The Increasing Population of the Spiritual but Not Religious — What Social Workers Need to Know
By Beth A. Christopherson, LCSW
Much of the research in the United States indicates that people who are religious and/or engage in spiritual practices, such as meditation or prayer, have better physical and mental health than those who do not. Pargament et al.'s 2011 study in the United States found exceptions to this in that "negative religious coping," such as the belief that one is being punished or abandoned by God, was "correlated with more signs of psychological distress and symptoms, poorer quality of life, and greater callousness toward other people."
A 2013 study by King et al. found some surprising correlations between mental health and spirituality. This study's results, along with several others conducted in the UK, indicated that people with a spiritual outlook on life without a religious framework might actually have poorer mental health. Specifically, they found these people were more likely to be taking psychotropic medications, using or abusing recreational drugs, and to have generalized anxiety disorder and phobias. It is not certain what processes explain this relationship, and certainly there could very well be complex factors involved.
One hypothesis suggests that persons who identify as spiritual but not religious (SBNR) tend to have higher levels of anxiety and use spiritual beliefs and practices to alleviate their distress. Another hypothesis is that spiritual persons may not have a consensus doctrine or well-formed conceptual scaffold with which to make sense of their spiritual explorations and questions, causing some associated anxiety. Yet another is that SBNR persons may end up feeling more anxious as a function of isolation from their family or community, should some of their spiritual practices seem odd, if not "crazy," to others (e.g., energy healing practices, eating biodynamic foods, or taking "intuitive" classes).
Regardless, it is important that social workers can identify and better assist SBNR people, as they are a growing part of the U.S. population. Furthermore, this segment of the population will typically not want to consult a religious clergy member for spiritual resources; in fact, they may have left traditional religion in hopes for alternative forms of guidance to assist in their personal spiritual journey.
Completing a Religiosity/Spirituality Assessment
To identify how your client or patient identifies spiritually and/or religiously and understand the importance it has to their life and the treatment at your place of work, it is likely beneficial to administer some kind of religious/spiritual assessment. The Joint Commission, the volunteer organization that accredits health care institutions in the United States, requires a spiritual assessment to be included in the patient's medical record. However, the scope and content of the assessment is left up to the institution. In some settings, e.g., a hospital, screening for issues such as dietary restrictions, which are pertinent to some religious practices in Judaism or Islam, is appropriate.
More comprehensive in nature would be utilizing a spiritual history tool, such as the FICA (Faith, Importance, Community, Address in Care), which contains questions on a variety of important spiritual issues and facilitates a more conversational, and therefore rapport-building, gathering of information from the patient. The FICA questions can be modified for the social worker's place of work to obtain information relevant to supporting the client's religious or spiritual needs while in the care of that specific institution, such as identifying whether access to a chapel, inspiring music, prayer partner, or clergy member is important to the client. In some cases, such as in longer-term psychotherapy, completing a more comprehensive assessment that includes administering quantitative measures or completing spiritual ecograms collaboratively with the patient/client may be beneficial.
What Does SBNR Look Like?
We know there are an increasing number of Americans who are SBNRs or otherwise not identifying as religious. According to Pew Research Center, "One-fifth of the U.S. public—and a third of adults under 30—are religiously unaffiliated today, the highest percentages ever in Pew Research Center polling." These data are indicative that it is particularly important that social workers feel competent addressing the needs of this growing population.
We also know that younger adults, even though they may not be as religious, still engage in spiritual practices.
In 2015, the Pew Research Center found that "But while millennials are not as religious as older Americans by some measures of religious observance, they are as likely to engage in many spiritual practices. For instance, like older Americans, more than four-in-ten of these younger adults (46%) say they feel a deep sense of wonder about the universe at least once a week. … they think about the meaning and purpose of life on a weekly basis (55%), … Roughly three-quarters of millennials feel a strong sense of gratitude or thankfulness at least weekly (76%)."
People who identify as SBNR tend to be seekers and explorers. They have a sense that there is "something bigger" but may not be quite sure what it is or what they are supposed to do with that knowledge. They may have been raised in a religious home but due to a personal spiritual experience or other reason, did not feel their religious doctrine was true or helpful for them. Being SBNR can take on many different forms. For example, some may identify as atheist while others do believe in a god (or gods). However, SBNRs also share things in common, as I've found in my clinical experience. For instance, they generally do not believe in a humanlike, masculine entity who doles out eternal punishments and rewards. Furthermore, people who identify with a SBNR outlook on life may engage in the New Age or metaphysical community, which in and of themselves have a huge diversity of beliefs and practices, including psychokinesis, healing with crystals, psychic-mediumship, yoga, astrology, or energy healing.
With such a diversity in what "spiritual" can look like, it is important for the social worker to keep in mind that a client saying that they are "spiritual" is actually not very informative, and it may be important to the client's care to do a more comprehensive assessment regarding what beliefs and practices are important and if he/she is struggling with any spiritual issues.
In addition, those who identify as SBNR seem to be more prevalent in Western societies. King et al. found in their 2006 study in England that "Our results suggest that spirituality divorced from religion is a concept that appears to be relevant mainly to people from Western European, Christian cultures as well as others that are profoundly influenced by it such as the Black Caribbean community in England." Knowing this, a more open and conversational spiritual history tool, such as the FICA, may be able to elicit much more meaningful information than just a checklist from a client regarding whether they are "religious," "neither religious nor spiritual," or SBNR.
Addressing the Needs of the SBNR
In many ways there is more of a clear-cut path when working with patients or clients who identify as "religious" or "neither spiritual nor religious." Religious persons often already have a community of support and a framework in which to understand life's challenges, meanings, and tragedies. Many persons who identify as religious will seek spiritual and emotional support from their religious leaders. Those who identify as "neither spiritual nor religious" are often not seeking nor struggling with a search for bigger meanings, and they do not have fears about angering or disappointing a god. These persons typically want pragmatic, solution-focused approaches to problems.
For clients who identify as SBNR, a specific question that can be included in the assessment and helpful in leading to the identification and provision of appropriate support may be, "Have you had any spiritual experiences you would like to share?" Taken together, near-death experiences, out-of-body experiences, powerful meditative experiences, deathbed visions, and after-death communications (a sense of presence of a departed loved one) are quite common. Despite the frequency of these experiences and the impact they can have on the experiencer, asking a question about personal spiritual experiences is neglected in most of the available spiritual history tools. Social workers can assist these clients, in some cases, by providing resources that have social and educational support. For example, the International Association of Near-Death Studies has ample research, educational resources, and social support options available on their website for the experiencers as well as for practitioners working with them. For spiritual persons who want to take a research-based approach to understanding consciousness and connectedness, the Institute of Noetic Sciences conducts research on consciousness and health.
Some clients may not feel safe sharing their spiritual beliefs and explorations with their spouse, family, or friends if they suspect that they could be met with ridicule or even ostracism. These people can often benefit from a supportive social and/or spiritual community. Many cities have Meetup or other social groups that can serve spiritual persons such as Humanist, Metaphysical, Nature-Lover, Divine Feminine, or Yoga/Meditation groups. Zen Centers, Spiritualist Churches, and Jung Centers may also be appropriate SBNR resources for some clients. Social workers excel at identifying and providing community resources, and can empower themselves and their clients by being more knowledgeable of their particular community's spiritual resources. Many clients with whom I have worked were unaware of these communities and felt a sense of "being home" once they discovered and connected with the group that best fit their needs and wants. For the SBNR person who resides in a small town and who may feel especially isolated from like-minded peers, most of the aforementioned groups have an online presence that provide webinars and/or social groups through video conferencing.
Because spiritual topics and spiritual experiences are often very abstract and difficult to put into words, the spiritual person may gain a sense of peace and stability by expressing their beliefs and knowings through art, music, and writing. This allows the expression of spirituality to take tangible form or even become part of a ritual, such as daily journaling, which can provide habitual comfort through deliberate reflection, exploration, and growth of one's belief system.
Social workers can also keep in mind that people with higher levels of anxiety are more prone to becoming absorbed or obsessed with certain topics and questions. Further research is needed on this, but it may be helpful to also speak with a client who is SBNR about when he or she would know whether their spiritual beliefs and practices were causing or exacerbating anxiety. Sometimes interests and passions can become obsessions. It may be beneficial for the social worker and client to have a discussion on the importance of being mindful about how much time and energy is being devoted to spiritual explorations and practices at the expense of work, exercise, family, or friendships—especially in light of King's 2013 research, which found a positive correlation between those who identified as SBNR and the presence of "any neurotic disorder." Furthermore, persons who exhibit paranoia, persecutory beliefs, or who have psychosis may do best focusing on life skills, healthy relationships with friends and family, medication management, and job opportunities vs. going down endless rabbit holes of spiritual explorations that could amplify psychotic thinking.
Persons who identify as SBNR may already feel like they lack a spiritual home and that their beliefs are not validated by the macroculture. Disturbance for many SBNR persons is due to feeling as though they need to hide their spiritual experiences and beliefs. SBNR persons will often not want to discuss their beliefs and practices with a religious clergyperson, and it is appropriate for the social worker to provide spiritual support by creating a respectful and warm environment that allows the client to express his or her beliefs, doubts, and spiritual experiences. If the client so desires, the social worker can also collaboratively identify appropriate resources such as spiritual literature, research, community social support, spiritual practice groups, and online resources. Lastly, for the SBNR client who is or desires to be an active spiritual seeker, the social worker can expand the conversation with him or her to include a discussion of when he or she will know whether the journey is becoming too consuming, as well as ways to course-correct so that the spiritual quests and engagements bring wisdom and empowerment, not distress.
— Beth Christopherson, LCSW, is a psychotherapist in private practice in Houston.