Spirituality in Family and Play Therapy

Spirituality in Family and Play Therapy
By: Julie R. Plunkett

Basics of Spirituality

Religion vs. Spirituality
Delaney, et. al (2013) defined: RELIGION: “…increasingly used to refer to institutional religion.” (p. 101). SPIRITUALITY: “..refers to the personal side of religious experience.” (p. 101). Walsh (2009) defined: RELIGION: “…formal, organized faith traditions and their shared beliefs, practices, and faith communities.” SPIRITUALITY: “…refers more broadly to a dimension of human experience, involving transcendent values, beliefs, and practices for meaning, harmony, and connection, which may be expressed within or outside religion.” Delaney, H. D., Miller, W. R., & Bisonó, A. M. (2013). Religiosity and spirituality among psychologists: A survey of clinician members of the American Psychological Association. Spirituality in Clinical Practice, 1(S), doi: / s.95

Religion vs. Spirituality
Griffith (2002) defined: Religion: “…represents a cultural codification of important spiritual metaphors, narratives, beliefs, rituals, social practices and forms of community among a particular people that provides methods for attaining spirituality, most often expressed in terms of a relationship with the God of the religion.” Spirituality: “…a commitment to choose, as the primary context for understanding and acting, one’s relatedness with all that is. With this commitment, one attempts to stay focused on relationships between oneself and other people, the physical environment, one’s heritage and traditions, one’s body, one’s ancesotrs, saints, Higher Power or God.” Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Relational Spirituality
Spiritual development in children takes place through the relationships that they have with significant people in their life. These relationships help them experience something beyond them such as, “understanding of existence, human nature, creation story and ultimate reality.” (p. 92). Both meaning and purpose are constructed within their particular network of relationships and contexts, including personal experience, family, peers, neighborhoods, schools, churches, societies and cultures.” (p. 92) Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: /

Healing and Treatment

Healing and Treatment HEALING- “…gathering of resources within the person, the family, and the community, and is fostered through a collaborative therapeutic relationship.” TREATMENT- “…externally administered by experts to reduce or eradicate individual disorders or family dysfunction. BIOPSYCHOSOCIAL-SPIRITUAL- “As we integrate spirituality and other aspects of our experience, we can advance a truly holistic view of families, their suffering, and their healing potential.” Western scientific medicine focuses on external causes of disease. Eastern religious and philosophical traditions believe there is a harmonious balance between mind-body-spirit. Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Healing and Treatment Many therapists are uncomfortable with the idea of “healing”, but: Carl Jung- healing means wholeness and wholeness includes the spiritual domain. “Gregory Bateson our most visionary systems theorist, taught us to look for the “patterns that connect” and to see mind and nature as a necessary unity.” (Bateson, 1979 as cited in Walsh, 2009) Virginia Satir- “…stood out in embracing a broad spiritualty in her view of healhy family functioning and in her practice approach Contextual Family therapy- “…emphasizes the ethical dimensional and issues of justice in intergenerational relationships.” Victor Frankl- “…both therapist and client ethical convictions are powerful resources to draw upon in the therapeutic process.” Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Spirituality in Treatment
“Spirituality is a universal dimension of life that lends a meaning to our existence, sets a moral standard for living, and assumes some sense of moral connection among people at the very heart of our humanity.” To gain further insight into clients consider family history, psychological dynamics of issues, and world view of the client about their struggles. Belief that there are moral components to the presenting problem. Presenting problems take place in a social context and social meaning to life. Increases options for solutions It gives purpose and significance to difficult situations It stabilizes and guides clients in an inconsistent and gray world. Aponte, H. J. (2002). Spirituality: The Heart of Therapy. In T. Carlson & M. J. Erickson (Eds.), Spirituality and family therapy. New York: Haworth Press. doi:Erickson, M. J. (2003). Spirituality and Family Therapy. [Bookshelf Online]. Retrieved from

We can only recognize spiritual issues and struggles in our clients if we first are aware of them in ourselves. “Spirituality is part of everybody’s life, be it a secular or religious spirituality. Therapists who do not consider the legitimacy of a spiritual perspective, or who are personally at war with their own spirituality, or who do not tolerate spirituality alien to their own, limit their ability to see and relate to the spirituality of their clients.” Aponte, H. J. (2002). Spirituality: The Heart of Therapy. In T. Carlson & M. J. Erickson (Eds.), Spirituality and family therapy. New York: Haworth Press. doi:Erickson, M. J. (2003). Spirituality and Family Therapy. [Bookshelf Online]. Retrieved from

“Spirituality is the heart of therapy, addressing the transcendent bonds to human and supernatural resources, along with the moral values and ideals undergirding the decisions that determine the course of people’s solutions. This is a materialistic and secular society in which there is a growing thirst for values and meaning beyond money, power, and personal gratification.” Aponte, H. J. (2002). Spirituality: The Heart of Therapy. In T. Carlson & M. J. Erickson (Eds.), Spirituality and family therapy. New York: Haworth Press. doi:Erickson, M. J. (2003). Spirituality and Family Therapy. [Bookshelf Online]. Retrieved from

Clinical Assessment Should explore the spiritual domain of the client.
Where the client finds spiritual nourishment: nature, creative arts, community/social activism. Seek to understand the client’s experience of religion and spirituality and spiritual resources Distress and Resilience: “Ways that religious/spiritual beliefs or experiences might contribute to current distress. Ways that past, current, or potential spiritual resources might be drawn upon to ease distress, resolve problems, and strengthen resilience in dealing with adversity.” Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Treatment RESILIENCE- “..the ability to overcome adversity, strengthened and more resourceful. (Walsh, 2013 as cited in Walsh, 2009). FAMILY RESILIENCE- “… involves key processes that enable the family system to rally in times of crisis: buffer stress, reduce the risk of dysfunction, and support optimal adaptation for all members (Walsch, 2003, 2006 as cited in Walsh, 2009). Family beliefs are important in times of crisis Cultural and religious beliefs are primary shared convictions during times of crisis Sharing spiritual values in the family helps them strengthen bonds Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Treatment Mental Health Benefits of Beliefs
Beliefs are a powerful influence and can enhance or block well-being Studies have shown faith, prayer, and spiritual rituals strengthen. Studies have shown meditation reduces physical and mental symptoms. Faith and congregational support can help overcome poverty and racism barriers Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Treatment Mental Health Benefits of Beliefs
Family-of-origin has hidden spiritual resources Forgiveness heals the wounds of the mind, body and spirit, unforgiveness creates the wounds. Rituals connect the client to their “deepest spiritual core” and all that is around them. Serving others and activism can help heal wounds Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Spiritual Diversity in Treatment
“Cultural traditions and spiritual beliefs need to be integrated in a holistic approach to mental health and health care.” When families have diversity in the therapist can help family members understand and respect each other’s beliefs and practices. Watch out for over identification with clients who have similar beliefs to yourself. Be respectful of those with different beliefs. Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

“We must learn from our clients about their own spiritual journey, their needs and preferences, how they may have been wounded, and how they have found healing. We need to be open-hearted in listening to and exploring religious and spiritual questions and beliefs that have profound implications for their lives. Most importantly, we need to encourage their efforts to open and expand spiritual pathways to meet current challenges and experience personal and relational growth.” Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

“When our clients lose hope, our faith in their potential can restore their faith. When we believe in their worth, our clients are better able to rise to meet their challenges with confidence and competence. Valuing human connection, we help our clients to seek reconciliation to heal wounded relationships and encourage them to forge more meaningful personal and spiritual bonds. These are essentially spiritual endeavors” (Aponte, 2002 as cited in Walsh, 2009). Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Honoring the Story Have an attitude of wonder
A climate of openness and respect Respect the personhood of the client Express, recognize and understand Listen carefully so client feels safe and respected. Meet the client where they are Griffith, J. L., & Griffith, M. E. (2002). Encountering the sacred in psychotherapy: how to talk with people about their spiritual lives. New York: Guilford Press. doi: VitalBook file.

Honoring the Story When not to pursue the story.
Client has good reason not to want to talk about it. Does not match the person’s agenda for therapy. When having inadvertently offended, attacked or silenced the client. “…seek a posture of noncertainty when conducting therapy. This does not mean that we each do not have beliefs, convictions, opinions, or prejudics, but that we have adopted an intentional plan to foster curiosity, openness, and wonder as our dominant emotions in the therapy room.” Griffith, J. L., & Griffith, M. E. (2002). Encountering the sacred in psychotherapy: how to talk with people about their spiritual lives. New York: Guilford Press. doi: VitalBook file.

Use of Therapist Beliefs
Spiritual enhancement of therapy Helps see clients issues and make moral choices. Helps ground the problem so solutions come from inner beliefs and motives. Adds to client’s resources through spiritual enrichment. Steps to solving basic problems: “Identify the key decisions vis-a-vis the focal issue that are necessary for people to begin turning their lives around; Set the value platform that is to serve as the moral standard upon which these decisions are to be made; Place the decisions within the key relationships in people’s lives, from human to divine, that will support their critical life-changing choices. Aponte, H. J. (2002). Spirituality: The Heart of Therapy. In T. Carlson & M. J. Erickson (Eds.), Spirituality and family therapy. New York: Haworth Press. doi:Erickson, M. J. (2003). Spirituality and Family Therapy. [Bookshelf Online]. Retrieved from

Why and How do I bring it up?

Spirituality and Psychotherapy Why don’t we bring it up?
APA found that their members were far less religious than the clients they saw. Members did believe they had spirituality in their lives. The widening gap is concerning if it leads therapists to not bring up religious and/or spiritual issues. Feelings of lacking competence in the area. Not valuing the importance of these issues in clinical practice. Delaney, H. D., Miller, W. R., & Bisonó, A. M. (2013). Religiosity and spirituality among psychologists: A survey of clinician members of the American Psychological Association. Spirituality in Clinical Practice, 1(S), doi: / s.95

Therapists hesitancy to bring up spirituality. Part of their training has been not to impose their values. Lack of training and confidence in integrating spirituality and therapy. Unfamiliar with families beliefs and spiritual issues. Their own religious and/or spiritual experiences. Socioculturally there is a separation of church and state. Psychology’s need to be seen as a legitimate science. Families often feel uncomfortable brining up spirituality and religion as well. Helmeke, K. B., & G. H. (2002). Recognizing and Raising Spiritual and Religious Issues in Therapy: Guidelines for the Timid. In T. Carlson & M. J. Erickson (Authors), Spirituality and family therapy. New York: Haworth Press. doi: VitalBook

Reasons it has traditionally been omitted from clinical training, practice and research. Spiritual issues were seen to be outside of the domain of therapy, but it is being shown that physical and psychosocial distress is connected to spiritual distress. Therapist might influence the client, but therapists can show respect to clients by recognizing and exploring their own values and beliefs. Separation of scientific paradigm and the medical model to prove credibility, but studies now show the spiritual influences mental and physical well-being. Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi:

Bringing up Spirituality and Religion
According to a survey done by Kahle (as cited in Griffith and Griffith, 2002) the following was found 98% of therapists would be willing to talk about spirituality if the family brought up the topic. 60% said they would bring up the topic of spirituality 48% said they would bring up the topic of God. Cited being discouraged by education, training and worksites. Concerned over imposing belief systems. Reliance on God would disempower the client. Fear differences in beliefs would build a barrier Griffith, J. L., & Griffith, M. E. (2002). Encountering the sacred in psychotherapy: how to talk with people about their spiritual lives. New York: Guilford Press. doi: VitalBook file.

Bringing up Spirituality and Religion
According to a survey done by Kahle (as cited in Griffith and Griffith, 2002) the following was found: Cited being encouraged to bring up the topic by clients. SAFE GUARD- curiosity of clients experience and its meaning. Asking about preferences. Belief in alternative stories. Ways to honor spiritual stories: Pay attention to their language. Notice shifts in the story Suspend familiarity with cultural stories Make it a space of that is welcoming to the story. Griffith, J. L., & Griffith, M. E. (2002). Encountering the sacred in psychotherapy: how to talk with people about their spiritual lives. New York: Guilford Press. doi: VitalBook file.

How do we Bring up Spirituality and Religion?
I. Spiritual issues raised by client. When there is no explicit mention of God or religious figures People who consider themselves moral with a moral code but do not belong to an organized religion. How to handle: Acknowledge the comment regarding spirituality. Assess the impact of spiritual beliefs and practices on the presenting problem. Assess the potential for spiritual beliefs to be a solution for presenting problem. Assess your own role in the families spirituality. Exploring life experiences that contribute to their spirituality and the impact on them. Helmeke, K. B., & G. H. (2002). Recognizing and Raising Spiritual and Religious Issues in Therapy: Guidelines for the Timid. In T. Carlson & M. J. Erickson (Authors), Spirituality and family therapy. New York: Haworth Press. doi: VitalBook

II. Religious issues raised by client. Direct comment on the belief in God and/or other religious figures. Direct comment about religious practice or organization. How to handle: Learn about the religious denomination. Consider brining in a leader from the religious denomination for consultation or to include in session. Pay attention to the religious language that is used. Know your triggers to religion based on family of origin or “church of origin” issues. Helmeke, K. B., & G. H. (2002). Recognizing and Raising Spiritual and Religious Issues in Therapy: Guidelines for the Timid. In T. Carlson & M. J. Erickson (Authors), Spirituality and family therapy. New York: Haworth Press. doi: VitalBook

III. Spiritual issues raised by therapist. How to handle: Brought up after recognizing how beliefs contribute to healthy functioning in life. Be willing to stop if client not interested in topic. Brought up when therapist sees that spirituality may be involved in presenting problem. Notice that some of the issues they are bringing up are really spiritual issues. Helmeke, K. B., & G. H. (2002). Recognizing and Raising Spiritual and Religious Issues in Therapy: Guidelines for the Timid. In T. Carlson & M. J. Erickson (Authors), Spirituality and family therapy. New York: Haworth Press. doi: VitalBook

IV. Religious issues raised by therapist. How to handle: Great caution and restraint is needed. Danger of over identifying with families of the same religion. Look at them with curiosity and wonder. During assessment while looking for strengths and resources. Spiritual genogram Adding it to your disclosure form. After a client has raised a related yet separate spiritual issue. Religious issues are impacting presenting problem. To acknowledge the family’s commitment and involvement in a religious denomination. Helmeke, K. B., & G. H. (2002). Recognizing and Raising Spiritual and Religious Issues in Therapy: Guidelines for the Timid. In T. Carlson & M. J. Erickson (Authors), Spirituality and family therapy. New York: Haworth Press. doi: VitalBook

Techniques for the Therapist

Therapist Self-Reflection
“The two central qualities of spirituality threatening its appropriate use in clinical setting are its highly subjective and identity defining nature.” Therapist should engage in self-reflection for clinical accountability. Maher, A. B., & Ford Sori, C. (2006). Incorporating Spirituality into the Therapeutic Setting: Safeguarding Ethical Use of Spirituality Through Therapist Self-Recognition. In K. B. Helmeke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

Therapist Self-Reflection Process
Therapists are encouraged to write their responses to the following categories: Spiritual History and current context of spiritual beliefs. Doing a spiritual Genogram would be helpful. Write out the religious denominations religious language and then make it more client friendly. Write out your theoretical base in the language of the theory then make it more client friendly. Write out your self-resources. Your own belief system Write out your personal biases and fears as well as comfort level discussing spirituality. Maher, A. B., & Ford Sori, C. (2006). Incorporating Spirituality into the Therapeutic Setting: Safeguarding Ethical Use of Spirituality Through Therapist Self-Recognition. In K. B. Helmeke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

Questions to look at theoretical orientation: “General theory of therapy: What brings people to therapy and how does it serve them? Describe the overall purpose and function of the therapeutic process, and of the therapist. What theorists and philosophical underpinnings influence your work? Nature of persons: How do you understand human beings? What makes us tick, what do we need to function optimally? Logical areas to explore include descriptions of what constitutes healthy functioning; how is it achieved, maintained, and restored. What constitutes dysfunction or lack of health (or whatever clinical language you use); how does it occur and how is it maintained?” Maher, A. B., & Ford Sori, C. (2006). Incorporating Spirituality into the Therapeutic Setting: Safeguarding Ethical Use of Spirituality Through Therapist Self-Recognition. In K. B. Helmeke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

Questions to look at theoretical orientation: “Assessment: What is the purpose and function of assessment? What processes do you use and why? How might these activities resonate or conflict with your philosophical beliefs as detailed in items 1 and 2 above? Treatment strategies: Describe what you do in session (in broad strokes and specifically) and why. Does it resonate with your theoretical orientation as described above?” Maher, A. B., & Ford Sori, C. (2006). Incorporating Spirituality into the Therapeutic Setting: Safeguarding Ethical Use of Spirituality Through Therapist Self-Recognition. In K. B. Helmeke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

Therapist Self- Reflection Process
Questions to look at theoretical orientation: “Assessment: What is the purpose and function of assessment? What processes do you use and why? How might these activities resonate or conflict with your philosophical beliefs as detailed in items 1 and 2 above? Treatment strategies: Describe what you do in session (in broad strokes and specifically) and why. Does it resonate with your theoretical orientation as described above?” Maher, A. B., & Ford Sori, C. (2006). Incorporating Spirituality into the Therapeutic Setting: Safeguarding Ethical Use of Spirituality Through Therapist Self-Recognition. In K. B. Helmeke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

Exploring Your Spiritual History
“Handout Three: Exploring Your Spiritual History—Then, Now, and in the Future Exercise One: Your Past and Present Spiritual History” “This exercise invites you to identify the role of spirituality in your life now and in the past. Our sense of the Divine or faith is influenced not only by what we learned and how we mulled that over in our minds, but by our personal encounters with significant individuals and our faith communities. This exercise offers a way for you to begin exploring those encounters and its influence on your understanding of faith and/or spirituality.” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

“Current Spiritual Interests What is prompting you to explore your spirituality at this point in your life? Later on in this exercise you will explore the growth of your spiritual beliefs over time. But for now, briefly describe your spiritual beliefs at this moment. If you believe in God or a Divine Being, how would you describe the “character” of this entity? And how do you believe this spiritual being relates to you in times of struggle, sadness, pain, fear, and happiness? Many people find support in their spiritual growth by identifying with a religious faith and/or spiritual community. What are your preferences today? Are you active in a religious group? Why have you chosen this group? Or, why have you chosen to not become involved in a religious or spiritual community?” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

“Family History of Spiritual and/or Religious Education What was the religious orientation of your parents and ancestors? Did they talk about and practice their faith openly? Do you consider their faith expression to be more conservative (strict adherence to traditional interpretations and religious practices), moderate, or liberal (flexible expressions of religious belief)? How did the adults in your family speak of belief systems other than their own? What were the primary sources of your religious instruction? Do you remember your first ponderings about God? What were you taught about the existence and nature of God or spirituality? Prior to right now, what has been your experience in religious communities? Was participation or nonparticipation an option for you?” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

“Exploring Life’s Ultimate Meaning and Purpose Religion and/or spiritual practices offer answers to the ultimate meaning and purpose of human life. Many of these answers are implied or accepted through an act of faith; some of the answers offered may be vague or specific, relative or absolute. How would you describe the purpose of your life? How have your spiritual and/or religious beliefs influenced these thoughts? Religious teachings and spiritual practices suggest codes of behavior, guidelines for how and why we should relate to one another. What does your faith system teach about morality and the intent behind behavioral guidelines? How are moral failures viewed by your faith system?” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

“Personal Encounter What about your religious/spiritual background do you value? How did it serve you growing up and how does it continue to serve you now? Tell a story illustrating a meaningful event capturing these thoughts. What aspects of your religious or spiritual upbringing do you now question? How are you still impacted by the limits of those teachings/experiences today? Tell a story illustrating hurtful, confusing, or empty experiences. Who in your life has served as a spiritual mentor or role model? Describe that person and how he or she has impacted your life and current spiritual beliefs and expression.” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

“Personal Encounter Describe a person whose professed faith stood in contrast to his or her behavior. How have your life and spiritual beliefs been impacted by this observation? Today we are increasingly aware of spiritual and religious diversity, both conservative and liberal expressions of a variety of faith orientations. This has led to much debate—and significant disagreement—about the influence of religion in all aspects of American culture and international affairs. What voices and opinions do you resonate with? What do you see as the cause and social consequences of these often contentious debates, both positive and negative? How do you think your own faith orientation or spiritual expression has been impacted?” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

Professional Disclosure
Sample Statements from Powell and Craig to include in professional disclosure process: “For a generic recognition of religion: “This therapist is committed to taking an unbiased approach regardless of age, race, gender, or religious affiliations.” For acknowledgment of religious beliefs: “Although this therapist is a practicing (therapist can fit in their religion or denominational affiliation, e.g., Roman Catholic, Christian, Reformed Jew), religious beliefs are not the primary focus of the therapy approach and the therapist will only be addressing spirituality when requested.” Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi:

Professional Disclosure
Sample Statements from Powell and Craig to include in professional disclosure process: “For an alternative acknowledgment of religious beliefs: “Although Christian (or insert other religious or denomination background) Counseling is not the foundation of this therapist’s approach, faith and religion will be explored if the client so desires.” For a strong statement of intent to bring spirituality into therapy: “This therapist is a practicing Christian (or insert other religious or denomination background) and will be using spirituality throughout the therapeutic process.” Powell, R. R., & Craig, S. E. (2006). Spirituality and Professional Disclosure. In K. L. Helmeke & C. Ford Sori (Eds.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

Spirituality in Play and Family Therapy

Spirituality in Counseling
Hausman (2004, as cited in Jackson, 2012) cites that there have been more than 200 studies that link spirituality and well being in children. Landreth and Sweeney (1993, as cited in Jackson, 2012) state that the child’s mental well-being is directly related to their spirituality. Mabe and Josephson (2004, as cited in Jackson, 2012) give core beliefs that shape the child’s view of: the purpose of life, meaning of suffering, and moral values Religious coping skills, believing in a higher power who is control, meditation, seeking strength from God and religious counseling help the child cope with negative life events. Religion give guidelines for healthy living. Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

Therapist’s role is to pay attention to the whole child- mind, body, emotions and spirituality. Therapist’s role is to help the parent pay attention to the whole child- mind, body emotions and spirituality. Animal and Nature therapy have been cited to increase a child’s ability to increase empathy, nurturance, confidence, and connections with the environment. Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

Josephson (2004 as cited in Jackson, 2012) propose we take a biopsychospiritual approach. This can be done through: having them develop a sacred place, journaling and storytelling, routines and rituals, prayer, forgiveness and hope. Therapist must first enter the child’s world. Play therapy is a good way of doing this as it is in itself a spiritual process (Landreth and Sweeney, 1993 as cited in Jackson, 2012) Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

Landreth and Sweeney (1993, as cited in Jackson, 2012): “As children develop emotionally and psychologically, they also develop spiritually. Play promotes children’s understanding and use of symbolism Symbolism can lead to faith which is believing in things that are not seen. Faith is necessary for spiritual growth. The relationship between the child and the child-centered play therapist can also foster most all the decisions that are made in the therapy room and experience the consequences of those decisions. The child’s consequences will influence the child’s life and the more significant choices that he/she will make as an adult (p. 3) Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

“…play therapy is the most appropriate way to help children develop their spirituality since religion and spirituality are abstract concepts while children tend to be concrete in their thinking. Play allows children to express themselves in a concrete way, and the play therapist is responsible for the development of the therapeutic relationship which is the main requirement for healing and growth.” (p. 3) Sandtray therapy can also be used to symbolize spirituality and religion. Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

ETHICAL ISSUES Therapist needs to choose their words carefully so as not to be suggestive of any belief. Must be aware of diversity in spiritual background and respect the diversity of beliefs and practices. Must be careful not to over pathologize religion and spirituality in the child. Be aware of transference and countertransference issues. Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

Developmental Spirituality
Focus on the child’s strengths and abilities and not just the limitations of their developmental stage. Cognitive development will affect their ability to regulate emotions and impulses. Young children can not only understand spiritual things, but sometimes understand it better than us. Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: /

PRESCHOOL (ages 4-6) Cognitive Development Level of moral development is punishment and obedience. What they receive, whether bad or good is due to the bad or good in them. Their image of God is related to their relationship with their primary caregiver. Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: /

PRESCHOOL (ages 4-6) Erikson’s psychosocial stage- Initiative versus Guilt Therapist’s role is to make the therapy time a safe place to take initiative. Therapist’s role is to build a relational space for the child to look at their beliefs, values and spiritual connectedness. Spiritual connectedness can be done by looking at God images, sacred texts, prayers and forgiveness. See their spirituality in their play themes, making Child Centered Play Therapy a very helpful approach Primary caregivers are the primary influence. Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: /

MIDDLE CHILDHOOD (ages 7-12) Cognitive Development Beginning to develop logical thought Their image of God is related to their relationship with their primary caregiver is still a major focus. Peers and school are increasingly becoming the primary influence. Forgiveness becomes an important spiritual concept. Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: /

MIDDLE CHILDHOOD (ages 7-12) Erikson’s psychosocial stage- Industry versus Inferiority The child will begin to compare themselves to others. School context becomes central to development Begin to develop a sense of emerging industry and productivity as it compares to their peers. Expressive therapies are effective: play, art, games, narrative, and so on. Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: /

God Images Therapist can help the child come to terms with the difference between what is believed about their God image and what is felt or experienced. God Images- how the child represents the relationship they have with their God Image, usually at an unconscious level. Heart Knowledge- how the child represents their feelings and beliefs about their relationship with the God image. God Concepts- represents the cognitive understanding of their God image based on religious teachings. This includes beliefs of how to relate an interact with their God image, how their God image interacts with people and the religious beliefs. Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

God Images God images are related to their relationship with their primary caregiver. Internal Working Models- represent how the child will predict how others, including their God image will relate to them. Attachment is important in developing a God image. This happens at an individual level and can be different for each child in a family. Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

God Images- Techniques
ART TECHNIQUES It provides a safe place for the child to identify and work through their God image challenges without being judged. DRAW A GOD (p. 216) Helps children tell the difference between heart and head understanding. First-Picture- “Draw a Picture of You and God.” Second Picture- “Draw a picture of how you and God look after you have done something wrong. Draw what you feel, now what you think.” Third Picture- Draw a picture of how you would like to feel you and God look when you do something wrong.” Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

ART TECHNIQUES God Image Automatic Thought Record (p ) Helps children adjust their thinking about God images. Helps the child learn to challenge automatic thoughts Helps the child with not only how they think about their God image, but also how they experience their God image on a day to day basis. Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

God Image Automatic Thought Record (p Have child describe an incident where they had negative thoughts about their God image. Give child a list of feeling words to express how they felt and have them rate from with 0 being no emotion and 100 being overwhelmed by the emotion. Child lists any negative thoughts or feelings their God image has about them after the incident. Child rates from with 0 being do not know what God image thinks to 100% being complete certainty of what the God image thinks. Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

God Image Automatic Thought Record (p ) Ask the child, based on their religious learning, what they think their God image was really thinking and feeling. Child will write out this response and rate it on a scale of with 0 being I don’t know at all what my God image was really thinking to 100 being 100% positive what the God image was really thinking. Child then closes their eyes and is instructed to come up with what their God image looks like. The child then looks into the eyes of their God image and imagines their God image responding to them as they just described. After the child opens their eyes the child relists negarive emotions that were originally felt about the incident. The child rates on a scale of with 0 being no emotion and 100 being overwhelming presence of emotion. Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Forgiveness Emotional Forgiveness: “…the emotional replacement of negative unforgiving emotions (i.e. hurt and anger) by positive other-oriented emotions, such as empathy, sympathy, compassion, or love.” (p. 234) Decisional Forgiveness: “…applies to their behavioral intentions toward the offender. They decide to steer clar of revenge, not to avoid the transgressor (unless continued interaction is potentially dangerous), and to treat the transgressor as a person of worth even though they may still have negative emotions.” (p. 234) Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Forgiveness Developmental View of Forgiveness: Early Childhood-
Conditional Done out of obedience Done out of fear of displeasing a caregiver Done out of fear of punishment Learning the mechanics of forgiveness by modeling what is taught by the primary caregiver Later Childhood- Beginning of recognizing what they learned early on does not always apply to their decision or emotional state Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Forgiveness Factors of influence on forgiveness in children:
Relationship with primary caregivers Child’s temperament Ability to regulate emotions Caregiver’s view of emotions Cognitive development Ability to understand justice and forgiveness Coping skills Religious and spiritual development Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Forgiveness-Techniques
“…forgiveness is a key that will usually unlock major therapeutic doors to resolving embittered relationships, child acting-out behaviors, self-destructive behavior that often accompanies long-term anger, depression, anxiety, and many other interrelated mental health disorders.” (p. 241). Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Forgiveness Techniques
Recognizing and Working Through The Hurt: Helping the child/family emotionally connect to what happened to them. Promoting Insight: Helping them gain a perspective of understanding as it relates to their history and views with the offender as well as the amount of intended harm. Searching for all the ways the offender and offended contributed to the problem. Releasing Negative Emotions: Often these emotions are internalized and they need help to release them in a safe environment that leads to therapeutic resolution. Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Encouraging Empathy: “Promoting empathy helps offenders understand and relate to the hurt they inflicted, which in turn gives the person offended a positive experience of being understood by the offender.” (p. 243). Empathy from the offender increases the chances of the offended granting forgiveness. Conducting Forgiveness Sessions: “…they benefit by processing the offense in one or more therapeutic sessions in a fashion that could lead to seeking or granting decisional forgiveness.” (p. 243). Sessions should be thorough, structured and focused. Using Role Play: “Use of role play allows the psychotherapist to take the role of either the offender, or if the child is the offender wanting to seek forgiveness, the offended person.” (p. 243) Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Creating Plans for Stopping and Preventing Hurtful Behaviors: “…encourage offenders to stop offensive behaviors and to set up plans that will prevent them fro offending in the future. Commitment to well-spelled-out ad specific items by the offender is necessary.” (p ). Creating Accountability: “Forgiveness work with children and parents is enhanced when they willingly give permission to a psychotherapist to help them stay focused and follow through on decisions and commitments made in treatment…outside accountability is often encouraged through the use of trusted relatives and other adults.” (p. 244). Committing to Forgiveness: “Encouraging them to decide whether to commit to a forgiveness effort is helpful because it enhances their participation and internal locus of control.” (p 244). Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Holding on to Forgiveness: “…hurtful feelings may emerge later on the subject of forgiveness, or worse, returning to the resentful and bitter behaviors. The psychotherapy becomes a safe haven to sort through hurt feelings, ad at the same time it provides children and parents encouragement that forgiveness can coexist with a time of emotional healing.” (p. 245). Involving Parents: “Parental involvement is highly valued when it is safe to do so. Much of the work surrounding forgiveness may not only involve parents but also be led by them with the assistance of the psychotherapist.” (p. 245). Making the Formal Request: “…either directly through a forgivenss session or indirectly through role play, children and aprents benefit from formal request for forgiveness. Much healing can take place for an offended child just hearing a heartfelt request from the one who inflicted the pain.” (p. 245). Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: /

Metaphors and Narrative Therapy

Ways to Express Spirituality
Language and Beyond Spirituality is expressed in language and bodily experience. “Relationships between individuals and spiritual beings- ancestors, saints, spirits, angels—bear many of the characteristic of human relationships.” No secrets in the relationship. Counted on to always be present and available. Provide a source of meaning. Stands witness to the just and injust. Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Ways to Express Spirituality
Metaphor Religious Rituals Spiritual practices that allow for openness to spirituality Community that follows the same beliefs Religious beliefs Stories and narratives Dialogue Rituals Ceremonies Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Metaphors Metaphors help make abstract concepts understandable by using images and events from daily life. Therapist can discover the person’s spirituality and the questions and comments to make about it by listening to the metaphors the family uses. Metaphors are the heart of what we do with child-centered play therapy. Metaphors are a tool to use, they are neither good or bad in and of themselves. Metaphors are often intergenerational transmissions. Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Metaphors New metaphors may not blend with older ones, they often replace them. Questions to ask: “Was this always the way you experienced God, or was it quite different when you were younger? Are there ever times now when you experience God in a different way? When your mood is different—you are not depressed, you feel inspired by life, you feel joy—does a different image or sense of God then appear at such times?” How is the metaphor shaping the child/families experience? Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Narrative Approaches Narrative Metaphors
We create and are created by our stories of spirituality. Stories come from us, our family, our society, our culture, and so on. There are contradictory stories to our spirituality, identity and relationships. Some narratives are known and easily shared, known but not easily shared, or only an outline and not fully formed. In therapy we can become co-creators in these narratives. Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Narrative Approaches Stories
Stories give meaning to a child/families experience and describe a sequence of events. They have a beginning, middle and end. “Stories make individual events comprehensible by locating them within the whole to which they contribute.” (Polkinghorne, as cited in Griffith, 2002). “We participate in the co-creation of stories by our way of listening, our questions, and our reflections. As stories are told, the response of silence, raised eyebrows, leaning forward, or distractedly doodling becomes ad edit, a punctuation, influencing the teller to shift topics, say more, soften a point, or cease speaking.” Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Narrative Approaches Stories Co-Creating Stories
Focuses on creating stories from one’s experience. Focuses on the relationship between the person and stories that are told. Focuses on the back and forth of the teller’s story and asking questions out of curiosity in order to introduce new aspects of the story. Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file.

Narrative Approaches Therapeutic Metaphors for Children and the Child Within 2nd Edition by Joyce Mills and Richard Crowley (2014)

Narrative Approaches Three Level Communication
Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Narrative Approaches Ingredients of Therapeutic Models “How does one go about creating the shared phenomenological reality by which the therapeutic metaphor achieves its effect? If we look at the classic fairy tales, we can discern elements or ingredients of storywriting that are common to many of them. In one way or another, most classic fairy tales: (1) Establish an overall theme of metaphorical conflict in relation to the protagonist; (2) Personify unconscious processes in the form of heroes or helpers (representing the protagonist’s abilities and resources), and villains or obstructions (representing the protagonist’s fears and negative beliefs); (3) Personify parallel learning situations in which the protagonist was successful; (4) Present a metaphorical crisis within a context of inevitable resolution, by which the protagonist overcomes or resolves his problem; (5) Develop a new sense of identification for the protagonist as a result of her victorious “hero’s journey”; (6) Culminate with a celebration in which the protagonist’s special worth is acknowledged.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Storyline: First Level- “As the first level of communication, the storyline occupies the child’s conscious mind by presenting an interesting plot.” Intersperesed Suggestions: Second Level- “While the child’s conscious mind is absorbed in the literal aspects of the story, important therapeutic suggestions that deal with the presenting problem can be interspersed throughout the storytelling process. These suggestions are assimilated into the context of the story so that they do not appear to be directed at the child. The child consciously hears the suggestions in relation to the storyline rather than as injunctions to himself. On an unconscious level, however, the suggestions are “heard” in a personally meaningful way. Lankton & Matthews (2008, p. 313) tell us that “[i]ndirect suggestion is aimed at creating an environment in the therapy session that can essentially create a permissive atmosphere for clients to project relevant meaning and motivation into the words spoken by the therapist.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Interweaving: Third Level- “We now turn our attention to the third level of communication, which takes place as the metaphor unfolds. Through a careful use of sensory-rich language, a simultaneous process of sensory interweaving is initiated. The purpose of sensory interweaving is twofold. One, it helps bring integration and balance to the child’s overall sensory functioning; and two, it is specifically focused on unblocking and opening up the out-of-conscious system. Sometimes this is accomplished by stressing the out-of- conscious system via a preponderance of appropriate predicates.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Mutual Storytelling “Recognizing the enjoyment children experience in both telling and listening to stories, Gardner (1970, 1971) developed the Mutual Storytelling Technique as a means of utilizing storytelling therapeutically. In this method Gardner begins by using a predetermined introduction such as, “Good morning boys and girls, I’d like to welcome you once again to Dr. Gardner’s Make-Up-A-Story Television Program.” This is followed by an array of instructions to the child in regard to the story he or she is going to create. Gardner tells the child that the story: (1) should have adventure and excitement; (2) should not be about things on television or in movies, or actually experienced by the child; (3) should have a beginning, middle, and end; and (4) should have a moral. After being given these instructions, the child creates a story that the therapist “probes (for) psychodynamic meaning.” The therapist then creates another story using the same characters and setting as created by the child but introducing “healthier adaptions” than those described by the child.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Mutual Storytelling MUTUAL STORYTELLING WITH PUPPETS
Make up a story with a beginning, middle and end. Make up the story as a family. Act out the story Families create the story while you leave the room Family puts on puppet show Process it while staying in the Metaphor Gil, Eliana. (2014) Play in Family Therapy, Second Edition, 2nd Edition. The Guilford Press, VitalBook file.

Artistic Metaphor “In addition to utilizing metaphors in a storytelling fashion to integrate sensory systems and evoke unconscious change, another therapeutic application of metaphor can occur through the use of what we term the artistic metaphor. The artistic metaphor utilizes drawing strategies, board games, and healing books, all originally conceived and created by the child, to provide another dimension of therapeutic experience.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Inner Resource Drawing
“As a means of therapeutic intervention, the Inner Resource Drawing serves several important purposes. For one, it helps the therapist identify the child’s out-of-conscious sensory system; for another, it can provide an experience of catharsis and emotional release. It can also act as a feedback system for families that helps to clarify each member’s view of solutions, and it acts as an immediate feedback system for the child, who can now see solutions and resources take tangible shape and color. For the therapist, the Inner Resource Drawing provides a map of resources and background structures that can be incorporated into later storytelling metaphors. It can also provide an alternative means of communicating with the excessively verbal or nonverbal child.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Resource Board Game “First the child is provided with a large piece of drawing paper or poster paper along with drawing implements such as crayons or markers. The child is asked to draw “something you want to have in your life—something important for you,” in one corner of the paper. In the opposite diagonal corner the child is told to draw a favorite character or object that could help him get to the goal. Second, the child is asked to close his eyes and imagine a map that would lead the character or object to the goal. When the map is very clear in his mind, he is told to open his eyes and begin drawing it. Third, the child is asked to draw three obstacles on the board that could impede the character or object from achieving its goal. The instruction could be stated something as follows: “Now put in three things that might get in the way of Mickey Mouse [or whoever] reaching the treasure chest [or whatever].” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Resource Board Game “Fourth, the child is asked to create a specific resource as a counterpart to each obstacle. These three resources (which are, of course, symbols of the child’s own inner resources) are drawn on paper (approximately 3″ × 5″) and cut out with scissors, to be used later as the game is played. These are called the “resource cards.” Fifth, the child is asked to draw as many connecting spaces as she wishes along the mapline from the starting point to the end of the game. In this fashion, the obstacles also become spaces on which to land. Sixth, the child now creates the symbolic pieces to move along the map’s spaces. These symbolic pieces can be drawn on paper and cut out, made out of clay, or borrowed from among the child’s favorite things. (One little girl suggested using her ring and the therapist’s ring as the pieces.)” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Resource Board Game Finally, the therapist or child draws a circle approximately six inches in diameter on a piece of paper and divides it into equal, pie-shaped pieces. The child then draws each of the original pictures from the smaller resource cards onto each of the pie-shaped pieces and numbers them with any number from one to six. These numbers correspond to the die used in the game. An option is to have the child choose two numbers for each pie-shaped space. This doubles the child’s chances of achieving success in overcoming the obstacles as the game is played. Pictorially, the first alternative would appear as follows:” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Resource Board Game Playing the Resource Board Game “The players (therapist and child) begin by placing their symbolic pieces on the favorite character/object and throwing a die. The player moves the piece according to the number shown on the die. If she lands on an obstacle, she throws the die until she gets the number corresponding to the matching resource on the larger resource card. She is then handed a corresponding smaller resource card that is turned in as a ticket to “go ahead,” and she now moves forward according to the number on the die. This process continues back and forth until the child reaches the goal. If the therapist reaches the goal first, she can either return to the beginning and continue playing, or simply stay on the goal and allow the child to play until she also reaches the goal. Some children will spontaneously add new symbols of obstacles and resources as they play. The case illustrations that follow will demonstrate how each child’s temperament must dictate the unfolding of the game.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Pathways to Success Map
“Derived from the Resource Board Game, this activity motivates older children, adolescents, and parents to create symbols that identify goals, overcome obstacles and enhance their inner resources. The Pathway to Success Map is particularly helpful for children and adolescents who have been abused and have to go to court by (1) awakening an inner sense of confidence (2) while at the same time reduce fear. Materials Needed: Provide a blank piece of paper, three 3 × 5 cards, crayons or markers. Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Directions: Ask client to draw a symbol of a goal—what your client wants to have in his/her life—in one corner of the blank sheet of paper. Next suggest that the client close his/her eyes and imagine a map that leads the goal. When the image is clear, tell client to open his/her eyes and draw it on the sheet of paper. Start: Then suggest to draw a symbol in the starting position that can help get to the goal. Obstacles: Draw a symbol for three obstacles that can get in the way of getting to the goal anywhere along the map lines. Three blank 3 × 5 cards: Ask client to draw a symbol of one resource on each card that client knows can help overcome each obstacle. Each of these cards can be used as a visual reminder, connecting your client to the solutions he or she has created for overcoming the obstacles that may block his or her pathway to success.” Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file.

Play Therapy Approaches

Play Therapy Techniques
Frame (2003 as cited in Helmeke, 2006) stated that: “…in working with children and adolescent spiritual beliefs, counselors who “exhibit nonjudgemental attitudes, who are receptive to a variety of beliefs and practices, and who approach children and youth with warm supportive inquisitiveness are likely to be effective in the therapeutic process (p. 261).” As with Filial therapy, the therapist can train parents in methods in spirituality that they can continue to use after therapy has ended. To understand a child’s spirituality in the concrete world of childhood, things must be expressed in a developmentally appropriate way. Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Sandtray Techniques “…spirituality is an abstract concept which is arguably beyond the scope of children’s developmental understanding, there are various expressive techniques which may be used.” Sandtray is one type of play therapy that can be used to help the child deal with spiritual concepts. In Sandtray the child, “is geven the freedom to fully express conscious and unconscious material in the sand.” A good resource for better understanding the basics of Sandtray is Homeyer and Sweeney’s (1998) Sandtray: A Practical Manual A good resource for better understanding the basics of play in family therapy is Gil’s (2015) Play in Family Therapy: 2nd Edition. Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Sandtray Techniques Sandtray and spirituality instructions-
“Here is a collection of miniatures toys (pointing to the collection, which is best placed on shelves). You can use as many of these as you want. Could you make a picture of what God is like to you? Take as much time as you need.” This could include any question of spirituality the child or family is dealing with. “The story which unfolds in the creation and expression with the play media is often sufficient to stand on its own when exploring spiritual issues with children and families.” Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Sandtray Techniques Spiritual Sandtray with Families-
“If more than one family member is present some of the following questions adapted from Sweeney (2001) may be considered by the therapist: 1. Who initiates the construction of the sandtray world? Who ends the process? 2. What objects are considered, selected, and rejected? By whom? Are one person’s suggestions and/ or sections rejected by another person? 3. Do the family members work together in the construction of the tray? Are separate worlds created in the one tray? Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Sandtray Techniques Spiritual Sandtray with Families- 4. Were friendly or hostile messages sent by anyone? Did anyone send a “You do your thing and I’ll do mine” kind of message? 5. Who contributed the most? What is the percentage of space used by each person? 6. Do the family members talk to each other during the process? Do they decide on a theme? If so, do they follow the theme? 7. Is the process structured or chaotic?” Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Sandtray Techniques “Also, following the construction of the tray, children and families can be asked some basic nonthreatening questions. These include asking what the title of the world is, and asking the client to tell a story about the tray. It may be helpful to elicit further information: What about this figure here? What is she doing? It looks like these two are saying something to each other—I wonder what they could be talking about? Are you [the client(s)] in this picture? Is there anyone else you know in here? What’s going to happen next [if it is an active scene]? What [not “who”] has the most power here? Questions should be simple and open-ended, and questions avoided that are intrusive or that jump to a conclusion. These simple instructions and questions can be used with a number of projective mediums, including puppets, dolls, drawing, clay, paints, etc.” Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

The “Out of Control” Balloon Technique-
Family beliefs related to locus of control help families adapt to stressful circumstances. Emotional distress can be decreased by identifying and changing these beliefs. “This activity aims to empower the family to focus on the controllable elements in their lives and give the uncontrollable aspects to a “Higher Power” (or whatever spiritual practice to which they may belong) by highlighting what stressors in their family life they can control.” Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Supplies: Paper, 3x5 cards, permanent marker, pen/pencil, camera, filled helium balloons. Instructions: “Following is a list of steps to take to prepare the family for this activity, as well as instructions on how to conduct and then process the Out of Control Balloon intervention. Therapists should: Instruct each family member to make a list of all the stressors in their lives on the handout entitled “Current Stressors.” Encourage them to share their lists aloud with their family. Discuss with the family what it means to them to be able to “control” something and what it means not to be able to “control” something. Instruct family members to revisit their “Current Stressors” handout and cross off each stressor over which they have some control. Encourage them to share how they exert influence over each stressor for which they do have some control. Ask each family member how it feels to be able to control those stressors in their lives. Sori, Catherine F. (2008) The Therapist's Notebook Volume 3. Routledge, VitalBook file.

Process with the family what stressors they could not mark through on their handout and why they feel those stressors are “out of their control” (i.e., something they have no ability to change), as well as how they feel about not being able to control them. Explore what makes the uncontrollable so difficult. Instruct family members to write the names of stressors that are out of their control on their helium-filled balloons, using a permanent marker. Each family member should have his or her own balloon, or the family can choose to share one balloon for a more collective experience. Process with the family what it would be like to “give” the stressors that are out of their control to a “Higher Power” (or God, or whatever term fits their religious or spiritual belief system) in which they believe. Discuss with them how this could occur and how they would feel about relinquishing the uncontrollable. Sori, Catherine F. (2008) The Therapist's Notebook Volume 3. Routledge, VitalBook file.

Process how it would feel to stop blaming themselves for the things that are out of their control and focus their attention on things that they are able to control. Discuss what, if anything, each person would like to say as he or she releases the balloons. On 3 × 5 cards have each person write down the name of the stressors and, below that, what they want to say as they release the balloons to symbolize letting go of trying to control things they cannot change. If possible, take the family outdoors and instruct them to release their “out of control” balloons and allow their stressors to be taken over by a “Higher Power.” For those who cannot go outdoors (e.g., due to incarceration, hospitalization, physical disability), other family members may be asked to release balloons, or the therapist can agree to do it. If possible, take photographs as each family member is in the act of letting go of his or her “out of control” balloons. Process with the family what it was like to release their “out of control” stressors and how their lives will be different now that they can focus on things they can control.” Sori, Catherine F. (2008) The Therapist's Notebook Volume 3. Routledge, VitalBook file.

The Spiritual Genogram Technique
“The spiritual genogram can be introduced at any time in the therapy process and can be made a standard part of gathering data regarding clients and their families of origin.” (p. 212). Steps: Creation of the spiritual genogram Reflection questions Connection to family of origin Integration into therapeutic process. Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. .

Important spiritual and religious events in the family and/or community are noted on this genogram. There is notation made if a family member has left a religious/spiritual organization or movement. Religious/spiritual closeness and/or conflict between family members is noted. Questions are asked for follow up and clarification. Families request information of family of origin to connect with their religious/spiritual beliefs and meanings that have been a part of the family of origin. Integrating into therapy: “…the therapist enables clients to make connections between past beliefs, experiences, and family-of-origin issues and their presenting problems.” Frame, M. W. (2000). The Spiritual Genogram In Family Therapy. Journal of Marital and Family Therapy, 26(2), doi: /j tb00290.x.

“Spirituality involves personal experiences that are both unique to each individual and that can be influenced and mediated by family and cultural processes.” They, “…provide a comprehensive means of exploring religious and spiritual issues and their impact on clients’ lives.” Can be used to give a general overview or for in-depth exploration of religious/spiritual issues. “..invaluable tool for exploring individual processes of spiritual development over time and their interconnections with other aspects of the clients’ life.” Helmeke, Karen B. (2006). The Therapist's Notebook for Integrating Spirituality in Counseling I. Routledge, VitalBook file.

“They can trace the transmission of values and core beliefs across generations and the tensions and agreements that result.” “…address the intersection of spirituality with other emotional, behavioral and psychological issues and show how spiritual issues may function as impasses to or resources for inspiration, reconciliation, and healing.” Helmeke, Karen B. (2006). The Therapist's Notebook for Integrating Spirituality in Counseling I. Routledge, VitalBook file.

Instructions: “..requires the therapists listen for clients’ needs to have the kind of information that the genogram might provide.” “…therapeutic problems involving family dynamics or individual growth and development may have a spiritual or religious component that might be helpful to explore using the spirituality-focused genogram.” “…useful in enabling individuals or families to discover untapped spiritual or religious resources that may facilitate the resolution of problems or assist in coping with difficult circumstances.” Should be done with the family. “…discoveries regarding spirituality and religion that emerge mst be connected back to the presenting problem or issue of concern to clients in order to keep the treatment clinically relevant.” Helmeke, Karen B. (2006). The Therapist's Notebook for Integrating Spirituality in Counseling I. Routledge, VitalBook file.

“Handout: Questions to Consider When Constructing Spirituality- Focused Genograms: Individual Factors What meaning does religion/spirituality/transcendence have for you? What are the first religious or spiritual experiences you can remember? What role does religion or spirituality have in your everyday life? What role does religion or spirituality play during times of difficulty or crisis? What defining experiences or individuals have influenced the development of your sense of spirituality or religion? Where do you find yourself currently in your own spiritual growth and where would you like to go?” Source: Adapted from Balaguer Dunn, 1998; Balaguer Dunn & Dawes, 1999. Helmeke, Karen B. (2006). The Therapist's Notebook for Integrating Spirituality in Counseling I. Routledge, VitalBook file.

“Handout: Questions to Consider When Constructing Spirituality-Focused Genograms: Family Influences What was the meaning of spirituality and religion for each member of your family going back for three generations? How did different family members express religious and spiritual beliefs? In which ways did family members make sense of their lives and derive meaning from their experiences? What was the level of involvement in organized religious institutions? How were differences in religious orientations/practices or spiritual experiences negotiated among family members? What role does spirituality or religion play in the everyday lives of members of the family? What were significant transitions and/or critical life events in the history of your family? What impact, if any, did religion or spirituality have in making sense of or coping with those life events? Who in your family most influenced your sense of spirituality and religion?” Source: Adapted from Balaguer Dunn, 1998; Balaguer Dunn & Dawes, 1999. Helmeke, Karen B. (2006). The Therapist's Notebook for Integrating Spirituality in Counseling I. Routledge, VitalBook file.

INDIVIDUAL AND FAMILY PLAY GENOGRAMS
Issues that typically arise with the Family Genogram: Should they go together or one at a time? It is better for them to work together. What if one of them chooses that could be seen as negative or critical? Observe the family during the task noting communication patterns, types of interactions, alliances and collusions, triangulations, and other systemic information. Once all family members have made their choices. Discuss the genograms and choices with the family. Use open-ended questions. Do not make interpretations or give explanations. Expand on the metaphors. Sori, Catherine F. (2015) The Therapist's Notebook for Children and Adolescents, 2nd Edition. Routledge, VitalBook file.

INDIVIDUAL AND FAMILY PLAY GENOGRAMS Handout 3
INDIVIDUAL AND FAMILY PLAY GENOGRAMS Handout 3.2 Family Play Genograms Data Recording Form Sori, Catherine F. (2015) The Therapist's Notebook for Children and Adolescents, 2nd Edition. Routledge, VitalBook file.

INDIVIDUAL AND FAMILY PLAY GENOGRAMS
Issues that typically arise with the Family Genogram: Should they go together or one at a time? It is better for them to work together. What if one of them chooses that could be seen as negative or critical? Observe the family during the task noting communication patterns, types of interactions, alliances and collusions, triangulations, and other systemic information. Once all family members have made their choices. Discuss the genograms and choices with the family. Use open-ended questions. Do not make interpretations or give explanations. Expand on the metaphors. Sori, Catherine F. (2015) The Therapist's Notebook for Children and Adolescents, 2nd Edition. Routledge, VitalBook file.

REFERENCES Aponte, H. J. (2002). Spirituality: The Heart of Therapy. In T. Carlson & M. J. Erickson (Eds.), Spirituality and family therapy. New York: Haworth Press. doi:Erickson, M. J. (2003). Spirituality and Family Therapy. [Bookshelf Online]. Retrieved from Delaney, H. D., Miller, W. R., & Bisonó, A. M. (2013). Religiosity and spirituality among psychologists: A survey of clinician members of the American Psychological Association. Spirituality in Clinical Practice, 1(S), doi: / s.95 Diblasio, F., Worthington, E. and Jennings, D. (2013). Forgiveness Interventions With Children, Adolescents, and Families (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: / Frame, M. W. (2000). The Spiritual Genogram In Family Therapy. Journal of Marital and Family Therapy, 26(2), doi: /j tb00290.x. Griffith, James L. (2002) Encountering the Sacred in Psychotherapy. The Guilford Press, VitalBook file Jackson, S. A. (2012). Children, Spirituality and Counselling. American Journal of Applied Psychology,1(1), 1-5. doi: /j.ajap

REFERENCES Helmeke, Karen B. (2006).The Therapist's Notebook for Integrating Spirituality in Counseling II. Routledge, VitalBook file. Helmeke, K. B., & G. H. (2002). Recognizing and Raising Spiritual and Religious Issues in Therapy: Guidelines for the Timid. In T. Carlson & M. J. Erickson (Authors), Spirituality and family therapy. New York: Haworth Press. doi: VitalBook Lewis Quagliana, H., Ebstyne King, P., Quagliana, D. P., & Mans Wagener, L. (2013). Spiritually Oriented Interventions in Developmental Context (H. L. W., Ed.). In W. F. D. (Ed.), Spiritual Interventions in Child and Adolescent Psychotherapy (pp ). American Psychological Association. doi: / Maher, A. B. (2006). Impact of Abuse on Inernalized God Images: Spiritual Assessment and Treatment Using Guided Imagery (C. Ford Sori, Ed.). In K. B. Helmke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, NY: Hawthorne Press. doi: Maher, A. B., & Ford Sori, C. (2006). Incorporating Spirituality into the Therapeutic Setting: Safeguarding Ethical Use of Spirituality Through Therapist Self-Recognition. In K. B. Helmeke (Ed.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi:

REFERENCES Mills, Joyce C. (2014)Therapeutic Metaphors for Children and the Child Within, 2nd Edition. Routledge, VitalBook file. Olson, L., Maclin, V., Moriarty, G., & Bermudez, H. (2013). God Images (D. F. Walker & W. L. Hathaway, Eds.). In Spiritual interventions in child and adolescent psychotherapy (pp ). Washington, DC: American Psychological Association. doi: / Powell, R. R., & Craig, S. E. (2006). Spirituality and Professional Disclosure. In K. L. Helmeke & C. Ford Sori (Eds.), The Therapist's Notebook for Integrating Spirituality in Counseling I. New York, New York: Hawthorn Press. doi: Walsh, F. (2009). Integrating Spirituality in Family Therapy. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed.). New York: The Guilford Press. doi: Sori, Catherine F. (2008) The Therapist's Notebook Volume 3. Routledge, VitalBook file. Sori, Catherine F. (2015) The Therapist's Notebook for Children and Adolescents, 2nd Edition. Routledge, VitalBook file.

Spirituality in Family and Play Therapy

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