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Emphasizing the spiritual

September 16, 2013
by Margaret Nagib, PsyD
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Margaret Nagib, PsyD

In the past two decades, an effort has been made to establish a new movement that seeks to challenge and improve upon the historically accepted ideas, methods and values surrounding addiction treatment. The movement’s name, Recovery-Oriented Systems of Care (or ROSC for short), highlights its mission. Put simply, the mission of a recovery-oriented system of care is to comprehensively identify and support the needs of an individual seeking addiction treatment by creating a wraparound, scaffolding approach to address all aspects contributing to successful recovery.

In 2005, participants in the National Summit on Recovery established a nationally agreed upon definition, 12 principles, and 17 elements of recovery that comprise a ROSC community. The credible efforts of those involved in the summit produced a 119-page report highlighting a much-needed framework for ROSC to begin to be established.1 A major theme in the report involves the importance of a ROSC identifying and addressing the needs of the whole person—mental, physical, relational and spiritual.

This article seeks to explore what it looks like specifically to address the spiritual needs of the individual in a ROSC, and the spiritual themes described therein. These themes will be discussed to help inform how the spiritual needs of those in recovery might be addressed in this model.

Characteristics of the holistic approach described in the ROSC report pertaining to spirituality include (1) a “responsiveness to personal belief systems” and (2) a ”person-centered” approach that provides choices in the area of spiritual supports that are (3) “anchored in the community.”

Responsive to personal beliefs

To date, research has shown that addressing the spiritual needs of those served in behavioral health systems is crucial. Most of the high-quality research in this area supports the connection between faith and health, and reports that the demand for health professionals to respect, acknowledge and integrate spirituality and religious beliefs is increasing.

Several studies suggest a positive association between measures of spiritual and religious beliefs and practices and measures of medical and psychological health, and there is an increased realization that these constitute essential aspects of providing individualized care that is sensitive to diversity.

Therefore, in a ROSC, responsiveness to personal belief systems along with a person-centered approach can occur only when appropriate measures are taken to understand, assess and then incorporate an individual’s spiritual and religious beliefs and practices.

Saunders, Miller and Bright have devised a model for assessing and addressing the spiritual and religious needs of the individual that can be adapted to a ROSC.2 Their model for “spiritually conscious psychological care” is philosophically aligned and, perhaps more importantly, clinically informative to providing a practical approach that is sensitive to individuals’ spiritual needs.

Philosophically, the model outlines the guiding principles of “respect, responsibility, integrity, competence and concern” in addressing spiritual care. Practically, it helps to define a continuum of spiritual care based on the level of spiritual and religious attribution and involvement of the individual.

The assessment questions in this model help to ascertain three aspects of spiritual needs: beliefs and behaviors; the interaction between the presenting problem and spirituality; and potential resources to help recovery. The authors state that “spiritually conscious care entails explicitly evaluating these issues during the formal evaluation of the intake phase of treatment, and remaining open to their emergence and potential influence as treatment progresses.”

This is done by utilizing opening questions that pertain to the three areas. The following questions are helpful when assessing beliefs and behaviors: Are you a religious or spiritual person? How important is spirituality or religion in your daily life? Has spirituality or religion been important to you in your life? What things are most important to you? Are there things in your life that are sacred to you? What gives your life purpose or meaning? Do you believe in a Higher Power? Are you part of a spiritual or religious community? Do you practice a religion currently? Are there spiritual or religious practices that you follow regularly?

Questions assessing the interaction between beliefs and attitudes and the presenting problem can include: Has your current problem affected your relationship with your Higher Power? Has the problem for which you are seeking help affected your religious or spiritual life? Are spirituality or religion important to this problem? Has your religion or spirituality been involved in your attempts to deal with this problem? Are you worried about possible conflicts between your beliefs and your treatment?

Questions to ascertain potential resources include: Are members of your spiritual or religious community (such as a spiritual leader) a potential resource for you in trying to deal with this problem? Is there someone you can talk to about spiritual or religious matters as they relate to this problem? Is there anything that I can do to help you access such resources? Would it be helpful if I consulted with your spiritual leader?

The model also focuses on the importance of providers’ becoming competent in addressing the spiritual needs of clients. One area of basic competency involves skilled interviewing that is respectful, non-judgmental and appropriate. Each provider has his/her own set of beliefs and attitudes and must put these aside to uncover another person’s meaning skillfully and in an unbiased manner, and use that meaning to guide treatment effectively and ethically.