Spirituality in Counseling and Psychotherapy

An Integrative Approach that Empowers Clients

Rick Johnson

• Publisher: Wiley
• Year: 2013
• ISBN:
  9781118239100
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

"Written with great clarity and intelligence, this book will be of benefit to all mental health practitioners, students of psychology, and those seeking a better understanding of their own process of psychological and spiritual transformation."
—Tara Brach, PhD, Author of Radical Acceptance and True Refuge

"In this wonderful book, Rick Johnson weaves together different theoretical perspectives in a way that welcomes religion, spirituality, and nature into the counseling and psychotherapy process. It's a delight to read Dr. Johnson's approach—an approach that teaches therapists how to empathically explore spirituality as an important dimension of human existence."
—John Sommers-Flanagan, PhD, coauthor of Counseling and Psychotherapy Theories in Context and Practice and Clinical Interviewing

"Rick Johnson's book Spirituality in Counseling and Psychotherapy is a rich introduction to the varied forms in which spiritual suffering enters the consulting room, the range of theories which address or fail to address this need, and specific attitudes and practices through which therapists can provide a non-doctrinal but open encounter with the spiritual needs of their clients."
—James Hollis, PhD, Jungian analyst, and author of fourteen books, among them What Matters Most: Living a More Considered Life

A practical integration of psychology and spirituality that builds upon existing psychological theories

While many clients want spiritual and philosophical issues to be addressed in therapy, many mental health professionals report that they feel ill-equipped to meet clients' needs in this area. Providing a model that is approachable from a variety of theoretical orientations, Spirituality in Counseling and Psychotherapy supports therapists in becoming open to the unique ways that clients define, experience, and access life-affirming, spiritual beliefs and practices.

Drawing on the author's research into spiritual issues as well as predictors of clients' psychological health, this reflective book presents an integrative approach to discussing the topic of spirituality. An essential resource for mental health professionals of all spiritual and religious persuasions, Spirituality in Counseling and Psychotherapy discusses:

• Client-defined spirituality
• Integrating spirituality with psychological theories
• Why clients become spiritually lost
• Practical steps for spiritual health and abundance in therapy
• Helping clients reclaim their real self
• How spiritually oriented therapy helps
• Guidance for therapists in differentiating their spirituality from their clients' to foster a more successful therapeutic relationship

Filled with numerous cases and stories illustrating how spirituality can be a natural and beneficial part of the therapeutic process, Spirituality in Counseling and Psychotherapy enables mental health professionals to nonjudgmentally invite a collaborative exploration of the role of spirituality in their clients' lives.

CHAPTER 1

SPIRITUAL COMPETENCIES AND PREMISES

Kristi, a mental health therapist in private practice, had just listened to a phone message from a potential client. (The term therapist will be used throughout the book to refer to various mental health clinicians, including psychologists, social workers, marriage and family therapists, and professional counselors.) On the voice mail, the client reported that she had the names of three therapists, and she was looking for the best fit. The client indicated that she wanted a therapist who could work with her nagging feelings of depression as well as her relationship issues. She described herself as “very spiritual” and needed her therapist to be a “good match” with her spiritual beliefs and practices. The client wanted to speak with Kristi, to ask questions about Kristi’s theoretical orientation as well as her spiritual beliefs in order to determine if they could work well together.

Although eager to build her practice and interested in talking with the client, Kristi experienced some apprehension about how to respond to the client’s desire to learn about her spiritual beliefs. Similar to many therapists, Kristi’s professional training had provided little guidance about how to respond to such requests, other than to not engage in excessive, personal self-disclosure. For the most part, she was diligent about keeping her personal values separate from her professional practice. In this case, she didn’t want to come across to the client as rigid, distant, and unapproachable. Yet, discussing her personal beliefs with the client felt invasive and complicated.

Kristi wasn’t entirely sure she knew what her own spiritual beliefs were. So, how could she discuss them in a therapeutic manner with the client? She had been raised in a family that did not attend church. She saw religion and spirituality as foreign to her, preferring to live her life based on rationality rather than faith. In addition, it seemed that the client wanted to integrate spirituality into the therapy process; Kristi had very little idea about how to do that, or even what the client meant by spirituality. She had received no training on how psychological theories and techniques could interface with religion and spirituality. Specifically, she wondered if her psychodynamically oriented approach was compatible with the client’s self-defined spirituality. Maybe the client needed a referral to a pastoral counselor instead of a therapist? The more she thought about it, the more unsettled she felt.

Carlos, a therapist working at a community mental health agency, had been seeing a 40-year-old client in weekly, outpatient therapy for five sessions. The therapy was focused on addressing generalized anxiety and panic attacks. Carlos had introduced various cognitive-behavioral techniques, including mindful breathing and thought stopping and thought replacement, which seemed to be helping reduce the client’s anxiety. In the sixth session, the client articulated that she “is a strong Christian” and attends church services several times a week. The client asked Carlos if he felt comfortable with her talking about the Bible and her “personal relationship with Jesus.” She indicated that she wanted to make sure that the therapy supported “God’s plans” for her.

Carlos was hit instantly by a wave of emotions, most notably anxiety and irritation. Carlos suddenly felt less comfortable with and trusting of his client. Part of him wanted to challenge the client’s beliefs while another part felt exhausted and unable to address her questions. The client’s words had obviously activated strong reactions in Carlos, including memories of his childhood.

Carlos was raised in a Christian family, which at times he experienced as oppressive and judgmental. His parents often used very similar words to the ones his client was now using. In young adulthood, he had a series of painful encounters with his parents whereby he vehemently disagreed with aspects of their beliefs and practices, which culminated in a several-year period of cutoff from his parents and extended family. He has since reinitiated limited contact with his family, and is raising his own kids without organized religion. Based on his strong emotional reactions, Carlos wondered if he could work effectively with the client; he considered referring her to another therapist.

Jana, a student in a clinical graduate degree program, was about to work with her first client at her practicum site. She had completed courses in theories and techniques, assessment, diagnosis and treatment planning, ethics, and basic counseling skills, and was excited to put her newly forming skills into action. She was anxious, however, about the interface between her personal beliefs about health and healing and traditional talk therapy.

Over the past few years she had been engaged in a variety of personal growth activities, including mindfulness practices, body-oriented therapy, yoga, and Buddhist meditation retreats. She had been in a great deal of talk therapy in the past, but nothing helped as much as the experiential approaches that she now utilized. She believed strongly that traditional therapy models were too restrictive and wouldn’t produce the lasting change that “spiritually oriented” techniques would. She felt that it was her responsibility to provide the best care for her clients, which included an infusion of spiritual practices and beliefs, although she was conflicted about this because of clinical concerns and ethical cautions raised by her professors. The concerns and cautions focused on the need to not impose her beliefs and practices on her clients. She wondered if she could be true to her beliefs and still be accepted into the traditional therapy community. Specifically, how could she integrate the therapy approaches she had been learning in graduate school with her spiritual beliefs?

These are just three of the many possible examples of the interface between therapy and religion/spirituality. Scenarios like these tend to generate a variety of reactions and questions for therapists, such as:

• What is spirituality, and how is it similar to and different from religion?
• Do clients have a right to know about therapists’ spiritual and religious beliefs when choosing a practitioner, much like asking about their theoretical orientation or cultural background?
• Is it even appropriate to address spiritual and religious issues in therapy?
• If yes, how does this happen without imposing the therapists’ beliefs and values onto the client?
• What should therapists do if they have strong beliefs about spirituality and religion, especially if they differ to a large degree from their clients’ beliefs?
• How do therapists deal with clients who espouse spiritual and religious beliefs and practices that the therapist views as unhealthy?
• What should therapists do if they are unclear about their own spiritual and religious beliefs?
• How should therapists manage their emotional reactivity to spiritual and religious issues that are based on their own upbringing and life events?
• How can spiritual and religious beliefs and practices be integrated with traditional therapy approaches?
• Are there models in the therapy field that provide a framework for addressing and integrating spiritual and religious issues?
• How could addressing spiritual and religious issues in therapy be useful to the therapeutic change process?

To address questions such as these, the following are central premises of the approach described in this book.

Central Premises

Premise 1: Spiritual, religious, and philosophical reflections, beliefs, and practices are foundational to the human experience and, therefore, are an essential aspect to consider in effective therapy.

Premise 2: Spiritually and religiously informed therapy is a form of multicultural therapy.

Premise 3: Many therapists struggle with addressing spiritual and religious issues in therapy based on foundational theoretical paradigms in the mental health field.

Premise 4: The therapist’s own level of spiritual-differentiation most often predicts his/her effectiveness with addressing spiritual and religious issues in therapy.

Premise 5: Utilizing a model that integrates psychological theories with a broad-based, thematic, and inclusive view of spirituality increases therapists’ competency in assessing and addressing spiritual and religious issues with clients from a variety of faiths and spiritual and philosophical positions.

Premise 6: The concept of the Real Self provides a conceptual link between psychological theories and client-defined, spiritual, and religious beliefs and practices.

Premise 7: Utilizing a client-defined sense of spirituality and religion in therapy can be a significant avenue for connecting with clients and a great asset and ally in the therapeutic change process.

Each of these premises is now discussed in greater detail.

Premise 1: Spiritual, Religious, and Philosophical Reflections and Practices Are Foundational

Research has consistently shown that a high percentage of Americans believe in God, pray, are church members, and attend religious services (Harris Interactive, 2009; Kosmin & Keyser, 2009). Many other people engage in a variety of ways of understanding and practicing spirituality outside of organized religion. Ninety-three percent of Americans consider themselves to be religious and/or spiritual (Gallup, 2007), with nearly 75% describing spirituality and/or religion as integral to their worldview, sense of self, and part of their daily lives (Hagedorn & Gutierrez, 2009). Virtually everyone has some philosophical beliefs about existence and meaning, which have significant implications for how they live life. People that define themselves as atheists or agnostics also have some philosophical notions about their lives.

Increasingly clients are seeking spiritual answers in therapy and view spiritual development as essential for dealing with concerns in their lives (Morrison, Clutter, Pritchett, & Demmitt, 2009; Sperry, 2003). A vast amount of research has shown that spirituality is positively related to health and inversely related to physical and mental disorders (Miller & Thoresen, 2003). Therefore, it behooves therapists to understand and address clients’ spiritual beliefs and philosophical notions as well as the practical implications of these beliefs and reflections, especially as they relate to clients’ thought processes and behavioral choices.

In response to client needs and research data, professional organizations and accreditation bodies (e.g., American Psychological Association, American Counseling Association, Council for Accreditation of Counseling & Related Educational Programs, National Association of Social Workers, Council on Social Work Education, American Association for Marriage and Family Therapy, Commission on Accreditation for Marriage and Family Therapy Education) have increasingly recognized spiritual and religious issues as foundational to the human experience, and as an important client variable to be assessed in therapy. Along with other cultural variables, having the clinical skills to address spiritual and religious issues is now viewed as an expectation for effective therapy and graduate-level clinical training. Specific competencies for addressing spiritual and religious issues in counseling have been created by the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) and have been adopted by the American Counseling Association.

ASERVIC (2009) lists 14 competencies across six categories for addressing spiritual and religious issues in counseling. The six categories are: (1) culture and worldview, (2) counselor self-awareness, (3) human and spiritual development, (4) communication, (5) assessment, and (6) diagnosis and treatment. Although the language of the competencies is focused on professional counselors, the message is aimed at all clinical mental health professionals. The complete ASERVIC standards can be accessed at www.aservic.org, and require that therapists are able to:

• Recognize the centrality of spirituality and religion in many clients’ lives as well as have an understanding of various spiritual systems, major world religions, agnosticism, and atheism.
• Have a high level of self-awareness of their own spiritual attitudes, beliefs, and values and how their attitudes, beliefs, and values may impact the therapeutic process.
• Apply theoretical models of spiritual and religious development.
• Identify spiritual and religious themes and communicate with clients about spiritual and religious issues with acceptance and in ways that match clients’ worldviews.
• Consider spiritual and religious issues when conducting client assessments.
• Consider and utilize clients’ spiritual and religious views when diagnosing and treating clients’ issues in ways that match clients’ preferences.

The development and adoption of the ASERVIC competencies point to the foundational importance of spiritual and religious issues in the lives of many individuals and the associated need for therapists to have the skills to address these issues. Unfortunately, many therapists feel unprepared to integrate these issues into the therapeutic process. In one survey, 73% of therapists reported that spiritual issues are important to address but did not believe that they possess the necessary competency to do so (Hickson, Housley, & Wages, 2011). Furthermore, although graduate faculty indicate that integration of spiritual and religious issues are important, many educators do not feel prepared to teach these topics to students (Kelly, 1995; Robertson, 2010; Young, Cashwell, Wiggins-Frame, & Belaire, 2002). Not adequately addressing spiritual and religious issues in therapy misses a central aspect of client functioning and fails to utilize a primary resource in clients’ lives (Robertson, 2010; Robertson, Smith, Ray, & Jones, 2009).

Premise 2: Spiritually Informed Therapy Is a Form of Multicultural Therapy

A multicultural perspective reminds therapists to conceptualize client worldviews as containing a variety of factors that combine to create a lens through which they define and experience themselves and the world. Cultural factors may include ethnicity, race, age, sex, gender identity and expression, sexual orientation, disabling conditions, spirituality and religion, political ideology, immigration status, and socioeconomic status, to name a few. Both clients and therapists bring their cultural lens to the therapy room. To raise awareness of the impact of culture for both therapists and clients, a commonly accepted process in multicultural therapy includes three general steps (e.g., Vacc, DeVaney, & Wittmer, 1995). Therapists should:

1. Be open to learning about and knowing themselves culturally.

2. Be open to learning about and knowing their clients culturally.

3. Be open to discussing the interface between their own and their clients’ cultural worldviews.

Although most therapists have embraced these steps as a minimum expectation for multicultural competency, many struggle with the execution of this process related to spirituality and religion, despite the generally accepted view that spirituality and religion are intertwined and interrelated with culture (Fukuyama, Siahpoush, & Sevig, 2005). For example, most therapists do not have difficulty addressing racial or sexual orientation differences between themselves and clients, but spiritual and religious issues seem to be a different story. This struggle is partly due to the personal and private nature of spiritual and religious values and experiences. In addition, spiritual and religious beliefs are often in flux and in process, which tend to make quick, sound-bite responses much more difficult for therapists.

Some therapists do not have a clear idea of their spiritual and religious beliefs, while others have very strong convictions. Either way, it can be quite intellectually and emotionally complicated to understand and then articulate one’s beliefs to others, especially clients, who...