Contemporary Family Therapy (2023) 45:218–227

https://doi.org/10.1007/s10591-021-09625-2

ORIGINAL PAPER

Internal Family Systems and Spirituality: Implications for Supervision

Emily E. Janes1 · Zachary R. Trevino1 · Heather Koehl1 · Yi‑Hsin Hung1

Accepted: 29 November 2021 / Published online: 10 January 2022

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021

Abstract
Religion and spirituality are an important part of the human experience for many of our clients. Clients often turn to their
religion or spirituality as one of their first resources when faced with significant stressors; however, therapists often feel ill-
equipped when spiritual or religious content is discussed in therapy. The efforts of clinicians to ethically and competently
address spirituality and religion with clients hinges on the work of supervisors and faculty members of Couple, Marriage,
and Family Therapy programs. This paper seeks to explain how the supervision process can help therapists overcome the
barriers they face when attempting to integrate spirituality and religion into session. A case vignette is presented where a
supervisor and supervisee use an Internal Family Systems lens to consult about a case where religious concerns are present.
Utilizing IFS, we believe that therapists can better acknowledge their spiritual or religious biases and begin to consider how
religion and spirituality can be respected as a diverse part of clients.

Keywords Spirituality · Therapy · Supervision · Internal Family Systems

Introduction in spiritual aspects of their lives to therapy, therapists are

often not given the training necessary to engage with clients
In the United States of America (USA), 89% of people around these important topics.
believe in a God or a Universal Spirit and 53% believe that Clients struggling with physical and mental health prob-
religion can answer all or most of today’s problems (Gal- lems often turn to spirituality and religion for coping and
lup, 2019). With spirituality being an important factor for so healing (D’Souza, 2002; Gockel, 2011; Larson & Larson,
many people, one would assume that mental health profes- 2003). Spirituality can be a powerful coping skill for clients,
sionals would integrate spirituality and religion into their but fear of judgement can become a barrier for clients to
treatment; however, research indicates that therapists are tap into this strength (D’Souza, 2002; Gockel, 2011; Lar-
often reluctant to include spiritual or religious content in ses- son & Larson, 2003; Martinez, 2004). Clients often hope
sions (Miller et al., 2004; O’Hanlon, 2006). Therapists, not to explore spirituality throughout the therapeutic process,
employed by religious institutions, report having concerns but when the therapist is unable to respond appropriately, in
when integrating spirituality and religion in therapy, most the eyes of the client, the therapeutic relationship could be
often due to insufficient training around the topic (Miller at stake (Gockel, 2011; Martinez, 2004). The attributes of
et al., 2004; O’Hanlon, 2006). The primary barrier to couple, warmth, empathy, openness, genuineness, and support are
marriage, and family therapists (CMFTs) integrating spiritu- often referred to as common factors among mental health
ality into their work is that most CMFT training programs care professionals; however, research indicates that when cli-
have neglected this topic (Frame, 2000; Gockel, 2011; Har- ents witness these attributes in their therapists, clients attrib-
ris, 1998; Prest & Keller, 1993). While many clients bring ute them to the spirituality of the therapist as an individual
(Assay & Lambert, 1999; Gockel, 2011; Wampold, 2001).
Using a case study developed based on the experiences of
* Emily E. Janes the authors as therapists, this paper explores potential self-
ejanes@ttu.edu of-the-therapist issues that may arise when spirituality and
1
religion are integrated into therapy, as well as implications
Community, Family, and Addiction Sciences Department,
College of Human Sciences, Texas Tech University, 1301
for clinical supervisors and the supervision process, using
Akron Avenue , PO Box 41250, Lubbock, TX 79409‑1250, an Internal Family Systems lens.
USA

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Contemporary Family Therapy (2023) 45:218–227 219

Literature Review spiritual or religious content is presented in therapy. Lack

of training, ethical concerns, and the therapist’s personal
Spirituality and religion are often used interchangeably; experiences with spirituality or religion may all be barri-
however, they have distinct meanings and implications for ers to processing religious or spiritual content in-session
practice. After reviewing several descriptions, Miller et al. (Ahn & Miller, 2009). Additionally, therapists may have
(2004) defined spirituality as an “overarching construct biases around spirituality or religion that may be barriers
that includes a personal journey of transcendent beliefs to them working effectively with religious clients (Ahn
and a sense of connection with other people, experienced & Miller, 2009). These barriers often lead to clinicians
either within or outside of formal religious structures” (p. inadvertently disregarding a critical piece of an individual
73). Religion can be defined as “formal, organized faith or family system. Beyond this, therapists may inadvert-
traditions and their shared beliefs, practices, and faith ently omit spirituality and religion as strengths that can
communities” (Walsh, 2009, p. 38). Spirituality and reli- be utilized throughout the therapeutic process. As such, it
gion can provide powerful coping skills and be a strength is particularly important for clinical supervisors and clini-
for clients and clinicians; however, religion and spiritual- cians in academic settings to provide thorough training and
ity can also be a source of distress, dilemma, and conflict supervision around the integration of spirituality and reli-
(Hamblin & Gross, 2013). gion into session, as well as creating space for therapists-
in-training to process self-of-the-therapist issues regarding
spirituality and religion that may impact the therapeutic
process.
Religion and Spirituality in Therapy

Spirituality and religion are a significant part of the human Spirituality and Religion in Training
experience that clients may bring with them into the ther- and Supervision
apy room. Clients often cite spirituality and religion as
sources of hope and factors which largely influence their In the USA, 49% of people report that religion and spiritual-
worldview. As indicated previously, conversations around ity are very important to them and an additional 26% report
spirituality in the therapeutic context are scarce; however, that it is fairly important to them (Gallup, 2019). This data
clients have identified that they want to discuss spirituality indicates that CMFTs are likely working with clients who
in the therapeutic process (Miller et al., 2007). Addition- value their spiritual or religious practices in day-to-day liv-
ally, Krok (2008) suggests that spirituality is an indicator ing. CMFTs pride themselves on their efforts to be attentive
of health and, as such, should be integrated into the thera- to diversity and multiculturalism; however, when it comes
peutic process. to the role of spirituality and religion, this identifying fac-
While spirituality and religion are different, research tor is often left unattended. CMFT training programs tend
consistently suggests that these factors can function as a to overlook spiritual or religious issues, leaving new thera-
buffer against a variety of stressful events that individuals pists and therapists-in-training unprepared to address these
and families encounter (Krok, 2008). Clients often turn to issues in-session (Miller et al., 2007). Research suggests that
their religion or spirituality as a resource when faced with most CMFT students personally value spirituality and reli-
illness or other significant stressors (Sharma et al., 2017). gion; however, they do not feel comfortable discussing it in
In fact, religion and spirituality have been linked to lower a therapeutic context (Miller et al., 2007). Errington (2017)
rates of depression, anxiety, substance use, and suicidality found that a lack of supervision around integrating religion
(Rasic et al., 2011). Spirituality and religion can help cli- and spirituality into the therapeutic process is one of many
ents find meaning, purpose, and hope, which may provide barriers therapists in training face when trying to attend to
strength as they endure suffering (Krok, 2008). Addition- spirituality and religion in session. Avoiding spirituality and
ally, spiritual and religious frameworks often inform peo- religion in theoretical application, assessment, case concep-
ple’s worldviews, providing them with specific goals or tualization, and treatment planning or attending to spiritual-
desired experiences to strive for. In addition to these goals ity and religion without proper training may result in violat-
and desired experiences, religious and spiritual teachings ing ethical codes and/or harming clients (Miller et al., 2007).
give practical pathways for living which directly influence Among CMFT training programs, some institutions are
individuals’ psychological and physical functioning (Krok, religiously based. Institutions that are religiously based
2008). typically require courses that specifically address spiritual
While religion and spirituality can be incredibly influ- integration with family therapy or require foundational
ential for clients, therapists often feel ill-equipped when religious courses (Coyle, 2017). In these institutions,
the scope of spirituality and religion goes beyond the

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classroom and is integrated into the supervision process own relationship with spirituality and religion and how this
to help therapists further develop and understand their own may impact the therapeutic process.
spiritual and religious journeys. In one program, Coyle Aten and Hernandez (2004) suggest that supervisors
(2017) found that students were required to read a religious should address spirituality and religion with their supervi-
text about a specific theology or spiritual practice and then sees across eight domains: (1) interventions, (2) assessment
to focus on their own theological or spiritual reflections. techniques, (3) individual and cultural differences, (4) inter-
This assignment helped students further develop self- personal assessment, (5) theoretical orientation, (6) problem
awareness about their spiritual or religious experiences conceptualization, (7) treatment plan and goals, and (8) eth-
and how these experiences inform the theoretical orien- ics. Their model of supervision suggests that supervisors
tation they utilize in clinical practice. These reflections should not only focus on issues of spirituality and religion
are further discussed in supervision and often act as an from a clinical perspective, but should also create space for
avenue for therapists to deepen their own spirituality or trainees to focus on self-of-the-therapist issues around reli-
religiosity (Coyle, 2017). It is important to note that laws gion and spirituality. Frame (2001) supports that spirituality
separating church and state in the USA often limit discus- and religion should be processed as a part of self-of-the-
sion of religion and spirituality in public academic institu- therapist work through spiritual genograms which can help
tions. This may contribute to CMFT’s limited integration clinicians identify how their own experiences with spiritual-
of religion and spirituality in therapeutic work. Private ity and religion may impact their work with clients. While
academic institutions have more liberty to integrate reli- there has been research completed around the importance of
gion and spirituality into their curriculum and training. attending to spirituality and religion in training and super-
These programs show that religion and spirituality can vision, the ambivalence and rigidity that clinicians experi-
be successfully incorporated in CMFT training programs. ence when it comes to spirituality and religion implores that
For programs that do not espouse spiritual or religious our efforts be examined and that new efforts be advanced.
ties, the depth to which issues related to spirituality and Using a case vignette, this paper offers an exploration of how
religion are discussed vary. While the training students supervisors can use an Internal Family Systems lens to help
receive around spirituality and religion differs, most schol- their supervisees navigate self-of-the-therapist challenges
ars and clinicians recognize it as a critical component of around spirituality and religion with highly religious clients.
family therapy training (Grams et al., 2007). The hesitancy
to approach these issues with confidence often lies in a lack
of comfort and personal biases held by those training new Internal Family Systems
therapists. Faculty members and supervisors may have their
own doubts and uncertainties around religious or spiritual IFS is an innovative therapy model that provides space
practices (Coyle, 2017; Errington, 2017). Errington (2017) for individuals to explore and confront conflict between
also found that those with strong religious or spiritual beliefs the inner parts of themselves, while also considering how
may fear imposing those beliefs on clients, which also acts these parts interact with others (Schwartz & Sweezy, 2020).
as a barrier to integrating spirituality and religion into the Effectively practicing IFS requires training and IFS specific
therapeutic process. Additionally, Errington (2017) found supervision. While there are an infinite amount of parts, IFS
that fear of religious or spiritual illiteracy, using treatment suggests that there are three types of parts that are forced
models that do not intentionally attend to spirituality and into extreme protective roles when an individual senses
religion, and the expectation to outsource to other profes- danger (Schwartz & Sweezy, 2020): Managers, Exiles, and
sionals are also barriers that therapists face when integrating Firefighters. Managers and Firefighters are protective parts
religion and spirituality into their sessions. that attempt to maintain safety within the internal system
Leaders in CMFT programs must consider how their (Schwartz & Sweezy, 2020). Managers and firefighters
training may be contributing to a lack of understanding hold the same goal “to keep exiles out of mind” (Schwartz
around the role of spirituality and religion as it relates to & Sweezy, 2020, p. 35); however, they have distinctly dif-
both client systems and developing clinicians. The ability ferent approaches to achieving this goal. While managers
of clinicians to ethically and competently address spiritual- take a logical and controlling stance, firefighters attempt to
ity and religion with clients hinges on the work of AAMFT maintain safety within the system impulsively (Schwartz &
Approved Supervisors and faculty members in CMFT pro- Sweezy, 2020). Exiles are the most sensitive parts of the
grams. It is vital that supervisors and faculty members are system and are generally tied to attachment injuries, painful
aware of their own spiritual or religious beliefs and how they memories, or trauma (Schwartz & Sweezy, 2020). In the face
may impact teaching, training, and supervision. Supervisors of these events and without protective factors, exiles take on
and faculty members must also be able to walk their super- painful burdens (Schwartz & Sweezy, 2020). In anticipation
visees and students through the process of navigating their of or the actual activation of these burdens, parts take on the

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Manager or Firefighter role to protect vulnerable parts and therapists can better identify and navigate their own “parts”
the entire system from feeling these burdens (Schwartz & and consider how leading from Self energy may increase
Sweezy, 2020). their level of comfort discussing these topics.
Ideally, The Self oversees the system and is in a place of
leadership within the system (Schwartz & Sweezy, 2020).
In IFS, the goal of therapy is to help clients find harmony, Case Vignette
leadership, and balance in life by identifying the parts of
their internal system and learning how to act from a place of Steve, a beginning therapist, is meeting with his clinical
Self-leadership (Schwartz & Sweezy, 2020). Therefore, the supervisor, Kelly, for their weekly supervision session. Steve
role of the therapist is to help the client identify various parts and Kelly have been working together for about six months
within the client’s system, as well as the influence that each and both use IFS as their main theoretical perspective. Steve
part has within the system. The therapist assists the client in asks to process a session from the past week where he felt
establishing the Self as the leader in the client’s inner system. uncomfortable and activated with a client. In describing
For a therapist to successfully utilize IFS with a client, the the case to his supervisor, Steve discloses that his client,
therapist must be aware of their own internal parts and be in Bethany, is working through the recent death of her mother.
tune with their inner Self. Bethany has spoken, at length, about how her faith in God
and prayers have sustained her during this difficult time.
Steve reports that he briefly processed with Bethany how
IFS and Spirituality her faith and prayers have been helpful; however, he quickly
turned the conversation to other coping mechanisms that
The spiritual foundations of IFS make it particularly helpful he views as more “valid and effective”, such as attending
in attending to spirituality or religion in therapy and super- support groups, utilizing social support from friends and
vision. When using IFS, the therapist or supervisor helps family, and self-soothing techniques. Throughout the ses-
clients or supervisees connect to their inner healing and wis- sion, Bethany continued to talk about the positive feelings
dom (Holmes, 1994). Schwartz and Sweezy (2020) acknowl- she has towards her religion and Steve found himself feel-
edge that this type of healing, inner-work has been an impor- ing frustrated at Bethany’s reliance on religion as a coping
tant part of Indigenous spiritual practices for generations. mechanism. Steve disclosed to his supervisor that he felt
Ginter and Horneffer (2006) discuss how IFS views indi- activated around the conversation and that he felt it difficult
viduals as inherently spiritual beings. As such, parts should to be present and connect with Bethany during the session.
not be judged or discarded in therapy; rather, they can be Steve’s goal in supervision was to recognize which part was
viewed non-judgmentally, with compassion and love. Ginter taking over his Self in-session and preventing him from con-
and Horneffer (2006) describe how the Self helps with this necting to his client’ Self and her parts.
process as it embodies spiritual traits that allow each part
to be seen in this light. For some, this inner strength is con-
nected to their Self, but for others, this wisdom comes from a Internal Family System Map
connection to spiritual guidance outside of themselves (Hol-
mes, 1994). It is important to recognize that the concept of Schwartz and Sweezy (2020) convey that when a therapist
Self and Self-energy are known and acknowledged in diverse has a map of their client’s internal system, including the
religious and spiritual practices, albeit by different names relationships between parts, therapists can more intention-
(Schwartz & Sweezy, 2020). Holmes (1994) explains that ally intervene in the system. As such, Kelly begins by having
“conceptualizing the individual as a system rather than a Steve map out Bethany’s internal system based on what they
monolithic structure opens up the possibility of getting more have processed in-session and the information Bethany has
directly in touch with our clients’ spiritual nature” (p. 33). disclosed about her parts and the functioning of her internal
IFS allows clients and therapists to tap into this spiritual system. Kelly asks questions, such as: What parts of Beth-
dimension in therapy (Ginter & Horneffer, 2006) and to dis- any’s came out in this past session?; Were there any parts
cover an inner power that is available at any time to assist that were not there that surprised you?; What are the rela-
with self-regulation (Holmes, 1994). tionships between the parts you’ve mapped out?; and What
This paper offers a fictional example of a supervisor and purpose do these parts play? After learning about Betha-
supervisee consulting about a case where religious concerns ny’s internal system, Kelly begins to weave in self-of-the-
are present. Utilizing IFS, we believe that therapists can bet- therapist questions about Steve’s internal system and how
ter understand their spiritual or religious biases and begin his parts interact with the parts Steve indicated on the map.
to consider how religion and spirituality can be respected Kelly asks: What parts in Bethany’s system feel activating
as a diverse part of the client. Through an IFS framework, to you in-session?; What parts of yours take over or become

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more vocal in-session with Bethany?; and What do your Steve: Hmm I think we can call it “The Flashlight”
parts believe about Bethany’s internal system? When Steve because it wants to shine a light on Bethany’s experi-
answers the final question, Kelly notices a key difference ence and stop her from using religion to push her feel-
between how Bethany perceives her internal system and how ings under the rug.
Steve perceives some of her parts. On the map of Bethany’s
By identifying how The Flashlight part takes over in-ses-
system, Steve indicated that Bethany views her religion as a
sion to protect Bethany, Steve and Kelly can now learn more
way to connect to her Self and feel grounded in Self energy;
about this part, its goals, and what it needs from Steve in-
however, Steve views her use of religion as a manager that
session to ensure that Steve’s Self energy can lead. Learning
prevents her from attending to her more vulnerable feelings
about his own internal system allows Steve to have more
and fears.
awareness of how his own system may be interfering with
the therapeutic process or how he may be prioritizing his
own goals for the client (Mojta et al., 2013). Kelly reminds
Work with Therapist’s Parts Steve of the importance of leading with Self energy in-ses-
sion and asks if they can continue to work with The Flash-
Recognizing that this pivotal difference is likely due to light to see what it needs from Steve during session.
Steve’s internal system and how his parts are interacting
Steve: Yes, I really don’t want to be activated with
with Bethany’s parts, Kelly asked the following questions
Bethany in-session, so I want to get to know this part
to learn more about which of Steve’s parts were present in
better and what it needs from me.
this session:
Kelly: Okay. Let’s have you close your eyes again and
Kelly: Tell me a little about why you view Bethany’s connect with The Flashlight. Imagine that Bethany is
religious part as a manager? talking about religion and the strength it is during this
Steve: Well, the way I view it, she’s using religion to time of mourning. Where do you feel The Flashlight?
shut down any vulnerable feelings about her mother’s Where is it in your body? Is it alone or does it come
death. When feelings arise, she immediately turns to with other parts?
religion and doesn’t allow herself to feel what she is Steve: The flashlight is definitely in my hands – like I
experiencing. I think it allows her to ignore her actual feel jittery and almost anxious. It feels like my intel-
experience. lectual parts are with The Flashlight too and they’re
Kelly: Okay, I can see from your view why it makes holding a lot of annoyance. Almost like they’re work-
sense that her religious part is a manager; however, she ing together to invalidate Bethany’s use of religion as
believes that religion helps her to connect to her Self. a coping mechanism.
What do you think about that? Kelly: Okay, so The Flashlight and your intellectual
Steve: I’m really not sure. I just feel so uncomfortable parts are working together here. What do you notice
with that. about The Flashlight?
Kelly: Tell me more about this discomfort. What part Steve: He’s frustrated and inpatient. He doesn’t think
feels uncomfortable when you hear Bethany discuss religion is beneficial at all.
how religion connects her to her Self? Does it feel okay Kelly: How old does he look?
to connect with this part today? Steve: About 16 years old.
Steve: Yeah, I think it would be important to connect Kelly: How do you feel toward The Flashlight?
with it (closes eyes and take a few deep breaths). It’s Steve: I feel sad because he seems like he has been
an angry part…maybe sad? Honestly, it’s a part that I hurt so much.
try to ignore – it’s been told it’s not allowed to feel any- Kelly: Tell him that. How does he respond?
thing negative. It’s sad that it can’t let its feelings out. Steve: (pauses) He says that religion hasn’t been posi-
Kelly: Does this part feel like Bethany is being told by tive for me, so there’s no way it can be positive for her.
her religion that she’s not allowed to feel? Kelly: The Flashlight cannot believe that religion
Steve: Yes. It worries that her feelings will just get could actually work for someone. Religion has been
bigger and bigger until they become unmanageable. such a challenging force in your life, it doesn’t make
Kelly: So, this part is trying to protect her. It doesn’t sense to The Flashlight that it could be so effective for
want her to get hurt or for her feelings to become out Bethany.
of control. Steve: Exactly – he feels like it’s not a “real” way to
Steve: Exactly. cope – almost like it’s passive. Which makes a lot of
Kelly: What do you think we should name this part so sense since I never felt like religion had an impact on
we can continue to get to know it? my life or well-being.

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Kelly: I wonder if you could ask The Flashlight to sit the difference he felt in-session and process anything that
beside you for a few minutes. Let him know he doesn’t feels important.
have to leave and he can speak up again if he needs to.
Let him know your Self energy can handle this. Is he
okay sitting beside you for a little while? Processing and Research
Steve: Yes, I think so, but it feels like he’s sitting on
the edge of the couch ready to jump back in. To end their supervision session, Kelly validated that, given
Kelly: I wonder what he needs from you to feel more his own personal relationship with religion, Steve’s percep-
at ease. Can you ask him? tion of Bethany’s use of religion makes sense. Kelly pro-
cessed with Steve how, although he does not find religion
During this dialogue, Kelly relies on information that she
helpful in his own life, research has suggested that religion
has about Steve and his relationship with organized reli-
can be helpful, especially within the context of mourning
gion. Having completed a spiritual genogram (Frame, 2001)
and loss. Kelly encouraged Steve to conduct research on
with Steve at the beginning of their work in supervision, she
the use of religion during times of tragedy and mourning
knows that Steve was raised in a strict, Christian household,
to begin reconceptualizing how religion can be helpful for
but always felt disconnected from the religious ideals he was
his clients.
taught. As such, he left the Christian church in emerging
adulthood and currently identifies as Agnostic. Kelly rec-
ognized that Steve’s internal system may be becoming acti-
Discussion
vated around Bethany’s reliance on her religion because of
his own experience with and negative views around organ-
A therapist’s ability to attend to spirituality and religion in-
ized religion. Kelly actively works with Steve’s activated
session is directly related to their training and supervision.
part to remind him that Steve’s Self can remain in a place
As CMFTs, one of our AAMFT Aspirational Core Values
of Self-leadership and to process what this part needs from
is, “diversity, equity and excellence in clinical practice,
Steve to ensure that his Self remains in a position of leader-
research, education, and administration” (American Asso-
ship during his sessions with Bethany.
ciation for Marriage and Family Therapy [AAMFT], 2015).
Steve indicates that The Flashlight needs him to acknowl-
Though efforts have been made to expand our knowledge
edge him during session instead of ignoring him or telling
in diversity training related to gender, race, and ethnicity,
him that they have no place in the therapeutic space. Steve
it is also imperative to understand that spirituality and reli-
assures The Flashlight that he will acknowledge him moving
gion are a part of the diverse human experience. The work
forward and that he recognizes the important information he
of developing culturally competent clinicians begins with
gave him in supervision. Steve processed that acknowledg-
individuals who are actively working to become aware of
ing these parts and the role they play helped them to feel at
their values, beliefs, biases, and assumptions about human
ease and that he felt like his Self was in a place of leader-
behavior (Sue & Sue, 2016). A clinician’s values, beliefs,
ship again. From this place of Self-leadership, Steve was
assumptions, and biases are influenced by many factors,
able to process how he can acknowledge his parts in-session
likely including their spiritual and religious beliefs. As a
with Bethany to remain in a place of Self-leadership. Steve
culturally aware CMFT, understanding the worldview of
identifies that by being more aware of his physical state, he
your clients is critical.
can slow himself down when he feels annoyed, anxious, or
Recently there has been a shift in the CMFT field to
jittery to acknowledge The Flashlight and his intellectual
focus on core competencies (Miller et al., 2010). As a field,
parts. After acknowledging these parts and the information
CMFTs have fought to be deemed credible by insurance
they have given him, he can invite them to sit beside him in
companies and other healthcare professions (Miller et al.,
the session to ensure he leads with Self energy.
2010). The shift to clearly defined competencies is to better
Kelly commended Steve on his work with his parts and
articulate what constitutes a competent CMFT (Miller et al.,
his new plan for how to work with his own parts in ses-
2010). Despite their importance, religion and spirituality are
sions with Bethany. Kelly emphasized the importance of
only mentioned once throughout the core competencies, stat-
therapist’s knowing their own internal system and how this
ing that CMFT’s must “recognize contextual and systemic
work can help him to strengthen his therapeutic relationship
dynamics (e.g., gender, age, socioeconomic status, culture/
with Bethany, recognize when his own goals are interfering
race/ethnicity, sexual orientation, spirituality, religion, larger
with the therapeutic process, and model for Bethany how to
systems, social context.)” (AAMFT, 2004, p. 2). With the
navigate her internal system effectively (Mojta et al., 2013).
demand to fulfill the core competencies, institutions are
Kelly encouraged Steve to reflect on these three areas after
required to make decisions regarding what to prioritize for
his next session with Bethany so that he can report back on
CMFT training programs. With the limited focus on religion

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and spirituality, it is likely that these topics are briefly dis- provide students with the skills to adequately assess when
cussed to fulfill core competencies; however, topics men- religion and spirituality may be counterproductive or harm-
tioned more frequently are likely prioritized in classes and ful to treatment (AAMFT, 2004, p. 2).
curriculums.

Implications for Supervision

Training Implications The reluctance of therapists to address spirituality and reli-

gion in therapy often results in the need for supervision and
The integration of spirituality and religion into therapy is an consultation. Ahn and Miller (2009) suggest that the pro-
important part of providing holistic care; however, therapists cess of integrating religion and spirituality into practice is
receive minimal training in this practice (Williams-Reade twofold, including work with clients and self-of-the-thera-
et al., 2018). This results in therapists and therapists-in- pist work. Using IFS, clinical supervisors can assist their
training overlooking the systemic effects of a client’s spir- supervisees in attending to their own parts and how they
ituality and religion on the system (Patterson et al., 2000). may be activated when a client discusses spirituality or reli-
For therapists to be more comfortable engaging with their gion in the therapy room. Supervisors should create space
clients around spirituality and religion, these topics must be for their supervisees to work through their own challenges
integrated into course work and clinical training. As part with spirituality or religion, as well as how their connection
of their multicultural training, students should familiarize to spirituality or religion may impact the therapeutic pro-
themselves with different spiritual and religious beliefs, cess. Additionally, supervisors can help their supervisees
organizations, and practices. Clinically, therapists-in-train- to identify their own biases about specific spiritual or reli-
ing should gain knowledge around therapy modalities that gious practices and how these biases may be impacting the
naturally integrate spirituality and religion, such as IFS, as therapeutic process and relationship. It is also important to
well as discuss how therapy modalities can be modified to note that the intersection of the client’s spiritual or religious
attend to spirituality and religion. In classes, students and practices and those of the therapist may result in transfer-
faculty members should frequently discuss the implications ence and/or countertransference. For instance, if a client and
of spirituality and religion on family systems, presenting therapist share the same religious identity, the therapist may
problems, and treatment plans. Resources such as the text- make assumptions about the client’s belief system or world-
book Integrating Spirituality in Family Therapy (Walsh, view based on their experience of the religion.
2009) and empirical studies can further students’ education While the supervisor and supervisee relationship can
on the topic of spirituality. Additionally, it is important that be a great support to beginning therapists, it is important
those in leadership (i.e., faculty members, supervisors, clini- to recognize that there may be barriers in openly discuss-
cal directors, etc.) do their work around their own spiritual ing religion and spirituality. Common barriers include the
journey and their level of comfort with this topic as it can organic differences in religious or spiritual practices and
directly impact the training, or lack thereof, that students beliefs between the supervisor and supervisee. Addition-
receive around spirituality and religion. ally, the theoretical application being utilized and how these
Although spirituality and religion may be important for approaches consider the role of spirituality and religion may
clients, it is essential to note that religion and spirituality can hinder a beginning therapist’s desire to attend to religion and
be a source of distress that greatly contributes to presenting spirituality in the room (Marterella & Brock, 2008). Super-
problems (Hamblin & Gross, 2013). Individuals who have visors must foster a caring relationship with their supervi-
a negative history with organized religion or spiritual prac- sees that is characterized by openness, a lack of judgement,
tices may reject the integration of religion and spirituality and the ability to check one’s biases.
in therapeutic work. For example, members of the LGBT- As demonstrated in the case vignette, IFS theory includes
QIA + community who have historically, and at present, constructs and assumptions that can help clinicians navigate
been pathologized and discriminated against by religious their level of comfort integrating spirituality and religion
communities may not be open to actively integrating spiritu- into session. When using IFS in supervision, it is essen-
ality or religion in session (Hamblin & Gross, 2013). Some tial that supervisors have advanced training in IFS and have
individuals may also have experienced abuse within their received their own supervision around how to use IFS effec-
religious or spiritual communities or religion-related abuse tively. Supervisors can help supervisees gain an awareness of
(Bottoms et al., 2004). Therapy is not “one size fits all” and their parts and how they present in the therapy room. Gain-
should not be treated as such. As the core competencies ing awareness of their parts will allow supervisees to better
state, CMFT’s must be able to “recognize contextual and understand how their parts present in the therapy room, what
systemic dynamics”, meaning that CMFT programs should is activating their parts, and what their parts need to allow

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Contemporary Family Therapy (2023) 45:218–227 225

the therapist to engage in therapy from a place of Self-leader- & Brock, 2008). Additionally, some argue that it is the ethi-
ship. Having a thorough understanding of their own internal cal responsibility of the therapist to be spiritually literate,
system and how it responds to topics around spirituality and while others believe that spirituality and religion is simply
religion in a therapeutic context will ultimately increase lev- a dimension of family therapy (Coyle, 2017).
els of competence around being able to initiate and engage in Other considerations are ensuring that the therapist is
dialogue around spirituality and religion with clients. abiding by their code of ethics. According to the AAMFT
Ethically, supervisors must ensure that they are abiding Code of Ethics (2015), accurate professional representation
by the AAMFT code of ethics. When using an IFS frame- is critical. This means that CMFTs accurately represent their
work, it is essential that supervisors are aware of the poten- competences, education, training, and experience relevant
tial impact and influence they may have on supervisees. to their practice of couple, marriage and family therapy in
While inviting supervisees to engage in parts work may be accordance with applicable law. When advertising your-
beneficial to their clinical work, it may also resemble ther- self as a therapist who specializes in religious or spiritual
apy. Supervisors must be clear with their supervisees about practice, it is important that it goes beyond your personal
the intention of their work and clarify that this is a supervi- spiritual or religious beliefs. Therapists should ensure that
sory intervention, not therapy. Supervisors must be careful they maintain competency of spiritual or religious practices
to not exploit their supervisees in this vulnerable work. It is through formal education and training. It is also essential
also recommended that supervisors ask for explicit consent that therapists know when to make appropriate referrals to
to engage in this work with their supervisees and make it other professionals, such as pastoral counselors or spiritual
clear in their supervision contract that supervisees are able directors. Errington (2017) suggests that, at times, clients
to refuse this work within supervision at any time without need spiritual care that is outside the scope of therapy. In
consequence. Utilizing an IFS framework in supervision also these cases, therapists should strive to effectively use com-
requires that the supervisor is aware of their own parts and munity resources, religious or spiritual leaders, and make
working from a place of Self-leadership when interacting referrals to other professionals, as appropriate. Though ethi-
with and providing feedback to their supervisees. cal concerns present themselves, spirituality and religion
should be commonly attended to in therapeutic practice,
just as you would address other identifying factors, such as
Ethical Considerations gender, race, or SES.

There are numerous ethical considerations that present

themselves when integrating religion and spirituality into
therapy. First is the reality that treatment consists of a cli- Limitations and Future Directions
ent system with unique spiritual or religious beliefs and a
clinician who also holds a unique set of spiritual or reli- There are some key limitations to our study that should be
gious beliefs (Marterella & Brock, 2008). This speaks to recognized. First, the case vignette presented in this article
the importance of clinicians addressing their own religious is fictional. While the case vignette is based on the author’s
or spiritual dilemmas in supervision or in consultation with experiences as therapists, it still does not definitively dem-
trusted colleagues. Spiritual and religious teachings are also onstrate the efficacy of IFS in supervision. Additionally, we
interpreted very personally. In working with client systems, recognize that the proposed modality of IFS is not the only
it is important to acknowledge how religious and spiritual model that can be used to navigate issues of spirituality and
teachings are interpreted and practiced by clients and how religion in a supervisory setting. The use of IFS may be
this may inform treatment goals and outcomes. Even when limited in helping the supervisor and supervisee, as they may
the therapist and client system share a religious or spiritual be inexperienced with this model or not resonate with the
identity, it is essential that therapists openly ask clients how “parts” language that is foundational to the model. It is also
they interpret beliefs and practices. important to note that the case vignette used in this paper is
Furthermore, with respect to the client’s religious and not the only scenario in which spirituality and religion could
spiritual autonomy, therapists must recognize how their be integrated into the supervision process. Future papers
expertise is limited in understanding certain religious or could focus on different scenarios where supervisors and
spiritual constructs (Marterella & Brock, 2008). It is par- supervisees consult around issues of spirituality and reli-
ticularly challenging when therapists must navigate how a gion. While this article focuses on the supervision process,
client’s beliefs are affecting or contributing to the presenting more research is needed to better understand how clinicians
problem. For therapists, it is important to know when it is can more confidently conceptualize and communicate about
appropriate or necessary to challenge aspects of a client’s spirituality and religion with their clients. Additionally, as
belief system that may be necessary for change (Marterella indicated throughout the paper, more research is needed

13
226 Contemporary Family Therapy (2023) 45:218–227

surrounding training in CMFT programs around issues of Bottoms, B. L., Nielsen, M., Murray, R., & Filipas, H. (2004). Reli-
spirituality and religion. gion-related child physical abuse. Journal of Aggression, Mal-
treatment & Trauma, 8(1–2), 87–114. https://​doi.​org/​10.​1300/​
J146v​08n01_​04
Coyle, S. M. (2017). Integrating spirituality in marriage and family
Conclusion therapy training. Australian and New Zealand Journal of Family
Therapy, 38(1), 142–155. https://​doi.​org/​10.​1002/​anzf.​1195
D’Souza, R. (2002). Do patients expect psychiatrists to be interested in
Therapists and therapists-in-training have an ethical obliga- spiritual issues? Australasian Psychiatry, 10, 44–47. https://​doi.​
tion to attend to the needs of their clients. While spiritual- org/​10.​1046/j.​1440-​1665.​2002.​00391.x
ity and religion are not the only factors encountered in the Errington, L. (2017). The uncomfortably important place of spirituality
therapeutic process, therapists must be prepared to attend in systemic therapy. Australian & New Zealand Journal of Family
Therapy, 38, 168–178. https://​doi.​org/​10.​1002/​anzf.​1196
to and utilize these factors as resources throughout therapy. Frame, M. W. (2000). Spiritual and religious issues in counseling: Ethi-
This manuscript contributes new information around how cal considerations. The Family Journal: Counseling and Therapy
supervisors can work with their supervisees to more effec- for Couples and Families, 8, 72–74. https://d​ oi.o​ rg/1​ 0.1​ 177/1​ 0664​
tively integrate spirituality and religion into therapy. The 80700​081011
Frame, M. W. (2001). The spiritual genogram in training and supervi-
case vignette included in this manuscript demonstrates how sion. The Family Journal: Counseling and Therapy for Couples
IFS can aid therapists and their supervisors in attending to and Families, 9(2), 109–115. https://d​ oi.o​ rg/1​ 0.1​ 177/1​ 06648​ 0701​
self-of-the-therapist issues around religion and spirituality 092004
that are interfering with the therapeutic process. Attending to Gallup. (2019). Religion. https://​news.​gallup.​com/​poll/​1690/​relig​ion.​
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(pp. 11–20). Routledge.
Gockel, A. (2011). Client perspectives on spirituality in the therapeu-
tic relationship. The Humanistic Psychologist, 39(2), 154–168.
Funding There was no funding required for this study. https://​doi.​org/​10.​1080/​08873​267.​2011.​564959
Grams, W. A., Carlson, T. S., & McGeorge, C. R. (2007). Integrat-
Declarations ing spirituality into family therapy training: An exploration of
faculty members’ beliefs. Contemporary Family Therapy, 29(3),
147–161. https://​doi.​org/​10.​1007/​s10591-​007-​9042-2
Conflict of interest The authors declare that they have no conflict of Hamblin, R., & Gross, A. M. (2013). The role of religious attendance
interest. and identity conflict in psychological well-being. The Journal
of Religion and Health, 52, 817–827. https://​doi.​org/​10.​1007/​
Human or Animal Participants This manuscript did not involve any s10943-​011-​9514-4
human or animal participants as it is a theoretical manuscript based Harris, S. M. (1998). Finding a forest among trees: Spirituality hiding
entirely on prior research. in family therapy theories. Journal of Family Studies, 4, 77–86.
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