Could a spiritually integrated approach enhance traditional psychotherapy? More to the point, does spiritually integrated treatment actually work?
Recently, Dr. P. Scott Richards, a psychologist and president of Bridges Institute, led a global study to understand the efficacy of different spiritually integrated treatments. Conducted by 20 teams of researchers, the study spanned 8 countries and collected data from over 400 therapists and 40,000 therapy sessions. The therapists represented diverse religious traditions as well as theoretical orientations. It was the biggest and most diverse study conducted on spiritual integrated treatment to date.
Many therapists reported that they began treatment with a spiritual assessment, in which they asked clients about their spiritual and religious beliefs. “How important is religion or spirituality to you?” they would ask. “Do you want to talk about it in treatment?” If clients answered yes, therapists would learn more about specific beliefs. The therapists’ goal, Richards says, was to understand clients’ belief systems so that therapists could work within the clients’ framework rather than imposing their own.
The study revealed that certain interventions were far more common than others. One intervention used in over a third of the sessions was to “affirm clients’ divine worth.” Therapists also frequently reported that they “encouraged clients to accept God’s love.” In over thirty percent of sessions, therapists encouraged clients to listen to their heart for spiritual impressions. “The heart is a metaphor for spiritual impressions and feelings,” says Richards. “It’s pretty universal, if you talk to people from a lot of different religions about listening to their heart, they resonate [with] that idea.” Other frequently-used interventions included encouraging clients to pray and discussing self-forgiveness. (On the flip side, encouraging clients in confession or repentance was a rarely-used intervention, which Richards attributes to it being a tricky intervention to get right.)
One exciting result of the study had to do with the efficacy of spiritual interventions.
Clinicians who practiced three basic skills—conducting a spiritual assessment, listening to the client's spiritual issues, and discussing spiritual dimensions of problems and solutions—saw reductions in both the client’s psychological and spiritual distress.
The study also revealed the benefits of affirming clients’ divine worth and encouraging them in their efforts to trust God. “These [interventions] were marked predictors of better treatment outcomes,” Richards says.
Girding Gen Z against suffering
Clinical psychologist Dr. Lisa Miller and her team at the Spirituality Mind Body Institute at Columbia University have developed a different sort of intervention: discussion-based wellness groups offered on college campuses. The Awakened Awareness groups are designed to address the mental health crisis experienced by young adults through supporting college students’ spiritual formation.
“Half of Gen Z in the country struggles with despair,” says Miller. “The rate of death by suicide rivals the rate of death by auto accident. Every single student on campus knows at least two people who attempted suicide.” But the groups don’t exist to educate students about the depression and anxiety that run rampant through their generation—they’re already well aware. Instead, the groups work to foster resilience and a spiritual foundation that the students can build on for the rest of their lives. As Miller says, “We’re girding them against suffering.”
Awakened Awareness groups focus on wellbeing, rather than treatment. The goal is to foster discussion and grow spiritual perception among participants. “We find that by putting an open group with an open door on campus, we can get upstream of treatment and address things at the level of prevention, wellness, and even formation,” Miller says. “We can catch students before they fall.”
During the program, trained leaders guide students through the science of their spiritually-attuned brains.
“It is simply a fact that there's a surge of spiritual awakening in the college years,”
says Miller. “We give students the science that says, ‘You’re a naturally spiritual being. You are in a phase of exquisite sensitivity and high impact. The work you do now will set you up for life.’” Group leaders encourage students to tune into their spiritual perception, knowing that a rich spiritual life can enhance wellbeing and act as a bulwark against anxiety, depression, and addiction.
After learning about the science behind their spiritually-inclined brains, students participate in different visualization exercises. One such visualization, called The Road of Life, encourages students to identify how they’ve been in dialogue with a higher power throughout their whole life. The third program component is discussion. The most robust protective factor against completed suicide, says Miller, is when spiritual life is strong and shared. Awakened Awareness provides a safe and pluralistic context where every student is invited to speak from their own spiritual context or religious tradition.
“Every college student in the United States is on a spiritual quest [that can] unfold into the most important formation of what is true and real, and that’s the compass bearings for the rest of their life,” Miller says. “But only if we show up.”
An intuitive and developing approach
Despite encouraging research findings and increased adoption of spiritually integrated treatment, most psychotherapists receive little if any training in how to address spiritual issues. This gap is one that the Spiritual Mind Body Institute and certain certifications like this one are beginning to address—but more training opportunities in spiritual and religious competency are needed. Training will also need to address a factor that makes spiritually integrated treatment difficult: the sheer diversity of spiritual and religious beliefs in the United States, from Western theistic religions to Eastern religions to the religious “nones.”
For therapists to engage this kind of religious pluralism effectively, says Miller, “it is necessary to cultivate what I call spiritual multilingualism. It’s not about theological debate; it’s an opportunity to deeply know you, in the first person, in your own language, whether that’s religious or spiritual, whatever faith tradition—Hindu, Jewish, Muslim, or Christian.”
For now, a therapeutic approach to integrating spirituality in treatment remains “pretty intuitive,” says Richards. “It’s based on [therapists’] clinical judgment and their sensitivity to the client’s beliefs and needs.” He’s quick to point out that spiritually integrated treatment is not something a therapist should impose on a client. Rather, it should emerge from dialogue and an understanding of what the client feels like would be most helpful to them. “It’s not done in a cookbook kind of way, or a rigid kind of way,” he says.
Despite a still-emerging field and limited training to guide them, psychologists continue to swim deeper into spiritual waters within the therapy room. Gradually and intuitively, they are integrating patients’ spirituality—their relationship to whatever it is they hold sacred—into the course of healing.