The Rise of Spiritually Integrated Psychotherapies

David

Welcome to the show! I'm David, and I want you to picture a therapist's office for most of the 20th century: a client says prayer matters, faith matters, God matters -- and the room gets awkward.

David

That's the reversal at the heart of this story. For decades, mainstream health care often ignored spirituality in healing, sometimes treated it with suspicion, and sometimes just quietly pushed it to the edge of the room. But over the last few decades, that posture has changed DRAMATICALLY. We now have hundreds of studies showing that religious involvement and personal spirituality can be therapeutic resources for healthy living, treatment, and recovery. A 2015 article in the APA journal, Spirituality in Clinical Practice, “Bringing Spiritually Integrated Psychotherapies into the Healthcare Mainstream,” by Scott Richards and colleagues puts it bluntly: religion can no longer be dismissed simply as a neurosis to be cured or ignored. That's a massive sentence. Massive.

David

And if you're hearing a little Freud in the background there -- yeah, that's part of the history. The older climate in psychology carried longstanding historical and philosophical biases against religion and spirituality. Authors like Allen Bergin in 1980, and later Griffin, Jones, Slife, Williams, Miller, Richards, and others, challenged those assumptions directly. What changed wasn't just that people became nicer about religion. The deeper shift was that the field had to confront its own hidden assumptions about what counts as real, relevant, or respectable in mental health.

David

I mean, think about what that means clinically. If a person's deepest sources of hope, guilt, forgiveness, community, meaning, or moral struggle are spiritual -- and the therapist acts like that whole layer is embarrassing, private, or somehow unscientific -- then treatment is already missing part of the person. Not always all of it, but often a very consequential part.

David

By the mid-2000s, the conversation had become much more nuanced. Major books appeared: Shafranske's "Religion and the Clinical Practice of Psychology" in 1996, Richards' and Bergin's "A Spiritual Strategy for Counseling and Psychotherapy" in 1997 and their "Handbook of Psychotherapy and Religious Diversity" in 2000, Sperry and Shafranske's "Spiritually Oriented Psychotherapy" in 2005, and Pargament's "Spiritually Integrated Psychotherapy" in 2007. And this wasn't one narrow school. Spiritual approaches were being integrated with Jungian, transpersonal, psychodynamic, cognitive-behavioral, rational-emotive-behavior, interpersonal, humanistic, and multicultural approaches. That's not fringe language anymore. That's the language of a field saying, okay, maybe this belongs in the actual toolkit.

David

As a clinician, this matters to me at a very human level. I've seen how different a session feels when a therapist doesn't flinch. When a client says, “My faith is what kept me alive,” or, “I'm angry at God,” or, “My community is carrying me right now,” and the clinician can engage that respectfully rather than stepping around it... something opens. The alliance gets stronger. The work gets more collaborative. Sometimes it gets more effective not because spirituality is a magic trick -- it isn't -- but because the therapy is finally honest about where the person's real sources of struggle and strength actually are.

David

And that's the key for me. This shift is not about forcing belief into therapy. It's about ending a longstanding neglect. It's about making room for clients whose healing is inseparable from faith, sacred practice, or spiritual community. If mainstream care can learn to do that without embarrassment, that's not a side issue. That's respect. That's cultural competence. And for a lot of people, that's the difference between feeling merely treated and genuinely understood.

David

Now, this change didn't happen just because attitudes softened. It changed because concrete professional gains stacked up. One of the biggest is ethical language. Richards and colleagues note in their article that health care professionals are now recognized as having an ethical obligation to develop competency in religious and spiritual aspects of diversity and treatment. They cite the American Psychological Association's 2002 ethics code and the American Psychiatric Association's 2013 ethics guidance. That's a big deal because once something enters the ethics conversation, it's no longer optional small talk. It becomes part of competent care.

David

Second, many practitioners are already doing this. Surveys cited in the article suggest sizable percentages -- anywhere from 30 to 90 percent, depending on the group surveyed -- use spiritual approaches or interventions in practice. That's a huge range, sure, but even the LOW end tells you this is not some rare boutique activity. And most of those clinicians aren't abandoning mainstream psychotherapy. They're tailoring treatment. They're integrating spiritual approaches with secular methods rather than replacing one with the other.

David

Third, there are outcome reviews. Eight reviews across about 25 years looked at spirituality and psychotherapy. Across those reviews, spiritually oriented treatments tended to be effective overall, with effect sizes ranging from .27 to .75 depending on which studies were included. And the reviewers consistently found support for Christian and Muslim forms of cognitive -- and rational-emotive -- psychotherapy for depression and anxiety. That's not proof that everything spiritual works. But it is meaningful support.

David

And here's where I wanna be careful, because health care lives and dies on distinctions. “Promising” is not the same thing as “fully mainstream.” Richards and his colleagues are crystal clear that the evidence base is still uneven. Many studies had methodological weaknesses: no random assignment, poor control of therapist effects, small samples, no treatment manual, no fidelity checks, nonstandardized outcome measures. And then the really glaring weakness: the VAST majority of spiritual approaches described in the literature have never been empirically evaluated at all.

David

So yes, celebrate the progress. Absolutely. But don't oversell it. In medicine and mental health, if we blur the line between encouraging evidence and settled evidence, we confuse clinicians and we shortchange clients. The honest position is stronger: some spiritually adapted therapies have meaningful support, many clinicians already use them, ethics now recognizes this domain, and the broader movement is real. Bridges Institute is one example among several -- formed in 2012 as a practice-research network to help researchers, practitioners, educators, and pastoral professionals collaborate. Useful work, important work. But the larger story is a field-wide change in the clinical conversation.

David

And I love that change because it gives us a more realistic sentence: spirituality is neither automatically pathology nor automatically cure. It is, very often, clinically relevant human material. That's a much better place to begin.

David

Once you see the gains, the next question is obvious: what does this progress make possible? For me, the answer starts with training. Because this is where the gap gets painfully concrete. Only about 10 to 25 percent of graduate mental health training programs systematically address religious and spiritual aspects of diversity and treatment competence. Ten to twenty-five percent! So even if many professionals believe spirituality matters, a lot of them were never really taught what to do with it.

David

That gap matters ethically and practically. If clinicians are not trained, they may avoid the topic, overstep, stereotype, or freeze when spiritually loaded issues show up -- grief, forgiveness, scrupulosity, religious trauma, vocation, shame, community belonging, conflict with clergy, all of it. And continuing education opportunities are still relatively scarce too. So you get this odd situation where the profession's beliefs have moved faster than its preparation. People think it's important, but they don't feel competent. That's not a small administrative problem. That's a treatment problem.

David

Better training would mean better ethical competence, yes, but also more culturally responsive care. It would help clinicians learn how to assess spiritual concerns, understand when clients want spiritually integrated treatment, and recognize when referral or collaboration makes sense. Richards and colleagues make a strong point here: pastoral professionals -- clergy, chaplains, pastoral counselors -- are often front-line mental health workers. Many people first bring psychological and relationship distress to them, not to a psychologist. So stronger partnerships between clinicians and pastoral professionals aren't just nice networking. They're part of how real communities actually seek help.

David

Richards and his colleagues also argue for collaboration between researchers, practitioners, educators, and pastoral professionals, and I think that's exactly right. Researchers strengthen credibility. Practitioners keep the work clinically grounded. Educators shape the next generation. Pastoral professionals keep us connected to how people actually live their faith. When those groups stay siloed, progress slows. When they work together, the field gets smarter and clients get more options.

David

There are barriers, of course: accrediting bodies often still don't require this training, some parts of the multicultural field have resisted including spirituality, and many educators were never trained in it themselves. But none of that sounds permanent to me. It sounds like a profession in transition. This transition is gaining momentum thanks to Joseph Currier at the University of South Alabama and his colleagues, who recently completed a major initiative funded by the John Templeton Foundation dedicated to enhancing training in spiritual competencies for mental health professionals.

David

And here's the larger opportunity I can't stop thinking about: if this momentum continues, spiritually integrated psychotherapy doesn't have to remain a niche option whispered about in specialized circles. It could become a standard option -- not for everyone, not imposed on anyone, but readily available for clients who want treatment that honors both science and faith. That's the future worth building toward. A health care system mature enough to say, without defensiveness and without hype, that evidence matters, ethics matter, culture matters... and for millions of people, the sacred matters too. Thanks for listening.