LIBERTY UNIVERSITY JOHN W. RAWLINGS SCHOOL OF DIVINITY
Does Religion Belong in Psychotherapy?
A Paper Submitted to
the Faculty of the School of Divinity
in Candidacy for the Degree of
Doctor of Education in Christian Leadership (Ed. D) Department of Christian Leadership and
Church Ministries
By
Mary Gracias
Lynchburg, Virginia
10/2022
Does Religion Belong in Psychotherapy?
This question is posed by a lot of mental health practitioners. Here’s the short answer: If
religion is important to our clients, religion will be part of psychotherapy whether we discuss it
or not.
A religious identity and worldview are integral aspects of how religious clients think about,
experience, respond to, and take action upon their world. This means there is a good chance
their religious faith is a lens through which they view their experience of mental health
problems and recovery. If we don’t discuss our clients’ religious beliefs and worldview, we may
be missing vital information and a significant way of improving their psychological well-being.
Did you know research says the majority of clients want their therapists to discuss their
religious beliefs and practices with them? In several studies, between 53% and 77% of clients
reported wanting to have a discussion about religious or spiritual issues (Baetz et al., 2004;
Rose et al., 2001), and 72% preferred to see a practitioner who respected and integrated their
religious beliefs into therapy (AACP, 2000). In fact, the more religious a client is, the more likely
she or he will want religion to play a role in therapy (Morrow, Worthington, & McCullough,
1993). Other research shows that some clients think therapists who integrate religion and
spirituality into treatment are more competent than those who do not (McCullough &
Worthington, 1995).
The Challenge in Clinical Practice
The challenge is that although the majority of therapists believe religion can be helpful to
their clients (Delaney, Miller, & Bisono, 2007), many do not feel comfortable engaging in these
issues because of their lack of familiarity with religion (Hathaway, Scott, & Garver, 2004). This is
in part because a majority of doctoral programs and pre-doctoral internships do not provide
clinical training in religious and spiritual issues (Vogel et al., 2013). It also does not help that
psychologists and psychiatrists are traditionally less religious than the population they serve
(Baetz et al., 2004; Delaney, Miller, & Bisono, 2007; Rosmarin et al., 2013). Not surprisingly,
therapists with lower levels of personal religious or spiritual involvement are less comfortable
assessing and addressing these issues in treatment and have less favorable attitudes toward
religion (Rosmarin et al., 2013).
This means that a potentially healing resource for our clients often goes unnoticed and
untapped. So, the question may not really be “Does religion belong?,” but rather, “How can we
help our religious clients engage with and use their faith as a healing resource in
psychotherapy?”
How to Address this Practice Challenge
To answer this question, we first need to know the benefits of addressing our clients’ faith
in psychotherapy. Then, we need an organizing therapeutic approach, a set of practical tools to
enable us to effectively integrate religion into treatment, and training to enable clinicians to use
the approach. Indeed, with training in this area, therapists report feeling more comfortable and
having more favorable attitudes toward religion (Rosmarin et al., 2013). Religiously-integrated
CBT (RCBT) is one therapeutic approach with practical tools shown to be effective not only in
reducing depression, but also in improving positive outcomes (e.g., gratitude, altruism, purpose
in life) among religious clients (Koenig et al., 2015; Koenig et al., 2014). The specifics of RCBT
are discussed in greater detail later in this article.
This is Therapy, Why Do I Need to Know about Religion?
Therapists need to know about religion for a number of reasons. First, America is a religious
nation. National polls reveal that 93% of Americans believe in God or a higher power and 77%
consider themselves to be religious (Kosmin & Keysar, 2009). Thus, the chances are excellent
that therapists will treat, and have already treated, religious clients who are dealing with
mental health issues.
Second, a large body of scientific work conducted by researchers worldwide has revealed a
relation between religion and mental health. Take depression for example. In general, the more
religious individuals are, the less likely they are to be depressed; and, if they do become
depressed, they tend to recover more quickly (Bonelli et al., 2012). This finding may be because
religion can help people cope with stress, buffer the effects of challenging life events, provide
social support, and offer a framework for meaning and purpose, particularly for circumstances
that seem senseless and beyond our control (Koenig et al., 2012).
Of course, religious individuals are not exempt from depression and other mental health
problems. Religious individuals can also experience spiritual struggles, including problems in
their relationship with God and with members of their religious community, all of which can
worsen psychiatric symptoms (Pirutinsky et al., 2011).
Third, we need to know about religion because our ethical practice codes mandate it. The
American Psychological Association’s ethical code states that religion is a domain of diversity
that requires clinical competence (APA, 2002). These guidelines suggest that respecting clients’
religion requires more than just being aware that they are religious. We need to be intentional
about knowing how our clients’ religion impacts how they view their world and function in it, as
well as how it impacts their experience of and recovery from mental illness. Just like with other
domains of diversity, we need ongoing training to achieve competency in this area.
Does Talking about Religious Beliefs and Practices in Therapy Actually Help Alleviate
Mental Health Problems?
Over the last two decades, over 50 studies have been conducted to test the effectiveness
of therapies that integrate clients’ religious and spiritual beliefs. In these studies, various forms
of psychotherapy were modified to include religious and spiritual themes, discussions, imagery,
sacred texts and, in some cases, prayer. Although the studies vary in their design and rigor,
overall, the results suggest that talking about clients’ religious beliefs and practices during
treatment helps to reduce symptoms of emotional distress. The majority of empirical studies
have demonstrated that spiritually-integrated therapies are at least as effective, if not more
effective, in reducing depression and anxiety than is traditional, non-religious therapy for
religious clients (Anderson et al., 2015; Azhar & Varma, 1995; Azhar, Varma, & Dharap, 1994;
Berry, 2002; Hodge, 2006; Hook et al., 2010; Koenig et al., 2015; McCullough, 1999; Pargament,
1997; Pecheur & Edwards, 1984; Propst, 1980; Propst, Ostrom, Watkins, Dean, & Mashburn,
1992; Razali, Hasanah, Aminah, & Subramaniam, 1998; Smith et al., 2007; Tan & Johnson, 2005;
Wade, Worthingon, & Vogel, 2007; Worthington & Sandage, 2001; Worthington et al., 2011).
Our research team, led by Drs. Koenig and King, conducted a multi-site randomized
controlled trial of religiously-integrated CBT (adapted for Christianity, Judaism, Islam,
Buddhism, and Hinduism) versus conventional CBT for the treatment of depression among
medically ill individuals (Koenig, Pearce et al., 2015). We found that religiously-integrated CBT
was as effective as conventional CBT in reducing symptoms of depression immediately after
treatment (12 weeks) and also three months later, and that it was more effective among those
who were more religious.
Religiously-Integrated CBT: A Therapeutic Approach for Treating Depression in Religious
Clients
CBT is the most empirically studied and validated treatment for depression (Chambless &
Ollendick, 2001). The CBT model rests on the premise that symptoms of depression reflect
deficits in cognitive and behavioral skills and functioning. As clients learn skills for changing
their unhelpful thinking patterns and behaviors, they can experience a lessening of depressive
symptoms.
Religiously-integrated CBT (RCBT) is based on the same principles as is conventional CBT.
Both are structured and directive, emphasize a collaborative partnership between the therapist
and client, set specific session agendas and treatment goals, use Socratic questioning, identify,
challenge, and seek to change unhelpful beliefs, modify behavior patterns, and solicit client
feedback (Tan, 2007).
RCBT is unique because it intentionally and explicitly uses clients’ religious worldview,
beliefs, practices, values, and resources as the foundation for the application of CBT. In other
words, therapists help clients to harness their religious resources and worldview to challenge
and change dysfunctional beliefs and behaviors in order to reduce depressive symptoms
(Pearce et al., 2014).
RCBT promotes positive attitudes and behaviors, such as gratitude, generosity, forgiveness,
acceptance, hope, and altruism. The goal is to create an optimistic, purpose-driven, and
meaningful outlook that is consistent with the client’s religious worldview and incongruent with
depression.
Specific components of RCBT include the following:
Challenging and changing thoughts using religious teachings
Contemplative prayer
Scripture memorization to renew the mind
Engaging in religious practices (e.g., gratitude, altruism, forgiveness)
Involvement in a religious community
Acknowledging and addressing spiritual struggles
Examples on how to employ RCBT can be found in the upcoming book publication as well
as these manuals.
Summary
Integrating religion into psychotherapy is more than inquiring about our clients’ religious
affiliation or the importance of their faith. Integrating religion into psychotherapy means
actively engaging and utilizing our clients’ faith to achieve psychological gains. Although a
majority of clients are answering the question “Does religion belong in psychotherapy?” with a
resounding “yes,” many mental health professionals are not taught how to engage with
religious issues in therapy. This means a potentially healing resource often goes unnoticed and
untapped.
An accumulating body of scientific research shows that our clients’ religious beliefs,
practices, and resources can have a positive and powerful impact when integrated into
psychotherapy. Religiously-integrated CBT (RCBT) is an effective psychological approach for
treating depression among religious clients (Koenig et al., 2015). RCBT uses a client’s own
religious beliefs and practices as a foundation to change depression-maintaining beliefs and
develop positive behaviors incongruent with depression. For a detailed description of RCBT, see
Pearce et al., 2014.
In summary, religion can play an important role in psychotherapy for religious clients.
Knowing how to appropriately integrate religion into therapy for individuals who desire this
allows us to better serve our clients and our profession.
