Journal of Psychology and Christianity

Discuss how the article can enhance your professional and education decisions in the future. Additionally, explain how you will apply the information in the article to your everyday lifestyle.Journal of Psychology and Christianity2009, Vol. 28, No. 2,141-148Copyright 2009 Christian Association for Psychological StudiesISSN 0733-4273141metaphysical extremism. Naturalistic metaphysi-cal extremism assumes that human nature—indeed all of nature—is a purely naturalistic sys-tem and that any reliance on religious systems islikely to be damaging psychologically. Whilemany psychologists adopt naturalistic assump-tions, it is probably fair to say that few of themoccupy the extreme position that sees religionand mental health as incompatible. For the pur-pose of the present discussion, it is the assump-tion that religious belief is pathological that isbeing labeled extremism rather than the questfor naturalistic explanations per se. An opposingextreme casts suspicion on natural explanationsand interventions because of what might becalled spiritualistic metaphysical extremism.The perspective that views mental and physi-cal health as having only religious cures is sadlyillustrated by the death of 15-month-old AvaWorthington, whose parents were members of asmall sect called the Followers of Christ. Ava,who had pneumonia and a secondary bloodinfection, was treated solely with prayer inaccordance with her parents’ religious beliefs;she would almost certainly have been savedwith a course of antibiotics (Faith Healing, 2008).This was not an isolated incident; a decade earli-er, a newspaper reporter investigated the deathsof 78 minors that occurred during the previous30 years among the small Followers of Christsect, and concluded that over a quarter of thedeceased children would have survived withA Holistic Psychology of Persons:Implications for Theory and PracticeDavid N. EntwistleMalone UniversityMany perspectives about what role spiritualitymay play in mental and physical health and ill-ness have been offered throughout history, rang-ing from the view that religious belief inevitablyleads to mental illness, on one extreme, to theview which claims that there are only religioussolutions for psychological or medical problemson the opposite extreme. The perspective thatsees religion and psychological health as incom-patible was common in psychology severaldecades ago, as illustrated by the following quo-tations from Albert Ellis, one from early in hiscareer and one shortly before his death:In most respects religion seriouslysabotages mental health. (Ellis,1980, p. 5) Try to avoid a doctrinalsystem through which you are dog-matically convinced that you abso-lutely must devote yourself to theone, only, right, and unerringdeity…. Otherwise, in my view as apsychotherapist, you most probablyare headed for emotional trouble.(Ellis, 2002, p. 365)Although Ellis modified his perspective some-what in later years, his comments are prototypi-cal of what might be called naturalisticPlease address correspondence regarding this article toDr. David N. Entwistle, Dept. of Psychology, MaloneUniversity, 2600 Cleveland Ave., NW, Canton, OH44709. Email dentwistle@malone.eduA Christian worldview that takes seriously the idea of personhood as a holistic unity presents an idealperspective from which to explore human behavior as an expression of biological, psychological, andsocial influences (the “biopsychosocial” perspective now common in psychology) as well as an expressionof spiritual realities that, while often expressed through biopsychosocial media, are not simply ‘explainedaway’ by them. A Christian worldview that holds that human beings are a unity of biological, psychologi-cal, social, and spiritual realities creates an opportunity for theoretical integration and holistic practice, butit also creates practical tensions regarding how to discern the root causes of behavior (e.g., biological, psy-chological, social, or spiritual etiology) and attempting to discover the best way to intervene when impair-ment of functioning is noted (e.g., whether biological therapy, psychotherapy, social intervention, orreligiously-based interventions are called for). Additionally, there are ethical and legal issues that must betaken into consideration by Christians who are licensed mental health practitioners, especially whenhypothesized causes or proposed interventions stand somewhere between recognized secular interven-tions and specifically religious interventions. In this article, these topics are addressed both as theoreticalissues about how best to conceptualize human behavior and the causes of impairment, as well as practi-cally in regard to how to proceed in evaluating and using religiously-based interventions.simple medical treatment (Von Biema, 1998).Cases such as the death of Ava Worthington gar-ner intense media attention because they areboth rare and tragic. To a lesser degree, mostmedical doctors have experienced cases inwhich individuals rejected medical care in favorof spiritual remedies. Likewise, most mentalhealth practitioners can recount stories of indi-viduals who refused medication or psychothera-py because of religious beliefs, sometimes withtragic consequences.Most people—including most psychologists,one would suspect—do not follow the extremesof Ellis or the Followers of Christ, but these twoprototypes illustrate what Entwistle (2004a)called an Enemies Paradigm in which the “adher-ents of these models see each other as enemies,and either reject or neglect one of the two booksof God: His word or His works” (p. 203). Adher-ents of the secular version of this paradigm viewreligious beliefs as inherently illogical and dan-gerous. Adherents of the sacred version of thisparadigm view personal belief or practice that isbased on science or logic as a dangerous depar-ture from religious fidelity.As psychology emerged from philosophy in thelate nineteenth century, it sought to establishitself as a science. In doing so it adopted method-ological naturalism, that is, “it seeks naturalexplanations for the phenomena it investigates”and it embraced the scientific method as themeans by which those explanations are sought(Entwistle, 2004a, p. 135). Gradually this becamecodified as the biopsychosocial approach, mean-ing that psychology seeks to understand behavioras it is mediated by biological, psychological, andsocial forces. The biopsychosocial approach hasbeen enormously successful, leading to medica-tions for mental illness, interventions based onintrapsychic phenomena (from cognitive behav-iorism to psychoanalysis), and awareness of howmembership in groups or the presence of othersinfluences behavior (social psychology). Psychol-ogy, as a science, is constrained to study religiousand spiritual matters as biological, psychological,and social processes. Notice, however, that evenif this approach is adopted, it does not mean thatspiritual beliefs are necessarily illogical or patho-logical, nor does not mean that there are not spir-itual realities; it just means that psychology—as ascience—cannot study spiritual realities directly.While psychology as a science adoptedmethodological naturalism, many psychologiststook a further step by embracing metaphysicalnaturalism, the belief that there is nothing otherthan the physical world. From this perspective,human behavior can only be seen as a productof material forces and as bounded by physicallife: death is the end of existence. Individualswho subscribe to metaphysical naturalism typi-cally view belief in supernatural phenomena asan impediment to science and as an expressionof primitive, illogical beliefs. It is from this per-spective that individuals like Ellis condemn reli-gious belief.Against this backdrop, a dominant strand oforthodox Christian theology views personhood asa holistic unity.1 An orthodox Christian worldviewaffirms that there are spiritual realities (e.g., theexistence of God and the activity of God withinthe created realm) and that we inhabit a physical,created world which we share with other createdbeings. Thus Christian theology affirms the exis-tence of spiritual, psychological, physical, andsocial realities. Christian theology does not giveus an explicit theory about how these realitiesoperate, but it affirms the essential unity of per-sonhood. Furthermore, it affirms that creation is“very good” (Gen. 1:31) and that we owe ourexistence to God. The natural realm of creationoperates by fixed, discernible rules made by God,which make scientific and rational inquiry possi-ble (Lewis, 1947/1996). A holistic view of humanpersonhood that emerges from a Christian world-view has important implications for how best toconceptualize psychological phenomena.Implications of a Holistic View ofPersonhood for Psychological TheoryA Christian conceptualization of human per-sonhood as a holistic unity allows us to respectbiopsychosocial and spiritual realities, and more-over, to see them as unified rather than bifurcat-ed. The most important implications of thisperspective are that it recognizes the legitimacyand boundaries of naturalistic science whilesimultaneously affirming the fundamentally spiri-tual nature of human beings and the truths thatGod proclaims about human beings. This beingthe case, theology and psychology can worktogether to inform our understanding of humannature and functioning.A holistic view of human personhood alsoallows us to see how spiritual realities might bemediated through biopsychosocial media. Forinstance, imagine that a woman is feeling lonely,depressed, and isolated. Her prayer for divine142 A HOLISTIC PSYCHOLOGY OF PERSONShelp might well be answered through the socialconnections that she has with others in herchurch family. In fact, a host of research on reli-gious coping suggests that meaning, purpose,social connection, and other tangible benefitsmay be directly attributable to the religiousbeliefs and practices of religiously committedindividuals (e.g., Koenig, 2004). The belief thatspiritual realities may be expressed through nat-ural media does not explain away their supernat-ural origins or reduce them to physicalphenomena. Affirming both natural and spiritualrealities allows us to avoid a dualistic splitbetween the sacred and the secular and to pro-vide holistic care. A holistic view of personhoodwill thus have implications for clinical practicefrom a Christian perspective.Implications for Psychological PracticeFor Christians who work in the mental healthfield, this conceptualization of the relationship ofthe supernatural and the natural opens a doorinto a patient’s religious life beyond merely seeingit as an expression of biological, psychological,and social factors. However, this conceptualiza-tion brings with it ethical issues about how towork with patients when their religious beliefscould be a matter of clinical concern or psycho-logical beneficence. Religious and non-religiouspeople can agree that religious beliefs may helpor hinder physical or psychological health. How-ever, Christians are committed to the belief thatthere are spiritual realities; they are not contentwith pragmatically using faith as a utilitarian cop-ing mechanism. Furthermore, religious belief canbe accurate or inaccurate, helpful or—as in thecase of Ava Worthington—harmful. This being thecase, theology cannot be seen as unimportant towell-being.In recent decades, clinical psychology hasretreated from the perspective that religion isbound to contribute to psychopathology. Inlarge part, this movement has resulted fromempirical data that clearly show benefits of reli-gious belief and practice (see Koenig, 2004, foran overview). As a result of this shift, many psy-chologists now consider how spirituality shouldbe addressed in therapy, whether through takinga spiritual history, through incorporating isolatedspiritual practices into therapy, or by offeringexclusively, religiously-based therapies. How toaddress religious beliefs in therapy ethically is asignificant matter.Ethical Boundaries of PracticePsychologists—and other mental health profes-sionals—are licensed or certified to provide psy-chotherapy and other services that fall within the“boundaries of their competence, based on theireducation, training, supervised experience, con-sultation, study, or professional experience”(APA Code of Ethics, Section 2.01). In normalusage, the boundaries of competence apply to“recognized techniques and procedures,” andspecial guidelines are called for if a psychologistprovides services that employ techniques or pro-cedures that are beyond the scope of the “gener-ally recognized techniques and procedures” ofthe profession (APA Code of Ethics, Section10.01-b). In summary, these guidelines are quiteclear—a psychologist is licensed to provide“generally recognized techniques” of psychother-apy that she is competent to provide based on“education, training, and supervised experience.”A secular materialist may deal with the spiritualas a mere expression of biological, psychological,and sociological phenomena, but the Christiansees spiritual phenomena as reflecting more thanmaterial reality. The secular materialist and theChristian may agree that it is important to takespirituality into account in psychotherapy, espe-cially as it regards the client’s phenomenologicalperspective. While it may be important to under-stand the client’s spiritual framework, to gobeyond this and make use of spirituality thera-peutically must be done with great caution. Apsychologist who considers using religiously-based interventions needs to consider severalissues: how to use religiously-based interventionsethically; how to be sensitive to the client’s beliefsystem; the inherent vulnerability of the clientdue to the inequality of the therapeutic powerstructure; and the dangers of reducing religiousbelief to a therapeutic enterprise.Using religiously-based interventions ethicallyA myriad of therapeutic techniques based onspiritual or religious beliefs and practices havebeen developed by Christians who believe thatthese techniques offer therapeutic benefits forpatients who have mental health problems (e.g.,Anderson, Zuehlke, & Zuehlke, 2000). Religious-ly-based interventions may include common reli-gious practices such as prayer, meditation, orscripture reading; many of these interventionsare used adjunctively to standard forms of psy-chotherapy. Other religiously-based interventionsmay combine elements of a standard form ofDAVID N. ENTWISTLE 143psychotherapy with spirituality, such as exploringdysfunctional religious beliefs from a cognitive-behavioral framework. Some religiously-basedinterventions may involve systematic techniquesderived from a particular theological perspective.Religiously-based interventions that are adjunc-tive in nature may pose few ethical issues whenthe primary treatment modality is a recognizedform of psychotherapy, although informed con-sent and other issues must be addressed. Howev-er, religiously-based interventions that are used asthe primary treatment modality, because they falloutside of the realm of “generally recognizedtechniques and procedures,” must be used withcaution, especially if they are portrayed to clientsas “psychological” interventions.2Religiously-based interventions that are utilizedas a primary treatment modality and billed for aspsychological services raise several ethical con-cerns (see also Hunter & Yarhouse, 2009). First,religiously-based interventions should not be usedunless the psychologist has demonstrated compe-tence in the use of the technique (APA EthicalPrinciples, 2.01 – a & e). Second, they should notbe used without first obtaining explicit informedconsent from the client. In cases where the pro-posed technique is not “generally recognized,” itis incumbent upon the psychologist to inform theclient “of the developing nature of the treatment,the potential risks involved, alternative treatmentsthat may be available, and the voluntary nature oftheir participation” (APA Ethical Principles, 10.01 –b). The following scenario illustrates how theseprinciples are sometimes violated.In 2002 I received an e-mail solicitation toattend a three day course on “Clinical Diagnosisand Treatment of Demonic Oppression.” The“course” was designed to teach “Christian coun-selors” to “diagnose and treat demonic influ-ences.” The seminar outline did not include anymention of ethics. It included the presenter’sclaim that when she “diagnosed” and “treated”demonic oppression in her clients she observedthat they “spent far less time in therapy andbecame functional faster.” This case is instructivein three ways. First, it demonstrates a flagrantconfusion of professional psychotherapy and anarrow religious practice; demonic deliverance isnot a “generally recognized technique” in mentalhealth treatment; using such a technique andcalling it counseling or psychotherapy (muchless billing for it as such) would be irresponsible,unethical, and illegal.3 Second, the advertisementfor the seminar did not seem to reflect an ade-quate recognition of the oversight of licensingboards and ethical guidelines. This case shows aclear failure to attend to the ethical issuesinvolved, whether in the use of a technique thatis not recognized as part of professional psychol-ogy or in securing informed consent. Third,there is a troubling claim that this “therapy” issomehow superior to and faster than other thera-pies, absent any empirical evidence to substanti-ate such a claim, and with no attention topossible harm that could come about as a resultof this “intervention.” The ethical codes of mosthelping professions explicitly condemn makingunsubstantiated claims that a particular methodis superior to others, especially if such claims areused for solicitation. For instance:Psychologists do not make false,deceptive, or fraudulent statementsconcerning… the scientific or clinicalbasis for, or results or degree of suc-cess of, their services…. (APA EthicalPrinciples, 5.01-b)We do not make public statementswhich contain… a statement intend-ed or likely to create false or unjusti-fied expectations of favorable results,a statement implying unusual,unique, or one-of-a-kind abilities,including misrepresentation throughsensationalism, exaggeration orsuperficiality, … a statement concern-ing the comparative desirability ofoffered services. (American Associa-tion of Pastoral Counselors Code ofEthics, Principle 7-D, 1, 5, & 7)It is worth noting that the person who offeredthe aforementioned “course” is no longer alicensed mental health professional.While the foregoing may be an extreme exam-ple, it illustrates a number of key concerns. First,there are some techniques that simply fall so faroutside of the practice of the profession of psy-chology that they cannot be ethically incorporat-ed into psychotherapy. Second, even withtechniques that are within the mainstream ofmost religious practices (such as scriptural medi-tation or prayer) it is important to inform clientsthat the use of such techniques is not consideredto be a standard treatment, and it is essential forthe therapist to secure informed consent. Third,a promise of superior results should always be ared flag, especially when it is presented withoutempirical support. Finally, the potential for harm144 A HOLISTIC PSYCHOLOGY OF PERSONSis something that should not be overlooked orunderestimated.Sensitivity to the client’s belief system andinherent vulnerabilityPsychotherapy inevitably involves a power dif-ferential: one person, the client, is seeking helpfor some type of distress or disability, fromanother person who is recognized legally and bysocial standing as having some form of expertisefor which remuneration is received (Zur, 2007).Some clients, such as minors and individualswith mental retardation, are particularly vulnera-ble and, as such, it is incumbent upon profes-sionals to make special efforts to protect theirwell-being (APA Ethical Principles, Principle Eand 3.10 – b). Furthermore, the professionalcode of psychology requires that “Psychologistsare aware of and respect cultural, individual, androle differences, including those based on… reli-gion…” (APA Ethical Principles, Principle E). Inthe event that a Christian client seeks out a par-ticular psychologist because she is a Christian,discussion of religious beliefs or the use of reli-gious practices that may have psychological ben-efits may well be appropriate if the client hasbeen made aware of the nature and limitationsof those techniques and informed consent hasbeen obtained. Even here, however, cautionmust be taken because of the inherent powerimbalance of the situation. Imagine that an indi-vidual tends to defer to religious authorities andmay hide religious misgivings out of fear of con-demnation. If a psychologist were to promotethe use of religious interventions in such a case,she might well miss the opportunity to explorethe client’s religious misgivings and interpersonaldynamics. This is not to say that such interven-tions are never appropriate, but it is intended tohighlight the fact that religiously-based interven-tions should not be undertaken lightly. Where aclient and therapist do not share a common reli-gious framework, religious interventions thatproceed from the stance of the therapist’s reli-gious viewpoint are particularly problematic.A further issue may be encountered in a situa-tion in which a psychologist judges her client’sreligious belief to be in error and damaging tomental health. For instance, had the parents ofAva Worthington made a psychologist aware oftheir decision to treat their daughter only withprayer, the psychologist could well incur aresponsibility to contact authorities to protect thechild’s safety and welfare. In a less serious situa-tion, one might face the difficulty of trying toassess the adequacy of a client’s religious beliefsystem. If therapy involves an attempt to “cor-rect” “faulty religious thinking,” or to use anexplicit religious practice therapeutically, thetherapist encounters a predicament: how shouldshe determine that a religious belief is maladap-tive or that a religious practice might be benefi-cially prescribed? Suppose that a client believesthat God is punishing him for his sins through aphysical infirmity. If his therapist concludes thatthere is no logical connection between theclient’s supposed sins and his physical infirmity,she may well conclude that there is a connectionbetween the client’s bad theology and his lessthan optimal state of mind. In such instances, itmay be appropriate and therapeutic for theclient’s cognitive religious distortions to be afocus of treatment, but this must be done care-fully, humbly, and ethically.Exploring the client’s religious experience maybe an important part of understanding how heframes his current situation and the resourcesand supports at his disposal. Furthermore, focus-ing on religious beliefs may be a necessary com-ponent of psychotherapy if those beliefsnegatively impact well-being.Potential harm and religiously-basedinterventionsThe first rule of good treatment can be tracedto the Hippocratic Oath: “primum non nocere—first, do no harm” (Lilienfeld, 2007). The bulk ofpsychotherapy research has focused on psy-chotherapy efficacy, but it is also notable thatunder certain circumstances, psychotherapy canbe harmful. Lilienfeld identified two types ofpotentially harmful therapies (PHTs): those thatprobably produce harm in some individuals(Level I) and those that have potential to pro-duce harm in some individuals (Level II). Level IPHTs include Recovered Memory Techniques(RMT) and Dissociative Identity Disorder (DID)oriented psychotherapy. The use of techniquesthat may be similar to RMT and DID orientedpsychotherapy was a major focus of Entwistle’s(2004b) critique of Theophostic Ministry (TPM),in which DID, Satanic Ritual Abuse (SRA), andRMT are commonplace. Some religiously-basedinterventions, especially those that reflect a“healing of memories” approach, may have anincreased risk of producing harm in some indi-viduals. It is important to note that any therapeu-tic intervention can have adverse effects, andDAVID N. ENTWISTLE 145that some techniques increase these risks. Giventhe centrality and importance of religious belieffor many individuals, a religiously-based inter-vention that was harmful to a client or that dam-aged the religious belief systems of a clientcould have long-term adverse effects. Further-more, as we will see, religious systems them-selves can suffer when religion is valued merelyfor its instrumental effects.Religious belief as more than therapeuticAn often overlooked problem in the use ofreligiously-based therapeutic techniques is therisk of reducing religious beliefs to their prag-matic value as a source of morality and comfort.Sociology of religion researcher Smith (2005)referred to this type of religious pragmatism as“moralistic therapeutic Deism.” However, Chris-tianity (and most other major religions) are notprimarily designed to bring about personal satis-faction and fulfillment. Rather, the focus of Chris-tianity (and most other major religions) is ontransforming people into the kinds of personsand communities that the religious system saysthey should be. This, in turn, may have signifi-cant personal and interpersonal benefit, but suchbenefit is not the overarching aim of the reli-gious system. In his extensive research of thereligious views of American adolescents, Smithfound that—for the majority of religious adoles-cents—religion was viewed instrumentally for itsbenefits to the individual.What we heard from most teens isessentially that religion makes themfeel good, that it helps them makegood choices, that it helps resolveproblems and troubles, that it servestheir felt needs. What we hardlyever heard from teens was that reli-gion is about significantly transform-ing people into, not what they feellike being, but what they are sup-posed to be, what God or their ethi-cal tradition wants them to be.(Smith, pp. 148-149)The risk of treating religious faith primarily as ameans to happiness and satisfaction is very sig-nificant when spiritual beliefs and practices areused as therapeutic interventions: we need tobe very cautious, or in the name of “integra-tion” we may actually propagate moralistic ther-apeutic Deism.C. S. Lewis (1943/1952) highlighted this con-cern far before modern sociologists or psycholo-gists saw the risk of reducing Christianity to atherapeutic technique. As he wrote in MereChristianity:Aim at Heaven and you will get earth‘thrown in’: aim at earth and you willget neither. It seems a strange rule,but something like it can be seen atwork in other matters. Health is agreat blessing, but the moment youmake health one of your main, directobjects you start becoming a crankand imagining there is somethingwrong with you. You are only likelyto get health provided you wantother things more—food, games,work, fun, open air. (pp. 118-119)Harold Koenig (2004) echoed this sentiment: “Ifhealth is your top priority, and religion is viewedonly as a means to that end, you are apt to bevery disappointed. Research has found no heal-ing connection to this sort of utilitarian use ofreligion….” (p. 163).To this point it might seem that there is arather doubtful tenor to exploring connectionsbetween faith and health, but this is not what Iwant to convey. Religious beliefs, for manypeople, convey a worldview that is an orientingforce in their lives. It is therefore important forclinicians to understand the things that givetheir clients meaning, value, purpose, anddirection. Good theology, it should be expect-ed, generally leads to better adjustment, andbad theology to poor adjustment. A holistic psy-chology of persons allows the clinician toexplore spirituality not simply as a utilitarianforce for personal betterment, but as a legiti-mate encounter between persons, religiouscommunities, and God, while simultaneouslyrecognizing the biological, psychological, andsociological forces that are the bread and butterof psychology. In fact, the relationship betweentherapist and client can be legitimately seen asa spiritual encounter (Buber, 1970). Additional-ly, it is clear that certain religious beliefs andpractices have beneficial consequences formental and physical health, and other religiousbeliefs and practices have negative conse-quences (Koenig, 2004; Pargament, Ensing, Fal-gout, Olsen, et al., 1990; Pargament, Olsen,Reilly, Falgout, et al., 1992). There is a place fordealing with spirituality in psychotherapy, butdoing so with a cavalier attitude is dangerousfor faith as well as for clients.146 A HOLISTIC PSYCHOLOGY OF PERSONSBeyond Albert Ellis and Ava WorthingtonWhile we may, artificially and for conveniencesake, focus on isolated biological, psychological,social, or spiritual aspects of human functioning,the reality is that we function as whole beings. Aholistic view of human personhood thusacknowledges that biological, psychological,social, and spiritual influences affect health andbehavior. As such, it is important to evaluate bio-logical, psychological, social, and spiritualdimensions, because each of these areas can bea cause of health or dysfunction. A holistic viewof personhood, though, calls us to a non-reduc-tive anthropology that acknowledges spiritualand biopsychosocial dimensions while maintain-ing a view of the fundamental unity of humanpersonhood.4The extreme positions that were considered atthe beginning of this article, those of Albert Ellisand those that led to the death of Ava Worthing-ton, do not leave much room for a holisticunderstanding of human behavior. In Ellis’ viewthe individual is treated as a soul-less body. Avadied because her parents’ beliefs led them toneglect her physical healing in the quest for aspiritual cure. The situation is much different ifhuman personhood is understood as a holisticunity. First and foremost, a Christian theology ofpersonhood means that every human being hasvalue because each person reflects the divineimage, the imago Dei. As a corollary, we have aresponsibility to care for one another, and psy-chotherapy may, under this view, be seen as asacred calling to care intimately about the wel-fare of others. Furthermore, if we take seriouslythe idea that spiritual realities have a supernatu-ral origin, then things such as God’s revelation,transcendent morality, and the worth and valueof every created being drive us to look at thepurposes for which we were created. It wouldstand to reason, then, that when we align our-selves with these purposes, we are more likelyto function as we should (cf. Bergin, 1980). Con-versely, when we try to live our lives counter tothese purposes, we are more likely to functionpoorly. Thus spiritual truths have real, tangibleconsequences for how we live. This can be seenquite clearly by exploring the implications ofsome basic Christian doctrines such as thathumans are created in the image of God, that weare sinful, and that God calls us to repentance(change our direction). These doctrines put us inour proper place. Likewise, many Christianteachings and practices orient us towards properliving by shaping character and mind. In thiscontext, prayer, scriptural meditation, and a widevariety of religious practices may have significantphysical or psychological benefits. However, it isimportant to keep in mind that religious prac-tices are intended primarily to orient and redeemhuman life, not to be used as isolated therapeu-tic techniques.While clinicians should not ignore the spiritualdimension, they also need to be aware of themyriad issues that are involved when this dimen-sion is a focus of clinical attention. The use ofspiritual practices or techniques in psychothera-py may be beneficial for some clients, but spiri-tuality ought not to be viewed merely throughthe lens of pragmatic utilitarianism. For thoseclinicians who choose to make use of religious-ly-based interventions, it is imperative that theyensure that these interventions are consonantwith established psychological techniques,grounded in sound theology, and applied ethi-cally and with great attention to their potentialfor misuse and for harmful consequences.Notes1. In an earlier draft of this manuscript I sought todescribe this unity by using the term “the embodiedsoul.” However, I soon became convinced that thisterm, which can be traced to Aristotle and later toPlontinus, carries too much of a Cartesian dualism thatworks against my thesis. I am not here assuming aparticular philosophical view of the relationship ofsoul to body, nor am I suggesting that the soul is theforce that animates the body. My point is simply toemphasize the idea that spirituality arises within thestuff of the material and social world, but cannot bereduced to mere physical substance.2. The remainder of the discussion is limited to theuse of religiously-based interventions that are por-trayed as psychological interventions, e.g., servicesthat are portrayed, provided, and/or billed for as psy-chotherapy. There is considerably more latitude forpastoral or lay counselors who are not portrayingthemselves as providing professional mental healthservices. However, even here there are important eth-ical considerations. See Tan (1991) for a helpful dis-cussion of lay counseling, including ethicalconsiderations.3. Different branches of Christianity disagree onwhether demonic influences should be understood lit-erally or figuratively. At present I am not expressing aposition on this issue. I am simply stating that, regard-less of one’s personal beliefs on this issue, incorporat-ing it into a professional service is blatantlyinappropriate, potentially dangerous, and likely to vio-late several ethical and legal guidelines.DAVID N. ENTWISTLE 1474. There are various theories about the nature of theconnection between biological, psychological, social,and spiritual dimensions, but considerations of thatsort are well beyond the scope of the present article.ReferencesAmerican Association of Pastoral Counselors. (1994).Code of ethics. Retrieved December 16, 2008, theAmerican Association of Pastoral Counselors website:http://www.aapc.org/ethics.htmAmerican Psychological Association. (2002). EthicalPrinciples of Psychologists and Code of Conduct. Wash-ington, DC: APA.Anderson, N. T., Zuehlke, T. E., & Zuehlke, J. S.(2000). Christ centered therapy. Grand Rapids: Zonder-van.Bergin, A. E. (1980). Psychotherapy and religiousvalues. 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Soul search-ing: The religious and spiritual lves of Americanteenagers. New York, NY: Oxford University Press.Tan, S-Y. (1991). Lay counseling: Equipping Chris-tians for a helping ministry. Grand Rapids: Zondervan.Von Biema, D., with Kray, D. (1999, August 31). Faithor Healing? Why the law can’t do a thing about theinfant-mortality rate of an Oregon sect. Time, 152 (9).Zur, O. (2007). Boundaries in psychotherapy: Ethicaland clinical explorations. Washington, DC: AmericanPsychological Association.AuthorDavid Entwistle earned a B.A. in Psychology fromTaylor University, and Masters and Doctoral degrees inClinical Psychology from Rosemead School of Psychology,Biola University. He is a licensed clinical psychologist.Dr. Entwistle is a Professor of Psychology at Malone Uni-versity in Canton, Ohio. His primary research interestinvolves coping and treatment adherence among indi-viduals with chronic illness, including the impact of posi-tive and negative religious coping mechanisms.148 A HOLISTIC PSYCHOLOGY OF PERSONSReproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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