Effects of Religious and Spiritual Struggles on Psychotherapy Process and Outcome

Abstract

The present study investigated whether distress related to religious and spiritual concerns (RSC) and a correlated concern, confusion about beliefs and values (CBV), predicted clients’ change in symptom severity over time in psychotherapy. Counseling center data from 18,529 clients seen at a large religious university were used to study client response curves as a function of RSC and CBV. Specifically, symptom severity related to RSC and CBV was estimated using multilevel modeling to predict psychotherapy outcome as measured by the 45-Item Outcome Questionnaire (OQ-45).Multilevel modeling with clients nestedwithin therapists demonstrated that although all clients showed significant decreases in symptom severity over time, clients with CBV and RSC had significantly slower improvement in outcomes than average. The response curve for CBV was slower than that for RSC. This research demonstrates that religious and spiritual problems impact response to psychotherapy. Also, differences in response curves for clients presentingwithCBVin contrast to those presentingwithRSC imply that potentially different treatment approaches are recommended when working with religiously committed clients versus those confused about beliefs and values.