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
[
Part one of our two part series examines
current research into the 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
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
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.
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).
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.
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.
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' 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.
published in Volume 1; issues 13, 14; July 2 & 16, 1998