Spirituality in trauma and grief psychotherapy

Hi, everybody and welcome back. It's Mary, the OG Woo Woo therapist.

And as usual, everything I talk about today is not intended to take the place of counseling or therapy but to highlight some of the issues that could or need to be addressed with a licensed counselor or therapist. None of the information that I'm going to talk about should be used to self-diagnose or diagnose anybody else with a mental health disorder or any issues related to the topics that I'm going to talk about today. Only a licensed practitioner can and should do that.

Today we’re talking about something that many therapists, counseling students, and clients feel unsure about at first… spirituality in psychotherapy. And this can be a touchy subject because spirituality is not religion necessarily — but meaning, purpose, identity, and how clients connect to the world around them and make sense of suffering. Spirituality refers to a personal, internal experience of connection to something larger than oneself. The core features are that it is individual and subjective, focuses on meaning, purpose, and values, and may or may not involve belief in God, it is flexible and self-defined, and often experiential rather than institutional. Spirituality can exist outside religion.

If you’ve ever sat with someone who asked, “Why did this happen to me?” or “Who am I now?” — you have already encountered the spiritual dimension of therapy. The quest for meaning making and identity. When clients are healing from CPTSD trauma there is a great deal of grief for the past they never had but wanted so badly. In trauma therapy, spirituality and religion can both become powerful healing resources — but they function differently, influence treatment in distinct ways, and require different clinical skills from therapists.

In this episode, we’ll walk through real clinical moments, talk about what therapists are actually thinking in those moments, and connect it all to counselor training and ethical practice. As you listen, see if you can notice three things: when spirituality naturally enters the conversation, what the therapist chooses not to do, and how meaning-making becomes part of clinical work.

Think of this as sitting in on a supervision session for counseling students or “baby therapists” who are gaining clinical hours for licensure. I am an LPC-S in the state of Texas and take ethical issues quite seriously when it comes to spirituality in the therapy room. Spirituality helps clients rebuild internal meaning systems when old beliefs no longer make sense.

So, what do we mean when we talk about spirituality? 

In counseling, spirituality is a broad idea. It might involve religion — but often it doesn’t. It can be a sense of purpose, connection to others, nature, values, or simply the belief that life has meaning. I tell my clients that it is about how they connect to the world around them. What’s important clinically is this, spirituality shapes how clients interpret suffering. Two people can experience the same trauma and walk away with completely different psychological outcomes depending on the meaning they assign to it. And that meaning system is often spiritual or existential.

A good example of trauma and grief is right here in north Texas where we have a lot of tornadoes. When the crisis of a situation that is out of our control is over, we see many times that there are folks who can acknowledge what happened, find the gratitude that is in their situation or experience and rebuild their lives. They grieve their losses and comfort others around them and find some peace for themselves.

There are others though that stay stuck in the moment of horror that a tornado bearing down on their home strikes in their hearts. Or theirs is the only house that didn’t get hit and now they are in existential crisis with survivors’ guilt. They are filled with tremendous grief and the trauma of what happened. Finding meaning and identity after losing it all is challenging to say the least, but somehow the ones who move on do and it seems it is usually gratitude and their trust in a higher power for sparing their lives that pulls them through. And the others who don’t pull through, hopefully come to therapy.

In supervision, I tell trainees that spirituality usually shows up indirectly. Clients don’t say, ‘I want to discuss spirituality today.’ Although some do. They say things like, ‘Nothing makes sense anymore.’ That’s often our cue. Those moments are not just emotional distress — they’re disruptions in meaning and identity. And therapy becomes a place where meaning gets rebuilt and they figure out who they are now.

Let’s look at a single trauma episode example. A client named Maria has survived a serious accident and this is an example of a conversation that could take place. Maria says “I keep thinking I should have died. There has to be a reason I’m still here.” The therapist thinks that this sounds like survivor’s guilt and says “It sounds like surviving has raised some big questions. Has spirituality ever helped you understand hard experiences before?”

Notice how gentle that question is. The therapist isn’t introducing spirituality — they’re checking whether it already matters to the client. This is an assessment move not a suggestion. When we ask about spirituality, we’re really asking, ‘What helps you make sense of this?’ If a belief system creates safety or hope, it becomes clinically useful. Maria eventually says she feels she survived for a reason. Together, they develop a grounding phrase: “I’m still here for a reason.”

Now clinically, this is doing several things at once. It’s cognitive restructuring. It’s emotional regulation. And it’s narrative repair. But to the client, it just feels calming and meaningful. And that’s often how good therapy works — complex mechanisms, simple experience.

In supervision I would ask of my supervisees, “Would you have felt comfortable asking that question of someone?” “If not — what might have stopped you?” “Does the topic of spirituality make you uncomfortable?” “If so, why do you think that is?” It is important for therapists to understand their own beliefs and ensure that they do not bring bias into the therapy room.

Many times, when I introduce spirituality into sessions, I do it in the first or second session when I talk about my therapeutic interventions, skills, and abilities. I tell my clients that I believe that one of the most important things that can happen in therapy is the magic of meaning making and sometimes spiritual practices can help with that. Then tell them a list of things that can be spiritual practices like journaling, putting their feet in the dirt, gardening, hiking, sitting on the dock at the lake, and other things that a lot of people forget can have spiritual significance to someone. And my clients have the permission and opportunity to reject spiritual practices altogether. They decide what they want to do but it certainly can’t hurt to experiment with putting your feet in the dirt or grass and letting the earth connect with you.

Now let’s shift to grief. Modern grief therapy doesn’t focus on letting go of the deceased. Instead, we talk about continuing bonds. Here’s another moment. The client says, “I still talk to my wife sometimes. I worry that means I’m not healing.” The therapist responds, “When you talk to her, what happens emotionally?” That question matters a lot. The therapist is evaluating the function of talking to his dead wife — not the behavior. The client responds, “It comforts me.” The therapist then says, “Does that connect with any spiritual beliefs you hold?” Then the discussion can move toward their practice of talking to their dead wife as a tool for healing. Because then, the question can be asked about what his wife would say if he asked her this or that.

Grieving clients often fear they’re doing grief wrong. Our role is to determine whether a behavior supports adaptation to the loss and new identity. Comfort and connection usually signal healthy processing. A suggestion could be made to write letters to the deceased, and this can become a ritual. I often suggest that they write on mylar balloons and release them. Rituals are powerful clinically because they slow emotion down. They give grief somewhere to go and allow for emotional processing.

Consider how this could be adapted if the client has no religious beliefs or affiliations. What would stay the same clinically? The answer is everything because there are so many non-religious “rituals” that the client can establish that will bring them comfort. The answer is that the mechanism is meaning, not religion.

There are times, however, when spirituality can increase distress and become part of the struggle. People with religious beliefs will sometimes get into comparison and legalistic interpretations of how they are supposed to be doing grief based on the teachings of the religion or advice of the religious leaders. But the thing we know as therapists is that grief and trauma are very personal and like snowflakes, each is individual with their process in dealing with these things and most especially, with how long it takes. Trauma can damage spiritual or religious beliefs. Clients may experience loss of faith, anger at God, spiritual disconnection, and religious trauma (which I will touch on later). This is called spiritual struggle, and research shows it is normal after trauma.

Many times, the client will say things like, “Maybe this happened because I’m being punished.” And the therapist will need to clarify this by asking, “Is that idea connected to your beliefs?” Instead of correcting or discounting the belief, the therapist explores it. We don’t debate beliefs because we are then moving towards conversion and I think this is where a lot of clients become leery of therapists with religious beliefs. We simply ask whether their beliefs help with healing. And if they don’t then we can explore with the client what types of beliefs would help them.

Often clients already have compassionate teachings within their worldview — they just don’t apply them to themselves.” A good question to explore with the client is, “If compassion exists in your faith, how might that apply to you?” That’s a subtle but powerful intervention. The therapist isn’t changing spirituality — they’re widening it and making it accessible.

Here’s the guiding principle to remember is if spirituality lives in the client’s story, it belongs in therapy. If it lives only in the therapist’s story, it doesn’t. Ethical integration means curiosity without influence. And this requires self-awareness. Personal beliefs — or lack of beliefs — will shape personal comfort level. Competent counselors aren’t spiritually directive. They’re spiritually literate — able to recognize meaning systems and work within them.

I have had clients comment on many occasions that their previous therapists have had certain religious beliefs and my clients felt as though they were not completely free to talk about their story. Sometimes I think it is more because the therapist hasn’t been around the block enough and they are surprised, shocked, or some other reactive way of being that is off putting for the client. I don’t think it is always because they are religious. As a therapist who has a story of my own, I am not shocked or surprised much anymore, but I do become angry that anyone could hurt my clients the way they have been hurt.

Back when I first opened my private practice, I had a new female client come for her first appointment and the first thing she told me was that she was lesbian before she even said hello. I was surprised that was the first thing she told me, and I asked her if that was why she was coming for therapy. She looked at me confused and I asked her why she thought that was the most important thing to tell me before she even said hello. She told me she wanted to see my reaction because she didn’t want “some Christian therapist” who was going to condemn her for being lesbian when she was there to do some trauma work.

I was able to quiet her fears by encouraging her to give a good look around my office and tell me what she saw. In my office I had two Native American hand drums and a standing drum, yoga cushions, a banner of the chakra symbols that that hung on my door, a deck of animal spirit cards, crystals of all types, and a big peace symbol in the middle of my wall. After she took a good look, she decided I was “eclectic in my beliefs” enough that we could work together.

In a way I’m glad she got that out in the open first because for her that would have been a block for her to share completely in therapy. But her opening in that first session did let us talk about spirituality right away and what her beliefs were. Turns out she attended a nondenominational church in town that welcomed the LGBTQIA community and she believed in a higher power. So spiritual practices did become a part of her therapy, but they were her spiritual practices not mine. She wasn’t interested in using any of the “spiritual” things I had in my office because she thought they were not in alignment with her beliefs, and that was perfectly fine because as she said, “I’m not here for spiritual counseling.” And she was right; she had some big trauma to work through.

Now, let’s look at when spirituality and/or religion is the trauma or when sacred ideas are misused in ways that harm people psychologically and emotionally. And when pain is framed as something holy, people often assume, “If this hurts, maybe I’m the problem.” That confusion is often the first clue that something deeper is happening. In clinical psychology, we now understand that harm connected to belief systems can affect identity, attachment, and even a person’s sense of reality.

Let’s start with spiritual abuse. Spiritual abuse happens when spiritual ideas or perceived spiritual authority are used to manipulate or control someone. And here’s what surprises many people, this doesn’t require organized religion. It can happen anywhere where spirituality exists. You might see it in meditation communities, wellness or manifestation spaces, guru–student relationships, coaching environments, or even intimate relationships. The common thread isn’t religion. It’s power disguised as spiritual wisdom.

Religious abuse looks similar emotionally — but structurally, it’s different. Religious abuse occurs within organized religious systems where doctrine, hierarchy, or sacred texts are used to control or shame. Here, authority usually comes from an institution rather than an individual personality. Examples can include fear-based teachings centered on punishment or damnation, leaders demanding unquestioned obedience, scripture used to justify harmful dynamics, discouraging autonomy or independent thinking. One of the strongest clinical markers is chronic guilt. Clients often describe feeling fundamentally flawed or sinful for normal human thoughts, emotions, or developmental stages. The nervous system learns to associate religion with fear instead of safety. And that fear can follow people long after they leave the environment.

Some individuals describe panic responses triggered by religious imagery, prayer language, or moral decision-making — even years later. When harm is spiritualized, people don’t just lose trust in others. They lose trust in their own perception. And that’s a profound psychological injury. Therapists sometimes call this sacred betrayal — when something meant to provide safety becomes the source of harm.

Sometimes, healing spiritual or religious abuse has to happen before trauma and grief work can be done. Many people assume healing means abandoning spirituality or religion entirely. But clinically, that’s not always true. Healing is less about what someone believes…and more about restoring choice. Some people rebuild faith differently. Some develop personal spirituality. Some move toward secular meaning-making. All are valid paths. Because the opposite of spiritual abuse isn’t disbelief. It’s freedom.

Let’s look at the hypothetical case of Maria. She is a 42-year-old teacher who lost her younger brother in a sudden accident eight months ago. Since his death, she reports insomnia, guilt, emotional numbness, and recurring thoughts that life feels “empty.” She was raised religious but stopped attending church years ago. She tells her therapist she feels lost — spiritually and emotionally.

THERAPIST: You’ve said a few times that things feel meaningless lately. Can you tell me more about that?

MARIA: Before… I believed everything happened for a reason. Now I just feel like the world is random and cruel. I don’t know what I believe anymore.

THERAPIST: It sounds like your grief didn’t just take your brother — it shook the way you understood life itself.

MARIA (quietly): Yes. Exactly.

THERAPIST: When people go through loss like this, it’s common for spiritual beliefs — whatever they are — to change or even break for a while. Would it feel okay if we explored what gave your life meaning before all this happened?

MARIA: I guess… I used to feel connected. Like my life mattered to something bigger.

THERAPIST: What did that connection feel like in your body or emotions?

MARIA: Peaceful. Grounded. Less alone.

THERAPIST: Maybe we’re not trying to force old beliefs back. Maybe we’re just curious about reconnecting with that sense of peace and connection again — in whatever form feels true now.

MARIA: I still talk to my brother sometimes… I don’t know if that’s weird.

THERAPIST: Not weird at all. Many people maintain continuing bonds with loved ones after loss. What happens when you talk to him?

MARIA: I feel calmer. Like he’s still part of me.

THERAPIST: That sounds like a meaningful relationship that didn’t end — it changed form.

Notice what the therapist does here. They don’t introduce spirituality — they follow the client’s language. Maria introduces meaning, connection, and continued relationship with her brother. The therapist validates these experiences without interpreting them as literal or symbolic. In trauma and grief work, spirituality often emerges through questions of identity, purpose, or connection rather than explicit religious discussion. The therapist’s role is curiosity, not direction.

THERAPIST: When you feel that calm connection, what does it say about your relationship with him?

MARIA: That love didn’t disappear.

THERAPIST: That sounds important.

MARIA: I think… maybe that’s what I’m afraid of losing. Not just him — but the meaning of loving someone.

THERAPIST: So part of healing might be discovering how that love continues to exist in your life now.

(Maria nods, emotional)

THERAPIST: Would you be open to creating a small ritual this week — something personal — to honor that ongoing connection?

MARIA: Like what?

THERAPIST: Maybe writing him a letter, lighting a candle, visiting a place you shared. Not to say goodbye — but to acknowledge the relationship still matters.

MARIA: I think I’d like that.

Over several months, Maria begins journaling letters to her brother and spending quiet time in nature — something they once loved together. Her grief remains, but the emptiness softens. She describes feeling “connected again,” not to certainty, but to meaning.

Here we see spirituality expressed through ritual and meaning-making. Rituals help trauma survivors regain agency and structure. They also allow grief to move instead of remaining frozen. Importantly, the therapist collaborates rather than prescribes giving Maria the freedom to choose what would be best for her. The ritual emerges from the client’s values, not the therapist’s worldview.

In this example we see that the therapist helped Maria with restoring meaning after existential disruption, creating continuing bonds with loved ones, supporting self-compassion and forgiveness, and increasing tolerance for uncertainty. And for Maria it helped with providing freedom to choose practices that regulate the nervous system, such as prayer, meditation, or reflection.

Freedom is the most important aspect of healing from spiritual or religious abuse because it funds choice in healing from trauma and grief. Trauma and grief force people into life’s biggest questions and they sometimes lose sight of who they are. They become lost in their emotions and can become erratic in their behavior. The good news is that psychotherapy helps regulate emotion and behavior. But spirituality and religious faith, when appropriate, often help them rebuild meaning and find their identity again. When both are respected, healing becomes deeper than symptom reduction — it becomes healing integration.

I would be interested to hear some of your comments about the incorporation of spirituality into therapy. Please leave a comment below, like and subscribe. Thanks for spending this time with me today. And I want to encourage us all to keep listening closely — because people often tell us what they need long before it is recognized by a clinical therapist. We can all be sources of hope for each other if we are listening for what someone needs when they speak instead of thinking about what we are going to say next.

Take care, and I’ll see you next episode when I return with another client suggested topic.