Spiritual Assessment in Social Work and Mental Health Practice

David Hodge

• Publisher: Columbia University Press
• Year: 2015
• ISBN:
  9780231538817
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Spirituality often plays a critical role in health and wellness, yet few have explored in detail the process through which practitioners can identify and use clients' spiritual strengths to their mutual advantage. To address this gap, this practice-oriented text equips helping professionals with the tools they need to administer spiritual assessments ethically and professionally. David R. Hodge outlines a number of assessment approaches, including an implicit method for evaluating "secular" forms of spirituality. Case examples illustrate the implementation of these strategies in different clinical settings and with groups from diverse racial, geographic, and socioeconomic backgrounds.

Understanding Spirituality and Religion

DEFINITIONS ARE IMPORTANT. They help us understand the landscape of a given phenomenon (Holloway & Moss, 2010). Definitions highlight areas that should be examined while simultaneously functioning to exclude certain other themes that are implicitly deemed irrelevant. Indeed, communication—the lifeblood of practitioner-client interactions—depends on a shared understanding of the concepts discussed (Ai, 2002). If practitioners and clients conceptualize an entity differently, effective communication may be hindered, even though both participants might believe that mutual understanding occurs since the same terminology is used.

Few topics, however, are more controversial in academic discourse than conceptualizations of spirituality and religion (Pattison, 2013). Also highly contested is the nature of the relationship between these two constructs. No consensus exists among either academics or potential clients, with conceptualizations of spirituality being the subject of particularly intense debate.

This chapter explores these topics. The goal of the chapter is not to posit definitive definitions of spirituality and religion. Rather, the aim is to sketch out various understandings, in tandem with some of the arguments for and against various conceptualizations. By developing a sense of the various views affirmed by scholars and members of the public, practitioners are better positioned to explore and identify the diverse understandings of spirituality and religion affirmed by clients (Fitchett, 2012). In keeping with this goal, the chapter begins by reviewing the traditional view of spirituality and religion.

TRADITIONAL VIEW OF SPIRITUALITY AND RELIGION

The academic study of spirituality and religion can be traced back at least to William James’s (1902/1985) seminal work at the turn of the prior century. Historically, James and other academics have understood spirituality as a dimension within religion (Koenig, 2011). In other words, religion is viewed as the broader, more encompassing concept. It includes individual and social dimensions, as well as subjective and objective dimensions (Pargament, Mahoney, Exline, Jones, & Shafranske, 2013).

In keeping with this understanding, religion has been defined “as a culturally shared system of values, beliefs, and rituals which include spiritual concerns” (Praglin, 2004:74). Put simply, religion is a spiritually animated culture characterized by certain ideals, principles, and practices that have a spiritual purpose.

In the traditional view, the term spiritual refers to a subset of individuals who are invested in, or committed to, their religious tradition, often in a deeply experiential manner (Koenig, 2011). James (1902/1985), for instance, understood religion to consist of an external, communal dimension manifested in forms such as church services, as well as a solitary, individual dimension manifested in the experience of the divine. This personal manifestation of religion was understood to encompass a dynamic, subjective, emotional element in a manner akin to contemporary understandings of spirituality. In essence, spirituality is a form of devout religion.

In a similar manner, Allport and Ross (1967) posited the existence of a construct they called intrinsic religion. For intrinsic individuals, religion is hypothesized to provide adherents with an internalized “master motive” that serves to guide and direct life. This conceptualization is congruent with many current conceptualizations of spirituality, as illustrated by the fact that the intrinsic measure has been used as a proxy for assessing individual spirituality in a variety of settings (Hodge, 2003b; Reinert & Koenig, 2013).

What about individuals who express their spirituality outside of traditional religious settings? Within the traditional framework, newer, postmodern forms of spirituality are viewed as representing new religions. Thus the New Age or syncretistic spirituality movement might be referred to as a new religious movement. Established but less common religions, such as neo-paganism, are commonly referred to as alternative religions (Canda & Furman, 2010).

In the past few decades, the traditional view of spirituality and religion has been largely supplanted in many academic circles (Swinton, 2010). The reasons behind the emergence of this new understanding of spirituality and religion are complex. One contributing factor was the success of the Enlightenment, and the attendant modernist metanarrative, in successfully delegitimizing religion among societal elites (Gellner, 1992). Another factor is the recent ascendance of postmodernism, with its emphasis on individualized ways of knowing, which includes individualized knowing in the nonmaterial, metaphysical realm (Gray, 2008). Together with other influences, these factors have led to new conceptualizations of spirituality and religion.

CONTEMPORARY VIEW

In the contemporary understanding, spirituality and religion are typically defined as distinct, unique concepts (Pargament et al., 2013). Spirituality is usually understood as an individualistic, relatively subjective construct. Religion tends to be conceptualized as a socially shared set of beliefs and practices that can be related to spirituality (Derezotes, 2006).

In contrast to the traditional understanding, it is spirituality, rather than religion, that is typically viewed as the broader, more encompassing concept (Swinton, 2010). Spirituality may or may not be expressed within a religious framework. As an individually oriented construct, it is hypothesized to exist separate from religion, which is viewed as a more communal entity. Thus, while understandings of religion in the traditional and contemporary view are somewhat similar, conceptualizations of spirituality have changed substantially.

Indeed, the terrain encompassed by the term spirituality has expanded markedly (Paley, 2008). In the contemporary framework, spirituality is commonly defined in universal terms. That is, everyone is understood to be spiritual (Canda, 2008). For instance, spirituality has been defined, in brief, as “lived experience that gives meaning to life and death” (Catterall, Cox, Greet, Sankey, & Griffiths, 1998:163); “an inner life of personal development” (Chandler, 2012:578); “aspects of human life relating to experiences that transcend sensory phenomena” (World Health Organisation [WHO], 1990:50); “the wholeness of what it means to be human” (Canda, 1997:302); and “what we do to give expression to our chosen worldview” (Moss, 2005:2).

Such definitions tend to implicitly frame spirituality as a positive construct. In contrast, religion is often depicted in more negative, institutionally oriented terms (Wolfer, 2012). Individually oriented spirituality is a positive, intrinsic dimension of human experience, which organized religion may facilitate or hinder.

This broad understanding of spirituality offers at least two advantages. First, the universal understanding ensures that no unique manifestation of spirituality is inadvertently overlooked or excluded. Since everyone is assumed to be spiritual in some sense, practitioners are implicitly encouraged to understand how this spirituality is manifested in each person’s life (Crisp, 2010). Clinically relevant aspects of clients’ lives that might have otherwise been overlooked may be identified as a result.

Second, this conceptualization of spirituality may resonate with a certain segment of the general population. Depending on the data source and question phrasing, roughly a quarter of the population self-identifies as “spiritual but not religious” (Ellison & McFarland, 2013). In many cases these individuals have effectively decoupled spirituality from traditional understandings of religion in pursuit of an individualized spiritual path. Theoretical frameworks that also reflect this decoupling may represent a particularly good fit for such individuals, enabling practitioners and clients to readily identify issues of relevance to service provision. In addition to these important advantages, some limitations also exist.

LIMITATIONS OF THE CONTEMPORARY UNDERSTANDING

A number of shortcomings regarding contemporary understandings of spirituality and religion have been noted. For example, defining spirituality as a universal facet of human experience effectively imposes this construct on people who may not wish to be described as spiritual (Paley, 2008). Approximately 10 percent of the American population rejects the term spiritual as a self-descriptor (see tables 1.3 and 1.5). Applying terms to individuals that they personally deny is ethically problematic and can impede the therapeutic relationship (Saleebey, 2013).

Another limitation is the capacity of broad definitions to assist practitioners in identifying spiritual content. The purpose of definitions is to distinguish one entity from another (Koenig, 2011). If spirituality is defined in broad universal terms, it can be difficult to distinguish it from other aspects of human experience (Canda, 1997). Practitioners may have trouble identifying the unique spiritual dimension of existence (Doherty, 2009).

In addition, some spirituality definitions confound outcomes with the underlying construct (Swinton, 2010). It is arguable that a sense of meaning, to cite one example, is an outcome or an effect of spirituality rather than its essence. Defining spirituality in terms of outcomes is problematic in both research and practice settings (Koenig, 2011). Clients who are depressed and lack a sense of meaning and purpose are essentially precluded from being spiritual. Deeply spiritual Catholic saints experiencing a “dark night of the soul” cannot be spiritual based on certain definitions.

Another potential limitation relates to the decontextualization of spirituality from its larger social context (Pargament et al., 2013). Like other human phenomena, an individual’s spirituality is shaped and informed by other people—usually those who share similar understandings of spirituality. This process occurs in traditional religious settings, such as the Catholic Church, as well as in newer and alternative religious environments, such as the syncretistic movement (Doherty, 2009). The tendency to conceptually decouple spirituality from religion can result in neglecting the important social context in which spirituality is formed. Indeed, for people in many cultural contexts, the separation of spirituality from religion makes little sense ontologically or epistemologically (Wong & Vinsky, 2009). As such, understandings that frame spirituality as a personal, private, interior const...