Retreats · Atlas

1. Introduction

Version followed: Roman Catholic retreat practice as published by Church law (the Code of Canon Law, canons 246 §5, 276 §2 and 663 §5) and by Jesuit retreat providers (Santa Clara University Ignatian Center with the Jesuit Retreat Center of Los Altos; Ignatius House, Atlanta; Ignatius Guelph through the Jesuits of Canada), with the Annotations of the Spiritual Exercises of Ignatius of Loyola as the reference text (public-domain English text on CCEL; translator [uncertain: not verified]). The therapist's work alongside follows the DSM-5 Cultural Formulation Interview supplementary modules; Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica; Cheetah House; and the IOCDF.

A Catholic retreat is a period set apart from ordinary work and duties for prayer, usually in silence, often at a retreat house run by a religious order or diocese. Common forms are the preached (group) retreat built around talks, the individually directed retreat in which a spiritual director meets the retreatant each day, and the full Spiritual Exercises of Ignatius, made either in seclusion or spread over months of daily life [source: Jesuits of Canada; SCU; Ignatius House; CCEL Annotations]. For the Spiritual Exercises, the Examen and discernment of spirits as a contemplative practice in their own right, see guide 185 (Ignatian Spiritual Exercises, Examen and discernment of spirits). Church law requires seminarians to make a retreat each year, binds priests to make retreats according to particular law, and requires religious to keep an annual retreat [source: Code of Canon Law, cc. 246 §5, 276 §2, 663 §5].

How change happens, as the tradition holds it: Ignatius calls any way of examining conscience, meditating, contemplating or praying a "spiritual exercise". He compares it to bodily exercise: it readies the soul to rid itself of disordered attachments and then to seek and find God's will for its life. The work is God's. The director gives the material briefly and leaves the retreatant to taste and understand it, because what the person finds for themselves bears more fruit than long explanation. The director helps them notice and discern interior movements, which the tradition calls consolation and desolation [source: CCEL Annotations 1, 2, 5–8, 15]. These are the tradition's terms, described here as it holds them.

A retreat is a religious observance, and the psychotherapist does not lead it. This guide covers the therapist's own work alongside it: what the retreat means to the client, cultural assessment, readiness and screening before intensive or silent retreats, health coordination, adverse effects, telling spiritual experience apart from illness, re-entry, scrupulosity, and collaboration with directors and clergy. Working model [synthesis]: a retreat is an intensive, meaning-laden experience. It can consolidate growth. It can also bring up unprocessed material, and occasionally it brings on adverse effects. The therapist's job is to help the client choose and prepare well, keep them safe, and integrate what happened, within the client's faith and on the client's terms.

2. Framework

2a. Retreat forms as Catholic institutions publish them

Canonical annual retreats for seminarians, priests and religious. The obligation comes from Church law. For priests the details are set by particular law [source: Code of Canon Law].
Individually directed retreat. Individual direction in an environment of silence and prayer. A spiritual director meets the retreatant each day, listens to their prayer experiences and helps them reflect and discern. Prayer is usually based on Scripture, and daily Eucharist is offered [source: Jesuits of Canada event page]. Prerequisites vary by house. That listing names none [source: same].
Preached or group retreats, parish retreats and movement weekends. These are common in Catholic life; their formats vary and are not described here.
Full Spiritual Exercises in seclusion ("Annotation 20"). The retreatant withdraws from friends and ordinary concerns, ideally near daily Mass and Vespers [source: CCEL Annotation 20]. The Exercises have four parts, called "Weeks": sin; the life of Christ up to Palm Sunday; the Passion; and the Resurrection and Ascension. Each Week lasts as long as the person needs, and the whole takes about thirty days [source: CCEL Annotation 4]. Admission is selective. One house asks for prior Ignatian directed retreats, current spiritual direction and a supporting letter from the director, and an endorsement from a superior or bishop for clergy and religious. It also asks for an autobiographical sketch, the applicant's reasons and hopes, any special health needs, whether the applicant has ever had counselling or therapy, the ability to keep silence, and an interview. The same house warns that total silence cannot be guaranteed because other groups share the house [source: Ignatius House 30-Day Application].
Exercises in daily life ("Annotation 19"). For people who cannot leave their occupations. The retreatant prays daily at home and meets a director weekly over many months. A preparation period comes first, during which the person and a retreat director discern whether the retreat suits them now [source: SCU 19th Annotation page; CCEL Annotation 19].

Who leads or authorises. The person who gives the Exercises (the director or giver) adapts the material to each retreatant. Retreat houses of religious orders and dioceses decide admission. For clergy and religious, superiors or bishops endorse or require retreats [source: CCEL Annotations 17–18; Ignatius House; Code of Canon Law]. Ignatius tells the giver to fit the Exercises to the person's age, education and ability, to give simpler exercises to those less able, and not to move them beyond the First Week until they are ready. This is the tradition's own principle of matching intensity to the person [source: CCEL Annotation 18].

2b. The therapist's phases alongside a retreat [synthesis]

No source gives a number of therapy sessions for this work. Let clinical need decide, and fit therapy around the client's retreat rather than the other way round.

Before the retreat: meaning, assessment and readiness. Goals: understand what the retreat means to the client, do a cultural assessment (section 4.2), review readiness and risk, and match the retreat's form and intensity to the client. Move to the next phase when the client has chosen a form, the safety and contact plan is in place, and health questions have gone to the doctor, or when the client decides to postpone or to choose a gentler form. The client makes the decision. The therapist gives information and a clinical opinion.
During the retreat: contact plan only. Goals: the client knows what to do if difficulties arise and has permission to slow down or leave. Usually there are no sessions during a silent retreat unless the plan provides for them. For a retreat in daily life running alongside therapy, keep regular sessions and agree how retreat material will be held in therapy (section 4.6).
After the retreat: re-entry and integration. Goals: consolidate what the client values, follow up any adverse effects, slow down major decisions made in fervour, and reconnect the client with their community. The phase ends when the client has returned to usual functioning and any adverse effects have resolved or are being treated.

3. Guiding principles

The client's faith and words lead. Use the client's own terms for their tradition and experiences [source: CFI Supplementary Modules, instructions]. Practical meaning: ask what "consolation" or "desolation" means to them before you interpret it.
Roles stay distinct. The director gives the Exercises and stays neutral about the retreatant's choices, leaving the person and God to deal directly [source: CCEL Annotation 15]. The director is not owed an account of sins, only of the interior movements, so confession belongs to the sacrament, not to direction [source: CCEL Annotation 17]. Practical meaning: the therapist is not a director, confessor or teacher of prayer [synthesis].
Intensity fits the person. The tradition itself scales the Exercises to the person's capacity [source: CCEL Annotation 18]. Practical meaning: a careful readiness review respects the tradition and does not oppose it.
No vows or big decisions made in fervour. Ignatius warns a fervent retreatant against hasty vows or promises, and says caution matters more the more impulsive the person is [source: CCEL Annotation 14]. Practical meaning: build in time before major life changes made on retreat.
Be gentle in desolation. The giver is to be gentle and encouraging with someone in desolation [source: CCEL Annotation 7]. Practical meaning: meet distress with warmth, not with interpretation or alarm.
Adverse effects are real and are not the client's fault. Challenging experiences occur. They can outlast the retreat and impair functioning, and they are not a sign of personal failure [source: Lindahl et al. 2017, PLOS ONE; Farias et al. 2020, Acta Psychiatrica Scandinavica]. Practical meaning: ask about them directly, before and after.
Don't pathologise, and don't miss illness. Religious and spiritual experiences need careful differential diagnosis [source: Stagno 2011 review of Peteet, Lu & Narrow]. Practical meaning: assess function, safety and the course over time, not the content of belief.
Health questions go to the doctor. Sleep, food, exertion and medicines are for the client's physician or prescriber. Practical meaning: the therapist never advises on medicines and sets no targets for prayer time, silence, sleep or food [synthesis].
Consent governs every contact. Speak to directors, clergy or retreat houses only when the client asks and gives written consent [synthesis].
Competence and self-awareness. Spiritual and religious competencies (attitudes, knowledge, skills) are part of basic competence [source: Vieten et al. 2013]. Practical meaning: know your gaps and biases about Catholic practice and consult when needed.
Safety outranks completion. Slowing down, shortening or leaving a retreat is a legitimate choice. It is not a failure [synthesis].

4. Intervention inventory

These are the therapist's own interventions alongside a retreat. The retreat practices themselves (prayer methods, the Weeks, the rules for discernment) belong to the director and are not given here.

4.1 Exploring the retreat's meaning in the client's life

Purpose / when: Whenever a client mentions an upcoming, current or past retreat. Find out why this retreat, why now, what they hope for and what they fear, and whether it is chosen or required (for example an annual retreat required of clergy or religious [source: Code of Canon Law]).
Steps: (1) Ask the client to describe the retreat in their own words: its form, the house, the director, and whether it is silent. (2) Ask about hopes, such as a decision, healing, closeness to God or rest. (3) Ask about fears and about earlier retreats, good and bad. (4) Ask who else knows and who will support them. (5) Reflect back what you heard without interpreting it theologically. (6) Note anything that bears on readiness (section 4.3). [synthesis]
Example language (illustrative): "Tell me about this retreat: what kind it is, and what you're hoping happens for you there." / "Is this something you chose, or something your community expects of you, or both?"
Watch for: A retreat used to escape a crisis or to force a decision. A hope that the retreat will replace treatment. Pressure from a superior or family. Working well: the client can say clearly what they want from the retreat and feels free to choose its form and timing.

4.2 Cultural Formulation Interview, core and Module 5 (Spirituality, Religion, and Moral Traditions)

Purpose / when: At intake for religiously committed clients, or before a significant retreat. Use it to map the client's tradition, how it shapes daily life, how it helps them cope, and where it causes stress or conflict.
Steps: The module has 16 questions in four areas: identity and affiliation; the tradition's role in daily life; its relation to the presenting problem (prayer, ritual, texts, leaders and community as coping); and stresses and conflicts (distress about identity or practices, discrimination, moral or religious conflict). (1) Put the client's own name for their tradition into the questions. (2) If they name more than one tradition, explore each. (3) Skip questions that repeat the core CFI. (4) Rephrase and follow up naturally to keep rapport. (5) Repeat parts later in therapy as trust grows. The APA allows clinicians to reproduce the modules for use with their patients. Do not paraphrase the items into a new instrument [source: APA CFI Supplementary Modules].
Example language (illustrative): "How does your Catholic faith show up in an ordinary week for you?" / "Has your faith ever made this problem harder, or been part of the struggle?"
Watch for: Religious practice that has become compulsive (section 4.12). Conflict with a community or superior. Coping that depends on one leader. Working well: you can say how the retreat fits the client's spiritual life and their problem.

4.3 Readiness and screening review before an intensive or silent retreat

Purpose / when: Before any residential silent retreat, individually directed retreat or full Exercises, and before an Exercises-in-daily-life programme for clients in active treatment. Retreat houses screen in their own ways: one asks about counselling history, health needs, prior retreats, current direction and the ability to keep silence, and holds an interview [source: Ignatius House]. Another builds in a period of discernment with a director beforehand [source: SCU]. The tradition itself says the Exercises should match the person's capacity [source: CCEL Annotation 18]. The therapist adds a clinical review. Teachers interviewed by Lindahl et al. pointed to practice intensity, psychiatric or trauma history and the quality of supervision as factors in difficulties, but these mattered only for some meditators. The study sampled Buddhist meditators, so applying it to Catholic retreats is an inference [source: Lindahl et al. 2017, PLOS ONE; applicability: synthesis].
Steps: [synthesis unless cited]
1. Current state. Mood, anxiety, sleep, substance use, and suicidal thoughts. Use standard risk assessment and do not rely on a single question.
2. History. Psychosis or mania. Dissociation or trauma, especially if it is easily triggered by silence, solitude or unstructured time. Earlier adverse reactions on retreat or in prayer or meditation. Recent hospitalisation: Cheetah House asks that people be out of hospital for at least a month, stable and under professional care before using its own services, which is a useful reference point but not a retreat rule [source: Cheetah House FAQ].
3. Current treatment. Whether treatment is stable. Any recent or planned change in medicines goes to the prescriber, and the therapist gives no medicine advice.
4. Life context. Recent bereavement, a decision under pressure, a crisis at work or in the community.
5. Retreat factors. How intense, long and silent it is; whether a director meets the client daily; how far the house is from support; whether the client can leave freely.
6. Synthesis with the client. Share your view. Options: go as planned; choose a less intensive form (shorter, preached rather than silent, retreat in daily life); postpone; or go with an agreed plan (section 4.5).
7. Disclosure. Ask whether the client wants to disclose relevant history on the house's application or to the director, and support whatever they decide.
Example language (illustrative): "Silent retreats are good for many people, and for some they bring up hard things. Can we look together at how this one fits where you are right now?" / "The retreat house asks about counselling history. How do you feel about answering that?"
Watch for: Minimising ("I'll be fine once I'm there"). Hoping the retreat will cure symptoms. Very recent destabilisation. Working well: the client makes an informed choice, can name early warning signs, and has a plan.

4.4 Matching form and intensity (dose at the planning stage)

Purpose / when: When the readiness review raises concerns, or when a client is new to silent retreat.
Steps: (1) Lay out the forms side by side: preached or group retreat, short directed retreat, Exercises in daily life with weekly direction, and full Exercises in seclusion [source: section 2a sources]. (2) Note that the tradition offers lighter material for some retreatants and does not move them on until they are ready [source: CCEL Annotation 18]. (3) Help the client consider stepping up gradually. Some houses already require earlier shorter directed retreats before the full Exercises [source: Ignatius House]. (4) Encourage the client to talk with their spiritual director or the retreat house about fit. [synthesis for steps 1, 3, 4]
Example language (illustrative): "Your own tradition expects the director to fit the retreat to the person. Would a shorter or less silent form fit better this year?"
Watch for: The therapist steering the client's spiritual choices. Offer clinical information and leave the decision with the client. Working well: the client feels their faith is respected and the choice is theirs.

4.5 Retreat safety and contact plan

Purpose / when: For any client with risk factors going on an intensive or silent retreat. [synthesis throughout]
Steps: (1) Write down early warning signs, such as being unable to sleep, panic, intrusive memories, feeling unreal or detached, unusual energy or certainty, or hopelessness. (2) Agree first steps on the retreat: tell the director, ease the intensity of prayer, and use grounding (section 4.9). (3) Agree who to contact if those steps don't help: the director, the house staff, the therapist (when and how), and emergency services. (4) Agree in advance that the client may speak despite the silence and may leave, and that this is not failure. (5) If there is a history of suicidality, review the client's existing safety plan and include lethal-means counselling where relevant. (6) If the client consents, give the director a brief contact route.
Example language (illustrative): "If you notice you can't sleep for a couple of nights or feel like you're floating outside yourself, what's the first thing you'll do?" / "Breaking silence to ask for help is allowed, and it's wise."
Watch for: The client treating silence as an absolute rule even when in distress. A house with no staff on hand. Working well: the client can repeat the plan and knows how to reach help.

4.6 Accommodation in scheduling and treatment

Purpose / when: Around residential retreats, and throughout a months-long retreat in daily life with weekly direction [source: SCU].
Steps: [synthesis] (1) Reschedule sessions around the retreat dates without making the client feel penalised. (2) Avoid starting intensive trauma processing just before a silent retreat. Schedule a check-in soon after the client returns. (3) For a retreat in daily life alongside therapy, agree what belongs in direction (prayer, discernment) and what belongs in therapy (symptoms, relationships, trauma). With consent, agree how to handle overlap. (4) For clergy and religious making required annual retreats, plan ahead each year.
Example language (illustrative): "Let's book a session for the week you're back, so we have a space to land what happened."
Watch for: Therapy and direction pulling in different directions, or the client feeling torn between therapist and director. Working well: the client can say what each relationship is for.

4.7 Health issues routed to the doctor

Purpose / when: Retreats can change sleep, eating, physical activity, travel and access to medicines. Some retreatants also choose voluntary fasting or ascetical practices.
Steps: [synthesis] (1) Ask whether the client plans any fasting, night prayer, sleep changes, physical exertion or pilgrimage-type walking. Describe the risks in general terms and set no targets. (2) For any chronic condition (for example diabetes, an eating disorder, bipolar disorder, a seizure disorder) or any medicines, ask the client to talk with their doctor or prescriber before the retreat. With consent, coordinate with that doctor. (3) Make sure the client will take their usual medicines and any needed health information with them. The therapist does not advise on medicines. (4) Encourage them to tell the retreat house about special health needs, which one application asks for [source: Ignatius House].
Example language (illustrative): "Before you go, could you check with Dr. ___ about the fasting you mentioned and about your medicines, so your body is looked after while you pray?"
Watch for: Restriction of food or sleep in a client with an eating disorder or a mood disorder history, where religious motives can mask relapse. Working well: the doctor is informed and any medical advice is in the plan.

4.8 Informed consent and psychoeducation about challenging experiences

Purpose / when: Before an intensive retreat, so the client can recognise difficulties early and is not ashamed of them.
Steps: (1) Explain plainly that a minority of people who meditate or pray contemplatively have difficult experiences. A systematic review of meditation studies found adverse events in about 8% of participants overall: 3.7% in experimental studies and 33.2% in observational studies. Anxiety, depression and cognitive anomalies were most common, and they also occurred in people with no psychiatric history [source: Farias et al. 2020, Acta Psychiatrica Scandinavica]. Cheetah House estimates that about 1 in 4 meditators report unwanted effects and about 10% have effects that impair functioning [source: Cheetah House FAQ]. These data come mainly from meditation, not from Catholic retreats; applying them to retreats is an inference [synthesis]. (2) Describe the two patterns Cheetah House names. Hyperarousal: anxiety or panic, insomnia, intrusive memories, emotional swings, involuntary movements. Dissociation: emotional flattening, loss of motivation, loss of sense of self or of the body, derealisation [source: Cheetah House FAQ]. (3) Explain that effects can last from days to months, occasionally years, and that some feel positive on retreat but impair life afterwards [source: Lindahl et al. 2017, PLOS ONE]. (4) Explain that the client's own tradition expects ups and downs (desolation) and tells the director to respond gently [source: CCEL Annotation 7]. Some distress is spiritually expected; impairing symptoms need help.
Example language (illustrative): "Most people come back from retreats feeling well. A minority have things like sleeplessness, panic or feeling unreal. If that happens it isn't a spiritual failure, and it's worth telling someone early."
Watch for: Frightening the client, or dismissing their faith. Keep the tone matter-of-fact. Working well: the client can name the warning signs and doesn't feel judged.

4.9 Responding to adverse effects: reducing intensity and grounding

Purpose / when: When a client on retreat, or just back, has hyperarousal or dissociation as described in 4.8. For trauma-sensitive principles, Cheetah House points first to Treleaven's Trauma-Sensitive Mindfulness (2018) [source: Cheetah House FAQ]. The steps below are general practice and are not attributed to that book [synthesis].
Steps: [synthesis] (1) Check safety first: suicidal thoughts, psychotic or manic features, inability to function. If present, go straight to urgent assessment (4.10). (2) Reduce intensity: encourage the client to ask the director for a lighter load, to pray for shorter periods, to use vocal or communal prayer rather than long silent contemplation, to keep eyes open, and to step out of the retreat if needed. Don't tell the client to stop praying. Help them find a gentler form their tradition allows. (3) Ground: orient to the room, name things seen and heard, feel the feet and the chair, walk outdoors, hold a familiar object (a rosary may be grounding for some clients and triggering for others, so ask). (4) Restore routine: regular meals, sleep at usual times, daylight, conversation. (5) Connect: talk with the director or a trusted person. In the Varieties study, talking with someone familiar with these experiences helped [source: Lindahl et al. 2017, PLOS ONE]. (6) Follow up: review weekly until symptoms resolve. Refer for psychiatric assessment if symptoms persist or impair functioning. Cheetah House offers consultation and referral for people with meditation-related difficulties, and professionals can book a consultation [source: Cheetah House FAQ].
Example language (illustrative): "Let's bring you back into the room. What five things can you see right now?" / "Your director can give you lighter material. Ignatius himself expected the exercises to be fitted to the person."
Watch for: Pushing through distress because of a belief that suffering must be endured. Shame. Working well: sleep and orientation return and distress falls within days. If it does not, escalate.

4.10 Telling spiritual experience apart from psychosis, mania, depression or dissociation

Purpose / when: When retreat experiences include visions, voices, intense certainty, profound desolation, a loss of felt faith (sometimes called a "dark night" [uncertain: not verified]), or altered sense of self.
Background: DSM-IV introduced "Religious or Spiritual Problem" as a condition that may be a focus of clinical attention. Its examples include distressing loss or questioning of faith, problems with conversion, and questioning of spiritual values [source: Stagno 2011, reviewing Peteet, Lu & Narrow 2011]. The same volume describes types of spiritual problems that include meditation- or practice-related problems and urges caution in deciding whether an experience is spiritual or a sign of illness [source: same]. The category is retained in DSM-5-TR (Z65.8) [source: ICD-10-CM Z65.8]. Use it only when the focus is the religious or spiritual problem itself and no mental disorder better explains the picture [synthesis].
Steps: [synthesis] (1) Ask what the experience means to the client and to their tradition, and whether their director and community see it as within ordinary spiritual life. (2) Look at function, safety, sleep, insight and course: can the client still eat, sleep, care for themselves and relate to others? (3) Screen for mania (decreased need for sleep, pressured speech, grandiosity, risky plans), psychosis (fixed beliefs beyond the tradition's own understanding, disorganisation), depression (anhedonia, hopelessness, suicidal thoughts beyond spiritual dryness) and dissociation (derealisation, amnesia, depersonalisation). (4) If red flags are present, arrange urgent psychiatric assessment, whatever the experience's spiritual meaning. (5) If no red flags are present, normalise the experience within the client's tradition, monitor it, and encourage continued spiritual direction. (6) Both can be true: a client can have an illness and a meaningful spiritual experience at the same time.
Example language (illustrative): "I'm not here to judge what this experience means spiritually. I do want to make sure your sleep, safety and mind are looked after. Can we check those together?"
Watch for: Dismissing faith-based experience as symptoms, or missing a first episode of mania or psychosis because the content is religious. Working well: the client feels their faith was respected and gets medical care when it is needed.

4.11 Re-entry and integration, including decisions made on retreat

Purpose / when: In the first sessions after a retreat, especially after the full Exercises, where an "election" (a choice about one's state of life) may be central [uncertain: not verified].
Steps: (1) Invite the client to tell the retreat story in their own terms. (2) Ask what they want to carry back into daily life. (3) For any major decision or vow, explore timing and consequences. Ignatius himself warns against hasty vows in fervour [source: CCEL Annotation 14]. Encourage the client to talk it through with their director or superior as well. (4) Ask directly about adverse effects that started during or after the retreat [source: Lindahl et al. 2017, PLOS ONE]. (5) Plan reconnection with family, work and parish. [synthesis for 1, 2, 5]
Example language (illustrative): "What from the retreat do you most want to protect now that you're back?" / "This decision sounds important. What would it look like to test it for a while before acting?"
Watch for: Abrupt life changes, withdrawal from others, or a low mood after a spiritual high. Working well: the client keeps what they valued and functions at least as well as before.

4.12 Scrupulosity during and after retreat

Purpose / when: Retreats often include examination of conscience and confession [source: CCEL Annotations 1, 18–19], which can trigger or worsen scrupulosity. The Exercises are also said to contain notes on scruples [uncertain: not verified].
How it presents: OCD often fastens on what matters most to a person, including their faith. Rituals can look like religious practice, such as excessive prayer or confession, and intrusive religious thoughts can feel like a spiritual problem [source: IOCDF, Living with OCD & Religious Traditions].
Steps: (1) Assess for OCD (repeated confession, reassurance seeking from priests or directors, compulsive re-praying, fear of sacrilege). (2) Offer ERP as first-line treatment, alongside medication assessed by a prescriber [source: IOCDF]. Frame ERP as separating OCD from the client's values, and accepting uncertainty as compatible with faith [source: IOCDF]. (3) With consent, consult the client's confessor or director so that religious guidance does not feed reassurance seeking. IOCDF notes that some providers work with clergy, and that some clergy may wrongly see OCD as a lack of faith [source: IOCDF]. (4) Design exposures within what the client and their religious authority accept as permissible. Do not ask the client to commit what they believe is a sin. Start low, with consent, and agree a plan for managing distress [synthesis]. (5) Before a retreat, plan how the client will handle confession and examen without feeding compulsions, for example by agreeing a plan with their confessor [synthesis].
Example language (illustrative): "It sounds like OCD has got into the place you care about most. Our work is to help you practise your faith on your terms, not OCD's."
Watch for: The therapist overruling religious authority, or clergy unknowingly reinforcing compulsions. Working well: less time spent on rituals, and religious practice becomes more freely chosen.

4.13 Moral injury, grief, ritual and community support

Purpose / when: Retreats can bring up guilt, shame, betrayal or grief, for example over past actions, bereavement or conflict with the Church. [synthesis throughout]
Steps: (1) Separate guilt over real wrongdoing (where the client's tradition offers confession and reconciliation) from shame, scrupulosity or betrayal by others. (2) For moral injury, explore values, responsibility and repair. With consent, involve a chaplain or priest for the sacramental side. (3) For grief, support rituals the client finds meaningful (Mass for the dead, anniversaries) and connection with their parish or community. (4) If the Church itself is the source of hurt, respect the client's pace and do not push them towards reconciliation or away from it.
Example language (illustrative): "Some of what came up sounds like grief, and some like guilt. Can we look at each separately?"
Watch for: Religious language used to bypass grief. Isolation from community. Working well: less shame, and the client chooses for themselves how to engage with ritual and community.

4.14 Collaboration with the retreat director, spiritual director or clergy

Purpose / when: When the client wishes it: before a high-risk retreat, during a crisis on retreat, after adverse effects, or in scrupulosity treatment.
Steps: [synthesis] (1) Get specific written consent: who, for what, and what information may be shared. (2) Clarify roles. The director accompanies prayer and discernment and stays neutral about life choices [source: CCEL Annotation 15]. The therapist treats mental health. Confession stays with the confessor [source: CCEL Annotation 17]. (3) Share only what is needed, such as warning signs and the contact route. (4) Respect the director's confidentiality and the seal of confession: never ask about confessional matter. (5) Bring the client back into the loop after every contact.
Example language (illustrative): "Would it help if I spoke with your director so you don't have to carry the plan alone? You decide what I may share."
Watch for: Triangulation, or either party undermining the other. Working well: the client feels held by both and knows who does what.

4.15 The therapist's role, boundaries and competence

Purpose / when: Throughout the work.
Steps: (1) Don't act as director, confessor or retreat guide, and don't give prayer instructions [synthesis]. (2) Avoid dual relationships, such as directing the client's retreat or attending the same retreat [synthesis]. (3) Disclose your own faith only when it serves the client [synthesis]. (4) Build spiritual and religious competencies: Vieten et al. propose 16 basic competencies in attitudes, knowledge and skills that all licensed psychologists should demonstrate [source: Vieten et al. 2013]. (5) Seek consultation when you lack knowledge of Catholic practice, and use cultural-formulation questions to notice your own bias [source: Stagno 2011, on Gellerman & Lu].
Example language (illustrative): "I'm not a spiritual director, so I won't guide your prayer. What I can do is help with how you're coping around it."
Watch for: Over-identifying with the client's faith or being hostile to it. Working well: the client experiences you as respectful and clear about your role.

4.16 Power, misconduct and safeguarding in retreat settings

Purpose / when: When a client describes pressure, secrecy, boundary violations or abuse by a director, retreat leader or community, or when minors attend youth retreats. [synthesis]
Steps: (1) Explore the relationship's power dynamics: the director's influence over decisions, any secrecy, isolation from outside advice, or punishment for questioning. Ordinary direction is supposed to be neutral about life choices [source: CCEL Annotation 15], so pressure toward a particular state of life is a warning sign [synthesis]. (2) Name boundary violations clearly and believe the client. (3) Explain reporting routes: the diocese or religious order's safeguarding office, civil authorities, and mandatory reporting where minors or vulnerable adults are involved, under local law [uncertain: routes vary by jurisdiction and were not verified]. (4) Support religious-trauma work and any wish to leave or stay, at the client's pace. (5) Never name or identify victims, and name alleged perpetrators only as courts, regulators or independent investigations have named them.
Example language (illustrative): "A good director leaves you freer. You're describing feeling controlled. Can we look at that together?"
Watch for: Self-blame, fear of spiritual consequences, and divided loyalty. Working well: the client is safe and informed and makes their own choices.

5. Handling problems

All guidance in this section is [synthesis] except where a source is cited.

Client insists on an intensive retreat despite clear risk. The choice is theirs unless risk is imminent. State your concern plainly and in writing. Offer gentler forms (4.4). Strengthen the plan (4.5). Ask whether they would let the house or director know about their history. If risk is imminent, follow standard crisis procedures.
Client feels screening questions are an attack on their faith. Point out that their own tradition fits the Exercises to the person [source: CCEL Annotation 18] and that retreat houses themselves ask about health and counselling history [source: Ignatius House]. Present your review as care, not judgement.
Adverse effects that persist after return (weeks or longer). Effects can last months or longer [source: Lindahl et al. 2017, PLOS ONE]. Treat the symptoms with standard evidence-based care, refer for psychiatric review, and consider Cheetah House consultation [source: Cheetah House FAQ]. Help the client find a gentler prayer life with their director rather than abandoning faith practice, unless they choose to.
Overwhelm or a crisis on retreat (by phone). Safety first: is the client safe, sleeping and oriented? Use grounding (4.9). Ask them to tell the director or house staff. If there are signs of psychosis, mania or suicidality, help them leave the retreat and get urgent care.
Spiritual high followed by a crash. Normalise the shift. Screen for depression and for a mixed or manic episode. Review any decisions made on the high (4.11) [source on hasty vows: CCEL Annotation 14].
Major life decision announced on return (leaving a marriage, entering religious life, quitting a job). Don't oppose it. Slow it down: suggest testing it over time, consulting the director or superior, and looking at practical consequences.
Stuck client who uses retreats to avoid therapy work. Name the pattern gently. Explore what retreat gives that therapy doesn't, and find a joint goal.
Non-adherence to the safety plan (didn't contact anyone despite symptoms). Review without blame. Find the barrier, such as the silence rule, shame or not wanting to burden the director, and adjust the plan.
Rupture: the client feels you pathologised a sacred experience. Acknowledge it directly. Separate respect for the experience's meaning from concern for health. Ask how to do better [source on non-pathologising differential: Stagno 2011].
Conflict between director and therapist advice. With consent, talk together. Clarify roles (4.14). Let the client decide spiritual questions, and hold firm on clinical safety.
Scrupulosity worsened by retreat confession or examen. Return to ERP. With consent, coordinate a plan with the confessor [source: IOCDF].
Required retreats (clergy, religious, seminarians, whose retreats are mandated by Church law [source: Code of Canon Law]). If the client is unwell, help them talk with their superior or formator about adaptations or deferral, with consent. Don't contact superiors without permission.
Retreat-related trauma or misconduct disclosed (4.16). Prioritise safety and support, explain reporting routes, and never pressure the client either way about staying in the community.
Problems the sources don't address: retreats for minors (follow the organiser's safeguarding policy and local child-protection law [uncertain: not verified]); clients making a retreat in another tradition (apply the same review); online or self-guided retreats with no director (the safety plan matters more, because no director is present to notice difficulties).

Sources

Web sources:

Books and papers cited:

Ignatius of Loyola. The Spiritual Exercises, Annotations 1–20 (public-domain English translation; translator [uncertain: not verified]).
Lindahl, J. R., et al. (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLOS ONE.
Farias, M., et al. (2020). Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica, 142(5), 374–393.
Vieten, C., Scammell, S., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2013). Spiritual and religious competencies for psychologists. Psychology of Religion and Spirituality, 5(3), 129–144.
Peteet, J. R., Lu, F. G., & Narrow, W. E. (Eds.) (2011). Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V (cited through the Stagno review).
ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances
Treleaven, D. A. (2018). Trauma-Sensitive Mindfulness (recommended by Cheetah House).
Code of Canon Law (1983), canons 246 §5, 276 §2 and 663 §5 (Holy See, vatican.va).

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