Let me start by questioning the wisdom of including Appendixes A-D (pp.  215-295) in the book.  While this material is useful, it is available on line in printable version, free of charge.  (The book retails at $ 36.37 US at Amazon.com; cutting 80 pages could lower the cost by $6.00 US or approximately ten dollars Canadian.) The trade-off for students (and I recommend the use of this book as a text) is between efficiency and costs.  Appendix A (American Association for Marriage and Family Therapy Code of Ethics: pp.  215-224)) and Appendix B (American Counseling Association Code of Ethics and Standards of Practice: pp.  225-249) are available online.  (Note that the URL given in the text p.  225 goes nowhere) Appendix C (American Psychological Association Ethical Principles of Psychologists and Code of Conduct: pp.  251-274) is available online also.  (Most recent draft; May 14, 2002).  Finally, Appendix D (National Association of Social Workers Code of Ethics pp.  275-295) is also on the web.  (See below for the links to these sites.)

The book has strong positive features, along with some weaknesses.  Among the things I liked about the book is the inclusion of case studies, exercises, recommended readings, including online references, after each chapter.  This is a useful feature for classroom discussion.  The book contains excellent short summaries throughout, reminding us of where we have been and pointing ahead to where we are going.  This makes for a smooth transition of topics.  The book is well written and free of distracting typographic errors.  Each chapter opens with a statement of objectives.  The development of ideas progresses logically from an introduction to the place of spiritual counseling in chapter one, to an historical development of spirituality/religion and therapy in chapter two.  Chapters three and four present a useful summary discussion of significant elements in Western and Eastern religions, respectively.  The material is well researched and insightful.  The cultural background (attitudes, values, and beliefs) of counselor/client is discussed in chapters five and six.  Chapter seven, 'Ethical Issues' examines the rights and obligations of counselor and client, though what parades as an ethical concern is mostly about informed consent.  While the detail provided on consent forms is useful (167-170), I would have liked to see more discussion of client rights.  Possibly this is where my own constructivist bias comes into the picture.  My training in ethics makes me more sensitive to client rights.  However, the book includes an in depth discussion of issue that have an impact on those rights such as the problem of countertransference and transference.  Still, in a discussion (175) on client rights, reference is made to the 'unequal power' of counselor and client.  This focus seems odd, given the book's (legitimate) critique of the stifling role of paternalism in religion (50).  In my opinion, the contractual model is more respectful of client autonomy and should be used.  However, in places, Miller seems to know this.  In a discussion on journal writing, for instance, she clearly values patient autonomy as she cautions counselors to avoid the use of techniques that do not fit a client's spirituality.  And she goes to some length to provide details on how to implement a technique the client can use to develop a sense of spiritual identity.  Her point is insightful because she is right to say that most people do not usually think of themselves as being spiritual (many confound religion and spirituality).  I teach courses in spirituality and health to nursing students.  In my experience, students express surprise at being spiritual, and it takes a month or so of work before they can make connections between elements like religion and their spirituality.  (This surprises me too).  The connection to spirituality can also come from a widened perspective that includes nature and all living things (native spirituality is a good case in point).  Perhaps the seemingly paternalistic dimension of counseling comes from its objective, scientific, methodology in contrast to the phenomenological, metaphysical 'letting-be' attitude of the contractual model?  More on this later. 

I enjoyed reading about treatment techniques, (prayer, sacred writings, religious community, bibliotherapy, focusing, journal writing, meditation, rituals).  I use similar techniques in the classroom.  However, the classroom focus is factual rather than normative; we seek healing but do not counsel students on ways of healing themselves.  This difference points to the benefits of interdisciplinarity as the issue of countertransference makes clear.  As Miller knows, the therapist's attitude is contagious.  The counselor has to be comfortable with an issue before he or she can counsel someone on that issue.      

If the book goes into a second edition, I would recommend that a clearer distinction be made between spirituality and religion.  The book opens with a very good description of spirituality (p.6), but the way in which religion is actually seen to connect with it or fill the void announced in the definition of spirituality, is poor.  The author does not implement the religious connection promised in the description of spirituality, or show why non religious clients can meet their spiritual needs in other ways.  For instance, a creative use of (Jungian) healing tools such as the mandala, dream analysis, temperament sorter, play, laughter, art, music, ...  can also substitute for the religious connection.  The second thing I noticed is that Miller sees spirituality as an 'add on'.  Is she overly concerned about the separation of church and state?  Her focus is not that spirituality is an integral characteristic of being human, but that it is an elective area that some counselors might decide to pick up.  But clients are not part-time spiritual beings.  In my opinion, courses in spirituality and religion need to become a required part of the curriculum.  I think that Miller would have picked this up if she had followed through on her definition of spirituality.  One other thing I noticed is the conspicuous absence of phenomenology in a book that purports to be about psychotherapy.  If the counselor is 'an attendant of the soul' as she says (22), then, the reader might expect a discussion on the phenomenology of care! Is spirituality a two edged sword?  

It strikes me as odd that spirituality could have two faces, one face when the individual presents as client to a counselor and the other as patient to a nurse.  Perhaps we are looking at different ends of the same elephant.  I see illness as divisiveness, a rupture in being, but I am not sure how Miller sees illness.  In my opinion, the individual is ill to the extent that he or she fails to act as a dynamic unit of mind and body (I take spirit to be a component of mind).  In the contractual model of health, the individual is the expert on the nature of that disunity.  This view is based on a distinction between healing and curing.  In my view, the role of the therapist is to facilitate reintegration (healing), as directed by the patient.  In Miller's model (scientific approach to a client), the counselor is the paternalistic agent of change, and healing presents itself through the curing perspective.  On another point, I would be amiss to overlook the insight Miller brings to the addiction field.  The addiction field is no doubt a growth area for counselors, but it concerns everyone.  I am pleased to see that Miller gets it right. 

Other things stand out.  The reader will appreciate the fact that the book has an author index as well as a subject index.  I am pleased to recommend this book, and though it is written primarily for counselors, I will use it as reference in my work with nurses.             

© 2003 Kenneth Bryson

Links

·        American Association for Marriage and Family Therapy Code of Ethics

·        American Counseling Association Code of Ethics and Standards of Practice

·        American Psychological Association Ethical Principles of Psychologists and Code of Conduct

·        National Association of Social Workers Code of Ethics

Kenneth A Bryson Ph.D., Professor of Philosophy, University College of Cape Breton