By: Mary Ann McColl, PhD, MTS
What can occupational therapists do to integrate spirituality in practice? First, let’s think about how spirituality might arise in the day-to-day interactions in occupational therapy. There are usually two ways that clients let us know that they have spiritual issues on their minds, or that their functional problems may have a spiritual dimension – directly and indirectly (McColl, 2000). Some clients will be explicit about their religious beliefs and convictions, their public or private faith practices, and their relationship with a Higher Power. Others will approach the issue indirectly, by displaying symbols of their faith, by asking questions about issues such as life after death, reasons for things that happen, search for meaning, loss of hope or faith.
There are at least four ways that occupational therapists can engage with clients in response to either a direct or an indirect overture about spirituality (McColl, 2011).
- The first thing an occupational therapist can do, and something that every therapist should be prepared to do (regardless of his or her own faith experience or preparation), is to listen for and recognize the words, symbols, ideas or themes that clients may use to alert the therapist to the potential for a spiritual issue. Spiritual issues are sufficiently sensitive in our culture that clients may be insecure about raising them. It would be a shame indeed if a therapist was unable to appreciate the depth and importance of a spiritual issue that a client was trying to raise, and therefore left it unattended.
Although discussions of spirituality requires a significant degree of cultural competence, one need not know about every religion to be able to talk to someone about his or her spirituality. Discussions of spirituality may deal with generic concepts, like the relationship with a higher power, hope for the future, meaning in life, or belonging in a faith community. There are two difficulties that therapists typically encounter when clients raise spiritual issues. Either they do not have language or concepts to respond confidently and professionally, or they are worried about imposing their own beliefs on the client. Both are legitimate concerns, but both can be dealt with by simply acknowledging the depth and importance of the issue the client is raising, and asking if he or she would like to discuss it further.
- Another very legitimate option for therapists encountering spiritual issues is to offer to help clients find someone who is qualified to have in-depth spiritual conversations with them. This may be an officiant of the client’s own faith tradition, or it may be a multi-faith chaplain, such as work in many health and social service facilities. Referral to a spiritual counsellor can be a very effective therapeutic contribution for a client who is struggling with a spiritual issue.
- Indirect spiritual interventions are a third way that therapists may choose to engage with clients whom they suspect have spiritual issues affecting their occupation. A review of the literature revealed six modalities that offer the opportunity of a spiritual experience or discussion, but that are not inherently spiritual or religious (McColl, 2011; 2016). These modalities can be used by therapists even if they are not spiritual or religious themselves.
- Narrative: The process of creating and relating narratives is a vehicle for spiritual exploration and growth, allowing the narrator to create meaning, to connect to spiritual themes (like hope, healing and redemption), and to make connections across past, present and future (Kirsch, 2011).
- Ritual: Rituals are ordinary activities that are invested with symbolic meaning when performed to celebrate, commemorate or sanctify important events or ideas ( Thibeault, 2011). They have the power to mark passages, transitions and milestones.
- Appreciation of nature: Experiences in the natural world can make one more aware of the mystery and connectedness of all things. The sense of awe and wonder that often accompanies experiences in nature can evoke thoughts and feelings about beauty, creation and the divine (Unruh, 2011).
- Creativity: A fourth type of indirect spiritual intervention is creative activity, or what Peloquin (1997) refers to as “making rather than doing” (p. 168). Creative activity affords an opportunity for unconstrained expression of spirit and communication of universal truths (Toomey, 2011; Woodbridge, 2011).
- Work: Work is an occupational medium that offers individuals an opportunity for service and contribution, for participation in a shared mission, for the dignity associated with a job well done, and for the rhythm of work and the orderliness of time structured by work routines (Baptiste, 2011).
- Movement: Movement therapy can evoke spiritual remembrance of our physical connection to the earth, to our bodies and to each other. Embodiment is a fundamental aspect of what it means to be human, even when the body is physically limited or constrained (McColl, 2016).
- The fourth option is direct spiritual intervention, meaning specific faith practices, such as prayer, meditation, worship, or spiritual counselling. These interventions usually require additional training and qualifications, and most therapists will feel that these are outside of their professional scope of practice, unless they have obtained some specialty certification. McColl & Farah (2011) offer guidelines for the use of direct spiritual interventions. They suggest that a therapist ask him or herself the following four questions:
- Is the client’s problem inherently spiritual in nature?
- Is the client receptive to spiritual intervention?
- Is the therapist qualified to offer the spiritual intervention?
- Would the therapist’s employer support him or her in offering this type of intervention?
If the answer to all four questions is “yes”, then a therapist may consider offering to pray, meditate, worship or engage in other spiritual practice with a patient. There are a number of cautions outlined in McColl and Farah (2011), such as the need for a secure therapeutic relationship, the necessity for the practice to be genuine, and the assurance that it is in no way forced or imposed.
In summary, there are a number of options for occupational therapists to acknowledge and honour the spiritual dimension of their clients. They fall on a continuum from simply recognizing and giving voice to spiritual concerns, all the way to engaging in direct spiritual practices. Therapists will vary on the extent to which they are comfortable with these options or even interested in this area of practice – and that is nothing to be ashamed of. What would be a shame indeed is to fail to recognize spiritual suffering in a client, or to recognize it but not know what to do. I hope this brief article reassures occupational therapists that they can not only identify spiritual issues, but also that they can do something helpful –
- by acknowledging the issue,
- by referring to a qualified spiritual health professional,
- by providing opportunities within familiar therapeutic modalities for spiritual expression and exploration, and
- in some carefully considered cases, by sharing in a spiritual practice with a client.
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About the Author:
Mary Ann McColl, PhD, MTS is a Professor of Occupational Therapy in the School of Rehabilitation Therapy at Queen’s University in Kingston, Ontario, Canada. She is also Associate Director of the Centre for Health Services and Policy Research, Professor in Public Health Sciences, and Academic Lead for the Canadian Disability Policy Alliance. Dr. McColl is author of Spirituality and occupational therapy (2nd ed.), as well as the Canadian Occupational Performance Measure (5th ed.), Theoretical basis of occupational therapy (3rd ed.), Disability & social policy in Canada (2nd ed.), and Inter-professional primary health care.
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2. Krisch, B. (2011). Narrative: What makes narratives spiritual and how can we use them in OT? In M.A. McColl (Ed.), Spirituality and occupational therapy (2nd ed.) (pp. 201-208). Ottawa, ON: CAOT Publ.
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