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Running head: SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE

Direct Social Work Practice with Clients who Experience Spiritual Abuse. Brenda L. Caballero Winthrop University

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE Abstract This paper explores the importance of assessing aspects of a clients spirituality as pertinent to social work direct practice. It recognizes that some of the problems and issues clients bring to therapy stem from or are influenced by their spiritual/religious beliefs and their involvement in

faith-based groups. I argue that social work practitioners need to be aware of the phenomenon of spiritual abuse, a term coined by pastoral counselors to describe a misuse of power in spiritual/religious contexts that result in significant psychological distress and a disruption in individuals relations with their significant others and with their social environment. I evaluate a variety of theories and intervention modalities that can be applied to assess and address spiritual/religious issues presented by clients to select a theory that, in my opinion, can be applied successfully in working with clients who experience spiritual/religious abuse. Finally, I present the argument that spiritual abuse is an empowerment issue, and as such, it is especially pertinent to and congruent with social work practice with individuals, families and groups. Keywords: Spiritual abuse, religious abuse, spirituality, cognitive theory, narrative theory, cognitive behavioral therapy, object relations theory, relational family therapy.

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE In the practice of social work with individuals, families and groups we assess clients situations from a bio, psychosocial, spiritual perspective; looking for aspects of a clients emotions, cognition, behavior and social functioning that are influenced by the social environment and the culture in which they live. As part of that systems perspective, in many occasions, social workers encounter in their practice issues related to a clients religious and spiritual beliefs and their involvement in faith-based groups. For many individuals and families, their affiliation to religious organizations is at the center of their lives. It greatly shapes their world views, the meaning of their lifes processes, the way they define the source and nature of their problems, the roles with which they identify themselves; and ultimately, their own sense of identity. Scott Richards, Bartz, OGrady (2009) argue that when social work professionals have an understanding of a clients spiritual worldviews, they are not only able to establish better rapport with their clients, but also determine if there are spiritual issues or concerns that need to be addressed as part of their interventions (p. 67). Literature Review The concept of spiritual abuse, also denominated religious abuse, was first addressed and explored by social scientists in their study of cults or new religious movements (NRM). NRMs are primarily religious groups/movements that operate apart from the dominant culturein our case, the Christian Westin which they are located and, in addition, seek adherents from their host culture (Healy, 2011). A diversity of helping professionals, in their encounter with former members of such groups in practice, developed material to work with them using diverse psychological models of cultic influence. In the attempt to conceptualize this phenomenon, researchers and practitioners often encountered difficulty

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE finding a clear-cut definition of what constitutes harmful, abusive or pathological behavior within diverse religious, faith-based settings. Clients who came to therapy as a result of traumatic experiences within cults, presented a number of psychological disturbances, and significant emotional and existential difficulties. Australian Social Worker David Ward (2010) indicate that research studies and clinical observations of individuals who had left NRMs led to the identification of philosophies, rituals and practices within such groups that were clearly physically and emotionally abusive. Empirically oriented research, focused on observable behaviors, was useful to identify forms of cult abuse: boundary violations by cults leadership, coercion and unethical behavior resulting in marked and significant emotional distress (p. 900). David Ward (2010) formulated a thesis on what he denominated toxic spirituality, or spiritual beliefs and practices that cease to be beneficial to the adherent, but instead become a tool to inflict psycho-spiritual damage (p. 899). Warp adopted the term spiritual abuse, coined for the first time by pastoral counselors Johnson and VanVonderen (1991) to propose the thesis that not all spiritually abusive behavior occurs in the context of cults. Johnson and VanVonderen (1991) conceptualized spiritual abuse as the mistreatment of a person who is in need of help, support or greater spiritual empowerment, with the result of weakening, undermining or decreasing that persons spiritual empowerment (p.20). To explore the phenomenon of spiritual abuse within groups of Judeo-Christian orientation, David Warp (2010) conducted a study on the experiences of individuals who left a diversity of these groups, using Interpretative Phenomenological Analysis (IPA). IPA consists of the analysis of the narratives of participants when describing their experience of spiritual abuse, exploring not just the objective nature of the occurrences, but the subjective,

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE internal processes of the person subjected to spiritual abuse, and the meanings they ascribe to such experiences (Ward, 2010, p. 901). From the narratives of the individuals in the study, Ward (2010) identified six core themes consisting of: (a) leadership representing God; (b) spiritual bullying; (c) acceptance via performance; (d) spiritual neglect; (e) manifestation of internal states; and (f) expanding external/internal tension (pp. 903-908). These identified common themes through the participants narratives provided the base to propose a definition of spiritual abuse, not just as a phenomenon related to cultic involvement, but as a psychologically damaging experience that occurs when there is a misuse or abuse of power in any religious or spiritual context. Similarly, spiritual abuse adversely affects the interaction of the individual with the social environment. Emerging sub-themes in this Wards study (2010) such as: collective consciousness, family impact, social isolation and submission to authority, suggest that this form of abuse has far-reaching social consequences. In this sense, Ward argues that spiritual abuse can be identified as social problem on its own right (p. 902). Spiritual Abuse and Clinical Work A study exploring the impact on counselors of their work with spiritually abused clients in the United Kingdom, identified a variety of treatment modalities in working with this population (Guby & Jacobs, 2009). These treatment approaches included: (a) Personcentered transpersonal; (b) Existential phenomenological; (c) Solution focused therapy; and (d) Psychodynamic and Gestalt. The clients seen by the counsellors in this study were from diverse Christian backgrounds, including the Church of England and Catholic denominations. The common concerns identified by these professionals in their work with spiritually abused clients are similar to the core themes in Wards study, but went further to

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE include: (a) character assassination; (b) sexual abuse; (c) physical abuse and psychological abuse, perpetrated by a leader who exerts an unhealthy form of power; (d) use of scriptures considered sacred by the adepts; and (e) use a leaders God-given authority to justify abusive actions (Guby & Jacobs, 2009, p.191). This small-scale study recognizes both the benefits and the disadvantages of clinical approaches that emphasizes a workers empathic connection with the client, such as the person-centered approach. As a benefit, connecting with a clients emotional experience of spiritual abuse, can lead to a better understanding of the clients subjective experience and inner processes, and provides the client with a model of healthy interpersonal relationships; in contrast with the authoritative and domineering relationship established with the abusive leader. As a disadvantage, it makes it more difficult for practitioners to distance themselves from the traumatic material, opening themselves up to vicarious trauma, as the experiences of their clients related to spiritual abuse have the potential to challenge their own cognitive schemas and religious beliefs. Regardless of the practice framework chose to work with these clients, Guby and Jacobss study (2009) recognizes the danger of a worker establishing an agenda for the client and trying to influence a clients views based on a practitioners own spiritual philosophy (p. 202, para. 1). Relational family therapy. In an article exploring religious-related abuse in the family, Mandelj B. Simoni (2013) addressed the emotional aspects involved in religious abuse and also its transfer across family generations. The author argues that certain interpretation of religious beliefs can lead to dysfunctional patterns of behavior in family relationships and disruptions in emotion regulation processes (p. 339). Religious abuse occurs in the family when a parent or spouse utilizes religious beliefs to excuse or justify

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE physical or emotional abuse of his or her children and/or partner. Simoni (2013) proposes the application of a Relational Family Therapy model in helping clients overcome the effects of religious abuse and restore disruptions in emotion regulation processes in the family system. Relational family therapy (RFT) is a theoretical and clinical model that incorporates aspects of self-psychology, object relations theory and interpersonal analysis. RTF explores the clients dysfunctional interpersonal dynamics in the family, understanding those dynamics as mechanisms created to regulate painful emotions. From this perspective, religious abuse is seen as a mean used by individuals to distance themselves from emotional distress, avoiding their true source, which lies in the relations from the family of origin. The goal of RTF is to assist religiously abused/abusive individuals to develop an awareness of how they have been using faith as a hiding place, to disconnect emotionally from the other family members, and to avoid personal responsibility. Simoni (2013) defines the practitioners role as helping clients in the process of reframing their understanding of those childhood experiences, and to gradually transform their notions of faith in a manner that is no longer used to perpetuate abusive relationship patterns (p. 345). Object relations theory. Object-Relations theory offers a unique framework to understand spiritual concerns in the lives of clients, and its application in practice allows a clinician to foster the clients psychological and spiritual development simultaneously. Gurney & Rogers (2007) argue that there is a cycle of relatedness between an individuals mental representations of the divine and his or her relationships, worldviews, and the purpose and meaning he or she ascribes to lifes experiences (p.691). A persons relation to the sacredwhether viewed as positive, nurturing, available and responsive; or negative,

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE demanding and punitivestems from internalized templates of his or her primary relationships with caregivers. Conversely, an individuals relationships with others are organized in ways that unconsciously reflect his or her construction of the sacred. As an alternative, this theory proposes that spirituality can be conceptualized as a compensatory object in the lives of those who experienced poor attachments in their early development and turn to religion in times of crisis or distress. The sacred, then becomes the idealized, caretaking, and nurturing other (Davis, Moriarty & Mauch, 2013) Recovery and restoration for the client overcoming spiritual abuse involves assisting clients in the process of separating and differentiating from the beliefs, practices and expectations of abusive spiritual leaders and embracing a unique and personal relationship with the sacred (Gurney & Rogers, 2007). In this process, the spiritual crisis experienced by the client, his or her clash with the incongruences between his or her beliefs, and his or her suffering within a religious context serves as a an element that instigates the formation of a more individuated spirituality. The practitioner provides a safe, self-sustaining, and nurturing environment for the exploration and critical reflection of those internalized beliefs. The clinical work involves then the recreation of fundamental elements of significant past relationships, and reworking and remodeling the persons blueprint for relatedness. As reparation is experienced and the development of an integrated self begins, a new blueprint for relatedness will be established (Gurney & Rogers, 2007). Cognitive-behavioral therapy. The experience of spiritual abuse fosters in the person highly distorted views of reality, of self and others. Those distorted religious views can be operationalized as the rejection of doctrines with emphasis on renewal, repentance, restoration, redemption, forgiveness, grace and mercy, but strongly embraces ideas that

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE promote guilt, shame, unworthiness, personal destruction, and self-condemnation (Edwards, 2006). Clinical interventions using cognitive-behavioral therapy are relevant with people whose view of religion and spirituality has been distorted by rigid beliefs and spiritually oppressive teachings and practices. In the clinical work, religious and spiritual cognitions can be challenged and corrected. Clients come to therapy projecting the relationship with abusive leaders unto their experience of God and their interpersonal relationships in general. In cognitive processing, the clinician identifies, explores and assists the client in correcting cognitive errors that have religious or spiritual content. Walker (2010) emphasizes the importance of keeping a nonjudgmental and supportively impartial attitude toward a clients personal religiousness and spirituality (p.178). One of the roles of the clinician in the context of CBT is to normalize the clients spiritual struggles, thus enabling the person to question distorted and oppressive beliefs. While honoring a persons religious roots and spiritual background, CBT can help clients analyze how their religious belief system and derived values contribute to their notion of self-worth and their personal boundaries for behavior (Edwards, 2006). Narrative theory. Spiritual abuse is a form of oppression exercised by leaders claiming divine authority and without accepting a proper accountability over the lives of the members of their groups. Spiritually abusive systems saturate peoples minds with selfdenigrating beliefs that disempower them to assume control of their lives. To work with clients who have lived the experience of spiritual abuse is a process of enhancing their awareness of such oppressive forces and enable their liberation from those limiting cultural influences. Narrative theory is based in the premise that a persons life is an ongoing process of constructing a personal narrative, what people believe about themselves, their

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE sense of competence and contentment, and the position they occupy in the world (Blanton, 2005, p. 81). Personal narratives, defined as a persons view of themselves and their problems, are shaped by beliefs that have their roots in socio-cultural-religious contexts. These beliefs, assumptions or ideologiessecular or religiousare oftentimes passively assimilated, overpassing the filter of critical thinking, and crystallized in rigid personal narratives that are perpetuated through generations (Blanton, 2007, p. 215). The application of Narrative theory to spiritual issues have been also denominated transformative narrative therapy more commonly utilized in pastoral counseling. De Beer & Mller (2006) defines transformative narrative therapy as an expansion of the use of narrative therapy in the spiritual domain through the application of three basic principles: It is dialectical and paradoxical. It embraces the paradox of evil and good coexisting and hope and despair living together. () a person is encouraged to integrate her or his problem-saturated stories with alternative ones, resulting in a more encompassing and a compelling new narrative. It is symbolic. The transformation is more fundamental and far-reaching when it occurs at a symbolic level. () Even negative events, whether early childhood abuse or adult traumatic experiences, can become symbolic of something spiritual, something positive. It is heroic. It does not seek easy victories, nor does it aim at superficial solutions. It demands taking a courageous stance in life; it requires an unwavering willingness to confront and slay ones dreaded dragon. The end result is that a victims journey is transformed into a heros adventure. (p. 77).

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE Spiritual Abuse and Cognitive Theory From the perspective of cognitive theory, the domain of spirituality is conceptualized as the core beliefs, and the values derived from those beliefs, that give meaning to a persons view of reality, to their life experiences and that motivate their actions. Johnson & VanVonderen (1991) maintain that in spiritual abusive systemswhere spirituality is used to inflict psycho-spiritual damagemembers struggle in the following areas: (a) the development of a distorted image of God; (b) tendency toward extremes of perfectionism, self-righteousness or shame, (c) development of a distorted self-identity, (d) a tendency to the extremes of compliance or defiance in relation to authority, (e) problem in the area of personal boundaries, (f) difficulty with personal responsibility, (g) lack of living skills, (h) hard time admitting the abuse: the person have lost track of what normal is, it feels like they are being disloyal to family, to church, even to God, and (i) difficulty with trust: hard time trusting a spiritual system again (p.44). Cognitive theory asserts that deeply held irrational beliefs about how things should or must be are the root of a persons most distressing emotions. These core beliefs or schemas lead to faulty assumptions and result in dysfunctional coping skills: in the sense that they prevent a person to succeed in achieving their lifes goals. Cognitive therapy provides a suitable framework to work with clients who experience spiritual abuse mainly because it is based in the premise that even when some of a persons beliefs are distorted, the potential to correct them in light of contradictory evidence is great (Walsh, 2010). In cognitive therapy those cognitive deficits and distortions are explored and addressed. The social worker assesses the clients cognitive assumptions, identifies any distortions and guides the client in reasoning through detailed, focused questioning with the purpose of

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE uncovering the rationality of thought patterns. The social worker serves the role of coach and educator, helping the client experiment with alternative ways of approaching challenges that will promote goal attainment. When addressing spiritual issues in the context of cognitive theory the practitioners role is not to question the validity of a clients religious beliefs, but to guide them in analyzing how their religious belief system and related values contribute to their conception of worth and their personal boundaries for behavior (Edwards, 2006). Cognitive therapy focuses on interventions that address a clients distorted view of religion and spirituality and its implications for their view of themselves, others, and their realities. Clients who have lived the experience of spiritual abuse view religion as a force that is emotionally and spiritually oppressive rather than a source of personal strength and inspiration for the improvement of self and the betterment of society. Cognitive therapy is a process in which the clinician and the client collaborate in a work of empirical investigation and reality testing; considering new perspectives and alternatives for understanding reality and the nature of problems, exploring and learning innovative problem solving. In working with clients deal with the effects of spiritual abuse, the social worker must endeavor to familiarize her/himself with the religious tradition and sacred texts that are the foundation of a clients belief system. Spiritually abusive systems are nothing but a distortion of more orthodox views of the divine. Spiritually abusive leaders teach skillfully manipulated and ill-interpreted notions derived from the foundational truths of universal religious traditions. Those maladaptive interpretations can be treated in cognitive therapy as testable hypotheses. The original sacred texts are then used by the practitioner to examine alternative interpretations and to generate contradictory evidence that support alternative

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE beliefs which may allow for therapeutic change (Edwards, 2006). Utilizing the same sacred writings manipulated by abusive leaders, the clinician encourages the clients to embrace their religious heritage considering alternative perspectives, rather than completely abandoning their spiritual roots. Trauma-focused Cognitive-Behavioral Therapy Based on the Wards (2010) investigation exploring the subjective states of those affected by spiritual abuse and the physical and psychological repercussions of their experiences, it is reasonable to consider the experience of spiritual abuse as a source of trauma for the purpose of clinical work. In many instances, spiritual abuse is accompanied by real or perceived threats of harm, and even physical or sexual abuse by members of the clergy. According to a study on victims of destructive cults (De la Pea, 2000), the pathology in the context of the structural organization of some religious movements is sufficient to generate psychic trauma in their adherents. De la Pea (2000) claims that victims of the most destructive religious movements present symptoms of Posttraumatic Stress Disorder (p. 192). Walker (2010) proposes a model for addressing religious and spiritual issues in trauma-focused cognitive behavior therapy that is also appropriate in the work with children and adolescents. Walker (2010) suggests that, in the context of trauma treatment, it is helpful to assess whether a clients religious beliefs play a role in exacerbating a clients symptoms or relieving the effect of the trauma (p. 177). In the assessment stage, the clinician explores clients core religious beliefs and values with open-ended questions with the goal of obtaining information to evaluate clients psychosocial and spiritual functioning. In the initial stages of the intervention, normalizing spiritual struggles is part of the

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE psychoeducation piece in trauma-focused cognitive behavioral therapy (Walker, 2010). By normalizing their struggle, and the projection of their relationship with the abusive leader onto their notions of God, we enable clients to question their wrathful and angry image of God, that will be probed and corrected on the subsequent stages of the intervention. Elements of narrative theory are incorporated to TF-CBT. The use of stories or narratives within the clients religious tradition is helpful to enhance clients perspectives of their traumatic experiences. The client is then encouraged to process their own experiences and to create their own narratives. The clinician assists the client in creating this narrative, inviting the client to reflect on what has changed since their involvement with the religious group and what is different since the clinical work began. This reflection involves the discovery of what the person has learned and what advice he or she might offer someone else going through similar situations. As part of the psychoeducation component in TF-CBT, the clinician can expose the client to books or audiovisual material related to spiritual abuse, including testimonies of former members of spiritually abusive churches. The clinician can provide assignments and tasks to facilitate the exploration of cognitive distortions. With the use of sacred texts of the clients own religious tradition, the client can be asked to find parallels to their spiritual struggle in stories from the scriptures. Most religious texts have narratives that intend to make meaning of suffering and teach to overcome adversity through faith. The clinician can assigned the client the task of identifying Bible characters or historical figures who struggle with their faith, or made bad choices and were able to restore their lives and be successful in the end Nonetheless, Walker (2010) discourages clinicians to attempt to answer clients existential questions, but rather help them process their thoughts and feelings about the

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE divine. For instance, the use of an empty chair technique in which the client alternates between asking God questions and stating what they think Gods responses (Walker, 2010, p. 179) can be useful. Spiritually toxic teachings instill in adherents a tendency to overgeneralization and dichotomous thinking patterns. This tendency is reflected in the clients use of strongly worded statements (Edwards, 2006) that contains words and phrases such as ought, should have, and must in describing their experiences. As part of the behavioral component of TF-CBT, the clinician can use the teaching of self-talk to assist clients in reflecting on their words and their unique interpretation of those messages. When clients are able to identify harmful thoughts and words in their own internal dialogue, the clinician can direct them to create a different script that reflect a less rigid view of God. An example of these thinking patterns can be statements such as unpardonable sin, bad decisions are made by bad people, doubting means you are spiritually weak and a backslider. The practice of mindfulness in TF-CBT is compatible with most religious traditions if the clinician has the cultural sensitivity to adapt the technique to a particular clients spirituality. Highly conservative clients with a religious fundamentalist orientation might be alarmed at the idea of a clinician teaching them to meditate. This practice can be adapted to incorporate a clients own spiritual practices and beliefs, like concentrating on the words of Bible verses or the Jesus Prayer. Similar passages from the Torah or the Quran could be identified in collaboration with clients of Jewish or Islamic traditions. Sacred texts can be extremely useful to challenge dysfunctional and maladaptive thoughts and replace them with highly positive, inspirational and constructive perspectives that are congruent with the clients own religious background.

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE Conclusion Spiritual abuse is an issue of oppression that involves the misuse of power to undermine a persons strengths and to weaken a persons sense of worth, value, competency and self-efficacy. Spiritually abusive leaders consistently violate their followers personal boundaries and their rights to self-determination. An empowerment based social work practice needs to acknowledge this phenomenon and recognize its impact in the personal, familial, social and spiritual struggles some clients bring to social work interventions. Most theories used in social work practice provide a useful framework to assess and address issues related to spirituality and are suitable in the intervention with clients who experience spiritual abuse. The experience of spiritual abuse generates cognitive distortions, maladaptive thought processes, and erroneous assumptions. A cognitive theory approach in social work practice focus on the evolution of these cognitive patterns and their impact on a clients internalized representation of the world that, in turn, influences a persons configurations of thought, action and problem solving. Cognitive interventions, such as TF-CBT, are applicable in correcting clients erroneous beliefs with the potential of helping them adjust cognitive possesses in a manner that facilitates their understanding of their spirituality and how it impacts the attainment of their lifes goals. However, it is important for the social work practitioner to be aware of the limitations of cognitive theory in working with children and adults with cognitive limitations. On the other hand, its emphasis on rationality may be unappealing for clients whose spirituality relies more on emotional or instinctual experiences and responses. Cognitive theory claims of objectivity, have the potential risk of the practitioner

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE overlooking the ways in which their own values can influence what is defined as erroneous thinking. An awareness of ones own biases, as well as knowledge of and respect for a clients religious or spiritual roots can lead to a more sensible application of this cognitive theory in addressing spiritual issues.

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SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE References Blanton, P. (2005). Narrative Family Therapy and Spiritual Direction: Do They Fit? Journal of Psychology & Christianity, 24(1), 68-79. Blanton, P. (2007). Adding Silence to Stories: Narrative Therapy and Contemplation. Contemporary Family Therapy: An International Journal, 29(4), 211-221.

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Davis, E. B., Moriarty, G. L., & Mauch, J. C. (2013). God images and god concepts: Definitions, development, and dynamics. Psychology of Religion and Spirituality, 5(1), 51-60. De Beer, S., & Mller, J. (2009). Using stories to assist storytelling in a pastoral setting: four female pastors in dialogue with Mary Magdalene. Hervormde Teologiese Studies, 65(1), 76-80. De la Pea, J. (2000). Trastorno por estrs postraumtico en vctimas de sectas religiosas destructivas [Posttraumatic stress disorder in victims of destructive religious cults]. Revista Acadmica Para El Estudio De Las Religiones, (3), 181-194. Edwards, A. (2006). Cognitive and cognitive-behavioral therapy with religiously-oriented clients: two case studies. Social Work & Christianity, 33(1), 36-57. Gubi, M.G. & Jacobs,R. (2008). Exploring the impact on counselors of working with spiritually abused clients. Mental Health, Religion & Culture, 12(2), 191-204. Gurney, A. G., & Rogers, S. A. (2007). Object-relations and spirituality: Revisiting a clinical dialogue. Journal of Clinical Psychology, 63(10), 961-977. Healy, J. (2011). Involvement in a New Religious Movement: From Discovery to Disenchantment. Journal of Spirituality in Mental Health, 13(1), 2-21. Johnson, D. & VanVonderen, J. (1991) The Subtle Power of Spiritual Abuse. Minneapolis, MN: Bethany House Publishers.

SOCIAL WORK PRACTICE AND SPIRITUAL ABUSE Richards, P., Bartz, J. D., & O'Grady, K. A. (2009). Assessing religion and spirituality in counseling: Some reflections and recommendations. Counseling and Values, 54(1), 6579.

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Simoni, B., Mandelj, T., & Novsak, R. (2013). Religious-Related Abuse in the Family. Journal of Family Violence, 28(4), 339-349. Walker, D. F., Reese, J. B., Hughes, J. P., & Troskie, M. J. (2010) Addressing religious and spiritual issues in trauma-focused cognitive behavior therapy for children and adolescents. Professional Psychology: Research and Practice, 41(2), 174-180. Walsh, J. (2010). Theories for direct social work practice (2nd Ed.) Belmont, CA: Thomson Brookes/Cole. Ward, D. (2011). The lived experience of spiritual abuse. Mental Health, Religion & Culture, 14(9), 899-915.