Client Preference Accommodation for Religious/Spiritual Integration and Psychotherapy Outcomes in Naturalistic Practice Settings

Clinical Impact Statement Question: Is there a relationship between client preference accommodation for religious/spiritual (R/S) integration in psychotherapy and treatment outcomes in outpatient private practice settings? Findings: Accommodating client preferences for R/S integration was associated with less frequent dropout and a greater likelihood of improvement while in treatment. Meaning: These findings suggest that therapists should seek to assess and accommodate client preferences for R/S integration. Next Steps: Further research in other settings and for specific R/S techniques is needed. The purpose of this practice-research network study was to examine client preferences for religious/spiritual (R/S) integration and test whether preference accommodation in this area is linked to positive treatment outcomes (i.e., less dropout and greater client change). Thirteen independent practice psychotherapists and their 175 clients completed measures of R/S integration preferences and use of R/S techniques and approaches throughout treatment. Psychotherapists also completed an assessment of treatment dropout and change for each participating client. Overall, participating clients expressed moderate preferences for R/S integration, time spent on R/S topics, and an R/S match with their psychotherapists. Preferences in each of these 3 areas were stronger for R/S identifying clients (compared with non-R/S clients) and when clients believed that R/S integration was more essential to produce positive treatment outcomes. Both client R/S identification and client R/S integration preferences predicted psychotherapist's use of R/S techniques in treatment sessions. Importantly, clients' ratings of R/S preference accommodation significantly predicted psychotherapists' ratings of client treatment completion and client change. Specifically, with each unit increase on a 5-point measure of client perceptions of R/S preference accommodation, clients were 1.63 times more likely to be rated as treatment completers and 1.83 times more likely to be identified as having improved while in treatment. Implications for R/S integration in psychotherapy and future research directions are discussed.