INTERSECTIONS OF DISABILITY, SEXUALITY, AND SPIRITUALITY WITHIN PSYCHOLOGICAL TREATMENT OF PEOPLE WITH DISABILITIES
Religion and spirituality have become more prominent in psychological research and practice and may have unique considerations for people with disabilities, in terms of conceptualisations of disability within various belief systems, as well as accessibility issues in engaging in religious practice. For those individuals with disabilities seeking psychological treatment around sexual intimacy, sexual expression, and close relationship functioning, many can benefit from consideration of this important variable if they identify as religious or spiritual. Identifying disability-affirming sexuality resources can be challenging for people with disabilities due to stigma around sexuality and disability (Mona et al. 2014), especially within a context of particular religious or spiritual beliefs. However, finding ways to access positive sexual expression can also lead to improvements in mental health outcomes and overall wellness (Sanchez-Fuentes et al. 2014). This chapter will explore the intersections among disability, sexuality, and spirituality with the goal of increasing understanding of their interrelatedness and potential impact on psychological health.
Definitions of disability and religion/spirituality (R/S) will first be addressed to create a foundation on which to illustrate how sexuality and intimacy intersect with this important life identity and experience. A review of the demographics of R/S will be presented, followed by examination of the reasons that mental health providers have traditionally excluded R/S in clinical work and reasons that this variable may be helpful to address. A discussion of the various potential psychological and physical health outcomes associated with R/S practice will follow. Specific religious traditions and their approaches to the human experience of disability will be reviewed, accompanied by examination of those traditions’ views and approaches to sexual expression and sexual relationships. Lastly, the chapter will offer brief practical suggestions regarding clinical assessment of these diverse issues.
Disability is a complex life experience. For the purposes of this paper, disability will be discussed as a culturally identifying variable, although there is wide variability among people with disabilities themselves and non-disabled people in terms of preferences regarding person-first language (“people with disabilities”) versus identity-first language (“disabled people”) (Dunn and Andrews 2015). Many people with disabilities identify strongly with and take pride in the cultural experience of disability and prefer identity-first language, whereas others choose person-first language, which historically was encouraged as a way to address the dehumanising social stigma around disability (Andrews et al. 2019).This preference is highly variable and dependent on numerous factors. Disability itself—aside from identity language—is defined as “a physical or mental impairment that substantially limits one or more major life activity” (ADA 2019) within the United States, but this definition does not fully embrace the cultural identity aspects of the lived disability' experience. It is also noted that some individuals do not identify as having a disability per se but may present for psychological treatment in the context of a chronic health condition or other, physical/mental state that negatively impacts life activities.
Within the research field of the psychology of R/S there has been a great deal of discussion regarding definitions and conceptualisations of these two terms, adding much complexity—and some debate—as to what these terms really mean. Pargament (2007) in his approach to spiritually integrated therapy conceptualises religiousness and spirituality together as “a set of pathways that people follow in search of the sacred” (p. 196).The word “religion” itself has origins in Latin, coming from the root word “religio,” meaning a bond between humans and some power greater than humanity (Hill et al. 2000). Spirituality, as a concept separate from religion, has been defined as an internal experience towards the sacred that an individual nurtures on a personal basis and that is “motivated by interest in meaning, purpose and significance” (Johnstone et al. 2007, p. 1154). Religion, in contrast, has been defined as a larger organised institutional system meant to facilitate spirituality, including traditions, practices, doctrines, beliefs and moral codes (Exline et al. 2014; Pargament et al. 2013). It is also generally accepted in the field of the psychology of R/S that an individual can be religious without being spiritual or spiritual without being religious (Pargament 1999). In more recent socio-cultural contexts—aside from the academic discipline of the psychology of R/S—there has been an evolution of the terms, such that religion has increasing been understood as a more static institutional religious experience, with spirituality meaning an elevated dynamic experience that is considered more in vogue culturally (Pargament 1999).These findings suggest that using both terms in assessment should prove useful in identifying those individuals who may benefit from the integration of R/S in clinical work.
Religion and spirituality have historically been important components in socio-cultural landscapes throughout the world, although fluctuations in that importance can occur over time and within certain age groups. Worldwide, only 16.4% of the worlds population are thought to be unafFiliated with any particular religious faith, with Christians (31.4%), Muslims (23.2%), Hindus (15%), and Buddhists (7.1%) representing the major organised religious affiliations (Pew Research Center 2010). Recent research on adult Americans (Pew Research Center 2014) indicates that 53% of those surveyed stated that religion was very important to them and 24% stated that it was somewhat important. In order of importance level, the following groups had more than
50% of respondents indicating that religion was very important them: Jehovah s Witness (90%), Historically Black Protestant (85%), Mormon (84%), Evangelical Protestant (79%), Muslim (64%), Catholic (58%), Mainline Protestant (53%) and Orthodox Christian (52%). Whereas there are virtually no reliable statistics on the affiliations of R/S for people with disabilities in particular, it is recognised that people with disabilities represent the largest minority group in the world, comprising approximately 15% of the global population (World Health Organization 2011). As such, people with disabilities represent a large cultural group that may benefit from culturally tailored healthcare services. It is also noted that some individuals with disabilities may carry “dual-minority” status, such as those who identify as sexual minorities (lesbian, gay, bisexual), or gender minorities (e.g., transgender), or ethnic minorities (Olkin 1999 p. 20).
Psychology and religion
For a myriad of reasons, R/S has only recently received attention as a variable to include in assessment and treatment within psychological practice, although the psychology of R/S has been studied as a basic science for a much longer time within the history of the field. Psychologists have, in the past, avoided addressing religion at all due to its association with superstition or magic and the fear that this could delegitimise psychology' as a professional field (Wulft 1997). It is noted also that, as a profession, psychologists tend to identify less as being religious or spiritual themselves, with surveys of psychologists finding much lower religiosity than the general population (Delaney et al. 2007; McMinn et al. 2009). As such, psychologists may unintentionally underestimate the significance of this aspect of peoples lives (Pargament et al. 2013). Rehabilitation psychologists---those
clinicians who work primarily with individuals with disabilities—who are not religious themselves may see R/S as an inappropriate method for coping with new physical disability or simply inappropriate to address (Johnstone et al. 2007). Others feel that R/S, like politics, may be too personal of a topic to include in assessment or therapeutic enquiry and the question might be experienced as an intrusion for many patients (Trieschmann 2001). Within the medical profession, efforts by physicians to include R/S in treatment have, in some cases, been met with criticism by faith leaders for being out of their scope of practice (Lawrence 2002; Sloan et al. 2000). In a practical sense, many professionals may simply feel unprepared to address these issues due to lack of training in many professional programmes and textbooks (Pargament et al. 2013; Plante 2016).
Despite these various negative sentiments and cautions to using R/S in clinically oriented psychology work, Pargament et al. (2013) acknowledged the more recent shift from a nowstrong research base in R/S to gradually seeing clinicians applying this positive research in psychology practice. On a more basic level, one of the most important reasons for including R/S in clinical work is that approximately 84% of the world’s population, including people with disabilities, identify religion and/or spirituality as being important in their lives (Pew Research Center 2010). Some research has also noted that people who identify as religious or spiritual may choose to engage more frequently in religious practices after they experience an acquired disability or as they are living with a progressive disabling condition (Chen and Boore 2008; Haley, Koenig and Bruchett 2001; Idler and Kasl 1997).