This article is part of a series written for mental health providers treating OCD. It can be found with minor edits on the International OCD Foundation’s Faith & OCD page. 

Acknowledge Your Limits- Your Role & The Role of Assessment

Therapy is an application of psychological science; it is not a worldview; therefore, it can only at best explore, not answer, questions about religion, spirituality, faith, and purpose.  In other words, it cannot tell you what to believe.  Undeniably, in the exploration process many come to find various answers.  Therefore, when working with any one person, specifically someone who adheres to a specific tradition or belief, it is crucial to acknowledge therapists’ limits.

• Guard against counter-transference!
• You will need to “dust off” those assessment skills!
• Determine what a client believes by asking them.
• Clarify, clarify, clarify.  
• Don’t make assumptions.  
  • Examples:
    • If a person states they’re Jewish, don’t assume they celebrate Yom Kippur.  Ask.
    • For someone who identifies as “spiritual, not religious,” ask if they wish to share, “In what ways is spirituality important to you?  What specific things do you do or ways do you think in relation to your views and practices?”
    • This extends even for those who have no faith, atheists, and agnostics.  “Tell me more about your experience as an atheist.  Is there anything important for me to know?  What does life look like in the context of being an atheist?”
    • Don’t start referencing the Bible, Koran, The Book of Mormon or anything simply because a person says they’re Christian, Muslim, Mormon, and so forth.

Incisive questions lead to better assessment which provides the opportunity for better treatment.  I have discovered over the years that many clients who don’t believe in God find it very important to talk about this and how difficult it is for them in their world- where they may be a minority group.

Tolerate Your Own Uncertainty and Lack of Expertise

You certainly don’t have to be an expert in religious beliefs- in fact, it would be rare if you were, as most clinicians focus their careers on clinical work. Only a minority of clinicians will have some secondary or additional spiritual or religious training.

Openness To Learning

Curiosity and openness is crucial for a growth mindset and in much of therapy (especially for those of us who are CBT clinicians).  It’s not only clients who must grow in their openness to learn.  Therapists are hopefully growing and learning regularly.

Training

You may need to get extra certification and training.  As already noted, few people will get a whole degree additionally.  Most therapists don’t have to.  While the IOCDF does not have any official recommendations, simply ask around.  There are many CEU/CMEs, certifications, programs, and clinic/hospital internships that will strongly set you up for success.

Reading

Don’t underestimate the power of reading.  Often we assign patients bibliotherapy.  Other views and reading in “black and white” often sit differently.  Jump to the end to consider some resources on sensitive integration.

Curiosity

Let’s not forget that good ol’ fashioned curiosity is part of what makes science move forward, and it’s better for relationships, ostensibly even therapeutic ones.

Let Clients Teach You

This is multicultural sensitivity 101.  No one person will be able to naturally understand every culture, condition, diagnosis, or experience.  While some clients may strongly desire for their clinicians to be experts in OCD treatment and share all the same faith beliefs, it’s unrealistic that all these factors will line up perfectly.  Using kindness, our training, and practical communication skills, clients willing to work with you will often be willing to teach you if you are open to learning.  Let them teach you so you can best serve them.

Keep it simple.

• Ask good questions.
• Feel free to say the three words: “I Don’t Know.”
• Let your client teach you.
• Start with simple questions in the intake process (both forms and meetings).
• At a minimum, R/S beliefs (or non-beliefs) are a part of cultural competency and appreciation for diversity.

7 Competency Keys

Vieten et al. (2016), posit in their research some excellent considerations for competency in R/S beliefs.  Here’s a brief overview from Vieten (2020):

• “Being able to conduct effective and empathic psychotherapy with clients from diverse religious and spiritual traditions.
• Routinely asking about clients’ spiritual and religious beliefs and practices as part of taking a client’s history and assessing their resources and strengths.
• Knowing ways that some religious and spiritual experiences mimic psychiatric symptoms, and being able to discriminate between the two.
• Knowing the difference between spirituality and religion, and being able to address both domains in psychotherapy.
• Being aware of therapists’ own biases based on their religious and spiritual background and beliefs.
• Treating religious and spiritual background as just as important as racial, ethnic, and socio-economic background in terms of diversity.
• Knowing how to work in concert with spiritual directors or clergy members in clients’ treatment when appropriate.”

Resources

Cashwell, C. S., & Young, J. S. (2020). Integrating spirituality and religion into counseling: A guide to competent practice. American Counseling Association.

Gill, C. S., & Freund, R. R. (Eds.). (2018). Spirituality and religion in counseling competency-based strategies for ethical practice. Taylor & Francis.

Kahle, P. A., & Robbins, J. M. (2004). The power of spirituality in therapy: Integrating spiritual and religious beliefs in mental health practice. Haworth Pastoral Press.

Vieten, C., & Scammell, S. (2015). Spiritual and religious competencies in clinical practice: Guidelines for psychotherapists and Mental Health Professionals. New Harbinger Publications, Inc.