| Original Full Text | Messiah University Mosaic Counseling Educator Scholarship Counseling 11-2024 ACPE’s Spiritually Integrated Psychotherapy (SIP) Training Program: Clinical Competencies for Integrating Religion and Spirituality in Counseling Carol ZA McGinnis PhD Maya Georgieva Mary Elizabeth Toler www.Messiah.edu One University Ave. | Mechanicsburg PA 17055 Follow this and additional works at: https://mosaic.messiah.edu/grcou_ed Part of the Counseling Commons, and the Psychology Commons Permanent URL: https://mosaic.messiah.edu/grcou_ed/14 Sharpening Intellect | Deepening Christian Faith | Inspiring Action Messiah University is a Christian university of the liberal and applied arts and sciences. Our mission is to educate men and women toward maturity of intellect, character and Christian faith in preparation for lives of service, leadership and reconciliation in church and society. This content is freely provided to promote scholarship for personal study and not-for-profit educational use. Journal of Faith Integration Counseling (JFIC) Volume 1 Issue 1 Article 2 November 2024 ACPE’s Spiritually Integrated Psychotherapy (SIP) Training Program: Clinical Competencies for Integrating Religion and Spirituality in Counseling Carol ZA McGinnis Messiah University Maya Georgieva Messiah University Mary Elizabeth Toler Moravian Theological Seminary Follow this and additional works at: https://jfic.researchcommons.org/journal Part of the Counseling Psychology Commons, Counselor Education Commons, and the Scholarship of Teaching and Learning Commons Recommended Citation McGinnis, C. Z., Georgieva, M., & Toler, M. (2024). ACPE’s Spiritually Integrated Psychotherapy (SIP) Training Program: Clinical Competencies for Integrating Religion and Spirituality in Counseling, Journal of Faith Integration Counseling (JFIC): 1(1), Article 2. Available at: https://jfic.researchcommons.org/journal/vol1/iss1/2 This article is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike (CC BY-NC-SA), (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly attributed. This article has been accepted for inclusion in Journal of Faith Integration in Counseling by an authorized editor. The author retains the copyright to this article. For more information, please visit https://jfic.researchcommons.org/journal/. ACPE’s Spiritually Integrated Psychotherapy (SIP) Training Program: Clinical Competencies for Integrating Religion and Spirituality in Counseling Acknowledgements The authors acknowledge all members of the ACPE Psychotherapy Commission who continue to contribute to the ethical value of the Spiritually Integrated Psychotherapy (SIP) training program. This article is available in Journal of Faith Integration Counseling (JFIC): https://jfic.researchcommons.org/journal/vol1/iss1/2 Carol .Z. A. McGinnis, Maya Georgieva, Messiah University; Mary Elizabeth Toler, Moravian Theological Seminary. Correspondence concerning this article should be addressed to Carol Z. A. McGinnis, cmcginnis@messiah.edu Journal of Faith Integration in Counseling | 2024 | Volume 1(1) ACPE Spiritually Integrated Psychotherapy (SIP) Training Program: Clinical Competencies for Integrating Religion and Spirituality in Counseling Carol Z. A. McGinnis , Maya Georgieva, Mary Elizabeth Toler Abstract Clients frequently seek psychotherapy that will incorporate their unique religious or spiritual values into the therapeutic process, yet they are discouraged by practitioners who are not equipped to provide those services. Licensed mental health practitioners can receive this training and certification from the ACPE Spiritually Integrated Psychotherapy Training Program. Spiritual competencies exclusive to this integrative process have been designed to guide and support SIP-certified practitioners in alignment with other professional ethical codes. It is our hope that students, educators, and licensed practitioners from all mental health fields will find this information helpful in understanding the ethical integration of spirituality into psychotherapy. Keywords: spirituality, competency, religion, counseling, ethics For several decades, religion and spirituality have been the subject of attention from researchers and other medical and mental health practitioners (Mandelkow et al., 2022). This growing body of work not only validates that religion and spirituality are important parts of the human experience, but it also reveals significant correlations and implications for physical and psychological health and well-being (Bożek et al., 2020). Some clients request spirituality or religion as a part of their therapeutic work, yet many mental health practitioners are not adequately equipped to provide spiritually integrated services (Harris et al., 2016). In this article, we introduce the ACPE Spiritually Integrated Psychotherapy (SIP) Training Program with competencies that are designed for all licensed mental health practitioners. These spiritual competencies align with those provided by the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC; 2023), yet they are more tailored to the spiritual integration process designed by ACPE (2024). It is our hope that students, educators, and licensed practitioners from all mental health fields will find this information helpful in understanding the ethical integration of spirituality into psychotherapy and the availability of certification through ACPE. Literature Review Research demonstrates that integrating religion and spirituality into the process of counseling and psychotherapy improves outcomes for a wide variety of mental health issues (Johnson et al., 2022). To avoid confusion about the use of the distinct terms “religion” and “spirituality,” we have elected to define each in a broader context. In this case, “religion” is understood as “an organized belief system, guided by shared values, practices and understandings of the divine, and 6 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) involvement in a religious community” (Vieten & Lukoff, 2022, p. 27). Alternatively, “spirituality” pertains to an individual’s internal sense of connection to something beyond oneself, whether this be a higher power or God or a more general sense of the sacred, consciousness, or interconnectedness of all of nature and life (Mahoney & Shafranske, 2013). Spirituality can also be understood as a human trait or element of diversity that may or may not be connected to personality traits (Stewart-Sicking & Piedmont, 2022). The biopsychosocial model (BPS) is derived from a humanistic view of human health that emphasizes the interconnection among biological, psychological, and socio-environmental factors (Engel, 1981). For decades, BPS has offered many clinical disciplines a way of understanding how suffering, disease, and illness can simultaneously impact multiple levels of organization and existence, from the societal to the molecular (Saad et al., 2017). BPS also emphasizes the inseparability of bio-psycho-social factors and demonstrates the importance of maintaining wellness in all aspects of our lives. When one or more of the three domains is disturbed, that domain can have a direct and often negative impact on the other domains. Due in large part to the growing interest in and research on religion and spirituality and health care, the BPS model recently has been expanded to include a spiritual dimension (Balboni et al., 2023; Mendenhall et al., 2022; Sulmasy, 2002). The spiritual dimension concerns a person’s relationship with transcendence; the spiritual dimension of existence is that which is beyond the limits of human knowledge and experiences. A plethora of research has examined the relationship between religious and spiritual struggles in the context of mental and physical health (Boyali, 2022; Pargament & Exline, 2016; Surzykiewicz et al., 2022). Vermette and Doolittle (2022) support the expansion of the model to a biopsychosocial–spiritual (BPS–S) one by insisting that for health to be genuinely holistic, it must address the totality of the client’s relational existence, which includes spirituality. Overall, research on the topic of integrating religion and spirituality in psychotherapy is broad, encompassing many smaller topics related to spiritual practices and resources for people who are representative of specific genders, ages, and faith traditions. For example, many empirical studies have shown the positive impact of prayer in the overall treatment and recovery rates of cancer, depression, anxiety, and heart-related conditions (Boelens et al., 2012; Lekhak et al., 2023; Tolson & Koenig, 2003). Thanks to careful research on immigrants who have been victimized by tragedy or other hostilities, we now understand a spiritually integrated approach is needed to help these clients heal (Wyrostkiewicz et al., 2022). Religion and spirituality offer important tools and resources for physical and psychological healing. Most academic training includes spiritual and religious beliefs and values as a part of a person’s broader multicultural identity. Students are encouraged to see religion and spirituality as important aspects of a client’s life that need to be assessed and engaged primarily for the purposes of promoting a person-centered, culturally sensitive counseling environment (Mandelkow et al., 2022). However, little, if any, attention has been paid to the depth, breadth, and nuances of the concepts of religion and spirituality and the ways in which these concepts are manifest in the lives of individuals and communities (Vieten & Lukoff, 2022). Within this multicultural framework, clients’ beliefs about God are seen as either roadblocks to be overcome or resources to be used in the quest for positive emotional and psychological functioning (Oxhandler & Pargament, 2017). Additional training to provide awareness, knowledge, and skills is necessary for practitioners who are not receiving that kind of training in their educational programs (Vieten & Lukoff, 2022). Because the therapeutic alliance is so deeply personal, even the smallest verbal or nonverbal responses can “give away” the internal McGinnis et al. 7 Journal of Faith Integration in Counseling | 2024 | Volume 1(1) processes of the practitioner and lead to unintentional distancing. Many practitioners struggle with bracketing and the process of inviting into the therapeutic process the client’s religious or spiritual integration beliefs in a way that does not discount their own beliefs and values. One way to accomplish that goal is to identify spiritual themes that can be used to find common ground (McGinnis, 2016). This type of “radical alignment” requires practice and training to prevent the unethical value imposition that may otherwise occur (McGinnis, 2016, p. 1). Clinicians who become aware of and manage their own values in the therapeutic process are more likely to engage in ethical decision-making when religious or spiritual beliefs intersect with the presenting problem (McGinnis, 2022; Sicking & Fox, 2019). An extension of practitioner self-awareness is the recognition of spiritual countertransference as a part of the spiritual integration process (Jones, 2019). Countertransference, in its broadest and most generally accepted sense, is the response of the clinician to the client that comes from the clinician’s own background, history, or psychological and emotional needs (Aleksandrowicz & Aleksandrowicz, 2016). Countertransference can also be a clinician’s response to the client’s transference when a client projects on the clinician certain thoughts, feelings, or wishes that originate from a prior experience, usually from childhood. Counter-transference can be conscious or unconscious and can be an important part of practitioner training when self-reflection is invited and explored (Hayes, 2023). As noted by Jones (2019), material related to religion and spirituality can exacerbate countertransference. However, as Jones notes, countertransference in this realm can also serve as a rich resource for clinicians who are willing to listen and engage this dynamic. Bowman (2017) offers an interesting perspective on Pargament’s (2007) framework for perceptions in spiritual care with attention to countertransference. His work provides context for interpreting and understanding internal thoughts and emotions held by the practitioner. These categories include explanations and definitions for the spiritual bias, myopia, timidity, enthusiasm, and cockiness that may be experienced by the practitioner. Other perspectives include an intolerance for ambiguity, the need for self-awareness, and the systemic countertransference that may stem from the personal experiences of the practitioner. Overall, this awareness of spirituality and countertransference is referred to as a “conundrum” that warrants training and education to help the practitioner understand how this process may manifest in their work with clients (Bowman, 2017, p. 160). Assessment of practitioner competence for spiritual integration has been the focus of recent inventories. One such assessment of this competence was developed for social workers yet has since been tested for use by other mental health professionals. The Religious/Spiritually Integrated Process Assessment Scale (RSIPAS) is a reliable inventory for spiritually integrated practitioners to use in order to determine how well they have been trained to incorporate religion and spirituality into their work (Oxhandler, 2019). Another inventory that was recently developed for use in assessing practitioner competency for caregiving is the Spiritual Supporter (SpSup) Scale (Fopka-Kowalski et al., 2023). These competency assessments highlight the need for evaluating practitioner knowledge and education that is oriented toward a sensitivity to spiritual needs and viable support skills. ACPE Spiritually Integrated Psychotherapy (SIP) Training Program The findings in the review of literature are not surprising when a client is viewed holistically with their religious or spiritual beliefs identified as a part of their unique worldview. Practitioner education programs strive to meet the ethical expectations set by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2024) and the American Counseling 8 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) Association (ACA; 2014). Other mental health professionals are also educated about and trained on the importance of spiritual beliefs that may or may not intersect with religion (Vieten & Lukoff, 2022). Until now, there has not been a training program designed specifically to address the “how” in conducting spiritual integration (Oxhandler & Pargament, 2017). To address this need, the Association for Clinical Pastoral Education (ACPE; 2023) formed its Psychotherapy Commission that oversees the Spiritually Integrated Psychotherapy (SIP) Training Program. Prior to 2019, ACPE was an association exclusively responsible for the clinical professional education of chaplains in the United States. After ACPE merged with the American Association for Pastoral Counselors in 2019, licensed, spiritually informed psychotherapists were moved under the umbrella of the Psychotherapy Commission, which conceived the SIP training program. The members of the commission had already been through rigorous training programs that are recognized for spiritually integrated psychotherapy, and the SIP Training Program represented the next logical step in advancing that work and expanding the invitation to all licensed mental health practitioners. Like other post–master’s degree certification programs, SIP training involves 30 hours of training (15 hours of Level 1 training and 15 hours of Level 2 training) and 20 hours of consultation work in both group and individual modalities. SIP graduates receive certification and are granted continued membership in unique communities of practice with recertification requirements to meet every three years. Licensed professional practitioners, social workers, psychologists, psychiatrists, psychiatric nurse practitioners, and marriage, couple, and family practitioners are all invited to make use of this training to learn how to integrate spirituality within the scope of their professional practice. Research on the effectiveness of the SIP program is still in its infancy, yet the pioneers of spiritually integrated psychotherapy continue to assist in the work that is being done. The competencies that are described in this article are an important part of that process. While there is a plethora of literature that outlines and unpacks the core competencies needed to integrate religion and spirituality ethically and effectively into the counseling process (Cashwell & Young, 2014; Sicking & Fox, 2019), the spiritual competencies that are specific to the integration process taught in the SIP Training Program are more focused than what is available elsewhere. Spiritual Competencies The SIP Training Program is built around a core list of competencies that resonate with and mirror what is found in current literature (Cashwell & Young, 2014; Sicking & Fox, 2019) as well as the competencies outlined by ASERVIC (2023) (see Table 1). Table 1 SIP Training Program Core Competencies Practitioners who earn ACPE Certification in Spiritually Integrated Psychotherapy will demonstrate the following competencies: 1. Appreciation for spiritual and religious diversity and ability to work across spiritual and religious difference. 2. Ability to work with clients holistically from a bio-psycho-social-spiritual perspective. 3. Ability to integrate spirituality into psychotherapy in ethically appropriate manner. 4. Ability to conduct spiritual assessment. 5. Ability to help clients leverage healthy spiritual resources. 6. Ability to use a variety of spiritual interventions. 7. Ability to help clients engage spiritual struggles. 8. Ability to address harmful spirituality and religion in the context of psychotherapy. 9. Ability to articulate how their personal spirituality is a resource in understanding clients, themselves, and therapeutic process. 10. Ability to be aware of and make therapeutic use of spiritual countertransference. Note: Adapted by the authors from SIP Comptencies, by ACPE, n.d. (https://acpe.edu/education/psychotherapy/spiritual-integrated-psychotherapy/spiritual-integrated-psychotherapy-(sip)-trainer-certification) McGinnis et al. 9 Journal of Faith Integration in Counseling | 2024 | Volume 1(1) It may seem redundant to have another set of professional competencies to follow— especially for licensed practitioners who already possess them—yet these ACPE SIP competencies use language that is specific to spiritual issues (e.g., harmful spirituality, spiritual struggle) and spiritual integration. The intention of the ACPE SIP competencies is not to supplant the ASERVIC and other competencies but rather to expand them to be helpful for a more specific practice of psychotherapy by a wider professional audience. What follows is an outline of these competencies and an introduction to the SIP Training Program. Using real-world practitioner–client vignettes, we hope to leave the reader with a better understanding of how competencies in the training program apply to clients who represent a wide range of spiritual beliefs and values. Competencies in the Practitioner–Client Context Competency #1: Appreciation for spiritual and religious diversity and ability to work across spiritual and religious difference. Competency #1 is oriented toward religious and spiritual beliefs as a strength when considering client diversity (Strawn & Sandage, 2022). A commitment to appreciating these differences is at the crux of the ethical work that a SIP practitioner delivers. Similar to the ASERVIC (2024) competencies that recognize the value of diverse client beliefs, the SIP Training Program tasks the practitioner with upholding a position of appreciation that goes beyond description and acknowledgement. SIP requires additional training and consultation for practitioners who intend to work with clients who are likely to have different or even conflicting beliefs than they themselves do. This nuance may be better understood as respect for spiritual beliefs versus an acknowledgement that may not communicate appreciation. Vignette #1: Clara is a SIP practitioner who identifies as an evangelical Christian with very clear personal boundaries related to sinful activity that could jeopardize her relationship with Jesus Christ who is her Lord and Savior. She values sexual fidelity very highly in her personal life and believes very strongly in the sanctity of marriage as a vow that cannot be broken in adultery. Clara has recently been assigned to work with a client, John, who does not share her religious or spiritual views and is proud of his many extramarital sexual adventures. John is a 46-year-old cisgender male who identifies as “spiritual not religious” and has come into therapy to work on his fear of flying. He needs to travel by plane to a work conference in a few months to be eligible for a promotion at work. John believes that his ability to perform sexually with many women throughout the week is an important part of his identity and represents his success as a businessman. He does not experience shame or guilt for any of this activity and would likely terminate psychotherapy if Clara attempted to reframe these behaviors in a negative way. According to SIP Competency #1, Clara must find a way to appreciate John’s beliefs even though they represent a conflict with her own spiritual worldview. She may need to build in extra self-care and consultation time to attend to her spiritual countertransference, which is likely to be negative (see Competency #10). Clara will need to listen for spiritual themes, beliefs, and values that are in alignment with her own to authentically interact with John in session (McGinnis, 2016). It may be that she and John both see freedom as an important spiritual theme and that through this theme, Clara will be able to connect emotionally to John and help him achieve his goal of overcoming his fear of flying. No matter how Clara decides to approach John’s case conceptualization and treatment planning, as a SIP practitioner, she will endeavor to appreciate his unique spiritual beliefs that are likely to remain in conflict with her own. To further this approach, Clara needs the competency of understanding spirituality in a holistic way. 10 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) Competency #2: Ability to work with clients holistically from a bio-psycho-social–spiritual perspective. Competency #2 is oriented toward an understanding of each client through a bio-psycho-social–spiritual (BPS–S) lens that is holistic and inclusive when considering religious or spiritual beliefs (Sulmasy, 2002; Vermette & Doolittle, 2022). This perspective values the client’s experience, which likely involves the intersection of biological, psychological, social, and spiritual elements—not just as a potential worldview factor that can influence psychosocial functioning, as suggested by the ASERVIC (2024) competencies. The SIP practitioner listens for these aspects of the client’s story and perspective to invite further exploration of these pieces as they arise. It is not a question of whether spiritual beliefs are related to the presenting problem but how they are at play for the client. Vignette #2: Tyrone is an SIP practitioner who identifies as an atheist and holds great appreciation for nature. He also sees scientific inquiry as the highest life experience. He does not appreciate religious or spiritual views that rely on divine intervention and believes that success in most social interactions is the result of unconscious biological processes and instincts. Tyrone is thrilled to learn that a new client, George, holds most of the same beliefs and values and looks forward to therapeutic work that focuses on the intellectual processes of this client’s presenting problem. George has suffered from prolonged grief disorder (American Psychiatric Association, 2022) since the death of his mother over two years ago and cannot find the will to return to work or social activities. George’s priority for psychotherapy is to alleviate the pain of his grief and move on. According to SIP Competency #2, Tyrone is obligated to consider George’s situation holistically with attention to the BPS–S aspects of his symptoms. It would be tempting for Tyrone to overlook spiritual beliefs that George holds and that may be connected to his grief and his inability to work or socialize. Tyrone cannot rely on George’s biological and psychological thoughts and behaviors alone because of their shared spiritual beliefs. He also cannot assume that his own beliefs will match up entirely with George’s in social and spiritual contexts and is obligated to explore these to the same extent as he would with any other client. To meet this SIP competency, Tyrone will respect the boundary between himself and George and invite his client to consider how these symptoms of grief may be connected to BPS–S elements in a manner just as he would with a client who held very different beliefs. Tyrone will take care to engage George in an ethical manner according to his professional association, state licensure, and SIP expectations that move beyond the ASERVIC (2024) competencies. He will focus on appropriate communication and recognition of spiritual differences. Competency #3: Ability to integrate spirituality into psychotherapy in ethically appropriate manner. Competency #3 is oriented toward the explicit expectation to adhere to all professional ethical standards related to religion and spirituality as well as those taught in SIP training. These ethical codes include the preamble and Sections A.11.b, F.2.b, F.1.b, F.11.c, C.5, and E.8 of the American Counseling Association’s code (2014); Principle E: Respect of People’s Rights and Dignity and Sections 2.01, 3.01, 3.03, and 3.04 of the American Psychological Association’s code; Core Value 4 of the American Association for Marriage and Family Therapists’ code (2015), and the preamble and Sections 1.05 and 1.06 of the National Association for Social Workers’ code (2017). Unlike beliefs and values, which are understood as a component of diversity, SIP competencies are specific to spirituality. The ASERVIC (2024) competency for assessment is limited to understanding or describing the client’s beliefs and values, whereas SIP competencies reference integration that is invitational, respectful, and comprehensive. Competency #3 is important because it underscores the fact that the practitioner’s beliefs and values cannot be McGinnis et al. 11 Journal of Faith Integration in Counseling | 2024 | Volume 1(1) imposed on the client due to ignorance or a lack of training specific to spirituality. In addition to undertaking this specialized training, the SIP practitioner engages in a community of practice in which regular consultation is available to help them to maintain the knowledge, awareness, and skills needed to integrate spirituality in an ethical manner. Vignette #3: Carlos is a Roman Catholic SIP practitioner who has strong beliefs about the effectiveness of ritual as a spiritual resource for clients. He wants to suggest ritual as a way for clients to overcome various problems related to stress and anxiety. While there is a large amount of research that supports the effectiveness of ritual as a psycho-spiritual intervention for some clients, not everyone subscribes to this spiritual practice. For example, if Carlos were to work with Sylvia, a 57-year-old cisgender woman who identifies as an Assembly of God Christian, Carlos’s proposing that she begin to use ritual to reduce her anxiety could be harmful to the therapeutic relationship. In a similar manner, any client who identifies as Jehovah’s Witness, Amish, or Mennonite might also feel distanced by such a recommendation. By attending to SIP Competency #3, Carlos recognizes the need to conduct a thorough spiritual assessment of any client he will be serving to determine whether ritual may be a part of their worldview. Carlos understands that spiritual practices are not universal and that careful consideration must be given to each person’s unique belief system. Even the concept of prayer requires respectful assessment to learn how the client may engage in that activity prior to the practitioner’s inviting it to be a part of therapeutic work. When practitioners attempt to incorporate spirituality into the therapeutic session according to the ASERVIC (2024) competencies, they are likely to miss many aspects of ethical engagement if they do not have access to the training content that includes comprehensive spiritual assessment. Competency #4: Ability to conduct spiritual assessment. Competency #4 is oriented toward the need for spiritual assessment as an important part of integrating spirituality (Fopka-Kowalski et al., 2023; Oxhandler, 2019). An ethical practitioner understands the need to gather pertinent data related to the client’s spiritual belief system in a way that can lead to helpful goal setting, treatment planning, and intervention selection. This competency recognizes the value of basic listening skills and reflection as well as other tools for assessment that may or may not be involve the use of standardized tests. The ASERVIC (2024) competency related to assessment is oriented toward understanding the client, which is helpful but insufficient for an ethically integrative approach. Vignette #4: Juan is a SIP-certified, licensed marriage, couple, and family counselor with a strong background in theology who identifies as a “spiritual not religious” practitioner. He also works as a spiritual leader in the community and has a strong belief about the sacredness of all people as a part of the natural universe. Juan believes that every person has a light of goodness within themselves that he recognizes as a part of his therapeutic work. Juan is diligent in viewing each person, regardless of their background, as an important member of a much bigger system. He has recently started working with Amena, a female client who identifies as a devout Muslim. Amena observes all Muslim holy days and practices and has come to psychotherapy to address depressive symptoms that are interfering with her ability to function as a wife and mother. According to SIP Competency #4, Juan must not assume that his universal spiritual worldview will be helpful to Amena and must recognize that it could cause harm to her therapeutic progress if a comprehensive spiritual assessment is not conducted. Juan knows that he cannot assume that Amena will share his love of nature and his beliefs about the interconnectedness and light in all human beings. These beliefs may help Juan to find meaning in his work, yet they could create distance between himself and Amena if he tried to use that kind of spiritual language in session. 12 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) Without appropriate spiritual assessment using gentle inquiry or standardized testing, Juan will likely miss important content that could be associated with Amena’s depressive symptoms. She may be holding on to guilt or shame related to her desire to be faithful in her Muslim practices or feel limited in connecting to new or previously helpful spiritual resources that would align with her beliefs. SIP has trained Juan to listen for the symbols, rituals, spiritual expectations, and themes that Amena uses to describe her presenting problem. He will take extra care to listen to Amena’s literal and figurative dreams, paying attention to the way she engages with him in the moment to identify biological, psychological, and social cues to her internal spiritual state. Without effective and comprehensive spiritual assessment, Juan is likely to engage in value imposition or miss valuable aspects of Amena’s spiritual worldview that are needed to help her escape her depression. Part of this careful assessment and engagement process will require Juan to listen for healthy spiritual resources identified by Amena in session. Competency #5: Ability to help clients leverage healthy spiritual resources. Competency #5 is oriented toward the practice of evaluating what healthy spiritual resources may be for the client according to their own testimony (Cashwell & Young, 2020; Harris et al., 2016). These resources may be understood as spiritually implicit or explicit, as defined by Jones (2019). Explicit spiritual resources are identified as such by the client. They often include traditional language such as prayer, religious events or holidays, types of worship, or places for communing (church, synagogue, mosque). Alternatively, implicit spiritual resources tend to be more universally understood as spiritual—for example, meditation, a love of music, hobbies, and walking in nature. SIP treatment planning involves seeking out healthy spiritual resources for the client to use. The ASERVIC (2024) competencies highlight that spirituality can have an impact on psychosocial functioning and enhance well-being, yet they do not presume that there are specific spiritual resources available to clients. This SIP competency requires the practitioner to listen for spiritual resources that the client may want to reconnect with or begin using according to their current stage of development. Vignette #5: Sandra is a licensed clinical social worker who holds very strong beliefs as a Jehovah’s Witness. She believes that healing and wellness are directly connected to an awareness of God who is given all glory in all things. Sandra is a certified SIP counselor and has been working with Taysha, who is struggling with anxiety due to the abrupt discovery of her twin sister’s affair with their married pastor. Taysha identified as a Southern Baptist Christian prior to the controversy, yet she has since turned away from that faith tradition out of anger related to her sister’s and pastor’s actions. Taysha wants to find a new path forward as she heals from this embarrassing event, yet she also wants nothing to do with “anything related to God or the Holy Spirit” as she struggles with the fact that she was lied to by two people she trusted so deeply. Sandra knows that she cannot impose her own beliefs onto Taysha and listens carefully for any spiritual resources that may be healthy for her to draw on now that her beliefs have been challenged. Taysha openly rejects traditional resources such as prayer, spiritual music, and the church community that used to give her strength, yet she does comment on the beauty of the forest that she walks through when coming to therapy. Recognizing in this commentary a potential implicit spiritual resource, Sandra will take time in session to invite Taysha to describe and explore what she enjoys about these walks and ask her whether this is something that she would like to incorporate in their work together—potentially moving therapy into the forest (literally or figuratively) as a part of one or more sessions. If Taysha continues to find the forest a positive spiritual resource, Sandra will endeavor to find other ways to engage her with this healthy practice as they work through her anxiety and grief using theoretically based interventions. To accomplish McGinnis et al. 13 Journal of Faith Integration in Counseling | 2024 | Volume 1(1) this task in an ethical manner, Sandra will use her training to identify different models of spiritual development according to Taysha’s strengths and spiritual personality, which will also help in the determination of appropriate interventions. Competency #6: Ability to use a variety of spiritual interventions. Competency #6 is oriented toward the implementation of spiritual interventions as taught in the SIP Training Program. Practitioners need to practice a variety of spiritual interventions to help clients approach therapeutic outcomes. It is not enough to know how SIP is conducted without understanding the implementation of spiritual interventions in conjunction with traditional theoretical approaches (Boyali, 2022; Stewart-Sicking et al., 2019). These psycho-spiritual interventions need to be connected directly to the goals of the client and the unique belief system of that individual. The ASERVIC (2024) competencies require the practitioner to modify therapeutic techniques as appropriate for the belief system of the client, yet these interventions are not identified as spiritual or oriented to include the belief system of the client other than to invite practices as they are relevant. This SIP competency represents an intentional shift toward the integration of the client’s spirituality into interventions such that the belief system becomes a part of the therapeutic journey. Vignette #6: Scarlett is an atheist who believes that all religion is evidence of colonization and potentially hazardous to the mental health of her clients. She is a licensed marriage, couple, and family therapist who works primarily with families in crisis. Aarush is an Indian-American cisgender male who holds traditional Hindu beliefs. He has come to psychotherapy as a father concerned about his children, who have recently lost both of their grandparents. These grandparents had been involved in his family’s day-to-day life ever since Shilpa, his wife, died 10 years ago. Now that he and his children are grieving again, Aarush wants help to re-establish his previous spiritual practices that connect with his beliefs about reincarnation that helped him to heal from his wife’s death. Some of these practices include recitation of the Vedas and a renewed dedication to living as a vegetarian. Scarlett recognizes these spiritual practices as an important part of Aarush’s identity and their value in helping him and his family grieve. While the recitation of spiritual texts and working toward a diet free of meat may feel awkward to Scarlett, she will look for ways to include these practices and beliefs as a part of the psycho-spiritual interventions that are used. For example, in narrative therapy, Scarlett will be careful to use language provided by Aarush related to his beliefs about reincarnation and death when she approaches the construction of a new family story. Scarlett will be respectful about Aarush’s beliefs about reincarnation when using family systems theory if a genogram is created to identify connections of resilience or strength between members. Traditional genogram diagramming may use an “x” to cross off deceased members, and Scarlett will be careful not to do so for Shilpa or the grandparents. Examples of family time might include a vegetarian menu that Aarush and his children can plan together in an Adlerian exercise in fictional finalism. Overall, Aarush’s belief system will be integrated into interventions as treatment planning progresses, with attention to the client’s spiritual struggle as a part of that clinical picture. Competency #7: Ability to help clients engage spiritual struggles. Competency #7 is oriented toward the recognition of spiritual struggle as a part of the human experience and inviting in that aspect of the presenting problem when it exists (Boyali, 2022; Pargament & Exline, 2016; Surzykiewicz et al., 2022). SIP practitioners do more than identify spiritual struggle and help the client to work through that part of the problem as connections are made. SIP practitioners also call themselves into that painful journey with equal importance to psychological factors. Spiritual struggles are not viewed as ancillary to the presenting problem but 14 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) instead an important aspect of what the client is experiencing. ASERVIC (2024) does not identify spiritual struggle as a specific part of clinical practice, yet the organization does acknowledge that spiritual beliefs may exacerbate symptoms or contribute to the presenting problem. Vignette #7: Candace is a gender-fluid licensed clinical social worker who specializes in couples counseling and spiritual integration. She believes in New Age philosophies that are eclectic and detached from any prescribed system of faith. Candace is happy to work with people through struggles that come about when their life choices come into tension with their religious or spiritual beliefs. Yasmine is a new client who identifies as a cisgender woman. She is engaged to be married to Scott in a few months. She wants help navigating the difficulty of sharing this news with her Mormon family, as Scott is no longer a member of that religious community. Scott left the Mormon church when he was 18 years old because he did not want to participate in mission work. Instead, he became a musician and met Yasmine after one of his concert performances. Yasmine is 25 years old and wants Scott to return to the Mormon church so they can be married in the temple. Scott is now 45 years old and refuses to comply. Candace will recognize Yasmine’s pain related to her spiritual struggle that forces a choice between her family and church community and her fiancé with whom she is deeply in love. This is a big decision for Yasmine, and Candace needs to tread very carefully to be sure that she does not impose her own values that prioritize freedom of choice and independence. Yasmine needs help to navigate her thoughts and emotions related to her faith community and a future that will be bereft of those supports if she goes through with the marriage to Scott. Candace will invite Yasmine to approach her spiritual struggle through theoretically based interventions that can help clarify Yasmine’s vision for the future. Psycho-spiritual use of the Gestalt empty chair intervention may help Yasmine to give herself advice and bring about new awareness related to this decision. Candace may invite Yasmine to reconstruct her own life story with Scott to highlight potential solutions or bring about new perspective on exceptions to what she may hope will be a “perfect life.” Overall, Candace will take time and energy to approach the spiritual struggle that Yasmine has identified with respect and care. She will not avoid the religious and spiritual aspects of this problem yet will not be drawn into giving spiritual direction or guidance that would be unethical. It can be especially difficult to know how to proceed with a client who presents with spirituality or religion that, while harmful, does not represent abuse that needs to be reported. Competency #8: Ability to address harmful spirituality and religion in the context of psychotherapy. Competency #8 is oriented toward the recognition that harmful spirituality and religion exist and may be connected to the client’s presenting problem (Jones, 2019; Mandelkow et al., 2022). The client’s telling of their story and the beliefs related to that narrative that can provide context for determining whether harmful spirituality or religion has occurred. It is important to note that harmful spirituality is rarely due to the client’s religious or spiritual orientation but rather a consequence of human error or abuse. The client may not recognize these beliefs or practices as harmful, and the SIP practitioner will be prepared to help the client work through pain that may be associated with the dawn of this understanding. As previously noted, the ASERVIC (2024) competencies do not address harmful spirituality outside of exacerbating symptoms or contributors to the presenting problem. Vignette #8: Louis is a licensed professional practitioner with very strong beliefs about marriage as a sacred religious event that can only occur between a cisgender man and woman. He identifies as a Messianic Jew with religious and spiritual beliefs that demand strict adherence to particular life choices and practices. He has been working with Steve, who identifies as a cisgender homosexual man with religious and spiritual McGinnis et al. 15 Journal of Faith Integration in Counseling | 2024 | Volume 1(1) beliefs rooted in Buddhism. Steve was reared as Greek Orthodox and was rejected by both his family and church when he came out as a gay man and has fallen into a pattern of depression since. Steve reports continued pain related to his ostracism from his family and church community and notes that his continued resistance toward repenting for his sexual preferences is considered an unforgivable sin. As Louis listens to Steve’s story, he learns about Steve’s shame and fear of damnation as a part of his depressed mood. Steve punishes himself through negative self-talk and shame that he feels the way he does toward other men. His partner, Carmine, wants Steve to marry him but the shame, fear, and depression prevent Steve from taking this step in their relationship. The harmful aspect of Steve’s situation is the ostracism that he is experiencing from his faith community and family members that has led to his own punitive attitude toward himself. Steve hates himself for the love he feels toward Carmine yet cannot bring himself to reject this relationship to rejoin his family and church community. Steve feels trapped and alone. Louis will listen for ways to help Steve find self-acceptance and reduce his shame by inviting him to connect with his new Buddhist belief system. Instead of relying on his own belief system to evaluate Steve’s identity as a homosexual man, Louis will work to connect Steve with spiritual resources that will help him move forward and reduce the pain that has paralyzed him. Note that this approach does not suppose that the Greek Orthodox belief system is faulty or harmful but rather that the ostracism and shame that have prompted the depression are what is harmful to Steve. Louis will help Steve find a way out of his isolating trap of self-recrimination so that new steps forward may occur. It is clear to see that Louis can only be effective as an ethical counselor if he has obtained the awareness, knowledge, and skills needed to journey with Steve without shifting the focus of therapy to his own beliefs and values. Competency #9: Ability to articulate how their personal spirituality is a resource in understanding clients, themselves, and therapeutic process. Competency #9 is oriented toward the self-awareness and self-reflection of an SIP practitioner that are important to the therapeutic process (Cashwell &Young, 2020; Randall & Levitt, 2022). SIP practitioners are not insulated from spiritual struggle themselves, and this competency requires them to engage in self-reflection and processing that may be connected to the work that they do with others. ASERVIC’s (2024) position on counselor self-awareness is in complete alignment with this SIP competency related to influence, limits, and active exploration of attitudes and beliefs that may be connected to the counseling process. Vignette #9: Daniel is a 48-year-old cisgender licensed psychologist who identifies as an Orthodox Jew. He only works with men to avoid issues related to his faith that prohibits physical touch with a woman other than his wife. Daniel’s client, Marc, is also 48 years old and identifies as a bisexual man. He holds Lutheran beliefs. Marc is struggling with shame and guilt for his sexual affairs that continue to occur with other men while his wife, Nancy, is going through Stage 4 breast cancer treatment. He has developed symptoms that meet the criteria for generalized anxiety disorder and wants help from Daniel to “feel normal” again. Marc does not want to reduce or eliminate his homosexual relationships with other men; he just wants to work on reducing the guilt that he is having because he is enjoying life while Nancy is suffering. As an Orthodox Jewish man, Daniel has difficulty understanding Marc’s interest in pursuing sexual relationships with other men and will take care not to impose his beliefs and values about marriage and fidelity on his client in session. Daniel does understand the struggle of being a middle-aged man who has wanted more out of his life experience and can tap into those thoughts and feelings that have also brought him 16 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) shame at times. Marc appreciates the support that his faith community offers to him and his wife at this time of crisis and wants to feel worthy of their care. In consultation with other SIP practitioners, Daniel shares that his own faith community is an important part of his daily life and that he appreciates having this extended family more than he can articulate. He finds a deeper empathy and understanding of Marc’s struggle with guilt due to his SIP self-awareness and self-reflection. These thoughts and feelings help Daniel to listen for spiritual themes that are important to Marc and to build upon those pieces that represent strength as Nancy continues in her own medical treatment. Marc may not limit or stop his sexual pursuits with other men as a part of this process, and Daniel knows that the goal of psychotherapy is to address the anxiety and guilt—not to prompt Marc into making a decision about his sexual activity. This self-awareness process has been an indispensable part of Daniel’s work to become an ethical counselor, and he knows that this reflective insight includes attention to spiritual countertransference. Competency #10: Ability to be aware of and make therapeutic use of spiritual countertransference. Competency # 10 is oriented toward the fact that spiritual countertransference exists and that it may or may not be useful as a part of a particular client case situation (Aleksandrowicz & Aleksandrowicz, 2016; Bowman, 2017). Practitioners are taught about the use of countertransference from a psychological viewpoint, and this competency requires that learning to be expanded to include spiritual beliefs and values. The ASERVIC (2024) competencies related to counselor self-awareness indirectly acknowledge spiritual countertransference as the influence of their own spiritual beliefs and values, which needs constant evaluation. Through awareness and the practice of identifying spiritual countertransference as a named process, SIP practitioners can listen for and become aware of helpful or hurtful internal perspectives that are elicited when they are actively listening to a client’s story. Vignette #10: Sasha is a SIP practitioner who identifies as a pro-choice Methodist Christian. She has a strong belief related to the love of Christ that transcends all human actions that are considered sinful. Sasha is a strong supporter of abortion as a health care right for all women and feels that her work as a professional practitioner is a small part of a higher mission to do good and fight oppression for all people. Mary has come to Sasha to work through anxiety related to an unwanted pregnancy that she must carry to term due to state regulations. Mary identifies as Roman Catholic and has been happily married for nine years to George, whom she describes as her best friend and supporter. Mary has learned that the fetus died near the 20th week of gestation and there is no hope of a healthy delivery. She cannot travel to another state to have the abortion because of finances and the demands of her other five children at home and is extremely anxious about how this whole process will work out. Mary reports that she has a strong belief about God’s will for her yet is frightened by the possibility that she may die while waiting for the natural resolution to the failed pregnancy. According to SIP Competency #10, Sasha needs to reflect on her spiritual countertransference that is likely to complicate psychotherapy with Mary if overlooked. Sasha’s own level of anxiety might limit her gentle inquiry into Mary’s fears or doubts. Sasha is likely to experience anger at the injustice of Mary’s plight given her own spiritual beliefs about abortion, and she might engage in value imposition without careful reflection or consultation. Sasha could make therapeutic use of this spiritual countertransference to tap into an authentic empathy for Mary and align with her emotionally at such a difficult time. Sasha could also use this spiritual countertransference to become resolute in her role as a provider of a safe space and support where Mary can share her doubts and fears openly and without judgment. McGinnis et al. 17 Journal of Faith Integration in Counseling | 2024 | Volume 1(1) Discussion It may be tempting to read these vignettes that have touched on various religious and spiritual orientations and topics and determine one’s own level of competence without engaging in external training or consultation. However, in light of the research noted in the literature review and the comprehensiveness of the SIP training, this would be a mistake. Many licensed mental health practitioners have received excellent academic training yet may not be aware of their own biases related to spirituality and religion. ACPE SIP training provides concrete examples and many reflective opportunities for the practitioner to identify gaps in their knowledge and self-awareness. For example, language can present a barrier to developing therapeutic rapport when the practitioner has not received SIP training because most programs do not engage their learners in the process of determining what different words mean in alternative faith traditions. Signs, symbols, and metaphors take on different meanings in the SIP program than those that traditionally have been described in psychological contexts. The SIP trainee enjoys a risk-free educational space to practice and learn what different words, phrases, and images may mean for others when considered from a religious or spiritual viewpoint. While a client-first approach that invites careful listening may help in this regard, SIP practitioners have more practice and consultation in determining specific types of explicit and implicit spiritual content than that which most individuals experience receive in other training programs. Competent integration of spirituality and religion into therapy involves the harmonious use of the SIP competencies along with other professional guiding documents, such as the ACA Code of Ethics (2014) and the ASERVIC Competencies (2014). The SIP competencies are not meant to replace any of the existing principles; rather, they complement them by offering more specific and targeted direction for the application of these principles. Skilled SIP practitioners should also actively participate in a community of practice where they can learn from and contribute to the growth of their peers. The ACPE SIP curriculum can easily be incorporated into graduate counseling programs and offered as an elective course that can give graduates a competitive advantage and help them to stand out when they apply for internships and employment opportunities. These competencies align with the CACREP (2024) standards that are related to professional counseling and ethical practice (Section 3, A) and social and cultural identities and experience (Section 3, B). Graduate students are likely to encounter clients who hold religious or spiritual beliefs that conflict with their own, and these SIP competencies help to prepare them for these circumstances when held in tandem with ASERVIC and other professional ethical codes. Overall, the competencies that exist in mental health professions are helpful when considered in the spiritual integration process yet do not capture the nuances needed when attempting to promote spiritual integration. This article proposes that additional, more focused competencies are needed to guide those individuals who have sought specialized training or are interested in learning more about the SIP process. Professional organizations already recognize spirituality as a part of the work that is accomplished in the field of mental health, yet practitioners have not had the opportunity for specialized training similar to that available for other topics of practice such as Eye Movement Desensitization and Reprocessing (aka EMDR), Trauma-Focused Cognitive Behavioral therapy (aka TF-CBT) and play therapy. The SIP Training Program leads to a similar type of certification. The competencies that are taught are important to the global effort in maintaining best practices for spiritual integration in psychotherapy. Conclusion This article introduced the reader to the need for professional competencies that move beyond what is offered by ASERVIC (2024) and focus on a more specific interpretation of what is required for 18 Spiritually Integrated Psychotherapy Journal of Faith Integration in Counseling | 2024 | Volume 1(1) ethical spiritual integration in psychotherapy. The ACPE SIP Training Program competencies were presented with practitioner–client vignettes to help illustrate how they can be applied to an ethical therapeutic relationship. We hope that these vignettes have helped to illustrate the unique role of the SIP Training Program for students, educators, and licensed practitioners from all mental health fields as a part of a global interest in spiritual integration. The spiritual integration process requires practice, supervision, and consultation to reduce the incidence of inadvertent value imposition, unexpected spiritual counter-transference, and other therapeutic missteps that are likely to occur. Spiritual and religious beliefs often evoke a powerful response in individuals, and the SIP competencies help to guide practitioners toward self-reflection and participation in useful training. More research is needed to determine the usefulness of the SIP certification and these competencies through evolving assessments. References Aleksandrowicz, D. R. & Aleksandrowicz, A.O. (2016). Countertransference in perspective: The double-edged sword of the patient-therapist emotional relationship. Liverpool University Press. American Association for Marriage and Family Therapy (2015). AAMFT code of ethics. https://www.aamft.org/AAMFT/Legal_Ethics/code_of_ethics.aspx American Association for Pastoral Counselors. (2023). 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Frontiers in Behavioral Neuroscience, 16, Article 954382. https://doi.org/10.3389/fnbeh.2022.954382 Vermette, D., & Doolittle, B. (2022). What educators can learn from the biopsychosocial–spiritual model of patient care: Time for holistic medical education. Journal of General Internal Medicine, 37(8), 2062–2066. https://doi.org/10.1007/s11606-022-07491-8 Vieten, C., & Lukoff, D. (2022). Spiritual and religious competencies in psychology. American Psychologist, 77(1), 26–38. https://doi.org/10.1037/amp0000821 Wyrostkiewicz, M., Wcisel, W., & Verkhovetska, A. (2022). The need for religious and spiritual counseling among Ukraine’s war refugees. Journal for the Study of Religions and Ideologies, 21(62), 3–19. https://thenewjsri.ro/index.php/njsri/article/view/195/65 Author Information Carol Z. A. McGinnis, PhD, is an Associate Professor of Counseling in the School of Graduate and Professional Studies at Messiah University. Maya Georgieva, EdD, is an Associate Professor of Counseling and Clinical Mental Health Counseling Track Coordinator in the School of Graduate and Professional Studies at Messiah University. Mary Elizabeth Toler, ThD, is an Associate Professor and Director of the Master of Arts in Chaplaincy & Master of Arts in Clinical Counseling at Moravian Theological Seminary. Disclosures and Acknowledgments The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. The authors reported no financial support for the research, authorship, and publication of this article. The authors acknowledge all members of the ACPE Psychotherapy Commission who continue to contribute to the ethical value of the Spiritually Integrated Psychotherapy (SIP) training program. All views and opinions expressed within the published articles are those of the author(s) and do not represent the views and/or opinions of The Journal of Faith Integration in Counseling or the Editors. Published articles and all information within the publication are solely the responsibility of the author(s) of the article. The authors retain the copyright to this article and have agreed to publish and distribute this article in the Journal of Faith Integration in Counseling. This article is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License. |
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