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…

10 comments

  1. Yes lets get real about it. I had to look up the word substantive and argument seemed a little esoteric to me- substantive vs. functional. Can yo put this in plain english for those less inclined?
    I liked the comment about we as chaplains often get, ” to deal with the leftovers areas of expertise.” Recently I was at a patient RPR where the pschologist gave an assesment of where the patient was in their grief process. If they take grief away from us too what is left?
    Are you still using the Highfield-Cason model? Have to look this one up.
    Thankyou.

    1. Hi Mike. Thanks for taking the time to comment. I initially wrote this piece for a course I was enrolled in — which may account for some of the word choice and difficulty tracing my line of thought (I was trying to summarise an article and then give a measured response).

      And thanks too for sharing about your experience with that psychologist. Sounds frustrating!

      I guess that’s often the problem with these models. Someone develops a model in order to help us get a handle on a very difficult experience that everyone goes through differently. They want to describe what seem to be common stages different people go through — so that we can make allowances and not rush anyone along or expect everyone to ‘get over it’ (a terrible phrase) at the same pace. But then we end up using the model to enforce what ‘normal grieving’ should look like.

      I don’t consciously draw on Highfield-Cason these days. But I do still spend a lot of time thinking about how the things we do and see express deep needs — for love and acceptance, for a sense of meaning or direction, or for the feeling of having at least some things in control.

  2. Thanks Chris. That helps to put it into perspective. Are you doing CPE?
    I did CPE last year at a mental health facility. One of the BCCI +certification questions I looked at asks for a current assesment model.
    Christian model? It would be tough in a state institution to openly practice a Christian model of assesment. I do believe in the work of the Holy Spirit- which in my opinion acts within and outside of Christian tradition.
    Thich Nhat Hahn-“Living Buddha-Living Christ.” Craig Rennebohn has some nice thoughts on the Holy Spirits work also. I will look up Highfield-Cason.
    Mike.B

    1. Hi Mike. I did an introductory CPE course (not the full thing) a few years ago — while I was a part-time intern with a hospital chaplain. I also spent a very profound month working with another chaplain in mental health.

      Now I work with a university Christian group. I’ll definitely look up those authors you mention — our campus ministry is planning to spend a week in the middle of the year engaging with who the Holy Spirit is and what he does. Thanks.

    1. Hi Mike. I haven’t thought about it for a while now. It was just something I observed when visiting long-term patients in hospital.

      I guess at a very sketchy surface level, it raises questions for me about how much we value productivity — or even just activity! And how much we wrap up our identity with this. In this case, we might need to learn to respond — and to help others respond — to boredom in a way that moves beyond this.

      I know that God is a worker/producer. But he is more primally a relater/lover. Remember he was Father, Son and Spirit before he became the Creator. And so while it’s perfectly right to affirm the dignity of work/productivity — and mourn when our ability to do so is eroded. It may also help us see that there’s meant to be more to us than this.

  3. Sometimes a great meal is had from leftovers … Mike, I appreciated your analysis of George’s 7X7 Model. I’ve been using it since the mid-90’s when it was still in its working draft. Rather than see the assessment tool as an instrument that identified disfunction or malady, I’ve always appreciated the model’s ability to help me better understand what was important to the person I was seeking to connect with. Using the tool helps me to bolster the spiritual strengths and supports inherent in the person, while also better understanding what their goals and desires were. All models are incomplete constructs of a person, but they can still be a helpful manner of our grappling with the complexity of personhood.

  4. Mike,

    Without moving overly much into an evangelical stance, boredom is perhaps the indicator that we are either depleted in the Spirit (burnout) and in need of renewing and reflective time, or that we are not using our gifts in the way most desired by God (our Calling) … just a thought ….

  5. Thanks for the comments, Phil!

    I’m not sure if you’re addressing them to the Mike/s who comment above or to me (the post’s author). But I appreciate your input about boredom.

    If you’re right about the two possible causes you suggest — (i) needing spiritual renewal and reflection, and (ii) needing to use our gifts in the way God desires/calls us to — then that would help explain why it can be such a big deal especially for long-term patients in a hospital.

    There’s lots that can be depleting about being institutionalised for a long period of time — you lose control of your rhythms and routines … and sometimes even your basic bodily functions. Even the most robust and buoyant people I met when hospital visiting would struggle at times with impatience and frustration (‘I just want this to be over!’).

    Likewise, aligning our gifts with our sense of God’s call is challenging enough at the best of times — let alone when we’re renegotiating our sense of gifting in light of changed circumstances, like impaired ability! There’s the whole added issue of not knowing what God’s calling us to — or how we’re supposed to achieve it — now that we’re stuck in hospital.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s