psychological care provided by the church: perceptions of christian church members

Counseling and Values ■ October 2012 ■ Volume 57 199

© 2012 by the American Counseling Association. All rights reserved.

Psychological Care Provided by the Church: Perceptions of Christian Church Members

Jennifer N. Bornsheuer, Richard C. Henriksen Jr., and Beverly J. Irby

Spirituality and religion are integral parts of a person’s belief system and support network. Although there are many avenues a person can take when seeking mental health care, conservative Protestant clients have a tendency to seek assistance through their church. There is a paucity of literature about conservative Protestant church members’ perceptions of mental health care. The authors used phenomenology to understand participants’ perceptions of mental health care provided by the church. Themes found within participants’ stories included the importance of the relationship when seeking care, the use of knowledgeable practitioners, and the use of religious practices in counseling.

Keywords: religion, mental health care, conservative Protestants

There is growing interest in caring for the psychological and mental health needs of members of Christian churches. Spirituality is also being viewed as an integral part of a person’s belief system and is being used

more in counseling sessions (O’Grady & Richards, 2009; Richards & Bergin, 2005; Walsh, 1999). Along with this growing trend, many Christian churches now offer mental health services. However, there is a paucity of research on the perceptions of church members regarding these services, particularly related to ways the church cares for parishioners’ psychological needs and improves the mental health services that are provided to the congregation (e.g., Bufford & Buckler, 1987; Kunst, 1993).

When seeking mental health care, some church members prefer care from community agencies and practices whereas others prefer care provided by church members and staff. Kunst (1993) indicated that positive gains and growth can occur in counseling when a person is engaged in treatment, has positive attitudes toward treatment, and has an interest in a particular form of therapy. In the same study, Kunst also noted that participants who identified themselves as theologically conservative tended to prefer interventions and counseling that followed a Christian model. Bartkowski and Wilcox (2000) stated that conservative Protestants follow a “traditional, fundamentalist viewpoint including literal translations of scripture” (p. 269) in guiding

Jennifer N. Bornsheuer, Richard C. Henriksen Jr., and Beverly J. Irby, Department of Educational Leadership and Counseling, Sam Houston State University. Jennifer N. Bornsheuer is now at Depart-ment of Counseling, Oakland University. Correspondence concerning this article should be addressed to Jennifer N. Bornsheuer, Department of Counseling, Oakland University, Pawley Hall, Rochester, MI 48309 (e-mail: [email protected]).

200 Counseling and Values ■ October 2012 ■ Volume 57

their actions and family relationships. This population understands and reads scripture in a literal way, thereby relying on the Bible to set guidelines for family and social life that are often different from the values and beliefs of the mainstream culture (Bartkowski & Wilcox, 2000). There are several identified conservative Protestant churches, including Southern Baptist, As-sembly of God, Pentecostal, Missionary Alliance, the Church of the Bretheren, Holiness, and Christian Reformed (Bartkowski & Wilcox, 2000; McClung, 2007). The Pew Forum on Religion and Public Life (2010) created a table of evangelical Protestant churches that included Evangelical Baptist, Southern Baptist, Lutheran Church Missouri Synod, Wisconsin Evangelical Lutheran Synod, Church of God, Assembly of God, Pentecostal Holiness Church, and Seventh-Day Adventists. Additionally, there are a number of independent churches that may or may not be a part of a larger umbrella organization of some kind, and their beliefs fall into the aforementioned categories.

The purpose of our study was to examine the perceptions of conservative Protestant church members in a southwestern state of how the church meets their mental health needs and what types of services they preferred. We asked two research questions: (a) What are conservative Protestant church members’ perceptions of mental health care provided by the church? and (b) How do conservative Protestant church members perceive the accessibility of mental health services provided by the church?

Mental Health Care Sought by Religious Clients

In a Gallup poll, 56% of those surveyed stated they believe religion plays an important role in their daily lives (Gallup Poll Organization, 2008a). In another Gallup poll, 85% of people who stated they were of a religious faith reported they were Christian (Gallup Poll Organization, 2008b). Richards and Bergin (2000) found that many clients of religious backgrounds, especially clients who define themselves as conservative, were hesitant to seek mental health assistance from secular therapists and prefer guidance and therapy from clergy or lay mental health professionals. Also, people who identified themselves as conservative or devout were more likely to choose mental health providers of the same religious faith, use mental health services after other supports or resources have failed, and underutilize mental health resources.

According to Thurston (2000), individuals who identified as conservative, Southern Baptist, or Fundamentalist tended to shy away from secular therapy because of the fear that the therapist would not understand them or their beliefs and that therapy would take away from their religious beliefs. He also uncov-ered several themes that pointed to helpful interventions when working with conservative Protestant Christians, which included (a) the teaching of forgive-ness, (b) exploring feelings surrounding their image of God, (c) understanding the dangers of perfectionism, and (d) using prayer. Furthermore, Richards and Bergin (2000) reported that people using religious coping skills, such as prayer, reading biblical scripture, meditation, and support or consultation from religious leaders, developed better adjustment and coping skills during times of stress.


Bufford and Buckler (1987) identified services that may be a fit for conser-vative Protestant clients seeking mental health care in the church, including support groups, therapy, prayer, discipleship, and various social programs. These are similar to services identified by Richards and Bergin (2000) as helpful ways to integrate religion into the counseling session, which include prayer; contemplation and meditation; reading sacred readings; repentance, atonement, and forgiveness; worship and ritual; fellowship and service; spiritual direction; and moral instruction. Other researchers have indicated that these interventions have had a positive impact on mental health issues (e.g., Aranda, 2008; Bhui, King, Dein, & O’Connor, 2008; Moberg, 2005). Overall, some researchers have determined that conservative Protestant church members seeking mental health care are more likely to seek treatment through the church and prefer treatment that is focused on the aforemen-tioned church techniques and biblical scripture.

Stone, Cross, Purvis, and Young (2004) purported that ministers and coun-selors who work with religious clients should focus on the whole person. In their view, this includes the person’s physical, emotional, and spiritual life to meet all the needs of the client who is requesting mental health services.

Mental Health Care From the Church

Pastoral counseling, lay counseling, church support groups, and spiritual care are all methods churches and religious organizations use to assist congrega-tions and members with their mental health needs. Religious leaders and lay counselors can be effective in providing spiritual guidance and in obtaining mental health treatment and interventions, and they can also be helpful in providing additional social and financial support through the greater religious community (Richards & Bergin, 2005). Anderson (2009) defined pastoral care as a relationship between two people that brings fellowship and redemption to each person by reminding them of God’s love and power and as a “ministry of Christ through a caregiver” (p. 106). Pastoral care may be conducted by a reli-gious leader or member of the clergy or a member of the religious community. It is also important that those practicing pastoral care have an understanding of biblical, spiritual, and psychosocial issues along with an understanding of family systems theory (Anderson, 2009). Just as important is the ability of the religious leader or person conducting the pastoral care to be aware of others in the community, including agencies that may be of assistance to the client, and to be aware of his or her own limitations. Furthermore, pastoral care is a way of meeting the needs of a member of the congregation, understanding his or her current struggles, and building or repairing his or her relationship with others and God (Anderson, 2009).

Church members often view pastoral care as being the same as pastoral counseling; however; there is a major difference between the two. Pastoral care can be defined as “all measures to assist an individual person or a com-munity to reach their full potential, success and happiness in coming to a deeper understanding of their own humanness” (Grove, 2004, p. 34). This


can be done by professional church workers, laity, and paraprofessionals. In contrast to pastoral care, pastoral counseling is defined as “a process in which a pastoral counselor utilizes insights and principles derived from the disciplines of theology and the behavioral sciences in working with individu-als, couples, families, groups and social systems toward the achievement of wholeness and health” (American Association of Pastoral Counselors, 2009, para. 3). Pastoral counselors are defined as ministers “who practice pastoral counseling at an advanced level which integrates religious resources with insights from the behavioral sciences” (American Association of Pastoral Counselors, 2009, para. 2). Many pastoral counselors have also obtained training and licensure in the areas of professional counseling, psychology, and marriage and family therapy in addition to their theological training. Many states require licensure of pastors when they engage in the provision of mental health counseling.

Lay counselors are those members within the church who may or may not have formal training but who have specific qualities for helping others and are typically trained and supervised by religious leaders or pastors (Garzon, Worthington, Tan, & Worthington, 2009). Such helping qualities can include having strong spiritual beliefs, having a warm and open personality, dem-onstrating self-confidence and also being able to build confidence in others, having unconditional positive regard for others, having the ability to recog-nize strengths in others, and being willing to be trained in communication and listening skills for working with others (Anderson, 2009). An example of trained and supervised lay counselors would be the Stephen Ministers founded in the Lutheran Church Missouri Synod (Stephen Ministries Saint Louis, 2010); today, they are also found in many different denominations. Stephen Ministers participate in an extensive training process that includes the church, the pastor, and trained lay Stephen Trainers before they provide lay counseling services to church members.

Researchers have found that specific techniques and interventions used by religious leaders and lay counselors can be helpful in addressing mental health needs. Richards and Bergin (2005) described several spiritual tech-niques and interventions that are effective when clients seek assistance in the area of religion and spirituality. These interventions can be used both by religious leaders who are helping members of their congregation with mental health concerns and by therapists and mental health professionals working with a client whose stated goal for counseling is in the area of spirituality and religion.

Overall, researchers have noted that religious clients seeking mental health services have certain values and needs that should be addressed in the counseling process. Some specific populations of religious clients who are seeking mental health services prefer to request and obtain services through their church because they believe their values and beliefs will be under-stood and recognized. Morrison and Borgen (2010) noted that counselors’ religious and spiritual beliefs can have a positive impact on their empathy


toward clients. In Morrison and Borgen’s study, 12 counselors indicated that their religious and spiritual beliefs played a role in developing empathy toward their religious clients. The results indicated that counselors can and do incorporate Christian values and beliefs in counseling in the following ways: (a) having an empathic relationship with the client; (b) connecting to the spiritual in the counseling relationship or in the client; (c) drawing on religious values of compassion, mercy, and acceptance; (d) following Jesus’ example of empathy; (e) using spirituality to inform ways of understand-ing the problem; (f) sharing similar life experiences; and (g) sharing the Christian culture. Morrison and Borgen made several recommendations in helping counselors understand how their religious and spiritual beliefs can influence empathy with a client. With increased awareness and reflection of their religious and/or spiritual beliefs, counselors both religious/spiritual and secular can identify what helps and hinders empathy toward a client and how their beliefs may help the counseling process. Religious leaders and lay counselors have worked to provide mental health services that meet the needs of their congregation. Literature exists concerning how the church provides mental health services to church members, such as different types of counseling and interventions. However, there is a paucity of literature about what has been done that incorporates the views of the church members in determining if these services are helpful and available.

Method

As mentioned earlier, the two research questions in our study sought to examine conservative Protestant church members’ (a) perceptions of mental health care provided by the church and (b) perceptions of the accessibility of mental health services provided by the church. By understanding church members’ perceptions, churches and other religious organizations are bet-ter able to assist church members in meeting their needs and identify what services are desired. We believed using a phenomenological approach was the most effective way to understand the essence of the participants’ experi-ences (Creswell, 2007; Moustakas, 1994) with the provision of psychological services in the church. Our study was conducted in accordance with the ACA Code of Ethics (American Counseling Association, 2005) and was approved by the institutional review board before data were collected.

Participants

We randomly chose four conservative Protestant churches, including Evangeli-cal Baptist, Southern Baptist, Church of Christ, and Lutheran Church Missouri Synod, in a southwestern state to gather participants for the study. Using snowball sampling (Miles & Huberman, 1994), we asked the pastors from each of the four churches to participate in an interview and to recommend counselors and church members for the study. Purposive sampling (Miles


& Huberman, 1994) was also used so that participants who were not easily identified could be found. Maxwell (2005) noted that the use of purposive sampling focused on three issues: (a) to increase the representativeness of the participants and group being studied, (b) to recognize and understand the heterogeneity of the population being sampled, and (c) to illustrate differences between participants or groups. Each participant was interviewed about her or his perceptions of psychological services in the church.

We chose to interview church members, counselors, and church counseling staff to identify commonalties and differences in their perceptions, including eight church members, three pastors, and three directors and therapists of the church counseling programs. All 14 participants identified as conservative Prot-estant Christians and were between the ages of 28 and 70 years. The participants included seven men and seven women. Of the participants, 10 were married, two were single, one was divorced, and one was widowed. Regarding the mar-ried participants, three participants had one child in the household, one had four children, three had two children, two had three children, and one had no children. A majority of the participants stated they were European American, and two of the male participants stated they were Puerto Rican and African American. All the participants had a range of income from $10,000 to $100,000.

Instrument and Data Collection

Once participants were identified, they completed an informed consent pro-cess and were reminded that they could end their participation at any time without penalty. Following this process, participants were asked to spend a total of 45 minutes to 1 hour completing a demographic questionnaire, four short-answer questions pertaining to mental health care in the church, and a four-question audiotaped semistructured interview about their perceptions of mental health care in their church. The interview questions were the following:

1. Tell me about your perceptions of mental health care provided by the church.

2. What could the church do that would give you the most support and help you if you experienced a mental health crisis?

3. What could make mental health services more accessible to you if you needed them?

4. What else would you want us to know about psychological care within the church?

The questions used in the short-answer form and in the face-to-face inter-view were adapted from the interview protocol used by Stone et al. (2004) in their study identifying perceptions of support provided by the church to church members during times of crisis. Questions used in the current interview protocol were also based on the existing body of knowledge and literature about mental health care provided by church personnel.


One of the researchers (first author) recorded all of the participants’ data and transcribed the individual face-to-face interviews. Participant names were changed to protect their privacy and confidentiality. Using the differ-ent forms of data collection, we were able to confirm the different themes found in the data and objectively analyze the information gathered. Maxwell (2005) listed several methods researchers can use to increase the validity of their study. In our study, we used quasi-statistics, triangulation of the data collection process including interview data, demographic and short-answer written responses, and field notes, as well as member checking, to ensure the accuracy of the themes found to increase the validity and credibility of the study. We also took into account researcher bias, which is a threat to valid-ity, and reduced it through the use of bracketing, an independent reviewer, peer debriefing, and multiple researcher perspectives. Triangulation of the data collected was used to increase the credibility and validity of the study and occurred through the use of multiple data collection procedures. We held positions of a counselor, counselor educator, and an associate dean of graduate programs and are members of various Protestant Christian churches; therefore, we had to take into account our own personal biases of the use of mental health services in a religious context. Through peer debriefing, member checking, and having an independent reviewer, we made every effort to remove our biases from the findings to best reflect the participants’ experiences. This approach helped to ensure the accuracy, credibility, and authenticity of the research findings (Maxwell, 2005).

Data Analysis

Moustakas’s (1994) adapted version of the Stevick–Colaizzi–Keen method was used in the data analysis procedures to describe the meaning of what the participants have experienced. We collected the various forms of data, transcribed all participant interviews, and identified each nonrepetitive statement as an invariant horizon, which was then clustered into themes to describe the essence of the participants’ experiences. Next, we created a textural–structural description of the participants’ experiences using verbatim statements from their interviews. The textural description involved identify-ing the qualities of the themes, such as large or small and colorful or bland, with a focus on the context in the experiencing of the themes, whereas the structural description focused on the relationship of the themes to each other (Moustakas, 1994). Member checking was used during the data analysis pro-cess to refine the themes noted and to also ensure accuracy of the findings.

Results

After each of the participant interviews was transcribed and analyzed, several themes emerged from the participants’ stories about how they believe the church helps members of the congregation through mental health struggles.


Furthermore, two themes were noted with regard to the second research question about conservative Protestant church members’ perceptions of the accessibility of the mental health services offered. As noted earlier, the names of participants were changed to protect their privacy and confidentiality.

Church Members’ Perceptions of Mental Health Care

Related to the first research question, in which we sought to understand conservative Protestant church members’ perceptions of mental health care offered by the church, three themes emerged from the participants’ stories: (a) the importance of relationships with church leaders and staff, (b) the use of knowledgeable professionals, and (c) religious practices used in the counseling process.

Relationships with church leaders. Thirteen of the 14 participants noted that they would seek care through the church or look for guidance from church leaders in locating and undergoing mental health care. A majority of the participants noted that the church is and should be the first place that church members seek help. Dale, one of the counselors, stated, “I think they need to be the first in line. I think churches should be [the] front line in offering mental health services.” These participants believed their relationships with church leaders helped to guide them in the right direction or directly helped them if they were experiencing a mental health crisis. Participants described their relationships with other church members and church leaders as a form of support and connection with others. The most common words used within this theme were support, family, relationship, connection, and safe. These relationships also helped to provide church members with a sense of safety and understanding that others understood their struggle and could relate to them through their same belief system or know who to refer them to who could best help them while also respecting their religious beliefs.

Larry, a church member, stated that he was able to find support for his mental health concern through his relationships with church leaders and members. He said,

As a community, you come together. It’s not just the pastors, maybe the pastor knows somebody that has been through the same situation that he can direct you to, and you can compare notes. If I come up on a problem then I will talk with the pastor. That is where I go first.

Hanna, another church member, had similar ideas about seeking help through church leaders or church members. She reported that she would

talk to other people that were going through the same type of problems. I, in our church, I would feel comfortable talking to our pastor. You would feel comfortable that you could go to them and they would know that either they could help you, or someone else within the church, or [they] would know where to send you to get that kind of help.

Casey, a pastor, believed it is the job of each church member to help and assist others. He said, “I do like being able to respond to people’s needs,


being the first responder, even if we’re not capable [of providing direct care], getting those people to the right place [is important].” Sarah, a church mem-ber, said she believed she could be helped by the church. She stated, “You are directly connected to those [persons within the church], you are going to feel more comfortable going to them if you have a problem” or church leaders or staff members can “guide me in the right direction.”

Knowledge of professionals’ expertise. All 14 of the participants noted that knowledge or expertise of the professional who is providing the mental health service, whether it is a church leader, layperson, or licensed counselor, is vital to providing appropriate care to members of the congregation. Sue, a church member, stated that church leaders and those providing services “having more knowledge and education about it” can lead to greater understanding of the mental health problem and helping the person more effectively. Tim, a church member, believed it would be beneficial for the church “if they got people who were licensed counselors.” Robert, another church member, agreed that it is important for the church to recognize when it is unable to help and to know how to refer appropriately. He said,

When it goes beyond the scope of what the church can handle, I’ve seen and actually ex-perienced being directed towards licensed Christian counselors. My experience has been when the church doesn’t have the expertise to handle an issue they’ll direct members to licensed counselors.

Additionally, Matthew, a pastor, believed it is important for someone helping a church member with a mental health struggle to “meet people where they are at and have an understanding of what mental health issues they’re facing and to partner with our counseling center to make sure that those needs are met and addressed.” Casey also had a similar belief that there needed to be people within the church who have “education” and “are wise enough” to do effective counseling. He also believed that each leader, staff member, and church member needs to be educated on how the church can help with mental health needs and what services are offered. This be-lief was also shared by Danny, a pastor, who stated that more training for church leaders and staff on mental health concerns needs to be addressed. He said, “My experience in the church is that we do very little staff training. We ought to be more heavily involved in training. Having a pastor that is trained in counseling? Yeah, I think we should.”

Religious practices within the mental health services. All participants believed that integrating religious practices and values into mental health services was the most helpful when they were facing problems. These practices included reading scripture, biblical teaching, and prayer. The participants valued the integration of religious practices in counseling sessions because it recognized their belief system and showed a valuing of their religion as important to mental health. Sammie, a counselor, mentioned how religion can be integrated into counseling when she stated that it would be “a great opportunity to show people the love of Christ in a new way, you know, and still support them at a level where it equips them to walk on their own.” Also,


all of the church members stated they desired counseling or help that was “based on the Bible,” “fits along with the Bible,” “do[es] everything from a Bible perspective,” “use[s] a Christian-based program,” and is “on the base of the Bible and scripture.” According to Joanne, a counselor, there is also a need for “prayer and guidance and encouragement” to those seeking help and counseling services through the church. She stated,

Because we are a church and we refer, we need somebody who probably is a member of our church but also need somebody who is readily willing to say, I am a Christian, I am a believer, . . . I do understand what scripture says.

Sue and Tim, in each of their individual interviews, also identified “biblical teaching” and “prayer” as things that should be included in the counseling process.

Church Members’ Perceptions of the Accessibility of Mental Health Services

Related to the second research question, two main themes were found con-sistently throughout the participant interviews. We sought to understand the essence of the participants’ beliefs and experience in accessing various mental health services offered by the church. Participants believed that greater awareness of the types of services offered and more marketing or advertising by the church of these services are needed to demonstrate to the congregation that the church is comfortable meeting the psychological needs of church members and that the church can be a place where parishioners seek mental health services.

Awareness of services. Nine of the 14 participants stated that they believed the church leaders could bring greater awareness of the services offered and that church members could find mental health assistance through church programs by discussing mental health struggles more openly and regularly. Laura, a church member, mentioned that greater awareness from church leaders would make an impact: “The only thing I could say that our leadership could do a better job of is just make it a little more visible from the pulpit.” Casey believed that teaching the church leaders and staff about the services offered would benefit the church and also the congregation in that they would be able to ask questions and learn what services are offered through their pastors, Bible study leaders, or church staff. He said,

I think the best thing we could probably do is make the leaders of our church, Sunday school leaders, and stuff like that more aware of what we do and what we don’t do. What we are happy to help out with, and what we can help people find as a resource.

Danny, a pastor, voiced the same opinion when he said, “I think it takes a lot for a member to finally approach a pastor, and that’s probably something that we, the pastors in the church, need to be more up front with our people about.” Sarah stated, “I think they could do a better job of getting the word


out to people. Especially for something that is continuously offered and ongoing.” One church member and one pastor mentioned that the stigma of requesting help for mental health concerns can be reduced by church leaders talking more openly about mental health needs and ways the church cares for their members’ mental health needs. Tim believed it is important for everyone involved in the church to “know the resources available.”

Advertising of services. Twelve of the 14 participants noted that increased advertising of the mental health services offered by the church could benefit the church leaders and staff as well as the church members. When the types of services such as individual counseling or group counseling are advertised, church members will recognize the services offered and may be more will-ing to seek out help when they are in need of assistance. For example, the participants suggested using the church’s Sunday bulletin, magazine, and web page as ways of advertising the availability of counseling services. Par-ticipants also suggested that church leaders should advertise their services through brochures and word of mouth.

Discussion

Overall, these findings can provide needed insights into the perceptions of conservative Protestant Christian church members’ views of mental health care within the church. The participants in this study noted the need to inte-grate religious practices into the counseling process, the importance of hav-ing knowledgeable mental health professionals, and the safety and security that come from close relationships with church staff and other members in guiding them in the right direction when they seek mental health services. Counselors who are members of the religious community that they serve will need to be mindful of the implications of possible multiple relationships and whether they would be beneficial or harmful so as to ensure ethical practice. Because of the difference in pastoral care and pastoral counseling, church members need to be told about the importance of confidentiality and the avoidance of nonbeneficial multiple relationships. For example, when possible, licensed mental health professionals who are also pastors should avoid entering professional counseling relationships with church members. Also, the themes found within the participant interviews suggested that counseling and other mental health services are important and necessary to church members as part of the care and support they receive from church leaders and staff. Several participants noted that although they believed it is important for the church to care not only for church members’ spiritual health but also for their mental health, it is important for those providing counseling services within the church to know how much the church is able to help. One pastor, Danny, noted that there is a stigma attached to pastors who seek mental health assistance. He believed that pastors and helpers within the church also need to be supported if they experience mental health concerns. He stated,


There is really not a good system for pastors who are struggling with anxiety, depression, emotional issues. There is supposed to be some sort of counseling system that I would be able to be involved in but, there’s a fear on behalf of pastors that, well, my district president knows that I’m broken, you know what my chances are.

Another pastor, Matthew, described how the church helps the church leaders and staff through mental health struggles. He reported,

We’re prone as pastors and ministers to depression just simply because of the nature of the intensity of our occupation and then also just other things, other temptations and things like that that ministers and pastors have to guard themselves from. Our elders are very compassionate that way, that we’re really trying to work more intentionally on helping their ministry staff with emotional issues. That’s a really new thing.

Last, many of the participants described a need for greater awareness and understanding of the services offered for both church members and leaders along with increased advertising of these services so that people recognize that the church is willing and able to help members with any mental health struggles they may be experiencing.

The findings related to the use of religious practices throughout the coun-seling process are similar to previous findings in the literature (Richards & Bergin, 2000; Richards, Rector, & Tjeltveit, 1999). The importance of the relationship with pastors and those providing the services and the use of knowledgeable, experienced professionals are unique findings within the participants’ stories. The themes that emerged from the participants’ stories are helpful in informing counselors and religious leaders of the mental health needs of conservative Christian church members and how to make these services more accessible and tailored to this specific population.

Because we were interested in studying this phenomenon more deeply, we chose a qualitative design. Consequently, when interpreting these findings, one should consider that only four churches were used to obtain participants for this study. Also, future studies should include a wider age range because there were no participants under age 28 or over age 70 in this study. Ad-ditionally, a more diverse racial/ethnic population would strengthen future studies because a majority of the participants in this study were European American and only two were of Puerto Rican or African American descent. There may be different perceptions for participants of different ages, other ethnicities, other geographic locales, and other Protestant denominations.

Implications

The results of this study are consistent with literature that focuses on the need to incorporate religious and spiritual values into counseling sessions. We found in this study that the incorporation of Christian values is paramount to an effective and lasting counseling relationship whether the counselor is a Christian or not. Secular counselors and Christian counselors need to gain insight into the particular conservative Christian values and beliefs of each


client so that the individual values and beliefs can be incorporated into the counseling process. Counselors seeking to work with conservative Christian clients who want their values and beliefs incorporated in counseling sessions should attempt to establish relationships with pastors from conservative Christian churches in an effort to gain additional information concerning the beliefs and to develop collaborative relationships so that counselors could consult with these pastors and vice versa. One result of the development of these relationships could be the inclusion of the counselor on the referral list of conservative Christian congregations. Establishing a strong working relationship with local conservative Christian pastors could also help bridge the gap in the provision of services to this population; allow for constructive dialogue between counselors, both Christian and secular, and conservative Christian congregations; and allow for the provision of information that clearly defines professional counseling and how it can be integrated with the values and beliefs of conservative Christians.

Those interested in the mental health needs of conservative Protestant church members and how to make mental health services more accessible to this population may find these findings useful. The implications from this study may help counselors, religious leaders, and religious organiza-tions who provide effective and culturally appropriate mental health care to conservative Protestant church members. First, it was important to all participants that their religious beliefs and values be incorporated into the counseling process. Therefore, counselors, laypersons, and pastors provid-ing mental health care need to determine if incorporating religious practices such as reading biblical scripture, using prayer, or discussing biblical teach-ing might help the client reach his or her desired goals. Past research has indicated positive results in counseling when church counselors work with religious clients (Aranda, 2008; Bhui et al., 2008; Richards & Bergin, 2000; Woodruff, 2002). Results also have shown that when a mental health pro-fessional is incorporating religious practices in the counseling relationship, it is important to do so in a culturally sensitive way so that the client does not feel exploited or coerced. The mental health professional can meet this goal by discussing with clients, during the initial sessions, how they would like their religious beliefs to be incorporated into counseling and develop-ing a greater understanding of what the clients’ religious beliefs mean to them and how they can be used as a support toward greater mental health.

Next, we found that there is a need for licensed professionals who have the expertise or knowledge to help clients work through mental health struggles. Most of the participants noted that it is important for church leaders and staff to know how to refer when they are unable to help and to have good working relationships with Christian community agencies to which they can refer church members, if needed. Finally, two of the participants mentioned that it would be helpful to have both male and female counselors available to church members.

Furthermore, the findings and themes from this study offer different avenues for future research. Future areas of research could include determining the


importance of the gender of the counselor and what treatment modalities are the most important when working with conservative Protestant clients and other religious clients in a religious setting. Also, an area of research that could build on the knowledge base would be to understand the difference between male and female conservative Protestant clients’ willingness to seek mental health services in a church setting. Another area for future research would be to explore the needs of pastors and other church staff members who provide mental heath services to church members. One pastor in the study believed that this is a greatly needed area. Pastors and other church staff who provide help need to be cared for and healthy to provide effective and ethical care for church members. Ongoing research needs to continue to determine if these themes are transferable across different populations, denominations, and localities. These research findings are not meant to be conclusive but rather to offer a deeper understanding of church members’ perceptions related to mental health services provided by the conservative Protestant churches.

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