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Article Excerpt
Spirituality has increasingly become a consideration for mental health practitioners. As a result, spiritual interventions, including prayer, are now more frequently used in counseling. However, no research has explored Christian clients' expectations regarding prayer in counseling. This study surveyed first-visit Christian clients and their therapists to ascertain client expectations and therapist beliefs and practices. Analysis with two sample t-tests with unequal variances, one-way analysis of variance, simple linear regression, Pearson correlations, and Fisher's exact tests indicated that (a) 82% of clients desired audible prayer in counseling; (b) they preferred that therapists introduce the subject of prayer; (c) they had strong expectations that prayer would be included in counseling; (d) they wanted counselors to pray for them outside of session; (e) religious conservatives had higher expectations for prayer than did liberals; (f) clients with prior Christian counseling had higher expectations of prayer than did clients without. Research implications are discussed.
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Spirituality has been increasingly recognized as important in mental health practice (Miranti & Burke, 1995; Wade & Worthington, 2003; West, 2004). Half of mental health professionals claim some type of religious affiliation, believe that spirituality is personally relevant, and value personal prayer (Bergin & Jensen, 1990; Carlson, Kirkpatrick, Hecker, & Killmer, 2002; Shafranske & Malony, 1990). Perhaps as a result, many mental health professionals consider spirituality to be important to people's well-being, including their clients' (Decker, 2007; Genia, 2000; Miranti & Burke, 1995; Wade & Worthington, 2003;). In fact, prayer is the most frequently used spiritual intervention by Christian counselors (Sorenson & Hales, 2002; Wade & Worthington, 2003). Even practitioners working in secular settings regularly incorporate prayer into their practices in some way (Ball & Goodyear, 1991; Marsden, Karagianni, & Morgan, 2007; Yoon & Black, 2006). For instance, such providers believe that praying for a client is appropriate, although most believe that praying with a client is inappropriate (Carlson et al., 2002; Gubi, 2004; Shafranske & Malony, 1990).
Many clients also want their religion or spirituality included within the context of counseling (Rose, Westefeld, & Ansley, 2001), perhaps because around 80% of the US population believes in God (Gallup, 2007) and the power of prayer (Princeton Survey Research Associates, 2003). Christian clients, in particular, expect prayer to be included in Christian counseling (e.g., Belaire & Young, 2002). Because sensitivity to clients' expectations helps build the therapeutic alliance, which in turn contributes to positive outcomes (Horvath & Symonds, 1991; Kim, Ng, & Ahn, 2005; Strauser, Lustig, & Donnell, 2004), methods for including prayer in counseling with some clients need to be examined. Important to this examination is determining client expectations about prayer in counseling; research is currently lacking about such expectations. This study rectifies that lack by surveying primarily Christian clients about their preferences regarding prayer in counseling. It further surveys their therapists about their beliefs and prayer practices in order to determine whether therapist factors are related to client expectations.
PROBLEM BACKGROUND
Historically, religion and psychology have been mutually exclusive disciplines, each field relying on competing theoretical assumptions (Wolf & Stevens, 2001). As indicated above, this situation is changing, and spiritual issues have more recently been deemed worthy subjects of study and research within mental health fields. "Religious or Spiritual Problem" was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994), and studies have linked people's spirituality with their mental health and clients' spirituality with effective psychotherapy (e.g., Gordon, Feldman, Crose, Schoen, Griffin, & Shankar, 2002; Wade & Worthington, 2003).
However, a review of the literature from the last 20 years indicates that the practice of spirituality in the practitioner's office has been somewhat controversial. While some mental health practitioners integrate spiritual practices into counseling practice, some professionals do not value the importance of spirituality (Bergin, 1980; Bishop, 1992; Gubi, 2004); others value its importance, but do not believe that spiritual issues should be included in psychotherapy (Gubi, 2004); others who believe that spirituality should be given a place in the counselor's office lack the training necessary to do so effectively (Carlson et al., 2002; Eriksen, Marston, & Korte, 2002; Richards & Bergin, 2002; Shafranske & Malony, 1990).
Ethical, multicultural, and developmental perspectives challenge practitioners to rectify the controversies. Ethical mandates now necessitate respect for clients' spiritual beliefs (ACA, 2005; APA, 2002; CACREP, 2001), and guidelines that have delineated harmful interventions, harmful countertransference, and harmful faith should assist with implementation (Case, 1997; Curtis & Davis, 1999; Genia, 2000; Lovinger, 1996; Mageletta & Brawer, 1998; Pargament, 2002; Richards & Bergin, 2002; Spero, 1982). Further, principles related to knowledge, skills, and awareness that are applied when working with those from different racial and ethnic cultures may also be applied to clients with particular religious or spiritual beliefs (Genia, 2000; Worthington, Kurusu, McCullough, & Sandage, 1996). In addition, some guidelines have been established to help clinicians match interventions with clients' spiritual developmental stages (Fowler, 1986; Griffith & Griggs, 2001; Worthington, 1989).
Specialty fields have also evolved that offer guidance to practitioners. For instance, within the Christian counseling specialty, studies have determined what spiritual techniques are used by clinicians-evaluating the client's religious background, recommending religious books, and praying with a client are among those used with the greatest frequency (Ball & Goodyear, 1991; Finney & Malony, 1985a, b, c; Moon, Bailey, Kwasny, & Willis, 1991; Wade & Worthington, 2003; Worthington et al., 2001).
THE CURRENT STATE OF RESEARCH ON PRAYER IN COUNSELING
A great deal of literature exists on the subject of spirituality and counseling (e.g., Gubi, 2004; Holeman, 1999; Kraus, 2003: Pargament, 2002). A large body of literature also exists on the subject of prayer (Finney & Malony, 1985a, b, & c; Hood, Morris, & Watson, 1987; Schneider & Kastenbaum, 1993). However, in a 10-year review of research on religion and psychotherapeutic processes and outcomes, Worthington, Kurusu, McCullough and Sandage (1996) concluded that few studies have focused on "the role of religion in clients' lives during their counseling" (p. 451, italics added). The subject of prayer as psychologically helpful or as an intervention in psychotherapy has received even less attention (Finney & Malony, 1985a; Gubi, 2004; Hood, Morris, & Watson, 1987; Poloma & Pendleton, 1989). However, a historical review of the literature that does exist is included below.
Studies on Prayer in Relation to Psychology or Psychotherapy
A body of research addresses prayer's relationship to psychology or psychotherapy. For example, one study determined that religious beliefs played a positive role in achieving mental health (Gordon et al., 2002) and another determined that meditative prayer was moderately related to quality of life (Poloma & Pendleton, 1989). Butler, Stout, and Gardner (2002) determined that the use of prayer among Christian spouses increased a feeling of being emotionally validated by the spouse and increased partner empathy. Fouque and Glachan (2000) found that survivors of sexual abuse who received Christian counseling that included the use of prayer and scriptures perceived the overall outcome of counseling negatively.
Frequency of Use and Acceptance of Prayer
Surveys of secular and Christian mental health professionals have begun to establish the frequency of use and acceptance of prayer as a counseling intervention (Ball & Goodyear, 1991; Carlson et al., 2002; Gubi, 2004; Shafranske & Malony, 1990; Sorenson & Hales, 2002; Wade & Worthington, 2003; Worthington, Dupont, Berry, & Duncan, 1988). For instance, Sorenson and Hales (2002) discovered that 30% of Christian therapists pray with clients during sessions. In Worthington, Dupont, Berry, and Duncan's (1988) study, therapists reported using in-session prayer in 32.5% of sessions, although it is unclear the degree to which their findings would be applicable today. Further, these researchers did not distinguish between praying with a client and telling the client that the therapist prayed privately for the client.
Other research corrected that problem. For instance, in an older study, Shafranske and Malony (1990) determined that 24% of secular clinical psychologists prayed privately for clients, and seven percent reported praying with clients. More recently, Wade and Worthington (2003) found that only 11% of therapists in secular agencies thought that praying with or for a client was appropriate, while the large majority of counselors in Christian counseling organizations believed praying with or for a client was appropriate (78% in Christian agencies and 100% in Christian private practices). In fact, praying with or for a client was the most frequently used religious intervention in Christian agencies, but the least used spiritual intervention in secular agencies. These researchers, however, did not assess who brought up spiritual issues, or initiated prayer; what the client's expectations were related to spiritual interventions, including prayer; or whether prayer was audible or silent.
More recently, Gubi (2004) surveyed 578 accredited counselors in England to determine the frequency of use of various prayer interventions. Eleven percent had prayed overtly with a Christian client, 37% had prayed for guidance during a counseling session without the client's knowledge, 49% had prayed for a client away from the client's presence, and 51% had prayed as a means of preparing themselves to work with clients.
Usefulness of Prayer in Counseling
Since 1957, only two empirical studies have been conducted...
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