The ethical challenge of working with spiritual difference: An interpretative phenomenological analysis of practitioners’ accounts

Addressing spirituality in therapy is not only important for a substantial number of clients but many therapists also regard it as potentially valuable. However, practitioners report difficulties and confusion regarding how to work with spiritual difference, especially when clients’ spiritual beliefs are perceived as undermining their psychological well-being. The current study aimed to explore this challenge through the use of a qualitative design. Semistructured interviews were conducted with 11 practitioners and the transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes were discerned in the data: ‘therapists’ perception of clients’ spiritual beliefs: psychological understanding and impact’, ‘therapists’ aims and responsibilities: (in)compatibility with clients’ spiritual beliefs’ and ‘therapists’ practice responses to psychologically unhelpful spiritual beliefs: explicit and implicit approaches’. When clients’ spiritual beliefs were perceived as psychologically unhelpful, therapists experienced a conflict between their ethical stance to respect clients’ beliefs and their aim to enhance psychological well-being. This conflict presented the greatest challenge for therapists working with different spiritual beliefs. Implications and recommendations for practice are considered and avenues for future research are highlighted. In particular, it is recommended for therapists to recognize this challenge as an ethical dilemma, to develop an ethical analytic framework and to reflect on their own beliefs within this framework.