Issues of integration in psychological counseling practice from pastoral counseling perspectives.

Pan, Peter Jen Der ; Deng, Liang-Yu F. ; Tsai, Shiou Ling 等

Client's perspective of counseling experience offers a promising possibility for deeper understanding of the overall counseling style in nature. Because counseling experience relates to client's perceptions, affections, awareness, and attitudes of the counseling, client's authentic voice is helpful to correctly identify the essentiality of the counseling (Elliott & James, 1989). Therefore, it is vital to use clients' perceptions of the counseling process because these perceptions often differ from those of the counselor (Paulson, Truscott, & Stuart, 1999). Using the perspectives of Christian client participants who have experiences the psychological counseling while taking the pastoral counseling course may be constructive to further understand how those two are different from each other in scope, focus, practice, and methods.

Although the integration of theology and psychology for psychotherapeutic purposes began in the 1930s, both professional scholars and practitioners found it difficult to integrate psychology with theology, seeing the two aspects as completely different (Guild, 2002; Wade, Worthington Jr., & Vogel, 2007). Although programs in both professions emphasizing the integration of pastoral and psychological counseling had existed for over half a decade, the empirical study that examined how such integration actually occurred is limited (Chang, 2005; Hall, Ripley, Garzon, & Mangis, 2009). To fill in the gap, there is a need to understand the commonality and uniqueness of both professions from Christian client participants' perspectives.

To date, pastoral counseling represents an attempt to hold together both scientific and subjective accounts of human existence, which will benefit through a clinical, ethical, and professional use of spiritual resources (Richards & Bergin, 2005). Christian faith, as well as spiritual resources, used properly and ethically, could have contributions to the science of psychology. Although previous studies confirmed that modern psychology had real value, it was not accepted by some of the Christian scholars (Chang, 2005; Guild, 2002; Tan, 2009). In contrast, pastoral counseling has not been accepted by most of the clinical counseling psychologists in Taiwan, either. There is, however, no difference between mainline and evangelical churches in the pastoral counseling movement in Taiwan. Instead, pastoral counseling services in urban churches are more popular than in suburban churches based on their tremendous needs in Taiwan Christian communities.

In fact, the pastoral and psychological counseling are not really against each other. They are very similar in some aspects and also very different in some others. Practically, a Christian counselor does not necessarily use the Bible as his or her only tool, yet their underlying practice is based on biblical foundations (Tan, 2009). Contextually, psychology and theology have common concerns and elements of focus such as humanity, purpose, meaning, the human soul, emotions, the mind, human behavior, philosophical perspectives on suffering, goodness, badness, and human potential (Tan, 2001; 2009).

It is important to note that several authors (Chang, 2005; Tan, 2001, 2009) suggested that the difference between pastoral and other forms of counseling lies within the goals that guide pastoral counseling. One of the most significant differences between psychological and pastoral counseling is related to the basic philosophy of the counseling process (Hall et al., 2009). Pastoral counselors recognize that everlasting love from God is powerful for healing, which lays a solid foundation for building up pastoral counseling assumption.

Psychological counselors are used to interact with their clients under a professional counseling relationship. This may differ from pastoral counselors who reach out their clients beyond the scope of the formal dialogues and counseling settings (Chang, 2005). In other words, the professional relationship for psychological counselors is within the counseling sessions that happened in the counseling room, whereas the pastoral counselor may reach out to the client on several levels such as praying for the clients before going to work, silently inviting God's guidance during a session, or responding to the intuitive/spirit-led sense of where hurt may be. In addition, pastoral counselors differ from psychological counselors in that they self-disclose and share their religious faith and values with their clients. Instead, psychological counselors are constraint in the degree to which they disclose and influence the client from counselor's own perspectives.

Nevertheless, there are some commonalities that exist in the two professions. First, both pastoral and psychological counseling are dedicated to the best interests of their clients, to the law, to the ethical standards of their governing bodies, to their specific educational and training requirements, and to their contractual obligations either in the church and/or in the workplace. Second, confidentiality is an important part for both pastoral and psychological counseling. The degree to which confidentiality is maintained depends on three factors: the nature of the topics discussed, the character of the counselor, and the legal and theological structures governing the counseling relationship (Chang, 2005). Finally, the role of clinical supervision is highlighted in both professions (Chang, 2005; Tan, 2009).

Because of the lack of empirical research in the area, Chang (2005) contended that initial exploratory research is necessary. The purpose of this study was to explore issues of integration in psychological counseling practice from pastoral counseling perspectives. The result of the study may answer the question of how the theology and the psychology could be integrated within pastoral counseling from Christian clients perspectives.

Method

Client-Participants

Twenty-two graduate students in a school of religion were invited using a class announcement in a three-credit PCC offered in a mid-size comprehensive university in Taiwan. Students were pre-screened in a 30-minute group interview by the primary researcher prior to the counseling sessions. After the interview, two students dropped out from this project because of personal concerns. Students were recruited to participate in this project based on following criteria: being a baptized Christian, having personal needs for receiving four non-Christian counseling sessions in the Student Counseling Center (SCC), and having pastoral counseling experiences as a volunteer counselor in the church fellowship more than half a year. After signing a consent form, 20 client-participants voluntarily participated in this study. Participants' ages ranged from 29 to 55 years, with a mean age of 35 years (SD = 6.6). Seventeen participants were married, and three were unmarried. Of the 20 participants, eight are from Baptist church, five from a Presbyterian church, two from a Protestant church, four from a Spiritual church, and one from a Catholic church. Their occupation included one preacher, one volunteer, one engineer, two military instructors, two church assistants, three high school teachers, two junior school teachers, and eight elementary school teachers. None of the participants ever met their counselors before counseling sessions.

Counselor-Participants

Seven counselor-participants, including one Cognitive Behavioral Therapy, one Eclectic, two Integrative, and three Interpersonal orientations, were on duty in the SCC during the semester year. Of the seven counselors, three held doctors of philosophy in counseling, and four were masters level counselors. Client-participants, based on their time availability, were randomly assigned to one of the seven counselor-participants after the intake procedure. The case load ranges from 2 to 3 clients for each counselor and lasts four sessions within two months. During counseling sessions, counselors did psychological counseling based on their professional orientation. Although some of the counselors were familiar with pastoral counseling, all of them did the counseling work in a secular context. The information given to each counselor prior to the first session was based on the intake report of the SCC, in which no information was related to the purposes of the study.

The Researchers

In qualitative research, researchers' roles were essential because of their role functions in data collection and analysis (Creswell, 2007). The qualitative research is interpretative, whereas the researchers' judgments, values, and biases should be clearly stated (Creswell, 2007). The primary researcher was one of the supervisors who served as a participant observer. He gathered information while being involved in the research field as well as in the focus group interview. The other two researchers, doctoral-level senior counseling psychologists, were qualitative oriented in research methods. Their main tasks in the current study were conducting data analysis. Because data are understood in the context of researchers' previous experiences (Creswell, 2007), the researchers consulted with experts in qualitative study to bracket their biases. Two research assistants, master-degree counseling psychologists, were responsible for conducting the in-depth interviews and transcribing data. Researchers' ages ranged from 30 to 60 years, with a mean age of 43 years (SD = 16.6).

Data Collection

Grounded theory research, often referred to as the constant comparative method, is a qualitative tradition built on compared concepts (Creswell, 2007). Qualitative research is interested in process and meaning rather than outcomes and products (Creswell, 2007). Therefore, it is well fitted for this study on the basis of its purpose. Grounded theory researchers use a set of procedures designed to give the analytic process precision, rigor, and creativity, with a commitment to focus on exploring and verifying concepts as they emerge through the interactive and systematic processes of data collection and analysis (Creswell, 2007). In the grounded theory tradition, researchers typically conduct interviews during several visits to the field to develop new research question and theory. In this study, data were collected from the focus group interview, interactive process notes, and open-ended questions. The interactive process note, which consists of weekly written input, is a useful technique to write down participants' on-going learning experience in the class. Then, the instructor of the PCC makes comments to form an interactive feedback. The premise in the use of the note was the belief that students learn as they write. In considering the consistency and dependability of this study, the focus group interviews were audio taped and transcribed. The focus group interview was conducted two weeks after termination of the four counseling sessions during the 14th week of the semester, in which three questions serve as a framework:

1. Talking about your counseling experience as a client, how do you perceive SCC, psychological counselor, and counseling process?

2. Overall, what are your perceptions and experiences of your involvement in the counseling sessions?

3. Do you expect to talk about issues of Christian faith-related topics during the counseling process? What are your counselor's responses? Then, how do you respond to him/her?

To collect participants' class learning experiences, the open-ended questions were completed after the PCC termination at the end of the semester. Based on the purpose of exploring issues of integration in psychological counseling practice from pastoral counseling perspectives, three open-ended questions were framed and asked:

1. In comparison of your learning experience in the class as a student with the counseling experience as a client, do you see any similarity and difference in the basic assumption between pastoral and psychological counseling?

2. Based on your learning experience, how do you see the relationship between the pastoral counseling and psychological counseling?

3. So far, how do you perceive the question that theology and psychology could be integrated within pastoral counseling?

Data Analysis

In accordance with grounded theory procedures (Creswell, 2007), we first read all of the participants' responses to have a general sense of their perceptions. In this process, the two interviewers each divided 20 transcripts into units that each contained one main idea called meaning units (Creswell, 2007). We also used a two-line margin of error in utilizing the interview transcripts. The agreement rate is 0.82 from the segmentation of 40 units from two randomly selected transcripts, demonstrating an acceptable level of consensus in identifying meaningful units.

Throughout this process of analysis, the researchers met regularly to discuss, review, and analyze data in terms of common reactions, concepts, and themes among all participants' responses to each question. The open coding was completed by separating, identifying, labeling, and categorizing data in terms of general themes. In open coding, for example, a theme surrounding "clients' involvement in the counseling process" was identified by researchers. Then, we grouped all information that seemed to relate to this theme into one large group named "clients' involvement in the counseling process." We further used participants' responses to build properties and provide characteristics within this domain to help describe it.

In addition, axial coding was used to reconnect data and highlight relations between categories and subcategories (Creswell, 2007). In axial coding, for example, we explored and coded those aspects that seemed to contribute to "clients' involvement in the counseling process," such as counseling themes, tentative participation, and first impression of counselors. In selective coding, all information attained through previous data analyses was integrated and utilized to develop clearer and more abstract explanations and descriptions of emerging themes and related information. During the process, we identified core categories, validated existing concepts, and refined the properties and domains to define categories and concepts. Thus, it was ensured that all categories would fully take in occurrences and fully immerse into phenomena to gain as full, comprehensive, and thorough of an understanding as possible. The analysis procedures were stopped when redundancies and duplication of similar ideas, meanings, experiences, and descriptions occurred among informants and when no more new information was forthcoming. In other words, data analyses continued until the categories were "saturated," that is, until further categories that added to or changed the meaning of the analysis did not seem to be forthcoming. Consequently, six selective categories were constructed and identified affirmatively (see Appendix for complete list of selective categories).

The prolonged engagement and triangulation were used to enhance the credibility of the research findings (Creswell, 2007). The prolonged engagement, which served as a form of clarification and verification, involved the primary researcher's presence in an 18-week-long PCC course and a 30-minute group interview with the participants. Furthermore, the primary researcher obtained further direct and often repeated affirmations of what he had heard, seen, or experienced with respect to the phenomena under study after the counseling sessions to ensure the credibility of findings.

For triangulation, this study utilized multiple data sources, collection techniques, and methods of analysis. Multiple data sources included the focus group interview (F-A-1), open-ended question (O-A-1), and interactive process note (I-A-1). The first letter of the alphabet in a pair of parentheses indicates where the data come from, and the second letter of the alphabet reveals who the participant is. The order of number identifies sequences. Finally, the peer debriefing, also known as collegial challenges, was utilized in the current study. This refers to the process when the researcher consults with peers or experts to discuss various aspects of the study, including the emerging categories, coding process, and any methodological concerns that may arise.

Results

Results from this study illuminated several concepts related to the issues of integration in psychological counseling practice from pastoral counseling perspectives. Data analyses yielded 54 meaning units or open codes, which were grouped together meaningfully to form 16 axial categories. Those were further grouped together to form six selective categories. These findings, emerged as prominent and consistent, included theoretical conceptualizations as the following: (a) Christian client involvement, (b) Christian client expectations, (c) counselor interventions, (d) establishing rapport, (e) similarities and differences, and (f) integration between two professions.

Selective Category 1: The Christian Clients Involvement

Participants described that their own involvement in the counseling session was related to their counseling experiences as a client. These experiences resulted from four counseling sessions interacting with a counselor in the SCC. Four axial categories, including first impression of counselors, counseling experience as a client, counseling themes, and tentative relationship, compose this selective category. Two open codes contributed to the first axial category regarding the first impression of the counselor. These themes were identified in this category because those help the participants to get involved in the counseling relationship and to self-disclose. One participant described, "My first impression of the counselor is that she is quite young. I felt she was very respectful, sincere and honest. She also demonstrated her personal counseling style when she talked to me. Although she is not a Christian, she affirmed my religion. She also gave me some encouragements and affirmations in the critical period" (F-J-3). Another indicated, "My counselor was warm, powerful, and empathetic. I really enjoyed talking with her. Well, she really performed her characteristics of the effective counselor" (O-G-6).

Three open codes contributed to the axial category of the counseling experience as a client. Participants reported that the SCC was cozy, friendly, and amiable. Objects displayed and arranged in the counseling room provided a sense of warmth, helping atmosphere, and professionalism for clients. One participant indicated, "The first time I saw counseling center, the background music, the green plants, the paintings on the wall, the color, the furniture.. .Wow, it was not just an office" (F-A-9). Another stated, "What I felt in the counseling center was its atmosphere. People here were really nice, warm, and gentle. The counseling room was a projection of the counselor, his counseling style, favorites, and characteristics. All these environmental qualities in the counseling room provided clients with a sense of being cared for. I just love it" (F-B-6).

However, conflicts and struggles emerged from some of the participants' own pastoral counseling/psychological counseling identity, which influenced their responses at the end of the first session. One participant described, "Counseling was not worthwhile, ineffective, or even a waste of time" (O-G-2). Another noted, "Instead of engaging in a close relationship with a counselor, I would rather trust in Lord, and have a trustworthy relationship with God" (I-A-3).

Data collection from the focus group interview indicated that the counseling themes included career development, marital relationship, sense of loss, affective concern, interpersonal relationship, and personal concerns. "The most troublesome issue to me is related to interpersonal relationship. However, the topic we talked seemed to be changeable and flexible. Following this context, we once talked about issues of interpersonal relationship, affective concern, and personal concerns" (F-T-2). Another stated, "The career development was the first topic to me. After then, the marital relationship and sense of loss from divorce event were treated" (F-S-3).

Three open codes contributed to the axial category of the tentative relationship between clients and counselors. One participant offered, "In the first counseling session, I was excited but a little bit anxious about interacting with the counselor. Was she a Christian? Did she understand what I meant from a Christian perspective?" (F-C-3). Another noted, "Would I get hurt in the following sessions? I hesitated whether to keep going on the rest of the counseling sessions because my counselor was unfamiliar with my personal Christian faith" (F-I-2). Based on the results, counselor/client matching is not a new issue in the previous literature. However, the matching issue between non-Christian counseling service and Christian participants is a new topic for future research.

Selective Category 2: Christian Client Expectations

Themes in the second selective category were referred to how participants expect to have spiritual dialogues with counselors. Two axial categories, including participants' seeking for a dialogue of Christian faith and religious consciousness compose this selective category. Four open codes contributed to the first axial category. One participant indicated, "The expectation about dialogues of Christian faith with a counselor was very natural and spontaneous in Christian daily life" (F-G-3). Another described, "I think, we are encouraged to share our spiritual life and to learn from one another in the church, our expectation for receiving feedbacks from Christians was a regular part of the Christian life" (F-B-2).

Three open codes were included in the second axial category of the religious consciousness, which reflects a core value of Christian's life and relationship with God. One participant described, "In the beginning of counseling, we were used to reveal our personal religion, meanwhile, eager to find out counselor's religion through his or her feedback" (F-O-2). Another indicated, "After receiving counselor's responses, we then decide how to interact with the counselor, that is, Christian-based or non-Christian-based dialogues" (F-L-2). The other one noted, "I was so happy to know my counselor is a devoted Christian. Although she identified herself as a Christian, she did psychological counseling with non-Christian oriented counseling sessions. She did not even use Scripture nor led a prayer before or after the counseling session. Honestly, I got a little disappointed in the first session" (O-K-4).

Although participants' expectations for spiritual concerns and dialogues were neglected in the beginning of the non-Christian counseling, participants' negative comments and conflicts were pretty normal reactions. One participant mentioned, "Although a variety of interventions were used in the counseling process, I would expect to read the Scripture and to pray at the end of each session" (I-A-2). Another noted, "Our expectation to seek for spiritual dialogues is important for us because it is part of my Christian life. However, it seemed to be forgotten" (I-G-1).

Selective Category 3: Counselor Interventions

Themes in the third selective category were referred to counselor interventions, including how and what counselors responded to clients' expectations and how they developed a counseling relationship in the early session. Three axial categories, including counselors' responses to clients' expectations, basic counseling skills and strategies, and specific counseling interventions, compose this selective category. One participant described, "My counselor said that it is good to have a religious faith. Although she was a Christian, she did not respond to me when I mentioned about my Christian identification during the initial counseling session. However, she expressed that she really understood what I meant and said Christian faith seems to bring you plenty of spiritual resources''(F-T-2). Another noted, "My counselor's responses were to encourage and foster a warm and helpful climate to explore my personal concerns. She was really an empathetic school counselor" (S-F-8).

Participants indicated that the use of the basic counseling skills in the counseling sessions were useful and proper. One participant described, "Based on my observation and learning experience, my counselor used the following basic skills, including active listening, open-ended questions, body language, paraphrasing, summarizing, genuineness, acceptance, and empathetic understanding" (I-d-5). In addition to specific techniques, she also described, "Counseling strategies used by the counselor included questioning, probing, challenging, teaching self-reflection, offering new perspectives, and allowing emotional experiences" (I-d-6).

Several specific counseling interventions were reported in the focus group interview, which included homework, cathartic techniques, role playing, empty chair, solution-focused approach, psychological testing, and goal-setting interventions. Although interventions used in the counseling process were perceived as helpful and constructive, dissatisfaction about the unfulfilled spiritual needs resulting from lack of spiritual interventions, such as prayer and Scripture seemed to be apparent and inevitable.

Selective Category 4: Establishing Rapport

Establishing rapport between a counselor and a client referred to participants' perspectives on their counseling relationship in terms of its meaning, quality, structure, commitment, and counselor's empathetic understanding. Three axial categories compose this selective category. Two meaning units contributed to the axial category of empathetic understanding. Participants revealed that their relationship with their counselor was changed and enhanced dramatically because of the counselor's successful empathetic understanding. One participant indicated, "It was like she was kind of like, an angle sent by our Lord to help me empathetically. Therefore, I was encouraged to open my heart and to engage in a trip of self-discovery" (F-K-2). Another noted, "It was great to have a counselor always demonstrate empathetic understanding of my concerns. He, my counselor, helped me to learn how to relax by changing the self-demanding behaviors. Although I was initially frustrated when the counselor did not respond to my expectation to have a spiritual dialogue, I have learned to participate in the counseling sessions" (F-L-2). Although the barrier and gap may have existed between Christian clients and psychological counselors, the use of empathetic understanding was definitely helpful for improving counseling relationship.

Two meaning units contributed to the axial category of the reliable and constructive working alliance. Between sessions, most of the participants indicated that they were very actively engaged in their counseling process. They felt that counseling gave them new perspectives to see their problems. As one participant described, "Thinking about the counseling dialogues, reflecting what happened in the counseling processes, and engaging in the counseling relationship was helpful and constructive. It was a special professional relationship which was built up only in the counseling room and would only be existed in a short period of time" (I-H-2). Obviously, an alliance was formed because an intensive interaction existed between the counselor and the client.

Only when a reliable and constructive working alliance was formed, the turning point for change might occur. Six meaning units contributed to this axial category. Participants' perceptions of the change and outcome were related to having new perspectives, emotional experiences, fulfillment of self-expression of the inner world, observation of personal problems, and changes made happen outside the healing scenario. One participant indicated, "During the counseling process, my counselor aimed at my value of separating the right from the wrong, and the good from the bad. She discovered that there was always a strict standard in my life. After talking to my counselor, I finally realized what I need to learn is to please myself. I was free from a rigid, fixed, and arbitrary rule" (O-3-2). Another noted, "After counseling, I found out I've changed my attitude from passive to positive. I had made up my mind to face my own problems which I had never faced in the past" (I-1-12).

Selective Category 5: Similarities and Differences

An initial understanding of the similarities and differences between two professions was gathered from participants' reflections of class learning and counseling experiences as a client. Two axial categories compose this selective category. Nine meaning units contributed to the axial category of the uniqueness of the psychological and pastoral counseling. One participant noted, "I think the critical issue related to a basic theological point of view is God's characteristics. More specifically, God is all powerful. God knows everything, and His knowledge is infinite. However, psychological counselor is a human being and thus his/her energy and professional knowledge are limited in the field of the profession. Counselors can do something for their clients in the professional relationship, but not everything" (I-F-13). Another noted, "It is obvious that the pastoral counseling focuses on the spiritual cares, the teaching, and the relationship with God; while the psychological counseling emphasizes on the psychological aspects and uses various counseling skills and strategies in the counseling process" (I-C-9). A devoted Christian participant indicated, "Pastoral counselors usually use self-disclosure, share their own spiritual experiences, and Scripture; while clinical counselors utilize more counseling skills, strategies, and confrontation in the counseling process" (O-E-2).

Four meaning units contributed to the axial category of commonality. One participant offered, "It was great to find out that both counseling professions can empower their clients either through effective intervention or reunion of the relationship with God" (F-K-10). Another noted, "I found that both counseling professions provided a positive and immediate supporting system for clients. It was great to have that experience. I thought helping clients to solve their problems, valuing freedom of choice for their clients, respecting clients' choices, and even taking own responsibility was formal procedures for both" (I-I-6). One senior school teacher mentioned, "Both professions, stress the importance of establishing rapport, have the same goal to help people overcome their problems, find meaning and joy in life, and become mentally healthy and well-adjusted individuals" (O-G-8).

Selective Category 6: Integration Between Two Professions

Two axial categories compose this selective category. Four meaning units contributed to the axial category of the essentiality of integration. One participant mentioned, "What I am thinking about the integration between the two professions is that it is natural in nature, because all truth comes from God, including truth about the people who God creates" (I-D-12). Another noted, "Based on my learning experience in the class and my observation in counseling sessions, I think the way to integrate the two professions is necessary and accessible, because efforts to combine counseling with Christian religious perspectives are sometimes called integration" (O-E-6). The other one noted, "What I thought is that professional dialogues between two professions are tremendously needed. The dialogue is not only an echo to clients' needs, but also a testimony for integration in a transit modern society. This will bridge an access for mutual integration. If not changed today, it must be about improving tomorrow" (I-I-9).

Self-reflection and transfer were recognized as participants' personal perception of the integration through focusing on thoughts, feelings, and ideas in which they can identify in their counseling professional development or apply to future counseling service. Three meaning units contributed to this axial category. One participant described, "Self-reflection is more than just a cognitive process, but was ideally translated into behavioral transformation. One of the functions is to integrate counseling knowledge into counseling practice. In terms of self-reflection, I found previous experiences of being with younger brothers and sisters in the church were congruent with the integration knowledge I learned this semester" (O-L-5). Another noted, "To see is to believe. It was great to have a sort of counseling experience as a client in SCC as well as a student in PCC. It seems like a sandwich design of learning process, in which three ingredients were included: prior knowledge of counseling, psychological counseling experience as a client, and learning experience in PCC. It makes sense to me the distinct domain between two professions" (O-G-3).

There were also anxiety emerged around the participants. One participant offered, "Although helping someone is valuable through empathetic understanding, unconditional regards, and acceptance in the counseling process, there was anxiety and difficulty to make a decision whether to use solely the psychological counseling or not" (F-F-8). The underlying assumption is that most of the students will transfer what they have learned in PCC to their career. However, the fear of misuse the profession does exist, hence there is a need for repeated practice and being supervised. One participant noted, "Compared to my education-majored background, the concepts and knowledge I learned in PCC are different from what I have learned in previous courses. I have difficulty in using the material in meaningful ways later in other contexts. To me, an experiential supervisor is helpful to my professional growth" (F-N-8).

Discussion

This study explored issues of integration in psychological counseling practices from pastoral counseling perspectives. Results of this study may contribute to a deeper understanding of Christian graduate students' experiences in non-Christian psychological counseling as a client and their reflections on the PCC. Results highlighted the process of establishing a reliable and constructive working alliance, similarities and differences between the two professions, and perceptions on integrating both professions into applications. Hence, integrating theology and psychology into pastoral counseling seems to be accessible.

Although most of the participants entered counseling session believing that commitment was important when seeking help, some of them entered with a sense of anxiety about psychological service provided by a non-Christian counselor. The participants were initially hesitant whether counselors would appreciate the significance of their Christian backgrounds because of fear of being devaluated or misunderstood. The result confirmed previous findings in this area that clients often make subtle assessments based on observations of their counselors as to whether sharing religious faith materials is welcome (Magaldi-Dopman, Park-Taylor, & Ponterotto, 2011). Indeed, they reported that a tentative relationship between counselors and clients was formed because of the lack of a dialogue on Christian faith or spiritual concerns in the initial counseling session. Based on our findings, the situation sometimes required counselors' direct intervention by an open discussion and using empathetic understanding. These sorts of open discussions led clients to know that their counselors understood what they felt. Hence, the efficient way to build up a rapport between a counselor of secular context and Christian client is to overcome the transitional period through a frank dialogue with empathy in the early counseling sessions.

Within the counselor interventions mentioned earlier, counselors' responding to client expectations was a dominant and critical factor to impact on Christian clients' involvement in the counseling session. Noticeably, clients frequently expressed their needs in seeking a discussion of Christian faith and concerns. Indeed, sharing Christian materials, including Scripture reading, prayer, insights of Gods' words, and dialogues, have become a popular issue in their lives, hence supporting Christian clients' tremendous needs in the counseling relationship (Magaldi-Dopman et al., 2011; Walker, Gorsuch, & Tan, 2004; Young, Cashwell, Wiggins-Frame, & Belaire, 2002). This suggests that religious dialogues in counseling are sensitive and may activate feelings within the client, which is supported by this present study.

From this perspective, the initial counseling sessions may be considered a transitional period to facilitate the tentative relationship to a reliable working alliance between a counselor of secular context and Christian counselees. Therefore, counselor's flexibility, that is, using the spiritual sources such as prayer and Scripture, contemplation and meditation, sacred writings, forgiveness, and repentance, is suggested if working with a heterogeneous client population such as Christians (Richards & Bergin, 2005; Tan, 2009). The importance of this finding adds to the counseling literature to suggest that counselors need to increase their knowledge, skills, and awareness in accordance with clients' religious identities and expectations. If it is not applicable, utilizing the empathetic understanding is effective and constructive for all counselors. In fact, discussion of the client's spiritual concerns should not completely replace psychotherapy in the counseling session. This assumption was supported by participants' indication that their counseling relationship with counselors changed dramatically from time to time and emphasized the importance of the experience of empathetic understanding from their counselors. Specific factors, such as counseling environment, basic counseling skills, and the first impression of the counselor, were perceived by clients as helpful and impressive, but clients rarely attributed any of those as factors in building up a reliable and constructive working alliance. This finding supports Chang's (2005) suggestions that empathetic understanding is the central part of interventions.

Based on participants' responses, findings indicated that pastoral and psychological counseling do have some overlapped parts. The results supported the view in previous studies that pastoral counselors, as well as psychological counselors, provide psychological guidance to people who are struggling with a variety of psychological issues, such as depression, trauma, broken marriage, and relationship recovery (Chang, 2005; Tan, 2001). Furthermore, this research further classifies similarities between the two professions as follows: both professions emphasize simultaneously on the basic counseling skills in the counseling process; accomplish a sense of empowerment; provide a positive and immediate support for a variety of clients; facilitate clients to make their own decisions and take responsibility; respect clients' decision making; and invite clients to get involved in the counseling sessions through formal procedures such as intake, registration, waiting list, and filling out a consent form. Finally, both professions make every effort to provide a helpful intervention for their clients.

However, there are differences as well. The description of the uniqueness in the pastoral and psychological counseling can be divided into three clusters. The first cluster is related to philosophical assumptions. The former focuses on God's power and characteristics, whereas the latter focuses on facilitating personal growth and strength to make changes. Particularly, the former uses God's words and love to comfort and to inspire people, whereas the latter uses a variety of strategies based on different counseling theories to help clients deal with their problems. In other words, the pastoral counseling mainly reconciles a new relationship with our Lord and facilitates a new life in accordance with the Bible and Christian faith. In contrast, psychological counseling is based on psychological and counseling theories and principles. These findings support the literature that pastoral counseling is mainly based on biblical foundations (Aten & Hernandez, 2004; Tan, 2001, 2009), which is absolutely reliable and authoritative in all its teachings.

The second cluster is referred to the counselor interventions and boundary. The former focuses on the spiritual cares, teaching, self-disclosure, and sharing their own spiritual experiences, whereas the latter emphasizes the psychological cares, facilitation, and interaction. The former builds up a close relationship through God's love and maintains this relationship much longer than counseling sessions. Furthermore, the relationship that exists in the pastoral counseling is not limited only in the counseling room but also allows for a dual relationship in a church context, which is consistent with previous findings (Collins, 1988; Tan, 2001, 2009). Pastoral counselors are allowed to have accesses and relationships with clients beyond the counseling settings (Hall et al., 2009).

The third cluster is regarding the counseling goals. Based on the results of this study, the former is to generate spiritual resources and new Christian faith perspectives, and the latter is to work through problems and concerns, to relieve emotions, and to think about things differently. However, one unique aspect of pastoral counseling suggested that the everlasting love from God is powerful for healing, and the ultimate goal of Christian counseling must always be to assist the client in becoming more like Jesus Christ (Chang, 2005; Hall et al., 2009). Such suggestions were not found in the psychological counseling.

As Tan (2001, 2009) indicated, an essential part of integration is to examine our own relationship with God and others. A further development of implicit integration strategies is suggested by our findings regarding the similarity and difference between two professions. Pastoral counselors may positively extend the use of the similarity and keenly utilize the difference for clients who are not interested in religious or spiritual resources (Chang, 2005; Tan, 2001). For other clients who are more religiously oriented, the pastoral counselors might adopt explicit integration strategies.

Indeed, Hall et al. (2009) suggested that facilitating integration and concepts of integration was practical strategies for training an integrative counselor. Tan (2009) further addressed that the use of integrative supervision was helpful and useful to integrate both professions. The findings of this study indicated that the self-reflection and transfer from class learning and counseling experience were vital for integrating theology and psychology into pastoral counseling through a sandwich design of learning process. A further study to explore such sandwich design and to compare different training programs may be constructive to develop a complete training model. Further study is needed, however, before any solid conclusions can be made regarding the questions of philosophical assumptions, participant clients' expectations, client-counselor religious matching, and self-reflections for integration.

Regarding the use of the grounded theory methods, there are several limitations that need to be noted. The findings should be interpreted with caution because of the retrospective reports, the lack of counselors' perceptions, the small sample size, the homogeneity of the sample, and the limited number of counseling sessions. First, the open-ended questions and the retrospective nature of relying on participants' self-reports may present some sort of risks, such as the important aspects or nuances of particular changing experiences being forgotten or misremembered. Second, this investigation is focused on client participants' perspectives. The lack of counselors' data in understanding the participants' perceptions may result in a methodological concern. Third, because of the small sample size and its relative homogeneity, replication is recommended with larger and more diverse samples. Large samples can provide more precise estimates of population parameters. Moreover, the homogeneity of Christian graduate students may affect the participants' perceptions of their counseling experiences as a client and class learning experiences. Particularly, participants being in a class together on the PCC would somehow influence one another. Thus, the data collection was presumably impacted. Forth, the length of four counseling sessions may limit participants' perceptions and reflections regarding the integrative issues in psychological counseling perspectives. To collect in-depth and representative data, it is suggested for future research to increase the number of treatment to more than six sessions. Finally, this study was conducted in Taiwan and may therefore be affected by cultural factors. Although a variety of participants' church backgrounds were included in the samples such as the Presbyterian, Baptist, Protestant, and Spiritual, cultural influences on issues of integration may inevitably exist. Replications in other locations are required to verify the results. Despite these limitations, the results may still have an important impact on the counseling practices.

The results of this study suggest important implications for counseling practitioners. First, because of the necessity of sharing Christian faith in the counseling process for Christian clients, it is strongly suggested that psychological counselors may invite an open discussion about the intervention format, the non-Christian counseling-oriented approach, professional ethics, and neutral value. However, if it is necessary, referral to pastoral counseling should be considered. Second, to build up a reliable and constructive working alliance, for Christian clients and psychological counselors, the importance of using empathetic understanding in counseling intervention is emphasized. Third, for pastoral counselors working with Christian or non-Christian clients, it is advisable to use prayer and scripture for clients in either explicit or implicit ways depending on clients' needs (Tan, 2009; Weld & Eriksen, 2007). Finally, counseling scholars and practitioners should sensitively consider Christian clients' religious identity and spiritual concern, and increase multicultural counseling knowledge, skills, and awareness (Magaldi-Dopman et al., 2011). Under this context, incorporating findings of this study to counseling training program seems crucial to the development of both professions.

Appendix

Selective, axial, and open categories for integrating pastoral and
psychological counseling

Selective         Axial               Open

1. Christian      1-1 First           1-1-1 Personal counseling
client            impression          style
involvement       of counselors
                                      1-1-2 Characteristics of the
                                      effective counselor

                  1-2 Counseling      1-2-1 Counseling environment
                  experience as a
                  client              1-2-2 Participants'
                                      impressions of the first
                                      counseling session

                                      1-2-3 Participants have
                                      personal conflicts and
                                      struggles

                  1-3 Counseling      1-3-1 Participants'
                  themes              perceptions on the
                                      counseling topics included
                                      career development, marital
                                      relationship, sense of loss,
                                      affective concern,
                                      inter-personal relationship,
                                      and personal concerns

                  1-4 Tentative       1-4-1 Participants were
                  relationship        vulnerable in relationship
                                      with counselors

                                      1-4-2 Anxious and nervous
                                      reactions

                                      1-4-3 Participants
                                      identified counselors'
                                      religious orientation

2. Christian      2-2 Religious       2-2-1 The expectation of
client            consciousness       receiving feedbacks from
expectations                          Christians was a regular
                                      part of the Christian life

                                      2-2-2 Client-counselor
                                      matching issues based on
                                      the Christian-oriented
                                      faith

                                      2-2-3 Separate pastoral
                                      and psychological counseling

3. Counselor      3-1 Counselors'     3-1-1 The positive
interventions     responses to        interpretation
                  clients'
                  expectations        3-1-2 Convey open and
                                      nonjudgmental manners

                                      3-1-3 Encourage and foster
                                      exploration

                                      3-1-4 Empathetically
                                      understanding

                  3-2 Basic           3-2-1 The use of basic
                  counseling skills   counseling skills
                  and strategies
                                      3-2-2 Counseling strategies
                                      used by counselors

                  3-3 Specific        3-3-1 Facilitate empowerment
                  counseling          and assertiveness
                  interventions
                                      3-3-2 Homework, catharsis,
                                      role playing, empty chair,
                                      solution-focused approach,
                                      psychological testing, and
                                      goal-setting interventions

4. Establishing   4-1 Empathetic      4-1-1 A key point for
rapport           understanding       developing counseling
                                      relationship

                                      4-1-2 The use of empathetic
                                      understanding was helpful
                                      for developing counseling
                                      relationship

                  4-2 The reliable    4-2-1 Participants were very
                  and constructive    actively engaged in their
                  working alliance    counseling process

                                      4-2-2 They felt that
                                      counseling gave them new
                                      perspectives to see their
                                      problems

                  4-3 The changes     4-3-1 A trip of
                  and outcomes        self-discovery

                                      4-3-2 Having new
                                      perspectives

                                      4-3-3 Emotional experiences

                                      4-3-4 Fulfillment of
                                      self-expression of the
                                      inner world

                                      4-3-5 Observation of personal
                                      problems

                                      4-3-6 Changes happened
                                      outside the healing scenario

5. Similarities   5-1 The             5-1-1 God is all powerful
and differences   uniqueness          and unlimited.

                                      5-1-2 God's characteristics

                                      5-1-3 Psychological and
                                      pastoral counselors' roles
                                      and functions

                                      5-1-4 Pastoral counselors
                                      focus on the spiritual care,
                                      the teaching, and the
                                      relationship with God

                                      5-1-5 Psychological
                                      counselors emphasize the
                                      psychological aspects and
                                      use various counseling
                                      skills and strategies.

                                      5-1-6 Pastoral counselors
                                      frequently use
                                      self-disclosure to share
                                      their spiritual experience
                                      and Scripture

                                      5-1-7 Psychological
                                      counselors utilize more
                                      counseling skills,
                                      strategies, and
                                      confrontations in the
                                      counseling process

                                      5-1-8 Most of the pastoral
                                      counselors discuss religious
                                      or spiritual issues and do
                                      it openly, directly, or
                                      systematically using
                                      spiritual resources like
                                      prayer and Scripture

                                      5-1-9 Psychological
                                      counselors treat clients
                                      psychologically or physically
                                      and use various psychological
                                      resources such as peer
                                      supportive systems, positive
                                      reinforcement, and
                                      effective interventions

                  5-2 The             5-2-1. Both professions
                  commonality         accomplish a sense of
                                      empowerment through
                                      effective intervention or
                                      reunion of the relationship
                                      with God

                                      5-2-2 The similarities
                                      include helping clients to
                                      solve their problems, valuing
                                      freedom of choice for their
                                      clients, respecting clients'
                                      choices, and encouraging
                                      clients to take own
                                      responsibility

                                      5-2-3 Both professions
                                      stress the importance of
                                      establishing rapport

                                      5-2-4. Both professions deal
                                      with clients' problems
                                      either psychologically or
                                      mentally

6. Integration    6-1 The             6-1-1. The integration is
                  essentiality of     natural in nature
                  integration
                  between             6-1-2 The way to integrate
                  psychological       is necessary and accessible
                  counseling and
                  pastoral            6-1-3 Both professions made
                  counseling          positive contributions to
                                      counseling

                                      6-1-4. One of the functions
                                      is to integrate counseling
                                      knowledge into counseling
                                      practice

                  6-2 The             6-2-1 Self-reflection is
                  self-reflection     more than just a cognitive
                  and transfer        process

                                      6-2-2 A sandwich design of
                                      learning process

                                      6-2-3 I have difficulty in
                                      using the material in
                                      meaningful ways later in
                                      other contexts

References

Aten, J. D., & Hernandez, B. C. (2004). Addressing religion in clinical supervision: A model. Psychotherapy: Theory, Research, and Practice, 41, 152-160.

Chang, T. C. (2005). Pastoral counseling: A helping model for changing life. Taipei, China: China Evangelical Seminary.

Collins, G. R. (1988). Christian counseling: A comprehensive guide. (Rev. ed.). Dallas, TX: Word.

Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five approaches (3rd ed). Thousand Oaks, CA: Sage.

Elliott, R., & James, E. (1989). Varieties of the client experience in psychotherapy: An analysis of the literature. Clinical Psychology Review, 9, 443-467.

Guild, W. M. (2002). Christianity and psychology: Integration with a counseling view. Retrieved May 7, 2010, from http://www.tiu.edu/cmx/seniors02/guild.htm

Hall, E. L., Ripley, J. S., Garzon, F. L., Mangis, M. W. (2009). The other side of the podium: Student perspectives on learning integration. The Journal of Psychology and Theology, 37, 15-27.

Magaldi-Dopman, D., Park-Taylor, J., & Ponterotto, J. G. (2011). Psychotherapists' spiritual, religious, atheist or agnostic identity and their practice of psychotherapy: A grounded theory study. Psychotherapy Research, 21, 286-303.

Paulson, B. L., Truscott, D., & Stuart, J. (1999). Clients' perceptions of helpful experiences in counseling. Journal of Counseling Psychology, 46, 317-324.

Richards, P. S., & Bergin, A. E. (2005). A spiritual strategy for counseling and psychotherapy (2nd ed.). Washington, DC: American Psychological Association

Tan, S.-Y. (2001). Integration and beyond: Principled, professional, and personal. Journal of Psychology and Christianity, 20, 18-28.

Tan, S.-Y. (2009). Developing integration skills: The role of clinical supervision. Journal of Psychology and Christianity, 37, 54-61.

Wade, N. G., Worthington Jr., E. L., & Vogel, D. L. (2007). Effectiveness of religiously tailored interventions in Christian therapy. Psychotherapy Research, 17, 91-105.

Weld, C., & Eriksen, K. (2007). Christian clients' preferences regarding prayer as a counseling intervention. Journal of Psychology and Theology, 35, 328-341.

Walker, D. F., Gorsuch, R. L., & Tan, S. Y. (2004). Therapists' integration of religious and spirituality in counseling: A meta-analysis. Counseling & Values, 49, 69-80.

Young, J. S., Cashwell, C., Wiggins-Frame, M., & Belaire, C. (2002). Spiritual and religious competencies: A national survey of CACREP-Accredited programs. Counseling & Values, 47, 22-47.

Peter Jen Der Pan

Liang-Yu F. Deng

Shiou Ling Tsai

Jenny S. S. Yuan

Chung Yuan Christian University

Authors

Peter J. D. Pan (Master in Counselor Education, University of Wisconsin) is a Professor of the College of Humanities and Education at Chung Yuan Christian University and editor of the Taiwan Journal of General Education. Dean Pan's interests include group process, verbal interaction, and integration between Christian pastoral and secular psychological counseling.

Liang-Yu F. Deng (Ph.D. in Family Study, Kansas State University) is a Professor of the College of Humanities and Education at Chung Yuan Christian University and a licensed counseling psychologist. Dr. Deng's interests include family counseling. parenting, verbal interaction, and group counseling process.

Shiou-Ling Tsai (Ph.D. in Educational Psychology & Counseling, National Taiwan Normal University) is an Associate Professor in the Center for Teacher Education and director of the Student Counseling Center at Chung Yuan Christian University. Dr. Tsai's interests include Solution-focused Brief therapy, Theories & Practicum of Counseling, and counselor training and supervision.

S. S. Jenny Yuan (Master in Guidance and Counseling, National Pingtung University of Education) is a licensed counselor in the Student Counseling Center at Kainan University. Her interests include group counseling, career guidance and counseling, Solution-focused Brief therapy, and counselor training and supervision.

Correspondence regarding this article should be addressed to Peter Jen Der Pan, Ph.D, College of Humanities and Education, Chung Yuan University, 200 Chung Pei Road, Chung Li, Taiwan; jender@cycu.edu.tw.