In the early history of psychotherapy, research on integrating faith and spirituality did not arouse much interest [1]. However, this attitude has changed in the latter part of the 20th century and the beginning of the 21st century. Psychology has, of late, experienced a paradigm shift with an increased openness to religion and spirituality [2]. This paradigm shift refers to the significant change in historical practices in science [3].  It is suggested that counselors, when building a therapeutic alliance with clients, explore and encourage spiritual expression at the client’s discretion. Current research also suggests individuals with a religious and/or spiritual worldview typically find comfort in their religious or spiritual beliefs and practices during times of un­certainty or crisis.

A practical question for integration becomes when and how to address the sacred in psychotherapy [4].

According to a Gallup poll conducted in 2012, up to 88% of the population said that  “religion is important” or fairly important” in their lives [5]. Studies show that “many people in the United States often turn to their spiritual beliefs and practices when they are facing significant problems “[6]. Equally important, some research suggests that clients’ spirituality may be a helpful resource influencing resilience in several areas, including ability to cope [7].

Spirituality Integrated in Psychotherapy

An increasing number of clients would like to have the option of including spirituality as part of their counseling [8]. Adding that spirituality is essential to many aspects of many clients’ lives such as their sense of self, worldview, and belief system [9].

For many clinicians, the integration process means more training and, in some instances, acknowledging a different perspective regarding spirituality in psychotherapy. In the APA 2002 Ethics Code, therapists are not required to agree with all spiritual and religious values of clients, yet, there is an ethical obligation for respect of clients’ religious and spiritual beliefs, behaviors and traditions [10].

For counselors exploring how to integrate spirituality into psychotherapy, this could be cognitively framed as part of the assessment process rather than an extra task in addition to the process. As the therapist gathers assessment information from the client, the client can agree or not agree to integrate the spiritual component into therapy [11].

In the context of psychotherapeutic work, it is important to note that each psychotherapist and each client, depending on their cultural background and life experiences, will conceptualize religion and spirituality somewhat differently [12].

Exploring Spirituality Can Help

As counselors achieve an increased understanding of the role of spirituality in clients’ core value system, collaboration with clients who rely on spirituality as a part of their value-driven decisions in daily life can have positive results. For example, according to Christian psychologist William Hathaway, discussing the ramifications of spirituality in a family’s life broadened patients’ experiences in the therapy room and allowed them to address religious issues as a serious component of their well-being [13]. Hathaway stated, “Being able to help a person connect with the variable of spirituality in their lives can be a beneficial and important therapeutic accommodation.” [14]

The American Psychological Association (2017) has suggested that clinicians be aware of each client’s age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider of these factors when working with members of diverse groups. Clinicians are often taught to pay attention to many, if not all these factors, but often religion is left unaddressed.

Counselors can be more effective helping clients in efforts to heal when the client’s core spiritual values and beliefs are in congruence with collaborated treatment goals [15].  In clinical practice, often goals are focused on helping clients to “take charge” of their problems and their emotions [16].

An assessment of a client’s worldview may assist the therapist in helping a client to alleviate unpleasant feelings of guilt and shame that could be associated with a client’s values or beliefs [17].  During the initial intake session, clients’ spirituality can be assessed by using a formal spiritual interview protocol [18].

Addressing Ethical Concerns

Pragment (2013) wrote, “People can draw on spiritual resources that have been tied to having better adjustment in times of crisis, while on the other hand, some forms of spiritual coping can be problematic.” [19]  How, then, does a clinician know how to proceed?

During the initial assessment, ask the client if spirituality is important to them, how important it is, and how the client utilizes spirituality in their day-to-day living experience. The collected data could reveal valuable assessment information that will help clinicians address the needs and beliefs of the individual in front of them. In paying attention to the clients’ specific practices and beliefs, counselors can avoid violating ethical boundaries. For example, research indicates that many therapists are integrating religion and spiritual­ity into counseling “through intrapersonal integration” which is interventions based on the counselor’s own religious experience. This can be problematic in that it “creates a risk of therapists imposing their own values or applying religious or spiritual interventions inappropriately.” [20]

Importantly, in professional psychological practice, therapists should use caution when integrating spirituality and religious tools in counseling, paying attention to professional ethics, competence, and scope of practice. Counselors are usually not theologians or clergy, so they should be cautious not to overstep their professional bounds in a therapeutic relationship[21].

Research suggests varied reasons for the concern. Richards, Bartz, and Ogrady (2002) note: “By understanding clients’ spiritual worldviews, counselors are better able to empathically understand them. Misunderstanding clients’ worldviews can undermine the therapeutic relationship, and mutual understanding may facilitate positive counseling outcomes.” [22] Currently, literature clearly suggests that psychotherapists are increasingly open to providing spiritually oriented psychotherapy for Christian clients [23].

Suggestions

As the interest has dramatically increased for integrating spirituality and psychotherapy, resources and opportunities for trainings (i.e., workshops, readings, courses on religious diversity, consulting with experienced peers) has risen. In addition, mental health professionals can organize workshops or seek out readings and other training opportunities in religious and spiritual diversity [24].

A primary concern for those promoting the field is ensuring there is proper supervision for therapists learning to use religious tools or help clients deal with religious issues while in their postdoctoral training. The training opportunities pertaining to religious and spiritual issues have not been as plentiful, as yet. Recommendations for training could include: take a course, attend a seminar or workshop, speak with religious leaders, or engage in a personal reading program to become familiar with prominent faith traditions. Clinicians could also take online courses, engage in supervision in a multi-faith peer supervision group, hire a clinical supervisor with expertise in religious and spiritual issues, or contact clergy [25].

Conclusion

Assisting clients in affirming and accessing their core values and beliefs, including religious values, can be effective in helping clients in their efforts to cope, heal, and grow [17].  Further emphasizing and honoring spiritual beliefs and religious practice could be an important factor relating to a clients’ progress in therapy.

In recognizing there are challenges associated with spiritual phenomena, mental health professionals are invited to join this important work [18] of integrating client spirituality in psychotherapy.

References

[1] Richards, P., & Bergin, A. (2000). Towards religious and spiritual competency for mental health professionals. In Handbook of psychotherapy and religious diversity. Washington, DC: American Psychological Association.

[2] Pargament, K. I., & Saunders, S. M. (2007). Introduction to the special issue on spirituality and psychotherapy. Journal Of Clinical Psychology, 63(10), 903-907.

[3] Tan, S. Y. (2007). Use of prayer and scripture in cognitive-behavioral therapy. Journal of Psychology & Christianity, 26(2), 101-111.

[4] Post, B. C., & Wade, N. G. (2009). Religion and spirituality in psychotherapy: A practice-friendly review of research. Journal of Clinical Psychology, 65(2), 131- 146

[5] Vieten, C., Scammell, S., Pierce, A., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2016). Competencies for psychologists in the domains of religion and spirituality. Spirituality in Clinical Practice, 3(2), 92-114.

[6] Pargament, K. I., Murray-Swank, N. A., & Tarakeshwar, N. (2005). An empirically based rationale for a spiritually-integrated psychotherapy. Mental Health, Religion & Culture (pp. 155-165).

[7] Smith, B., Ortiz, A., Wiggins, K., Bernard, J., & Dalen, J. (2012). Spirituality, resilience, and positive emotions. In The Oxford handbook of psychology and spirituality. New York: Oxford University Press.

[8] Barnett, J. E., & Johnson, W. B. (2011). Integrating spirituality and religion into psychotherapy: Persistent dilemmas, ethical issues, and a proposed decision making process. Ethics & Behavior, (21)147-164.

[9] Barnett, J. E., & Johnson, W. B. (2011). Integrating spirituality and religion into psychotherapy: Persistent dilemmas, ethical issues, and a proposed decision making process. Ethics & Behavior, (21)147-164.

[10] Plante, T. G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider. Journal of Clinical Psychology J. Clin. Psychol., 63(9), 891-902.

[11] Tan, S. Y. (2007). Use of prayer and scripture in cognitive-behavioral therapy. Journal of Psychology & Christianity, 26(2), 101-111.

[12] Bartoli, E. (2007). Religious and spiritual issues in psychotherapy practice:  Training the trainer. Psychotherapy:  Theory, Research, Practice, Training, 44(1), 54-65.

[13] Kersting, K. (2003). Religion and spirituality in the treatment room. 34(11), pg. 40. Apa.org https://www.apa.org/monitor/dec03/religion.aspx

[14] Kersting, K. (2003). Religion and spirituality in the treatment room. 34(11), pg. 40. Apa.org https://www.apa.org/monitor/dec03/religion.aspx

[15] Richards, Rector, & Tjeltveit. (1999). Values, spirituality, and psychotherapy. In Integrating spirituality into treatment: Resources for practitioners (pp. 133 -160).

[16] Cole, B., & Pargament, K. (1999). Assessing spirituality. In Integrating spirituality into treatment: Resources for practitioners. Washington, DC: American Psychological Association.

[17] Richards, Rector, & Tjeltveit. (1999). Values, spirituality, and psychotherapy. In Integrating spirituality into treatment: Resources for practitioners (pp. 133 -160).

[18] Post, B. C., & Wade, N. G. (2009). Religion and spirituality in psychotherapy: A practice-friendly review of research. Journal of Clinical Psychology, 65(2), 131- 146

[19] Pargament, K.I. (2013). Searching for the sacred:  Towards a non-reductionistic theory of spirituality. (n.d.). APA handbook of psychology, religion, and spirituality (Vol. 1): Context, theory, and research., 257-273.doi:10.1037/14045-014

[20] Walker, D. F., Gorsuch, R. L., & Tan, S. (2004). Therapists’ integration of religion and spirituality in counseling: A meta-analysis. Counseling and Values, 49(1), 69-80.

[21] Plante, T. G. (2008). What do the spiritual and religious traditions offer the practicing psychologist?. Pastoral Psychology, 56(4), 429-444.doi:10.1007/s11089-008-0119-0

[22] Richards, P. S., Bartz, J. D., & Ogrady, K. A. (2009). Assessing religion and spirituality in counseling: Some reflection and recommendations. Counseling and Values, 54(1), 65-79.

[23] Post, B. C., & Wade, N. G. (2009). Religion and spirituality in psychotherapy: A practice-friendly review of research. Journal of Clinical Psychology, 65(2), 131- 146

[24] Richards, P., & Bergin, A. (2000). Towards religious and spiritual competency for mental health professionals. In Handbook of psychotherapy and religious diversity.
Washington, DC: American Psychological Association.

[25] McMinn, Mark R.; Worthington, Everett L. Jr; and Aten, Jame D., “Spiritually Oriented Interventions: Future Directions in Training and Research (Chapter 14 of Spiritually Oriented Interventions for Counseling and Psychotherapy)” (2011). Faculty Publications – Grad School of Clinical Psychology. Paper 230.
http://digitalcommons.georgefox.edu/gscp_fac/230

[26] Richards, Rector, & Tjeltveit. (1999). Values, spirituality, and psychotherapy. In
Integrating spirituality into treatment: Resources for practitioners (pp. 133 -160).

[27] Scott, A. (2013). An exploration of the experience of Christian counsellors in their work with both Christian and non-Christian clients, with particular reference to aspects of cultural transition. Counselling and Psychotherapy Research, 13(4), 272-281.