Occhat, occupational science, OTalk

#OTalk – 15th July 2014: Spirituality


Date: 15/07/2014  Host: @OTAccessStudy

Blog Post  –  Transcript

Our guest host for this week’s #OTalk on Spirituality is Michael Flores (@OTAccessStudy). I saw Mick present on this topic at the College of Occupational Therapist’s Conference in Brighton and invited him to use OTalk to share with you guys too. Thankfully he said yes – here’s his introduction and some questions to get you thinking.


“Can I introduce you to Jesus?”

This was the first thing I was asked by a service user at my first placement.

I knew there was going to be a situation where I wouldn’t know how to handle something quite neatly at some point in my student career. The question made me nervous and uncomfortable. I mean, c’mon – how many of you felt a little bit odd when you simply read a sentence with ‘Jesus’ in it?

But to be asked about Jesus, on my first day of my first placement, at my first encounter – what are the chances? I didn’t know quite what to do, but I definitely tried to use my polite Canadianisms to try and deflect. She was neither responsive nor interested in what I had to say.

After my brief encounter with who I’ll call Gertrude, I asked my educator: “Hey – can I ask you a question, can I introduce you to Jesus?” The look on my educator’s face was: is he serious? Is he trying to evangelize to me? Later, she told me at the end of placement she found me odd, but entertaining (whatever, I’ll take it). We laugh about it now. But back then, she was confused, and after I had explained to her my spiritual encounter, I reflected on my first day. Which led me on a literal spiritual journey.

I first asked myself why it was so important to address spirituality. Compelling research has led me to discover that spirituality can be life enhancing and sustaining, and empowering. It was also a coping strategy for people with diagnoses such as schizophrenia and other mental health issues (Huguelet et al., 2006; Jackson & Fulford, 2005; Koenig, 2009; Wilding et al., 2005). Spirituality affect how people think, how they behave and how they care for themselves (Benson, 1996). According to Gilbert (2008), ‘‘recognising a person’s spiritual dimension is one of the most vital aspects of care and recovery in mental health’’ (p. 2).

Results from recovering lives: the strategy for occupational therapy in mental health service 2007-2017 stated that being able to work with families and understanding people’s spirituality were important and that spiritual needs need to be addressed

However, it is a really difficult subject matter for OTs (Wilson, 2010). I had to look deeper at this. I found that there was inadequate education with regards to teaching pertaining to the inclusion of client spirituality in treatment. There was a huge gap between education, theory and practice. There are also unclear guidelines, no set parameters, and there are unclear personal and professional boundaries. I didn’t find anything particularly helpful on the college of OT website.

Csonto (2009) looked at OT students studying OT at several British Universities: findings indicated that spirituality had a range of meanings for different people/students. Perhaps this is the biggest issue with trying to address spirituality is the lack of clarity with trying to define it. Johnston and Mayer (2005) set out in defining spirituality as the following:

“…[spirituality is] the search for meaning and purpose in life, which may or may not be related to a belief in God or some form of higher power. For those with no conception of supernatural belief, spirituality may relate to the notion of a motivating life force, which involves an integration of the dimensions of mind, body and spirit. This personal belief or faith also shapes an individual’s perspective on the world and is expressed in the way that he or she lives life.

Therefore, spirituality is experienced through connectedness to God/a higher being; and /or by one’s relationships with self, others or nature (pp. 386).”

I then asked my cohort what spirituality meant to them and the following responses echoed that of Johnston and Mayer’s definition; whereby a motivating life force, a FIRE deep within, ebb and flow of energy, what makes them tick, faith, what drives me/people to do, are some of the definitions captured.

Spiritual education is important for practitioners and future practitioners as it improves confidence and increases awareness (Barry & Gibbens, 2011). Asking the right questions, without being too confrontational I found the most useful. Questions like:

“What gives you hope?”

‘‘What helps you cope when things are difficult?’’

“How are things going for you, physically, emotionally AND spiritually, since your injury?”

“How do you make sense of the ‘bigger picture’?”

(Smith et al., 2013)

Use of the FICA assessment tool has also been shown to effective with OTs:

F: What is your faith or belief?
Do you consider yourself spiritual or religious?
What things do you believe in that give meaning to your life?

I: Is it important in your life?
What influence does it have on how you take care of yourself?
How have your beliefs influenced in your behavior during this illness?? What role do your beliefs play in regaining your health?

C: Are you part of a spiritual or religious community?

A: How would you like me, your healthcare provider to address these issues in your healthcare?

I went back to Gertrude and I this time I was ready for any questions regarding spirituality, by being prepared, she was ready to reveal many aspects about her life that involved many of her roles and routines where spirituality (in this case, her faith) was at the centre. She revealed to me that every time she would talk about Jesus, she felt pathologized and she was quite happy to find someone to talk to who didn’t look at her like she was mentally ill. This showed me the importance of being properly educated as to how to handle the issue of spirituality.


Some questions to think about:

  1. What does spirituality mean to you personally?
  1. How would you approach the sensitive issue of spirituality?
  1. Do you think that your personal spiritual beliefs influence how you would handle spiritually sensitive issues with service users?
  1. Do you think that the College of OT should outline formal guidelines that should dictate how OTs handle the issue of spirituality?
  1. How do you think OTs would react to specific guidelines set out formally by the College?
  1. Why do you think it’s so difficult for OTs to address spirituality?
  1. How could you positively influence student OTs in handling sensitive issues like spirituality?
  1. Spirituality is outlined in the American OT Practice Framework, are there any other examples of college guideline that may be beneficial that the COT should adopt?



  1. Barry, E. and Gibbens, R. (2011) Spirituality in practice: using personal reflection to prepare occupational therapy students. British Journal of Occupational Therapy 74(4), 176-180.
  2. Csonto, S. (2009) Occupational therapy students’ consideration of clients’ spirituality in practice placement education. The British Journal of Occupational Therapy, 72, 442-449.
  3. Huguelet, P., Mohr, S., Betrisey, C., Borras, L., Gillieron, C., Marie, A. M., and Brandy, P.Y. (2011) A randomized trial of spiritual assessment of outpatients with schizophrenia: Patients’ and clinicians’ experience. Psychiatric Services, 62, 79–86.
  4. Jackson, M., and Fulford, K. W. M. (2005) Spiritual experience and psychopathology. Psyche and Geloof, 16(1), 9-33.
  5. Johnston, D. and Mayers, C. (2005) Spirituality: A review of how occupational therapists acknowledge, assess, and meet spiritual needs. British Journal of Occupational Therapy, 68, 386-392.
  6. Koenig, H. G. (2009) Research on religion, spirituality, and mental health: A review. Canadian Journal of Psychiatry, 54, 283-291.
  7. Wilding, C., May, E., and Muir-Cochrane, E. (2005) Experience of spirituality, mental illness and occupation: A life-sustaining phenomenon. Australian Occupational Therapy Journal, 52, 2-9.
  8. Wilson, L. (2010) Spirituality, occupation and occupational therapy revisited: ongoing consideration of the issues for occupational therapists. British Journal of Occupational Therapy, 73(9), 437-440.





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