Good morning Jim. Sorry for the delay in getting to this email. It got
lost at the bottom of my Inbox.
> I would not use psychotherapy to convert anyone or direct anyone
> towards or away from a religious worldview. That is not the purpose
> of psychotherapy.
> > But what if the religious worldview appeared to be having a harmful
> > influence on the person? You still would not try to change that
> > worldview (either directly or indirectly, by guiding clients to
> > reflect on the negative consequences)? I've never quite understood
> > this "hands-off" attitude expressed by some therapists about
religion,
> > culture, or perhaps even values in general.
I may not have been too clear in my answer. I would help my clients
explore both the positive and negative consequences of their worldview.
But I would do this with all clients and worldviews, not just my
religious ones. I suppose you could say one of my goals would be to
help them increase their awareness, take ownership of their choices, and
then make informed and proactive decisions.
> adjustment to life stressors. One of the problems is that many
> psychologists are neither trained nor comfortable in dealing with
> religious issues in therapy. This is supported by survey research
> investigating training issues (cf Schulte et al, 2002).
> > But lack of training about specific attitudes and values must be
> > true for many areas, not just religious values (e.g., training in
> > attitudes of poor to financial problems, attitudes of rural people
> > toward the land, attitudes of gay and lesbians toward gender, ...).
> > Is it necessary to have "training" in all possible values and
attitudes,
> > or is it possible to develop generic skills (e.g., interviewing
skills,
> > empathic understanding skills, ...) that make such specific and
diverse
> > training unnecessary? And to what extent is the discomfort because
> > certain people in the profession and society recommend a "hands off"
> > attitude toward religion?
I think religiousness and spirituality should be addressed as a topic
within a multicultural course or curriculum. We should also be
exploring these issues in applied courses, such as practica,
externships, and internships. My training completed neglected this
area. And then one time I was doing a practicum in the hospital and one
of my clients as a preacher (who happened to belong to my particular
denomination) who was dying of cancer. One day as I was
leaving--counseling sessions were conducted by his bedside in the
hospital--he asked me to say a prayer for him. I probably looked like a
deer in the headlights because I had no idea what to do in this
situation! However, undergraduate and graduate training programs can't
cover every topic, as you suggested, so some of the responsibility for
getting this training lies with the individual practitioner.
> As a result,
> many psychologists ignore religious or spiritual issues that may be
> very important to their clients. The point of addressing religious
> issues in therapy is not to evangelize or promote my own religious
> beliefs, but rather to help clients explore their own religious or
> spiritual worldviews and practices as they are related to their goals
> for treatment.
> > Sorry, but it seems to me that if you advocate some of the
> > religious coping strategies (e.g., collaborating with god),
> > then you are indeed lending your professional support to those
> > religious beliefs. I can also imagine a scenario where
> > people with certain beliefs find like-minded "psychologists"
> > to help them "cope" without really challenging those beliefs
> > (e.g., that everyone but people in their clique will go to hell for
> > eternity, that women should be subservient to men, that parents
> > are allowed to punish children and withhold medical treatment, ...).
Your last few comments represent stereotypes and it probably wouldn't be
productive for me to address those. You first comments are very
relevant, though. If clients come to me with strong religious values
and a belief in a personal God, I do not have a problem advocating the
use of collaborative religious coping styles. That sort of
collaborative approach helps clients to assume more responsibility for
their lives within a context that is meaningful and important to them.
Sometimes religious clients will come to me with a passive approach
("God will solve everything") that inhibits them from making any
significant changes in their life. If I tell them that God won't solve
anything and that they need to pull themselves up by their bootstraps,
then they would walk out the door and I would not be any help to them.
If I help them explore their beliefs, worldviews, and relationship with
God (which I'm assuming for this example that they have already told me
were important to them), the introducing them to the idea of a
collaborative approach is useful and helpful. But of course, they are
the ones that make the decision of collaboration versus passivity. I
see my role as helping them gain greater awareness of their options and
to assume responsibility for their decisions. On the other hand, I've
had some non-religious clients who were overly self-reliant and
independent to the point that it was a major contributor to their
presenting problems. With these clients I helped them to explore the
value of interdependence or dependence on other people. I wouldn't
address the issue of dependence on God, however, if they hadn't already
told me that a personal relationship with God was important to them.
You're also right in that some religious clients come to me because they
have heard that I was a Christian psychologist, but I've also had other
clients come to see me because they heard that I was affirming of
religion and spirituality in general. Sometimes these clients are
unprepared when I challenge to explore their beliefs. But I would ask
you not to assume that Christian psychologists don't challenge their
Christian clients. I challenge my Christian clients all the time to
explore their beliefs and make more proactive (less reactive) decisions.
BAD CHRISTIAN COUNSELING:
Husband: It's my right to make all the decisions in the household,
that's what the Bible says.
Counselor: No, it's not. The Bible says that you are to mutually
submit to one another. You are misinterpreting the Bible and are wrong.
BETTER CHRISTIAN COUNSELING:
Husband: It's my right to make all the decisions in the household,
that's what the Bible says.
Counselor: What kind of effect does it have on your wife when you do
this?
Husband: It has no effect on her at all.
Counselor: I wonder if we could check this out with your wife.
(Turning to wife) How does it feel to you when your husband makes all
the decisions in the relationship.
Wife: I've never really told him this directly before, but it really
bothers me. Makes me feel like I'm not important, that he doesn't love
me enough to value my opinion.
Counselor: (Turning to husband) Sounds like it has more of an effect
on your wife than you may have thought. What did you hear her saying?
And then we facilitate the process of exploring his beliefs about why he
feels he has to be the one to make all the decisions in the household,
as his beliefs are one component of the broader problem for which they
are seeking therapy. Where did he learn these beliefs? What role did
his parents, his peers, his minister, etc. play in shaping these
beliefs? Do these beliefs work? Do they work to build intimacy in the
relationship? Have there been times when he let his wife make
decisions? What happened then, were there any changes in the quality of
the relationship? How does he feel about how upset his wife is?
Granted, this is a greatly simplified example, but that is the kind of
approach I might take in initially challenging my Christian clients. I
would also work with the wife in being more assertive, help them develop
listening, communication, and conflict resolution skills.
When I did work with male batterers I would often have some Christian
clients who used the Bible as a means to batter their wives ("I need to
keep her submissive"). When I first started working with these clients,
I found out that it was completely unproductive to directly challenge
their religious beliefs. So I started off by asking them some variation
of, "Is your current approach to solving your problems (i.e., beating
your wife) working for you?" They invariably say that it isn't, because
they end up in jail, paying fines, having problems with their family,
etc. So I ask them, "Well, let's take a look at some other ways that
might work more effectively for you" and then I go into the standard
anger management approach stuff. Usually, once they have developed some
trust in me, and with therapeutic guidance, they are able to tell me
that the reason they are violent is because they feel vulnerable, which
scares them, and the only way they know how to deal with it is through
violence. So they come to see that their behavior is less related to a
belief that the Bible tells them to keep their wife submissive and more
related to their own underlying feelings of vulnerability and
inferiority. In the end, they get the same message that it is wrong to
abuse another person, but I relate to them in a way that they will hear
me and not shut me out.
> I've had many atheistic, agnostic, or non-religious clients
> and the issue of religion or spirituality was never addressed. But
> I've also had a number of religious client (primarily evangelical
> Christians) for whom their faith was a central organizing framework
> through which they conducted their life.
> > And what have you done when you thought that their religious
> > perspective contributed to the> ir problems?
I address it with them and help them explore it. I don't say (or imply
through my words or behaviors): "You're
crazy/uneducated/unrealistic/stupid/ignorant because you belief in X."
...
> The results of these and other studies, both experimental and
> correlational, show that religiousity can affect physical health
> directly by two major mechanisms and indirectly by two other
> mechanisms. And none of these mechanisms are based upon "supernatural"
> effects but rather can be explained by known naturalistic and
> physiological pathways. The two direct mechanisms are (a) earlier
> diagnosis and better treatment of physical diseases, and (b) reduction
> in behaviors that negatively affect health (reduced drinking, smoking,
> unsafe sexual practices, etc.). The two indirect mechanisms are (a)
> enhancement of social support, and (b) reduction of distress,
> depression, anxiety, and other emotional disorders.
>
> What is the practical usefulness of all of this? I would hope that it
> would be apparent. But if it's not, let me try to make it clear. If
> we can understand the complex associations between religiosity and
> mental and physical health, then we can better understand our
> religious patients and we can design more efficacious treatment
> interventions. To me, that is useful.
> > And are you honest with your clients that although you are using
> > "religious" strategies, those strategies do not in fact operate by
> > supernatural (i.e., religious) means? And do you provide them with
> > the non-religious explanations for their effectiveness?
If I am doing Christian counseling with a client, I would certainly
discuss both natural and supernatural explanations. I believe that God
often works through natural means. For instance, if I had a Christian
client with cancer who was isolated from everyone, I would encourage him
to strengthen his social support system. I would talk with him about
some of the recent research showing the importance of encouraging
relationships as a buffer against stress, how it affects the immune
response, etc. I would also ask him to explore what his religious
beliefs say about the role of encouraging relationships. He would then
likely tell me about Scripture passages which talk about the importance
of interdependence and the need to meet with others on a regular basis
for encouragement and support. I might wonder out loud, "Isn't it
interesting that scientific research is now showing us that
relationships are vital for our health and well-being, and that the
Bible has also mentioned the importance of relationships." And to be
honest with you, Jim, I believe that the reason social support increases
our health and well-being is because God created us as relational
beings. I believe that God often works in our lives through
relationships. The evolutionist might believe that relationships are
important because it led to our proliferation as a species and we would
have died out if we hadn't formed social units. But these are my
personal beliefs and I understand that you or others may not agree with
them. But to answer your question, yes I do offer them non-religious
explanations for their effectiveness. If a client talks to me about
the importance of prayer and meditation in her life, I would probably
work with her to incorporate some deep breathing activities or other
meditative approaches that have been shown to reduce autonomic arousal.
I would help her understand how these behaviors affect her naturally
(through the nervous system, for instance) and help her also explore
these behaviors from a supernatural (biblical) perspective.
> > Can my more religiously oriented colleagues explain how
> > they can in good conscience NOT challenge a religious
> > explanation and treatment for such conditions?
It's actually not uncommon for me to have religious clients who think
that they are possessed or oppressed by demons. One really depressed
client told me that she thought she was being influenced by a demon of
depression. So I took out my handy-dandy diabolical demon detector and
... (just kidding). If they respond to psychotherapy or medication
(which is usually what happens), they are probably not demon possessed.
If their head starts spinning and they begin spewing fire and brimstone,
then it's probably a demon (which hasn't happened ... yet!). All jokes
aside, I think you respect their beliefs but also encourage them to
consider the role of cognitive and social processes that may affect
their depression, and you encourage them to give therapy or medication a
trial run. There is a reason they are coming to a psychologist and not
going to a priest. In my experience, they have always been willing to
try therapy and most have benefitted from it to some degree.
> > Why this discussion on TIPS?
That's a good question. I don't mind talking about these topics, and I
assume that those who are not interested don't even read these posts. I
appreciate your comments and questions and hope I was helpful to you,
Jim.
Regards,
Rod
______________________________________________
Roderick D. Hetzel, Ph.D.
Assistant Professor of Psychology
LeTourneau University
President-Elect, Division 51
American Psychological Association
Department of Psychology
LeTourneau University
Post Office Box 7001
2100 South Mobberly Avenue
Longview, Texas 75607-7001
Office: Heath-Hardwick Hall 115
Phone: 903-233-3312
Fax: 903-233-3246
Email: [EMAIL PROTECTED]
Homepage: http://www.letu.edu/people/rodhetzel
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