As a counselor in a group supported by a church, I regularly encounter clients who want to discuss spirituality, or who even want spiritual guidance, assuming that because the counseling department is located within the church building, all the counselors are equipped to be spiritual leaders.
The situation can cause ethical concerns, especially considering Standard A.4.b. of the 2014 ACA Code of Ethics: “Counselors are aware of — and avoid imposing — their own values, attitudes, beliefs and behaviors.” The struggle emerges when clients want to discuss spirituality. Although I wish to stay clear of this topic, it can be misinterpreted as my being uninterested or avoiding the topic, which can lead the client to feel disrespected or unimportant. At the very least, the scenario is challenging.
The role of a counselor becomes blurred if too much emphasis is placed on spirituality; in the client’s eyes, the representation of the counselor’s job changes. For instance, the use of prayer can be risky, perhaps setting the counselor up as an “expert” in addressing God and conveying personal beliefs in the wording or delivery. There may be drastically differing belief systems between the counselor and the client, which could potentially damage the relationship. How can I address this situation so that the client’s beliefs and values are respected, while at the same time I follow my ethical code?
In his book Spiritual Practices in Psychotherapy: Thirteen Tools for Enhancing Spiritual Health (2009), Thomas Plante gives some very thoughtful suggestions on using spirituality in one’s practice. I have listed them here, followed by my personal experience of working with them in my practice.
1) Become aware of your cultural competencies.
I have learned not to be afraid to admit when I am unfamiliar with a client’s belief system. As with all clients, I strive to be respectful and sensitive to them and make notes to guide myself in learning more. Research, research, research: The internet is a treasure trove of information. Take advantage of programs offered by different faiths and different cultures. For instance, in a larger neighboring city, several annual festivals are held that highlight Native American, Hispanic, Asian and Greek cultures. Food, ritual, and crafts abound, and the experience lessens anxieties when working with other races.
In my graduate multicultural course, I was required to experience a different cultural setting. I attended the Hispanic mass at a Roman Catholic church. The mass was in English and Spanish, but the hymns were all Spanish. A little boy helped me sing by pointing to the words as they came up. It was a warm and uplifting evening, showing the importance of faith and family and giving me a new picture of that culture.
2) Take advantage of available resources and programs to increase your knowledge base.
Although I may be a church-based counselor, my job is not to promote my own belief system but rather to be available to hurting people. Learning about these clients’ cultures and beliefs assists me in becoming a better counselor. I mentioned some ways to connect in the previous paragraph, and looking for more opportunities around your area can be a fun way to expand your family’s knowledge too.
3) Consider religion to be like any other type of diversity.
Removing the emotion that can be attached to religion frees me to see it as just another facet of the client, just like race or sex. In fact, it can help me form a more objective view of the client’s total perspective. The ACA Code of Ethics emphasizes the need for counselors to honor diversity and adopt a multicultural approach to treating clients. Spirituality is a part of that diversity.
4) Consult colleagues.
I am fortunate to have three other counselors who are available for “brainstorming” sessions, and I receive differing viewpoints and possible approaches from them. Additionally, the American Counseling Association offers a wealth of resources on its website (counseling.org) that can guide counselors in learning more about multicultural counseling.
At times, the questions raised by clients are above my expertise. For example, one client questioned why she had not been given the desires of her heart when the Bible plainly states they will be granted. With her consent, I emailed the senior pastor and asked for his guidance. His answer was considerate and timely and gave her comfort in the situation.
Additionally, my mentor has a degree in theology, in addition to his counseling degree, and is always available for my queries. Clients appreciate that I will go the extra mile in exploring a matter that has so much importance for them and that I consult with reliable sources. It enhances the counseling relationship.
At times, the problem is deciding whether spirituality works in the treatment plan designed for a client. In his article, “A Qualitative Exploration Into How the Use of Prayer in Counseling and Psychotherapy Might be Ethically Problematic” (2009), Peter Madsen Gubi presented four words that can assist in deciding whether to include spirituality. He refers to it as EBQT, an easy way to remember his guide.
Evidence: Does enough quality evidence exist to support a spiritual adjunct to therapy? For me, this would be the amount of importance the client attaches to his or her spirituality and beliefs. Another decision-making took is determining whether the presenting problem includes a struggle with spirituality, which happens quite frequently in the church setting.
Belief: Is there congruence between the client’s beliefs, the counselor’s beliefs and the relevance of therapy? I see this as meaning do we both agree on the necessity of inclusion, and does respect exist for differing viewpoints? This is where knowledge and respect come into play. I must examine my own beliefs and biases to provide the best care for my client.
Quality: Will this improve the quality of care for the client? Does it enhance or detract? Will it derail what has been accomplished? Will it derail where counseling is supposed to take the client to accomplish his or her goals? I must be brutally honest on this point and be sensitive to where the client leads, not where I want to go.
Time: Can the component of spirituality be addressed in the time constraints of the session, with respect to the client? My sessions are 50 minutes in length. At times, addressing a spiritual problem can take the whole session, or a session might even have to be ended before crucial questions are addressed. I don’t have the luxury of allowing the session to run over because of other scheduled clients. This can be a real concern.
One last consideration does not apply to me but may to other people. Addressing components of spirituality can be tricky when dealing with third-party payers (insurance) because, generally, it is not reimbursable. We do not accept insurance at my church, but many other church-based counseling groups do. The treatment plan must be grounded in applicable theory, with goal-oriented, measurable results, to be reimbursed by insurance. Spirituality may be mentioned, but other treatment options must be included in filing claims. This is another time when consultation with peers is most helpful. Experience is the best teacher.
These recommendations have served me well for the past three years of practice. They have kept me on target and allowed me to provide the highest-quality attention to my clients’ needs without the input of my own beliefs. By following these shared techniques, it is my hope that your own practice will be strengthened and improved.
Jane Joyce is a licensed professional counselor and doctoral candidate at Carson-Newman University in Tennessee. She is a counselor with LifeSource Counseling, First Baptist Church, Morristown, and an assistant to Dr. William Blevins at the Blevins Institute for Spiritual and Mental Health of Carson-Newman. She retired in 2014 from the Tennessee State Board of Probation and Parole after 25 years and began her second career. Contact her at firstname.lastname@example.org.
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