Therapists Weave Spirituality and Psychology Into One Clinical Practice, Study Finds

Spirituality and psychotherapy, split apart more than a century ago by Freud’s insistence that religion was an illusion, are being quietly stitched back together in hospital corridors and training clinics across Ontario. A new qualitative study published in Pastoral Psychology offers one of the most detailed looks yet at how novice therapists actually understand spiritually integrated psychotherapy, or SIP, a modality that deliberately brings clients’ religious and spiritual lives into the therapeutic conversation. The research, conducted by Angela Schmidt, Maryka Potgieter, and Thomas St. James O’Connor, followed eleven master’s-level psychotherapy and spiritual care students as they learned to practice SIP in hospital practicum settings, and its findings challenge the long-standing assumption that the sacred and the psychological are separate professional domains.

The historical backdrop matters here. Before Freud published The Future of an Illusion in 1927, the care of souls, a phrase Socrates used in Greek and from which the word psychotherapy ultimately derives, was an integrated enterprise in which religious traditions, philosophy, and early psychology worked in concert. Freud’s atheism and his dismissal of religion as wishful thinking helped drive a wedge between pastoral care and clinical treatment that persisted throughout the twentieth century. Only in recent decades has the pendulum swung back. A growing body of evidence, including a comprehensive 2018 meta-analysis and national surveys showing that most mental health clients consider religion and spirituality relevant to their wellbeing, has pushed SIP into the mainstream of mental health and healthcare practice.

Yet despite this clinical momentum, researchers knew surprisingly little about how practitioners themselves conceptualize the approach. Most existing studies measure outcomes or client preferences; few have examined the mental models of the therapists doing the integrating. Schmidt and her colleagues addressed this gap with a practice-based qualitative design, recruiting eleven participants enrolled in supervised psychospiritual education programs at theological colleges affiliated with the Toronto School of Theology. These programs train master’s-level students whose curricula align with the competencies required by provincial psychotherapy regulators, meaning graduates qualify for registration as psychotherapists. The participants were learning to engage in SIP while completing clinical placements in hospitals serving as practicum sites.

The methodological apparatus was rigorous for a qualitative study. Participants completed weekly clinical reflections throughout their placements, producing forty-four anonymous reflection forms, and then sat for post-study semi-structured interviews. The researchers analyzed the data using constant comparative methods, an iterative approach in which emerging codes are continuously compared against new data until stable themes crystallize. They also employed both data triangulation, drawing on multiple sources of evidence, and investigator triangulation, with all three authors coding and analyzing the material manually rather than relying on qualitative data management software. This combination is designed to guard against the single-analyst bias that can distort interpretive research.

Three primary themes emerged from the analysis, and together they paint a striking picture. First, participants described spirituality and psychotherapy as inseparable and interwoven throughout clinical practice, not as two tools pulled from different boxes depending on the client. For these novice therapists, the sacred was not an add-on module activated only when a client raised religious concerns; it was woven into the fabric of every session. This finding suggests that, at least for practitioners trained in integrated programs, SIP is less a technique and more a fundamental orientation toward the therapeutic encounter.

Second, participants understood SIP as rooted in a wholistic view of personhood, which made it applicable to all clinical encounters, including those with nonreligious clients. This is a subtle but consequential point. If spirituality is understood broadly, as the dimension of human experience concerned with meaning, purpose, and connection to the sacred or transcendent, then every client has a spiritual life worth attending to, whether or not they belong to a faith tradition. The participants’ framing echoes the work of Kenneth Pargament, whose foundational 2007 text defined spiritually integrated psychotherapy as understanding and addressing the sacred in its many forms, and it aligns with large-scale research on spirituality and meaning-making showing that spiritual processes operate across religious and secular contexts alike.

Third, participants described an alignment, a good fit, between their personal and spiritual identities and person-centered therapy, and they treated this congruence as the foundation of their clinical work. Person-centered therapy, developed by Carl Rogers, emphasizes empathy, unconditional positive regard, and the therapist’s authentic presence rather than directive technique. For these trainees, the relational stance of person-centered practice resonated with their own spiritual commitments, making SIP feel less like a foreign import and more like a natural extension of who they already were. The study suggests this identity-practice alignment is what grounds their clinical encounters and sustains their confidence in bringing spiritual dimensions into the room.

Taken together, the three themes point to what the authors call a unified ontological conceptualization of SIP, grounded in a relational understanding of both person and practice. Ontology, in this context, refers to beliefs about the fundamental nature of reality and of the human being. The participants were not treating spirituality and psychology as two parallel languages requiring translation; they operated from an underlying vision of the person as an integrated whole, in which the psychological and the sacred are aspects of a single reality encountered through relationship. The researchers note a conceptual resonance with the Indigenous framework of two-eyed seeing, or Etuaptmumk, articulated by Mi’kmaq elder Albert Marshall, in which one eye is trained on the strengths of Indigenous knowledge and the other on Western knowledge, with the two perspectives deliberately woven together rather than held apart.

The implications for training are significant. The authors argue that supervised education in SIP should include ontological integration, helping trainees develop a unified worldview, rather than treating spirituality and psychology as separate domains that students must learn to toggle between. This matters because the field is expanding rapidly: theological colleges in Canada are training growing cohorts of psychotherapists and spiritual care practitioners whose clinical specialty is spiritual integration, and organizations such as the Association for Clinical Pastoral Education have developed formal SIP training programs with defined clinical competencies. If novice practitioners naturally conceptualize the work as unified, training models that fragment the material may work against the very integration they aim to teach.

The study also contributes to a broader methodological movement. Practice-based evidence, the paradigm of deriving knowledge directly from routine clinical settings rather than controlled laboratory conditions, has been championed by researchers seeking to bridge the gap between research and real-world practice. By examining how practitioners think rather than merely what outcomes they achieve, this study adds a cognitive and formational dimension to that evidence base. The authors note that a separate paper drawn from the same dataset will address how competency in SIP is actually learned in clinical practice, promising further insight into the formation of the next generation of spiritually integrated therapists. As healthcare systems increasingly recognize spirituality as a dimension of serious illness and health, understanding how clinicians internalize this integration may prove as important as the integration itself.

Subject of Research: How novice psychospiritual therapists and spiritual care interns conceptualize spiritually integrated psychotherapy in clinical practice

Article Title: Weaving the Sacred and the Psychological: A Practice-Based Study of How Practitioners Conceptualize Spiritually Integrated Psychotherapy

Article References: Weaving the Sacred and the Psychological: A Practice-Based Study of How Practitioners Conceptualize Spiritually Integrated Psychotherapy. (n.d.). https://doi.org/10.1007/s11089-026-01377-w

Image Credits: AI Generated

DOI: 10.1007/s11089-026-01377-w

Keywords: spiritually integrated psychotherapy, pastoral psychology, qualitative research, person-centered therapy, clinical training, spirituality, psychotherapy, practice-based evidence, spiritual care, mental health, two-eyed seeing, wholistic personhood