Fostering Spiritual Care Competency among

Analysts – A Jungian Perspective

Joint IAAP/Vilnius University/LAAP Conference

Eckhard Frick sj
Klinikum rechts der Isar der Technischen Universität München
Klinik für Psychosomatische Medizin und Psychotherapie
Forschungsstelle Spiritual Care

Hochschule für Philosophie München

www.spiritualcare.de
1 | Vilnius 12.5.2018 Hochschule für
Philosophie

Dear Colleages, laba diena: First of all I would like to thank you for this
invitation to Lithuania: to Marianne Müller who brought up the idea, to
Gražina Gudaite who generously accepted a research cooperation in the
field of Spiritual Care Competency, and especially to Vanda Sodaitienė
who contacted health professionals in several fields: physicians and
nurses of the Republican Vilnius Psychiatric Hospital, the Vilnius
University Hospital, psychodynamic psychotherapists and a small but
precious group of Jungians. Last not least to my Jesuit brother Lukas
Ambraziejus who translated the SCCQ into Lithuanian and to Dalia
Kulvieciuviene who did the backward translation. To all of them and to
those who completed the questionaire a very warm Ačiū!
I am honoured to share with you some of our results and reflections about
Spiritual Care Competency.

1
 1. What is Spiritual Care Competency?
2. How can we assess it?
3. SCCQ: Validation and intercultural
project
4. SCCQ: The Lithuanian sample
5. Discussion: A Jungian perspective on
spiritual care competency

2 | Vilnius 12.5.2018 Hochschule für

Philosophie

Spiritual Care addresses patients’ needs, resources and problems in the

wide field of spirituality, comprising their religious belonging, but also
conflicts with their original church, mosque, synagogue or temple, with
believing without belonging, with existential questions as Irvin Yalom
described them: death, freedom and anxiety, isolation, meaning and
purpose in life. All these questions are addressed to ourselves, too. We
share them with our patients whether consciously or unconsciously,
whether verbally expressed or in a shame protected taboo zone.
Competency in this field is basically to address a hidden and privatized
experience which very often does not have suitable words to express it.

2
 1. What is Spiritual Care Competency?
2. How can we assess it?
3. SCCQ: Validation and intercultural
project
4. SCCQ: The Lithuanian sample
5. Discussion: A Jungian perspective on
spiritual care competency

3 | Vilnius 12.5.2018 Hochschule für

Philosophie

We looked for all available studies about spiritual care competency, most
of them in English and most of them in a cultural context influenced by
Christian traditions. Interestingly, we also found some studies which have
a Muslim context. We collected the already studied items, translated them
into German and submitted them to expert who also helped us in the face-
validation of what was our original tool.

3
 1. What is Spiritual Care Competency?
2. How can we assess it?
3. SCCQ: Validation and intercultural
project
4. SCCQ: The Lithuanian sample
5. Discussion: A Jungian perspective on
spiritual care competency

4 | Vilnius 12.5.2018 Hochschule für

Philosophie

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 5 | Vilnius 12.5.2018 Hochschule für
Philosophie

The current original instrument has been shortened during the validation
process. Studies with English, French, Spanish, Norwegian, Arab, Hebrew
and Italian versions are in preparation. You are welcome to cooperate in
this fascinating intercultural project.

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6 | Vilnius 12.5.2018 Hochschule für
Philosophie

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7 | Vilnius 12.5.2018 Hochschule für
Philosophie

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 0.31
0.52 0.30

s1 s2 s7 s8 s28
s19 s20

0.73 0.63 0.76 0.74 0.38

0.87 0.83

perceiving 0.77
negotiating
s30
0.77
0.61
0.51 0.33
s42
s12 0.55

0.86
0.40 Self 0.74
0.35 experience 0.80
s43
s13
& opening
0.48
Team 0.56
0.50
s48
s14 0.86 Spirit 0.57 0.38

0.60
s49
0.60
s15 0.26 0.55
0.56 0.83
0.24
0.64
s17
0.91 0.30
0.39 0.43

0.47

s3
0.52 0.88

Empowerment 0.59 Knowledge 0.23 Doc‘tation 0.85 s4

0.68
s5
0.20

0.53 0.61 0.72 0.66 0.58 0.92

s24 s25 s26 s35

s38 s39

0.28

8 | Vilnius 12.5.2018 Hochschule für

Philosophie

Let’s have a look on the structural equation modelling (SEM) following our
inquiry among 717 health professionals in Germany and Austria,
confirming our explorative factor analysis (EFA). We obtained a seven
factor structure for SCCQ comprising 26 Items: (1) Perceptual
Competences; (2) Team-Spirit Competences; (3) Documentation
Competences; (4) Self-awareness and proactive Opening Competences;
(5) Knowledge about other Religions Competences; (6) Interviewing /
negotiating Competences; (7) Proactive Empowerment Competences.
Interviewing Competences scored highest and Documentation
Competences lowest There were no relevant significant gender
associated but some age associated differences, e.g., in self experience
and deepening of personal spirituality. Double arrows in the structural
equation modelling are correlations, single arrows show the factor
loadings.

8
1
I am confident I can perceive the spiritual
needs of patients.
2
I am confident I can perceive the spiritual
needs of patients´ relatives.
7
I am able to perceive existential / spiritual 19
I am able to conduct an
needs even if patients have little relation to open discussion on
religion. existential issues.
8
I can also talk with non-religious patients 20
I am able to conduct an
about their existential / spiritual needs. open discussion on religious
28
I am able to tolerate the pain / suffering of issues.
patients and their relatives
30
My own spirituality shapes my dealings
12 In our team, we speak regularly about with others / sick people.
the spiritual needs of the patients. 42
I regularly approach patients to talk
13 In our institution (practice, clinic, etc.) with them about their spiritual needs.
there is a great openness to the topic of 43
I open verbally, but also non-verbally,
spirituality. a ‘space’ in which the patient may
14 In the team, we exchange regularly
bring spiritual concerns - but is not
about spirituality in patient support.
forced to do so.
15 In the team, we regularly exchange
about our own spirituality.
48
I regularly take care of deepening my
17 In the team, we have rituals (for own spirituality (for example, through
example farewell and interruption rituals) contemplation, meditation, worship,
to deal with problematic situations. etc.).
49
I regularly attend professional
development sessions on spiritual
topics.
24
I enable my patients to participate 3 I am familiar with
in religious activities / celebrations. 38
I am well aware of the
instruments (i.e., topic list)
25
In the case of therapeutic decisions, religious characteristics
for creating a short spiritual
I pay attention to religious / of patients from other
history.
spiritual attitudes and convictions of religious communities. 4 I am familiar with
the individual patient. 39
I take care that the
instruments / questionnaires
26
I encourage my patients to reflect religious characteristics
for structurally assessing
their spiritual beliefs and attitudes. of patients from other
spiritual needs.
35
I pay attention to the appropriate religious communities 5 I know how to document the
framework for spiritual are adequately
spiritual history of my
conversations. considered.
patients in a comprehensible
way.

9 | Vilnius 12.5.2018 Hochschule für

Philosophie

What items are united in a given factor? I shall read the first question of
each factor as an anchor-item, in order to give you an idea of our factors:
Perceiving: I am confident I can perceive the spiritual needs of patients
…

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 Correlations between SCCQ-Scores (N=714) and external variables

Self exp & opening

Knowledge about
Documentation

Empowerment
Team-Spirit

negotiating
perceiving

religions
1.99 1.02 0.67 1.31 1.71 2.28 1.81
M ± SD (Range: 0-3)
±0.61 ±0.66 ±0.76 ±0.78 ±0.72 ±0.73 ±0.75
Spiritual Care Competencies
perceiving (n=714) 1.000
Team-Spirit (n=711) .428** 1.000
Documentation (n=713) .381** .394** 1.000
Self experience & opening (n=713) .518** .409** .364** 1.000
Knowledge about religions (n=703) .310** .229** .224** .255** 1.000
negotiating (n=710) .581** .325** .229** .458** .246** 1.000
Empowerment (n=709) .541** .508** .341** .592** .357** .469** 1.000
Spiritual Care barriers (n=706) -.417** -.381** -.266** -.538** -.179** -.415** -.424**
s56 Own weaknesses & wounds hinder from spiritual
competency (n=595) -.089 -.099 .076 -.072 -.046 -.157** -.076

Spirituality Indicators
Actively believing vs. not believing (n=702) -.030 -.035 .010 .070 -.059 -.051 -.037
Prayer / meditation practice (n=690) .006 -.004 -.017 .127** -.035 -.014 -.010
s31 my S/R has no relevance at all for my profession -.240** -.147** -.112** -.448** -.085** -.195** -.262**
Age (n=688) .201** .121** .116** .419** .027 .169** .255**
Weekly work time (n=684) -.025 -.040 .021 -.096 .065 .051 -.004
Professional satisfaction (n=702) -.001 .039 -.002 -.043 -.013 -.023 -.048
Self efficacy expectation (n=700) .171** -.001 .047 -.054 .146** .196** .072

10 | Vilnius 12.5.2018 Hochschule für

Philosophie

I already told you that there are some internal correlations. Let us choose
the column “self experience and opening”. We find positive correlations
with negotiating / interviewing, with empowerment and with age.
Conversely, lack of time and other frequently mentioned “barriers” are
negatively correlated with this factor. We also tested a very “Jungian” item
mentioned by Cicely Saunders: the influence of my own wounds. We
tested it negatively, as a barrier, and found no influence. We will correct it
and maintain it in a positive way: own weaknesses & and wounds are a
help for spiritual care competency.

10
 1. What is Spiritual Care Competency?
2. How can we assess it?
3. SCCQ: Validation and intercultural
project
4. SCCQ: The Lithuanian sample
5. Discussion: A Jungian perspective on
spiritual care competency

11 | Vilnius 12.5.2018 Hochschule für

Philosophie

Now let‘s have a look on our Lithuanian sample which is small but which
nevertheless confirms the factorial structure found in the German
speaking sample.

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 The Lithuanian sample (N=181)

Women 173
Married/with partner 123

Confession
Catholic 147
Protestant 4
Jewish 3
Others 6
Without religion 20

Profession
Physicians 32
Nurses 103
Other professions 46
Age m=42.2 11.05

12 | Vilnius 12.5.2018 Hochschule für

Philosophie

As in the original inquiry, the LT sample is predominantly female and

Catholic. The majority of participants are nurses in a psychiatric hospital.

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 Lithuania: SCCQ-Factors & professions
(m, ANOVA)
Perceiving TeamSpirit Doc‘tation Self exp & Knowledge negotiating Empower Barriers
opening ment

Physicians
(n=32)
2.0625 .6922 .5417 1.15 1.2344 1.2969 1.3672 1.4167

Nurses
(n=103)
1.8583 1.3024 1.3464 1.3874 1.6250 1.2327 1.4337 1.6567

others
(n=46)
2.2076 .9329 .6884 1.3705 1.5109 1.6630 1.6033 1.1196

Total 1.9831 1.054 1.0352 1.3239 1.5253 1.3547 1.4650 1.4747

(N=181)

p .000 .000 .000 .113 .010 .003 .177 .000

13 | Vilnius 12.5.2018 Hochschule für

Philosophie

In the following slides, you see the medium item scores for each factor.
The range is from 0 to 3. Let’s have a look on the first two columns:
“others” (among them psychologists) score better in perceiving than
physicians and nurses. Nurses are the best in “team spirit”.

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 Lithuania: SCCQ-Factors & institutions
(m, ANOVA)
Perceiving TeamSpirit Doc‘tation Self exp & Knowledge negotiating Empower Barriers
opening ment

PD psycho- 1.9872 .7309 .5532 1.0213 1.2553 1.3936 1.2766 1.3617

therapy
(n=47)

Jungians
(n=24)
2.4896 1.1806 .9306 1.8104 1.8125 1.9167 2.0 .8696

Psychiatric
Hospital
1.8562 1.3051 1.3409 1.3944 1.5698 1.2241 1.4625 1.6628
(n=89)

University
Hospital
1.9545 1.0364 .9848 1.2636 1.6364 1.25 1.3182 1.6136
(n=22)
Total
(N=182)
1.9854 1.054 1.0387 1.3371 1.5279 1.3639 1.4679 1.4747

p .000 .000 .000 .000 .002 .000 .000 .000

14 | Vilnius 12.5.2018 Hochschule für

Philosophie

Let’s see how Jungians are scoring: They are champions in perceiving,
self-experience and opening, knowledge about religions, and
empowerment. And they have less complaints about hinderances than
others have. We are talking about perceived spiritual care competencies,
not about an objective assessment of capacities.

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 S57 „I think that my professional group has a
special spiritual competence”

strongly disagree (%) disagree (%) agree (%) strongly agree (%)

15.6 38.2 39.3 6.9

All (N=173)

29.8 53.2 12.8 4.3

PD psychotherapy
(n=47)

0 42.9 47.6 9.5

Jungians (n=21)

9.6 32.5 49.4 8.4

Republican
Vilnius
Psychiatric
Hospital (n=83)

15.6 38.2 39.3 6.9

University Hospital
(n=22)

p=.001 (χ2)

15 | Vilnius 12.5.2018 Hochschule für

Philosophie

We are still in the Lithuanian sample. When compared to the group of

psychodynamic psychotherapists. Jungians are more likely to affirm the
spiritual competency.

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 S58 „I think that my professional group has a
special spiritual competence”, namely:
N56: I work with oncology
patients, in collaboration
with oncologists I help
patients keep the faith and
hope, hence spiritual
topics and the meaning of
life are main themes, even
if not explicitly discussed.
N25: In my
workplace Minnesota
and 12 steps
programs are used,
these programs
discuss the higher
power.
N54: The topics of spirituality
often come up in psychotherapy.
These questions are directly
related to the individuation
process of a human being.
16 | Vilnius 12.5.2018
What do those who affirm a profession-bound spiritual competency tell us
explicitly? Arguments are:
N167: Spiritual needs and
spiritual life is part of the
patient's personality, hence it
N159: Psychologists
is important for psychologists
are trained and are
and psychotherapists to be
able to create space
emotionally and spiritually
to talk about spiritual
sensitive, empathic, to have
topics, help patients
tolerance for patient’s
find answers
spiritual needs. They also
need to know about the
meaning of spiritual and
religious life practices, they
need to fully acknowledge
N166: Because we understand their own spiritual (religious)
that spiritual matters have a life's values and attitudes.
huge impact on people's
mental health and can help
them see meaning during the N179: recognized
difficult times. and dictated by the
transcendent
N50: In their work psychotherapists function.
face human suffering, desperation,
quest for meaning and other questions
that are inevitably related to spiritual
matters. Holistic view does not allow
to separate spiritual topics from the
other topics.
Hochschule für
Philosophie
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 S58 „I think that my professional group has a
special spiritual competence”, namely:

-A holistic view of the patient’s

personality, encompassing spirituality,
-A Jungian view of the individuation
process & symbolism / transcendent
function
-The importance of spiritual coping
-A reference to the AA movement, famous
by Jung’s definition of AA spirituality:
spiritus contra spiritum, the holy spirit
against the spirit of wine

17 | Vilnius 12.5.2018 Hochschule für

Philosophie

What do those who affirm a profession-bound spiritual competency tell us

explicitly? Arguments are:

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 S59 „I think that my professional group is not
responsible for spiritual care”

strongly disagree (%) disagree (%) agree (%) strongly agree (%)

8.3 39.6 40.8 11.2

All (N=169)

8.7 37.0 43.5 10.9

PD psychotherapy
(n=46)

21.1 73.7 5.3 0

Jungians (n=18)

7.2 34.9 43.4 14.5

Republican
Vilnius
Psychiatric
Hospital (n=105)

8.3 39.6 40.8 11.2

University Hospital
(n=21)

p=.008 (χ2)

18 | Vilnius 12.5.2018 Hochschule für

Philosophie

The cross check is still clearer: Jungians reject the uttering that the are
NOT responsible for spiritual care.

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 S60 „I think that my professional group is not
responsible for spiritual care” because:
N4: We don't have enough
time and a dedicated space
(if we'd have time).
N53: Almost no attention for
spiritual competency in the
training program for
psychologists. Not enough
attention for spirituality in the
training program for
psychotherapists, no connection
with practical work. During
supervisions psychotherapists in
training are not encouraged to
reflect on their religious
experiences.
N98: A lot of work for
one nurse... Medical
tasks come first.
N163: Patients don't stay long
in our unit. I think that our
group is not responsible for
N43: These are spiritual help, however could
different areas, in a way provide more support
psychologists are not to people to whom
responsible for spirituality/religiosity is an
providing spiritual important part of their life and
support. one of the sources of support.
N96: I think that we don't have
enough competence in religious
and spiritual topics.
N44: I think that
emotional
N16: Because it is the conversation could
competency of serve as a kind of
clergymen. psychotherapy.
The psychiatrist
could offer to go
to church to talk
with a priest.

19 | Vilnius 12.5.2018 Hochschule für

Philosophie

What are arguments for not being responsible, once more in the whole
Lithuanian sample?
- The time barrier even if the importance of spirituality is acknowledged
- The referral to chaplains
- The lack of training

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 S60 „I think that my professional group is not
responsible for spiritual care” because:

- The time barrier even if the

importance of spirituality is
acknowledged
- The referral to chaplains
- The lack of training

20 | Vilnius 12.5.2018 Hochschule für

Philosophie

What are arguments for not being responsible, once more in the whole
Lithuanian sample?
- The time barrier even if the importance of spirituality is acknowledged
- The referral to chaplains
- The lack of training

20
 1. What is Spiritual Care Competency?
2. How can we assess it?
3. SCCQ: Validation and intercultural
project
4. SCCQ: The Lithuanian sample
5. Discussion: A Jungian perspective on
spiritual care competency

21 | Vilnius 12.5.2018 Hochschule für

Philosophie

I would like to conclude with some remarks which may introduce our
discussion.

21
 Jung, Alsatian pastoral conference of May 1932 (CW
11, par. 509)

Among all my patients in the second half of life—

that is to say, over thirty-five—there has not been
one whose problem in the last resort was not that
of finding a religious outlook on life. It is safe to
say that every one of them fell ill because he had
lost that which the living religions of every age
have given to their followers, and none of them
has been really healed who did not regain his
religious outlook This of course has nothing
whatever to do with a particular creed or
membership of a church.

22 | Vilnius 12.5.2018 Hochschule für

Philosophie

Very often quoted is Jung’s allocution about the “religious outlook” which
may be lost in our biography and which may be regained in analysis.

22
 Kast Psychother For 16 (2008)

23 | Vilnius 12.5.2018 Hochschule für

Philosophie

I fully agree with Verena Kast that Jung uses “religion” in the broad sense
we found in William James, too and which we call nowadays “spiritual
experience”. “Religion” has two etymologies. The first one, coined by
Cicero has its root in “relegere”: to read again, to observe traditions,
rituals, pious behaviours. This meaning is rejected by many
cotemporaries. They may prefer another etymology: “religare”, to be
attached, to be linked to a human or dive person.

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 „The process of individuation – Exercitia spiritualia
of St Ignatius of Loyola“ (Jung 1939/40)

„[…] does the feeling of being anticipated engender a feeling of purpose? In

other words, have we the feeling that life has meaning? I must say here,
from the psychological point of view, that the discovery or experience of
having been anticipated always brings a feeling of meaning with it. If I
discover that I have been anticipated it makes an enormous impression
upon me: I could not in that moment clearly define the meaning of my
life, but I feel it as something living.. We could perhaps formulate it : ‚it
must have a meaning‘ but what peculiar kind of meaning is it? A certain
line of thought, for instance, is developed through a series of dreams:; and
I discover that I am the duplicate of my unconscious anticipation of
myself; at the same moment I am filled with a sense of purpose as if a
secret arrangement of my fate existed. One no longer asks ‚What meaning
has my life‘, but one is filled with the meaning itself (81).“

24 | Vilnius 12.5.2018 Hochschule für

Philosophie

In his seminars about the Spiritual Exercises interpretes a central phrase

formulated by Ignatius of Loyola: “El hombre es criado” – the human being
is created. For Jung, being created is an equivalent of being anticipated by
the unconscious. The big existential and spiritual questions of meaning
and purpose - may be asked in the religious context of obedience towards
God, or translated into the spiritual framework of meaning and purpose, or
reformulated in the process of individuation.

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 25 | Vilnius 12.5.2018 Hochschule für
Philosophie

Observatione et calculo. Let me finish with our meeting’s lemma: We have

observed spiritual care competence and we have calculated a lot,
especially my friend and colleague Arndt Büssing and our doctoral
students Mayla Theiss and Philip Ziemer. But what does the person in the
middle, between observation and calculation? SHe brings together, throws
together, sym-bolizes what research obtained by data collecting and
statistics. That’s what we can try to do now in our discussion.

25
 Fostering Spiritual Care Competency among
Analysts – A Jungian Perspective
Joint IAAP/Vilnius University/LAAP Conference

Eckhard Frick sj
Klinikum rechts der Isar der Technischen Universität München
Klinik für Psychosomatische Medizin und Psychotherapie
Forschungsstelle Spiritual Care

Hochschule für Philosophie München

www.spiritualcare.de
26 | Vilnius 12.5.2018 Hochschule für
Philosophie

Dear Colleages, laba diena: First of all I would like to thank you for this
invitation to Lithuania: to Marianne Müller who brought up the idea, to
Gražina Gudaite who generously accepted a research cooperation in the
field of Spiritual Care Competency, and especially to Vanda Sodaitienė
who contacted health professionals in several fields: physicians and
nurses of the Republican Vilnius Psychiatric Hospital, psychodynamic
psychotherapist and a small but precious group of Jungians. Last not least
to my Jesuit brother Lukas Ambraziejus who translated the SCCQ into
Lithuanian and to Dalia Kulvieciuviene who did the backward translation.
To all of them and to those who completed the questionaire a very warm
Ačiū!
I am honoured to share with you some of our results and reflections about
Spiritual Care Competency.

26