Popular Encyclopedia of Christian Counseling

General Editors

Managing Editors George Ohlschlager and Pat Springle

Contributing Editors Ryan Carboneau Joshua Straub Laura Faidley Hitomi Makino

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Popular Encyclopedia of Christian Counseling.indd 1 6/10/11 8:54 AM All Scripture quotations, unless otherwise indicated, are taken from The Holy Bible, New International Version® NIV®. Copyright © 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide. Verses marked nasb are taken from the New American Standard Bible®, © 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977, 1995 by The Lockman Foundation. Used by permission. (www.Lockman.org) Verses marked nlt are taken from the Holy Bible, New Living Translation, copyright © 1996, 2004. Used by permission of Tyndale House Publishers, Inc., Wheaton, IL 60189 USA. All rights reserved. Verses marked nkjv are taken from the New King James Version. Copyright © 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved. Verses marked esv are from The Holy Bible, English Standard Version, copyright © 2001 by Crossway Bibles, a division of Good News Publishers. Used by permission. All rights reserved. Verses marked ncv are taken from The Holy Bible, New Century Version, Copyright © 1987, 1988, 1991 by Word Pub- lishing, Nashville, TN 37214. Used by permission. Verses marked msg are taken from The Message. Copyright © by Eugene H. Peterson 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used by permission of NavPress Publishing Group. Verses marked tlb are taken from The Living Bible, Copyright © 1971. Used by permission of Tyndale House Publish- ers, Inc., Wheaton, IL 60189 USA. All rights reserved. Verses marked amp are taken from The Amplified Bible, Copyright © 1954, 1958, 1962, 1964, 1965, 1987 by The Lock- man Foundation. All rights reserved. Used by permission. (www.Lockman.org) Cover by Koechel Peterson & Associates, Inc., Minneapolis, Minnesota Cover photo © Thomas Northcut / Digital Vision / Thinkstock

THE POPULAR ENCYCLOPEDIA OF CHRISTIAN COUNSELING Copyright © 2011 by Tim Clinton and Ron Hawkins Published by Harvest House Publishers Eugene, Oregon 97402 www.harvesthousepublishers.com Library of Congress Cataloging-in-Publication Data The popular encyclopedia of Christian counseling / Tim Clinton and Ron Hawkins, general editors. p. cm. Includes bibliographical references. ISBN 978-0-7369-4356-7 (hardcover) 1. Counseling—Religious aspects—Christianity—Handbooks, manuals, etc. I. Clinton, Timothy E., 1960- II. Hawkins, Ronald E. BR115.C69P67 2011 253.5—dc22 2011013247 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, digital, photocopy, recording, or any other—except for brief quotations in printed reviews, without the prior permission of the publisher. Printed in the United States of America 11 12 13 14 15 16 17 18 19 / LB-SK / 10 9 8 7 6 5 4 3 2 1

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Popular Encyclopedia of Christian Counseling.indd 2 6/9/11 3:53 PM CONTENTS

Preface ...... 7 Spiritual Support Systems ...... 72 American Association of Christian Part 1: christian counseling Counselors ...... 73 definitions and foundations Advocacy ...... 76 1. Christian Counseling Described Professional Identity and Disclosure . . 78 and Deﬁ ned ...... 11 Christian Counseling ...... 11 Part 2: change in and Process Soul Care ...... 15 of christian counseling Psychotherapy and Values ...... 17 5. Change and Resistance to Change . 83 Psychology of Religion ...... 20 Counselor-Client Relationship . . . . 83 Spirituality in Counseling ...... 22 Change Readiness ...... 84 Christian Psychology ...... 24 Denial ...... 86 Christian Counseling Effi cacy . . . . . 26 Defense Mechanisms ...... 87 2. Th eological Foundations ...... 29 Resistance ...... 90 Doctrine of God ...... 29 Reframing ...... 91 Doctrine of Christ ...... 30 Goal Setting ...... 93 Doctrine of the Holy Spirit ...... 33 6. Assessment, Diagnosis, and Doctrine of Man ...... 35 Treatment Planning ...... 95 Doctrine of Salvation ...... 37 Clinical Assessment ...... 95 Doctrine of the Bible ...... 39 Genograms ...... 99 Doctrine of Sin ...... 40 Interviewing ...... 101 Th eology of Suff ering ...... 42 Psychological Testing ...... 103 Sanctifi cation and Spiritual Growth . . 44 Psychopathology ...... 106 3. Psychosocial Development and Diagnosis of Mental Disorders . . . . . 108 Neurobiology ...... 47 Suicide Assessment and Developmental Psychology ...... 47 Intervention ...... 111 Social Infl uence Th eory ...... 49 Treatment Planning ...... 114 Attachment Th eory ...... 50 7. Interventions ...... 117 Interpersonal Neurobiology ...... 54 Behavioral Interventions ...... 117 Brain Imaging ...... 57 Exposure Th erapy ...... 119 Psychopharmacology ...... 58 Operant Conditioning ...... 120 Antianxiety Drugs ...... 60 Stress Reduction and Relaxation . . . 122 Antidepressant Drugs ...... 62 Schema-Based Interventions ...... 123 Antipsychotic Drugs ...... 64 Family and Systems Interventions . . 125 Psychoactive Drugs ...... 66 Challenging Unbiblical Th inking . . 127 4. Christian Counseling as Ministry Using the Bible in Counseling . . . . . 129 and Profession ...... 69 Client Homework in Counseling . . 131 Lay Counseling ...... 69 Confession and Repentance ...... 132 Spiritual Disciplines ...... 70 Forgiveness ...... 134

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Popular Encyclopedia of Christian Counseling.indd 3 6/9/11 3:53 PM Forgiveness Counseling Session . . 136 Somatoform Disorders . . . . . 212 Inner Healing ...... 138 Bipolar Disorders and Mania . . . 214 Mindfulness ...... 140 Oppositional Defiant Disorder . . 215 Prayer in Counseling ...... 142 Delusional Disorder ...... 217 Worship ...... 144 Dementia and Alzheimer’s . . . . 219 Relational Spirituality and Complex Trauma and Dissociative Transformation ...... 146 Identity Disorder ...... 221 8. Core Skills and Character Traits to Eating Disorders ...... 223 Teach and Strengthen in Clients . 149 Paranoid Schizophrenia . . . . . 227 Assertiveness ...... 149 11. Counseling Personality Disorders . 231 Boundaries ...... 150 Personality Disorders ...... 231 Communication Training . . . . 151 Antisocial Personality Disorder . . 233 Faith ...... 153 Avoidant Personality Disorder . . . 234 Hope ...... 154 Borderline Personality Disorder . . 236 Humility ...... 156 Dependent Personality Disorder . . 238 Social Justice ...... 157 Histrionic Personality Disorder . . 240 Problem Solving and Decision Narcissistic Personality Disorder . . 242 Making ...... 159 Obsessive-Compulsive Personality Responsibility ...... 160 Disorder ...... 243 Restitution ...... 162 Paranoid Personality Disorder . . . 245 Self-Monitoring ...... 163 Self-Efficacy and Generalization . . 164 Part 4: Modes and Applications Resilience ...... 165 of Christian Counseling 12. Group Counseling ...... 249 Part 3: Various Kinds of Disorders Group Counseling ...... 249 9. Counseling Biblical and Small-Group Dynamics . . . . . 251 Spiritual Issues ...... 173 Psychoeducation Groups . . . . 253 Abortion ...... 173 Small-Group Fellowships . . . . 254 Abuse ...... 175 13. Premarital, Marriage, and Family Anger ...... 178 Counseling ...... 257 Bitterness ...... 180 Prepare-Enrich . . . . . 257 Doubt ...... 181 Premarital Counseling . . . . . 259 Shame ...... 183 Love Languages ...... 260 Jealousy ...... 185 Marriage Enrichment and Intimacy . 262 Lust ...... 187 Hope-Focused Marital Therapy . . 265 Self-Esteem and Other Esteem . . 188 Conflict Resolution ...... 267 Sin and Redemption ...... 190 Fidelity and Infidelity ...... 269 Perfectionism ...... 192 Emotional Abuse ...... 271 Legalism ...... 194 Domestic Violence ...... 272 Spiritual Warfare and Deliverance Victimization ...... 275 Ministry—Possession and Aging ...... 276 Oppression ...... 195 Empty-Nest Issues ...... 278 10. Counseling Clinical Disorders . . 199 Retirement Planning ...... 279 Adjustment Disorder ...... 199 14. Separation, Divorce, and Divorce Anxiety Disorders ...... 201 Mediation ...... 281 Gender Identity Disorder . . . . 203 Separation ...... 281 Mood Disorders ...... 205 Divorce ...... 283 Major Depression ...... 208 Children of Divorce ...... 288 Sleep Disorders ...... 211 Reconciliation ...... 292

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Popular Encyclopedia of Christian Counseling.indd 4 6/9/11 3:53 PM Mediation ...... 294 Gambling ...... 384 Divorce Recovery ...... 296 Pornography and Sex Addiction . . 386 15. Sexuality and Sexual Therapy . . . 299 Substance Abuse ...... 388 Sex After 50 ...... 299 19. Grief, Crisis, and Trauma Sexual Intimacy and Delight . . . 301 Intervention ...... 393 Sexual Abuse ...... 303 Grief ...... 393 Sexual Desire Disorders . . . . . 305 Disability ...... 394 Orgasmic Disorder ...... 307 End-of-Life Issues and Death . . . 396 Sexual Pain Disorder ...... 309 Death of a Child ...... 398 Paraphilias and Sexual Deviance . . 313 Crisis Intervention ...... 399 Pedophilia ...... 316 Combat Trauma ...... 402 Sexually Transmitted Diseases . . . 317 Posttraumatic Stress Disorder . . . 404 Sexual Therapy ...... 319 Traumatic Memory ...... 406 Sensate Focus ...... 321 DEC-R Sexual Coaching . . . . 323 Part 5: Counselor Skills, Sexual and Gender Identity . . . 325 Theories, and Therapies Homosexuality ...... 327 20. Core Skills and Concepts for Homosexuals Seeking Change . . 329 Christian Helpers ...... 413 Sexual-Identity Therapy . . . . . 332 Helping Relationships ...... 413 HIV/AIDS Counseling . . . . . 334 Therapeutic Alliance ...... 414 16. Families and Family Therapy . . . 337 Counseling Skills ...... 416 Family-of-Origin Issues in Blended Core Skills Families ...... 337 Compassion and Empathy . . . . 418 Blended Families ...... 338 Genuineness ...... 419 Generational Transmission . . . . 340 Respect ...... 421 Blessings ...... 342 Individuation ...... 343 Intermediate Skills Identified Patient ...... 345 Nonverbal Communication . . . 423 Triangulation ...... 346 Attending Skills ...... 423 Double Bind ...... 347 Reflecting Skills ...... 424 Modeling ...... 426 17. Child and Adolescent Issues . . . 349 Open-Ended Questions . . . . . 428 Childhood Development . . . . 349 Visualization ...... 429 Childhood Maturation . . . . . 351 Role Playing ...... 430 Moral Development ...... 353 Identity Formation ...... 354 Advanced Skills Developmental Disorders . . . . 357 Immediacy ...... 431 Intellectual Disabilities . . . . . 360 Self-Disclosure ...... 432 Conduct Disorder ...... 362 Transference and Impulse Control Disorders . . . . 363 Countertransference . . . . . 434 Attention-Deficit/Hyperactivity Silence ...... 436 Disorder (ADHD) ...... 366 Motivational Interviewing . . . . 437 Child Abuse ...... 369 Expertness ...... 438 Play Therapy ...... 371 Psychodrama ...... 440 18. Substance Abuse and Behavioral 21. Counseling Theories and Therapies . 443 Addictions ...... 375 Psychodynamic Theory . . . . . 443 Addiction ...... 375 Adlerian Therapy ...... 445 Addictions Counseling . . . . . 377 Existential Counseling . . . . . 447 12-Step Programs ...... 380 Logotherapy ...... 449 Dual Diagnosis ...... 381 Rogerian Therapy ...... 451

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Popular Encyclopedia of Christian Counseling.indd 5 6/9/11 3:53 PM Reality Therapy ...... 452 24. Ethical and Legal Counseling Integrationist Perspective . . . . 454 Issues ...... 513 Cognitive-Behavioral Therapy . . 455 Accountability ...... 513 Dialectical Behavior Therapy . . . 458 Confidentiality and Exceptions . . 514 Narrative Therapy ...... 460 Documentation and Records . . . 516 General-Systems Theory . . . . . 461 Dual Relationships (Ethics) . . . 519 Emotion-Focused Therapy . . . . 462 Informed Consent ...... 520 Interpersonal Psychotherapy . . . 465 Legal Issues in Counseling . . . . 522 EMDR Practice ...... 466 Consultation and Referral . . . . 525 Eclecticism ...... 468 Termination ...... 527 Thinking/Feeling/Acting Paradigm . 471 Compassion Fatigue, Burnout, Multimodal Therapy ...... 472 and Self-Care ...... 529 Theoretical Integration . . . . . 474 25. Education, Supervision, and Career Counseling ...... 475 Research ...... 533 School Counseling ...... 477 Counselor Education ...... 533 Gerontological Counseling . . . . 479 Continuing Education . . . . . 534 22. Christian Cognitive and Supervision ...... 536 Strength-Based Therapy . . . . . 481 Effectiveness of Psychotherapy . . 538 Christian Cognitive Therapy . . . 481 Evaluation in Counseling . . . . 539 Core Beliefs and Schemas . . . . 483 Empirically Supported Treatments . 541 Self-Talk ...... 485 Meta-Analysis and Theory . . . . 543 Emotional Reasoning ...... 486 Outcome Research ...... 545 Renewing Your Mind ...... 488 Qualitative Research ...... 546 Brief Therapy ...... 489 Quantitative Research ...... 548 Solution-Focused Counseling . . . 491 26. New Developments in Christian Strength-Based Counseling . . . . 493 Counseling ...... 551 TRUTH Model of Counseling . . 495 Coaching ...... 551 Cognitive Change Techniques . . 497 Cyber-Counseling ...... 552 Part 6: Systemic and Ethical Forensic Psychology ...... 554 Issues, Education, and Research Leadership and Organizational Psychology ...... 557 23. Multiculturalism, Diversity, and Positive Psychology and Human Other Challenging Issues . . . . 501 Flourishing ...... 559 Assimilation and Acculturation . . 501 Managed Care ...... 562 Cultural Competence and Minority Groups ...... 503 Contributors ...... 565 Ethnicity ...... 505 Alphabetized Index of Articles . . . 571 Multicultural Counseling . . . . 507 Racial Identity ...... 509

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CHRISTIAN COUNSELING DESCRIBED AND DEFINED

christian counseling abilities, skills, training, knowledge, and insights Christian counseling is a worldwide enterprise—a ministry-profession that is • to the task of helping others move maturing in complexity and in membership. to personal wholeness, interpersonal It consists of professional clinicians, pasto- competence, mental stability, and ral counselors, and many others who deliver spiritual maturity (Collins, 1993, counseling and care-giving services to a wide p. 21). range of clients from a distinctively Chris- tian worldview. It is a triadic form of coun- Another pioneer, Larry Crabb (1977), seling that implicitly or explicitly honors argued that the goal of Christian counsel- Jesus Christ and believes the Holy Spirit is ing should not be to make clients happy, but always present in the counseling relationship to promote Christian maturity (both spiri- with the counselor and the client. Chris- tual and psychological) and to “free people tian counseling has many goals, including to better worship and serve God by helping helping people deal with severe losses, con- them become more like the Lord” (p. 20). fl icts, and disorders, but it has one ultimate He suggested that eff ective counseling needs concern: helping clients become more like both “a caring relationship and an under- Christ and grow into a deeper intimacy with standing of human functioning” (p. 14) and God and with one another. that counseling insights and skills should be fi lled with Christ’s love. Definitions and Purposes. Christian Everett Worthington (1999) off ered counseling has grown into a “big tent” that this careful, cryptic, and comprehensive encompasses a wide range of defi nitions and defi nition: practices. A pioneer Christian counselor, Gary Collins (1993), found that… Christian counseling is an explicit or implicit agreement for the provision of attempts to defi ne or describe Chris- help for a client, in which the counselor tian counseling tend to emphasize the has at heart the client’s psychological person who does the helping, the tech- welfare, but also the client’s Christian niques or skills that are used, and the spiritual welfare and tries to promote goals that counseling seeks to reach. those goals through counseling meth- From that perspective the Christian ods, and the client can trust the coun- counselor is: selor not to harm and to try to help the client psychologically and spiritually • a deeply committed, spirit-guided (Worthington, 1999, p. 189). (and Spirit-fi lled) servant of Jesus Christ In Competant Christian Counseling (Clin- • who applies his or her God-given ton & Ohlschlager, 2002), we wrote that:

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we propose…a Paracentric focus that… biblical-clinical process that facilitates melds two crucial aspects of Christian case-wise client sanctification. It is built counseling…. Our yieldedness to the on the sure foundation of Scripture, Paraklete of God—the Holy Spirit— dependent on the inspired leading of who is the invisible God present in the Holy Spirit, and selectively using the counseling…[and our commitment] best of helping ministry resources and to Paraklesis…to “come alongside the bio-psycho-social sciences (Clinton someone to help.” These terms describe & Ohlschlager, 2002, pp. 50-51). Spirit-directed and Christ-centered people committed to assisting others The revised edition of Psychology and across a wide range of needs, from con- Christianity (Johnson, 2010) has five core solation to encouragement to confron- paradigms through which to view the con- tation…. A Paracentric focus represents tent and process of Christian counseling, up a centered convergence in Christ as our from the four views of the original edition. exalted model, and on the client as the clinical and ethical object of our minis- • The biblical counseling model holds that try. This focus…conveys the full arc of the Bible alone is the source of all wis- the helping process… dom and revelation in counseling, and • The competent Christian counselor, any reliance on psychology or extra- yielded to an active, holy, and merci- biblical resources has a high likelihood ful God (1 Corinthians 1:18), meets of tainting the counseling endeavor. the client at his or her point of need • The levels-of-explanation model holds (diverging and becoming all things that Christian religion and psychol- to all people [1 Corinthians 9:19, ogy are two different fields that are 2]), and connects with the client to create a working alliance. best left and approached as they are, without any mixing. • This activity includes comfort- ing the brokenhearted, supporting • The integration model attempts to syn- the weak, encouraging the dis- thesize psychology and theology with couraged, exhorting those who are the Bible as the controlling source. motivated, entreating and guid- Any psychology in contravention of ing the misdirected, and warning the Bible is rejected as unacceptable the rebel and sinner (the full scope for integration. of Spirit-led counselor behavior is described in 1 Thessalonians 5:14 • The Christian psychology model asserts and 2 Corinthians 1:3-7). that psychology from every era and history is worthy of study, especially • The counselor serves to refocus, facil- that done by church leaders and itate, instruct, and reinforce client saints from throughout history. action toward growing up into maturity (Ephesians 4:12-16) and living • The newest model, the transformative in more intimate relationship (John worldview, conceives of doing psy- 17:9-13) with the divine object of chology and theology in an embodied our faith, Jesus Christ. This involves redemption, in the power of the Holy de-centering ourselves (Lamenta- Spirit. Sanctified scientists make a huge tions 3:20-24) and converging or difference in the doing of psychology. centering on the Author and Finisher of our faith (Hebrews 12:2). Possibly the best one-sentence description Christian counseling must be a of Christian counseling was given recently

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by Siang-Yang Tan (2011, p. 363), empha- nouthetic counseling, and Gary Collins’ sizing the role and work of the Holy Spirit: Helping People Grow (1980) and Case Stud- “Christian counseling or psychotherapy can ies in Christian Counseling (1991). After be simply described as counseling conducted evaluating the various theories and their by a Christian who is Christ-centered, bibli- construction, Worthington notes, “the chal- cally based, and Spirit filled” (p. 363). lenge before our profession [is] to fashion a truly integrated set of Christian counseling Theory-Building and Research. theories, supported by Scripture, experience, Everett Worthington (1993) has analyzed and research” (1993, p. 33). Recent devel- Christian counseling theory building from opments, such as Mark McMinn and Clark three distinct conceptualizations. Campbell’s (2007) social cognitive the- Academic and research-based theories. Beut- ory and Siang-Yang Tan’s (2011) Christian ler and Bergan (1991) have shown not only counseling development reflect Worthing- the value-laden nature of psychotherapy but ton’s concern and integrate Scripture, the- also how values similarity influences client ory, experiences, and science. identification with a counselor, and how values differences (faith-based vs. secular Current Status. Currently, many levels of approaches) impact counseling outcomes. care can be given to clients based on the pro- Worthington (1988) suggested three dimen- fessional proficiency of the helper. sions of values (i.e., the role of authority of human leaders, Scripture or doctrine, and • Professional counselors and clinicians religious group norms) essential in working are licensed professionals across the with religiously committed clients. Allen disciplines of psychology, social work, Bergin (1980) identified and contrasted mental-health counseling, marriage theistic values with nonreligious clinical and and family therapy, and the two medi- humanistic values. cal disciplines, psychiatry and nursing. Religious versions of secular theories. The • Pastoral and biblical counselors work many adaptations of secular models revealed largely in the church. the strong reliance of cognitive therapies transformed into sources of “renewing the • Recovery counselors work largely in the mind.” These included counseling models by addictions field. Larry Crabb (1977), Robert McGee (1990), • Lay and peer counselors also work Norm Wright (1981), Everett Worthington mostly in the church. (1989), and Bill Backus (1985). Also noted were eclectic attempts at integration, such In Caring for People God’s Way (Clinton, as models by Smith (1990) and the leaders Hart, & Ohlschlager, 2005), we outlined of the Minirth-Meier Clinic in their heyday seven synthesizing traits that we believe (Minirth, Meier, & Wichern, 1982). Jones anchor most of what is done in Christian and Buttman’s (1991) analysis of secular the- counseling today. ories from a Christian worldview is also an 1. Scripturally anchored. True Christian important contribution. counseling is as dependent on Scrip- Specifically religious theories. Some the- ture as people are on food and water ories have been developed superficially to live. The Scriptures are, in fact, the as Christian approaches. These theories food and water of spiritual life. are represented by Paul Tournier’s (1965) The Healing of Persons, Charles Solomon’s 2. Spiritual forming. Christian counsel- (1977) spirituotherapy, Jay Adam’s (1973) ors are called to help form the Spirit

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of God into the lives of those who • Assessment. Assessment also begins come to us for help. from the first meeting, a flexible process of detailing both problems and 3. Short-term (initially). Nearly all cli- strengths to define where the client is ents terminate counseling in six to now and where she or he wants to go ten sessions. Brief therapy is man- when counseling is done. datory for all clients, but long-term therapy is discretionary, chosen by • Gaining insight. Clients must be able those who want it and can afford it. to make connections that have not yet been made that increase their under- 4. Solution-focused. Solution-focused standing of why they are where they therapy arose as did brief therapy, are and what must be done to get with counselor and clients looking for where they want to go. solutions that have worked before and work partially on the client’s behalf. • Yielding to God’s healing touch. As with salvation and every step of 5. Strength-based. Intimate sibling to growth and sanctification, all heal- solution-focused and brief forms of ing is the gracious work of God in therapy, strength-based assessment Christ through the power of the Holy involves searching for and magnify- Spirit. All that is required of us is that ing client strengths, which, as they we yield in faith, believing that God grow stronger, crowd out any room will do a good and godly work within. for problems to fester and grow. • Active change (brief therapy for all). Inter- 6. Storied narratives. Human beings ventions that facilitate active changes in live by stories, tell about their lives thinking and behavior—in pursuit of in stories, and relate to God and oth- at least one agreed goal—are the objec- ers primarily in storied forms. God tives of brief therapy for everyone. A reveals himself to us primarily in the strength-based approach involves way of a grand story of creation-Fall- strengthening what the client is already redemption that cycles over and over doing partially or has done before. throughout history. Therapy at its best is a lived narrative. • Transformative change (long-term therapy for some). Some clients will pur- 7. Scientific. In a scientific world, all sue longer-term goals of deep spiritual truth claims are submitted to the rig- and character change, either by con- ors of the empirical way. Christian tinuing in long-term therapy or by counseling must do the same and has engaging a coach or mentor. nothing to fear by doing so. • Counseling as discipleship. We recog- We then noted the seven stages through nize Christian counseling as an inten- which the Christian counseling process sive form of case-based discipleship. passes from beginning to end. The pursuit of spiritual maturity in • Intake. The therapeutic alliance begins Christ shows that the goals of disci- with the first handshake, so it is pleship and Christian counseling are important to instill hope and inspire synonymous. confidence in the client, who usually Tim Clinton has voices inside telling him or her to Ron Hawkins turn and run. George Ohlschlager

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to Psychology and Counseling: Christian Perspectives References and Applications. Grand Rapids, MI: Baker.

Adams, J. E. (1970). Competent to Counsel: Introduc- Ohlschlager, G., & Mosgofian, P. (1992). Law for the tion to Nouthetic Counseling. Grand Rapids, MI: Christian Counselor. A Guidebook for Clinicians and Zondervan. Pastors. Dallas, TX: Word Books.

Adams, J. E. (1973). The Christian Counselor’s Manual. Pargament, K. I. (2007). Spiritually Integrated Psycho- Nutley, NJ: Presbyterian and Reformed. therapy: Understanding and Addressing the Sacred. New York, NY: Guilford Press. American Association of Christian Counselors. (2004). Powlison, D. (1997). Critical issues in biblical counseling. AACC Christian Counseling Code of Ethics. Forest, In D. Powlison (Ed.), Counseling the Word: A Selec- VA: Author. tion of Readings from the Journal of Biblical Counsel- Backus, W. (1985). Telling Truth to the Troubled People. ing. Glenside, PA: Christian Counseling and Education Minneapolis, MN: Bethany House. Foundation.

Bergin, A. E. (1980). Psychotherapy and religious val- Richards, P. S., & Bergin, A. E. (2005). A Spiritual Strat- ues. Journal of Consulting and Clinical Psychology, egy for Counseling and Psychotherapy. Washington, 48, 95-105. DC: American Psychological Association.

Beutler, L., & Bergan, J. (1991). Value change in coun- Smith, D. (1990). Integrative Therapy: A Comprehensive seling and psychotherapy: A search for scientific cred- Approach to the Methods and Principles of Counsel- ibility. Journal of Counseling Psychology, 38, 16-24. ing and Psychotherapy. Grand Rapids, MI: Baker.

Clinton, T., Hart, A., & Ohlschlager, G. (2005). Caring for Solomon, C. (1977). Counseling with the Mind of Christ. People God’s Way: Personal and Emotional Issues, Old Tappan, NJ: Revell. Addictions, Grief, and Trauma. Nashville, TN: Thomas Sweet, L. (1999). Soul Tsunami: Sink or Swim in Nelson. the New Millennium Culture. Grand Rapids, MI: Clinton, T., & Ohlschlager, G. (1997). Law, Ethics, and Zondervan. Values in Christian Counseling: Practice and Advo- Tan, S.-Y. (2011). Counseling and Psychotherapy: A Chris- cacy in a Brave New World. Presentation at the tian Perspective. Grand Rapids, MI: Baker Books. 1997 World Conference on Christian Counseling, Dallas, TX. Tournier, P. (1965). The Healing of Persons. New York, NY: Harper & Row. Clinton, T., & Ohlschlager, G. (2002). Competent Chris- tian Counseling: Foundations and Practice of Compas- Worthington, E. L., Jr. (1988). Understanding the val- sionate Soul Care. Colorado Springs, CO: WaterBrook ues of religious clients: A model and its application Press. to counseling. Journal of Counseling Psychology, 35, Collins, G. R. (1980). Practical Approaches to Christian 166-174. Counseling. Santa Ana, CA: Vision House. Worthington, E. L., Jr. (1989). Marriage Counseling: A Collins, G. R. (1991). Case Studies in Christian Counsel- Christian Approach for Counseling Couples. Down- ing. Dallas, TX: Word. ers Grove, IL: InterVarsity.

Collins, G. R. (1993). The Biblical Basis of Christian Worthington, E. (Ed.). (1993). Psychotherapy and Reli- Counseling for People Helpers. Colorado Springs, gious Values. Grand Rapids, MI: Baker Books. CO: NavPress. Worthington, E. L., Jr. (1999). Christian counseling and Crabb, L. (1977). Effective Biblical Counseling. Grand psychotherapy. In D. Benner & P. Hill (Eds.), Baker Rapids, MI: Zondervan. Encyclopedia of Psychology and Counseling (2nd ed.). Grand Rapids, MI: Baker Books. Croucher, R. (1991). Spritual formation. Grid (A Publica- tion of World Vision Australia), 1(2). Wright, H. N. (1981). Marital Counseling: A Biblical, Hawkins, R., & Clinton, T. (2011). The New Christian Behavioral, Cognitive Approach. San Francisco, CA: Counselor: A Fresh Biblical and Transformational Harper and Row. Approach. Eugene, OR: Harvest House Publishers. Johnson, E. L. (2010). Psychology and Christianity: Five Soul Care Views. Downers Grove, IL: InterVarsity Press.

Jones, S. L., & Butman, R. E. (2001). Modern Psycho- Definition. The definition of soul care therapies: A Comprehensive Christian Appraisal. is vast and varied. The word soul is trans- Downers Grove, IL: InterVarsity Press. lated from the Greek word psuche, meaning Koenig, H. G. (2004). Religion, spirituality, and medicine: Research findings and implications for clinical practice. “the breath, breath of life” (Vine, Unger, & Southern Medical Journal, 97, 1194-1200. White, 1996, p. 588). The Latin words for McGee, R. S. (1990). The Search for Significance (2nd the care of souls are cura animarum. Cura ed.). Houston, TX: Rapha. means the “care of” or “cure for,” and ani- McMinn, M. R., & Campbell, C. D. (2007). Integrative Psycotherapy: Toward a Comprehensive Christian marum means “breath, breeze, air, wind.” Approach. Downers Grove, IL: InterVarsity Press. Soul care, according to the strictest sense of Minirth, F., Meier, P., & Wichern, F. (1982). Introduction the words, involves literally caring for and

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curing the very breath that gives us life. It are not involved in small groups that meet is tending to the deepest needs of the soul. for spiritual purposes.

History. The Bible is filled with examples Counseling and Spiritual Direction. of soul-care ministry (Ex. 3:16; 1 Sam. 3:9; Being both counselor and spiritual direc- 2 Sam. 12:7; Mt. 14:13; Mk. 1:35; Gal. 6:2; tor is an attainable goal. “The boundaries Jas. 5:16). Soul care is originally a monastic between spiritual counseling and mental- concept in which men would teach others health counseling cannot be drawn easily the deep mysteries of God as well as draw or clearly” (Buford, 1997, p. 112). Often, away from their communities and seclude counselors work to help mature people so themselves in solitude. Merton (1960) also that they are free to grow in Christ, and spir- connected soul care to spiritual direction itual directors then are given the challenge of (Demarest, 2003; Imbach, 2007; Johnson, helping persons take on the character and 2007; Nouwen, 2006). the imitation of Christ. Both the counseling According to Merton (1960), the pur- and spiritual direction worlds move along pose of spiritual direction is to dig beneath the same path of spiritual transformation the surface underneath the typical Chris- when they fully expect the Holy Spirit to tian facade and bring people to their inmost intervene and cause supernatural change in truth, the center of their soul, which strives the life of the client (Clinton & Ohlschlager, for the likeness of Christ. Benner (2002) 2002; Moon & Benner, 2004). This process described spiritual direction as a process could be understood as the “transformation whereby “a person seeking help in culti- of the spirit” (Willard, 2002), the divine vating a deeper personal relationship with process of becoming an apprentice of Jesus God meets with another for prayer and (Moon, 2009). conversation that is focused on increasing According to Clebsch & Jaekle (1964), awareness of God in the midst of life expe- soul care involves four primary elements: riences and facilitating surrender to God’s healing, sustaining, reconciling, and guiding. will” (p. 188). The goal of spiritual direc- Many researchers believe the church is to be tion (soul care) is spiritual formation. Row- a spiritual hospital, caring for those hurt- land Croucher speaks of spiritual formation ing and debilitated by mental and spiritual as “the dynamic process whereby the Word disorders (Clinton & Ohlschlager, 2005; of God is applied by the Spirit of God to Crabb, 1999). The church is absolutely crit- the heart and mind of the child of God so ical to the care and solace of those suffering that he or she becomes more like the Son of with problems in this world (Crabb, 2009). God” (1991). Nouwen (2006) defined it as In soul care the triune God and the the capacity to live a spiritually disciplined Christian helper work together to bring the life from our hearts and souls. Foster (2002) sojourner to a deeper level of union and says that the spiritual disciplines of the faith communion with God (Johnson, 2007). are “instruments of human transformation.” Crabb (1999) states that “life is a journey Soul care, however, is not at the top of toward a land we have not yet seen along a many Christians’ lists of things to work path we sometimes cannot find. It is a jour- toward. Research by the Barna Group ney of the soul toward its destiny and its (2001) found that four out of ten “born home” (p. 182). again” Christians do not attend church or read the Bible in a typical week, three out of Application. The apostle Paul’s words in ten say they are not “absolutely committed 2 Corinthians 1:3-4 are instructive here: to the Christian faith,” and seven out of ten “Praise be to the God and Father of our Lord

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Johnson, E. L. (2007). Foundations for Soul Care: A Jesus Christ…who comforts us in all our Christian Psychology Proposal. Downers Grove, IL: troubles, so that we can comfort those in InterVarsity Press. any trouble with the comfort we ourselves Merton, T. (1960). Spiritual Direction and Meditation. Col- receive from God.” Soul care helps conform legeville, MN: The Order of St. Benedict. Moon, G. W. (2009). Apprenticeship with Jesus: Learn- lives to the life of Jesus Christ so they reflect ing to Live Like the Master. Grand Rapids, MI: Baker the image of God (Demarest, 2003; John- Books. son, 2007). All believers are hastened toward Moon, G. W., & Benner, D. G. (2004). Spiritual direction and Christian soul care. In G. W. Moon & D. G. Ben- soul care with the command, “Above all else ner (Eds.), Spiritual Direction and the Care of Souls guard your heart, for everything you do (pp. 11-28). Downers Grove, IL: InterVarsity Press. flows from it” (Proverbs 4:23). Ultimately, Nouwen, H. J. M. (2006). Spiritual Direction: Wisdom for the Long Walks of Faith. New York, NY: Harper the spiritual journey is navigated with the Collins. purpose of accomplishing what is at the Vine, W. E., Unger, M. F., & White, W. (1996). Vine’s heart of Paul’s words in 2 Corinthians—to Complete Expository Dictionary of Old and New Tes- reach out and comfort others with the com- tament Words. Nashville, TN: Nelson. Willard, D. (2002). Renovation of the Heart: Putting fort that we ourselves receive from God. On the Character of Christ. Colorado Springs, CO: Tim Clinton NavPress. Ron Hawkins Psychotherapy and Values Ryan Carboneau Understanding Values. Counseling is a discipline that cannot be separated from its References moral and philosophical roots (Christopher, 1996). One of the most important aspects of Barna Group. (2001). Annual Study Reveals America Is Spiritually Stagnant. Retrieved from www.barna.org becoming a counselor is awareness of one’s

Benner, D. G. (2002). Sacred Companions: The Gift of own values and their influence in the coun- Spiritual Friendship and Direction. Downers Grove, IL: seling process. Counselors’ recognition of InterVarsity Press. their beliefs and values, where they came Buford, R. K. (1997). Consecrated counseling: Reflec- tions on the distinctives of Christian counseling. Jour- from, and why they hold them is crucial to nal of Psychology and Theology, 25(1), 111-122. understanding how those values may or may Clebsch, W. A., & Jaekle, C. R. (1964). Pastoral Care in not be exposed or even imposed on their cli- Historical Perspective. New York, NY: Seabury. ents (Corey, 2008). Whether we realize it or Clinton, T. E. (2005). Introduction to Christian counseling: The 21st century state of the art. In T. Clinton, A. Hart, not, our values impact nearly every facet of & G. Ohlschlager (Eds.), Caring for People God’s Way: the therapeutic process, including intake Personal and Emotional Issues, Addictions, Grief, and Traumas (pp. 3-25). Nashville, TN: Nelson. and assessment, goal setting, problem solv- Clinton, T. E., & Ohlschlager, G. (2002). Competent Chris- ing, therapeutic technique, outcomes, and tian Counseling: Foundations and Practice of Compas- evaluation (Corey; Ellis, 1973). In fact, sionate Soul Care (Vol. 1). New York, NY: WaterBrook. research has shown that clients can and do Crabb, L. J. (1999). Becoming a True Spiritual Commu- nity: A Profound Vision of What the Church Can Be. often assume the values of the counselor Nashville, TN: Thomas Nelson. (Richards, Rector, & Tjeltveit, 1999). Many Crabb, L. J. (2009). Real Church: Does It Exist? Can I authoritative figures in the field of counsel- Find It? Nashville, TN: Nelson. ing have attested that there is no such thing Croucher, R. (1991). Spiritual formation. Grid (a publication of World Vision Australia), 1-2. as values-neutral psychotherapy (Corey; Fal-

Demarest, B. (2003). Soul Guide: Following Jesus as ender & Shafranske, 2004; Jones, 1994; Tan, Spiritual Director. Colorado Springs, CO: NavPress. 2011). To assume that we can enter into the Foster, R. J. (2002). Celebration of Discipline: The Path therapeutic relationship without our val- to Spiritual Growth. New York, NY: HarperCollins. ues influencing the client is presumptu- Imbach, J. D. (2007). The River Within: Loving God, Liv- ing Passionately. Abbotsford, BC, Canada: Fresh Wind ous. Corey (2008) suggests that counselors Press. avoid two extremes regarding values in the

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counseling setting: (a) holding to an abso- explored, respected, and agreed upon, such lute position on a particular value whereby value congruence between therapist and cli- they impose that value onto the client in a ent leads to richer therapeutic outcomes. For forceful or proselytizing manner (for exam- example, several studies showed that the use ple, if a client has decided to get an abortion of Christian cognitive-behavioral therapy and the therapist gets into an ethical debate (with explicit use of Christian beliefs, prayer, with the client about this position and and Scripture) was not only as effective as threatens to end the treatment relationship traditional cognitive-behavioral therapy but if the client does not agree to refrain from also more effective in enhancing clients’ spir- obtaining the abortion); and (b) holding to itual health, which includes a sense of well- a position of values-free counseling, whereby being as it relates to God, life satisfaction, their fear is having too much influence on and life purpose (Tan & Johnson, 2005). clients, thereby rendering themselves inef- fective (e.g. in the above situation the coun- Exposing Versus Imposing Personal selor refuses to discuss values with the client Values. The psychotherapeutic climate and and therefore does not address some of the setting should be characterized by a sense possible negative consequences of abortion). of safety, including unconditional positive regard and respect for clients’ value systems. Religious Values. Research suggests that Within a safe environment, clients can freely both clients and therapists have religious val- express their thoughts, beliefs, feelings, and ues and preferences. For instance, Fouque behaviors without feeling judged or ridi- and Glachan (2000) found that 42% of culed. Effective therapy allows for the pro- people seek help from clergy first for their cessing of these behaviors to be evaluated on emotional problems, showing the desire for the basis of clients’ quality of life. their faith to be addressed when in need. Fur- As a professional counselor, the goal of thermore, according to Hage (2006), two therapy should not be to impose your val- thirds of Americans reported that they prefer ues on clients in an attempt to get them to to be treated by therapists who have spiritual believe what you think is right, but to help beliefs. A majority of therapists also acknowl- them determine whether they are living up edge their religious beliefs and values; for to their own values and whether those beliefs example, 80% of professional therapists (psy- are leading to behaviors that negatively affect chologists and psychiatrists excluded) claim their lives and relationships with others. a religious preference, and 77% “try to live Helping clients discern these behaviors based according to their religious beliefs” (Bergin on their own value systems may require them & Jensen, 1990). While the numbers for psy- to reevaluate their core beliefs. Clients can chiatrists and psychologists are lower, these define and refine their value systems, choose statistics on therapists is encouraging, for it their own actions, and then evaluate those seems to meet many clients’ desire for faith- actions based on their therapeutic goals. Psy- based or spiritual psychotherapies. chotherapists will inevitably expose their values based on their own theoretical approaches, The Significance of Congruence. Even goals for therapy, and evaluation of the cli- when the client identifies himself or herself ent’s progress, but they must remain aware of as having the same religious background or their value system so as not to impose their denomination as the therapist, the thera- values on the client (Corey, 2008; Tan, 2011). pist should not assume that their beliefs are exactly the same (Bergin & Jensen, 1990). Client Right to Self-Determination. However, when these values and beliefs are As mentioned, it is unrealistic to think that

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a counselor-client relationship can be val- gay-affirming therapist, the preferred ethic ues-neutral. Richards and Bergin’s (1997) is to refer the client to a competent profes- suggestion regarding the ethical principles sional counselor who will affirm the desires of values in counseling is applicable. For and religious beliefs of the client. instance, the counselor should respect the A great deal of controversy related to client’s right to self-determination in the these issues has been raised recently with counseling process when it comes to spiri- the expulsion of two graduate counseling tuality and religious values, even if the client students who had a conflict of values with and counselor hold to different faith back- the practice of same-sex behavior. (For more grounds. If a client’s choices and behaviors information on these cases, refer to links in are valuably different, it is an ethical viola- reference section.) Leading experts (Corey, tion to condemn, judge, or punish the client 2008; Richards & Bergin, 1997; Tan, 2011) for those choices. Those choices can be dis- believe that when values conflicts are clearly cussed as they relate to the client’s presenting found in therapeutic relationships, com- problems and impact on therapeutic goals, petent referrals should be made to men- but if they ever cross a point whereby the tal-health professionals who can better help therapeutic relationship is negatively affected the clients reach their goals. This same stan- as a result, the counselor and client must dard is upheld by the American Counseling begin discussing the possibility of referral to Association code of ethics in Section A.11.b., another counselor. Only when the client is Inability to Assist Clients: interested in pursuing spiritual, religious, or If counselors determine an inability related interventions and informed consent to be of professional assistance to cli- is provided should a counselor utilize these ents, they avoid entering or continuing interventions in professional psychotherapy. counseling relationships. Counselors are knowledgeable about culturally and Value Conflicts: Protocol and Pro- clinically appropriate referral resources cedure. Counselors and clients need to and suggest these alternatives. If clients understand and respect clients’ rights. For decline the suggested referrals, counsel- instance, if you are a professional Chris- ors should discontinue the relationship. tian counselor and a Muslim client comes in to seek help for an issue related primarily This ethical standard is consistent with to his Islamic faith, it would behoove you the American Association of Christian to refer that client to a Muslim therapist Counselors code of ethics found in section who can address his faith issues more effec- I-222 Referral Practice: tively than you can. There has been considerable debate on Referral shall be made in situations this issue, especially as it pertains to seeing where client need is beyond the coun- clients who value living a homosexual life- selor’s ability or scope of practice or style. Counselors with faith backgrounds when consultation is inappropriate, unavailable, or unsuccessful. Refer- who feel conflicted about counseling people rals should be done only after the cli- living a gay lifestyle are ethically responsible ent is provided with informed choices to refer to professional counselors who can among referral sources. As much as pos- best help those clients obtain their goals in sible, counselors referred to shall honor therapy. Conversely, if a Christian client is prior commitments between client and conflicted over same-sex behavior and wants referring counselor or church. to lead a celibate heterosexual lifestyle that conflicts with the beliefs and practices of a Such professional behavior demonstrates

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a clear respect of client self-determination References Regarding the Dis- and honors our freedom to worship God missal of Counseling Students and embrace our faith of choice within the Schmidt, P. (2010, July 27). Federal judge upholds mental-health profession. dismissal of counseling student who balked at treating gay clients. The Chronicle of Higher Edu- Tim Clinton cation. Retrieved from http://chronicle.com/article/ Joshua Straub Judge-Upholds-Dismissal-of/123704/ Schmidt, P. (2010, July 22). Augusta State U. is Gary Sibey accused of requiring a counseling student to accept homosexuality. The Chronicle of Higher Educa- tion. Retrieved from http://chronicle.com/article/ Augusta-State-U-Is-Accused-of/123650/ References Psychology of Religion American Association of Christian Counselors. (2004). AACC Christian Counseling Code of Ethics. Retrieved Description. The psychology of religion from http://www.aacc.net/about-us/code-of-ethics/ is the study of religious traditions and prac- American Counseling Association (2005). ACA Code of Ethics. Retrieved from http://www.counseling.org/ tices and people’s beliefs through the lenses Resources/CodeOfEthics/TP/Home/CT2.aspx of psychological approaches and interpre- Bergin, A. E., & Jensen, J. P. (1990). Religiosity of psy- tation. The psychological study of religion chotherapists: A national survey. Psychotherapy, 27(1), pp. 3-7. concerns itself with three primary tasks:

Christopher, J. C. (1996). Counseling’s inescapable moral visions. Journal of Counseling & Development, • defining the terms, observances, ritu- 75 (1), 17-25. als, and individual experiences related Corey, G. (2008). Theory and Practice of Counseling and to religion, beginning with the very Psychotherapy. Belmont, CA: Thomson Brooks/Cole. word religion itself Ellis, A. (1973). Humanistic Psychotherapy. New York, NY: McGraw-Hill. • explaining from a psychological per- Falender, C. A., & Shafranske, E. P. (2004). Clinical Super- spective why religion and its related vision: A Competency-Based Approach. Washington, DC: American Psychological Association. observances and experiences came to prominence in society Fouque, P., & Glachan, M. (2000). The impact of Chris- tian counseling on survivors of sexual abuse. Coun- seling Psychology Quarterly, 13, 201-220. • describing the positive and negative

Hage, S. (2006). A closer look at spirituality in psy- outcomes of religious practices on chology training programs. Professional Psy- individuals and the community and chology: Research and Practice, 37(3), 303-310. doi:10.1037/0735-7028.37.3.303. culture at large (Wulff, 2010).

Jones, S. L. (1994). A constructive relationship for religion with the science and profession of psychology: Confusion of Terms. A primary con- Perhaps the boldest model yet. American Psycholo- gist, 49(3), 184-199. cern in the psychology of religion is the

Richards, P. S., & Bergin, A. E. (1997). A Spiritual Strat- difficulty defining the term religion and egy for Counseling and Psychotherapy. Washington, differentiating it from the term spirituality DC: American Psychological Association. (Schlehofer, Omoto, & Adelman, 2008). Richards, P. S., Rector, J. M., & Tjeltveit, A. C. (1999). Values, spirituality, and psychotherapy. In W. R. Miller Part of the problem includes the way the (Ed.), Integrating Spirituality in Treatment: Resources term religion has changed in its defini- for Practitioners (pp.133-160). Washington, DC: American Psychological Association. tion and practice over the course of cen- turies (Smith, 1963). In recent years, the Tan, S.-Y. (2011). Counseling and Psychotherapy: A Chris- tian Perspective. Grand Rapids, MI: Baker Books. term spirituality has risen to prominence

Tan, S.-Y., & Johnson, W. B. (2005). Spiritually oriented to describe people’s experience in light of cognitive-behavioral therapy. In S. Len. & E. P. Shaf- a postmodern culture. Therefore, the need ranske (Eds.), Spiritually Oriented Psychotherapy (pp. 77-103). Washington, DC: American Psycholog- to develop and use objective measures to ical Association. doi:10.1037/10886-004 determine empirical validation of these

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religious phenomena cannot be underesti- an attachment process; later studies by Kirk- mated (Hill, 2005). patrick and another researcher named Pehr Granqvist (2005) have supported the idea Early Proponents. William James, known of God as an attachment figure. Since these as the father of psychology, is one of many findings, Richard Beck and Angie McDon- writers in the field to describe the extent to ald (2004) developed the Attachment to which religion can help people function God Inventory to empirically document the more effectively throughout life because of way one relates to God. the security and confidence it provides. Sig- The major studies presently taking mund Freud (1927/1961) also saw religion place in the psychology of religion pri- as a place of security and comfort for believ- marily involve religious coping strategies ers. Freud’s value-laden theoretical approach, (Pargament, 1997) and God attachment however, used terminology such as regression (Kirkpatrick, 1992; Granqvist, 2005). In and dependence to negatively characterize a recent studies in the psychology of religion, believer’s relationship with God. researchers have found that in times of dis- Carl Jung had more appreciation of reli- tress, people of faith seek proximity to God gion than did Freud. He put more weight on in ways similar to those in which an infant the individual experience of religious symbols seeks closeness to the caregiver (Kirkpat- and believed a psychologist could not resolve rick, 1999). Kirkpatrick argues that even the issue of God (Jung, 1969). Alfred Adler the imagery and language used in the Judeo- theorized that people primarily seek to over- Christian faith is representative of attach- come a sense of inferiority. He saw religion ment relationships. Coping with distress in as a way of people overcoming their inferi- life is much easier when Christians speak of ority by desiring to become unified with a Jesus being by our side, holding our hand, more superior, perfect God. In The Individ- or holding us in his arms (Kirkpatrick & ual and His Religion (1950), Gordon All- Shaver, 1990, p. 319). port described how people use their religion Prayer is a second way people turn to in both mature and immature ways. Erich God (Spilka, Hood, Hunsberger, & Gor- Fromm, in his work Psychoanalysis and Reli- such, 2003). Research supports the claim gion (1950), wrote a response to Freud’s the- that people seek God as a safe haven during ories in an attempt to explain that religious times of stress (Granqvist, 2005). Other stud- devotion had less to do with a sexual motiva- ies have shown that higher religious com- tion than with a motivation to remain close mitment and intrinsic religious orientation to a stable and protective parental figure. are positively correlated with more active problem-solving skills (Pargament, Steele, Contemporary Proponents. Research- & Tyler, 1979), a sense of internal locus of ers such as Allen Bergin, Robert Emmons, control (Kahoe, 1974; Strickland & Shaffer, and James Hillman are key contemporary 1971), a sense of personal competence (Ven- contributors to the psychology of religion. tis, 1995), and a more optimistic and hope- Kenneth Pargament (1997) has also been a ful outlook on the future (Myers, 1992). As a key researcher in the past few years on devel- whole, attachment to God seems to increase oping measures to study religious coping a person’s ability to handle both present and strategies. In conjunction with Pargament, future challenges (Sim & Loh, 2003). attachment theorists have recently taken Joshua Straub John Bowlby’s approach to describe God as an attachment figure. Lee Kirkpatrick (1992, 1999) first conceptualized religion as

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Smith, W. C. (1963). The Meaning and End of Religion: References A New Approach to the Religious Traditions of Man- kind. New York, NY: Macmillan. Allport, G. (1950). The Individual and His Religion. New York, NY: MacMillan. Spilka, B., Hood, R. W., Jr., Hunsberger, B., & Gorsuch, R. (2003). The Psychology of Religion: An Empirical Beck, R., & McDonald, A. (2004). Attachment to God: Approach (3rd ed.). New York, NY: Guilford Press. The attachment to God inventory, tests of working model correspondence, and an exploration of faith Strickland, B. R, & Shaffer, S. (1971). I-E, I-E, and F. Jour- group differences. Journal of Psychology and Theol- nal for the Scientific Study of Religion, 10, 366-369. ogy, 32, 92-103. Ventis, W. L. (1995). The relationships between religion Emmons, Robert A. (1999). The Psychology of Ultimate and mental health. Journal of Social Issues, 51, (2), Concerns: Motivation and Spirituality in Personality. 33-48. New York, NY: Guilford. Wulff, D. M. (2010). Psychology of religion. In D. A. Freud, S. (1927/1961). The Future of an Illusion (J. Leeming, K. Madden, & S. Marian (Eds.), Encyclope- Strachey, Trans.). New York, NY: Norton. dia of Psychology and Religion (pp. 732-735). New York, NY: Springer. Fromm, E. (1950). Psychoanalysis and Religion. New Haven, CT: Yale University Press.

Granqvist, P. (2005). Building a bridge between attach- Spirituality in Counseling ment and religious coping: Tests of moderators and mediators. Mental Health, Religion & Culture, 8(1), Currently, spirituality is vying for recogni- 35-47. tion as the “fifth force” in counseling. Until Hill, P. C. (2005). Measurement in the psychology of reli- recently, however, spirituality was neglected gion and spirituality: Current status and evaluation. In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the as a legitimate domain of client inquiry in Psychology of Religion and Spirituality. New York, NY: professional counseling. This rapid transition Guilford Press. from outcast to important treatment consid- Jung, C. G. (1969). On the Nature of the Psyche. Prince ton, NJ: Princeton University Press. eration has caught some clinicians unaware.

Jung, C. G., Hull, R. F., & Adler, G. (1969). On the Nature We need a clear definition of Christian spiri- of the Psyche (C.W.8, Aphorisms 362, 420). Princeton, tuality, information to contrast the religiosity NJ: Princeton University Press. of the public and of mental-health profes- Kahoe, R. D. (1974). Personality and achievement cor- relates of intrinsic and extrinsic religious orienta- sionals, and an understanding of the ethical tions. Journal of Personality and Social Psychology, and empirical support for the inclusion of 29, 812-818. spirituality in counseling. Kirkpatrick, L. A. (1992). An attachment-theoretical approach to the psychology of religion. International Journal for the Psychology of Religion, 2(1), 3-28. Spirituality Defined. The counseling lit- Kirkpatrick, L. A. (1999). Toward an evolutionary psychol- erature continues to debate the specific defini- ogy of religion and personality. Journal of Personal- tion of spirituality, often separating spirituality ity, 67, 921-952. and religion as constructs (Aten & Leach, Kirkpatrick, L. A., & Shaver, P. R. (1990). Attachment theory and religion: Childhood attachments, religious 2009). For Christians, however, these con- beliefs, and conversion. Journal for the Scientific cepts are intertwined. Christian spirituality Study of Religion, 29, 315-334. focuses on cultivating an intimate relationship Myers, D. G. (1992). The Pursuit of Happiness. New York, NY: Morrow. with Jesus Christ that progressively transforms Pargament, K. I. (1997). The Psychology of Religion and one’s values, sense of purpose, beliefs, and life- Coping: Theory, Research, Practice. New York, NY: style in the context of a faith community. Guilford Press. Pargament, K. I., Steele, R. E., & Tyler, F. B. (1979). Reli- gious participation, religious motivation, and individ- Contrasts in Faith Characteristics. ual psychosocial competence. Journal for Scientific Gallup polls consistently find more than Study of Religion, 18, 412-419. 90% of U.S. citizens believe there is a God, Schlehofer, M. M., Omoto, A. M., & Adelman, J. R. (2008). How do “religion” and “spirituality” differ? more than 80% try to live according to their Lay definitions among older adults. Journal for the faith, and about 85% self-identify as Chris- Scientific Study of Religion, 47, 411-425. tians. These percentages suggest that the Sim, T. N., & Loh, B. S. M. (2003). Attachment to God: Measurement and dynamics. Journal of Social and majority of clients coming to therapy will Personal Relationships, 20, 373-389. have a spiritual perspective.

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The statistics for mental-health profes- in therapy rather than having to bring it up sionals differ substantially. For example, Del- themselves (Weld & Eriksen, 2007). aney, Miller, and Bosonó (2007) found that only 46% of clinical psychologists identi- Spiritual Assessment and Interven- fied themselves as Christian, 38% endorsed tions in Counseling. The cited empirical other religions, and 16% stated they were evidence supports including faith in treat- agnostic, atheists, or had no religious faith. ment; however, therapists who misjudge a Such contrasting views highlight the com- client’s spirituality or impose their values on plexity of ethically incorporating spiritual- clients jeopardize the therapeutic relation- ity in therapy. ship. Consequently, careful assessment and informed consent are needed before incor- Ethical Support for Spirituality in porating spirituality in therapy. Such assess- Counseling. These statistical differences ment can begin with two simple questions: and the historical tendencies to pathologize “Are spiritual resources important in your religion in early psychology led theorists (e.g., coping?” If the answer is yes, the second Freud, Skinner, etc.) to a “don’t ask, don’t tell” question is appropriate. “Would you like to policy in previous decades regarding a client’s discuss them in treatment when relevant?” faith. Increasingly, however, religion and spir- (Richards & Bergin, 2005). Further assess- ituality have become recognized as important ment might involve exploring childhood aspects of a client’s culture. Accordingly, the experiences of religion, conversion, the role ethics codes of all professional mental-health of prayer and Scripture in the client’s life, organizations now include religion and spir- positive and negative experiences of church, ituality as important components of cultur- spiritual struggles, and disengagement from ally sensitive treatment. faith-related activities (Pargament, 2007). A wide variety of spiritual interven- Empirical Support for Spirituality in tions exist for appropriately religious clients. Counseling. Numerous studies indicate These include prayer, discussions of Scrip- spirituality can positively impact a person’s ture themes, Scripture study, devotional physical and mental health (Koenig, 2004). meditation, forgiveness, therapist spiritual For example, church involvement can pro- self-disclosure, confrontation of sin, values vide critical social support that decreases exploration, church involvement, encour- loneliness. Devotional meditation has been agement of confession, spiritual books and helpful in treating hypertension, cardiac websites, spiritual direction, and pastoral conditions, and anxiety. consultation and referral (Richards & Ber- Research has also suggested that at times gin, 2005). As with other interventions, spirituality can lead to harmful effects on counselors should evaluate their competency a client’s health. For instance, people who and seek additional training and consulta- use spirituality more extrinsically (for self- tion when necessary. focused reasons, such as inclusion in the right social circles, etc.) appear more vulner- Training. Many clinicians graduated from able to a variety of mental-health problems. programs that did not include spirituality Finally, clients who are deeply committed as a key instructional component; therefore, to their faith appear to prefer clinicians who they need additional training. A wide vari- can incorporate prayer, Scripture, and other ety of Christian spiritual formation, spir- faith resources in therapy (Wade, Worthing- itual direction, and Christian counseling ton, & Vogel, 2007). They also expect the organizations exist to provide such train- therapist to bring up the subject of prayer ing. For example, the American Association

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of Christian Counselors offers conferences, immaterial aspect of individual human webinars, and has certificate training pro- beings. Among its activities are research, grams in biblical counseling, addiction and theory building, education and publication recovery, stress and trauma, etc. (the dissemination of its findings and con- clusions), and counseling and psychotherapy. Conclusion. The characteristics of the U.S. Currently, the dominant model of psy- population, the ethical mandate for cultur- chology in the West is called modern psy- ally sensitive treatment, and empirical find- chology, and it arose in the late 1800s. This ings on the role of faith in mental health version was patterned on the natural sci- justify the inclusion of spirituality in coun- ences (physics and chemistry) and based on seling. If careful assessment and informed the worldview of naturalism, so it restricts consent procedures are followed, therapists itself to publicly verifiable empirical descrip- have a wide variety of spiritual interventions and theoretical statements about tions to consider. Proper training should be human beings that are supposedly devoid of sought for using these strategies. Truly, spir- beliefs regarding the nature of human beings, ituality should be considered the fifth force including what humans should be. As a in counseling and psychotherapy. result, it does not permit any reference to Fernando Garzon supernatural beings (such as God) or ethical values (such as righteousness or sin). Over the past 140 years, modern psychology has References developed an extremely rich and varied literature describing human beings. However, Aten, J. D., & Leach, M. M. (Eds.). (2009). Spiritual- ity and the Therapeutic Process: A Comprehensive in keeping with its underlying naturalistic Resource from Intake to Termination. Washington, worldview, it is thoroughly secular. DC: American Psychological Association. By contrast, Christian psychology is based Delaney, H. D., Miller, W. R., & Bisonó, A. M. (2007). Religiosity and spirituality among psychologists: A on and shaped by a Christian worldview. survey of clinician members of the American psy- Like modern psychology, it is interested in chological Association. Professional Psychology: Research & Practice, 38(5), 538-546. empirical descriptions and theoretical state- Koenig, H. G. (2004). Religion, spirituality, and medicine: ments, but in keeping with a Christian Research findings and implications for clinical prac- worldview, it also utilizes biblical and theo- tice. Southern Medical Journal, 97, 1194-1200. logical teaching and Christian philosophi- Pargament, K. I. (2007). Spiritually Integrated Psycho- therapy: Understanding and Addressing the Sacred. cal reflection on human beings. As a result, New York: Guilford Press. a Christian psychology includes statements Richards, P. S., & Bergin, A. E. (2005). A Spiritual Strat- about human beings that refer to God, sin, egy for Counseling and Psychotherapy. Washington, DC: American Psychological Association. and salvation (see Charry, 2010; Evans, 1990; Wade, N., Worthington, E. L., Jr., & Vogel, D. (2007). Johnson, 2007; Roberts & Talbot, 1997). Effectiveness of religiously tailored interventions Given Christianity’s broader sources of in Christian therapy. Pychotherapy Research, 17, 91-105. psychological knowledge, some of the dis- Weld, C. & Eriksen, K. (2007). Christian clients’ prefer- tinctives of Christian psychology include ences regarding prayer as a counseling intervention. the concept of the image of God and the Journal of Psychology and Theology, 35(4) 328-341. belief that it is humanity’s most important psychological characteristic, the ultimate Christian Psychology loves (and objects of worship) of humans, All sciences are conducted within and uniquely Christian motivation, the pro- guided by a worldview, a set of founda- found alienation of humans from their Cre- tional assumptions regarding reality (Nau- ator and each other due to sin, the nature gle, 2002). Psychology is the science of the and effects of original sin, the development

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of sins and vices, the nature of salvation (and or creation grace. However, because modern its soul-healing benefits), stages of Christian psychology is formulated according to secu- spiritual development, the indwelling of the lar standards of knowledge, such interpretive Holy Spirit in the Christian, the causal role work may be more difficult than the term of God in human good and especially in the integration implies. From a Christian stand- Christian life, Christian self-representations point, modern psychology is less distorted (including the old self and new self), the by what it asserts than by what it leaves out, nature of human personhood and Christian and the distortions that result from leaving maturity, uniquely Christian virtues (includ- God and Christian teachings out of psycho- ing faith, hope, humility, and agape love) and logical theory are difficult to assess without uniquely Christian understandings of human a deep and detailed familiarity with the rele- strengths (a Christian positive psychology), vant teachings of the Christian faith. To cite the relation between the body/brain and the one such hole in modern social psychology, soul, ethical and spiritual psychopathology, attribution theory studies humans’ beliefs distinctive means of counseling and psycho- about what causes human behavior (like therapy that make use of salvation in Christ success on a test). Modern psychology has (including healing prayer and utilization of focused exclusively on natural causes, such as the cross of Christ), and unique perspectives personal ability and effort, other people, or on social dynamics and relationships (such as unique circumstances, but it does not con- the nature of love and spiritual communion). sider the possibility of God’s involvement. There is a tremendous need to do psycholog- As a result, careful Christian reading of ical research and build theories in such areas non-Christian psychology texts in more (Roberts and Watson, 2010). worldview-dependent areas might be more At the same time, Christians do not like translation than integration (John- need to redo work that non-Christians have son, 2007; MacIntyre, 1988). Good Chris- already done well (Kuyper, 1898, p. 159). tian translation is a complex interpretive Also, in many areas of psychology, one’s task, involving a faithful rendering of the worldview makes little difference on one’s truths of a non-Christian text into Chris- observations and theoretical formulations tian discourse, and this requires an expert (for example, in neuropsychology, sensation knowledge of both language systems and a and perception, animal learning, and cogni- personal commitment to the Christian way tion). In such areas, Christians will be able of life (Coe and Hall, 2010). to incorporate the findings of non-Chris- Some might worry that Christian psy- tians and contribute to mainstream psychology will result in a Christian intellectual chology without much difficulty. Christian ghetto that would marginalize Christians in psychology is more likely to differ from psy- the field. However, Christian psychologists chologies based on other worldviews in areas are committed to collaboration with other that have greater human significance and psychologists on research, theory build- existential import, such as personality the- ing, and practice in areas where worldview ory, distinctly human motivation, psycho- differences are not very influential. More- pathology, counseling and psychotherapy, over, as modern psychologists become more and social psychology. Nonetheless, even in aware of modern psychology’s antitheistic these areas, Christians will usually benefit bias (Slife and Reber, 2009), it will become greatly from reading well-done non-Chris- increasingly possible for Christians to make a tian psychology, confident that God enables distinctive impact on contemporary psychol- all humans to understand his creation scien- ogy as Christians—for example, by getting tifically through what is called common grace articles published in mainstream journals

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on Christian theories of the self, motivation, or moral issues. In recent years, there have and counseling techniques. Nonetheless, been numerous attempts to develop coun- the development of distinctively Christian seling treatments that fit within a Christian psychological theory, research, and practice worldview. A few recent studies evaluate the for the Christian community will be of pri- efficacy of Christian counseling. mary importance. The Society for Christian Psychology, a division of the AACC, was History. Concern over treatment effec- established in 2003 to advance just such an tiveness intensified when managed men- agenda (visit www.Christianpsych.org). tal-health care took hold in the late 1980s. Eric L. Johnson Mental-health costs had gotten out of hand. For example, the hourly rate for psychotherapy was more than $100. (Adjusted for References inflation, this would correspond to approx- imately $200 today.) Research also showed Calvin, J. (1960). Institutes of the Christian Religion. (F. L. Battles, Trans.). Philadelphia, PA: Westminster. that most improvement occurred within Charry, E. (2010). God and the Art of Happiness. Grand the first seven sessions, and additional ses- Rapids, MI: Eerdmans. sions of psychotherapy suffered diminishing, Coe, J. H., & Hall, T. W. (2010). Psychology in the Spirit: marginal returns (Howard, Kopta, Krause, Contours of a Transformational Psychology. Downers Grove, IL: InterVarsity. and Orlinsky, 1986). Consequently, man- Evans, C. S. (1990). Søren Kierkegaard’s Christian Psy- aged care companies often decided to pay for chology. Grand Rapids, MI: Baker. brief treatments with demonstrated effec- Johnson, E. L. (2007). Foundations for Soul Care: A tiveness. Christian counselors still operate Christian Psychology Proposal. Downers Grove, IL: InterVarsity. under this pressure to show that their treat- Kuyper, A. (1898). Encyclopedia of Sacred Theology: Its ments are effective. Principles. New York, NY: Scribner. MacIntyre, A. (1988). Whose Justice? Which Rational- Assessment. Treatment effectiveness is usu- ity? South Bend, IN: University of Notre Dame Press. ally assessed by a clinical trial. Most com- Naugle, D. K. (2002). Worldview: The History of a Con- cept. Grand Rapids, MI: Eerdmans. mon is the randomized clinical trial (RCT), Roberts, R. C., & Talbot, M. R. (1997). Limning the in which participants are randomly assigned Psyche: Explorations in a Christian Psychology. Grand to a specific treatment, control, or alterna- Rapids, MI: Eerdmans. tive condition. Although the RCT is the Roberts, R. C., & Watson, P. J. (2010). A Christian psychology view. In E. L. Johnson (Ed.). Psychology and gold standard, this type of research design Christianity: Five Views. Downers Grove, IL: InterVar- has limitations. For example, clinical tri- sity Press. als sometimes recruit participants who dif- Slife, B. D., & Reber, J. S. (2009). Is there a pervasive bias against theism in psychology? Journal of Theoret- fer from real clients who seek treatment. ical and Philosophical Psychology, 29(2), 1-15. For example, individuals paid to partici- pate in a study may differ from individu- Christian Counseling Efficacy als who would pay to attend counseling at a Description. Religious people often pre- private practice. Also, research-based treat- fer approaches to their psychological healing ments sometimes diverge from psychother- that are explicitly tailored to their beliefs and apy that occurs naturally in real-life settings. values (Aten, McMinn, and Worthington, For example, RCTs often rely on treatment 2011; Worthington, Kurusu, McCullough, manuals that guide what the therapist does, & Sandage, 1996). The Christian Scrip- which may stifle some of the spontaneity tures do not explicitly discuss psychotherapy. that occurs in other settings. Likewise, psychological science is limited in Even the ideal RCT (such as one that the extent to which it can address theological uses real clients and counselors) cannot

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provide utterly trustworthy results. Every the history of the church prior to 1900. study, no matter how rigorous, has many Thus, sincere and thoughtful Christians biases and limitations. Qualitative literature disagree about its scriptural support. Some reviews investigate patterns found within Christians denigrate the value of psycho- outcome research. For example, Hook et logical science to inform counseling the- al. (2010) detailed which Christian-accom- ories, methods, or approaches. Others are modated treatments were effective in two or extremely cautious to say that anything can more independent labs and were therefore be learned from the Bible to apply to mod- empirically supported treatments (ESTs). ern counseling. We think humility is war- Even better, meta-analytic reviews quanti- ranted (see Worthington, 2010). Theology tatively summarize studies by converting is a human enterprise, susceptible to all the results from each study to a common metric distortion of sin and human nature. Like- (an effect size) and aggregating across studies. wise, psychological science cannot address A meta-analysis was recently conducted issues of right and wrong. That said, as on religiously accommodated treatments Christian counselors, we can evaluate the (Worthington, Hook, Davis, & McDan- fruits of our work with psychological science. iel, 2011). Generally, the results showed Everett L. Worthington Jr. that when theoreticians or counselors have Don E. Davis adapted religious treatments, clients have Joshua N. Hook reduced psychological symptoms, and the effects are at least as strong as with secular treatments. Religiously accommodated References treatments have produced more positive Aten, J., McMinn, M. R., & Worthington, E. L., Jr. (Eds.). spiritual changes. The most consistently (2011). Spiritually Oriented Interventions for Counsel- effective psychotherapies or couple treating and Psychotherapy. Washington, DC: American Psychological Association. ments have been Christian-oriented cog- Hook, J. N., Worthington, E. L., Jr., Davis, D. E., Gartner, nitive and cognitive-behavioral therapies A. L., Jennings, J., & Hook, J. P. (2010). Empirically (which are ESTs) and forgiveness therapies supported religious and spiritual therapies. Journal of Clinical Psychology, 1, 46-72. based on Worthington’s REACH forgive- Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. ness model (an EST). Christian PREP and E. (1986). The dose-effect relationship in psychother- the hope-focused approach to enrichment apy. American Psychologist, 41, 159-164. have been found to be efficacious, and both Worthington, E. L., Jr. (2010). Coming to Peace with Psy- chology: What Christians Can Learn from Psycholog- have been designated ESTs. ical Science. Downers Grove, IL: InterVarsity Press. Worthington, E. L., Jr., Hook, J. N., Davis, D. E., & Biblical and Spiritual Issues. A word McDaniel, M. (2011). Religion and spirituality. Jour- nal of Clinical Psychology: In Session, 67(4), 204-214. of caution is warranted. Counseling is a Worthington, E. L., Jr., Kurusu, T. A., McCullough, M. E., modern invention. It is not something that & Sandage, S. J. (1996). Empirical research on religion Scripture even mentions. In fact, there was and psychotherapeutic processes and outcomes: A 10-year review and research prospectus. Psychologi- no parallel to professional counseling—and cal Bulletin, 199, 448-487. perhaps not even pastoral counseling—in

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