Practicing psychotherapy that is sensitive to spirituality and spiritual issues involves recognition of various cultural and ethical considerations. Just as professional ethical standards require therapists to be sensitive to cultural issues, therapists are also required to be sensitive to spiritual issues influencing their clients. This chapter discusses some common cultural and ethical considerations in the practice of spiritually oriented psychotherapy. It begins with a discussion of some key cultural considerations. These include the complex relationship between spirituality and culture, and the importance of cultural sensitivity and competence in the practice of spiritually oriented psychotherapy. Then, ethical considerations common in spiritually oriented psychotherapy are addressed. These include informed consent, boundaries, and praying with the client. Next addressed is the matter of scope of practice, that is, the type and extent of practice that a licensing board considers acceptable practice for a professional. To summarize the discussion of the chapter, seven practice guidelines are then highlighted. Finally, key points of this chapter are illustrated with the continuing case of Maria.