Tag Archives: Spirituality and Religious Values

Spirituality and Religious Values

Helping clients navigate religious trauma

By Diane Walsh and Gillian Koch November 15, 2023

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New Africa/Shutterstock.com

As counselors, we seek to support others in their search for meaning, wholeness and healing. This journey can lead us to work with clients who have had various experiences — both positive and negative — with religion and spirituality. Therefore, we must be prepared to address issues of religion and spirituality when appropriate, especially for those who have survived religious and spiritual trauma.

Many researchers in the social sciences describe religion as a shared set of practices and beliefs and spirituality as a personal relationship with God(s) or a Higher Power. Based on this understanding, an individual could experience spirituality through organized religion, be spiritual but not religious, or participate in religion but not be spiritual. According to the Pew Research Center, 63% of individuals in the United States identified as Christian, 9% identified as a member of a non-Christian religion and 29% identified with no religious tradition in 2021. An increasing number of individuals are leaving the religion they were raised in or not identifying with any religious tradition due to changing beliefs or finding community elsewhere.

Significant life events can shape a person’s spiritual and religious identity. In a recent study on religious trauma, published in the Socio-Historical Examination of Religious and Ministry in 2023, Darren Slade and colleagues found that “likely that around one-third (27-33%) of U.S. adults (conservatively) have experienced religious trauma.” Although no known studies have been done to determine the number of individuals who leave a religious tradition after experiencing religious/spiritual trauma, religious/spiritual trauma can deeply affect how individuals identify with and experience their own religion and spirituality. Understanding clients’ spiritual experiences is a critical part of engaging in multiculturally competent care, especially as research indicates that religion and spirituality can impact meaning making, worldview, social connections, physical and emotional health, and more.

The Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of the American Counseling Association, identified 14 competencies across six areas for addressing religion and spirituality in counseling. These competencies are a helpful framework for understanding ethical ways to address religion and spirituality in counseling when appropriate. The competencies include standards related to basic knowledge of religion and spirituality, awareness of how they may impact a client’s worldview, self-awareness on the part of the counselor and use of appropriate treatment methods in counseling. These competencies are of particular importance when working with survivors of religious/spiritual trauma to avoid further traumatization or inappropriate care.

The impact of religious/spiritual trauma

Religion and spirituality can have a positive impact on overall well-being, but they can also be harmful, damaging or traumatic. Lisa Ruth Oakley and Kathryn Susan Kinmond conducted a study on spiritual abuse and Christian adults in the United Kingdom and found that almost 75% of individuals felt “damaged by a church experience.” (Their findings were published in the Journal of Adult Protection in 2014.)

Religious/spiritual trauma is similar to other types of trauma, and it can overlap or co-occur with physical, sexual or emotional trauma. However, religious/spiritual trauma can be a particularly life-altering experience because religion and spirituality are often lenses through which people view the world. Religious/spiritual trauma can thus impact a person’s sense of identity, their core beliefs and values, and their perception of safety in the world. Moreover, it can deeply alter or damage an individual’s relationship and previous understanding of that which they consider to be sacred.

In a 2022 systemic review published in Spirituality in Clinical Practice, Heidi Ellis and colleagues reviewed 25 studies on religious/spiritual abuse. They identified three common elements of religious/spiritual trauma: misuse of power by religious/spiritual leaders, psychological harm and spiritual harm. Religious/spiritual trauma can be particularly painful when it desecrates core values or co-occurs with other types of trauma, such as sexual or physical trauma. It can also severely impact an individual’s sense of community and relationship with others.

The review found high rates of religious/spiritual trauma across many populations and locations, including the United States, Canada and the United Kingdom, but it indicated that certain populations may be more at risk for experiencing this type of trauma. For example, the review included a doctoral dissertation by Brian Simmons that analyzed data from almost 300 individuals who identified as LGBTQ+ and were either current or former members of The Church of Jesus Christ of Latter-day Saints. Simmons’ study found that almost 90% of participants met components of the diagnostic criteria for posttraumatic stress disorder due to spiritual trauma. This finding contrasts sharply with Slade and colleagues’ 2023 study that suggested 1 in 3 adults experience religious trauma.

Although the Diagnostic and Statistical Manual of Mental Disorders does not distinguish diagnoses based on the type of trauma a client experienced, conversations about religious/spiritual trauma have been occurring in the larger community of mental health professionals. For instance, Marlene Winell, a licensed psychologist, used the term “religious trauma syndrome” to describe the various symptoms that might emerge when an individual leaves a fundamentalist or manipulative religious tradition. Individuals who leave such religious traditions may have to navigate situations and their beliefs in new ways, including their understanding of the Transcendent and personal salvation or even deciding how to dress or talk to others.

The concept of deconstruction (the process of breaking down and exploring underlying previously held beliefs, understandings and practices) can also help provide insight into the unique characteristics of religious/spiritual trauma. Through deconstruction, individuals may leave their faith tradition entirely or emerge with a newfound strength and religious conviction, but the process itself can be highly challenging and requires reconstruction of personal identity and beliefs.

Many common symptoms occur across types and experiences of trauma, including psychological distress, intrusive memories of the trauma and heightened levels of arousal. Religious/spiritual trauma not only affects individuals’ physical, mental and emotional well-being but also their spiritual well-being. Because religious/spiritual trauma can deeply impact clients’ mental health, counselors have a responsibility to develop the knowledge, skills and awareness to support clients who have experienced this type of trauma.

Working with clients experiencing religious/spiritual trauma

Like with other forms of trauma, individuals who experience religious/spiritual trauma vary in their responses and reactions. Some clients may try to preserve their previously held religious/spiritual beliefs, while others may change or abandon their beliefs. As counselors, we may see clients who are conflicted or who do not know how they want to respond to the religious/spiritual trauma.

As with any traumatic experience, we first work collaboratively with clients to establish safety and healing. But there are a few other ways we can ensure we are providing effective care for clients who have experienced religious/spiritual trauma. In the following sections, we highlight key components of care for clients who have experienced religious/spiritual trauma. We also offer examples of specific language counselors can use in session with clients.

Cultivate safety through a trauma-informed approach. When clients have experienced religious/spiritual trauma, they often have a natural and automatic instinct toward self-protection and preservation that may be expressed as guardedness within the therapeutic space. Counselors must carefully consider how they build the therapeutic relationship and create safety with this population. Seemingly small considerations such as asking permission and allowing clients a sense of control can have a significant impact.

For example, counselors can get a client’s permission before asking questions about the trauma: “I’m curious about how that experience felt to you. Would you feel comfortable sharing more about it?” They can also allow clients to decide where to sit in session: “It’s great to see you today. Feel free to sit wherever feels most comfortable.” Or they can validate and let clients have a sense of control and ownership over their experiences: “That experience sounds really heavy. Where are you now emotionally?”

Perform an initial and ongoing assessment of risk. It is extremely important for counselors to assess the client for risk of suicide, self-harm and other safety concerns. This risk assessment should be conducted during intake and accompanied by appropriate follow-up assessments, including assessing if the client is at risk for further religious/spiritual trauma. The client may not be ready to dive into the details of the religious/spiritual trauma, but it is helpful to get a broad sense of what the trauma is, how the client understands the religious/spiritual trauma and where they currently are regarding their personal religion or spirituality.

For example, if a client has experienced trauma perpetuated within a specific religious community, a counselor can assess the client’s current level of engagement in that community by saying, “I hear how important that community was to you at that time. What’s your involvement like now — and how do you feel about it?” Then, it may be helpful to explore with the client the impact of their engagement, including if continued engagement may lead to increased risk of religious/spiritual trauma.

Other areas of assessment include the client’s symptoms such as emotional or physiological experiences, feeling of shame or detachment, and levels of reactivity. Counselors can broach these topics by saying, “How does it feel to talk about what happened? When you talk about the experience, does it feel like you’re telling a story or like you’re reliving the story?” or “That experience sounds so challenging. Which part of the story is the hardest for you to hold right now?”

Remember, regulation before intervention. Clients who have experienced any trauma (including religious/spiritual trauma) may experience symptoms of nervous system dysregulation throughout their daily lives. These symptoms may intensify during the therapy session, especially when discussing the trauma(s) they have experienced. Thus, it is important to make sure clients are not experiencing overwhelm or flooding in the therapy space because this will inhibit the client’s ability to experience the clinical interventions as intended. Grounding and mindfulness interventions (such as progressive muscle relaxation, 5-4-3-2-1 sensation naming activities or gentle stretching) can be helpful when working with this population. It can also be useful to develop a common language with your client so that you can remain attuned to their level of distress throughout the session. This can take the form of hand gestures, a subjective units of distress scale or code words — anything that allows the client to quickly and accurately communicate their level of distress so that the counselor can adjust the clinical intervention as needed.

For example, the counselor may tell the client, “I want to support you as much as possible as we talk about your past experiences. Let’s imagine a 10-point scale, with 1 being the least distressed (e.g., peaceful, at ease, relaxed) and 10 being the most distressed (e.g., angry, anxious, upset). We’ll use this scale throughout our work together so that I can stay attuned to how you’re feeling; I really care about that. Using that scale, where is your level of distress right now?”

If the client shares something about the traumatic experience in session, the clinician could say, “What you just said felt really impactful. Can I check in with you quickly? Where’s your distress level right now on a scale of 1-10?” If the client says they are at a 7, then the counselor could respond, “Thanks for letting me know you’re at a 7. Would it help to pause the story and do some grounding exercises? I can give you a few options to pick from if that’s helpful.”

Considerations for counselors

Working with clients with religious/spiritual trauma requires counselors to develop specialized skills and self-awareness as well as be trauma informed. To provide the best care for these clients, practitioners should not overlook the following four clinical considerations:

  • Learn trauma modalities. There are many trauma theories and techniques available for counselors to learn. Most evidenced-based trauma therapies share two primary common factors: First, they provide a corrective emotional experience for clients through a supportive, genuine and boundaried therapeutic relationship. Second, they include an exposure component while remaining respectful of the client’s pace. In some modalities, the exposure component takes a narrative form, and in others, it is conducted via an exposure hierarchy that includes imagined or in vivo exposure to triggers. As with any trauma treatment, it is crucial that pacing be closely monitored by the clinician to ensure that the client is receiving a level of treatment that is challenging but not overwhelming to prevent accidental traumatization. There may be some situations in which exposure work is not appropriate for clients, so counselors need to engage in critical case conceptualization, collaborative decision-making and consultation when determining treatment options. It is imperative that counselors receive thorough and complete training as well as ongoing support for the trauma modalities they practice.
  • Understand personal worldview and religious/spiritual experiences. Throughout the process of working with clients who have experienced religious/spiritual trauma, counselors may also experience different feelings, emotions and expectations. It is crucial that counselors manage and identify potential areas of countertransference. This is especially true when considering how the counselor’s own experiences of religion and spirituality could impact their work with the client. Bracketing is one tool counselors can use to manage their own experiences; Michael Kocet and Barbara Herlihy, in a 2014 article on ethical decision-making published in the Journal of Counseling & Development, defined ethical bracketing as a practice in which a counselor intentionally sets aside their beliefs and personal views when working with a client. In alignment with the ASERVIC competencies, counselors also need to understand different religious/spiritual traditions and perspectives outside of their own to avoid assumptions or generalizations. Clients experiencing religious/spiritual trauma may not be able (or ready) to leave the environment in which they experienced trauma. In these situations, taking a harm reduction approach can help clients explore ways to increase their safety while feeling understood and supported by the counselor.
  • Foster resilience. Burnout, compassion fatigue and vicarious trauma are risks for counselors engaging in trauma work. However, an emerging body of research also suggests that counselors may experience vicarious resilience and other positive impacts from witnessing posttraumatic growth and resilience in clients. Using a wellness-focused and strengths-based model can help build resilience in both the survivors we work with and in our own personal lives.
  • Take care of yourself. Because trauma work can be challenging, we encourage counselors engaging in this work to actively care for themselves. Supervision and consultation are vital, especially when working with clients experiencing religious/spiritual trauma. These spaces can facilitate growth in clinical skills as well as the development of professional support networks. In addition to supervision and consultation, self-care is key to preventing compassion fatigue, vicarious trauma or burnout. When a counselor is grounded in their own life’s peace and meaning, they are better able to create a space for clients to cultivate these in their own lives.

Religious/spiritual trauma is unique in its ability to uproot even the most deeply held beliefs in a person’s life, including those related to self, identity, religion, spirituality and the world. Working with clients who are navigating through religious/spiritual trauma can be challenging, but if counselors take the time to gain awareness and develop the clinical skills needed to help this population, then the work can be a profound and meaningful experience for both the client and the counselor.

 


headshot of Diane Walsh

 

Diane Walsh is an assistant professor of counseling at McDaniel College in Maryland. She is a licensed graduate professional counselor who maintains a small caseload of clients. Her research areas of interest include religion, spirituality, social class and counselor education.

 

headshot of Gillian Koch

Gillian Koch is a licensed professional clinical counselor in Minnesota. She served as president of the Minnesota Counseling Association for two years and is currently serving as the board’s past president. She works in private practice and specializes in supporting health care professionals as well as folks experiencing grief and loss.

 


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Incorporating clients’ faith in counseling

By Lisa R. Rhodes November 2, 2022

A South Asian Muslim woman in her 20s lives at home with her Muslim family and has been struggling in her relationship with her parents. She feels they interfere with her ability to make decisions for herself and treat her like a child.

The woman decides to go to therapy. After listening to the client talk about the issue, the counselor says, “If you move out, this will no longer be an issue.” But this advice was not helpful, and this woman sought out a different clinician, which led her to Nadia A. Aziz, a licensed professional counselor (LPC) at the Empowerment Therapy Center in Manassas, Virginia.

“The client felt the counselor wasn’t informed on how to deal with issues in a culturally informed manner,” Aziz recalls. “The counselor failed the client by not incorporating [her] values” into treatment.

In South Asian cultures, which embrace the spiritual teachings of Islam, Hinduism, Sikhism and Buddhism, it is expected that adults live at home with their families until they either get married or move away for work or college, explains Aziz, who is South Asian and Muslim.

“A counselor suggesting moving out of a family’s home would be insensitive to the [client’s] cultural and religious needs because the client was not able to move out and it wasn’t a realistic expectation,” she says. 

 Aziz, a member of the American Counseling Association, worked with the young woman in therapy to set healthy boundaries and develop assertive communication skills so she could express her feelings and needs to her parents in a way that was respectful of her family’s cultural and religious beliefs.

An evolving practice

This scenario is an example of what many clinicians fear — not knowing how to respond to the religious and spiritual needs of a client. J. Scott Young, a licensed clinical mental health counselor and professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro, says his research on religion and spirituality in counseling, which includes conducting counselor surveys, shows that many mental health professionals feel anxious and uncertain about incorporating a client’s faith into therapy.

“They don’t want to do anything unethical,” Young explains. “They’re worried that they don’t know what to do to help people with [these] issues.”

The uneasiness counselors feel stems from a long history of prohibiting the intersection of religion and spirituality in the therapeutic process. In the third edition of Integrating Spirituality and Religion Into Counseling: A Guide to Competent Practice (published by ACA), Young and Craig S. Cashwell point out that “religion has long been a highly controversial topic in the mental health disciplines.” They also note that Sigmund Freud and B.F. Skinner, two pioneers of psychology, considered religious and spiritual belief systems to be frivolous.

However, the counselors interviewed for this article all agree the counseling profession, and the mental health field in general, has evolved over the years to regard religion and spirituality as important additions to counseling education and practice. And they stress that with the proper education, training, and focused introspection into their own religious and spiritual beliefs, counselors can effectively bring a client’s faith into the therapeutic process, if that is the client’s desire for treatment. 

In 2009, the Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of ACA, developed the Competencies for Addressing Spiritual and Religious Issues in Counseling to serve as a guideline for counselors seeking to incorporate a client’s religion and spirituality into practice. The competencies work in tandem with the ACA Code of Ethics.

Jesse Fox, an ACA member and the current president of ASERVIC, says evidence-based research into the importance and efficacy of religion and spirituality have made them topics for therapeutic exploration. 

“The evidence base for interrelationships between spirituality, religion and mental health has grown exponentially,” says Fox, an associate professor of counselor education at Stetson University. “In the most recent systematic review in 2012 produced by Harold Koenig at Duke University Medical School, there were over 3,000 published peer-reviewed studies documenting the connection between spirituality, religion and health. In fact, the number of studies grows exponentially every year.”

This empirical work has mapped out how these domains — religion, spirituality and health — of human experience function psychologically, he explains. 

“The net effect is that mainstream mental health models have recognized that spirituality needs to be considered alongside of other dimensions of wellness like emotional health or physical health, as well as intersectional models of identity like race and sexuality,” Fox says.

Religion and spirituality continue to be important to many in the United States. According to a 2022 Gallup Poll, 81% of U.S. adults believe in God. Statistics such as this, Fox says, suggest that religion or spiritual matters will likely be “an aspect of a client’s identity” in counseling.

Young, an ACA member, says research has shown that people who have a faith or religious commitment that supports them tend to experience less anxiety and depression, more stability in their primary relationship, and more stability and commitment in their work and career. This commitment “seems to be sort of a buffer against some of the stressors that they might otherwise face,” he explains. “And if that’s that case, [it] sort of helps to support their mental health as well.”

People often use spirituality or religion to make meaning of their lives, notes Young, who treats clients at Triad Counseling and Clinical Services PLLC, which has offices in High Point and Greensboro, North Carolina. “In counseling, we talk to people about their childhood, their parents, their family drama … [and] their sex life — all these are very personal things for people,” he says. “At times counselors are hesitant to discuss spirituality or religion for fear that it is too personal or that they may misstep.” 

Know thyself, know the client 

The counselors interviewed for this article say that before attempting to bring a client’s faith into therapy, counselors should thoroughly explore their own religious and spiritual beliefs, or the lack thereof.

“If counselors have not taken the time, or realized the importance of taking the time, to know themselves — their values, their beliefs, their own spirituality and religious preferences — then that’s not going to be a good match for clients who have needs in that area,” says Amy Evans, a licensed professional clinical counselor in Minnesota. 

“The challenge is making sure we do not push our own values, worldview and perspectives on our client,” Evans stresses, which is something both the ACA Code of Ethics and ASERVIC competencies make clear counselors should not do. “To make sure we’re not doing that, we have to know ourselves,” she adds. 

Aziz says she was able to explore her religious and spiritual identity in undergraduate and graduate school, where she took courses in multicultural counseling and faith-based counseling, as well as other classes that encouraged self-discovery, self-awareness, and exploring one’s own values and biases in the realm of religion and spirituality.

Justin K. Hughes, a LPC in Dallas who offers religious/spiritual integration, most commonly for Christians, says he learned important tools for bringing a client’s faith into treatment from his own experience receiving counseling as an undergraduate student and from the counselors he worked with during his Christian seminary training and clinical internship. 

Hughes, owner of Dallas Counseling PLLC, says these mental health professionals set the model for him by being respectful and humble and always asking questions to assess his needs and learn more about his religious and spiritual experiences. He says he now mirrors these traits in his own practice. 

Faith and self-disclosure

While it is important for counselors to feel comfortable with their own faith and belief systems, the counselors interviewed for this article agree that it is not necessary for clinicians to share this part of their lives with clients. If clients do inquire about their faith, they advise clinicians to be thoughtful in how they respond. 

Young, a past president of ASERVIC, says he doesn’t discuss his spiritual views in session unless the client brings up the topic, and even then, he is careful not to divulge too many details. 

“I have, on occasion, had a client who really wanted to know how I see these things, so I always preference [my response] with ‘We’re here for you,’” Young explains, noting that he will then try to explore what salience religion and spirituality holds for the client and what the client may be trying to learn by asking about his beliefs. 

Lemonsoup14/Shutterstock.com

 “I do not try to deflect or redirect if they are truly curious,” Young says, “but I do want to understand why it is important for them to know my beliefs.”

Aziz says her faith is evident in the photograph she posts on Psychology Today’s directory of mental health providers and her practice’s website. “I wear the head scarf, the hijab, [so] it’s kind of hard to miss,” she says. “A lot of times I do get contacted through those avenues, so I am implicitly disclosing that I am Muslim, and they are looking for a Muslim therapist.”

If clients inquire to know the specifics about her faith, Aziz says she always brings the discussion back to what the client is looking for and what they need in treatment. Although a discussion of Aziz’s faith may sometimes be helpful in building rapport with a client, she is mindful that it is not relevant to the therapeutic process. 

“A lot of times it is [about] setting boundaries with them,” she says, “and making sure they understand that the counseling session is not about me, it’s about [them], keeping the focus on them.”

Hughes, who specializes in treating obsessive-compulsive disorder (OCD), anxiety and related disorders, is a member of the International OCD Foundation, which has been examining the role of religion and spirituality in the treatment of OCD during the past couple of years. 

Hughes says he is “usually fairly open about being a Christian” with clients if they bring it up. For example, some of his clients have asked, “Are you a Christian?” “Would you be willing to pray with me?” and “I’m not very religious. Are you OK with that?” He only provides specific information if he feels it will be a therapeutic benefit for the client, which he notes varies case by case.

Counselors do not have to share the same religious or spiritual beliefs as their clients to be effective in therapy, yet for some clients, having a match in faith may matter to the client. Evans, an associate professor and program director of the master’s in counseling program at Bethel University in St. Paul, Minnesota, says research shows that what matters in practice is the quality of the therapeutic relationship and the counselor’s responsiveness to the client. 

“If a counselor is trained well and really considers the client’s worldview, culture and values — then that can be helpful to the [therapeutic] relationship,” says Evans, an ACA member. A counselor’s training and ability to modify therapeutic techniques to meet the client’s needs is what is most helpful in practice, she stresses, not the counselor’s faith.

Young acknowledges that a counselor’s faith may be important for some clients. If there’s not a match in faith, it may be barrier for some clients who may not feel as safe in the relationship as they should, he explains. But “as long as the counselor is open and meeting the client where they are [and] they’re not anti-religious or struggle with it themselves,” Young says, “it really shouldn’t make much of a difference.”

Broaching the topic

Counselors must first determine a client’s therapeutic needs to find out if they would like to include their faith in counseling. The counselors interviewed for this article suggest bringing up the topic of religion and spirituality in the first session and including it on intake forms. 

“One of the most important things is to … broach the topic,” Evans says. “If we don’t let clients know it’s OK to talk about it [religion and spirituality], they may not know it is acceptable to bring it up.”

Evans says counselors should also inquire about a client’s faith on the intake form. Then during the first session, they can ask open-ended questions in response to what clients have shared on the form. Evans provides a few examples of things counselors can say to initiate this conversation: 

  • It sounds like your spirituality/religion is important to you. 
  • How might you envision bringing your spirituality/religion into the therapeutic work we are doing?
  • You mentioned that spirituality/religion is an important part of your life. How might it relate to the therapeutic goals we have agreed to focus on?

Evans says partnering with the client to agree on goals, including goals surrounding the client’s faith, helps builds the therapeutic relationship so it can be effective and have positive outcomes for the client.

Aziz also brings up the client’s faith during the intake process. “I ask [clients] if there is anything they want me to know about their cultural or religious beliefs and if they are looking for faith-based counseling,” she says. 

Aziz notes that about 70% of her clients are South Asian and follow the teachings of Islam, Hinduism, Sikhism or Buddhism, and about 30% are from a different cultural background or faith. So she first works with clients to help them identify their own values. “That gives me a better understanding of what they’re looking for in session, and I tend to take the counseling sessions in those directions,” she says. 

Blending faith and counseling

Once counselors assess the religious or spiritual needs of the client, or the lack thereof, they can work with the client in treatment to resolve any issues or explore new insights. Young says bringing a client’s religion or spirituality into practice should be a collaborative process that is not one size fits all. 

One approach, he continues, is to ask open-ended questions that explore the client’s thoughts and feelings around their religious or spiritual practices and traditions. For example, he says counselors could ask:

  • When or where do you feel most connected to the larger whole?
  • What brings you the greatest sense of peace in your life?
  • What rituals, if any, do you practice that bring you comfort (prayer, meditation, walks in nature, etc.)?
  • Have you thought about using these rituals or practices to help resolve problems?
  • Do you have an understanding about a higher power? How is this helpful to you?

Evans co-authored, along with Jennifer Koenig Nelson, an article exploring adapting counseling to clients’ spirituality and religion, which was published in Religions in 2021. In it, Evans and Nelson argue that using the therapeutic approach of cultural humility to incorporate a client’s religion or spirituality into practice can result in positive outcomes for the therapeutic relationship and the client’s treatment goals. Citing Joshua Hook and colleagues’ 2013 article published in the Journal of Counseling Psychology, they define cultural humility as “having an interpersonal stance that is other-oriented in relation to another individual’s cultural background and experience, marked by respect for and lack of superiority toward another individual’s cultural background and experience.”

Cultural humility “relates to positive outcomes and reduces power dynamics in the [therapeutic] relationship,” Evans says. “The openness allows the counselor to step back and have the client determine what is most salient to them, rather than the counselor pushing for the client to focus on certain parts of their identity.” 

The counselor operating from a stance of cultural humility “allows for the client to determine if spirituality/religion is something important to them [or] salient to the work they are doing in counseling,” Evans continues. The client can then decide if they want their faith brought into counseling.

In their article, Evans and Nelson suggested an adaptation to Hook and colleagues’ guidelines for integrating cultural humility into therapy that focuses on religion and spirituality. Their revised guidelines are:

  • Remain humble when engaging with clients around spirituality and religion.
  • Do not assume you understand the client’s spirituality and religion based on prior training, knowledge or experiences.
  • Explore spirituality and religion with the client to determine what is positive and what might be detrimental in relation to their beliefs.
  • Remain curious about the spirituality and religion of the client as it relates to the presenting issues and ask questions when appropriate.

Aziz finds creative ways to incorporate the client’s faith into session when appropriate. If a client is having a hard time controlling their anger, for example, she may integrate the client’s religion into a breathing and mindfulness exercise to help them learn to respond to stressful situations in a healthy way. 

In this scenario, Aziz would first ask the client to come up with a word or phrase that is connected to their faith and has a calming effect. The client must be able to repeat the word or phrase with ease. A client may choose the word “patience” as their mantra for breath exercises, for example, because it reminds them of the Islamic scripture “God is with those who are patient,” Aziz says. 

She would ask the client to relax and clear their mind of any thoughts. Once the client is settled, she would ask them to take four deep breaths in through the nose, hold for a count of six and then breathe out through the mouth for a count of six. While engaging in this breathing exercise, they would focus on repeating their mantra in their mind. This exercise is a helpful way for clients to calm their body and mind and focus on inner peace, Aziz notes. 

Asking clients to select a mantra that resonates with them makes it more likely that they will follow through with the practice on their own, Aziz says, because it helps to make the practice personal to them. And that approach works with clients whether they are religious or nonreligious, she adds. 

“If the client requested faith-based counseling, they usually gravitate toward phrases that have religious significance” to them, she says, noting that she may also talk to the client about why the phrase is important to them.

The guided imagery “wise being” exercise (see lifepluswork.com/guided-imagery-wise-being) is another technique that counselors can adapt to incorporate a client’s religion/spirituality, Aziz says. This technique, she explains, allows clients to tap into their own faith and values.

Aziz begins the exercise by asking the client to imagine a safe space where they would feel comfortable having a personal conversation with someone they view as a wise being. The purpose of the conversation is to allow the client to discuss their problem or issue with the wise being without judgment and to receive guidance from the wise being on how to resolve or approach the problem, Aziz says.

“A lot of times people might pick a spiritual guide based on their faith,” Aziz says. For example, a Muslim client may select the Prophet Muhammad, a Christian client may select Jesus Christ or a Buddhist client may select Buddha.

After the client selects their wise being, Aziz asks them to imagine the guide walking toward them to begin the conversation. “It is almost a spiritual moment for them to have this conversation,” she notes. They “may have felt the presence of their spirit guide” during this exercise. And the exercise often provides clients with clarity or helps lead them to what they want to discuss in counseling, she adds. 

Aziz leaves the decision to share the details of this conversation with her up to client. Sometimes, it takes clients a few sessions before they are ready to share what they felt or experienced in that moment, she says. 

If a client chooses to discuss the exercise with her, Aziz often asks, “Why do you think [the] wise being said what they said?” Then together they process the client’s feelings about the wise being’s message and its meaning. She asks, “How are you going to incorporate [the wise being’s advice] into your life?” 

Overcoming challenges

Integrating a client’s faith into session may not be easy for some clinicians. Young reminds counselors that they don’t have to be an expert on a client’s religious or spiritual beliefs to be effective.

“Counselors don’t have to have the answers for [a] client’s faith questions,” he says. “It is an important part of faith development for people to struggle with questions that do not have clear answers.”

Young advises counselors to remember that staying present for the client, being curious about their experience and not projecting their own values onto the client can help to navigate the ups and downs of practice if they are focusing on a client’s faith or another area of the client’s life. 

Hughes says counselors must be willing to meet challenges and make reasonable mistakes when bringing a client’s faith into practice, and they must be willing to use compassion to correct themselves. But when counselors deal with religious and spiritual sensitivities, they don’t feel they have any space for errors.

Counselors don’t want to violate the code of ethics, Hughes says, but even if they’re doing therapy competently, they may sometimes ask irrelevant questions or make a human gaff. For example, he once worked with a Jewish client who often brought details about her faith into therapy. But when he attempted to define the Hebrew word “shalom” in reference to the client’s therapeutic goals, the attempt “fell flat,” he recalls.

“I have studied some of the original Hebrew and knew what I was talking about technically,” Hughes explains. But the client “corrected me from her personal understanding, and because I am neither Jewish nor living her life, she had the right to define what the word meant to her in relation to her goals.” This exchange highlights the need for communication and questions as well as the importance of never taking things for granted, he adds.

Fox, executive director of the Episcopal Counseling Center in DeLand, Florida, says navigating a client’s faith can be challenging for counselors when they realize the diversity of religious and spiritual perspectives. 

“You encounter a myriad of worldviews, practices, frameworks of meaning, [and] it can be daunting about where to start,” Fox says. It can be hard for counselors to “discern when a client’s religious or spiritual life has become unhealthy,” or if the real dangers of imposing their values onto the client have become evident, he adds.

Fox and Aziz recommend counselors find a mentor or supervisor or seek additional training if they have questions or want guidance on discussing faith with clients. “I think there’s a lot of benefit to talking to colleagues and supervisors [to get] a different opinion or view of things,” Aziz says.

Be curious

The counselors interviewed for the article agree that clinicians should take advantage of opportunities through professional channels and in their community to learn more about the diversity of religious and spiritual traditions of their clients.

“We learn best by engaging with individuals who are different from us,” Evans says. “Get out there, get to know people, … and be curious.”

She suggests attending different religious services and reaching out to local religious leaders who are open to sharing information about specific religious and spiritual practices.

“[Do] what makes sense clinically,” Evans says. “Start exploring things. … Take the time to be curious and investigate and interact with people outside [your] regular circle.” 

Most professional trainings about religion and spirituality are Christian in nature, Aziz notes, so counselors who are seeking guidance about other religious or spiritual traditions should consider reading books or researching multicultural blogs. 

Evans, Fox and Young recommend counselors take advantage of the resources offered by ASERVIC, including Counseling and Values (their official publication and one of the oldest peer-reviewed journals on the topic of spirituality and religion), their annual conference and webinars. 

Fox serves as co-investigator of the Spiritual and Religious Competency Project (srcproject.org), an initiative funded by the John Templeton Foundation, which aims to provide mental health professionals with basic competencies to address the spiritual and religious aspects of their clients’ lives. His team of researchers are “testing methods of training mental health professionals in spiritual and religious competence” and are tracking how mental health professionals may utilize this training nationwide. They are also “using implementation science to discover the best ways to make this type of training more likely to happen in mental health care in the future,” he says.

The project’s early research has found that more mental health training programs are open to including religious and spiritual studies, but staff lack the training to confidently teach and supervise students, Fox explains.

“Over the next five to 10 years, we are hoping that through our efforts we see this gap close so that every client who brings religion and spirituality into their counselor’s office will be met with competent help,” he says. 

Young is also hopeful about what the future holds for the integration of religion and spirituality within counseling. He says the more research that is done in this area and the more conversations that takes place among counselors, the more possibilities there are to expand the reach of religion and spirituality in clinical practice for the benefit of clients.

 

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Working with clients who are angry at God

By LaVerne Hanes Collins May 11, 2021

What, exactly, are we to expect from God? What is God’s role in the human experience? What’s a counselor to do when a client is angry at God?  

In 2020, 48% of Americans surveyed by Gallup said that religion was “very important” in their life, and an additional 25% said that religion was “fairly important.” Only 27% said that religion was “not very important” in their life. 

Among the 73% who answered that religion was very important or fairly important to them, there are undoubtedly a variety of beliefs about what a person should expect, or not expect, from God. Those deeply personal expectations can be dynamic as they are shaped throughout the life span, evolving and changing over time. 

As a licensed clinical mental health counselor trained in Christian thought and faith-based counseling approaches, I’m used to my clients coming to my office with a range of definitions for faith, religion and spirituality. They come with varied beliefs and assumptions about God. These have typically been shaped by family tradition, religious institutions, influential friends and thought leaders, their own singular experiences and interpretations, or by any combination of these factors.  

I recognized early in my career that people sometimes become angry at God when there is a discrepancy between their expectations and their experiences. I was already an ordained minister when I went into counseling, but I knew that I needed more training to be effective with faith-based concerns. So, after receiving my master’s degree in community counseling, I earned a doctorate in Christian counseling so that I could help people work through issues of faith and spirituality. 

Clients usually come to me because of something painful and unexpected: any kind of loss; a misfortune; an untimely death; a miscarriage; a broken marriage; a sick child; an economic or job-related crisis; an abuse, assault or robbery; a health crisis; an injustice; a natural disaster; or any other traumatic event you can imagine. Clients suddenly feel that their situation — or even their life — bears the imprint of a rubber stamp: “Goodness Denied!” It brings about an unnerving discrepancy between the individual’s expectation of a loving God and their lived reality. 

Why it’s hard to talk about anger at God

When a person experiences a crisis or traumatic event, the initial feelings — sadness, anger, disappointment, fear — are typically about the event itself. Other powerful emotions often reflect existential questions about God’s role in their situation. Was God present (abandonment)? Why was this allowed to happen (confusion)? Then there are questions about their own feelings. Is it OK to be mad at God? Are they allowed to feel this way?

Depending upon a person’s beliefs, the thought of being angry at God, an all-powerful transcendent being, can seem rather taboo. The very mention of God suggests authority — an ultimate moral authority. So, to be angry at God can seem irreverent or sacrilegious. It may be an anger that is easy to feel but terrifying to verbalize.

Clients with a spiritual or religious worldview may come to therapy afraid of being judged for those beliefs in the same way that they fear being judged by factors such as race/ethnicity, economic status or sexual orientation. It is a sensitive area because spiritual or religious values reflect the principles upon which a person makes decisions that govern their life. Those values reflect a moral compass that provides direction for one’s views, perceptions and choices. Counselors are bound by our professional codes of ethics to respect the diversity of religious and spiritual positions held by clients. We are to regard those spiritual beliefs as elements of cultural diversity, requiring a commitment to cultural awareness and sensitivity in our counseling work.  

The painful questions

When crisis strikes, a person may tend to question God’s goodness. “God is good. What happened to me is not.” Did God cause the crisis? Why didn’t God prevent it? Why is God always loving to everyone but me?  

A 2010 Baylor University Religion Survey project suggested that a person’s expectations of God are determined by their answers to two questions. First, is God involved or uninvolved in human affairs? Second, is God benevolent and merciful toward humanity, or is God judgmental and critical toward humanity? The model that came out of this study suggested that the aspect of religion that is most relevant to a person’s mental health is the nature of their relationship with God. It’s a matter of how people see God relating to them.

Baylor University’s Paul Froese and Christopher Bader described this in their 2010 book, America’s Four Gods: What We Say About God — And What That Says About Us. They asserted that regardless of our religious tradition (or lack thereof), Americans worship four distinct types of God. First, nearly all Americans believe that God is loving. But there are significant differences in the way people view God’s involvement and God’s judgment in the world. The study said that some Americans (31%) believe in an authoritative God who is more engaged and more judgmental. Others (24%) believe in a benevolent God who is more engaged and less judgmental. There are also those (16%) who believe in a critical God who is less engaged and more judgmental. The last group represents people (24%) who believe in a distant God who is less engaged and less judgmental. 

The Baylor model has provided me with a useful paradigm for case conceptualization. When I see clients who are angry at God, it is typically because of a discrepancy between their experience and their expectation. The characteristics that they ascribe to God no longer make sense. On the other hand, when their situation is consistent with the extent to which they believe God engages and judges the world, there is less tendency for cognitive discrepancy and anger at God. 

In therapy, I give the client space to vent their anger. The way the client explains why they’re angry at God provides insight about which profile they ascribe to God. That profile essentially forms the underlying beliefs that get explored in cognitive behavior therapy (CBT).  

When the person’s complaint against God stems from something that God failed to do or failed to provide, it suggests that the person expects God to be involved in and benevolent toward the situation. They may be angry at God for neglecting to provide protection from a tragedy, for denying something that they expected to receive or for failing to heal a disease. This is inconsistent with their expectation of a benevolent God who is kind, merciful, compassionate and protective. A major cognitive discrepancy then exists.

Although people generally perceive God to be loving, some clients may question why God seems to not dole out punishment or judgment for wrongdoing. These clients may describe dismay because they expected some execution of justice, yet it seems that God is allowing someone to “get away with” something. This departs from their expectation of an authoritative God who is engaged and who also judges and punishes sin without delay. “Why did God not bring that party to justice? Why was I unjustly denied while someone else was unjustly allowed?” they ask.

Clients who believe in a distant God will see God as being uninvolved with today’s world. They may believe that God created the world through a kind of cosmic force, but they see God as now being removed from that world and simply observing from afar. For them, God set the world in motion but has remained unknowable and perhaps even mysterious. This belief suggests that God may not be paying much attention to mere mortals. When tragedy comes — to good people or to evil people — there are absolutely no answers from God. God exists, but not for the sake of involvement. 

Clients who see themselves as having created their problems may expect to go through life hopelessly. They often believe that a critical God allows punitive misfortune and is not engaged in the business of bettering human conditions for those who have morally failed. This leads to low expectations about improvement in their situation. 

So, while religious activities such as prayer and regular attendance at services have been the traditional measures of religiosity in Western culture, Froese and Bader suggest that those behaviors have little effect on someone’s reported mental health. The study found that people who believe their troubles are the result of God exacting judgment because of sin have higher levels of anxiety, paranoia and compulsion than those who believe in a caring, engaged God who will help them cope with life’s challenges.

When counselors understand a client’s image of God, they have an opportunity to explore and invite reflection upon that person’s internal beliefs and thoughts. That can be helpful to counselors in health care and disaster response because many painful issues give rise to the question of “Why me?” The most effective way of answering that question is from within that person’s view of or belief in God, not by trying to change that person’s belief (unless the person is ready to challenge their own belief system).  

A cognitive behavioral response

CBT involves the exploration of underlying beliefs that form the foundation of a person’s thoughts, feelings and subsequent actions. The Baylor study’s typologies of God in America offer four different cognitive beliefs that clients may subscribe to. Cognitive discrepancy is present when two cognitions are experienced as conflicting. One example comes from a client who said, “God is good and brings good things to our lives, but what happened in my life is not good.” Another client grieving a series of miscarriages said, “The womb is for giving life; my womb only gives death.” These statements reflect emotionally painful discrepancies between these clients’ expectations and their experiences. 

People will naturally seek information that is congruent with their beliefs. However, when their emotional pain becomes too great, they will also try to engage in dissonance reduction by avoiding information that is incongruent with the belief they want to hold on to. When they cannot find a way to retain the belief, they may abandon their faith completely. 

An alternative approach: Creation-Fall-Redemption

In my practice, clients who come from Judeo-Christian traditions have found the following reframe particularly helpful for taking God out of the four boxes. In this way of looking at problems, clients can consider and develop a theology of suffering that normalizes their pain and gives them an alternative lens for their situation.  

Creation: The sacred texts of Judaism and Christianity begin with the story of how God created the earth, everything in it, and humanity. At each stage of Creation, God paused and said it was good. God gave permissions and parameters to the man (Adam) and woman (Eve). As long as they followed God’s plan, life was blissful. They were warned, however, that operating outside of God’s permissions and healthy parameters would start a cascade of difficulties throughout the whole earth and throughout all generations. This disobedience would add the knowledge of evil to the good things they already knew and disrupt the harmony of the entire creation. 

The Fall: The second stage in the human experience was an unfortunate one, as Adam and Eve both went beyond the limitations that had been set. This is commonly referred to as “the Fall” (of humanity). Artists often portray this event as the eating of an apple, but that seems to just be artistic interpretation. The important thing to realize is that the consequences of this event introduced into the world three sources of problems: moral evil, natural evil and human limitation.

Each of these represents a different source of pain that all of humanity is unfortunately destined to experience because of the introduction of evil into the world. Moral evil includes all of the selfish human choices that bring harm to others or to our world: violence, greed, assaults, etc. Natural evil includes those things that bring destruction and devastation beyond our control: health issues such as sickness, disease, infertility and miscarriages, and atmospheric conditions such as destructive weather, earthquakes, pestilence and accidents. The third category, human limitation, includes restrictions on our capabilities, which we call weaknesses, and our now-limited life spans, which we call death. 

Clients benefit from being able to categorize their problems. They long to know how to interpret them, and often, God has seemed like the only one to blame. Instead, clients can choose at least one of these three categories for every problem known to humanity. If they subscribe to a Judeo-Christian belief system, they find the answer in the very beginning of the history of humanity, in the context of a faith that they already believe in. 

Redemption: Can something good come out of this? Is there any comfort to be found in this pain? If the effects of the Fall cannot be immediately reversed, where is hope? For clients looking for an answer within the Judeo-Christian tradition, redemption is found in one’s faith — in the belief that God will not leave the world forever in the condition that sin left it in through the Fall. 

There are different symbols for redemption that depend on the faith belief system of the client. I often ask clients what redemption means for them in the context of their faith. Some find comfort in knowing that God’s love is available to them no matter how painful their situation and that God is lovingly walking beside them through the worst of times. Others may speak of present opportunities to turn their painful experience into something positive by helping others. Many Christians will speak of Jesus’ resurrection. Still others describe a sense of eternal justice that is yet to be understood here on earth. 

In this way, God is seen as being with them in their pain but not as the cause of their pain. The key point is that clients examine their discrepant beliefs and find a way to reframe their tragedy or pain into beliefs that empower them with resilience. With that, they can more easily resolve the cognitive discrepancy without letting go of the faith that they hold dear.

The cognitive behavioral inquiry

The process of exploring which of the four God types the person subscribes to and then introducing a Creation-Fall-Redemption alternative involves a basic cognitive behavioral approach. Here are some key talking points for the cognitive behavioral process.

Identification of beliefs

  • Identify the spoken and unspoken beliefs about life, suffering, God, people, etc.
  • Explore where those beliefs came from.  
  • Discuss the expectations that are held in those beliefs.

Thought reconciliation

  • Identify the client’s thoughts about this particular situation.  
  • Explore any incongruence, inconsistencies or dissonance between beliefs and thoughts.
  • Identify the form of evil in the client’s situation: moral evil, natural evil or human limitation.

Emotion management

  • Name the emotions. (What’s the individual’s history with that emotion?)
  • Determine if there is a need for forgiveness of self or others. If so, ask the client to choose whether they’d like to act upon that.

Behavioral adjustments

  • Encourage the client to determine how to use the anger or other emotions constructively.

Sample questions for cognitive behavioral processing

Socratic questioning is a valuable tool in CBT. This method is especially useful with the sensitive issues of spirituality and religion because counselors must approach this topic without judgment about the client’s beliefs or values. The best questions are open-ended, focused, concise and neutral. Questions such as these can be used at any appropriate point in the process described above.

  • What would change for you if you could see God being as angry about this injustice as you are?
  • How would it be for you if you knew God was as saddened by your loss as you are?
  • What would you like the fruit of your pain to be?
  • What if you didn’t need to figure out how you’re supposed to feel or supposed to act?
  • What if your situation is a result of a fallen world rather than a fallen God?

Diagnosis and treatment planning

What about a billable diagnosis? What about measurable treatment goals? Counselors often avoid religious and spiritual discussions in therapy because they need a billable clinical diagnosis for third-party payers. Rarely, however, does a client initially state their presenting concern as anger at God. That’s mainly because it feels taboo and unacceptable to be angry at a Supreme Being. Clients do present with symptoms of depressive disorders, generalized anxiety disorder, adjustment disorder and trauma-related disorders. The billable diagnosis is there. 

Specific and measurable goals are found in reducing the frequency and severity of the diagnostic symptoms associated with the disorders. This might include a specific reduction in the number of days when particular symptoms cause clinically significant distress or impairment in functioning. It might include a specific reduction in undesirable self-medicating behaviors each week or a reported improvement in problematic sleep patterns. As the person resolves the religious- or spiritually related anger, issues such as these will often improve. The success in this kind of goal setting is in getting a baseline severity measure and then measuring symptom improvement over time. 

Issues of abuse are a clear exception to this CBT approach. When a client’s history involves any form of victimization such as spiritual manipulation or sexual abuse, the counselor must exercise extreme caution. In these cases, trauma-informed care and trauma-specific interventions are more appropriate than CBT interventions. 

Summary

Clients of deep spiritual and religious faith may come to counseling at a major life crossroads. The perception of God denying goodness can lead to a real crisis of faith. The tendency to typecast God into one of four frameworks leaves people struggling to make sense of a situation that creates a discrepancy between their expectations and their experience. As counselors respond in ways that help clients clarify their theology of suffering, we can also help them cope effectively with present and future problems.

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LaVerne Hanes Collins is a licensed clinical mental health counselor, licensed professional counselor and national certified counselor. She is the owner of New Seasons Counseling, Training and Consulting LLC, where she develops in-person and virtual continuing education (CE) training for licensed counselors on issues of race, faith, culture and trauma. Her web-based CE training on CBT for clients who are angry at God is available at: http://bit.ly/3tqfMGu. Contact her at DrCollins@NewSeasons.training.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling in the land of religious liberty

By Cebrail Karayigit and Jason Kushner August 7, 2019

The MerriamWebster online dictionary defines minority as “a part of a population differing from others in some characteristics and often subjected to differential treatment.” The United States is perhaps the most religiously pluralistic country in the world and one of the few to integrate religious freedom into its Constitution. Christianity is far and away the largest religion in the United States, however, and is in some ways the baseline faith that guides — simply as a matter of familiarity — how many counselors approach working with religious traditions that are different from their own.

According to the 2014 Pew Research Center Religious Landscape Study, Christians represent 70.6% of the U.S. population. Meanwhile, religious minorities in the U.S., such as Jews (1.9% of the population), Muslims (0.9%), Hindus (0.7%) and Buddhists (0.7%), are frequently viewed through the context of media and other popular portrayals. These portrayals often perpetuate stereotyped perceptions and promote the notion that religious minorities and Western traditions are in conflict with one another. Counselors, like all humans, have biases that inform our perceptions of self relative to some “other.” Given misunderstandings about religious minorities in the United States, this topic is particularly relevant for counselors because we are part of an inclusive profession that is oriented toward social justice.

Rethinking multiculturalism

In an era in which many people get to know about “others” via social media, an unfortunate side effect is that stereotypes can be easily formed or solidified because we usually see what we want to see. Therefore, counselors have an ethical obligation to cautiously evaluate their sources of information relative to news coverage and social media mentions about religious minority groups in the U.S. As is the case when working with people who are different from us in other characteristics such as gender, race, ethnicity, sexual orientation and degree of ability, there is no substitute for direct contact with religious minority groups to promote counselor competency. According to a report released by Pew in 2017, knowing someone from a particular religious group was associated with warmer feelings for that group. So, direct interaction with people of a faith tradition different from our own (or the absence of a faith tradition altogether) is key to reducing or eliminating our biases — conscious or otherwise — toward religious minorities.

Within and outside the counseling profession, the terms multiculturalism and cultural diversity tend to focus on racial and ethnic minority groups, a practice promoted at least in part because of the categories used by the U.S. Census Bureau and data collected on applicants by American employers. Religious minorities are not so highly visible and are not generally regarded as “important” by mainstream American society because of this relatively hidden status. As counselors, we are in a unique position to interact with people from diverse backgrounds, and in this way, we have a meaningful role to play in ensuring that minority groups’ values are incorporated into American society. Standard A.1.d. of the 2014 ACA Code of Ethics states, “Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent.”

Misconceptions about religious minorities in Western societies are not new, but there remains an opportunity for counselors to lead the discussion and practice of widening the tent to welcome those of minority faiths. To do this, we must be uniquely competent as a collective profession at addressing the needs of this relatively small but growing population.

The relative absence of competence and knowledge about a plurality of traditions, beliefs and spiritual practices is perhaps one reason that counselors may not actively seek opportunities to engage with religious minorities. Within the counseling literature, few studies address the unique experiences of religious minorities. Therefore, engaging more research on this topic is an important step in increasing the visibility of religious minorities within the counseling profession. That larger research base would then inform practice as it does in the cases of other kinds of minority populations with whom counselors practice.

Do’s and don’ts

Perhaps the most important step is to examine our own attitudes and behaviors as counselors toward religious minorities. To that end, in their seminal cultural diversity book Counseling the Culturally Diverse: Theory and Practice, Derald Wing Sue and David Sue focused on the importance of examining our own attitudes by asking the following questions: Have you been influenced by the negative stereotypes regarding individuals of these groups? What would your reaction be if a client came in wearing traditional clothing?

One of the most common mistakes made by counselors is failing to recognize clients’ social and cultural identities and focusing only on visible manifestations of those identities, such as wearing a kippah or hijab. For example, when white American clients come to counseling, we do not typically refer to them as “Catholic clients” or “Protestant clients” and thereby put them in a categorical box. On the other hand, when a client wearing an orange robe comes to counseling, we are more likely inclined to refer to that person as a “Buddhist client.” Such labeling should not be considered the best practice of our profession.

It is necessary to challenge our stereotypical notions of the phenotypical appearance of minority groups to overcome the prejudiced messages that may be sent. Counselors must also be cautious in assuming that clients’ religious identity is the same as their social and cultural identity. Understanding clients’ behavior as a social-cultural concept, especially in today’s American society, is necessary to avoid a fixed and prejudicial view of their identity.

Religious minorities have typically been exposed to a history of oppression, so trust and empathy may be particularly important to them in a counseling relationship. Building rapport and developing a relationship with these clients is crucial to developing effective communication. Counselors should also understand that some religious minorities may be reluctant to seek counseling for a variety of reasons. Therefore, when working with these clients, counselors are encouraged to be active in and affirming of their help-seeking behavior and to assist them in processing resistance if any exists without forcing any particular religious or faith perspective.

In most cases and with most faiths, the individual expression of that faith is a uniquely personal experience. To that end, counselors should explore what it means to their clients without making assumptions based on the counselor’s own perceptions of various faith traditions. It is also important to note that people usually overestimate their openness to minority groups. As suggested in a 2014 study by David Amodio, individuals are typically unaware of their implicit biases. These biases can be particularly difficult to change in an era of news and social media that often reinforces prejudicial or stereotyped thinking rather than calling it into question.

Counselors are also encouraged to examine their use of theories in their practices because many widely used theoretical orientations (e.g., cognitive behavioral, person-centered) are rooted in Western value traditions that may ignore the unique needs of some minority groups. Some approaches focus on inward problems and view the individual as “problematic” outside of the context in which the individual lives. For example, some religious minorities experience a significant amount of tension and stress because of societal pressure and reminders of their differences. For this reason, a theoretical orientation that emphasizes knowledge of the effects of societal pressure and that has a social justice perspective ensures greater likelihood of a therapeutic alliance that will lead to more satisfying outcomes for the client and counselor alike.

As Derald Wing Sue suggested in Counseling the Culturally Diverse, to be multiculturally competent, counselors must also be knowledgeable about discrimination policies. If counselors learn about anti-discrimination policies, they will be able to raise clients’ awareness of their legal rights so that they can challenge discrimination and take appropriate actions when faced with discrimination. To be most effective, counselors need to educate themselves about laws, practices, policies, history and situations in a global context. No one expects counselors to be living encyclopedias, but to be competent healers, we have to be comfortable enough to ask religious minority clients about their faith traditions. In doing this, the counseling profession will expand its reach, make a difference and continue to uphold the value of diversity for which it is known.

Religious competencies

Religious competencies are important for all counselors to have, in particular when working with clients with religious and spiritual issues. Consistent with the 2014 ACA Code of Ethics, the Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC) provides a set of competencies for integrating knowledge of spiritual and religious issues into counseling practice. The purpose of the ASERVIC competencies is to “recognize diversity and embrace a cross-cultural approach in support of the worth, dignity, potential and uniqueness of people within their social and cultural contexts.”

The following competencies shed light on how to improve our ability to serve members of religious minority groups:

  • 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. Counselors cannot effectively assess their clients’ problems and formulate strategies without first understanding their clients’ worldviews.
  • The professional counselor actively explores his or her own attitudes, beliefs and values about spirituality and/or religion. It is important for counselors to seek self-knowledge through an active practice of self-awareness and self-reflection. For example, counselors can examine their attitudes about religion by asking themselves the following questions: When did I last push the boundaries of my comfort zone to learn about religious topics that are different from my own perspectives?
  • 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. It is necessary and essential to assess any possibilities of countertransference to prevent the development of a negative relationship with clients. For example, counselors who are very involved with religious organizations should not impose such practices on their clients. Many members of religious minorities have a paradoxical relationship to religion. Although they may have firm religious convictions, attending religious services can be a less frequent activity for them.
  • 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 and leaders who can be avenues for consultation and to whom the counselor can refer. The fear of not knowing should not keep us from learning from our clients. Our clients are our best teachers. Although we strive to understand clients’ religious perspectives, it is important to allow our clients to educate us about their religious beliefs.
  • The professional counselor responds to client communications about spirituality and/or religion with acceptance and sensitivity. Counseling is a profession based on understanding, which goes well beyond simply showing tolerance for those who are different from us. Seeking understanding and respecting our clients’ religion is key to accepting clients for who they are.
  • The professional counselor can therapeutically apply theory and current research supporting the inclusion of a client’s spiritual and/or religious perspectives and practices. It is important that counselors are flexible enough to modify their treatment perspectives to best match the unique needs of clients. Perceiving psychological functioning as an internalizing problem or an inward-directed form of distress can be problematic when serving some religious minority populations. The most well-known therapeutic techniques do not emphasize a religious perspective; it is important that counselors strive to use techniques that will reduce clients’ symptoms, even if that includes learning about faith-affirming interventions that would be most helpful. One example could include using the egalitarian and empowerment principles of feminist therapy. From that perspective, clients could be encouraged to recognize the many aspects of their religious identity, increase their awareness of the origins of their presenting problems, and enhance their well-being.

Hypothetical case study

To further illustrate the highlighted competencies, we offer a hypothetical case study as an example of how specific strategies could be integrated into counseling practice.

Mary, a 19-year-old college student, was initially referred to counseling because she was experiencing social isolation and increased levels of stress. During the initial interview, Mary, a native-born U.S. citizen, described herself as an American Muslim feminist woman. She reported having never felt treated differently in the past by her friends, teachers or peer groups, perhaps because she was fair skinned, spoke English without an accent, and came from a family of high socioeconomic status. She also changed her original name, Mariam, to the English translation, Mary, while in high school. When Mary was asked about her motivation for doing this, she stated that she wanted to be well-integrated and active in larger American society.

After Mary began college, she decided that she wanted to learn more about her faith tradition, which eventually led her to choose to wear a hijab (headscarf). She realized that the hijab had a large impact on her relationship with her friends and with people in general. She even stated that she started getting fewer likes on her Instagram photos. Although Mary has never questioned her choice, she no longer feels like she fits in with her peer group.

Because building rapport and developing a relationship with a client is crucial in any counseling relationship, the counselor shows genuine interest in Mary’s story and demonstrates an openness to discussing her attitudes toward Mary’s religious beliefs. It is important to closely examine Mary’s own feelings and values regarding the hijab. By having an open dialogue with Mary, the counselor attempts to explore the meaning that Mary ascribes to the hijab. Mary states, “A lot of my friends are asking if I was forced to wear the hijab because a headscarf can be seen as a symbol of oppression. I think that my hijab gives me the freedom to set my own standards in a land of religious liberty, but I cannot convince people about that.”

The counselor acknowledges Mary’s emotional experience by stating, “You value your hijab and see it as a symbol of freedom. While you are also frustrated by your friends’ comments, you are aware that you do not have control over what your friends or society think of your decision.” The counselor further explores Mary’s experience by asking another question: “A friend you haven’t seen for a while sees you after you choose to wear the hijab. What would be different?” Such questions help Mary to reflect changes within herself and her environment.

The counselor knows that understanding Mary’s worldview and experiences is a crucial step toward effectively assessing her presenting problems and then formulating strategies to address them. From here, the counselor will connect on a deeper level the literal and metaphorical symbolism of the hijab. The counselor also examines her own attitudes by asking herself some questions: “What was my initial reaction when this client came in wearing a hijab? Have I been influenced by the negative stereotypes regarding individuals of groups who wear symbols?”

While exploring Mary’s religious values, the counselor avoids responding in a stereotypical manner by asking to be educated by Mary about her background and beliefs. The counselor encourages Mary to do this by saying, “Tell me more about your experiences of being treated differently.”

Mary states, “I do not understand why people focus only on my hijab. My hijab is an important part of my life, but I was born and raised in American culture, and that has always been the most important thing in my life.”

The counselor reflects, “You feel it is unfair that people ignore your core identity, which is your social and cultural identity. You want them to see you as an American Muslim feminist woman, not as an oppressed person who wears a hijab.” The counselor acknowledges Mary’s cultural background as a salient aspect of her identity. This could be an important step toward achieving a positive outcome. If the counselor focused mainly or exclusively on Mary’s religious identity, the counselor might fail to recognize Mary’s social and cultural identity.

The counselor will also help Mary recognize how her religious identity, even if it is not her core identity, may have caused her some disadvantages. The counselor will help Mary examine whether she has suffered from oppression as a member of a subordinate group, both as a woman and as a Muslim. It is important to note that Mary’s overall experiences make her an excellent candidate to benefit from a feminist counseling orientation, especially because of Mary’s stated identity as a feminist. Therefore, the counselor acknowledges the societal impact on Mary’s life.

Because Mary describes herself as a Muslim feminist woman, encouraging her to engage in an action can be an important step toward a commitment to social change. The counselor asks, “Do you like to do tasks between sessions? What is one powerful thing you could do for yourself between now and the next session?” By asking such questions, the counselor empowers Mary to take action and promotes an egalitarian relationship.

Mary answers, “One thing I would like to do is to share my personal story about why I decided to wear a hijab. I hope that this will lead to an open dialogue with my friends, and they will be more comfortable asking questions.”

The counselor asks, “What have you done toward this goal? How will you go about doing this? What difficulty might you have?” The counselor helps Mary to specify her direction and organize small steps toward desired behaviors.

The counselor also encourages Mary to be active in the therapeutic relationship by inviting her to direct the conversation. The counselor might ask, “Are there topics you talked about or discovered that you would like to pick up on next time?”

Finally, for the purpose of achieving better and longer lasting outcomes, it is important to help Mary build her own support system. The counselor says, “I wonder if there are any particular groups that could make you feel more connected and involved in the community?” This is important so that Mary can recognize she is not alone and that there are other women who are experiencing similar experiences. By engaging with other women, Mary can find support and become more assertive in promoting social justice.

Conclusion

In thinking about ways to work with clients from minority religions in the United States, counselors can pick from any number of similar cases in which they counsel people who are different from them in some aspect. It is important to remember that more often than not, a client’s religion, the client’s perspective on that religion, the client’s perspective of others, and what the client wants from a counselor will vary quite a bit. A client’s expression of faith is completely subjective and unique to that person. These hypothetical case studies should not be used to describe the basis of a faith’s visual aspects. Counselors should not make judgments or use phrases that may alienate clients over issues of religion, faith or spirituality. That is why it is important to have a discussion, or at least include a question, about the subject.

There are universal elements to most faith traditions (or the absence thereof) that transcend counselors’ observations about a client’s observable characteristics. The task for counselors is to understand our own perspectives and what they mean to us, and to obtain a general knowledge of many religious/spiritual traditions and how those traditions intersect with the experiences of our clients and the help they are seeking from us.

 

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Cebrail Karayigit is an assistant professor in the Department of Psychology and Counseling at Pittsburg State University in Kansas. Since coming to the United States in 2010, he has gained a reputation as an expert in multicultural counseling and school counseling, which are his areas of research and practice focus. Contact him at ckarayigit@pittstate.edu.

Jason Kushner is a professor of counselor education at the University of Arkansas at Little Rock. He is a licensed professional counselor with experience in school counseling, college counseling and mental health counseling. Contact him at jdkushner@ualr.edu.

 

Letters to the editor: ct@counseling.org

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Respecting the faith of clients and counselors

By Laurel Shaler May 20, 2019

The Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC) describes itself as “an organization of counselors and human development professionals who believe spiritual, ethical, and religious values are essential to the overall development of the person and are committed to integrating these values into the counseling process.” Although ASERVIC is a division of the American Counseling Association, and all counselors likely would agree to the importance of ethics, not all counselors share the mission of ASERVIC in its entirety.

With some counselors and counselor educators, this is related to a lack of knowledge, in particular because few counseling programs — other than those whose own missions include the integration of faith — address spirituality and religion thoroughly. Still other counselors and counselor educators perceive a value conflict between counseling and religion or spirituality. Although other spiritual, ethical and religious values should be explored, this article pertains specifically to the Christian faith because I believe this is something that is often misunderstood and overlooked by many counselors and counselor educators.

Unfortunately, many individuals in the counseling field are not comfortable addressing issues of faith. Although the majority of Americans highly value faith, the same cannot be said of mental health professionals, according to researcher Pamela Paul. If counseling students are not being trained to assess and treat from a faith-based perspective, how can they best meet the needs of clients who are seeking this?

The lack of comfort and competency in this area is reflected across presentations, publications and even Listservs such as CESNET (the Counselor Education and Supervision Network). At best, this is because of a lack of knowledge, training or understanding. At worst, it is a brushoff of the Christian faith of clients — in particular, if those clients are conservative or evangelical. Sadly, it is not just clients’ faith that is sometimes disrespected. Often, the Christian faith of the counselor is not respected by fellow counselors either.

From a personal perspective, I have seen many professional counselors put in writing disparaging remarks about conservative and evangelical Christians — including their own clients. If these counselors are making those comments publicly, how can we ensure that they are treating their clients who hold these views with authenticity and respect? I have even read where counselors attempt to persuade clients to “explore” their biblical worldviews — with a clear agenda of trying to encourage clients to change their deeply held beliefs. Much like the serpent in the Garden of Eden asks Eve in Genesis 3:1, “Did God really say you must not eat from any tree in the garden?” there are counselors who ask their clients, “Does the Bible really say … <fill in the blank>?”

There may be a place for this — such as when a Christian counselor and a Christian client are working together, based on a common belief system, to explore the truth of God’s Word about who the client is at his or her core, for example — but there is no place to try and convince clients that they are wrong about their biblical convictions.

Simply put, the faith of the client and the faith of the counselor must be respected. It is entirely possible for clients and counselors who do not share a similar faith to work together effectively. The ACA Code of Ethics applies equally to the evangelical Christian who should not force his or her beliefs on to a client as it does to the nonevangelical (Christian or otherwise) who should not attempt to force his or her beliefs on to a client.

Instead of just lamenting over the way that this population of clients and counselors is often discounted, I would like to offer three practical tips for integrating and respecting faith. Truly, this is what is expected of all counselors as they work with clients and interact with colleagues.

1) Listen: As the saying goes, listen to hear rather than to respond. If your first instinct is to prepare a rebuttal, that is a clear indication that you need to take a step back. Understand first, respond second. This is true not only in the counseling room with our clients, but also in communication with our fellow counselors. We should be willing to hear from those who are not like us without making assumptions or jumping to conclusions.

It is not our job to change anyone else’s belief system or way of thinking. While we absolutely should ensure that students and fellow counselors are upholding ethical standards, we should also recognize that we are all different; that is not only “OK,” it is good. For example, on more than one occasion I have worked in non-faith-based settings. When a potential client would come in requesting to see a counselor who was Christian, the client was often referred to me. It wasn’t that the other counselors could not work with the client effectively. Rather, we were trying to listen to the client and meet his or her needs. Instead of going to a place of defensiveness, our team was able to see the benefit of placing clients with counselors who shared similar values with them when possible.

2) Think: Put yourself in the other person’s shoes. We often call this empathy. Ask yourself how you might feel if your deeply held beliefs were brushed off or challenged in a demeaning or disrespectful way. Think through how you would want to be treated, and then treat the other person that same way. Take some time to reflect on what you are hearing before you immediately respond.

Interact critically with what you are hearing. It is unlikely that someone will change their mind because someone has belittled or criticized them, but they may be willing to flex a bit in their thinking if given some time to process. For example, CESNET often becomes abuzz with emails flying back and forth rapidly. What if we took some more time (as some do) to really think through what is being stated before we respond? We talk about the value of silence in counseling. Perhaps it would be helpful if we put that into practice and spent more time thinking and less time speaking.

3) Ask: After taking the time to listen and to think, there is also a time and a place to ask questions. As every counselor learns in a basic counseling skills course, this can be done in a respectful manner. As we all know, open-ended questions typically produce richer responses that contain more depth and meaning. We should make sure that we are not attempting to lead the other person to what we perceive to be the “correct” answer.

Ask to learn rather than to teach. What do you want to know about the faith of the client? Don’t be afraid to ask about the client’s belief system, how they came to that belief system, how they are living out their belief system, and how they want to (or do not want to) integrate their belief system into their counseling sessions.

This does not mean that the counselor has to share the client’s belief system (although they very well may, and there is strength in that too). It does mean that as counselors, we should be able to respect our clients and meet their needs to the best of our abilities.

Evangelical Christian clients — as well as those who simply identify as traditional or conservative — deserve to be heard and treated with dignity and respect, even when the counselor does not agree with their points of views. I also identify as a Christian who is evangelical and conservative, but there are certainly times when I do not agree with all of these clients.

Years ago, I was working with an individual whose relative was dating someone of a different race. Because of my client’s deeply held beliefs, the client became distressed about this. When seeing the young couple together, my client became distraught, went home and attempted suicide.

Was there more going on with this client? Yes. Yet the reality was that this was the straw that broke the proverbial camel’s back. I consulted with a colleague about this case. In the process, I expressed my shock and disdain over someone reacting this way to a relative dating someone of a different race. I did not understand the client’s gross overreaction.

My fellow counselor reminded me of what I have shared in this article — that although I may not always understand my clients’ views, I should strive to empathize with them and that this situation had meaning for my client beyond what I could comprehend. My colleague was neither conservative nor Christian, but she was respectful of all clients — and of me.

Although I viewed my client’s beliefs as a distortion of the Bible, the client and I both identified as conservative evangelical Christians. Yet we have to be able to accept our clients where they are and take them where they desire to go — not based on our own agendas but on theirs. (There are limitations to this, of course, such as in the case of suicidal ideations.) I had to work hard to empathize with my client’s pain while also helping him work on his desired outcome of changing his thoughts and feelings about the situation as he grappled and struggled to accept what he could not change. With proper supervision, I was able to do this and supported this client during his time in counseling.

Likewise, we should be respectful of our fellow counselors. When we make disparaging remarks about people who are not like us — when I make disparaging remarks about people who are not like me — we are inevitably disparaging some of our colleagues. It is one thing for us to challenge one another, hold each other accountable, and even heartily debate. It is another thing entirely to expect that any group of people should change their entire belief system or else not be included in the field.

Conservative or evangelical Christians are not a rogue group or a small group. We constitute a substantial number in the field who share varying views and beliefs. We cannot all be lumped together. Neither can our clients. With so many clients seeking Christian counseling, perhaps the field should recognize the value of having counselor education programs that teach the ethical integration of Christian faith into counseling (while also recognizing that not all graduates from these programs will hang their shingles as Christian counselors). In fact, it may be time for more training programs to address spiritual assessments, religiously accommodated psychotherapy, and the impact of spirituality and religion on both the client and the counselor.

If you do not understand this perspective, I encourage you to get to know us for yourself. Listen. Think. Ask. Most importantly, get to know your clients. And respect them — and us — for who we are rather than for who you want us to be.

 

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There are many excellent resources for the integration of the Christian faith into counseling settings. These books, journal articles and videos provide the research behind and the details about the practice of being an ethical and effective Christian counselor. They make it clear that this type of treatment is not one-size-fits-all, and it can (and should) be provided at the highest competency level. If one wishes to be a Christian counselor, or if one desires to further understand the Christian faith of a client, the education is available and accessible through the works of individuals such as Tim Clinton, David Entwistle, Fernando Garzon, Ron Hawkins, Harold Koenig, Anita Knight Kuhnley, Mark McMinn, Jim Sells, Lisa Sosin, Siang-Yan Tan, John Thomas and many others.

 

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Laurel Shaler is a national certified counselor and licensed social worker. She is an associate professor and the director of the Master of Arts in professional counseling program at Liberty University. Contact her at doctorlaurelshaler@gmail.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.