Clinical Psychology Review, Vol. 21, No. 7, pp. 989–1003, 2001 Copyright D 2001 Elsevier Science Ltd. Printed in the USA. All rights reserved 0272-7358/01/$ – see front matter

PII S0272-7358(00)00078-7

Dominic A. Carone, Jr.
Nova Southeastern University

David F. Barone
Illinois State University

ABSTRACT. Religious beliefs are an important part of clients’ culture, whether acknowledged or not. Psychological theories about social and cognitive processes can help mental-health professionals better understand the function of religious beliefs in coping and their role in therapy. Religious individuals are likely to use heuristics to form rapid judgments rather than engage in formal information-gathering processes. The confirmatory and in-group/out-group biases support such judgments and shield them from disconfirmatory evidence. Religious beliefs provide order and understanding to an otherwise chaotic and unpredictable world. Many religions advocate forgiveness, which is often helpful in resolving conflicts. Another beneficial religious belief is an ever-present spiritual attachment figure. Negative effects of religion include its exercising aversive control to maintain conformity and its promoting an external locus of control. In contrast, mental-health professionals belong to a tradition of free inquiry and selfdevelopment, and guide clients to acquire competencies necessary to change and direct their lives. Therapist attitudes are far less likely to include allegiance to religion than are those of the public and psychiatric patients. Rather than being biased against religion or trying to debate religion, therapists need to engage in problem solving with clients in the context of this example of sociocultural factors. D 2001 Elsevier Science Ltd. All rights reserved. KEY WORDS. Religious beliefs, Therapist attitudes, Forgiveness, Attachment, Locus of control, Sociocultural factors

Correspondence should be addressed to David F. Barone, Department of Psychology, Illinois State University, Campus Box 4620, Normal, IL 61790, USA. Phone: (309) 438-8651; Fax: (309) 438-5789; E-mail: dbaron@ilstu.edu



D. A. Carone, Jr. and D. F. Barone

MOST PEOPLE, TODAY as in the past, draw on religious beliefs to understand themselves and the world around them. Psychologists, in contrast, rely on their own naturalistic theories; most are nonreligious or antireligious. However, psychologists are also increasingly cognizant of the importance of culture in understanding cognition about self and others in cultural context. Thus, we need to consider religion as an important cultural source of attitudes, high-level theories, and specific beliefs. Irrespective of their accuracy, religious beliefs can provide heuristic answers to vexing questions. Practitioners need to consider how religious attitudes and beliefs affect clients’ lives — negatively or positively — and how their own beliefs about religion, especially when they differ from those of a client, affect the therapeutic process.

RELIGIOUS BELIEFS AS AIDS TO THINKING The contemporary motivated-tactician model of social knowing posits that we think strategically, either as cognitive misers or naıve scientists, as the particular ¨ situation and our goals vary (Barone, Maddux, & Snyder, 1997; Fiske & Taylor, 1991). If a person is pressed for time, is dealing with multiple tasks, or has inadequate information, he or she is likely to use a heuristic (cognitive shortcut) or theory-based deduction to achieve a good-enough understanding and decision. Such rapid, easy judgments result in biases, errors, and illusions, but cognitive conservatism and social support mask these costs. If a person is motivated to obtain intensive understanding and has the capacity to do so, he or she is likely systematically to gather information and thoroughly to deliberate about it. Such scientific thinking consumes time and effort and may not be conclusive. Epistemologists and psychologists traditionally have treated deliberative, systematic thinking as the only kind worth studying. However, we now realize that its costs prevent its use ‘‘on-line’’, in the time press of conversation and activity. Everyday thinking is more often that of the heuristic, cognitive miser. Religion typically offers an elaborate set of beliefs and therefore promotes theorybased knowing. Believers are likely to use heuristics (What does our creed say?) to form rapid judgments rather than engage in extended inquiry. A well-documented consequence of heuristic processing is the confirmatory bias, in which selective perceiving and remembering seem to validate beliefs, hypotheses, and schemas about the world even when they do not (Snyder & Swann, 1978). In Piagetian terms, the confirmatory bias includes excessive assimilation of data to schemas and insufficient accommodation of schemas to discrepant data. This strategy is efficient, takes less effort, and is associated with enhanced, although possibly illusory, predictability and control and the accompanying reduced anxiety. Thus, the religious person feels certain of his or her understanding of the world and is confident that he or she is taking correct action. For example, some Christians follow a well-rehearsed heuristic in social situations that is popularly known as WWJD (What Would Jesus Do?). Individuals who use this heuristic apply their knowledge of Jesus’ life and try to model their behavior after his. So, for example, if punched in a fight, a person following the WWJD heuristic might ‘‘turn the other cheek’’ like Jesus is written to have done. Also, when wronged, such a person would try not to get revenge but instead to behave like Jesus reportedly did and forgive the wrongdoer.

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Religion also activates biases involving the in-group and out-group. Each religion typically identifies itself as the only true one, while all other religions are in error. Those who believe in the religion are righteous and holy; all others are not. The religious faithful prefer to socialize with each other and congregate periodically to reaffirm their beliefs. Thus, in addition to the cognitive confirmatory bias, religious persons are reinforced socially that their beliefs are correct. Religious individuals, supported by their confirmatory and in-group biases, will not systematically and objectively evaluate other points of view as a naıve scientist would because they ¨ already believe that other viewpoints are either wrong or misguided. As Albert Ellis stated, ‘‘If they [devoutly religious people] believe in a hypothesis, they almost always shut out experiments that would falsify it’’ (Nielsen & Ellis, 1994, p. 336). In his classic work The Future of an Illusion, Freud (1961) pointed out some ways that religious individuals have used the confirmatory bias throughout history to support their particular schemas about the world. For example, Freud stated that mankind’s helplessness in such a chaotic and unpredictable world led to the religious notion that ‘‘ everything that happens in this world is an expression of the intentions of an intelligence superior to us’’ (p. 26). Thus, early in human history, natural events such as thunder and lightning were interpreted as evidence that the gods were angry about something, and familiar social strategies of appeasing a powerful other or asking for forgiveness were instituted. With the advent of philosophy and science, fewer natural events are attributed to divine anger, but religious people nevertheless interpret the laws of nature as proof that their general schema is correct. That is, God/gods cause natural events by having created the laws of nature, which are allowed to operate without interference. Then how does the religious person explain phenomena that seem to contradict the laws of nature? An example of such a phenomenon would be if a hurricane suddenly changed course at the last minute and did not hit the landmass as predicted by meteorologists based on known weather patterns. Naıve scientists ¨ might explain this, after systematically reevaluating their worldviews, by stating that most phenomena in the world follow fixed laws and predictable patterns but that weather is a chaotic exception of such complexity that it precludes error-free prediction. Freud (1961) argued that religious people instead would claim: ‘‘Only occasionally, in what are known as miracles, did they [the gods] intervene in its [nature’s] course, as though to make it plain that they had relinquished nothing of their original sphere of power’’ (p. 24). In sum, both the laws of nature as well as events that seem to contradict these laws are interpreted by many religious people as support of their general schema that superior beings control the events of this world. Not surprisingly, the antipathy between Freud and religion has been intense. Freud posited a whole array of unworthy motives that religion serves in addition to cognitive convenience, such as need for a father figure and denial of death. Religious believers vigorously sought to discredit Freud’s psychodynamic theory as providing laws of human nature. If sex and aggression are explainable outcomes of id impulses overwhelming superego restrictions and ego efforts, then a noninterfering God who created these laws no more requires appeasement and forgiveness for these behaviors than for thunder and lightning. Of course, most religions maintain the belief that ethical failings do require divine appeasement and forgiveness; thus, religions resist attempts to naturalize all human activity and free us of blame and guilt for our transgressions.


D. A. Carone, Jr. and D. F. Barone

RELIGIOUS BELIEFS AS AIDS TO ADJUSTMENT Positive Coping Strategy While many scientists and intellectuals have decried religion for promoting a false sense of certainty and security, others have been appreciative of its therapeutic effect. William James and Carl Jung were among the latter, and Freud strongly objected to their giving aid and comfort to religion (Carier, 1986). Psychologists have mostly been silent on religion, considering it a nonscientific topic; those speaking out about it, like Freud, have been most likely to oppose it as antiscientific. However, psychologists today are once again interested in the function of beliefs rather than their epistemological status as truths. A pragmatic psychology, in the tradition of James, can inquire about the positive effects of religious beliefs, even if they are positive illusions (Barone et al., 1997; Taylor & Brown, 1988). Religious beliefs provide people with a strategy to cope with the hardships of life. Recent research has shown that people use religion to cope with loneliness (Rokach & Brock, 1998), psychoses (Kirov, Kemp, Kirov, & David, 1998), illnesses such as Parkinson’s disease (Hermann, Freyholdt, Fuchs, & Wallesch, 1997) and the human immunodeficiency virus (Woods, Antoni, Ironson, & Kling, 1999), and loss of a family member to homicide (Thompson & Vardaman, 1997). From a social cognitive perspective, as already noted, religious beliefs can provide order and understanding to an otherwise chaotic and unpredictable world. In arguing for the therapeutic benefit of religious belief, Pargament and Brant (1998) stated that ‘‘only with the aid of the sacred can we understand the incomprehensible, manage the unmanageable, and endure the unendurable’’ (p. 112). Without the belief in an afterlife, for example, the death of a child from a stray bullet could seem utterly meaningless to the parents and leave them inconsolable. But religious beliefs can endow even this horrendous event with value and therefore help coping with it: God planned for the child to die to become an angel in Heaven, or the child’s death was part of his or her karma and will yield benefits in his or her next life. Religious beliefs justifying control by powerful others (a god and his/her appointees) allow people to maintain hope for themselves and loved ones and regulate negative emotions when no active coping strategy seems possible. Substitute Attachment Figures Religion can also be helpful by providing ever-present spiritual attachment figures (gods, saints, ancestors, etc.). Attachment theory, as formulated by Bowlby (1969, 1973, 1980, 1982) posits that an infant develops emotional regulation through coping with the absence of a primary caretaker. During the infant’s repetitive interactions with caregivers, he or she produces internal working models, or generalized expectations, about the caregiver and their relationship. Is she (or he) predictable? Is she responsive to the infant’s needs? Does she return reliably? Is she comforting or upset when she returns? Bowlby hypothesized that these internal working models are then applied to later relationships. Most research on attachment styles has focused on how an infant reacts after his or her mother/caretaker leaves the room, is replaced by a stranger, and then reenters the room, a procedure known as the Strange Situation (e.g., Ainsworth, Blehar, Waters, & Wall, 1978; Egeland & Farber, 1984; Gloger-Tippelt & Huerkamp, 1998;

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Kiser, Bates, Maslin, & Bayles, 1986; Schuengel, Bakermans-Kraneburg, Van Ijzendoorn, 1999). Fewer studies have been conducted to evaluate children’s attachment to their fathers (e.g., Cox, Owen, Henderson, & Margand, 1992; Main & Weston, 1981; Pipp, Easterbrooks, & Brown, 1993). However, long before research focused on an infant’s attachment to the mother, Freud (1961) asserted that the father is the central attachment figure for religious individuals. Although he acknowledged that the mother initially serves to protect the child, Freud believed that the father soon takes over this role. Freud (1961) claimed that human cultures’ condensation of the notion of several gods into a single father-figure-like God was an expression of mankind’s ‘‘longing for his father, and the gods’’ (p. 24). God became the father figure who would protect humanity despite its helplessness. Freud concluded that ‘‘his [mankind’s] longing for a father is a motive identical with his need for protection against the consequences of his human weakness’’ (p. 35). Freud’s language demonstrates his male bias, and he paid little attention to the widespread belief in female spiritual beings (goddesses, saints, etc.), who can be conceptualized as feminine attachment figures. An individual’s representation of God can be a continuation of childhood attachment experiences or a compensation for them if they have gone awry (Sorenson, 1997). Common beliefs about God (e.g., loving, protective, responsive) meet the defining criteria of a secure attachment figure (Kirkpatrick, 1994). Research has shown that secure attachment to a caregiver can help individuals develop positive internal working models of the social world (Klohnen & Bera, 1998; Priel et al., 1998). A secure attachment has also been found to be strongly related to a low level of anxiety (Sable, 1989) and to high levels of self-esteem (Bylsma, Cozzarelli, & Sumer, 1997), curiosity (Johnston, 1999; Mikulincer, 1997), and creativity (Rinich, Drotar, & Brinish, 1989). Thus, having a caring, responsive God or other spiritual being as a substitute attachment figure could improve one’s well-being. There is research suggesting that for individuals with poor attachment histories a secure attachment to God has positive effects. Kirkpatrick and Shaver (1992) found that subjects reporting insecure maternal attachment histories and secure attachment to God also reported secure attachments to adults. This finding is consistent with earlier research showing that a substitute human attachment figure drastically improved the lives of many children from an overcrowded orphanage who had received little attention and presumably had insecure attachments (Skeels, 1966). Thus, whether it is a physically present human being or a supernatural being in whom one believes, substitute attachment figures can help people with poor attachment histories understand and relate to the world around them more effectively. How do those with insecure attachment histories come to believe that God is loving and caring toward them when they have developed negative schemas of themselves and/or others? Many religions state that God’s love is universal and unconditional; thus, cultural beliefs provide a positive back-up for those with varied attachment histories. The message is that God will love you no matter how cruel and indifferent those around you are or how insecure and worthless you feel about yourself. Even in a religion in which one’s relationship with God is conditional, it typically can be improved by having faith and/or observing rituals, praying, doing good deeds, etc. (Kirkpatrick, 1998). A belief in this contingency provides hope when one’s social world offers no possibility of acceptance, as is the case for those degraded because of caste, class, slavery, servitude, gender, age, etc.


D. A. Carone, Jr. and D. F. Barone

Forgiveness Forgiveness is a traditional concept highly valued by religious and philosophical ethicists. For example, Aristotle (1987) wrote in his Nichomachean Ethics that ‘‘no one who is highminded will dwell upon the past, least of all upon past injuries; he will prefer to overlook them. . . . A good tempered or gentle person is inclined to forgiveness rather than revenge’’ (pp. 126, 130). Forgiving others who have done one wrong can have psychological benefit irrespective of the beliefs that support it. In recent years, psychologists have begun to study the social cognitive processes involved in this traditional way of resolving interpersonal transgressions. Forgiveness generally refers to giving up anger and resentment towards a wrongdoer. Some authors (Enright & The Human Development Study Group, 1991; Smedes, 1984) have added that forgiveness occurs in the context of a deep, personal, and unfair hurt. The main function of forgiveness is that it allows one to replace negative feelings with positive ones, such as empathy and love toward the offender (Scobie & Scobie, 1998). As such, therapists have recommended using forgiveness as a way for patients to deal with issues such as anger (Davenport, 1991; Grosskopf, 1999), sexual abuse (Bass & Davis, 1988; Farmer, 1989), betrayals in marriage (Gordon & Baucom, 1998), posttraumatic stress disorder (Johnson, Feldman, Lubin, & Southwick, 1995), and suicide (Al-Mabuk & Downs, 1996). Factors influencing forgiveness include the perceived severity of the offense (Girard & Mullet, 1997), judgements of responsibility (Weiner, 1995), the closeness of one’s relationship with the offender (Roloff & Janiszewski, 1989), and whether or not the offender apologizes (Weiner, Graham, Peter, & Zmuidinas, 1991). These findings accord with popular knowledge that it is easier to forgive a dating partner who apologizes for a one-night drunken stand than one’s committed partner caught in a secret long-running affair. Rumination over an offense may make one less inclined to forgive (McCullogh et al., 1998). Before one decides to forgive, one presumably must first change one’s causal attributions regarding the offender’s actions (Weiner, 1991, 1993). Thus, it would be easier for one to forgive an associate for breaking one’s computer if one believed that the offender broke it by accident rather than on purpose. Such social and cognitive factors facilitate empathy, a hypothesized precursor to forgiveness. Empathy is central to a recent conceptualization of forgiveness as altruistic behavior (McCullough, Worthington, & Rachal, 1997; McCullough et al., 1998). As with other altruistic behaviors, taking the perspective of another individual is the essential cognitive aspect of empathy. These authors conceptualize forgiveness as occurring in interpersonal relationships when one partner becomes motivated to have empathy towards the offending partner. Such empathy can lead the offended partner to care that the offender feels guilt and distress over what he or she has done, to care that the offender feels lonely because of their damaged relationship, and to care about restoring the damaged relationship with the offending partner. McCullough et al. (1997) hypothesize that, once the offended partner’s empathy exceeds a certain threshold, ‘‘the perceptual salience of the empathy for the offender overshadows the perceptual salience of the offending partner’s hurtful actions, leading to the set of motivational changes that we have defined as forgiving’’ (p. 323). They report findings that support empathy as a mediator of the positive relationship between receiving an apology and forgiving a wrongdoer. They also reported that empathy and forgiveness can be promoted through clinical interven-

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tion. They provided a seminar encouraging forgiveness by means of empathy or a seminar encouraging forgiveness without explicitly mentioning empathy. Participants who attended the empathy seminar were more likely to increase affective empathy and forgive wrongdoings than those who attended the comparison seminar. McCullough et al. (1998) conceptualize interpersonal forgiveness as part of a twofactor motivational system that mediates one’s responses to interpersonal offenses. The first factor is automatic and affective while the second factor involving empathy and forgiveness is a controlled process — a transformed motive (Barone et al., 1997; Kelley & Thibaut, 1978). Gottman (1993, 1994) found that hurt-perceived attack (fear and worry) and righteous indignation (anger, contempt, and thoughts of revenge) are the affective reactions that most people experience initially in response to the hurtful actions of their spouses. McCullough et al. (1998) hypothesized that these two affective reactions would be associated with different behaviors by the offended partner: seeking to avoid the offender in a personal and psychological context if hurt-perceived attack and being motivated to seek revenge if righteous indignation. They proposed that forgiveness allows one to inhibit these negative affective reactions in order to preserve a relationship. In support of their position, they found that forgiveness is negatively correlated with avoidance behaviors and positively correlated with conciliatory behaviors. This social cognitive account is consistent with contemporary discussions of accommodation in relationships (Barone et al., 1997; Rusbult, Verette, Whitney, Slovik, & Lipkus, 1991) and traditional religious discussions of forgiveness. Thus, religious beliefs about the value of forgiveness can instigate the affective process of empathy and facilitate this altruistic behavior that helps preserve relationships and relieve offended parties of extended emotional distress. In this case, cultural beliefs have promoted an effective coping behavior that overrides powerful, automatic emotional reactions. Observations of the positive consequences of forgiveness have long provided sound experiential support for it, but only recently have psychologists begun to investigate the conditions that promote or discourage it and to formulate a theory of its action. In the mean time, religious clients may have brought to therapy a coping strategy based on a religious belief that went beyond the psychological theories of the therapists. However, as good empiricists, most therapists report having discovered and used forgiveness in their practice (Cole & Barone, 1992).

RELIGIOUS BELIEFS AS THERAPEUTIC OBSTACLES In order to maintain conformity with their beliefs, religions (like other moral and social systems) often exercise aversive control. Members of a religious group are threatened with loss of righteousness before divine power and loss of favor, even shunning and exile, before the religious community. Clients strongly socialized this way may present for mental-health services experiencing anxiety about the prospects of such punishment or guilt about previous acts (Pargament & Brant, 1998). In contrast to the undersocialized who need to take personal responsibility for problems such as aggression, out-of-control sex, and substance abuse, these clients are being distressed by their religious beliefs. Further, these beliefs may undermine their confidence that they can change or that they and their lives are worth changing. Therapists from Freud (1961) to Albert Ellis (Nielsen & Ellis, 1994) have written


D. A. Carone, Jr. and D. F. Barone

about the anxiety of such clients, who are preoccupied with unattainable standards, harsh self-evaluations, low self-esteem, and helplessness. Rigid adherence to religious beliefs (or any beliefs) can interfere with adaptive coping. Clients coming for professional help need to make changes in their lives, but changes in belief or behavior may be opposed by religious doctrine. A religious woman may believe that it is her duty to bear children despite her health and poverty, to submit to her husband’s abuse, or to continue indefinitely in a failed relationship. Religious parents may believe that it is their duty to punish their children severely or deprive them of opportunities commonly shared by their peer group. They attribute their children’s rebelliousness and surliness to willfulness that needs to be broken rather than as an outcome of their authoritarianism. While there usually is a range of opinion about moral dilemmas within religions, such clients may adhere strongly to that sect or segment of opinion that rigidly supports their belief. Thus, the ‘‘permeability of constructs’’ (Kelly, 1955) to accommodate negative feedback can be undermined by religious belief. An extreme example of strong religious beliefs interfering with coping is ignoring medical advice and/or treatment that contradict these beliefs. Jehovah’s Witnesses are members of a Christian group that refuse blood transfusions (Migden & Braen, 1998), even when necessary to save a life. Their belief, based on their interpretation of three biblical passages (Muramato, 1998) and supported by their practice of shunning and ostracizing dissenters, is powerful enough to result in their choosing death for themselves or their dependents. This contemporary example of the long history of religious martyrdom provides a sobering warning to mental-health professionals. Religious beliefs may be very resistant to change, irrespective of how much the therapist believes that they hinder improved coping. In contrast to the tradition, going back to Freud, of mental-health professionals’ considering religious beliefs as wrong and antitherapeutic, the contemporary consensus is to accord respect to clients’ cultures. Today’s professional seeks to understand the positive psychological functions served by religious beliefs and the cultural nexus in which they exist. Respect and tolerance is less likely to threaten clients’ valued beliefs and social identification, thereby inflaming resistance, and more likely to support an alliance for solving clients’ problems. In the process of doing so, a client may rationalize a behavioral change without modifying a belief, may deliberately change a belief, or may even change their religious identification. As long as the client takes the lead, the therapist can maintain the goal of solving the client’s problem and not of changing the client’s religious beliefs.

THERAPIST AND CLIENT DIFFERENCES OVER RELIGION Although mental-health treatment is a secular professional activity, it impinges directly on issues, beliefs, and behaviors that carry religious prescriptions (Bishop, 1992). Some of these issues include sex, abortion, divorce, women’s role, the meaning of life, and death. Thus, religious issues are never far from the surface, despite efforts by both parties to avoid them. Despite their claims of neutrality, mental-health professionals typically conceptualize coping and changing differently from religious clients. The four conceptual models presented by Brickman et al. (1982) illustrate these differences. The models result from combining self versus nonself attributions about

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the cause of one’s problems with self versus nonself attributions about their solution. Religions typically follow the moral model, which blames persons for their problems but nonetheless expects them to solve them, or the enlightenment model, which also blames persons but considers them powerless to solve them without the intercession of a holy, powerful other. In contrast, mental-health professionals follow models that relieve the person of blame. The medical model favored by psychiatrists (and some other mental-health professionals) focuses on biological causes and solutions but requires the professional intercession of a scientific clinician. The compensatory model favored by most other mental-health professionals attributes problems to persons’ pasts and seeks to empower clients to master their problems in the future. One has a problem not because of willfulness but because of having been in a stressful environment that did not promote effective coping skills. Therapy provides the supportive experience needed to acquire such competencies, possibly supplemented by pharmacological treatment of chemical imbalances. Therapists are likely to agree with the statement that ‘‘while there is much that we do not know, humans are responsible for what we are or will become. No deity will save us; we must save ourselves’’ (American Humanist Association, 1973, p. 3). Thus, the therapist and religious client typically begin their relationship with very different expectations and goals. Religious clients may be preoccupied with their guilt and worthlessness, whereas the therapist believes in their personal worth and wants to put the past to rest and begin planning for a better future. For example, Jehovah’s Witnesses believe that God provides them with their mental health and that only He can help them overcome personal obstacles (Bishop, 1992). Thus, as Carroll (1993) found, such individuals would be most likely to use prayer and meditation to help them overcome a problem such as alcoholism. For the therapist, in contrast, the solution involves changing, loosening, or finessing certain religious attitudes or beliefs. Psychiatric treatment offers a less threatening alternative: The problem is construed as a disorder of human nature and the solution is provided by a physician with expertise in curing such disorders. Although religion has a high allegiance among the public, mental-health professionals are not nearly as religious as their clients. According to the 1997 Yearbook of American and Canadian Churches (as cited in Koenig, 1998), hundreds of millions of individuals in the United States report belonging to a religious group such as Christianity and Judaism. Poll results (Gallup, 1993) show that approximately 40% of Americans report going to church or synagogue in the last 7 days. Results from that same poll reveal that 55% of Americans believe that religion is very important in their lives and that 30% believe is religion is fairly important. Among psychiatric patients aged 20 – 89, 80% consider themselves to be a religious or spiritual person (Fitchett, Burton, & Sivian, 1997). In contrast, psychologists and other mental-health professionals are more likely to be nonbelievers or not to practice religion seriously (Bergin, 1991; Bergin & Jensen, 1990). More recent research has shown that 50% of psychologists state that they have no religious preference, compared to 7% of the American public (Shafranskee, 1996). Thus, in addition to the difference in models of coping noted above, there are differences in therapists’ and clients’ attitudes about religion. Therapists’ views about religion influence how they perceive and behave towards religious clients. In a cautionary study by Gartner, Harmatz, Hohmann, Larson, and Gartner (1990), over 350 clinicians, with mostly liberal left-wing views, rated two similar case histories. The two cases differed only in whether the patients were identified as belonging to an extreme religious or political group. Clinicians felt less


D. A. Carone, Jr. and D. F. Barone

empathy toward the patients who belonged to the extreme religious and political groups as compared to those who did not. In addition, the clinicians were more likely to pathologize the behavior of the members of political and religious groups and see them as less mature as compared to those who did not belong to these types of groups. How does a therapist deal with religious beliefs? Problems are likely to occur if a therapist attempts directly to challenge a client’s religious views. For example, a cognitive therapist may decide to confront a Hindu’s strong belief that the mother goddess, Shakti, is causing him/her bad luck. Although the therapist may think that he/she is doing this client a favor by ridding him/her of an ‘‘irrational’’ belief, research has shown that clients who are highly religious will react very negatively to such an antagonistic approach (Morrow, Worthington, & McCullough, 1993). As another example, a Buddhist client from India may come to see a counselor because she argues with her husband a lot. Because Buddhism is a religion that emphasizes self-sacrifice (De Silva, 1993), this client may express a desire to defer to her husband’s wishes in order to avoid any further disputes. The client’s attempt at self-sacrifice is inconsistent with the modern Western view that healthy marriages are based on fairness and equality (Bishop, 1992). The counselor thus runs the risk of imposing his or her view on the client, which can disturb the client’s value system and cultural practices as well as the therapeutic relationship. Like other aspects of their culture, religion needs to be appreciated as part of who clients are and as supported by their social environment (Bishop, 1992; Kelly, Aridi, & Bakhtiar, 1996; Langman, 1995). As an outsider to the religion and the culture, the therapist is not a credible judge of it or commentator on it. The therapist’s responsibility extends only to learning about religious aspects of a client’s history and current problems. The therapist’s role requires maintaining focus on her or his expertise — mental health — and demurring from religious debate or comment. A therapist can explore, for example, with the Buddhist client mentioned above, why she and her husband argue a lot and what are methods to achieve her goal of a less strife-ridden marriage. If a client says that her religion requires her to severely punish her child’s wickedness, the therapist should reply that he or she is not trained in religion but does have expertise in what gets children to be more cooperative and less defiant. If religious qualms occur about more positive child-rearing tactics, the therapist cannot settle these but can encourage the client to try out the new methods before reaching any conclusions about them. One example of religious issues as presenting problems occurs when a couple comes to counseling because of difficulties resulting from an interfaith marriage. These can lead to divorce, as occurs in 32% of interfaith marriages by Jews (Eaton, 1994). One of the main goals in treating interfaith marital discord is for the counselor to help the couple become more aware and understanding of their cultural differences. This is consistent with the more general goal of couple counseling to improve communication about one’s expectations, needs, and desires so that both individuals can achieve an enjoyable and blended experience. Again, the couple may initially frame the issue as a religious or cultural one but the therapist reframes it as a relational issue, one that he or she has expertise in addressing. As noted at the beginning of this paper, religious clients are likely to be oriented toward conformity to religious beliefs. In contrast, therapy is a cultural practice based on free inquiry and self-determination. Research has shown that Muslims, for example, rate themselves high in conformity with regards to social expectations and norms (Kelly et al., 1996). A Muslim client may seek counseling because she is

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failing out of her first year of medical school. The apparent cause is the demand of Islam that she should pray five times a day. She may complain that she cannot decide which is worse: (a) continuing to pray five times a day and risk being kicked out of medical school or (b) to pray less, improve her grades, and risk alienating herself from her very religious family. Valuing education and independence, a counselor could easily side with praying less, but this position would disregard the value that this Muslim woman places on religious observance and family approval. By coming to a therapist rather than a religious advocate, the client is demonstrating her willingness to work through these differing values. By being sensitive to this cultural dilemma and working with the client to find the best personal resolution for her, the therapist demonstrates a professional commitment to inquiry and self-determination rather than to a specific outcome or choice. Religion may sometimes contribute positively to therapeutic change. As noted earlier, religion can promote mental health, and the client may tap this resource (Bishop, 1992; Fitz, 1990; Watson, Folbrecht, Morris, & Hood, 1990; Watson, Hood, Morris, & Hall, 1984). If a client feels that prayer, meditation, or chanting helps him feel better, the therapist should not discourage him from doing so unless these activities have other compelling negative outcomes. Ivey, Ivey, and Simek-Morgan (1993) advocate that therapists use relaxation and free association with religious, cultural, and gender symbols to help the client. For example, ‘‘a Jewish –Canadian client might focus on the Star of David, a Navajo on a mountain or religious symbol, [and] a Mexican –American on the Christian cross or the pyramids near Mexico City’’ (p. 199). Thus, from a social cognitive perspective, the therapist uses his/her knowledge of clients’schemas as an aid to treatment. Ivey and his colleagues go on to suggest ways that counselors can help improve their clients’ abilities to both focus on and discuss their problems by helping them use the positive resource images mentioned above. However, empirical support for these ideas is lacking, and research has failed to find enhanced treatment efficacy from including religious material (Llobera-Bunce, 1995).

SUMMARY Religion is of major importance in the lives of most people, providing them with a way to understand their own lives as well as the world around them. It is because religion is such an important issue to mental-health consumers that it is critical for psychologists and other mental-health workers, who are generally not as religious as their clients, to develop a better understanding of their clients’ religious worldviews. A social cognitive analysis of self and social cognition provides mental-health practitioners with a better understanding of the various ways in which religion influences their clients. Religion typically involves an elaborate set of beliefs that promotes theory-based knowing. Religious individuals are likely to use heuristics (e.g., ‘‘What would Jesus do?’’) to form rapid judgments rather than engage in formal information-gathering processes. A well-documented consequence of heuristic processing is the confirmatory bias, in which selective perceiving and remembering seem to validate beliefs, hypotheses, and schemas about the world even when they do not. Religion also activates the in-group and out-group biases in that each religion identifies itself as the only true one, while all other religions are in error. These biases prevent an objective analysis of information that conflicts with one’s religious beliefs.


D. A. Carone, Jr. and D. F. Barone

Religion provides people with ways to cope with the many hardships encountered in life. The main way is by providing order and understanding to an otherwise chaotic and unpredictable world. Religion can also be helpful to people by providing them with models of how to act positively towards others. Forgiveness is a very important concept that is advocated by many religions, often helping religious believers resolve conflicts in their lives. Another benefit of religion is that it can provide people with an ever-present spiritual attachment figure. One’s representation of God can be a continuation of his or her childhood attachment experiences or a compensation for childhood attachment experiences that have gone awry. Given the many benefits of a secure attachment style, having God as a substitute attachment figure can be particularly helpful to clients. While religion can impact people’s lives in a positive manner, it can have negative effects as well. Religion can cause people a great deal of anxiety by exercising aversive control in order to maintain conformity with a particular belief system. Religions also tend to promote the belief in an external locus of control (i.e., God), which causes individuals to feel that they do not have much control over their own lives. Strong adherence to religious beliefs can, in extreme cases, lead people to refuse proper medical treatment for themselves or for others who are dependent on them, as in the case of Jehovah’s Witnesses. Although mental-health treatment is a secular professional activity, it impinges directly on issues, beliefs, and behaviors that carry religious prescriptions. Religious clients and mental-health professionals often clash over locus of control, especially for future events. While mental-health professionals try to teach clients to acquire the competencies necessary to change their lives themselves, many religious individuals have an external locus of control emphasizing one’s helplessness before the will of a supernatural being. Furthermore, far fewer mental-health professionals have allegiance to religion than do the public and psychiatric patients. Therapists’ views about religion influence how they perceive and behave toward religious clients. Clinicians showed less empathy toward patients who belonged to extreme religious and political groups as compared to those who did not. Clients’ religious beliefs, no matter how much a therapist disagrees with them, need to be appreciated as part of clients’ cultures supported by their social environment. In sum, the mental-health professional does not engage in religious discourse but can use psychological knowledge about cognitive and social processes involved in religious believing as an aid to treatment.

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