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Psychology of Religion in Clinical and Counselling Psychology

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Title: Psychology of Religion in Clinical and Counselling Psychology


1
Psychology of Religion in Clinical and
Counselling Psychology
2
Psychology of Religion in Clinical and
Counselling Psychology
  • Of particular relevance to clinical practice are
    the results of empirical investigations in which
    correlations between religious involvement and
    mental health have been found (Mills, 2002)
  • Although, not all forms of religious involvement
    enhance psychological adjustment meta analyses
    have generally found religious commitment to be
    associated with factors important to mental
    health (Koenig Larson, 2001)

3
Psychology of Religion in Clinical and
Counselling Psychology
  • Religion/spirituality is the ultimate value base
    upon which personal goals are established and
    resources for well-being and psychological coping
    are found (Baumeister, 1992)
  • Clinical practice necessarily involves beliefs
    and values in which the division between personal
    and professional beliefs is poorly demarcated
    (ODonohue, 1989)
  • Because of the high importance most Americans
    place on religion, clinicians should develop
    increased competence in bringing spiritual
    factors into assessment and treatment

4
Approaches to religion and spirituality within
the clinical setting
  • Religious/spiritual approach to counselling
    considers the role that religion plays in a
    clients worldview and brings into focus the
    unique contributions of religion to the
    conception of psychological difficulties
  • Richards and Bergin (2005) called for a viable
    spiritual strategy that would be empirical in
    nature

5
Assessing religion and spirituality as clinical
variables
  • Richards and Bergin (2005) suggest that
    conducting a religious/spiritual assessment can
    help therapists
  • Understand their clients worldviews
  • Determine whether the clients religious/spiritual
    orientation is healthy/unhealthy
  • Determine whether religious/spiritual beliefs
    could help clients better cope, heal and grow
  • Determine whether clients have unresolved
    spiritual needs that should be addressed in
    therapy
  • Situating religious phenomena within a cultural
    framework aids in differentiating between
    religious experience and psychopathology

6
Preliminary religious/spiritual assessment
  • The outcome of the initial phase of assessment
    should include an understanding of salience,
    which will determine the extent to which the
    therapist will focus inquiry into religion and
    spirituality as clinical variables

7
In-Depth Religious/Spiritual Assessment
  • A second level of assessment is recommended when
  • Religion/spirituality features prominently in the
    clients worldview
  • Religious/spiritual problems are themselves the
    focus of clinical attention
  • Psychological crisis has led to a sudden loss or
    change in spiritual orientation
  • Religion/spirituality is producing a detrimental
    effect
  • Religious/spiritual resources have been
    overwhelmed by psychological crisis

8
In-depth religious/spiritual assessment
  • Religious assessment may incorporate
  • Metaphysical worldview
  • Religious affiliation
  • God image
  • Religious/spiritual health and maturity
  • A spiritual history
  • Assessment may also incorporate procedures
    derived from specific treatments orientations
  • E.g., within cognitive-behavioural therapy (CBT)
    focus may be placed on assessing cognitive
    distortions and the clients style of thinking
    about his/her relationship with God

9
Assessment of religious coping
  • An assessment should consider that some forms of
    religious involvement are more helpful than
    others
  • Attention should also be placed on the style of
    religious coping in respect to the degree of
    autonomous control the client may have in
    responding to the immediate crisis
  • There are some forms of religious/spiritual
    involvement that may produce negative effects and
    exacerbate psychiatric symptoms
  • E.g., anger and disappointment
  • Anger and distrust of God
  • Interpersonal strains associated with affiliation
  • Problems faced in attempting to exercise moral
    standards

10
Assessment of religious coping
  • Consideration of the direction that religious
    participation encourages may point to the
    relative adaptive or pathological consequences in
    the way in which individuals hold their beliefs
    (Meissner, 1996)
  • Assessment could also consider religious/spiritual
    impairment because of a psychological disorder
    (Hathaway, 2003)

11
Techniques and resources in religious/spiritual
assessment
  • Assessment of the spiritual dimension within the
    clinical setting is accomplished primarily
    through the use of interview procedures
  • Familiarity with the major religious traditions
    readies the clinician to assess dimensions of
    religious involvement that are clinically salient
  • Clients may be asked to construct a spiritual map
    depicting on a timeline the significant
    milestones, events and challenges within their
    spiritual journeys (Sperry, 2001)

12
Techniques and resources in religious/spiritual
assessment
  • Instruments developed within the psychology of
    religion may also be used to supplement interview
    data, although few have been systematically
    evaluated for their application in clinical
    practice (Hill Hood, 1999)
  • Through the exercise of intentional orientation,
    the nature, salience, and integration of religion
    and spirituality in the clients orienting system
    can be assessed

13
Addressing religious and spiritual dimensions in
psychological interventions
  • The incorporation of religious or spiritual
    interventions or resources should not be
    determined by the psychotherapists personal
    faith orientation rather it should correspond to
    the salience and function of religion in the
    clients life
  • The degree of integration should be tailored to
    the mutually defined goals and tasks of the
    treatment and in respect to an established
    therapeutic alliance (Sperry, 2004)

14
A conceptual framework for integration
  • Tan (1996) proposed a model that presents two
    distinct forms of integration
  • Implicit integration a covert approach that does
    not initiate the discussion of religious/spiritual
    issues
  • Explicit integration uses spiritual resources
    like prayer or sacred texts
  • E.g., in Cognitive-behavioural therapy explicit
    forms of integration may readily be assimilated
    such as addressing misinterpretation of scripture
  • Psychodynamic and other insight oriented
    approaches usually employ implicit integration in
    which religious content is addressed through
    interpretation and exploration

15
A conceptual framework for integration
  • Approaches such as alcoholics anonymous offer a
    spiritual perspective that incorporates spiritual
    beliefs and values, and practices without being
    located within specific religious traditions
  • There are also approaches that bring directly
    into the therapeutic relationship the faith
    commitments of both the client and the clinician
  • Belief in the healing power of God
  • Consideration of a theistic moral framework
  • The explicit use of spiritual interventions such
    as prayer

16
The integration of religious and spiritual
interventions and resources
  • Survey research suggests that many patients
    believe that the spiritual dimension should be
    considered in consultation
  • Neither patients nor clinicians have demonstrated
    how such integration is to be accomplished
  • Spirituality contributed to the solution in 37
    of the cases and in 26 of the cases was involved
    in both problem and solution (APA Practice
    Directorate, 2003)

17
The integration of religious and spiritual
interventions and resources
  • Richards and Bergin (2005) identified 19 examples
    of religious/spiritual interventions e.g.,
  • Therapist prayer
  • Client prayer
  • Religious relaxation or imagery
  • Spiritual self-disclosure
  • Dream interpretation
  • Reviews of the literature suggest that
    religious/spiritual interventions
  • Does not appear to be consistent across
    clinicians
  • Is influenced by the personal commitment of the
    clinicians
  • Varies according to the degree of involvement of
    the clinician in explicit religious/spiritual
    behaviour

18
The integration of religious and spiritual
interventions and resources
  • Patient interest in religious/spiritual
    interaction decreased when the intensity of the
    interaction moved from a simple discussion of
    spiritual issues (33 agree) to physician silent
    prayer (28 agree) to physician prayer with a
    patient (19 agree) (MacLean et al., 2003)
  • Religious CBT has been at least as effective as
    secular CBT, for religious clients (Worthington
    Sandage, 2001)

19
Education and training
  • Most clinicians receive little or no training in
    religiosity or spirituality as clinical
    variables, or in the use of religious/spiritual
    interventions
  • Survey research has shown that personal faith,
    intrinsic religious orientation and religious
    involvement play significant roles in the use of
    religious interventions (Shafranske Gorsuch,
    1985)
  • Psychologists as a group appear to be less
    institutionally religious compared with the
    general population
  • This may influence their perspective when working
    with clients for whom participation in
    denominational religion is central

20
Consultation and collaboration
  • It appears that psychologists rarely consider
    clergy as potential collaborators (Walker et al.,
    1997)
  • Referral to a religious professional, who by
    virtue of education and training offers
    competence in matters of religion is generally
    the ethically appropriate intervention when
    clients are addressing explicitly religious issues

21
Ethics
  • Richards and Bergin (2005) cite the following
    ethical pitfalls
  • Dual relationship (religious and professional)
  • Displacing or usurping religious authority
  • Imposing religious values on clients
  • Practicing outside the boundaries of professional
    competence
  • Therapists must consider that explicit
    integration leads into a territory in which
    statutory authority for such practices and
    empirical support for the use of such
    interventions have not been established

22
Ethics
  • Client informed consent is a reasonable but may
    not be a sufficient safeguard
  • A firm foundation for practice will be
    established through advances in the empirical
    standing of these procedures within the clinical
    setting
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