Running head: 1

Brenda L. Caballero

Winthrop University

2

Abstract

This paper explores the importance of assessing aspects of a client’s spirituality as pertinent to

social work direct practice. It recognizes that some of the problems and issues clients bring to

therapy stem from or are influenced by their spiritual/religious beliefs and their involvement in

faith-based groups. I argue that social work practitioners need to be aware of the phenomenon of

spiritual abuse, a term coined by pastoral counselors to describe a misuse of power in

spiritual/religious contexts that result in significant psychological distress and a disruption in

individuals’ relations with their significant others and with their social environment. I evaluate a

variety of theories and intervention modalities that can be applied to assess and address

spiritual/religious issues presented by clients to select a theory that, in my opinion, can be

applied successfully in working with clients who experience spiritual/religious abuse. Finally, I

present the argument that spiritual abuse is an empowerment issue, and as such, it is especially

pertinent to and congruent with social work practice with individuals, families and groups.

Keywords: Spiritual abuse, religious abuse, spirituality, cognitive theory, narrative theory,

cognitive behavioral therapy, object relations theory, relational family therapy.

3

In the practice of social work with individuals, families and groups we assess clients’

situations from a bio, psychosocial, spiritual perspective; looking for aspects of a client’s

emotions, cognition, behavior and social functioning that are influenced by the social

environment and the culture in which they live. As part of that systems perspective, in many

occasions, social workers encounter in their practice issues related to a client’s religious and

spiritual beliefs and their involvement in faith-based groups. For many individuals and

families, their affiliation to religious organizations is at the center of their lives. It greatly

shapes their world views, the meaning of their life’s processes, the way they define the

source and nature of their problems, the roles with which they identify themselves; and

ultimately, their own sense of identity. Scott Richards, Bartz, O’Grady (2009) argue that

when social work professionals have an understanding of a client’s spiritual worldviews,

they are not only able to establish better rapport with their clients, but also determine if there

are spiritual issues or concerns that need to be addressed as part of their interventions (p.

67).

Literature Review

The concept of spiritual abuse, also denominated religious abuse, was first addressed

and explored by social scientists in their study of cults or new religious movements (NRM).

“NRM’s are primarily religious groups/movements that operate apart from the dominant

culture—in our case, the Christian West—in which they are located and, in addition, seek

adherents from their host culture” (Healy, 2011). A diversity of helping professionals, in

their encounter with former members of such groups in practice, developed material to work

with them using diverse psychological models of cultic influence. In the attempt to

conceptualize this phenomenon, researchers and practitioners often encountered difficulty

4

finding a clear-cut definition of what constitutes harmful, abusive or pathological behavior

within diverse religious, faith-based settings. Clients who came to therapy as a result of

traumatic experiences within cults, presented a number of psychological disturbances, and

significant emotional and existential difficulties. Australian Social Worker David Ward

(2010) indicate that research studies and clinical observations of individuals who had left

NRM’s led to the identification of philosophies, rituals and practices within such groups that

were clearly physically and emotionally abusive. Empirically oriented research, focused on

observable behaviors, was useful to identify forms of “cult abuse”: boundary violations by

cults’ leadership, coercion and unethical behavior resulting in marked and significant

emotional distress (p. 900).

David Ward (2010) formulated a thesis on what he denominated toxic spirituality, or

spiritual beliefs and practices that “cease to be beneficial to the adherent, but instead become

a tool to inflict psycho-spiritual damage” (p. 899). Warp adopted the term spiritual abuse,

coined for the first time by pastoral counselors Johnson and VanVonderen (1991) to propose

the thesis that not all spiritually abusive behavior occurs in the context of cults. Johnson and

VanVonderen (1991) conceptualized spiritual abuse as “the mistreatment of a person who is

in need of help, support or greater spiritual empowerment, with the result of weakening,

undermining or decreasing that person’s spiritual empowerment” (p.20).

To explore the phenomenon of spiritual abuse within groups of Judeo-Christian

orientation, David Warp (2010) conducted a study on the experiences of individuals who left

a diversity of these groups, using Interpretative Phenomenological Analysis (IPA). IPA

consists of the analysis of the narratives of participants when describing their experience of

spiritual abuse, exploring not just the objective nature of the occurrences, but the subjective,

5

internal processes of the person subjected to spiritual abuse, and the meanings they ascribe

to such experiences (Ward, 2010, p. 901). From the narratives of the individuals in the

study, Ward (2010) identified six core themes consisting of: (a) leadership representing God;

(b) spiritual bullying; (c) acceptance via performance; (d) spiritual neglect; (e) manifestation

of internal states; and (f) expanding external/internal tension (pp. 903-908). These identified

common themes through the participants’ narratives provided the base to propose a

definition of spiritual abuse, not just as a phenomenon related to cultic involvement, but as a

psychologically damaging experience that occurs when there is a misuse or abuse of power

in any religious or spiritual context. Similarly, spiritual abuse adversely affects the

interaction of the individual with the social environment. Emerging sub-themes in this

Ward’s study (2010) such as: collective consciousness, family impact, social isolation and

submission to authority, suggest that this form of abuse has far-reaching social

consequences. In this sense, Ward argues that spiritual abuse can be identified as social

problem on its own right (p. 902).

Spiritual Abuse and Clinical Work

A study exploring the impact on counselors of their work with spiritually abused

clients in the United Kingdom, identified a variety of treatment modalities in working with

this population (Guby & Jacobs, 2009). These treatment approaches included: (a) Person-

centered transpersonal; (b) Existential phenomenological; (c) Solution focused therapy; and

(d) Psychodynamic and Gestalt. The clients seen by the counsellors in this study were from

diverse Christian backgrounds, including the Church of England and Catholic

denominations. The common concerns identified by these professionals in their work with

spiritually abused clients are similar to the core themes in Ward’s study, but went further to

6

include: (a) character assassination; (b) sexual abuse; (c) physical abuse and psychological

abuse, perpetrated by a leader who exerts an unhealthy form of power; (d) use of scriptures

considered ‘sacred’ by the adepts; and (e) use a leader’s ‘God-given authority’ to justify

abusive actions (Guby & Jacobs, 2009, p.191).

This small-scale study recognizes both the benefits and the disadvantages of clinical

approaches that emphasizes a worker’s empathic connection with the client, such as the

person-centered approach. As a benefit, connecting with a client’s emotional experience of

spiritual abuse, can lead to a better understanding of the client’s subjective experience and

inner processes, and provides the client with a model of healthy interpersonal relationships;

in contrast with the authoritative and domineering relationship established with the abusive

leader. As a disadvantage, it makes it more difficult for practitioners to distance themselves

from the traumatic material, opening themselves up to vicarious trauma, as the experiences

of their clients related to spiritual abuse have the potential to challenge their own cognitive

schemas and religious beliefs. Regardless of the practice framework chose to work with

these clients, Guby and Jacobs’s study (2009) recognizes the danger of a worker establishing

an agenda for the client and trying to influence a client’s views based on a practitioner’s own

spiritual philosophy (p. 202, para. 1).

Relational family therapy. In an article exploring religious-related abuse in the

family, Mandelj B. Simonič (2013) addressed the emotional aspects involved in religious

abuse and also its transfer across family generations. The author argues that certain

interpretation of religious beliefs can lead to “dysfunctional patterns of behavior in family

relationships and disruptions in emotion regulation processes” (p. 339). Religious abuse

occurs in the family when a parent or spouse utilizes religious beliefs to excuse or justify

7

physical or emotional abuse of his or her children and/or partner. Simonič (2013) proposes

the application of a Relational Family Therapy model in helping clients overcome the effects

of religious abuse and restore disruptions in emotion regulation processes in the family

system.

Relational family therapy (RFT) is a theoretical and clinical model that incorporates

aspects of self-psychology, object relations theory and interpersonal analysis. RTF explores

the client’s dysfunctional interpersonal dynamics in the family, understanding those

dynamics as mechanisms created to regulate painful emotions. From this perspective,

religious abuse is seen as a mean used by individuals to distance themselves from emotional

distress, avoiding their true source, which lies in the relations from the family of origin. The

goal of RTF is to assist religiously abused/abusive individuals to develop an awareness of

how they have been using faith as a hiding place, to disconnect emotionally from the other

family members, and to avoid personal responsibility. Simonič (2013) defines the

practitioner’s role as helping clients in the process of reframing their understanding of those

childhood experiences, and to gradually transform their notions of faith in a manner that is

no longer used to perpetuate abusive relationship patterns (p. 345).

Object relations theory. Object-Relations theory offers a unique framework to

understand spiritual concerns in the lives of clients, and its application in practice allows a

clinician to foster the client’s psychological and spiritual development simultaneously.

Gurney & Rogers (2007) argue that there is a cycle of relatedness between an individual’s

mental representations of the divine and his or her relationships, worldviews, and the

purpose and meaning he or she ascribes to life’s experiences (p.691). A person’s relation to

the sacred—whether viewed as positive, nurturing, available and responsive; or negative,

8

demanding and punitive—stems from internalized templates of his or her primary

relationships with caregivers. Conversely, an individual’s relationships with others are

organized in ways that unconsciously reflect his or her construction of the sacred. As an

alternative, this theory proposes that spirituality can be conceptualized as a “compensatory

object” in the lives of those who experienced poor attachments in their early development

and turn to religion in times of crisis or distress. The sacred, then becomes the “idealized,

caretaking, and nurturing other” (Davis, Moriarty & Mauch, 2013)

Recovery and restoration for the client overcoming spiritual abuse involves assisting

clients in the process of separating and differentiating from the beliefs, practices and

expectations of abusive spiritual leaders and “embracing a unique and personal relationship

with the sacred” (Gurney & Rogers, 2007). In this process, the spiritual crisis experienced

by the client, his or her clash with the incongruences between his or her beliefs, and his or

her suffering within a religious context serves as a an element that instigates the formation

of a more individuated spirituality. The practitioner provides a safe, self-sustaining, and

nurturing environment for the exploration and critical reflection of those internalized beliefs.

The clinical work involves then the recreation of fundamental elements of significant past

relationships, and reworking and remodeling the person’s blueprint for relatedness. “As

reparation is experienced and the development of an integrated self begins, a new blueprint

for relatedness will be established” (Gurney & Rogers, 2007).

Cognitive-behavioral therapy. The experience of spiritual abuse fosters in the

person highly distorted views of reality, of self and others. Those distorted religious views

can be operationalized as “the rejection of doctrines with emphasis on renewal, repentance,

restoration, redemption, forgiveness, grace and mercy, but strongly embraces ideas that

9

promote guilt, shame, unworthiness, personal destruction, and self-condemnation”

(Edwards, 2006). Clinical interventions using cognitive-behavioral therapy are relevant

with people whose view of religion and spirituality has been distorted by rigid beliefs and

spiritually oppressive teachings and practices. In the clinical work, religious and spiritual

cognitions can be challenged and corrected.

Clients come to therapy projecting the relationship with abusive leaders unto their

experience of God and their interpersonal relationships in general. In cognitive processing,

the clinician identifies, explores and assists the client in correcting cognitive errors that have

religious or spiritual content. Walker (2010) emphasizes the importance of keeping a non-

judgmental and supportively impartial attitude toward a client’s personal religiousness and

spirituality (p.178). One of the roles of the clinician in the context of CBT is to “normalize”

the client’s spiritual struggles, thus enabling the person to question distorted and oppressive

beliefs. While honoring a person’s religious roots and spiritual background, CBT can help

clients analyze how their religious belief system and derived values contribute to their

notion of self-worth and their “personal boundaries for behavior” (Edwards, 2006).

Narrative theory. Spiritual abuse is a form of oppression exercised by leaders

claiming divine authority and without accepting a proper accountability over the lives of the

members of their groups. Spiritually abusive systems saturate people’s minds with self-

denigrating beliefs that disempower them to assume control of their lives. To work with

clients who have lived the experience of spiritual abuse is a process of enhancing their

awareness of such oppressive forces and enable their liberation from those limiting cultural

influences. Narrative theory is based in the premise that a person’s life is an ongoing

process of constructing a personal narrative, what people believe about themselves, their

10

sense of competence and contentment, and the position they occupy in the world (Blanton,

2005, p. 81). Personal narratives, defined as a person’s view of themselves and their

problems, are shaped by beliefs that have their roots in socio-cultural-religious contexts.

These beliefs, assumptions or ideologies—secular or religious—are oftentimes passively

assimilated, overpassing the filter of critical thinking, and crystallized in rigid personal

narratives that are perpetuated through generations (Blanton, 2007, p. 215).

The application of Narrative theory to spiritual issues have been also denominated

transformative narrative therapy more commonly utilized in pastoral counseling. De Beer

& Müller (2006) defines transformative narrative therapy as an expansion of the use of

narrative therapy in the spiritual domain through the application of three basic principles:

It is dialectical and paradoxical. It embraces the paradox of evil and good coexisting

and hope and despair living together. (…) a person is encouraged to integrate her or

his problem-saturated stories with alternative ones, resulting in a more encompassing

and a compelling new narrative.

It is symbolic. The transformation is more fundamental and far-reaching when it

occurs at a symbolic level. (…) Even negative events, whether early childhood abuse

or adult traumatic experiences, can become symbolic of something spiritual,

something positive.

It is heroic. It does not seek easy victories, nor does it aim at superficial solutions. It

demands taking a courageous stance in life; it requires an unwavering willingness to

confront and slay one’s dreaded dragon. The end result is that a victim’s journey is

transformed into a hero’s adventure. (p. 77).

11

Spiritual Abuse and Cognitive Theory

From the perspective of cognitive theory, the domain of spirituality is conceptualized

as the core beliefs, and the values derived from those beliefs, that give meaning to a person’s

view of reality, to their life experiences and that motivate their actions. Johnson &

VanVonderen (1991) maintain that in spiritual abusive systems—where spirituality is used to

inflict psycho-spiritual damage—members struggle in the following areas: (a) the

development of a distorted image of God; (b) tendency toward extremes of perfectionism,

self-righteousness or shame, (c) development of a distorted self-identity, (d) a tendency to

the extremes of compliance or defiance in relation to authority, (e) problem in the area of

personal boundaries, (f) difficulty with personal responsibility, (g) lack of living skills, (h)

hard time admitting the abuse: the person have lost track of what normal is, it feels like they

are being disloyal to family, to church, even to God, and (i) difficulty with trust: hard time

trusting a spiritual system again (p.44).

Cognitive theory asserts that deeply held irrational beliefs about how things should

or must be are the root of a person’s most distressing emotions. These core beliefs or

schemas lead to faulty assumptions and result in dysfunctional coping skills: in the sense

that they prevent a person to succeed in achieving their life’s goals. Cognitive therapy

provides a suitable framework to work with clients who experience spiritual abuse mainly

because it is based in the premise that “even when some of a person’s beliefs are distorted,

the potential to correct them in light of contradictory evidence is great” (Walsh, 2010). In

cognitive therapy those cognitive deficits and distortions are explored and addressed. The

social worker assesses the client’s cognitive assumptions, identifies any distortions and

guides the client in reasoning through detailed, focused questioning with the purpose of

12

uncovering the rationality of thought patterns. The social worker serves the role of coach

and educator, helping the client experiment with alternative ways of approaching challenges

that will promote goal attainment.

When addressing spiritual issues in the context of cognitive theory the practitioner’s

role is not to question the validity of a client’s religious beliefs, but to guide them in

analyzing “how their religious belief system and related values contribute to their

conception of worth and their personal boundaries for behavior” (Edwards, 2006).

Cognitive therapy focuses on interventions that address a client’s distorted view of religion

and spirituality and its implications for their view of themselves, others, and their realities.

Clients who have lived the experience of spiritual abuse view religion as a force that is

emotionally and spiritually oppressive rather than a source of personal strength and

inspiration for the improvement of self and the betterment of society. Cognitive therapy is a

process in which the clinician and the client collaborate in a work of empirical investigation

and reality testing; considering new perspectives and alternatives for understanding reality

and the nature of problems, exploring and learning innovative problem solving.

In working with clients deal with the effects of spiritual abuse, the social worker

must endeavor to familiarize her/himself with the religious tradition and sacred texts that are

the foundation of a client’s belief system. Spiritually abusive systems are nothing but a

distortion of more orthodox views of the divine. Spiritually abusive leaders teach skillfully

manipulated and ill-interpreted notions derived from the foundational truths of universal

religious traditions. Those maladaptive interpretations can be treated in cognitive therapy as

testable hypotheses. The original sacred texts are then used by the practitioner to “examine

alternative interpretations and to generate contradictory evidence that support alternative

13

beliefs which may allow for therapeutic change” (Edwards, 2006). Utilizing the same

sacred writings manipulated by abusive leaders, the clinician encourages the clients to

embrace their religious heritage considering alternative perspectives, rather than completely

abandoning their spiritual roots.

Trauma-focused Cognitive-Behavioral Therapy

Based on the Ward’s (2010) investigation exploring the subjective states of those

affected by spiritual abuse and the physical and psychological repercussions of their

experiences, it is reasonable to consider the experience of spiritual abuse as a source of

trauma for the purpose of clinical work. In many instances, spiritual abuse is accompanied

by real or perceived threats of harm, and even physical or sexual abuse by members of the

clergy. According to a study on victims of destructive cults (De la Peña, 2000), the

pathology in the context of the structural organization of some religious movements is

sufficient to generate psychic trauma in their adherents. De la Peña (2000) claims that

victims of the most destructive religious movements present symptoms of Posttraumatic

Stress Disorder (p. 192).

Walker (2010) proposes a model for addressing religious and spiritual issues in

trauma-focused cognitive behavior therapy that is also appropriate in the work with children

and adolescents. Walker (2010) suggests that, in the context of trauma treatment, it is

helpful to assess whether a client’s religious beliefs play a role in exacerbating a client’s

symptoms or relieving the effect of the trauma (p. 177). In the assessment stage, the

clinician explores clients’ core religious beliefs and values with open-ended questions with

the goal of obtaining information to evaluate clients’ psychosocial and spiritual functioning.

In the initial stages of the intervention, normalizing spiritual struggles is part of the

14

psychoeducation piece in trauma-focused cognitive behavioral therapy (Walker, 2010). By

normalizing their struggle, and the projection of their relationship with the abusive leader

onto their notions of God, “we enable clients to question their wrathful and angry image of

God”, that will be probed and corrected on the subsequent stages of the intervention.

Elements of narrative theory are incorporated to TF-CBT. The use of stories or

narratives within the client’s religious tradition is helpful to enhance clients’ perspectives of

their traumatic experiences. The client is then encouraged to process their own experiences

and to create their own narratives. The clinician assists the client in creating this narrative,

inviting the client to reflect on what has changed since their involvement with the religious

group and what is different since the clinical work began. This reflection involves the

discovery of what the person has learned and what advice he or she might offer someone

else going through similar situations.

As part of the psychoeducation component in TF-CBT, the clinician can expose the

client to books or audiovisual material related to spiritual abuse, including testimonies of

former members of spiritually abusive churches. The clinician can provide assignments and

tasks to facilitate the exploration of cognitive distortions. With the use of sacred texts of the

client’s own religious tradition, the client can be asked to find parallels to their spiritual

struggle in stories from the scriptures. Most religious texts have narratives that intend to

make meaning of suffering and teach to overcome adversity through faith. The clinician can

assigned the client the task of identifying Bible characters or historical figures who struggle

with their faith, or made bad choices and were able to restore their lives and be successful in

the end Nonetheless, Walker (2010) discourages clinicians to attempt to answer clients’

existential questions, but rather help them process their thoughts and feelings about the

15

divine. For instance, the use of an “empty chair technique in which the client alternates

between asking God questions and stating what they think God’s responses” (Walker, 2010,

p. 179) can be useful.

Spiritually toxic teachings instill in adherents a tendency to overgeneralization and

dichotomous thinking patterns. This tendency is reflected in the client’s use of “strongly

worded statements” (Edwards, 2006) that contains words and phrases such as “ought”,

“should have”, and “must” in describing their experiences. As part of the behavioral

component of TF-CBT, the clinician can use the teaching of self-talk to assist clients in

reflecting on their words and their unique interpretation of those messages. When clients are

able to identify harmful thoughts and words in their own internal dialogue, the clinician can

direct them to create a different script that reflect a less rigid view of God. An example of

these thinking patterns can be statements such as “unpardonable sin”, “bad decisions are

made by bad people”, “doubting means you are spiritually weak and a backslider”.

The practice of mindfulness in TF-CBT is compatible with most religious traditions

if the clinician has the cultural sensitivity to adapt the technique to a particular client’s

spirituality. Highly conservative clients with a religious fundamentalist orientation might be

alarmed at the idea of a clinician teaching them to meditate. This practice can be adapted to

incorporate a client’s own spiritual practices and beliefs, like concentrating on the words of

Bible verses or the “Jesus Prayer”. Similar passages from the Torah or the Quran could be

identified in collaboration with clients of Jewish or Islamic traditions. Sacred texts can be

extremely useful to challenge dysfunctional and maladaptive thoughts and replace them with

highly positive, inspirational and constructive perspectives that are congruent with the

client’s own religious background.

16

Conclusion

Spiritual abuse is an issue of oppression that involves the misuse of power to

undermine a person’s strengths and to weaken a person’s sense of worth, value, competency

and self-efficacy. Spiritually abusive leaders consistently violate their followers’ personal

boundaries and their rights to self-determination. An empowerment based social work

practice needs to acknowledge this phenomenon and recognize its impact in the personal,

familial, social and spiritual struggles some clients bring to social work interventions. Most

theories used in social work practice provide a useful framework to assess and address

issues related to spirituality and are suitable in the intervention with clients who experience

spiritual abuse.

The experience of spiritual abuse generates cognitive distortions, maladaptive

thought processes, and erroneous assumptions. A cognitive theory approach in social work

practice focus on the evolution of these cognitive patterns and their impact on a client’s

internalized representation of the world that, in turn, influences a person’s configurations of

thought, action and problem solving. Cognitive interventions, such as TF-CBT, are

applicable in correcting clients’ erroneous beliefs with the potential of helping them adjust

cognitive possesses in a manner that facilitates their understanding of their spirituality and

how it impacts the attainment of their life’s goals.

However, it is important for the social work practitioner to be aware of the

limitations of cognitive theory in working with children and adults with cognitive

limitations. On the other hand, its emphasis on rationality may be unappealing for clients

whose spirituality relies more on emotional or instinctual experiences and responses.

Cognitive theory claims of “objectivity”, have the potential risk of the practitioner

17

overlooking the ways in which their own values can influence what is defined as “erroneous

thinking”. An awareness of one’s own biases, as well as knowledge of and respect for a

client’s religious or spiritual roots can lead to a more sensible application of this cognitive

theory in addressing spiritual issues.

18

References

Blanton, P. (2005). Narrative Family Therapy and Spiritual Direction: Do They Fit? Journal of

Psychology & Christianity, 24(1), 68-79.

Blanton, P. (2007). Adding Silence to Stories: Narrative Therapy and Contemplation.

Contemporary Family Therapy: An International Journal, 29(4), 211-221.

Davis, E. B., Moriarty, G. L., & Mauch, J. C. (2013). God images and god concepts: Definitions,

development, and dynamics. Psychology of Religion and Spirituality, 5(1), 51-60.

De Beer, S., & Müller, J. (2009). Using stories to assist storytelling in a pastoral setting: four

female pastors in dialogue with Mary Magdalene. Hervormde Teologiese Studies, 65(1),

76-80.

De la Peña, J. (2000). Trastorno por estrés postraumático en víctimas de sectas religiosas

destructivas [Posttraumatic stress disorder in victims of destructive religious cults].

Revista Académica Para El Estudio De Las Religiones, (3), 181-194.

Edwards, A. (2006). Cognitive and cognitive-behavioral therapy with religiously-oriented

clients: two case studies. Social Work & Christianity, 33(1), 36-57.

Gubi, M.G. & Jacobs,R. (2008). Exploring the impact on counselors of working with spiritually

abused clients. Mental Health, Religion & Culture, 12(2), 191-204.

Gurney, A. G., & Rogers, S. A. (2007). Object-relations and spirituality: Revisiting a clinical

dialogue. Journal of Clinical Psychology, 63(10), 961-977.

Healy, J. (2011). Involvement in a New Religious Movement: From Discovery to

Disenchantment. Journal of Spirituality in Mental Health, 13(1), 2-21.

Johnson, D. & VanVonderen, J. (1991) The Subtle Power of Spiritual Abuse. Minneapolis, MN:

Bethany House Publishers.

19

Richards, P., Bartz, J. D., & O'Grady, K. A. (2009). Assessing religion and spirituality in

counseling: Some reflections and recommendations. Counseling and Values, 54(1), 65-

79.

Simonič, B., Mandelj, T., & Novsak, R. (2013). Religious-Related Abuse in the Family. Journal

of Family Violence, 28(4), 339-349.

Walker, D. F., Reese, J. B., Hughes, J. P., & Troskie, M. J. (2010) Addressing religious and

spiritual issues in trauma-focused cognitive behavior therapy for children and

adolescents. Professional Psychology: Research and Practice, 41(2), 174-180.

Walsh, J. (2010). Theories for direct social work practice (2nd Ed.) Belmont, CA: Thomson

Brookes/Cole.

Ward, D. (2011). The lived experience of spiritual abuse. Mental Health, Religion & Culture,

14(9), 899-915.