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Presenters Religion, Spirituality, Ethics, Valerie Lemmon, Psy.D. PPA Member, Associate Professor of Psychology at Messiah College, and Psychotherapy Psychologist at Upturn LLC, Chair of the PA Psychological Association Ethics Committee, teaches ethics in upper-level undergraduate psychology courses. Pennsylvania Psychological Association Convention 2019

Samuel Knapp, Ed.D., ABPP PPA Member, Director of Professional Affairs, PA Psychological Association, has written almost 100 peer reviewed articles and conducted almost 400 professional workshops, most of them dealing with ethical issues.

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Program Objectives Why is this an ethical issue?

At the end of the workshop the participants will be able to: Since 1990s, religion and spirituality in psychology:

1. Address or clarify the religious or spiritual issues that patients bring into ● More open zeitgeist, therapy; ● Explicit acknowledgement in APA Ethics Code:

2. Mobilize religious or spiritual strengths to promote patient well-being or Principle E (Respect for People’s Rights and Dignity) ethically sound outcomes; and ● Psychologists are aware of and respect cultural, individual, and role differences, including those 3. Articulate strategies for enhanced cultural competence related to working based on . . . religion . . . , and consider these factors when working with members of such groups. with patients from diverse religious and spiritual backgrounds.

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Tentative Definitions Similarities

APA Handbook of Psychology, Religion, and Spirituality (Pargament, Mahoney, The sacred is core Exline, Jones, & Shafranske, 2013) Dynamic, searching processes Spirituality: the search for the sacred Concepts of God and higher powers with divine qualities Multidimensional and multilevel processes

Religion: the search for significance that occurs within the context of Multivalent established institutions that are designed to facilitate spirituality Emphasis on searching for significance Concerned with issues of great value

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Dissimilarities Competence

Religion is imbedded in an established, institutional context, including beliefs, Standard 2.01 (Boundaries of Competence) practices, and relationships in traditional contexts ● Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with . . . religion . . . is essential for effective Spirituality is not restricted to God or a higher power, including beliefs, implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, practices, and relationships in nontraditional contexts or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies. “Competency in religious diversity is an ethical imperative” (Richards & Bergin, 2000, p. 4)

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Competence in Religious and Spiritual Diversity (Richards & Bergin, 2000) Eucumenically Effective Therapists

1. Religious diversity is a cultural fact, and most mental health professionals will encounter “An attitude and approach to therapy that is suitable for clients of diverse it in their practices. religious affiliations and backgrounds” (Richards & Bergin, p.17) 2. Psychologists will enjoy more credibility and trust with religious clients, leaders, and communities if they obtain training and competency in religious and spiritual diversity. Generalize multicultural attitudes and skills to religious and spiritual work 3. Psychotherapists have an ethical obligation to obtain competency in religious and spiritual diversity. 4. Competency in religious diversity may help psychotherapists understand how to access more fully the healing resources in religious communities to assist their clients in coping, healing, and changing.

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Spiritually Integrated Psychotherapy (Pargament, 2019) Definition of Spiritual Struggles

It is spiritually attuned Spiritual struggles refer to experiences of tension, strain, and conflict about sacred matters with the supernatural, within oneself, and with others. It is spiritually integrative

It is psychotherapy Three kinds: Supernatural It is not a competitor to other models of therapy Intrapersonal Interpersonal

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Supernatural Intrapersonal

Divine struggles Moral struggles

Demonic struggles Ultimate meaning struggles

Spiritual doubt struggles

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Interpersonal Exercise One

Interpersonal struggles What are examples of religious or spiritual issues that patients may bring into psychotherapy? Hurt or rejected by religious/spiritual people

Angry at organized religion

Beliefs questioned by others

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Religious/Spiritual Beliefs Vignette Exercise Two

Consider this scenario: A patient presents with mild depression and anxiety What competencies should psychologists have before they integrate spiritual related to recent stressors, most notably his significant other recently breaking and religious issues into psychotherapy? up with him. This particular stressor precipitated him having difficulty concentrating at work, as well as experiencing insomnia, fatigue, guilt, and hopelessness about the future. He reports that he is suffering because he became sexually attracted to another person while dating his former significant other, and in his religious tradition this kind of thinking and feeling is forbidden.

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Spiritual and Religious Competencies for Psychologists Attitudes

Vieten, Scammell, Pilato, Ammondson, Paragment, 1) Psychologists demonstrate empathy, respect, and appreciation for clients from diverse spiritual, religious, or secular backgrounds and affiliations. and Lukoff (2013)ilato, Ammondson, Paragment, and 2) Psychologists view spirituality and religion as important aspects of human Lukoff (2013) diversity, along with factors such as race, ethnicity, sexual orientation, socioeconomic status, disability, gender, and age. 3) Psychologists are aware of how their own spiritual and/or religious background and beliefs may influence their clinical practice, and their attitudes, perceptions, and assumptions about the nature of psychological processes.

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Knowledge Knowledge (cont)

4) Psychologists know that many diverse forms of spirituality and/or religion exist, and 7) Psychologists recognize that spiritual and/or religious beliefs, practices, and explore spiritual and/or religious beliefs, communities, and practices that are important to experiences develop and change over the lifespan.

their clients. 8) Psychologists are aware of internal and external spiritual and/or religious resources 5) Psychologists can describe how spirituality and religion can be viewed as overlapping, and practices that research indicates may support psychological well-being, and recovery yet distinct, constructs. from psychological disorders.

6) Psychologists understand that clients may have experiences that are consistent with 9) Psychologists can identify spiritual and religious experiences, practices, and beliefs their spirituality or religion, yet may be difficult to differentiate from psychopathological that may have the potential to negatively impact psychological health.

symptoms. 10) Psychologists can identify legal and ethical issues related to spirituality and/or religion that may surface when working with clients.

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Skills Skills (cont)

11) Psychologists are able to conduct empathic and effective psychotherapy with clients 15) Psychologists stay abreast of research and professional developments regarding from diverse spiritual and/or religious backgrounds, affiliations, and levels of involvement. spirituality and religion specifically related to clinical practice, and engage in ongoing

12) Psychologists inquire about spiritual and/or religious background, experience, assessment of their own spiritual and religious competence. practices, attitudes and beliefs as a standard part of understanding a client’s history. 16) Psychologists recognize the limits of their qualifications and competence in the

13) Psychologists help clients explore and access their spiritual and/or religious strengths spiritual and/or religious domains, including any responses to clients’ spirituality and/or and resources. religion that may interfere with clinical practice, so that they (a) seek consultation from and collaborate with other qualified clinicians or spiritual/religious sources (e.g. priests, 14) Psychologists can identify and address spiritual and/or religious problems in clinical pastors, rabbis, imam, spiritual teachers, etc.), (b) seek further training and education, practice, and make referrals when necessary. and/or (c) refer appropriate clients to more qualified individuals and resources.

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Exercise Three Discussion

A psychologist was treating a woman who was in a troubled marriage. Her What do you know? husband was verbally abusive and overly disciplines their children. The school had filed a child abuse report on the family, but the physical discipline did not What do you need to know? reach the threshold necessary for child abuse to be founded. She was miserable but said that she would not divorce her husband because “my religion is opposed to divorce.”

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More Information Discussion

Before her husband lost his job a year ago, he was a good husband and father. What do you know? Since losing his job he has started to drink a lot, become morose and become verbally aggressive with his children. He acknowledged he was wrong on over What do you need to know? disciplining his children and has become more appropriate since the event that the school reported. He has curbed his drinking substantially.

She considers himself moderately religious and reports that some of the elders in her Church know of the situation and are trying to find her husband a new job.

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Even More Information Discussion

The patient came from a divorced family and felt that she and her sister What do you know? suffered substantially from the divorce. She wants her children to have a better life than she had. Also, the idea of living on her own frightens her and she is not What do you need to know? sure how she and the children could make it financially. When asked further about her attitudes toward divorce, she said that she might consider it if she thought that all possibility of saving the marriage was lost, but right now she wants to give her marriage a try. She says that the pastor at her church has offered them couples counseling.

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Resources That Predict Growth Post Struggle (Pargament, 2019) Practical Responses

❖Don’t change the subject ❖Finding meaning in the struggle ❖Don’t assume you understand ❖Religious hope ❖Don’t judge ❖Seeing life as sacred ❖Don’t offer easy answers ❖Deeper religious commitment ❖Don’t try to “solve” the struggle ❖Experiencing sacred moments ❖Perceiving a helpful response from God ❖Accepting the struggle

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Assessment Strategies

❖Assess Spiritual Struggles ❖Normalize Spiritual Struggles ➢ By explicitly asking. ❖Access Resources for Spiritual Struggles ■ “Have your problems affected you religiously or spiritually? How?” ❖Foster Wholeness ➢ By listening for signs of struggle. ❖Develop and Evaluate Interventions to Address Spiritual Struggles ➢ By exploring spiritual struggles. ❖Help People Anticipate Spiritual Struggles Before They Occur ➢ By exploring religious/spiritual equivalents (e.g., values).

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Therapist Self-Disclosure and Qualities

Therapist presentation creating safety

Opening the door in the assessment process

Assessment of values and morals

Humility and engaging in inquiry

Explicit versus implicit - intentional presentation

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