Holly J. Hartwig Moorhead, Ph.D., LPC(NC), PCCs, NCC hollymoorhead@yahoo.com

1. Association for Spiritual, Ethical, and Religious Values Issues in Counseling (ASERVIC) Teaching ModuleEthical Considerations in Assessing Spiritual and Religious Issues in Counseling Holly J. Hartwig Moorhead, Ph.D., LPC(NC), PCCs, NCC hollymoorhead@yahoo.com

2. Outline • Teaching Module Objectives • CACREP 2009 Standards - Standard G.1.j • ACA 2005 Code of Ethics Standards – Sections A.2.c, E.5.b, and E.8 • ASERVIC 2009 Competencies for Addressing Spiritual and Religious Issues in Counseling – Competency 10 • Experiential Exercise • References

3. Teaching Module Objectives • Recognize specific ethical standards that relate to counselors’ obligations to recognize and attend to spiritual issues within the counseling relationship; • Adhere to specific ethical standards by integrating spiritual assessment within the counseling relationship; and, • Demonstrate an understanding of the role of spiritual assessment within the counseling relationship.

4. CACREP 2009 Standards CACREP Standard G.1.j “Studies that provide an understanding of […] standards of professional organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling.” Denotes obligation of counselor training programs to orient students to professional ethical standards and guide students in applying such ethical standards in practice.

5. ACA 2005 Code of Ethics ACA Code Section A.2.c. Developmental and Cultural Sensitivity Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language used by counselors, they provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly. [Emphasis added.] ACA Code Section E.5.b. Cultural Sensitivity Counselors recognize that culture affects the manner in which clients’ problems are defined. Clients’ socioeconomic and cultural experiences are considered when diagnosing mental disorders. (See A.2.c.) [Emphasis added.] ACA Code Section E.8. Multicultural Issues/Diversity in Assessment Counselors use with caution assessment techniques that were normed on populations other than that of the client. Counselors recognize the effects of age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation, and place test results in proper perspective with other relevant factors. (See A.2.c., E.5.b.) [Emphasis added.] Denote counselors’ obligations to attend to and assess spiritual issues with clients as part of multicultural sensitivity and responsiveness.

6. ASERVIC 2009 Competencies for Addressing Spiritual and Religious Issues in Counseling ASERVIC Competency 10. Assessment During the intake and assessment processes, the professional counselor strives to understand a client’s spiritual and/or religious perspective by gathering information from the client and/or other sources. Standard of competence that counselors should be able to demonstrate related to assessing clients’ spiritual issues.

7. Experiential Exercise Purpose of exercise: • To help students fulfill ethical and professional obligations (e.g., standards set forth by CACREP, ACA and ASERVIC) to ethically incorporating spiritual assessment into practice. Materials and preparations needed: • Brief class discussion and/or presentation of ethical and professional standards noted in this presentation related to students’ obligation to ethically incorporate spiritual assessment into clinical practice (i.e., CACREP Standard G.1.j; ACA Code of Ethics Sections A.2.c, E.5.b and E.8; and, ASERVIC Competency 10). • Presentation of case study and directions for exercise. • Access to research materials (e.g., library resources, internet, or faculty preassembled materials). Time required: • Option 1: Approximately 30 – 45 minutes for research and discussion of case study only (no role-play of case study). • Option 2: Approximately 1.5 – 2 hours for research and role-play of case study with integration of spiritual assessment and follow-up group processing of experiences.

8. Experiential Exercise Directions for Option #1: • Divide students into groups (3-4 students per group is ideal). • Have students review case study provided. • Allow students access to appropriate resources (e.g., library, internet, or faculty preassembled materials) to work in teams to find at least two (2) qualitative or quantitative spiritual assessments to utilize with the client described in the case study. Students should critically review and analyze assessments in order to articulate the following: 1) issues addressed by assessments; 2) psychometric properties of assessments; 3) how assessments will assist in developing diagnostic impressions and treatment plans; 4) limitations of assessments and other information or resources needed to address limitations of assessments; and, 5) how assessments might be integrated into clinical sessions with clients. ** Examples of assessments that may be located and utilized include, but are not limited to: Daily Spiritual Experiences Scale (Underwood & Teresi, 2002); Five-Factor Wellness Evaluation of Lifestyle Inventory (Myers & Sweeney, 2005); Spirituality and Assessment Scale (Howden, 1992); Spiritual Well-Being Scale (Ellison, 1983); spiritual timelines (Curry, 2009); spiritual ecomaps (Hodge, 2000). **

9. Experiential Exercise • Have students role-play case study in fish-bowl simulated setting. That is, one student role-plays the client, one student acts as the counselor, and other students serve as observers and offer feedback to the counselor as needed (e.g., how to structure questions, further exploration to consider, etc.). Students should act out a typical 50-minute counseling session, including start of session, working phase of session, and closing up of session. During the session, students should incorporate at least one of the spiritual assessments researched and utilize the assessment and/or results as part of the session. • Upon completing the role-play, have students process in their groups the experience of utilizing spiritual assessment as part of a session with a client. If needed, question prompts may include: How did talking about spiritual issues feel? What was helpful about using the assessment? What was challenging about using the assessment? What other information might need to be obtained? How was this experience different from other counselor-client interactions that do not address spirituality? What (potential) ethical issues (for the counselor and/or client) arose when working with spiritual assessment? How does the spiritual assessment aid in formulating a treatment plan? • After students process in groups, the whole class may process different and similar group experiences. Students also are encouraged to share resources in order to develop a resource folder of spiritual assessments to use in practice.

10. Experiential Exercise Directions for Option #2: • Divide students into groups (3-4 students per group is ideal). • Have students review case study provided. • Allow students access to appropriate resources (e.g., library, internet, or faculty preassembled materials) to work in teams to find at least two (2) qualitative or quantitative spiritual assessments to utilize with the client described in the case study. • Students should critically review and analyze assessments in order to articulate the following: 1) issues addressed by assessments; 2) psychometric properties of assessments; 3) how assessments will assist in developing diagnostic impressions and treatment plans; 4) limitations of assessments and other information or resources needed to address limitations of assessments; and, 5) how assessments might be integrated into clinical sessions with clients. ** Examples of assessments that may be located and utilized include, but are not limited to: Daily Spiritual Experiences Scale (Underwood & Teresi, 2002); Five-Factor Wellness Evaluation of Lifestyle Inventory (Myers & Sweeney, 2005); Spirituality and Assessment Scale (Howden, 1992); Spiritual Well-Being Scale (Ellison, 1983); spiritual ecomaps (Hodge, 2000); spiritual timelines (Curry, 2009). **

11. Experiential Exercise • Students should develop a plan to incorporate at least one of the spiritual assessments into a counseling session. If needed, question prompts may include: When will assessment be utilized? How will assessment and/or results be utilized by the counselor within the session and longer-term treatment plan/approach? What might be some counselor and client reactions to assessment of spiritual issues and how might such reactions be addressed? What ethical considerations should be anticipated in utilizing spiritual assessment? • After students process in groups, the whole class may process different and similar group experiences and information. Students also are encouraged to share resources in order to develop a resource folder of spiritual assessments to use in practice.

12. Experiential Exercise Case study: Jan is a 54 year-old Caucasian female, presenting to her first counseling session with a concern of not being able to stop feeling anxious. She reports feelings almost debilitating panic at least a few times a week when she is required to interact with people with whom she does not have regular contact (i.e., they are not friends or family). Jan describes feeling sick to her stomach, flushed, paralyzed with indecision, and anxious in circumstances such as arranging medical appointments over the phone, dealing with credit card discrepancies over the phone, and confronting poor customer service when eating out, shopping, etc. Within the past 6 months, Jan has been diagnosed with fibromyalgia and states that she is in constant pain. Consequently, she stays in bed most of the day, occasionally watching tv news shows or primarily reading the newspaper or news magazines. Rarely does she exercise because “I just can’t.” She reports her primary form of “exercise” is walking while shopping at the mall. She is particular about the foods that she likes to eat, preferring comfort foods that remind her of family (e.g., fried foods, casseroles, significant starches). She insists that certain foods make her sick because of past negative experiences with food poisoning or negative experiences connected to particular foods. Since she no longer cooks, most of her meals are take-out from restaurants or pre-prepared foods. Jan reports that she “rarely” drinks, stating that she “doesn’t need that stuff like other people do.” Upon a basic visual examination, Jan appear to be about 20-30 pounds overweight.

13. Experiential Exercise She is married to her husband of 30 years, Pete, and they have 3 grown children who live with their respective families in other states. Jan speaks with her children by phone weekly most of the time, and she talks freely and happily about her 7 grandchildren. Jan frequently speaks with frustration about Pete not understanding her condition and just “being a man” and working all of the time. Jan identifies several close friends; however, she only sees them every couple months. She states that she does not like to talk on the phone and “just doesn’t get around” to emailing much either. Daily, her social interactions appear to primarily center around those she has with Pete. Her 9 year-old dog passed away approximately a year and a half ago.

14. Experiential Exercise Jan self-identifies as a Christian; however, she indicates that she has not attended church in approximately 4 months because she is in too much pain to travel. Jan reveals that she and her husband were very active in their home church for decades. Pete served as an assistant church pastor for pay, and Jan headed up all of the children’s ministries as an unpaid volunteer. However, they left that particular church about 5 years ago and currently attend church in another city. Jan provides no further initial explanation regarding this issue and demonstrates irritation toward this vein of conversation. Her husband works at a local big-box retailer since he no longer works at the church, in order to provide medical benefits for them. The youngest of 4 children of a minister and his wife, Jan grew up in a small, rural, southern community. She had an uncle and grandfather who both were ministers as well in the communities surrounding her small town. Two of her siblings are full-time clergy and the other sibling is a professional gospel music singer. Fifteen years ago her father died from a heart attack and 3 years ago her mother passed away from complications following a broken hip. Jan was her mother’s primary care-taker for more than a year while her mother was in and out of hospitals and rehab facilities. Following the death of their parents, Jan and her siblings rarely keep in touch.

15. Experiential Exercise Jan is not employed because “I just cannot do much physically” She asserts that she will return to work “someday,” but does not identify any specific plans for what type of work she would like to do. When discussing employment, Jan repeatedly returns to the topic of her previous work experience (being a mother and unpaid church worker) not being valued and verbalizes anger towards church leadership, society, and parishioners regarding this. Currently, Jan and Pete are on a very limited budget, which she blames upon the “years of service we donated to the church.” Throughout the conversation, Jan articulates feeling anger toward her husband and children for not “really understanding” both her constant pain and the limitations she has for what she can and cannot do in terms of exercising. She states that she is “sick of dealing with all this stress constantly” and relates numerous stories about the activities that she was involved with before she “got sick” as examples of how she has worked hard for her “entire life.”

16. References American Counseling Association. (2005). The ACA Code of Ethics. Author. Retreived May 21, 2011 from: http://www.counseling.org/resources/CodeofEthics/TP/Home/CT2.aspx Association for Spiritual, Ethical and Religious Values in Counseling. (2009). Competencies for Addressing Spiritual and Religious Issues in Counseling. Author. Retrieved May 21, 2011 from: http://www.aservic.org/wp-content/uploads/2011/01/ASERVIC-Competencies-for-Addressing-Spiritual-and-Religious-Issues-in-Counseling-2009.pdf. Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 Standards. Author. Retrieved May 21, 2011 from: http://www.cacrep.org/doc/2009%20Standards%20with%20cover.pdf. Curry, J. (2009). Examining client spiritual history and the construction of meaning: The use of spiritual timelines in counseling. Journal of Creativity in Mental Health, 4, 113-123. Ellison, C. W. (1983). Spiritual well-being: Conceptualization and measurement. Journal of Psychology and Theology,11, 330-340.

17. References Hodge, D. R. (2000). Spiritual ecomaps: A new diagrammatic tool for assessing marital and family spirituality. Journal of Marital and Family Therapy, 26, 217-228. Howden, J. W. (1992). Development and psychometric characteristics of the Spirituality Assessment Scale. Dissertation Services. Ann Arbor, MI: Bell & Howell Company. Morrison, J. Q., Clutter, S. M., Pritchett, E. M., & Demmitt, A. (2009). Perceptions of clients and counseling professionals regarding spirituality in counseling. Journal of Counseling and Values, 53, 183-186. Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2000). The Wheel of Wellness counseling for wellness: A holistic model for treatment planning. Journal of Counseling & Development, 78, 251-266. Underwood, L .G., & Teresi, J. A. (2002). The Daily Spiritual Experience Scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health related data. Annals of Behavioral Medicine, 24, 22-33.