(p. 277) Working with the Religiously Committed Client
Large numbers of people believe in and are devoutly committed to their faith. For example, Gallup polls have consistently found that more than 90% of Americans profess belief in God and approximately 60% are members of a church. In light of these statistics, it is evident that most psychotherapists will work with religiously committed clients during their careers. But if they are not adequately prepared, psychotherapists may find it particularly challenging to work effectively with them.
There is evidence that religiously committed people from diverse traditions, including many Buddhists, Christians, Jews, Muslims, and Hindus, have unfavorable views of the mainstream, secular mental health professions and a distrust of psychotherapy (Richards & Bergin, 2000). These fears are rooted in an awareness of the reality that many psychologists during the past century have endorsed anti-religious, hedonistic, and atheistic values that conflict with those of traditional religious communities (Bergin, 1980).
Psychotherapists can increase their competency to work with religiously committed clients by reading books on the psychology and sociology of religion; canvassing literature about religion and spirituality in mainstream mental health journals; taking a workshop or class on religion and mental health and spiritual issues in psychotherapy; reading books or taking a class on world religions; acquiring specialized knowledge about religious traditions that they frequently encounter in therapy; seeking supervision or consultation from colleagues when they first work with a client from a particular religious tradition; and seeking supervision or consultation when they first begin using religious and spiritual interventions (Richards & Bergin, 2000).
Accommodating clients’ religious and spiritual beliefs into psychotherapy and adapting treatment to those beliefs have been shown to enhance the efficacy and acceptability of mental health treatment (e.g., Worthington, Hook, Davis, McDaniel, 2011). Following are a series of therapeutic guidelines, culled from both the research evidence and clinical experience, designed to do just that.
• Develop multicultural spiritual sensitivity. Psychotherapists with good multicultural skills are aware of their own religious and spiritual heritage and are sensitive to how they could impact their work with clients from different religious and spiritual traditions. They are capable of communicating interest, understanding, and respect to clients who have spiritual beliefs that differ from their own. They seek to learn more about the spiritual beliefs and cultures of (p. 278) clients with whom they work. They make efforts to establish trusting relationships with members and leaders in their clients’ religious communities and seek to draw upon these sources of social support when it seems appropriate. They use spiritual resources and interventions in harmony with their clients’ beliefs when it appears that these could help their clients cope and change (Richards & Bergin, 2000).
• Select a spiritually oriented treatment. Psychotherapists may wish to select a spiritually oriented treatment consistent with their own worldview and values to help guide their work with religiously committed clients. A large number of spiritually oriented therapies have been developed during the past couple of decades that affirm the importance of spirituality in therapeutic change. Buddhist, Hindu, Christian, Jewish, Muslim, and ecumenical theistic approaches have been proposed. Some scholars have also incorporated spiritual perspectives and interventions into cognitive, interpersonal, humanistic, multicultural, psychodynamic, and transpersonal psychologies (Richards & Bergin, 2000; Sperry & Shafranske, 2005). There is growing empirical evidence that with religiously committed clients, spiritually oriented psychotherapies are as effective, and sometimes more effective, than secular treatments (Richards & Worthington, 2010).
• Prepare spiritually for psychotherapy sessions. Psychotherapists incorporating spirituality into treatment may find they are more effective if they engage in personal spiritual preparation. Several research studies provide evidence that some psychotherapists prepare spiritually for sessions by praying, meditating, contemplating, or by engaging in other spiritual practices consistent with their beliefs that help them to be spiritually attuned.
• Establish a spiritually safe environment. Psychotherapists should explicitly let their clients know it is permissible to explore religious and spiritual topics should they so desire, and that their religious beliefs will not a priori be viewed as pathological. Therapists can do this in the written informed consent documents they give clients at the beginning of treatment and/or they can do so verbally during the course of therapy.
• Respect other values and worldviews. Psychotherapists should deal with religious differences and value conflicts with clients in a respectful and tolerant manner. Differences in religious affiliation and disagreements about specific religious doctrines or moral behaviors can threaten the therapeutic alliance if they are disclosed prematurely or addressed inappropriately. When such value conflicts become salient during therapy, it is important for therapists to openly acknowledge their values, while also explicitly affirming clients’ rights to differ from them without having their intelligence or morality questioned. Psychotherapists should also openly discuss with clients whether the belief or value conflict is so threatening that referral is advisable.
• Conduct a spiritual assessment. Psychotherapists can include questions about clients’ religious and spiritual backgrounds on an intake questionnaire. During the initial phase of the assessment process, therapists may wish to collect only information that will help them understand whether their clients’ religious background may be relevant to their presenting problems and treatment planning (Richards & Bergin, 2005). Asking the following questions may help in making such a determination: (a) Is the client willing to discuss religious and spiritual topics during treatment? If not, this must be respected, although the issue may be returned to if new information warrants it. (b) What is the client’s current religious-spiritual affiliation, if any? How important is this affiliation to the client? (c) How orthodox and devout is the client? (d) Does the client believe his or her spiritual beliefs and lifestyle are contributing to his or her presenting problems and concerns in any way? (e) Does the client have any religious and spiritual concerns and needs? (f) Is the client willing to participate in spiritual interventions if it appears that they may be helpful? (g) Does the client perceive that his or her religious and spiritual beliefs and/or community are a (p. 279) potential source of strength and assistance? If it seems relevant, more in-depth spiritual assessment questions can then be pursued. Gathering information and seeking clarifications about clients’ spirituality may be needed throughout the course of treatment.
• Learn the language of clients’ spirituality. As psychotherapists conduct a religious and spiritual assessment, they can begin to understand a client’s language of spirituality (Berrett, Hardman, & Richards, 2010). There are a number of spiritual themes that seem to be universal in the human family that can help clinicians and clients find common ground for understanding one another’s spiritual language. These themes include love, faith, suffering, death and loss, meaning and purpose, responsibility, repentance, forgiveness, gratitude, belonging, congruence, honesty, family, community, enlightenment, transcendence, and the quest for a relationship with a higher power or Creator. These can be talked about and can help expand psychotherapists’ understanding of their clients’ spirituality as well as clients’ understanding of their own spirituality.
• Set appropriate spiritual therapy goals. Spiritual goals that may be appropriate for psychotherapy, depending on the clients’ unique concerns: (a) examine and better understand what impact clients’ spiritual beliefs exert on their presenting problems and their lives; (b) identify and use the spiritual resources in clients’ lives to assist them in their efforts to heal and change; (c) examine and resolve spiritual concerns that are pertinent to clients’ disorders; and (d) examine how clients feel about their spiritual well-being and, if they desire, help them determine how they can continue their quest for spiritual growth (Richards & Bergin, 2005).
• Create a space for spiritual awareness and experiences. Psychotherapists can create an environment that gives clients the opportunity to recognize and affirm spiritual insights, impressions, and experiences (Griffith & Griffith, 2002; Richards & Bergin, 2005), that occur both within and outside of the therapy hour.
• Appropriately use spiritual resources and interventions. Religious and spiritual practices can both prevent problems and promote healing where problems have occurred. Examples of spiritual interventions include praying for clients, encouraging clients to pray, discussing theological concepts, making reference to scriptures, using spiritual relaxation and imagery techniques, encouraging repentance and forgiveness, helping clients live congruently with their spiritual values, self-disclosing spiritual beliefs or experiences, consulting with religious leaders, and recommending spiritual bibliotherapy (Plante, 2009; Richards & Bergin, 2005). Most of these spiritual interventions are actually practices that have been engaged in for centuries by religious believers.
• Consult with clergy and other pastoral professionals. Clergy and other pastoral professionals, such as clinical chaplains and pastoral counselors, can often be of assistance in helping clients more fully access the financial, social, and spiritual resources of their religious communities during treatment. Collaborative relationships can also help psychologists keep their role boundaries clear so that they do not engage in ecclesiastical functions that are more appropriately performed by clergy (Richards & Bergin, 2005). Clients can be asked if they would like to sign a release and provide contact information for their clergy person so that their psychologist can consult or refer if indicated.
References and Readings
Bergin, A. E. (1980). Psychotherapy and religious values. Journal of Consulting and Clinical Psychology, 48, 75–105.Find this resource:
Berrett, M. E., Hardman, R. K., & Richards, P. S. (2010). The role of spirituality in eating disorder treatment and recovery. In M. Maine, B. H. McGilley, & D. W. Bunnell (Eds.), Special issues in the treatment of eating disorders (pp. 367–385). Burlington, MA: Elsevier.Find this resource:
Griffith, J. L., & Griffith, M. E. (2002). Encountering the sacred in psychotherapy: How to talk with people about their spiritual lives. New York: Guilford Press. (p. 280) Find this resource:
Plante, T. G. (2009). Spiritual practices in psychotherapy: Thirteen tools for enhancing psychological health. Washington, DC: American Psychological Association.Find this resource:
Richards, P. S., & Bergin, A. E. (Eds.). (2000). Handbook of psychotherapy and religious diversity. Washington, DC: American Psychological Association.Find this resource:
Richards, P. S., & Bergin, A. E. (2005). A spiritual strategy for counseling and psychotherapy (2nd ed.). Washington, DC: American Psychological Association.Find this resource:
Richards, P. S., & Worthington, E. L., Jr. (2010). The need for evidence-based, spiritually oriented psychotherapies. Professional Psychology: Research and Practice, 41, 363–370.Find this resource:
Sperry, L., & Shafranske, E. P. (Eds.). (2005). Spiritually oriented psychotherapy. Washington, DC: American Psychological Association.Find this resource:
Worthington, E. L., Jr., Hook, J. N., Davis, D. E., & McDaniel, M. A. (2011). Religion and spirituality. In J. C. Norcross (Ed.), Psychotherapy relationships that work (2nd ed., pp. 402–421). New York: Oxford University Press.Find this resource: