“SPIRITUALITY: A GENTLE AND MEANINGFUL PATHWAY TO RECOVERY FROM EATING DISORDERS AND RELATED ILLNESS”
by Michael E. Berrett, PhD
Psychologist, CEO, CO-founder, Center for Change
Co-author of APA book “Spiritual Approaches in the Treatment of Women with Eating Disorders”
This article will briefly consider the “what, why, and how” of integrating spirituality into the psychotherapeutic treatment of eating disorders and other related illnesses.
WHAT IS SPIRITUALITY?
That has been a question of focus in philosophy, religion, and psychology for centuries. Spirituality is no easy description, for it is in the eye of the beholder, and in the meaning of the individual. There are 7 billion plus individuals on planet earth, and thus, there are 7 billion spiritual points of view. Even those who share spiritual or religious beliefs within a religious or spiritual community have very different definitions of what spirituality is for them. We know that spirituality and religiosity are not the same thing, as we all know those individuals who are religious but not spiritual, spiritual but not religious, and those who are both. Additionally, acceptance is crucial since in the critical judgment of another’s spirituality, we may in that very moment, be at risk in of losing our own.
It is my hope that in consideration of spirituality, that we learn an openness to both theistic and non-theistic spiritual orientation. The vast majority of those living in the United States are theistic in orientation, while a narrow majority of mental health professionals are non-theistic in spiritual orientation. No matter what our personal view as professionals, in the benefit of our clients, we need to learn to understand and honor both, as we strive to honor our patients and embrace our brothers and sisters everywhere.
It is not the purview of this article to highlight the most popular, accepted, or comprehensive definition of “spirituality.” Rather, exploration, consideration, increased understanding, and potential clinical application of spiritual principles in the benefit of the suffering patient is the intention of these written words.
I propose that spirituality is evidenced in relationships with others, as Scott Peck has taught, “extending oneself towards the spiritual growth of another human being” (Peck, 1978). A simple story paints a beautiful picture, “A little boy was walking the beach with his grandfather, as they came upon what seemed miles of shoreline with thousands, or millions of beached star fish. As the boy felt compassion on those small creatures from the sea, he started frantically throwing them back into the ocean. Grandfather said “Don’t try to save them – there are so many that there is no way you can make a difference”. The little boy picked up another star fish and threw it far out into the sea, and turned to grandfather and said “well -it made a difference to that one” (Unknown).
Spirituality can also be evidenced in a respectful relationship with self. This may include the practice of mindfulness, meditation, yoga, honoring dreams and deeper desires, living with purpose, honoring internalized principles, and living with congruence and integrity. It may well include self- mastery and discipline, delayed gratification for a greater good, engaging spiritual practices, keeping commitments, and taking the higher road despite the difficulty of that road. It includes the practice of both listening to, and following the heart. Spirituality can include experiences of vision, harmony, truth, transcendence, and oneness with God, nature, or the universe. It includes compassion, loving, being loved, having hope, gratitude, enlightenment, and living with a positive sense of purpose and meaning.
Attending to spirituality pushes us to be the best that we can be, and concerns itself with not only who we are, but also who we can become. Spirituality is both “being” and “becoming”. Acceptance in the moment is matched with the reality that we have capacity to “become” as well. As said well by George Eliott, “It is never too late to become who you might have been.” In spirituality, our concern is not only about being and becoming the best that we can, but also in realization that on our journey, we will leave footprints for others, that we cannot avoid being an example to others, and that we have opportunity to leave a legacy which blesses others and is worthy of emulation.
WHY IS SPIRITUALITY IMPORTANT IN THE PROCESS OF RECOVERY?
First, there is plenty of research which suggests that spirituality has great value in treatment and assists recovery from eating disorders and other illnesses (Richards, Hardman & Berrett 2007). When asked about key elements contributing to their recovery, past patients have reported that spirituality is important to their recovery (Hawkins 2014).
Another important reason to include spirituality is that in the development of the illness over time, those suffering from eating disorders begin to experience negative effects on their spirituality which damage a positive sense of self, impair their relationships with others, and stifle their efforts for recovery. It is important because in the developing illness, they become disconnected from themselves, their goodness, and their worth. It can be said that they “forget who they are.” Spirituality is an important pathway back to understanding self and reclaiming a positive sense of identity, goodness, capacity, and value. The illness can cause disconnection from heart – which they perceive as broken. These hearts need to be healed.
Spirituality is important in treatment because it honors far eastern world truths about healing and the importance of treating the whole person. The western world’s artificial division and separation of scientific from spiritual, has been at the expense of those individuals seeking help and healing. We must treat the whole person in every aspect of his or her life. Both science and spirituality are important.
Spiritual beliefs are among the deepest and most cherished that individuals have. The depth of allegiance many patients have to their spiritual beliefs highlight the potential power available if those beliefs can be harnessed and directed in the service of recovery from illness. Sometimes patients have had painful experiences connected to religious or spiritual experiences or beliefs. These can be addressed. Some patients tend to use their spiritual or religious beliefs against themselves, and providers can help in re-directing those patterns in the service of inner peace rather than self- destruction. Inappropriate guilt, shame and perfectionism are examples of spiritual concerns which can hold patients back from their potential and from experiencing the joy which life has to offer. Thankfully, spiritual beliefs can either be a roadblock or an open door into a new life which includes light, hope and meaning.
It is understood that spirituality is just one aspect of needed dietary, medical, and psychotherapeutic treatment, and that the best that science can offer in terms of treatments and best practices is the main course of treatment. Spirituality, however, is also an important part. Spirituality as a part of treatment is not complicated. It can be simple. Even a small dose of spiritual focus can be powerful and life changing. I call spirituality the “tabasco sauce” of treatment and healing. A little bit can go a long way! “Spirituality can help patients find meaning and purpose in their lives, expand their sense of identity and worth, and improve their relationships with self, family, God, and Others.” (Richards, Hardman, Berrett 2007)
Spirituality can play a significant role in helping clients find reasons and strengthen motives for recovery, since spirituality is connected to the most important things in their lives. It can also lead patients towards finding again their faith in things beyond illness: faith in themselves, recovery, future, their own hearts, others who love them, higher power, and in their spirituality.
Inclusion of the spiritual in treatment can and should happen when the client desires it, when it is important to them, and when doing so aligns with their pre-eminent goals of wellness. When it matters to them – then it should matter to us. While re-nourishment of body and mind is the initial and pre-eminent goal of eating disorder treatment, there is no reason to wait, avoid, or neglect the need for re-nourishment of the soul.
HOW CAN WE INCLUDE SPIRITUALITY INTO PSYCHOTHERAPEUTIC TREATMENT?
We begin by introducing a few process guidelines for inclusion of a multi-dimensional spiritual framework in treatment:
1) Establish a safe therapeutic environment and relationship
2) Initial and ongoing religious and spiritual assessment and understanding
3) Implement appropriate spiritual focus and interventions
Once we understand the basic process guidelines, we must consider and embrace the possibility that regardless of the providers spiritual beliefs, many patients will consider “the spiritual” to be an important part of the recovery process.
We can create a safe environment for patients by giving them permission to include spiritual matters in their quest for wellness and healing if they so desire. Further, we can and must provide an environment in which they feel assurance that they will not be shamed, criticized, confronted, or put down for their spiritual beliefs by us, or by anyone else in our sphere of influence. They must know that sacred and deeply held beliefs will be understood, examined and utilized only within the safety and security of guaranteed respect. Simply asking a client about their spirituality with genuine interest goes a long way in giving a message of permission and safety about including spiritual concerns and resources in treatment. Ignoring or avoiding spiritual issues when such is important to the patient, is a passive message that it is not valued by us, which may lead to the client feeling that they are not valued. Pushing our spiritual beliefs on a patient may be considered a “mistake of commission,” while ignoring the clients interest may be considered a “mistake of omission.” Either can negatively impact the joint pursuit of healing.
In assessing and increasing understanding of a patient’s spirituality, we can ask within a spiritual realm about spiritual background, negative experiences, wounds, positive experiences, current stances, worries, confusion, or concerns. We can help them clarify, declare, and focus on what they do know, rather than getting stuck in rumination about “what they don’t know” about their spirituality.
We can ask them about their beliefs, about the role of spirituality in the journey of recovery. We can ask them about their spiritual goals in treatment which we can add to many other outcome goals for treatment. As we work to more deeply understand the patient, it strengthens our ability to better serve them.
The following are some ideas for Integrating spirituality into clinical treatment. These are personal lessons learned from three decades of spiritually influenced psychotherapy practice. They include general principles and practical interventions:
1) Be mindful of your own spiritual beliefs, and how those impact the way you approach life and approach your work with patients.
2) Be mindful that acceptance and example are the most powerful interventions in the world of helping others change and heal.
3) Help clients open and broaden their understanding and views of what it means to be spiritual.
4) Help clients from different beliefs and backgrounds respect differences and help them find similarities and common ground with others.
5) It is their spirituality, not ours, that we are nurturing in them. Help them realize, connect with, and make good use of their own spiritual beliefs.
6) Believe that in addition to naturalistic laws of scientific investigation, there are spiritual ways of knowing.
7) Be clear and aware of your own spiritual beliefs, and possibly, your own prejudices.
8) Use your own spiritual beliefs towards the benefit of you clients, including having good will and high hopes for them.
9) Seek wisdom, intuition, and inspiration in your efforts to help your clients.
10) No matter what your own beliefs are, know and respect that many clients have cherished spiritual beliefs that significantly influence their lives.
11) Create an environment and relationship of safety and respect versus judgment and rejection around the clients’ spiritual beliefs.
12) Teach that an increased understanding of one’s life purpose and meaning is possible.
13) Teach that faith is real and that “where and what” we invest our faith in is a conscious and personal choice.
14) Help clients explore, find, reveal, illuminate, strengthen, and remember reasons for recovery.
15) Help clients learn to listen to and follow messages of their own heart.
One focus for spiritual intervention is to support an “examination of faith” with a client. Faith is a reality and we have choice in what it is that we put our faith in day by day. Faith is a spiritual concept, which while rooted in religious language, is not just a religious construct. We can help clients explore where they place their faith, and help them see that the object or focus, direction of faith is a choice. And that this is a spiritual principle, and that we might as well chose well in our placement of faith.
We can help patients reveal and take a hard look at their deepest desires and dreams: What they really want including passion, purpose, and principles for guidance in life. These are all connected to and can be best utilized as reasons for recovery from illness.
Spiritual themes for discussion, based on individual needs and timing, might include the following:
faith, love, gratitude, responsibility, forgiveness, belonging, harmony, balance, mindfulness, spiritual-mindedness, principled living, listening to heart, giving and receiving love, and holding up the mirror which reflects spiritual identity.
The following is a list of possible structures, activities, or interventions which can integrate spirituality into the process of treatment: 12 step group, spirituality group, yoga and meditation, dance and movement therapies, art and music therapies, activities of forgiveness of self and others, loving and compassionate service, solo/quiet times, mindful eating, practice of mindfulness (Kabat-Zinn 1994), DBT and ACT therapies, prayer, connection to religious community, connection to religious clergy, religious or spiritual practices, rituals, or observance, reflective writing of impressions of the heart, noticing providence or miracles in our lives, sharing beliefs with others, honest living through self- correction, making commitments and keeping them, giving love, asking for help, noticing and documenting personal success, documenting evidence of good intention and loving kindness, practicing listening to and following impressions of the heart.
With patients suffering from eating disorders, the first imperative is proper nourishment of the brain and body, which can increase assurance that life will go on. Then our work becomes a re-feeding of the soul. This is where spirituality comes in. There is something spiritual about the work that we all do in the professions of teaching, counseling, treating, and healing. There is something spiritual about it whether we know it or not. It is a spiritual work because of the immeasurable worth of each individual with whom we work. Mother Theresa said it well, “I serve not because people are broken, but because they are holy” (Teresa 1995). As we strive to provide the evidence based treatments, best practices and the highest quality care, let us not lose track of our opportunity to love and care about our patients, to help them know of our genuine interest and concern for them. This will help them experience not only a healing of body and mind, but of the soul as well. I hope we will all have an increased measure of compassion, which illuminates goodness, strengthens and uplifts the individual soul, and penetrates another’s heart and heals it. A well-known story gives this key message about spirituality in treatment. “There was a small group of friends, who after much courage and work, barely made it forging thru and across a raging river. Safely on the other side, they turned away from the river and resumed their journey. One traveler stayed back and found some timbers and began building a small foot bridge. His friends came back for him, and in a questioning and critical way said “what are you doing – we have already crossed the river safely – let us go”. The bridge builder turned to his friends and said “I will make a bridge for the other pilgrims who will come this way” (Unknown).
May we all strive to have within our own lives, and nurture in the lives of our patients, spiritual harmony, which comes, at least in part, from walking a spiritual pathway, and from diligently extending the gift of good will to oneself and others.
Peck, S.M (1978) The Road Less Traveled: A New Psychology of Love, Traditional Values, and Spiritual Growth, a Touchstone Book
Starfish Story: author and source unknown
George Elliot Quote: source unknown
Richards, P.S, Hardman, R, Berrett, M (2007) Spiritual Approaches in the Treatment of Women with Eating Disorders, American Psychological Association Book
Hawkins, N (2014) 10 Top Factors in Recovery From Eating Disorders: Results of a Past Patient Survey, Professional Presentation at Center for Change Annual National Eating Disorder Conference for Professionals, January 2014
Berrett, M, Hardman, K, Richards, P S The Role of Spirituality in Eating Disorder Treatment and Recovery, in Treatment of Eating Disorders: Bridging the Research-Practice Gap (2010), Maine, M, McGilley, B.H, Bunnell, D an Academic Press /Elsevier Book
Kabat-Zinn, J, Wherever You Go There You Are: Mindfulness Meditation in Everyday Life (1994) a Hyperion Book
Teresa, M (1995) Mother Teresa: A Simple path, A Ballantine Book
Bridge Story: author and source unknown