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Spirituality and Religion in Counseling andPsychotherapy - Part 1

Steve was seeing the counselor for follow-up counseling after several episodes of manic-depressive behavior, including a brief but terrifying period of paranoid hallucinations. Steve spoke with relief and gratitude about the skillful counseling, reassuring manner,and timely psychiatric consultation that had resulted in his considerable and sustained improvement. However, he also mentioned his disappointment that neither his counselor nor his psychiatrist responded with any interest when he mentioned to them that he also thanked God for his recovery.

Lisa spoke to the counselor about how she first chose a particular counselor specifically because her referral source had said that the counselor would be receptive to discussing issues in a religious context. However, when she tried to talk about her difficulties in a religious framework, the counselor led her away from the religious perspective. She soon terminated.

Robert, a client in his mid-20s, came to a beginning counselor with problems relating to persons at work and constant arguing with his parents. He said that the arguments with his parents had been aggravated over the past year because he had stopped going to church and had become interested in meditative and spiritual practices, with a special interest in Buddhism. The client said these spiritual interests and activities represented serious changes in his life; however, the counselor, herself a regular member of a mainstream Christian church, was puzzled and uncomfortable with this line of thought. She found it difficult to respond in ways that might help the client explore the meaning and behavioral consequences of his newly emergent spiritual concerns. 

These incidents in themselves do not, ofcourse, prove anything about the sensitivity or insensitivity of all or even most counselors toward religious or spiritual issues in counseling. However, they suggest that some counselors outside of religious settings may hesitate to try or be uncertain about incorporating the spiritual and religious dimension of clients' lives and problems into the counseling process. Ethical concerns about improperly influencing clients' values, a strong opinion about the privacy of religious beliefs, reservations about discussing religious issues in a publicly funded counseling setting, lack of knowledge about or skill in dealing with the spiritual or religious aspect of clients' issues, uncertainty about the relevance of clients' spiritual beliefs to their developmental and mental health issues -- all these may cause counselors, even those who personally value spirituality and religion, to avoid including clients' spiritual beliefs in the counseling process. 

A fundamental thesis of the [author's] book [Religion in Counseling and Psychotherapy: Diversity in Theory and Practice] is that a client's spiritual and religious beliefs and values, like any other set of personal beliefs and values, are potentially legitimate considerations in the counseling process. To the extent that they are pertinent to clients' issues in counseling, they deserve the same respectful, ethical, and skillful attention as any other relevant values. The particular setting in which counseling occurs may set certain limitations; however, setting-specific requirements should not be generalized as a limitation inherent in thecounseling process itself.

Part one of our two part series examines current research into the importance of religion and spirituality in the general population. 

Importance of religion and spirituality in the general population

Survey Data
Over many years large numbers of Americans have reported that religion is important to them. Assuming that potential clients are representative of the general population, the implication for counselors is that a substantial proportion of their clients may have religious beliefs, attitudes, and practices that potentially affect their personal development and problem solving. The importance of religious for large numbers of people has shown up again and again in Gallup polls since the 1950s. In a 1993 Gallup poll (Gallup & Bezilla, 1994), 59% of those interviewed said that religion was very important to them, down from a high of 75% in 1952 but up from a low of 52% with the same view in 1978. An additional 29% in the 1993 poll said that religion was "fairly important" in their lives, while 12% responded that religion is "not very important" to them. There are some significant differences among the population in rating religion as very important. For example, Gallup's 1993 poll showed that women (65%) are more likely than men (52%) to consider religion as very important; African Americans (87%), more likely than whites (56%); persons 65 or older (76%), more likely than persons under 30 (less than50%); and persons with incomes of less than $20,000 (67%), more likely than those earning $50,000 or more (45%). 

It is reasonable to expect that from such a large pool of people for whom religion is important there are going to be clients who would welcome counselors' sensitivity toward and respect for their religious and spiritual beliefs. This expectation is directly supported by a 1992 Gallup survey showing that two-thirds of the respondents, when faced with a serious problem, would prefer to see a counselor who personally holds spiritual values and beliefs (Lehman, 1993). Similar to findings with respect to the importance of religion generally, women and lower-income individuals indicated a generally higher preference for counselors with spiritual values and beliefs than did men and individuals with higher incomes; also, people with less formal education also reported a generally higher preference for such counselors. A related finding in the same survey shows that 81% of the respondents would prefer a counselor who integrates their values and beliefs into the counseling process. These data parallel those of Quackenbos, Privette, and Klentz (1985) who found that for many potential clients the religious dimension of their lives is considered a legitimate aspect of counseling, especially in marriage and family issues. 

Some caution must be exercised in interpreting persons' stated opinions about the importance of religion and their preference for religious and spiritual values in counseling. Gallup (as cited in Kinsolving,1992), for example, has found a knowledge and behavior gap in American spirituality, noting that whereas 8 of 10 Americans profess to be Christians, only 4 of 10 know who delivered the Sermon on the Mount (Jesus did). Furthermore, whereas regular survey reports spanning many years show that 70% of Americans claim church membership and 40% attend religious services weekly (Warner,1993), other counts of actual attendance are about half that of reported attendance (Hadaway, Marler, & Chaves, 1993). Social desirability (attendance at religious service is what is socially expected), personal desirability (I value going to religious service), and cognitive mixing of events stored in short-term memory (what I actually did last weekend) with rules in long-term memory (I go to church on Sunday) all may play a part in the significant discrepancies between perceived, self-reported behavior and actual behavior with regard to recent attendance at religious services. 

Differences between individuals' reported values or preferences and their actual behavior are a well-known phenomenon in research and ordinary experience, not only in religion but also in other life areas such as marital, family, and relationship behavior. For counselors, differences between stated values or preferences and actual behavior spotlight the need for a careful and balanced weighing of client values, including spiritual and religious, and how values with varying personal potency can be used effectively in counseling. Chapter 4 examines in more detail how counselors can assess the presence, power, and relevance of spiritual and religious values and beliefs for clients' developmental and therapeutic welfare. 

The point to be emphasized here is that the widely stated valuing of religion and spirituality should be viewed in light of people's actual knowledge and practice; taken together they provide a balanced perspective for neither neglecting nor overestimating the importance of these values in counseling. In this perspective spiritual and religious beliefs and values are seen as potentially relevant to counseling as any other set of personal attitudes that influence a client's thoughts, feelings, and behavior. Counselors need a knowledgeable openness to the developmental and therapeutic relevance of spiritual and religious issues comparable to what they are expected to have for any other set of client beliefs.

Spirituality, Religion, and CriticalLife Issues
In addition to quantitative data pointing to the potential significance of spirituality and religion, qualitative connections of the spiritual/religious dimension with other critical areas of human development and behavior especially underscore the potential relevance of the spiritual/religion dimension to counseling. Schumaker (1992) recently brought together a series of reviews examining the consequential connections between spirituality and religion on the one hand and critical life areas like sexual adjustment, depression and suicide, anxiety and fear of death, self-esteem, rationality, self-actualization, meaning in life, and psychological well-being on the other. In addition to these life issues, other areas in which spirituality and religion may play an important role include, for example, issues of aging (Idler & Kasi, 1992; Owens, Berg, &Rhone, 1993; B. P Payne, 1990), stress and coping (Maton, 1989), AIDS and death anxiety (Franks, Templer, Cappelletty, & Kauffman, 1990), community service work (Serow & Dreyden, 1990), alcoholism (R. A. Johnson, Sandier,& Griffin-Shelley, 1987), and attitudes toward work (Chusmir &Koberg, 1988; Iwata, 1993). Counselors can expect that at least for some clients spirituality and religion play a part in how the client feels and thinks about these issues and problems. As counselors explore the cognitive, affective, and unconscious elements of issues such as these, they can help clients by an alert openness to how spiritual and religious threads may be woven into such concerns and used in their resolution.

The spiritual/religious values of counselors and other mental health professionals

Counseling is clearly not a value-free enterprise (Jensen & Bergin, 1988; E. W Kelly, in press; Norcross & Wogan,1987), and there is a subtle, complex, and influential interplay between the values of the counselor and those of the client (Beutler & Bergan,1991). Various patterns of similarity and dissimilarity between counselor and client values indicate that client values sometimes shift in the direction of counselor values. With respect to spirituality and religion, the interaction of client-counselor values raises several questions: What in general are the spiritual/religious values of counselors? How in general do counselors'own spiritual/religious values affect the counseling process? What are counselors' ethical obligations with regard to the inclusion of spiritual and religious values in counseling? What methods can counselors ethically use to integrate spiritual and religious values in counseling for the benefit of the client? The first three of these questions will be addressed in this article. For a thorough discussion of assessing the spiritual/religiousdimension in counseling as well as treatment and intervention and the spiritual/religious dimension we highly recommend Dr. Kelly's book Spiritualityand Religion in Counseling and Psychotherapy: Diversity in Theory and Practice,(1995, ACA).

Counselors' Spiritual and Religious Values

A recent survey of counselor values, based on a nationally representative sample of counselor members of the American Counseling Association, showed that almost 64% of the respondents believe in a personal God while another 25% believe in a transcendent or spiritual dimension to reality (E. W. Kelly, in press). Approximately 70% expressed some degree of affiliation with organized religion, with almost 45% indicating that they were highly active or regularly participate in religion. Those who identified themselves as religious also expressed a substantially greater intrinsic than extrinsic religious orientation, that is, they value religion more for its importance as a guide in life than for its socially beneficial or personally comforting aspects. This last finding suggests that counselors who are religious tend to have a religiousness grounded in a spiritual orientation toward life. 

With respect to spirituality as distinguished from religion in its more external manifestations, the survey showed that counselors affirm spirituality more extensively than religion expressed as an affiliation with organized religions. For example, 85% of the counselors agreed with the statement, "Seek a spiritual understanding of the universe and one's place in it," with 69% highly agreeing. Eighty percent agreed with the statement, "Seek inner wholeness and strength through communion with a higher power," with 62% highly agreeing. Fewer than 5%of the counselors expressed an opinion that the notions of transcendence or spirituality are illusions, while another 7% expressed no opinion regarding their religious or spiritual ideology. The difference between the combined percentage of counselors who affirmed a spiritual or spiritually grounded religious orientation and the percentage who indicated a specific religious affiliation suggests that many counselors make a distinction between spirituality and religion and that more counselors value spirituality in its broad understanding than religion understood in its institutional sense. 

Surveys of other mental health professionals have shown that the spiritual and religious values and beliefs of clinical psychologists, social workers, and psychiatrists are, in some respects, similar to those of counselors (Haughen, Tyler, & J. A. Clark, 1991;Bergin & Jensen, 1990; Shafranske & Malony, 1990b), while in other respects are somewhat dissimilar. For example, other mental health professionals indicate rates of religious affiliation (approximately 70%) and participation (approximately 40%) similar to those of counselors (Jensen & Bergin,1988; Shafranske & Malony, 1990b), and rate their religious commitment relatively high on an 8-factor scale of mental health values (Haughen etal., 1991). On the other hand, 68% of these mental health professionals agree that seeking a spiritual understanding of one's place in the universe is an important mental health value (Jensen & Bergin, 1988), compared with 85% of counselors who agree with the same statement. Also, 70% of clinical psychologists express a belief in some transcendent or divine dimension in reality and 30% believe these notions are illusory products of human imagination (Shafranske & Malony, 1990b), compared with 89% of counselors who believe in a personal God or transcendent dimension, with less than 5% believing that these are illusory. Although counselors and other mental health professionals differ to some extent in their spiritual and religious beliefs, all groups show a high to moderately high valuing of spiritual and religious belief and practice in general. 

In contrast to this generally high valuing of spirituality and religion, counselors and other mental health professionals manifest substantial differences about specific, traditional religious beliefs. Indeed, while counselors and other mental health professionals indicate high levels of agreement on a wide range of mental health values such as self-determination, personal responsibility, and human relatedness, they differ significantly in their opinions regarding specific kinds of religious belief--for example, in the nature of humans' relationship to God or the transcendent and in religiously associated morality in the area of sexuality (E. W. Kelly, in press; Jensen & Bergin, 1988). 

When the spiritual and religious beliefs of counselors are compared with those of the general population, we find that counselors' overall beliefs and rates of affiliation and participation are similar, although not identical, to those of the general population. For example, about 90% of the general population report that they never doubted the existence of God (Gallup & Castelli, 1989), while 89% of counselors indicate a belief in a personal God or a transcendent dimension to reality. Both professional counselors and the general population, as well as other mental health professionals, report about a 70% level of some affiliation with organized religion, with 40% reporting a high to moderate level of participation; however, these self-reports may be subjective overestimations of actual participation (Hadaway et al.,1993). On the other hand, the almost 30% of clinical psychologists who believe that God or the divine are illusory notions contrasts with the 90% of the general population who report a belief in God. These data suggest that a substantial minorityof clinical psychologists share the nontheistic, nontranscendental perspective that has prevailed for many years in much of psychology and Freudian-influenced psychotherapy (Beit-Hallahmi, 1989). These discrepancies have led a numberof authors to highlight a historical tension or even animosity between religion and the mental health professions, especially psychiatry and psychology (Bergin, 1980a; Gigho, 1993). Nonetheless, the accumulation of recent evidence indicates that a substantial majority of major mental health professionals appear to believe in the validity and value of a spiritual dimension to reality (Bergin & Jensen, 1990; E. W. Kelly, in press), with moderate numbers of these reporting affiliation with organized religion in percentages not much different from the general population. Counselors specifically report a valuing of spirituality and religion in percentages very closeto the general population. 

Counselors' Spiritual and Religious Values in the Counseling Process

That so many counselors on average report a valuing of spirituality and religion quite similar to the general population creates a reasonable probability that clients who bring spiritual and religious issues to counseling will be met by a counselor who personally values these issues. Counseling, however, does not occur on the "average." Specific clients with their own particular beliefs and values meet with specific counselors who have distinctive beliefs and values. This raises the question of how counselor-client dissimilarities and similarities in religious values and beliefs may affect the counselor's relationship with the client and the counseling process. A good deal of evidence suggests that non-religious counselors do not in general assess or treat spiritual/religious clients differently from counselors with a spiritual/religious orientation. 

For example, religious and nonreligiousclinicians have been found to make very similar clinical judgments about religious, moderately religious, and nonreligious clients (Houts &Graham, 1986), not to differ in their diagnoses according to clients' religious affiliation (Wadsworth & Checketts, 1980) or their religious beliefs (Hillowe, 1985), or to differ in their perception of the therapy process(Gibson & Herron, 1990). Christian and secular counselors, despite some differences in attention to clients' spiritual issues, have been found not to differ in their rating of the pathology of clients, in their degreeof "liking" of religious clients, or in their expectations of clinical success with religious clients (Worthington & Scott, 1983). In a study of cognitive-behavioral treatments with and without religious content, nonreligious therapists were found to be as effective in religiously oriented treatment of clinical depression of religious individuals as were religious therapists in a nonreligiously oriented treatment (Propst, Ostrom, Watkins,Dean, & Mashburn, 1992). Potential clients who were asked to rate several counselors who differed only in terms of religious values have reported a willingness to see all rated counselors and a belief in their helpfulness (Wyatt & Johnson, 1990). Based on their thorough review of research on the effects of client-counselor similarity and dissimilarity on values, including religious values, Beutler and Bergan (1991) concluded: 

Given the social importance of views about one's relationship to God and nature, we emphasize that there is currently little evidence that counseling outcome is substantially affected by the degree of client-counselor similarity of such views. This not to say that research should not proceed on the effects of client-counselor differences of religious belief. However, the lack of evidence indicating that the differences that exist between counselor and client groups on this dimension exert either a positive or a negative effect on counseling processes and outcome suggests the concerns that [have been] raised may not be as serious as proposed. (p.23)

One possible exception to this general finding about the non-significance of counselor and client similarity on religion is that of highly religious clients, who might be expected to do better in counseling and be less likely to drop out of counseling when matched with a counselor with similar religious values (McCullough &Worthington, 1994; Weisbord, Sherman, & Hodinko, 1988; Worthington,1991). Another area in which a counselor's religiousness or nonreligiousness may have an effect is the extent to which the counselor shows concern about spiritual values as relevant to counseling and includes spiritual goals as important to counseling (Worthington & Scott, 1983). Although evidence indicates that a counselor's personal nonreligiousness does not generally affect his or her assessment and professional treatment of religious clients or the process or outcome of counseling, a counselor's personal religiousness or spirituality may prompt the religious counselor to be more sensitive to the explicitly spiritual aspects of a client's issues. If this is the case, survey findings showing that a substantial majority of counselors themselves value spirituality and that many counselors are religiously affiliated mean that religious clients who wish to incorporate their spirituality into counseling have a reasonably good chance of matching their spiritual interests with those of a counselor. Such matching is relatively easy in counseling settings associated with religious institutions or explicitly offering spiritually oriented counseling. Furthermore, the large numbers of counselors who value spirituality and religion irrespective of theirwork setting (E. W Kelly, in press) further increases the likelihood that spiritual/religious clients might receive counseling that is explicitly attuned to the spiritual/religious dimension. 

Influence of the Counseling Setting

A counselor's work setting, however, may affect how a counselor responds to the spiritual/religious dimension (Worthington& Scott, 1983). Not only are religiously and spiritually associated counseling settings likely to employ religiously oriented counselors, but such settings also provide an atmosphere and expectation conducive to the raising of spiritual and religious issues. 

But what about religiously sensitive counseling in secular settings? Most professional counseling and psychotherapy takes place in the secular domain, in public schools and colleges, human service agencies, clinics, workplaces, and nonaffiliated private settings. Moreover, the prevalence of spiritual and religious beliefs among the general population, the preference of so many individuals for counselors who value spirituality, and the connection of spirituality and religion to many critical life issues certainly suggest that the spiritual/religious dimension is pertinent to counseling in secular settings. Because many counselors and other mental health professionals, regardless of their work setting, hold the spiritual dimension as important in their personal life and relevant to counseling, we can reasonably assume that clients will encounter spiritually/religiously oriented counselors working in secular as well as religious settings. 

It does not necessarily follow, however, that even religiously believing counselors will be actively responsiveto the spiritual/religious dimension in secular settings. Secular counseling settings, like other secular settings, are likely to be characterized by what might be called a passive neutrality with respect to persons' spiritual and religious beliefs. This stance is often unarticulated, a mark of American society in which the typical cultural norm is that individuals' religion and spirituality are private matters, usually confined to specifically religious settings and activities and separated from the day-to-day affairs of the secular world. This passive neutrality toward religion and spirituality in the secular counseling setting is mirrored in the widespread omission f religious and spiritual issues in the training of counselors and other mental health professionals (E. W. Kelly, 1994b; Sansone, Khatam, &Rodenhauser, 1990; Shafranske & Malony, 1990b). Given this atmosphereof passive neutrality toward the spiritual/religious dimension and the effect it has on typically suppressing discussion of spirituality and religion, counselors in secular settings, including those who value spiritualityand religion, need to be particularly sensitive that they do not inadvertently miss or sidestep clients' religious and spiritual concerns when these are relevant to the counseling process and outcome. Nor should counselors work only with religious issues that appear to have a negative effect on a client's development and mental health. 

Counselors' Openness to theSpiritual/Religious Dimension in All Settings

Counselors' alert openness to spiritual and religious issues in secular settings, although it may go against the grain of how these issues are ordinarily ignored in secular settings, is justified by the nature of counseling itself. The very purposes of counseling for enhancing personal development, facilitating personal problem solving, and overcoming emotional and mental distress provide a clear rationale for incorporating the cognitive, affective, attitudinal, and behavioral aspects of individuals' religious beliefs and values as these bear on client improvement. How is it that a counselor would have clients explore all life aspects germane to their improvement yet omit exploration of pertinent spiritual and religious factors? Seen in this light, a carry over of the general cultural tendency to separate the spiritual/religion dimension from secular activities is contrary to the purposes of counseling. The point here, of course, is not to elevate religious values and attitudes to a special place in counseling nor should counselors' own personal spirituality intrude into the counseling process. Rather, in line with counseling's concern for all psychosocial factors pertinent to clients' development and improvement, it is to encourage counselors in the many secular settings in which most professional counseling and psychotherapy occur to be as alert to spiritual and religious concerns as they are to other counseling-relevant issues in clients' lives. 

A counselor's personal spirituality/religiousness may provide a value base for being especially attuned to clients' spiritual and religious issues; however, it is not necessary for being sensitiveto and dealing effectively with these issues in counseling. We have already seen that nonreligious counselors and therapists have been found to be little different from religious counselors in their assessment and effective clinical treatment of religious clients. Furthermore, nonreligious therapists trained specifically to provide treatment with religious content to religious clients have been found to be as effective as religious therapists (Propstet al.,1992). Sensitivity and skill in working with spiritual and religious clients do not require counselors to be personally spiritual or religious. Counselors' authentic respect for others, their relationship abilities, and their technical competence, not their personal religiousness or nonreligiousness, constitute the fundamental base for sensitive and effective counseling with religious as well as nonreligious clients. An attentive openness to spiritual and religious issues in secular counseling settings depends on counselors' knowledgeable sensitivity to the potential pertinence of thespiritual/religious dimension for clients, despite the inattention typically given to this dimension in secular settings. This is not to say that a counselor's special interest and expertise in spiritual and religious issues are unimportant in particular cases involving these issues, but that proficient counselors, irrespective of their personal spiritual/religious orientation, can and should incorporate clients' spirituality or religiousness when appropriate.

Excerpted from 
Spirituality and Religion in Counseling and Psychotherapy: Diversity in Theory and Practice  
Author: Eugene W. Kelly,Jr., PhD 
Copyright 1995, American Counseling Association

published in Volume 1; issues 13, 14; July 2 & 16, 1998