means of extraordinary prowess, initiating a psychospiritual examination. Catastrophe interferes with our lives, interferes with social relationships, enforces rest or a halt to normal activity, and basically acts as an instigating experience in a rite of a spiritually transcendent passage.

Karasu (1999) cautions counselors that too much emphasis is placed on the technical aspects of therapy.

   Those therapists who become overcommitted to the
   sciences of psychology, biology, or sociology, invariably
   end up underplaying man's ethical and spiritual
   dimensions. Other therapists, by overemphasizing
   specific techniques, whether analyzed or behaviorally
   manipulated, also make man impersonalized,
   compartmentalized, calculated (and most recently,
   "managed"), thereby diminished. (p. 54)

Karasu (1999) further states that the client may evolve only as much as the therapist herself has developed. For Karasu, a therapist is a secular minister, tailoring her skills, theory, and spirituality to the therapeutic relationship and to whatever the client brings to that relationship. He subsequently speaks to the educational format now in place for counselors at the graduate school level.

   Yet too much attention is paid to the (technical) training
   and credentialing of therapists.... Of course, the
   therapist is expected to be an empathic, caring,
   responsible, psychologically minded person, but in order
   to be a true healer, the therapist must also cultivate his
   or her soul and spirit.... Then psychotherapy becomes
   not so much a profession as a way of being. It is a
   matured quality of mind and heart and soul, a
   commitment to a spiritual existence. (Karasu, 2001, p.
   121)

While the literature on the relevance of spiritually transcendent issues in practice of rehabilitation counseling has been granted increased significance in the new millennium, little attention has been given to the integration of a course on Spiritual Transcendence into core rehabilitation counselor education programs. Recognizing this oversight, Green, Benshoff, and Harris-Forbes (2001) conducted a pilot survey of 28 rehabilitation counseling program directors concerning coursework in spirituality. The survey's findings revealed the directors to be "equally divided regarding making it required part of the curriculum." (p.55) These indistinct results led the researchers to conclude that:

   spirituality remains ambiguous within the field of
   rehabilitation counseling, needing a definition and
   further clarification. Although some of the rehabilitation
   counselor training programs surveyed indicated that
   spirituality had a role in rehabilitation counseling
   practice, a call for CORE (Commission On
   Rehabilitation Education) standards seems unwarranted
   at this time. (Green et al., 2001, p. 59).

The conclusions of the Green et al. study give credence to the supposition that perhaps the graduates of these programs, CRCs practicing in the field, had in fact acquired the proficiency to attend to issues of Spiritual Transcendence. The results of the present study are intended to shed light on how successfully rehabilitation counselors have been educated to deal with issues of Spiritual Transcendence, both in their own lives and in their counseling sessions.

Perhaps it is Nosek (1995) who presents the most convincing case for the professional consideration of each client's spiritual expression. She laments that her personal spirituality, as a seeker of God, was completely ignored in her lifetime of contact with the rehabilitation system, as a client, as a student and even as a rehabilitation researcher. She speaks knowingly of spiritual crises being ignored or downplayed, despite the fact that for both Nosek and other clients with disabilities, spirituality is necessary for coming to terms with living with a disability. She contends that if it is possible to measure amorphous concepts such as self-esteem and positive or negative attitude, surely we must be able to deal with spiritual growth in the same fashion. She admonishes those who criticize the deficiency of a common language of spirituality by addressing this lack of consensus as a counselor's challenge to investigate personal spiritual beliefs as well as each client's relationship with their own spirituality.

The purpose of this study is to accept the challenge of Nosek (1995) and Vash (1994) and to investigate rehabilitation counselors' consideration of Spiritual Transcendence (Piedmont, 2004a) in their own lives and their willingness to introduce and address Spiritual Transcendence in counseling sessions. Three research questions were generated in order to pursue this line of thinking:

1.) To what degree do rehabilitation counselors incorporate Spiritual Transcendence in their personal lives?

2.) How willing are rehabilitation counselors to introduce and/or pursue Spiritual Transcendence in counseling sessions with their clients?

3.) Is there a correlation between the first two research questions? That is, does a rehabilitation counselor's personal theory of spirituality parallel their application of spirituality in counseling sessions?

Methodology

Instrumentation

An instrument was developed to a) measure the importance rehabilitation counselors placed on Spiritual Transcendence in their own lives, and b) their inclination to address Spiritual Transcendence in counseling sessions with their clients. In order to accomplish the former, Piedmont's Spiritual Transcendence Scale-Revised (STS-R) Short Form [renamed Assessment of Spirituality and Religious Sentiments (ASPIRES) in 2004] was selected for use.

STS-R Short Form

STS-R Short Form composed the first nine items of the survey used in the study (Table 1). The responses to the nine questions of the STS-R are measured on a 5-point Likert scale: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, and Strongly Disagree = 1. For questions 5 and 6 inverse scoring was used where Strongly Disagree = 5, Strongly Agree = 1. The STS R produces a Total Score (the sum of all items), and three facet scores: Prayer Fulfillment (the total for items 3, 6, and 7), Universality (the total for items 2, 5, and 8), and Connectedness (the total for items 1, 4, and 9).

Concerning interpretation, respondents scoring higher than average on the overall dimension of the STS-R Short Form are seen as "concerned with living a life that is in accord with values and meanings that originate with some larger understanding of the purpose of the universe" while those lower than average are seen as "focused on the tangible realities of daily living" (Piedmont, 2004a, p.3). Respondents scoring above-average in the Prayer Fulfillment dimension are seen as "find(ing) a personal sense of emotional satisfaction, strength, and support in their efforts to connect with some larger reality" (Piedmont, 2004a, p.3) while scoring below average shows a trend of non- involvement in this area, with an average score con-notating life at times interfering with employing such practices. Respondents scoring above-average in the Universality dimension "share a common belief that all of life is interconnected ... seeing humanity as a single interrelated body", while a low score signifies an autonomous characterization of humanity, "a collection of individuals, some ... seen as more similar to self than all others" (Piedmont, 2004a, p.4). An above-average score for the Connectedness dimension indicates "a special sense of responsibility (and gratitude) for the many gifts received from those who came before.... a need to grow those gifts through sharing with the others ... and an obligation ... to those who come after, whereas a below-average score indicates "difficulty to find a sense of belonging and meaning within any type of group or community" (Piedmont, 2004a, p.4). Average scores on the STS-R indicate neither emphasis nor de-emphasis of the particular dimension measured.

The STS-R Short Form is normed on a sample of convenience of 411 individuals from Massachusetts, Illinois, Mississippi, and Maryland comprised of mostly undergraduate students, graduate students in pastoral counseling, and general adults, mostly Caucasian, with an average age of approximately 21 years (Piedmont, 2004a, p.7). Normative data is categorized in by age and gender (N for Men = 120; N for Women = 291; N for 17-25 age range = 367; N for 26-45 age range = 30, N for 46-62 age range = 14.).

Based upon responses of the normative sample (n = 411, the internal consistency reliability for the short 9-item form of the STS was reported as .76 (Total Score). The internal consistency of the three facets measured by the STS was reported as .89 (Prayer Fulfillment), .59 (Universality), and .68 (Connectedness; Piedmont, 2004a). The normative sample produced strong, positive correlations between the short form of the STS and the longer ASPIRES: .90 (Total Score), .94 (Prayer Fulfillment), .89 (Universality), and .81 (Connectedness).

Cross observer convergence was employed to investigate validity information for the STS-R. (Number of Raters, two = 364 subjects, one = 34 subjects; Length of acquaintance, M = 8.3 years; Familiarity with subject (l "not at all' to 7 'very well' scale): M = 6.15.) Observer ratings were gathered from people personally familiar with the respondents comprising the normative sample. Piedmont (2004) postulates that when investigating the validity of an instrument dealing with personality traits, if there is a strong correlation between the self-report of a respondent and the reports of knowledgeable and acquainted observers of the same respondent, the validity of that instrument can be supported. Observer ratings were positively correlated with self-ratings of the normative sample on the ASPIRES Scale: .63 (Total Score), .69 (Prayer Fulfillment), .43 (Universality), .28 (Connectedness; all correlations were significant a the .001 level of probability). The STS was found to be a significant predictor of positive affect and general health in a sample of people with chronic arthritis (Bartlett, Piedmont, Bilderbaek, Matsumot, and Bathon, 2003).

The remaining seven items of the instrument were developed by the author to investigate rehabilitation counselor willingness to introduce and/or deal with Spiritual Transcendence in counseling sessions. This notion of the rehabilitation counselor's willingness to introduce spirituality into counseling sessions is based primarily on the work of Vash (1994), with consideration given to both Nosek (1995) and Shafranske (2000), incorporating the following factors:

a) The rehabilitation counselor's willingness to introduce spiritually transcendent issues in the course of counseling or counseling relationships;

b) The rehabilitation counselor's belief that Spiritual Transcendence is therapeutically beneficial in a counseling relationship;

c) The rehabilitation counselor's feeling of competence and ability to focus a counseling session on issues of Spiritual Transcendence.

d) The rehabilitation counselor's belief that Spiritually Transcendence is a positive factor related to dealing with the psychosocial aspects of disability.

Based on this logic, the author developed six items designed to measure rehabilitation counselor willingness to deal with spirituality issues in a counseling session. The items (along with the STS-R) were e-mailed to a panel of three experts in the field of spirituality and rehabilitation counseling to determine content validity. Each of the experts had a Ph.D. in the field of rehabilitation and has published research in the area of spirituality and counseling. The panel members were asked to review each item in terms of its ability to measure a component of rehabilitation counselors' willingness to work with issues related to Spiritual Transcendence in counseling sessions. Panel members were prompted to add appropriate comments concerning each item. The review process was a qualitative one, with the experts responding with suggestions for revisions by e-mail, telephone, and mail. This qualitative process was chosen instead of scaling or using subscales in order that all parties involved have access to the logic incorporated in the revision process. The revision/review process continued until all three experts and the author reached agreement that the items were a valid means of assessing rehabilitation counselor's willingness to introduce or develop Spiritual Transcendence in counseling situations.

Revisions were made to the items on addressing Spiritual Transcendence in counseling sessions based on panel feedback. Revisions included eliminating some ambiguity in wording and focusing the respondent to the area of readiness to integrate Spiritual Transcendence in counseling sessions. Also items were added to investigate practices in both individual and group counseling sessions. Table 2 presents the definition of Spiritual Transcendence and the seven items addressing rehabilitation counselor readiness to integrate it into counseling sessions:

In addition to the STS-R and the items regarding integrating Spiritual Transcendence into counseling sessions, the instrument included eight demographic items gathering data on age, gender, education and major area of study, work experience, certification, spirituality training, and client population served. Subjects were provided with Piedmont's definition of Spiritual Transcendence previously presented (Piedmont, 2004a).

Procedures

A total of 51 practicing rehabilitation counselors were contacted and asked to participate in the study. Twenty-eight rehabilitation counselors were identified from a list of clinical supervisors who were affiliated with a local CORE accredited rehabilitation counselor education program. Initial contact was made via telephone (e-mail addresses were obtained from all who agreed to participate; e-mail was then used to administer the instrument). An additional eight potential participants were identified by nominations received from the initial group. An additional 15 practicing rehabilitation counselors, who were known by the author to be Certified Rehabilitation Counselors, were also contacted and asked to participate. Of the total of 51 rehabilitation counselors contacted, 35 agreed to participate (response rate = 68%). All surveys were administered via e-mail or fax.

Participants

Twenty-one (60%) of the 35 respondents were female; 14 (40%) were male. Four (11%) of the respondents stated having obtained Ph.D. while the remaining 31 (89%) had Masters Degrees, with all participants having attained the Certified Rehabilitation Counselor (CRC) credential. Twenty-five (71.4%) of the respondents majored in Rehabilitation Counseling, four (11.4%) in Counselor Education, two (5.7%) in Counseling Psychology, two (5.7%) in Social Work, one (2.9%) in Pastoral Counseling, and one (2.9%) in Psychology. The age of the respondents varied from 29 years to 61 years (M=43.74, SD=8.20). Years of work experience ranged from two years to 34 years (M=13.86, SD=9.21). Nine (25.7%) of the respondents indicated they had coursework or other training in the area of spirituality. Eleven (31%) of the participants reported primarily serving a client population dealing with mental health disabilities; ten (29%) substance abuse disabilities; seven (20%) cognitive disabilities; four (11%) physical disabilities; two (6%) with learning disabilities; and one (3%) "Other" disabilities.

Data Analysis

Responses to the STS-R items were entered into an SPSS data file and raw scores were converted into T- scores for the Total Score and the three facets of the STS-R in order to create a comparison with Piedmont's (2004) norm group of undergraduates used in developing the STS-R. Responses to the seven items on counselor willingness were analyzed using descriptive statistics (frequencies, means, and standard deviations). Pearson correlations were calculated to investigate the relationship between the STS-R results and the items regarding counselor willingness/readiness to integrate Spiritual Transcendence into counseling sessions.

Results

The responses to the STS-R items were converted to t-scores using means and standard deviations produced by the norm group of STS-R Short Form. T-scores were derived for the Total Score and each of the three facets (Prayer, Universality, and Connectedness) scores (Piedmont, 2004a). The sample of 35 Certified Rehabilitation Counselors produced a total mean t-score of 53.3 (slightly higher than the mean for the normative sample). STS-R Total Scores for the sample ranged from 28.7 to 68.5 with 18 respondents scoring in Piedmont's high Spiritual Transcendence range (above 55), 10 in the average range (45-55) and 7 in the low range (below 45). The mean T-score for the Prayer Facet score was 53.9 (T-scores ranged from 36.0 to 65.0) for an effect size of 3.9. The mean T-score for the Universality Facet was 53.7 (T-scores ranged from 22.0 to 70.1) for an effect size of 3.7. Finally, the mean T-score for the Connectedness Facet was 49.8 (T-scores ranged from 31.5 to 63.5), nearly identical to the norm group.

In addition to STS-R items, the instrument included seven items generated by the author to examine counselor willingness and practices regarding integrating Spiritual Transcendence into their counseling. Five of the items produced Likert-type agreement scores ranging from 1 (Strongly Disagree Agree) to 5 (Strongly Agree). The content for the five Likert-type items are reported in Table 2. Table three presents the frequencies, means, and standard deviations of the sample's Likert-responses to items 10-14.

The last two items of the instrument investigated rehabilitation counselor practices regarding individual and group counseling (item content is contained in Table 2) and were scored using the following continuum: 1 = Nearly every session; 2 = Whenever the client introduces a Spiritually Transcendent issue; 3 = Some of the time; and 4 = Never (hence the smaller the value, the more Spiritual Transcendence is integrated into counseling). The two respondents who chose #5 to Item 15 and the seven respondents who chose #5 to Item 16 were not analyzed. Responses to Item 15 regarding individual counseling generated a mean score of 3.1 (SD = .90) on the 4 point scale. Only 1 (3%) respondent selected # 1 or "nearly every (individual) session," and 15 (43%) selected #2 "whenever the client introduces a Spiritually Transcendent issue." Responses to item 16 regarding group counseling generated a mean score of 3.2 (SD = .89) on the 4 point scale. Only 1 (3%) respondent selected response #1 or "nearly every session," and l0 (36%) selected response #2 or "whenever a group member introduces a spiritually transcendent issue."

The research question, "Does a relationship exist between the importance of Spiritual Transcendence, in the rehabilitation counselor's personal lives, and their willingness to address the topic in counseling sessions with clients pertaining to disability," was investigated by correlating the STS-R Total Scores and the group's responses to items 10 to 16. The Spearman correlations between the STS-R and each of these items were as follows: Item #10 (r = .37), Item 11 (r = .42), Item 12 (r = .33), Item 13 (r = .37), Item 14 (r = .31), Item 15 (r = .37), and Item 16 (r = .28). Correlations were found to be significant for Items 10, 12, 13, 14 and 15 at the .01 level (one-tailed) and the correlation between the STS-R Total and Item 11 was significant at the .05 level (one tailed). The STS-R Correlation with item 16 was found to be non-significant.

Discussion

The analysis of the data revealed the mean score for the respondents on the STS-R Total Score (overall facet) was slightly higher than the mean for the normative sample. Notable was that about half the group (18) scored in the high range (T-score > 55), interpreted by Piedmont as "living a life that is in accord with the values and meanings that originate with some larger understanding of the purpose of the universe" (Piedmont, 2004a, p. 41). Seven of the respondents, however, fell into Piedmont's lower scoring range (T-score < 45), categorized as "more focused on the tangible realities of daily living" (Piedmont, 2004a, p. 41).

In terms of the Prayer Fulfillment facet of the STS-R, the sample mean was more than a third of a standard deviation above Piedmont's normative group. While six respondents scored in the high range , deriving "great emotional satisfaction from prayer and/or meditation," only five fell in the lower category, "tending not to involve themselves with this type of inner work" (Piedmont, 2004a, p. 44).

On the Universality facet of the STS-R, the sample group was again about one third of a standard deviation above Piedmont's normative group, with 18 rehabilitation counselors reaching Piedmont's high range placing belief in the "convergence of all humanity," and internalizing the concept that "all people share a common bond and heritage that supersedes any external differences". Six respondents registered in the low group defined as a more "each person needs to rely on him/herself' (Piedmont, 2004a, p. 44).

Examining the Connectedness facet of the instrument, the mean for the rehabilitation counselor sample was near that of the normative group, with 14 counselors scoring in Piedmont's higher range reflecting "a special sense &responsibility and gratitude" for all humanity. Nine respondents placed in the low range who "reflect a potential difficulty to find a sense of belonging and meaning within any type of group or community" (Piedmont, 2004a, p. 44).

Considering the Total Score and all three facets of the STSR, one may conclude that rehabilitation counselors embrace Spiritual Transcendence in their personal lives to a somewhat greater degree than Piedmont's normative sample. There were nine respondents who reported completing a course or other training on spirituality. Of this subgroup, six scored in the high range, two in average range and one in the low range on the STS-R Total Score. The remainder of the sample who had no additional training had 12 high, eight medium and six low scores.

The second research question concerned the willingness of rehabilitation counselors to introduce and pursue Spiritually Transcendent issues in counseling sessions. It was scrutinized in light of the data generated by responses to the seven items created by the author. These questions were developed under the advisement of a panel of experts in the area of Spirituality and Rehabilitation Counseling. Approximately 50% of the rehabilitation counselors surveyed acknowledged a willingness to introduce Spiritually Transcendent issues into a counseling session. Only 60% of the survey harbored a conviction that integrating Spiritually Transcendent issues into a counseling session had therapeutic benefits for the client. Moreover, about 60 % of the sample expressed confidence in their ability to discuss spiritual values in session with clients. Additionally, 62 % of the sample reported some degree of amenability to either encourage a client to discuss Spiritually Transcendent issues introduced by the client or to extend a psychosocial discussion into the realm of Spiritual Transcendence. Finally, only 46% of the survey reported integrating Spiritually Transcendent issues into individual sessions with 39% integrating these issues into group sessions. That is, fewer than half the counselors assimilated spirituality into individual sessions for any reason and less incorporated spirituality into group sessions.

It must be noted that the nine respondents who did complete a course on spirituality or acknowledged specific spirituality training were more willing to integrate Spiritual Transcendence into both their individual and group counseling sessions. Of this subgroup, about 67% selected either #1 or 2 to indicate a willingness to integrate Spiritually Transcendent issues into individual sessions creating an effect size of 1.0. Moreover, 50% of the training subgroup indicated a willingness to do so in group sessions, an effect size of .44.

A significant proportion of the sample (52%) reported (despite 50% stating their willingness to do so) not integrating spirituality into their individual counseling sessions indicating that they never introduce the topic or only some of the time, usually when nothing else has helped the client. Even more (61%) were less likely to deal with the topic in group counseling. Another avenue for understanding the survey results would be to apply them to any other the psychosocial aspect of disability. For example, imagine greater than 50% of a sample of C.R.C.s indicating that they were not willing to discuss cultural or sexual issues in an individual counseling session. It is perplexing that a group personally committed to Spiritual Transcendence has a low comfort level with these concepts in counseling sessions.

A Spearman correlation was used to investigate the third research question; does a relationship exist between the importance of Spiritual Transcendence in the rehabilitation counselors' personal lives and in their disposition to address Spiritual Transcendence with clients in counseling sessions. Moderately sized, but statistically significant correlations between the STS-R and six of the seven other items were discovered. So it seems that counselors who have integrated Spiritual Transcendence into their own lives are more likely to address the topic with their clients. Due to both the small sample size and the use of ordinal data, it was not possible to calculate a regression equation to verify the predictive value of the data.

A few important limitations to the study warrant discussion. Due to the small size of the sample, any conclusions drawn from these results must be considered to be tentative and exploratory at best. This article portrays a modest pilot study of 35 rehabilitation counselors currently practicing in the field. This relatively small investigation was a sample of convenience, with a majority of the respondents either having affiliations with or having graduated from the same rehabilitation counselor education program. Moreover, all of the respondents to this inquiry practiced in the same area of the country, perhaps being affected by the social norms and attitudes concerning Spiritually Transcendent issues particular to that given area. Hence, the generalizability of the findings is limited. Finally, though the STS-R (Piedmont, 2004a) has been recognized as an effective instrument for assessing the dimensions of Spiritual Transcendence (McCullough, Emmons, & Tsang, 2002) its normative data are limited and there is no other literature using STS-R with practicing therapists or for that matter, any physical or mental health professionals.

Despite these limitations, a number of recommendations may be made. Recognizing both importance of Spiritually Transcendent issues in the field of professional counseling, particularly rehabilitation counseling (Bergin & Richards, 1997; Shafranske, 2000; Standard, Sandhu, & Painter, 2000; Vash, 1994) and the results of this pilot project, perhaps this research instrument might be utilized on a national level with a larger, more representative sample. Were this research initiated, it might again be beneficial to focus on the variance in results between the respondents who disclose specific spirituality training and the remainder of the sample.

Conceivably, the research of Green et al. (2001) might be replicated on a larger, more time intensive study. A more robust investigation is suggested, questioning not only rehabilitation counselor education program directors, but also faculty members and students. Such an undertaking might render a more complete representation of the perceptions of academic community in this crucial area of rehabilitation counseling.

Moreover, depending on the results garnered by the above recommendations, it may be time to call for a change in The Commission On Rehabilitation Education (CORE) standards in regards to Spirituality and Spiritually Transcendent issues. Assuredly, an investigation by CORE seems warranted at this time based on the results of this inaugural research into a critical area for rehabilitation counselors.

In terms of practical recommendations for rehabilitation counselors currently conducting sessions, the possible therapeutic benefits of facilitating client exploration of Spiritual Transcendent issues in dealing with disability has been well established in the literature (Vash, 1994; Nosek, 1995; Wilber, 1995; Shafranske, 2000; Piedmont, 2004b). Rehabilitation counselors not trained in the area of Spiritual Transcendence might be urged to seek such training, possibly in fulfillment of continuing education requirements. Courses and Seminars dealing with Spiritual Transcendence might be locally presented by universities or be part of agency sponsored training. Rehabilitation counselors may be advised to be aware of the therapeutic effectiveness of the concept of Spiritual Transcendence when introduced by a client, facilitating client in-session development of a personal narrative concerning this salubrious principal.

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Daniel J. Smith

University at Buffalo--State University of New York

Daniel J. Smith, Doctoral Student, University at Buffalo--State

University of New York.

Email: [e-mail]

Table 1

Spiritual Transcendence Scale--Revised (STS-R)
--Short Form Items

Item #                                            Item Content

1. I have done things in my life because I believed it would please a
parent, relative, or friend that had died.

2. I feel that on a higher level all of us share a common bond.

3. I find inner strength and/or peace from my prayers and/or
meditations.

* 4. I do not have any strong emotional ties to someone who has died.

5. Although individual people may be difficult, I feel an emotional
bond with all of humanity.

6. My prayers and/or meditations provide me with a sense of emotional
support.

7. In the quiet of my prayers and/or meditations, I find a sense of
wholeness.

* 8. There is no higher plane of consciousness or spirituality that
binds all people.

9. Although dead, memories and thoughts of some of my relatives
continue to influence my current life.

Note. Responses to each item were coded as:
Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, Strongly
Disagree = 1

* Items 4 and 8 were reverse scored.

Table 2

Items Designed to Examine Counselor Attitudes Towards Integrating
Spiritual Transcendence into Counseling Sessions.

Item #                                        Item Content

10. I am willing to introduce Spiritually Transcendent issues in
counseling sessions with my clients.

11. I believe that the integration of Spiritually Transcendent issues
in a counseling session is therapeutically beneficial for
rehabilitation clients.

12. I am able to discuss spiritual values with my clients in session.

13. When the client introduces a Spiritually Transcendent issue, I
will encourage the client to discuss the issue.

14. I am willing to extend a psychosocial discussion with a client
into the realm of Spiritual Transcendence.

15/16. Which of the following best describes you? In my role as a
Rehabilitation Counselor, I integrate Spiritually Transcendent issues
into my individual (group) sessions:

1.) Nearly every session, allowing the client to either accept or
reject the topic.

2.) Whenever the client introduces a Spiritually Transcendent issue
during the session.

3.) Some of the time, usually when nothing else has helped a client
adjust to a disability.

4.) Never, I plan to use limited session time dealing with concrete
issues Not Applicable, I don't conduct individual sessions

Responses to items 10-14 were scored on a Likert-Agreement scale
where: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2,
Strongly Disagree = 1.

Note. Items 15 and 16 were used to gather counselor practices for
either individual or group counseling sessions and were reverse
scored using the 1-4 scale as indicated.

Table 3
Means and Standard Deviations of Items
measuring Counselor Willingness
to Integrate Spiritual Transcendence
into Counseling Sessions.

        Response Frequencies

Items   SA   A    N    DA   SDA   M     SD

10      2    16   10   6    1     3.3   0.94
11      4    18   11   1    1     3.7   0.84
12      5    16   10   3    1     3.6   0.95
13      6    16   10   3    0     3.7   0.86
14      4    18   7    4    2     3.5   1.00

Note: Strongly Agree =5, Strongly Disagree = 1.