Abstract
Ann M. Callahan, PhD., LCSW, professor of social work at the University of Tennessee at Knoxville College, has spent 10 years researching the spiritual dimensions of therapeutic relationships. In Spirituality and Hospice Social Work, she distills her research and that of others into eight chapters designed to build on practitioners’ preexisting clinical skills to add comfort and competence in caring for the spiritual needs of persons in hospice care.
Citing a steadily growing body of literature that supports an interdisciplinary response to the spiritual concerns of those served by hospice and palliative care, Callahan argues that social workers must understand and “Champion Spiritual Care” (Chapter 1) and acknowledge “Spiritual Diversity” (Chapter 2) to honor a patient’s world view while also accepting the ambiguity and difficulty of clearly defining spirituality. They must also recognize the “Spiritual Needs” (Chapter 3) and “Spiritual Suffering” (Chapter 4) patients in hospice may face as their illness progresses and prognosis becomes terminal when they may experience challenges to their systems of beliefs and methods of coping. Deftly highlighting the difference between pain as a symptom and suffering as an experience that may be interpreted for good or for ill by patients, Callahan explores the importance of supporting patients in accessing and strengthening their own spiritual resilience.
Callahan then looks at how the therapeutic and relational skills social workers possess can build upon the practice of interdisciplinary spiritual support. Drawing on research that supports the significant impact the therapeutic alliance may have on patient outcomes, she presents a model of “Relational Spirituality” (Chapter 5). To be both powerful and protective for all involved, such relationships necessitate creating both the empathy of connection and the safety of boundaries. She notes that once this safe space is established, patients may experience a healing sense of fulfillment and greater capacity for the cultivation of meaning. She artfully uses this model throughout the book, and this is perhaps her greatest contribution to the field of both social work and interdisciplinary spiritual care.
In the final three chapters Callahan discusses various spiritual care models (Chapters 6, “Spiritual Care,”), the necessary qualities for spiritual sensitivity (Chapter 7, “Spiritual Sensitivity,”), and methods of spiritual assessment as well as necessary clinician competencies for the provision of quality spiritual care (Chapter 8, “Spiritual Competence”). She provides an excellent overview of helpful resources, tools, and concepts from which all disciplines, including spiritual care counselors, may benefit.
Callahan has provided the next logical step in supporting the provision of quality interdisciplinary spiritual care. She has added brilliantly to the work of Pargament, Spiritually Integrated Psychotherapy (2007); Puchalski and Ferrell, Making Healthcare Whole (2010); Cobb and Puchalski, eds., the Oxford Textbook of Spirituality in Healthcare (2012); Ferrell, Spiritual, Religious, and Cultural Aspects of Care (2015), and others that have sought to support non-chaplain disciplines to recognize and respond to spiritual needs.
A primary strength of this book is the sheer amount of information (e.g., almost 30 pages of cited references) Callahan has distilled and placed into appropriate context. While not an exhaustive literature review, Callahan has included the most relevant content from researchers and authors in medicine and health, psychology and social work, philosophy, and spirituality and religion. Professional care providers across disciplines will benefit from the breadth of material that Callahan references and her discussion of the variables and competencies that make for ethical, quality spiritual care.
However, one significant weakness of her book is the blurry and inconsistent understanding of the interdisciplinary boundaries between psycho-social and spiritual care professionals. The function of the interdisciplinary team in hospice offers tremendous advantages and definite challenges; navigating the disciplinary boundaries often falls into both of these categories. Collaboration and cooperation within a team involves clearly defining boundaries while being open in dialogue about the substantial areas of professional overlap that may exist among nurses, social workers, chaplains, and other members of the interdisciplinary team.
While Callahan often notes the important role of all disciplines in screening for and responding to the immediate spiritual needs of patients, I do not think she conveys clear professional respect for the chaplain’s role as the primary team lead and resource for the spiritual support of patients and families. While acknowledging the necessity of social workers to remain within their scope of practice many statements in the text appear to hint, and even outright presume, that the social worker, not the chaplain, will lead on the assessment and response to patients’ spiritual needs. An example of this in Chapter 6 is, “ … some patients may still require spiritual care beyond the expertise of a hospice social worker that necessitates, for example, a referral to a chaplain with training to provide religious care” (p. 118). This statement seems to communicate that the social worker will take care of the spiritual needs and refer to the chaplain only if the patient expresses needs or struggles decidedly religious in nature.
Again in Chapter 7, she assumes the social worker will lead in conducting the initial spiritual assessment, care for the bulk of patients’ spiritual concerns and only refer to chaplains or community religious leaders to answer religious questions or perform religious rituals: If a hospice social worker does not have the training to use advanced generalist and/or clinical interventions for explicit spiritual care, then consultation with interdisciplinary team members with more expertise, including the social worker’s supervisor, is required. When spiritual needs require more than advanced generalist and/or clinical intervention, such as to resolve religious conflicts, the hospice social worker should ask whether the patient is willing to meet with a formal spiritual-care provider such as a hospice chaplain or religious/spiritual community leader. (pp. 145–146).
As the Spiritual Caregiver Section Leader for the National Hospice and Palliative Care Organization (NHPCO), I advocate that all disciplines are to notice, screen for, and respond in the moment to spiritual distress. But by NHPCO’s Guidelines for Spiritual Care in Hospice, best practice is for spiritual care counselors to directly introduce themselves and the concept of spiritual care to patients and families and assess for spiritual concerns within the first 5 days of patient admission and take the lead responsibility for overseeing this aspect of care. Other disciplines participate, collaborate, and contribute to the information that the spiritual care professional incorporates into the Initial Plan of Care in conjunction with the Interdisciplinary Team.
This book could have painted a more balanced picture of what such respectful collaboration can look like between the two professional disciplines of social work and spiritual care. A slight nod is given to such issues in the final pages (pp. 182–184), but it did not go nearly far enough to overcome the rest of the text’s message on this issue. When chaplains and social workers work collaboratively in the way envisioned by the NHPCO standards of care, with care taken to respect both the interprofessional overlap of roles and the boundaries of scope of practice, everyone, especially patients and families, are the better for it.
Footnotes
Editor’s Note
The Rev.