Previously ignored or “treated,” religion is increasingly being discussed in psychotherapy. Psychotherapists are recognizing the power of religion to contribute to healing as well as to clients’ problems.
Viewed through the rearview mirror, mainstream psychotherapy prior to the 1980s was conducted on a predominantly secular landscape where therapists challenged religious beliefs or sidestepped discussions of religion. Three of the most influential theoreticians of the time were atheists. A core concept in the behaviorism of B. F. Skinner was the futility of exploring the “black box” which encased consciousness. He reduced religious belief to a function of reinforcement patterns and insisted that science could not reliably deal with subjective (supernatural) experience and, therefore, needed to be limited to the exploration of observable phenomena. Freud viewed belief in God as a superstitious, primitive way to cope with helplessness, loneliness, loss, and frustration by satisfying a profound wish to be dependent through creating an imaginary, loving, protecting, forgiving, consoling parent figure (Freud, 1964). He also saw belief in God as a means of fostering obedience and control of id impulses by creating a fear-inducing, punitive, all-knowing parent figure. Although more tolerant of religion in his later years, Albert Ellis (1980) thought that religious beliefs were irrational, and “that human disturbance is largely (though not entirely) associated with and springs from absolutistic thinking- from dogmatism, inflexibility, and devout shoulds, oughts, and musts- and that extreme religiosity…is essentially emotional disturbance (p. 635).” His treatment relied on a dose of rational thinking that is now considered insufficient to alter emotionally-anchored religious beliefs.
Another influential theoretician was Carl Rogers, who provided a non-religious, but spiritual integration. After leaving the seminary to attend Columbia University he rejected the Christian faith of his youth which he described as a dogmatic system that imposed fixed values, prescriptions and rules on the individual in a way that was incompatible with the most important principle of Rogers’ approach, namely, that personal experience is the highest authority (van Kalmthout, 2004). Rogers believed that the therapist should assume a non-directive stance and help the client find his or her personal truth. Rogers was spiritual as he described the core process in his therapy: “my inner spirit has reached out and touched the inner spirit of the other. Our relationship transcends itself and becomes a part of something larger. Profound growth and healing and energy are present (Rogers, 1980, p. 129).” He described this larger something as “the actualizing tendency.” Rogers believed that when a therapist creates the right climate in the relationship with the client, a spiritual dimension can be addressed which is not only present in the two involved, but in the whole cosmos and in all living organisms (p. 199).” Religious scholars (Roberts, 1985, p. 267) have described Rogers’ treatment for emotional problems, “unconditional positive regard,” as analogous to “the love of God,” while fundamentalists have criticized Rogers’s treatment philosophy for fostering narcissism and a lack of common values in families and our culture.
Religious theorists tried to bring religion into psychotherapy because they saw the effective components of psychotherapy as similar to elements in religious healing. Mowrer (1958) believed that clients felt guilty because they sinned, and that therapy was analogous to confession and supported self-punishment by fostering penance, atonement and restitution. This attack on the secular-humanistic-scientific tradition was furthered by Bergin (1980b) who described these values as “selfish and hedonistic” and went on to conclude: “the psychological sciences are implicitly sanctioning them and colluding in subverting values and traditions that have had a demonstrated, constructive role in the positive achievements of western civilization (p. 642).” He advocated for “a restoration of religious thought to psychology (p. 645).”
Bergin (1985) proposed that psychotherapy could include the teaching of values based on divine authority. He contended that: “Although therapists may need to be patient while clients struggle with their choices, they also need to inform clients of educated opinions about alternatives. The client is working toward becoming a fully functioning person who considers a range of alternatives for optimal fulfillment at any choice point. Considering values may help both therapist and client think in broad terms of modifying lifestyle rather than in the usual narrow terms of relief from distress or symptom removal (p. 99).”
Bergin (1980a) claimed that “science has lost its authority as the dominating source of truth (p. 95)” and that religious values should be integrated into treatment because secular-humanist therapists are not value free and promote a morality that “clash[es] with theistic systems of belief (p. 98)” and may be “unethical and subversive.” He proposed that therapists adopt alternative values: “The first and most important axiom is that God exists, that human beings are the creations of God, and that there are unseen spiritual processes by which the link between God and humanity is maintained (p. 99).” This orientation leads to supporting such values as: “obedience to the will of God;” the belief that “personal identity is derived from the divine;” that therapists should support a high level of client self-control, obedience to a strict morality, and commitment to marriage; that self-sacrifice, “acceptance of guilt, suffering, and contrition [are] keys to change;” and that knowledge, meaning and purpose are derived from faith (p. 100). Although Bergin advocated supporting “traditional religious morality” and Ellis felt such values caused many client problems; interestingly, they both supported trying to change clients’ values and world views.
To deal with this clash between science and religion in 1981 the National Academy of Sciences passed a resolution stating that “religion and science are separate and mutually exclusive realms of human thought whose presentation in the same context leads to misunderstanding of both scientific theory and religious belief (National Academy of Sciences, 1984, p. 6).” Thus science and religion were seen as fundamentally incompatible because science rests on facts and religion on faith, and scientific claims are verifiable or falsifiable whereas religious claims are evaluated by subjective experience.
Several subsequent societal trends laid the foundation for the integration of religion into psychotherapy. Post-modern thought supports an understanding that moral beliefs are inescapably influenced by the personal needs and the cultural context of the believers, so that beliefs cannot be evaluated by their truthfulness or rationality. Thus, because Truth cannot be objectively assessed and known, therapists are cautioned to avoid judging religious beliefs and to consider them as another form of cultural diversity.
Political correctness (which values minimizing offense to those with culturally diverse value systems), client-driven therapy (in which the client’s goals and theory of change determines the direction of treatment), and family values (the right, if not the responsibility, of parents to mold their children) have spawned the general acceptance of a groups’ broadly defined right to expect freedom from having their religious beliefs and practices judged and challenged as long as the practices do not constitute legally reportable abuse.
Therapists are trained to be non-judgmental, to respect culturally diverse viewpoints, and may practice in a managed-care, client-driven environment in which they are evaluated by their clients. Furthermore, therapists are guided by professional ethical principles that now emphasize fostering client autonomy and self-determination, rather than beneficence, which previously dominated ethical values but came to be seen pejoratively as paternalistic.
Professional Ethics and Law
Professional ethics as well as laws are often statements that support beliefs that are currently the most popular or practical according to the most powerful decision makers within these fields. The National Association of Social Workers (1999) code of ethics requires practitioners “to respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals (1.02).” Psychologists are particularly cautioned to protect client’s rights, do no harm, respect privacy, confidentiality and self-determination, not exploit or discriminate and avoid dual relationships (American Psychological Association, 2002). Psychiatrists are expected to “not use the unique position of power afforded him/her by the psychotherapeutic situation to influence the patient in any way not directly relevant to the treatment goals (American Psychiatric Association, 2008, p. 5).” Subject to laws, contemporary professional ethics represent, in part, a rapprochement between religion and psychotherapy.
Therapists have had little guidance from their professional training in regard to dealing with religious beliefs in psychotherapy. Three-fourths of social workers reported that they had almost no content on religion/spirituality during their graduate education (Canda & Furman, 1999). Similar minimal levels of exposure to religious issues in training were reported by psychiatrists (Waldfogel, Wolpe, & Shmuely, 1998) and clinical psychologists (Brawer et al, 2002; Russell & Yarhouse, 2006; Shafranske & Malony, 1990).
Increasing Religiousness in Therapists and Clients
Since the 1980’s the increasing religiousness of clients and therapists has also contributed to talking about religion in psychotherapy. Therapists have expressed a growing interest in discussing religious and spiritual beliefs and practices in therapy as indicated by the finding that 47% of a sample of social workers in England believed that including religion and spirituality in psychotherapy was a part of social work’s mission (Furman, Benson, Grimwood, & Canda, 2004). In America 60% of a national sample of experienced social workers stated that they “sometimes” or “often” “help a child or youth clarify their religious or spiritual values.” Sixty-eight percent of surveyed therapists also reported that they “encourage caretakers to support spiritual development or religious participation of their child(ren).” Over one quarter of therapists sampled reported sharing their own religious or spiritual beliefs and recommending religious or spiritual books or writings (Kvarfordt & Sheridan, 2007). A survey of psychiatry residents indicated that 74% agreed that “religion can solve personal problems” and 41% agreed that “religion is important in clinical settings (Waldfogel, Wolpe, & Shmuely, 1998, p. 31). In a later survey 93% of psychiatrists sampled agreed that “it is usually or always appropriate to inquire about religion/spirituality” in treatment (Curlin, et al., 2007). At the same time some therapists appear to be sensitive to the dangers of addressing client’s religious/spiritual beliefs. For instance, 57% of those sampled by Kvarfordt and Sheridan (2007) reported being concerned about presenting their personal religious biases.
Clients are also interested in religious/spiritual treatments for their problems. Hodge (2002, p. 86) noted that “according to Gallup data reported by Bart (1998), 66% of the public would prefer to see a professional counselor with spiritual values and beliefs and 81% wanted to have their own values and beliefs integrated into the counseling process. Since the 1980’s at least 60% of the general public has believed that their faith can be marshaled to address most of the problems they encounter (Gallup & Castelli, 1989).” Turning to religion and spirituality may be even greater in patients with severe mental illness. A survey (Tepper, et al., 2001) of 406 such patients found that over 80% used religion to cope and most spent as much as half of their total coping time in such religious practices as prayer. Guidelines are available for using spiritually based activities in social work that depend largely on whether or not a) the client expresses interest in spiritual activities, b) there has been established a spiritually sensitive relationship, and c) the therapist is competent to provide the spiritual activity (Canda & Furman, 1999).
Research on the Effects of Religion
Discussions of religious practices have been incorporated into treatment at least in part because of the misunderstanding and misinterpretation of the research on the positive effects of religion that is believed to have challenged Freud’s assertion that religious belief correlates with psychopathology. Until recently these studies were inadequately controlled (especially for researcher biases and inadequate or insufficient control groups); many were non-quantitative and involved non-treatment seeking populations; typically they were correlational, so they could not be interpreted to show a causal relationship between religious practices and mental health; and they concluded that a marker of religious behavior co-varied with a measure of well-being or improvement, usually in physical health. However, these correlations were low. For instance, a meta-analysis (Smith, McCullough, & Poll, 2003) of 147 studies that involved nearly 100,000 subjects found the correlation between religious involvement and depression to be about –0.10.
The relationship between religious practices and improvement or health is probably more powerful for some individuals in both a positive or negative direction that would account for a low overall correlation. In other words, some clients might benefit from their religious teachings while others might be harmed by them. Also, the research indicating that religious involvement correlated with physical health and longevity; lower depression and suicide rates; less nicotine, drug and alcohol use; and less divorce and delinquency (Gartner, 1996), has been challenged by the recent trend of looking at the effects of particular aspects of religion on mental and physical health problems. This research indicates that intrinsic religious beliefs, as well as beliefs in a loving God and certain loving and forgiving coping strategies are related to beneficial effects. However, extrinsic religious beliefs, belief in a vengeful and punishing God, and certain fear and punishment based coping strategies are related to harmful effects.
Perhaps the field is moving toward a synthesis of the opposing viewpoints of Ellis and Bergin that acknowledges that religious clients can use religious beliefs and resources to cope with their problems and that some problems are fueled by religious beliefs or have a religious component that needs to be addressed in psychotherapy.
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About this Contributor: George Rosenfeld, Ph.D. is a psychologist teaching at the Sacramento campus of University of San Francisco. He is the author of Beyond Evidence-Based Psychotherapy: Fostering the Eight Sources of Change in Child and Adolescent Treatment, Routledge, 2009. He can be reached at firstname.lastname@example.org.
Note: this article first appeared in The Clinical Update, the newsletter for the California Society for Clinical Social Work.