Integrating spirituality as a multicultural component into time-limited psychotherapy: Two case studies.

Multicultural orientation (MCO; Owen, Psychotherapy, 50, 2013, 496; Owen et al., Psychotherapy, 48, 2011, 274) is a framework for understanding how psychotherapists engage with their clients’ cultural identities within session and focuses on interpersonally humble processes rather than implementing specific skills that are unique to specific cultural groups. Clients who have therapists with higher MCO report better mental health outcomes and better therapeutic alliances (for a review, see Davis et al., Psychotherapy, 55, 2018, 89). Moreover, religious and spiritual (R/S) clients whose R/S wellness is addressed in session have higher mental health outcomes (Captari et al., Journal of Clinical Psychology, 74, 2018, 1938). However, little is known regarding how psychotherapy processes and MCO align when therapy dyads are discussing religious and spiritual (R/S) issues in session. This empirical case study reviews qualitative and quantitative data from two psychotherapy dyads wherein the clients had similar presenting problems, demographics, and discussed R/S issues with their therapists. Coder ratings of MCO and client-reported mental health and working alliance outcomes of selected sessions were analyzed to understand how these processes occur in actual psychotherapy sessions and what clinical gains were made. While both dyads discussed R/S issues and made clinically significant gains via self-reports of wellbeing, the dyads differed in MCO ratings of humility and comfort. Content analysis of session transcripts unpacked these differences and identified the psychotherapists’ interventions and responses to their clients. Key takeaways for psychotherapists working with R/S clients are discussed.