White British Londoners’ experiences of a transpersonal relationship in spiritually-based addiction recovery groups
There is an expanding field of studies about how spirituality can support people in their addiction recovery. Many of these studies involved participants who attended 12-step type support groups in the US and focussed mainly on the roles of a ‘Higher Power’ (HP) in participants’ recovery. In the UK, there are very few studies exploring people’s experiences of their transpersonal relationships (TPRs) as part of their addiction recovery. A TPR is a relationship that takes place beyond our daily experiences, beyond our ordinary sense of self, resulting in a more expansive, higher, deeper or greater sense of who we are, of others, or of the nature of reality.
This study focuses on White British Londoners’ experiences of a TPR in spiritually-based addiction recovery groups (SBARGs) and the ways in which these are linked to their addiction recovery.
A Grounded Theory method was used and was aiming to explore a theory explaining their TPRs. Eleven White British Londoners (3 man and 8 women) were interviewed. This grounded theory highlights the importance of participants’ development of their HP representation. This development of their HP Representation leads to the three findings in this research: “I am in Love with my HP”, “My HP gives me the freedom” and “I have this spiritual energy that is always very close to me”. By developing their images and concepts about their HP, participants see their alternative self-identity who portrays their HP’s characteristics. This self with HP’s qualities (also called the transpersonal self) is the result of an overlap between HP’s characteristics and participants’ characteristics. This overlap means participants start to express their HP characteristics in their daily life. As a consequence, participants’ actions, thoughts, believe and judgement change. The main change in their behaviour is their ability to maintain their addiction recovery.
Table of Contents
1. Introduction (1,176 words > 800 words)
1.1.5. Spiritually-based addiction recovery group
2. Literature review (1,662 words < 2,000 words)
3. Methodology (2,619 words > 2,000)
3.11. The paradigm model or coding paradigm
4. Results (179 + 305 + 1,155 + 625 + 172 + 172 + 527 + 4,883 + 180 = 8,198 > 6,600)
4.1. Overview of the Grounded Theory (305 words)
4.2. The central phenomenon (152 + 763 + 240 = 1,155 words)
4.2.1. HP Concept (135 + 179 + 211 + 145 + 93 = 763 words)
4.2.2. HP Image (45 + 110 + 48 + 37 = 240 words)
4.3. The causal condition (625 words)
4.4. The contextual condition (172 words)
4.5. The intervening conditions (172 words)
4.6. The (action/interaction) strategy (527 words)
4.7. The consequence (190 + 1,493 + 1,322 + 1,878 = 4,883 words without quotes)
4.7.2. My HP gives me freedom (1,322 words without quotes < 2,200 words)
4.7.3. I am in Love with my HP (1,878 words without quotes < 2,200 words)
4.8. Summary of findings (180 words)
5. Discussion (2,102 words < 2,200 words)
6. Conclusions (732 words < 1,000 words)
7. References (Total = 16,490 words )
8.1.2. Re-viewing my own code and re-coding
8.2. Diagram (First iteration of the ‘storyline’ – 20th August 2016)
8.3. Diagram (later iteration of the ‘storyline’ – 5th February 2017)
8.4. Diagram (Final iteration of the ‘storyline’ – 22nd May 2017)
8.6.2. Theoretical sensitivity
8.6.4. Criteria for rigorous qualitative research
8.7.1. The central phenomenon (152 + 763 + 240 = 1,155 words)
8.7.2. The causal condition (625 words)
8.7.3. The contextual condition (172 words)
8.7.4. The intervening conditions (172 words)
8.7.5. The (action/interaction) strategy (527 words)
8.7.6. The consequence (190 + 1,493 + 1,322 + 1,878 = 4,883 words without quotes)
8.10. Examples of social recovery groups
8.13. Recruitment poster and flyer
8.14. Interview schedule at the beginning of the research
8.15. Interview schedule adjusted during the GT process
8.19. Length of the interviews
8.20. Permissions to use data from blogs
8.21. Decision of Psychology Ethics Review Committee
8.22. Research Questions adjusted
8.23. Semi-structured interviews
Results from the 2013 to 2014 Crime Survey for England and Wales (Office for National Statistics, 2015) indicated that around one-third of adults had taken drugs at some point during their lifetime. Of 16 to 59 year olds, 35.6% had reported ever using drugs. Other statistics show that there may be as many as 593,000 problem gamblers in UK (NHS, 2016a) and findings from a research (Cowlishaw and Kessler, 2016) now support recognition of problem gambling as a public health concern in the UK. In 2011, shopping addiction affected between 8-10% of the British population (eight million people). Problematic gambling (or gambling addiction), shopping addiction, alcohol addiction, drug addiction, … have a detrimental effect on various aspects of someone’s life and quality of life of too many individuals, families, and communities and they also drains public resources. The cost of crimes related to drugs in the UK is £13.3 billion every year (Department of Health, 2015). There are different recovery programmes available for people suffering from addictions. These programmes will differ in terms of the monitoring involved around the patient (Appendix 8.10). Some patients may need to be removed from their old ways of life entirely for 30 days or as long as a year (Long-Term Residential treatment) or for a shorter period of time (Short-Term Residential treatment). These inpatients will have medical support to address additional mental health or physical complications. Patients who need closer medical attention (e.g. during detoxification) will benefit from a Hospital Based Inpatient treatment. A third group of patient may find Outpatient Treatment, an alternative to either individual therapy or residential treatment, allowing them to have a treatment without the need to stop working or live away from home.
Those recovery programmes can incorporate a Christian belief (e.g. Overcomers Outreach), a Buddhism belief (e.g. Buddhist Recovery Network), a Jewish belief (e.g. Jewish Alcoholics, Chemically Dependent Persons and Significant Others), a spiritual belief (e.g. AA and its sister organisations) or a secular belief (e.g. Self Management and Recovery Training Recovery). Those recovery programmes can also address different particular issues (e.g. sexuality, gender, social…) through various support groups. In those groups, participants (usually peers) support and help each other without professional therapy or guidance. In this study, my focus will be on the recovery process. Within the recovery process, many of the studies have involved participants who attended 12-step type support groups in the US. These studies focussed mainly on the roles of a higher power in participants’ recovery. For those scarce studies on the TPRs and its impacts on the recovery process, most of the American participants were from Black African ethnic groups. In the UK, there are very few studies exploring people’s experiences of their different transpersonal relationships (TPRs) as part of their recovery from addiction. I have then focussed my interest on White British Londoners’ experiences of a TPR in spiritually-based addiction recovery groups (SBARGs). My research questions are: How is the transpersonal relationship experienced by white British Londoners’ in SBARGs and how these experiences are linked to their recovery from addiction?
My literature review, in the next chapter, shows that there are very few studies on the TPR in counselling (Clarkson, 2003). Rarer are studies of the TPR in the context of an addiction recovery group. This research also aims to explore a theory explaining White British Londoners’ experiences of a TPR in SBARGs.
This work is divided into six chapters. In the first two chapters, I will present the field I am researching, define some key words used in this dissertation, highlight the gaps existing in the literature and give a formulation of my research questions. In the third chapter, I explain why Grounded Theory was selected as the method to research this field and answer my research questions. I present my qualitative analysis and my findings in chapters four and five. Finally, my conclusions will form the last chapter.
Spirituality is a personal experience. A spiritual experience tends to include a desire for more knowledge about the self and the world. Spirituality is linked with experiences of love and peace. It has the potential to offer some insight into someone’s search for meaning, hope, transcendence, connectedness, compassion, wellness, and wholeness. Spiritual experiences can be sustained through spiritual practices or belief systems (ASERVIC, 2005)
Organized religion can be defined as: “… a particular set of beliefs and practices with which people affiliate themselves” (Shafranske and Maloney, 1990).
The relationship between spirituality and religion can be described as follow: “Religion provides a structure for human spirituality, including narratives, symbols, beliefs, and practices, which are embedded in ancestral traditions, cultural traditions, or both” (Young and Cashwell, 2011, p. 9).
People will be addicted to a substance or behaviour for various reasons. They may be aware of this addiction or not. An addiction is a compulsive and all-consuming activity that can lead the individual to harm themselves or others. (Action on Addiction, 2016; NHS, 2016b).
Addiction can be conceptualised using different models. West (2013) found 13 theories of addiction. Those 13 theories show how complex and varied the study of addiction is. This research does not focus on a particular theory but participants’ understanding of their addiction may reveal a theory of addiction. For example, one of our participants whose HP is Krishna described his addiction as a constant need to reward himself, which illustrates one of the positive reward theories (Kanayama, Brower, Wood, Hudson, & Pope, Jr., 2009). Another participant described how addiction helped her to regulate her emotions. Miller and Cohen (2001) and Baumeister and Vohs (2007), described this in their self-regulation theories.
Based on two expert panel definitions constructed in the United States and United Kingdom, recovery has three core dimensions: (1) resolution of alcohol and other drug (AOD) problems (abstinence or disorder remission), (2) progress toward global (physical, mental, emotional, relational, spiritual) health, and (3) community reintegration (Betty Ford Institute Consensus Panel, 2007; Laudet, 2007).
Research into various recovery methods and therapies suggests that mutual aid can help recovery and so can treatment – a combination of the two is probably even better for many people.
Groups offer a natural environment where people can feel that that they are not alone and that they can have the life they want to have. (Corey and Corey, 1997)
In this study, groups are social groups where participants (usually peers) support and help each other without professional therapy or guidance. Examples of social groups are listed for information in appendix 8.10.
A SBARG is defined in this study as a social group of clients who meet regularly to address their addiction in an attempt to recover from the negative effects of their addictions. Various techniques and approaches may be used, but the basis of their work will rely on a spiritual approach to life.
The following paragraphs explore studies of the TPR in SBARGs.
There is a literature in SBARG addressing the TPR in group work. In the next paragraphs, I offer a definition of the TPR and analyse how the TPR in SBARGs has been studied.
The TPR is one of the five relationships patients may experience in their counselling session. According to Clarkson (2003), there are 5 potential therapeutic relationships in a counselling session. One of these relationships is the working alliance, which includes the terms of counselling/therapy contract between the therapist and the patient. Then there is the reparative relationship, where the therapist offers to repair a patient’s previous relationship. Another relationship is the person-to-person relationship, where the roles of the patient and therapist are ‘removed’ to give way to an authentic conversation between two adults. The fourth relationship takes place when patient and therapist see themselves beyond their races, gender, ethnic groups, beliefs…it is when there is a connection between two individuals who see themselves as spiritual being. We can call this the I-Thou relationship. The fifth relationship is the TPR, when we extend the previous connection between two spiritual being and include ‘something’ like Nature, the Universe or ‘some entity’ like a Higher Power into this ‘conversation’. This TPR has also been studied by Grof (1979). For Grof (1979) the TPR is a set of “Experiences involving an expansion or extension of consciousness beyond the usual ego boundaries and beyond the limitations of time and/or space” (Grof, 1979, p. 155).
Although there are some definitions out there, many authors recognise the difficulty to describe this relationship:
“The transpersonal relationship is the timeless facet of the psychotherapeutic relationship, which is impossible to describe, but refers to the spiritual dimension of the healing relationship” (Clarkson, 2003, p 187).
Grof (1979) and Clarkson (2003) ‘s definitions have been combined here to produce the definition used in this dissertation: A transpersonal relationship (TPR) or a transpersonal experience is beyond our daily experiences, beyond our ordinary sense of self, resulting in a more expansive, higher, deeper or greater sense of who we are, of others, or of the nature of reality.
The transpersonal self is defined as this expansive, higher, deeper or greater sense of who we are (Daniels, 2002). Vaughan (1986) states that “the concept of a transpersonal Self can be perceived as an image of qualities one chooses to value, rather than a separate identity to be constructed. It may be considered as existing a priori as an embodiment of abstract ideals such as truth, goodness, and beauty … or it may be considered to have no existence apart from concrete expressions and manifestations”.
People who had a TPR come from various walk of life and have different spiritual beliefs. There is no specific time of the day or day of the month where someone can experience a TPR. Similarly, there is no specific location or places where this relationship can be experienced. Very few studies have explored the TPR.
In group counselling, SBARGs like the Buddhist Recovery Network, Refuge Recovery, NAFAS, Narcotics Anonymous and Alcoholics Anonymous, Al-Anon and other groups mixing meditation and recovery offer an environment suitable for exploring the TPR.
Unfortunately, despite calls to increase research on spiritual issues and psychotherapeutic processes and outcomes (e.g., Clements & Ermakova, 2011; Poloma & Pendleton, 1991), there are still very few studies of the TPR. Authors have suggested that this is due to the inherent difficulty in defining “spirituality” and the difficulty to integrate concepts like meaning, purpose, higher self, … within established theories that measure recovery or well-being (Beitel and Genova, 2007).
In the field of addiction, there are few studies on the TPR.
In the United States, Green, Fullilove and Fullilove (1998) conducted a qualitative research exploring people‘s experiences with the Higher Power. Their findings suggested that people accepting a higher power had a profound life transformation and were able to achieved sustained abstinence, if further into recovery they develop a working relationship with their own Higher Power. How this working relationship with their own Higher Power feels like was not discussed in their research. Although positive outcomes were achieved, there was very few information on the quality of this relationship.
Another research in the United States by Heinz, Disney, Epstein, Glezen, Clark and Preston (2010) examined the beliefs about the role of spirituality in recovery and its appropriateness in formal treatment. They interviewed 25 methadone-maintained outpatients. They concluded that the process of recovery represented a renewed TPR. Participants described their transpersonal experiences through their recent success. This research gives us some ideas about the felt experiences of the participants. The authors invited more studies of more diverse samples to help guide the development and evaluation of spiritually based interventions in formal treatment settings.
Wallace, Reese, Chard, Roth, Quinn, Eckert (2016) examined the intersections of drug abuse histories and medication adherence among urban, older African Americans with type 2 diabetes mellitus. They concluded that in an effort to maintain sobriety and stay on a positive course of life, this population expressed the importance placed on a higher power overseeing life events by helping to resist temptations that may result in relapse.
In her study with 26 African American women, Blakey (2016) found that restoring a relationship with a Higher Power brought the women back to life. These participants had previous traumatic experiences and experiences of substance abuse. 73% of the participants had a mental disorder (like depression, bi-polar disorder, or anxiety). In this study, none of the interview questions asked specifically about the role of spirituality in these women’s lives. Blakey’s study is one of the rare studies of the lived experiences of a TPR amongst participants suffering from addiction. Blakey (2016) suggested that asking in-depth questions specifically about the women’s use of spirituality may have yielded different results. This research took place in the United States.
In the UK, Arnaud, Kanyeredzi and Lawrence (2015) used a thematic analysis to research how AA members understood the Higher Power (HP). Participants were six men and four women. They were British (majority), others were Irish, Polish, South African Iranian-Pakistani, and other mixed race origins. This research focussed on one specific SBARG, AA. They concluded that the participants’ relationships with their HP give a new meaning to their life which goes beyond their sense of identity. They also discovered that the main understanding of the HP is Love.
My research will use another assumption; I will take into account ‘Other experiences beyond normality’ where a spiritual experience and its impact on a participant can take place before, during or after a SBARG. Therefore I will not request my participants to have two years minimum in a SBARG. I will also consider other SBARGs, not only AA.
Members of SBARGS do not always have a positive experience of the group. Some studies highlight that the participation in a SBARG has also its own barriers and challenges. Caldwell & Cutter (1998) identified the individuals’ inability to embrace or utilize other aspects of the 12-step programme as obstacles to their recovery. Laudet (2003) identified lack of motivation for change, lack of readiness for change and lack of perceived need for help as obstacles to participation in 12-steps programmes.
Focusing more specifically on AA, Medina (2013) examined how the daily life of AA members was influenced by their long term recovery from addiction. The results indicated that rather than losing themselves or their sense of agency, these participants have overcome their alcoholic selves and emerged as more responsible, empowered, connected and free selves.
As a conclusion, there are few gaps in the literature: many of these studies occurred in the United States and mostly with Black African participants. Most of those participants had also a religious belief. This reflects the 76.5% of the American population who identified themselves with any organized religion (Pew Research Center, 2015). In the “United Kingdom of Great Britain and Northern Ireland” (UK), this percentage was 51% (NatCen, 2015). Some studies in this literature research were qualitative studies with a focus on the role of spirituality in recovery (Heinz et al., 2010), people‘s experiences with the Higher Power (Green, Fullilove and Fullilove, 1998), the intersections of drug abuse histories and medication adherence (Wallace et al., 2016) or AA members understanding of the Higher Power (Arnaud, Kanyeredzi and Lawrence, 2015). Most of those studies reported at least one participant’s experiences of his/her TPR. This study will take place in London (UK), with white British Londoners who mostly have no religious belief. This study aims to explore this in more details by asking the following research questions are: How is the TPR experienced by white British Londoners’ in SBARGs and how these experiences are linked to their recovery from addiction? In order to add to the existing knowledge, I will interview White British participants (because many of the previous studies occurred with Black African participants as stated earlier).
When I started to work on this dissertation, the research question for this work was broader, unfocused and did not take into account some of the studies in that field. My research questions were about the experiences of a TPR in SBARGs and how these experiences are linked to their recovery from addiction.
Another reason to adjust or re-focus my research questions was related to diversity issues around access to therapies to minority ethnic communities. When I started this research, I did not want to exclude one or another ethnicity; the original research topic, purposely open to a larger audience of participants, was aiming to recruit participants from different ethnic communities. However, as the data collection progressed, majority of the participants were white British living or born in London. After a discussion with my dissertation supervisor, I read few more research papers. In the light of some studies in this field and the data collected at that stage, I changed my focus and decided to examine white British Londoners’ experiences of a transpersonal relationship in SBARGs.
I will first establish the theoretical underpinnings of my chosen research method, Grounded Theory (GT) with the Paradigm Model (Glaser and Strauss, 1967; Strauss and Corbin, 1998) by explaining its framework and detailing how I have adhered to it in this research.
Details of my reflexive engagement with the research questions have been explored in Appendix 8.6 Reflexivity (page 136), assess validity, take account of ethical considerations and describe the research procedure.
As a means of reducing researcher effect, such as biased selection of data that ‘fitted’ my views on spirituality, I used various coding software to re-analyse the data. The results of this coding showed that I could keep the principal phenomenon as the ‘Development of a HP Representation’. These results are presented in Appendix 8.1 (page 113).
The research questions are: How is the transpersonal relationship experienced by white British Londoners’ in SBARGs and how these experiences are linked to their recovery from addiction?
To answer these research questions, 11 semi-structured interviews were used (Appendix 8.15). The semi-structured interviews consisted of open-ended questions which invite the participants in a more meaningful exchange than closed-questions requiring a yes/no-style of answer. As there are very few qualitative researches and theories in this field, a semi-structured interview suits a discovery approach to data. Discovery approaches to data or emergent approaches (Dick, 2001) include action research and some varieties of grounded theory. Action research is concerned with the perspective and interests of the research participants (Reason & Goodwin, 1999; Dick, 2001; Reason, 2006). Grounded Theory (GT) is concerned with the generation of new theory emerging from the data, i.e. GT is an inductive methodology. Based on my previous knowledge of GT, GT seemed to be the appropriate discovery approach in this instance.
There are different conceptions of GT. The original conception of GT has been created by Glaser and Strauss (1967) and developed by Glaser (1978, 1992). Glaser’s GT method is known as classic GT or Glaserian GT. Compared to other GT methods, classic GT is less structured (Altrows, 2006: p.53). In order to guide and direct thinking and decision-making in classic GT, Strauss and Corbin (1990, 1998) introduced the paradigm model. The paradigm model brought more structure and framework to the classic GT process. Later, Charmaz (2006) underlined the importance of the multiple voices, views and visions of participants in rendering their lived experiences. Charmaz’s GT is an example of constructivist GT; constructivist GT attempts to explain how people construct their realities and present multiple perspectives. In section 2.11, I described how I have applied the paradigm model of Strauss and Corbin to my research.
Reflexivity is the researcher’s ability to be aware of his/her own view of the world on the research process (Creswell and Miller, 2000; Hall & Callery, 2001; Malterud, 2001). I have explored the key elements of reflexivity in Appendix 8.6 (page 136).
An initial purposive sampling of 4 participants was selected. The selection was according to criteria specified by the researcher (see section 8.13 Recruitment poster and flyer and 8.21 Decision of Psychology Ethics Review Committee). Later analysis of data indicated an issue related to the ethnic backgrounds of my participants: I was expecting to interview participants from different ethnic backgrounds but most of my participants were white British Londoners. I adjusted my research questions to reflect this (Appendix 8.15). The final sampling consisted of 11 participants. They were 11 adults aged 32 to 65. The average was 43 years old (See Table 1: Participant demographics). Participants were fluent in spoken English, are attending or have attended a SBARG in London. In the context of this study, I define ‘being in recovery’ as being abstinent or trying to pursue an improved way of living/being for at least 1 year prior to the interview.
Table 1: Participant demographics
| Participant Name[1] | SBARG[2] | Gender | Londoner? | Faith / Belief |
Ethnicity | Time in Recovery | Length of interview in words / minutes |
| Albert (interview number 1) |
NA, AA | Male | Londoner | Christian | White British | 7 years | 43′ / 6312 words |
| Bella |
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