Honoring Clients’ Spirituality in Therapy

Since the onset of the pandemic, especially amongst my Gen-Z therapy clients, I’ve heard quite a bit more about a vast array of clients’ spiritual practices than ever before. Maybe it was the uncertainty and the isolation inherent in the early days of COVID quarantine. Maybe it was the fact that the changeover to video sessions meant I was now present in the homes of my clients, providing me with a window into their rooms, and a new glimpse into their lives. 

It could also be that these are the same clients who prompted me to explore concerns about social media, namely Tik Tok, where spiritual accounts were on the rise, self-proclaimed “babywitches” were eager to learn, and different spiritual concepts took turns trending during that same time. Whatever it was, I found the insight into these beliefs and practices invaluable—as well as a bit troubling at times.

The Uptick of Spirituality

In my practice, the questions and conversations about spirituality haven’t died down.  Spiritual concepts had already been trending up prior to the pandemic, and now it seems that they are a major part of the zeitgeist. Conversations around  things like manifestation, astrology, and moon phases seem quite commonplace, and have been for some time. Years ago, when I worked at an intensive outpatient program, my colleagues and I tracked when Mercury went into and out of retrograde, along with the full moons, as we anecdotally noticed an uptick in dysregulation and conflicts at those times. 

In recent years, however, in my private practice, I’ve begun to hear much more about my clients’ practices—everything from tarot reading, interpreting birth charts, and using crystals, to spells for clearing a malevolent spirit, or cracking an egg to see if the formation indicates being cursed with the evil eye. 

Had my clients always been doing these things? Were they just suddenly becoming more open about it? As their therapist, I wondered how I should be responding, especially to a new influx of questions about my own beliefs, in clients’ seeming attempts to put feelers out. I could sense these clients wondering how much they should say, whether I would understand, or, most importantly, whether I would think they sounded crazy. 

Examining Roots in Religion

Visit any “new age” shop and you’ll find crystals and meditation chimes or singing bowls—the tones of which correspond with chakras, which in turn originated from the Hindu texts the Vedas. You also might find statues of the Buddha, tarot and oracle cards for divination, astrologically based books, candles for Pagan and Wiccan rituals, sage smudges and Palo Santo pulled from Indigenous traditions, and a lot more. 

All of these “new age” concepts are anything but new or the same as each other, but sometimes they’re presented in a way that suggests they’re pulled from one distinct belief system—rather than as pulled from various religious and cultural backgrounds. Many of us, including our clients, may have any or all of these elements in our homes, having melded them into one set of practices that might be labeled “spiritual, but not really religious.”

Many therapists may rather be unfamiliar, nervous, or even disapproving or scared of these practices or the people who engage in them. There’s a lot there to understand, and even more to unpack. What’s your knee jerk reaction to words like “occult”, “spirit guides” or “witchcraft”? 

In your training, were you taught that words like these may signal mania or psychosis? Religiously, do you have any personal belief that they’re evil? On the flip side, if you’re not a member of a major organized religion, such as Christianity, Judaism, or the Muslim faith, do you have any automatic assumptions about people who are? About people in other religions?

Let’s be real: unless it’s a personal passion of yours to study world religions, as therapists we don’t receive training to intimately understand the huge scope of spiritual practices. Even if you are a religious or spiritual therapist, under any one religious umbrella there are still divisions and differences of opinion and beliefs. A Christian therapist seeing a Christian client doesn’t automatically understand their client’s belief system. 

What’s a Therapist To Do? Ethics Around Spirituality in Therapy 

That being said, therapists have an obligation to try to understand—and avoid placing their own values on—their clients. In the ACA Code of Ethics, section A.4.b. states, “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor ’s values are inconsistent with the client’s goals or are discriminatory in nature.” 

Note that it doesn’t suggest we must seek training when there are areas of our clients’ lives we don’t know about or understand, but rather when we believe the difference may cause a problem. In fact, fundamental religious or spiritual differences aren’t a dealbreaker that indicates a need for a referral. The opposite is true. “We should not refer out based solely on the counselor’s personally held values, beliefs, and behaviors.” (ACA A.11.b.) 

Spiritual and religious practices are no different, in my opinion, than any other interest of a client’s. I don’t personally understand or like football, for instance. But if my client loves football, I want to know why. I want to know what it does for them, who their team is, whether they go to games or watch them with friends or their dad, if they often drink while watching. And if I ask whether they watched the game on Sunday and they tell me no, I need to know if that means they’re getting depressed. 

Asking what makes someone think they have the evil eye, what they do to rid themselves of it and why, or the meaning they derive from a tarot card, is equally important to understanding my client as any of their other interests—and equally unimportant for me to have any knowledge before we have that conversation. Exploring what someone’s belief system is, from a neutral perspective, crucial, even if we think we understand it because we share some part of it. As therapists, it’s our curiosity and interest in our clients that helps them to feel understood and seen. We just have to care to know. 

Why Spirituality Matters for Our Clients

Aside from it simply being an interest or facet of our client’s lives, spirituality specifically can have an important role in mental health, and at times be an indicator that healing is taking place—so much so that there’s overlap between spiritual concepts and therapeutic work.

Inherent in the mindfulness strategies, for instance, that are part of so many therapeutic modalities that have increased in popularity over the last 10 years, is connection—to ourselves, to our bodies, to others, and to the universe at large. Mindfulness as a concept is derived from Zen Buddhism, thus demonstrating that a form of spiritual work can not only provide a pathway and practice for that connection, both on its own and in conjunction with therapy, but that it can actually become a form of therapy. 

In the model of post-traumatic growth, the theory behind how certain transformations can occur following a trauma, one of the domains that indicate that growth is occurring is spiritual development. Though this is often a later stage of healing from trauma, and not something all survivors may achieve or strive for, this model provides hope for a kind of reconnection (or in some cases initial connection) following a traumatic event. 

Baked into the 12-step model of recovery from addictions, almost half of the steps involve opening up to the idea of a Higher Power, and working on ways to maintain and strengthen spirituality. This, in combination with the fellowship format of the program, has helped countless people heal in relationship to others and to a Higher Power. 

Though certainly and erroneously more stigmatized than mindfulness or the mere acknowledgment of something bigger than ourselves, modern witchcraft also provides a direct connection to the Divine. Not all who practice witchcraft consider themselves to be Wiccan or Pagan, and are considered to be practitioners more than believers in any formally structured belief system. Often these practices are focused on connection to nature, honoring changes of the seasons, as well as connecting practitioners to their inherent, often feminine, power. While many are solitary practitioners, there is certainly community available as well that can provide additional relational connection.

Practices and rituals themselves, whether part of an established structure, handed down in the family, or learned online, can have a number of benefits. Tracking the phases of the moon or the astrological movement of the planets can provide a sense of meaning, as well as a heads up about what is to come in order to feel more prepared in otherwise uncertain times, creating a form of radical acceptance of situations we cannot control but can learn to cope with. 

Understanding birth charts can help to understand fundamental differences between people that lead to conflict, in order to get around them. Rituals that remove the “evil eye” or burning rituals that clear negative spirits can provide a sense of protection or relief when someone is scared. Carrying a crystal can increase confidence going into a difficult situation. Increasing a sense of control or hope is part of the benefit of manifestation, rituals of all sorts, and even divination such as use of a pendulum or reading the tarot. While something like tarot can be used to predict the future, it’s also used to seek guidance from the universe, spiritual guides, or even ancestors.

Tarot reading can provide a sense of connection to another realm or to deceased loved ones, reinforcing the feeling that help is available at all times (much like for those who believe in a Judeo-Christian God), and can aid in healing work that one of my clients said “soothes your soul.” Many believe that the Universe wants what is best for them, and even when a hardship occurs, it’s in the interest of their greater good. This can reduce a sense of victimization, and increase self-compassion. There’s no denying that all of these may be things we would wish our clients to cultivate and experience, for their own greater good.

When is Spirituality Harmful? 

Though I have outlined what can be helpful about spirituality, and how we might be more accepting and curious about it as therapists, there have been some situations that gave me pause. One client, for example, began overly relying on pulling tarot cards (and friends’ or books’ takes on the meanings) to make decisions, when her treatment goal was to get more in touch with her gut and trust her intuition—something that had been lost following her trauma.

Another used astrology to write off other people who she believed would be incompatible before getting to know them at all, and explained her feelings with planetary events so often that it became self-invalidating. I wanted her to understand that sometimes she might experience an emotion based on a situation, simply because it’s valid, not just because Venus was conjunct Pluto or the full moon was coming. These are just some of the ways client behavior can cause innocuous spirituality to become harmful to, or at least block, their growth. 

Other times, the spiritual content itself can be harmful. I was troubled to learn that a client was following a spiritual guru of sorts on social media who was teaching that, in order to truly have a spiritual awakening, you must cut off all of the people in your life and replace them with others who understood and shared your new beliefs and practices. Just like any other forms of self-help, spirituality and self-healing is a booming industry, and not everyone can be trusted. 

Sadly, some prey on the desperation of those who want to feel better, and can utilize tactics similar to those that a toxic partner might use, to isolate people in order to indoctrinate them. We as therapists are sometimes tasked with being stakeholders for our clients. Just like with any other social media content, when we learn about something our client has heard, or plans to do, we may need to challenge that which seems harmful or contrary to what we know about our client’s values. 

Harm can also come in a well-intentioned form, such as espousing toxic positivity (“positive vibes only”), including platitudes about trauma being something we signed up for in a past life and agreed to experience, or it being something that we needed in order to learn a lesson. While some survivors may ultimately arrive at these beliefs during a phase of making meaning of their trauma, when pushed on people preemptively, it can be some of the most maddening and invalidating messaging around.

Ultimately, it’s up to us to utilize our clinical judgment about whether a client is using spiritual concepts or practices in an obsessive way to bypass emotional work, or in any way that is harmful for them, based on their core values. 

While I did occasionally ask my clients about religion and spirituality pre-pandemic, I’m so grateful to have had the opportunity to talk about it differently, and more in depth, since it began. These conversations have provided me with so much insight into what additional resources exist for my clients. Spirituality isn’t going anywhere, and it’s something that I plan to explore more with clients going forward. By opening these conversations and ensuring that I’m integrating spirituality into therapy as much as is needed and safe, I can help them feel truly seen and accepted.