CPE reflections (4)

4. Assessing spiritual needs

George Fitchett’s 7 x 7 model for spiritual assessment can help pastoral carers ‘accurately identify problem areas and needs in the spiritual lives of the people with whom they work’.

Fitchett’s is only one model. And there are alternatives that can be useful in various situations (e.g., Highfield and Cason’s simpler model, which I’ve found both easier to remember and helpful in unlocking something of the pastoral significance of boredom). But it proves its usefulness by its provision of meaningful labels and a grid for reflection on how to minister to people where they’re at.

The backbone of the model is the plotting of seven holistic dimensions of a patient’s situation — including the spiritual dimension, which can be further analysed in terms of the following seven variables:

1. Beliefs and Meaning
2. Vocation and Consequences (or Obligation)
3. Experiences and Emotion
4. Courage and Growth
5. Ritual and Practice
6. Community
7. Authority and Guidance

The connections between these variables are worth dwelling on. It is possible to relate most of variables 2 through 7 to ‘Beliefs and Meaning’. Of course, Fitchett explicitly swears off the kind of substantive model, preferring a functional one — which explores how beliefs are formed and meaning is made rather than what (particular, concrete) beliefs are held and meaning found. But there’s a significant sense in which no matter what particular beliefs are held they manifest in the person’s lived experience in their sense of ‘Vocation and Consequences (or Obligation)’ as well as the ‘Rituals and Practice’ that are significant to them.

Likewise, their experiences (e.g., of a serious health crisis or of loss) and the emotions associated with them can present massive challenges to belief, potentially even provoking a crisis of faith. This is where the ‘Courage and Growth’ variable comes it. It doesn’t so much tell us about a person’s bravery (or bravado) but about the resources and flexibility the patient is able to bring to bear to negotiate any apparent discrepancy between their beliefs and their experience — either to adapt their beliefs (ditching unhelpful or unbelievable ones, etc) or to deepen them to reinterpret the experience and begin making meaning out of it.

On the flip side, a person’s community — connections to others who share key beliefs and values as well as important rituals and practices — is often involved in sustaining their beliefs and sense of meaning, especially in confrontation with apparent ‘falsifiers’ in experience. ‘Authority and Guidance’ by extension says something about who (or what) is trusted in the midst of such a confrontation.

Much of this is extremely valuable. However, I have some nagging doubts about the model. What particularly bothers me is the way it seems to presuppose a (covert) substantive vision while claiming to offer a purely functional perspective without reference to substantive commitments. This becomes especially clear once you move to apply the model, asking not only ‘What is this person’s situation?’ but ‘Where to from here?’

Once you start talking about how to minister to a patient whose needs you’ve successfully labelled with Fitchett’s categories, you’re automatically working with a vision of ‘healthy functioning’ that I can’t help but see as substantive. What is ‘healthy’? Where do we get our sense of ‘healthy functioning’ from? Who decides? As far as I can see, all the answers to these questions are substantive. They come down to particular, concrete beliefs and values.

And this leads to an even more serious question about the exercise of ‘spiritual assessment’. As another participant in the course pointed out, the whole question of defining spiritual needs is fraught with ambiguity:

• On the one hand, it seems like spiritual needs are simply those needs that are left over when all the other healthcare professionals — doctors, nurses, physiotherapists, social workers, etc — have laid claim to the needs their expertise qualifies them to deal with. Spiritual needs thus fall in the gaps. (Fitchett’s attempt to provide a holistic model of course seeks to avoid this, thus proving compatible with the gospel’s claim to speak to the whole of life and the human person.)
• On the other hand, if we take seriously the claim of spiritual needs to concern the whole of a person’s life then the danger becomes adopting a kind of implicit ‘cookie cutter’ theology — ‘needs’ are defined and determined on the basis of observation (or, if we’re realistic, on the basis of the concealed assumptions about what healthy functioning looks like), then we cast around for what aspects of the Christian message might fit with this. This is a recipe for disaster. What aspects of the message of the crucified and risen Messiah are going to be left out of this? What happens to the gospel’s claim to diagnose our needs — not just as Christians (or potential Christians) but also as human beings?

Maybe what we need is an unashamedly substantive and Christian model for spiritual assessment — one that allows the Holy Spirit to determine what counts as spirituality and spiritual needs — which is nevertheless flexible and holistic enough to recognise that a whole range of factors contribute to the way a person’s beliefs and values interact with their experiences and emotions…