Back to Basics: Integrating spirituality into Multicultural Counselling | EAPA-SA

zen stone garden, spa wellness relaxation and buddism or yoga spirituality relaxation and balance backgroundMental health professionals are increasingly being called to work holistically with all of the elements of a client’s cultural identity.  Cultural identity includes an individual’s complete social identity which includes age, sexual orientation, disability, socioeconomic status, race/ethnicity, and religious and spiritual orientation.  Individuals may be spiritual not religious or religious not spiritual – or they could be both or neither of these things.

Often times the spiritual not religious individual is seeking meaning, connection with others, and completeness. The religious not spiritual person typically participates in religious institutions, holds theistic beliefs, and institutionalized moral values. The spiritual and religious person holds characteristics of both while the neither spiritual nor religious person holds few if any of these characteristics.” 1

The Intersection of Culture, Spirituality and Counselling

According to Mary A. Fukuyama, Clinical Professor and Psychologist for the Counselling Center at the University of Florida, USA in her book titled Integrating Spirituality into Multicultural Counselling, both spirituality and religion have been recognised as important aspects of healing, recovery from addictions, and support during times of human suffering.   Spirituality may be experienced and expressed through religion, which is characterised by beliefs, social organisation, and cumulative traditions. However, spiritual issues that arise in counselling may or may not be associated with a religious belief system.2

It is important for the multi-culturally aware counsellor to be able to understand their client’s worldview, in particular the client’s beliefs around spirituality and his or her relationship to the supernatural.  Research has found that clients may tend to seek help elsewhere when they perceive a therapist does not understand or disregards their perspective about their beliefs. On the other hand religion and spirituality can be successfully used to cope with psychological disorders, prevent unhealthy behaviours and promote resilience.

The Benefits of Integrating Spirituality into Counselling

There is growing empirical evidence that our spiritual values and behaviours can promote physical and psychological well-being.

  • Exploring these values with clients can be integrated with other therapeutic tools to enhance the therapy process.
  • During the assessment process, it can be ascertained how certain beliefs and practices of the client can be a useful focal point for exploration.
  • Counselling can help clients gain insight into the ways their core beliefs and values are reflected in their behaviour. Clients may sometimes discover that they need to re-examine these values. (Clinicians must remain open and nonjudgmental. It is not the role of the counsellor to prescribe any particular pathway.)
  • Counsellors can make use of the spiritual and religious beliefs of their clients to help them explore and resolve their problems. (To effectively be able to address spiritual concerns in assessment and treatment, counsellors need to have competencies in working with values.)
  • Building on the religious and spiritual strengths of the client may serve as a support and enable them to improve on their coping skills. Therapeutic interventions that include a spiritual component have a better chance of enabling clients in their ability to cope with physical or mental illness.3

The FICA Spiritual History Tool © 

The FICA Spiritual History Tool was developed by Dr. Christina Puchalski, Professor of Medicine and Health Science and Director at The George Washington University’s Institute for Spirituality, with a group of primary care physicians, to help healthcare professionals address spiritual issues with patients.

It allows spiritual histories to be taken as part of the regular history. The FICA tool serves as a guide for conversations in the clinical setting with the acronym FICA to help structure questions in taking a spiritual history by healthcare professionals, as follows:

F – Faith and Belief

“Do you consider yourself spiritual or religious?” or “Is spirituality something important to you” or “Do you have spiritual beliefs that help you cope with stress/ difficult times?” “What gives your life meaning?”

I – Importance

“What importance does your spirituality have in our life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your healthcare decision making?

C – Community

“Are you part of a spiritual community? Is this of support to you and how? Is there a group of people you really love or who are important to you?”

A – Address in Care

“How would you like me, your healthcare provider, to address these issues in your healthcare?”

(Copyright, Christina M. Puchalski, MD, 1996)

The South African context

Culture is intrinsic to the construction of human identity.  In the South African counselling context multiple cultures co-exist and counselling along with other psychosocial interventions would do well not to neglect this important fact.  To work effectively with spiritual issues, counsellors need to have knowledge of all aspects of spirituality, and a broad knowledge of different religious beliefs and world views.  Furthermore they need guidelines on how to include this dimension in their counselling practice in an ethical and skilled manner.

1Blando, J. (2006). Spirituality, religion, and counseling. Counseling and Human Development,

2Fukuyama, M.A. (1999). Integrating spirituality into multicultural counselling