Social work and deliverance practice: The Pentecostal practice

Belcher, John R

Abstract

The authors discuss the relevance, propriety, and use of prayer In addressing the recovery of women from substance use. They describe the use of prayer to facilitate the process of rehabilitation and recovery of women who are chemically dependent and illustrate the application of prayer in the context of group treatment and support.

AT FIRST GLANCE, social work and religion make for strange bedfellows. As one looks closer, this seemingly unlikely juxtaposition becomes more tenable. Indeed, religious values, traditions, and beliefs significantly contributed to the establishment of American social welfare (Leiby, 1978; Marty, 1980; Ortiz, 1995; Siporin, 1986). In fact, the profession has a long tradition of working with the religious community. Much of the profession's early casework with the poor was conducted in conjunction with religious institutions (Trattner, 1989).

The rich connection between religion and social work is also demonstrated by the profession's interest in moral philosophy (Billups, 1992; Lowenberg & Dolgoff, 1982; Reamer, 1982; Rhodes, 1986). Further, both traditions also share beliefs regarding the interdependence among people, social responsibility, and the intrinsic worth of the individual (Mancoske, 1987; Siporin, 1986). Finally, one of social work practices' goals is empowerment practice (Gutierrez, 1990; Swenson, 1998). For social workers, empowerment is a process consisting of:

Exercising psychological control over personal affairs, as well as exerting influence over the course of events in the socio-political arena. ... Empowerment refers to a state of mind, such as feeling worthy and competent or perceiving power and control; and it also refers to a reallocation of power that results from modifying social structures (Miley & DuBois, 1999, p. 2).

Empowering people is also an important yet overlooked part of religious practice (Cnaan, 1999). For many Christians, empowerment comes through their spiritual journey. Belief in Christ enables many Christians to begin a journey where they examine more closely their relationship to Christ and any impediments that interfere with that relationship. This process, for many Christians, becomes a spiritual journey because so much of the process is based on faith rather than fact.

Empowerment is particularly germane when working with clients of different cultural groups. Social work literature has pointed out the need to recognize the specific and special needs of groups, such as Puerto Ricans (Delgado & Tennstedt, 1997) and African Americans (Carter, 1999). In fact, the person-in-situation perspective demands that social workers understand people from the standpoint of their culture. There has been some reluctance, however, to recognize conservative Christianity as a separate culture.

This paper discusses the culture of conservative Christianity, through the example of Pentecostalism; it also presents the process and outcome of deliverance-based practice within the Pentecostal movement and how social workers can work in consort with this approach for the good of the client.

Conservative Christian Culture

Conservative Christians are in many respects a unique culture (Carpenter, 1997; Denton, 1990). For example, much conservative Christian thought is impervious or indifferent to modern thought. Indeed, Alvarez (1998) faults conservative Christians, such as Pentecostals, for failing to "engage with modernity" (p. 12), and Moyers (1990) asserts that "fundamentalism discourages awareness of other religions, the humanities, and modern critical thought" (p. 43).

It is often difficult to accurately describe the belief systems of different cultures. Too often, scholars, media, and other interested parties rely on broad generalities. Conservative Christians, however, are a broad-based group of people sharing some similar values and tenets. At the same time, they are a diverse group of individuals with beliefs and views that are not shared among other Christian groups. Many conservative Christians adhere to a literal interpretation of the Bible (Denton, 1990; Moyers, 1990) and share a worldview, which sees "human nature ... as inherently flawed and sinful" (Moyers, 1990, p. 42). According to Moyers (1994), "The life of the believer is marked by ... adherence to a strict moral code" (pp. 190-191). Further, for many conservative Christians, "Religion permeates every aspect of family life-interpersonal relationships, roles, family boundaries, relationships to community, and help-seeking behavior" (Denton, 1990, p. 10). Denton (1990) describes some conservative Christians as having a hierarchical orientation whereby the husband has authority over the wife, the family over the individual, and the church over the family. He also cites a strong prohibition against abortion and divorce as normative among many conservative Christian families (Denton, 1990). Finally, Denton (1990) states that among these families, there is "a reliance on faith that leads to a passive approach to life" as well as "a strong `we vs. them' mentality that encourages members to seek help from only the church" (p. 8).

The Pentecostal Movement

Pentecostalism, a conservative Christian movement, is uniquely American (Koenig, Meador, Blazer, & Dyck, 1994). The movement borrows from the Holiness religion, an offshoot of Methodism (Wilson & Clow, 1981). The Pentecostal movement includes individuals who believe that the miracles and practices of Jesus continue today just as they did before Pentecost (Parker, 1996; Ruthven, 1997). As opposed to more mainstream Protestant groups, such as the United Methodists, most Pentecostals practice an experience-based theology-that is, Pentecostalism often emphasizes emotion as opposed to logic. In fact, Menzies (1985) notes that "a common complaint against Pentecostals is that they experience something, then rush to the scripture after-the-fact for a rationale for what happened to them" (p. 12).

Indeed, there is a strong emphasis on emotional experience and "release" during Pentecostal worship. In fact, most Pentecostals tend to be more experiential and emotionally expressive than other Christian movements (Koenig, George, Meador, et al, 1994). Moreover, many Pentecostals de-emphasize formality in their worship experiences. Instead, most Pentecostals rely on the Holy Spirit to direct them. In general, most Pentecostals tend to have a "simple faith." Unlike more liberal Christians, most Pentecostals and other conservative Christians rely more on personal experience than written theology.

For many Pentecostals, faith is based on a belief that when they join the church they have undergone a deep emotional and spiritual conversion during which they have been "born again." Many people attracted to the Pentecostal movement want to leave behind problems, such as addiction or personality issues. Instead of seeking help from a therapist to work on their problems, they are drawn to Pentecostalism; they go to the church for help as opposed to a therapist. Many of these people are looking for something that will "jolt them out of their spiritual doldrums and complacency" (Young, 1998, p. 51).

Most Pentecostals practice a language called glossolalia, or speaking in tongues, (Hughes, Cross, & Slay, 1996; Young, 1998). This practice can confuse other Christians who do not practice the language, and non-Christians who may be unfamiliar with it. This paper does not focus on this issue, but points to it as a practice that is common to many Pentecostals. Glossolalia highlights the Pentecostal movement, which for many non-Pentecostals is a mystery that cannot be logically analyzed (Syrian, 1971).

As stated earlier, some people with a variety of problems, such as alcohol and drug addiction, personality problems, and other mental health needs are drawn to Pentecostalism. This is not to suggest that Pentecostals, as a group, are generally mentally ill. It does suggest that Pentecostalism tends to draw an overrepresentation of people with emotional problems (Koenig, Meador, Blazer, & Dyck, 1994). One reason for the higher incidence of mental health problems is that Pentecostal worship is so highly energized and "free," yet much of Pentecostalism doctrine is repressive and inflexible. Freud (1907) referred to a dissonance that occurs in people who live in such an apparent dichotomy.

An alternative explanation is that many people with certain types of mental health problems prefer the Pentecostal experience because it provides both structure and freedom of expression. Further, people are frequently drawn to a particular denomination because of their personality style, and there has been research on this linkage (Clarke, 1983; Michael & Norrisey, 1984; Osiek, 1985). Obviously, one's view of God also influences what kind of psychological change one accepts. Pentecostalism also tends to appeal to people with lower socioeconomic backgrounds who commonly lack advanced education (Conn, 1996; Land, 1994). Mental illness is disproportionately represented among lower socioeconomic status groups. In fact, the Pentecostal movement has been described as functioning like a community mental-health center (Griffith, 1984). Thiven this, it is not surprising that Pentecostals with mental illness are not often seen in traditional mental health settings. Psychologically, it is then the Pentecostal minister who becomes a therapist who will "heal" the afflicted.

There has been little emphasis on formal advanced education for Pentecostal pastors. For example, in The Church of God, Cleveland, Tennessee (which is one of the larger denominations within the Pentecostal movement), less than five percent of its pastors have more than a high school degree (Crick, 1997). The Pentecostal movement is very fluid, and more formal education is now being encouraged. One result of a less-educated clergy is that theological and/or church disputes are settled without reference to standards that might be drawn from the fields of psychology, counseling, or other educational disciplines. Moreover, some Pentecostal pastors are dealing with significant mental-health issues without benefit of information that could be drawn from a post-secondary education. Thus, in their attempts to understand sometimes puzzling human behaviors, while viewed as feeble by experienced cliniclans, they use the tools they understand best, which are the Bible and human experience.

Deliverance Based Practice

The focus of much Pentecostal worship is the altar call, which involves the physical approaching of the altar by church members (petitioners). Their pastor has instilled, through preaching, that the member will be "delivered" from their problems. It is a highly emotional experience in which the petitioner often cries and shouts with joy as he or she believes that the Holy Spirit has "fallen" down on them and they have been "delivered." Their problems are supposed to be literally "washed away," and they can leave the altar a "healed" and/or "delivered" person. For many Pentecostals, the altar call includes a combination of practices involving deliverance, healing, and exorcism.

Some authors have argued that the Pentecostal movement and its use of deliverance practice is "compensatory" by offering compensation in the hereafter for "the pains of the present (deprivation, marginality, insecurity, anomie, and so forth)" (Koenig, George, Meador, Blazer, & Dyck, 1994, p. 594). Not surprisingly, many Pentecostal Christians view deliverance practice as a source of liberation. The Pentecostal movement offers a cause to believe in, something that is more palatable and understandable than traditional therapy. Most Pentecostals practice deliverance as a normal function of the church (Bull, Ellason, & Ross, 1998). Deliverance practice has not received much attention in the literature, perhaps because it is a religious practice, and religious groups in general are not noted for scientifically exploring their traditions.

Deliverance practice is used to treat a variety of conditions, many of which resemble mental illness. It needs to be noted that many Pentecostals blur the definitions of deliverance, healing, and exorcism. For many Pentecostals, there is a relationship between mental illness and demon possession, a term commonly used in the bible to refer to mental illness. Mental illness is often described in the Bible as demon possession. Mark 9:17-21 describes the "spirit" being exorcised. Jesus commands the spirit to "come our of him and never enter again." Who was the spirit in these verses? Thomas (1988) points out that, for many Pentecostals, the spirit represents a mixture of illnesses, which is both psychological and physical. Therefore, most Pentecostals accept as normative the practice of blending together healing, exorcism, and deliverance.

The concept of demon possession is not new to mental health practice (Bowman, Coons, Jones, & Oldstrom, 1987; Hale & Pinniti, 1994). Clinicians have long described behaviors that are so bizarre that they defy explanation. Rokeach (1964) describes three men hospitalized at Ypsilanti State Hospital who maintained they were Jesus Christ. The three men were brought together but continued to maintain their beliefs. While Rokeach could explain much of the behavior of the three men, much could not be explained. Rokeach's example shows what many clinicians have lost with the advent of the various editions of the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the associated, more detailed categorization of "mental illness," which is the fact that much of "mental illness" is unexplainable. The Pentecostal movement has captured the notion that human behavior consists of complex and often difficult-to-- understand phenomena.

Some people engage in behaviors that they and nonclinicians consider to be horrific. This is particularly true of people with DSM-IV, Axis II, Cluster B-- type traits; this cluster includes anti-social, borderline, narcissistic, and histrionic personality disorders (American Psychiatric Association, 1994). Rosik (1997), in reviewing the literature on demon possession, found that several of the attributes of demon possession are related to DSM-IV, Axis II disorders. Rosik points out that these individuals manifest a variety of symptoms, such as the presence of a different voice in the individual, particularly one provoking fear or hatred. In addition, people manifest the occurrence of unwanted, forced behavior. Many of these individuals exhibit an anesthesia to pain as well as superhuman strength. Some individuals manifest a separate personality. Moreover, individuals will experience the entity of not being part of themselves. Therefore, dissociation, confusion, or a clouding of consciousness are common symptoms. Often, these individuals do not benefit from therapy or medication, and frequently manifest addictive patterns of behavior, telepathy, clairvoyance, and/or paranormal knowledge.

There is a long history in the Pentecostal movement of labeling these "strange" and "horrific" behaviors as being driven or directed by some outside force, such as demons. Many Pentecostals view the Bible literally in regards to "deliverance," "healing," and/or "demon possession," as do other conservative Christians. There are several examples in the New Testament of Jesus driving "demons" out of people. Some theological authors have taken a different approach and argued that there is a historical Jesus separate from the Jesus, Son of God (Herzog, 1999). For example, some authors have argued that when Jesus performed miracles, his purpose was to criticize the Temple (main temple in Jerusalem) (Crossan, 1973). These authors argue that miracles were performed to address social problems, such as debt forgiveness, as opposed to a "miraculous" healing (Belo, 1981).

Most Pentecostals do not adhere to what they perceive as liberal interpretations of the Bible (Faupel, 1996). Therefore, when Pentecostals do want to address mental health problems, they often do so within the confines of the Pentecostal movement. Those Pentecostals who have used secular mental health agencies often experience difficulties. Unfortunately, many professional mental health practitioners frequently demand changes that are overwhelming to the client. The first author treated a client who was suffering from major depression with psychotic features and who talked about their praying to God daily for a miracle. The client was told to "pay more attention to the medicine [prescribed by the psychiatrist] and not wait for a miracle." The client was devastated and quit taking the medication.

Many Pentecostals find it normative to view their problems in religious terms as opposed to using mental-health definitions. Mental-health clinicians use words such as pathology, clinical syndromes, and other terminology, which are foreign to many Pentecostal clients. People who are used to religious terminology may find it easier to view their problems as simply sinful. The imagery of Christ "washing away" one's sins (problems) enables the person needing help to gain some assistance in addressing their problems. This process is different than traditional psychotherapy where the impetus to change is placed solely on the individual.

For those individuals who approach the altar for deliverance, there appear to be predictors of those who are most likely to succeed. Rosik (1997) describes the traits common to people who are good candidates for deliverance: "the individual shows revulsion to the name of Jesus, maintains an arrogant or devious attitude, and the individual reports prior occult involvement" (p. 358). Many of the traits that Rosik (1997) identifies could be re-labeled using secular psychology terminology. For example, Millon (1981) used phrases such as adaptive inflexibility, vicious circles, and tenuous stability to refer to people who are pathological and could be described as being categorized on the II Axis of the DSM-IV. (The traits that Rosik (1997) and Millon (1981) discuss can be summed up as character disorders traits.) Fenichel (1945) referred to these traits as describing how the ego repeatedly "satisfies" the demands of the id, superego, and environment.

People with character disorders behave in selfdestructive and self-defeating ways to "satisfy" demands being made. Over time, a person with these issues can develop other problems, such as addiction, and other more severe forms of psychopathology.

Millon (1981), as well as Kaplan and Saddock (1998), argue that people with Axis II conditions (character disorders) do not easily change. Many studies of deliverance have focused on Dissociative Identity Disorder (DID; Bull, Ellason, & Ross, 1998); however, many of the church members (clients) who experience exorcism and/or deliverance in the Pentecostal church are not DID.

Instead, they are more likely diagnosed as Axis II, Cluster B. In the short run, the altar and the "cleansing" they are able to receive is often more productive than therapy. In a psychological sense, people with emotional problems are able to "change" without much effort on their own. However, many people who experience deliverance, healing, or exorcism will continue to experience problems. Although the surface of personality changes, the core of personality remains unchanged. Therefore, the church provides an important aftercare environment.

Aftercare

Social work has long advocated for effective aftercare models (Vourlekis, Edinburg, & Knee, 1998). Moreover, it is important for discharge planning to insure that clients receive proper aftercare (Belcher, 1997). The literature makes clear that people with Axis II disorders are best treated in a comprehensive model which includes aftercare (Millon, 1981).

After their deliverance, members of the church set up a caring environment for new adherents to the faith. Care consists of regular attendance at church and the ongoing use of "accountability." In this process the "delivered" person teams up with another church member or group of church members, and they engage in ongoing Bible study, prayer, and discussion about one's life. If one of the members begins to engage in "old" behaviors or behaviors that are deemed problematic to the member, such as having an extramarital affair, the "accountability" partner may urge the member with problems to pray more, attend church more, or in some way change their behavior.

Members do not receive any therapy per se; however, ongoing support is available. In many respects, much like the 12-step programs that become a way of life for people, some conservative Christians use the church as an ongoing process of recovery. Aftercare, within the Pentecostal context, recognizes that people will "backslide."

While mental health clinicians would use words, such as regress, decompensate, or the reemergence of symptoms to describe backsliding and urge appropriate mental health treatment, many Pentecostals simply acknowledge the behavior and urge the participant to change with the help of the church.

The pastor may appoint one of the elders to pray or "counsel" a particular member. "Counsel" usually involves pointing out how the behavior the member is exhibiting is contrary to God.

More often than not, counsel focuses on specific issues, such as the use of profanity, not loving your spouse by ignoring him or her, and yelling rather than listening. Despite aftercare, there are situations that bring these clients to the attention of professional social workers. First, although there have been calls for more well trained conservative Christian-- pastoral counselors to step forward (Vining, 1995), there remains an inadequate supply of such counselors.

Further, there is an upsurge in people first contacting pastors for mental health needs concomitant with an increase in the number of malpractice suits brought against pastors (Miller, 1998).

Moreover, many of the individuals who present themselves to pastors for assistance have premorbid functioning that is quite poor; their problems are so severe, or the aftercare is so incomplete, that the church member (client) needs to seek professional help. A confluence of these factors means that social workers are increasingly likely to encounter Pentecostal or other conservative Christians in their practices.

Implications for Social Work Practice

Social workers are likely to treat people after their deliverance experience and when problems from the past have resurfaced. The first temptation in addressing an individual who has undergone deliverance is to undo the process. But the client has come looking for treatment-not to have his or her theological position challenged.

This is not to suggest that the social worker needs to be a Pentecostal or a Christian, but the Pentecostal may use a language that is foreign to the social worker. For example, Pentecostals generally verbalize God's intervention in their lives. The client may point out that they talked with God today and God directed them to behave a particular way. The social worker may become easily frustrated by the apparent inability of the client to speak the same language as the social worker.

At this juncture it is important for the social worker to engage in culturally sensitive practice. Instead of the social worker trying to have the client reframe the client's problems or experiences in a different language, the social worker should join the client in the client's sense of reality. This is not to suggest that the social worker needs to agree with the client's perception of demon possession. However, the concept of demon possession may enable the client to better describe the behaviors and problems they have experienced. It is important to realize that the conservative Christian client may be frightened by going to see someone who is not a conservative Christian. Efforts to change the person's theology or confront the culture in which they live their lives will both offend the client and make the client further distrustful of clinical intervention. The social worker should allow the client to express his or her view of their problems without assuming that the client is pathological because of their language or concepts.

After the client has "unloaded," the social worker can begin the process of understanding the problem and developing a strategy of intervention. Unfortunately, there is a tendency to try to draw clients away from their roots. The "earthiness" of many Pentecostals in which they freely describe their experience with God can be disarming. The social worker needs to develop an intervention that respects the client's culture. For example, the social worker should, with the client's permission, contact the client's pastor or encourage the client to continue to go to church. If the client finds comfort in prayer, the social worker should encourage the client to continue this practice.

Case Example

A member of a local Pentecostal congregation approached the first author for counseling. The first author is both a social worker and a pastoral counselor. The client complained that their marriage was "falling apart." As the counselor listened, the client began to talk about how they once drank heavily and met their spouse at a revival meeting where they both had been delivered from their drinking and depression. The client attended church regularly with their spouse, but the client had begun to drink because they were under so much stress.

The counselor reflected back to the client presenting the problem in a clinical manner that also acknowledged the client's "deliverance," stating, "I understand what you believe God has done for you, and I encourage you to take your burdens to God in prayer. I also feel that your drinking is masking a major depression, and I want to begin cognitive behavior therapy as well as refer you to a colleague of mine who will evaluate you for medication." The counselor frames the problem and the treatment in a way the client can understand and recognizes the importance the client places on prayer and the church. He also recommends, in addition to prayer and involvement in church, that the client engage in cognitive behavior therapy (CBT; a secular intervention) and that the client be evaluated for medication (a secular intervention).

The client was able to accept these suggestions, continued with their church experience, and benefited from CBT and antidepressants. The counselor was able to address the marital problem by encouraging the client and spouse to attend a marriage enrichment program and subsequent couples' retreat at church and also contract for three sessions of marital therapy with the counselor. The result of the counselor acknowledging the client's faith and the use of secular therapeutic tools enabled the couple to grow and work out many of their problems. The identified client recovered from depression and quit drinking. Problems, which many clinicians would label as being character-driven, persisted, but the couple was able to stay together with the help of the church.

Conclusion

There is much in Pentecostal practice that raises concerns among clinicians who are not Pentecostal or another type of conservative Christian; concepts that raise concern include being born again and speaking in tongues.

The purpose of this article is not to argue that social workers should change their views to accept a practice they are either against or uncomfortable with. Instead, culturally sensitive practice demands that the social work profession understand Pentecostal practices, such as deliverance.

At the same time, it is clear that research needs to be conducted on certain practices, including deliverance. Indeed, Cascio (1998) argues that one reason social workers shy away from dealing with religious and spiritual issues in practice is that they have misconceptions and biases about many religious groups. Research of various religious communities, such as conservative Christians, can help provide knowledge and dispel myths.

Further, the mental health environment is changing for a great many Americans. with many people turning to the church for assistance with mental health problems before turning to secular counselors (Belcher & Hall, 1999).

In addition, conservative Christian groups, such as Pentecostals, have been growing rapidly, whereas more mainline Protestant denominations, such as the United Methodist, are declining (Brinkley, 1998; Carpenter, 1997). Pentecostals are no longer a fringe group that should be dismissed by mental health professionals (Poloma, 1996).

Therefore, social work practice needs to find ways to build bridges to better facilitate the process of referral from conservative Christians. There have been bad feelings and distrust between conservative Christians and social work practitioners for too long. Reamer (1998) emphasizes the importance of collaboration and the need for continuing practice knowledge.

Many individuals who engage in religious deliverance have continuing mental health needs that ultimately are likely to be addressed in a psychiatric clinic, community mental health center, or other practice arenas. Culturally based, sensitive practice is one model that enables the two groups to work together.

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John R. Belcher is a professor, and Toni Cascio is an assistant professor, School of Social Work, University of Maryland, 525 West Redwood Street Baltimore, MD 21201.

Original manuscript received: May 12, 2000

Accepted: August 10, 2000

Copyright Manticore Publishers Jan/Feb 2001
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