1. Introduction
Belcher et al. (
1991) have suggested that homelessness can be divided into three stages that are often progressive in their development. In Stage 1, what is called Marginal Homelessness, an individual’s connection to a home is tenuous and episodic. A single setback may threaten this connection significantly. Though not entirely without housing resources, individuals in this stage may still utilize services provided to the homeless community including clothing drops and soup kitchens. Stage 2, Recent Homelessness, involves the recent (typically within the past nine months) loss of housing. Despite no longer being able to afford shelter, people in this stage still maintain hope that they will be able to recover their losses (job, house, familial relationships, social standing, etc.) and still more closely identify with the community they were a part of than with other homeless individuals. Common issues that surface during this time center around increasing friction with family and friends who may supply temporary housing, depression, substance abuse, loss of self-esteem, shame, and dwindling healthcare resources. In Stage 3, Chronic Homelessness, individuals have typically been without housing for over 1 year and have accepted their experiences on the street as normative and grown very suspicious of people who they consider part of mainstream society. At this point, individuals experience social decompensation as a result of severe stress, and subsequently experience a deepening decline in mental and physical health symptoms, paranoia, as well as in-grained patterns of addiction.
In a recent report by the Institute for Studies of Religion at Baylor University, it is estimated that 60% of emergency shelter beds for homeless individuals are provided by Faith-Based Organizations (FBOs) nationally (
Johnson et al. 2017). FBOs are institutions for which a particular religion (e.g., Jewish, Christian, Buddhist, etc.) creates the primary inspiration and motivation for providing services to individuals and their families. Cities in which FBOs provide the majority of shelter beds in their community also tend to have the smallest percentage of unsheltered homeless overall. For this reason, FBOs provide the majority of support for what is known as “the safety net of all safety nets” to prevent individuals and families from falling into irrecoverable destitution. Rescue missions are a type of FBO that exist to provide holistic interventions for problems that create poverty and homelessness. These programs involve shelter, food, religious education, substance addiction treatment, and psychological counseling. Whereas many government institutions target lack of housing as a primary cause of homelessness, rescue missions (and FBO in general) view homelessness as a symptom of a larger societal problem that is a direct result of psycho-social and spiritual breakdowns that lead to a loss of relational support, and, consequently, a complete cessation of productive energies which a person needs to possess to become a contributing member of society.
Studies on homelessness and shelters rarely involve any direct focus on religion and spirituality.
Belcher (
2003) acknowledged that while this may be unsurprising given the destitution and need for basic care that homeless individuals present with at shelters, spirituality remains relevant for people experiencing homelessness, even if primarily in the form of spiritual crisis:
Although many people who are homeless continue to search for meaning in their lives, others who are homeless give up hope and become ghosts of the people they once were. Over time, it becomes difficult to reconcile a life of homelessness with a God who is benevolent, omniscient, guiding, stable, and caring. Many people who are homeless have given up on God both directly and indirectly; they no longer live in anticipation of God’s transforming power.
(p. 184)
Unfortunately, these spiritual needs remain unaddressed for many of the homeless who receive assistance through non-faith-based shelters.
However, despite the critical role that rescue missions play in preventing individuals who are caught in the cycles of homelessness from reaching even deeper points of destitution, the populations that rescue missions minister to are almost completely unrepresented in psychological research. These groups of people fall far outside the bounds of the oversampled and over-represented WEIRD (Western, Educated, Industrialized, Rich, and Democratic) populations. Beyond demographic statistics, little is known about the psychological health of such persons. Likewise, even though FBOs provide a significant amount of shelter-based services for homeless individuals, there are few studies that have empirically investigated the role that religion and spirituality assume in the lives of such people. There is also a scarcity of program evaluation information that could provide any insight regarding the influence rescue missions have on the psycho-social-spiritual outcomes for those to whom they wish to minister. For these reasons, we conducted a program evaluation of one such Rescue Mission (RM) in rural Maryland. Given the salience of religious/spiritual content in such programs, we were interested in investigating any effects the program had on these qualities in residents staying at least three months.
4. Methods
4.1. Participants
Participants were 121 men, aged 19 to 60 years of age (
M = 40.6,
SD = 12.2) who were consecutive admissions to a residential rehabilitation center between August 2011 and July 2013. Most individuals were referred to this center because of issues relating to substance and alcohol abuse. However, co-morbid issues regarding emotional and family issues, homelessness, and vocational issues were also prevalent (see
Table 1 for a breakdown of psychological issues). In terms of race, 69% were Caucasian, 13% were African-American, 7% selected “Other”, and 11% did not indicate a race. Concerning religion, 87% were of some Christian denomination, 5% indicated a non-Christian faith or were agnostic, and 8% did not respond to this question. Regarding education, 75% indicated some high school to some college educational experience. Two percent had only a grammar school education, 13% had a college or graduate degree, 6% had a technical/trade diploma, and 4% did not indicate a response. At the time of admission, 70% were unemployed (mean length of unemployment was 84 weeks), and 88% had been previously arrested, with 20% currently on parole at the time of admission.
After approximately three months, participants remaining at the center were again assessed. The mean number of weeks between assessments was 16 (range: 2 weeks to 48 weeks, SD = 7.6). The sample of 55 men did not differ from those who had left the center in terms of race, religious affiliation, education level, health status, and marital status. However, those who remained for the three months were significantly older (M = 43.1 years) than those who left (M = 38.6 years), t(119) = −2.10, p < 0.05, d = 0.39. When comparing those who left (n = 68) with those who stayed (n = 53) on the ASPIRES, no significant differences were noted on the five scales (Wilks Λ = 0.92, multivariate F(5,114) = 2.08, p > 0.05). Overall, there does not appear to be any systematic differences either demographically or numinously between those who stayed and those who left.
4.2. Measures
The Assessment of Spirituality and Religious Sentiments (ASPIRES). Developed by
Piedmont (
1999,
2020) the ASPIRES is a 32-item measure of numinous motivations. The scale is comprised of two sections. The first section is a measure of Religious Sentiments, further comprised of two sub facets: Religious Involvement (RI) and Religious Crisis (RC). The first nine items measure RI, which captures the extent to which religion is an important part of one’s life, including how often one engages in religious activities such as reading sacred scriptures or attending religious gatherings. Responses are recorded using a variety of Likert-type sets. RC captures the degree to which one feels a sense of strain or conflict with the transcendent, which
Piedmont and Wilkins (
2020) referred to as lacking Worthiness. For the purposes of this study, we used the RC facet to operationalize R/S struggle. Responses on these four items are recorded using a five-point, Likert-type response set ranging from strongly disagree (1) to strongly agree (5). Alpha coefficients for the current study are reported in
Table 2.
The second section measures spiritual transcendence. Spiritual Transcendence is defined as a universal human capacity to understand one’s life from a broad, eternal perspective. The construct of Spiritual Transcendence is comprised of three sub-facets: Prayer Fulfillment (10 items), Universality (7 items), and Connectedness (6 items). Prayer Fulfillment refers to a sense of satisfaction or joy as a result of personally encountering the transcendent. Universality refers to a belief in the unitive nature of life. Finally, Connectedness refers to a belief in ones’ participation in a larger human reality that extends beyond generations and groups. Responses are recorded using a five-point, Likert-type response set ranging from strongly disagree (1) to strongly agree (5). Alpha coefficients for the current study are reported in
Table 2.
Piedmont and Wilkins (
2020) provide information on the construct and predictive validity of this scale.
Affect Balance Scale. Developed by
Bradburn (
1969), this 20-item true–false scale captures these dimensions of affective well-being: Positive Affect (PAS), Negative Affect (NAS), and Affect Balance (NAS subtracted from PAS). Scores on these scales have been shown to correlate with global happiness (
Lowenthal et al. 1975). In the current sample, alpha reliabilities for PAS and NAS were 0.69 and 0.73, respectively, for Time 1 and were 0.67 and 0.75, respectively for Time 2.
Delighted-Terrible Scale. This scale was developed by
Andrews and Withey (
1976) as a cognitive measure of global well-being. Participants rate their overall level of life satisfaction on a Likert scale of 1 (terrible) to 7 (delighted). As a single-item scale, it is not possible to obtain an alpha reliability estimate for this scale.
Personal Problems Check List for Adults (PPCL). Developed by
Schinka (
1985), this 208-item checklist was designed for adults aged 18 to 60 years. Respondents simply check those items that represent an area of distress currently being faced. Items are grouped into 13 areas: Social, Appearance, Vocational, Family/Home, School, Financial, Religion, Emotional, Sexual, Legal, Health/Habits, Attitude, and Crises. This scale was not constructed to be a multi-scale inventory; items were selected for content coverage on the basis of expert judge panels.
Piedmont et al. (
2000b) provided evidence of reliability and validity for the instrument for both student and clinical samples. For the purposes of this paper, only the total number of problems checked was used.
Psychiatric Diagnostic Screening Questionnaire (PDSQ). Developed by
Zimmerman (
2002), this 225-item scale is self-administered and screens for DSM-IV (
American Psychiatric Association 1994) Axis I disorders. The clinical areas assessed by the PDSQ are listed in
Table 1. Individuals check issues they are experiencing, and scores for each scale are found by summing the number of indicated responses. A total raw score is also obtained that can be transformed into a T-score based on normative information presented in the manual. Cut-off scores for each subscale have been identified that indicate the possibility of a clinical diagnosis. Scores have a sensitivity of 0.90, a mean negative predictive power of 0.97, and a mean positive predictive power of 0.28. The scale is only a screener and should not be used without a concurrent diagnostic interview. However, scores can be a useful indicator of psychopathology. There are no internal validity scales and a fairly high level of reading ability is necessary. In the current sample, alpha reliabilities for the 13 scales ranged from 0.63 (Somatization) to 0.96 (Anxiety) with a mean alpha of 0.86 at Time 1. For Time 2, alphas ranged from 0.59 (Somatization) to 0.97 (Anxiety) with a mean alpha of 0.84. For purposes of this report, only the total number of symptoms score is used.
Intake Demographic Form. Developed for the purposes of this study, this form was completed on entry into the center. The form contained questions about personal demographics (e.g., age, marital status, education level) and also asked clients to indicate their usage of various substances over the past month. Participants also provided information on their recent employment status.
Client Evaluation Assessment. Developed for the purposes of this study, this form was given to clients after being in the program for three months (or upon their departure). Survey questions queried clients about their perceived efficacy of the program during their residence at the center. The seven items examined in this assessment evaluated the extent to which clients believed they had grown spiritually and emotionally and felt prepared to manage the personal, social, and financial aspects of their lives. All responses were provided on a seven-point Likert-type scale ranging from strongly disagree to strongly agree or from not much to very much, depending on the question.
4.3. Procedure
The Program. The residential rehabilitation center is a Christian-based Rescue Mission located in rural Maryland. This center can accommodate up to 40 men at one time, who can stay for as long as they feel comfortable, although the initial program of activities is designed to last from 3 to 9 months. Extended programs are also available for clients who qualify (e.g., finding some gainful employment in the community). Clients are mostly referred by community mental health and social agencies, the judicial system, and churches. The men who come to the center do so as an act of last resort, having exhausted all other living options. While at the center, the men are involved in a number of programs including individual and group therapy, AA/NA (substance abuse treatment programs) groups, vocational training, General Education Diploma (GED) classes, and spiritual development. The aim of this program is to rescue men from lives of addiction, homelessness, and mental illness and to reintroduce them back into the community as productive and useful citizens.
Assessment Protocol. Within 7 days of entering the center, participants provided informed consent to participate in the study. Clients were free to refuse to complete the assessment forms without prejudice. Clients completed the forms in their own time, usually in one sitting. However, some men required longer to finish all the required materials. It would take from 60 to 90 min to fill out all the forms. After approximately three months at the center (or upon their departure from the program), clients were once again asked to complete the assessment materials. The order in which the forms were presented was varied to control for order effects. For those who completed the forms when leaving the center, the time interval between assessments may be less than three months. Because some participants did not complete all forms, sample sizes will vary across analyses.
6. Discussion
There are two important aspects to this study. First, it examines a very under-represented group: those individuals who are quite marginalized and existing at the fringes of society. These are individuals who are the most vulnerable and the most overlooked in the research literature. As such, the current study fills an important gap in the knowledge base. Second, and more importantly, investigating the role of the numinous in this sample provides a very important test of the generalizability of current findings in this area. The great majority of studies on religiousness and spirituality (R/S) have focused on mainstream groups, including an overrepresentation of White, middle-class, Protestant individuals (
Ecklund 2020). It has only been in the last decade that efforts have been made to include non-Christian groups in the research process. The obtained findings have been quite consistent: religiously oriented individuals do seem to experience positive emotional and physical benefits associated with their belief systems. This is especially true with regards to religious coping, where including numinous aspects facilitates better emotional adjustment. But the real test of these associations can be found by investigating the role of the numinous in such socially, politically, and economically marginalized individuals. Several key questions emerge: Are R/S constructs even relevant to such individuals? Do religious beliefs mean nothing to those that society has both rejected and forgotten? Or, do religious beliefs become essential for such individuals, providing important sources of emotional support and encouragement in times of such challenges?
It is easy to believe in a just, kind God when everything is going your way. It is an entirely different reality when one is feeling oppressed and rejected; the mainstream values associated with religion and faith may only serve to remind the downtrodden of their powerlessness. Further, some religious beliefs may even blame such individuals for their predicament, that such rejection may be a sign of spiritual weakness or inadequacy. Thus, the current sample offers an important look at just how important and relevant R/S constructs are in the lives of such marginalized men.
In response to these questions, the current findings do offer some interesting insights. First, scores on the ASPIRES ST scales were all in the average range. These socially alienated men do have levels of spirituality consistent with a representative sample of men their own age who are not so disconnected. Spiritual motivations do have meaning and relevance to these men and scores in these dimensions were related to aspects of emotional well-being and life satisfaction. We believe this finding represents the true robustness of the numinous for influencing the psychological world of all people. It also supports the hypothesis that the numinous represents a universal, psychological quality.
Second, this sample scored high on the RC scale, indicating feelings of rejection and alienation from God. This may be a consequence of their life situations, and the internalization of the rejection these men have experienced from family, friends, and community. More than just an impaired sense of self-esteem, high scores on RC indicate the presence of an existential crisis of worth and value that is independent of feelings of depression, anxiety, and loneliness. Such individuals are at risk of developing psychological difficulties (both emotional and characterological problems;
Piedmont et al. 2020), as well as at risk of self-destructiveness (e.g., suicide, substance abuse;
Piedmont and Wilkins 2020). As such, it was not surprising to find significant, positive correlations between RC and scores on the psychological symptoms and personal problems scales. Scores on the ASPIRES clearly demonstrate that while these men are spiritually aware with an eye towards the transcendent, there are clear existential conflicts that create significant personal vulnerabilities and keep them at risk of further marginalization: It was not unexpected that this sample had high levels of psychopathology.
The rescue mission certainly recognized the spiritual and religious issues that confront these men and attempted to provide a compassionate response. What the ASPIRES data reveals about the programs offered at the mission, is that their focus is more on the religious sentiments aspects of faith than on the spiritual dimensions. Programs were designed to provide a safe, supportive, environment where these men could attempt to regain personal balance and direction. The impact of these programs focused strongly on involvement in ritual and practice. It is not surprising, then, that scores on the ASPIRES RI scale increased significantly over the three months. Learning improved prayer techniques, involvement in religious services, and working in tasks that support the common good of the mission appear to help these men develop the practical aspects of a spiritual life, although levels of spirituality were not affected. Second, it is encouraging to note that the programs at the mission also significantly reduced levels of RC over time. These men felt less isolated and rejected by the God of their understanding and encountered a more compassionate, loving God who, despite their marginal status, does indeed love and care for them as well. As a consequence, these men were less existentially vulnerable, which ought to allow them to approach life with more confidence in themselves and their own sense of worthiness.
6.1. Study Strengths and Limitations
One value of this study is its utilization of well-validated, standardized measures. Having scales that are normed enables an assessment of mean levels of emotional problems and spiritual/religious motivations. Such values can give an empirical sense of how the current sample compares to the general population. As seen here, it is important to note the normative standing of these men on spirituality, underscoring the relevance and importance of this construct for understanding the mental lives of all people, irrespective of their social-economic standing. Further, the pattern of findings here is consistent with those obtained previously with an inner-city, dual-diagnosed substance abuse sample (
Piedmont 2004); the ASPIRES was found to predict a number of important outcomes longitudinally. Specifically, higher scores on the ST scale were found to also predict more positive involvement in the therapeutic regimen as well as more favorable outcomes.
Research with marginalized samples presents its own set of challenges, many of which were encountered here. One issue concerns the intrinsic transientness of the sample; people come and go from a center for a myriad of reasons, including relapses into substance abuse, pending criminal charges, and subject fatigues/loss of interest with the program. Drop-out rates can be challenging, with this study losing approximately 54% of the original sample. A second challenge is finding the time to obtain the necessary assessments and monitoring the conditions under which the measurements are being obtained. While the original set of assessments were closely monitored by program staff and the researchers (RLP), the follow-up assessments were less structured. This study also lacked staff member ratings of client success and level of engagement in the program. This information would certainly have complemented the self-report scores. Given the inherent fluidity of the current sample, we did experience challenges in obtaining a meaningful sample size. Our nominal sample of 55 is small and may help explain both the magnitudes and patterns of obtained associations; a larger sample size would have certainly provided a more reliable index of the program’s impact.
Because no control group was included in this study, causal inferences cannot be derived from these data. While scores did change over time, it cannot be determined whether this was due to specific aspects of the program itself, or a function of some other, extra-program experiences (e.g., employment opportunities). Future research should attempt to isolate those aspects of the program that are related to specific improvements in particular numinous dimensions. For example, while we postulate that the strong focus on religious activities such as attending services and Bible study groups was responsible for the changes on the Religious Sentiments scales, the obtained data do not allow for a direct empirical link to be made.
Another practical limitation of the data concerns the attrition of men from the mission over time. As noted above, this group of men is quite fluid in terms of their presence at the mission. Why men decide to leave is not known, it could be for a number of reasons including being terminated by the Mission for noncompliance with program rules, not finding the program personally useful, and being incarcerated. Even if present for the duration of the study, individuals sometimes did not complete all forms, so sample sizes do vary over the analyses. In order to conserve power for the analyses, missing data were handled using the case-wise strategy rather than the list-wise approach. This may introduce some error because slightly different groups of men are being examined across analyses. Clearly, these initial findings are in need of a more controlled replication effort. Further, there was no examination of potential expectancy effects (i.e., program staff may have biased respondents to make favorable ratings about themselves and the program at Time 2), which may have influenced the findings. However, this seems unlikely given that participants did change in some of the numinous constructs but not all. Any implicit staff influence would have impacted scores on all scales, not only some of them.
Finally, these findings are from only a single site, located in a rural location. As such, the current findings are in need of replication using different missions (especially those from divergent faith traditions) located in various areas (e.g., inner-city, suburban). Would different centers focus on different aspects of the numinous that would result in different patterns of change? While it is interesting to note the average overall levels of spirituality in the current sample, it must also be noted that there is a self-selection process at work here. Individuals who are atheistic or agnostic may avoid going to a rescue mission entirely or may quickly tire of the religious regimen that such institutions provide. Thus, the current sample may be comprised of only those individuals who possess a spiritual interest.
6.2. Implications for Future Research
While this study is one of only a small handful of projects that have examined this very marginalized sample, the findings are consistent with previous research using both similar and more mainstream samples. The ASPIRES continues to demonstrate itself as an empirically useful instrument that can provide insights into the numinous motivations of respondents. Because scores on this instrument have been normed, it can provide useful insights into the mean level functioning of samples in a manner that facilitates cross-sample comparisons. The ASPIRES has been broadly used (e.g., cross-culturally, cross-faith) and there is a large validity literature. It is also one of the few measures of spirituality indexed by the Mental Measurement Yearbook (
Schoenrade 2014). It is critical when working with marginalized samples that well-validated instruments be used that provide standardized assessments with useful interpretive and predictive validity.
It may be time for research to begin to conduct more integrative research paradigms. Much has been learned in the past 20 years about the role and value of R/S constructs (e.g.,
Pargament 2013) and there have been advances in theory development (e.g.,
Piedmont and Wilkins 2020) that outline the psychological significance and action of numinous constructs to enable the development of research that is more proactive in scope. For example, it is time to develop specific therapeutic interventions that are strictly of a psychological nature and to assess their impact on psycho-social-spiritual development and adaptation. Rather than just measuring the spiritual dimensions of different groups, the focus should now begin to move towards more controlled, experimental studies that can add greater depth to our understanding of the numinous in the mental lives of people. It is becoming clear that R/S constructs (or the numinous) are universal aspects of human functioning that are independent of other, already existing psychological constructs. Everyone possesses, to some degree, numinous motivations irrespective of language, culture, religious affiliation, and, as shown here, economic/social status. These levels of the numinous do have significant psychological implications. It is time to start more systematically evaluating these constructs in the context of controlled experimental studies so that the true value of these variables can be more clearly articulated to the field.
6.3. Implications for Spiritually Integrated Psychological Care
Bringing R/S into psychological care is not a novel concept.
Stewart-Sicking et al. (
2019) categorized R/S intervention strategies into four areas of therapeutic action: (a) the level of the client’s ecological system (individual, family, organizational, etc.), (b) level of critical reflection and transformation of the client’s existing R/S framework, (c) the phenomenological level of experience addressed (conscious, unconscious, or transpersonal), and (d) the degree to which the intervention is embedded in a R/S tradition. The rescue mission we studied utilized all four of these methods. First, participants in this sample had all experienced an ecological crisis through societal alienation that spanned their micro to macrosystems, effectively severing their support structures in terms of family, work, and social services in their communities. In effect, these were community-less people. Thus, the ecological context for these men itself was a problem. The rescue mission services are effective in part because they employ a R/S frame to reinvent an ecological system by providing a new community of belonging inclusive of Christian fellowship, twelve-step support, and gainful employment.
Second, the current findings support the hypothesis that the rescue mission was effective in addressing the existential turmoil of participants’ religious crises through a transformation of the client’s R/S coping resources. It is perhaps in this way that a R/S-based treatment program like that of the rescue mission is uniquely poised to address numinous constructs. Because the Christian religion emphasizes clearly the innate image of God in all people, the unconditional love of God, and the unmerited mercy of God to forgive anyone despite their personal failings no matter how terrible, participants may have experienced a significant reduction in their sense of ultimate condemnation through scripture reading, practicing new ways to pray, and learning from religious teachings. These interventions, though robust for engendering a transformation in coping and renewing a sense of personal worthiness, were limited to a certain extent when considering Stewart-Sicking and colleague’s third category: the phenomenological level of experience.
Third, utilizing traditional psychotherapy techniques can target psychological distress symptoms through what
Stewart-Sicking et al. (
2019) called above and below consciousness. Above consciousness refers to interventions that engage a client’s conscious thought and cognition. Many Cognitive Behavior Techniques fall into this category. They can also be adapted to R/S cognition, such as drawing upon a client’s R/S beliefs to dispute problematic core beliefs. Below consciousness refers to interventions that engage a client’s experience and emotion that resides outside of linguistic awareness, and is deeply experiential. Again, there are examples of below consciousness from traditional psychotherapy, such as
Rogers’ (
1951) Core Facilitative Conditions, as well R/S sources, such as Inner Healing Prayer (see
Tan 1996). At the same time, what makes the rescue mission distinct from a state or county-run homeless shelter, is that it also hopes to target what Stewart-Sicking and colleagues refer to as the transpersonal level of consciousness, which are interventions that go beyond the self; hence, the name beyond consciousness. It is here that interventions are “experienced not as everyday consciousness, but as encounters with depth, the numinous, or a perspective beyond dualism” (p. 82). Though participants’ spirituality overall fell within average limits, there were no meaningful shifts observed over the course of their treatment that one may expect from a R/S program. This would suggest that the interventions the rescue mission employed were effective in enacting changes in above and below consciousness, but did not target beyond consciousness to effect meaningful change in participant’s experience of the numinous, with the exception of neutralizing the tension they experienced with the God of their understanding.
Finally, R/S interventions can be either embedded within a tradition, or extracted out of one (as in the case of mindfulness). The rescue mission clearly utilizes interventions from the former framework. As
Worthington (
1986) formulated, interventions like those employed by the rescue mission staff that come from a R/S tradition can be used to effect psychological change, but they can also be used to strengthen the faith of clients. The observed reduction in participants’ psychological dysphoria, coupled with positive growth in religious sentiments, and reduction in religious crisis, may be taken as preliminary evidence of the effectiveness of R/S interventions embedded in the Christian tradition.
Evidence-based practices are paramount to effective psychological care. What this study has shown is that there is evidence to support the utility of incorporating R/S into psychological care for marginalized populations. This study clearly demonstrated that even in the most downtrodden population, R/S interventions can be beneficial. From this single case alone, it is evident that the numinous is a part of those in the direst of circumstances and, with proper care, these individuals can reduce their psychological conflicts, and approach their issues with the numinous in a supportive and secure context. Moving forward, the most important thing that we can do is work towards a culture of R/S competency in psychological care (
Matise et al. 2018). This study empirically supports the positive implications of spiritually integrated psychological care. It is now up to clinicians to use it appropriately to aid their clients.