Our Healing: An Empirical Study of the Interrelationship Between Therapeutic Intervention and Spiritual Intervention in a Social Work Private Practice

ABSTRACT This article is about the exploration of the interrelationship of therapy and spirituality in a private practice. The study draws on qualitative research for a PhD and asks what clients want in their counseling and spiritual healing. Clients were invited to participate in the research after experiencing a social work mental health service in interrelationship with managed spiritual interventions. Mental health professions have discussed the inclusion of spirituality, however the inclusion of the client's voice on this topic is yet to be fully explored. It is hoped this research will inform professionals on psychosocial spiritual issues. The PhD proposed the resurrection theory based on the results of the research study. In this way a deeper and enhanced understanding of the meaning-making surrounding the interrelationship of spirituality and mental health can emerge.


Introduction
The focus of this article is specifically the client's voice on spirituality and counseling in private practice.It is concerned with a client-centered focus to direct future mental health service provision in the ever-changing health field.During eight years of the research project, the broader role of social work counseling evolved with the introduction in Australia of Medicare rebates for accredited mental health social workers in private practice.It is important to note that at the time of publication of the research for a PhD at La Trobe University, the clients of Eden Therapy Services had participated in the counseling services they received without the assistance of the mental health rebate scheme.All clients chose to pay for their work without rebate.In other words, the services for clients of the practice were valued and often requested, possibly because of the spiritual interventions offered within the counseling private practice.The clients of the practice felt a strong agreement with the provision of psychosocial spiritual services.The clients were prepared to risk meeting with a small team of trained volunteers to address their spiritual needs for healing.In the ever-shrinking economic rationalist environment of mental health care, these volunteers proved that managed relationships can assist and accelerate clients' healing and wellbeing through spirituality in mental health.The risks to confidentiality can be managed and monitored, while maintaining managed healing relationships in the client interview and with the volunteers.The idea of attending to the client's voice is not new to making meaning for clients.The idea of attending to client's voice on counseling and spirituality may be an addition to the professional discussion.

The context
Private practice social work in Australia provokes an unsettled response from government, nongovernment, and academic circles.Eden Therapy Services has been operating as a private practice for over 20 years, offering an interrelationship of counseling intervention with spiritual principles.I believe that the Australian social work response to private practice has been cautionary due to the perceived elitism associated with offering services to paying clients, which may not be an issue for American colleagues.One of the advantages of operating Eden Therapy Services with accreditation under the Attorney Generals Victims Services Scheme (VS) and more recently the Medicare Mental Health Rebate Scheme (MHCP) has been the ability to provide counseling and spirituality to financially challenged clients.Another advantage of private practice is to make available to financially stable clients a professional view they may not have received from the traditional services used in government funded community-based mental health services.
During the course of the PhD research the practice operated out of rented rooms that were owned by a government-accredited college attached to a church in Oxford Falls, Sydney.Eden Therapy Services currently operates out of rooms in Balgowlah, Sydney, Australia.The practice now works with a social worker, family therapist, a private advocate, and social work students.This means the practice no longer shares premises and is able to provide dedicated group rooms and meeting rooms for the work.The spiritual intervention is carried by the managed team of volunteers who attend the practice each month and make their time available to enter into relationship with clients' who choose this service.The volunteers are managed with inservice education three times a year and a weekend retreat once a year.They are required to be supervised and asked to sign confidentiality agreements.In this way, Eden Therapy Services practices counseling mindful of spiritual needs and therapeutic meaning just as native American Communities see "wellness and spatiality as inseparable" (Weaver, 2002, p. 7) and Eastern traditions of health are informed by spirituality (Chan, Sik Ying Ho, & Chow, 2001, p. 262) and just as Jung employed spirituality in practice for healing (Sermabeikian, 1994, p. 178).
People come to Eden Therapy Services for many and varied reasons but commonly domestic violence, historic childhood sexual abuse, marital or couple work, church abuse, and depression bring people to the practice.Once a client they can access counseling services through the VS, MHCP, or by private means.Clients can opt for individual work, group work, spiritual work, or community interaction or a combination of these interventions to assist their healing.Eden Therapy Services has close links with survivor organizations such as Mayumarri and advocates community interaction with local women's refuges, the Department of Housing, Centrelink, Community Housing Options, pastoral networks, and Relationships Australia.
During the period of this research study the Australian professional interaction on spirituality has increased.Cox raised the issues in the professional context as far back as 1985 (Cox, 1985, p. 5).Edwards researched six Tasmanian social workers by semistructured, in-depth protocol to thematically analyze the links between the secular and spiritual in their work (Edwards, 2002, p. 78).Rice researched social workers experience of spirituality in practice (Rice, 2004, p. 9).These studies were all presented in the Australian Social Work journal.Lindsay began exploring the reasons why social work is cautious of its spiritual professional roots and finds definitions of spirituality challenging (Lindsay, 2002, pp. 46-47).Healy on writing for social work education has given over a chapter to "Alternative Service Discourses: Consumer Rights, and Religion and Spirituality," stating that service users are asking for these themes in their work (Healy, 2005, p. 69).Editorial groups on professional practice are asking for "real world examples of the application of the research method" to be used (Simpson & Lord, 2015, p. 281).Once again what is needed is the clients voice on the issue of spirituality.
On the international scene the awareness of issues of spirituality has been steadily increasing.Canda and others have been developing the discourse in conferences in the United States such as "Retrieving the Soul of Social Work" in 1995, "Expressing the Soul of Social Work" in 1996 and "Nurturing the Soul of Social Work" in 1997 (Canda, 1998, p. xii).Social workers were agreeing that the roots of the profession in spiritually based morals needed discussion (Canda & Furman, 1999;Canda, 2004, p. 1;Russel, 1998, p. 16;Walton, 2007, p. 171).Others have actively included tools such as spiritual histories and life maps in assessing spiritual issues for clients (Hodge & Limb, 2007, pp. 297-298).Hodge has produced a Spiritual Competence Scale (Hodge, 2007, p. 287).Similar scales have been developed by Rose, Westefield, and Ansley (2001), Larimore, Parker, and Crowther (2002), Arnold, Avants, Margolin, and Marcotte (2002), and Mathai and North (2003).Out of the international scene has come a curiosity for the clients voice, Thyer, as editor of the 2000 special edition of Research on Social Work Practice which specialized in faith-based social work programs, wrote: If a prestigious group.like the Cochrane Collaboration can commission a systematic review of the effects of intercessory prayer on health (Ahmed, 2000), it is most certainly appropriate that the critical lens of scientific research be applied to faithbased social work services (Thyer, 2007, p. 170) The study The research study was conducted over a period of eight years.The ethical approval for the research was via the Ethics Committee at La Trobe University, Melbourne Australia.The study was based on a sample of the clients of the private social work mental health practice who had chosen both the therapeutic intervention and the spiritual intervention for their healing.A total of 30 research participants, 24 clients, and 6 volunteers took part in an in-depth interview and a focus group.discussion.A basic demographic questionnaire was given to each research participant to provide a social profile.Interview schedules were developed for the interviews and group discussions after trialing with a pilot process and later refinements.
The research was approached as a collaborative project.Many of the research participants were very keen to be given an opportunity to voice their need for spirituality in their healing.Over 50 clients were invited to attend the research and with 24 client research positions available we were overwhelmed with 48 of the clients stating they wanted to be involved.Turning down so many interested clients was a daunting experience.However, the time needed to run the in-depth interviews and focus groups spread across a year only allowed for the total number of 30 client and volunteer participants.
Data analysis was based on grounded theory which has become a recognized qualitative research process (Padgett, 1998, p. 5;Strauss & Corbin, 1998, pp. 57-58).It is interesting to note that Strauss and Corbin were also curious about spirituality when they stated: Our version of qualitative analysis offers a cluster of very useful proceduresessentially guidelines, suggested techniques, but not commandments.We also offer a methodology, a way of thinking about and studying social reality.True, only God can tell fallible humans the "real" nature of reality … but hopefully research moves us increasingly toward a greater understanding of how the world works (Strauss & Corbin, 1998, p. 4) The information gathered from all in-depth interviews and groups were transcribed verbatim and reviewed for categories and then thematically analyzed.As each in-depth interview was performed, a group discussion followed and then the process repeated, ending with the in-depth interview of the volunteers and group discussion with the volunteers.Themes were checked with each set of interviews and group discussions throughout the research-gathering year.As themes emerged and were repeated they were analyzed for theoretical possibilities.If themes were consistent across interviews and groups over time they were incorporated into the developing theoretical framework of the psycho-social spiritual informed resurrection theory.As a result of this rolling analysis five themes emerged, the esoteric client theme, the change and intervention theme, the social work intervention theme, the current client theme, and the pattern change theme.
The sampling of past service users and volunteers of the service obviously has flaws.The service users have presumably taken something from their interaction with the service that they enjoyed otherwise they would not have paid for the service and be agreeing to be part of the research.However, I am aware of no other mental health practices providing an active managed spiritual process of intervention that could be studied.It would appear that the uniqueness of the psych-social spiritual interventions of the practice have made sampling other services possible only in the future with a major service shift to incorporate spiritual interventions.In regard to faith based teaching organizations such as Excelsia College and C3 College, both offering to teach faith based counseling to students, their focus remains on educating spiritually aware students to secular counseling theories with some additional spiritual awareness as an augmentation.Having taught in such college environments for several years and managing students on research assignments, students come away with secular theory rather than a focus on spiritual exploration.It may be possible in future to encourage these educational institutions to interventions that are equally spiritually and psycho-socially orientated rather than the current situation of secular interventions with a spiritual augmentation.What was done in the research to ameliorate the positiveness of the participants was to ask several questions for the interviews and groups that invited negative feedback.The results of these have been used to improve the service with practical additions such as recording of major points of a client's spiritual intervention so they can take notes home with them after interventions rather than just relying on their recall for their healing and meaning making.

The form of the healing and the psychosocial spiritual intervention
In describing the interrelationship. of spirituality and counseling in their counseling interventions clients spoke of the form of their healing as "going through," "timing," "awareness of the cause of issues," and trying to describe an experience of form that is "fuzzy."As research questions further explored the form, respondents described a healing that was not like the new age "relativistic" healing, but rather a "reference point."One respondent summed the experience up by stating: The healing was more, of more [sic] me seeing myself as how God sees me, instead of just of the shame and the guilt of what was put on me.And so I suppose that led to an improvement of how I saw myself, how I was able to communicate to other people, how I was able to feel comfortable in a group … I was more confident in going with my intuition, my gut feeling about things.
It is interesting to note that at this early stage of the research respondents were already using words such as "God" or "prayer" to describe the experience of the counseling and spirituality.When asked to further explain this aspect of their healing, one respondent said, "Just a feeling of peace and acceptance and joy I guess peace that I can be who I am," and another stated "But the prayer was good because it helped me seal something that I needed to know about not looking back and just looking forward to tomorrow."Respondents found their experience of the spiritual interventions harder to explain: I think somehow related to it all was also a spiritual healing as well but that's much harder for me to define or place within that whole thing it was much more, much less direct than the emotional and mental healing that I experienced.
As a result of the thematic and recurrent curiosity and perplexing way clients revealed their experiences of a spiritually driven intervention the esoteric client theme emerged and was repeatedly observed with microscopic examination of color code memo notes (Braid, 2009, pp. 268-269).This was theme number one and best described by a client observing "an environment that could foster the truth" (Braid, 2009, p. 269).
Respondents could state that the psychosocial spiritual experience that they had was different when counseling was used or when spirituality was used.In exploring the two interventions, comparison seemed to make it easier for the respondents to describe their changes: I think there's two things.One was just the therapy session … learning the process of learning how to verbalize thoughts and feelings, emotions and that sort of thing into language … and the other thing I think was in the spiritual side … I guess it kind of was the final seal I guess on other things, that were going on.
Respondents would describe the understanding they had gained of themselves in the psychosocial spiritual intervention, but that the "incorporation" of these things made them feel better.Terms such as "related," "understanding," "incorporation," and "intermingled" were used to describe their experience.The therapy was important and the spirituality was also important, and these aspects stood alone but were somehow in relation to each other.This is best described by the following respondent statement: I found that it is it [sic] helped me understand a lot of who I am today and it kind of helped me understand my journey into the person I have become.But it also so it's interesting because in one sense there's you can almost see that there's a social work aspect and there is a spiritual aspect and yet the two aren't intermingled together.And I actually found that its, I found that I wouldn't be where I am at now if the spiritual aspect hadn't been incorporated into it.
As a result the change and intervention theme emerged which described the combination of interventions for healing was profound for the clients The theme is best described as "intertwining like two cords on a sewing machine" (Braid, 2009, p. 270).Respondents were aware that they had healed, they were aware that this was hard to describe and that the relationship of counseling to spirituality was necessary and separate but that the psychosocial spiritual intervention was experienced by the whole provision of meaning making counseling services at Eden Therapy Services.

In relationship one to another: The psychosocial spiritual intervention
The professional relationship of the counselor to the client and the volunteers adds another dimension to the making of meaningful relationships.If the client can see other relationships as well as the professional one played out for their benefit and managed for their benefit on a spiritual level, the healing can be augmented and rendered even more meaningful.The psychosocial spiritual intervention was best described by research respondents as a "check and balance," "Its two different things and I try and put them together and say well have I got two things working together here, one's a check and balance kind of thing."Without the combination of the relationships another respondent said the intervention would be lacking hope: Because of the spiritual side of me and I know that God's always been there for me even though you know for years, but you don't sort of really recognize that.Okay with just the therapy it would be just like someone is hearing my story but then there would be, and that would be a release in itself, a big release, but where does it go from there like for my healing for me, I think if there was no spiritual aspect on it, all my hope would still be lost.
Hearing the respondent's story in the counseling in a therapeutically supportive environment is helpful, but this experience had been enhanced by the spiritual relationship with the volunteers and the hope the respondent felt.This respondent went on to say that the spiritual process of the counseling helped with "clarification." Without the psychosocial spiritual intervention one respondent clearly stated that their healing would not be complete: I would like to say I known [sic] the spiritual realm is out of scientific range or gauging and what they would prefer to do, but it exists and I say we have to give credence to that.And that's part of the whole body needing healing and until we start attending to that side of people, they're not going to get complete healing.They will improve but there will be part of them that isn't healed (4 II 14.5.01,p. 11).
Another respondent commented on the social worker having a spiritual perspective themselves and holding a faith.The social worker practicing a psychosocial spiritual perspective and letting the counseling be informed by this view was important to enact their healing: Well I just imagine sometimes that your insight and understanding that I was talking about before sometimes I believe that the spiritual aspects are certainly to do with that … there were certainly spiritual aspects to me appreciating the meaning of the work that we did.
Another respondent put it this way: "I think you are really in tune with spiritual things and people and their spiritual needs."In this way the client is informed of the counselors stance on spiritual issues and when it is incorporated in a safe and managed way into the mental health intervention the healing is described as more beneficial by the client.Research respondents had noted the freedom to include their own spiritual reactions to their healing external to the professional relationship as part of the process."The most exciting part was what God actually told me when I wasn't here and I would come in and I would say this has happened and this had happened," the freedom to enter into the professional relationship with spiritual process was quite exciting for clients.As a result of this thematic examination the third theme emerged as the social work intervention theme, which included comments on life stage development by the combination of spiritual and professional intervention (Braid, 2009, p. 273).
It is interesting to note that one respondent's view made a comparison of the psychosocial spiritual intervention to the intervention of Australian NGO's or charities.Many charities and NGO's have spiritual roots however the public face of their spiritual roots is managed very carefully.In an up-front psychosocial spiritual process the respondent stated that they could be "unlocked" rather than "pushed down."The respondent stated, "Government departments or Lifeline or something they've got this authoritativeness over you because they see you are weak and you can't problem solve, they are focusing too much on you trying to help yourself instead of unlocking; it's being pushed down." The incursive relationship: Expanding the psychosocial to include the spiritual One of the surprising findings of the research was that the respondents identified that their counseling empowered them to find an unexpected way forward for their healing.The incursion or the combination of counseling and spirituality empowered or took advantage of unexpected experiences to unlock the respondent's sense of wellbeing.This combination took the form of a desire for respondents to have the resources available for them to work together.The resources respondents identified were not only the social work intervention and the spiritual intervention but also included the pastoral intervention.One respondent summarized this: "Professional counseling brings process, theory and systems to therapy and this needs to intermingle with pastors" (Braid, 2009, p. 275).A fourth theme emerged in the respondents' responses which became the current client theme.
In expanding the psycho-social to include the spiritual the final theme emerged that demonstrated a pattern change for the respondents.This provided an unexpected way forward for them both experientially and emotionally.One respondent described the incursive nature of their counseling and spiritual intervention as suddenly becoming "awake": I found with one of the prayer sessions that I did I was very angry … I didn't blame the prayer, it was good and I knew the anger was something that just was an after affect.Like I'd been numb for so long and all of a sudden bang I'm awake.
Another respondent stated: The healing was more, of more [sic] me seeing myself as how God sees me, instead of just the shame and the guilt … that led to an improvement of how I saw myself, how I was able to communicate to other people, how I was able to feel comfortable in a group.
The incursive agent in the research respondents' eyes was the mental health counselor and the interrelationship to the spirituality.The counselor had certain skills to offer, "knowledge," "memory," "understanding," "listening," "direction," "sensitivity," and "nonjudgementalism."Once this is in interrelationship with spirituality the respondents noted a completeness to their change or healing: I think its' more complete because I, I consider myself not only physical and mental but spiritual as well; and while on the counseling level you've got the physical and mental aspects of it, the prayer is actually under-birthing the spiritual side.
The data emerged the final theme, which was the pattern change theme, to resonate the nonlinear pattern change that respondents repeatedly identified as new directions and new patterns.Becoming awake and enabled in new ways assists the exploration for respondents into their "governance of their own selves and the opportunities they describe to recast the self-government apart from evangelical norms and the previous shaping of their thoughts and behaviors" (McSkimming, 2017, p. 157).The themes emerged such as strong sense of empowerment and self-governance for the clients of the research that the theory proposed in 2009 to teach other practitioners about this unlocked pattern change which was hard to define and delineate was the resurrection theory.Since then, many training days at Eden Therapy Services for practitioners in private practice has engendered much discussion about the name of resurrection theory.It is a provocative term and one which encompasses the mystery of the movement of a client's experience from a death to a life as the term resurrection implies (Braid, 2009, p. 280).The term also holds allegiance to a spiritual mystery, which is understood by many faith based groups such as Catholic, Anglican, Pentecostal, and Baptist believers in Australia.
The resurrection theory is the psychosocial spiritual movement of a client from the place they enter counseling in interrelationship with their spiritual beliefs towards healing.In proposing a resurrection theory for the arena of social work the idea of practice being psychosocial-spiritual in orientation is introduced.A resurrection is not complete unless the whole of the person is supernaturally moved to another existence.The resurrection theory proposes the movement of a client from a place of referral, surrounded by anxiety and distress, to a place of relationship and resurrection surrounded by a new understanding of their whole being.While this has resonance with the foundation principles of social work, the resurrection theory challenges the long held resistance of the profession to actively include spiritual issues in education and practice.The profession has apparently not formally raised the issue of psychosocial-spiritual practice with clients or asked the clients' permission to actively practice interventions on the clients' behalf with a psychosocial-spiritual component.The resurrection theory is based on the study's findings and my years of such practice where the interrelationship of social work intervention and spirituality has been combined to produce healing for clients.
In conclusion, this article has attempted to document some of the results of a qualitative research study exploring the psychosocial spiritual interventions and the incursive client voice, which informed the resurrection theory.Recently, in 2015, while attending a training event at Victims Services Justice Precinct Sydney and in discussion with other practicing colleagues I was concerned to hear from the presenter, a psychologist, that nothing was known about how to manage a safe spiritual intervention.As a result while it is increasingly difficult to fund research privately in the Australian context it would seem timely to document and share some of the professional research results with the broader counseling community.In the last few years the practice has also provided some private professional education in regard to the client-informed spiritually driven interrelationship.The feedback from colleagues has encouraged this article with specific case examples to explore further the clients' voice on counseling, spirituality, and meaning making in private practice.It is hoped that as a result further studies of spirituality will move the mental health intervention field away from the "symptom and risk" view of intervention toward the "strengths, hopes and supported decision-making" interventions for future healing.(Davidson et al., 2016, p. 166).