ADDRESSING CLIENTS SPIRITUALITY & RELIGION ETHICAL AND BEST PRACTICE GUIDELINES CECILE BRENNAN, Ph.D. Associate Professor John Carroll University Department of Counseling cbrennan@jcu.edu ETHICAL GUIDELINES Ethical Guidelines found in the ACA Ethical Code focus on non- discrimination and imposition of personal values. A.4.b. Personal Values Counselors are aware of and avoid imposing their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor s values are inconsistent with the client s goals or are discriminatory in nature. 1
A.11.b. Values Within Termination and Referral Counselors refrain from referring prospective and current clients based solely on the counselor s personally held values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor s values are inconsistent with the client s goals or are discriminatory in nature. C.5. Nondiscrimination Counselors do not condone or engage in discrimination against prospective or current clients, students, employees, supervisees, or research participants based on age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital/ partnership status, language preference, socioeconomic status, immigration status, or any basis proscribed by law. CARE These guidelines mean that counselors must be comfortable working with clients from various religious and spiritual backgrounds. Counselors can prepare for this by implementing: CARE Becoming familiar with the ASERVIC COMPETENCIES. Implementing use of an ASSESSMENT tool. Developing RELIGIOUS and spiritual literacy. EVALUATING whether the religious/spiritual practice is life and health affirming. 2
ASERVIC SPIRITUAL COMPETENCIES http://www.aservic.org/resources/spiritual- competencies/ Preamble The Competencies for Addressing Spiritual and Religious Issues in Counseling are guidelines that complement, not supersede, the values and standards espoused in the ACA Code of Ethics. Consistent with the ACA Code of Ethics (2005), the purpose of the ASERVIC Competencies is to recognize diversity and embrace a cross- cultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts (p. 3). These Competencies are intended to be used in conjunction with counseling approaches that are evidence- based and that align with best practices in counseling. CULTURE and WORLDVIEW 1. The professional counselor can describe the similarities and differences between spirituality and religion, including the basic beliefs of various spiritual systems, major world religions, agnosticism, and atheism. 2.The professional counselor recognizes that the client s beliefs (or absence of beliefs) about spirituality and/or religion are central to his or her worldview and can influence psychosocial functioning. COUNSELOR SELF-AWARENESS 3. The professional counselor actively explores his or her own attitudes, beliefs, and values about spirituality and/or religion. 4. The professional counselor continuously evaluates the influence of his or her own spiritual and/or religious beliefs and values on the client and the counseling process. 5. The professional counselor can identify the limits of his or her understanding of the client s spiritual and/or religious perspective and is acquainted with religious and spiritual resources, including leaders, who can be avenues for consultation and to whom the counselor can refer. 3
HUMAN and SPIRITUAL DEVELOPMENT 6. The professional counselor can describe and apply various models of spiritual and/or religious development and their relationship to human development. COMMUNICATION Communication 7. The professional counselor responds to client communications about spirituality and/or religion with acceptance and sensitivity. 8. The professional counselor uses spiritual and/or religious concepts that are consistent with the client s spiritual and/or religious perspectives and that are acceptable to the client. 9. The professional counselor can recognize spiritual and/or religious themes in client communication and is able to address these with the client when they are therapeutically relevant. ASSESSMENT 10. During the intake and assessment processes, the professional counselor strives to understand a client s spiritual and/or religious perspective by gathering information from the client and/or other sources. 4
DIAGNOSIS and TREATMENT 11. The professional counselor sets goals with the client that are consistent with the client s spiritual and/or religious perspectives. 12. When making a diagnosis, the professional counselor recognizes that the client s spiritual and/or religious perspectives can a) enhance well- being; b) contribute to client problems; and/ or c) exacerbate symptoms. SPIRITUAL ASSESSMENT TOOL--FICA Puchalski, c. (1999) F =FAITH or BELIEFS What is your faith or belief? Do you consider yourself spiritual or religious? What things do you believe in that give meaning to your life? I=Importance and Influence Is it important in your life? What influence does it have on how you take care of yourself? How have your beliefs influenced your behavior during this illness? What role do your beliefs play in regaining your health? 5
C=COMMUNITY Are your part of a spiritual or religious community? Is this of support to you and how? Is there a person or group of people you love or who are really important to you? A=ADDRESS How would you like me, your healthcare provider, to address these issues in your life? FICA GENERAL RECOMMENDATIONS 1. Consider spirituality as a potentially important component of every patient s physical well being and mental health. 2. Address spirituality at each complete physical exam and continue addressing it at follow- up visits if appropriate. In patient care, spirituality is an on- going issue. 3. Respect a patient s privacy regarding spiritual beliefs; don t impose your beliefs on others. 6
4. Make referrals to chaplains, spiritual directors or community resources as appropriate. 5. Be aware that your own spiritual beliefs will help you personally and will overflow in your encounters with those for whom you care to make the doctor- patient encounter a more humanistic one. Puchalski, C. (2009). Spiritual assessment in clinical practice. Psychiatric Annals, 36, 150. RELIGIOUS LITERACY QUIZ PROTHERO, S. (2007) 1. Name the Four Gospels. List as many as you can. 2. Name a sacred text of Hinduism. 3. Name the holy book of Islam. 4. Where, according to the Bible, was Jesus born? 5. George Bush spoke in his first inaugural of the Jericho road. What Bible story was he invoking? 6. What are the first five books of the Hebrew Bible or the Christian Old Testament? 7. What is the Golden Rule? 8. God helps those who help themselves. Is this in the Bible? If so, where? 9. Blessed are the poor in spirit, for theirs is the Kingdom of God. Does this appear in the Bible? If so, where? 10. Name the Ten Commandments. List as many as you can. 7
11. Name the Four Noble Truths of Buddhism. 12. What are the seven sacraments of Catholicism? List as many as you can. 13. The First Amendment says two things about religion, each in its own clause. What are the two religion clauses of the First Amendment? 14. What is Ramadan? In what religion is it celebrated? MATCH Adam and Eve Paul Moses Noah Jesus Abraham Serpent MATCH Exodus Binding of Isaac Olive Branch Garden of Eden Parting of the Red Sea Road to Damascus Garden of Gethsemane Evaluate Responding to questionable practices: Apply the ACA Ethical Principles Autonomy, Beneficence, Fidelity, Justice, Non- maleficence & Veracity Consult cultural informants, cultural brokers Consult the United Nations Declaration of Human Rights: http://www.un.org/en/documents/udhr/ Apply a decision- making model. 8
Summary Become familiar with the major religions and denominations in your area. Religious Literacy: What Every American Needs to Know and Doesn t- - Stephen Prothero The World s Religions- - Huston Smith A New Religious America: How A Christian Country Has Become the World s Most Religiously Diverse Nation Diane Eck Religion That Heals, Religion That Harms: A Guide for Clinical Practice James Griffith When doing an intake assessment, or having an initial session, assess for the role of religion and spirituality. Do this using an assessment tool and incorporating the core counseling concepts of unconditional positive regard, non- judgment, and genuineness. Research approaches determined to be effective with your populations. For instance, individuals with a more literal understanding tend to prefer more practical approaches: CBT not insight oriented approaches. Learn about the major holidays, festivals, beliefs of your religiously- oriented clients. Listen for your client s use of religious concepts and images. If appropriate, mirror these back to the client. Be aware that not all belief systems are mentally healthy. As with anything else, there are toxic forms of religion/spirituality. 9
QUESTIONS OR COMMENTS? Please feel free to contact me: Cecile Brennan John Carroll University cbrennan@jcu.edu 216-397- 1987 THANK YOU!! (Enjoy the conference) 10