The research makes a clear distinction between religiosity and spirituality. Religiosity generally involves factors such as religious affiliation, participation, religious rituals and practices, religious commitment, and interpretation of religious values into spiritual beliefs. Whereas, spirituality belongs to all cultures and has both an individual, cultural-specific, and within-group interpretation. Thus, spirituality is integrated into the service member or veteran’s consciousness, emotions, and overall health and well-being.
Military counselors’ work with service members, veterans, and family members who have both religious and spiritual concerns due to military-life. The nature of the service member or veteran’s spiritual health presents a conceptual dilemma in the military counseling literature. This same dilemma is a concern with military counselors because spirituality lacks a precise and comprehensive definition with few guidelines for integrating spirituality into theory and practice. The scope of practice for military Chaplains regularly address spiritual and religious concerns. However, other counseling professionals have difficulties approaching these issues in counseling interactions primarily because the: (a) conceptual boundaries between religion and spirituality are sometimes difficult to discern, (b) service members’ spiritual health are difficult to measure and at times are irrelevant to the presenting problems within military life, and (c) literature in counseling and psychology lacks guidelines for training military counselors how to assess and treat the service member or veterans’ psychospiritual health.
Spirituality indeed is difficult to define because it exists in the hearts and minds of all races, ethnic groups, and faiths which permeates the culture in which they live. It is a subjective experience for service members and veterans. Religiosity is more noticeable because it involves the individual’s expression of a particular set of beliefs, doctrines, and rituals that are typically institutional or based within a church or religious organization (Frances, 2016; Miller, 2003; Shafranske & Maloney, 1990; Vaughan, 1991). In contrast to religiosity, spirituality describes the relationship between the person and a transcendent being or higher power. It is described as the courage to look within and to trust a deep sense of belonging, wholeness, connectedness, and openness to the infinite (Schafranske & Gorsuch, 1984). Spirituality, then, is not an entity on its own; rather, a person's spiritual being is interwoven within the individual’s physical body and emotional psyche (Ellison & Smith, 1991). It is present in all human beings and cultures as a way to find and construct a personal meaning about life and its existence (Myers, Sweeney, & Witmer, 2000; Stebnicki, 2016a). Overall, as a result of exposure to complex trauma then spirituality can create meaning and purpose in the service member or veteran’s life and can be a vital therapeutic resource for healing.
INTEGRATING SPIRITUALITY IN MILITARY COUNSELING PRACTICE
Despite a lack of guidelines offered in the literature that speaks to integrating spirituality in military counseling, there appears to be increased interest in addressing spiritual issues for civilian trauma survivors as well as those that have acquired chronic illnesses and disabilities (Burke & Carruth, 2012; Stebnicki, 2001; Stebnicki, 2006, Stebnicki, 2017). For the most part, these principles and practices require translation into military mental health practice. However, there appears to be a growing body of literature in the fields of military counseling, psychology, and behavioral health where resources are offered to military service members, veterans, and family members (Real Warriors, 2018; Robertson, 2016; U.S. Army Public Health Command). Research is taken primarily from the psychospiritual (CIV) literature but reinforces the notion that spirituality is positively associated with good physical and psychological health. Spirituality and religion both honor what is held sacred.
Clearly, there is a new science of the mind, body, and spirit. This has developed over the last 20 years which suggests that a person's spiritual health has a major influence on the body's immune system and may affect the ability to combat chronic illness and life-threatening disability (Aldridge, 1993; Cousins, 1979; Goleman, 2003; Kelsey, 1981; Moodley & West, 2005; Peck, 1993; Roud, 1990; Schwartz, 1994; Siegel, 1990; Simonton, 1978; Walsh, 1999; Weil, 1995). This is an emerging area of interest to counseling professionals, primarily because Western models of evidenced-based medicine and psychotherapy often do not integrate alternative forms of therapy which promote optimal levels of health and healing (Bliss, 1985; Chandler, Miner-Holden, & Kolander, 1992; Frame, 2002; Goodwin, 1986; McKee, 1988; Trieschman, 1995). Many persons are dissatisfied with the ineffectiveness of the medical and psychiatric models of mental health treatment primarily because of (a) the heavy reliance on pharmaceutical products, (b) a philosophy of treating the “disease” while minimizing psychosocial aspects of the person, and (c) a perceived lack of control clients/patients have in choosing alternative treatment options (Astin, 1998; Weil, 1995; Weil, 2011).
It is believed by many of the earlier theorists and psychotherapists (Assagioli, 1971; Frankl, 1959; Fankl, 1967; Freud, 1966; Jung, 1916, 1933; Maslow, 1971) that dealing with spiritual issues in counseling are not only powerful in facilitating personal growth, but is necessary in order to understand and work with the whole person. Discussing spiritual values and beliefs within counseling services is perceived by some to be the most influential factor in healing negative patterns of behaviors, personal beliefs, and increasing awareness of the meaning and purpose of chronic illness and disability (Krippner & Welch, 1992; Peck, 1993; Siegel, 1990). Accordingly, understanding or making sense of a chronic illness, disability, or traumatic experience essentially is a search for the meaning which is a spiritual pursuit (Byrd & Byrd, 1993; Garfield, 1979; Goodwin, 1986; Lane, 1992; Vash, 1994). Overall, military counselors who are competent in facilitating spiritual growth during counseling sessions may assist clients in gaining a deeper understanding and meaning of their experiences of trauma, existential crisis, or moral injury.
PRACTICE GUIDELINES FOR INTEGRATING PSYCHOSPIRITUALITY
The integration of spirituality and spiritual identity within the military service member or veterans’ counseling session many times is dependent upon the military counselor’s level of interest, motivation, and training to pursue such integration of spiritual practice. A major misconception is that you must be a Chaplain to address spiritual issues. This, along with the confusion between religiosity and spirituality, is perhaps one of the reason’s military counselors relegate these issues to other clergy professionals such as Chaplains.
This section offers some suggested spiritual-existential questions that can assist the military counselor in opening-up a discussion of their client’s spiritual beliefs, values, and philosophies that have transformed them within military life. Integrating spirituality into psychotherapy practice, with the intention of achieving optimal spiritual well-being, has been well documented in community or civilian counseling settings (Chandler et al., 1992; Ellison & Smith, 1991; Goodwin, 2002; McKee, 1988; Meyers & Sweeney, 2008; Meyers, Sweeney, & Witmer, 2000; Meyers & Williard, 2003). However, it continues to struggle for credibility among many military counselors and clients alike. Thus, the following guidelines are offered to assist military counselors with the intention of opening up an exploration of the client’s psychospiritual nature and integrating some of these issues within therapeutic interactions.
Guideline 1: Before integrating spirituality into therapeutic practice, gain a complete understanding of your client's socio-cultural background, spiritual-religious values and beliefs, and any specific spiritual concerns. Both you and your military client should feel comfortable and motivated to discuss any psychospiritual concerns related to trauma, moral injury, and military life. Military counselors can create a therapeutic environment that accepts, without judgements or conditions, their client’s spiritual-religious practice. Being open to integrating psychospiritual practices can expand therapeutic opportunities for your military or veteran client.
Guideline 2: The shift to addressing psychospiritual concerns can be aided by using the example of Meyers and her colleagues’ who have created the foundational work in the Wheel of Wellness (WoW) (Meyers et al, 2000). The WoW is a theoretical model which combines empirical research from 17 specific areas of health, longevity, and quality of life. This model suggests there are five life tasks central to healthy human functioning which includes (a) work, (b) friendship (c) love, (d) self, and (e) spiritualty. Although there are 17 categories of wellness in the WoW model, spirituality is hypothesized to be the most essential aspects of wellness and healthy human functioning (Meyers et al., 2000; Shannonhouse, Myers, & Sweeney, 2016). This particular model is useful in therapeutic interactions because it incorporates the core of medical, physical, mental, cognitive, behavioral, psychological, social, emotional, behavioral, vocational/occupational, and spiritual functioning. Clearly, the search for personal meaning in one’s chronic illness, disability, or traumatic experience is an existential and spiritual pursuit. Many in the military community have already become attuned to spiritual matters when faced with trauma, loss, and chronic health conditions. Thus, it is vital for military counselors to understand the holistic needs of their clients by exploring their military life experiences from a metaphysical or spiritual perspective. The power of spiritual practices offers a therapeutic opportunity particularly for those who must cope with adversity (Chang, Noonan, & Tennstedt, 1998; Goodwin, 1986; Lane, 1992; McCarthy, 1995; Stebnicki, 2016; Vash, 1994; Walker & Walker, 1995).
Guideline 3: There are multiple areas for military counselors to consider before fully integrating psychospiritual approaches into sessions. This includes, but is not limited to: (a) administering spiritual assessments during intake interviews (see SWBS; Paloutzian & Ellison, 1982 in References), (b) countertransference issues and ethical guidelines for counselors, (c) self-exploration of the counselor’s own spiritual/religious identity, (d) the acceptance of supervision strategies that may help guide clinical practice in this area, (e) the military counselors’ knowledge of different Eastern, Western, and indigenous religious and spiritual practices, and (f) specific treatment issues and referral sources related to spirituality. These are all critical issues to consider prior to infusing spiritual issues in clinical practice.
Guideline 4: Military counselors should create a supportive environment that allows clients to explore, understand, and articulate a personal meaning of their spiritual or religious practices and be aware of how their values may potentially impact others within their military family. From an ethical perspective, military counselors are not providing counseling services with a particular spiritual or religious orientation (i.e., Christian counseling). Rather, after a comprehensive intake interview, military counselors know when it is appropriate to refer their client for religious or other types of spiritual counseling approaches that are traditionally addressed by Chaplains and Clergy members.
Guideline 5: Some of the following brief questions may be asked during therapeutic interactions to begin an exploration of your military or veteran clients’ psychospiritual concerns:
* Tell me about some of your spiritual/religious beliefs?
* Do you practice any particular rituals, observe any religious holidays, or find any other types of spiritual practices comforting?
* What role, meaning, or purpose does your spiritual/religious belief play in your military (or veteran) life?
* Are there any particular beliefs that create anxiety or confusion for you?
* What do you believe your Higher Power or God has to teach you about your military life experiences?
Guideline 6: Assessing Spiritual Well-being and integrating issues of spirituality during military or veteran counseling interactions can be an opportunity for clients to explore the meaning and purpose of their military life, coping with adversity, and issues related to trauma exposure and overall life-readjustment. Polanski (2003) provides sample questions to initiate an exploration of the client’s spirituality such as:
* What in your life do you hold sacred or spiritual?
* Is there a particular poem, song, or passage from scripture that speaks to your life right now?
* I wonder what kind of spiritual growth you see yourself making as a result of your situation?
* If you thought of your situation as a map given to you by your higher power, where do you see yourself lead?
Cashwell and Young (2005) offer the following sample questions that may be useful for exploring the individual’s religious/spiritual beliefs:
* What are some of your earliest memories of religion, church, synagogue, or perhaps the absence of religion?
* What, if any, were your early images of God or your Higher Power?
* What are your earliest memories of non-ordinary reality, a Higher Power, some mystery in the universe, or other meaningful spiritual or transpersonal experiences?
* What resistance or barriers exist that prevent you from connecting with sources of spirituality? * Where are you at now on your spiritual journey?
SUMMARY AND CONCLUSION
If in fact, the body, mind, and spirit comprise the whole person, then we should be able to demonstrate a positive relationship between the military or veterans’ spiritual and psychological health using subjective measures of psychological, physiological, and spiritual well-being. Despite complex interacting variables, measuring the effects of spiritual practices on the person’s spiritual well-being, there is a paucity of research on measuring spiritual well-being within the military and veteran community. The Spiritual Well-Being Scale (see SWBS; Paloutzian & Ellison, 1982) is just one example which is considered the most extensively researched measure of subjective spiritual well-being (Ellison & Smith, 1991; Ledbetter, Smith, Vosler-Hunter, & Fischer, 1991; Watson, Morris, & Hood, 1990). The WoW (Meyers et al., 2000; Shannonhouse, Myers, & Sweeney, 2016) is an example of a model that could be adapted to the military culture.
Overall, the search for personal meaning in one’s chronic illness, disability, or traumatic experience is thought to be an existential and spiritual pursuit. Openness to infusing issues of spirituality into clinical military practice are essential for treating the whole person. The impact that trauma and disability has on the military service and family members are enormous. Thus, integrating spirituality within therapeutic engagements will assist service members and veterans’ coping and resiliency skills. I have offered guidelines for military counselors to implement in their clinical practice. Advancing the theories and practice of spiritual integration, particularly for military clients with chronic medical/physical/mental illnesses and disabilities are essential for healing trauma.
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