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Stephanie Dailey Nov 3, 2010

Spirituality and Intake: Taking that first step…

Martin Luther King Jr. once said, “Faith is taking the first step even when you don't see the whole staircase.” This is similar to the leap of faith our clients take when coming into counseling. In the last blog I talked about spirituality and informed consent, stating that it is our ethical responsibility to inform clients of our approach to therapy. I also stated that oftentimes it becomes clear during intake and informed consent whether spirituality will be a part of the initial counseling process. The purpose of this blog is to talk about specific questions counselors can ask, during intake, to gain clarity regarding the client’s spiritual and/or religious self.

Initial assessment can assist both the counselor and client in obtaining a better understanding of the role spirituality and/or religion plays in issues the client brings to counseling. Assessment is also helpful in designing appropriate treatment interventions. The initial intake session is typically comprised of direct assessment activities which may include intake forms completed by the client, interviewing the client, and observation of the client. The use of intake forms can be helpful to obtain basic assessment information about the clients’ religious and spiritual beliefs and practice history, including denomination/faith of origin, current denomination/faith, role of faith in the client’s life, religious conflicts/support, or other important issues. Simple “yes,” “no,” “somewhat,” or “maybe” options keep the form brief, allowing it to be completed quickly by the client. Questions that leave space for the client to write more provide counselors with a more in depth understanding of the client’s perspective.

Examples of yes, no, somewhat/maybe questions include: “Do you have a belief in God, a higher power, universal spirit, or other?”, “Would you like to discuss this belief/absence of beliefs?”, and “Have you experienced any changes in religious affiliation since childhood?”  Open ended questions include: “How would you describe your religious or spiritual beliefs and practices?”, “What role has religion and/or spirituality played in your life?”, and “Has religions and/or spirituality contributed to any stressors in your life?” Questions which combine both open and closed ended questions are: “Are there any spiritual and/or religious resources that you feel are a source of strength? If so, what resources have you found helpful?” and “Are you currently affiliated with any religious denomination and/or spiritual practice? If so, what religious denomination or spiritual practices you are affiliated with?” Finally, including a disclaimer that clients can skip the remainder of the form if they do not want to discuss religious or spiritual issues in counseling is also important and typically is a clear indication of how much of the client’s spiritual or religious domain can or should be integrated in counseling.

Graphing techniques, including genograms and ecomaps, can be used during the intake interview but often are utilized after the counselor had obtained basic information from the client and begun to explore the client’s presenting issue. Expressive techniques, which may include using sandtray, music, or various art forms, are not typically used. These are most helpful after the intake is complete, but they can be used if the counselor is having difficulty obtaining information from verbal methods, is trained to use these methods, and if the counselor has obtained consent from the client.

Having addressed intake forms and the initial interview, the last tool which is helpful during intake is observation. Upon first seeing a client, the counselor begins observing the client’s appearance, behaviors, and word choices. Some aspects can provide the counselor with information about the client’s spiritual and religious perspectives. The counselor then can use this information to begin a discussion with the client about the client’s spiritual and religious beliefs and overall values. Wedding and engagement rings, cross and star pendants, bindis, Masonic rings, novelty t-shirts, uncut or shaved hair, head coverings, flag pins, colored ribbons, and tattoos are just a few examples of an endless assortment of  ways that appearance can imply personal or spiritual beliefs and values. It is this type of observation of the client’s initial appearance and changes in the client’s appearance throughout counseling that helps the counselor obtain clues about the client’s spiritual and/or religious beliefs and overall values.

Stephanie Dailey is a counselor, adjunct faculty and doctoral candidate at Argosy University-Washington, D.C.
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