There is increasing recognition of the importance of identifying and perhaps incorporating into psychological services the spiritual and religious beliefs and practices (SRBP) of patients. Research suggests that psychologists are reluctant to address the SRBP of their patients, because they are unsure how to do so without contravention of ethical standards. Moreover, numerous approaches have been published and promoted, and psychologists may feel overwhelmed by the profusion of advice. We organize the suggested approaches into four categories and place them on a continuum, and we discuss the ethical concerns related to each. At one end is spiritually avoidant care, which entails the attempt to avoid conversations with patients about their SRBP. Given the importance of these issues to psychological health and to understanding the patient, this approach is untenable. At the other end of the continuum, spiritually directive psychotherapy is characterized by an explicit attempt to maintain or change the SRBP of patients. Spiritually integrated psychotherapy entails utilizing SRBP to ameliorate patients’ emotional distress. We suggest that psychologists should at least engage in spiritually conscious care, which we characterize as the explicit assessment of the general importance of SRBP to the patient, its influence on the presenting problem, and the potential of SRBP as a resource to help recovery. Specific suggestions are presented for how spiritually conscious care might be implemented. Finally, the need for better training in both basic and specific competencies needed to address patients’ SRBP is reviewed.