The Varieties of Religious Therapy (VRT) is a blog series where representatives from twelve belief systems discuss how they integrate faith with their approach to psychotherapy. This installment is an interview with a psychologist and professor who is actively involved with the Church of Jesus Christ of Latter-Day Saints (LDS). See the Introduction for a full description of VRT and the table of contents.
The LDS Church is one of the fastest growing churches worldwide with a membership of over 14 million, including more than six million in the United States. Adherents (known informally as Mormons) follow theology proposed in the Christian Bible as well as the Book of Mormon and other writings that were revealed to founder Joseph Smith in 1823. Mormons are recognized for many unique qualities like their active missionary program, emphasis on family and maintaining a vice-free lifestyle.
Derek Hatfield (Ph.D., Ohio University) is an Associate Professor of Psychology at Indiana University of Pennsylvania where he teaches both undergraduate and doctoral-level courses. Derek's research interests include client deterioration in therapy, feedback systems alerting therapists to client deterioration, and clinical judgment and decision making. He's also a psychotherapist in private practice. Derek served a two-year mission in Osaka, Japan for the LDS Church after his freshman year at Brigham Young University. In his current church-related service, Derek has had the opportunity to council with members of the Church who struggle with various emotional and behavioral problems.
As I stated in the introduction, these responses are Derek's own personal views and should not be interpreted as official statements for the Church or representative of other LDS therapists. Having said that, enjoy these thoughtful responses from a faithful clinician:
What is the role of religion or spirituality in your clinical practice?
First, let me explain that I work as a traditional therapist in my role as a psychologist. If one of my clients does not want to discuss religion or spirituality, I do not force the issue with them (I find that this is often the case). However, when a client expresses interest in spirituality, I am willing to explore this with them. I have known therapists who will change the subject when these issues are raised, but I feel quite comfortable in these discussions. If a client talks about an experience with prayer, I accept it as a real experience and treat it as such. I view spirituality and religion as healthy and helpful aspects of life and I am supportive of clients who are pursuing this. I find myself taking extra caution to listen to the client's perspective on spirituality, to best understand their background and belief system. If the client has questions about their standing before God, forgiveness of sin, or similar matters, I believe it is best to encourage the client to counsel with their ecclesiastical leader. While I feel comfortable exploring spirituality if a client desires to, I do not believe that my role extends to that of the client's minister or spiritual advisor.
In the course of my service in the Church, I have had the opportunity to counsel with members who are struggling with depression, anxiety, and other "typical" clinical presentations. In this context, it is anticipated that I will council with them from an LDS perspective. In these situations I still utilize many of my normal clinical skills, but I will incorporate principles of faith in our discussions. Religion and spirituality are a major part of an active church member's life, and if these things are ignored, I would be missing a very important aspect of the individual's worldview. Latter-day Saints believe that God cares very much about our individual lives and that He can be intimately involved in our lives if we accept His invitation to be close to Him. So in this sense, helping members of the Church to draw closer to God would be an important aspect of counseling with them. This still leaves open the use of cognitive, humanistic, behavioral and other "traditional" interventions. I find that working with LDS people within an LDS perspective allows us to explore a more complete realm of the person's existence.
How does your technique or theory differ from mainstream psychotherapy?
As mentioned previously, techniques in my traditional clinical practice are fairly mainstream. I usually approach therapy with a cognitive conceptualization, frequently integrating client-centered techniques within this cognitive framework. I have also found contemporary psychodynamic interpersonal therapy to be helpful in some of my therapy cases. The differences between my techniques and mainstream psychotherapy are less stylistic or related to specific interventions.
Let me offer a specific example that will illustrate how my religious background influences my therapy work. Suppose a client discloses that he is cheating on his wife and feels guilty about his behaviors. He states that his wife does not fulfill all of his needs and that his mistress "fills in the gaps." I know therapists that would work at alleviating their client's guilt (I realize that not all therapists would do this, but I do know therapists that would). I believe that infidelity violates the commandments of God and I would not feel comfortable helping this client feel better about his behaviors. Rather than working to eliminate the feelings of guilt, I would explore with the client what meaning he derives from the feelings of guilt. After fully understanding the reasons he feels guilty, we could then discuss what he chooses to do as a result of it. It is sometimes the case that the client does not share my same moral values. As a therapist, I do not force my values on the client, so in situations in which the moral values differ between myself and the client, I usually take a non-directive therapy approach of self-exploration. My desire is to help my clients fully understand the choices they make, even if their value-system is different than mine.
In counseling with members of the Church from an LDS perspective, I would encourage them to make prayer an important part of their life. Studying the scriptures and serving others would also be recommendations for the individual to more fully incorporate into their lives. Clearly, these are not things that I typically talk about in more traditional therapy if the client has no interest in them.
Let me mention one other difference between my counseling with members of the Church and more traditional mainstream psychotherapy. Similar to many Christians, we believe that Jesus Christ suffered for our sins, allowing us to be redeemed from sin if we follow Him. We also believe that when He was atoning for our sins, He also experienced all of the sorrow and afflictions that each one of us have in our lives. Therefore, Jesus Christ knows exactly how we feel in any moment, because He has felt it too. This is very important in working with members of the Church. They never need to feel alone - if they will draw close the Lord. This is a strong source of support for an individual suffering and feeling that nobody understands what they are going through.
A new client comes to therapy reporting his main issue is feeling detached from God. How would you proceed?
As I would for any other issue, I would want to learn about the context of his current presenting problem. How long has he felt this way? Did something else important occur in his life when he started feeling detached from God? Was there a time when he used to feel closer to God? How does he understand the change he has experienced? If detachment from God is a new awareness for him, what led to this awareness? What is his religious background? I would explore with him the reason why he wants to feel more attached to God. How does he think that this will be good for him in his life?
My personal process for becoming close to God may or may not be the same as this client's method of doing so. I will need to ask the client what his ideas are for becoming closer to God. If he has a solid notion of what he needs to do, I would explore with him the barriers preventing him from implementing his ideas. I could likely work with him in this regard. It is quite probable that I would recommend that he meet with his ecclesiastical leader for more specific guidance that fits his religious beliefs. This would especially be true if the client was feeling detached from God because of sin.
If this were a member of the LDS Church and he wanted to work from an LDS perspective, I would certainly do all that I've written above. In addition, I would likely discuss with him issues of personal prayer and worship. If sin were the reason he feels detached from God, we would discuss the process of repentance and faith in the redeeming power of Jesus Christ. According to LDS doctrine, when we knowingly choose to not keep the commandments of God, His spirit does not stay with us, leading us to feel detached. This is why repentance is so important - it can heal this chasm and lead us to feel close to Him once again. True repentance means that we will strive to do the best we can in the future. Faithfully keeping the commandments will help us feel closer to God.
What is the relationship between sin and psychopathology?
My experiences as a therapist have made me very grateful that God is the judge of our souls and not myself or any other person. As almost everyone knows, the reasons why people engage in various behaviors are usually multifaceted and complicated. This makes the relationship between sin and psychopathology complex as well.
I have seen people who are living lives of sin who are sorrowful and even depressed as a result of their choices. I suppose that this would indicate a causal relationship between sin and psychopathology, at least in this specific case. If you consider pride a sin, is Narcissistic Personality Disorder a sin? Should the behaviors associated with Antisocial Personality Disorder be considered sin? Is there a relationship between vanity and Body Dysmorphic Disorder? I have also done marital therapy with couples whose primary problem is selfishness on the part of one or both of the spouses. Again, I have seen people who are committing sin and consequently are depressed. Each of these examples suggests a relationship can exist between sin and psychopathology.
Having said that, I think that more commonly there is not such a relationship. I have known many people who are leading righteous lives and yet find themselves depressed. I do not know of a relationship between sin and schizophrenia. I do not think that OCD, PTSD, or Social Anxiety are the result of sin. I have trouble seeing the connection between sin and many other disorders. While I believe that living the gospel of Jesus Christ can and will bring us blessings and happiness, I think that in many cases, psychopathology is not the direct result of sin. Certainly there are exceptions, but the exceptions are not the rule.
Who or what is the primary agent of change in therapy?
In traditional psychotherapy, I believe that the client is responsible for making changes in the client's life. The therapist can help facilitate this process, but unless the client begins thinking differently or makes changes to their environment, therapeutic success is unlikely. In an LDS counseling context, the individual also bears much of the responsibility for change. An important difference exists, however. I believe that because of the atoning sacrifice of Jesus Christ, He has the power to heal emotional wounds. For me, this healing power is real and actually does occur. An individual still bears the responsibility to have the faith for the Lord's healing power to be activated in their lives. To experience a "change of heart," a person must still make the necessary choices for it to occur. If they do, then the Lord can perform miracles in their lives - even a change of heart or the healing of a broken heart.
What is the most difficult part of practicing psychotherapy while maintaining your religious beliefs?
Although I do not share this with the client, I sometimes have thoughts that a particular client would be so much happier if they had the same belief system and moral values that I have. They usually have no interest in this and I do not pursue it in therapy, but it leaves me a little sad. I experience this in everyday life as well, and not just in therapy.
The most difficult aspect of practicing psychotherapy is when my moral values and the client's values do not match. I have had clients who want to feel happy about their extramarital affair. This puts me in a difficult place as a therapist because I personally believe that it is likely the affair which is causing the feelings of depression. Situations such as this leave me wondering whether I can help this client. I suppose I could help the client feel less depressed about the affair, but in my own mind, I believe that the most long-lasting solution is to not have the affair. Also, I could not in good conscience help someone openly violate their marital commitment. As I mentioned previously, I usually engage in non-directive exploring in these situations. I find it helpful to consult with other therapists who are not necessarily religious to see if they feel that I am proceeding in a manner respectful of the client. The decision of whether I need to transfer the client to another therapist because I do not feel comfortable with the case is always very difficult. Consulting with other therapists in these cases is usually quite helpful.
What is the most rewarding part?
The most rewarding part of practicing psychotherapy while maintaining my beliefs is the opportunity to see people change for the better. In my church service, I am almost entirely focused on helping people make changes for a more spiritual and better life. Therapy is very similar in that I am helping people make changes that will lead to improvement in their lives. Both are concerned with helping people grow and make improvements for themselves. From the perspective of eternity, the help I can provide in someone's spiritual growth is much more important than helping people with their daily problems or other psychopathology. I still feel satisfaction, however, from helping people in therapy and I believe that it is a noble work to be engaged in.