What is provided in this post is based on Pargament's work in Spiritually-integrated Psychotherapy. This is an untested instrument designed to offer a profile the client's subjective relationship with spirituality and at least some elements of their personal theology in a systematic way that offer indications of both supportive and unsupportive spiritual contexts. A fairly complete profile may be required for clients with hyper-religiosity, command or persecutorial hallucinations with a religious character as this will be key to developing behavior management plans. For the more typical geriatric client, you may wish to develop this spiritual profile over time and in the context of various crises as deeply or completely as might be required to address the issues at hand.
To develop the context of spirituality and its practice by the client, it is important to start with simple probing questions that establish the knowledge of the client in this area and the level of participation and reliance on spirituality for support. [3]
1. Would you call yourself a religious or spiritual person?
2. Are you a member or do you affiliate with a particular spiritual community? If so, which one?
3. Would you say that this current situation affects you spiritually (or religiously)? If so, would you tell me more about that?
4. Does your spirituality help you in any way with this situation? If so, how?
Given the answers to the above questions it will be possible to determine whether further questions will be helpful. If the client has a strength in the spiritual arena, it would be appropriate to begin looking systematically at the resources and spiritual challenges that most clients face. The resources will give the care provider some spiritual tools for helping and noting the spiritual challenges will help place the client in their spiritual journey. Knowing what spiritual challenges the client faces will allow you to gauge your use of spiritual tools for the spiritual maturity and spiritual directions that will be most helpful.
KNOWING
[These questions may be answered by the client without directly asking them. Not all may be applicable. In some cases, the spiritual maturity of the client will make some of the questions redundant or unnecessary.]
1. What spiritual or religious sources do you find help you to go on? [Bible, sermons, prayer, rituals such as saying the rosary / counting decades / daily prayers / reflection / devotionals, lighting candles, meditation, attending to a shrine...]
2. Where do you find peace? [In prayer, in church, in communion with God/ ancestors / Spirit(s), in special place, in nature...]
3. Who truly understands you situation? [Jesus, God, Allah, ancestors, Angel(s), Spirit...]
4. When you are afraid or in pain, how do you find comfort and solace? [Pray, rituals, Bible,
5. What might you be deeply grateful for?
DESTINATIONS
1. What might you be striving for in your life?
2. Why, would you say, is it important for you to be here in this world?
3. What legacy would you like to leave behind in your life?
4. How would you like people to remember you when you are gone?
5. To whom or to what are you most devoted?
6. What is your true self?
7. Who or what do you put your faith and hope in?
8. To whom or what do you most freely express love?
9. When have you felt most deeply and fully alive?
CHALLENGES AND TRANSFORMATION
1. Are there any deep questions that this situation has raised for you? Would you tell me about them?
2. What causes you the greatest despair and suffering, do you think?
3. How has this situation changed you at your deepest levels?
4. What have you discovered about yourself that you find most disturbing?
5. How has this situation shaken your faith?
6. Is there anything you have learned from this situation that you wish you had never discovered? Tell me about that, if you will.
7. Do you have regrets? What might your deepest regrets be?
8. If you could let go of somethings in your life, what would they be?
9. Have you experienced forgiveness in your life? When was that? What was happening? How did that affect you?
These questions provide a rough set of questions to start conversations about spirituality. You will be looking to develop a spirituality profile of the client. To develop a plan for therapy and deal with spiritual challenges, you will require an evaluative framework to identify issues and approaches. For those wishing to understand spiritual strengths for the client and not necessarily deal with spiritual issues directly, a mapping of these answers to a strengths inventory will be required. These will be offered in the next blogs.
NOTES:
[1] An example of such a form can be found at:
- https://shop.briggscorp.com/pdf/3887P.pdf
- http://www.med-pass.com/Docs/Products/samples/MP5455_sp.pdf
[2] These health claims are documented in:
- Koenig, H., McCullough, M., Larson, D. (2001) . Handbook of religion and health. Oxford, UK: Oxford University Press.
- McCullough, M., Hoyt, W.T. Larson, D. B., Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19, 211-222.
- Pargament, K., Koenig, H.G., Tarakeshwar, N., Hahn, J. (2004). Religious coping methods as predictors of psychological, physical, and spiritual outcomes among mentally ill elderly patients: A two-year longitudinal study. Journal of Health Psychology, 9, 713-730.
- Pargament K., McCarthy, S., Shah, P. Ano, G., Tarakeshwar, N., Wachholtz, A. B.. et al. (2004). Religion and HIVL A review of the literature and clinical implications. Southern Medical Journal, 97, 1201-1209.
- American Academy of Family Physicians has an article on a similar tool: http://www.aafp.org/afp/2001/0101/p81.html
- American Academy of Family Physicians has a patient handout on this topic at: http://www.aafp.org/afp/2001/0101/p89.html
- Puchalski, C., M.D. has developed a FICA form that is available at: http://www.lumetrasolutions.com/uploadedFiles/resource-center/tools/spiritual-assessment-tip-sheet.pdf
- American Cancer Society's brief is available at: http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Spirituality_and_Prayer.asp?sitearea=ETO
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