Spiritual Assessment
TOWARDS MIND-BODY-SPIRIT ASSESSMENT
During ministry training – either at seminary or during a Clinical Pastoral Education (chaplaincy, or CPE) training – you likely became familiar with spiritual assessment tools. During my own CPE training at Stanford Hospital, I was taught and primarily used the following two: Faith/Hope/Charity, and FICA (Faith & belief, Importance/influence, Community, Address in Care).[1] There are, of course, many others, most of which focus on the spiritual aspect alone, without addressing the physical aspect (the embodied person) or the mental landscape (mind).
Without considering how balanced a person’s mind is, and what is going on with a person’s body, a practitioner (e.g., non harming minister, or holistic practitioner) may miss important clues to well being. For that reason, we are now offering a new guideline methodology or way of approaching assessment which is reasonably easy to remember. Although it is reasonably straightforward, it should not be taken as a checklist, but instead as a guide to aid in conversation. The practitioner considers each area, and weights whether an area feels out of balance one way or another. The areas of inquiry are kinesthetically easy to remember, simply by considering the space around one’s own body. They are: about(embodied), within, without, beside, before, behind, above, and below.
| MBS AREA | TOO LITTLE | IDEAL | TOO MUCH |
| About: Embodied. Physical well-being. Daily practice… | Self-denial. Anorexia. Inattention to physical needs. Wasting conditions. | Healthy self-care. Body state provides a sense of physical well-being. Reasonable prevention steps | Gluttony. Excess. Addictions and the resulting wear on the body. Body self-attack (cancer, autoimmune, overproduction of antibodies, gout, GERD). Body succumbs to any extent to attacks by outside organisms of any type. |
| Within: Internal landscape. Mental stability. Coherence. Self-content. | Instability or lack of balance. Untreated mental illnesses, resulting in anguish. Alternatively, lack of stimulation and growth. | Mind in comfort and at ease. Treatment of diagnosable conditions where applicable, leading to stasis. Special mental faculties focused in areas where they can bring positive benefit (e.g., manic depression useful in leadership, in times of crisis). | Over-focus on mental attributes to detriment of spiritual / physical. Over-reliance on mind. Out of balance. |
| Without: Role. World connection. Functioning. Societal norms conforming.Before: Planning. Perception of future. | Unable to cope with day-to-day requirements of role. Alternatively, problems with authority. Rebellion. | Derives satisfaction from meaningful work. Role is not so overpowering as to be subsuming of self. | Overwork. Over-identification with work-role (confusion work/self). Over-conformity with norms for this role. |
| Beside: Connectedness. Compassion. Healthy ability to give / receive love. Social competence and support. | Alienation. Lack of empathy. | Social competence. Able to feel empathy and express and receive love in a healthy way. Healthy sense of connectedness to others. Sense of being supported by others and finds support in outside community (a “third place,” sometimes but not necessarily religious community). | Confusion of love and pity. Feels need to rescue and care for others. Fears of abandonment. Expression of clinging. |
| Before. What lies ahead, and the resiliency of hope. | Unable to perceive any positive future for self or others. Obsessed with doomsday fears. | Able to envision positive outcomes. Flexible and resilient in maintaining a hopeful, positive attitude. | Overly optimistic to the point of making costly, unrealistic plans. |
| Behind. Life history. Perception of personal past (life story). Disappointment. | Unwilling to examine past history. Deluded in a negative or positive way about the past. | Reasonably well-developed, acceptable, useful self-narrative or life-story which is flexible and adaptable and constantly being added to. | Too focused on the past in a nostalgic way (living in the past). Unable to self-forgive (unable to let-go of the past). |
| Above. Theology or life perspective. Spiritual resources. Beliefs as comfort (hope, meaning). | Not thought through. Inconsistencies. Little or no interest. | Coherent perspective. Area of interest and growth. Beliefs may provide source of comfort, hope, meaning, peace, and strength. Can provide moral code or spiritual compass. | Closed-minded, reactive, or self-righteousness. Judgmental attitude. Idealogue. Rigidity. |
| Below. Sense of connection to family history, roots. | Sense of alienation. Disconnected from family history. Strain. | Strong sense of roots leading to greater self-understanding and sense of groundedness. | Overly idealized family history. Familial pride and tribalism leading to misplaced loyalties and overzealousness, even to persecution. |
Created by Lauren Speeth on December 3, 2011 and copyright Center for Non Harming Ministries. All Rights Reserved. Ministers may consider this methodology in their day to day work helping others, see disclaimer and legal/ethical considerations section for requirements for use.
CONSIDERATIONS DURING USE
ABOUT: Consider primary physical complaint and chart notes from physician. Questions about the embodied self can include: Tell me about your condition. How do you take care of yourself? Are you sleeping? Are you eating? In the ideal, there is healthy self-care. Reasonable prevention steps are taken, and the body state can provide a sense of physical well-being. When there has been a health crisis, the subject has come to a “new normal.”
WITHIN: Consider results of mental health diagnostics tools, notes from mental health practitioner. Notice demeanor, coherence. On a scale of “too little” includes lack of treatment, lack of stability, and lack of mental harmony. On a scale of “too much” includes focusing on the mind to the detriment of the body or spirit. In the center, any diagnosable conditions are being treated, leading to stasis, and any differentiating mental faculties are understood and used to advantage (e.g., a tendency towards obsession can be useful in meticulous fields, such as computer programming).
WITHOUT: Consider role and recent changes in that role. How well is the person functioning, and how satisfied does the person feel within that role. If dissatisfied, is the person working towards healthy change. How much do work, role, and future and past accomplishments come up in conversation. Does it dominate, or is it a healthy part of the whole. In the center, a subject who is not experiencing a role crisis (e.g., job loss) can invest in career and takes pride in achievements, but does not confuse self with accomplishment, nor allow the pursuit of accomplishments to harm physical, emotional or spiritual well-being.
BESIDE: Consider a person’s social competence and social capital. Does this person show an ability to maintain a healthy connection with others, and are there others in the person’s life on whom the person relies and with whom the person experiences love? Does subject express fears of abandonment, or a history of confusion of love with pity? In the center, for an individual who is not experiencing a relationship crisis (e.g., bereavement), one is able to give and to receive love in a healthy and life-affirming way.
BEFORE: Consider whether a person has a resilient measure of hope, including the ability to envision a positive outcome, with a flexible and positive attitude. Is the attitude forced, and are the envisioned outcomes overly optimistic to the point of making overly unrealistic, perhaps harmful plans? In the center, there is a flexible sense of hope and optimism about the future which is resilient. That is, given new information, even negative information, what is hoped for may change, even as hope itself remains available.
BEHIND: Consider the life story as perceived by the subject. Is the person willing to examine their past and move forward in a healthy way? Are they deluded or stuck in the past, whether wallowing in negativity and an inability to forgive self or others, or are their eyes veiled to the present because a nostalgic glow that dims their current experience? In the center, there is a reasonably well-developed, acceptable, useful, self-narrative which is flexible and adaptable, and open to additions as life continues to unfold.
ABOVE: How well-thought-through is the theological perspective? Is it coherent? Has it been completely ignored, or is it an area of interest or growth? Or, perhaps the individual is strongly reactive, either in theology (e.g., self-righteous, judgmental idealogue) or against thoughts of any transcendent element. A non harming minister will not impose beliefs on the subject. In the center, the subject’s beliefs can provide a source of comfort, hope, meaning, peace and strength.
BELOW: How well-connected is the individual to their family history. Is there alienation and strain? Or, is the family history overly idealized, leading to overzealousness and strife (e.g., Hatfields vs. McCoys)? In the center, the family history narrative adds grounding to the personal narrative.
DISCLAIMER
The Assessment Tool, information and other content made available through this site is provided for educational purposes only and is not intended as a substitute for professional advice, guidance, training, assessment, therapy or treatment of any kind. The information and products provided through this site have not been evaluated by any governing body or licensing authority and are not approved to assess, diagnose, treat, cure or prevent any disease or disorder. You should consult with a trained or licensed professional before relying on any information or product on this site. We do not warrant or guarantee that this site or the content provided are current, accurate, or error-free.
Use of the Assessment Tool is controlled. The Tool may only be made by a properly trained or licensed practitioner in a proper setting under written agreement from The Center for Non Harming Ministries. If you believe that you may qualify to use the Tool and would like to be considered for a license, please contact The Center for more information.
ETHICAL CONSIDERATIONS
As with all such tools, there are ethical considerations to be remembered. First, if you haven’t been trained in ministry or spiritual assessment, do not use this tool. Do not attempt to assess the mental and physical state alone, as a private practitioner. This tool is intended for use in a teamwork setting, where mental and physical records can be obtained. Ministers and medical doctors have differing skills, and competence is an ethical requirement. So is maintaining patient privacy. Another is respecting not only an individual’s dignity and worth, but also their spiritual beliefs, rather than imposing one’s own beliefs, either about the world or about the transcendent. When a practitioner in a position of spiritual power does impose views in a moment of physical or emotional pain, this can be dubbed spiritual violence. And that’s the farthest thing away from the end result desired by a non harming minister.
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[1] Handout from Fr. John Hester’s didactic of June 16, 2011, at Stanford Hospital and Clinics. Puchalski, Christina, “FICA: A Spiritual Assessment.” Journal of Palliative Care, 1999.
