THE ROLES OF CLIENT RELIGION, COUNSELOR RELIGIOSITY, AND SPIRITUAL COMPETENCE IN COUNSELORS’ CLINICAL JUDGMENT A DISSERTATION IN Counseling Psychology Presented to the Faculty of the University of Missouri-Kansas City in partial fulfillment of the requirements for the degree DOCTOR OF PHILOSOPHY by DOMINICK A. SCALISE B.A., Truman State University, 2004 M.A., Truman State University, 2006 Kansas City, Missouri 2011 © 2011 DOMINICK ANTHONY SCALISE ALL RIGHTS RESERVED THE ROLES OF CLIENT RELIGION, COUNSELOR RELIGIOSITY, AND SPIRITUAL COMPETENCE IN COUNSELORS’ CLINICAL JUDGMENT Dominick Anthony Scalise, Candidate for the Doctor of Philosophy Degree University of Missouri-Kansas City, 2011 ABSTRACT The present study explored the roles that clients’ religious beliefs, therapists’ spiritual/religious beliefs, and therapists’ attitudes toward spirituality and religion may play in how therapists conceptualize a prospective client case. The study also explored the role that the construct “spiritual competence” played in moderating the relationship between therapists’ attitudes toward spirituality and religion and factors related to their clinical judgment of the client’s concerns. One hundred seventy-six therapists and doctoral students were randomly assigned to read one of four vignettes differing only on the client’s spiritual/religious beliefs and practices (Christian, Muslim, Buddhist, or an unstated religious preference). In order to account for various forms of clinical decision-making, a MANCOVA was used with dependent constructs of psychopathology, attribution for the problem, and prognosis. A separate MANCOVA was conducted in order to determine whether the interaction of client religious orientation (religious vs. unidentified religion) and counselor spiritual competence (high vs. low) would be related to different clinical judgments. iii APPROVAL PAGE The faculty listed below, appointed by the Dean of the School of Education, have examined a dissertation titled, “The Roles of Client Religion, Counselor Religiosity, and Spiritual Competence in Counselors’ Clinical Judgment,” presented by Dominick Anthony Scalise, candidate for the Doctor of Philosophy degree, and certify that in their opinion it is worthy of acceptance. Supervisory Committee LaVerne Berkel, Ph.D., Committee Chair Division of Counseling and Educational Psychology Changming Duan, Ph.D. Division of Counseling and Educational Psychology Jake Marszalek, Ph.D. Division of Counseling and Educational Psychology Nancy Murdock, Ph.D. Division of Counseling and Educational Psychology Johanna Nilsson, Ph.D. Division of Counseling and Educational Psychology iv CONTENTS ABSTRACT .................................................................................................................................... ii LIST OF TABLES ...........................................................................................................................x LIST OF ILLUSTRATIONS ......................................................................................................... xi ACKNOWLEDGEMENTS .......................................................................................................... xii Chapter 1. INTRODUCTION ............................................................................................................... 1 2. REVIEW OF THE LITERATURE .....................................................................................7 Clinical Judgment ....................................................................................................7 Clinical Judgment and Race, Sex, and Sexual Orientation ........................11 Evidence from racism ....................................................................12 Evidence from gender bias .............................................................15 Evidence from heterosexism ..........................................................16 Attribution Theory and Bias ......................................................................17 Clinical Judgment and Religion and Spirituality .......................................18 Spirituality and Psychology ...................................................................................19 Client Spirituality and Religiosity and Clinical Judgment ....................................25 Cultural Competence .............................................................................................27 Cultural Competence and Spiritual/Religious Concerns ...........................28 Measures of Competence ...........................................................................33 Summary of Literature and Rationale for Present Study .......................................34 Research Questions and Hypotheses .....................................................................36 Planned Comparisons ................................................................................36 v Research Questions ....................................................................................37 Pilot Study ..................................................................................................37 3. METHODS ........................................................................................................................39 Pilot Test and Pre-Analysis Procedures .................................................................39 Pilot Study ..................................................................................................39 Participants .....................................................................................39 Measures ........................................................................................42 Demographic Sheet ............................................................42 Duke University Religion Scale.........................................42 Counselor attitudes toward religion and spirituality ..........44 Client vignette manipulation ..............................................46 Global Assessment of Functioning (GAF ..........................47 Procedure .......................................................................................49 Pilot Study Findings .......................................................................49 Vignette Results .................................................................50 Factor Analysis ..................................................................50 Religion Scale ........................................................51 Spiritual and Religious Antagonism Scale ............54 Main Study .................................................................................................57 Participants .....................................................................................57 Measures ........................................................................................60 Counselor religious identification ......................................60 Client vignette manipulation ..............................................61 vi Religion Scale-Revised ......................................................61 Spiritual and religious antagonism.....................................61 Spiritual competence ..........................................................62 Clinical Judgment ..............................................................65 Problem Attribution ...............................................65 Global Assessment of Functioning ........................67 Prognosis ................................................................67 Alternative Research Questions .........................................68 Empathy .................................................................68 Number of Sessions ...............................................68 Diagnosis................................................................69 Procedure .......................................................................................70 Exploratory Analysis .........................................................72 Power Analysis ..................................................................73 4. RESULTS ..........................................................................................................................74 Preliminary Analysis ..............................................................................................74 Statistical Assumptions ..............................................................................76 Hypothesis Testing.....................................................................................80 Hypothesis 1...................................................................................84 Hypothesis 2...................................................................................84 Hypothesis 3...................................................................................87 Analysis of Alternative Research Questions..............................................89 5. DISCUSSION ....................................................................................................................95 vii Hypothesis 1 ........................................................................................................96 Christian Vignette ......................................................................................97 Buddhist Vignette…………… .………………………………………….98 Not Identified Vignette ..............................................................................98 Muslim Vignette ........................................................................................99