Front Porch Essay #2

Working with Spiritual Concerns in Mental Health Practice
Gene Deegan, Psy.D and Monika Eichler, LMSW?

When working with spiritual concerns in mental health practice, several questions seem to arise. One is "Why is it important?" Another is "Can I, as a professional, explore this dimension?" Finally, the question of "how" arises. In other words, "How does one approach this sensitive and often controversial area with clients?"

First, we’ll address the question of "Why is it important to address spiritual concerns?" At the National Mental Health Consumer’s Self-Help Clearinghouse Summit in 1999, attendees were asked to reflect on the important aspects of recovery. They were asked, "What are the top priorities for supports necessary to the recovery process?" as well as "What are the values that are most important to recovery?" "Relationship with God" and "spirituality" were common answers to these questions.?

In our own research, 85% of those surveyed (professionals and consumers) believe that spirituality should be explored in the context of recovery. Similarly, 91% of those responding to an NASW survey by Canda and Furman (1999) said they have dealt with "nonsectarian spirituality in their practice."

In Mental Health: A Report of the Surgeon General (2001), David Satcher, M.D., Ph.D., highlights the importance of spiritual beliefs, practices, and communities as mental health resources for members of minority groups and cultures. Such citizens are often reluctant to seek out help from the mental health establishment. They frequently use their indigenous spiritual resources as a natural alternative.

Since the 1980's, research has demonstrated a clear connection between spirituality and positive health outcomes, including less depression, less pain, greater health-related knowledge, and behaviors that enhance recovery from illness (Levin, 2001). In 1997, the Journal of American Medical Association published a special volume on spirituality, religion, and medicine in which they urged physicians and medical educators to "become more aware of the importance of spirituality in patients’ lives" (Levin, Larson, Puchalski, 1997). As a leader in defining standards of medical practice, the American Medical Association’s acknowledgment of this importance marks a new era that encourages the exploration of the spiritual dimension in health care.

Now we’ll address the question, "Can I, as a professional, legally and ethically respond to clients’ spiritual concerns?" The First Amendment of the U.S. Constitution guarantees freedom of religious expression. Interpreting this "religious freedom clause," recent Supreme Court rulings have required public agencies to provide reasonable accommodations to facilitate disabled clients' spiritual expression and development (McNeely, 1995). However, the "separation clause" of the First Amendment of the US Constitution prohibits 1) promoting one religion or faith group over any other; 2) promoting a religiously based life over a secularly based life; and, 3) promoting a secularly based life over a religiously based life. Mental health professionals can respond to their clients' spiritual concerns. However, they must respect clients’ own spiritual and religious inclinations, and not impose other spiritual beliefs, practices or values on them.?

Finally, we'll address the question of "how" to approach spiritual concerns. As with all concerns, one should approach these with respect, tolerance, and validation.

Ethical standards from professional associations further guide our practice in approaching spirituality. According to the Code of Ethics for the National Association of Social Workers, for example, "Social workers should not take unfair advantage of any professional relationship or exploit others to further their personal, religious, political, or business interests."

Using the resources described above, we have developed a few basic guidelines for our own practice. These include:


  1. Do facilitate the exploration of spiritual concerns, but only if out client seeks that exploration.
  2. Do accommodate clients' access to spiritual resources in the community when needed.
  3. Do refer to appropriate resources, especially when we don't feel qualified in a particular area.
  4. Do follow our client's lead.


  1. Don't pressure consumers to explore spiritual concerns when they don’t want to.
  2. Don't judge the merits of clients' spiritual or religious beliefs.
  3. Don't proselytize.
  4. Don't encourage clients to follow our spiritual beliefs or practices.

The role of the mental health professional is to facilitate consumers’ access to a spiritual life and spiritual resources, if these are sought, without imposing any specific spiritual beliefs or practices on them.


Canda , E.R. & Furman, L.D. (1999) Spiritual Diversity in Social Work Practice: The Art of Helping. New York: Free Press

Department of Health and Human Services (2001). Mental health: Culture, race and ethnicity: A supplement to mental health: A report of the surgeon general. Washington, DC: Author

Levin, J.S. (2001) God, Faith, and Health: Exploring the Spirituality-Healing Connection. US: John Wiley & Sons.

Levin, J.S., Larson, D.B., Puchalski, C.M. (1997) Religion and Spirituality in Medicine: Research and Education. JAMA, 278, 792-793.

McNeely, R. (1995). The secularizing of the faith: Recent supreme court decisions regarding religion. Premise, 2 (6), 8-15.

National Association of Social Workers. (1996). The NASW Code of Ethics. Washington, DC: Author.