Moral Stress, Resilience, Integration

Instructor: Carrie Doehring, PhD

Course textbook: Graham, Larry Kent. (2017). Moral injury: Restoring wounded souls. Nashville, TN: Abingdon . ISBN: 978-1-5018-0075-7

Course Description

This advanced level course helps students continue to learn and practice competencies in intercultural, evidence-based and socially just spiritual care: critical thinking skills, spiritual integration, intercultural competence, self-differentiation, theological empathy, and essential spiritual care skills of establishing trust and collaboratively searching for meanings with care seekers. In such courses, Iliff students are expected to bring travelling knowledge from many of their courses to learn how to offer socially just spiritual care that fits Iliff’s “commit[ment] to social justice, inclusiveness, and religious diversity” ( http://www.iliff.edu/our-president/ ). This competency-based pedagogy helps students identify and spiritually integrate their own experiences of moral stress and injury, in order for them to experience the ways that spiritual care—especially the search for spiritual/religious practices and meanings—is different from mental health of moral stress and injury.

Moral stress arises from shame/guilt/fear of causing harm involving conflicts in values. Moral injury arises from traumatic stress that is more shame than fear based, and has been research extensively among military personnel and veterans. Spiritual integration of moral stress and injury uses spiritual practices and theological meaning-making to compassionately identify life-limiting embedded shame-based values, beliefs, and ways of coping with moral stress and injury (lived theologies) in order to compassionately understand the origins of moral stress and injury. Relational resilience is the outcome of spiritual integration based on spiritual practices fostering compassion and more complex theological/moral ways of understanding moral conflicts, stress and injury.

This course is designed to meet the needs of (1) religious leaders in the M.Div. program, (2) those preparing for the specialized vocation of pastoral and spiritual care, (3) military chaplains in Iliff’s online course provider program in military ministry available to anyone studying military ministry in an ATS school, and (4) PhD students studying religion and human experience using religious, psychological, and theological studies.

PROFESSIONAL DEGREE LEARNING GOALS (MDIV, MAPSC) AND PHD LEARNING GOALS

MDIV Degree: Demonstrate a complex interdisciplinary understanding of theological disciplines, as well as develop and embody a comprehensive range of ministerial responsibilities, skills, and capacities – intellectual and affective, individual and corporate, ecclesial and public – that inform and support a life of religious leadership.

MAPSC Degree: Demonstrate a complex interdisciplinary understanding of the human person in social context, develop and demonstrate an intercultural approach to pastoral and spiritual care[i], and demonstrate personal and professional competencies needed by effective caregivers.

Courses in Theology and Religious Practices (PR): Engage in analysis of contemporary religious traditions and institutions in order to assess, design, and perform meaningful leadership practices with sensitivity to contextual realities and relationships.

DU/Iliff Joint PhD in the Study of Religion: Understand key ideas, themes, theories, questions, problems, and trends in the study of religion and human experience using religious, psychological, and theological studies. Spiritual care courses may require students to demonstrate competencies in intercultural, evidence-based, and socially justice spiritual care.

INTERCULTURAL SPIRITUAL CARE COMPETENCIES

Goal 1.  Critical Thinking Skills: Develop critical thinking skills in religious, theological, and psychological studies, drawing upon coursework in all areas of one’s degree curriculum.

1. In religious studies (e.g., MDiv/MAPSC courses in Comparative Religious Traditions [CR]), become literate in core beliefs and practices of religions of the world (patheos.com; see also Prothero’s Chapter 6 “A Dictionary of Religious Terms” (2007); think critically about how a search for similarities among religions of the world has historically been a search for the ‘one God’ of Christianity (Prothero, 2010); use particularist approaches to religion that pay attention to differences among the worldviews, beliefs, values, and practices of religions of the world (see footnote 1 below).
2. In theological, biblical, historical, and ethical studies (e.g., MDiv/MAPSC courses in Sacred Texts [TX], Social/Contextual Analysis [AN], Historical Development/ Expressions of Religious Traditions [HI], and Constructive Theology [TH]), identify the biblical, ethical, historical, and theological ways that religious and, in particular, Christian approaches to religions of the world—exclusivisms, inclusivisms, pluralisms, and particularities^[ii]—shape pastoral and spiritual care within communities of faith, in religiously diverse settings like health care and military contexts, and in global contexts. Identify and assess values, beliefs, and religious/spiritual practices—especially related to suffering and hope—using biblical, ethical, historical, theological, and philosophical sources and critical methods.
3. In psychological studies of religion, know how to search databases to find and use research on religious coping, in order to provide evidence-based spiritual care that identifies and assesses how people draw upon aspects of religion and spirituality to cope with stress in helpful and/or harmful ways.

Outcomes: Students demonstrate critical thinking skills in forum discussions, reading assignments, and case study/journal assignments using course readings, traveling knowledge from other courses, and literature searches required for assignments. 

Goal 2. Spiritual Integration: Engage in a personal process of spiritual integration by finding and using intrinsically meaningful body-aware practices that

1. Increase self-awareness of one’s stress-based reactions/emotions that give rise to life-limiting, socially oppressive beliefs, values, and consumer ways of coping, especially for coping with academic stress.
2. Increase self-compassion, self-transcendence, and relational systems that support use of meaningful body-aware practices as a basis for searching for meanings about one’s stress responses and life experiences (Doehring, 2018b).

Outcomes: Students become accountable for their use of body-aware practices in weekly posts, in journal assignments, and in video recorded spiritual care conversations, helping them experiment with using practices that foster spiritual integration.

Goal 3. Intercultural Competence: Develop and demonstrate an intercultural approach to pastoral and spiritual care that respects what is unique and distinctive about each person’s religious, spiritual, existential, or moral orienting system (values, beliefs, practices).

Outcomes: Students will demonstrate their intercultural capacity in the ways they respond to each other’s forum discussions and journal/case study assignments, and in their spiritual care conversations.

Goal 4. Self-Differentiation: Demonstrate psychological and theological self-differentiation by (a) tracking one’s personal theologies/orienting systems that arise from stress in the midst of a spiritual care conversation, and (b) using momentary spiritual practices in order to not blur boundaries between self and other, over-identify with the other, or emotionally disengage. 

Outcomes: Students will demonstrate self-differentiation in the ways they respond in forum discussions, in reading and responding to each other’s journal/case study assignments, and in their spiritual care conversations.

Goal 5. Theological Empathy: Demonstrate theological empathy by (1) respectfully stepping into another’s religious, spiritual, existential, or moral orienting systems; (2) imagining how these orienting systems ‘work’ contextually, especially as a way of coping with stress; and (3) using their social empathy and critical thinking skills to understand the personal and cultural contexts of the other’s beliefs and values, especially about suffering exacerbated by injustice and hope for justice (Doehring, 2018a).

Outcomes: Students will demonstrate theological empathy in the ways they respond in forum discussions, in reading each other’s journal/case study assignments, and in their spiritual care conversations.

Goal 6. Establishing Trust and Searching for Meanings: Understand and practice these two key ingredients of intercultural spiritual care (Doehring, 2015):

1. Establish trust by (1) respecting care seekers’ values, beliefs, ways of coping and connecting with the sacred, and (2) helping care seekers experience self-compassion and safety by finding intrinsically meaningful spiritual care practices that make them aware of stress in their bodies.
2. Collaboratively search for life-giving intentional beliefs and values about suffering that arise from experiencing compassion that helps care seekers understand the ways automatic stress responses often make them feel anxious, angry, ashamed and guilty, which in turn gives rise to life limiting values and beliefs and consumer ways of coping shaped by intersecting social oppressions.

Outcomes: Students demonstrate how they implement these two key ingredients in intercultural spiritual care in their journal/case study assignments and spiritual care conversations.

References

Doehring, C. (2015). The practice of pastoral care: A postmodern approach (Revised and expanded ed.). Louisville, KY: Westminster John Knox.

Doehring, C. (2018a). Teaching theological empathy to distance learners of intercultural spiritual care. Pastoral Psychology 67 (5), 461-474. doi: 10.1007/s11089-018-0812-6

Doehring, C. (2018b). Searching for wholeness amidst traumatic grief: The role of spiritual practice that reveal compassion in embodied, relational, and transcendent ways. Pastoral Psychology. doi: 10.1007/s11089-018-0858-5

Hedges, P. (2010). Controversies in interreligious dialogue and the theology of religions. London: SCM Press.

Hick, J. (1989). An interpretation of religion. London: MacMillan.

Moyaert, M. (2005). Interreligious dialogue and the debate between universalism and particularism: Searching for a way out of the deadlock. Studies in Interreligious Dialogue, 15(1), 36-51.

Moyaert, M. (2012). Recent developments in the theology of interreligious dialogue: From soteriological openness to hermeneutical openness. Modern Theology, 28(1), 25-52. doi: 10.1111/j.1468-0025.2011.01724.x

Prothero, S. R. (2007). Religious literacy: What every American needs to know--and doesn't. San Francisco, CA: HarperSanFrancisco.

Prothero, S. R. (2010). God is not one: The eight rival religions that run the world and why their differences matter. New York, NY: HarperOne.

Race, A. (1983). Christians and religious pluralism. London: SCM.

[i] Pastoral care historically describes care with Christian traditions/communities, although it has also been used to describe care in Jewish traditions. Spiritual care is now used in healthcare and military contexts to describe care offered by chaplains. Spiritual care within a religion is now described by identifying the religion/tradition (e.g., Buddhist spiritual care).

[ii] A three-fold typology of Christian approaches to religions of the world as exclusivist, inclusivist, and pluralist was first proposed by Race (1983). Here are simple descriptions of these approaches:

Exclusivisms: Religious sources of authority (e.g., sacred texts, doctrine, religious authorities, religious experiences of, for example, the Holy Spirit) are exclusively true, with literal norms of interpretation (e.g., Christianity is the only truth; confessing Jesus as Lord and Savior is the only means of salvation; the goal of faith is salvation through belief in cornerstone doctrines). Exclusivist pastoral care tries to convert or persuade people through witness to find salvation/fulfillment/faith/healing through singular exclusively true beliefs and/or practices. Moyeart (2012, p. 27) notes that many Christian exclusive theologies emphasize the sinfulness of humanity, a high Christology, and salvation through affirmation of Jesus as one’s personal savior. Those within religious traditions/communities that require literal faith affirmation of exclusivist beliefs may require their religious leaders to provide pastoral care within their communities that is based on exclusivist religious goals, as the only way to save those who are fallen. Pastoral care to those outside one’s community must also focus on salvation, since “Religions are understood as the expression of human attempts to achieve salvation on their own power, neglecting thereby the fact that salvation comes only through faith in Christ” (Moyeart,  2012, p. 27). 

Inclusivisms: Many religious paths lead to same end, often configured as the ‘one God’ of Christianity (Prothero, 2010). Examples of inclusivist metaphors are the many paths that lead to the same mountain top, or the sight-impaired people touching different parts of the elephant. Inclusivist pastoral or spiritual care accepts a diversity of paths, but sees all paths as leading to the same God/salvation/fulfillment, although belief in a singular truth/God may not be necessary for salvation/fulfillment, as it is in exclusivist approaches.

Pluralisms: Religious diversity is a given and needs to be respected. Those committed to inter-religious dialogue search for ways to talk about universal aspects of religious experiences of transcendence and ineffable mystery, like John Hick’s references to the Real, the Ultimate, or Ultimate Reality (1989). “Faith is believed to be essentially the same for all religious traditions, whereas belief and tradition stand for the historically and culturally determined interpretation of ultimate reality (Moyaert, 2005, p. 42, italics in original). Pluralist spiritual care respects differences yet seeks to find common ways across traditions to spiritually care for people, and to find out, especially through research, how aspects of religion or spirituality help or hinder people, especially in coping with stress.

Particularities: assert that searching for ways to talk about and do research on what is shared or universal across religions of the world inevitably erases what is unique and particular to each religion/culture:

Thus, particularistic theologians state that the differences between the ethics of the religions are substantial and they question the value of global ethical declarations. Of course, one might say that all religions are for peace, love, hope, justice, human dignity and the protection of animals. However, these very formal notions and concepts come to mean very different things within each tradition. The stories, rituals and doctrines of each tradition give particular continence to each of these formal ethical terms, and at the level of the concrete religious and ethical praxis of the religious communities the differences are immense. (Moyaert, 2005, p. 44)

Particularist spiritual care builds trust by listening for and respecting what is unique and particular to the ways persons and communities search for meaning and experience transcendence and mystery.

Hedges (2010, p. 30) summarizes these four approaches to religious truth/difference as follows: “Exclusivist approaches typify ‘discontinuity’, inclusivist approaches typify ‘fulfillment’, pluralist approaches typify ‘openness’, and particularist approaches typify ‘difference’.”

Moyaert (2012) notes that interreligious dialogue is challenging because of potential conflicts between commitment to one’s own religion and openness to the other. Such challenges are often inherent in intercultural spiritual care, especially for caregivers who experience religious, spiritual, and moral struggles about when and how to be committed to particular beliefs within one’s ordaining/endorsing tradition, as Doehring (2018b) notes in describing struggles over beliefs in resurrection.

Intercultural spiritual care begins with particularities by respecting the alterity of care seekers’ orienting systems. Simply remaining in a stance of listening for differences is often not sufficient spiritual care, especially if caregivers are using critical thinking skills and knowledge about what might exacerbate or ameliorate the other’s suffering. If trust is established then spiritual care may move into a collaborative search for practices, meanings, and values that support and help people who are suffering. In healthcare and military contexts, caregivers will need to use research based on pluralism that assesses when and how aspects of religion or spirituality help or harm people, especially those experiencing religious, spiritual, or moral struggles.

Learning Covenant

Students develop critical thinking skills that they use in developing competencies for spiritual care, by integrating theory and practice through experiential learning. The competencies that shape these learning goals are also part of covenants necessary for intentional learning communities.  

Confidentiality: Personal disclosures are not to be discussed outside of class without agreement and permission. Students can talk about their stress/emotional reactions with trusted others, as long as the focus is on them and not the content of what other students share. In case study assignments that are not fictional, students need to disguise the identity of care seekers. Students must be aware of and abide by the mandatory reporting laws of the state in which they provide professional caregiving. If they are designated spiritual caregivers within their religious tradition, they need to also be aware of what their religious organization requires. If students have reason to suspect or have first-hand knowledge of recent, current, or ongoing child abuse or neglect perpetrated on a child currently under the age of 18 years, elder abuse, sexual and domestic violence, or threats of homicide or suicide in any of the pastoral situations they use for fulfilling the requirements of this course they need to seek immediate consultation with supervisors, denominational leaders, and the professor of this course so that proper reporting procedures can be ascertained. State laws on mandatory reporting are available at State Laws on Mandatory Clergy Reporting  Colorado mandatory reporting requirements may be found at Colorado Revised Statutes 19-3-304, 1a, 2(aa, II, III); 13-90-107c.  Faculty will abide by the bounds of professional and Title IX reporting laws rather than absolute confidentiality.

Self-Differentiation: In preparing forum posts and responses, assignments, and spiritual care conversations, students are responsible for (1) tracking how they experience stress in their bodies and stress-related emotions, and (2) using practices that foster self-compassion and empathy, such that their emotional/stress reactions are resources for learning, not liabilities.

Levels of self-disclosure: The purpose of self-disclosure is to develop competencies in spiritual care, and not for personal healing. In deciding how to use/disclose personal experiences in assignments, students need track their levels of stress as they work on assignments, and to not use/disclose experiences that overwhelm their capacities for self-differentiation, spiritual integration, and critical thinking skills. Students need to use their support systems when they become overwhelmed and in making decisions about what personal experiences to share in weekly posts and journal/case study assignments.

Respect for differences: Students are responsible for using social and theological empathy to imaginatively step into and respect the worlds of those who are different from them in terms of beliefs, values, practices, and social location.

Group and team learning depends upon timely posts and assignments: Every effort must be made to post on time. If posts will be late, faculty, students must notify faculty, forum discussion groups, and/or learning partners. If assignments are consistently late and if late assignment will jeopardize their learning partner’s deadlines, students may be required to withdraw from the course. Normally incompletes are not granted because all learning in the course is collaborative.

Availability of faculty: Carrie Doehring will normally respond within 24 hours to emails sent to cdoehring@iliff.edu (note that emails sent within Canvas are sometimes hard to track amidst other Canvas notifications). Spiritual care faculty offer support but not spiritual care or counseling, and are available to help students with referrals for spiritual care, spiritual direction, and counseling.

Academic standards: In all forum posts and assignments, students need to use academic and professional standards of good grammar, writing skills, and appropriate in-text citation using APA formatting (used through course material; see also writing center resources on APA formatting). Iliff School of Theology uses inclusive language, and language that respects all forms of religious traditions, theological, and political perspectives, and gender and sexual orientation diversity.

 Requirements

1. Weekly posts and responses: Students will be expected to do the readings and cite them in weekly discussion forums. 60% of total grade (Weeks 1 – 7: 8 points each for 56%, and week 10: 4%). Some weeks may include assignments requiring students to answer the following questions about readings: What is the author's thesis or main argument? A quote can be copied and pasted to answer this question. What are the main concepts used to develop the author’s thesis or argument? 
2. Journal assignment on a personal experience of religious/spiritual/moral struggle (20%) due on Friday, February 22 (see outline with grading rubric Journal Assignment Outline and Grading Rubric 2-12-2019.docx and sample assignment Doehring Journal Assignment Revised 1-9-2019.docx)  Go to this page for How to do a literature search
   

   Grading rubric for Journal Assignment:

   8/20 points: literature search and references used to enhance critical think in sections 3 and/or 5

   5/20: Part 3 critical thinking, engaging in a process of spiritual integration that enhances self-differentiation

   2/20: Part 4 critical thinking, reflecting on social advantage and disadvantages in order to enhance social empathy

   5/20: Part 3 critical thinking, engaging in a process of spiritual integration that enhances self-differentiation
3. Spiritual care conversations with your partner based on the journal assignments (one in which you give spiritual care and one in which you receive spiritual care) will be video recorded in week 8. Here is an Outline for preparing spiritual care conversation questions about moral stress.docx  as well as Sample Journal Questions from caregivers.docx. Here is  a sample of a spiritual care conversation  Week 2 Ruben's Conversation with Carrie.mp4     You will answer questions related to what you learned about competencies for spiritual care in your role as caregiver Sample Verbatim with analysis, goals, and a check list.docx due on March 8 (20%)

Academic standards: In all forum posts and assignments, students need to use academic and professional standards of good grammar, writing skills, and appropriate in-text citation using APA formatting (used through course material; see also writing center resources on APA formatting). Iliff School of Theology uses inclusive language, and language that respects all forms of religious traditions, theological, and political perspectives, and gender and sexual orientation diversity.

Group and team learning depends upon timely posts and assignments: Every effort must be made to post on time. If posts will be late, faculty, students must notify faculty, forum discussion groups, and/or learning partners. If assignments are consistently late and if late assignment will jeopardize their learning partner’s deadlines, students may be required to withdraw from the course. Normally incompletes are not granted because all learning in the course is collaborative.

Final Grade Scale (Note: at Iliff professors determine grading scales they will use to assign final course grades) A 97-100; A- 93-96; B+ 89-92; B 85-88; C+ 77-80; C- 69-72; D+ 65-68; D 61-64; D- 57-60; F 0-59

When you have found a learning partner, click on EDIT (top, right) and remove your name from under the heading of those who do not have a partner and add your name under the heading of those who do have a partner, so that others can see who still needs a partner. Then hit SAVE (lower right)

Those who do not have a partner: 

Those who have a partner: DC Sills, Kyndyl Greyland, Deirdre Brouer, Muhammad Kolila, Sara Keith, Maxine Christopher, Joanna Douglass, Deborah Svec-Carstens, Sarah Atamian, Berry Wilson, Jonathan Drummond, Patrick Hellman, Elizabeth Butche, Dee Torrell, C.J. Dolehanty, Maurine Nichols, [Thomas Cruse, Jordan Derhammer, John Case]

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