Do lay Christian counseling approaches work? What we currently know.

Garzon, Fernando ; Tilley, Kimberely A.

The role of paraprofessional counseling is increasing both nationally and internationally. Internationally, the breadth of need (e.g., mainland China, Hou & Zhang, 2007), as well as efforts to reduce the cost of some socialistic healthcare programs (e.g., Great Britain, Clarkson, McCrone, Sutherby, et al., 1999) has driven the proliferation of these services. Nationally, limitations in mental health insurance benefits have increased the need and utilization of paraprofessional services. With increased usage comes increased need for empirical evaluation; therefore, this article explores the current research on paraprofessionals who use lay Christian models.

Paraprofessional counselors (lay counselors) are persons who lack formal credentialing, training, and experience as licensed mental health professionals, yet they are involved in the care of emotionally hurting people (Tan, 1997). Example venues for lay counseling include hotlines, peer counseling, home visitation programs, and church-based ministries (Tan, 1991).

Tan (1991, 1992, 1997) described three common models used in delivering paraprofessional counseling. The informal, spontaneous model provides support in natural settings (restaurants, homes, churches, etc.) through informal friendships. These paraprofessionals may or may not have some basic training in helping skills. No ongoing supervision occurs. In the second model, the informal organized model, paraprofessionals still help in informal settings, but they receive systematic training and ongoing supervision. Finally, in the formal organized model, paraprofessionals counsel in more official settings such as a community agency or a church counseling center, receive regular supervision, and are usually trained by mental health professionals. Sometimes, hybrid models that combine the informal organized and formal organized models occur (Tan, 1997).

Research demonstrates the effectiveness of some kinds of paraprofessional counseling. Durlak (1979) reviewed 42 studies comparing professional and paraprofessional counselors. The studies focused primarily on mildly to moderately disturbed clients. Surprisingly, Durlak found no difference in client outcomes and some studies suggested paraprofessionals provided better care. Others reanalyzed the data using meta-analysis (e.g., Nietzel & Fisher, 1981; Hattie, Sharpley, & Rogers, 1984; Berman & Norton, 1985), yet similar results remained. Christensen and Jacobson (1994) conclude:

 The later reviews often begin with a
 criticism of the previous reviews and
 then try to improve on the methodology.
 Yet, whatever refinements are
 made, whatever studies are included
 or excluded, the results show either
 no differences between professionals
 and paraprofessionals or, surprisingly,
 differences that favor paraprofessionals.
 (p. 9)

While more refined future studies matching specific diagnoses with particular clinical techniques (cf., Beutler, 2002) might lead to different comparative outcomes between lay counselors and professionals, current evidence supports no difference with generalized client populations. Given the number of studies done, one might anticipate strong current evidence for the effectiveness of lay Christian counseling. Yet, some conservative Christian groups, such as Nouthetic biblical counseling (e.g., Adams, 1970), exhibit a high distrust of psychology and thus have little interest in research or collaboration with mental health professionals. Many other lay Christian counseling approaches exist however (Garzon, Worthington, Tan, and Worthington, 2009). The authors found no summary of research on these approached in the literature.

Indeed, many questions exist regarding lay Christian counseling models: (a) How effective do clients perceive such counseling to be? (b) What does current outcomes research on lay Christian counseling models indicate?, and (c) What future studies on lay Christian counseling programs should be considered? This article will review the currently available research on lay Christian counseling models in an attempt to answer these questions.

Method

Definitions

For the purposes of this review, lay Christian counseling applies to paraprofessional religious ministries that affirm doctrinal tenets consistent with the Nicene Creed (a standard creed of Christian orthodoxy), that minister or counsel primarily face-to-face, have a clear focus on training non-professionals/non-clergy in their approach, and which focus on a wide variety of client types instead of focusing on one type (for example, Christian 12-Step programs for addiction and Exodus Ministries programs for Christians experiencing same-sex attraction).

The models found in this review appear to derive from evangelical Christian or Charismatic-related contexts. Lay Christian counseling has some commonalities with spiritual direction in that both may explore the client's spiritual life with the purpose of increasing the person's spiritual growth. Unlike spiritual direction, lay counseling also generally has a primary mental health goal (e.g., decrease anxiety, improve interpersonal relationships, etc.). Such goals are normally secondary in spiritual direction. Finally, spiritual directors are often clergy with additional training rather than lay people.

Procedure of the Search

The writers consulted several databases (Academic Search Premier, Blackwell Synergy, Medline, ATLA, and PsycINFO) to identify pertinent lay Christian counseling research. Dissertations were also reviewed in the ProQuest Dissertations and Theses database. Search words used included lay Christian counseling, the names of a variety of lay Christian models (See Garzon, et al., 2009, for a table listing these models), the names of lay Christian counseling model developers, religious paraprofessional counseling, and spiritual paraprofessional counseling. Finally, faculty at various integration-focused psychology programs were contacted regarding any on-going lay counseling research.

Lay Christian Counseling Research

The authors divide this review of the literature into early research (1980-1990) and then by the four categories described in Garzon, et al., (2009). The reviewed categories include Active Listening, Cognitive & Solution-Focused Approaches, Inner Healing Approaches, and Mixed Models. Nouthetic biblical counseling (e.g., Adams, 1970) was not included given its lack of research and the distrust of some of its leaders in using empirical methods. Specific models with research are briefly described with references provided for further details on the approach. Table 1 summarizes all the studies found in this review. The authors note overall findings, significant limitations, and make design improvement suggestions in the discussion section.

Early Research (1980-1990)

The authors identified 3 early studies on lay Christian counseling (Boan & Owens, 1985; Harris, 1985; Walters, 1987), but the articles lacked specific information on the lay ministry approach used. Therefore, the ability to generalize this research to other lay Christian approaches is highly suspect. Many models have developed since this initial research.

Active Listening Approaches

Stephen Ministry (Haugk, 1984; Haugk, 2000) represents a classic example of these models. The approach combines Rogerian principles of empathy, positive regard, and supportive listening with prayer, scripture, and biblical themes as appropriate. No research was found on this or other active listening Christian approaches, although the developers voiced openness to this. See Garzon, et al., (2009) for a description of this ministry's training and organizational structure.

Cognitive & Solution-Focused Approaches

While a number of lay Christian cognitive approaches exist (e.g., Crabb, 1977; Backus, 1985; Tan, 1991), the authors found no outcomes research focusing exclusively on a lay cognitive, cognitive behavioral, or solution-focused strategies. It should be noted however that Christian cognitive therapy approaches have some studies with doctoral level clinical psychology graduate students or professional therapists as the treatment providers (See McCullough, 1999, and Worthington & Sandage, 2002, for meta-analyses). These suggest efficacy with mildly to moderately depressed clients. Lay models with an eclectic framework and a cognitive behavioral component have been researched however. Because of the multiple therapeutic strategies involved, these studies are described under the Mixed category (see below).

Inner Healing Prayer Models (IHP)

Hurding (1995) noted that these prayer approaches represent "a range of 'journey back' methodologies that seek, under the Holy Spirit's leading, to uncover personal, familial, and ancestral experiences that are thought to contribute to the troubled present" (p. 297). These troubles may be physical, emotional, or spiritual. See Garzon and Burkett (2002), and Garzon, et al., (2009) for more in-depth descriptions of inner healing prayer. The present authors reviewed only IHP research that focused on clearly identified models.

Christian Healing Ministries (Francis MacNutt, CHM). CHM displays a Christian inner healing prayer focus in lay training very similar to Elijah House Ministries described in Garzon, et al., (2009). One study (Matthews, Marlowe, & MacNutt, 2000) has been done on this approach.

Theophostic Prayer Ministry (TPM). Theophostic Prayer Ministry was developed by Ed Smith, a pastoral counselor, in the mid-1990's. Smith (2007) differentiates his approach from inner healing prayer strategies in several ways which will be acknowledged here. It is included in the general IHP research category because of its emphasis on addressing current life stressors through prayer focusing on the client's past, frequently involving childhood memories.

In TPM, the lay counselor asks the person to focus on the painful emotions involved in her currently distressing situation. The person is then encouraged to let her mind connect to "the original memory container" (Smith, 2007, p. 31) which holds the embedded lies amplifying the distress. "Lies" are similar to core beliefs or schema in cognitive therapy. Here Smith (2007) differentiates himself from typical IHP approaches. He emphasizes that it's the lies embedded in the memory versus the memory itself that is causing the person's distress. The person and prayer partner collaborate to identify the lies present in the memory that surfaces. Once these are identified, something similar to what a therapist might identify as an exposure protocol occurs. The person is asked to feel the affect around the beliefs in the memory without resisting the emotions or examining the rationality of the belief. Then, unlike cognitive therapy or exposure protocols, petition is made for the Lord Jesus to reveal the truth to the person about these beliefs. A variety of experiences at this point can occur as the client listens for Christ's response. Prayer continues until there is a sense of complete peace in the memory. Further information on TPM may be found in Smith's latest basic training manual (2007 at the time of this article). As some proponents of TPM have at times made dramatic claims based on anecdotal (testimony) evidence and critics have expressed concerns about possible harm from TPM (e.g., Entwistle, 2004), the need for research is apparent. Several surveys and one outcomes-based case study project have been done (Garzon, 2004, 2008; Garzon & Paloma, 2003, 2005; Tilley, 2008).

Mixed Lay Christian Models

Mixed approaches have similarities to Active Listening, Cognitive, and Inner Healing Prayer categories, but they have sufficient differences to lead to a separate category. They either reflect a more heterogenous application of various psychological theory bases, or a more thorough examination of theological aspects, such as the role of the flesh and the demonic in emotional distress, or both. One eclectic lay model and one theologically in-depth model was found with research. These models are described below.

Eclectic with an Integrated Cognitive Behavioral Component (E-CBT). Lay Christian counseling models with an eclectic base that incorporate a clear cognitive behavioral component have received two outcome studies (Toh, Tan, Osburn, & Faber, 1994; Toh & Tan, 1997). Rogerian, psychodynamic, and family systems elements also composed the eclectic base of these approaches.

Freedom in Christ Ministries (FICM). FICM proposes that the unbiblical lies Christians believe often lead to spiritual and psychological distress (Anderson, 1990a/2000a). These lies can arise from the flesh, demonic deception, and messages received from popular culture (Anderson, 1990b/2000b). Seven key areas (described as "the Steps to Freedom," or "the Steps" in FICM literature) are seen as essential for resolution in order to resolve personal issues. These include confession and renunciation of occult/non-Christian religious involvement; confession of defensive strategies outside of Christ; forgiveness of others, self, and God; confession of rebellion to proper authority; repentance for areas of pride; confession and repentance in areas of habitual sin, and confession of family generation sin patterns (Anderson, 1990/2000b). For a more indepth description of FICM, see Garzon, Garver, Kleinschuster, Tan, and Hill (2001), and Garzon, et al., (2009). Several preliminary effectiveness studies of FICM were identified (Garzon, Garver, Kleinschuster et al., 2001; Combs, 2006; Crabtree, 2006; Fisher, 2006; Seitz, 2006; Hurst, Williams, King, & Viken, 2008).

Discussion

The writers identified above several convenience sample surveys and quasi-experimental studies used to investigate lay Christian counseling, along with one randomized waiting list control group study. A brief summary analysis of current research findings, limitations, and future design recommendations follow.

Surveys of practitioners (TPM) and surveys of client satisfaction (TPM, FICM) provide a sketch of the characteristics and satisfaction level of lay counselors and clients who appear to endorse these particular approaches. Such effectiveness evaluations appear very high. Design flaws in the surveys done however suggest the possibility of biased sampling, so these results must be taken with caution. The surveys do suggest that some mental health professionals are incorporating lay strategies into their practices. Also, several approaches (TPM, FICM, Cognitive) appear open to interact with mental health professionals for supervision and referral. Some have written explicitly describing potential models of interaction (Cognitive, Tan, 1991; FICM, Anderson, Zuehlke, & Zuehlke, 2000). This is encouraging since it appears lay Christian counselors are at times treating quite complex conditions.

Improved methodology can reduce the biased sampling risk. A recent study of religiously-tailored interventions in Christian therapy (Wade, Worthington, & Vogel, 2007) suggests a potential design for improved representativeness of survey samples. In this study, therapists and their clients were recruited from seven different agencies in different regions of the country. Anonymous survey data examined a one week cross-section of the clients' experiences for that week's session and their satisfaction with the session and treatment up to that point. Information on the length of treatment, perceived effectiveness of treatment, the therapeutic alliance, and demographics were obtained. Since all clients for that week who saw therapists were given the opportunity to participate, the probability of a more representative sample increased.

Given that many of these lay counseling models are nationwide and have church-based ministry centers, the possibility of a similar methodology to Wade, Worthington, and Vogel's exists. Should such a study occur, efforts should be made to include lay Christian counseling centers for investigation that operate in ethnically diverse communities, as this was one weakness in the Wade, Worthington, and Vogel study.

Single group pre-treatment post-treatment short term follow-up studies (E-CBT, FICM), quasi-experimental studies (FICM, IHP), and outcomes-based case studies (TPM, FICM) have produced intriguing results meriting further exploration. A strength of these studies is their demonstration of an association between several approaches (E-CBT, TPM, FICM) and symptom reductions in naturalistic settings. For additional studies of a similar design, the writers recommend a time series pre-treatment symptom baseline to compare with the post treatment outcome, and longer term follow-up (six months or more). Only one identified study had a pretreatment baseline (Fisher, 2006). Comparison groups also would be helpful. Only one study in this category (FICM; Hurst, Williams, King, & Viken, 2008) utilized such a group.

Mixed design qualitative studies may also be beneficial (Garzon, 2008). These studies permit in-depth exploration and comparison of both positive lay Christian counseling experiences and negative ones. For example, a quantitative survey with questions focusing on specific intervention aspects could evaluate whether the client experienced the lay model of interest or a "hybrid" developed by the particular lay counselor, while a qualitative semi-structured interview would permit comparisons of clients with positive lay Christian counseling experiences with negative ones.

The presence of only one randomized waiting list control group study (E-CBT category) after over twenty-five years of published lay Christian counseling models is disconcerting. The writers found no placebo or minimal support randomized control group or randomized active comparative group study of any lay Christian counseling approach in this literature review. undoubtedly, more randomized efficacy and effectiveness studies are needed before a clear assessment of lay Christian counseling can be made. in addition to psychological symptom measures and spiritual outcome measures, these studies should include an instrument measuring the influence of client expectancy effects in treatment outcome, and consider the role lay counselor allegiance to the model might play in the results.

The authors recognize a caveat however for the lack of randomized comparative or control group studies in lay Christian counseling models. Most lay Christian counseling model developers have no research training. Only E-CBT developers had substantial training in this area. Not surprisingly, only this lay model had an investigation that utilized random assignment and a waiting list control group (Toh & Tan, 1997). An informal survey of each of the non-E-CBT model developers (See Table 1 in Garzon, et al., 2009, for a listing of the models contacted) indicated their willingness to cooperate with religiously-sensitive researchers who wanted to do studies on their approaches. some have already started cooperating (e.g., Matthews, Marlowe, & MacNutt, 2000). This is an encouraging sign.

Challenges remain however. only one clearly identified research team currently appears to be investigating lay Christian models. integration-focused clinical psychology and counseling programs can change this. These have existed now for over thirty years; thus, the potential for these programs to get more involved in investigating lay Christian counseling models is apparent. Lay Christian counseling model developers need their empirical expertise. Given that some counseling professionals are incorporating lay interventions into psychotherapy, the time for research collaboration with lay model developers is now.

Conclusion

Current findings on lay Christian counseling are very limited compared to paraprofessional counseling as a whole. only one randomized waiting list control group study has been done, this on an eclectic approach with a CBT component. Numerous other lay models exist. Present preliminary studies on two approaches, one from the IHP category (TPM) and one from the mixed models category (FICM) provide a sketch of those receiving these approaches and give some preliminary evidence of effectiveness. These findings need to be confirmed with well-designed efficacy and effectiveness studies. in short, current data does not allow us to say definitively that lay Christian counseling works. Given the openness of lay model developers to collaborate on research, integration-focused graduate programs have an opportunity to address this important gap in the literature.

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Fernando Garzon

Liberty University

Kimberely A. Tilley

San Diego, CA

Fernando L. Garzon, Psy.D., is an Associate Professor in the Center for Counseling and Family Studies at Liberty University. His research interests include spiritual interventions in psychotherapy, lay Christian counseling, multicultural issues, and integration pedagogy.

Kimberely A. Tilley, Psy.D., is an Adjunct Professor at Southern California Seminary in San Diego, CA, and works as a Program Coordinator at Halcyon Crisis Center, which is a residential alternative to hospitalization built around a bio-psychosocial approach.

Please address correspondence regarding this article to Fernando Garzon, Psy.D., Center for Counseling and Family Studies, Liberty University, 1971 University Drive, Lynchburg, VA 24502. Email fgarzon@liberty.edu. Liberty University does not officially endorse lay Christian counseling approaches. Rather, it supports the theological and scientific examination of these strategies.

Table 1
Summary of lay Christian Counseling Research

Lay Model Study Participants

Early Research (1980-1990)

Non-model specific, Harris (1985) Four groups with each
early lay Christian group having differing
counseling levels of "resource person"
 involvement
 N = 44

Gerald Egan's work Boan & Owens Current & past clients
(1975) as (1985) of Reformed Church
foundation, along in Carmichael, CA
with specialized N = 215
training

Non-model specific Walters (1987) Clients who received
 lay counseling from the
 First Presbyterian Church
 in Boulder
 N = 98

Active Listening Approaches

Stephen Ministry N/A N/A

Cognitive & Solution-Focused Approaches

Lay Christian N/A N/A
cognitive approaches

Inner Healing Prayer Models (IHP)

Christian Healing Matthews, Rheumatoid arthritis
Ministries Marlowe, and patients
 MacNutt (2000) N = 40

TPM Garzon and Attendees at an
 Paloma (2005) advanced TPM training
 conference
 N = 111

TPM Garzon and TPM email database
 Poloma (2003) of purchasers of materials
 N = 1,352

TPM Tilley (2008) Email respondents
 from TPM database
 N = 2,817

Lay Model Study Participants
TPM Garzon (2004, Clients from both
 2008) professional and lay
 counseling settings
 N = 22

Mixed Lay Christian Models

E-CBT Toh, Tan, Clients from La
 Osburn et al. Canada Presbyterian
 (1994) Church, CA
 N = 18

E-CBT Toh & Tan Clients from First
 (1997) Evangelical Free Church
 in Fullerton, CA,
 N = 46

FICM Garzon, Garver, Graduate student class
 Kleinschuster N = 32
 et al. (2001)

FICM Combs (2006) Adult Sunday school
 participants at large
 evangelical church
 N = 21

FICM Fisher (2006) Participants at 4-day
 FICM conference
 N = 56

FICM Hurst, Williams, Participants at two FICM
 King, and Viken weekend conferences
 (2008) Treatment group n = 33
 Non-treatment group
 n = 18

FICM Anderson, Clients in a clinical
 Garzon, & King setting
 (2002) N = 10

FICM Seitz (2006) Clients were referred
 for treatment by lead
 pastor of a large church
 N = 3

Lay Model Design Measures

Early Research (1980-1990)

Non-model specific, Pretreatment- Schulman's (1978)
early lay Christian post treatment self concept scale
counseling

Gerald Egan's work Lay peer evaluation Likert scale peer
(1975) as and mailed client evaluation instrument,
foundation, along survey client satisfaction
with specialized survey
training

Non-model specific Evaluations of A primarily Likert-scale
 client change and item questionnaire
 satisfaction (psychometrically
 researched) developed
 by the Family Service
 Association (FSA)

Active Listening Approaches

Stephen Ministry N/A N/A

Cognitive & Solution-Focused Approaches

Lay Christian N/A N/A
cognitive approaches

Inner Healing Prayer Models (IHP)

Christian Healing Nonrandomized Ten medical
Ministries waiting list outcomes measures
 crossover design

TPM Convenience Self report survey
 sample
 descriptive study

TPM Descriptive online Self report web-based
 survey study survey

TPM Descriptive online Online client
 survey satisfaction survey

Lay Model Design Measures
TPM Outcomes-based SCL 90-R, SWBS, ROS-R,
 time series case DAS, BPRS, client
 studies with 3 satisfaction survey,
 month follow-up blind independent
 review post treatment

Mixed Lay Christian Models

E-CBT Combined group Target Complaints, BSC,
 pre-post outcome SWBS, Brief Symptom
 study Checklist, and the lay
 person's Global Rating
 of Client's Psycho-
 logical Adjustment

E-CBT Randomized waiting Target Complaints, BSC,
 list control group SWBS, and the lay
 study with one person's Global Rating
 month follow-up of Client's Psychological
 Adjustment

FICM Single group RSEI, BAI, SCL 90-R,
 pre-post 3-week 12-item inventory
 follow-up

FICM Single group time PAS, DES-II as screeners,
 series design with the BSI, BDI-II, TSOS,
 six week follow-up and 12-item inventory as
 outcome measures

FICM Time series one SCL 90-R and a
 group design with 12-item Likert scale
 pre and post questionnaire
 treatment baseline

FICM Non-randomized 12-item Likert scale
 comparison group questionnaire
 study

FICM Times series SCL 90-R, DAS, SWBS,
 effectiveness case and a 12-item
 study design questionnaire

FICM Three time series DASS, TSOS, SCID I,
 design case studies PAS, DES-II, the BAI,
 and the BDI-II.

Lay Model Major Findings

Early Research (1980-1990)

Non-model specific, All groups improved statistically and
early lay Christian the addition of a resource person
counseling improved client outcome

Gerald Egan's work Level of client satisfaction with the lay
(1975) as ministry was not reported, focus appeared
foundation, along primarily on assessing the utility of lay
with specialized peer evaluations, which were found to be
training useful in predicting client satisfaction

Non-model specific Lay counselors compared favorably
 with FSA professionals on measures of
 client change and client satisfaction

Active Listening Approaches

Stephen Ministry No research was found on Active Listening
 approaches

Cognitive & Solution-Focused Approaches

Lay Christian Christian cognitive therapy models have
cognitive approaches been researched in psychotherapy (See
 Worthington & Sandage, 2002) with good
 results, but no cognitive therapy studies
 have utilized lay counselors in their
 investigation. No outcomes-related research
 on lay solution-focused counseling
 was identified.

Inner Healing Prayer Models (IHP)

Christian Healing Statistically significant differences in two
Ministries of the 10 outcome categories and a trend
 towards significance in 7 of the remaining
 8 categories were found.

TPM Lay counselors are working with a wide
 range of conditions using TPM.
 High perceptions of effectiveness for TPM
 were found.

TPM Similar high effectiveness perceptions with
 larger sample. Openness to mental health
 supervision indicated. No difference between
 lay counselors and licensed clinicians in
 in effectiveness perceptions.

TPM Participants rated previous non-TPM
 counseling experiences as effective, but
 reported TPM's effectiveness as significantly
 higher in a variety of areas.
 Table 1 continues next page

TPM Case results supported clear symptom
 improvement, decreased dysfunctional beliefs,
 and enhanced spiritual outcomes for most
 clients

Mixed Lay Christian Models

E-CBT No difference between 10 and 20 session
 groups. Combined group had significant
 decreases on the four outcome measures
 used pre to post counseling

E-CBT Significant improvements in target complaints,
 symptoms reported, spiritual well-being, and
 lay counselor ratings of client improvement
 occurred at post-treatment in the treatment
 group in comparison to the waiting list control
 group, maintained at one-month follow-up.

FICM Significant decreases in several SCL-90-R
 subscales and the BAI. The RSE indicated
 increased levels of self esteem. Results
 maintained at the 3-week follow-up.

FICM Significant decreases in several BSI subscales
 and the BDI-II occurred. BAI results were not
 significant. The TSOS indicated significantly
 improved spiritual functioning. Results were
 maintained at the 6 week follow-up.

FICM The Global Severity Index of the SCL 90R
 reflected a statistically significant symptom
 reduction pattern. Client satisfaction
 ratings at post conference and the
 three-month follow-up appeared positive.

FICM Results for the treatment group indicated
 significant differences on all 12 items, and
 significant differences with the
 comparison group on all 12 items.

FICM The results appeared to suggest a positive
 treatment effect overall. Therapists varied
 the timing of Steps implementation
 according to client characteristics.

FICM Results for two clients with prominent
 Axis II features did not reflect a symptom
 reduction series pattern. The third client
 reduced in depression symptoms. Nonspecific
 factors could not be ruled out.

Note. BAI = Beck Anxiety Inventory (Beck & Steer, 1993), BDI-II =
Beck Depression Inventory II, BPRS = Brief Psychiatric Rating Scale
(Fisher & Corcoran, 1994), BSI = Brief Symptom Inventory
(Derogatis, 1993), DAS = Dysfunctional Attitude Scale (Weissman &
Beck, 1978), DASS = Depression Anxiety Stress Scale (Lovibond &
Lovibond, 1995), DES-II = Dissociative Experience Scale II (Carlson
& Putnam, 1993), E-CBT = Eclectic with a Cognitive Behavioral
Therapy component, FICM = Freedom in Christ Ministry, PAS =
Personality Assessment Screener (Morey, 1997), ROS-R = Religious
Orientation Scale-Revised (Gorsuch & McPherson, 1989), RSEI =
Rosenberg Self Esteem Inventory (Rosenberg, 1965), SCID I =
Stuctured Clinical Interview for DSM IV Axis I disorders, SCL 90-R
= Symptom Checklist 90-Revised (Derogatis, 1994), SWBS = Spiritual
Well-Being Scale (Paloutzian & Ellison, 1982), TPM = Theophostic
Prayer Ministry (Smith, 2007), TSOS = Theistic Spiritual Outcome
Survey (Richards, Smith, Schowalter, et al., 2005).