I spent a lot of time working on this so I figured I might as well post it here and earn a few cryptopennies for my time and effort. This was written for an online graduate course I'm taking in research and psychotherapy ethics, but since ethics is a topic I discuss often on my own I figured I would put it with the rest of my content.
According to Fisher, religious and spiritual practices are typically implemented into therapy along a secular-theistic therapy continuum (2017). At one extreme are religiously sensitive therapies that combine a purely clinical approach to therapy with a tolerance and acceptance for the diverse religious and spiritual beliefs of clients (Fisher, 2017). At the other end of the spectrum are theistic therapies that utilize the religious and spiritual beliefs, practices, and texts of the client and therapist during treatment (Fisher, 2017). Between these two extremes are religiously accommodative therapies that utilize religious vernacular and practices that are drawn from the client’s faith to facilitate their mental health goals (Fisher, 2017). The subject of this paper will be the second category, theistic therapy, and the ethical restraints and guidelines that psychotherapists must following when implementing it.
Several obvious concerns come to the forefront. Without delving into the details of the subject one would immediately question a therapist’s competence in handling something as sensitive as religious belief given the various and subtle nuances that exist even within the same religion. Another immediately obvious concern is the slippery slope that religious beliefs and practices could completely supplant the evidence based clinical approach. Fisher echoes such concerns by pointing out the indispensability of professional mental health knowledge (2017). A third apparent concern is that some therapist may use the cover of theistic therapy to impose their religious or spiritual values, beliefs and practices on clients. This one would be a significant concern in ethics since it strikes at the very foundation of professional ethics: the informed consent doctrine shared by both psychological and medical practitioners. These three obvious concerns, and several less obvious concerns, can be addressed within the pre-established categories of the APA code of ethics. The use of religious beliefs, texts, and practices within the context of therapy also has the potential to establish multiple relationships between the therapist and client, which is already discouraged and often outright prohibited by standard 3.05 of the APA code of ethics. As mentioned earlier, the imposition of religious or spiritual values, beliefs or practices already constitutes a fundamental violation of informed consent, and incompetence in the implementation of religious techniques and practices is already regulated under standard 2.01, which establishes the boundaries of practitioner competence, but there are less obvious ethical concerns to address. As Richards and Bergin mention in A Spiritual Strategy for Counseling and Psychotherapy, seeing clients from the same church or congregation as the therapist may lead to the unintentional leaking of a client’s confidential information, violating standard 4.01 of the APA ethics code (1997). Similar concerns can be found when therapist use their religious values to confront their client’s lifestyle choices. Condemnation of clients for their lifestyle choices could break their trust in the therapist and bring them undue harm, which is contrary to the general principle of beneficence (Richards and Bergin, 1997). If the client is of a different faith than the therapist, particularly a minority faith, it could be unfair discrimination, which is a violation of standard 3.01. None of this implies that theistic therapy is infeasible, but it is a grey area that therapist should approach with caution by following a handful of guidelines that protect the client from harm and exploitation.
There are several precautions that therapist can take to implement theistic therapy and spiritual interventions while remaining in compliance with the code of ethics. One step that therapists can take, that is often ignored by mainstream psychotherapists, is to collaborate and consult with the client’s ecclesiastical leader whenever they implement any religious or spiritual elements (Richards and Bergin, 1997). Therapists who use theistic therapy run the risk of usurping the ecclesiastical leader's authority and assuming the dual role of both psychotherapist and religious leader, which constitutes an unethical multiple relationship (Richards and Bergin, 1997). Collaborating and consulting with the client’s ecclesiastical leader allows therapists to establish firm boundaries between these two roles and helps therapists better assist clients in meeting their mental health and spiritual needs. Furthermore, as Richards and Bergin note, religious communities can provide benefits that therapy alone cannot provide (1997). For instance, religious communities can alleviate social isolation, which is major factor in preventing suicide (Richards and Bergin, 1997). Religious communities can also provide financial and employment assistance and help clients find meaning in their lives (Richards and Bergin, 1997). Regardless of the benefits of collaborating with clients’ ecclesiastical leaders, therapists should always get the expressed permission of their clients to contact their religious leaders and affirm this permission upon initial contact.
Insensitivity to diverse religious traditions, imposition of one’s religious values, beliefs, or practices and unfair discrimination against certain religions can be avoided by learning about the diverse cultural backgrounds of their clients and exploring how their own cultural identities affect their beliefs about therapy (Weld and Eriksen, 2007). Some behaviors that therapists may think are friendly and benign could be forms of proselytizing that make clients uncomfortable and less willing to share their problems with therapists. Proselytizing includes giving clients literature about one’s religious sect or spiritual beliefs, inviting clients to attend religious services, and teaching clients about one’s belief system when it is irrelevant to the client’s mental health goals (Richards and Bergin, 1997). One step that therapists can take to avoid offending clients is to make sure they work within the client’s belief system when they pray with them or encourage them to pray (Weld and Eriksen, 2007). Similarly, condemnation of clients’ lifestyle choices can cross the thin line between moral confrontation and religious imposition (Richards and Bergin, 1997). For this reason, Richards and Bergin recommend that therapists inform clients about the physical, mental and spiritual consequences of their behavior and the risks they take in continuing this behavior (1997). Clients that do not share the same faith as their therapists may engage in certain behaviors that are integral to their faith, but which their therapists consider spiritually harmful. For instance, a Christian therapist may view a wiccan client’s spell casting as playing with fire. In such instances, it would be best to focus on the common ground between therapist and client and suggest practical ways that the client can go about meeting their mental health goals. Weld and Eriksen recommend that therapists examine the values inherent in their own counseling process to further manage and assess their client’s expression of values and beliefs (2007). This could include discussing their own perspective on prayer with their clients (Weld and Eriksen, 2007).
Confidentiality is perhaps as fundamental in a therapeutic relationship as a client’s trust in their therapist. In fact, the two are inseparable. Therapists that serve members of their own congregation or religious organization run the risk of breaching client confidentiality. Their interaction with clients in multiple settings makes it less likely for them to remember where they learned certain information about their clients (Richards and Bergin, 1997). In such instances, they may accidentally disclose information about their clients, to other members of the congregation, that they learned during a therapy session, but which they mistakenly believe came from a church related activity (Richards and Bergin, 1997). Even telling clients that they need to reschedule their appointments, during a religious gathering, constitutes a serious breach of client confidentiality (Richards and Bergin, 1997). To avoid this ethical pitfall, therapists and clients from the same congregation should have their arrangements approved and monitored by a board of review (Richards and Bergin, 1997).
Theistic therapy is a feasible approach to psychotherapy that can help clients cope with their mental health problems and meet their spiritual needs too, but like other kinds of therapy it has ethical pitfalls. Fundamental ethical standards are at stake when religion and spirituality are incorporated into therapy, so therapists must take multiple precautions to avoid unethical conduct. In general, they should develop a sensitivity to the cultural and religious diversity of their clients, research the nuances and religious belief systems, and always obtain the expressed permission of their clients before incorporating any spiritual or religious practices.
References
Weld, C., & Eriksen, K. (2007). The Ethics of Prayer in Counseling. COUNSELING AND VALUES, (2). 125.
Fisher, C. B. (2017).Standards on therapy. In Decoding the ethics code: A practical guide for psychologists (4th ed., pp. 113-171).Los Angeles: SAGE.
Richards, P. S., & Bergin, A. E. (1997). Ethical issues and guidelines. In , A spiritual strategy for counseling and psychotherapy (pp. 143-169). Washington, DC, US: American Psychological Association. doi:10.1037/10241-007