Title: RELIGIOUS ISSUES IN SECULARLY BASED PSYCHOTHERAPY , 

By:
Genia, Vicky, Counseling & Values, 01607960, Apr2000, Vol. 44, Issue 3
Database: Academic Search Premier

RELIGIOUS ISSUES IN SECULARLY BASED PSYCHOTHERAPY

Contents
RELIGION Because many potential clients have religious as well as
AND secular concerns, secular counselors and
MENTAL psychotherapists are striving to become more empathic
HEALTH and competent in treating religious individuals. This
article discusses some issues and implications involved
ASSESSME
in working with religiously committed clients in secularly
NT
based counseling.
SELF-
DISCLOSU Religion serves as an important influence in the lives of
RE many Americans (Hoge, 1996). In stark contrast to
PSYCHOSP most of the U.S. population, secular mental health
IRITUAL professionals seem to eschew involvement in organized
INTEGRATI religion (Bergin & Jensen, 1990; Goud, 1990;
ON Shafranske & Malony, 1990a, 1990b). Given that a
COUNTERT substantial constituency of clients with religious
RANSFERE concerns might prefer a secularly based
NCE psychotherapeutic approach and may be unlikely to
REFERRAL seek religious counseling (Quakenbos, Privette, &
Klentz, 1985), psychotherapists are challenged to
CONCLUSI provide sensitive and competent treatment to religiously
ON committed clients. These are clients for whom
REFERENC conventional religious beliefs and practices are
ES important.

Although many forms of psychotherapy do not address religious issues,

several approaches are noted for their spiritual perspectives on
psychotherapeutic healing. The various twelve step programs are based
on an individual's reliance on a higher power for assistance in stopping
destructive behaviors. Positive life changes are considered to result from
an act of faith. However, twelve step programs may emphasize the
importance of personal spirituality and deemphasize involvement in
traditional established religions (Hopson, 1996).

Transpersonal psychotherapy is another approach that recognizes the

potential value of a spiritual worldview in promoting psychological
health. Because transpersonal therapists believe that spiritual
development can occur within or outside of organized religion (Vaughan,
Wittine, & Walsh, 1996), religiously committed clients can talk openly
about their religious beliefs and values.

Despite some notable exceptions, many secular practitioners still

assume that traditional religious involvement is a liability (Wulff, 1996).
In addition, many report that they have received no training in the
psychology of religion and feel unprepared to competently work with
religious material in therapy (Shafranske, 1996b; Shafranske & Malony,
1990b). The purpose of this article is to discuss some of the therapeutic
issues involved in working with religiously committed clients in secularly
based psychological treatment. If they are informed about important
issues regarding the treatment of religious clients, psychotherapists will
be better prepared to address the needs of this population.

RELIGION AND MENTAL HEALTH

Because traditional psychology-oriented professions seem to disfavor

conventional religious beliefs and practices (Lovinger, 1984; Meissner,
1984), some mental health providers may automatically assume that
clients with strong religious convictions are unhealthy psychologically.
Exposure to information about religion and mental health can help dispel
an uncritically examined antireligious bias.

Much research suggests that strong religious commitment is associated

with positive mental health. High levels of religious involvement predict
lower suicide ideology (Gartner, Larson, & Allen, 1991; Payne, Bergin,
Bielema, & Jenkins, 1991; Stack & Wasserman, 1992) and depression
(Gartner et al., 1991; Genia & Shaw, 1991) and greater marital
satisfaction (Payne et al., 1991). Alcohol and drug use tends to be low
among individuals who attend religious services frequently (Gartner et
al., 1991; Payne et al., 1991). Moreover, studies show that a strong
religious commitment helps alcoholics achieve abstinence and maintain
recovery (Payne et al., 1991).

Given that mental health professionals see large numbers of clients who
experience marital discord and suffer from depression and chemical
dependency, the aforementioned findings are encouraging. Although it is
not appropriate for therapists to convince clients to accept religious
solutions to their problems, stronger therapeutic alliances with religious
clients can be maintained if secular therapists appreciate the benefits of
faith. Therapists should familiarize themselves with religious research,
not to become proreligious but to appreciate the healthy potentialities of
religious involvement.
 ASSESSMENT

The psychotherapeutic process typically begins with a psychological

assessment. Although inquiry is made into the most private aspects of
the client's life, therapists rarely ask questions about the religious
dimensions of the client. Including questions about religious upbringing,
feelings, beliefs, and practices during the initial interviews not only
assists the clinician in formulating an accurate psychological profile but
also conveys to the client that religious material may be explored in
therapy.

The taking of a family history should routinely solicit information about

the family's religious affiliation and level of religious involvement. The
family's religious history can assist in understanding the client's religious
concerns or provide clues to unacknowledged psychospiritual issues. For
example, adult children of dual-faith marriages may need help in
choosing a faith or resolving conflicting religious loyalties (Goodman-
Malamuth & Margolis, 1992). Clients from religious families that strongly
discourage marriage to individuals outside the faith may experience
significant distress if their spouse or romantic partner does not share a
common religious heritage.

Certain presenting problems may arouse religious conflicts that were

previously dormant or contained. Religious matters may surface in
clients who are coping with the death of a significant other, suicidal
urges, an illicit sexual affair, divorce, or a life-threatening illness. Among
religiously unaffiliated clients, the effects of early religious education
may exert unconscious pressures that create psychological
disequilibrium during traumatic or life-transitioning experiences.
Therefore, at least some information about the client's religious
background should be obtained early in the treatment.

During the information-gathering process, as well as throughout the

treatment, therapists should keep in mind that religious and
psychological issues are inextricably interconnected. Religious material
may inform the clinician of important psychological struggles. The
client's personal images of God provide a window into the quality of his
or her formative relationships and level of psychological development
(Rizutto, 1979, 1993). Religious doubts and uncertainties, desires to
disaffiliate, interest in divergent faiths, and spiritual identity confusion
suggest that the client may be struggling with issues concerning
separation and individuation (Genia, 1995).

In sum, valuable diagnostic information may be lost if the clinician does

not take a religious history during the initial assessment. Because
comprehensive treatment planning requires a thorough and accurate
assessment, mental health providers are encouraged to give some
attention to the client's religious thoughts, feelings, and activities.

SELF-DISCLOSURE

Although clients are often curious about the therapist's personal beliefs,
those who wish to discuss religious matters are particularly likely to
insist on knowing the therapist's religious orientation. Concerns that
secular clinicians will undermine their faith is common among religiously
conservative clients (Worthington, 1986). Given that religious
involvement is low among secular mental health providers (Bergin &
Jensen, 1990; Goud, 1990; Shafranske & Malony, 1990a, 1990b), the
fears of highly religious clients are not entirely unfounded.

Religious disaffiliates and ex-believers may also be concerned about the

therapist's religious identity. These clients may fear that therapists who
share their former religious allegiance will be judgmental toward their
unorthodox views or interests in other religions. Some religious
defectors, on the other hand, are concerned that atheistic clinicians will
not support their efforts to replace their former faith with a more
personally satisfying religious worldview.

Mental health providers must decide how to respond to clients' inquiries

about their religious preferences. Theorists disagree about the
desirability of therapist self-disclosure of religious beliefs.
Psychoanalysts in particular support nondisclosure as necessary for
client autonomy and freedom of inquiry. Deviation from therapeutic
abstinence is an anathema to many psychodynamically oriented
therapists who contend that therapist self-disclosure of religious
orientation is likely to inhibit the client from revealing private feelings,
especially in morally sensitive areas (Rizutto, 1993).

Others counter-argue that psychotherapy is not a value-free enterprise

and object to a strategy of trying to be noncommittal or objective
(Bergin, 1980, 1991). These theorists further contend that therapist
self-disclosure of spiritual values is central to ethical treatment and
helps to preserve client autonomy (Bergin, 1991; Presley, 1992).
Therapist transparency is viewed as necessary to protect clients from
being inadvertently persuaded to accept the clinician's superordinate
values without critical examination.

Without professional consensus and definitive guidelines, the task of

deciding if, when, and how much therapists should reveal about their
private religious choices becomes more complicated. However, careful
consideration of the theoretical and ethical issues will help clinicians
make more consciously determined and informed decisions. An evasive
answer to the client's inquiry may heighten the client's anxiety and lead
to premature termination (Lovinger, 1984). I have found it helpful to
give a direct but brief response and then explore the client's reactions
and concerns. Professional helpers who demonstrate tolerance of
divergent beliefs can challenge the client's assumption that religious
differences are dangerous and threatening.

PSYCHOSPIRITUAL INTEGRATION

Given that it is advisable to regard religion as a touchable aspect of the

client's experience, therapists might consider ways of incorporating
religion into the psychotherapeutic process. Tan (1996) distinguished
two major approaches to integrating religion in clinical practice: explicit
integration and implicit integration.

Therapists who work from the explicit integration model directly

integrate spiritual approaches with traditional psychotherapeutic
methods. Explicit interventions may include time-honored religious
practices such as prayer, discussion and interpretation of sacred
writings, and encouragement of forgiveness (Richards & Bergin, 1997).
Therapists who follow an explicit approach may also use standard
psychological techniques that are adapted to include religious content.
Religious cognitive therapy (Propst, 1992, 1996), inner healing prayer
(Tan, 1996), and the use of guided imagery with direct reference to
spiritual concepts are examples of integrated psychospiritual
interventions that blend traditional psychotherapeutic help and spiritual
direction.

Although religious and spiritual techniques have attracted enthusiastic

proponents, these methods have also received scathing criticism.
Therapists who assume roles of both counselor and spiritual guide may
transgress appropriate psychotherapeutic boundaries in ways that
confuse clients or collude with religious defenses. Psychodynamic
therapists, in particular, contend that blending psychotherapy with
ministering may disrupt the therapeutic alliance and impede the
psychotherapeutic process (Rizutto, 1996).

In addition to possible role confusion, there exist other therapeutic and

ethical reasons why an explicit approach may be contraindicated. First,
surveys have indicated that many therapists receive little or no training
in working with religious material in therapy (Bergin & Jensen, 1990;
Shafranske & Malony, 1990b). Therefore, it would be helpful for
therapists who wish to incorporate religion into psychotherapeutic
practice to pursue additional training (Richards & Bergin, 1997;
Shafranske & Malony, 1996). Second, therapists should be careful that
the use of religious interventions does not violate laws regarding the
separation of church and state (Richards & Bergin, 1997). Third,
religious interventions may be iatrogenic for more severely disturbed
clients (Genia, 1995; Richards & Bergin, 1997). Fourth, it seems that
therapists who conduct spiritual interventions would benefit from
nurturing their own religious development.

According to Tan (1996),

implicit integration of religion in clinical practice refers to a more covert

approach that does not initiate the discussion of religious or spiritual
issues and does not openly, directly, or systematically use spiritual
resources like prayer and . . . sacred texts in therapy. (p. 368)

Therapists who follow the implicit integration model respectfully and

sensitively respond to religious themes as they emerge in the therapy.
Although empathically attuned to the client's religious worldview, the
therapist does not explicitly endorse the client's faith or share his or her
own religious views with the client. Clients who prefer a more religiously
oriented approach to counseling are referred to a clergyperson, pastoral
counselor, or therapist who practices from an explicit integration
perspective. Several excellent texts provide rich and detailed case
examples of how an implicit listening perspective on religious material
contributes to the psychological and spiritual development of clients in
therapy (e.g., Randour, 1993; Spero, 1985).

COUNTERTRANSFERENCE

Because secular therapists tend to be far less religiously involved than

the general population and receive little or no training in working with
religious concerns (Bergin & Jensen, 1990; Shafranske & Malony,
1990b), they may be particularly vulnerable to experiencing strong
countertransference reactions with religious clients. Considering that
traditional psychotherapeutic settings offer little opportunity for
discussion of religious issues with other professionals, the need for
therapist self-scrutiny is heightened.

A common countertransference is to react against the client's religiosity

(Kochems, 1993). Despite a resurgence of interest in spirituality and in
the psychology of religion, antireligious biases seem deeply entrenched
in the mental health profession. Among a national sample of mental
health providers, only 29% expressed the belief that religious matters
are important for treatment efforts (Bergin & Jensen, 1990). Shafranske
and Malony (1990b) found a high rate of religious disaffiliation among a
national sample of clinical psychologists, 25% of whom reported
negative feelings about past religious experiences. Significant
underrepresentation of religious people in the profession of psychology
may be partially due to religious discrimination in admission to graduate
programs in clinical psychology (Gartner, 1986).

Evangelizing clients who present themselves as morally superior may

evoke a hostile reaction, especially if the therapist's nonbelief was
formed in response to past negative experiences. Moreover, the
fanaticism, intolerance, and disputatiousness of dogmatic clients are
highly antithetical to therapist allegiance to humanistic principles.
However, therapists who become drawn into religious debates with
highly orthodox clients risk colluding with client resistance to deeper
self-exploration and may miss vital opportunities to promote client self-
discovery. Vigorous attempts to prove the correctness of their religious
worldview may reflect client intolerance of ambiguity and a need for
certainty emanating from authoritarian parenting (Genia, 1995).

The hostile countertransference evoked by the religiously orthodox client

may be an indication that the therapist is experiencing projective
identification that occurs when the client deposits his or her
uncomfortable feelings into the therapist. By identifying with their
intolerant and judgmental caretakers, these clients unconsciously
convey to the therapist how it feels to be belittled and disaffirmed.
Astute therapists can use their own feelings of resentment to
empathically understand, the client's childhood experience instead of
being drawn into a reenactment of that experience.

Another countertransference may be relief some therapists experience

when dogmatic clients begin to question and change their prior religious
convictions. Therapists who encourage clients to challenge or abandon
their fundamentalist beliefs too quickly may overlook the grief and sense
of groundlessness that can accompany loss of one's former faith. Those
who enjoyed an unquestioning relationship to God and their religious
community may experience a profound sense of loss, anxiety, and
depression as they become disembedded from the worldview that they
previously took for granted.

More opportunities for clinicians to receive professional training and

collegial consultation regarding religious issues in therapy can help them
better understand and manage these and other countertransference
reactions. Psychotherapists may also find it helpful to avail themselves
of the growing literature on religion in the practice of psychology (e.g.,
Genia, 1995; Kelly, 1995; Lovinger, 1984; Shafranske, 1996a; Spero,
1985; Stern, 1985).

REFERRAL

After the initial assessment, counselors and other psychotherapists

should collaborate with clients in deciding whether secularly based
therapy, religious counseling, or both will be the best therapeutic
modality for the religiously committed client. In making this
determination, therapists should consider the nature of the client's
religious concerns, the client's comfort with secularly based therapy, and
the degree of psychological disturbance.

The level of psychopathology and extent to which spiritual and emotional

concerns are inextricably interconnected are of primary consideration in
recommending the type of counseling that is most likely to be beneficial
for the religious client. Spiritual intervention alone may be insufficient
with more psychologically disturbed clients (Richards & Bergin, 1997).
Moreover, clergypersons and pastoral counselors may lack the
psychological expertise necessary to diagnose and treat mental
disorders (Domino, 1990). Where spiritual concerns are intertwined with
deficits in ego and superego functioning, faith is unlikely to be
transformed without changes in the quality of internalized objects and
acquisition of impulse control (Genia, 1995). Clients under the dominion
of internalized sadomasochistic God representations are unlikely to
receive religious consolation through spiritual practices.

Because some highly religiously orthodox clients fear that

psychotherapists will undermine their faith, it may be best to refer to a
psychologist who is also a religious professional of the client's faith.
Growing numbers of rabbis, priests, ministers, and other religious
professionals are also competent mental health providers.

Referral to a pastoral counselor may be indicated for reasonably

adjusted clients who need both psychological counseling and religious
consolation. These clients may have psychospiritual concerns that lend
themselves to a more focused treatment. For example, a pastoral
approach may be the treatment of choice for dying or grieving clients.

Religious counseling with a clergyperson in combination with secular

counseling may be recommended for psychotherapy clients who are also
struggling with questions of theology or religious practice. To make
appropriate referrals, it is recommended that psychotherapists have
connections with competent religious professionals and pastoral
counselors of various faiths.

CONCLUSION

This article discusses some issues involved in conducting secularly based

therapy with clients who are committed to a traditional faith. A proactive
approach toward greater understanding of the influence of religion in
psychological functioning can enhance the mental health community's
accessibility to religious populations.

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~~~~~~~~

By Vicky Genia

Vicky Genia is a staff psychologist in the Center for Psychological Services at

American University, Washington, DC. Correspondence regarding this article
should be sent to Vicky Genia, Center for Psychological Services, American
University, 4400 Massachusetts Avenue, Washington, DC 20016 (e-mail:
vgenia@aol.com).

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