Client’s experiences and perceptions of religious and spiritual issues in psychotherapy: a meta-synthesis of qualitative studies

Objective: Recently, several studies have examined the role of spiritual and religious (R/S) issues in psychotherapy. However, to our knowledge, no studies have systematically synthesised clients’ qualitative perspectives on how these themes are addressed during sessions. The present study is a meta-synthesis of qualitative studies focusing on clients’ experiences and perceptions of their R/S issues in individual or group secular psychotherapy contexts. Methods: Original studies were identified by systematically searching six databases and conducting subsequent manual literature searches. A meta-aggregation approach was used to synthesise the findings from the primary studies. Results: Fourteen studies met the inclusion criteria and quality appraisal. The meta-aggregation identified three synthesised findings: (a) R/S clients’ experiences and perceptions of the therapeutic relationship, (b) R/S topics addressed in psychotherapy, and (c) client preferences for R/S integration in psychotherapy. Conclusion: Clients valued therapists who were open, respectful, and able to incorporate their beliefs into treatment. This seemed to strengthen the therapeutic alliance. Some clients may view psychotherapy as a complement to their R/S practices, which could influence their perceptions and expectations of therapy. The main limitations were the small number of studies included, the restriction to English-language articles and secular settings, and the underrepresentation of non-Western/non-Christian cultures.