Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas,Ethical Issues,and a Proposed Decision-Making Process

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems.     

Therapists' Use of Religious and Spiritual Interventions in Christian Counseling: A Preliminary Report

This study explored the use of religious and spiritual interventions in counseling by Christian therapists (N = 100). Use of religious and spiritual interventions correlated with personal religiousness and clinical training involving religious clients and religious and spiritual interventions. Course work involving either psychology or theology did not correlate with use of or self‐reported competency in using religious and spiritual interventions. Self‐reported competency was associated with personal religiousness; professional beliefs, attitudes, and values; personal experiences with counseling; and clinical training involving religious clients and religious and spiritual interventions. It is suggested that training programs incorporate clinical rotations, workshops, and supervision involving religious clients and religious and spiritual interventions to teach therapists to use religious and spiritual interventions in counseling.     

Addressing Spiritual and Religious Issues in Counseling African Americans: Implications for Counselor Training and Practice

Addressing spiritual and religious issues in the context of counseling relationships may be beneficial to many African American clients. The authors discuss various roles and functions of spirituality and religion in the lives of many African Americans, with particular attention to the impact of these issues on their mental health functioning and willingness to seek formal mental health services. The importance of academic training programs that prepare counselors to address potential spiritual and religious issues with their clients, is also highlighted.     

Reprint of: Working with religious and spiritual athletes: Ethical considerations for sport psychologists

With a growing number of sport performers revealing their religious and spiritual beliefs, it is becoming increasingly important for sport psychologists to recognize and appreciate the values (and value systems) to which such beliefs are attached. Using the RRICC model (Plante, 2007) as a framework for discussion, and through the lens of cultural praxis, the purpose of this article is to highlight ethical issues for sport psychologists when working with religious and spiritual athletes. The RRICC model addresses the ethical principles of respect, responsibility, integrity, competence, and concern. It is hoped that a discussion of these guidelines will help sport psychologists better navigate the often challenging landscape of working with athletes whose everyday lives and identities are grounded in religious and spiritual association.     

Working with religious and spiritual athletes: Ethical considerations for sport psychologists

With a growing number of sport performers revealing their religious and spiritual beliefs, it is becoming increasingly important for sport psychologists to recognize and appreciate the values (and value systems) to which such beliefs are attached. Using the RRICC model (Plante, 2007) as a framework for discussion, and through the lens of cultural praxis, the purpose of this article is to highlight ethical issues for sport psychologists when working with religious and spiritual athletes. The RRICC model addresses the ethical principles of respect, responsibility, integrity, competence, and concern. It is hoped that a discussion of these guidelines will help sport psychologists better navigate the often challenging landscape of working with athletes whose everyday lives and identities are grounded in religious and spiritual association.     

Use of religious and spiritual interventions by trainees in APA-accredited Christian clinical psychology programs

Little is known about the effectiveness of Christian clinical programs accredited by the American Psychological Association in training students to use religious and spiritual interventions in therapy. We surveyed 162 student therapists from three such programs regarding their training experiences and use of religious and spiritual interventions. Self-reported competency and use of religious and spiritual interventions correlated with a number of training components. However, none of the training components predicted unique variance in regression equations above and beyond that of general professional training, personal religiousness, and intervention-specific training. Suggestions are offered regarding intervention-specific training in both Christian and secular programs, the role of personal therapy in training, and the development of guidelines for competency in using religious and spiritual interventions.     

What Do the Spiritual and Religious Traditions Offer the Practicing Psychologist?

There has been a remarkable amount of interest in the relationship among spirituality, religion, psychology, and health of late. Contemporary interest in spirituality and religion is hot among not only the general population but among professionals in the mental and physical health disciplines. While most people believe in God and consider themselves to be spiritual, religious, or both, most mental health professionals have little if any training in this area. Psychologists can use spiritual and religious principles and tools to better serve their clients even if they do not share the same religious interests. The purpose of this article is to offer thirteen spiritual and religious tools common among all of the major religious traditions that can be used by contemporary professional psychologists in clinical practice to enhance the already high quality professional services that they provide. Examples of spiritually and religiously integrated treatment along with several ethical precautions are noted as well. This article is based on book project by Plante currently in press.     

Spiritual Issues in Counseling: What Do Students Perceive They Are Being Taught?

Client religious and spiritual practices have recently emerged as beneficial to both mental and physical health. However, graduates of counseling programs indicate that they have not been adequately trained to address religious and spiritual issues with clients. This exploratory study focused on the perceptions of counselors‐in‐training regarding what messages they received about these issues during their training programs, as well as their potential behaviors when working with clients. Results indicated that potential behaviors are not always consistent with what they are taught. Implications for training and future research are discussed.     

Observations of Muslim Physicians Regarding the Influence of Religion on Health and Their Clinical Approach

Although most patients report wanting their physicians to address the religious aspects of their lives, most physicians do not initiate questions concerning religion with their patients. Although religion plays a major role in every aspect of the life of a Muslim, most of the data on the role of religion in health have been conducted in populations that are predominantly non-Muslim. The objectives of this study were to assess Muslim physicians' beliefs and behaviours regarding religious discussions in clinical practice and to understand the factors that facilitate or impede discussion of religion in clinical settings. The study is based on a cross-sectional survey. Muslim physicians working in a tertiary care hospital in Saudi Arabia were invited to complete a questionnaire that included demographic data; intrinsic level of religiosity; beliefs about the impact of religion on health; and observations, attitudes, behaviours, and barriers to attending to patients' religious needs. Out of 225 physicians, 91% agreed that religion had a positive influence on health, but 62.2% thought that religion could lead to the refusal of medically indicated therapy. Over half of the physicians queried never asked about religious issues. Family physicians were more likely to initiate religious discussions, and physicians with high intrinsic religiosity were more likely to share their own religious views. Residents and staff physicians tended to avoid such discussions. The study results highlight the fact that many physicians do not address patients' religious issues and that there is a need to clarify ethically sound means by which to address such needs in Islamic countries. Medical institutions should work to improve the capacity of medical personnel to appropriately address religious issues. The training of clinical religious advisors is a promising solution to this dilemma.     

Religion,Spirituality, and Positive Psychology in Adulthood: A Developmental View

For decades, psychologists have been interested in the question whether, and how, religious and spiritual behavior, in terms of beliefs, attitudes, practices, and belonging, could be scientifically studied and assessed in terms of their relative good, or ill, for human well-being. This article considers contributions of religious commitment and spiritual practice to well-being and cognitive-developmental theoretical models and related bodies of empirical and clinical research regarding religious and spiritual development across the life cycle, with particular attention to questions related to positive adult development.     

Marriage and Family Therapy Graduate Students’ Satisfaction with Training Regarding Religion and Spirituality

Marriage and family therapists are likely to encounter religious or spiritual clients in their career and thus are encouraged to be aware of their clients’ religious and spirituality. This awareness is often fostered within graduate training programs. This study aims to examine graduate students’ incorporation of religion and spirituality in therapy and their satisfaction with the quality and amount of training programs’ adherence to religion and spirituality. A sample of 135 graduate students from American Association for Marriage and Family Therapy accredited programs completed the survey. Findings showed that graduate students with greater levels of religiosity and spirituality were more likely to perceive it important to address religion/spirituality in therapy and to perceive there is a need for religious/spiritual education. When controlling for religious and spiritual orientations, overall regression results revealed that not having a course on religion and spirituality and perceiving a need for religious/spirituality in education predicted lower satisfaction with the amount and quality of current training surrounding these dimensions. Implications demonstrate the need to address religious/spiritual concepts in the curriculum, supervision, and in marriage and family therapy training.     

Establishing the Validity of the Spirituality in Clinical Training Scale: Measuring the Level of Integration of Spirituality and Religion in Family Therapy Training

The existing literature suggests that family therapy training programs are not adequately preparing students to address spiritual and/or religious beliefs as a resource for change in therapy. Therefore, this study sought to validate the Spirituality in Clinical Training Scale (SCTS) as a measure of the level of integration of spirituality and/or religion in family therapy training. Additionally, this study examined the latent associations among the subscales of the SCTS and measures of personal importance of spirituality, spiritual clinical competence, and spiritual self-exploration. Finally, given that the type of educational institution (i.e., religious compared to non-religious schools) may influence the extent to which spirituality is addressed in training, this study examined whether attending a religious or non-religious institution moderated the associations among the SCTS and constructs used to assess validity. A sample of 341 master’s and doctoral family therapy students completed an on-line survey for this study. The results suggest that the SCTS is a reliable and valid measure for assessing integration of spirituality into family therapy training. The establishment of this measure is important given that no previous scale measuring the integration of spirituality into therapy training exists. The results also suggest that spiritual self-exploration is associated with increased use of interventions that integrate spirituality into therapy. Implications for clinical training are discussed.     

Psychology of Conversion and Spiritual Transformation

This article provides an overview of the four major psychological approaches used in the study of religious change. A heuristic stage model of conversion consisting of seven stages: context, crisis, quest, encounter, interaction, commitment, and consequences (Rambo 1995) serves as a framework for integrating the research of these four approaches, providing a fuller understanding of the multilayered processes involved in conversion. The authors hope that the phenomenon of spiritual transformation and conversion will continue to draw the attention of psychologists who increasingly appreciate the complexity and dynamism of religious/spiritual transformation. For the psychology of religion in general and the psychology of conversion and spiritual transformation in particular to be viable and valuable, psychologists will need to join with researchers in the human sciences and religious studies to develop methods and theories worthy of this complex subject. Additionally, through collaboration with psychologists in the People’s Republic of China, the authors look forward to exploring together the fascinating and important issues that emerge as we seek to understand the nature of conversion and spiritual transformation in China.     

Therapists' Integration of Religion and Spirituality in Counseling: A Meta‐Analysis

The authors conducted a 26‐study meta‐analysis of 5,759 therapists and their integration of religion and spirituality in counseling. Most therapists consider spirituality relevant to their lives but rarely engage in spiritual practices or participate in organized religion. Marriage and family therapists consider spirituality more relevant and participate In organized religion to a greater degree than therapists from other professions. Across professions, most therapists surveyed (over 80%) rarely discuss spiritual or religious issues in training. In mixed samples of religious and secular therapists, therapists' religious faith was associated with using religious and spiritual techniques in counseling frequently, willingness to discuss religion in therapy, and theoretical orientation.     

Religiosity/Spirituality of German Doctors in Private Practice and Likelihood of Addressing R/S Issues with Patients

This study examined the self-assessed religiosity and spirituality (R/S) of a representative sample of German physicians in private practice (n = 414) and how this related to their addressing R/S issues with patients. The majority of physicians (49.3 %) reported a Protestant denomination, with the remainder indicating mainly either Catholic (12.5 %) or none (31.9 %). A significant proportion perceived themselves as either religious (42.8 %) or spiritual (29.0 %). Women were more likely to rate themselves R/S than did men. Women (compared to men) were also somewhat more likely to attend religious services (7.4 vs. 2.1 % at least once a week) and participate in private religious activities (14.9 vs. 13.7 % at least daily), although these differences were not statistically significant. The majority of physicians (67.2 %) never/seldom addressed R/S issues with a typical patient. Physicians with higher self-perceived R/S and more frequent public and private religious activity were much more likely to address R/S issues with patients. Implications for patient care and future research are discussed.     

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.     

Religious and Spiritual Beliefs of Physicians

The aim of this study is to describe religious and spiritual beliefs of physicians and examine their influence on the decision to pursue medicine and daily medical practice. An anonymous survey was e-mailed to physicians at a large, multidisciplinary tertiary referral center with satellite clinics. Data were collected from January 2014 through February 2014. There were 2097 respondents (69.1 % men), and number of practicing years ranged from ≤1 to ≥30. Primary care physicians or medical specialists represented 74.1 %, 23.6 % were in surgical specialties, and 2.3 % were psychiatrists. The majority of physicians believe in God (65.2 %), and 51.2 % reported themselves as religious, 24.8 % spiritual, 12.4 % agnostic, and 11.6 % atheist. This self-designation was largely independent of specialty except for psychiatrists, who were more likely report agnosticism (P = 0.003). In total, 29.0 % reported that religious or spiritual beliefs influenced their decision to become a physician. Frequent prayer was reported by 44.7 % of physicians, but only 20.7 % reported having prayed with patients. Most physicians consider themselves religious or spiritual, but the rates of agnosticism and atheism are higher than the general population. Psychiatrists are the least religious group. Despite the influence of religion on physicians’ lives and medical practice, the majority have not incorporated prayer into patient encounters.     

Therapist Spiritual and Religious Values in Psychotherapy

In training and in supervision, counselors learn to be cognizant of personal values (e.g., spirituality, religiosity), yet they are enjoined to except them from practice. This article examines the nature of therapist spiritual and religious values and the impact of these values on the practice of psychotherapy. A goal of effective treatment should be the integration of therapist spiritual and religious values with therapist epistemic values in order to accommodate the spiritual and religious needs of both client and counselor. Counselor spiritual and religious values can contribute to therapy, even when the therapist is engaged in a dialectic involving personal and epistemic values.