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Gordon, R.M., Hoffman, L., and Tjeltveit, A (2010). Religion and Psychotherapy: Ethical Conflicts and Confluence, Pennsylvania Psychologist, 70, 9, 3-4.

Religion and Psychotherapy: Ethical Conflicts and Confluence

Gordon, R.M., Hoffman, L., and Tjeltveit, A (2010). Religion and Psychotherapy: Ethical Conflicts and Confluence, Pennsylvania Psychologist, 70, 9, 3-4.

Religion and Psychotherapy: Ethical Conflicts and Confluence*

Robert M. Gordon, Ph.D., Lowell Hoffman, Ph.D., and Alan Tjeltveit , Ph.D.

Since religious beliefs are part of our definition of internal and external reality, they can become the source of either great conflict or great contentment. Healthy aspects of religious beliefs and practices include positive identification with family and heritage, social support, a source of comfort, meaning, and spiritual connection beyond material existence. Unhealthy reasons for religion include its use as a defense against reality, moral aggression, and splitting people into “the saved” or the demonized. Likewise there are healthy reasons for being an atheist, such as facing reality without magical thinking, and having faith in secular institutions and verifiable knowledge. Unhealthy reasons for atheism include concreteness and cynicism**.  When religious issues emerge in psychotherapy, we need to attend—carefully and without bias—to both its healthy and pathological elements. Timing and sensitivity are essential.

APA Ethical Principle E, Respect for People’s Rights and Dignity, holds that we are to respect all people, including those whose religion is very different from our own. We thus need to be aware of and address any negative effects that religious differences might have on the quality of our work.  Religious issues in therapy may produce in psychotherapists strong emotional and cognitive reactions that may be partly unconscious or automatic, including countertransference reactions. For example, when patients consider acting in a manner abhorrent to our most deeply held beliefs, or tell us that they are uncomfortable working with us because of our beliefs, we may react strongly in ways that surprise us, that we don’t fully understand.  Optimal ethical and clinical responses to such clients involve our becoming aware of these reactions and addressing them effectively.

Because the respect for which Principle E calls must be balanced with the beneficence and nonmaleficence for which Ethical Principle A calls, we may appropriately address pathological beliefs that may be rationalized in the name of religion. We act in ways that benefit others, and don’t harm them. Respecting, understanding, and empathizing with different frames of reference does not, however, mean that we should be afraid to question assumptions and rationalizations that lead to harm, hostility, or exploitation of others (recognizing that our approach to religion may shape our understanding of what is helpful and harmful). A psychologist’s countertransference reactions may lead, not only to an over-reaction to a person’s beliefs, but also to an under-reaction based on the fear of being perceived as being biased. Psychologists who are silent about religion may reinforce the stereotype that psychologists are disinterested in and scornful of religious experiences. Problems may also arise when psychologist and patient share the same background—and blind spots.

When psychologists work with clients, they operate within the boundaries of their competence (Ethical Standard 2.01). This does not mean that they should reframe from treating someone about whose religion they lack expertise (by one account, there are about 42,000 faith groups in the world). Psychologists may need to increase their knowledge and skills to work effectively with religious clients—by studying a patient’s beliefs, consulting experts, or asking the patient. Many patients welcome such questions and see them as an opportunity to help their psychologist appreciate their frame of reference; their reluctance to discuss religion should, however, be respected, especially if religion is not related to their presenting problem. It is crucial that psychologists maintain objectivity, respect, and empathy. If countertransference interferes with effective work, psychologists should seek supervision or refer the patient to a more appropriate psychologist.

Careful assessment of the role of religion in a patient’s psychological functioning may be very important. The psychologist should recognize any religiously dynamic countertransference during the assessment phase of treatment and determine whether the psychologist’s personal identifications and feelings will be useful or harmful to the treatment process. Assessment conclusions should be drawn with humility and an awareness of the ways in which a psychologist’s own approach to religion can lead to misunderstanding the role of religion in particular clients’ lives. A sensitively-obtained lifespan religious history may be important both with religious and non-religious patients, producing a wealth of helpful information.

Some religious conflicts arise from underlying neurotic conflicts and may be dealt with as such. However, some individuals seek treatment for both psychological and religious issues.  These patients may benefit from the expertise of a therapist trained in both psychology and the beliefs and practices of a particular religious tradition. Certain issues may require clarification when therapist and client share a religious perspective: A patient may consciously or unconsciously hope to exploit a perceived shared belief system, expect religious instruction or quasi-pastoral ministry rather than psychotherapy, or expect moral homogeneity with their psychologist.

Non-religiously-identified clinicians can help religiously committed patients when there is no collusion of silence about religion.  If clients choose to work with such a psychologist, mutual respect will usually overcome the asymmetry of religious differences. Psychologists, therefore, shouldn’t automatically assume that religiously committed patients need to be referred to a religiously-identified clinician. 

Psychologists who offer psychological services from a particular religious orientation need to fully disclose their approach at the beginning of treatment. Patients who know a psychologist’s approach to religion and agree with it are less likely to be influenced in ways they do not want.

In summary, the ethical practice of psychotherapy with respect to religion is not derived from the prevalent illusion of achieving a value-free therapeutic dialogue.  Values are embedded in all presuppositions, including those that guide some psychologists to ignore religion.  We believe that when psychologists practice in ways that invite the full participation of patients (including their religious sensibilities), respect the patients (including their choices to not address religion), are aware of religious differences, are informed by relevant knowledge (obtained either before or after therapy begins), and strive to benefit patients, the treatment they provide will be both efficacious and ethical.

*This paper is a summary of the Pennsylvania Psychological Foundation fundraising ethics workshop, “Religion and Psychotherapy: Ethical Conflicts and Confluence” on May 14, 2010, by Robert M. Gordon, Ph.D., Alan Tjeltveit , Ph.D., and Lowell Hoffman, Ph.D.

**Akhtar, S. and Parens, H. (2001) book “Does God Help?: Developmental and Clinical Aspects of Religious Belief” further explores the healthy and pathological aspects of religious belief.

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