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This study explores the role of spirituality in psychotherapy, comparing how traditional therapists and holistic therapists address mental health in light of contemporary crises. Based on interviews with 40 licensed therapists (20 conventional and 20 holistic) in the San Francisco Bay Area, the study investigates two key questions: (1) How do traditional psychotherapists and holistic psychotherapists, both trained in psychological frameworks, make sense of and/or address the spiritual dimension of the emerging “biopsychosocial-spiritual model,” particularly when treating anxiety? (2) How have they adapted their approaches amid contemporary crises, especially for those affecting racialized minorities? This research offers insights into how therapists navigate spirituality and mental health care in a profession shaped by medicalization, and how they adapt their approaches to meet the needs of patients in a changing social, cultural, political, and ecological landscape.