Audience members at a Christian performance at South by Southwest Brian Snyder / Reuters

In the lead-up to the 2016 presidential election, life in the town of Easley, South Carolina, was tense for Leigh Drexler. Pick-up trucks with airborne Confederate flags seemed more prevalent than ever before, and her grandparents—who had never voted in their lives—registered to cast their ballots for the Donald himself.

Drexler felt isolated. “My family has always directed their point of view at me, but it has been a million times worse than normal,” she told me last October. “Every time we’re in a conversation, it’s either about the election or religion.”

It’s a dynamic that led Drexler, who identifies as a democratic socialist and an atheist, to go online in search of a therapist—someone who would perhaps better understand her lack of faith. She scouted towns within a 20-mile radius, but only “faith-based” practitioners turned up. She resorted to distance counseling over the phone with a therapist a few states away. “I knew there would be Christian counselors here, but I didn’t think that was all I was going to find,” she said.

In the U.S., people are less religious than ever. Adults in their 20s and early 30s make up more than one-third of the country’s “nones,” or those who consider themselves religiously unaffiliated. Church attendance among young Americans has also declined, and most adults nationwide rely on internet research, rather than prayer, when faced with life decisions.

But for many non-believers living in the country’s most religious regions, namely the Bible Belt and parts of the Midwest, the idea that religion in America is somehow eroding seems foreign, if not far-fetched. Despite the overall decline in religiosity over the past decade, around 70 percent of Americans still identify as Christian, currently making the U.S. home to more Christians than any other place in the world.

So what does that mean for atheists, agnostics, secularists, and “nones” living in the country’s most faithful pockets? Well, historically, a kind of culture war, where the separation of church and state is hotly debated in places like restaurants, schools, and the workplace. However, in recent years, a more understated and intimate clash over religious liberties has been playing out—only this time, it’s on a therapist’s couch.

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Sigmund Freud once called religion the “universal obsessional neurosis of humanity,” setting the tone for a long-fractured relationship between psychology and theology. Although tensions between the two domains have softened over the past few decades, the tête-à-tête persists, in part because they are devoted to a similar purpose: explaining the intricacies of the human mind, and soul.

The degree to which “He” fits into the mix can vary. From Christian rehabilitation centers and biblical life coaches to religious private practices, spiritual counselors, and something as contentious as conversion therapy, Christian groups have been adopting mental health as a new frontier in recent years. And at the forefront of this trend are faith-based therapies, which have reportedly experienced a surge in popularity over the last decade.

Some practitioners point to substance-rehabilitation programs as the driving force behind this surge. Alcoholics Anonymous meetings, for instance, traditionally come to a close by reciting the Lord’s Prayer, and six of the famous 12 steps cite “God,” “Him,” or “a Power greater than ourselves.” “The chemical-dependency field really began to integrate spirituality long before the mental-health field,” says Gregory Jantz, the founder of The Center: A Place of Hope, a faith-based treatment center in Washington that specializes in depression and anxiety. For Jantz, who is a licensed mental-health counselor, acknowledging the prospect of a higher power can be integral to a person’s well-being. “‘Why am I on this planet? What's my purpose? Who am I?’ Those are questions that are often addressed by looking at faith,” he says.

Last April, Tennessee Governor Bill Haslam signed legislation that would allow psychologists and therapists to deny patients based on their own “sincerely held principles.” The controversial move prompted the American Counseling Association to cancel its annual conference in Nashville, on the basis that the law targeted the LGBTQ community. The gesture was political—something both therapists and Christian-counseling networks condemned—but it also exposed a growing conversation, or concern, about the presence of religion in the field of mental health.

For many clients who aren’t religious, like Drexler, this concern has been a reality for some time. “Their entire lives have been wrapped up in religion, and they were raised and socialized to have that be everything,” says Patricia Guzikowski, a licensed professional counselor based in Wisconsin. “It is hard for them to make a transition.”

Guzikowski provides distance counseling for clients throughout the U.S., many of whom identify as atheists living in religious communities. She’s spoken with women who are afraid of losing custody of their children during a divorce, as a result of losing their faith. She’s counseled ex-Mormons and former Jehovah’s Witnesses secretly over the phone or through email conversations, so that their families and friends do not find out.

Reddit threads are filled with similar stories of people seeking guidance after religious renunciation. An atheist teenager, whose dad is a preacher, asks for help on how to cope with a loss of faith. In Alabama, one person searches for a non-religious therapist to deal with depression. Another, in Dallas, seeks a secular trauma counselor for PTSD.

And then there’s “Grief Beyond Belief,” a support network on Facebook for people who have lost a loved one and want to grieve faith-free. “If you’re grieving without a belief that you’re going to be reunified or that your loved one is somewhere better, your needs are really different,” Rebecca Hensler, the group’s founder, says.

Hensler started the page shortly after the death of her infant son in 2009, and was surprised by the response. She saw stories that read like her own: parents who weren’t comforted by the idea that their baby was now “in Heaven,” or that death might be anything other than death itself. Today, the page has nearly 20,000 likes. Users post daily about what it’s like to mourn alongside pressures from family, friends, or their counselors. “I couldn’t count the number of posts from people who share stories about being in therapy, and then the therapist offers to pray with them or talks about Heaven,” Hensler says. “It’s so profoundly harmful to that therapeutic relationship.”

What groups like Grief Beyond Belief ultimately hint at is a basic ideological divide in the way Americans deal with their problems: Some people are comforted at the thought of a higher power, while others are repelled by it. Applying a similar logic to therapy, people want counselors who share their beliefs and can understand their struggles. Perhaps that is part of the reason faith-based counseling has garnered strength in recent years: For religious patients and therapists who’ve felt underrepresented in a traditionally secular therapeutic community, these programs represent an invaluable part of their identity.

“I identify as a female, wife, daughter, aunt, and Catholic,” says Jill Duba Sauerheber, a licensed clinical counselor in Kentucky. “But I’m also very careful about advertising that I’m a Christian counselor, because I'm a counselor—that’s what I am. … When you label yourself as anything, you automatically begin to narrow your client pool, and potential clients can make assumptions about you.”

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Regardless of approach, religious and secular therapists share a fundamental question: If the purpose of psychotherapy is to remain a theoretical “blank slate,” how much does a patient benefit from knowing a therapist’s personal beliefs? How much should a practitioner reveal?

These are questions my stepmother, Donna, raised two years ago when she hoped to find work at a private practice near her home in Dallas, Texas. At the time, she perused local counseling websites—none of which identified as being Christian—and noticed a common trend: During the application process, some employers wanted a “statement of faith,” while others asked what church she belonged to. “I was like, ‘What does that mean? I don't understand what that has to do with counseling and my work,’” she says.

Caleb Lack, a clinical psychologist based in Oklahoma, has heard similar concerns. “We have lots of people—particularly in the Bible Belt or Deep South—who think, ‘If it becomes known that I am an atheist, there goes part of my practice,’” he says.

Lack is the director of the Secular Therapy Project, or STP, a program designed to connect non-religious people with mental-health services in their local area. As an offshoot of the non-profit “Recovering From Religion,” STP currently has more than 10,000 users who can search the online database for counselors around the world.

To join the website as a therapist, applicants must be secular, possess a state license, and employ what’s known as evidence-based practice in their work, i.e., base their psychological approach on scientific research. Lack says the scrutiny is to avoid any confusion between patients and therapists when it finally comes time to meet, especially in more radical cases. “I met someone who was suffering from depression and their therapist told them, ‘Well, the reason you’re depressed is because the devil is putting thoughts in your head. So we have to pray more now,’” Lack says. “It’s like, ‘Well, wait, I think according to our evidence-based practice guidelines, prayer for depression is not one of them.’”

As faith-based therapies have branched out of the clergy, they’ve taken on different approaches—and credentials. Biblical counselors, for example, reject the psychotherapeutic model, and claim their title simply by expressing a devotion to Jesus Christ and sometimes completing one of several available training courses. It’s a distinction they feel sets them apart from Christian counselors, who tend to employ secular psychology through a Christian perspective. Nevertheless, Christian counselors often do not have to obtain a degree or special certification to practice. Pastoral counselors, on the other hand, are often ministers, priests, or rabbis, and the American Association of Pastoral Counselors only accepts people with postgraduate degrees from accredited universities.

It’s precisely this kind of gray area that secular therapists do not take lightly, yet it should be said that every practitioner I interviewed for this article made a point to clarify that there are, undoubtedly, qualified counselors who are privately religious but keep their personal beliefs out of the office—or who are openly religious but properly credentialed. In a similar vein, many patients do wish to talk about faith, and some experts have reported that a “spirituality integrated” clinical approach can be as effective as other treatments.

That is why programs like STP don’t intend to hamper faith-based therapy, but rather, draw a more distinct line for people in search of secular help. In any therapeutic relationship, regardless of belief, there is a certain level of betrayal in an absence of transparency. When a patient confides their innermost thoughts with a therapist only to later discover after many sessions (and dollars) that they are completely unfit for one another, the experience can be damaging.

It was for Tiffany Russell. Her decision to seek therapy wasn’t easy; she operated a trucking company in Oklahoma City and only had so many free hours. She had to find a practitioner who accepted her insurance—and had to confront years of emotional abuse for the first time.

“It took me awhile to get the nerve up, but my first couple of sessions were uneventful,” Russell says. “There wasn’t anything to suggest there would be an issue.” The therapist had a Ph.D. in counseling, and never identified her practice as faith-based, so she continued the sessions.

“I was comfortable seeing her, and we were getting more into the issues that I was having with my father. She stopped me at one point and goes, ‘Well, you know, your real Father loves you,’” Russell says.

She never went back.

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