The past decade has witnessed increased attention to the importance of understanding and respecting client/patient spirituality and religiosity to psychological assessment and treatment, as well as recognition that religious and spiritual factors remain under examined in research and practice (APA, 2007d). Advances in addressing the clinical relevance of faith in the lives of clients/patients have raised new ethical dilemmas rooted in theoretical models of personality historically isolated from client/patient faith beliefs, the paucity of research on the clinical benefits or harms of injecting faith concepts into treatment practices, group differences in religious practices and values, and individual differences in the salience of religion to mental health (Shafranske & Sperry, 2005; Tan, 2003).
The Secular–Theistic Therapy Continuum
Integration of religion/spirituality in therapy can be characterized on a secular–theistic continuum. Toward the secular end of the continuum are “religiously sensitive therapies” that blend traditional treatment approaches with sensitivity to the relationship of diverse religious/spiritual beliefs and behaviors to mental health. Midway on the continuum are “religiously accommodative therapies” that do not promote faith beliefs but, when clinically relevant, use religious/spiritual language and interventions consistent with clients’/patients’ faith values to foster mental health. Toward the other end of the continuum are “theistic therapies” that draw on psychologists’ own religious beliefs and use sacred texts and techniques (prayer, forgiveness, and meditation) to promote spiritual health.
The sections that follow highlight ethical challenges that emerge along all points of the secular–theistic therapy continuum.
All psychologists should have the training and experience necessary to identify when a mental health problem is related to or grounded in religious beliefs (Standards 2.01b, Boundaries of Competence, and 2.03, Maintaining Competence; see also Bartoli, 2007; W. B. Johnson, 2004; Plante, 2007; Raiya & Pargament, 2010; Yarhouse & Tan, 2005). Personal faith and religious experience are neither sufficient nor necessary for competence (Gonsiorek, Richards, Pargament, & McMinn, 2009). There is no substitute for familiarity with the foundational empirical and professional mental health knowledge base and treatment techniques. While personal familiarity with a client’s/patient’s religious affiliation can be informative, religious/spiritual therapeutic competencies for mental health treatment include
· understanding how religion presents itself in mental health and psychopathology;
· self-awareness of religious bias that may impair therapeutic effectiveness, including awareness that being a member of a faith tradition is not evidence of expertise in the integration of religion/spirituality into mental health treatment;
· techniques to assess and treat clinically relevant religious/spiritual beliefs and emotional reactions; and
· knowledge of data on mental health effectiveness of religious imagery, prayer, or other religious techniques.
Collaboration With Clergy. Collaborations with clergy can help inform psychologists about the origins of the client’s beliefs, demonstrate respect for the client’s religion, and avoid trespassing into theological domains by increasing the probability that a client’s incorrect religious interpretations will be addressed appropriately within his or her faith community (W. B. Johnson, Redley, & Nielson, 2000; Richards & Bergin, 2005; Standard 3.09, Cooperation With Other Professionals). When cooperation with clergy will be clinically helpful to a client/patient, psychologists should
· obtain written permission/authorization from the client/patient to speak with a specific identified member of the clergy,
· share only information needed for both to be of optimal assistance to the client/patient (Standard 4.04, Minimizing Intrusions on Privacy),