Sacred Sessions: Approaches to Religious Integration in Psychotherapy

Writer: Keila Cruz

Amidst the growing interest in the incorporation of Eastern religious practices such as yoga and mindfulness into the psychotherapeutic environment, it is worth considering how the field of psychotherapy might be able to make strides by further integrating religious faith and/or spirituality (R/S) into mental health care practice and training. A link between R/S and psychotherapeutic treatment can be found as early as the publishing of The Varieties of Religious Experience in 1902 by the infamous father of psychology William James. James advocated for the empirical study of religious experience, noting that the value of a religious experience is inherently subjective and arguing that religion is as worthy of scientific study as any other discipline as it is an integral part of human existence (Blanch, 2007). Since religion is known to constitute a large portion of an individual’s life, practitioners who wish to understand how intersectionality may inform a patient’s identity, should consider its significance in enhancing holistic care. By “intersectionality”, we refer to the interrelatedness between elements that constitute one’s identity. Elements include race, class, gender, and religion. Approaching psychotherapy from a religious and spiritual footing may lend patients of various cultures, beliefs, and walks of life a new lens through which they might be able to understand their experiences. The present article seeks to present evidence that highlights the theoretical implications of integrating R/S into psychotherapy, while simultaneously addressing strategies for practical integration, and admitting the challenges which may arise in this endeavor. 

Of first importance, is the recognition that Western science is heavily anchored on empirical knowledge–the theory that all knowledge is derived from sense experience (Russell, 1935)– as the surest way of acquiring objective knowledge and understanding psychopathology. Such an emphasis on empiricism tends to neglect the methodology employed by Eastern traditions which place qualitative –experience based –evidence at the forefront as opposed to quantitative –data based– evidence. Both methods have their roses and their thorns, however, a number of studies on the confluence of religion and psychotherapy operate by uniting both Western science and Eastern wisdom teachings. Although, that is not to say that there have not been attempts at the integration of religion and psychotherapy in Western Science. In fact, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), contains a category on “Religious or Spiritual Problem” (American Psychiatric Association, 2013). In addition, the Joint Commission of the Accreditation of Healthcare Organizations asks that a spiritual assessment be conducted with mental health patients (Blanch, 2007). Still, from the limited research, resources, and initiatives that have been publicized and implemented, it is evident that the integration of religion in psychotherapy demands further study given that a considerable “87% of Americans view themselves as ‘religious’” (Blanch, 2007). 

This prompts the question: How effective have the implemented integrative efforts truly been? A metaanalysis assessing the several clinician’s integration of R/S in the treatment of addiction, anxiety, and depression observed that there was significant improvement in psychological outcomes, namely, reduced distress and improved psychological well-being were recorded, along with the promotion of spiritual well-being (Captari et al., 2018). From a theoretical perspective, spiritually integrated care may be particularly effective because it provides the patient a non-pathologized method to understand their condition. For instance, a patient experiencing a mental health condition, might choose to work on understanding their condition from a religious perspective, such that the implication that there is something inherently “atypical” about their condition and that it must be treated may be replaced with a personally meaningful understanding of how their condition might be a part of their spiritual process. However, such a position will take some stretching from the therapeutic provider’s end, that is, the provider must be open to accept that there are various dimensions through which one may view a problem, precisely because the psyche may be affected by a number of factors –biological, social, and psychological. While some may counter that patients may feel uncomfortable with the discussion of R/S topics in a therapeutic space, a survey conducted found that a majority of Americans prefer for R/S beliefs, practices, or relationships to be discussed in mental health (Currier et al., 2023). In addition, Americans were more likely to turn to clergy or their congregation when experiencing life hurdles in comparison to human services professionals (Blanch, 2007). There are a myriad of individuals for whom seeking out professional mental health counseling is not a viable option–either due to financial, personal or other extenuating circumstances. To better meet the mental health care demands of the contemporary world, accessible and alternative counseling options offered by religious leaders and mentors should be integrated into the mental health care realm. It is evident that the integration of religion and spirituality into the therapeutic space would broaden the scope of support offered to individuals. 

Moreover, the religious and/or spiritual integration in psychotherapy is not entirely groundbreaking as other religious traditions including Christianity and Buddhism have long emphasized the importance of spiritual well-being in psychological health. One example we might turn to is the ancient tradition of Christian soul care which included practices such as prayer and pastoral counseling (Hathaway, 2009). Yet, such pastoral care has also been documented in Buddhist traditions where teachers provide spiritual, emotional, and psychological support. In “The Couch and the Cushion: Integrating Zen and Psychoanalysis”, psychiatrist Barry Magid shares that when he first began integrating Zen into his psychotherapeutic practice, he was severely aware of their differences, yet, as the years progressed, Zen and Psychotherapy became one and their implementation into therapy was seamless. The latter anecdote illustrates beautifully how R/S and psychotherapy may meld together and structure a dynamically beneficial experience for patients who are interested. R/S integration into psychotherapy has been shown to help those in crisis situations; several studies have demonstrated that the meaning-systems –beliefs and practices used to understand and interact with the world– from religious and spiritual practice aid those in crisis because individuals direct their worries toward a higher force which is beyond the scope of the material world (Viftrup et al., 2013). 

Religious integration in psychotherapeutic practices may also help individuals feel accepted in their milieu. With an increase in immigration throughout the United States, practitioners may desire to reconsider therapeutic practice with diverse populations from a multifaceted perspective. That is, there should exist an awareness of varying tolerances and approaches to mental health within different cultural and religious practices. By tailoring therapeutic needs to their patient’s cultural and religious preferences, practitioners may help patients feel comfortable with seeking out therapy and also build rapport with their patient. One such example of religious integration can be spotted in a study conducted by Raiya and Pargament (2010) that investigates the implications of employing a program named the “Psychological Measure of Islamic Religiousness (PMIR) in the clinical setting. The researchers detailed that participants –of the Muslim population– were separated into two groups that both received standard psychological treatment from a trained professional. Yet the treatment group also received additional religious-socio cultural psychotherapy that rested on Islamic principles (i.e., prayer, repentance, and reliance on Allah in times of need). Results revealed that clients in the treatment condition demonstrated better response and adjustment to therapy compared to those in the control condition. Since religion makes up a large portion of the individual’s identity, embedding their religious practice into the therapeutic space may help to dismantle several stigmatized ideas held by various cultures regarding therapy. Stigma regarding mental health care is not only present within the Muslim community, it exists amongst various religious and cultural groups – embedding religious beliefs into a field that is stigmatized may bridge the gap between these individuals and therapy. 

Important to consider is the notion that significant physiological and psychological distress may arise out of religious questioning. The resolution of religious issues was shown to have an influence on participants in a study mentioned in Blanch (2007)’s literature review. Where psychological diagnoses from a provider might inspire feelings of helplessness in a patient, integrating a religious or spiritual dimension into this diagnosis aids the individual in making sense of ineffable experiences which their medical diagnosis might not entirely explain. Of these include: visions, voices, and unusual smells or sounds. With that being said, practitioners should take heed of the dangers associated with romanticizing spirituality as a purely positive endeavor as researchers stress that R/S can have both constructive and destructive effects on a patient’s life (Viftrup et al., 2013). Because religion is firmly intertwined with one’s identity, the practitioner’s method of integration should be mindful of any trauma the patient has experience within the realm of a religious or spiritual tradition; negative experiences including sexual abuse by clergy or punitive punishment from a religious tradition should be navigated carefully by the therapeutic provider. 

No discussion on the benefits of a religio-spiritual and psychotherapeutic renaissance would be complete without an assessment of the many dangers and limitations which arise when considering this integration. For one, religious discussions may make either the client or therapist feel uncomfortable, especially if either one has had a negative bias toward religion or is atheist. Therefore, Blanch (2007) advises practitioners to let their client lead the session, ensuring that their personhood is respected. It could also be that the therapist may indirectly impose their religious values on the client and conflicts may arise if both of their values clash. The review by Currier et al. (2023) shares a hypothetical scenario in which Javier, a thirty year old, shares that he has been experiencing “spiritual darkness” with his social worker. In response, the social worker suggests that Javier read about how different religious approaches might grapple with his experiences, however, he stops coming to therapy about this session. The latter example demonstrates the tension between religious and scientific authority systems– where the social worker’s approach toward understanding Javier’s experiences differed from his own. In this case, the practitioner should embrace differing religious viewpoints rather than hurting their own beliefs on the patient. Another important limitation is competency. The practitioner should be active in cultivating the awareness, knowledge, and skills needed to implement R/S– this may include obtaining proper training and experience. 

The implementation of R/S in therapeutic practice does require some stretching on both the psychotherapist and the client’s end. Practitioners who wish to address religious and/or spiritual factors as part of their practice may seek out accredited training programs such as “Spiritually Integrated Psychotherapy Training” (SIP), the American Institute of Healthcare Professional’s “Spiritual Counseling Certification”, or even the “Board Certified Christian Counseling Program” from the National Association of Christian Counselors. Other resources for practitioners include books on the collaboration between mental health and religion. It is also encouraged that researchers continue to conduct empirical research both to prove the Western materialist science wrong, and to widen the scope of resources available to practitioners who wish to employ R/S in practice. One notable example can be observed in Currier et al. (2023)’s “Spiritual and Religious Competencies Project” that aims to fill the gap left by the lack of reliable resources and tools for amalgamating spirituality and therapeutic practice. The program is responsible for ensuring that health providers around the country receive necessary training to address R/S beliefs, relationships, and practices. 

As present and future practitioners committed to addressing the mental health needs of individuals from diverse backgrounds, it is essential to consider how one might contribute in the facilitation of such services. Integrating religion and spirituality into therapeutic practice is one of the many ways a practitioner may honor a client’s intersecting identities while fostering a holistic approach to mental health care.