How Therapists Often Fail Religious Clients

Religious belief and practice remain central to the lives of large segments of the public, yet many mental health professionals assign relatively little importance to religion and feel unprepared to address faith-related issues in clinical work. This article examines the gap between therapists’ and clients’ religiosity, reviews evidence that religion is often intertwined with mental health outcomes, and considers how neglect of religious concerns can impede therapeutic alliance and effectiveness. Without advocating faith-based therapy or proselytization, the article argues for greater religious literacy, cultural competence, and openness among clinicians, emphasizing the need for a more balanced, research-informed approach to religion in psychotherapy.

Keywords: religion and psychotherapy, cultural competence, religiosity, bias in psychotherapy, spirituality, mental health

A typical client who walks into a therapist’s office is likely to encounter a practitioner who assigns far less importance to religion than does the client. One survey found, for example, that only about one-quarter of cognitive and behavioral therapists professed a certain belief in God. Just under half of the clinician sample deemed themselves nonbelievers.¹ Another study found that 50% of academic psychologists considered themselves atheists, and an additional 11% were agnostic.² In this survey, psychology professors emerged as the least religious of all academics studied.

The United States public overwhelmingly values religion and believes in God.³ Only about 4% say they are atheists, and—although the past decade may have witnessed some slight declines in religiosity—for quite a while, about eight to nine out of every 10 American adults reported a belief in God. Roughly three-quarters of the public identifies with some religious faith. According to a 2025 survey of United States respondents, 67% report praying at least sometimes and 44% pray daily. About one American in three says grace (or prays) before meals “always or often.” For people affiliated with historically Black Christian churches, this number rises to approximately two in three.⁴ While Western Europeans are somewhat less religious than Americans, many from other parts of the world tend to view religion as even more central to their lives. In quite a few non-European countries, atheism—or at least a willingness to report atheism to pollsters—is virtually nonexistent; for example, in Bangladesh, Egypt, Pakistan, the Philippines, Nigeria, Thailand, Indonesia, Ghana, and Georgia (among others), less than one-half-of-one percent of people say they do not believe in God.⁵ As the United States becomes increasingly diverse, immigrants from such backgrounds become an ever-larger percentage of the public served by mental health practitioners.

People in need of psychological assistance may resist seeking care if they feel they will be openly or secretly denigrated because of their religious beliefs. The therapist-client gap in religiosity does not necessarily lead to insensitivity, but clinicians and patients report various difficulties that can impede therapeutic progress, even when everyone is well-intentioned.

Pastoral counseling can, of course, meet the needs of religiously observant clients who seek therapy within the context of a particular religious tradition. But plenty of people who do not choose this path still want—and would benefit from—a therapist with religious literacy and knowledge about faith-based issues.

Though therapists exist at all levels of religiosity and a growing number today think of themselves as “spiritual but not religious,” many are uncomfortable discussing religious matters in therapy, and some—when they do consider organized religion—view it mainly as a source of dysfunction. This is partly a legacy from Freud, Ellis, and other founders of clinical psychology. In 1993, the prominent Yale clinician Seymour B. Sarason commented with some concern that, if a psychologist learned that a colleague was “... devoutly religious, or even ... [tended] in that direction,” most of the time he or she would “... look upon that person with puzzlement, often concluding that [the] psychologist [in question] had or has personal problems.”^6(p187) However, the reluctance to deal with religious matters also stems from a reasonable unwillingness to cross the line between therapy and proselytization for one’s own religious or nonreligious views, whatever they may be.⁷

Another concern is the inadequacy of clinical training in teaching practitioners to address religious issues in therapy.⁸ In one study, about one-fifth of therapists admitted to never discussing religious matters in therapy.¹ Several studies document psychologists’ belief that religion and spirituality have not been adequately addressed in their clinical education, despite the imperative to incorporate such issues as part of the diversity agenda.⁹

Sometimes, religious knowledge is needed to address specific client conditions. Research suggests, for example, that schizophrenia is no more likely among the religious. However, religiosity may influence how the condition manifests, for instance, in the content of particular delusions and hallucinations. Similarly, therapists might need some background in religion to distinguish culturally sanctioned religious behavior from pathology.¹⁰

Mainstream therapy should not become faith-based, but several recent works have argued that neglecting religious issues can negatively impact the therapeutic process and client outcomes.¹¹ For starters, if a therapist seems uncomfortable or unreceptive to discuss religious matters, a client may not share problems and potential solutions steeped in religion because they fear an ignorant or negative response. Thus, a central part of the client’s life and significant resources for improvement would be inaccessible to the therapist.

Thousands of studies conducted over the past three decades have explored the relationship between religion and health, encompassing both physical and mental aspects.¹² It is now clear that religious beliefs and practices are often intertwined—for better or worse—with psychological well-being. Most meta-analyses of this literature conclude that, on balance, religious belief and affiliation are net positives. For example, the religiously affiliated seem to receive benefits in longevity, mental health, the ability to cope with severe illness, avoidance of substance abuse, and an obedience to the law. Needless to say, there is much room for debate about why these correlations occur and their generalizability. Park and Slattery¹³ offer one thoughtful model highlighting the many variables that mediate the relationship between religiosity and mental health outcomes.

Proponents of a greater integration of religion into therapy argue that the world’s religious traditions, both Eastern and Western, can sometimes be a source of insight and mental health.¹⁴ They suggest that religion can provide a positive outlook, hope for the future, a sense of control, a pathway to meaning, constructive role models, and an ability to integrate loss.¹⁵ No reasonable person would claim that religion always provides these benefits, and it is not hard to see how religion could be a destructive force for some clients. Regardless, the religious aspect of clients’ lives should often be examined in therapy by therapists who are at least willing to bracket their own preconceptions about faith. Even a modest familiarity with a patient’s religious practice can greatly support the therapeutic alliance.

Most psychologists would benefit from greater cultural competency in religious matters and from an evenhanded, open-minded, and more research-based attitude toward the role that religion plays in clients’ lives. Recently, some psychologists have argued in favor of formalizing religious and spiritual competencies for psychologists. Vieten and her colleagues¹⁶ developed 16 religious and spiritual competencies and evaluated their acceptability to a sample of practitioners. Applying these competencies to practice, a therapist needs to:

• show “empathy, respect, and appreciation”¹⁶ for clients from diverse spiritual, religious or secular backgrounds;

• understand how one’s own religious or nonreligious outlook might influence one’s clinical approach;

• develop awareness of the kinds of experiences clients might have with religion;

• acquire familiarity with research on religion, spirituality, and the psychology of religion;

• help clients explore spiritual and religious resources that might aid in managing life concerns;

• ask about spiritual and religious matters when they take a client history; and

• consult with, or refer to, persons more knowledgeable about particular religious practices when needed.

The boundary between religious belief and health care may be growing more porous.¹⁷ Several scholars, for example, have proposed various models for integrating spiritual and religious matters more effectively into cognitive-behavioral and rational-emotive therapy.^18,19 Future research and debate should address whether and how these projects should proceed.¹²

Even if one accepts that religion and spirituality can be constructive forces, there are reasonable arguments for keeping some aspects of religion out of therapy. It is essential to avoid turning therapists into proselytizers or arbiters of questions of faith. The therapist possesses power, and such power could, of course, be abused. Still, given the history of negativity toward religion among many early theorists and practitioners of clinical psychology, the field would benefit from a serious and foundational reassessment of the desired relationship between religion and therapy. Therapists should evaluate just how porous they want the wall between religion and therapy to be. As with other aspects of one’s treatment approach, there is no reason to insist on a single solution or to require that one size fits all.

Nonetheless, nearly all psychologists would benefit from a richer understanding of the centrality of religious belief and practice in the lives of many who seek their assistance. After all, religion is commonly a defining aspect of a patient’s culture. Religion also frequently lies at the core of a person’s identity and self-definition. Few contemporary psychotherapists would consider it responsible to ignore matters of culture and identity, and it is therefore hard to see how the current neglect of religion can be justified.