Religion and Spirituality Integration in Therapy: Ethics

Religion and Spirituality Integration in Therapy: Ethics Ethical Issues for the Integration of Religion and Spirituality in Therapy Danelle J. Hollenbeck Abstract Psychologists are professional who have undertaken a code of ethics mandatory in practicing psychology. Ethical issues arising from religion and spirituality that is integrated into therapy requires psychologists to undertake a moral and ethical view on treating these clients. This paper addresses the codes in which psychologists adhere to when undertaking secular-theistic therapy, avoiding bias, multiple relationships, imposing religious views, and competence, and informed consent. This paper discusses relevant ethical dilemmas when providing psychotherapy to clients. This paper also reviews ethical circumstances in which American Association of Psychologist Codes (APA) applies to these ethical and moral situations. It will also briefly discuss ethical consideration of the codes at intake, assessment, treatment, and over-all accountability of clients in regards to religion and spirituality. Introduction Psychology (as well as science in general) has embraced spirituality and religion more and has used rigorous scientific methods such as double-blind randomized clinical trials to examine important questions related to psychology and religion integration (Plante, 2007). Many individuals are more religious and spiritual than previously and therefore are requesting that health professional integrate this into their professional work, in particularly psychology, as well as psychologists have become interested in the same and look for ways to integrate this into their practice (Plante, 2007). Discussion The American Psychology Association (APA) supports religious diversity and states that  psychologists are aware of and respect cultural, individual, and role differences, including those  based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual  orientation, disability, language, and socioeconomic status and consider these factors when  working with members of such groups (American Psychological Association, 2015). This focuses on Principle E, Respect for People’s Rights and Dignity (Fishers, 2013, pg. 13), which ensures fair treatment of all people regardless of ethnicity, gender, culture, religion, disability, etc. We may not agree with our client’s religious beliefs, but we are asked to respect them and the traditions of others (Plante, 2007). We are to avoid bias and according to Standard 3.01 we are to avoid discrimination based on other qualities and religion (American Psychological Association, 2015). Psychologists must be competent in the services provided. We must adhere to Standards 2.01b Boundaries of Competence, and 2.03, Maintaining Competence. According to Gonsiorek et al. (2009) â€Å"Competence in the services providing regarding spirituality and religion is a fundamental ethical requirement†. Just because we might be of the same faith or have a similar interest in our client’s religious practices does not make us to be experts in the field, therefore we must adhere to Standards 2.01b and 2.03 and have the appropriate training and experience necessary to provide services. We must also remember that psychologists trained as theologians may not satisfy the ethical code, even if dually trained and could face potential challenges (Gonsiorek, Richards, Pargament, McMinn, 2009) therefore standard training is the key. The Ethical Code also avoids secular-theistic bias. It’s important to refrain from perceiving a client’s faith as low intelligence just as it’s important to refrain from viewing a client from a different faith as misguided or as second class (Gonsiorek et al, 2009). Principle D: Justice and Principle E: Respect for People’s Rights and Dignity, and Standards 2.06, Personal Problems and Conflicts and 3.01 Unfair Discrimination are applied towards bias. Positive biases can also be just as destructive as the negative biases. Gonsiorek, et al. (2009) states positive biases can result in serious problems being misconstrued as diversity and in behaviors with significant mental health implications being ignored (2009). Standard 3.04, Avoiding Harm applies as such we must take reasonable steps to avoid harming clients when possible (APA, 2015). Biases of any type interfere with the therapeutic relationship and diminish psychological services, thus psychologists are expected to have self-reflection and examination to screen biases (Gonsiorek et al, 2009), Assuming a client has sought a psychologist who is trained in theistic therapies or is not  aware that a psychologist offers religious modalities such as Mindfulness, Ho’oponopono, or  prayer would be incorporated into treatment; therefore Standard 10.01 A B, Informed  Consent is mandatory in any treatment offered, yet also in disclosing and discussing the  psychotherapist’s qualifications, background, theoretical orientation, and specific areas of  expertise; specific goals of treatment; and reasonably available treatment options and alternatives  are included in informed consent (Barrett Johnson, 2011). A psychologist also needs to  address concerns or issues that have arisen during intake regarding deep-seated sectarian beliefs,  and their levels of comfort and practice, as well as how this may impact their goals and process  of treatment (Barrett Johnson, 2011). Before embarking on any effort to challenge  troubling or discordant aspects of rel igious belief, it is essential that the psychotherapist  evaluate his or her competence in this area, provide appropriate informed consent, and consider  seeking consultation from clergy or other professionals with expertise in this area (Barnett Johnson, 2011). The risk of multiple relationships provides many challenges for psychologists who are also clergy members. Multiple relationships may raise boundary concerns, specifically if a client requests his or her religious aspect of the same church in which the psychologist attends be implemented into their treatment. In this case, psychologists must adhere to Standard 3.05B, Multiple Relationships, which states a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code (apa.org). These ethics codes (and their understanding) join psychologists to respect each client’s  religious/spiritual beliefs and practices reducing any harmful effects on the client’s own biases when formulating treatment for each individual client. References American Psychological Association. (2015). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/ Barnett,J.E., Johnson,W.B. (2011). Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas, Ethical Issues, and a Proposed Decision-Making Process.Ethics Behavior. doi:10.1080/10508422.2011.551471 Fisher,C.B. (2013).Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage Publications. Gonsiorek,J.C., Richards,P.S., Pargament,K.I., McMinn,M.R. (2009). Ethical Challenges and Opportunities at the Edge: Incorporating Spirituality and Religion Into Psychotherapy.Professional Psychology-research and Practice. doi:10.1037/a0016488 Plante,T.G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider.Journal of Clinical Psychology. doi:10.1002/jclp.20383 Burj Khalifa: The Worlds Tallest Building Burj Khalifa: The Worlds Tallest Building On 4th of January, 2010, Dubai, where there was only wind-blown litter a generation ago, witnessed the opening ceremony of the worlds tallest building,Burj Khalifa. A brilliant work of art with difficult structural problems took 1,325 days to completion since the start of the excavation work in January,2004. Burj Khalifa has returned the name of the Worlds Tallest Structure back to the Middle-Eastern structures where the Great Pyramid of Giza claimed that honor for millions of years before the construction of Lincoln Cathedral in England in 1311. It is amazing to know that the triple-lobed foot print is inspired from the desert flower Hymenocallis which is common in Dubai. Being located in Dubai, UAE, the tower was influenced by Islamic and middle-eastern architecture.This influence resulted in the tri-axial geometry of Burj Khalifa. The tower consists of three wings arranged around the a central core in the shape of Y.As the tower rises from the flat desert ground, setbacks occur through the 26 helical levels decreasing the cross-section of the tower as it spirals skywards. The Y-shape plan is ideal for residential and hotel usage maximizing outwards view and inward natural light.Plus,it allows maximum view of the Arabic Gulf. As a super-tall structure, there were many difficult structural problems.To ensure safety and effectiveness of the selected design,a model of the building was subjected to extensive peer program. Designers used the buttressed core in Burj Khalifa consisting of a hexagonal hub buttressed by three wings bracing each other forming the Y-shape. Not only bracing each other but acting as a tripod base which is more stable than a four-cornered base. The corridor walls of the wings extending from the central core to the end of each wind terminate in a thickened hammer head walls. The main purpose of the Y-shape is to reduce the wind effects as well as keeping the structure simple, safe and foster constructability. The result is a stiff tower that can support itself laterally and overcomes twisting. Setbacks in each tier occur in a spiral stepping pattern up the building. These setbacks confuse the wind as the wind vortices never get organized because at each tier the building has different shape. The hexagonal core provides the essential torsional resistance like a closed tube. The wing walls and hammer head walls behave as webs and flanges of a beam resisting wind shears and moments. Specific strength of concrete walls ranges from C60 to C80 cube strength using Portland cement and fly ash. The C80 concrete used in the lower portion of the building has a specified Youngs Elastic Modulus (E) of 43,800 N/mm2 after 90 days. Wall and column sizes were determined using Virtual work/LaGrange multiplier methodology which results in very efficient structure. Wall thickness and column sizes are adjusted to reduce the effect of concrete creep and shrinkage. To reduce the effect of differential column shortening between perimeter columns and interior walls,the size of perimeter columns were adjusted such that the self-weight gravity stress acting on it is equal to that stress on the interior walls. As shrinkage in concrete occurs faster in thinner elements ,the perimeter columns had the same thickness of interior corridor walls(600 mm)to ensure that both columns and walls will shorten by the same rate due to concrete shrinkage. That super-structure had foundations consisting of a reinforced concrete raft of thickness 3.7 meters supported by 194 piles. Pouring the raft was divided into four separate pours. Self consolidated concrete (SCC)of C50 cube strength was used. Each pile is 1.5 meters diameter; 43 meter long buried more than 50 meters deep. Piles were designed to support 3,000 tons each and while load tests, they supported over 6,000 tons. Unfortunately, the towers substructure is constructed in a groundwater having chloride and sulfate concentrations higher than those in sea water! Having these aggressive conditions, a strict program of measures was required to ensure the durability of the foundations. Measures applied specialized waterproof covers, increasing concrete thickness, addition of corrosion inhibitors to the concrete mix and a cathodic protection system using titanium mesh. To get higher strength and lower permeable concrete cover to the steel bars, a controlled permeability formwork was used. Besides, a special concrete mix was designed to resist the attack from the groundwater. The concrete mix for piles having 25% fly ash, 7% silica fume and a water to cement ratio of 0.32, was designed to be fully self consolidating concrete having slump of 675 ±75 mm to avoid defects during construction. For that unprecedented height of the building, it was essential to compute wind forces and resulting motions in the upper levels as they became dominant factors in the structural design. Wind tunnel tests were undertaken under the direction of Rowan Williams Davies and Irwin Inc. The wind tunnel program included rigid-model force balance test, a full multi-degree of freedom aeroelastic model studies, measurements of localized pressures, pedestrian wind environment studies and climatic studies. Models used was of scale 1:500. The wind tunnel data was then combined with the dynamic property of the tower to get the full towers dynamic response to wind and the overall effective wind force distributions. The tower has six important wind directions. The principal three wind directions are when the wind is blowing into the nose of each of the three wings. The other three directions when the wind is blowing between the wings. The orientation and setbacks of the tower were selected relative to the most frequent strong wind direction for Dubai. A several round of wind tunnel tests were undertaken during the construction of the tower. After each round of tests, the geometry of the tower as well as the number and spacing of setbacks changed to minimize the effect of the wind forces on the tower by confusing the wind. As the design reached its end, a more accurate aeroelastic model was made. The aeroelastic model is as elastic as the building. The results of testing the aeroelastic model showed that the predicted towers motion was within the ISO standard recommended values without the need of any auxiliary damping. At the tallest point of the tower, it sways a total of 1.5 meters. Special concrete mix design having compressive strength of 10 MPa at 10 hours for the vertical elements to permit the continuity of construction cycle and a design strength/modulus of 80 MPa/44GPa. The concrete tests indicated that the compressive strength of used concrete used was much higher than the required one. One of the most difficult issues in concrete design is to ensure pumpability of concrete to reach world record heights especially in high summer temperatures. Four basic separate mixes were developed to enable reduced pressure pumpability when the building gets higher. A horizontal pumping trial was conducted in February 2005 having the same pressure losses equivalent to height of 600 meters to determine the pumpability of these mixes .The concrete mix used contained 13% fly ash and 10% silica fume with maximum aggregate size of 20 mm. The mix is virtually self consolidating concrete having slump of 600 mm and used for pumping pressure exceeding 200 bars. After the level 127,a less strength concrete is required(60 MPa compressive strength) having maximum aggregate size of 10 mm. High quality control was required to ensure pumpability to the highest concrete floor considering the severe conditions of weather which vary from a very cool winter to a very hot summer with temperature exceeding 50 °c. Pumping concrete was executed using Putzmeister pumps which are capable to pump concrete up to 350 bars through high pressure 150 mm pipeline. To convert the dream of Burj Khalifa to reality, the latest advancements in construction techniques and material technology were used. The walls forms were made using Dokas SKE 100 automatic self-climbing formwork system. Steel forms were used in the circular nose. Columns and the floor slabs are poured on MevaDec formwork. The construction sequence for the structure began with the central core and slabs being cast in the three sections, followed by the wings walls and slabs and then the nose columns and slabs. To ensure the verticality of the structure, a special GPS monitoring system was developed to monitor the verticality of the building as it gets higher. This was due to the limited convential surveying techniques in the site. When completed, Burj Khalifa has become the worlds tallest structure. Being a magnificent achievement in using the latest technologies and materials, able to integrate the architectural design concept with the structural design, Burj Khalifa will always be a special case to study. N.B: Highlighted sentences are from (Engineering the Worlds Tallest Burj Dubai)