Therapy With the Nonreligious

Therapy With the Nonreligious: Ethical and Clinical Considerations

Ethan Sahker The University of Iowa

Current estimates suggest anywhere from 16% to 23% of American adults and 33% of adults under the age of 30 identify as nonreligious. Many people experience spiritual struggles and may seek counseling when deciding to leave the religion of their family of origin. The current state of nonreligiousness in America suggests psychologists may see an increase in clients who experience spiritual struggles and could be deciding to leave their family religion. Psychologists may not feel prepared to work with such clients, or actively avoid religious discussions. Being prepared to work with nonreligious clients and the unique issues they bring to treatment calls for a practical evaluation of ethical and clinical considerations. Demographic trends suggest nonreligiousness is a topic that will only become more relevant to psychology, and beginning an exploration now will greatly contribute to the profession at an opportune time.

Keywords: atheism, religious disaffiliation, deconversion, spiritual struggle

Many people experience spiritual struggles and may seek coun- seling when deciding to leave the religion of their family of origin. In fact, the number of nonreligious Americans is increasing (Key- sar, 2014; Kosmin, Keysar, Cragun, & Navarro-Rivera, 2009; Pew Research Center, 2012, 2015). Current estimates suggest anywhere from 16% to 23% of American adults identify as nonreligious (Keysar, 2014; Pew Research Center, 2012, 2015). Moreover, approximately 33% of adults under the age of 30 identify as nonreligious (Kosmin et al., 2009; Lipka, 2015; Pew Research Center, 2012). These trending numbers suggest psychologists may see an increase in clients who struggle with the decision to leave their family religion. With this increase, it is important psycholo- gists are aware of ethical considerations and understand the fea- tures that accompany clients’ spiritual struggles. Existing research focused on the intersections of religion, spirituality, and clinical practice is generally concerned with integrating religion and spir- ituality into practice, increasing therapist competence with reli- gious beliefs of the client, and assessing for religious concerns (Cornish & Wade, 2010; Gonsiorek, Richards, Pargament, & Mc- Minn, 2009; Hodge & Nadir, 2008; Hodge, 2006). Nevertheless, little research has focused on the mental health outcomes associ- ated with clients leaving their childhood religion (Brewster, Rob-

inson, Sandil, Esposito, & Geiger, 2014; Hwang, Hammer, & Cragun, 2011; Whitley, 2010).

Understanding nonreligious clients is important for psycholo- gists because the ethical considerations have not yet been dis- cussed in the area of nonreligiousness, religious struggle, and deconversion. Navigating client goals can be the cause of ethical dilemmas and potential therapeutic ruptures depending on the therapist’s values (Delaney, Miller, & Bisonó, 2007, 2013; Gon- siorek et al., 2009). Many clients may experience phases of reli- gious deconversion, a process of disaffiliation from the religion of their family of origin (Altemeyer & Hunsberger, 1997; Bainbridge, 2005; Hunsberger & Altemeyer, 2006; Smith, 2011). This decon- version may be a source of clinical concern (Altemeyer & Hunsberger, 1997; Cragun, Kosmin, Keysar, Hammer, & Nielsen, 2012; Exline, Kaplan, & Grubbs, 2012; Exline, Yali, & Sanderson, 2000). Psychologists ill prepared to work with these issues are at a disadvantage and risk making uninformed clinical decisions. On the whole, psychologists tend to rank higher across academic disciplines in terms of nonbelief in God at approximately 50% (Shafranske, 1996). Other studies have found the percentage of nonbelief to be at about 70% (Delaney et al., 2007, 2013). Psy- chologists do find that religion is important to consider in mental health, yet they rarely inquire about it (Delaney et al., 2007, 2013). This lack of inquiry may be due to the disparate religious makeup of Americans compared to psychologists (Delaney et al., 2007, 2013; Pew Research Center, 2012; Shafranske & Malony, 1990; Shafranske, 1996). This difference calls for a critical evaluation of clinical and ethical considerations as there may be a relevant interaction between client and therapist beliefs and values within therapy.

This article addresses the gap in the literature by highlighting ethical issues that may arise when working with nonreligious clients experiencing spiritual struggles and consequences related to deconversion. The purpose is to begin developing an understand- ing of ethical considerations for (a) issues related to the nonreli- gious, (b) ethical considerations for working with the nonreligious, and (c) clinical issues associated with the nonreligious. The goal of

This article was published Online First July 14, 2016. ETHAN SAHKER received his MA from Chatham University and is cur-

rently a doctoral-level student in counseling psychology at The University of Iowa. He works as a graduate research assistant at the Iowa Consortium for Substance Abuse Research and Evaluation. His areas of professional interest include addictions treatment for underprivileged groups and out- comes related to access; marijuana use treatment; underresearched reli- gious, spiritual, and nonreligious groups; masculinity in religion; and atheist identity and relationships.

CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Ethan Sahker, Counseling Psychology Program, Department of Psychological and Quantitative Foundations, The University of Iowa, 361 Lindquist Center, IA City, IA 52242. E-mail: ethan-sahker@uiowa.edu

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Professional Psychology: Research and Practice © 2016 American Psychological Association 2016, Vol. 47, No. 4, 295–302 0735-7028/16/$12.00 http://dx.doi.org/10.1037/pro0000087

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this article is not to suggest mandates for training or inclusion. Rather, the goal is to begin a discussion of the relevance nonreli- gious concerns have in an increasingly nonreligious society.

Issues Related to the Nonreligious

Spiritual Struggle

Researchers in the area of religion and spirituality assert that religion and spirituality are two disparate but overlapping con- structs. Religion consists of traditional and institutional rules and observances, whereas spirituality consists of subjective beliefs surrounding one’s relationship with existence and/or creation (Hill & Pargament, 2003; Saucier & Skrzypińska, 2006). Worthington and Aten (2009) introduced four dimensions of spirituality sug- gesting a superordinate construct of spirituality with subordinate relationships to something greater: (a) religious spirituality—a connection to God or deity, (b) humanistic spirituality—a connec- tion to people, (c) nature spirituality—a connection to the earth, and (d) cosmos spirituality—a connection to the universe. Spiritual struggle is defined by conflicting intrapersonal, interpersonal, re- ligious, and spiritual beliefs causing significant distress, negative affect, and anger at God and/or religious institutions (Abu Raiya & Pargament, 2010; Pargament, Murray-Swank, Magyar, & Ano, 2005). This spiritual struggle can lead to a strengthening and recommitment to religious affiliation and belief (Pargament et al., 2005). Conversely, spiritual struggles have been linked to in- creased depression and suicidality at the extreme (Exline et al., 2000). More likely however, this struggle can lead to a rejection of religion and process of religious disaffiliation known as deconver- sion associated with its own mental health outcomes (Hunsberger & Altemeyer, 2006; Smith, 2011).

Deconversion

Researchers have recently begun to develop defining features central to the meaning of being nonreligious in America. The primary conceptualization of identity is concerned with the process of deconversion (Hunsberger & Altemeyer, 2006; LeDrew, 2013; Smith, 2011). Deconversion is the act of leaving a religion because of changing personal beliefs precipitating from life events unique to each person (Hood, Hill, & Spilka, 2009). Smith (2011) pro- posed the rejection model of atheist identity which includes (a) the ubiquity of theism—the ever-presence of religion in one’s life, (b) questioning theism—experiencing religious doubts and exploring personal beliefs, (c) rejecting theism—an internal position of dis- belief and separation from religion, and (d) coming out—claiming one’s rejection of theism in a public manner. This model of deconversion may be helpful in conceptualizing clients with dif- ferent religious and spiritual struggles. Other features of the non- religious highlighted in the literature relevant to spiritual struggle and rejecting religion are prejudice and discrimination (Cragun et al., 2012; Gervais, Shariff, & Norenzayan, 2011; Hammer, Cra- gun, Hwang, & Smith, 2011), family and romantic relationships (Hunsberger & Altemeyer, 2006; Smith, 2011), and community or organizational support (Cimino & Smith, 2011; Guenther, Mulli- gan, & Papp, 2014). In addition, intellectual and ethical develop- ment may be salient to college-aged clients (Perry, 1970) and a possible precursor to spiritual questions and struggles.

In Perry’s (1970) theory of intellectual and ethical development, people are forming a system of beliefs from knowledge learned from authority and wading through their own experiences to de- velop identities through developmental positions. Perry cites nine positions within the four overarching stages of (a) dualism, (b) multiplicity, (c) relativism, and (d) commitment. These intellectual and ethical stages may help psychologists to understand a deeper mental representation of what a client understands as truth while navigating through the four stages of deconversion. First, dualism is learned morality accepted as dictated by authority. Next, multi- plicity is the notion that multiple truths can exist simultaneously and that one’s personal truth is garnered by weighing the least wrong answer. Then, relativism is a deeper understanding, analy- sis, and evaluation one’s own beliefs. Relativism may lead to a disengagement from religious authority and religious assertions. Finally, commitment is the integration of knowledge learned from authority but examined from one’s personal lived experience. This position may lead to a more solid and secure identity (Perry, 1970).

Psychologists can conceptualize clients within the deconversion model. Though it is a model of atheist identity, those experiencing spiritual struggle may be at relevant levels of the model. To add further nuance, Perry’s (1970) theory of intellectual and ethical development may help to conceptualize a client’s rationale for separation from previously revered religious authority. Both Smith (2011) and Perry’s (1970) models may be helpful in case formu- lation and treatment planning. Treatment needs may vary based on where one lies in the deconversion model and interventions may correspond with client readiness to discuss such topics.

Ethical Considerations for Working With the Nonreligious

The ethical considerations involved in working with the nonre- ligious or those going through spiritual struggles may be similar to literature concerned with integrating religion and spirituality into clinical practice. For instance, a theme in religious and spiritual ethics literature focuses on competence (Delaney et al., 2013; Gonsiorek et al., 2009; Hodge & Nadir, 2008; Magaldi-Dopman & Park-Taylor, 2010). First, this article is an effort to begin the discussion on psychologists’ competence with nonreligious cli- ents. Second, and related to competence, a lack of training and education is consistently highlighted in the religious and spiritual literature (Gonsiorek et al., 2009; Magaldi-Dopman & Park- Taylor, 2010; Schulte, Skinner, & Claiborn, 2002; Shafranske & Malony, 1990; Shafranske, 1996). Third, assessment issues are similar with religious and nonreligious clients (Garfield, Isacco, & Sahker, 2013; Hodge, 2006; Oakes & Raphel, 2008) and have been discussed specifically for nonreligious clients (Cragun, Hammer, & Nielsen, 2015; Goodman & Mueller, 2009). The nuances left to the unknown are perhaps the most important issues needing to be raised in the scholarly literature. The differences associated de- conversion and spiritual struggle are varied but are primarily focused on the space given to the client to maintain autonomy, respect for client rights and dignity, and psychologist competence. Awareness of client autonomy may suffice in working with the nonreligious. However, conceptualizing within a model of decon- version may help to bring a focus on nuanced developmental issues.

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Competence

When working with any minority group or with a client whose background is different than the therapist’s, boundaries of compe- tence (Standard 2.01) are at issue (American Psychological Asso- ciation, 2010). Gonsiorek et al. (2009) suggested four questions a psychologist should ask to assess their own competence in inte- grating religion and spirituality into practice. They described the need for the psychologist to (a) create a safe environment affirm- ing and accepting of spirituality, (b) assess for religiosity and spirituality, (c) use interventions to aid in accessing of resources, and (d) consult with community religious figures. The same may be true for the nonreligious. However, there are other issues such as knowledge of religious background differences, knowledge of the outcomes associated with deconversion, and desire to disclose therapists’ values and beliefs. In addition, for psychologists to successfully create a safe environment they must first address their own personal problems and conflicts (Standard 2.06) as it pertains to their own religious beliefs and beliefs about others’ nonreli- giousness (American Psychological Association, 2010).

Religion and spirituality are imbued throughout ethnicity and family dynamics, making it an important component of cultural competence (McGoldrick, Giordano, & Garcia-Preto, 2005) and potential identity differentiation from one’s family of origin. Cre- ating and affirming a safe environment to explore spiritual strug- gles and deconversion is upholding multicultural competence as it pertains to religion, or lack thereof (Sue, Arredondo, & Mcdavis, 1992). In addition, it is upholding many of the ethical principles— specifically Principle E, Respect for People’s Rights and Dignity, by being aware of the client’s cultural and individual differences and removing bias from the work (American Psychological Asso- ciation, 2010). Moreover, an affirming space would provide a healthy place for self-discovery to unfold in the decision to re- commit to the religion of their family, reject theism, or come out to friends and family.

Assessing for religiosity and spirituality may be aided by gath- ering a religious or spiritual history. It may include further ques- tions important to case conceptualization as outlined by Hodge and Nadir (2008) or tailored to communities as outlined by Goodman and Mueller (2009). Gathering a spiritual assessment can aid in understanding family religious background information important to issues such as differences among religious groups.

Religious background differences. Some nonreligious peo- ple report poor relationships with family members due to decon- version and coming out (Hunsberger & Altemeyer, 2006; Smith, 2011). For example, family relationship conflicts may be an issue with ex-Muslims due to Islam’s negative views of apostates (Saeed, 2011). In addition, some nonreligious people report expe- riencing prejudice and discrimination (Gervais et al., 2011; Ham- mer et al., 2011), which is likely to come from their own family (Cragun et al., 2012). This may be doubly troubling with the ex-Muslim nonreligious who are already experiencing anti- Muslim prejudice and discrimination (Ali, Liu, & Humedian, 2004; Schlosser, Ali, Ackerman, & Dewey, 2009).

Clients from a wide variety on ethnic and cultural backgrounds may be experiencing deconversion, yet may wish to maintain certain traditions and customs related to their cultural upbringing. For example, some Muslims (Froese, 2004) and Jews (Schlosser et al., 2009) have a tendency to view their religious backgrounds as

cultural or ethnic. This unique identity may lead to the desire to maintain Muslim and Jewish cultural practices such as halal or kosher restrictions in the absence of belief in God. Understanding one’s cultural capital may help in improving social support for those clients interested in maintaining certain cultural practices.

If the client comes from a family of low religious importance, the process of deconversion may be an easier topic to broach. Yet, this is not necessarily the case as was shown in Altemeyer and Hunsberger’s (1997) study on amazing conversions. They found that college students raised in the most extreme levels of religious- ness had a group of “amazing apostates” who could not make themselves believe despite the negative family consequences. Likewise, some raised with the least amount of religiousness came to develop a high level of religiousness on their own. Dubbed “amazing believers,” they found comfort and solace in their reli- gious and spiritual beliefs. Without acquiring the competence to understand these clients many opportunities may be lost or ap- proached in less effective conceptualizations. Psychologists would be better served by increasing their competence on religious and spiritual struggles and the process of deconversion for diverse religious groups. One method of gathering the information neces- sary to form appropriate case conceptualizations is to conduct spiritual assessments.

Assessments

Spiritual assessments are not new to psychology. There are many existing assessments on the topic of religion and spirituality (Hood et al., 2009). Instruments measure a number of different correlates of religiosity and spirituality (e.g., commitment, church attendance, prayer frequency, connection to something greater). However, many assessments are aimed at the religious, or are more research-oriented instruments (Cragun et al., 2015; Hwang et al., 2011). Furthermore, the measurements do not help to differentiate between subgroups within the religiously unaffiliated and may not provide the necessary information needed for clinical work with the nonreligious (Cragun et al., 2015). Psychologists are required to base their clinical interpretations of assessments on proven and sufficient instrumentations (American Psychological Association, 2010). However, many of the existing religious and spiritual assessments lack the validity and reliability needed (Cragun et al., 2015) and, in this sense, are conflicting with ethical standards concerning the use of assessments (American Psychological As- sociation, 2010). Moreover, beneficial assessments may be less associated with instrumentation and more pertinent to questions guiding informed case formulation and conceptualization.

Perhaps a structured assessment is not appropriate for many psychologists working in individual therapy settings. An alterna- tive approach is to conduct a spiritual history at intake or when otherwise indicated. This may be as simple as asking if religious and/or spiritual concerns are present. An answer to this question may halt further inquiry. However it may signal a need for further clinical investigation. Spiritual history assessments are gaining traction in other health care settings as health practitioners find them increasingly useful (Garfield et al., 2013; Koenig, 2000, 2002). Koenig (2000, 2002) suggests questions helpful in conduct- ing spiritual assessments. Koenig’s spiritual history assessment, modified for psychological assessment with nonreligious, may be administered as such: (a) Is religion or spirituality important to

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you? (b) Do your religious/spiritual beliefs, past or present, pro- vide comfort or do they cause stress? (c) Do you have someone to talk to about religious/nonreligious matters? and (c) Would you like to explore religious/nonreligious matters with someone? Fur- ther, the assessment may serve as a useful intervention in and of itself (Koenig, 2000).

Training

Educational programs in psychology lack sufficient training needed to work with a focus on religious and spiritual issues (Cornish & Wade, 2010; Delaney et al., 2007; Gonsiorek et al., 2009; Miller & Thoresen, 2003; Schlosser et al., 2009). Although programs focus on multiculturalism, work with religious and spir- itual issues in particular may be less of a focus. Nonreligious training may be lacking to an even greater extent. The ethical issues underlined by competence and assessment cannot be satis- factorily addressed if training is lacking. Training directors are responsible for including content fulfilling of appropriate knowl- edge and experience (American Psychological Association, 2010). Psychologists do agree that work involving religious and spiritual issues is important in clinical practice but may not feel comfortable addressing it (Delaney et al., 2007, 2013). This may be due to a lack of training and uncertainty about how to address such issues.

Unlike psychology, the psychiatric profession has mandated training on religious and spiritual factors (Koenig, 2009). Though this may be a difficult task in psychological training programs, Gonsiorek et al. (2009) suggest several topics to include for appropriate training: (a) ethical examples in spiritually integrated therapy; (b) assessment addressing religious and spiritual needs, resources, and stressors; (c) religious and spiritual issues arising in psychotherapy; (d) an evidence base of religious and spiritual integrative treatments; (e) informed consent practices with reli- gious and spiritual issues; and (f) collaboration practices with religious community leaders. With all of these suggestions and other calls for more training, objectives focused on clinical issues uniquely related to nonreligious clients has been glaringly over- looked. With the increasing population of nonreligious Americans, and the potential for more issues to arise in clinical sessions, more discussion is needed.

Clinical Issues Associated With the Nonreligious

It is important to understand who the nonreligious are in a general sense to improve competence, training, and clinical assess- ment. Furthermore, psychologists may be able to improve the relationship and understanding of their client as cultural beings with a better understanding of issues related to the nonreligious. Figure 1 provides a theoretical model of assessment, conceptual- ization, and intervention for nonreligious clients based on work of Smith (2011); Perry (1970); Koenig (2000), and Gonsiorek et al. (2009). This model is meant to help guide psychologists when presented with clinical issues related to nonreligious clients. Im- portant clinical issues highlighted in the literature are (a) demo- graphics of the American nonreligious, (b) prejudice and discrim- ination, (c) relationship distress, and (d) social support.

Demographics of the American Nonreligious

Pew Research Center (2015) reported 23% of American adults identified themselves as nonreligious. These nonreligious Ameri- cans have been referred to as religiously unaffiliated (Gervais et al., 2011; LeDrew, 2013; Merino, 2012) and the religious “nones” (Hwang et al., 2011; Kosmin et al., 2009; Pew Research Center, 2012). Further separation of American nonreligious identification suggests in 2012, 2.4% identify as atheist, 3.3% agnostic, and 13.9% are “nothing in particular” (Pew Research Center, 2012). However, the increase is apparent as the most recent religious demographics are trending up, putting atheists at 3%, agnostics at 4%, and the nothing in particular at 16% (Pew Research Center, 2015). The nothing in particular are comprised of unaffiliated believers (i.e., believe in nontraditional God/higher power) and unaffiliated nonbelievers (i.e., spiritual but not religious). None of the religiously unaffiliated belong to a religious organization, or attend a place of worship (Pew Research Center, 2012).

Clients in an active process of questioning religion may be struggling with personal beliefs and affiliations. In addition, there may be consequences unknown to the client as well as the therapist in terms of deconversion. Just because one is struggling does not mean they have made a decision to deconvert. Psychologists prepared to work with the nonreligious should be aware of their own religious and spiritual values. Psychologists’ religious values are important to note because of the historical psychological per- spectives on religion in clinical practice, as well as the current state of psychologists’ religious beliefs.

Lower levels of religiosity are associated with a slew of negative mental health outcomes (Exline et al., 2000; Garfield et al., 2013; Koenig, 2009). However, the samples in the religion/health asso- ciations do not contain nonreligious samples (Hwang et al., 2011). Therefore, outcomes related to the nonreligious specifically have primarily focused on religious struggle, deconversion, and athe- ism. Many of the issues pertaining to deconversion and spiritual struggle have to do with internal conflict and fear of relationship deterioration in the form of discrimination (Gervais et al., 2011), family and relationship stress and tension (Hunsberger & Alte- meyer, 2006), and lack of social support (Goodman & Mueller, 2009). The nonreligious have the choice to make public their disaffiliation from the religion of their family (Altemeyer & Hunsberger, 1997). Choosing to come out about atheist beliefs in a public manner is associated with some psychological and phys- ical losses (Altemeyer & Hunsberger, 1997; Exline et al., 2012; Hunsberger & Altemeyer, 2006; Smith, 2011). In addition to improving the boundaries of competence, understanding the de- mographics of nonreligious clients can aid in clinical assessment and gathering spiritual histories. For instance, if a client is expe- riencing discrimination in some form, psychologists understanding the difference between atheist and spiritual but not religious clients may be better prepared.

Prejudice and Discrimination

The nonreligious, especially atheists, are more likely to experi- ence discrimination from their own families and other social situations compared to other situations such as work, school, or the military (Cragun et al., 2012). The relationship between prejudice and its source may be related to fundamentalism and how religious families and religious organizations teach their children and mem-

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bers to dislike religious others (Altemeyer, 2003). For example, atheists are a religious minority in the United States (Pew Research Center, 2012) and may be prone to experiencing significant levels of stress and tension from prejudice or discrimination (Gervais et al., 2011; Hammer et al., 2011; Hunsberger & Altemeyer, 2006; Hwang et al., 2011; Smith, 2011). Other nonreligious clients may not experience such discrimination. However, the fear of making their nonbelief public may be a source of distress (Hunsberger & Altemeyer, 2006).

Distrust is one factor in promoting prejudice toward atheists (Gervais, 2013). Trust is lost when atheists are viewed by the religious in-group to be working against prosocial religious beliefs. Gervais et al. (2011) measured trustworthiness of different minor- ity groups. Participants rated the trustworthiness from 1 to 100. Their results demonstrated atheists were viewed as being less trustworthy than Christians, Muslims, feminists, Jews, and gay

men. Hard to believe as it may be, people are just as likely to trust a rapist as they are an atheist in a hypothetical scenario (Gervais et al., 2011). Trustworthiness may also be related to morality and the fear of nonreligious living immoral lives without religion (Edgell, Gerteis, & Hartmann, 2006). Perceived discrimination is related to some levels of nonreligiousness. Psychologists working with such clients can improve case conceptualization by understanding the presence of perceived discrimination, and the potential fear of discrimination from those who have not come out as nonreligious. Many perceived discrimination issues may give rise to rifts and distress emanating from one’s family of origin.

Relationship Distress

The Diagnostic and Statistical Manual of Mental Disorders 5 (American Psychiatric Association, 2013) defines a parent–child

Figure 1. A theoretical model of assessment, conceptualization, and intervention for nonreligious clients.

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relational problem as a clinical concern when the quality of the parent–child relationship causes mental or physical distress from stressors such as, parental control, excessive parental pressure, escalating arguments, and problem avoidance. Relational problems may lead to loss of family connectedness. Loss is defined as either a death or nondeath related separation that may lead to stress and mental illness (Bloom-Feshbach & Bloom-Feshbach, 1987). Indi- viduals may experience serious psychological, physical, and/or spiritual distress form grief experienced because of separation (Servaty-Seib, 2004). Furthermore, the feeling of stress and ten- sion may present as a reaction to anger at God or the feeling of alienation preceding deconversion (Exline et al., 2000). Family stress, tension, or distress may be factors of concern for nonreli- gious clients. Moreover, there may be significant levels of stress and tension experienced by the nonreligious coming from friends and romantic partners due deconversion (Hammer et al., 2011; Sahker, 2014).

For atheists in particular, the experience of deconversion has been likened to the lesbian, gay, bisexual, transgender, and queer (LGBTQ) experience of coming out due to similarities in minority status, choice to remain closeted or out, discrimination as a result of coming out, family responses, and perceived stigma (Brewster et al., 2014; Cragun et al., 2012; Smith, 2011). In addition, the coming out process has many parallels in perceived benefits such as empowerment and increased independence (Smith, 2011). As a reaction against discrimination, atheists have adopted a minority group approach to activism similar to LGBTQ groups (Cimino & Smith, 2007). Of course, the atheist experience cannot be consid- ered an equal phenomenon to the LGBTQ experience. However, the coming out process has similarities between both groups. Both atheist and LGBTQ populations experience significant distress because of prejudice and discrimination from their own families (Cragun et al., 2012; Newman & Muzzonigro, 1993). Furthermore, this prejudice may be related to religious values and lifestyles conflicting with dogma (Newman & Muzzonigro, 1993). Thus, the consequences related to coming out as nonreligious may cause relationship distress and may benefit from interventions aimed at increasing deficient social supports.

Social Support

Psychological and medical research suggests that being less religious is associated with decreased health and well-being (Baetz & Toews, 2009; Flannelly, Galek, Ellison, & Koenig, 2010; Hood et al., 2009). However, the relationship between health and religi- osity may be mediated by social support (Garfield et al., 2013; Pirutinsky et al., 2011). In addition, organizational programming may lack awareness about nonreligious groups (Goodman & Mu- eller, 2009). Therefore, developing support systems for nonreli- gious clients may provide positive identity development, feelings of inclusion, and nurture like-minded relationships (Goodman & Mueller, 2009; Smith & Cimino, 2012). Social support aids in one’s ability to cope with stress and religious communities in- crease social networks that nonreligious clients may lack (Horning, Davis, Stirrat, & Cornwell, 2011). Garfield et al. (2013) reported well-being may be related to religious service attendance as me- diated by social support. The nonreligious may not have the social benefits of a religious community. However, there are alternative

communities such as online forums, organized nonreligious orga- nizations, and university programming for the nonreligious.

Nonreligious organizations such as the Atheist Alliance of America and Atheists for Humanity and the American Humanist Society are groups where the nonreligious gather and may gain social benefits by belonging to a group. Smith (2013) found participation aids in identity development, increased activism, and volunteerism. Many nonreligious may not be active members and do not appear at group functions (Hunsberger & Altemeyer, 2006). In addition, many may not be interested in this type of organized group due to their values and presuppositions about such groups (Langston, Hammer, & Cragun, 2015). However, many are look- ing for a community to attend functions aimed at social gatherings, activism, conferences, debates, and volunteer opportunities and may serve the clients’ needs for support (Smith, 2013). The small amount of research on support groups for atheists has begun to highlight possible benefits for a group that perceives themselves as marginalized (Smith, 2013). Nonreligious organizations can pro- vide a place for atheists to develop a collective identity (Cimino & Smith, 2011; Smith, 2013). Nonreligious clients may benefit from an increased knowledge of these community support systems.

Conclusion

The increasing numbers of nonreligious Americans suggests a need to address therapeutic issues unique to this population. Many clients may be looking for a safe place to discuss doubts and spiritual discovery. However, many may be experiencing acute distress related to internal conflict involving nonbelief. To prepare for those seeking help for spiritual struggle and deconversion, psychologists can benefit from a better understanding of ethical considerations for working with the nonreligious and clinical is- sues associated with the nonreligious. Increasing therapist and researcher competence, assessment, and training in the area of nonreligious issues will aid in better practice. Furthermore, under- standing clinically relevant issues related to nonreligious clients will solidify a beneficial approach to practice. The theoretical model of assessment, conceptualization, and intervention for non- religious clients may be a helpful clinical tool to guide work in this area. Nonreligiousness appears to be a topic that will only become more relevant to psychology, and beginning a discussion now will greatly contribute to the profession.

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