In clinical training and professional settings, we are taught the importance of ethical practice: to “do no harm,” to be non-discriminatory, and to respect the identities of our clients. Yet one area that often receives only surface-level attention is the inclusion of spirituality and religion within the therapeutic relationship. This inclusion can be viewed through the lens of multicultural dimensions.
Historically, spiritual and religious themes were seen as either irrelevant or potentially inappropriate to discuss in therapy. In some circles, such conversations were discouraged, dismissed as unscientific, or pathologized altogether. But the field has evolved—and continues to evolve—toward a more expansive view of identity and wellness, recognizing that spiritual and religious beliefs can be central to a person’s worldview, coping strategies, and meaning-making.
From Catholicism to Wicca, from sacred texts to tarot cards, religion and spirituality span both structured tradition and personal revelation—each a valid expression of the human search for meaning, connection, and the divine.
From a cultural perspective, ignoring a client’s religious or spiritual identity is not just a missed opportunity for connection and insight—it can actually be an ethical misstep.
The Ethical Landscape
The major codes of ethics in the U.S. are clear about one thing: discrimination based on religion is unethical. The following organizations include religion in their nondiscrimination policies:
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American Psychological Association (APA)
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National Association of Social Workers (NASW)
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American Association of Marriage and Family Therapists (AAMFT)
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National Board of Certified Counselors (NBCC)
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American Counseling Association (ACA)
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The Association for Addiction Professionals (NAADAC)
Of these, only the ACA and NAADAC make specific mention of spirituality, both in regard to respecting client belief systems and in attending to the spiritual self-care of the therapist. For instance:
ACA Code of Ethics (Section C, Introduction):
“Counselors engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities.”
NAADAC Code of Ethics (Section III.18):
“Addiction professionals shall continuously self-monitor… Providers shall engage in self-care activities that promote and maintain their physical, psychological, emotional, and spiritual well-being.”
Additionally, both ACA and NAADAC encourage appropriate referrals to religious or spiritual leaders when necessary, further underscoring the integration of these dimensions into ethical practice.
Spirituality and Religion: Not the Same Thing
It is vital to understand the distinction between spirituality and religion:
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Religion is typically structured, often involving organized beliefs, rituals, and doctrines. It is usually a closed system with explicit tenets and community-based practices.
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Spirituality, on the other hand, is often open, fluid, and implicitly expressed. It may involve a sense of connection to something greater than oneself, practices of inner reflection, or the search for meaning and purpose.
Therapists must be able to hold space for both—and to inquire sensitively about the client’s unique expressions of these experiences. Assuming religion and spirituality are synonymous—or assuming either is irrelevant—is a form of cultural blindness. Instead, we must broaden our understandig of multicultural dimensions within counseling and therapy.
A Multicultural Imperative
Religion and spirituality are central components of many people’s cultural identities. While U.S.-based professional organizations are increasingly integrating these dimensions into multicultural competence frameworks, the same cannot be said for some international counterparts. For example, current ethics codes for:
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UK Council for Psychotherapy (UKCP)
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British Association for Counselling and Psychotherapy (BACP)
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College of Registered Psychotherapists of Ontario (CRPO)
do not explicitly mention spirituality or religion as part of multicultural competence. This omission reflects a wider pattern of assuming secularism or neutrality within clinical settings—when, in fact, neutrality may unintentionally obscure essential parts of a client’s experience.
Embracing the Sacred in the Room
It is time to reframe our understanding. Spirituality and religion are not “off-topic” in therapy—they are part of the landscape. Therapists must create an open invitation for clients to bring all of who they are, including their sacred practices, beliefs, doubts, rituals, and questions.
To ignore these dimensions is to miss an opportunity for authentic engagement. And in some cases, it may border on unethical neglect.
A valuable resource for counselors looking to expand their capacity in this area is ASERVIC (Association for Spiritual, Ethical and Religious Values in Counseling), a division of the American Counseling Association. ASERVIC provides extensive guidance on how to integrate spiritual and religious values into ethical, culturally competent practice. Their white paper on spirituality competencies is a must-read for practitioners committed to truly holistic care.
Final Reflection
As therapists, we are not required to share the beliefs of our clients—but we are ethically bound to respect them, to remain curious, and to integrate them when relevant. Spirituality, in its many forms, can be a powerful force for healing. When we make room for that in the therapy space, we honor not only the profession’s evolving ethical standards but also the profound, multidimensional humanity of the people we serve.
Summarized from:
Nagel, D.M. & Edelman, G.N. (2023). Spiritually integrated coaching: Case in point. In D.M. Nagel & M.L. Akridge (Eds). Case Studies in Spiritual Coaching: A Survey Across Life, Wellness and Work Domains. Charles C. Thomas, Publisher.
Nagel, D.M. & Akridge, M.L. (2023). Conclusion. In D.M. Nagel & M.L. Akridge (Eds). Case Studies in Spiritual Coaching: A Survey Across Life, Wellness and Work Domains. Charles C. Thomas, Publisher.
