A Spiritually Integrated Approach to Trauma, Grief, and Loss: Applying a Competence Framework for Helping Professionals

Abstract

Exposure to trauma, grief, and loss (TGL) can elicit spiritual pondering and meaning making, which can manifest as unsettled spiritual rumination or evolve into spiritual growth and transcendence. Incorporating a spiritually informed approach with TGL survivors invites spiritual interaction between the individual and professional helper to move beyond the trauma story and influences toward hope and possibility. This approach benefits survivors and offers the professional helper the potential for personal growth and transcendence. Integrating a spiritually informed approach encourages professionals and clients to engage as co-collaborators, co-creators, and co-authors in the change process. It is proposed that appreciation for spiritual attributes is essential for creating a spiritually interactive and dynamic dialogue. This spiritually informed approach can assist the professional helper in guiding individuals through spiritual processes that evoke hope, elicit meaning, and promote growth, offering spiritual transformation following a traumatic event. While the literature offers valuable information concerning the importance of spiritual intelligence and competence, little has been written about the significance of these spiritual attributes for professional helpers as they pertain to the competencies and development of knowledge, skills, and attitudes required for promoting resilience and posttraumatic growth for clients. This reflective article invites readers to consider the value of professional helpers accessing their spiritual aptitude and competence, emphasizing their integral role in facilitating and nurturing resilience and growth for those exposed to trauma. It offers a conceptual framework, which is structured around three developmental levels: exposure, immersion, and mastery. At each level, the framework incorporates specific knowledge, skills, and attitudes that are essential for the professional helper’s spiritual competency development. This framework integrates literature emphasizing spiritual aptitude and post-trauma growth as critical components of spiritual competency development, further highlighting the importance of the role of spirituality in the helping process.

1. Introduction

Frontline professional helpers (FPHs) are often called through their spiritual beliefs, values, and desires to serve people, bringing meaning and purpose to their chosen vocation (Abrami 2011; Freeman 2007). When questioned directly, many employees offer reflections about their work in spiritual terms (Rosso et al. 2010). In secular and religious contexts, descriptives such as feeling called to a particular profession, feeling that one should share a possessed talent or ability, a desire for meaningful work, or that one’s spiritual belief influenced work choices and behavior are typical examples (Wrzesniewski et al. 2003). Due to their professional location, FPHs are routinely exposed to traumatic and critical incidents involving human suffering due to their employment (Behnke et al. 2019; Conrad and Kellar-Guenther 2006; Huggard et al. 2017; Regehr et al. 2004). The constant effects of bearing of witness to adverse outcomes for those who have been exposed to and are struggling with trauma, grief, and loss (TGL) can come at a professional and personal spiritual cost. Returning to one’s spirituality, meaning, and purpose may offer professional helpers the needed resources, support, and practices to persevere and provide hope and guidance to others.

FPHs who offer support to those who have been exposed to a psychologically traumatic event and loss include first responders, military, mental health workers, psychotherapists, social workers, and varied medical personnel (Huggard et al. 2017; Regehr et al. 2004; Vis 2022). While not an exhaustive list, typically, FPHs spend a large portion of their career working with people who have faced violence, mental health, homelessness, abuse, disasters, accidents, addiction, oppression and discrimination, trauma, grief, and loss. These professionals are often asked to respond to crises, guide, answer complex questions, provide physical, emotional, spiritual, and material interventions, and counsel, mediate, and offer solace and hope for the future.

Moreover, spirituality has been discussed as an essential factor in professional resiliency for frontline workers who support others who have experienced a traumatic event (Vis 2022). Frontline workers “are increasingly examining how their spiritual values affect the practice of the profession, as well as how clients’ spirituality impacts world view, coping skills, and ability to manage adversity” (Weinstein-Moser 2008, p. 32). Concrete examples of this type of reflection occur when frontline workers engage in spiritual practices and re-evaluate their spiritual worldview and what is most important in their lives and work. As a result, some frontline workers will re-experience a sense of calling; others may develop a conviction that they have made a meaningful difference in the world, while others may experience a sense of personal fulfillment (Martela and Pessi 2018; Rosso et al. 2010; Vis 2022). This connectedness is what Canda et al. (2020) deemed to be the heart of helping and is spiritual in nature. However, others may find themselves pessimistically ruminating over their experiences, attempting to make sense of what they witnessed, potentially leading to unhealthy coping and decisions to leave the profession.

Additionally, FPHs are often challenged to address their critical incident stress and TGL while attending to others. Subsequently, these frontline workers usually experience competing emotional, personal, and professional (Avraham et al. 2014; Behnke et al. 2019; Conrad and Kellar-Guenther 2006; Geisler et al. 2019; Lowery and Stokes 2005) and spiritual demands (Boynton and Vis 2022; De Vynck et al. 2023). Regardless of whether professionals integrate spiritual practice to address the demands of TGL exposure because of one’s employment or not, spiritual challenges will surface. Regardless of one’s intrapersonal awareness concerning spirituality, as an FPH, the likelihood of exposure to TGL will generate spiritual rumination. Knowledge of spiritual coping can lead to enhanced skill development that can be used personally and professionally, enhancing an appreciative attitude about the importance of spirituality as a vital tool to promote posttraumatic growth (PTG).

This reflective article accomplishes three objectives: (1) It invites readers to reflect on the value of professional helpers accessing their spiritual aptitude and competence and focusing on their evolving spiritual development and intelligence; (2) it emphasizes FPHs’ integral role in facilitating resilience and growth for trauma survivors; (3) it also offers a conceptual model that includes elements of spiritual awareness, humility, safety, attunement, and appropriateness as critical components of spiritual competency development.

2. Conceptual Aspects

Psychological trauma is defined in many ways, but common themes suggest that a critical traumatic incident is often sudden and unexpected or cumulative over time, and challenges one to question whether one can control its outcome and ability to cope with the aftermath, and leaves individuals struggling with emotional, psychological, behavioral, physical, and spiritual symptoms (Boynton and Vis 2022; Pandya 2018; Stoddard 2012). According to McCann and Pearlman (1990), trauma may be physically or psychologically threatening and affect one’s sense of safety, security, survival, or sense of self. Psychological trauma involves intense feelings that challenge one’s cognitive structures and perceptions regarding worldview, meaning, and life purpose (Pandya 2018; Vis and Boynton 2008).

While ample research has focused on psychological trauma, it is essential to recognize that trauma is interconnected with grief, loss, spirituality, and PTG and should be incorporated as part of the trauma–healing experience across the lifespan (Boynton 2016; Boynton and Vis 2022). Within recent years, spirituality has surfaced in the literature, describing its potential for reflection, intervention, and evaluation in trauma therapy. Following a traumatic event, individuals are at higher risk of experiencing a spiritual emergency, crisis, or distress and engage in existential rumination and questioning (Vis and Boynton 2008).

Over the past decades, the definition of spirituality has expanded beyond its religious roots to become more inclusive of culture, personal practices, diverse beliefs, and subjective understanding. Spirituality is more broadly defined as an essential and universal human capacity that involves a search for connectedness to oneself, others, nature or a higher power of one’s belief, meaning and purpose, and may or may not be linked with any form of religion (Canda et al. 2020). Also, spirituality has been linked to culture, particularly as it relates to customs, rituals, and beliefs (Ortiz et al. 2000), and with creativity, compassion, empathy, and joy (Canda et al. 2020). Furthermore, spirituality has been noted as a strength-based internal and external resource (Canda et al. 2020; Pandya 2018). These inclusive definitions of spirituality launch new opportunities for FPHs to engage in spiritually sensitive assessments and interventions and to draw upon the innate spiritual potential of clients to meet spiritual goals of peace, well-being, and wellness (Hodge et al., forthcoming). Offering spiritually competent service as an FPH worker requires initiating spiritually sensitive assessments and interventions to promote client change, including meaningful connections between oneself, the universe, and others (Gray and Coates 2013; Pandya 2018). “Spiritually sensitive practice is a way of being and relating throughout the helping process” (Canda and Furman 2010, p. 214). As noted earlier, when exposed to a TGL, one often experiences a disconnect between these relational experiences.

Occupational Psychological Injuries

For FPHs, traumatic events can lead to occupational psychological injuries (OPIs) that can include a range of aspects such as traumatic stress, moral injury (MI) (Jinkerson 2016), emotional labor (Perry and Ricciardelli 2021), compassion fatigue (Figley 2002), burnout (Papovic 2009), and disenfranchised grief (Doka 1999), with personal and organizational effects. Jinkerson (2016) proposed that MI, specifically, is a trauma-related outcome that includes feelings of intense guilt, shame, lack of trust, and spiritual crisis, adding to the psychological complications associated with trauma healing. MI, when intertwined with the post-trauma experience, contributes to additional challenges connected to traumatic grief, which can create intrusive, disturbing thoughts and images (Hooyman and Kramer 2006) and spiritual distress (Kubitza et al. 2023). This type of TGL has historically been disenfranchised and not socially supported, which is also a political and ethical failure to respect suffering and can interfere with resiliency and transcendent processes (Attig 2004).

Traumatic distress and MI can challenge one’s spirituality, resulting in spiritual challenges and distress, creating a need for spiritual meaning reflection and processing (Carey et al. 2016; Kubitza et al. 2023; Smiechowski et al. 2021). Spiritual distress is a complex phenomenon, and emerging literature contends that treating MI, trauma, and spiritual distress requires spiritually integrated approaches to reduce mental health psychopathology and even suicide (Carey et al. 2016; De Vynck et al. 2023; Harris et al. 2018). Researchers and theologists have noted the significance of exploring spirituality after a traumatic event to promote spiritual growth (Morrison et al. 2009). Research over the past decade has demonstrated that when therapy includes dimensions of spiritual and religious content, individuals experience positive mental health outcomes (Dailey et al. 2015; Koenig 2012; Oxhandler and Ellor 2017; Oxhandler and Pargament 2014; Pomeroy et al. 2021). Attending to spiritual distress and challenges, revising one’s spiritual worldview, and focusing on spiritual strengths and resources can support the healing processes and journey through trauma and MI, resulting in better recovery outcomes.

Likewise, research continues to support the importance of spirituality in treatment as it is essential for clients and is being dealt with by clinicians in various frontline contexts, recognizing the need for professional helpers to develop spiritual competency (Canda et al. 2020; Hodge 2015; Husain and Sherr 2015; Kvarfordt and Herba 2018; Oxhandler et al. 2015; Pomeroy et al. 2021). Exploration has shown that many North Americans believe in God, a higher power, a universal spirit or consciousness, or have some connection to religion (Statistics Canada 2022; Newport 2012). Morrison et al. (2009) noted that many clients’ spiritual growth is linked to success when managing life challenges. According to Dailey et al. (2015), clients expect that “counsellors will understand their spiritual concerns and use holistic interventions” (p. 16). Yet training for FPHs in spirituality and spiritual interventions continues to be an unaddressed area (Boynton 2016; De Vynck et al. 2022; Kvarfordt and Herba 2018; Pinto and Pinto 2020; Zollfrank et al. 2014) requiring attention in curricula and professional practice.

This increased exposure to the clinical significance of including religion and spirituality (R/S) for physical and mental health outcomes has prompted a resurgence of interest in how to include R/S as part of the therapeutic process (Boynton and Mellan 2021; Boynton and Vis 2022). Over the past two decades, discussions have continued advocating for the importance of education and training to enhance spiritual competence among FPHs, and it is emerging in accreditation standards (Boynton forthcoming; Graham et al. 2006; Pomeroy et al. 2021). Incorporating a spiritually informed approach with trauma survivors by those who are trained to help them invites the opportunity for spiritual interaction among the client and professional helper to move beyond the trauma story to that of hope and possibility. However, little has been researched or written about how spiritual aptitude interrelates with spiritual competence and skill development. More discussion is needed to determine how the spiritual capacity of FPHs can be accessed as a strength-based resource to promote resilience and growth for those exposed to trauma. Facilitating spiritual competencies and enhancing the spiritual intelligence of future workers could translate to best practices and improved outcomes for trauma survivors. Emmons (2000) conveyed that spiritual intelligence involves the knowledge, skills, and abilities for adaptively using spirituality and argued that spiritual virtues, maturity, and skills could be acquired and cultivated.

3. Guiding Assumptions

Hermeneutic phenomenology offers a guiding research context for this reflection. The philosophic perspective of hermeneutic-phenomenological research involves the writer disclosing and embracing one’s prejudgment very personally (Vis 2008; Patton 2015). As authors, we have reflected on what experience or interest led us to ask about the significance of FPHs’ awareness of spiritual intelligence. We surmised that spiritual intelligence influences spiritual competence and skill development and reasoned what is required for education and training. We pondered how a conceptual model might assist in promoting spiritual intelligence for FPHs to incite resilience and growth for themselves, as well as offering support for those who have experienced trauma that focuses on spirituality.

This inquisitive process has evolved over the past few decades with the authors engaged in direct clinical interaction with clients, providing supervision, consultation, and mentorship to FPHs, offering support to frontline workers exposed to trauma material, and engaging in scholarly endeavors such as research, writing, and academic presentations. Through this experience, eight guiding assumptions are highlighted in this reflection:

• Everyone is spiritual at some level.
• Spiritual development is part of human development.
• Trauma events can create a spiritual crisis or distress that can be an opportunity for PTG.
• There is a relationship between spirituality, trauma, resilience, recovery, and PTG.
• Spiritual intelligence and competencies can be learned and increased.
• Spirituality is a strength-based asset that can be used to make meaning of self, purpose and being, foster connectedness, and can lead to PTG.
• Discussions of spirituality are welcomed when safer spaces are created.
• Suffering and trauma can play a significant role in transformation and transcendence, spiritual development, and a deepening of spiritual understandings. Trauma can be the beginning of a new story.

4. The Value of Spiritual Aptitude

Research in psychological TGL has demonstrated the significance of spirituality as a core area of intervention (Harris et al. 2018; Post et al. 2022). FPHs who incorporate spirituality into their practice also know the positive influence spiritual questioning and resourcing can offer individuals as a strength-based resource (Pandya 2018). While spiritual competency tools exist to measure a frontline worker’s competency in delivering spiritual conversations and interventions, little is written concerning teaching and promoting this competency in FPHs (Robertson 2010; Dailey et al. 2015). The lack of education and training concerning spiritual intelligence, competence, and skill development leaves FPHs feeling ill-equipped to address spiritual issues, even when directly presented by the clients (Boynton 2016; Dailey et al. 2015; De Vynck et al. 2022). For example, healthcare providers’ lack of education on R/S is a significant barrier to integrating R/S care into healthcare services (Pomeroy et al. 2021; Richardson 2012; Zollfrank et al. 2014). Equally, social work professionals recommend a holistic approach to social work practice, including spiritual health and the ecobiopsychosocialspiritual issues that affect well-being (Boynton and Margolin 2024; Richardson 2012). Dailey et al. (2015) also noted that counsellors who self-reported some level of spirituality or religion scored higher in spiritual competence and tended to seek ongoing spiritual training than those who disclosed that they were neither spiritual nor religious.

While this research is limited to specific frontline work, we support the perspective that basic spiritual knowledge would benefit a much broader professional scope. The growing acknowledgement of the value of spiritual assessment and interventions, particularly for individuals exposed to TGL, highlights the benefits of spiritual competence for various frontline professionals to assess and support TGL for individuals to whom they provide service (Dailey et al. 2015; Robertson 2010). Spiritual struggles can occur for many different reasons such as identity concerns, interfaith marriages, political conflicts, various relationship concerns, and even through the academic learning process.

At its most fundamental level, spiritual aptitude is an adaptive use of information that can be used to assist with problem solving and goal attainment (Emmons 2000). When people face significant life pressures such as TGL, their spiritual capacity can help them find meaning in stressful situations, connect with spiritual resources, and engage in spiritual activities and practices. Through that, they can more easily cope with the circumstances. Developing spiritual aptitude gives people a new insight into themselves and their place in the world and improves their self-confidence and sense of mastery. It also helps people achieve self-consistency, reduce their worries and anxiety, and create strong relationships (King and DeCicco 2009).

5. The Value of Spiritual Competence and Skill Development

Much research has been carried out to clarify what FPHs can do to foster the delivery of spiritual practice. Canda and Furman (2010) developed five core principles of spiritually sensitive practice. Dailey et al. (2015) noted that the work of the Association for Spiritual, Ethical, and Religious Values in Counseling shaped the development of the Spiritual Competency Scale (SCS), as well as the six distinct factors for spiritual competence. Its final revisions comprise the Competencies for Addressing Spiritual and Religious Issues in Counseling (see related citations for further information). Nevertheless, despite these endeavors aimed at promoting the inclusion of spiritual practice with clients, the lack of training and education within various frontline line professions presents a challenge. It continues to be difficult to know how best to translate these principles and competencies from FPHs to client experience (Dailey et al. 2015). When the concept of R/S is ignored in the training of FPHs, it becomes counterintuitive to understanding and treating the whole person, leading to missed opportunities for healing. As a result, FPHs may question their ability to make meaning, assess, intervene, and evaluate R/S aspects related to the TGL experience (Cashwell and Young 2004).

FPHs who come to their education and training with an appreciation of the role of R/S in one’s life may be more sensitive to their spirituality and strengths and their client’s needs for R/S exploration. However, more is needed to encourage the spiritual capacity of FPHs and practice with those exposed to TGL. Based on our guiding assumptions, supported in the literature, we propose that spiritual competency emerges as one is exposed to self-reflection, life experience, spiritual awareness, action, and evaluation (Heredia et al. 2020). A conceptual framework aimed at awakening the FPH’s spiritual appreciation can be the route to formulating consistent R/S practices enhancing professional and personal capacities for effective practice in the field.

6. The Value of a Conceptual Framework

The focus on spirituality reflects shifts in the scientific and academic communities and global demographic and socio-cultural transitions that stress the importance of exploring spirituality in people’s lives (Ai 2002). Exposure to life-threatening traumatic events involves reactions of fear and anxiety and creates a sense of inability to control or manage the outcome, amplifying the need for spiritual exploration (Boynton and Vis 2022). When one is exposed to a traumatic event, spirituality can be an integral aspect of how one engages in the process of making meaning. When we ignore the spiritual dimension of people’s lives, we may miss an opportunity to help people construct holistic narratives that accurately fit their experiences (Canda et al. 2020). This can also be known as engaging in spiritual attunement whereby an FPH builds capacity that includes spiritual awareness and responsiveness (listening, attending, and responding) to spiritual content and creating a safe space for spiritual dialogue and expression (Boynton 2016; Boynton and Mellan 2021). FPHs, regardless of their job role, will likely find themselves in situations with those who have experienced a TGL event and organically engage in dialogue of a spiritual nature. Regardless of where they might meet individuals throughout their trauma-processing journey, spiritual attunement and competency can promote opportunities for understanding, healing, and growth.

While some educators remain cautious due to the relatively underdeveloped research on spiritual competency, others recognize the importance of integrating spirituality into teaching practices. Nurses, physicians, social workers, psychologists, first responders, and mental health practitioners are just some of the professions currently proposing the benefits of including education about spirituality in one’s professional practice (Ai 2002; Burke et al. 1999; Kubitza et al. 2023; Pinto and Pinto 2020; Zollfrank et al. 2014).

The significance of spiritual intelligence and posttraumatic growth are essential concepts to incorporate when conceptualizing a framework for developing spiritual competency for FPHs. The conceptual framework presented here aims to increase the discourse concerning how to enhance FPHs’ spiritual competency. It is primarily informed by the combinedscholarly work and research of Emmons (2000), Tedeschi and Calhoun (1995), and Wigglesworth (2012). These authors offer differing yet interconnected concepts important to consider when attempting to create a framework to promote spiritual competence when addressing TGL.

Emmons (2000) defined spiritual intelligence as “the adaptive use of spiritual information to facilitate everyday problem solving and goal attainment” (p. 59). Emmons also proposes that spirituality is a set of tools that allow individuals to explore meaning and offer knowledge to address problems in living, leading to a quality of life. Specifically, Emmons offers a list of core components of spiritual intelligence: (a) the capacity for transcendence, (b) the ability to enter heightened spiritual states of consciousness, (c) the ability to invest everyday activities, events, and relationships with a sense of the sacred or divine, and (d) the ability to utilize spiritual resources to solve problems in living (p. 64). FPHs are challenged in their professional practice to problem-solve, set, and achieve goals. These skills are not only required for oneself but to offer pathways for one’s clients. When clients are exposed to traumatic incidents, they often struggle with meaning, problem solving, and goal-setting, which reflects their experience. When FPHs have spiritual tools at their disposal, they can confidently transfer them to those they provide service to.

Calhoun and Tedeschi (1999) stated that for PTG to be more likely, “the clinician must be knowledgeable about, comfortable with, alert to, and active in working with the client’s spiritual issues” and that the therapist “develop some degree of comfort in the roles of philosopher and spiritual guide” and that this is carried out “in the service of the client’s wellbeing and growth” (p. 120). FPHs, in their various roles, often find themselves in situations where spiritual questioning or processing might occur. Questions related to meaning making, self-blame, and wonderment about the afterlife are just some of the spiritual issues that can arise throughout a person’s timeline following exposure to a traumatic event. Processing traumatic memories and cognitive restructuring play a crucial role in the processes of healing, recovery, positive growth, and personal change (Tedeschi and Calhoun 1995) as well as existential and spiritual change (Tedeschi et al. 2017) and can occur at any time during a person’s change trajectory. Nevertheless, spiritual and transcendent meaning making is pivotal in processing and cognitive restructuring. The five domains of PTG outlined by Calhoun and Tedeschi (2006) include (1) new possibilities, (2) relating to others, (3) personal strength, (4) appreciation of life, and (5) spiritual change. Not all FPHs are in a therapist role, and many will encounter individuals processing traumatic events while in crisis, in emergencies, or amid other grief and loss experiences. Regardless, FPHs can be invited into conversations and in processing with individuals during or after encountering a TGL event. In all these situations, spiritual awareness, attunement, and spiritual tools can be used in attending to the individual at any point in the trauma trajectory and to promote PTG.

Bratianu (2013) described a triple helix of knowledge involving “cognitive, emotional and spiritual knowledge that are dynamically interconnected” (p. 210). Spiritual knowledge involves values, beliefs, morals, life aspirations and motivations, deep life matters, and the ability to draw on the strengths and resources of the human spirit stems from one’s spiritual capital (Zohar and Marshall 2004). Spiritual competency requires some level of spiritual knowledge and spiritual intelligence (SQ), which Wigglesworth (2012) defined as “the ability to behave with wisdom and compassion while maintaining inner and outer peace regardless of the situation” (p. 8). SQ involves awareness, openness, and intuitiveness in spiritual realms. Wigglesworth (2012) created the SQ model with four quadrants consisting of self/self-awareness, which includes profoundly knowing oneself; universal awareness, which entails knowing the world; self/self-mastery, which is a deep understanding of who you are; and social mastery/spiritual presence, which includes being a wise and effective teacher/mentor, leader/change agent, making compassionate and wise decisions, and being a healing presence. The SQ model encompasses 21 skills that build upon one another and can be learned, developed, and evaluated. SQ skills can be taught to FPHs to embrace spirituality for personal and professional development and self-transcendence.

7. Conceptual Framework for FPHs Part 1

Our conceptual framework assumes that FPHs can grow in their SQ and competence as they gain professional and personal experience engaging in job duties and through training and development. Adapted from Boynton’s (forthcoming) research on spiritual competencies for social work professionals, this conceptual framework addresses professional workers on the frontlines. It involves three interlinked levels: exposure and awareness, immersion and experience, and integration and sense of mastery.

7.1. Exposure and Awareness

In this first introductory level, awareness and critical reflection are used to build the foundational conceptualizations of spirituality and TGL and their intersections. The individual becomes aware of the formation of their spiritual worldview, values and beliefs, and their ethnocentricity. Through a pluralist and expansive lens, the diversity of spirituality, faith, religions, and traditions and respectful attitudes emerge. While this is a transformative learning process, it may involve discomfort. It is proposed that sense-making and self-awareness are essential characteristics for individuals to feel empowered in their abilities through their process from being to becoming when exposed to crisis and difficulty (Maitlis and Sonenshein 2010; Mayer and Salovey 1993). Specifically, Mayer and Salovey (1993), in their seminal research, discuss emotional intelligence or competence as an ability to “monitor one’s own and others’ emotions, to discriminate among them, and to use the information to guide one’s thinking and actions” (p. 433). These authors access the scholarly work of Gardner’s (1983) “[intra]personal intelligence” (Mayer and Salovey 1993, p. 433) to highlight the significance of feeling life and that processing emotions can lead to meaning and understanding and how this might guide one’s behavior. Building on these concepts, spiritual exposure, awareness, and meaning making are explored within a professional context where emotional and spiritual self-awareness are seen as critical ingredients to offering FPHs the ability to reflect on their job experience, emotions, and how sense-making shapes change related to their spiritual competence. Self-directed learning and discussion with peers is encouraged and fostered. Awareness of the importance of spiritual self-care activities and contemplative and reflective practices is expanded.

7.2. Immersion and Experiencing

At the immersion and experience level, FPHs are in the process of understanding the benefits of spiritual intelligence and competence personally and professionally. They engage with a professional curiosity that involves seeking, reflecting, and integrating knowledge, skills, and attitudes through experience (Kolb 1984). Utilizing foundational knowledge from the exposure and awareness level, FPHs are challenged to explore and engage their sense of spirituality and how this might lead to PTG for themselves and those to whom they provide service. Knowledge and skills continue to develop as they actively participate in experiential learning, including case studies, role plays, review and discussion on research and best practices, and further engagement in spiritual self-care activities and contemplative and reflective practices. Through practicing attunement, they develop attitudes, skills, and spiritual competence directly through their professional practice of supporting the people they assist.

7.3. Integration and Sense of Mastery

At the integration and sense of mastery level, FPHs combine personal and professional experience with a desire to engage in lifelong learning and knowledge expansion, hone their skills, and refine their attitudes. They more fully understand their scope of practice and utilize critical thinking. They are more adept at problem solving and decision making and continue to utilize and expand their tools and resources for practice and personal use. As a result, they not only integrate experiences that have reaffirmed the benefits of spiritual attunement to promote PTG, but they have also received positive evaluative feedback from peers and clients and have experienced positive outcomes. Peer mentoring becomes important and offers opportunities for mentees to observe and learn from those with experience and practice knowledge. In addition, mentors also experience personal rewards through positive role modeling, leadership, and growth in their knowledge, skills, and attitudes through assisting others (Ross et al. 2015). FPHs become comfortable practicing spirituality in their lives and job roles, value ongoing education in this area, and continue to transcend in spiritual intelligence and competence.

8. Conceptual Framework Part 2

The second part of the conceptual framework includes the three categories of knowledge, skills, and attitudes interconnected within the competency levels and has a broad list of evidence. Each category offers a point of reference to evaluate where one might be, depending on the evidence provided in each category. The framework (see below Conceptual Framework Part 3) outlines the levels and categories, offering more specific information.

• Knowledge: Includes conceptual understandings, self-awareness, worldviews, self-regulation, self-acceptance, scope of practice, and research knowledge;
• Skills: Includes interpersonal effectiveness and humility, self-confidence and sense of mastery, spiritual assessment, treatment, and evaluation competencies;
• Attitudes: Includes self-identity and practice identity, anti-oppressive practice, authentic use of self, a sense of meaning and purpose, and spiritually sensitive practice.

9. Conceptual Framework Part 3

As noted above, the following list of spiritually informed practice competencies has been adapted from Boynton (forthcoming).

Table 1. Spirituality and trauma, grief, and loss competency framework.

Intrapersonal Awareness and Competence
Level	Knowledge	Skills	Attitudes
Exposure and Awareness	Understands the importance of self-awareness of one’s spirituality, values, and beliefs. Exposure to TGL can reaffirm one’s knowledge and reconfigure one’s sense of identity. Competence and awareness are reawakened—or new appreciation for the need for competence and understanding.	Can articulate how one’s spiritual beliefs and biases might arise in practice. Awareness of tools needed to address TGL exposure, self-regulation, and embodiment. Able to assess own level of spiritual development and identify spiritual activities for self-care.	Adopts a pluralist lens and respects different orientations of spirituality and various world religions, traditions, and faiths. Comes to view TGL as an injury, and spiritual healing processes can facilitate PTG. Values spirituality as a resource, strength, and resiliency factor.
Immersion and Experiencing	Can identify personal experiences with TGL, one’s spiritual worldview, practices, inner resources, and the influences across one’s life.	Uses self-reflection for self-assessment. Able to identify possible biases, assumptions, judgements, and how they might miss spiritual content of importance. Engages in embodied awareness and self-regulation. Engages in own spiritual practice and contemplation.	Openness and understanding to different orientations of spirituality and various world religions, traditions, and faiths. Values spirituality and the strengths and resources for TGL and PTG.
Integration and Sense of Mastery	Knowledge of levels of faith and spiritual development and intelligence (Wigglesworth 2012; Zohar and Marshall 2004). Knowledge of own spiritual strengths and areas of development. Understand one’s TGL effects and processes for healing and PTG.	Able to assess own level of spiritual development. Identifies own TGL and spiritual needs and accesses support as required. Utilizes tools for self-regulation—effective use of self, including spiritual strengths. Integrates and relies on one’s spiritual activities and practices as a strength and coping tool.	Appreciates the value of one’s spirituality and its influence on identity—acceptance of human suffering and the need for self-care and compassion.
Interpersonal Attunement and Humility
Level	Knowledge	Skills	Attitudes
Exposure and Awareness	Demonstrates knowledge and understanding of various religions, faith traditions and spiritual practices, activities, and rituals. Recognizes how spirituality can affect decision making and problem solving in self and others, particularly about TGL—awareness of transference and countertransference.	Can respectfully initiate discussion of spirituality with another. Uses communication and interpersonal skills for effectively attuning to spirituality and TGL.	Has an appreciation and respect for unique and diverse expressions of spirituality—openness to the benefits of spiritual tools and coping strategies others used to promote healing and PTG.
Immersion and Experiencing	Demonstrates knowledge of the interconnectedness of TGL and spirituality. Understands how religion can be a source of struggle and comfort.	Practices humility, openness, respect, and reflection of affect. Asks questions regarding spiritual strengths, challenges, supports, and resources. Can suggest spiritual tools and coping strategies for healing in TGL and promote PTG, even if different from one’s orientation.	An open and respectful attitude toward the other individual and their spiritual uniqueness. Authentic attention to TGL and spirituality.
Integration and Sense of Mastery	Can articulate an understanding of spiritual components, strengths, and spiritual needs in TGL and PTG.	Demonstrates openness, respect, the reflection of affect, and capacity for co-regulation. Demonstrates effective use of self. Articulates, understands, and is sensitive to the spiritual strengths and challenges of the individual and their worldview. Exhibits the ability to pick up on spiritually themed dialogue, ask questions, and explore spiritual aspects. Open to spiritual questioning or rumination from clients without triggering unresolved or personal TGL and spiritual challenges. Can manage differences in spiritual worldviews in families or among community members. Recognizes and responds to transference and countertransference.	Embraces an attitude of acceptance, validation, empathy, and compassion, as well as appropriate questioning and reflection of struggles and challenges for the other. Supportive of and respects the decision making of others about their spiritual worldview. Demonstrates respect for differences and spiritual self-determination for individuals, families, and communities.
Professional Practice—Assessment and Planning
Level	Knowledge	Skills	Attitudes
Exposure and awareness	Aware of various types of trauma exposure and their impact on spirituality. Introductory knowledge of therapeutic rapport building, spirituality, and TGL assessment processes. Knowledge of informed consent and limits of confidentiality.	Can conduct a spiritual assessment by asking implicit and explicit questions about one’s spirituality. Asks about the trauma event and its effects without going into specific details. Can identify spiritual strengths, resources, and supports, as well as needs and challenges.	Demonstrates consideration of varying spiritual developmental levels and practices beyond one’s scope of practice. Displays respect and joins with individuals to co-create space for dialogue and planning.
Immersion and experiencing	Has a sense of one’s spiritual strengths and the benefits of spiritual strengths in others. Understands spiritual distress, struggles, and crises and interconnection with TGL. Has experienced or witnessed spiritual post-trauma growth following a distressful or crisis event.	Can engage in conversations about spirituality and its link to PTG, allowing for client reflection on how spirituality might be pertinent to the trauma effects. Able to conduct a more thorough spiritual assessment to collaboratively identify strengths, challenges, and needs, reflecting client readiness resources. Able to collaboratively set spiritual goals and those for healing. Awareness of when to refer to spiritual care, elder, or religious leader.	Demonstrates openness and allows for self-determination of the individual. Engages with compassion, empathy, safety, and care. Attends to the best interests of others.
Integration and sense of mastery	Understands the need to assess spiritual emergencies following a TGL event. This includes negative beliefs, mental health issues, psychosis, and psychopathology. Awareness of issues that can arise in relationships with a higher power or meaning making following a TGL event.	Able to assess helpful and positive as well as unhelpful or harmful spiritual coping activities and practices pre- and post-exposure to TGL. Collaboratively sets goals with the individual, family, or community, incorporating spiritual and TGL healing strategies.	Adopts openness and respectfully engages others without imposing one’s sense of spirituality on another. Is respectful and welcomes the diversity of spiritual differences. Appreciates spiritual experiences and the effects of TGL events.
Professional Practice—Interventions and Appropriateness
Exposure and awareness	Knowledge of determining if spiritually focused intervention strategies are appropriate for the client. Knowledge of alternative and holistic trauma therapies, including grounding techniques, sensorimotor and embodiment practices, expressive arts and play therapies, bibliotherapy, and spiritual interventions.	Demonstrates an awareness of spiritual resources to support or deliver interventions within the community. Can assess the appropriateness of spiritual referral and follow through. Able to implement spiritual activities in treatment.	Openness to the positive impact of spiritual strengths and needs and the client’s challenges for intervention planning. Understands the importance of informed consent when referring to alternate providers. Sensitive to client readiness and need for safety and stabilization.
Immersion and experiencing	Considers theoretical underpinnings of trauma-informed care and articulates this to the client when appropriate. Has explored a range of tools and strategies for spiritual and TGL treatment.	Responds to spiritual needs and challenges utilizing agreed-upon strategies with the individual. Links clients to support and resources where appropriate. Treatment approaches fit the client’s spiritual and TGL needs.	Demonstrates a spiritually integrated trauma-informed approach to intervention and treatment. Appreciates the importance of discussing informed consent and engaging the individual in the change process.
Integration and sense of mastery	Demonstrates intentionality of integrating spiritual interventions within a trauma-informed lens while also matching the client’s needs and worldview.	Demonstrates a comfortability and willingness to engage in collaborative conversations about spiritual struggles related to trauma exposure. Can respond and engage in conversations with individuals struggling with meaning formation and purpose of the event. Integrates client’s beliefs and practices into trauma treatment approach. Can pivot and respond to struggles arising in treatment.	Holds regard for and addresses client’s questions, concerns, desires, wonderings, values, and beliefs and how they might have changed because of TGL.
Professional Practice—Evaluation and Professional Development
Exposure and awareness	Accesses and evaluates relevant research in trauma and spirituality in one’s own and across disciplines. Able to recognize influences of one’s own spiritual beliefs in treatment. Understands the need for personal self-care assessment and that of another.	Identifies areas of spiritual strength and resources support and how they have been used to manage client challenges, distress, and struggles as part of the evaluation process. Able to assess the effectiveness of spiritual exploration and interventions.	Appreciates the importance of evaluation and skill development for collaboration, client-directed assessment, goal setting, and treatment. Values and seeks out professional development in spirituality and TGL and how they might be applied within one’s work role.
Immersion and experiencing	Begins to critically examine and evaluate research in TGL, spirituality, and PTG. Understands evidence-based practice approaches and practice-based evidence.	Demonstrates ability to seek out and engage in consultation to enhance assessment and intervention skills in spirituality, TGL, and PTG. Works collaboratively with clients to evaluate spiritual strengths and barriers and their relation to PTG. Ability to self-reflect about one’s capacity to offer spiritual support and when to refer to spiritual care, leader, or elder.	Appreciates the significance of spiritual assessment and interventions to support effective trauma processing and PTG and can evaluate effectiveness. Respects the scope of practice and is aware of one’s level of competency. Values personal self-evaluation and engages in continued professional development.
Integration and sense of mastery	Develops and shares knowledge among professional peers about research in spirituality, TGL, and PTG. Recognizes the need for ongoing training and education concerning spiritually informed trauma care and PTG.	Can assess and evaluate spiritual post-trauma growth and development of another. Supports continued spiritual engagement as part of the ongoing care plan upon service closure. Able to offer ongoing resources where appropriate. Advocates for spiritually integrated and sensitive practice. Regularly engages in own spiritual self-care.	Values critical thinking as it pertains to spirituality and growth in the assessment and treatment process. High regard for the need for ongoing professional growth and competency in spiritually trauma-informed practice. Values ongoing personal spiritual self-care and development of spiritual intelligence and competence.

below combines competencies that pertain to the diversity of FPHs and addresses the components of intrapersonal awareness and competence, interpersonal attunement and humility, and professional practice. Intrapersonal awareness and competence, along with interpersonal attunement, focus primarily on the personal experiences and strengths one brings to one’s professional role, with a recognition that these attributes will grow over time. Professional practice focuses on how FPHs can intentionally increase their spiritual attunement, assessment, intervention, evaluation, and development practices, recognizing how spiritual attributes can enhance positive change and growth for those experiencing TGL.

10. Implementation of the Learning Process

As noted in the literature, it is unlikely that FPHs will have opportunities to explore the transformative potential of spiritual attunement in their formal education (Ai 2002; Pinto and Pinto 2020; Zollfrank et al. 2014). Equally, it is unlikely that a student pursuing one’s education within the scope of an FPH’s profession will fully appreciate the transformative power of spiritual attunement until they experience TGL within their work role or life. It is supposed that FPHs may rely on their spiritual understanding to field questions, concerns, or directions brought forward by their client or disengage from such interactions. It is possible to consider that without formal education to prompt FPHs’ awareness and exposure to spiritual competencies, professionals will resort to their own beliefs and practices. While the literature shows that those who are R/S are more likely to engage in R/S with clients when it is reasonable to do so, they might also use their R/S coping tools to personally manage the impact of exposure to TGL in their work (Pandya 2018). Thus, all FPHs could benefit from training around spirituality.

Implementing a learning process that prioritizes spiritual competency for FPHs exposed to TGL offers opportunities for PTG in both the professional helper and those to whom they provide service. The conceptual framework presented in this manuscript provides a tool within which FPHs can self-assess and determine the areas for growth. The following learning process suggests various opportunities to apply the conceptual framework, whether one engages in self-directed learning, peer mentoring, organizational, professional development, or, where possible, within formal education programs for FPHs.

11. Self-Directed Learning

The conceptual framework provides ample opportunities for FPHs interested in personal and professional growth. Self-directed learning can take the form of personal growth activities rooted in spiritual practices, counselling, reading resources, web-based learning, certificate or course study, or participating (virtually or in person) in seminars, workshops, and training initiatives related to R/S, TGL, and PTG.

12. Peer Mentoring

Healthy peer relationships create a significant learning environment for the mentor and mentee. FPHs exposed to TGL often encounter personal and professional teaching moments through direct observation, shadowing, and confiding. When a mentee is experiencing awareness and exposure to TGL, observation of a mentor accessing one’s spiritual competency at the integration and sense of mastery level provides learning and support that can be invaluable.

13. Organizational Development

Organizations that provide services to marginalized populations, those in crisis and emergencies, or those involved in TGL are accountable to their employees to ensure best practices based on service and employee health. Recruitment and retention are often related to morale, healthy employee–management relations, and the purpose of one’s work. Professional development incorporating spiritual attunement to complement other mental health and wellness training would provide an expanse of tools and resources to support employees.

14. Integration into FPH Education

Ultimately, formal education in any FPH program could provide the foundation for awareness and exposure concerning R/S in situations of TGL. Within a formal education setting, students can begin to appreciate the importance of spiritual attunement for themselves and others exposed to TGL as a pathway to PTG.

In any of the above learning process opportunities, the FPH can use the conceptual framework as a guide to self-assess, placing oneself according to each level and category and determining the next steps for growth.

15. Conclusions

This reflective article opens a discourse to highlight the importance of spiritual attunement and competence for FPHs and tools to promote PTG following TGL. It offers a conceptual framework incorporating knowledge, skills, and attitudes within growth levels of exposure and awareness, immersion and experiencing, and integration and a sense of mastery. This emerging framework integrates literature and research emphasizing the significance of spiritual attunement for FPHs and PTG as critical components of spiritual competency development, further highlighting the importance of spirituality in the helping and TGL healing process.