Full text of DOI:10.1080/01926180126136

This article was downloaded by: [State University NY Binghamton]
On: 04 July 2013, At: 07:59
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number:
1072954 Registered office: Mortimer House, 37-41 Mortimer Street,
London W1T 3JH, UK
The American Journal of
Family Therapy
Publication details, including instructions for
authors and subscription information:
http://www.tandfonline.com/loi/uaft20
The Effects of Religiosity on
Preferences and Expectations
for Marital Therapy Among
Married Christians
Jennifer S. Ripley a , Everett L. Worthington Jr b
Jack W. Berry b
&
a Regent University, Virginia Beach, Virginia, USA
b Virginia Commonwealth University, Richmond,
Virginia, USA
Published online: 30 Nov 2010.
To cite this article: Jennifer S. Ripley , Everett L. Worthington Jr & Jack W. Berry
(2001) The Effects of Religiosity on Preferences and Expectations for Marital
Therapy Among Married Christians, The American Journal of Family Therapy, 29:1,
39-58, DOI: 10.1080/01926180126136
To link to this article: http://dx.doi.org/10.1080/01926180126136
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all
the information (the “Content”) contained in the publications on our
platform. However, Taylor & Francis, our agents, and our licensors
make no representations or warranties whatsoever as to the accuracy,
completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of
the authors, and are not the views of or endorsed by Taylor & Francis.
The accuracy of the Content should not be relied upon and should be
independently verified with primary sources of information. Taylor and
Francis shall not be liable for any losses, actions, claims, proceedings,
demands, costs, expenses, damages, and other liabilities whatsoever

or howsoever caused arising directly or indirectly in connection with, in
relation to or arising out of the use of the Content.
This article may be used for research, teaching, and private study
purposes. Any substantial or systematic reproduction, redistribution,
reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access
and use can be found at http://www.tandfonline.com/page/terms-and-
conditions

The American Journal of Family Therapy, 29:39–58, 2001
Copyright ©2001 Brunner-Routledge
0192-6187/01 $12.00 + .00
The Effects of Religiosity on Preferences
and Expectations for Marital Therapy
Among Married Christians
JENNIFER S. RIPLEY
Regent University, Virginia Beach, Virginia, USA
EVERETT L. WORTHINGTON, JR., and JACK W. BERRY
Virginia Commonwealth University, Richmond, Virginia, USA
Highly religious couples constitute a substantial portion of marital
therapy clients in the U.S. Married Christian individuals (N = 211)
completed a survey of demographics and religiosity (religious val-
ues and Christian beliefs). They rated preferences and expectations
for one of four marital therapy situations: Christian therapist using
Christian practices (e.g., prayer or reference to Scripture), Chris-
tian therapist using psychological practices only, non-Christian
therapist willing to use Christian practices, and non-Christian thera-
pist using psychological practices only. High religious values and
high Christian beliefs predicted ratings of marital therapy situa-
tions, where high was defined as one standard deviation above the
mean of standardized norm groups. Low to moderate religious
values or Christian beliefs did not predict ratings of marital therapy.
It was concluded that highly religious couples present a special situ-
ation where the marketing, assessment, and practice of marital
therapy might differ from therapy with other types of couples.
In this postmodern society, multicultural sensitivity to values and prefer-
ences of significant population groups is necessary for clinicians (Richards &
Bergin, 1997; Shafranske, 1996). The U.S. is religiously diverse, including
many people who adhere to no particular religion (Barrett, 1996). Research-
ers and clinicians must understand the influence of religion in shaping cli-
ents’ preferences. Worthington, Kurusu, McCullough, and Sandage (1996)
reviewed the status of religion in individual therapy and found that there has
Portions of this article were supported by a grant from the John Templeton Foundation
in marriage research.
Address correspondence to Jennifer Ripley, PhD, Regent University, 1000 Regent
University Dr., Virginia Beach, VA, 23464-9800 .
39

40
J. S. Ripley et al.
been considerable progress in understanding the role of religion and indi-
vidual therapy during the last 10 years. Many highly religious people see the
world through their religious worldview. Although many highly religious
couples also seek therapy from secular therapists, many seek explicitly reli-
gious therapists—either clergy or religious mental health practitioners—when
they have psychological problems. As a result of the religious worldview of
both religious clients and religious therapists, religiously based therapies
have developed, particularly in the Christian, Jewish, and Muslim traditions
(see Thoresen, Worthington, Swyers, Larson, McCullough, & Miller, 1998).
Research has investigated the preferences and expectations that reli-
gious individuals have for individual therapy—whether they would prefer to
meet with a similarly religious therapist and how they would like their reli-
gion handled in either secular or religious therapy (for a review, see
Worthington, et al., 1996). Worthington et al.’s review indicates that those
religious people who are highly committed to their religiosity tend to prefer
to meet with a similarly religious therapist, rate therapists more favorably if
they are labeled as religious, and might use religion as a litmus test for their
reaction to therapy. However, results have varied depending largely on the
way religiosity has been measured (Worthington et al., 1996).
Religiously based treatment has extended into marital therapy. In fact,
in the U.S., religious marital counseling through churches and synagogues
was widely practiced before the mental health community offered wide-
spread couple therapy (Broderick & Schrader, 1981). Currently, religiously
based marital interventions—largely drawing from the Christian tradition—
are common. They are recognizable by their explicitly religious therapists,
integration of religious interventions such as prayer into treatment, and match-
ing of religious interventions to clients who share the religious values, be-
liefs, and behaviors on which the interventions are based.
Religious people differ substantially within their religion as a function of
religious beliefs (e.g., theologically conservative or liberal) and values (e.g.,
high versus moderate or low value placed on religion). Measures of religious
beliefs assess religiosity based on an individual’s agreement with orthodox
religious propositional statements. Religious values are superordinate orga-
nizing statements of what one considers important in life (Rokeach, 1968).
Highly religious persons are considered to be those rating their religiosity as
very valuable, engaging in religious behaviors often, and tending to have
well-defined religious beliefs.
The value placed on one’s religion has been particularly useful in pre-
dicting client responses to individual therapy and potential clients’ expecta-
tions and preferences for individual therapy. Worthington et al. (1988) hy-
pothesize that those who value their religion highly would react differently
in therapy than would those who placed moderate-to-low value on religion.
Specifically, it is hypothesized that highly religiously committed people would
prefer

41
Religiosity in Marital Therapy
(a) therapists whose values were similar to their own,
(b) therapists who employed explicitly religious interventions characteristic
of the clients’ religion,
(c) form faster and stronger working alliances with such therapists,
(d) are less likely to drop out of therapy with such therapists, and
(e) expect better outcomes from such therapists, and relative to clients whose
religious values were moderate or lower.
Highly religious clients were hypothesized to have a perceptual screen
that sensitized them to be likely to perceive the world according to religious
categories; whereas, people with no, low, or moderate religious values might
respond to religious stimuli but would rarely perceive secular stimuli in reli-
gious terms. In a variety of tests by several investigators, some of those
hypotheses have been supported (for a review of the research, see Worthington
et al., 1996). Alternatively, religious beliefs (as opposed to religious values)
have not always been found to predict preferences for therapy (Keating &
Fretz, 1990; McCullough & Worthington, 1995; McCullough, Worthington,
Maxie, & Rachal, 1997; Morrow, Worthington, & McCullough, 1993).
People who prefer religious therapy consonant with their own beliefs,
values, or practices might differ according to what they would actually con-
sider appropriate religious therapy. For example, some people might be
content to receive therapy from a therapist whom they know to share their
religious beliefs or practices. Others might prefer to have explicitly religious
techniques (e.g., prayers, religious homework, Scriptural integration) em-
ployed in therapy.
The research that has investigated the match between client and thera-
pist religiosity has typically used a therapist label (e.g., “Christian therapist”
versus “not a Christian therapist”) or a description or other external stimuli
(i.e., displaying a crucifix or wearing a yarmulke) as the index of therapist
religiosity. While several studies have found that explicitly religious thera-
pists frequently use explicitly religious interventions (e.g., Ball & Goodyear,
1991; Worthington, Dupont, Berry, & Duncan, 1988), studies have not inves-
tigated perceptions by potential clients of the use of religious interventions
by either similarly religious therapists or therapists dissimilar to the potential
clients’ religion.
Most research on explicitly religious clients has investigated Christians—
probably because of the size of that subpopulation within the U.S. First,
most people in the U.S. describe themselves as Christian (Barrett, 1996; Gallup,
1981). Second, most therapists who describe themselves as religious are
Christian (Shafranske & Maloney, 1990). Third, many Christian clients re-
quest (or demand) therapy from therapists who profess Christianity—whether
the therapist has an explicitly Christian or secular practice. Christians as a
group seem to value the permanency of marriage more than do many other
subgroups (Thornton, Axinn, & Hill, 1992), so the preference for explicitly

42
J. S. Ripley et al.
“Christian marital therapy” with explicitly “Christian therapists” is particularly
relevant. These factors have spawned
(a) large organizations such as the 17,000-member American Association of
Christian Counselors (AACC)—over half of whom describe themselves
as marital therapists,
(b) professional journals (e.g., Marriage and Family: A Christian Journal),
and
(c) clearly articulated explicitly Christian interventions with marriages.
Worthington (1996) collected essays on eight approaches to Christian marital
therapy. Other, nontherapy, intervention programs include Marriagebuilders
(Harley, 1996), Saving Your Marriage Before It Starts (SYMBIS; Parrott &
Parrott, 1996), Marriage Encounter (Silverman & Urbaniak, 1983), and Chris-
tian Prevention and Relationship Enhancement Program (Christian PREP;
Stanley, Trathen, & McCain, 1996; Stanley, Trathen, McCain, & Bryan, 1998).
Research in marital therapy with couples professing to be Christians (or
those professing any other religion) is virtually nonexistent (for reviews, see
Ripley & Worthington, 1996, 1998). Studies have not investigated married
Christians’ preferences and expectations for marital therapy, should the need
arise. Considering the widespread existence of Christian-based marital inter-
ventions, might some married Christians prefer to meet with an explicitly
Christian marital therapist and might some prefer to have interventions drawn
from Christian ecclesiastical practices integrated into marital therapy? If that
is so, what distinguishes those who would prefer religious marital therapy
from those without such preferences or from those who would prefer not to
have a Christian-based marital therapy? In the present study, married Chris-
tian individuals’ preferences for marital therapy and expectations of the ef-
fectiveness of marital therapy were investigated relative to the following
conditions:
• Christian marital therapist or one who is not a Christian
• A marital therapist who is willing to use Christian techniques such as
prayer and Scripture reading in treatment or one who uses standard psy-
chological techniques only.
Based on previous research with individual therapy, it was expected
that religious values, but not Christian beliefs, would predict ratings of the
four situations of marital therapy (Keating & Fretz, 1990; McCullough &
Worthington, 1995; McCullough et al., 1997; Morrow et al., 1993). Because
marriage is highly valued by most Christians and many have strong beliefs
about it, it is necessary to investigate responses of married Christians to
explicitly Christian or secular marital therapy. The main hypothesis con-
cerned the interaction between participant religiosity and rating of marital
therapy situations.

43
Religiosity in Marital Therapy
METHOD
Design and Independent Variables
The study used a 2 × 2 × 2 (participant religiosity × religiosity of therapist ×
use of religious techniques) quasi-experimental design. Participants of higher
and lower religiosity were randomly assigned to one of four conditions as
described below (religiosity of therapist × use of religious technique).
PARTICIPANT RELIGIOSITY
Participants were divided into high versus low to moderate in their religios-
ity measured two ways: Christian beliefs and religious values. Participants
who scored one standard deviation higher than the standardized mean based
on the standardization statistics of the Shepherd Scale (Bassett, Camplin,
Humphrey & Door, 1991) and the religious values scale (Worthington, Hight,
et al., 1998) were considered high in Christian beliefs or religious values; all
others were considered low-to-moderate in their Christian beliefs and reli-
gious values.
MARITAL THERAPY SITUATION
Participants read one of four descriptions of the conditions, supposing that
they were to seek marital therapy. In each situation, the therapist was de-
scribed as a male with considerable marital therapy experience, well-re-
spected in the community, and married with two children. Each therapist
was also described as someone who respected his clients’ values and beliefs
regarding religion. The description was then varied based on (a) the thera-
pists’ religiosity and (b) the use of religious techniques in therapy. Thera-
pists’ religiosity was indicated with a description as either a Christian who
attends a local church or someone who does not believe in Christianity and
does not attend church. To indicate the use of Christian techniques, the
therapist was described as willing to use Christian practices such as prayer
and Scripture reading in therapy or as using only standard psychological
practices in therapy.
Measures
DEMOGRAPHIC INFORMATION
Demographic information was obtained as part of the assessment. Individu-
als reported their gender, age, race, educational attainment, and they com-
pleted a measure of marital adjustment. Marital adjustment was measured by
the Dyadic Adjustment Scale (DAS, Spanier, 1976). The original study was
conducted with 400 subjects from rural Pennsylvania. Factor analysis of the
Dyadic Adjustment Scale using oblique rotation, with a loading of at least
.30, found four factors: dyadic satisfaction, dyadic cohesion, dyadic consen-

44
J. S. Ripley et al.
sus, and affectional expression (Spanier, 1976). For the present study, only
full-scale scores were used to measure marital adjustment because the
subscales have not been found to be as reliable and valid as the entire scale
(Cohen, 1985). Content, criterion-related, and construct validity were estab-
lished by Spanier (1976). Total sample correlation with the Locke–Wallace
Marital Adjustment Scale was .93. A total reliability score of alpha = .96 was
established as well (Spanier, 1976). Subsequent tests of reliability, utilizing
similar samples, have repeatedly supported Spanier’s Dyadic Adjustment Scale
to be an adequate measure of marital adjustment (Spanier & Filsinger, 1983).
The Dyadic Adjustment Scale has been evaluated as a better measure of
marital satisfaction than was the Locke–Wallace (1959) Marital Adjustment
Scale (Cohen, 1985). A score of less than 100 on the DAS is considered to be
clinically troubled.
RELIGIOSITY
Religiosity was measured in two ways. First, Christian beliefs were assessed
using the Shepherd Scale (Bassett et al., 1981). The Shepherd Scale is a 38-
item instrument, derived from Christian Scripture references, to survey sub-
jects’ traditional (theologically conservative) Christian beliefs and practices.
The Shepherd Scale has produced a reasonable split-half reliability when
corrected using the Spearman Brown procedure, r = .91 (Bassett et al., 1981).
In addition, Bassett et al. (1981) reported good 3-week test-retest reliability,
r = .82. Internal consistency was estimated by Cronbach’s alpha at .86. In a
subsequent study, Bassett et al. found that among participants who identi-
fied themselves as Christians, the mean score was 131, while non-Christians’
mean score was 91 (standard deviation was 8.7). In studies with random
sampling, distributions on religious beliefs and values tend to be bimodal
more often than normal (Kelly & Strupp, 1992). For the present study, people
categorized as having high Christian beliefs scored at least one standard
deviation above the mean in the Christian standardized sample (Bassett et
al., 1991).
Second, the construct of religious values was measured using the Reli-
gious Commitment Inventory-10 (RCI-10; Worthington et al., 1998). The RCI-
10 is a 10-item nonsectarian measure of an individual’s values regarding
commitment to religiosity such as “religious beliefs influence all my dealings
in life. The RCI-10 was found to have strong internal consistency (Cronbach’s
alpha = .94; Worthington et al., 1998), and 3-week test-retest stability (.87;
Worthington et al., 1998). Construct and criterion validity were established
against a variety of criteria. Confirmatory factor analyses on two university
samples and one community sample supported a consistent factor structure
(CFI = .90, .94; Worthington et al., 1998). A score of 42 was one standard
deviation greater than the mean and was used as the score beyond which
individuals would be classified as high in religious values (Worthington et
al., 1998).

45
Religiosity in Marital Therapy
PREFERENCES AND EXPECTATIONS FOR MARITAL THERAPY DESCRIPTIONS
After participants read one of the descriptions of a marital therapy situation,
they rated the following questions (a) “if you were to seek marital therapy
how likely would you be to visit the therapist described in the vignette,” and
(b) “how effective do you believe the therapist would be in improving your
marriage.” Participants answered each question on a 7-point Likert-scale from
“definitely would not” (1) to “definitely would” (7). These scales have been
used in many previous research studies except for the modification to stipu-
late “marital therapy” rather than “therapy” (e.g., Dougherty & Worthington,
1982; Morrow et al., 1993; McCullough & Worthington, 1995; McCullough et
al., 1997; Worthington & Gascoyne, 1985; Worthington & Scott, 1983). Al-
though the different measures of religiosity are conceptually different, they
are usually highly correlated.
Procedure
Participants were recruited from eight churches (n =162). Denominations
included Episcopalian, Presbyterian, Baptist, Nondenominational, Assemblies
of God, and Christian Missionary Alliance. Married Christian students from
introductory psychology classes at a public university were also recruited (n
= 49). The church population was used to ensure that the specific group of
highly religious individuals sought for this study were obtained and to in-
crease the ecological validity. University students were included to increase
the generalizability. Participants were presented with the opportunity to par-
ticipate with an in-person request and given packets of the questionnaires to
return within 2 weeks. Each participant was assessed on all of the demo-
graphic, marital adjustment, and religiosity measures. Participants were ran-
domly assigned one of the four marital therapy situations according to their
packet of questionnaires (i.e., the combinations of the 2 × 2 design) which
were randomly distributed.
RESULTS
Equivalency of Conditions
Demographic information by condition is reported in Table 1. In Table 2, the
means and standard deviations are reported of preferences and expectations
for marital therapy for people at each level of religiosity assigned to rate
each marital therapy situation. Among this sample 86% (n = 181) had used
resources to improve their marriage. Among these, 70% (n = 147) had read a
book to improve their marriage, 64% (n = 135) had premarital counseling,
45% (n = 93) had attended a marital enrichment workshop or seminar, and
28% (n = 57) had attended marital counseling with a mean of 7.3 sessions.
Participants were randomly assigned to one of the four marital therapy
situations; several analyses were conducted to insure the equivalency of the

46
J. S. Ripley et al.
TABLE 1. Distribution of participants with different demographic characteristics across
different stimulus conditions
Non-Christian Therapist
Christian Therapist
Psychological
Techniques
Christian
Techniques
Psychological
Techniques
Christian
Techniques
Gender (n)
Male
Female
21
36
23
24
22
33
20
30
Education (n)
Less than H.S.
High School
College
0
24
21
12
1
16
16
14
2
21
19
13
0
20
20
10
Graduate Degree
Race (n)
African–American
Asian
9
0
6
3
7
3
8
2
Caucasian
Hispanic
40
0
45
1
35
0
46
0
Native American
Christian Beliefs (n)
Low to Moderate
High
0
0
1
1
17
40
10
36
14
41
12
38
Religious Values (n)
Low to Moderate
High
21
36
18
29
20
35
10
38
Note: Unequal n are due to missing data. For each condtion, Dyadic Adjustment Scale Score was as
follows: For non-Christian therapist using psychological practices (M = 114.40, STD = 15.5); for non-
Christian therapist willing to use Christian practices (M = 113.40, STD = 17.2); for Christian therapist
using psychological techniques (M = 110.12, STD = 20.7); for Christian therapist using Christian tech-
niques (M = 112.44, STD = 16.1). For each condition age mean was as follows: For non-Christian
therapist using psychological practices (M = 39.9, STD = 11.30); for non-Christian therapist willing to
use Christian practices (M = 39.44, STD = 13.49); for Christian therapist using psychological techniques
(M = 39.94; STD = 13.17); for Christian therapist using Christian techniques (M = 41.82, STD = 11.95).
conditions. For categorical variables, Chi-square analyses were conducted,
which found no differences (all p < .05) across conditions by gender, X2 (1)
= 1.67; education, X2 (9) = 30.84; race/ethnicity, X2 (1) = .54; or high versus
moderate to low Christian beliefs, X2 (1) = .81; high versus low to moderate
religious values X2 (1) = 4.44. For continuous variables, one-way (four mari-
tal therapy situations) analyses of variance (ANOVAs) were conducted on
marital adjustment, F (3, 205) = .55, p = .65, and age, F (3, 205) = .40, p = .75.
It was concluded that random assignment to the four conditions resulted in
equivalency.
Preliminary Analyses
The intercorrelation was examined (see Table 3) and ANOVAs were con-
ducted to determine whether any demographic variables or the marital ad-

47
Religiosity in Marital Therapy
TABLE 2. Means and standard deviation of dependent variables by conditions
Non-Christian Therapist
Christian Therapist
Psychological Christian
Techniques Techniques
Psychological Christian
Techniques Techniques
Christian Beliefs
Preferences for Description of Marital Therapy Situation
High Christian Beliefs
Low-Moderate Christian Beliefs
1.88 (1.07)
3.41 (1.77)
4.33 (1.84)
3.70 (1.70)
5.48 (1.43) 5.71 (1.41)
3.64 (1.86) 4.42 (2.35)
Anticipated Efficacy of Descriptions of Marital Therapy Situations
High Christian Beliefs
Low-Moderate Christian Beliefs
2.28 ( .91)
3.47 (1.33)
3.92 (1.52)
4.00 (1.33)
5.00 (1.52) 4.97 (1.55)
3.64 (1.69) 3.92 (1.68)
Religious Values
Preferences for Description of Marital Therapy Situation
High Christian Beliefs
Low-Moderate Christian Beliefs
1.76 ( .91)
2.93 (1.72)
5.00 (1.92)
3.62 (1.47)
5.41 (1.64) 5.86 (1.33)
4.52 (1.76) 4.65 (2.08)
Anticipated Efficacy of Descriptions of Marital Therapy Situations
High Christian Beliefs
Low-Moderate Christian Beliefs
2.21 ( .77)
3.07 (1.36)
4.48 (1.60)
3.54 (1.21)
5.07 (1.65) 5.11 (1.59)
4.16 (1.57) 4.00 (1.45)
Note: On a scale from 1 (not at all) to 7 (very).
justment variable were related to the dependent variables. None of these
variables were related to the dependent variables.
The data was analyzed using four sets of 2 × 2 × 2 (participants’ religi-
osity × therapist’s religiosity × use of religious techniques) ANOVAs. In two
sets of ANOVAs, religiosity was determined by Christian beliefs and, in the
other two, by religious values. Each set of ANOVAs examined the prefer-
ence for the therapist first and the expectations for the outcome of therapy
second. This method yields four three-way interactions and eight relevant
two-way interactions. To control for Type I error a modified Bonferroni of p
< .02 is used as the criterion for significance (Keppel, 1991). The interactions
of therapists’ religiosity by use of religious technique and the main effects
are irrelevant to the hypotheses and were not examined.
The Effects of Christian Beliefs on Ratings
of Marital Therapy Descriptions
A 2 × 2 × 2 (participants’ Christian beliefs {high, low-to-moderate} × thera-
pists religiosity {Christian, non-Christian} × use of religious techniques {will-
ing to use Christian practices, using psychological practices only}) between
subjects ANOVA was performed on the two dependent variables associated
with perception of the therapist: preference for and anticipated efficacy of
the therapy situation.

48
J. S. Ripley et al.
TABLE 3. Intercorrelation matrix of variables
1
2
3
4
5
6
7
8
1. Age
2. Ethnicity
3. Subject Pool
4. Education
.11
–.40*
.07
–.08
–.17
–.03
–.04
.05
–.26*
.04
–.47*
–.49*
–.10
–.10
5. Marital Adjustment
6. Religious Values
7. Religious Beliefs
8. Preference
.08
.07
.16
.12
–.01
–.03
.29*
.25*
.01
.18
.15
.10
.02
.58*
.17
.11
–.01
.01
.14
.08
9. Anticipated Efficacy
.05
.83*
*Denotes P = < .001 (significant after Bonferroni correction).
PREFERENCE FOR THERAPY DESCRIPTION
Contrary to expectations, there were significant interactions between partici-
pants’ Christian beliefs, therapist’s religiosity, and use of religious techniques
for preference for therapy situation. The three-way interaction of partici-
pants’ Christian beliefs by therapists’ religiosity by use of religious technique
was significant, F (1, 199) = 7.01, p = .009. Post-hoc Tukey tests for the three-
way interaction (minimum pairwise difference) = 1.99) revealed that for those
with high Christian beliefs there was a significant difference between the
non-Christian using psychological practices only (mean = 1.88) and all other
types of therapy descriptions (non-Christian willing to use Christian tech-
niques = 4.33; Christian with psychological techniques only = 5.48; Christian
with Christian techniques mean = 5.71). There were no significant post-hoc
differences for those with low-to-moderate Christian beliefs.
The two-way interaction of participants’ Christian beliefs by therapist’s
religiosity was also significant, F (1, 199) = 15.52, p = < .000. Post-hoc Tukey
tests for the two-way interaction (minimum pairwise difference = 1.33) re-
vealed that for those with high Christian beliefs there was a significant differ-
ence between the non-Christian therapist (mean = 3.12) and the Christian
therapist (mean = 5.09). However, for those with low-to-moderate Christian
beliefs there were no significant differences between the non-Christian thera-
pist (mean = 3.26) and the Christian therapist (mean = 4.09). The two-way
interaction of participants’ Christian beliefs by the therapists’ use of religious
technique alone was not significant, F (1, 199) = 2.88, p = .09.
ANTICIPATED EFFICACY OF THERAPY DESCRIPTION
The three-way interaction of participants’ Christian beliefs by therapists’ reli-
giosity by use of religious technique on anticipated efficacy of therapy was
not significant, F (1, 199) = 4.78, p = .13. However, the two-way interaction
of participants’ Christian beliefs by therapist’s religiosity was significant, F (1,
199) = 16.08, p = < .001. Post-hoc Tukey tests for the two-way interaction

49
Religiosity in Marital Therapy
(minimum pairwise difference = 1.22) revealed a significant difference for
those with high Christian beliefs but not for those with low-to-moderate
Christian beliefs. For those with high Christian beliefs, there was a significant
difference between the non-Christian therapist (mean = 3.05) and the Chris-
tian therapist (mean = 5.59). However, for those with low-to-moderate Chris-
tian beliefs there were no significant differences between the non-Christian
therapist (mean = 3.67) and the Christian therapist (4.00). The two-way inter-
action of participants’ Christian beliefs by the therapist’s use of religious
technique was not significant, F (1, 199) = .78, p = . 38.
The Effects of Religious Values on Ratings
of Marital Therapy Description
Similar 2 × 2 × 2 (participants’ religious values {high, low to moderate} ×
therapists’ religiosity {Christian, non-Christian} × use of religious techniques
{willing to use Christian practices, use of psychological practices only}) be-
tween subjects ANOVAs were performed on the two dependent variables
associated with perception of the therapist: preference for and anticipated
efficacy of marital therapy.
PREFERENCE FOR THERAPY DESCRIPTION
As expected, there were significant interactions between participants’ reli-
gious values, description of therapist’s religiosity, and use of religious tech-
niques for preference for therapy situation. The three-way interaction of
participants’ religious values by therapist’s religiosity by use of religious tech-
nique was significant, F (1, 198) 6.16, p = .014. Post-hoc Tukey tests for the
three-way interaction (minimum pairwise difference = 1.79) revealed that for
those with high religious values there was a significant difference between
the non-Christian using psychological practices only (mean = 1.76) and all
other types of therapy descriptions (non-Christian willing to use psychologi-
cal techniques = 5.50; Christian with psychological techniques = 5.41; Chris-
tian with Christian techniques = 5.86). There were no significant means dif-
ferences for those with low-to-moderate religious values.
The two-way interaction of participants’ religious values by therapist’s
religiosity was not significant, F (l, 198) = 4.36, p = .04. However the two-
way interaction of participants’ religiosity by therapist’s use of religious tech-
nique was significant F (1, 198) = 10.08, p = .002. Post-hoc Tukey tests for the
two-way interaction (minimum pairwise difference = 1.03) revealed that for
those with high religious values, there was a significant difference between
the descriptions with the use of psychological techniques (mean = 3.59) and
use of Christian techniques (mean = 4.84). For those with low-to-moderate
religious values, there were no significant differences between the descrip-
tions with the use of psychological techniques (mean = 3.58) and use of
Christian techniques

50
J. S. Ripley et al.
ANTICIPATED EFFICACY OF THERAPY DESCRIPTION
The three-way interaction of participants’ religious values by description of
therapists’ religiosity by use of religious technique for the dependent vari-
able anticipated efficacy of therapy was not significant, F (1, 198) = 4.04, p =
.05. However both two-way interactions were significant. The two-way inter-
action of participants’ religious values by therapists’ religiosity was signifi-
cant, F (1, 198) = 5.93, p = .016. Post-hoc Tukey tests for the two-way inter-
action (minimum pairwise difference = 1.30) revealed that for those with
high religious values there was a significant difference between the non-
Christian therapist (mean = 3.16) and the Christian therapist (mean = 5.63)
for those with high Christian values. For those with low-to-moderate reli-
gious values, there were no significant differences between the non-Chris-
tian therapist (mean = 3.35) and the Christian therapist (mean = 4.58).
The two-way interaction of participants’ religious values by use of reli-
gious technique was also significant, F (1, 198) = 6.29, p = .013. Post-hoc
Tukey tests for the two-way interaction (minimum pairwise difference) =
.95) revealed that for those with high religious values there was a significant
difference between the use of psychological practices only (mean = 3.64)
and the use of Christian techniques (mean = 5.49). Similar to the previous
significant interactions, post-hoc Tukey tests for those with low-to-moderate
religious values indicated that there were no significant differences between
descriptions with the use of psychological techniques (mean = 3.68) and the
use of Christian techniques (mean = 4.07).
DISCUSSION
Married Christian individuals’ preferences for and anticipated effectiveness
of marital therapy were examined relative to the perceived religiosity and
behavioral preferences of therapists. Most of the participants were from com-
munity churches representing six denominations, but a minority were se-
lected from married university students who rated themselves as Christian
from numerous denominations. Findings inform marital therapists about two
subgroups of potential clients (i.e., highly religious Christians and Christians
who are of low-to-moderate religiosity).
Preferences and Expectations Stimulated
by Descriptions of Marital Therapy
Some people have speculated that religious people might have some resis-
tance to certain marital therapy contexts (see Worthington & Scott, 1983).
This study found that therapist’s religiosity and willingness to use religious
techniques may influence whether highly religious couples would engage in
therapy and anticipate positive outcomes of treatment.

51
Religiosity in Marital Therapy
As in previous research (Godwin & Crouch, 1989; Keating & Fretz, 1990;
McCullough & Worthington, 1995; Morrow et al., 1993; Pecnik & Epperson,
1985; Worthington & Gascoyne, 1985; Worthington et al., 1988; cf. McCullough
et al., 1997), Christians who were highly religious (one standard deviation
from the mean of a Christian population) perceived therapy differently from
Christians who were low-to-moderate in religiosity. In the present research,
previous investigations were broadened to examine marital therapy. For the
person of low-moderate religiosity, whether marital therapy was offered by
a Christian or non-Christian therapist did not matter, which was consonant
with research in individual therapy. Nor did the issue of whether a therapist
was willing to use interventions in therapy that were derived from ecclesias-
tical practices, which has not previously been investigated. That is good
news for most practitioners in general practice who see many Christian cli-
ents—even though the clients might not identify themselves as Christians.
On the other hand, highly religious Christians made substantial distinc-
tions across marital therapy situations. They did not necessarily seek highly
religious Christian therapists as much as they rejected a marital therapist who
was religiously different and appeared uninterested in the client’s religion.
They did not strongly prefer a non-Christian therapist who was not willing to
use Christian techniques—despite the assurance that the therapist respected
the clients’ religious values. If an avowed non-Christian therapist professed
willingness to use some Christian interventions, that was enough to offset
the potential clients’ antipathy.
Worthington (1988) suggests that in Western traditions highly religious
people tend to perceive the world through a perceptual lens colored by their
religious values. Why would highly religious people make distinctions among
therapists based on therapists’ dissimilarity to their religious values? It has
been hypothesized that many religious persons (and members of other mi-
nority groups; Watkins, Terrell, & Miller, 1989) distrust mainstream American
culture, which they might fear is represented by secular therapists. Highly
religious clients might, therefore, prefer to stay with their own cultural group
when seeking marital therapy. This may be particularly true considering the
general acceptance of divorce in mainstream culture. Highly religious Chris-
tians generally adhere to traditional marital values (Glenn & Supancic, 1984;
Thornton, 1989) and may believe that secular therapists are more accepting
of divorce. To date, no published research has directly investigated the role
of trust in influencing expectations of therapy by religious individuals for
either individual and couples treatments.
In addition, in the history of psychology there have been a number of
psychologists who have been less than-favorable towards Christians (Ellis,
1992; Carroll, 1988). There are also issues within psychology that many Chris-
tians would find objectionable, such as issues around sexuality (Whitehead,
1996), child-rearing practices (Bromley & Cress, 1998), and the value of self-
esteem over self-sacrifice (Bromley & Busching, 1988). Many Christians hear

52
J. S. Ripley et al.
of these psychologists and issues and conclude that psychologists are not
supportive of Christians at best and anti-Christian at worst. The call for re-
search by the American Psychological Association in religious issues as a
part of multicultural understanding should begin to send a message to this
population that Christians can seek therapy without fear that their faith will
be ignored, ridiculed, or attacked. In fact, it’s probable that most Christians
would find their faith and values supported whether or not the therapist
holds the same beliefs. However, this issue has not been fully explored in
research and clinicians may differ on their approach to the issue.
How important are preferences and expectations? There is some evi-
dence that despite differences in expectations of individual therapy between
highly religious and less religious people, when people actually seek therapy,
the highly religious and less religious do not respond differently (Beutler &
Bergan, 1991). However, that finding is opposed by substantial research (see
Worthington (1991) for a review). One important study by Propst, Ostrom,
Watkins, Dean, and Mashburn (1992) suggests that religious matching is im-
portant to therapy outcome. No research has investigated matching religious
or nonreligious marital therapy with similarly religious couples or partners.
Apart from outcomes, preferences for and expectations of the efficacy
of therapy are likely to have strong effects on whether potential clients ever
set up an appointment or keep the initial appointment with a therapist. Many
moderately or nonreligious therapists might have few interactions with highly
religious clients simply because highly religious people usually either (a)
seek therapy from clergy or their religious community, (b) seek therapy from
an explicitly like-religious professional, or (c) do not seek therapy even
when they need it.
Christian Beliefs or Religious Values as Predictors?
A methodological issue arose in the findings. Previous research on indi-
vidual therapy found that high religious values predict preferences for and
anticipated efficacy of individual therapy while high Christian beliefs do not
(see Worthington et al. (1996) for a review). The present study found that
religious beliefs and religious values both predicted preferences for and an-
ticipated effects of marital therapy. Two potential reasons are suggested why
perceptions of marital and individual therapy might differ.
First, marriage and religiosity are highly interrelated for Christians—
especially theologically conservative married Christians, such as those who
comprised much of the present sample (Prest & Keller, 1993; Waanders,
1987; Worthington, 1989). These people might not see their religion linked
as closely to their individual mental health as to their marriage. Studies have
shown there to be a positive correlation between measures of spiritual well-
being and marital adjustment (Benda & DiBlasio, 1992; Dudley & Dudley,
1994; Roth, 1988; Wilson & Filsinger, 1986). Exactly how one’s marriage
might be intertwined with one’s spirituality is a matter of debate even among

53
Religiosity in Marital Therapy
religious theorists. Nevertheless, many people in the general population,
and especially among highly religious Christians, believe religion and mar-
riage affect each other.
Second, highly religious people’s beliefs might affect their perceptions
of marital therapy because both could be related to their philosophy of
social relations. Christianity and marriage might both be seen as rooted in a
covenantal, communal value system of human relations (Adams, Spain, &
Hunt, 1998; Bromley & Busching, 1988; Browning, Miller-McLemore, Cou-
ture, Lyon, & Franklin, 1997; Witte, 1997). In a covenant, a permanent com-
mitment is made between two parties in which each is seen as being of
shared blood with the other. According to Bromley and Busching (1988),
covenantal social relations can be contrasted to social relations that are seen
as implicitly or explicitly contractual. Contractual social relations are those
held together by mutual contract fulfillment. Whereas covenantal social rela-
tions are largely seen as permanent, contractual social relations are often
more temporal and contingent on contractual performance. If Christians per-
ceive themselves as covenantal in their marital social values and perceive
their therapist as contractual in marital social values, then clients might per-
ceive their therapist to be working at cross-purposes to the clients’ goals.
Thus, highly committed married Christian individuals might be seeking a
therapist with values similar to their own. Their preference for a similarly
religious therapist, or at least one open to their religion, might have little to
do with religious faith per se.
Implications for Marital Therapy
For the Christian marital therapist, the present research indicates that the
explicit identification of himself or herself as a Christian is likely to attract
highly religious Christian clients, while not affecting the moderate-to-less
religious Christian clients. Marketing ventures that target highly religious Chris-
tians, such as seeking referrals from ministers and word-of-mouth in reli-
gious organizations, may be a method for attracting new couples seeking
therapy or promoting enrichment endeavors.
For the marital therapist whose religion is dissimilar from that of Chris-
tian clients, the willingness to use interventions consistent with their clients’
religion may make the therapist more appealing to highly committed Chris-
tian clients than might refusal to use such techniques. This research implies
that, similar to research in other cultural groups, many from the Christian
religion may prefer respect for and incorporation of their beliefs and values
in marital therapy. Therapists who are willing to explore the religious beliefs
and values of their clients and then to allow for the incorporation of those
beliefs into the therapy process may be meeting the needs of their clients
(Richards & Bergin, 1997). The present research is limited in that it did not
investigate the effect of simply not mentioning the therapists’ personal Chris-
tian commitments or willingness to use Christian-consonant interventions.

54
J. S. Ripley et al.
An important question is, does the typical religious marital therapist feel
comfortable engaging in this type of integration, not to mention the marital
therapist who is less committed to religion or who is not religious? One of
the marital therapy situations in the present research described a nonreli-
gious therapist who was willing to engage in religious practices as part of the
therapy. How comfortable might a nonreligious therapist feel saying a prayer
in session, or referring to Scriptures that he or she may not have studied or
understand, not to mention may not believe? Some therapists may be com-
fortable with this type of situation while others may not (Lovinger, 1990).
Beyond a therapists’ comfort in using religious interventions is his or
her competence at doing so. Propst et al. (1992) found that non-Christian
individual therapists who followed an explicitly Christian protocol for treat-
ing depression had clients who actually improved more than did Christian
therapists who followed the same protocol. However, professional ethics
will play a large part in a therapist’s willingness and competence relative to
using explicitly religious interventions (Sanders, 1997). For example, just
because a therapist can pray with a client who requests prayer does not
mean that the therapist should pray, especially if the therapist does not share
similar religious beliefs and values as the client. An analogy would be the
suburban Caucasian therapist who suddenly adopts an African-American urban
dialogue with an African-American client without understanding the experi-
ence of African-American urban life. Such an attempt to join with the client
would likely be perceived by the client as insincere.
Limitations of the Present Study
The present study investigated married individuals who indicated some com-
mitment to Christianity. Within the U.S., a majority of people self-identify as
Christian (Barrett, 1996). At present, the findings are generalizable to many
potential clients for marital therapy but do not apply to nonreligious clients
or those of other religions.
In addition, it is also possible that except for those that market them-
selves as “Christian counselors” the religious beliefs and values of a therapist
would not be readily available for a client when they seek a therapist. How,
when, and if highly religious clients ascertain this information about their
therapist would be an interesting process to observe and study. The present
study cannot speak to this phenomenon because the religiosity of each thera-
pist was described. In addition, the condition in which the therapist is a non-
Christian willing to use Christian interventions is somewhat unrealistic. It’s
possible that a non-Christian therapist might encourage a client to use their
faith and faith community as a source of strength, but the therapists’ use of
ecclesiastical techniques in counseling is unlikely and may have been con-
fusing to participants.
Another limitation of the present research is that it surveyed expecta-
tions of married people who were not clinically referred to marital therapy.

55
Religiosity in Marital Therapy
In fact, many individuals reported high marital adjustment. While the vast
majority of participants had sought some help with their marriage and 28%
of the sample had attended marital counseling at some time, only 38 of the
211 participants had a score on the DAS of below 100 at the time of the
study, a standard below which Spanier and Filsinger (1983) would consider
to be clinically distressed. When couples become distressed enough to seek
marital therapy, their preferences for specific therapist characteristics might
change—becoming either more or less tolerant of differences in values or
beliefs. Generalizations should be made circumspectly. As has been argued,
expectations of marital therapy will likely affect whether couples seek therapy,
and perhaps how they might respond to it. With marriages deteriorating in
large numbers today, many of the people surveyed in the present study
might actually be candidates for marital therapy in the future.
REFERENCES
Adams, J. M., Spain, J. S., & Hunt, K. (1998, May). The measurement of exchange and
communal attitudes in marriage: Scale development and initial validation. Pa-
per presented at the meeting of the American Psychological Society, Washing-
ton, DC.
Ball, R. A., & Goodyear, R. K. (1991). Self-reported professional practices of Chris-
tian psychotherapists. Journal of Psychology and Christianity, 10, 144–153.
Barrett, D. G. (1996). Religion: World religious statistics. In Encyclopedia Britannica
book of the year (p. 284). Chicago: Encyclopedia Britannica.
Bassett, R. L., Camplin, W., Humphrey, D., & Door, C. (1991). Measuring Christian
maturity: A comparison of several scales. Journal Psychology and Theology, 19,
84–93.
Bassett, R. L., Sadler, R. D., Kobischen , E. E., Skiff, D. M., Merrill, I. J., Atwater, B. J.,
& Livermore, P. W. (1981). The Shepherd Scale: Separating the sheep from the
goats. Journal of Psychology and Theology, 9, 335–349.
Benda, B. B., & DiBlasio, F. A. (1992). Clergy marriages: A multivariate model of
marital adjustment. Journal of Psychology and Theology, 20, 367–375.
Beutler, L. E., & Bergan, J. (1991). Value change in counseling and psychotherapy: A
search for scientific credibility. Journal of Counseling Psychology, 38, 16–24.
Broderick, C. B., & Schrader, S. S. (1981). The history of professional marriage and
family therapy. In A. S. Gurman & D. P. Kniskern (Eds.), Handbook of family
therapy (pp. 5–35). New York: Brunner/Mazel.
Bromley, D. G., & Busching, B. C. (1988). Understanding the structure of contractual
and convenantal social relations: Implications for the sociology of religion. So-
ciological Analysis, 49, 15–32.
Bromley, D. G., & Cress, C. H. (1998). Locating the corporal punishment debate in
the context of conflicting forms of social relations. Marriage and Family: A
Christian Journal, 1, 152–164.
Browning, D. S., Miller-McLemore, B. J., Couture, P. D., Lyon, K. B., & Franklin, R.
M. (1997). From culture wars to common ground: Religion and the American
family debate. Louisville, KY: Westminster John Knox Press.

56
J. S. Ripley et al.
Carroll, M. P. (1988). Moses and monotheism and the psychoanalytic study of early
Christian mythology. Journal of Psychohistory, 15, 295–310.
Cohen, P. (1985). Locke marital adjustment scale and the dyadic adjustment scale.
American Journal of Family Therapy, 13, 66–71.
Dougherty, S. G., & Worthington, E. L., Jr. (1982). Preferences of conservative and
moderate Christians for four Christian counselors’ treatment plans for a troubled
client. Journal of Psychology and Theology, 10, 346–354.
Dudley, R. L., & Dudley, M. G. (1994). Lifestyle stress and marital adjustment among
seminary students and their spouses. Family Perspective, 28, 139–153.
Ellis, A. (1992). Do I really hold that religiousness is irrational and equivalent to
emotional disturbance? American Psychologist, 47, 428–429.
Gallup, G. (1981). Religion in America. Princeton: Gallup Organization and Princeton
Religion Research Center.
Glenn, N. D., & Supancic, M. (1984). The social and demographic correlates of
divorce and separation in the United States: An update and reconsideration.
Journal of Marriage and the Family, 46, 563–576.
Godwin, T., & Crouch, L. (1989). Subjects’ religious beliefs and their perception of
the psychotherapy process. Psychological Reports, 66, 3–9.
Harley, W. F., Jr. (1996). Teaching couples to fall in love. In E. L. Worthington, Jr.
(Ed.), Christian marital counseling: Eight approaches to helping couples (pp.
39–62). Grand Rapids, MI: Baker.
Keating, A. M., & Fretz, B. R. (1990). Christians’ anticipations about therapists in
response to counselor descriptions. Journal of Counseling Psychology, 7, 293–
296.
Kelly, T. A., & Strupp, H. H. (1992). Patient and therapist values in psychotherapy:
Perceived changes, assimilation, similarity, and outcome. Journal of Consulting
and Clinical Psychology, 60, 34–40.
Keppel, G. (1991). Design and analysis: A researcher’s handbook. Upper Saddle
River, NJ: Prentice-Hall.
Lovinger, R. J. (1990). Religion and counseling: The psychological impact of religious
belief. New York: Continuum.
McCullough, M. E., & Worthington, E. L., Jr. (1995). College students’ perceptions of
a psychotherapists’ treatment of a religious issue: Partial replication and exten-
sion. Journal of Counseling and Development, 73, 626–634.
McCullough, M. E., & Worthington, E. L., Jr., Maxie, J., & Rachal, K. C. (1997).
Gender in the context of supportive and challenging religious counseling inter-
ventions. Journal of Counseling Psychology, 44, 80–88.
Morrow, D., Worthington, E. L., Jr., & McCollough, M. E. (1993). Observers’ percep-
tions of a counselors’ treatment of a religious issue. Journal of Counseling and
Development, 71, 452–456.
Parrott, L., III, & Parrott, L. (1996). Relationship development. Christian marital coun-
seling: A review and analysis. In E. L. Worthington, Jr. (Ed.), Christian marital
counseling: Eight approaches to helping couples (pp. 109–134). Grand Rapids,
MI: Baker.
Pecnik, J. A., & Epperson, D. L. (1985), Analogue study of expectations for Christian
and traditional counseling. Journal of Counseling Psychology, 32, 127–130.
Prest, L. A., & Keller, J. F. (1993). Spirituality and family therapy: Spiritual beliefs,
myths, and metaphors. Journal of Marital and Family Therapy, 19, 137–148.

57
Religiosity in Marital Therapy
Propst, L. R., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992). Comparative
efficacy of religious and nonreligious cognitive-behavioral therapy for the treat-
ment of clinical depression in religious individuals. Journal of Consulting and
Clinical Psychology, 60, 94–103.
Richards, P. S., & Bergin, A. E. (1997). A spiritual strategy for counseling and psycho-
therapy. Washington, DC: American Psychological Association.
Ripley, J. S., & Worthington. E. L., Jr. (1996). Christian marital counseling: A review
and analysis. In E. L. Worthington, Jr. (Ed.), Christian marital counseling: Eight
approaches to helping couples (pp. 234–256). Grand Rapids, MI: Baker Book
House.
Ripley, J. S., & Worthington, E. L., Jr., (1998). Christian marital counseling: What the
pastor, clinician, and researcher can learn from extant journal articles. Marriage
and Family: A Christian Journal, 1, 375–396.
Rokeach, M. (1968). Beliefs, attitudes, and values: A theory of organization and
change. San Francisco: Jossey–Bass.
Roth, P. D. (1988). Spiritual well-being and marital adjustment. Journal of Psychology
and Theology, 16, 153–158.
Sanders, R. K. (Ed.). (1997). Christian counseling ethics: A handbook for therapists,
pastors & counselors. Downers Grove, IL: InterVarsity Press.
Shafranske, E. P. (Ed.). (1996). Religion and clinical practice of psychology. Washing-
ton, DC: American Psychological Association.
Shafranske, E. P., & Maloney, H. N. (1990) Clinical psychologists’ religious and spiri-
tual orientations and their practice of psychotherapy. Psychotherapy, 27, 72–78.
Silverman, M. S., & Urbaniak, L. (1983). Marriage encounters: Characteristics of par-
ticipants. Counseling and Values, 28, 42–51.
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the
quality of marriage and similar dyads. Journal of Marriage and the Family, 38,
15–28.
Spanier, G. B., & Filsinger, E. E. (1983). The dyadic adjustment scale. In E. E. Filsinger
(Ed.), Marriage and family assessment: A sourcebook for family therapy (pp.
155–168). Beverly Hills, CA: Sage.
Stanley, S. M., Trathen, D. W., & McCain, S. C. (1996). Christian PREP: An empirically
based model for marital and premarital intervention. In E. L. Worthington, Jr.
(Ed.), Christian marital counseling: Eight approaches to couples (pp. 135–158).
Grand Rapids, MI: Baker.
Stanley, S. M., Trathen, D. W., McCain, S. C., & Bryan, M. (1998). A lasting promise:
A Christian guide to fighting for your marriage. San Francisco: Jossey-Bass.
Thoresen, C. Worthington, E. L., Jr., Swyers, J. P., Larson, D. B., McCullough, M. E.,
& Miller, W. R. (1998). Religious/spiritual interventions. In D. B. Larson, J. P.
Swyers, & M. E. McCullough (Eds.), Scientific research on spirituality and health:
A consensus report (pp. 104–128). Rockville, MD: National Institute for Healthcare
Research.
Thornton, A. (1989). Changing attitudes toward family issues in the United States.
Journal of Marriage and the Family, 51, 873–895.
Thornton, A., Axinn, W. G., & Hill, D. H. (1992). Religiosity, cohabitation, and mar-
riage. American Journal of Sociology, 98, 628–651.
Waanders, D. D. (1987). Ethical reflections on the differentiation of self in marriage.
American Journal of Pastoral Care, 41, 100–110.

58
J. S. Ripley et al.
Watkins, C. E., Terrell, F., & Miller, F. S. (1989). Mistrust level and its effects on
counseling expectations in black client-white counselor relationships: An ana-
logue study. Journal of Counseling Psychology, 35, 194–197.
Whitehead, B. K. (1996) Lesbianism, causality and compassion. Journal of Psychol-
ogy and Christianity, 15, 348–363.
Wilson, M. R., & Filsinger, E. E. (1986). Religiosity and marital adjustment: Multidi-
mensional interrelationships. Journal of Marriage and the Family, 48, 147–151.
Witte, J., Jr. (1997). From sacrament to contract: Marriage, religion, and the law in
Western tradition. Louisville, KY: Westminster John Knox Press.
Worthington, E. L., Jr. (1988). Understanding the values of religious clients: A model
and its application to counseling. Journal of Counseling Psychology, 35, 166–
174.
Worthington, E. L., Jr. (1989). Marriage counseling: A Christian approach to counsel-
ing couples. Downers Grove, IL: InterVarsity Press.
Worthington, E. L., Jr. (1991). Psychotherapy and religious values: An update. Jour-
nal of Psychology and Christianity, 10, 211–223.
Worthington, E. L., Jr., (Ed.). (1996). Christian marital counseling: Eight approaches
to helping couples. Grand Rapids, MI: Baker Book House.
Worthington, E. L., Jr., Dupont, P. D., Berry, J. T., & Duncan, L. A. (1988). Christian
therapists’ and clients’ perceptions of religious psychotherapy in private and
agency settings. Journal of Psychology and Theology, 16, 282–293.
Worthington, E. L., Jr., & Gascoyne, S. R. (1985). Preferences of Christians and non-
Christians for five Christian counselors’ treatment plans: A partial replication
and extension. Journal of Psychology and Theology, 13, 29–41.
Worthington, E. L., Jr., Hight, T. L., McCullough, M. E., Schmitt, M. M., Berry, J. T.,
Ripley, J. S., & Bursley, K. H. (1998). The Religious Commitment Inventory-10:
Development, refinement, and validation of a brief scale for counseling and
research. Unpublished manuscript, Virginia Commonwealth University, Rich-
mond, VA.
Worthington, E. L., Jr., Hsu, K., Gowda, K., & Bleach, E. (1988, November). Prelimi-
nary tests of Worthington’s (1988) theory of important values in religious coun-
seling. Paper presented to the International Congress on Christian Counseling,
Atlanta, GA.
Worthington, E. L., Jr., Kurusu, T. A., McCullough, M. E., & Sandage, S. J. (1996).
Empirical research on religion and psychotherapeutic processes and outcomes:
A ten-year review and research prospectus. Psychological Bulletin, 119, 448–
487.
Worthington, E. L., Jr., & Scott, G. G. (1983). Goal selection for counseling with
religious clients by professional and student counselors with explicit Christian
or secular settings. Journal of Psychology and Theology, 10, 346–354.