Am I doing the right thing?” he asked me in earnest as he was preparing to leave the detoxification unit of a nationally recognized psychiatric hospital. “Dan,” a 32-year-old single man, had lost his job at a local clinic because he was forging prescriptions for a variety of opiate-based medications. With no insurance, no savings, and no family support, Dan had few options for extending his treatment. As we explored the possibilities, Dan settled on a faith-based residential treatment program.
Still, some doubts lingered for Dan. Was he making the right decision? Would his treatment be compromised in any way by entering this program? As I helped Dan to negotiate the terrain of low- to no-cost recovery programs, I could not help but remember my work in a faith-based nonprofit agency serving addicted people and their families. For seven years I worked at this organization, which was one of the largest care providers to the homeless in the Southeast. For six of those years I served as a program director with both clinical and administrative responsibilities.
The facility that I managed housed up to 162 homeless men. Excluding myself, we had five full-time counselors and one part-time counselor, with the average caseload for a full-time counselor between 25 and 30 clients. The environment often was stressful, as there was a high level of acuity among clients and few resources to meet their demands. Despite these pressures, referring agencies, government officials, and clients often compared our programs favorably with those of other providers.
In terms of the range of services, few differences exist between faith-based and secular providers.1 Religious services and a religious culture in faith-based organizations constitute the main programmatic differences between the two. These differences afford faith-based organizations both advantages and disadvantages in comparison with secular organizations. These considerations will be important to the potential success of a client who enters a faith-based program.
The faith-based culture
Upon walking into a faith-based program, one is likely to see expressions that represent the organization's beliefs. The lobby at the center where I worked featured a depiction of Jesus surrounded by carpenter's tools, a large painting of a dove, statues of angels, and the organizational logo incorporating a cross. The center's name also used a religious reference to identify as a Christian organization.
Such usage of symbols and language is not uncommon among faith-based social service agencies. Ebaugh and colleagues found that 78% of these organizations operated under names that referenced a religious connection. In addition, 69% claimed that their logo contained religious symbolism.1
From a clinical perspective, one of the first things one notices in a faith-based setting is the language used to stimulate change. An addictions counselor at my center was as likely to use the Bible as he was AA's Big Book or a clinical approach such as Rational Emotive Behavior Therapy.
For example, one client at our ministry was expressing anger toward the many authority figures in his life—especially the probation officer who was structuring his recovery. In this case, the therapist intervened with the client by expressing, “You have a problem with God, not your probation officer. God is the one who put this PO in your life in the first place.” The response easily could have been one of exploring the client's anger at himself or his disease. Or it could have been to go to page 449 in the Big Book and read about acceptance. (This therapist also used these approaches at times.) This particular intervention developed into a conversation about authority figures in general and how the client's higher power can use them for good in the client's life.
Since faith-based programs often make their general religious tenets known from the beginning, new clients have an idea of what to expect. For many, coming into a recovery program that shares their faith values can be like coming home. This may explain why churchgoers are more likely to choose a faith-based provider than a secular one.2 In these cases, the therapeutic alliance can be achieved quickly because of the common understanding and values already in place. Coming from a place of deep pain through a chaotic pattern of addictive behavior, these clients are looking for a place they know to be safe.
Using the language of religion can be a productive avenue to reaching a client, instead of relying on clinical language alone. At my former center, for example, when talking about cognitive restructuring, one of our clinical staff would use a passage from Romans 12:2. It reads, “Do not be conformed to this world, but be transformed by the renewing of your mind.” By building on existing knowledge, a client may feel more empowered on his/her journey in this new and seemingly foreign world of recovery.
Tangenberg acknowledges the use of nonscientific language in faith-based organizations and suggests that by being exposed to narratives of personal and spiritual transformation, clients may gain positive connections among those who share similar experiences.3