Experience of Spiritual Coaching for Peer Educators

Background: To protect against burnout syndrome and enhance the work capacity of peer educators who work with those who inject drugs under “A project to end AIDS, reduce new HIV infections and decrease tuberculosis in vulnerable populations of People Who Inject Drugs (PWID)”. This research aimed to study the process of the spiritual development of peer educators through exposure to spiritual coaching. The spiritual coaching in this study incorporated theoretical techniques of counseling psychology as well as an effective coaching approach. Methods: This study was a qualitative research using the narrative approach. The data were collected from five in-depth interviews of peer educators who received spiritual coaching. The data were then analyzed by using thematic analysis. Results: Three focus areas of the spiritual development of peer educators were found to be important/central: 1) knowledge and understanding, 2) enhancing experience and practice, and 3) belief in the spiritual to help with the field work. Conclusion: Base on the interaction between the counseling psychology theories and other related theories, the results of this study supported the benefits arising from improvements in the spiritual identity of the peer educators. This was reflected in the enhanced mental energy and work strategies. The latter finding can be applied to other peer educators who work with those who inject drugs in other settings.


Introduction
The research field of this study was peer educators involved in "A project to end AIDS, reduce new HIV infections and decrease tuberculosis in vulnerable populations of People Who Inject Drugs (PWID).For the specific research area, the researchers selected the project's operations center located in the southern part of Thailand which experiences one of the highest rates of HIV transmission attributed to intravenous drug use."Peer Educators" can be defined as persons who play a role in providing health information, distributing clean needle supplies and helping refer intravenous inject drug users to the hospital to prevent HIV infection in the community.This type of drug-related work is complex, involving multiple dimensions such as social and family stigma, physical and mental health problems of the peer educators as well as the drug users, condemnation from the law enforcement bodies, and financial problems.These factors can lead to a lack of commitment to work among the peer educators.Based on the experience of the researchers as counselors and the results of a survey and assessment of the problems of the peer educators conducted by the experts, a psychologist, it was observed that most peer educators experience 'burnout' and require mental care (PSI foundation, 2012).The major cause of this burnout was attributed to being repeatedly disappointed from the results of the work, which can cause a lack of enthusiasm to continue with the work.This was usually found in people who worked as a caregiver to complex patients (Acker, 2011;Amiri, 2016;Griner, 2013;Vilardaga, 2013).According to the literature review and related research, it was found that spiritual development may prevent and reduce this problem (Hardiman, & Simmonds, 2013;Penmen, 2013).This research was therefore devoted to the spiritual development of the peer educators to encourage them to work enthusiastically based on the symbolic interaction theory, by George Herbert Mead, who believed that 'self' was the product of social processes.When people interact with each other by interpreting or defining each other's actions instead of merely reacting to each other's actions.Their "response" is not made directly to the actions of one another but instead is based on the meaning which they attach to such actions.The 'mind' learns and decodes the symbols and takes a role in the society based on our social beliefs, values, and norms.Thus the spiritual development process is a study of the social processes that lead to the development of identity.The process also stimulates the mind's workings to absorb the 'spiritual' role we take (Alver, & Caglar, 2015;Blumer, 1986;Yanyongkasemsook, 2013).Taking the role of spirituality or spiritual growth, a basic conceptual framework of the synthesis of relevant literature could then be formed.Spiritual development includes the following elements: 1) consciousness, 2) faith and belief, and 3) discovery the meaning and value of life (Caswell & Bentley, 2007;  Dobmeier, Robert, & Reiner, 2012; Janesawang, 2012; Larsen, 2012; Meyer, 2012; Myer, & Kirk, 2003; Green; &   Harris -Fobes, 2001; Saengsakorn, 2012; Shaw, & Lorelle, 2012; Young, Frame, & Cashwell, 2004).Thus, the spiritual coaching process in this study was designed based on the combination of counseling psychology theories and other related techniques, as well as effective coaching methodlogy (Chuenklin, & Laowreandee, 2007;Maynard, 2006;Rasameethamchot, 2015;Wongyai, & Maruyat, 2014).The counseling theories and techniques chosen are as follows: (Corey, 2008 ), -the theory of person-centered therapy developed by Carl R Rogers using the reflection of thoughts and feelings technique; 2) concepts of cognitive behavior theory using the self-management technique; 3) the existential approach using the explore the world and values technique; 4) Corey's psychoanalytic concepts using psychoeducational groups; and 5) the concept of mindfulness of consultation and therapy of Therdsak Dekong, which were the techniques of body and emotional training (Dechkong, 2008).This brought knowledge and understanding to the spirit development process of the peer educators as a result of the interactions between the counselling theories and other related theories as well as various other elements of spiritual coaching.The findings can be useful for empowering peer educators, social workers or medical personnel.

Design
This research aimed to study the spiritual development process of peer educators.It was a qualitative research using a narrative approach.The researcher believed that the knowledge of the study is constructivis by the researchers and the peer educators by interpreting the phenomenon of interaction with the spiritual coaching process (Havanon, 2007;Riessman, 2008;Traimongkon, 2010).The experience of acceptance coaching of the peer educators reflected the perceptions of peer educators towards the spiritual coaching process.This lead to the understanding of the change in the spiritual identity of the peer educators, resulting from the spiritual coaching process.

Tools
1) Spiritual coaching is a combination of psychological counseling techniques and effective coaching methods.There were five stages of the spiritual coaching process: 1) preparation, 2) planning and setting the goals, 3) spiritual empowering, 4) taking action and 5) evaluation.It took 22 hours to complete the activity.(2) Interview Questions.(3) Tape recorders.

Settings
The research field of this study was peer educators involved in "A project to end AIDS, reduce new HIV infections and decrease tuberculosis in vulnerable populations of People Who Inject Drugs (PWID)".For the specific research setting, the researchers selected the project's operations center located in the southern part of Thailand which experiences one of the highest rates of HIV transmission attributed to intravenous drug use.

Participants
Five peer educators who have passed through the spiritual coaching process (22 hours), which is one of the most widely used strategies of the HIV prevention programming under the PWID project, were selected through a specific selection method.The project is a collaboration between the government and civil society.It is based on the work process of "find" and "reach" the target groups and then forward them for blood tests for HIV.It is a systematic approach to the diagnosis and treatment of HIV in accordance with WHO principles and it adopts a conceptual action plan framework for ending AIDS in Thailand from 2015 to 2019.

Data Collection
The researchers collected data from their personal observations and by recording systematically structured and in-depth interviews as well as semi-structured interviews to gather the information required for answering the research questions.The recorded data were collected from the dialogues of the researchers and the data providers.Information was collected during the coaching process from start to finish (tape recordings and note taking).In addition, information was also gathered immediately after finishing the coaching process by recording the recalled experiences of the participants.

Data Analysis
After the systematic recording of data, the researchers coded the information in accordance with the research.By reviewing the information and taking notes of the important issues encountered, it was then possible to categorize the coded information into a story, displaying information in a narrative style, supported by grouped data, tables, etc.After this, the data were inducted into the conceptual framework of spiritual development and analyzed in order to answer the research questions.Thematic analysis from the dialogue was used to make the changes made by the process understandable and enable a conclusion to be drawn from the knowledge of this study.

Trustworthiness
For the trustworthiness of the results, specifically the study of the effectiveness of the spiritual coaching process, this research has been validated using triangulation methods focusing on monitoring from multiple sources in diverse point of views.This study employed two types of triangulation methods (Chantavanich, 2010) which were: 1) Data Triangulation: Data collected from multiple sources (five peer educators) on various points of view were used in the research.Collecting data from different sources made the findings on the spiritual development process and the effect of spiritual coaching on the psychosocial functioning more reliable.
2) Method Triangulation: A variety of data collection methods were used in this research.There were three main methods of data collection: in-depth interviews with the participants, observations by the researchers, and note-taking and tape recordings collected during the entire coaching process.From these sources, all of the data were coded and analyzed together.

Results
In the study, "Spiritual coaching for peer educators" aimed to study the spiritual development of peer educators by studying their experience of being spiritually coached.Based on data gathered from in-depth and semi-structured interviews as well as audio recordings made during the spiritual coaching sessions between the coaches and five participants, the results of thematic analysis were as follows: the nature of the peer educators' spirituality was intentionally attentive, devoted, conscious, faithful, patient when faced with obstacles, inspired, hopeful, encouraged, willing to work and mindful of the spirit.The results were divided into main themes and sub themes reflecting the process of spiritual development so that, coaching experience could be compared with spiritual self-development.The data were divided into three themes, which were the stages of the process: cognition, learning from practice, and belief in the spirit to work.

Understanding
In the early stages of the spiritual coaching process, it was found that the peer educators participating in the process had no basic knowledge about spiritual matters.It was new and different from what they had learned.In the early part of the process, the peer educators were interested in spirituality, wondering what it was and how it related to them.As spirituality is an abstract concept with a broad meaning, the role of the coach in this session was to clarify the project and the coach's activities by explaining and documenting, using open-ended questions to explore the spirit of the peer educators, and listening to their viewpoints in order to build relationships and a good learning atmosphere.According to the experience of the peer educators, there were two sub-themes at this stage, which were new knowledge and motivation.

New Knowledge
The peer educators perceived that the 'spirit' was a new subject that they had never learned.They responded to the process with new reactions.They were both interested and confused about how it related to their role.During this time, the coaches focused on communicating spiritual knowledge and work in terms of documents and instructions to enable the peer educators to become more knowledgeable about the spirit before moving on to the next step of spiritual development.

Motivation
After clarifying and explaining the meaning and importance of the spirit, the coaches strived to link spiritual development with the work of the peer educators by using challenging questions to explore the joys of working.The questions focused on the peer educators to reflect their needs and expectations with the aim of motivating them to apply knowledge and to engage in the coaching process.The peer educators responded to the process by applying the knowledge to their work immediately, even in the early stage of the coaching process.This happened with peer educators who had problems in their work, such as trying to encourage their drug user friends to trust them and do blood screening and treatment. "

Enhanced Experience and Practice
After introducing the spiritual coaching process and the related importance of the spirit to the peer educators, the peer educators reflected on the action during the process that focused on learning from experience and practice.It was found that the parts of the process of spiritual development that were most meaningful to the peer educators were setting goals, using questions to explore the world and its values to discover meaning and confidence in work, receiving mindfulness training to focus on tasks, and practicing by being coached.This helped the peer educators to be encouraged to face problems and understand the importance of faith, which is the significant power of life.The details were divided into two sub-themes: the development of the spiritual elements and the promotion of the success of the work.

The Development of Spiritual Elements
From the study, the essential elements of spirituality were found to be consciousness, belief, faith and the discovery of values and meaning in life.The peer educators reflected on the coaching process that focused on the development of the spiritual elements that were categorized into 3 points as follows:

Develop Consciousness
From learning the techniques and methods of developing consciousness/awareness by asking the peer educators to review and evaluate their goals and accomplishments, as well as their own thoughts daily, it was found that the peer educators realized the importance and benefits of consciousness while working, especially when working with drug users.They had to be mindful of what they said (or become more reflective than reactive, less verbal?) as well as what they did.

Know Your Faith
The coaches used questions to explore the world and values techniques, allowing the peer educators to review their faith and beliefs through a life-crisis narration.At this stage, the peer educators were able to understand their faith and belief and link the concept of faith and belief to the work of searching for and understanding the faith or influence of drug users.
"Because we are drug users and the drug users are often stigmatized from society, we even call ourselves a junkie.At that time, I was discouraged but luckily my parents always supported me while other people disliked or stigmatized me.I always have my parents by my side.That is faith."(Third peer educator, Interview, 2017)

Discover the Inspiration
Resulting from the techniques of the world and values explosion which involved using ten questions to have the peer educators explore the world and their own values, the peer educators had been inspired and discovered the meaning and value of their work.
"This process is in our work and we are peer educators.Getting knowledge and exchanging ideas could be inspiration and had a spirit of work.Having faith and belief made us hopeful.We haven't done this just for success but we know we're doing it for a friend."(Third peer educator, Interview, 2017)

Strengthen Success
The spiritual coaching process not only provided the peer educators with encouragement to work but also strengthened their success.There were techniques to set goals and practices.The peer educators responded to the techniques and the process in 2 sub-categories.

Work Purposefully
In the spiritual coaching process, the peer educators were encouraged to set goals and work plans.When the peer educators reviewed their work, it could make them happy if they were able to accomplish their goals.The goals were specific and could be completed in time, which was in the middle of coaching process.It was found that encouraging the peer educators to work purposefully helped them to plan and follow a clear direction.
Setting the goals helped me to review myself.I take the planning more seriously and also have guidelines to work by.It seemed to give me more clear directions at work." (Fourth peer educator, Interview, 2017) 3.2.2.2 Try to Solve Problems and Obstacles When the peer educators followed the plan and encountered obstacles in their work that prevented them from reaching their goals, the coach listened and gave consultation by providing chances to review the situation and find solutions as companions, as well as guiding them to learn and solve the problems.In this way, the peer educators were more willing to try to solve the problem.when the peer educators have gone through all of the stages of the spiritual coaching process to the end, it could be clearly seen that the spiritual coaching process developed the peer educators in two areas, which were developing working strategies and empowering the mind.Both were complementary to each other which was encouragement to work, and the achievement was clear.This in turn gave them the encouragement to push forward.The following points were observed:

Working Strategies
The peer educators who had completed the spiritual coaching process applied what they had learned to develop working strategies.This was divided into 2 sub-categories: "I used belief and faith.We all have them depending on what we believe.Like our members, they might believe in God, parents, family or even their children.We must remind them what is meaningful to them and then encourage them to rethink.If I love and believe in someone and that person asks me to do something, I will do it anyway."(Fifth peer educator, Interview, 2017) "In this family, he has a daughter and a son.We took his faith, which is his family, as his encouragement.Even though he was a drug user, he was never away from his family."(Third peer educator, Interview, 2017)

Set Goals and Plan
The peer educators reflected on the learning experience of the coaching, that by setting goals and planning, the work is clear and practical.
"The work is clearer.I live in a remote area and may not be able to commute every day but I still have plans to move on.I can go to the working area and don' t have to go to the center because of time and distance."(First peer educator, Interview, 2017)

Empower to Work
The spiritual coaching process focused on the inner strength of the peer educators and it was found that when the peer educators set goals and they were able to achieve their goals, they were empowered to work.
"I feel more energized to work based on my assessments.On that day, the goal was 3 but I could do 7.This actually empowered me." (Fourth peer educator, Interview, 2017) "Spiritual activity helped me to see myself clearly, to see that I was committed to helping my friends.I am happy to help them like taking them to be cured or seeing a doctor, talking to them when they were arrested.I see my strength or my spirit."(First peer educator, Interview, 2017) "This activity helped us to feel the power, feel myself as a power to work.The work I've done is for others.If we only care for compensation or just focus on the problems, we may not be able to do it completely."(Second peer educator, Interview, 2017) In addition to the findings on the spiritual development of the peer educators, the peer educators also gave feedback on the role of the coaches.They commented that the coaches needed to be a part of the peer educators' work.They were able to help increase their success rate in counseling and problem-solving.They enabled the peer educators to be more motivated and confident in their work.
"I would like to have a permanent coach in each operation center to be a counselor to the peer educators, to cheer us on, listen and help solve problems.The coaches can also help to set the goals and help us to achieve them.The activity was successful and we were very proud."(First peer educator, Interview, 2017) "I would like the activity be continued in many areas of work under the project.Also there should be chances to exchange experience or knowledge because I can work better now.Even if is not 100% perfect, at least it makes a difficult job easier."(Fifth peer educator, Interview, 2017)

Discussion
This study explored the spiritual development process for peer educators with a focus on the concept of the symbolic interaction theory "spirit", which is the product of the spiritual coaching process.From the experience of the peer educators that were coached in this study, it was found that the coaching helped them understand the spiritual development process.To sum up, it was the process of developing a spiritual person.This is consistent with the spirit concepts that were defined by the researchers, which were to be purposeful, attempt to solve problems and face obstacles, be conscious, have faith, discover meaning and values, and be hopeful.However, spirit caring, goal setting and planning were additional spiritual aspects that were discovered later.In addition, the findings reflected that the techniques and theories that were meaningful to the recognition became the spiritual development.In this study, during the first stage, discovering the knowledge and understanding the spirit was meaningful to the peer educators.Spirituality is an abstract subject that has a very broad meaning.It was new knowledge for the participants so the communication had to be very clear.The linking of spiritual knowledge to the needs of the peer educators will motivate them to learn.Using the 'listening and reflecting' technique of the person-centered theory helped to identify the interests of the participants, which was related to building motivation (Lai, 2011).In terms of spiritual development based on the elements of the spirit, it was found that using the therapeutic techniques of Therdsak Dechkong (2008) in the development of consciousness enabled the peer educators to be aware of their identity and influenced the spirit of the caregivers or the peer educators (Ricci-Allegra, 2015).The technique of using "questions to explore the world and values" of the theory of existentialism helped the peer educators to review their own faith and discover the value and meaning of life.Thus, the concept of existentialism was related to the development of the spirit (Boston & Mount. 2006).It was found that family (Sakunpong, Choochom, & Taephant, 2015) was meaningful and important to the drug users.Faith and this discovery led to them being confident and empowered them to work as peer educators for other people, which was related to job meaningfulness (Rodell, 2013).Addressing the spiritual was used more for drug users for whom spirituality was an important tool for drug rehabilitation (Heinz, Disney, Epstein, et al. 2010).The techniques of goal setting and planning helped to make the peer educators more targeted and motivated.It was a leadership skill that built confidence in their work and reduced burnout syndrome (Papathanasiou, Fradelos, Kleisiaris, Tsaras, Kalota, & Kourkouta, 2014).The technique of behavioral adjustment homework encouraged the peer educators to act according to the plan and enabled them to learn from the practice.In particular, the peer educators reviewing the practice by accompanying the coaches to help with solving problems could reinforce their efforts to fight obstacles and problems (Fuller, 2000).When finishing the process, it could be clearly seen that spiritual coaching led to spiritual development, which involved developing work strategies and empowering the peer educators to work.

Limitations of Study
The researchers focused on the study of internal potential development and strategies for working successfully.However, the study did not cover other factors related to the peer educators, such as their physical and mental factors as well as social and environmental factors that directly affect the peer educators and the drug users.Further research should study these factors more deeply in order to provide a more complete analysis of spiritual development.

Clinical Implications
The findings of this research on spiritual coaching show that it can be a new approach or technique used for counseling psychologists.The coaching techniques and spiritual development can be helpful for peer educators or anyone with burnout syndrome from dealing with drug users or other complicated problems.Spiritual coaching does not only develop the internal mind but also builds on concrete successes.

Conclusion
This study provides new knowledge on the spiritual development of peer educators based on spiritual coaching which focused on spiritual understanding in the first stage.The next stage involved enhancing experience and practice.It created spiritual confidence in the fieldwork which was a result of the process design that determines the pattern of interaction based on psychological counseling and related techniques.It enabled the peer educators to absorb a spiritual identity and encouraged them to be energetic and have strategies by which to work.In addition, the role taking of the spiritual character of this study is spiritual caring and goal planning.
faith and belief which were the important elements of spirituality provided deep communication skills and techniques of using what you believe or what is meaningful to motivate drug users to have HIV testing and treatment.
Because I have a new style of work, I try to use it.WhenI met the coach on the first day, which is Saturday, then I used it on Sunday.It was Ok.It works about 70-80% ."(Fifthpeer educator, Interview, 2017) "I have helped people in the community but I didn't know what true volunteering was.When I stared learning with a coach, it made me understand my spiritual level.Because I know what I work for, I saw my real self.Also the coach pushed me, so I tried to work more on the second day of the traning."(Thirdpeer educator, Interview, 2017) "The first goal was not accomplished but I didn' t stop.We have to rethink how we can do it more easily.Reviewing the work and listening to the suggestions helped me to know what to do."(First peer educator, Interview, 2017)"Because we planned and set goals, took action and reviewed the unsuccessful issues, then the problems have been solved."(Thirdpeereducator, Interview, 2017)3.3Be Confident in Spirit to Carry Out Future Work