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Psihologia Religiei
Anul II, semestrul II
Disciplină opțională
An universitar 2019-2020
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THE HISTORIOGRAPHY OF SCIENCE AND RELIGION
David B.Wilson
The history of science and religion has been a contentious subject. In addition to the usual scholarly
disputes present in any academic area, this historical subject has been enmeshed in more general historiographical
debates and influenced by the religious or antireligious beliefs of some historians. After considering some basic
issues, this essay discusses several works written during the previous century and a half, while focusing on the last
fifty years. Recent decades have seen a radical shift in point of view among historians of science. Although
historians have espoused various approaches to the past, it will make our subject more manageable if we concentrate
on the polar opposites around which views have tended to cluster. One approach has been to examine past ideas as
much as possible in their own context, without either judging their long-term validity or making the discussion
directly relevant to present issues. Another approach has been to study past ideas from the perspective of the present,
taking full advantage of the hindsight provided by later knowledge to judge which ideas have proven to be valid.
The second approach has apparent advantages. It does not exclude current knowledge that can assist us in the
historical task. It also keeps present issues to the fore by insisting that historians draw lessons from the past that are
relevant to current issues. However, historians have tended to regard the second approach as precariously likely to
lead to distortion of the past in the service of present concerns. Dismissing this as ― presentism,‖ therefore, historians
of science have come to favor the first, or contextualist, approach. Whichever method historians use, they might
reach one of several possible conclusions about the historical relationship between science and religion. Conflict,
mutual support, and total separation are three obvious candidates. One of these models might long have
predominated, or the relationship might have changed from time to time and place to place. The discovery of
conflict might raise the further questions of which side emerged victorious and which side ought to have done so.
The discovery of mutual support might lead to the question of whether either science or religion contributed to the
other‘s continued validity or even to its origin.
Conclusion
This essay, in rejecting presentist histories of science and religion, may itself seem somewhat presentist.
Though it tries fairly to present the opposite point of view, it favors the recent historiographical revolution in
advocating a contextualist approach, with all its attendant complexities. Though the new point of view has decided
advantages over the old, it has the potential of leading historians astray. Pursuit of complexity could produce ever
narrower studies that are void of generalization. Moreover, awareness of the great variation of views in different
times and places could lead to the mistaken conclusion that those ideas were nothing but reflections of their own
― cultures.‖ Instead, in thinking about science and religion, as in most human endeavors, there have always been the
relatively few who have done their work better than the rest. Existence of differences among them does not mean
that they have not thought through and justified their own positions. In fact, that they have done so is an example of
a contextualist generalization—one that is not only in harmony with the evidence of the past, but also relevant to
present discussions. Indeed, the whole non-Whiggish enterprise might inform the present in other ways, too, though
scholars are understandably wary of drawing very specific lessons from history for the present. Consider, however, a
few general points. Study of past ideas on their own terms might provide a kind of practice for working out one‘s
own ideas or for nourishing tolerance for the ideas of others. There have been and, no doubt, always will be
disagreements among our strongest thinkers, as well as questions of the relationship between their ideas and those of
the population at large. Moreover, things always change, though not predictably or necessarily completely. Indeed,
the most influential thinkers seem fated to have followers who disagree with them, even while invoking their names.
Even the most well-founded, well-argued, and well-intentioned ideas about science and religion are liable to later
change or eventual rejection. The same is true for historiographical positions, including, of course, the complexity
thesis itself.
Issues of Contention
First, it may be helpful to spell out briefly the chief issues of contention around which the real or imagined
conflict revolves. Initially these issues were in the area of epistemology: Could what we know about the world
through science be integrated with what we learn about it from religion? If not, a situation of permanent conflict
seemed probable. Such epistemological issues were first raised on a large scale by the Copernican displacement of
the earth from the center of the solar system, which was clearly incompatible with what seemed to be the biblical
world picture of a geocentric universe. The question, though posed by Copernicus (1473–1543) himself, caused little
public stir until the apparent conflict became inextricably intertwined with other clerico-political disagreements at
the time of Galileo. With hindsight, it is truly remarkable that, as early as the sixteenth century, Copernicus and his
disciple Georg Joachim Rheticus (1514–74) resolved the issue to their satisfaction by invoking the patristic
distinction between the Bible‘s teaching on spiritual and eternal realities and its descriptions of the natural world in
the language of ordinary people. Rheticus specifically appealed to Augustine‘s doctrine of ― accommodation,‖
asserting that the Holy Spirit accommodated himself on the pages of Scripture to the everyday language and
terminology of appearances. What began to emerge was what later became the distinction between world picture and
worldview, the former being mechanistic, tentative, and expendable, while the latter concerned values and principles
that were likely to endure. This same principle imbued the work both of Galileo and his followers and of Johannes
Kepler (1571–1630) and effectively defused the issue for a majority of Christian believers. If they were right, there
was an absence of conflict not only over the specific case of cosmology but, in principle, over anything else in
which scientific and biblical statements appeared to be in contradiction. A ― conflict thesis‖ would have seemed
untenable because there was nothing to fight about. However, the historical realities were such that these lessons
were not quickly learned. Despite the advent in the late eighteenth century of evidence for a much older Earth than
had been imagined on the basis of the Mosaic account in Genesis, little opposition arose until the emergence in
early- Victorian England of a disparate but vocal group of ― scriptural geologists.‖ They were not, as is often
claimed, a group of naive scientific incompetents, but, indeed, were often rather able men who saw a distinction
between biblical descriptions of the present natural world and of events in the past, respectively corresponding to
their understandings of physical science and history. While for the most part happy to accept ― accommodation‖ over
biblical references to the sun and Earth, they were not prepared to extend it to what appeared to be descriptions of
history, including chronology. The potential for conflict was greatest where science had a historical content (as in
geology or biology).
The war cries of the ―scr iptural geologists‖ were echoed by those who, in due course, assailed Darwinian
evolution on the same grounds. A second, and related, area of contention has been in the realm of methodology.
Here we find the age-old polarization between a science based on ― facts‖ and a theology derived from ―f aith,‖ or
between a naturalistic and a religious worldview. Naturalism has had a long history, going back to the early Middle
Ages and beyond, with a spectacular revival in nineteenth-century England that was dignified by the title of
― scientific naturalism.‖ It was a view that denied the right of the church to ―in terfere‖ in the progress of science by
introducing theological considerations into scientific debates. By the same token, any appeal to divine purpose as an
explanation of otherwise inexplicable phenomena has been a famous hostage to fortune. This philosophy of ― God of
the gaps‖ has generated special heat when one of the ―g aps‖ has later been filled naturalistically. In these cases,
conflict has certainly appeared, though whether it is really about methodological issues may be doubted. It has also
been argued in a veritable torrent of informed and scholarly works that the methodologies of science and of religion
are complementary rather than contradictory, and local instances of dispute have been assigned to other causes. Yet,
this confusion still penetrates popular thinking, and the conflict thesis has been thereby sustained. The third potential
for conflict has been in the field of ethics. Most recently this has been realized in such questions as genetic
engineering, nuclear power, and proliferation of insecticides. Past debates on the propriety of such medical
procedures as vaccination and anesthesia have been replaced by impassioned conflict over abortion and the value of
fetal life. In Victorian times, one of the more serious reasons for opposing Darwin was the fear that his theories
would lead to the law of the jungle, the abandonment of ethical constraints in society. Yet, in nearly all of these
cases, it is not so much science as its application (often by nonscientists) that has been under judgment. Fourth,
some opposition between science and religion has arisen from issues of social power. In Catholic cultures in
continental Europe, the polarity between sacred and secular was often much sharper than in Britain and the United
States, with the result that progressive science-based ideologies were more frequently in explicit contention with
conservative political and ecclesiastical forces. In early-nineteenth-century Britain, certain high-church Anglicans
turned on science for threatening their dominant role in society.
While this debate was formally about the authority of Scripture, in reality it was about the growing spirit of
liberalism within the universities. Not surprisingly, the community of science resented such attacks and, in due
course, turned the table on the enemy. Their response came in the form of a concerted effort by certain scientific
naturalists in Victorian England, most notably those associated with Thomas Henry Huxley (1825–95), to overthrow
the hegemony of the English church. The movement, which was accompanied by bitter conflict, generated a flood of
articles, lay ―sermons,‖ and verbal attacks on the clergy and included conspiratorial attempts to get the ― right men‖
in to key positions in the scientific establishment. It involved lectures, secular Sunday schools, and even a successful
lobby to have Charles Darwin‘s body interred in Westminster Abbey. Yet, it was not a battle between science and
religion except in the narrowest sense. Unlike White, who averred that he opposed not religion but dogmatic
theology, Huxley sought to undermine organized religion, though his rhetoric frequently sought to convey the
impression of a disinterested defence of truth. One recent writer identifies the driving force behind at least the
Victorian struggles as ― the effort by scientists to improve the position of science. They wanted nothing less than to
move science from the periphery to the centre of English life‖ (Heyck 1982, 87). It was at this time that science
became professionalized, with the world‘s first professional institute for science, the Institute of Chemistry,
established in 1877. In Europe, it was also the period when scientific leadership began to slip from Britain to
Germany, generating a fierce rearguard reaction by some British scientists against anything that could diminish their
public standing. If the Church was seen to be in their way, it must be opposed by all means, including the fostering
of a conflict myth, in which religion routinely suffered defeat at the hands of triumphalist science.
Greek Pantheism
The full articulation of a new program for science, within which the concept of organism was the chief
explanatory device, is contained in Aristotle‘s (384–322 B.C.) On the Heavens and Meteorologica, of which the first
deals with celestial, and the second with atmospheric and terrestrial, physics. They do not contain, to recall a remark
of E.T.Whittaker, a single acceptable page from the modern scientific viewpoint. This ― scientific‖ debacle is the
result of Aristotle‘s assumption of the radical animation of all nonliving matter, as initiated by Socrates, who
claimed that man‘s soul (anima) is best manifested by his purposeful actions aiming at what is best for him. It was,
however, in the writings of Aristotle that this trend of attributing a ― soul‖ to everything was given a sweeping
theological twist in a pantheistic sense. Since Aristotle deified the universe in that sense, he had to deny that the
universe could have been created out of nothing. Consistent with this denial, he also rejected the view that the actual
universe was only one of the infinitely many possibilities for physical existence.
The Prime Mover of Aristotle is a part, however subtly, of the sphere of the fixed stars, which obtains its motion
through an emotive contact with the Prime Mover and directly shares, therefore, in its ― divine‖ nature. This sharing
is the source of all other motions in the Aristotelian universe, in both its superlunary and its sublunary parts. In both
parts, things are animated to move naturally in order to achieve their purpose by reaching their natural places. This
animation of nature, in a more or less pantheistic sense, which discouraged a quantitative (or geometrical) approach
to nature, is everywhere noticeable in the discourse of post-Aristotelian Greek thinkers, especially when their extant
writings are sufficiently extensive. It should seem significant that not even the non-Aristotelians among the ancients
took issue with Aristotle‘s patently wrong statement (On the Heavens 1.6) that the rate of fall is proportional to the
mass of the body, a statement that logically follows from his ― animation‖ of nature. The scientifically valuable (that
is, quantitatively correct) achievements in Greek science seem to have been worked out mostly in isolation from
broader views of nature. Among them are Eratosthenes‘s (c. 275– 194 B.C.) geometrical method to ascertain the size
of the earth and a similarly geometrical method by Aristarchus of Samos (c. 215–c. 145 B.C.) to deduce the
dimensions of the earth-moon-sun system. These achievements form an indispensable basis on which all subsequent
science rests. They made possible the Ptolemaic system as the culmination of Greek efforts, at the instigation of
Plato, ―to save the phenomena.‖ This phrase expressed the methodological conviction that the complex and variable
planetary motions could be reduced to, and explained by, a simple and harmonious geometrical model. Still, when
the extant corpus is fairly large, one cannot help noticing the intrusion of traces of the Aristotelian, and at times
worse, forms of animization into scientific discourse. There are traces of it even in the Almagest of Ptolemy of
Alexandria (second century A.D.). His astrological compendium, Tetrabiblos, remains the ― Bible‖ of that animistic
preoccupation. In his ― physical‖ astronomy, a work on planetary hypotheses, Ptolemy considers the coordination of
planets in terms of human beings. Only Archimedes‘s (c. 287–212 B.C.) writings do not show any trace of this
animization of nature.
The ancient Greeks certainly recognized something of the nonideological character of quantitative
considerations about nature, but, owing to the pervasive presence of pantheistic considerations, they failed o make
the most of that character. The pantheistic conviction that the superlunary matter is divine prompted opposition to
Anaxagoras‘s idea that a large meteor, which hit Aegospotami in 421 B.C., could come from above the moon‘s
orbit. The pantheistic animation of the world also lurked behind the opposition to the heliocentric system proposed
by Aristarchus of Samos. In pantheism, the human mind is in particular a sharer in the divine principle. Therefore,
pantheism encourages the idea that the human mind has some innate insights into the overall structure and workings
of nature. This idea fosters an a priori approach, as opposed to an a posteriori, or partly experimental and
observational, approach. This is particularly clear in the case of Aristotle‘s dicta on the physical world. This
aprioristic influence could be harmless when the subject matter of investigation was rather restricted. There is no
trace of pantheism in Aristotle‘s valuable observational researches in biology. Of course, there the subject matter
consisted of living organisms that, in all appearance, acted for a purpose, and, therefore, there was no special need to
fall back on the broader perspective of a pantheistically colored animation of nature. The animation of nature
exerted its unscientific impact with particular force in respect to the study of motion. First, it was asserted that since
only the superlunary region was totally divine, matter in that realm obeyed laws of motion different from those of
ordinary, or sublunary, matter. Moreover, this dichotomy between superlunary and sublunary matter implied that the
latter was not truly ordered in its motions and interactions. Again, it was one thing to predict planetary positions; it
was another to work out a physics of the motion of planets together with the motion of bodies on the earth. Here
pantheism, as codified by Aristotle, blocked any meaningful advance. For, in Aristotle‘s system, the motion of
planets (and even of things on the earth) was but a derivative of the motion of the sphere of the fixed stars, which,
in turn, had its source in a continuous contact, however refined, with the Prime Mover. And since the source of all
motion was thought to reside in that kind of contact between the Mover and the moved, the logic of that starting
point demanded that all motion be explained as a continuous contact between the Mover and the moved. This,
however, meant a rejection of the idea of inertial motion, which, as will be seen, proved to be indispensable for the
eventual birth of a science that could deal with that most universal aspect of inanimate material things, which is their
being in motion. Greek science, with its major achievements and stunning failures, represents a tantalizing case of
the most crucial, and most neglected, aspect of the history of premodern science. That aspect consists of the
invariable failure of all major ancient cultures to make a breakthrough toward the science of motion. The ultimate
root of that systematic failure is theological, a point that will stand out sharply when we turn to the impact that
theism had on science. That theism was Christian theism.
Christian Theism
The possibilities that a theistic conviction could hold for science first appeared in the writings of
Athanasius (c. A.D. 296–373), a resolute defender of the strict divinity of the Logos (Christ), through whom God the
Father created all. If, however, the Logos was divine, its work had to be fully logical or ordered and harmonious.
This theological insistence on full rationality in the created realm inspired Augustine of Hippo (354–430) to lay
down the principle that, if conclusions that science safely established about the physical world contradicted certain
biblical passages, the latter should be reinterpreted accordingly. This is not to say that this principle quickly or
invariably found a praiseworthy implementation among Christian thinkers. But it acted as part of a broader
perception within Christian theism wherever serious attention was paid to Paul‘s insistence that Christians should
offer a well-reasoned worship (Romans 12:1). Hence, the rights of scientific reasoning were protected whenever the
rationality of faith was defended against various champions of fideism or against the claim that faith in a
supernatural mystery is the condition for the understanding of this or that plainly philosophical proposition.
More generic, though very powerful and still to be fully aired, was the impact that the Christian doctrine of the
Incarnation had. According to that doctrine, a real human being, Jesus Christ, was the ― only begotten‖ Son of God,
in the sense of possessing a truly divine status. For those adhering to that doctrine, it was impossible to embrace the
tenet, popular among Greek as well as Roman authors, that the universe was the ― only begotten‖ emanation from the
divine principle. Hence, Christian theism contained a built-in antidote against the ever-present lure of nature worship
or pantheism. Apart from these general principles, Christian theism also showed its potential usefulness for science
in some particular matters, as can be seen in the writings of John Philoponus (d. c. 570). He was the first to argue
that, since stars shine in different colors, they should be composed of ordinary matter. The argument had for its
target the divine status ascribed throughout pagan antiquity to the heavens, a status that introduced a dichotomy in
the physical universe and thereby set a limit to considering scientific laws as being truly universal.
The crucial impact of Christian theism on science came during the intellectual ferment brought about by the
introduction of Aristotle‘s works to the medieval educational system during the latter part of the thirteenth century.
Whatever the medieval enthusiasm for Aristotle, his pantheistic doctrine of the eternity and uncreated character of
the world was uniformly opposed from the start as irreconcilable with the basic tenets of Christian theism. With
John Buridan (c. 1295–c. 1358), the opposition took on a scientific aspect as well. For if it was true that the world,
with its motions, had a beginning, then one could logically search for the manner—the how?—in which that
beginning could be conceptualized. Buridan explained that how? was an eminently scientific question by saying that,
in the first moment of creation, God imparted a certain quantity of impetus (or momentum, as it was called later) to
all celestial bodies, which quantity they keep undiminished because they move in an area where there is no friction.
Such a motion, insofar as it implied a physical separation between the Mover and the things moved, is the very core
of the idea of inertial motion, to employ a term to be used later.
In the context of his commentaries on Aristotle‘s On the Heavens, Buridan carefully notes that ― inertial‖ motion,
insofar as it is a physical reality, does not mean absolute independence of things from the Creator. Anything, once
created, remains in existence only through the Creator‘s general support, which is, however, distinct from the act of
creation. In other words, Buridan is not a forerunner of deism. In deism, there is no room for such a support.
Buridan‘s notion of a created world implies, in a genuinely Christian vein, the world‘s utter, continuous dependence
on the Creator. The depth of createdness reveals, in turn, a Creator so superior to his creation that he can give his
creation a measure of autonomy without any loss to his absolute and infinite supremacy. Similar is the theological
background of Oresme (c. 1320–82), Buridan‘s successor at the Sorbonne, who looked at the world as a clockwork.
While the world had already in ancient times been referred to as a clockwork, Oresme used that concept with an
important theological surplus. This is why Oresme‘s clockwork universe is not an anticipation of Voltaire‘s and
other eighteenth-century deists‘ celebration of the idea of a clockwork universe.
Buridan‘s step can be seen rather as an anticipation of the Cartesian or Newtonian idea of inertial motion as long as
one focuses on that step‘s very essence. It lies deeper than the difference between a circular and a rectilinear motion.
There is no question that Buridan retained the Aristotelian idea of a naturally circular motion for the
celestial bodies. But he broke with Aristotle on the truly essential point—namely, that celestial motions were not
caused by those bodies remaining in a quasi-physical contact with the divine power. This represented the crucial
breakthrough toward the Cartesian formulation of linear inertia and of its incorporation into Newton‘s laws of
motion. That Buridan‘s and Oresme‘s teaching about motion was a genuine product of their Christian theistic
thinking is shown by the eagerness with which it was espoused in the fast-growing late-medieval and early-
Renaissance university system. Buridan‘s and Oresme‘s doctrine was carried by their many students at the Sorbonne
to the far corners of Europe. Among the many universities with copies of Buridan‘s commentaries was Cracow in
Poland. It was there that Copernicus (1473–1543) learned a doctrine that sustained him in his efforts to cope with
the dynamic problems created by the earth‘s motion in his system. With his vast articulation of the heliocentric
system, Copernicus forced the physics of motion to the center of scientific attention. There was, of course, plenty of
room to improve on the medieval doctrine of impetus, but only because that doctrine opened the way for meaningful
advances toward a fully developed science of motion, which came only with Isaac Newton‘s Principia. One cannot
overestimate the support that Christian theism afforded Copernicus and the major early Copernicans, especially
Johannes Kepler (1571–1630). It was becoming increasingly clear that data of measurements were to have the last
word concerning the structure and measure of the physical world. While the rhapsodically pantheistic Giordano
Bruno (1548–1600) merely promoted confusion, Baruch Spinoza (1632–77) was so consistent with his pantheism as
to be unable to explain why there had to be finite things, if everything was part of the infinite God.
Idiothetic Nomothetic
Individual-behavioral General-behavioral
Qualitative Quantitative
Concern with depth Attention to the surface
European origin American origin
Clinical Experimental
Intuitive (subjective) Objective
Holistic Atomistic
Phenomenological Positivistic
Source: Medicine Source: Physical science
The Complementary Nature of Qualitative and Quantitative Research
The distinction between ― qualitative‖ and ―quantitative‖ research is somewhat related to the
idiographic–nomothetic difference, but the two distinctions should not be confused. Qualitative data collection
ranges from writing the biography of a religious person to chatting with several people about a religious topic,
conducting interviews with open-ended questions, or having people tell a story about a picture they are given.
Central to this process is how experience is interpreted. In short, it is ―t he interpretative study of a specified
issue or problem in which the researcher is central to the sense that is made‖ (Banister, Burman, Parker,
Taylor, & Tindall, 1994, p. 2), and is thus ―( a) an attempt to capture the sense that lies within, and that
structures what we say about what we do; (b) an exploration, elaboration and systematization of the
significance of the identified phenomenon; and (c) the illuminative representation of the meaning of a
delimited issue or problem‖ (Banister et al., 1994, p. 3). The use of qualitative methods often allows
researchers to ―getbehind‖ the quantitative data to uncover specific issues of meaning. People may have
specific reasons—sometimes common and sometimes uncommon—for responding, for example, with a 4 on a
7-point scale as a statement of moderate agreement on a religious belief statement. Without qualitative
methodologies to unpack what a 4 actually means, we have limited understanding of the phenomena of
interest. At issue is the fact that many of our quantitative measures involve ―ar bitrary metrics‖ (Blanton &
Jaccard, 2006), which do not tell us the absolute standing of an individual or group on an underlying
psychological construct. For example, a score of 68 on a 100-point measure of depression does not tell us how
depressed a person actually is. Such arbitrariness, of course, is not a death sentence for research, in that
quantitative measures are used to test ideas and theories; therefore, the relative standing of scores is useful. We
can say that a score of 68 on a measure of depression is more than a score of 38, and this difference, for
example, may support or not support a hypothesis. However, what the score means in terms of the actual
experience of depression is limited. Therefore, several researchers in the psychology of religion have called for
a greater role for qualitative methods (e.g., Belzen, 1996; Belzen & Hood, 2006). This call is especially
relevant to an understanding of religion as a meaning system—the approach taken in this text.
It also resonates well with the earlier-noted call by Emmons and Paloutzian (2003) for a new
multilevel interdisciplinary paradigm that values multiple levels of analysis and nonreductive assumptions
regarding the nature of religious and spiritual experience. Qualitative methods are the methods of choice in
idiothetic research, but many such methods are used in nomothetic research as well. Therefore, it is an error to
equate qualitative methods with idiographic research and quantitative methods with nomothetic research,
as is frequently done. For example, determining what religious behaviors people perform in certain specific
settings may call for a novel procedure. This could include observing missionary activity in a Third World
village undergoing cultural change, or the behavior of congregants during a church service (Wolcott, 1994). In
contrast, quantitative data collection techniques might ask people to rate how strongly they agree with a
particular statement or to report how often they attend worship services. The major distinction is that
quantitative measures give scores directly, but qualitative data must be processed by a rater or by a computer
program for information.
A similar distinction can be made between qualitative and quantitative analyses of data. Qualitative
treatment can involve a more or less subjective review that enables a scholar to make sense of the information
and draw conclusions. A researcher employing quantitative analysis uses statistics such as means, standard
deviations, significance levels, and correlations in order to draw conclusions. Although quantitative methods
have been typical of data collection and analysis in the sciences as well as in the psychology of religion, there
is no doubt that they miss something. A description of a sunset in terms of physics is quantitative, but none
would argue that a painting of that sunset is replaced by the physical description. Physics has never claimed to
contain the whole of human experience regarding physical phenomena; nor does the psychology of religion
claim to contain the whole of human experience regarding religion. Just as a personal experience with a sunset
is meaningful in addition to the physics of a sunset, so a personal religious experience cannot be replaced by
the psychology of that experience. Similarly, psychology does not directly cover the history of religions, the
biographies of religious leaders, or the anthropology of religions, although they may be considered within the
new paradigm insofar as interdisciplinary considerations provide a broader context within which to understand
psychological findings (Hood & Williamson, 2008a, b). The psychology of religion is an application of
scientific methods to enhance our psychological understanding of religion.
Reliability and Validity
The acceptability of both quantitative and qualitative methods within the psychology of religion
depends on whether they can be shown to meet the scientific criteria of reliability and validity. For example,
when Ponton and Gorsuch (1988) used an instrument called the Quest Scale in Venezuela, its reliability was
low, so the authors were hesitant to draw any conclusions from it. Qualitative measures also need to
demonstrate reliability. Do different persons or judges agree in their observations and/or interpretations? If
they reach different conclusions as to whether a person feels God’s presence during meditation, for example,
then there is no reliability in their measure.
Once it has been shown that the qualitative or quantitative method is reliable, validity must then be
established. Usually ―cont ent validity‖ is used, as noted earlier. This means that psychologists examining the
method agree that the items or interview or rating criteria are appropriate for whatever descriptive term is
employed. Since both qualitative and quantitative methods are acceptable if they meet the standards of being
reliable and valid, why are quantitative methods so popular? One important problem is that reliable qualitative
methods are rather expensive to use. Consider the question of how a victim becomes a forgiving person after
major harm has been done to that person. Using an interview-based qualitative approach, a researcher might
ask each of 100 people to describe a time when a person harmed them, and then, in their own words, to explain
how they forgave that person and how their religious faith was a part of that process. The interviewing would
take about 300 hours (including setting up the interviews, doing the interviews, finding new people to reduce
the ―no -shows,‖ transcribing the interviews, etc.). Then the interviews would need to be rated by two people
trained to use the same language to describe the processes that were reported, and differences would need to be
reconciled with the help of a third rater (all this would take another 300 hours). At this point, a total of 600
hours would be needed for collecting and scoring the data. By contrast, in quantitative measurement utilizing a
questionnaire, a group of 100 people might take 2 hours to fill out the questionnaire. Scoring these responses
would take another 4 hours. The quantitative approach would thus take an estimated 6 hours, versus 600 hours
for the qualitative approach. Which procedure would you rather use in a research project? In some cases,
qualitative methods are the only ones we currently have to tap into the psychological processes being studied.
It is, for example, difficult to understand children’s concepts of God without using their drawings of God,
which are then rated. And in models where a person makes a choice, it is also a problem to find out what
options spontaneously occur to that person without utilizing at least somewhat qualitative methods.
Throughout this text, we report many studies that use qualitative research methods, provided that those
methods demonstrate sufficient reliability and validity. When they do meet adequate psychometric criteria, we
can be just as confident in reporting the results of qualitative research as those of quantitative research.
Theoretical Considerations
Any attempt to measure a concept such as religiousness or spirituality requires that the concept be
specified in measurable terms. Such an ― operational definition‖ is especially important when applied to
religiousness and spirituality, because, as we have seen in Chapter 1, there is considerable variety in how these
terms are conceptualized. The importance of theoretical clarity extends beyond how the constructs are
conceptualized; good theory is necessary in providing a framework for testable hypotheses as well.
Furthermore, researchers must consider the various dimensions of religious and spiritual experience (a topic
that we consider shortly) to help determine the appropriateness of potential measures.
Technical Considerations
A scale’s reliability and validity are the two most important technical issues to consider. The more
reliable and valid a measure is, the more useful it is for conducting scientific research. Though brief scales
(sometimes just one-item scales) may be appealing because they are time-saving and convenient, they also
tend to be less reliable and perhaps less valid. ― Reliability‖ refers to the consistency of a measure and is
usually assessed in terms of either (1) ―cons istency across time‖ or (2) ―internal consistency.‖ When assessing
consistency of a measure over time, better known as ― test–retest reliability,‖ the reliability coefficient is a
correlation between the test scores of a group of individuals who are administered the scale on two different
occasions (usually at least 2 weeks apart). More common is the use of internal consistency as a reliability
indicator. The better multiple scale items fit together (as determined statistically by factor analysis), the higher
the internal consistency. Internal consistency is most often measured by a statistic called Cronbach’s alpha,
which ranges from 0 to 1.00, with a higher value indicating greater consistency. Alpha levels of religious and
spiritual constructs are preferably above .80, but frequently are acceptable at about .70. Consideration of the
scale’s ―v alidity,‖ or the extent to which a test measures what it purports to measure, is also essential to good
measurement. There are many different ways to think of and measure validity. For example, though it may be
tempting to do so, we cannot rely simply on our subjective sense of whether or not the scale appears to
measure what it is supposed to be measuring, referred to as ―f ace validity.‖ Face validity is subject to all sorts
of human bias and is therefore not scientifically useful. ―Conte nt validity‖ refers to whether or not a
representative sample of the domain is being covered. For example, perhaps you are working with a measure
of spiritual disciplines. If your measure inquires about prayer, fasting, and tithing, but does not address reading
sacred texts or service, content validity is sacrificed—because the entire behavioral domain has not been
included in your measure.
―Const ruct validity‖ examines the agreement between a specific theoretical construct and a
measurement device, and may rely heavily on what is already known about a construct. ―Conv ergent validity‖
and ―di scriminant validity‖ are both subdomains of construct validity and can be considered together.
Convergent validity asks, ―H ow well does this measure correspond to similar measures of the same or similar
constructs?‖; discriminant validity asks, ―H ow is this test unrelated to measures of different constructs?‖ Those
who develop scales try to demonstrate as much reliability and validity as possible, though it is highly unlikely
that any single measure will be perfectly reliable or score high on all types of validity just discussed.
Sample Representativeness
There are many measurement scales in the psychology of religion that adequately meet these technical
criteria, but care must still be taken in their use. Why? Because these scales were developed on a rather limited
sample that may not reflect the population of interest under investigation. The most common form of such
limitation is that many of the scales were initially developed for a Christian population, but now many
researchers wish to investigate religious and spiritual experience outside the confines of Christianity, or
perhaps even outside the context of any formal religious tradition (Hill, 2005). Even more problematic is that
many of the scales were initially developed among white, young, middle-class, American (and, to a lesser
extent, British) college students (Hill & Pargament, 2003). Four variables known to be strongly correlated with
religious experience are age, socioeconomic status, race, and educational level (Hill, 2005); therefore, caution
is necessary if one should choose to use such a scale for a population with a different demographic profile or
outside the Judeo-Christian context.
Scales created on the basis of either unrepresentative samples or samples representing a narrow
population (e.g., a single denomination) are usually insensitive or inapplicable to broader groups (Chatters,
Taylor, & Lincoln, 2002). For example, Protestant African Americans— among the most religious of all ethnic
groups in the United States—emphasize community service (Ellison & Taylor, 1996), as well as the notion of
reciprocal blessings with God (Black, 1999). Both of these characteristics are ignored in virtually all measures
of religiousness or spirituality, in favor of other issues that may be irrelevant to African Americans. Hill and
Dwiwardani (in press) provided a fascinating example of how difficult it is to transport the study of religious
experience to other world religions when they attempted to apply Allport’s I-E distinction to Indonesian
Muslims. In order to make the scale that measures both I and E religious orientations applicable to the Muslim
context, more than just the language of the scale needed to be changed (e.g., changing the word ―chur ch‖ to
―m osque‖). Because Islam is such a strong pillar of the overall collectivistic culture in Indonesia, the concept
of the social basis of the E religious orientation as a form of immature religion is simply not as applicable to
Muslims as it is to Christians. Fortunately, however, another group of researchers has provided the Muslim–
Christian Religious Orientation Scale (Ghorbani, Watson, Ghramaleki, Morris, & Hood, 2002), which takes
into account a social dimension in relation to the broader community and culture rather than to the mosque. It
is important that we recognize the limits of our measures and seek to improve them for more diverse settings.
Measurement Domains
Because religiousness is a highly complex and varied human experience, good measurement must
reflect this complexity. This does not mean that any single measure must reflect all of this complexity, for
many times the topic of interest is but a piece of the religion pie— for example, religious beliefs or specific
religious behaviors. Psychologists, especially social psychologists, frequently discuss the totality of human
experience in three domains: ―cogni tion,‖ or how the ideological aspect of (in our case) religion is
conceptualized; ―af fect,‖ or the emotional, ―l ike–dislike‖ facet of belief or behavior (which frequently includes
attitudes and values); and ―behav ior,‖ or what people do and how they act. It is important that measures reflect
these individual domains. Mixing these domains often leads to confusing research. So, for example, of about
125 measures identified by Hill and Hood (1999a), there was a cluster of measures stressing religious beliefs,
another cluster emphasizing religious attitudes, and so forth. Sometimes it is desirable to have a single
multidimensional measure, but even then there will usually be subscales (often determined by factor analysis)
tapping more specific domains. Table 2.4, adapted from Hill (2005), provides a summary of 12 common
categories of measures that have been developed, with examples of measures from the literature that fit each
category. One might be surprised by the number of measures available, especially since the measures and their
respective categories in the table are not exhaustive. In fact, the table includes only a small percentage of
measures, though Hill (2005) maintains that they represent some of the better measures in the psychology of
religion. Notice that the first four categories cover what Tsang and McCullough (2003) refer to as ― Level I‖
measures, which represent ―hi gher levels of organization reflecting broad individual differences among
persons in highly abstracted, trait-like qualities‖ (p. 349). Level I measures may help assess how religious or
spiritual a person is, and here we refer to this as ―di spositional religiousness.‖ The final eight categories of
measures represent ―L evel II‖ measures, which get at how religion or spirituality functions in a person’s life,
referred to here as ―f unctional religiousness.‖ For example, highly religious people may use their religion in
different ways to help cope with life’s stressful agents. More scales and more detailed discussions of scales can
be found in a number of resources: Hill (2005), Hill and Hood (1999a), MacDonald (2000), and MacDonald,
LeClair, Holland, Alter, and Friedman (1995).
Gorsuch’s (1984) claim that the psychology of religion had been dominated by issues of measurement
up to that time led him to conclude that measurement scales were ―r easonably effective‖ and ―av ailable in
sufficient varieties for most any task in the psychology of religion‖ (p. 234). Now, a quarter of a century later,
we can say that Gorsuch was both correct and incorrect. Within the psychology of religion proper, and
especially at Level I dispositional measurement, Gorsuch was clearly correct. Researchers have a sufficient
arsenal of measurement instruments at hand to adequately assess a person’s level of religiousness or
spirituality, even given the complexities of what it means to be religious or spiritual. The one caveat, however,
is that measures within the psychology of religion will need to become increasingly pluralistic, to better
represent (1) religious traditions other than Christianity and (2) those forms of spirituality that do not conform
to any formal religious tradition. However, Gorsuch (or anyone else, for that matter) was, quite
understandably, unable in 1984 to envision the direction the field would take, particularly the move toward
examining the many functional varieties of religiousness (Level II measurement) that would require further
scale development. So, for example, in reviewing the significant association between religion and both mental
and physical health (to be discussed in considerable detail in Chapter 13), Hill and Pargament (2003) have
highlighted ongoing advances in measurement (e.g., measuring perceived closeness to God, religious struggle)
that help delineate why religiousness and spirituality seems to contribute (mostly positively, but sometimes
negatively) to health and well-being. It is safe to say that measurement issues, particularly of the Level II
functional variety, will continue to be of great interest and concern to psychologists of religion (vezi anexa).
Implicit Measures
The final measurement issue we wish to discuss is an issue that plagues all of psychology—the field’s
overreliance on self-report measures. Every measure (including qualitative measures) discussed thus far in this
section relies on self-reports, which of course may be biased for a number of reasons: intentional deception,
impression management, personal bias, and many more. The accuracy of self-reports is especially suspect
when the topic being investigated is personal and sensitive in nature (Dovidio & Fazio, 1992), which religion
and spirituality often are. As a result, there has been an increasing interest in developing other measurement
techniques (such as physiological measures, better behavioral measures, etc.), including the use of ―i mplicit‖
measures, particularly as measures of attitudes. Greenwald and colleagues (Greenwald & Banaji, 1995;
Greenwald, McGhee, & Schwartz, 1998) have defined implicit attitudes as unconscious, automatic evaluations
that influence thoughts, feelings, and behaviors. Probably the most common implicit measure is the Implicit
Association Test (IAT; Greenwald et al., 1998) which uses response latency as a marker of one’s unconscious
and automatic attitudes. The IAT was first developed as an implicit measure of racial attitudes, whereby an
associative strength between two concepts (e.g., objects and evaluative adjec tives) is measured by the amount
of time (measured in milliseconds) it takes to determine whether the concepts go together. Thus it may be
easier for a racially prejudiced white person to categorize two objects that are congruent (and hence take less
time to determine that the two concepts go together) in his or her thinking (e.g., white and good; black and
bad) than objects that are incongruent (e.g., white and bad; black and good). Though there are many
assumptions underlying the IAT (and the notion of implicit measurement in general), social- psychological
research has shown it to be psychometrically adequate in terms of its internal consistency, temporal reliability,
and validity (Rowatt & Franklin, 2004). Only recently has research in the psychology of religion utilized
implicit measures. Some of these studies have investigated explicit (i.e., self-report) measures of religiousness
or spirituality in relation to some implicit measure, such as race attitudes (Rowatt & Franklin, 2004), humility
(Powers, Nam, Rowatt, & Hill, 2007; Rowatt, Powers, et al., 2006), attitudes toward homosexuals (Rowatt,
Tsang, et al., 2006; Tsang & Rowatt, 2007), or attitudes toward other religious groups (Rowatt, Franklin, &
Cotton, 2005). The results of much of this research are covered later in this book, particularly in Chapter 12.
Others (e.g., Hill, 1994; Wenger, 2004), however, have made the case that religion itself may be a topic that
can be implicitly measured, and several notable attempts have now been made (Bassett et al., 2004; Cohen,
Shariff, & Hill, 2008; Gibson, 2006; Wenger, 2004). This research is still in its earliest stages, with the implicit
measures themselves needing more frequent testing before any judgment of their utility can be made. These
attempts do represent, however, important efforts at getting beyond reliance on self-report measures.
Individual Differences
Many people perhaps do not recognize that much of the psychology of religion falls primarily within social
psychology (though other subdisciplines, particularly clinical and developmental psychology, are well
represented) in general, and within the domain of individual differences in particular (Dittes, 1969). Social
psychology studies the person in the social context. Because religiousness varies from one person to another,
the psychology of religion stresses the individual-variability aspect of social psychology. Most research (and
hence most measures used in the research) in the psychology of religion stresses individual differences. That
is, the person’s own attitudes and behavior are studied as dependent and independent variables. Social
psychology further examines how independent variables, such as religiousness, affect people and their
relationships with others. Much of this research is devoted to social-cognitive processes. As noted earlier,
individual differences in social psychology are typically accounted for in three domains that are easily applied
to religious experience: cognition, affect, and behavior. To these three, we perhaps should add habit, since
there are important habitual components in religious experience. Cognition is primarily concerned with beliefs
and how they are learned—in other words, how the ideological aspect of religion is conceptualized. The
affective realm emphasizes feelings and attitudes—the emotional, ―l ike–dislike‖ facet of belief or behavior.
The attitude concept is especially important to the psychology of religion, since attitudes are often important
predictors of behavior. Behavior, of course, consists of what people do, how they act. Finally, habit involves
what people do regularly, consistently, and often automatically. The psychology of religion looks at individual
religious differences within each of these areas.
For our current purposes, the important point to note is that because each domain has a separate purpose, these
domains should be kept distinct in measurement. Items representing these domains are exemplified in Table
2.5. The first and third illustrations in the cognitive area use a response format that emphasizes the definition
of the domain, mostly here belief. The second and fourth illustrations use a common response format that
emphasizes belief but includes an element of affect—namely, value. This distinction is not made for the other
domains. Because each domain has a different purpose, it is important to keep them distinct.
Research can then identify the conditions under which they relate to each other. For example, Allport (1959) as
interested in total religiousness, based on both the I and E scores of religious orientation (Allport & Ross,
1967). He stressed affect or motivation in these orientations, and he ignored cognition. The original scale,
however, included behavioral items, which created conceptual confusion. Later versions of the I and E scales
dropped the behavioral items, and the measure of I and E became clearer. The research reported throughout
this text cuts across these different domains. It is important to keep in mind whether we are talking about
beliefs, values, motivations, and so forth. Because each of the areas functions differently, it is often important
to distinguish among them. Still, at other times we may wish to investigate some overriding concern, and to
do so we measure across several of these areas. As noted throughout this book, religiousness and spirituality
are complex, multidimensional phenomena, and this includes the fact that they incorporate each of these
domains as part of the complete experience.
Introducere
1
• Spiritualitatea umanistă este un sentiment de conexiune cu omenirea. Este un
sentiment de a fi relaţionat cu sau de a face parte dintr-un grup general de oameni,
sentiment de multe ori susţinut de iubire, altruism şi reflectare (de ex.
contemplarea sensului şi împlinirii unei relaţii).
• Spiritualitatea naturalistă este definită ca un sentiment de apropiere cu mediul
înconjurător sau cu natura. De exemplu, o persoană poate simţi un sentiment de
admiraţie şi mirare evocat de un peisaj natural foarte frumos, de vederea unui
apus de soare splendid, sau de experienţierea unei minuni naturale.
• Spiritualitatea cosmică este un sentiment de conexiune cu Creaţia. Acest
sentiment poate fi stimulat de contemplarea limitelor aparent nesfârşite ale
creaţiei sau de admirarea cerului noaptea, vederea miliardelor de stele şi
contemplarea naturii cosmosului. Astfel, o persoană se poate simţi insignifiantă ca
individ, dar unită cu restul cosmosului (care poate părea magnific, de dimensiuni
inestimabile şi foarte frumos).
2
Unii clienţi resimt o tensiune când merg la şedintele de psihoterapie. Mulţi
consideră terapia ca pe un domeniu de activitate secular (Kurtz,1999). În acest fel, clienţii
religioşi pot să conchidă că nu trebuie să aducă în discuţie probleme religioase cu
terapeuţi nonreligioşi. Această ezitare poate izvorî din frica de a nu se considera că au
tulburări patologice, tocmai din cauza credinţelor lor. Mulţi clienţi religioşi nu vorbesc
niciodată despre religia lor în cadrul psihoterapiei, decât dacă religia este problema
centrală sau dacă se leagă serios de problema cu care se prezintă la psihoterapie. Pe de
altă parte, mulţi clienţi religioşi, în special cei cu credinţe teologice conservatoare
(Thurston, 2000), au căutat şi chiar au cerut o terapie construită în aşa fel încât să includă
concepte religioase (de ex. păcat, suflet, karma, dharma, cei 5 piloni ai Islamului, salvare,
reîncarnare, legile lui Moise), teme religioase (de ex. iertare, milostenie), şi chiar practici
religioase (de ex. rugăciunea sau folosirea textelor religioase). Astfel de clienţi caută o
abordare psihoterapeutică construită special pentru setul lor de credinţe şi valori.
Înainte de anii ’80, clerul era cel care se ocupa în cea mai mare parte de
consilierea religioasă (Kurtz, 1999). În timp ce o astfel de consiliere presupune o
compatibilitate din punct de vedere telogic între client şi terapeut, o serie de probleme de
natură practică reies din această situaţie. În primul rând, preotul/pastorul/autoritatea
religioasă nu are o formare în psihoterapie. În al doilea rând, din cauza multiplelor roluri
şi îndatoriri pe care le au, autorităţile religioase nu pot face faţă la întreaga congregaţie
care are nevoie de terapie şi consiliere. În al treilea rând, preoţii s-ar putea să nu se poată
întâlni cu clienţii atât de des precum ar vrea aceştia.
În aceeaşi perioadă din anii ’80, mulţi clienţi conservatori din punct de vedere
teologic au devenit mai asertivi în căutarea explicită a psihoterapeuţilor religioşi care îşi
construiau abordarea incluzând elemente din religia de care aparţineau (Miller &
Lovinger, 2000; Thurston, 2000; Wylie, 2000). De exemplu, Asociaţia Americană a
Consilierilor Creştini (AACC) are peste 50.000 de membri, majoritatea dintre ei fiind
terapeuţi la nivel de master. Alţi consilieri se descriu în mod explicit ca fiind
psihoterapeuţi evrei, musulmani, buddhişti sau hinduşi. Un terapeut religios poate să
lucreze într-o organizaţie şi să lucreze cu toţi clienţii lui de aceeaşi confesiune.
Totuşi, în ultimele două decenii mai ales, psihoterapeuţii din toate sectoarele de
angajare (employment site) au declarat că oferă terapie care înglobează elemente ale unor
religii specifice. De obicei, astfel de terapeuţi oferă (de exemplu) atât psihoterapie bazată
pe religia iudaică, cât şi psihoterapie seculară. Clienţii lor sunt de obicei informaţi de la
început despre aceste opţiuni de psihoterapie. Dacă clientul alege varianta seculară,
atunci problemele religioase vor fi adresate numai în cazul în care clientul le aduce în
discuţie. Dacă acest lucru nu se întâmplă, psihoterapia va continua ca una seculară.
Estimări ale prevalenţei terapiei religioase nu sunt prezente în cercetările
reprezentative. Chiar şi aşa, să ne amintim că există peste 50.000 de mii de terapeuţi
afiliaţi AACC (Wylie, 2000) – o organizaţie în cadrul unei singure religii. Să ne
imaginăm că fiecare din acei terapeuţi are mai mulţi clienţi curenţi. Să luăm în
considerare numere proporţionale de terapeuţi religioşi şi pt alte religii, fiecare terapeut
având propria clientelă. Astfel, putem deduce că există un număr substanţial de clienţi
care parcurg o psihoterapie religioasă, în orice moment dat.
Modele teoretice
3
Teoria stres-şi-coping
Poate cel mai recunoscut model al terapiei religioase este cel de stres-şi-coping,
propus şi promovat de decenii de către Kenneth Pargament (1997, 2007). Pargament
sugerează că, atunci când oamenii experienţiează stresori, ei îi aduc în discuţie în cadrul
terapiei, prin accentuarea strategiilor de coping religios existente până atunci sau prin
învăţarea unora noi. La început, clienţii folosesc un coping conservator în încercarea lor
de a se confrunta cu problema, fără să îşi schimbe credinţele religioase. Ei încearcă să
asimileze evenimentele stresante şi reacţiile la eveniment în schema mentală de până
atunci.
Dacă copingul tradiţional/conservator nu îi ajută pe clienţi să îşi rezolve
dificultăţile emoţionale, clienţii se pot angaja în coping transnormativ. În acest fel, ei îşi
modifică schema religioasă de până atunci, pentru a face faţă problemei curente.Un astfel
de coping poate fi adaptativ sau maladaptativ (de ex. mâncatul sănătos vs. mâncatul
compulsiv). După Pargament şi colegii săi, copingul religios poate, de asemenea, să fie
adaptativ sau maladaptativ (de ex. să te simţi protejat de Dumnezeu vs. să te simţi
pedepsit de Dumnezeu) şi este evaluat prin scala R-COPE (Pargament, Koenig & Perez,
2000).
4
sau chiar înainte de a iniţia terapia. Cel mai frecvent, terapeuţii răspund indirect la acest
tip de întrebări, întrebând, la rândul lor, “De ce este acest lucru important pentru tine?”.
Un client foarte religios poate resimţi această contracarare a întrebării lui ca pe o ofensă
şi o poate interpreta ca fiind un răspuns evaziv, deducând faptul că terapeutul nu îi
împărtăşeşte credinţele religioase. Chiar dacă terapeutul în cauză face ulterior afirmaţii ce
dovedesc acceptare şi toleranţă, clientul nu mai poate fi domolit şi, în mod inevitabil, va
termina terapia sau va fi refractar la orice intevenţie a terapeutului (Thurston, 2000).
Şi psihoterapeuţii au zonele lor de toleranţă pentru valori religioase, în special
dacă sunt, la rândul lor, foarte religioşi. Terapeuţii care nu pot tolera dovezile de
intoleranţă din partea altora, e foarte probabil să nu poată lucra bine cu clienţi care
afişează credinţe religioase fundamental diferite de ale lor, care au credinţe religioase
extremiste sau care sunt rigizi în credinţele lor. În unele cazuri (de ex. diferenţa de
credinţe religioase poate duce la o prognoză slabă a tratamentului), terapeuţii ar trebui să
comunice clienţilor, în limita posibilului, dacă neconcordanţele în viziunile şi credinţele
religioase nu pot fi depăşite (de ex. în şedinţa de terapie, printr-un supervizor al
procesului terapeutic sau ca o consultare cu clientul). Alţii ar putea utiliza aceste reacţii
negative ce ar putea apărea în timpul terapiei ca pe un proces de confruntare. În cazurile
unde nici recomandarea unui alt terapeut, nici confruntarea nu e posibilă, terapeutul
trebuie să încerce să dezolte empatie şi acceptare faţă de valorile clientului, să facă
compromisuri cu clientul, înspre “a cădea de acord că nu pot fi de acord”, sau să dezolte
anumite limite, care să-l ajute să-şi menţină obiectivitatea în procesul terapeutic.
Unii terapeuţi seculari se pot simţi confortabil şi într-o situaţie în care trebuie să
ofere terapie augmentată religios unor clienţi care nu sunt de acord cu valorile religioase
ale lor. De fapt, există un studiu clasic, care a investigat terapia cognitiv-
comportamentală creştină (CBT), în cazul unor voluntari cu depresie (Propst, Ostrom,
Watkins, Dean & Mashburn, 1992). Terapeuţii care nu erau creştini au utilizat un manual
de terapie cognitiv-comportamentală augmentată religios (creştin), iar aceştia au obţinut
trezultate mai bune cu clienţii lor, decât au obţinut terapeuţii care într-adevăr erau
creştini. Rezultate contradictorii au fost regăsite pe un eşantion clinic (Wade et al., 2007),
în contrast cu reculul unor persoane care au avut depresie clinică (Propst et al., 1992). Un
terapeut secular care urmează un protocol de augmentare religioasă a terapiei, cu clienţi
religioşi, are, într-adevăr, o probabilitate mare de a obţine rezultate favorabile în procesul
terapeutic.
În articolul ce urmează celui de faţă, Post şi Wade fac o analiză a cercetării din
psihoterapia religioasă, focalizându-se pe terapia religioasă condusă de terapeuţi religioşi,
unor clienţi religioşi şi în care se utilizează intervenţii religioase. Cercetările recente arată
că terapeuţii sunt încă în mod semnificativ mai puţin religioşi şi spirituali decât clienţii
lor (Delaney et al., 2007). Cei mai mulţi dintre psihoterapeuţi privesc în mod pozitiv
religiozitatea clienţilor lor, iar nu ca pe o dovadă de maladaptare sau patologie. Cel mai
adesea, terapeuţii sunt predispuşi la a face greşeli de judecată atunci când au de-a face cu
persoane aparţinând unor religii cu care ei nu sunt familiari. Majoritatea terapeuţilor
religioşi oferă clienţilor posibiliatea de a alege între terapia seculară sau cea augmentată
religios. Clienţii – chiar şi cei nonreligioşi – sunt deseori deschişi înspre a include
5
elementul religios/spiritual în procesul lor terapeutic, vor ca terapeuţii lor să abordeze
această problematică şi obţin beneficii din aceasta (chiar dacă terapeutul nu le
împărtăşeşte valorile sau credinţele religioase). Per total, numărul proceselor terapeutice
clinice care cuprind elemente religioase a crescut în ultimii 10 ani. Mai multe abordări
terapeutice augmentate religios beneficiază acum de manuale publicate (de ex. schema
spirituală a sinelui) şi de date publicate, care susţin eficienţa sau eficacitatea lor.
Studiile de caz din acest număr (al revistei) abordează o gamă largă de orientări
teoretice şi formate terapeutice. Shafranske oferă o descriere a terapiei psihodinamice
orientate spiritual, accentuând câţiva paşi de bază ce trebuie urmaţi în adresarea sacrului
din această perspectivă. Această abordare este apoi exemplificată în cazul impresionant al
unui bărbat care experienţia o mare tensiune religioasă. Se fac conexiuni între experienţa
acestui client legată de slăbiri ale credinţei lui (catolice) şi alte forme de pierdere suferite
de-a lungul vieţii (de ex. moartea tatălui în copilăria timpurie). Pe durata terapiei, clientul
îşi revede locurile unde a copilărit şi astfel îşi consolidează insighturile obţinute în
dificilul proces al terapiei psihanalitice.
Hathaway şi Tan descriu şi ilustrează terapia cognitiv-comportamentală
augmentată religios, care include metode legate de mindfulness (înţelegere profundă –
n.n.). Autorii încep prin a analiza caracterizarea făcută de Hayes evoluţiei terapiei
cognitiv-comportamentale (CBT), în trei etape: terapie comportamentală, terapie
cognitivă şi mai noile terapii centrate pe acceptare/mindfulness. Unele forme de terapie
din această ultimă etapă abordează tematici religioase inspirate din tradiţiile religioase
orientale. Hathaway şi Tan analizează procesul terapeutic al unui client depresiv,
conservator din punct de vedere teologic. Terapeutul a utilizat metode ale terapiei
cognitiv-comportamentale augmentate de elemente scripturale şi mindfulness. Autorii
analizează provocările şi raţiunile presupuse de utilizarea acestui tip de metode religioase
orientale cu clienţi creştini sau cu alţi clienţi deişti.
În următorul articol, Richards şi colegii descriu forma lor de psihoterapie
spirituală deistă, care este integrativă şi universală, în aşa fel încât să poată fi folosită în
cazul oricărui tip de spiritualitate deistă. Cu toate acestea, permite şi personalizarea
abordării, pentru a include subtilităţi confesionale. Autorii îşi ilustrează metoda
terapeutică prin cazul unei femei care suferă de tulburări de alimentaţie. Ei descriu o
abordare deistă a tulburărilor alimentare, care susţine că sunt bazate pe pierderea
identităţii şi a simţului valorii personale. Hiperfagia devine, în acest fel, un mod de a
compensa pierderea identităţii spirituale. Se recomand㸠în acest caz, o restructurare
cognitivă, pe premisa că starea de bine psihică a clientei este interconectată cu starea de
bine emoţională, relaţională şi cu cea spirituală. Autorii susţin că focalizarea pe
spiritualitate poate fi o cale majoră de a pătrunde concepţiile de viaţă ale clientului.
Delaney, Forcehimes, Campbell şi Smith prezintă, apoi, un tratament orientat
spiritual, pentru dependenţa de alcool. Aceştia descriu rolul pe care spiritualitatea şi
religia îl joacă în prevenţia şi tratamentul abuzului de substanţe şi apoi propun câteva
mecanisme responsabile de aceste efecte. Ei fac o distincţie importantă între intervenţiile
din cadrul confesiunii (within-faith) şi cele dintre confesiuni (between-faith). Sugerează
că metodele centrate pe client sunt în mod special eficiente în intervenţiile
interconfesionale (between-faith). În experimentul lor clinic recent, i-au învăţat pe
terapeuţi să utilizeze o abordare centrată pe client, pentru a-şi ajuta clienţii să exploreze
propria spiritualitate şi să folosească cu succes practici spirituale în terapie. Abilitatea
6
terapeutului de a-şi angaja clienţii într-o discuţie pe tema spiritualităţii poate depinde de
felul în care terapeutul respectiv îşi ponderează rolul de autoritate/expert cu cel de
facilitator evocativ.
Pe urmă, Dwairy descrie şi ilustrează psihoterapia în cazul musulmanilor. Acesta
sugerează că încercarea de a revela procese inconştiente şi de a promova autoactualizarea
în cazul clienţilor provenind din culturi colectiviste, poate duce la confruntări puternice
între client şi familia acestuia. Autorul recomandă terapia metaforică şi analiza culturală
pentru persoanele din asemenea culturi colectiviste. În terapia metaforic㸠clientul poate
relaţiona simbolic şi indirect cu conţinutul inconştient şi totodată poate evita ameninţările
directe ale conceptelor religioase. În analiza culturală, clienţii îşi pot revela nevoile
inconştiente şi pot să restabilească ordinea în sistemul lor de credinţe şi în familie.
Dwairy prezintă cele două metode terapeutice utilizate în terapia cu un client arab
musulman, suferind de depresie. Printr-un astfel de proces terapeutic ancorat în cultura şi
religia lui, clientul şi-a ameliorat credinţele maladaptative, a devenit mai mulţumit de sine
şi a găsit căi eficiente de a se adapta în familia sa.
Duba şi Watts oferă un exemplu de tratament al cuplurilor religioase, din
perspectivă adleriană. Autorii observă că în cupluri există o mare variaţie în felul cum
indivizii se bazează pe orientarea religioasă pentru a-şi defini sau restructura relaţia
romantică. Confesiunile diferite vor stabili “reguli” specifice sau vor forma modul în care
cuplul rezolvă greutăţile la nivel interpersonal şi familial, ca de exemplu sexualitatea,
stilul parental sau autoritatea. Aceşia propun o serie de principii ce trebuie respectate
atunci când se tratează cupluri religioase, inclusiv discuţii premergătoare terapiei sau
consimţământul informat al clienţilor. Ei observă existenţa a numeroase paralele între
terapia adleriană şi credinţa religioasă creştină (de ex. orientarea relaţiei, focalizarea pe
stilul de viaţă, interesele sociale). Cuplul ilustrat, romano-catolic, a fost tratat de
asemenea de un terapeut de confesiune romano-catolică. Partenerii aveau probleme legate
de stres, conflicte frecvente şi erodarea intimităţii în cuplu. Terapia a implicat o
anamneză a vieţii de cuplu şi a dinamicii iniţiale a relaţiei, precum şi training pe aspecte
de management al timpului. În timp, cei doi şi-au corectat percepţiile greşite care
afectaseră dinamica relaţiei lor.
În final, noi (Aten & Worthington) eaminăm ce s-a învăţat în acest număr (al
revistei). Propunem paşi ce vor trebui luaţi în viitor în practicarea terapiilor augmentate
spiritual şi religios şi luăm în considerare modalităţi de lucru în cazul clienţilor care
iniţiză terapia cerând în mod explicit abordări spirituale sau religioase, dar şi în cazul
celor care cer o terapie seculară, dar care e posibil să se confrunte pe durata procesului
terapeutic cu probleme ce ţin de spiritualitate sau religiozitate. Sugerăm că ar trebui
dezvoltate şi testate noi metode clinice, care să încorporeze practici religioase occidentale
şi orientale. De asemenea, recomandăm o mai bună colaborare atât între preoţi
(duhovnici) şi psihoterapeuţi, cât şi între psihoterapeuţi şi cercetători. În final, subliniem
faptul că formarea clinică are nevoie de îmbunătăţiri în sensul acesta şi propunem câteva
direcţii la care s-ar putea interveni.
Sperăm că acest număr (al revistei) oferă o ghidare clinică în munca cu clienţii –
chiar dacă aceştia caută psihoterapie augmentată religios sau psihoterapie seculară.
Integrând practica clinică cu cercetarea, putem să ne raportăm la clienţii religioşi mai
precis şi mai eficient. Sperăm că aceste articole îi vor ajuta pe practicieni (dar şî pe
7
cercetătorii din domeniul clinic) să depăşească tensiunile istorice dintre psihoterapie şi
religie.
Bibliografie
(...)
ARTICOL TRADUS DE
Laura Belean
Ramona Monica Rad
Cristina Tacaciu
8
Intervenţii spirituale în psihoterapie: evaluări făcute de clienţi foarte
religioşi
Jennifer S. Martinez, Timothy B. Smith and Sally H. Barlow
Brigham Young University
Journal of Clinical Psychology, vol. 63(10), 943-960 (2007)
1
multe dintre intervenţiile investigate au un fundament religios explicit (de ex. citirea
Scripturii), vom folosi termenul religios pe parcursul articolului, cu excepţia situaţiilor în
care contextul justifică o formulare mai exactă.
În psihoterapie, clienţii se luptă nu doar cu probleme ce ţin de starea de bine
personală, ci şi de perspectivele lor în viaţă, relaţiile cu ceilalţi sau valorile lor cele mai
adânci. Pentru mulţi clienţi, problematica religioasă se suprapune cu aceste preocupări ale
lor (Smith & Richards, 2005). În aceste circumstanţe, clienţii respectivi ar putea obţine
beneficii de pe urma abordării explicite a problematicii religioase în cadrul terapiei sau de
pe urma augmentării metodelor terapeutice de coping cu resurse religioase. La fel cum
ajustarea psihoterapiei în funcţie de experienţele şi valorile culturale ale clientului poate
spori eficienţa tratamentului (Griner & Smith, 2006), tot aşa, ajustarea psihoterapiei cu
elemente religioase, în cazul clienţilor care valorizează puternic religia, ar putea duce la
un tratament mult mai eficient (Richards, Keller & Smith, 2004; Smith et al., in press).
Mai mult decât atât, psihologii au obligaţia etică de a oferi servicii care ţin cont de
context în cazul fiecărui client, acest lucru incluzând contextele religioase (American
Psychological Association [APA], 2002).
Psihoterapeuţii trebuie, cu atât mai mult, să ţină cont de experienţele şi credinţele
clienţilor care valorizează puternic religia. O înţelegere acurată a concepţiilor religioase
ale clienţilor poate avea un impact pozitiv asupra tratamentului, în vreme ce ignorarea
credinţelor religioase poate reduce eficienţa terapiei şi poate creşte frecvenţa cu care
clienţii pun punct terapiei (Miller, 2003; Propst, 1980; Smith & Richards, 2005). În mod
specific, indivizii foarte religioşi consideră de multe ori că psihologii clinicieni s-ar putea
să nu aprobe valorile, ideile sau purtarea lor (Worthington, 1986), motiv pentru care vor
evita terapia sau vor căuta alţi specialişti în sănătatea mentală, despre care cred că le
împărtăşesc credinţele (Worthington, Duport, Berry & Duncan, 1988). Clienţii care sunt
foarte religioşi sunt cei mai predispuşi la a-şi dori integrarea intervenţiilor religioase în
terapie. Aşadar, studierea încorporării acestui tip de intervenţii în psihoterapie întâlneşte
cea mai mare justificare în cadrul populaţiilor care deja raportează puternice valori
religioase.
După cum a fost documentat pe larg în literatura de specialitate, includerea
problematicii religioase în psihoterapie potenţează apariţia unui număr de dileme etice
(Richards & Bergin, 2005). Luarea în considerare a consimţământului informat (Hawkins
& Bullock, 1995), a dezvoltării identităţii religioase/spirituale (Fowler, 1991; Hulk,
Spilka, Hunsberger & Gorsuch, 1996; Poll & Smith, 2003), a relaţiilor biunivoce (Sonne,
1999), a colaborării cu liderii religioşi (Chappelle, 2000), a respectului pentru valorile
clienţilor (Haug, 1998; Neusner, 1994), a limitelor impuse de locul de muncă (Chapelle,
2000; Richards & Bergin, 2005) şi a nivelului de competenţă a terapeutului (Barnett &
Fiorentino, 2000; Lannert, 1991) este esenţială în a decide dacă să se folosească
intervenţii bazate pe religie. Pentru fiecare din aceste arii, au fost făcute recomandări în
literatura de specialitate, terapeuţii fiind informaţi despre aceste potenţiale probleme şi
sprijiniţi în practicarea psihoterapiei în mod etic. Cu toate acestea, înţelegerea
perspectivelor clientului asupra factorilor care reduc eficienţa intervenţiilor religioase în
terapie ar oferi informaţii importante pentru practicieni.
O largă varietate de intervenţii care pot fi considerate de natură religioasă au fost
promovate în literatură, inclusiv rugăciunea împreună cu clienţii, discuţiile pe baza
textelor sacre, includerea resurselor disponibile în cadrul comunităţilor religioase,
2
angajarea în meditaţie spirituală sau în ritualuri religioase şi încurajarea
comportamentelor morale, precum iertarea (Richards & Bergin, 2005). Deşi terapeuţii pot
aborda în mod diferit felul cum integrează aceste tipuri de intervenţii în terapie (de ex.
Worthington, 1986), ele s-au dovedit a fi eficiente într-o varietate de cadre şi s-au dovedit
a augmenta eficienţa terapiei (Smith et al., in press). Intervenţiile religioase au fost
integrate cu succes în tratamente tradiţionale seculare, cum ar fi terapia cognitiv-
comportamentală (Nielsen, Johnson & Ridley, 2000; Propst, Ostrom, Watkins, Dean &
Mashburn, 1992), psihoanaliză (Rizzuto, 1996), terapia transpersonală (Vaughan, Wittine
& Walsh, 1996) şi terapia maritală (Sperry & Giblin, 1996). Cu toate acestea, în
momentul de faţă avem puţine cunoştinţe legate de care intervenţii sunt cele mai eficiente
sau de motivele pentru care acestea sunt eficiente în cazul clienţilor foarte religioşi.
Utilizarea intervenţiilor religoase de către psihoterapeuţi, aşa cum a fost raportată
de către clienţi, a fost investigată într-o serie de studii de specialitate (Ball & Goodyear,
1991; Jones, Watson & Wolfram, 1992; Moon, Willis, Bailey & Kwashny, 1993;
Richards & Potts, 1995; Worthington et al., 1988). Totuşi, cele mai multe cercetări
disponibile la ora actuală evaluează utilizarea intervenţiilor religioase din perspectiva
clinicienilor. Cu toate că două studii anterioare oferă date privind preocupările de natură
religioasă ale clienţilor (Johnson & Hayes, 2003; Rose, Westefeld & Ansley, 2001), iar
un alt studiu evaluează opiniile clienţilor privitoare la utilitatea intervenţiilor religioase
(Worthington et al., 1988), nu am reuşit să identificăm nici un studiu bazat pe
experienţele propriu-zise ale clienţilor şi pe opiniile lor privind adecvarea şi utilitatea
acestor intervenţii în tratamentul lor curent. Acest tip de informaţii ar putea fi esenţiale
pentru a ajuta terapeuţii să optimizeze felul în care integrează intervenţiile religioase în
psihoterapie. Prin urmare, studiul de faţă a încercat să răspundă la următoarele întrebări:
Care dintre intervenţiile religioase sunt percepute de către clienţii foarte religioşi ca fiind
cele mai adecvate? Care dintre aceste intervenţii sunt percepute ca cele mai utile? Care
sunt motivele pentru care clienţii foarte religioşi percep intervenţiile religioase ca
eficiente/ineficiente?
Metode
Participanţi
Eşantionul pe care s-a desfăşurat acest studiu a fost format din 152 de studenţi,
care au utilizat serviciile centrului de consiliere al unei mari universităţi private,
sponsorizate de Biserica lui Iisus Hristos a Zilei Tuturor Sfinţilor (Church of Jesus Christ
of Latter-Day Saints – LDS). 56 de participanţi (37%) au fost bărbaţi şi 96 (63%) au fost
femei, toţi având vârste cuprinse între 18 şi 37 de ani, în felul următor: 62 de participanţi
(41%) au avut între 18 şi 21 de ani, 71 dintre ei (47%) au avut între 22 şi 25 de ani, iar 19
participanţi (12%) au avut între 26 şi 37 de ani. Toţi clienţi care au participat la acest
studiu, la fel ca toţi terapeuţii de la centrul de consiliere, au fost membri ai Bisericii Zilei
Tuturor Sfinţilor (ZTS). Participanţii au raportat rezidenţă permanentă în mai multe state,
dar cele mai des declarate au fost Utah (19%), California (12%) şi Idaho (5%); 10
participanţi au fost din afara graniţelor Statelor Unite ale Americii (7%).
Centrul de consiliere oferă servicii proshologice gratuite pentru studenţii la zi ai
universităţii. Nu există o limită a numărului de şedinţe de consiliere la care pot lua parte,
3
iar în acest studiu, 63 dintre clienţi (41%) au participat la 1-4 şedinţe, 31 de clienţi (20%)
au participat la 5-9 şedinţe, iar 58 de clienţi (38%) au participat la 10 sau mai multe
şedinţe de consiliere. La centrul de consiliere sunt angajaţi 27 de psihologi licenţiaţi, 2
terapeuţi specilizaţi pe probleme maritale şi de cuplu, 4 psihologi cu studii postdoctorale,
4 psihologi urmând studii predoctorale şi fac practică cu jumătate de normă (part-time)
20 de studenţi la psihologie. Acest centru oferă servicii de sănătate mentală concordante
cu cele ale altor centre de consiliere din Statele Unite şi include un program de practică
acreditat de APA. Intervenţiile religioase nu se numără printre practicile standard, însă¸
datorită faptului că centrul de consiliere deserveşte preponderent clienţi aparţinând
Bisericii ZTS, o parte dintre terapeuţii de aici folosesc ocazional acest tip de intervenţii
pe durata tratamentului.
Nu au fost stabilite restricţii cu privire la diagnosticul clienţilor. Problemele
pentru care aceştia au iniţiat terapia au variat în eşantionul folosit, în felul următor: 53 de
clienţi (35%) au raportat depresie, 20 (13%) au venit la centru pentru probleme de
anxietate, alţi 20 (13%) pentru probleme în relaţia de cuplu, iar restul de 59 de clienţi
(39%) au raportat o varietate de probleme, printre care se numără disfuncţii alimentare,
tulburare compulsiv-obsesivă, schizofrenie, preocupări de natură sexuală şi dificultăţi
legate de etapa de vârstă. Antecendente legate de traume sau abuzuri au fost raportate de
9 clienţi (6%). Probleme de natură spirituală sau religioasă nu au fost raportate de nici
unul dintre clienţi ca fiind o problemă primară.
Procedură
Instrument
4
întregii mele vieţi. S-a dovedit că această întrebare corelează pozitiv (0.84) cu un factor
pro-religios intrinsec, derivat dintr-o scală cu itemi multipli (Gorsuch, 1972); această
corelaţie are aproximativ aceeaşi valoare ca mediana intercorelaţiei itemilor ce măsoară
religiozitatea (0.76) (Gorsuch, 1984). Scorul mediu obţinut la itemul care evaluează
religiozitatea a fost de 8.2 (SD = 1.4), pe o scală cu 9 trepte, fapt ce indică un nivel foarte
ridicat de religiozitate raportat de eşantionul folosit, aşa cum s-a preconizat (Richards,
1994). Deşi 12 participanţi (8%) au avut scoruri mai mici de 7 pe scala cu 9 trepte
(indicând un nivel personal al devoţiunii religioase mai redus decât nivelele cele mai
înalte), aceşti participanţi nu au fost excluşi din analiză deoarece am considerat că (a)
nivele foarte înalte ale religiozităţii ar fi relevante, dar nu sunt absolut necesare pentru
integrarea intervenţiei religioase în terapie; (b) variaţia interpersonală la nivel devoţiunii
apare între membrii oricărui grup; şi (c) a fost important să reprezentăm experienţele
tuturor clienţilor care au completat chestionarul.
Pe a doua pagină a chestionarului, clienţii au notat dacă cele 18 intervenţii
religioase au fost utilizate de către terapeuţii lor în cadrul terapiei. Lista a fost creată de
Richards şi Potts (1995), care au elaborat lista şi definiţiile intervenţiilor religioase dintr-
o listă de răspunsuri adunate de Ball şi Goodyear (1991). Deşi intervenţiile religioase
evaluate în studiul curent nu sunt o listă exhaustivă a tuturor celor care ar putea fi
încorporate în psihoterapie, lista prezintă cele mai comune intervenţii implementate şi
procedura ne permite compararea cu cercetările anterioare care vizau opiniile
terapeuţilor. Richards şi Potts au divizat cele 18 intervenţii în două categorii de
intervenţii: 9 în cadrul sesiunii de terapie şi 9 în afara sesiunii (de terapie), pe baza celei
mai probabile locaţii pentru intervenţie. Chestionar nostru oferă definiţii pentru fiecare
intervenţie, pentru ca participanţii să înţeleagă corect sensul terminologiei.
A treia pagină a chestionarului a interogat respondenţii cu privire la utilitatea
oricăreia dintre cele 18 intervenţii religioase, pe care le-au identificat ca fiind utilizate de
terapeutul lor. Intervenţiile au fost evaluate pe o scală de tip Likert cu 6 trepte (0 = foarte
inutil, 1 = moderat de inutil, 2 = oarecum inutil, 3 = oarecum util, 4 = moderat de util,
5 = foarte util). În mod similar, a patra pagină a chestionarului a cerut respondenţilor să
indice pe o scală Likert cu 6 trepte, în ce măsură au considerat ca fiind potrivit/adecvat ca
terapeutul lor să utilizeze fiecare dintre cele 18 intervenţii religioase prezentate. (0 =
foarte neadecvat, 1 = moderat de neadecvat, 2 = oarecum neadecvat, 3 = oarecum
adecvat, 4 = moderat de adecvat, şi 5 = foarte adecvat).
Pe a cincea pagină, respondenţilor li s-a cerut să-şi amintească dacă intervenţiile
religioase au fost în mod particular eficiente în ajutorarea procesului de
creştere/dezvoltare şi schimbare şi să scrie pe scurt despre experienţele lor. A şasea
pagină a fost identică, cu excepţia faptului că respondenţilor li s-a cerut să noteze când
intervenţia religioasă nu a fost eficientă.
Răspunsurile scrise ale participanţilor la întrebările cu sfârşit deschis (open-ended
questions) de pe ultimele două pagini au fost analizate folosind metode prestabilite pentru
analiza de conţinut (Denzin & Lincoln, 2002). Răspunsurile oferite de participanţi au fost
mai întâi dactilografiate şi apoi citite în întregime de mai multe ori pentru a obţine o
înţelegere deplină a conţinutului acestora. Ulterior, au fost identificate şi evidenţiate
sintagmele semnificative din răspunsuri. Pe urmă, a fost realizată o categorizare a
conţinutului prin citirea iniţială a răspunsului şi generarea unei definiţii şi al unui nume
pentru categorii preliminare care să reflecte modul de înţelegere al participantului.
5
Răspunsul ficărui participant a fost citit şi adăugat într-o categorie sau a fost pus într-o
categorie nouă. Acest proces de sortare a fost continuat până când fiecare răspuns a fost
pus într-o categorie. Fiecare categorie a primit apoi un titlu şi o descriere. Procesul de
categorizare a fost repetat, însă, de acestă dată, a fost ghidat de titlurile şi definiţiile
stabilite. Deşi rezultatele au fost similare, câţiva dintre respondenţi au fost plasaţi în
categorii diferite pe baza definiţiilor şi titlurilor care au fost identificate. Rezultatele celei
de-a doua runde de analiză au fost date unui evaluator independent, care a evaluat
dinstinctivitatea şi claritatea conceptuală a categoriilor, a examinat răspunsurile
participanţilor pentru a detecta eventuale semnificaţii adiţionale, care nu au fost incluse în
anumite categorii şi a verificat acurateţea globală a codificării. Evaluatorii au rezolvat
discrepanţele la nivel de codificare prin revizuirea transcrierilor până la stabilirea unui
acord.
Tabel 1
Mediile şi abaterile standard ale corelaţiilor între evaluările adecvării şi utilităţii intervenţiilor religioase
Notă: Cei 146 de participanţi au oferit evaluări privind adecvarea (6 au avut date lipsă), dar doar clienţii
care au experienţiat o anumită intervenţie au oferit evaluări ale utilităţii pentru acea intervenţie. Evaluările
mai ridicate au indicat o aprobare/susţinere mai mare.
Rezultate
Adecvare raportată
6
Mediile şi abaterile standard ale evaluărilor făcute de clienţi, privind adecvarea
celor 18 intervenţii sunt prezentate în tabelul 1. Intervenţiile din timpul sesiunii, care au
fost considerate ca fiind cele mai adecvate de către respondenţi au fost: referirile la
scriptură, rugăciunea privată a terapeutului şi predarea conceptelor religioase/spirituale.
Intervenţiile din afara sesiunii care au fost considerate mai adecvate sunt: încurajarea
iertării, facilitarea tratamentului prin consultarea comunităţii religioase şi încurajarea
rugăciunii private a clientului. Binecuvântarea dată de terapeut (prin punerea mâinilor) şi
rugăciunile client-terapeut au fost intervenţiile considerate ca fiind cele mai neadecvate.
Intervenţia din afara sesiunii care a fost evaluată ca fiind cea mai neadecvată a fost
memorarea Scripturii. Per total, evaluările clienţilor cu privire la adecvarea intervenţiilor
din afara sesiunii (M=33.7) au fost semnificativ mai mari t (144) = 10.4, p< .01, Cohen
d=.65, decât evaluările intervenţiilor din timpul sesiunii, (M=28.3).
Utilitate raportată
7
preotului sau a liderului ecleziastic; şi a fost o relaţie inversă între utilitatea percepută şi
evaluarea adecvării printre clienţii care au primit recomandarea de a confesa păcatele
unui preot. Prin urmare, clienţii care credeau că practica confesiunii este potrivită au avut
tendinţa să considere această intervenţie ca fiind inutilă.
Tabel 2
Categorii calitative de motive pentru care clienţii au perceput intervenţiile spirituale ca fiind eficiente şi
ineficiente
Eficace (n = 78)
Insight sporit ; percepţii restructurate (47%)
Confort personal sporit, prin împărtăşirea de valori similare cu terapeutul (19%)
Recunoaştere mai bună a influenţelor/realităţilor spirituale (12%)
Sentiment mai accentuat de empatie/conexiune cu terapeutul (8%)
Credibilitate crescută a terapiei pentru clienţi iniţial sceptici (8%)
Adresare către “sinele întreg” al clientului (6%)
Ineficace (n = 37)
Aplicarea inefiecientă a intervenţiei spirituale (32%)
Sporirea sentimentelor de anxietate şi vină (27%)
Rol neadecvat al terapeutului de a se comporta ca un lider ecleziastic (22%)
Neadecvarea includerii intervenţiilor religioase în psihoterapie (19%)
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Insight sporit; percepţii restructurate. De departe cel mai comun motiv citat de
către clienţi, pentru care intervenţiile religioase au fost eficiente în cazul lor, a implicat un
insight sporit sau reformarea percepţiilor. Abordarea problemelor dintr-un punct de
vedere religios a oferit clienţilor noi modalităţi în care să-şi înţeleagă şi interpreteze
starea.
Terapeutul meu mi-a prezentat un citat despre vrednicia sufletelor şi mi l-a explicat în aşa fel
încât să realizez că Dumnezeu mă iubeşte necondiţionat, chiar dacă sufăr de depresie, nu mă duc la
cursuri întotdeauna etc. Acel citat şi acel gând au fost foarte folositoare pentru mine şi mi l-am repetat
de câteva ori de atunci. Presupun că e un simplu gând, dar chiar îmi dă speranţă şi încurajare.
Terapeutul meu m-a întrebat cât de importantă e religia mea pentru mine. Pentru că e centrul
vieţii mele, mi-am dat seama că trebuia să fac nişte schimbări care să-mi schimbe viitorul în bine.
Indiferent de tehnicile specifice pe care terapeutul le-a folosit (de ex. învăţături
despre doctrină/scriptură, confruntarea părerilor, întrebări), beneficiul general perceput a
fost acela că clienţii au dobândit o nouă perspectivă/conştientizare cu privire la ei înşişi
sau la problemele lor, ceea ce le-a facilitat progresul.
Nu am nici o problemă cu faptul că terapeutul meu citează pasaje din Scriptură, lideri
bisericeşti sau teme spirituale – de fapt, mă ajută să mă simt mai confortabil când discut cu el. Pot să
mă deschid mai mult, pentru că ştiu că mă înţelege la un alt nivel, dar şi pentru că nu sunt nevoit să-mi
restricţionez vocabularul sau să evit subiecte religioase, ce ar putea să-mi facă relaţia (terapeutică) mai
puţin confortabilă, cum ar fi în cazul unui terapeut laic (nereligios).
9
de care aveam atâta nevoie.” Discutarea problemelor spirituale/religioase în sesiunile de
terapie poate, de asemenea, să sporească abilitatea clientului de a trăi o conexiune
personală cu o putere superioară, care permite schimbarea în bine:
Eram destul de furios pe Dumnezeu pentru abuzurile care s-au întâmplat în viaţa mea şi,
ajutându-mă să înţeleg importanţa liberului arbitru şi faptul că Dumnezeu mă iubeşte, [terapeutul] m-a
făcut capabil să folosesc o conexiune spirituală pentru a mă vindeca, în loc să exclud acea sursă şi să
încerc să fac totul pe cont propriu.
Mai mare credibilitate a terapiei. Pentru câţiva clienţi aparent sceptici, includerea
intervenţiilor religioase a sporit percepţia pozitivă asupra terapiei în general. Aceste
intervenţii nu doar s-au adresat unor probleme specifice experienţate de client, dar au şi
avut, per ansamblu, efectul de a creşte încrederea lui în procesul terapeutic.
Din cauză că terapeutul îşi susţinea spusele cu cuvinte din Scriptură şi din cauză că m-a ajutat
să văd cum pot trăi mai deplin acele concepte în care deja credeam, am fost capabil să am încredere în
el, transferând asupra lui încrederea pe care o aveam în credinţa mea, în religie, în scripturi etc.
În terapie, consilierul meu a făcut câteva referiri la scripturi. Pentru mine, acest lucru a fost în
mod special eficient, pentru că studiez scripturile şi cred în ele şi a adăugat validare externă la ceea ce
de multe ori percep ca fiind fleacurile şi nimicurile psihologiei.
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spirituale.” Adresarea problematicii religioase a fost privită de unii clienţi ca necesară
pentru a reflecta cu acurateţe sinele lor în întregimea lui şi, deci, pentru ca experienţa lor
în cadrul psihoterapiei să fie semnificativă.
Tehnicile spirituale au fost întotdeauna eficiente pentru mine, deşi uneori, dacă îmi amintesc
de vreun citat din Biblie pe care mi l-a spus, mă simt vinovat că nu l-am respectat întocmai, prin
urmare am sentimetul de vinovăţie şi deci resimt mai multă presiune în a trebui să fiu mai perfect.
Am primit o listă de citate din Biblie referitoare la anxietate şi mi s-a spus să le citesc şi să
reflectez la ele. Îmi pare rău să spun că nu le-am citit, din lipsă de timp. Aşadar, acest lucru mi-a sporit
anxietatea, de fapt, în loc s-o reducă.
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Rol neadecvat al terapeutului de a se comporta ca un lider ecleziastic. Unii
respondenţi au exprimat ideea că includerea intervenţiilor religioase în terapie depăşeşte
limitele şi încalcă atribuţiile de rol între responsabilităţile profesionale şi cele ecleziastice.
Clienţii care au considerat necesară o separare între rolul de terapeut şi cel de lider
bisericesc au făcut comentarii ca: “Nu mi se pare potrivit ca un consilier să-şi asume rolul unui
episcop” sau “În opinia mea, se poate vorbi despre religie, dar nu trebuie folosită aşa mult înspre a
influenţa. Asta e treaba preoţilor sau a părinţilor, dar consilierea ar trebui să rămână profesională.”
Aceşti respondenţi şi-au exprimat explicit disconfortul resimţit din rolurile contrastante
asumate de terapeut.
Terapeutul n-a adus niciodată în discuţie religia. Eu am fost cel care a iniţiat acest subiect, iar
discuţiile pe tema asta de obicei se centrau pe sentimente de obligaţie şi vină... iar el m-a ajutat să
privesc lucrurile în perspectivă (nu sunt un om rău dacă nu merg la biserică etc.), iar problematica
religioasă abordată în terapie s-a rezumat la aceste discuţii. Înafară de acestea, religia n-ar fi fost un
subiect potrivit, iar pentru mine ar fi fost chiar dăunător.
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Adecvarea intervenţiilor religioase depinde de obiectivele terapiei. 17 participanţi
au indicat că intervenţiile religioase ar trebui să fie relaţionate cu obiectivele
tratamentului. Utilizarea lor ar trebui să se potrivească valorilor clientului şi felul cum
sunt implementate ar trebui să varieze în funcţie de client: “Nu văd nimic greşit în tehnicile
religioase atâta timp cât sunt pertinente pentru progresul clientului” şi “religia e doar atât de utilă pe
cât o facem noi să fie. Trebuie să fie inclusă în terapie într-un mod adecvat fiecărui client şi în funcţie
de valoarea pe care acesta o dă tehnicilor religioase.” Aceste răspunsuri sugerează că terapeuţii
ar trebui să ajusteze utilizarea intervenţiilor religioase în funcţie de necesităţile fiecărui
client în parte.
Discuţie
Clienţii care au luat parte la acest studiu au susţinut câteva intervenţii religioase
ca fiind adecvate şi de ajutor, în cadrul terapiei la un centru de consiliere al unei
universităţi cu afiliere religioasă. Unii dintre ei şi-au exprimat dorinţa ca intervenţiile
religioase să fie mai mult integrate în tratamentul lor, dar ratele de prevalenţă raportate de
clienţi pentru intervenţii religioase specifice în acest studiu aproximează rezultatele
obţinute în cercetări anterioare, ce implicau estimările terapeuţilor (Moon et al., 1993 ;
Richards & Potts, 1995 ; Worthington et al., 1988).
Cu privire la nivelul de adecvare al intervenţiilor religioase în psihoterapie,
intervenţiile religioase din afara sesiunii terapeutice au fost considerate mai adecvate
decât cele din cadrul ei. Cu toate acestea, intervenţiile din cadrul sesiunii de terapie au
tins să fie evaluate ca mai de ajutor (helpful). Se poate ca intervenţiile din afara şedinţei
de terapie să fi fost văzute ca fiind mai puţin invazive sau mai puţin ameninţătoare decât
cele din cadrul şedinţei, care au loc în prezenţa terapeutului. Oricum, trebuie luat în
considerare faptul că intervenţiile religioase în afara şedinţei teraputice au fost utilizate
mai puţin de jumătate la fel de des precum cele din cadrul acesteia, cu doar 148 de
intervenţii utilizate în afara şedinţei terapeutice raportate, faţă de 299 raportate în cadrul
ei. Utiizarea mai puţin frecventă a intervenţiilor religioase în afara sesiunii terapeutice de
către terapeuţi ar putea avea câteva explicaţii, care ar putea fi investigate în cercetări
ulterioare, în cazul în care acest pattern se menţine şi în alte condiţii, cu alte eşantioane.
Acest eşantion de clienţi, membri ai Bisericii Zilei Tuturor Sfinţilor, a evaluat
anumite intervenţii religioase ca fiind moderat de ajutătoare (helpful) când sunt incluse în
psihoterapie. Intervenţiile care au fost evaluate ca fiind cele mai de ajutor au fost
instruirea de către terapeut în principii religioase/spirituale, deschiderea (self-disclosure)
terapeutului în legătură cu problematica religioasă/spirituală, încurajarea terapeutului
către client de a-i ierta pe ceilalţi, evaluarea religiozităţii/spiritualităţii clientului de către
terapeut şi utilizarea citatelor din Biblie. Aceste rezultate se suprapun oarecum cu acelea
obţinute de Worthington şi col. (1988), incluzând încurajarea înspre iertarea semenilor şi
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sarcini de lucru orientate spre Dumnezeu sau religie. Sunt, de asemenea, similare şi cu
percepţiile terapeuţilor (Richards & Potts, 1995), care au enumerat instruirea în concepte
religioase, utilizarea comunităţii religioase şi citatele din Scriptură ca fiind cele mai utile
ajutoare pentru clienţi. Ar trebui, de asemenea, luat în considerare faptul că în studiul de
faţă, cele mai utile intervenţii au fost şi cele evaluate de clienţi ca fiind cele mai adecvate
şi cele mai utilizate. Astfel, se pare că terapeuţii din studiul curent au utilizat în general
intervenţii care au fost percepute utile de către clienţii lor. Cu toate acestea, în anumite
cazuri, clienţii au oferit evaluări combinate (în sensul că aceeaşi intervenţie era văzută de
unii ca fiind utilă, iar de alţii ca fiind inutilă), ceea ce sugerează că alte variabile decât
intervenţia specifică ar putea fi responsabile de eficienţa percepută a acesteia. Literatura
precedentă sugerează că elemente cum ar fi variabile ce ţin de client, variabile ce ţin de
terapeut şi variabile ce ţin de proces contribuie mai mult la eficienţa unei intervenţii decât
intervenţia în sine (Bergin & Garfield, 1994).
Analiza de conţinut a întrebărilor deschise la care au răspuns clienţii din studiul
curent a extras teme centrale ale motivelor pentru care intervenţiile religioase au fost
percepute ca fiind eficace sau ineficace. Per ansamblu, aceste răspunsuri au indicat o
coincidere semnificativă între competenţa generală de consiliere şi competenţa în
utilizarea intervenţiilor religioase. De exemplu, clienţii s-au concentrat în general pe
factori ca dobândirea unei noi perspective, dobândirea atenţiei pozitive din partea
terapeutului şi adresarea necesităţilor clientului, mai degrabă decât pe intervenţiile
religioase specifice, atunci când au listat motive pentru care intervenţiile religioase ar
putea fi eficace. În mod similar, s-au concentrat în general pe factori ca “livrarea”
ineficientă atunci când au listat explicaţii pentru experienţele ineficiente legate de
intervenţiile religioase în terapie. Date fiind aceste rezultate, nu ar fi surprinzător dacă
cercetări ulterioare ar confirma faptul că efectele potenţate asociate cu intervenţiile
religioase (Smith et al., in press) se datorează factorilor generali ce influenţează relaţia
terapeutică şi expectanţele clientului, la fel de mult ca impactului intervenţiei în sine.
Ca răspuns la cele două întrebări deschise despre eficienţa şi ineficienţa
intervenţiilor religioase, clienţii din acest studiu au listat de două ori mai multe situaţii în
care intervenţiile au fost eficiente faţă de situaţii în care au fost ineficiente. Au raportat,
de asemenea, o varietate de efecte cognitive şi emoţionale pozitive care au emers din
utilizarea intervenţiilor religioase. De exemplu, câţiva clienţi au indicat că au resimţit mai
mult confort şi mai multă încredere interacţionând cu cineva care le împărtăşeşte
credinţele religioase şi valorile, o concluzie care a fost consecventă şi în cercetările
anterioare (de ex. Bergin & Jensen, 1990). În orice caz, o descoperire care nu a mai fost
în mod particular menţionată în cercetările anterioare este faptul că unii dintre clienţii din
studiul de faţă au considerat că abordarea problematicii religioase în terapie a încurajat
experienţe transcendente, cum ar fi perceperea influenţei lui Dumnezeu în viaţa lor.
Psihologii, în general, au evitat sau au minimizat experienţele care nu sunt observabile
(Bergin, 1980 ; 1991), dar decizia de a a evita experienţele transcendente s-ar putea să nu
fie justificabilă, dat fiind faptul că şi alte variabile psihologice (nereligioase) se bazează,
de asemenea, exclusiv pe percepţiile participanţilor la terapie. Cercetările ulterioare ar
putea avea de câştigat de pe urma mai bunei înţelegeri a acestor experienţe, din
perspectiva clienţilor.
Cu toate că situaţiile în care intervenţiile religioase au fost eficiente au fost
descrise mai frecvent decât situaţiile în care acestea au fost ineficiente, faptul că 37 dintre
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clienţi au raportat totuşi existenţa unor intervenţii religioase ineficiente este esenţial de a
fi luat în considerare. Convergent cu accentul plasat de Chapelle (2000) pe importanţa ca
terapeutul să nu impună valorile sale proprii, clienţii care au luat parte la acest studiu au
preferat ca terapeuţii să se lase conduşi de ei în discutarea problemelor de ordin religios.
Descrierile de către clienţi a altor aspecte de ineficienţă ale intervenţiilor religioase au
mers în paralel cu aspectele discutate anterior în literatura de specialitate, cu privire la
contextul în care se desfăşoară terapia şi la natura relaţiei terapeutice (Richards & Bergin,
2005), ca de exemplu preocupările referitoare la faptul că terapeutul îşi asumă un rol
ecleziastic sau la timpul de inserare (timing) a intervenţiilor religioase. Aceste îngrijorări
sunt în concordanţă cu constatările lui Worthington şi ale colegilor (1988), care au sesizat
că momentul de inserare (timing) a unei intervenţii este mult mai important pentru terapia
efectivă, decât numărul de intervenţii spirituale utilizate de către un terapeut. Clienţii care
au acuzat în trecut experienţe provocatoare de anxietate sau insultătoare în legătură cu
aspecte ce ţin de religie, au precizat faptul că, în cazul lor, simpla introducere a
intervenţiilor religioase dobândeşte conotaţii negative, cu precădere sentimente de
vinovăţie vizavi de propriile lor insuficienţe/inadecvări. Anumiţi clienţi cred că
psihoterapia este este un cadru nepotrivit pentru a discuta subiecte religioase, indiferent
de consideraţiile contrare. Prin urmare, intervenţiile religioase nu ar trebui privite ca un
lucru subînţeles, chiar şi în cadrul clinicilor asociate cu organizaţii religioase, necesitând
aprobarea clientului.
Uneori, clienţii percep intervenţia religioasă din cadrul psihoterapiei ca fiind
ineficientă, din cauza dificultăţilor la nivelul aplicării (comunicare deficitară). Studii
anterioare au indicat faptul că o minoritate dintre clinicieni exprimau încredere şi
competenţă privind integrarea subiectelor religioase în cadrul terapiei (Shafranske şi
Malony, 1990; Young, Cashwell, Wiggins-Frame, şi Belaire, 2002). Programele
doctorale nu abordeză adecvat subiecte religioase (Brawer, Handal, Frabicatore, Roberts,
şi Wajda Johnson, 2002; Walker şi colab. 2004), iar acestă lipsă de pregătire ar putea
determina: evitarea acestor subiecte de către terapeut, supracompensarea pentru lipsa de
pregătire printr-o preocupare excesivă pentru acest aspect sau aplicarea ineficientă a
intevenţiilor religioase în momentul în care încearcă. Ne-am alăturat altor academicieni în
recomandarea de a aborda în mod serios a aspectele privind pregătirea profesională
pentru abordarea religiei şi pentru aplicarea intervenţiilor religioase (Crook-Lyon şi
colab, 2007; Young, Cashwell şi Wiggins-Frame, 2007).
15
terapeuţii din cadre caracterizate prin diversitate denominală, unde ar fi clară necesitatea
aplicării unei abordări ecumenice. Cu toate acestea, Bergin şi Payne (1991) au afirmat că
studiul centrat pe denominare poate fi util pentru acest domeniu, iar noi îndemnăm
efectuarea unor studii comparative cu alte populaţii şi în alte cadre. Cercetările ulterioare
ar trebui să continue evaluarea perspectivei clientului cu privire la utilitatea intervenţiilor
religioase în cadrul psihoterapiei, în mod particular când clienţii, inclusiv cei 26% de
studenţi din universităţi religioase, raportează distres moderat spre extrem cauzat de
problemele religioase sau spirituale.
Utilizarea auto-rapoturilor ca metodă de colectare a datelor este o altă limită potenţială a
studiului. Nu am putut face dinstincţia între intervenţiile realizate cu adevărat şi
intervenţiile raportate, iar rezultatele sunt expuse unui bias de mono-operaţionalizare.
(Cook şi Campbell, 1979). Am eşuat în evaluarea simptomatologiei sau stării de bine a
clientului, ca funcţie a intervenţiei puse la dispoziţie. Mai mult, intervenţiile religioase nu
au fost stardardizate între terapeuţi, deci se poate să fi existat o variabilitate considerabilă
în felul în care a fost abordat fiecare tip de intervenţie pentru diversele cazuri de terapie.
În cele din urmă, din cauză că nu toţi clienţii care s-au prezentat la centrul de consiliere
au dorit să completeze chestionarul, participanţii la acest studiu se poate să fi diferit de
non-participanţi în moduri care ar fi putut biasa rezultatele (de ex., participanţii au putut
fi mai motivaţi sau mai complianţi decât non-participanţii, fapt ce poate reflecta diferenţe
implicite în ceea ce priveşte simptomele depresive sau dispoziţia de a pune în discuţie
convenţiile sociale, inclusiv normele religioase etc.)
Sumar
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necesită, de asemenea, o explorare mai amănunţită. Studierea proceselor psihoterapeutice
care examinează explicit aceste chestiuni ar putea reprezenta o direcţie viitoare pentru
eforturile de cercetare.
Bibliografie
(...)
ARTICOL TRADUS DE
Laura Belean
Ramona Monica Rad
Cristina Tacaciu
17
The Role of Religion in Therapy: Time for Psychologists to Have a Little
Faith?
Kevin S. Masters
PII: S1077-7229(10)00052-0
DOI: doi:10.1016/j.cbpra.2009.11.003
Reference: CBPRA 272
Please cite this article as: , The Role of Religion in Therapy: Time for
Psychologists to Have a Little Faith?, Cognitive and Behavioral Practice (2010),
doi:10.1016/j.cbpra.2009.11.003
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Running head: RELIGION IN PRACTICE 1
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COMMENTARY
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The Role of Religion in Therapy: Time for Psychologists to Have a Little Faith?
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Kevin S. Masters, Syracuse University
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Abstract
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The argument has been made that religious and spiritual (R/S) forms of treatment, or R/S
efficacious method of intervention when working clinically with religious patients experiencing
series describe four such interventions designed for use with patients with particular presenting
problems including serious mental illness, cancer, eating disorders, and scrupulosity. This article
offers a brief historical presentation on the growth of interest in R/S in clinical psychology and
behavioral medicine, with particular attention to the general issue of the role of values in therapy,
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RELIGION IN PRACTICE 2
and includes criticisms of integrating R/S in treatment. The difficulty of appreciating unique R/S
perspectives and their relevance for particular clients is emphasized and the question of whether
a “true” understanding of R/S beliefs necessarily leads to better health is examined. Each of the
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four therapies presented in this special series is individually analyzed, and it is clear that they
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offer sensitive and culturally relevant approaches to treating the various disorders, though areas
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of potential improvement or possible confusion are highlighted. Finally, the following are
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deemed essential if R/S-informed therapies are to impact the field and be appropriately
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introduced with clients: (a) training of future and current practitioners; (b) longitudinal research
on R/S; (c) outcome studies of R/S interventions; and 4) adequate funding for the achievement of
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these goals.
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RELIGION IN PRACTICE 3
Well-known sportswriter Mitch Albom has the current (November, 2009) New York Times
number-one nonfiction bestseller with his book Have a Little Faith (Albom, 2009). The work
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chronicles the faith experiences of two men: Albom’s rabbi from his youth and an African-
American inner-city preacher working with the homeless in Detroit. In the rabbi, we read of a
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man whose faith was a continuous lifelong journey that touched the lives not only of the
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members of his synagogue but many others in profound ways. This is symbolized at one point by
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the story of his delivery of a eulogy at the funeral of the Catholic priest whose church was next-
door to the synagogue. For the preacher, the faith journey was quite different. Heavily involved
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in illicit drug abuse, one night he feared being shot by the dealers he had robbed and so he
prayed to Jesus, promising that if his life would be spared then he would serve God with his
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remaining days. Though many have no doubt offered similar prayers in such times of duress and
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failed to follow through, this man kept the promise. His life literally changed overnight: the next
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day he began a self-imposed drug detoxification that started him down the path to a life of
ordination and religious service among the down-and-out of society. The book speaks of
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transformation, of the power of faith to change and enrich lives in both dramatic and small,
everyday ways. It poignantly notes that for the person of religious faith, all of life is conceived
and viewed through the lens of belief. In short, these individuals cannot live without it.
This has, of course, been true throughout the ages. The major world religions have
survived numerous proclamations of their imminent demise precisely because they possess
extraordinary power to change lives, to offer rebirth and renewal, new beginnings. So I find it
strange that psychology, particularly the applied area of psychology—the area that is largely
concerned with change processes—has for so long viewed religious faith as, at best, irrelevant
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RELIGION IN PRACTICE 4
and perhaps pathogenic. Social psychologist Robert Hogan stated, “Religion is the most
important social force in the history of man [sic] … But in psychology, anyone who gets
involved in or tries to talk in an analytic, careful way about religion is immediately branded a
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meathead; a mystic; an intuitive, touchy-feely sort of moron” (quoted in Bergin, 1980, p. 99).
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Fortunately this view, though perhaps still held privately, is no longer dominant in psychology.
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As demonstrated by this series, and many other special issues of prominent peer-reviewed
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scientific journals over the last decade, religion and spirituality (R/S) have become legitimate
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areas of inquiry in psychology and other behavioral sciences as well as in epidemiology and, to a
lesser extent, medicine. The Society of Behavioral Medicine has a Spirituality and Health
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Special Interest Group (SIG) whose membership total ranks 10th out of 18 SIGs. Masters (2007)
addressing R/S. This trend began in about 1980 and substantially increased in around 1990, with
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recent movement showing a greater rate of increase for articles pertaining to spirituality than
religion.
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There are many factors that likely played a role in this increased interest in R/S. As
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articles in the present series noted, religious beliefs and practices are highly prevalent in the U.S.
population. Though accurate religious service attendance figures are difficult to gather and some
reports may be overestimates (Hadaway & Marler, 2005), it is clear that for at least a significant
percentage of the population, religion is important to daily life. This widespread acceptance of
religion in the American culture has potentially important research funding implications. To
obtain support from the National Institutes of Health, it has become essential to demonstrate the
public health significance of the study. Thus, introductory sections to published articles and grant
funding proposals consistently portray the disease or health relevant behavior under study as of
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utmost importance to the health of the country, often on the basis of how pervasive it is. In this
there is no reason to believe that the percentage of Americans for whom religion is important has
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in any significant way increased in recent times. What is new, however, is the appearance of
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several large epidemiological studies and meta-analyses, some of which included appropriate
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statistical controls, demonstrating beneficial relationships between religion (typically defined as
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religious service attendance) and various indices of morbidity and mortality (e.g., Clark,
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Friedman, & Martin, 1999; Gillum & Ingram, 2006; Goldbourt, Yaari, & Medalie, 1993;
Hummer, Rogers, Nam, & Ellison, 1999; McCullough, Hoyt, Larson, Koenig, & Thoresen,
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2000; Oman, Kurata, Strawbridge, & Cohen, 2002). A behavior or phenomenon that a large
segment of the population participates in, deems important, and also affects health should draw
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understanding both behavioral pathology and its treatment. An important pioneer in this regard is
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Jerome Frank, who in his classic 1961 work Persuasion and Healing (subsequent editions
published in 1973 and 1991) noted that the therapeutic encounter takes place within a certain
cultural context that influences definitions of illness, acceptable treatments, and what it means to
be healthy. Frank was clearly ahead of his time, but the movement toward respect and
understanding of ethnic and cultural factors as they impact therapy process and outcome has
been perhaps the major accomplishment in clinical psychology in the last two decades.
Association (APA Presidential Task Force on Evidence-Based Practice, 2006) and the Council
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for Training in Evidence-Based Behavioral Practice (2009) include specific reference to patient
values and culture. Further, the Guidelines and Principles for Accreditation of Programs in
Professional Psychology (APA Commission on Accreditation, 2009) and the APA Ethical
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Principles of Psychologists and Code of Conduct (American Psychological Association, 2002)
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explicitly recognize the importance of respect and competence when it comes to religious issues
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in therapy and other applied contexts.
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The factors noted above have important implications for psychological and behavioral
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practice, but a watershed event of relevance to this discussion occurred in 1980 when Allen
values were an important and potentially helpful aspect of therapy. Not everyone agreed then and
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not everyone agrees now, but the work of Bergin and many others, particularly Larry Beutler,
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demonstrated the centrality and importance of values in therapy and behavior change. Beutler’s
work through the 1970s to 1990s established that patients tended to adopt the values of their
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specific therapists. Previously, other investigators (Murray, 1956; Truax, 1966) demonstrated
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that even Carl Rogers was not able to keep values out of therapy—that he systematically
rewarded and punished expressions on the basis of what he liked and disliked. Clearly any
encounter wherein two people come together and one has as his/her function in the relationship
value free. In fact, such an encounter will necessarily be quite the opposite, call it value
saturated. Choice of outcome goals, techniques, appropriate sequencing of events, and so forth
are all heavily influenced by values. It is in this regard that a common and significant thread runs
through the presentations found in this special series. What is different about these therapies, as
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opposed to many of their more standard counterparts, is the explicit acknowledgment of the
importance of values, particularly religious values, and the need to not only respect but actively
incorporate them in the service of therapeutic change. Weisman de Mamani and colleagues
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(2010; this issue) note that “…R/S values may bolster the effects of psychotherapy because they
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incorporate themes of gratitude, forgiveness, and empathy, which are essential in the therapeutic
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process” (p. xx). Karekla and Constantinou (2010; this issue) adapt Acceptance and Commitment
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Therapy (ACT) for use with cancer patients, in part because of the central nature of values in this
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approach and the importance it places on living in congruence with one’s values. Similarly,
Spangler (2010; this issue) notes that client values are “deliberately explored” (p. xx), again with
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the likely possibility of uncovering discrepancies between what patients purposely and
consciously value and what they are doing when engaged in eating disordered behavior. Finally,
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Huppert and Siev (2010; this issue) offer a very thoughtful and culturally sensitive approach to
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treating scrupulosity among religious individuals and note that the therapeutic process includes
helping the patient notice how symptoms of obsessive-compulsive disorder (OCD) interfere with
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other highly valued areas of life, including religious observance and family. These four
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therapeutic approaches take seriously the imperative to be not only culturally sensitive but to go
beyond this and be culturally informed, the culture in this case being distinguished by its
But do they go too far? Weisman de Mamani and colleagues (2010; this issue) note, “…
we talk to clients about the research pointing to positive links between religion and psychological
adjustment, and we engage them in a conversation about the potentially beneficial role of
religion and spirituality in their own lives as a means of coping with adversity” (p. xx). This is
exactly what Richard Sloan (Sloan & Bagiella, 2002; Sloan, Bagiella, & Powell, 1999, 2001) has
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warned behavioral medicine practitioners to avoid. Sloan posits many reasons why religion
should stay out of therapy, but principle among them are fears of coercion, violations of privacy,
the possibility of doing harm, and discrimination against individuals for whom religion is not
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important. (Note that Sloan’s written comments seem more directed toward medical practice, but
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clearly his point is that “health professionals” need to steer clear of religion when engaged in
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practice. He presented his work to the Society of Behavioral Medicine, an organization
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comprised of many psychologists. Further, therapists treating serious mental illness, eating
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disorders, cancer, and OCD would presumably be considered health professionals and thus the
therapies in this issue fall under Sloan’s indictment.) Sloan analogizes that even though it is
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known that marriage is good for mental and physical health, practitioners would not instruct an
unmarried patient to marry because this would be a violation of privacy that would overstep the
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and beliefs are private matters that are not the purview of the health care professional.
too narrow and consequently excludes much of what is essential to human health and well-being.
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Though researchers and therapists operate in a world of highly differentiated and specific
theoretical constructs, patients come as whole organisms. They “connect the dots” of their lives;
they integrate experience and find understanding and meaning in it. In fact, a major drive of
humans is the quest for wholeness, to feel an integration and consistency among their beliefs,
feelings, actions, experiences, and so forth. For religious patients, their religious beliefs often
form the point of integration, the fulcrum in the void, that brings together life experiences. To
them, mental and physical function cannot be divorced from R/S aspects of life, and therapists
that attempt to do so with these patients will find themselves distant from those they are treating.
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But Sloan’s objections deserve hearing, for in the area of religion, as in any culturally
sensitive domain, the possibilities for misunderstanding, inefficiency, and even harm are
numerous. In one instance Sloan (Sloan et al., 2001) argues that discussions of religious
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activities (e.g., suggestions to attend church) take up scarce intervention time that could be better
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spent in many other ways that have stronger empirical support for their effectiveness. Indeed, it
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seems that one of the risks of developing forms of therapy that specifically integrate religious
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perspectives might be the tendency to overemphasize the importance of religious influences.
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Therapists in the past were often accused of conforming patients’ problems to the therapists’
preferred form of treatment. The relevance of particular R/S interventions must vary according to
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the idiographic characteristics of the patient, the problem, the particular point in time, etc.
monitor their own exuberance to make sure that their therapeutic approach creates the best
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A related issue pertains to developing an understanding for how the particular client
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integrates religious concerns. Not only do different identified religious groups differ in their
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beliefs, but individuals within religious groups also show substantial heterogeneity in terms of
not only the content of their beliefs but also in the relative importance those beliefs have for their
psychological functioning. Thus, for example, knowing that someone is Catholic, Mormon,
Presbyterian, or Jewish is informative but until the therapist understands what this means for the
particular individual as applied to the current therapeutic problem, the possibility for
misunderstanding remains great. Fortunately, the therapies presented in this special section are
very alert to this issue and clearly specify that therapists must understand the unique workings of
religion for their particular clients before effective integration of religious constructs can begin.
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The writers are also sensitive to the need to sometimes include clergy in order to better
understand particular beliefs from the “official” perspective of the religious group. This can be
important for correction when patients have a misunderstanding of their religious organization’s
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views and thus are likely applying them in ways that reinforce pathology rather than health.
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However, as these therapies become more widely disseminated it will be essential that those
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training others in their application remain vigilant to emphasize the need for understanding the
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religion of the individual.
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An assumption potentially underlying the integration of R/S values into therapy that
deserves at least brief discussion is the idea that these religious values are, ipso facto, healthy.
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Thus if individuals truly understood and applied the religious precepts in the manner intended by
the authors of the faith they would experience mental health and, to the extent that mental health
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influences physiological functioning, physical health as well. I cannot say if this assumption is
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accurate. In an empirical sense this seems to be a question that can be addressed, but not
answered. The obstacles are numerous. For example, whose interpretation of the faith is the
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correct/intended interpretation and therefore the one to empirically study? What, in fact, are the
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informed statements on the basis of testable hypotheses regarding the relations between specific
religious values and particular mental health variables. In fact, Bergin (1980) declared several
such hypotheses, and data addressing them are now available. Further, there are centuries of
evidence suggesting that the principles of the world’s religions have stood the test of time, that
they offer to believers something important and beneficial for their lives. But surely any
consideration of religious values and mental health also needs to take into account the particular
culture surrounding a person who holds specific beliefs. The Bible, for example, in many places
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suggests that faithfulness to Christian morals and principles is antithetical to the social standards
accepted by the surrounding culture (in biblical terms, the world). In such instances the believer
could expect persecution, ostracism, or at least a feeling of not fitting in. Could this cause mental
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health concerns for these individuals? (I use Christianity as the example but the principle applies
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to any faith). Finally, consider the purpose of religion. I make no pretense to being a theologian
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or church historian, but it seems that the emphasis in religious teaching has historically been the
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development of faith and the ability to follow the precepts of that particular religion because
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these teaching are true, not because they are necessarily comfortable or emotionally satisfying in
one’s particular life circumstance. This is a noteworthy distinction. One might hypothesize that
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certain religious teaching could, in some circumstances, be quite comforting. For example, when
one is ill and believes that a loving God is personally comforting and controlling the events, a
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sense of peace or relaxation may follow. Alternatively, the belief that one should attempt to win
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converts to the faith may present religious individuals with a significant inner struggle in terms
of being faithful to this teaching and acting on it in daily life in addition to desiring to not be
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relationships are lost because of such actions, a new set of stressors is faced. In short, I believe it
is a mistake for psychologists to assume that religious teaching, if followed, will necessarily
bring about beneficial psychological results. After all, Jesus himself, the model for Christians
around the world, is described as a man who clearly experienced psychological distress during
his life.
Keeping these general thoughts in mind, I will now offer brief comments on each of the
Weisman de Mamani et al. challenge traditional thinking by proposing a form of treatment for
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those suffering from serious mental illness that purposely includes religious perspectives. They
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offer an excellent and informative review of the literature on previous attempts to incorporate
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religious principles into treatment and cite positive (e.g., discussions of spiritual resources,
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strivings, forgiveness, intrinsic religiosity, positive religious coping) and negative (e.g.,
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obsessive prayer or Bible reading) uses of religion. Importantly, they directly discuss the issue of
religiously themed delusions, clearly an area worthy of more research. In this regard one
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question that seems deserving of investigation is the possible influence of a religiously oriented
or informed therapist on clients’ willingness to report religious delusions. Given the episodic
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course of many serious mental illnesses, such as schizophrenia, patients have periods of greater
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and lesser understanding of their external world and interpersonal relationships. During the times
when patients are in relatively better contact with their therapist and therefore have greater
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sensitivity to interpersonal nuance and better communication, is it possible that patients could
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feel inhibited about disclosing experiences of religious delusions when talking with a religiously
Weisman de Mamani’s team (2010; this issue) notes that they have two forms of their
Exploring Your Spirituality handout. One uses overtly religious or spiritual language whereas the
other, intended for families that are not religious, focuses on existential beliefs about meaning
and purpose. A possible research question pertains to whether religious families would actually
have better outcomes with the overtly R/S treatment. In this regard I am reminded of the
somewhat surprising results from the well-known study by Propst and colleagues (Propst,
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Ostrom, Watkins, Dean, & Mashburn, 1992), found that found nonreligious therapists who used
a religious form of cognitive-behavioral therapy (CBT) with religious clients had better
outcomes than religious therapists using the same treatment. This was not predicted and so far as
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I know has never been adequately explained, but it demonstrates that when it comes to religion
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in therapy one must be open to surprises.
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Finally, case study one in this article raises a host of significant concerns that will be
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encountered by those attempting to use spiritually oriented therapy. The client presents with an
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unorthodox combination of beliefs drawn from many different traditions and streams of thought.
For some therapists, even those working within a spiritual perspective, it may be difficult to
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meaningfully operate within a client’s worldview if that view presents unusual beliefs or beliefs
that the therapist personally finds untenable. It is noteworthy that one of the therapeutic tactics in
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this case was steering the conversation away from “philosophical conjecture” and back toward
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topics that seemed more directly related to coping. A basic pragmatism is, in my opinion, good
for therapists of all stripes. But one can easily see how it might be difficult to work toward
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pragmatic ends without in some way conveying to clients that their particular beliefs are not
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being taken seriously. A therapist’s philosophical conjecture may be a client’s central belief! To
avoid the trap of getting caught up in theological or philosophical discussion that may in fact be
irrelevant to the treatment, the therapist needs sensitivity and careful judgment. I appreciate the
authors sharing this case as it highlights many challenges to be understood and met when
Religious Coping and Cancer: Proposing an Acceptance and Commitment Therapy Approach
Karekla and Constantinou introduce the idea of adapting ACT to a spiritual perspective for use
with cancer patients. They provide a concise overview of religious coping, discuss subtypes of
coping styles, and note factors that influence whether and what type of religious coping is used.
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They specifically identify mechanisms that may mediate effects of R/S for cancer patients and
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provide a detailed review of religious coping measures. In their discussion of the Functional
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Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire, they briefly address
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a key issue that should perhaps be highlighted because of its more general implications. Some,
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maybe many, measures of R/S are worded such that in order to score high on them (i.e., to be
characterized as more spiritual or religious) one must answer in what would generally be
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considered a mentally healthy way. In studies attempting to demonstrate that R/S predicts mental
health, use of these measures presents a case of confounding the predictor with the outcome. It is
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important that when investigators are interested in ascertaining relations between R/S variables
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and mental health outcomes that they carefully consider the issue of conceptual overlap between
measures. It is not enlightening for the study of R/S to demonstrate that one measure of mental
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health predicts the score on another measure of mental health. Careful construct definition and
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Another major issue that these authors highlight is the paucity of studies that assess
religious coping over time (i.e., longitudinal investigations). They note that individuals may
experience change in the quantity (more or less) of their faith or they may even change faiths. In
fact, the recent Pew report on religion in America (Pew Research Center, 2008) noted a complex
pattern of change characterizing Americans that are members of a faith tradition different from
the one they were raised in. Though there are cross-sectional studies of individuals at all ages,
there are very few studies of individuals across time. This limits progress in many ways. Not
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only does it make it difficult to discuss R/S development across the lifespan but it also makes it
exceedingly hard to determine the temporal sequence of events. Prayer is one example. There is
logical and empirical support for the following hypotheses: (a) there is a positive relationship
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between prayer and illness, and (b) there is a positive relationship between prayer and health.
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When people become ill they are likely to increase their prayer life; thus, more prayer is
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associated with worse health. But people who pray regularly may also find peace with God,
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experience relaxation, and thus more prayer could be associated with better health or disease
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prevention. These can only be teased apart if the progression over time of both prayer and health
and timely. Spangler (2010; this issue) also uses aspects of ACT in her approach to treating
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eating disorders. It is noteworthy that many of the so-called third-wave CBTs allow—even
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philosophically amenable to most R/S perspectives. It is not coincidence that two of the therapies
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Spangler, a recognized expert in CBT, provides a well-thought-out plan for integrating religious
concepts into traditional CBT for eating disorders, though ACT and other approaches are also
included. She begins by citing data demonstrating that prevalence rates for eating disorders vary
across denominations and hypothesizes that different aspects of particular religious doctrines
may influence these varying rates. She freely acknowledges from the outset that cultural and
environmental factors with no connection to religion are also potent causal mechanisms.
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Throughout the article Spangler cites many different religious concepts or practices that are
relevant to eating and potentially to the development and sustenance of eating disorders. In
general, I agree with this premise, but I register two concerns. First, she seems somewhat
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ambivalent as to whether religions promote pathogenic cognitions relative to eating disorders or
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whether these are distortions by clients of healthier messages inherent in the religious teaching.
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She states, “Several theologians from major world religious traditions similarly conceptualize the
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nature of the body as carnal, degraded, in need of discipline, and something to eventually be
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discarded… Some Christian religions regard the body as a vexation for the spirit … Moreover,
several major world religions that are based upon the Bible support anti-body conceptualizations
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by interpreting sin as entering the world through the ‘disobedient bodily appetite of a woman’”
(p. x). Is this true? Again, the reader is cautioned that I am not a theologian. Nevertheless, I did
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minor in biblical studies as an undergraduate, have degrees from universities affiliated with
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Baptist, Catholic, and Mormon traditions, and over the last 35 years have been at least a
Conservative, and Mormon churches. I have never heard a healthy religious individual, be they
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clergy, professor, or parishioner, espouse these views. There may be historical precedent for such
thoughts in centuries gone by, but I highly doubt that they have credibility or widespread
dissemination today, and I am therefore skeptical about their involvement in the etiology of
eating disorders, among religious individuals. Later in the manuscript Spangler repeats many of
these views, however, she also discusses at length how those with eating disorders distort Bible
passages to match their neurotic needs and that the cure for this is a proper understanding of
scripture. She also suggests that clients, as they make changes in therapy, should check with
clergy to determine if their beliefs about their body align with the teachings of their religious
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tradition. She states, “Typically, clients are pleasantly surprised to find that leaders in their
religious tradition endorse their new experiences and ideas of the body and its sensory capacities
as good and God-given” (p. xx). Spangler (2010; this issue) concludes by noting, “Moreover,
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clients can marshal religious beliefs or practices to support maladaptive beliefs and behaviors
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wholly unintended by the religion” (p. xx, emphasis added). On the one hand, she seems to state
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that religious beliefs, endorsed by theologians, potentially reinforce disordered thinking that
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could contribute to eating disorders, but on the other hand she notes that clients think in
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maladaptive ways never intended by the religion. Based both on my understanding of these
matters, as well as the arguments presented by Spangler, the second option seems more likely.
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My second concern, related to the first, is that I believe Spangler (2010; this issue)
overstates the potential role of religious belief and teaching in the development of eating
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disorders. Clearly this point flows from the one above, and if I am wrong there I might well be
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wrong here as well. But it seems to me that cultural ideals regarding beauty and attractiveness, as
communicated in a media-saturated world, possibly along with family dynamics and genetic
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patterning, account for the major portion of variance in the etiology of eating disorders. R/S
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beliefs, in my view, come in to play as attempts to somehow make the disordered thoughts
congruent with one’s religion, a valued aspect of life. This is, of course, an empirical question
None of my misgivings, however, regarding the role of religious factors in the etiology of
their treatment. Spangler (2010; this issue) cites evidence of the importance of R/S variables in
recovery, even for clients treated in non-spiritually-oriented therapy. Further, for exactly the
reasons cited by Spangler, I view the incorporation of healthy religious perspectives into
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treatment as a valuable strategy in helping clients appreciate that religion, properly understood,
teaches them the value of not only their life but also the gift that is their body. A particularly
poignant aspect of this treatment occurs when clients’ disappointed over how much of their time
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is consumed by their eating disorder opens the door for expanded discussion of religious values
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and better, more valued, uses of time. This section of the article is particularly worthy of note
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and, in my opinion, contains the potential for powerful intervention.
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Treating Scrupulosity in Religious Individuals Using Cognitive-Behavioral Therapy (Huppert
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& Siev, 2010; this issue)
Huppert and Siev offer a fascinating discussion of and treatment for scrupulosity in religious
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individuals, mostly focused on ultra-Orthodox Jewish patients. In the first paragraph they state,
complicated interplay between psychopathology and clinical technique on the one hand, and
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cultural sensitivity and patient values on the other” (p. xx). Indeed, when I began reading their
manuscript this thought was central. Though their focus was with ultra-Orthodox Jewish
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individuals, the issue has broad applicability across religious groups. From the perspective of
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many mental health professionals, herein lies one of the common criticisms of religion—that it
promotes an irrational fear of sinning or not being perfect that causes anxiety and associated
emotional disturbance and dysfunction. Huppert and Siev put the question squarely: “So how
does one distinguish OCD from strict, devout observance?” (p. x). I found the treatment of this
theme, which permeated the article, to be not only thoroughly thoughtful and appropriate for
scrupulosity but applicable to virtually any potential mental disorder that exists within a religious
context. I will not repeat their observations here but strongly urge the reader to review them. The
related discussion pertaining to the risk of sin was brilliant, as was their recognition of the
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potential problems of such an approach and the need to consult with clergy to determine how this
concept integrates with religious teaching. The related discussion pertaining to thought exposure
as well as the differentiation between intentional and unintentional thoughts was similarly
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important, yet probably difficult to implement with many religious clients. I am reminded of the
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scripture where Jesus instructs that to lust after a woman is to commit sin, even in the absence of
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any accompanying behavior. Many observant and devout religious individuals must struggle
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with the meaning of this passage (or similar ones from their faith) and how it might or might not
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be possible to, without violating sacred command, engage in the type of tasks demanded by an
(2010; this issue) point out that patients get so caught up in their symptomatic behavior that they,
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inadvertently, end up failing at the very religious devotion they desire. The insight that, “…
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distancing from sin has become a goal in its own right, ironically more than serving God, and
therefore tolerating acceptable risk of sin facilitates the service of God” (pp. xx) was particularly
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compelling.
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The discussion on including or consulting with clergy has broad applicability. Certainly
there is risk involved whenever a third party is included as an adjunct for therapy—and with
clergy unique perils in terms of potential misunderstanding, professional turf issues, and
philosophical conflicts are possible. The importance of resisting the temptation to “cherry pick”
more liberal, agreeable, or known clergy is consistent with the general theme of this manuscript,
i.e., that respect for clients and their faith is preeminent in treatment. These authors have a strong
and abiding conviction that it is possible to adapt the treatment approach to work within the
these authors recommend—that is, knowledge of the rules, culture, and beliefs of the applicable
religious community.
Concluding Thoughts
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Together the articles in this series represent an important step forward in the integration
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of R/S frameworks and considerations into therapy. They present particular treatment approaches
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for specific disorders, but, more importantly, they provide general frameworks to integrate R/S
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into treatment more broadly. This is perhaps their greatest contribution.
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But will those in charge of the curricula of professional training programs take notice and
implement instruction of such treatments? Rosmarin, Pargament, and Robb (2010; this issue), in
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their introduction to this special series, noted that only 13% of doctoral training programs in
North America offered a course on R/S. What is potentially even more disconcerting is the extent
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that R/S issues are (not) discussed in the context of training in cultural diversity. I do not have
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hard data on this, but my over 9 years of experience as the director of a training clinic (in a
heavily religious area of the country) and 5-plus years as a Director of Clinical Training at a
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different university in a different part of the country is that graduate students are, frankly, fearful
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of approaching R/S issues in therapy and faculty generally lack any real understanding of them.
Consequently, R/S concerns are typically acknowledged as “important” but rarely discussed
much further. There are, however, encouraging developments. For example, I understand that a
special issue of Professional Psychology: Research and Practice is in preparation that will focus
on practice issues relevant to R/S. Further, the increase in empirical studies of R/S bodes well for
greater integration of R/S into treatment. Ultimately, however, psychologists will need to
overcome their own fears and biases if they are going to adequately learn about these patients
Finally, controlled outcome research demonstrating the efficacy and effectiveness of R/S-
informed treatments is essential. In the absence of such data, training directors and faculty can
hardly be criticized for offering a lukewarm reception to their implementation. This type of work
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is necessary, difficult, and expensive. I earnestly hope that funding sources, including federal
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agencies such as the National Institutes of Health, will recognize its importance and realize the
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potential value to millions of Americans and others throughout the world. It is the culturally
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responsible thing to do.
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RELIGION IN PRACTICE 24
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Author Note
Address correspondence to Kevin S. Masters, Ph.D., Department of Psychology, 430 Huntington Hall, Syracuse
Abstract
Introducere
Studiile asupra influentei religiei asupra sanatatii fizice sugereaza faptul ca religia,
in mod uzual, dar nu intotdeauna, are un efect pozitiv. O posibila Influenta pozitiva a fost
descoperita in cercetariile care includeau subiecti de toate varstele, ambele genuri si o
varietate de religii (protestanta, catolica, iudaica, budista si musulmana). Subiectii
selecati din mai multe regiuni (America de Nord, Asia, Africa) si din mai multe grupuri
etnice, masurandu-li-se gradul de religiozitate printr-o varietate de indici (participarea
activa la biserica, activitatea de rugaciune si alte masuratori subiective).
Efectele pozitive ale experientei religioase si spirituale asupra sanatatii sunt bazate
pe asumptia ca experienta in sine este pozitiva si "sanatoasa". Bineinteles, religia si
spiritualitatea pot fi de altfel si patologice: obedienta oarba sau autoritarism, interpretarea
literala, strict extrinseca sau auto beneficiara, sau fragmentata. Intr-adevar, asemenea
comportamente religioase sau spirituale nesanatoase pot sa aibe implicatii serioase pentru
sanatatea fizica, fiind asociate cu abuzuri in copilarie si respingere, conflicte intergrupale
si violenta, si false perceptii de control, rezultand in indiferenta asupra starii medicale
(Paloutzian & Kirkpatrick, 1995). Asemenea asocieri nesanatoase pot sa apara cand
individul crede ca el sau ea poate comunica direct cu Dumnezeu cu putin sau fara
facilitare sociala(ex. "Dumnezeu mi-a spus...") sau implica o amanare, o responsabilizare,
a elementului divin (ex. Dumnezeu ma va ajuta"; Pargament, 1997).
Cercetarile care investigheaza sanatatea mentala indica un efect protector similar al
religiei. Intr-o metaanaliza a 139 de cercetari care foloseau masuratori cantitative ale
angajamentului religios, Larson et al. (1992) au descoperit ca doar 39% raportau orice
asocieri, si din acestea, 72% au fost pozitive. Masuratorile variabilei religioase in aceste
studii au inclus rugaciunea, suportul social, relatia cu Dumnezeu, participarea la
ceremoniile religioase si credintele si valorile. Gartner (1996) a rezumat literatura
existenta si a descoperit asocieri pozitive intre religiozitate/spiritualitate si starea de bine,
satisfactia maritala si functionarea psihologica generala; el a gasit asocieri negative cu
suicidul, delicventa, comportamentul criminal si abuzul de substante si alcool.
Religia a fost de asemenea asociata cu cateva forme de psihopatologie, ce includ
autoritarismul rigiditatea dogmatismul sugestibilitatea si dependenta (Gartner, 1996).
Aditional, s-au identificat forme de coping atat daunator cat si benefic, iar formele
daunatoare (nemultumire sau furie fata de Dumnzeu, clerici sau congregatie) au corelat
cu o stare de sanatate mentala proasta si disfunctionala (Pargament, 1997). Luata per
ansamblu, in literatura s-a sugerat faptul ca desi exista unele efecte dezadaptative ale
religiei asupra sanatatii mentale, frecventa depresiei sau a stimei de sine scazute sunt
uneori inevitabile in cazurile unor indivizi profund religiosi (Watters, 1992).
Research report
a r t i c l e i n f o a b s t r a c t
Article history: Objective: Previous research has uncovered relationships between religion/spirituality and
Received 18 January 2009 depressive disorders. Proposed mechanisms through which religion may impact depression
Received in revised form 11 April 2009 include decreased substance use and enhanced social support. Little investigation of these
Accepted 27 April 2009 topics has occurred with adolescent psychiatric patients, among whom depression, substance
Available online 17 May 2009
use, and social dysfunction are common.
Method: 145 subjects, aged 12–18, from two psychiatric outpatient clinics completed the Beck
Keywords: Depression Inventory-II (BDI-II), the Fetzer multidimensional survey of religion/spirituality, and
Religion
inventories of substance abuse and perceived social support. Measures were completed again six
Spirituality
months later. Longitudinal and cross-sectional relationships between depression and religion
Depression
Adolescents were examined, controlling for substance abuse and social support.
Results: Of thirteen religious/spiritual characteristics assessed, nine showed strong cross-sectional
relationships to BDI-II score. When perceived social support and substance abuse were controlled
for, forgiveness, negative religious support, loss of faith, and negative religious coping retained
significant relationships to BDI-II. In longitudinal analyses, loss of faith predicted less improvement
in depression scores over 6 months, controlling for depression at study entry.
Limitations: Self-report data, clinical sample.
Conclusions: Several aspects of religiousness/spirituality appear to relate cross-sectionally to
depressive symptoms in adolescent psychiatric patients. Findings suggest that perceived social
support and substance abuse account for some of these correlations but do not explain
relationships to negative religious coping, loss of faith, or forgiveness. Endorsing a loss of faith may
be a marker of poor prognosis among depressed youth.
© 2009 Elsevier B.V. All rights reserved.
0165-0327/$ – see front matter © 2009 Elsevier B.V. All rights reserved.
doi:10.1016/j.jad.2009.04.029
150 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157
religion in the context of health and medicine has been rapidly in relatively homogenous white American Christian samples,
increasing over the last thirty years (Koenig, 2004). Although there is no consensus on how to define or measure religion.
definitions of these terms may vary, this manuscript will use Investigators have conceptualized religiousness variously as
religion to refer to an organized system of beliefs, rituals, attendance at services, self-reported devotion, frequency of
practices, and community, oriented toward the sacred; spiri- prayer, using religion to cope with adversity, and other
tuality will refer to more personal experiences of or search for constructs. A newer literature describes the concept of
ultimate reality or the transcendent that are not necessarily “negative religious coping”, defined as “expressions of
institutionally connected (Josephson and Dell, 2004). conflict, question, and doubt regarding matters of faith, God,
Studies among adults reveal fairly consistent relationships and religious relationships” (McConnell et al., 2006) p.1470).
between level of religiousness/spirituality and depressive This body of work has found a higher rate of depression in
disorders that are significant and inverse (Koenig et al., 2001). those who feel abandoned or rejected by God or the religious
Research on this topic among adolescent subjects, however, community (Ano and Vasconcelles, 2005). Because several of
has yielded mixed findings. Dew and colleagues (Dew et al., the many constructs called “religion” correlate with mental
2008a), in a review of 21 studies on religion and depression in health outcomes, clarification of these questions will require
adolescents, reported that most described conflicting results: use of multidimensional measures.
some comparisons showed, as commonly found among Inconsistency may also relate to geographic variability
adults, that religiousness related to lower levels of depression, between studies. Concentrations of specific denominations, as
but some showed no relationship. In addition, four of the 21 well as local culture in general, may cause religion/depression
studies found religious variables (including personal impor- relationships to vary by region. Strong social cohesion seen in
tance of religion (Cotton et al., 2005) and church attendance certain religious minorities may be helpful in some contexts
(Sorenson et al., 1995)) correlated with higher levels of and more stigmatizing in others. Regional differences have
depression. proved important in previous studies examining religiosity in
Few studies on religion/depression relationships among relation to longevity (la Cour et al., 2006), delinquency (Stark
adolescents include psychiatric populations. Osman et al. et al., 1982), and suicide (Zhang and Jin, 1996).
(1996) found that moral objections to suicide, which An additional issue to consider is the inconsistent use of
referenced religious concepts, correlated negatively with multivariate analyses in religion/health studies. While most
depression in adolescent psychiatric inpatients. Cole, how- researchers account for demographics, psychosocial variables
ever, reported that, in juvenile delinquents in psychiatric such as family cohesion or social support are not uniformly
treatment, these same moral objections did not relate to controlled for (or examined as explanatory/mediating vari-
depression (Cole, 1989). Miller et al. (2002) followed a clinical ables). In studies that consider such variables as family closeness
sample of depressed children longitudinally; when religious or school stress, these constructs often weaken or eliminate
variables and depression were measured in adulthood, the zero-order correlations of religion to mental health outcomes
relationship varied by childhood depression status. This raises (Benda and Corwyn, 1997; Nooney, 2005; Stewart et al., 1999).
the possibility that early depression affects religious devel- Furthermore, previous studies have rarely considered substance
opment, determining whether or not religiousness is protec- use as a mediator, despite its consistent negative relationship to
tive against adult psychopathology. Dew and colleagues teenage religiosity (Koenig et al., 2001) and its status as a
found that in adolescent psychiatric outpatients, scores on proposed mechanism through which spirituality positively
the Beck Depression Inventory related positively to negative impacts mental health (George et al., 2002).
religious coping (perceptions of God as punishing or A major limitation of current religion/health research is
abandoning), positively to negative religious support (per- the dearth of longitudinal studies. Extrapolation of cross-
ceptions of the religious community as critical or demand- sectional correlations to longitudinal or predictive relation-
ing), and inversely to forgiveness (self-reported tendency to ships is questionable. A correlation between depressive
practice forgiveness or feel that God is forgiving) (Dew et al., symptoms and religious variables at a single point in time
2008b). may indicate any of several long-term relationships between
Population-based studies hold value due to the wide these constructs. For example, depression could cause a
generalizability of their results. However, a low case rate can temporary emergence of certain religious traits, such as
limit the ability to find correlations in a general sample. seeing God as more punitive, or the decline in other traits,
Psychiatric samples feature high rates of depressive disorders, such as religious service attendance. Alternatively, certain
as well as important covariates such as substance use, family religious tendencies could either raise or lower risk for
pathology, and social disadvantage. Therefore, clinical sam- depression. Clarification of such temporal relationships is
ples add much to research in this field. This article describes crucial to our understanding of the intersection of religion
the first study, known to the authors, of religion and and mental health.
depression in adolescent psychiatric patients, using a long-
itudinal design and accounting for psychosocial covariates. 2. Methods
Variability in findings of religion/depression research with
adolescents complicates consideration of its clinical utility. In order to address the above gaps in the religion/
Several factors likely contribute to this inconsistency. One depression literature, the following prospective study was
such factor is the diversity of definitions of religion. This carried out at two outpatient psychiatric clinics in North
complex subject has been contemplated in myriad fields such Carolina. Counties containing the two clinics are predomi-
as sociology, anthropology, theology, and psychology. Even nantly Christian and Protestant, with the largest denomina-
within medical research, which has overwhelmingly occurred tions being Southern Baptist and United Methodist.
R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157 151
Table 1
Subscales analyzed from the brief multidimensional measure of religiousness/spirituality.
Adolescent participants were asked to complete self-report to give consent, or were otherwise deemed inappropriate for
measures of depressive symptoms, substance abuse, per- the study by their treating clinician. Fifty-one potential subjects
ceived social support, and a multidimensional measure of refused participation, usually citing lack of time. One hundred
religiousness/spirituality. The same measures were adminis- forty seven subjects gave consent/assent and completed the
tered a second time approximately six months later. first data collection. Two were subsequently excluded due to
Parents/guardians provided treatment history and demo- diagnosis of mild mental retardation found on chart review.
graphics, and diagnosis made by the treating clinician was
recorded. Because of possible reliability problems with non- 3. Procedures
standardized diagnosis, chart diagnosis was used to char-
acterize the sample only. The primary aim of the study was to Following consent and assent, parents/guardians of partici-
assess the cross-sectional and longitudinal relationships pants completed a demographic/treatment history form. In a
between religious/spiritual characteristics and depression in separate room, adolescent enrollees completed four instruments:
adolescent psychiatric outpatients. We hypothesized that the Beck Depression Inventory-II (BDI-II, (Osman et al., 2004), the
negative religious coping, negative religious support, and loss Brief Multidimensional Measure of Religiousness/Spirituality
of faith would relate positively with depressive symptoms, (BMMRS, (Fetzer, 1999), the Multidimensional Scale of Perceived
while the remaining variables would relate inversely with Social Support (MSPSS, (Canty-Mitchell and Zimet, 2000), and
depression. Additionally, we hypothesized that social support the Problem Oriented Screening Instrument for Teenagers–
and substance abuse would serve as mediators between Substance Abuse Subscale (POSIT,(Knight et al., 2001). Study
religion/spirituality and depression. personnel reviewed the clinical chart to obtain the diagnosis
The study was approved by the Institutional Review documented by the subject's primary mental health care provider
Boards of Duke University Medical Center and Wake Forest as near as possible to the day of data collection. Approximately
University Health Sciences. Participants were recruited con- six months later, participants completed the measures again at
secutively from clinic schedules. Potential subjects were the clinic, by mail or by telephone interview. Subjects were
approached by their treating clinicians. If subjects were paid five dollars for participation in each data point.
interested, study staff explained the study and obtained
written informed consent from their parent or legally 4. Measures
responsible person. Subjects could be included if they were
aged 12–18, were presenting for treatment, and were able to Participants completed the Beck Depression Inventory-II
understand and complete the questionnaires. Assistance with (BDI-II, (Osman et al., 2004), a 21-item self-report scale
reading was given as needed. Those with mental retardation, (possible scores 0–63). This scale has been validated in
either reported by the treating clinician or documented in the adolescent psychiatric patients. Cronbach's alpha of the BDI-II
medical record, were excluded. in this study was 0.90. Adolescents completed the Brief
Of 267 potential subjects identified from clinic schedules, 75 Multidimensional Measure of Religiousness/Spirituality
were excluded because they were unable to understand and (BMMRS, (Fetzer, 1999), a 40-item, 14-subscale inventory
complete the questionnaire, had no available parent or guardian querying various aspects of religion and spirituality. For this
152 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157
study, 34 items comprising 14 subscales were analyzed. outliers with no appreciable change in results. All analyses
Subscales include: daily spiritual experiences, forgiveness, were performed using SAS Enterprise Guide 3.0 (Cary, NC).
private religious practices, positive religious coping, negative
religious coping, positive religious support, negative religious 6. Results
support, commitment, positive religious/spiritual history, loss
of faith, organizational religiousness, overall self-ranking, and Seventy-eight subjects (54%) were recruited from Duke
meaning. These subscales and sample items for each are University and 67 (46%) from Wake Forest University Health
presented in Table 1. Unanalyzed items include: the item “I Sciences. The 145 subjects had a mean age of 14.3 years (SD 1.8).
feel deep inner peace and harmony”, as this item could Sixty-one (42%) were female. Ethnic composition of the sample
artificially inflate correlations with depression; an item was as follows: Caucasian n = 82 (56%), African American
asking for a total number of hours spent weekly in religious n =50 (35%), and other n = 13 (9%). Fifty-two percent reported
activity, due to excessive missing data; the values/beliefs family incomes of less than $40,000/year and 12% had incomes
scale, due to poor internal reliability; the coping item “I try to over $100,000. 92% of parents/guardians reported having at
make sense of a situation and decide what to do without least a high school education.
relying on God”, due to poor correlation with either the Religious affiliations of subjects, as reported by parents/
positive or negative religious coping items, and an item guardians, were classified as Conservative Protestant (Baptist,
querying monetary donations to religious organizations, non-denominational Christian, Church of Jesus Christ of Latter
which was not felt to be age appropriate. This instrument Day Saints (LDS), and others; 71% of sample), Liberal
has been recently validated in an adolescent clinical sample Protestant (Methodist, Presbyterian, and others; 15% of
(Harris et al., 2008) and previously used in adolescent and sample), Roman Catholic (7%), other (5%), or none (5%).
adult populations (Fetzer, 1999; Knight et al., 2007; Pearce Although LDS youth could represent a unique category based
et al., 2003). Cronbach's alpha for subscales in this study on theological and social distinctions, only two subjects
ranged from 0.59 to 0.87. endorsed this preference; thus, based on shared views toward
The Problem Oriented Screening Instrument for Teen- substance use, these subjects were included in the “Con-
agers–Substance Abuse Subscale (POSIT) contains 17 items servative Protestant” category.
related to drug and alcohol use, related behaviors, and
consequences. It has been shown to be internally consistent 6.1. Illness and treatment parameters
and reliable (Knight et al., 2001). Cronbach's alpha for the
scale in this study was 0.88. Participants reported a mean substance use score of 0.8,
Social support has been theorized to mediate relationships with a median score of 0, on a possible scale of 0 to 17.
between religiousness and mental health (George et al., Reported substance use scores ranged 0–13. Due to this skew
2002). Perceived social support was measured via the Multi- in the data, scores on the POSIT were dichotomized. Thirty-
dimensional Scale of Perceived Social Support (MSPSS, two subjects (22%) scored one or greater on this inventory.
(Canty-Mitchell and Zimet, 2000; Clara et al., 2003). The The sample had a mean BDI-II of 13.5 (SD 9.6). Forty-four
MSPSS contains 12 items, and has been found reliable and subjects reported past admissions to psychiatric hospitals
valid in adolescent populations. Cronbach's alpha for the scale (31%), and 116 (81%) had used psychotropic medications.
in this study was 0.88. Seventy-two subjects (51%) endorsed having been prescribed
Demographics and treatment history were obtained from antidepressant medications. Depression (including major
the consenting parent or guardian. Demographics included depression, dysthymia, adjustment disorder with depressed
age, race/ethnicity, gender, and religious preference of the mood, and depressive disorder not otherwise specified) was
adolescent. Parents/guardians were asked to provide their diagnosed in 52 patients (38%). Other mood disorders
own highest level of education and family income. Treatment (including bipolar disorder and mood disorder not otherwise
history obtained included length and type of services used. specified) were noted in 15 patients (10%). ADHD, diagnosed
in 75 subjects (55%), was the most common diagnosis. No
5. Analysis clinical diagnosis was available for 7 subjects.
Data imputation was performed on scales if at least 80% of 6.2. Religious and social characteristics
the total items were completed, substituting the mean of the
remaining items; if less than 80% of the scale was complete, Sample means of each BMMRS subscale are presented in
the item remained missing. Imputed values represent b0.01% Table 1. Mean item scores indicate that subjects generally
of the data. endorsed having spiritual experiences on most days, often
Regression models were created with BDI-II score at time used religion to cope with problems, and participated in
1 as the dependent variable and demographic and religious/ organized religious activities once or twice per month. The
spiritual variables as predictors. Models were then controlled mean score on the MSPSS was 66.5 (SD 13.5; range 17–84).
for substance abuse and social support. Our final model This indicates that the average respondent expressed mild to
included all religious/spiritual, control, and explanatory strong perception of good social support.
variables. Due to skew in the distribution of BDI-II scores at
time 2, a change score was created using the difference 6.3. Follow-up
between BDI-II at time 1 and time 2. This change score was
modeled using linear regression and controlled for BDI-II at One hundred four subjects (72%) of the original sample
time 1. Analyses were repeated excluding five significant completed measures approximately six months following
R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157 153
Table 2
Bivariable and multivariable correlates of BDI-II score at Time 1.
Uncontrolled Controlled for gender, social support, and Religious variables compete in
analysis substance abuse⁎ single model
Independent variable β p β p β p
Site 1.47 0.3772 –
Age − 0.32 0.4795 –
Female gender 3.15 0.0599 –
Caucasian – – –
African American − 0.84 0.6353 –
Other race 4.15 0.1595 –
SES 0.79 0.2194 –
No religion − 1.91 0.5940 –
Conservative Protestant 1.33 0.4696 –
Liberal Protestant −1.06 0.6576 –
Catholic 0.74 0.8280 –
Other religion 4.20 0.3069 –
Substance abuse 6.05 0.0022 –
Social support −0.29 b .0001 –
Daily spiritual experiences − 0.35 0.0032 − 0.01 0.9157 − 0.06 0.8054
Forgiveness −1.84 b .0001 − 1.14 0.0034 − 1.18 0.0221
Private religious practices − 0.12 0.2248 0.13 0.2018 0.23 0.1228
Positive religious coping −0.60 0.0176 0.09 0.7442 −0.33 0.4956
Negative religious coping 2.00 b 0.0001 1.53 0.0006 1.14 0.0223
Positive religious support −0.98 0.0171 − 0.14 0.7268 − 0.06 0.9026
Negative religious support 1.00 0.0360 1.22 0.0045 0.59 0.1936
Commitment − 1.08 0.2521 0.73 0.4185 2.26 0.0787
Positive religious history 0.12 0.8963 − 1.62 0.0612 − 0.89 0.3806
Loss of faith 5.81 0.0006 3.73 0.0185 4.33 0.0086
Organizational religiousness − 0.71 0.0066 − 0.22 0.3941 − 0.55 0.0975
Overall self-ranking −1.41 0.0063 − 0.28 0.5791 − 0.87 0.2190
Meaning − 0.93 0.0760 0.24 0.6573 0.10 0.8789
⁎Religious variables entered into base model (gender, social support, and substance abuse).
study entry. t-tests comparing demographics and depression religious support, negative religious history, and negative
severity of completers and non-completers revealed no religious coping remained significant and could not be
significant differences between the groups. explained by social support or substance abuse. When all
religious variables were allowed to compete in the model,
6.4. Regression analyses forgiveness, negative religious coping, and loss of faith were
retained, each contributing unique variance. When gender,
Uncontrolled cross-sectional correlations with BDI-II substance abuse, and social support were added to this
scores are displayed in Table 2. Among demographic parsimonious model, forgiveness and loss of faith retained
measures, only gender showed a near-significant correlation significance, and negative religious coping became non-
with BDI-II scores. No treatment variables related to BDI-II. significant (β = 0.87, p = 0.07).
Religious characteristics which negatively correlated with Next, baseline predictors were sought of change in BDI-II
BDI-II scores included the following: daily spiritual experi- score over time, controlling for the initial BDI-II. Only loss of
ences, forgiveness, positive religious coping, positive religious faith predicted change in depression, such that endorsing a
support, loss of faith, organizational religiousness, and self- loss of faith at time 1 predicted less improvement in BDI-II
ranking as religious/spiritual. Negative religious coping, score six months later (β = 4.69, p = 0.007). This effect
negative religious support, and loss of faith were related persisted when controlled for gender, social support, and
positively to BDI-II, such that higher levels of these char- substance abuse.
acteristics related to greater depressive symptoms. Both To further characterize the meaning of loss of faith in this
substance abuse and perceived social support were signifi- sample, an attempt was made to correlate it with a lack of
cantly related to BDI-II score, such that greater levels of religiosity. Disagreeing with the BMMRS item “I believe in a
substance abuse and lower levels of social support correlated God who watches over me” did not relate to a loss of faith, nor
with increased depression. did endorsing “no religion.”
Multivariable results are summarized in Table 2. When
perceived social support and substance abuse measures were 7. Discussion
added to models predicting BDI-II score, daily spiritual
experiences, positive religious coping, organizational reli- We hypothesized that negative religious coping, negative
giousness, and self-ranking became non-significant (implying religious support, and loss of faith would relate positively to
that social support and substance abuse explained these depressive symptoms, while other aspects of religiousness/
relationships with depression). Only forgiveness, negative spirituality would relate negatively to depression. We expected
154 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157
this relationship to be apparent cross-sectionally and long- PTSD (Fontana and Rosenheck, 2004), and a longitudinal
itudinally. Our secondary hypothesis stated that social support survey which found that a decrease in religiosity predicted
and substance abuse would mediate or explain the observed conduct problems equaling or exceeding the conduct pro-
relationships between religion/spirituality and depression. blems of those who were never religious at all (Peek et al.,
The primary hypothesis was partially confirmed. Nine of 1985).
13 religious subscales related significantly to BDI-II score in It is possible that adolescents completing this survey
uncontrolled analysis. Greater use of negative religious coping interpreted “loss of faith” to mean “loss of hope”. Hope-
and endorsing negative support from the religious commu- lessness is a concept highly relevant to the study of
nity correlated with higher depression scores, as did endor- depression, and has been found to relate to suicidality
sing having experienced a loss of faith. In contrast, daily (Nrugham et al., 2008). Although there was no direct measure
spiritual experiences, forgiveness, positive religious coping, of hopelessness in this study, it may be noted that loss of faith
positive religious support, organizational religiousness, and did not correlate independently with suicidality. Further
self-ranking as religious/spiritual were inversely related to investigation, likely involving qualitative methodology, will
depressive symptoms. These findings are consistent with be needed to clarify this issue.
previous research (Ano and Vasconcelles, 2005; Dew et al., The findings of this study also mirror results of several
2008b; Knight et al., 2007; Koenig et al., 2001), and argue for a studies in adolescents (Miller and Gur, 2002; Schapman and
more complex model of the religion/depression relationship; Inderbitzen-Nolan, 2002; Wright et al., 1993; Pearce et al.,
all religious beliefs and experiences are not necessarily 2003). Unlike our study, Harker found that religious atten-
related to better mental health. dance predicted lower depression scores one year later
Contrary to our hypothesis, longitudinal analysis showed among adolescent participants of the Add Health Study
that only endorsing a loss of faith predicted less improvement (Harker, 2001). This study, however, did not control for
in depressive symptoms over time. This argues against the baseline depression.
hypothesis that religious beliefs or behaviors cause or prevent As stated above, previous literature on religion and
depression, but rather correspond to concurrent level of depression among young psychiatric patients has been sparse
depression. and inconsistent. The current study provides partial replica-
In accordance with our secondary hypothesis, that sub- tion of previous results found among a sample of 117
stance abuse and social support may serve as mechanisms adolescent psychiatric outpatients (Dew et al., 2008b).
through which religiousness impacts depression, five of the Cross-sectionally related to lower scores on the BDI-II in
nine subscales initially correlating with BDI-II score became that sample, after controlling for substance use, were
non-significant when substance abuse and social support forgiveness, negative religious coping, and negative religious
were controlled. However, these two control variables failed support; in the current study, these scales, in addition to loss
to completely explain the observed relationships: four of faith, retained significant relationships to depression even
subscales — forgiveness, negative religious coping, negative controlling for potential mediators.
religious support, and loss of faith, continued to relate
significantly to BDI-II score despite control for substance 7.1. Interpretation of findings
abuse and social support. The prospective contribution of loss
of faith to the variance in BDI-II change score also retained Why might these religious variables relate to depressive
significance when controlled for these potential explanatory symptoms? Theories on how religion might impact mental
variables. Accordingly, it appears that religion and spirituality health abound (Koenig et al., 2001). The fact that five of the
may relate to adolescent depression both indirectly through nine subscales lost significance when substance abuse and
social support and substance abuse, and also directly. social support were added to the model gives us insight into
These findings are consistent with other psychiatric possible mechanisms. It has been consistently found that
research. First, as in the adult literature, several aspects of religious variables relate inversely with teenage substance
religiosity related inversely to depressive symptoms. Among abuse (Brown et al., 2001b; Heath et al., 1999; Nonnemaker
adults, similar relationships have been found cross-section- et al., 2003; Wallace et al., 2003). It is also known that
ally (Baetz et al., 2004; Hahn et al., 2004; Koenig et al., 2001), substance use relates to depression (Conway et al., 2006;
and longitudinally (Braam et al., 2004; Koenig et al., 1998). Currie et al., 2005; Goldstein et al., 2007). It is therefore likely
Also consistent is the observed association between negative that one way religion relates to depression is that those who
religious coping and higher levels of depression. This embrace religion use fewer substances, protecting them
relationship has been confirmed among adults in a recent against depression.
meta-analysis (Ano and Vasconcelles, 2005). Social support has also been found to relate to depression
The finding that baseline “loss of faith” predicted less (Buist-Bouwman et al., 2004; Dahlem et al., 1991; Denny
improvement in depressive symptoms over time is consistent et al., 2004a,b). Possible explanations of this relationship
with the idea that faith somehow protects against depression. include the theory that social support prevents or alleviates
However, loss of faith does not seem to be the same as not depression, as well as the idea that non-depressed persons
having faith, as this construct did not correlate with measures are better able to engage with others socially. Religion and
of atheism or having no religion. It may be that it is spirituality can provide social support in several ways. Church
specifically the loss rather than the absence of faith that is membership may allow teens to develop extra-familial
important. Previous literature supportive of this idea includes relationships with stable adult figures, sometimes providing
a study which found a decrease in religious faith predicted guidance and affection lacking in their own families. Church
greater use of mental health services among veterans with youth groups likely help establish healthy peer bonds. Trends
R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157 155
in contemporary American evangelical Christianity toward 2001). If it is discovered that interpersonal interactions
intense individual relationships with God, who is perceived to between the patient and his or her religious congregation
accompany the adherent throughout daily life, have been are in fact negative and stressful, discussion with parents may
observed in anthropological research (Luhrmann, 2004). A help alleviate this.
close and nourishing relationship with the Divine may
mitigate the effects of negative life experiences or other 7.3. Limitations
risks for depression. Possibly, adolescents in this study who
were not depressed were better able to connect and bond This study has several features that limit its general-
with social contacts. Alternatively, those who endorsed izability. First, subjects were all psychiatric patients. Differ-
religious connections may also tend, independently, to have ences between depressed and non-depressed psychiatric
close, supportive families and friends. patients will not necessarily generalize to non-clinical
Four subscales contributed unique variance to the BDI-II populations. Second, the data presented here are observa-
score beyond that of substance abuse and social support: lack tional and cannot prove or disprove causal relationships
of forgiveness, negative religious coping, negative religious between any of the measured variables.
support, and loss of faith. These phenomena can be under- Thirdly, both clinical sites are in the Southeast United
stood in several ways. Such feelings could precede and States, and the sample was dominated by those with
contribute to the onset of depression. Alternatively, they conservative Protestant religious affiliations; thus, results
may represent depressive symptoms — negative thoughts of may not generalize to samples from other geographic areas or
those looking at the world through the depressed lens. religious groups. Religious groups growing out of other
Cognitions about the harsh and punitive character of God may cultures as well as newer movements in American spirituality
represent a way to cope with depression; e.g., some depressed may differ vastly in emphasis and relationship to health.
subjects may understand their illness as divine retribution for Important information may be gleaned by comparing these
past sins. It is also possible that these phenomena represent results to future studies in more religiously-diverse areas.
the type of religion that emerges in someone who has Fourth, the sample size of 145 is relatively small given the
experienced depression in youth; adolescent depression may number of comparisons made; thus replication with larger
leave a scar on the personality or worldview that distorts samples is needed. Larger studies may be better able to
mainstream religious experience. Finally, these religious explore how religious variables interact to predict health
variables and depression may in truth be unrelated, but outcomes; for example, some studies find that level of
instead both related to a third variable not assessed in this religiousness interacts with denomination to predict sub-
study. stance use (Dew et al., 2008a). Larger studies will also be
Only one variable, loss of faith, related to change in better equipped to examine non-linear relationships, which
depressive symptoms prospectively. Independent of the level are sometimes found in substance abuse (Shedler and Block,
of depressive symptoms at Time 1, those endorsing a loss of 1990) and religion/health research (Brown et al., 2001a). In
faith showed less improvement over time. Thus loss of faith addition, large studies will be able to analyze important
may represent a marker of poor prognosis in treatment- subgroups such as lesbian/gay/bisexual youth.
seeking adolescents. Fifth, the substance abuse measure showed low variability
Most other religious variables correlated with depressive necessitating use of a dichotomized score; it is possible that if
symptoms cross-sectionally, but did not predict change in more variance in substance abuse could be captured, results
depression over time. This is noteworthy, in that the field to would change. However, approximately 20% of the sample
this point has often supposed causal relationships between reported some substance abuse, a figure consistent with
religion and depression. Rather, these results support the previous literature on rates of substance abuse in mental
hypothesis that such variables as lack of forgiveness, negative health care settings (Rush and Koegl, 2008). Sixth, recruit-
religious coping, and negative religious support are depres- ment for this study required the assistance of subjects'
sive symptoms. These may to some extent represent state, treatment providers; providers were approached by study
rather than trait, attributes. personnel about all identified eligible candidates and exclu-
sion criteria were explained. It is unknown if any treatment
7.2. Clinical implications provider introduced bias by encouraging or discouraging
participation based on any of our salient variables, e.g.,
Given associations with depression, religious/spiritual encouraging more religious or less depressed subjects to
characteristics may require assessment in the mental health participate.
care setting. Inquiries can be made about perceptions of the Despite these limitations, this study represents the most
relationship to the Divine and to the religious community, extensive longitudinal analysis to date of the relationship of
about inability to forgive oneself for past wrongs, and about religiousness/spirituality to depression among adolescent
loss of previously held religious faith. As these phenomena psychiatric patients, and the first such study (known to the
may represent clinical symptoms, they may be monitored authors) to investigate the possibility of mediation through
over time as such. If they represent risk factors, then they may substance abuse and social support. Future studies should
be useful in terms of prognosis. Direct intervention into attempt to replicate these findings. In addition, more
religious matters is more controversial. It is not clinically qualitative research should be done to further understand
accepted at present for therapists to attempt to reshape a the meaning and function of spiritual concepts to adolescents.
client's relationship with God, but referral to a chaplain or Such research will pave the way for more concrete clinical
pastoral counselor may be helpful and appropriate (Koenig, applications.
156 R.E. Dew et al. / Journal of Affective Disorders 120 (2010) 149–157
Role of funding source among adolescents in an urban emergency department. J. Adolesc. Health
Support for this manuscript provided by a grant from the John Templeton 40, 276–279.
Foundation, which had no further role in study design; in the collection, Hahn, C.Y., Yang, M.S., Yang, M.J., Shih, C.H., Lo, H.Y., 2004. Religious attendance
analysis and interpretation of data; in the writing of the report; and in the and depressive symptoms among community dwelling elderly in Taiwan.
decision to submit the paper for publication. Int. J. Geriatr. Psychiatry 19, 1148–1154.
Harker, K., 2001. Immigrant generation, assimilation, and adolescent psycho-
logical well-being. Soc. Forces 79, 969.
Harris, S.K., Sherritt, L.R., Holder, D.W., Kulig, J., Shrier, L.A., Knight, J.R., 2008.
Conflict of interests Reliability and validity of the brief multidimensional measure of religious-
All authors declare that they have no conflicts of interest. ness/spirituality among adolescents. J. Relig. Health 47, 438–457.
Heath, A.C., M.P., Grant, J.D., McLaughlin, T.L., Todorov, A.A., Bucholz, K.K., 1999.
Resiliency factors protecting against teenage alcohol use and smoking:
influences of religion, religious involvement and values, and ethnicity in the
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Clinical Psychology Review 24 (2004) 379 – 397
Abstract
Religion’s effects on mental health have been debated for years, yet only in the last half century have these
theories been empirically tested. While a number of mental health constructs have been linked to religion, one of
the most prevalent and debilitating mental health indices, anxiety, has been largely ignored. This paper categorizes
and critically reviews the current literature on religion and general indices of anxiety in terms of findings linking
decreased anxiety to religiosity, increased anxiety to religiosity, and those finding no relation between anxiety and
religiosity. Results from 17 studies are described and synthesized. Conceptual and methodological weaknesses that
potentially threaten the validity and generalizability of the findings are discussed. Finally, conclusions and
directions for future research are provided.
D 2004 Elsevier Ltd. All rights reserved.
1. Introduction
Physicians and mental health professionals are finding growing evidence that humans’ spiritual lives
are related to physical and mental well-being (Koenig, McCullough, & Larson, 2001). Aspects of
religion have been linked to the outcomes of such physical ailments as cancer (Acklin, Brown, &
Mauger, 1983), kidney disease (Baldree, Murphy, & Powers, 1982), and heart disease (Croog & Levine,
1972). Other studies have examined the relation between religion and emotional constructs such as
depression (Braam et al., 1998), well-being (Ayele, Mulligan, Gheorghiu, & Reyes-Ortiz, 1999), and
self-esteem (Commerford & Reznikoff, 1996; Sherkat & Reed, 1992).
Relatively fewer studies have examined the relation between anxiety, a pervasive and ubiquitous
index of mental health, and religion. This paper will include a summary of the research on general
0272-7358/$ - see front matter D 2004 Elsevier Ltd. All rights reserved.
doi:10.1016/j.cpr.2004.02.003
380 A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397
indices of anxiety and religion. A critical review will follow that identifies potential conceptual and
methodological problems in the studies, as will a final section of recommendations for future research in
this area. Before this review, however, the definition of religion and the history of the debate on the
relation between religion and mental health will be discussed.
Many studies have tapped into one aspect of religion such as church attendance or frequency of
prayer. Relatively few have defined religion multidimensionally or utilized a psychometrically
standardized assessment of religion. This lack of a universally accepted definition and consequently
poor or varied operationalization of the construct has led to a number of contradictory or mixed findings.
Bergin (1983) asserted that ambiguous results reflect a multidimensional phenomenon that has both
positive and negative aspects.
Krause (1993) conceptualized religion as having three major components: organizational religiosity,
subjective religiosity, and religious beliefs. Organizational religiosity involves participation in religious
institutions and is frequently related to church attendance, church membership, or that aspect of religion
embedded in a larger organizational context. Subjective religiosity is related to commitment and the level
of importance people place on religion in their personal lives. Finally, religious beliefs are the core
beliefs people have as related to their religion and man or woman’s relationship to God. Krause claims
that the religious belief dimension has historically been that most neglected in religiosity research.
Some may posit that it is impossible to define a construct as personal and abstract as religion, but
recent work by researchers is demonstrating otherwise. Measures are being developed, such as that by
the Fetzer Institute (1999), that tap into multiple aspects of religion that have been identified by leading
researchers in the field.
Researchers from various disciplines at a series of recent conferences called for a definition of religion
that captured a number of characteristics and dimensions including ‘‘feelings, thoughts, experiences and
behaviors that arise from a search for the sacred,’’ with ‘‘sacred’’ referring to a ‘‘divine being, Ultimate
Reality, or Ultimate Truth, as perceived by the individual’’ (as cited in Koenig et al., 2001). While
assessing such seemingly abstract constructs as Ultimate Reality and Ultimate Truth appears daunting, a
move to define religion according to a number of dimensions that may affect mental health would be
advantageous for future research.
The terms ‘‘religiosity’’ and ‘‘spirituality’’ are used interchangeably in much of the literature.
Religiosity is frequently associated with overt behavior. It stipulates behavioral patterns and encourages
overt religious expression (Hill et al., 2000). As such, rituals and overt practice are key elements in the
construct of religion. Religion is generally linked to formal institutions such as churches, temples, or
synagogues. Personal beliefs are also a part of religiosity, but even more so are institutional beliefs (Hill
et al., 2000). The membership in an organization implicates the person’s belief system with that which is
already established by that institution. Because religiosity is often associated with institutions, church
attendance is frequently viewed as a measure of religiosity (Lester, 1987). Church attendance is an overt
behavior that may easily be quantified and equated with religiosity. Church attendance can also serve as
a measure of social support.
In contrast to the more overt behavioral and institutional emphasis of religiosity, spirituality has more
to do with individual experience, and is generally linked to private events and transcendence (George,
Larson, Koenig, & McCullough, 2000; Hill et al., 2000; Piedmont, 1999). Spirituality is most often
A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 381
described in personal or experiential terms, including ‘‘belief’’ or ‘‘having a relationship with God or a
higher power’’ (Hill et al., 2000). Spirituality is idiographic and covert. It is a broader category of
experience than religiosity that is not restricted to institutions or religions. Thus, spirituality does not
depend upon a collective or institutional context (Pargament, 1997), but rather is an independent
experience marked by a quest for meaning and an appreciation for nature and life in general.
Unfortunately, due to a number of studies utilizing religiosity and spirituality interchangeably, one is
sometimes difficult to discriminate from the other. A number of recent studies are based on measures of
religion rather than spirituality, but these studies tend to neglect that portion of the population that
considers themselves spiritual and not religious (George et al., 2000). There are multiple similarities and
differences between religiosity and spirituality. For example, there are many overt behavioral practices
associated with religiosity such as going to church, and many covert private behaviors associated with
spirituality, such as praying or meditating.
Another body of literature has described an aspect of religiosity termed ‘‘religious coping,’’ where
one’s religion is a source through which critical life situations and stressors are dynamically processed
and understood. As a result, the person can cope and change can occur both cognitively and behaviorally
to meet the demands of the environment. The literature on religious coping and mental health is
extensive (see Pargament, 1997; Pargament, Smith, Koenig, & Perez, 1999), and interestingly, there
appear to be both positive (healthy) and negative (unhealthy) patterns of religious coping.
For the purposes of this review, the terms, ‘‘religion’’ and ‘‘religiosity’’ are defined broadly and
multidimensionally. Thus, studies are included that operationalize religion according to conceptual
aspects, such as intrinsic or extrinsic orientation, or organizational versus subjective religion. Studies that
examine one or more individual aspects of religion, such as affiliation, prayer, fundamentalism, or
church attendance, also are included.
For years, prominent mental health professionals have commented on the relation between religion
and psychopathology, based primarily on anecdotes and case studies. Freud (1953) referred to religious
rituals as obsessive–compulsive acts and portrayed the religious person as neurotic, if not delusional.
Similarly, Ellis (1980) equated religiosity with being mentally unhealthy, inflexible, and intolerant.
Watters (1992) asserted that Christian doctrine, specifically, is incompatible with many components of
both sound mental and physical health (Koenig et al., 2001).
In stark contrast to these conceptualizations, other prominent mental health professionals, including
Rogers, Maslow, and Bandura, have claimed that religion is related to a number of positive mental
health outcomes (Bergin, 1985, 1991). Jung wrote that of his many hundreds of clients, he believed that
each ‘‘fell ill because he had lost that which the living religions of every age have given to their
followers, and none of them has been really healed who did not regain his religious outlook’’ (as cited in
Koenig et al., 2001).
Since the 1950s, various conceptualizations of religion as related to other constructs have been tested
empirically, resulting in a number of mixed and contradictory findings. In a critical review of the
literature relating religion to mental health, Sanua (1969) described a number of empirical studies that
found evidence for a positive relation between religiosity and psychopathology. Stark (1971), however,
also critically reviewed studies that attempted to test this relation and found the opposite to be
overwhelmingly the case, that religion was not only negatively correlated with psychopathology, but
382 A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397
was also related to healthful outcomes. Interestingly, although both of these authors were purporting to
review the existing relevant literature relating some aspect of religiosity to mental health, the studies that
were reviewed did not overlap.
Bergin (1983) also reviewed the existing literature and found no support for the assertion that religion
is correlated with psychopathology, but also found only slight support for its relation to positive or
healthful outcomes. Bergin’s review found that sociological and psychiatric reports were more favorable
to religion while the psychological literature tended to be more negative. Thus, it appears that the history
of the debate over religion’s relation to mental health is racked with inconsistencies and contradictory
findings that may ultimately be attributed to the researchers’ biases, poor operationalization of
constructs, or both. Perhaps ‘‘overall mental health’’ is simply too broad a construct to attempt to
assess in an empirical context. Assessing religion’s relation to one both prevalent and pervasive index of
mental health that preliminary work has suggested may be related to religiosity is more pragmatic.
Anxiety, as an index of mental health, meets all of these criteria.
Although religion and its relation to a number of mental health disorders have been studied, relatively
fewer studies have addressed general indices of anxiety and their relation to religion. This lack of
research is surprising in light of studies demonstrating the reliance of many on religion as a coping
mechanism when dealing with health-related stressors (Princeton Religion Research Center, 1982), and
the opposing assertion by others that religion exacerbates rather than relieves anxiety (Ellis, 1988;
Watters, 1992). Recent work with caregivers of older adults with Alzheimer’s disease (Burgener, 1994)
found that caregiver reliance on religion was positively related to general well-being, social functioning,
and successful coping.
It is apparent that many Americans utilize some aspect of religion or integrate it into their belief
systems. When many of the same people are experiencing anxiety at some level, with symptoms that
do not necessarily meet criteria for a disorder, it seems fitting that clinicians and other health
professionals would want some clarification as to the role religion may play in the formation,
prevention, and alleviation of anxiety. The relation between religiosity and several specific anxiety
disorders, especially obsessive–compulsive disorder (Taylor, 2002; Tek & Ulug, 2001), has been
examined previously in the literature, as has religiosity and death anxiety (Clements, 1998; Swanson
& Byrd, 1998). Inclusion of all studies pertaining to general indices of anxiety, specific anxiety
disorders, and death anxiety would make integration of findings quite difficult and yield an unwieldy
document. In addition, while the literature addressing the relation between religion and specific
anxiety disorders is useful, it offers little insight into how religion may be related to anxiety in those
who do not meet diagnostic threshold for a disorder. Thus, this review will only describe studies that
assess anxiety as a broad construct that also includes such related constructs as distress, worry,
insecurity, and fear.
This paper includes a critical review of the existing research on the relation between general indices
of anxiety and religion. Studies that have examined religiosity, or the degree to which one is religious,
or some other aspect of religion as related to anxiety are included. Studies are categorized according to
whether they linked religiosity to decreased anxiety, linked it to increased anxiety, or found no
significant relation between religiosity and anxiety. After presenting and summarizing study findings,
relevant problematic methodological and conceptual issues are discussed. Finally, conclusions and
A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 383
future directions follow based on a synthesis of the research findings and relative shortcomings of the
reviewed studies.
For years, researchers have assessed religiosity in terms of overt behavioral practice. Church
attendance can easily be quantified and thus analyzed, so it is not surprising that many studies have
utilized it as a measure of religiosity. In a study that explored factors affecting anxiety, depression, and
hostility in rural women, Hertsgaard and Light (1984) administered the Multiple Affect Adjective Check
List (Zuckerman & Lubin, 1965) and a biographic and demographic questionnaire they developed to 760
randomly selected women (mean age = 44 years) living on farms in a Midwestern U.S. state. Personal
characteristics, including church attendance, were entered as predictors of anxiety in a stepwise
regression analysis. Women who attended church more than once per month scored significantly lower
on the Anxiety subscale than those who attended less often. The authors concluded that some factors,
including church attendance, minimize anxiety in rural women and that awareness of these factors can
enhance mental health service in rural areas.
In an effort to determine causal directionality between religiosity and psychological distress,
Williams, Larson, Buckler, Heckmann, and Pyle (1991) used data from participants in a longitudinal
study of mental health (Myers, Lindenthal, Pepper, & Ostrander, 1972) in New Haven, CT. Data were
available for 720 participants (mean age = 44.8) who were interviewed once in 1967 (Time 1) and then
again in 1969 (Time 2). Psychological distress was assessed with the Symptom Checklist Scale
(Gurin, Veroff, & Feld, 1960), where higher scores are indicative of less distress. In addition, two
measures of stressful life events developed for the study were used. The first measure indexed
undesirable stressful events and the second measure summed the number of physical health problems
experienced in the previous 2 years. Religious attendance was assessed with one question that asked
respondents to rate their frequency of church attendance. Participants were classified as ‘‘high
attenders’’ (who attended church once a week or more), ‘‘moderate attenders’’ (who attended once
per month to two or three times per month), and ‘‘low attenders’’ (who never attended or who only
attended a few times per year).
Regression analyses revealed religious attendance at Time 1 to be significantly positively related to
Symptom Checklist Scale scores at Time 2, and thus negatively related to psychological distress. In
addition, the authors tested whether religious attendance protected or buffered individuals from the
negative effects of stress. A regression model revealed that both the multiplicative terms for interactions
between life events and religious attendance and health problems and religious attendance were
significant. The authors concluded that religious attendance is negatively related to distress and that
religious attendance does appear to buffer the impact of stressful life events and physical health
complaints on psychological well-being.
Petersen and Roy (1985) studied the relation between anxiety and religiosity in an entirely Christian
sample (N = 318) in Memphis, TN. Church attendance was assessed with a single item that asked
respondents if they ‘‘attended Sunday worship services every week, several times a month, several times
a year, or never.’’ Anxiety was assessed utilizing a three-item scale developed by the authors. The
anxiety items were purported to assess ‘‘how often the respondent worries or feels discouraged about the
way his/her life is going and feels that life treats him/her unfairly,’’ but actual scale items were not
published. When religious variables were entered as predictors of anxiety in a multiple regression
384 A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397
analysis, church attendance proved to be the only significant predictor. The authors concluded that
church attendance is an important factor in reducing anxiety, which may be due to emotional support
offered by the church community.
While church attendance is one easily measured aspect of religiosity, some researchers have
assessed other avenues of religious participation. Williams and Cole (1968) recruited 161 under-
graduates from a state college in the South. The authors expanded Ligon’s (1965) Religious
Participation Questionnaire and devised their own Religious Participation Scale, which instructed
participants to indicate the extent of their church attendance, personal prayer, reading of religious
material, Sunday school attendance, and church-related activity. Participants were also given Maslow’s
(1952) Security–Insecurity Inventory. High scores were reported to be indicative of generalized
psychological insecurity.
For analyses, those scoring at least one standard deviation below the mean on the Religious
Participation Scale were categorized as the ‘‘low religiosity group,’’ while those scoring at least one
standard deviation above the mean constituted the ‘‘high religiosity group.’’ Those falling between .14
and +.14 standard deviations from the mean were labeled the ‘‘intermediate religiosity group.’’ Although
the high and intermediate religiosity groups did not differ significantly in indices of security, both high
and intermediate groups were significantly more secure than the low religiosity group. The authors
hypothesized that either more secure persons tend to become religious, religion facilitates security, or
religious individuals do not openly admit insecurities.
In an earlier study that explored the relation between affiliation and anxiety, Brown (1962) recruited
203 undergraduates (mean age = 22) from the University of Adelaide. Four questionnaires were
administered. Intensity of religious beliefs was assessed with Thouless’s (1935) questionnaire, and
personality measures included Eysenck’s (1958) questionnaires for neuroticism and extraversion, the
Taylor Manifest Anxiety Scale (MAS; Taylor, 1953), and items from the Minnesota Multi-Phasic
Personality Inventory (MMPI; Hathaway & McKinley, 1940). In addition, a questionnaire developed by
the author assessing a number of religious attitudes was included, and information on sex, age, and
religious affiliation was obtained. Religious affiliations included Roman Catholic, Church of England,
Methodist, Lutheran, Presbyterian, Baptist, Atheist/none, and miscellaneous. Higher manifest anxiety
scores for those with no religious affiliation were the only significant findings. There were no significant
differences in anxiety scores found among the other denominations. While this study did not find
evidence for direct positive effects of religiosity, it is notable that lack of religion in this instance was
related to higher anxiety.
Thus far, findings have been linked to church attendance and affiliation. The following study assessed
religiosity in terms of contemplative prayer, a more covert behavior. Finney and Malony (1985) recruited
nine nonpsychotic adult Christians (3 male, 6 female; mean age = 30.3) from an outpatient clinic. The
experimenters were testing whether the use of contemplative prayer as an adjunct to psychotherapy
would result in decreased anxiety and target complaint distress. Contemplative prayer was defined as
‘‘prayer that utilizes techniques of meditation as a means of relating to God in a nondemanding and
nondefensive way.’’
A set of cassette tapes providing approximately 3 hours of contemplative prayer instruction was
given to each participant. After listening to the tapes, each participant reviewed the content of the tapes
with a researcher who also presented written procedures for contemplative prayer. The researcher and
participant then prayed together in the prescribed manner. After the session, participants were instructed
to take the written procedure home and follow it carefully, spending 20 minutes per day in
A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 385
contemplative prayer. Phone contact was maintained with the participants during the following weeks to
ensure compliance.
The dependent measure used to assess anxiety was the trait anxiety scale from the Spielberger State–
Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). After 6 weeks of
psychotherapy, participants were trained in contemplative prayer and told to practice it as described
above. The STAI was administered weekly, and participants were also encouraged to keep daily records
of length of contemplative prayer sessions, rate the ‘‘greatest focus of attention,’’ and indicate whether
the participant sensed the presence of God during the session. Participants engaged in contemplative
prayer for approximately 14 weeks total.
The relation between time spent in contemplative prayer and STAI scores for each week was
examined, revealing significant composite (using all nine participants’ data) correlations for three of
the weeks. The authors concluded that their results lend modest support for their hypothesis that
contemplative prayer would be related to lower anxiety. They cautioned, however, that their results could
also mean that participants tended to engage in more contemplative prayer when they were less anxious.
A number of researchers have altered the way they conceptualize and thus operationalize religion.
Allport and Ross (1967) conceptualized religiosity as having two primary components: intrinsic and
extrinsic. Allport and Ross and later Donahue (1985) conceptualized extrinsic religiosity as being
associated with comfort and social convention and intrinsic religiosity as a framework in terms of which
all life is understood. Allport and Ross claimed that the extrinsically religious persons use their religion
while the intrinsically religious persons live their religion. Several studies have explored each
dimension’s relation to anxiety.
Baker and Gorsuch (1982) recruited 52 participants from a religious wilderness camp in southern
California. Each participant was administered the Intrinsic – Extrinsic measure of the Religious
Orientation Scale (ROS; Allport & Ross, 1967) and the Institute for Personality and Ability Testing
(IPAT) Anxiety Scale (Scheier & Cattell, 1960). Total trait anxiety was significantly negatively
correlated with intrinsic religiousness. The authors concluded that intrinsicness is associated with
‘‘the ability to integrate anxiety into everyday life in an adaptive manner.’’
In a similar study, Bergin, Masters, and Richards (1987), administered the ROS and MAS to 61
undergraduate students at Brigham Young University. A significant negative correlation was found
between the Intrinsic subscale of the ROS and the total anxiety score. The authors concluded that their study
provided moderate evidence that intrinsicness is negatively associated with manifest anxiety, but cautioned
that because 98.6% of the sample was intrinsically oriented, their findings were not very generalizable.
Sturgeon and Hamley (1979) utilized an entirely Christian sample to examine the relation between
trait and existential anxiety and intrinsic/extrinsic religiosity. Existential anxiety was defined as ‘‘a
product of despair, alienation, and emptiness that results from an individual’s inability to see meaning
in life’’ (Good & Good, 1974). The authors recruited 148 students from a conservative, Protestant-
affiliated college. Each participant was administered the ROS, the STAI, the Existential Anxiety Scale
(Good & Good, 1974), and An Inventory of Religious Belief (Brown & Lowe, 1951). Only data from
participants with the 20 highest (intrinsic group) and 20 lowest (extrinsic group) ROS scores were used
for analyses; t tests revealed the intrinsic group to be significantly less existentially anxious and
evidence less trait anxiety than the extrinsic group. The groups did not differ significantly on state
anxiety, which was expected since no stress condition was present. The authors concluded that, as
found in previous studies, intrinsic believers evidenced lower anxiety and thus appeared to be better
adjusted.
386 A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397
In a study that compared measures of worry and intrinsic/extrinsic religiosity in elderly Buddhists and
Christians, Tapanya, Nicki, and Jarusawad (1997) recruited 104 noninstitutionalized, middle-class,
healthy older adults. Half of the sample (18 males, 34 females; mean age = 73) were Christians from
Fredericton, New Brunswick, Canada, while the other half (23 males, 29 females; mean age = 69) were
Buddhists from Chiang Mai, Thailand.
Each participant was administered the Penn State Worry Questionnaire (PSWQ; Meyer, Miller,
Metzger, & Borkovec, 1990), the Age Universal I-E Scale (Gorsuch & Venable, 1983), an adaptation of
the ROS that widens its applicability to children and older adults, and were asked to keep a daily journal.
Both the PSWQ and Age Universal I-E Scale were translated into Thai, with words such as ‘‘church,’’
‘‘Bible,’’ and ‘‘God’’ modified to fit Buddhism, and then retranslated into English to ensure validity.
Participants were asked to keep their journal for 3 days, during which they recorded daily occurrences of
worrisome thoughts and their reactions to them, and rated their level of success in coping with the thoughts.
Multiple regression analyses revealed intrinsic orientation to account for a significant amount of
variance in PSWQ scores. In addition, a significant negative correlation emerged between intrinsic
orientation and worry for Buddhists. Buddhists had more extreme scores on the Age Universal I-E Scale,
and thus were both more intrinsically and extrinsically oriented to religion than Christians. Entries in
daily journals differed between groups only with respect to Buddhists worrying more about matters
related to Church/Temple than Christians. The authors concluded that intrinsic religiosity is associated
with lower levels of worry, especially for Buddhists, although this may have to do with religion playing a
greater role in Buddhist Thais’ lives in general.
In summary, the findings from the previously reviewed studies suggested that church attendance was
related to decreased anxiety for several populations. Several authors concluded that having some type of
religious affiliation was related to lower anxiety levels, and contemplative prayer was associated with
increased security and less distress. Finally, when religiosity was conceptualized as intrinsic or extrinsic,
intrinsic religiosity was related to less worry and anxiety.
While several studies found evidence for religious affiliation being linked to positive mental health
outcomes, it may be that some affiliations are more healthful than others, and that some may even prove
harmful. In Hertsgaard and Light’s (1984) study described previously, the authors explored factors
related to anxiety in 760 rural women. After administering the Multiple Affect Checklist and a
demographics questionnaire to each woman, analyses revealed that Catholic women scored significantly
higher on the Anxiety subscale of the Multiple Affect Checklist than women of other affiliations.
Spellman, Baskett, and Byrne (1971) investigated the relation between sudden religious conversion
and manifest anxiety. The authors defined religious conversion as ‘‘changing from one religion to
another or from a nonreligious state to a religious one,’’ with those who do this suddenly characterized as
‘‘sudden’’ converts. The experimenters asked two ministers to place members of a predominantly
Protestant Texas farming community into three categories. The categories comprised ‘‘the nonreligious’’
(n = 20; mean age = 38.6), ‘‘the regular attenders’’ (n = 20; mean age = 41.3), who were assumed to
represent a gradual conversion experience, and ‘‘sudden converts’’ (n = 20; mean age = 36.9). The
ministers evidenced 92% interrater agreement. All participants were given the MAS.
The MAS means for the three groups proved to be significantly different. Orthogonal comparisons
revealed a higher mean for the sudden converts than for the other two groups combined, which did not
A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 387
differ significantly. The authors concluded that their study offered tentative support for the hypothesis
that people who have had a sudden religious conversion score higher on manifest anxiety than those
without such experiences. The authors further discussed conversion as being a ‘‘pseudosolution’’ to life’s
problems since the conversion experience fails to bring a permanent reduction in anxiety.
Wilson and Miller (1968) tested whether fear and anxiety were related to religious practice in a
sample of 100 undergraduates from the University of Alabama. The participants completed a short form
of the MAS (Bendig, 1956), an unpublished measure of fearfulness, and a self-report questionnaire that
included common dimensions of religious participation and beliefs (e.g., church attendance, belief in a
supreme being, soul immortality, and religious immortality) developed by the authors. Correlational
analyses revealed religiosity to be positively correlated with both fearfulness and anxiety. The authors
concluded that there seems to be a small but reliable tendency for nonreligious persons to give
‘‘healthier’’ answers on these measures of fear and anxiety.
When religion was broken into its intrinsic and extrinsic components in the studies described earlier,
the authors concluded that intrinsic religiosity was related to less anxiety. The same authors concluded
that the opposite was true for an extrinsic orientation. Baker and Gorsuch (1982) examined the relations
between trait anxiety assessed by the IPAT Anxiety Scale and the Intrinsic–Extrinsic measure of
Religious Orientation in a sample of 52 participants. The results revealed total trait anxiety scores to be
significantly positively correlated with ‘‘extrinsicness.’’ The authors concluded that extrinsicness is
associated with the ‘‘inability to integrate anxiety into everyday life in an adaptive manner.’’
Bergin et al. (1987) had similar findings in their study examining the relation between intrinsic/extrinsic
religiosity and anxiety. Correlation analysis of ROS and MAS scores revealed a significant positive
relation between extrinsic orientation and manifest anxiety. The authors concluded that extrinsicness is
associated with anxiety, and that previous studies have found conflicting evidence for the relation between
anxiety and religion because they failed to assess religion’s intrinsic/extrinsic dimensions.
Tapanya et al. (1997) compared intrinsic/extrinsic orientation and worry levels in Buddhists and
Christians by administering the PSWQ and Age Universal I-E Scale to samples previously described.
Multiple regression analyses revealed variance in PSWQ scores to be uniquely related to a two-way
interaction between extrinsic orientation and religious affiliation. The authors interpreted this as levels of
worry being associated with extrinsic orientation in different ways for Christians and Buddhists. Indeed,
first-order correlations revealed a significant correlation between worry level and extrinsic orientation for
Buddhist participants only. The authors theorized that the Buddhist belief in the law of karma, which
implies, in contrast to Christianity, that there is no escape from the consequences of one’s actions
through redemption, might have contributed to higher levels of worry in extrinsic Buddhists.
Heintzelman and Fehr (1976) tested the relation between manifest anxiety and religiosity by adminis-
tering the Brown modification of the Thouless Test of Religious Orthodoxy (Brown, 1962; Thouless, 1935)
and the MAS to 82 undergraduate students (41 male, 41 female; mean age = 20.6) at the University of
Cincinnati. Correlation analysis revealed no significant relation between anxiety and religiosity.
In a similar study, the same authors (Fehr & Heintzelman, 1977) administered the Allport, Vernon, &
Lindzey (1970) Study of Values, the Thouless Test of Religious Orthodoxy, and the MAS to 120
undergraduates (60 male, 60 female; mean age = 19.8) at the University of Cincinnati. Again, the
relations between the two measures of religiosity and anxiety were nonsignificant. The authors did not
388 A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397
address their nonsignificant findings except to say that they were consistent with findings by Brown
(1962). They did, however, assert that using two divergent measures of religiosity as they did in their
second study does result in different profiles of the ‘‘religious’’ individual, thus lending further support
to the notion that religiosity is multidimensional and should be assessed as such.
Frenz and Carey (1989) examined the relation between intrinsic/extrinsic religiosity and trait
anxiety in a sample of 119 undergraduate students (76 female, 43 male) from a private university in
New York. Participants were administered the Intrinsic/Extrinsic Scale (Feagin, 1964), which is a 12-
item adaptation of the ROS, and the Trait version of the STAI. Participants were categorized as
‘‘intrinsic’’ (n = 12), ‘‘extrinsic’’ (n = 46), ‘‘indiscriminate’’ (n = 41), and ‘‘nonreligious’’ (n = 20),
based on Donahue’s (1985) fourfold typology for the ROS. The four religious groups did not differ
on trait anxiety, and correlations between trait anxiety and continuous scores on both ROS subscales
were also nonsignificant. The authors attributed their nonsignificant findings to their use of a more
heterogeneous sample in terms of intrinsic/extrinsic religiosity than those used in previous studies. The
authors opined that previous findings might have been distorted by a social desirability response bias
of samples recruited from religious institutions.
In a longitudinal study that tested models relating religiosity, stress, and self-esteem/mastery,
Krause and Van Tran (1989) analyzed data from 2107 people in the National Survey of Black
Americans (Neighbors, Jackson, Bowman, & Gurin, 1982). A 10-item checklist developed for the
study assessed stressful life events including health, financial, and interpersonal problems, and six
items assessing ‘‘organizational’’ and ‘‘nonorganizational’’ religiosity were used as the religiosity
measure.
A structural equation model was used to test three hypothetical models. The first was a ‘‘moderator
model,’’ which assumes that the correlation between stress and religiosity is low, and that a statistical
interaction effect exists between stress and religiosity and self-esteem. The second, a ‘‘suppressor
model,’’ assumes that the level of religious involvement is dependent on the amount of stress present in
the person’s life, and thus stress and religiosity are moderately correlated. The third was a ‘‘distress-
deterrent model,’’ which assumes that stress and religiosity are not correlated, but rather each exerts
direct, additive effects on self-esteem.
Findings revealed the distress-deterrent model had the highest goodness of fit and showed that
increases in the number of life event stressors failed to be related to either organizational or
nonorganizational/subjective religiosity. The authors concluded that their findings supported the
distress-deterrent model, with religious involvement appearing to be an important factor in maintaining
self-esteem, but that these additive effects operate independently of the amount of stress present. Thus,
religiosity and stress were unrelated.
In summary, conclusions from these studies revealed no significant relations between anxiety and
religiosity. The authors of these studies concluded that both manifest and trait anxiety appeared not to be
related to religiosity, and stress and religious involvement appeared to be unrelated.
The studies reviewed above have rendered mixed and often contradictory findings when examining
the relation between anxiety and religion. This section will address methodological and conceptual
weaknesses that may have contributed to those findings.
A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 389
subjectively categorizing citizens of a farming community into ‘‘regular attender,’’ ‘‘nonreligious,’’ and
‘‘sudden convert’’ groups. While the authors did report interrater reliability, the validity of this sampling
method is questionable due to potential biases on the part of both clergy and the experimenters in their
selection of clergy. In addition to sampling procedure problems, several studies lacked generalizability
due to homogenous sample composition.
Finney and Malony’s (1985) sample consisted of nine Christian volunteers, whereas Bergin et al.
(1987) recruited a completely Mormon sample from Brigham Young University, 98.6% of whom
were categorized as intrinsically (vs. extrinsically) religious. Similarly, Sturgeon and Hamley (1979)
used a Christian sample from a conservative, Protestant, private college. Baker and Gorsuch (1982)
recruited their sample from a religious wilderness camp. These studies used participants who were
religiously homogeneous who may have responded to self-report questionnaires in ways they thought
were socially desirable in terms of their religion.
All of the reviewed studies, with the exception of one (Tapanya et al., 1997), used Christian-
based measures of religion and consequently tapped into only Christian samples. Interestingly,
Tapanya et al. (1997) found differences in measures of anxiety and intrinsic/extrinsic religiosity
between Christian and Buddhist samples. This finding demonstrates the potential for differential
findings according to the sample’s religion. Because religiosity was a variable of interest in each of
these reviewed studies, a religiously heterogeneous sample would have been optimal to ensure
validity and generalizability to other populations.
A number of studies (e.g., Bergin et al., 1987; Brown & Lowe, 1951; Fehr & Heintzelman, 1977;
Frenz & Carey, 1989; Heintzelman & Fehr, 1976; Sturgeon & Hamley, 1979; Williams & Cole, 1968;
Wilson & Miller, 1968) used entirely young, undergraduate samples. While using samples of
convenience is common in psychological research, results from these studies were severely limited
in their generalizability to other populations.
An explanation for how particular analyses were chosen over others when analyzing similar types of data
would be beneficial for a number of the reviewed studies.
nature of religion has been espoused throughout this paper, the already well established multiple
dimensions or tripartite model of anxiety should not be ignored.
Taken together, findings from several studies (e.g., Hertsgaard & Light, 1984; Petersen & Roy, 1985)
suggest that while overt interpersonal behaviors may be linked to decreased anxiety, other more covert
and personal behaviors may be linked to increased anxiety. One study (e.g., Krause & Van Tran, 1989)
found that for older adults, there was not a relation. Other studies (e.g., Levendusky & Belfer, 1988;
Williams et al., 1991) found that religious affiliations may vary in relation to anxiety. Results from
several studies (e.g., Baker & Gorsuch, 1982; Bergin et al., 1987; Sturgeon & Hamley, 1979; Tapanya
et al., 1997) suggested that those who ‘‘live’’ their religion (e.g., intrinsic) endorse less anxiety than
those who ‘‘use’’ their religion (e.g., extrinsic). These findings are tentative, however, due to
methodological and conceptual problems that likely contributed to the contradictory findings of a
number of these and other studies that have attempted to examine the relation between religion and
mental health.
For the last half century, experimenters have been studying the relation between religiosity and mental
health. Anxiety is a debilitating and ubiquitous emotion, yet only a handful of studies has examined the
A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397 393
relation between general anxiety and religiosity. These studies yielded mixed and often contradictory
results that may be attributed to a lack of standardized measures, poor sampling procedures, failure to
control for threats to validity, limited assessment of anxiety, experimenter bias, and poor operationaliza-
tion of religious constructs. It is also likely that some religious aspects are positively related to anxiety
while others are not, and results vary according to which is assessed. No study in this review escaped
methodological and/or conceptual criticism. This leaves much work for future researchers who can
address these shortcomings in a number of ways.
Several studies failed to use a multidimensional measure of religiosity or poorly operationalized the
religious aspect they were purporting to measure. Just as with other psychological constructs such as
depression or well being, initial research has historically been informed by theory and hypotheses, and
dimensions of constructs have subsequently been identified and empirically validated through
thorough assessment. Psychometrically sound, multidimensional assessment of religion is just in its
developing stages. Future studies utilizing well-validated multidimensional measures can clarify
specifically which aspects of religiosity are linked to anxiety. The Fetzer Institute (1999) has devised
such a measure that includes multiple subscales (e.g., religious commitment, organizational religious-
ness, religious support, private religious practices, values, beliefs, forgiveness, and daily spiritual
experiences). Preliminary studies have demonstrated the measure’s promising psychometric properties.
Future work with this measure may further elucidate the nature of the relation between religiosity and
anxiety.
Physiological or behavioral assessments of anxiety were also largely absent from the literature.
Because anxiety is manifested in cognitive, physiological and behavioral response systems, this is a great
limitation. Future work can address this limitation by incorporating physiological or autonomic measures
in addition to direct observation of behavioral anxiety-related responses to supplement and further clarify
the relation between anxiety and religion.
Numerous studies have demonstrated that older adults are especially religious and tend to integrate
religiosity into their daily lives (Koenig, George, Blazer, Pritchett, & Meador, 1993; Krause & Van
Tran, 1989). Future work with older adults is promising both because religiosity is especially salient to
many in this population, and because there is growing evidence to suggest that this population taps into
some of the more positive and healthful aspects of religion. In fact, Crowther, Parker, Achenbai,.
Larimore, and Koenig (2002) propose adding a ‘‘positive spirituality’’ dimension to Rowe and Kahn’s
(1998) model of successful aging because they believe it is the missing component that addresses the
relations between older adults’ beliefs, values, community, and the efficacy of interventions focused on
successful aging.
There is also evidence to suggest that although anxiety disorders are less frequent in older adults,
subsyndromal or subthreshold anxiety is more common (Heun et al., 2000; Papassotiroopoulos & Heun,
1999). Studies that incorporate general measures of anxiety instead of standard diagnostic measures
when utilizing older adult populations may find relations between religion and anxiety that would not
and have not been detected otherwise.
In addition to using multidimensional measures, future researchers could broaden their samples in
terms of demographics and religiosity. Many studies relied solely on homogenous samples of
convenience recruited from religious, primarily Christian, institutions. Sample inclusion of nonreli-
gious or diversely religious individuals would increase generalizability of findings. In terms of
statistical analyses, studies that utilize mean difference statistics and path analyses to test buffering
and moderator hypotheses, would offer information regarding directionality not provided in most of
394 A.K. Shreve-Neiger, B.A. Edelstein / Clinical Psychology Review 24 (2004) 379–397
these studies. It would also be beneficial for future researchers to support their choices of statistical
analyses and incorporate additional methods that could supplement these traditionally correlational
studies.
Finally, while one study (Finney & Malony, 1985) attempted to examine the relation between
integration of religion into clinical treatment and efficacy of outcome, this study poorly operation-
alized and assessed the religious construct involved. The utility of integrating or simply acknowl-
edging religious aspects/practice in clinical treatment for those who are religious is worthy of future
examination. Specifically, clinicians might assess a client’s degree of religious involvement as a
standard part of an intake interview. Through continued scientific inquiry, a therapist can be
informed on how to successfully validate or discuss the role of religion in a client’s life while
maintaining objectivity. In addition, through the identification of aspects of religion that may protect
one from or increase the chances of developing anxiety, proactive or preventative treatments may be
developed. This is not a call for clinicians to practice religion in therapy or let religion influence
therapy, but rather acknowledge and discuss the role religion may play in the client’s life and
potentially in treatment. Because religion appears to be important to so many people, including it as
a variable for study in clinical settings may contribute greatly to our understanding of the interplay
between religiosity and mental health for much of the clinical population.
In conclusion, healthcare professionals are calling for increased awareness and study of religious
variables and their impact on mental and physical health. Anxiety is a prevalent and pervasive
mental health construct that has been understudied in relation to religion. Preliminary evidence
suggests that anxiety and religion are related in some ways. Empirically and conceptually sound
research addressing the anxiety–religiosity relations, with an eye to the shortcomings of previous
research, will hopefully further our understanding of the relations between religion and anxiety,.
Finally, it also may inform treatment and prevention of anxiety in a variety of populations,
especially the many for whom some aspect of religion is fundamentally important.
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Religious Factors and Values in Counseling: A Symposium 263
The topic "Religious Factors and Values or entirely ethnic; but at another he pro-
in Counseling" excites this dilemma—where claims strong positive feelings toward
does psychology end and theology begin? Judaism which he seems to claim to be the
At a comparable symposium at New York only historical religion to have successfully
Medical Center, a psychiatrist admitted resolved his prehistoric crime of father-
religious faith might be helpful in healing, murder. "It has seldom been so clear to me
but he refused to define religious faith on as now," Freud wrote, "what a psychologi-
the grounds that it was outside his pro- cal advantage it signifies to be born a
fessional competence. A professor of pas- Jew and to have been spared in one's child-
toral theology, on the other hand, was hood all the atavistic nonsense," and he
shocked when the writer made the sugges- declared, "Judaism is a triumph of spiritual-
tion that the effect of prayer be submitted ity over the senses and a self-confidence
to an objective psychological investigation. that accompanies progress in spirituality"
This, he contended, would not only be an (Freud, 1939, p. 178).
invasion of a man's religious privacy but Freud did not confine his ambivalence
an insult to God even though it should have on religious values to his Jewish heritage.
been obvious that the proposed study would Among the many letters written to his stu-
perforce be confined to prayer's effect on dent, the Swiss Christian clergyman, Oscar
man's and not on God's mind. Pfister, whom in good humor Freud calls
The dilemma does exist. It exists not be- "a true servant of God the very idea of
cause psychology and theology disagree on whose existence seems to me highly un-
the reality of religious experience as a sub- likely" we read: "In itself psychoanalysis
jective phenomenon, but because they may is neither religious nor the opposite but an
differ on the objective validity of that ex- important instrument which can serve the
perience. Even so, the relation between clergy as well as laity when it is used only
religion and psychotherapy is inextricable, to free suffering people. I have been very
certainly from their historical development stuck at realizing how I had never thought
and the theoretical point of view and in- of the extraordinary help the psychoanaly-
creasingly so from their contemporary func- tic method can be in pastoral work, prob-
tional mutuality. ably because wicked heretics like myself
are far away from that circle" (Jones, Vol.
Freud and Religion 2, 1955, p. 440). In that same letter this
Freud, himself, devoted much of his in- strictly moralistic heretic suggested that it
tellectual energies to theorizing about re- is because most people are no longer re-
ligion. To be sure, most of his speculations ligious that those among them who cannot
were about religion as an obsessional deter- endure their suffering must needs turn to
rent or unhealthy retardation of maturity. psychoanalysis to master their "obdurate
Freud did reckon with religion as a factor, instincts."
indeed, as the most profound of factors, but Freud even admired proper religious sub-
he did not recognize it as a value in psy- limation, adding, to be sure, that such re-
chotherapy. However, even on this matter ligious success will depend on the maturity
of religious values, recent anniversary of the person-to-person relationship be-
studies by Jones and others reveal Freud's tween pastor and parishioner, for Freud
own ambivalence. writes to Pfister: "You are in the fortunate
At one point Freud's pride in his own position of leading them to God and re-
Jewishness appears to be simply defensive constructing conditions of earlier times,.
264 Henry Enoch Kagan
fortunate at least in the one respect that derived in dealing with religious factors in
religious piety stifles neuroses" (Jones, Vol. counseling. The religious connotations and
2, 1955, p. 440). In discussing transference even stubborn religious convictions that
which he considered to be a "curse," Freud underlie many factors in the therapeutic
wrote to Pfister: "psychoanalysis perhaps relationship cannot be categorically denied
achieves a cure but not the necessary de- by the rigid formulas of frigid counselors
gree of independence or a guarantee nor be cavalierly circumlocuted by a con-
against relapse" and to the clergy therapist, fidant because of his own religious un-
he continued, "it is easier for you in this certainties.
respect than for us physicians because you How can the feeling of guilt in our cul-
sublimate the transference on to religion ture be completely separated from the
and ethics and that is not easy with serious- religious concepts of sin? The anxiety of
ly ill people. From the therapeutic point guilt is one of the most painful of psychic
of view I can only envy your opportunity illnesses just because its roots are deep in
of bringing about sublimation into religion. religious origins which intensify guilt. Af-
But the beauty of religion assuredly has ter a period of dark despair following a
no place in psychoanalysis" (Jones, Vol. 2, decimating persecution, there arose among
1955, p. 448). East European Jews in the eighteenth cen-
Since Freud made this statement 40 years tury a religious movement of joyful pietism
ago, has the development of dynamic psy- called Hassidism. The Hassidic Rabbis were
chology reached the point, unrelated to the concerned about the abnormal guilt which
present popular and suspect religious re- profoundly depressed the Jew, derived as
vival, where "the beauty of religion" can it was from his belief that his suffering was
take place in the psychotherapeutic pro- a punishment by God. A piquant example
cess? In the long run, Freud's critique of of their effort to normalize guilt is the
religion may prove to be more constructive Hassidic explanation of why the liturgical
than Jung's affirmations of religion which listing of sins recited on the Jewish Day
are so frequently referred to in order to of Atonement is arranged in alphabetical
bring "the beauty of religion" into therapy. order. "If it was not otherwise," these
If "any statement about the transcendent" Rabbis said, "we should not know when to
is "always only a ridiculous presumption of stop beating our breasts for there is no
the human mind which is unconscious of end to sin and no end to being aware of
its boundaries" and "God for our psychol- sin, but there is an end to the alphabet."
ogy is only a function of the unconscious,"
to quote Jung (Buber, 1952, p. 79), we Today, it is popular to accuse the psycho-
have to deal here with something, but it is therapist of relieving the person of all sense
not religion. While religion does glorify of guilt for the sake of his physical health
man for being able to communicate with and to charge the clergyman with inducing
God, it is also humble enough not to make a sense of guilt for the sake of the person's
God's existence depend upon man. The spiritual improvement. Such can only be
religious philosopher, Martin Buber, prop- the case when either party is insensitive
erly criticizes Jung for failing to make this to the distinction between normal guilt and
distinction between the religious and the neurotic guilt which can be as harmful as
pseudo-religious in which every "alleged being unable to distinguish between exis-
colloquy with the divine is only a solilo- tential anxiety and pathological anxiety.
quy" (Buber, 1952, p. 134). Into this area of guilt there can impinge
the theological concept of original sin
which does compound anxiety because it
Psychology and Religion in Guilt bears with it not only the sinfulness of sex
This sensitive distinction between the but the forfeiture of free will. Judaism does
religious and the pseudo-religious will have not ascribe man's conscious awakening to
to be made if positive values are to be sexuality as punishment for Adam's fall
Religious Factors and Values in Counseling: A Symposium 265
from grace and therefore does not believe life. Hope vanishes when the need to be-
men are predetermined by the act of birth long, the need to be loved and the need
to evil. However, regarding religious con- to believe are unmet. These three needs
cepts which do abnormalize the natural, the appear to be so closely interrelated that
observation of the Christian theologian, it ought to be investigated how the absence
Paul Tillich, is relevant. "If religion," he of belief will warp the capacity for human
says, "does not lead to or does not directly love, physical and psychic, and will abuse
support pathological self-reduction, it can companionship to conquer loneliness. As the
reduce the openness of man to reality, case histories of Mortimer Ostow show,
above all the reality which is himself. In the disavowal of religion does not cancel
this way religion can protect and feed a this need to believe (Ostow, 1954). Some
potentially neurotic state" (Tillich, 1952, may place their faith in scientific method
p. 73). To what extent will the highest and others will create objects images
level of aspiration which religion demands, which are quasi-religious. Self-made fan-
itself contribute to the frustration-aggres- tasies are like acquired classic religious
sion pattern which can lead to a violence superstitions in that both are used by the
without shame in the very name of religion? self to protect it against a hostile world.
They are intrapsychic, whereas the high-
Contrariwise, can the symbol of God as est aspirations of religion are interpsychic
a forgiving and a loving Father help to heal in that they relate self to others in a hos-
guilt? Here again the patience to discrim- pitable world.
inate on the part of a counselor becomes
appropriate. How often is overt rebellion
against a so-called angry God by a coun- Clergyman as Psychologist
selee but a temporary concealment of his Because our society is no longer made
hate for his own father? Does rebellion up of integrated communities with religious
against God reflect the presence of an over- orientation, there is a crisis in meeting the
powering father in the home or does it need to believe. A recent study of the
point even more to resentment over the changing role of the clergyman shows that
absence of paternal authority in the mod- as his role as ritual symbolizer or congre-
ern family? Will the deification of a mater- gational leader has declined, his role as
nal figure provide a greater feeling of at pastoral counselor has grown because there
homeness in the world any more than does are isolated, mobile individuals in our
the mother-dominated, absentee-father extensive, secularized and atomized society
home provide security for the child? Unless in search of roots they hope to find through
counseling is to be conducted in a spiritual a personal spiritual relationship which they
vacuum, this current complex between fam- can no longer find in traditional theological
ily role and religious figure will require symbols. This will not sound sacrilegious
increasing attention as a pertinent factor. to those who remember that the founders
Serious as is anxiety over guilt, sex, free of all religions clearly differentiated be-
will or family role and their religious over- tween the outward symbolic and the in-
tones, the greater anxiety which compels ward spiritual. To them the beginning of
persons to seek counseling arises from mod- the latter was a unique relationship of man
ern man's search for meaning and quest for to man, each concerned for the other's
hope. Those who think with Macbeth that mutual sanctity. Thus conceived, therapeu-
life "is but a tale told by an idot, full of tic counseling, whether done by a secular
sound and fury, signifying nothing" do be- therapist or by an equally trained clergy
come as emotionally distraught and hope- therapist (whose role must become a new
lessly depressed as Macbeth. Recent psy- religious specialization relieving him of the
chiatric studies lead to the conclusion that more obvious judgmental ecclesiastical
where there is hope there is greater success functions), not only deals with religious
in enduring pain, in healing and prolonging values since value judgments are intrinsic
266 Charles A. Curran
to the counselor as well as to the counselee able psychology and theology which one
no matter how objective and nondirective Hassidic Rabbi said he learned from an
the technique, but the relationship may untutored peasant.
well be in itself a religious value. Said Rabbi Moshe Leib of Sassov (died
The crux of the matter depends upon 1807), "How to love men is something I
how the counselor looks upon himself as learned from a peasant. He was sitting in
well as upon the other as a person. This an inn along with other peasants drinking.
applies to counselor and to clergy alike. For a long time he was as silent as all the
Whether the one or the other conceives rest, but when he was moved by the wine,
of himself as acting in the role of inter- he asked one of the men seated beside
mediaryship or in the role of relationship him, "Tell me do you love me, or don't you
will not depend on whether he feels or- love me?" The other replied, "I love you
dained by God or ordained by degrees. All very much," but the first peasant in his
of us are persons of doubt as well as faith. wine replied, "You say that you love me
Some of us consciously devout are un- but you do not know what I need. If you
consciously skeptical; and some consciously really loved me, you would know!" The
skeptical are unconsciously devout. As per- other had not a word to say to this and the
sons we will not assume an omnipotence peasant who had put the question fell silent
which is not ours. The expectancy of such again. "But I understood," said Rabbi Leib,
omnipotence in us by our clients is a meas- "To know the needs of men and to help
urement of their neuroticism. We will not them bear the burden of their sorrows,
look upon ourselves solely as the experts that is the true love of men."
who have the skill to help others. Total
preoccupation with technique may conceal References
one's own uncertainty in the art of living. Buber, M, I and thou. Edinburgh: T. & T. Clarlc,
Rather we should say of ourselves, "I am 1937.
a person who is myself helped when I Buber, M. The eclipse of God. New York: Harper,
help others." This requires the intimate 1952.
converse of two in a dialogical interchange Freedman, M. S. Martin Buber: The life of dia-
whose essential element is experiencing the logue. Chicago: Univer. of Chicago, 1955.
other side. In the first attitude, the relation- Freud, S, Moses and monotheism. New York:
Knopf, 1939.
ship is that of subject to an object, an I to Jones, E. The life and work of Sigmund Freud,
an It; in the second attitude, the relation- Vol. 2. New York: Basic Books, 1955.
ship is one of person to person, an I to Kagan, H. E. Atonement for the modern Jew.
Thou relationship which in Martin Buber's CCAR Journal, 1958, 4, 8-15.
definition is itself a religious experience. Ostow, M., & Scharfstein, B. The need to believe
Such an interhuman relationship is of the New York: International Univer., 1954.
rarest sanctity beyond the most knowledg- Tilhch, P. The courage to be. New Haven: Yale,
1952.
In some of the old classic Dutch and The experience afforded the viewer here
Italian paintings, it was the artists' practice, . . . is essentially one of gazing beyond the im-
as Stephen Tennant (1949) has pointed mediate scene to a timeless sky or a timeless room,
in which the future and the past, the unspoken
out, to give a and the unknown, forever beckon . . .
drawing-room or kitchen in which there is a If we were to ask what religious factors
window open, through which you see the masts
of ships, or a strip of grey sea, or vistas or colon- and values introduce into the counseling
nades or a balcony, a garden or a court . . . process, we might answer that, like the
Percepţiile despre smerenie: studiu preliminar
Percep oamenii smerenia ca fiind o forţă sau ca o slăbiciune? Studiul acesta a încercat
să răspundă întrebării având un eşantion de 127 de studenţi. Contrar definiţiilor date de
dicţionare, care adesea asociază smerenia cu auto-retrogradarea, participanţi studiului au avut o
opinie bună despre smerenie. La reamintirea situaţiilor în care s-au simţit umili, ei susţin că au
fost experienţe cu succes asociate cu emoţii pozitive. Participanţi au asociat smerenia cu o bună
reglare psihologică, deşi nu erau decişi dacă smerenia poate fi asociată cu încrederea sau
leadershipul. Deşi participanţii au privit smerenia ca pe o forţă în rolurile sociale, părerile mai
favorabile au suţinut că smerenia este o calitate a persoanelor religioase, nu este o calitate cu care
poţi să îi subordonezi pe ceilalţi, cu atât mai puţin o calitate a liderilor. Opiniile pozitive despre
smerenie au fost asociate cu o stimă de sine ridicată şi religiozitate. Opiniile mai puţin favorabile
au fost asociate cu narcisismul-în special faţă de exploatarea/intitularea dimensiunii.
Percep oamenii smerenia ca fiind o forţă sau ca o slăbiciune? Aşa cum a fost descris de
către Tangney (2000), definiţiile date de dicţionare descriu smerenia în sens negativ, asociind-o
cu auro-retrogradarea, stimă de sine scăzută şi umilinţă. Pe de altă parte smerenia poate fi văzută
ca pe o forţă, o virtute, aşa cum aste sugerat în scrierile religioase (de ex. Casey, 2001;Murray,
2001) tratate filozofice (ex. Morgan, 2001; Richard, 1992) şi cercetările recente din psihologie
(ex. Exline, Campbell, Baumeister, Joiner & Kruger, 2004; Emmons, 1999;Friesen, 2001;
Landrum, 2002, Sandage, 1999, 2001; Tangney, 2000, 2002).
În ciuda atenţiei care se acordă recent smereniei, psihologii încă ştiu puţine lucruri despre
percepţiile oamenilor despre smerenie- o văd doar ca pe o slăbiciune sau o forţă. Scopul acestui
studiu preliminar a fost să analizeze percepţiile despre smerenie dintr-un eşantion cu studenţi din
America de Nord. Ne-am axat în particular pe următoarele întrebări: cred oamenii că smerenia
este o virtute care se poate cultiva, sau o slăbiciune care trebuie minimalizată? Este smerenia
văzută ca o trăsătură dezirabilă doar pentru anumite tipure de oameni-figuri religioase poate,
opusă liderilor? Totodată am dorit să cercetăm în ce fel diferenţele individuale variabile cum
este religiozitatea, narcisismul şi stima de sine, pot fi relevante asupra percepţiilor despre
smerenie.
Smerenia este o piatră de temelie pentru “Alcoolici Anonimi” şi alte programe de tip “12
paşi”, create pentru a distruge adicţiile (ex. Kurtz & Ketcham, 1992).
Cei care au scris despre programul “Alcoolici Anonimi” s-au referit la faptul că smerenia
este văzută aici ca fiind abilitatea de a accepta onest umanitatea omului, cunoştinţele sale limitate
şi imperfecţiunile sale-inclusiv slăbiciunea omului faţă de alcool (Pasul 1) (Kurtz & Ketcham,
1992). Conform lui Kurtz şi Ketcham (1992), smerenia implică respingerea implicită a cererilor
de genul “totul sau nimic” şi în locul acesteia să se pună alegerea unui statut de om simplu. Se
descrie cum smerenia poate pava calea alcoolicilor spre a se supune Marii Puteri (Pasul 2) şi să
cedeze controlul recuperării acetei Mari Puteri (Pasul3). După aceste raţionări, o lipsă a
smereniei ar împiedica recuperearea din alcoolism (de văzut Tiebout, 1994). Cercetări empirice
recente despre noile recuperări ale pacienţilor alcoolici (Hart & Huggett, 2003) oferă rezultate
relevante care susţin acest argument. Studiile arată că o auto-percepţie narcisistă a autorităţii şi
superiorităţii corelează negativ cu recuperarea alcoolicilor şi cu predarea în faţa Marii Puteri aşa
cum s-a descris la paşii 2 şi 3.
De asemenea susţinem ideea că oamenii văd smerenia mai mult sau mai puţin pozitiv în
funcţie de rolul social al persoanei smerite. Pentru că smerenia este asociată cu religia (ex.
Morgan, 2001; Murray, 2001), este văzută ca pe o calitate printre figurile religioase. Mai departe
smerenia facilitează cooperarea, arătând o lipsă a preocupării despre sine, oamenii pot aprecia
prin smerenie pe ceilalţi ca prietenii, familia, sau partenerii romantici (vezi Friesen 2001, pentru
o discuţie despre cum poate smerenia să faciliteze comunicarea maritală).
Genul. Cercetările sugerează că femeile se comportă cel mai adesea mai modest decât
bărbaţii (ex. Heatherington et al., 1993) şi tot ele sunt adesea mai sensibile decât bărbaţii în ceea
ce priveşte riscul social al supraperformării faţă de ceilalţi oameni (vezi Exeline &Label, 1999).
În procesul de socializare bărbaţii învaţă să valorifice individualismul şi căutarea de dominanţă
mai mult decât femeile (ex. Brod, 1987. Ne aşteptăm deci ca relativ la bărbaţi, femeile să aibă o
opinie mai pozitivă despre smerenie.
Metoda
Participanţi şi procedură
Măsurare
Definiţii ale smereniei. Participanţii au fost întrebaţi despre definiţiile smereniei într-un
format deschis. Răspunsurile au intrat într-un text pentru a ne asigura că cei care codifică inlud
scorurile în toate măsurătorile. Bazaţi pe prima teoretizare şi o citire iniţială a răspnsurilor, cel de
al doilea autor a codat categoriile şi a calificat rata independentă în utilizarea sistemului de
codare.
Al doilea autor a fost cel care a codificat al doilea. Înţelegerea dintre cei doi a fost bună,
rangul k de 0,89 până la 1,0. Discrepanţele au fost rezolvate de către primul autor.
Situaţii în care participanţii s-au simţit umili/smeriţi. Participanţii au fost rugaţi să-şi
amintească situaţii în care ei s-au simţit umili/smeriţi. Au fost rugaţi apoi să descrie situaţia şi
emoţiile pe care le-au experimentat în acea situaţie. S-a notat de la 0-deloc la 10-foarte mult în
funcţie de măsura în care şi-au amintit. Au utilizat apoi aceaşi scală pentru a nota situaţiile
neplăcute pe care şi le-au amintit. Răspunsurile deschise au fost codate folosind aceaşi procedură
descrisă mai devreme, iar k dintre cei doi care au codificat a fost între 0,89 şi 0,92. Discrepanţele
au fost rezolvate de către primul autor.
Tipuri de persoane pentru care smerenia este o slăbiciune sau un punct forte. Participanţi
au citi:” Dacă ai şti că........(vezi lista de alături) a fost o persoană smerită ai vedea asta ca pe o
slăbiciune sau ca pe un punct forte pentru acest tip de persoană?” Promptul a fost urmat de o listă
de persoane având diferite roluri sociale. O scală cu 11 puncte a fost folosită pentru a marca
fiecare item (-5=slăbiciune, 0=neutru, 5=punct forte. Analiza factorială sugerează crearea a 4
subscale: lider/entertainer (lider de afaceri, lider militar, preşedinte al SUA, entertainer,
instructor de cursuri) alfa=0,91. alţii (partener de întâlnire, prieten, părinte, alfa 0,86; subordonat
(servitor, angajat, 0,83) şi lider religios (vorbitor religios sau spiritual, lider religios, alfa 0,79).
Stima de sine. Am utilizat scala Rosenberg a stimei de sine (Rosenberg, 1965, 1979)
pentru a măsura stima de sine. Participanţii au raspuns la 10 itemi pe o scală cu 5 puncte (1=în
dezacord, 5=foarte de acord)
Rezultate.
În schimb a fost văzută ca similară modestiei m=7,8 SD= 2,2.Media pentru modestie
deferă faţă de media pentru stimă de sien scazută, ruşine sau umulinţă la p<.oo1, utilizând măsuri
de contrast repetate. Legat de corelaţiile ridicate între itemii smereniei similară cu cei ai ruşinii,
jenei sau umilinţei (Alfa Crombach=0,84), aceşti 3 itemi au fost combinaţi într-unul singur
pentru analiza rămasă.
Alte caracteristici asociate cu smerenia includ lipsa egoismului (17%), lipsa vanităţii sau
a aroganţei (19%) şi prezenţa atributelor pozitive sau a abilităţilor (17%). Mai degrabă decât a
încadra smerenia ca pe o preocupare pentru deficienţe, participanţii au asociat smerenia cu
atitudinile despre calităţile pozitive ale fiecăruia.
În ciuda acestei opinii pozitive uni participanţi au asociat smerenia cu rşinea, umilinţa şi
jena (10%) sau cu atitudinea sumisivă sau pasivă (5%).
Când au fost rugați să se gândească la o persoană pe care o văd foarte smerită, participanții au
ales colegi cum ar fi prieteni, colegi de clasă sau colegi de cameră (41%), rude (22%), figuri
religioase populare cum ar fi lideri religioși , Iisus Hristos sau sfinții (13%), celebrități sau
indivizi faimoși (10%), și personalul religios conducător cum ar fi pastori sau preoți (3%). Când
au fost rugați să descrie persoana sau /și de ce au văzut-o ca smerită participanții au identificat
caracteristici pozitive cum ar fi bunătatea, îngrijirea celorlalți (56%) abținere de la laudă (55%)
succesul sau inteligența (47% ) și un altruist sau atitudine de sacrificiu de sine (21%). Oricum,
unii indivizi (47%) au remarcat un potențial dezavantaj al smereniei menționând că persoanele
smerite sunt timide, tăcute și neasertive. Când participanții au fost întrebați despre calitățile
asociate cu oamnii smeriți, ei au dat evaluări pozitive. Indivizii smeriți au primit evaluările de
mai sus pe scala cu mijlocul 0 pe ambele indicele de adaptare și indicele de leadership /încredere
(pentru adaptare, M= 2.0, SD= 1.9, t(126)=11.78, p<.001 ; pentru leadership /încredere, M=0.7,
SD= 2.0) t(126)=4.0, p<.001. Oricum, evaluările adaptării au fost superioare evaluărilor
leadership-ului și încrederii, F(126)=103.39, Wilks λ=.54, p<.001. Acestea sugerează că oamenii
umili sunt în general văzuți ca bine adaptați și amabili. Dar sunt oamenii smeriți la fel de buni în
rolul în care sunt chemați de lider sau dominanță. Această întrebare va fi examinată în
următoarea analiză.
Este văzută smerenia ca mai mult decât o rezistență în anumite roluri sociale?
Dacă ne gândim la cum este văzută smerenia la alți oameni, ca rezistență, putere sau ca
slăbiciune, participanții au raportat că în general smerenia este văzută ca punct forte.Chiar și
participanții au făcut distincția între meritele smereniei bazate pe rolul social și persoana smerită.
Măsurătorile repetate au arătat că smerenia a fost evaluată mai favorabil la căutătorii religioșii
(M=3.4, SD= 1.7) decât în ceilalți apropiați (M=2.9, SD=1.8)sau subalterni(M=2.7, SD= 2.1,
ambii ps<.01 ). Aceste constatări oglindite sunt rezultate din itemi ce sugerează că indivizii
smeriți au fost percepuți ca fiind religioși saa spirituali, M=1.6, SD=2.2 care diferă de la punctul
neutru de mijloc de la 0 la t(125)=7.99, p<.001. Smerenia a fost evaluată mai puțin favorabil în
grupul lider/animator decât în orice alt rol social (M=1.0, SD= 2.6, ps împotriva celorlalte trei
grupuri <.001).
Potrivit cu predicția, religiozitatea a fost asociată cu concepții pozitive ale smereniei. Așa cum
arătăm în tabelul 2 religiozitatea a fost asociată cu dorința de a deveni mai smerit, cu credința că
smerenia este asociată cu o bună adaptare și încredere și cu o vizualizare a smereniei ca putere,
tărie în oameni în diverse roluri (căutătorii religioși/liderii, subalternii și alții aproape).
Religiozitatea a fost de altfel asociată cu o probabilitate mai mare ca emoție pozitivă și cu o
probabilitate mai mică, ca emoție negativă. Genul nu a arătat asociații consistente cu vizualizarea
smereniei așa cum se vede în tabelul 2 .
Mai multe corelații sunt nesemnificative. În cazul femeilor este mai probabil decât în cel
al bărbaților să vadă smerenia ca un punct forte în cazul căutătorilor religioși sau liderilor și au o
mai amre tendință să asocieze smerenia cu o bună adaptare. În cazul femeilor este ai probabil ca
în descrierea situațiilor în care s-au simțit smerite să menționeze și emoții negative. Investigați
recente au arătat că este mai probabil ca femeile să raporteze emoții negative în situațiile care
implică succesul (femei 72%, bărbați 28%, x²(77)=6.12, p<.01). Mai specific, când femeile și-au
reamintit situații de succes în care s-au simțit smerite ele raportează într-o măsură mai mare ca
bărbații, jenă (femei 23%, 8% bărbați, x²(75)=3.52, p<.10). În urma cercetărilor s-a constat că
femeile sunt mult mai sensibile decât bărbații în ceea ce privește costurile sociale (e.g., Exline &
Lobel, 1999, Heatherington et al. 1993; Heatherington, Burns, &Gustafson, 1998). Așa cum se
vede în tabelul 2, narcisismul este corelat negativ cu credința că smerenia este asociată cu o bună
adaptare și încredere. Stima de sine nu a arătat asociații potrivite cu vizualizarea smereniei.
Pentru a extinde asta, participanții cu stimă de sine ridicată au manifestat o probabilitate mai
mare de a lega smerenia cu o adaptare bună și mai puțin probabil cu rușinea, jena, umilința.
Aceste rezultate sugerează că stima de sine și narcisismul pot să se deosebească în termenii de
asocieție cu smerenia.
Narcisismul și stima de sine corelează pozitiv în exemplul dat, r(126)=.23, p<.01,
potrivit cu idea că ambele, narcisismul și stima de sine ridicată implică păreri despre sine
pozitive. Pentru a examina contribuția unică a ambelor, narcisismul și stima de sine am făcut o
serie de analize care sunt prezentate în tabelul 3. Aici se rescoperă asociațiile divergente ale
narcisismului și stimei de sine cu vizualizările smereniei.
Discuții
Chiar dacă stima de sine se suprapune cu narcisismul, stima de sine a fost asociată cu păreri
favolabile asupra smereniei în exemplul nostru- mai precis când asociațiile cu narcisismul au fost
din punct de vedere statistic controlate. În alte cuvinte, pentru a extinde această înaltă stimă de
sine implică un rezultat pozitiv, acceptând orientarea spre sine mai degrabă decât un sentiment
de superioritate față de ceilalți, acesta este asociat cuo perspectivă pozitivă pe smerenie. Pentru a
face acest pas logic mai departe, speculăm că acea persoană ci stimă de sine ridicată și
narcisism scăzut poate fi categorizat ca fiind umilitor- în special dacă stima de sine este uan
stabilă. (Kernis, Cornell, Sun, Berry, & Harlow, 1993). În general păreri pozitive dar fără să fie
umflate, exagerate, a sinelui pare să se potrivească cu recentele descrieri ale caracteristicilor
smereniei. (Tangney, 2000, 2002). Date fiind serioase bariere de măsurare care au înconjurat
încercarea de a evalua smerenia prin auto raport (Exline et al. , 2004 ; Tangney, 2000, 2002), ar
fi extrem de util dacă scorurile existente cu privire la măsurătorile pe narcisism, nivelul stimei de
sine și stabilitatea stimei de sine pot fi combinate pentru a identifica indivizi smeriți. Evaluarea
altor cosntructe legate cum ar fi auto-compasiunea (Neff, 2003a, 2003b), validare căutării
(Dykman, 1998) sau nevoia de a câștiga stima de sine (Forsman & Johnson, 1996) pot de
asemenea să ajute la identificarea inivizilor smeriți. O altă tehnică posibilă ar putea fi să
evaluăm smerenia prin auto raport dar controlate pentru dezirabilitățile sociale(vezi Landrum,
2002).
Când reamintim situația în care s-au simțit umili, participanții și-au amintti situația
implicând succesul și împlinirea. Cu alte cuvinte, este mai probabil ca ei să fi văzut smerenia ca
o atitudine spre un punct forte decât ca o preocupare pentru slăbiciune. Gândindu-ne la smerenie
ca o atitudine spre un punct forte, ridică noi posibilități pentru modul în care statului smereniei
poate fi indus în setările experimentale. Dacă smerenia este văzută ca o focusare pe o limită ar
însemna să rugăm participanții să reflecteze asupra limitărilor sau căderilor. Oricum, am găsit
că astfel, inducerea auto-scăderii de multe ori provoacă reacții defensive și/sau efecte negative
de dispoziție sufletească. Datele recente sugerează că cea mai eficientă cale de a induce
smerenia poate fi focusarea pe atribute pozitive sau experiențe. O altă alternativă poate fi să
rugăm oamenii să se focuseze pentru început asupra atributelor lor pozitive (sau să folosească
alte mijloace pentru a se afirma pe ei înșiși) înainte să-i rugăm să se focuseze asupra defectelor l
or (vezi Schimel, Arndt, Pyszczynski , & Greenberg, 2001).
Un mijloc alternativ de a induce smerenia poate să implice furnizarea participanților o
experiență de succes înainte să le ofere un fedbeck negativ. Astfel de design ar da probabil
participanților un sentiment de securitate sau pozitivism înainte să se deplaseze focalizarea lor
pe limitele lor. Idee de a precede experiența auto scăderii cu acele ecouri pozitive, abordare
utilizată în studii pe procese de auto afirmare, care sugerează că oamenii sunt mult mai capabili
să tolereze efectele negative dacă ei au avut șansa înainte să se autoafirme(pentru a revizui vezi
Steele, 1999). Indiferent ce tehnică este folosită pentru încercarea de inducere a statutului de
smerenie, se pare că trebuie să ne așteptăm la diferențe individuale în succesul acesti manipulări.
De exemplu, indivizii cu stimă de sine instabilă sau apărare narcisistă pot să nu răspundă
succesului sau eșecului în același fel în care cea mai mare parte dintre indivizii smeriți ar face-
o.
Religiozitatea și smerenia
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JOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION
JEFFREY P. BJORCK
JOHN W. THURMAN
colaboratorii săi (1998) au descris două tipuri de coping religios: pozitiv și negativ. Primul
exprimă spiritualitate, conștientizarea unui sens al vieții, a unei relații sigure cu Dumnezeu și
apropiere spirituală de Acesta. O asemenea fumnamentare religioasă stabilă este manifestată
prin „reevaluări religioase pozitive, coping religios colaborativ, căutarea suportului spiritual,
conexiune spirituală, purificare spirituală, căutarea suportului membrilor Bisericii, oferirea de
ajutor și iertare” (1998:712). Spre depsebire de acesta, copingul religios negativ este
caracterizat de o relație tensionată cu Dumnezeu, o viziune amenințătoare asupra lumii și o
luptă continua de a găsi un sens al vieții. Această bază religioasă șubredă se manifestă prin
„reaprecieri religioase negative, demonice, reevaluări negative ale puterii Lui Dumnezeu,
nemulțumire spirituală, coping religios direcționat spre sine și nemulțumire față de relațiile
interpersonale (1998:712)”. Pargament a evaluat copingul religios la trei eșantioane: membrii
bisericii din Oklahoma după explozia unei bombe în oraș, un grup de studenți care au
experiențiat un eveniment negativ foarte serios, și un grup de pacienți în vârstă, internați într-
un spital. În fiecare eșantion, copingul religios pozitiv a fost mai des utilizat decât cel negativ,
iar primul tip a fost corelat cu o sănătate mentală mai bună, în timp ce copingul negativ a fost
corelat cu efecte negative.
Koenig, Pargament, and Nielsen (1998) au identificat atât strategii de coping pozitive,
cât și negative pe un eșanțion de 557 adulți bolnavi, internați într-un spital. Copingul religios
negativ a fost corelat cu o sănătate fizică mai precară, o calitate a vieții mai scăzută și nivele
mai înalte de depresie. În schimb, personale care utilizau copingul religios pozitiv aveau o
sănătate mentală mai bună și un nivel mai înalt de satisfacție față de viață.
Așa cum am menționat anterior, majoritatea studiilor s-au focusat pe răspunsurile la
evenimente stresante singulare (e.g., Koenig, Pargament, and Nielsen 1998; Pargament et al.
1998). Doar Park, Cohen, and Herb (1990) au studiat copingul religios ca răspuns la stresul
general cauzat de multiple evenimente de viață, însă rezultatele lor au fost ambigue. În
consecință, studiul nostru a extins spectrul cercetărilor anterioare în două moduri. Primul,
copingul religios a fost investigat în relație cu impactul unui agregat de evenimente negative
și nu ca răspuns la un stresor specific. Al doilea, ambele tipuri de coping religios au fost
evaluate prin scale sumative.
Niciun studiu anterior nu a cercetat modul în care evenimentele negative cumulate
interacționează cu tipurile de coping religios pozitiv și negativ. Conceptul de „reevaluare” al
lui Lazarus și Folkman (1984) și teoria clasică a lui Caplan (1964) ne sunt utile aici. Lazarus
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și Folkman postulează că după ce este inițiat copingul, persoanele reevaluează situația în care
se află și își modifică strategia de coping în consecință. Astfel, pe măsură ce numărul
evenimentelor negative crește semnificativ, este posibil că persoanele religioase vor reevalua
viziunea asupra Lui Dumnezeu. Acest fapt poate să conducă și la utilizarea mai frecvență a
copingului religios negativ, de exemplu: reaprecierea iubirii și suportului Lui Dumnezeu sau
reinterpretarea evenimentului negativ ca și pedeapsă dată de El. Similar, Caplan (1964)
argumentează faptul că indivizii care se confruntă cu un stresor vor utiliza la început copingul
lor habitual. Dacă stresul continuă să crească, indivizi vor căuta noi strategii de coping, prin
încercare și eroare. În privința copingului religios față de un singur eveniment, strategiile
pozitive sunt comune, iar cele negative nu sunt comune (e.g., Pargament et al. 1998), primele
sunt mai habituale, în timp ce ultimele sunt mai neobișnuite.
Așadar, prima ipoteză a studiului este: copingul religios ca răspuns la evenimentele
negative este mai degrabă pozitiv decât negativ. A doua: odată ce evenimentele negative sunt
mai numeroase, copingul religios negativ va fi utilizat cu o frecvență mai mare decât cel
pozitiv. A treia: copingul religios negativ corelează cu intensificarea distresului, în timp ce
copingul religios pozitiv corelează cu diminuarea distresului. (Pargament et al. 1998; Koenig,
Pargament, and Nielsen 1998). A patra: vor fi replicate corelațiile tradiționale dintre
evenimentele negative de viață și funcționarea psihologică. Ultima ipoteză: copingul religios
pozitiv diminuează efectele intensificării evenimentelor negative.
METODA
Procedura
Acest studiu a făcut parte dintr-un proiect mai vast (de ex., Fiala, Bjorck, şi Gorsuch
2002) care a utilizat un eşantion de convenienţă. Cu acordul conducătorilor bisericilor, au fost
selectate aleator 400 de nume din fiecare dintre cele trei mari biserici Protestante din sudul
Californiei (N> 1,200). Una dintre congregaţii (Misionară Baptistă) era predominant Afro-
Americană, celelalte două biserici (nondenominaţională şi respectiv Conferinţa Creştină
Congregaţională Conservativă) erau mixte din punct de vedere etnic. Membrilor bisericilor li
s-au trimis prin poştă pachete cu chestionare, inclusiv un plic timbrat autoadresat. Participarea
a fost voluntară şi confidenţială. După două săptămâni au fost trimise cărţi poştale de
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reamintire. S-au primit 337 de răspunsuri (27,1 %), dintre care unul a fost respins, deoarece
era incomplet.
Participanţii
Respondenţii (197 de femei, 139 de bărbaţi; M = 38.87 ani, SD = 12.12) erau albi
(39.3 %), Afro-Americani (28.0 %), Latino-Americani (13.7 %), Asiatic-Americani (11.0 %)
ş.a. (8.0 %). Participanţii erau căsătoriţi (46.1 %), necăsătoriţi (35.1 %), divorţaţi (13.7 %),
văduvi (3.9 %) ş.a. (1.2 %). Ultimul stadiu educaţional terminat era şcoala postliceală (67.9
%), liceu sau echivalent (26.2 %), 10-12 ani (5.7 %) şi 7-9 ani (0.3 %).
Măsurători
Prezentarea măsurătorilor a fost contrabalansată (pentru a controla efectele de ordine)
în pachetele distribuite aleatoriu. Participarea religioasă a fost evaluată pe două scale cu un
singur item: (a) participarea la slujbe religioase formale; şi (b) activităţi religioase informale
(de ex., lectura Bibliei, rugăciune, etc.).
Fiecare din acestea a fost cotată pe o scală cu 5 puncte (1 = o dată pe lună, 5 = de
patru sau mai multe ori pe săptămână).
Evenimentele de viaţă au fost cotate cu ajutorul scalei LES (70-event Life Experience
Survey; Sarason, Johnson, and Siegel 1978). Participanţii au indicat evenimentele
experienţiate în timpul ultimului an şi le-au cotat pe fiecare ca pozitiv, negativ sau neutru.
Numărul total al evenimentelor negative a servit ca măsurătoare a evenimentelor negative
(Cohen 1988). Alpha pentru această măsurătoare, pentru acest eşantion a fost 0.88.
Chestionarul Brief RCOPE cu 14 itemi (Pargament et al. 1998) include două subscale cu şapte
itemi, care evaluează coping-ul religios pozitiv respectiv pozitiv. Itemii pozitivi (de ex., „Am
căutat dragostea şi afecţiunea lui Dumnezeu”) includ reevaluări religioase benevole, coping
religios colaborativ, căutarea suportului spiritual, a conectării spirituale, a purificării
religioase, căutarea ajutorului din partea clerului sau a membrilor, ajutorul religios şi iertarea
religioasă. Itemii negativi (de ex., „ M-am îndoit de dragostea lui Dumnezeu pentru mine”)
includ reevaluări religioase punitive, reevaluări religioase demonice, reevaluări ale puterii lui
Dumnezeu, nemulţumire spirituală, coping religios centrat pe sine şi nemulţumire religioasă
interpersonală.
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Itemii sunt cotaţi pe o scală cu cinci puncte (1 = deloc, 5 = o mare parte din timp),
iar cei şapte itemi ai fiecărei subscale sunt adunaţi pentru a produce un scor de coping religios
pozitiv respectiv negativ.
În studiul curent, scala Brief RCOPE a urmat imediat după LES, iar instrucţiunile
RCOPE au fost alterate. În loc să se refere la un singur eveniment, participanţii au raportat
cum au făcut faţă la toate evenimentele negative din ultimul an. Cu această modificare, Alpha
pentru coping-ul pozitiv şi negative au fost 0.83 respectiv 0.79.
Funcţionarea psihologică a fost evaluată cu ajutorul Scalei SWLS (Satisfaction With
Life Scale; Diener et al. 1985) şi cu Scala CES-D (Center for Epidemiological Studies-
Depressed Mood Scale; Radloff 1977). SWLS măsoară starea de bine subiectivă generală
(overall subjective wellbeing), iar CES-D măsoară simptomele depresive doar din ultimele
şapte zile. Pentru a păstra consistenţa măsurătorilor, timpul pentru CES-D a fost schimbat în
“pe durata ultimului an”. În plus, pentru a îndeplini claritatea instrucţiunilor, itemii tuturor
măsurătorilor, înafară de LES, au fost transformaţi într-o gamă de răspunsuri cu cinci puncte.
Alpha pentru acest eşantion pentru SWLS şi CES-D au fost 0.82 respectiv 0.90.
REZULTATE
Media şi abaterea standard pentru variabilele de interes sunt prezentate în Tabelul 1.
Pentru a facilita interpretarea, toate scorurile scalelor (excepţie făcând evenimentele negative
pentru LES) au fost împărţite la numărul respectiv de itemi. Această operaţie a generat scoruri
totale de la 1 la 5, reprezentând ancora fiecărei scale. În sprijinul primei noastre ipoteze,
coping-ul religios pozitiv a fost utilizat mult mai frecvent decât coping-ul religios negativ, t
(1,335) = 44.06, p < 0.001.
Apoi au fost efectuate corelaţii de ordinul zero. Cum era de aşteptat, evenimentele
negative au fost corelate pozitiv atât cu pattern-urile de coping religios pozitiv cât şi negativ
(rs = 0.32 şi 0.11, respectiv ambele cu un ps < 0.05). A două ipoteză a noastră, că
evenimentele negative vor corela mai puternic cu coping religios negativ decât cu coping
religios pozitiv, a fost evaluată cu ajutorul testului t Hotelling pentru coeficienţi de corelaţie
corelaţi (Hotelling, cum este citat în Guilford 1965:190). Cum am prezis, prima corelaţie (r =
0.32) a fost semnificativ mai puternică decât cea mai târzie (r = 0.11), t Hotelling (333) =
2.99, p < 0.01). În sprijinul celei de a treia ipoteze, coping-ul religios negativ a fost corelat cu
depresie crescută (r = 0.51, p <0.001), şi satisfacţie în viaţă (life satisfaction) scăzută (r = -
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0.27, p < 0.001), dar, surprinzător, coping-ul religios pozitiv nu a fost relaţionat semnificativ
cu niciuna dintre ele.
Ipoteza a patra a fost sprijinită de corelaţiile semnificative între evenimentele
negative şi creşterea depresiei (r = 0.41, p < 0.001), dar şi cu scăderea satisfacţiei de viaţă (r =
-0.26, p < 0.001).
Mai departe, am efectuat analize canonice ierarhice, evaluând numai varianţa unică
pentru a: (a) examina interacţiunea prevăzută şi (b) a testa ulterior corelaţiile de mai sus în
timp ce sunt controlate covariatele relevante. Întâi, însă, depresia şi satsifacţia de viaţă au fost
ortogonalizate (Gorsuch 1991) datorită intercorelaţiei lor semnificative (r = -0.50). Ca şi în
studiile precedente (de ex., Bjorck et al. 2001; Fiala, Bjorck şi Gorsuch 2002; Maynard,
Gorsuch şi Bjorck 2001), această tehnică a produs corelaţii pozitive puternice între variabilele
originale (adică depresia şi satisfacţia de viaţă) şi noii lor factorii (ambii rs = 0.97).
pattern-uri de coping religios, având ca criterii depresia şi satisfacţia de viaţă. Analiza globală
a fost semnificativă, F (16,654) = 9.36, p < 0.001. Aceeaşi analiză (vezi Tabelul 2) a scos la
iveală un efect principal semnificativ al evenimentelor negative asupra depresiei şi a
satisfacţiei de viaţă. În plus, s-au găsit efecte esenţiale semnificative pentru setul celor două
scoruri pentru coping religios asupra depresiei şi a satisfacţiei de viaţă. În sprijinul celei de a
treia ipoteze, analizele univariate ale varianţei unice au arătat că, coping-ul religios pozitiv
este corelat negativ cu depresia şi pozitiv cu satisfacţia de viaţă, F (1,654) ≥ 3.74, ambele ps ≤
0.05. Invers, coping-ul religios negativ a fost corelat pozitiv cu depresia şi negativ cu
satisfacţia de viaţă, F (1,654) ≥ 4.32, ambele ps < 0.05.
În final, aceeaşi analiză (vezi Tabelul 2) a arătat că setul celor două tipuri de coping
religios x interacţiunile evenimentelor negative au fost semnificative cu privire la depresie dar
nu şi cu privire la satisfacţia de viaţă. O analiză univariată a varianţei unice a arătat că acest
efect asupra depresiei este datorat unei interacţiuni semnificative între coping-ul religios
pozitiv şi evenimentele negative, în sprijinul ultimei noastre ipoteze, F (1,654) = 4.90, p <
0.05. Figura 1 arată că, pentru persoanele care raportează coping religios pozitiv ridicat,
impactul evenimentelor negative asupra depresiei a fost scăzut, comparat cu cei care
raportează coping religios pozitiv scăzut.
DISCUŢII
În trecut au fost identificate pattern-uri de coping religios pozitiv şi negativ şi s-a
descoperit că corelează cu rezultate diferenţiale cu privire la evenimente stresante specifice
(de ex., Koenig, Pargament şi Nielsen 1998; Pargament et al. 1998). Studiul de faţă arată ca
astfel de diferenţă se aplică la evenimente negative în general şi demonstrează relevanţa
coping-ului religios în paradigma evenimentelor de viaţă stresante (adică, cu privire la toţi
stresorii negativi experienţaţi în ultimul an). Numeroase ipoteze au fost sprijinite.
Aşa cum s-a prezis, participanţii au utilizat mai mult coping religios pozitiv decât
negativ ca răspuns la stresul general. De asemenea, cum era de aşteptat, evenimentele
negative crescute au fost relaţionate cu creşteri atât în coping-ul pozitiv, cât şi în cel negativ,
iar aceste constatări au rămas robuste chiar şi după controlul participării religioase. Cercetări
anterioare au arătat cum un singur stresor, cum ar fi o vizită la spital, bombardarea oraşului
Oklahoma sau orice eveniment singular poate cauza atât răspunsuri de coping religios pozitiv
şi negativ. Totuşi, stresorii nu vin, în mod tipic, singuri, ci în perechi sau în grupuri.
Constatările actuale sugerează că, odată cu acumularea evenimentelor negative, membrii
bisericii Protestante nu numai că îşi menţin, ci îşi şi intensifică strategiile de coping religios,
atât pozitiv, cât şi negativ.
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religos pozitiv mai mic. Această sugerează faptul că coping-ul religios pozitiv ajută la
atenuarea impactului acumulării evenimentelor asupra depresiei. Aceasta ar putea fi adevărat
în măsura în care un astfel de coping accentuează o relaţie colaborativă, afectivă cu un
Dumnezeu personal.
De asemenea există posibilitatea ca membrii bisericii protestante să considere
evenimentele negative ca provocări, pe care Dumnezeu le permite, pentru a le întări credinţa.
(Park, Cohen şi Herb 1990). În consonanţă cu aceasta, există un item de coping religios
pozitiv precum: “să văd cum Dumnezeu vrea să mă întărească în această încercare".
(Pargament et al. 1998:718). O asemenea viziune îi poate face pe protestanţi să caute
aspectele pozitive ale oricărui stresor, ceea ce duce la creşterea speranţei şi la simptome
depresive reduse. De partea cealaltă, coping-ul religios negativ nu interacţionează cu
evenimente negative în ceea ce priveşte funcţionarea psihologică.
Cu toate acestea, luând în considerare efectele puternice ale coping-ului negativ, se
poate infera că acest tip de strategii sunt legate de o adaptare şi mai proastă, indiferent de
cantitatea de stresori. Prin urmare, constatările noastre la adresa protestanţilor, indică faptul că
este la fel de important, sau chiar mai mult, să atenuăm coping-ul religios negativ, decât să
maximizăm coping-ul religios pozitiv. Rezultatele actuale trebuie totuşi interpretate în lumina
variilor limitări metodologice. Mai întâi, studiul este transversal, limitând inferenţele de ordin
cauzal. Apoi, deoarece au fost investigaţi numai protestanţii, a existat riscul de a studia
comportamentele de coping în cazul unei tradiţii religioase particulare, ceea ce poate duce la
reducerea abilităţii de a generaliza rezultatele şi în cazul altor religii.
O altă limitare se referă la utilizarea evocării de tip retrospectiv din ultimul an, dat
fiind faptul că participanţilor li s-a cerut să facă o medie a coping-ului religios folosit în mai
multe evenimente. Fără îndoială, o asemenea strategie este ţinta multor erori şi biasări în ceea
ce priveşte procesul de evocare. Într-adevăr, deoarece unii din participanţi au raportat un
coping religios pozitiv, nu este ieşit din comun ca distibuţia eşantionului actual să fie
îngustată puternic negativ, sugerându-se posibilitatea unei supraraportări a copingului religios
pozitiv. În ciuda acestor limitări, studiul de faţă procură un sprijin serios pentru evaluarea
importanţei coping-ului religios şi pentru distincţia dintre strategii pozitive şi negative când
este vorba de stresul acumulat de-a lungul timpului (versus un eveniment specific).
Pattern-uri pozitive de coping religios pot fi eficiente în combaterea efectelor
negative de viaţă. Astfel de circumstanţe stresante aduc cu ele şi un risc crescut de utilizare a
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coping-ului religios negativ, care este legat inevitabil de funcţionare proastă. Prin urmare,
rafinarea distincţiei dintre coping-ul religios negativ şi cel pozitiv, poate constitui o resursă
preţioasă pentru cercetătorii din psihologia religiei, pentru comunitatea psihologilor, consilieri
pastorali şi clinicieni care tratează clienţi religioşi.
NOTE
Tradus de:
Costache Roxana Elena
Costaș Meda
Brumă Valeria
Facultatea de Psihologie și Științe ale Educației, Anul al II-lea. 2010
Journal of Psychology and Theology Copyright 2001 by Rosemead School of Psychology
2001, Vol. 29, No. 3, 201-211 Biola University, 0091-6471/410-730
CONTEXTUALIZING MODELS OF
HUMILITY AND FORGIVENESS:
A REPLY TO GASSIN
STEPHEN J. SANDAGE and TINA WATSON WIENS
Bethel Theological Seminary
We reply to Gassin’s (2001) valuable description of tion of Eastern Orthodoxy. Instead, we will engage
an Eastern Orthodox perspective on interpersonal some socio-cultural issues related to eastern and west-
forgiveness by discussing some socio-cultural issues ern construals of forgiveness. Gassin focused mostly
related to eastern and western construals of forgive- on theological and psychological differences between
ness and humility. Differences in the social function eastern and western models with some mention of cul-
of humility and forgiveness are outlined based on dif- tural differences. We believe differences in socio-cul-
fering cultural contexts. Crysdale’s (1999) theological tural contexts strongly influence the theological and
model of the cross and resurrection is utilized for psychological differences in how forgiveness and
developing an integrative perspective on forgiveness humility are construed. We will outline some differ-
and empowerment. ences in the social function of humility and forgiveness
based on differing cultural contexts and conclude by
assin (2001) has made an extremely impor- describing Cynthia Crysdale’s (1999) integrative theo-
201
202 CONTEXTUALIZING HUMILITY AND FORGIVENESS
Table 1
The Contours of Individualistic and Collectivistic Worldviews in Relation to Forgiveness
Individualistic1 Collectivistic
Worldview Worldview
giveness tend to be more individualistic and make a contemporary collectivistic contexts. Moreover, we
sharp distinction between forgiveness and reconcili- would argue that extreme forms of both collectivism
ation, with the latter being unnecessary, cautioned and individualism have weaknesses. Therefore, the
against, or simply optional for healing (e.g., see challenge for Christian integration involves develop-
Freedman, 1998; McCullough, Sandage, & Wor- ing culturally-contextualized models of forgiveness
thington, 1997). In an individualistic culture, forgive- that weave together biblical theology and spirituality
ness might frequently be construed as a pathway to with quality psychological science.
self-heal from relational injuries without necessitat- Social relations. The view of social relations from
ing the communal reconciliation that is so counter to an individualistic worldview is one of contractual
the prevailing individualistic social scripts. Forgive- exchange (Bromley & Busching, 1988; Triandis,
ness might even be framed as a unilateral method of 1995). Relational commitment is based on a mutual-
disembedding oneself from painful relationships ly-satisfying contract or exchange that meets one
(Augsburger, 1997).2 In collectivistic cultures, for- another’s felt needs (Bellah, Madsen, Sullivan, Swi-
giveness and reconciliation will be much more close- dler, & Tipton, 1985). Relationships that do not
ly related (Augsburger, 1992, 1997), as depicted by meet one’s personal needs tend to be viewed as
Gassin in Eastern Orthodoxy’s emphasis on reconcil- unnecessary or expendable.
iation. Collectivistic cultures are so strongly oriented The view of social relations from a collectivistic
toward preserving group and familial cohesion that worldview is more communal and covenantal than
mutual forgiveness will tend to be viewed as a path- the view of social relations from an individualistic
way toward reconciliation (Augsburger, 1997). worldview. Collectivistic relationships are based
People living in the ancient Mediterranean social upon making and keeping vows or covenants, which
context of the New Testament would have certainly require greater consideration of the needs and well-
construed the self in a more collectivistic or interde- being of the group or community. Forgiveness in col-
pendent fashion (Malina, 1993a). Forgiveness and rec- lectivistic cultures is more likely to be framed as a
onciliation are, therefore, probably more closely relat- social duty that preserves social harmony rather than
ed in the New Testament than in contemporary a personal decision or attitude. The Eastern Ortho-
western psychological models of forgiveness (Jones, dox respect for martyr-like attempts at reconciliation
1995). Gassin (2001) makes the point that “the only make sense from a collectivistic worldview, not
Church” (p. 41) (i.e., presumably the contemporary an individualistic one.
church) should be communal rather than individualis- Face concern. Interpersonal conflict creates crises
tic in cultural orientation. We would certainly agree of social face. “Social face” refers to a person’s sense
that the Church should be a community that embod- of social worth or dignity. A “loss of face” involves a
ies many of the interpersonal values of communal or shameful or humiliating experience of being dishon-
collectivistic worldviews, especially if the goal is corre- ored before others (Goffman, 1967). Efforts to save
spondence to the New Testament vision. Western psy- face can be directed at saving one’s own face (i.e.,
chologists and therapists interested in Christian inte- self-face concern) or saving the face of others (i.e.,
gration would be wise to give greater attention to other-face concern) (Triandis, 1995). Individualistic
connections between forgiveness and reconciliation cultures promote self-face concern while collectivistic
(Sandage, 1999; Worthington & Drinkard, 2000). cultures promote both other- and self-face concern.
Again, Eastern Orthodoxy as described by
However, it seems realistic to acknowledge that the
Gassin (2001) is consistent with a collectivistic
contemporary social context of highly urbanized and
worldview by encouraging the practice of “victims”
industrialized western countries is far different from
seeking forgiveness from their offenders. In socio-
that of both the New Testament context and many
logical categories, this practice demonstrates a valu-
2 Itis noteworthy that some research on forgiveness even in the ing of other-face concern. The tremendous empha-
largely individualistic context of the U.S. suggests that, in actual sis in contemporary western psychological literature
practice, forgiveness and reconciliation are quite closely related on forgiving others and the relative paucity of litera-
(McCullough et al., 1998). That is, people tend to be more forgiv-
ture on seeking forgiveness from others (see
ing toward those they are close to prior to an offense, and for-
giveness predicts closeness following an offense. Forgiveness Sandage, Worthington, Hight, & Berry, 2000) high-
without reconciliation might be relatively rare outside of psy- lights the western emphasis on self-face concern
chotherapy. above other-face concern.
204 CONTEXTUALIZING HUMILITY AND FORGIVENESS
Self-forgiveness. Gassin (2001) suggested that the to which the individual should strive (MacIntyre,
western concept of self-forgiveness finds “no place in 1984). Those living in contemporary individualistic
the Orthodox tradition” (p. 19). This is probably cultures who find themselves disembedded from
related to the differing construals of the self such communal moral sources and traditions may
described above with self-forgiveness being poten- feel the need to engage in radical self-reflexivity to
tially vital from an individualistic worldview and confer forgiveness upon the self. This individualistic
potentially implausible from a collectivistic world- self-forgiveness can then be viewed as providing the
view. Some historical context can shed light on these foundation of self-healing and self-esteem that
cultural differences regarding self-forgiveness. encourages the generosity to forgive others. Self-for-
Taylor (1989) has traced the historical develop- giveness would seem to be a potentially implausible
ment of modern western notion of the self, and he construct from a collectivistic worldview because
emphasizes the pivotal role of Descartes. Descartes forgiveness is mediated through relationships in col-
considered the exercise of rational control over the lectivistic cultures (Augsburger, 1992; Braithwaite,
material world as the epitome of the human endeav- 1989). To “forgive oneself” could imply an inappro-
or. The instrumental exercise of control requires a priate independence from communal sources or ritu-
motivational source, and Descartes transformed the als of forgiveness.
seventeenth century virtue of “generosity” into that Forms of forgiveness. These differing cultural
motivational source. Generosity was the crowning views on self-forgiveness are related to the differing
virtue that promoted honor or a willingness to con- forms of forgiveness. Gassin (2001) described some
quer one’s fears in order to accomplish heroic mili- of the rich Eastern Orthodox rituals for encouraging
tary feats or other acts of public service. The mean- forgiveness. Collectivistic cultures will be more likely
ing of “generosity” could be translated as a sense of than highly individualistic cultures to retain the cohe-
dignity, worth, or honor. According to Taylor, siveness of communal rituals, stories, and symbols
Descartes transferred this virtue from the public that narrate forgiveness. Individualistic cultures will
sphere, where it was conferred by others in honor- tend to rely on what Rieff (1966) called “analytic
shame cultures, to make generosity toward oneself therapies,” which provide individuals with informa-
the internalized “motor of virtue” (p.154). This idea tion, skills, or personal insights for privatized healing
of self-generosity may be an ideological root of mod- rather than employing the use of more public rituals
ern psychological notions of self-esteem, and or symbols. According to Rieff, most forms of mod-
Descartes called this sense of self-worth “the key of ern western psychotherapy would qualify as “analytic
all other virtues, and a general remedy for all disor- therapies.” Western psychological models of “thera-
ders of the passions” (as quoted in Taylor, 1989, p. peutic forgiveness” (Jones, 1995) might be viewed as
155). This may in part explain the historical develop- a type of analytic therapy that relies upon personal
ment of the uniquely modern and western concept insights or skills rather than communal rituals, narra-
of self-forgiveness. tives, and practices.
Taylor (1989) goes on to suggest that the individ- This issue of the differing forms of forgiveness is
ualistic self of modern western cultures is disembed- central to some of the critiques of therapeutic for-
ded from all social identity and social connections giveness (Augsburger, 1997; Jones, 1995) and the de-
and, therefore, lacks internalized “moral sources” of contextualizing of forgiveness as simply a “tech-
identity. In a similar fashion, Cushman (1995) argues nique” removed from any historical or communal
that the modern, individualistic Cartesian self context (McMinn, 1996; Meek & McMinn, 1997).
stripped of relational or moral ties to community is Individualistic models of forgiveness do seem at risk
really an “empty self” waiting to be filled by a con- of lacking cultural richness and historical depth.
sumer society (also, see McCullough et al., 1997). Conversely, Foucault (1993) argued that communal
According to Cushman, the source of moral authori- institutions (e.g., churches) are capable of imple-
ty for the modern, individualistic self is the individu- menting oppressive rituals that subjugate rather than
al’s own self-constructed attitudes. In contrast, col- empower members. Communal rituals carry tremen-
lectivistic cultures identify the source of moral dous power for good or evil. Therapeutic approach-
authority as a spiritual and/or social community. es to forgiveness might be particularly relevant for
This community is generally responsible for the tra- individuals who are disconnected or estranged from
ditions and narratives that illustrate the moral virtues traditional forms of community. Foucault’s analysis
SANDAGE and WIENS 205
also raises questions about the relationship between Biblical Views of Humility
models of forgiveness and social justice. Gassin (2001) provided a helpful challenge to
Sandage’s (1999) attempt to connect his definition
Social Justice of ego-humility with two biblical passages (Rom
The social function of forgiveness involves how a 12:3; Phil 2:3). Sandage (1999) defined ego-humility
cultural group or society approaches issues of social as “a realistic self-orientation that includes a willing-
justice (Braithwaite, 1989). Gassin (2001) points out ness to acknowledge one’s strengths and face one’s
that western psychologists might strongly object to limitations” (p. 261). Building on the work of
the Eastern Orthodox practice of encouraging vic- Roberts (1982), he further suggested that an inter-
tims to apologize to offenders. This is probably true. personal correlate of such humility is a tendency to
Western psychological models of forgiveness have “view others as one’s equal” (p. 261). Gassin pointed
arisen in a professional therapeutic context that has out that Paul actually exhorts the readers at Philippi
involved grappling with the realities of abuse and the to humility and to “consider others better than your-
injustice of blaming victims for that abuse (McMinn, selves” (Phil 2:3; New International Version), sug-
1996). We are curious how Eastern Orthodox clergy gesting that Sandage’s egalitarian construal of humil-
and church leaders approach issues of abuse and the ity might not be fully consistent with this biblical
dynamics of social justice. Young (2000) described text. Gassin also questioned an egalitarian implica-
the Eastern Orthodox church as generally maintain- tion to Paul’s exhortation in Romans 12:3 to not
ing a “very conservative or traditional moral system” think of oneself “more highly than you ought.” These
(p. 97). This does not imply a lack of concern for are points well-taken and serve to highlight some of
social justice in Orthodoxy, but it could translate the first author’s contemporary egalitarian social val-
into less focus on violations of individual rights and ues. This calls for an examination of the New Testa-
individual liberation than promoted by western ment meaning of humility, as well as the social func-
models of psychotherapy. tion of humility in that ancient context.
These issues of social justice are related to the At the same time, we will argue that the context
social function of anger, as well. Gassin (2001) of both passages suggests Paul is primarily con-
described the general lack of support for interper- cerned with a humility that promotes the unity of the
sonal anger in Eastern Orthodoxy, which is Christian community within the diversity of mem-
assumed to be a “result of our fallen nature” (p. 9). bers. In Romans 12:3-8, Paul moves directly from
The Orthodox tradition seems to suggest that calling for sober self-assessment to a discussion of
anger is better directed against the self. As Gassin the differing gifts within the body of Christ with each
suggests, western psychologists do put more member’s gifts being important to the overall body.
emphasis on the legitimacy of interpersonal anger His point is that each member has a place of belong-
and the dangers of self-directed anger, probably ing within the community.
due to many cultural and worldview factors. For In Philippians 2:1-4, Paul is also calling the commu-
example, the social cost of interpersonal anger and nity at Philippi to a spirit of unity through humility
confronting abuse might be greater in collectivistic (e.g., verse 3 says, “in humility consider others better
cultures than in individualistic cultures. The theo- than yourselves”). The Greek word for “humility” in
logical and spiritual legitimacy of anger involves verse 3 ( ) implies a “lowliness of
complex issues beyond the scope of this paper. We mind” (Fee, 1995). Humility was generally not consid-
do resist an assumption that all interpersonal anger ered a virtue in the Greco-Roman world, which
results from our fallen nature (see Jones, 1995; regarded humility as a form of servility and weakness
Volf, 1996). Such a view would seem to offer no (Bockmuehl, 1998; Fee, 1995). Paul sets humility in
legitimation for anger against injustice. contrast to “selfish ambition” and “vain conceit” (verse
3), giving humility a connotation of unselfishness
THE SOCIAL FUNCTION OF HUMILITY (Grundmann, 1972) that counters the grandiose
Gassin’s (2001) article raises important issues temptation to that “strangely addictive and debasing
about the social function of humility, as well as for- cocktail of vanity and public opinion” (Bockmuehl,
giveness. We will briefly consider biblical and con- 1998, p. 110).
temporary psychological views on humility. It appears that the Philippian church was at risk for
206 CONTEXTUALIZING HUMILITY AND FORGIVENESS
experiencing division due to some “selfish ambition” Creator, utterly dependent and trusting. Here one is well
or what Fee (1995) calls “posturing” (p. 33). It is possi- aware both of one’s weaknesses and of one’s glory (we are in
his image, after all) but makes neither too much nor too little
ble that the social values of the prominent Roman
of either. True humility is therefore not self-focused at all, but
colony of Philippi were influencing some members in rather, defined by Paul in v.4, “looks not to one’s own con-
this posturing. Paul holds out the sacrificial example cerns but to those of others.” (p. 188)
of Christ’s humility in going to the cross (Phil 2:5-8) as
Rather than social comparison or self-denigra-
an alternative to selfish ambition and vain conceit.
tion, Paul is encouraging the Philippians to humbly
This raises several questions about the meaning of bib-
care for others and to put their concerns ahead of
lical humility. First, does humility mean considering
their own. The goal is one of mutual love and honor-
everyone better than oneself? If so, this would seem
ing others in a Mediterranean cultural context where
to create a tremendous burden of social comparison
honor and shame were the core social values (Mali-
that would be contrary to the values of most contem-
na, 1993). The Greek word for “better” in verse 3
porary western psychologists and therapists. Second, ( ) can also be translated “surpassing”
is self-disparagement or abasement a central feature of and does not suggest a comparative evaluation of the
humility? Again, this would make humility contradic- worth of others (i.e., “consider others more worthy
tory to most contemporary western models of healthy than yourselves”) (Fee, 1995). Instead, we concur
human development. with Fee’s (1995) interpretation that Paul is saying
Social comparison. Interpreting Paul’s exhorta- “consider the needs of others in the community as
tion to “in humility consider others better than your- surpassing your own and care for them.” Bockmuehl
selves” (Phil 2:3) requires understanding the occa- (1998) points out that the central social dynamic that
sion of the letter to the Philippians. Paul does not distinguishes the Christian view of humility from the
use the more serious language of “division” or “strife” Greek is the “non-hierarchical intent [of Christian
in this letter as he does in First Corinthians (1 Cor humility]: it governs relations between people who
1:10-12). This suggests the tensions Paul has in mind are in principle equals, and is not a cliche for exces-
at Philippi, such as that of Euodia and Syntyche (Phil sive deference to superiors” (p. 111). Thus, it appears
4:2), are basically between friends within the Chris- that the biblical view of humility, at least as devel-
tian community (Fee, 1995). Therefore, Paul is not oped by Paul in Philippians, is consistent with an
commending an attitude of considering oppressive egalitarian social ethic. Christian humility involves
or abusive people morally better than oneself. In the willingness to take a humble relational posture
fact, he does not even seem to be encouraging the (when appropriate) by surrendering the motives of
Philippians to consider everyone better than them- selfish ambition and grandiosity while considering
selves because he refers to a certain group he consid- the needs of others above one’s own. This is qualita-
ers to be destructive “enemies” (Phil 3:18). Paul tively different from the false humility of perpetual
seems to be encouraging a capacity to consider some self-denigration or a need for self-abasement. This
people “better than” oneself while still being able to understanding counters the position of Nietzsche
critique the character and values of some other (1886/1989), who despised both Christianity humili-
destructive persons. ty because he believed it did represent a false defer-
Self-disparagement. We must also determine the
ence that masked true motives (see Roberts, 1982).
precise meaning of humility in Philippians 2:3 and
whether humility requires self-denigration. Several Contemporary Western Psychological
biblical scholars have argued that the kind of humili- Views of Humility
ty Paul is encouraging is not one of self-disparage-
ment, abasement, nor low self-esteem (Bockmuehl, How might contemporary western psychology
1998; Fee, 1995; Grundmann, 1972; Hawthorne, view this biblical understanding of humility? 1
1987). Fee (1995) explains the meaning of humility Gassin is correct that there has been very limited
in Philippians 2:3 in this way: consideration of humility in contemporary western
psychology (for reviews, see Exline, Campbell,
Humility is not to be confused with false modesty, or with that
kind of abject servility that only repulses, wherein the “humble Baumeister, Joiner, & Krueger, 2000; Emmons,
one” by obsequiousness gains more self-serving attention than
he or she could do otherwise. Rather, it has to do with a prop- 1Thisis not to imply a uniformity in contemporary western psy-
er estimation of oneself, the stance of the creature before the chology but simply a way of framing some general differences.
SANDAGE and WIENS 207
2000; Tangney, 2000), so there are no well-devel- restrict the self, and they can actually increase the
oped psychological theories of humility. Neverthe- kinds of self-consciousness and interpersonal
less, we will outline a few areas of potential disso- defensiveness that prohibit caring for others
nance and rapprochement between Eastern (McMinn, 1996; Tangney, 1995). A shame-prone
Orthodox and biblical views of humility and con- fragile sense of self can lead to defensive narcissism
temporary western psychology. (Sandage, 1999; Tangney, 2000), and narcissism is
First, contemporary psychologists in the west certainly contrary to humility, empathy, and forgive-
would probably advocate for more emphasis on ness (Emmons, 2000; Exline et al., 2000; Tangney,
self-care and personal boundaries than is evident in Fee, Reinsmith, Boone, & Lee, 1999). Empathy
either Eastern Orthodoxy or New Testament litera- may be a vital dimension of humility or at least a
ture. Even if Paul’s exhortation in Philippians 2:3 closely related virtue (Emmons, 2000; Means et al.,
to “consider others better than yourselves” is not 1990; Sandage, 1999). Empathic humility involves
universal and does not mean self-denigration, it the ability to accurately perceive the needs of oth-
does run counter to the individualistic cultural val- ers (cf. Phil 2:3), as well as the ability to forgive by
ues that dominate parts of the United States (U.S.) viewing oneself as morally similar to offenders
and some other western nations. Many clinicians (Exline et al., 2000).
in the U. S. could probably quickly think of clients Contemporary psychologists might also be con-
whose problems involve a self-defeating proclivity cerned to distinguish mature humility from the kinds
to view others “as better than themselves.” This dis- of pathological shame and self-abasement that can
crepancy can be mitigated by realizing that Paul is become ego-syntonic. Simone Weil (1951/1973), a
not prohibiting what contemporary psychologists social philosopher and spiritual writer, described the
would call “self-care” even if it is given much less potential dark side of shame-proneness that differs
emphasis than in our contemporary therapeutic from genuine humility by suggesting “consciousness
culture. Jesus himself practiced a form of spiritual of sin gives us the feeling that we are evil, and kind of
self-care that placed limits on the amount of ser- pride sometimes finds its place in it” (p. 109). Weil
vice he offered to those in need (Mark 1:35-38). succinctly captures the irony of how self-satisfaction
Self-care and humility actually form a healthy in false humility or even one’s own need for forgiv-
dialectic that represents spiritual and emotional ingness can be a way of assuming “the moral high
maturity. Self-care practices (e.g., prayer, sleep, ground” in relationships.
nutrition, exercise) contribute to the energy need- Millon (1996) describes masochistic personality
ed to humbly care for others, and humility con- disorder as involving self-denigration and abase-
tributes to the dynamics of a healthy community ment that is ego-syntonic. Individuals with such
that benefit both self and others. self-defeating personalities usually have painful rela-
Second, contemporary western psychologists tional histories of abuse or neglect (or both), and
would probably be eager to have humility distin- Millon suggests that they can be unconsciously
guished from low self-esteem or shame-proneness motivated toward an excessive self-sacrifice that
(Exline et al., 2000; McMinn, 1996; Means, Wilson, obligates or shames others. It is important to distin-
Sturm, Bion, & Bach, 1990; Tangney, 2000). guish humility from such self-destructive masochis-
Emmons (2000) explains: tic propensities. The Eastern Orthodox practice of
encouraging victims to apologize for the sins of
To be humble is not to have a low opinion of oneself; it is to
have an opinion of oneself that is no better or worse than
their offenders, as described by Gassin, seems high-
the opinion one holds of others. It is the ability to keep one’s ly questionable in this regard. A core fear of many
talents and accomplishments in perspective . . . to have a victims of abuse is that they are either culpable for
sense of self-acceptance, an understanding of one’s imper- the abuse or capable of becoming abusive them-
fections, and to be free from arrogance and low self- selves. These fears would seem to be exacerbated
esteem.” (pp. 164-165)
by a practice of victims apologizing for the sins of
Tangney (2000) likewise defines humility as their offenders. On the other hand, the cultural
including an accurate self-assessment and relatively context and religious rituals of Eastern Orthodoxy
low self-focus. Humility involves an ability to view might prevent such practices from producing the
oneself from a broader perspective (Exline et al., same psychological consequences as would occur
2000). Conversely, shame and low self-esteem in western individualistic contexts.
208 CONTEXTUALIZING HUMILITY AND FORGIVENESS
Figure 1.
CRYSDALE’S INTEGRATIVE MODEL involves oppression. Along with many liberation and
Cynthia Crysdale (1999) has developed an inte- feminist theologians, Crysdale argues that the gospel
grative theological model of the cross and the resur- speaks to disempowered victims of oppression of a
rection in her book, Embracing Travail: Retriev- loving God who identifies with innocent victimiza-
ing the Cross Today, which weaves together tion yet overcomes evil with good (also, see Volf,
1996). For the oppressed, the gospel first offers heal-
feminist, evangelical, and liberationist theological
ing for the wounds of social shame (Jewett, 1997)
perspectives. Crysdale records some of her own
and an affirmation of selfhood and voice (also, see
journey of wrestling with how to personally and the-
Cone, 1991; Jones, 1995).
ologically reconcile her evangelical background with
One of the unique dimensions of Crysdale’s
the truth she has found in feminist and liberationist
(1999) contribution is her suggestion that both sides
Christianity. Her work is integrative at several levels.
of the cross (i.e., the healing of wounds and the for-
For example, she integrates theories from both the-
giveness of sins) are ultimately relevant to every per-
ology and the social sciences, and she is well-attuned son in order to break the victim-perpetrator cycle.
to the spiritual struggles of both individuals and Social location influences the side of the cross that
social systems. What makes her model particularly represents a person’s primary initial need. A victim
relevant to our discussion is her integration of for- of oppression needs the empowerment of voice, but
giveness and empowerment. We suggest that her eventually that person also needs to experience
model goes beyond many traditional Christian theo- repentance and the forgiveness of sins. A person
logical views of the cross and offers a sound and just from a position of social privilege needs to experi-
theological foundation for understanding the social ence the humility of repentance and the grace of
dynamics related to humility and forgiveness. being forgiven, but eventually that person also needs
Crysdale’s (1999) major thesis is that Christians to grow into the empowerment of true voice. It
can affirm “two sides” to the cross and resurrection seems to us that western psychotherapists have tend-
(see Figure 1). Traditional orthodoxy has empha- ed to focus on the side of the cross that involves the
sized the gospel’s promise of forgiveness of sins for healing of shame and woundedness and the empow-
those who are humbled by the cross into repentance. erment of voice without necessarily using the theo-
This side of the cross speaks most directly to those logical language. Evangelical Christian churches have
who come from a place of privilege and social focused on the side of the cross that invites humility,
power. Crysdale suggests that the other side of the repentance, and offers the forgiveness of sins. Based
cross is primarily for those whose social location on Gassin’s description, Eastern Orthodoxy also
SANDAGE and WIENS 209
appears to focus on humility, repentance, and the denigration or accepting “too much limitation” (pp.
forgiveness of sins. However, much is lost when 128-129) among oppressed groups of people. She
either side of the cross is neglected. warns that an over-emphasis on humility can exacer-
We will briefly highlight three theological themes bate this problem for people who already struggle
from Crysdale’s model that are relevant to an with self-denigration (also, see McMinn, 1996).
approach to forgiveness that integrates both sides of A call to name one’s victimization is part of over-
the cross . These themes include suffering, sin, and coming the effects of evil and sin. Crysdale (1999)
salvation. writes,” ‘Confess your sins’ and ‘embrace your
wounds’ are both true” (p. xii). The redemptive
Suffering drama of the bible describes a God who sees inno-
The title of Crysdale’s book, Embracing Travail cent blood crying out from the ground (Gen 4; see
(1999), is the major motif for her model. Embracing Volf, 1996) and promises to bring ultimate justice.
travail is likened to the process of giving birth, and it Integrative models of forgiveness will need to give
speaks to the centeredness of being that is open to much greater attention to the relationships
new life including both the pain and the responsibili- between interpersonal forgiveness, systemic sin,
ties involved. She suggests grief and suffering are and social justice.
often pathways to healing (and probably forgiveness,
see Augsburger, 1997; Layton, 1998), yet she is con- Salvation
cerned about a theology that over-valorizes suffering Crysdale (1999) argues that salvation involves
or martyrdom. Over-valorizing suffering can be an both sides of the cross (forgiveness of sins and heal-
insidious way of maintaining social hierarchies and ing of wounds), and both sides are eventually impor-
keeping power from those who are oppressed. tant for everyone. She explains, “Sooner or later, in
While some project evil onto others to justify domi- some form or other, one must discover oneself as
nation, others have been socialized to introject evil both a crucifier and a victim. The failure to do this
into themselves, resulting in a theology of self-deni- can lead to self-righteousness on the one hand or
gration and self-defeating shame. In contrast, Crys- self-immolation on the other” (p. 20). Salvation leads
dale points out that Jesus refused to project or intro- to a process of transformation or sanctification that
ject evil. Crysdale’s work challenges us to consider means “completing the circle: victims discovering
how we socialize people into the sacrificial virtue of responsibility and perpetrators embracing wounds
forgiveness and whether issues of voice, power, and ... the cycle becomes not victim-perpetrator-victim,
boundaries are also part of that socialization. A but healed-forgiven-healed” (pp. 23-24). The Eastern
Christian integrative model of forgiveness and Orthodox theology that Gassin describes might res-
empowerment should suggest the importance of onate with Crysdale’s process-oriented view of salva-
helping people overcome tendencies to either pro- tion and sanctification, though the contextualized
ject or introject evil. socio-political dimensions of Crysdale’s model do
not seem to find any parallel in Gassin’s account of
Sin Eastern Orthodoxy. Also, the concern about self-
Sin has been traditionally viewed as pride, arro- immolation and the need to discover healing for
gant ambition, or narcissism by many Christian the- one’s victimhood might run counter to the world-
ologians (Crysdale, 1999; Volf, 1996), and pride view of persons from an Eastern Orthodox tradition.
seems to be a dominant sin motif in Eastern Ortho- Crysdale (1999) goes on to develop her view of
doxy (Gassin, 2001). But Crysdale (1999) effectively salvation by suggesting that the resurrection calls for
argues that narcissism is not the universal core the risk of voice, telling the story, and the discovery
dynamic of sin. Other themes and metaphors for sin of discovery. Again, she integrates the spiritual and
are needed in order to generate contextualized mod- the socio-political in her use of the resurrection as a
els of forgiveness and reconciliation. For example, salvific motif by explaining,”Some people inherit a
Volf (1996) suggests exclusion of those we find dif- presumption of voice and the confidence to know
ferent, strange, or “outgroup” is an important dynam- they are knowers. Others are socialized into silence
ic of sin that wars against forgiveness and reconcilia- and are carefully ‘protected’ from discovering that
tion. Crysdale suggests that sin can take the form of they can make discoveries” (p. 76). Western litera-
210 CONTEXTUALIZING HUMILITY AND FORGIVENESS
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can Psychological Association, Boston, MA. health, adolescents.
Deconectare, Depresie si spiritualitate: Un stiudiu despre rolul
Abstract
Introducere
Spiritualitatea
Spiritualitate si depresie
Curs de tratament
Teme comune
Spiritualitatea
Definirea spiritualităţii
În timp ce starea de spirit generală a acestor participanţi în timpul depresiei a fost cea de
deconectare din spiritualitatea lor, spiritualitatea a jucat încă un rol în ajutarea multor sa facă
faţă acestora stari întunecoase. Toti cei 15 participanţi au recunoscut spiritualitatea ca una
dintre metodele lor de coping. Când întrebati despre cum se confruntă cu depresie, termenul
de "Dumnezeu" a fost prezent în rândul tuturor participanţilor.
Din cei 15, o fata a simţit că Dumnezeu a abandonat-o, dar a indicat, în acelaşi timp că pe ea
spiritualitatea ei a împiedicat-o de la sinucidere. "Uneori, eu vreau doar să merg acolo
repede la Dumnezeu. Şi cred că singurul lucru care mi-a ţinut să facă aceasta este faptul că
mi-au spus ca o să ard în iad ", a spus ea. Două persoane au crezut în posibilitatea ca
spiritualitatea ar putea aduce vindecare, dar a trebuit încă să-l aduca aceasta experienţă în
viaţa lor. Un participant a indicat, "Eu caut pentru că eu cred. Şi aş vrea să pot simţi. Aş vrea
să pot simţi căci eu cred ...rugăciunile mele private sunt pentru a-mi deschide inima ". Restul.,
într-o măsură variabilă, au recunoscut spiritualitatii rolul pozitiv jucat în viaţa lor. Un
participant care a luptat cu durere cronica a descris rolul jucat de spiritualitate:
Prima dată când m-am dus înapoi la biserica a fost la începutul lunii februarie şi a fost
prima oară când am simţit pacea în peste un an. Nu am simţit durerea mea (in biserica). Vreau
să ma sinucid, dar apoi speranta venea înapoi, atunci când am imi citeam Biblia... este ca un
fel de furnicături, senzatia care trece prin corpul meu. Eu nu pot explica, dar este pace,
bucurie, şi dragoste. Toate într-un mod necondiţionat .... Uneori am, de asemenea, acest
sentiment coplesitor, şi ştiu că există, fie cineva acolo care se uita la mine, fie este îngerul
meu pazitor sau un înger .... Începe prin stomacul meu sau prin umeri. Este un sentiment ca si
cum am fost atins. Este ca şi cum cineva pe care il iubesti vine sa te atinga.
Un alt participant a declarat, "Când mă gândesc la asta [o putere mai mare], chiar şi numai
gândind despre asta, ma face sa ma simt mai bine". Un participant de sex masculin care a fost
spitalizat de mai multe ori, a raportat: "Nu m-am simţit sinucidal într-o perioadă lungă, doar
în depresie, şi cred că motivul pentru care aspectul suicidare nu a venit e spiritualitatea". Un
alt participant a împărtăşit o experienţă similară: "Aceasta nu mă lasă să mă omor oricât de
mult am încercat [să ma sinucid], deoarece nu vreau să merg în iad ... depresia te face să te
simţi deconectat de la alţii, dar simţi că Dumnezeu este mereu cu tine, indiferent cât de greu
este. "
Sensul
Problema sensului este adesea conceptualizat în ceea ce priveşte scopul în viaţă. Scopul poate
fi obţinute din ataşamentul fata de oameni, cum ar fi prietenii şi familia sau implicarea în
anumite activităţi, cum ar fi cariera sau de recreere. Scopul poate fi, de asemenea, exprimat
prin explicaţii teologice sau teoretice pentru lupta existenţiala a persoanelor. Intenţia
acestui studiu a fost de a lăsa deschisă întrebarea astfel încât participanţii au putut să răspundă
în conformitate cu înţelegerea lor actuală a termenului "sensul". Pentru majoritatea dintre
participanţii la acest studiu, sensul a constat în capacitatea lor de a explica situaţia traumatică
în care s-au găsit ei înşişi. Este interesant de observat că 13 din cei 15 participanti au văzut o
legătură strânsă între spiritualitate si sensul vietii. Ceilalţi doi participanţi, deşi nu în mod
explicit au facut o conexiune a sensului cu spiritualitatea, cred în Dumnezeu. Unul dintre cei
doi participanţi defineste spiritualitatea ca având o relaţie cu Dumnezeu şi s-a crezut că sensul
este atins atunci când el este conectat. Sensul, pentru acest participant, a fost legat de
capacitatea de a găsi o explicaţie pentru evenimentul lui traumatic.
Cum se reflectă în descrieri ale participanţilor la acest studiu, persoanele cu
depresie au o dorinta intensa de a face sens din experienţa lor cu depresie. Ei
vor sa stie de ce trebuie să treacă printr-o astfel de experienţă şi au nevoie sa inteleaga
că această suferinţă nu este în zadar, că există un anumit scop ataşat la aceasta. Treisprezece
de 15 participanţi au exprimat aceasta dorinta de a face sens al experienţei lor cu
depresia. O tanara participanta a declarat:
L-am întrebat pe Dumnezeu de ce atunci când am fost abuzata sexual de către tatăl meu. Am
ajuns la concluzia ca poate că acest lucru imi poate permite sa-i ajut pe alţii. Dar când am fost
abuzata a doua oară de [fratele meu], nu avea sens ... lucru pe care m-am lupta cu este, de ce a
trebuit să se întâmple de două ori? De ce a fost fratele meu un pic ca tatal meu? Intotdeauna
am crezut că totul se întâmplă pentru un motiv, că fiecare situaţie nu poate fi doar pozitiva.
Dar ce scoti din ea poate fi pozitiv şi asta este ceea cu ce ma lupt eu acum.
S-a întâmplat o dată şi trec prin chestiile astea, dar de ce de două ori ...de ce... Cred că
depresia mi-a deschis cu adevarat ochii la spectrul de durere şi de suferinţă care
cred că sunt importante în viaţă. Că nu poţi pe deplin experienta fericire, până când pe deplin
nu experientezi durerea. Tu nu stii fericirea până când nu ştii durerea.
Un student la muzică descrise căutarea pentru înţelegerea de sine prin explorarea
credinţele religioase din diferitele tradiţii religioase, cum ar fi hinduism, budism, Zen şi
altele. "Depresia ma face sa ma cine sunt eu si nu voi fi asa cum sunt fara ea. Odată
ce iesi din depresie, poti realiza modul în care aceasta vă ajută cu perspectiva in viata. " O altă
încercare comuna de a face sens din depresia acestora în raport cu Dumnezeu a fost de a
spune "Dumnezeu ma pune aici cu un scop. Nu ştiu acum. Chiar acum am nevoie pentru a
găsi scopul. Sunt disperat dupa scopul meu. Ştiu că Dumnezeu are unul pentru mine, dar eu
nu stiu care este". În timp ce unii ar putea să nu ştie de ce a trebuit să mearga prin
depresie, au existat câţiva care au crezut ca depresia sa întâmplat, pentru a-i aduce
înapoi la Dumnezeu. "Am cam simtit ca depresia trebuie să fi fost ca o bataie la uşa mea de la
Dumnezeu să mă trezesc". Sau cum a declarat o alta participanta care s-a afiliat cu Cruciada
Campusului: "Simt ca acest lucru este tot o parte din mine pentru a-L cunoaşte pe Dumnezeu
mai bine ... Eu mă vad în cele din urmă apropiindu-ma, ştiindu-L mai bine". Pentru cei mai
multi participanti., depresia a fost instrumentul care le-a permis de a servi mai bine altora.
"Cred ca singurul lucru pe care într-adevăr il urmaresc cu nerăbdare în restul vietii mele este
doar posibilitatea de a ajuta alţi oameni ...pe care este mai bine să-i ajute mult
cineva care a fost deja prin foc sau iad". În conformitate cu o participanta, "Cred ca depresia,
probabil ma ajută să ma facă mai sensibila sau conştienta de ceea ce oamenii
trec prin atunci când sunt în acest tip de situaţie". Un participant a declarat." Eu cred că
suferinţa noastră este pentru binele altora. "
Din 15 participanţi, unul a ataşat sensul cu familia sa. Trei au văzut depresia ca o
parte din planul lui Dumnezeu pentru a-i aduce mai aproape de Dumnezeu. Restul au crezut
ca depresia i-a făcut mai plini de compasiune şi le-a permis să fie mai capabili de a ajunge la
alţii si a-i intelege.
Acceptarea
O altă temă interesantă a fost locul acceptarii în viaţă în ceea ce priveşte situaţia lor sau
experienta de depresie. Conceptul de acceptare articulat de către participanţi
părea să fie strâns legat de speranţa lor pentru viitor şi sentimentul lor de vindecare. Din cei
15 participanţi, 12 s-au descris ca vin la termeni oarecum cu situaţia lor de viata. Unul dintre
acesti 12 a recunoscut importanţa renuntarii, cu toate că a admis că ea nu este la acelnivel în
viaţa ei. Ceilalti trei nu au prezentat nici o indicaţie a faptului că au ajuns la un acord cu starea
lor. Prezenţa de luptă a fost evidentă la acesti trei. Această temă de acceptare a fost exprimat
în mod curent în două forme: acceptarea situaţiile neplăcute din viaţa lor sau de acceptare a
depresiei lor (recunoaşterea faptului că aceştia va trebui să continue să trăiască cu depresie la
un anumit nivel).
Acceptarea circumstantelor vietii
Acceptarea depresiei
Pentru cei mai multi participanti cu depresie, impacarea cu depresia lor a fost un
pas important în procesul de vindecare. Un participant a clarificat frecventele interpretari
gresite a vindecarii în înţelegerea ei: "având depresie nu înseamnă că nu sunteţi
vindecat". Pentru alţii, a fost despre posibilitatea că încă ar putea exista viaţă cu depresie.
"Cred că am început să constat că depresia nu este, probabil, cel mai rău lucru din
lume care se poate intampla". Un alt participant a declarat: "Obişnuiam să cred că depresia
este ceva ce se poate evita, dar acum am înţeles că nu este aşa. Este ceva
că se întâmplă cu oameni diferiti pentru diferite motive. Acesta nu este ca si cum aveţi o
alegere. Eu nu cred că va disparea pentru totdeauna".
Acceptarea de depresie pot fi, de asemenea, reflectata în capacitatea de a accepta negativ
emotii. Un participant dintr-o familie abuzivă a declarat: „Sunt un pic deprimat acum. Voi
trece peste asta, dar înainte, niciodată n-am crezut că, da,
este ok să ma simt trist. Înainte când am fost într-un fel de etapă de negare, era ok ca sunt trist,
dar eu nu ar trebui să am sentimentul trist acum, deoarece nu sa intamplat nimic, nu este mare
lucru şi lucruri de genul asta. Dar acum ştii ce, sunt trist ... Eu pot plânge,eu pot trece
prin asta”. Aceasta capacitatea de a imbratisa depresia a fost, de asemenea, exprimate în
raport cu spiritualitatea. Un participantul credea că a avea o relaţie cu Dumnezeu însemna
"aducerea lui Dumnezeu în tot ce se întâmplă. Ea poate fi durere. Ea poate fi nimic. Dacă este
durere, te duci la Dumnezeu în durerea aceea, şi dacă este bucurie, acelaşi lucru. Eu încerc
întotdeauna să fac tot posibilul să-l accepte de acum. Poate ca, de asemenea, conceptul
spiritual poate aduce predarea".
În final, dacă a fost acceptarea circumstantelor vietii sau a depresiei, vindecarea a avut de a
face cu una din doua.
Reflecţii teologice
Concluzii