Integrative Body–Mind–Spirit Social Work Practice
Integrative Body–Mind–Spirit Social Work Practice
- Salome Raheim, Salome RaheimProfessor, University at Albany SUNY School of Social Welfare
- Sue Tebb, Sue TebbProfessor Emerita, Saint Louis University College for Public Health and Social Justice
- Mo Yee Lee, Mo Yee LeeOhio State University
- Collina D. Cooke, Collina D. CookeUniversity of Albany
- Chang LiuChang LiuProfessor, Electrical Engineering and Computer Science, Ohio State University
- and Siu-Man NgSiu-Man NgUniversity of Hong Kong, Department of Social Work and Social Administration
Integrative body–mind–spirit social work is a client-centered, strength-based holistic approach that blends the conventional social work professional practice base with Eastern philosophies. This whole person approach views harmony, balance, and awareness of connectedness among body, mind, and spirit and between the individual and larger significant systems as fundamental to health, mental health, and well-being. Acknowledgment of the body, mind, and spirit as sources of power and wisdom and attention to each of these domains in treatment are distinguishing features of this approach. Research findings during the past 20 years in the fields of neuroscience, psychoneuroimmunology, psychosocial genomics, epigenetics, health, and behavioral health support this more nuanced understanding of the biopsychosocial spiritual perspective. The unique features of this approach are based on selected aspects of several Chinese traditions—philosophical Buddhism and Daoism, traditional Chinese medicine, and the yin–yang perspective. Beyond problem-solving and symptom elimination, the focus of intervention is creating long-term healing and spiritual growth. Treatment techniques include meditation, other mindfulness exercises, and body movement therapies such as qi gong to deepen awareness of the body, mind, and spirit and their interconnection, restore balance and energy flow, and nurture the body.
- Clinical and Direct Practice
A core tenet of the social work profession is that reciprocal interactions between multiple domains of human activity influence well-being. These domains include the biological, cognitive, affective, behavioral, social, economic, and environmental (Germain & Gitterman, 2013; Martinez-Brawley & Zorita, 2017). During the past few decades, social work has increasingly recognized spirituality, defined as a sense of meaning and purpose, as an important dimension of well-being (Canda, 2013), giving rise to the biopsychosocial spiritual perspective. Integrative body–mind–spirit social work is a holistic approach that extends this perspective. The multiple domains of human experience are understood as intimately connected parts of a whole in a state of constant change seeking dynamic equilibrium (M. Lee, Chan, et al., 2018; Leung et al., 2009; Van der Kolk, 2015).
A unique feature of this whole person approach is the view that harmony and balance among body, mind, and spirit are fundamental to health, mental health, and individual well-being, along with harmony, balance, and connection between the individual and larger significant systems (M. Lee, Chan, et al., 2018). Acknowledgment of the body, mind, and spirit as sources of power and wisdom and attention to each of these domains in treatment are distinguishing features of this approach (Chan et al., 2002). During the past 20 years, research findings in the fields of neuroscience, psychoneuroimmunology, psychosocial genomics, epigenetics, health, and behavioral health support this more nuanced understanding of the body–mind–spirit connection and the dynamic interplay between individual well-being and the physical and social environments (Garland & Howard, 2009).
Integrative body–mind–spirit social work views problems that people experience in daily living as manifestations of imbalances within the body–mind–spirit and/or between the individual and family, social groups, organizations, community, or their broader sense of purpose (M. Lee, Chan, et al., 2018). Beyond problem-solving, the focus of intervention is creating positive change by nurturing the body, engaging the mind in health-promoting ways, and promoting spiritual growth. Mindfulness practices, movement therapies, spiritual interventions, and other techniques are used, along with conventional social work methods such as talk therapies and support groups. A social justice lens is important in the application of this approach to promote recognition that the imbalances, disharmonies, and disconnection people experience may be related to oppressive systems such as racism, sexism, heterosexism, and related structural inequalities.
“Everything is connected” is a fundamental principle in the integrative body–mind–spirit approach, which acknowledges that the practitioner is among the significant systems influencing and being influenced by the client. Practitioners’ internal and external states are of critical importance in their efforts to promote clients’ well-being. Consequently, practitioners’ ongoing growth, development, and self-care are essential for effective practice and to facilitate their ongoing well-being (M. Lee, Chan, et al., 2018; Raheim & Lu, 2014).
History: Roots of Integrative Body–Mind–Spirit Social Work Practice
The integrative body–mind–spirit social work approach blends Eastern and Indigenous philosophies and practices with conventional social work knowledges and skills. Eastern influences on Western culture, in general, and on social work practice, specifically, span more than a century. In the 1800s, Ralph Waldo Emerson, Henry David Thoreau, Walt Whitman, and other transcendentalists disseminated Buddhist, Confucian, and Hindu principles broadly in Western culture through literature (Seager, 2012). Through the works of these transcendentalists, particularly Emerson, Eastern philosophies influenced Jane Addams’ humanistic approach to social work, although she continued to embrace the pragmatism of the time (Greenstone, 1979).
By the mid-20th century, Eastern influences on Western thought and cultural practices were reflected in applications of Buddhist philosophy in social work (Krill, 1966) and psychotherapy (McCown & Micozzi, 2011). Meditation, yoga, and other Eastern approaches to health and wellness grew in social work and other health professions (Davidson et al., 2003; Kabat-Zinn, 1982, 2009; Kabat-Zinn et al., 1985; Krill, 1978), as well as among the general population in Western countries (De Michelis, 2005; Harvey, 2012; National Center for Complementary and Integrative Health, 2017). In addition to the proliferation of specific Eastern practices, two Eastern holistic medical systems gained popularity in the West—Ayurveda from India and traditional Chinese medicine. In tandem, two holistic medical systems born in the West—homeopathy and naturopathy—re-emerged after decades of suppression by organized biomedicine (Micozzi, 2014; Thomas, 2001). By 2007, 4 of 10 U.S. adults were using health practices that are grounded in the concept of body–mind–spirit holism, and data show use is on the rise (Barnes et al., 2008; Nahin et al., 2016). These developments reflect a cultural shift in the West toward a more holistic orientation to health and well-being.
Social work is incorporating acupressure, meditation, reiki, yoga, and other techniques that promote awareness of body–mind–spirit balance and connectedness in health and mental health fields of practice (Block, 2006; Cook et al., 2000; Dziegielewski & Sherman, 2004; Finger & Arnold, 2002). Social workers are using these therapies with specific populations, including children (Fishbein et al., 2016), families (Becvar, 2010), older adults (Behrman & Tebb, 2009; E. Lee et al., 2012; Wang, 2010), oncology patients (Runfola et al., 2006), trauma survivors (M. Lee et al., 2011), and youth sex offenders (Derezotes, 2000). Social workers are also using them for specific health and behavioral health conditions, such as addiction (Carlson & Larkin, 2009; Garland, 2013; Garland et al., 2013; Temme et al., 2012), depression (Hicks, 2009), and schizophrenic disorders (Leahy, 2005).
Indigenous worldviews have also played an influential role in shaping the concept of integrating body, mind, spirit, and larger systems in social work practice. In the mid-1990s, the National Indian Child Welfare Association advanced the relational worldview, a practice orientation that reflects North American Indigenous knowledges of the medicine wheel or Sacred Hoop (Cross, 1997). The organization’s founder, Terry L. Cross (1997), a social work educator, scholar, and practitioner from the Seneca Nation of Indians, explains:
The relational worldview . . . finds its roots in tribal cultures. . . . The balance and harmony in relationships between multiple variables, including spiritual forces, make up the core of the thought system. Every event is understood in relation to all other events regardless of time, space, or physical existence. Health exists only when things are in balance or harmony. (p. 2)
The relational model of intervention that arises from this worldview seeks to restore harmony and balance among and between four dimensions that are in a constant state of flux: body, mind, spirit, and context (i.e., family, peers, work, school, community, culture, and social history) (Cross, 1997, 1998). This model’s nonlinear, holistic perspective supported expansion of social work’s biopsychosocial model to include spirituality and recognize the connection and need for harmony and balance between the domains of human existence.
In the early 2000s, the University of Hong Kong Department of Social Work and Social Administration established the Centre on Behavioral Health, where a group of scholars coined the term “integrative body–mind–spirit social work.” They defined and delineated the philosophical framework, practice principles, and elements of this practice approach (Chan et al., 2002). The seminal and only comprehensive examination of the philosophy, theory, and application of this practice approach in social work is Integrative Body–Mind–Spirit Social Work (M. Lee, Chan, et al., 2018), which grew out of one of the author’s international collaborations with the Centre on Behavioral Health.
Philosophical Foundations and Practice Approach
Integrative body–mind–spirit social work builds upon the foundation of professional social work knowledge, skills, and values. M. Lee, Chan, and colleagues (2018) assert that the unique features of this approach are based on selected aspects of several Chinese traditions—philosophical Buddhism and Daoism, traditional Chinese medicine, and the yin–yang perspective. Guided by principles from philosophical Buddhism, this social work approach views difficulties and hardships in life as suffering, an inevitable aspect of living, which can be exacerbated by the rational mind’s endeavors to avoid pain and control circumstances.
Acceptance of the impermanence of life is the health-promoting alternative to efforts to control uncontrollable conditions, such as illness and death. Integrative body–mind–spirit practice assists clients to accept suffering as a part of living, appreciate it as an opportunity for growth, and work to increase their confidence in their ability to overcome life’s challenges and hardships. Toward these aims, spiritual interventions are used to promote clients’ sense of meaning and purpose in life and support them in finding meaning within the challenges that they are facing. Examples of these interventions are forgiveness work, meditation for compassion, and letting go rituals (M. Lee, Chan, et al., 2018).
Four key Daoist precepts inform integrative body–mind–spirit practice: (a) The universe is constantly changing; (b) all things are connected to each other; (c) abandon human effort to control others and nature; and (d) pursue ways to be in harmony with the Dao, the absolute underlying principle of the universe (M. Lee, Chan, et al., 2018). The related yin–yang perspective suggests that all aspects of life exist in a complementary, interconnected, and interdependent way and give rise to each other (e.g., day becomes night, night becomes day), reflecting necessary movement and ongoing dynamic balance. Integrative body–mind–spirit social work draws upon the perspective of traditional Chinese medicine, which applies the yin–yang concepts of complementarity, interconnection, dynamic flow, and equilibrium to the human experience, viewing the body, mind, and spirit as a connected system through which life force energy, called chi or qi, must flow freely for healthy functioning (Leung et al., 2009).
The clinician teaches clients techniques that are evidenced-based and can be self-administered, such as meditation, other mindfulness exercises, and body movement (e.g., stretching) to deepen awareness of the body, mind, and spirit and their interconnection, restore balance and energy flow, and nurture the body. These techniques expand clients’ awareness of their strengths and self-healing abilities (M. Lee, Chan, et al., 2018). A substantial body of research supports the efficacy of the techniques used for a wide range of behavioral health conditions (M. Lee, Wang, et al., 2018).
Contrasts With Traditional Social Work Perspectives
The philosophical foundations of the integrative body–mind–spirit practice approach differ from the Western roots of social work in significant ways. Social work emerged in Europe and North America as a formal profession in the early 20th century (Stuart, 2013) and continues to reflect European intellectual thought regarding the nature of human existence and valid sources of knowledge. In the Western view, the mind is primarily the locus of cognition. Cartesian mind–body dualism and Cartesian rationalism, which privileges the rational mind as the only valid path to knowledge, are prominent in Western thought and academic institutions in which social work education is situated. Integrative body–mind–spirit social work holds a more holistic view to include the cognizant body, mind, and spiritual functions (Cameron & McDermott, 2007; M. Lee, Chan, et al., 2018). This perspective is consistent with the traditional Chinese concept of mind (xin), which is both heart and mind (Yu, 2009). M. Lee, Chan, et al. (2018) assert that in addition to the cognitive function of decision making, the mind is the locus of emotions, care, compassion, perseverance, discipline, self-concept, and self-confidence, whereas the spiritual mind is the center of values and beliefs, sense of meaning in life, insights and intuition, aspirations, acceptance of vulnerabilities in life, and hope. The mind and the spirit are so interconnected to the body that none can be separated from each other in an integrated approach to working with people.
Another significant Western worldview that influences conventional social work is the Newtonian mechanistic paradigm, which continues to influence perception of the body as a machine to be acted upon. Although social work embraces the biopsychosocial spiritual perspective, the body as a source of wisdom and focus in social work intervention is frequently ignored. Integrative body–mind–spirit social work engages the body—for example, conscious breath work and body movement (Pyles, 2018, 2020)—as a partner and source of wisdom that is part of a fluid interplay of harmony and balance with the mind, spirit, and larger systems.
The materialist worldview is another area of divergence between the Western philosophical foundations of social work and integrative body–mind–spirit practice. Materialist philosophy holds that only matter and what arises from matter exist. Materialism views consciousness and spiritual phenomena as functions of biological processes (Nash, 2013). The lingering influences of this philosophy and social work’s striving for credibility as a profession have resulted in the profession’s neglect of both the body (Cameron & McDermott, 2007) and spirituality (Canda, 1998, 2013; Canda & Furman, 2010) as appropriate and important domains for intervention. In contrast, M. Lee, Chan, et al. (2018) explain:
Integrative body–mind–spirit social work believes that spirituality is the foundation for the healthy and dynamic functioning of the body–mind system, which connects to, and interacts with, different domains of human existence. . . . The facilitation of spiritual growth in individuals and families is therefore a key component of integrative body–mind–spirit social work. (p. 163)
“Western” social work approaches, such as cognitive–behavioral therapy, acceptance and commitment therapy, and eye movement desensitization and reprocessing, use cognitive/mind techniques (Beck, 2011; Hayes et al., 2012; Kabat-Zinn, 2013; Shapiro, 1989) similar to the integrative body–mind–spirit practice approach. However, none integrates body, mind, and spirit together in a treatment plan.
Application of the Integrative Body–Mind–Spirit Social Work Approach
This section describes the application of the integrative body–mind–spirit social work approach as detailed by M. Lee, Chan, et al. (2018). As the name suggests, this practice approach is integrative, building on existing therapeutic knowledge and skills by incorporating Eastern philosophies and therapeutic techniques. The approach may be used with individuals, families, or in a treatment or educational group setting. It follows the conventional, nonlinear stages of social work intervention—assessment, intervention planning and implementation, evaluation, and termination. In the initial phase of treatment, the therapist works to develop a facilitator–participant relationship that positions clients as experts in their own lives and the therapist as the expert in facilitating change. Assessment and intervention are ongoing and mutually embedded processes. Beginning with what clients present, the therapist guides clients to assess the presenting problems and envision problems as positively stated goals. To support clients to identify and mobilize their strengths, the therapist asks questions to bring attention to clients’ skills, resourcefulness, positive qualities that others recognize, current achievements, and past success in overcoming challenges.
Problem-based diagnostic labeling is avoided because of potential pathologizing effects of such conceptualizations. Instead, clients are guided to assess the problem using a person-in-environment and systemic perspective. The yin–yang principle of complementarity is used to identify the strengths of the problem—that is, what contribution the problem is making in their lives. For example, debilitating grief after the loss of a loved one (problem) may create deeper awareness of the preciousness of life (contribution).
Although the presenting problem serves as a starting point, a systemic perspective recognizes that this problem is not the core problem and is one of many indicators of system imbalance. Expanding clients’ awareness of the body, mind, and spirit domains and their interconnection, recognizing the systemic imbalance within these domains, and identifying issues with energy flow are important tasks during the assessment process. Rather than a deep and ongoing examination of the problem, discussion of the presenting problem is suspended when no new information results or when such explorations become repetitive.
Assessment of systemic imbalance is guided by the yin–yang concept, which supports a neutral view of phenomena. Clients’ responses to their circumstance are understood as part of complementary states (e.g., attached–detached, hopeful–pessimistic) that are neither positive nor negative but can be unhealthy when excessive (i.e., hyper yin or hyper yang) or deficient (i.e., hypo yin or hypo yang). According to Chinese medicine, moment-to-moment equilibrium is created through a dynamic flow of energy, chi/qi. Too little energy flow (i.e., stagnation) or too rapid energy flow (i.e., hyperactivity) creates imbalance and unhealthy states. Ongoing assessment of the nature of clients’ imbalance and energy flow guide interventions that are used in the initial and subsequent sessions.
Formulation of the intervention plan and its implementation begin in tandem with the assessment process. Techniques are used during the first session to enhance the client’s body–mind–spirit awareness, while promoting a sense of stability, calm, and presence in the moment. These techniques may include the body scan, breathing exercises, and meditation. The clinician’s selection of techniques is highly individualized based on the client’s needs and the initial assessment of the imbalance and nature of energy flow the client is experiencing. The debriefing process that follows provides valuable information for the assessment, as clients identify bodily sensations, thoughts, and insights that arose during the exercises.
After initial assessment, initial interventions, and client-centered goal development, treatment plan formulation proceeds with agreement between clinician and client about the most useful point(s) of entry to achieve the client’s goals. “The entry points can be cognitive, behavioral, interpersonal, physical, environment” (M. Lee, Chan, et al., 2018, p. 105) or may address other domains with the aim of achieving positive changes as quickly as possible. Interventions are designed to assist clients to distinguish past from present, support their ability to achieve a state of physiological calmness, and increase their self-regulating capacities. These enable the client to respond effectively to present challenges and make choices that are responsive to their current needs. As clients work toward attaining their goals, the clinician highlights their self-healing ability and assists them to recognize their resilience, which supports their empowerment. The therapeutic relationship is fundamental to creating a safe environment and promoting an empowering, strength-based partnership that supports clients to achieve their goals.
Spirituality, life values, culture, and personal meaning provide a foundation for the mind and body, [with] the other functions [e.g., self-concept, life goals, interpersonal relationships] revolving around mind and body in a dynamic and vibrant way. We use the metaphor of a spinning wheel to represent the dynamic movement of the system. It is conceptualized as somewhat like a body–mind wheel spinning on top of a spiritual health base. If the spiritual foundation is fragile or distorted, the body–mind wheel on top can easily topple. (p. 102)
The healing wheel metaphor conveys the centrality of promoting spiritual growth in integrative body–mind–spirit intervention, as well as the importance of balance between components of the system. Techniques that may be used in the treatment process include, but are not limited to, acupressure, breathing exercises, creative visualization, various forms of meditation and mindfulness exercises, self-massage, stretching, and letting go rituals. Table 1 illustrates some of these techniques (M. Lee, Chan, et al., 2018, p. 108). These and other techniques may serve multiple purposes given the body–mind–spirit connection. For example, breathing exercise may increase awareness of the body and the body–mind connection, create a physiological sense of calm, and support self-regulation. Many forms of meditation may accomplish the same aims, as well as promote spiritual awareness and a sense of connection beyond the ego-self. The clinician must offer treatment techniques that match clients’ treatment goals, needs, and preferences.
Table 1. Roadmap of Integrative Body–Mind–Spirit Social Work
Stage of Change
1. Building relationships
Forming collaborative facilitator–participant relationship
Strength-oriented, acknowledgment, normalization, and de-stigmatization
Unconditional positive regards
2. Expanding awareness
Articulation and emotional expression
Meditation, body scan
In touch with one’s body, mind, and spirit
Body–mind–spirit connection within the family and broader social systems
Understanding “strengths” of problems or symptoms
Systemic perspective: balance and flow of various systems and subsystems
4. Making shifts
Acceptance of ambiguity, letting go of control
Regaining balance and fluidity
Source: M. Lee et al. (2018, p. 112, Table 5.2).
The integrative body–mind–spirit model emphasizes preparation for termination beginning with the initial meeting and continuing throughout the therapeutic relationship. Clients are consistently treated as experts in their own lives, with the clinician playing a facilitative role in the change process. Clients are taught techniques that can be done at home without the ongoing guidance of the clinician to expand awareness of their body–mind–spirit connection, promote self-regulation, and support well-being. Once clients have reached their goals for treatment and the clinical intervention process nears closure, the clinician invites clients to join in expressing feelings about the treatment process and its ending. Consistent with the ongoing focus on self-efficacy, the clinician encourages clients to continue their transformation after the treatment ends, independently of the practitioner.
Group Work and Integrative Body–Mind–Spirit Interventions
Integrative body–mind–spirit interventions may be implemented in a treatment or educational group context. Establishing a “community of others” who are experiencing similar life challenges normalizes the problems clients are facing, fosters mutual learning and support, and instills hope through witnessing the success of others (Chan et al., 2002). Length of groups may range from 5 weeks to several months, with each session lasting 2 or 3 hours. Each group’s specific focus and session themes are determined by group member characteristics, needs, and life challenges. For example, an integrative body–mind–spirit group designed for women with breast cancer encouraged participants to face cancer positively; deepen awareness of the interconnectedness of their physical, emotional, and spiritual being; and promoted mutual aid and development of a healthy lifestyle (Ho et al., 2016). Group session themes included the interconnectedness of body, mind, and spirit; letting go and accepting the uncontrollable difficulties in life; forgiveness and self-love as the keys to joy and peace; self-transformation through self-appreciation; sharing transformation and growth; planning and commitment to goals; giving as a means to happiness; and action planning to help self and others (Ho et al., 2016).
For women with depressive disorders, an integrative body–mind–spirit treatment group was designed to normalize traumatic experiences and view suffering as a disguised opportunity for growth (M. Lee et al., 2009). The group provided a space to explore and discuss the meaning of suffering, attachment, and letting go and enabled participants to practice forgiveness strategies and self-love. In addition, social support and commitment to help others served as a way for participants to find meaning in their own suffering and reduced clients’ sense of isolation and loneliness (M. Lee et al., 2009).
Empirical Support for Integrative Body–Mind–Spirit Practice
Scholars collaborating with the Centre on Behavioral Health have developed a substantial body of research that suggests the efficacy of their integrative body–mind–spirit social work model with a range of clients and conditions, including women with breast cancer (Chan et al., 2006; Ho et al., 2016); women survivors of trauma (M. Lee et al., 2011); patients with colorectal cancer (A. M. Lee et al., 2009); displaced persons due to war and violence (Das, 2018); and people experiencing dementia (Chow et al., 2018), depression (Brenner et al., 2018; M. Lee et al., 2009), insomnia (Ji et al., 2018), and chronic skin disease (Chan & Fung, 2018). There is also promising research support for use of this practice model in couples counseling (Peterson & Hodgson, 2018), counseling on reproductive medicine (Chan & Wong, 2018), wellness coaching (Beauchemin, 2018), and efforts to combat burnout and promote workplace well-being (Ng et al., 2018).
Chan and colleagues (2006) conducted a randomized controlled trial of three psychosocial interventions with 76 Chinese women breast cancer patients, including a 15-hour body–mind–spirit group (n = 27), a 16-hour supportive–expressive therapy group (n = 16), and a 15-hour social support self-help group (n = 16). The control group (n = 17) was given 15 hours of educational materials on nutrition, diet, and physical care after cancer treatment. Several psychological measures (e.g., Mini-Mental Adjustment to Cancer Scale) and one physiological measure (i.e., salivary cortisol levels) were administered pre-intervention and at 4- and 8-month follow-up intervals. Results showed that the body–mind–spirit intervention group reported the largest number of beneficial effects, including reduction of psychological distress and salivary cortisol levels (p < .01, effect size [ES] = 1.11), improved emotional control (p = .02, ES = 0.42) and negative emotions (p = .04, ES = 0.4), and enhanced general health (p = .01, ES = 0.63) and social support (p = .02, ES = 0.42) as soon as 4 months into treatment.
In a three-armed randomized controlled trial, Ho et al. (2016) examined outcomes of 157 nonmetastatic breast cancer patients in Hong Kong. Participants were randomized to three 2-hour session weekly groups for 8 weeks, including integrative body–mind–spirit group intervention, supportive–expressive group therapy, and social support control group. The study measured emotional suppression, perceived stress, anxiety, and depression at baseline and at three follow-up assessments in 1 year. The body–mind–spirit group showed significant improvement on perceived stress (p = .024, ES = 0.46).
Another Hong Kong–based study examined the use of this practice model to improve quality of life and psychological well-being among patients with colorectal cancer (M. Lee et al., 2009). In this randomized control clinical trial, 75 men and women patients in the treatment group and 82 controls completed the study. Treatment participants met for 5 weekly 3-hour sessions in groups of 10–12. Control group participants received health education materials on colorectal cancer but no active interventions. Data were collected pre- and post-intervention using three psychological measures: the Chinese versions of the post-traumatic growth inventory, Mini-Mental Adjustment to Cancer Scale, and SF-36 Health Survey. The treatment groups showed significant positive changes, especially in growth after the traumatic cancer experience (p = .000), enhanced positive attitude (p = .05), and improved social (p = .034) and physical functioning (p = .02) (M. Lee et al., 2009).
Hsiao (2009) studied the feasibility of using an integrative body–mind–spirit group intervention with 14 Taiwanese women who had been diagnosed with depressive disorders. Using a single-group pre-/post-test design, data were collected with the Beck Depression Inventory, the World Health Organization Quality of Life inventory, and semi-structured interviews. Results showed significant improvements in participants’ levels of depression (p < .001) and increases in life satisfaction from “somewhat satisfied” to “moderately satisfied” (p = 0.04).
Findings of these studies provide encouraging support for the efficacy of the integrative body–mind–spirit social work practice approach, although more research is needed due to their limitations. Sample sizes in each study were small. One study used “incomplete randomization” (Chan et al., 2006), and another used no control group (Hsiao, 2009). In addition, one study cited failure to access fidelity in the delivery of the model of therapy as a limitation. Research using randomized controlled trails is needed with larger samples sizes and in a wider range of cultural contexts. Studies are also needed on the efficacy of this practice approach with a variety of behavioral health conditions not discussed in this article. Therefore, practitioners must employ their clinical training to competently assess the appropriateness of interventions with persons experiencing severe behavioral health issues.
Implications for Social Work Practice and Education
Integrative body–mind–spirit social work transcends the limits of Cartesian mind–body dualism and the Newtonian mechanistic paradigm to provide a framework that is consistent with Eastern and Indigenous perspectives and recent scientific findings about the body–mind–spirit connection and role of the physical and social environments in health and well-being. This approach is congruent with the worldview and healing practices of many traditional cultures that have not been usurped by Western dominance (Cassidy, 2011; Smith, 2012) and, therefore, supports social workers’ efforts to engage in culturally competent practice. To effectively use this practice approach, clinicians must acquire knowledge and skills beyond the conventional social work practice base, as well as reassess their beliefs, values, and worldview.
Enhanced awareness of the clinician’s own body–mind–spirit interconnections and reciprocal influences of external environments is a fundamental step toward competently using this practice approach. The techniques that are commonly used with clients in integrative body–mind–spirit practice are valuable tools for the clinician’s professional development and self-care, including meditation, other mindfulness exercises, and body movement practices such as yoga and qi gong. Learning their origins, underlying principles, and evidence base for their efficacy supports culturally and scientifically ground understanding and appropriate use of these techniques.
Acquiring newly developed knowledge from several scientific fields about the body–mind–spirit connection and the mutual influences of the individual and environment is a requirement for integrative body–mind–spirit social work practice. Several branches of neuroscience are particularly relevant, including affective, behavioral, cognitive, and cultural neuroscience. Familiarity with recent developments in epigenetics, psychosocial genomics, and psychoneuroimmunology is also important.
Developing holistic engagement skills to bring the clinician’s whole self—body, mind, and spirit—to work with the whole self of clients is essential for integrative body–mind–spirit practice. Pyles and Adam (2015) offer a model that defines holistic engagement as “an intentional practice of using the whole self to tune into and creatively respond within a dynamic, globalizing social work environment” (p. 32). They identify four essential skills for holistic engagement: presence with the whole self, whole self-inquiry, empathic connection, and compassionate attention (pp. 35–46):
Presence with the whole self: Showing up fully for what is, with an expanded sense of self, including experiences of the individual’s body, mind, heart, culture, and spirit; awareness of and interaction with the historical and current physical, social, and energetic environment; and how experiences and awareness interact with other individuals’ experiences and awareness
Whole self-inquiry: A lifelong authentic and deliberate learning about all aspects of the whole self
Empathic connection: Intentionally joining with the experiences of an other to bear witness to that experience, while recognizing the limits of that joining
Compassionate attention: Seeing things as they are with a discerning capacity to suspend action or judgment en route to uninterrupted presence
The divergence between the philosophical foundations of conventional social work and integrative body–mind–spirit practice suggests a need for clinicians to engage in clarification of their beliefs, values, and worldview before attempting to implement this approach. The philosophical Buddhist and Daoist underpinnings of this practice approach give rise to perspectives that are in conflict with some Western perspectives. Seeking to control circumstances and avoid pain aligns with Western views of mastery, in contrast to the Buddhist value of letting go of efforts to control. Encouraging clients to embrace adversity, crises, and problems as opportunities for growth and transformation rather than focus on eliminating symptoms and solving problems may be at odds with a clinician’s beliefs and worldview. Willingness to consider alternatives to the Western social work problem-solving approach is needed to engage in this holistic practice approach.
Increasingly, social work literature is including new scientific findings about the body–mind–spirit connection and its relevance to social work education (Ballan et al., 2014; Egan et al., 2011). However, many of the critical knowledges, skills, and learning experiences clinicians need to develop competence in integrative body–mind–spirit practice are not broadly included in social work curricula. In a survey of U.S. schools of social work, Raheim et al. (2015) found that few master’s programs offered courses in the integrative body–mind–spirit social work approach, and more than 50% of the 56 respondents offered no courses about specific techniques that support this approach. The same survey found that lack of faculty expertise and lack of resources and curricular supports were impediments to including relevant courses. These findings suggest that broader inclusion of integrative body–mind–spirit social work curricular content may require initiatives by social work professional organizations, such as the Council on Social Work Education, that can support these efforts.
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