Assessment of Spirituality

In the Whole-Person Clinic we conduct a spiritual assessment as the third window in which to view the person’s health status.  The content of this assessment is based loosely on a seven stage model of the human spirit.  Each level of the human spirit needs to be explored, and only the seventh level is concerned with the patient’s religious experiences.

Spiritual assessment – interview structure

Each of the following areas would be explored, preferably in this order to leave religious issues to the end.  We should probably develop a sort of self-administered questionnaire – with mainly open type questions for the person to consider before the first “spiritual window” interview.

There is a huge overlap with the counselling interview, and the first three spiritual elements may be well covered in sessions before the spiritual assessment, which should therefore concentrate on the last four levels of spirituality.  This long list of questions will act as a checklist for a semi-structured interview which will seek to explore the most important of the areas below.  The actual interview will be driven by the health needs of the person and their attitudes and responses. In real life only a fraction of the topics may be covered, some in greater depth than others.

1   RELATING TO SELF

• Each person is a unique individual  – thus the Personality is explored in three ways –

Weaknesses reveal the fallen state

• Failures
• Bondages and recurrent sins  
• Demonic issues?

Strengths indicate what God intended

• Look at personality (say with StrategA system)
• Or use MMM and other tools we have experimented with   

Potential  to develop

• The person’s view and understanding of their individual Self is important.

• What is their self-understanding and self-awareness, how willing to explore?
• What is their self-acceptance, too critical, not critical enough?

•  An essential part of the human spirit is  to be Creative.

• What creativity do they use on a regular basis?
• What frustrated creative instincts are there?
• Is the person able to use their imagination creatively?

• How mature is the person, how do they learn from life’s experiences.

• What is their view of wisdom
• How good are they at learning from experience
• How have they grown through suffering?
• How open are they to criticism

2   RELATING TO OTHERS

            The second part of the human spirit is to be in relationship.  We are made to relate and the quality and usefulness of our relationships is a spirit led activity. We relate  with other people who include friends, family, neighbours and strangers.

  a)       Friends are a sign of the person’s ability to relate with like minded people

• How many friends, work or leisure pursuits?
• Depth of support from them, how deeply can they share?
• Understanding and practice of honour, loyalty, respect

 b)        Family relationships are an example of relating to people we have to live closely with

• Ability to give and receive love
• Ability to confront and deal with conflicts
• Ability to recognise own weaknesses and say “sorry”

  c)       Strangers relationships include neighbours and enemies.

• How much empathy and compassion do they have
• Are they able to show mercy to those in need
• Is there bitterness and un-forgiveness in their heart

  d)       The spirit enables us to be peacemakersin conflicts

• What is their ability to bring harmony and peace to situations?

3   RELATING TO THE WORLD

            We have a duty and responsibility to rule and have authority within the world – to control ourselves and our actions in a constructive way. How does the person relate to the world around them?

  a)       Explore the locus of control in their lives

• How much control do they have over their lives, and how much do others have
• How do they respond to the authority of others?
• How do they take authority themselves?

  b)       How do they view the world of animals?

• Too sentimental or too harsh?

  c)       What is their view about the world’s resources and our responsibilities

• How do they structure their lives?
• What is there attitude to wealth?
• Is there dissonance between their views and their actions?

  d)       What is their work ethic

• Does work cause stress?
• Are they in the correct job?
• Do they know their personal strengths and weaknesses?
• Are work relationships supportive?
• Are they balanced between work, personal life, relationships and ministry?

  e)       Society and cultures

• How have they been influenced by their own culture?
• How has their education affected their beliefs?
• Are they engaged with their culture?
• Are there cultural and religious tensions in their family and friends?
• Are their leisure activities appropriate?

  f)       How comfortable with science and how it relates to them as individuals

• Are there clashes between their beliefs and scientific theory?
• Especially in the area of health care

4   ETHICS and MORALITY

            Our conscience enables us to have a personal morality and a set of ethics to guide our actions and behaviour.

  a)       The conscience

• Do they set too high standards for themselves?
• Is the conscience weak?
• Any problems?

  b)       Basis of personal ethics

• What is  their world view?
• What is their ethical stance on common issues?

  c)       Nature of moral decisions taken

• How do they put their ethics into practice

5   PURPOSE and MEANING

            God gave us a sense of purpose for our lives, and the will-power to see us through the difficulties and challenges.

  a)       Hope for the future

• What plans do they have for the future?
• Do they have hope?
• Have there been shattered hopes in the past?

  b)       Desires of the heart

• What are the desires of their heart?
• Dreams and aspirations
• What plans to bring them to pass

  c)       Priorities in life

• How do they place personal needs, family, work and ministry
• Is God a part of their decision making process?
• Do they involve relevant others in decision making?

  d)       Fulfilments

• What successes have there been in their lives?
• Have they turned failures into successes
• Do they have bitterness towards others
• How do they view themselves – as a failure or a success
• What areas of their lives have been successful?

  e)       Understanding of the purpose of life – their personal theology

6   FAITH and BELIEF

            We all have a well developed set of beliefs – many derived subconsciously from our upbringing and culture.  Faith is belief in action – we all have to have faith.

  a)       What are their beliefs about God

• Which religion has influenced them most?
• Have they developed their own beliefs
• How influential has the family been

  b)       What are their beliefs about the purpose of their own life

  c)       Do they believe in the spirit world

• What is their view of the occult and satan?
• Have they experienced demonic activity?

  d)       Do they believe that God can communicate with them?

• Do they pray
• What results have they seen

  e)       What do they put their faith in?

7   RELIGION

            Finally we come to their personal understanding of the Divine and their relationship with God.

  a)       Describe the religious pilgrimage they have made

• Did they have good experiences as a child?
• Which religion did they grow up in?
• What battles and struggles with belief did they experience as they were growing up?

  b)       What have been the painful and harmful elements

  c)       What have been the positive and helpful elements

  d)       Do they have a personal relationship with God?

  e)       Do they have a false understanding about God

C:\Documents and Settings\Emmanuel\My Documents\Human Spirit Assessment notes for Burrswood.doc

Importance of forgiveness to health
A friend of mine has had a long and successful work in Rwanda running seminars which attempted to bring reconciliation to Christians and others who were on the opposite sides during the genocide in the 1990s. After a recent visit she wrote –“I was privileged to interview people from different parts of the nation who had been helped through the seminar. Some had been severely wounded but had found healing and the ability to forgive. Others had participated in the killings. This is the first time I had sat with killers and listened to their hearts. (They had served their sentence in prison and were now completing the sentence in the community.) Let me tell you about two of them:

Almost all of Renata’s family had been killed in the genocide. On top of this she had been raped many times and now is HIV positive. She was very traumatised and could trust no-one. Then last year someone invited her to a healing seminar. When she arrived she saw that there were released prisoners there also, this was too painful for her and she almost left. But then the teachings began to heal her and she felt the seminar had been designed solely for her. She cried a lot and gave up to God all her sufferings and felt a great release. The next day a prisoner stood and confessed he had killed her family. She was shocked and felt great sorrow. But then she told him he had been very courageous to confess and she walked up to him and hugged him, telling him she forgave him. Since then she has also been able to forgive those who raped her, and says her health is much better since then.

Next I interviewed a young man called Francois. His story was very different. With head bowed, he told me he had killed many people but had come under a heavy weight of guilt in prison and had confessed. After his release, awaiting trial, he was invited to a seminar. Here he heard what he described as wonderful teachings, especially about forgiveness through the death of Jesus on the cross. This was new to him, and during the workshop he took everything to the foot of the cross. For the first time he felt clean and pure. But the amazing thing, he said, was that that the survivor of the family he killed was present and was able to forgive him. I suddenly realised this was probably the man who killed Renata’s family. He said it was the case, and that they had travelled there together. “We have a good relationship now”. All the time he gave me no eye contact and kept his head bowed, and I began to feel compassion toward him. I assured him –
“I need forgiveness too. I have not killed anyone, but I have hated. Without forgiveness there is no hope for me either.”
“Eh, murakose!” (“Thank you!”) His head was still bowed.
“We are now equal and you are my brother.”
“Eh, murakose!” but still no eye contact.
“Please look me in the eyes, for God’s plans towards you are for good and not for evil, to give you a future and a hope.”
“Eh, murakose!” but this time he grasped my hands and looked me in the eye.

5.14.4
Personal growth through pain and difficulty
A little while later my friend was able to spend some time with the team who ran these seminars. We had heard that they were upset and angry about the funding for their work being stopped so abruptly. The next day it was time to hear their pain and anger. Their main problem was not the cessation of funding but the way it was communicated, and that it was done so abruptly. It meant they had to cancel events that they had already arranged. They felt abandoned. We just let them talk and then Joseph asked forgiveness for the way the decision was communicated. Several then came forward to forgive him, and there were many tears. In the afternoon there was a time of discussion and the leader did something very daring. He asked them to think what good things would come out of stopping the funds. I wondered of we would get any response at all, but to my amazement we had the most wonderful response.  They said things like –

“This is the big test. Are we in this for the love of the work or for the money? No-one will be able to accuse again of doing it for the money.”
“No child likes being weaned but this is a sign that we have grown up.”
“Other trained people wanted to join us before but we wouldn’t let them because there wasn’t enough money for everyone. Now we can all work together.”
“We were restricted and stuck because of depending on the money. Now we are released to be creative.”

(Rhiannon has given me permission to use these stories – via e-mail 24.02.2006)

Spiritual Assessment

About the human spirit and not just religious experience

Varies according to known Christian or religious beliefs of the person

Assessment and not therapy at this stage

Start with explanation of what the spirit is and does

Spiritual Assessment Process

Two pastoral counselling sessions of an hour or more

Structured interview based on the seven areas of spiritual activity

Getting the patient to tell their health story again

Concentrating on their beliefs

Exploring in depth the spiritual aspects of health in these 7 areas of spirituality

1 Relating to Self

Self-Image

Describe their strengths and weaknesses

Self-acceptance

Locus of control – internal or external

Creativity, leisure and time for themselves

Maturity

Learning from failures

Handling success

2 Relating to the world

How they deal with authority figures

Attitudes to work

Attitudes to science

Dealings within society

Caring for others

Taking responsibility

3 Relationships

Are they able to give and receive love?

What is the quality of their close relationships?

Do they argue, or passively withdraw when there is conflict?

Can they confront in a positive way?

Can they act as peacemakers?

4 Ethics and Morality

What do they think of their conscience

What is their life ethic based on?

What is truth for them?

Discuss actions in the past they feel bad about

Are they able to forgive

themselves

others

5 Purpose and meaning

Do they have hope in the future?

What is their purpose in life?

What do they live for?

Have they been fulfilled in life?

Discuss the dreams of their heart

6 Faith and Belief

What belief system were they given as children?

Struggles with belief and doubt

What do they put their faith in?

Self

Others

Medicine

God

7 Religious Experience

Childhood religious experiences

Helpful events in past

Harmful events

Understanding of God and religion

Relationship with God

prayer

church

beliefs

Final integrated assessment

Three therapists (doctor, counsellor and pastor) come together

Pray and put together combined report

One therapist takes this back to the patient

Patient alters the report so that they can OWN it

Action plan produced with the patient

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