We investigated the process and outcome of spiritually integrated psychotherapies (SIPs) with 34 Catholic therapists and 359 clients in Asia, Africa, Europe, and Latin America using a practice-based evidence design. The three most frequently used spiritual interventions across all therapists were: "encouraging personal prayer," "affirming trusting God," and "encouraging listening to the heart," but "discussing hope" was also one of the top three in Asia and Africa, "self-control" in Asia, "spiritual confrontation" and "self-disclosure" in Latin America, and "listening to spiritual issues" in Europe. In addition, using growth curve analyses, we found a significant decrease in both spiritual and nonspiritual distress over the course of SIPs; the levels of spiritual and nonspiritual concerns were highly correlated (but distinct) at any given time point. Also, the nonspiritual outcomes at one session significantly predicted the subsequent session's spiritual outcomes, but not the other way around. Finally, a moderate number of spiritual interventions were associated with a faster decline in nonspiritual distress than was a low number, although we found mixed results regarding whether a high number of spiritual interventions was associated with a faster decline of clients' nonspiritual distress than a moderate number. Results suggest that therapists should attend to spiritual concerns in psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).