As counselors, we seek to support others in their search for meaning, wholeness and healing. This journey can lead us to work with clients who have had various experiences — both positive and negative — with religion and spirituality. Therefore, we must be prepared to address issues of religion and spirituality when appropriate, especially for those who have survived religious and spiritual trauma.
Many researchers in the social sciences describe religion as a shared set of practices and beliefs and spirituality as a personal relationship with God(s) or a Higher Power. Based on this understanding, an individual could experience spirituality through organized religion, be spiritual but not religious, or participate in religion but not be spiritual. According to the Pew Research Center, 63% of individuals in the United States identified as Christian, 9% identified as a member of a non-Christian religion and 29% identified with no religious tradition in 2021. An increasing number of individuals are leaving the religion they were raised in or not identifying with any religious tradition due to changing beliefs or finding community elsewhere.
Significant life events can shape a person’s spiritual and religious identity. In a recent study on religious trauma, published in the Socio-Historical Examination of Religious and Ministry in 2023, Darren Slade and colleagues found that “likely that around one-third (27-33%) of U.S. adults (conservatively) have experienced religious trauma.” Although no known studies have been done to determine the number of individuals who leave a religious tradition after experiencing religious/spiritual trauma, religious/spiritual trauma can deeply affect how individuals identify with and experience their own religion and spirituality. Understanding clients’ spiritual experiences is a critical part of engaging in multiculturally competent care, especially as research indicates that religion and spirituality can impact meaning making, worldview, social connections, physical and emotional health, and more.
The Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of the American Counseling Association, identified 14 competencies across six areas for addressing religion and spirituality in counseling. These competencies are a helpful framework for understanding ethical ways to address religion and spirituality in counseling when appropriate. The competencies include standards related to basic knowledge of religion and spirituality, awareness of how they may impact a client’s worldview, self-awareness on the part of the counselor and use of appropriate treatment methods in counseling. These competencies are of particular importance when working with survivors of religious/spiritual trauma to avoid further traumatization or inappropriate care.
The impact of religious/spiritual trauma
Religion and spirituality can have a positive impact on overall well-being, but they can also be harmful, damaging or traumatic. Lisa Ruth Oakley and Kathryn Susan Kinmond conducted a study on spiritual abuse and Christian adults in the United Kingdom and found that almost 75% of individuals felt “damaged by a church experience.” (Their findings were published in the Journal of Adult Protection in 2014.)
Religious/spiritual trauma is similar to other types of trauma, and it can overlap or co-occur with physical, sexual or emotional trauma. However, religious/spiritual trauma can be a particularly life-altering experience because religion and spirituality are often lenses through which people view the world. Religious/spiritual trauma can thus impact a person’s sense of identity, their core beliefs and values, and their perception of safety in the world. Moreover, it can deeply alter or damage an individual’s relationship and previous understanding of that which they consider to be sacred.
In a 2022 systemic review published in Spirituality in Clinical Practice, Heidi Ellis and colleagues reviewed 25 studies on religious/spiritual abuse. They identified three common elements of religious/spiritual trauma: misuse of power by religious/spiritual leaders, psychological harm and spiritual harm. Religious/spiritual trauma can be particularly painful when it desecrates core values or co-occurs with other types of trauma, such as sexual or physical trauma. It can also severely impact an individual’s sense of community and relationship with others.
The review found high rates of religious/spiritual trauma across many populations and locations, including the United States, Canada and the United Kingdom, but it indicated that certain populations may be more at risk for experiencing this type of trauma. For example, the review included a doctoral dissertation by Brian Simmons that analyzed data from almost 300 individuals who identified as LGBTQ+ and were either current or former members of The Church of Jesus Christ of Latter-day Saints. Simmons’ study found that almost 90% of participants met components of the diagnostic criteria for posttraumatic stress disorder due to spiritual trauma. This finding contrasts sharply with Slade and colleagues’ 2023 study that suggested 1 in 3 adults experience religious trauma.
Although the Diagnostic and Statistical Manual of Mental Disorders does not distinguish diagnoses based on the type of trauma a client experienced, conversations about religious/spiritual trauma have been occurring in the larger community of mental health professionals. For instance, Marlene Winell, a licensed psychologist, used the term “religious trauma syndrome” to describe the various symptoms that might emerge when an individual leaves a fundamentalist or manipulative religious tradition. Individuals who leave such religious traditions may have to navigate situations and their beliefs in new ways, including their understanding of the Transcendent and personal salvation or even deciding how to dress or talk to others.
The concept of deconstruction (the process of breaking down and exploring underlying previously held beliefs, understandings and practices) can also help provide insight into the unique characteristics of religious/spiritual trauma. Through deconstruction, individuals may leave their faith tradition entirely or emerge with a newfound strength and religious conviction, but the process itself can be highly challenging and requires reconstruction of personal identity and beliefs.
Many common symptoms occur across types and experiences of trauma, including psychological distress, intrusive memories of the trauma and heightened levels of arousal. Religious/spiritual trauma not only affects individuals’ physical, mental and emotional well-being but also their spiritual well-being. Because religious/spiritual trauma can deeply impact clients’ mental health, counselors have a responsibility to develop the knowledge, skills and awareness to support clients who have experienced this type of trauma.
Working with clients experiencing religious/spiritual trauma
Like with other forms of trauma, individuals who experience religious/spiritual trauma vary in their responses and reactions. Some clients may try to preserve their previously held religious/spiritual beliefs, while others may change or abandon their beliefs. As counselors, we may see clients who are conflicted or who do not know how they want to respond to the religious/spiritual trauma.
As with any traumatic experience, we first work collaboratively with clients to establish safety and healing. But there are a few other ways we can ensure we are providing effective care for clients who have experienced religious/spiritual trauma. In the following sections, we highlight key components of care for clients who have experienced religious/spiritual trauma. We also offer examples of specific language counselors can use in session with clients.
Cultivate safety through a trauma-informed approach. When clients have experienced religious/spiritual trauma, they often have a natural and automatic instinct toward self-protection and preservation that may be expressed as guardedness within the therapeutic space. Counselors must carefully consider how they build the therapeutic relationship and create safety with this population. Seemingly small considerations such as asking permission and allowing clients a sense of control can have a significant impact.
For example, counselors can get a client’s permission before asking questions about the trauma: “I’m curious about how that experience felt to you. Would you feel comfortable sharing more about it?” They can also allow clients to decide where to sit in session: “It’s great to see you today. Feel free to sit wherever feels most comfortable.” Or they can validate and let clients have a sense of control and ownership over their experiences: “That experience sounds really heavy. Where are you now emotionally?”
Perform an initial and ongoing assessment of risk. It is extremely important for counselors to assess the client for risk of suicide, self-harm and other safety concerns. This risk assessment should be conducted during intake and accompanied by appropriate follow-up assessments, including assessing if the client is at risk for further religious/spiritual trauma. The client may not be ready to dive into the details of the religious/spiritual trauma, but it is helpful to get a broad sense of what the trauma is, how the client understands the religious/spiritual trauma and where they currently are regarding their personal religion or spirituality.
For example, if a client has experienced trauma perpetuated within a specific religious community, a counselor can assess the client’s current level of engagement in that community by saying, “I hear how important that community was to you at that time. What’s your involvement like now — and how do you feel about it?” Then, it may be helpful to explore with the client the impact of their engagement, including if continued engagement may lead to increased risk of religious/spiritual trauma.
Other areas of assessment include the client’s symptoms such as emotional or physiological experiences, feeling of shame or detachment, and levels of reactivity. Counselors can broach these topics by saying, “How does it feel to talk about what happened? When you talk about the experience, does it feel like you’re telling a story or like you’re reliving the story?” or “That experience sounds so challenging. Which part of the story is the hardest for you to hold right now?”
Remember, regulation before intervention. Clients who have experienced any trauma (including religious/spiritual trauma) may experience symptoms of nervous system dysregulation throughout their daily lives. These symptoms may intensify during the therapy session, especially when discussing the trauma(s) they have experienced. Thus, it is important to make sure clients are not experiencing overwhelm or flooding in the therapy space because this will inhibit the client’s ability to experience the clinical interventions as intended. Grounding and mindfulness interventions (such as progressive muscle relaxation, 5-4-3-2-1 sensation naming activities or gentle stretching) can be helpful when working with this population. It can also be useful to develop a common language with your client so that you can remain attuned to their level of distress throughout the session. This can take the form of hand gestures, a subjective units of distress scale or code words — anything that allows the client to quickly and accurately communicate their level of distress so that the counselor can adjust the clinical intervention as needed.
For example, the counselor may tell the client, “I want to support you as much as possible as we talk about your past experiences. Let’s imagine a 10-point scale, with 1 being the least distressed (e.g., peaceful, at ease, relaxed) and 10 being the most distressed (e.g., angry, anxious, upset). We’ll use this scale throughout our work together so that I can stay attuned to how you’re feeling; I really care about that. Using that scale, where is your level of distress right now?”
If the client shares something about the traumatic experience in session, the clinician could say, “What you just said felt really impactful. Can I check in with you quickly? Where’s your distress level right now on a scale of 1-10?” If the client says they are at a 7, then the counselor could respond, “Thanks for letting me know you’re at a 7. Would it help to pause the story and do some grounding exercises? I can give you a few options to pick from if that’s helpful.”
Considerations for counselors
Working with clients with religious/spiritual trauma requires counselors to develop specialized skills and self-awareness as well as be trauma informed. To provide the best care for these clients, practitioners should not overlook the following four clinical considerations:
- Learn trauma modalities. There are many trauma theories and techniques available for counselors to learn. Most evidenced-based trauma therapies share two primary common factors: First, they provide a corrective emotional experience for clients through a supportive, genuine and boundaried therapeutic relationship. Second, they include an exposure component while remaining respectful of the client’s pace. In some modalities, the exposure component takes a narrative form, and in others, it is conducted via an exposure hierarchy that includes imagined or in vivo exposure to triggers. As with any trauma treatment, it is crucial that pacing be closely monitored by the clinician to ensure that the client is receiving a level of treatment that is challenging but not overwhelming to prevent accidental traumatization. There may be some situations in which exposure work is not appropriate for clients, so counselors need to engage in critical case conceptualization, collaborative decision-making and consultation when determining treatment options. It is imperative that counselors receive thorough and complete training as well as ongoing support for the trauma modalities they practice.
- Understand personal worldview and religious/spiritual experiences. Throughout the process of working with clients who have experienced religious/spiritual trauma, counselors may also experience different feelings, emotions and expectations. It is crucial that counselors manage and identify potential areas of countertransference. This is especially true when considering how the counselor’s own experiences of religion and spirituality could impact their work with the client. Bracketing is one tool counselors can use to manage their own experiences; Michael Kocet and Barbara Herlihy, in a 2014 article on ethical decision-making published in the Journal of Counseling & Development, defined ethical bracketing as a practice in which a counselor intentionally sets aside their beliefs and personal views when working with a client. In alignment with the ASERVIC competencies, counselors also need to understand different religious/spiritual traditions and perspectives outside of their own to avoid assumptions or generalizations. Clients experiencing religious/spiritual trauma may not be able (or ready) to leave the environment in which they experienced trauma. In these situations, taking a harm reduction approach can help clients explore ways to increase their safety while feeling understood and supported by the counselor.
- Foster resilience. Burnout, compassion fatigue and vicarious trauma are risks for counselors engaging in trauma work. However, an emerging body of research also suggests that counselors may experience vicarious resilience and other positive impacts from witnessing posttraumatic growth and resilience in clients. Using a wellness-focused and strengths-based model can help build resilience in both the survivors we work with and in our own personal lives.
- Take care of yourself. Because trauma work can be challenging, we encourage counselors engaging in this work to actively care for themselves. Supervision and consultation are vital, especially when working with clients experiencing religious/spiritual trauma. These spaces can facilitate growth in clinical skills as well as the development of professional support networks. In addition to supervision and consultation, self-care is key to preventing compassion fatigue, vicarious trauma or burnout. When a counselor is grounded in their own life’s peace and meaning, they are better able to create a space for clients to cultivate these in their own lives.
Religious/spiritual trauma is unique in its ability to uproot even the most deeply held beliefs in a person’s life, including those related to self, identity, religion, spirituality and the world. Working with clients who are navigating through religious/spiritual trauma can be challenging, but if counselors take the time to gain awareness and develop the clinical skills needed to help this population, then the work can be a profound and meaningful experience for both the client and the counselor.
Diane Walsh is an assistant professor of counseling at McDaniel College in Maryland. She is a licensed graduate professional counselor who maintains a small caseload of clients. Her research areas of interest include religion, spirituality, social class and counselor education.
Gillian Koch is a licensed professional clinical counselor in Minnesota. She served as president of the Minnesota Counseling Association for two years and is currently serving as the board’s past president. She works in private practice and specializes in supporting health care professionals as well as folks experiencing grief and loss.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.