Values and religious issues in psychotherapy and mental health

A decade of work by Bergin and others is reviewed and synthesized concerning two broad issues: (a) the role of values in psychotherapy and (b) the relation of religion to mental health. Trends have changed and there is now more professional support for addressing values issues in treatment. There is also more openness to the healthy potentialities of religious involvement, and therapists themselves manifest a new level of personal interest in such matters. Cautions and guidelines for dealing with such issues are considered in both empirical and clinical terms. The multifactorial nature of religion is documented, and healthy and unhealthy ways of being religious are described. Suggestions are given for including education in values and religious issues in the training of clinicians so that the vast population of religious clientele may be better served.     

Fostering ethical willingness: integrating emotional and contextual awareness with rational analysis

Ethical dilemmas are inherently challenging. By definition, clinicians decide between conflicting principles of welfare and naturally confront competing pulls and inclinations. This investigation of students' responses to an ethical scenario highlights how emotions and concerns can interfere with willingness to implement ethical knowledge. Clear-cut rules are the exception in psychotherapy, and clinicians must judge ethical issues on the basis of the unique context of each case. As such, subjectivity and emotional involvement are essential tools for determining ethical action, but they must be integrated with rational analysis. Strategies for attending to influential emotions and contextual factors in order to mobilize ethical commitment are described.     

The Efficacy of Adult Christian Support Groups in Coping with the Death of a Significant Loved One

Psychologists sometimes minimize important resources such as religion and spiritual beliefs for coping with bereavement. Alienation of therapeutic psychology from religious values contrasts to professional and public interest in religious experience and commitment. A supportive viewpoint has come about partially as a result of recognizing important values which clinicians have found absent in many of their clients. Until spiritual belief systems become integrated into the work of clinicians, clients may not be fully integrative in coping with loss. The key finding of this study was that individuals who participated in Christian and secular support groups showed no statistically significant difference in their mean endorsement of negative criteria on the BHS, and no statistically significant difference for their mean score endorsement of positive criteria on the RCOPE. However, a Christian-oriented approach was no less effective than a psychological-oriented one. In both groups, a spiritual connection to a specific or generalized higher power was frequently identified which clients ascribed to facilitating the management of their coping.     

Religious Orthodoxy and the Complexity of Thought about Religious and Nonreligious Issues

Two studies examined the relationship between religious orthodoxy and the complexity of thinking about religious and nonreligious issues. In both studies, participants who were high or low in religious orthodoxy wrote a paragraph outlining their thoughts about a religious issue (life after death in Study 1; existence of God in Study 2) and/or a nonreligious issue (capital punishment in Study 1; free trade between Canada and the U.S. in Study 2). The results of both studies indicated that participants who were high in religious orthodoxy were less complex in their thinking about religious issues than those low in religious orthodoxy, but did not differ in the complexity of their thinking about nonreligious issues. These results do not support the notion that orthodoxly religious individuals are dispositionally inclined to think in simpler or more rigid ways overall, but they do suggest a tendency to think less complexly about religious issues.     

The Spiritual Needs and Resources of Hospitalized Primary Care Patients

Previous studies have recognized the importance of hospitalized primary care patients’ spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients’ internal and external resources for addressing spiritual questions, while also exploring the physician’s role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients’ desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as “R/S respondents”) reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients’ physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.     

Intrinsic-Extrinsic Religiosity and University Students' Willingness to Donate Organs Posthumously

This research focuses on the links between intrinsic and extrinsic religious orientations as they relate to willingness to donate organs posthumously. Participants responded to a factual test of their knowledge about organ donation, indicated their degree of willingness to donate organs, and filled out personality inventories measuring their intrinsic and extrinsic orientations. The data indicated a high level of factual knowledge about organ donation. Also, contrary to Allport's (1966) arguments, people with an intrinsic religious orientation were not more likely to donate their organs, nor were people with an extrinsic religious orientation less likely to do so. Instead, it was found that intrinsic religiosity was unrelated to willingness to donate organs and that extrinsics with strong social orientations were more willing to donate their organs. Discussion centers on the need to develop more psy-chometrically sound measures of mature religiosity as a means of conducting a fairer test of Allport's original theorizing about intrinsic religiosity.     

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.     

Enforcing Christian Nationalism: Examining the Link Between Group Identity and Punitive Attitudes in the United States

This article examines whether the convergence of an individual's religious and national identities promotes authoritarian attitudes towards crime and deviance. Drawing on theories of social control and group conformity, as well as Christian nationalism's influence on intolerance toward out‐groups, I argue that the inability to distinguish between religious and national identities increases desire for group homogeneity and therefore increases willingness to utilize formalized measures of social control. Analysis of 2007 Baylor Religion Survey data demonstrates that adherence to Christian nationalism predicts three indicators of authoritarian views toward controlling crime and deviance: support for capital punishment, stricter punishment for federal crime, and for society to “crackdown on troublemakers.” These effects are robust to the inclusion of a comprehensive battery of 20 socioeconomic, political, and religious controls, and are consistent with previous research on Christian nationalism showing it is not religious commitment or traditionalism per se that leads to intolerant attitudes, but rather the conflation of one's religious identity with other social identities, in this case national. These findings indicate that, beyond sociopolitical and religious influences, the belief that the United States is, and should be, a “Christian nation” increases desires for group conformity and strict control for both criminals and “troublemakers.”     

Latina college students' sexual health beliefs about human papillomavirus infection

To examine Latina college students' sexual health beliefs about human papillomavirus (HPV), 16 self-identified Latina college students from a large Midwestern university participated in three focus groups. The authors found that participants' knowledge of HPV and cervical cancer was extremely low. Women did not obtain Pap screenings consistently, nor did they use condoms in a consistent manner. They perceived that cultural norms that support silence about sexual topics hinder their knowledge acquisition about sexual issues. Participants also recognized that their insufficient knowledge could jeopardize their health and expressed a willingness to actively stop this intergenerational cycle of silence within their families. Findings highlight the importance of incorporating cultural considerations when designing research and educational programs with Latina college students.     

Treating Scrupulosity in Religious Individuals Using Cognitive-Behavioral Therapy

Scrupulosity, the obsessional fear of thinking or behaving immorally or against one's religious beliefs, is a form of obsessive-compulsive disorder that has been relatively understudied to date. Treating religious patients with scrupulosity raises a number of unique clinical challenges for many clinicians. For example, how does one distinguish normal beliefs from pathological scrupulosity? How does one adapt exposures to a religious patient whose fears are related to sinning? How far should one go in exposures in such cases? How and when does one include clergy in treatment? We address these issues and report a case example of the successful treatment of an ultra-Orthodox Jewish woman using the treatment principles that we recommend for religious individuals with scrupulosity.     

Can Religious Beliefs be a Protective Factor for Suicidal Behavior? A Decision Tree Analysis in a Mid-Sized City in Iran, 2013

This study aimed to assess using tree-based models the impact of different dimensions of religion and other risk factors on suicide attempts in the Islamic Republic of Iran. Three hundred patients who attempted suicide and 300 age- and sex-matched patient attendants with other types of disease who referred to Kerman Afzalipour Hospital were recruited for this study following a convenience sampling. Religiosity was assessed by the Duke University Religion Index. A tree-based model was constructed using the Gini Index as the homogeneity criterion. A complementary discrimination analysis was also applied. Variables contributing to the construction of the tree were stressful life events, mental disorder, family support, and religious belief. Strong religious belief was a protective factor for those with a low number of stressful life events and those with a high mental disorder score; 72 % of those who formed these two groups had not attempted suicide. Moreover, 63 % of those with a high number of stressful life events, strong family support, strong problem-solving skills, and a low mental disorder score were less likely to attempt suicide. The significance of four other variables, GHQ, problem-coping skills, friend support, and neuroticism, was revealed in the discrimination analysis. Religious beliefs seem to be an independent factor that can predict risk for suicidal behavior. Based on the decision tree, religious beliefs among people with a high number of stressful life events might not be a dissuading factor. Such subjects need more family support and problem-solving skills.     

Religious Diversity in a “Christian Nation”: The Effects of Theological Exclusivity and Interreligious Contact on the Acceptance of Religious Diversity

Using data from the nationally representative Religion and Diversity Survey, Americans’ responses to religious diversity are examined at the national and community levels. While an overwhelming majority of Americans agree that religious diversity has been good for the nation, support for the inclusion of non‐Christians in community life is mixed. Theological exclusivism is consistently and strongly associated with negative attitudes toward religious diversity and less willingness to include Muslims and Hindus in community life. Belief that the United States is a Christian nation is associated with a positive view of religious diversity but decreased willingness to include Muslims in community life. Prior contact with Muslims, Buddhists, and Hindus is predictive of more positive views of religious diversity; contact with Muslims is associated with greater tolerance for a mosque in one's community.     

Attitudes and Behaviors Regarding Organ Donation: a Study on Officials of Religion in Turkey

The aim of this study is to determine the attitudes and behaviors of religious scholars regarding organ donation and transplantation. In this study, 540 officials working in the Department of Religious Affairs in Kayseri, Turkey, were included. Overall, 86.6% response rate (n = 468) was achieved. Although a majority of the officials of religion in this study stated that they believed in the importance of organ donation (90.8%), the rate of considering donation (57.9%) and the donation rate (1.1%) were found to be substantially low. There is a difference between the employment status and willingness to donate organs. The rate of willingness to donate was significantly high in men than women. And also was high in imams and preachers. Regarding the sources of information, the majority of the respondents (70.0%) cited mass media. Overall, 15.3% cited school education and 42.0% religious publications. The most common question (83.1%) that was asked was “whether or not organ donation was suitable for Muslim religious”. Our study revealed that although the research groups have positive ideas about organ donation and transplantation, their role was low in informing and motivating people about organ donation and transplantation.     

Fostering critical religious thinking in multicultural education for teacher education

Religious diversity as a consequence of global immigration has become a cultural phenomenon of pluralism in society. The fear of indoctrination and the desire for religious freedom fuel the debate on whether to remove religion from school education. Freire’s Pedagogy of the Oppressed offers a positive perspective on the debate by calling attention to the pedagogy of religious education in the pursuit of religious freedom for all human beings. Rather than transferring religious knowledge to students, the challenge for religious education is to foster critical religious thinking in them. Unfortunately, many teachers lack the confidence to address religious issues, as well as lacking support in the professional development of critical religious thinking. Hence, this article proposes a tentative model for fostering critical religious thinking that might fit into a course in multicultural education for teachers.     

Religion and the decision to donate organs: Exploring the potential role of religious leaders

The two‐step flow model of communication (Katz, 1957 ) suggests opinion leaders obtain critical information from the mass media and, in turn, communicate this information to interpersonal contacts such as friends, family and co‐workers. It is suggested that religious leaders (RLs) may serve as opinion leaders on the topic of organ donation by debunking donation myths, promoting donation during worship services, or communicating the benefit of donation to families faced with the opportunity to participate in living or cadaveric donation. The current study examined the personal knowledge, experiences, and willingness to communicate about organ donation in a sample of RLs (N = 59) in Rochester, New York. Structured interviews were conducted in summer and fall of 2009 with a random sample of RLs. Results indicate a disparity between RLs' expressed personal support for donation and their engagement in donor registration. Approximately one‐quarter of RLs have spoken about donation during a religious service and many indicate their knowledge is not sufficient to discuss organ donation in detail. Results elaborate on how RLs may be trained to serve as opinion leaders in the promotion of organ donation. Copyright © 2010 John Wiley & Sons, Ltd.     

Pro-Active Intercultural Pastoral Care and Counseling with Lesbian Women and Gay Men

Clinical work with persons from lesbian and gay communities requires a clear sense on the part of the clinicians about how understandings of homosexuality shape our interactions. The importance of the religious and theological claims of the counselor cannot be underestimated in their ability to support and nurture, or to damage, the spiritual lives of lesbians and gay men. This paper first describes four religious perspectives on homosexuality, arguing for one that is proactive and affirmative. Second, this paper explores the multiple issues presented by lesbian and gay clients, including the role of marginalization, racial and ethnic heritage, internalized homophobia and heterosexism. Third, this paper closes with an invitation to counselors to participate in the public debates about homosexuality as a way of making the world a safer and healthier place for lesbians and gays to live.     

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.     

Religious issues in diagnosis: The V-Code and beyond

This paper addresses the issues around considering clients' religious and spiritual functioning as a matter of client diversity. Such issues may be under appreciated by many clinicians. The introduction of a religious and spiritual problem V-Code (V62.89) into the DSM-IV provided a significant accommodation of client religious and spiritual functioning in contemporary psychodiagnostics. The V-Code allows for explicit identification of a non-pathological religious or spiritual focus in treatment. The nature of and history of the V-Code's inclusion in DSM-IV is briefly reviewed. The strengths and limitations of the V-Code for raising clinician awareness of the religious and spiritual domain of client functioning is discussed and illustrated by a number of case examples. The V-Code approach is contrasted with Hathaway's (2003) clinically significant religious impairment concept. Both are viewed as making complementary contributions to a religiously and spiritually sensitive clinical practice.     

Children as Mystics, Activists, Sages, and Holy Fools: Understanding the Spirituality of Children and Its Significance for Clinical Work

This article explores children's spirituality and its significance for health care providers seeking to provide “spiritually competent care” of children amidst religious and spiritual diversity. Four metaphors of different spiritualities evidenced among children are explored: mystics, activists, sages, and holy fools. The article addresses issues clinicians face such as the problem of defining spirituality in relation to religion, and countertransference around religious and spiritual matters. Current research shows that spiritual and religious involvements constitute positive factors promoting resiliency and health in children. James W. Fowler's theory of faith development facilitates an exploration of questions concerning how children develop a belief system, leading to a view of children's spirituality as multidimensional. This article preserves the less formal conversational style of an earlier version's presentation in Grand Rounds at the UCLA Medical Center's Neuropsychiatric Hospital on December 10, 2003.     

Regulatory mode and willingness to increase retirement savings contributions

This study examined how two self‐regulatory modes, locomotion and assessment, relate to the willingness to increase retirement savings. Locomotion is concerned with making things happen (“just do it”). Assessment is concerned with critical evaluation (“do the right thing”). We hypothesized that individuals who score high (vs. low) in locomotion, but not those who score high (vs. low) in assessment, would be more willing to increase their savings for retirement. In addition, because high (vs. low) assessment can lead to doing the right thing in terms of seeking to maximize economic returns, we hypothesized that combining high locomotion with high assessment would especially motivate willingness to increase retirement savings. We found support for both hypotheses from a survey of university employees.