For many doctors, let alone the general public, the relationship of psychiatry to psychotherapy is a source of confusion. When is emotional disturbance a sign of a mental illness requiring drug treatment? When is it a problem that can be resolved through discussion and discovering how it arose? When is it a mixture of the two? And what is best done about it? People seeking help are often directed to psychiatrists, psychologists, psychotherapists, or counsellors without understanding either the range of options available to them or the rationale for consulting one rather than the other.

Spiritual concerns are regarded with even less clarity. Where there is a core religious problem and the person belongs to an established faith tradition, the priest, imam, rabbi or appropriate spiritual advisor is likely to become involved. However, for people who do not belong to a religious community or faith tradition there are no guidelines; the healthcare practitioner may or may not be personally interested in the patient's spiritual reality. In addition, psychiatrists working with a medical model of mental illness are likely to see spiritual issues as beyond their competence and many psychotherapists prefer to stick specifically to psychological objectives.

Yet some psychiatrists and psychotherapists do see the importance of addressing spiritual concerns, either because they intuitively recognise this to be an essential part of treating the ‘whole’ person or because they have undergone training in therapy that values this dimension of human life.