Practice & Theory

Integrating Positive Psychology

Into Counseling: Why and
(When Appropriate) How
Alex H. S. Harris, Carl E. Thoresen, and Shane J. Lopez
Counseling psychology has a historical commitment to enhancing human strengths, a focus that has enjoyed broader
interest with the recent emergence of positive psychology. However, theory and evidence linking strength enhancement
to counseling goals are still relatively nascent. The authors outline rationales and practical strategies for integrating
strength promotion into counseling practice. Forgiveness and spirituality are used as examples illustrating the opportunities, limitations, and challenges of making strength promotion practical (and reimbursable) in counseling.

In recent years, the study of human strengths (termed positive

psychology) has enjoyed wider popularity. Positive psychology includes, among other topics, the study of subjective
experiences (e.g., well-being, satisfaction, flow, happiness),
individual traits or dispositions (e.g., capacity for love,
courage, hope, gratitude, patience, forgiveness, creativity,
spirituality, wisdom, humor), and interpersonal/group level
virtues (e.g., civility, sense of community, altruism; Seligman
& Csikszentmihalyi, 2000). Several books (e.g., Aspinwall
& Staudinger, 2003; Lopez & Synder, 2003; Walsh, 2003)
and special journal issues (e.g., The American Psychologist,
55[1]; Journal of Social & Clinical Psychology, 19[1]) have
been dedicated to positive psychology research and theory. In
these volumes, authors identify and define human strengths
and virtues; examine means of assessing these constructs;
and, to a lesser degree, describe efficacy studies of strengthenhancing interventions. However, relatively little attention
has been given to developing rationales or strategies that link
positive psychology to the daily work of counselorswork
that often involves the relief of acute suffering in a timelimited manner.
Counseling psychology was founded with a primary
orientation toward problems of adjustment and development
(vs. psychopathology), a focus on strengths and assets, and
an emphasis on relatively brief interventions (Gelso & Fretz,
2001; Lopez, Edwards, Magyar-Moe, Pedrotti, & Ryder, 2003).
However, applying positive psychology theory, research, and

interventions to counseling practice is easier said than done.

Increasing numbers of counselors are working in health care
settings (really illness treatment settings), such as hospitals,
community mental health centers, college counseling centers,
and psychotherapy practice, rather than strength-enhancement
settings, such as vocational counseling, education, executive
coaching, and strength-focused private practices (Fitzgerald
& Osipow, 1986; Neimeyer, Bowman, & Stewart, 2001). In
illness treatment settings, the biomedical model is dominant
and strength-based approaches may be viewed as ineffective,
frivolous, and even minimizing of serious problems. With few
exceptions, research does not exist directly linking strengthpromoting approaches or interventions to common, reimbursable counseling goals. For counselors drawn to the idea
of balancing psychologys focus on pathology with a focus
on fostering human strengths, these cultural and evidentiary
hurdles can loom large.
Our goal is to discuss applications of positive psychology
to counseling practice in pathology-focused settings, where
many counselors work. First, we discuss the main rationales
for increasing the prominence of positive psychology in
counseling practice. Specifically, how can strength promotion
be justified in the service of attaining common (and reimbursable) counseling goals such as the treatment of depression,
anxiety, substance abuse, and relationship difficulties? Put
more bluntly, we examine why anyone (e.g., clients, insurance companies) should pay counselors to focus on strengths.

Alex H. S. Harris, Department of Veteran Affairs Health Care System, Palo Alto, California; Carl E. Thoresen, School of Education,
Stanford University; Shane J. Lopez, Department of Psychology and Research in Education, University of Kansas. Preparation of
this article was supported by the Veteran Affairs Office of Academic Affiliations (first author) and by grants from the Fetzer Institute
and the John Templeton Foundation (second author). The views expressed here are those of the authors and do not necessarily
represent the views of the Department of Veteran Affairs or other affiliate institutions. Correspondence concerning this article should
be addressed to Alex H. S. Harris, Center for Health Care Evaluation (MC: 152), VA Palo Alto Health Care System, 759 Willow Road,
Menlo Park, CA 94025 (e-mail: Alexander.Harris2@va.gov).

2007 by the American Counseling Association. All rights reserved.

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Harris, Thoresen, & Lopez

Then, after discussing why strength promotion should be
done in specific circumstances, we discuss how it might be
done. Specifically, we discuss ways counselors might infuse
a strength orientation into current modes of assessment and
treatment, including identifying client strengths, using more
positive language and conceptualizations, and expanding the
counseling framework to include strengths and environmental
(outside the person) considerations. It must be emphasized that
we are not promoting positive psychology in a blanket manner.
Rather, we are raising the possibility that strength promotion
might be useful and efficient in specific situations.
Some positive psychology constructs, such as self-efficacy
and self-regulation, have already achieved mainstream status.
The theory and evidence linking these constructs to important
counseling goals are well-known. Rather than focus on how
counselors might integrate these relatively uncontroversial
intervention targets into their work, we have selected constructsforgiveness and spiritualityfor which the rationales
and evidence for integration are still developing. Our hope
is to encourage counselors to entertain the possibility that
consideration of forgiveness and spirituality-related issues
might address certain counseling targets more effectively
than current, pathology-focused approaches. These constructs
have also been chosen because they provide examples of the
different ways strength-focused counseling may be integrated
into practice. Forgiveness-focused counseling has been addressed in numerous psychology handbooks and chapters
(e.g., Enright & Fitzgibbons, 2000; McCullough, Pargament,
& Thoresen, 2000b; McCullough & Witvliet, 2002) and
may be specifically requested by clients. Addressing clients
spiritual and/or religious involvement in counseling provides
an example of how to assess and support strengths without
actively conducting strength-promoting interventions. Also,
spirituality is increasingly recognized as an important cultural
and coping factor that may affect counseling relationships,
processes, or outcomes. Forgiveness and spirituality provide
instructive, if not compelling, examples of current possibilities, limitations, and challenges of more fully integrating human strengths into counseling practice.

Rationales for Increasing the Integration

of Strength Promotion Into Counseling
(Why Should Anyone Pay for It?)
Clearly, no omnibus rationale exists to justify the integration of all positive psychology constructs into all counseling situations. Ideally, counseling practice is informed by
evidence-supported theory as well as by evaluation of the
resources available to achieve reimbursable counseling goals.
Some positive psychology constructs, such as self-efficacy,
have well-developed theory as well as impressive empirical
evidence that justify specific interventions in many specific
counseling contexts. The importance of self-efficacy in psy-

chological and health-related processes has been demonstrated

in literally hundreds of empirical studies. Self-efficacy has
been shown to play significant roles in health-related processes
and outcomes (e.g., biochemical effects, autonomic activity,
pain regulation, and immune functioning), behavioral effects
(e.g., smoking, changes in diet and exercise, adherence to
medical regimens, and reductions in substance abuse), as well
as self-regulation and other psychological factors (Bandura,
1997). A substantial amount of evidence exists indicating
that efficacy beliefs strongly influence a persons efforts to
change. Specifically, the person with higher self-efficacy for
a particular task will exert more energy, persist longer at the
task, and acquire more knowledge and skills related to the
task compared with someone with lower baseline self-efficacy.
Most important, through both direct and mediated paths,
interventions that increase self-efficacy have been found to
powerfully effect the attainment of desired counseling targets
(Bandura, 1997). These facts make selling self-efficacy interventions to various stakeholders relatively easy.
Although similar rationales might be made for a few other
positive psychology constructs (e.g., optimism, self-mastery, selfregulation) in specific contexts, most other facets of positive psychology currently lack the theoretical models and/or the evidence
linking their associated interventions to common counseling
targets. The main rationale for self-efficacy promotion in counseling can be reduced to the following: By increasing this positive
characteristic, counselors more efficiently reduce the negative
state that is the explicit target of counseling. In this article, we
entertain the notion that the same may be true for other positive
characteristics, such as the capacity to forgive, but recognize that
current theory and evidence need further development.
Although specific models might be, and in some cases
have been, developed linking positive psychology concepts
to common counseling goals, it is also possible to outline a
general model. For example, it is possible that, in certain situations, the growth and maintenance of positive characteristics
and behaviors may ensure the absence of the negative characteristics and behaviors. It is possible that by encouraging
the growth of strengths, we as counselors can simultaneously
reduce the negative states we are explicitly paid to reduce. In
effect, we might get 2-for-1. For example, by increasing the
amount of time a client spends thinking grateful and calming
thoughts, there is simply less time and attentional resources
to think upsetting and unhelpful thoughts. If one assumes
that attention is a zero-sum game, the most efficient way to
reduce negative thoughts and emotions and increase positive
ones may be to focus on increasing the positive. Similarly,
because of the nature of the autonomic nervous system, it is
physiologically impossible to become more upset and more
relaxed at the same time (Raven & Johnson, 1999). The most
efficient way to reduce stress and upset and increase calm
and tranquility may be to focus on increasing positive states,
such as positive emotions (e.g., hope, joy), rather than just

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the eradication of negative states, such as negative emotions
(e.g., sadness, anger; Fredrickson, 2001).
We hypothesize that in some circumstances, strength enhancement may be more efficient and/or more acceptable to
clients than pathology-focused approaches to reaching common
counseling goals. Of course, the counselor needs to assess a
host of client, problem, evidentiary, and situational factors in
choosing a counseling approach. When entertaining the possible
utility of integrating the strategies outlined in the following
sections into a specific counseling situation, consider that appraisals of what constitutes a strength or something positive vary
substantially based on many factors, such as culture, gender,
and developmental stage. The value of a psycho-educational,
preventive forgiveness intervention probably will be greater for
a high school student than for a hospice patient, although other
forgiveness-based interventions may be more relevant to the
latter. A particular characteristic may be valued and desirable
in certain cultures and denigrated and seen as a weakness in
others. All counseling and intervention choices must occur with
sensitivity to these concerns. For further discussion regarding
the cultural embeddedness of strengths and positive psychology
constructs, see Sue and Constantine (2003).
We offer a few general strategies to infuse counseling with
a strength orientation. Then, we discuss the specific examples
of spirituality and forgiveness. While reviewing the strategies
we outline, the reader is invited to critically evaluate whether
or not each strategy would add value to specific counseling
contexts in terms of providing a more direct means to counseling goals, improving a clients motivation for counseling,
improving the counseling relationship, or providing the client
with a culturally acceptable means of engaging in the process
of change.

Infusing Counseling With a Focus

on Strengths
Identify Strengths and Use Strength-Oriented
Language
Language used to describe clients personalities and their
concerns most often are drawn from a lexicon of weakness.
For example, counselors refer to some clients who are grappling with depression as hopeless, anhedonic, and/or
lacking motivation. These descriptions, when accurate, communicate only half the story. That is, all clients experiencing
symptoms of illness also possess basic human strengths and
complex coping skills. Although the hypothesis has not been
addressed in a controlled study, we speculate that identifying
and supporting clients strengths and resources may motivate
them toward change strategies needed to reach their goals. At
this time, we encourage counselors to expand their vocabulary
and to experiment with identifying their clients strengths
and resources in daily practice. A lexicon of human strengths
can be constructed by consulting one of numerous positive

psychology volumes (Aspinwall & Staudinger, 2003; Lopez

& Synder, 2003; Peterson & Seligman, 2004).
In certain contexts, framing problems from a strengthbased perspective may not change what we as counselors do
but will change the language we use to describe the process
and goals. For example, although termed differently in various
therapeutic traditions, such as cognitive behavioral therapy
(CBT), rational-emotive therapy, and narrative therapy, cognitive restructuring is one of the main tools counselors use to
help people with their problems. From a pathology-focused
perspective, we may dispute irrational thoughts in the tradition
of rational-emotive therapy. From a strength-based approach,
we might help our clients learn more constructive and helpful
ways of thinking. Another example lies in the juxtaposition
of reducing dissatisfaction and increasing satisfaction. As
the underlying theory of cognitive restructuring suggests, the
way people use language, with themselves and others, does
matter (Beck, 1995). We suspect it is possible to be either
strength or pathology focused within any of these (or other)
therapeutic traditions, although some perspectives may have
associated language or central metaphors that lean more to
one side or the other. To what extent does the difference in
focus (strength vs. pathology) inform differences in procedures that in turn might produce different outcomes? The
strength-based reframing and re-languaging of established
counseling practices is an important area of research and
application in positive psychology.
Expand the Framework of Problem
Conceptualization and Assessment
Assessment, intake, and history-taking procedures, often institutionalized and guided by the medical model, can expand or
can sharply limit counselors problem conceptualization and,
therefore, the value of the intervention approaches counselors
choose. How a problem is conceptualized inherently implies
the universe of potential solutions. In many counseling settings, in accordance with the biomedical model, problems
are typically framed as the presence of something bad that
resides within the individual client (e.g., mania, depression,
substance abuse, diabetes). This negative and individual bias
in problem framing (Wright & Lopez, 2002) partially explains
the ubiquity of individually focused, negative-eradicating
interventions. Problem conceptualization is the foundation on
which treatment planning and evaluation rest. A critical step
in integrating positive psychology perspectives into health
care may be to develop and evaluate the use of assessment
and history-taking procedures that facilitate expanded case
conceptualizations. History-taking procedures should assess, within the person and the environment, the presence of
liabilities to be reduced, the absence of skills or knowledge
to be developed, and the presence of strengths and resources
to be supported and maintained. Along these lines, Wright
and Lopez proposed a four-front approach to diagnosis and

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assessment that guides counselors to assess both assets and
liabilities in the individual and environment. Assessing for
strengths and relevant environmental factors not only is helpful to the counselor but may help the client view the problem
from a more realistic and helpful perspective.
Other Resources
Several other authors have proposed general strategies for
infusing a positive focus into counseling. Gelso and Woodhouse (2003) noted that counselors can explicitly comment
on a clients strengths, including those that become apparent
within the counseling relationship. These authors also suggested that counselors can reframe perceived weaknesses as
strengths and highlight the strengths that are often imbedded
in problematic defenses. From this view, weaknesses are not
pathology as such, but possibly strengths run amok. For example, being careful and cautious, qualities that are adaptive
and functional in moderation, may become problematic if
taken to extremes. Similarly, Ivey and Ivey (1998) proposed
a means to work with so-called disorders and psychopathology that is positive and strength focused. They suggested that
counselors reframe a clients distress and symptomology as
logical responses to his or her developmental history. Masters
(1992) discussed the use of positive reframing and strength
promotion in the supervision relationship, a process that may
trickle down to the counselorclient relationship. From the
tradition of narrative therapy, Freedman and Combs (1996)
emphasized the importance of locating problems in their clients sociocultural context and opening space for alternative,
perhaps more positive, stories.
To bring these ideas to life in the context of specific
strengths, we present the following examples. By focusing on
strategies designed to address forgiveness and spirituality, we
hope that readers will better appreciate the potential roles and
limitations of strength promotion in counseling practice.

Forgiveness
To understand the potential benefits of forgiveness, it is useful
to consider the potential negative effects of what Worthington,
Berry, and Parrott (2001) called a state of unforgiveness.
When a person is stuck in a position of unforgiveness from being hurt, offended, wronged, cheated, or violated, he or she may
experience persistent feelings and states such as anger, stress,
hostility, hopelessness, depression, shame, and hatred (McCullough et al., 2000b). The negative social, emotional, and
physical consequences of these states (especially if chronic)
on overall health, including increased disease risk, have been
documented elsewhere (e.g., Everson, Goldberg, Kaplan, &
Cohen, 1996; Everson, Kauhanen, & Kaplan, 1997; Williams
& Williams, 1993). To the extent that forgiveness acts as one
path out of unforgiveness, it may reduce these negative states
and associated behaviors and mitigate their detrimental consequences. Along these lines, it has been hypothesized that

forgiveness may reduce the unhealthy physiological arousal

and health-endangering allostatic load (McEwen, 1998)
associated with unforgiveness (Harris & Thoresen, 2005;
Thoresen, Harris, & Luskin, 2000). However, forgiveness is
more than the reduction of unforgiveness. Forgiveness also
includes increases in positive states, such as empathy and
compassion, that may in turn produce greater social integration and increased quality of relationships.
There may be, however, a danger in presenting forgiveness
as a panacea, seen as the only healthy, reasonable, or morally
appropriate course of action to remedy any hurt, transgression,
and injustice. Forgiveness, however, is simply one possible path
among others to reduce chronic negative thoughts, feelings,
and actions associated with being in a state of unforgiveness
(Worthington & Wade, 1999) and to reduce long-standing
grudges and deep resentments. Given the costs of unforgiveness, we believe it is highly desirable for people to have several
strategies, including the ability to forgive, in their behavioral
repertoires to cope with lifes inevitable hurts (Thoresen et al.,
2000; Worthington, Sandage, & Berry, 2000). Because forgiveness appears to be a learnable skill (see subsequent discussion),
we believe it is beneficial for counselors to be able to provide
empirically supported, brief forgiveness-related interventions
in their practices. In many situations, forgiveness interventions
may directly address the goals of counseling (e.g., chronic anger,
social isolation) more effectively than do other approaches (e.g.,
pure anger management). We discuss interpersonal forgiveness
here rather than forgiveness of self, situations, or God (or Higher
Power), primarily because almost all controlled studies to date
are in this area and because theory and research in these areas
are not well developed.
We discuss the following questions about interpersonal forgiveness: (a) What is interpersonal forgiveness? (b) What is the nature
of and empirical support for interpersonal forgiveness interventions? (c) How can brief forgiveness interventions be integrated into
counseling practice? and (d) How does the example of forgiveness
apply to strength-focused counseling more generally?
What Is Interpersonal Forgiveness?
Although no gold standard definition of interpersonal forgiveness exists (Worthington, 1998), there is general agreement among theorists and researchers about what forgiveness
is not. Forgiveness is not pardoning (legal term), excusing
(implies good reason for offense), condoning (implies justification), denying (implies unwillingness to acknowledge),
forgetting (implies failed memory, something outside conscious awareness), or reconciliation (implies relationship
restored (Enright & Coyle, 1998; Enright, Freedman, &
Rique, 1998; McCullough, Pargament, & Thoresen, 2000a).
Agreement, however, on just what forgiveness is has been
somewhat more elusive.
Most definitions of forgiveness vary yet share the following
features: (a) Forgiveness is a choice and a conscious effort

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by the person who has perceived the offense; (b) forgiveness
involves altering or reframing negative cognitions and perceptions (such as It is all his fault or vengeful ruminations),
affective states (e.g., anger, fear), and behaviors (avoidance
of aggression toward the offender); (c) forgiveness focuses
primarily on intraindividual change relative to particular interpersonal situations or contexts; and (d) forgiveness involves
increases in the offended persons understanding (often empathetic) of the offender and the contexts involved. In summary,
when a person forgives, thoughts, feelings, motivations, and
behavior toward the offender (or offending situation) become
more positive and less negative. Note that reconciliation is not
required nor does it necessarily follow forgiveness.
Forgiveness occurs as a process over time, not as an isolated
momentary event, such as saying I forgive you. Enright and
Fitzgibbonss (2000) model of the forgiveness process is most
relevant here because it is a clearly articulated conceptual
framework with an explicit focus on fostering human strengths
(e.g., compassionate understanding), the existence of empirical
studies examining interventions related to this model, as well
as the models adaptability to a variety of counseling theories
and contexts. Enright and Fitzgibbonss model represents the
forgiveness process as having four phases: Uncovering, Deciding, Working, and Deepening. For example, the Deciding phase
involves three subprocesses: (a) insight that old resolution
strategies are not working and have a high cost, (b) willingness
to consider forgiveness as an option, and (c) commitment to
forgive the offender. Enright and Fitzgibbonss (2000) Helping
Clients Forgive: An Empirical Guide for Resolving Anger and
Restoring Hope provides a full discussion of the model and
associated intervention strategies.
What Is the Nature of and Empirical Support for
Interpersonal Forgiveness Interventions?
To date, more than 20 forgiveness intervention studies have been
reported, mostly using brief, small-group formats. Results have
been promising, especially in demonstrating that grievances
or hurts can be significantly reduced and that willingness to
forgive an offender can be increased through forgiveness training. Some studies also report greater generalized forgiveness
across various situations (see Worthington et al., 2000). In a
few cases, intervention studies also have demonstrated notable
reductions in chronic anger (trait-based), perceived stress, and
depressive affect compared with randomized wait-list or assessment control groups. Various studies have included student and
community samples as well as samples with common offenses
(e.g., romantic infidelity) or with diverse sources of their unforgiveness. For the interested reader, there are several reviews
of forgiveness intervention research available (e.g., Enright &
Fitzgibbons, 2000; Worthington et al., 2000).
For example, the Stanford Forgiveness Project (Harris,
Luskin, et al., 2006), a primarily cognitive behavioral intervention, consisted of six once-weekly, 90-minute sessions

conducted in small, same-sex groups. Participants were 259

adult community members randomized to the intervention
or a wait-list control group. The sessions focused on helping
participants understand the cognitive, emotional, and behavioral ingredients of three major themes: (a) taking personal
offense (e.g., perceiving hurt), (b) attributing blame, and (c)
creating a grievance narrative. For example, the taking-offense
theme included didactic education about how physiological
arousal (e.g., heart rate variability) powerfully influences
cognitive processing and emotional reactivity, primarily at
the automatic and subconscious level. Also included was
training in specific cognitive and behavioral skills to help alter
the automatic chaining of perception, physiological arousal,
cognitive processing, and emotional reactivity involved in
taking offense. One of the goals relevant to this themetaking
offensewas learning to raise the interpersonal bar for
experiencing offense or hurt, thus reducing the probability of
perceiving others as hurtful. Many components of this intervention can be found in Luskins (2001) Forgive for Good: A
Proven Prescription for Health and Happiness.
How Can Brief Forgiveness Interventions
Be Integrated Into Counseling Practice?
We now attempt to distill features of forgiveness research that
are most useful to the counselor. Once a counselor becomes
sensitive to and adept at identifying unforgiveness, then he
or she can engage clients in discussions about the costs and
benefits of unforgiveness, as well as the costs and benefits of
various paths out of unforgiveness, including forgiveness, if
clients so choose. These steps roughly correspond to Enright
and Fitzgibbonss (2000) Uncovering and Deciding phases. It is
important to remember the following points when addressing issues of unforgiveness/forgiveness with clients or colleagues:
1. Education about what forgiveness is and is not is a
potentially powerful and brief intervention. Forgiveness is
best achieved if done after weighing the costs and benefits of
forgiving and not forgiving. This dialogue alone is a useful
and often brief intervention. Many of the interventions begin
with a version of this process.
2. The word forgiveness can be seen as making one weak or
vulnerable. In the Stanford Forgiveness Project, when the titles
of recruiting materials were changed from Have something to
forgive? to Grudge Management Training, many more men
expressed interest (Harris, Luskin, et al., 2006).
3. Forgiveness can be the focus of counseling or a small
component that is periodically revisited. Many forgiveness
approaches have several components (e.g., CBT reframing,
guided visualization) or use several exercises designed to move
people along in the forgiveness process. These components
provide the counselor with a means of addressing forgiveness issues in a limited way when it is not the primary focus
of treatment.

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4. Prominent researchers in the forgiveness field have written books to guide counselors and clients who want to explore
forgiveness as a potential therapeutic path. Luskins (2001)
Forgive for Good is an adaptation of many of the components
of the Stanford Forgiveness Project. Enright and Fitzgibbonss
(2000) Helping Clients Forgive is written explicitly for counselors from varied theoretical orientations who want to learn to
provide forgiveness-focused counseling. Worthingtons (2001)
Five Steps to Forgiveness: The Art and Science of Forgiving;
McCullough, Sandage, and Worthingtons (1997) To Forgive
Is Human: How to Put Your Past in the Past; and Enrights
(1998) Forgiveness Is a Choice are all excellent bibliotherapy
resources for people considering forgiveness.
How Does the Example of Forgiveness Apply to
Strength-Focused Counseling More Generally?
In many ways, the area of forgiveness provides a template for
those interested in promoting other strengths in illness-focused
settings. Of all the constructs subsumed under the umbrella
of positive psychology, it appears that forgiveness is among
those that have received the most interest and application in
counseling settings (e.g., Konstam, Marx, Schurer, Lombardo,
& Harrington, 2002). We suspect that forgiveness interventions have been relatively accepted because they are viewed
as a unique solution to otherwise unaddressed suffering. Also
forgiveness interventions are straightforward, time-limited,
and supported by good research. These are characteristics we
believe are needed if other strength-promoting interventions
are to become commonplace in counseling. We now discuss
how counseling might benefit from consideration of clients
religious and/or spiritual (RS) involvement.

Client RS Involvement
If RS involvement or beliefs act as sources of wisdom, community, strength, or health, how can counselors appropriately
support (and not unwittingly discourage) clients in these
domains? Conversely, if a clients RS involvement or beliefs
are liabilities, by what means and criteria can counselors
make this determination? Empirically and theoretically based
justifications for addressing religious and spiritual factors in
counseling have increased in frequency and quality in recent
years (Hill & Pargament, 2003; Miller & Thoresen, 1999,
2003; Thoresen & Harris, 2004; Thoresen, Harris, & Oman,
2001). Even so, many counselors and other professionals
still doubt that RS factors are related to mental or physical
health or believe that RS factors should not be addressed in
counseling even if such relationships exist (Sloan, Bagiella,
& Powell, 2001; Thoresen, 1999). As with other potential human
strengths, we suggest that RS factors may be a great benefit in
certain forms and contexts yet may be impediments, if not hazardous to ones health, in other forms and contexts (Thoresen et
al., 2001). For example, one need not look far to find examples

of religious involvement or religiously motivated behaviors that

are unhealthy (e.g., suicide bombing, clergy sexual abuse). It is
clear that religious communities and beliefs may act as important
resources or liabilities, although much skill and careful thought is
required to discern one from the other (Putnam, 2001). It is also
clear that many people in America and elsewhere are religiously
or spiritually active, and more than 60% of the population views
this part of life as very important (Koenig, McCullough &
Larson, 2001; Thoresen, 1999). As with any factor that may
influence counseling processes or outcomes for better or worse,
RS variables should be routinely assessed, and counselors need
to know how to assess and use this information.
The percentage of people who consider themselves spiritual
but not religious has increased in recent years. Estimates suggest that 15% to 20% of the population identify themselves
as spiritual but not religious. Spirituality, as distinct from
religiousness, has been seldom studied until very recently (for
exceptions, see Keefe et al., 2001; Shahabi et al., 2002; Woods
& Ironson, 1999). Current evidence suggests that religious
involvement or experiences are associated with a variety of
mostly desirable but also some undesirable mental health
outcomes (Bergin, 1983; Bosworth, Park, McQuoid,
Hays, & Steffens, 2003; Exline, Yali, & Sanderson, 2000;
Levin, Markides, & Ray, 1996; McCullough, Larson, &
Worthington, 1998; Pargament, Smith, Koenig, & Perez,
1998; Worthington, Kurusu, McCollough, & Sandage,
1996). For example, greater frequency of religious service
attendance (i.e., weekly or more often), when compared
with little or no attendance, has been consistently related to
greater subjective well-being, life and marital satisfaction,
fewer depressive symptoms, less suicidality, reduced delinquency, and decreased substance abuse (McCullough et al.,
1998). It is impressive that frequent attendance has been found
to independently predict reduced all-cause mortality, even
when more than 12 control variables that could account for
changes are examined (McCullough, Hoyt, Larson, Koenig,
& Thoresen, 2000).
Some have found, however, that certain RS factors, such
as the presence of religious strain (Exline et al., 2000) and
difficulty forgiving God (Exline, Yali, & Lobel, 1999), are
related to greater stress, depression, and suicidality. The use of
religious beliefs or practices to cope with stressful life events,
termed religious coping, has been studied more extensively
(Pargament, 1997; Pargament et al., 1998). Being able to
identify and discriminate between positive and negative religious coping may be especially useful to counselors in daily
practice (see Pargament, Koenig, & Perez, 2000)
Given the mixed results cited previously, not to mention
a host of possible ethical concerns (e.g., practicing beyond
ones professional competence, usurping religious authority,
imposing religious values on clients), we do not recommend
that counselors routinely intervene to promote clients spirituality or religious involvement. However, it is apparent that

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RS factors may be therapeutically relevant in many cases. In
light of the research linking RS factors to important counseling outcomes, it is important to have a well-articulated
rationale for appropriately and ethically assessing RS issues
in counseling as well as some basic strategies for doing so.
Again, we cannot fully address this complex topic here but
intend to show, using RS involvement as an example, how
clients strengths might be appropriately assessed and put
on the table in counseling. We address three questions: (a)
What rationales exist for and against integrating RS factors
into counseling practice? (b) How can a counselor distinguish
between different and deviant religious or spiritual involvement? and (c) What are appropriate means of assessing clients
RS worldview and involvement?
Rationales for Addressing RS Factors
in Counseling
A lively debate exists among researchers and counselors
regarding the appropriateness of integrating RS concerns
into counseling and other helping professions. The main
points of contention have been twofold: (a) the quality of
the evidence linking religious activity, especially religious
service attendance, to beneficial health outcomes and (b) the
potential ethical problems of mixing religious and spiritual
concerns and the professional services counselors provide.
Sloan et al. (2001) found that the current evidence linking
forms of religious activity to beneficial health outcomes to
be weak and to have serious methodological problems. From
our perspective, epidemiological studies linking structural
religious variables, such as religious service attendance, to
various outcomes are impressive but are not directly applicable to counseling practice, regardless of quality or claims.
These studies, although noteworthy, should not be used as a
rationale to prescribe religion to all clients any more than
counselors should prescribe marriage across the board solely
based on many population studies showing that married persons commonly live longer than unmarried persons. Rather,
we characterize the evidence from the study of RS factors,
particularly psychologically based factors such as religious
coping, as suggestive that RS factors may influence mental and
physical health for better or worse. Therefore, these findings
are relevant to consider in counseling specific clients. This
suggestion, coupled with the cultural relevance of religion
and spirituality in shaping counselor and client worldviews,
informs and justifies the inclusion of RS assessment and cultural sensitivity in the intake and counseling process.
Along the same lines, Shafranske and Malony (1996) argued for the inclusion of religious issues in the provision of
psychology services based on four major points:
the professional ideal of cultural inclusion; the substantial
evidence of religion as a cultural fact; the developing body
of theoretical, clinical, and empirical research literature

concerning religion as a variable in mental health; and the

appreciation of psychological treatment as a value based
form of intervention. (p. 561)

As noted in the recently released APA Guidelines for Providers

of Psychological Services to Ethnic, Linguistic, and Culturally
Diverse Populations (American Psychological Association,
2003), psychological service providers should respect clients
religious and/or spiritual beliefs and values, including attributions and taboos, since they affect worldview, psychosocial
functioning, and expressions of distress (Guideline 5). Gorsuch
and Miller (1999) persuasively argued that religious and spiritual factors may be related, and may be central in some cases,
to taking a good clinical history. Religious or spiritual factors
actually may be central to the presenting problem (or solution)
yet may not come to light unless prompted by the counselor.
Religious beliefs, behaviors, and experiences may be disturbing to the client (or others) or may directly result in unhealthy
outcomes. The Diagnostic and Statistical Manual of Mental
Disorders (4th ed., text rev.; American Psychiatric Association, 2000) lists Religious or Spiritual Problem (V62.89) as
a condition that may be the focus of clinical attention including
distressing experiences that involve loss or questioning of faith,
problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an
organized church or religious institution (p. 741). Religious or
spiritual beliefs may dramatically affect a clients view of the
etiology of a problem (e.g., It was Gods will), motivation to
comply with treatment suggestions, or the clients interactions
with the treatment team. Richards and Bergin (1997) argued that
conducting a religious/spiritual assessment can help therapists
to (a) better understand the clients worldview, increasing the
therapists ability to work with greater empathy and sensitivity;
(b) determine if the clients RS orientation is health or unhealthy
and its impact on the presenting problem; (c) assess whether the
clients religious or spiritual community is a resource to aid the
therapeutic process; (d) determine if a religiously or spiritually
oriented or modified intervention is indicated to achieve therapeutic goals; and (e) identify unresolved religious or spiritual
doubts, concerns, or needs that might become the focus of
clinical attention or prompt an appropriate referral.
Respecting clients RS beliefs does not mean ignoring them
or blindly accepting them as healthy. Respecting a clients culture
and worldview, including RS beliefs, entails routine assessment
and skillful use of the information gathered. Without sensitivity to individual and cultural differences based on religion or
spirituality, counselors risk excluding critical information from
their clinical practice. Issues of distinguishing different from deviant, liabilities from resources, and spiritual emergencies from
psychiatric disorders must occur with knowledge of the cultural
framework of the client. For further discussion of the issues surrounding the integration of RS issues in counseling, the reader
is referred to Harris, Standard, and Thoresen (2006).

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Harris, Thoresen, & Lopez

Different or Deviant?
Discerning pathological from healthy or mature RS adjustment
is sometimes difficult, particularly for a counselor with little
professional or personal experience in this domain. Lovinger
(1996) offered 10 markers of potentially unhealthy religious
adjustment that counselors may find useful, including, among
others, conspicuous self-oriented display of religious adherence, intense focus on scrupulously avoiding sin, relinquished
responsibility to divine or evil forces, persistent church shopping, use of the Bible (or presumably other sacred texts) as a
moment-to-moment guide to life, and demonic possession.
These markers do not necessarily imply maladjustment and
need to be understood from the perspective of the clients RS
tradition. Nevertheless, they do serve as red flags. Lovinger
also offered five markers of healthy or mature religious adjustment: (a) awareness of complexity and ambiguity in sacred
texts and traditions, (b) intentional choice of religious affiliation rather than blind acceptance of parental preferences, (c)
some degree of and desire for valuebehavior congruence, (d)
recognition and acceptance of personal shortcomings, and (e)
respect for appropriate boundaries (i.e., not forcing religious
enthusiasm and beliefs on others). Pargament and colleagues
(Pargament, 1997; Pargament et al., 2000) offered a thorough
discussion of positive and negative religious coping styles.
Assessing and Supporting (When Appropriate) RS
Factors in Counseling
What features of religious involvement or spirituality should
be routinely assessed, and how should this assessment be
accomplished? The answers to these questions are similar to
those pertaining to other areas, such as personality, sexuality,
social functioning, or physical health status. Given that the
goal of the initial clinical interview is to get a broad picture
and to identify areas of potentially fruitful exploration, the
counselor needs a few concise questions in each domain
area that serve the dual purpose of putting the domain on
the table for potential discussion and helping the counselor
choose among many competing potential foci of treatment
and more in-depth assessment. Ultimately, the counselor is
trying to assess if RS factors are part of the problem, part of
the solution, or largely irrelevant to treatment. The same can
be said for other positive psychology constructs. As noted
by Gorsuch and Miller (1999), RS factors are a small subset
of the areas the counselor will want to learn about during the
initial phases of counseling. Questions they suggest that may
prove useful are the following: (a) How important is spirituality or religion in your daily life? and (b) Tell me in what
ways spirituality (or religion) has been important to you? (p.
52). The authors recommend following these broad questions
with reflective listening rather than a barrage of more detailed
questions. Other potentially useful questions include asking if
there are spiritual or religious practices that the client performs
regularly as well as asking what the client feels or thinks gives

10

life meaning or purpose. For the deeply religious client, or when

RS factors are clearly central to counseling, specific questions
about positive and negative religious coping may be useful, such
as those found on the Religious/Spiritual Coping Long Form
(Fetzer Institute/National Institute of Aging, 1999; Pargament
et al., 2000). For further information about conducting initial
and more in-depth RS assessments, as well as strategies for
using the information gathered, several resources exist (e.g.,
Harris, Standard, et al., 2006; Richards & Bergin, 1997, 2000;
Shafranske, 1996).
Lessons for Strength-Focused Counseling
Clearly, we have only scratched the surface regarding the topic
of how, when, and why a counselor might address RS issues
in his or her work with a client. Our discussion of RS factors
was intended as an example of how a focus on strengths might
be justified and integrated into counseling, without conducting strength-promoting interventions. From this example, we
emphasize the following points: Positive psychology constructs
often need to be broken down and contextualized to be useful. Simply asking initial screening questions about potential
strengths, such as spirituality, can be helpful to the client and
bring relevant information to light. What may be a strength in
one case may be a liability in another. Working to understand
what aspects of multidimensional constructs are relevant to
the counseling process is a vital first step from which counselors can support strengths and modify liabilities. People,
their strengths, and their problems exist within relationships,
communities, and cultures. Infusing a focus on strengths into
counseling need not take substantially more time or require
the use of explicitly strength-promoting interventions.

Concluding Comments
Infusing a focus on strengths into standard assessment and
counseling procedures may or may not result in better outcomes, adherence, customer satisfaction, or other import
outcomes. Evidence is needed to support this approach. Subtle
infusion, through the means we have discussed, may be the most
effective and culturally acceptable way to integrate a focus on
strengths into counseling in pathology-focused settings.
Integrating the ideas and research of positive psychology
into counseling practice requires much thought. Using language and problem conceptualizations that are more positive
provide relatively simple and low-cost strategies for infusing
strength promotion into counseling. Another basic strategy
involves expanding the counseling framework to include
assets as well as liabilities and factors outside as well as
inside the person. In all cases, strength promotion should be
supported by a strong rationale linked to explicit counseling
goals. Awareness that notions of strength and weakness are
personally and culturally constructed and exist within specific
contexts is also critical. More time-limited, empirically supported interventions that directly improve reimbursable coun-

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Integrating Positive Psychology Into Counseling

seling outcomes are needed if strength promotion is to become
more central to counseling. To become valued by patients,
colleagues, and insurance plans, intervention strategies aimed
at fostering human strengths will need to be justified by new
conceptualizations of problems and shown to be improvements to
more pathology-focused theories and solutions. Unless positive
psychology can produce effective ways to solve problems that
people pay to have solved, at times out of their own pockets, and
unless these improved approaches are effectively sold to various
stakeholders (i.e., patients, insurance companies, colleagues
on multidisciplinary teams), the current barriers to integrating
strength promotion in counseling will remain.

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