Wrestling With Angeles

Am I doing the right thing?” he asked me in earnest as he was preparing to leave the detoxification unit of a nationally recognized psychiatric hospital. “Dan,” a 32-year-old single man, had lost his job at a local clinic because he was forging prescriptions for a variety of opiate-based medications. With no insurance, no savings, and no family support, Dan had few options for extending his treatment. As we explored the possibilities, Dan settled on a faith-based residential treatment program.

Still, some doubts lingered for Dan. Was he making the right decision? Would his treatment be compromised in any way by entering this program? As I helped Dan to negotiate the terrain of low- to no-cost recovery programs, I could not help but remember my work in a faith-based nonprofit agency serving addicted people and their families. For seven years I worked at this organization, which was one of the largest care providers to the homeless in the Southeast. For six of those years I served as a program director with both clinical and administrative responsibilities.

The facility that I managed housed up to 162 homeless men. Excluding myself, we had five full-time counselors and one part-time counselor, with the average caseload for a full-time counselor between 25 and 30 clients. The environment often was stressful, as there was a high level of acuity among clients and few resources to meet their demands. Despite these pressures, referring agencies, government officials, and clients often compared our programs favorably with those of other providers.

In terms of the range of services, few differences exist between faith-based and secular providers.1 Religious services and a religious culture in faith-based organizations constitute the main programmatic differences between the two. These differences afford faith-based organizations both advantages and disadvantages in comparison with secular organizations. These considerations will be important to the potential success of a client who enters a faith-based program.

The faith-based culture

Upon walking into a faith-based program, one is likely to see expressions that represent the organization's beliefs. The lobby at the center where I worked featured a depiction of Jesus surrounded by carpenter's tools, a large painting of a dove, statues of angels, and the organizational logo incorporating a cross. The center's name also used a religious reference to identify as a Christian organization.

Such usage of symbols and language is not uncommon among faith-based social service agencies. Ebaugh and colleagues found that 78% of these organizations operated under names that referenced a religious connection. In addition, 69% claimed that their logo contained religious symbolism.1

From a clinical perspective, one of the first things one notices in a faith-based setting is the language used to stimulate change. An addictions counselor at my center was as likely to use the Bible as he was AA's Big Book or a clinical approach such as Rational Emotive Behavior Therapy.

For example, one client at our ministry was expressing anger toward the many authority figures in his life—especially the probation officer who was structuring his recovery. In this case, the therapist intervened with the client by expressing, “You have a problem with God, not your probation officer. God is the one who put this PO in your life in the first place.” The response easily could have been one of exploring the client's anger at himself or his disease. Or it could have been to go to page 449 in the Big Book and read about acceptance. (This therapist also used these approaches at times.) This particular intervention developed into a conversation about authority figures in general and how the client's higher power can use them for good in the client's life.

Clinical advantages

Since faith-based programs often make their general religious tenets known from the beginning, new clients have an idea of what to expect. For many, coming into a recovery program that shares their faith values can be like coming home. This may explain why churchgoers are more likely to choose a faith-based provider than a secular one.2 In these cases, the therapeutic alliance can be achieved quickly because of the common understanding and values already in place. Coming from a place of deep pain through a chaotic pattern of addictive behavior, these clients are looking for a place they know to be safe.

Using the language of religion can be a productive avenue to reaching a client, instead of relying on clinical language alone. At my former center, for example, when talking about cognitive restructuring, one of our clinical staff would use a passage from Romans 12:2. It reads, “Do not be conformed to this world, but be transformed by the renewing of your mind.” By building on existing knowledge, a client may feel more empowered on his/her journey in this new and seemingly foreign world of recovery.

Tangenberg acknowledges the use of nonscientific language in faith-based organizations and suggests that by being exposed to narratives of personal and spiritual transformation, clients may gain positive connections among those who share similar experiences.3

Clinical disadvantages

On the other side of the coin, use of explicit religious references in a clinical setting can have disadvantages. For some, their religious “home” was not a safe place. Scriptures were used to condemn and judge, with references to drunkenness and other “sinful” acts committed. A faith-based program offers opportunities for spiritual healing for persons who have been wounded by a religious organization or other religious persons; however, this spiritual reconciliation is not guaranteed. Some persons may fare better in a secular program (if available) in the early stages of recovery.

Another problem of faith-based programs occurs with persons who use their faith to avoid difficult psychological change. This phenomenon is referred to as the “spiritual bypass.”4 Clients experiencing this may make statements such as, “I don't have to worry about using again; God has healed me.”

Unfortunately, many churches and religious bodies promote these shortcuts because they lack the tools to inspire real change in addicted persons. In a ministry center that housed our shelter, men would arrive in droves for an altar call at a worship service but would sit waiting in the shelter for the miracle to happen. A faith-based ministry has the potential to challenge these beliefs and to communicate the real work that needs to be done in recovery. My supervisor would frequently challenge clients and shelter guests looking for this spiritual shortcut, saying, “God will move a mountain, but we have to bring a shovel!”

Are all persons welcome?

The mission statement of the organization where I worked stated that it brought “Christ's healing power to any person in crisis through programs of rescue and recovery.” I remember hearing us read it aloud, often emphasizing “any person” with a claim (or perhaps a hope) that all persons were really invited equally to the table. As much as we wanted this to be true, limitations existed for many, particularly for those of different religions or alternative lifestyles.

We, like many, were challenged to be able to serve fully persons of different religions without compromising our own religious identity. Those who were Muslim, Jewish, Rastafarian, or in another faith tradition might have felt neglected or even offended receiving their treatment within a Christian context. Why did they come to a Christian ministry in the first place? Many were mandated; others believed there were no other options. If these individuals had difficulties in the program for this reason, we would refer them to a secular program.

It was not uncommon to have questions about what types of accommodations to make for clients. Muslim clients were allowed to make daily prayers, but they had to do this in their private rooms. They were not afforded the opportunity to worship publicly unless it was part of the Christian service. Being a nonprofit agency and dependent upon food donations because of a slim bud-get, we needed to make dietary compromises. We offered a non-pork menu for clients who had religious or medical reasons to abstain. Some Christian clients took exception to this, as most of them did not qualify. Unfortunately, because of cost, we were not able to provide full menu choices to all clients.

Many Christian recovery programs make even stronger efforts to convert their clients to Christianity. Discipleship is a greater concern for these organizations, often seen as the only “true” path to recovery. One program with which I was in contact would accept persons of a different faith and refer them out if they did not convert within a stated period. This was not the position of the ministry center where I worked.

A special concern also exists over gay, lesbian, bisexual, and transgender (GLBT) clients in a faith-based organization. The more evangelical a program is, the greater the tendency to attempt to transform a person into the heterosexual norm. My experience also has shown that these organizations would not hire a person who disclosed a nonheterosexual orientation. From a GLBT client's perspective, discriminatory hiring policies send a message that can perpetuate self-loathing that may impede recovery.

Counselors in faith-based programs find themselves caught among the client's expressed needs, their own beliefs, the stated institutional beliefs, and the constituents who donate funds to maintain operations. Rarely will all of these agree. If the counselors are certified or state-licensed, they are bound by a code of ethics that prohibits discrimination and promotes client welfare. The organization where I worked was much more progressive than other Christian ministries, but there was still room to grow.

Called to serve the poor

One of the faith-based community's greatest strengths is it is often willing to serve those who can get help in few other places. People who work in these programs often share a deep commitment to serve at little to no money. For some people devastated by addiction, if they have no insurance, no money, no family support, and no job, any alternative can seem preferable to living on the street.

This was the case for Dan. He wanted help. He was trying to start over. Without a dime in his pocket, he was willing to take a chance most anywhere. But even if Dan had ample finances, a faith-based program still could be his best choice. Through common religious values and the efforts of competent professionals, such a program could help Dan in ways no secular organization could. A careful assessment of Dan's situation would help him to make an informed decision and be prepared for any challenges that lie ahead of him.

References

1. Ebaugh HR, Pipes PF, Chafetz JS, et al. Where's the religion? Distinguishing faith-based from secular social service agencies. J Scientific Study Relig 2003; 42:411-26.
2. Wuthnow R, Hackett C, Hsu BY, et al. The effectiveness and trustworthiness of faith-based and other service organizations: A study of recipients' perceptions. J Scientific Study Relig 2004; 43:1-17.
3. Tangenberg KM. Twelve-step programs and faith-based recovery: Research controversies, provider perspectives, and practice implications. In: Hilarski C. Addiction, Assessment, and Treat-ment With Adolescents, Adults, and Families. Binghamton N.Y.:The Haworth Press, Inc.; 2005.
4. Cashwell CS, Myers JE, Shurts WM, Using the developmental counseling and therapy model to work with a client in spiritual bypass: Some preliminary considerations. J Couns Devel 2004; 82:403-9.