Latter-day Saint temple ordinances and fast offerings

1. Introduction

Version followed: the public teaching of The Church of Jesus Christ of Latter-day Saints as published in its General Handbook (online chapters 22, 26, 27 and 28), its Gospel Topics entry "Fasting and Fast Offerings" and its Newsroom page on fasting; clinical work follows the DSM-5 Cultural Formulation Interview (Supplementary Module 5), the IOCDF page on OCD in Latter-day Saint members (Hagen and Smith), a Church-published article on scrupulosity (McClendon, Ensign, September 2019), Brooks (2020) on distress after leaving the Church, and Vieten et al. (2013) on spiritual and religious competencies.

This is an observance, not a therapy. It covers two connected parts of Latter-day Saint religious life. Temple ordinances are rites the Church performs only in its temples: for the living, the endowment (whose first part is the initiatory) and the sealing of husband and wife and of children to parents; and, by proxy, the same ordinances plus baptism and confirmation for deceased people [source: General Handbook 27.0, 27.2–27.4, 28.0]. The Church teaches that "The temple is the house of the Lord" and that it points members to Jesus Christ (27.0). Fasting and fast offerings: on one Sunday each month, usually the first, members are encouraged to go without food and drink for a period and to give the money they would have spent to the Church, which uses these "fast offerings" through its welfare system, administered by the local bishop, to help people in need [source: Newsroom "Fasting"; Gospel Topics "Fasting and Fast Offerings"]. The Church describes fasting as a commandment and a way to draw closer to God; these are the tradition's claims, reported here, not assessed.

The psychotherapist's role is not to teach, judge or perform any of this. It is to understand what these observances mean in the client's life, accommodate them in care, route health questions about fasting to the client's doctor, recognise when devotion has been captured by scrupulosity (religious OCD) or worthiness anxiety, support grief and community, and work alongside clients whose relationship to the Church is changing or ending, including those describing religious trauma. The core idea of change is [synthesis]: when a clinician respects the observance and its limits on what is discussed, clients can separate what their faith asks of them from what anxiety, shame, eating-disorder pressure or loss is demanding, and choose their own way forward.

2. Framework

2a. The observance as the Church publishes it

Who authorises temple participation. A member needs a temple recommend. In a ward the bishop or an assigned counsellor interviews, and the bishop personally interviews those receiving their own endowment or being sealed to a spouse; a member of the stake presidency then interviews as well. Leaders issue a recommend if the member "answers the temple recommend questions appropriately" and are told not to "add or remove any requirements" [source: General Handbook 26.3, 26.3.1, 26.3.3]. Interviews are to be private and unhurried, and the member may invite a spouse, parent or another adult to be present (26.3.3).
Limited-use recommends let unendowed members take part in proxy baptisms and confirmations from age 11, and in some sealing-related ordinances from ages 8 to 20 [source: 26.4.1]. A bishop who finds a recommend holder is not living the standards may cancel the recommend (26.2.3); someone who has committed a serious sin does not receive a recommend until they have repented (26.5.8).
Ordinances for the living. Members prepare spiritually and meet their bishop beforehand; the endowment is described as a gift from God; the initiatory includes being "symbolically washed and anointed" and instruction about the temple garment, which the Church calls "a sacred symbol of Jesus Christ"; sealing joins husband and wife "for time and all eternity" and children to parents [source: 27.1.1, 27.1.2, 27.2, 27.3, 27.4]. Members with physical disabilities may receive all ordinances; members with intellectual disabilities may receive the endowment or be sealed if they can understand and keep the covenants (27.1.3, 27.2.1.3).
Ordinances for the deceased. Living members act as proxies for deceased people; the Church teaches that the deceased "can choose to accept or reject" these ordinances. Members are encouraged to identify deceased relatives through family history and to submit only relatives' names [source: 28.0, 28.1, 28.1.1.1].
What may be discussed. The Church states that temple ordinances and covenants "are sacred" and that the symbols associated with temple covenants "should not be discussed outside the temple", while members may discuss the basic purposes and doctrine of the ordinances and "the spiritual feelings we have in the temple" [source: 27.0]. This guide contains no confidential temple content, and the therapist should neither ask for nor offer any.
Fast Sunday and fast offerings. One Sunday a month is the fast day; members are also free to fast at other times for special purposes. Families are encouraged to attend fast and testimony meeting together. The bishop determines who receives help from fast offerings and how; there is no standard amount to give [source: Gospel Topics "Fasting and Fast Offerings"; Newsroom "Fasting"]. The duration the Church asks for is a matter for the client and their own leaders and doctor; this guide gives no fasting length.
Exemptions as Church sources state them. The Gospel Topics entry quotes President Joseph F. Smith that people who are "subject to weakness", "delicate in health" or have "nursing babies" should not be required to fast, that parents should not "compel their little children to fast", and that "There is such a thing as overdoing" [source: Gospel Topics "Fasting and Fast Offerings"]. Pregnancy and specific illnesses are not named on that page [uncertain: not verified in other Church sources].

2b. The therapist's work alongside it

Sources give no session count or phase model for this work; the sequence below is [synthesis], built from the CFI and the clinical sources cited.

Engage and assess culture (early meetings, then revisited): CFI core plus Module 5; establish the client's own words for the Church and its observances; agree the confidentiality boundary around temple content. Move on when you can state, in the client's terms, what temple and fast Sunday mean to them and where (if anywhere) distress attaches.
Formulate: is the observance a resource, a site of a clinical problem (scrupulosity, eating disorder, health risk from fasting, moral injury), a site of loss or conflict (faith transition, mixed-faith family, being unable to attend a family sealing), or several? Move on when the client agrees with the formulation.
Intervene with the inventory items that fit (Section 4), with medical coordination for any fasting-related health issue and clergy collaboration only with consent.
Consolidate and close: relapse-prevention around predictable triggers (monthly fast Sunday, recommend renewal, temple trips, family sealings, mission departure), and agreed routes back to the doctor, bishop or therapist.

3. Guiding principles

Describe, do not adjudicate. Report Church teaching as the Church's teaching. Practical meaning: say "the Church teaches…" or use the client's words; never argue doctrine for or against. [source: Vieten et al. 2013 framing; synthesis]
Respect the temple boundary. Practical meaning: do not ask what happens in the temple beyond what the client chooses to share in public terms; work with feelings, meanings and consequences, which the Church itself says members may discuss [source: General Handbook 27.0].
Client-led role of faith. Practical meaning: the client decides whether, and how much, their faith enters therapy; ask before using scripture or Church-leader quotations. [source: CFI Module 5 instructions; synthesis]
Health first, routed correctly. Practical meaning: any question about whether to fast with a medical condition, pregnancy, an eating disorder or medication goes to the client's doctor or prescriber; the therapist does not advise on medicines or set fasting terms. The Church's own sources already state that the weak, unwell and nursing need not be required to fast [source: Gospel Topics].
Religiosity is not scrupulosity. Practical meaning: high devotion is not a symptom; distress, rigidity, repetition, reassurance-seeking and loss of the observance's purpose are the markers [source: IOCDF Hagen and Smith; McClendon 2019].
Treat OCD as OCD, adapted. Practical meaning: exposure and response prevention is the core for scrupulosity, adapted for religious content and done without asking the client to act against their faith [source: Siev, Huppert and Zuckerman 2017 abstract; IOCDF].
Roles stay distinct. Practical meaning: the therapist is not a confessor, bishop or spiritual director; the bishop is not a mental health professional. A Church-published article quotes Elder Alexander B. Morrison that "ecclesiastical leaders are spiritual leaders and not mental health professionals" [source: McClendon 2019].
Collaborate only with consent. Practical meaning: contact a bishop or other leader only with written consent and an agreed scope; tell the client what you will and will not share. [synthesis]
Neutral about staying or leaving. Practical meaning: support the client's own direction, whether deepening activity, adjusting it, or leaving; do not assume the Church or family is a support for someone leaving, nor that leaving is liberation [source: Brooks 2020].
Know your own position. Practical meaning: examine your own religious or secular assumptions and how they colour your reactions; self-disclose only when it serves the client [source: Vieten et al. 2013; Brooks 2020; synthesis].
Avoid dual relationships. Practical meaning: if you share a ward or stake with the client, or hold a Church calling over them, discuss and manage it or refer. [synthesis]
Safeguard children. Practical meaning: parents' choices about children's fasting and youth temple participation are discussed with attention to the child's health and assent; Church sources state little children should not be compelled to fast [source: Gospel Topics; synthesis].

4. Intervention inventory

These are the psychotherapist's own procedures alongside the observance. None is a Church rite; none involves teaching or performing one. Steps are [synthesis] unless a source is tagged.

4.1 Exploring what temple and fast Sunday mean to the client

Purpose / when: At intake and whenever temple, recommend, sealing, garments, fast Sunday or fast offerings come up. Establishes whether the observance is a source of meaning, belonging and coping, a source of strain, or both.
Steps: (1) Ask what the client calls the Church and its practices, and use those terms. (2) Ask what temple attendance, their own or family members' sealings, proxy work for ancestors and fast Sunday mean to them and their family. (3) Ask how often they take part now compared with before, and how that feels. (4) Ask what these practices give them (peace, connection to deceased relatives, community, service to the needy through fast offerings) and what, if anything, they cost. (5) Reflect back meanings without evaluating doctrine. (6) Note any area of distress for formulation.
Example language (illustrative): "You mentioned the temple a few times. Without going into anything you hold sacred, what does going there mean for you?" / "What is fast Sunday like for you and your family?"
Watch for: Over-explaining or guardedness, which may signal fear of judgement; meanings that sound rule-bound and fearful rather than chosen (possible scrupulosity, 4.6); grief about family members who cannot or do not attend. Working when the client uses their own vocabulary freely and links practices to their values. [source: CFI Module 5; IOCDF barriers to care]

4.2 Cultural Formulation Interview with the spirituality, religion and moral traditions module

Purpose / when: Structured assessment early in care, or when religion appears central to the problem or to coping.
Steps: (1) Complete the core CFI. (2) Use Supplementary Module 5, which has 16 questions in four areas: spiritual, religious and moral identity; the role of the tradition in daily and family life and decisions; how the tradition relates to the problem, including help from community leaders, texts and practices; and potential stresses or conflicts, including distress tied to identity or practices, discrimination, and conflict with others [source: APA CFI Supplementary Modules, Module 5]. (3) Insert the client's own term for their tradition, as the module instructs; if they name more than one (for example a convert, or someone in a mixed-faith marriage), explore each. (4) For each practice they name, ask about level of involvement and how it affects coping, as the module instructs. (5) Summarise in a cultural formulation and check it with the client. Do not reproduce the module's item wording on handouts; use the official document.
Example language (illustrative): "Some of my questions are about faith, because for many people it matters a lot. You can tell me as much or as little as you like."
Watch for: Brooks (2020) notes that cultural-formulation guidance tends to frame religion as a resource; ask equally about religion as a source of distress or loss, especially for people leaving the Church. Working when the client adds information you did not ask for and corrects your summary. [source: Brooks 2020]

4.3 Holding the temple confidentiality boundary

Purpose / when: Whenever temple experience is relevant, including scrupulosity about temple covenants and distress after leaving.
Steps: (1) Early on, say you will not ask about anything the client considers too sacred to discuss. (2) Note that the Church itself says members may discuss the basic purposes and doctrine of the ordinances and their spiritual feelings, while the symbols are not discussed outside the temple [source: General Handbook 27.0]. (3) Work at the level of feelings, meanings, thoughts and consequences. (4) If a client chooses to describe more, that is their decision; listen respectfully without encouraging or discouraging. For a client who has left and wants to talk about their temple experience, follow their lead without assuming they still hold the boundary. (5) Never repeat, write down or research confidential ceremony content.
Example language (illustrative): "We can talk about how the temple feels for you, the thoughts that come up and what they lead you to do. You never need to describe parts you hold sacred for this to work."
Watch for: Relief when the boundary is named; anxiety that disclosing feelings is itself a breach (which may be a scrupulosity symptom, 4.6). [synthesis]

4.4 Accommodation in scheduling and treatment

Purpose / when: At contracting and when planning interventions.
Steps: (1) Ask about Sunday worship, fast Sunday, temple attendance, family sealings or temple weddings, Church callings and missions that may affect attendance or energy. (2) Avoid scheduling demanding sessions on the client's fast day if they prefer. (3) In exposure planning, food-related work or medical procedures, ask whether garments, the Sabbath or fasting affect what is acceptable, and let the client consult their own leaders on religious questions; the Handbook's guidance on garments is in section 38.5 [uncertain: not verified]. (4) Agree how to handle missed sessions around temple trips or family ordinances. (5) Record accommodations in the care plan.
Example language (illustrative): "Are there days or times that don't work because of church or temple? I'd rather plan around them than have you choose between them and therapy."
Watch for: Clients over-accommodating the therapist out of politeness; accommodation requests that are actually avoidance driven by OCD (discuss openly). [synthesis]

4.5 Fasting health screen and coordination with the doctor

Purpose / when: At intake for any client who fasts, and whenever there is an eating disorder, diabetes or another chronic condition, pregnancy or breastfeeding, older age or frailty, regular medication, or a planned special fast.
Steps: (1) Ask whether and how the client fasts, without giving any target. (2) Ask about health conditions, pregnancy or nursing, and medication. (3) If any apply, recommend they discuss fasting with their doctor, and with the prescriber for any medication question; with consent, contact the doctor yourself. (4) Share, as the client wishes, the Church's own statements that people who are weak, "delicate in health" or nursing should not be required to fast, and that fasting can be "overdoing" [source: Gospel Topics]. (5) If they want religious reassurance about not fasting, suggest they speak with their bishop. (6) Explore alternative ways to observe the day if they cannot fast, such as giving a fast offering, prayer, service or attending fast and testimony meeting; Renfrew suggests non-food fasts or adding practices such as volunteering, reading, rest or prayer for people in eating-disorder recovery [source: Renfrew Center 2023].
Example language (illustrative): "Fasting is between you, your faith and your doctor. Because of your diabetes, would you be willing to ask your doctor what's safe before next fast Sunday?" / "Your Church's own guidance says people in poor health shouldn't be required to fast. How does that sit with you?"
Watch for: Guilt about not fasting; fasting used as weight control; dizziness, fainting or other symptoms (route to the doctor promptly). No practice here is presented as treating physical disease; the Church's stated physical benefit of fasting (Gospel Topics, quoting Elder L. Tom Perry) is a religious teaching, not a clinical claim [uncertain: not verified]. [synthesis for steps 1–3, 5]

4.6 Recognising scrupulosity and worthiness anxiety

Purpose / when: When the client reports persistent guilt, worthiness fears or repetitive religious behaviour, especially around recommend interviews, the sacrament, confession or temple attendance.
Steps: (1) Listen for the presentations the IOCDF lists for Latter-day Saint members: doubt whether guilt is a sign from the Holy Ghost; fear that thoughts are sins; triggers around the Word of Wisdom, the Law of Chastity, mission rules followed "with exactness", answering recommend questions honestly, and uncertainty about worthiness for the temple or sacrament [source: IOCDF Hagen and Smith]. (2) Listen for the confession patterns McClendon describes: repeated confession to a bishop, including sins already confessed, confessing to a stake presidency member "just in case", confessing trivial matters, and feeling "perpetually guilty" [source: McClendon 2019]. (3) Map obsessions, compulsions (confession, reassurance seeking, repeated prayer, avoidance of the temple or sacrament, re-checking recommend answers) and safety behaviours. (4) Distinguish from religiosity: the IOCDF warns that over-zealous practice may be mistaken for devotion, and that people lose sight of the purpose of practices. (5) Consider a structured OCD assessment by a qualified clinician; screen for comorbid depression and suicidality. (6) Note misdiagnosis risk: the IOCDF page (Hagen and Smith) cites a study in which family physicians misdiagnosed about half of OCD cases [source: IOCDF Hagen and Smith; uncertain: original study not verified].
Example language (illustrative): "Many faithful people have doubts now and then. What you're describing sounds different: the doubt comes back no matter what you do, and confessing helps only for a while. Does that fit?"
Watch for: Shame about being labelled ill; the client recruiting the therapist for reassurance ("Am I worthy?"). Working when the client can label an intrusive thought as OCD while keeping their faith intact.

4.7 Exposure and response prevention adapted for Latter-day Saint scrupulosity

Purpose / when: Once scrupulosity is formulated and the client consents. Siev, Huppert and Zuckerman (2017) state that ERP for scrupulosity is in principle the same as for other OCD, with adaptations to assessment, stance, psychoeducation, work with clergy, exposure and prayer; IOCDF describes values-based exposures and psychological flexibility without asking clients to act against their faith [source: Siev et al. 2017 abstract; IOCDF]. The chapter's detailed recommendations are [uncertain: not verified].
Steps (synthesis, standard ERP adapted): (1) Psychoeducation on the OCD cycle, using the client's faith language. (2) With consent, agree which behaviours are required by the Church and which go beyond it; where unclear, the client asks their bishop, ideally with a jointly agreed question, rather than the therapist ruling on doctrine. (3) Build a hierarchy of exposures that the client and, if they wish, their leader agree are religiously permissible: for example taking the sacrament after an intrusive thought without re-confessing, answering recommend questions once, attending the temple while uncertain, or writing the feared thought. (4) Response prevention: delay then drop repeat confessions, reassurance requests and ritual repetition of prayer; agree with the bishop, with consent, how he will respond to repeat confessions. (5) Prayer: help the client tell apart prayer they value from compulsive prayer, and keep the former. (6) Practise tolerating uncertainty about worthiness rather than resolving it. (7) Track anxiety, urges and values-consistent action across sessions. Exposures need informed consent, a safety plan and a pace the client chooses; do not use exposures that the client believes would be sinful.
Example language (illustrative): "We're not going to ask you to break any commandment. We're going to practise not doing the extra things OCD demands, like confessing again, and see what happens to the anxiety." / "Your bishop has told you this is resolved. The urge to confess again is OCD asking for certainty. Can you let the urge be there today without acting on it?"
Watch for: Covert compulsions (mental review, silent re-confession); the client asking the therapist to confirm worthiness; exposures drifting toward actions against the client's values (stop and renegotiate); depression or suicidal thoughts when guilt is high (assess risk using current standard practice). Working when urges fall over repeated exposures and the client re-engages with practices for their purpose. [source: IOCDF; synthesis]

4.8 Telling the conscience or Spirit apart from OCD

Purpose / when: When the client cannot tell whether guilt is a spiritual prompting or anxiety.
Steps: (1) Ask whether the client wants faith-based tools in this work. (2) If so, use the client's own tradition's contrasts: McClendon's Church-published article contrasts scrupulosity as condemning, fear-inducing and rigid with "pure religion" as loving, hopeful and flexible; the IOCDF page offers a similar "Spirit vs. OCD" contrast [source: McClendon 2019; IOCDF]. (3) Invite the client to apply the contrast to a recent episode. (4) Avoid using it as a reassurance ritual: apply once, then return to exposure. (5) The client may also bring Church leaders' statements quoted by the IOCDF, such as Elder Holland that perfection is a gift "we can't 'earn'"; use only if the client values them.
Example language (illustrative): "In your own tradition's terms, does this guilt feel more like the loving, hopeful voice or the harsh, rigid one?"
Watch for: The discernment becoming a new compulsion (checking whether it was 'really' the Spirit); the therapist being cast as spiritual arbiter. [synthesis]

4.9 Preparing for recommend interviews when anxiety is high

Purpose / when: Before a recommend interview or renewal, a pre-endowment or pre-sealing interview, or a mission interview, for clients with worthiness anxiety or scrupulosity.
Steps: (1) Separate the interview as the Church describes it from the feared version: leaders issue a recommend if the member "answers the temple recommend questions appropriately", must not add or remove requirements, and interviews are private and not rushed [source: General Handbook 26.3, 26.3.3]. (2) Note, if useful, that the member may invite a spouse, parent or other adult to be present (26.3.3). (3) Identify compulsive preparation (rehearsing answers, re-reading questions, pre-confessing) and set response-prevention limits (4.7). (4) Plan for anxiety during the interview with brief grounding the client already finds acceptable. (5) Afterwards, review what happened versus what was predicted, without reassurance-seeking.
Example language (illustrative): "What does OCD predict will happen in the interview? What does your Church's own guidance say the interview is for?"
Watch for: Avoiding renewal altogether (avoidance compulsion) versus a genuine, values-based choice not to renew; treat these differently. [synthesis]

4.10 Moral injury, real transgression and shame

Purpose / when: When guilt relates to an actual act the client believes violated their covenants or values (as distinct from OCD), or when the client feels betrayed by leaders or the institution.
Steps: (1) Clarify whether the issue is OCD (4.6), a real transgression, or moral injury from what others did. (2) For a real transgression, the Church's repentance process runs through the bishop; a Church-published article notes confession to a leader is required only for serious transgressions [source: McClendon 2019; General Handbook 26.5.8]. The therapist supports the client emotionally and does not act as confessor or rule on whether to confess. (3) Work on shame versus guilt, self-compassion in the client's own terms, and repair where the client chooses. (4) For moral injury involving leaders or the institution, validate, explore the meaning of the betrayal, and support the client's decisions about reporting, distance or continued involvement.
Example language (illustrative): "Whether and how to confess is something for you and your bishop. My part is helping you carry this without it crushing you."
Watch for: Disclosures of abuse or harm to others that trigger the therapist's own reporting duties (explain limits of confidentiality at intake); shame-driven suicidal thinking (assess). [synthesis]

4.11 Eating-disorder recovery and fast Sunday

Purpose / when: For clients with a current or past eating disorder who fast or feel pressure to fast.
Steps: (1) Ask about religious and cultural food norms the client grew up with and their current relationship to them [source: Renfrew 2023]. (2) Explore whether fasting has shifted "in service of the eating disorder" [source: Renfrew 2023]. (3) Agree with the client and the treatment team, including the medical provider, a plan for fast Sunday. (4) With consent, involve the bishop, who may give spiritual guidance or formally excuse the client, as Renfrew describes religious leaders doing [source: Renfrew 2023]. (5) Plan alternative observance (fast offering without fasting, prayer, service). (6) Process guilt about departing from family or community expectations; include family where appropriate.
Example language (illustrative): "Your recovery plan comes first, and your Church's guidance says people in poor health needn't fast. What would it look like to keep the meaning of fast Sunday without the fasting part?"
Watch for: Bingeing or purging after the fast, restriction continuing after the fast, praise for weight loss, and shame spirals when the client realises the practice was taken over [source: Renfrew 2023]. Route physical warning signs to the doctor.

4.12 Grief, ritual and community

Purpose / when: Bereavement; family history and proxy temple work for deceased relatives; illness in the family; isolation from the ward.
Steps: (1) Ask whether proxy ordinances, family history or a family fast for someone who is ill are part of how the client grieves or copes; the Church lists comfort in mourning and blessing the sick among purposes of fasting [source: Newsroom "Fasting"]. (2) Support these as the client frames them, without asserting or denying their spiritual effects. (3) Explore ward and family support, ministering and Relief Society or elders quorum help if the client values it [uncertain: not verified]. (4) Address grief linked to temple exclusion: for example, family members who cannot attend a temple sealing, or a client who no longer holds a recommend [synthesis]. (5) Address the loss of community for clients stepping back from activity.
Example language (illustrative): "You said doing your grandmother's family history has helped. What does that work give you right now?"
Watch for: Proxy work or family history becoming compulsive; family conflict over who may attend ordinances; complicated grief. [synthesis]

4.13 Collaborating with a bishop or other Church leader

Purpose / when: When the client wants their leader involved: scrupulosity treatment, fasting exemptions, repentance questions alongside therapy, or practical support.
Steps: (1) Discuss benefits and risks; get written consent specifying what may be shared. (2) Agree a narrow purpose (for example, how the bishop will respond to repeat confessions). (3) Share the IOCDF's free guide for faith leaders on scrupulosity if helpful [source: IOCDF]. (4) Respect roles: the bishop handles spiritual matters and welfare; the therapist handles the mental health condition; the Church article quotes Elder Morrison that leaders are "not mental health professionals" [source: McClendon 2019]. (5) Keep notes of contacts; review the collaboration with the client.
Example language (illustrative): "Would it help if your bishop and I were on the same page about the confessing? I'd only share what we agree on."
Watch for: Leaders unsure how to find OCD-trained therapists (an IOCDF-listed barrier); clients feeling pressured; leader advice that conflicts with treatment (raise with the client). For clients leaving the Church, do not assume leaders are a support [source: Brooks 2020].

4.14 Supporting faith transition, leaving the Church and religious trauma

Purpose / when: Clients doubting, stepping back or leaving; mixed-faith marriages and families; clients who describe their religious upbringing as traumatic.
Steps: (1) Take a neutral stance on the outcome; follow the client's own direction. (2) Assess the distress Brooks (2020) describes among people who left the Church in Utah: a sense of "world collapse", loss of meaning, identity and community, strained family ties, loneliness, persisting embodied guilt or inhibition (especially about sexuality and the body), the world feeling unreal, and existential fear about death [source: Brooks 2020]. (3) Differentiate this distress from depression, anxiety disorders, dissociation, trauma disorders and personality or family problems, while not pathologising disenchantment itself; if it fits, consider coding a religious or spiritual problem (DSM-5-TR code Z65.8). (4) Work on meaning and values reconstruction, grief for lost certainty and community, and self-trust. (5) Support communication with believing family members, spouse or children, including planning conversations about temple-related events the client may no longer attend. (6) For trauma symptoms, use established trauma-focused treatment, with attention to religious triggers. (7) Examine your own secular or religious assumptions [source: Brooks 2020].
Example language (illustrative): "Some people find leaving a faith feels like the ground has gone. Others feel relief, or both. What has it been like for you?" / "You don't need to decide anything about belief in here. We can look at what you want your life to be about now."
Watch for: The therapist cheering or discouraging departure; isolation and suicidal thinking during acute loss (assess); family rupture; old guilt reactions around sexuality, food, drink or Sunday activity. Brooks notes people raised in the Church may be more affected than converts and some leave with little distress; the evidence is qualitative and limited [source: Brooks 2020].

4.15 Screening for coercive or controlling dynamics

Purpose / when: When a client describes pressure, threats or control from family, a spouse, a group or individuals, in any religious setting. This section is [synthesis]: no source cited in this guide addresses coercive control in this setting.
Steps: (1) Ask neutrally how decisions about faith activity are made at home and who has a say. (2) Listen for general markers of coercive control: isolation, monitoring, threats, financial control, punishment for doubts, pressure on children. (3) Distinguish ordinary religious expectations and community norms from coercion targeted at the client. (4) Safety-plan where needed and follow local safeguarding duties. This guide does not characterise the Church as a high-control group. [synthesis]
Example language (illustrative): "When you think about stepping back from church, what do you expect would happen at home?"
Watch for: Fear of consequences for children; intimate-partner abuse framed in religious terms. [synthesis]

4.16 Children and youth

Purpose / when: Working with children, adolescents or parents where fasting, youth temple trips (proxy baptisms from age 11), missions or worthiness interviews are involved.
Steps: (1) Note the Church's own guidance that parents should not "compel their little children to fast" [source: Gospel Topics]. (2) Screen for eating-disorder risk and scrupulosity in youth; IOCDF lists a teen resource, Live with Faith Not Fear [source: IOCDF]. (3) Seek the young person's assent as well as parental consent for any faith-related work. (4) Involve the paediatrician for any health concern about fasting. (5) Follow safeguarding procedures if a child's health or safety is at risk. [synthesis for 3–5]
Example language (illustrative): "What's fast Sunday like for you? Is that something you choose, or does it feel like you have to?"
Watch for: Adolescent scrupulosity around worthiness for youth temple trips or mission preparation; family conflict over a teen's participation. [synthesis]

4.17 The therapist's competencies, self-disclosure and dual relationships

Purpose / when: Throughout; especially for therapists who are themselves members, former members, or unfamiliar with the Church.
Steps: (1) Review the 16 spiritual and religious competencies for psychologists across attitudes, knowledge and skills [source: Vieten et al. 2013]. (2) Learn basic Church doctrine and culture, as IOCDF advises for clinicians treating Latter-day Saint clients [source: IOCDF]. (3) Disclose your own faith or lack of it only when it serves the client, and be ready to discuss a client's worry about a non-member therapist [source: IOCDF barriers; synthesis]. (4) Manage overlap if you attend the same ward or stake, hold a calling relevant to the client, or know their family; refer if it cannot be managed. (5) Seek consultation for cases that stir your own religious history. Professional ethics codes (for example the APA Ethics Code) govern multiple relationships and competence [synthesis].
Example language (illustrative): "You asked whether I'm a member. I'm happy to answer briefly, but first, what would it mean for you if I were or weren't?"
Watch for: Collusion with a client's views because they match yours; avoidance of religious material because it is uncomfortable. [synthesis]

5. Handling problems

Most guidance here is [synthesis]; sourced points are tagged.

Client fears a non-member therapist will undermine their faith. The IOCDF lists this, fear of judgement and worry about being asked to act against faith among barriers to care [source: IOCDF]. Response: name the fear, state that treatment will not ask them to break commandments, offer bishop collaboration (4.13), or refer to a clinician they trust.
Client wants the therapist to say whether they are worthy. This is reassurance-seeking and outside the therapist's role. Response: decline warmly, link it to the OCD cycle, and return to exposure (4.7); worthiness questions belong with the client and their bishop.
Stuck ERP: the client will not drop repeat confession. Response: check the hierarchy is religiously acceptable to the client; with consent, involve the bishop so he declines to re-hear confessed matters and points the client back to treatment [source: McClendon 2019 notes re-confession is not needed once a bishop has confirmed repentance]; reduce step size; look for covert mental confession.
Overwhelm during exposure. Response: pause, ground in ways the client accepts (including prayer they value, if not compulsive), step back on the hierarchy, and review consent. Do not push an exposure the client experiences as sin.
Non-adherence on fast Sunday in eating-disorder recovery. Response: treat as information, not failure; review the plan with the medical provider and, with consent, the bishop; consider alternative observance (4.11) [source: Renfrew 2023].
Health risk from fasting the client will not discuss with a doctor. Response: share the Church's own statements that people "delicate in health" need not fast [source: Gospel Topics]; explore what makes medical contact hard; with urgent symptoms, follow medical-emergency procedures. The therapist does not set or relax fasting terms.
Rupture over religion. For example the client hears a question as anti-Church, or as pro-Church pressure if they are leaving. Response: acknowledge, invite feedback, restate neutrality, and check whether your own assumptions showed [source: Brooks 2020 on clinician self-examination].
Client discloses confidential temple content and then panics. Response: stay calm, do not repeat or record details, reflect that this is their choice and their conscience to weigh, and if anxiety becomes obsessive, treat it as scrupulosity (4.6–4.7).
Leader advice conflicts with treatment. Response: explore the client's understanding of it; with consent, clarify roles with the leader; leave religious rulings to the client and leader.
Client leaving the Church whose family is distressed. Do not assume family or leaders are supports; Brooks reports such advice sometimes re-traumatised people [source: Brooks 2020]. Response: help the client set boundaries and plan conversations; consider family or couples work if all parties wish.
Acute existential distress, isolation or suicidal thinking during faith loss or high scrupulous guilt. Response: assess risk using current standard practice, safety-plan, increase contact, involve supports the client chooses, and treat comorbid depression.
Therapist shares the client's ward or stake. Response: discuss at once, set boundaries about Church contact, consult, and refer if the overlap cannot be managed [synthesis].
Child or teen pressured to fast or to attend temple trips. Response: assess health and distress; engage parents with the Church's own statement against compelling little children to fast [source: Gospel Topics]; follow safeguarding procedures if needed.

Sources

Sources cited:

Further points: references to professional ethics codes are [synthesis]; General Handbook 38.5 on garments [uncertain: not verified].

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

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