Implicit and Explicit Integration
Implicit integration of spirituality or religion in clinical practice refers to a more covert approach that may not initiate the discussion of religious or spiritual issues and does not systematically use spiritual resources like prayer and Scripture or other sacred texts, in therapy. Explicit integration regularly and systematically incorporates these resources which is a more overt and intentional approach (Tan, 1996). While I tend to use a combination of implicit and explicit Christian practices, I primarily lean along the continuum toward implicit, with degree varying based on the expressed desires of the client. For example, I always privately pray, prior to and following each session, for my clients’ clarity and healing, and for their lives to be blessed.
The challenge in integration styles for Christian versus non-Christian clients varies. With clients that specifically have expressed a desire for Christian counseling, for example, I open the floor for them to make choices surrounding prayer before or and/or after the session. Scriptures often help the client to learn. The use of scriptures can encourages growth within the session. Between sessions assignments researching specific scriptural topics also encourage growth. This is guided by the client’s expressed openness. With non-Christian clients, movement towards increased openness regarding understanding the spiritual side of clients’ beings has been well received. While historically we are trained as counselors not to mention spirituality or religion at all unless it is mentioned by the client, I have found that many clients who are not actively practicing a form of religion are relieved when I open the door to the discussion, and then allow them the choice to walk through it, close it, or leave it ajar to be entered when they are ready. If individual clients ask specifically for details on my beliefs, I willingly offer it. However this does not take the form of lecturing on my personal Christian beliefs, nor pressing them to believe what I believe. In addition, I look for opportunities to broach the subject of spirituality and religion in a general sense as part of my holistic approach within my view of the individual. I encourage clients to explore the idea that balance in emotional and mental healing are not solely related to the addressing of the specific problem for which they chose to enter the counseling relationship; rather, being able to approach completeness in healing must incorporate the multiple dimensions of the person, which includes spirituality. With this education and foundational framework set, it is up to the client then to make the choice to explore further how their spiritual beliefs and practices are related to the difficulties in functioning they have been experiencing, and how their spiritual beliefs are impactful in their healing. Research suggests, that it is very likely that therapists greatly underestimate “the number of clients that had spiritual or religious issues because” clients “often had mistaken assumptions that spiritual and religious issues were not appropriate for discussion” in settings that were not clearly defined as Christian counseling settings (Gingrich & Worthington Jr, 2007, p. 342).
As part of the intake assessment, general questions about client’s beliefs are always explored. Additionally clients are asked at the beginning of the therapeutic relationship (during the review of HIPPA practices and the setting of ground rules and expectations) to give their thoughts surrounding integration of faith issues and preferences during the counseling relationship. I honor these requests and also let them know the door is always open for exploration of their thoughts and feelings in the area of spirituality and religion. They may enter or exit as they desire. Also assessed is the client’s willingness to allow leeway as the therapeutic relationship strengthens, to suggest revisiting their willingness to explore this area if getting “stuck” appears connected to and avoided spiritual issue. Whatever their decision, it will be honored (American Counseling Association, 2005).
Theoretical Orientation and Applied Integration
Cognitive-Behavioral Therapy (CBT), within a psychodynamic relational vehicle is primary anchors to my counseling orientation. Spiritual underpinnings, or the influence of an individual’s relationship with God as related to life dysfunction, are also primary anchors, with the level of integration guided by the desires of individual clients in terms of addressing spiritual needs.
A relational Psychodynamic approach in simple terms allows the honesty and depth of connectedness of the therapeutic relationship between client and therapist to be a primary vehicle through which healing can occur. CBT, emerging from the Rational Emotive Behavior Therapy tradition, is a blend of behavioral and cognitive techniques, focusing on changing both thought patterns and behaviors. Aaron Beck’s cognitive approach to therapy, in the most basic sense, rests on the premise that negative, self-defeating, automatic (distorted) thoughts are “chained” to negative affective states (unpleasant physical or emotional symptoms) such as depression or other emotional disorders. In other words, “the way we perceive situations influences how we feel emotionally”, thus by changing our thought patterns, our emotional responses and behaviors can change as well. To be clear, while cognition does not directly cause depression for example, how people feel and behave is largely influenced by their cognitions, and changing how people structure their experience is the most efficient way to change disordered feelings/behaviors. Individuals’ concepts of self and the world (i.e. their positive or negative perceptions of both how the world relates to them and how they can impact / control the world based on their personal experiences in it) directly influence how individuals handle relationships (family friends, bosses, co-workers, etc), money, sexuality, career choices, etc. How an individual intellectually and emotionally makes sense of all these ties directly into their beliefs about God thinks of them. This in turn directly impacts thoughts and emotions that arise in relationships with others, and their exhibited patterns of life interactions. While behavior change and improved functioning can certainly be accomplished through counseling without considering the spiritual realities of our human existence, peace or lack thereof within this spiritual dimension must be considered as involved in true overall healing. I seek to offer this perspective and education to clients as we engage in the counseling relationship, as much as the client will allow.
When counseling with couples and families who have a desire to work through conflictual and painful situations, I engage a mix of Cognitive Therapy and Systems Theory. DiBlasio’s decision-based forgiveness model provides a vehicle for forgiveness, defined as “the cognitive letting go of resentment and bitterness and need for vengeance” (DiBlasio, 1998. p. 78). Significant biblical basis exists for making the choice to forgive, independent of an emotional desire to forgive. We are instructed in the scriptures to forgive as the Father through Christ forgave us, not to forgive because it is deserved or because our connected negative emotions have gone away (Luke 15: 11 – 32; Col. 3:13; Matt 6: 14 – 15). Through the process and implemented steps of decision-based forgiveness, cognitive exploration and clarity is encouraged. Illumination of distortion-based beliefs and emotions can occur, potentially resulting in healing and a willingness to make alternative behavioral choices. Encouraging the decision to love and forgive in the same way Jesus did creates in the soul of a married couple, the same type of healing and redemption that can be experienced through Christ. For the Christian couple, decision-based forgiveness can strengthen their individual walks with Christ, as well as strengthen the clarity and direction of their joint ministry purpose. For non-Christian couples, it is a powerful witness of what the love of Christ can mean in the life of individuals. Within families, Christ-like forgiveness of past and present family members (as well as self) aids in the process of healthy individuation and differentiation from family, in healing of the family system, and in creating a healthier homeostatic balance within the family (breaking of intergenerational dysfunction). The decision-based forgiveness process promotes these, while increasing insight, understanding, and often times, empathy for offending individuals. The healing impact to current relationships, familial or otherwise, is tremendous.
Considerations for Clinical Supervision
The broaching of spirituality by clients has been a catalyst for clinicians’ bringing the issue of spirituality and religious integration to the clinical supervision setting (Gingrich & Worthington Jr, 2007). Although I interned in a private Christian organization, during those years my comfort in dealing with spirituality and religion in the counseling session was minimal. Years of supervision following my internship were completely void of discussions on spirituality. I consider supervision the primary place for teaching and learning about spiritual and religious issues as relates to counseling, and how to work with and integrate them in the counseling session. The supervisory relationship is also the primary place in which the counselor can feel freedom to explore their own personal beliefs and determine how these beliefs inform and impact their theoretical stance on human motivation and healing. Additionally, I believe incorporation of spiritual and religious issues is a natural part of a holistic approach to the overall health of my clinicians. I currently seek to encourage exploration in clinicians I supervise, not for the purpose of evangelizing, but rather to allow them space to become comfortable in exploring, and for the purpose of modeling, towards increasing their comfort levels and flexibility for helping their clients to do the same. The working out of their personal integration of psychological and spiritual experience is critical to their ability to assist others in doing so. Tan (2001) supports this in his espoused view that “personal or intrapersonal integration is…the foundational category of integration without which integration in the principled and professional areas cannot be substantially achieved” (Tan, 2001, p. 18).
The integration of spirituality and religious beliefs within any counselor’s theoretical frame has an impact on clients’ overall holistic healing. My integration will continue to evolve as I strive for ever-increasing competency and effectiveness in my field.
American Counseling Association. (2005). American counseling association code of ethics, Alexandria, VA.
DiBlasio, F. A., & Benda, B. B. (2008). Forgiveness intervention with married couples: Two empirical analyses. Journal of Psychology and Christianity, 27, 150 – 185.
DiBlasio, F. A. (1998). The use of decision-based forgiveness intervention with intergenerational family therapy. Journal of Family Therapy, 20, 77-94.
DiBlasio, F. A. (2010). Christ-like forgiveness in marital counseling: A clinical follow-up of two empirical studies. Journal of Psychology and Christianity, 29(4), 291-300.
Gingrich, F., & Worthington Jr, E. L. (2007). Supervision and the integration of faith into clinical practice: Research considerations. Journal of Psychology and Christianity, 26(4), 342-255.
Tan, S.-Y. (1996). Religion in clinical practice: Implicit and explicit integration. In E. P. Shafranske (Ed.), Religion and the clinical practice of psychology (pp. 365-387). Washington, DC: American Psychological Association. Retrieved from http://www.ccaa.net.au/aust/documents/TanonIntegration.pdf
Tan, S.-Y. (2001). Integration and beyond: Principled, professional, and personal. Journal of Psychology and Christianity, 20(1), 18 – 28.