Spirituality in Clinical Practice © 2016 American Psychological Association

2016, Vol. 3, No. 1, 18 –21 2326-4500/16/$12.00 http://dx.doi.org/10.1037/scp0000098

REFLECTIONS

Finding a Place for Spirituality in Psychology Training:

Use of Competency-Based Clinical Supervision

Edward P. Shafranske
Pepperdine University
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Psychologists are required to perform professional services in accordance with Amer-

This document is copyrighted by the American Psychological Association or one of its allied publishers.

ican Psychological Association’s (2010) Ethical Principles of Psychologists and Code

of Conduct and policy regarding evidence-based practice. In light of these mandates,
clinical competence includes the ability to take into consideration individual differ-
ences and client characteristics, context and preferences, including the contributions of
religion and spirituality, in the practice of psychology. A review of the literature
suggests that psychologists generally receive little education and training in the applied
psychology of religion and spirituality, which calls into question the adequacy of their
preparation. However, through the use of competency-based clinical supervision,
competence can be enhanced through attention to the knowledge, skills, and attitudes
that are assembled to conduct psychological treatment that is sensitive to the religious
and spiritual beliefs, values, and commitments of patients.

Keywords: clinical supervision, clinical competence, religion, spirituality, education

and training

When I was trained as a psychologist, there
weren’t courses in cultural diversity; in fact, I do
not believe the term multicultural competence had
yet been coined. And discussions of religion or
spirituality were for the most part lacking or, if
raised, were met with a degree of skepticism or
curiosity as to their relevance. On reflection, it is
telling to recall that during my internship (at a
large metropolitan Catholic-affiliated institution),
there was not a single training seminar or lecture
on integrating spirituality into psychological treat-
ment; although, many clients sought services in
the clinic, owing to its religious standing. The
point here is not to criticize, because the training
was outstanding in other regards, rather it provides
a personal reference point to situate the question:
How far has clinical psychology (now referred to
as health service psychology) progressed in re-
spect to inclusion of the spiritual dimension, in-
Correspondence concerning this article should be ad-
dressed to Edward P. Shafranske, Graduate School of Ed-
ucation and Psychology, Pepperdine University, 18111 Von
Karman Avenue, Irvine, CA 92612. E-mail: eshafran@
pepperdine.edu
18
cluding religion, in its science, applied practice,
education, and clinical training?
A review of the scientific literature finds a
remarkable advance in scholarship; for exam-
ple, there was a 10-fold increase in PsycINFO
citations (using the keywords religion/religious,
spirituality/spiritual) comparing 1981 and 2015.
The publication of the APA Handbook of Psy-
chology, Religion, and Spirituality (Pargament,
Exline, Jones, Mahoney, & Shafranske, 2013)
and the establishment of two American Psycho-
logical Association (APA) journals, Psychology
of Religion and Spirituality and Spirituality in
Clinical Practice, in addition to many authori-
tative texts in the applied psychology of religion
and spirituality, provide benchmarks of the de-
velopment and vibrancy of the field. However, I
am less certain about the extent to which prog-
ress has been made in graduate education and
training. Despite a flourishing body of empirical
research, which has established the relevance of
religious or spiritual variables on health and
treatment, psychologists generally receive quite
limited education and clinical training on the
topic (Shafranske & Cummings, 2013). This
concerns me. Why? First, as a practicing clini-
 ADDRESSING SPIRITUALITY IN CLINICAL SUPERVISION
cian I have observed over time the importance
of spirituality (however individually experi-
enced and defined) in the lives of most, al-
though not all, patients. Facing the hardships of
life, including trauma, psychological conflicts,
personal disappointments, and psychiatric ill-
ness, no matter root cause, people seek mean-
ing, understanding, and hope. The great reli-
gious traditions, in addition to personal spiritual
experiences, offer narratives that contextualize
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
human suffering (as well as human purpose) in
This document is copyrighted by the American Psychological Association or one of its allied publishers.
their transcendent cosmologies and unique
worldviews and offer sacred rituals (private and
public) to sustain hope and give direction.1 Psy-
chology also offers perspectives and therapies
to remedy suffering and offer hope and direc-
tion to enhance adaptation and functioning.
These approaches need not be exclusive, but
rather, in my view, should be brought into
meaningful correspondence. More to the point,
Pargament et al. (2013) observed, “a substantial
part of the world’s population looks at life
through a sacred lens, a lens that colors, filters,
and clarifies their view of reality. Psychologists
who encourage people to replace their glasses
with psychological prescriptions are unlikely to
meet with a great deal of success” (p. 296). My
personal experience confirms the wisdom of his
statement. Further, treatment is often enhanced
by some form of inclusion of the patient’s reli-
gious faith or spirituality into the therapeutic
process because the psychology of religion and
spirituality (R/S) informs understanding of the
patient’s presenting problems, worldview, deci-
sion-making, personal appraisals, coping, and
life satisfaction.
My concern is also based on the readiness of
psychologists to fulfill their ethical obligations
in respect to infusing professional practice with
consideration of culture, including the contribu-
tions of religion (APA Ethical Principles of
Psychologists and Code of Ethics, Standard
2.01 [American Psychological Association,
2010]) and to implement the policy of evidence-
based professional practice (APA Presidential
Task Force on Evidence-Based Practice, 2006),
which requires integration of the “best available
research with clinical expertise in the context of
patient characteristics, culture, and preferences
[emphasis added]” (p. 273). I argue that it is
difficult to accomplish such an ethical respon-
sibility, absent sufficient education; however,
clinical supervision, through the use of an in-
19
tentional framework, offers a remedy by pro-
viding a context and method to develop clinical
competence, which may include consideration
of religious or spiritual preferences. It can be
tailored to assist trainees to become more aware
of the contributions of R/S to enhance (or to
diminish) the well-being of individuals (APA
Presidential Working Group, 2008) and to inte-
grate approaches sensitive to the patient’s R/S
characteristics and preferences.
Competency-Based Clinical Supervision
Competency-based clinical supervision (Fal-
ender & Shafranske, 2004) provides a system-
atic, metatheoretical approach that is uniquely
suited to develop clinical competence in the
culturally sensitive integration of R/S in psy-
chological treatment (and in other professional
services). In the following sections, I briefly
sketch the principles used in its application (see
Shafranske, 2014). Central to the approach is
the identification of the knowledge, skills, and
attitudes that contribute to the development of
clinical competence, which is, in this case, spe-
cific to psychological practice attuned to the R/S
values and preferences of clients.
Attitudes
We begin with attitudes because developing
an understanding of the client’s R/S beliefs,
commitments, affiliations, and practices is reli-
ant on a stance of genuine and respectful inter-
est. Supervisees must gain an awareness of their
own beliefs, attitudes, and assumptions about
R/S because personal biases will inevitably af-
fect their ability to understand the worldview of
the other. Agreement with the client’s spiritual
worldview is not required to appreciate the role
it serves; however, cultural humility is neces-
sary to be receptive to client perspectives that
are in variance with the supervisee’s beliefs and
ontological commitments. Also, it is important
to consider that psychologists in general are in
many ways less religious that the U.S. popula-
tion and, for example, psychology professors
1
Religion can also have negative impacts as identified in
the literature and discussed in APA’s (APA Presidential
Working Group, 2008) resolution on religious, religion-
based, and/or religion-derived prejudice.
 20 SHAFRANSKE

are among the least religious in the academy ing, posttraumatic growth, and treatment
(Shafranske & Cummings, 2013), which may compliance in schizophrenia) and be prepared
result in a professional culture that is not at- to counter misassumptions as well as supply
tuned (or is potentially antagonistic) to the R/S information.
moorings of clients. It is important for supervi-
sors to model respect for R/S in their comments
regarding patients as well in creating a psycho- Skills
logically safe space for supervisees to examine
Following attention to attitudes and knowl-
how their own faith perspectives influence their
edge, supervisors can assist supervisees to de-
work with clients.2 And it is useful at the be-
velop skills in the ability to assess the relevance
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

ginning of training to include in the supervisory

of R/S to psychological coping and to identify
This document is copyrighted by the American Psychological Association or one of its allied publishers.

contract the expectation that issues related to

religious beliefs or forms of religious scrupu-
client R/S, the use of religiously accommodated
losity or misconceptions impacting psychologi-
interventions, and possibly discussion of the
cal adjustment as well as spiritual struggles.
supervisee’s personal reactions to client R/S
Approaches to explicit and implicit integration
may occur. Also, when client issues emerge in
can be undertaken, from respecting and support-
respect to R/S, it is important to inquire not just
ing of the client’s spirituality and religious tra-
about personal reactions, but also to gauge the
ditions to employing empirically supported re-
supervisee’s knowledge and attitudes toward
ligious-accommodative therapies. Integration of
R/S transmitted in graduate school and in pre-
R/S approaches and resources in psychological
vious supervision. The intent is not only to
treatment should be consistent with client val-
obtain information relevant to set the supervi-
ues and preferences, within the expertise of the
sory agenda and training, but also to open a
supervisor and the developing competence of
dialogue and create a space in which issues
the supervisee, based on the scientific literature,
related to spirituality may be discussed, aimed
consistent with ethics, and with the patient’s
at providing treatment responsive to the client’s
informed consent. Careful assessment of the
beliefs and values and facilitating the supervis-
therapeutic alliance should be conducted and
ee’s competence. Supervisors must also be
feedback solicited throughout the treatment to
mindful of the potential harm to clients and the
monitor the impacts of efforts at integration.
possible necessity to intervene, should the su-
Supervisors should carefully assess their com-
pervisee display spiritual intolerance or any
petence (knowledge, skills, and attitudes) be-
form of imposition of their personal beliefs. It is
fore embarking on such training and supervi-
equally important to respect the supervisee’s
sion with their supervisee and always place
R/S commitments as well as to be mindful of
client welfare at the top of their responsibilities.
the complex issues involving “conscience
clauses” when trainees’ personal beliefs collide
with professional competence (Forrest, 2012). Reflection

Knowledge I wish to return to where I began with a

It is likely that most supervisees come into
supervision with little knowledge of the psy-
chology of religion and spirituality. Pargament
(2007) identified spiritual literacy to be a com-
mon problem, given the lack of exposure in
graduate education. Supervisors can address
this gap by referring supervisees to the literature
(as well as enhancing their familiarity of the
field). There is an extensive body of empirical
research that is relevant to clinical practice and
hence to training and clinical supervision. Su-
pervisors should be conversant with that litera-
ture (e.g., R/S and mental health, religious cop-
personal reflection. Although there was no ex-
plicit attention given to the integration of R/S in
treatment, my supervisors were respectful and
genuinely committed to my development as a
psychologist and created a space in which I
could explore my experiences as a clinician,
receive feedback and direction, and begin a
journey that has been deeply meaningful and
professionally satisfying. I believe conditions of
2
It is never appropriate for supervisors to inquire about
the supervisee’s R/S beliefs and commitments outside of the
immediate relevance to the supervisee’s present clinical
work. To do so would constitute a boundary violation.
 ADDRESSING SPIRITUALITY IN CLINICAL SUPERVISION
respect, empathy, genuine concern, and ethical
practice, complemented by clinical competence
and skills in the conduct of competency-based
clinical supervision are required to foster the
creation of a supervisory relationship in which
the spiritual dimension can fully be considered
for the benefit of the client. Such a relationship
creates the conditions of safety out of which
self-reflectivity and authentic discourse can oc-
cur, and sets into motion a trajectory of open-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ness to experience. For some supervisees and
This document is copyrighted by the American Psychological Association or one of its allied publishers.
clinicians, this openness to experience will fos-
ter a deep appreciation for humanity and grati-
tude for having the opportunity to be of service
to others—for some, such is a charism of spir-
ituality.
References
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(2002, Amended June 1, 2010). Retrieved from
http://www.apa.org/ethics/code/index.aspx
APA Presidential Working Group. (2008). Resolu-
tion on religious, religion-based, and/or religion-
derived prejudice. American Psychologist, 63,
431– 434.
APA Presidential Task Force on Evidence-Based
Practice. (2006). Evidence-based practice in psy-
chology. American Psychologist, 61, 271–285.
http://dx.doi.org/10.1037/0003-066X.61.4.271
Falender, C. A., & Shafranske, E. P. (2004). Clinical
supervision. A competency-based approach.
21
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Received January 19, 2016
Accepted February 1, 2016 䡲