Disaster spiritual and emotional care in professional psychology: a Christian integrative approach.

Aten, Jamie D.

In this article, I introduce a Christian integrative approach to disaster spiritual and emotional care in professional psychology. I also contextualize the subfield of disaster intervention within my view of how integration overall will develop in the future. Practice guidelines for integrative disaster spiritual and emotional care are offered, as well as a series of diverse examples of faith-based disaster interventions. Theological and integrative implications are also raised, as well as thoughts on how disaster spiritual and emotional care will contribute to the future of integration.

My family and I had moved to South Mississippi just six days before Hurricane Katrina struck the Gulf Coast. We had just moved from the Chicago area and did not have phone service or a decent television signal, so we were unaware of the ever so rapidly and dangerously increasing storm that was headed our way. We attended a large church just down the road from where we lived. After the warm welcome and greetings that followed the bellowing choir's opening praise song, the pastor walked solemnly to the podium. With his jaw squared away, in a slow southern draw, he began his message by saying, "If you remember Camille, you know what I'm about to say." My wife looked at me and asked, "Who is Camille ?" to which I replied jokingly, "She must be in the Old Testament." Unfortunately, we quickly learned about Hurricane Camille and were soon introduced to her counterpart, one of the worse natural disasters to ever strike our nation, Hurricane Katrina.

Within a few weeks, I found myself active in studying and joining the community response to address the overwhelming spiritual and emotional needs left behind in the wake of the storm, and have been active in this area of work ever sense. Since that time, through various roles and capacities, I have been active in responses to a number of other disasters, such Hurricanes Rita and Gustav, H1N1 pandemic, 2010 Mississippi Delta and 2011 Alabama Tuscaloosa Tornadoes, Deepwater Horizon Oil Spill, Japan Tsunami, and New Zealand and Haiti Earthquakes. It is against this backdrop that I introduce a Christian integrative approach to disaster spiritual and emotional care. However, before doing so, I want to contextualize the subfield of disaster intervention within my view of how integration overall will develop in the future.

Contextualizing Disaster Intervention within the Future of Christian Psychology

It appears that Christian integrationists are becoming more socially aware and action oriented in responding to social injustices and in responding to the root causes of social problems. If we are going to truly attempt to tackle societal systems that cause oppression and suffering, then we must also adopt a broader community approach to our work. I believe the practice and study of disaster intervention rooted in faith has the potential to make significant contributions to the field of integration by stretching our professional identify and by enhancing our professional capabilities and skill set. I would argue that society and the Church need more Christian psychologists who are prepared to provide disaster spiritual and emotional care to help address the challenges and suffering of those affected by disaster. Moreover, I believe that lessons learned from disaster circumstances can give us insight and enhance our work with a wide range of clients (not just disaster survivors). Following are a few examples of ways I see integrationists uniquely contributing to disaster intervention in the future, and conversely, examples of ways I see disaster intervention uniquely contributing to integrationists.

Christian psychologists engaged in disaster spiritual and emotional care will be uniquely positioned not only to he able to identify a community's weaknesses but also strengths which can be leveraged for healing in the wake of catastrophe as well as leveraged for the long-term spiritual and emotional resilience of a community. Disasters are much more than just an "event: such as a tornado striking. A disaster reflects the sum of a community's vulnerabilities, the realities of catastrophe, and possibilities or challenges to resilience. Disasters give us insights into the gestalt of the social systems and needs within a community. Disasters inevitably bring both strengths and weaknesses of a community to the forefront. Acute weakness at a systems level are forced to the surface after a disaster, which can help us begin to better recognize the larger social injustices and systems embedded in our communities that affect spiritual and emotional health. To help strengthen and build capacity for disaster spiritual and emotional recovery is to help strengthen and build capacity for spiritual and emotional wellness.

Christian psychologists will be uniquely positioned to offer holistic emotional and spiritual care. There is much that integrationists can offer in disaster circumstances. Disasters have often been described as "acts of God," which can evoke strong emotional responses, as well as give rise to challenging theological and existential questions among survivors. Disasters can challenge survivors' views of a just world and just God. For many disaster survivors, their ability to recover hinges on their ability to make meaning of disaster experience and to integrate their disaster experience into their life narrative (Aten, Moore, Denney, Bayne, Stagg, Owens, Daniels, Boswell, Schenck, & Jones, 2008). After Hurricane Katrina, it was common to hear survivors talk about their lives "before Katrina" and "after Katrina." Moreover, it was common for survivors to retell their "Katrina story over and over, sometimes to mental health professionals, which helped them gain mastery of their disaster experience. However, if a mental health professional is only attuned to survivors' emotional meaning made after a disaster, then they may miss half of the story so to speak, or for survivors whose faith provides their life lens, the therapist may nearly miss the whole story.

Christian psychologists will be capable of strengthening multidisciplinary disaster collaboration. Christian psychologists who have established collaborative relationships with local churches and other faith-based organizations will be able to help facilitate greater post-disaster clergy-psychologist collaboration. Researchers have found that clergy are very interested in collaborating with psychologists after a disaster, and disasters appear to reduce barriers to collaboration. Similarly, local, state, and federal disaster response is becoming more and more multidisciplinary. For example, FEMA has adopted the "whole community" philosophy, which stresses greater collaboration across the continuum of response. Yet, multidisciplinary disaster collaboration can be challenging. Disciplinary turf wars, disciplinary differences in philosophical approaches to helping, and sometimes distrust of other disciplines. Add elevated stress into the mix, and one quickly begins to see the potential for conflict. However, the ancillary skills (e.g., advocacy, consultation) and familiarity with multidisciplinary treatment teams will give Christian psychologists an edge in helping to facilitate greater multidisciplinary collaborations (Aten, Avila, Hosey, Topping, & Weaver, 2009).

Practice Guidelines for Integrative Disaster Spiritual and Emotional Care

Christian psychologists providing disaster spiritual and emotional care need to take steps to ensure they are operating within their professional scope of practice and personal limits. Steps should be taken to become more familiar with ethical codes and principles related to providing disaster care (e.g., American Psychological Association Code of Conduct, National Voluntary Organizations Active in Disaster Points of Consensus on Emotional and Spiritual Care). Psychotherapy competence does not necessarily equate with disaster spiritual and emotional care competence. Christian psychologists providing disaster spiritual and emotional care also need to be aware of their own psychological limits and self-care practices in attempt to stave off burnout and vicarious trauma. There have been numerous reports of well meaning mental professionals who have actually caused more harm than help as a result of practicing beyond their scope of practice or self-limits (Aten, Madson, Rice, & Chamberlain, 2008). Though these aforementioned challenges are not limited to just psychologists of faith, the pressure sometimes felt by Christian psychologists to do "God's work," may cause some to ignore signs of fatigue, or add additional pressures.

Disaster spiritual and emotional care needs to be sensitive to the spiritual and cultural needs of survivors. For some disaster survivors, faith may act as a buffer and provide additional resources for support and recovery. At the same time, disasters have been shown to raise existential issues that may cause experiences of spiritual struggle for some. The culture of the disaster survivors and communities also need to be taken into account. Steps should be taken to avoid simply "parachuting in" western or commonly used disaster spiritual and emotional services from other contexts. If a treatment is not congruent with a community's culture, such services are unlikely to be utilized, may be harmful, or may create animosity toward the caregiver, to name a few. The most successful interventions have staying power; that is, they either are able to be incorporated into local infrastructure or help build new capacity. Adopting a participatory learning and action focus, where the local knowledge and capabilities are recognized and incorporated into response and recovery process provides a helpful framework for incorporating the faith and culture of the survivor into the healing process.

Those providing disaster spiritual and emotional care also need to be cognizant of issues that may vary across types and phases of disasters. For example, research has shown that survivors utilize religious coping processes and religious resources more often in natural and human-made disasters circumstances than in technical disaster circumstances. Divorce rates provide another example of how stressors manifest themselves differently across disaster types, with rates increasing in the early phases after a natural disaster while decreasing after a man-made disaster. Interventions should also be matched to the phase of disaster response (e.g., impact, immediate, recovery). For example, research has shown more psychoeducational and psychosocial support based approaches (e.g., Psychological First Aid) to be more effective in the immediate aftermath of a disaster, where as more traditional psychotherapy approaches (e.g., cognitive behavioral therapy) appear more effective during later phases of recovery. Research has shown that poor matching of disaster mental health interventions will not only lead to ineffective treatment, and can actually cause harm. We need more Christian psychologists engaged in disaster intervention and research to help further and sharpen our understanding of effective disaster spiritual and emotional care.

In addition to clinical skills, disaster spiritual and emotional care seeks to leverage numerous skills beyond psychotherapy, such as consultation, supervision, program evaluation and development, advocacy and training skills. To ensure proper delivery of disaster spiritual and emotional care interventions, Christian psychologists need to also consider approaches beyond traditional therapeutic modalities such as a community psychology paradigm. I state this not to discount the important role that psychotherapy plays in disaster spiritual and emotional care; psychotherapy skills are readily embedded across disaster spiritual and emotional care, including later phases in which psychotherapy is the primary form of intervention. Rather, my intent is to emphasize that a paradigm shift will be required by many, which will require greater attention to community and systems treatment approaches and interventions. Overall, a community psychology mindset is extremely useful in disaster spiritual and emotional care, even if one's primary roles tend to be more clinically oriented, treatment should still take into account the larger community context.

Examples of Integrative Disaster Spiritual and Emotional Care Interventions

In the following section, I introduce five core categories of disaster spiritual and emotional care interventions, as well as provide some examples. The examples are not exhaustive, but are rather presented to provide readers with a basic introduction of a few key interventions:

1. Congregational capacity-building interventions help create infrastructure and build up local resources necessary for sustained care. One approach is to encourage preparedness among the local church, including leaders and congregation members (Aten & Topping, 2010) Another intervention is to help create networking opportunities, such as helping facilitate relationships between local clergy and trauma specialists. Assessment skills might also be used to help identify community vulnerabilities and needs, as well as possible resources for strengthening community resilience (Aten, Topping, Denney, & Bayne, 2010). For instance, I collaborated with a local faith-based non-profit organization to develop a disaster chaplain network to provide training in psychological first aid for community religious professionals which later evolved into a disaster chaplain credential which was connected to the local emergency operation response center so that the group could be dispatched in times of crisis to provide disaster spiritual and emotional care.

2. Faith-based training and education interventions are another way that psychologists can enhance disaster spiritual and emotional care capacity. For example, based on interviews and subsequent post-disaster work in the Gulf Coast region with clergy affected by disasters, we developed a three-tier model of training. In tier one, mental health professionals helped provide basic disaster mental health information to local clergy. In tier two, mental health professionals and religious leaders were paired together to help educate their congregation members. In tier three, the congregation members' reach out to their local communities to provide information on topics like common reactions and problems, as well as when and where help can be found in the region (Aten, Topping, Denney, & Hosey, 2011).

3. Christian advocacy interventions help to champion causes using the best science and information available to address disaster needs and policy. Christian psychologists can work with local churches and organizations to help identify needs and gaps in service and help them bring those needs to light (Aten, 2008). For example, after Hurricane Katrina, there had been concern by several faith communities about how local authorities were planning to distribute relief dollars, particularly fund that these groups had hoped would go to build back low income housing over expanding a local port used for industry. In this case, several local mental health professionals collaborated with churches to help them develop a "voice" and refine their message. Moreover, empirical data was provided to church leaders to help support their arguments and help them influence policy.

4. Spiritual and emotional support interventions are less clinically oriented in nature, and focus on addressing immediate needs. These sorts of interventions have more of a triage focus, with the goal of helping to secure and stabilize disaster survivors, such as psychological first aid. Case management is also frequently used to help identify and provide basic needs and services. After Hurricane Katrina, I helped supervise a practicum course of advanced doctoral students who were paired with lay religious leaders involved in case management. By pairing together representatives from psychology and the church, a more holistic approach to care was created.

5. Spiritual and emotional clinical interventions are more well suited for long-term recovery. In contrast to support interventions, this set of interventions seek to explore and understand how survivors' ways of thinking, feeling, and behaving are affecting their adjustment. In many cases, these interventions also seek to help people either change or accept their circumstances. For example, research has shown a strong evidence for the usefulness and effectiveness of cognitive behavioral therapy to treat disaster survivors. Though not within a disaster context, there has also been strong support for religious accommodative cognitive behavioral therapy. In working with survivors more long-term I have found it helpful to integrate the Christian themes from the religious accommodative approach into the disaster approach when appropriate.

Theological and Integrative Reflections

Whenever I am asked to provide training or consultation on disaster spiritual and emotional care, I typically begin with the same question, "What is your theology of disasters?" I begin this way for several reasons. I have found that in many cases our theology, though we may not have devoted study or reflection in light of disasters per se, often spurs and shapes the way in which we will (or will not) prepare for and respond to disasters. For example, theological beliefs about pain and suffering and the nature of God are often triggered in survivors and helpers alike when faced with a disaster. Consider the following, on the Sunday before Hurricane Katrina, I found myself in a church where the pastor ended the service by saying that everyone who had been in the pews that morning had been called to be there, and that anyone who evacuated, would be ignoring God's calling and lacked faith. Fast forward to the Sunday before Hurricane Gustav was predicted to hit the Gulf Coast region, I found myself in the pews of a church whose pastor preached that those who did not take precaution and do all they could to avoid potential harm were putting God to the test. Each of these sermons highlights distinct theological perspectives, as well as provides examples of how theology can influence behavior.

As highlighted in the examples above, disasters create a microcosm by compressing experiences that may have otherwise taken a lifetime to observe into the matter of moments or series of events through disaster spiritual and emotional care and research. Those which may have been previously thought of as purely philosophical questions become practical ways of living. Those which may have been previously unthinkable experiences become existential reality. A Christian integrative approach to disaster spiritual and emotional care and research has the potential to yield insights into (but not limited to) how faith and psychology: (a) help make-meaning of and find purpose in disasters, and what breakthroughs can be learned about theodicy; (b) contribute to extraordinary acts of altruism and generosity in the wake of catastrophe, as well as acts of violence and civil unrest; (c) facilitate human flourishing including sacred and peak experiences, or doubts about humanity and or God after disasters; (d) cause future mindedness such as preparedness activities, or spiritual surrender and changes in locus of control; and (e) differ across cultures, belief systems, and type of disasters (natural vs. human made), or provide points of shared experience despite differences.

Conclusion

Disaster spiritual and emotional care disaster care has received little attention within the integration movement. Therefore, those interested in pursuing competence in disaster spiritual and emotional care, specialized training, supervision, and consultation in disaster spiritual and emotional care is encouraged. Overall, future inquiry and interface with disaster issues may help deepen the science and practice of Christian integration. Perhaps more importantly, disaster spiritual and emotional care and research may also lead to new questions that warrant integrative inquiry, as well as more nuanced theories, research, and ultimately--practices.

References

American Psychological Association. (2002). Ethical principles of psychologists code of conduct. American Psychologist, 57, 10601073.

Aten, J. (2008). Equipping faith communities for disaster: The church disaster mental health project website. Journal of Applied Research in Economic Development, 5, 56-57.

Aten, J., Avila, It., Hosey, J., Topping, S., & Weaver, J. (2009). Organizing faith-based responses to Hurricane Katrina: An interfaith task force model. MEM Bulletin, 26, 9-10.

Aten, J., Madson, M., Rice, A., Chamberlain, A. (2008). Supervisor post-disaster strategies for promoting supervisee self-care. Training and Education in Professional Psychology, 2, 75-82.

Men, J., Moore, M., Denney, R., Bayne, T., Stagg, A., Owens, S., Daniels, S., Boswell, S., Schenck, Adams, J., & Jones, C. (2008). God images following Hurricane Katrina in South Mississippi: An exploratory study. Journal of Psychology and Theology, 36, 249-257.

Aten, J., & Topping, S. (2010). An online social networking disaster preparedness tool for faith communities. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 130-134.

Aten, J., Topping, S., Denney, R., & Bayne, T. (2010). Collaborating with African American churches to overcome disaster mental health disparities: What mental health professionals can learn from Hurricane Katrina. Professional Psychology: Research and Practice, 41, 167-173.

Aten, J., Topping, S., Denney, R., & Hosey, J. (2011). Helping African American clergy and churches address minority disaster mental health disparities: Training needs, model, and example. Psychology of Religion and Spirituality, 3, 15-23.

National Voluntary Organizations Active Disaster. (2009). Disaster spiritual care points of consensus. Arlington, VA: Author.

Jamie D. Aten, Ph.D.

Wheaton College

Author Information

ATEN, JAMIE D., Ph.D. Address: Department of Psychology, Wheaton College, 501 College Avenue, Wheaton, IL 60187-5593, (630) 752-5609. Email: jamie.aten@wheaton.edu. Title: The Dr. Arthur P. Rech and Mrs. Jean May Rech Associate Professor of Psychology and Co-Director of the Humanitarian Disaster Institute at Wheaton College.

Please send correspondence to her email address, thanks!