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Article

Training Integrated Clinicians by Example: A Practical Call for Ongoing Spiritual Formation and Mentoring amongst Christian Integrative Counseling Faculty

Graduate School of Counseling, Oral Roberts University, Tulsa, OK 74171, USA
Religions 2023, 14(10), 1260; https://doi.org/10.3390/rel14101260
Submission received: 3 August 2023 / Revised: 29 September 2023 / Accepted: 2 October 2023 / Published: 5 October 2023
(This article belongs to the Special Issue Incorporating the Sacred in Counselling)

Abstract

:
The body of literature on the integration of Christianity and psychology and/or counseling indicates that integration is best learned and taught through spiritual formation and mentoring relationships. More specifically, the ongoing spiritual formation of counseling or psychology faculty in Christian, integrative programs and their ability to mentor students well are significant in shaping the integrative development of those they educate and train, and for ensuring integrative practice. However, what is underexplored in the literature is how faculty members in integrative programs might personally grow and develop in these areas if they are not already in existence or are underemphasized. This article seeks to address this need by providing an overview of practical ways for strengthening the spiritual formation and mentoring opportunities for Christian, integrative faculty, ultimately with the aim of encouraging greater integrative activity in counselors entering the field. Through a review of the pertinent counseling literature, as well as scholarship on spiritual formation, and spiritual formation and mentoring in educational contexts, a summative list of practical strategies is presented. Implications for broader use and application are also discussed, along with potential opportunities for future research.

1. Introduction

In recent decades, multiple studies on Christian integration in counseling and clinical psychology have concluded that integration is best taught and learned through spiritual formation and mentoring relationships (e.g., Hall et al. 2009; Loosemore 2021; Sorenson 1994, 1997a, 1997b; Sorenson et al. 2004; Staton et al. 1998; Tipton et al. 2022). Trainees in Christian, integrative psychology and counseling programs at the master’s and doctoral levels have been shown to gain the most from faculty members who are actively growing in relationship with God and who can mentor students in this process with openness, honesty, and humility (Hall et al. 2009; Sorenson et al. 2004; Staton et al. 1998)—those who effectively model how faith and professional practice come together in embodied, lived expression. Students’ personal therapists have also been found to have a powerful ability to shape the integration of their faith and professional work, even outweighing the impact of early childhood spiritual role models and influences (Sorenson 1994, 1997a). Additional research has shown that greater spiritual formation in Christian professional counselors is correlated with increased integrative activity in their counseling practice, stressing the importance of prioritizing spiritual formation in integrative counselor training programs (Loosemore 2021). Thus, it can be suggested that those in mentoring roles (i.e., counseling faculty, therapists) have the potential to significantly contribute to the integrative development of counselor trainees and to their practice of integration in therapy.
There exists a robust body of literature on Christian integration that explores the complex relationship between psychology or counseling and Christianity, both in theory and practice (e.g., Coe and Hall 2010; Entwistle 2015; Greggo and Sisemore 2012; Jastrzębski 2023; Johnson 2010; Jones and Butman 2011; McMinn 2011; Richards et al. 2023; Tan 2022). Traditional Christian integration models have been proposed and written on extensively (e.g., Greggo and Sisemore 2012; Johnson 2010); levels or types of integration in counseling have been named and discussed, including explicit, implicit, and intrapersonal integration (see Tan 1987, 1996); and the recent scholarship on integration reflects a shift from traditional approaches in teaching integration (i.e., a dominantly conceptual and theoretical approach) to more relational, embodied, and contextual approaches (e.g., Hathaway and Yarhouse 2021; Callaway and Whitney 2022; Neff and McMinn 2021).
However, there appears to be a gap in the literature. Despite an abundance of scholarship on integration and research that specifically encourages spiritual formation and mentoring in counselor training, there is limited discussion provided for how counselor educators in integrative programs can practically develop these areas (i.e., spiritual formation and mentoring) in their own lives and/or in their training programs, if they do not already exist or are underemphasized. If training in integration, particularly through spiritual formation and mentoring, has been shown to be crucial to the learning and practice of integration in counselors, then a greater focus on the spiritual lives and qualities of faculty, their pedagogy, and the ethos of integrative training programs is necessary.
This article is one attempt to fill the gap by encouraging counseling faculty members in Christian, integrative programs to intentionally pursue spiritual formation practices and mentoring opportunities to (1) grow personally as Christian integrators and (2) increase the likelihood that they can effectively mentor others in how to integrate faith and learning as Christian professional counselors. By equipping these individuals and their programs with practical strategies by which to increase these dimensions of themselves and their programs, it is hoped that effective integration education will be provided, and future counselors will be better prepared to integrate their faith and professional work, especially when counseling self-identified Christian clients who desire an explicitly integrated approach.
To this end, I review the literature that details the relationship between Christian integration in counseling, spiritual formation, and mentoring. Next, I engage more broadly with additional scholarship that explores spiritual formation practices for those in educational contexts with an aim to identify potential resources for those looking to grow in their identity and practice as Christian counselor integrators. Several practical strategies are recommended to emphasize spiritual formation and mentoring relationships within a graduate-level integrative counseling program, primarily, from which those in other training positions can glean and adapt for use in their own professional contexts. Some of these practices are taken from the initial integration scholarship reviewed, and others from a broader scope of the literature introduced later in the article.

2. Overview of Selected Literature

Between 1994 and 2004, a series of five foundational studies (Sorenson 1994, 1997a, 1997b; Sorenson et al. 2004; Staton et al. 1998) were published that explored how students in evangelical, doctoral psychology programs learned Christian integration, culminating in the final National Collaborative Research report (Sorenson et al. 2004). Sorenson’s (1994) pilot study documented the impact of doctoral psychology students’ therapists on their personal integration. These students, from programs at Fuller and Rosemead, were greatly influenced by the affective relationships with their current therapists, to the point of eclipsing earlier spiritual influences and relationships. How their therapists responded to their representations of God directly influenced their own integration of psychology and their Christian faith. Critical to this was relational attachment. The relationship forged between the student counselees and their current therapists had significant bearing on how they understood and practiced integration personally. The second study replicated the findings of the first with a sample size nearly five times larger. Notably, the second study identified specific behaviors or therapist responses to students’ God concepts that were shown to have a formative impact on students’ integrative development, for good or for bad. Some therapist behaviors moved students from benign to malignant God concepts, and others moved students from malignant to benign God concepts. Therapists who nondefensively welcomed integrative issues into therapy, who treated students’ relationships with God as real, who were open themselves to the transcendent, etc., were those who encouraged favorable outcomes in students’ integrative development (Sorenson 1997b, pp. 188–95; see also Sorenson et al. 2004, p. 356 for a concise summary).
Considering the impact of students’ therapists on their integrative development, Sorenson and others turned their focus to integrative training programs and faculty to ascertain the degree to which these impacted students’ integrative efforts (see Sorenson et al. 2004, p. 357). Thus, the third study (Sorenson 1997a) included 48 doctoral psychology participants from Rosemead, with the specific goal of determining how these students were impacted in their integrative development by their current faculty members in a Christian psychology program. The findings showed that students evaluated their faculty across three latent dimensions—evidence that the professor has an ongoing process of a personal relationship with God, emotional transparency, and a sense of humor (p. 539). These findings were replicated in the fourth study with students in the Graduate School of Psychology at Fuller Theological Seminary (Staton et al. 1998). As noted by Staton et al. (1998):
From the student’s point of view, the most salient dimension to contribute to their own integration was how well they could determine that a given professor had an authentic, lively, and growing relationship with God, coupled with the professor’s non-defensive, emotionally unguarded, and even vulnerable relationship with students.
(p. 348)
The fifth and final study (Sorenson et al. 2004) included data from upper division students in the graduate psychology programs at George Fox University and Wheaton College, along with new data from students at Rosemead. This study replicated the relational attachment model of the previous two studies in the series, again confirming that a professor’s evidence of an ongoing process of a personal relationship with God is highly associated with a student’s ability to learn integration from the professor. Sorenson et al. (2004) concluded that students best learned integration through relational attachments with mentors who were affectively present and who personally modeled integration for them.
Since the publication of these five foundational studies, and particularly the critical research of Sorenson on attachment theory and integration, many others have furthered the research into integration learning and practice in notable ways, a few studies of which I explore here. Hall et al. (2009) conducted a qualitative study with 595 graduate and undergraduate participants at four evangelical Christian institutions of higher education to assess student perceptions on how integration knowledge is transmitted within programs that self-identify as being “integrative.” Among the findings, five professor characteristics were prominent and felt to be crucial for the effective teaching (and learning) of integration. The five included (1) a professor’s ability to be self-revealing, which was associated with Sorenson’s (1997a) earlier idea of a professor’s ongoing process in a relationship with God being demonstrated and expressed in an emotionally transparent manner; (2) an attitude of care and receptivity that professors exhibited toward students; (3) an attitude that welcomed conversation about integration and opportunities to integrate; (4) dedication to the integrative endeavor; and (5) a professor’s open-mindedness, particularly in valuing differing views and opinions.
Of these five characteristics, I highlight two in greater detail for the purposes of this article and its focus. The first—a professor’s ability to be self-revealing about his or her ongoing process in relationship with God—was evidenced primarily through the following: discussions about moral decision making, accounts of professors’ personal struggles in their lives with God, stories of experiences that led to personal growth, and insights gained through practicing personal devotional habits. What stood out to participants in this study was the living out of a professor’s life before God, what Sorenson (1997a) earlier described as the “professor before God, student before professor” (p. 542). Students distinguished between professors who simply described integration and those who lived out integration in a “humble”, “transparent”, “vulnerable”, “honest”, and “open” way (p. 17). Catching a glimpse into the life of a professor and his or her pilgrimage of faith was felt to be necessary for facilitating real integrative learning. The second, and related to the descriptors above, was a professor’s caring attitude and receptivity toward students, and an openness to allow students to see what it might look like in “real life” to be a Christian professional in and outside of the classroom. As one participant described:
These [mentoring relationships] took the form of inviting students into professors’ homes, open discussions on topics of interest and a general openness toward life and friendship that made the reality of the professor’s commitment to the faith in and outside of the classroom vivid and vibrant.
(p. 19)
As summarized by Hall et al. (2009), “This lends further support to the notion that these personal qualities of the professor are crucial to the facilitation of integration” (p. 25).
Importantly, Hall et al. (2009) also collected data on integration concepts and how students felt integration was best taught. What they discovered is that propositional content on integration (e.g., the explanation of traditional integration models) was important to students, but not nearly sufficient on its own. Students expressed a desire to see embodied integration (again highlighting the importance of mentoring figures who can live out integration that students can observe in real time). Thus, Hall et al. emphasize that faculty must be able to bridge the gap between propositional/theoretical content on integration and applied experience because “students are discriminating consumers, and notice when attempts at integration are half-hearted, insincere, done out of duty, forced, or of poor quality” (p. 27). As is further noted in their discussion:
Students seem to be communicating here the incongruity between preaching integration, and not having the depth of Christian character to provide a foundation for that integration. Consequently, while simply having a good Christian character may not suffice for good integration to occur (after all, living the faith and reflecting Christ is something all followers of Christ are called to—not just integrative professionals), it does appear to be a necessary foundation for integration in the minds of students.
(p. 24)
The robustness of one’s Christian formation is clearly important to students and likely that which distinguishes a professor from offering insincere integration from genuine integration.
In another study, Loosemore (2021) sought to further understand how spiritual formation and mentoring relationships impact the integrative activity of practicing counselors and their satisfaction with those efforts. With a convenience sample of 226 counselors who are Christians, a multivariate analysis of variance (MANOVA) found that both spiritual formation and mentoring relationships significantly impacted integration activity and satisfaction in the participants’ counseling practice. Interestingly, however—and seemingly contrary to the previous findings already discussed—spiritual formation was shown to exceed mentoring relationships in its contribution to participants’ integrative activity and satisfaction in counseling practice. As such, Loosemore (2021) recommends that those who wish to increase their integrative activity in counseling must focus more intently on their own spiritual formation, while still recognizing that mentoring is likely to be more important to counselor trainees who have not yet completed their training than for those who are already in the field practicing.
Loosemore (2021) found that by increasing spiritual formation, counselors experienced large increases in integrative activity in their professional work. In contrast, low levels of satisfaction and integrative activity were demonstrated by those with lower spiritual formation on almost all indicators (p. 370). Motivation to learn about integration, thinking about the “Christian impact” while counseling, and utilizing a model or theory to guide interventions were demonstrated by those with greater spiritual formation. To this point, Loosemore notes, “Possible explanations are that spiritual formation might bring the notions of spiritual competency and/or integrative motivation to mind more regularly, resulting in the increase of activity” and, he further posits, “What is clear is that spiritual formation and not mentoring relationships correspond to increases in satisfaction with integrative practice across multiple elements, and this likely occurs by primarily promoting alignment between a counselor’s life, work, and thoughts while they work” (p. 369). Considering his findings, Loosemore (2021) recommends that spiritual formation be given “prime importance” in counselor training contexts (i.e., graduate programs, supervision, consultation) for the purpose of inspiring both the study and activity of integration on the part of counselors who are Christians (p. 370).
Finally, I turn to the recent study of Tipton et al. (2022). In their transcendental phenomenological exploration of the lived experiences of 10 counselors who were originally trained in evangelical institutions and practice from a faith-informed perspective, they identify six themes that capture important essences of providing counseling from a Christian worldview (i.e., faith-informed clinical practice emerges from an eternal perspective; distinct aspirations of the faith-informed clinician; the clinician’s inner world; the bi-directional influences between faith and professional development; the experience of clinical issues specific to clients of faith; and educational antecedents to faith-informed practice, p. 309). Of these six, I highlight two for the purposes of this article: (1) faith-informed practice emerges from an eternal perspective, and (2) educational antecedents to faith-informed practice.
The first is defined as the following:
[P]articipants described working from an eternal perspective as defining their way of being, their way of seeing clients, and their way of seeing themselves. They described their life and practice as flowing from their relationship with God the Father and God the Son, mediated by the Holy Spirit.
(emphasis added, p. 309)
Participants described their counseling practice as an expression of their identity in Christ and Christian worldviews, by which their professional work as counselors and their faith were felt to be inseparable. To this end, participants articulated a dependence and “conscious connection” to God, by which the application of integration in counseling sessions came more readily (p. 311). Thus, it was not an intellectual integration that they described but a lived and embodied integration that was felt to be “marshalled” through the work of the Holy Spirit (see Smith 2013). To these participants, integration was about being an integrated clinician, not a clinician who integrates—what Tipton et al. (2022) refer to as an “ontological reality”—because their integration was deeply (and inseparably) rooted in their “life in God and God in them” (p. 314; see also Sites et al. (2009) on the integration construct of “ontological foundation” as “the natural outflowing of a person’s spiritual essence” p. 37). Tipton et al. (2022) therefore suggest that “the more experiential, embodied, and holistic way of being with a client” exceeds the conceptual models of integration learned in evangelical counseling programs, or the emphasis on “doing integration” (p. 314) that has been so dominant.
To this point, and in line with another major theme in their article, “educational antecedents to faith-informed practice”, Tipton et al. (2022) note the “reciprocal influence of professional development on faith development and faith development on professional development” in those they interviewed (p. 311). Many participants noted their disappointing experiences with integration education in their graduate training programs, describing it as feeling “fabricated”, “falling flat”, or simply “learning about integration” without living examples of integration or integrated professionals (p. 312). Interestingly, many participants felt the term “integration” was insufficient and recommended, instead, that training be more experiential, spiritual, holistic, and practical (see also Neff et al. 2021 regarding student feedback on integration in Christian doctoral psychology programs and the expressed desire for relational, contextual, and applied integrative learning).
Integration was seen to be what took place inside of the participants in Tipton et al.’s (2022) study, not something they did through a rigid combination of two disciplines outside of themselves. Ultimately, participants expressed a desire to see “spiritual formation replace integration” in training programs (p. 316), through the offering of spiritual formation or process groups, increased case study instruction, and relational mentoring. This finding gives increased credence to the other studies mentioned above, which document the impact and importance of spiritual formation and mentoring for the learning of integration. Through these findings, integrative counseling programs are encouraged to provide far more than integration or capstone classes, and instead, offer experiential and relational spirituality where integration is not only taught but caught (echoing Sorenson; see Staton et al. 1998, p. 341).

3. Implications from this Research

Considering the findings discussed above, a few ideas have been consistently reiterated. First, the spiritual lives and personal development of faculty (and those in other mentoring roles, i.e., therapists) have a formative influence on those under their guidance, especially in how trainees will ultimately integrate their Christian faith into their therapeutic work. Second, the relationships established between faculty and those under their guidance creates a crucial “space” in which integration can be modeled, taught, and learned in real and meaningful ways that exceed propositional instruction and content alone. Third, both are necessary for integration to be effectively learned and to encourage the practice of integration by trainees in their clinical work, and for them to feel satisfied in those integrative endeavors. This is a crucial point—if we hope to prepare future Christians to practice counseling in such a way that the integration of their faith and learning is done well, and with competency, then we must pay special attention to what is occurring in the training process beforehand. The same goes for any other skills that we hope to instill in counseling trainees in their graduate programs.
As noted at the outset of this article, the research reviewed is replete with suggestions of the effectiveness of those who practice the activities listed above. However, this literature is limited in discussing what others might be able to do to increase these capacities in themselves and in their educational/training communities if they do not already exist or are underemphasized. To this end, I wish to explore some possibilities for increasing the focus on personal spiritual formation and the mentoring culture in graduate counseling programs that are specifically integrative (i.e., housed within Christian, evangelical institutions).
To do this, I provide a brief definition of spiritual formation and draw upon the selected literature that addresses spiritual formation and mentoring in educational contexts. This is followed by a more in-depth discussion on the connection that exists between Christian practices, spiritual formation, and pedagogy. From there, I review additional literature that points us toward helpful practices to grow spiritually and mentor others well in the integration of faith and counseling.

4. Defining Christian Spiritual Formation

It is generally understood that Christian spiritual formation is the process of growing into Christlikeness or being increasingly formed into the image and character of Christ (see Gal. 4:19). Christian spiritual formation has been a focus of the Church since its inception. In the Book of Acts, the practices of worship, teaching, preaching, and service, amongst others, were actively engaged in for the purpose of equipping bold, compassionate, and counter-cultural witnesses for Christ in their hostile surroundings. From there, many notable figures throughout Church history have developed models of spiritual formation or written on specific spiritual disciplines that are beneficial for the cultivation of one’s inner, devotional life and formation into Christlikeness (e.g., the desert mothers and fathers, St. Augustine, St. Francis, Julian of Norwich, Teresa of Ávila, John Wesley) (Wilhoit and Howard 2020; see also Foster [1978] 2018).
Dallas Willard (2000), philosopher and pillar in the field of Christian formational scholarship, presents various dimensions or concepts of spiritual formation, including the outward training and practices for those in ministerial roles, active participation in the shaping of one’s inner life or spirit (heart or will) through overt spiritual practices (e.g., fasting, prayer, worship, confession, study), and the shaping of one’s spiritual realm by the working of the Holy Spirit, the Word of God, and other spiritual agents of the Kingdom of God. Willard reminds us that spiritual formation is not summed up solely in the doing of Christian disciplines or practices (lest we become legalistic), but nevertheless, action is important. He writes
We teach people to do “all things whatsoever” by shaping their hearts to love Christ and his commandments, and by training their entire personality (soul, mind, body, and to some degree even environment) to side with their new heart or spirit, which is the creative element of the self that we also call the will.
(p. 256)
Willard (2000) ultimately suggests that formation into Christlikeness has occurred, and the Great Commission is fulfilled when “…[T]he regenerated soul makes its highest intent to live in the commandments of Christ, and accordingly makes realistic plans to realize this intent by an adequate course of spiritual disciplines” (p. 257).
To deepen our understanding of formation, I also consider the work of Christian philosopher, James K.A. Smith, who has arguably written some of the most compelling literature on spiritual formation and worship in recent years. In two of the texts from his Cultural Liturgy Series, Smith (2009, 2013) offers extensive accounts of how worship and formation occur, at the heart of which he describes a transformation of the imagination (the seat of human affection and desire) by which we— “liturgical animals”—become what we love. Through concrete rituals and embodied practices of Christian worship, we are captivated and invited into a new narrative, ultimately re-shaping our very being in the world. As Smith (2013) describes it:
The Spirit marshals our embodiment in order to rehabituate us to the kingdom of God. The material practices of Christian worship are not exercises in spiritual self-management but rather the creational means that our gracious God deigns to inhabit for our sanctification.
(p. 15)
Thus, Christian formation requires a philosophy of action, as it cannot be focused solely on “Christian thinking.” Thinking, with all its rational propositions and choices, is not often the largest motivator for action. Rather, our actions grow out of that which has most captivated and shaped our inmost desires and longings, drawing us magnetically to a particular telos. As Smith writes:
If we … are going to be “prime citizens of the kingdom of God” who act in the world as agents of renewal and redemptive culture-making, then it is not enough to equip our intellects to merely think rightly about the world. We also need to recruit our imaginations. Our hearts need to be captured by a vision of a telos that “pulls” out of us action that is directed toward the kingdom of God.
(p. 6)
To this point, it is important that we understand action holistically. It concerns our being, not just our doing; it involves feelings, as well as our relating to God, self, and others. In this sense, action is robust and complex. It is not reducible to a narrow set of behaviors or things that we “do”, but it truly involves our whole “body-self-world intertwining” (Finlay 2011).

5. Spiritual Formation, Christian Practices, and Pedagogy

Keeping this discussion of spiritual formation in mind, I turn now to explore the idea of Christian pedagogy through a formational lens. This will aid us in deepening the connection between spiritual formation, as above, and the work of Christian educators, with a particular focus on the formational power of Christian practices in the classroom.
In their edited volume, Teaching and Christian Practices, Smith and Smith (2011) suggest that Christian educational contexts be seen as “communities of practice” in which faculty and students should be formed not only in knowledge, but also in Christian virtue. This occurs through engagement in Christian practices, which Smith and Smith describe (based upon the work of Dykstra 2005) as actions that Christians engage in together in response to God’s redemptive presence and activity in the world. These practices are oriented and aimed toward the Christian eschatological future (telos) and believed to be “places” or “spaces” in which the Holy Spirit transforms us as we participate in them. Thus, true Christian education must exceed simply talking about Christian content, covering activities in prayer, attending chapel services, or producing scholarship as Christians. It must give attention to the classroom as a formational space in which practices are engaged in specifically for the purpose of cultivating (in students and faculty) both learning and Christian virtue.
Resonating with this idea, Otto and Harrington (2016) emphasize that spiritual formation must occur in the classroom, lest we risk making it an “add-on component” of Christian universities or something consigned to campus life outside of the classroom. In an academic, institutional context that values spiritual formation, there can and should be a “God-responsiveness” cultivated holistically and at every level, and amongst all involved. As Otto and Harrington write:
Spiritual formation is not to be viewed as the only important goal of the university, thereby sacrificing intellectual or relational development. Rather, spiritual formation should be seen as the product of all that the Christian college is doing. It is not an either–or phenomenon, but a coordinated commitment that should be engaged holistically.
(emphasis added, p. 260)
Considering this idea of spiritual formation and “God-responsiveness”, we should also consider the role of faculty in this process. While we might be inclined to think of a faculty member’s personal spirituality as hugely significant in cultivating formation in the classroom, a more accurate understanding is that personal spirituality is not what is most impactful, in and of itself. Rather, the practices in which faculty engage with students are that which have the potential to be formational (Smith and Smith 2011).
This constructively critiques and challenges the preceding discussion, up to this point. The findings have repeatedly indicated that a mentor’s own spiritual life and formation are influential upon the counselor under his or her guidance. But perhaps what the research has not clearly stated enough is that it is not only the fact that these mentor figures have vibrant spiritual lives or are clearly committed to an ongoing process in relationship with God. Rather, it is likely that these figures embody and live out integration in practice.
I want to note how important this is, especially for Christian counselor educators, since the disciplines of psychology and counseling are inherently at odds with the theistic worldview of Christianity due to their philosophical roots in naturalism (e.g., see Slife and Reber 2009; Slife and Whoolery 2006), hence the need for the “integration project”, in the first place, which numerous scholars and practitioners have devoted their time and energies to for decades. To have a Christian professor who can not only teach about integration but also demonstrate integration in action, with application to real-life situations and with reference to his or her ongoing, personal relationship to God, is hugely instrumental. It allows students a glimpse into the integrating and “choreographing” work of the Holy Spirit in the practitioner to join what might appear to be disparate threads (i.e., disciplines) that are difficult to weave together into a meaningful way considering their philosophical and theological differences (see Poloma 2010, p. 182).
Thus, teaching integration well must exceed verbal instruction. It must also include a living out of a personal, embodied relationship with God in a transparent way. It is not merely the teaching of orthodox beliefs or modeling religious piety, either (Sorenson et al. 2004). Rather, faculty and other mentors must humbly model, for students, a real-time process of relating to God, others, and one’s professional discipline. As Sorenson et al. (2004) poignantly state:
…[S]tudents want personal access to someone who is modeling integration before them as a living, breathing, flesh-and-blood manifestation of integration-in-process. Students want broad and candid access to integrators so they can see how their mentors think, weigh choices, make clinical judgements, pursue courses of research, and, most importantly, how they interact with themselves and others, including God.
(pp. 363–64)

6. Spiritual Formation in Educational Contexts

To elaborate on the preceding discussion on spiritual formation and Christian practices within educational contexts, it is helpful to begin to identify specific practices by which counseling faculty members, in particular, can cultivate (in themselves and in their programs) a greater focus on spiritual formation and mentoring.
Referring back to the integrative studies documented at the outset of this article, we can identify a few practices therein that are useful for developing training in integration that is more “holistic, practical, experiential, and spiritual” (Tipton et al. 2022, p. 313). One recommendation was to place greater emphasis on “thinking” in an “integrated fashion”, instead of merely discussing conceptual models of integration in counselor training. To do this, a participant in Tipton et al.’s (2022) study suggested the use of incorporating far more case studies into integration education, which would allow for a thinking through of integration issues in relation to a particular case or situation. Resonating with this, Hall et al. (2009) suggest the following ideas specific to pedagogy and learning activities: the use of more real-life examples in class, engagement in simulation or role-play exercises, increased use of vignettes, and opportunities for guest speakers to share with students (p. 25).
In Loosemore’s (2021) study, he suggests that spiritual formation/mentoring relationships or groups be prioritized in integrative counseling training programs, saying, “For example, mentoring relationships could focus in part on spiritual formation; a supervisor (or peer-mentor) might guide supervisees (or peer-mentee) to develop a professional and personal rhythm of spiritual formation and encourage them to maintain this throughout their career” (p. 370).
Additionally, Tipton et al. (2022) suggest that Christian institutions consider funding spiritual development activities and resources for their faculty (e.g., spiritual formation retreats), as well as allowing built-in time in faculty schedules specifically for mentoring students.
However, what else might counseling faculty in Christian, integrative counseling programs be able to do to grow spiritually, encourage the same in their students, and create additional opportunities for mentoring? Due to the limited recommendations for this in the counseling literature reviewed, I find it helpful and necessary to widen the scope of consideration and turn to additional literature on spiritual formation and mentoring in educational contexts, more broadly. In the selected literature below, several practices are named and discussed that could aid counseling faculty in integrative programs.

6.1. Cultivating a “Rich Inner Life” Worthy of Being Modeled

Robin Wrigley-Carr (2022) draws upon the works of Parker Palmer, James K.A. Smith, and British spiritual writer, Evelyn Underhill (1875–1941), when addressing the spiritual lives of Christian educators (specifically those teaching in church-based schools). She emphasizes the importance of developing a vibrant inner life to enable teachers to model Christlike behavior and provide spiritual nurturance to their students. Quoting Parker Palmer, Wrigley-Carr reminds us that “we teach who we are” (emphasis added, p. 112). She draws upon the image of an endangered bird, the Australian Regent honeyeater, who imitates the songs of other dominant bird species around it, when it cannot locate and imitate the natural song of its fellow Regent honeyeater. Students, like these birds, are primed to imitate the “songs” of those that bear influence upon them. The essence of the educator is what students mimic, for good or for bad. Again, pulling from Palmer’s work, Wrigley-Carr speaks of the “inner landscape” of the educator. From this inner spiritual life emerges a “song”—one that will be imitated. These points resonate greatly with the earlier discussion offered in this article. Students best learn how to integrate faith and learning (in counseling and clinical psychology) when they have educators who can vulnerably, openly, and humbly share themselves, their “inner landscapes”, and ultimately, give insight into their processes of relating to God and others (questions, doubts, struggles, and all). From the “songs” of these faithful professors, students “hear and learn their “song”—rather than simply sing[ing] the dominant culture’s noise they’re immersed in” and, “[u]ltimately, it’s about learning to sing His song—Christ’s song …” (emphasis in original, Wrigley-Carr 2022, p. 110).
Joining these insights with those offered by Underhill, especially about the importance of educators actively cultivating their relationships with God, Wrigley-Carr (2022) makes a compelling point: “The vitality of our relationship with God is the crux of who we are and our work as teachers. … Our loving intimacy with God can provide some of the richest, spontaneous influence upon our students” (pp. 113, 114). It is the overflow of “a rich, inner life” (p. 110) that allows the Christian educator to shine forth Christ’s character in the classroom; thus, the intentional cultivation of one’s “inner landscape” is necessary. In support of this, and pulling from Underhill, Wrigley-Carr poses that “an adoring soul is essential for teachers” (p. 118), and she discusses specific spiritual practices that can cultivate in educators a more vibrant spiritual life: adoration of God through personal prayer; spiritual reading (to include a liturgical reading of Scripture (lectio divina) and the reading of Scripture out loud), as well as reading works of the “Saints” throughout Church history; and communing with God through silence, the sacraments, and meditative prayer.
Furthermore, Wrigley-Carr (2022) discusses the importance of partaking in the Eucharist as a means of offering ourselves to God and receiving God’s spiritual nourishment for our souls, and she recommends that Christian educators also practice Sabbath rest, noting its capacity for restoring the energies of those involved in the demanding work of teaching. Ultimately, she calls upon Christian educators to become “reservoirs” instead of “canals”, borrowing from the words of St. Bernard of Clairvaux—those who, through engagement in spiritual practices, are able to provide refreshment in abundance to those they educate and mentor.
This idea is reminiscent of the words of graduate counseling educator, Virginia Holeman (2012), when she discusses the necessity of becoming “theologically reflective counselors” who drink deeply from theological study and resources to assist clients well in the face of life’s spiritual trials—so many of which are theological issues at heart. Perhaps counselor educators who are effective “reservoirs” for students are those with vibrant spiritual lives in Christ through the regular practice of spiritual disciplines (worship, prayer, Sabbath rest, participation in the sacraments, study, etc.), including a commitment to theological reflection, and to establishing a theology that is complex enough to sustain them and assist others well in the face of life’s perplexing and constant challenges.

6.2. Developing a Genuine Personal Faith and Humility before God and Others

Laurie R. Matthias (2008) conducted a research study on seven identified “exemplars” of faith and learning amongst faculty at Wheaton College, an evangelical Christian institution known for its integrative acumen.
Her findings show that the following traits were shared amongst these integrative exemplars: passion for one’s academic discipline; genuine faith; a desire for integrity and wholeness; humility; and an openness to change. For the sake of space and the purposes of this article, I focus on two of these traits, in particular—a genuine faith and humility.
What Matthias (2008) found is that these professors had a strong personal faith that accompanied their academic passion and expertise. They readily engaged in conversations about their spiritual journeys, and though their spiritual journeys varied one from the other, they all expressed and demonstrated a faith in Christ that was “personal, deep, and genuine” (p. 150). With this, humility amongst these exemplars was found to be the most significant and influential trait. As Matthias (2008) writes: “…underpinning and permeating everything these professors do and say is a genuine humility sometimes missing among those who work in higher education” (p. 151). This was demonstrated in the following ways, as described by Matthias:
There is a humble admission in both their spiritual and their academic lives that despite their considerable accomplishments, they do not have all the answers … They acknowledge that while their faith certainly impacts their learning, their learning also impacts their faith. … Thus, their pursuit of excellence in their pedagogy and in their research is permeated by their humble spirituality.
(p. 153)
These faculty exemplars were seen to pursue humility volitionally, understanding that as they grow in both their faith and learning, change is inevitable (touching on the “openness to change” trait also identified in the findings). Ultimately, these faculty exemplars demonstrated that “it is possible to achieve academic and pedagogical excellence and still ‘walk humbly with [their] God’ (Mic. 6:8 NIV)” (p. 153). Humility is such a necessary precursor to effective integration between faith and learning that Matthias (2008) subsequently poses this question to her readers, driving home the point: “…[I]s it possible to integrate [faith and learning] well if one is not humbly walking with God?” (p. 155). We can easily deduce the answer.
The findings from Matthias’s (2008) study resonate with the earlier discussions. Again, it is not about being the most pious instructor, but allowing students access to one’s life before God in a vulnerable, non-pretentious, or defensive manner. Humility enables the faculty member to wrestle with God, to not have all the answers, and to assume the role of a fellow sojourner on the pilgrimage of faith, instead of attempting to be an expert. Moreover, it requires one to assume a posture of yielded surrender to God with a constant recognition of our creaturely dependence on God’s grace.
Matthias (2008) further notes that the pursuit of humility in any Christian community—educational or otherwise—is essential. One of the primary practical ways this can be actualized is through seeking out interactive collaboration amongst colleagues (and I would suggest students, too). As Matthias proposes, it is through a “communal perspective” that truth is apprehended. This point reminds us that integration is not simply a personal endeavor, but something we do in relationship and through dialogue with others (see Neff and McMinn 2021 for a compelling discussion on “integration as conversation”).

6.3. Creating Opportunities for Spiritual and Interdisciplinary Dialogue

In their article on the integration of psychology and spiritual formation, Sandage et al. (2014) discuss a number of personal and communal qualities that are necessary for effectively drawing together these two disciplines in learning and training contexts. Similar to Matthias (2008), they highlight the importance of relational spirituality and “intellectual humility”, which Sandage et al. (2014) identify as being a key virtue necessary for facilitating interdisciplinary collaboration between psychology and spiritual formation. As they discuss, intellectual humility is demonstrated by an awareness of the limits of one’s personal knowledge and an openness to new ideas, as well as the ability to regulate one’s arrogance by being receptive to contrary ideas and alternative viewpoints. This, they posit, is what enables people to engage in interdisciplinary dialogue and to adopt a truly relational framework for the integration of spiritual formation and psychology. Reading about the epistemological issues of integration will always be endemic to integrative psychology (or counseling) programs. But, as Sandage et al. (2014) rightly note, a program that strives to be intellectually humble, relational, and focused on spiritual formation will prioritize one-on-one or small group conversations alongside conceptual materials and learning, so that resistance and questions can be properly explored in the community. They state “[P]rioritizing a concern for healthy relational process over achieving agreement from others … can be a valuable pathway for psychological and spiritual formation in the practice of “loving mercy” or lovingkindness (hesed; Mic. 6:8)” (p. 236).
In addition to their recommendation for personal or small group conversations about integration, Sandage et al. (2014) offer other practical ideas for integrative programs. First, they recommend hosting regular “diverse supervision groups focused on spiritual, existential, religious, and theological issues as they impact personal aspects of therapeutic work” (p. 238). In such groups, the goal is not to offer clinical assessment or consultation, but “to provide a relational holding environment for sharing personal spiritual journey narratives with one another and processing the existential and spiritual challenges of clinical work” (p. 238). Second, Sandage et al. suggest that programs create time and space for interdisciplinary dialogue. They have observed the growing interest amongst therapists and psychologists in the role of spirituality in treatment, and likewise, there is increased interest amongst spiritual and religious leaders to incorporate psychological insights into their efforts to encourage spiritual formation and well-being. To this end, they observe the following:
There is a tremendous need for scholars, leaders, and practitioners with the intercultural and collaborative competence to work effectively within these differing orientations or “starting points” relative to the integration of psychology and spiritual formation. … Disciplines more oriented toward the humanities (e.g., theology, religious studies) often start theorizing related to spiritual formation with historical, philosophical, or linguistic methodologies, whereas social sciences often start with empirical methodologies emphasizing description of lived human experience. These differening methodologies can provide a useful and complementary integration of prescription and description…
(p. 235)
These two recommendations—(1) to facilitate regular group meetings to share personal spiritual narratives and process theological and spiritual issues, and (2) to offer opportunities for interdisciplinary dialogue—are effective and practical means by which spiritual formation and mentoring can be further prioritized by faculty and integrative counseling programs, overall. Moreover, these practices emphasize relational spirituality. They require humility, transparency, and vulnerability in those who participate, from faculty and students alike. There must also be a disposition of hospitality toward others and their views, an openness to dialogue, and a willingness to “meet at the table” to listen, share, and collaborate on how a discipline, like counseling, can exist in relationship with Christianity.

6.4. Additional Practices for Increasing Spiritual Formation and Mentoring in Integrative Programs

Adding to these suggestions, I want to conclude this section with a list of other practices that might be implemented by counseling faculty in integrative programs. In his article on spiritual formation in Christian graduate seminaries, H. Frederick Reisz (2003) defines Christian spirituality as the “…intentional practice of the Christian faith, both corporate and individual, insofar as it seeks to build up Christian identity and nurture “life in the Spirit” in the multiple dimensions of personal existence (pp. 30–31). He, like Smith and Smith (2011), reiterates that Christian practices and disciplines are formative to one’s identity, and it is Christian spirituality—outworked through these individual and shared practices—that “upbuilds” the person and the community in which he or she is situated. Moreover, these practices foster “…a deepening awareness of the presence of the Holy with us, and a living out of that Holy accompaniment” (p. 32).
Thus, Reisz (2003) recommends that Christian graduate seminaries (and I would extend this to Christian graduate counseling programs) be mindful not to simply “add on” spiritual disciplines and practices as “an ornament for the purpose of good appearances”, but rather, operate from a conviction (as a community) “that this also is of the essence of quality theological education” (p. 36), and I would add Christian counseling education. Such practices should be integrated into the vision and mission of a seminary or graduate counseling community, so that they are “actualized and visible, and not simply left to the ‘mind’ and ‘heart’ of the student” (p. 37). In other words—programs, at every level, should “walk the walk” and not only “talk the talk.”
To this end, Reisz (2003) provides an extensive list of Christian practices that could be implemented into a seminary context to encourage greater spiritual formation. I feel that many of these practices (all of which are not listed here) would be profoundly useful in a graduate integrative counseling program, too, most of which are already housed within graduate seminaries:
Prayer in classes; the integrating of spiritual disciplines into the process of a course as aids to concentrated learning; the presence of faculty members at retreats as participants [with students]; the ability of the community to pray together regularly; the use of classical spiritual disciplines and rituals [e.g., fasting, prayer] in responding to events in the life of the community; the ability of the community, as a whole community, to observe times of communal quiet and contemplation; the presence of pastors and lay leaders [and I would add practicing Christian counselors] on campus regularly to speak about how they integrate spiritual disciplines into their lives as ministers [or counselors].
(p. 37)

7. A Summative Paradigm

Considering the discussion to this point, it is helpful to draw together the key concepts and suggested practices reviewed into one summative paradigm, as seen below. This captures various ways in which spiritual formation and mentoring can be prioritized by integrative counseling educators and their programs, with the intention that Christian integration in counseling is well taught, learned, and ultimately practiced. I have provided examples for most practices suggested below, many of which were already mentioned in the literature reviewed above, and some of which are my own interpretation and or creative suggestions for actualizing specific ideas.
  • Cultivating a strong personal relationship with God (i.e., rich inner life/landscape) amongst counseling faculty members:
    Personally and regularly practicing spiritual disciplines, e.g., prayer, worship, theological and biblical study, practicing Sabbath rest, partaking of the Eucharist, reading sacred works from throughout Church history, contemplation, and silence (Holeman 2012; Reisz 2003; Wrigley-Carr 2022; see also Foster [1978] 2018);
    Participating in additional activities geared toward spiritual formation, e.g., spiritual retreats (Reisz 2003; Tipton et al. 2022);
    Regularly meeting together with fellow believers in corporate worship (Hebrews 10:25).
  • Modeling (living out, expressing, embodying) this rich inner life for students/mentees in the educational process:
    Sharing openly about one’s personal faith pilgrimage with trainees, e.g., sharing stories of the struggles and joys of one’s life with God in a humble, open, and transparent way (Hall et al. 2009; Sandage et al. 2014);
    Discussing with students what one has learned through the practice of regular devotional habits and what has led to personal growth (Hall et al. 2009);
    Demonstrating personal integration-in-action, e.g., discussing personal examples of how one has thought through and acted in clinical situations as a Christian in the counseling profession, and opening up opportunities in class discussions or mentoring groups to “work through” clinical situations or ethical issues from an integrated perspective (Hall et al. 2009; Tipton et al. 2022);
    Incorporating spiritual disciplines and practices into the learning experience, e.g., prayer in class, engaging in lectio divina, responding to events in the learning community with spiritual disciplines (fasting, prayer, etc.), observing times of contemplation and reflection, and incorporating theological reading and study (Holeman 2012; Reisz 2003; Smith and Smith 2011; Wrigley-Carr 2022);
    Inviting seasoned integrators into the classroom to discuss their integrative journeys and give insight into how they walk humbly with God as professional counselors (Hall et al. 2009; Reisz 2003);
    Spending time with students outside of the classroom to demonstrate “life before God” in other contexts, e.g., in one-on-one mentoring sessions, and over community meals or gatherings in professors’ homes (Hall et al. 2009);
    Modeling, for students, how to think, write, and research well as a Christian integrator (lecture content, publications, speaking engagements, panel discussions, etc.).
  • Intentionally pursuing and demonstrating humility, openness, and transparency:
    Openly acknowledging the limits to one’s academic and theological knowledge and remaining open to change (Matthias 2008);
    Demonstrating to students that spiritual formation is a continuous and ongoing process, and one that we submit ourselves to over a lifetime (Hall et al. 2009; Matthias 2008; Sorenson 1997a);
    Approaching students with an attitude of receptivity and openness in discussions on the integration of faith and learning (i.e., not defensively or pretentiously) (Staton et al. 1998; Matthias 2008);
    Hospitably engaging with diverse viewpoints (e.g., theological, psychological) and seeing the necessity of a communal perspective for apprehending truth (Matthias 2008; Sandage et al. 2014);
    Humbly seeking out opportunities for interactive collaboration with colleagues and students, e.g., writing projects and panel discussions (Matthias 2008; Sandage et al. 2014).
  • Prioritizing relational engagement and mentoring in integrative learning:
    Hosting regular supervision groups (with faculty and students) in which to process spiritual, religious, and theological issues related to counseling practice (Sandage et al. 2014);
    Providing regularly scheduled opportunities (panel discussions or discussion groups) for interdisciplinary dialogue, e.g., bringing together faculty from professional counseling, biblical studies, theology, and psychology to discuss integration and what each discipline offers to our understanding of important topics, such as personhood, sin, healing, suffering, and hope (Sandage et al. 2014);
    Attending spiritual formation retreats—faculty and students together (Reisz 2003);
    Providing one-one-one mentoring from counseling faculty to students specific to integration (Loosemore 2021);
    Scheduling times of corporate prayer amongst counseling program faculty, students, and staff (Reisz 2003).
  • Offering more holistic, relational, and spiritually integrative learning activities:
    Providing ample integrative case studies, vignettes, and simulation activities into course curriculum, i.e., requiring students to think integratively and work through specific clinical scenarios in which the integration of faith and learning are appropriate (Hall et al. 2009);
    Guiding students through real-life, integrative issues in their clinical training experiences (i.e., practicum, internship) (Hall et al. 2009).

8. Broader Relevance and Application

Kristen White (2020) conceptualizes the counseling process itself as a spiritual discipline, inasmuch as it is a practice that is (or can be) dependent upon the grace of God, intended to carry one through suffering, and ultimately utilized for the purpose of forming in a person greater Christlikeness. Crucial to this is the development of counselors’ personal spiritual lives, by which they are enabled to attune to the sacred more effectively in the lives of their clients. This resonates with the findings of van Asselt and Baldo Senstock (2009) who researched the influence of counselor spirituality on treatment focus, evaluating results from 572 counselor participants from diverse religious and spiritual traditions (i.e., Christian/Protestant, Catholic, Jewish, Buddhist, no religion, and “other”). As they note in their discussion: “It seems that when a counselor is more spiritually aware, his or her ability to recognize a client’s spiritual concerns is also greater” and “[A]s counselors believe themselves to be more spiritual, they may also perceive themselves to be more competent to work with spiritual issues” (p. 417).
The findings reviewed in this article seem to support this premise and illustrate how personal spiritual formation and effective training in integration encourage greater integrative counseling practice (see, especially, Loosemore 2021). That is, more attention to the personal spiritual development of the counselor seems to have a direct impact on the degree to which a counselor will effectively recognize and attune to spiritual concerns in counseling. We therefore recognize the importance of cultivating in ourselves that with which we also hope to effectively explore in counseling with our clients, hence the thorough discussion above on how one might do this, practically, as faculty in a Christian, integrative counseling program.
While this article is limited in its focus on Christian integration in counseling, the discussion offered here may hold important implications for those in other traditions, as well, specifically as they seek to explore the impact of their religious and/or spiritual beliefs and formation on their treatment approaches. To this end, it is pertinent to keep in mind that the spirituality of the counselor is, in many ways, that which integrates and synthesizes the counselor’s identity in a deeply comprehensive manner (Blaire 2015).

9. Opportunities for Future Research

As noted at the outset of this article, the content provided herein is intended to assist Christian faculty in integrative counseling programs to practically invest in their own spiritual formation and mentoring activity, for the purpose of increasing integrative learning and practice in those they train. More specifically, this piece was written for those who may not have a strong emphasis on these components in their personal lives or programs. What has been discussed here may also raise important questions and indicate potential opportunities for future research. For example, one might explore why these dimensions (spiritual formation and mentoring) are prioritized, valued, and practiced more readily in certain counseling programs, but not others. Are there institutional, cultural, or personal factors to take into consideration? If these dimensions are valued and prioritized within an institution or program, it may be important to ascertain if there are any obstacles that hinder counseling faculty from implementing these practices more thoroughly into their personal lives and/or educational content (time constraints, curriculum limitations, etc.). If so, one might also consider researching adaptive ways to address such barriers. These and related questions may merit further exploration and assist in further addressing the identified gap in the literature.

10. Conclusions

In this article, I reviewed selected literature that documents the importance of prioritizing spiritual formation and mentoring in Christian, integrative training programs for counselors. When these dimensions are flourishing in faculty members and programs, overall, counselor trainees are equipped to become skilled integrators and those who will engage more frequently in integrative activity in their clinical work (Loosemore 2021). Though the literature emphasizes this connection between integrative training and practice, there is a notable gap in addressing the practical ways in which integrative counseling faculty and programs can increase these dimensions in themselves and in their programs, if they are underemphasized or do not already exist.
In my attempt to fill the lacuna, I explored the spiritual formation literature with a particular focus on Christian education, stressing the relationship between spiritual formation and Christian practices. I encouraged integrative faculty to see their role in not only teaching about integration, but in living out integrated lives before students, as evidenced through specific practices. Since integration is more often “caught” than “taught” (Staton et al. 1998, p. 341), it is essential for integrative faculty to develop in themselves the rich inner spiritual lives and landscapes that inevitably overflow into the classroom. Research has shown that students are “discriminating consumers” (Hall et al. 2009, p. 27) when it comes to integration education, and ultimately the “proof is in the pudding”, as the old adage goes. Skilled integrative counselors are formed by those who proficiently exemplify the integration of faith and learning, personally. Therefore, it is my suggestion that we must not only consider the practice of integration, but first training in integration if we hope to develop future generations of integrators. When the training is strong—offered by faculty and programs that value and prioritize spiritual formation and mentoring practices—trainees will be at an increased advantage to integrate well in their therapeutic work, instead of leaving their programs feeling disillusioned by “forced” or sub-par integration education.
I concluded this article with the literature that explored possible practices for increasing both spiritual formation and mentoring in Christian educational contexts, which I adapted and applied to integrative, Christian counseling programs. This summation of practices is intended to aid others in integrative programs as they seek to produce professional counselors that are wise and skilled in the integration of the Christian faith in counseling. Implications for use beyond Christian integrative counseling programs were discussed, along with potential opportunities for future research.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The author declares no conflict of interest.

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French, H.R. Training Integrated Clinicians by Example: A Practical Call for Ongoing Spiritual Formation and Mentoring amongst Christian Integrative Counseling Faculty. Religions 2023, 14, 1260. https://doi.org/10.3390/rel14101260

AMA Style

French HR. Training Integrated Clinicians by Example: A Practical Call for Ongoing Spiritual Formation and Mentoring amongst Christian Integrative Counseling Faculty. Religions. 2023; 14(10):1260. https://doi.org/10.3390/rel14101260

Chicago/Turabian Style

French, Haley R. 2023. "Training Integrated Clinicians by Example: A Practical Call for Ongoing Spiritual Formation and Mentoring amongst Christian Integrative Counseling Faculty" Religions 14, no. 10: 1260. https://doi.org/10.3390/rel14101260

APA Style

French, H. R. (2023). Training Integrated Clinicians by Example: A Practical Call for Ongoing Spiritual Formation and Mentoring amongst Christian Integrative Counseling Faculty. Religions, 14(10), 1260. https://doi.org/10.3390/rel14101260

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