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A mixed methods national survey of 2,069 National Association of Social Workers members examined ethical concerns regarding religious and nonreligious spiritual issues in clinical practice settings. This qualitative study focuses on responses to open-ended survey questions and relates them to quantitative findings. Practitioners' insights provide a basis to extend ethical guidelines in practice and education. The findings indicate that most respondents deal with spirituality in practice, and many use general ethical principles and situational considerations. However, they likely lack guidelines for systematic ethical decision making about the use of spiritually oriented activities in practice. The authors suggest ways that social work educators and supervisors should provide ethical guidelines and case examples for spiritually oriented activities in both educational and direct practice contexts.

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