The last 3 decades have seen a dramatic increase in the creation and effective use of spiritually integrated therapy (SIT) for a wide variety of client populations and clinical issues. The outcome research on SIT has increased and improved dramatically, yet process research on SIT has lagged somewhat. While valuable, prior process-oriented studies on SIT have used retrospective survey methods and asked about generalized usage rates of predetermined spiritual interventions. Rather than relying on retrospective reports of SIT with clients, there is great value and likely greater accuracy in examining session-by-session usage of SIT with clients and identifying correlational patterns between clinical issues and spiritual interventions. The current study used a descriptive, practice-based evidence approach and analyzed session-by-session process data from a private practice explicitly marketed as offering SIT. After every therapy session, eight therapists at this site completed an in-depth process measure, the Clinically Adaptive Therapist Session Checklist, and reported which clinical issues they discussed and which spiritual interventions they used in session. Findings revealed that therapists discussed self-esteem, anxiety, depression, and religious/spiritual concerns in over half of their sessions. Therapists also endorsed affirming clients' divine worth, encouraged trusting God, encouraged clients to listen to their heart, and encouraged accepting God's love in over half of their sessions. The strongest positive correlations between spiritual interventions and clinical issues were between challenging shame and challenging fear, and emotional orientation (r = 0.664 and 0.648, respectively). The clinical patterns found in this analysis illustrate one way of incorporating spirituality into clinical work. This study highlights the importance of routine outcome/process monitoring systems to help illuminate the process of SIT and contribute to deliberate practice efforts in the field. This study also stimulated discussion on the distinction between SIT and being a spiritually centered therapist.