Clinical Practice with Religious/Spiritual Issues: Niche, Proficiency or Specialty:

The process of specialty recognition in professional psychology has become increasingly formalized in recent years. The American Psychological Association (APA) now formally defines and recognizes specialties in psychology and organizations such as the American Board of Professional Psychology have repositioned themselves as specialist credentialing bodies. A process model of specialization is presented with increasing levels of specialization arranged from more generalized to more specialized as follows: nonspecialized general practice, niche practice, proficiency, and formal specialty practice. The distinction between de facto and de jure recognition of specialty practice is discussed. It is argued that clinical work with religious/spiritual issues (RSI) already constitutes a practice niche and that numerous de facto proficiencies have been developed for this niche. The prospects and challenges for more formal specialty recognition of the domain of practice are discussed. The article concludes by briefly considering the relationship of "Christian counseling" to a possible formal specialty in clinical work with religious/spiritual issues. The APA (2002) Ethics Code calls all practitioners to show respect for client religiousness and spirituality as a diversity domain. But how equipped are they to do this? Only a small subset of psychologists report receiving any training in working with religious/spiritual issues (hereafter referred to as RSI) in practice. Researchers have found only between 10 to 30% of psychologists report that they have ever received training in working with RSI (Hathaway, Scott & Garver, 2003). There are also indications that professional psychologists as atypically irreligious compared to the general American population (Shafranske & Maloney, 1990, Sorenson & Hales, 2002). This finding has led some to wonder whether RSI are being neglected in routine practice (Hathaway, Scott, & Garver, 2003). Still there is evidence that at least some clinicians have developed more deliberate and informed approaches to working with RSI. There has been a promulgation of scholarly texts and journals dedicated to the practice area (Richards & Bergin, 2000, 2005; Shafranske, 1996; Miller, 1999; Griffith & Griffith, 2002; Nielsen, Johnson, & Ellis, 2001). Additionally, an increasing number of articles have been published in mainstream clinical journals focusing on practice with RSI (Ellis, 2000; Miller & Thoresen, 2003; Pargament, Koenig & Perez, 2000; Zinnbauer & Pargament, 2000). There are now several APA accredited doctoral programs that focus on the provision of professional training in a context that emphasizes the integration of RSI. Graduates from these programs are typically required to take formal coursework in the domain. Other doctoral programs and internships exist that offer specialty rotations or practice concentrations in contexts where clients frequently present with RSI (Yarhouse & Fisher, 2002). Client demand for therapists who personally share a particular faith perspective with the client is not uncommon (Worthington, Kurusu, McCullough, & Sanders, 1996). In some cases, mental health professionals have self-identified as providing services that incorporate faith traditions such as "Christian counseling" (AACC, 2008). This client demand, coupled with the professional self-identification, has produced enough public awareness for some managed care panels to inquire whether professionals do "Christian counseling" as part of their range of services. Given these trends, how are we to understand clinical practice in this domain? Is practice with RSI an underdeveloped area of general practice or is it a type of emerging specialty practice whose maturation would improve the services delivered? In order to more clearly address this topic, a brief overview of recent trends in clinical specialization will be given. SPECIALIZATION IN CLINICAL PRACTICE The Specialization Trend The trend towards specialization in professional psychology, and some of the factors driving it, has been described by Drum and Blom (2001). …