What "spiritual practice alongside therapy" actually looks like

There is a category of reader who is in therapy, finds it helpful, and is also drawn to a contemplative or spiritual practice — a daily prayer, a structured grief observance, a contemplative reading practice. The reader sometimes worries that the two are in tension. If I am working on this in therapy, am I undermining that work by also reaching toward something religious? Should I pick one?

The short answer is no, and the long answer is more interesting. The longer answer involves what each of the two things is actually doing, what the research says, and what the practical patterns of doing both at once look like.

The two things are not the same kind of thing

Therapy is a clinical practice. It assesses mental-health states, applies evidence-based protocols (CBT, ACT, IFS, DBT, psychodynamic, EMDR, and so on), is conducted by a licensed practitioner, and operates within a regulatory framework. Its purpose is the treatment of psychological symptoms and the building of psychological capacities. It is paid for, scheduled, and bounded.

A spiritual or contemplative practice is something different in kind. It does not assess. It does not treat. It does not produce a clinical outcome that can be measured against a baseline. It is, in most religious traditions' own self-description, an orientation rather than an intervention. The Jewish tradition is particularly clear about this distinction. Maimonides, in the Mishneh Torah, writes about the regulation of body and soul (Hilchot De'ot) as one category of work, and about prayer (Hilchot Tefillah) as a different category. They are both real, both serious, and both are taken up by the same tradition. They are not interchangeable, and the rabbinic literature does not pretend that they are.

This distinction is operationally useful. It means a person can be in therapy for the symptoms — anxiety, grief, trauma, a difficult life passage — and have a contemplative practice for the orientation. The therapy works on the disorder. The contemplative practice works on the relationship the person has with being a person. Neither is doing the other's job.

What the research actually says

A reader who has heard "studies show prayer is good for mental health" should know what those studies actually say. The findings are real, the effect sizes are modest, and the qualifications matter.

The most comprehensive review available is Harold G. Koenig's "Religion, Spirituality, and Health: The Research and Clinical Implications," published in ISRN Psychiatry in 2012. Koenig is a psychiatrist at Duke University Medical Center. The review is open access (DOI 10.5402/2012/278730) and consists of a systematic look at the original quantitative research on religion/spirituality and health published in peer-reviewed journals from 1872 through 2010, plus selected studies after that.

The findings, broadly: across hundreds of studies, regular religious or spiritual practice is associated with modestly better outcomes on a range of mental-health markers — lower rates of depression, lower rates of suicide, lower substance-use disorder rates, higher subjective well-being, faster recovery from depression in patients who already have it, better coping with chronic illness. The effect sizes are not large, but they are consistent across many studies and many populations.

A few honest qualifications.

The studies are mostly correlational rather than experimental. People who pray regularly differ from people who do not in many ways besides praying. Some of the observed benefit is probably from social support (community membership), some from health behaviors (lower rates of risky behaviors among regular practitioners), some from the practice itself, and disentangling these is difficult. Koenig's review acknowledges this directly and devotes a section to causal pathways.

The benefit is not uniform. The same review documents that certain kinds of religious experience — particularly negative religious coping ("God is punishing me," "I have been abandoned by God") — are associated with worse mental-health outcomes, not better. The form of the practice and the relationship the practitioner has with their tradition matters more than the simple fact of practicing.

The benefit is not a substitute for clinical treatment. The research consistently shows religious practice as one factor among many that contributes to mental-health outcomes. It does not show religious practice as a treatment for clinical conditions. A person with major depression who prays regularly is, on average, slightly better off than a person with major depression who does not — but a person with major depression who is in evidence-based treatment is much better off than either.

So: the research supports the intuition that contemplative practice contributes positively to mental health, on average, modestly. It does not support the claim that contemplative practice substitutes for clinical care. The two findings are stable across the literature and not in tension with each other.

How the two practices actually fit together

In practice, when a person is doing both, several patterns recur.

The therapy works on the structure; the contemplative practice works on the orientation. Therapy is unusually good at things contemplative practice does not do well — identifying cognitive distortions, processing traumatic memories, rebuilding behavioral patterns, treating symptoms of depression and anxiety. Contemplative practice is unusually good at things therapy does not do well — locating one's particular grief or fear or gratitude in a long line of human experience, providing a daily structure of attention, holding the question of meaning during ordinary days when no specific therapy work is happening. Most readers find the two doing different work without much overlap.

The therapy is the place where the harder things get said. A contemplative practice is usually not the right setting for the work of identifying and changing maladaptive patterns. The patterns are too entangled, the unconscious too active, the work too dependent on a skilled outside observer. The contemplative practice can name something, but the unpacking of it usually happens with the therapist. This is fine; this is what the therapist is for.

The contemplative practice is the place where the daily structure lives. Therapy is once a week, usually. Contemplative practice is daily. The day-by-day texture of working with anxiety, or processing grief, or sustaining gratitude, often happens on the contemplative side — saying the morning prayer, lighting the candle, reading the daily portion. The therapy session is the studio; the contemplative practice is the rehearsal that happens between sessions.

Both practices are honest with their own scope. A contemplative practice that claims to substitute for clinical care — just pray, you don't need a therapist — is doing damage. A clinical practice that dismisses a patient's spiritual life as irrelevant or pathological is also, in a less obvious way, doing damage. The research, again, is clear: for many patients, the spiritual or religious dimension is a real source of resilience that is worth working with, not against. Most contemporary therapy training (the AAMFT, the APA practice guidelines, mainstream clinical psychology programs) now includes some component of spiritual sensitivity for this reason.

What this looks like in a particular case

A reader recently wrote to describe their pattern. They lost a parent eighteen months ago. They are in grief therapy with a clinical psychologist who specializes in bereavement. They are also walking through the Jewish year of mourning — saying Kaddish at a daily minyan, lighting yahrzeit candles, observing the calendar of restrictions and transitions described in our other post.

The two practices, they said, do not contradict. They do different things. The therapy is where the harder material comes up — the complicated relationship with the parent, the unfinished conversations, the parts of the grief that do not fit the standard arc. The Kaddish is where the daily texture of mourning lives. Showing up at minyan, every day, surrounded by other people doing the same thing, is doing a kind of work the therapy could not do — it is structuring time, it is preventing the grief from disappearing, it is keeping the relationship to the deceased active rather than recessed.

When asked which they would keep if they had to pick, the reader answered: "Both, obviously. They aren't the same thing." That is the right answer. They aren't the same thing.

A few practical notes

If you are starting therapy and you have a contemplative practice already, tell the therapist. Most therapists will integrate the information into how they work with you. A few will not — if your therapist treats your spiritual practice with hostility or contempt, that is information about that therapist, not about your practice. The American Psychological Association's own clinical practice guidelines now treat religious and spiritual content as a routine part of culturally competent care.

If you are in therapy and considering starting a contemplative practice, you do not need permission. Begin small — one practice, ten seconds a day, like the Modeh Ani we describe in another post. See how it sits alongside the therapy work. Most people find it adds rather than competes. If you find it interfering — for example, if a particular prayer is bringing up content that the therapy is not yet ready to address — talk about it in therapy. The therapy is the place where that conversation happens.

If your spiritual practice and your therapy seem in genuine tension, it is worth examining the source. Sometimes the tension reveals that one of the two practices is in a phase that needs adjusting — a therapist who is not actually a fit for you, or a contemplative practice you are doing performatively rather than meaningfully. Sometimes the tension is the productive friction that healthy practice in either domain produces. A therapist and a thoughtful religious teacher can each help you sort which is which.

The basic frame

A spiritual practice is not a treatment. A treatment is not a spiritual practice. The two do different work in different ways. They both, at their best, contribute to a life. The Jewish tradition has been, in its own self-understanding, comfortable with this division of labor for a long time — the same medieval rabbis who wrote prayer books also wrote medical advice, and they did not confuse the two. A contemporary reader can hold the same frame without difficulty.

If you are in therapy and you are drawn to a contemplative practice, do both. The two are not in competition. They are complementary by design, even when the design is implicit and the language for it has to be reconstructed in pieces.

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Sources:

• Koenig, H. G. (2012). "Religion, Spirituality, and Health: The Research and Clinical Implications." ISRN Psychiatry, 2012, Article 278730. DOI: 10.5402/2012/278730. Open access at PubMed Central (PMC3671693). The most comprehensive systematic review available.
• Koenig, H. G. (2009). "Research on Religion, Spirituality, and Mental Health: A Review." Canadian Journal of Psychiatry, 54(5), 283–291. The earlier review feeding into the 2012 piece.
• Pargament, K. I. The Psychology of Religion and Coping (Guilford Press, 1997). The foundational text on religious coping, including the distinction between positive and negative religious coping that recurs in the contemporary literature.
• Maimonides, Mishneh Torah, Hilchot De'ot — the Jewish tradition's body-and-soul regulation literature, distinct from its prayer literature.
• American Psychological Association, Multicultural Guidelines — the contemporary clinical-practice framework that includes religious and spiritual content as part of competent care.

This post is published by Shalem, a Jewish wisdom app. Shalem is contemplative, not clinical. It does not assess mental-health states or provide treatment. If you are in mental-health crisis, please reach out to clinical support. We mention this for transparency.

If you are in immediate crisis, please contact local emergency services or a recognized hotline. In the United States: 988 (Suicide and Crisis Lifeline). In the UK: 116 123 (Samaritans). In Israel: 1201 (ERAN). In Italy: 800 86 00 22 (Telefono Amico).