When Spiritual Struggles Drive Distress in Psychotherapy

David

Hey everyone, welcome back to Bridging Spirituality and Science. I’m David. If you’ve tuned in before, you know we’ve talked a lot about integrating spirituality into psychotherapy, and today we’re zooming in on a pretty crucial piece of that puzzle—spiritual struggles. So, what are we even talking about when we say “spiritual struggles”? These are those moments of conflict, doubt, or distress popping up around your faith or spiritual beliefs. Things like feeling abandoned by God, struggling with guilt or shame for not living up to some kind of moral ideal, or wrestling with big questions about your religious identity. They can get pretty personal and cut deep, right?

David

Now, here’s something that kind of grabs me every time—when we look at folks participating in spiritually integrated psychotherapy, more than half, like 53%, say that religion has, in some way, made their lives harder or contributed to challenges. And this is not just one group; we’re talking folks from all walks—different ages, races, genders, sexual orientations, you name it. It’s not just something you see in one faith tradition either; these struggles show up across different backgrounds and levels of belief, even among folks who don’t affiliate with a religion at all.

David

Let me bring this down to earth with a real example—an experience I had with a student of mine. This was a young woman, deeply religious, who came to see me after losing her father very suddenly. What tore at her most wasn’t just the loss—it was the crushing guilt she felt for being angry at God. She kept asking herself, “Is it wrong to question or doubt? Am I failing my faith somehow?” And the more she struggled to “fix” her feelings, the more isolated, anxious, and honestly, depressed she became. For her, spiritual guilt created more distress than the grief itself. That stuck with me. Spiritual struggles are not an academic idea—they’re real, and they shape people’s healing.

David

Alright, so why does any of this matter—besides just being interesting? Well, recent research led by Dr. Scott Richards of the Bridges Institute for Spiritually Integrated Psychotherapies—175 clinicians, over 1,400 clients—looked at exactly how these spiritual struggles play out in the context of therapy. What’s wild is, they didn’t just look at “does this make you feel worse right now?” They tracked it over the first 6 weeks of psychotherapy, which, by the way, is when most of the big changes usually happen anyway.

David

Here’s the headline: The data showed that spiritual struggles actually predict increased psychological distress as therapy goes on. It’s not just that if you’re feeling anxious or depressed you start doubting your faith more. That wasn’t it. The researchers found this clear direction—if someone is still wrestling with spiritual conflict after about a month of treatment, they tend to get even more distressed later on. In other words, the trouble starts from the spiritual end, and then spills over into your mental health, not the other way around.

David

I might be oversimplifying, but this “primary struggle model” was stronger than the reverse—psychological distress didn’t trigger more spiritual struggle in the data. Let’s get concrete for a minute. Imagine you’ve got a client who comes in with unresolved doubts during the early weeks—maybe around whether their suffering means they’ve done something wrong, or if their pain means God’s abandoned them. If those doubts aren’t addressed—for example, by week three or four—what happens is that their anxiety or depression often gets worse in the following weeks. This is huge for clinicians because it basically says: don’t brush off spiritual content, or think it’ll just resolve itself if you focus only on mood or thoughts.

David

By the way, this research is solid. It was published in Psychotherapy, a respected journal of the American Psychological Association. The researchers used cross-lagged panel models—don’t worry, I always have to remind myself what those are too—but basically, it’s for figuring out what causes what over time. Their results were the same across different backgrounds, clinical settings, and cultures. So, when spiritual distress lingers, it’s a reliable predictor that psychological symptoms like depression and anxiety won’t get better, or might even get worse, unless those spiritual pieces get some focused attention.

David

So how do we actually help clients when spiritual struggles are in the mix? What works in practice? One of the best starting points—honestly, I come back to this a lot—is simply asking: “How has your presenting problem affected you spiritually?” Or “In what ways has your faith, or spiritual background, made things easier or harder?” That opens the door. From there, you can invite folks to name barriers or resources, or even what meaning they pull from their struggles, using some of the questions recommended by Pargament and Exline. Like, “Can you tell me more about these struggles?” or “What kind of support or obstacles do you feel around these issues right now?”

David

But asking the right questions is just the start. Honestly, clinicians need to have a few key skills in their back pocket. First is genuineness—clients know if you’re faking interest or running on autopilot. Then there’s cultural humility, because spiritual struggles are so tied up in someone’s identity and what they hold sacred. Sometimes, collaborating with chaplains, clergy, or other spiritual care pros makes a big difference, especially when the struggles cut really deep, like after a loss, or during crises of faith.

David

Here’s my take, and I’ll stand by this—it’s not about imposing what you believe, or shaping clients to fit some mold. It’s about facilitating their own meaning-making process, and helping them heal in ways that make sense for them, in their own worldviews. I’ve watched this work. I’ve seen clients completely shift—sometimes moving from a place of pain and stuckness to actual growth when they’re given the space to wrestle with these big, sacred questions. Especially for people grappling with loss, doubt, or even just that sense of “I’m not enough” spiritually, this approach can transform outcomes.

David

So that’s a wrap for today. Spiritual struggles aren’t just “nice to explore if you get around to it.” They can drive real distress in therapy, but also open up transformative healing when addressed skillfully. Thanks for joining me, and stick around—we’ve got more coming on how spirituality and psychological science can work hand in hand for real, lasting growth. See you next time.