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Religious Counseling:
A Review of Published
Empirical Research

EVERETT L. WORTHINGTON, JR.


The empirical research on religious counseling from the last 10 years religion (or some personal variant of organized religion). Secular
is reviewed. Research is grouped broadly under three headings—reli- refers to that which characterizes ‘general society. In recent years,
gious counselors, religious clients, and religious counseling techniques. secular has come to be understood as nonreligious (not neces-
Methodologically, most studies rely on questionnaires with Christian sarily anti-religious), pluralistic, and characteristic of contem-
samples. More analogue and experimental designs are appearing in porary society.
recent literature. Findings show that clergy do most of the religious Based on these distinctions, religious counseling can be defined,
counseling. Clients are often concerned with challenges or potential for the purpose of this review, as counseling that primarily
challenges to their values. There have been few examinations of religious involves content associated with an organized religion or coun-
counseling techniques. Researchers are urged to continue to increase seling done in an explicitly religious context (e.g., by a pastor
the quality and variety of their religious research. at a church). Secular counseling is defined as counseling not in-
volving religious content or not set in an explicitly religious

W
hether religious or secular, counselors encounter re- context. Thus, a counselor conceivably could do secular coun-
ligious clients and often feel uncertain about the effects seling with a client, except for an isolated session that involves
of their counseling on their clients’ spiritual lives. Re- religious counseling. Also, counseling could be based on the
ligious issues may arise in counseling or may influence clients precepts of organized religion throughout counseling, except
and counselors silently without being addressed. This is espe- for an isolated incident of secular counseling. Obviously, these
cially true since the recent revitalization of interest in religious distinctions are not precise or mutually exclusive, and they can-
experience in the United States. Researchers have begun to in- not be because of the ebb and flow of human discourse during
vestigate religious experience with increased intensity. For ex- counseling. These definitions, however, should permit a cir-
ample, the National Council on Family Relations recently formed cumscribed review of religious counseling.
a special committee to study religion and the family, publishing
articles on research in the Journal of Marriage and the Family (Thomas Procedure of the Search
& Henry, 1985). In the last 5 years, several debates and discus- Empirical studies of explicitly religious counseling published
sions concerning religious counseling have been published in between 1974 and early 1984 were reviewed. A list of journals
prominent journals (see Journal of Consulting and Clinical Psy- that might publish research on religious counseling was com-
chology, 1980, Vol. 48, Nos. 1 & 5; Psychotherapy: Theory, Research piled (see Table 1). These journals were subdivided into four
and Practice, 1980, Vol. 17, No. 4; and Personnel and Guidance categories: secular psychology and counseling journals (n = 9),
Journal, 1980, Vol. 58, No. 9). More researchers have investigated pastoral counseling journals (n = 4), general religion and science
religious counseling as a consequence of its attention in the journals (n = 9), and psychological journals with a religious or
journals, but the research has been scattered throughout psy- values orientation (n = 3). Of these, five were unavailable in the
chology, pastoral counseling, and religious journals. No review- libraries of Virginia Commonwealth University, the University
er has yet organized the topics of research and summarized the of Richmond, and Union Theological Seminary of Richmond.
findings. In this article I hope to promote more understanding Each available journal’s table of contents was examined, and
among counselors about religious counselors, religious clients, articles pertaining to religious counseling were photocopied.
and religious counseling techniques. Occasionally, an article would cite a reference not published in
the journals preselected for review. If available, that article was
METHOD
included in the review.
Definitions of Religious and Most religion has relied primarily on revelation for obtaining
Secular Counseling truth. Theology, the study and systematization of religious be-
Most psychologists and counselors find the terminology used lief, uses (a) logical analysis of sacred writings and their impli-
by religious publications and religious clients to be unfamiliar cations, (b) research on the authenticity and style of writing of
and confusing. Whereas the secular counselor understands re- sacred manuscripts, and (c) research on historical events told of
ligious terminology in a general sense, religious clients and in sacred writings to apprehend revealed truth. As a conse-
professionals often draw fine distinctions. Some of the more quence, religious counselors, like other religious people, have
commonly used terms are defined below. often deemphasized empiricism. An effort was made to examine
Strictly, religious is a generic term denoting reliance on the published research on religious counseling in all religions; how-
assumptions on which a belief system is built, but in this article ever, most research used Christian counselors or clients. The
religious will refer specifically to identification with organized writings of religious counselors have traditionally consisted mostly

JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64 421


Worthington
TABLE 1
Journals That Publish Reviews and Empirical Studies of Religious Counseling
Name General Description Dates Reviewed
Secular Psychology and Counseling Journals
American Psychologist Theoretical articles and position papers of general interest to 1974-1984
psychologists
Cognitive Therapy and Research Research and some theoretical articles concerning cognitive therapy 1976-1984
Counselor Education and Supervision Research and theoretical articles concerning training and 1975-1984
supervision of counselors and counselor educators
Journal of Consulting and Clinical Mostly research on treating clinically disturbed clients; occasional 1974-1984
Psychology theoretical or review articles
Journal of Counseling and Development Theoretical and some research articles on topics of interest to 1974-1984
(formerly Personnel and Guidance counselors and other human service professionals
Journal )
Professional Psychology: Research and Research articles of interest to applied psychologists 1974-1984
Practice
Psychological Bulletin Reviews of empirical research 1974-1984
Psychotherapy (formerly Psychotherapy: Mostly theoretical articles with some research and reviews on 1974-1984
Theory, Research and Practice) individual, group, couples, and family therapy

Pastoral Counseling Journals


Journal of Pastoral Care Research, review, and theoretical articles about pastoral counseling 1974-1984
Journal of Pastoral Counseling Mostly theoretical and practical (case study or technique description) 1974-1984
articles about pastoral counseling; little research
Journal of Pastoral Practice Theoretical practical and scriptural review of issues related to 1974-1984
Christian (esp. nouthetic) counseling
Pastoral Psychology unavailable

General Religion and Science Journals


Journal of the American Scientific Theoretical articles about science and Christianity; occasional article 1977-1984
Affiliation about psychology; little or no research
Journal of the Evangelical Theological unavailable
Society
Journal of Judaism and Psychology Papers involving clinical and philosophical issues relating Judaism unavailable
to psychology
Journal of Psychology and Theology Mostly research and theoretical articles about the integration of 1974-1984
Christianity and psychology
Journal of Religion and Health Mostly theoretical articles on religion 1982-1984
Journal of the Scientific Study of Religion Research on religion in general; few apply to counseling 1974-1984
Review of Religious Research Mostly research on religion in general and reviews; little concerning 1982-1984
religious counseling
Journal of Psychology and Christianity unavailable

Psychological Journals with Religious (or Values) Orientation


Counseling and Values Mostly theoretical articles about secular values; fewer research 1974-1984
articles; little on religious values (cf. one special issue on Christian
counseling)
Dialogue: A Journal of Mormon Thought Variety of articles dealing with various aspects of Mormonism 1983-1984
Journal of Religion and the Applied Articles about the New Age religion and behavioral sciences; no 1984
Behavioral Sciences research apparent yet

of position papers, logical analyses, theories (derived from other which is consistent with other religious research described by
psychological theories and scriptures), and expositions of scrip- Gorsuch (1984). Samples generally were of moderate size, from
tures. The volume of such writings is enormous and would be 50 to 150, and sampled Protestant clergy in the United States.
impossible (for me) to review. Thus, this review focuses on pub- No studies sampled Roman Catholic or Jewish counselors or
lished empirical studies of religious counseling (dissertations were counselors from other faiths (e.g., Buddhist, Moslem, Hindu).
not included), which are clustered in three areas: religious coun- This is in contrast to a few past studies that sampled from other
selors, religious clients, and techniques of religious counseling. In faiths and had large samples (see Arnold & Schick, 1979, for a
a final section, the findings are summarized. review of earlier studies). Much of the research on clerical coun-
selors is not published in journals and the research is often not
RELIGIOUS COUNSELORS programmatic, consisting of many isolated studies (Arnold &
Methodology of Research Schick, 1979; Goldsmith, 1983).
About Religious Counselors
Nineteen empirical studies and two reviews of empirical re- Who are Religious Counselors?
search concerning religious counselors were reviewed. All but Religious counselors are often ordained clergy (ministers, pas-
one of the empirical studies used questionnaires to gather data, tors, priests, rabbis). Pastoral counselors, certified by the Amer-

422 JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64


Religious Counseling
ican Association of Pastoral Counselors and the Association of veyed 130 clergy from the Midwest. Conservative clergy per-
Mental Health Clergy, also counsel professionally. Pastoral ceived counseling to be more of a moral and religious activity
counselors are ordained clergy who may or may not consider than did liberal clergy. Abramczyk (1981) surveyed 55 pastors
themselves to be religious counselors. For histories and reviews of the United Methodist Church (generally theologically liberal).
of pastoral counseling, see Van Wagner (1983), Powell (1975), These pastors described their counseling style as largely Ro-
Rader (1980), and Thornton (1970). gerian. They used support, reflection of feeling, reflection of
Recently, a new type of religious counseling has emerged. content, clarification, attending behavior, and focusing, but they
Clinical and counseling psychologists, trained in secular PhD seldom gave direct advice. On the contrary, Virkler (1979, 1980)
programs or in PhD programs that are approved by the Amer- interviewed 54 theologically conservative pastors, who reported
ican Psychological Association and that provide the required giving direct advice in 89% of all cases and who showed a rel-
training in religious content, have attempted to integrate reli- atively low level of facilitativeness.
gious faith and clinical practice. Generally, these practitioners Clergy counsel people with the full range of psychological
have been conservative Christians in theology. Many writers difficulties. In fact, after physicians, clergy are the second most
have attempted to integrate psychology and Christianity (e.g., frequently consulted professionals (Lieberman & Mullan, 1978).
Carter & Narramore, 1979; Collins, 1983; Crabb, 1981; Ellens, Marriage difficulty was rated as the first or second most frequent
1982; Guy, 1982). Differences in how to integrate counseling and presenting complaint in 10 of 11 studies reviewed by Arnold
faith abound, even among practitioners with similar theologies and Schick (1979). Parent-child relationship problems were also
and similar counseling theories. frequently encountered, as were depression, grief, illness, and
Lay counselors also do considerable religious counseling (Col- substance abuse. Problems that are concerned specifically with
lins & Tornquist, 1981). For example, Adams (1973), the origi- spirituality, such as loss of faith, are encountered relatively in-
nator of nouthetic counseling, has spawned training and cer- frequently by clergy, despite the lingering stereotype that clergy
tification of numerous “nouthetic counselors.” These lay people deal mostly with spiritual issues. Rather, clergy deal with prac-
receive coursework and supervised practice from clergy at cer- tical problems but believe that their counseling is unique relative
tified nouthetic counseling centers. Nouthetic counseling is a to other professional counselors because they bring a spiritual
theologically fundamentalistic approach to counseling that is perspective to the problems (Abramczyk, 1981). There is some
supportive, confrontational, and behavioral in technique. Gen- evidence that this perception is more important to clergy than
erally, nouthetic counselors are not remunerated for services to some clients (Posavac & Hartung, 1977), who often simply
and operate with the approval of local churches. Clients may want relief from their psychological pain and suffering.
be Christian or non-Christian, and they are informed in writing In addition to providing direct counseling, clerics also serve
that the focus of counseling will be explicitly based on the Bible. as valuable referral sources for the rest of the mental health
community (Piedmont, 1968; Weiss, 1973). Theological positions
The Caseloads of Clerics can predispose clergy to refer to or castigate other mental health
Who Counsel workers (Cole, Costanzo, & Cox, 1975). In a survey of 61 Lu-
Clerics are not the only religious counselors; however, few theran pastors, Hong and Weihe (1975) found that 93% knew
researchers have investigated (a) pastoral counselors; pastoral counselors but only 41% referred clients to them. On
(b) psychologists, psychiatrists, counselors, and social workers the other hand, 85% of the pastors knew a psychologist and
who explicitly label themselves as religious counselors; or 85% knew a social worker, and 52% referred clients to them.
(c) paraprofessional counselors affiliated with religious organi- Psychiatrists were known by 68% of the pastors and used by
zations. In the past, numerous studies focused on the perceived 36%. Most pastors preferred to know the religious orientation
importance of counseling to clerics and on the time they spend of the therapist to whom they referred clients, but 37% said that
counseling. In the past 10 years, however, only three studies they had referred clients to therapists they knew were not Chris-
have addressed these topics (Abramczyk, 1981; Clark & Thomas, tian. Over half of the sample (53%) preferred to refer to thera-
1979; Tisdale, 1977). Recently, more attention has been focused pists they knew were Christian.
on why pastors choose to counsel or refer, how well they coun- Gilbert (1981a) found that referral by pastors was most strong-
sel, and how they interact with other mental health profession- ly affected by their theological position; this finding was repli-
als. cated in six studies, mostly dissertations. Theologically conser-
Generally, the best predictor of the caseloads of clerics is the vative clergy were largely isolated from mental health
size of their congregation (Tisdale, 1977). Gilbert (1981b) sur- professionals. Theologically liberal pastors referred more and
veyed 64 Assembly of God pastors from west Texas and found counseled less than did conservative pastors.
that 3 of 14 variables predicted pastors’ decisions to counsel Rumberger and Rogers (1982) surveyed pastors of recent clients
parishioners: training in counseling and psychology course- at a Christian counseling service. Pastors with high counseling
work, acquaintance with mental health professionals, and per- activity, those who were highly educated, and those who reg-
ceiving counseling as an important part of ministry. ularly interacted with a variety of professional colleagues were
Many clerics counsel only those in their congregations likely to refer clients to the agency. Theological orientation of
(Abramczyk, 1981). Some restrict their counseling to “believ- referring pastors was not related to their openness to the agency,
ers,” religious people of fundamentally the same beliefs as them- but this sample was composed of clients who had attended an
selves, and believe that seeing nonbelievers is unwise and in- agency-many of whom might have been referred by the pas-
effective. Some clerics, however, believe that they can also succor tors. Finally, Gilbert (1981a) reported that authoritarianism and
“nonbelievers” and that, indeed, they have a mandate to do so. poor self-concept were predictive of failure of clergy to refer to
This difference is probably due to theological differences among other mental health professionals. Pastors of small churches
Christian pastors. Theologically conservative pastors are gen- were also less likely to refer than were pastors of churches with
erally concerned with the truth of their counsel (as they interpret 500 or more members.
scripture) and the acceptance of that truth by their clients. Theo-
logically liberal pastors are less concerned that their clients be- Religious Characteristics of Professional
lieve as they do. This theological distinction between liberals Counselors Other than Clerics
and conservatives has shown up repeatedly in differences in Religious counseling may be performed when any professional
the counseling styles of pastors. Clark and Thomas (1979) sur- counselor addresses a religious issue with a client. What are the

JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64 423


Worthington
religious values of professional counselors? Cross and Khan lems from a theological perspective. One question raised by
(1983) and Khan and Cross (1984) surveyed psychologists, Virkler’s research is whether facilitative conditions are valued
social workers, and psychiatrists in Queensland, Australia. by pastors and, more important, by their clients or parishioners.
The survey contained four sections: demographics, value In a rather old but comprehensive study, Gurin, Veroff, and
rankings (Rokeach’s [1967] Value Survey), religious beliefs Feld (1960) studied people‘s responses to various mental health
and attitudes, and Rosenthal’s (1955) Moral Values Question- workers. Most clients who attended counseling with a member
naire. They found that in comparison to other groups, of the clergy reported that counseling helped extensively (65%)
(a) psychologists placed more emphasis on individual devel- or partially (13%); only 18% reported not being helped. These
opment (ambitious, independent), (b) social workers placed data are comparable with success rates reported by Strupp, Had-
more emphasis on the values of a good life (equality, cheer- ley, and Gomez-Schwartz (1977) for therapy in general. Gurin
fulness), and (c) psychiatrists placed more emphasis on values et al. asked people how counselors helped them. Clients of
supporting conventional society (obedience, national securi- pastors most frequently mentioned advice (34%) and encour-
ty). All three groups of professionals ranked salvation the agement to endure (23%) as being helpful. Patients of psychi-
lowest of Rokeach’s 18 terminal values. atrists stated that they were helped less frequently by advice
None of the groups could be considered very religious com- (15%) and encouragement to endure (7%).
pared to the national norms in Australia. Social workers, how- Pastors generally see their own parishioners (Abramczyk, 1981).
ever, were found to be more religious, to pray more frequent- Presumably, they already have a personal relationship with many
ly, and to have had an experience with God in more cases or most of them and can help them more rapidly and more
than did psychologists or psychiatrists, who were similar to directly than can a professional who sees a stranger for only
each other in their ratings of religiosity. These results are one hour per week and who must develop a therapeutic alliance
similar to previous findings in the United States (Henry, Sims, before giving much substantive direction. In Virkler’s study, the
& Spray, 1971). client was described as a 30-year-old parishioner (for 6 years)
who was seeking help with marital problems. The client sup-
Training and Effectiveness posedly taught Sunday school and supported the church in
of Religious Counselors other ways. Pastors may have offered few facilitative responses
How well prepared are pastors to counsel? Arnold and Schick and many direct suggestions because they perceived themselves
(1979), in a comprehensive review of 20 years of research, re- as already knowing the client. They may have hypothesized
ported that pastors usually feel underprepared for their coun- that the researcher was not interested in their listening skills
seling responsibilities. Many seek additional training and many but in what they would say to the client. On the other hand,
simply do not counsel. Linebaugh and Devivo (1981) surveyed one would hope that facilitativeness would be part of any help-
55 of 76 accredited Protestant seminaries in the United States. er’s behavior repertoire, regardless of how well two people know
Only about half required at least one course in counseling or each other. One conclusion, then, is that pastors may lack con-
pastoral care. Many students took courses in counseling, even fidence in their counseling skills and may not always be facili-
when they were not required. Some supplemented classwork tative, but their parishioners seem to be as satisfied as are clients
in counseling (if available) with a 10- to 12-week unit (or units) of other professional counselors.
in Clinical Pastoral Education (CPE). This intensive, full-time
chaplaincy experience usually involves contact with patients, Summary of Research on
spouses or relatives of patients, and staff members. The trainee Religious Counselors
may receive individual supervision and will usually receive group Studies of religious counselors need to go beyond questionnaires
supervision that is often highly confrontive. and study the behavior of religious counselors, perhaps in an-
Most of the research on training in religious counseling fo- alogue situations (e.g., Virkler, 1979, 1980), field studies (e.g.,
cuses on CPE training. In general, CPE might produce some selection of the sample in Rumberger & Rogers, 1982), or ob-
changes in trainees, but the permanence of the change is suspect servation and analysis of counseling sessions.
(Geary, 1977; Grant, 1975; Thomas, Stein, & Klein, 1982). Fur- Almost all researchers have investigated Protestant pastors.
thermore, there is no empirical evidence that CPE training pro- Nothing is known about the religious counseling of profession-
duces changes in counseling competence. Seaton-Johnson and als who are not pastors. How does the clinical or counseling
Everett (1980) and Everett and Seaton-Johnson (1983) surveyed psychologist, social worker, or psychiatrist who sees religious
the 900 individuals designated as supervisors of the Association clients counsel? How does that counseling differ from secular
for Clinical Pastoral Education (ACPE) and the diplomats and counseling? How do differences (if any) depend on character-
fellows of the American Association of Pastoral Counselors istics of religious counselors, religious clients, or the interaction
(AAPC). Most supervision involved verbatims (i.e., transcribed between them? Are there counseling process differences be-
excerpts from counseling), which indicates that pastors who tween religious counseling and counseling that is not explicitly
receive CPE training at least receive supervised counseling. Most religious? Are there differences in religious counselors that de-
supervisors were heavily engaged in CPE training. pend on the type of religion—Protestant (liberal, conservative),
Some evidence suggests that pastors not only do not feel they Catholic, Jewish, Mormon, Buddhist, or other? These and other
are competent counselors but also that they do not behave as important questions remain unanswered.
competent counselors. The few courses in counseling required On the other hand, some things have been well established
for most pastors are usually cognitively oriented around com- about religious counselors. Theological beliefs, at least those of
mon problems (Virkler, 1979, 1980) or are expositions on Ro- Protestant clerics, play a large role in (a) counseling style,
gerian basic helping skills. These courses might not help pastors (b) counseling content, (c) decisions to refer or counsel, and
act facilitatively. Virkler (1980) found that seminary training per (d) acceptable referral sources. Pastors do much of the mental
se was unrelated to level of facilitativeness; however, training health work in the United States (probably more than psychol-
in counseling was related to facilitativeness. Theologically con- ogists, psychiatrists, and social workers combined). Many pas-
servative pastors were less facilitative than were theologically tors are ill equipped for counseling and may function at low
liberal pastors, even when differences in educational level were levels of helpfulness (Virkler, 1980), but parishioners generally
controlled statistically. Virkler argued for more practice in coun- seem satisfied with the counseling they receive. The religious
seling to supplement teaching about how to conceptualize prob- values of most nonreligious mental health professionals differ

424 JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64


Religious Counseling
substantially from the values of the general population and those prehend spiritual language and concepts, (d) assume that reli-
of religious clients (Bergin, 1980). gious clients share nonreligious cultural norms (e.g., premarital
cohabitation, premarital intercourse, divorce), (e) recommend
RELIGIOUS CLIENTS
“therapeutic” behaviors that clients consider immoral (e.g., ex-
Methodology of Research perimentation with homosexuality), or (f) make assumptions,
About Religious Clients interpretations, and recommendations that discredit revelation
Between 1974 and 1984, 23 empirical articles and 3 reviews of as a valid epistemology. Conservative Christians prefer like-
empirical research (Beutler, 1979, 1981; Galanter, 1982) were minded counselors and distrust secular counselors. They gen-
reviewed. The methodology of the empirical studies was di- erally fear having their values changed and misunderstood or
verse. Of the 23 empirical studies, 5 were clinical studies, 5 used being misdiagnosed because of their beliefs. These two fears
experimental manipulations, 6 were counseling analogues, and have been investigated thoroughly. It is unclear whether other
3 were structured interviews. All involved Christians, Jews, or Christians or clients with other religious orientations share the
clients of unspecified religion. Programmatic research was rare; fears of conservative Christians.
however, Beutler and his colleagues have systematically inves- Fear of having values changed. Are the concerns of Christians
tigated changes in religious values and other values in psycho- unfounded? Might their religious beliefs be undermined through
therapy since 1971. Two replications were found (Dougherty & counseling? There is some evidence that when counseling is
Worthington, 1982; Margolis & Elifson, 1979, 1983; Worthington effective, clients change their values. During effective counsel-
& Gascoyne, 1985). ing, the client’s values move in the direction of his or her coun-
selor’s values (Beutler, Pollack, & Jobe, 1979; Parloff, Iflund, &
Who Are Religious Clients? Goldstein, 1960; Rosenthal, 1955; Welkowitz, Cohen, & Ort-
Religious clients are religious people who have human problems meyer, 1967). Early studies, however, did not uncover many of
so bothersome that they seek help from a professional. When the complexities of value influence. Through a series of clinical
they seek help from clergy, they sometimes seek advice more studies, Beutler and his colleagues refined the understanding
than psychotherapy, but there is no evidence to indicate that
of how secular counselors affect the values of secular clients (for
those who seek help from a member of the clergy rather than reviews, see Beutler, 1979, 1981).
a psychiatrist, psychologist, social worker, or any professional Not all client values are equally affected. Beutler, Jobe, and
counselor are either more or less severely disturbed than are Elkins (1974) studied 34 group therapy patients and their ther-
other clients (Arnold & Schick, 1979). apists. All were measured on seven values. Three values were
To understand religious clients, one must understand reli- defined by Beutler et al. to be of high centrality to the patients
gious people, especially as their lives relate to psychological and their therapists (need for approval, the threatening nature
problems. As with other individual variables, however, people of the world, and belief in God); two were defined as being of
simply cannot be treated uniformly based on religious values. medium centrality (reactions to Karl Marx and to Jesus Christ;
People who counsel religious clients must (a) distinguish among and two were defined as being of low centrality (premarital sex
value patterns of different groups to provide a general frame- and the need for laws). Patients who initially agreed with their
work for understanding the value structure of the individual,
therapist’s high centrality values did not change those attitudes
and (b) understand the variations of the individual from that or improve in therapy more than those who initially disagreed
group. It is especially important for counselors of religious clients with their therapist’s high centrality values. Patients who ini-
to assess the religious commitment of the individual, because
tially disagreed with their therapist’s medium centrality values
this commitment is an important mediating variable in under-
(Jesus and Marx) changed their values to be more like their
standing how similar a client’s behavior might be to behavior therapist’s values, rated themselves as more improved, and were
unearthed through scientific investigation of religious clients. more satisfied than were patients who initially agreed with their
Generally, research on religious clients has addressed two major therapist’s medium centrality values. Patients who initially agreed
areas: (a) concerns of religious clients (especially Christians) over with their therapist’s low centrality values (sex and laws) changed
attending counseling and (b) perceptions of potential clients. their attitudes less but did not improve less than did patients
Concerns of Clients About who initially rejected their therapist’s low centrality values. Beu-
Religious Counseling tler et al. (1974) concluded that “psychotherapy may have its
King (1978) surveyed parishioners and pastors from, theolog- greatest effect on attitudes of a philosophical nature dealing with
ically conservative congregations throughout San Diego County. ethics and religion” (p. 552).
He found that 10% of the pastors and 27% of the lay people In addition, differences in initial values between clients and
had had psychological problems within the last 10 years. Most their counselors affect different aspects of counseling. Beutler
(59%) had sought help from family and friends; about half et al. (1978) investigated 13 psychotherapy dyads. They found
went to a pastor for counseling. Many of King’s participants that clients’ liking of their therapists depended on (a) the clients
criticized available counseling sources, especially nonpastors. initially disagreeing with their therapists about the therapist’s
For example, 89% of those who were dissatisfied with avail- belief in God but changing their beliefs throughout therapy to
able counseling sources expressed concern that their Christian be more like the therapists’ beliefs, and (b) the therapists initially
faith would be misunderstood, unappreciated, or perhaps even rejecting their clients’ opinions both of Christianity and of ap-
ridiculed or eroded by an agnostic or atheistic counselor. King proval. Beutler et al. (1978) also found that when therapists
also found that the more Christians agreed with the doctrines agreed with their clients’ initial values, clients reported more
of the church, the less likely they were to seek professional personal growth than when therapists did not. When clients
counseling. agreed with the initial values of their therapists, they were more
Concern about attending secular counseling is a prevalent attracted to their therapists and were more trusting of them than
theme among conservative Christians (see Gilbert, 1981a; Ko- were clients who did not.
teskey, 1974). Worthington and Scott (1983) identified at least In summary, religious value similarity between counselors
six fears of conservative Christian clients relative to secular coun- and clients certainly affects counseling, but the relationship is
seling. Conservative Christians fear that a secular counselor will not simple. Numerous aspects of counseling are affected, in-
(a) ignore spiritual concerns, (b) treat spiritual beliefs and ex- cluding outcome of counseling (clients report more improve-
periences as pathological or merely psychological, (c) fail to com- ment when they change values to be more like their counselor’s,

JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64 425


Worthington
but counselors do not rate those clients as any more improved may differ, evidence to date suggests that secular and religious
than clients who do not change values). counselors do not differ in their abilities to classify religious
Worthington and Scott (1983) hypothesized that counselors experiences as authentic, fabricated, or resulting from psycho-
influence clients’ beliefs by the goals they lead clients to select pathology.
in counseling. They surveyed 81 counselors and counseling stu-
dents in explicitly Christian settings (pastoral counseling centers Clients’ Perceptions of
or seminaries) or in secular settings (counseling centers, private Religious Counselors
practice, and universities). Professionals in different settings Religious and nonreligious clients attend counseling with reli-
defined the problems differently and set different goals for the gious and nonreligious counselors. How do they perceive these
client, depending on the client’s stated perceptions. Profession- counselors? Pecnik and Epperson (1985) divided college stu-
als in religious settings paid high attention to religious issues; dents into those high in conservative Christian beliefs and those
professionals in secular settings paid less attention to religious low in such beliefs. They described a counselor to the students.
issues. Students were more extreme than were professionals in Half were told the counselor was a Christian. All other parts of
their adherence to goals appropriate to their setting. Of course, the description were identical. Pecnik and Epperson found that
goals are not selected unilaterally by the counselor but are ne- students higher on conservative Christian beliefs rated the coun-
gotiated between client and counselor; however, these data in- selor higher than did those lower on conservative Christian
dicate that counselors might guide clients subtly toward or away beliefs. When described as a Christian, however, the counselor
from religious considerations through their problem definition was rated lower than when that phrase was omitted from the
and selection of goals for counseling. description. Surprisingly, no interaction was found.
Religious clients who undergo counseling with counselors On the other hand, three studies have employed methods
who have similar values are likely to experience little challenge similar to each other to investigate the effects of initial perception
to their values, and in about one-third of the cases they report and perception after some experience with the counselor. Seif
that their faith is strengthened (King, 1978). Clients who enter (1981) investigated the responses of 180 9th- and 12th-grade boys
counseling with secular professionals may adopt their counse- at a large, urban, Catholic high school to videotapes of coun-
lors’ values. That therapists generally are less religious than are seling. Long (1978) had Catholic and non-Catholic young adults
their clients suggests an erosion of clients’ religious beliefs (Ber- (ages 16-21) undergo a structured interview with a female in-
gin, 1980; Cross & Khan, 1983). terviewer. Haugen and Edwards (1976) had 71 undergraduate
Fear of being misunderstood. Highly religious people often de- students from a small, private, Christian evangelical college lis-
velop behaviors and language patterns that sound strange to ten to a brief audiotape of a counselor. In each of these studies,
people outside their social circle. A Pentecostal (theologically participants were given information about the counselor. The
conservative), Protestant Christian may speak normally of counselor was described as either similar to or different from
“hearing God’s voice, ” “speaking in tongues,” “fasting and the participants in religious denomination or approach to reli-
praying for God’s miraculous answer to prayer,” or miraculous gion. Students then interacted with or observed the counselor.
“healings.” A secular professional or even a theologically liberal Finally, they rated the counselor on various dimensions, such
counselor may misunderstand the normal vocabulary of Pen- as facilitativeness, persuasibility, and their attraction to the
tecostals and may misdiagnose them as pathological. At least, counselor. Results in the three studies were similar. The ex-
such is the fear of the highly religious person. perience of the participants with the counselor overshadowed
Three studies have focused on the diagnosis of religious clients. any precounseling verbal descriptions of what the counselor was
Wadsworth and Checketts (1980) had 60 psychologists, either like. Students responded similarly to the counselor regardless
Mormon or of another religion, respond to four written, ficti- of what they were told, which suggests that religious values
tious case reports of clients who were described as being of may be more important in religious clients’ selection of a coun-
either Mormon or of another religion. The psychologists who selor than in their continuing with a counselor once counseling
were Mormon did not differ in their diagnoses from psychol- begins.
ogists of another (or no) religion. Client religion was not a factor, In a different type of study, Dougherty and Worthington (1983)
nor was there a counselor-client interaction. surveyed 45 conservative and moderate Christians. They had
Margolis and Elifson (1983) had expert and nonexpert raters participants read four 1,200-word treatment plans for a fictitious
distinguish among genuine religious experiences, fabricated client, respond to each plan, and compare plans directly.
religious experiences, and psychotic experiences. Expert ra- Dougherty and Worthington found that, especially among the
ters distinguished among the experiences better than did non- more conservative Christians, there was a reluctance to seek
expert raters; however, nonexpert raters who were trained secular counseling and a preference for treatment plans that
briefly did as well as the experts. Psychotic experiences were were perceived as being congruent with their beliefs. Even though
more easily identified than were genuine and fabricated ex- all treatment plans clearly reflected the Christian beliefs of the
periences. counselors, who were overtly Christian, participants made fine
Worthington and Scott (1983) had professional counselors dif- distinctions along theological lines—apparently using theolog-
ferentiate between religion used responsibly and religion used ical similarity as the most important selection criterion.
pathologically (some psychotic and some neurotic behaviors). Worthington and Gascoyne (1985) replicated and extended
Religious and secular counselors were equally facile at making the study of Dougherty and Worthington (1982). They had 255
the distinction. Worthington and Scott speculated that gross college students (some were Christian and some were not) give
differentiation, such as between clearly pathological behaviors their responses to the treatment plans of the five overtly Chris-
and clearly responsible behaviors, might be easier to identify tian counselors. Among the Christian students, they found the
than more unfamiliar behaviors, such as if a client spoke of same pattern as had Dougherty and Worthington (1982): People
glossolalia (speaking in tongues), supernatural healing, mira- preferred treatment plans that reflected an approach to religion
cles, the direct leading of God, or the power of prayer to create that was similar to their own. Worthington and Gascoyne found
objective changes in the physical world. If this is true, the coun- that the non-Christians were generally satisfied with the ap-
selor has the responsibility to understand the client’s idiosyn- proach that the Christian counselors outlined. Non-Christian
cratic language before making a damaging diagnosis. Despite participants were willing to refer Christian friends to all Chris-
these speculations about how secular and religious counselors tian counselors but were willing to refer non-Christian friends

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Religious Counseling
only to the least fundamentalistic Christian counselors. Appar- use techniques different from those of a Jewish or Christian
ently, the categories that non-Christians used to evaluate the counselor. Critics of this position might argue that the use of
appropriateness of a counselor were more undifferentiated (fun- formal religious practices is religious but is not counseling; rath-
damentalistic versus not fundamentalistic) than were the cate- er, it is spiritual guidance. Proponents of the position might
gories used by Christians to evaluate the appropriateness of the counter that whatever counselor interventions promote mental
counselors. health in clients are appropriate for counseling and that psy-
chotherapy is not an exact science defined by a closed set of
Summary of Research on specific techniques.
Religious Clients Obviously, there are gray areas around these extremes. Coun-
Research on religious clients has been diverse in methodology, selors can be so secular that they stop doing religious counseling
even though the primary methodological tool is the survey. or so religious that they stop doing religious counseling. In prac-
More studies are needed that examine clients during counseling. tice, counselors have proposed both types of interventions as
In addition, more analogue experiments could help define cru- religious techniques.
cial variables in understanding religious clients during coun- A third view defines a religious counseling technique as a
seling. Most studies have involved Christians. counseling technique that originates in secular theories but has
Many researchers have investigated the fear and concerns of religious content and is used to strengthen clients’ faith as well
religious clients about attending counseling with a counselor as alleviate their distress. Critics find this approach either too
who has different values. Clients prefer counselors who have religious or not religious enough, depending on their position.
values similar to their own. Yet, extant research indicates that Proponents of this position believe that they are truly counseling
once counseling is begun, clients are apparently less able to while being religious.
discriminate counselors with similar values and counselors with
dissimilar values. Research is needed to test this implication Examples of Religious
directly. There is also evidence that once counseling is begun, Counseling Techniques
the client’s religious values are likely to become more like the Lovinger (1979, 1984), who writes from a psychoanalytically
counselor’s. Thus, some of the client’s fears are substantiated informed position and a Jewish perspective, is a proponent of
by research. The client should select a counselor whose religious the first approach to religious counseling techniques, although
values are admired. Other fears (e.g., that the client will be he will address religious content (especially when the client uses
misunderstood or undiagnosed) have not been supported. it as a way to resist progress in counseling). He outlined several
Much of the research on religious clients has focused on re- therapeutic techniques to handle resistances by religious clients.
ligious values, which have been consistently important in un- The therapist can “join the resistance.” If a client is beset with
derstanding clients’ preferences, attitudes, and beliefs; how- doubts, the therapist can show the client some benefits of doubt.
ever, no studies have convincingly linked client values with The therapist can find alternative translations or connotations
client (or counselor) behavior during counseling. One possible in the text of sacred writing, which obviously requires extensive
exception is the research program of Beutler. Beutler, however, knowledge of the writings the client subscribes to. The therapist
used clients who were not highly religious. He did not show can pit one imperative against another (see Coyle & Endberg,
convincing links between client values and behavior. Appar- 1969, for several examples). When Biblical directives are inferred
ently, client values are important in how religious clients sub- indirectly by the client from selected scriptures, the therapist
jectively perceive counseling. Client values may or may not be might provide a different overall interpretation and suggest that
important in affecting actual client behavior. the client read in a particular area. Finally, the therapist might
Religious people evaluate their counseling experiences along explore other things that were going on in the person’s life when
more differentiated religious dimensions than do nonreligious a particular attitude developed. Lovinger cautioned therapists
people. Theological variables are often more important to reli- that many religious clients will directly question the therapist’s
gious clients than are other variables in counseling. If the reli- personal religious beliefs. He suggested that “candid but concise
gious client is to be understood, research and theorizing is nec- answers with an exploration of what the answers mean to the
essary to map the cognitive structures of the religious individual patient and what it is that is important to the patient have
and to design counseling theories, methods, and techniques that generally been most productive [for him]” (Lovinger, 1979, p. 426).
directly address those cognitive structures. Griffith (1983a, 1983b) described the practice of religious coun-
RELIGIOUS COUNSELING TECHNIQUES seling in a Christian-based, holistic clinic in Jamaica. The treat-
ments involved medical, psychological, and spiritual care, and
What are Religious the clinic was staffed by medical practitioners, psychological
Counseling Techniques? counselors, and lay counselors. In that setting, the first two
There are three primary competing views about what religious definitions of religious counseling were employed by different
counseling techniques are. From one perspective, a religious counselors. Most lay counselors relied on techniques such as
counseling technique is any counseling technique, regardless of prayer, testimony, singing, and, in general, an expectation of
theory or theology of origin, that is used in (religious) coun- God’s divine intervention in healing. Most psychological coun-
seling. Proponents of this perspective might argue that a coun- selors, however, usually described themselves as operating within
selor can use completely secular counseling techniques and still a Christian framework, although their practice consisted largely
be profoundly religious in promoting a client’s religious view of secularly derived techniques.
of the world. People who adopt this point of view often favor McGuire (1980) offered a Buddhist approach to counseling,
counseling that is not technique oriented, and therefore they an example of the second definition of religious counseling tech-
may not believe that religious counseling, or any counseling, niques. Buddhist counseling is based on gnosis (knowledge), the
can be defined in terms of techniques. Critics argue that if secular transcendence of self and unity with the cosmos (Ehrlich, 1976;
techniques and secular content are used in counseling, then the Stark, 1981). Techniques for promoting such knowledge include
counseling is secular, not religious. having the counselor act like a Buddhist master, “making a point
A second view defines a religious counseling technique as any and timing it in an attempt to shock the disciple [client] out of
practice used in counseling that originated within the practice the patterns of thought and rationality that hold the individual
of formal religion. In this definition, a Buddhist counselor might in bondage” (McGuire, 1980, p. 583). This is likened to the aso-

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Worthington
cial counselor response (Beier, 1966). Although knowledge is held twice a week for 4 weeks. There were two therapists, one
desirable, rationality is not. The counselor might also recom- a first-year graduate student and one a second-year graduate
mend (a) meditation, of which there are at least four types in student; both were nonreligious but reported no feelings of dis-
Buddhism (see Hendlin, 1979) and other types based on Hin- comfort in describing the religious imagery. Use of religious
duism (e.g., Transcendental Meditation), and (b) use of a koan, imagery resulted in lower MMPI-D scores, fewer depressed clients
a paradox not understandable through rational thought. The (using the Beck Depression Inventory [BDI]), and lower behav-
desire is to reorganize consciousness to integrate the person ioral indications of depression on three measures than a self-
with the totality of existence. Although many people use med- monitoring only group. Use of nonreligious imagery did not
itation techniques without reference to Buddhism or Hinduism, produce any differences from the self-monitoring group. In a
meditation is nonetheless derived from a religious practice and direct comparison, use of religious imagery did not produce any
fits one definition of a religious counseling technique. differences from use of nonreligious imagery.
Strong (1980) also represents the second definition of religious Pecheur and Edwards (1984) compared secular cognitive be-
counseling techniques. For example, he claims that counselor- havior modification, religious cognitive behavior modification,
client contact is facilitated by agape (selfless, giving love) and and a waiting list control group in treating mild depression in
empathy. He also recommends prayer as “a key process” (p. 592), undergraduate students at a Christian college. Their treatments
along with having the counselor induce the client to confess involved rational cognitive restructuring. Treatment consisted
self-justification, to repent (turn away from sin), and to forgive of eight l-hour sessions that were held twice a week. The ther-
others. The counselor listens to the confession, motivates the apist was a fifth-year graduate student who was a Christian.
client to behave more positively in the future, and pronounces Both treatments were superior to the waiting list in reducing
Gods absolution. Other Christians have recommended this ap- rating of depression on five inventories. The religious and non-
proach (e.g., Nelson & Wilson, 1984; Wilson, 1974). religious treatments did not differ from each other.
The third approach, in which secular theories are adapted to Despite the methodological differences in these two studies
be compatible with religious assumptions, has been used fre- (e.g., differences in content of treatment and experience and
quently, especially by Christians. For example, Crabb (1977) has religious orientation of the therapists), the moderately religious
recast cognitive therapy into a biblical mold. Vitz (1977) has done and mildly depressed clients did not respond significantly better
the same with psychoanalysis, Adams (1973) with behavioral to religious interventions than to nonreligious ones. Both in-
therapy, Malony (1980) and Lawrence (1983) with transactional terventions were effective. Two other questions need to be in-
analysis, Lawrence and Huber (1983) with rational-emotive ther- vestigated. Would strongly religious clients, especially those
apy, Worthington (1982) with cognitive behavior modification, who are theologically conservative, respond better to religious
and Morris (1974) with reality therapy. Also, many others have treatments than to secular treatments? Also, would nonreligious
used this approach (see Collins, 1980). or mildly religious clients resist religious treatments?
Regardless of one’s perspective on the definition of religious
Empirical Research on Religious counseling techniques, research is scant. Techniques are ill-spec-
Counseling Techniques ified and ill-researched. The research that does exist indicates
Despite the various proposals about what constitutes religious that in treating religious clients, religious counseling techniques
counseling techniques, little research has been done. No re- are either marginally better or no better than secular techniques.
searchers have investigated the secular-based counseling that is More and better research is desperately needed.
thought to be religious because the counselor considers himself
or herself religious. Proponents of this approach rarely define SUMMARY AND EVALUATION OF RESEARCH
religiosity as being related to technique or formal religious prac- ON RELIGIOUS COUNSELING
tice. Methodology
Some researchers have investigated the use in counseling of As Gorsuch (1984) suggested, the questionnaire is the most often
techniques derived from religious practices. For instance, Wil- used research tool, although in recent years several studies have
son (1974) reported the use of commitment, rededication, been published that have used videotapes, audiotapes, and an
confession, forgiveness, and change of place of worship as sup- occasional behavioral rating. Participants are usually Christians,
plements to psychotherapy with 18 patients in his private prac- especially conservative Christians, and research on religious
tice. Previous therapy had been unsuccessful for 14 of the 18 counseling with people of other faiths is rare. Outcome research
patients. Symptomatic relief was found in 16 of the 18 patients. on clinical treatments with clinical populations is almost non-
The results are impressive, although the lack of experimental existent and is certainly not reflective of the state of the art of
control and poor specification of the psychotherapy techniques outcome research. Kazdin (1982) proposed that outcome re-
that were used prevent definitive interpretation of the cause of search in psychotherapy use the full range of techniques avail-
the beneficial effects. able, including the carefully controlled, single-case design, the
Additional research, much more carefully executed, has fo- analogue experiment for study of critical aspects of counseling
cused on the effects of meditation in counseling. Although med- that cannot be conveniently investigated in the clinic, and clin-
itation originated in Eastern religion, most applications within ical trials. Research in religious counseling is less varied, has
counseling have not presented it as a religious technique. Gen- fewer programmatic efforts, and has less replication than seems
erally, meditation has been found to help clients relax, but most optimal.
of the enthusiastic early claims about its benefits have been
mitigated (e.g., Goldman, Domitor, & Murray, 1979; Parker, Findings
Gilbert, & Thoreson, 1978; Smith, 1975, 1976; Zuroff & Schwartz, Throughout this article, I have identified themes involved in
1978). religious counseling. Many of these themes indicate the need
Two well-controlled counseling analogue studies have tested for modifications in current research or practice.
the third definition of religious counseling techniques (secular-
based techniques with religious content). Propst (1980) adapted Religious Counselors:
systematic desensitization procedures to include Christian im-
agery to help mildly depressed undergraduates who scored 1. Clergy do most religious counseling. Some evidence indi-
moderately high on a religiosity scale. Therapy sessions were cates that they are not very good counselors and that they do

428 JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64


Religious Counseling
not receive good training in counseling. Other evidence indi- demonstrates this conclusively. The only good outcome stud-
cates that parishioners are largely satisfied. Research into actual ies show secular and religious counseling to be equally effec-
counseling, rather than self-reports, is needed. tive with religious clients.
2. Most research concerning religious counselors has focused 2. Techniques of religious counseling have not been well
on pastors or pastoral counselors. No studies have been con- researched. This is a crucial need in the field of religious coun-
ducted on professionals who identify themselves openly to clients seling.
as Christians doing Christian counseling, Jews doing Jewish
counseling, or people from other religions doing counseling Throughout this article, I have been critical of much of the
with clients who are explicitly religious. research investigating religious counseling. Although there
3. Investigations of the process and outcome of lay counseling have been some good studies, for the most part the research
are desirable to define the competencies and limitations of trained quality lags behind many of the subdisciplines of psychology.
lay counselors. Research on religious counseling is a risky undertaking, only
4. There are too few studies concerning female counselors. occasionally acceptable to some of the major counseling jour-
Furthermore, research and formal theorizing by women is in- nals. Yet, if knowledge is to be advanced in the area, more
frequent. researchers must accept the risks and venture into the main-
5. More research and theory are needed on marriage and stream of the methodology of counseling research.
family counseling with religious people. Most clients seen by
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430 JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64


Religious Counseling
A partial replication and extension. Journal of Psychology and Theology, of control, and drug use. Journal of Consulting and Clinical Psychology,
13, 20-41. 46, 264-271.
Worthington, E.L., Jr., & Scott, G.G. (1983). Goal selection for coun-
seling with potentially religious clients by professional and student Everett L. Worthington, Jr., is an associate professor in the Department of
counselors in explicitly Christian or secular settings. Journal of Psy- Psychology, Virginia Commonwealth University, Richmond. The author would
chology and Theology, 11, 318-329. like to thank Stanley R. Strong, James S. Goalder, and Cynthia A. Clark for
Zuroff, D.C., & Schwartz, J.C. (1978). Effects of transcendental medi- their helpful comments on an earlier draft of this manuscript and Rodney Good-
tation and muscle relaxation on trait anxiety, maladjustment, locus year for supplying many references and for encouraging me to persevere.

TOC Electronic Journal: To print "Guidelines" select page 15.

Guidelines for Authors


The Journal of Counseling and Development invites manuscripts directed to the common interest of counselors and personnel workers
in schools, colleges, community agencies, and government. Particularly welcome is stimulating writing dealing with (a) current professional
and scientific issues, (b) research reports of unusual significance to practitioners, (c) critical integration of published research, (d) new
techniques or innovative practices and programs, and(e) AACD as an organization and its role in society. All material should communicate
ideas clearly and interestingly to a readership composed mainly of practitioners.
Manuscripts will be acknowledged on receipt. Following preliminary review by the Editor, they will be sent to members of the Editorial
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each author will receive five copies of the Journal. Verse and In The Field authors will receive two copies of the Journal.
Following are guidelines for developing and submitting a manuscript. Manuscripts that do not conform to these guidelines will be
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Manuscript Categories
1. Full-length articles. Manuscripts should be typed in lines of 62 spaces and generally should not exceed 500 lines. In tallying lines
authors should be sure to count everything (including headings, footnotes. tables, and references) except the title and abstract. They
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exchange, oral or written, between two or more people.
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ready art (glossies prepared by a commercial artist) wherever possible. Figure captions may be attached to the art and will be set in the
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8. Place authors’ names, positions. titles, place of employment, and mailing addresses on the cover page only so that the manuscripts
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9. For arrangement and form of references, subheads, tables, etc., see recent issues of JCD (P&G). (A valuable resource for authors
regarding manuscript preparation in general and reference style in particular is the Publication Manual, Third Edition, of the American
Psychological Association. Ordering information can be obtained from APA, 1400 N. Uhle Street, Arlington, Va. 22201.)
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JOURNAL OF COUNSELING AND DEVELOPMENT / MARCH 1986 / VOL. 64 431

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