Tag: counseling

A short paper on the topic of religious trauma for a class in “Treatment in Clinical Counseling.”

Target Population

Religion and spirituality are a source of strength and meaning for many people, but for others, they are the cause of significant distress. Religious trauma (or spiritual trauma, a closely related phenomenon) can be defined as “pervasive psychological damage resulting from religious messages, beliefs, and experiences” (Stone, 2013, p. 324). Unlike trauma resulting from acute events, religious trauma tends to unfold gradually, as the product of “long-term exposure to messages that undermine mental health” (Stone, 2013, p. 325). The effects of religious trauma are varied, but include interpersonal, emotional, and cognitive difficulties (Winell, 2007), as well as enduring negative impacts on physical and spiritual well-being.

A person can experience religious trauma at the hands of religious leaders, parents, or lay members of a spiritual community. Examples of potentially traumatic adverse religious experiences include: the use of guilt and shame to control behavior (often in the context of institutions with strictly defined moral codes); the repression of critical thinking; fear-based teaching (focused, for instance, on threats of eternal punishment); the enactment of strict gender roles and definitions of sexuality (as a way to justify discrimination and unfair power dynamics); physical, emotional, sexual, or financial abuse (often as the result of religious leaders abusing their authority); and shunning or excommunication (when “disobedient” members of a religion are isolated from their community). In all of these examples, a person’s core values, sense of self, and trust in the world are severely threatened.

Unfortunately, the academic literature devoted to the discussion of religious trauma is somewhat limited, and it is hard to find empirical data documenting the exact scope of this problem. Indeed, most existing research is qualitative in nature and developed primarily through case studies and interviews. However, one recent study estimates that, among U.S. adults, approximately 27-33% have experienced religious trauma at some point in life, while approximately 10-15% are currently suffering from debilitating religious trauma symptoms (Slade et al., 2023). According to the author of the study, these estimates are conservative, so we can imagine that the consequences of adverse religious experiences are in fact even more wide-reaching.

Rationale

Just as there is a dearth of academic research on religious trauma, there is a notable deficit in clinical training. At present, most clinicians receive “little to no training on the exigencies of religious disenchantment” or other forms of religious trauma (Brooks, 2020, p. 194). This gap in competence results in a failure to serve many suffering people. And because spiritual practices are often regarded as a helpful coping strategy, unwitting clinicians may end up doing more harm than good as they try to walk their clients through the process of healing. Indeed, many popular treatment programs, such as the 12-Step recovery programs, are rooted in faith-based principles and may be triggering to spiritually traumatized clients.

How do we best serve these clients? Research suggests that, for people who struggle to make sense of a trauma, religious doubts and confusions can lead to greater distress, which in turn can lead to worsening symptoms of post-traumatic stress disorder (PTSD) (Ter Kuile & Ehring, 2014). Meanwhile, intense spiritual struggle, or “negative religious coping,” is associated with worse mental health outcomes following trauma (Kucharska, 2020). When a person experiences religious trauma, she may feel deeply lost and confused, and as if a very intimate part of her being (as well as her support system) has been stripped away. It is important that we understand this struggle so that we can facilitate the process of uncovering renewed purpose and meaning in a client’s life.

Problem Identification

Religious trauma comes with many losses: a loss of community and belonging, a loss of structure, a loss of meaning. Indeed, grief is a salient theme in the narratives of people experiencing religious trauma (Jones et al., 2022). There are also casualties to spiritual self-concept, leading to existential anxiety. Feelings of shame, abandonment, and isolation are common, too, as is a profound loss of trust, both in oneself and in the systems a person depended on to make sense of the world. In this sense, religious trauma impacts a person at the intrapersonal, interpersonal, and structural levels.

According to Johnson and VanVonderen (1991), the effects of religious trauma impair a person’s image of God, as well as impede her ability to accept grace, set healthy boundaries, and establish trusting relationships. Revictimization is also possible, since religious texts are misused to keep people in abusive situations by instilling messages of unhealthy submission and forgetting of past wrongs. Other consequences of religious trauma may include limited decision-making skills, emotional delays, low self-esteem, and a proneness to mental disorder.

Indeed, religious trauma is linked to depression and anxiety (Cashwell & Swindle, 2018). Scrupulosity, a morality-focused presentation of obsessive-compulsive disorder, is especially common. Of course, the associations with PTSD and complex (c-)PTSD are evident. It is also possible for religious trauma to masquerade as other disorders, such as bipolar disorder and borderline personality disorder, or to co-occur with eating disorders and substance use problems (Winell, 2011). Clinicians must be educated on the etiology and expression of religious trauma so that they are equipped to differentiate it from other, seemingly similar conditions. Treating a client’s presenting concerns while ignoring the presence of trauma hinders the provision of effective services.

Community Intervention System

Unfortunately, the number of clinicians specializing in religious trauma is small, and it can be hard to come by counselors who are familiar with the nuances of this problem. Below, I have listed a reference to a religious trauma-informed therapist directory, which could be useful in securing distance counseling services with virtual providers around the country. Professional resources, including trainings on treatment considerations and interventions, are also provided. In the event that a client cannot connect with a specialist in religious trauma, practitioners offering broad “trauma-informed care” are recommended.

• Reclamation Collective
  https://www.reclamationcollective.com
  Community advocacy organization offering a wide variety of support groups, workshops, and help for people navigating religious trauma. Hosts an online directory of religious trauma-informed therapists across the country.
• Center for Trauma Resolution and Recovery
  https://www.traumaresolutionandrecovery.com/
  A group of trauma-informed practitioners from across the U.S. who use online coaching and support groups to provide access to trauma resolution and recovery to clients around the world. Specializes in addressing trauma resulting from religious abuse, cults, purity culture, and harmful theology.
• Religious Trauma Institute
  https://www.religioustraumainstitute.com
  Religious trauma trainings, support, and community for therapists, researchers, advocates, and survivors. Featuring a series of clinical trainings, consultation groups, assessment tools, and treatment resources for mental health professionals, as well as workshops (like “Religious Trauma and Politics”) for the general public.

Treatment Interventions

When undertaking the treatment of religious trauma, clinicians should be mindful of a few guiding principles: evaluate the extent of the trauma; honor the losses it caused; address the impact of religion as a tool for social injustice; and assemble a list of religious and spiritual resources for clients (Morrow, 2003). Throughout, clinicians must remember the primacy of client self-determination vis-à-vis religious belief and avoid imposing personal values.

Specific approaches to treatment vary and depend on clinician orientation as well as client preference. In general, identifying adverse religious experiences from a trauma-informed lens is recommended. Winell’s (2007) phases of recovery may also guide the treatment process, helping clinicians to situate their interventions in the context of distinct phases (separation, confusion, avoidance, feeling, and rebuilding) that characterize the healing journey.

One approach to consider is trauma-focused cognitive-behavioral therapy (TF-CBT), which has been adapted to address religious trauma in children and adolescents (Walker et al., 2010). This modality involves psychoeducation (on, for instance, how a person’s religious beliefs may change because of the abuse she has experienced); parenting skills (focused on the role of praise and selective attention rather than harsh discipline); relaxation exercises; cognitive coping and processing (with an emphasis on deconstructing religious threats and exploring cognitive distortions); constructing a trauma narrative (allowing the client to process her trauma and find meaning in her experiences, while borrowing, if appropriate, from the wisdom of spiritual frameworks); safety planning; and in vivo exposure (to prevent generalization of anxiety symptoms). Other tools consistent with this approach include creating a spiritual timeline (in which clients map out the history of their trauma) (Super & Jacobson, 2011) and utilizing a blend of thought-stopping techniques, positive imagery, and positive self-talk (Walker et al., 2010). If a client wishes to retain her religious affiliation, the counselor may help her to locate Scriptural texts or other religious evidence which affirms, rather than condemns, these healing attitudes.

Another approach which has been proposed as a treatment for religious trauma is Internal Family Systems (IFS). IFS is evidence-based and supported in the treatment of PTSD (Hodgdon et al., 2022) and depression (Haddock et al., 2017). Interestingly, the concept of “Self” in IFS bears a resemblance to the concept of the Divine in various spiritual traditions (Schwartz, 2001), perhaps making it well suited to clients grappling with spiritual themes. Although promising, IFS would benefit from greater empirical support for its application to religious trauma. Other trauma-informed approaches, like eye movement desensitization and reprocessing (EMDR), are likely also good choices for this population, as is a combination of individual and group therapy with a focus on the role of secure attachment (Stone, 2013).

Regardless of the approach chosen, clinicians should be aware of unique obstacles which may arise. Some people who have experienced religious trauma have been taught to ignore or distrust their emotions or bodily cues (Stone, 2013). Since trauma is often stored in the body, the introduction of somatic interventions may be helpful, but should be done slowly and with care. In addition, mindfulness techniques may be uncomfortable for some clients, and should be implemented gently. For clients wishing to retain a spiritual connection, elements of meditative prayer may be incorporated into these exercises. In all things, the client should retain the right to make her own decisions as she regains a sense of personal agency and navigates the process of her healing.

References

Brooks, E. M. (2020). The disenchanted self: Anthropological notes on existential distress and ontological insecurity among ex-Mormons in Utah. Culture, Medicine, and Psychiatry, 44(2), 193-213.

Cashwell, C. S. & Swindle, P. J. (2018). When religion hurts: Supervising cases of religious abuse. The Clinical Supervisor, 37(1), 182-203. https://doi.org/10.1080/07325223.2018.1443305

Haddock, S. A., Weiler, L. M., Trump, L. J., & Henry, K. L. (2017). The efficacy of internal family systems therapy in the treatment of depression among female college students: A pilot study. Journal of marital and family therapy, 43(1), 131-144.

Hodgdon, H. B., Anderson, F. G., Southwell, E., Hrubec, W., & Schwartz, R. (2022). Internal family systems (IFS) therapy for posttraumatic stress disorder (PTSD) among survivors of multiple childhood trauma: A pilot effectiveness study. Journal of Aggression, Maltreatment & Trauma, 31(1), 22-43.

Johnson, D. & VanVonderen, J. (2005). The subtle power of spiritual abuse. Baker Publishing Group.

Jones, T. W., Power, J., & Jones, T. M. (2022). Religious trauma and moral injury from LGBTQA+ conversion practices. Social Science & Medicine, 305. https://doi.org/10.1016/j.socscimed.2022.115040

Kucharska, J. (2020). Religiosity and the psychological outcomes of trauma: A systematic review of quantitative studies. Journal of Clinical Psychology, 76(1), 40-58. https://doi.org/10.1002/jclp.22867

Morrow, D. (2003). Cast into the wilderness: The impact of institutionalized religion on lesbians. Journal of Lesbian Studies, 7(4), 109-123. https://doi.org/10.1300/J155v07n04_07 

Schwartz, Richard C. (2001). Introduction to the internal family systems model (5th reprinting). Oak Park Il: Trailheads Publications.

Slade, D. M., Smell, A., Wilson, E., & Drumsta, R. (2023). Percentage of U.S. adults suffering from religious trauma: A sociological study. Socio-Historical Examination of Religion and Ministry 5(1), 1-28. https://doi.org/10.33929/sherm.2023.vol5.no1.01 

Stone, A.M. (2013). Thou shalt not: Treating religious trauma and spiritual harm with combined therapy. Group 37(4), 323-337. https://doi.org/10.13186/group.37.4.0323

Super, J. T. & Jacobson, L. (2011). Religious abuse: Implications for counseling lesbian, gay, bisexual, and transgender individuals. Journal of LGBT Issues in Counseling, 5(3-4). https://doi.org/10.1080/15538605.2011.632739

Ter Kuile, H., & Ehring, T. (2014). Predictors of changes in religiosity after trauma: Trauma, religiosity, and posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 353.

Walker, D. F., Reese, J. B., Hughes, J. P., & Troskie, M. J. (2010). Addressing religious and spiritual issues in trauma-focused cognitive behavior therapy for children and adolescents. Professional Psychology: Research and Practice, 41(2), 174-180. https://doi.org/10.1037/a0017782

Winell, M. (2007). Leaving the fold: A guide for former Fundamentalists and others leaving their religion. Apocryphile Press.

Winell, M. (2011). Religious trauma syndrome. Cognitive Behavioural Therapy Today, 39(4), 19-21.