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Counselor's Corner: Integrating Spirituality and Counseling for African American Clients with Mental Illness and Substance Use Disorders, Part 2

September 6, 2023

Twelve Steps Programs, Spiritually-Modified CBT, and Mindfulness-Based Art Therapy

By: Kisha Freed, Success Coach, Six Seconds Certified EI Practitioner/Assessor, Mindfulness Meditation Instructor

       Mark Sanders, Licensed Clinical Social Worker, Certified Substance Use Disorders Counselor.


The first article of this series establishes the contextual framework that we build upon in this discussion—especially regarding the historical significance of spirituality for enslaved Africans in America, the cultural importance of community and spirituality for African Americans, and the effectiveness of spirituality as an instrument of self-connection for African Americans engaging in mental health and substance use recovery services.

In this installment, we explore various methods for integrating spirituality and counseling for African American clients in recovery and fostering a connection of trust and care in therapist-client relationships.


Kisha: Mark, you have a lot of first-hand experience with spiritually integrated therapy. What advice can you give to providers who are interested in offering spiritually integrated services for African American clients?


Mark: My approach to integrating spirituality and counseling begins by asking clients a series of questions so I can better understand their perspectives, their needs, and what's culturally or spiritually important to them:

  1. What are your sources of comfort, strength, peace, love, joy, and connection?
  2. What do you hold on to or what gives you strength during difficult times?
  3. When you experience racism, discrimination, or oppression as an African American, what sustains you and keeps you going?
  4. Do you believe there are differences between religion and spirituality? If yes, what are those differences?
  5. Are you a part of a religious or spiritual community?
  6. Did your parents follow any specific religion or spiritual belief system? If yes, what were their views? Do you believe their beliefs influenced their response to experiences of racism, oppression, and other life challenges?
  7. Have you kept the same religion or spiritual beliefs you were raised with (if any), adopted new beliefs, or integrated new beliefs with those you were taught as a child?
  8. Which aspects of your religion are helpful to you (if any)? Which do you find challenging or not so helpful (if any)?
  9. Have challenges caused by mental illness or substance use changed the manner or modality through which you express your spirituality? If yes, how?
  10. Many African Americans celebrate and/or share their spirituality through artistic expression (e.g., music, poetry, painting, dancing, rap, drama, creative writing, etc.) How do you celebrate and/or share your spirituality (if at all)?
  11. Are you interested in pursuing any creative expressions of spirituality and/or art therapy in your recovery?
  12. As a counselor, is there anything I can do to help you access resources so you can stay connected with your spirituality and/or support a burgeoning sense of spiritually or artistic expression on your recovery journey?


Kisha: These are some powerful questions–they invite the client to review how the past has affected their present and they provide an opportunity for clients to openly discuss both secular and spiritual motivations within the scope of self-empowerment. This approach has been known to speed recovery by compounding clients' desires to address the problem. By using open-ended questions, you are creating a space for the client to exercise self-agency and get in touch with themselves as the author of their life. It might be a bit uncomfortable at first, but the discussion can help them ease into a mindset of personal responsibility.

How has integrating spirituality with counseling impacted your clients, and how has it changed your practice on a larger scale?


Mark: I first had the idea to try spiritual integration based on census results and Gallup polls that revealed more than 50% of Americans practice a religion and consider religion to be a very important part of their life. When I began introducing this approach to African American clients, it wasn't easy—particularly with clients who were resistant to considering other spiritual approaches that differed from what they'd learned as a child. Sometimes, folks were resistant even if they no longer ascribed to those religious beliefs because they felt as though they might be betraying their parents. To overcome this barrier, I found it helpful to discuss the differences between religion and spirituality and describe some of the common artistic expressions of spirituality that could be used in our therapy.

On a larger scale, I realized that I bring my own spirituality to my counseling relationships because it's an integral aspect of who I am. My spirituality is demonstrated by my enthusiasm, my energy, and my deeply held belief in the capacity of individuals to change and grow and hope. Many African American clients seeking recovery need hope!


Kisha: I agree—many are seeking hope, meaning, and a deeper purpose for life. Bringing awareness to the idea that spiritual experiences can be broader than religion is a good way to introduce complementary practices, such as art and music therapy. Art therapy and similar art-based therapeutic practices often help accelerate recovery because clients are more likely to lean into the interventions and treatments.

The arts in general are often meditative and mindful activities that increase an individual's awareness of the present moment and the connection between mind, body, and spirit. Art therapist Laury Rappaport has described that mindfulness-based art therapy (MBAT) “[adds] a dimension of connecting the imaginal realm with the bodily felt experience.”

When I hear you talk about integrating spirituality into your counseling with clients, I see a similar opportunity for creating connection, encouraging individual expression, and cultivating safe and compassionate therapeutic space. This is especially true for African American clients, since we know that African Americans with SUDs and mental illness often experience greater stigma, conscious and unconscious bias, and discrimination.


Mark: Yes! What you just shared reminds me of a story from a book entitled, Not God: A History of Alcoholics Anonymous (1991). Bill Wilson, the cofounder of Alcoholics Anonymous, exchanged letters with the renowned psychiatrist, Carl Jung. It was Dr. Jung that convinced Bill to add the spiritual component to Alcoholics Anonymous. During the U.S. Prohibition and earlier, alcohol was often referred to as "the spirits" or "the evil spirits." Dr. Jung suggested that if people are giving up the spirits, it might be helpful for them to fill that void with spirituality.

In part one of this series, we discussed the word "connection" as one of many definitions of spirituality. African Americans seeking recovery have found connections in Twelve Steps groups, Women for Sobriety, SMART recovery, Celebrate Recovery, African American Faith-based Ministries, and many more recovery-oriented communities.


Kisha: The spirit of connection provides a sense of camaraderie and belonging that is similar to African tribalism and the fulfillment of communion and community. African American people are communal, and we thrive on fellowship.

Similarly, African Americans attend church not only for worship but also for fellowship. I'm curious to know why some people believe that the Twelve-Step programs (TSPs) don't work for African Americans. Do these programs offer African Americans a community where they feel understood and where they see themselves reflected back—not only physically, but also in a cultural and spiritual sense?


Mark: I'd like to share with you how your question resonates with me. I've attended meetings in communities where I was the only African American. Although TSPs are spiritual in nature, you can still feel traces of Christianity. For example, at the end of many meetings, members hold hands, say the Lord's Prayer and the Serenity Prayer, and conclude by hugging each other. When I was the only African American at a meeting and it was time for the hug, the person to my right would first hug the person to their right and the person to my left would first hug the person to their left, leaving me with no one to hug until the second hug. I like to ask my clients what's important to you in selecting peer support? Do you want to attend groups with people who share your age, your drug of choice, people who are similar to you racially or culturally, etc. If we can connect clients to the specific support groups that work for them, they can experience a greater sense of community and comfort.


Kisha: I can see that. There are also people in recovery who may want a different experience. The field of behavioral healthcare continues to expand the options for person-centered services. However, that is not to say the TSP is going away!

I've read that some treatment facilities are taking a multi-step approach and combining  cognitive behavioral therapy (CBT) with TSPs. Furthermore, using culturally or spiritually-modified CBT specific to what is culturally appropriate for the group has proven to be an effective evidence-based approach.

Working with our young people in group workshops, I've observed that some of our Generation Z folks are not as communal as the older generations. A recent psychological marketing study indicates that Gen Z are more likely to share personal information on social media due to social expectations, social anxiety, and being addicted to the use of social media platforms. It's been suggested that younger people don't feel aligned with the TSP concepts of “powerlessness” or a “higher power.” In these cases, a good alternative might be the use of spiritually-modified CBT that can offer a more individualized experience of self-discovery and recovery. 

Speaking from an emotional intelligence perspective, I think it's vital that service providers facilitate and support the most important connection of all—our connection to ourselves. It is the first and foremost relationship that must be acknowledged and repaired when beginning any pathway to recovery, because without that foundation, you cannot build authentic connections with others. From generation to generation, person to person, spiritual values vary. Diversifying our approaches to treatment, counseling, and recovery ensures we can meet people where they are with sincere compassion and a promise of hope for the future.


In case you missed it, check out the first blog post of this 3-part series where we discuss the differences between religion and spirituality, the historical context of spirituality for enslaved Africans in America, and the impact of spiritual resiliency in African American communities today. 


Photo credit: Delmaine Donson





Booth, L. Breaking The Chains: Understanding Religious Addiction and Religious Abuse. (1989). Emmaus Publishing. Dubuque, IA.


Gallup Poll. Religion. (2022).


Hinchey, L. M. (2018). Mindfulness-Based Art Therapy: A Review of the Literature. Inquiries Journal, 10(05).


Hodge, D. R. (2011). Alcohol Treatment and Cognitive-Behavioral Therapy: Enhancing Effectiveness by Incorporating Spirituality and Religion. Social Work, 56(1), 21–31.


Kingston, S., Knight, E., Williams, J., & Gordon, H. (2015). How do Young Adults View 12-Step Programs? A Qualitative Study. Journal of Addictive Diseases, 34(4), 311–322.


Kurtz, E. Not God: A History of Alcoholics Anonymous. (1991). Hazelden Publishing. Center City, MN.


Jenkins, R. (2022, August 16). 3 Things Making Gen Z the Loneliest Generation | Psychology Today.


Lyngdoh, T., ElManstrly, D., & Jeesha, K. (2022). Social isolation and social anxiety as drivers of generation Z’s willingness to share personal information on social media. Psychology & Marketing, 40(1).


National Alliance on Mental Illness. (2017). African Americans | NAMI: National Alliance on Mental Illness.


O’Day, E. B., & Heimberg, R. G. (2021). Social media use, social anxiety, and loneliness: A systematic review. Computers in Human Behavior Reports, 3(100070), 100070.


Wilson, B. Alcoholics Anonymous. (2011). Dover Publications. Mineola, NY.


Winner, N. A. (2021). Bridging the gap: The compatibility of cbt-based approaches with twelve-step programs in the treatment of substance use disorders. Substance Use & Misuse, 56(11), 1–8.




Related Resources from the ATTC Network

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Great Lakes ATTC



Integrating Spirituality for African American Clients, Part 2
By: Kisha Freed and Mark Sanders
Contributing Center(s):