Cultural processes for addressing clients' spiritual and religious identities in psychotherapy: A proof-of-concept investigation.

Limited research has examined cultural processes for addressing spirituality and/or religion (S/R) in psychotherapy. In total, 143 religious and/or spiritually oriented psychotherapy clients who preferred a spiritually integrated approach completed outcome measures (well-being, depression, anxiety, spiritual struggles) in the first month of treatment and 3 months later. Participants also completed assessments of treatment dropout and satisfaction, along with validated measures of their clinician's cultural humility for their S/R, clinicians' cultural missed opportunities for addressing their S/R, and their own concealment of S/R, at follow-up. Cultural processes related to S/R were associated with treatment outcomes, dropout, and satisfaction in anticipated directions in bivariate analyses. Findings for cultural humility fell to nonsignificant in the presence of baseline outcomes, working alliance, and other cultural processes. In contrast, adverse cultural processes emerged as robust correlates of indices for a successful course of psychotherapy in multivariate analyses. Specifically, clients' concealment of their spiritual and/or religious identities was uniquely associated with poorer outcomes (lower well-being, greater anxiety symptoms and spiritual struggles) and clinicians' missed opportunities to discuss S/R in the treatment process were uniquely linked with lower satisfaction. Cultural processes did not predict the likelihood of dropout beyond the participants' working alliance ratings. Overall, this pattern indicates the utility of attending to cultural processes associated with addressing S/R in psychotherapy with religious and/or spiritually oriented clients while also highlighting a need for rigorous research that might advance clinical training and practice along these lines. (PsycInfo Database Record (c) 2026 APA, all rights reserved).