ACA Blog

Ryan Thomas Neace
Jun 14, 2011

Prayer In Therapy: An Ethical Primer

(This blog is a response to the blog, “SHOULD I EVER PRAY WITH MY CLIENT?” by Ray McKinnis. You may read that blog here – http://my.counseling.org/2011/05/31/should-i-ever-pray-with-my-client/) Recently, Ray McKinnis blogged about prayer with clients, stating that the practice is categorically unethical and worthy of abstinence. I respectfully disagree. I want to address the major premises of that blog specifically, and then posit a few ideas that I think will more effectively unpack why praying with clients, when executed appropriately, is in fact ethical. Laying the Groundwork. In order to have a meaningful conversation surrounding ethics, the nature of ethicality cannot be overstated at the outset. While legality is seen as mostly black and white, ethicality is experienced and evaluated on a continuum. Certainly there is some overlap between the two, but rarely do you hear someone refer to an action as being “more legal” than another. The finer points of what is and is not illegal may be debated, but legal questions themselves are still primarily answered in “either/or” terminology. Ethical questions, on the other hand, are more gray. While certainly there are some actions that are probably “never” ethical, very few of those are ever actively up for debate. For example, engaging in sexual relationships with clients is generally seen across the board as unethical. Explanations in defense of sexual engagement with clients are seen as unfounded rationalizations. Though the phenomenon certainly exists (see the collective works of Dr. Ken Pope, former chair of the APA Ethics Committee), there exists no substantial larger debate about its ethicality. However, other issues are in fact debated, because some behaviors are more or less ethical than others, and sometimes variations on the same behaviors are similarly more or less ethical. These kinds of issues are ultimately subject not to the black and white rigidity of legal review, but the scrutiny of peers, supervisors, and regulatory bodies that place them appropriately on the continuum of ethicality. Here’s my point. With some major exceptions, actions within the therapeutic context aren’t unethical unless…well…unless they are. Generally speaking (again, with some contextually appropriate exceptions), there is no grand metanarrative to which one can appeal to rule out a particular behavior as completely, always, and forever unethical because of the dynamic nature in which most actions are approached by therapists and experienced by clients. Saying that something is “never” ethical is usually not the most accurate way to conceptualize the diverse and complex experiences we have as therapists. This includes the practice of prayer. Ray’s Assertions. 1. Prayer “always involve[s] a dual relationship…[because] a counselor assume[s] a spiritual role which can only be done based on their own belief system concerning that which is beyond.” As written, this description of a “dual relationship” fails to meet the criterion for dual relationships described in most of our field’s ethics codes (e.g., ACA, AAMFT, APA). According to the American Psychological Association’s Society of Clinical Psychology division, “a dual relationship exists when there is a combining of incompatible professional roles and behavior, to the detriment of someone to whom the [counselor] owes a fiduciary duty” (Florida Psychological Association, n.d., p.2). To suggest that the role of a therapist as a praying cohort involves inherent or implicit incompatibility or neglect of fiduciary duty simply because the nature of the role or behavior is spiritual is inaccurate, subjective, and assumptive of a number of factors about how, why, and to what extent prayer is employed. Below, I outline a few situations where these roles are potentially incompatible, but suffice it to say here that a carte blanche rejection of the practice of prayer as unethical is inappropriate. 2. “Furthermore, if you feel it is a way of showing support and empathy for your client, you reduce the spiritual to merely a matter of projected wish fulfillment or expression of caring (and many psychologists do) and discount a critical aspect of your client.” Here Ray asserts that if counselors do not (/do not fully) embrace the possibility of a spiritual dimension, or if counselors do not view the spiritual dimension in the same way as their clients, praying with them in a manner consistent with clients’ own spiritual paradigms trivializes core components of who they are. That is, my inability to fully espouse a client’s spiritual viewpoint (and engaging them in it anyhow) means I am somehow devaluing that viewpoint and its fundamental connection to their person. As a Cognitive-Behavioral Therapist, I spend a better portion of my time working with individuals whose beliefs, spiritual or otherwise, are central to their dysfunction. I do not agree with, nor operate from their paradigm as a matter of personal belief or practice. Yet, when utilizing some techniques (e.g., motivational interviewing/enrichment), I enter in to the client’s paradigm and use its scaffolding for therapeutic ends. That I would not practice the client’s way of life personally is irrelevant, and should not be construed to devalue it. My Vantage Point. The above stated aside, the rest of the blog is difficult for me to address directly because Ray and I apparently so fundamentally disagree on a number of basic assumptions regarding the spiritual, prayer in therapy, and perhaps, therapy itself. Instead, I’d like to outline for you here a consistent and thoughtful approach to how precisely prayer can be ethical in therapy. Basic Assumptions (for prayer to be ethical in therapy): 1. Prayer Must Not Involve the Need for Special Training You Do Not Possess. According to the ACA Code of Ethics, section, C.2.a., Boundaries of Competence, “Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience.” Therefore, so long as the practice of praying with clients does not invoke a need for you to be formally trained in the specific prayer techniques in which your client wishes to engage, or does not involve special theological, religious, or other training, its practice is in that sense ethical. If it does require specialized training of some sort, and you possess that training, it is in that sense ethical. 2. Prayer Should Not Involve an Undisclosed Role Change. According to the ACA Code of Ethics, section A.5.e., Role Changes in the Professional Relationship, “When a counselor changes a role from the original or most recent contracted relationship, he or she obtains informed consent from the client and explains the right of the client to refuse services related to the change. Examples of role changes include 1. changing from individual to relationship or family counseling, or vice versa; 2. changing from a nonforensic evaluative role to a therapeutic role, or vice versa; 3. changing from a counselor to a researcher role (i.e., enlisting clients as research participants), or vice versa; and 4. changing from a counselor to a mediator role, or vice versa. Clients must be fully informed of any anticipated consequences (e.g., financial, legal, personal, or therapeutic) of counselor role changes.” At the outset, if prayer seems a likely possibility with clients, simply include such a disclosure in the informed consent policies, so that you are contracted in such a fashion that does not evoke a change in your role. The disclosure must advise your client that you may, at times, engage them in practices consistent with their faith belief (e.g., prayer), but that your role is not to be construed as shifting from therapist to spiritual guide. And of course, you should not actually shift from therapist to spiritual guide. Or, if you will be employing specialized training, or if the client’s faith belief is assumptive that your engagement in prayer constitutes a shift in role (e.g., from therapist to spiritual guide), and you will in fact shift roles, simply include that notion in your informed consent disclosures, along with the client’s right to refuse services related to that change. Do not engage in such a change if your shift in roles represents a step outside your competence. 3. Prayer Should Involve, When Appropriate, Members from the Client’s Support Network. According to the ACA Code of Ethics, section A.1.d., Support Network Involvement, “Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent.” If prayer arises to the level of need for practice in therapy that outside support is warranted or desirable (e.g., a client’s faith belief or practice of prayer requires the presence of other members of his/her faith community, clergy, etc.), the ethical therapist should enlist such support with client consent. 4. Prayer Should be Non-Discriminatory According to the ACA Code of Ethics, section C.5., Nondiscrimination, “Counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion/ spirituality, gender, gender identity, sexual orientation, marital status/ partnership, language preference, socioeconomic status, or any basis proscribed by law. Counselors do not discriminate against clients, students, employees, supervisees, or research participants in a manner that has a negative impact on these persons.” So, in this sense, if you are professionally, personally, or otherwise limited in your capacity to engage prayer in a manner that affirms all of the above points, as well as a general commitment to respect the dignity and to promote the welfare of clients (ACA Code of Ethics, Section A.1.a. Primary Responsibility), then it is your responsibility to refer. This is where I believe Ray may have something to say to us. It is possible that our limited ability to completely and utterly discard our own spiritual constructs (or lack thereof) may render the activity of prayer with clients meaningless, trivial, or otherwise inappropriate for our clients. But, this is only true to the direct extent that doing so actually has that outcome. Final Thoughts. None of this should be construed to imply that because you may have spiritual, religious, or other related differences in viewpoint from your clients that you are necessarily being discriminatory, otherwise unethical, or that you must refer. Likewise, none of it suggests that engaging in prayerful activity with clients is inherently unethical because it involves that which Ray refers to as “transcendent”. There are no existing ethical codes of which I am aware that support that kind of reasoning. Certainly, there are some ground rules you might wish to adhere to, but I’m certain that if the practice of prayer seems worthwhile and beneficial for your client, you’re capable of navigating them with a little thought. If one truly believes in the spiritual realm, and therefore in the holistic nature of humans as physical, mental/emotional, social, and spiritual beings, then in some senses, each interaction we have with clients touches all of the dimensions in which we exist, whether or not we perceive as much. To suggest otherwise is probably intellectually dishonest. This is precisely why studies about the role of prayer, for example, in effecting physical or emotional healing are so fascinating and important, and why our nation’s foremost educational centers are becoming overwhelmed with the body of scholarly literature that suggests spiritual practices do in fact improve emotional functioning (e.g., Harvard Medical School, 2004). If my clients are spiritual beings, then to engage them mentally is to engage them spiritually as well, and vice versa. It is this important fact that informs my own counseling practice’s employment of a bio/psycho/social/spiritual model. Though we do in fact employ spiritual directors to do the bulk of spiritual work, I am not precluded from touching on these areas with clients provided I adhere to the aforementioned ethical structures. And neither are you. Sources: American Association for Marriage and Family Therapy. (2001). American Association for Marriage and Family Therapy code of ethics. Retrieved from http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx American Counseling Association (2005). ACA Code of Ethics. Alexandria, VA: American Counseling Association. American Psychological Association. (2002). American Psychological Association ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics. Florida Psychological Association. (n.d.). Fresh legal perspectives: Psychologists in dual relationships. Florida: James Meyer. Harvard Medical School. (2004). Mindfulness improves quality of life. Retrieved from http://www.health.harvard.edu/press_releases/mindfulness_improves_quality_of_life

Ryan Thomas Neace is a counselor, professor, and entrepreneur. He is the co-founder and managing director of The Change Group. More at http://changegroupcounseling.com

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