Implicit spiritual assessment: an alternative approach for assessing client spirituality.

Author:Hodge, David R.
 
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It is increasingly realized that spirituality plays an important role in fostering health and wellness (Koenig, King, & Carson, 2012). To help social work practitioners understand this relationship in clients' lives, a spiritual assessment is commonly recommended as a routine component of practice (Canda & Furman, 2010; Furness & Gilligan, 2010). Administering a spiritual assessment--as part of a larger bio-psycho-social-spiritual assessment--provides a more holistic understanding of clients' realities, which in turn provides the basis for subsequent practice decisions.

As a result of the time constraints that exist in therapeutic settings, spiritual assessment is widely conceptualized as a two-stage process: a brief preliminary assessment followed--if clinically warranted--by an extensive comprehensive assessment (Canda & Furman, 2010; Pargament, 2007; Shafranske, 2005). The brief assessment consists of a few questions that are typically administered to all clients (for example, "I was wondering if you are interested in spirituality or religion?"). The purpose of the preliminary assessment is to determine the clinical relevance of spirituality and to ascertain whether a comprehensive assessment is needed. In situations where clients' spiritual beliefs and practices intersect service provision, practitioners can select from an array of comprehensive assessment tools to explore this intersection (Hodge & Limb, 2010).

Although this explicit approach to spiritual assessment represents an important contribution to the literature, it may not be effective with all clients (Nelson-Becker, 2005). Some clients may benefit from what might be called an implicit spiritual assessment. In this approach, the use of traditional spiritual or religious language is avoided. Instead, practitioners use terminology that is implicitly spiritual in nature to explore potentially relevant content. As such, an implicit assessment provides a method to identify and operationalize dimensions of clients' experience that may be critical to effective service provision but would otherwise be overlooked in an explicit spiritual assessment.

Approximately two-thirds of direct practitioners affiliated with NASW believe social workers need to become more knowledgeable about spirituality (Canda & Furman, 2010). Indeed, studies have repeatedly found that most direct practitioners report receiving minimal training in spirituality during their graduate educations (Canda & Furman, 2010; Sheridan, 2009). This article addresses this knowledge gap by orienting readers to the process of conducting an implicit spiritual assessment as a supplement to existing assessment approaches.

The article begins by defining spirituality and religion and noting contexts in which an implicit spiritual assessment may be particularly germane. The process of administering a spiritual assessment is discussed, and sample questions are provided to help practitioners implement this approach in practice settings. The article concludes by offering some suggestions for integrating an implicit assessment with more traditional explicit approaches to assessment.

CONCEPTUALIZING SPIRITUALITY AND RELIGION

Spirituality is understood and expressed diversely among social workers (Hodge & McGrew, 2006) and the general public (Gallup & Jones, 2000). One way to conceptualize spirituality is in terms of connectedness with what is perceived to be sacred or transcendent (Hodge, 2001; Koenig et al., 2012; Pargament, 2007). As such, spirituality can be seen as a fundamental human drive for transcendent meaning and purpose that involves connectedness with oneself, others, and ultimate reality (Canda & Furman, 2010; Crisp, 2010).

Religion can be conceptualized as a shared set of beliefs and practices that have been developed over time with people who have similar understandings of the sacred or transcendent (Geppert, Bogenschutz, & Miller, 2007; Koenig et al., 2012). These beliefs and practices, which are designed to mediate an individual's relationship with the sacred, are transmitted through community-based structures or organizations (Canda & Furman, 2010). These organizations can be traditional, such as the Catholic Church, or of more recent origin, such as the New Age or Syncretistic movement. As such, religion is relatively objective, concrete, and communally oriented, whereas spirituality tends to be more subjective, private, and personal.

Understood in this sense, spirituality and religion are overlapping but distinct constructs.

Spirituality is posited to be a universal human impulse that may or may not be expressed in religious forums (Derezotes, 2006). Thus, whereas spirituality is commonly manifested in an individual's relationship with God (Wuthnow, 2007), a person's connection with the transcendent may be displayed in many forms, including those that might be considered secular in nature (Crisp, 2010). In other words, the drive to construct a sacred reality is expressed in a variety of relationally oriented settings. This understanding of spirituality suggests two contexts in which an implicit spiritual assessment may be particularly germane.

CONTEXTS IN WHICH AN IMPLICIT ASSESSMENT IS ESPECIALLY RELEVANT

Research with various samples suggests most clients want to have their spiritual and religious beliefs integrated into the therapeutic conversation (Arnold, Avants, Margolin, & Marcotte, 2002; Dermatis, Guschwan, Galanter, & Bunt, 2004; Mathai & North, 2003; Rose, Westefeld, & Ansley, 2001, 2008; Solhkhah, Galanter, Dermatis, Daly, & Bunt, 2009). A brief preliminary assessment helps to legitimize the topic and provides a forum for clients to explore issues that might otherwise have remained undiscussed (Nelson-Becket, Nakashima, & Canda, 2007; Richards & Bergin, 2005). There are, however, at least two contexts in which an implicit spiritual assessment is particularly useful: (1) when spiritual language is perceived to be irrelevant, and (2) when practitioners' level of spiritual competence is questioned.

Spiritual Language Is Irrelevant

For some clients, the spiritual or religious language used in an explicit preliminary assessment does not resonate with their personal worldviews. As implied by the above conceptualization of spirituality, essentially anything can be imbued with transcendent significance (Crisp, 2010). In many cases, people construct a sense of meaning, purpose, and identity outside the confines of traditional spiritual and religious settings.

For example, the sacred can include art, collecting, gardening, sports, nature, and a myriad of other activities and entities (Griffith & Griffith, 2002; Pargament, 2007). These endeavors can provide a transcendent sense of meaning, purpose, and connectivity for some individuals. Although the beliefs and practices might be considered secular, they are effectively accorded a sacred role in clients' lives. In other words, the fundamental human drive to construct a sacred reality is manifested in secular activities that provide people with a transcendent sense of meaning and purpose in their lives (Crisp, 2010; Pargament, 2007).

For such individuals, typical spiritual terminology can seem like a culturally foreign language that is irrelevant to their lived experience. Indeed, some secular individuals consider the use of spiritual terminology to be offensive (Paley, 2008, 2010). Even though secular activities may...

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