Ethical Issues for the Integration of Religion and Spirituality in Therapy
Danelle J. Hollenbeck
Psychologists are professional who have undertaken a code of ethics mandatory in practicing psychology. Ethical issues arising from religion and spirituality that is integrated into therapy requires psychologists to undertake a moral and ethical view on treating these clients. This paper addresses the codes in which psychologists adhere to when undertaking secular-theistic therapy, avoiding bias, multiple relationships, imposing religious views, and competence, and informed consent. This paper discusses relevant ethical dilemmas when providing psychotherapy to clients. This paper also reviews ethical circumstances in which American Association of Psychologist Codes (APA) applies to these ethical and moral situations. It will also briefly discuss ethical consideration of the codes at intake, assessment, treatment, and over-all accountability of clients in regards to religion and spirituality.
Psychology (as well as science in general) has embraced spirituality and religion more and has used rigorous scientific methods such as double-blind randomized clinical trials to examine important questions related to psychology and religion integration (Plante, 2007). Many individuals are more religious and spiritual than previously and therefore are requesting that health professional integrate this into their professional work, in particularly psychology, as well as psychologists have become interested in the same and look for ways to integrate this into their practice (Plante, 2007).
The American Psychology Association (APA) supports religious diversity and states that psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider these factors when working with members of such groups (American Psychological Association, 2015). This focuses on Principle E, Respect for People’s Rights and Dignity (Fishers, 2013, pg. 13), which ensures fair treatment of all people regardless of ethnicity, gender, culture, religion, disability, etc. We may not agree with our client’s religious beliefs, but we are asked to respect them and the traditions of others (Plante, 2007). We are to avoid bias and according to Standard 3.01 we are to avoid discrimination based on other qualities and religion (American Psychological Association, 2015).
Psychologists must be competent in the services provided. We must adhere to Standards 2.01b Boundaries of Competence, and 2.03, Maintaining Competence. According to Gonsiorek et al. (2009) “Competence in the services providing regarding spirituality and religion is a fundamental ethical requirement”. Just because we might be of the same faith or have a similar interest in our client’s religious practices does not make us to be experts in the field, therefore we must adhere to Standards 2.01b and 2.03 and have the appropriate training and experience necessary to provide services. We must also remember that psychologists trained as theologians may not satisfy the ethical code, even if dually trained and could face potential challenges (Gonsiorek, Richards, Pargament, &McMinn, 2009) therefore standard training is the key.
The Ethical Code also avoids secular-theistic bias. It’s important to refrain from perceiving a client’s faith as low intelligence just as it’s important to refrain from viewing a client from a different faith as misguided or as second class (Gonsiorek et al, 2009). Principle D: Justice and Principle E: Respect for People’s Rights and Dignity, and Standards 2.06, Personal Problems and Conflicts and 3.01 Unfair Discrimination are applied towards bias. Positive biases can also be just as destructive as the negative biases. Gonsiorek, et al. (2009) states positive biases can result in serious problems being misconstrued as diversity and in behaviors with significant mental health implications being ignored (2009). Standard 3.04, Avoiding Harm applies as such we must take reasonable steps to avoid harming clients when possible (APA, 2015). Biases of any type interfere with the therapeutic relationship and diminish psychological services, thus psychologists are expected to have self-reflection and examination to screen biases (Gonsiorek et al, 2009),
Assuming a client has sought a psychologist who is trained in theistic therapies or is not aware that a psychologist offers religious modalities such as Mindfulness, Ho’oponopono, or prayer would be incorporated into treatment; therefore Standard 10.01 A& B, Informed Consent is mandatory in any treatment offered, yet also in disclosing and discussing the psychotherapist’s qualifications, background, theoretical orientation, and specific areas of expertise; specific goals of treatment; and reasonably available treatment options and alternatives are included in informed consent (Barrett & Johnson, 2011). A psychologist also needs to address concerns or issues that have arisen during intake regarding deep-seated sectarian beliefs, and their levels of comfort and practice, as well as how this may impact their goals and process of treatment (Barrett & Johnson, 2011). Before embarking on any effort to challenge troubling or discordant aspects of religious belief, it is essential that the psychotherapist evaluate his or her competence in this area, provide appropriate informed consent, and consider seeking consultation from clergy or other professionals with expertise in this area (Barnett & Johnson, 2011).
The risk of multiple relationships provides many challenges for psychologists who are also clergy members. Multiple relationships may raise boundary concerns, specifically if a client requests his or her religious aspect of the same church in which the psychologist attends be implemented into their treatment. In this case, psychologists must adhere to Standard 3.05B, Multiple Relationships, which states a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code (apa.org).
These ethics codes (and their understanding) join psychologists to respect each client’s religious/spiritual beliefs and practices reducing any harmful effects on the client’s own biases when formulating treatment for each individual client.
American Psychological Association. (2015). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/
Barnett,J.E., & Johnson,W.B. (2011). Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas, Ethical Issues, and a Proposed Decision-Making Process.Ethics & Behavior. doi:10.1080/10508422.2011.551471
Fisher,C.B. (2013).Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage Publications.
Gonsiorek,J.C., Richards,P.S., Pargament,K.I., & McMinn,M.R. (2009). Ethical Challenges and Opportunities at the Edge: Incorporating Spirituality and Religion Into Psychotherapy.Professional Psychology-research and Practice. doi:10.1037/a0016488
Plante,T.G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider.Journal of Clinical Psychology. doi:10.1002/jclp.20383