Spirituality, Congruence, and Moral Agency in a Stigmatized Context: A Single-Case Study Using Satir Transformational Systemic Therapy (STST)

This qualitative single-case study examines how spirituality promotes mental health within a stigmatized occupation by analyzing an in-depth interview with “Perla,” a 62-year-old Mexican woman with decades of experience in sex work. Guided by Virginia Satir’s Transformational Systemic Therapy (STST), specifically the Self-Mandala and Iceberg Metaphor, we conceptualize spirituality as a universal human dimension of meaning, moral orientation, and relational connection that may be expressed within or beyond formal religion. Narrative thematic analysis identifies processes through which Perla cultivates congruence (alignment of inner experience and outward conduct), safeguards dignity, and sustains hope amid systemic constraints. Her Catholic practices (prayer, ritual boundaries regarding Eucharist) coexist with a broader spiritual agency that supports self-worth, emotional regulation, boundary-setting, and coherent identity, factors associated with mental well-being. Interdisciplinary implications bridge marriage and family therapy, psychology, pastoral care, and cultural studies. Clinically, we translate Satir’s constructs (yearnings, perceptions, expectations, coping stances) into practical assessment and intervention steps that can be applied in secular settings without religious presuppositions. Analytic rigor was supported through reflective memoing, a structured three-level coding process, constant comparison, and verification by a second coder. The case challenges pathologizing frames of sex workers by demonstrating how spirituality can function as a protective, growth-oriented resource that fosters agency and moral coherence.