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September/October 2011 Issue

Connecting With Clergy: Stepping Stone to Treatment?
By Lindsey Getz
Social Work Today
Vol. 11 No. 5 P. 16

Clergy may be a valuable conduit to addictions treatment in some communities. Is connecting social workers with local clergy an underutilized resource?

Churches can serve as strong pillars of local communities. They can provide great support for members seeking help for various problems. But are clergy truly equipped to handle some of the issues their congregation members may share? After all, clergy have spiritual training, but they’re not psychiatrists, social workers, or other professional counselors.

Considering a new study has found that individuals with alcohol use disorders (AUDs) in some communities are seeking the help and services of clergy members, the answer is yes, clergy may be capable of providing meaningful assistance.

According to the study, which was conducted by researchers at the University of Michigan Health System and Saint Louis University, among 1,910 people with an alcohol-related problem who sought help, 14.7% said they used clergy services.

While professional services are used more commonly than the counsel of a clergy member, the findings demonstrate that clergy services are an important part of the overall system of care for a person with alcohol-related problems.

The study also found several factors associated with an increased likelihood that an individual would seek the help of clergy services, including being black, being aged 35 to 54, having a lifetime history of alcohol dependence, or having a major depressive or personality disorder.

“We found that among those with an AUD, black individuals were more likely than white individuals to report seeking help from a clergyperson, which is consistent with the centrality of religion and churches to black American life,” says Amy S. B. Bohnert, PhD, lead study author and an assistant professor in the University of Michigan’s department of psychiatry. “Outreach to clergy in African American communities specifically may help address underutilization of professional services in these communities. We also found that individuals with major depressive disorder and with personality disorders were more likely than those without these disorders to seek help from a clergyperson for an alcohol problem. Outreach to interested clergypersons that includes information on identifying and providing referrals to treatment for mental disorders could be particularly fruitful.”

Qualified to Help?
Researchers believe the study findings are encouraging in the fight against alcohol-related problems considering the statistics on alcohol treatment. Based on the Substance Abuse and Mental Health Services Administration’s 2007 National Survey on Drug Use & Health, the majority of those who needed alcohol treatment either did not perceive the need for treatment or did not receive it.

Still, the question lingers as to whether clergy members—though often trusted members of the community—are qualified to sufficiently handle the needs of these individuals. Many may believe they are, but it ultimately comes down to each clergy member’s background and training.

“Clergy members’ level of qualifications to provide counseling or to refer people with substance abuse issues is related to whether or not they have received any specific education and training in this area,” says study researcher Linda M. Chatters, PhD, a professor of social work and health behavior and health education at the University of Michigan School of Public Health. “In thinking about clergy, it is important to remember that the category as a whole includes individuals with a range of prior training and education. This ranges from clergy who may have attended seminary or hold degrees in divinity, pastoral counseling, psychology, general counseling, social work, and other related fields. But clergy also includes individuals who may have not had any formal higher education.”

The researchers believe that the ability of those with an AUD to come forward and speak to a clergy member about their problems may be a first step in diminishing their barriers to treatment. Those who enter treatment are typically referred from other settings, such as a primary care or mental health provider. Others may enter treatment when ordered by the criminal justice system. But it may be the help and guidance of a clergy member that eventually leads an individual into treatment.

There’s no question that clergy members are in a unique position to potentially recognize problems and provide help to individuals who need it, says study researcher Brian E. Perron, PhD, an associate professor in the University of Michigan School of Social Work. What makes ministers, priests, and rabbis a good source of help is that they are involved in their communities, know their congregants well, and see them on a regular basis, so they may be the first to notice something is “wrong” with an individual.

“Clergy are in a unique position to notice changes in behavior over time,” says Perron. “Their roles as senior leaders of churches, their embodiment of important tenets of faith, and their formal roles as caregivers of their congregations also lend clergy considerable credibility, particularly within African American communities. Clergy are often seen as being deeply committed to their congregants and willing to honor desires for confidentiality.”

Of course when a person seeks counseling from a clergy member who is part of the same congregation, a dual relationship between the individual and the clergy may result since they will likely see each other during one-on-one counseling and in other social contexts, says Bohnert. However, that is something any clergy member has likely become accustomed to handling.

“Since clergy must often deal with complex dual relationships with congregants who also seek counseling from them for any number of reasons, confidentiality is particularly important, especially for counseling on alcohol use problems and other similarly stigmatized conditions,” she says.

Faith-Based Counseling
How a clergy member tries to help an individual with an AUD may be very different from the approach a social worker or other mental health professional would take. It’s plausible that some clergy may make an alcohol abuse problem more of a faith issue rather than a clinical one. However, that’s not to say this approach wouldn’t be effective, but whether it is appropriate is not within the scope of this article.

The fact is that for some individuals, a faith-based approach may be a suitable method of not only addressing the problem but also potentially overcoming it. “Research shows that faith, religion, and spirituality are important factors in recovery for many people,” says Perron. “Clergy can be an excellent resource for these areas, which are often overlooked by professional service providers.”

“While the data we used for this study cannot speak to the content the counseling clergy provide to individuals seeking assistance, it is reasonable to believe that it would be influenced by their faith,” adds Bohnert. “There is certainly some proportion of individuals for whom a faith-based approach would not be appealing, but the individuals who seek out counseling from a clergyperson are likely to at least be open to that approach.”

Bohnert notes that many 12-step programs, which are the most common type of alcohol treatment in the United States, incorporate spiritual elements. “So spirituality has traditionally played a not insignificant role in recovery in the U.S.,” she adds. “Both 12-step programs and counseling from clergy have an important role in that they provide access to alcohol treatment services regardless of insurance status or severity of alcohol problems. However, for all counselors providing community-based alcohol treatment—like clergy members and 12-step facilitators—it is important to recognize which individuals would be better served by other forms of treatment, such as those for whom a spiritual approach is not helpful. Referrals could be provided in those cases.”

Connecting Two Worlds
Another key finding of the study was that the majority of individuals who used services from clergy at some point also used professional services (eg, Alcoholics Anonymous, psychologists, social workers). In fact, only 0.5% of individuals studied used clergy services exclusively for their alcohol abuse problems. Bohnert says the study did not address whether clergy offered referrals. But from this study, she sees an opportunity for social workers to connect with local clergy.

“Outreach by social workers and other service providers to clergypersons could increase referrals in a way that would be helpful to the individuals seeking help,” says Bohnert.

This raises an interesting concept—social workers connecting with local clergy in order to provide more comprehensive help. It’s a connection that may currently be underutilized.

“The ties between the professional service community and clergy are probably not as strong as they could be,” says Perron. “There is probably a lot of regional variation as well, although I am not aware of any research specifically on this matter. Many pathways exist for getting people connected to professional treatment services. Social workers have a unique and specialized skill set that complements the type of support that clergy offer. I think social workers can be effective in building ties with the clergy community to help ensure access to professional treatment when needed.”

However, it’s important to consider that a tighter connection between social workers and clergy may also warrant a stronger understanding of how faith plays a role in some individuals’ treatment.

“In some ways, the health and social service professions need to be prepared to better understand the role of religion and spirituality in relation to physical and mental issues,” says Chatters. “The most recent Gallup Poll indicates that the American public is very religious, certainly as compared to other Western societies.
Persons in the human services sectors, and psychiatrists in particular, generally have lower levels of religious involvement than the general public. In some instances, they may be biased against religious perspectives and clients sensing this are not likely to talk about the significance of religion in their lives. In many ways, the helping professions should address issues of religion and spirituality as a form of competence.”

Conversely, it’s equally important that clergy members are aware of what professionals such as social workers have to offer. They should be as open to the idea of an individual seeking professional help as professionals are to the idea of their client seeing a clergy member. Of course it’s even more important that clergy know when it’s time to refer an individual for further help. Chatters says research seems to support the idea that clergy members would know when a problem is beyond their ability to help, but whether they actually reach out for additional help is again dependent on each individual clergy member.

“At least one small study that I am aware of found that clergy were clear in making distinctions between the types of problems that reflected the need for spiritual/religious care vs. those that should involve professional social services, including addiction services,” she says.

The “partnership” between a clergy member and a social worker could potentially be quite effective in helping an individual since each has his or her own expertise to provide. A clergyperson can offer the spiritual guidance an individual may seek while a social worker or other helping professional can provide the necessary clinical support. Since both the clergyperson and the social worker may see the same individual simultaneously—and offer help—it’s important that there is a sense of working together.

“At the very least, social workers should have some sense of their clients’ views concerning religion and spirituality,” says Chatters. “Social workers should also have a sense of what sorts of social resources and networks are available in faith settings and how the client defines the problem [in terms of spirituality]. A social worker should also know whether seeking a secular solution is an acceptable way for the patient to address the issue.”

Increased Understanding
While the study indicates that the large majority of those seeking help from clergy also sought help from another professional, this scenario may have the potential to change. That half-percent of individuals who exclusively sought the help of a clergy member could grow.

“I would venture that the percentage of persons who only seek clergy assistance could grow dependent upon cutbacks in social service funding and treatment for substance use,” says Chatters. “Also, evidence indicates, for a variety of reasons, racial and ethnic minorities are traditionally underserved in the specialty mental health sector, giving rise to disparities in care and treatment.” It’s all the more reason for an increased understanding of the roles clergy may play in the treatment of individuals with AUDs.

“I think one implication of the study is that where it is not already happening, there could be a lot gained by social workers forming links with clergypersons in their community,” Bohnert says. “This study suggests that clergy members are positioned to be a bridge between their congregants and mental health services. In forming these links, social workers may have an opportunity to inform clergypersons of the roles that social workers have in a community as well as local low-cost treatment options and other resources in the community.”

— Lindsey Getz is a freelance writer based in Royersford, PA.