THE INTERSECTION OF RELIGION/ SPIRITUALITY AND TRAUMA

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THE INTERSECTION OF RELIGION/ SPIRITUALITY AND TRAUMA

Keya Banks grew up in rural North Dakota in an intact, Presbyterian family, the daughter of a physician and a homemaker.1 Her family was financially secure and respected in the community, and through her elementary and high school years, she had strong social support in her peer group and was academically successful. She regularly participated in youth group mission trips with her church, engaging in activities such as building houses after natural disasters. Before she went to college, her most stressful experience was watching her family deal with her sister's Addison's disease. She was concerned about her sister and quite involved in her care. Months of testing were necessary to arrive at a diagnosis, and the family's lifestyle changed dramatically to help her sister return to health. Ms. Banks's faith group valued occupations that provided help and care for others, so she went to college

1The details of the case studies in this volume have been changed to preserve the anonymity of the individuals involved. Trauma, Meaning, and Spirituality: Translating Research Into Clinical Practice, by C.L. Park, J.M. Currier, J.I. Harris, and J.M. Slattery Copyright ? 2017 by the American Psychological Association. All rights reserved.

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considering a career in biological sciences, possibly to become a nutritionist or a physician, like her father. For her, a career in this area felt like the most effective way she could pursue a religious mission to help and serve others.

However, in her first week of school, at a fraternity party to welcome first-year students, she was given punch that had been laced with hypnotics and was subsequently sexually assaulted. Having grown up in a secure community and environment, it had never occurred to her that anyone would deliberately harm her; she felt betrayed by her college community and by God. She felt that she had been doing everything she could to do what she thought was right, and interpreted the predestination beliefs of her church to mean that God had planned for this assault to happen to her. Her faith was severely challenged, and her acute trauma reaction was sufficiently disabling that she left college midway through her first semester, certain that she would not return to the same college, if she returned to school at all.

This case illustrates the sudden and severe nature of trauma and the sweeping impact it can have in key life domains. Importantly, for Ms. Banks, as for many who experience trauma, among the most damaged domains was her spiritual life.

OUR AIMS IN WRITING THIS BOOK

Given the pervasive roles of spirituality and religiousness in many individuals' responses to traumatic events and in their efforts to cope with them, attending to the ways in which religion and spirituality impede or foster resilience in trauma survivors and the ways that trauma may shape people's subsequent religious or spiritual lives will advance our understanding of human adaptation to trauma and our ability to help those who are suffering. It is our shared conviction that attending to the conjoint influences of spirituality and trauma is essential to a full understanding of human behavior and is highly relevant to clinicians working with clients who have a history of trauma.

The authors of this book include leading theorists and researchers in psychology of religion as well as active clinicians working with trauma survivors in both clinical and research settings. All the authors have backgrounds in clinical or counseling psychology, and this book is intended for mental health professionals from these and other disciplines who similarly focus on trauma survivors in their practice and research. Importantly, the authors collectively span a range of religious and spiritual backgrounds as well as current beliefs and practices (e.g., Roman Catholic and Evangelical Christian to agnostic and Buddhist or yogic spiritualities). We feel it is important to disclose the diversity of our perspectives to emphasize that, regardless of readers' personal backgrounds and current spiritual lives, this book can be

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quite relevant to their values and clinical approach; we attempted not to privilege any particular spiritual or religious backgrounds, beliefs, and practices. In fact, for each of the authors, research findings and clinical experiences have demonstrated the importance of individuals' spiritual lives in the process of making meaning of and recovering from traumatic experiences. All the authors have also been struck by the lack of scientific literature necessary to effectively address spiritual concerns in trauma survivors and have dedicated much of their careers to addressing this need.

OVERVIEW: THEORY AND RESEARCH ON TRAUMA AND SPIRITUALITY

Research on trauma and its aftermath has been increasing in volume and scope in recent decades (Friedman, Keane, & Resick, 2007). This proliferating interest has been spurred in part by the recent wars in which the United States has been involved, as well as official recognition of posttraumatic stress dis order (PTSD) following the challenges of many Vietnam veterans (American Psychiatric Association, 1980), and in part by a general increase in cultural awareness of the toll taken by many types of trauma (Friedman et al., 2007). However, researchers have only relatively recently begun to focus on spirituality in the context of trauma (Y.Y. Chen & Koenig, 2006a). Theory and research in this area primarily have focused on the ways in which religion or spirituality may serve as coping or resilience factors when people confront traumatic events (e.g., Fallot & Heckman, 2005; Peres, Moreira-Almeida, Nasello, & Koenig, 2007). A smaller amount of theory and research has outlined the effects of traumatic and highly stressful events on people's spiritual lives (e.g., P. Kennedy & Drebing, 2002; Uecker, 2008).

In tandem with the increased research focus on trauma, clinicians have increasingly focused on developing effective assessment and clinical interventions following trauma and its aftermath (e.g., van der Kolk, 2007), yet the spiritual aspects of trauma and recovery are rarely considered in clinical practice. Most mainstream approaches to treating trauma exposure and diagnosed PTSD, including the work of Resick (2001), Foa and Rothbaum (1998), Briere and Scott (2006), and Ehlers and Clark (e.g., Michael, Ehlers, Halligan, & Clark, 2005), make almost no mention of spiritual or religious issues. Such omission may suggest that these issues are unimportant to clinical practice with people who have histories of trauma. Briere and Scott, for example, mentioned spirituality only once. Numerous books are available regarding spiritual and religious issues in counseling and therapy, many with an explicit Christian focus (e.g., McMinn & Campbell, 2007; Worthington, Johnson, Hook, & Aten, 2013). These books, however, make minimal

intersection of religion/spirituality and trauma 5

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reference specifically to trauma. For example, Pargament's (2007) book, Spiritually Integrated Psychotherapy, mentions the word trauma 18 times in 384 pages. However, along with a growing appreciation by mental health professionals regarding the critical role of religion and spirituality in many people's lives, the intersection of spirituality and trauma appears to be garnering more attention. For example, Walker, Courtois, and Aten (2015) recently published an edited book, Spiritually Oriented Psychotherapy for Trauma, which brings together these two themes.

This relative lack of attention to the spirituality?trauma interface may be, at least in part, because psychologists tend to be far less religious than the average American (Delaney, Miller, & Bison?, 2007). For example, survey responses of a sample of members of the American Psychological Association were compared with responses from the general U.S. population. Psychologists were much less religious than was the general population. The vast majority, however, regarded religion as beneficial (82%) rather than harmful (7%) to mental health (see Table 1.1). Although recent data have suggested that fewer Americans identify with a specific religious affiliation (termed the religious nones), most of these people still report believing in God or a higher power and endorse some aspects of spirituality (Pew Research Center, 2015). Still, the composition of religiousness in Americans is changing, which may have implications for both therapists and the clients they serve.

Although researchers have been slow to attend to the links of religion and spirituality with trauma and most approaches to clinical intervention still ignore religious and spiritual issues, we take the position that religiousness and spirituality should indeed be considered in the context of trauma because they are often closely intertwined in human experience. We now know that trauma often forces individuals to face the uncertainty and instability underlying human existence and reconsider their sense of identity as well as their deepest beliefs regarding control, responsibility, justice, trust, guilt, suffering, and forgiveness (S. Smith, 2004). These confrontations frequently tap into individuals' most profound dimensions of spirituality, regardless of whether they are explicitly framed as such. Further, research has made it clear that individuals often turn to religious and spiritual strategies to cope with their traumas (e.g., Y.Y. Chen & Koenig, 2006b).

DEFINING RELIGIOUSNESS AND SPIRITUALITY

In spite of the extensive efforts of many theorists and researchers over the past few decades to develop satisfactory definitions of religiousness and spirituality (Oman, 2013), such definitions remain elusive. Any proposed definitions of religiousness and spirituality (and any distinctions drawn between

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TABLE 1.1 Survey Responses (in Percentages) Regarding Spirituality and Religion in Members of the American Psychological Association (APA)

Compared With the General U.S. Population

Questions and responses

APA, 2003 U.S.

How important is religion in your life?

Very important

21

55

Fairly important

31

30

Not very important

48

15

During the past year, how often did you participate in religious

worship at a church, mosque, synagogue, feast day, etc.?

Never or rarely

55

40

Once or twice a month

22

13

Once a week or more

23

47

Belief in God

God really exists

32

64

Some doubts but believe in God

19

20

Some belief, higher power

25

10

Don't believe in God, don't know

25

5

What do you personally believe about the effects of religion, in

general, on mental health? Do you think that being religious

is most likely to be:

Harmful to mental health

7

Irrelevant to mental health

11

Beneficial to mental health

82

How often do you inquire about or assess your clients' religion

or spirituality?

Never/rarely

14

Sometimes

35

Often

37

Always

14

How often are spiritual or religious issues relevant in the

treatment that you provide?

Never/rarely

17

Sometimes

57

Often

23

Always

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Note. From "Religiosity and Spirituality Among Psychologists: A Survey of Clinician Members of the American Psychological Association," by H.D. Delaney, W.R. Miller, and A.M. Bison?, 2007, Professional Psychology: Research and Practice, 38, p. 540. Copyright 2007 by the American Psychological Association.

them) generate vigorous dissent (see L.H. Martin, 2015; Paloutzian & Park, 2015), leading others to try once again. In this book, we follow the lead of a recent proposal by Pargament and his colleagues in their APA Handbook of Psychology, Religion, and Spirituality (Pargament, 2013; Pargament, Mahoney, Exline, Jones, & Shafranske, 2013). They defined spirituality as "the search for the sacred," with sacred referring not only to God or higher power but also to "other aspects of life that are perceived to be manifestations of the divine or

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