Bringing Religion and Spirituality Into Therapy

A Process-based Model for Pluralistic Practice

Joseph A. Stewart-Sicking, Jesse Fox, Paul J. Deal

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781351030526
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Bringing Religion and Spirituality into Therapy provides a comprehensive and timely model for spirituality-integrated therapy which is truly pluralist and responsive to the ever-evolving World of religion/spirituality.

This book presents an algorithmic, process-based model for organizing the abundance of theoretical and practical literature around how psychology, religion and spirituality interact in counseling. Building on a tripartite framework, the book discusses the practical implications of the model and shows how it can be used in the context of assessment and case formulation, research, clinical competence, and education, and the broad framework ties together many strands of scholarship into religion and spirituality in counseling across a number of disciplines. Chapters address the concerns of groups such as the unaffiliated, non-theists, and those with multiple spiritual influences.

This approachable book is aimed at mental health students, practitioners, and educators. In it, readers are challenged to develop richer ways of understanding, being, and intervening when religion and spirituality are brought into therapy.

1 Introduction

Learning to be a therapist is not just an academic challenge. No matter how strong we are as students, internships often confront us with situations that slip between the cracks of what we learned in class. Working with student interns can make this abundantly clear. For example, consider the experience of one intern, a committed evangelical Christian who hoped to enter faith-based counseling, meeting his client, Lillian. Lillian was a 27-year-old, second-generation Chinese-American woman seeking counseling for symptoms of depression. During the initial intake, she had focused on problems related to her meaning and purpose in life that had become very intense after caring for an ailing grandparent. Layered amid her feelings of grief and loss, Lillian recalled being struck by the quiet serenity her grandmother exuded, particularly during her final weeks. Now she was wondering about her own capacity to feel at ease.

In discussing where she was finding meaning, Lillian described herself as having no formal religious upbringing and being an atheist for most of her life. Her parents were raised through the Cultural Revolution in which traditional religion was suppressed, and upon immigrating, they embraced secular humanism. Additionally, much of the Christian tradition she had been exposed to through American culture seemed unconvincing and irrelevant to everyday life. However, more recently, she had found her perspective changing after several experiences while camping in which she felt a deep sense of awe and connection with the natural world. She had never been able to describe adequately what those experiences meant for her, but simply noticed that during them she felt less depressed and more energized. Upon a recommendation from a friend, Lillian had recently begun practicing mindfulness meditation. She said that she hadn’t thought of it as particularly spiritual, but out of curiosity she had started reading some books on Zen Buddhism recommended by her friend. She really liked them, and they made her think about meditation in new ways. Knowing that her grandmother was, at least, influenced by Buddhism, Lillian was feeling as though she may be on a path not only to cultivating her own sense of serenity, but to deepening a connection with her beloved, and now deceased, grandmother.

Lillian did not have an unusual problem, and she fit into multiple categories of diversity training, but she still gave the intern pause. Was it OK to label her meaning-making process “spiritual”? If he opened the possibility of talking about spirituality, what parts of her spirituality were OK to focus on in therapy, and which could be useful for interventions to help her cope? Should he encourage her to explore Buddhism more? And if so, how much did he need to learn about Buddhism? How should he monitor himself for countertransference with someone whose experience and commitments were so different than her own? The intern said he had been anxious to engage clients’ spiritual and religious resources in therapy, but when the client’s identity was so different, he wasn’t sure what it was ethical to do, especially since he was working in a secular clinic.

The Spiritual and Religious Landscape

Therapists across the US are becoming more and more familiar with clients like Lillian, who provides an example of the many ways that spiritual concerns can interface with therapy even among nonreligious clients. Part of this increasing familiarity is due to the shifting religious landscape in the US. The Pew Research Center (2015) has documented that from the years of 2007 to 2014, there has been a precipitous decline in both the total number and the percentage of people overall who identify with a religious tradition. The mainline Protestant and the Roman Catholic traditions have seen the greatest exodus of affiliates. Meanwhile, the number of nonreligious (those who identify as atheist, agnostic, and nothing in particular) has risen during that same time frame, the religiously unaffiliated or “nones.” This demographic also represents the largest minority of the millennial population. These now decade-old cultural winds prompted a focus on the cleaving of spirituality from religion, birthing what is now colloquially known as the “spiritual but not religious” phenomenon (Pew Research Center, 2012). Still, other fresh nuances continue to emerge today. Recent polling (Pew Research Center, 2018) finds that 39% of Americans are highly religious (Sunday Stalwarts, God-and-Country Believers, Diversely Devout), 29% are nonreligious (Religious Resisters and Solidly Secular), and 32% are those in between (Relaxed Religious and Spiritually Awake). The exponential growth in the latter two groups has prompted complex typologies to account for the varieties of atheism/agnosticism. For instance, Silver, Coleman, Hood, and Holcombe (2014) found six types of nonbelief in an American sample: intellectual atheist/agnostic (38%), activist atheist/agnostic (23%), seeker agnostic (8%), anti-theist (15%), nontheist (4%), and ritual atheist/agnostic (13%).

Despite decreased belonging to religious organizations, however religious traditions are often present in the developmental ecosystems of seemingly secular clients’ lives, for instance, through the faith and practices of friends or through family traditions. The reason for this is because even though the US culture is more secular than it has ever been, the majority of the population remains both religious and Christian. Christians represent about 70% of the population while minority traditions (including Jewish, Muslim, Buddhist, and Hindu, among others) make up about 6%. Likewise, despite the decline of Christian denominations, the number of people identifying with a minority tradition has increased by more than 1%. Thus, as was the case for Lillian, it is possible that spiritual and religious influences might lay dormant until life experiences unearth them again even if they do not identify with them at a given moment.

For many in the industrialized West, spirituality and religion make an appearance through therapeutic or wellness practices, which they might pursue initially without any concern for the broader tradition from which that practice came. The broad appeal of meditation as a complementary and alternative medicine serves as a prime example; it often is seen in popular outlets ranging from Scientific American (Ricard, Lutz, & Davidson, 2014), to Shape (Editors of Shape.com, n.d.). However, these practices are powerful, and as studies of wellness-based and alternative spiritualities suggest (e.g., Bender, 2010; Heelas, 2008), for many who employ them, pathways develop from the practice into other spiritual and religious concerns, leading from wellness to exploring ethics or mysticism. For instance, individuals might enter a yoga class for exercise and become intrigued by its spiritual underpinnings. In the end, however, many individuals practice and believe without belonging (Davie, 1990), which can complicate notions of religious and spiritual identity.

While many of the non-affiliated bring spiritual and religious concerns into counseling, it is also worth remembering that most individuals in the United States claim an explicit religious identity, and that religious adherence is even more the norm for individuals outside of the West where roughly 84% of the world’s population belongs to a religion (Pew Research Center, 2015). Interestingly, the projected numbers over the next 50 years predict an overall decline in the number of nonreligious globally (from 16% to 13%) even while these populations grow in Europe and the US. Thus, regardless of affiliation status, spirituality and religion are often important to clients from either background and are likely to remain that way for the foreseeable future.

Responding to What Clients Want

This larger religious landscape has direct bearing on the practice of therapy. In a review of the literature on client preferences regarding religion and spirituality (R/S) in counseling, Harris, Randolph, and Gordon (2016) highlighted two consistent findings: most clients (a) want to be able to include R/S issues in therapy and (b) rate religiously supportive therapists more highly. As client religiosity increased, the clinician’s knowledge and respect for R/S became increasingly important. For these clients, explicitly R/S interventions produce superior spiritual outcomes than do secular treatments while producing equivalent psychological benefits (Captari et al., 2018). In fact, even when a nonreligious strategy is adopted, clients will still credit their religion or spiritually as part of what helped them (Pargament & Rye, 1998; Pargament, 2011).

For another group of clients, between 18–37% (Harris et al., 2016), religion and spirituality are salient in that they actively do not wish to discuss these issues and preferred therapists who focused on clinical skills. This polarized set of preferences creates a difficult path for therapists to navigate, since they must be open and supportive for clients who wish to include R/S but also able to avoid these topics for those who do not.

The history of psychology exacerbates this problem. Pivotal figures such as Freud, Skinner, and Ellis belong among the “masters of suspicion” (Ricoeur, 2008) who tend to view R/S as a mask for darker motivations, such as infantilism, social control, or neurosis. While there are counterexamples such as Jung, therapy has tended to see only the downside of R/S. Therefore, until recently, therapists trained in mainstream programs have not received training in the positive use of R/S resources in psychotherapy and would not be likely to be able to give many clients what they desired.

For this reason, many potential clients are suspect of just what kind of “help” they expect to receive from a therapist. Highly religious clients are more likely to seek out religious sources of help than they are to contact a therapist (Wamser, Vandenberg, & Hibberd, 2011). Likewise, religious clients sometimes worry that if they see a therapist, they will be judged for their beliefs and practices or will be asked to abandon them entirely (Mayers, Leavey, Vallianatou, & Barker, 2007). Since clinicians tend to be less religious than the general population (Shafranske & Cummings, 2013), differences in identity can complicate seeking help.

Some religious groups have responded to this lack of clinicians whom they trust by developing their own approaches. Most notably, conservative Protestants have created a parallel source of therapists through the nouthetic or biblical counseling movement. Leaders of this movement, notably Jay Adams (1986), believed that psychology was promoting a picture of human nature that directly contradicted biblical teaching. Some of these biblical counselors eschew the notion of holding a therapy license while viewing counseling as the prerogative of the Christian church and the only sure means of believers receiving real or adequate help (Powlison, 2010). More hard-line versions also exist that denounce psychological science as “psychoheresy” (see www.psychoheresy-aware.org/mainpage.html). While some conservative Protestants have developed more accommodating approaches to traditional psychotherapy (Johnson, 2010), the de facto stance of many potential clients has been that only this parallel system is “safe” for people of faith. This situation limits access to treatment for many potential clients, not to mention that it provides no alternative for devout clients from traditions outside conservative Protestantism.

Fortunately, mental health professionals have realized both the necessity and complexity of addressing R/S in therapy over the past two decades. In response, professional organizations have required R/S competence be an aspect of clinical training. For example, in 2009, The Council for Accreditation of Counseling and Related Educational Programs (CACREP) mandated that counselors be competent in addressing spirituality as a facet of multicultural competence and as a means of effective treatment of addiction. As this has become incorporated into counselor education, there has been a call to make R/S competence into a full-fledged curriculum area required of all counselors (Bohecker, Schellenberg, & Silvey, 2017). This change in accreditation followed a series of developments within the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) that proposed in 2009 a set of spiritual competencies for counselors to use when navigating spirituality and religion in therapy (see Robertson, 2008, 2010). Similarly, in 2013, The Society for the Psychology of Religion and Spirituality (APA Division 36) embraced R/S as a multicultural competency and more recently a set of spiritual competencies for psychologists was created (Vieten et al., 2013). Though not yet codified into a list of competencies as in counseling and psychology, recent scholarship in social work has also taken up the mission of developing competency-based measures in the field to promote more effective clinical practice (Oxhandler & Parrish, 2016).

The Discrepancy between Therapists' Values and Practices

Practitioners seem to agree that R/S competence is important. Surveys across professional disciplines (social work, psychology, marriage and family therapy, mental health counseling) have found that clinicians desire to have more discussion of R/S in their training (Oxhandler & Pargament, 2014). And yet, even among therapists who report that they feel competent with many aspects of integrating spirituality into therapy, studies have consistently found that they do not report using spiritual and religious resources in counseling to the extent that they rate these resources as important (Cashwell et al., 2013). For instance, most clinicians report never conducting a spiritual assessment with their clients (Oxhandler & Parrish, 2018). Since the assessment phase is the most pivotal time to raise topics that will be explored later, not directly assessing for R/S topics can send the implicit message that such areas are not welcomed in therapy.

While therapists may endorse that R/S are potentially important areas to include in therapy, there is mixed evidence that they directly explore these areas. Some of this discrepancy may be related to therapists’ concern to avoid harm in this central aspect of life, especially with limited training. For instance, in a sample of recent counselor trainees, the only area in which they did not feel prepared for practice was the cultural and social manifestations of clients’ spirituality and religion (Dobmeier & Reiner, 2012). For many clinicians, the level of competence required in current training standards does not appear to be adequate, and it is the rare program that has dedicated training on this area (Bohecker et al., 2017). A recent study of mental health counselo...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of Illustrations
• 1 Introduction
• 2 Ways of Understanding
• 3 Ways of Being
• 4 Ways of Intervening
• 5 Assessment and Case Formulation
• 6 Diversity
• 7 Ethics
• 8 Learning From Research
• 9 Competencies and Education
• 10 Epilogue
• Index