LIBERTY UNIVERSITY JOHN W. RAWLINGS SCHOOL OF DIVINITY
Faith-informed therapies in practice
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
8/2022
Faith-informed therapies in practice
There are currently three main routes by which faith-informed approaches are entering
mental healthcare.
As described in the literature, mindfulness-based cognitive therapy (MBCT) is an entirely
secular technique, closely allied to cognitive–behavioural therapy (CBT), with an empirical
evidence base. No secret is made of the fact that it has been derived from Buddhist practice,
although other religions (most obviously Hinduism, though Judaism, Islam and Christianity all
have strong contemplative traditions) also practice mindfulness as part of their devotions.
Many influential therapeutic practitioners of mindfulness are Buddhist, and consider it to
be congruent with general healthcare ethics, rather than detachable from Buddhist practice.
Courses involving mindfulness-based therapeutic techniques are taught in Buddhist centres,
and university courses of mindfulness-based therapy include teaching Buddhism: both settings
are seen as providing appropriate training. Some have extended the use of mindfulness to the
inclusion of Buddhist psychology, and there is a plethora of books by mindfulness-oriented
psychotherapists recommending a rapprochement with Buddhism.
Mindfulness has been taught without Buddhist background in effective psychotherapies
targeted at borderline personality disorder, in particular dialectical behaviour therapy (DBT)
(Reference LinehanLinehan 2014) and mentalisation-based treatment (MBT) (Reference
Bateman, Bales and HutsebautBateman 2014). However, even here it has been theorised that
the observed benefits result from a spiritual dimension that mindfulness has introduced
(Reference Bennett, Shepherd and JancaBennett 2013).
Therapeutic prayer, mostly promoted by Christian and Moslem practitioners, has relied on
a three-step religious engagement with patients. The first step is to assert that private prayer
by the practitioner for the welfare of their patients is unexceptionable and an appropriate
expression of compassion. The second is to argue that shared faith between practitioner and
patient may be a help, rather than a hindrance, and may even be sought by patients,
particularly from a religious minority. The third is an extension of the second, that joint prayer
between practitioner and patient, or religious observance, may be an appropriate part of care
(Reference KoenigKoenig 2008).
When faith-informed therapies are developed, a common approach is to construct
therapies that combine religious and therapeutic elements within their delivery. Frequently, the
therapeutic component is of known efficacy, and a secular version may be tested against a
faith-informed version as part of the therapy's evaluation. Such approaches inform much of the
research on the specific contribution that faith makes to therapeutic efficacy, which is discussed
next.
Evidence for therapeutic efficacy of faith-informed therapies
Proponents of faith-informed therapies need to claim that there is evidence for the
benefits of faith on sustaining mental health and well-being, both generally and in adversity.
Although it has been claimed that the empirical case for the benefits of faith-based therapy is
made, this is far from clear. Religious patients report adverse experiences associated with some
faith-congruent spiritual interventions, especially joint praying (Reference Martinez, Smith and
BarlowMartinez 2007). There is evidence for the apparent benefit being at least partly due to
selection bias and, if not, being restricted to specific groups (Reference Balbuena, Baetz and
BowenBalbuena 2014).
Non-specific spirituality, such as that encouraged by mindfulness practices, has been
associated with worse mental health and increased undesirable behaviour (Reference King,
Marston and McManusKing 2013). Measurement of spirituality has conflated the concept with
more general ideas of well-being, thus introducing a positive bias into much empirical
assessment (Reference ChildsChilds 2014). A similarly circular bias is introduced when risky
behaviours that are condemned by religions, but may not in themselves be harmful (e.g. having
a number of sexual partners), are used as outcome variables. Healing touch (‘laying on of
hands’) is a useful paradigm here, being a faith-informed therapy that requires no
contaminating therapeutic effort from the patient. In a systematic review (Reference Anderson
and TaylorAnderson 2011), the only adequately masked study found, in the absence of a
nonintervention group, a difference favouring ‘mock’, rather than ‘genuine’, healing touch.
Another useful approach, mentioned above, is the direct comparison of ‘faith-informed’
and ‘secular’ versions of the same therapy. No difference has been found (Reference
Worthington, Hook and DavisWorthington 2011), suggesting that any ‘added value’ for faith
does not come from efficacy. A more recent contrary claim was based on an unplanned
secondary analysis of a randomised controlled trial examining optimism (Reference Koenig,
Pearce and NelsonKoenig 2015a), which was not supported by an earlier publication from the
same study that focused on depression (Reference Koenig, Pearce and NelsonKoenig 2015b).
Likewise, although empirical benefits of mindfulness for mental health have been
established for depression, and especially depressive relapse, its effect is adjuvant to CBT when
the two are combined (as in MBT): studies have found it inferior to other forms of CBT for some
depressive subtypes or sleep disorder, and ineffective for, at least, social anxiety (National
Institute for Health and Care Excellence 2014). Social constructs such as salutogenesis may be
more important than spiritual ones in understanding its impact (Reference
WijesingheWijesinghe 2013). Should a practitioner offer a faith-informed therapy other than
mindfulness, the evidence for equivalent effectiveness is likely to be of lower quality than that
supporting the secular comparison (Reference Paukert, Phillips and CullyPaukert 2011), which,
under the doctrine of double effect, must be balanced against any spiritual benefit experienced
by patients (Reference Worthington, Hook and DavisWorthington 2011).
None of the above caveats contradicts the finding that patients do report a separate,
spiritual benefit from faith-informed therapies (Reference Worthington, Hook and
DavisWorthington 2011) or that therapist-initiated, faith-informed values such as compassion,
blame and moral responsibility may be essential for effective treatment in at least some cases
(Reference PickardPickard 2011; Reference Braehler, Gumley and HarperBraehler 2013). Also,
studies on religious coping have demonstrated that the effect of patients’ religious engagement
on psychopathology may be positive or negative (Reference Pirutinsky, Rosmarin and
PargamentPirutinsky 2011), suggesting that this is an important target for both assessment and
intervention.
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