Faith in the Therapy Room
FAITH DEFINED
How faith is defined depends on each individual person. Even in religious circles faith is defined differently by each individual (New World Encyclopedia, n.d.). The common theme in all faith: a belief or inner conviction of something greater than self exists (Britannica, 2023). Faith arguably can be part of all people in some way and in some thing (Bishop & McKaughan, 2023). We oftentimes think of faith as only applicable to Christians or people of religious backgrounds, however, the true definition of faith is not subject to only people of religious beliefs. Faith is the internal experience that we believe something is going to happen and because we believe that something is going to happen we choose behaviors that align with the wait of the thing we have faith in or for. For instance, people have faith their favorite professional football team is going to win the Super Bowl so they buy tickets, spend money, and watch all season games because they believe they will win that year; people hold out for the perfect job, having faith the job they really want will come; or how about the example of women and men staying in relationships for years because they have faith the person they are spending so much time on is going to be the person they marry, despite the fact that most relationships end permature of marriage. Notice, faith is something that leads to a behavior regardless of evidence that behavior is going to lead where we want it. So faith is not really sided to religious people only, but instead is an inner experience inside that we can all relate to having about people, places, and things which holds us set in one position versus another position.
So again, we all experience faith. This article focuses on providers, specifically counselors and social workers, providing services to people, in order to help this group of professionals understand the importance of assessing for faith background of their clients throughout the therapy experience. Regardless of the professional’s religious background, or non-background, giving a voice to our clients to choose how they want to bring faith into the counseling journey is important.
Interesting Finding
Currier et al. (2023), focused on the importance of behavioral health professionals (counselors, psychologists) assessing for and focusing on throughout the therapeutic session time on religious and spirituality of their clients to ensure their clients know they have a safe space to discuss such important areas of their culture and person. Currier et al. found evidence that a primary reason for behavioral health professionals not focusing on these areas with clients is their own lack of cultural sensitivity and knowledge and discomfort surrounding the topics. This is not abnormal. When we as human beings lack knowledge and experience in any area we tend to feel discomfort and shy away from the role. This research provides support for additional training to be implemented across professional roles of people working in direct care settings to expand their cultural awareness and increase sensitivity to other backgrounds. Training is best to focus on various religious beliefs, backgrounds, and how to bring this into the work with clients including the assessment phases and counseling phases.
Assessing for Faith
Importance of Assessment
Assessment is an important timeframe of treatment that is critical to the development of goals and the treatment journey. Take time to assess your clients treatment goals and objectives and ensure you are giving the right time allotment to understanding their spirituality and religious importance.
Incorporating in the initial assessment questions regarding faith background, current faith, and how our clients define faith is important (Richards, Bartz, & O'Grady, 2009). It is also important to understand what faith means to our clients. How we get to this information can vary depending on the tool we use. Using a standardized assessment tool to assess for faith while it can be helpful it is not needed. Asking questions and having dialogue about faith is more key, in most cases, then having to be formal with questionnaires and scoring. This dialogue alone will encourage your client to feel open and comfortable beginning to talk about faith with you. Even this simple process is many times removed from the therapeutic setting due to the discomfort of the therapist or their lack of experience. I remember being at a conference a few years ago and the speaker was presenting on two options of how to ground your clients using Eye Movement Desensitization and Reprocessing (EMDR) and a visualization tactic. He said to an audience of professional direct clinical staff of over 200 attendees that the two options include the option to use a faith-based visualization or a non-faith based visualization. When he said this a woman in the audience said very loud her disclaimer that she would “never” bring faith into the therapy room with her clients. The presenter informed her and the audience that the opportunity for clients to choose is very important regardless what the therapist own belief background is. I thought of all the literature that supports our client’s ability to present in therapy their own belief patterns and as counselors we have to set aside our own beliefs in that moment and be able to join our clients to help them regardless if their belief is opposite of our own. Placing our own beliefs aside does not mean we neglect to support ourselves but instead we understand the true meaning of being a counselor which is the ability to be a tool of healing for our clients and help them obtain the goals they sought therapy to meet. So remembering that faith is part of all people in some way it should be a bit easier for counselors to assess for faith in our clients. In addition, knowing that faith is part of all people should make it easier to help their clients create their own definition of faith for themselves.
Saunders et al. (2017) describes an overview of faith-based assessment tools, which point to the meaning of faith as subject to religious backgrounds. Saguil and Phelps (2012) discusses the findings of several studies, which they highlight the high number of clients who state they prefer their provider to ask them about their faith. Despite wanting to speak to their providers about their faith and beliefs the majority also state this rarely happens. Why do providers state they tend not to ask? Per the articles reviewed by Saguil and Phelps, providers do not ask because they feel they do not have enough time to ask. Scott et al. (2016) found that licensed counselors were more comfortable using standardized tools for assessing faith then they report liking to use faith as an intervention tool in the therapy hour. Utilizing a faith assessment tool is useful, though should not be regarded as the only time a therapist should inquire about faith. Understanding how to talk about faith following the assessment period is also major. There does not need to be a question of “do you believe in Jesus Christ?” This question can be especially uncomfortable for the provider or client alike who does not have the belief in Jesus Christ. Even to the person who does believe and is a Christian this very direct question about faith from someone not in church is unusual and somewhat strange. Instead, there needs to be just a very general conversation about the person and their life and make sure you as the provider are connecting to all of their resources and supports that you can. And ultimately there does need to be an openness of counselors to be okay with the talk about significant faith figures and their names like Jesus, Buddha, Joseph, among others and symbols of faith and religion when their clients want to speak on the topic. So if using a formal assessment tool, which is great, make sure to turn the assessment into a therapeutic conversation as well to explore further areas of faith for your client. Knowing that faith is not necessarily faith in God or belief in religion, finding an assessment tool that can be used with these types of populations is important.
Assessment Tools
Faith
Faith is subject to your own perspective. Be open to hearing the story of faith from others.
There are several assessment tools to measure for faith. I will discuss just two: FICA [Faith or beliefs; Importance and influence, Community, Address] and HOPE [Sources of Hope, meaning, comfort, strength, peace, love and connection. Organized religion. Personal spirituality/practices. Effects on medical care and end-of-life issues] (Anadarajah & Hight, 2000). I will talk about each of them below and also develop them around a non-religious or spiritual foundation to utilize.
FICA Assessment Tool
FICA’s four parts (beliefs, influence, community, address) are separated into specific and organized questioning to get the answers from clients we need to support their spiritual beliefs and foundation. Puchalski’s (1999) article provides specific questions providers can ask when assessing for religious importance and spirituality in their clients. For F, Puchalski recommends asking clients if they consider themselves religious or spiritual and what things in their lives they believe give their lives meaning. For I, Puchalski recommends asking what type of influence spirituality and religion has on their lives, how their beliefs influence their behavior and choices, and what influence or role do their beliefs have in helping them to be a better you. For C, Puchalski recommends asking what role and influence the community has on your beliefs or your beliefs have on the community of support you choose to influence your life and if their are specific people in their lives that positively influence their beliefs. And finally, for A Puchalski recommends providers to ask their clients how they can help support their beliefs and religious background in treatment.
FICA supports a client’s own experience of spirituality and religion and how they want to express and share this to their providers in their treatment. Providers are also supported through this assessment tool as it allows the provider to have their own beliefs while taking and showing interest in their client’s beliefs and religion without changing their own. Providers need to remain open to their client’s experience and what they share, open and ready to provide referrals for religious support, remember not to impose their own beliefs onto their clients, and consider spirituality and religious importance an ongoing topic to be discussed (Puchalski, 1999).
HOPE Assessment Tool
HOPE is another assessment tool popular to use with clients to review and assess their religious and spiritual backgrounds. Anadarajah and Hight (2000) discuss in their article the sections of HOPE, providing recommendations for how to assess for faith in clients by providing example questions to illicit the information. For section H, questions recommended to ask clients include questions about how they experience hope and peace in difficult times. For section O, it is recommended that counselors ask if their clients are involved in any organized religion; and if yes, then how they align with their religious practices. It is noted that even when clients are not involved in a religious circle these questions are still relevant to ask. Many clients started with faith and religion and as they aged they changed their perspective and beliefs. These past experiences are important to understanding clients in the now. Section P, corresponds to questions of spirituality apart from religion to inquire if spirituality is different for clients and if so, what they are. The last section E, focuses on whether or not the type of treatment being recommended is in any way against your clients religious or spiritual beliefs. Providers need to be open to their clients beliefs in order to ensure their chosen treatment interventions do not undermine their client’s beliefs. The easiest way to understand this type of dilemma is to simply ask clients if they see any type issue with treatment. If your client says yes, then together with your client come up with a new treatment intervention.
Treatment Planning
A treatment plan is a document that is created at the start of treatment and updated periodically throughout treatment. Treatment plans are individualized and aligned with the goals and objectives of each client. Treatment plans are not created by providers without the client involved in the development of the goals. When developing a treatment plan, goals and objectives are specific and measurable. Measurable goals means that when these goals are complete the journey to completion can be tracked easily. When creating goals with clients it is important to integrate into the treatment plan any spiritual or religious goals and interventions. It is also important to leave these subjects out when they are not important to the client. Just as it is important to include religious and spirituality into assessment and treatment planning phases it is also important to leave these subjects out if that is what the client prefers.
Discharge Planning
A discharge summary is formed at the beginning of treatment. Discharge planning happens at the start in the assessment timeframe and is ongoing throughout treatment to ensure medical necessity is met ongoing. Consider including any and all spiritual and religious referrals for treatment discharge that you and your client believe are important to ongoing care services.
What to do Now?
Take the opportunity next session you have to use one of these assessment tools to discuss and further assess your client’s spiritual and religious backgrounds, learn about your clients in a new way and light, and be open to exploring areas with your clients that you never thought were important.
References
New World Encyclopedia. (n.d.). Faith. https://www.newworldencyclopedia.org/entry/Faith
