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Should we add religious content to CT with religious clients?
Jim Pretzer · 2/3/99 at 3:28 PM ET
I stumbled across an interesting study recently: Propst, L. R., Ostrom, R., Watkins P., Dean, T., & Mashburn, D. (1992). Comparative Efficacy of Religious and Nonreligious Cognitive-Behavioral Therapy for the Treatment of Clinical Depression in Religious Individuals, Journal of Consulting and Clinical Psychology, 60, 94-103.
- ABSTRACT: Two versions of cognitive-behavioral therapy (CBT), one with religious content (RCT) and one with standard protocol (NRCT), were used to treat 19-20 religious patients each. Fifty-nine religious patients who met the Research Diagnostic Criteria for nonpsychotic, nonbipolar depression were treated in 18-20 1-hr sessions over 3 months. Religious and nonreligious therapists were used in each CBT group. Pastoral counseling (PCT) treatment-as-usual and waiting-list control (WLC) conditions each contained 10-11 patients. RCT and PCT patients reported significantly lower posttreatment depression and adjustment scores than did either the NRCT or the WLC condition. The CBT difference was due largely to superior performance of the nonreligious therapists (with dissimilar values to the patients) in the RCT over the NRCT condition. Improvement in the three follow-ups and greater than posttreatment WLC improvement levels.
In discussing their findings, the study's authors say "The most surprising finding in this study was the strong therapist-treatment interaction. Generally, there was a differential performance between cognitive treatments for the nonreligious therapists, with these therapists generally performing better in the RCT condition than in the NRCT condition. However, there was less difference in performance between the cognitive-therapy conditions for the religious therapists. This pattern was present on all four outcome measures, both self-report and interviewer evaluations. Additionally, the group showing the best performance on all measures was the RCT condition with nonreligious therapists, whereas the group with the worst pattern of performance was the NRCT with the nonreligious therapists."
So, should non-religious cognitive therapists make a point of addressing religious issues when working with religious clients? I'd argue that, in doing CT, I need to address the client's major belief systems which are relevant to the issues we are working in therapy. When working with religious clients, religious beliefs often will be important and need to be addressed whether or not I share those beliefs.
For example, this afternoon I saw a woman who was sexually abused by a neighbor when she was 8, who was raped twice as an adult, and who now has PTSD. She is an observant Catholic. It seems obvious that I need to address her beliefs about guilt and responsibility, many of which are religiously based, whether or not I am a Catholic (I'm not).
It's not that we need to add religious content to CT, it is that CT needs to address religious issues whenever they are relevant. Non-religious therapists may tend to overlook this either because religious beliefs are not important to them or because they are not familiar enough with clients' religious beliefs to recognize their relevance. After all, if I was not familiar with Catholic beliefs about guilt and responsibility, I could easily overlook their relevance to my client's PTSD.
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