Assessing clinically significant religious impairment in clients: Applications from measures in the psychology of religion and spirituality

This article reviews measures in the psychological study of religion and spirituality (RS) in terms of Hathaway's (1999) conceptualization of clinically significant religious impairment (CSRI). It is maintained that RS can be regarded as an endogenous variable impaired by psychopathology. Specific RS measures are discussed in terms of how they may be used to assess RS impairment in clients in terms of performing RS activities, achieving RS goals, and experiencing desired RS states.     

The Wretchedness of Belief

In Culture and Value Wittgenstein remarks that the truly “religious man” thinks himself to be, not merely “imperfect” or “ill,” but wholly “wretched.” While such sentiments are of obvious biographical interest, in this paper I show why they are also worthy of serious philosophical attention. Although the influence of Wittgenstein's thinking on the philosophy of religion is often judged negatively (as, for example, leading to quietist and/or fideist‐relativist conclusions) I argue that the distinctly ethical conception of religion (specifically Christianity) that Wittgenstein presents should lead us to a quite different assessment. In particular, his preoccupation with the categorical nature of religion suggests a conception of “genuine” religious belief which disrupts both the economics of eschatological‐salvationist hope, and the traditional ethical precept that “ought implies can.” In short, what Wittgenstein presents is a sketch of a religion without recompense.     

Ethics in Case Conceptualization and Diagnosis: Incorporating a Medical Model Into the Developmental Counseling Tradition

In this literature review, the author focuses on several ethical considerations in case conceptualization and diagnosis, including diagnostic training and competence. Meeting the American Counseling Association's (1995) ethical standard for diagnostic training has several ethical implications for counselors, counselor educators, and supervisors. For counselors who might struggle with how to meet their ethical responsibilities in diagnosis but who want to remain true to their developmental counseling emphases, the author discusses some of their concerns, the implications of and possible approaches to this aspect of their work. Conclusion Yalom (2002) asked a poignant question of counselors in his book, The Gift of Therapy: “If you were in personal psychotherapy or are considering it, what DSM‐IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?” (p. 5). This question and continued dialogue about the ethics and implications of diagnosis are essential aspects of diagnostic training. Yalom's poignant and deeply personal question seems especially appropriate for increasing a counselor's empathy toward the client's sensitivity and vulnerability during the diagnostic process. Counselor educators might ask how one remains true to a developmental model of counseling while adhering to the ethical and accreditation standards of teaching the DSM's medical model of diagnosis. Counselors may also question how to use diagnosis ethically and empathically. Seligman (1999) recommended that clinicians view the DSM as one of many important sources of information about a person. Furthermore, counselors should seek to incorporate diagnostic information into a holistic context, recognizing that a diagnosis does not reflect the totality of the client. Some counselor educators have advised students to integrate the DSM model into their work with clients rather than abandoning their developmental roots (Waldo et al., 1993). Some counselors may not actually put their diagnoses in writing; Seligman believed, however, that thinking diagnostically may assist counselors in determining the best approaches to help clients and to help clients help themselves. This clinical and ethical debate about how, and in fact, whether, to integrate the medical model of the DSM and the developmental origins and distinctiveness of counseling continues. However, the CACREP (2001) standards, managed care systems, and other forces have pushed counseling professionals toward a medical model by mandating counselor knowledge and use of the DSM. Whatever a counselor's stance and behavior on client assessment and diagnosis may be, the literature presented in this review and discussion seems to suggest a need for heightened sensitivity to, preparation for, and accuracy in all facets of client assessment, especially diagnosis.     

National identity and ethno-religious identity: A critical inquiry into Chinese religious policy,with reference to the Uighurs in Xinjiang

Abstract

On the basis of data from the survey of religion and values in Central and Eastern Europe Aufbruch – 2007 this article questions the applicability of the basic theoretical propositions about the relations between religion and modernity, such as theory of secularisation (classically understood) and rational choice theory, and the thesis about the vicarious nature of religion, to the religious situation in the traditionally Orthodox part of Eastern Europe (Romania, Moldova, Serbia, Bulgaria, Belarus' and Ukraine). Following Shmuel Eisenstadt's concept of multiple modernities and Grace Davie's thesis of the secular character of Western European societies, it explores the possibility of viewing the religious modernity/modernities in the postcommunist traditionally Orthodox area of Eastern Europe as an alternative to the (secular) modernity of Western Europe, and the region itself as an ‘other-worldly’ Europe. After an overview of the specific features of Orthodox Christianity enabling this traditional religion to respond successfully to the demands of modern society, the article turns to the survey data covering a range of standard and also less frequently researched aspects of religiosity. The analysis concludes with a summary of the challenges that Orthodox Europe presents to the basic theoretical propositions about religion and modernity and stresses the important role that religion (and traditional churches) play in the social and political life of this region – a role that should not be ignored.     

Religious Research in Gerontology, 1980–1994: A Systematic Review

ABSTRACT

This article presents results of an NIA-funded systematic review of research on religion and aging published from 1980–1994 in mainstream gerontology and religion journals, including the Journal of Religious Gerontology. Findings are summarized from 73 empirical studies, a subset of the 115 articles included in NIA's bibliography on this topic. In general, these studies use multiethnic samples, include multiple religious dimensions, and focus on age comparative analyses and on analyses of religious effects on life satisfaction, health, and well-being. Also summarized is gerontological research on patterns, predictors, outcomes, and measures of religious involvement, and an agenda for future research is proposed.     

Ethics in the Teaching of Mental Health Professionals

Summary

It is the position of the authors that mental health professionals-in-training must be well versed in the ethical/legal matters of clinical practice. Indeed, most graduate programs in the field of mental health require formal training in Ethics. The California School of Professional Psychology (Alliant International University) San Diego campus has developed a model that requires (a) an ethics course integrated with the student's on-campus supervision in the Fall and Spring semesters at the practicum level, focusing on the American Psychological Association's Ethics Code (2002) and California's Licensing Laws; and (b) an advanced ethics course (in the fourth year of training) that focuses on the integration of ethical and legal issues in clinical practice and providing a knowledge base of sound ethical judgment. Syllabi for these two courses are included.     

National alliance for family life

Abstract

This article presents a review of the early attempts to classify the field of family therapy, including Haley's (1962) caricatures, the Group for the Advancement of Psychiatry's (1970) classification, Beels and Ferber's (1969) antitheoretical model, and others. A recent paradigmatic scheme (Ritterman, 1977) based on the pretheoretical assumptions of the family theorists is examined in detail, extended to encompass more of the field and critiqued from the perspectives of its overall validity and utility. Finally, a new paradigmatic model based on the formal aspects of the family therapy theories is presented.     

Whither the Psychology of Religion: A Spirituality-Focused Discussion of Paloutzian and Park’s (2005)

Presuming Rayburn’s (2006: Child & Family Behavior Therapy, 28, 86–92) review of (Paloutzian and Park, 2005, Handbook of the psychology of religion and spirituality. New York: The Guilford Press) and sketching an alternative paradigm, this review focuses on the Handbook’s virtual conflation of religion and spirituality; relates this conflation to the hegemony of Protestant theology in North American psychology of religion; highlights the Handbook’s neglect of spirituality per se, which, if not inseparably linked with theism, is, nevertheless, related to the self-transcending, meaning-making dimension of the human mind, could provide an explanatory breakthrough in the field of the psychology of religion and of the social sciences overall; and sees Handbook’s advocacy for a “multilevel interdisciplinary paradigm” as a regrettable acceptance of the failed, long-term strategy of the field of psychology in general.     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

Reducing the risk of bias in health behaviour change trials: Improving trial design,reporting or bias assessment criteria? A review and case study

Objective: It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than – for example– drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria.

Design: First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework.

Main outcome measures: Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework.

Results: Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented.

Conclusions: The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.     

A descriptive study of e-counsellor attitudes,ethics, and practice

Introduction: The purpose of this study was to examine questions related to the process, perceived outcomes, and ethics of therapists who provide counselling and therapy online. Method: An online survey was conducted (N=93) with identified e-counsellors with at least a Master's Degree. Questions included demographic information and Likert-type scales related to extent of practice, theoretical orientation, training and supervision, attitudes about appropriate practice, referral, legal and ethical issues, practice difficulties, and therapist satisfaction. Results: Overall, e-counsellors are satisfied with their practice and believe it is effective. They generally do not have formal training or supervision in online practice. Current e-counselling appears to be a part-time, supplemental practice with little overlap to FTF practice. There was little agreement among respondents on attitudes, practice, ethical issues, and knowledge of regulations related to e-counselling. Discussion: Lack of consensus about ethical obligations and practice suggest the need for formal training in e-counselling by professional programmes and international cooperation in formulating practice ethics. Areas for further research are discussed.     

Religion and development ethics in global perspective: a case study of a foreign Christian NGO in China

ABSTRACT

Much academic writing on religion and development tends to focus on the values, beliefs, and modes of operation of religious organizations to examine whether religion contributes ethically to development. A problem with such an approach is its disregard of the contested and evolving nature of religious participation in development in broader national and global contexts. What constitutes ethical religious contribution to development? How can we study the question sociologically? To answer these two questions, I develop Roland Robertson’s notion of the global field to present a framework for analyzing the dynamic interaction between religion and development ethics. In terms of methodological contribution, the framework proposed here prompts us dynamically to contextualize the issue of religious development ethics with reference to four components that make up the global field: the religious agent, the national society, the global civil society, and the global discourse on wellbeing and development. This means that, from an analytical perspective, what is proper or ethical in religious development ethics should not be construed in absolute terms, but in terms of degree and variation. I demonstrate the usefulness of such a contextual approach by drawing on research on ‘GMV’ (pseudonym for an international Christian medical professional services group actively engaged in community development) in China and examining the relationship between religious NGOs, the party-state, and evolving discursive practice of development in the country.     

Accepting Fallibility: A Model for Personal Responsibility for Nonegregious Ethics Infractions

The profession's ethics standards require counselors to self‐monitor their professional actions and take responsibility for misconduct. However, the professional literature has focused on preventing misconduct and on response to serious violations and has offered little guidance regarding the minor infractions that all professionals are vulnerable to committing during their careers. The author presents a 4‐element model to guide counselors in ethically repairing damage when they recognize they have violated ethics codes or ethical principles in minor ways. The model uses the ethical principles that underlie the American Counseling Association's (1995) Code of Ethics and Standards of Practice and J. R. Rest's (1983, 1994) model of moral behavior as a foundation.     

Big Gods in review: introducing Ara Norenzayan and his critics

This essay introduces a review symposium on Ara Norenzayan's book Big Gods (2013). The essay reviews Norenzayan's earlier publications on religion, sums up the main points of criticism that have been put forward by the contributors, and raises some concerns about the questions to be asked about ‘religion.’     

‘Polydorus Italus’

Abstract

In his Anglica Historia, the expatriate Italian cleric, Polydore Vergil (1470–1555), cultivated a flexible and resourceful relationship with ecclesiastical and temporal authorities in Henrician and Edwardine England when residing there. His humanist learning enabled him to adapt to changes of power and religion by means of a prudent publishing strategy, to challenge with a degree of impunity the perceived wisdom of both kings and clerics, and to carry out revenge upon one who had wronged him: Cardinal Wolsey. Using primary and secondary source material, this article examines, for the first time, Vergil’s attitude to and dealings with those in authority through an assessment of his Anglica Historia. Dying a Roman Catholic in his native Italy, ‘Polydorus Italus’ adjudged the Henrician Reformation, in so far as he actually presents it, as deficient.     

Religion and Armed Conflict: Evidence from the Kurdish Conflict in Turkey

This article examines the effectiveness of religion as a solution to ethno-nationalist conflicts, drawing on the case of the Kurdistan Workers’ Party (Partiya Karkerên Kurdistan [PKK]) in Turkey. We utilize an original data set that contains data on Turkey's state-sponsored mosques between 1980 and 2016 to test for the purported peacemaking potential of religion. Results from this data set, coupled with an alternative measure of the state's involvement in religion, show that increased Islamization has no discernible impact on lowering support for the ethno-nationalist Kurdish political parties or insurgency.     

Digging beneath the surface: Results from stage one of a qualitative analysis of factors influencing the well-being of trans youth in Quebec

ABSTRACT

Background: The literature on trans youth has been dominated by etiological studies interested in trans experience as a medical phenomenon. An emerging body of literature has begun to document that trans youth are a diverse, vulnerable, yet resilient population, and to investigate the role of various sites of support such as the family, peer groups, institutions, and community spaces in contributing to or impeding trans youth's well-being.

Method: This article presents the results of Stage One of interviews (n = 24) conducted for a Community-Based Participatory Action Research (CBPAR) qualitative research project based in Quebec. It studies the factors that enhance trans youth's well-being as well as the factors of oppression that negatively affect it. This paper offers a brief overview of the anti-oppressive methodology used for this project, emphasizing how CBPAR was combined with Grounded Theory (GT) methods to encourage the direct involvement of communities and the translation of knowledge into action.

Results: We present preliminary categories emerging through the ongoing axial coding process. These categories address trans youth's experiences in and perceptions of various “sites”: 1) healthcare services both for gender-related and general care, 2) other institutional spaces, 3) the family and other social circles, and 4) community spaces.

Conclusion: While much of this study's results support existing evidence on trans youth's experiences, they also provide a more nuanced portrayal of the complex ways in which recognition, as well as non-, mis-, or mal-recognition, influence trans youth's well-being at different sites. We also argue that recognition itself must be considered through the lens of intersectionality.     

Secularism's threat to tradition: A reading of Europe,India and the Limits of Secularism

ABSTRACT

This article offers a reading of Jakob De Roover's important book, Europe, India and the Limits of Secularism (New Delhi: Oxford University Press, 2016). It invokes the way in which the English courts have re-described Sikh tradition as religion in order to illustrate the relevance of Jakob De Roover's hypothesis about secularism, explaining its dependence on Christian theology and its inbuilt normative dynamic, which reframes tradition and poses a lethal threat to it.     

Clinically significant religious impairment

Recent psychodiagnostic practice, as embodied in the DSM IV, requires that psychopathological features result in a "clinically significant impairment" to qualify as a "mental disorder" in many cases. The impairment must be in social, occupational, or other important areas of functioning. The current proposal is that clinicians should consider the potential impairment in religious functioning arising from mental disorders in diagnostic process. It is suggested that psychopathology may result in a clinically significant religious impairment that is defined as a reduced ability to perform religious activities, achieve religious goals, or to experience religious states, due to a psychological disorder. Various existing approaches to studying the relationship between religious functioning and psychopathology are briefly reviewed and roughly categorized as either focused on 'symptomatic religiosity' or reflecting a 'religiously sympathetic' posture. Yet, in both of these approaches, religion has predominantly been construed as an exogenous variable contributing to mental health in some fashion (for good, for ill, or for both). The current proposal suggests that clinicians should also consider religion in endogenous perspective. So construed, religion is a significant domain of adaptive functioning, which may be adversely impacted by psychopathology. A discussion of various clinical, research and ethical issues involved in realizing the proposal is provided.     

A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

ABSTRACT

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e., desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender-nonconforming children.

Methods: A critical review methodology is employed to systematically interpret four frequently-cited studies that sought to document identity outcomes for gender-nonconforming children (often referred to as “desistance” research).

Results: Methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, “How should children's gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?”

Conclusion: The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children's gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children's voices seriously. Listening to children's experiences will enable a more comprehensive understanding of the needs of gender-nonconforming children and provide guidance to scientific and lay communities.