Psychotherapy and Spirituality

The significance of spirituality as a health-related variable has been the focus of attention in theory, research and application in academic psychology and other health-related disciplines since around the beginning of the 1990s. It is in the nature of things that the possible inclusion of the spiritual dimension of human experience is particularly important in the case of life-shortening and serious illnesses. The clinical approaches of psycho-oncology and palliative psychology were developed for the psychological support of such courses. The interdisciplinary inclusion of the spiritual and religious dimension in a clinical environment is referred to as “spiritual care”.

The project “Spirituality in psycho-oncological and palliative psychological care” is dedicated to the following questions:

• How can the spiritual dimension be incorporated into the treatment of physically ill and mentally distressed people in a professionally appropriate and supportive way?
• What experiences, attitudes and needs do palliative psychologists and psycho-oncologists report with regard to their own work in this field?
• Which guiding psychotherapeutic aspects should be taken into account with regard to the inclusion of the spirituality of those affected?

Project staff

• Liane Hofmann

Cooperations

• Daniel Berthold, Medizinische Klinik und Poliklinik II, Innere Medizin, Schwerpunkt Palliativmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen. ; Institut für Palliativpsychologie, Frankfurt a. M.
• Jan Gramm, Institut für Palliativpsychologie, Frankfurt a. M.

Publications

Hofmann, L. & Berthold, D. (2025). Spiritualität in der psychoonkologischen und palliativpsychologischen Behandlung. Onkologie, 31, 69–74. https://doi.org/10.1007/s00761-024-01627-7

Hofmann, L., Berthold, D., & Gramm, J. (angenommen). Reden über Gott und die Welt. Spiritualität und Religiosität in der palliativpsychologischen Behandlung. In C. Zwingmann, C. Klein, & F. Jeserich (Hrsg.), Religiosität/Spiritualität – Sterben – Tod – Trauer. Beiträge zur empirischen Religionsforschung. Waxmann.

Hofmann L. (2021). Spirituell, aber nicht religiös? Überlegungen zur Einbeziehung der spirituellen Dimension in der Behandlung von religiös nicht gebundenen Krebspatienten. Bewusstseinswissenschaften. Transpersonale Psychologie und Psychotherapie, 27(1), 66–79.

Berthold, D., Gramm, J. &  Hofmann, L. (2016). Spiritualität und Religiosität in der Weiterbildung von Psychologen in Palliative Care. Spiritual Care – Zeitschrift für Spiritualität in den Gesundheitsberufen, 5(1), 17–24. https://doi.org/10.1515/spircare-2016-0004

As part of an approximately representative nationwide questionnaire survey, 895 psychological psychotherapists in private practice were interviewed on the topics of spirituality and religiosity. The research project aimed to explore the attitudes and experiences of representatives of established psychotherapeutic care with regard to the topics of spirituality and religiosity. In addition, the extent to which and in what form these topics play a role in current psychotherapeutic practice was to be recorded.

The following questions should be investigated in more detail:

1. To what extent and in what specific way are the topics of spirituality and religiosity important in German psychotherapeutic practice?
2. To what extent were clinically relevant questions on these topics taken into account in psychotherapy training?
3. How do psychotherapeutic practitioners assess their training in this area and what needs do they express?
4. How can the personal spiritual/religious involvement and orientation of the psychotherapists be described?
5. What influence does a psychotherapist’s spiritual or religious orientation have on their psychotherapeutic work?
6. What significance does the theoretical orientation have with regard to the attitude towards and handling of these subject areas?

Selected Findings

A random sample of 1700 psychological psychotherapists in private practice were contacted and asked to complete a questionnaire. The statistical analysis included 895 responses from licensed psychological psychotherapists. It was found that the topics of spirituality and religiosity are also a current and relevant topic for many psychological psychotherapists in the Federal Republic of Germany. The interviewees proved to be very open-minded and interested in these issues. According to the psychotherapists’ assessment, an average of 22% of their clients address issues and problems relating to spirituality or religiosity during the course of treatment. In contrast, similar to US studies, it was found that psychologically relevant issues relating to spirituality and religiosity were only considered to a limited extent in psychotherapy training. At around two-thirds, a considerable proportion of respondents were in favor of greater consideration of relevant content in academic and psychotherapeutic education and training. Furthermore, it became clear that spirituality and religiosity are also important in the personal lives of many psychotherapists.

Variance analysis group comparisons (validated by non-parametric procedures) showed that psychotherapists with a humanistic and cross-methodological orientation attached more importance to these topics than those with a psychodynamic and behavioral therapy orientation. However, the significance of the theoretical orientation with regard to the topic of the study proved to be comparatively low.

As part of a stepwise multiple regression, the question of which factors on the part of the psychotherapists contribute to predicting the thematization of spiritual/religious content and problems in the course of treatment was investigated. It was found that personal characteristics of the therapists, such as their personal involvement with these topics, the significance of spirituality or religiosity for their own lives or the belief belief in a higher, transcendent reality, are more important than structural factors such as health insurance license or psychotherapeutic orientation.

What conclusions can be drawn from these findings?

The findings of this study show that spirituality and religiosity play a significant role both in the psychotherapeutic setting and in the personal lives of many psychotherapeutic practitioners. In this respect, the data collected implies that clinically relevant spiritual and religious influencing factors should be more strongly included in academic training, postgraduate psychotherapy training and scientific research.

The findings of this survey are particularly significant in that it is the only nationwide, almost representative and large-scale study on this topic in Germany to date. This study received a correspondingly broad response in widely read psychotherapeutic journals. For example, it was reported on in Psychotherapy Research 2011, 21 (02); Psychotherapeuten Journal 2012 (2 and 3), 2016 (2); Deutsches Ärzteblatt 2/2017; Psychotherapeut 2015, 60 (5).

The spiritual and religious dimension of human experience has received increasing attention from established psychotherapy and health professions since around the beginning of the 1990s. While, on the one hand, a wealth of high-quality clinical-therapeutic material on the subject has emerged during this time, many open questions are still being discussed quite controversially. The findings of this study could undoubtedly make a valuable contribution to clarifying open questions in this field.

Project Team

• Leitung: Harald Walach
• Mitarbeiterin: Liane Hofmann

Cooperation

• Prof. em. Dr. phil. Franz Caspar

Publications

Hofmann, L. (2020). Spiritualität in der Psychotherapie. In D. Vaitl (Hrsg.). An den Grenzen unseres Wissens. Von der Faszination des Paranormalen (S. 283–304). Herder.

Walach, H. & Hofmann, L. (2018). Spiritualität und Religiosität in der Psychotherapie. In G. Juckel, K. Hoffmann & H. Walach (Hrsg.), Spiritualität: in Psychiatrie & Psychotherapie (S. 283–304). Pabst Science Publishers.

Hofmann, L. (2012). Nun sag, wie hältst Du‘s mit Spiritualität und Religiosität? Ergebnisse einer bundesweiten Befragung unter Psychologischen Psychotherapeuten. In M. Schetsche und K. Krebber (Hrsg.), Grenzpatrouillen. Sozialwissenschaftliche Forschung zu außergewöhnlichen Erfahrungen und Phänomenen (S. 223–259). Logos.

Hofmann L. & Walach, H. (2011). Spirituality and religiosity in psychotherapy – A representative survey among German psychotherapists. Psychotherapy Research, 21(02), 179–192. https://doi.org/10.1080/10503307.2010.536595

Hofmann, L. (2011). Spirituelle oder religiöse Orientierung und deren Auswirkung auf die psychotherapeutische Tätigkeit. In A. Büssing & N. B. Kohls (Hrsg.), Spiritualität transdisziplinär. Wissenschaftliche Grundlagen im Zusammenhang mit Gesundheit und Krankheit (S. 173–192). Springer. https://doi.org/10.1007/978-3-642-13065-6_15

Hofmann, L. (2009). Spiritualität und Religiosität in der psychotherapeutischen Praxis. Eine bundesweite Befragung von Psychologischen Psychotherapeuten. Dissertation. Carl von Ossietzky Universität Oldenburg.

Hofmann, L., Möckelmann, B., Walach, H. (2003). Entwicklung und empirische Validierung einer Skala zur Erfassung der Einstellung von Psychotherapeuten zum Verhältnis von Psychotherapie und Spiritualität / Religiosität. In W. Belschner, L. Hofmann & H. Walach (Hrsg.), Auf dem Weg zu einer Psychologie des Bewußtseins (S. 113-154). BIS-Verlag.