Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas, Ethical Issues, and a Proposed Decision-Making Process

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems.