Mental Health Basics for Spiritual and Religious Leaders

MENTAL HEALTH BASICS FOR SPIRITUAL

AND RELIGIOUS LEADERS

MENTAL HEALTH BASICS FOR SPIRITUAL AND RELIGIOUS LEADERS

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Copyright & Acknowledgements

Copyright 2023 Dr. Awa Jangha.

Copyright will be pending [I will send in an application once the final version is complete]

I extend my deep gratitude to the wonderful people who helped make this project come to life. Gena St. David, Stephanie Ramirez, Maria Spellings, Marlon Johnson, and Laura Swann, thank you so much for your willingness to review this work and share your thoughts. Eric Scott and Keela Vaughn, thank you for your formatting support and generosity with your time. Kip Keller, thank you for being an amazing copyeditor.

To the fabulous faculty and students at the Seminary of the Southwest: I am blessed to work with amazing people who inspire conversations and collaboration across the theological and counseling realms. My gratitude goes also to the Henderson-Wessendorff Foundation, which prompted the creation of this book.

To my family and friends who have been the circle of support that grounded and encouraged me throughout this process, I thank you and I love you. Finally, I give thanks to the one I deem sacred, to the reason for my purpose and vocation, to the never ceasing joy of my soul: God I am grateful.

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Introduction

Welcome! This compact resource aims to provide mental health information, space for reflection, and resources for persons working in spiritual and religious contexts. The dual purposes of this work are to: share mental health basics with spiritual and religious leaders so that they might better understand how a range of mental health matters can affect the people they serve; and to offer ways to explore how mental health matters may affect your own spiritual journey. This book is for practicing spiritual and religious leaders, students training to become spiritual leaders, and persons discerning their call to spiritual and religious work. It can also be a resource for community members in a variety of spiritual and religious settings as well as spiritual directors, chaplains, and mental health professionals looking for information to share with spiritual and religious organizations about ways to address mental health matters.

While the stigma around mental health counseling has decreased, making discussion of and access to mental health support a bit easier, stigma is still present. Being able to recognize the need for help, to ask for help, and to follow through with obtaining that help requires courage. Often, people turn to medical professionals and to their spiritual and religious leaders first for support. This guide is meant to be a resource for spiritual and religious leaders trying to help others navigate next steps in that journey and to normalize the experience of using the resources available to help people be well.

I hope this book will serve as a source of information, of ideas for collaboration, and of inspiration. As a faculty member in a clinical mental health counseling program at an Episcopal seminary, I have seen the value of collaboration across programs training students to be

helping professionals in the areas of counseling, spiritual direction, chaplaincy, and parish ministry. Yet often it can be challenging to create the time and space for dialogue across the realms of spirituality and religion, on the one hand, and counseling and psychology on the other. This book is meant to provide both a foundation and a continuing resource for spiritual and religious leaders about core areas of mental health that they might encounter in their spiritual work (both personal and professional). In-depth descriptions of mental health disorders are beyond the scope of this work, but when you are not sure when to refer a community member to a counselor, when you are not sure what is within the scope of practice for a counselor, or when you have questions about the basics of mental health matters, this guide can provide some initial information and point you to additional resources for further support. The aim is to help you begin the collaborative journey of working with mental health professionals such as licensed professional counselors. Throughout the book, when referring to you as the reader, the general term 'spiritual or religious leader' is used in order to speak to a broad array of leadership that spans different types of spiritual and religious communities (recognizing that while some communities identify as both spiritual and religious, there are communities that only identify as spiritual or religious).

The next eight chapters of this book address topics such as the role and work of mental health counselors; diversity across intersecting identities; human development; crisis and trauma; substance use dependence and behavioral addictions; grief; and self-care and burnout prevention. While not an exhaustive list of mental health topics, these topics cover common questions and encounters regarding mental health and the wider community. Chapter 1, "What Counselors Do," is an overview of the work of counseling, including information about settings, approaches,

ethics, and time frames. The counseling process, diagnosis, spirituality in counseling, and spiritual bypass are also reviewed. In addition, this chapter gives brief descriptions of the main types of mental health professionals.

In Chapter 2, "Social and Cultural Diversity," aspects of identity and culture are described according to the ADDRESSING model, an acronym for: age and generational influences, developmental disability, disability acquired later in life, religion and spiritual orientation, ethnicity and racial identity, socioeconomic status, sexual orientation, Indigenous heritage, national origin, and gender (Hays, 2008). The third chapter, "Human Growth and Development," highlights the importance of understanding self and others through a developmental lens and mentions several human developmental models, including one for spiritual development. Chapter 4, "Crisis and Trauma," describes types of trauma; differences between stress, crises, and trauma; and encountering each as a spiritual or religious leader. Compassion fatigue and vulnerability are also reviewed in this chapter.

Chapter 5, "Substance Use Dependence and Behavioral Addictions," describes different types of substance use dependence and behavioral addictions, the overall impact of addiction, and forgiveness. Chapter 6, "Grief," contains information on how grief may manifest (i.e., types of grief and tasks of the grief process), what to say to someone grieving, and what to consider when you as a spiritual leader are grieving. Chapter 7, "Self-Care and Burnout Prevention," begins with clarity on what self-care is and is not, and discusses wellness in the areas of physical health, emotional health, social and relational health, and spiritual health. In addition, the chapter covers areas that often prompt the need for self-care among spiritual and religious leaders, including feeling like an imposter, establishing boundaries, preventing burnout, facilitating

hard conversations, and managing conflict. Each chapter begins with an overview of the topic from a counseling perspective, then offers four devotional reflections for personal reflection, and concludes with a consultation example of how you might collaborate with a counselor in the area under discussion.

The devotional reflections center on four psychospiritual themes: identity, suffering, change, and flourishing. These themes are drawn from Bringing Religion and Spirituality into Therapy (Stewart-Sicking et al., 2020), which describes them as “themes that straddle and connect the world of psychological life and our sense of the spiritual that is greater, beyond, and transcends the self” (p. 24). Reflection across these four themes integrates the topic of each chapter, creating space for you to explore your current experience, thoughts, and perspectives as the topic applies to your personal life and your professional life. The devotional concludes with a few questions for personal contemplation and for consideration when working with your spiritual or religious community.

A short consultation example completes each topic-centered chapter. It provides a fictional case study of how you might encounter the topic of focus within your spiritual or religious community and how you might consult and work with a counselor. Suggestions are provided for ways to collaborate in providing support within the case study.

My hope is that this guide will become a useful resource for enabling connection and collaboration between mental health professionals and spiritual or religious leaders. May the information prompt personal reflection that leads to insight, growth, and care of the self. May the content spark interest in engaging in a deeper understanding of the topics introduced, and in making wider use of the

resources provided. May this humble written offering be shared widely. May it provide normalization, knowledge, and tools for consultation and for the support of spiritual and religious communities around the world. Finally, may it inspire psychospiritual wellness, bringing the ever-important conversation about mental health into spiritual and religious communities.

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Chapter 1: What Counselors Do Overview

You may be asking yourself, what is involved in the work of counseling? Well, I am happy to provide an answer. It can be extremely helpful to have a general idea of what counselors do when considering how to best collaborate and deciding when to refer. According to the American Counseling Association, counseling is “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals” (ACA, n.d.-a https://www. counseling.org/aca-community/learn-about-counseling/ what-is-counseling). Let us explore what work with members of each of these three categories- individuals, families, and group- entails.

Individual counseling often involves a counselor and client working one on one to create and work towards goals that address problems that bring a client to counseling. These presenting problems can include emotional stressors, interpersonal conflict, and a range of challenges across areas such as self-esteem, major life changes, communication, career change, quality of life, physical crises, and spiritual struggles. In individual counseling, an expert walks with a client as they find solutions and makes progress towards the goals of therapy.

Family counseling considers the family unit as the client. Counselors work with couples, parent-child dyads, siblings, and constellations of members within a family unit, including biological family members, legal guardians, extended family, and chosen family members. Counseling tries to help the family navigate major life changes affecting the homeostasis (or balance) and wellness of the

family as a whole.

Group counseling works with people who come to therapy based on a common experience. Counseling generally takes the form of short-term or ongoing group meetings such as those focusing on grief, addiction, or caregiving. Groups can focus on psychoeducation (i.e., teaching mental health information), experiential activities (i.e., the practicing of coping skills), and processing (i.e., working together to process members' presenting problems), to name just a few.

Counseling Settings

Mental health counseling occurs across settings ranging from the least to the most restrictive levels of care. Support groups and outpatient counseling services represent the least restrictive level of care. Counseling can include weekly, biweekly, or monthly meetings with counselors across individual, group, and family counseling contexts. For instance, a person experiencing anxiety may meet with their counselor once a week. Support groups may be led by peer support specialists or by counselors trained to provide support in a specific area (for example Alcoholics Anonymous [AA] or a grief group) and may occur in addition to other counseling contexts (for example, a person may attend AA meetings and also meet weekly with a personal counselor).

Intensive outpatient (IOP) services represent the next level of care. IOP clients need intensive, structured support which is typically provided by an agency. Often, an interdisciplinary team provides a variety of services for a specified amount of time before ‘graduating’ the client down to outpatient services. For example, an eating disorder clinic may have IOP services in which a nutritionist, counselor, psychiatrist, and physician work together to provide group and individual support to a client. IOP

services may consist of clients going to a facility for treatment for half days for a few days a week.

Partial hospitalization programs (PHP) are the next level of care. Clients may receive services like those in an IOP setting, but for longer periods of time, sometimes for full days and for more days a week.

Residential programs and hospitalization are at the most restrictive level of care. Clients temporarily live in a treatment facility or hospital. Services to help stabilize the client’s physical and emotional health are provided by a team of medical professionals and therapists. Once stabilized, clients are moved to a lower level of care.

The overall goal across all these settings is to get clients to a place where they are best able to function and to provide them with the right level of support in that process.

Counseling Approaches

Counseling is based on the approach of the counselor. Counselors typically identify with a particular theoretical approach, which they use as the foundation of their work with clients. Approaches frame how the counselor understands the client and the presenting problem, how the counselor presents themselves in the room, and how the counselor intervenes in a session. Common approaches include psychoanalytic, humanistic, behavioral, cognitive behavioral, and systems approaches. Although each approach is rooted in its own theory of how personal change occurs, all of them are designed to produce change, often in emotion, thought, and action. It is beyond the scope of this guide to explain each of the counseling approaches listed above. It is enough to know when someone in your community is looking for a counselor, finding a good fit between what they need and the approach of the counselor is

an important consideration. Community members should ask potential counselors about their approach or style of counseling to see whether there is a possible fit between counselor and client. Community members should know, too, that a poor fit with one counselor may just mean that they may benefit from a different approach to counseling.

The Counseling Process

Overall, the counseling process has core components that resonate across theoretical approaches. These include creating a therapeutic relationship, engaging in ongoing assessment, and developing treatment plans and interventions. Much of the effectiveness of counseling comes from the development of the therapeutic relationship between the counselor and client. Counseling (including family and group counseling) provides a confidential space where the client can share openly and honestly with a supportive counselor. This dynamic is different from other interpersonal relationships in that the focus is on one participant, the client, and for the most part there is limited self-disclosure from the other, the therapist. Thus, the relationship can feel very one-sided.

Counseling typically starts with an assessment of the client, although the assessment process is also ongoing. The counselor makes inquiries into the client's background, current status, and needs, using tools such as intake questionnaires, questions during the counseling process, and standardized instruments. Counselors assess initially in order to know where to begin in working with a client, and thereafter to measure progress. Going forward, treatment plans (often created in collaboration with clients) are frequently used to specify the client's goals for therapy. In addition, the plans specify interventions that the counselor will use in working with the client, interventions that are consistent with the counselor’s theoretical approach and

that meet the client where they are. Depending on the severity of clients' symptoms and on their life experiences, the duration of the counseling experience can vary.

Diagnosis

Treatment plans often include a mental health diagnosis, which licensed professional counselors are trained to provide. It is helpful to note that diagnosing can be a controversial topic: some people focus on how a past misdiagnosis negatively affected loved ones, while others focus on its benefits. In the former case, concerns about a diagnosis becoming a ‘label’ that might increase stigma and mistreatment are valid. It is therefore important for a counselor to consider the culture and context of the client in order to help prevent misdiagnosis. The benefits of a correct diagnosis are substantial: a client may feel less alone in knowing that others have similar symptoms, may gain access to needed services (since most insurance companies require a diagnosis for reimbursement), and may benefit from evidence-based practices shown to work with persons sharing the same diagnosis.

I conceptualize mental health diagnoses as extremes of common experiences that disrupt one’s ability to function in life. The standard classification manual for mental health diagnoses, the Diagnostic Statistical Manual of Mental Disorders (fifth edition, text revised, abbreviated DSM 5-TR) describes this disruption, for many of the mental health disorders included in it, as causing clinically significant distress or affecting or impairing one’s ability to work, go to school, or engage socially (APA, 2022). For example, it is common to feel anxious from time to time, but constant or extreme anxiety could result in a diagnosis of an anxiety disorder. Mental health disorders are at one end of a mental health spectrum that goes from mental health wellness (characterized by the

ability to navigate typical human emotion in the face of triumph and tragedy) to mental health disorders, in which one’s symptoms are clinically distressful (with distress as defined by the DSM criteria for each disorder). See chapter 8, "Additional Resources," for more information on common mental health disorders encountered in therapy. For counselors, knowledge of diagnostic criteria can allow for the development of treatment plans that fit the client’s needs, since the interventions associated with a diagnosis have proved effective for that diagnosis.

Mental Health Wellness

The Counseling Time Frame

Mental Health Disorder

Counseling sessions occur for varying lengths of time most commonly, for fifty minutes, on a weekly, biweekly, or monthly schedule. Initial sessions might be longer, with some counselors meeting for ninety minutes to review intake information and informed consent. Couples, family, and group counseling may also be longer than the standard ‘fifty-minute hour,’ since more time may be needed when more than one person is the client. On the opposite side of things, initial consultation sessions, often used by the client and the counselor to learn more about each other and determine whether to schedule an initial session, are often as short as fifteen minutes. In addition, depending on the theoretical approach and the client’s needs and financial ability, counseling can be brief (i.e., fewer than six sessions) or extended (i.e., lasting more than a year).

Types of Mental Health Professionals

This guide focuses on spiritual and religious leaders working with licensed professional counselors, but the information presented can be useful in understanding the overall

work of mental health professionals, including psychologists, psychiatrists, clinical social workers, marriage and family therapists, and expressive therapists, to name a few. Brief, snapshot descriptions of the main types of mental health professionals are given here.

Counselors. Licensed professional counselors provide mental health services to clients in a variety of settings and focus both on mental health wellness and mental health disorders. Grounded in a wellness-based philosophy, counselors take human development, ethics, culture, and advocacy into the heart of their work done with individuals, families, and groups. More information can be found from the American Counseling Association (ACA, n.d.-b): https://www.counseling.org/about-us/what-is-acounselor.

Psychologists. Psychologists provide services similar to that of licensed professional counselors. They have specific training as clinical or counseling psychologists (which requires a doctorate degree), engage in research, and can provide PhD-level mental health assessments (for example, ADHD assessments, intelligence tests, and personality tests). In addition, their work may include seeing clients individually, as a family, or in group settings, and they may work with organizations. More information can be found from the American Psychological Association (Am. Psyh. Assoc, 2022): https://www.apa.org/about.

Psychiatrists. Psychiatrists provide services similar to those of licensed professional counselors. Whereas some engage in therapy with clients, the primary focus of this profession is to assess, prescribe, and monitor the use of psychopharmacological medication to help with mental health disorders. They are physicians (which requires a medical degree) and often work in collaboration with other mental health professionals. More information

can be found from the American Psychiatric Association (APA, 2023): https://www.psychiatry.org/patients-families/what-is-psychiatry.

Clinical Social Workers. Licensed clinical social workers provide services similar to those of licensed professional counselors. In addition to the general training required to be a social worker, which includes the ability to provide case management, they have specialized training in psychotherapy for individuals, families, and groups. More information can be found from the National Association of Social Workers (NASW, n.d.): https://www.socialworkers.org/Practice/Clinical-Social-Work.

Marriage and Family Therapists. Marriage and family therapists provide services similar to those of licensed professional counselors, with a specialized focus on working from a family systems lens. They provide short-term therapy that often includes working with persons in the context of marriage, family, and couples counseling. More information can be found from the American Association for Marriage and Family Therapy (AAMFT, n.d.): https://www.aamft.org/About_AAMFT/About_ Marriage_and_Family_Therapists.aspx?hkey=1c77b71c0331-417b-b59b-34358d32b909.

Expressive Therapists. Expressive therapists include art therapists, music therapists, and dance movement therapists. Like licensed professional counselors, they provide mental health counseling services to persons across individual, group, and family contexts and across a variety of settings. They have specific training in their therapeutic modality (art, music, or dance), which serves as the primary means of engaging with clients as a form of expression, process, and therapeutic intervention. More information can be found from their national organizations: the American Art Therapy Association (https://arttherapy.

org/; AATA, n.d.), the American Music Therapy Association (https://www.musictherapy.org/; AMA, n.d.), and the American Dance Therapy Association (https://www.adta. org/; ADTA, n.d.).

It can be helpful to differentiate between counseling that includes spirituality, such as pastoral counseling, and the integration of spirituality in mental health counseling. Pastoral counseling is most commonly understood as being provided by religious practitioners, who are accountable to their religious organizations and who provides counsel to their community, but do not engage in professional counseling under the title of pastoral counselor. Some spiritual and religious practitioners have been trained and licensed as professional counselors but operate in that role in boundaried ways that adhere to the rules of their state’s regulating body. For example, a minister licensed as a professional counselor could provide counseling to people outside their faith community.

Spirituality and Counseling

An example of professional counseling that can resemble pastoral counseling is the case of licensed counselors who specialize in providing mental health counseling from the perspective and tenets of a specific religion, for instance, a Christian counselor or a Buddhist counselor, licensed by the state and abiding by the statutes of the state, whose approach is derived from their religion. This differs from pastoral counseling in the areas of licensure, training, and authorizing bodies. Pastoral counselors are authorized by their religious organizations, whereas religiously identified licensed counselors are authorized by state boards. One additional practice to consider is that of biblical counseling. Biblical counseling uses concepts, principles, and scriptures from the Bible as the foundational approach to working with persons in need. While

biblical counselors identify as Christian, not all Christian counselors engage in biblical counseling (ABC, 2023).

One last approach to highlight is that of a spiritually integrated counselor (who may or may not use that name). This is a licensed mental health counselor who integrates spirituality into counseling if the client desires it and who is open to any type of spiritual or religious perspective that the client may identify with. This type of counseling honors the value that spirituality and religion may have in a client's life, values, morals, meaning making, decision making, understanding, and behaviors while also allowing spirituality or religion to be a strength or a struggle to be processed in connection with one’s mental health. The spiritually integrated counselor uses the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC)'s Competencies for Addressing Spiritual and Religious Issues in Counseling as a guideline for competent practice (2009). The integration of spirituality is limited to the scope of the counselor's training and ability to support the client on the road to emotional and mental health wellness.

Ethics in Counseling

Counselors adhere to codes of ethics and the law to ensure that they provide a high standard of care to the public. The code of ethics for counselors (ACA, 2014) lists the best practices for counselors nationally, and a state's laws provide the minimum standard of care required in its jurisdiction. Each state has its own statutes and laws that govern the scope of counselors' practice and responsibilities as well as the consequences of breaching those responsibilities. Counselors need to be licensed in their state and are held accountable by that state’s board of pro-

fessional counselors. Counselors cannot practice in states where they are not licensed unless they have been granted a temporary license. At the time of this writing (2023), legislators and advocates are working toward licensing reciprocity across state lines. The lack of cross-licensing arrangements might be helpful to be aware of especially given the growing use of teletherapy (or virtual counseling), for example, if you have a referral to a counselor who is licensed in state other than the one where your community member resides.

Additional ethical considerations to keep in mind include those involving multiple relationships and limits to legal confidentiality. For most counselors, best practices discourage them from having multiple relationships with a client. For example, a counselor would not provide counseling to someone they know in another context (church member, friend, family member, coworker, etc.). This can be helpful to keep in mind if someone in your spiritual or religious community is a licensed counselor whom you are thinking of referring another member of your community to for counseling. In this scenario, you would need to refer the potential client to someone outside your community. Note that it would be permissible to consult with the counselor in your community on referrals or for them to provide psychoeducation to the community about counseling. These restrictions do not apply to spiritual or religious leaders who offer counsel to their community, since that practice is regulated by a different governing body.

Best practices discourage a counselor from befriending a client or having a sexual relationship with one (with some allowance for relationships that begin a set number of years after the termination of counseling, and with the former client’s well-being always at the center of the decision). It is useful to keep this in mind if a community member is curious why they cannot become friends with

their counselor after ending counseling or cannot, for instance, invite them to join in community events. A few exceptions to this discouragement on counselor-client relationships outside of therapy occur in unavoidable contexts such as rural or military communities, where there may not be enough people to provide services needed who are not also part of the community.

The confidentiality of a counseling session creates the space necessary for a client to experience vulnerability. Confidentiality means that a counselor to whom you have referred a member of your community cannot later tell you that they are working with the community member (if they are), much less how therapy is going. The only things the counselor is allowed to share are the kinds of information whose release the client has consented to, typically through a release of information form.

But there are limits to confidentiality. Most counselors review these limits at the beginning of the process so that clients are fully informed. When you provide a referral, you might want to review these limits with that community member, especially if they have questions about confidentiality or are unsure about what can be shared in counseling. Counselors are mandated reporters, which means they must break confidentiality when child abuse or neglect is shared or when elder abuse, neglect, or exploitation is shared; in most states, this imperative applies also to adults with disabilities. In addition, if a client intends to kill themselves or others, counselors must breach confidentiality and notify the police. Other instances requiring the breaking of confidentiality vary by state; for instance, counselors in Texas must break confidentiality if they are aware of another counselor who has sexually exploited a client.

When to Refer

In many ways counseling and spiritual support may overlap and look similar. Active listening is present in both contexts, as are respect and the provision of support when someone is struggling or seeking to improve their wellness. Emotions may be shared, crises may be walked through, and values explored around how the client lives their life. The primary indication of when it is time to refer to a counselor is when what is needed by the community member exceeds your scope of competence. When addressing a community member's problem would exceed your expertise or the context of your work (that is, would require you to shift from the spiritual into the emotional and psychological), it may be time to consult and possibly refer.

Consultation with a counselor can consist of sharing nonidentifying information about the general concern your community member has shared with you and getting professional thoughts on whether counseling might be beneficial. If counseling is in fact deemed beneficial, or if the potential client is very clearly in need of psychological support, referring is a great next step. Referring someone does not have to mean that you no longer work with them. You could be working on spiritual matters with a community member while a counselor is working on that person's emotional and psychological matters. That said, sometimes a referral can lead to limited contact if a high level of care is needed, but that restrictiveness may be in place for only a limited amount of time.

The referral and consultation process has a higher chance of success if you have a diverse, curated list of counselors to reach out to. This list is one that you can add to over time, and it can include a varying range of mental health professionals. To start, therapy directories as gen-

eral as the national one maintained by the magazine Psychology Today (PsychologyToday.com, n.d.; see under "Find a Therapist"), or as specific as the guide on the website, Therapy for Black Girls (n.d.), can offer snapshots of counselors near you and the type of counseling they engage in. Checking in with peers and colleagues who might have counselor recommendations can also be a big help.

It is recommended that you reach out to a counselor before adding them to your referral list. The two of you can talk on the phone, meet virtually (on Zoom, etc.), or for coffee, tea, or lunch. Meeting a candidate for your list of counselors can provide you with additional information regarding what content areas the counselor specializes in (e.g., trauma) or what populations they specialize in working with (e.g., couples). Such information can be helpful when referring a community member who needs specialized support. You can also ask about a counselor's style or approach to counseling, fees, and availability. In addition, a meeting may help expand the counselor’s list, so that they can at some point consult with and refer to you clients seeking spiritual guidance (with the clients’ consent).

Devotionals

This first set of devotionals explores each psychospiritual theme (identity, suffering, change, and flourishing) in a bit more depth in order to provide a foundation for the devotionals in future chapters, which focus more on integrating the chapter topic with the theme. The purpose for these devotionals is to offer space to personally apply some of the content reviewed to your own understanding of self and then to begin to consider the application of the content within your spiritual community. The premise of this process of engaging with the material before using it with your community is based on the belief that we must engage in the work of knowing ourselves in order to help others do the same.

You are invited to engage in personal reflection across these four devotionals. I encourage you to find a quiet space where you can read each devotional, reflect on what comes up for you, and record your responses to the reflection questions for additional processing. Let us begin with identity.

Identity

The psychospiritual theme of identity highlights the core of who someone is when what is spiritual and what is psychological overlaps. When considering identity, who someone has been in the past confronts who they are in the present and stands at the doorway to meet who they will become in the future. Figuring out who you are is a lifelong journey that can require patience, flexibility, and openness to joy, wonder, and awe. Witnessing our evolution can bring up a multitude of thoughts and emotions that may be helpful to our self-awareness or, at the other extreme may be harmful to our understanding of self.

Consider times when you have experienced joy and had thoughts of encouragement, celebration, and gratitude for living into who you have envisioned yourself to be. Now consider times when you have experienced frustration, anger, hurt, disappointment, and negative self-talk, when you have not liked a version of yourself that did not meet your expectations. We live in a constant flow of life events that present opportunities to tap into either extreme of how we think and feel about ourselves. The question is: how do you choose to respond to those life events that call into question who you are?

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You may spiritually align with or strive toward a way of being and moving in the world that provides a beacon of light to return to when negative perceptions abound. You may also psychologically align with reclaimed or newly discovered aspects of your identity that ground you when others' perfectionist ideals (whether imposed by persons within your family or your spiritual community) do not align with your own ideals or what you are emotionally capable of in the present moment. Normalizing the range of thoughts and emotions that come up when navigating identity can help you feel less alone, since you realize that many others are experiencing similar journeys and seeking ways to align spiritually and psychologically.

Reflection Questions

For Personal Contemplation:

• Who are you in this moment, compared to who you have been and who you would like to be?

• How has your spirituality and your emotional intelligence or emotional coping skills supported you in the process of becoming who you are?

• When might the support of a counselor be helpful when negative emotions, thoughts, or coping skills impact your sense of self? How might you go about seeking that support?

When Working with Your Spiritual or Religious Community:

• How would you describe the identity of your spiritual or religious community?

• Is there anything you would like to change or amplify regarding your community’s identity?

• When might the support of a counselor be helpful if a rift occurred within your community’s

identity (for example, with the loss of a leader, a split in community’s ideals, a disaster crisis, etc.)?

Suffering

Across history, suffering has been central to humans' life experience. Spiritual and religious tenets provide ways of understanding and working through inevitable times of suffering, offering examples of important figures who have found a way through. Psychological theories offer ways to understand, reframe, and engage in the work of addressing inevitable suffering and preventing avoidable suffering. The lessons learned from times of suffering can lead to insight, to closer connections with others who traversed experiences of suffering with you, and to personal growth.

One example of this is the concept of spiritual bypass, a term coined by John Welwood (1984), a Buddhist practitioner and psychologist. Spiritual bypass occurs when spirituality is used to avoid experiencing and working through emotional and psychological suffering (Gill et al., 2020). The researchers Jesse Fox, Craig Cashwell, and Gabriela Picciotto (2017) identify two components of spiritual bypass: psychological avoidance, defined as “the process of sidestepping or avoiding difficult emotions, experiences, or circumstances through spiritual beliefs or assumptions,” and spiritualizing, defined as “ways of appraising ordinary scenarios and exaggerating their spiritual significance” (p. 283). For example, if someone has

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experienced trauma, they might throw themselves into service to their spiritual community as a coping mechanism. Ordinarily, service is healthy and supportive, but can act as a spiritual bypass if engaged in so frequently that it supersedes working on and processing the experience of trauma. Understanding the concept of spiritual bypass as a means of coping can be helpful in assessing how someone may or may not be dealing with their suffering.

Suffering can foster compassion for others. When you know what it is like to have suffered, reflection on the process of experiencing emotional, spiritual, relational, financial, or physical pain can help you connect with the shift in life circumstances that suffering can bring to someone else. Your suffering need not be the same as the other person's for this sense of fellow feeling to occur. Both spirituality and psychology can help you understand what suffering is, why you suffer, how you have responded to suffering in the past, and how you can change your reactions to suffering into responses that align with wellness.

Reflection Questions

For Personal Contemplation:

• In what ways has your spirituality shaped your understanding and navigating of suffering?

• What is your interaction with others like when you are suffering? What is your interaction with others like when they are suffering?

• When suffering, at what point might you consider the support of counseling?

• Upon reflection, have you engaged in spiritual bypass? If so, how did you navigate attending to the emotional or psychological pain that was

being avoided?

When Working with Your Spiritual or Religious Community:

• What occurs in your spiritual or religious community when someone is suffering (for example, during a medical emergency)? What occurs in your spiritual or religious community when the whole community is suffering (for example, during the pandemic)?

• How might you work with someone in your community who is engaging in spiritual bypass?

• What might be a time when you would consult a counselor for someone in your community who is suffering?

Change

A major life change involves going from one state to another and provides an opportunity to learn about yourself in the process. The shift that occurs can inform you of how you felt and what you thought about before the change, and of what you are anticipating the change to result in. The aspect of the unknown may be extra challenging as you notice the thoughts and emotions that come up when things are in flux and unsettled. At these times, you can draw on spiritual and psychological coping skills and strengths. Exciting changes can bring about celebration (individual and communal), along with nervousness, gratitude, and a sense of elation that can shift as you become accustomed to the change. You might see this confluence of conflicting emotions when embarking on a career change, going on vacation, or having a child. Challenging changes can bring about lament, reaching out for help, sorrow, reliance on spiritual and emotional strengths, and a sense of unease that can shift as you adapt to the reality of the change. You might see these responses after the sudden loss of a job or a loved one, after sustaining an injury, or after expanding your family. A change in your

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life can shift from being challenging to being exciting, or vice versa, depending on your understanding and ability to cope with it.

Reflection Questions

For Personal Contemplation:

• What changes in your life are you looking forward to and which are you dreading?

• What is your typical response to major life changes?

• When navigating change, when might you seek the support of a counselor?

When Working with Your Spiritual or Religious Community:

• How do you manage when a change affects you personally as a leader, but also affects your community and how you have to show up for them?

• What strengths can you identify that become evident when your community is navigating change?

Flourishing

When I think of flourishing, I think of thriving and of living the best way that you can in a particular place and time. Flourishing is an optimal way of living and experiencing what joy, peace, and wellness looks like for you. It varies for each person, and within the same person it can vary based on where you are in life-- flourishing at the age of fifteen can look very different from the way it does at fifty-five. I also believe that flourishing can be a mindset for spiritual and psychological support when life circumstances reflect the opposite. The practice of gratitude is one such mindset. It can allow you to flourish spiritually or emotionally even when experiencing challenges or suboptimal experiences in areas such as finances or interpersonal relations. Being able to authentically be your full self with joy is another example of flourishing. And while others may not accept or like the change that flourishing can bring, being true to yourself can be transformative. Others may be inspired by your experience of flourishing and seek to find what it could mean for them.

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Reflection Questions For Personal Contemplation:

• What does flourishing look like for you?

• How does your spirituality support your flourishing?

• How might you be able to engage in flourishing in one area even if you are struggling in another area?

• When might you seek the support of a counselor to support your wellness journey of engaging in flourishing?

When Working with Your Spiritual or Religious Community:

• How does your spiritual/religious community flourish?

• In what ways might you support portions of your community to flourish when others are not experiencing it?

A Consultation Example

You work in a spiritual or religious community that openly encourages its members to seek mental health support when needed. You welcome Adam, a new member to the leadership of the community, who comes from a background that stigmatized counseling. While Adam was secretly open to counseling at his former community, he was never truly informed about it. He comes to you feeling overwhelmed when a current community member seeks his advice about whether counseling might help their family deal with their adult son’s alcohol dependence. Adam describes his sense of anxiety and shame around not knowing how to help this community member, since he has little knowledge of counseling or your community’s way of handling such requests.

• How might you help Adam address his lack of knowledge about counseling, his feelings of shame and anxiety, and his adjustment to a spiritual community that is supportive of mental health counseling?

• How would you explain the process of how to consult or refer to a counselor?

There are many ways to approach this conversation with Adam. Here are a few suggestions:

• Normalize the challenge of adjusting to a new community that has its own way of working, and perhaps share your experience of being a new leader in the community.

• Provide some basic information about counseling and encourage Adam to explore general topics of mental health and local resources. You could steer him toward a counselor to consult with.

• Next, process with Adam how he views the community member’s request, by talking through the family's background information, Adam’s scope of

competence, and his sense of how he can serve as support.

• Role play how Adam might share this information with the community member so that the community member can ultimately make the decision for themselves.

• Offer to share your own working resource list of local mental health professionals.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

CHAPTERTWO

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Chapter 2: Social and Cultural Diversity

Overview

Diversity can be a hot topic. The term, "diversity," which has been a central part of societal conversations over the years, highlights the reality of staunchly different opinions that affect experiences of acceptance, community, and mental health. When I think of diversity, I consider the many ways that make the human race a beautiful variety of lived experiences. Identity is at the core of my conceptualization of diversity because so much of who we are is centered on the intersecting of identities. Our gender identity, age, ability, socioeconomic status, educational level, race, spirituality or religion, and sexuality all contribute to who we are.

Pamela Hays (2008) uses the acronym ADDRESSING to capture considerations of diversity in a mental health context as an aid in better understanding and providing care for clients. ADDRESSING stands for age and generational influences, developmental disability, disability acquired later in life, religion and spiritual orientation, ethnicity or racial identity, socioeconomic status, sexual orientation, Indigenous heritage, national origin, and gender. Within the counseling field, the importance of culture and context in its many diverse manifestations has become a central part of providing competent care. The incorporation of multiculturalism into the training of mental health counselors continues to evolve, with social justice and advocacy now incorporated as part of cultural competency (Ratts et al., 2015). The integration of diversity within counseling, while central and clear to counselors and

counselors in training, does not preclude clinicians asking the inevitable question “Why do we have to learn about and continue to grow in this area?” Tending to diversity is an ongoing journey of self-awareness, of discovery of blind spots, of unconscious engagement in privilege, and of learning skills for addressing conflict due to perspectives on social and cultural diversity.

Your community members may come to you, as a spiritual or religious leader, with questions regarding how your faith responds to current events pertaining to diversity such as racial injustice, religious hate crimes, legal changes affecting gendered rights, and how your faith responds to changing language and acceptance of diversity across the range of human sexuality. It can be daunting to hold space for the varying perspectives that your community may have, especially when you include your perspective and that of the spiritual authority or governing body of your faith. Counselors similarly face the challenge of needing to be self-aware, aware of the guidelines of their national organization, aware of legal or statutory to rules for practice, and aware of the sometimes-polarizing views that can be present in working with groups, couples, families, and individuals with differing perspectives.

One helpful tool is to be curious and to acknowledge that people are in different places on their developmental life journey. Curiosity can be helpful when someone comes to us with a personal concern. We can ask ourselves some straight forward questions during the encounter: what assumptions am I making about the person in front of me, what comes up for me regarding an aspect of diversity that I see or that the person emphasizes, and what other, as-yet-unconsidered aspects of the person’s identity affect their experience? After this personal reflection, curiosity can help us professionally by engaging persons with opposing or polarizing views to consider the context,

identities, and culture of the ‘other’ of whom they speak of. The same questions we asked ourselves can be used to explore with the community member how their response and the values and tenets of your faith interact. That can be hard but good work. I do not believe that you have to have all of the answers; there is power in raising questions for community reflection and spiritual discernment. Understanding that not everyone is in the same place in their spiritual journey, nor in their level of openness and self-awareness, is key to fostering compassion, patience, and an offering of grace for the potential to grow. In the spirit of curiosity, we will use the ADDRESSING model to consider how some aspects of diverse identity can negatively or positively affect mental health.

Age and Generational Influences: Lived experience and generational expectations are relevant when considering how age affects mental health. Development across the lifespan often comes with experiences common to persons in defined age ranges. This phenomenon is explored further in the next chapter. When your life experience deviates from what is considered typical development, there can be dissonance between expectations you may have of yourself and others at a certain age and how you actually present or live. For instance, someone who may have expected to have a family by the time they were in their thirties may have to deal with the grief that can come from not meeting this generational expectation. This grief might be amplified by criticism or shame from community members and family members, thus negatively impacting their self-esteem and mental health. On the other hand, age and generational influence can positively affect mental health when it gives you a sense of support from preceding generations, a sense of normality or commonality on reaching a certain age and knowing that others who reached that

point experienced the same thing, and a sense of what one may have accomplished on reaching a certain age, for example shifting from adolescence to adulthood.

Developmental Disability: Differences in the ability to navigate the world physically, emotionally, or interpersonally from an early age can shape how people see themselves and others. A sense of belonging can be a central component of how we feel about ourselves. How one’s family and local community respond to and engage with someone with differing abilities from childhood can affect self-worth, especially when there is intentional or unintentional communication around belonging-- for example bullying (direct) or not inviting someone with differing ability to a group function because of assumptions about their ability (indirect). Figuring out where one belongs and is welcomed can become a skill for survival and safety. Being made to feel excluded can affect mental health negatively, especially if someone takes in that message as truth and applies it to their self-worth: "I do not belong anywhere." Such beliefs can generate a sense of anxiety regarding future encounters. The feeling of not belonging can be amplified when someone's differing ability is not considered during the planning of an event. For instance, offering a youth movie night without providing closed captions could make a teen who is deaf feel excluded and make it very difficult for the teen to track the story, or to laugh or cry with peers at appropriate times as the movie plays. At worst, it could send a message of being ‘less than.’ Alternatively, for a person of differing ability to be an advocate for themselves and others with similar levels of ability can improve their mental health. For instance, sharing one’s lived experience can be an opportunity to educate one’s family and local community and can foster a sense of pride, autonomy, confidence, and leadership.

Disability Acquired Later in Life: As we age, our bodies change, and our ability to function as we had previously been able to do may diminish. The shift in ability can be a challenging time of transition depending on the support available and on someone’s personal conception of who they were and what the change in ability means in how they see themselves. Mental health problems may arise regarding anxiety, trauma (especially if the change in ability is due to a traumatic event), depression, and addiction (for example, if self-medicating is a part of coping). Someone who lost their sight in a car accident may experience anxiety around their ability to navigate the world, their lack of ability to use previous means of coping with challenges (i.e., if reading a spiritual text was a coping skill in the past), or changes in their relationships with others. On the other hand, a disability acquired later in life could enhance someone's internal loci of control, instill pride as one adapts to the change, and even lead to reframing the experience as a new adventure to explore in this part of life.

Religion and Spiritual Orientation: Much of how we make meaning and formulate our values comes from spiritual and religious foundations. Religion and spirituality may be perceived as one and the same or as different experiences, depending on who you ask. What is understood when we say ‘religion’ and ‘spirituality’ varies, since each is defined individually, based on experience and context. When life circumstances cause us to question our values or the way we make meaning, our religion or spirituality can serve as a support, a hindrance, or something in between. In a reciprocal relationship, mental health can affect our religious and spiritual orientation, and vice versa: our religious and spiritual orientation can affect our mental health. Consideration of how we have coped spiritually

and religiously in the past and whether that practice is still beneficial in the present, can be a useful reflection on how the emotional and spiritual aspects of our health influence each other.

Ethnicity and Racial Identity: The treatment of people based on race, a social construct (Hays, 2008, p.11), can bring them together and become a cornerstone of their culture. Race can foster a community's collective navigation of the world--of how to adapt to the way members of their race are seen and treated. Race can help communities come together to coexist under this classification. Joys and sorrows experienced throughout history by persons of the same race and ethnicity inform current choices, mindsets, and emotional safeguards. On the other hand, race can be used as an institutional weapon. Race can determine which resources are made available or denied to members of a community. Racial discrimination enforced by systems of power generates mistrust, which can lead to assumptions that may be acted on without substantiation. Social and political discrimination can contribute to people's experiences of racialized trauma (such as that resulting from hate crimes), hypervigilance (a means of self-protection when the environment does not feel safe), low self-esteem (when encountering messages saying that members of a race are not valued or worthy), and grief (which can be compounded by multiple losses arising from racialized maltreatment), just to name a few. But one’s racial and ethnic community can be a source of empowerment and resilience for countering those messages with a communal reclaiming of self-identity and worth via affirmation, support, and embracing of the group's strength.

Socioeconomic Status: Class and socioeconomic status greatly affect the opportunities and resources available to a person trying to create a life of wellness. The condition of having enough, too much, or not enough applies not only to money, but also to energy, food, education, and mental health. Before one can thrive and engage in self-care, one must have enough to survive. One can live in poverty and yet have enough emotional and community support to experience positive mental health. Resources may be shared so that even if one person does not have enough, collectively needs can be met. On the other hand, one can live in wealth amid an abundance of material things, but be starved emotionally or constantly stressed from working to maintain an affluent lifestyle. In both circumstances, it is helpful for religious and spiritual leaders to be curious about how someone seeking their aid understands their experiences and what they articulate as their needs. This kind of curiosity can help us not treat others on the basis of assumptions or stereotypes. Many religions make some type of provision for the poor, and it is important to consider how one might set aside false judgments--such as equating personal wealth with personal worth-- in order to tend to the many areas where class affects access to and engagement in mental health. Perhaps we can consider how to meet people where they are and offer what is needed so that they can emotionally and energetically attend to their mental health and the stressors, anxieties, and shifts in mood that can be affected by their socioeconomic status (or a move from one status level to another).

Sexual Orientation: The experience of love and attraction can be a complex one and can in many ways affect our mood and emotional wellness. If things are going well in a relationship, there may be feelings of euphoria and joy; if things are merely routine, there may be feelings

of boredom or contentment; and if things are going poorly, there may be feelings of heartbreak and sadness. A relationship becomes more complicated when the persons involved in it experience it differently, a condition often encountered when people seek couples counseling. The experience of complexity can be heightened even more when one’s family, community, or society is not open to or affirming of love and attraction that differs from their own. Being rejected or made to feel Othered can negatively affect someone’s self-esteem and decrease sources of support. To counteract this experience of being ostracized, those affected can seek out spaces that are affirming and that can bolster their self-esteem through acceptance and normalization of whomever they love. Additional resources on terminology and allyship can be found in chapter 8.

Indigenous Heritage: Consideration of Indigenous heritage can shed light on the richness of diversity among people. Indigenous peoples across the globe represent the diverse cultures of the first people to inhabit land in varying regions. Indigenous culture and practices embody a sacred respect and connection to the earth and bears the history of the land with honor. Indigenous peoples have often been mistreated and misplaced over time. The experience of oppression and the pressure to acculturate have impacted the respect and treatment that Indigenous peoples have received or been denied. On the other hand, the pride of their lineage, beauty of their culture, and ability to resiliently carry on tradition to the next generation can be a true wonder to behold.

National Origin: National origin can be closely related to Indigenous heritage if your ancestry includes Indigenous peoples. Ancestral practices, places, and peoples can pro-

vide additional understanding of how we have been formed biologically and historically. Knowledge of one’s ancestry can foster connections across family lines that have informed how we were raised and how we think about the world. Experiences that affected our ancestors can still affect us generations later, since the way they experienced life eventually helped shape how our parents lived, might have been passed on to us (in spoken and unspoken ways), and may yet reach future generations. When considering national origin, it is not uncommon to find that someone's place of origin is different from where they live now. The language and customs of their homeland may differ from how they now live their life, which could be in sync with their national origin or out of sync.

There can be joy in reconnecting with our ancestral heritage within our national origin and there can also be sorrow. Joy may come in the rich culture, practices, foods, and customs that bring people together. The shared commonality of language and rituals also can be a source of normalization and comfort. Sorrow may arise if we do not have the ability or privilege to identify our ancestral roots or background. It can also be present if our national origin is not accepted or becomes a marker for persecution in the country that we have immigrated to. Sorrow may also arise if we find out that some actions or practices of our ancestors do not align with our way of being now. These experiences, joyful or sorrowful, can affect our mental health, especially regarding the development of our identity and self-understanding not only in our lifetime, but also within the span of our ancestral history.

Gender: Discussion of and education about gender identity has become prominent recently. The spectrum of gender identity and the journey of discovering what that means

for each person can affect mental health. For instance, a cisgender female’s exploration of the kind of femininity that she embraces versus the kind that is traditionally placed on her can affect her sense of self (acceptance, beauty, worth, purpose, and access to aspirations in life). Each person’s experience of living their gender identity is unique to them. This process may include naming their gender identity, exploring the fullness of how that identity manifests within (intrapersonally) and with others (interpersonally), and defining it for themselves in the face of what society sets as expectations or of what systems in society put in place as law. Being understood and supported can boost one’s mental health, while being rejected and denied rights can be a detriment to one’s mental health. Additional resources on terminology and allyship can be found in chapter 8.

One thing to remember is that none of these aspects of identity occur on their own; people are a compilation of these areas of identity which are influenced by how they were raised and additional biological factors. The intersectionality of our identities can also highlight the overlapping layers of discrimination based on the combination of identity (such as race, gender, and class; Crenshaw, 2019). Consideration of how these areas of identity overlap speaks to taking a more holistic view of who we are as humans into our understanding of each other and ourselves.

Devotionals

You are now invited to engage in personal reflection across the following four devotionals centered on identity, suffering, change, and flourishing. I encourage you to find a quiet space to read each devotional, reflect on what comes up for you, and record your responses to the reflection questions for additional processing.

Identity

Who are you? When answering this question, I invite you to notice the first descriptors that come to mind. Is it race, religion, gender, or profession? Now, consider all the intersecting identities that make you who you are. How much fuller is your depiction of yourself when you expand the way you describe yourself? What additional meaning or value rises to your awareness when you examine which aspects of self are the first ones that you articulate, compared with the last ones? For instance, if an initial response to the question ‘Who are you?’ is ‘I am a biracial spiritual woman,’ then it can be a helpful reflection to con-

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sider what each of those terms means to you personally and expand that description to consider additional identities perhaps overlooked or not given as much time and attention. Further reflection on the meaning ascribed to additional aspects of ourselves can help us articulate the prioritization that may exist in our self-description. This reflection may also give us the opportunity to modify how we engage with or prioritize parts of who we are that may currently need more attention. Perhaps we have not been giving a lot of time or energy to our changing abilities due to age, but with reflection, they can be given increased attention. It can be important to give oneself compassion and grace in navigating how we see ourselves which leads to an additional consideration: apply the same compassion and grace we give to ourselves to how we see others. This fellow feeling can broaden our perspective beyond the initial descriptors we may use to describe someone and cause us to consider additional areas of identity they embody and the value that may mean for them.

Reflection Questions

For Personal Contemplation:

• Using the ADDRESSING model, how would you answer the question "Who are you?" Do additional descriptors beyond the identities in ADDRESSING come to mind in how you answer this question?

• If you were to select one area of identity and consider the value you have ascribed to it over time, what comes up for you?

• How do you hold space for others' areas of diversity that are different from yours?

When Working with Your Spiritual or Religious

Community:

• How is your community diverse? Consider the identities in the ADDRESSING model?

• What area of diversity might be challenging to discuss in your community?

• What type of helping professional might be a beneficial resource in providing education and support when there is a conflict in your community based on an area of diversity?

Suffering

Current events are full of examples of suffering caused by Othering, treating members of nondominant groups as exotic, alien, or threatening. When someone is different, they can easily become Othered, excluded, and cast outside the net of safety, compassion, respect, and dignity provided to persons who are similar. Othering can also lead us to ascribe things that we do not like about ourselves to people who differ from us. In doing this, we can bring pain and suffering, whether physical, emotional, or spiritual, on the Othered people. And who are the Othered? It is a fluid designation. The subjective and fickle delineation between ‘us’ and ‘them’ can make one wonder when the line of distinction might shift, leaving us as the Othered. Fear and anxiety around exclusion can lead us to associate and affiliate ourselves with those in power who articulate exclusion criteria; we do so in order to feel safe, to not find ourselves suddenly outside and Othered. But what do you do when you or someone you love is Othered and caused to suffer? How do you navigate the risk of caring for, welcoming in, and advocating for persons who have historically or recently been excluded and caused pain? Recognition of the risk inherent in any life endeavor may spark the courage to commit and live out one’s values

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to love and respect the humanity in everyone.

Reflection Questions

For Personal Contemplation:

• Have you experienced suffering based on an aspect of your identity?

• In what ways do you envision yourself supporting and protecting those who are Othered and suffering because of that exclusion?

• What does your faith say about how to navigate suffering due to differences?

When Working with Your Spiritual or Religious Community:

• How do you navigate division in your community based on identity differences?

• How can you support community members who are suffering from being Othered by systems outside your faith community?

• How can a counselor be of support when you and your community experience suffering due to your spiritual or religious beliefs?

Change

We have the capacity to change with each life experience. This change can be an indication of growth, or a regression, or an exploration across our intersecting identities. Periodic reflection on how we describe ourselves can allow for the value and meaning we ascribe to aspects of our identities to flow and shift across time. Who you were ten years ago may be different from who you are now considering the meaning associated with your varying identities and the energy and intentionality that shifts in response to that meaning. For instance, as a child the people in your inner circle influenced who you were socialized to be attracted to and love, but your inner circle may have shifted to a different group in adolescence, and may shift again, becoming more specific and authentic as you become an autonomous adult.

The process of knowing ourselves more fully and deeply can involve a spirit of experimentation in which we take the risk to genuinely show up in each new context we find ourselves in. It is a risk because we may be surprised by how we engage with a new context, whether it is an event, relationship, institution, or challenge. That interaction may teach us something new about ourselves, reveal the value we place on aspects of our identity, or highlight

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our attitude toward change, perhaps an eagerness to grow or a resistance to change. For example, how we handle oppression based on class or social discrimination can alter over time as we tap into the power and resources at our disposal to improve the chances that we and others can engage in growth-based change.

Reflection Questions

For Personal Contemplation:

• How have you changed in your understanding of diversity in yourself and in others?

• In comparing who you are today with who you would like to be twenty years from now, what change may be a part of that process? How do the intersecting aspects of your identity come into play?

When Working with Your Spiritual or Religious Community:

• How do you hold space for others as they change in understanding and grow in their diversity?

• How does your community respond to change based on an area of diversity--for example, when the community experiences a large-scale change in level of income or ethnicity?

Flourishing Live Your Best Life!

This exhortation beckons us to consider what exactly is our best life, and in light of the mix of identities that we embody, how we can access what is best for all parts of ourselves. How can you thrive in intersecting and overlapping areas of diversity? I believe we can do this by honoring each part of our overall identity. We need to give time and attention to what is yet to be understood, valued, and uplifted in each part of ourselves. Perhaps there are one or two areas of our identity, such as spirituality and gender, that we have honored by investing time in them and seeing the resulting growth. Perhaps other areas of our identity have been neglected or overlooked (perhaps ability and age), and we can give intentional care and support to those areas so that they will also be honored and flourish. Asking yourself what living your best life looks like across the ADDRESSING model could be a great first step to moving toward reaching a sense of overall flourishing.

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Reflection Questions For Personal Contemplation:

• Considering the aspects of your identity (ADDRESSING), are you currently living your best life? If so, in what specific ways are you doing this? If not, what might be the reasons or barriers preventing it, and what would you like to do to change that?

• How does your flourishing affect others in your support system?

When Working with Your Spiritual or Religious Community:

• What does your community look like when it is flourishing in diversity?

• How can a counselor support the growth of flourishing across areas of diversity in your community?

A Consultation Example

A family in your faith community comes to you because their child has shared that they are transgender. One parent is fully supportive, while the other is reluctant and fearful of how society at large and the faith community in particular might hurt their child if they are not accepted. The two siblings of the child are confused; they are looking to their parents to gauge how to respond, but are getting mixed signals. The child has expressed feeling relief in having shared their gender identity with their family, but also feeling shame because of not having the support of both parents. The child feels, not unnaturally, that something is wrong with them if both parents are not supportive. The family seeks spiritual guidance in determining how to navigate family members' varying level of support for the child, and seeks interpersonal support as they determine how to navigate the faith community’s response to the changes the child seeks to make in appearance, name, and pronouns.

• What comes up for you personally in considering the family's requests for spiritual and personal guidance?

• How would you work with the family to create a safe space where they can hear one another out?

• How could you locate appropriate resources for support for them?

• What are the laws around care of transgender minors where you reside? How might legislature and the level of openness or hostility in your jurisdiction affect the family and the decisions before them?

There are many ways to approach this conversation with the family. Here are a few suggestions:

• It can be helpful to take a moment to reflect on what comes up for you so that you will know your own

thoughts and attitudes towards the matter at hand and recognize those as yours without imposing them on the family.

• Curiosity and empathy can be strong tools for creating a safe enough space for conversation, as can modeling or showing family members how to provide that space for each other.

• Collaboration and creativity can be useful. You do not need to have all the answers, and taking that load off your shoulders can keep you from feeling stuck or overwhelmed. Being able to work together (whether with the family or your community) to navigate this new experience for the family and the faith community can be a source of support. New responses or considerations, along with a variety of perspectives can be shared and heard in the decision-making process.

• It is often a good step to include a mental health professional to provide emotional, educational, and communication support to the family. A counselor can also provide psychoeducation to the community if needed, and can be a resource for you if you find you need a confidential space to process navigating the experience with the family.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

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Chapter 3: Human Growth and Development

Overview

One of the things that I greatly appreciate about the counseling field is that typical human development is taken into consideration in the process of understanding the client (Remley & Herlihy, 2020). For instance, being able to compare an adolescent’s behavior with the behavior typically experienced by persons in that chronological age range brings a level of normality to that adolescent’s behavior without pathologizing it. Normalizing developmental behaviors and tasks across the life span can help provide perspective and foster realistic expectations of the people we encounter. There are many models of human growth and development. Some pertain to the way we develop our ability to think (Inhelder & Piaget, 1958; Vygotsky, 1978), the way our moral values develop (Kohlberg & Hersh, 1977), the way our faith develops (Foster & Holden, 2020), the way our racial identity develops (Helms, 1995), and the way our social and psychological skills develop (Erikson & Erikson, 1998). It is beyond the scope of this book to go into detail about these models, but resources are provided in chapter 8.

As human beings, we have the opportunity to grow and develop across a range of domains (cognitive, emotional, relational spiritual etc.), and it is important to note that development will vary greatly between individuals. Some people experience barriers across developmental domains because of intellectual developmental delays or traumatic experiences; others may experience barriers to

development because of a lack of access or exposure to educational or relational experiences. For example, research indicates that by age two, children who are living with caregivers under economic stress begin to show signs of cognitive, social-emotional, and language delays (Zaslow et al., 2009).

People may expect everyone in their generation to be in the same place developmentally and while consistencies may be present (for example, striving to belong to a peer group as a preteen or striving to become your own self as a young adult), in certain areas some people are more advanced and others are behind. Culture contributes to our understanding of what is considered typical development, and the cultural aspects of our identity contribute to our development. (For a detailed discussion of aspects of identity, see the ADDRESSING model in chapter 2). In counseling, this information can be used to consider additional goals for growth consistent with both the client’s goals and typical developmental progress.

Using a Developmental Lens

This developmental lens may help you as a spiritual or religious leader to speak to generational differences in your community. The ability to give grace to one another by putting words and actions into a developmental context can allow for increased empathy and openness to work across generations. Perhaps an elder has life experience that allows them to normalize new experiences for younger generations, and perhaps a child expressing curiosity about all things unknown might spark a sense of wonder and deeper understanding in older generations who may have taken the working of things for granted. This developmental lens may also help you as a spiritual or religious leader when responding to intergenerational conflict. Particularly when working with parent-child dynamics, such

as concerns regarding the parenting of minors, the parenting of adult children, or the caregiving for elderly parents, this perspective can help to foster patience, understanding, and communication.

For example, in an individualistic context, parents facing what they perceive as "teen rebellion" might come to you seeking help to "fix" their teenager or the conflictual parent-child relationship, or both. If parents conceptualize developmentally normal display (in which teens shift their primary identification away from their parents and align with their peer group, all while forging their own identity) as malicious, or else place blame on their teen rather than acknowledge the stress that this developmental period can have on the family unit, it can lead to ruptures in their relationship with their teen. Your understanding of this typical stage of teenage development can help you support the parents. You can discuss with them that it is normal, though often wrenching, for teens to differentiate themselves, frequently in ways that parents dislike. You can connect parents with others currently going through the same experience and with those who have already raised teenagers. Connections with other parents in your community, and with professional counselors, can provide space for parents to learn ways to self-regulate the stress they are experiencing during this time, and ways to provide love and support to their self-differentiating teen.

A Spiritual Developmental Model

A developmental lens can be useful when considering spiritual matters at significant times of one’s life. Spiritual development can occur gradually in a relatively natural unfolding, across your life span. By contrast, spiritual transformation occurs rapidly, often in response to an experience such as intense suffering, a near-death experience, a conversion experience, or some other crisis (Hold-

en, 2000; Pargament, 2006).

Let us focus on a spiritual development model that can be useful for broadening our developmental lens: the stages of faith model (Fowler, 1981). Its six stages and one pre-stage speak to how we spiritually make meaning along our faith journey. Ryan Foster and Janice Holden (2020) conceptualize the stages in a lovely way:

• Pre-Stage: Undifferentiated or primal faith. Trust is built between children younger than three years old and their primary caregiver. This relationship sets the foundation for how children make meaning and begin to learn about hope, love, and security.

• Stage 1: Intuitive-projective faith. Children (ages three to seven) engage in observation and imagination to express their faith. This exploration may be seen in their imitation of the faith practices of others around them. Children at this stage understand their faith from a self-focused perspective (as is normal for this age) that may be filtered through their emotions and imagination.

• Stage 2: Mythic-literal faith. Children from the ages of around eight to twelve shift from an egocentric perspective toward one that integrates the perspectives of others and of their culture into their understanding of faith. This maturation may be seen in the use of narratives and stories to understand their faith. These stories often provide guidelines that children strictly follow as a means of creating a structure for navigating the world and interacting with others. Most people, but not everyone, progress beyond this stage.

• Stage 3: Synthetic-conventional faith. Typically, this stage is associated with adolescence. In it, the meaning making of faith is aligned with belong-

ing to and identifying with a group or spiritual community. Identity is formed within the belonging found across shared common beliefs and people at this stage often place a high value in the opinions and practices of persons in authority.

• Stage 4: Individuative-reflective faith. People at this stage, typically in their late teens and early adulthood, shift their experience of authority from external sources (leaders, groups, communities) to internal ones. People at this stage strive to reach a balance between valuing and adhering to their internal authority, which defines their personal beliefs and faith, and honoring the group beliefs that they still find to be important and valuable to meaning making and their faith journey. Black-and-white thinking may be prevalent as a means of trying to balance internal and external authority.

• Stage 5: Conjunctive faith. Beginning in their thirties, people typically shift beyond black-andwhite thinking toward the notion that multiple truths or perspectives can exist simultaneously. People can define for themselves, and in their own words, how they make meaning and how they define their faith. They do so in a way that acknowledges the strengths and limitations of their beliefs and their progress in their faith journey.

• Stage 6: Universalizing faith. The concluding stage of faith, which adults rarely reach. In this stage, self, others, and the world are understood from a universally transcendent and united perspective. Universal love and faith are experienced and engaged in tandem with holding the reality of the limitations of humanity.

This model may be helpful for understanding where

someone in your faith community is at a particular point in their life, especially when they are faced with experiences that prompt a reevaluation or a closer look at their relationship with what they define as sacred. The use of this model to understand where you or another person is within these stages involves the complex overlap of the types of development. Your cognitive, social, and emotional development will affect where you are in the stages of faith since these aspects of your life interact with one another.

It is important to note that this model has some limitations. Research has found an inconsistent fit between this model and some non-Western cultures, and some have criticized the model for positing development that occurs in a linear progression of stages rather than with the fluidity that some experience across stages and ages. Heinz Streib and Barbara Keller (2018) reconceptualized this model as a more contemporary theory of development, called religious styles theory, which addresses some of the limitations to the stages of faith model. In addition, other spiritual developmental models can serve as alternatives, including the spiritual judgment model (Oser et al., 2006), the development of growth model (Genia, 1990), the transpersonal development model (Washburn,1995), and the integral psychology propounded by Ken Wilbur (2000).

Values are often based on a spiritual or religious foundation taught to us as children. Children's curiosity about God and religious practices may arise as part of their natural inclination to expand their understanding. This understanding can be simplistic and egocentric initially, but as children reach adolescence, it usually expands to consider the perspective of others, particularly if teenagers

are exposed to persons outside their spiritual or religious community, as in school or extracurricular activities. As young people's ability to shift from concrete to abstract thinking develops, so does their ability to hold space for the numinous and at times unexplainable. Young adulthood often brings up matters of becoming one’s own self, and it can include a time of questioning the spiritual or religious beliefs that they were taught, whether or not they came from a set spiritual or religious tradition. It can be a time of exploration, and people at this stage often decide for themselves what fits for them regarding spirituality and religion.

Adulthood may bring numerous life experiences in which spirituality can play a major role: finding a partner, since similar or differing spiritual or religious values often is considered; creating a family, since spiritual or religious values affect how you raise children and form a family; establishing a career, which implicates ideas of meaning and purpose; losing loved ones, since spirituality or religion may guide death rituals, inform an understanding what happens after death, and shape grief practices; and navigating experiences of the unknown, which may require faith as a guiding and grounding means of coping. In later adulthood, people may also evaluate their life and the legacy, and divert their remaining energy into areas of significance. This process of reflection later in life can have a spiritual or religious basis, especially when we evaluate our past actions according to our spiritual or religious tenets. This evaluation can spur the desire to continue on the path we are on until the end of our days, or the desire to change in order to better align our actions with those tenets in the time left to us.

Devotionals

You are now invited to engage in personal reflection across the following four devotionals centered on identity, suffering, change, and flourishing. I encourage you to find a quiet space to read each devotional, reflect on what comes up for you, and record your responses to the reflection questions for additional processing.

Identity

Consideration of where we are developmentally can help foster self-compassion. Knowing that growing and evolving are a part of our developmental processes can prompt in us a sense of patience and care toward ourselves and our self-expectations. Our identity is subsumed in the developmental processes of life, whether spiritual, psychosocial, cognitive, racial, moral, or physical. Knowing where we are in these overlapping processes is a great first step in considering who we are right now. Self-awareness can open space for celebration if we are ahead of our expectations for ourselves in these developmental areas; or for dissatisfaction

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if we are not as far along as we would like to be yet are still within the developmental range of our peers; or for shame if we are nowhere near where we expected to be or where our peers are. During times of dissatisfaction and shame, self-compassion can be a gift, since the practice reinforces that we are not alone and encourages us to offer the same lovingkindness to ourselves that we would give to another in our same position. These are two components of Neff and Germer’s (2018) definition of mindful self-compassion.

Self-compassion can be fostered when you consider the external factors that affect your ability to develop, factors that may be out of your control and that may slow down your development or stop your progress for a time. External factors could include your level of access to resources, cultural factors, laws or institutional guidelines, or family dynamics, to name just a few. Recognizing these external factors and your ability to navigate them may reframe how you think about yourself, especially if you were able to make any developmental movement when these factors proved prohibitive. For instance, perhaps in your psychosocial development, you may still be working on the ability to create intimacy in relationships. Your ability in this area could have been affected by family dynamics that failed to model healthy relationships or that denied you access to them while you were growing up. Realizing this may shift your perception of yourself from ‘being a failure’ for not cultivating a romantic relationship (a common negative thought) to one of self-compassion for never having been shown a healthy romantic relationship. This shift might open space where you can be easier on yourself and become motivated to learn about tools

needed to grow in this area.

Reflection Questions

For Personal Contemplation:

• How does where you are developmentally affect how you understand and see yourself?

• In what areas might you use self-compassion when considering your identity through a developmental lens?

When Working with Your Spiritual or Religious Community:

• Where do you understand your community to be developmentally as it pertains to the identity of your community in meeting, not meeting, or exceeding your expectations?

• How do you foster self-compassion for yourself in working with your community when the people you serve are at different places in their spiritual development?

Suffering

Suffering can arise when we are not perceived to be ‘normal,’ whether that is a self-imposed perception or one imposed by others. The next logical question is, what is normal? Often, how members of our society and cultural context typically develop provides the basis for what is considered normal for one’s age, gender, race, and spirituality. Existing outside typical or normal development may be a source of suffering, since it indicates not belonging, can induce shame, and can lead to one being treated differently from others. Another question that sometimes arises when we find ourselves out of sync with typical development is, what is wrong with me? This question may bring up a spiritual or religious exploration of reasons why we suffer when our development is on its own unique journey. It is important to be able to hold space for the attendant emotions and to process them, and just as important to examine the accompanying thoughts, which may need to be reframed in a way that includes a positive consideration.

As an example, we can use self-compassion when

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being mindful of the emotions that arise during developmental suffering. We can remind ourselves that everyone develops at their own pace, in numerous ways, and that they may have emotions similar to ours when they feel out of sync with the norm. We can reframe the question "What is wrong with me" as "What is this portion of my journey teaching me as I strive toward growth in my own time?" This altered perspective allows for our suffering to be acknowledged and moved through and may open us up to sharing this experience with others in our support system as a way to help steer ourselves towards change.

Reflection Questions

For Personal Contemplation:

• When have you experienced suffering from being out of typical or normal development?

• Which spiritual or religious coping skills helped you process that suffering and move forward?

When Working with Your Spiritual or Religious Community:

• When a community member is suffering because of being out of sync with normal development-spiritually, racially, or interpersonally-- how do you support or help them?

• How might you partner with a counselor when community-wide developmental suffering occurs?

Change

Moving from one developmental stage to another can bring up many emotions, including anxiety, excitement, fear, grief, anger, or joy. We might remember being young and wanting to hurry up and be an adult so that we could do whatever we wanted. We might likewise recall the disappointment we felt when we realized that our expectations of freedom and autonomy did not match the responsibilities that come with living independently. We might remember the nervousness we felt as preteens as our bodies changed; being in sync with our peers may have brought relief and a feeling of being normal, while being out of sync may have led to embarrassment and feeling like an outsider.

I can recall one classmate of mine in fifth grade being able to grow a full beard and how awkward his early development was for him. Some of his peers gaped in wonder, wishing to also be able to do the same. Some of his peers showed envy by teasing him. Some parents were both bewildered and curious when their children would begin making the transition into teenage bodies. This natural physical development, unique to each person, paral-

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lels other types of human development in which the factors that contribute to the timing of certain changes (as with hormone levels in beard growth) is often out of one’s control, but how we respond to those changes as a community can make all the difference.

While we cannot control other people’s words or actions, we can have agency over our own responses. When we encounter people we know and love moving through their developmental journey (forward, backward, cyclically, higher, or deeper across stages of development), we can be honest about what comes up for us, and consider what that person might most need as support while experiencing the newness of change. When we find ourselves experiencing a shift in our developmental journey, we might engage similarly in a nonjudgmental and honest self-assessment of how we feel, how we are handling the change, and what comes up for us. In this way, we can seek to understand it before giving ourselves self-compassion and the encouragement to find the support in navigating the change.

Reflection Questions

For Personal Contemplation:

• How have you handled change in your physical, social, emotional, and spiritual development?

• In the past, what developmental change did you find the most joyful? Which one did you find the most challenging? Consider how you were able to work through that change and if applicable, what you might have done differently.

• What type of developmental change are you looking forward to? What type of developmental change are you dreading? Consider the supports

that may be helpful for you?

When Working with Your Spiritual or Religious Community:

• How do you offer guidance to people in your community who are struggling with adapting to developmental changes in their lives?

• What type of support can your community provide persons or families during or after a developmental change that shifts the dynamics of their lives such as a change in their spiritual development?

• Would you consider a counselor an emotional or educational resource for your community's support system?

Flourishing

There can be times when we look back and wonder at how we have managed to grow, change, adapt, and develop in a world where there are many obstacles to that process. I envision a sense of joy when considering the ways we can be resilient and continue to grow during and after hard times. It can be important for us as social beings to find ways to celebrate with one another when we have managed to resolve a previously unfinished developmental stage (for example, learning to trust), when we shift to a more integrative and compassionate phase of spiritual or racial identity development, or when we exceed expectations for someone our age. From the visible things, such as becoming aware of our privilege and changing our words and actions accordingly, to the unseen things, such as not always taking things literally and holding space for abstract ideas, we can celebrate ourselves and one another. It might be encouraging to consider an area that you might take for granted (such as socially navigating peer groups, becoming self-confident while also finding belonging, learning how to do your job well) and reflect on how years of striving for that developmental growth have paid off with a sense of flourishing. It might also be

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encouraging to sit with where you are in your spiritual development and consider how to enrich your experience, how to deepen it, and how to celebrate that deepening with those in your support circle as a way of not just marking the developmental growth but flourishing in it.

Reflection Questions

For Personal Contemplation:

• What developmental growth do you want to celebrate for having successfully navigated it?

• How might you enrich or deepen your spiritual development, and who would you share that with?

When Working with Your Spiritual or Religious Community:

• How can your community celebrate when members flourish developmentally?

• Is there a ritual or a practice for engaging in a communal celebration of flourishing?

A Consultation Example

Ashti comes to you because she has reached the stage in her life where she wants to do something more meaningful in her career. Historically, she has sought the wisdom of your faith tradition to help her discern how to offer service to the community, and she has had many experiences of providing support to people in and outside your spiritual community. Her service has been her spiritual outlet, while her work has been the financial support of her and her family. She has twin daughters who will be going to college next year and as the sole income provider for her family, she feels a responsibility to continue in her corporate job. Yet she cannot ignore the pull she feels to change careers so that her work aligns with her spiritual beliefs of contributing more to the community. She has an opportunity to make a change after seeing a job posting for her ideal job. It has a start date later in the month, but the salary is only half of what she currently makes. Her daughters think that it is preposterous to even consider this change. They are angry and anxious about how the financial change would affect their lifestyle and future opportunities. She seeks your guidance in deciding on her next steps.

• What comes up for you as you consider this case?

• Have you personally experienced a similar yearning toward a vocational change based on developmental changes?

• What would you advise?

There are many ways to approach this conversation with Ashti. Here are a few suggestions:

• Consider your faith community’s point of view regarding family, vocation, and service. How might this influence your approach with Ashti, as well as Ashti’s understanding of the choice before her? It

is recommended that you head into a conversation with Ashti with curiosity and an openness to hear her conceptualization of the experience. Hearing her perspective about her faith’s role in her decision could help you clarify your response. For Ashti, hearing her reasoning as she articulates it out loud could make her decision straightforward.

• Consider Ashti’s spiritual developmental stage and how that might contribute to her experience.

• Consider the various aspects of Ashti’s cultural identity and how they might contribute to her developmental experience. How might race, age, gender, and class affect this case? Not knowing the specifics, since they have been intentionally left vague for this example, you might explore answers to this question multiple times but change Ashti's race, age, or class.

• Referral or consultation with a counselor could help Ashti explore the underpinnings of her experiences, such as the psychosocial developmental stage she is in, which is a normal time for reflection on one’s life and legacy, and her pattern of decision making in the past, which will likely guide this upcoming decision. A counselor could help her explore the impact of potential decisions on her and her family. In addition, family counseling could be offered to foster communication with her daughters as the family navigates the decision-making process.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

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Chapter 4: Crisis and Trauma

Overview

Experiences can affect us differently. While one person may respond to an event with resiliency, another person may respond to the same event with symptoms of trauma. Both might experience the event as a crisis, yet their responses might differ. Often the difference in people's responses is related to their resources (emotional, spiritual, financial, and social) for handling the event. Trauma occurs when crises not only exceed our ability to handle them, but produce long-term symptoms causing people to respond in the present moment as if the crisis were still occurring. These symptoms include hypervigilance, flashbacks, and nightmares. The body, and the brain in particular, continues to use the self-protective measures that were needed during the crisis, even long after the crisis or immediate danger has passed, which can take a toll on the body physiologically (van der Kolk, 2015).

Types of Trauma

There are many types of trauma: being bullied, being cut off from one’s family, experiencing sexual violence, being spiritually ostracized, experiencing a natural disaster, being in a life-threatening situation and the like. Trauma can occur in a single moment, persist over a longer period of time, or be ongoing. Trauma may consist of one event, multiple events of the same nature, or different multiple events. The experience of multiple traumas over time is conceptualized as complex trauma. We can understand trauma as existing on a spectrum from stress to complex trauma.

Stress is something we encounter every day. It stretches the problem-solving parts of our brain, fosters creativity, signals when we have too much on our plate, and indicates when we need support. A crisis is “a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanism” (James & Gilliland, 2017, p.3). My colleagues, Dr. Marlon Johnson and Dr. Maria Spellings provide great descriptions of trauma. Dr. Johnson defines trauma as an “ongoing response of the body to a crisis that can be a heightened response to the stressor they are encountering” (personal communication, March 2, 2022). Dr. Spellings describes trauma as “exposure to an event/ circumstance with certain types of reactions that can be disruptive to a person, overwhelms a person’s ability to cope, and has enduring effects” (personal communication, December 9, 2022).

Post-traumatic stress disorder (PTSD) may occur when a person is unable to cope psychologically with a life-threatening trauma. According to the DSM-5-TR, PTSD affects one’s ability to engage in daily life activities such as interacting with others socially or being able to be effective at work or at school. See chapter 8, "Additional Resources," for more information. Complex trauma occurs when the horrific experience of trauma cannot be easily escaped and is often prolonged or repeated (WHO, 2019). The World Health Organization's (WHO) International Classification of Disorders, 11th revision, (ICD-11) includes diagnostic criteria for complex PTSD and provides additional information about the criteria (https://icd.who.int/browse11/l-/en#/http%3a%2f%2fid.

who.int%2ficd%2fentity%2f585833559). Complex trauma often includes chronic relational trauma, which may result in developmental deficits in areas such as self-regulation (Gingrich, 2020) and increased instances of functional impairment (DePierro et al., 2022).

Coping with Trauma

Coping with trauma involves dealing not only with the traumatic event itself, but also with the consequences or aftermath of the event. Consequences can be financial (affecting your livelihood if the funds needed to ameliorate a trauma exceed your emergency or existing funds), spiritual (affecting your faith if severe doubt or a spiritual crisis occurs), social (if you isolate or withdraw as a self-protective measure or means of coping), emotional (if guilt, shame, or blame affect your self-worth or if your emotions overwhelm your ability to cope), and physical (if harm was done to your body or if the emotional toll of the event is expressed in the body as illness).

As a spiritual or religious leader, you may be called on to be a first responder when significant stressors, crises, or trauma occur in the lives of people in and outside your spiritual community. You may be asked to create and hold space for people to process their experiences. Some persons impacted by trauma may express their raw reactions without filters, and some may present in numb or guarded ways as they turn to you to figure out how best to spiritually respond in accordance with the beliefs and value systems of your spiritual community. It can be a sacred offering to be present, to witness the pain and suffering caused by the crisis or trauma, and to be a source of the support and, often, the hope provided by the spiritual tenets of your community. You may also encounter conflict in a family, for instance, in which people with very different responses to a crisis or trauma may not be in a place of

openness to validate or honor responses that conflict with their own.

For times of crisis, it is recommended that you create a running list of resources, adding to it and updating it as needed, that can help members of your community to meet their needs in the face of disaster. Resources can include things such as: food pantries, social service assistance, the local mental health authority, transportation and housing assistance, medical assistance, and many more. Hotlines for crisis intervention, suicide prevention, and domestic violence assistance can be helpful as well. Resources for self-care, including information about respite centers, spiritual retreats, and support groups, can be included in this list. As new crises occur, you may find additional resources to add to the list. And as community members engage with these resources and give you feedback, you can modify the list accordingly. I encourage you to share your list with other leaders in your community so that all of you can share what you have found helpful. Two extremely beneficial trainings are available to increase your understanding and provide additional tools to help people cope; psychological first aid and critical-incident stress debriefing. Information about these trainings is in chapter 8, "Additional Resources." You do not need a mental health license to access these trainings which can help you be more prepared when a crisis occurs.

When a crisis or traumatic event affects an entire spiritual community or the community at large, helping professionals face an enormous challenge. As a counselor, I can attest to the difficulty of helping others through something that I am experiencing, too. The COVID-19 pandemic devastated people worldwide and continues, at the time of this writing, to affect some communities. The long-lasting effects (whether grief, physical symptoms, or anxiety) are being collectively navigated. As a whole, we

have had to learn how to adapt to living with an endemic virus and have seen how people in our community have responded to it.

As spiritual or religious leaders, you are encouraged to consider how to help others when you are affected by the same event, as with COVID. Members of your community may look up to you or assume you have all the answers, know what to do, or have the right words to say. Recognition of our common humanity can be empowering, and sharing how you turn to or lean on your spiritual or religious beliefs can model for your community a way of imperfectly living the best we can. Also, it can be crucial to seek support for yourself in a space where you can be open and honest about your initial raw reactions, thoughts, and feelings before deciding on your response to a crisis. This support could come via counseling, a spiritual or religious mentor, a family member, or an anonymous online support group; whatever form feels safest and supportive, I hope you access it, especially during times of trauma.

Spiritual and Religious Trauma

Having support in place for yourself can be essential when faced with others' spiritual or religious trauma, especially trauma inflicted by persons within or leading a spiritual or religious community. As someone in a position of leadership, you might become the symbol or representation of that person's pain, even without having been involved in the traumatic event. For instance, someone’s family may be a part of your spiritual community, but does not participate in it, because of past spiritual trauma experienced in a different community of the same faith. You might be sought out and asked tough questions about why the trauma was allowed to happen. You might have to field generalized accusations that the whole faith community is as bad and

wrong as the person who hurt them. Even if you do not have the answers, you can provide a corrective experience by loving the person for who they are and holding space for them to process their pain and ask questions. The goal is to find a place of peace where they can reengage with their personal spiritual beliefs as a survivor of religious trauma. The provision of love and support for those navigating spiritual or religious trauma will likely require you to use your own wellness and self-care practices for your emotional health and your spiritual disciplines for your spiritual health.

Compassion Fatigue

We need to acknowledge the reality of compassion fatigue, or vicarious traumatization, among spiritual and religious leaders. This occurs when someone who supports those in crisis or trauma (especially if done regularly or for a large number of people) becomes so affected by constantly hearing and bearing witness to others’ experiences of trauma that they begin to exhibit harmful symptoms themselves. Often the symptoms can mirror those of trauma or burnout (see chapter 7). To prevent compassion fatigue, be aware of the signs, seek support from others, and care for yourself. Signs of compassion fatigue can include feeling exhausted, ineffective, disconnected, depressed, excessively anxious that something bad will soon happen, or fearful without reason; compassion fatigue can result also from taking on others’ trauma as your own (SAMHSA, n.d.-a). Consider which of these symptoms you may have experienced or where stress begins to show up in your body, in your words, and in your thoughts. These initial indicators can be a signal to intentionally engage in self-care. Caring for others during difficult times of crisis and trauma requires that we care for ourselves and nurture our relationships with self, others, and our spiritual or religious beliefs. Doing so keeps our energy tanks full so that

we can continue to be of support to others.

Devotionals

You are now invited to engage in personal reflection across the following four devotionals centered on identity, suffering, change, and flourishing. I encourage you to find a quiet space to read each devotional, reflect on what comes up for you, and record your responses to the contemplation questions for additional processing.

Identity

During adverse times, we find out who we are, what we are made of, and what we can do. When facing a personal crisis or trauma, it is a good first step to acknowledge that the experience exceeds our resources and ability to cope. This admission can be a hard one for persons in leadership positions, for persons who like to be independent, and for persons who are private in nature. Seeking support and assistance requires first admitting that there is a need for it. Facing up to that truth requires vulnerability. We know from Brene Brown’s work (2012), that there is strength and power in vulnerability, but that acknowledging our vulnerability is difficult because shame is often associated with it as well.

Culture contributes to this mixture of need and strength, vulnerability and shame. The unspoken rules

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of our culture (ethnic, spiritual or religious, class, etc.) contribute greatly to who we are, how we seek support, and how much we share. A reckoning with our cultural identity can be freeing. Cultural awareness helps us see that there are many ways to express vulnerability, based on the intersection of our identities. We can try to find a way that both honors who we are and gives us access to needed support in times of crisis and trauma. We may surprise ourselves when we look back at ways in which we overcame crises and trauma. These experiences can serve as motivation for being able to persevere through current challenges. I hope that when reflecting on times when you overcame adversity, you are reminded that you were not alone, and that support and resources were shared (whether spiritually, interpersonally, or emotionally). I hope too that you can recognize when you were that resource or support for someone else in crisis, and then extend yourself some gratitude for showing up and showing what you are made of.

Reflection Questions

For Personal Contemplation:

• When experiencing a crisis or trauma, who or what do you turn to?

• How is vulnerability engaged with across your cultural identities (spiritual, ethnic, gender, socioeconomic, ability, etc.)?

When Working with Your Spiritual or Religious Community:

• What comes up for you when persons in your community turn to you during times of crisis or trauma?

• In what ways have you been able to support your

community members when they have experienced a crisis or trauma? Was there anything that surprised you about how you showed up or what you were able to do?

• How might a counselor help support you when you are called on to support your community during a time of crisis or trauma?

Suffering

The first question that comes up for many when a crisis or traumatic experience occurs is "what?," often closely followed by, "why?" The first question occurs as we try to wrap our minds around what can feel like the impossible. We seek clarity while hoping for the reality not to be true. Asking "what?" helps us home in on a situation that will call on our time, attention, and resources. It also makes us aware of the resources we lack, which is a starting place when we are ready to seek support. Before we are ready to answer the first question, the second usually emerges. Asking "why?" is an attempt to understand and is a logical way of coping. Some people feel that if we can understand the reason behind a crisis or trauma, we can end it.

We may turn to our spiritual and religious beliefs when asking "why?" Meaning might be found in the answer, if an answer is available-- for example, the weather patterns behind a tornado that devastates a town. When no answer is readily available, we may offer multiple possible reasons in an attempt to understand what may seem inexplicable. I believe that meaning can also be found without answering the question "why?," since in seeking to understand the crisis or trauma, we can learn about ourselves,

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others, and life itself. Suffering usually accompanies a crisis or a traumatic event, but comfort can be found in not enduring the suffering alone. For instance, we can connect with others when asking what and why. And meaning may be found as the crisis recedes and we find a new way to navigate the world.

Reflection Questions

For Personal Contemplation:

• From your spiritual or religious perspective, how do you understand suffering arising from a crisis or trauma?

• What are some examples of crisis or trauma in the history (spiritual text) of your spiritual or religious community?

When Working with Your Spiritual or Religious Community:

• How do you assist members of your community when they come to you with the question, "why?" after a crisis or traumatic event?

• What do you do to care for yourself when you have to hold multiple experiences of suffering from different members in your community?

• How might a counselor be a support to your community when a traumatic event affects everyone?

Change

When a crisis or a traumatic event occurs, change is inevitably a part of the experience. We go from living our lives as usual to experiencing a radical, life-altering event. We do not know what will unfold as we face an unexpectedly disrupted life experience. We go from having the tools and resources that we need for handling daily life stressors to feeling inept in the face of events that call for more resources than we have available to us. We try hard to identify what we will need and where to get it. Change occurs when the event begins, as it transpires, and afterward. Change can feel devastating at the onset of crisis and trauma, as if we were powerless when confronted with the unexpected. As we begin to understand what we will need in order to recover from crisis and trauma, we often still face uncertainty. Change is present also in the recovery from a crisis. Change can be motivating as communities can come together and pool resources. This change can feel empowering, vindicating, supportive, comforting, and at times joyful when considering the growth that has occurred.

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Reflection Questions For Personal Contemplation:

• How do your spiritual or religious beliefs respond to change?

• What spiritual or religious resources do you turn to when grappling with the changes arising from crises and trauma?

• What feelings come up for you when navigating the multiple changes caused by a crisis or a traumatic event?

When Working with Your Spiritual or Religious Community:

• How do you pivot when multiple changes occur during a crisis or a traumatic event affecting a community member or the community as a whole?

• What spiritual resources does your community turn to when navigating change during crisis and trauma?

Flourishing

It might feel odd to consider the theme of flourishing in the context of crisis and trauma. But it is often a silver lining, experienced by those who have survived crises and traumatic events, survived the consequences or aftermath of those events, and grown from the overall experience. We see flourishing when someone is able to create a new sense of balance and homeostasis after a trauma. They may be stronger, more mature emotionally, and perhaps more willing to live fully in the moment. That said, not everyone's traumatic experience ends. As in cases of complex trauma, some people may live under ongoing traumatic conditions. But even in those cases, I believe that there can be opportunities for flourishing. For example, people might find ways to spiritually flourish while living in a war zone. How we flourish is personal and unique to who we are and what brings us joy. A sense of accomplishment or confidence can be a manifestation of flourishing after overcoming a crisis or trauma. Becoming closer to your community after sharing resources to rebound from a collective traumatic event can likewise be a manifestation of flourishing. Flourishing is possible both in the midst of chronic trauma and after a trauma event ends.

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Reflection Questions For Personal Contemplation:

• How have you engaged in flourishing, either during or after a crisis or traumatic event?

• How did you (or how do you currently) find ways to flourish during the COVID-19 pandemic?

• In what ways would you like to grow in your sense of spiritual flourishing when facing a crisis or trauma?

When Working with Your Spiritual or Religious Community:

• How have you seen members of your community flourish when navigating a crisis or a traumatic event?

• How can you help your community spiritually flourish when facing an individual or communal crisis or trauma?

A Consultation Example

A hurricane destroyed the gathering space for your spiritual community and flooded many of the homes of your community members. Your home was left intact, as were the homes of about half of your community. For the past six months you and others in your community with homes unaffected by the hurricane have had several families stay with you on a rotating basis while their homes were being repaired. This change to people's living conditions has been both stressful and joyful, and has taxed everyone’s resources. Also during this time, your community has shifted to gathering virtually since the community's gathering space is still under repair. As a spiritual leader, you are exhausted. Neither your office nor your home is a place of solitude or refuge, and you feel as though you are working nonstop. While you realize that this arrangement is not sustainable, you recognize that your community continues to have many unmet needs and is still finding its way through this collective traumatic experience.

• How would you find support for yourself and create time and space for that support?

• What resources are available to you? What resources are available to your community? What resources are still needed? What might be an initial step toward obtaining the needed resources?

There are many ways to approach this situation. Here are a few suggestions:

• Finding big and small ways to care for yourself can be an important way to get yourself out of a state of exhaustion. This might include finding rest in your vehicle, a park, a library, or friend's or relative’s home. It could include putting a sign on a bedroom or bathroom door to give you some ‘restorative time,’ even if it is only five minutes. You could ex-

plore ways to spiritually recharge during that time. The point is to begin to create boundaries that will allow you to restore some energy. You can care for yourself also by seeking support from a counselor, spiritual director, mentor, or trusted loved one who can maintain confidentiality and allow space for you to openly process without censoring yourself.

• You can brainstorm with your community to come up with ways to share the load of providing support for one another. Relief can be sought outside your spiritual community as well as within it. Once your community identifies its most pressing needs, a team or committee could take responsibility for locating and connecting with relevant external resources. These external resources could be sought in the greater spiritual community (such as governing faith bodies or communities in other states), in the local city or state community (which can provide emergency shelters, housing programs, etc.), and at the national level (federal disaster relief).

• A counselor could also be an external resource for providing emotional support to the community as well as education about crisis, trauma, and coping. If engaging in your own personal counseling, I recommend that you find a different counselor than your own to provide these resources to your community.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

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Chapter 5: Substance Use Dependence and Behavioral Addictions Overview

Over the past decade, the term “substance use dependence” has begun to be used more often than the term “addiction,” since the former shifts the focus from the label of addiction toward the person struggling with dependence. Both terms are used in this overview, “addiction” applying also to behavioral dependencies.

To me, addiction means the overuse of a substance or activity to the detriment of someone’s life functioning. This overuse is often due to an attempt to deal with emotional pain, such as an undiagnosed mental illness or a learning disability, or by self-medicating, which results in a physiological dependency. Or it could be due to use of a pain medication that develops into a physiological dependency. Or it could be due to exposure to a substance or activity that activates a biological predisposition to dependency. This list, though not exhaustive, emphasizes the physiological foundation of substance use dependence as a mental health disorder. Like many others, I approach addiction through a “biopsychosocial model,” or biological perspective, rather than a “moral model”; the latter puts the burden of ending an addiction on a choice made by the person dependent on the substance or behavior, and equates the inability to do so with moral weakness (Miller, 2015).

The decision to change is an essential, active part of recovery, but more is needed, and the impact of substance use dependence on the body and brain cannot be overlooked. The brain changes in addiction, sending signals to the body to continue using in order to avoid withdrawal. Tolerance occurs with many drugs: the longer a person uses them, the greater the amount needed to reach the desired outcome. Increased tolerance leads to further, severe physical and emotional withdrawal and cravings, becoming a vicious cycle. While often unacknowledged, cravings are a significant factor in a person’s return to substance use (Inaba & Cohen, 2014).

If these physiological changes to the brain and body are overlooked and a moral or solely choice-based perspective is adopted, we risk shaming, and rupturing relationships with, persons struggling with addiction. The moral perspective assumes that since they are continuing the addictive behavior, seemingly regardless of the consequences, they are actively choosing and even desiring to hurt themselves and others. I encourage all of us to seek more information and education about substance use dependence and behavioral addictions. We need to know more about their effects on the body, the recovery process, and the best ways to support when someone we know, or we ourselves, are struggling with them. The Substance Abuse and Mental Health Service Administration's website (SAMHSA, n.d.-b) offers a wealth of information and can be a good starting place (https://www.samhsa.gov/).

Addiction goes beyond dependence on a substance or activity and involves craving, tolerance, withdrawal, risky use, and social impairment (APA, 2022). We can conceptualize substance use disorders as extremes of typical behavior regarding the use of something as a means of socializing, enjoying life, or coping with stressors. The substances and activities may be socially acceptable in

certain quantities and contexts--such as social drinking, or neighborhood poker games-- yet may harm oneself and others when they are indulged in to a point of excess or result in dependency. Dependency takes many forms: an athlete who is prescribed pain medication after surgery and continues to rely on the medication after recovering from the operation. A teenager who tries a substance for the first time, discovers that it decreases their chronic anxiety, and then continues to seek out the substance for relief. Or a person who, in the wake of a devastating loss, turns to a substance or behavior to self-medicate the emotional pain and comes to rely on the substance or activity to keep the devastating emotional pain at bay.

Types of Substance Use Dependence and Behavioral Addictions

The DSM-5-TR identifies ten classes of substances-- alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives-hypnotics-anxiolytics, stimulants, tobacco, and other substances prone to producing dependence along with one behavioral addiction, gambling (APA, 2022). Other types of behavioral addictions involve eating, sex, video gaming, shopping, and social media use. What is common to these behaviors and substances is that they initially provide an intense sense of reward: comfort, euphoria, relief, energy, numbness, relaxation, or pleasure. If the drug or behavior is used too often and in lieu of healthy coping skills, the former feeling of reward can shift toward its opposite-- discomfort, pain, emptiness, and the like when the effects of the drug or behavior wear off. This downturn in emotion can prompt the continued use of the substance or behavior to experience the reward again.

Impacts of Substance Use Dependence and Behavioral Addictions

Substance use dependence and behavioral addictions often affect the lives of others in one’s social circle. They may not know what to do or how to help the person struggling with addiction. Previous experience with someone struggling with addiction may have taught them to protect themselves financially, since addictions tend to be expensive to maintain; relationally, since the addiction takes priority over everything else, including relationships; emotionally, since worry and concern may increase as the overall health of the struggling person worsens; and spiritually, since they may question, from a faith perspective, why the addiction occurred and what will be the consequences if it continues.

As spiritual or religious leaders, you may find yourself working with persons struggling with addiction or with their loved ones. They may turn to you when they realize that an addiction exists, or when they realize there is a need for help, or during treatment and recovery when use could recur after a period of abstaining, and during the continued work thereafter to maintain distance from the experience of addiction.

You are in a unique position to model through the tenets of your spiritual or religious beliefs how to love the person struggling with dependence throughout the good and the bad of the process. This may include separating your feelings for the person from your feelings about addiction. That is, your spiritual beliefs may have clear guidelines and thoughts around people’s actions (the dependence), but can still call for loving and respecting the person without enabling the behaviors that can accompa-

ny addiction. That separation of feeling is not easy to do, but it can make a world of difference in the availability and clarity of support for the person; you value them for who they are and hold out hope for them to be able to eventually embrace that value for themselves.

Part of this process includes consideration of cultural beliefs around addition and recovery. Acknowledging when cultural messaging differs within one’s family or support system, or is in conflict with one’s current views or spiritual beliefs, can create an opportunity to understand aspects of identity that influence how one copes or deals with addiction and recovery. In addition, being clear about the role of culture in forming how you as a spiritual leader view substance use dependence and behavioral addiction can be a great first step in becoming aware of what you bring, knowingly and unknowingly to the process of providing support. Self-exploration of cultural formation can assist in fostering compassion for those who have not yet considered the role of culture in substance use dependence and behavioral addiction.

Forgiveness

Forgiveness is often discussed in the recovery process of substance use dependence and behavioral addiction. Someone in recovery may seek forgiveness from themselves, from others they may have been wronged or negatively affected while dependent, or from their spiritual or religious community or Higher Power. Generally speaking, people often avoid working through forgiveness, since it can be considered synonymous with reconciliation or absolution, but I do not believe that to be true. I consider that a myth of forgiveness. Forgiveness may include reconciling, or it may not. It may include wiping the slate clean, or it may not. Different circumstances during recovery may result in different kinds of connection with the person who hurt us

or whom we offended. Forgiveness can play out in varying ways, and it can be helpful to share some of those ways with persons struggling to seek forgiveness from others and with persons being asked for forgiveness. It is a reality that forgiveness may not ever be granted; the actions of others are not in our control. For people in recovery, having the courage to seek forgiveness can be a gift they give themselves, a sign that they are doing all they can do to get better.

Our spiritual or religious backgrounds may have differing perspectives on forgiveness and the steps for achieving it. People in your community may look to you, as their leader, to help facilitate forgiveness, or they may refuse to entertain the idea of forgiving because of myths about it. I encourage you to think about your views on forgiveness and how they come into play in different circumstances and contexts, such as forgiving oneself, forgiving others, and so forth.

One perspective on forgiveness that I like is the REACH model, constructed by Everett Worthington and his colleagues (2011). The model is based on engaging in decisional forgiveness (making the cognitive choice to forgive), doing the long-term work of emotional forgiveness (working through steps to no longer harbor negative energy and emotion towards someone who offended you), and freeing yourself from the emotional and physical toll that unforgiveness may take on you. In chapter 8, "Additional Resources," I have included information about the free resource (a forgiveness workbook) that Worthington provides. This workbook can be used on one's own, in the context of counseling, or in working with a spiritual or religious leader.

Devotionals

You are now invited to engage in personal reflection across the following four devotionals centered on identity, suffering, change, and flourishing. I encourage you to find a quiet space to read each devotional, reflect on what comes up for you, and record your responses to the reflection questions for additional processing.

Identity

In counseling, you often see the use of person-first language, which centralizes the person who is suffering rather than using the mental health disorder as a label or descriptor of the person's identity. For example, identifying someone as a "person with an alcohol use disorder" or a "person struggling with food addiction" humanizes our conversations with and conceptualization of others. The words we speak have power. They shape how we view and engage with others. By seeing people, rather than their problems first, we reinforce their value beyond their current circumstances.

If you were to apply this type of reframing to yourself, which label might you shift from being a first line of identification to a descriptor? For example, you could

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shift from "clumsy me" to "I tend to be clumsy," or from "I’m an emotional eater" to "I tend to turn to food for comfort when emotionally taxed."

What do you overindulge in? When do you tend to turn to this overindulgence-- at stressful times, joyous times, times of celebration or mourning? Has the overindulgence ever felt beyond your control, that is, has it ever resulted in a physiological need, a struggle to stop, or continued use despite negative consequences? These questions focus on our natural tendency to turn to things that give us pleasure in some way and to continue to return to them. We see the extreme of this inclination in substance use dependence and behavioral addiction. Whenever a behavior becomes problematic, it is important to remember that we are persons engaging in behaviors and not the behavior itself. We are much more than our deficiencies, and our spiritual or religious beliefs can support our understanding of the expansiveness of our identity and others'.

Reflection Questions

For Personal Contemplation:

• How much of your self-description is based on your actions or behaviors? How can shifting to person-first language help you de-identify with behavior?

• What comes up for you when you consider addiction? Was substance use dependence or behavioral addiction a part of your formation (within your social circle or upbringing), and if so, how has it affected you?

When Working with Your Spiritual or Religious Community:

• How have you seen your community affected by addiction?

• How can you be a support to community members who are experiencing addiction or who have a family member experiencing addiction? How do you see support for these two needs differing? How might a counselor be of support?

• What is your faith community’s stance on substance use dependence and behavioral addiction?

Suffering

No one wants to feel pain. We often will do all that we can to avoid it. For some, this involves using a substance or engaging in a behavior that can become addictive. But life tends to teach us that pain is inevitable and that we must learn how to deal with it. We must each find our own way of handling and working through pain. Rather than suffer in silence, we can shoulder pain together, perhaps finding support and connection in the process. By being present and witnessing or walking with another as they traverse a painful moment, we not only support that person, but may also learn of alternate ways of coping with pain and may even find persons who could later support us when we need it.

Being able to recall an experience when pain and suffering were so overwhelming that you felt willing to do almost anything to stop them can be a starting place for creating empathy around others wanting to end their addiction-related pain. That pain could be the emotional pain that drove them to search for a numbing substance or activity, the physical pain from withdrawing from an addictive substance, or the spiritual pain that comes from reckoning with the consequences of actions taken while

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under the influence. While we cannot and dare not assume to know exactly what another person is going through, tapping into the core of common human experiences-- in this case, seeking comfort or an ending to suffering-- can help us develop empathy when we do not understand. There is power in connection. It is a way of showing up, being present, and providing support by relating from one heart to another.

If you have worked through your own substance use dependence or behavioral addiction, you can be a mentor or an encouraging example of the possibility of overcoming dependence. On the other hand, if you find yourself suffering and then coping with that suffering through dependence on substances or behaviors, I hope that the resources shared in chapter 8 might be useful for you in starting the journey of finding another way to navigate suffering. One resource listed there is the book Refuge Recovery, by Noah Levine (2014), which many who are struggling with suffering during the recovery process have turned to.

Reflection Questions

For Personal Contemplation:

• In what ways have you coped with suffering?

• Do you find yourself avoiding pain and suffering?

• What is it like for you to try to empathize with persons struggling with addiction?

When Working with Your Spiritual or Religious Community:

• What are your spiritual or religious community’s beliefs around suffering and how to deal with it?

• How might a counselor support you or your com-

munity when someone is affected by substance use dependence or behavioral addiction?

• What might we do to help our communities become better equipped to handle pain and suffering?

Change

Within the world of addiction counseling is a model for determining a person’s readiness for change. It is also used to consider their readiness for the work of counseling that ultimately prompts change. This trans-theoretical model of behavioral change, which was created by James Prochaska and Carlo DiClemente (1992), is also known as stages of change. It includes the following stages: 1) precontemplation, 2) contemplation, 3) preparation, 4) action, and 5) maintenance. In precontemplation, you do not recognize that there is a problem or need for change. In the contemplation stage, you acknowledge that a change is needed, but are ambivalent about it. In the preparation stage, you are motivated to change, you articulate a commitment to the work needed for change, but you have not yet taken action. In the action stage, steps are taken toward change. In the maintenance stage, you do the ongoing work to maintain the change. It can be helpful to note that these stages do not always happen linearly and that one may go back and forth among them in a process of change and recovery.

Some conceptualizations of this model include an additional stage: relapse or termination. The inclusion of relapse as an additional stage is to normalize relapse or

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reuse as part of the recovery process. Contingency plans are made in the action stage or maintenance stage to cope with reuse if it occurs later. That way, if reuse occurs, the process of working through the stages of change can begin again, but with more structure and support, since the person will have worked through them previously. In the termination stage, the level of care decreases (for example, from a treatment center to outpatient counseling) and counseling is no longer needed every week. Termination does not mean that a person will no longer or never again need counseling; other supports are put in place-- a sponsor, a support group, sober friends to provide ongoing support. Counselors work themselves out of a job but keep the door open, and there is no shame if additional counseling support is needed in the future. These stages can also be applied when you seek to make a life change. When you consider a change needed in your life right now related to addiction or otherwise, where do you place yourself in the stages of change?

Reflection Questions

For Personal Contemplation:

• What change would you like to see occur in your life? Where are you in the stages of change related to this change? Are you satisfied with the stage you are in, or would you like to change? How might a counselor assist in your pursuit of change?

• How might understanding the "stages of change" model shift how you support those with an addiction when people at different stages of the model seek your help? For example, family members seeking help for a person struggling with addiction who might be in the precontemplation and

contemplation stages. A person struggling with addiction might seek help when in the preparation and action stages. Or a person with addiction and their family might seek support in navigating the maintenance stage and beyond?

When Working with Your Spiritual or Religious Community:

• According to your faith community’s spiritual tenets, how are change and the process of change understood, that is, how are they supposed to occur?

• How do you help support a family unit in which the person struggling with addiction is in the precontemplation or relapse stage? What thoughts or emotions come up for you when encountering someone in those stages?

• How might collaboration with a counselor help a community struggling with several people experiencing addiction?

• Is there some psychoeducation around substance use dependence and stages of change that might help your community?

Flourishing

A widely used support for persons struggling with addictions is the twelve steps of Alcoholics Anonymous (AA: Alcoholics Anonymous, 1939/2001). Some people absolutely love this approach and others do not. The twelve steps provide a common language for people from a variety of backgrounds to recognize where they are in the recovery process. AA meetings can provide connection, support, and encouragement from others who are further along in the process. In fact, community is the biggest benefit that people draw from working the twelve steps. The twelve steps have been used in groups that have descended from AA, such as Narcotics Anonymous (NA). Community is also a benefit made available to persons related to members of AA or NA through the affiliate groups AlAnon and Nar-Anon. One note to keep in mind is that the AA framework is steeped in religious language; a Higher Power is engaged, and for those who do not hold such beliefs or are working through spiritual struggles with the concept of a Higher Power, the twelve steps may not seem to apply or be the best fit.

For a person with a belief in God or a Higher Power, the twelve-step process can be supported by a faith com-

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munity. As spiritual or religious leaders, you might be very well equipped to walk someone through steps five, six, seven, and eleven. Within these steps, someone may come to you to share or confess what they have done that may have hurt themselves, others, or their relationship with their Higher Power (step five). They may seek guidance for getting to a place of spiritual readiness for repentance or the intentional turning away from thoughts, words, and deeds that caused harm (step six). When ready, they may seek assistance from you to help formulate communication or prayer for the removal of their shortcomings or the things that cause or have caused harm (step seven). They may also seek your spiritual expertise and support in the ongoing work of prayer and meditation in maintaining their spiritual relationship with God and God’s purpose in their lives (step eleven). Engaging in these steps that have specific spiritual content can be essential to the flourishing of someone in your community if they find the twelve steps to be a helpful framework for recovery.

I greatly admire steps four, eight, nine, and ten, which do not require a designated belief system (although a spiritual or religious foundation would be helpful in navigating them). These steps focus on engaging in an honest moral inventory of ourselves (step four), becoming aware of harm we have done (step eight), seeking to make amends (step nine), and committing to continue this process (step ten). The courage and bravery to be honest with yourself, see the actions that have harmed yourself and others, become accountable for them, and seek to make amends is very admirable. The steps do not guarantee that you will be forgiven, but I do not believe that is the point. I think the point is to see oneself and one’s actions across time, to be intentional about acknowledging ruptures made by past actions, and to form an intention to change. If we as a human community could tap into this

process of reflection, accountability, and amends making, just imagine how much lighter we would feel and kinder we would be towards one another. Engaging in this type of process worldwide would help us all flourish.

Reflection Questions

For Personal Contemplation:

• Do any ruptures come to mind that if mended, would create space for your flourishing?

• What thoughts, words, or feelings come up for you when you consider the work of people who have worked the twelve steps?

• Have you seen people who have struggled with addiction flourish? If you have not, where might you search for examples? How might witnessing the flourishing of persons who have experienced substance and behavioral dependence affect your understanding of, connection with, and support of them?

When Working with Your Spiritual or Religious Community:

• Have you encountered supporting persons in your community who were making amends as part of a twelve-step program? How might this apply in making spiritual amends within your faith?

• How might the way your community understands forgiveness interact with the amends process of the twelve steps?

• Is there a member of your community who is in recovery and who might consider speaking to the larger spiritual community or providing it with psychoeducation about dependence and recovery?

A Consultation Example

Anthony comes to you after having successfully completed a ninety-day residential substance-recovery treatment program. He is proud of his progress but uncertain about how to move forward. He and his family have been through a lot over the past two years. After becoming dependent on an opioid prescribed to help him cope with a college football injury, he started seeking the substance by other means which involved lying to and stealing from family members. His family belongs to your spiritual community, and while they are proud of his progress toward recovery, they are also guarded, and unsure of how long it will last. Anthony has been in treatment a few times before and later returned to substance use each time with devasting financial and emotional consequences for the family. His family has set boundaries to protect themselves, which keep Anthony at a distance, but now seek your guidance in how to possibly repair the relationship. Anthony comes to you after making a list of the persons he has harmed. He seems really dejected. He says that he is not sure what to do, or whether forgiveness is possible in the context of his family, his spirituality, or himself.

• What comes up for you as you consider Anthony and his family?

• How have you personally experienced and worked through the struggle to forgive or be forgiven?

• What would you advise?

There are many ways to approach this conversation with Anthony. Here are a few suggestions:

• Reflect on your own experiences with forgiveness, with persons struggling with substance use dependence, and with family conflict. Becoming clear about your thoughts and feelings can increase your ability to make space for the multiple perspectives

of Anthony and his family.

• Explore how you might communicate your understanding of forgiveness according to your spiritual or religious beliefs, to all persons involved in this situation. This could go beyond Anthony and his family to include other people in your spiritual community who were harmed by Anthony’s actions when he was dependent on opioids. Perhaps also explore the ideas of hope and change according to your faith’s tenets, and how you would communicate that.

• Consider consultation with mental health professionals who specialize in substance use dependence. Individual counseling with Anthony, and family counseling with his family, might provide additional support in repairing relationships.

o Your spiritual support: Anthony’s reckoning with his actions may prompt a need to explore spiritual forgiveness and self-forgiveness in the context of your shared spiritual beliefs. You could provide your expertise here. You could also establish healthy boundaries to model for Anthony’s family ways to support and love him.

o A counselor’s support in individual counseling: A counselor could work with Anthony through this process of navigating his emotional reaction to acknowledging the harm he has done, and could hold space to process the thoughts and feelings about himself that arise as he moves through the stages of change. A counselor might also collaborate with you (with Anthony’s consent) in creating a list of spiritual and religious coping skills that Anthony can turn to as alternatives to self-medicating when times get challenging in his re-

covery and amends-making process.

o A counselor’s support in family counseling: A counselor working with the family could provide education about addiction and hold space for respectful communication around boundaries and rupture repair.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

CHAPTER SIX

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Chapter 6: Grief

Overview

Experiencing a loss of any kind can instantly shift our mood, energy level, and social interactions. Most often when we hear the term "grief," we associate it with the death of someone we know, but grief applies to a vast array of losses. These can include the loss of a job, relationship, loved one, home, expectations for self or other, identity or sense of self, safety or peace, security, and much more. Grief over some of these losses has been labeled "disenfranchised grief" (Doka, 2002) because the type of loss and subsequent grief may not be recognized by others as something to grieve over. For example, the third party in an extramarital affair who mourns the loss of their lover may not be provided comfort from their support circle because the affair was not socially supported. Another type of grief is anticipatory grief, in which one prepares for a loss by beginning the grieving process before the loss occurs. Anticipatory grief can be observed when a loved one is in hospice before their death, or in the months leading up to a divorce or an empty nest. Do any additional kinds of losses come to mind?

In counseling, the source of the problem that brings someone to therapy (the presenting problem) is often a loss of some kind. The extreme version of the natural experience of loss can manifest in complicated grief or a prolonged grief disorder. As in previous chapters that use a spectrum to indicate breadth of a concept, I view grief as lying along a spectrum.

Complicated grief can occur when there are many losses, when the process of grieving is not engaged in immediately but festers over time, when unresolved matters will remain that way because of the loss, and when grief is extended by external factors such as legal proceedings that prevent one from being able to grieve. Prolonged grief disorder is a mental health diagnosis within the DSM-5-TR. In prolonged grief disorder, a person still displays grief symptoms-- a sense of disbelief that someone is gone, intense loneliness, longing for the loved one, preoccupied thoughts of the loved one-- a year after the death of the loved one, to a clinical degree that exceeds social, cultural, and religious norms or context (APA, 2022; see chapter 8 for additional information).

How Grief May Manifest

Regardless of the type of loss, the news of it often prompts a slowing down of time. We feel our emotions change and our bodies respond in kind. We may go numb, which can be a way of our bodies allowing us to digest the information mentally and emotionally. A feeling of surreality may overtake us as we begin to accept that the loss has occurred. This feeling can lead us from numbness to sadness, the depth of sadness corresponding to the type of loss and to our connection with the loss. Our bodies respond in kind: our appetite decreases or increases, our concentration wavers, our sleep becomes insufficient or excessive, and our energy level drops to the point that accomplishing everyday tasks seems impossible.

Socially, we may withdraw and isolate ourselves, es-

pecially if we express and process best in private. Others may express and process grief in community, surrounding themselves with friends and loved ones. Or there can be a mix of grieving modes. Changes in social interaction also occur over time, since it is not uncommon for a support group to show significantly more care to the bereaved person immediately after a loss than months down the line. The shift of support can make those grieving feel alone or left behind as they navigate their grief process in their own time.

This description of how grief may manifest is just one example. There are so many ways to grieve. None of the many ways to grieve is the only right one. The experience of grief is unique to the individual and the loss. The expectation in American culture to grieve quickly and in one way can shut down the support needed by the bereaved. Most often, grief creates its own path in the lives of those who experience a loss. Grieving may take longer than expected, look different from the process undergone by people who experienced the same loss, and may have unexpected residual consequences that could prompt additional losses.

For instance, one's wedding anniversary may occur six months after a divorce or the death of a spouse, but be remembered only by the person grieving. They may encounter surprise from others who see their grief and had forgotten about the loss or who had returned to the demands of their own lives and were neither tracking nor aware of that significant day. The grieving person might have begun to shift to a new sense of normal, without the former spouse and marriage in their life, but feel overcome on that day (as if the loss had just occurred) with sadness or irritation or however their grief expresses itself. Loss of the relationship, whether by divorce or death, could lead to further losses-- financial, social, emotional, or spiritual.

The person grieving would have to contend not only with the loss itself but also with the additional grief of further losses, for example, if they could no longer afford their home, or if their social circle decreases as mutual friends of the marriage no longer socialize with them, or if their spouse served as their emotional support, or if spiritual questions or doubts arise from the loss.

When considering the process of grief, I prefer a model that centers on tasks to work through. J. William Worden (2009) describes four tasks of grief: 1) to accept the reality of the loss, 2) to process the pain of grief, 3) to adjust to a world without the deceased, and 4) to find an enduring connection with the deceased in the midst of embarking on a new life. While these tasks were created around the death of a loved one, I believe that they can be applied to other losses and that they allow space for the variety of individual expressions and time frames of grief.

As a spiritual or religious leader you may encounter someone who is working at any of these tasks as they seek spiritual guidance in the process of accepting, processing, adjusting, and connecting. They may turn to you for understanding how to work through these tasks from the perspective of your spiritual principles. Most often grieving people will not use the language of these tasks to express what they are doing. They may use language that expresses their desire to learn how to make it through their grief, how to live without what has been lost, how to accept the loss even if they do not want to, and, once on the other side of grief, how to honor what they have learned, who they have become, and, if applicable the legacy of the impact of what was lost. When these questions are asked of you, it is normal to be concerned about the possibility of fumbling about for what to say in response.

What to Say to Someone Grieving

In general, people do not know what to say following a loss, and that is fine. Part of helping others through grief is to know when to say something and when to invoke the power of presence and silence. Some, in their insistence to say something or anything, often because of social expectations or discomfort with silence and grief, may choose words that are unhelpful. Statements such as “it is okay,” “I understand,” and “the person is in a better place” can spark anger, confusion, or more pain especially if the beliefs of the person grieving do not align with those words in that moment.

Having worked as a grief counselor, I do not believe you have to have the ‘right’ words since each instance of grief is different and may call for its own responses. I also think it is okay to state that you do not know what to say when that is true for you. There can be power in showing up, seeing and meeting needs, and asking the person what they would like, such as a visit, some space, a call, a shared activity totally unrelated to the loss, a meal, a cleaning service, or a conversation about the loss in their own time. In addition, specific cultural norms can affect beliefs about grief and practices around loss.

Taking a person’s culture into consideration can help you, in the role of a religious or spiritual leader, figure out what to say and what not to say. It is important to note that even within a given cultural perspective, there can be many nuances in how that culture is lived and understood in the context of grief. How then can we know what to say when there are so many considerations to keep in mind? One way is to do research, starting generally and then getting more specific. You could begin by exploring, via a quick internet search, a specific culture's practices and attitude towards grief and then get more specific by

reaching out to a community member (or a distant family member of the person grieving) to inquire about grief and culture from a local perspective. While this does not give an individualized answer, it may highlight multiple perspectives centered on common cultural beliefs, and those may guide you in providing culturally sensitive support. Another way is to directly ask the person who is grieving about how their culture affects their experience of loss. The caveat here is that you want to do this only after you have discerned their readiness to have a conversation. This question should not be asked when someone is expressing their grief through wailing, but might be useful when they are planning a way to commemorate the loss.

As a spiritual or religious leader, you can bring the rituals, texts, songs, words, and practices of your spiritual community into the grieving process. You represent a faith or set of beliefs that can be accessed when a grieving person is ready, and that steadiness of structure and support can be a comfort for many. In your role, as a religious or spiritual leader, you may be caught off guard by someone wanting to share a loss with you, unprompted based on your leadership position. You may find yourself not knowing what to say. At a minimum, you can commend that person’s courage to share and offer the possibility of providing more extensive support when they are ready.

When You Are Grieving

What happens when you as a spiritual or religious leader are grieving? This can be an individual experience in which only you and your family undergo a loss, or it can be a collective experience when you and your spiritual community experience the same loss. Serving while grieving can be challenging. I hope you can give yourself self-compassion, understanding, and patience as you work through it. I hope you can allow others to show up for you

and support you; it can often be challenging for a helper to receive help. I hope you discern how to allow your grief to be seen so that others can join you and witness the natural experience of working through the tasks of grief. There is a tendency to be strong for others when in leadership roles, but this does not have to prevent you from processing grief. If a confidential space for grief processing is needed, I hope you seek the support of a counselor so that you do not have to carry your own and your community’s grief processes by yourself.

Devotionals

You are now invited to engage in personal reflection across the following four devotionals centered on identity, suffering, change, and flourishing. I encourage you to find a quiet space to read each devotional, reflect on what comes up for you, and record your responses to the reflection questions for additional processing.

Identity

When we grieve, we may question who we are given what we have lost. The part of our identity wrapped up in what we do can be affected by the loss of a job or a significant role. The part of our identity tied to who we love can be wrenched by the loss of a loved one or a relationship. The part of our identity that thrives on expectations can become unbalanced by a loss of sense of self, of confidence, and the like. But discovering that the core of who we are remains intact while we are navigating a loss can give us confidence to persevere. If we have survived previous losses, we can draw on that experience to survive the one we face at present. Our self-perception is allowed to expand and change as we learn more about ourselves through grief and loss. We can look back over our history of losses and see that we

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have endured.

I encourage you to check in with yourself and consider what thoughts emerge when navigating a loss. What do you think about yourself in relation to the loss? What do you understand regarding what happened and how that affects you now? I encourage you to consider your feelings. What emotions related to the loss are most prominent for you? How do you feel about yourself? I also encourage you to consider your actions. What have you done or are you doing as a result of the loss? How does your means of coping align with your spiritual values? These questions may prompt further reflection as you think about how you show up for yourself and for others when you are living through the grief of a loss.

Reflection Questions

For Personal Contemplation:

• What does grief look like for you? What does the process consist of?

• In reflecting on the history of loss in your life, how have you seen yourself change or grow in response?

• How do your spiritual beliefs support how you see yourself when you are grieving?

When Working with Your Spiritual or Religious Community:

• What comes up for you as the spiritual or religious leader when a loss occurs in your community? What does your professional identity call for during these times?

• What rituals or practices of grief does your spiritual or religious community perform? What is it

like for you to lead those rituals?

Suffering

One of the most challenging experiences for a spiritual or religious leader happens when you are called on to provide spiritual support to others while you are also grieving the same loss. The professional responsibility to be present, walk with, support, and spiritually guide your community may be extraordinarily difficult when you need those same things. Collective suffering across a community can bring people together, and yet it can also prompt the suppression or compartmentalization of our own grief if we have no time or place to process it. Grief is the normal reaction to suffering due to loss. Walking through that suffering, sitting in it with someone, standing in the thick of it when the next steps are unclear-- these are all hard undertakings. They do not feel good in the moment. Holding suffering is not something we as human beings generally run toward. Yet the search for aid during suffering comes to your front door. Finding a way to both hold it and surrender it, and to make space for something else to emerge, is essential. Working through the tasks of grief can, I hope, guide you toward making space for the suffering to subside, for discovering and using healthy coping skills, and for finding a

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new sense of normal. If you can find support for yourself as you progress through the tasks, you can model how to do so for your community, and you can create energy, via caring for yourself, that will sustain you in caring for others.

Reflection Questions

For Personal Contemplation:

• How do you manage when you and your community are grieving the same loss? How is the experience different when you and your community are grieving different losses but at the same time? For example, if you are called to comfort a family in your community that has lost their home and all their belongings in a house fire, but you are grieving the loss of a sibling?

• How do you cope with personal suffering?

When Working with Your Spiritual or Religious Community:

• In holding space for the grief of multiple community members, whom do you turn to for comfort?

• How have you been able to support others in their grief when managing your own?

• How might the support of a counselor assist in processing grief in your spiritual community?

Change

The grief process results in many changes. We may experience shock, anger, sadness, longing, physical and emotional pain, laughter in sharing memories, relief (especially if suffering ends), guilt, confusion, a lack of concentration, and a different orientation to time (it can feel speeded up or slowed down). As our bodies do their best to cope with the changes we experience, they offer natural ways to release tension and the buildup of emotion. Our tears can be cathartic. Our wailing can be a release and an acknowledgment of our pain. Our stillness can be a reminder to slow down and process the depth of the experience of loss. Our smile can be a bittersweet celebration of the life of a loved one as we do things that person loved.

Change is frequent and fluent throughout the grief process. I had a colleague, Vicki Johnson, who described the grief process as a tornado that is tight and intense at the bottom (the beginning of the grief process), but loosens as time goes on, with the spirals spreading out and becoming larger toward the top of the funnel cloud. The emotions, reminders, and thoughts related to grief do not disappear. They may spread out and become less intense over time,

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showing up sometimes expectedly (at major holidays, for instance) or unexpectedly, as when walking by someone wearing the same scent that your partner wore. Our recovery from the expected and unexpected feelings of grief often improves over time as we develop a better idea of how we can best cope and seek support. The change into a new sense of normal can almost be imperceptible because of the gradual nature of working through grief, but when we realize that we have crafted a new normal, we can smile because of that change.

Reflection Questions

For Personal Contemplation:

• What changes are the most difficult to navigate when a loss occurs?

• How has your body responded to the changes brought on by grief?

• What are your coping skills when facing changes in the grief journey? Are there any that you would change or amplify?

When Working with Your Spiritual or Religious Community:

• What does change look like in your spiritual community when an individual or collective loss occurs?

• How can you support community members as they navigate the many changes they may face in their grief journey?

Flourishing

It may sound weird, but I loved working as a grief counselor. One of the things that I most appreciated was being able to see a person who had experienced loss be able to find their own sense of flourishing once they had processed their grief. This is not to say that they forgot what they lost, that it no longer mattered, or that they did not feel grief from time to time later when they missed what they lost. But to say that they were ready and prepared for that adjustment to loss to become a part of their new sense of normal. Being informed about how grief could manifest in many ways, how individualized the grief experience could be, how to find ways to cope and connect across the grief journey-- all these things helped create space where flourishing could be present as well. This could be seen in the energy that went into creating legacy projects for loved ones who had died, or in the energy to defy the odds and do better vocationally after the loss of a job, or in the energy to find someone to respect and love them in a healthy way after the loss of a relationship. Flourishing is an honor to witness and beautiful to behold after watching someone go through the depths of intense suffering and change.

Reflection Questions

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For Personal Contemplation:

• When you consider life after a loss, how have you seen yourself flourish?

• What helps you move from suffering to flourishing?

• How do your spiritual or religious beliefs contribute to your being able to flourish after a loss?

When Working with Your Spiritual or Religious Community:

• What does flourishing after an experience of grief look like in your community?

• How have you been able to be of support when someone in your community begins to shift their energy toward flourishing after a time of suffering in grief?

A Consultation Example

Your community is shocked by the news that Logan, a prominent member, recently died. Additional ripples of emotion and confusion emerge when the manner of death is revealed to be by suicide. Not only are you personally affected by the loss of Logan, who was a friend, but you are also called on to be a support to Logan's family members, who had different kinds of relationships with Logan. Logan’s only child was estranged, and their last words with Logan were three years ago. Logan’s partner had a loving relationship with both Logan and their child. While Logan’s parents were loving and close, Logan’s siblings were amicable but not very close. Logan’s family of origin follows a different set of religious beliefs from those of his partner, who is part of your spiritual community. Each family member has come in town to commemorate Logan’s life and has different ideas of how to do so. Your spiritual community has called on you to help process the loss as a suicide within your faith community’s spiritual beliefs.

• What comes up for you as you consider this case?

• What professional responsibilities do you feel are important to attend to?

• What initial thoughts and feelings come up in thinking about supporting the grief of the family (partner, estranged child, parents, and siblings), the grief of the community (grappling with the spiritual implications and understanding of suicide), and your own grief (when you are affected by the death of someone in your community)?

• What would you advise?

There may be many ways to support Logan’s family and your community. Here are a few suggestions:

• Identifying the practical responsibilities of your role

as a spiritual or religious leader may provide some structure for a situation that could feel like chaos. It can be helpful to map out what needs to be done and then include yourself in that consideration.

o For yourself, you could schedule a block of time to process the loss, reaching out to your own support system to let them know what kind of support might be helpful to you in the near future. This could include reaching out to a counselor with whom you could confidentially express yourself. And of course you can engage in the spiritual or religious practices that help you cope with grief.

o For the family, you could assess their physical, emotional, and spiritual needs. You might note what physical needs your spiritual community might be able to meet (a place for out-of-town family members to stay, a meal train, someone to help clean the house for guests, funeral home recommendations, etc.). Emotional needs may be gauged by checking in with each family member and discerning where they are emotionally. Do they need space, silence, people, or information for emotional processing? Spiritual needs may be assessed by listening closely to the questions asked and the comments raised regarding death, suicide, what happens after death, and spiritual practices when a death occurs. Down the line, a grief group or a counselor may be helpful resources for individual family members. The partner’s experience of grief may be different from the child’s experience, who may be feeling anger or guilt. If there is conflict between the partner and the parents on what type of rituals or practices to follow to memorialize Logan, family

counseling could be helpful.

o For the spiritual community, you might schedule a time for spiritual reflection, collective mourning, and answering questions about the loss itself and the nature of the loss. It might also be helpful to call on others in your community to lead with you, in order to collectively shoulder the shock and aftereffects on the community. A counselor may be a helpful resource for providing information about the grief process and ways to emotionally support one another and Logan’s immediate family.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

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Chapter 7: Self-Care and Burnout Prevention Overview

This final content-focused chapter discusses self-care, which is present across all the topics reviewed in this book. Thus far we have covered basic information about counseling and ways to collaborate with counselors; matters of diversity; human development; stress, crisis, and trauma; substance use dependence and behavioral addiction; and grief. These content areas do not exist in isolation and often overlap with one another. For example, you may be called on to assist a community member as they work through an area of diversity that has been brought to their attention because of a crisis. The community member may experience grief too in this scenario, and there is the possibility of developing of an addiction as a means of self-medication. Collaboration with a counselor might be part of providing support to this community member and their family. Your ability to be present and support this community member will be affected by your ability to care for yourself and to keep yourself from burning out, since you may have multiple community members, with different problems, requiring your care and attention. I consider self-care to be vital, not only for the preservation of yourself, but also for the good of the work you do with your community. Let us consider what we mean by selfcare.

What Self-Care Is (and Is Not)

Self-care has become a popular term often associated with massages, retreats, and large blocks of time to

relax. While this conceptualization of self-care can be a part of someone’s wellness practice, it requires the time and financial means to afford it. This idea of self-care can seem to suggest that it should look the same for everyone. I do not believe this to be true. What works for some may not work for others, and what some have access to, others may not. That said, self-care can be enjoyed regardless of your resources.

I consider self-care to be just what the word suggests: taking care of yourself. Since we are all different, it makes sense that how you take care of yourself is unique to your needs and may be different from how I care for myself. To provide ourselves the care we need, we need to first assess what our needs are. This may require slowing down and tuning into our body, which alerts us when we need rest and rejuvenation. This idea may run counter to society's message of scarcity (there is not enough for everyone), which contributes to the need to always grind away and overwork in order to survive. Allotting ourselves a few minutes to assess our energy level and what we need in order to keep going can be an eye-opening gift to ourselves.

I encourage you to assess how you spend your time. Perhaps create a pie chart and list what portions of the pie use up most of your time and energy. If you consider how much energy goes into the work you do, next consider how much needs to go back in and how to make time for that.

Caring for yourself is not just reactionary (a response to feeling exhausted), but can be proactive as a way to engage in the ongoing maintenance of your wellness. What does wellness look like for you? When you envision what it means to be thriving in wellness, what would you be doing? How might you be able to incorporate into your schedule one of the things you came up with, or how

could you amplify one of the things you are already doing? Caring for yourself can apply to your physical health, emotional health, social and relational health, and spiritual health. The assessment of our needs not only happens when we first consider self-care, but is also an ongoing practice in which we evaluate our wellness as we encounter new challenges, transitions, and phases of life. When a change occurs in one of these areas of health, it might be a good time to take a moment to pause and assess how to care for yourself and boost your wellness.

What does this look like, you ask? Well, even if you did not ask, it may be helpful to give some ideas here and I encourage you to add your own. While money is not required for engaging in self-care, time and intentionality are essential. As noted earlier, you do not have to set aside large chunks of time for self-care, doing so may not be realistic or possible for some. Self-care can be as simple as carving five minutes out of your day, giving a few extra moments to yourself when in the bathroom getting ready for the day, stepping outside for a few minutes between meetings, or taking a short stroll when unexpected free time emerges. However much time you decide to spend, the point is to be intentional in committing to it and prioritizing your wellness in the process. I encourage people to put themselves on their calendar as a visual reminder of the importance of giving time to yourself and your wellness, which, as mentioned before, ultimately helps others.

Self-care ideas across the areas of health and wellness previously mentioned can include the following (though this is not an exhaustive list):

Physical health: If you are able, it is a great idea to get a physical check-up to know your health status and whether any adjustments need to be made. Checking in with a doctor can be helpful also if your self-care involves

something that may be taxing to your physical health. Some people have been intentional about moving their body more, which could include walks, jogging, hikes, stretching, and periodically standing up and moving if they work in a seated position most of the day. Some people have increased their intake of foods that are good for them or eaten less of foods that are not good for them. Some people have improved their sleep hygiene by creating bedtime routines and working toward getting the number of hours of sleep that best fits their body. Some have focused on staying hydrated (getting enough water), on caring for their skin (with pleasant-scented moisturizers), and on engaging in regular oral and body hygiene.

Emotional health: Developing coping skills for times when you do not feel your best, along with identifying skills that boost positive emotions, can be helpful as self-care. Finding a space to process and work through challenging emotions is also beneficial as self-care. Coping skills can include things such as moving your body, which can be a mood booster, and writing personalized positive affirmations. The affirmations you select can be unique to aspects of your identity and can be reframed thoughts to counter negative thoughts or disparaging selftalk. Journaling or finding another creative outlet to express how you feel may also be useful, whether through free writing, audio or video recording, or visual or artistic expression. Journaling is not for everyone, but I wanted to include it here, since some have found it helpful. Engaging in deep breathing, if you are able, is also a means of grounding yourself, bringing you into the present moment, and connecting with your body via the sensations felt as you tune into the breath. Counseling can also be a strong resource for engaging in emotional self-care.

Social and relational health: Finding time to connect with people who provide care, joy, fun, comfort, and

support can be crucial to your self-care. We often hear the terms "introvert" and "extrovert" associated with how much one engages with others, and to some extent these labels are accurate. But these terms largely deal with how we restore our energy: introverts find their energy restored when they are alone or around only a few people, and extroverts find their energy restored in social situations and when they are around more people. People can identify as either type or as a mix of both, but it can be helpful to consider which you are when handling your relational self-care. Identifying who is part of your self-care circle and knowing when to connect with which person are crucial ways to not overextend yourself and to find the right balance of caring for yourself socially. For instance, you might find that humor and laughter are what you need, and so you seek out those in your circle whom you connect with in that way.

Some of our relational connections have been replaced by social media, which has a much different emotional value from face-to-face encounters. For example, your communication with friends may have shifted from phone calls or in-person conversations to texting, direct messaging, or meme sharing, which may not allow for in-depth support. If this is something you would like to change, one way of caring for yourself might be to reconnect with someone via a phone call, letter, or in-person conversation from time to time.

Spiritual health: As starting points for spiritual selfcare, consider the spiritual or religious practices in your belief system that provide care. Some engage in prayer, meditation, contemplation, and gratitude as spiritual practices. Others may connect with spiritually meaningful music, literature, and art as a means of experiencing and rejuvenating their spiritual or religious beliefs. If someone has been away from their spiritual community, reconnecting

with it can be a means of self-care. On the other hand, if someone has been steeped in their spiritual community, taking a moment for individual spiritual reflection can also be a way to periodically think about where they are spiritually and what they would like to have more (or less) of within their spiritual journey.

One question to consider is: what circumstances might necessitate the use of self-care for you in your vocation as a spiritual or religious leader?

Imposter Syndrome

When considering self-care in your role as a spiritual or religious leader, you may feel the need to use self-care when dealing with imposter syndrome, especially when you are starting out in your vocation. Imposter syndrome occurs when you feel as if you are an imposter, lacking the attributes, skills, or training needed to perform your role, despite actually possessing the necessary qualities (Bravata et al., 2020). I believe it is common to experience imposter syndrome whenever we embark on something new. The nervousness, second-guessing, and feelings of inadequacy can be normal as you become accustomed to a new role, task, or initiative. For spiritual or religious leaders, this can feel especially daunting when you are sought out as the initial or sole source of support for someone who is struggling emotionally. You might feel out of your depth, overwhelmed, and alone when multiple members of your community seek you out for support. The weight of holding that responsibility may make you feel like an imposter.

Imposter syndrome can manifest when navigating the stress of accountability. In some spiritual or religious communities there is a governing body or spiritual authority to whom you may be accountable. For instance, religious leaders in the Episcopal Church may be accountable

to their diocese and to their parish. A feeling of imposter syndrome can arise from trying to meet the expectations of both the religious authority and the spiritual community, a sense of responsibility that can feel daunting. These expectations may be vast in depth and competing in nature. In a hierarchy of power and disciplinary structures, the pressure to make everyone happy, to not make mistakes, and to excel may exacerbate the feelings associated with imposter syndrome and may make it feel unsafe to share what is coming up for you around those feelings. This can affect whether you feel you can care for yourself, whether you have time to care for yourself, and whether you can ask for help if you are experiencing a mental health concern.

We often do not let others know when we feel this way because it may prompt shame or embarrassment and because it may lead us to think that we are not up to the job. Normalizing this experience of feeling overwhelmed is part of caring for ourselves when we face imposter syndrome. Knowing that we are not alone, that what we are feeling is common, and that there are ways to navigate it can be great motivators to engage in self-care. Caring for ourselves by being intentional about making time and engaging in wellness is a major way of working through imposter syndrome. Giving ourselves self-compassion especially when imposter syndrome manifests with a new endeavor may spark the ability to be patient with ourselves as we learn to be proficient in the new endeavor. Countering negative self-talk that may come out of imposter syndrome (such as "I am not enough," "I’ll never get this right," "They will find out that I am faking it," "I don’t know what I am doing," etc.) with reframed thoughts and positive affirmations can be helpful, too. Reframed thoughts can consist of statements such as "I am enough and can ask for help when I don’t know something," "I am

learning, I can keep trying, and I can utilize my resources," and the like.

Connecting with others who are currently in similar positions or have been in your position can be another way to combat imposter syndrome. Having the support and ideas of peers can create community, and receiving wisdom from a mentor who has already navigated your position can foster additional support. One helpful thing to keep in mind is that if you work through imposter syndrome, you can gain clarity about the insecurities it brings up for you and address those doubts (perhaps in counseling) in order to strengthen yourself and grow. Often, I find that with time, experience, and discernment associated with what brings up imposter syndrome, the feelings and thoughts around it dissipate as you grow into a role or choose a different one that better aligns with your strengths and spiritual journey.

Boundaries and Burnout Prevention

Another area that prompts the need for self-care is boundaries, especially when boundaries are lacking. Being able to safeguard some of your space and time, along with your energy, is important to your work as a spiritual or religious leader. Discerning the type of boundaries you need in order to care for yourself and to care for others is a process, and it may take some time and experimentation to find what works best for you. Boundaries pertain not only to what you do and who you engage with, and when, and how you do it, but also to what you say and what you allow to affect you, that is, what you internalize. Carving out time for your wellness can be a way to establish a boundary regarding the work you do. You might also find that having designated blocks of time can provide structure for attending to work that has multiple responsibilities.

Knowing whom to let into your inner circle can cre-

ate a useful boundary. As you learn to identify those people, you can decide what to share with them. For example, you might fully share personal health information or relationship changes with those in your inner circle, but only sparingly, if at all, with those in your outer circle. Emotional boundaries may also be helpful as a means of creating systems that allow you to keep your peace. For instance, if you know that a community member is fussy with everyone, then deciding to not take their fussiness personally when it is directed at you can be a boundary. Being able to own what is yours and to set a boundary for what is not yours can be a good emotional boundary as well. If you receive criticism, an observation about yourself regarding something you were not aware of, or negative feedback, you can reflect on whether, and to what extent, what was expressed is true-- that is, what you can own and take responsibility for-- and on how much of what was expressed is not yours (and may only be projected onto you).

Not having boundaries can lead to burnout, which the World Health Organization (WHO) defines as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” (2019). This kind of stress can come from saying yes to all requests made of you, which can nullify your wellness-oriented plans, since they often are the first thing to be sacrificed. Not upholding the boundaries that you set can lead to burnout. If you set a boundary but do not honor it when it is tested, your actions communicate to others that your boundaries are negotiable. Not respecting others' boundaries can contribute to burnout, too. When we cross others' boundaries, it can communicate disrespect and may rupture the relationship, causing tension, anger, or distance, since some people default to avoiding persons who do not respect their boundaries rather than discussing the problem with them.

Contrastingly, establishing boundaries can contrib-

ute to burnout prevention. The boundaries we set do not have to be rigid or inflexible, but should be stable and consistent. The difference between setting rigid boundaries (never yielding, no matter the circumstance) and establishing stable yet flexible boundaries (upholding boundaries but allowing for some wiggle room in exceptional circumstances) is also something learned in the process of finding what is right for you. For instance, you may have a firm boundary about not missing your child’s parent-teacher meetings but during one meeting an emergency comes up in your community. Enforcing a rigid boundary would mean upholding the commitment to the meeting no matter the emergency; honoring a stable but flexible boundary would mean considering whether the emergency could be met by someone else and, if not, attending to it and rescheduling (not canceling) the parent-teacher meeting.

Burnout prevention involves actively caring for yourself. If we can recognize the signs of burnout when they begin to occur, we can use the tools and resources at hand to care for ourselves. Left unattended, burnout can progress from small irritations to distress severe enough to have long-lasting impact, for example, leading to physical illness, resignation from your job, and so forth. Some of the signs of burnout include the beginning of chronic stress; mental fatigue by the end of each day; feeling helpless, unappreciated, or bored; and experiencing headaches, lower self-confidence at work, and cynicism (Wicks, 2010).

Steps that may prevent burnout include ensuring sure that you get sufficient rest, reframing negative thoughts, adding variety to your day, using spiritual practices, spending time with your support system, maintaining your physical health, and engaging in the self-care practices that work best for you. Remembering why you were excited or passionate about your work in the first

place can be a good spark to try to rekindle when you question your motivation for continuing in your vocation. For some, this exercise may prompt reflection on whether continuing in your current work is part of your path or whether a different path is available for you to follow. For others, this exercise may feel like an invitation to look at your work with fresh eyes and expand your perspective on how you engage with it.

Facilitating Hard Conversations and Conflict Management

Conflict often contributes to the need for self-care. The focus here on conflict management pertains to facilitating and having hard conversations. As spiritual and religious leaders, we know that conflict and hard conversations are unavoidable. We may be called on to give bad news to someone, to share constructive feedback, to work with personalities that clash, and to help resolve ingrained differences in your community. You may need to have hard conversations within your administration, manage conflict in your community, and create space for the inevitable conflict that can cycle in and out of your personal life.

In dealing with conflict, it is beneficial to consider the cultural context of the persons involved, including yourself. Most of us were culturally taught how to handle conflict and how to express ourselves in hard conversations. Exploring the messages you received while growing up about how to speak up for yourself, stand up for yourself, and allow your voice to be heard can inform your understanding of how you show up in conflict-management situations. This exploration can inform you if there are areas that you need to change. For example, perhaps you were not encouraged to use your voice as a child, and now you overcompensate for it. But by doing all the talking, you do not give anyone else the opportunity to use their voice,

and realizing this can allow for more equity in conversations and for multiple perspectives to be heard. Applying a cultural lens to how we handle conflict can also be beneficial. You can explore what informs your navigation of conflict from a familial standpoint, an ethnic standpoint, a socioeconomic standpoint, and a spiritual standpoint. Understanding this for yourself can help foster compassion when you consider the influence of these standpoints on the perspective of the other person.

If I took a poll and asked people to raise their hands if they liked to dive into hard conversations in which emotions could run high, harsh words could be said, sensitive topics could be raised, and vulnerability was asked for, I think that very few people would have their hands up. I admire those drawn toward and excited about hard conversations. Once those of us less inclined this way learn how to facilitate these conversations and consider the stakes that prompt the need for them, we too can become skilled at facilitating hard conversations, which may no longer feel ominous or beyond our ability.

Let us begin with the motivation or the need to have the conversation in the first place. For a low-stakes conversation, it is common to brush it off or avoid it, in the hope that someone else will facilitate it. What needs to be addressed may seem like a mild irritant rather than a big issue, and it may not require our personal attention. Somewhere in our minds, we mark that we have noticed the matter, but the need to address it may not feel urgent.

When the stakes are higher, failing to address the matter can result in serious consequences. The motivation to prevent harm-- whether emotional, physical, relational, financial, or spiritual-- often moves us from avoidance to action. The motivation to protect others, ourselves, and even the people with whom the matter resides can boost

our willingness to step into something that might be emotionally messy or relationally hard. We nonetheless take the risk, with the clarion call of our leadership responsibility in mind, with compassion in our heart, and with the good of the people involved brimming in our souls. We know that we must have the conversation and that in doing so we will enter the unknown, unsure of how hard the conversation will be or how our feedback will be received. We hope that once the matter is put on the table, there can be a way forward, which may include offering support that the person can accept or reject, creating a plan, or parting ways.

Once we have identified the motivation for the conversation and are ready for action, we can draw on conflict-management tools. One good way is to start with yourself. Being a calm presence can set the tone for the conversation. Finding ways to ground yourself before and during the conversation can model for all involved how to self-regulate if emotions run high, how to slow down and take information in, and how to note our natural raw reactions and yet choose a response that allows our voice to be heard.

One grounding tool is deep breathing, if this is accessible to you. Noticing your natural way of breathing and then extend the inhalation and the exhalation for an additional second can be a gentle way of engaging in deeper, longer breathing. When we are stressed or anxious, our breathing becomes shallow and quicker. Deeper breathing slows down that breathing pattern, activating a part of our body that helps us relax and be present. In addition to counting or extending the breath, some people pay close attention to the physical sensations of breathing, for example, feeling the air going into the nose or mouth, feeling the belly expand and contract, and feeling the chest rise and fall. This noticing allows us to be and stay in the

present moment, which can counteract getting lost in worries about the future or dwelling on memories of the past, a coping mechanism that can be triggered by experiencing conflict or a hard conversation.

Other tools can help facilitate these uncomfortable experiences. The use of ‘I’ statements helps shift language from statements that might be received as accusatory, judgmental, or evaluative toward language simply expressing one’s experience. An example is the shift from "You never follow through on what you say you will do" to "I get frustrated when a deadline arrives and the work is not completed, because I fall behind in my own work as a consequence." Here the tone shifts from accusatory, which will often put someone on the defensive and make them unwilling to hear anything you have to say, to one of self-expression and vulnerability. The statement concerns your perspective rather than your assumptions about or your evaluation of the other person. In group settings where everyone expects conflict-- for example, a committee meeting or a family meeting on a contentious issue-the use of 'I' statements can be a one of the ground rules for communicating with one another. If you are the only one aware of the potential for conflict in a conversation (for instance, you have to give constructive feedback to a staff member, but the person is not initially aware of the purpose of the meeting), then the use of 'I' statements may not be a ground rule, but a model you set by using it in the conversation.

Articulating what you hear from persons in the meeting can be a nice way of making sure everyone is heard and has the opportunity to correct misunderstandings of what they want to communicate. I am not encouraging you to be a parrot, summarizing every sentence after someone says it, but I think it can be useful to occasionally check in to make sure you are fully hearing someone. One of the

beautiful and transformative experiences of counseling is the experience of being heard. You can offer that same validation by simply checking in; it shows your interest in another's perspective even if that perspective is the source of conflict. Holding what is conflictual with compassion and a grounded presence may support you in being able to connect with the hurt or the source of the conflict and to externalize or separate it from the person in front of you. Leaning into your spiritual or religious beliefs may also be a source of sustaining you when having hard conversations and handling conflict. For instance, you might open the conversation with a prayer or meditation (vocal or silent, depending on the circumstances) and draw on the core aspects of your faith community as the driving sentiment for maintaining (or returning to if things gets heated) respect for one another.

When we address group conflicts (those involving more than two people), ground rules for communication become critical. For example, state the purpose of the meeting and have it visually displayed so that the conversation can return to the meeting’s purpose if it goes off course, as it often will in strong disagreements. Returning to a shared goal or focus can bring opposing perspectives back to the common work identified at the beginning. A good follow-up is to help people with differing views articulate their perspective and hear opposing ones. Moving toward resolution of a conflict may occur naturally if one party realizes that they were mistaken, and this realization could result in forgiveness or making amends. It may occur with your guidance toward compromise if both parties are willing to yield in order to move forward. Or it may not occur as expected if both parties agree to disagree or if an executive decision is made. Following up with both parties after the conversation can be part of your spiritual support and care.

For additional information on developing the skill to have hard conversations, I recommend Marshall Rosenberg’s (2003) work on engaging in nonviolent communication (a four-part communication technique that can address conflict) and Mary-Frances Winters’s (2020) work on having inclusive conversations, in which equitable outcomes are sought in dialogue with persons of different cultural identities. These books are listed in chapter 8, "Additional Resources."

Devotionals

You are now invited to engage in personal reflection across the following four devotionals centered on identity, suffering, change, and flourishing. I encourage you to find a quiet space to read each devotional, reflect on what comes up for you, and record your responses to the reflection questions for additional processing.

Identity

I admire people who graciously take care of themselves. It is visible in how they carry themselves and how they interact with others. A level of respect and love for the physical, emotional, and spiritual self is wrapped in their human body which shows their ability to steward and care for themselves. In doing this, they show others how to treat them: what is acceptable and what is not. They create boundaries that reinforce the respect and care they apply to themselves without being arrogant or unkind. This overflows into their ability to respect, care, and love others. I find myself inspired when I encounter someone taking their own advice and being intentional in seeking and accessing the support they need in both good and challenging times. The ability to do this may wax and wane over time,

Photo by Jeremy Bishop on Unsplash

depending on life circumstances. It is not helpful to hold people to levels of perfection or put them on a pedestal for having it all together. Instead, within our community, we can acknowledge the full embodiment of love and selfcare in each other; being a model of self-care when we are able and giving compassion to ourselves and others when we are not the model of self-care. If we or our communities have previously been able to engage in self-care, we can seek to do it again.

Reflection Questions

For Personal Contemplation:

• What does your life look like when you are caring for yourself? What are your words, actions, and thoughts and feelings about yourself?

• How does caring for yourself affect how you view who you are?

• Who do you look up to as an example of caring for self and others, whether spiritually, in your community, or in the larger society?

When Working with Your Spiritual or Religious Community:

• What does (or would) our spiritual community look like when collectively engaged in self-care?

• How do you support the self-care of your spiritual community? What does that involve?

• How might collaboration with a counselor support your community’s self-care?

Suffering

Burnout, compassion fatigue, and lack of self-care can be experienced as suffering. When we put ourselves last, regarding the provision of care, our bodies, hearts, and minds become sites for suffering to manifest. We may ignore initial signs of bodily suffering-- anxiety, tightened muscles, and lowered mood-- and try to push through without listening to these warnings. Some of the ideas about "pushing through" come from how US culture regards work ethic and success. Taking a moment to consider how people in your family and neighborhood navigated stress related to money, work, family, and other aspects of their lives can remind you of the practices that you may still be following.

It is not uncommon for Americans to hustle, grind, and push through warning signs for the need of self-care in order to achieve some definition of success or even simply to survive. When we ignore our bodies, our suffering increases. We face the possibility of burnout. We may experience the wisdom of our bodies if they physically sit us down by making us sick and decreasing our functioning so that we are not able to continue at our former pace.

Our thoughts and emotions may reinforce our suffering if we experience guilt or shame around not living up to our version of success or feeling as if we are letting others down. This may be the time to redefine success less as a destination (that is, thinking, "I will be successful when I have done all of these things") and more as a journey (thinking, "Success is my increased ability to live through the ebb and flow of my work and to care for myself, which takes time and varies over time"). The experience of suffering can also be a great indicator to evaluate your selfcare practices and perhaps add to them, one small practice at a time.

Reflection Questions

For Personal Contemplation:

• Have you ever experienced burnout? If so, what were your body’s warning signs? If not, what does your body do when under stress to inform you of the need to care for yourself?

• How do you define success? How does your cultural and familial background affect that definition, and how you view burnout and self-care?

• How might a counselor support you when experiencing suffering and lack of self-care?

When Working with Your Spiritual or Religious Community:

• How does your spiritual community conceptualize and handle burnout, particularly burnout suffered by leaders and overworked community members?

• How do you support your spiritual community when members may be suffering from compassion fatigue or regretting unmet expectations of success?

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Change

Changes in our engagement with self-care can gradually occur, and we may not notice them until we feel depleted. Our busy schedules and many responsibilities can prompt us to slowly scale back the time we set aside for our wellness. This can be a slippery slope. A decrease in self-care may start off small-- you might shorten your quiet time for spiritual reflection one morning-- but gradually gradually get used to and decrease the amount of times you engage in self-care, such that you shorten your quiet time each week until you no longer engage in it. This change in self-care may be replaced by work or family responsibilities, which are not bad in and of themselves, or may be replaced by going down a rabbit hole of scrolling through social media or news alerts. When we do not pay attention to what is occurring to our self-care routines, we may find ourselves depleted and wondering what happened. Or we may find our bodies informing us of our lack of selfcare by displaying physical symptoms (stomach trouble, headaches, colds, etc.). This shift in our self-care upkeep happens to us all. It may be a gradual experience in which we do not notice change occurring, or an emergency can cause us to alter our routines and we fail to resume them. One way we can be proactive and manage these inevitable

changes is to periodically check in with ourselves to reflect on our recent engagement in self-care. This reflection can be reinforced by finding a self-care accountability partner with whom you can check in so that you can support each other in maintaining self-care.

Reflection Questions

For Personal Contemplation:

• When you reflect on the past year, how have you seen your self-care practices change?

• How often do you check in to reflect on your selfcare practices? Would you like to increase or decrease this frequency?

• Who could potentially serve as a self-care accountability partner for you?

When Working with Your Spiritual or Religious Community:

• What changes have you seen in the self-care among members of your spiritual community?

• How do you contribute to the intentionality of reflecting on the wellness of your community?

• How might a counselor support a self-care checkin for your spiritual community?

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Flourishing

When self-care routines are good and your wellness is in tip-top shape, meaning that it is prioritized and attended to, we flourish. Our flourishing in self-care can make us glow with joy and contentment in the care we give ourselves. Being at our best personally allows us to be at our best when called on to care for others. Others will notice this glow and ask, “How do you do it?” Your response may reflect your work over the years to find the right balance of attending to your health, of making time for wellness into your schedule, and of embracing the experience of selfcare as both work and reward. It is a misconception that self-care always feels good. I think the work done toward self-care can have that result and feel rewarding, yet it is important to acknowledge that the work itself might not feel good in the moment. For example, when emotionally taking care of yourself, you might begin seeing a personal counselor in order to address emotional hurt or pain. The work required may be challenging, the insight obtained may be jarring, and the goals may be achieved through discomfort. But ultimately, the pain and discomfort morph into joy and pride in the growth obtained. This is a form of flourishing. The good, the bad, and the monotonous encounters we experience in attending to our wellness are

all worth it. Flourishing can be recognized in our growth process and can be celebrated each step of the way.

Reflection Questions

For Personal Contemplation:

• When do you know you are flourishing in your wellness and self-care? What practices do you engage in that indicate an experience of thriving and growth?

• When has your self-care been challenging but worth it? When has self-care been joyous?

• In what areas might counseling help you flourish in your wellness journey?

When Working with Your Spiritual or Religious Community:

• How have you seen your spiritual community grow into flourishing? What wellness or self-care practices contributed to this growth?

• How do you celebrate community wide flourishing and flourishing in the individual lives of your community members?

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A Consultation Example

A new staff person, Traci, joins your spiritual community. She is paired with your colleague Javier. Traci, who has just completed theological training, is experiencing imposter syndrome in this new setting. Traci is also finding her mentor sessions with Javier to be more challenging than helpful since Javier verbalizes disdain for the work, has low energy (and often cancels meetings), and prompts self-doubt in Traci regarding how helpful any spiritual leader can be to the community. Traci turns to you for guidance on how to have a hard conversation with Javier about potentially ending the mentorship relationship and about encouraging Javier to get support for what Traci thinks may be burnout. Traci does not feel qualified to have the conversation, let alone engage in her assigned work responsibilities, and so she comes to you feeling at a loss. She asks you to handle the situation.

• What comes up for you as you consider Traci’s experience of imposter syndrome and Javier’s experience of apparent burnout?

• How have you personally experienced and worked with imposter syndrome and burnout?

• What would you advise?

There are many ways to approach these conversations with Traci and Javier. Here are a few suggestions:

• Recalling when you had similar experiences of being new (like an imposter) and of feeling burned out may bring to mind important considerations in navigating this experience. Your experience may help you express empathy for both persons. Considering what you would have done differently and what helped you get through these experiences may prompt additional ideas of how to support Traci and Javier. If you have not had either experience, imagine what

you would think and feel if in Traci's position.

• Holding space for Traci can be important during her transition from trainee to leader. Traci’s confidence in addressing Javier's mentorship and his bandwidth for problem solving may be affected by the experience of imposter syndrome. Yet, this is still Traci’s work to do in order for growth to occur.

o It may be helpful to discuss with Traci the choices available regarding mentorship, according to your spiritual community’s protocol. In some communities, the assigning of mentors occurs within a hierarchical decision-making process that may involve communicating with senior persons in authority. If this is the case, Traci may have to advocate with these authorities for a change in mentor or may not be able to change at all, depending on the availability of persons willing to be mentors.

o Regardless of the administrative process for mentorship, Traci will have to share the reasons for the desired change. You can help her identify how the mentorship has gone thus far in comparison to what she needs. Creating a list of her current experiences versus her needs may help Traci articulate this to Javier. The anticipation of potential conflict with Javier in having the hard conversation can also be normalized for Traci, and ways that Traci can care for herself in preparation for and during the conversation can be explored. These ways can include techniques described earlier, such as grounding and the use of ‘I’ statements. Whereas conflict-management skills may not feel good when put into practice, the experience of doing so can be a means of working toward relational self-care and may build a skill

that Traci can then use in her work responsibilities. As an additional benefit, practicing conflict management may help decrease her experience of imposter syndrome.

• Holding space for Javier may also be called for, since Javier may not be aware that he is burned out or nearly so. Once the conversation around the possibility of burnout has occurred (whether with Traci or with someone of higher spiritual authority), you may be able to provide Javier support. Sharing information about burnout prevention, assisting Javier in assessing his current self-care strategies, and normalizing the experience of burnout could be helpful. If desired, you may offer to be a self-care accountability partner to help both Javier and you stay attuned to the maintenance of self-care. You might suggest that Javier work with a counselor so that he could explore experiences of burnout (and potentially compassion fatigue) in confidence with someone not affiliated with your community.

• Can you think of anything else that you might add or change to the above suggestions to better fit your community or circumstances?

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Chapter 8: Additional Resources

This chapter offers resources regarding mental health basics. Arranged by the content areas covered in the previous seven chapters, the resources can help you explore some of the content in greater detail. I hope you find the information to be useful to you personally as well as to your spiritual community. Note: The links provided were live and active at the time of this publication.

Mental Health Professionals

National Professional Mental Health Organizations

Here are links to the professional organizations of some of the mental health professions discussed in chapter 1. The websites for these associations describe each profession, highlight the focus of the organization, and share additional resources.

• American Art Therapy Association: https://arttherapy.org/

• American Counseling Association: https://www.counseling.org/

o The website provides an extensive list of additional resources: https://www.counseling.org/ knowledge-center/mental-health-resources/resources-for-counselors-and-clients

• American Dance Therapy Association: https://www.adta.org/

• American Association for Marriage and Family

Therapists: https://www.aamft.org/

• American Music Therapy Association: https://www.musictherapy.org/

• American Psychiatric Association: https://www.psychiatry.org/

• American Psychological Association: https://www.apa.org/

• National Association of Social Workers: https://www.socialworkers.org/

Therapy Directories (a sample list)

Below you will find a small sample of the counseling and therapy directories that can help you locate a mental health professional. Directories range from broad to specific, and the few included here are national directories. For more specific information on local support, you can search online for the local mental health authority in your state or county. Local mental health authorities often provide access to community services.

• Open Path Psychotherapy Collective provides a national directory of mental health professionals who offer slots for affordable counseling: https://openpathcollective.org/

• The online edition of the publication, Psychology Today provides a national directory of mental health professionals. Its settings allow you to filter information you may need to help find a good fit,- such as city, acceptance of insurance, specialties, telehealth, etc.: https://www.psychologytoday.com/us

• Therapy for Black Girls provides a national directory of mental health professionals who provide counseling for Black females: https://therapyforblackgirls.com/

Diversity Resources

• Intersectionality. Kimberlé Crenshaw, who coined the term, gives a short description of the term in this video: https://www.youtube.com/watch?v=JRci2V8PxW4

• Information on racism from the American Counseling Association: https://www.counseling.org/knowledge-center/mental-health-resources/racism

• Glossary of terms for diversity, inclusion, and belonging, provided by Harvard University: https:// edib.harvard.edu/files/dib/files/dib_glossary.pdf

• Glossary of gender identity terms, provided by National Public Radio: https://www.npr. org/2021/06/02/996319297/gender-identity-pronouns-expression-guide-lgbtq

• A guide to pronouns, distinguishing sex from gender from sexuality, and terminology, provided by the Society for Sexual, Affectional, Intersex, and Gender Expansive Identities, a division of the American Counseling Association: https://saigecounseling.org/public-resources/

• Glossary of terms related to transgender identity, provided by the Gay and Lesbian Alliance Against Defamation: https://www.glaad.org/reference/trans-terms

• Glossary of terms related to LGBTQ identifies, provided by the Gay and Lesbian Alliance Against Defamation: https://www.glaad.org/reference/terms

• LGBTQ Allyship. Information provided by the Gay and Lesbian Alliance Against Defamation: https://www.glaad.org/resources/ally/2

• Resources on preventing suicide among LGBTQ youth, provided by the Trevor Project: https://www.thetrevorproject.org/

• "Guide to Being an Ally to Transgender and Nonbi-

nary Young People," published by the Trevor Project: https://www.thetrevorproject.org/resources/ guide/a-guide-to-being-an-ally-to-transgender-andnonbinary-youth/

• National Coalition on Mental Health and Aging: https://www.ncmha.org/

•

Additional Suggested Books

• The Brain and the Spirit, by Gena St. David

• Overhearing a Christian Apology to the Nones, by Thomas E. Rodgerson

• The Book of Joy, by Desmond Tutu, Douglas Carlton Abrams, and Dalai Lama XIV

• My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending our Hearts and Bodies, by Resmaa Menakem

Developmental Resources

Models of Typical Human Development

• Early childhood development, provided by the organization Zero to Three: https://www.zerotothree.org/

• "Eriksons’s Stages of Psychosocial Development," by Gabriel Orenstein and Lindsay Lewis, provided by the National Institutes of Health: https://www.ncbi.nlm.nih.gov/books/NBK556096/

• "Piaget’s Stages: 4 Stages of Cognitive Development and Theory," by Alicia Nortje, provided by PositivePsychology.com: https://positivepsychology.com/piaget-stages-theory/#:~:text=Sensorimotor%20stage%20(0%E2%80%932%20years,11%20 years%20old%20through%20adulthood)

• "Summary of Stages of Racial Identity Development," provided by the Facilitating Racial Equity Collaborative: https://overcomingracism.org/ wp-content/uploads/2021/05/stages-of-racial-identity-development-oct2019.pdf

• "Kohlberg’s Stages Theory of Moral Development ," by Kendra Cherry, provided by Verywell Mind: https://www.verywellmind.com/kohlbergs-theory-of-moral-development-2795071

Symptoms of Common Mental Health Disorders

This is a table of symptoms of common mental health disorders: major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), prolonged grief disorder, and substance use disorder. It is important to note that whereas some of the symptoms included below (whether in isolation or in combination) may seem similar to ‘typical’ experiences of emotion, one of the distinguishing factors between typical and clinical symptoms is that the latter result in clinically significant distress or impairment to engage in life or work activities. Persons trained to diagnose assess these components when considering whether symptoms meet the criteria for a diagnosis. I want to encourage you, as I do my students, not to diagnose yourself or others in your community. These symptoms are presented here to increase your understanding of the range of human emotional experiences; the symptoms in this table represent the extreme manifestation of ‘typical’ emotional experiences. If in doubt, reach out to a counselor or other mental health professional regarding a diagnosis.

Symptoms of Common Mental Health Disorders

(from the DSM-5-TR; APA, 2022)

Major Depressive Disorder

(p.183)

-depressed mood and/or loss of pleasure along with potential changes in sleep (too much or too little), eating/weight (too much or too little), movement (agitated or slowed down), concentration (decreased or indecisive), energy (decreased or fatigue), and feelings or thoughts about worth, guilt, or death

-the combination of some of the above symptoms are accompanied by clinically significant distress or impairment (in one’s social, work, or home life) and is not due to use of a substance or the experience of a medical condition

Generalized Anxiety Disorder

(pp.250-251)

-excessive worry and anxiety about several events or activities (such as work) that is difficult to control and may include behaviors such as restlessness, fatiguing easily, trouble concentrating, irritability, tense muscles, and/or disturbed sleep

-the combination of some of the above symptoms are accompanied by clinically significant distress or impairment (in one’s social, work, or home life) and is not due to use of a substance or the experience of a medical condition

-symptoms are in response to exposure to actual or threatened death, serious injury, or sexual violence (this can occur via direct experience, witnessing it, learning about a violent/accidental event that occurred to someone one is close to, or repeated exposure to details of the event)

-symptoms last more than one month and they fall under the categories of intrusion, avoidance, negative alterations, and alterations in arousal

-Intrusion (such as nightmares, intrusive memories, triggers that prompt physiological responses to things that resemble the traumatic event, or flashbacks)

-Avoidance (such as distressing memories or reminders)

-Negative alterations in cognitions and mood (such as blaming oneself; lack of memory about the event; persistent fear, negative beliefs about oneself, or anger; decreased interest in important activities, feeling detached, or an inability to feel positive emotions)

-Alterations in arousal and reactivity (such as angry outbursts, hypervigilance, reckless behavior, trouble concentrating, exaggerated startle response, or disturbed sleep)

-the combination of some of the above symptoms are accompanied by clinically significant distress or impairment (in one’s social, work, or home life) and is not due to use of a substance or the experience of a medical condition

Substance Use Disorder

(pp.545-546)

-symptoms fall under the four categories of impaired control, social impairment, risky use, and pharmacological criteria

-Impaired Control (such as craving; increase of the amount of the substance taken over time; efforts to decrease or cease use are unsuccessful; or large amounts of time are spent in the process of seeking, using, or recovering from use)

-Social Impairment (such as inability to fulfill roles at work, school, or home; continued use despite negative impact on relationships; or ceasing of engaging in regular social activities due to use)

-Risky Use (such as using in risky or dangerous environments; or continued use despite development or exacerbation of a physical or mental health problem over and above the use)

-Pharmacological Criteria (such as tolerance where more of the substances is required to have the same desired effect; or withdrawal)

The following disorder, while not yet common, since it was introduced in the DSM-5-TR only in 2022, is included because the symptoms can mirror the kinds of extreme presentations of grief that you may encounter as a spiritual or religious leader.

Prolonged Grief Disorder

(pp.322-323)

-symptoms are in response to a death of close person (that occurred at least 12 months ago) where the person grieving displays intense longing for the deceased and/or preoccupied thoughts or memories of the deceased nearly every day for a month

-symptoms can include: intense loneliness; sense of disbelief about the death; identity disruption; avoidance of reminders of the deceased; intense emotional pain related to the death such as anger, bitterness, or sorrow; difficulty returning to one’s previous level of engagement in activities or relationships; emotional numbness; or feeling that life is meaningless

-the combination of some of the above symptoms are accompanied by clinically significant distress or impairment (in one’s social, work, or home life) that exceeds cultural/social/religious context and is not due to use of a substance or the experience of a medical condition

While beyond the scope of this book, it is worth mentioning other mental health disorders that you may encounter within your community: psychotic disorders (such as schizophrenia), feeding and eating disorders (such as anorexia nervosa, bulimia nervosa, or binge-eating disorder), sleep disorders (such as insomnia), bipolar disorders (such as bipolar I or bipolar II disorder), neurodevelopmental disorders (such as attention-deficit / hyperactivity disorder [ADHD] or autism spectrum disorder), and neurocognitive disorders (such as dementia). The American Psychiatric Association (APA)’s Diagnostic Statistical

Manual of Mental Disorders text revised 5th edition (DSM5-TR) and the World Health Organization (WHO)’s International Classification of Disorders 11th revision (ICD-11) have more in-depth information regarding all these disorders (APA, 2022; WHO, 2019). Another great resource for increasing your understanding of mental health disorders is Mental Health First Aid, a program that offers training to helping professionals on how to help someone dealing with a mental health problem or crisis (https://www.mentalhealthfirstaid.org/take-a-course/).

Bear in mind that for some mental health disorders, spiritual or religious beliefs have to be taken into consideration, because of an overlap of experiences and content. Overlapping experiences may include spiritual fasting and the refraining from eating in an eating disorder; mystical experiences with visual or auditory aspects and the experience of visual or auditory hallucinations in psychosis; or spiritual rituals of cleanliness or prayer and compulsions or obsessions in obsessive-compulsive disorder. Overlapping content can be seen in religious or spiritual thoughts, ideas, or texts that also are seen in delusions of a religious nature. While this is not an exhaustive list of how spirituality and mental health disorders may intersect, it is helpful for you, as a spiritual or religious leader whom community members seek out for support, to be aware of them. It may also be helpful to know that counselors, specifically those trained to integrate spirituality in counseling, stay aware of the culture and context of an individual during the diagnostic process, and religion or spirituality is taken into account when considering community norms before pathologizing behaviors.

Crisis and Trauma Resources

• Suicide and Crisis Lifeline: 988

• Suicide Hotline: 1-800-SUICIDE

• Veterans Crisis Line: 1-800-273-8255, https://www.veteranscrisisline.net/

• National Domestic Violence Hotline: 1-800-7997233 https://www.thehotline.org/

• Mental Health First Aid: https://www.mentalhealthfirstaid.org/take-a-course/

• Psychological First Aid (a training offered by the National Child Traumatic Stress Network to support persons of all ages exposed to a disaster or terrorism): https://learn.nctsn.org/course/index.php?categoryid=11

• American Red Cross disaster relief services: https:// www.redcross.org/about-us/our-work/disaster-relief.html

• International Critical Incident Stress Foundation, education and training programs: https://icisf.org/education-training/

Additional Suggested Reading

• Trauma and Recovery by Judith Herman

• The Body Keeps the Score by Bessel van der Kolk

• Daring Greatly by Brene Brown

Substance Use Dependence and Behavioral Addiction Resources

• Substance Abuse and Mental Health Administration : https://www.samhsa.gov/

• REACH model of Forgiveness: http://www.people.vcu.edu/~eworth/

• Twelve Steps of Alcoholics Anonymous: https://www.aa.org/the-twelve-steps

Additional Suggested Reading

• Refuge Recovery: A Buddhist Path to Recovering from Addiction by Noah Levine… This is a useful resource for those struggling with the suffering component of recovery.

Grief Resources

• Compassionate Friends, an organization that supports families after the death of a child. Education about grief, local chapters, and online support: https://www.compassionatefriends.org/grief/

• The Dougy Center, which offers support and resources to grieving persons of any age:

https://www.dougy.org/grief-support-resources

• Good Grief, an organization providing grief support and resources for children and families:

https://good-grief.org/resources/

• It is not uncommon for local hospice providers to offer grief support to the community.

Additional Suggested Reading

• Grief Counseling and Grief Therapy by William Worden

• Disenfranchised Grief by Kenneth Doka

Self-Care Resources

• "Emergency Responders: Tips for Taking Care of Yourself," provided by the Centers for Disease Control and Prevention: https://emergency.cdc.gov/coping/responders.asp

• "Self-Care Resource Center," provided by the American Psychological Association: https://www.apa. org/topics/working-psychologist/self-care

• "Caring or Your Mental Health," provided by the National Institute of Mental Health: https://www.nimh. nih.gov/health/topics/caring-for-your-mental-health

• "Self-Care Resources for Adults," provided by the US Department of Health and Human Services: https://eclkc.ohs.acf.hhs.gov/mental-health/article/ self-care-resources-adults

Additional Suggested Reading

• Nonviolent Communication by Marshall Rosenberg

• Inclusive Conversations by Mary-Frances Winters

Resources for Families and Caregivers

• The National Alliance on Mental Illness (NAMI) provides support for persons struggling with mental illness and for their families and support systems: https://www.nami.org/Home

• Families Anonymous, for families and friends of people struggling with substance addiction: 1-800736-9805

• Al-Anon Family Groups, for those affected by another's alcoholism: 1-888-425-2666

• "Caregiving for a Person with Mental Illness," provided by Mental Health America: https://www. mhanational.org/caregiving-person-mental-illness

• National Alliance for Caregiving: https://www.caregiving.org/

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About the Author

Awa Georgia Jangha is the Loise Henderson Wessendorff Associate Professor of Spiritual Integration in Counseling at the Seminary of the Southwest in Austin, TX. She is passionate about counseling, social justice, spirituality, creativity, and teaching. French fries are also one of her unofficial love languages. She teaches in the clinical mental health counseling program at the seminary and leads the spiritual integration in counseling scholars program. In her private practice, Art and Spirit counseling, she counsels clients and supervises post-graduate licensed professional counselor- associates. Her counseling specializations include art therapy, spiritual integration, grief counseling, and working with Black women. She supports and champions the development of collaboration and conversation between mental health professionals and spiritual or religious leaders to meet the needs of this diverse world.

Mental Health Basics for Spiritual and Religious Leaders

This book presents the basics of mental health ranging from topics such as the work of counseling, crisis and trauma, grief, diversity, self-care and much more. Intended as an introduction to mental health matters for spiritual and religious leaders, this guide includes information about additional resources for those who want to explore the content in further depth.

Each chapter centers on a mental health topic and has four devotionals for personal and professional reflection. A consultation example is also provided to spark ideas of how to collaborate and consult with mental health professionals. I hope you enjoy this book and find it to be a helpful resource.

Photo by David Clode on Unsplash