Spiritual Assessment in Counseling: Methods and Practice

Beginning of article

Given the widely expanding professional and empirical support for integrating spirituality into counseling, the authors present a practical discussion for raising counselors' general awareness and skill in the critical area of spiritual assessment. A discussion of rationale, measurement, and clinical practice is provided along with case examples. D. R. Hodge's (2001) spiritual life map is highlighted as an assessment tool. The authors also discuss the influence of counselor-client values and beliefs in therapy and the need to incorporate developmental and cultural influences in spiritual assessment.

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The conceptualization of spirituality as an intervention domain in counseling has evolved as its relative importance has grown. Historically, research in psychology and counseling began to focus first on spirituality as a phenomenon in clinical treatment and then as an indispensable domain of investigation for understanding human nature and psychology. Today, spirituality is a widely investigated research variable in counseling and psychological treatment with several established theoretical and clinical frameworks available for integrating it into treatment (see Cashwell & Young, 2005; Faiver, Ingersoll, O'Brien, & McNally, 2001; Miller, 1999; Pargament, 1997; Richards & Bergin, 1997; Shafranske, 1996).

In actual practice, the ability to integrate spirituality into treatment requires the counseling professional to be skilled in spiritual assessment. Consequently, there is increasing clinical and empirical recognition of the importance of assessment in understanding spirituality (Curtis & Davis, 1999; Faiver & O'Brien, 1993; Hodge, 2003; Lovinger, 1996; Oakes, 2002; Raphel, 2001; Richards & Bergin, 1997) and growing emphasis on developing clinical assessment protocols for integrating spirituality into treatment (Richards & Bergin, 2000; Young, Cashwell, Wiggins-Frame, & Belaire, 2002). The purpose of this article is to (a) present an overview of the conceptualization and rationale of spiritual assessment, (b) discuss specific spiritual assessment methods and related practices, and (c) illumine these methods and practices with actual clinical case examples.

Spiritual Assessment: What is it?

Sperry (2001) defined spiritual assessment as the process of "eliciting a client's spiritual and religious history" (p. 103) within the development of an overall clinical appraisal. Consistent with this perspective, research and clinical experience have demonstrated that spirituality can be a significant strength that may be used to overcome psychological problems (Frame, 2003; Miller & Thoresen, 1999; Richards & Bergin, 1997). Therefore, conducting a spiritual assessment provides an important framework for eliciting the spiritual assets of the client that are then integrated into treatment (Hodge, 2001; Wiggins, 2000).

When considering spirituality as a treatment domain, it is important both to define the domain and to describe it within specific measurement and evaluation contexts. Empirical and clinical evidence have determined that spiritual assessment is driven by the multifaceted aspect of human nature and that spirituality is a facet of human nature that has a significant positive and negative influence over emotional and cognitive well-being (Ciarrocchi, Piedmont, & Williams, 2003; Diener, 1984; Diener, Suh, Lucas, & Smith, 1999).

As with other clinical evaluation process, spiritual assessment requires specific knowledge and skills (i.e., competencies), which are currently being developed within the counseling profession (see Young et al., 2002). In addition, there is clinical evidence that spiritual assessment models should be holistic and interdisciplinary, drawing from medicine, social work, counseling, and psychology (Raphel, 2001). Furthermore, counselors should know that any assessment of spirituality must be conducted within the interrelated contexts of religion, culture, and psychopathology (Cashwell & Young, 2005; Frame, 2003; Lovinger, 1996; Oakes, 2000; Richards & Bergin, 2000; Sperry, 2001).

Rationales for Conducting Spiritual Assessments

Counseling professionals must learn to value the rationale and relevance of evaluating the relationship between clients' religiousness/spirituality and their clinical issues. Following Miller's (1988) view, spiritual assessment should evaluate the essential beliefs and values of clients. The related work of Richards and Bergin (1997) is also instructive. In examining recent empirical and clinical evidence, Richards and Bergin (1997) identified five conceptual reasons for conducting a religious-spiritual assessment, which have been interpreted as follows: (a) the assessment of a client's religious and spiritual beliefs illumines the counselor's understanding of the client's worldview, thereby enhancing the counselor's empathy and sensitivity toward the client's unique experiences; (b) a specific religious-spiritual assessment can support the counselor's diagnosis of healthy or unhealthy spirituality and its related influence on the treatment problem; (c) such an assessment can help the counselor to identify religious and spiritual resources that, when used adjunctively, can contribute to successful treatment outcomes; (d) assessment results can point generally to the types of spiritual or religious interventions that may be adapted to the client's needs and are also adaptable to the treatment model in which the counselor practices; and (e) assessment can uncover spirituality issues that are clinical problems in and of themselves.

Hodge (2003) also provided four basic reasons for conducting an assessment: to gain an understanding of worldview, to enhance client self-determination/autonomy, to identify client's spiritual strengths as resources, and to comply with professional ethics. Moreover, referring to a spirituality assessment model designed for direct application to clinical practice, we believe an assessment protocol should be used that is holistic and inclusive and provides an actual adaptation of Richards and Bergin's (1997) and Hodge's (2003) conceptual reasons for using religious-spiritual assessment in treatment. The following anecdotal case example provides an illustration of the complex interface between the client's spiritual resources …