Integrating Spirituality Into Clinical Practice

By Karyn Maczka, MA, MFTI

Politics. Money. Religion. We are often discouraged to bring up these three topics in everyday conversation, as they are considered highly controversial issues in our society. Despite the fact that religion, faith, and/or spirituality are an important part of most Americans’ lives, religion has not always been viewed in a positive light within the field of psychology, and key figures in the field have expressed differing opinions about spirituality. Freud and Skinner, for example, questioned the value of religion or criticized it as harmful, while others like James and Jung held more positive, hopeful views. In recent decades, more contemporary psychologists have valued the role of religion in people’s lives, and the interest in the relationship between spirituality and psychotherapy has grown rapidly in the last 20 years. This shift is consistent with current research, which indicates a positive association between religious practice and mental health, recovery from mental and physical illness, subjective well being, and marital satisfaction.

Moreover, psychology professionals have begun to consider the ability to work with client’s religious and spiritual beliefs a form of cultural competency. Not only is it important to learn about client’s ethnicity, language, race, age, sexuality, and past history, it is equally valuable to understand an individual’s relationship with religion and how she/he experiences spirituality. Unfortunately, studies show a trend indicating that many clinicians are not comfortable exploring such areas while conducting therapy, since therapists receive no or minimal training, supervision, and coursework that present spirituality as an important element in therapy. Spirituality can manifest in people’s lives, and hence in the therapy room, in a variety of ways. Many people who seek help for physical, emotional/psychological, or interpersonal problems are also experiencing spiritual distress. In some cases, devastating events can bring one’s faith into question and even alienate some from their faith. In yet other instances, religious values can become too rigid, resulting in a punitive, harmful experience by the believer. However, spirituality can also be a source of incredible healing power form which individuals draw strength, inspiration, and meaning. As others in the field have suggested, most people across faiths consider their spiritual beliefs to bring them closer to loved ones, solve problems, respect themselves and others, refrain from doing undesirable things, help others in need, and find healing. Spirituality offers options for solutions to clients’ struggles. It also facilitates finding meaning in the human experience, as well as offers answers to often difficult conundrums. In addition, studies have asserted that spirituality provides motivation to remain committed to love in the face of a partner’s flaws; it gives purpose and significance to the passing of a loved one; and that spirituality offers a consistent morality that can serve as a stabilizing guide to those facing difficult circumstances.

Spiritual expression can be seen in many different forms, through religious as well as secular practices. Personal faith may involve belief in a higher power, a divine spirit dwelling in all things living, or an ultimate human connection for which we strive. While religious spirituality may involve attending a church/temple/sanctuary, praying, ceremonial milestones, rituals, etc., atheist/agnostic practices often include meditation, creative arts, chanting, a connection with nature, social activism, and interpersonal bonds.

While incorporating spirituality into clinical practice can enhance therapy, there are some precautions of which therapists who wish to do so must be aware, such as exploring our own spirituality and creating an open and safe space for spiritual discussions. Also, it is important to refer clients when appropriate, and to be careful about imposing one’s own beliefs and values or simply ignoring the client’s beliefs. In addition to respecting every client’s particular ethnic, cultural, and religious practices, we as therapists can expand our own knowledge by seeking training and doing further research. These steps will be key in assuring an adequate level of competence. It is critical not to make assumptions about clients’ spirituality, religious identification, upbringing, or community affiliation. Instead, we ought to strive to understand the individual experience of a client’s spirituality. In doing so, studies have suggested some guidelines: to respectfully inquire about the meaning of spiritual practices in clients’ lives, particularly as they relate to the presenting problem(s); explore religious/spiritual beliefs that may contribute to an individual’s suffering; facilitate understanding and mutual respect among families and couples facing spiritual conflicts; and identify different resources to increase resilience and facilitate healing.

Research demonstrates that secular, as well as religious counselors are integrating a spiritual element into therapy. The approaches can range form implicit to explicit integration. Implicit integration may occur when a counselor’s views and interventions are influenced by her own spiritual beliefs, yet they are not discussed with the client. A clinician may also engage in prayer and/or meditation prior to sessions. During explicit integration, on the other hand, the clinician may openly address a client’s spiritual beliefs, discuss spirituality as an element in the therapeutic process, or use overt spiritual tools such as prayer and meditation with her client.

Given the new trends, social changes, and increasing openness of both clients and therapists to integrate religious/spirituality elements into the therapeutic process, the field of mental health must continue to adapt and incorporate spiritual elements into both therapeutic interventions, as well as clinical training programs. While many clinicians recognize the need to delve into issues of spirituality and religion as part of clients’ presenting circumstances, we don’t always know how to do so in a way that is supportive and nonjudgmental. In light of widespread racism, faith intolerance, and mass discrimination inside and outside our country, it is imperative that we as clinicians equip ourselves with the tools and skills to engage in courageous conversations about such issues that affect all of us. Mental health professionals face an ongoing responsibility to make clinically appropriate decisions that serve our clients and enhance the therapeutic process. However, clinicians may struggle to balance our clinical judgment with newly emerging ethical, social, and moral responsibilities that arise as society continues to become segmented by ideological differences.

Integrating Spirituality Into Clinical Practice

Karyn Maczka, MA, MFTI.
Registered Marriage and Family Therapist Intern #81717 Ph: (858) 761-7121


Path to success may have ten thousand steps

We live in a world where you can google and get an answer to almost every question you have. Life has become a lot easier at some levels and we have become a global community with an exchange of ideas and thoughts from all reaches of the world. There is an answer waiting for every question. One question that many people have is what is standing between them and their success in life. By success, people are often referring to tangible economic success, the kind of success Bill Gates, Oprah Winfrey, J. K. Rowling  and others in that league have attained. There is a book that made it all look simpler; The Secret provided answers that appealed to the masses. There were a lot of inspiring quotes from people who have reached a level of success in their respective worlds. The law of attraction, made popular by this book, fed the same belief proposed by many self-help books; positive thinking propels us to positive outcomes in our lives. That it all resides in our thoughts and patterns of thinking leaves the rest of us believing that the ordinary successes are a result of ordinary thoughts.

Shedding light on the real secrets to success are two books, Outliers by Malcolm Gladwell and Better by Atul Gawande. These authors acknowledge the role of intelligence and ambition (nature) and opportunities (nurture) on the road to success. The 10,000 hour rule outlined by Gladwell helps us understand the many traits that successful people have in common. He provides several examples of all the work that goes into the ultimate success of most outstanding athletes, entertainers and entrepreneurs. It brings to mind the humorous line “the harder I work, the luckier I get”.

Gawande, a physician observing our health care climate, brings home more simple truths about success and failure. He attributes success to diligence, doing the right thing and ingenuity in the way we approach work. In his attempt to improve the world of medicine, he found that examining the failures is just as helpful as seeking out answers to what contributes to success. He brings home the point that we generally look for easy fixes: the one simple change that will improve every thing. It is not uncommon for people to use antidepressant as the easy fix when sad or depressed, which is a lot easier than looking into circumstances that caused the sadness, or working hard to change their outlook or find tools to cope with the circumstances. People struggling with weight issues are seduced into using appetite suppressants rather than making healthier choices every step of the way. In fact, walking ten thousand steps a day, as recommended by conventional wisdom has more benefits to the mind and body than simple weight loss. Maybe more simply, success involves thousands of hours, hundreds of little steps, and retracing steps when lost to reach the ultimate goals.

The secret to success is not really a big secret. There are things we can control and things we have little control over. Realistic assessment of our abilities, work ethic, diligence, focus, desire are within our control for the most part. The factors that are not within our control are often determined by social, economic, cultural and political forces and have more to do with the opportunities presented to us and the choices we can make in our lives. In Outliers, Gladwell even attributes success in some sports to the time of the year the athletes were born. The naive assumption that we are entirely responsible for our successes or failures is based in the widely held individualistic value system and it leads us to seek simple answers to complex problems.

The truths that our grandparents knew or that our faiths drilled into us are often not as palatable or accessible to us as what is available on the world wide web. It is this confusingly ever present web that traps us while it provides a lot of access to the world.