Faith in Practice — Religious Beliefs in the Client Relationship
By David Surface
Social Work Today
Vol. 6 No. 4 P. 44

Once discouraged by standards of practice, social workers are examining the judicious, ethical recognition of religious beliefs in the client relationship.

With the growth of the conservative Christian movement in the United States, increasingly more social workers find themselves face-to-face with their clients’ religious beliefs—the fervent Christian who brings the Bible to each session and insists on relating everything to scripture, the fundamentalist parents who want to disown their gay son, the family in the hospice who want to be reassured of their dying relative’s place in heaven.

But there is concurrently another kind of change taking place in the social worker-client landscape; one in which the social worker’s religious beliefs play an equally significant role. The degree to which social workers allow their personal religious beliefs to enter into their relationship with clients varies greatly from case to case and runs the gamut from the social worker simply admitting to being a religious person to allowing and, in some cases, even encouraging overtly religious practices such as prayer to become part of the session.

What’s going on here? Is this growing religious openness among social workers a threat to long-held professional standards? Or is it, as some would tell us, a fulfillment of those standards?

Training and History: How Did We Get Here?
While social workers have been encouraged to be aware of how their clients’ religious beliefs influence their working relationships, social workers themselves are not as often encouraged to take their own religious beliefs into account—perhaps because, until fairly recently, they were assumed to have none. Or, if they were religious, social workers were expected to be able to keep those beliefs completely separate from their relationships with clients.

“Historically, the introduction of religious beliefs on the part of the therapist or social worker into the relationship with the client was thought to bias the relationship,” says Lina Hartocollis, PhD, associate dean for students at the University of Pennsylvania School of Social Policy & Practice, where she teaches clinical social work courses. “It was thought to somehow interfere with the social worker’s ability to be open to the client’s point of view.”

David Sherwood, PhD, LICSW, ACSW, is a professor in the School of Social Work at Baylor University, which is affiliated with the Baptist General Convention of Texas. He is also the editor of Social Work and Christianity. According to Sherwood, social workers who try to deny that they have deep personal beliefs that affect their relationships with clients may end up doing more harm than those who admit to those beliefs and try to deal with them in an honest and professional manner.

“When I got my MSW, long ago in the pre-postmodern, Freudian psychoanalytic days, one of the things we were taught was that we were supposed to be value-neutral and totally objective,” recalls Sherwood. “Of course, that’s impossible.”

Need for Religious Literacy
Today, social workers are being challenged to acknowledge and understand how their own core beliefs enter into their relationships with clients, and then manage that in ethical and competent ways.

“I think there’s a turn toward viewing social workers’ attitudes, beliefs, and personal values in a new light,” says Hartocollis. “It’s impossible to fully disguise them—they’re going to come through anyway. If carefully used, in the sense of the social worker’s use of self, they can help to build the relationship with clients.”

“We always bring our religious faith and belief into every relationship,” says Diana Garland, PhD, dean of the School of Social Work at Baylor. “I teach our students that every crisis in life that brings a client to a social worker has a faith dimension to it. These situations tend to raise fundamental questions like, Why did this happen to me? What meaning does my life have? These are spiritual questions that are of great importance to the client, and we need to be able to deal with them.”

Why Now? Reasons for the Growth of Spirituality in Social Work
Why this growth of interest in religion and spirituality among social workers? According to Carolyn Jacobs, MSW, PhD, dean and Elizabeth Martin Treuhaft professor at Smith College School of Social Work, the reasons are threefold.

“First, there’s the impact of 12-step programs,” Jacobs says. “Clinicians today have to deal with the fact that there are all these people out there who’ve had some kind of profound experience in these programs, which nearly all refer to a ‘higher power.’” Jacobs points out that the “higher power” spoken of in 12-step programs is nondenominational, which probably increases its appeal to people with no previous church affiliation.

Jacobs points to the media as the second-most-powerful reason for the growth of interest in spirituality among social workers. “The media has had an enormous impact with stories about the impact of God and spirituality in people’s lives. There’s also all the publicity given to research about the effect of prayer and healing in medical settings.”

The third reason Jacobs cites is found in social work education itself. “Medical schools have started including courses on religion and spirituality in their curriculum to help medical personnel better understand and treat their patients,” Jacobs says. “Similarly, this trend of introducing religious and spiritual topics into the curriculum has also reached schools of social work, and not just in faith-based institutions.” Jacobs herself leads continuing education workshops on spirituality and trauma.

Professionalism and Self-Examination
Addressing how social workers’ religious beliefs ought or ought not enter relationships with clients is no easy matter because social workers initially lacked the language to discuss it. Sherwood points out that while some social work professionals relate to the language of integrating faith and practice, others tend not to relate to it or are uncomfortable with it. The answer, Sherwood believes, is to view the issue through the lens of professionalism.

“I like to think about it in terms of what is competent and ethical social work practice,” says Sherwood, “and how a given social worker’s personal beliefs as well as the client’s beliefs intersect with that.”

Sherwood believes the first step to successfully integrating religion and social work practice is critical self-awareness, an understanding of one’s own beliefs and values and how they affect professional perceptions in practice. “What are my core beliefs and assumptions and how do those affect how I deal with clients?” Sherwood says. “How can they sometimes be helpful and how can they be harmful?”

Avoiding Easy Assumptions
While the most dramatic examples of religion being a problematic factor are when the client’s beliefs clash with the social worker’s beliefs, there is still reason for caution when the client and the social worker share the same faith.

Just as social workers who don’t consider themselves religious should resist the impulse to view their clients’ religion as a sign of avoidance or pathology, social workers who are religious should not automatically interpret their clients’ religious beliefs as a sign of positive growth or health.

Sherwood offers an example: “Suppose I’m a Christian and I encounter a client who expresses himself in Christian terms and says that prayer is very meaningful to him. Let’s say that, as a Christian, I happen to believe that prayer can be a good thing. How do I ethically and competently deal with this? There is no stock answer. It takes assessment. You have to ask, ‘What would it mean to this client if I acknowledge that I also believe in prayer? What would it mean to him if I agreed to pray with him?’ Just because we happen to share the same belief doesn’t answer those questions.”

Garland believes it’s important for social workers to use all their skills of assessment when allowing the topic of religion to enter into their sessions with clients.

“For social workers who are practicing Christians, the assumption that if a client is a Christian then we can pray together is dangerous,” says Garland. “It’s always dangerous to make assumptions about clients’ religious beliefs without knowing what the meaning of it is for them. In religious or spiritual matters, we need to understand the client with as much skill and knowledge as we do in any other kind of assessment.”

“I think it’s very dependent on the particular client,” says Hartocollis. “For example, if the social worker is working with a client who discloses his own deeply held religious beliefs and has gotten negative feedback from others saying that he should not be so religious, and the social worker wants to help the client feel more free to express himself and be more accepting of himself, the social worker might say, for example, ‘I appreciate how important religion is to you—I’m also a religious person.’ If the social worker goes on, however, to talk in detail about his own spirituality, it might be problematic because his beliefs might differ from the client’s and the client might feel compelled to follow.”

Jacobs advises social workers to consult with religious authorities from their client’s tradition to help them interpret how that particular religious community views religious concepts such as sin and forgiveness. “If a client in crisis says, ‘This is happening because God wants it to happen to me,’ it may help to talk to a religious leader from the client’s tradition to help make sense of a statement like that, to understand what it means to the client.” Jacobs points out that this may also clarify the social worker’s own deeply held religious concepts and how they may be similar to or differ from the client’s.

The Urge to Refer
Social workers may not be as skilled at assessing the religious attitudes of their clients as they are with other areas of clients’ lives simply because they have denied themselves that opportunity.

Garland encourages social workers not to respond to clients’ religious questions or statements by immediately referring them to some outside religious authority. “The fear is that the social worker is taking over the role of the clergy,” says Garland. “That’s nonsense.”

Garland offers this historical perspective on social work’s uneasy but insoluble relationship with religion. “Social work began in the church in this country and in Europe by well-meaning women and men who volunteered their services because they felt called to do something about the social injustices and poverty around them. As we moved into being professionalized, we distanced ourselves from that which drove those early women or men. Coupled with the theoretical foundations that we embraced in psychoanalytic approaches and behavioral approaches that left no room for addressing the meaning and purpose of life and that which is ultimate.”

“Not long ago, the bias in social work and psychiatry was that talk of religion was assumed to be pathological,” Sherwood recalls. “Social workers, therefore, refused to engage in religious discourse with clients. In what other area of human life and struggle would we be so quick to refer? When a client starts dealing with sexual issues, the immediate thought may be, ‘Well, I’m not a trained sex therapist, so I must refer to someone else.’ But to jump to the referral the first time the subject comes up is simply not good practice.”

What’s the Harm?
One concern that’s often voiced about social workers allowing their personal religious beliefs to become part of their discussions with clients is that the social workers may be abusing the power he or she has in a client relationship by either inadvertently or explicitly connecting agreement with the social worker’s religious beliefs and practices as a condition of services. Sometimes this can happen without a social worker appreciating the power they have in a relationship. For example, a social worker who’s working with a client who is lonely and bereft of a social network may suggest that the client find a church in their community—that suggestion may become, in the client’s mind, an expectation.

Social workers should be careful not to share their religious beliefs at a time when the client is especially psychologically or emotionally vulnerable. Frederic G. Reamer, PhD, ethics expert and professor in the graduate program of the School of Social Work at Rhode Island College, warns that the client may make decisions involving deeply moral matters, such as divorce and reproductive rights, based on the social worker’s beliefs.

“If you have this combination of a very vulnerable client and a social worker who is using the client to meet his or her own needs, perhaps with good intentions, it seems to me you’ve got the ingredients for harm,” says Reamer. “Clients who are seeking spiritual or religious guidance are better served by practitioners who have appropriate education and training in spiritual or faith-based counseling. To practice ethically, social workers should make their faith-based orientation and approach to practice clear to potential clients.”

When Is a Little Faith a Good Thing?
Are there any cases in which it might be appropriate or ethical for a social worker to allow religious practice or religious language to enter their relationship with clients?

“If they’re introduced by the client, it’s a very different thing,” says Hartocollis. “If the client brings the Bible to the session and wants to read from it and the social worker can use that as a way of exploring feelings the client may have, that can be very useful. If the client says, ‘I’d like to pray,’ the social worker who is not religious can be more in a bind, but in that case, it’s fine to say, ‘Tell me what praying is for you, let’s talk about what you have in mind.’ But if the social worker introduces religious materials without any prompting from the client and brings in a Bible and says, ‘Shall we read a passage from the Bible?’ or says ‘Let’s pray,’ that’s a very different thing. In that case, my alarm bells would ring and I’d have to ask if the social worker is imposing his or her own beliefs on the client in a way that’s not respectful.”

What about the client and social worker praying together, especially in a public, non–faith-based institution? “I can see this happening in the case of a major trauma or a major loss,” says Jacobs, “But only if the social worker already has a relationship with the client and is familiar with the client’s religious beliefs and knows what prayer would mean to the client.”

When Faith Goes Too Far
On occasion, social workers might decide that allowing religion to become part of their discussions with clients is a good idea. Unfortunately, the strength of the social worker’s religious convictions may cloud their professional judgment.

Reamer cites a case in which it was alleged that a social worker had engaged in an inappropriate dual relationship with the client by introducing his personal religious beliefs. “The social worker was providing what he called spiritual counseling,” says Reamer. “He gave the client literature about this particular spiritual movement, ended up traveling with the client to spiritual retreats, and even assigned the client a new spiritual name to enhance the client’s commitment to the movement.”

While extreme cases like this aren’t common, Reamer describes a more typical example.

“About a year ago, I was asked to consult a program that involves the delivery of services to kids with developmental disabilities. It turned out that this particular practitioner was also an ordained minister in her church,” says Reamer. “One of the issues that came up was that she said that she finds it very helpful to share her faith with clients. Many of the families she’s working with are struggling to cope with all the stresses of coping with a child with disabilities, and she said she finds that sharing her faith with these clients is helpful to them. Well, that raised a few eyebrows in the room. To her credit, she disclosed this. She was so immersed in her faith that she didn’t even seem to recognize that there was a complicated boundary issue there.”

As for whether it’s right or wrong for a social worker to engage in prayer with a client, there apparently are no easy answers.

“I don’t think anything in this work is so easily categorized as the ‘right thing’ or the ‘wrong thing’—it’s very, very situational,” says Hartocollis. “One has to be able to sit in those gray areas and be very thoughtful about each individual situation. If the social worker said ‘Let’s pray’ to the client without knowing the client’s orientation, without knowing the meaning it may have for the client, I find that problematic. If on the other hand the social worker knew that the client found prayer to be very comforting and something that is a good coping skill, and that doing it with someone else is even more powerful, and the social worker could in good conscience genuinely participate in that, then it’s OK in my view.”

Reamer cautions that social workers who are tempted to bring their religious faith and practices into their client relationships should be particularly careful in nonsectarian settings.

“I was involved with a case many years ago in which a psychiatrist, a person of deep faith, was observed by another staff person praying on his knees with a client,” says Reamer. “This particular psychiatrist was very public about his beliefs and actually lost his job. The patient may have been interested in religion, but it’s the context that makes a difference. In a state hospital, one has to be not only concerned about the impropriety of imposing one’s beliefs on a client, but also about the appearance of impropriety. The sight of a social worker on their knees praying with a client might be perceived as unethical, and that’s just as important.”

Parting Advice
So how far should social workers go in bringing their personal religious beliefs into their relationships with clients? How much self-disclosure of this kind is too much?

“In my view, there are strong limits that should be placed on the kinds of things that social workers can do in public agencies,” says Sherwood. “But the way to solve this is not to have these simplistic and draconian pronouncements that seem like the easiest and safest way. It’s not good practice.”

In their rush to explore and experiment with religious concepts and practices, social workers must exercise caution.

“Be chronically aware of the way in which you’re using religion, whose needs are being met and whether there’s any way in which the client might be harmed by the inclusion of religion and spirituality,” says Reamer. “Also, keep your eye on the slippery slope. Be aware of the fact that once you put your toe on that slope, there’s always a potential for taking a slide into an arena that would be considered unethical.”

Jacobs is even more blunt in her advice. “People should not romanticize spirituality,” says Jacobs. “Let’s not forget that there are many people who’ve done bad things in the name of God.” Finally, Jacobs reminds social workers that the best way to integrate their religious beliefs into their practice is by subjecting them to the same standards and safeguards they apply in other areas. “We need to remember to do the same kind of self-assessment social workers do in other types of cases,” says Jacobs. “We need to examine and question our own religious and spiritual histories to see if that may be getting in the way of the work with clients. Joseph Campbell once said, ‘One’s membership in a religious community is not important. What’s important is what that membership is doing in their psyche.’”

If that’s true for clients, it’s equally true for social workers.

— David Surface is a freelance writer and editor based in Brooklyn, NY.