Editor’s note: This is the first in a two-part series examining how counselors can work more effectively with clients who hold strong religious beliefs. The second article will appear in the August issue.
Jill D. Duba has long been interested in where issues of religion and faith fit into the counseling process, sparked in part by her own developing faith and the questions she wrestled with along the way. “A person’s faith development is such a journey,” says Duba, an assistant professor in the Department of Counseling and Student Affairs at Western Kentucky University. “I often found myself thinking, ‘It would be nice if there was a mental health professional whom I could bounce my personal reflections off of,’ but there really wasn’t.”
That point was further driven home to Duba when she sought counseling while going through a divorce. It was important to Duba to filter what was happening in her life through her faith perspective, so she tried to broach the subject. “I brought up my faith as bait for the therapist in session, but she never took it. It was very frustrating for me, so I stopped going to see her,” says Duba, a member of the American Counseling Association, the International Association of Marriage and Family Counselors, the Association for Counselor Education and Supervision and other professional counseling organizations. “You know, I’m an informed client, so when she avoided talking about religious issues, I was able to say to myself, ‘She’s the one with the problem, not me.’ But most clients aren’t going to be able to reframe that.”
“Based on those experiences, I’ve taken it on myself to say to my students and my profession, ‘Hey, you’ve got to pay attention to a client’s religion and faith in counseling,” says Duba, who has researched and written about the subject extensively.
Duba isn’t alone in her perception that many counselors and related helping professionals remain hesitant to engage their clients’ religious identities and sensibilities. The reasons are varied but may include a lack of proper training, a fear that counselors are imposing their values on the client by even mentioning anything of a religious nature, a struggle overcoming their own bad experiences with organized religion or a distaste for the client’s religious beliefs and values.
When Robert Brammer attempted to obtain a dual doctorate in counseling and religion, he was told that the fields were incompatible. “My initial reaction was that it was very sad that we don’t see how intertwined these two fields really are. After all, the cultural identity of religion is fundamental for a large number of people,” says Brammer, an associate professor of psychology and director of both the mental health and school counseling graduate programs at Central Washington University.
J. Scott Young was likewise taken aback as he embarked on a counseling career. Growing up in a highly religious family, he thought of himself as “spiritually curious” and had been intrigued by Eastern religious thought since he was a kid. “So when I came to graduate school 20 years ago, I was interested in how religion/ spirituality and psychology relate as people look for meaning in what is happening to them. I was struck by the fact that it really wasn’t talked about at all, and I thought it was a bit odd that we wouldn’t consider these connections as counselors,” says Young, professor and chair of the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.
“Both religion and psychology are trying to answer some of the same questions,” Young adds, “but from very different perspectives.”
A historical tension
Those different perspectives have contributed to what Young terms a “historical tension” between religion and the mental health professions. “I’m not personally uncomfortable working with religious clients, but I often hear that concern from counselors — that it brings them great anxiety,” says Young, coauthor with Craig Cashwell of Integrating Spirituality and Religion Into Counseling , which is published by ACA. “If a conservatively religious person comes in for counseling, the worldview is a little different from that of the typically more liberal counselor. If (the client) holds really rigid perspectives, it sort of goes against the mental health perspective that most counselors are working from. Counseling’s emphasis on self-determination goes back to the self and how decisions can make the individual happy, while in religion, the emphasis is on sacrificial ideas. There is a focus on God and others. In some instances, that’s actually getting in the way of the client being happy. In other instances, it brings them their greatest joy.”
Studies have shown that mental health practitioners tend to be less religious than the average American, Young says. However, he thinks counselors, as a group, are more open to religious belief — both their own and that of clients — than their colleagues in related mental health fields because “we don’t teach one model. It’s a buffet of beliefs in counseling.”
Perhaps for that reason, the concept of spirituality has made greater inroads into counseling than has religion. As Brammer explains, “Spirituality is a broader construct that includes all of our religious beliefs and focuses on an individualized component. Religion is an organized sense of beliefs that is shared, that is corporate, and there is a behavioral component to it.”
Adds Lisa Jackson-Cherry, the outgoing president of the Association for Spiritual, Ethical and Religious Values in Counseling, a division of ACA, “When you look at religion, it involves customs, traditions and a set belief system shared by a group of individuals. A person doesn’t necessarily need to belong to a religious group to be spiritual.”
Young, Brammer and others in the counseling profession readily acknowledge that clients who have strong religious beliefs generally cast a wary eye toward counseling, sometimes out of suspicion that practitioners will try to divest them of their faith, sometimes because they assume the counselor will judge them negatively for their religious views or even regard them as pathological for expressing faith in a higher power at all.
“Historically, a lot of counseling approaches have taken a neutral or even negative view of religion — think of (Sigmund) Freud and (Albert) Ellis,” says Richard Watts, professor and director of the Center for Research and Doctoral Studies in Counselor Education at Sam Houston State University and editor of the ASERVIC journal Counseling and Values. “Of course, Ellis later went on to say that the Bible was the greatest self-help book ever published, even though he didn’t believe in it personally.”
Even when religious clients don’t sense any hostility toward their beliefs, they may question whether a secular counselor can truly grasp what drives their life. “Religion is about the transcendent, while in counseling, the approach is more humanistic,” explains ACA member Kenneth Anich, an associate professor of psychology at Divine Word College and a member of the Society of the Divine Word, an international congregation of Catholic missionary priests. “When the client is devout — whether the client is Muslim, Roman Catholic, Protestant or some other religion — for them, life is about a personal relationship with a higher power they identify with and not just about being a ‘good guy.’ The question for these clients is will the counselor respect that as a guiding force in their life?”
LaVerne Hanes Stevens, an ACA member who is both a counselor and an ordained Protestant minister, concurs. “There are so many worldviews, and when a person is truly guided by their faith, they want congruency. When they come for counseling, it’s often at a time when they are struggling to find congruency between their faith and their problem. The two may seem divergent or even conflicting, yet the individual wants to protect and preserve the faith they have developed,” she says. “During times of struggle, people realize just how vulnerable they are, so they are reluctant to sit and receive advice from someone who may be in opposition to what they believe.”
These individuals often have a fear of being judged, not just by the counselor but by their religious body for needing “outside” help, she says. “There can be an added sense of shame: ‘As a person of faith, my life should transcend these habits or struggles.’ So they may decide to stay in a place of struggle without getting help at all,” says Stevens, who wrote the book The Fruit of Your Pain precisely because she saw certain elements of religious extremism making people of faith believe that they weren’t “allowed” to struggle.
Individuals for whom religion is an important part of their identity can struggle with the same problems — including pornography, depression, substance abuse and temptation in their marriage — as those who profess no faith in a higher power, says Stevens, who has done clinical practice work in both secular and faith-based settings. “But when they’re struggling is when religious clients are least likely to feel they should be talking about God to a counselor,” she says. “Some may even worry that they will spoil the image of their faith in front of a nonbeliever. You know, ‘A-ha! I knew you Christians or you Muslims or you Jewish people weren’t really …”
It’s interesting, says Anich, that the wall separating therapy and religion or matters of faith wasn’t always so imposing. He points out that the original definition of therapy was “doing the work of the gods or serving the gods.”
“Therapy really had to do with soul work until we tried to move it into the field of pure science,” he says. “Then, if something didn’t make perfect logical sense, we decided that it didn’t exist and labeled it stupid. Therapy championed a belief that humans are machines that just need to be oiled correctly.”
But he believes that wall is slowly being lowered again. According to Anich, when he joined ACA in 1975, there was virtually no mention of a person’s spirituality or religious beliefs having any type of role in the therapeutic process. “It was almost treated as if it was unethical,” he says. “But now I see all these sessions on spirituality and treating the person holistically at ACA conferences. We’re realizing again that people are not machines.”
Anich says this gradual acknowledgement that clients’ religious beliefs and religious identity are important to the counseling process is a very positive development. “There is this history of the twain shall not meet,” he says, “but I think there is a real hunger for it among clients.”
In the opinion of those interviewed by Counseling Today , counselors who avoid bringing up issues of faith and religion are actually doing their clients a disservice. “In looking at treating the whole person, I believe that if an individual comes in with a strong religious foundation, that aspect of their lives should at least be investigated,” says Jackson-Cherry, chair of the Department of Counseling and director of the community and pastoral counseling program at Marymount University. “I think religion is a very heavy cultural component. Their religion is part of their identity, and we should have the desire to learn about their religious beliefs. Counselors inviting clients to express who they are in all areas is important.”
“I think there are still a lot of counselors and counseling students who are resistant because they believe they are somehow imposing their own values on the client in even asking basic questions about religion in the intake,” adds Jackson-Cherry, who maintains a private practice in Maryland. “We assess for everything from suicide to sexual orientation, but if we ask about religion, we assume we’re instilling our own values.”
In fact, adds Watts, it could be a covert imposition of the counselor’s values on the client if issues of faith and religion are ignored. “To not address the client’s faith is to leave a big hole in the counselor’s understanding of the client,” he says. “Typically, the religious or spiritual beliefs of spiritually active clients provide a values system for how they see themselves and others in the world. To truly understand a person, you have to understand the values and constructs that guide his or her life.”
“To me, a counselor would be acting unprofessionally to say, ‘I just don’t discuss these issues.’ They’re on the spectrum of multicultural and diversity issues,” says Michael Kocet, incoming president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling and past chair of the ACA Ethics Revision Task Force. “I don’t think counselors have to specialize in spirituality issues, but they should be open to working on them if that’s important to their clients.”
Many counselors don’t feel competent touching on issues of religion and spirituality, Kocet says. In those instances, they need to pursue competence — read counseling literature, take workshops, seek supervision and collaborate with others, including religious leaders of diverse faiths, he says.
But counselors who disagree with certain religious viewpoints may assume that it’s fine to simply refer these clients on to another professional. “In some cases, it’s absolutely ethical for a counselor to refer, but it can be unethical if it’s simply a matter of perpetuating our own prejudices and bigotry as counselors,” says Kocet, chair of the Department of Counselor Education at Bridgewater State College. “It’s at least bordering on unethical conduct if we refer when we actually have the necessary competency to work with them. Referrals should not be automatic, and the ethical step doesn’t end at the referral. We have to identify what’s blocking us from working effectively with that client. ”
Counselors also have to be careful not to make assumptions about clients based on their stated religious background, Kocet warns. For instance, he says, even if the counselor and client come from the same faith background, the counselor shouldn’t assume that they have the same beliefs. Or if a client identifies as being religiously conservative, the counselor shouldn’t automatically conclude that the client is anti-homosexual.
Watts has also heard counselors and counselors-in-training admit to reservations about working with clients who hold divergent religious views and beliefs. “I view religion and spirituality under the rubric of cultural diversity,” he says. “By definition, I don’t need to believe the same thing that the client does. That’s analogous to having to change skin color to work with someone of a different ethnicity. If a counselor doesn’t attend to religious issues in counseling, I think they’re being culturally insensitive and unethical.”
Neither does Anich believe that the counselor and client must share the same — or even similar — religious beliefs to have a productive, respectful relationship. As a guest professor at the University of New Orleans, he taught a class on integrating counseling and spirituality. To his students’ surprise, his first guest speaker was a Wicca high priestess. “One of the main points I want to get across to students is that the only thing that will fail them in their work is intolerance,” he says.
When Anich was a chaplain in a hospital, he was asked to speak with a nurse overheard administering satanic rites to a patient. In working with the nurse, who identified herself as a high priestess in the satanic church, Anich used a simple but effective approach that he recommends for any counselor struggling with a client’s religious values, views or beliefs. “I simply engaged her and asked her what her beliefs meant to her,” Anich says. “And even as a satanic believer, she was comfortable coming and talking to me — a Catholic priest. She told me, ‘You’re the first religious person who didn’t run from me as soon as I told you what I am.’”
The counselor educators with whom Counseling Today spoke said that graduate programs need to do a better job of preparing counseling students to deal with religious issues (also see “The student perspective” on p. 31), but many also emphasized the importance of practitioners taking steps to become more conversant with religious clients. “It needs to start outside of the counseling office,” Duba says. “Counselors are their own toolbox. Build relationships with people who are religiously different than you outside of the workplace. We have to practice being uncomfortable and put ourselves out there. Stumbling through conversations of a religious nature (outside of the office) will be a big help.”
Brammer, an ACA member, advocates counselors attending different religious events and asking questions about anything they don’t understand. “Developing religious multicultural competency requires exposure,” he says. “If we fail to understand the religion from a personal perspective, our questions may sound like an anthropological investigation. It would be like a counselor who hates sports and exercise helping an Olympic athlete with performance anxiety. Clients need to believe their counselors can understand their culture and preferred coping mechanisms.”
“If you want to work with this population, you have to develop competency for it,” says Stevens, who works for Chestnut Health Systems training clinicians to do substance abuse assessments and treatment planning using the Global Appraisal of Individual Needs. She encourages counselors to talk with clergy and other spiritual leaders. Taking that step will help counselors learn more about their clients’ belief systems while simultaneously allowing them to market themselves and develop relationships with spiritual leaders for possible consultation later, she says. “The only way to develop that bond of trust is to spend time talking with various religious leaders,” says Stevens.
Next month: Effective counseling approaches for working with religious clients.
In May, the Association for Spiritual, Ethical and Religious Values in Counseling approved its revised Competencies for Addressing Spiritual and Religious Issues in Counseling.
Culture and worldview
1. The professional counselor can describe the similarities and differences between spirituality and religion, including the basic beliefs of various spiritual systems, major world religions, agnosticism and atheism.
2. The professional counselor recognizes that the client’s beliefs (or absence of beliefs) about spirituality and/or religion are central to his or her worldview and can influence psychosocial functioning.
3. The professional counselor actively explores his or her own attitudes, beliefs and values about spirituality and/or religion.
4. The professional counselor continuously evaluates the influence of his or her own spiritual and/or religious beliefs and values on the client and the counseling process.
5. The professional counselor can identify the limits of his or her understanding of the client’s spiritual and/or religious perspective and is acquainted with religious and spiritual resources, including leaders, who can be avenues for consultation and to whom the counselor can refer.
Human and spiritual development
6. The professional counselor can describe and apply various models of spiritual and/or religious development and their relationship to human development.
7. The professional counselor responds to client communications about spirituality and/or religion with acceptance and sensitivity.
8. The professional counselor uses spiritual and/or religious concepts that are consistent with the client’s spiritual and/or religious perspectives and that are acceptable to the client.
9. The professional counselor can recognize spiritual and/or religious themes in client communication and is able to address these with the client when they are therapeutically relevant.
10. During the intake and assessment processes, the professional counselor strives to understand a client’s spiritual and/or religious perspective by gathering information from the client and/or other sources.
Diagnosis and treatment
11. When making a diagnosis, the professional counselor recognizes that the client’s spiritual and/or religious perspectives can (a) enhance well-being, (b) contribute to client problems and/or (c) exacerbate symptoms.
12. The professional counselor sets goals with the client that are consistent with the client’s spiritual and/or religious perspectives.
13. The professional counselor is able to (a) modify therapeutic techniques to include a client’s spiritual and/or religious perspectives and (b) utilize spiritual and/or religious practices as techniques when appropriate and acceptable to a client’s viewpoint.
14. The professional counselor can therapeutically apply theory and current research supporting the inclusion of a client’s spiritual and/or religious perspectives and practices.
Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at firstname.lastname@example.org.