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Deliverance, demonic possession, and mental illness: some considerations for mental health professionals. 

This paper outlines an unconventional treatment for mental illness, the exorcism or deliverance ritual used by Pentecostals and some other charismatic Christians. Deliverance beliefs and practices are based on the assumption that both mental and physical ills result from possession of the sufferer by demons, and are to be treated by the expulsion of those demons. Deliverance practitioners claim to treat schizophrenia, ADHD, and Reactive Attachment Disorder, and believe that these problems are related to sins either of the person in treatment or of an ancestor. Clinicians and counsellors dealing with clients who partially or completely espouse deliverance beliefs may need to understand their worldviews and to discuss their belief system before managing to engage them in conventional mental health treatments. Unusual ethical problems may also be met in the course of such work.

Keywords: faith-based interventions; faith-based mental health theories; evidence-based practice; professional ethics; deliverance practices

Religions contain within them the seeds of psychologies, in the form of statements about the nature of human beings and about their right or wrong conduct. These seedling psychologies include views of mental illness, its causes, and its treatment, and may emphasise either supernatural or natural causes for mental disturbance. In the Western world, mainstream Christian and Jewish groups generally consider natural factors as primary in mental illness and mental health interventions, in spite of their acknowledgement of the importance of spiritual or supernatural phenomena. Pentecostal believers, on the other hand, emphasise the role of the supernatural in both causation and healing of mental and physical disorders. These disorders are considered as due to demonic possession, and effective interventions are thought to require expulsion of the responsible demons by means of deliverance (exorcism). Some Pentecostals are said to reject medical and psychological treatment for mental illness, and to consider such treatment to have the potential for exacerbating the disorder, even in cases of serious depression or of schizophrenia (Harley, [23]), but others accept the use of secular treatments while at the same time requiring that interventions have some congruence with Pentecostal beliefs.

The present paper will address beliefs about mental illness and deliverance as they have been outlined by Pentecostal authors and by members of other groups who are committed to the deliverance concept (for example, some Roman Catholics and Anglicans of charismatic types). Although Pentecostalism lacks hierarchical organisation, tends to be highly congregational in nature, and has frequent schisms, a number of concepts about deliverance appear to be shared by most groups that would claim the Pentecostal category. Mental health professionals attempting to work with deliverance-believing clients, or to cooperate with deliverance ministers, need to understand the deliverance background in order to meet potential challenges in both practical and ethical realms.

The need for psychologists and counsellors to understand deliverance beliefs is underscored by the existence of an estimated 80,000,000 Pentecostals in the United States (“The new face of global Christianity”, [42]) as well as by the rapid growth of this belief system in Latin America and Africa. Some older works suggest that there have been significantly higher six-month and lifetime rates of depression, anxiety, and other mental health disorders among Pentecostals than among mainline Protestants (Koenig, George, Meador, Blazer, & Dyck, [27]). Where this large population is concerned, deliverance beliefs and practices may have serious implications for treatment of mental health problems.

Among those sharing charismatic beliefs (not all of whom are Pentecostals), opinion varies about the need for psychological or psychiatric training, or other education, for those working with the mentally ill. Anglicans and Roman Catholics make deliverance the task of ordained clergy and expect them to consider psychological and psychiatric concepts before taking a supernatural approach. Pentecostals, however, who have little hierarchical organisation, may use psychological terms and concepts but do not consider them essential to the task of casting out demons, nor do they consider any form of ordination or training to be necessary. Any Christian (as defined by Pentecostals) is thought to be able to deliver a sufferer from demons and thus from mental illness, although individuals have differing abilities for this work. Mainstream mental health professionals working with believers of these types need to have sufficient understanding of deliverance principles to be able to tolerate these views, so different from most of their own perspectives, and to anticipate their influence.

The present paper will outline some of the historical background explanatory of the deliverance belief system, and will explore some aspects of deliverance-oriented mental health practice. Because many Pentecostals and related groups believe that treatment of mental health problems cannot be complete without deliverance, psychologists, psychiatrists, and counsellors can expect that their contributions to treatment will be in cooperation with a deliverer; this paper will include a discussion of the ethical problems that may result from this cooperation.

Historical background and evolution of Pentecostal beliefs

Pentecostalism is usually considered as an aspect of evangelicalism, a Protestant Christian movement that began in the 1700s with groups like the Methodists (Bebbington, [ 4]). Evangelical thinking stresses the need for conversion (being “born again”), the reliance on biblical authority, an emphasis on Jesus’ death and resurrection as the primary factor in salvation, and the importance of actively spreading the gospel. Pentecostals share the belief in the critical nature of personal conversion and on the final authority of the Bible. However, in addition to a focus on Jesus’ death, Pentecostals adhere to a pneumatological soteriology (Ngong, [35]), in which the works of the Holy Spirit are seen as central to salvation and to life events. These include such gifts of the Holy Spirit as casting out of demons and speaking in tongues.

As is well-known, traditions of exorcism date back to ancient times. Roman Catholic rituals for exorcism were formulated in the seventeenth century, as were those of the Church of England (Malia, [32]). However, the capacity for deliverance (the expulsion of demons), as a gift of the Holy Spirit, and one among several gifts said to have been received by the Apostles at the event celebrated as Pentecost or Whitsunday, was not an aspect of these rituals. Neither were the gifts, which included “speaking in tongues” as described in the New Testament, part of the periodic religious revivals experienced in North America in the eighteenth and nineteenth centuries. The Pentecostal practice of glossolalia apparently emerged in about 1830 as a practice of a British millennial Presbyterian group known as the Catholic Apostolic Church (Ellis, [16]). At about the same period, the Holiness Movement developed out of Wesleyan Methodism; this group stressed an experience of conversion in which the presence of the Holy Spirit was felt, and the experience of “signs and wonders” was expected (Poole, [37]). Pentecostalism proper, which is usually dated to a revival meeting in Los Angeles at the turn of the twentieth century, held that this experience was shown to be genuine only when the individual spoke in tongues. The gradual development of this belief in the influence of the Holy Spirit, and the symmetrical belief in the powers of demons, followed a folkloric pattern rather than emerging as an organised, hierarchical set of religious beliefs.

The practice of “pleading the Blood” for purposes of healing and deliverance, mentioned later in this paper, appears to have begun in a 1907 London prayer group headed by Catherine Price. An important Pentecostal figure, H.A. Maxwell Whyte, whose mother had been a follower of the prophetess Joanna Southcott, joined this group in 1939. By 1948, Maxwell Whyte was running a charismatic ministry in Toronto and using deliverance to treat arthritis and homosexuality, among other things. His 1959 book The power of the Blood described the use of pleading the Blood for the purpose of casting out spirits (Ellis, [16])

During the 1940s and 1950s, some Pentecostal groups, like the Assemblies of God, became more mainstream and marginalised the “gifts” that had been characteristic of the movement. From about 1960, however, there was an increasing influence of Pentecostal/Charismatic beliefs and practices among both Catholics and Protestants; a 1972 report of the Church of England discussed appropriate use of exorcism and suggested that some events resembling mental illness could be caused by demonic possession (Malia, [32]).

Other factors like the rise of “prosperity theology” (Roberts & Montgomery, [39]) and missionary efforts in Africa that brought in themes of African traditional religion also contributed to the developing syncretism that combined deliverance beliefs with psychological concepts (cf. Betty, [ 6]). An example of this syncretism is a paper in which Euteneuer [17] listed a number of risk factors for demon possession, but noted that persons who have been subjected to Satanic Ritual Abuse require the care of a therapist skilled in treatment of Dissociative Identity Disorder. Another example is the use of “Theophostic” (Bidwell, [ 8]), a treatment that expels demons in order to remove “lie-based thinking.”

Because of their folkloric and syncretic nature, deliverance beliefs and practices are dynamic and show continuing influences from both religious and psychological or psychiatric sources. Pentecostals on the whole are little influenced by mainstream religious positions, and have been described as taking “an eschatological position that feared ecumenical contact” (World Council of Churches, [49]). However, Pentecostal groups’ influence on each other is exemplified by the visits made to churches in the United States by Helen Ukpabio, the Nigerian “lady evangelist” and accuser of child witches (Ngong, [35]); advertising for her planned 2012 “marathon deliverance” at a church in Houston stated her expertise at helping those under attack by “mermaid spirits” (“Marathon deliverance,” [33]).

Pentecostal beliefs and mental health

The estimated number of Pentecostals in the United States – equivalent to one out of four people – and the history of adverse effects from deliverance practices (discussed later in this paper) suggest that we need to examine the specifics of Pentecostal thinking about mental illness and its treatment. A better understanding of these points may be of help in understanding the attitudes of a large group towards conventional psychological approaches to the prevention and treatment of mental illness, and may thus contribute to related public health efforts as well as to the effectiveness of work by mental health professionals.

Although much Pentecostal teaching occurs in small, private groups, there has been sufficient agreement to support a number of publications about the nature of demonic possession and deliverance, and the positions advocated by these publications appear to be acceptable to many Pentecostals. The most popular of these is Pigs in the parlor: The practical guide to deliverance (Hammond & Hammond, [20]). The same authors have published A manual for children’s deliverance (1996/2010). A similar guide is Deliverance for children and teens(Banks, [ 3]). These and a series of Internet sites are sources of information about Pentecostal approaches to both mental and physical illness. The following section will outline relevant Pentecostal beliefs as described in those sources. (However, it is quite possible that between the time of writing and the publication of this paper, further schisms will have created some differences in the thinking of Pentecostals, especially in the United States and Canada, where Pentecostal beliefs seem to be particularly volatile.)

Causes of mental illness

In the Pentecostal view, mental illnesses, including autism, bipolar disorder, depression, Reactive Attachment Disorder, and schizophrenia, all have their direct causes in the presence or “indwelling” of demons who have entered the victim’s body. These demons, who are servants of Satan but not usually Satan himself, are spiritual in nature, but can operate through material bodies, and are thus parallel to the Holy Spirit, which can also enter a body and cause behaviours like speaking in tongues. Behaviours caused by spiritual entities show the presence of those entities; just as speaking in tongues indicates the presence of the Holy Spirit in the speaker, disturbed behaviours are indicators of the demonic presence.

The type of mental illness manifested by an individual depends on the type of demons influencing him. Hammond and Hammond [20] provide four pages of names for groupings of demons, including spirits of bitterness, rebellion, strife, control, nervousness, and paranoia. In each case of demonisation, there is considered to be one ruling spirit, or “strong man,” and it is essential that this one be addressed, but also that every one of the subordinate demons be expelled as well.

Hammond and Hammond [20] devoted an entire chapter to demonic causes of schizophrenia, which they regarded as “split personality.” Mrs. Hammond described being awakened from sleep by a revelation in which God described the nature of schizophrenia.

The Hammonds’ description of schizophrenia is typical of Pentecostal thought in its selection of specific demons who cause a problem. In addition, it characteristically points to experiences or conditions that invite the entrance of specific demons. Mrs. Hammond continued her description of her revelation by discussing the indirect causes of schizophrenia:

Schizophrenia can be demonically inherited … demons seek to perpetuate their like kind. It is easiest for them to do this in a family. For example, suppose the schizophrenia nature is in the mother. The demons will pick out one or more of her children to feed down through. The schizophrenic mother feels rejection … She is the one who touches, handles, and fondles the infant. The rejection within herself creates problems in her relationships with the child. So, the child is opened for rejection by the mother’s instability. I repeat, schizophrenia ALWAYS begins with rejection. (p. 144)

Read without the reference to demons, this view of mental illness may appear simplistic, but not completely unlike a conventional but strongly environmental approach to psychological disorders; however, understanding the claimed role of demons makes it clear that the Pentecostal system shares little with conventional, naturalistic approaches.

Mrs. Hammond’s reference to rejection in early life and the entrance of a demon into the individual typifies the Pentecostal view that experiences and circumstances open “ports of entry” for demons, who are attracted by certain situations. In some cases demonisation follows the person’s intentional participation in sinful actions; in others, the sins of related persons cause the attraction of demons to an individual; in still other situations, demons are attracted by events that are neither intentional nor sinful, but accidental. Demonisation is not always preventable even by the most committed Pentecostal. Of the circumstances thought to create mental illness by attracting demons, some, but not all, have been posited as potentially disturbing by conventional psychologists.

Adoption

Adopted children are considered very likely to be afflicted by demons. Although the child himself may never have experienced thoughts or behaviour that created vulnerability to demons, Pentecostals hold that the circumstances under which adoption is likely to occur attract demonic interest (Banks, [ 3]; Hammond & Hammond, [21]). These may include the death of a parent, after which spirits of abandonment and fear may make their entrance. More often, the child who is to be relinquished for adoption has already been exposed to demonic activity, produced when a conception occurred out of wedlock or in a spirit of lust.

The mother’s consideration of abortion also invites demons to enter the child and the womb itself (although spiritual in nature, demons appear to experience some constraints of time and space and thus may preferentially affect certain body parts). According to Hammond and Hammond [21], “A spirit of death gains a legal right to a child yet in the womb if the mother and/or father attempt or even contemplate an abortion” (p. 86). In the opinion of Banks [ 3], the demonic dangers of abortion extend also to contraception by means of IUDs, foams, and contraceptive pills “that work by inducing an abortion” (p. 83).

Childhood trauma

Pentecostals consider demons to enter during traumatic events, and stress the possibility that this will happen during early life. The use of drugs in childbirth is questioned; apparently referring to Pitocin, Hammond and Hammond [21] state that when “the mother is given the drug patosium to induce labor, the drug passes through the placenta into the baby affecting the nervous system with adverse effects upon his emotions” (p. 86). Birth traumas are given special consideration, as they may have attracted “spirits of birthing trauma, oxygen deficiency, and death” (Hammond & Hammond, [21], p. 87) that remain with the afflicted person into adulthood, causing intellectual delays. Physical, emotional, and sexual abuse all attract demons that distort thought, emotion, and behaviour, as do other experiences of fear.

Sickness and death

Experiences of one’s own illnesses or those of other people and of pets, or of deaths, are thought to invite demonic entry through grief, abandonment, loneliness, and insecurity. These spirits may remain with the affected person from childhood into adulthood, and bereavement even in adulthood may lead to similar demonisation.

Occult experiences

Association with any aspect of the occult is thought to attract demons. This includes stories or movies involving magic or witches, Ouija boards and tarot cards, having one’s fortune told or palm read, and dressing in costumes for Halloween. All “New Age” practices are considered occult, and Pentecostal schisms may include references to schismatic practices as occult in nature (Ray, [38]).

Curses

According to Banks [ 3], a curse is “a demonic force brought to bear upon a person or family by the words, will or actions of another individual” (p. 84). The other person may create a curse by ill-wishing or by specific behaviours or words that are hostile to the cursed individual, the latter explanation of mental illness being congruent with the concern of mainstream psychology about experiences with hostile interactions.

Some curses are also considered to be generational in nature, so that an individual is demonically attacked because of actions or experiences of parents, grandparents, or more distant generations. Generational curses are likely to involve occult activities of the ancestor or prohibited sexual practices. Adopted children are particularly likely to suffer from generational curses, because they inherit from a “double lineage” (Banks, [ 3]) with evil spirits potentially coming to them from both adoptive and biological parents.

Results of demonic attack

What are the results of demonic possession? They may include an extensive list of physical and mental ills, including infertility, obesity, asthma, seizure disorders, ADHD, and schizophrenia. Alcoholism and drug use in adults, and disobedience or nightmares in children, are attributed to demonic activity. Deliverance, or expulsion of the demons, is expected to cure these and other conditions, and even Pentecostals who accept some medical intervention would deny the possibility of a complete cure without deliverance (Legako & Gribble, [29]).

Some African Pentecostals have in recent years emphasised the belief that children may be demon-possessed and as a result may be dangerous to others as well as suffering their own symptoms. These “child witches” are thought to be stubborn and resistant to schooling, and to plot with other children and with evil spirits to do harm to people and property. They can “drain” adults’ happiness and prosperity and cause electronics to fail (Wilson, [47]). The “child witch” belief has not so far been a major part of Pentecostalism in the United States, but in 2012 a Houston church planned a “marathon deliverance” involving the Nigerian Pentecostal minister Helen Ukpabio, who is known as an accuser of “witch children” (Ngong, [35]). Her books and a film, The end of the wicked, have encouraged this type of belief. Whether Ukpabio has already influenced beliefs among US Pentecostals, or whether she will do so in the future, is not known.

Treatment of mental illness by deliverance

As would be the case for any conventional psychotherapy or counselling technique, deliverance techniques address mental illness, educational, and behaviour problems by both diagnosis and intervention.

Discernment

Diagnosis of demonic presences begins with reports of problems and with very general clues to the presence of demons. For example, demonic possession can be indicated by behaviours a person cannot control, by extreme mood changes, by cravings for power or the practice of manipulation, by persistent bad habits, and by a pattern of being victimised (Legako & Gribble, [29]). Some descriptions of demonic possession stress altered appearance of the victim’s eyes, which may be red in colour or “almost black like shark’s eyes” (“Warning signs of demonic … ,” [45]). Animals may appear frightened of the person, and there may be incontinence.

The diagnosis of which spirits are responsible for these or more specific problems involves the process of discernment. Discernment is one of the gifts of the Holy Spirit, Biblically described as having occurred at Pentecost.

Discerning of spirits is the supernatural ability given by the Holy Ghost to perceive the source of a spiritual manifestation and determine whether it is of God … It implies the power of spiritual insight – the supernatural revelation of plans and purposes of the enemy and his forces (Boshart, [ 9]).

Discernment, which is most often an ability shown by women (Franklin, [19]), may proceed by way of a word of knowledge.

A word of knowledge is a definite conviction, impression, or knowing that comes to you in a similitude (a mental picture), a dream, through a vision or by a scripture that is quickened to you. It is supernatural insight or understanding of circumstances, situations, problems, or a body of facts by revelation; that is, without assistance by any human resource but solely by divine aid. Furthermore, the gift of the word of knowledge is the transcendental revelation of the divine will and plan of God. (Boshart, [10])

Discernment is also based on certain assumptions about the relationship between a problem and the responsible demon. According to Hammond and Hammond [20], groups of demons can be associated either with symptomatic moods or behaviours (e.g., anxiety, lying) or with past experiences (e.g., occult practices, cult membership, or membership in certain churches or societies). The discerning individual can use those connections to make decisions about specific demons involved. Some attribute specific demon-attracting events, like adoption, to specific diagnoses, such as Reactive Attachment Disorder.

Deliverance

Deliverance, also known as exorcism or expulsion of demons, is the primary mode of treatment for mental illnesses thought to be caused by demonic possession. It is possible for deliverance practices to include violent or dangerous actions, and this will be discussed later in this paper when deliverance will be considered as a potentially harmful intervention. In the present section, common deliverance methods will be described, with the understanding that specific techniques may vary from one deliverer or group to another.

Deliverance is often carried out with a group attending a scheduled church service. There is usually a deliverance team rather than a single deliverer, and the team is encouraged to include both men and women. Not only are women thought to be superior at discernment and men at deliverance, but it is thought desirable to have members of each sex so that a person who needs restraint will be held only be same-sex individuals. Vomiting, spitting, and thrashing are all part of the deliveree’s behaviour, and sufficient team members are needed to manage these as well as to move from person to person as needed (Cuneo, [13]). Deliverance of a single individual may also be the work of a team, and it is possible that this is a more common approach when a child is to be delivered.

Organising the room and equipment

Suggestions for the conduct of deliverance include the choice of a room where others will not intrude, and one “so situated that others will not be disturbed or excited by sounds emitted” (Hammond & Hammond, [20], p. 117). A secretary is to be appointed and notes taken, to be provided to the deliveree and used in any follow-up proceedings. One deliverer (Wagner, [44]) advises the use of an informed consent document.

Pleading the Blood

An essential step in deliverance is to “plead the Blood” by spoken references to the powers of the blood of Jesus as a weapon of spiritual warfare, which may be as simple as stating “I plead the Blood,” or may include phrases like “This child is covered with the precious blood of Jesus,” coupled with references to the blood of the lamb at Passover (Hammond & Hammond, [21], p. 54). Pleading the Blood is a first step in casting out demons as well as for magical healing of burns and excessive bleeding (Ellis, [16]).

Investigating demons

The deliverance process begins with an anamnesis-like period, during which the deliveree is encouraged to remember events in childhood that might have attracted demons and permitted their entry. Once a demon has entered, it is not thought to leave until deliverance occurs, so early events continue to influence the adult. As Hammond and Hammond noted,

Current problems with the person usually have their roots in earlier life. For example, there may be tension and strife between a husband and wife. It could stem from a spirit of rebellionthat entered the wife when she was a little girl and a spirit of resentment that entered the husband when he was only a small boy. These are the facts that the conference will bring to light. (1973/2010, p. 118; italics in original)

The procedure leads to the identification of specific demons that are causing problems.

The deliverance proper

The deliverance begins with a prayer, read verbatim by the deliverance team and candidate, citing the power of Jesus’ blood, forgiving others, and renouncing sins. The deliverer then commands all evil spirits to unlink themselves from each other and forbids them to help or encourage one another. The spirits are to be “bound,” and the ruling spirit of the hierarchy forbidden to do its managerial or administrative work. One of the deliverance team commands specific demons to go, while others sing or pray or speak in tongues.

The deliverance candidate is not to pray aloud or speak in tongues, because his mouth and breath need to be available for the exit of the evil spirits. At this point, he or she blows out forcefully several times or forces a few coughs. These actions, or yawning, are ways in which the demons may be expelled. According to Hammond and Hammond, breathing or coughing will usually be “enough to ‘prime the pump’ and the demons will begin to move out readily … [or] the demons then begin to yawn themselves out” (1973/2010, p. 123).

Some deliverers emphasise the use of “eye contact” and treat mutual gaze as a mode of direct contact with the demon – presumably the “strong man” who manages a group of demons, as they are generally thought to be present in multiples. One deliverer has suggested,

Once you have established the distance you want to work at, then you can look directly into the eyes of the demonized person [The term ‘demonized’ is used to indicated that the person is possessed or attacked by demons. J.M.] The demon will not like the light of Jesus that you will have coming out of your eyes. The person may try to look away, but if at all possible try to have them maintain proper eye contact with you through most of the actual deliverance if they possibly can. (“Deliverance system for casting out demons on the inside of a person”, [14])

Deliverance may require several hours or longer to accomplish, however. The candidate may ask for a drink of water or the use of the toilet, but the deliverance team needs to take care that this request was not made by the demon rather than the person. Hammond and Hammond suggest that alert deliverers will not be taken in, but will consider

How deeply has the person been taken over by the spirits? Are the eyes glazed or fixed? Is the voice that of the person? What does your own spirit say? [again, the issue is the existence of a word of knowledge that is of necessity true. J.M.]. (1973/2010, p. 98)

Similarly, demons may cause the deliverance candidate to become wildly active and dangerous to the deliverers:

[in one case] spirits had taken the man over and the two [deliverers] were down on the floor forcibly restraining his arms and legs. After awhile the man pleaded that they were hurting him and that he needed to rest for a few minutes. Not realizing that it was a demon speaking … they released their holds. As soon as the legs were released the demon caused the man to kick, and [one of the deliverers] suffered three broken ribs. (Hammond & Hammond, [20], pp. 98–99)

Positioning of the deliverance candidate is an important part of the proceedings. This is because the expulsion of the demons, along with mucus and possibly vomit, through nose and mouth is more easily accomplished in certain postures.

One of the best positions is for the person to be seated in a straight chair and bent forward from the waist with forearms resting on the knees … In a few cases the person may want to lie face down on the floor or get on his hands and knees. (Hammond & Hammond, [20], p. 99)

When a child is the deliveree, the situation is somewhat changed. Adult deliverance candidates have asked for help, and although they may show “demonic” resistance, they are on the whole cooperative. Children have usually not asked for deliverance, but are brought by parents who attribute child moods or behaviour to demonic possession. Deliverance of children begins with laying on of hands, which may be resisted by the child, who complains that it hurts or burns. These objections are treated as statements made by demons and thus further proof of demonic possession. An additional step is the testing of the child’s will, which

must be brought into subjection by use of authority and of perseverance … When you encounter a stubborn child, he will set his will against the ministry. He will not cooperate but will resist you. The child will not willingly sit on your lap or do anything you suggest … [Demon spirits] may cause the child to struggle to get off your lap and struggle against your restraint of his flailing arms and legs. He may be screaming, kicking, clawing and biting. This is no time for faintheartedness. You are engaged in spiritual combat with a heap of flesh thrown in, and you must be committed to see the battle through to victory. (Hammond & Hammond, [21], p. 55)

Although deliverers may refer to words of knowledge received in the course of a deliverance, or may report that they are not conscious of the proceedings (Wagner, [44]), students of the “anthropology of Christianity” have reported that the ritual used appears repetitious and exterior-originated. Bialecki [ 7], who observed the deliverance practices of a California group, described the events as focused on the conventional and material. Bialecki commented that

there is a sense that the demonic presence has a crypto-physical aspect, with coughing and vomiting often taken as a sign that the demon has either exited, or is on its way out. Even some of the language used to control the demon has a mechanistic quality – the staccato recitation of the command to depart “in Jesus’ name”, rapidly repeated and paired with the repetitive punctuation of snapped fingers, seems to stress the magical aspect of language in its reliance upon the power of that name; it also implied a conception of repeated invocations of that name that seems divorced from any semantic meaning attached to it. (p. 696)

Factors that interfere with deliverance

Advocates of deliverance theology recognise that deliverance practices do not always cure physical and mental illnesses, even when deliverers claim the disorders as demon-caused. Factors present in the deliverance situation are blamed for the lack of efficacy. For example, a lack of forgiveness in the deliverance candidate will interfere with deliverance. Similarly, a person’s deliverance will fail if he or she has been involved with occult matters or any religious cult (as defined by Pentecostals), without subsequently confessing this and asking God’s forgiveness. Unconfessed connections with abortion have the same effect; for instance, a woman who had not confessed agreeing with a neighbour that the neighbour should terminate a fourth pregnancy could not be delivered from her demons. However, there is disagreement about whether or not an unconfessed adultery will prevent successful deliverance (Hammond & Hammond, [21], pp. 119–120).

Discussion 1: Ethics And The Law And /Discussion 2: Reflections On Ethical Leadership

Discussion 1: Ethics and the Law

When working with clients, it is important to maintain professional boundaries to safeguard both you and your clients. Legislation such as HIPPA (Health Insurance Portability and Accountability Act of 1996) and the National Association of Social Workers Code of Ethics are specific in how you as a social worker should protect client information and safeguard confidentiality. Responding ethically in a professional situation may be clear in most situations, but not necessarily in all situations. Even though you have established laws and code of ethics to guide your decision-making process, you may still face ethical conflicts.

For this Discussion, review the media of the Bradley case and consider how the case relates to social work professional ethics.

By Day 3

Post the strategy you would use to address the Teen First director’s request if you were the social worker in the Bradley case. Then, describe a hypothetical situation in which an organization’s decision conflicts with your personal/professional ethics but remains within the law. Explain how you would respond to this situation, and why.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

AND

 

Discussion 2: Reflections on Ethical Leadership

What does it mean to be an ethical leader? How is ethical leadership demonstrated in social work practice? As a leader in the social work profession, you have to achieve a balance between your professional and personal ethics. At times, these may be aligned with each other, but there may be situations in which they conflict. Because leadership includes value and moral dimensions, your character, actions, and goals as a social work administrator should reflect ethical leadership.

For this Discussion, consider the characteristics of ethical leadership and the challenges associated with practicing ethical leadership.

By Day 4

Post your definition of ethical leadership as it relates to the social work profession. Explain what it means to be an ethical leader and describe the challenges of being an ethical leader.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

Career Scavenger Hunt Assignment

Overview

This scavenger hunt comprises two primary sections. In the first section, resources available through the National Career Development Association (NCDA) are explored through a question and answer scavenger hunt. The intent is to familiarize students with the various NCDA resources available. The purpose of Part II of this assignment is to learn how to use the Occupational Outlook Handbook to gather relevant labor market information that would be commonly solicited from career counseling clients. The Occupational Outlook Handbook, available online through the Department of Labor (bls.gov/ooh/), is a comprehensive source of career information that is often used by career counselors. The OOH, which is updated every 2 years, provides detailed information on hundreds of careers.

Instructions

Part I: NCDA Scavenger Hunt

You will find the answers to 8 questions by searching the NCDA website. If you have difficulty in navigating around a website, ask your classmates for help.

**Answer these questions using complete sentences.

Directions: Go to the NCDA website (ncda.org) and find the answers to the following questions:

  1. What is the relationship of the NCDA to the American Counseling Association?
  2. What is the purpose of the NCDA?
  3. What are your personal results after taking the Career Decision Making Difficulties Questionnaire (CDDQ)? Note: Once you are at the CDDQ launch page, you can opt to take either the CDDQ or the CDDC (Coping with Career Decision-Making Difficulties).
  4. What is the purpose of the Motivational Assessment of Personal Potential (MAPP)?
  5. Find the website that will take you to the Occupation Data from the U.S. Bureau of Labor Statistics. Find the Occupational employment projections to 2022 link. What are the anticipated fastest growing fields?
  6. What is the purpose of America’s CareerInfoNet?
  7. According to CareerInfoNet, what are the top five fastest growing occupations for persons with a bachelor’s degree? (Hint: Start with the Occupation Information links)
  8. Using salary.com (NCDA has a link), what is the base salary range for a licensed professional counselor in Baton Rouge, Louisiana?

Part II: Occupational Outlook Handbook (OOH) Scavenger Hunt

You will use the Occupational Outlook Handbook, available online through the Department of Labor (bls.gov/ooh) information to answer questions from the 5 scenarios presented below.

Use the information from the OOH to find the answers presented in the following scenarios:

**Answer these questions using complete sentences. Provide justification for your answer when requested.

Scenario 1: A client, who has recently lost his job as an automobile dealer, is interested in exploring other career opportunities and has narrowed his search to those found below. Specifically, he is interested in a job that “pays well.” Which of the following occupations would you recommend and why?

  • Investment Banker
  • Mortgage Broker
  • Airline Pilot
  • Dermatologist
  • Electrical Engineer

Scenario 2: A client who is just starting college is interested in exploring career opportunities that will best ensure finding a job after graduation. Specifically, she has narrowed her choices to 1 of the following careers. What are the employment outlooks for each of these occupations?

  • Counselor
  • Photographer
  • Occupational Therapist
  • Childcare Worker

Scenario 3: A client who is just graduating from high school is looking for a career that will provide the most flexibility in a work schedule. Specifically, your client has narrowed his choices to 1 of the following. Which offers the highest possibility of a flexible work schedule?

  • Registered Nurse
  • Tour Guide
  • Private detective
  • Bank teller

Scenario 4: A client who has been a trucker for 15 years and has recently suffered a back injury is interested in finding a career that requires little physical risk. He has narrowed his interest to 1 the following. Which career requires the least physical risk?

  • Motorcycle repair technician
  • Chef
  • Landscaper
  • Security Guard

Scenario 5: A client who is a skilled artist and has an Associate’s degree from the local community college, is interested in becoming a medical illustrator. He wants to know the following:

  • Does he need any more education or training?
  • What is the average income of a medical illustrator?

Record your answers to these questions on a separate document and submit through the link in Blackboard.

Ethics Of Religion

1,750 words, describe the ethical implications of implementing religion or spirituality into therapy regarding the four areas of ethical consideration listed below. Explain how the Christian worldview can be used to help guide ethical decision making for each of these areas.

1. Competence

2. Multiple relationships

3. Imposing religious values in therapy

4. Informed consent

The Christian worldview GCU Statement on the Integration of Faith and Work document attached has been included as a possible reference.

Use a minimum of three peer-reviewed sources as well as the textbook and the APA Code of Ethics with APA formatted in-text citations and references. Refer to the informed consent document.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

This course requires the use of the “Integration of Faith and Work at GCU” found on the GCU website at https://www.gcu.edu/sites/default/files/media/Documents/IFLW.pdf (or a PDF is attached).

  • 65

    3 ETHICAL GUIDELINES FOR USING

    SPIRITUALLY ORIENTED INTERVENTIONS

    WILLIAM L. HATHAWAY

    The empirical literature pertaining to clinical practice with religious and spiritual issues is still at a relatively early stage, but in recent years a substantial amount of attention has been paid to ethical issues in this domain (Gonsiorek, Richards, Pargament, & McMinn, 2009; Hathaway & Ripley, 2009; Plante, 2007, 2009; Richards & Bergin, 2005; Sperry & Shafranske, 2005). This liter- ature has focused on a wide range of ethical concerns, such as protecting against harmful bias, practicing within one’s boundaries of competence, and exploring role considerations in working with religious issues.

    In this chapter, I begin by bringing attention to how psychologists’ rela- tive lack of religious commitment has the potential for creating and introduc- ing biases into treatment. A brief introduction provides readers with common conceptualizations of spiritually oriented interventions in the recent psycho- logical literature. This is followed by an examination and application of rele- vant ethical codes to the use of spiritually oriented interventions. Spiritually oriented interventions are then discussed from an accountable practice perspec- tive. Training recommendations are also provided to help facilitate the ethical application of such interventions. Brief clinical examples and questions are also offered to help readers delve deeper into thinking about the ethical issues that

    To the psychologist the religious propensities of man must be at least as interesting as any other of the facts pertaining to his mental constitution.

    —William James (1997)

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    http://dx.doi.org/10.1037/12313-003 Spiritually Oriented Interventions for Counseling and Psychotherapy, by J. D. Aten, M. R. McMinn, and E. L. Worthington, Jr. Copyright © 2011 American Psychological Association. All rights reserved.

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    must be considered before using spiritually oriented interventions in clinical practice.

    POTENTIAL FOR PROBLEMATIC BIASES

    It has been frequently noted that professional psychologists appear to be atypically irreligious compared with the general North American popu- lation. Plante (2009), for instance, cited Gallup polls indicating that 95% of Americans believe in God and 40% of attend religious services on a weekly basis. Despite a widespread prevalence of religiousness in the general popula- tion, researchers (Bergin & Jensen, 1990; Delaney, Miller, & Bisono, 2007; Hathaway, Scott, & Garver, 2004; Shafranske, 2000) have noted that, relative to the general population, psychologists (a) have double the rate of claiming no religion, (b) are more likely by a factor of three to report religion being unim- portant in their life, (c) have a five-fold higher rate of denying belief in God, and (d) report lower likelihoods of attending religious services, being a member of a congregation, or engaging in prayer.

    The risk is that this lower level of conventional religiousness among psy- chologists may result in biasing blind spots that lead them to erroneously dis- regard significant religious issues in clinical practice. Unfortunately, there is evidence that just this sort of neglect is occurring. Russell and Yarhouse (2006) found that over two thirds of a sample of training directors at American Psychological Association (APA) internships never foresaw offering training in religious and spiritual issues at their sites. Brawer, Handal, Fabricatore, Roberts, and Wajda-Johnston (2002) surveyed training directors of APA- accredited doctoral training programs and found that only 17% reported sys- tematic coverage of religion and spirituality in their programs. There is little evidence that such findings cause much concern outside of the niche of psychologists who specialize in the clinical psychology of religion. Imagine if such lassitude in the profession were the case for any of the other named diversity domains highlighted for particular attention in the APA (2010) Ethics Code (hereafter referred to as the Code).

    Yet the situation may be even more problematic than just a climate of indifference. There is evidence that psychologists may be more likely than the general population to be hostile and prejudicial to conventional religion. Delaney, Miller, and Bisono (2007) noted that “it appears to be a relatively fre- quent experience among psychologists to have lost belief in God and disaffili- ated from institutional religion” (p. 542). They found this experience to be nearly 7 times more frequent in their sample of psychologists than in the gen- eral population. In a study of whether antireligious discrimination may be occurring in admissions to doctoral programs in clinical psychology, Gartner

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    (1986) found that a sample of faculty at doctoral programs accredited by the APA were less likely to grant admission or to have positive feelings about appli- cants whose admissions protocols contained a conventional religious identifi- cation than about those whose protocols were otherwise identical except for the absence of such religious identification.

    It seems unlikely that a negative or less receptive atmosphere among psy- chologists toward conventional religion would not translate into problematic clinical practice patterns toward this client population or niche. In a random national sample of clinical psychologists, Hathaway et al. (2004) found that most psychologists do not routinely assess for clinically relevant spiritual or reli- gious issues in practice. They also noted that a sizeable portion of their sample did not feel that religion is more than a slightly important adaptive domain for such focus.

    Although there is no systematic research on the prevalence of apparent antireligious biases and/or overt discrimination toward conventionally religious clients by psychologists, numerous anecdotes have been recounted by clini- cal psychologists (Cummings, O’Donohue, & Cummings, 2009). A doctoral psychology intern at a respected internship informed me about being instructed by his supervisor to diagnose a client with a delusional disorder because the client expressed belief in intelligent design as opposed to evolution. The client reportedly did not display any other indications of thought disorder, psychotic process, or life impairment related to her beliefs. The intern expressed concern about giving this diagnosis, but the supervisor insisted and explained that the intelligent design belief itself was sufficient to warrant the diagnosis.

    Let us assume that naturalism is true and all of the varieties of beliefs self- identified as intelligent design are false. This would hardly justify a mental health professional diagnosing a believer in intelligent design with a delusional disorder. It has become common in the polemics surrounding the new atheism to declare either theistic or atheistic belief to be a delusion (Dawkins, 2006; Hart, 2009). In terms of pure logic, either atheism or theism is true, but not both, so one of the two groups believes something that is false. Yet having a false belief is not the same thing as having a delusional belief, in a technical psy- chological sense. Delusional beliefs involve a disordered thought process and not just acceptance of beliefs that turn out to be factually incorrect (Clarke, 2001). Giving such a diagnosis in the absence of a genuine psychotic process runs a significant risk of iatrogenic consequences for the client, such as bearing the stigma of receiving an unwarranted diagnosis of a serious psychiatric con- dition, potentially having career and life options adversely affected, or being the recipient of unnecessary treatments. Thus, this practice may constitute a violation of the cardinal ethical concern of doing no harm.

    Although negative or undervaluing biases toward conventional religion appear to be a common risk among psychologists, problems can also arise from

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    proreligious biases. The American Psychiatric Association (1989) adopted guidelines warning against a psychotherapist imposing his or her religious val- ues or beliefs on clients. The ethical principle of nonmalfeasance (i.e., doing no harm) implies that psychologists should not attempt experimental proce- dures in lieu of standard proven psychotherapies without clear warrant and informed consent. I have encountered some psychologists who are personally religious abandoning standard approaches to common clinical problems for which well-supported treatments exist in favor of stand-alone explicitly reli- gious interventions. The stand-alone approaches eschew any other form of assistance apart from the religious or spiritual practice. Typically, these reli- gious caregivers have justified the stand-alone spiritual approaches in terms of their own religious beliefs about what is right for the person. Sometimes these spiritual-only-approach psychotherapists are licensed mental health professionals and other times they are not.

    Some of their care recipients report benefits from such stand-alone spiritual-only approaches, but others do not. Their clients are not typically given any scientific data about likely responses to the approach (e.g., success rates, rates of nonresponders, adverse risks), although testimonials of success are frequently shared with the clients. Some persons in our community sought assistance from nonreligious caregivers after dropping out from these stand- alone spiritual-only treatments. The stand-alone dropouts indicated that they were not typically informed by the spiritual-only-approach provider about standard treatments for their concerns or about the experimental nature of the approach. In cases in which this care was being provided by a nonmental health professional, this is perhaps not surprising, but some of these cases involved licensed mental health professionals.

    The stand-alone dropouts typically reported that their presenting issues had not improved. In fact, they sometimes now had added guilt and shame over not getting better from the stand-alone spiritual approach. When the lack of positive treatment response is attributed to God being unable or unwilling to help, it may deepen recipients’ faith conflicts and emotional pain.

    Now, I am not suggesting that such anecdotes prove the stand-alone spir- itual treatments to be ineffective or noxious. Every treatment, even ones with good empirical support, has nonresponders and dropouts. Furthermore, there is a growing body of evidence that spiritually focused and accommodative approaches that combine spiritual interventions with standard psychotherapeu- tic techniques and relational skills are benign and helpful to clients (Tan & Johnson, 2005; Worthington & Sandage, 2002). My concern has more to do with ethical issues raised by the way the licensed caregivers engaging in the stand-alone spiritual approaches practiced (Gonsiorek et al., 2009).

    These stories call attention to the need for psychologists to adequately consider the range of relevant ethical principles, standards, and other consid-

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    erations that should guide our practice with regard to religious and spiritual issues (Knapp & VandeCreek, 2006). Hathaway and Ripley (2009) pointed out that such guidance can be found by reflecting on relevant ethical codes, pol- icy statements, practice guidelines, legal precedents, exemplar guidance, and evidence-based practice considerations. Let us now reflect on their relevance for the explicit use of spiritually oriented interventions by psychologists.

    SPIRITUALLY ORIENTED INTERVENTIONS

    A growing literature on spiritually oriented interventions provides detailed descriptions of how to conduct such interventions competently and ethically (Plante, 2009; Richards & Bergin, 2005; Schlosser & Safran, 2009). There is no standard language used to identify this group of interventions. Plante (2009) described them as spiritual practices or tools. Richards and Bergin (2005) referred to them as either theistic or spiritual interventions (p. 281). Schlosser and Safran (2009) called them spiritual interventions and techniques (p. 199). There is considerable overlap among the spiritually oriented interven- tions enumerated by these authors (see Table 3.1). Although some of these would likely be readily thought of as spiritual by most individuals (e.g., the use of prayer), others may be less obvious examples to some of a specifically “spiri- tual” intervention (e.g., meaning making or relaxation).

    Among psychotherapists who seek to incorporate an explicitly spiritual aspect to treatment, Schlosser and Safran (2009) also distinguished between two general approaches: “spiritually accommodative approaches typically com- bined a manualized treatment with practices and beliefs from a particular world religion, whereas spiritually oriented approaches are typically less standardized and more inclusive” (p. 200). It should be noted that none of the psychologists whose work is cited in Table 3.1 is proposing a stand-alone use of spiritual and religious interventions or techniques regardless of whether they are used in a spiritually accommodative or spiritually oriented manner.

    RELEVANT ETHICAL GUIDANCE

    The Code provides psychologists with a list of ethical aspirational princi- ples and enforceable standards that are either explicitly or implicitly relevant to the use of spiritually oriented interventions in clinical practice. An example of an explicitly relevant principle from the Code is Principle E, titled “Respect for People’s Rights and Dignity.” The principle states the following:

    Psychologists respect the dignity and worth of all people and the rights of individuals to privacy, confidentiality, and self-determination.

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    Psychologists are aware that special safeguards may be necessary to pro- tect the rights and welfare of persons or communities whose vulnerabil- ities impair autonomous decision making. Psychologists are aware of and respect cultural, individual, and role differences, including those based on . . . religion . . . and consider these factors when working with mem- bers of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices. (APA, 2010, p. 1063)

    The earlier discussion of the role of bias in psychological practice with religious issues directly and explicitly intersects with Principle E. Psychologists should be diligent and intentional in preventing relevant biases from affect- ing religious or spiritual issues in treatment. The simplistic characterization of

    70 WILLIAM L. HATHAWAY

    TABLE 3.1 Three Lists of Spiritually Oriented Interventions

    Theistic/spiritual Spiritual interventions interventions and techniques Spiritual practices or tools

    Richards & Bergin (2005) Schlosser & Safran (2009) Plante (2009)

    Therapist prayer Teaching spiritual

    concepts Reference to Scripture Spiritual self-disclosure Spiritual confrontation Spiritual assessment Religious relaxation

    or imagery Therapist and client prayer Blessing by therapist Encouragement for

    forgiveness Use of religious community Client prayer Encouragement of client

    confession Referral for blessing Religious journal writing Spiritual meditation Religious bibliotherapy Scripture memorization Dream interpretation

    Prayer (therapist or client guided)

    Teach spiritual concepts Forgiveness Reference sacred writings Meditation Spiritual self-disclosure Encourage altruism and

    service Spiritual confrontation Spiritual assessment Spiritual history Spiritual relaxation and

    imagery Clarify spiritual values Use Spiritual community

    and spiritual programs Spiritual journaling Experiential focusing

    methods Encourage solitude and

    silence Use spiritual language

    and metaphors Explore spiritual elements

    of ereams Spiritual genogram

    Prayer Meditation Meaning, purpose, and

    calling in life Bibliotherapy Attending community

    services and rituals Volunteerism and charity Ethical values and

    behavior Forgiveness, gratitude,

    and kindness Social justice Learning from spiritual

    models Acceptance of self and

    others (even with faults)

    Being part of something larger than oneself

    Appreciating the sacred- ness of life

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    a client’s belief in intelligent design as a delusional disorder illustrates the inap- propriate operation of such a bias. However, the desire of a proreligious psy- chologist to promote a spiritual activity in psychotherapy when the spiritually oriented intervention is not chosen in deference to an informed client’s own beliefs, values, and preferences would also be example of such bias.

    The Code’s second standard on competence has both explicit and implicit relevance to the use of spiritually oriented interventions. Standard 2.01a states, “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience” (APA, 2010, p. 1063). Thus, a psychologist who is not trained to appropriately use spiritually oriented interventions would be wise in avoiding their use until he or she takes steps to ensure competency and avoidance of client harm. Until such training is received, it would be appropriate to make a referral for a client who requests explicit use of spiritually oriented inter- ventions or who presents with prominent religious and spiritual issues.

    Yet this does not mean that psychologists should be content simply to avoid this domain indefinitely. Standard 2.01b further states the following:

    Where scientific or professional knowledge in the discipline of psychol- ogy establishes that an understanding of factors associated with . . . religion . . . is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consulta- tion, or supervision necessary to ensure the competence of their services, or they make appropriate referrals. (APA, 2010, pp. 1063–64)

    The relatively ubiquitous nature of religion and spirituality renders it pro- pitious for general practitioners to obtain at least a basic competence in this domain. Standard 2.01c states that “psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or tech- nologies new to them undertake relevant education, training, supervised experience, consultation, or study” (APA, 2010, p. 1064). Given that formal training in this domain is the exception for most psychologists as part of their prelicensure preparation for practice, seeking out continuing education, con- sultation, and a supervisor to obtain a religious and spiritual practice compe- tency would be a commendable priority for many psychologists. For those psychologists who do have a proficiency in working with religious and spiritual issues, continued consultation and professional development is advised, partic- ularly when encountering clients whose spirituality diverges from one’s prior preparation.

    APA’s Division 36 (Psychology of Religion) appointed an ad hoc com- mittee that has formulated preliminary practice guidelines for clinical work with religious and spiritual issues (Hathaway, 2005). The guidelines were developed by identifying common shared recommendations offered by over

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    20 exemplar professionals in the clinical psychology of religion. Guidelines related to assessment, intervention, and relevant multicultural competency issues in the domain were formulated. The subset of preliminary guidelines specifically addressing the use of religious and spiritual interventions can be found in Exhibit 3.1. The full set of preliminary guidelines can be found in Hathaway and Ripley (2009).

    As part of the ad hoc committee’s ongoing work, I presented a set of five principles that undergird the preliminary practice guidelines (Hathaway, 2009). The Division 36 preliminary guideline principles are presented in Exhibit 3.2 and include awareness, respect, routine assessment focus, clinically congruent roles, and competence. These themes converge with those noted as relevant for clinicians seeking to appropriately incorporate spirituality and religion into practice by Plante (2004, 2007, 2009) and others (Gonsiorek et al., 2009). Plante has summarized the relevance of five ethical principles derived from the Code for guiding psychologists in the use of spiritually oriented interventions in practice under the acronym RRICC (i.e., Respect, Responsibility, Integrity, Competence, and Concern).

    ETHICAL USE IS APPROPRIATE CLINICAL USE

    Many of the spiritual and religious practices listed in Table 3.1 are fre- quently used in nonclinical contexts and for other purposes. For instance, the use of directed prayer or scripture reading could be used as an evangelistic tool designed to cultivate or instill faith. If these practices were used in an evan- gelistic context, such use would be congruent with the explicit purpose of the context. However, if they were being used for this purpose in the context of professional psychological practice, it would likely violate numerous ethical principles and standards.

    Principle B of the Code states the following:

    Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations. (APA, 2010, p. 1062)

    A professional psychologist operates within a publically and legally granted fiduciary space (Reaves, 1996). As licensed professionals, psychologists agree to practice congruent with applicable scope of practice, standards, legal precedent and other structures arising from relevant regulatory codes.

    To appropriately use spiritually oriented interventions, licensed psychol- ogists must do so congruent with their clinical role and regulating standards.

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    ETHICAL GUIDELINES 73

    EXHIBIT 3.1 Division 36 Preliminary Religious and Spiritual Intervention Guidelines

    1. Psychologists obtain appropriate informed consent from clients before incorpo- rating religious/spiritual techniques and/or addressing religious/spiritual treat- ment goals in counseling.

    2. Psychologists accurately represent to clients the nature, purposes, and known level of effectiveness for any religious/spiritual techniques or approaches they may propose using in treatment.

    3. Psychologists do not use religious/spiritual treatment approaches/techniques of unknown effectiveness in lieu of other approaches/techniques with demon- strated effectiveness in treating specific disorders or clinical problems.

    4. Psychologists attempt to accommodate a client’s spiritual/religious tradition in congruent and helpful ways when working with clients for whom spirituality/ religion is personally and clinically salient.

    5. Religious/spiritual accommodations of standard treatment approaches/protocols are done in a manner that (a) does not compromise the effectiveness of the standard approach or produce iatrogenic effects, (b) is respectful of the client’s religious/spiritual background, (c) proceeds only with the informed consent of the client, and (d) can be competently carried out by the therapist.

    6. Psychologists are mindful of contraindications for the use of spiritually/ religiously oriented treatment approaches: (a) Generally, psychologists are discouraged from using explicit religious/spiritual treatment approaches with clients presenting with psychotic disorders, substantial personality pathology, or bizarre and idiosyncratic expressions of religion/spirituality. (b) Psychologists should discontinue such approaches if iatrogenic effects become evident.

    7. When psychologists use religious/spiritual techniques in treatment, such as prayer or devotional meditation, they (a) clearly explain the proposed technique to the client and obtain informed consent, (b) do so in a competent manner that is respectful of the intended religious/spiritual function of the technique in the client’s faith tradition, and (c) adopt such techniques only if they are believed to facilitate a treatment goal.

    8. Psychologists appreciate the substantial role faith communities may play in the lives of their clients and consider appropriate ways to harness the resources of these communities to improve clients’ well-being.

    9. Psychologists avoid conflictual dual relationships that might arise in religious/ spiritually oriented treatment or in adjunctive collaborations with faith communities.

    10. Psychologists set explicitly religious/spiritual treatment goals only if (a) they are functionally relevant to the clinical concern, (b) can be competently addressed within the treatment, (c) can be appropriately pursued within the particular context and setting in which treatment is occurring, and (d) are consented to by the client.

    11. Psychologists commit to a collaborative and respectful demeanor when addressing aspects of a client’s religion/spirituality the psychologist deems maladaptive or unhealthy. The preferred clinical goal in such cases is to pro- mote more adaptive forms of the client’s own faith rather than to undermine that faith.

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    This can be illustrated by considering one such spiritually oriented intervention. Moriarty and others have been investigating interventions to alter God image (Moriarty & Hoffman, 2007), defined as “the complex, subjective emotional experience of God” (p. 2). A variety of strategies have been deployed in an effort to alter God image, including bibliotherapy, appropriate use of cognitive psy- chotherapy strategies, group psychotherapy, and integrative–psychodynamic approaches. Certain types of God image are more associated with depressed states and others with less depressed states. Let us suppose that God image psy- chotherapies are successful at fostering a shift toward God images that are less associated with depression. When would such an intervention be appropriate? Several factors that are highlighted in Exhibit 3.1 would impinge on determin- ing whether such an intervention is ethical. Did the client provide informed consent from the intervention? Did the information provided to the client prior to this consent “accurately represent to the client(s) the nature, purposes, and known level of effectiveness” (see Exhibit 3.1, item 2) for the God image inter- vention? Was the God image intervention used adjunctively and not in lieu of other interventions that have higher levels of demonstrated effectiveness for treating the clinical concern (unless the God image intervention has been demonstrated to be equally effective as a stand-alone treatment through ade- quate research)? Is the God image intervention being used in a manner that is respectful of the client’s religious and spiritual tradition? If the God image inter- vention is being used adjunctively with another established treatment, is it being done in a manner that does not compromise the effectiveness of the stan- dard treatment? Can the psychologist using the God image intervention do so in a competent manner? A negative answer to any of these considerations would contraindicate that use of the God image intervention.

    The fourth Division 36 preliminary practice guideline principle states, “When engaged in spiritually oriented practice activities, psychologists should do so congruently with their clinical roles” (see Exhibit 3.2, item 4). So in

    74 WILLIAM L. HATHAWAY

    EXHIBIT 3.2 Division 36 Preliminary Practice Guideline Principles

    1. Awareness: Psychologists aspire to cultivate deliberate and nuanced awareness of relevant religious and spiritual issues in practice.

    2. Respect: Psychologists seek to maintain a respectful demeanor towards the religious and spiritual domain in clinical practice.

    3. Routine assessment focus: Psychologists strive to routinely and intentionally assess for relevant religious and spiritual considerations in practice.

    4. Clinically congruent roles: When engaged in spiritually oriented practice activities, psychologists should do so congruently with their clinical roles.

    5. Competence: Psychologists seek to maintain ongoing competence in their spiritually oriented practice activities.

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