Religion and spirituality in counselor education: Do we really need to talk about this?

Abstract

There are few topics that can raise countertransferential tension in a counselor education classroom as quickly as religion can. Why is that so? There are typically two answers one encounters. One source of this tension may originate in close association with trauma: religion has become a controversial topic partially due to the fact that religions have been the sources of oppression, violence, social control, and privilege that have done great harm to many people, especially marginalized groups. As soon as the topic of religion surfaces, it can trigger these intergenerational and personal wounds. The other source comes from the deep reservoirs of the human experience religion can tap into; to energize and embolden the highest ideals one may hold to. Thousands of years of reflection from saints, sages, prophets, and divine figures on the questions of human existence still speak to many people in the form of the world's religions. In fact, most of the world's population still practice them (Pew Research Center, 2012). For this reason, religion tends to be supercharged with meaning. But just because religion, and the associated topic of spirituality, is a common human phenomenon does not necessarily mean it is something that counselor educators should involve themselves in or include in their education and supervision of counselors. After all, counselor educators by and large are not trained philosophers or theologians. To expand upon the work of Currier et al. (2024), this special issue of Counselor Education and Supervision will explore reasons for incorporating R/S in counselor curricula, as well as provide strategies and examples for effective incorporation into counselor pedagogy and supervision. Before doing so, there needs to be a substantive rationale for including religion and spirituality in counselor education.

Historically, the US has been one of the most religious countries in the world, and remains the most religious of all industrially and economically developed economies (Pew Research Center, 2023a). Concurrently, the US population has experienced significant shifts in religious affiliation and devotional religious practices like prayer and service attendance since the 1990s; for example, fewer people now identify with Christianity compared to the past, though it remains the largest represented religion with 60%–65% of US citizens identifying with one of the many Christian denominations (e.g., Catholicism, Lutheranism, Pentecostalism; Pew Research Center, 2021). Conversely, the number of people belonging to minority religious traditions has slightly increased, with 6%–7% now belonging to traditions like Judaism, Islam, Hinduism, Buddhism, among others. However, the largest growth, in terms of religious identity, has occurred in the religiously unaffiliated. This portion of the population includes atheists and agnostics, but it also includes a category called nothing in particular. The number of atheists and agnostics has remained more or less stable since the early 2000s, with each group representing between 4%–6% of the population, respectively. However, the nothing in particular is the group that has grown exponentially in the last 20 years, representing somewhere between 28%–32% of population. This group is quite diverse in terms of holding traditional religious beliefs like the belief in God or higher power, practices (e.g., prayer), and even religious service attendance. More of the US population is also seeking spiritual connection outside the boundaries of a traditional religion; 22% of US adults identify as spiritual but not religious (Pew Research Center, 2023b). Despite declines in religious affiliations in recent years, 83% of all U.S. adults believe people have a soul or spirit in addition to their physical body; 81% say there is something spiritual beyond the natural world, even if we cannot see it; 74% say there are some things that science cannot possibly explain; and 45% say they have had a sudden feeling of connection with something from beyond this world.

Surveys of clients seeking inpatient and outpatient counseling have found that anywhere between 50%−80% would like their counselor to address R/S in the midst of the care they receive (Abernethy et al., 2021; Currier et al., 2019, 2020; Oxhandler et al., 2018, 2021; Rosmarin et al., 2015). For these clients, they report that R/S are relevant to their mental health, motivate them to pursue methods to improve or maintain their mental health, serve as sources of coping, and can also create crisis or distress. When counselors openly include R/S in their intake processes, clients rate their counseling as more effective and are more willing to discuss other dimensions of their cultural identities (Huguelet et al., 2011; Terepka & Hatfield, 2020). To the point: when counselors remain open to exploring these topics with their clients, it enhances the therapeutic process.

Since 2000, published reviews of the research literature have documented a substantial upsurge of studies investigating the linkages between R/S and many dimensions of wellness, health, and social functioning. For example, in their 2012 systematic review, Koenig and colleagues found over 3,000 empirical studies of R/S and health. By 2023, Koenig et al. next review found that this number had doubled to over 6,000. Specifically, in terms of mental health, studies have examined the direct and indirect relationships between R/S and positive affect (including constructs like wellbeing, hope, optimism, meaning and purpose, self-esteem, personal control), negative affect (depression suicide, anxiety, addiction), and social connections (social support, martial stability, social capital, delinquency/crime) the vast majority of these studies find psychologically healthy associations with a minority of studies finding negative relationships (Koenig et al., 2023. Most of these studies have used cross-sectional or prospective (i.e., correlational) designs. However, there is also evidence across 97 randomized controlled trials of causal effects of R/S psychological treatment approaches to influence mental health outcomes (e.g., depression) on par with traditional secular therapies (Captari et al., 2018). At the same time, when R/S are explicitly incorporated into these treatments, they can improve wellness outcomes across R/S domains (e.g., spiritual wellbeing) over and above secular treatments (Captari et al., 2018). In response to this growing evidence base, mainstream medical and federal health entities developed wellness models that incorporated spirituality as one of the dimensions of wellbeing, as in the case of the Substance Abuse and Mental Health Service Administration (SAMSHA, 2006). Due to these findings and organizational efforts (e.g., SAMHSA), the counseling profession continues to look for ways to include R/S in training standards and ethical practice.

Since 1988, R/S has been included in curricula standards of the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), and was first required to be taught as part of the Multicultural standards under the term religious preferences. Since then, R/S has been included in multicultural; addictions; and marriage, couples and family courses, typically using the terms religion and spirituality. The 2024 CACREP Standards continue this decades-long commitment to including R/S under Standard 3.B.11: “the role of religion and spirituality in clients’ and counselors’ psychological functioning.” R/S are also included in the Ethical Codes of the American Counseling Association (ACA, 2014). Specifically, these codes require counselors to enlist the support of R/S communities when appropriate (A.1.d), refrain from discriminatory practices based on R/S identities of their clients (C.5), and provide inclusive assessment practices of R/S (E.8). Spirituality is explicitly mentioned as an aspect of professional responsibility to maintain counselor wellbeing by providing oneself with adequate support to prevent burnout and impairment (Section C, Introduction; ACA, 2014).

During the 1990s, in a movement consistent with the emergence of the multicultural competencies, a division of the ACA, the Association for Spiritual Ethical and Religious Values in Counseling (ASERVIC), developed a set of R/S competencies to provide counselors with effective guidelines to work with clients from diverse R/S beliefs, practices, and identities in a manner consistent with the CACREP Standards (2009) and ACA Ethical Codes (2006). At that time, it was perceived that multicultural competence lacked practical inclusion of R/S; additionally, counseling leaders at the time were questioning whether R/S could completely be subsumed under multiculturalism (Cashwell & Young, 2020). Thus, these competencies were first published in 1999 through ASERVIC, and later revised in 2009 to their current form consisting of 14 individual competencies grouped into six domains that cover Culture and Worldview, Counselor Self-Awareness, Human and Spiritual Development, Communication, Assessment, and Diagnosis and Treatment.

Research has found that when counselor educators and counselors are queried about the importance of including these competencies in training, they are overwhelmingly endorsed. For example, most counselor educators and counselors (typically 80% or more across samples) believe that training in R/S competence is important for all counselors, not just those who specialize in these topics as niche areas of advanced expertise (Vieten et al., 2023; Young et al., 2007). Since the publication of the ASERVIC Competencies (2009), there have been published guides to practice R/S competence (Cashwell & Young, 2023; Gill & Fruend, 2018), textbooks covering R/S and counseling theory and techniques (Pargament, 2007; Stewart-Sicking et al. 2019), as well as manualized treatments that incorporate R/S into established therapeutic models (e.g., CBT; Captari et al., 2018).

Considering the aforenamed research, can we assume that R/S is already being included as part of standard counselor education? For many years, scholars have inquired of both faculty and students in counseling programs about the quality of the training they received for working with clients about R/S topics and the results are perhaps surprising (Oxhandler & Pargament, 2018). Published peer-reviewed studies (e.g., Cashwell et al., 2013) and dissertations (e.g., Todd, 2021) have surveyed and interviewed faculty and students, and analyzed course syllabi for the inclusion of R/S in their counselor education programs. In one of the first studies to compare syllabi across courses, Cashwell and Young (2007) content analyzed 14 counselor education program syllabi which offered stand-alone courses on R/S. They found that these courses differed significantly in terms of content on the topic, with a substantial number (29%) incorporating content that were inconsistent to the ASERVIC R/S competencies.

In the most recent and comprehensive study conducted to date comparing syllabi to assess how R/S are addressed in core CACREP curriculum, Todd (2021) compared course syllabi, readings, and assignments from multicultural courses across 74 CACREP programs. They found that only 24% of courses explicitly devoted a day in the course calendar to R/S, 54% had no assignments that including R/S, and 11% made no mention of R/S whatsoever in their syllabi. Delving deeper into what content about R/S is taught, Todd analyzed required reading content (i.e., multicultural textbooks and peer-reviewed articles) and found that the way R/S are approached in courses differs substantially between courses. The best-selling and most influential textbooks, in fact, covered R/S in the most superficial style, giving minimal detail regarding demographics of various R/S traditions, while less popular texts treated R/S with greater nuance delving into the diversity that exists not only between R/S traditions, but also the diversity of perspective for members within the same R/S tradition. Given their popularity as standard reading in multicultural courses, it is likely that most counselors are primarily exposed to a more superficial reading of R/S, which is the least effective training approach for later application to practice. Unfortunately, after two decades since the initial development of R/S competencies for counselors, there is still a lack of consistency in how R/S are incorporated into counselor education.

This lack of consistency appears to also have filtered out into the counselor education field writ large and, by consequence, into the professional practice of counselors. In 2002, Young et al. were some of the first scholars to look at this dynamic by surveying 94 faculty at CACREP programs about the importance of addressing R/S in counselor education. These faculty universally endorsed the importance of training their students consistently with the ASERVIC R/S competencies. However, only 53% of these same faculty agreed or strongly agreed that they were confident in teaching these competencies to their students; those who could not clarified that to feel more comfortable introducing these topics in their courses, they needed additional education, training, and resources.

Despite Young et al.’s (2002) work being 22 years old, the hesitancy and inconsistency in introducing R/S in the classroom continue to impact counselors’ willingness to bring R/S into the counseling session. Cashwell et al. (2013) found that counselors are more likely to endorse the importance of using clinical skills that address their client's R/S than they are to rate the actual frequency in which they use these skills with their clients. Unfortunately, corollary findings have emerged regarding practicing counselors’ training in R/S topics. In 2023, Vieten et al. conducted a national survey of 894 licensed mental health professionals (including allied professions like marriage and family therapy), 47% reported they had received either none or not very much R/S training in their professional education; another 35% had only received some training. Importantly, there were no statistical differences attributable to type of professional identity (e.g., counseling vs. clinical psychology) and the quality of training clinicians have received around R/S topics. This means that lack of consistency is a shared problem for counselors, psychologists, social workers, and marriage and family therapists nationally at all levels of mental health service delivery. Vieten et al. (2023) findings are consistent with previous survey studies for at least the last 20 years that highlight half of practicing counselors or more report that their training was inadequate to meet the demand for services from clients who present with R/S concerns or do not routinely inquire about the relevance of their client's R/S to their treatment (Oxhandler & Parrish, 2017; Young et al., 2007).

This lack of consistent inclusion of R/S in counselor education begs the question: if R/S identities are salient to most of the US population, clients frequently wish to discuss R/S with their counselor, R/S are associated with both mental health and distress, and they are topics that are required of standard training and education in competent and ethical clinical practice, why are their such high rates of counselor educators and counselors reporting that these topics were underemphasized in their education resulting in their lack of comfort and preparedness to address R/S with their students and clients?

Alongside the gathering evidence base for the value of including R/S competencies in mainstream counselor education, there have also been barriers that have prevented their widespread adoption. The most frequent and obvious recurrence across studies is simply a lack of training. Counselor educators were not trained when they were students, and so there is no training to pass on to their students. In turn, when their students become counselor educators, they have no training to pass on; this continues for the subsequent generations of counselors and counselor educators. Taking lack of exposure to training into account, readers may question what is preventing the reversal of this generational year-to-year. In an attempt to answer these questions, scholars have suggested other barriers (e.g., taboo history, conflicting paradigms) that may also discourage counselor educators from (a) fully engaging in these topics, and (b) seeking out their own educational experiences to expand their R/S competence.

Drawing from recent work on multicultural orientation, cultural comfort is the perceived sense of ease or lack of tension counselors experience when they venture into cultural territory with their clients (Watkins et al., 2019). From research, two of the top predictors of whether counselors will report this comfort and openly explore R/S topics with their clients is (1) if they have prior familiarity with the topics in their personal life, or (2) if they have been exposed to training or resources that are professionally useful (Vieten et al., 2023). Furthermore, cultural humility, the disposition of counselors to acknowledge their limitations, be oriented toward their clients, and seek out additional training as it relates to culture, is significantly related to clinical outcomes (Owen, 2011). Importantly, cultural humility is most strongly associated with clinical outcomes when working with clients who are highly religious commitment, and less associated with clients who are less religiously devout (Owen et al., 2014). Despite noteworthy progress in developing basic and applied research delineating the associations with, and in some cases, the causal effect of R/S on mental health (e.g., Garssen et al., 2021), a plethora of models and approaches to providing R/S competent counseling (e.g., Stewart-Sicking et al., 2019), there is still a sizeable portion of counselor educators who are hesitant to bring these topics into their courses. It appears that even though resources may be available, those resources are remaining on the shelves and not getting into the hands of counselor educators for various reasons (e.g., lack of personal relevance; Adams et al., 2015). What is needed is clear guidance that can increase confidence and cultural comfort for counselor educators by familiarizing them with ways they can introduce R/S competence into existing CACREP courses. Specifically, this special issue is structured to mirror the CACREP (2024) Section Five Specialized Practice Areas to ensure counselor educators are equipped to integrate R/S into their student's specialized areas.

With this overarching purpose in mind, each article in this special issue will describe the growing rationale for additional R/S training for counselor educators, R/S as a critical component of multicultural counseling, offer in-depth overviews of R/S integration in the CACREP (2024) specialized areas. Each article provides the reader with practical pedagogical tools and strategies to introduce R/S competence into these courses, along with guidance for how they can be implemented. One frequent issue that resurfaces in this realm of the counseling literature is the question of what counts for basic competence versus advanced clinical expertise; the first article in this collection helps to clarify this question by delineating what can reasonably be taught in a CACREP curriculum versus areas for additional, outside training.

Spirituality, religion, and faith are common terms that cover a broad array of psychological domains, including motivations, beliefs, emotions, behaviors, social, and political contexts (Pargament, Exline, & Jones, 2013). For the sake of clarity, each time these domains are referenced in this issue, the authors use the abbreviation R/S to signify this inclusive set of factors. Likewise, there is not one single definition of R/S that is standard across usages (Paloutzian, & Park, 2021). Defining a social science-based definition of R/S is still subject of some controversy, and one that is not expected to be resolved in this special issue, nor does it need to be in order for readers to use the resources in this special issue. Understanding and accepting the existence of the nuances and differences between how R/S can be used by counselors, clients, and the public, is an aspect of competence (Stewart-Sicking et al., 2019). Therefore, the authors were asked to provide some definition of how they are using the term, but readers will inevitably encounter some differences as they move from one article to the next.

The author declare no conflicts of interest.