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David R. Hodge and Crystal Holtrop

Assessment is considered by many to be an underdeveloped area in social
work (Mattaini & Kirk, 1991). The lack of development is particularly
acute in the area of spiritual assessment (Bullis, 1996; Sherwood, 1998).
For instance, numerous studies have found that most social workers have
received no training in the area of spiritual assessment (Bullis, 1996; Canda
& Furman, 1999; Derezotes, 1995; Sheridan & Amato-von Hemert, 1999;
Furman & Canda, 1994). The lack of attention devoted to spiritual assess-
ment represents a significant oversight. Four issues, ontology, ethics,
strengths, and autonomy will be discussed in brief to highlight the impor-
tance of spiritual assessment in social work.

Spirituality is often central to clients’ personal ontology, meaning it
may be the essence of their personhood. Spirituality may inform atti-
tudes and practices in such areas as child rearing, diet, marriage, medi-
cal care, military participation, recreation, schooling, social interactions,
as well as many other dimensions of life (DiBlasio, 1988; Rey, 1997).
For one third of the general population, religion is the most important
facet of their lives and over 50% consider it to be a very important as-
pect of their lives (Gallup & Lindsay, 1999; Walsh, 1999). Further, for
African Americans, Hispanics, women, the elderly, the poor, and many
other populations of significance to social workers, spirituality is even
more salient (Gallup & Lindsay, 1999; Pargament, 1997). The provi-
sion of respectful services to these groups is often contingent upon prac-
titioners’ awareness of clients’ spiritually based beliefs and practices. In
order to provide effective services, social workers must develop some
understanding of clients’ spiritual worldview.

A second factor stems from the profession’s ethical mandates. Spiri-
tuality is often expressed in distinct traditions or faith-based cultures
(Fellin, 2000; Talbot, 2000). The NASW Code of Ethics (1999) stipu-
lates that social workers are to demonstrate competence and sensitivity
toward faith based cultures (1.05b) and recognizes the strengths that
exist among such groups (1.05a). Ethically sound practice entails ob-
taining the knowledge to exhibit spiritual sensitivity to clients.


168 David R. Hodge and Crystal Holtrop

Social workers are increasingly recognizing the importance of
strengths (Cowger, 1994; Hwang & Cowger, 1998; Saleebey, 1997).
Reviews have consistently found a generally positive association between
spirituality and a wide number of beneficial characteristics (Ellison &
Levin, 1998; Gartner, Larson & Allen, 1991; Koenig, McCullough &
Larson, 2001; Pargament, 1997). More specifically, various dimensions
of spirituality have been associated with recovery from addiction (Turner,
O’ Dell & Weaver, 1999), depression (Propst, 1996), divorce (Nathanson,
1995), homelessness (Lindsey, Kurtz, Jarvis, Williams & Nackerud, 2000;
Montgomery, 1994), serious mental illness (Sullivan, 1997), sexual as-
sault (Kennedy, Davis & Talyor, 1998) as well as empowerment
(Calhoun-Brown, 1998; Maton & Salem, 1995) and healing (Maton &
Wells, 1995; McRae, Thompson & Cooper, 1999). While spirituality is
often an important client asset, unfortunately, these strengths often lie
dormant (Saleebey, 1997). To tap clients’ spiritual assets for the pur-
poses of ameliorating problems, practitioners must use methods designed
to identify clients’ strengths (Ronnau & Poertner, 1993).

Finally, there is the issue of client autonomy. Many clients desire to
integrate their spiritual beliefs and values into the helping relationship
(Privette, Quackenbos & Bundrick, 1994). According to Gallup data re-
ported by Bart (1998), 66% of the general public would prefer to see a
professional counselor with spiritual values and beliefs and 81% wanted to
have their own values and beliefs integrated into the counseling process.
Further, research suggests that spirituality tends to become more salient
during difficult situations (Ferraro & Kelley-Moore, 2000; Pargament, 1997),
when individuals may be more likely to encounter social workers.

In sum, spiritual assessment provides social workers with a means
to understand clients’ spiritual strengths, beliefs, and values—in short—
their worldview. Not only is such knowledge often critical for culturally
competent practice, in many instances it is an ethical imperative. Spiri-
tual assessment provides a mechanism to identify clients’ spiritual re-
sources and honor their desire to integrate their beliefs and values into
the clinical dialogue.

In light of the importance of spiritual assessment, this chapter re-
views a number of recently developed assessment approaches and pro-
vides examples of how they may be applied in practice with Christian
clients. Our intent is not to provide an exhaustive review of various
assessment methods, but rather to review a specific series of assessment
instruments. These four instruments were developed to complement
one another in the hopes of providing social workers with a set of as-
sessment tools for use in numerous settings with a variety of clients.
Rather than being interchangeable, one approach may be ideal in one

Spiritual Assessment 169

context while another tool may be better suited to address a different
client-to-practitioner interface. Readers are encouraged to obtain the
original articles in which the instruments first appeared and to become
familiar with the strengths and limitations of each assessment instru-
ment. The assessment tools may be used with a variety of different reli-
gious traditions, but here we will be applying a Christian point of view
and using examples from practice with Christian clients.

After defining spiritual assessment, spirituality, and religion, four
assessment instruments are reviewed—spiritual genograms (Hodge,
2001b), spiritual lifemaps (Hodge, in press), spiritual histories (Hodge,
2001a), and spiritual eco-maps (Hodge, 2000; Hodge & Williams, in
press). A brief overview of the assets and limitations of each method is
provided and, for the three diagrammatic instruments, case examples
are provided to familiarize the reader with the instrument. A brief dis-
cussion on conducting an assessment concludes the chapter.


Spiritual assessment is defined as the process of gathering and orga-
nizing spiritually based data into a coherent format that provides the
basis for interventions (Hodge, 2001a; Rauch, 1993). The subsequent
interventions may or may not be spiritually based. As implied above, a
spiritual assessment may be conducted for the purposes of using tradi-
tional, non-spiritual, interventions in a manner that is more congruent
with clients’ beliefs and values.

Spirituality is defined as an existential relationship with God (or
perceived transcendence) (Hodge, 2001a). Religion flows from spiritu-
ality, expressing the spiritual relationship in particular beliefs, forms,
and practices that have been developed in community with other indi-
viduals who share similar spiritual experiences (Hodge, 2000). Accord-
ingly, spirituality and religion are overlapping but distinct constructs
(Canda, 1997; Carroll, 1997).

Spiritual Genograms

In a manner analogous to traditional genograms, spiritual genograms
provide social workers with a tangible graphic representation of spiritu-
ality across at least three generations (Hodge, 2001b). Through the use
of what is essentially a modified family tree, they help both practitio-
ners and clients understand the flow of historically rooted patterns
through time. In short, spiritual genograms are a blueprint of complex
intergenerational spiritual interactions.

170 David R. Hodge and Crystal Holtrop

In keeping with standard genogram conventions (McGoldrick,
Gerson & Shellenberger, 1999; Stanion, Papadopoulos & Bor, 1997),
the basic family structure is commonly delineated across at least three
generations. Typically, squares represent males and circles denote fe-
males. In some cases, triangles or other geometric shapes can be used to
designate individuals who have played major spiritual roles but are not
members of the immediate biological family (Hodge, 2001b).

To indicate clients’ spiritual tradition, colored drawing pencils can
be used to shade in the circles and squares (Hodge, 2001b). Color cod-
ing provides a graphic “color snapshot” of the overall spiritual compo-
sition of the family system (Hardy & Laszloffy, 1995). Various colors
can be used to signify religious preference (Buddhist, Christian, Hindu,
Jewish, Muslim, New Age, none, etc.), or more specifically when the
information is known, denomination (Assemblies of God, Brethren,
Catholic, Southern Baptist, Presbyterian, etc.). For example, a circle rep-
resenting a female Southern Baptist could be colored red, a member of
the Assemblies of God might be colored orange, a Muslim might be
colored brown, and an individual whose affiliation and beliefs are un-
known could be left uncolored. A change in an adult’s religious orienta-
tion can be signified by listing the date of the change beside a circle
which is drawn outside the figure and filling in the space between the
circle and the figure with the appropriate color, a procedure which indi-
cates the stability or fluidity of the person’s beliefs over time. Using a
similar approach, changes in orientation might also be noted by color-
ing the vertical segment connecting the child with the parents.

If needed, the color scheme can also be used to incorporate infor-
mation on commitment (devout vs. nominal) and theology (conserva-
tive vs. liberal) (Hodge, 2001b). For example, yellow might be used to
signify a devout, conservative Methodist while gray could be used for a
nominal Methodist. Alternatively, symbols, which are placed beside the
appropriate circle or square, could be used to indicate the degree of
commitment or theological orientation. An open set of scriptures, for
instance, might be used to indicate a devout person. Social workers
should explain the options to clients and allow them to select the colors
and symbols that they perceive best express their worldview.

Spiritually meaningful events should also be incorporated, such as
water and spirit baptisms, confirmations, church memberships, and bar
mitzvahs (Hodge, 2001b). Symbols drawn from the client’s spiritual jour-
ney can be used to signify these events. For instance, a cross might be
used by a Christian to indicate reaching a point of conversion, a dove
might be used by a Pentecostal to depict a deeper work of the Holy
Spirit, or a sunbeam might used by a New Age adherent to symbolize a

Spiritual Assessment 171

time of profound spiritual enlightenment. In addition, short summary
statements can be used to denote significant events or personal strengths.

In addition to depicting religious beliefs, it is also possible to include
an affective component (Hodge, 2001b). In other words, felt spiritual close-
ness between family members can be illustrated on spiritual genograms.
Lines with double-headed arrows [ ] can be used to symbolize a
relationship in which individuals experience a close reciprocal spiritual bond.
The thickness of the line can indicate the intimacy or strength of the rela-
tionship. In situations where the relationship is more hierarchical and less
reciprocal—as might occur with a grandparent mentoring a grandchild—
a single arrowhead can be used to depict the flow of spiritual resources.
Finally, spiritual conflict can be portrayed with a jagged line, similar to a
lightening bolt, drawn between the two individuals.

Case Example

Diagram 1 (following page) indicates what a relatively straightfor-
ward spiritual genogram might look like for a couple, Mark and Beth,
who are experiencing marital problems. In place of the colors that would
normally be used with a spiritual genogram, patterns (for example, dots,
diagonals, waves) are employed to depict various denominations.

After three years of marriage, Mark, 26, and Beth, 23, requested
counseling after the recent birth of their daughter, Megan. Her birth
renewed their interest in church attendance as they both desired to raise
Megan with spiritual values and to have her baptized. However, they
disagreed on practically everything else—how to spend money, parent
their daughter, where to go to church, and how to accomplish house-
hold tasks. Mark and Beth’s inability to resolve conflict was due to a
power struggle over whose family of origin’s rules they were going to
follow. Due to their conflict over which church to attend, the therapist
developed a spiritual genogram to enhance their traditional genogram.

During Mark’s childhood, his nuclear family and his paternal grand-
parents attended the Baptist church that was 3 blocks away from their
house. His family shared a tradition of going to Mark’s paternal grand-
parents’ house every Sunday after church. Although Mark knew that
Aunt Betty and Uncle Joe attended a Lutheran church regularly, he had
never heard them talk openly about their faith at family gatherings and
was unsure how important it was to them. His maternal grandmother
attended an Assemblies of God church before she was placed in the
nursing home. He recalled his grandmother sharing a story about how
she prayed for 30 years that her husband would become a Christian,
and that her prayers were answered shortly before her husband died.

172 David R. Hodge and Crystal Holtrop

Diagram 1.

During his adolescence, Mark perceived his parents’ rules as old-fash-
ioned and rigid and rebelled against them. As soon as he left home, Mark
stopped attending church, much to his parents’ chagrin. His sister, Alice,
left the Baptist church when she was 23 years old and started attending a
non-denominational church where she met her husband, Jay. Alice and Jay
are still actively involved in this church and frequently share information
with Mark and Beth about family activities that are occurring there. As

Spiritual Assessment 173

Mark shared this information, the therapist drew a cross by the names of
his parents, paternal grandparents, maternal grandmother, sister, and brother-
in-law to indicate that they were Christians. She put a question mark next
to his aunt and uncle due to Mark’s lack of clarity about their level of com-
mitment to their faith. In order to signify Alice and Jay’s devout faith and
active participation in their church, the therapist drew an open Bible near
their names. She colored their circles and squares different colors to indi-
cate the various denominations represented in Mark’s family. Uncle Joe’s
and Alice’s rectangles that attach them to their respective parents have two
colors, indicating that they switched from attending the Baptist church to a
different denomination.

Beth’s family attended a Methodist church when she was young.
However, their attendance dwindled to Easter and Christmas as Beth
became active in school activities. She knew that her parents both be-
lieved in God, but did not see this belief influencing their lives. How-
ever, Beth had fond memories of sitting on her paternal grandmother’s
lap as she listened to her grandmother, Carol, read Bible stories to her.
She also recalled attending Vacation Bible school which was sponsored
by the Evangelical Free church her grandmother attended. She assumed
that “Grandma Carol” was a committed Christian because she over-
heard her mother complain about “how religious Grandma Carol was”
and observed her mother rebuff Grandma Carol whenever she offered
to pray for the family. To signify Beth’s mother’s underlying conflict to-
wards Grandma Carol over spiritual matters, the therapist drew a jagged
arrow between their circles. Although her paternal grandfather died
before Beth was born, she recalled her Grandma Carol fondly referring
to her husband as “a fine man who loved people and the Lord.”

Although Beth stated she believes in God, she acknowledged that
she presently refers to God primarily when she is swearing angrily at
Mark. However, as the conflict between Beth and Mark continued to
escalate, she started contemplating “giving God a try.” She was open to
attending a church as long as it was not Mark’s parents’ church. She
thought his mother already interfered with their marriage far too much.
The therapist colored Beth’s maternal grandparents’ and parents’ circles
and squares red to represent the Methodist denomination. Due to their
nominal interest in spiritual matters, Beth and Mark agreed that the
therapist should not draw a cross by their names. She did draw a cross
by Grandma Carol’s name and by her paternal grandfather’s name, and
also drew an arrow from her Grandmother Carol to Beth, indicating the
spiritual influence she had on Beth.

With the multi-colored spiritual genogram directly in front of them,
Mark and Beth were struck by the diversity of denominations repre-

174 David R. Hodge and Crystal Holtrop

sented in their extended families. This new perspective helped them see
beyond their original, narrowly defined choices of Baptist vs. Methodist
that Mark and Beth clung to out of loyalty to their families of origin.
The therapist encouraged the couple to interview members of their ex-
tended family, asking questions concerning their faith, their religious
practices, and the strengths and limitations of their church and denomi-
nation. Beth and Mark discovered that the new perspectives gained from
the interviews helped them be more evaluative in their decision-mak-
ing process and moved them beyond their stalemate.

Assets and Limitations

Although spiritual genograms can be effective assessment instruments
in a number of situations, they may be particularly useful when the family
system plays an especially salient role in the client’s life or when the client
presents with problems involving family members or family of origin issues
(Hodge, 2001b). For example, spiritual genograms might be used with in-
terfaith couples experiencing spiritually based barriers to intimacy to ex-
pose areas of difference and potential conflict as well to highlight the re-
spective spiritual strengths each person brings to the relationship. Simi-
larly, spiritual genograms could also be used with couples from similar back-
grounds to increase their level of intimacy.

Conversely, spiritual genograms may be an inappropriate assessment
instrument in situations where historical influences are of minor im-
portance. Further, even in situations where generational influences are
pertinent, many clients do not connect past events with current diffi-
culties. Accordingly, clients may view genogram construction and be-
tween-session tasks as an ineffective use of time. As Kuehl (1995) notes,
proceeding with such interventions before clients appreciate their use-
fulness can reduce treatment adherence and jeopardize outcomes. Con-
sequently, in some contexts it may be best to use assessment approaches
that do not focus on the generational aspects of spirituality.

Spiritual Lifemaps

While spiritual genograms chart the flow of spirituality across at
least three generations, spiritual lifemaps depict clients’ personal spiri-
tual life-story (Hodge, in press). More specifically, spiritual lifemaps are
a pictorial delineation of a client’s spiritual journey. In a manner analo-
gous to renowned African writer Augustine’s (354-430/1991) Confes-
sions, spiritual lifemaps are an illustrated account of clients’ relation-
ship with God over time—a map of their spiritual life.

Spiritual Assessment 175

At its most basic level, a drawing pencil is used to sketch various
spiritually significant life events on paper (Hodge, in press). The method
is similar to various approaches drawn from art and family therapy in
which a client’s history is depicted on a “lifeline” (Tracz & Gehart-Brooks,
1999). Much like road maps, spiritual lifemaps tell us where we have
come from, where we are now, and where we are going.

To assist clients in the creative expression of their spiritual jour-
neys, it is usually best to use a large sheet of paper (e.g., 24” x 36”) on
which to sketch the map (Hodge, in press). Providing drawing instru-
ments of different sizes and colors are also helpful as is offering a selec-
tion of various types and colors of construction paper and popular peri-
odicals. Providing these items, in conjunction with scissors, glue sticks,
and rulers, allows clients to clip and paste items onto the lifemap.

Spiritually significant events are depicted on a path, a roadway, or a
single line that represents clients’ spiritual sojourn (Hodge, in press).
Typically, the path proceeds chronologically, from birth through to the
present. Frequently the path continues on to death and the client’s tran-
sition to the afterlife. Hand drawn symbols, cut out pictures, and other
representations are used to mark key events along the journey. In keep-
ing with many spiritual traditions, which conceive material existence to
be an extension of the sacred reality, it is common to depict important
lifestage events on the lifemap (for example, marriage, birth of a child,
death of a close friend or relative, or loss of a job). While it is often
necessary to provide clients with general guidelines, client creativity
and self-expression should be encouraged.

To fully operationalize the potential of the instrument, it is impor-
tant to ask clients to incorporate the various crises they have faced into
their lifemaps along with the spiritual resources they have used to over-
come those trials (Hodge, in press). Symbols such as hills, bumps and
potholes, rain, clouds, and lightning can be used to portray difficult life
situations. Delineating successful strategies that clients have used in
the past frequently suggests options for overcoming present struggles.

Case Example

Diagram 2 (folowing page) provides an example of what a spiritual
lifemap might look like on a smaller scale. Tyrone, a 42 year-old black
male, was recently diagnosed with terminal cancer. The doctor con-
firmed his worst fears that the cancer was inoperable, and predicted
that Tyrone had approximately 6 months to live. A medical social worker
on the oncology ward met with Tyrone to help him process the shock of
his prognosis and prepare for what appeared to be a premature death.

176 David R. Hodge and Crystal Holtrop

Shortly into their conversation, the social worker discovered that Tyrone
was actively involved in the Third Missionary Baptist Church. Tyrone’s
eyes lit up as he shared that he began playing guitar in the church’s
music ministry 10 years ago, a couple of years after he became a Chris-
tian. It soon became clear to the social worker that Tyrone’s faith was a
significant strength and could help him cope with his present crisis. In
order to help Tyrone identify effective coping strategies, the social worker
encouraged Tyrone to develop a spiritual lifemap. Tyrone’s creativity
and musical interests seemed to indicate that this assignment would be
a good fit for his personality.

Tyrone’s parents divorced when he was 9 years old. He and his 2
older sisters lived with his mother and periodically visited his father.
His mother was actively involved in a Pentecostal church and sang in
the church choir. When Tyrone reached adolescence, his anger toward
his absent father began to mount and was acted out in rebellion toward
his mother. Out of desperation, his mother arranged guitar lessons for
Tyrone to creatively redirect his anger and build his self-esteem. Tyrone
established a lifelong mentoring relationship with his guitar teacher,
Jerome, who consistently believed in him and spawned a passion for a
variety of musical styles including blues, jazz, gospel, and rock. When
he graduated from high school, he joined a band and played in clubs for
the next 9 years. Disillusioned with God for not answering his child-
hood prayers for his father, Tyrone started experimenting with drugs
and alcohol to numb his emptiness inside.

By age 27, Tyrone had successfully recorded a CD with his band and
was gaining local notoriety. Life was good. He was doing well finan-
cially and he enjoyed dating several different women. However, this
season was short-lived. By age 30, he was significantly in debt and was
emotionally broken. After 3 years of dating, Tyrone’s girlfriend, Janet
concluded that Tyrone was more committed to his band than to her and
she broke up with him. He coped by increasing his alcohol consump-
tion, which hurt his performance and created conflict with his band
members. After a particularly heated argument, Tyrone sought solace
from Jerome, his former guitar teacher. Through this renewed friend-
ship, Tyrone began examining his life, his priorities, and the source of
his emptiness and bitterness. He forgave God for what he perceived to
be abandonment (a replication of his father’s abandonment) and he ex-
perienced a profound sense of God’s love and acceptance. Tyrone soon
realized that it was he, not God, who had abandoned divine and human
love out of bitterness and despair.

Tyrone started attending the Third Missionary Baptist church. Upon
Jerome’s advice, Tyrone took a break from playing guitar and immersed

Spiritual Assessment 177

Diagram 2.

himself in Bible study, prayer, and Christian books to help him sort out
his unresolved hurts, develop effective anger management skills, and
evaluate his life goals. He also developed significant relationships with
other men in a Promise Keepers group. He watched several men in the
group weather severe trials by clinging onto God’s promises and by re-
ceiving love and support from their friends. He gradually learned that
no matter what happens in life, God is good, faithful, and in control.

178 David R. Hodge and Crystal Holtrop

After a 2-year hiatus, Tyrone began playing guitar in church. Using his
talents to worship God gave him a sense of meaning and joy that was
deeper than any he had experienced before. Completing the spiritual
lifemap helped Tyrone reflect on his life, his pit and peak experiences,
the lessons he had learned, and the people who had blest him. Most
importantly, he identified key people that would support him through
his present illness and pray for God to heal him. While discussing the
lifemap with his social worker, Tyrone began to clarify the goals he still
wanted to accomplish, like mentoring some young boys in church who
were growing up in single parent homes. Through this reflective assign-
ment, he also made the decision to write some songs as a creative way to
express his pain, cry out to God, and receive strength and comfort.

Assets and Limitations

Of the assessment methods reviewed in this chapter, spiritual
lifemaps are perhaps the most client-directed. Consequently, there are a
number of unique advantages associated with the use of this diagram-
matic model (Hodge, in press). By placing a client-constructed media at
the center of assessment, the message is implicitly communicated that
the client is a competent, pro-active, self-directed, fully engaged partici-
pant in the therapeutic process. Additionally, individuals who are not
verbally oriented may find pictorial expression more conducive to their
personal communication styles (McNiff, 1992).

The relatively secondary role that social workers play during as-
sessment also offers important advantages. For many clients, spiritual-
ity is a highly personal, sensitive, and important area. Most social work-
ers have had limited training about various spiritual worldviews, in spite
of the central role spirituality plays in human behavior. (Canda &
Furman, 1999). Consequently, there is the distinct risk that social work-
ers may offend clients and jeopardize the therapeutic relationship
through comments that are inadvertently offensive, especially with the
use of more practitioner-centered, verbally-based assessment approaches.
The pictorial lifemap affords practitioners the opportunity to learn more
about the client’s worldview while focusing on building therapeutic rap-
port by providing an atmosphere that is accepting, nonjudgmental, and
supportive during assessment (Kahn, 1999).

In terms of limitations, some social workers may feel so removed
from the process that this assessment approach makes poor use of thera-
peutic time. Indeed, in the time constrained, managed care world in
which many practitioners work, in some cases it may be advisable to
use the lifemap as a homework assignment (Hodge, in press). Another

Spiritual Assessment 179

significant limitation is that many clients, such as those who are more
verbal, those that are uncomfortable with drawing, or those who prefer
more direct practitioner and client involvement, may find the use of a
largely non-verbal, pictorial instrument to be a poor fit.

Spiritual Histories

A spiritual history represents a narrative alternative to a spiritual
lifemap (Hodge, 2001a). Instead of relating the client’s spiritual sojourn
in a diagrammatic format, the client’s spiritual story is related verbally.
In a process that is analogous to conducting a family history, the client
is provided an interactive forum to share his or her spiritual life story.

To guide the conversation, a two-part framework is used (Hodge, 2001a).
As can been seen in Table 1, the first part consists of an initial narrative
framework. The purpose of these questions is to provide practitioners with
some tools for structuring the assessment. The aim is to help clients tell
their stories, typically moving from childhood to the present.

It should also be noted that the questions delineated in Table 1 are
offered as suggestions (Hodge, 2001a). Social workers should not view
them as a rigid template that must be applied in every situation, but
rather as a fluid framework that should be tailored to the needs of each
individual client. In other words, the questions provide a number of
possible options that can be used to facilitate the movement of the nar-
rative and to elicit important information.

The second part of Table 1 consists of an interpretive framework (Hodge,
2001a) based on the anthropological understandings of Chinese spiritual-
ity writer Watchman Nee (1968). In addition to soma, Nee envisions a
soul, comprised of affect, will, and cognition, and a spirit, comprised of
communion, conscience, and intuition. Although human beings are an in-
tegrated unity and, consequently, the six dimensions interact with and in-
fluence one another, it is possible to distinguish each dimension. As is the
case with other human dimensions, such as affect, behavior, and cognition,
the dimensions of the spirit also can be discussed individually.

Communion refers to a spiritually based relationship. More specifi-
cally, it denotes the ability to bond with and relate to God. Conscience
relates to one’s ability to sense right and wrong. Beyond a person’s
cognitively held values, conscience conveys moral knowledge about the
appropriateness of a given set of choices. Intuition refers to the ability
to know—to come up with insights that by-pass cognitively based, in-
formation-processing channels.

As is apparent in Table 1, the questions in the interpretive anthro-
pological framework are designed to elicit information about each of

180 David R. Hodge and Crystal Holtrop

Table I. Guidelines for conducting spiritual histories

Initial Narrative Framework

1. Describe the religious/spiritual tradition you grew up in. How did your
family express its spiritual beliefs? How important was spirituality to your
family? Extended family?

2. What sort of personal experiences (practices) stand out to you during
your years at home? What made these experiences special? How have
they informed your later life?

3. How have you transitioned or matured from those experiences? How
would you describe your current spiritual/religious orientation? Is your
spirituality a personal strength? If so, how?

Interpretive Anthropological Framework

1. Affect: What aspects of your spiritual life give you pleasure? What role
does your spirituality play in handling life’s sorrows? Enhancing its joys?
Coping with its pain? How does your spirituality give you hope for the
future? What do you wish to accomplish in the future?

2. Behavior : Are there particular spiritual rituals or practices that help you
deal with life’s obstacles? What is your level of involvement in faith-based
communities? How are they supportive? Are there spiritually encouraging
individuals that you maintain contact with?

3. Cognitive: What are your current religious/spiritual beliefs? What are they
based upon? What beliefs do you find particularly meaningful? What does
your faith say about trials? How does this belief help you overcome
obstacles? How do your beliefs affect your health practices?

4. Communion: Describe your relationship to the Ultimate. What has been
your experience of the Ultimate? How does the Ultimate communicate
with you? How have these experiences encouraged you? Have there been
times of deep spiritual intimacy? How does your relationship help you face
life challenges? How would the Ultimate describe you?

5. Conscience: How do you determine right and wrong? What are your key
values? How does your spirituality help you deal with guilt (sin)? What role
does forgiveness play in your life?

6. Intuition: To what extent do you experience intuitive hunches (flashes of
creative insight, premonitions, spiritual insights)? Have these insights been a
strength in your life? If so, how?

Table from Hodge (2001)

Spiritual Assessment 181

the six dimensions. The questions are not meant to be asked in any
specific order. Rather, they are provided to help social workers draw out
the richness of clients’ spiritual stories. As clients relate their spiritual
narrative, they may tend to touch upon some of the dimensions listed
in the interpretive anthropological framework. Social workers can pose
questions drawn from the framework to more fully explore clients’ spiri-
tual reality in the natural flow of the therapeutic dialogue.

Assets and Limitations

There is a considerable amount of evidence that information is stored
and organized narratively in the mind (Strickland, 1994). Accordingly, as-
sessment methods that are congruent with this reality work with, rather
than against, clients’ mental thought processes. Indeed, for verbally ori-
ented persons, spiritual histories may provide the best assessment method.
The non-structured format allows clients to relate their stories in a direct,
unfiltered manner. For example, whereas genograms require clients to cir-
cumscribe their spiritual reality upon a generational chart, assessment with
spiritual histories allows clients to choose the relevant material to be shared.

However, not all clients are verbally oriented and some may find
that a narrative assessment places too much attention on them in light
of the sensitive, personal nature of spirituality. Some clients find it help-
ful to have a specific framework. Given the amorphous, subjective na-
ture of spirituality, physical depiction may help concretize the client’s
strengths (Hodge, 2000). In other words, the process of conceptualiz-
ing and depicting one’s spiritual journey may help to focus and objec-
tify spiritual assets, which can then be discussed and marshaled to ad-
dress problems. Still another limitation is the time spent exploring por-
tions of the client’s spiritual history that may have limited utility in
terms of addressing the present problem the client is wrestling with.

Spiritual Eco-maps

In contrast to the above assessment tools, spiritual eco-maps focus on
clients’ current spiritual relationships (Hodge, 2000; Hodge & Williams, in
press). The assessment instruments previously are united in the sense that
they all are designed to tap some portion of clients’ spiritual story as it
exists through time. Spiritual genograms, lifemaps and histories typically
cover one to three generations of a client’s spiritual narrative. Spiritual eco-
maps, on the other hand, focus on that portion of clients’ spiritual story
that exists in space. In other words, this assessment approach highlights
clients’ present relationships to various spiritual assets.

182 David R. Hodge and Crystal Holtrop

In keeping with traditional eco-gram construction (Hartman, 1995)
the immediate family system is typically portrayed as a circle in the
center of a piece of paper. Household family members can be sketched
inside the circle, with squares depicting males and circles representing
females (Hodge, 2000). Alternatively, separate eco-maps can be drawn
for each individual (Hodge & Williams, in press).

Significant spiritual systems or domains are depicted as circles on
the outskirts of the paper, with the names of the respective systems
written inside the circles. The circles are placed in a radius around the
family circle, which may consist of a single figure representing the cli-
ent. While clients should be encouraged to depict the domains that are
most relevant to their spiritual worldviews, there are a number of spiri-
tual systems that are strengths in particular spiritual traditions.

More specifically, social workers should generally seek to explore
clients’ relationships with God, rituals, faith communities and encoun-
ters with angels, demons, and other spiritual visitations (Hodge, 2000).
One’s relationship with God is widely regarded as a key strength, as are
rituals, or codified spiritual practices such as devotional reading, medi-
tation, prayer, scripture study, singing hymns, worship, “practicing the
presence” of God by focusing on God’s presence and active involvement
in daily affairs. Faith communities refer to various church and para-
church communities that individuals may associate with on a regular
basis, such as church services, fellowship groups, mid-week Bible stud-
ies, youth groups, and singles associations.

As suggested above, social workers should also seek to incorporate
into the eco-map any spiritual system that has meaning to the client
(Hodge, 2000). For example, one may wish to explore clients’ relation-
ship to their parents’ spiritual traditions or their relationship to indi-
viduals who hold a position of significant spiritual leadership in their
lives, such as a pastor, spiritual mentor or elder. The goal should be to
delineate on the eco-map all the spiritual systems that are relevant to
the client’s present spirituality.

The heart of the spiritual eco-map is the depiction of relationships
between the family system and the spiritual systems, which are repre-
sented by various types of sketched lines (Hodge, 2000). Thicker lines
represent stronger or more powerful relationships. A dashed line repre-
sents the most tenuous relationship, while a jagged line denotes a con-
flicted one. An arrow is drawn on the line to indicate the flow of energy,
resources, or interest. As is the case with the other diagrammatic instru-
ments profiled above, short, descriptive encapsulations, significant dates,
or other creative depictions, can also be incorporated onto the map to
provide more information about relational dynamics.

Spiritual Assessment 183

When using eco-maps with individuals, the appropriate type of line
is drawn in between the family system (the figure representing the cli-
ent) and the spiritual systems. When working with families, lines are
drawn to the family system as a unit when the family shares a particular
relationship in common, or more frequently, connections are drawn to
individual family members depicting the various unique relationships
between each family member and various spiritual systems.

A Case Example

In an abbreviated manner, Diagram 3 (following page) depicts how a
spiritual eco-map might be used with the Martinez family, consisting of
Miguel and Maria, and their two children, Angie, 16, and Tony, 10. The
Martinez family sought counseling as part of a relapse prevention plan for
Angie who had recently been released from an in-patient alcohol treatment
program. The goal of counseling was to reduce the conflict and distrust
that existed between Angie and her parents. Angie thought her parents
were overly strict, and her parents felt betrayed by Angie’s chronic lying. In
addition, Miguel and Maria removed Angie from public school and en-
rolled her in a Christian school in an attempt to prevent her from associat-
ing with her peer group that frequently abused alcohol.

Angie and her parents were embroiled in a heated conflict as Angie
complained that the Alcoholic’s Anonymous (AA) groups that her par-
ents insisted she attend were “stupid and a waste of time.” Due to Angie’s
prior deceitfulness and poor decision-making, her parents did not trust
Angie’s assessment of the AA groups and were adamant that she needed
to continue attending two groups per week to help her maintain her
sobriety. In order to address this dilemma, the therapist developed a
spiritual eco-map with the family to explore the family’s spiritual
worldview and resources and identify spiritually based alternatives to
AA attendance. The family was receptive to this because AA had sub-
stantiated the benefits of spirituality in treating alcoholism.

The Martinez family was currently attending St. Vincent’s parish.
Maria had grown up in this parish and knew many of the parishioners.
She and Miguel had attended Cursillo, a weekend retreat that guided
participants as they explored a deeper relationship with God, and they
continued to participate in Cursillo’s on-going groups. Maria, in par-
ticular, stated that she had received a great deal of support and prayer
from this group when she and Miguel discovered Angie’s struggle with
alcoholism. Tony had been an altar boy for a couple years and looked
forward to seeing his friends at his Christian education class. In the
past, Angie had viewed attending mass with disdain and thought that

184 David R. Hodge and Crystal Holtrop

Diagram 3.

her peers at their parish were “stale.” However, after attending in-pa-
tient treatment and switching to the Christian school, Angie slowly be-
gan to develop an interest in spirituality. Upon invitation from her new
friends at school, Angie attended several local youth groups. Specifi-
cally, she enjoyed the “cool music” at Solid Rock Gospel Church, and
liked the youth pastor, Dan, and his wife, Karen, at Victory Faith Temple.

Spiritual Assessment 185

The therapist asked Miguel and Maria if they would be comfortable
replacing the AA groups with the youth groups. Although they both
wished Angie would attend the Catholic youth group at their parish,
they agreed to give it a try and the family contracted to evaluate the
youth groups’ effectiveness in two months.

The therapist asked the Martinez family if they practiced any family
rituals at home. Maria stated that she and Miguel each individually spent
some time reading scripture and praying. Angie surprised her parents
by stating that, after a conversation with Karen, she had recently started
reading a devotional book when she felt upset and praying when she
felt tempted to drink. Miguel shared that they discontinued their at-
tempt at family devotions a year ago after a major fight arose between
Angie and him. The therapist asked if they would be interested in initi-
ating family devotions again. However, in order to break the conflictual
pattern of the parents lecturing and Angie bristling at their rigid rules,
the therapist encouraged structuring the family devotional time as an
open forum in which all family members would be free to share their
perspectives and struggles. Miguel and Maria might share how their
faith guides their decision-making and helps them deal with life’s pain
and hardships. Angie and Tony might share what they were learning in
youth group, school, and Christian education class. This weekly ritual
could potentially reassure Miguel and Maria that Angie was learning
productive coping skills, build trust between family members, and help
them forgive past grievances.

In congruence with the AA model, the therapist asked Angie if she
could identify anyone on the spiritual eco-map that she respected and
would like to be her sponsor who would provide support, guidance,
and accountability for her. Angie stated that Karen had shared her life
story in youth group, and was sure that Karen would be understanding,
nonjudgmental, and helpful to her.

By developing the spiritual eco-map, the therapist was able to use
the Martinez family’s current spiritual resources to help them identify
new solutions to their problems. Before this counseling session, Miguel
and Maria had briefly heard Angie mention Karen’s name, but their dis-
trust and concern that the youth groups were not Catholic had pre-
vented them from hearing the positive influence Karen and the groups
were having in Angie’s life. The process of developing the spiritual eco-
map allowed Angie to openly share for the first time that her new-found
faith was helping her stay sober and that the youth groups were helping
her grow spiritually. As a result, the family moved past their stalemate,
broke down barriers to communication, and began establishing trust.

186 David R. Hodge and Crystal Holtrop

Assets and Limitations

The main asset of spiritual eco-maps is that they focus upon clients’
current spiritual strengths (Hodge, 2000). For social workers seeking
to operationalize clients’ spiritual assets to help clients solve their prob-
lems, this assessment approach may be ideal. The time spent in assess-
ment is focused upon tapping into present spiritual resources.

In some cases, clients may find it less threatening to have a concrete
object that functions as the focus of subsequent conversation. As is the
case with all diagrammatic instruments, spiritual eco-maps provide an
object that can serve as the focal point of discussion. The design of eco-
maps, however, with their focus on environmental systems rather than,
for example, clients’ life stories, helps remove the emphasis from the
client as an individual. In short, while other approaches may implicitly
emphasize clients, devoid of their contexts, spiritual eco-maps explic-
itly stress the spiritual systems in clients’ environments (Hartman, 1995).

Spiritual eco-maps suffer from the same limitations as other dia-
grammatic instruments relative to verbally based spiritual histories. In
addition, in at least some situations, the focus on current spiritual as-
sets may result in a limited assessment that overlooks salient historical
factors. In other words, in some contexts an approach that allows social
workers to explore current and historical resources may be useful.

Conducting an Assessment

Knowledge in terms of how to conduct an assessment is also impor-
tant. Developing familiarity with assessment tools is only part of the assess-
ment process. Practitioners must also know how to use these tools in an
appropriate, spiritually sensitive manner. Although a detailed discussion of
the mechanics of conducting a spiritual assessment is beyond the scope of
this chapter, a few important points will be highlighted.

Social workers should be aware that many clients may be hesitant to
trust practitioners due to concerns that practitioners will not treat with
honor that which is held to be sacred (Furman, Perry & Goldale, 1996;
Richards & Bergin, 2000). Consequently, due to the highly personal nature
of spirituality, it is appropriate to procure clients’ consent before engaging
in a spiritual assessment. Additionally, social workers should explain a par-
ticular assessment instrument to ensure that the client is comfortable with
the particular approach before engaging in an assessment.

To a great extent, clients’ apprehension can be alleviated by express-
ing genuine support. Adopting an attitude of interest and curiosity to-
ward the client’s belief system is an appropriate therapeutic stance

Spiritual Assessment 187

(Patterson, Hayworth, Turner Christie & Raskin, 2000).
Social workers can also demonstrate spiritual sensitivity by obtain-

ing knowledge of common spiritual traditions. For example, if one works
in an area where Mormons and Pentecostals are prominent spiritual
traditions, then seeking out information on Mormonism (Ulrich,
Richards & Bergin, 2000) and Pentecostalism (Dobbins, 2000) can as-
sist social workers in exhibiting spiritual sensitivity with these popula-
tions. Ideally, in the process of attempting to understand clients’ spiri-
tual worldviews, social workers should seek to envision life through the
particular worldview of the client.

In their attempts to understand the worldviews of clients, social
workers should develop their understanding of the oppression people
of faith often experience in the largely secular culture. It is important
for social workers to recognize that the dominant secular culture often
marginalizes or otherwise de-legitimizes devout faith in such influen-
tial forms as television (Skill & Robinson, 1994; Skill, Robinson, Lyons
& Larson, 1994), popular periodicals (Perkins, 1984), and high school
(Sewall, 1995; Vitz, 1986; Vitz, 1998) and college level textbooks (Cnaan,
1999; Glenn, 1997; Lehr & Spilka, 1989). Social workers should reflect
on how living in a culture that often ignores, devalues, and even ridi-
cules believers’ most cherished beliefs and values affects the psychology
of people of faith.

Developing their understanding of clients’ worldviews can assist
social workers in respecting clients’ spiritual autonomy. The focus of
practice should not be on determining whether clients’ spiritual beliefs
are right or wrong, but rather on how their values animate their lives
and assist them in coping with difficulties. The social worker’s job is not
to accept or reject clients’ spiritual values but to understand them and
help them use their beliefs and practices to assist clients in overcoming
their problems (Fitchett & Handzo, 1998).

In some cases, however, social workers may perceive that clients’
spiritual beliefs may be problematic. In such situations, social workers
should not attempt to change clients’ values in an area that lies outside
the realm of their professional competence. Rather, practitioners should
collaborate with or refer such clients to clergy (Johnson, Ridley &
Nielsen, 2000). Given that this is the clergy’s area of professional com-
petency, pastors, priests, and other spiritual specialists are better equipped
to ascertain the appropriateness of a given set of beliefs and practices. It
is critical, however, that practitioners respect clients’ spiritual autonomy
by forming collaborative relationships with clergy that share the same
denominational and theological orientation as the client. It would be
unethical to covertly attempt to subvert clients’ values by, for example,

188 David R. Hodge and Crystal Holtrop

referring a client who holds conservative beliefs to a liberal pastor.
In keeping with their roles as social workers, practitioners should

remain focused on empowering clients to address their problems. Dur-
ing the assessment process, social workers should keep two questions
in mind. First, during past difficulties, how have clients culled from
their spiritual frameworks, various resources to address their problems?
Second, what types of unaccessed resources are available in this frame-
work that can be marshaled to address current problems? Social work-
ers can attempt to link clients with untapped resources to help them
solve their problems. Practitioners might, for example, suggest particu-
lar interventions either drawn from, or consistent with, clients’ spiri-
tual worldviews.

More specifically, social workers might employ a modified form of
cognitive therapy in which unhealthy beliefs are identified and replaced
with positive beliefs drawn from the individual’s spiritual belief system
(Backus, 1985; Propst, 1996). Similarly, practitioners may explore the
possibility of reframing current problems as opportunities for spiritual
growth (Pargament, 1997). In attempting to foster the adoption of more
productive patterns of behaviors, spiritual rituals may be employed as
“exceptions” to unproductive behavioral patterns (Hodge, 2000). Deci-
sion-based forgiveness interventions may be useful in some contexts
(DiBlasio, 1998) while existential, brevity of life interventions may be
appropriate in other situations (Hodge, in press). In each individual
setting, the unique spiritual beliefs of the clients and the theoretical
orientation of the social worker will indicate which interventions are
selected. In any setting, however, the goal should be to help clients use
their spiritual strengths to address their issues and concerns.


In order to provide services that are sensitive to clients’ spiritual
worldviews, social workers must conduct spiritual assessments to have
some awareness of clients’ spiritual realities. Similarly, to help clients
tap into their spiritual strengths to address the problems they wrestle
with, it is necessary to undertake an assessment of clients’ strengths. A
single assessment approach, however, is unlikely to be ideal in all situ-
ations; diverse needs call for a variety of approaches. If the profession of
social work is to take seriously its mandate to provide culturally sensi-
tive services that build upon clients’ unique strengths, then in many
cases performing a spiritual assessment is an imperative.

Spiritual Assessment 189


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