Ethics of Religion

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Ripley, J. S., Leon, C., Worthington, E. J., Berry, J. W., Davis, E. B., Smith, A., & ... Sierra, T. (2014). Efficacy of religion-accommodative strategic hope-focused theory applied to couples therapy. Couple And Family Psychology: Research And Practice, 3(2), 83-98. doi:10.1037/cfp0000019

There is a long tradition of religious accommodation in psychotherapy. In fact, Norcross (2011) headed a joint task force by Divisions 12 (Clinical Psychology) and 29 (Psychotherapy) to examine relationship factors in psychotherapy. Meta-analyses were conducted in each case, and the task force evaluated the strength of the evidence supporting the relationship factors by classifying them as demonstrably effective, probably effective, and promising but with insufficient evidence to judge. Four matching variables received the highest level of support: reactance/resistance level, client preferences, culture, and religion–spirituality. Those classified as probably effective were stages of change and coping style, and those considered to be promising but without sufficient evidence were client expectations and attachment style. The meta-analysis on which this judgment was based was by Worthington et al. (2011a). They concluded that religion-accommodative psychotherapy was superior to weak controls in mental health outcomes, better than alternative treatments unless the alternative treatment was strictly a dismantling design, which we are attempting in the present study. In strict dismantling designs, secular and religion-accommodative psychotherapies were equal in mental health but religion-accommodative therapies had more change on spiritual measures.

The literature on religion and couples has developed several important themes including marriage as sacred, perception of God as agency in marriage, and forgiveness in marriage. Research by Mahoney, Pargament, Tarakashwar, and Swank (2008) demonstrated in a meta-analysis the importance of the sense of the sacred in marriage relationships. The number of people identifying with a religion has dropped from historical highs, but most Americans do identify with a religion with 15% reporting they have no religion (Harris, 2009). Religious couples tend to see God as having agency in their relationship indicating that the couple relationship may be more relevant to religion than other issues addressed in therapy (Mahoney et al., 2008). In contrast, research on forgiveness of a violation of the sacred, including sacred marriage, may demonstrate increased challenges for couples (Mahoney, Rye & Pargament, 2005). HFCA has proposed that an emphasis on forgiveness is necessary for relationship repair efforts, and may be more necessary with couples who view their relationship as sacred (Worthington et al., 1997).

A small collection of research on religion-accommodative couples interventions is supportive of accommodating religion in treatment (Worthington et al., 2011b). A religion-accommodative version of the Prevention and Relationship Enhancement Program has been used in church settings with positive results comparing trained graduate students, clergy, and ministry leaders (Markman et al., 2004). In addition, research on prayer with couples is supported with a conceptual framework for intervention (Beach, Fincham, Hurt, McNair, & Stanley, 2008), research in support of prayer as an intervention (Fincham, Beach, Lambert, Stillman, & Braithwaite, 2008), and a special issue on prayer in couples intervention in the Journal of Social and Clinical Psychology in 2008. This line of research has delineated numerous issues relevant to ethical and empirically informed religion-accommodative couples treatment specific to prayer.

Hook, Worthington, Davis, and Atkins (2014) reported a naturalistic study that examined religion and couples therapy with Christian couples. At three time points during therapy, the 68 couples entering explicitly Christian therapy completed measures of relationship satisfaction, working alliance with the therapist, and satisfaction with therapy. Religious techniques were used in about half of the sessions, and the religious commitment of clients was positively related to the number of religious techniques used. Preliminary evidence revealed that clients improved over time in relationship satisfaction and working alliance, and reported a high level of satisfaction with couples therapy.

Hook, J., Worthington, E., Davis, D., & Atkins, D. (n.d). Religion and Couple Therapy: Description and Preliminary Outcome Data. Psychology Of Religion And Spirituality, 6(2), 94-101.

McGeorge, C., Carlson, T., & Toomey, R. (2014). The Intersection of Spirituality, Religion, Sexual Orientation, and Gender Identity in Family Therapy Training: An Exploration of Students' Beliefs and Practices. Contemporary Family Therapy: An International Journal, 36(4), 497-506. doi:10.1007/s10591-014-9312-8