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Let me start by questioning the
wisdom of including Appendixes A-D (pp.
215-295) in the book. While this
material is useful, it is available on line in printable version, free of
charge. (The book retails at $ 36.37 US
at Amazon.com; cutting 80 pages could lower the cost by $6.00 US or
approximately ten dollars Canadian.) The trade-off for students (and I
recommend the use of this book as a text) is between efficiency and costs. Appendix A (American Association for
Marriage and Family Therapy Code of Ethics: pp. 215-224)) and Appendix B (American Counseling Association Code of
Ethics and Standards of Practice: pp.
225-249) are available online.
(Note that the URL given in the text p.
225 goes nowhere) Appendix C (American Psychological Association Ethical
Principles of Psychologists and Code of Conduct: pp. 251-274) is available online also. (Most recent draft; May 14, 2002). Finally, Appendix D (National Association of Social Workers Code
of Ethics pp. 275-295) is also on the
web. (See below for the links to these
The book has strong positive
features, along with some weaknesses.
Among the things I liked about the book is the inclusion of case
studies, exercises, recommended readings, including online references, after
each chapter. This is a useful feature
for classroom discussion. The book
contains excellent short summaries throughout, reminding us of where we have
been and pointing ahead to where we are going.
This makes for a smooth transition of topics. The book is well written and free of distracting typographic
errors. Each chapter opens with a
statement of objectives. The
development of ideas progresses logically from an introduction to the place of
spiritual counseling in chapter one, to an historical development of
spirituality/religion and therapy in chapter two. Chapters three and four present a useful summary discussion of
significant elements in Western and Eastern religions, respectively. The material is well researched and
insightful. The cultural background
(attitudes, values, and beliefs) of counselor/client is discussed in chapters
five and six. Chapter seven, 'Ethical
Issues' examines the rights and obligations of counselor and client, though
what parades as an ethical concern is mostly about informed consent. While the detail provided on consent forms
is useful (167-170), I would have liked to see more discussion of client
rights. Possibly this is where my own
constructivist bias comes into the picture.
My training in ethics makes me more sensitive to client rights. However, the book includes an in depth
discussion of issue that have an impact on those rights such as the problem of
countertransference and transference.
Still, in a discussion (175) on client rights, reference is made to the
'unequal power' of counselor and client.
This focus seems odd, given the book's (legitimate) critique of the
stifling role of paternalism in religion (50).
In my opinion, the contractual model is more respectful of client
autonomy and should be used. However,
in places, Miller seems to know this.
In a discussion on journal writing, for instance, she clearly values
patient autonomy as she cautions counselors to avoid the use of techniques that
do not fit a client's spirituality. And
she goes to some length to provide details on how to implement a technique the
client can use to develop a sense of spiritual identity. Her point is insightful because she is right
to say that most people do not usually think of themselves as being spiritual
(many confound religion and spirituality).
I teach courses in spirituality and health to nursing students. In my experience, students express surprise
at being spiritual, and it takes a month or so of work before they can make
connections between elements like religion and their spirituality. (This surprises me too). The connection to spirituality can also come
from a widened perspective that includes nature and all living things (native
spirituality is a good case in point).
Perhaps the seemingly paternalistic dimension of counseling comes from
its objective, scientific, methodology in contrast to the phenomenological,
metaphysical 'letting-be' attitude of the contractual model? More on this later.
I enjoyed reading about treatment
techniques, (prayer, sacred writings, religious community, bibliotherapy,
focusing, journal writing, meditation, rituals). I use similar techniques in the classroom. However, the classroom focus is factual
rather than normative; we seek healing but do not counsel students on ways of
healing themselves. This difference
points to the benefits of interdisciplinarity as the issue of
countertransference makes clear. As
Miller knows, the therapist's attitude is contagious. The counselor has to be comfortable with an issue before he or
she can counsel someone on that issue.
If the book goes into a second
edition, I would recommend that a clearer distinction be made between
spirituality and religion. The book
opens with a very good description of spirituality (p.6), but the way in which
religion is actually seen to connect with it or fill the void announced in the
definition of spirituality, is poor.
The author does not implement the religious connection promised in the
description of spirituality, or show why non religious clients can meet their
spiritual needs in other ways. For
instance, a creative use of (Jungian) healing tools such as the mandala, dream
analysis, temperament sorter, play, laughter, art, music, ... can also substitute for the religious
connection. The second thing I noticed
is that Miller sees spirituality as an 'add on'. Is she overly concerned about the separation of church and
state? Her focus is not that
spirituality is an integral characteristic of being human, but that it is an
elective area that some counselors might decide to pick up. But clients are not part-time spiritual
beings. In my opinion, courses in
spirituality and religion need to become a required part of the curriculum. I think that Miller would have picked this
up if she had followed through on her definition of spirituality. One other thing I noticed is the conspicuous
absence of phenomenology in a book that purports to be about
psychotherapy. If the counselor is 'an
attendant of the soul' as she says (22), then, the reader might expect a
discussion on the phenomenology of care! Is spirituality a two edged
It strikes me
as odd that spirituality could have two faces, one face when the individual
presents as client to a counselor and the other as patient to a nurse. Perhaps we are looking at different ends of
the same elephant. I see illness as
divisiveness, a rupture in being, but I am not sure how Miller sees
illness. In my opinion, the individual
is ill to the extent that he or she fails to act as a dynamic unit of mind and
body (I take spirit to be a component of mind). In the contractual model of health, the individual is the expert
on the nature of that disunity. This
view is based on a distinction between healing and curing. In my view, the role of the therapist is to
facilitate reintegration (healing), as directed by the patient. In Miller's model (scientific approach to a
client), the counselor is the paternalistic agent of change, and healing
presents itself through the curing perspective. On another point, I would be amiss to overlook the insight Miller
brings to the addiction field. The
addiction field is no doubt a growth area for counselors, but it concerns
everyone. I am pleased to see that
Miller gets it right.
Other things stand out. The reader will appreciate the fact that the
book has an author index as well as a subject index. I am pleased to recommend this book, and though it is written
primarily for counselors, I will use it as reference in my work with nurses.
2003 Kenneth Bryson
Association for Marriage and Family Therapy Code of Ethics
Counseling Association Code of Ethics and Standards of Practice
Psychological Association Ethical Principles of Psychologists and Code of
Association of Social Workers Code of Ethics
Kenneth A Bryson Ph.D., Professor
of Philosophy, University College of Cape Breton