Chapter 16

FICA Spiritual History Tool

The George Washington Institute for Spirituality and Health’s FICA Spiritual History Tool provides a brief framework for asking about faith or beliefs, their importance and influence, spiritual community, and how the client would like these concerns addressed in care. Instructors can use the tool for role-play exercises in which students practice respectful spiritual inquiry without assuming that a client is religious or that spirituality should become part of treatment.

VA National Center for PTSD: Addressing Religious or Spiritual Dimensions of Trauma

The VA National Center for PTSD’s Addressing Religious or Spiritual Dimensions of Trauma and PTSD resource examines how trauma may strengthen, disrupt, or complicate a person’s religious and spiritual beliefs. It addresses spiritual struggle, meaning-making, assessment, referral to chaplaincy, and ways clinicians can remain attentive to spiritual concerns while continuing to use evidence-based trauma treatment. Students can apply the resource to cases involving guilt, perceived abandonment, loss of meaning, moral injury, or conflict with a faith community.

Spiritual Competency Training in Mental Health

The Spiritual Competency Training in Mental Health project provides freely available curriculum materials designed for students and practitioners across mental-health disciplines. The training addresses spiritual and religious diversity, practitioner self-awareness, assessment, spiritual strengths and struggles, ethical integration, and referral or collaboration. Instructors can assign individual modules or adapt the materials for classroom discussion and skills practice.

Spirituality and Psychotherapy

Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L., Jr. (2018). Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta-analysis. Journal of Clinical Psychology, 74(11), 1938–1951.

This meta-analysis examines 97 studies of psychotherapies adapted to clients’ religious or spiritual beliefs and values. Spiritually accommodated treatments produced outcomes comparable to or better than nonadapted treatments in several comparisons, particularly for clients who wanted spirituality included. The findings support client-centered integration rather than routine spiritual intervention with every client.

Currier, J. M., Fox, J., Vieten, C., Pearce, M., & Oxhandler, H. K. (2023). Enhancing competencies for the ethical integration of religion and spirituality in psychological services. Psychological Services, 20(1), 40–50.

This article identifies attitudes, knowledge, and skills needed to address religion and spirituality ethically in mental-health care. It discusses assessment, practitioner bias, professional competence, informed consent, boundaries, and the need to distinguish client-directed spiritual integration from the imposition of a practitioner’s own beliefs.

Spiritual integration should be guided by the client’s preferences, worldview, and treatment goals. Practitioners should not presume that religion is protective, interpret symptoms through their own beliefs, engage in spiritual direction outside their competence, or pressure clients to forgive, find meaning, or reconnect with a religious community.

Historical and Intergenerational Trauma

Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among Indigenous Peoples of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(4), 282–290.

This article reviews the historical-trauma framework, efforts to measure historical loss and distress, and culturally grounded clinical and community responses among Indigenous peoples. It emphasizes both the collective effects of colonization and the importance of recognizing differences among tribal, cultural, and regional communities.

Joo-Castro, L., & Emerson, A. (2021). Understanding historical trauma for the holistic care of Indigenous populations: A scoping review. Journal of Holistic Nursing, 39(3), 285–305.

This review examines definitions and measures of historical trauma, possible mechanisms of intergenerational transmission, the continuing effects of racism and discrimination, and the role of cultural connection and community-based healing. It also identifies important limitations in the evidence and unresolved questions concerning how historical and present-day harms interact.

Historical trauma should not be used as a deterministic explanation for the mental health of every member of a population. Analysis should connect past collective harms with continuing policies and conditions while also recognizing cultural survival, resistance, community knowledge, and self-determined approaches to healing.

Trauma, Spiritual Struggle, and Meaning-Making

Leo, D., Izadikhah, Z., Fein, E. C., & Forooshani, S. A. (2021). The effect of trauma on religious beliefs: A structured literature review and meta-analysis. Trauma, Violence, & Abuse, 22(1), 161–175.

This review examines how interpersonal trauma may affect religious beliefs. Most people did not report major changes, but a smaller group experienced either increased or decreased religious belief, with stronger changes among people reporting posttraumatic stress. The article helps challenge the assumption that trauma produces one predictable spiritual response.

Van Tongeren, D. R., Aten, J. D., Davis, D. E., et al. (2023). Use of religious and spiritual responses after trauma to prevent posttraumatic stress symptoms and suicidality: The role of meaning in life. Clinical Psychology & Psychotherapy.

This longitudinal study of veterans examines positive religious coping, spiritual struggle, meaning in life, posttraumatic stress, and suicidality. Spiritual struggle was associated with reduced meaning and greater distress, illustrating that spirituality can be a source of conflict as well as support. The study provides a basis for discussing meaning-making without assuming that spiritual coping is uniformly beneficial.

Assessment should include both spiritual resources and spiritual distress. Trauma may produce anger toward God, shame, loss of faith, alienation from a religious community, fear of punishment, or conflict between lived experience and previously held beliefs. These responses should not automatically be interpreted as pathology or religious failure.

Faith Communities and Mental-Health Partnerships

Perez, L. G., Cardenas, C., Blagg, T., & Wong, E. C. (2025). Partnerships between faith communities and the mental health sector: A scoping review. Psychiatric Services, 76(1), 61–81.

This review examines partnerships involving faith communities and mental-health organizations. Common activities included training religious leaders, providing mental-health education, reducing stigma, making referrals, and offering counseling or supportive services. Promising partnerships emphasized reciprocal relationships, support from faith leaders, shared power, and clarity about the expertise of each partner.

Codjoe, L., Barber, S., Thornicroft, G., et al. (2021). Evidence for interventions to promote mental health and reduce stigma in Black faith communities: A systematic review. Social Psychiatry and Psychiatric Epidemiology, 56, 895–911.

This review evaluates mental-health promotion and stigma-reduction initiatives in Black faith settings. It identifies community participation, co-production, trusted mental-health champions, and collaboration as important elements while noting that the available evidence remains limited in quality. The review can support discussion of both the reach of faith communities and the need to avoid treating them as substitutes for adequately funded professional services.

Partnerships should recognize that faith communities vary widely in beliefs, leadership, resources, and attitudes toward mental health. Collaboration requires clear referral pathways, confidentiality protections, mutual respect, attention to possible spiritual abuse or exclusion, and recognition that some clients do not belong to—or may have been harmed by—religious institutions.