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Practicing REBT With Religious Clients
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Rational Emotive Assessment With Religious Clients
REBT therapists conduct thorough assessments with religious clients for the purpose of determining whether to engage them in treatment, and if so, to determine what set of therapeutic strategies may be most efficacious. During the assessment, it behooves REBT practitioners to consider their ability to ethically offer services to religious clients. For example, the APA Ethics Code (1992) cautioned psychologists to function within their boundaries of competence, to respect human differences (including those based on religious faith), and to identify and respond appropriately to assessment situations with special populations, such as religious persons for whom traditional assessment measures and techniques may not be valid or useful. Similarly, the APA guidelines for providers of psychological services to diverse populations (APA, 1993) emphasized the significance of client religious commitment and spirituality in offering interpersonal and community support, influencing the form of expressions of distress and disturbance, and determining the clientâs probable response to treatment. These guidelines and those from related mental health fields underscore the tremendous importance of honoring client religious beliefs and tailoring assessment and intervention practices to accommodate faith commitments.
Assessment with the religiously committed client presents the REBT therapist with a dilemma, particularly if the therapist has little training in treatment of religious clients and is largely unaware of the beliefs and practices common to the religion endorsed by the specific client (Rowan, 1996). Although professional guidelines highly endorse obtaining training and supervision in order to competently treat religious persons, the reality is that the range of religious communities, not to mention the idiosyncratic experiences and expressions of religion, make âexpertiseâ with most religious populations highly unlikely. Furthermore, very little literature exists regarding the unique clinical issues common to specific religious groups.
This chapter recommends a careful and religion-sensitive approach to assessment with REBT clients. It begins with a brief summary of traditional or general REBT assessment and then addresses more focal assessment of both the personal and clinical salience of a clientâs religious/spiritual status. It concludes by highlighting the pragmatics and perils of assessing a clientâs religious beliefs.
ASSESSMENT IN THE GENERAL REBT TREATMENT SEQUENCE
Although REBT is widely recognized as one of the most efficient approaches to psychotherapy currently available, excellent REBT therapists are careful to conduct detailed assessments of all clients. As an example, here is DiGiuseppeâs (1991) description of the standard intake assessment process for all clients at the Albert Ellis Institute for REBT in New York City. Clients are asked to arrive early for their first appointment in order to complete the assessment materials:
Although there is nothing particularly sacred about the assessment protocol used by the institute, it is wise to collect broad spectrum assessment data on all clients as a prelude to REBT. Such an assessment will typically include information on personality functioning, symptom distress, and relational patterns, as well as detailed biographical material. In addition, utilization of brief symptom-specific measures for depression, anxiety, or anger is recommended and their selection should be tailored to the clientâs primary presenting complaint. In selecting measures for use in assessment, parsimony is recommended. Hayes, Nelson, and Jarrett (1987) wisely reminded clinicians to consider the treatment utility of tools selected for clinical assessment. Avoiding redundancy and collection of irrelevant data is critical for maintaining rapport and enhancing the efficiency and effectiveness of the assessment process. For this reason, projective measures and more than one measure of personality and/or global symptom functioning are rarely administered.
Beyond general assessment of psychological functioning, the REBT therapist is interested in rapidly gaining an understanding of the clientâs essential beliefs (including those that are evaluative, demanding, and disturbance inducing). REBT therapists begin with the assumption that psychological disturbance is equivalent to the tendency of humans to make extreme, absolutistic evaluations of themselves or perceived events in their lives.
The next chapter outlines the suggested sequence for an REBT therapy session. Certain steps are particularly relevant to the process of assessment with religious clients: specifically, agreeing on a target problem for the session and assessing beliefs, especially irrational, evaluative beliefs (IBs). The remainder of this chapter considers ways the therapist may specifically augment the assessment process in order to address client religiousness. A strategy is presented for both preliminary and advanced assessment of religiousness in REBT clients (W.B.Johnson & Nielsen, 1998). As noted earlier, client religious commitment and belief may become evident and relevant at various stages in the treatment sequence. During the REBT assessment process, a two-step approach for assessing the salience of religiousness to treatment is recommended.
PRELIMINARY ASSESSMENT OF CLIENT RELIGIOUSNESS
The effective REBT therapist is likely to routinely consider the salience of religiousness in the lives of clients. In fact, this may be the most important question to ask in the process of assessing client religiousness: âIs my clientâs religion salient and therefore possibly relevant to understanding and treating the presenting problem(s)?â Worthington (1988) emphasized that clients high in religious salience may be either pro- or antireligious. In contrast, a person low in religious salience is unlikely to even consider religion. Those high in religious salience are prone to evaluate their world on at least three important religious value dimensions, including the role of authority of human leaders, scripture or doctrine, and religious group norms. When a client for whom religious faith appears quite salient who is also pro-religious is living a life or engaging in behavior incongruent with religious beliefs, psychological distress and conflict may ensue (Shafranske & Malony, 1996). Further, beliefs that are highly idiosyncratic or at odds with the clientâs religious tradition may suggest potentially disturbed or disorganized thinking. Of course, it is important to avoid making assumptions about the client on the basis of religious affiliation alone. Compared to members of their faith or religious community, how committed are they?
After determining that the REBT clientsâ religious faith is a significant component of their self and/or community experience (what is referred to as personally salient religion), the clinician must then determine the extent to which religious factors are connected to the essential presenting problem(s). The question here might simply be: âTo what extent is the clientâs religious involvement relevant to the current disturbance?â When religious beliefs and behaviors are clearly linked to the unique expression of pathology, this is described as clinically salient religion. A religious college student presenting in the midst of an existential âcrisis of faithâ following several courses that have challenged core religious assumptions, or the middle aged woman who remains in a physically destructive marriage secondary to a belief that God demands this of her, might both be considered clients for whom faith is clinically salient.
A final preliminary assessment question involves determination of the extent to which maximal treatment outcome is likely to hinge on overt work with client religious material. In other words, having determined that religion is salient and connected to this personâs presenting disturbance, the REBT therapist then considers the extent to which achievement of treatment goals requires more concerted assessment of religiousness and, possibly, intentionally religious interventions. Can standard REBT protocols be implemented or does maximal therapeutic gain hinge on a focal assessment of the nature of religious belief and expression? If the latter is indicated, is the therapist competent to conduct such an assessment? When the REBT therapist determines that religion is clinically salient for the client and that treatment will be enhanced by more careful exploration of client religiousness, we recommend some assessment of the following dimensions of religiousness.
ADVANCED ASSESSMENT OF CLIENT RELIGIOUSNESS
Religious Orientation
Allport and Ross (1967) distinguished between the extrinsic and intrinsic religiousness:
The Religious Orientation Scale (ROS; Allport & Ross, 1967) is a 20-item measure with intrinsic (9 items) and extrinsic (11 items) scales (Donahue, 1985). The ROS may assist the REBT therapist in determining those clients who tend to âuseâ their religion (extrinsic) versus those who tend to âliveâ their religion (intrinsic). In addition, high scores on both scales suggest an indiscriminately proreligious stance, and low scores on both scales suggest a nonreligious approach to life. At present, no instrument in the psychology of religion field has been better constructed or researched.
Spiritual Well-Being
Traditional measures of well-being or satisfaction with life have tended to focus exclusively on material and psychological well-being. For this reason, the spiritual well-being (SWB) scale was developed to incorporate the dimension of spiritual satisfaction or well-being (Bufford, Paloutzian, & Ellison, 1991). The SWB includes 20 items and two subscales. The first assesses religious well-being (tapping the vertical dimension of spirituality or the relationship between person and God). The second is titled existential well-being and evaluates the horizon...