ACA Blog

Ray McKinnis
Jul 26, 2011

Evidence-Based Cognitive-Behavioral Wrestles with Spirituality

Evidence-Based (EB) and Cognitive-Behavioral (CB) are two terms that have wormed their way into contemporary counseling jargon. Their major motivation is to help put counseling on a more firm=scientific base. They do have their merit. But they are completely incompatible with spirituality as I define it: spirituality essentially refers to that which is ultimately beyond—especially beyond evidence and cannot be captured with rational thinking. That, I believe, is the heart of the challenge we counselors face when want to include a spiritual dimension into our practice. And it faces all counselors when they counsel a client for whom spirituality is an important part of their lives.

Many CB counselors handle the problem by claiming that all religious and spiritual thinking is distorted thinking and must be corrected by the counselor. On the other side, some ‘spiritual counselors’ claim that mere thinking is inadequate and must be always be done in a context of faith. I have the image of CB counselors forcefully confronting the spiritual beliefs of an individual who is having difficulty because he cannot understand how God could have let him down when he had been such a faithful follower. The counselor lets him know that those beliefs are really infantile wish fulfillments, have no basis in reality and must be replaced by ones that are more efficacious and in touch with reality.

On the other hand, I still have echoes in my mind from the aggressive, forceful evangelist I saw haranguing a confused and terrified teenager as the preacher tried to ‘correct’ the young man’s thinking into accepting the Lord Jesus as his personal savior so that he wouldn’t spend eternity burning in hell.

Both of them assumed that what one thinks controls their behavior and both of them believed that their own way of thinking was the only correct way of thinking and it was their mission to change the other person’s way of thinking. Both were using a standard script which has proven efficacy to bring about change. Thus both were practicing CB and were evidence-based—one was adamantly secular, excluding any spiritual aspect; the other was adamantly spiritual, claiming the secular was always inadequate for a meaningful life.

What is the difference? I believe that spirituality offers an individual greater possibilities for change than do purely secular approaches. Such changes can be extremely helpful or they can be extremely damaging. In the literature discussing incorporating spirituality into counseling, I rarely find considerations of the potential destruction that spirituality can bring; most seem to be ‘pastoral’ in nature. But as many religions warn, there are good spirits and there are evil spirits—and one must learn to discern them. Although we as counselors are not operating from a religious base and thus have no ‘discerning of the spirits’, we too must be aware of the power of spirituality.

Would Dr. Martin Luther King, Jr.’s ‘dream’ be ‘corrected’ and the Civil Rights Movement have no power to go forward had he gone to a CB or EB therapist? If your client was wrestling with whether to sacrifice himself as a suicide bomber in his fight against the evil that had invaded his country, how would you respond? Hope is often not based in ‘reality’. How do you as a counselor evaluate a client’s hope? Be careful—‘Woops there goes another banana tree plant.’

The strength of the secular approach is that it operates ‘within the box’ of what can be conceptualized, measured, reproduced, controlled. Antidepressants approved by the FDA are secular and sometimes effective for treating depression; they have been proven effective by at least two carefully controlled, double-blind, randomized trials. If you follow directions, you can expect certain results. It is a scientific approach.

The strength (and the danger) of the spiritual approach as I define it, is that it operates ‘outside the box’. The mind has an amazingly powerful ability to receive information in many different formats and figure out possible meaningful configurations. Gestalt psychologists have given us some remarkable examples of ‘trick’ figures which the mind makes sense of even though that sense may not be in the original stimulations. For one individual the mind can take patterns of stimuli from several differences sources and make meaning patterns from them—even though that meaning was not in the original stimuli. Personally I believe that is the power of the word ‘god’. As a counselor, note carefully the importance of the word ‘power’, not ‘meaning’.

It is also important to note here that many individuals have unusual experiences or sensitivities that they have to deal with that the counselor has no idea what is going on. Martha Beck’s description of her first pregnancy in her book Expecting Adam should humble every counselor. As doctoral student at Harvard in sociology, she began having incredible experiences which she did not try to explain—only report. She knew things she should not have known. If I were her counselor, I would neither affirm nor deny her descriptions—and most of all I would not try to ‘explain’ them. My responsibility would be to help her deal with their impact on her and her life.

EB and CB have some currency currently in today’s counseling environment because they identify some processes of the human experience that can be studied and controlled. But spirituality is beyond them and offers more possibilities and potentially greater power.

I firmly believe that a counselor must never enter into the spiritual world of the client whether it be by praying together (or some other ritual), by affirming or denying some spiritual belief of the client, or in any other way to presume to know what ‘beyond’ the client is experiencing. A counselor can never know exactly what the client is actually experiencing. They can only deal with the meaning of what the client is experiencing and that meaning must be treated as sacred. The most the counselor can do is to be aware of the impact which the client’s spiritual realm has on the client if he or she includes such a dimension in their lives. I as a counselor can only observe the wind/spirit blowing on the leaves of my client’s life, but I cannot presume to understand the wind itself—where it comes from or where it goes.

Ray McKinnis is a counselor with a special interest in 'spirituality beyond religion' and veterans 'beyond PTSD' with a website at

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