Hail satan, As-salamu alaykum, Namaste, Mazel tov, and thank god

Being a therapist in Southern Louisiana means that many of my clients have grown up with religion and that their religion/faith is an integral part of their life. It also means that many of my fellow therapists are religious, with most of the clinicians I know here in Lafayette ascribing to some form of Christianity. What is interesting to me though, is how many of my peers practice their faiths overtly within their therapist roles. They speak about their faith in specific ways, display religious content (like Bible verses or crosses) in their offices and on their social media, offer to lead prayer during sessions, advertise their willingness to provide Christian counseling...and more. And let me be specific here, these fellow therapists are not Board Certified Christian Counselors. They are Licensed Professional Counselors (and much more rarely, Licensed Clinical Social Workers). And I see this as a huge problem.

Before we get too far into this conversation, I want to make clear that I am a supporter of someone's faith being a source of peace, direction, and healing in their life. The National Alliance on Mental Illness (NAMI), American Counseling Association (ACA), American Psychological Association (APA), and other large therapy-oriented organizations and governing bodies all have resources for and ample references of research supporting religious faith as a tool for and source of improved mental health (some of which you can see for yourself by clicking those links).

Some benefits of religion on mental health listed by those organizations include, but aren't limited to:

• connection with members of a group and sense of belonging
• improved coping with difficult situations and life experiences
• clear guidelines from which to live
• routine and predictability; meaningful ritual
• opportunity for development of values and valued living
• exposure to the arts, such as singing, dancing, theatre, poetry, etc.
• ability to do meaningful and impactful deeds for the community

Most of the world's population report being religious or spiritual in some way, so knowing how to navigate this piece of someone's identity is an important factor of culturally-competent care (Ellis et al., 2022). A quick search of one psychology subject research database produced over 13,000 articles focused on religion and mental health, the majority of them being focused on the previously mentioned benefits of religion and spirituality on mental health, coping, and resilience. So heavy is the disparity between research exploring the benefits of religion and research exploring its harms, that I believe mental health clinicians have a blind spot to the latter. 

Now let's get back to that huge problem i mentioned earlier

When I am on social media (which I am a lot) and when I talk with clients, I see and hear so many examples of fellow counselors leading with their personal religious beliefs. And each time this happens, I am immediately brought back to the American Counseling Association's Code of Ethics, specifically Standard A.4. Avoiding Harm and Imposing Values.

A.4.b. Personal Values Counselors are aware of—and avoid
imposing—their own values,  attitudes, beliefs, and behaviors.
Counselors respect the diversity of clients, trainees, and research
participants and seek training in areas in which they are at risk
of imposing their values onto clients, especially when the
counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.

The part that feels most relevant and most explains my immediate reaction to overt religion in the therapy realm is that very first bit:

Counselors are aware of - and avoid imposing - their own values, attitudes, beliefs, and behaviors.

What does it mean to impose your values, attitudes, beliefs, and behaviors on someone? At its most basic, imposing on someone is forcing something (in this case, religion) on someone without their consent. What is it like for someone coming into the therapy space for the first time to come face to face with scriptures and/or symbols from a religion that is not their own? Even when a therapist is a part of and displays content from a specific religion is the dominant faith of a culture, it's impossible to know ahead of time whether a client ascribes to that same faith or not, if they are seeking therapy for an issue or trauma related to religion, or if they are interested in religion at all, let alone whether they would like it to be a part of their therapy.

Religious trauma/religious abuse is gaining research attention as of late, though I have rarely heard it talked about in my local community (and never heard it mentioned in graduate school). In reading the literature on the prevalence of religious trauma, some estimates have been as high as nearly 75% of adults endorsing having been "damaged by a church experience" (Oakley, Kinmond, & Humphreys, 2018). This is likely to become a larger issue as time goes on, with fewer and fewer people attending religious services (with a 2024 Gallup poll finding that only 3/10 adults attending church "regularly") and as millennials are actively parenting children and processing the influences of the religious majority of their childhood in the 80s and 90s.

Understanding the religious and spiritual beliefs of clients is one factor of being a multiculturally-competent clinician; however, even more important is being aware of the intersectionality of religious/spiritual and other sociocultural identities that can lead a client to be more vulnerable to religious/spiritual abuse and trauma. Being trauma-informed means being acutely aware of and practicing from a place that is intentional about not causing further harm. It seems natural, then, that being trauma-informed would require religious neutrality.

It's a complicated dance, being an ethical therapist who is also fully human.

There isn't much research on how many mental health therapists are religious, but one 2012 study looking specifically at Licensed Psychologists found that while 95% of the general population endorsed some form of religious affiliation, only 66% of Psychologists did (Delaney, Miller, & Bisonó, 2013). We are taught through our graduate training that the most powerful therapeutic tool we have is ourselves - in all of our humanity - which includes our value systems. Practicing as ethically as possible while also allowing space for the parts of us tied with our most important values is incredibly difficult.

I believe that many of my peers who readily advertise their religious beliefs are doing so from a place of authenticity and passion, and I also actively work to recognize when my passions and values are showing up in the therapy space without being invited. For example, I actively choose to display books and art with a decidedly pro-LGBTQ+ message because being queer competent and affirming is something important to my practice and my personal values, and not all clients will agree with or ascribe to those beliefs in their personal life.

A call to action for my fellow therapists and clients alike

I'm not pretending to know the answer to the question requirement of ethical practice within the counseling world as it applies to imposition of values and beliefs. I'm also fully human.

I fully own and will advocate for my belief that it is unethical for therapists to display, advertise, or otherwise bring religion into the therapy space.

Fellow therapists:

I will continue to explore the topic, discussing with and challenging my fellow therapists who practice differently in this specific area. I challenge my fellow therapists here now to take the time to think about the things they share in their bios and on social media, the decor in their offices, etc. Imagine, therapists, if you stumbled upon my social media and saw in the bio and proud exclamation of "Hail Satan!" Take a moment, friends, to feel that in your body and listen to what your mind has to say about it. How is this statement in a bio any different from one that says "Christ follower" or one that mentions scripture? How might your overt religiosity be a trauma trigger for clients?

I should also confess that because I feel so strongly about this topic and believe it to be such an ethical problem, my likelihood of referring to overtly religious therapists is very small. Fellow therapists - would you be willing to refer to another clinician who was a vocal Satanist? Muslim? Jew? Atheist? Seventh Day Adventist? When you consider these hypothetical fellow therapists, how is your response different from the one you have with therapists who share your faith? And, my friends, what do you actually know about the faiths that differ from your own?

Suggested Sources to Learn More

There are a few recommendations I have for therapists who do desire to learn more about the numerous world religions and faiths, and some of them are included here:

• The Pew Research Center: they have a variety of data on religious topics, which can help clinicians and laypeople alike learn more about what majority and minority groups believe
• The CIA World Religion Factbook: this database is searchable and gives a broad overview of majority/minority worldwide religions
• The Parliament of the World's Religions: this group conducts regular events, has a mission of building religious tolerance worldwide (for example, through involvement with the United Nations), provides course for individuals and groups wanting to improve their religious literacy (the Seeking Religious Literacy online course), and more.
• The World Religion Database: hosted by Boston University, this website houses data related to religion from every country in the world, including "best estimates" of religions (including agnostics and atheists) from 1900 to 2050.
• The Religious Trauma Institute provides resources, training, and community for therapists, researchers, advocates and survivors of religious trauma.
• Religion 101: From Allah to Zen Buddhism, an Exploration of the Key People, Practices, and Beliefs that Have Shaped the Religions of the World by Peter Archer
• The Religions Book: Big Ideas Simply Explained by DK
• Who Believes What? Exploring the World's Major Religions by Anna Wills and Nora Tomm
• Understanding Religion: Theories and Methods for Studying Religiously Diverse Societies by Paul Michael Hedges
• Seek out continuing education on religion and therapy
• Consider the overt and covert ways that your own faith/religious beliefs sneak into your everyday life, especially with clients (e.g., offering prayers (even if just a way of stating support and empathy); unconscious reactions and body/facial language; affiliation with community groups/organizations, etc.) and how this may impact current and potential clients.
• Most importantly, expand your social circle to include people from different faiths. Hearing directly from loved ones who are experiencing life as part of the religious minority can be eye opening and help to bring to light some of those blind spots mentioned earlier.

Want to learn more about the relationship between ethics and religion? Check out the resources (especially the Competencies and White Paper) provided by the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC), a division of the ACA. I also recommend exploring the ACA's November 2023 publication on religious trauma here.

Clients and non-clinicians:

It's important to know what to expect from a potential (or current) clinician, so here are some things to know about me. I will continue, in my therapy room, to ask my clients how religion shows up or doesn't show up in their life and encourage them to explore that as much as they choose to. Beyond that, I will continue to be as areligious in my practice as possible. I will continue to have conversations, read literature, and consult with folks smarter than me on this particular standard of the ethical code. Being a clinician who is aware of and who intentionally avoids imposing my faith on clients is of utmost importance to me. In fact, beyond what would be a good guess based on my appearance and/or what I have shared in previous blogs/posts, I would like to think that most folks who stumble upon my professional online presence would not be able to say with certainty what my religious beliefs even are.

What if you are wanting your faith to be a part of your therapy?

This is something great to want for yourself! I would expect every clinician's intake paperwork to ask you about your current religion/faith system, so this is something your therapist should be aware of and feel comfortable asking you about. You are also welcome to bring it up more directly during any session in whatever form makes sense for you and your needs. It's also very reasonable, especially if it directly relates to your work in the therapy room, to desire to have a therapist who is familiar with your particular religion/faith, so this is something you can ask directly of your counselor. There are databases online where religious/secular therapists and clients can find one another, including but not limited to:

• Christian Counselor Directory
• Secular Therapy Project
• Muslim Therapist Directory

One of the major therapist directories, Psychology Today, also allows clients to search for therapists according to religion/faith along with many other characteristics (e.g., insurance, specialty, gender, etc.).

All of this being said, every licensed clinician should have the education and desire to be competent and effective with clients to the point that even if you, as the client, aren't able to find a clinician who has direct experience with your religious background or advertises their current commitment to that particular religion/faith, it may be worth giving them a chance. There are so many factors that have been shown to be important for the effectiveness of therapy, the main factor being that there is good rapport between clinician and client. Do they see me? Do they understand me, and do I understand them? Do I feel like they have my best interests in mind? If the answer to those questions is "yes," that is likely to be just right.

Clients, if you would like to explore the Ethical Standards from the ACA from which every Licensed Counselor should be practicing, you should! You can find them here: https://www.counseling.org/resources/ethics#2014code

It's also important to know that you do have the right to end any therapy relationship for any reason at any time.

Licensing boards also have specific ways for clients to report unethical behavior for review, so this is an option you should be aware that you have should you need it. If your clinician is a Licensed (or Provisionally Licensed) Professional Counselor here in Louisiana, you can learn more about your rights at the Licensed Professional Counselors Board of Examiners and file a complaint with the LPC Board here: https://www.lpcboard.org/file-complaint

Each state and each specific discipline within the mental health world will have its own ethical standards, licensing board, and complaint process, all of which focus primarily on the rights and protection of clients. Your individual therapist should do the same.

References

Delaney, H., Miller, W., & Bosonó, A. (2013). Religiosity and spirituality among psychologists: A survey of clinician members of the American Psychological Association. Spirituality in Clinical Practice, 1. 95-106. DOI: 10.1037/2326.4500.1.S.95

Ellis, H. M., Hook, J. N. Zuniga, S., Hodge, A. S., Ford, K. M., Davis, S. E., & Van Tongeren, D. R. (2022). Religious/spiritual abuse and trauma: A systematic review of the empirical literature. Spirituality in Clinical Practice, 9, 213-231. DOI: 10.1037/scp0000301

Jones, J. (2024). Church attendance has declined in most U.S. religious groups. Gallup. https://news.gallup.com/poll/642548/church-attendance-declined-religious-groups.aspx

Oakley, L., Kinmond, K., & Humphreys, J. (2018). Spiritual abuse in Christian faith settings: Definition, policy and practice guidance. The Journal of Adult Protection, 20. 144-154. DOI: 10.1108/JAP-03-2018-0005