Social workers must understand the meaning of spirituality to be spiritually sensitive. Relational spirituality pertains to the experience of relationships that enhance life meaning. The therapeutic relationship can inform a client's worldview and sustain a social worker's capacity to care.
It is Monday morning and the first face I see is Sue looking back at me. There she sits in a wheelchair covered with a blanket and a huge smile. As I enter the nursing home, Sue welcomes me. We talk for a moment to usher in my day as a clinical social worker. Sue greets everyone who enters from her station in the lobby. If you want to find someone—staff or client—Sue will gladly help. Today Sue is wearing a pink cowboy hat decorated with metal studs that form a cross on the front. Each day, Sue carefully selects which hat to wear based on her outfit. Over the years, people have given Sue hats, which she proudly displays on the walls in her room. Sue is also an artist and has numerous sketch pads and art supplies she uses when she is not enjoying activities such as bingo with the other clients. Later in the afternoon, when I search for Sue, she is in her bed watching television. Sue gracefully allows for my intrusion to have a psychotherapy session. Based on previous sessions, Sue will focus on significant relationships.
Stereotypes of nursing homes suggest a scary place where suffering begins and life ends, but my work in nursing homes suggests a different place. Nursing homes are a place for rehabilitation until discharge to home, while for others chronic illness demands a commitment to long term care. In the process, nursing homes provide an instant community that is invested in a client's care. People in this community include clients as well as staff, family members, and friends. Each nursing home operates differently, but all nursing homes consist of relationship networks that inform life meaning. For clients such as Sue, nursing homes can provide opportunities for self-discovery, to develop new relationships, and have "bucket list" experiences.
Relationships that emerge as part of nursing home care help clients not only survive but in some cases also thrive. Life becomes defined by activities of daily living where clients engage in tasks structured around the clock: nursing shifts, activities schedules, therapy sessions, and anticipated visits. Relationships with certified nursing assistants enable clients to bathe, put clothes on, and brush their teeth. Relationships with nurses enable clients to take their medications and receive additional health care as per medical necessity. Relationships with family and friends help clients feel connected to the outside world. This daily routine tames fears inspired by the unpredictable nature of life.
As a clinical social worker, my job is to engage clients in a therapeutic relationship. I attend to significant relationships and develop interventions to help clients strengthen relationships with what matters to them most. Significant relationships can be determined by the way clients treat themselves, the people for whom they care, and how they engage with their environment. Social workers who are sensitive to the spiritual importance of relationships allow clients the opportunity to explore how relationships nurture them spiritually. Relational spirituality is defined by the experience of meaningful, life enhancing relationships (Faver, 2004; Canda & Furman, 2010). Relationships across levels have the potential to enhance life meaning.
Micro Level: Intrapersonal Relationships
Mezzo Level: Interpersonal Relationships
Macro Level: Transpersonal Relationships
Bird feeders as well as flowering bushes surrounded the building. Being sensitive to the need to feel connected to something bigger, I encouraged Sue to look out her window to enjoy the changing seasons and to go on outings arranged by activities staff.
Therapeutic conditions that a client experiences as spiritually sensitive provide a foundation for relational spirituality. Spiritually sensitive practice means social workers are sensitive to a client's need for meaningful, life enhancing relationships and that social workers have the capacity to recognize how a therapeutic relationship can help clients experience significant relationships as life enhancing. Based on Buber's (1970) theory of dialogue, "I-Thou" communication validates a client's human dignity and worth and recognizes that all clients deserve respect. "I-Thou" communication provides a way to impart spiritual sensitivity throughout the provision of care.
For example, generalist qualities such as collaboration, cohesion, empathy, goal consensus, positive regard, affirmation, congruence, and genuineness significantly influence treatment outcomes (Norcross, 2012). These relational qualities also provide a foundation for advanced psychotherapeutic interventions such as client-centered and existential therapy as well as dignity therapy and relational social work. So, as with generalist interventions, spiritual sensitivity can be conveyed through advanced generalist and clinical interventions. Congruent with the concept of relational spirituality, spiritual sensitivity requires the professional capacity to facilitate relationships that enhance life meaning, starting with the therapeutic relationship.
Author's note: This article is based on some of the research done for the author's book Spirituality and Hospice Social Work, Columbia University Press.
— Ann M. Callahan, PhD, LCSW, teaches social work at the University of Tennessee, Knoxville and is a clinical social worker for MedOptions Behavioral Health Services. She has more than 20 years of social work related experience. Callahan specializes in spiritually sensitive hospice and palliative social work.
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Faver, C. A. (2004). Relational spirituality and social caregiving. Social Work, 49(2), 241-249.
Hodge, D. R. (2016). Spiritual competence: What it is, why it is necessary, and how to develop it. Journal of Ethnic and Cultural Diversity in Social Work, 1-16. doi: 10.1080/15313204.2016.1228093.
Norcross, J. C. (Ed.). (2012). Evidence-based therapy relationships. Retrieved from http://www.nrepp.samhsa.gov/pdfs/Norcross_evidence-based_therapy_relationships.pdf.
Callahan, A. M. (2017b, February). Therapeutic relationship as a spiritual resource. Webinar for the North American Association of Christians in Social Work. Retrieved from http://www.nacsw.org/.