their client's beliefs. Religious issues are difficult to negotiate in trauma treatment, especially when clinicians are expected to be adept enough to juggle countertransference. Using both research and case vignettes to illustrate our professional experience, we discuss approaches to the more common choice points in the therapy working alliance, such as interventions and disclosure of beliefs.
COUNTERTRANSFERENCE TO RELIGIOUS MATERIALReligious and spiritual issues are among the most contentious and most meaningful areas for human discussion. Therefore, religion and topics relevant to religion as foci for attention in psychotherapy are to be expected. Among the great questions of the client's life, one would predict that clinician and client would struggle with religious and spiritual dilemmas in the safety of the therapeutic hour: How do I use my spiritual beliefs to comfort myself, address my issues regarding death or justice, or face my future? Why did God allow the struggles that my loved ones or I face?Surprisingly, many authors have reported that religious and spiritual issues are in fact avoided in psychotherapy (Frazier & Hansen, 2009;Hawkins & Bullock, 1995;Sloan, Bagiella, & Powell, 2001). In a recent study by Frazier and Hansen (2009), 30% or less of professionals reported discussion of religion in their clinical sessions. Further, surveys of directors of American Psychological Association (APA)-accredited programs and internships have found that few programs systematically address religion and spirituality (Russell & Yarhouse, 2006). Eighty-three percent of clinical psychologists recalled that spiritual issues were never or rarely presented in their supervision and training (Shafranske & Malony, 1990). This is despite the fact that 32% of clients reported some distress and 19% reported significant distress that they feel stems directly from religious concerns (Johnson & Hayes, 2003).The failure to address religious issues in psychotherapy could arise from a number of sources. First, psychotherapists appear to be less religious or find religion to be less important in their daily lives than is typical for their community of clients (Cross & Khan, 1983;Delaney, Miller, & Bisonó, 2007;Hawkins & Bullock, 1995;Plante, 2007). Second, many psychotherapists report that they are poorly trained in dialogue containing religious content, perhaps engendering concern about competence to deal with religious issues (Saunders, Miller, & Bright, 2010). Third, the psychotherapists may struggle with ethical issues, such as beliefs that religious discussion is outside the appropriate role of the psychotherapist (Rosenfeld, 2010) or legal and moral concerns regarding influencing religious behavior (Rosenfeld, 2010), or they
