Integration of Religion and Spirituality in Therapy
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Religion plays an important role in the lives of many people, and in such cases, religious principles and beliefs influence all aspects of their lives. With the increasing interest in spirituality in the community, the intersection of psychological services, religion and spirituality is likely to be a growth area in psychology (Plante, 2007). However, working with clients around religion and spirituality issues does present potential ethical challenges.
Integrating spiritual and religious dimensions of clients’ lives into their treatment requires consummate professionalism and the highest quality of knowledge, skills, and attitudes. Psychologists who use or are thinking about using religious and spiritual therapies should be confident that these therapies are efficient for the religious/spiritual clients. They also need to remain alert to potential ethical violations when working with their clients. The American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct (hereinafter referred to as the Ethics Code) (2010) provides some useful standards to help navigate this path.
Keywords: religion, spirituality, ethics, competence, multiple relationships, informed consent, integrity, respect.
Ethical Issues for the Integration of Religion and Spirituality in Therapy
Fisher (2012) explains the characteristics of integrating religion in therapy on a secular-theistic continuum and describes several areas of potential ethical concerns for practitioners. The following sections highlight those ethical challenges that transpire between both ends of the continuum.
Integrity issues: Blurred boundaries and multiple relationships
There are instances of registered psychologists providing psychological services who are also members of the clergy and religious orders, raising the potential for multiple relationships (Principle C: Integrity and Standard 3.05, Multiple Relationships). In such cases it is advisable that psychologists do not provide psychological services to people to whom they are also providing spiritual/religious guidance. Clients will be less likely to confuse the two roles, or have misplaced expectations of the psychologist.
Where clients are aware of a psychologist’s religious affiliation, it is crucial that the boundary between the two roles is clearly communicated. Clients need to know the limits to confidentiality for that situation (Standard 4.05, Disclosures and Standard 3.06, Conflict of Interest). For example, if a client spoke to a psychologist believing that the seal of confession applied, he or she may be shocked to find that a psychologist hearing about child abuse could be obliged to report the client under law.
Respect issues: Spiritual and religious bias
Deeply held religious beliefs, or agnostic or atheist views, may form part of a psychologist’s world view. However when working with clients, it is important the beliefs do not interfere with the psychologist’s primary role, which is to place the wellbeing of the client as paramount (Principle D: Justice and Principle E: Respect for People’s Rights and Dignity; Standard 2.06, Personal Problems and Conflicts, and 3.01, Unfair Discrimination).
For example, an atheist psychologist who strongly believes that religion is a way of avoiding responsibility for one’s life may advise a client to abandon their use of prayer when overcoming grief, amounting to the psychologist imposing their own world view and not respecting that of the client.
Competence issues: Membership of a faith tradition does not make one an expert
Although there is a growing interest in the recent years in researches about religion and spirituality, there is a gap between the researchers’ interest and clinical practice. There is a lack of accredited training programs for therapists in the use of spirituality in therapy. Due to the lack of specialized training, some therapists do not know how to integrate spirituality in therapy. If therapists are not trained, they may easily violate the Ethics Code, by either avoiding addressing spirituality in therapy or by addressing spirituality in an unethical manner which adversely affects the therapeutic process (Barnett, 2011; Standards 2.10b, Boundaries of Competence, and 2.03, Maintaining Competence).
Religious psychologists who want to integrate their faith in their professional work should not display their religious beliefs until they go through specialized training; the fact that the psychologist is an active member in his/her religious group does not make him/her an expert on pastoral counseling (Plante, 2007).
The psychologist must carefully assess his/her clients’ opinions and needs of religious intervention and, in most cases he/she must obtain informed consent (Fisher, 2012; Standard 10.01, Informed Consent to Therapy). Many religious interventions may be considered appropriate by some clients and inadequate by others. Different spiritual beliefs may affect clients’ hopes, expectations and needs in therapy.
A study on clients with regard to the approach of religion/spirituality in therapy suggests that they consider their initiated religious discussions – which gradually appear in the first year of therapy – to be effective and they consider inefficient those discussions initiated by both, the clients and the psychologist, as they occur very early in the first session, when the clients feel judged (Gonsiorek, Richards, Pargament, & McMinn, 2009; Principle C: Integrity and Principle E: Respect for People’s Rights and Dignity). Couple and family psychologists consider that it is ethical to approach spiritual and religious issues in therapy, only if they are brought by the client and not by the psychologist (Barnett, 2011).
Concern issues: Destructive religious beliefs and behaviors
There is a wide array of different religions represented by clients of psychologists. Unfortunately, some religious beliefs are associated with people taking extreme actions such as acts of terrorism (Plante, 2007). Other views can also have a potential detrimental effect on clients.
For example, where a psychologist is working with a teenage girl and her parents wish to exclude her from the family because she identifies as a lesbian – a position which is against their religious beliefs – there is a need to balance respect for the family’s beliefs against the potential harm to the client (Standard 3.04, Avoiding Harm). As stated above, ultimately psychologists do need to place the wellbeing of their client as paramount, which would inform the course of action.
In psychotherapy, the client’s values and strong beliefs – often strongly influenced by his/her spirituality and religion – are the most important resources that can be used to produce therapeutic change (Gonsiorek et al., 2009). The therapeutic environment should provide clients the freedom to express their thoughts and emotions regarding religious and spiritual values. If clients feel uncomfortable and inhibited, the therapeutic process could suffer. Discussions on religious themes can become embarrassing or problematic especially when the psychologist is not prepared to deal with such issues.
Psychologists must respect the rights of clients who require assistance. It is also important for psychologists to be aware of their openness to spirituality and religious conversations concerning their clients, and they should build a safe, professional and therapeutic relationship to protect the integrity of clients seeking wellbeing.
In the absence of specialized training, psychologists will violate ethical principles and standards either by not addressing spirituality and religion in therapy, or by violating the rights of clients. The relevant standards from the Ethics Code are provided to offer additional guidance. Psychologists experiencing a sense of concern when dealing with spiritual or religious issues are strongly advised to consult a senior colleague and the APA’s ethical resources.
Barnett, J. E., & Johnson, W. (2011). Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas, Ethical Issues, and a Proposed Decision-Making Process. Ethics & Behavior, 21(2), 147-164. doi:10.1080/10508422.2011.551471 Fisher, C. B. (2012). Decoding the Ethics Code: A Practical Guide for Psychologists, Updated Second Edition. Thousand Oaks, California: Sage Publications, Inc.
Gonsiorek, J. C., Richards, P., Pargament, K. I., & McMinn, M. R. (2009). Ethical challenges and opportunities at the edge: Incorporating spirituality and religion into psychotherapy. Professional Psychology: Research And Practice, 40(4), 385-395. doi:10.1037/a0016488
Plante, T. G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider. Journal Of Clinical Psychology, 63(9), 891-902. doi:10.1002/jclp.20383