Counseling Clients with Chronic Pain: A Religiously Oriented Cognitive Behavior Framework.

Each year, 50 million Americans are affected by chronic pain, resulting in annual health care and economic costs of more than $100 billion (American Chronic Pain Association, n.d.). Physically, these individuals face functional limitations, reduction in activity levels, loss of libido, sleep disorders, and appetite changes; these and other issues often lead to a pervasive dependence on the health care system (Eimer & Freeman, 1998). Social implications include occupational, familial, or other interpersonal difficulties that further complicate successful adaptation (Lewandowski, Morris, Draucker, & Risko, 2007). However, psychological factors may pose the greatest impediment to effective coping with chronic pain. The literature supports the notion of the mind-body-spirit as an interactive system, with each element influencing the other, particularly in the case of chronic pain (Culver & Kell, 1995; Lewandowski et al., 2007). Cognitions, including religious beliefs, play a crucial role in the appraisal, management, and outcome of this condition (Bush et al., 1999). Although religious beliefs derived from institutional doctrine and practice may differ from personalized spiritual beliefs, both often include faith in a transcendent force. Religious beliefs are common in our society; for example, 90% of Americans state a belief in God (Winseman, 2005). When positive (e.g., a benevolent, supportive God), these beliefs can contribute to healthy adaptation; conversely, negative religious beliefs (e.g., a conditional, vengeful God) may exacerbate problems associated with chronic pain (Rippentrop, Altmaier, Chen, Found, & Keffala, 2005). Although the inclusion of religious material has been historically overlooked in therapy (Faiver, O'Brien, & Ingersoll, 2000), many clients state a preference for counselors who hold similar beliefs or who are at least sensitive to religious issues (Burke et al., 1999). The Association for Spiritual, Ethical and Religious Values in Counseling created the Spiritual Competencies to guide ethical practice in this regard (Genia, 1994). Yet, some counselors continue to believe that religious topics should be left to clergy, whereas others admit that they lack the expertise to address these concerns (Faiver et al., 2000; Genia, 1994). Failure to consider religious matters may constitute neglect of a viable resource. For example, positive religious beliefs have been shown to moderate pain beliefs, alleviate helplessness, and reinstate hope (Cole, 2005; D' Souza & Rodrigo, 2004; Keefe et al., 2001). Thus, it is essential for counselors to gain an awareness of their clients' religious belief system, explore its interaction with pain-related beliefs, and guide clients toward more positive coping strategies (Bond, 2001). The purpose of this article is to examine the effects of religious beliefs on the mental health outcomes of clients experiencing chronic pain. A framework involving religious schemas and pain-related beliefs is proposed, along with a cognitive behavior strategy for moderating negative patterns. Pain, Depression, and Counseling Pain, as defined by the International Association for the Study of Pain, is a subjective, "unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Merskey & Bogduk, 1994, p. 210). Pain is considered chronic when, despite treatment, it persists for months or years beyond the expected recovery period (American Chronic Pain Association, n.d.). Individuals experiencing chronic pain commonly hold beliefs that compromise their self-image, they believe that pain is beyond their control, and they harbor excessive concern about present and future functioning, all of which lead to perceived hopelessness, meaninglessness, social isolation, and exaggerated fear-based beliefs (Bond, 2001; Eimer & Freeman, 1998; Westgate, 1996). …