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Jul172010

Divine Interventions

Spiritual Assessment Techniques Meet Mainstream Counseling

By Stacy Notaras Murphy

One of Tony Brunswick’s clients was wrestling with the “higher power” component of his substance abuse recovery program. The client struggled with his concept of God and organized faith traditions, making his 12-Step-style recovery more difficult. Brunswick, an American Counseling Association member who is a counselor at the So Others Might Eat Jordan House program in Washington, D.C., suspected that his client might appreciate a visual tool to help him map the origin of this conflict.

“We used a timeline to illustrate his spiritual journey,” Brunswick explained. “There was a lot of activity during his early childhood. We also created a ‘loss line,’ which incorporates all the significant periods of loss in someone’s life. When we put the two timelines together, we realized that there were a lot of abuse-related issues when he was young and that the abuse was perpetrated by people in his church. On the spiritual timeline, we saw a lot of spiritual experiences occurring at the same time as the abuse. You could just see on the paper that the conflict was visible, but yet it had gone unnamed for him for so long.”

The client had never before considered that during the time he was enduring abuse, he simultaneously had experienced strong faith in God. “His understanding of God was very masculine, authoritative and very abusive,” Brunswick said. “With the timeline, he was able to make the connection that some of the role models of faith for him were some of the perpetrators of the abuse. His ability to establish a relationship with God has been difficult because the imagery he uses to understand God also is very masculine. As a result of the timelines, he realized that there was a lot of connection between his conflicted God images and his experiences with abuse when he was young.”

Spiritual assessment techniques such as the spirituality timeline can serve as an entryway for counselors to begin conversations about faith and meaning making in their clients’ lives. Counselors may use a growing body of history-taking methods to contextualize their clients’ spiritual development, including self-awareness checklists and online surveys. Specific tools can be as formal as research-based assessment scales and inventories or as simple as drawing a family tree that includes spiritual events and overtones.

Research suggests that counseling clients are open to this kind of discussion. A 2000 survey commissioned by the American Association of Pastoral Counselors and the Samaritan Institute found that 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their mental and emotional health. Further, 75 percent of respondents said it was important to see a professional counselor who integrated their values and beliefs into the counseling process.

AAPC President Anne Ross Stewart, a member of ACA, suggested that the rising interest in spiritual assessment techniques parallels the increasing interest in pastoral perspectives in the traditional counseling world. “Many students in pastoral counseling programs today have not had a degree in theology, and many do not even intend to get one,” Stewart said. “They don’t have the background of some of the theological and spiritual lenses that one might acquire in seminary education such as pastoral diagnosis or inquiry, which might be more comparable to what is understood in the mainstream as ‘spiritual assessment.’ Most traditional counselors, and even some pastoral counselors, are trained today without a theological background and, therefore, may not have as many ‘windows’ to get into the spirituality of the clients. I think that is part of why these assessment tools are coming into play more and more.”

Questions open the door
While the list of available spiritual assessment techniques ranges from the casual to the complex, Carol Fournier’s favorite is quite basic. “I really think it’s essential,” explained Fournier, a board member of the Association for Spiritual, Ethical and Religious Values in Counseling, a division of ACA, “to just be asking the questions: What gives meaning to your life? Do you believe in an ultimate reality? How would you name this? What does this mean to you? What is the foundation for your values and some of your choices?”

Fournier, an assistant professor at the University of Vermont, said many people have both positive and negative experiences of religion and spirituality, and learning about those episodes can be critical to understanding a client’s mental health. “Anything you don’t bring into a counseling situation gives the impression that someone shouldn’t be talking about it or they may not think to talk about it, and yet it might be having a strong influence on how they are living their lives,” she said.

“I’ve found it’s really important to spend time flushing out what that story is in someone’s life,” she continued, “because it really permeates all aspects, either consciously or unconsciously. I think the more questions that can be asked … the easier it is to see its impact and to support someone in their overall movement toward health and healing. I think it’s a disservice not to ask those questions, whether that’s choosing to use a more elaborate assessment tool or simply to bring the questions into the initial interview. It’s amazing the responses you get just by (saying), ‘Tell me a little bit about your experience of religion.’ There’s just a lot of story underneath those questions.”

Stages of faith development
Once a counselor has asked those questions, however, it can be helpful to have knowledge of a theoretical model for interpretation. Brian Griffith, an assistant clinical professor at Vanderbilt University, created a religious identity status model that applies James Marcia’s identity formation model to a faith perspective.

The four stages of identity status are:

• Diffusion, when there is no clear understanding or a lack of motivation
• Foreclosure, when a superficial religious identity is adopted
• Moratorium, a time of significant questioning and searching
• Achievement, which is characterized by commitment and spiritual maturity

By asking specific questions about religious practice and conceptualization, counselors can assess a client’s stage of faith development and tailor interventions based on that knowledge.

“The religious identity status model is a process model,” Griffith said. “It assesses people’s faith based on where they are in a process; it’s not judgmental. Other assessment tools look at things like content (what do you believe) and practices (how often do you go to church or synagogue). This model is more process-oriented, and that’s a little less threatening. The goal is to have the person find their own belief system, integrate it into their own identity(and) to live more faithfully to their core spiritual center. The counselor is not defining that core spiritual center but just facilitating the process for the client to get here and live consistently with that.”

Griffith noted that religious identity formation is not permanent. For example, clients may reach one stage and then spin back into the searching process of moratorium following specific life events such as births, deaths or divorces. “We re-evaluate our spiritual belief system,” he said. “To further refine it, my faith at age 44 is certainly different from what it looked like at age 24. For me, in some ways the more I know, the less I understand and the more complex and nuanced it becomes.” Counselors can use the stages to help conceptualize a client’s situation and determine appropriate interventions.

Sincere social science
Still, for many, the warning to steer clear of religion and politics at family gatherings also applies in the counseling room. There, counselors may be constrained by the rules of their employer, while clients may not see a connection between their faith experience and their current functioning. Ralph L. Piedmont, an ACA member who is director of doctoral research for the Department of Pastoral Counseling at Loyola College in Maryland, set out to discover a new way to talk about spirituality that would not get bogged down by political correctness or denominational doctrine.

“One of the problems of working in the field of spirituality and religiosity is that it often reflects a very specific religious orientation, such as the orientation that is modal for the United States,” he said. “But it leaves out a lot of people, like Jews, Hindus, Muslims and people who don’t have religion but consider themselves to be very spiritual or may have a spirituality that doesn’t fit into any of the above categories. What about their spirituality? Where does that fit in? How do I measure that, and how do I work with these individuals?”

Piedmont continued, “Our goal in developing our measure of spirituality was not to be denominationally based. So we asked the question, what is it that all religions seem to have in common about their spirituality?” His research team gathered representatives from a variety of religions to take part in an “interfaith quorum” conference in 1997. “We came upon the concept of ‘spiritual transcendence,’” he said, “which seemed to be the point of commonality for all faiths in that our religious beliefs are basically trying to help us step outside of our immediate sense of place and time and to recognize that there’s a bigger process going on beyond who we are.

“Spiritual transcendence is the ability of the individual to step back and construct a broad sense of united meaning and purpose for their lives; they recognize that there is some transcendent reality out there that seems to provide an organizing framework for a person’s life. … That basically means, since we know that we are going to die, how do we make sense of the life we’re leading? That’s essentially the essence of all spirituality — trying to answer that question.”

Utilizing this new concept, Piedmont developed a spiritual transcendence assessment known as the ASPIRES scale (Assessment of Spirituality and Religious Sentiment) that measures both spiritual transcendence and religious involvement. The survey tool offers both long and short formats, and may be self-scored and interpreted.

“The scale is not denominationally based,” Piedmont emphasized. “It asks how the client is making meaning. Talking about that is what therapy is all about. Giving the instrument is opening the door (and) telling the client that it’s OK to talk about these themes. Spirituality is a long continuum, from people who are very materialistic to people who are transcendent and people who fall somewhere along that continuum. The scale gives a therapist some idea of where a client is on that continuum so they can engage the client where he or she is at.”

The scale has been used to predict outcomes in substance abuse recovery programs, in work with chronic arthritis sufferers and around the world with a vast list of cultures. “A group of people is using it with Mesoamericans who are gay and HIV-positive,” Piedmont said. “They liked the scale because it captured aspects of Mesoamerican spirituality that seem to have been left out in more Christian approaches. The things about connectedness and honoring the dead, having ongoing relationships with people who have died — those are important themes for those folks.”

Piedmont notes that Christian fundamentalists, on the other hand, have generally discounted the scale as New Age spirituality because it makes no mention of Jesus Christ. “I understand that for them a measure of spirituality has to talk about Jesus,” he conceded. “I always argue that my scale is not designed to be a theological instrument; it was designed to be a motivational scale. I want spirituality to be considered a psychological variable because we are social scientists. As social scientists, we need to concern ourselves with social issues. We can’t be theologians or spiritual directors. That’s not what we are trained to be. We need to use instruments that fit into the social science model. We have to show reliability and validity. We need to have clear definitions (and) theoretical models that are testable scientifically. Theological models can’t fit into that world.”

Narrowing the discussion to meaning making, rather than theology, is what counselors need to do with their clients, according to Piedmont. “Remember,” he said, “spirituality is not religion. So, to the question of whether it’s appropriate to talk about spirituality with a client, I say, why not? Spirituality is about meaning, and that’s a good thing to talk about with your client.”

Handle with care
Amid the growing interest in applying such assessment techniques to counseling, it is key to remember that issues of religion and spirituality must be handled with kid gloves, as their nuances often mean very different things to different people.

Griffith recalled being interviewed for his Vanderbilt professorship eight years ago. His interviewers asked about his dissertation, which explored the role of spirituality and religion in counseling. “I said, ‘I always approach the topic of spirituality much the way Moses approached the burning bush in the Christian Scriptures. He was told to take off his sandals because it was holy ground. I really do believe that this is holy ground which we tread upon with very gentle and respectful care.’

“One of my interviewers said, ‘Actually, that’s the Jewish Scriptures. It started in the Hebrew Old Testament, so it might be good to give credit to the source.’ It was a great case in point. I was considering the Old Testament as an exclusively Christian sacred document, when in fact it was originally a Jewish sacred document. She took it with good nature, but it was a great warning for me that these are very delicate issues. These are sensitive issues that should be talked about with delicacy, gentleness and great care for others.”

Griffith advises that clients need to invite therapists to intervene in this area. “There is cautiousness around spirituality,” he said. “When counselors delve into issues of the soul, those are very delicate areas to explore. There is this tendency to boundary spiritual beliefs, to put them in categories and labels, and to define one group of people against another based on those labels. So people are cautious about talking about their deepest spiritual beliefs and feelings.”

Brunswick tends to use spiritual assessments such as the spiritual timeline with clients who first volunteer information about their faith journeys. “Usually I do it with people who are currently in some sort of conflict with their faith experience — with their image of God, with their sense of religion or church,” he said. “It’s a way to sort of help determine what are the things about that tradition or that spirituality or that experience that might be causing the conflict today. It’s very client-driven. I really want them to be the maker of the meaning of their own experiences. I certainly try to help make the exploration happen, offer insight and suggest possible inferences that we can make from the experiences, but I really hope that any insight they get comes from them through using the assessment.”

Such techniques are also useful with clients who are not experiencing a crisis of faith, Brunswick said. “The spiritual timeline is also used as an affirmation tool as much as it is a clinical assessment,” he said. “It’s not meant just to root out pathology or conflict or anxiety. It’s also meant to be an affirmation of a person’s particular journey. Some people are celebrating their faith experience aside from other difficulties. This can be a really beautiful way for them to identify and highlight what it is about their experience that they find so uplifting.”


This article originally appeared in the May 2006 issue of Counseling Today, the monthly newspaper of the American Counseling Association (www.counseling.org).