How to Ethically Integrate Faith and Spirituality into Therapy

Article written by Justin K. Hughes, MA, LPC

Common Concerns

There are common hesitations and fears providers have in integrating their clients’ religious or spiritual beliefs into practice. Here are a few common concerns that quickly arise:

  • Does spirituality really have any place in a clinical setting? Isn't this supposed to be about the evidence-base and science
  • What about those who don't have an interest in spiritual things? Won't this be off-putting? Or worse, unethical?
  • Is this using undue influence? Is it proselytizing? 

These very common questions only add uncertainty and fear to clinicians' already existing reticence.

Psychology’s Reticence & Hesitance

It is also highly influential that some key theorists' non-belief in a higher being along with their negative commentary about such beliefs may scare off some providers- the big examples being Sigmund Freud and Albert Ellis.  Psychiatry itself is known for being the “least religious” among all types of doctors in the United States alone.  Lastly, throw into the mix the varying theoretical orientations which have differing arguments as to what is appropriate to address in counseling, with some positions arguing there is no place for religious or spiritual integration in evidence- based therapy.

For practitioners considering asking their clients about spirituality, the result is usually just leaving it alone. However, it’s not only okay to talk about faith/religion/spirituality in therapy, it’s evidence-based!

Though the scope of this article is not to address abuses of power, countertransference, and so forth, it is of the utmost importance to guard against harm towards clients. Ethical violations, however, do not prove the need for total avoidance into something that most clients consider very important in their lives. Not only is it OKAY to discuss faith and spiritual concerns, it’s evidence-based!

Research Support

  • Vieten, et al., 2013 note that “...There is evidence that clients would prefer to have their spirituality and religion addressed in psychotherapy.”  
  • One study in an inpatient setting (Rosmarin et al., 2015) discovered most patients are interested in integrating spirituality. As Dr. Rosmarin argues in a separate piece (2021), “By not making more of an effort to incorporate spirituality in treatment, we are doing a disservice to patients.” Potentially up to two-thirds of patients prefer a therapist who is religious (Kahle and Robbins, 2004).   
  • Another study by McCord et al. (2004) found a majority of those surveyed wished, under certain circumstances, for their physician to ask about their spiritual beliefs (with physicians typically less involved than therapists are in a patient’s life).

The evidence leaves us very confident that spirituality, faith, and religion matter to most clients. However, the main issues arise in the realm of researched approaches and techniques and how to ethically execute them (see “Religion and spirituality in the treatment room” by the APA).  

“Spirituality and religion are critical sources of strength for many clients, are the bedrock for finding meaning in life, and can be instrumental in promoting healing and well-being. There is growing empirical evidence that our spiritual values and behaviors can promote physical and psychological well-being. Exploring these values with clients can be integrated with other therapeutic tools to enhance the therapy process.”  

Gerald Corey, Integrating Spirituality in Counseling Practice

What We Know So Far:

At a minimum, though, we can recognize:

  1. Clients often wish to discuss at least some aspects of religion or spirituality.
  2. Therapists can assess and seek to understand these factors when done so sensitively.

Yes, clearly the evidence-base needs to be developed further on how to better involve spirituality in treatment. However, given that clients not only want to incorporate these things into therapy but also benefit from it, such omission misses crucial components of patient care that can be achieved while best approaches are being studied.

Related Articles