Digital Commons @ George Fox University Faculty Publications - Grad School of Clinical Graduate School of Clinical Psychology Psychology 2009 Ethical Challenges and Opportunities at the Edge: Incorporating Spirituality and Religion Into Psychotherapy John C. Gonsiorek P. Scott Richards Kenneth I. Pargament Mark R. McMinn George Fox University, [email protected] Follow this and additional works at: http://digitalcommons.georgefox.edu/gscp_fac Part of the Psychology Commons Recommended Citation Gonsiorek, John C.; Richards, P. Scott; Pargament, Kenneth I.; and McMinn, Mark R., "Ethical Challenges and Opportunities at the Edge: Incorporating Spirituality and Religion Into Psychotherapy" (2009). Faculty Publications - Grad School of Clinical Psychology. Paper 158. http://digitalcommons.georgefox.edu/gscp_fac/158 This Article is brought to you for free and open access by the Graduate School of Clinical Psychology at Digital Commons @ George Fox University. It has been accepted for inclusion in Faculty Publications - Grad School of Clinical Psychology by an authorized administrator of Digital Commons @ George Fox University. For more information, please contact [email protected]. Ethical Challenges and Opportunities at the Edge: Incorporating Spirituality and Religion Into Psychotherapy John C. Gonsiorek P. Scott Richards Argosy University, Twin Cities Brigham Young University Kenneth I. Pargament Mark R. McMinn Bowling Green State University George Fox University Incorporating spirituality and religion into psychotherapy has been controversial, but recent contri- butions have argued the importance and provided foundations for doing so. Discussions of ethical challenges in this process are emerging, and this contribution discusses several preliminary issues, relying on the Resolution on Religious, Religion-Based and/or Religion-Derived Prejudice adopted by the American Psychological Association in 2007, as guidance when used with the American Psychological Association’s (2002) Ethical Principles of Psychologists and Code of Conduct. Specifically, this discussion of preliminary challenges addresses competence, bias, maintaining traditions and standards of psychology, and integrity in labeling services for reimbursement. Commentators deepen the discussion, addressing what constitutes minimal competence in this area; effective and truly mutual collaboration with clergy; the high level of ethical complexity and “inherent messiness” of this domain of psychological practice; and the particular challenges of demarcating the boundaries of these domains for regulatory and billing purposes. This discussion offers decidedly preliminary ideas on managing the interface of these domains. Further development is needed before this nascent area approximates precise guidelines or standards. Keywords: psychotherapy, religion, spirituality, ethics, competence important facets in the lives of most Americans (Gallup Foundation, Ethical Challenges Incorporating Spirituality 2007) and may be related to physical health and emotional well-being (Hill & Pargament, 2003). Incorporating spiritual and religious con- and Religion Into Psychotherapy cepts into psychotherapy has been controversial but is becoming less By John C. Gonsiorek so (see Plante, 2007, pp. 891–893). Recent work focuses on clinical applications of spiritual and religious perspectives (Aten & Leach, Survey data suggest that spirituality and religion (see Hill & Par- 2008; Miller, 1999; Plante, 2009; Richards & Bergin, 1997; Sperry & gament, 2003, for a discussion of the differences between these) are Schafranske, 2005), but conceptual frameworks (Hill & Pargament, JOHN C. GONSIOREK received his PhD in clinical psychology from the The work on this commentary was supported in part by funding from the University of Minnesota. After many years in independent practice of John Templeton Foundation. clinical and forensic psychology, he is now Professor in the PsyD Training KENNETH I. PARGAMENT received his PhD in clinical psychology from Program at Argosy University, Twin Cities. His areas of professional the University of Maryland. He is professor in the Clinical Psychology interest include human sexuality, forensic psychology, ethical and profes- PhD Program at Bowling Green State University. His areas of research sional issues, religion and psychology, and public policy implications of and practice focus on the psychology of religion and spirituality; the behavioral sciences. interface between religion, spirituality, trauma, coping, and health; and P. SCOTT RICHARDS received his PhD in counseling psychology from the the development and evaluation of spiritually integrated approaches to University of Minnesota. He is a professor of counseling psychology at treatment. Brigham Young University. His areas of scholarly interest include religious MARK R. MCMINN received a PhD in clinical psychology from Vanderbilt and spiritual issues in psychotherapy and the role of spirituality in eating University. He is currently a professor of psychology at George Fox disorder treatment and recovery. Dr. Richards thanks Rev. George F. University, Newberg, Oregon. His primary research interests pertain to Handzo and Rev. Martin G. Montonye at the HealthCare Chaplaincy in spiritual and religious issues in psychotherapy. New York City, Rev. Dr. Leonard M. Hummel at The Lutheran Theolog- CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to John C. ical Seminary at Gettysburg, and Rick Gabbitas at Brigham Young Uni- Gonsiorek, 3514 Lilac Lane, Minnetonka, MN 55345. E-mail: versity for their helpful suggestions and assistance with this commentary. [email protected] 2003), research applications (Miller & Thoresen, 2003), and ethical training provides depth, but rarely breadth; individuals are typi- analyses are also emerging (Plante, 2007, 2009, chap. 6). cally trained only in particular faith traditions. Unless the compe- A massive (N ϭ 35,556) survey on religion in the United States tence is limited to that particular tradition, they will have the same by the Pew Forum on Religion and Public Life (2008a) further challenges as do other psychologists in developing general com- illustrates the importance of this issue. While 56% of their total petence in spiritual and religious issues. Such dually trained psy- sample reported that religion is “very important” in their lives, chologists also face unique challenges. The intellectual and phil- 44% also reported that they have switched religious affiliation, osophical bases of religious training fit imprecisely, perhaps moved from religious nonaffiliation to specific affiliation, or poorly, with scientific traditions of psychology, requiring extra moved from specific affiliation to nonaffiliation. The overall pic- care in translation, as is addressed below. Additionally, most who ture of religious life in U.S. adults emerging from this study is one opt for religious training are understandably partisan about their of “constant movement” as characteristic of a fractionated yet faith and may have to work harder to be receptive to clients from vibrant “American religious marketplace.” It is reasonable to con- other traditions. clude that religion is very important both to those who retain Personal faith and spirituality can certainly serve as important affiliation with their initial faith traditions but to those whose components in expertise. Psychologists who establish competence religious affiliations change over time. It is inevitable, therefore, in areas related to features of their own status are likely to be that such deeply held aspects of the human experience will regu- personally animated and genuinely informed by personal experi- larly express themselves in clients’ presentations for psychological ences. Such experiences, however, are not sufficient for compe- services. tence; standard training mechanisms remain central. They are not This contribution discusses some of the ethical challenges as- even necessary conditions: As behavioral scientists, our expertise sociated with incorporating spiritual and religious concepts in must be learnable by those who do not have personal experience. psychotherapy. It is not intended as comprehensive, instead tar- Expertise in spiritual and religious issues must also be learnable geting some preliminary issues, the resolution of which can assist regardless of personal faith. Otherwise, such expertise is removed psychologists in ethically and effectively incorporating this impor- from the realm of psychological services and recast as ministerial. tant component of client diversity in psychotherapy services. The This focus on acquired skill instead of personal experience in American Psychological Association’s (APA; 2008) recently defining competence helps minimize “balkanization”: the assump- adopted Resolution on Religious, Religion-Based and/or Religion- tion that clients are best treated by psychotherapists who are like Derived Prejudice (hereinafter referred to as Resolution) is high- them. This position ultimately means that many clients will be lighted as providing guidance beyond requirements of the Amer- without services, because matching is impractical. Some clients ican Psychological Association’s (APA; 2002) Ethical Principles express strong preferences for working with psychotherapists who of Psychologists and Code of Conduct (hereinafter referred to as share a particular status. Their reasons may be sound (i.e., a history Ethics Code). of discrimination such that trusting an outsider is too