The scale of the problem is difficult to overstate. Surveys suggest that approximately 27 to 33 percent of U.S. adults report religious trauma, a figure that implies tens of millions of people carrying psychological, spiritual, relational, and somatic injuries linked to their religious lives. Yet current diagnostic frameworks, the paper argues, do not fully capture these consequences. Survivors may present with symptoms that resemble post-traumatic stress, complicated grief, or moral injury, but the harm is threaded through their relationship with the divine, their sense of identity, and the communities that once structured their entire social world. Clinicians are actively treating this population without validated guidance, improvising from adjacent trauma literatures.

Summers grounds the framework in attachment theory, the account of human development first articulated by John Bowlby, in which infants build internal working models of relationships from the responsiveness of their caregivers. Research on the psychology of religion has extended this logic upward: many believers treat God as an attachment figure, a source of proximity, comfort, and safe haven whose perceived responsiveness shapes emotional regulation much as a parent’s does. Experimental work has supported this picture, showing that activating thoughts of God can buffer distress in ways that track a person’s internal working models. If God functions as an attachment figure, then abuse mediated by religious authority can wound the very attachment system that once provided the survivor’s deepest sense of safety.

This is why the framework treats attachment to God and the God image as primary clinical targets, distinct from general psychological symptomatology. A survivor may reduce their anxiety scores while still carrying a terrifying or humiliating internal representation of the divine, one that reactivates under stress, prayer, or even the sight of a church steeple. The framework also attends to the developmental pathways through which each survivor’s religious life was formed. Someone raised from childhood inside a high-control community has a different architecture of harm than an adult recruited into an abusive group, and the clinical entry points differ accordingly. Religious life, in this view, is not a belief system bolted onto a personality but a developmental structure interwoven with emotion regulation, identity, and relationships.

The five clinical targets around which the framework is organized come from the psychotherapy literature on trauma more broadly: they encompass the survivor’s capacity for emotional regulation, their attachment relationships, their sense of self, their narrative and meaning-making, and the somatic residues of threat that lodge in the body. Religious and spiritual abuse touches each of these. Shame, a recurrent theme in the empirical literature on religious trauma, functions as a self-directed emotion that corrodes identity rather than merely signaling bad behavior. Studies of former members of high-demand religious groups point to identity, meaning, and social support as the key mediators between spiritual abuse and psychological outcomes, which is precisely the territory these targets are designed to cover.

Against those targets, the framework positions four therapy modalities, selected on theoretical grounds rather than on outcome data, which for this population does not yet exist. Emotionally focused individual therapy, developed from Susan Johnson’s attachment-based model, works directly on emotional processing and the restructuring of attachment bonds, making it a natural fit for a survivor whose attachment to God has become a source of terror rather than comfort. The approach has a substantial process research base in couples work and a manualized individual variant, and its core claim, that adaptive adult functioning depends on accessible and responsive attachment figures, translates coherently to survivors reworking their image of the divine.

Internal family systems therapy offers a different technical angle. Richard Schwartz’s model conceptualizes the mind as a system of subpersonalities, or parts, including exiles carrying trauma burdens and protectors that manage them, led by a core Self with capacities for calm and compassion. A pilot effectiveness study of internal family systems for PTSD among survivors of multiple childhood traumas reported reductions in symptoms, and the model’s pluralistic view of the self maps well onto survivors who hold warring internal positions, the devout believer and the furious critic, the obedient child and the escaping adult. Narrative therapy, meanwhile, addresses the meaning-making target directly: abusive religious systems often supply totalizing stories that define the survivor’s worth, and narrative practice helps people externalize those stories and author alternatives, a technique with growing support in trauma-related disorders.

The fourth modality, somatic experiencing, developed by Peter Levine and grounded in part in Stephen Porges’s polyvagal account of the autonomic nervous system, targets the body. Religious abuse frequently deploys fear of eternal punishment, social exclusion, and divine wrath, threats that condition deep physiological defensive responses. Somatic experiencing works by titrating discharge of survival energy and restoring regulation of the autonomic nervous system, and it is one of the few modalities in the framework supported by a randomized controlled outcome study for PTSD, published in 2017. For survivors whose religious fear lives in their bodies as much as in their beliefs, this somatic route addresses a dimension that talk-centered therapies can miss.

The paper is careful about the limits of what it can claim. The four modalities are presented as promising, not proven, for this specific population, and the theoretical fit of each to the harm dimensions of religious abuse is an argument, not a demonstration. Measurement itself remains immature: spiritual abuse questionnaires and scales such as the Spiritual Harm and Abuse Scale have only recently been developed, and definitional debates continue across the literatures on spiritual abuse, religious trauma, and adverse religious experiences. A systematic review of empirical work on religious and spiritual abuse and trauma confirmed a growing but still thin evidence base, concentrated in descriptive studies rather than treatment research.

That gap is the paper’s closing argument. With roughly a third of American adults reporting religious trauma and no intervention outcome studies of any design available, the field’s most urgent priority, Summers writes, is rigorous testing of treatments for survivors of adverse religious and spiritual experiences. Until those trials exist, clinicians must work from theory, and the value of this framework lies in making that improvisation systematic: matching specific dimensions of harm to specific therapeutic mechanisms, honoring the attachment relationship with God as a clinical target in its own right, and giving researchers a structured map of where the evidence must go next. For a population that has often been told its pain is not real, the recognition that it demands serious science is itself a clinical intervention.

Subject of Research: Attachment-informed clinical framework for treating religious and spiritual abuse as trauma

Article Title: Religious and Spiritual Abuse: Trauma, Attachment, and an Integrative Framework for Clinical Response

Article References: Summers, H. (2026). Religious and Spiritual Abuse: Trauma, Attachment, and an Integrative Framework for Clinical Response. Pastoral Psychology. https://doi.org/10.1007/s11089-026-01375-y

Image Credits: AI Generated

DOI: 10.1007/s11089-026-01375-y

Keywords: religious trauma, spiritual abuse, attachment theory, attachment to God, trauma-informed care, emotionally focused therapy, internal family systems, narrative therapy, somatic experiencing, clinical framework, Pastoral Psychology, psychotherapy