LIBERTY UNIVERSITY JOHN W. RAWLINGS SCHOOL OF DIVINITY
Delivering faith-informed therapies
A Paper Submitted to
the Faculty of the School of Divinity
in Candidacy for the Degree of
Doctor of Education in Christian Leadership (Ed. D) Department of Christian Leadership and
Church Ministries
By
Mary Gracias
Lynchburg, Virginia
10/2022
Delivering faith-informed therapies
Consideration of the empirical evidence just reviewed in the light of the doctrine of double
effect suggests that simply avoiding faith-related values in therapy (as adopted by the majority
of practitioners) is not sufficient. Similarly, basing a choice on no more than congruence with
patients’ beliefs and preferences may not be in their therapeutic interest.
If changing spiritual belief is seen as a risk, then there is insufficient evidence to suggest
that faith-informed therapies, other than mindfulness for depression, provide sufficient
additional benefit to justify such a risk being taken. However, if such change is not a concern,
then the doctrine of double effect suggests that faith-informed therapies of equivalent
effectiveness become an option for discussion with patients, and could be potentially valuable
for those patients whose religious engagement exacerbates or mitigates their psychopathology.
Figure 2 shows as a flowchart a faith-sensitive decision-making process for therapy choice
and monitoring derived from the research just discussed. The flowchart begins with the
practitioner asking himself or herself a very simple assessment question: is faith important for
this patient? Reference CookCook (2015) gives a range of approaches to assess this.
Given the evidence discussed above, the practitioner should also assess whether the
patient's faith and coping style is a support or a risk to recovery, by deciding, for example,
whether faith informs anxious or depressive ruminations. As Fig. 2 shows, faith-informed
therapy is non-controversially indicated when faith is important to the patient, the patient's
faith-related coping style is helpful, and the faith-related beliefs and values of therapist and
patient are shared. If a patient's faith-related coping style is unhelpful, then the choice lies
between a secular alternative, or – rarely – a faith-informed therapy designed to maximise
alternative benefit and challenge the unhelpful coping style while minimising risk.
There could also be occasions when a faith-informed therapy is indicated, but made
difficult through an irreconcilable difference between the patient's and the therapist's values.
To manage these potential risks, Fig. 2 suggests that practitioners should, from the outset, have
access to a reference group of mental healthcare professionals who have received anti-bias
training. The classic ‘Delphi’ system remains the gold standard for such groups: a detailed
discussion is beyond the scope of this article, but its key components are aggregated,
anonymised responses and the opportunity for multiple iterations. Although anonymity would
be hard to achieve, both of the other criteria have been greatly facilitated by electronic
communication, which also avoids the need for the group to schedule meetings. The use of a
reference group, and HRQoL as well as symptom-based routine outcome measures, extends the
application of ‘spiritually conscious care’ (Reference Saunders, Miller and BrightSaunders 2010)
and descriptions of expected competencies (Reference CookCook 2015) by deploying
techniques and strategies that specifically address practitioner bias relating to their patients’
faith, once it is elicited. Although the process appears complex and potentially resource-
intensive, in practice most cases will not require detailed group discussion, though the
individual practitioner will need appropriate training in the faith-informed therapy chosen.
We have seen above that a secular and empirical training will make it easy for mental
health professionals to underestimate the importance of faith-informed values in the lives of
patients, and they cannot presume to approach these issues without being affected by biases of
their own. There is currently an unhelpful gap in the research: while it is possible to identify
groups of patients whose faith interacts with their psychopathology, such patients have not
been selected for trials of faith-informed therapy. Therefore, practitioners will need to have
recourse to their own clinical judgement about the utility of faith-informed therapy to these
patients when applying the flowchart in Fig. 2, and the failure to demonstrate additional clinical
efficacy for faith-informed therapies may be unduly conservative.
Practitioners seeking training in faith-informed therapies face a dilemma. The research
suggests that there is a role for these therapies, improving the quality of life of patients and
meeting patient concerns that might otherwise not be addressed. However, much training in
faith-informed therapies is provided within the relevant faith tradition, which has been shown
to lead to biased decision-making. For such therapists, recommendations such as those in the
learning objectives at the beginning of this article may prove useful in minimising the
unavoidable influence of their training. Mindfulness is different, as it may be presented either
as a faith-informed or a completely secular therapy. At present, much mindfulness-based
therapy combines a secular presentation with a training heavily influenced by religious
(Buddhist) philosophy. The potential for conversion or rejection for faith reasons is, prima facie,
clear and unhelpful. A better separation between mindfulness training and Buddhism seems
desirable: DBT and MBT show that this can be done with no loss of efficacy.
MCQs
Select the single best option for each question stem
1. 1 The most important reason to assess faith in patients is:
1. a unresolved guidance about faith in therapy
2. b avoidance of secular bias
3. c salience for patients
4. d maintenance of social cohesion
5. e acceptability of mindfulness-based cognitive therapy.
2. 2 The biggest risk to patients in using faith-informed therapies arises from:
1. a lack of efficacy
2. b a negative religious coping style
3. c conflict between therapist and patient
4. d changing the patient's faith
5. e impact on quality of life.
3. 3 The best reason for using faith-informed therapies is:
1. a reliable evidence of efficacy
2. b patient acceptability
3. c positive change in symptomatology
4. d improvements in health-related quality of life (HRQoL)
5. e demonstration of therapist empathy.
4. 4 The doctrine of double effect is most helpful in making decisions about faith in
therapy because:
1. a it can be used in end-of-life care
2. b it is inherently free from bias
3. c it minimises risk to the patient
4. d it recognises patient preferences
5. e it explicitly values both faith and symptomatology separately.
5. 5 Therapists can improve their practice when encountering faith by:
1. a making use of a skilled reference group in difficult circumstances
2. b taking time over faith-related decisions
3. c avoiding early compromise in situations where values seem to clash
4. d explicitly considering both quality of life and symptom change as separable
treatment goals
5. e all of the above.
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