Spiritual and Religious Competencies for Psychological Practice in the Third Millennium

Great.

So, they have much lengthier and very impressive bios that hopefully they can tell you a little bit about while they're talking. Um, and I just also

they're talking. Um, and I just also want to note that Carrie O'Grady was going to join us uh as a presenter but wasn't able to. So, um, just thinking

about her and hoping her wishing her the best. So, I'll pass it over to you all.

best. So, I'll pass it over to you all.

>> Great. Well, it's wonderful to see everyone here. thanks for coming and um

everyone here. thanks for coming and um we'll just roll right into it. It's good

to see some old friends and new friends and people who I know are working in similar ways and throughout the field of

mental health and public health. And so

um we'll dive right in. So

this work has been a long process. Um

I've been working on these competencies for quite a long time now. I think my first paper um reporting on a study that started a couple years before that was

in 2013. So now it's been about 15 years

in 2013. So now it's been about 15 years working on this. And just want to acknowledge all the teams who have worked on developing spiritual and religious competencies over the years

for mental health professionals and psychotherapists. and Joe especially is

psychotherapists. and Joe especially is such a valued colleague and I'm so glad to be speaking with you Joe and I'm really grateful for division 36 also um

carrying the flag all this time in psychology which is oddly sometimes not the most um uh friendly field for what we're looking at so I'm just not going to be able to

read all these names but want to say that there are a whole lot of people who have been involved in the work that Joe and I are about to share and Joe and I had the great pleasure pleasure of working with other principal

investigators including Michelle Pierce and Holly Oxandler, Clay Pollson, Kenneth Paramment, um, and Jesse Fox on the spiritual and

religious competencies project supported by the John Templeton Foundation. And so

if you scan this QR code or go to srcpro uh.org, org, you'll be able to reach us or COM, I'm sorry, srcro.com and learn about what we've been doing

over the last several years to see if we can equip mental health professionals with the competencies they need to address the religious and spiritual dimensions of people's lives. And so,

most of you on this call are well aware that spirituality and religion is not just sort of a niche topic for a minority of our patients. It really is a

core aspect of many many people's a large majority of people's identity and their sense of who they are, their diversity. A core component of

diversity. A core component of multicultural diversity and identity.

It's associated with the same kinds of historical oppression and privilege at times that other um aspects of diversity and identity have been associated with.

And it's highly intersectional with other aspects of diversity such as gender and age and region of the country, socioeconomic status, and it

really is just inseparable from in most people's lives from who they are. And

then also a core component of psychological functioning. So when we

psychological functioning. So when we think about spirituality and religion, we're not only thinking about it as a diversity variable. We're also thinking

diversity variable. We're also thinking of it as a way that many people cope, a way that uh a whole set of resources for people both internal and external that

lead to mental and physical health and well-being. Uh helps them make meaning

well-being. Uh helps them make meaning of their world. And this is true whether they are religious or spiritual or not religious or spiritual. those become

ways that people make meaning as well.

So we see spirituality and religion as a diversity variable across the board from having no identification with any spirituality or religion all the way to

being um very uh have having these things be very central in somebody's life. It really does affect people's

life. It really does affect people's sense of self and even just their whole understanding of reality. And so we know that our clients, the people that we

serve are spiritual and religious. The

vast majority of people believe in God.

Still to this day, even though attendance in religious services has declined quite a bit, four out of five people are affiliated with a religion.

And 40% of people would call themselves very religious. Um, and you know, again,

very religious. Um, and you know, again, vast majority of people would say that it's either very important or fairly important. And these are from general

important. And these are from general social surveys and random samples of um the American public. And so these this this form of diversity and these aspects

of people's lives are at least as important to their psychological, emotional, and mental health as other forms of diversity. as I was mentioning um they're also quite clinically

relevant because participation in organized religion and spirituality religious and spiritual coping personal religious and spiritual practices all

have robust you know tens of thousands of articles showing their relationship to psychological well-being and we know that religious and spiritual struggles

and problems are also quite prevalent um and even recently you know out in the public. Multiple mass shootings have had

public. Multiple mass shootings have had problematic religious and spiritual elements. And so we really do need to

elements. And so we really do need to pay attention to it as a profession.

And as a profession in psychology, most psychologists are much less religious or spiritual than their the clients they serve. And so like 75% of the public

serve. And so like 75% of the public says their approach to life is based on their religion. Only 35% of mental

their religion. Only 35% of mental health professionals do. And we have a really strong history in psychology of pathizing religion and spirituality. So

Freud, of course, you know, says the whole thing is patently infantile, completely foreign to reality. It's so

sad that people will never be able to rise above this view of life. Albert

Ellis, who kicked off cognitive and rational behavioral therapies, you know, has nothing good to say about religion and spirituality. And, you know,

and spirituality. And, you know, behaviorists led by John Watson think it's not a great thing either. So

there's been this kind of um from the very beginning of psychology a little bit of a bias against these things. But

we know today that so many people who re receive mental health services and their family members, this is a great survey of a group of 2,000 individuals

receiving mental health care services saying that 80% of them agreed or strongly agreed that their spirituality was very important to their mental health. And so back in 2011, we started

health. And so back in 2011, we started to work on how could we train therapists to address spirituality and religion in

a more ethical and competent way. We did

a number of interviews and focus groups and sort of uh deli expert panels and came up with a provisional list of 16 competencies. And I'm not going to go

competencies. And I'm not going to go into those now because as you'll see over time, these have evolved. But this

was sort of like the whole universe of what would we really want psychologists and mental health professionals to know if we had our ideal. And these were published in this early book I wrote

with Shelley Scaml, Spiritual and Religious Competencies in Clinical Practice. We continue to do more surveys

Practice. We continue to do more surveys with the field now trying to figure out, okay, those of us who are experts and geek out on this topic think that there

should be 16, but what does the general population of psychologists and mental health professionals think they need to know? So, we asked them a lot of

know? So, we asked them a lot of questions about what do you think mental health professionals should be required to receive training in? How much

training did you get? And how important do you think each of these are? And

that's allowed us to kind of hone these competencies down to a set that we think are very basic and very relevant to

practice. You can also look at a recent

practice. You can also look at a recent article in 2022 by myself and David Lukov who was the co-author of the spiritual and religious problems DSM5

now category. And this is just an

now category. And this is just an overview of spiritual and religious competencies in psychology. Where we are now and what we need to do next. And so

division 36 now we've created a task force to develop professional practice guidelines for APA to propose that they adopt for addressing spirituality and

religion in psychology. And these are the members of our task force. We've

been working on this for about five years. And the purpose is to develop

years. And the purpose is to develop these competencies. And right now we

these competencies. And right now we have a full draft. We have somebody on the line who has been helping us with a

fresh eyes. Um Kevin Armstrong and um

fresh eyes. Um Kevin Armstrong and um one of his students has been taking the most recent look at it and the next step will be to collaborate with APA divisions to gain feedback. Um and then

we'll submit it to the APA Board of Professional Affairs and hopefully they will be adopted to help people understand what they could be doing um

what they need to learn. And so

over the last few years, we've been engaged in the spiritual and religious competencies project that I mentioned earlier that Joe Courier's the primary PI of. And it was a collaboration

PI of. And it was a collaboration between five different universities.

And over time, we have worked very hard to scale down those 16 competencies into these six domains. And Joe's going to go in depth into these, but I'll just

mention them briefly. that number one, people who are in mental health care professions would inquire routinely about somebody's religious and spiritual background, belief, and practices. That

this would not be something you would wait for the patient to bring up or the client, that you would always ask about it. That mental health professionals

it. That mental health professionals understand that spirituality and religion are distinct yet overlapping expressions of human experience and core

areas of diversity and identity. that

they do their own personal work and look at how their own spiritual and religious background or their background of agnosticism or atheism has influenced their attitudes and perceptions and

assumptions about their clients and their religion and spirituality or even just how they move through life. that we

know that religion and spirituality can offer resources and strengths and so people would understand how what those are and how to help their clients access the ones that are important to them. But

mental health professionals would also know that there can be problems and struggles and we don't expect them to be experts in helping patients navigate or practice these things necessarily in

session. But they should have the

session. But they should have the ability to recognize them, identify them, help their clients explore them, but practice within the boundaries of

their competence and refer to or collaborate with spiritual care professionals such as clergy or other qualified individuals, spiritual guides,

meditation teachers, or psychologists or mental health professionals that have some um expertise in this arena. And so

to us that's sort of kindergarten level but to the field this is really challenging. This is like elevating to a

challenging. This is like elevating to a much higher level of competency than the field is necessarily comfortable with.

Uh having said that we have now done so much work on trying to make sure that people who are not into all this stuff would be okay with these. And now we feel like we've reached that level where

people feel like yes these are important. I would be okay with putting

important. I would be okay with putting this in my program. I would be okay with being trained in this and I wish I had been is what most people say and this is

all within a context of u you know the work on cultural humility and the multicultural orientation that the old ideas about competence in diversity were

that you should become an expert in as many of the possible things that you might see as you can or at least have a little bit of knowledge let's say in every religion which is how I was taught

um when I was taught any kind of religious and spiritual competency. It

was like, you know, here's what Buddhism thinks and here's what Christianity thinks. Now, we know that the skills

thinks. Now, we know that the skills really have more to do with cultural humility and cultural comfort and taking advantage of cultural opportunities the

same way they do in other arenas.

So, cultural humility, as you guys know, is not that we become completely competent about it. It's just that we gain appreciative knowledge about

another cultural or religious identity.

Um, we engage in the process of exploration and that we're really open-minded. Uh, we're willing to engage

open-minded. Uh, we're willing to engage in self-reflection, growth, a commitment to treating others with respect, celebrating and honoring diversity.

And, um, we can sort of be somewhat at ease and relaxed and open when we're discussing these issues in therapy. and

then taking those opportunities when somebody does say something about it to explore more aspects of this aspect of their life. So often what clients tell

their life. So often what clients tell us in our surveys is that I brought it up but it was never followed up on often because the mental health care professional doesn't feel competent or

capable of following up on it. And

really it just boils down to kind of genuine curiosity about what's going on with someone. So in the last few years

with someone. So in the last few years we have continued this work figuring out how can we get these into training? How

do we get these into graduate programs um practicum um internship and continuing education?

And so we've created a roadmap by which um several people from lots of different levels all the way from professors to

deans to program chairs to licensing exam professionals, accrediting bodies, um people who were very much not excited about bringing spiritual or religious

competencies into um mental health care training programs and people who were very interested in it. And we think we did a pretty good job of coming up with

how we might be able to train people.

The barriers and concerns that people out in the field have about training new professionals or existing professionals in these domains is that they just don't feel like they even have any room in the

curriculum. There's so much that they

curriculum. There's so much that they already have to teach. They don't feel like they have competent faculty to teach it in their program.

um they're they're hesitant and sometimes there's hostility from faculty and administrators saying, you know, they don't think that they should teach things that are non-scientific, they

would call it, or imaginary. Um

they they are concerned that if they include this, it will lessen training and or emphasis on other areas of multicultural diversity. And of course,

multicultural diversity. And of course, there are some concerns that there's like a hidden agenda and some kind of evangelicism happening. They're also

evangelicism happening. They're also concerned about perpetrating or um alienating people because of some of the

injustices and oppression that have been supported by several world religions or that religions and spiritual traditions have been used um as a a way of

justifying these things even if they themselves don't believe in them. So

this is kind of what people are concerned about. So what we've been

concerned about. So what we've been working on is defining the basic facets of the competencies that we want to teach, demonstrating the evidence for them, the research evidence, not that

they're just opinion, but we know that these things are helpful because we have evidence. Establishing some teaching

evidence. Establishing some teaching guidelines and providing professional development, providing highquality training resources and materials, which you can find a number of those on our

website. now and then influencing

website. now and then influencing licensing and accreditation standards so that they do require this for internship programs and other kinds of programs. So

you can find our training road map here and hopefully this will be helpful if you are in a position to be able to influence training guidelines

and at this point I will turn it over to Joe and um I think we'll go ahead and leave the Q&A for the end. Joe, does

that sound like a good plan?

>> Sounds great. Thank you, Cassie.

All right. Um, so I'm I've been tasked with kind of giving, you know, a bit of a crash course, you know, through, you know, the six competencies that Cassie

introduced a moment ago.

um you know as we you know kind of think about uh defining you know uh spiritual religious competencies you I think here would be some of the the key distinctives about like what what what

we intend them to be you know and then also like what what they're not intended to be right so I would imagine that that most of us you know who are here you

know on this call um that these competencies would be pretty rudimentary you know and basic right and I think it's important to highlight that as we think about, you know, sort of, you

know, moving the field forward, like we're we're really talking about kind of foundational generalist competencies that we think, you know, are going to apply to all

psychologists and and possibly other mental health professions as well. Most

of us here have gone above and beyond these six competencies, right? and and

and we've maybe even you know developed specialized expertise you know in attending to religion and spirituality in our practice of psychotherapy or other clinical practice activities right

so as we go through these competencies like I would encourage everybody think about the colleague in the office next to you you know that you might have

a good friendship with um but is maybe a little bit skeptical you know about what we do um in this division and is maybe you know a little bit ambivalent about you know attending to religion and

spirituality right so you want to be thinking about you know those those persons in your professional network or community department clinic um you know

who you know may not share the same kind of specialized interests as we do here you know in this department or I should say in in this uh I got to go forth here we go um all

right so I'm going to you know go very very quickly through these competencies just because I want to make sure that we have time for rich discussion at the end, you know. So, um, you know, as Cassie has already highlighted, you

know, the first, um, you know, guideline I'm and I'm going to go in a little bit of a different order, you know, that that Cassie went in a moment ago. And in

some ways, that just shows that this is pretty fluid right now. And this is pretty much like we're still like we we we do not have everything ironed out

right now. and that these these

right now. and that these these competencies, you know, are subject to change, right? You know, so the the the

change, right? You know, so the the the first um you know, competency or in APA terms, you know, this would be a professional practice guideline, you know, would be, you know, that

psychologists have the ability to define religion and spirituality as related but yet distinct aspects of diversity,

well-being, and psychological functioning. you know, so as we know,

functioning. you know, so as we know, there are virtually hundreds of definitions, you know, in our uh mental health literature right now. Um these

are just two of the definitions that I find to be, you know, particularly helpful. They come from uh Ward Davis

helpful. They come from uh Ward Davis and colleagues um recently published handbook of positive psychology of religion, spirituality. Um but like we

religion, spirituality. Um but like we know you know that there's a large contingent you know of you know our society you know who would identify as

religious and spiritual. There are

people who identify as religious but not spiritual. There's a growing percentage

spiritual. There's a growing percentage of folks who identify as being very spiritual but not religious. And then

there are folks who might not identify with either religion or spirituality but for whom like you know this is still going to be you know a clinically

relevant area that we need to possibly attend to right so like what might be some of the you know the the signs of someone you know who's you know uh

really pursuing this guideline seriously you I think first you know you know I mean ideally you know psychologists like will you appreciate the fact that um that we do include religion in you know

our conception of multicultural diversity you know within the American Psychological Association right so um these would be quotes you know from the APA ethics code the the standards of

accreditation you know for health service psychology programs you know as well as you know the APA dictionary and you can see that you know religion you

know in most in in all instances and sometimes spirituality will sort make it into the list of the the family of the

different sources of diversity, right? But we know that that in practice

right? But we know that that in practice kind of religion and spirituality are are a little bit like you know maybe that third cousin that you see you know maybe you know every few years at a

holiday gathering and maybe you enjoy seeing that person you don't have any issues with that person but but that maybe that that family member doesn't necessarily factor too much in your day-to-day life and in some way like I

would I I would say that that's that's generally kind of like mainstream psychologies posture toward religion and spirituality right now. Um I think we've come a long

right now. Um I think we've come a long way. Um I think psychologists are

way. Um I think psychologists are generally open you know to religion and spirituality much because of research that people in this division have done and the way that we have represented to

the broad broader field but yet you know these are areas that don't necessarily get a lot of attention or engagement you in our profession you know also I mean ideally you know psychologists will

understand that you know spirituality and religion are highly prevalent you know in our society Cassie you know shared some statistics already and and

these these are um uh percentages of different aspects of religiousness and spirituality that that come from uh Harvard's uh consortium for psychosocial

stress uh religion and health you know and if you look at these different types of beliefs or different types of spiritual practices I mean you'll see that you

know across major racial ethnic groups in the United States there's there's a very very small percentage of persons who would not identify as either spiritual or religious, right? You know,

so if we use these numbers, you know, we're looking at roughly 95% or more of the people that would come for care to psychologists, right? So, so these are

psychologists, right? So, so these are highly prevalent areas, you know, of of diversity and well-being that, you know, that ideally, you know, psychologists are going to, you know, know about. You

know, I think as as Cassie highlighted, another key guideline, you know, you know, would be, you know, as psychologists that that we know ourselves, you know, with respect to our

own backgrounds and attitudes toward spirituality and religion, you know. So,

ideally, in the same way that that we're hopefully, you know, uncovering, you know, our implicit bias, you know, for other areas of diversity such as race, sexual orientation, the list goes on.

Ideally, we're going to have that same disciplined commitment to cultivating self-awareness about spirituality and religion,

right? So, like we're going to ideally

right? So, like we're going to ideally know and and recognize, you know, when, you know, we're possibly overidentifying, you know, with the clients that we care for, right? that

you know it seems you know a little bit counterintuitive but from a multicultural standpoint the most dangerous sort of situations you know are when

like we we think we have similarity with the people that we're caring for right you know so if if I'm a you know you

know a devout uh you know uh Catholic um in my personal life and I'm caring for another you know Catholic cl like I can I'm going to tend to make assumptions

you know about that person, right? Or

maybe if I've had negative experiences about religion and I'm caring for, you know, a a client who's experienced spiritual trauma, I might make certain assumptions, right? that that ideally

assumptions, right? that that ideally like we're going to be able to, you know, to understand our backgrounds, you know, and, you know, we're never completely bias-free, but ideally like

we're going to have enough awareness where we'll be able to give every single person who comes to us the fullest opportunity, you know, to get, you know, high quality

and hopefully spiritually responsive care, you know. So if you think about you know like the different diads that would emerge I mean there can be situations you know where there's maybe a religious client working with a

religious person you have you have matching in religiousness you can also have matching in secularity you know I think you know as a you know faculty member and an APA accredited uh training

program in clinical counseling psychology I think this this diad of you know kind of secular clinicians working with secular patients is is very very common and I can you know tell on a

number of cases, you know, in which, you know, you know, students who come from secular backgrounds underestimate the importance of spirituality to their clients because maybe it hasn't been

important to them. or cases when you know maybe a religious you know clinician is working with a um another religious client and then

they might make assumptions that relig that they might want to incorporate their faith their spirituality in the process because this is what they might want in their own treatment um and

that's you know unfortunately you know not necessarily going to allow for you know effective care um I think guideline

three, you know, would be, you know, as uh, you know, psychologists, you know, that we appreciate, you know, the different ways that spirituality and religion can provide strengths and

resources, you know, in people's lives, you know. So um I think one of the um

you know. So um I think one of the um just the the most encouraging and major advancement you know in in our profession you know over recent decades you know has entailed you know the

serious rigorous research you know that has uncovered you know different ways you know that spirituality and religion you know one you know can reduce the risk of developing mental health

disorders but then when mental health disorders occur you know in people's lives we now know through research church that many people turn to faith

and spirituality in in really helpful ways, you know, to draw strength and comfort, you know, and that also, you know, spirituality, religion can also be part of, you know, the the healing and

recovery process, you know, for many people, you know. So these would just be some of the you know the review articles you know that have been published you

know that have you know uh really kind of told the story of of where we are you know in terms of the state of the science you know with respect to you know mental and physical health related

benefits of religion spirituality um you know so as we think about um you know psychologists you know hopefully you know being aware of different ways that

spirituality, religion can provide strength and resources and and being willing to then harness or attend to these strengths in their clients lives when they can occur. You know, it's it's

important you know to you know to understand the ways that you know faith or spirituality may function differently you know uh in these ways in different

people's lives you know. So this is a quote from uh one of Ken Paraman's articles you know that that was really helpful for me right you know so it's

not you know um adequate to only know that a client is religious or a client is very religious you know that ideally when it comes to attending to strengths

and resources we need to go beyond that and we need to understand how religion is involved you know in their lives who does who does their their faith um their lived experience of religion or

spirituality consist of what do they do when do they do it where do they do it right and then you know as you know Cassie has already highlighted what what

are the psychological needs or functions that you know religion and spirituality is possibly meeting you know for that person you know is it social connectedness is it meaning making is it

coping right the list the list can go on you know we also know I mean and hopefully you know psych ologists will will understand this you know that there's a you know pretty sizable literature that um you know that

culturally adapted you know psychotherapies you know that have been designed you know for you know uh attending to strengths and resources for different religious groups you know that there's there's an evidence base you

know for these treatments now um they're equally effective you know to the standard forms of those therapies in terms of reducing mental health symptoms and other psychological outcomes you

know and they're more effective um in promoting spiritual outcomes you know so like how how would a psychologist you know ideally harness

you know spiritual religious resources you know in their clients lives I don't think it's um feasible that every single psychologist is going to get training in

implementing spiritually integrated psychotherapies um many of us here this this may be our bread and butter but this might be a bridge that's too far to

cross for many psychologists, you know, but you know, ideally, you know, you know, hopefully, you know, psych all psychologists would have the ability to tailor, you know, treatment, you know,

according to, you know, their client's spiritual, religious beliefs when, you know, it would benefit the client, right? You know, so here would just be

right? You know, so here would just be kind of some of the tips, you know, um, you know, for doing so. I mean, you'll see these are pretty basic fundamental,

you know, practices. Take a deep breath, know yourself, you know, give yourself permission, you know, simply to apply

the skills you already have to, you know, spiritual content and, you know spiritual um kind of experiences that your client

is having, right? So, you know, expanding your empathy and your cultural humility to attending to the spiritual and religious aspects of people's lives, right? So we may not necessarily even

right? So we may not necessarily even need, you know, uh, psychologists to necessarily learn this entire new set of skills. It's just sort of expanding

skills. It's just sort of expanding their frame of reference, right? They're

probably already attending to strengths and resources. just expand your frame of

and resources. just expand your frame of reference to recognize that spirituality, religion often, you know, really shapes the ways that people um

cope, you know, and and and persevere and keep going forward and heal and recover. Um, you know, so that would be

recover. Um, you know, so that would be the good news about spirituality religion. The bad news about

religion. The bad news about spirituality religion is that um you know for for many people um it can also be a source of you know tremendous pain

and struggle you know. So I think another kind of major um advancement you know in our our scientific literature you know has you know entailed you know work of Julie

Xline, Ken Paramament, many many other people now you know to show you know one you know that uh many people particularly those who are dealing with mental health issues you know you know

can really struggle you know with their faith or spirituality you know so here would be some of the common struggles you know that come from uh Julie's work

you And you know there have now been you know roughly you know maybe 30 to 40 you know rigorous longitudinal studies you know that show that when spiritual

struggles are present along with mental health symptoms that kind of over time those who are struggling with their spirituality and religion along these lines they tend to

fare worse over time from a mental health standpoint when you account for the the severity of their mental health symptoms. Right? So what does this mean?

symptoms. Right? So what does this mean?

This means that you know for people who experience these spiritual struggles their chances of recovery are less than those who don't. Right? So this makes it

a highly relevant clinical issue for us.

But there are other you know problems related to religion or spirituality that you know psychologists might encounter.

You know that there's a a growing literature on you know spiritual bypassing. you know, there's um kind of

bypassing. you know, there's um kind of passive uh deferring strategies of spiritual religious coping. Um you know, scrupulosity is a unique form of

obsessivecompulsive disorder, you know, that you know, is is characterized, you know, by um kind of religious beliefs, perceptions, behaviors. Um you know if

perceptions, behaviors. Um you know if if anybody works with you know people um suffering from you know severe persistent mental illness you'll know that that many people you know their

delusions hallucinations you know are often kind of spiritually or religiously themed you know we're we're learning kind of more and more you know about you know the frequency of spiritual trauma

you know and abuse I mean the list goes on and on and on right um you know and and these are clinical problems that you know psychologists and other mental

health professionals will encounter time and again you know in their practices right so ideally mental health professionals are going to have the ability to recognize these problems you

know and then to be able to distinguish these problems from you know kind of psychopathology and and possible kind of other forms of

um kind of impairment right so how do you do this like I think you know Just a couple questions that ideally people would ask themselves, you know, would be like one like, well, is this problem consistent with cultural

norms, you know, and you know, how is this this problem impacting my my client's well-being and functioning at this time, right? You know, so ideally like psychologist, I mean, this is where

like a psychologist may refer to a spiritual or religious leader, maybe a chaplain, maybe a colleague who who might have, you know, specialized expertise in this area. um you know so

it might be a bridge too far to cross that all psychologists will be able to deal or address these problems but we need we need all folks to be able to

identify them we think just be here be some of the dos and don'ts you know for you know addressing spiritual struggles in day in dayout

clinical practice um this comes from uh uh Ken Paramament and Julie Xline's recent book uh working with spiritual struggles in psychotherapy Um I think it's going to become another classic. I

encourage everybody to read it if you haven't done so already. Um you know so you know ideally you know we don't want psychologists you know to avoid neglect you know change the subject when

spiritual you know struggles you know or other problems emerge. Um you know don't assume you know that you know you you

understand don't judge or criticize.

Um, you know, I think there's this tendency, you know, as psychologists, right? You know, that if if if there's a

right? You know, that if if if there's a a belief or an area of life that's causing distress, right? That we often want to kind of, you know, help our clients to get rid of it, right? You

know, to maybe have like a faith ectomy of sorts, but we don't want to do that.

Uh, we also don't want to slip into the role of overfunctioning and, you know, trying to be a theologian or a pastor, right? But ideally, you know, we want to

right? But ideally, you know, we want to inquire explore listen normalize you know, and assume a posture of culture, humility, as Cassie has highlighted.

Um, collaborate, you know, with chaplain, other spiritual care professionals, you know, you you know, who, um, who might have the skills that that the client needs. Um, and then there's

needs. Um, and then there's evidence-based interventions out there, you know, like building spiritual strength and and other interventions, you know, to that that you, you know, possibly could implement. um you know if

your if your your setting would allow for that you in terms of you know the skill-based you know guidelines that we're suggesting uh we're keeping things you

know pretty minimal you know so you'll notice we don't have you know any guide we're not suggesting any guidelines you know that psychologists will learn to implement spiritually integrated

psychotherapies you know but as Cassie already highlighted like we do think you know it's important that every psy psychology ologist, possible other

mental health professional has the willingness to like directly ask your clients in, you know, caring, empathic,

curious ways about their spiritual and religious identity, right? So, you know, this would be kind of a a three-phase kind of process, you know, for how psychologists may do that. You know, I

think one, you know, ideally, you know, psychologists are going to approach, you know, about spirituality, religion, you know, hopefully, you know, as early as,

uh, relevant in in the clinical or treatment process, right? And then depending on how their

right? And then depending on how their clients respond, you know, ideally, you know, psychologists are going to, you know, respond skillfully in those moments in the same way that, you know,

hopefully we would respond skillfully, you know, when broaching about, you know, a client's the significant of a client's racial background or sexual orientation or other, you know, sources

of identity, you know. And then you know as we um you know engage you know our our clients you know in exploration discussion about their faith or their

spirituality you know ideally you know we're going to have the willingness you know to include you know you know those those strengths or resources in the treatment to tailor the treatment

accordingly according to our clients preferences you know which would be very much in keeping with evidence-based practice um or um you know to possibly like you know look look into referring

or collaborating with you know spiritual care professionals, clergy that we would you know address in the last guideline you know. So here are a set of questions

you know. So here are a set of questions you know that I think are are pretty helpful. Um, you know, there have been a

helpful. Um, you know, there have been a lot of really helpful books, you know, written, you know, on spiritual religious assessment. You know, these

religious assessment. You know, these questions come from Ken Paramman's book.

Um, but just imagine, you know, the impact that what what if every, you know, you know, psychologist, you know, just had a set of questions that they've

memorized, you know, that they asked their clients kind of early on in the treatment process. Do you see yourself

treatment process. Do you see yourself as a religious or spiritual person?

Okay. If the client says no, that might be the end of the conversation and you move on and you talk about kind of other clinically relevant areas in that person's life. If they say yes, you you

person's life. If they say yes, you you explore, well, in what ways? Like what

does it mean for you to be spiritual?

What does it mean for you to be religious? You know, are you affiliated

religious? You know, are you affiliated with a religious or spiritual denomination or community of some sort?

In what ways? Again, it's not enough just to know that that person is affiliated with the synagogue or the mosque or the congregation down the street. It's important to know, okay,

street. It's important to know, okay, well, how often are they going to services and how do how do they intersect with the people in their spiritual religious community? You know,

how has your problem affected you religiously or spiritually? Right? This

is, you know, kind of getting at, you know, you know, the possible uh presence of spiritual struggle or spiritual issues. um how has your religion or your

issues. um how has your religion or your spirituality been involved in the way that you've coped you know with your problem right again you know and then depending on the response you know then

probing you know and exploring how how has the client drawn strength or coped you know with with their religion and spirituality um again there's a distinction between

implicit explicit spiritual religious assessment you know here's some references you know for books that do a great job of you know disentangling these approaches.

Um the sixth guideline you know would you know kind of entail sort of working within our scope of practice you know you know as psychologists and

having the willingness to collaborate with clergy and other spiritual care professionals you know when needed. um

you know so this just be a continuum that I think for some of us you know we might you know be kind of more at the end of the novice I think for for most psychologists they're going to be more

at the end of the novice you know for attending religion spirituality whereas some of us might have a background in theology or we might might even um you know be something of a spiritual

religious guru ourselves right but again like I mean that introduces a whole other set of ethical challenges right?

You know, to to still function in the role of the psychologist.

Um, you know, here just be kind of some of the stumbling blocks um, you know, for collaborating with clergy, you know, that psychologists kind of may encounter. Um, I think a really great

encounter. Um, I think a really great model right now um, you know, would be Glenn Milstein's uh, uh, cope um, kind of framework, you know, so I would, you know, just encourage people to, you

know, to check out, you know, Glenn's work. you know, he's got some great

work. you know, he's got some great principles, you know, and actionable strategies, you know, for overcoming, you know, these barriers.

Um, I'll I'll just, you know, very very quickly say that, um, we're we've got a lot of research, you know, basic research, you know, about the health,

mental health benefits of religion, spirituality, the ways that spirituality can also harm health, mental health.

We're also doing really good in meas about measurement. We're also doing good

about measurement. We're also doing good about kind of to move that research forward in terms of applied clinical research like the intervention studies, you know, on spiritually integrated

psychotherapies. We still have a science

psychotherapies. We still have a science practice gap for this this body of knowledge. It's not making it into the

knowledge. It's not making it into the mainstream like like it could be right now. How do we overcome that? I would I

now. How do we overcome that? I would I would encourage everybody that as as we identify these guidelines and these kind of universal um kind of areas of

practice that we would hope all psychologists would aspire to the the bridge is going to be promoting training in these areas. You know that training

is going to be the mechanism that really allows us to try to overcome this this practice gap. you know that that right

practice gap. you know that that right now we we're sort of lost in translation that our research is not making it into practice and this is um a universal problem you know across all APA

divisions and you know other areas of scientific research um again I would just point people to our spiritual religious competencies website there's a lot of resources for training on that

website including the road map that Cassie has highlighted um so I'm going to stop now and I think we've um saved 10 15 minutes for questions

Thank you both so so much. That was so interesting. Um I'll just invite anyone

interesting. Um I'll just invite anyone who has a question to raise your hand and we'll call on you.

Yeah, go ahead Chris.

>> Thank you. Um so my name is Chris. I'm

I'm in I live in Santa Clara County, home of San Jose, California. uh and I have been working uh on the California mental health and spirituality initiative which I know David Lukov is a

part of and we have um in California there are four counties uh that have adopted what are called spirituality policies and those are Los Angeles,

Alama, San Monteo and then my county Santa Clara in 2022 and essentially those policies uh that policy basically states that uh upon intake a a county

employee or county contracted employee will um ask uh is to ask about spirituality and religion and we utilized some of the the research work that that your team you know has kind of

put together which is great. Um my

question is uh is anyone on here aware of any other kind of jurisdictions that are going that route of incorporating it

into into a a government um adoption if you will.

>> That's kind of amazing. Yeah. I the only thing I am aware of is the um cal the um OSHA standards for hospitals across the

board of hospital accreditation. So

medicine is kind of ahead of mental health professions in requiring attention to these domains. So in

hospital accreditation you have to show that you are inquiring about someone's religion and spirituality and you are providing religious and spiritual resources for them. Um mental health is

kind of far behind that. Right. So um

but that's that is a it's interesting that during our whole road mapping that didn't really come up that there could be like a jurisdictional um requirement or at least a

recommendation to do that. That's

amazing.

Yeah, that's really inspiring. Um, yeah,

so that would be a top-down way of trying to promote, you know, systemic culture change, I think. Um,

as as we know, um, top down, um, initiatives, you know, um, can be very very effective. Um, how are like how are

very effective. Um, how are like how are like clinicians, you know, or or mental health professionals responding to the these mandates that they have now?

>> Uh, that's a great question. You know, I I find that effective things happen when uh change happens when top down meets bottom up. And I mean, we have this

bottom up. And I mean, we have this policy now. I I can't tell you if it's

policy now. I I can't tell you if it's being implemented. I mean, I know that

being implemented. I mean, I know that when we were putting the policy together, we utilized the the FICA, if I remember correctly, >> as a as a assessment tool that the counties can use. And there was some

training, but I think that's where, you know, that's where the the proof is in the pudding is, you know, is the county uh through its through its uh systems uh hospital systems and health care systems

actually incorporating the policy. And

that's where I think some some additional work needs to be done. But I

I do think from you know from a policy perspective at least you know at least it's there and you know so that's the first step but that's a great point of you know is it being I don't know I

don't know the answer to that. Yeah. Or

like how how are the mental health professionals receiving it, right?

Because I mean sometimes we don't really like to be told what we need to do, you know. Um but I I love that image of the

know. Um but I I love that image of the top down meeting the bottom up. And I do think there is consensus among most mental health professionals that religion and spirituality are important

aspects of multiculturalism and well-being. And because of that, I think

well-being. And because of that, I think most people just want to do the best job they can. And if this will allow them to

they can. And if this will allow them to be more responsive, more effective, I mean, they're going to welcome it.

>> Do you know if there have been any surveys of the clients in those counties?

>> You know, you thought about that?

>> I know that um I think it was David and Ann Marie Yamada, I believe, did a evaluation of Los Angeles County's policy a few back and I think that

that's that's available. I know Santa Clara County, it's too new.

two years ago that it was adopted or two and a half years ago, but I I don't I don't want to dominate the conversation.

So, anyone else has other questions, but thank you.

>> Thanks, Chris.

>> You want to go ahead and then Leo?

>> So, um first of all, thanks for this wonderful presentation. Um I have two

wonderful presentation. Um I have two questions that relate to the concept of time. um the con it seems that at the

time. um the con it seems that at the moment the emphasis is on the um initial assessment of the client and you know

and and I understand that often in some in research you're looking for you know studies in which a clients are presenting with one well well-defined

problem that is now going to be you know evaluative you know at the end um you know for for uh improvement um in clinical practice ICE, which is which is

my emphasis. Um, exclusively. I'm I'm

my emphasis. Um, exclusively. I'm I'm

not in a in a university setting. Um,

you know, often people are coming in um with developmental histories.

>> Um, and so and and also with problems, potentially multiple diagnosis.

And the reason that they're there at the moment, the crisis for which they came in may not be related to something that

is explicitly spiritual or religious.

Um, but there may be developmental aspects of their experience, even if they don't currently consider themselves affiliated, that emerge in different nuanced ways

over time. So I'm curious if the new

over time. So I'm curious if the new guidelines and the teaching that's being developed a have look backs to the developmental impact of different types

of not only explicit messaging but also some of the structural features that happen when people grow up. You know it with different types of religious experiences in their families of origin.

And what is being encouraged about looking at religion and spirituality over the course of treatment and not only at the initial clinical evaluation?

[Music] >> Go ahead, Joe.

>> Um, so, so I guess kind of two questions about like maybe how how we're attending to these these issues of timing, you know, in the professional practice guidelines. So I think yeah at this

guidelines. So I think yeah at this point in time like like like so for the section on you know spiritual religious assessment like we we don't we don't go

into too much depth you know about like you know you developmental experiences you know and and the possible role of like developmental trauma of a spiritual

religious nature like you know like like we're we're very intentionally keeping you know keeping the background section you know um you know somewhat lean and

mean and um and not you know going into too much detail um I I do think those are really important points the question about like when when to ask clients about their spirituality religion I

think that's a very important question right so you know so ideally like you know we're going to be training you know psychologists to appreciate that assessment is a process in the same way

that spirituality is a process right you know so it takes a process to assess and understand a process, right? I think you know the first step is just having the willingness to ask clients about their

spirituality, religion. But you know,

spirituality, religion. But you know, ideally like psychologists are going to, you know, they're going to have this knowledge about the the double-sided nature of spiritual religion, the ways that spirituality helps, harms mental

health. And then on the basis of that

health. And then on the basis of that that awareness, they're going to hopefully have the ability to be listening for spiritual themes and content throughout the the

treatment process. And when it emerges,

treatment process. And when it emerges, hopefully they're going to have the courage and the skill to attend to those things. So, it's not really a one-time

things. So, it's not really a one-time thing. It it's really going to be, you

thing. It it's really going to be, you know, I mean, driven by clients and, you know, just the unique things, right? in

my experience is that clients often don't want to bear their souls in the very first session, right? And it can take time to build those relationships and Yes. And yeah,

and Yes. And yeah, >> thank you so much. I don't want to take >> Yeah. And I think a lot of clients have

>> Yeah. And I think a lot of clients have had negative responses to their sharing about their religion and spirituality.

So they're not they don't feel very safe in the first session saying anything about it even if asked. And so, you know, I always like to use the the word

the the phrase spiritual and religious backgrounds, beliefs, and practices.

And I think that came from another set of researchers that escape me right now.

Um, and so spiritual and religious beliefs, backgrounds, and practices, I think, encompass better what we're talking about. Um there are also

talking about. Um there are also assessment tools like a spiritual religious genog that people can do that tracks back over their own history and their family history and how it affected

them. Um and there was in the initial

them. Um and there was in the initial set of competencies a competency that said psychologists understand that religion and spirituality develop and change over a lifespan. And that was

kind of one that got axed as being a little bit too advanced to expect every single mental health professional to be have expertise in. Um but I think you're absolutely right.

>> Yeah.

>> Thank you.

>> See, we have time for I think five more questions. Um so I know Leoi you had

questions. Um so I know Leoi you had your hand up before and Pete I see you have your hand up. if you want to just email the presenters after. Um, I

welcome you to start a conversation with them, but Leo, you go ahead and then we'll have like 30 seconds per speaker and then we'll wrap up.

>> Thanks so much again for the presentation. Um, I'm just wondering

presentation. Um, I'm just wondering about are there any systematic efforts looking at the process of developing these competencies?

And uh I know Jen Ripley and I or she approached me and we worked on a presentation that we that we made at the National Council of Schools and Professional Psychology that I've been

involved in and and I'm an educator. Uh

but I'm just wondering is there any research because I think um I think we we need some and I think that could be really compelling to our field.

And so you're asking is there uh research into the process of developing the competencies, >> right? Into emerging psychologists and

>> right? Into emerging psychologists and clinicians learning these competencies and and how best to teach it.

>> Oh yes. Yeah. Yeah. The the most the the most recent work we did with the spiritual and religious competencies project was focused almost completely on

how to train and integrate. And so we used a dissemination and implementation science approach um and we collaborated with our disk

institute on campus and had a a dissemination and implementation scientist as part of our team for that reason. It was really fascinating to

reason. It was really fascinating to learn about how you shorten the time between um in medicine they call it bench to bedside. you know that the time

between discovering and applying is something like 17 years, some insane amount of time. And so how to accelerate that is kind of where it's a good place

to end is sort of balancing top down and bottom up and making sure that all stakeholders have had a voice and been

heard about their concerns and their so that you can sort of bulletproof your strategy ahead of time. so that by the time you're rolling it out, you've already heard most of the barriers and

concerns that people might have. Um

that's been really really helpful.

>> Okay, I think um if everyone's okay with that, we'll leave it there. We're one

minute over, which is pretty good. Um

so, thank you so so much to our wonderful presenters. Really, really

wonderful presenters. Really, really spectacular. Um, we will be posting this

spectacular. Um, we will be posting this on the website in about a week. So,

you're welcome to rewatch it um and continue the conversation. And I hope you all have a good night.

Thank you, Charlotte, for organizing >> and Connie.