The field of psychotherapy has historically regarded religion with suspicion, viewing faith as a crutch for the weak and a security blanket for those too fearful to face reality. Freud’s famous declaration that religion is “the universal obsessional neurosis of humanity” rippled out across decades. Spirituality, many psychotherapists assumed, was more likely to be a source of disorders than of healing. 

But the past few decades have seen a sea change in this assumption. Empirical evidence shows that religious belief and spiritual practice, from prayer to meditation to community participation, have a positive impact on mental health. Given these findings, some therapists now turn to spirituality as an ally rather than a foe in helping clients find healing. Spiritually integrated psychotherapy, as it’s known, is a treatment approach that draws on spiritual resources to address relational and psychological problems. This approach is distinct from pastoral counseling and spiritual direction. The end goal is psychological, not spiritual, change. 

Those in favor of giving religion a seat on the therapist’s couch point out that religion and spirituality are vital aspects of most people’s lives in the United States. Seventy percent of US adults identify with a religion, according to the Pew Research Center. This number doesn’t include the growing group of those who count themselves as spiritual but not religious.

 Many turn to communities of faith in times of crisis and find religious rituals an important part of coping, healing, and finding closure. On the darker side of things, religion can wound and traumatize. Spiritual struggles are a real source of psychological distress, and these struggles may find healing through psychotherapy.

As clinical psychologist Shamaila Khan writes, “When people enter the therapy room, they don’t leave their religious and spiritual beliefs behind—they bring them along implicitly or explicitly. We as clinicians need to have an ear out for it when it emerges.”

So when do psychotherapists invoke the sacred in their approach—and does it work?

The emergence of spiritually integrated psychotherapy

The practice of integrating spirituality into psychotherapy is relatively new. Dr. P. Scott Richards, a psychologist and president of Bridges Institute, which provides research and training resources on spiritually integrated psychotherapy, literally wrote the book on it. “45 years ago nobody was talking about it,” he says. 

In the 1980s, research on spirituality and mental health began in earnest. It was around this time that data began to show the psychological benefits of religious and spiritual practice. “A lot of evidence came in that supported the idea that religious faith and spirituality—not religious dogmatism or extremism, but devout, mature, religious faith and spirituality—is predictive of better mental health and better physical health,” says Richards. This insight challenged what was then the prevailing, Freud-influenced viewpoint of religion as a harmful delusion. Psychologists began taking seriously the possibility that faith could be a source of healing for patients—a salve, rather than the source of psychosis.

By the early 2000s, a trickle of books had been published outlining different approaches to incorporating spirituality into treatment. These years also led to research on spiritual interventions. Thanks to recent studies, says Richards,

There’s also evidence that spiritually integrated treatment not only reduces psychological distress but also has positive effects on people’s spiritual well being—something that’s not true of purely secular therapies.

Dr. Lisa Miller is a clinical psychologist and the author of The Awakened Brain. She is the Founder and Director of Columbia University’s Spirituality Mind Body Institute, the first Ivy League graduate program and research institute in spirituality and psychology. Miller explains that psychology’s attempts to be open to all kinds of beliefs resulted in an overcorrection: “In the good attempts to be inclusive we threw religion out of the public square, but actually became radically exclusive. We threw the spiritual baby out with the bathwater, and we lost the ability to connect to one another at a deep spiritual level.”

Miller argues that the ability to connect spiritually with one another is essential, both in the therapy room and in the world at large. “In the past decade there has been a tidal wave of transformation of what clients are seeking in their therapists,” she says. “It is now very often the case that a client will ask a therapist, ‘Do you work from a spiritual perspective? Do you include spirituality in your work?’”

In practice, spiritually integrated treatment can look as diverse as the range of religious beliefs. Therapists who take spirituality into account might encourage their patients to practice compassion or self-forgiveness. Part of treatment might involve volunteering, or participating in a community service, or enacting certain rituals. Therapists might encourage clients to pray or meditate or reflect on the times they’ve felt closest to God or nature or a higher power. 

Our spiritual brains

Clients’ hunger for spiritually-integrated treatment has a biological basis. Whether or not we consider ourselves spiritual or participate in any form of organized religion, “our brain has a natural inclination toward and docking station for spiritual awareness,” Miller writes in The Awakened Brain. Tapping into this spiritual awareness—what she calls “awakening”—improves our well-being by enhancing optimism and resilience, while simultaneously insulating us against addiction and depression.

The view that a psychological ailment like depression is purely biological and therefore can’t have a spiritual component is an outdated view. “We now know that everything—body, mind, and spirit—has a biological correlate, and there’s a biological set of correlates to spirituality,” says Miller. “We now have a view that all human experience is vertically integrated: body, mind, and spirit. That’s not biological reductionism, that simply means there’s a neuro docking station for spiritual awareness.” Psychologists who attend to a patients’ spiritual beliefs operate from this holistic view, understanding that humans are spiritual beings as much as we are physical and psychological beings.

For Miller, spiritually integrated psychotherapy not only requires therapists to acknowledge the patient’s spirituality. It also requires therapists themselves to be on a spiritual path, understanding their own capacity for spiritual attunement and attending to the spiritual dimension of life. “It’s not just about listening to someone else’s so-called subjective reality,” she says. “It’s about joining in a foundationally shared spiritual reality, where the axiom for transformation is spiritual.” 

To that end, the Spirituality Mind Body Institute equips therapists to integrate spirituality outside of a faith tradition into treatment, prevention, and wellness work. Speaking about therapists, Miller adds, “We cannot just nod acceptingly; we need to be able to be in a state of deep spiritual understanding.”

Read part 2 of this story.