Article written by Justin K. Hughes, MA, LPC
Integrating a person’s faith or religious practices into their therapy isn’t overly complex. It takes intentionality and care, which if you are a licensed clinician, are skills that you likely already possess because of your training.
Your Client Is Who You Work For
While part of clinical work requires addressing areas the client doesn’t see or lacks desired change, we need to let clients guide and coach us on their experience since clients are who we work for in the end. As Noted in the “7 Competency Keys” prior, there is no reason to place less importance or emphasis on religious and spiritual matters when the client wishes to. As a clinician, you must be aware of your own bias but avoid talking about these topics simply because of your own discomfort.
Follow Your Ethical Board
There are certainly core ingredients most ethics boards or professional organizations share. Whether you’re in Texas or Massachusetts, Spain or Brazil, or are a psychologist or social worker or professional counselor, when in doubt about actual hard-and-fast rules and laws, consult your board and/or an attorney. But for most day-to-day considerations, we must think autonomously for each client, in each case, based on our training and ethical requirements.
Incisive questions lead to better assessment which provides the opportunity for better treatment. Clients who don’t believe in God may find it very important to talk about this and how difficult it is for them in their world where they may be a minority group.
Ask Attentive Questions
We can miss bringing to light a client's personal incongruence between states beliefs and daily practice. For example, it is common in general therapy and in treatment for OCD for a client to feel dissonance over what they ultimately want and what in the moment captures their attention. CBT, of all counseling theories, deals with this directly in cognitive restructuring and the like. If a person is to challenge their thoughts and beliefs and restructure them to be more realistic, bigger picture, then how do we help clients do this if we're spiritually avoidant ourselves?
Ask your client:
- good questions
- relevant questions
- how you should ask them questions
Treat OCD With CBT/ERP First
This possibly goes without saying for most clinicians on this site, but it’s an important reminder: treating OCD from a therapeutic first line means utilizing CBT and ERP. Assessment out of this approach then requires considering the framework of CBT. “Therapist drift” can occur when clients and clinicians alike get comfortable and/or feel okay, but it is the provider’s role to continue to examine how this fits into the larger treatment plan.
Utilize A Robust Consent Process
When assessing and/or addressing any core domain in treatment, always ask for permission and gain consent paperwork throughout the treatment process to ensure a client’s best interests are being served. Remember, it's called a process for a reason and that changes will occur. If there is an evidence-based or religious and spiritual - congruent consideration for that client, ensure they have been given an appropriate opportunity to address how their belief and/or practice is a part of their life and/or how they wish it to be.
Only Thoughtfully Self-Disclose Appropriate To Treatment
By the nature of therapy and developing a working alliance, clients are often very curious about their providers in various ways. Sometimes personal details about the provider are what makes or breaks their decision for treatment. This is not necessarily problematic.
Technically speaking, even self-disclosure that a clinician has a diagnosis of OCD or any other diagnosis is still self-disclosure. Such sharing is to be thoughtful and not violate boundaries. However, when its use is ethical and further advances a clients’ treatment (e.g., knowing it’s possible to be successful and have OCD to encourage someone suffering), there is much backing for this, though a clinician’s skill is a significant moderator of whether this is helpful or not. Much of the uncertainty about application of R/S into therapy centers on how it could have adverse impacts.
At the end of the day, if there is something concerning religious and spiritual matters a clinician considers sharing that they do not have a theoretical or therapeutic defense for sharing, it’s best kept to themselves.
Key Reminder: You Don’t Have to Practice Clients’ Religious or Spiritual Approaches
As a clinician, most of us work with a lot of different backgrounds. You do not have to practice or believe the religious or spiritual approaches of a client. You have hopefully already covered this fairly extensively in your training, and how to approach when someone differs from you. As clinicians we must constantly be growing towards awareness of our own biases, beliefs, and how to help clients in the best way for them. But it bears reminding: you can help another person live congruently even when you approach it differently.
Train Clients To Be Assertive For Their Needs- Watch For Unhelpful Dependencies
The IOCDF has a wonderful article on “How To Find The Right Therapist.” We can extrapolate a lot of the principles to locate a therapist who is respectful of your diversity, culture, and religion/spirituality.
Clients need to be assertive in the therapy process for their own success. Therefore, while you might have to prompt a client initially as to whether their faith/religion/etc. pertains to the therapy session, helping them take initiative over time to connect the dots where necessary is crucial.
Particularly with OCD, we cannot underestimate the amount of secondary reassurance that occurs simply by the presence of someone else who is known to think or believe a certain way. This is inevitable at some point. For instance, many clients are reassured when they state they fear losing their mind or killing someone, when the therapist clearly does not take action to respond to what is actually deemed an intrusion. However, over time, minimizing and eliminating this reassurance (sometimes once therapy is discontinued) is crucial. For clients who gain reassurance or otherwise compulse through their therapist’s support on spiritual matters, this necessarily must be considered in assessment and treatment planning.
For example, if a clinician knows the client finds prayer valuable, and avoidance of prayer is a compulsion, it is likely helpful to ask if the client thinks resuming prayer for the week would be advisable and reminding them this is a part of their values. However, the therapist needs to be formulating ways where this encouragement could also be reassurance, such as in the context of another obsession. An exhortation to prayer could be such reassurance if the client obsesses on whether they have OCD or not and such an admonition seems to remind the client to do “business as usual”, thus telling them they’re okay with some uncertainty that they rather need to tolerate.
Therapist Collaboration With Clergy
It may be necessary if you work closely with clients on R/S topics that you may need to confer with clergy and/or other relevant support to best facilitate treatment. Whether that’s an Advisor, Pastor, Priest, Rabbi, Imam, and so forth, treat it not differently from consulting with another medical provider- when useful to the client to facilitate their treatment, many clergy are quite impressed to be outreached by a mental health clinician.
Reasons working with Clergy may be helpful:
- Your own education and understanding to best serve clients you help
- Clarification on specific topics or practices that require more precision and exactness (e.g., Practices around food, liturgy and prayers, disciplines and concepts around purity (all forms- ritualistic, sexual, etc.)
- Help the client by educating clergy to ERP-friendly approaches that will help them integrate both their faith and treatment of OCD
- Through collaboration, clergy can assist clients with acceptance, rather than offering accommodation
- Advocate for others who suffer and be of general help in reducing stigma and human suffering
- Clergy can help clients grieve what they've lost (or perceived faith changes) as a result of OCD
- Clergy can assist the client with meaning-making through a new relationship with faith
Cashwell, C. S., & Young, J. S. (2020). Integrating spirituality and religion into counseling: A guide to competent practice. American Counseling Association.
Gill, C. S., & Freund, R. R. (Eds.). (2018). Spirituality and religion in counseling competency-based strategies for ethical practice. Taylor & Francis.
Kahle, P. A., & Robbins, J. M. (2004). The power of spirituality in therapy: Integrating spiritual and religious beliefs in mental health practice. Haworth Pastoral Press.
Vieten, C., & Scammell, S. (2015). Spiritual and religious competencies in clinical practice: Guidelines for psychotherapists and Mental Health Professionals. New Harbinger Publications, Inc.