Integrating Religion and Spirituality in Marriage and Family Counseling
Wolf, Chelsea T., Stevens, Patricia, Counseling and Values
In the fields of counseling and psychology, interest in religious and spiritual issues is expanding. The authors examined integrating religion and spirituality with marriage and family counseling. They explored potential obstacles and negative consequences for this integration, as well as clinical implications. The positive impact of incorporating a religious or spiritual perspective into clinical practice is discussed. Ethical considerations, techniques, and strategies are presented.
According to a 1991 Gallup poll, 94% of adult Americans believe in God or a universal spirit. In addition, 68% of adult Americans are members of a church, synagogue, or place of worship, and 58% of the same population rate religion as being very important in their lives (Gallup, 1993). Richards and Bergin (1997) also noted a recent growth in interest in spiritual and religious issues in the United States, as evidenced by increased coverage of these topics in leading newspapers, magazines, books, and television specials. Likewise, in the fields of counseling and psychology, there has been a growing awareness about the importance of incorporating spirituality and religion into psychotherapy. For example, in the code of ethics, the American Psychological Association (APA; 1992) recognized religion as a component of human diversity. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (APA, 1994) includes spiritual problems as a V-code, which is the code that designates relational problems. In addition, both the American Counseling Association (1995) and the American Association for Marriage and Family Therapy (1998) identified religion as an element of human diversity. Finally, there have been several recent publications devoted to religious counseling (e.g., Richards & Bergin, 1997; Shafranske, 1996).
However, despite this heightened awareness in the general counseling and psychology fields, we found relatively little literature regarding the integration of religion and spirituality in marriage and family counseling. Watson (1997) articulated this dearth in literature after examining journal articles, books, and book chapters from 1974 to 1996. According to his search, there were only 48 references relating to religion and spirituality in family systems theory and therapy. This number of references is compared with 389 references relating to religion and spirituality in general counseling and psychotherapy.
Although comparatively small, the body of research regarding the inclusion of religion and spirituality in marriage and family counseling is expanding. This article presents potential negative and positive consequences, as well as ethical considerations, concerning spiritual and religious integration in the field of marriage and family counseling. In addition, several techniques and strategies for practicing from a spiritual or religious perspective are explored.
Defining the Terms
Religion and spirituality are terms for which there are a multitude of definitions. In fact, references offer slightly different definitions of these two words (e.g., Hoge, 1996; Richards & Bergin, 1997). However, the definitions of religion and spirituality given by Wright, Watson, and Bell (1996) are representative of definitions presented in many resources and are the definitions used throughout this article. Wright et al. defined religion as "shared, usually institutionalized, values and beliefs about God [implying] involvement in a religious community" (p. 31). Spirituality refers to
a personal belief in and experience of a supreme being or an ultimate human condition, along with an internal set of values and active investment in those values, a sense of connection, a sense of meaning, and a sense of inner wholeness within or outside formal religious structures. (Wright et al., 1996, p. 31)
Thus, religion and spirituality are interrelated but are not exactly alike; one can be religious and not spiritual, spiritual but not religious, as well as spiritual and religious. Richards and Bergin (1997) provided a rather useful and concise description of differences between the two terms. Religion tends to be "denominational, external, cognitive, behavioral ritualistic, and public" (p. 31). Spirituality tends to be "universal, ecumenical, internal, affective, spontaneous, and private" (p. 31). Although some authors choose to use the words religion and spirituality interchangeably (e.g., Joanides, 1996; Watson, 1997), we do not and instead recognize differences between the terms.
In addition, in the incorporation of religion and spirituality into the counseling process, the term clinical integration is often used. In this article, clinical integration refers to Hall and Hall's (1997) definition:
the term clinical integration, broadly defined, refers to the incorporation of religious or spiritual beliefs, values, and methods into the process of psychotherapy that results in a different way of being a therapist, understanding the client, or doing therapy. (p. 86)
Barriers to Inclusion
Historically, religion and spirituality have been excluded from the field of psychology. A primary reason for this exclusion is that from its onset, psychology has attempted to distinguish itself as a scientific domain. Emphasis has routinely been placed on the empirical and observable (Richards & Bergin, 1997). Thus, because spirituality and religion cannot be observed or objectively measured, psychological researchers and practitioners have regularly criticized or dismissed these "unquantifiable, mysterious aspects of human life" (Frame, 1996, p. 300). This historical exclusion creates a current barrier to effectively practicing from a religious or spiritual perspective because often clinicians are not trained to handle religious or spiritual issues when they arise (Frame, 1996).
There are several other barriers to integrating religion and spirituality in marriage and family counseling. One such obstacle is the notion that religious and spiritual issues should only be discussed with spiritual or ecclesiastical leaders. Another potential challenge to this clinical integration is the field's historical stand that religion and spirituality are more closely related to pathology than to health (Thayne, 1997). This perspective dates back to Freud and continues to be affirmed by many psychotherapists today (Frame, 1996).
In addition, counselors may have personal barriers to integrating religion and spirituality into their clinical practice. For example, clinicians may have spiritual and religious views that are different from those of their clients. Thus, they may worry about potential for conflict and friction because of their differing viewpoints. Clinicians may also believe that they are not religiously or spiritually oriented. Consequently, they may assume that they cannot relate to religious or spiritual clients (Thayne, 1997).
In addition to obstacles involved with integrating religious and spiritual issues into clinical practice, there are also potentially negative implications to this integration. For example, by advocating certain religious beliefs such as negativity toward sexuality or divorce, a counselor may actually inhibit a client's independence, growth, and well-being. Similarly, an emphasis on religious concepts like sin, "a judgment leading to guilt feelings and low self-esteem," may be detrimental to both individuals and families (Sperry & Giblin, 1996, p. 515). By promoting these ideals, the counselor may, in fact, be causing more harm than good (Sperry & Giblin, 1996).
Benefits of Clinical Integration
Despite potential barriers and negative consequences, there are many positive reasons for integrating religion and spirituality into marriage and family counseling. One argument in favor of clinical integration is that religious and spiritual practices and commitment may actually have a positive effect on human physical and psychological health, including areas such as depression, anxiety, and adjustment, as well as marital and sexual functioning (Thayne, 1997). In addition, religion and spirituality can provide support to individuals, couples, and families. For instance, a client may benefit from perceived support from God or a higher power, as well as from social support of his or her religious or spiritual group. Religious and spiritual practices can also benefit family cohesion as the family joins to participate in ceremonies and traditions associated with various holy days (Sperry & Giblin, 1996).
Hall and Hall (1997) provided three other reasons why clinical integration was beneficial. The first reason was that many people seemed to prefer "religiously sensitive psychotherapy" (p. 87) and that this type of therapy might actually be more effective, especially for religious clients. The second reason was that, given the number of people in the United States who are religious, religious concerns might be unavoidable in the therapeutic process. Hall and Hall's final argument in support of clinical integration was that, ethically, the religious variable of human diversity should not be ignored in therapy. Because cultural background and values were often intertwined with religiosity and spirituality, to shun or dismiss religious or spiritual aspects of a person would be to neglect an integral part of a client's culture (Stander, Piercy, Mackirmon, & Helmeke, 1994).
As previously noted, there is a relative scarcity of literature regarding the incorporation of religion and spirituality into marriage and family counseling. This dearth is perplexing, given that marriage and family counseling may, in fact, be one of the most responsive mental health disciplines to this integration. One central reason for marriage and family counseling's openness to clinical integration is that the field has historically dismissed traditional theories of psychology and psychiatry. Instead, the discipline emerged from many diverse influences, including anthropology, computer science, biology, and sociology, all of which are concerned with the nature of systems. Thus, antireligious bias promoted by the medical model and early psychological thought has much less of a foundation in marriage and family counseling (Watson, 1997).
Ethical Considerations of Integration
It is important to note that when integrating religion and spirituality with marriage and family counseling, the clinician may be confronted with unique ethical challenges. Richards and Bergin (1997) provided an excellent overview of several of these potential ethical challenges that might face a religiously or spiritually oriented counselor. One ethical challenge concerns dual relationships. The counselor should avoid both therapist-religious leader and therapist-religious associate dual relationships. A therapist-religious leader dual relationship occurs when the counselor is in a position of leadership in a religious denomination (e.g., priest or rabbi) and provides counseling, either in an environment such as a mental health center or at a monetary cost to members of that denomination (Richards & Bergin, 1997). A therapist-religious associate dual relationship is similar to the therapist-religious leader dual relationship. However, in this type of relationship, the counselor is not an ecclesiastical leader but is rather an active member of the religious denomination.
A second ethical challenge is to avoid displacing or usurping religious authority (Richards & Bergin, 1997). An example of this occurs when the counselor fails to consult with, or refer the client to, a religious leader. A more overt example of undermining religious authority occurs when the counselor belittles advice given by the client's religious leader or makes demeaning comments about the client's religion. Yet another ethical roadblock, which religiously or spiritually oriented counselors must avoid, is imposing their religious or spiritual values on their clients. Examples of this ethical pitfall include religious proselytizing and making judgments, either explicit or implicit, about the client's lifestyle choices (e.g., abortion and sexual orientation). An additional example of value imposition occurs when the therapist uses a religious or spiritually based intervention without the client's consent (Richards & Bergin, 1997).
Furthermore, the clinician must avoid practicing outside of the boundaries of his or her competence. Before integrating religion and spirituality into counseling, the counselor should receive adequate training in this area. Given the lack of training in religious and spiritual issues in graduate counseling programs, it will likely be necessary to receive additional education and training through outside resources, such as literature and workshops (Richards & Bergin, 1997).
Finally, when integrating religion and spirituality with marriage and family counseling, the clinician should avoid violating laws regarding the separation of church and state. Especially in a state-funded setting, the counselor should be aware of the policies concerning church-state boundaries (Richards & Bergin, 1997). Historically, in the United States, it has been important that religious values not be imposed or mandated. However, this does not imply that religious and spiritual issues should not be addressed or discussed in secular settings. Instead of dismissing these issues altogether, the counselor should respect the client's religious and spiritual autonomy. In this way, values are not imposed on the client, but the client remains free to discuss these issues if he or she chooses (Stander et al., 1994).
Techniques and Strategies for Integration
There are a variety of techniques and strategies for integrating religion and spirituality into marriage and family counseling. Tan (1996) emphasized the importance of this clinical integration from the onset of therapy. Early clinical integration may entail taking a religious or spiritual history during the intake. This can begin with a simple question such as "What is your religious affiliation or religion, if any?" (Tan, 1996, p. 370). If the clients show interest, more information can be gathered regarding the clients' religious or spiritual experiences, values, and beliefs.
After ascertaining the importance of religion and spirituality in clients' lives, the clinician may then choose to conduct a spiritual assessment of the couple or family. Several instruments are available to assess clients' religiosity and spirituality. These instruments include The Spiritual Well-Being Scale (Ellison, 1983), The Spiritual Experience Index (Genia, 1991), and Hall and Edward's (1996) Spiritual Assessment Inventory. By conducting a spiritual assessment, the clinician may discern whether religion and spirituality have had a positive or negative impact on the marital or family system (Sperry & Giblin, 1996). An assessment can also shed light on the clients' perception of self and others. In addition, the spiritual assessment may elucidate connections, if any, between the clients' presenting issues and the clients' religious and spiritual beliefs, values, and experiences (Hall & Hall, 1997).
After the intake and spiritual assessment, there are different ways in which religion and spirituality can be integrated into the therapeutic process. Not only are there unique approaches to this clinical integration, but one can also use existing family counseling techniques and principles to address religious and spiritual issues (Stander et al., 1994). Tan (1996) described two general types of clinical integration. The first type of clinical integration is implicit integration. Implicit integration does not introduce religious or spiritual issues into the counseling process. In addition, this approach to clinical integration does not overtly incorporate religious practices or resources, such as prayer, in therapy. The second type of clinical integration described by Tan is explicit integration. This approach deals openly with religious and spiritual issues. Furthermore, unlike implicit integration, explicit integration draws on spiritual or religious resources, including prayer, sacred texts, and referrals to church.
Practicing implicit integration often involves the clinician's incorporation of his or her own spirituality in the counseling process. One method that clinicians can use to integrate their own spirituality involves the way that they listen during the session. For example, spirituality may influence the way that the counselor hears and contemplates the couple's issues. The counselor may reflect on complaints and issues that the couple presents by asking himself or herself, "What is this symptom expressing about these persons' unfulfilled spiritual longings?" (Anderson & Worthen, 1997, p. 6).
When listening to a couple from a spiritual perspective, the counselor might take a meditative stance. When taking this type of stance, the clinician can focus on his or her own breathing, as well as emotions, cognitions, and images that may arise during the session. This can have several positive results. The first potential result is that the counselor may become more able to notice subtle details in the couple's process. Second, this meditative stance may stimulate new, creative responses to the partners. Third, the meditative environment may allow the couple to let go of fixed ideas of self and of the relationship. Listening to the couple from a spiritual perspective or in a meditative way may also help enable the counselor to respond to the couple more compassionately and with unconditional acceptance (Anderson & Worthen, 1997). For example, Anderson and Worthen suggested that the counselor silently repeat his or her own name, followed by "I forgive you" throughout the session. By constantly accepting himself or herself, the counselor may be better able to view the couple with grace or with unconditional positive regard.
Anderson and Worthen (1997) also presented several other ways that counselors might share their spiritual self. For instance, the counselor can visualize the couple bathed in a golden light, while silently repeating "You are being loved." Other clinicians may pray silently to themselves, before or during a therapy session, asking God or a higher power for courage, both for the couple and for the counselor. Still other counselors may simply attend to their breathing with the intention of opening space to receive wisdom from a higher power. In addition, Stander et al. (1994) suggested that the counselor's own faith helps put the clients' problems in perspective. Perhaps most important, according to Anderson and Worthen, the counselor brings to the couple's counseling session his or her own spiritual growth; by living the qualities of forgiveness, acceptance, and compassion in his or her daily life, the counselor can then model and teach these qualities to the clients.
In addition to counselors drawing on their own spirituality, the clients' religion or spirituality can be integrated into the counseling process. This integration often takes the form of explicit integration. Watson (1997) described three broad ways of including religion and spirituality in marriage and family counseling. The first method is to use "religion as resource" (p. 130); the religious tradition of the family can be used as a means of promoting healing or growth. In this type of incorporation, the counselor does not need to have the same religious values as the client, nor must the counselor have any religious or spiritual values at all. Instead, the therapist should simply be open to the values and beliefs of the family. Indeed, a prerequisite for any integration is respect for the clients' experiences and ideals (Thayne, 1997). Incorporating religion as a counseling element or resource may include strategies such as praying with the family, assigning homework that may involve religious practices from the clients' tradition, contemplation, and the inclusion of the family's religious views and religious leaders in the therapy session.
According to Watson (1997), another means of incorporating religion and spirituality into marriage and family counseling is to use "religion as culture" (p. 130). This refers to using religion to join with a family. For instance, a client may prefer a counselor who shares the same religious views and practices. In addition, a counselor who is familiar with the client's religious tradition may be better able to understand the client's story. An example of this situation is "a Jewish therapist understanding the full significance of the son of the Jewish family marrying a Gentile" (Watson, 1997, p. 130).
Finally, the counselor may use "religion as context" (Watson, 1997, p. 130), integrating his or her own religiosity or spirituality in both professional and personal realms. The process of incorporating the counselor's spirituality into clinical practice was explored earlier in this article. In addition to the previously mentioned benefits, this implicit integration can allow the client to feel open in therapy. It helps to create a climate of safety and trust in which the family is able to examine the spiritual and religious aspects of self and of others (Watson, 1997).
Other authors have described different perspectives and techniques for integrating religion and spirituality into marriage and family counseling. For example, several authors (e.g., Frame, 1996; Thayne, 1997) suggested that a social constructivist approach to clinical integration might be especially useful. From a social constructionist viewpoint, the counselor recognizes and understands his or her subjective role as counselor. This, in turn, allows the counselor to remain open to and nonjudgmental about the client's religious and spiritual experiences (Thayne, 1997). Another approach to integrating religion and spirituality and family counseling is a solution-focused approach. For example, Stander et al. (1994) suggested that the clinician assist clients in applying the religious and spiritual values and practices that have helped in the past to their current situation.
A clinician may use additional existing family counseling techniques and perspectives to address religious and spiritual issues. Griffith (1995), for instance, took a systemic viewpoint and proposed that a client's "sense of self is co-created in a social network of relationships and conversations with others" (p. 123), including the client's personal God. Hence, just as other personal relationships may be explored in the counseling process, the client's relationship with his or her God can also be examined and nourished. Butler and Harper (1994) proposed that the relationship between God and a religious couple can be viewed as a triangle, capable of triangulation, as well as detriangulation. This God-couple triangle can be an effective tool with religious couples and may have significant implications for marital counseling.
As an additional strategy for integrating religion and spirituality into marriage and family counseling, counselors may ask questions regarding the religiosity and spirituality of the couple or family (Watson, 1997). Anderson and Worthen (1997) emphasized that questions should be asked using words that the couple understands and that relate to the couple's spiritual or religious orientation. Furthermore, questions that are creative and stimulating seemed to be most effective. Examples of such questions include "What would it be like if you could see yourself through God's eyes?" or "Do you have a sense that God understands some things in a way that I, as your therapist, cannot?" (p. 8).
Although beyond the scope of this article to discuss in detail, religious and spiritual interventions can also be used for children and adolescents. For example, religious and spiritual interventions for adolescents may include "prayer, meditation, spiritual literature and music, fellowship and service with peers in the religious community, and spiritual direction from leaders" (Richards & Bergin, 1997, p. 251). Adolescents coping with life stresses and issues such as identity formation, belonging, and modifying and formulating personal values might find these interventions especially helpful. Furthermore, integrating religion and spirituality in counseling with adolescents might help prevent problems such as unplanned pregnancy, alcohol and drug abuse, suicide, and gang involvement (Pargament, 1996; Richards & Bergin, 1997). Religious and spiritual interventions for children and young adolescents might also include prayer, meditation, and spiritual literature. However, interventions for younger children might additionally make use of "play, art, stories, dance or movement, games, drama or role-play, imagery, puppets, and music" (Richards & Bergin, 1997, p. 251).
Implications for Practice
Because the majority of people in the United States are religious or spiritual (Gallup, 1993), it seems inevitable that marriage and family counselors will work with clients who wish to share, explore, and perhaps draw on their beliefs in the therapeutic process. In many cases, for example an interfaith couple seeking help to decide on the religious upbringing of their child, the topic of religion or spirituality may be a primary issue. Religion and spirituality may also be more covertly intertwined with myriad issues, including divorce, sexuality, and death (Lovinger, 1990). Thus, counselors should be cognizant of both positive and negative implications, as well as ethical considerations, of integrating religion and spirituality with marriage and family counseling. Through this awareness, counselors can make informed decisions regarding the inclusion of religion and spirituality in their clinical practice.
Given the likelihood of encountering spiritual and religious issues in the counseling process, it is vital that counselors seek training in this area. Training may include course work in religion, spirituality, and counseling; supervision regarding working with religious or spiritual clients; and continuing education in this area. In addition, education and knowledge about the core concepts and beliefs of world religions is important to understand a client's subjective frame of reference (Genia, 1994).
The current literature on religion and spirituality provides both positive and negative aspects of clinical integration as well as a variety of techniques for this integration. Clearly, however, the counseling field is just beginning its exploration of the integration of religion and spirituality into therapy. Although research on the subject has increased over the past 10 years, there are still noticeable deficiencies that need to be explored.
Most theory and research in this area focuses on Judeo-Christian traditions and Western culture (Richards & Bergin, 1997). It is important to explore other religious and spiritual traditions, including Hinduism, Buddhism, and Islam. In addition, it is essential to investigate integrating religion and spirituality in therapy with couples and families of different ethnicities, socioeconomic positions, as well as gay and lesbian couples and families (Anderson & Worthen, 1997). Finally, more empirical research is needed on the effectiveness of using various techniques and strategies to integrate religion and spirituality into the counseling process. Further exploration of the clinical integration of marriage and family counseling can serve to benefit clients and to enhance the therapeutic relationship.
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Chelsea T. Wolf is a master's degree student in the Department of Counseling Psychology and Counselor Education, and Patricia Stevens is an associate professor in the Department of Counseling Psychology and Counselor Education and director of the Marriage and Family Therapy Program, both at the University of Colorado at Denver. Correspondence regarding this article should be sent to Chelsea T. Wolf, Department of Psychology and Counselor Education, University of Colorado at Denver, Campus Box 106, PO Box 173364, Denver, CO 80217-3364 (e-mail: email@example.com).…
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Publication information: Article title: Integrating Religion and Spirituality in Marriage and Family Counseling. Contributors: Wolf, Chelsea T. - Author, Stevens, Patricia - Author. Journal title: Counseling and Values. Volume: 46. Issue: 1 Publication date: October 2001. Page number: 66. © 2008 American Counseling Association. COPYRIGHT 2001 Gale Group.
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