Spiritual Direction vs. Therapy: How They Differ

Spiritual direction is an ongoing conversation about your life with God. You meet with someone, usually once a month, and talk about how you pray, what is happening in it, what is drawing you toward God and what is pulling you away. The Catechism describes it in one line, in its section on guides for prayer: the Holy Spirit gives some of the faithful gifts of wisdom, faith and discernment for the sake of prayer, and the Church calls this help spiritual direction. ¹

The person helped is the one who decides. Pope Francis, closing a long series of talks on discernment, said the companion in this work does not take the Lord’s place or do the work for the person, but walks beside them and helps them read what is stirring in their own heart. He added that he preferred the name "spiritual accompanier" to "spiritual director." ² In the Catholic understanding the real director is the Holy Spirit, and the human one is there to help you listen.

Some basics are worth having straight. Spiritual direction is not a sacrament, and the Church does not require it of lay people. A director need not be a priest: laymen, laywomen and religious sisters and brothers direct many people. For a fuller picture, see what spiritual direction is and what to expect in spiritual direction.

Psychotherapy, often just called talk therapy or counseling, is a treatment. The National Institute of Mental Health describes it as a range of approaches that help people identify and change troubling emotions, thoughts and behaviors, and lists psychiatrists, psychologists, social workers, counselors and psychiatric nurses among those who provide it. ³ A therapist assesses what is going on, may give a diagnosis, and works toward goals you agree on, using methods that have been studied and tested.

Therapists are licensed health professionals. SAMHSA, the federal agency for mental health and substance use, lists the common credentials: clinical social workers (LCSW and similar), licensed counselors (LPC, LADC), psychologists (PhD, PsyD, EdD) and marriage and family therapists (LMFT). It also notes that what each may do depends on the state you live in, and that psychiatrists and psychiatric nurse practitioners can prescribe medication while most therapists cannot. ⁴

Faith is not off limits in therapy, and many therapists, Catholic or not, will work respectfully with a patient’s religious life. But a therapist’s job is your health, not your prayer, and a good one will say so.

The differences are easiest to see one at a time.

• Aim. Direction aims at a deeper relationship with God and a life more faithful to him. Therapy aims at mental and emotional health and better functioning.
• Focus. A director asks about prayer, the sacraments, desires, temptations and decisions in the light of faith. A therapist asks about symptoms, history, relationships, patterns of thought and behavior.
• Who leads. In direction you bring what you want to talk about, and the director listens and asks questions; the Holy Spirit is understood to be the one really at work. In therapy the clinician is responsible for assessment and treatment and often proposes a plan.
• Training and licensing. Therapists hold state licenses and answer to licensing boards. Spiritual directors have no license. Some complete formation programs, but nothing equivalent to clinical licensing exists.
• Confidentiality. A therapist’s confidentiality is set by law and professional ethics, with legal exceptions. A director’s is a matter of trust within the Church’s internal forum, and is not the seal of confession.
• Frequency. Direction is usually monthly, for years. Therapy is often weekly, sometimes for a set number of sessions.
• Cost. Direction from a parish priest is often free, and some lay directors ask a modest fee or a donation. Therapy is paid professional care, sometimes covered by insurance.

Therapists keep what you tell them confidential under state law and the ethics codes of their professions, but the law also sets limits on that confidentiality, and the limits vary from state to state. The clearest example is child abuse. Every state names people who must report suspected abuse or neglect; according to a federal summary of state statutes, about 38 states list counselors, therapists and other mental health professionals by name, and a handful of states require every adult to report. ⁵ A therapist should explain the limits of confidentiality at the first appointment, and you are entitled to ask.

Spiritual direction is confidential in a different way. What you say belongs to what the Church calls the internal forum, the sphere of conscience, and a good director treats it with great discretion. But it is not sacramental confession, and only confession carries the seal. Canon law calls the sacramental seal inviolable and forbids a confessor to betray a penitent in any way and for any reason. ⁶ That absolute protection covers what is said in confession, not what is said in a direction session, even when the director is a priest.

Civil law reaches spiritual directors too. The same federal summary counts about 29 states that list members of the clergy among mandated reporters of child abuse. ⁵ If this matters to you, ask a director at the start what they would be obliged to report. The question is reasonable, and a good director will not take offense.

Pastoral counseling is a loose term. It can mean a priest or deacon helping a couple through a hard patch in the parish office, or it can mean a licensed mental health professional who also has theological training and works from a faith perspective. The first is pastoral care, usually short-term and focused on a particular problem. The second is clinical therapy with a religious dimension. If someone offers you pastoral counseling, it is fair to ask which they mean, and whether they hold a state license.

Confession, the sacrament of penance, is different from all of these. In it a penitent confesses sins to a priest, is sorry for them and intends to change, and receives God’s forgiveness through the priest’s absolution; canon law also says that only a priest can be the minister of the sacrament. ⁶ Confession is brief and is about sin and forgiveness. Some people make their confession to the priest who directs them, but the sacrament and the direction remain distinct even then. The guide to confession walks through what happens.

Life coaching is aimed at goals: a career change, a business, habits, performance. A coach helps you set targets and keep to them. Coaching is not health care and holds no state license of the kind therapists hold; such credentials as exist come from private associations. A Catholic coach may share your faith, but coaching is not spiritual direction, and it is not a substitute for therapy when something deeper is wrong.

A typical direction session is about an hour, once a month, sometimes more often during a retreat or a time of decision. People often stay with the same director for years, and the relationship ends when one of them moves, the director retires, or the person and director agree it has run its course.

Therapy is usually weekly, at least at first. Some treatments are designed to last a set number of weeks; others continue as long as they help. The National Institute of Mental Health suggests asking a prospective therapist whether they recommend a specific time frame or number of sessions. ³

Spiritual direction is not treatment, and it is not the right first help for illness. See a doctor or a licensed therapist if you are dealing with depression that does not lift, anxiety or panic that disrupts daily life, the aftermath of trauma or abuse, an addiction to alcohol, drugs, gambling or pornography that you cannot break, an eating disorder, thoughts of harming yourself, or anything that feels like losing touch with reality. SAMHSA suggests that your regular primary care provider is often a good place to start, since many can treat anxiety and depression and can refer you on. ⁴

If you are in crisis or thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline. It is free, confidential and open at all hours, anywhere in the United States, and it also offers online chat. ⁸ If you or someone else is in immediate danger, call 911.

A good director will recognize when something is beyond spiritual direction and will say so. The Church’s guidelines on psychology in seminary formation describe exactly this: a spiritual director may suggest a psychological consultation to someone in his care, though never demand it. ⁷ Being sent to a therapist says nothing against your faith.

The clearest recent statement is a 2008 document from the Congregation for Catholic Education, "Guidelines for the Use of Psychology in the Admission and Formation of Candidates for the Priesthood." It says that a priestly vocation, as a gift of God, lies outside the strict competence of psychology, but that experts in the psychological sciences can be useful: in assessing a candidate’s psychological state, in diagnosing and treating disturbances, and in helping heal old psychological wounds that block growth. It also requires that any such assessment be done only with the candidate’s explicit, informed and free consent. ⁷

The same document draws the line this article has been drawing. It calls it a firm principle that "spiritual direction cannot, in any way, be interchanged with or substituted by forms of analysis or of psychological assistance." ⁷ Pope Francis made the matching point from the other side: spiritual discernment does not exclude insights from psychology and the other human sciences, but goes beyond them. ⁹

In practice, then, the two can go together well. A person in therapy for anxiety may find that direction helps them pray through it; a person in direction may find that their director’s gentle suggestion to see a counselor was the most helpful thing said all year. With your permission, the therapist and the director may even speak, though neither should do the other’s job.

If you are looking for a director, start with your parish priest or your diocese, which can often point to trained directors and retreat houses nearby. GraceBook also lists Catholic mentors who offer spiritual guidance by video; they are not clinicians, and under the Mentor Agreement each undertakes to work within their competence. Our guide on how to find a spiritual director covers what to look for.