How Religious Beliefs And Practices Influence The Psychological Health Of Cathloic Priests.pdf

567325 research-article2015

JMHXXX10.1177/1557988314567325American Journal of Men’s HealthIsacco et al.

Article

How Religious Beliefs and Practices Influence the Psychological Health of Catholic Priests

American Journal of Men’s Health 2016, Vol. 10(4) 325­–337 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1557988314567325 ajmh.sagepub.com

Anthony Isacco, PhD1, Ethan Sahker, MA2, Elizabeth Krinock, MSCP3, Wonjin Sim, PhD1, and Deanna Hamilton, PhD1

Abstract Roman Catholic diocesan priests are a subgroup of men with unique religious and spiritual roles, beliefs, and practices. This qualitative study of 15 priests from the mid-Atlantic area of the United States focused on how priests’ relationship with God and promises of celibacy and obedience influenced their psychological health. Using a consensual qualitative research (CQR) design, the analysis revealed that participants described their relationship with God as central to their health and contributing to positive outcomes (e.g., sense of connection and support). The influence of their promises of celibacy and obedience were linked to both positive outcomes (e.g., decreased stress, improved relationships) and negative outcomes (e.g., internal conflict, depression/loneliness). This study highlighted the central role that priests’ relationship with God has on positive psychological health. Future research is necessary to understand how to maximize the positive effects and minimize the negative effects of priests’ promises of celibacy and obedience, which would benefit programs aimed at supporting priests’ psychological health. Keywords priests, clergy, relationship with God, religion/spirituality, obedience, celibacy Roman Catholic diocesan priests represent a group of men fulfilling a religious and spiritual ministry. The role, function, and ministry of Roman Catholic priests (shortened to priests for remainder of the manuscript) is considered a calling from God that is expressed through service to others, sacramental duties, and overseeing the administration of parishes (i.e., organized, geographicallybased faith communities; Hankle, 2010). The psychological health of priests received little attention until the international sexual abuse scandal was uncovered in 2002. Since 2002, much of the health-related scholarship about priests across disciplines such as psychology and psychiatry has focused on identifying and preventing clergy sexual abuse of minors (e.g., Plante, 2003). Such empirical, policy, and treatment efforts are needed, warranted, and must be continued to overcome the terrible damage of the sexual abuse scandal. The enormity of the sexual abuse scandal and the widespread media coverage may have created some misconceptions about priests that could negatively bias health professionals’ treatment of priests (Plante & Daniels, 2004). For example, one myth that has developed is that all priests are likely to be pedophiles despite recent statistics indicating that 2%–4% of priests are sexual offenders of minors (John Jay College Research Team, 2011). Few empirical studies have been conducted

in the health sciences that address salient aspects of psychological health with a sample of priests that is more representative of the majority, non–sexual-offending priest population (Rossetti, 2009). Priests are faced with several challenges that have increased the importance of examining and addressing their psychological health. There are currently 38,275 priests in the United States compared to 58,632 in 1965, and 49,054 as recently as 1995 (Center for Applied Research in the Apostolate, 2014). Priests are often expected to take on more responsibilities and live alone as a result of the dwindling numbers. Basic workplace research has consistently indicated that increased workloads and decreased supports are correlated with negative psychological outcomes such as burnout (Maslach, Schaufeli, & Leiter, 2001).

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Counseling Psychology Programs, Chatham University, Pittsburgh, PA, USA 2 Counseling Psychology Program, University of Iowa, Iowa City, IA, USA 3 Chatham University, Pittsburgh, PA, USA Corresponding Author: Anthony Isacco, Counseling Psychology Programs, Chatham University, Woodland Road, Pittsburgh, PA 15232, USA. Emil: [email protected]

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Indeed, some evidence of burnout and role stress has been reported in international samples of priests and related samples of parish-based clergy (Doolittle, 2007; Raj & Dean, 2005). In addition to burnout, some research has reported that priests have high levels of depression, perhaps seven times the rate of the general population (Knox, Virginia, Thull, & Lombardo, 2005). In addition to depression, Knox, Virginia, and Smith (2007) discovered evidence of obsessive compulsion, interpersonal sensitivity, and psychoticism among a sample of U.S. Catholic priests. Qualitative and quantitative research has identified that priests experience some common occupational stressors (e.g., time pressure) as well as unique stressors such as unusually high self-expectations and chronic loneliness (Hoge, Shields, & Soroka, 1993; Isacco et al., 2014). The extant literature on priests’ psychological health is inconclusive, with research also finding positive outcomes in various samples of Catholic priests. For example, some research reported that Catholic priests (as well as brothers and nuns) experienced less vocational strain and more community support than Protestant ministers (Weaver, Flannelly, Larson, Stapleton, & Koenig, 2002). Rossetti (2011) indicated that about 6.3% of the priests in his sample (n = 2,482) met clinical criteria for a psychological disorder (likely depression and/or anxiety), 11% of the sample endorsed emotional exhaustion (a component of burnout), and 1.5%–2.3% were reported to be “highly burnt out”—all of which were lower than a community sample of men. Given the religious and spiritual roles, activities, calling, and nature of the priesthood, it makes sense to investigate priests’ psychological health in relation to their religious beliefs and practices. However, some studies of priests’ psychological health have not accounted for their religious/spiritual experiences, resulting in the absence of a key factor to their psychological health (e.g., Zickar, Balzer, Aziz, & Wryobeck, 2008). Aspects of religiosity and spirituality (R/S) are increasingly being identified as a pathway toward health and well-being, especially as a positive coping mechanism and source of support for men (Garfield, Isacco, & Sahker, 2013). Therefore, any examination of priests’ psychological health would benefit from accounting for religious and spiritual factors. This study aimed at understanding how priests describe their religious beliefs (relationship with God) and practices (adherence to promises to be celibate and obedient) as influencing their psychological health.

The Psychological Health of Priests: The Role of Religious Beliefs and Practices Religiosity and spirituality (R/S) is general phrasing, but the scientific study of R/S in health sciences is composed

of specific constructs that measure religious practices (e.g., attending religious services, reading religious books, praying), religious beliefs (e.g., belief in God or higher power), and religious attitudes (e.g., importance of faith in one’s life) among many other constructs, theories, and variables (e.g., Miller & Thoresen, 2003). R/S experiences have increasingly been studied in health professions such as medicine and counseling (e.g., Flannelly, Galek, Ellison, & Koenig, 2010; Worthington & Aten, 2009). The increased attention to R/S factors in the health professions can be attributed to a growing awareness that R/S is important to many patients, evidence of new links to positive health outcomes, and increased importance placed on health practitioners to enhance their multicultural competence such as attending to and being respectful of their patient’s R/S beliefs and practices (e.g., Koenig, 2009; Powell, Shahabi, & Thoresen, 2003). However, the scientific data is still inconclusive as R/S constructs have been correlated to both positive and negative health outcomes in various studies and debates among scholars persist (e.g., Moreira-Almeida, Neto, & Koenig, 2006). The extant literature with priests has not identified a single R/S construct that is most salient to their psychological health, but a cluster of constructs has begun to emerge. Rossetti and Rhoades (2013) conducted a study with 2,482 Catholic priests and reported that clergy are less likely to become burned out than people in other occupations; a strong relationship with God and inner peace were two factors that were negatively correlated with burnout. Using the same sample of 2,482 priests in a different analysis, relationship with God was identified to be the second highest factor (out of list of 22 possible factors) related to priests’ happiness (Rossetti, 2011). In a study with a similar sample, 2,000 Anglican clergy in England, more positive attitudes about prayer were correlated with decreased instances of burnout (Turton & Francis, 2007). A smaller, qualitative study reported that Catholic priests in the United States emphasized the importance of prayer for their mental health, and their suggestion to have spiritual activity incorporated into counseling with priests (Isacco et al., 2014). Other studies have indicated that religious and spiritual constructs can have a negative effect or no effect on priest psychological health. For example, a study of Catholic priests in India reported that involvement in spiritual activities was not correlated with reduced burnout and depression, although this finding may be accounted for by a lack of a strong measure of spiritual activities (Raj & Dean, 2005). The latter point raises the important issue of how difficult it has been for researchers to operationalize and measure complex religious and spiritual experiences, which suggests that qualitative inquiry may be helpful to examining such experiences among priests. Qualitative methodology is well-positioned and designed to investigate complex

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Isacco et al. and hard-to-measure phenomena, using the participants’ own words without having to respond to forced-choice survey items for a specific variable (Hill, Thompson, & Nutt-Williams, 1997). Using qualitative methodology, our primary research question was broad and open-ended: What faith beliefs or spiritual practices of priests influence their psychological health?

Priestly Promises, Lifestyle Expectations, and Psychological Health Although no single R/S factor emerged from the extant literature as most salient to priest psychological health, this study specifically examined the priestly promises of celibacy and obedience. Roman Catholic diocesan priests (who are participants in this study) make two promises once they are ordained. Diocesan priests are ordained to a particular diocese and work in a parish, but do not take vows (e.g., poverty). Comparatively, religious priests are ordained, live in a community with other religious priests, and take vows of poverty, celibacy, and obedience. First, diocesan priests promise to live a celibate, chaste life that is prohibitive of marriage and sexual behavior in order to facilitate priests’ full devotion of service to the Church. Second, diocesan priests promise to be obedient to the local bishop in such ways as acceptance of particular Church teachings and in practical matters of being transferred to a new parish. The promises of celibacy and obedience for diocesan priests are based in a spirituality and theology within the Catholic faith tradition. It is beyond the scope of this article to review the theological basis of the promises; rather, the focus is an investigation of how celibacy and obedience may influence priests’ psychological health. Much has been written and debated about the role of celibacy in the Catholic priesthood (e.g., Farrell, 2009). Recently, Pope Francis made newsworthy comments about celibacy, which suggested that he may welcome discussion about mandatory celibacy for priests. Celibacy has been identified as a contributor to the declining number of priests in the United States (Conway, 2001). In the aftermath of the sexual abuse crisis, celibacy was investigated as a possible cause to sexual misconduct by priests (Adams, 2003). However, there seems to be agreement among some scholars that celibacy per se is not a cause of priests becoming sexual offenders of minors (e.g., Doyle, 2006; John Jay College Research Team, 2011; Plante & Daniels, 2004). Yet, Doyle (2006) argued that celibacy can be related to a misguided sense of superiority and psychosexual immaturity among some priests, which can be linked to sexual misconduct and offenses of minors. Of the few empirical investigations of celibacy in the health sciences literature, a more positive trend of findings has emerged. In a sample of 511 Catholic priests in South India, commitment to celibacy was related to a

decrease in burnout (emotional exhaustion and depersonalization) and positively related to personal accomplishment and positive work-related engagement (Joseph, Corveleyn, Luyten, & De Witte, 2010). Rossetti (2011, p. 106) reported that most priests in his study considered celibacy to be “a personal grace,” a part of their calling and that their high commitment to celibacy was significantly related to their perceived happiness. Priests make a promise of obedience to the authority of the Catholic Church when they are ordained. The local bishop in the diocese represents the authority of the Catholic Church. Thus, most health science research about obedience is not about the promise per se but the priests’ relationship with their bishop. An earlier study (Hoge, Shields, & Soroka, 1993) indicated that priests experienced intense stress from closed and aloof communication patterns with their superior. In a quantitative study with 190 U.S. priests, support from the bishop was a nonsignificant factor related to stress, while priests in this study benefited more from support from parishioners and fellow priests (Zickar, Balzer, Aziz, & Wryobeck, 2008). Trust in their relationship with the bishop may play a role in how much stress priests experience due to obedience. In a qualitative study with 22 priests, most participants reported that they lost faith in their bishop after the sexual abuse scandal surfaced as well as other negative feelings such as betrayal because some priests felt that bishops were not acting in their best interests (Kane, 2008b). Distrust of bishops was reported by a few priests in a qualitative study about mental health helpseeking, while other priests in the same study reported that their bishop encouraged them to seek mental health services (Isacco et al., 2014). Given the mixed and often individualized findings between the promises and priests’ psychological health, our second research question asked, how do the promises of celibacy and obedience affect the psychological health of priests?

Method The study used consensual qualitative research (CQR) as the overarching research methodology (Hill et al., 1997). CQR is a qualitative methodology that is well suited to answer open-ended research questions about hard-tomeasure phenomena with understudied populations from a postpositivistic philosophy (Hill et al.). The specific application of CQR is noted throughout the Method subsections.

Participants Participants consisted of 15 Roman Catholic priests, from a Mid-Atlantic city of the United States, which is at the upper end of CQR’s suggested range of 8–15 participants (Hill et al., 1997). All of the priests were White; age

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ranged from 29 to 76 (M = 47), with a range of years in the priesthood from less than 6 months to 50 years (M = 16.2 years). Nine participants were pastors, 5 were parochial vicars (i.e., assistant priests to the pastor), and 1 participant did not report his role. Participants primarily worked in a parish (n = 13). Some participants served in multiple roles such as overseeing two parishes simultaneously (n = 3), at a parish and school simultaneously (n = 2), and having multiple duties outside a parish (n = 1; specific duties were not reported to protect the identity of the participant).

Procedure Collecting data from priests is a difficult task because of Catholic Church oversight, skepticism with research, and the sexual abuse scandal (e.g., Kane, 2008a). Snowball sampling methodology was used to recruit participants because it is an effective method to use with targeted sampling populations and difficult-to-recruit populations such as priests (Kappler, Hancock, & Plante, 2012; Sadler, Lee, Lim, & Fullerton, 2010). Snowball sampling is not incompatible with CQR; CQR places a high emphasis on recruiting participants that can speak articulately about the topics and recognizes that qualitative studies are often based on nonrandom samples (Hill et al., 1997). This study was approved by Chatham University’s Institutional Review Board. The study utilized a priest as a consultant throughout several stages of the research process, including data collection. The first snowball-sampling step entailed contacting two priests suggested by the consultant. The study was described over the phone to the two priests and verbal consent was obtained. After they verbally agreed to participate, an in-person interview was scheduled over the phone. Written informed consent was provided inperson, through a document that was signed by the participant and primary investigator. At the conclusion of the interview, participants were asked if they knew other priests willing to participate in the study. Participants listed and provided contact information for two or three priests. This process was repeated until data saturation was achieved (Hill et al., 1997). One priest retired before the interview could take place, 2 priests scheduled interviews but backed out, 2 declined upon initial contact, 6 received messages but did not call back, and 14 others were recommended but not contacted because of data saturation. All 15 interviews were conducted in-person and were audio-recorded for transcription purposes. The interviews were transcribed for analysis by the research team. Transcribed data was assigned a numerical value and identifying information (e.g., name, name of parish, unique roles) was omitted to protect participant

confidentiality as much as possible. Participants were informed that their responses would be presented in aggregate form, with limited identifying information to maintain their confidentiality. Participants were asked for contact information in order to provide them with results and for follow-up interviews, if needed for more information and/or to clarify responses. Follow-up interviews were conducted by phone with 11 participants. The follow-up response rate was 85%; 1 participant did not respond and 1 participant retired in the interim and could not be located. All participants were mailed a debriefing letter detailing the study’s questions, findings, and primary products (e.g., academic presentations and papers).

Measure Qualitative data were gathered through a semistructured interview, which was developed through a thorough review of the literature and input from the study’s consultant (Hill et al., 1997). First, an initial pilot interview was created using the extant literature. The interview was given to the consultant and three expert reviewers for feedback. The interview was revised four times based on their feedback. The completed interview included 22 open-ended questions designed to be 60–90 minutes. The present study is part of a larger project examining priest health and well-being; the questions most relevant to this study were as follows: (a) What faith beliefs and/or spiritual practices of yours most influence your mental and physical health? (b) Catholic priests take promises of celibacy and obedience. How do those promises affect your health and well-being? (c) In what ways do priests engage in self-care? (d) What contributes to burnout among priests? (e) How can burnout be prevented? (f) What do you think your strengths are that help you be a priest? and (g) How do you cope with stress?

Research Team CQR requires the use of a diverse research team to collect and code the data. The primary research team consisted of eight members. The primary investigator is a 34-yearold White, Catholic man with a PhD in counseling psychology; he was an interviewer, data analyst, and coauthor. The other researchers were a 33-year-old White, atheist man and counseling psychology PhD student (interviewer, data analyst, and coauthor), a 61-year-old White woman with a PhD in clinical psychology with a Christian background but currently religiously unaffiliated despite involvement in religious/spiritual activities (data analyst); a 40-year-old White Catholic woman with a PhD in clinical psychology (data analyst and coauthor); a 28-year-old White Christian woman with an MS in counseling psychology (interviewer and data analyst); a

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Isacco et al. 36-year-old White Catholic woman with an MS in counseling psychology (interviewer and data analyst); and a 23-year-old White Catholic woman with an MS in counseling psychology (coauthor). The auditor (and coauthor) is a 34-year-old Asian Catholic woman with a PhD in counseling psychology. All had extensive training in CQR methodology. For example, interviewers were trained in interviewing competences such as asking openended questions, probing, and remaining nonjudgmental (Hill et al., 1997). Biases and expectations. CQR suggests that researchers discuss biases and expectations prior to coding the data and throughout the research process to ensure the highest level of objectivity (Hill et al., 1997). Biases and expectations are personal experiences and beliefs about the study’s topic that may affect objective data analysis. Research meetings were initially devoted to discussing biases and expectations and to equalizing power dynamics between student and faculty researchers. Biases were focused on differing views of the Catholic Church and religious experiences, as the researchers are six Catholics, two Protestants, and one atheist. Biases consisted of (a) negative associations with the Catholic Church (e.g., sexual misconduct, hierarchical power and control, rules and regulations) and (b) positive associations with the Catholic Church (e.g., spiritual strengths of priests, supports of priesthood). More specific to religious beliefs and practices, biases and expectations consisted of (a) an understanding of a relationship with God that was more “top down,” simple, and one-sided; (b) belief that a relationship with God is bidirectional and similar to companionship and friendship; (c) an expectation that priests would not talk negatively about hierarchical issues related to obedience; and (d) a nonbelief in God.

Qualitative Data Analysis Using CQR Developing domains.  A domain is a broad topic area used to code large sections of the interview. First, the research team constructed a domain list based on the prior literature review, interview questions, and an initial reading of interviews. Analysis began with each team member coding domains from the list separately. Team members read transcripts individually, selected sections of participant responses, and coded them with existing domains or constructed new domains. The team members met to achieve consensus of the domain coding. Team members rotated initiating the discussion for each domain and the remaining members agreed or disagreed. Team members stated their case until consensus was achieved. The consensus process was continued until a unanimous agreement was reached for every domain. After the team had gone

through the first 2 transcripts, additional domains emerged and the early transcripts were recoded for all newly emergent domains in a recursive process (i.e., the constant comparative method). For example, one of the main domains explored in this study, priests’ relationship with God, was not on the initial domain list but emerged in the interview narratives. Each coded interview was sent to an external auditor and was returned with feedback. The auditor provides an objective check of the coding. The team met to review the auditor’s feedback and informed the auditor of changes made in response to the feedback. Constructing core ideas.  A core idea is a concise and comprehensive summary of participants’ words within a domain. Core ideas provided specific information about priests’ relationship with God (e.g., health outcomes). Team members would select smaller sections within domains and code them as separate core ideas. For example, one “relationship with God” domain code may have a core idea addressing how speaking with God during prayer reduces their anxiety. After the team completed coding for core ideas of a few cases and all team members had a solid understanding of the coding process, a modified approach to CQR was used by splitting the team into two smaller groups and coding for domains and core ideas simultaneously (Thompson, Vivino, & Hill, 2012). Team members continued to meet to discuss their individual coding of domains and core ideas and to reach a consensus. The coded transcripts were sent to the auditor and returned with feedback for both the domains and the core ideas. Conducting a cross-analysis.  Group members reviewed all coded transcripts and developed categories that emerged from the domains and core ideas across all of the participants. A cross-analysis is meant to be a higher level of data abstraction by finding representativeness of categories in the entire sample (Hill et al., 1997). Team members independently developed a coding matrix that described an in-depth construction of categories and subcategories. Categories are developed to describe common core ideas across participants. For example, participants described how celibacy affected their psychological health in positive and negative ways. Positive and negative effects of celibacy represented two categories and the specific positive and negative effects of celibacy on their psychological health emerged as the subcategories underneath the two broader categories. The final consensus of the cross-analysis was sent to the auditor for feedback; corrections were made in response to feedback. Frequencies of categories and subcategories were calculated and reported.

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Unique Positive Health Effects -

Increases Support Decreases negative emotions Transforms/empowers Enables authenticity Creates balance

Dynamic Relationship with God

Unique Negative Health Effects -

Internal conflict Disrupts relationships

Unique Negative Health Effects -

Biological desires Depression/loneliness

Shared Positive Health Effects Promise of Obedience

-

Increases positive emotions Decreases stress Strengthens relationships and connection

Promise of Celibacy

Unique Positive Health Effects -

Increases focus on vocation

Figure 1.  Dynamic relationship with god and religious promises: Priest psychological health.

Results Descriptions of Priests’ Relationship With God The semistructured interview asked participants to reflect on what influenced their health and well-being. Please see Figure 1 for an overview of the findings. Throughout the interview process and in response to different questions, 13 priests (86%) emphasized the importance of their relationship with God to their health and used several active descriptors of their relationship. The participants’ descriptions of their relationship with God were coded into the following categories: (a) bidirectional/ mutual, interactive; (b) personal, intimate, and unitive; (c) central/foundational to their lives; and (d) fluid, not static. The categories are described in more detail below. As is the case throughout the results section, the percentages provided indicate the number of participants who reported the theme out of 15. The same priest may be totaled into multiple themes, resulting in percentages above 100%. Pseudonyms were used to protect the identity of the participants while still providing a personal perspective to representative quotes. Relationship with God is mutually beneficial and interactive. Eight (53%) participants indicated that their relationship with God is mutually beneficial and interactive with bidirectional communication. Their relationship entails distinct roles that facilitate mutual benefits; God’s role is to be there and to handle “the big stuff” for the

priest and the priest’s role is to be God’s instrument in the world. Father Henry, a middle-aged priest, stated, In a prayerful relationship, you hear God saying, “I need you. I need your hands to continue to bless. I need your lips to continue to proclaim the gospel and speak the truth. I need your ears to listen and to absolve sins.” If I did the best I could possibly do, then that gives praise and glory to God because I used what he has given me in the best way.

Father Robert, a 41-year-old priest, reported, “I’m the instrument. I’m trying to do my best and follow him to see where the results go. He’s got the whole world in his hands and I have to trust him.” Relationship with God is unitive.  Eight (53%) participants reported that their relationship with God is unitive, which provided a sense of companionship with God and reliance on God during difficult times. Father Jim, an older priest close to retirement, shared, I find a sense of peace and calm because I know God is here and I’m not alone with this [difficulty] or any kind of situation. Sometimes you walk in to a hospital room, you don’t know what you’re going to. . . . It’s the thought of “God be with me.” I’m not alone here.

Father Charlie, a 37-year-old priest, stated, “I’m united with Christ. It proves I’m His beloved. It is a great comfort and allows me to be more hopeful.”

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Isacco et al. Relationship with God is central/ foundational.  Four (26%) participants shared that their relationship with God is central or foundational in their lives. Their lives grow around their relationship and communication through prayer with God. Father Robert, a middle-aged priest, stated, “It’s just that central focus on Christ, is the main function, the main faith belief that supports me and I know he’s with me in whatever I say and do and he’s always here.” Relationship with God is fluid. Four (26%) participants indicated that their relationship with God is fluid because it continues to change, deepen, and grow rather than remaining static. Father Charlie, a priest in his thirties, reported, “I think the answer is a relationship that the priest has with Christ has to keep deepening. Because I don’t think any of those things are static.”

Dynamic Relationship With God and Psychological Health Of the 15 participants, 13 priests (86%) discussed the importance of a dynamic relationship with God to their psychological health. Seven psychological health benefits were linked to their dynamic relationship with God: (a) provides a sense of connectedness and support, (b) decreases negative emotions, (c) increases positive emotions, (d) transforms and/or empowers, (e) helps develop strengths, (f) enables authenticity, and (g) creates a balance. Provides a sense of connectedness and support.  Eight (53%) participants indicated that a relationship with God led to a feeling of connectedness or support. Father Jim described the importance of this connection as, I need to be connected with God because you see people so overwhelmed with life’s problems. Not that spirituality is going to solve all these problems, but realizing you’re not alone is helpful. How’s it going to come out? I don’t know. I don’t worry about the outcome, because God’s there somewhere and it’s going to be okay.

Father Stew, a 48-year-old priest, shared, “By being able to have prayer and talk to God, priests have a support system. They are not alone.” Decreases negative emotions / Increases positive emotions.  Seven (46%) participants said that their relationship with God helped to decrease negative emotions (stress, anxiety, pressure, loneliness, burnout) that they were experiencing and increase positive emotions (comfort, peace, joy, hope, and optimism). Father Henry stated, I think to one degree or another, you know, in celibacy, you’re going to feel loneliness. But that’s the time in a

special way to enter into prayer and a deeper relationship with Christ and you say yes to the call. You recommit to that call and that lifts you up.

Transforms and empowers / Helps develop strengths. Four participants (26%) discussed that a relationship with God transforms them or empowers them to be a better person and that it helps them to develop strengths such as being more “like Christ.” Father Charlie made a comparison between praying to God and choosing good influences in friends: The prayer life transforms us and unites us with Christ and enters us into this relationship. How do we love someone we don’t really know? It brings us into this union with Christ and we become more like Christ because you become who you’re hanging out with.

Father Jim, a 68-year-old priest nearing retirement, stated, “I need to know that God is with me. This empowers me.” Enables authenticity. Two participants (13%) discussed that their relationship with God enables authenticity. In other words, they feel true in themselves and do not feel concerned with the thoughts or perceptions others may have of them. Father Charlie said, “And that’s why prayer is so important. If you pray enough, if you stop enough and just spend some time with Him, you’re not gonna get caught up in who you’re supposed to be. Because whatever it is, you’re His beloved, you’re ok.” The relationship with God provides a sense of security for priests. The ability to feel unconditional love allows the priests to be self-confident. Creates a balance. The final theme discussed by two (13%) participants was that a dynamic relationship with God creates a balance in their lives by providing a time to share, a time to relax, and a time to recharge. Father Brandon, a pastor with many years in the priesthood, explained, I know that if I don’t participate in it or if I start to slack I notice it in other areas of my life. I notice it in my personal well-being, in my attitude and my moods. That’s something I can’t explain concretely. Because again that’s all part of the balance that you have to have in your life. It has to be part of that mix and if you don’t do it, then life starts to get unbalanced and it’s like watching a three-legged dog trying to run.

How the Promises of Celibacy and Obedience Influence Psychological Health Participants were asked during the semistructured interview, “Catholic priests take promises of celibacy and obedience. How do these promises affect your health and well-being?” The responses were mixed and, thus,

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categorized into positive and negative effects for both promises with specific subcategories that provide depth to their responses.

what those above you say. That can really be a strain. It depends on leadership but we pledge obedience to our bishop and if there’s no dialogue with your bishop about the decisions that are being made that so impact your life, that gives you a feeling of helplessness and resentment sometimes.

Obedience positively affects health and well-being. Nine (60%) participants indicated that the promise of obedience positively affects their health and well-being by (a) increasing positive feelings, (b) strengthening the relationships with God and/or the church, and (c) decreasing the stress of daily life and providing a sense of stability.

Father Thomas, a 40-year-old priest, reported, “Obedience is a challenge at times, especially if we take obedience to mean that you are supposed to look at everything as just ‘do your job.’”

Increases positive feelings.  Six participants (40%) cited positive feelings associated with their promise of obedience such as happiness, freedom, and a sense of fulfillment. Father Michael, a middle-aged priest, stated,

Disrupts relationships. Two (13%) participants identified that obedience can negatively affect priests’ health and well-being by disrupting relationships. Father Thomas, a middle-aged priest, reported,

The right objective obedience is freeing, it frees you, because you’re doing something the bishop wants you to do to build up the local church. So when you know you’re doing that you’re doing it because of the will of the Church in general.

Strengthens relationships with God and the church. Three participants (20%) shared that the promise of obedience strengthens their relationships with God and the church when trust has been established. Father Henry reported, “I don’t think it’s a blind obedience. You’re working in conjunction with your bishop, and obedience could be and should be a dialogue.” Decreases stress of daily life / Provides stability. Three (20%) participants reported that the promise of obedience decreases the stress of daily life and provides a sense of stability because some big decisions are made for them. Father Richard, a relatively younger, newly ordained priest, stated, “The promise of obedience is good for the health because you don’t have to worry so much. I’m obedient. It’s up to the Bishop in the end.” Father Stew added, “Obedience provides a sense of stability because we know those who are in charge of us know what they are doing.” Obedience negatively affects health and well-being. Nine participants (60%) reported that the promise of obedience negatively affects their psychological health by (a) creating an internal conflict and (b) disrupting relationships. Creates an internal conflict.  Seven priests (47%) indicated that obedience can negatively affect their psychological health by creating an internal conflict due to uncertainty and strain related to how to manage differing views from the Bishop (e.g., parish assignments). Father Tony, a middle-aged priest, described, Obedience can be a pain in the butt and can be very challenging especially if obedience is interpreted as you do

You’re in a place, you put down roots, you get intimate relationships with your people, and you get a phone call and say, “Hey in two weeks you’re gonna be in [town] or something like that.” Yeah, that’s hard because after that happens a couple of times you start to think, “Oh I’m not gonna reach out to anybody” because it hurts too much.

Celibacy positively affects health and well-being.  Ten participants (66%) reported that the promise of celibacy positively influenced their psychological health based on the following outcomes: (a) decreases stress without family obligations; (b) strengthens relationships with the Lord, the church, and others; (c) leads to positive feelings; and (d) increases focus on vocation. Decreases stress without family obligation.  Six participants (40%) indicated that celibacy is a positive factor on their health because they have less stress from family obligations and are able to focus on the congregation. Father Douglas, a younger, newly ordained priest, stated, “It’s a joy to be able to serve the people of God and to be available to them and not be tied down to a family and the familial obligations.” Father Luke, an elderly priest with extensive time in the priesthood, agreed, “Practically speaking, the ability to exercise your ministry and not have family responsibilities is wonderful.” Strengthens relationships.  Four participants (26%) indicated that the promise of celibacy allows them to build relationships with the Lord, the church, and parishioners because they are not committed to one single person or a family. Father Pat reported, Because we make a promise of celibacy we’re not giving our whole life to one person, but we’re giving our life to the church in general. So it frees you to be available and to have intimacy with a family at large. In a parish, in your diocese.

Leads to positive feelings. Four (26%) participants reported that the promise of celibacy leads to positive

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Isacco et al. feelings (appreciation, happiness, and a sense of balance in life). Father Robert stated, “Through your life of celibacy, you feel His closeness where it’s almost beyond ‘Thank you.’ How am I even deserving?” Increases focus on vocation. Four (26%) participants indicated that celibacy allows the priest to put energy toward his church and his priestly vocation. Father Matt, a middle-aged, newly ordained priest, reported, “My idea of celibacy is making sure that my commitment to the church, to my parish, and my vocation comes first, above everything else.” Celibacy negatively affects health and well-being.  Six (40%) participants reported that celibacy negatively affects their psychological health because of (a) difficulty managing a biological desire to create a family and (b) having feelings of depression or loneliness. Contributes to difficulty managing a biological desire.  Three participants (20%) indicated that it is hard to manage feelings of temptation for intimate relationships or a desire to have and raise a family. Father Tony reported, We have to find ways to be in real relationships with people and to love and at the same time to do that in a way that’s true to celibacy. That can be a very challenging, a messy reality because of the human physical side and because of sexual attractions.

Leads to depression/loneliness.  Two participants (13%) reported that celibacy leads to feelings of depression or loneliness because they lack an intimate relationship with one person or having a family. Father Henry stated, “There are lonely times. There are certainly times when you think, ‘Wouldn’t it be wonderful to have a wife and a family?’”

Discussion Priests fulfill a specific religious role in a major world religion (Catholicism), but previous research has yet to clearly identify what religious and spiritual factors may impact priests’ psychological health. As a result, this study investigated what religious practices and beliefs contribute to priests’ psychological health. This study’s key finding is that the majority of participants (13/15; 87%) highlighted their relationship with God as a dynamic, positive influence on their psychological health and well-being. Promises of celibacy and obedience were described as impacting their psychological health in both positive and negative ways. Implications of those findings are further discussed.

Dynamic Relationship With God: Measurement, Practical, and Research Implications When asked what faith beliefs or spiritual practices most influence their psychological health, most participants (13/15; 87%) identified their relationship with God. Participants reported that their relationship with God is mutually beneficial, interactive, unitive, central to their lives, and fluid. The descriptors were action-oriented, leading the research team to label the construct “Dynamic Relationship with God.” Participants contended that their dynamic relationship with God had a positive effect on their psychological health. The finding fits with previous research with a larger sample of priests, which found that a relationship with God was a strong significant, positive correlate to priests’ happiness (Rossetti, 2011) and a strong significant, negative correlate to burnout among priests (Rossetti & Rhoades, 2013). Thus, a primary contribution of this study is adding evidence to the extant literature indicating a relationship with God is a positive religious/spiritual factor to priests’ psychological health. Through the use of qualitative research methodology, our participants provided a rich conceptualization of how their relationship with God provided a sense of connectedness and support, decreased negative emotions, increased positive emotions, transformed and empowered their lives, helped to develop strengths, enabled authenticity, and created balance. Thus, this study extends the extant literature by identifying some of the mechanisms that underlie the positive association between relationship with God and psychological health. For example, participants described not feeling alone during the most difficult times of their work because they felt united to God and that God was with them. Participants also shared that their relationship with God actively promoted positive emotions and minimized negative emotions, particularly during stressful situations. Participants felt empowered and transformed by their relationship with God, which contributed to feeling like a better and more authentic person. Finally, participants were able to find balance through their relationship with God, which enhanced their sense of well-being. Those pathways to psychological health are important to consider within the context of previous research with priests that has reported that priests may experience stress because of juggling multiple roles, managing increased workloads, and handling negative media attention and reactions from people because of sexual abuse scandal (Isacco et al., 2014). The dynamic relationship with God described in this study may represent a protective factor from stress and burnout for priests. Future research is warranted to further examine how priests’ relationship with God may buffer or

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protect against negative psychological processes and outcomes. Health practitioners who work with priests may use the findings about dynamic relationship with God to inform interventions. Including R/S questions during assessments has been recognized as an important clinical strategy to identify salient R/S issues of patients (Koenig, 2000). When working with priests with psychological concerns, our data indicate that it would be worthwhile to ask about their relationship with God, which may provide insight into their psychological concerns and resiliency. Priests may feel detached from God, which may prompt the health practitioner to encourage the priest to engage more in his relationship with God and promote participation in religious practices such as prayer (Reinert, Edwards, & Hendrix, 2009). Prayer, which is often considered the vehicle to talk with God and nourish one’s relationship with God, has been identified as important to integrate in mental health services with priests (Isacco et al., 2014). Health practitioners can explore with priests how prayer and their relationship with God can serve as a coping mechanism during times of stress and to buffer against more severe psychopathology (Bade & Cook, 2008). Future research that examines the psychology of priests would benefit from taking into account the importance of priests’ relationship with God. However, that task is difficult because relationship with God has been a difficult construct to conceptualize and measure. For example, relationship with God (i.e., one’s feeling of closeness, safety, and love with God) has often overlapped with other constructs such as God image (i.e., one’s perception of God) and attachment to God (i.e., one’s feeling of closeness and affectional bond with God; Cassibba, Granqvist, Costantini, & Gatto, 2008; Rossetti & Rhoades, 2013). Narratives from participants in this study about their relationship with God also included some aspects of their God image and attachment to God. Yet, the participants clearly described a personal relationship with their God, marked by four distinguishable components: (a) mutually beneficial; (b) unitive; (c) central to their life and health; and (d) fluid, changing, not static. Incorporating those components into the conceptualization of relationship with God may help to further distinguish the construct from overlapping constructs in future studies with priests. In addition to conceptual overlap, studies have used limited items to measure and distinguish such a complex construct as one’s relationship with God. For example, in Rossetti’s large study of 2,482 priests, relationship with God was measured with five items: “I feel that God loves me personally and directly”; “I feel a sense of closeness to God”; “I feel thankful for my blessings”; “from time to time, I feel a joy that is a grace from God”; and “I have a

relationship to God (or Jesus) that is nourishing me” (Rossetti & Rhoades, 2013, p. 108). Those five items are a good start, but lacked psychometric evidence to support the reliability and validity of measuring the construct. In order for quantitative research with priests about their psychological health to progress, a reliable and valid measure of their relationship with God is needed. A secondary contribution of this study is the identification of specific components of relationship with God that can be used to operationalize the construct in a scale development effort.

Promises of Celibacy and Obedience: Future Research Questions and Hypotheses Our second research question asked how the priestly promises of celibacy and obedience influenced priests’ psychological health. For both promises, participants reported similar positive health benefits such as decreased stress, strengthened relationships (God and others), and increased positive emotions. In terms of negative health effects, participants perceived that celibacy was associated with some difficulty managing biological urges and loneliness while obedience was reported as contributing to internal conflict and disruption in relationships. The data contributes to an emergent conceptualization of how the promises of obedience and celibacy affects priests’ psychological health. Such a conceptualization is a promising addition to the extant literature. Open and frank discussion of celibacy and obedience within the Catholic priesthood is limited and often considered controversial (e.g., Joseph et al., 2010). There are very few empirical studies with priests that investigate celibacy and obedience in association with health outcomes. The conceptualization from this study suggests that the promises were underlying factors to psychological health benefits by “freeing” priests from daily stress and providing a sense of stability to experience positive aspects of their vocation. For example, the promises of obedience and celibacy enabled participants to defer/rely on the “will of the Church” in difficult situations. The reliance on “will of Church” seemed to deepen the relationship between the priests and the Church and God. However, the promise of celibacy was identified as challenging at times because it cannot always free one from biological urges and the need for intimate relationships with people. In a similar way, some participants were challenged by the promise of obedience because they may have a different perspective from the Bishop or are asked to leave parishes after establishing intimate relationships with parishioners. Thus, the promise of obedience can disrupt important interpersonal relationships and create internal conflict for some priests, which may lead to loneliness and other negative psychological health

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Isacco et al. outcomes. Future research would benefit from investigating moderating variables (i.e., for who?) that may interact with the negative link between obedience and negative psychological health outcomes among priests. The findings from this study provide a preliminary understanding of how celibacy and obedience influence priests’ psychological health, which is a meaningful contribution to such an underdeveloped extant literature. An important contribution of this study is to use the strengths of qualitative methodology to generate hypotheses and questions for future research based on our baseline data with other threads of related scholarship. McDevitt (2012) examined the association between a lack of intimacy and sexual misconduct among a sample of 484 priests, with limited conclusive evidence of any association. This study found evidence of loneliness among some participants stemming from celibacy. Future research might continue to investigate possible pathways between loneliness from a celibate lifestyle and a lack of intimacy, which may develop into sexual misconduct issues for priests. For priests similar to our participants that were lonely, in part because of celibacy, we can hypothesize that they are more vulnerable to leave the priesthood or disengage from ministry (Joseph et al., 2010). Some scholars have contended that positive health outcomes associated with celibacy stem from an acceptance of their sexuality, clarity of their sexual identity, and an integration of sexuality and sexual identity into their personality (John Jay College Research Team, 2011; Kappler, Hancock, & Plante, 2012). As Kane indicated (2008a, p. 582), “there is an insufficient amount of rigorous and methodologically sound research that investigates priests, their sexuality, and their sexual behavior.” Further research would be a valuable contribution to the extant literature. The limited research on obedience has produced mixed findings that future research can clarify. Priests considered the relationship with their bishop to be a key factor to their happiness, but priests have lost respect and trust for their bishops in the aftermath of the sexual abuse scandal, resulting in strained relationships (Kane, 2008b; Rossetti, 2011). Similarly, our participants reported that obedience can lead to internal conflict between following the bishop and their own desires. Thus, future research could clarify how the strained relationships between priests and bishops can be healed and healed in a manner that would contribute to priest psychological health. For example, would a forum that allowed priests to voice concerns and feelings to bishops be beneficial, as Kane (2008a) suggested? Given that priests will continue to promise obedience to their bishop, clarity into how that promise affects their psychological health and what can facilitate a more positive relationship is needed.

Limitations Limitations to this study should be noted. First, participants were obtained using a snowball sampling of Catholic priests. The original selection of participants, based on recommendations from the study’s consultant, may have biased the recruitment toward priests with more positive views of the topics under examination in this study. Yet, participants may have been suspicious and/or distrustful of this research study, or certain questions in the interview, and may have filtered their responses (Kane, 2008a). The sample used was small and consisted entirely of Catholic priests who were White, middleaged, and living in the United States. The homogeneity of the sample limits the ability to generalize these data to diverse populations of priests. In addition, all of the priests who were interviewed reported a positive relationship with God and a positive impact on their psychological health. This did not allow researchers to learn about the components of an anxious or avoidant relationship with God in Catholic priests. It would be interesting to explore which common themes (or different themes) arise among the Catholic priests who have less positive or insecure relationships with God.

Conclusion This study provided useful information about Catholic priests’ dynamic relationship with God and promises of celibacy and obedience. The research highlighted key, measurable components to a relationship with God and the positive impact on their psychological well-being. Future research in this novel area is ripe with many opportunities to better understand the experience of priests and to enhance their psychological health. Transforming the measurable components of DRG into a valid and reliable scale will facilitate better assessment and investigation of priest psychological health at a quantitative level. Practitioners are urged to integrate findings into their assessment and intervention efforts with priests as priests’ DRG seems important to their psychological health. Continued empirical and clinical efforts can further clarify how R/S beliefs and practices impact the psychological health of priests. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

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