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Ethical issues of integrating spirituality and religion in

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 Romanian Journal of Bioethics, Vol. 9, No. 1, January - March 2011

ETHICAL ISSUES OF INTEGRATING

SPIRITUALITY AND RELIGION IN
COUPLE AND FAMILY THERAPY
Petruţa Paraschiva Rusu*
Maria Nicoleta Turliuc**
Abstract
The present study analyzes a series of principles and ethical standards on the integration of
spirituality and religion into couple and family psychotherapy, referring to the Code of
Deontology for the profession of psychologist, elaborated by the Romanian College of
Psychologists and the American Association for Marriage and Family Therapy Code of Ethics.
We will present aspects of professional integrity, professional competence and responsibility to
clients (the autonomy, the informed consent, the clients’ well-being and the disclosure of
information) in couple and family therapy context which integrate clients’ religious approach
and spirituality. In the analysis of ethical issues, we shall refer to the manner in which the
therapist relates with his/her clients’ spirituality and religion, to the techniques used and to the
ethical decisions influenced by religious beliefs.

Keywords: couple and family therapy, spirituality, religion, integrity, competence, responsibility
to clients.

1. Introduction by the religious values. The life of

Religion plays an important role in families and couples is shaped by their
the lives of many people, since religious beliefs and their spiritual and religious
principles and beliefs influence all values, which may have effects on the
aspects of their lives. The values and cognitive, emotional, and behavioral
beliefs are the vital cultural elements of level. The family system can be
any system that helps to determine the positively or negatively affected by
conduct of its members, and the family spirituality and religion; religion can be a
values were and are strongly influenced foundation of privacy within the family
*
PhD candidate, “Al. I. Cuza” University, Faculty of Psychology and Educational Sciences, Iaşi, Romania,
e-mail:petrutarusu@gmail.com
**
Professor Ph.D, “Al. I. Cuza” University, Faculty of Psychology and Educational Sciences, Iaşi, Romania,
e-mail: turliuc@uaic.ro

83
system, but on the other hand, religious
issues might cause conflicts and increase
anxiety in relationships.
The popularity of the
religious/spiritual therapy has increased
in the recent years. In the U.S.A. there
are professional organizations related to
religious/spiritual therapy (American
Association of Christian Counselors),
journals approaching the integration of
spirituality/religion in psychotherapy
(Journal of Psychology and Christianity,
Journal of Psychology and Theology,
Pastoral Psychology), special editions of
journals dedicated to spirituality/religion
in psychotherapy (Journal of Clinical
Psychology has a special edition, in
2009, dedicated to the religious/ spiritual
therapy) and different books on this
topic. Since religion plays an important
role in the Romanians’ life
(approximately 78% of the Romanian
answered positively to the question "Is
religion an important part of your daily
life?" according to Gallup poll results,
cited by EU Observer, 2009) it is
necessary that the couple and family
therapists should be trained to integrate
their clients’ religiosity in therapy.
The use of psychotherapy based on
the integration of spirituality has the
following arguments: 1. spirituality can
be a part of the solution to psychological
problems, 2. spirituality itself can be a
source of problems, 3. people want
spiritual help, and 4. spirituality cannot
be separated from psychotherapy
(Pargament, Murray-Swank & couples’ religious faith, preferences and
Tarakeshwar, 2005). Psychotherapy
integrating spirituality should have
several defining characteristics: to be
based on a theory of spirituality, to be
empirically validated, to be ecumenical
(apply to the patients of different
religions) and to be integrated into any
form of psychotherapy: psychodynamic,
cognitive-behavioral, family systems,
84
humanistic, existential (Pargament,
Murray-Swank & Tarakeshwar, 2005).
Therapists who use or are thinking about
using religious and spiritual therapies
should be confident that these therapies
have evidence-based research supporting
their efficacy, are efficient in the therapy
of religious/spiritual clients and in few
cases may be more efficient than secular
therapies (Hook et al., 2010).
Although most families are part of a
particular religion, the way religion is
integrated into their relationship widely
varies. There are differences concerning
religiosity and religious motivation in
couples, differences of religious practice,
of involvement or intensity of faith. Each
religion provides rules and models for
family changes, sexuality, parenthood
and the distribution of power within the
couple (Duba & Watts, 2009). There are
many religious issues that should be
taken into consideration when attempting
to understand a family during therapy,
from child discipline to accepted gender
roles (Hoogestraat & Trammel, 2003).
Couple and family therapists
encounter clients with different religious
beliefs and values. The practical question
for clinicians is not whether to address
sacred issues in the psychotherapy of the
religious and spiritual clients; the
problem is when and how to address the
sacred aspects (Post &Wade, 2009).
Duba & Watts (2009) propose to
therapists working with religious
couples: a) to systematically assess the
potential conflicts; b) demonstrate
respect for and try to use the couple's
religious beliefs to establish the
therapeutic relationship; c) to investigate
together with partners the strengths,
supports and opportunities of their
religious beliefs in marriage; d) to
integrate the religious language of the
couple in the therapeutic process; e) to
consult with religious leaders who can
better understand the couple’s needs and
beliefs.
Many authors differentiate between
the concepts of spirituality and religion.
Spirituality is individual and self-
determined, while religion involves
community connections, shared beliefs
and rituals (Koenig, 2004). Therefore,
spirituality may or may not include
religion; it may find expression in a
religious context or remain outside it.
Given the difference between religion
and spirituality, Carlson, Kirkpatrick,
Hecker, Killmer (2002) show that 88% of
couple and family therapists consider it
appropriate to ask their patients’
questions about spirituality, and only
66% deem it appropriate to ask questions
on religion, during therapy, and a lower
percentage (47%) considers it appropriate
to talk about God with their patients.
Haugh (1998) presents four
dimensions through which spirituality
influences a person’s functioning:
cognitive (the interpretation of life events
in terms of spirituality, the acceptance of
the past, valuing the present and looking
with hope to the future), behavioral
(religious rituals and practices, by which
an individual relates to himself, to others
and to community), affective (spirituality
grows hope, love, care and security) and
developmental (living spirituality
throughout life, as the individual
integrates his teachings and life
experiences).
Spirituality and religion have
bioethical implications, both in medical
and psychotherapeutic practice. Bioethics
is based on certain fundamentals rooted
in Christian moral: doing good, avoiding
evil, the principle of justice and equity
(Vicol, M.C., 2006). Churches of various
religions have official positions on issues
of bioethics. The Holy Synod of the
Romanian Orthodox Church has issued
85
official documents relating to organ
transplant, abortion and euthanasia,
focusing on: the Christian attitude toward
life and death, defending the Christian
sense of human dignity, respect for the
patient, preparing the priests on matters
of bioethical decision (Iloaie, 2009) and
these documents have also an impact on
the couple and family psychotherapy.
The Christian bioethics does not provide
universal solutions or solutions for any
ethical issue, but offers correct references
to deliver the good and avoid the bad
(Florea, 2010).
Koenig (2004) shows the implications
of religiosity and spirituality of the
patients and their families in medical
practice. Thus, the patients’ religiosity
and spirituality may have the following
effects: 1. influence some decisions about
medical procedures (decisions
concerning withdrawal of life support,
refusing resuscitation), 2. generate beliefs
in conflict with the medical care
standards (Jehovah's Witnesses refuse
blood transfusions, Scientologists are
against drugs to treat psychiatric
disorders), 3. religiosity leads to spiritual
conflicts, causing stress and affecting the
spiritual health (patients may wonder
why that happens exactly to them or they
just see the disease as a punishment for
their sins), 4. influence adherence to
treatment (religiosity is associated with
hope, optimism and the existence of
meaning and purpose in life, thus making
religious people have reasons to live for
and to recover, in full compliance with
the prescribed treatment).
Koenig (2004) contends that it is not
acceptable that a physician treats only the
medical problem without taking into
account the whole person. Constantly
having to deal with life-and-death issues,
physicians should have spiritual reserves
to combat emotional exhaustion.
Practicing whole-person medicine is the
best kind of care both for those who
receive it and those who give it. We also
believe that the couple and family
therapists should practice psychotherapy
of the whole person, taking into
consideration the principles of bioethics.
In the integration of spirituality in
psychotherapy, Pargament (2007)
contends that, when people enter into the
therapist’s office, they bring with them
their spiritual beliefs, practices,
experiences, values, relationships and
spiritual dilemmas. Implicitly or
explicitly, this complex of spiritual
factors often comes into the therapeutic
process.
In the present paper we focus on the
ethical issues related to the manner in
which the therapist is reporting to the
couple and family (focusing on the well-
being of the patient, respect, integrity,
autonomy, informed consent), on the
ethical issues regarding the techniques
used in the religious/spiritual couple and
family treatment (prayer, meditation,
reporting to the sacred texts) and ethical
decisions influenced by religious beliefs.
2. Ethical principles
and standards
In Romania there is a single code of
ethics for counselors, psychologists and
psychotherapists in all areas. The code of
deontology for the profession of
psychologist with the right of free
practice, developed by Romanian
College of Psychologists, therefore
directs the couple and family therapists’
activity. This code refers to the following
principles and standards: the principle of
respecting the rights and dignity of every
person, the principle of professional and
social responsibility, the principle of
professional integrity, standards of
competence, standards of human
relations, standards of confidentiality,
standards of collegial conduct, standards
86
of fees and charges for public statements
and advertising and a series of specific
standards relating to: education and
training, therapy and counseling,
assessment and diagnosis, scientific
research and valuing results. Turliuc
(2008) states that this code does not
sufficiently address the needs of
guidance and ethical dilemmas for the
couple and family therapists, and
supports the need for a strong
professional association in the Romanian
background and for a code of ethics of
the Romanian couple and family
therapists.
In the U.S.A there is a specific code
of ethics of the couple and family
therapists: American Association for
Marriage and Family Therapy Code of
ethics, which refers to the following
principles: responsibility to clients,
confidentiality, professional competence
and integrity, responsibility to students
and supervisees, responsibility to
research participants, responsibility to the
profession, financial arrangements and
advertising.
Moreover, in the USA there is the
Association for Spiritual, Ethical and
Religious Values in Counseling -
ASERVIC. This association suggests
several competences on spirituality and
religion in counseling approach,
integrated into the following categories:
culture and worldview, counselor self-
awareness, spiritual development,
communication, assessment, diagnosis
and treatment. The competences in
integrating spirituality and religion
presented by ASERVIC stand for a guide
for ethical practice and refer to:
counselor’s knowledge on the differences
and similarities between spirituality and
religion; counselor’s ability to understand
the intercultural differences on spiritual
and religious practices; counselor’s
capacity to increase the understanding
level of self-knowledge and acceptance
of different spiritual and religious beliefs;
counselor’s ability to identify his/her
own limitations in understanding the
clients’ religiosity and spirituality and the
ability to redirect the clients; counselor’s
capacity to assess the relevance of the
client’s spirituality and religion;
counselor’s ability to determine whether
spirituality and religion help the client
problem or be part of the solution; and
the use of spiritual and religious beliefs
of the client for therapeutic purposes.
Richard & Bergin (2005) present the
main ethical pitfalls for therapists who
integrate religion and spirituality in
therapy: 1. dual relationships (religious
and professional), 2. undermining the
authority and credibility of religious
leaders (the therapist rejects cooperation
with religious leaders, belittles the advice
given by the client’s religious leader or
makes negative comments about the
client’s religion), 3. imposing their
spiritual or religious values on their
clients (judging clients’ decisions:
abortion, marital fidelity, gender roles or
using spiritual or religious interventions
without the client’s consent), 4.
practicing outside the boundaries of
competences (lack of specialized training
for integration of spirituality and religion
in psychotherapy), 5. violation of the
boundaries of contingent work
(separation of church and state -
therapists working for the state will be
more careful in using religious
interventions compared to therapists
working in a religious organization - who
are expected to use such interventions).
Plante (2007) proposes RRICC
model (respect, responsibility, integrity,
competence and concern) to highlight
ethical issues of integrating spirituality
into psychotherapy.
We further analyze the principle of
professional competence and integrity
87
and the principle of responsibility to
clients in integrating spirituality and
religion into couple and family therapy,
referring to the Code of deontology for
the profession of psychologist, elaborated
by the Romanian College of
Psychologists and to the American
Association for Marriage and Family
Therapy Code of ethics.
2.1. Professional integrity
Article III.2. of the Romanian Code
of deontology for the profession of
psychologist stipulates: “Psychologists
do not practice, tolerate, instigate,
cooperate, and consent or facilitate any
form of discrimination”. The refusal to
approach spirituality and religion in
couple and family psychotherapy, when
they are important issues for clients, as
well as addressing spirituality and
religion only when the therapist shares
the same religious beliefs and values of
clients means discrimination. Zinnbauer
and Pargament (2000) describe how
clinicians address religious issues in
psychotherapy. The authors present four
approaches to religion in psychotherapy:
the rejectionist approach (the denial of
sacred realities), the exclusivist approach
(the belief that is only one pathway to
spiritual or religious reality and therapists
must share the religious beliefs of their
clients), the constructivist approach (is
based on the existence of multiple
religious realities and the ability of
individuals to construct their own
personal meanings) and the pluralistic
approach (the belief that there is one
absolute religious reality but this reality
can be express in various way).
Couple and family therapists should
avoid engaging in dual relationships:
religious and professional.
“Psychologists will avoid multiple
relationships and other situations that
may present a conflict of interest or may
reduce their ability to be objective and
impartial”, in accordance with Article
III.7 of the Romanian Code of
deontology for the profession of
psychologist. In some religions it is
possible for a therapist to perform the
role of religious leader (Richard &
Bergin, 2005). It is also possible that the
couple and family therapist have a
relationship of friendship and
cooperation with his/her clients, as
members of the same church (Stander,
Piercy, Mackinnon, Helmeke, 1994).
Clients in this case can have great
confidence in the therapist, since he/she
has the same religious beliefs with them,
but, at the same time, the therapist may
be in a vulnerable position. This is
possible especially for minority religions,
which have a small number of members,
having close relations among them.
Clients who work with a therapist of the
same religious confession may feel
uncomfortable and embarrassed to see
their therapist at social or religious
meetings, since he/she knows the details
of their lives, and therefore, they can
avoid further participation in other
meetings (Richard & Bergin, 2005).
Therapist self-awareness of
spirituality is the crucial part of the
effective and ethical treatment (article
III.9 of the Romanian Code of
deontology for the profession of
psychologist states: “Psychologists will
be reflective, open and aware of their
personal and professional boundaries”).
A study on couple and family
therapists shows that 95% of research
participants considered themselves
spiritual, 71% pray regularly, 96%
believe there is a link between spiritual
health and mental health, 48% consider it
necessary to take into account spirituality
to help client, 62% agree that every
person has a spiritual dimension to be
considered in clinical practice. 53% of
88
participants considered that a course on
spirituality should be part of the training
of couple and family therapists. These
results indicate that the couple and family
therapists are available to address
spirituality and religion in therapy. But in
terms of efficiency, although it seems
clear that spiritual therapists are more
effective in psychotherapy based on
spirituality, there are studies showing that
even non-spiritual therapists can obtain
good results in this type of therapy
(Propst et al, 1992). A very religious
therapist may be ineffective when
personal religious values are in conflict
with those of the client and the therapist
considers this unacceptable.
Pargament (2007) argues that
personal religiosity or spirituality does
not automatically help a therapist to do
psychotherapy based on spirituality.
More important are the therapist's
openness, sensitivity and willingness to
discover what role spirituality plays in
the lives of his clients. This attitude could
be common to both, spiritual and non-
spiritual therapists.
During training therapists should be
encouraged to recognize and solve
personal problems and vulnerabilities
that can influence the therapeutic process
to the detriment of the client (Haug,
1998). The therapist’s attitudes and
spiritual beliefs, his/her philosophy of
life and values have profound impact on
the therapeutic process and outcome of
therapy. Therefore, the therapist must be
aware of his/her beliefs and their
evolution over time, which is possible
through a spiritual genogram. Also, the
exploration of the therapist’s spiritual
beliefs involves an ethical dimension
(Haug, 1998). Spiritual development of
the therapist's assessment should be done
in a context of acceptance and respect
and be perceived as encouraging and
empowering, not intrusive or forced.
 The therapist’s religious beliefs can
influence the language used in therapy. If
the therapist uses his/her language
specific to his religion, the client can
interpret he/she wishes to induce his own
beliefs (Stander, Piercy, Mackinnon,
Helmeke, 1994). It is required that the
therapist become familiar with his/her
client religious terminology and uses it as
a therapy resource without any prejudice
(Haug, 1998).
Hoogestraat & Trammel (2003)
suggests that the way the couple and
family therapist directs the emotional
relationship with clients depends on the
level of differentiation of therapist’s self.
Differentiation of the self is the
psychological separation of the self’s
intellect, emotions and independence of
others; the reverse of the fusion (Nichols
& Schwartz, 2005, p. 497). If the
therapist has a low level of differentiation
of the self, the addressing of the spiritual
and religious issues in family therapy
may create stress, discomfort and
anxiety; therapists with a high level of
differentiation of the self will be more
open in discussing issues of spirituality,
they will show respect and validation, so
that the approach would be beneficial for
clients (Hoogestraat &Trammel, 2003).
When the partners of a couple are of
different religions, they may try to
triangulate the therapist in their own
dispute over religion (Haug, 1998).
Triangulation is removing the conflict
between two persons by involving a third
person, in order to stabilize the
relationship in the original pair. If the
therapist does not accept triangulation,
remaining emotionally detached, the
members of the family system will calm
down so far that they could begin to find
solutions to their dilemmas (Nichols &
Schwartz, 2005).
89
2.2. Professional competence
Although there is a growing interest
in the recent years in researches about
religion and spirituality, there is a gap
between the researchers’ interest and
clinical practice. There is a lack of
accredited training programs for
therapists in the use of spirituality in
therapy. Due to the lack of specialized
training, therapists do not know how to
integrate the spirituality in the couple and
family therapy. If therapists are not
trained, they may easily violate the
ethical codes, by either avoiding
addressing spirituality in therapy or by
addressing spirituality in an unethical
manner which adversely affects the
therapeutic process (Ahn, Miller, 2009).
Religious therapists who want to
integrate their faith in their professional
work should not display their religious
beliefs until they go through specialized
training; the fact that the therapist is an
active member in his/her religious group
does not make him/her an expert on
pastoral counseling (Plante, 2007).
Article III.1 of the Romanian Code of
deontology for the profession of
psychologist states: "Psychologists will
present in a fair manner the specialized
fields they are accredited, their
competences, affiliations and experience,
and no distortions, omissions or
misleading presentations in this regard
are accepted.”
Spiritual training (expertise) should
make therapists to show openness,
respect and to be non-judicative in
addressing religious or spiritual content
important for clients. Moreover, training
should aim to adapt therapists to the
views of religious/spiritual needs of
clients and to their language.
Even if the therapist shows sensitivity
and respect, if he/she has another
religion, couples may not trust his/her
ability to understand and help them. In
case these differences appear, Duba &
Watts (2009) suggest that the therapist’s
possibilities are: a) collaboration with a
religious leader, b) agreeing supervision
or consultation with a knowledgeable
colleague, c) availability and opening to
use couple’s religion as a therapeutic
resource, d) discussing the ways the
couple would like their religious beliefs
to be integrated in therapy and discussing
the role of the therapist, e) acceptance of
therapy interruption in order to obtain
adequate skills by the therapist.
2.3. Responsibility to clients
Therapists may avoid exploring their
clients’ spirituality, in order not to violate
the ethical principles. However,
therapists who avoid approaching
spirituality in therapy may induce their
clients the idea that spirituality is taboo
(Hage, 2006).
As the therapist is introducing
himself/herself and begins to establish a
therapeutic relationship (e.g. obtaining
informed consent), he/she may require
the couples verbally or by filling in an
item in the initial assessment, to tell
whether they would like or not to
approach spirituality or religion in the
therapeutic process. Thus, the couple will
understand that the therapist is open to
addressing spirituality or religion in
therapy (Duba& Watts, 2009). It possible
that couples also ask questions related to
the therapist’s religion. It
recommended that the therapist take
these questions seriously and answer
honestly (Wothington et. al., 2008). Even
if the therapist does not share the same
religious beliefs with the clients, it is
very important to create a climate of
respect, safety and trust.
Respect for the client’s religious and
spiritual beliefs and opening for their
inclusion in therapy are important aspects
of ethical treatment. Therapists must be
careful in discussing spiritual beliefs of
their clients, both for clinical and ethical
reasons (Duba & Watts, 2009).
Religious beliefs may influence the
decisions that partners make in their
couples or families: the decision to
divorce or abortion, for example. In such
cases the therapist may try to impose
his/her own religious beliefs and values.
By supporting religious beliefs such as
sexuality or divorce negativism, the
therapist inhibits the independence,
development and well-being of the
clients (Wolf & Stevens, 2001). Nichols
& Schwartz (2005) argue that when the
couple and family therapist is confident
in his/her own judgment, in ambiguous
ethical situations he/she will tend to
impose his/her own values in what
should be a professional decision.
Nevertheless, to respect the ethical
principles is more important than the
therapist’s morality and good intentions.
To resolve ethical conflicts arising in
couple and family therapy, Turliuc
(2008) proposes the following steps:
identifying the values or ethical
principles in conflict, identifying the
persons involved in ethical dilemmas,
identifying personal values and beliefs
held by the therapist on the treated family
and case, considering alternative
treatment options and their consequences
and analyzing the need to discuss a
particular issue with colleagues and
is supervisors.
An important aspect of therapy,
which integrates religion and spirituality
is to help clients identify and overcome
their dysfunctional beliefs that led to
problems that have come to therapy and
to assist them in connecting or
reconnecting with spiritual beliefs -
which can be liberating and helpful in
solving their problems (Haug, 1998).
Christian couples therapy may be
helped by the dialogue between biblical
90
teachings and dysfunctional beliefs or
behaviors that determine disadaptative
marital problems. Couples are
encouraged to consider perceptual and
behavioral alternatives without having
the feeling that the therapist challenges
their spiritual beliefs (Watts, 2008).
2.3.1. Autonomy - respect
for the right of clients
to self-determination
Article V.7 of the Romanian
Psychologists’ Code of Ethics states that:
“Psychologists will encourage active
participation in decisions which affect
them directly, by respecting their justified
desires and valuing their views,
whenever possible”.
Under article 1.8 of American
Association for Marriage and Family
Therapy Code of Ethics, clinicians must
respect their clients' rights to make
decisions and help them understand the
consequences of those decisions. Article
1.8 also states that the couple and family
therapists should inform clients that they
have the responsibility to decide on
cohabitation, marriage, divorce,
separation, reconciliation, custody and
visiting.
Clients’ spirituality and religiosity
will influence such decisions; most
religions prohibit cohabitation and
divorce. It is important that the therapist
should not impose his/her own religious
beliefs and values and respect his/her
clients’ autonomy.
To respect the clients’ right to
autonomy, therapists must examine
whether spirituality has a role in the
clients’ lives and, if so, to approach this
issue. Clients who grew up in a religious
environment can benefit from the
messages they received in their
childhood; for those who actively
participate in spiritual practices,
discussing spiritual issues in the therapy
91
sessions could make them able to
discover resources inside spirituality
(Ahn & Miller, 2009).
Clients should understand the
difference between therapists and
pastoral counselors, so that they know
what therapy they will get and they can
choose other forms of assistance as well
(Richard & Bergin, 2005).
2.3.2. Informed consent
The therapist must carefully assess
his clients’ opinions and needs of
religious intervention and, in most cases
he must obtain the informed consent
(Post & Wade, 2009). Many religious
interventions may be considered
appropriate by some clients and
inadequate by others. Different spiritual
beliefs affect clients' hopes, expectations
and needs in therapy.
Article V.1 of the Romanian
Psychologist’s Code of Ethics states:
"Psychologists shall ensure that in the
process of obtaining informed consent,
the following points are understood:
purpose and nature of work, mutual
responsibilities, benefits and risks,
alternatives, the circumstances of
termination of action, the option to refuse
or withdraw at any time without suffering
any injury, period of time when consent
is valid, the manner in which consent
may be withdrawn - if desired.”
A study on clients with regard to the
approach of religion/spirituality in
therapy suggests that they consider their
initiated religious discussions - which
gradually appear in the first year of
therapy - to be effective and they
consider inefficient those discussions
initiated by both, the clients and the
therapists, as they occur very early in the
first session, when the clients feel judged
(Knox et. al, 2005). Couple and family
therapists consider that is ethically to
approach spiritual and religious issues in
therapy, only if they are brought by the
client and not by the therapist (Carlson,
Kirkpatrick, Hecker, Killmer, 2002).
2.3.3. Clients’s wellbeing
Therapeutic process should promote
the clients wellbeing. Avoiding
approaching spirituality in therapy has
also a negative impact on clients (Ahn &
Miller, 2009). Article II.1 of the
Romanian Psychologists’ Code of Ethics
states: "Psychologists will protect and
promote the clients’ wellbeing avoiding
to cause damage to the clients..."
Therapists must maintain high
standards of professional competence. If
they do not have a proper training to
address religion and spirituality in
therapy, they should adopt a requires the couple and family therapists
collaborative approach to overcome the
lack of specialized training (Haug, 1998).
Collaboration can be achieved in two
ways (Ahn & Miller, 2009): 1. therapist
adopts a posture of learning about faith in
the dialogue with the client (through
general questions: “Help me understand
your faith!” or specific questions: “What
is your faith teaching you about
parenting?”) and 2. therapist’s
collaboration with the client's spiritual
community.
"Psychologists will consult with other
specialists or with various institutions to
promote the wellbeing of the individual
and society" in accordance with article
II.13 of the Romanian Psychologist’s
Code of Ethics. Haug (1998) suggests
that, when the therapist does not possess
the required competencies or when it is
dealt with psycho-religious issues (such
as loss of faith), he could redirect his/her
patients towards: clerics - to discuss
issues regarding faith and doctrine, or
towards psychiatrists - in case of severe
mental disorders. In some cases the
redirecting of the clients is the most
ethical option (Duba & Watts, 2009).
92
2.3.4. Disclosure of information
Article VI.4 of the Romanian
Psychologists’ Code of Ethics states:
"Psychologists can share confidential
information with others only with the
consent of those concerned or in a way
that those concerned cannot be
identified, except as justified by law or in
circumstances imminent or possible
physical injury or murder.” In some
cases, religious beliefs may induce the
family members to engage in destructive
behaviors. For example, some religions
accept physical violence against children
and spouses or refuse of medical
treatment for the children in case of
illness. Although the ethical code
to respect the religious beliefs of their
clients, certainly, it is not ethical for the
therapist to accept destructive behavior,
abuse and neglect. Plante (2007) argues
that in such circumstances the
psychologist must break confidentiality
and report cases.
3. Conclusions
Beliefs and values underlie any group
or social system, including the family.
The family system develops and
maintains sets of values and beliefs
which define rules of conduct for family
members. On the one hand, the values
are supra-individual preferences,
promoted and transmitted by social
mechanisms with an important role in
guiding behavior, in setting objectives,
strategies and ways of achieving them.
Once set in the individual, the values
become a latent variable that is prone to
certain behaviors relatively stable,
without establishing a strictly
deterministic relationship - value-action.
On the other hand, beliefs are a type of
key of reading and interpreting reality of
the whole family. They describe the ideal
image of the world (the world is good,
right), of the family achievements (we
are a happy, successful, honest family,
etc.), specify what should not happen,
offer knowledge common to all family
members. In psychotherapy, the patient's
values and strong beliefs - often strongly
influenced by his/her spirituality and
religiosity - is one of the most important
resources that can be used to produce
therapeutic change. There is not an effect
of any of the patient’s beliefs, but only of
those strongly internalized, supported
and followed.
Therapeutic environment must
provide to the family members the
freedom of expressing thoughts and
emotions regarding religious and spiritual
values. If the clients feel uncomfortable
and inhibited, the therapeutic process
could suffer. Discussions on religious
themes can become embarrassing or
problematic especially when the therapist
is not prepared to deal with such issues.
It is important that the therapist be aware
of his openness to spirituality and
religiosity conversations concerning his
clients and he/she should create a
professional therapeutic safety
relationship, to protect the integrity of
clients seeking wellbeing of individuals
and families. Couple and family
therapists must respect the rights of
persons who require assistance and strive
to ensure that it provides adequate
services.
We consider that in Romania is
necessary to perform more consistently
researches to identify the clients needs of
religiosity and spirituality integration in
couple and family therapy, therapists
availability to explore clients spirituality
and religiosity and to be proposed
specialized training on spirituality and
religiosity approach into couple and
family therapy. Since the majority
religion of Romania is Orthodox
Christian religion, research should cover
the construction and validation of
assessment tools of religion/spirituality
validated by the Romanian population
and the effectiveness of certain
techniques of psychotherapy and
religious/spiritual in the Orthodox
people. In the absence of validated
instruments for evaluating the Romanian
population spirituality and religiosity for
couples and families and without any
specialized training, therapists will
violate the ethical principles and
standards either by avoiding addressing
spirituality and religion in therapy, or by
violating the rights of clients.
Aknowledgements
This work was partially supported by
the European Social Fund in Romania,
under the responsibility of the Managing
Authority for the Sectoral Operational
Programme for Human Resources
Development 2007-2013 [grant
POSDRU/88/1.5/S/476 46].

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