A Systematic Review of Relations Between Psychotherapist Religiousness/Spirituality And

Supplemental Materials

A Systematic Review of Relations Between Psychotherapist Religiousness/Spirituality and Therapy-Related Variables

by J. P. Cummings et al., 2014, Spirituality in Clinical Practice

http://dx.doi.org/10.1037/scp0000014

Table S1

Therapist R/S and Integration of R/S into Treatment

Citation / Sample / R/S Measures / Results
Shafranske & Gorsuch, 19841,a / 272 clinical psychologists (CPA) / Personal relevance of spirituality / Positively related to relevance of spirituality to clinical work
Religious upbringing / Unrelated to relevance of spirituality to clinical work
Kivley, 19861,a,b / 56 therapists (Illinois yellow pages) / Self-rated religiousness / Negatively related to viewing religiousness as neurotic
Positively related to viewing religiousness as therapeutically beneficial, favorable attitude toward integrating religiousness, and perceived competence in addressing religiousness
Shafranske & Malony, 19901,b,c / 409 clinical psychologists (APA Division 12) / Affiliation and participation in organized religion / Positively related to use of R/S interventions
Negative personal religious experiences / Negatively related to use of R/S interventions
End, Means, and Quest Orientations (Batson & Ventis, 1982) / End-oriented reported greatest perceived competence in addressing R/S
Holden, Watts, & Brookshire 19912,a,b / 95 National Certified Counselors and Christian clergy / Theological conservatism (denominational and self-rated) / Unrelated to perceived benefit of addressing depressive R/S ideation in case vignette or perceived right and competence to address it
DiBlasio & Proctor, 19931,c / 128 AAMFT members / Self-rated importance of religious beliefs / Unrelated to use of R/S interventions
Prest, Russel, & D’Souza, 19991,a,c / 52 marriage and family therapy students / Attendance at R/S services / Positively related to perceived link between spiritual health and well-being, appropriateness of discussing and recommending specific religious behaviors
Unrelated to perceived importance of addressing non-specific spirituality
Belief in personal God (Shafranske & Malony, 1990) / Positively related to perceived appropriateness and importance of addressing non-specific spirituality
Unrelated to perceived link between spiritual health and well-being, appropriateness of discussing and recommending specific religious behaviors
Payman, 20001,c / 143 geriatric psychiatrists / Religious affiliation (versus none) / Having an affiliation related to more disclosure of personal R/S beliefs to client
Attendance at religious function / Positively related to asking clients about R/S beliefs
Gubi, 20041,c / 343 counselors / Affiliation with R/S counseling organization (CMCS) versus secular organization (BACP) / Positively related to use of overt or covert prayer in therapy (theistic and nontheistic)
Walker, Gorsuch, & Tan, 20051,b,c / 100 Christian therapists / Combination of validated measures and new items (Christian Conservatism, Stellway, 1973; Religious Belief Salience, King & Hunt, 1972; religious behaviors, Jones et al., 1992; Attitude Toward Christianity, Francis, 1992; R/S values) / Positively related to self-reported competence in using R/S interventions and use of R/S interventions
Beatty, Hull, & Arikawa, 20071,a / 80 APA therapists (new psychologists and practitioners listservs) / Having any R/S affiliation (versus none)
Wilson-Patterson Attitude Inventory (Religion subscale - conservatism) / Positively related to Therapist’s Religious Attitude Scale (appropriateness of discussing R/S, Levinson et al., 1999)
Wade, Worthington, & Vogel, 20073,a,c / 51 therapists; 220 clients / Agency type (Christian versus secular) / Unrelated to therapist willingness to discuss R/S if raised by client and perceived appropriateness of knowing client’s religious background
Clinicians at Christian agencies report greater appropriateness of active R/S interventions
Clients at Christian agencies report greater therapist use of active R/S interventions
Walker, Gorsuch, Tan, & Otis, 20081,b,c / 162 student therapists from Christian clinical psychology programs / Similar combination of measures as in Walker et al., 2005 / Positively related to self-reported competence in using R/S interventions
Unrelated to frequency of using R/S interventions
Frazier & Hansen, 20091,c / 96 APA professional psychologists / Personal importance of R/S / Positively related to use of R/S interventions
Kellems, Hill, Crook-Lyon, & Freitas, 20101,a,b,c / 220 university counseling center therapists / Religious Commitment Inventory-10 (Worthington et al., 2003) / Positively related to use of R/S interventions (Shafranske & Malony, 1990; Richards & Potts, 1995); importance of facilitating R/S-neutral and R/S-promoting goals; and self-efficacy in addressing R/S in therapy
Cornish, Wade, & Post, 20121a,b,c / 242 members of AGPA / Religious Commitment Inventory-10 (Worthington et al., 2003) / Positively related to perceived appropriateness of R/S interventions and use of R/S interventions
Unrelated to comfort with spiritual discussions or barriers to addressing spirituality
Spiritual Transcendence Index (Seidlitz et al., 2002) / Positively related to perceived appropriateness of R/S interventions, comfort with spiritual discussions, and use of R/S interventions
Negatively related to barriers to addressing spirituality

1Cross-sectional, correlational study with only therapists providing data.

2Cross-sectional, correlational study with therapists responding to case vignette.

3Cross-sectional, correlational study with therapists and clients providing data.

aReports relation(s) between R/S and attitudes toward integrating R/S into treatment.

bReports relation(s) between R/S and comfort/competence in integrating R/S.

cReports relation(s) between R/S and actual use of R/S interventions.

CPA = California Psychological Association; APA = American Psychological Association; AAMFT = American Association for Marriage and Family Therapy; AGPA = American Group Psychotherapy Association; BACP = British Association for Counselling and Psychotherapy; CMCS = Churches Ministerial Counselling Service.

Table S2

Therapist R/S and Treatment Related Values and Interventions

Citation / Sample / R/S Measures / Results
Bilgrave & Deluty, 19981,a / 237 APA clinical, counseling, psychotherapy, humanistic psychologists / Author-developed measures of R/S beliefs:
Orthodox Christianity / Positively related to commitment to CBT orientation;
Negatively related to psychodynamic and existential
Eastern/Mysticism / Positively related to humanistic and existential orientations
Negatively related to CBT
Atheism/Agnosticism / Not related to any orientation
Jewish self-identification / Positively related to psychodynamic orientation
Parker, 19901,b / 50 beginning master’s counseling students / Christian orthodoxy (Dimensions of Religious Commitment Scale; Glock & Stark, 1966) / Related to greater reliance on external authority in making ethical judgments (Ethical Judgment Scale)
Galanter, Larson, & Rubenstone, 19912,b / 193 psychiatrists in Christian Medical and Dental Society / Evangelical Christian beliefs and belief in therapeutic effectiveness of prayer / Positively related to willingness to advise Christian client not to engage in abortion, same-sex behavior, or premarital sex
DiBlasio & Proctor, 19931,b / 128 AAMFT members / Self-rated importance of religious beliefs / Unrelated to development of techniques to promote seeking and granting forgiveness and forgiving self
DiBlasio, 19931,b / 70 social workers in AAMFT / Self-rated importance of religious beliefs / Positively related to perceived importance and usefulness of forgiveness in clinical practice
Unrelated to development of forgiveness techniques and perceived link between forgiveness and resolving depression/anxiety
Hecker, Trepper, Wetchler, & Fontaine, 19952,b / 199 AAMFT members / Self-rated religiousness / Positively related to viewing highly sexually active client with nontraditional sexual behaviors in case vignette as a
sex addict
Highly religious male therapists perceived vignette as more pathological than female therapists and less religious men
Unrelated to estimated number of therapy sessions needed, therapy outcome (positive or negative), and approach to therapy
Pais, Piercy, & Miller, 19982,b / 309 AAMFT members / Religious affiliation (Protestant, Catholic, Jewish, none) / Catholics rated anonymous, unprotected sex in case vignette as more dangerous
Catholics more likely to disclose vignette sex behavior
Self-rated religiousness / Positively related to perceived dangerousness of vignette sex behavior and likelihood of disclosure
Liszcz & Yarhouse, 20052,b / 85 LGB specialists, 53 CAPS members, 48 generalists in APA / Affiliation with Christian psychological association (CAPS) vs. LGB specialty vs. APA generalists / CAPS members less likely to agree with vignette client’s goal to “come out of the closet”
LGB specialists less likely to endorse client’s goals to change sexual behavior or orientation
Beatty, Hull, & Arikawa, 20071,b / 80 APA therapists (new psychologists and practitioners listservs) / Having any R/S affiliation (versus none) / Having an affiliation related to greater conservatism and anti-hedonism (Wilson-Patterson Attitude Inventory)
Kellems, Hill, Crook-Lyon, & Freitas, 20101,a / 220 university counseling center therapists / Religious Commitment Inventory-10 (Worthington et al., 2003) / Unrelated to self-report theoretical orientation (psychoanalytic, humanistic, or behavioral)

1Correlational, cross-sectional study with only therapists providing data.

2Correlational, cross-sectional study with therapists responding to case vignettes.

aReports relation(s) between R/S and theoretical orientation.

bReports relation(s) between R/S and other treatment-related values and interventions.

APA = American Psychological Association; AAMFT = American Association for Marriage and Family Therapy; LGB = Lesbian, Gay, Bisexual; CAPS = Christian Association for Psychological Studies.

Table S3

Therapist R/S and the Therapeutic Relationship

Citation / Sample / R/S Measures / Results
Bilgrave & Deluty, 19891,a / 237 APA clinical, counseling, psychotherapy, humanistic psychologists / Author-developed measures of R/S beliefs:
Orthodox Christianity
Eastern/Mysticism
Atheism/Agnosticism / Positively related to perceived influence of therapist R/S beliefs on practice
Jewish self-identification
Christian self-identification / Negatively related to perceived influence of therapist R/S
Gartner, Harmatz, Hohmann, Larson, & Gartner, 19901,a / 363 clinical psychologists / Self-rated religious conservatism/liberalism / Therapists reported greater empathy for vignette clients who shared their ideology;
Ideology unrelated to ratings of client pathology, client stress, and client maturity and openness to treatment
Lyons & Zingle, 19902,b / 46 Christian clergy; 96 clients / End, Means, and Quest Orientations (Batson & Ventis, 1982) / Clients rated End- and Quest-oriented counselors as more empathic (Truax-Carkhuff Relationship Questionnaire) than Means
Graham, Furr, Flowers, & Burke, 20011,a / 115 counseling students / R/S self-description (religious and spiritual, spiritual only, religious only, neither) / Religious-and-spiritual counselors less comfortable than spiritual-only counselors in working with vignette clients hostile to religion
Wade, Worthington, & Vogel, 20073,b / 51 therapists; 220 clients / Agency type (Christian vs. secular);
Religious Commitment Inventory-10 (Worthington et al., 2003);
Interaction between therapist and client Religious Commitment;
Interaction between therapist Religious Commitment and use of R/S interventions / Unrelated to client-rated closeness with therapist
Kellems, Hill, Crook-Lyon, & Freitas, 20102,b / 220 university counseling center therapists – reported on experience with client with R/S issue / Religious Commitment Inventory-10 (Worthington et al., 2003) and
Perceived R/S similarity with client / Unrelated to therapeutic relationship (Hill & Kellems, 2002)

1Correlational, cross-sectional study with therapists responding to vignettes.

2Correlational, cross-sectional study with only therapists providing data.

3Correlational, cross-sectional study with therapists and clients providing data.

aReports relation(s) between R/S and therapist attitude toward client.

bReports relation(s) between R/S and quality of therapeutic relationship.

Table S4

Therapist R/S and Treatment Outcome

Citation / Sample / R/S Measures / Results
Martinez, 19912,b,d / 16 university counseling center therapists; 20 clients / Therapist–client dissimilarity of religious values (Religious Values Scale; Allport, Vernon, & Lindzey, 1970) / Positively related to client-rated improvement
Unrelated to therapist rating
Therapist–client convergence of values / Positively related to therapist-rated improvement when less religious client became more religious;
Unrelated to client rating
Therapist–client dissimilarity of religious orientation (fundamentalist/conservative; Heist, Yonge, McConnell, & Webster, 1968) / Positively related to client- and therapist-rated improvement when therapist was more conservative than client
Therapist–client convergence of orientation / Positively related to therapist-rated improvement;
Unrelated to client rating
Kelly & Strupp, 19921,b,d / 36 patient–therapist dyads in study of Time-Limited Dynamic Therapy / Post-treatment similarity between therapist and client on value of salvation;
Convergence on value of salvation (retrospectively reported by client) / Unrelated to symptom improvement assessed by client, therapist, independent clinician, and Inferiority-Personal Discomfort subscale of MMPI
Propst, Ostrom, Watkins, Dean, & Mashburn, 19923,c / 10 student therapists; 59 depressed Christian clients / Therapist self-identification as Christian or not religious;
Each therapist conducted both standard CBT (NRCT) and CBT that integrated R/S (RCT) – compared to wait-list control (WLC) / Beck Depression Inventory: RCT with non-R/S therapists scored lower than WLC and NRCT with non-R/S therapists;
NRCT with R/S therapists scored lower than WLC
Hamilton Rating Scale for Depression:
RCT with non-R/S therapists scored lower than WLC
Global Severity Index of Symptom Checklist:
RCT with non-R/S therapists scored lower than WLC
Social Adjustment Scale:
RCT with non-R/S therapists and with R/S therapists had better scores than WLC;
Non-R/S performed better in RCT than NRCT condition
Brooks & Matthews, 20002,a / 11 inpatient addiction counselors; 94 inpatients in addiction treatment / Therapist’s score on Spiritual Well-Being Scale (Paloutzian & Ellison, 1982) / Unrelated to change in client Spiritual Well-Being score
Wade, Worthington, & Vogel, 20071,a,b,c / 51 therapists; 220 clients / Agency type (Christian vs. secular);
Religious Commitment Inventory-10 (Worthington et al., 2003);
Interaction between therapist and client Religious Commitment;
Interaction between therapist Religious Commitment and use of R/S interventions / Unrelated to client-rated improvement

1Correlational, cross-sectional study with therapists and clients providing data.

2Correlational, longitudinal study.

3Randomized controlled trial.

aReports main effect(s) of therapist R/S on outcome.

bReports interaction effect(s) of therapist and client R/S on outcome.

cReports interaction effect(s) of therapist R/S and integration on outcome.

dReports relation(s) between client assimilation of therapist R/S and outcome.