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Talking About Religion and Spirituality in Therapy

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Spirituality: an individual’s sense of connection to or search for the sacred.

Spirituality: an individual’s sense of connection to or search for the sacred.

An Overview of World Religions

There are 7 billion people in the world. About 4 million people follow Abrahamic religions. These are the religions that recognize Abraham as their first prophet. (Abraham was the first Jew and made a covenant with God.) Abrahamic religions include Judaism, Christianity, and Islam.

Another 1.5 billion people follow Eastern religions of Buddhism and Hinduism. Almost .5 million people follow African, Native American, Australian, and Chinese Folk religions, as well as a growing number of other religions including Taoists, Jains, Sikhs, Bahai, Shintoists, Wiccans, and others.

Over 1 billion people are unaffiliated with religion. This number includes agnostics, atheists, irreligious and secular, as well as many people who believe in God or a universal spirit but do not attend services.

Religion: affiliation with an organization  that is guided by shared beliefs and practices, with members who adhere to a particular understanding of the divine and participate in sacred rituals.

Religion: affiliation with an organization that is guided by shared beliefs and practices, with members who adhere to a particular understanding of the divine and participate in sacred rituals.

Religious Affiliation and Practice in the US

The unaffiliated group in the US grew by almost 7% between 2007 and 2014, which corresponds with an equal loss of membership in Catholic (3%), mainline Protestant (3%), and Evangelical Protestant (1%) congregations in the US. Most Americans (80%) identify with a religious practice and participate in some form of Christianity. Half of US citizens participate in a religious congregation or community. A growing number participate in non-Christian faiths, and some identify as having no religious preference. Overall, 92% of Americans believe in God.

Religion Is Important to Clients

The US population remains the third most religiously affiliated nation among other developed Western nations, preceded only by Italy and Ireland. Throughout much of the world, religiousness decreases when economic development and national wealth increase. Yet, religiousness remains high in the US. Up to 59% of Americans report that religion is “very important” in their lives, and 29% report that religion is “fairly important.” Clearly, religion is important to clients.

The Dilemma

Studies show that clients want to discuss religion and spirituality in therapy, but many therapists are reluctant to do so. There are many reasons for this.

  • In general, therapists are less religious than their clients and the population at large.
  • Additionally, mental health providers, like other health care providers, have historically identified as scientists and have distanced themselves from religion and spirituality out of concern for being viewed as pseudo-scientists or paraphysicists by their scientific peers.
  • Many early leaders in the mental health field lacked respect for religion and mystical experiences, viewing them as infantile, borderline psychotic, and “horseshit.”
  • A desire to maintain separation of Church and state also plays a role, as it does in our educational systems and other health care fields.
  • Ethically, therapists are careful to attend to their clients’ needs and refrain from imposing their own beliefs on clients. Out of an abundance of caution, they avoid the topic altogether.
  • Some believe that religion is too emotional to discuss in therapy and fear they may overreact emotionally and hinder therapy.
  • Some therapists lack confidence in how to address religion and spirituality ethically and effectively in therapy. Until recently, therapist education did not include coursework in religion and spirituality. Religious and Spiritual Beliefs and Practices are now included in coursework related to cultural diversity and are considered an area of competence for therapists.

A client’s desire to discuss spirituality and religion in session and a therapist's reluctance can present a dilemma that can result in avoiding an area of a client’s life that is every bit as important and clinically significant as their family, health, thoughts, emotions, and educational, occupational, and social functioning. It is now understood that a client’s religious and spiritual beliefs and practices have a significant effect on mental well-being and psychological functioning. If a therapist is not prepared to address these issues in therapy, he/she can seek consultation or education or make a referral to a spiritual leader or another provider.

The Religious Landscape and the Therapist's Role Is Changing

While traditional church congregations have shrunk, a generation of religiously unaffiliated persons has emerged. Past generations looked to religious leaders for guidance and as a resource to help with family, marriage, relationships, work, career, and financial issues. The current culture now looks to mental health professionals for guidance in these areas and help with existential and moral issues.

Religious and Spiritual Beliefs and Practices and Psychological Health

A growing body of research demonstrates that there is a relationship between religious and spiritual beliefs and practices and psychological health and functioning. The research shows which of these are helpful and which can be harmful. Talking about religion and spirituality in therapy can help a client identify helpful beliefs and practices and avoid or change harmful ones that may contribute to mental health symptoms. Therapists can help clients recognize and access internal and external resources that can improve wellbeing and effective coping.

Ways Spiritual and Religious Beliefs and Practices Improve Psychological Functioning

Religious and spiritual beliefs and practices are important to the psychological development and functioning of most adolescents and adults in many ways. They:

  • contribute to identity development,
  • inform worldview,
  • help them avoid risky scenarios,
  • help them cope with difficulties,
  • provide meaning and support in times of stress,
  • contribute to successful stress management, and
  • provide internal and external resources.

80% of severely mentally ill patients use religion to cope, and spirituality is a core component of recovery from substance use It has also been linked to increased meaning, purpose, resilience, satisfaction, and happiness.

Internal and External Resources

Religious and spiritual beliefs and practices can provide internal and external resources that support psychological health. For example, participating in church-based social functions and accessing social supports are external resources, and using prayer to cope is an internal resource.

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External Resources

Participating in church activities can be a source of comfort and relief.

Social SupportsServicesActivitiesFunctional Support

shared meals


a source of structure to get out of the house or in a more positive environment


engaging in positive activities with others

spiritual guidance

bingo or quilting can be a distraction from loneliness or rumination


opportunities to be of service to others

inclusion in a prayer or healing circle


Internal Resources

Individuals may use prayer and meditation for the following reasons:

  • To seek guidance for making decisions
  • To cultivate a sense of closeness with God that reduces loneliness
  • As a method of dealing with stress or difficult situations

Positive and Negative Religious Coping

Positive religious and spiritual coping can be used to reframe situations in a positive way. People sometimes use negative religious coping instead, which appears to be unhelpful.

An example of negative coping is using the concept of a punishing God to understand a situation, such as seeing a child's illness as a punishment from God. Another example of negative coping is when a person abandons their faith due to a traumatic event or loss.

It may seem odd to refer to this as coping, but for those who engage in this, there seems to be a paradoxical relief in feeling punished for their sins or being angry at God for abandoning them rather than facing the reality of the traumatic issue at hand.

People are often taught negative religious coping in their family of origin or from their perceptions of the teachings of their religion (whether accurate or not).

Greater use of negative religious coping has been associated with more severe symptoms of PTSD, suicidal ideation, depression, anxiety in psychotic patients, and poorer mental health outcomes.

Positive Religious Coping

Positive forms of religious coping include:

  • working collaboratively with God to solve a problem,
  • seeking God’s love and care,
  • seeking spiritual support from others,
  • reappraising a situation in a benevolent way,
  • looking for a stronger connection with God,
  • seeking help from God in letting go of my anger,
  • trying to put my plans into action together with God,
  • trying to see how God might be trying to strengthen me in this situation,
  • asking forgiveness for my sins, and
  • focusing on religion to stop worrying about my problems.

Negative Religious Coping

Negative forms of religious coping include:

  • spiritual discontentment,
  • feeling angry with God,
  • questioning God’s existence, benevolence, or power (after having believed strongly in it),
  • appraising difficult situations as a manifestation of having been abandoned or punished by God,
  • wondering whether God had abandoned me,
  • feeling punished by God for my lack of devotion,
  • wondering what I did for God to punish me,
  • questioning God’s love for me,
  • wondering whether my church had abandoned me, and
  • deciding the devil made this happen.

Harmful Spiritual and Religious Beliefs and Practices

Generally, spiritual and religious beliefs and practices have been shown to improve psychological well-being. There are, however, forms of spiritual and religious beliefs and practices that can be harmful emotionally and psychologically. An intervention may be needed when a person engages in activities or practices that cause or worsen mental or emotional problems.


  • pathological guilt or obsession about moral or religious issues that:
    • is distressing,
    • impairs functioning, and
    • involves compulsive moral or religious observance.
  • a person's obsessions focus on moral or religious fears, such as
    • the fear of being an evil person, or
    • the fear of divine retribution for sin.
  • May involve
    • obsessive religious doubts and fears,
    • unwanted thoughts and images perceived as blasphemous,
    • compulsive religious rituals,
    • reassurance-seeking, and
    • avoidance.


  • Involves intense religious beliefs or experiences that interfere with normal functioning
  • Includes abnormal beliefs and a focus on religious content or even atheistic content, which interferes with work and social functioning
  • Can be connected to cultic abuse
  • An increased tendency to report spiritual, religious, or mystical experiences, religious delusions, rigid legalistic thoughts, and extravagant expression of religiosity
  • May include religious hallucinations
  • Can be common among individuals who have intense atheistic beliefs

Over Involvement in Spiritual and Religious Practices

  • Can be an increase in meditation in response to increased stress that results in isolation.
  • The increase in meditation did not likely cause problems, but the stress and isolation may have.
  • Practices are performed with a compulsive quality: “I feel like I have to pray more” or “I can’t help it.”
  • Becomes obsessional rather than adaptive and supportive
  • Signs that the practice is not adaptive include time spent in practice that appears to interfere with functioning; causes disruption of relationships; avoidance of important responsibilities; too much isolation; increased symptoms; physical pain or harm.

Spiritual Bypassing

  • Unhealthy misuse of religious and spiritual practices and terminology to avoid dealing with important psychological issues or problems in relationships.
  • Used as an escape
  • Sometimes referred to as “religious addiction.”

Belonging to a Cult or Cult-Like Group

One defining feature of a cult is that members hold a shared belief system that can go so far as to deny reality in order to sustain the social cohesiveness of the group, often to the point that a distorted consensus emerges. Reality becomes less important to members than maintaining their ties to the group. Members are strongly influenced by the group’s behavioral norms and feel compelled to conform to them. The group might employ manipulative techniques like powerful group pressure, special methods to increase suggestibility and obedience, managing information, and suspension of individuality or critical judgment.

conflict with family members over differences in religious beliefs and practices.

conflict with family members over differences in religious beliefs and practices.

Unresolved Religious and Spiritual Struggles Which May Require Intervention

Spiritual struggles can be defined as tension and conflict over sacred matters. They can occur in three domains: divine, intrapersonal or interpersonal.


A spiritual struggle in the divine domain may involve anger at God or feeling abandoned or punished by God.


A spiritual struggle that is intrapersonal may involve an inability to forgive oneself for a transgression or falling short of one's intentions to incorporate religious and spiritual practices into one's life as intended. These struggles can lead to despair and signs of depression and can be misperceived as depression. Rather than being pathological, they can be a catalyst for positive change. They do involve periods of angst and disillusionment and can be disruptive. They are opportunities for individuals to reflect on their lives and are often referred to as "Dark Night of the Soul" experiences.


Spiritual struggles involve feeling betrayed by a leader or member of one's spiritual or religious group. Being part of a spiritual or religious community can lead to struggles involving gossip, judgment, or hypocrisy on the part of leaders or other members of the community. Interpersonal struggles can also involve conflicts around differences in beliefs and practices with family members, in one's social life, or in the workplace.

Spiritual Emergencies or Crises

Sometimes mystical experiences can reach such a high level of intensity and duration they become a cause for concern. During or following prayer, meditation, or other spiritual practices, or at times spontaneously, people may have profound childhood memories, visions, or hallucinations (depending on your perspective), or insights into the nature of reality or their own nature that cause psychological disruption for a time. These experiences can provide opportunities for growth. They may also be misunderstood as a classic first psychotic break. Dr. David Lukoff describes his spiritual crisis in his video.

Religion and Spirituality Are Important Things to Discuss in Therapy

Research demonstrates that there is a relationship between religion and spirituality and psychological health and functioning. The numbers show that religion and spirituality are important to most clients. The therapist's role is changing as more people are unaffiliated with religion and looking to mental health providers for guidance once provided by spiritual leaders.

While some therapists are reluctant to address religion and spirituality in session for various reasons, therapists are able to address these issues with varying levels of comfort and proficiency. It is important to recognize internal and external resources associated with religious affiliation and to be aware that there are positive and negative ways of using religious coping.

While religious and spiritual involvement can promote psychological well-being, there are some harmful forms of involvement, and some religious and spiritual beliefs and practices can result in spiritual emergencies.


Cashwell, C., & Young, J. (2020). Integrating spirituality and religion into counseling: A guide to competent practice. 3rd edition. Wiley.

Pew Research Center. (2015). America’s Changing Religious Landscape. Retrieved from

Vieten, C., & Scammell, S. (2015). Spiritual and religious competencies in clinical practice: Guidelines for psychotherapists and mental health professionals. New Harbinger Publications.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2021 Kim Harris

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