Ch. 6.2: Integrating Spirituality or Religion into Assessment and Treatment

While over half of social workers agree spirituality should be included in a standard assessment, it was not until 2001 that the largest health care accrediting body, the Joint Commission (formerly JCAHO), mandated its inclusion.

During a spiritual assessment JCAHO requires exploration of three domains,

“(1) denomination or faith tradition,

(2) significant spiritual beliefs, and

(3) important spiritual practices.”

Although no specific questions are required, Hodge (2006, p. 327) provides a suggestion for questions that can be included as part of a spiritual assessment,

“1. I was wondering if spirituality or religion is important to you?

2. Are there certain spiritual beliefs and practices that you find particularly helpful in dealing with problems?
3. I was also wondering if you attend a church or some other type of spiritual community?
4. Are there any spiritual needs or concerns I can help you with?”

Following the spiritual assessment, as an expression of cultural informed practice, there are many ways to integrate spirituality or religion into treatment for clients who express an interest in doing so.  For example, in support of cognitive restructuring to replace maladaptive thoughts integral in Cognitive Behavioral Therapy, religious or spiritual self-statements can be developed that integrate a spiritually motivated client’s religious beliefs.  Hodge (2011, p. 27) provides an example of how this may be applied to Latino Pentecostals,

“God promises never to let me experience more than I can bear. Although feelings such as anxiety or depression are uncomfortable, I can manage them by turning to God. I am not bad or a sinner for having such feelings, rather I have unique dignity, worth, and strengths because I am a child of God, created in His image.

It is critical client autonomy and self-determination is respected throughout this process of developing self-statements. The goal is to integrate and build on client existing spiritual strengths, not persuade clients into accepting a new religious belief. Hodge (2011, p. 26) summarizes a three part process of constructing these statements, 1) “the underlying therapeutic concept is identified,” (2) it is “discussed with the client to ensure congruence with the client’s belief system,” (3) “and then rearticulated in language drawn from the client’s spiritual narrative.” Similarly, prayers meditation or other religious or spiritual activity can be used to maladaptive behaviors.

This process is enhanced when practitioners have basic knowledge about the tenants of major religions so that it is easier for the practitioner to aid in the development of culturally informed self-statements.  Partnering with leaders from various religious traditions is one way to enhance existing knowledge about religions.

In summary, practitioners need to recognize that religion may be viewed along a continuum from disdain to integral importance.  Religion has had a complicated history in relation to substance use in this country.  Some have embraced a moral model as helping to guide and shape a sober lifestyle, while others feel hurt by the historical judgement and discrimination connected to this model.  Most clients desire to have their spiritual or religious beliefs integrated into their counseling experiences.  Counseling professional should be prepared to conduct spiritual assessment and integrate spiritually informed practices when indicated.