How Therapists Often Fail Religious Clients

Article from "Frontiers in Mental Health" Issue 2

By Neil J. Kressel, PhD

The following article appears in the second issue of “Frontiers in Mental Health,” journal of the Open Therapy Institute. Read the full issue here.

Statistically speaking, the typical client who walks into a therapist’s office is likely to encounter a practitioner who assigns far less importance to religion than does the client. One survey found, for example, that only about one-quarter of cognitive and behavioral therapists professed a certain belief in God. Just under half of the clinician sample deemed themselves nonbelievers (Rosmarin et al., 2013). Another study found that 50% of academic psychologists considered themselves atheists, and an additional 11% were agnostic. In this survey, psychology professors emerged as the least religious of all academics studied.

Background

The United States public overwhelmingly values religion and believes in God. Only about 4% say they are atheists, and—although the past decade may have witnessed some slight declines in religiosity—for quite a while, about nine out of ten American adults reported a belief in God. Seventy-seven percent identify with some religious faith. In the United States, 76% report praying at least sometimes, and 55% pray daily. While Western Europeans are somewhat less religious than Americans, many from other parts of the world tend to view religion as even more central to their lives.

People in need of psychological assistance may stay home if they feel that they will be openly or secretly denigrated because of their religious beliefs. The therapist-client gap in religiosity does not necessarily lead to insensitivity, but clinicians and patients report various difficulties that can impede therapeutic progress, even when everyone is well-intentioned.

Pastoral counseling can, of course, meet the needs of religiously observant clients who seek therapy within the context of a particular religious tradition. But plenty of people who do not choose this path still want—and would benefit from—a therapist with religious literacy and knowledge about faith-based issues.

How Current Practices Impact Clients

Though therapists exist at all levels of religiosity and a growing number nowadays think of themselves as “spiritual but not religious,” many are uncomfortable discussing religious matters in therapy, and some—when they do consider organized religion—view it mainly as a source of dysfunction. This is partly a legacy from Freud, Ellis, and other founders of clinical psychology. In 1993, the prominent Yale clinician Seymour B. Sarason commented with some concern that, if a psychologist learned that a colleague was “... devoutly religious, or even ... [tended] in that direction,” most of the time they would “... look upon that person with puzzlement, often concluding that [the] psychologist [in question] had or has personal problems” (Sarason, 1993). However, the reluctance to deal with religious matters also stems from a reasonable unwillingness to cross the line between therapy and proselytization for one’s own religious or nonreligious views, whatever they may be.

Another issue concerns the inadequacy of clinical training in teaching practitioners to handle religious issues in therapy (Vieten et al., 2016). In one study, about a fifth of therapists admitted to never discussing religious matters at all in therapy (Rosmarin et al., 2013). Several studies document psychologists’ belief that religion and spirituality have not been adequately addressed in their clinical education, despite the imperative to incorporate such issues as part of the diversity agenda (Jafari, 2016).

Sometimes, religious knowledge is needed to address specific client conditions. Research suggests, for example, that schizophrenia is no more likely among the religious. However, religiosity may influence how the condition expresses itself, for instance, in the content of particular delusions and hallucinations. Similarly, therapists might need some background in religion to distinguish culturally sanctioned religious behavior from pathology (Loewenthal, 2007).

What Should Be Done?

Mainstream therapy should not become faith-based, but several recent works have argued that neglect of religious issues can negatively impact the therapeutic process and client outcomes (Pargament et al., 2013). For starters, if a therapist seems uncomfortable or unreceptive to discussion of religious matters, a client may not share problems and potential solutions steeped in religion because they fear a negative response. Thus, a central part of the client’s life and significant resources for improvement would be inaccessible to the therapist.

Thousands of studies conducted over the past three decades have explored the relationship between religion and health, encompassing both physical and mental aspects (Kressel, 2024). By now, it is clear that religious beliefs and practices are often intertwined—for better or worse—with psychological well-being. Most meta-analyses of this literature have concluded that, on balance, religious belief and affiliation are net positives. For example, the religiously affiliated seem to receive benefits in maintaining longevity, managing mental health, coping with severe illness, avoiding substance abuse, and staying on the right side of the law. Needless to say, there is plenty of room for debate about why these correlations occur and their generalizability.

Proponents of a greater integration of religion into therapy argue that the world’s religious traditions, both Eastern and Western, can, at least sometimes, be a source of insight and mental health. They suggest that religion can provide a positive outlook, hope for the future, a sense of control, a pathway to meaning, constructive role models, and an ability to integrate loss (Rosmarin & Koenig, 2020). No reasonable person would claim that religion always provides these benefits, and it is not hard to see how religion could be a destructive force for some clients. Regardless, the religious aspect of clients’ lives must very often be examined in therapy by therapists who are at least willing to bracket their own preconceptions about faith.

Most psychologists would benefit from greater cultural competency in religious matters and from a fairer, more open-minded and more research-based attitude toward the role that religion plays in clients’ lives. Recently, some psychologists have argued in favor of formalizing religious and spiritual competencies for psychologists. Vieten and her colleagues (Vieten & Lukoff, 2022) developed sixteen religious and spiritual competencies and evaluated their acceptability to a sample of practitioners. Applying these competencies to practice, a therapist needs to:

• show “empathy, respect, and appreciation” for clients from diverse spiritual, religious or secular backgrounds;

• understand how one’s own religious or nonreligious outlook might influence one’s clinical approach;

• develop awareness of various kinds of experiences clients might have with religion;

• acquire familiarity with scientific studies and the psychology of religion;

• help clients explore spiritual and religious resources that might aid in managing life concerns;

• ask about spiritual and religious matters when they take a client history; and

• consult with, or refer to, more qualified individuals when needed.

The boundary between religious belief and health care may be growing more porous. Several scholars, for example, have proposed various models for integrating spiritual and religious matters more effectively into cognitive-behavioral and rational-emotive therapy (Tan, 2013). Future research and debate should address whether and how these projects should proceed.

Conclusion

Even if one accepts that religion can be a constructive force, there are reasonable arguments for keeping aspects of religion out of therapy. More generally, clinicians should reassess and better articulate just how porous the wall between religion and therapy should be—and there is no reason to insist on one solution or to require that one size fits all. Still, most psychologists would benefit from a better understanding of the centrality of religious belief and practice in the lives of many who seek their assistance.

References

Jafari, S. (2016). Religion and spirituality within counselling/clinical psychology training programmes: A systematic review. British Journal of Guidance & Counselling, 44(3), 257–267. https://doi.org/10.1080/03069885.2016.1153038

Kressel, N. J. (2024). The psychology of religion: A social force. Cambridge University Press.

Loewenthal, K. (2007). Religion, culture and mental health. Cambridge University Press.

Pargament, K. I., Mahoney, A., Shafranske, E. P., Exline, J. J., & Jones, J. W. (2013). From research to practice: Toward an applied psychology of religion and spirituality. In K. I. Pargament, A. Mahoney, & E. P. Shafranske (Eds.), APA handbook of psychology, religion, and spirituality: Volume 2 An applied psychology of religion and spirituality (pp. 3–22). American Psychological Association. https://doi.org/10.1037/14046-001

Rosmarin, D. H., Green, D., Pirutinsky, S., & McKay, D. (2013). Attitudes toward spirituality/religion among members of the Association for Behavioral and Cognitive Therapies. Professional Psychology: Research and Practice, 44(6), 424–433. https://doi.org/10.1037/a0035218

Rosmarin, D. H., & Koenig, H. G. (Eds.) (2020). Handbook of spirituality, religion, and mental health (2^nd ed.). Academic Press.

Sarason, S.B. (1993). American psychology, and the needs for transcendence and community. American Journal of Community Psychology, 21(2), 185–202. https://doi.org/10.1007/BF00941621

Tan, S.-Y. (2013). Addressing religion and spirituality from a cognitive-behavioral perspective. In K. I. Pargament, A. Mahoney, & E. P. Shafranske (Eds.), APA handbook of psychology, religion, and spirituality: Volume 2 An applied psychology of religion and spirituality (pp. 169–188). American Psychological Association.

Vieten, C., & Lukoff, D. (2022). Spiritual and religious competencies in psychology. American Psychologist, 77(1), 26. https://doi.org/10.1037/amp0000821

Vieten, C., Scammell, S., Pierce, A., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2016). Competencies for psychologists in the domains of religion and spirituality. Spirituality in Clinical Practice, 3(2), 92–114. https://doi.org/10.1037/scp0000078

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