Psychology of Religion in Clinical and Counselling Psychology

1
Psychology of Religion in Clinical and
Counselling Psychology
2
Psychology of Religion in Clinical and
Counselling Psychology

• Of particular relevance to clinical practice are
  the results of empirical investigations in which
  correlations between religious involvement and
  mental health have been found (Mills, 2002)
• Although, not all forms of religious involvement
  enhance psychological adjustment meta analyses
  have generally found religious commitment to be
  associated with factors important to mental
  health (Koenig Larson, 2001)

3
Psychology of Religion in Clinical and
Counselling Psychology

• Religion/spirituality is the ultimate value base
  upon which personal goals are established and
  resources for well-being and psychological coping
  are found (Baumeister, 1992)
• Clinical practice necessarily involves beliefs
  and values in which the division between personal
  and professional beliefs is poorly demarcated
  (ODonohue, 1989)
• Because of the high importance most Americans
  place on religion, clinicians should develop
  increased competence in bringing spiritual
  factors into assessment and treatment

4
Approaches to religion and spirituality within
the clinical setting

• Religious/spiritual approach to counselling
  considers the role that religion plays in a
  clients worldview and brings into focus the
  unique contributions of religion to the
  conception of psychological difficulties
• Richards and Bergin (2005) called for a viable
  spiritual strategy that would be empirical in
  nature

5
Assessing religion and spirituality as clinical
variables

• Richards and Bergin (2005) suggest that
  conducting a religious/spiritual assessment can
  help therapists
• Understand their clients worldviews
• Determine whether the clients religious/spiritual
  orientation is healthy/unhealthy
• Determine whether religious/spiritual beliefs
  could help clients better cope, heal and grow
• Determine whether clients have unresolved
  spiritual needs that should be addressed in
  therapy
• Situating religious phenomena within a cultural
  framework aids in differentiating between
  religious experience and psychopathology

6
Preliminary religious/spiritual assessment

• The outcome of the initial phase of assessment
  should include an understanding of salience,
  which will determine the extent to which the
  therapist will focus inquiry into religion and
  spirituality as clinical variables

7
In-Depth Religious/Spiritual Assessment

• A second level of assessment is recommended when
• Religion/spirituality features prominently in the
  clients worldview
• Religious/spiritual problems are themselves the
  focus of clinical attention
• Psychological crisis has led to a sudden loss or
  change in spiritual orientation
• Religion/spirituality is producing a detrimental
  effect
• Religious/spiritual resources have been
  overwhelmed by psychological crisis

8
In-depth religious/spiritual assessment

• Religious assessment may incorporate
• Metaphysical worldview
• Religious affiliation
• God image
• Religious/spiritual health and maturity
• A spiritual history
• Assessment may also incorporate procedures
  derived from specific treatments orientations
• E.g., within cognitive-behavioural therapy (CBT)
  focus may be placed on assessing cognitive
  distortions and the clients style of thinking
  about his/her relationship with God

9
Assessment of religious coping

• An assessment should consider that some forms of
  religious involvement are more helpful than
  others
• Attention should also be placed on the style of
  religious coping in respect to the degree of
  autonomous control the client may have in
  responding to the immediate crisis
• There are some forms of religious/spiritual
  involvement that may produce negative effects and
  exacerbate psychiatric symptoms
• E.g., anger and disappointment
• Anger and distrust of God
• Interpersonal strains associated with affiliation
• Problems faced in attempting to exercise moral
  standards

10
Assessment of religious coping

• Consideration of the direction that religious
  participation encourages may point to the
  relative adaptive or pathological consequences in
  the way in which individuals hold their beliefs
  (Meissner, 1996)
• Assessment could also consider religious/spiritual
  impairment because of a psychological disorder
  (Hathaway, 2003)

11
Techniques and resources in religious/spiritual
assessment

• Assessment of the spiritual dimension within the
  clinical setting is accomplished primarily
  through the use of interview procedures
• Familiarity with the major religious traditions
  readies the clinician to assess dimensions of
  religious involvement that are clinically salient
• Clients may be asked to construct a spiritual map
  depicting on a timeline the significant
  milestones, events and challenges within their
  spiritual journeys (Sperry, 2001)

12
Techniques and resources in religious/spiritual
assessment

• Instruments developed within the psychology of
  religion may also be used to supplement interview
  data, although few have been systematically
  evaluated for their application in clinical
  practice (Hill Hood, 1999)
• Through the exercise of intentional orientation,
  the nature, salience, and integration of religion
  and spirituality in the clients orienting system
  can be assessed

13
Addressing religious and spiritual dimensions in
psychological interventions

• The incorporation of religious or spiritual
  interventions or resources should not be
  determined by the psychotherapists personal
  faith orientation rather it should correspond to
  the salience and function of religion in the
  clients life
• The degree of integration should be tailored to
  the mutually defined goals and tasks of the
  treatment and in respect to an established
  therapeutic alliance (Sperry, 2004)

14
A conceptual framework for integration

• Tan (1996) proposed a model that presents two
  distinct forms of integration
• Implicit integration a covert approach that does
  not initiate the discussion of religious/spiritual
  issues
• Explicit integration uses spiritual resources
  like prayer or sacred texts
• E.g., in Cognitive-behavioural therapy explicit
  forms of integration may readily be assimilated
  such as addressing misinterpretation of scripture
  
• Psychodynamic and other insight oriented
  approaches usually employ implicit integration in
  which religious content is addressed through
  interpretation and exploration

15
A conceptual framework for integration

• Approaches such as alcoholics anonymous offer a
  spiritual perspective that incorporates spiritual
  beliefs and values, and practices without being
  located within specific religious traditions
• There are also approaches that bring directly
  into the therapeutic relationship the faith
  commitments of both the client and the clinician
• Belief in the healing power of God
• Consideration of a theistic moral framework
• The explicit use of spiritual interventions such
  as prayer

16
The integration of religious and spiritual
interventions and resources

• Survey research suggests that many patients
  believe that the spiritual dimension should be
  considered in consultation
• Neither patients nor clinicians have demonstrated
  how such integration is to be accomplished
• Spirituality contributed to the solution in 37
  of the cases and in 26 of the cases was involved
  in both problem and solution (APA Practice
  Directorate, 2003)

17
The integration of religious and spiritual
interventions and resources

• Richards and Bergin (2005) identified 19 examples
  of religious/spiritual interventions e.g.,
• Therapist prayer
• Client prayer
• Religious relaxation or imagery
• Spiritual self-disclosure
• Dream interpretation
• Reviews of the literature suggest that
  religious/spiritual interventions
• Does not appear to be consistent across
  clinicians
• Is influenced by the personal commitment of the
  clinicians
• Varies according to the degree of involvement of
  the clinician in explicit religious/spiritual
  behaviour

18
The integration of religious and spiritual
interventions and resources

• Patient interest in religious/spiritual
  interaction decreased when the intensity of the
  interaction moved from a simple discussion of
  spiritual issues (33 agree) to physician silent
  prayer (28 agree) to physician prayer with a
  patient (19 agree) (MacLean et al., 2003)
• Religious CBT has been at least as effective as
  secular CBT, for religious clients (Worthington
  Sandage, 2001)

19
Education and training

• Most clinicians receive little or no training in
  religiosity or spirituality as clinical
  variables, or in the use of religious/spiritual
  interventions
• Survey research has shown that personal faith,
  intrinsic religious orientation and religious
  involvement play significant roles in the use of
  religious interventions (Shafranske Gorsuch,
  1985)
• Psychologists as a group appear to be less
  institutionally religious compared with the
  general population
• This may influence their perspective when working
  with clients for whom participation in
  denominational religion is central

20
Consultation and collaboration

• It appears that psychologists rarely consider
  clergy as potential collaborators (Walker et al.,
  1997)
• Referral to a religious professional, who by
  virtue of education and training offers
  competence in matters of religion is generally
  the ethically appropriate intervention when
  clients are addressing explicitly religious issues

21
Ethics

• Richards and Bergin (2005) cite the following
  ethical pitfalls
• Dual relationship (religious and professional)
• Displacing or usurping religious authority
• Imposing religious values on clients
• Practicing outside the boundaries of professional
  competence
• Therapists must consider that explicit
  integration leads into a territory in which
  statutory authority for such practices and
  empirical support for the use of such
  interventions have not been established

22
Ethics

• Client informed consent is a reasonable but may
  not be a sufficient safeguard
• A firm foundation for practice will be
  established through advances in the empirical
  standing of these procedures within the clinical
  setting