LIBERTY UNIVERSITY JOHN W. RAWLINGS SCHOOL OF DIVINITY
Religion and spirituality in the treatment room
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
Religion and spirituality in the treatment room
Christian psychologist William Hathaway, PhD, of Regent University in Virginia, found
himself the latest in a long line of therapists to work with a family in crisis over the son's
uncontrolled attention-deficit hyperactivity disorder (ADHD). Hathaway asked the family
members about their religious beliefs and, finding that they were Jewish and that the boy's
behavior in temple was preventing them from attending services, encouraged them to go back
to their religious rituals.
"They had made the decision not to and were tearful about it when asked, especially
because none of their mental health providers had considered it before," says Hathaway.
Discussing the ramifications of spirituality in family life broadened the family's experience in the
therapy room and allowed them to address religious issues as a serious component of their
well-being, he says. And, he adds, their religious practices might well have strengthened the
family's ability to deal with their son's ADHD.
"Just being sensitive to a possible role of religion in a client's life can broaden your
evaluation and provide different solutions," he explains. "Being able to help a person connect
with the variable of spirituality in their lives can be a beneficial and important therapeutic
accommodation."
That heightened awareness of spirituality, or even taking it a step further by directly
incorporating religion and spirituality--different but not mutually exclusive concepts--into
therapeutic practices, is common for some psychologists. Moreover, the expansion of its use is
leading to efficacy research, specific training and even tacit specialization.
Spirituality as a therapeutic strategy
"Using religion as a therapeutic tool is a little controversial and still emerging," Hathaway
says. "Techniques include use of prayer during a session, ways to direct clients to pray, spiritual
journaling, forgiveness protocols, using biblical texts to reinforce healthy mental and emotional
habits and working to change punitive God images."
For example, Hathaway uses spiritually guided forgiveness protocols to help clients deal
with emotional problems that resulted from harm inflicted by friends or family members. Using
religious teachings on forgiveness can direct clients to let go of unhealthy anger and move past
an abusive situation without justifying the abuse, he says.
In the context of implementing these techniques, however, the possibility that religion may
have a negative influence on a client's life--believing in an angry God, for example--should be
assessed carefully so that therapy doesn't make emotional crises worse, says Carrie Doehring,
PhD, a psychologist at the Iliff School of Theology in Denver who studies how people use
religion to deal with experiences of violence.
"During assessment, I ask about religious and spiritual backgrounds, ask the client if they
pray and if it helps or not. And if they do have a belief in a personal God, I ask them what they
think God wants from them right now, and that leads them to talk about their experience with
God," Doehring says. "It's the sum of that conversation that helps me to understand what
religion's impact is on their life."
With religious or spiritual clients, that sensitivity and willingness to interact in a religious
way helps them to trust the therapist and, Doehring says, can bring a beautiful aspect of the
human experience into the therapy room.
"Some people describe the beauty of spiritually guided therapy as experiencing a third
presence in the room--a spiritual presence or a God presence," she says. "There's a mystery
being revealed to the patient in that presence; it's a sort of an epiphany that can be extremely
useful in therapy."
Precautions to ponder
Although potentially effective, use of religiously guided treatments needs to be considered
carefully, especially when a therapist is new to using them, Doehring says.
"I think it's important for all psychologists to understand how spirituality and religious faith
are important to them personally, both as a tool and as a way to prevent personal roadblocks,
but there are pitfalls to incorporating religious practices into therapy," she says.
A primary concern for those promoting the field is ensuring there's proper supervision for
therapists learning to use religious tools or help clients deal with religious issues while in their
postdoctoral training. For that reason, specific training programs should be available for
psychologists looking into developing practices that include religious therapies, Doehring says.
Psychologists who do work with clients on religious issues need to be particularly careful of
their personal ideas about religion and the possibility of countertransference problems. They
also need to guide their clients to healthy views of religion in their lives--without allowing
religious practices to get in the way of pursuing traditional markers of psychological
improvement, Doehring says.
And finally, the practice as a whole needs to rely on more than anecdotal treatment
strategies, instead turning to evidence-based practices, she says.
Building the research base
Although anecdotal evidence of the impact of spiritually inclined therapy is strong, most in
the field agree that psychologists must develop both research and theoretical models to
understand the connection between religion and spirituality in practice, says Edward
Shafranske, PhD, a psychology professor at Pepperdine University.
The field has recently reached a point where there's a substantial body of high-quality
literature that discusses the connection between mental health and spirituality, says
Shafranske.
"But until we have good, solid empirical evidence and studies about how to integrate
religion into practice, it may be premature to encourage widespread use," Shafranske says.
Psychologist Kenneth Pargament, PhD, of Bowling Green State University says research
evaluating the efficacy of specific therapeutic techniques, such as forgiveness interventions,
spiritual meditation, rituals and religious coping resources, is under way. Some of the graduate
students he supervises have created spiritual interventions for people who've struggled with
significant problems, including cancer, incest and serious mental illness.
The evidence indicates that the sense of hope, meaning and spiritual support that clients
gain from discussing religious issues and drawing upon spiritual resources helps them cope
better with their situation, Pargament says.
"The research is showing that spiritual dimensions brought into therapy can add something
distinctive to health and well-being," he says. "People ask, 'Is religion just another version of a
healthy social support or a positive system of meaning?' We're finding that there's something
special about the religious dimension that cannot be easily reduced to traditional psychological
constructs."
For example, Pargament cites research done at the University of Minnesota by
psychologists Patricia Frazier, PhD, and Andrew Tix, PhD, that demonstrates that patients
undergoing kidney transplants who turn to God or a higher power for transcendent support had
greater life satisfaction following their surgery, even after taking into account their general
secular coping methods.
Building the expertise
With that growing body of evidence, some in the field are working to develop ways to
teach religious sensitivity and spiritual practice to psychologists.
"Right now, we're not certain we know that most clinicians use religion or spirituality at
all," Shafranske says. "Most do consider it in assessment, but have very little training in how to
do it, what models to use, and there's almost no supervision in it.
"The use of scripture, the use of prayer, is very low--which might be good because very few
are trained," he adds.
Only about 10 percent of new psychology PhDs report moderate to high levels of exposure
to religious sensitivity or guided practices in their training, and most of that goes on at
religiously affiliated training programs at schools like Brigham Young University and the Fuller
Theological Seminary, Shafranske says.
Making sure religious diversity is presented as a key issue in training programs is an
important first step, Shafranske says, and that could, in turn, open doors to postdoctoral
emphasis on using religious techniques in practice.
By incorporating spirituality into therapy, practitioners can add richness and depth to the
treatment of their clients, Pargament says, and it's incumbent upon training programs to at
least teach students an openness to it.
"Some of the most basic questions and problems people face in life have a spiritual
dimension to them," he says. "These kinds of questions can be viewed in purely psychological
terms, but, for many people, they have a profound, existential, spiritual meaning--one that
shouldn't be ignored."
Notes
Richards, P.S., & Bergin, A.E. (Eds.). (2003). Casebook for a spiritual strategy in
counseling and psychotherapy.Washington, DC: American Psychological Association.
Richards, P.S., & Bergin, A.E. (Eds.). (2000). Handbook of psychotherapy and religious
diversity. Washington, DC: American Psychological Association.
Shafranske, E. (Ed.). (1996). Religion and the clinical practice of psychology. Washington,
DC: American Psychological Association.
