Spirituality in Treatment?

 By David S. Prescott, LICSW

When I was a very, very new clinician, I worked in a residential treatment program for adolescents. One day, I was tasked with handling the admission of a new student. Typical of many of our admissions, he was escorted to our program with all of his belongings in a couple of clear plastic bags. He had a few changes of clothes, numerous pairs of old sneakers, and a poster with a drawing of a wolf and the words “spirit animal.” 

At the time, as now, there were periodic discussions in the media about how adults, and in particular schools, handled the topics of religion/spirituality and sex education. The bottom line was that each was a third-rail issue and among the fastest routes to being the subject of an official grievance or complaint. I asked the adolescent about the poster and with standard teen reticence he stated only that he had a connection to wolves. Leaning more in the direction of avoiding trouble than deep understanding, I let the matter drop and helped him to settle in. It’s a decision I’ve regretted for years; there are any number of ways I might have been more helpful in that moment. Instead, I took an easy way out. While we were able to talk about his spiritual path later on in treatment, I’d already established a relational template in which these discussions were less likely to occur. I’d also provided a lesson in adult discomfort with some topics. 

Fast forward a few decades to when I worked in a civil commitment program. A notorious client refused any treatment and all but a few interactions with the administration. He angrily complained to the facility director that because he worshipped the Norse God Thor he should be allowed to keep a sword in his room, along with a blacksmith’s hammer and anvil. This situation seemed to require little clinical nuance: The Security Director took over the discussion and said that he could have a piece of cardboard painted silver to resemble a sword and left it at that. Were we closer? I think not. 

In this second case, contextual factors ruled out serious discussion. This person was refusing treatment while exercising his rights. The clinical staff all had far more urgent matters at hand, or so it seemed. Had someone been able to listen to this person not just to resolve the issues, but with a goal of deeply understanding the client, it might have led to an honest discussion of how they might work together to find religious items that represented this man’s beliefs. 

Even more recently, after pondering the above, I came to find that one of the few books, probably the only book written on the topic of managing objections by self-identified Christians to participating in abuse-specific treatment is long out of print and unavailable; it had been self-published. Likewise, my (and others’) search for an expert who can talk about how to help Muslims place treatment goals and activities into the context of Islam has also turned up no leads despite some promising starts. 

Meanwhile, within the field of treating individuals who’ve sexually abused others, it is unusual to see discussions of enlisting spirituality in treatment. In some cases, modifications made by administrators and clinicians to the Good Lives Model involve tucking spirituality away under the broader rubric of inner peace. I’m confident that many clinicians do excellent work in this area, and yet we seem to remain so quiet about it. After a certain point, I have to wonder what this says about us.  Are we afraid to discuss these matters that we could help make stronger as protective factors, as in the first example? Do we not consider spirituality because it only seems to connect to a small portion of the principles of risk, need, and responsivity? Or are we too busy to consider spirituality, as in the second example? Or do we consider it unlikely that our clients have bona fide spiritual paths? Or do we, in some cases, actually believe them incapable of redemption or of building a more solid spiritual base? 

I don’t have answers to these rhetorical questions and don’t consider myself to have any particular expertise in spiritual matters. I once visited a country that had experienced significant strife over religious freedoms. When conversing with someone new, one never inquired about where the other had gone to school, since that would be an indication of religious beliefs. For them, it seemed that spirituality had become a kind of demilitarized zone. 

A colleague recently commented that in her region in the American south, Christianity is indeed a focal point of treatment. A colleague in South America recently stated the same. As an outsider, I’ve often wondered about programs that describe themselves as having a spiritual foundation in only one direction. Are we really doing enough? 

The possibility for practical challenges and ethical tensions is ever-present. On the other hand, those assisting individuals who have abused have long faced ethical challenges in the routine performance of their everyday duties. Still, it’s more common to see requests for immediate concerns such scoring risk scales and what kinds of travel restrictions might limit where clients may travel in particular US states. 

In the end, every human being has a desire to know how they fit into the universe around them, as described in Robert Emmons’ book, The Psychology of Ultimate Concerns. Perhaps it’s time for a broader conversation in our field?