Spirituality in Psychotherapy: Evidence and Ethical Practice
Author: Angela Bogdanova · Published: October 11, 2026 · Editorial Policy
Research cluster: Religion, Spirituality & Meaning-Making · Written by Artificial Sapiens
Spirituality can be clinically relevant in psychotherapy because people often understand suffering, hope, identity, responsibility, relationships, mortality, and recovery through religious or spiritual frameworks. Ethical psychotherapy can make room for those frameworks without turning therapy into religious instruction and without asking psychological science to decide whether a sacred belief is true. The clinical task is to understand what a belief, practice, community, or spiritual experience means in this particular person’s life, how it relates to the presenting problem, and whether the client wants it included in care.
The strongest contemporary position is therefore client-centered and competence-based. Religion and spirituality may be important sources of meaning, belonging, coping, moral orientation, and resilience; they may also be connected with conflict, guilt, exclusion, doubt, or distress. A therapist’s responsibility is to assess relevance respectfully, follow the client’s preferences, work within professional competence, use evidence-informed methods, obtain meaningful consent for explicitly spiritual interventions, and protect the client from coercion or the therapist’s own worldview. Vieten and Lukoff (2022) describe religious and spiritual competencies as a component of culturally responsive psychological practice, while Currier et al. (2023) focus specifically on the ethical skills needed to integrate these dimensions in psychological services.
What Does Spirituality in Psychotherapy Mean?
Spirituality in psychotherapy means that a client’s religious faith, spirituality, sacred values, practices, community ties, existential commitments, or questions of ultimate meaning can be discussed when they matter to the client and the clinical work. The term does not name one therapy school. It describes a dimension of person-centered care that can appear inside cognitive-behavioral, psychodynamic, humanistic, systemic, trauma-focused, existential, interpersonal, and other evidence-based approaches.
Religion and spirituality overlap, but they are not interchangeable. Religion commonly includes shared traditions, doctrines, rituals, communities, institutions, and inherited practices. Spirituality can refer more broadly to experiences and commitments related to the sacred, transcendence, ultimate meaning, connectedness, or deeply held values. Some people identify as religious and spiritual, religious but not spiritual, spiritual but not religious, atheist, agnostic, secular, or undecided. Competent therapy starts with the client’s own language rather than assigning an identity category from the outside. The APA Monitor overview of religion and spirituality in therapy likewise emphasizes the need to understand these dimensions as potentially distinct and personally defined.
A spiritually attentive therapist may ask how faith affects coping, whether a religious community is supportive, whether spiritual questions have intensified during a crisis, or whether the client wants a practice such as prayer, meditation, scripture reflection, ritual, or consultation with clergy to be part of treatment. The same therapist must also be able to hear, without defensiveness or proselytizing, that a client does not want spirituality discussed at all.
Why Religion and Spirituality Belong in Cultural Formulation
Religion and spirituality are dimensions of culture and identity for many people. They can shape family roles, moral language, expectations about illness, ideas about agency and responsibility, interpretations of suffering, decisions about treatment, community support, and the vocabulary a person uses to describe inner experience. The APA Multicultural Guidelines place psychological work within intersecting cultural contexts, and the APA Ethics Code explicitly includes religion among the individual and cultural differences psychologists should respect.
This matters clinically because the same behavior can have different meanings in different traditions and for different people. Fasting may be a normative devotional practice, a cultural observance, a personal discipline, or—under different circumstances—part of a clinical problem. Repetitive prayer may be freely chosen worship, a source of comfort, a communal practice, or an OCD compulsion. A therapist cannot determine its psychological function merely by looking at the surface form.
The cultural formulation therefore asks what the practice means to the client, whether it is voluntary and flexible, how it fits the person’s community norms, what emotions and expectations surround it, and whether it is associated with impairment, compulsion, fear, support, or relief. Religious content alone does not establish psychopathology.
What the Evidence Shows
Evidence on spirituality in psychotherapy comes from several different literatures that should not be collapsed into one claim. Some studies examine whether clients want religion or spirituality discussed. Others study explicitly religious or spiritually adapted treatments. Still others examine therapist competence, treatment alliance, qualitative experiences, or real-world implementation. These questions produce different kinds of evidence.
Clients Often Consider Religion and Spirituality Relevant
In a national U.S. survey of 989 adults who had recently seen a mental health provider, many participants regarded religion and spirituality as relevant to their mental health, although attitudes and desired levels of integration varied. The study developed a measure of perceived relevance rather than demonstrating that spiritual integration improves outcomes for every client. Oxhandler et al. (2021) therefore supports routine openness and assessment of preference, not an assumption that every client wants spiritual content.
Preference is clinically important because clients can experience omission as a loss of context and unwanted integration as intrusion. In a naturalistic practice study involving 175 clients, accommodation of preferences for religious or spiritual integration was associated with treatment completion and therapist-rated improvement. Because the study was observational and conducted in real-world practices, it cannot establish that preference matching itself caused the better outcomes. Swift et al. (2022).
Spiritually Integrated Treatments Can Help Some Clients
Meta-analytic evidence indicates that explicitly religious or spiritually adapted psychotherapies can be beneficial, particularly for clients for whom religion or spirituality is personally important. A comprehensive meta-analysis by Captari et al. (2018) concluded that integrating clients’ religion and spirituality can contribute to psychological and spiritual outcomes when treatment is responsive to client characteristics and preferences.
A later multilevel meta-analysis of randomized trials compared religious or spiritually based therapy with non-religious or non-spiritual treatment across 23 studies and 27 comparison groups. It found moderate average advantages at posttreatment and follow-up, with the authors emphasizing people with strong religious or spiritual affiliation. Bouwhuis-Van Keulen et al. (2024) provides evidence for tailored treatment in selected populations; it does not justify adding spiritual techniques indiscriminately to psychotherapy.
An earlier systematic review and meta-analysis of randomized trials also found potential additional benefits for some mental-health outcomes, while noting substantial diversity in interventions and outcomes and a need for better standardization. Gonçalves et al. (2015). A review of 35 real-world studies likewise described a growing practice-based literature while identifying major needs for stronger designs, clearer training models, and culturally contextual research. Captari, Sandage, and Vandiver (2022).
The Evidence Does Not Support Universal Claims
These findings do not show that spirituality is a treatment for mental disorders, that religious practice guarantees psychological benefit, or that spiritually integrated therapy is superior for everyone. Trials differ in diagnosis, intervention, religious tradition, degree of adaptation, therapist training, comparison condition, outcome measure, and follow-up period. Many studies have been conducted in populations where a particular faith tradition is prominent, which limits broad cultural generalization.
The correct evidence-based conclusion is conditional: when religion or spirituality is important to the client, ethically and competently integrating that dimension can improve fit and may improve outcomes. When it is irrelevant or unwanted, introducing it can reduce fit and violate client autonomy. A high-quality treatment plan therefore begins with the person rather than with a spiritual technique.
What Clients Say Helps—and What Can Harm
Quantitative outcome research is only part of the picture. Clients also describe how therapists’ behavior feels inside the relationship. A 2025 meta-synthesis of 14 qualitative studies found that clients valued therapists who were open, respectful, and able to incorporate beliefs into treatment when desired. The authors also noted that the evidence base underrepresented non-Western and non-Christian perspectives. Morbach, Lagetto, and Gelo (2025).
A national U.S. survey asked current mental-health clients to describe helpful and harmful experiences of religious or spiritual integration. Nearly half described helpful approaches; 9.6% described hurtful experiences; and about half reported that religion or spirituality had not been discussed or was not applicable. The helpful-versus-harmful distinction reinforces a central ethical point: simply mentioning spirituality is not inherently beneficial. The quality, timing, consent, and stance of the therapist matter. Oxhandler et al. (2024).
The Ethical Foundation: Client Autonomy, Competence, and Non-Coercion
Ethically sound integration begins with the client’s goals. A therapist may invite discussion, but should not use clinical authority to promote a religion, discourage a religion, convert a client, argue against sacred beliefs, or make spiritual participation a condition of receiving competent care. The APA Ethics Code grounds this work in respect for dignity, self-determination, cultural differences, competence, informed consent, and avoidance of harm.
Consent Is More Than Permission
Informed consent means that the client understands what is being proposed, why it is relevant, what alternatives exist, and that declining spiritual content will not jeopardize care. A general intake question such as “Are religion or spirituality important in how you understand what is happening?” is different from proposing a spiritually explicit intervention. The more specific and value-laden the intervention, the more important it is to clarify its purpose and obtain explicit agreement.
Consent also remains revisable. A client may initially want prayer or scripture integrated and later decide that it is unhelpful. Another may begin treatment wanting no spiritual discussion and later discover that grief, guilt, identity, or belonging cannot be understood without it. Respectful practice lets the client change course.
Competence Includes Knowing the Limits of One’s Knowledge
Therapists do not need to be theologians, clergy, or members of a client’s faith to provide competent psychotherapy. They do need enough cultural and clinical knowledge to ask intelligent questions, recognize when assumptions are replacing understanding, distinguish psychological tasks from religious authority, and seek consultation or referral when specialized knowledge is necessary. Vieten and Lukoff (2022) and Currier et al. (2023) frame this as a combination of attitudes, knowledge, and skills rather than mere familiarity with religious vocabulary.
Training evidence is still developing. A randomized study of 363 mental-health trainees found that structured self-study, particularly when combined with peer-group work, improved several self-reported religious and spiritual competency outcomes, although some comparisons weakened under missing-data analyses. This is promising evidence that competence can be taught, while the outcomes remain measures of trainee competence rather than direct patient benefit. Lall-Alvarez et al. (2026).
What Ethical Integration Can Look Like in Practice
Spiritual integration can be subtle. It may consist of learning the client’s language for meaning and suffering, asking about faith-community support, clarifying whether a moral conflict is religious or personal, exploring how a spiritual practice affects emotion regulation, or understanding how a religious identity intersects with family, sexuality, migration, disability, grief, or other identities.
When the client wants more explicit integration, therapy may incorporate spiritually congruent metaphors, values, readings, contemplative practices, forgiveness work, compassion practices, rituals, or prayer. The intervention should remain linked to a clinical formulation and treatment goal. A spiritual element is not evidence-based merely because it feels meaningful, and an evidence-based therapy does not become culturally responsive merely by adding spiritual vocabulary.
The APA Handbook of Spiritually Integrated Psychotherapies documents a range of approaches and provides a useful professional map. This article addresses the broader ethical and evidentiary conditions for including spirituality. Specific methods and comparative outcomes belong to the separate clinical question of spiritually integrated psychotherapy.
Should a Therapist Ask About Religion or Spirituality?
A brief, non-assumptive question is often clinically appropriate because it allows clients to say that spirituality is central, complicated, irrelevant, private, or unwanted. The aim is not to complete a theological inventory. It is to learn whether this domain affects the presenting problem, coping resources, relationships, treatment preferences, or risk.
Good questions leave room for every answer: “Are there religious, spiritual, philosophical, or cultural beliefs that are important for me to understand?”; “Do these beliefs help, complicate, or have no bearing on what you are going through?”; “Would you like any part of this to be included in therapy?” The therapist should also be prepared for “no.” A secular or nonreligious worldview deserves the same respect as a religious one.
Detailed spiritual assessment is a distinct clinical task with its own instruments, interview methods, and limitations. Screening or questionnaire scores can identify themes for discussion; they do not diagnose a disorder and do not determine what a belief means to the individual.
Prayer in Psychotherapy
Prayer is one of the clearest examples of why preference and role boundaries matter. A client may already use prayer privately and want to discuss its emotional meaning without praying in session. Another may explicitly ask a therapist to join a prayer. A third may experience therapist-led prayer as intrusive even when the therapist intends support.
There is no single answer that applies to every client, jurisdiction, profession, setting, or treatment model. When prayer is considered, the therapist should examine the client’s request, treatment relevance, power dynamics, cultural context, professional competence, informed consent, and whether participation could blur the therapist’s role. The therapist should also consider alternatives, such as inviting the client to describe the prayer, use it privately, or involve a clergy or spiritual-care professional when that better matches the need. Ethical analyses in psychiatry and psychology similarly emphasize boundaries, respect, and client-centered decision-making. Dike et al. (2022); Currier et al. (2023).
Prayer should never be used to imply that recovery depends on religious conformity or that a lack of improvement reflects insufficient faith. Psychological treatment and sacred practice have different forms of authority. Therapy can respect both without collapsing one into the other.
Does the Therapist Need to Share the Client’s Faith?
Shared faith can make some clients feel immediately understood, but religious matching is not a prerequisite for effective psychotherapy. A therapist from the same tradition can still misunderstand a client’s beliefs or impose assumptions, while a therapist from a different or no religious background can work skillfully through curiosity, cultural humility, competence, and respect.
The clinically relevant question is whether the therapist can understand the client’s worldview well enough to formulate the problem accurately and deliver appropriate care without imposing personal beliefs. Some clients specifically prefer a faith-concordant therapist; others prefer a secular therapist; still others care more about clinical expertise than worldview matching. The preference itself is legitimate and can be discussed openly.
Therapist Self-Disclosure and Religious Identity
Clients sometimes ask therapists what they believe. A therapist’s answer can affect trust, safety, transference, alliance, and perceived authority. Self-disclosure is therefore a clinical decision, not a social obligation. The therapist should consider what purpose disclosure serves for this client, whether it shifts attention toward the therapist, and whether withholding or sharing information could create pressure.
A useful response may explore what the client hopes to know: perhaps they fear judgment, want assurance that a religious practice will be respected, or need to know whether a therapist can work within a particular worldview. Often the underlying concern can be answered directly without making the therapist’s personal theology the center of treatment.
Spiritual Struggle, Guilt, and Adverse Religious Experiences
Religion and spirituality can be sources of comfort and also contexts in which people experience doubt, moral conflict, fear, community exclusion, interpersonal injury, shame, or loss. Psychotherapy can address the psychological consequences of those experiences without declaring a religious tradition true or false and without assuming that difficulty within a religious context represents pathology.
The therapist’s task is to understand the person’s experience: what happened, how the client interprets it, what emotions and relational patterns are involved, how it affects functioning, and what the client wants now. When a client reports coercion, abuse, discrimination, or other concrete harm, normal standards of trauma-informed and ethical care apply. When the distress concerns doctrine, conscience, or spiritual meaning, the therapist can work with the psychological dimensions while respecting the limits of clinical authority.
Religious Guilt, Moral Concern, and OCD
Religious guilt is not inherently pathological. Moral emotions can be part of healthy conscience, repair, repentance, reconciliation, and value-guided behavior. Clinical concern increases when guilt becomes persistent, disproportionate, disabling, tied to broader symptoms, or maintained by compulsive attempts to achieve impossible certainty.
When intrusive doubts, repeated confession, ritualized prayer, reassurance seeking, or certainty checking form an obsessive-compulsive cycle, the canonical clinical owner is OCD rather than spirituality in psychotherapy. See Scrupulosity OCD and Moral OCD for the disorder-specific distinction between ordinary religious or moral concern and obsessions and compulsions.
Spiritual Experiences and Clinical Assessment
People may report experiences they understand as divine presence, revelation, calling, unity, transcendence, answered prayer, spiritual communication, or other sacred events. Psychology can study the person’s perception, emotion, behavior, culture, distress, functioning, and associated symptoms. It does not determine whether the sacred interpretation is metaphysically true.
A clinically careful assessment asks whether the experience is culturally and religiously contextualized, whether it is sought or unwanted, whether it causes distress or impairment, whether thought and behavior are organized, whether there are safety concerns, and whether other symptoms suggest a psychiatric or neurological condition. An unusual experience is not a diagnosis by itself. Conversely, religious language does not exempt clinically significant symptoms from assessment.
Clinical disorders involving trance and possession-like states require their own diagnostic and cultural framework; see Trance Disorder and Possession Trance Disorder: ICD-11 and Cultural Context. The broader differential between spiritual experience and mental-health symptoms is a separate EN-47 clinical topic and should not be reduced to a checklist.
Collaboration With Clergy and Spiritual-Care Professionals
Some questions belong primarily to psychotherapy; others belong primarily to pastoral, chaplaincy, or theological care; and many sit at the boundary. With the client’s permission and when clinically useful, collaboration can help. A clergy member may clarify a tradition’s norms, support community reintegration, or address sacramental and theological questions. A psychotherapist can assess symptoms, functioning, risk, relational patterns, trauma responses, and evidence-based mental-health treatment.
Referral should expand care rather than abandon the client. The therapist remains responsible for professional decisions within psychotherapy, confidentiality, documentation, and coordination. Likewise, a spiritual-care professional does not become a mental-health clinician solely because spiritual concerns affect psychological wellbeing. Clear roles protect the client.
Spirituality, Grief, Illness, and Existential Questions
Questions of meaning often intensify around bereavement, serious illness, disability, migration, war, infertility, aging, and other life transitions. Clients may draw on prayer, ritual, community, ancestors, sacred texts, philosophical commitments, or nonreligious forms of meaning. Others may experience anger at God, spiritual doubt, alienation from community, or a loss of previously sustaining beliefs.
Therapy can make room for these responses without prescribing a correct spiritual resolution. In grief, for example, the clinical task is to support adaptation to loss while understanding how beliefs, rituals, family traditions, and community shape mourning. See Grief: Psychological Responses to Loss for the broader psychology of bereavement.
Common Ethical Failures to Avoid
One failure is omission: treating religion or spirituality as automatically irrelevant even when the client says it is central. Another is imposition: introducing spiritual interpretations or practices because they fit the therapist’s worldview rather than the client’s goals. A third is overconfidence: assuming that belonging to the same faith provides sufficient cultural competence.
Other risks include using sacred texts as unquestionable clinical directives, framing symptoms as evidence of spiritual deficiency, discouraging indicated medical or psychological treatment, treating normal religious observance as pathology, dismissing a client’s spiritual interpretation, or presenting a therapist’s personal belief as professional knowledge. Each of these misuses the power of the therapeutic role.
Ethical practice also avoids romanticizing spirituality. Religious communities can provide profound support, and they can contain ordinary human conflict, hierarchy, exclusion, and harm. A culturally competent therapist holds both possibilities open and follows evidence from the client’s actual life.
How a Client Can Bring Spirituality Into Therapy
A client can raise the subject directly: “My faith is important to how I understand this,” “I want therapy to respect my religious practices,” “I am struggling spiritually and do not want you to settle the theology for me,” or “I do not want religious approaches used in my treatment.” These are clinically useful preferences, not tests the client must pass.
It is reasonable to ask a therapist about experience working with a particular religious or spiritual issue, how they handle value differences, whether they use spiritually integrated methods, how consent works for explicit practices, and whether they collaborate with clergy. A competent therapist can describe scope and limits without requiring the client to disclose more than they choose.
If a therapist repeatedly pressures a client toward or away from a religion, dismisses deeply held beliefs, uses spirituality to replace indicated care, or refuses to respect stated boundaries, the problem is not a failure of the client’s spirituality. It is a problem of therapeutic fit, competence, or ethics.
How Therapists Can Practice Responsively
A strong clinical sequence begins by asking rather than assuming. Determine whether religion or spirituality is relevant, learn the client’s preferred language, identify resources and struggles, and clarify how much integration the client wants. Formulate the clinical problem using the same evidence standards that would apply in any psychotherapy, then decide whether spiritual content adds therapeutic value.
When an explicitly spiritual intervention is proposed, explain its purpose, alternatives, and boundaries. Monitor outcomes rather than treating spiritual congruence as proof of effectiveness. Consult when cultural or theological knowledge is insufficient. Refer or collaborate when the client’s need exceeds the therapist’s scope. Document clinically relevant decisions in the same way other preference-sensitive adaptations are documented.
This approach respects both psychology and religion because it gives each domain appropriate authority. Psychology contributes methods for assessment, formulation, therapeutic relationship, behavior change, emotion, cognition, and mental-health treatment. Religious traditions and spiritual communities contribute their own languages, practices, meanings, and forms of guidance. Psychotherapy can work at the intersection while remaining psychotherapy.
Frequently Asked Questions
Is spirituality in therapy evidence-based?
There is evidence that spiritually or religiously integrated psychotherapies can benefit selected clients, especially those for whom religion or spirituality is important. Meta-analyses support potential advantages in some settings, while heterogeneity and cultural limitations remain substantial. Evidence therefore supports preference-sensitive, competent integration rather than routine spiritual treatment for everyone. Captari et al. (2018); Bouwhuis-Van Keulen et al. (2024).
Should every therapist ask about religion and spirituality?
A brief, respectful opportunity to identify cultural and spiritual factors can be clinically useful, particularly when they may affect coping, treatment preferences, community support, or meaning. The question should make refusal easy. Detailed spiritual assessment is warranted only when the domain is relevant.
Can a therapist pray with a client?
Prayer may be considered in some settings when the client wants it and the therapist can use it competently and ethically. It requires attention to informed consent, treatment relevance, professional role, power dynamics, and alternatives. A client should never feel pressured to pray, and therapy should not imply that clinical improvement depends on religious compliance.
Do I need a therapist who shares my religion?
No universal rule requires a shared faith. Some clients prefer a therapist from the same tradition, while others prefer a therapist with different or no religious affiliation. Competence, respect, curiosity, clinical skill, and the ability to work within the client’s worldview are more fundamental than identity matching alone.
Is a spiritual experience a sign of mental illness?
A spiritual experience is not a diagnosis. Clinical assessment considers cultural context, the person’s interpretation, distress, functioning, safety, organization of thought and behavior, and accompanying symptoms. Religious content should neither be pathologized automatically nor used to dismiss symptoms that require care.
Can spirituality replace psychotherapy or medication?
Spiritual practices and communities may be important resources, but they do not automatically substitute for indicated mental-health treatment. Decisions about psychotherapy, medication, and other medical care should be based on clinical assessment, evidence, risks, preferences, and appropriate professional guidance. Spiritual care can complement treatment when the client wants it.
What if my therapist disagrees with my beliefs?
Therapeutic competence does not require agreement. It requires the ability to understand the client’s beliefs accurately enough to work respectfully and effectively, without imposing the therapist’s worldview. Persistent pressure, ridicule, or dismissal is incompatible with culturally respectful care.
Evidence Boundaries and Research Gaps
The literature is substantial enough to reject the idea that spirituality is automatically outside psychotherapy, but it remains uneven. Research samples have often been Western and disproportionately Christian; intervention protocols vary; measures do not always distinguish religion from spirituality; therapist allegiance and client preference can confound outcomes; and long-term follow-up is limited.
Evidence is also stronger for some questions than others. We know more about client preferences and selected spiritually adapted interventions than about which specific spiritual components produce change, which clients benefit most, and how findings generalize across religions and cultures. Qualitative work is expanding the picture, but it cannot by itself establish comparative effectiveness. Morbach et al. (2025).
Future research needs preregistered comparative trials, clearer descriptions of spiritual adaptations, broader cultural representation, measures that capture both benefit and harm, longer follow-up, and better study of therapist competence. The ethical standard in the meantime is proportionate confidence: use what the evidence supports, state what remains uncertain, and center the client’s informed preferences.
Related Articles
References
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
American Psychological Association. (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. https://www.apa.org/about/policy/multicultural-guidelines
American Psychological Association. (2023). Can religion and spirituality have a place in therapy? Experts say yes. Monitor on Psychology, 54(7). APA Monitor
American Psychological Association. (2023). APA handbook of spiritually integrated psychotherapies. APA Books
Bouwhuis-Van Keulen, A. J., Koelen, J., Eurelings-Bontekoe, L., Hoekstra-Oomen, C., & Glas, G. (2024). The evaluation of religious and spirituality-based therapy compared to standard treatment in mental health care: A multi-level meta-analysis of randomized controlled trials. Psychotherapy Research, 34(3), 339–352. https://doi.org/10.1080/10503307.2023.2241626
Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L., Jr. (2018). Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta-analysis. Journal of Clinical Psychology, 74(11), 1938–1951. https://doi.org/10.1002/jclp.22681
Captari, L. E., Sandage, S. J., & Vandiver, R. A. (2022). Spiritually integrated psychotherapies in real-world clinical practice: Synthesizing the literature to identify best practices and future research directions. Psychotherapy, 59(3), 307–320. https://doi.org/10.1037/pst0000407
Currier, J. M., Fox, J., Vieten, C., Pearce, M., & Oxhandler, H. K. (2023). Enhancing competencies for the ethical integration of religion and spirituality in psychological services. Psychological Services, 20(1), 40–50. https://doi.org/10.1037/ser0000678
Dike, C. C., Briz, L., Fadus, M., Martinez, R., May, C., Milone, R., Nesbit-Bartsch, A., Powell, T., Witmer, A., & Brendel, R. W. (2022). Religion, spirituality, and ethics in psychiatric practice. Journal of Nervous and Mental Disease, 210(8), 557–563. https://doi.org/10.1097/NMD.0000000000001505
Gonçalves, J. P. B., Lucchetti, G., Menezes, P. R., & Vallada, H. (2015). Religious and spiritual interventions in mental health care: A systematic review and meta-analysis of randomized controlled clinical trials. Psychological Medicine, 45(14), 2937–2949. https://doi.org/10.1017/S0033291715001166
Lall-Alvarez, C., Wade, N. G., Hook, J. N., & Davis, D. E. (2026). Efficacy of a trainee-driven approach to achieving religious and spiritual competencies in psychotherapy. Psychotherapy, 63(2), 173–185. https://doi.org/10.1037/pst0000596
Morbach, A. C. B., Lagetto, G., & Gelo, O. C. G. (2025). Client’s experiences and perceptions of religious and spiritual issues in psychotherapy: A meta-synthesis of qualitative studies. Psychotherapy Research. Advance online publication. https://doi.org/10.1080/10503307.2025.2592953
Oxhandler, H. K., Pargament, K. I., Pearce, M. J., Vieten, C., & Moffatt, K. M. (2021). The relevance of religion and spirituality to mental health: A national survey of current clients’ views. Social Work, 66(3), 254–264. https://doi.org/10.1093/sw/swab025
Oxhandler, H. K., Polson, E. C., Ander, G., Moffatt, K. M., Pearce, M., Vieten, C., & Pargament, K. I. (2024). Helpful and harmful approaches to integrating religion and spirituality into mental health care: A national survey of current clients’ experiences in the United States. Journal of Religion and Health, 63(4), 2924–2940. https://doi.org/10.1007/s10943-024-02072-x
Swift, J. K., Bird, M. O., Penix, E. A., & Trusty, W. T. (2022). Client preference accommodation for religious/spiritual integration and psychotherapy outcomes in naturalistic practice settings. Psychotherapy, 59(3), 392–399. https://doi.org/10.1037/pst0000386
Vieten, C., & Lukoff, D. (2022). Spiritual and religious competencies in psychology. American Psychologist, 77(1), 26–38. https://doi.org/10.1037/amp0000821