Therapists’ Integration of Religion and

Spirituality in Counseling: A Meta-Analysis

Donald F. Walker, Richard L. Gorsuch, and Siang-Yang Tan
The authors conducted a 26-study meta-analysis of 5,759 therapists and
their integration of religlon and spirituality in counseling. Most therapists
consider spirituality relevant to their lives but rarely engage in spiritual
practices or participate in organized religion. Marriage and family thera-
pists consider spirituality more relevant and participate In organized
religionto a greater degree than therapists from other professions.Across
professions, most therapists surveyed (over 80%) rarely discuss Spiritual or
religious issues in training. In mixed samples of religious and secular thera-
pists, therapists’ religious faith was associated with using religious and
spiritual techniques in counseling frequently, willingness to discuss reli-
gion in therapy, and theoretical orientation.

-r” erapists’ integration of religion and spirituality in counseling has been

evaluated in 26 studies of 5,759 psychotherapists from the fields
of clinical and counseling psychology, psychiatry, social work, and pas-
toral counseling. We suggest that it is now appropriate to perform a meta-
analysis of the existing research. We discuss the relevance of religion and
spirituality to counseling, review methods of integrating religion and spiri-
tuality in counseling, and conduct a meta-analysis of studies concerning thera-
pists’ integration of religion and spirituality into counseling.

Relevance of Religion and Spirituality to Counseling

In the area of multicultural theory, psychologists have continued to call for
psychological treatments and interventions that are culturally sensitive and
relevant and that integrate aspects of client culture into the counseling pro-
cess (D. w. Sue & Sue, 1999; s. Sue, 1999).In addition, psychologists have
increasingly recognized that religion and spirituality are relevant aspects of
client diversity that psychologists should be able to recognize while treat-
ing religious or spiritual clients with sensitivity (Ridley, Baker, & Hill, 2001;
D. W. Sue, Bingham, Porche-Burke, & Vasquez, 1999).
Richards and Bergin (2000) have proposed that the integration of religious
and spiritual culture in counseling is conceptually similar to the dynamics of
more general multiculturalcounseling attitudes and skills previously advanced
by other multicultural researchers (e.g., D. W. Sue & Sue, 1999).Richards and
Bergin (2000) further suggested that multicultural competent attitudes and skills
regarding religion and spirituality encompass several domains.

Donald F. Walker, Richard L. Gorsuch, and Siang-Yang Tan, Graduate School of Psychology,
Fuller Theological Seminary. A portion of this research was presented at the 2001 annual meeting
of the American Psychological Association, San Francisco. Correspondence concerning this article
should be addressed to Donald F. Walker, Fuller Theological Seminary, Graduate School of Psy-
chology, 180 N . Oakland Avenue, Pasadena, C A 91101 (e-mail: dfwalker@hotmail.com).

Counseling and Values October 2004 Volume 49 69

 Among the domains of multicultural attitudes and skills most pertinent to this
study are (a)an awareness of one’s own cultural heritage, (b)respect and comfort
with other cultures and values that differ from one’s own, and (c) an awareness of
one’s helping style and how thisstyle could affect clientsfromother culturalback-
grounds.Hence, knowledge of religion and spiritualityis an important element of
therapists’multicultural competency.
Religion and spiritualityare important aspects of multiculturalcompetencyfor
therapists to considergiven the religiousculturein America.Researchershave found
that more than 90% of Americans claim either a Protestant or Catholic religious
affiliation (Keller,2000), 40% of Americans attend religious services on a weekly
basis, and more than two thirds of Americans consider personal spiritual prac-
tices to be an importantpart of their daily lives (Hoge, 1996).Thus,it is important
for counselors to understand how their own religious and spiritual culture may
differ from that of the generalpopulace and the clientswhom they serve.
This meta-analysishas several aims. One purpose of thisstudy was to examine
via meta-analysis the spiritual and religious culture and values of counselors. We
use this information to suggest ways in which therapists’ religious culturesmay
differ from those of their clientsand to explorehow such differences might be con-
structively approached in counseling. A second purpose of this study was to ex-
plore via meta-analysislinksbetween the personal religiousness of cou~lselors and
therapists and several counseling-related variables. We use this information to
understand across studies how therapists’ religiousness relates to their helping
style with clients from varying religious and spiritualbackgrounds.

Methods of IntegratingReligion and Spirituality in

Counseling
One issue that has been problematicwhen discussingmethods of integrating reli-
gion and spirituality in counselinghas been agreeingon exactly what is being inte-
grated. Pargament(1999),for example,noted that psychologistsof religionrarely agree
on specificdefinitionsof religion and spirituality.However, on a broad level, religbn
has typicallybeen defined as that which is more organizational,ritual, and ideologi-
cal, whereas spiritualityhas typically been defined as that which is more personal,
affective, and experiential(Pargament, 1999; Richards & Bergin, 1997).In thisstudy
the samebroad definitionswill be used when referring to religion and spirituality.
Therapistshave proposed several differentmethods of integrating religious and
spiritualculture into counseling.Accordingto Tan (1996),explicit integrationrefers to
a more overt approach that directly and systematically deals with spiritual or religious
issues in therapy, and uses spiritual resources like prayer, Scripture or sacred texts, referrals
to church or other religious groups or lay counselors, and other religious practices. (p. 368)

Tan noted that this approach to counseling emphasizes both therapist and cli-
ent spirituality and integrates counseling with some form of spiritual direction.
Another approach to integrating religion and spirituality in counseling is
the implicit integration of religion or spirituality. Implicit integration is “a more
covert approach that does not initiate the discussion of religious or spiritual is-

70 Counseling and Values m October 2004 m Volume 49

sues and does not openly, directly, or systematically use spiritual resources like
prayer and Scripture or other sacred texts, in therapy” (Tan, 1996, p. 368).An ex-
ample of implicit integrationis basing therapeuticvalues on theisticprinaples from
an organized religion. Implicitintegrationmay be the preferred mode of integra-
tion for therapists who profess a religious faith or engage in spiritualpracticesbut
who are not trained in the explicit integration of religion and spirituality.
Shafranske (1996)conducted a review of training in explicit and implicit inte-
gration. His review suggested that “educationand training within the area of psy-
chology and religion appears to be very limited (p. 160)and that the majority of
therapistsnever discussreligious or spiritualissues in their clinicaltraining.Richards
and Bergin (1997)noted that such therapists runthe risk of practicing outside the
boundaries of professionalcompetenceor imposing their own values on religious
or spiritualclients. Shafranske (1996)suggested that most therapists’approachto
theintegrationof religionandspiritualityinpsychotherapywasnotbasedongraduate
training in the area but centered primarily on the personal religious and spiritual
experienceof the therapist.
A third form of integration is intrupersonalintegration, which refers to the manner
in which a therapist uses his or her personal religious or spiritual experience in
counseling (Tan, 1987).An example of intrapersonal integration is silently pray-
ing for a client during counseling.
This study attemptsto determinehow therapists practice their religionand spiri-
tuality and to determine the degree to which the personal religious faith of thera-
pists is associated with the use of religion and spirituality in counseling. This is
accomplished through the use of meta-analysis.

The Use of Meta-Analysis as a StatisticalTechnique

Although meta-analysisofteninvolvesaggregahgrefllltsfromexperimentalstudies,
it can alsobe used in aggregatingcorrelationaldata, as was done in thismeta-analysis.
As Rosenthal(l991)explained, the only constraintin determiningthe relationship
between two variablesis that the relationshipbe of interest to the investigator.The
investigator determinesrelationshipsbetween variablesby obtaining an estimate
of the effect sizebetween two variables, which some studies do not provide along
with their tests of sigruficance(Rosenthal,1991).In these instances,the test of sig-
nificance that is provided (whether x2,f, or F)is transformed to an r for the purpose
of computing an overall averaged r across studies.
Hunter and Schmidt (1990)noted that one criticism of the meta-analysis of
correlations is that it typically provides a slightly downward bias in the esti-
mate of population correlations. In practical terms, this is not problematic; if
anything, such correlations are more conservative estimates of the relationship
between two variables.
In the current meta-analysis, we considered several issues to be relevant.
The first issue we considered was the personal religion and spirituality of
therapists. As mentioned earlier, thisinformationis used to determinehow differ-
ent the culture of counselorsmightbe from their clients and, thus, how the need for
respect for, and comfort dealing with, culturesother than one’s own might present

Counseling and Values October 2004 .Volume 49 71

in a counseling situation. A second issue we considered concerned therapists’
personal religiousnessand their use of explicitintegration of religion and spiritu-
ality in counseling. This information is used to inform how therapists’ personal
religiousness may relate to their helping styles with religious clients.
Finally we made comparisons, where possible, between samples that were iden-
tified as containing explicitlyreligious therapists and sample groups that may have
contained a mix of secular and religious therapists. We also made comparisons
between therapists from different professional backgrounds to understand how
each of the multiculturalcompetencies(respectfor cultures other than one’s own,
one’s helping style as a therapist) might be different across professions.
Method
Literature Search
We identified studies for inclusion in the meta-analysisusing literaturesearchesin
the PsycINFOand Dissertation Abstracts International databasesusing the search
terms counseling and religion,counseling and spirituality, psychotherapyand religion, and
psychotherapy and spirituality. We sought unpublished studies, such as unpublished
doctoral dissertations,in order to reduce the ”file drawer problem” identified by
Rosenthal(1979),in which the meta-analysisindicates ahigher effect size than actu-
ally existsbecause studieswith nonsigruficanteffectshave not been located.
We identified40studies throughthe literature search. Of those studies, we elimi-
nated six dissertationsbecause they were not empirical.We eliminated threeother
empiricaldissertationsbecause they did not contain variablesof interest.We elimi-
nated a final dissertation because it was not available, and the author did not
respond to an emailmessage that had been sent. We eliminated 2published studies
by explicitly Christian therapists (Ball & Goodyear, 1991;Worthington, Dupont,
Berry, & Duncan, 1988)because they were methodologically different from the
other studies, making it impossible to include them in the meta-analysis. Two
studies (Bergin& Jensen, 1990;Jensen& Bergin, 1988)were of the same sample.
We considered these to be 1 study. One study (Sorenson & Hales, 2002)was a
new analysis of two samples already included in the total data set, so this study
was reviewed but not included in the analyses. Thus,the final number of studies
included in the analyses was 26.
Demographic Characteristics of the Total Sample
We aggregated the demographic characteristicsof the total sample across stud-
ies to describe the sample. Regardingprofessionalbackgrounds, clinicaland coun-
seling psychologists composed 44.15%of the total sample, explicitly Christian
counselors 21.30%, marriage and family therapists 14%, social workers 5.859’0,
psychiatrists4.32%, explicitlyMormon psychotherapists3.54%, psychotherapists
2.77%,licensed professionalcounselors1.82%, and pastoralcounselors 1.71°/0.(Per-
centages do not total 100due to rounding.)With respect to gender, men composed
58.11% of the sample, and women composed 41.89% of the sample. The sample
ranged in age from 22 to 89 years, with a mean age of 46.1.Only five studies re-
ported the race of the therapist sample. The authorsof those five studies estimated

72 Counseling and Values October 2004 Volume 49

the percentage of White therapists to be 83%to 95% (Bilgrave& Deluty, 1998,2002;
Case & McMinn, 2001; Forbes, 1995;Sheridan,Bullis, Adcock, Berlin, & Miller, 1992).
Computation of Effect Size
First, we converted all relationships of interest to an Y, and then we calculated a
weighted overall averagedY by weighting eachindividual correlationby the sample
size associated with each individualstudy. Second, we calculated the overall sig-
nificance level of each correlationby the method of adding z scores. Following the
techniqueproposed by Rosenthal(1991),we added z scoresfrom samplesand then
divided the sum of the z scoresby the square root of the number of studies. Third,
we compared the sigruficanceof severalcorrelationsusing Fisher’s test of sigrufi-
cance between independent correlations(Cohen& Cohen, 1983).We used appen-
dixes from Cohen and Cohen to transform correlationsto z scores.Then, we divided
the differencebetween the z equivalentsby the standard error to obtain a normal
curve deviate. We used appendixes provided in Cohen and Cohen to obtain the p
value for the sigruficancetest. Finally we added the raw scores from some items of
interest (such as religious denomination)across studies.
Results
Personal Religion and Spirituality of Therapists
Religious affiliationsof therapists from mixed sampleswere provided in 18studies
of 3,813 therapists. The majority of therapists in these samples were Protestant
(%.51%),Jewish (19.61%),or Catholic (13.89%).Religious denominationsamong
therapists from differentprofessionalbackgroundsare presented in Table 1.Clinical
and counselingpsychologistswere more likely to be either an agnostic (x’= 10.27,
p < .005)or atheist (x’ = 27.19, p c .005) when compared with marriage and fam-
ily therapists but were not more likely to be either an atheist or agnostic when
compared with social workers. Clinical and counseling psychologists were also
more likely to endorse no religion than either marriage and family therapists
(x’ (x’
= 34.13, p < .00Ol) or social workers = 7.98, p < .01).
Five studies (N = 1,738) of therapists from mixed samples and 2 studies
(N = 762) of explicitly religious therapists reported frequency of therapists’
participation in organized religion or church activities. Among therapists from
mixed samples, 21.1%reported being inactive, whereas 44.8% reported being
active. Among explicitly religious therapists, only 8.79% reported being inac-
tive, compared with a majority (82.54%)who reported being active.With respect
to professionalbackground, more marriage and family therapists were active
(59.58%, 2 studies, N = 438) than either secular clinical and counseling psy-
chologists (39.75%,5 studies, N = 1,122)or psychiatrists (32%,1study, N = 71).
Psychiatrists also endorsed inactive (68%)more frequently than either clini-
cal and counseling psychologists (54.63%) or marriage and family therapists
(16.21%).Possible reasons for these findings may have been that 15% of the
sample in Winston’s (1991)study of marriage and family therapists was com-
posed of pastoral counselors, as well as the fact that psychiatrists were repre-
sented in only a small, single sample.

Counseling and Values rn October 2004 rn Volume 49 73

 TABLE 1
Differences in Religious Denomination by Professional Background
Marriage and
Psychologistsa Family Therapistsb Social WorkersC
Affiliation N YO N YO N YO
Protestant 593 35.85 433 50.0 109 40.1
Jewish 339 20.49 110 12.7 56 20.6
Catholic 250 15.11 126 14.6 32 11.8
Atheist 31 1.87 3 0.03 3 1 .I
Agnostic 74 4.47 6 0.07 6 2.2
No religion 270 16.32 71 8.2 27 9.9
Other 297 17.96 117 13.5 39 14.3

Note. Percentages do not total 100 due to rounding.

‘Ten studies. bSix studies. “Three studies.

Six studies (N = 1,678) were used to calculate frequency of personal spiritual

practices (such as prayer or meditation).We observed large differencesbetween
therapists from mixed samples (4 studies, N = 916) and explicitlyreligious (2 stud-
ies, N = 762) therapists.Among therapists from mixed samples, 40.6%reported
engaging in personal spiritual practices on a weekly or daily basis compared
with 78.8%of expliatly religioustherapists.Among therapistsfrom mixed samples,
45.5%reported engaging in personal spiritual practices infrequently or never
compared with only 9.1%of explicitly religious therapists.
Religion and Spirituality in Counseling
To determine how often therapists use religious or spiritual techniques in
counseling, we added responses and then averaged them across eight stud-
ies (total N = 2,253). Four studies (N = 1,102) of therapists from mixed samples
reported on the number of therapists who had previously used a religious
or spiritual technique in therapy. The majority of therapists from mixed
samples (66.6%) reported using prayer in therapy; 64.1% reported using
religious language, metaphors, and concepts in therapy; and a minority
(44.4%)reported using scripture in therapy.
Four studies (N = 1,037) reported explicitly religious therapists’ frequency
of using spiritual or religious techniques with religious clients rather than
the percentage of those therapists who had used a technique before. Among
explicitly religious therapists, forgivenesswas used in 42.2%of therapy cases,
use of scripture/teaching of biblical concepts in 39.2%, confrontation of sin
in 32.6%, and religious imagery in 18.2%of therapy cases.
Prayer is a spiritualtechnique that has been studied in severalways among ex-
plicitly religious therapists. Three studies (N = 1,097) reported that 73.6”/0of explic-
itly religious therapistsprayed for their clients outside of session. Five studies (N =
1,372)reported therapists’frequencyof in-sessionprayer with clients. In those five
studies, therapists used in-sessionprayer in 29.1%of therapy cases.
We calculated separate overall averaged TS for therapists from mixed samples
and explicitly religious therapists to determine the relationshipbetween thera-

74 Counseling a n d Values rn October 2004 rn Volume 49

pists’ personal religious faith and therapists’ frequency of use of religious
and spiritual techniques in counseling. Authors of the studies that examined
therapists’ use of religious and spiritual techniques in counseling typically
summed a list of individual religious and spiritual techniques and then cor-
related that scale with a self-report measure of either religious attitudes or
religious behaviors. The overall averaged T among therapists from mixed
samples (using six studies, N = 873) was 24, p c .0002. The correlation among
explicitly religious therapists was higher, overall averaged t = .41, p c .0001.
We also calculated separate overall averaged ts for therapists from different
professionalbackgrounds to determine the relationshipbetween therapists’per-
sonal religious faith and use of spiritual techniques in counseling. The overall
averaged T for marriage and family therapists was .12, p = .005.The correlation
among clinical psychologists was higher, overall averaged t = .30, p < .001.
We conducted a series of tests of the difference between correlations using
Fisher’s comparison of t (Cohen & Cohen, 1983). The correlation between
personal faith and therapists’ use of spiritual techniques among explicitly
religious therapists was significantly higher than the same correlation among
therapists from mixed samples, p c .0001. Only one study (Forbes, 1995) com-
puted a correlation between training in religious and spiritual issues and use
of spiritual techniques in therapy (t= .38). This correlation was not statisti-
cally significantly different from the correlation between personal faith and
use of spiritual techniques among explicitly religious therapists ( p = .12).Fi-
nally, the correlation between personal religious faith and use of spiritual tech-
niques among marriage and family therapists in mixed samples was compared
with the same correlation among clinical psychologists from mixed samples.
This correlation was significantly higher for clinical psychologists ( p = .004).
Finally, we calculated the frequency with which therapists from mixed
samples discussed religion and spirituality issues during training using four
studies ( N = 1,156). The majority of therapists (82%)reported that they never
or rarely discussed religious or spiritual issues in training, 13.6 % stated that
they sometimes did, and 4.3%reported they discussed them often.
Relationship of Personal Religion to Counseling-Related Variables
We calculated the relationship between therapists’personal religiousness and
openness to discussing religious issues in counseling using an overall aver-
aged t. The overall averaged r among therapists from mixed samples (3 stud-
ies, N = 216) was equal to .37, p < .02, compared with an overall averaged t of
.39, p = ,007, using all 4 studies, and with .40 in the Jones, Watson, and Wol-
fram (1992) study of religious therapists. These correlations were not statisti-
cally different.Finally, we calculated an overall averaged T between the personal
religious faith of the therapist and therapist theoretical orientationamong thera-
pists from mixed samples (5 studies, N = 1,474). This correlation was equal to
2 5 , p < .001. (As noted earlier, Sorenson & Hales, 2002, performed a reanalysis
of two data sets already included in the meta-analysis. As part of an analysis
of covariance including other variables, they found that religious therapists
trained at secular programs were significantly more likely, F[1,396] = 19.82,

Counseling and Values m October 2004 =Volume 49 75

p c .001, to use explicit religious and spiritual interventions than were reli-
gious therapists trained at explicitly religious training programs.)

Discussion
One issue we examined in this study was the religious and spiritual cultural
heritage of psychotherapists. The results confirm that the religious and spiri-
tual cultural heritage of psychotherapists differs from that of the average
American. Indeed, the majority of therapists from mixed samples were affili-
ated with a religious denomination but were largely inactive within organized
religion. This contrasts sharply with the general US.population, because
approximately40% of Americans attend church on a weekly basis (Hoge, 1996).
In addition, although the majority of psychotherapists claim that spirituality
is relevant to them, most engage in personal spiritual practices infrequently,
whereas approximately two thirds of Americans consider spiritual practices
such as prayer an important part of their daily lives (Hoge, 1996). Thus, if a
therapist comes from a religious and spiritual cultural heritage that differs
from the client’s, he or she should consider the potential impact of their cul-
tural differences on the course of treatment.
Therapists’ religious cultural heritage may be an especially salient issue for
clinical and counseling psychologists, who were more likely to endorse athe-
ism, agnosticism, or no religion than either marriage and family therapists or
social workers. Among Americans claiming a religious affiliation, the majority
of them (56.6%)are Protestant, followed by Catholic (37.8%), with people from
Jewish,Muslim, Buddhist,or other religiousbackgroundscomposingthe remaining
5.5%of religious people in America (Keller,2000). Thus, religious cultural differ-
ences with regard to denomination (as well as the beliefs and practices associ-
ated with being in a denomination)between client and therapist are likely to exist,
particularly for clinical and counseling psychologists.
Clinical and counseling psychologists who find it difficult to understand the
cultural heritage of clients who practice their spirituality within the context of an
organized religion may wish to consult with explicitly religious therapists on
such therapy cases. Explicitly religious therapists were more similar to the ma-
jority of Americans, as measured by previous polls (e.g.,Gallup & Lindsay, 1999),
with respect to religious affiliationsand personal spiritual practices. Thus, ex-
plicitly religious therapists may be a particularly valuable resource for therapy
cases with religious clients when the consulting therapist does not have a good
understanding of the cultural heritage of the client.
It is clear from the results that personal religiousness on the part of both explic-
itly religious therapists and therapists from mixed samples was associated with
being able to integrate religion and spirituality into several aspects of counseling
(e.g., the use of spirituality,being willing to discuss religious issues, even choice
of theoretical orientation).Given the lack of training regarding the integration of
religion and spirituality into counseling, it seems that most integration of reli-
gion and spirituality in counseling occurs through intrapersonal integration as
a result of therapists’own religious or spiritualexperience.As such, it seem that

76 Counseling and Values rn October 2004 Volume 49

explicitlyreligious therapists (whoengage more frequentlyin religious and spiri-
tual practices),rather than nonreligious therapists, would be better equipped in
some instances to provide religious and spiritual interventionsfor clients.
One danger in providing religious and spiritual interventions is that the
lack of formal training to supplement therapists’ personal religious or spiri-
tual experience creates a risk of therapists imposing their own values or
applying religious and spiritual interventions inappropriately. Given that
therapists do use their own personal religious and spiritual experience in
integrating religion and spirituality into counseling, additional training, when
offered, should address how to make appropriate use of one’s own reli-
gious and spiritual experience when integrating religion and spirituality
into counseling, as well as training regarding clients‘ religious backgrounds
and the appropriateness of various religious and spiritual interventions with
clients from differing religious backgrounds.
Training need not occur solely in the classroom but could also be effectively
provided in the context of supervision or consultation on therapy cases involv-
ing religious and spiritual issues. There are a few explicitly religious graduate
training programs in clinical psychology that have been accreditedby the Ameri-
can PsychologicalAssociation.It is hoped that graduates of suchprograms would
be equipped to provide appropriate consultationand/or supervision.However,
the efficacy of these training programs in helping therapists integrate religion
and spirituality into counseling above and beyond drawing on their own per-
sonal religious and spiritual experiences has yet to be documented.
The results indicate that many therapists are already making use of religion
and spiritualityin therapy. Therapistsfrom mixed samplesreported a muchlarger
percentage using religious and spiritual techniques in therapy than the percent-
age of explicitly religious therapists reported using religious or spiritual tech-
niques in therapy.However, studies of explicitlyreligioustherapists reported how
often they used a technique rather than the number of participants in the sample
who had ever used a technique at all, as was done in studies using mixed samples
of therapists. Thus, the different research questions make direct comparisons
between therapists difficult.However, one noteworthy trend across both groups
of therapists is that scripture and prayer were spiritual techniquesthat were com-
monly used by both groups. This finding suggests that prayer and scripture, in
particular, are religious and spiritualinterventionsthat therapists should receive
training on for counseling.

Limitations of the Current Study and Suggestions for

Future Research
The first limitation of the study is that we analyzed two major variables
that had varying degrees of relatedness. Rosenthal (1991) referred to this
common limitation of meta-analysis studies as the problem of heterogeneity
of method. As did Glass (1978),Rosenthal also referred to this as the “apples
and oranges issue” and suggested that they are good things to mix when at-
tempting to generalize to fruit.

Counseling and Values rn October 2004 Volume 49 77

 One variable was the diverse professional background of the therapists in
the meta-analysis.The analyses indicated differences among therapists in the
areas of religious denomination and organized religion and in the relation-
ship between personal religious faith and use of spiritualityin therapy. It would
have been preferable to make explicit comparisons of therapists from differ-
ent professional backgrounds for every analysis.This limitation was unavoid-
able, because some major primary studies grouped therapists together and
some analyses did not have a sufficient number of representatives from vari-
ous professions to allow for explicit comparisons.
Other variables with varying degrees of relatedness were the religious and
spiritual variables used in the analyses. We aggregated each of these indi-
vidual variables to represent global religious and spiritual constructs, but we
might have obtained larger effect sizes had there been a greater degree of
specificity between independent and dependent variables in the analyses.
A second limitation of the study was the possible sampling bias of therapists
from mixed samples. Because most studies designated as being a mixed sample
did not explicitly state whether they were sampling therapists from explicitly
religious programs along with therapists from secular programs, it is difficult
to know just how religious the therapists in some of these samples were. This
was less problematic when authors reported the number of explicitly religious
therapists in their sample (e.g., Kochems, 1983; Winston, 1991). In such cases, it
would have also been desirable to split the samples and analyze them sepa-
rately, but the primary studies themselves have not done so.
A finallimitation was the use of small subsamplesof the data to perform analy-
ses. This is a common practice when examining different independent and
dependent variables in meta-analyses of correlations,because not all studies
using correlations will use the same independent or dependent variables in the
analysis. However, it would have been desirable to have more studies available
on which to do some of the analyses, particularly when attempting to compare
religious and secular therapists and therapists from different professionalback-
grounds. The small number of published studies is informative because it leads
to the conclusion that the field could clearly benefit from additional research
regarding therapists’ integration of religion and spirituality in counseling.
Most important, we suggest that studies are needed that relate meaningful
variables to therapists’ use of religion and spirituality in counseling with a
variety of religious clients. Therapists’ frequency and competency of use of
spiritual techniques need to be assessed, rather than whether a therapist has
used a technique, as some studies have done. Such precision will allow fur-
ther refinement and training for therapists who see religious and spiritual
clients. Only two studies (Forbes, 1995; Sorenson & Hales, 2002) have exam-
ined the relationship of any training variables to therapists’ ability to inte-
grate aspects of clients’ religion and spirituality in therapy. Therapist variables
associated with the integration of religion and spirituality in counseling have
also yet to be identified. As these and other variables are identified, clients
who participate in organized religion can look forward to counseling services
that actively and effectively use their religious culture.

78 Counseling and Values rn October 2004 rn Volume 49

 References
References marked with an asterisk indicate studies included in the meta-analysis.
Ball, R., & Goodyear, R. K. (1991). Self-reported professional practices of Christian psycho-
therapists. Iournal of Psychology and Christianity, 2, 144-153.
‘Bergin, A. E., & Jensen, J. I? (1990). Religiosity of psychotherapists: A national survey.
Psychotherapy, 27, 3-7.
‘Bilgrave, D. P., & Deluty, R. H. (1998). Religious beliefs and therapeutic orientations of c h i -
cal and counseling psychologists. Ioumal for the Scientific Study of Religion, 37, 329-349.
‘Bilgrave, D. P., & Deluty, R. H. (2002). Religious beliefs and political ideologies as predictors
of psychotherapeutic orientations of clinical and counseling psychologists. Psychotherapy,
39, 245-260.
‘Case, P. W., & McMinn, M. R. (2001). Spiritual coping and well-functioning among psy-
chologists. Iournal of Psychology and Theology, 29, 29-40.
Cohen, J., & Cohen, P. (1983). Applied multiple regressionlcorrelation analysis for the behav-
ioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
*Diblasio, F. A. (1993). The role of social workers’ religious beliefs in helping family mem-
bers forgive. Families in Society. 74, 163-170.
*Diblasio, F. A., & Benda, B. 8. (1991). Practitioners, religion, and the use of forgiveness
in the clinical setting. Iournal of Psychology and Christianity, 10, 166-172.
*Diblasio, F. A., & Proctor, J. H. (1993). Therapists and the clinical use of forgiveness.
American Iournal of Family Therapy, 21, 175-184.
*Eckhardt, C. I., Kassinove, H., & Edwards, L. (1992). Religious beliefs and scientific
ideology in psychologists: Conflicting or coexisting systems? Psychological Reports,
71, 131-145.
*Forbes, E. (1995). Therapist religious beliefs and clinical praxis. Unpublished doctoral dis-
sertation, California School of Professional Psychology, Berkeley/Alameda.
Gallup, G., Jr., & Lindsay, M. D. (1999). Surveying the religious landscape. Harrisburg, PA:
Morehouse.
Glass, G. V.(1978). In defense of generalization. The Behavioral and Brain Sciences, 3,394-395.
*Hales, S. W. (1995). Doctorally educated psychotherapists and evangelical spirituality: Per-
sonal beliefs and professional practice. Unpublished doctoral dissertation, Rosemead School
of Professional Psychology, Biola University, La Mirada, CA.
Hoge, D. R. (1996). Religion in America: The demographics of belief and affiliation. In E. P.
Shafranske (Ed.), Religion and the clinical practice of psychology (pp. 2 1 4 2 ) . Washington,
DC: American Psychological Association.
Hunter, J. E., & Schmidt, F. L. (1990). Methods of meta-analysis: Correcting error and bias in
researchfindings. Newbury Park, CA: Sage.
*Hutton, M. S. (1994). Spiritual beliefs, spiritual practices, psychotherapeutic techniques and person-
ality types among behavioral, cognitive behavioral, and psychounulytic psychotherapists. Unpub-
lished doctoral dissertation, California Institute of Professional Studies, San Francisco.
“Jensen, J. P., & Bergin, A. E. (1988). Mental health values of professional therapists: A na-
tional interdisciplinary survey. Professional Psychology: Research and Practice, 19, 290-297.
*Jones, S. L., Watson, E. J., & Wolfram, T. J. (1992). Results of the Rech Conference Survey on
religious faith and professional psychology. Ioumal of Psychology and Theology, 20, 147-158.
‘Kahle, P. A. (1998). The influence of the person of the therapist on the integration of spirituality
and psychotherapy. Unpublished doctoral dissertation, Texas Woman’s University, Denton.
Keller, R. R. (2000). Religious diversity in North America. In P. S. Richards & A. E. Bergin
(Eds.), Handbook of psychotherapy and religious diversity (pp. 27-56). Washington, DC:
American Psychological Association.
‘Kively, L. R. (1986). Therapist attitude toward including religious issues in therapy. Iournal
of Psychology and Christianity, 5, 37-45.
*Kochems, T. P. (1983). The relationship of background variables to the experiences and values of
psychotherapists in managing religious material. Unpublished doctoral dissertation, The George
Washington University, Washington, DC.

Counseling and Values October 2004 .Volume 49 79

‘Lange, M. A. (1983). Prayer and psychotherapy: Beliefs and practice. Journal of Psychol-
ogy and Christianity, 2(3), 36-49.
‘Moon, G . W., Willis, D. E., Bailey, J. W., & Kwansy, J. C. (1993). Self-reported use of
Christian spiritual guidance techniques by Christian psychotherapists, pastoral coun-
selors, and spiritual directors. Journal of Psychology and Christianity, 22, 24-37.
Pargament, K. (1999). The psychology of religion and spirituality? Yes and no. International
Journal for the Psychology of Religion, 9 , 3-16.
*Prest, L. A., Russel, R., & D’Souza, H. (1999). Spirituality and religion in training, prac-
tice, and person development. Journal of Family Therapy, 22, 60-77.
Richards, P. S., & Bergin, A. E. (1997). A spiritual strategyfor counseling and psychotherapy.
Washington, DC: American Psychological Association.
Richards, P. S., & Bergin, A. E. (2000). Handbook of psychotherapy and religious diversity. Wash-
ington, DC: American Psychological Association.
‘Richards, P. S., & Potts, R. W. (1995). Using spiritual interventions in psychotherapy: Prac-
tices, successes, failures, and ethical concerns of Mormon psychotherapists. Professional
Psychology: Research and Practice, 26, 163-170.
Ridley, C. R., Baker, D. M., & Hill, C. L. (2001). Critical issues concerning cultural compe-
tence. The Counseling Psychologist, 29, 822-832.
Rosenthal, R. (1979). The file drawer problem and tolerance for null results. Psychological
Bulletin, 86, 638-641.
Rosenthal, R. (1991). Meta-analytic procedures for social science research (Rev. ed.). Newbury
Park, CA: Sage.
Shafranske, E. P. (1996). Religious beliefs, affiliations, and practices of clinical psychologists.
In E. P. Shafranske (Ed.), Religion and the clinical practice ofpsychology (pp. 149-164). Wash-
ington, DC: American Psychological Association.
‘Shafranske, E. P., & Gorsuch, R. L. (1984). Factors associated with the perception of spiri-
tuality in psychotherapy. Journal of Transpersonal Psychology, 26, 231-241.
‘Shafranske, E. P., & Malony, H. N. (1990a). California psychologists’ religiosity and psy-
chotherapy. Journal of Religion and Health, 28, 219-231.
*Shafranske, E. P., & Malony, H. N. (1990b). Clinical psychologists‘ religious and spiritual
orientations and their practice of psychotherapy. Psychotherapy, 27, 72-78.
‘Sheridan, M. J., Bullis, R. K., Adcock, C. R., Berlin, S. D., & Miller, P. (1992). Practitioners’
personal and professional attitudes and behaviors toward religion and spirituality: Is-
sues for education and practice. Journal of Social Work Education, 28, 190-203.
Smith, D. P. (1998). Patterns of religious experience among psychotherapists and their relation to
theoretical orientation. Unpublished doctoral dissertation, University of Chicago, Chicago.
Sorenson, R., & Hales, S. (2002). Comparing evangelical Protestant psychologists trained
at secular versus religiously affiliated programs. Psychotherapy, 39, 163-170.
Sue, D. W., Bingham, R., Porche-Burke, L., & Vasquez, M. (1999). The diversification of
psychology: A multicultural revolution. American Psychologist, 54, 1061-1069.
Sue, D. W., & Sue, D. (1999). Counseling the culturally different: Theory and practice (3rd ed.).
New York Wiley.
Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American Psychologist,
54, 1070-1077.
Tan, S. Y. (1987). Intrapersonal integration: The servant’s spirituality. Journal of Psychology and
Christianity, 6, 34-39.
Tan, S. Y. (1996). Religion in clinical practice: Explicit and implicit integration. In E. P. Shafranske
(Ed.), Religion and the clinical practice of psychology (pp. 365-390). Washington, DC: Ameri-
can Psychological Association.
*Winston, A. (1991). Family therapists, religiosity, & spirituality: A survey of personal and
professional beliefs and practices. Unpublished doctoral dissertation, The Union Institute,
Cincinnati, OH.
Worthington, E. L., Jr., Dupont, P. D., Berry, J. T., & Duncan, L. A. (1988). Christian thera-
pists’ and clients’ perceptions of religious psychotherapy in private and agency settings.
journal of Psychology and Theology, 7 6, 282-293.

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