Integration in Hong Kong: a phenomenological study of Chinese Christian therapists.

The voices of other cultures need to be heard in the growing field of the integration of psychology and theology. This study phenomenologically explored the experience of integration for Chinese Christian therapists practicing in Hong Kong. The emerging themes placed the context of integration outside of the Hong Kong culture, with psychology and Christianity as foreign to the Chinese culture. Integration was founded on a dynamic and committed relationship to God. The centrality of relationship with God led to the sharing of personal beliefs with clients as well as encouragement to seek religion in their own lives. The power of theology to meet needs that could not be met elsewhere and provide meaning where none could be found, resulted in deference to the truths of theology.

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In an age of globalization, mass communication and air travel, exposure to other cultures is inevitable. Research indicates what is obvious at face value: cultures have different and distinct ways of living in this world. This has implications for the study of the integration of theology and psychology. Do different cultures experience their faith differently? How does this impact the way integration is conceptualized? How much does the historical and cultural context influence the experience of integration? Is there something to be learned from other approaches to integration? These issues were explored by studying the experiences of Chinese therapists practicing in Hong Kong using phenomenological qualitative research.

The integration of faith and psychology has been growing as a topic of interest in both the academic and clinical domains. Rather than compartmentalize personal faith and professional interests, integrationists strive to experience a fuller expression of both by allowing them to interact and inform each other. The initial literature on integration focused on models of integration and establishing criteria for inclusion of data for these models (e.g., Carter, 1977; Collins, 1981; Crabb, 1977; Farnsworth, 1982). The nature of this interest in integration has gradually moved from building a theoretical foundation, to its clinical application (e.g., Brokaw, 1997; Hall & Hall, 1997; Sorenson, 1996). In a reflection upon the character of integrative theorizing in the past quarter century, Sorenson (1996) points out that it has been "predominantly white, Western, stereotypically masculine, and theologically Reformed" (p. 182). In order to remain relevant and stay true to its enterprise of the unity of truth, the next step in integration may be to expand its scope beyond the Western cultural belief system to include the voices of the rest of the world.

The neglect of cultural issues in the integrative literature is merely a reflection of the under-representation of culture in the larger field of psychology. Hall and Maramba (2001) point out that the nature of American mainstream psychology does not reflect globalization, nor the fact that one out of every three persons in the United States is an ethnic minority. Rather than imposing Western-based models, Ratner (2000) emphasizes the need to use culture as a guide to study psychology.

In cross-cultural research, Western and East Asian cultures in particular have been contrasted in their different perspectives on self-concept, thinking, learning, and problem solving. Traditional Asian values and orientation to life are rooted in the traditions of Confucianism, Taoism and Buddhism. These values continue to be played out in modern Chinese culture, including a collectivist/external orientation, holistic thinking, a quest for harmony and the pursuit of knowledge. The impact of modernization certainly has an impact on the dynamic of these values. However, any study of the Chinese people should take into account the historical backdrop of their traditions and how the culture has been shaped.

As a country that has been built astride the line of East and West, Hong Kong provides a unique study in cultural psychology. Hong Kong was originally a part of China until the British took control in 1842. As a British colony, Hong Kong experienced relative freedom of expression and religion and is a unique blend of Eastern and Western ideas. On July 1st, 1997, Hong Kong changed from a British colony to a Special Administrative Region of the People's Republic of China. Traditional Chinese values are emphasized in the socialization processes; however, Hong Kong Chinese are Westernized in many aspects of their self-concept and value system.

The differences in culture indicate that models of integration and understanding of integration based on Western experience and thinking may differ from those in Asia. For example, the influence of Confucianism in the Chinese culture carries with it the assumption that these values are to be integrated through all of life. It is possible that this tradition combined with a more holistic style of thinking may result in a more natural integration of faith and profession in Chinese psychologists. The unique blend of Western and Eastern culture and religious freedom makes Hong Kong a valuable testing ground to see how Chinese Christian psychologists approach, understand, experience and practice the task of integrating their faith with their profession.

METHOD

The qualitative method of phenomenology is used in this study because there is no existing theory or model of choice regarding the integration of theology and psychology from a Hong Kong Chinese cultural background. The target characteristics were: doctoral level clinical psychologists, of Chinese descent, educated in Hong Kong, with an active Protestant Christian faith. These criteria represented an ideal population. The number of participants that met each of these criteria was too low (in order to meet saturation). Thus, standards were adjusted according to what was available. The participants in this study consisted of 3 men and 12 women, ranging in age from 26 to 65 years old. Twelve held master's degrees in clinical psychology and three held doctorate level degrees in psychology. Years of clinical practice ranged from 1 to 35 years. For those with a master's, the average number of years of practice after schooling was five years. All of the participants saw clients on an outpatient basis. Places of work included Christian centers, government clinics and hospitals. All 15 participants were practicing at the time of the interview. The 12 with master's degrees had received their education in Hong Kong. The three doctorates had received their doctorate training in North America, and their master's in Asia. Fourteen of the participants came from church denominations with a Protestant evangelical belief system. One was a professing Catholic. The majority identified themselves as Christian for more than 15 years. All had been born and raised in Hong Kong and self-identified as Chinese. The number of participants was small due to the limited number of people who fulfilled the category of being a Christian Chinese therapist in Hong Kong. However, for qualitative research, it was an adequate sample size in order to discover common generalizable patterns and themes.

Participants were recruited for interviews through an initial connection with a Christian psychologist in Hong Kong. An email was sent by this contact to the Hong Kong Psychological Society members citing the above stated criteria for participants and asking for volunteers to take part in the study. Participants were self-referred and responded via email to indicate their interest. Snowball sampling was also employed, which consists of identifying participants who are then used to refer the researcher on to other potential participants. The interviews were conducted over a two-week period. Participants began by reviewing and signing an informed consent. A semi-structured interview format consisting of open-ended questions was conducted with each participant on an individual basis (See Table 1). These questions were used to explore their experience of integration in their personal life and in their professional life as a psychologist. The questions served as a guide to ensure that the same information was obtained from each participant. However, the interviews were conducted in a conversational and interactive style, allowing the participants to express themselves freely. The interviews were tape recorded and transcribed verbatim and ranged from one to two hours in length.

All interviews were conducted, transcribed and coded by the first author. Moustakas' (1994) modification and adaptation of the Stevick-Colaizzi-Keen method was used as a guide to analyze the interview transcripts. Epoche is the necessary first step to prevent a priori assumptions on the data and should guide each part of the research process. Creswell (1998) affirms that researchers must clarify their bias from the outset of the study so as to bracket prejudices or experiences that will likely influence the interpretation and approach to the study.

Both during and after the transcription process, the interview material was reviewed for potentially relevant material, particularly anything that pertained to the experience of integration. Significant statements (descriptions, phrases, and sentences directly pertaining to expression, interpretation, responses, thoughts and feelings regarding integration) were extracted from each interview transcript. This material was read several times to enhance immersion and familiarity with the experience of the participants. After duplicate and overlapping statements were eliminated, these statements were coded into the HyperRESEARCH software. Phenomenological Reduction was achieved by taking emerging units of meaning from the interview data, which were thematically collected and organized into clusters to form a textural description for each participant. Imaginative Variation resulted in a structural description that was constructed from the underlying dynamics of the experience. A universal description was formed by integrating each of the individual textural and structural descriptions into a Synthesis that represented the commonalities of meaning and essence underlying all of the participants' descriptions of their experience.

In order to further establish the accuracy and credibility of the results, member validation was used (Seale, 1999). This technique involved getting feedback from the very participants that were interviewed regarding the accuracy of the description of their experience of the phenomenon based on their interviews (Creswell, 1998). Data, analyses, interpretations and conclusions were shared with the participants via email so they could judge the accuracy and credibility. Validity was also established via peer review, a procedure that utilizes an external check of the research process and approximates inter-rater reliability for quantitative research (Creswell, 1998). This entailed ongoing involvement throughout the research process from a peer whose role was to question methods, meanings and interpretations, essentially to "keep the researcher honest" (p. 202). This process provided a place to discuss ideas, assess the soundness of interpretations and to explore alternative explanations. Validity was further established by having this peer re-code three interviews to verify accurate interpretation of the data.

RESULTS

The phenomenological analysis resulted in three themes relating to the experience, or phenomenon, of integration for Chinese therapists in Hong Kong. First, integration was viewed as something outside of the Hong Kong culture. Second, the foundation of doing integration was largely based on relationship with God and as a response to God. Finally, the practice of integration included the sharing of personal beliefs with clients, valuing religion as a resource, giving authority to theology and believing that relationship with God provided something above and beyond what was humanly possible.

The Context of Integration: Outside of Culture

The participants in this study had to take on a large number of obstacles to establish their role as Christian psychologists in Hong Kong. Both psychology and Christianity as separate entities are relatively new to the Chinese culture. Although all of the participants affirmed that the Hong Kong culture is open to psychology, this has been a recent development within the past decade. The cultural values of keeping things within the family and personal privacy are somewhat at odds with the nature of therapy. Thus, its establishment in Hong Kong is slow but growing. Overall, people see the utility of clinical psychology but may not be as willing to endorse it for themselves or family members.

Although Christianity has been around longer than psychology and has many positive associations, it is still seen as something outside of traditional Chinese culture. This participant recalled experiencing powerful feelings of alienation from Christianity when she first heard about it:

When I first learned about Christianity when I was a young child, I
thought, "wow, he [God] is a foreigner, a Westerner, he is not us, he is
not one of us.".... Jesus never came to China. He doesn't know us.

Christianity as a belief system in Hong Kong is somewhat drowned out by the other belief systems already in place that have much deeper roots in the Chinese culture.

And here, you see fashion shops at every corner of the street. You
seldom find a church.... But in [a Western country], they have all the
grand cathedrals, always remind you of going to church. But in Hong
Kong, you cannot even see the cross ... and right next to it, there is a
Buddhist temple.

Their identity of being Christian was something that was evidently very salient in the lives of the participants. Christianity is a more radical faith than the traditional Chinese religions that are more tolerant of other gods and practices. The Chinese have always had the ability to select the religious practices and teachings that work best for them at the moment. Ching (1993) points out that it is impossible to separate religion in China from her culture and history. Although Confucianism, Taoism and Buddhism are not without their differences, they have historically been able to coexist and complement one another. This spirit of harmony and reconciliation is characteristic of the Chinese traditional cultural value of "a harmony of parts within a whole, in which each religion serves a socially useful function" (p. 222). It is possible that the strong identity the participants felt with their Christian faith was in part due to defining themselves in contrast to the majority of the population. They are more aware of their status as being Christian because they are in the minority, and are thus set apart from their clients.

The values of the Hong Kong culture add to the challenge of the foreign status of both Christianity and psychology. All of the participants cited materialism and an accompanying desire for personal gain, as the most dominant cultural force. One participant provided her opinion of Hong Kong values in the following way: "Money. Advantages. Something that you get in addition.... Like the mobile phone, they want a free gift with it. 20% discount, free chicken, one dollar for the pigeon." With an overall focus on the value of money and benefiting oneself, there is an expectation from the culture to receive quick and efficient service. Underlying this is a strong sense of pragmatism. Things are discarded if there is no practical gain to be had.

The participants sought to express themselves in contrast to these cultural values by focusing more on spiritual values, being fulfilled in life and giving of themselves. However, they still had to respond to the demands of the culture in order to function in their profession. One participant expressed the pressure she feels from the culture by stating, "I think Hong Kong is a very quick city. We are always expecting something that happens quickly. So in that sense, I work fast." In the midst of holding on to their identity as Christians, responding to a culture that only wants "what works," and practicing in a field that is still establishing itself, integration is a "luxury." As the following sections will show, the participants experienced integration as something that was necessary and important. However, it was not something they could always afford the time to contemplate and develop in a scholastic sense, but rather something that expressed itself as an outward manifestation of their inner spirituality.

The Foundation of Integration: Relationship with God

Integration was experienced and defined by the participants as something flowing out of their relationship with God. Their integration was not something that was systematically thought through or developed as an academic subject. Most participants had never heard of integration in this way nor had they read any integration literature. Rather, it was more of a spontaneous response to being in relationship with God and desiring to honor Him with all of their lives, including their profession. To not allow their professional identity to reflect their identity as a child of God would be "unnatural." They appeared to reflect the perspective of Johnson (1997), who affirms that the psychologist who is a Christian, "does not seek to integrate faith with psychology, for psychology, as all of life, is an expression of faith" (p. 22).

The participants had a sense that this spontaneous response to God had to come out of a strong spiritual focus. Cultivation of their spiritual life was a foundation that was laid for its manifestation in daily life and in their work. In addition to a personal quiet time with God, all of the participants intentionally engaged in other regular spiritual practices. They seemed to intuitively grasp the importance of Sorenson's (1996) advice to those who aspire to integrate, to invest in their personal spirituality through such events as spiritual retreats such that their integration becomes a lived enterprise.

Throughout the interviews was a sense of deliberate nurturing and cultivating of the spiritual life. Participants felt that their clients were able to perceive the quality of their relationship with God:

Yes, many clients, no matter they are Christians already or secular ...
ask if I am a Christian.... And so they subtly see from me the God
behind me.... And actually, I keep reminding myself that I want to act
like God as I follow Him. So not only in my life as a Christian, but
also as a psychologist.

The desire and commitment to integrate their beliefs with the activities of the day was a natural response to their experience of God and their faith. They experienced the concept of integration as somewhat abstract, possibly because they took it as common sense that they would live their lives in this way. This participant viewed integration as giving something back to God out of the blessings He had given her:

Just as some people asking his partners or her partners, "why do you
love me?" and so, this is a very natural response ... that I think
integration is very important. And if I see my studies, my work and my
position as a clinical psychologist as a gift from God.... And so I
think there is only one way I could work for God, and it is through the
integration of psychology and theology.

Integration was not something that was a mental pursuit so much as a way of living and interacting in the world. According to this participant:

Jesus sent us to the world. So that's something, I mean, it's not just
integrating counseling, but integrating all the things that work with
me. I play golf. I try to integrate golf with Christianity. So to me,
it's a life, it's an attitude, integrating. I integrate my work-place, I
try to integrate everything that is part of me into Christianity....
Because if there's no integration, then why am I doing that, why?

The integrity of the participants' commitment to God and their desire for Him to be part of every aspect of their life laid a strong and necessary foundation for integration to take place.

THE PRACTICE OF INTEGRATION: A LIVED ENTERPRISE

Tan (1996) advocates integration as something that should flow out of the spiritual development of the therapist. The identity the participants experienced in relationship with God was expressed through the integration of psychology and theology. This was specifically manifested for these participants through viewing religion as a resource, ascribing to the authority of theology, and experiencing relationship with God as a unique dimension.

Religion as a Resource

Over the past several decades, evidence has accumulated that spiritual and religious factors benefit mental and physical health (e.g., Koenig, 1998). As a resource that is important in their lives and helpful to them, the participants in turn, encouraged their clients to make use of the same resource:

And I realized that eventually it was my faith that helped me work
through very difficult times from my past. So I think if spirituality is
so important for me, it has to be important for everyone. I know that
I'm not imposing my faith on them ... but withholding that part of me is
also depriving my clients from the resources that I have to share with
them.

The participants experienced religion as a resource for themselves through a strong sense of God's presence during therapy and recognition of the work of the Holy Spirit. One participant acknowledged that, "I have to trust the Holy Spirit moves within me." This presence served to guide them with explicit techniques such as prayer and the use of Scripture, and also provided an implicit sense of guidance and support during therapy:

I pray and invite God to treat the client through my mouth and wisdom.
God cannot or will not treat the client directly. So it's through using
someone to treat the client, so I will pray and invite God to use my
mouth to help the client.

The practice of prayer in therapy seemed to flow out of the participants' own spiritual life and was not necessarily grounded in any kind of theory or model. They experienced the freedom to listen and respond to the voice of the Holy Spirit.

Religion was viewed as an invaluable resource for the therapists in their personal and professional lives. The importance of this resource and its centrality in their lives resulted in a desire to share this resource with their clients.

Authority of Theology

The amount of time the participants spent in church and pursuing their own spiritual lives reflected a value of knowing what they believed, which was necessary for being able to live out what they believed. In the words of one participant, "if you don't have a very powerful spiritual flow, if you don't know your Bible well, how can you use it?" This seems to be in line with Sorenson's (1996) warning that "superficial integration is often a result of superficial theology" (p. 190).

The participants viewed theology as creating parameters or boundaries to definitions of life, and also to the tenets of psychology. One participant stated, "I always measure what I encountered here with my faith. And that is my guiding post." They sought to filter their experiences through the truths they had learned in theology.

Sorenson (2004) advocates reclaiming theological priority in integration. His belief is that the theological orientation will allow for a more coherent and truthful organization of integrative questions and integrative research. In considering the question of how to "pass on" the concept of integration, this participant emphasized the need to have a solid Christian worldview before attempting to integrate knowledge derived from psychology:

If we do not understand the Bible well, or we do not understand our
religion well, sometimes the knowledge, the psychology level, can cause
confusion to us. We do not know how to choose. After all, it is just
knowledge, it is not the truth.

When there was a clash of values, psychological principles were generally forfeited to theological principles. Rather than work through the factors that contributed to the clash of values and consider how they might be resolved, the participants tended to drop psychology as the offending party. After all, according to one participant, "psychology actually is a science, actually we couldn't say psychology is the ultimate facts. All are assumptions." The authority of theology meant that dilemmas between the two were resolved by standing on the theological truths. In considering the freedom allotted to her at her place of work, one participant stated, "so I have the freedom to integrate them together and to give up the psychological principal if it clashes with the Christian faith."

The ease with which these participants let go of psychological principles may also have been influenced by an instinctive desire to attain the Chinese cultural value of harmony. According to Peng and Nisbett (2000), the Chinese way of thinking takes a compromise approach when facing contradictions. One participant commented on the relationship between psychology and theology, stating that, "they're working together fine!" As opposed to Aristotelian logic, the Chinese prefer dialectical resolutions and solutions to problems. This form of thought, "denies the reality of true contradiction, accepts the unity of opposites, and regards the coexistence of opposites as permanent" (p. 1067). This way of thinking may lend itself to disregard for apparent contradictions between psychology and theology. Furthermore, values regarding holistic thinking may take priority over dissecting the dichotomies presented by psychology and theology. It seemed that the participants moved beyond dilemmas between psychology and theology by taking the pragmatic route of "what works." In general, this meant emphasizing the theological truths and allowing psychological principles to take a back seat.

It is likely that as psychology grows as a field in Hong Kong and the therapists gain more clinical experience and knowledge, it will continue to inform and develop the psychological aspect of their integration that already has a strong spiritual base.

Relationship with God as a Unique Dimension

Having a relationship with God provides something that cannot be provided by anything else. Pargament and Brant (1998) state that "religion seems to offer a response to the problems of human insufficiency" (p. 125). There is evidence that religion offers a distinctive dimension and adds unique explanatory power to the prediction of both physical and mental health (Hill & Pargament, 2003). These participants experienced God as providing something beyond what was possible in the human realm. Furthermore, this unique dimension was something that was fundamental to human functioning. This was made manifest in receiving support from God and in addressing the spiritual needs of their clients.

Relationship with God sustains. The participants credited their relationship with God as being an invaluable source of restoring both emotional and physical energy as they did their work. They acknowledged other forms of support, such as their family, friends and church, but there was a clear sense of God's infallibility. These participants attributed their ability to sustain themselves in the midst of the difficulties they encountered with the strength that came from their spiritual life. For example:

I think I get support from my spiritual life. It gives me strength and
support in my work. Otherwise, I think I would easily burn out, because
every day we see people with problems, problems, problems. I am not that
strong myself.

Being in relationship with God gave the participants a reason for maintaining their oftentimes difficult role of being a therapist, which in turn gave them what they needed to continue on.

Spiritual needs of clients. The therapist's relationship with God was not just a background mechanism of support, but also something that directly impacted what they did with their clients. The truths that are from God are truths that the therapist also hoped to impart to the client. This participant reflected on one of the criticisms she has heard from other Christians who are not in psychology:

And they [non-psychologist Christians] tend to think that's good to be a
clinical psychologist, but when we are going to counseling or talking
about peoples' problems, it is hard to mention results without
mentioning spirituality. So, I think they see the limitations of
clinical psychologists because we touch on the psychological health, but
as a [non-Christian] clinical psychologist, many will not touch on the
higher level, that is the spirituality level.

This participant acknowledged the value of secular therapists but felt that there were essential needs that they could not meet:

People with psychological training without Christian values can still be
very powerful and very good therapists. But when we give them spiritual
direction, it's not only psychological health, but spiritual growth and
spiritual direction gives us the power to commit to do something that is
out of our human nature that they may not be able to do.

Spiritual needs are significant and cannot be discounted when considering an individual's psychological functioning. The participants could not ignore the spiritual needs of their clients when their spirituality was such a focal point in their own lives.

Ultimate concerns. The participants certainly valued and respected what psychology could offer, but felt that theology provided answers that were beyond the realm of psychology. Pargament, Murray-Swank and Tarakeshwar (2005) found that people tend to turn to spiritual beliefs when they encounter difficulties in life because of the existential issues inherent in concerns such as illness, relational problems, death and so forth. This participant agreed that being a Christian made her work as a psychologist somehow distinct from non-Christians:

I think so, particularly on issues of life and death.... I think the
difference is that for [those] who are not Christians but are clinical
psychologists, I think they will regard ... this kind of religious
belief ... as a coping strategy. For me, if I make religious beliefs
equivalent to coping strategies, then I will just consider it as a very
low level technique. But as a Christian, I think, religion gives me
faith and I will view life after death positively; it will instill hope.
I think this makes a great difference ... as a guidance in every day
life. To give us more, a sense of peace, on a more consistent and
persistent basis.

The truths of theology were seen as providing something that could transcend the issues of everyday life for their clients.

The centrality of their relationship with God led to sharing their beliefs with their clients as well as encouragement to seek religion in their own lives. The power of theology to meet needs that could not be met elsewhere and provide meaning where none could be found, resulted in deference to the truths of theology.

DISCUSSION

For the participants of this study, the experience of integration was something that came hand in hand with their identity as being a Christian. They did not have the foundation of a formal study of integration but viewed integration as an inevitable and necessary expression of their faith. They sought to allow the strength of their faith to be made manifest in their lives and particularly in their vocation, which they viewed as something to be given back to God. The participants did not necessarily differentiate the integration of their spirituality into their vocation from integration in their everyday life. Their profession was viewed as a natural and obvious setting for their faith to be made manifest, both implicitly and explicitly. As a manifestation of their faith in God, the participants expressed their integration as a natural response to God.

Christianity is a comparatively radical religion that does not tolerate the incorporation of tenets from other religions. The lives of the participants reflected this radical nature in the strength of their commitment to maintaining an identity that was faithful to the truths of Christianity in the midst of opposing cultural values. It is likely that Christianity as being outside of culture enhanced the minority status the participants felt as Christians and may have lent itself to the ease with which they shared of their faith with their clients. The participants did not spend a great deal of time questioning the nature of integration and considering its implications. They simply sought to do well by their clients and to be faithful to God and trusted that all else would fall into place.

The participants recognized that what they had was not enough to do integration well. Their lack of definitive guidelines to their integration made it difficult for them to express it and even perhaps to develop it, other than further cultivating their spiritual life. They considered their lives to belong to God, and as such, whatever they did with their lives should reflect His glory and His nature. Integration resided in the personhood of each of the participants.

Limitations

Due to the small number of participants, the experiences of these participants cannot claim to be representative of the average Christian Chinese therapist in Hong Kong. The specifics of practicing in Hong Kong and being from the Hong Kong culture further limits its generalizability. Second, the interviews were conducted in the participants' second language, English. It is possible that speaking about integration in their native tongue of Cantonese, may have provided additional nuances to their experience of integration. Despite these limitations, this study has contributed the voices, perspectives, and experiences of a population that has not received specific attention in the integrative literature.

Directions for Future Research

There is continued need for research on culturally specific minority groups, both in and outside of the United States. The study of integration needs to be open to being influenced by different ways of being. Further questions regarding the integrative experience with degree of acculturation could also provide valuable insight into the impact of culture on integration. The fact that these participants were able to develop their own way of integrating without specific training, suggests that formal training may be useful, but not necessary for the development of a conception of integration. The implications of this information for Christian graduate programs that emphasize integration could be the reconsideration of what may or may not be necessary in order to equip students with an adequate education on integration. A key component is gaining an understanding of how the practice of integration is shaped by the norms and values of the culture. Given that the integration of the participants in this study was based on such a strong faith commitment, more systematic examination of how level of faith commitment interacts with integration and how integration is manifested clinically will also have implications for educators of integration.

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Ching, J. (1993). Chinese religions. Hong Kong: MacMillan Press.

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Crabb, L. (1977). Effective biblical counseling. Grand Rapids: Zondervan.

Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks, CA: Sage Publications.

Farnsworth, K. E. (1982). The conduct of integration. Journal of Psychology and Theology, 10, 308-319.

Hall, M. E. L., & Hall, T. W. (1997). Integration in the therapy room: An overview of the literature. Journal of Psychology and Theology, 25(1), 86-101

Hall, G. C. N., & Maramba, G. G. (2001). In search of cultural diversity: Recent literature in cross-cultural and ethnic minority psychology. Cultural Diversity and Ethnic Minority Psychology, 7, 12-26.

Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality. American Psychologist, 58(1), 64-74.

Johnson, E. L. (1997). Christ, the Lord of psychology. Journal of Psychology and Theology, 25(1), 11-27.

Koenig, H. G. (Ed.) (1998). Handbook of religion and mental health. San Diego, CA: Academic Press.

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Pargament, K. I., & Brant, C. R. (1998). Religion and coping. In H. K. Koening (Ed.), Handbook of religion and mental health (pp. 111-128). San Diego: Academic Press.

Pargamcnt, K. I., Murray-Swank, N. A., & Tarakeshwar, N. (2005). An empirically-based rationale for a spiritually-integrated psychotherapy. Mental Health, Religion & Culture, 8(3), 155-165.

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AUTHORS

HSU, SHARON S. Address: [e-mail]. Title: Psychologist Candidate. Degrees: BA, Wheaton College; MA, Rosemead School of Psychology; PhD, Rosemead School of Psychology. Specializations: Cross-Cultural psychology.

HALL, M. ELIZABETH LEWIS. Address: Rosemead School of Psychology, Biola University, 13800 Biola Ave., La Mirada, CA 90639. Title: Associate Professor. Degrees: BA, MA, PhD, Biola University. Specialization: Psychodynamic therapy, missions and mental health, women and work.

COE, JOHN. Address: 13800 Biola Avenue, La Mirada, CA, 90631. Title: Associate Professor of Philosophy and Theology; Director, Institute for Spiritual Formation. Degrees: B.A., Biola University, M.A., Talbot School of Theology, M.A., Western Kentucky University, M.A., University of California, Irvine, Ph.D., University of California, Irvine. Specializations: spirituality, theology and psychological maturity; gender issues; integration between theology, psychology, philosophy, and ethics.

SHARON S. HSU

M. ELIZABETH LEWIS HALL

JOHN H. COE

Biola University

Correspondence concerning this article may be addressed to [e-mail].

Table 1 Interview Questions

Hong Kong Attitudes
   1. What is the attitude/climate in Hong Kong towards therapy/
      psychology?
   2. What is the attitude in Hong Kong towards religion/spirituality?
   3. What is the attitude in Hong Kong towards Christianity?
Faith and professional practices
   4. What attracted you to psychology?
   5. How do you perceive your role as a therapist/psychologist?
      a. Is this different because you are a Christian?
   6. Do you address religious issues with clients?
      a. Are religious issues an acceptable topic in therapy?
      i. If so, how do you decide when to address such topics?
      ii. If not, why not?
   7. How do your spiritual beliefs impact your work as a psychologist
      and how you do therapy? (Do they engage in "implicit/explicit"
      integration?)
   8. Do you have explicit spiritual goals for your clients? Examples:
   9. Do you use explicit spiritual techniques? Examples:
      a. How do you decide which practices you will use and with whom?
      b. Do you ever witness to a client?
  10. How do you work on your own spiritual growth and how does this
      affect your therapy?
  11. How do your Christian beliefs make your therapy different from
      those trained in the same way, but who are not believers?
Experience with the discipline of integration
  12. How do you see psychology and your Christian faith working
      together?
      a. How might they be opposed?
      b. Do you consider these things in your therapy?
  13. When did this become an issue to consider? How did that come
      about? i.e. what were the influences?
      a. How has this experience of integration been? (i.e. any
         challenges/opposition?)
  14. What makes integration important for you personally and
      professionally?
  15. Case example of the use of integration in therapy.
  16. What do you do when values relating to your faith are different
      from the values of those you work with?
      a. Case example of client choosing behaviors at odds with personal
         spiritual beliefs of the therapist. How did therapist handle
         this? (i.e. conflicts in profession and personal beliefs).
  17. How does integration happen for you? Do you work to cultivate your
      integration "skills"? If so, how?
  18. How does one "pass on" the idea of integration?
      a. How would you teach someone about integration/what is the best
         way to learn about it?
  19. Have you ever read any integration literature?
      a. If so, what was it? (Source, language, year, etc.)
      b. Do you identify with what you read? Examples:
      c. Are there specific models you draw on?
Culture
  20. How do you identify/describe your cultural background?
      a. What are the main values from this culture?
   b. How have these values shaped your identity?
  21. How do you see your culture as influencing your personal/
      professional identity?
  22. How has your faith impacted your life?
      a. Are there cultural values that have clashed with values of
         faith?
         i. Examples:
         ii. How have you dealt with this?
  23. How do your cultural values impact your integration?