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In an increasingly globalized world, clinicians are met with novel challenges. New ideas, cultures, religions, spiritualities, and many other facets of the human experience have been dispersed globally. As such, clinicians must rise to the challenge: How can we provide mental health services to this changing world?

Religion and spirituality are two facets of the psychological experience that all people have. Even if a client is not religious or spiritual, they have most likely come across religion or have been influenced by it to some degree. This pervasiveness of spirituality and religion in both the individual and collective consciousnesses, therefore, necessitates a thorough reflection upon not only religion and spirituality as they are involved in clinical psychotherapy practice but also the multicultural considerations that must be included. Without including these, a complete understanding of the client’s psychological experience would not be able to be attained to the necessary degree.

Of course, a significant amount of this relies on the competencies that the clinicians have acquired and continuously develop. Notably, Vieten & Scammell (2015) have laid out 16 guidelines that pertain to spiritual and religious competencies within the context of clinical practice. To fully explore the role that the clinicians take when working with matters of spirituality and religion, all 16 of these guidelines will be reflected upon, divided into three sections: Attitudes, knowledge, and skills. All clinicians working with these matters must consider these competencies if wanting to responsibly fulfill their duty as clinical psychologists and spiritual or religious practitioners.

Attitudes

When it comes to being a clinical psychologist, one’s attitudes are of utmost importance. They are critical in how the therapeutic relationship is formed and how the client receives the presence of the therapist. Within the tradition of humanistic psychology, an identical weight is applied to attitude. As such, integrating humanistic attitudes into one’s pursuit of spiritual and religious competencies in clinical practice ought to be explored.

Empathy, Respect, and Appreciation

The first competency set forward by Vieten & Scammell (2015) pertains to the necessary demonstrations of regard that clinicians should be able to communicate to clients:

Psychologists demonstrate empathy, respect, and appreciation for clients from diverse spiritual, religious, or secular backgrounds and affiliations. (p. 15)

As we can see, the psychologist must treat and see the client with empathy, respect, and appreciation. Carl Rogers (1951, p. 20) believed that the client-centered counselor should see the client as having inherent worth, deserving of respect and dignity, and as having an innate capacity for self-actualization. Considering this, if the clinician is able to hold this humanistic attitude, they will have met this competency.

It should be mentioned that in some cases, the psychologist might need to take a more active role in the therapeutic relationship. Person/client-centered therapy as Rogers described it is largely non-directive, making it difficult to address problems where clients might be at risk and in need of a more directive approach. With this in mind, the guiding spirit behind motivational interviewing provides alternative or supplementary attitudes that the humanistically-inclined clinician can hold. In MI, a helper should be calm, open, and compassionate, seeing the therapeutic relationship as a partnership, and being able to accept and empower the client regardless of belief or orientation (Miller & Rollnick, 2023, pp. 6–10). By being able to uphold these attitudes, clinicians can lay the philosophical and ideological foundation to be able to work with a diverse range of clients of all origins, faiths, spiritualities, and groups. Motivational interviewing has been discussed by Legate & Weinstein (2024) to have the potential to make diversity, equity, and inclusion (DEI) training more effective. As such, clinicians should also consider seeking out continued training and education so as to remain aware of their strengths and shortcomings when it comes to the attitudes they hold with clients.

Diversity

Each of these competencies should be interconnected with each other to some degree, and this is the case with the second competency described by Vieten & Scammell (2015):

Psychologists view spirituality and religion as important aspects of human diversity, along with factors such as race, ethnicity, sexual orientation, socio-economic status, disability, gender, and age. (p. 27)

Continuing with the necessity of an approach that considers multicultural and socioeconomic factors, this competency is concerned with viewing religion and spirituality as an integral component of the human experience in the same way that all other factors of diversity are. However, they are often overlooked despite the necessity of inclusion. In one study of school psychology student’s perceptions of spiritual and religious diversity training, Parker et al. (2023) found that these graduate students received limited explicit instruction and preparation on religion and spirituality as diversity factors. Clinicians should reflect on their own training and experience to consider whether they have enough so that they can either reflect on and refresh their knowledge or so that they might seek additional education and experience.

While there are many differentiating factors within the diversity of religions and spiritualities, one often not discussed is that of the emotional differences that arise within each individual, influenced by these factors. Between religions and spiritualities, there are differences in the language of emotion, emotional intensity, the rules in where one can display emotion, and differences in moral judgments such as unfairness, purity/impurity, authority and hierarchy, and collectivist or individualist attitudes (Teske, 2014). While there are countless other aspects of human psychology that are influenced by spirituality and religion, this serves as an excellent example of the pervasiveness and complexity of these influences. Acceptance of diversity is a lifelong pursuit and way of being, and clinicians should feel compelled to take this path not only for religious and spiritual competency but also for secular practice.

Self-Awareness of Beliefs

In addition to what attitudes clinicians should hold towards clients, clinicians should also develop a self-awareness of their own religious/spiritual biases and beliefs. Vieten & Scammell (2015) address this need in their third competency:

Psychologists are aware of how their own spiritual or religious background and beliefs may influence their clinical practice and attitudes, perceptions, and assumptions about the nature of psychological processes. (p. 35)

Within this third competency, they not only emphasize how clinicians’ own religious/spiritual practices may influence perceptions and attitudes but also how these beliefs may influence their views on psychological phenomena and processes. Within Buddhism, there is the concept of the self as arising from the Five Aggregates, which then sets the foundation for an assertion on the self as not existing separate from anything, as being constructed and the result of causes and conditions (Chuang, 2012, p. 76). However, this may conflict with Christian or Western ideas of the immortal soul, as one has individualistic implications of individuation while the other has collectivist ideals of non-self and interbeing. On the other hand, Elkins (1995, p. 83) defines the soul as the I-Thou encounter, as being awe and empathic resonance. The belief in the soul extends largely past Christianity, also belonging to individual spiritualities and folk psychologies. Bering (2006) outlines many different understandings of the soul within folk psychologies, with their origins being from simulation constraint, cognitive defaults of psychological immortality, preservation of reputation and morality, and many other theories. From the wealth of perspectives, the soul is a perfect example of how beliefs may influence our psychological practices. If a clinician believes that the self is the result of delusion and attachment, then they are likely to interact with desires that pertain to the self as being overly self-concerned. On the other hand, it is possible that clinicians who believe in the soul might be more supportive of individual boundaries and desires, as the soul is the extension of the self past a material existence. However, the reality is that all people are different and, therefore, should not be so easily sorted into beliefs. Instead, the clinician ought to examine how their beliefs may impact or affect the therapeutic process while simultaneously holding a person-centered and non-assumptive frame.

Knowledge

In addition to the attitudes adopted as discussed above, knowledge and its continuous development are integral to the spiritually or religiously competent clinician. However, there is much work done by clinicians outside of therapy. Case formulation, treatment planning, and the interventions chosen to be used in psychotherapy are all highly dependent on the clinician’s knowledge. The following competencies discussed all concern this aspect of clinical work.

Exploring the Diversity of Practices and Beliefs

Competency four, which states the importance of knowledge regarding spiritual and religious diversity, is as follows (Vieten & Scammell, 2015):

Psychologists know that many diverse forms of spirituality and religion exist, and explore spiritual and religious beliefs, communities, and practices that are important to their clients. (p. 45)

As discussed in the previous section on competency two, the diversity of spirituality and religion is often overlooked in diversity training and education (Parker et al., 2023). Outside of formalized or standardized education or training, it can be even harder to be exposed to diversity, especially if the clinician is not in an urban environment. As such, clinicians should seek this knowledge, especially if they find themselves inadequate.

Knowing that diversity exists within spiritual and religious beliefs and practices (SRBPs) is not only being exposed to diversity. It is also having the knowledge to know that assumptions should not be made when approaching the SRBPs of clients. Historically, significant figures such as Freud and Ellis treated religion and spiritual matters with antipathy, with attitudes only shifting to understand the necessity of including religious and spiritual considerations in the multicultural movement of the 1990s (Sandage & Strawn, 2022, p. 3). Now, with the movement of the field moving towards including considerations of diversity and multiculturalism within psychology, there is much room for growth. There are years of antipathy that must be overcome, and we will surely be finding unforeseen aftereffects of this sentiment as we progress further.

For the multicultural and diversity-conscious psychologist, remaining open and humble is necessary. As Spaeth (2019) discusses, remaining open to the spiritual and religious experience of clients can open new opportunities for understanding not only differences but also similarities between beliefs and practices. Each person will have their own unique SRBPs, and it is the clinician’s duty to put aside assumption and sit with them as they are. By honoring their spiritual practices and including them in unconditional positive regard, the therapeutic relationship is strengthened, and clients are empowered to walk their own path of healing according to their beliefs.

Spirituality and Religion: Similar But Different

The fifth competency pertains to the clinician knowing religion and spirituality as being different yet similar. The specific language of the fifth competency is as follows:

Psychologists can describe how spirituality and religion can be viewed as overlapping yet distinct constructs. (p. 51)

Within the definition of this competency, there are some interesting implications. Firstly, spirituality and religion are often seen as being extremely similar, sometimes causing confusion for people who see them as being so alike that they might as well be the same. However, important distinctions between spirituality and religion are noteworthy enough to be discussed. Spirituality can be defined as a belief in a non-material aspect of existence, as well as the acknowledgment of one’s spiritual nature (Fontana, 2003, pp. 11–12). Psychologists such as David Elkins have done significant work in developing an understanding of humanistic spirituality (Elkins, 1995; Elkins et al., 1988). Religion, on the other hand, can be defined as having three factors: belief in a spiritual dimension, spiritual rituals or practices, and ethical conduct sourced from spiritual teachings ((Fontana, 2003, p. 10). Even from the definitions, we can see that there is an overlap. Spiritual nature and spiritual dimensions are included in both religion and spirituality, with differences seemingly apparent within systemization, relative heterodoxy, and organizational structure. Religion, in this sense, is relatively more institutional and organized at a greater scale than individualized spirituality (Vieten & Scammell, 2015, p. 52), though these points can be further discussed ad infinitum.

Ultimately, clinicians must understand the nuances in contrast and comparison. Clients may have both spiritual and religious aspects of their experience and thus require the clinician to understand what pertains to the individual and what is within the creed and structure of organized religion. If a clinician misidentifies what may belong to one, it could prove to be harmful, as not all spiritual beliefs might be accepted in religious communities. Additionally, belonging to a religion may not be indicative of a client’s individual spirituality. Continuing with the humanistic spirit, the psychologist should remain open and curious about SRBPs.

Differences Between Spirituality and Psychopathology

Psychologists must know when clients are describing or undergoing spiritual experiences and be able to differentiate these experiences from psychopathology. This is the sixth competency. The language used by Vieten & Scammell (2015) is as follows:

Psychologists understand that clients may have experiences that are consistent with their spirituality or religion, yet may be difficult to differentiate from psychopathological symptoms. (p. 61)

Perhaps the most well-documented spiritual experience that might be mistaken for a series of psychopathological symptoms is that of Jung’s creation of his Liber Novus (Jung, 2009). In his memoir, Jung described the period of his life in which he undertook his work in exploring the unconscious via active imagination as approaching the “same psychic material which is the stuff of psychosis and is found in the insane” (Jung, 1989, p. 188).

It is not absurd to then expect that clients may have spiritual experiences of their own that delve into the realm of what might be deemed “the stuff of psychosis.” While the DSM-V-TR provides for such categorizations via it’s Z-code for “religious or spiritual problem” (Z72.811), some argue that the DSM increasingly encroaches on normal parts of human life, furthering the medicalization of human experience (Frances, 2013). On the other hand, some point out that religion and spirituality are left out of the considerations within the DSM, noting the religious and spiritual aspects of depression, psychotic disorders, substance use disorders, and personality disorders (Chandler, 2012, pp. 580–581). Nonetheless, clinicians should utilize their knowledge of Z-codes, diagnostic considerations, psychology, and religious/spiritual experiences to better understand and help their clients.

Change

As all things are subject to change, SRBPs also transform with time. As part of the seventh competency, clinicians should develop an awareness of this phenomenon and process (Vieten & Scammell, 2015):

Psychologists recognize that spiritual or religious beliefs, practices, and experiences develop and change over time. (p. 81)

There are many different types of change when it comes to SRBPs. Clients may switch religious/spiritual denominations, convert to another, leave their faith, or intensify and/or deepen their connection with their current affiliation (Vieten & Scammell, 2015, p. 81). One way of understanding spiritual development has been explored by Walker & D. Lang (2023), applying the lens of self-determination theory (SDT) to understand the role of religious pressures in Christians’ spiritual/religious development. Additionally, recent trends in the study of religious and spiritual development have focused on the connection between developmental outcomes and religiosity/spirituality, with specific interest in the mediating and protective potential of SRBPs (Hardy & Taylor, 2024, pp. 111–115). Since SRBPs are so intertwined with the human developmental process, it then becomes difficult to differentiate between what counts as spiritual/religious development and general psychological development. On the other hand, it can be argued that for those that are religious or spiritual, they are one and the same.

While theory and understanding are beneficial, it becomes necessary for the clinician to be able to use this knowledge to support clients in their spiritual and or religious development. For Buddhist psychotherapy, spiritual development is part of the process of psychological healing and growth. The note, know, choose, counseling model by K. C. Lee & Tang (2021) uses the development of mindfulness, self-knowledge, and behavioral change to foster such development for the client. In a more general approach, Holmberg et al. (2021) emphasize the importance of including spiritual literacy in family therapy practice, noting that unwillingness or discomfort regarding the topic on behalf of the clinicians can hinder therapeutic growth (Holmberg et al., 2021). Expanding on this idea, it is worth considering that openness and willingness to support clients in their own spiritual development is enough (Vieten & Scammell, 2015, pp. 88–89), as clinical avoidance of the topics could stifle healing and growth.

Resources for Growth

Beyond openness, clinicians should also develop an awareness of the positive potential of the SRBPs of clients. Competency eight addresses this need with the following language (Vieten & Scammell, 2015):

Psychologists are aware of clients’ internal and external spiritual resources, and practices that research indicates may support psychological well-being and recovery from psychological disorders. (p. 91)

The responsibilities within this competency can be understood as twofold. Firstly, the psychologist must be able to understand the strengths and potential within the SRBPs of the client. Secondly, the psychologist must be aware of the current literature regarding the connections between SRBPs and psychological well-being and recovery. An additional point in this aspect is that the clinician should expand their exploration of resources beyond the psychological literature, also looking into religious and spiritual resources that might be able to assist clients.

For the first aspect of this competency, the process of acquiring familiarity with the client’s strengths that reside within their SRBPs has already been discussed. Remaining open and curious and embodying the humanistic and person-centered spirit is integral to determining the client’s strengths as they see them. By allowing them to see their own resources, the client may be able to increase their self-efficacy and confidence in enacting meaningful change. Yalom (2013, pp. 39–41) noted the importance of assisting patients to assume self-responsibility, even if met with avoidance or if it causes stages of regret for the client. Despite much of life remaining out of one’s control, one must look at the things they have agency in and work with what they have. Understanding the positive and protective factors of SRBPs can, therefore, provide clients with the knowledge that they have the tools to overcome or accept hardships as they come.

This leads to the question that psychotherapists should be continuously studying: What are the spiritual and religious resources associated with well-being? This answer can depend on the religion or spirituality. Mindfulness practices with incorporated Buddhist ethics have been found to have positive effects on well-being and prosocial behavior (Chen & Jordan, 2020). Additionally, just experiencing Buddhist practices as a non-believer has been found to impact preferences in intertemporal decision-making (Wang et al., 2023). For religion as a whole, religion has been found to have positive effects on mental health, as it can function as a way to relieve tension that arises due to mental health problems, as a coping or soothing mechanism, and serve to inhibit mental health symptoms, as well as offer opportunities for socialization (Pastwa-Wojciechowska et al., 2021). Considering these benefits, clinicians can learn interventions that complement the client’s SRBPs, providing them with skills that aid in their well-being. Additionally, clinicians can develop an awareness of trustworthy and beneficial local organizations, religious centers, and spiritual groups that may be able to provide clients with more specialized support with the SRBPs.

Developing an Awareness Towards Potential Harm

In addition to recognizing the positive and healing aspects of religion and spirituality, psychologists should also be intimately aware of the potential harm of certain SRBPs. Competency nine explores the clinician’s role in upholding this responsibility (Vieten & Scammell, 2015):

Psychologists can identify spiritual and religious experiences, practices, and beliefs that may have the potential to negatively impact psychological health. (p. 99)

It is hardly a novel idea that religion and spirituality can negatively affect mental health. As mentioned previously, significant figures such as Freud and Ellis had negative opinions as to the function of religion as it relates to psychology (Sandage & Strawn, 2022, p. 3). Freud saw religion as the obsessional neurosis of humanity, as a repressive force, and as a fatherly presence that fosters ambivalence, which fosters guilt (Kistner, 2021). Existential philosopher and author Albert Camus, pp. (1955, pp. 41–42) famously stated that seeking to transcend the tension between the inherent meaninglessness of existence and the desire to find meaning (the Absurd) via belief in a god was “philosophical suicide” insofar as it is a negation of human reason. From this perspective, religion and spirituality prevent some from fully accepting and finding fulfillment in the Absurd. From the perspective of family therapy, Dollahite et al. (2018) present a system of religious harm and help dualities within family lives. Religion can create conflict, guilt, repression, hypocrisy, and gender inequities, promote passive fatalism, encourage irrationality, enable victimization and abuse, and act as a catalyst for extremist destructive force or weaponization (Dollahite et al., 2018, p. 223). Seeing all of the potential for harmful social effects, it is not difficult to see how these effects can impact family life, resulting in individual mental health psychopathology. Beyond the mind, the COVID-19 pandemic showed some negative aspects of religion, as it constrained early crisis responses, potentially exacerbating sources of suffering via the mind-body connection (Schnabel & Schieman, 2022).

With all of this in consideration, the clinician should consider the potential harm that is associated with client SRBPs. Vieten & Scammell, p. (2015, pp. 91–98) specifically discuss SRBPs as possessing the potential of associations with negative coping, scrupulosity, and overinvolvement, and as a source of exploitation via cults or cult-like groups. Awareness of such effects can allow the therapist to discuss and enable clients to work towards a healthy median. As with all other things, SRBPs can be beneficial in balance but detrimental in extremes. Clinicians can suggest interventions such as journaling, nutrition, and physical activity. Clinicians should additionally consult with community spiritual leaders as appropriate to best support the client.

Identifying Legal and Ethical Issues

From the discussion so far on these competencies, the ethically-conscious clinician might have some concerns that surfaced. Competency 10 addresses these concerns, reinforcing the legal and ethical obligations of all psychologists, especially as they apply to dealing with spiritual and religious issues (Vieten & Scammell, 2015).

Psychologists can identify legal and ethical issues related to spirituality and religion that may surface when working with clients. (p. 111)

While the wording of this competency is comparatively open, this is most likely due to the seemingly endless legal and ethical differentiations that exist between regions, countries, professional boards, and institutions.

The American Psychological Association (APA) (2017, Principle E) includes religion as a factor of diversity and requires that psychologists respect the dignity, worth, and rights of all people. Additionally, the APA (2017, Standard 2.01) requires psychologists to consider the boundaries of their competence, which the competencies laid out by Vieten & Scammell (2015) can assist with. Psychologists, when doing clinical work, are not spiritual/religious guides or leaders. They should be mindful of not prescribing SRBPs, as that rests outside of their domain of competency and/or expertise. This then gives rise to the discussion of dual relationships. If consulting with religious or spiritual figures regarding SRBPs, there is the potential for communities to recommend clients. If the clinician is actively involved with a religious or spiritual community, it is necessary to maintain boundaries and confidentiality. APA ethical standards pertaining to human relations (American Psychological Association, 2017, Section 3) apply to such situations and compel psychologists to avoid taking cases which could be considered to be conflicts of interest (Standard 3.06), multiple relationships (Standard 3.05), and or exploitative relationships (Standard 3.08). Additionally, if a third party, such as a spiritual or religious community, requests services for the client, the psychologist should clarify the nature of the therapeutic relationship with the client and remain mindful of their obligations to observe confidentiality as per Standard 3.07 (American Psychological Association, 2017).

While Vieten & Scammell, p. (2015, p. 115) voice their opinion that psychologists should generally not self-disclose to clients regarding their SRBPs, this can be a complicated matter. As such, clinicians should be mindful of ethical obligations. Hoffman (2008, pp. 7–8) discusses the importance of clinicians remaining aware of the power differential, and for them to remind themselves that their SRBPs may be different from the clients. In such cases, appropriate levels of self-disclosure may be appropriate so that the therapeutic relationship is properly defined.

Skills

The last category of competencies pertains to skills that the psychologist should develop when working with SRBPs. Like the previous categories, each competency will be reflected on and defined so that the skills needed for competency are clear.

Working with Diversity

As discussed previously, the clinician should be knowledgeable of diversity in addition to maintaining an attitude of respect and compassion. Vieten & Scammell (2015) present competency 11 as:

Psychologists are able to conduct empathic and effective therapy with clients from diverse spiritual or religious backgrounds, affiliations, and levels of involvement. (p. 119)

Much of the material within this competency has already been covered so far. However, it is helpful to discuss it once more to understand the acquired values and knowledge on working with diversity as applied to action in the form of psychotherapy. Non-directive modalities such as person/client-centered therapy (Cain, 2014; Rogers, 1951) can be used to allow the client to self-actualize with little interference from the therapist. This approach gives client SRBPs the respect, dignity, and support needed to develop and enable their well-being. However, the clinician should remain aware of the biopsychosocial factors that are involved in the client’s mental health and offer appropriate interventions as needed. Knowledge of the benefits and harms of SRBPs is integral to this process.

Clinicians should also be experienced and competent in a variety of secular psychotherapeutic interventions so that they can be prepared to work with the diversity of SRBPs. Interventions such as MBSR and MBCT can be helpful for developing emotional and stress regulation skills (Kabat-Zinn, 2003; N. Lee et al., 2024; Szymonik & Szopa, 2024). Additionally, existential psychotherapy (Yalom, 1980) might be attractive to those who wish to work with existential issues on their own terms since spirituality, religion, and existentialism are often interlinked due to their shared interest in finding meaning. Above all, clinicians should remain curious, compassionate, and mindful. Therapists should additionally utilize active listening (Fitzgerald & Leudar, 2010; Rogers & Farson, 1957) skills to engage with clients effectively.

Spiritual and Religious Personal Histories

In addition to the therapeutic skills needed to work effectively with clients, psychologists should include spiritual and religious experiences when understanding a client’s history. Competency 12 is as follows (Vieten & Scammell, 2015):

Psychologists inquire about spiritual and religious background, experience, practices, and beliefs as a standard part of understanding a client’s history. (p. 133)

Personal history is a foundational part of case intake and analysis. As such, for those working with SRBPs they should include the spiritual and religious histories of their clients so that they can conscientiously apply the appropriate interventions. Besides interviewing, one way to do this is to use spiritual and religious assessments in the intake process. Potential assessment questions can be found in those provided by the Joint Commission on Accreditation of Healthcare Organizations, with additional consideration provided to client autonomy, cultural competence, spiritual norms, and spiritual salience (Hodge, 2006). Stewart-Sicking (2024) also provides a discussion of assessment via interview, bringing up salient points regarding clinicians’ spiritual/religious maturity and the potential of broaching as opening up opportunities for future discussion that might not be available otherwise. If assessment brings up potential complications of an interconnected nature between religion/spirituality and mental health, clinicians should consider additional, more focused assessments. One example is that of the Inventory of Complicated Spiritual Grief 2.0 (Burke et al., 2021), in which proper attention is paid to understanding spirituality’s role in complicated grief.

By understanding the spiritual and religious aspects of the client’s mental health history, as well as their SRBP experiences, the clinician can gather more objective and assistive data for choosing the most effective interventions and modalities for healing or recovery. As such, psychologists should use the discussed assessments and interviewing topics as appropriate for the client’s situation.

Exploring and Accessing Spiritual and Religious Resources and Strengths

            As discussed previously, it is important to be knowledgeable about the client’s spiritual and religious strengths and resources, as well as the positive impact SRBPs can have on mental health and well-being. However, it is just as important to be able to support clients by using this knowledge and to help them explore on their own. Competency 13 (Vieten & Scammell, 2015) establishes this idea using the following wording:

Psychologists help clients explore and access their spiritual and religious strengths and resources. (p. 148)

This goal can be attained via many means, but Vieten & Scammell (2015) approach these strengths via the categorization of inner and outer resources. Inner resources include practices that influence emotional and psychological well-being from an internal source. Prayer, meditation, and similar more personal spiritual practices are examples of inner resources. Therapists can assist clients by finding out what works for them and what they are motivated to do. As mentioned earlier, motivational interviewing (Miller & Rollnick, 2023) is a great technique for making behavioral changes in a humanistic and person-centered manner.

As for outer resources, these can include belonging to a religious/spiritual community, volunteerism, group practices, and many others. Volunteering can be a great suggestion for those with SRBPs, as it can have a moderating effect on depressive and anxious symptoms (Jang & Tang, 2016). Of course, participating in group rituals or practices also has positive aspects. Chinese Buddhist repentance rituals can provide opportunities for mourning, reducing self-blame and guilt and facilitating a space for public forgiveness and connection (Lee et al., 2017). Clinicians can support the client with finding places that fulfill their needs and strengths in outer resources, regardless of the diversity of SRBPs.

Identifying and Addressing Spiritual and Religious Problems.

Just as the previous competency explored the psychologist’s role in applying their values and knowledge to supporting the strengths of their clients, competency 14 does the same for their role in identifying and addressing any potential spiritual or religious harm (Vieten & Scammell, 2015):

Psychologists can identify and address spiritual and religious problems in clinical practice and make referrals when necessary. (p. 157)

Many of the previous competencies can assist with this task. For instance, having a knowledge of the literature regarding harmful aspects of SRBPs can assist with identifying similar occurrences within the experiences explored with the client. Similarly, being aware of multicultural factors of consideration can enable the clinician to understand the nuances of harm and beneficence within different cultural contexts.

As Vieten & Scammell, p. (2015, p. 157) point out, the best way to often find out if a client is experiencing a spiritual or religious problem is by asking them skillfully and straightforwardly. This is an opportunity to use empathy and compassionate listening skills. In cases like this, a genuine “non-attached warmth” can improve therapy outcomes (Truax et al., 1966). Another way to humanistically guide a client is to offer advice not from a way of undermining their self-determination, but to provide differing insights and alternatives to their usual thought patterns (Yalom, 2013, pp. 150–154). However, as Vieten & Scammell, p. (2015, p. 158) point out, the therapist should fulfill their role by inquiring and acknowledging the experiences of the client. Additionally, clinicians should consider whether or not applying relevant Z-codes, such as Religious or Spiritual Problem (Z72.811) (American Psychiatric Association, 2022), would be appropriate and or helpful to the client.

Continuing Awareness and Education

Just as the clinician is implored to acquire knowledge to assist clients with SRBPs, psychologists also have an obligation to continue learning about and developing professionally in matters related to psychology, religion, and spirituality. Competency 15 is as follows (Vieten & Scammell, 2015):

Psychologists stay abreast of research and professional developments regarding spirituality and religion specifically related to clinical practice, and engage in ongoing assessment of their own spiritual and religious competency. (p. 168)

Plenty of attention so far has been applied to acquiring the necessary knowledge and experience for becoming competent in handling matters regarding SRBPs. As such, the last necessary inclusion to be made should address the clinician’s self-assessment process. While there are many ways to approach this, continuously reflecting on how one is fulfilling these competencies individually can be a greatly beneficial way to self-assess. For those wishing to assess themselves more objectively, assessment scales such as the spiritual competency scale (SCS-R-II) (Robertson, 2010) are helpful. While it is usually used for assessing students’ spiritual competency, it can be useful for providing specific strengths and weaknesses. While the SCS-R-II has issues with reaching adequate levels of reliability, it is most likely the only measurement tool for spiritual competency (Lu et al., 2018, p. 231). As such, clinicians can still use it as a way to reflect on themselves to an adequate level.

The ultimate goal of this competency is to remind psychologists to not become complacent and assumptive with their practice. This should apply not only to matters including SRBPs but to all aspects of psychotherapy. With this in consideration, clinicians should continue to develop themselves with the methods discussed.

Understanding Limitations

The final competency relates to the clinician’s own humility. As with the rest of psychology, those pursuing spiritual and religious competency in clinical practice should keep Principles A and B of the APA ethical principles (2017) in mind. Psychologists have a responsibility to strive for beneficence and to establish and maintain levels of professional trust both individually and in the field. Part of these responsibilities include knowing what one cannot do. Competency 16 is included to remind psychologists of these obligations, and is as follows (Vieten & Scammell, 2015):

Psychologists recognize the limits of their qualifications and competence in spiritual and religious domains, including their responses to clients’ spirituality or religion that may interfere with clinical practice, so that they (1) seek consultation from and collaborate with other qualified clinicians or spiritual or religious sources (priests, pastors, rabbis, imams, spiritual teachers, and so on), (2) seek further training and education, and/or (3) as appropriate, refer clients to more qualified individuals and resources. (p. 171)

Seeing as this is the lengthiest competency, there is much to discuss. However, similar to the other skills in this category, some of the points have been covered already. In previous competencies, we have discussed how clinicians can seek further education, training, and develop a self-awareness of their own shortcomings. However, there has been no previous discussion of consultation with religious sources or of referrals.

In the modern age, consulting spiritual sources is easier than ever. There are many different forums and places where one can meet with reputable figures and discuss any issues one might face within a clinical setting. Of course, one should be mindful of confidentiality, especially if there are third parties.

As for the topic of referrals, psychologists should maintain knowledge of the mental health experts local to them with competency in dealing with spirituality and religious matters. As (Brownell, 2014) points out, we are not always aware of the subtle ways we influence the therapy process, meaning that our lack of knowledge and competency in dealing with SRBPs could cause harm as an unintended consequence. Additionally, as Spaeth (2019, pp. 208–209) points out, those wishing to work with spiritual and religious perspectives should be willing and able to have their own spiritual lives, beliefs, and practices. If a clinician is unwilling, then they are knowingly conducting therapy inauthentically, hiding their inexperience and incompetencies behind a façade of spirituality.

Conclusion

The integration of spiritual and religious competencies into clinical psychology is an essential adaptation to the growing diversity and interconnectedness of the modern globalist era. As demonstrated throughout this reflective work, psychologists are tasked with adopting a threefold approach encompassing attitudes, knowledge, and skills to effectively meet clients’ needs from diverse spiritual and religious perspectives. The 16 competencies outlined by Vieten & Scammell (2015) provide a robust framework for clinicians to navigate this nuanced domain with empathy and humility while observing their ethical obligations to their roles.

From fostering empathy and respect to developing self-awareness, psychologists must strive to establish therapeutic relationships that respect their clients’ rights, potential, and diversity. Equally important is their ability to be intimately aware of the interplay between spirituality, religion, and psychological well-being, utilizing these insights to support clients’ journeys of growth while identifying and addressing potential harms. This calls for a skillful balancing act: We must honor clients’ spiritual/religious beliefs and practices (SRBPs) while upholding ethical and professional standards. The competencies focusing on continued education and collaboration underscores the adaptive nature of observing these competencies. Just as spirituality and religion evolve over time, clinicians must adapt their understandings and practices. By remaining open and curious, seeking further training, and engaging with spiritual and religious resources, psychologists can ensure that their interventions are both culturally considerate and clinically effective.

Ultimately, developing one’s spiritual and religious competencies not only enhances the therapeutic process but also affirms the humanity of both clients and clinicians. In embracing these competencies, psychology as a field moves closer to becoming more able to meet the world’s increasingly diverse requirements regarding addressing clients’ needs when working with SRBPs. We must acknowledge the profound influence of spirituality and religion in shaping the human experience while upholding a humanistic spirit, empowering individuals to pursue healing, meaning, and fulfillment.

References

American Psychiatric Association. (2022). Other Conditions That May Be a Focus of Clinical Attention. In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787.Other_Conditions_Z_codes

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). http://www.apa.org/ethics/code/index.html

Bering, J. M. (2006). The folk psychology of souls. Behavioral and Brain Sciences, 29(5), 453–462. https://doi.org/10.1017/S0140525X06009101

Brownell, P. (2014). Competence, ethics, and cultural sensitivity. In Spiritual competency in psychotherapy (pp. 10–13). Springer Publishing Company, Incorporated.

Burke, L. A., Crunk, A. E., Neimeyer, R. A., & Bai, H. (2021). Inventory of Complicated Spiritual Grief 2.0 (ICSG 2.0): Validation of a revised measure of spiritual distress in bereavement. Death Studies, 45(4), 249–265. https://doi.org/10.1080/07481187.2019.1627031

Cain, D. J. (2014). Person-centered therapy process. In G. R. VandenBos, E. Meidenbauer, & J. Frank-McNeil (Eds.), Psychotherapy theories and techniques: a reader (pp. 261–269). American Psychological Association.

Camus, A. (1955). The myth of Sisyphus (J. O’Brien, Trans.; Second International). Vintage Books.

Chandler, E. (2012). Religious and spiritual issues in DSM-5: Matters of the mind and searching of the Soul. Issues in Mental Health Nursing, 33(9), 577–582. https://doi.org/10.3109/01612840.2012.704130

Chen, S., & Jordan, C. H. (2020). Incorporating ethics into brief mindfulness practice: Effects on well-being and prosocial behavior. Mindfulness, 11(1), 18–29. https://doi.org/10.1007/s12671-018-0915-2

Chuang, T. (2012). Faxiang: A Buddhist practitioner’s encyclopedia (R. Smitheram, Ed.; First Edition). Buddha’s Light Publishing.

Dollahite, D. C., Marks, L. D., & Dalton, H. (2018). Why religion helps and harms families: A conceptual model of a system of dualities at the nexus of faith and family life. Journal of Family Theory & Review, 10(1), 219–241. https://doi.org/10.1111/jftr.12242

Elkins, D. N. (1995). Psychotherapy and spirituality: Towards a theory of the soul. Journal of Humanistic Psychology, 35(2), 78–98.

Elkins, D. N., Hedstrom, L. J., Hughes, L. L., Leaf, J. A., & Saunders, C. (1988). Toward a humanistic-phenomenological spirituality. Journal of Humanistic Psychology, 28(4), 5–18. http://www.archive.org

Fitzgerald, P., & Leudar, I. (2010). On active listening in person-centred, solution-focused psychotherapy. Journal of Pragmatics, 42(12), 3188–3198. https://doi.org/10.1016/j.pragma.2010.07.007

Fontana, D. (2003). Psychology, religion, and spirituality. Blackwell Publishing.

Frances, A. (2013). Saving normal. HarperCollins Publishers.

Hardy, S. A., & Taylor, E. M. (2024). The past, present, and future of research on religious and spiritual development in adolescence, young adulthood, and beyond. In Archive for the Psychology of Religion (Vol. 46, Issue 2, pp. 109–120). SAGE Publications Inc. https://doi.org/10.1177/00846724241235172

Hodge, D. R. (2006). A template for spiritual assessment: A review of the JCAHO requirements and guidelines for implementation. Social Work, 51(4), 317–326. https://doi.org/10.1093/sw/51.4.317

Hoffman, L. (2008). Working with religious and spiritual issues in therapy from competency to practice. https://www.academia.edu/3314724/Working_with_Religious_and_Spiritual_Issues_in_Therapy_From_Competency_to_Practice

Holmberg, Å., Jensen, P., & Vetere, A. (2021). Spirituality – a forgotten dimension? Developing spiritual literacy in family therapy practice. Journal of Family Therapy, 43(1), 78–95. https://doi.org/10.1111/1467-6427.12298

Jang, H., & Tang, F. (2016). Effects of social support and volunteering on depression among grandparents raising grandchildren. International Journal of Aging and Human Development, 83(4), 491–507. https://doi.org/10.1177/0091415016657561

Jung, C. G. (1989). Memories, dreams, reflections. (A. Jaffe, R. Winston, & C. Winston, Eds.; Vintage Books). Random House Inc.

Jung, C. G. (2009). The red book: Liber novus (S. Shamdasani, Ed.; M. Kyburz, J. Peck, & S. Shamdasani, Trans.). W. W. Norton & Company.

Kabat-Zinn, J. (2003). Mindfulness-based stress reduction (MBSR). Constructivism in the Human Sciences, 8(2), 73–83. https://tcsedsystem.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/mindfulness-based-stress-reduction-mbsr/docview/204582884/se-2

Kistner, U. (2021). Religion as ‘universal obsessional neurosis of humanity’? Re-reading freud on religion. HTS Teologiese Studies / Theological Studies, 77(2). https://doi.org/10.4102/hts.v77i2.6723

Lee, K. C. (George), Oh, A., Zhao, Q., Wu, F.-Y., Chen, S., Diaz, T., & Ong, C. K. (2017). Repentance in Chinese Buddhism: Implications for mental health professionals. Journal of Spirituality in Mental Health, 19(3), 210–226. https://doi.org/10.1080/19349637.2016.1204258

Lee, K. C., & Tang, J. L. K. (2021). Note, know, choose: A psychospiritual treatment model based on Early Buddhist Teachings. Spirituality in Clinical Practice, 10(2), 150–167. https://doi.org/10.1037/scp0000220

Lee, N., Kim, M., & Jung, M. (2024). Effects of a mindfulness-based education program on mindfulness, emotional regulation, interoceptive awareness, and university-life adjustment for Korean university freshmen. Journal of Research and Health, 14(1), 31–42. https://doi.org/10.32598/JRH.14.1.2358.1

Legate, N., & Weinstein, N. (2024). Motivation science can improve diversity, equity, and inclusion (DEI) trainings. Perspectives on Psychological Science. https://doi.org/10.1177/17456916231186410

Lu, J., Woo, H., & Huffman, K. (2018). Spiritual competency scale: A confirmatory factor analysis. Measurement and Evaluation in Counseling and Development, 51(4), 219–234. https://doi.org/10.1080/07481756.2018.1435191

Miller, W. R., & Rollnick, S. (2023). Motivational interviewing (Fourth Edition). The Guilford Press.

Parker, J. S., Murray, K., Boegel, R., Slough, M., Purvis, L., & Geiling, C. (2023). An exploratory study of school psychology students’ perceptions of religious and spiritual diversity training in their graduate programs. Contemporary School Psychology, 27(2), 370–385. https://doi.org/10.1007/s40688-021-00396-z

Pastwa-Wojciechowska, B., Grzegorzewska, I., & Wojciechowska, M. (2021). The role of religious values and beliefs in shaping mental health and disorders. Religions, 12(10). https://doi.org/10.3390/rel12100840

Robertson, L. A. (2010). The spiritual competency scale. Counseling and Values, 55(1), 6–24. https://doi.org/10.1002/j.2161-007X.2010.tb00019.x

Rogers, C. R. (1951). Client-centered therapy. Robinson.

Rogers, C. R., & Farson, R. (1957). Active listening. Martino Publishing.

Sandage, S. J., & Strawn, B. D. (2022). Introduction: Spiritual diversity in psychotherapy. In S. J. Sandage & B. D. Strawn (Eds.), Spiritual diversity in psychotherapy: Engaging the sacred in clinical practice. (pp. 3–15). American Psychological Association. https://doi.org/10.1037/0000276-001

Schnabel, L., & Schieman, S. (2022). Religion protected mental health but constrained crisis response during crucial early days of the COVID‐19 pandemic. Journal for the Scientific Study of Religion, 61(2), 530–543. https://doi.org/10.1111/jssr.12720

Spaeth, D. (2019). Religious and spiritual diversity and humanistic psychology. In L. Hoffman, H. Cleare-Hoffman, N. Granger, & D. St. John (Eds.), Humanistic approaches to multiculturalism and diversity. Routledge. https://doi.org/10.4324/9781351133357

Stewart-Sicking, J. A. (2024). Broaching spiritual and religious issues in assessment in counseling: A model for counselor preparation and practice. Counselor Education and Supervision. https://doi.org/10.1002/ceas.12315

Szymonik, J., & Szopa, S. (2024). Application of mindfulness-based interventions – MBCT and MBSR – in depression treatment and relapse prevention. Quality in Sport, 15, 50536. https://doi.org/10.12775/qs.2024.15.003

Teske, J. A. (2014). The emotional psychology of religious diversity. In A. N. Balslev (Ed.), On world religions: Diversity, not dissension. Sage Publications India Pvt Ltd. https://www.ebsco.com/terms-of-use

Truax, C. B., Wargo, D. G., Frank, J. D., Imber, S. D., Battle, C. C., Hoehn-Saric, R., Nash, E. H., & Stone, A. R. (1966). Therapist empathy, genuineness, and warmth and patient therapeutic outcome. Journal of Consulting Psychology, 30(5), 395–401. https://doi.org/10.1037/h0023827

Vieten, C., & Scammell, S. (2015). Spiritual and religious competencies in clinical practice. New Harbinger Publications.

Walker, A. C., & D. Lang, A. S. I. (2023). Perceived religious pressures as an antecedent to self-reported religious/spiritual development and well-being for Christians. Journal of Psychology and Theology, 51(3), 439–455. https://doi.org/10.1177/00916471231157006

Wang, Z., Chen, C., Mo, J., Lu, F., Ma, J., Chen, C., & He, G. (2023). Experiencing Buddhist practices promotes nonbelievers’ preference for future rewards in intertemporal choices. European Journal of Social Psychology, 53(1), 230–244. https://doi.org/10.1002/ejsp.2900

Yalom, I. D. (2013). The gift of therapy: An open letter to a new generation of therapists and their patients. Harper Perennial. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=nlebk&AN=3086371&site=ehost-live&scope=site&custid=s6007724

Yalom, I. D. (1980). Existential psychotherapy. Basic Books.