Spiritual Integration Into Family Therapy, Case Study Example

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Case Study

Clients’ problems

Isaac, a ten year old boy experiences severe behavioral problems including fighting at school, intense, sudden anger outbursts and does not cooperate with his old brother, Sam. He has attention and hyperactivity problems at school, and has trouble sleeping at night. Isaac yearns for his mother in his life but fears rejection at the same time, and thus sometimes he may attempt to pull his mother closer in forceful, aggressive ways and at times attempts this by asking for closeness or reassurance from a far away secondary perspective, but does not understand what he is asking for. This has led to uneasiness in both of them. The mother is quite sick all the time and is creating an immense distance between them.

Isaac’s parents divorced 3 years ago, and Isaac only sees his father once a year. His father, with a terminal cancer, lives in a different province. The mother as well is seriously sick with three brain tumors, which are causing difficulties in mobility and functioning. Recently they had a house fire, which killed their pets- two dogs and a cat. Isaac had an unusually strong attachment to the pets. Isaac is trying to make the adjustment from a house with six bedrooms to a 2-bedroom apartment with his mother and older brother.

The mother’s family is all back in Ontario, but she cannot visit them easily as she claims  that they give her a hard time for being “so far away”. She does not feel close ties to her mother, and she says it feels “fake” and “awkward” with her mum when they hug. The mother feels she is similar to her own mom in many ways including: “high expectations, nobody can ever do anything right and there is nothing sturdy enough”. She also says she is close with her dad. Her two sisters complain to her about her being away from the family. Her one sister she was extremely close to through childhood, attempted suicide a few months ago and she feels guilty for not being there with them after a family phone call. After she hangs up, she feels restless and blames her sickness that she is just sitting at home doing nothing.  This cycle continues with a period of not talking to the boys and isolating herself.  At times, the boys will try to make things better after these conversations with her family, but they never know how their mother will react so they are exceedingly cautious to approach the situation.  The mother does believe in God and has been seeking support from friends at a local church.

Preferred outcome for therapy

The outcome of therapy for the family is to make them have close ties. Isaac who fears of rejection from his mother and showing an ambivalent behavior needs to get rid of this attitude at the result of the intervention therapy plan. Isaac’s mother needs to come to the realization that she should not blame herself for the problems she perceives to be responsible. Attending to Christian gatherings or participating in Christian practices including prayer, meditation and scripture reading will be of enormous help to this family. Thus, in this case study, I will present how the family should cope, with the situation at hand, to bring the family in order once again.

Assessment procedure

I have purposed to deal with the family’s problems by attending to them giving them assurance and hope in the venture. I have purposed to address the problems and not viewing the individuals as the problems. I have the following questions to take the clients through as part of the therapist-client intervention. The questions include:

  1. What is the problem that brought you for this therapy?
  2. How long has the problem disturbed you?
  3. How has the problem affected your relationship to other individuals in the family?
  4. Could you tell sometimes when you mastered control over your anger? What peculiar or distinct characteristics did you have that time?
  5. What measures have you attempted using to solve the problems?
  6. If it happened that the problems you have presented disappeared, how would you behave and how would you relate to the other family members?

Spiritual matters

Researchers have shown religion to play a significant role in mental health. Religious commitment has a positive association with positive affect, life satisfaction, optimism and hope. In palliative circumstances, mental health and spirituality have proved to have a strong relationship. According to Lucchetti et al. (2012), people with high spirituality levels have a high degree to tolerate fatigue and pain from life threatening diagnosis of HIV or cancer. The same study exhibited marked and positive relationships between quality of life measures and spiritual well-being measures, faith and peace. Studies have also shown that patients with terminal cancer who believed in afterlife, reported belief in a power higher than man report and believed in the power of prayer, experience lower pain degrees than patients who did not share the spiritual beliefs.

Researchers have also associated low levels of anxiety and distress with religion and spirituality. Spiritual well-being correlates negatively with the end of life despair, assessed on variable outcomes including a desire for hastened death, hopelessness, and suicidal ideation (Plante, 2007). Again, according to researchers, individuals affiliated with religion have few suicide attempts and more reasons to forge ahead in living compared to individuals not affiliated with religion. Thus, attending to church functions for the family in this case will help considerably. Holding prayers in the church as well as at home will help them establish a rapport to ease communication among themselves and build trust and hope on each other.

Attachment theory

John Bowlby (1907- 1990) developed the attachment theory. He was a British psychoanalyst attempting to find about intense distress among infants separated from their caregivers or parents. Bowlby noted separated infants going to extraordinary lengths such as crying, franticly searching and clinging to reestablish proximity to a missing parent or prevent separation from their parents. Other researchers who have contributed to this theory are Ainsworth, Blehar, Waters and Wall. In their work, the researchers observed that psychoanalytic theories of their time never gave an adequate explanation on how the bond between mother and child functions, develops and influences personality.

There are many key aspects of attachment theory, which are relevant in my case study. Within the first several months of the child’s life, an affectional bond forms in the typical caretaker-child relationship and, which does not, have any relationship to the child’s gratification from breast-feeding (Edwards et al, 2009). The researchers have argued that the child develops an internal working model of both self and other, through the mother-child interaction. The internal working models developed influences the relationships quality throughout life. In the initial life stages, the relational attachment serves a survival function, thus, making the child safe from predators and other dangers and ensuring closeness to the mother. Cues that signal danger, threats, or other stressors trigger attachment behaviors such as proximity seeking.

Four key components of attachment theory exist. These include safe haven, secure base, and proximity maintenance and separation distress. For safe haven, a child returns to the caregiver for comfort and soothing when he or she feels threatened or afraid. The parent or caregiver provides a dependable and secure base for the child to explore the world in a secure base component. Edwards et al. (2009), assert that in proximity maintenance, the child strives staying, near the parent, to keep himself or herself safe. The separation distress component means a child becomes upset and distressed when the caregiver leaves.

A study by Ainsworth which observed the dyads of mother-infant in both laboratory and field settings characterized the relationships of attachment as secure or insecure. Insecure attachment relationships were anxious and ambivalent, and others were insecure avoidant. Children who had no coherent care-seeking strategy fell into a fourth category of disorganized-disoriented.

The attachment theory has shown children to develop along with the behaviors they have into adulthood because of the experiences they pass through in relating with the caregivers.  Secure attachment can incorporate religious matters into it in order to ensure that children develop into their adulthood with positive thoughts and optimism in facing life challenges (Edwards et al, 2009). Religion, spirituality, science and psychology integration in the recent years has received both public and professional support and significant grant. Many professional organizations have come up with interest groups focusing on health and religion integration. Depending on a power above the ability of man, is characteristic of many religions. In Christianity, God is above all and Christ takes the burdens of repenting sinners. In this case study, I will use attachment theory to show that just like children depending on their parents for protection in situations of trouble, people can depend upon God. Dependence upon God for those who believe leads to a relief of worries and creation of hope even amid myriad problems.

Summary of planned interventions

In preparation to provide counseling for clients in this case, I have taken consideration to understand my own attachment experience in my childhood, adult life and my relationships with God. By doing; thus, I will be able to use my position to give counseling to Isaac and his mother on how to approach the issues they are facing for a change.

Counseling of the clients

I will undertake this task by tackling each client separately at the initial stage. I have chosen to start with Isaac who seems to have so much distress. I will start by welcoming him to the programme intervention and giving him my assurance and trust that he will change in the end. I will seek to point him to God’s concern over his problems and make him hope that, through prayer, his problems will disappear. I will take him through the questions in the assessment procedure above making sure that he gets enough time to respond. I will seek, for maximum cooperation from him, to ensure that we move together through the process. I will hold a prayer with him and suggest a daily practice of prayer and meditating upon the scriptures for him to get nourishment. I will also encourage him to attend church functions regularly for him to   belong to a group that cares for his problems. I will encourage him to talk freely to his mother and the brother concerning his problems. I will encourage him to capitalize on emphasizing the traits he has used, at some time, to conquer his outrageous outbursts.  I will help him through this exercise and organize to meet him again after every week to outline some of the improvements and challenges affecting him in implementing the suggestions.

I have planned to counsel Isaac’s mother second where I will use a similar approach as for his son Isaac. I will give her an assurance of her problems ending giving her a chance to enjoy her daily living. I will take her through the questions in the assessment procedure allowing her to speak herself out. I will strive to convince her that just as I have strongly attached myself to God, she can as well do the same and find a solution to her problems through prayer and daily reading of the scriptures. I will seek to know whether she wishes to reunite with his husband and encourage her to forgive him in any wrongs he might have done. I will also encourage her to talk freely and draw close to her son Isaac. I will hold a prayer with her and request her to do the same always. I will advise her to have a regular communication with her family including her sisters and mom. Just as having a regular communication with them will build a strong bond relationship, so will prayer create a strong attachment bond for them, as well. I will also meet her on a weekly basis, thereafter, to discuss the progress and new challenges faced.

I have also planned to hold a joint counseling session where I will have both Isaac and his mother together. I will hold prayers with them and encourage them to pray together at home as a family.

Ethical issues

Ethical issues that warrant consideration in this case study include respect, responsibility, integrity, competence and concern. In the past, it was common practice to find professional psychology and clinicians pathologizing highly religious or spiritual minded persons (Lucchetti et al., 2012). Professionals saw them as insecure, defended, deluded and suffered from some psychological disorders needing treatment. The views and beliefs of these people received no attention and respect.  Professional ethics codes articulate the need to respect values and beliefs on spirituality and religion and avoidance of pathologizing individuals seeking spiritual and religious growth, involvement and development. Respect of the spiritual and religious beliefs, traditions and behaviors of others is highly crucial in family therapy, even if we find some views of certain religions destructive and distasteful to human health and well-being. We should respect all religious and spiritual beliefs, though we may not agree with them. We must be respectful of roles played by spiritual models and religious clergy in the lives of spiritual and religious clients we treat.

Research has indicated that a large percentage of Americans and other people in the world affiliate themselves to a religious tradition and some  mosque, church or temple, believe in God, wish to develop spiritually, and would like health care providers to respect their spiritual and religious traditions, practices and beliefs (Plante, 2007). Since spirituality and religion play such a crucial role in most people’s lives, ignoring this critical aspect of peoples’ lives is irresponsible as we work with them in professional psychological services or psychotherapy. Thus, it is a responsibility worth considering how spiritual and religion matters affect the clients we serve in psychotherapy. Psychologists and other mental professionals should work collaboratively with clergy and other religious leaders involved in pastoral care of the clients when desired by the clients. We also must manage the responsibility of being thoughtful and aware about religious issues and influences just as we have some responsibility to be aware of influence and cruciality of psychological, biological and social influences on the functioning and behavior.

In providing therapy for the clients, we should act with integrity by being just, honest and fair with all the clients. According to Brelsford, & Friedberg (2011), R Integrity demands surety, openness and honest about the skills and limitations of therapists and avoiding deception. We should avoid fake agreements or interests with the clients. Integrity calls for professionals to be sure that they carefully monitor personal and professional boundaries easily blurred by religion and psychology integration.

Currently, a vast majority of postgraduate and graduate training programmes ignore religious and spirituality integration training of professionals. Thus, professionals need training for competence in psychotherapy and spirituality integration. Professionals should read publications and quality books on the topic, attend seminars and workshops, find out consultation and supervision from appropriate colleagues, and learn much concerning spiritual and religious traditions of clients they encounter in their fields.

In the counseling profession for therapy, we should have at the heart concern for the welfare and well-being of others. Professionals working in the area of psychology and religion integration must nurture and express concern over their clients (Plante, 2007). It is unfortunate that over the centuries and even today, many people have suffered due to beliefs and religious conflicts. There are many examples of people suffering abuse, victimization, neglect, and even killings for religious behaviors and beliefs. We should have a concern for the people we encounter in professional psychology work, more so those with religious beliefs that create harm to others or self.

The case of Isaac and his mother is a situation that has affected their thinking patterns and habit. Thus, their psychological status face issues that they may not comprehend should there be no intervention. Both of them need psychological counseling. Because they all believe in God and have Christian faith, they will need a clergy to counsel them, as well. Encounter with both a professional psychotherapist and a clergy will help to integrate psychology and Christianity, therefore, achieving the best desirable changes. It is vital to note that it is helpful for the counselor to bear in mind that the client’s personality affects the image of God to some degree. The therapeutic process tends to improve clients’ image of God over time whether or not the counselor addresses religious issues. This means that an interaction exists between the clients’ conceptualization of God and their internal working models and that professionals can tap their approach to religion in the therapeutic process.

The counselor should consider the clients level of attachment to the counselor and the resultant effective bonding in the termination phase of the therapeutic process, in the case of long-term therapy. The counselor might encourage the client to connect with his or her religious community for support and fellowship, as well as to engage, in familiar and personal relationship with God, to help the client transition from the close, supportive bond to being independent of the counselor.

References

Brelsford, G., & Friedberg, R. (2011). Religious and Spiritual Issues: Family Therapy Approaches with Military Families Coping with Deployment. Journal of Contemporary Psychotherapy, 41(4), 255. doi:10.1007/s10879-011-9174-4

Edwards, E. C., Heindrix, R. R. & Reinert, F. D. (2009). Attachment Theory and Religiosity: A summary of Empirical Research with Implications for Counseling Christian Clients. Counseling and Values, Vol. 53, 112-123.

Lucchetti, G., Aguiar, P., Braghetta, C., Vallada, C., Moreira-Almeida, A., & Vallada, H. (2012). Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy. Culture, Medicine & Psychiatry, 36(1), 124. doi:10.1007/s11013-011-9239-6

Plante, G. T., (2007). Integrating Spirituality and Psychology: Ethical Issues aand Principles to Consider. Journal of Clinical Psychology, Vol. 63(9), 891-902.

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