Toward effective service to individuals, and divorcing families and stepfamilies
	Spiritual Assessment and Interventions - p. 1of 3 Tap Your and Your Clients' Spiritual Resources! By Peter K. Gerlach, MSW

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The Web address of this article is http://sfhelp.org/etx/basics/spirituality.htm

        Clicking any link in these pages will open an informational popup or new window, so please turn off your browser's popup blocker or accept popups from this nonprofit site.

        This research-based Web site exists to...

• motivate people to stop the toxic [wounds + unawareness] cycle

• improve the nurturance level of typical families, and...

• reduce epidemic American divorce.

        This article is one of a series on effective professional counseling, coaching, and therapy with (a) these families, and with (b) typical survivors of childhood neglect and trauma.

        In these articles, "co-parent" means any part-time or full-time caregiving adult in a divorcing family or stepfamily. The "/" in re/marriage and re/divorce notes it may be a stepparent's first union.  These articles for professionals are under construction.

        Before continuing, pause and reflect - why are you reading this article? What do you need?

        This three-page Web article focuses on an often-neglected aspect of clinical service to persons and families - using clients' spiritual resources. This page offers ...

• key semantic definitions;

• a self-assessment inventory about your spirituality and your workplace;

• a core reason to include spirituality in clinical work with divorcing families and stepfamilies;

• basic perspective on, and premises about spirituality and clinical spirituality interventions; and...

• potential benefits of including spirituality in the work with receptive clients. 

        Page 2 offers (a) perspective on toxic spirituality, and options for (b) assessing client spirituality, and (c) effective spiritual interventions with these clients.

        Page 3 suggests spirituality-interventions with co-parents with (a) nurturing and (b) toxic spiritual beliefs, and (c ) hilights key questions that arise from spirituality assessments and interventions.

        To get the most from this article, first please read...

• this perspective on the difference between spirituality and religion,

• this article on healthy and toxic spiritual and religious beliefs and practices; and...

• this article for stepfamily adults on options for managing family values and/or loyalty conflicts about religion or spirituality.

        This article is not a sales pitch for God or a religion. It invites you to reflect and clarify your own beliefs on using spirituality in your life and work. I write this as a seeker and fellow explorer, not an authority. Though every client, clinician, and case is unique, my experience suggests some general benefits to selectively including spirituality in helping clients achieve desired systemic changes.

Terminology

        Clear semantic definitions promote effective thinking and communication - specially on a topic as primary, abstract, and controversial as this one. Compare these definitions to yours. In these articles...

        Spirituality means "the innate human ability to experience mind-body-spirit states of awe, reverence, and faith in one or more transpersonal, numinous presences and powers (spirits) which can provide significant comfort, hope, guidance, and serenity." Even in this age of unprecedented scientific knowledge, most people explain the unexplainable and counteract despair via faith in a spiritual reality greater than themselves. Faith is trusting something to be true or real without being able to "prove," demonstrate, or replicate it.

        Healthy spirituality means personal, family, and organizational beliefs and related behaviors about interacting with a benign Higher Power which consistently _ promote inner-family (personality) harmony, and _ fill current primary personal needs. Toxic spiritual beliefs and behaviors, like spiritual and religious abuse,   neglect, and addiction ; (a) promote false-self wounds , (b) inhibit personal wholistic health , and (c) lower a family's nurturance level .

        Spirituality assessment is intentionally forming an opinion about an individual's or group's _ attitudes about and _ faith in an accessible, impactful Higher Power in their lives, and about _ whether they want or expect to include spiritual faith in clinical work.

        A spiritual intervention is any unconscious or intentional clinician behavior acknowledging or including a Higher Power which causes some meaningful shift in one or more client-family members - according to someone. Shift includes changes in attitudes, focus, moods, awareness, expectations, roles, communication, and behaviors. Successful spirituality interventions improve a client family's wholistic health and nurturance level, as judged by family members.

        Praying is intentionally or reflexively focusing on a personal Higher Power and venting, requesting something, and/or expressing thanks. People with genuine spiritual faith can feel comfort [hope, connection (vs. isolation), and potency (vs. helplessness)] in the act of praying alone or together whether they "get a response" or not. Clinician's can ask "Is your praying one-way, or do you expect a response?" They also can decide if, when, and how to pray with (vs. for) receptive clients. Do you have an opinion on "What is an effective prayer?"

        Spiritual or pastoral counseling aims to _ help seekers clarify their personal beliefs about a Higher Power, _ identify and resolve questions about religion, _ expand their spiritual awareness and experiences, and _ harmonize spiritual faith with other aspects of life. Clients may seek these, or clinicians who feel qualified may choose to focus on client spirituality as part of the work.

        Religion refers to the man-made beliefs, rituals, Holy book/s, and organizations that groups of like-minded worshippers co-create. Being "religious" does not necessarily mean "spiritual." Worship and prayer are intentional personal and group behaviors which focus on experiencing meaningful communion with a Higher Power. Attending church can fill personal needs for structure, relationship harmony, inspiration, and social companionship, support, and normalcy without being spiritual.  And...

        Theology is a coherent or vague set of beliefs about the interrelationships of God and/or other spiritual entities, the Earth, the universe, living things, souls, humans, religion, origins, good and evil, and what happens after death. Psychologically wounded and unaware people tend to have an undeveloped or a rigid, c/overtly elitist personal theology. A family's theology may range from harmonious and unified to fragmented and conflictual.

        I invite you to use these definitions to clarify your own. Let's use them now to explore some key basics...

Perspective

        The keystone question here is "What do you believe now about spirituality, the "human condition," and your work?" You'll get the most from what follows if you're _ non-distracted, and _ your team of subselves is guided by your true Self. Learn about yourself by reflecting on these and related questions. As you do, notice your "self talk." Option: journal about your reaction to these questions now or later...

Are you a spiritual (vs. religious) person? if so, what does that mean?

What percentage of your past and present _ clients and _ colleagues would you say were or are "significantly spiritual"?

Do you feel a person can be wholistic healthy without having some meaningful, coherent spiritual beliefs and experiences?

Do you feel spirituality can be toxic? Do spiritual or religious aggression, abuse, and neglect exist? Spiritual or religious addiction? If you say "yes," on a range of 1 (not at all) to 10 (extremely), how qualified are you now to clinically assess and intervene with each of those now?

What are your current _ personal and _ workplace policies about including "appropriate spirituality interventions" (using personal and client spiritual faith to promote desired systemic change) in clinical work?
 

From 1 to 10, how qualified do you feel now to provide meaningful spirituality interventions to receptive clients? If you don't feel able enough, what do you need, specifically, to gain such qualification?

Can you recall instances where spirituality seemed a significant positive factor in your and/or others' clinical outcomes?

In discussing cases with colleagues and supervisors, is it common for you all to include spirituality assessments and intervention strategies? How does spirituality affect your clinical assessment-intervention paradigm ?

If a young teen asked you to describe spiritual health, how would you respond?

How would you describe your ethical _ responsibilities and _ boundaries towards promoting clients' spiritual health and well-being - specially if they don't ask you to?
 

If you judge a client person's or a family's spirituality to be significantly toxic, what do you do now? What would your clinical mentor/s or hero/ines do?

Do you believe that focused genuine (vs. rote) spiritual faith and prayer can permanently reduce _ psychological distress and/or _ cause lasting physiological change ("healing")?

If your clinical mentors and hero/ines use spirituality in their life work, how - and with what personal and professional effects?

How do you currently react to any significant differences in spiritual faith with your clients, specially if they infer or declare that your beliefs are "wrong"?

Do you believe your Higher Power is present and accessible in typical - or all - client sessions? If so, do you openly _ acknowledge that, and/or _ ask for guidance, courage, and inspiration?  If so, how do your clients typically respond?
 

Do you feel it's _ safe and _ appropriate to discuss spirituality assessment and interventions with your supervisor, case manager, and/or consultants? If not - why?

Do you believe that each person has a latent or active personality subself or "higher Self" whose gift is spiritual awareness, sensitivity, and communion? Is it useful to you to acknowledge or define a human soul? 

Do you feel "spiritual assessment and intervention options" would be a useful clinical in-service topic? How would your colleagues feel about this?

Do you feel that a child's or adult's beliefs affect their _ behaviors and _ openness to second-order systemic change? Do you see client beliefs (in general) as potentially-useful intervention opportunities?

        Pause, breathe, and reflect - what other questions or awarenesses about spirituality and clinical work occur to you now? Have you ever meditated on or discussed a set of questions like these before?

        Is spirituality a valid clinical focus with these clients? I believe so, with some limits. Here's why:

        My professional experience since 1979 is that typical mental-health workers feel ambivalent or cautious about including spirituality in their work, except pastoral counselors. I've also experienced that fewer than ~25% of my (white, suburban Chicago-area) clients spontaneously brought up "God" in 27 years' clinical practice. It seems that our ancestry and culture teach average clients to expect that spirituality is outside the boundaries while "seeing a counselor" - except in a church setting or with a pastoral professional. Yet recent CNN polls suggest a high majority of Americans believe in a Higher Power, and well over half believe in "miracles."

        I write this as a former atheist. My 19-year recovery from growing up with two alcoholic (i.e. psychologically wounded) parents has led me to solid faith in the reality of a benign God. This belief-shift has many roots: my 12-step ACoA (Adult Child of Alcoholics) work, the writings of many recovery and clinical mentors, the Unitarian and Unity church movements, hundreds of recovering clients and friends, informal study of Buddhism and other Eastern beliefs, and my aging and other life experiences. I've cautiously used my emerging spiritual faith in working with clients who seemed open to it. Where I have, believing and affirming the strength and guidance of a Higher Power to be present during and outside the work has always expanded our therapeutic alliance and options.

        I estimate that over 80% of the many hundreds of therapy clients and students I've worked with since 1981 have shown clear symptoms of childhood neglect and significant false-self wounds . Most were used to living chaotic, stressful - or numb - inner and outer  lives shaped by major anxieties , guilts, shame, losses, frustrations, and confusions. These self-referred men and women have ranged from spiritually cynical to indifferent to blindly religious to truly spiritual. The great potential for easing their journey and nurturing their kids by weaving respectful spirituality interventions into our clinical work went untapped, until my own recovery from false-self dominance freed me to do that.

        In this clinical model, site, and related guidebooks, co-parent Project 1 of 12 focuses on identifying  and healing false-self wounds in clients and clinicians. From my personal and clinical experience, true (vs. pseudo) healing is far more likely for persons believing in an unconditionally-loving, accessible Higher Power. If "healthy spirituality" is necessary for personal wholistic health and high-nurturance (need-fulfilling) relationships and groups, then ethically and practically, effective clinical work needs to include it in assessments, goals, and interventions. This premise needs to be formally researched and validated or rejected.

        Because spiritual faith and religious practices are subjective and personal, using "strategic spirituality interventions" in clinical work raises ethical, moral, and procedural debates. Each human-service professional and policy-maker must evolve their own values and priorities. Textbook, rote, and classroom answers appeal to people who haven't yet needed to clarify their personal theology, and integrate it into their professional choices and behaviors.

Basic Premises about Spirituality and Relationships

        Expand your self-awareness by musing on these ideas. Try responding to each with A(gree), D(isagree), or "?" - i.e. "I'm unsure now, or it depends (on what?)". Take your time.

        This clinical model proposes that...

        1)  Human spirituality is real, innate, and ranges from nurturing (health-promoting) to toxic. A corollary is that every personality includes a latent or active subself whose gift is spiritual sensitivity, wisdom, and connection with a or the Higher Power. This subself can manifest as "the still small voice within" and "intuitive wisdom." People have varied conceptions of and names for this entity, including Guardian Angel, fairy (Godmother), "Old Ones," totems, spirit guides and councils, "My higher Self," "God within," and others.

        3) Spiritual beliefs can significantly affect emotional and physiological dis/comfort. This implies that spiritual and religious abuse , aggression, neglect , and addiction are real, and can promote significant  psychological wounds . It also implies that nurturing spirituality can promote recovery from false-self wounds. A corollary: religions range from wholistically nurturing to personally and socially toxic in their beliefs and practices. (A  D  ?)

        4)  Individual spiritual and religious beliefs and practices are strongly shaped by ancestral and societal traditions and the primal need to feel and be seen as "normal," so ruling subselves resist changing them. Personal, family, clan, and religious-denominational scripts (belief systems) are based on inherited tradition and fear of scorn and rejection, not logic. Therefore, reasoning is rarely effective in promoting second-order change in client's (or a clinician's) toxic spiritual beliefs. (A  D  ?)

        5) One person inferring or proclaiming that they know the real truth about God, Heaven, Hell, worship, and "salvation" and another person doesn't usually promotes repressed or open resentment and conflict. Even when framed as "But I'm trying to save your soul!", the insulting implication is "I don't accept you as you are - you are not OK." Despite noble intentions, trying to c/overtly change another person's beliefs ("help them") is implicitly disrespectful if they aren't seeking help: "I know better than you, so you're 1-down ." This dynamic can cause major strife as new stepfamily members try to blend their belief systems and traditions. (A  D  ?)

        6)  Personal and family spiritual beliefs and practices change spontaneously with maturity and life experience. By definition, such changes are second-order (core attitude). (A  D  ?)

        7)  Inter-subself and interpersonal disputes over spirituality and religion are always surface conflicts. The underlying primary discomforts are unrecognized or unhealed psychological wounds , amplified by unawareness of _ the seven communication skills , and _ how to spot and resolve values conflicts . (A  D  ?)

        8) Every clinician and human-service organization has covert or stated policies (belief and value sets) on personal and client spirituality. These policies shape clinical outcomes in minor or major ways. "No policy" is a policy. (A  D  ?)

         9) Clinicians can shift their policies on spirituality at any time if _ they're consistently guided by their true Selves and _ they work in a high-nurturance organization. (A  D  ?) And ...

         10)  A clinician may or may not believe that prayer can promote desired client changes. What is more relevant for effective clinical work is what each client adult and child believes and expects.

         11) Well-designed, respectful spirituality interventions can promote personal healing and growth, in clients who are ready for second-order (personality) change. (A  D  ?)

         12) One indicator of a clinician's true spirituality is whether s/he believes something like "God works through me to nurture my clients" or something like "I often ask God for help when I'm stymied or conflicted about my clients." The fundamental question is "Who directs this work - my and my client's true Selves, God, or all of us?" The answer affects how relevant and useful the Serenity Prayer is to clinicians, supervisors, and case managers; and if, how, when, and what spirituality interventions seem appropriate. (A  D  ?)

        Pause and reflect - why are you reading this article? What do you need? Try summing up your basic belief about including spirituality in your work in one or two sentences. To augment or clarify your beliefs, see how you feel about these...

Potential Clinical Benefits

... of using strategic spirituality assessments and interventions. Recall: "effective spirituality interventions" _ raise an inner-family's or client-family's nurturance level, and _ help client family members and clinicians fill their needs in a way that feels good to all participants. See how you feel about these possible clinical benefits to including respectful (vs. authoritarian) spirituality in your work with receptive clients...

    1) Overtly agreeing on a Higher Power greater than themselves can strengthen the client-clinician alliance. It also creates the options of a whole class of spirituality interventions not otherwise available, including the clinician and attending clients praying together. Have you ever experienced this as a client or professional? Shared belief in a responsive Higher Power suggests that the clinician need not feel solely responsible for clinical decisions and outcomes. The responsibility is shared by clinician's and clients' respective ruling subselves, as influenced by their Higher Power. Acknowledging God's caring presence in each session can feel like having a real time "supervisor" and mentor advising and guiding. This can be specially reassuring with highly wounded, conflicted, reactive, and "hostile" client adults and kids. 

    2) Focusing strategically on a client's spiritual beliefs and practices may disclose new ways they can increase personal and family harmony and wholistic health. One example is raising a client's _ awareness of toxic spiritual faith and practices (page 2), and their motivation to change these.

    3) The clinician may initiate strategic spiritual experiences that expand the client's awareness and options - e.g. guided imagery involving interaction with a spiritual presence or icon like Jesus or Buddha. A potentially powerful therapeutic question to Christian clients is "What would Jesus say about (or do in) this situation?" Or in inner-family work, the clinician can suggest "Get quiet, breathe well, and focus on the young part of you who is terrified of abandonment... Have a safe three-way inner conversation between that subself, your true Self, your Nurturer,  and your Higher Power (or God, your Spiritual part, your Guardian Angel, your Spirit Guide, etc.). I'll be quiet while you do that." 

    4) The undeniable global success of the 12-step "Anonymous" philosophy in controlling toxic compulsions (i.e. false-self dominance) is based on recoverers' choosing to abandon fruitless attempts to control the uncontrolable, and "turning such problems over" to a responsive, benign Higher Power of their own conception. In accord with that, my 12-year experience with inner-family therapy ( phase-threework in this model) is that client + clinician faith in the reality of an accessible, caring Higher Power is essential for genuine progress.

    5) Spirituality interventions may promote using the client's religious community, if any, as a resource in the work. Alternatively, they may raise awareness about, and reduce the influence of, a low-nurturance (toxic) church community.

        A final potential benefit to including spirituality assessment and intervention in working with these clients is...

    6) Exploring spirituality issues can illuminate repressed or minimized personal and family conflicts, alliances, coalitions, cut offs, scripts, and secrets that may contribute to the client family's current presenting and/or underlying problems. ("So your wife's grandmother scorns you as a father and son-in-law because she feels you're an unrepentant, arrogant sinner?")

        Can you think of other benefits? Each unique case may present benefits beyond these generic ones.

Continue by exploring (a) nurturing vs. toxic spirituality and (b) options for assessing client spirituality...

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Updated October 12, 2008