SPIRITUAL ASSESSMENT TOOL
S – Spiritual History
What were the spiritual/religious beliefs and practices of your parents, if any?
What were the most important spiritual beliefs in your family, if any?
How do these beliefs or practices impact you today?
What people, events, ideas, books, etc. have most influenced your views of life?
P – Present Spiritual Environment
Have your spiritual and/or religious beliefs changed since childhood?
What events or experiences influenced this change, if any?
What is the spiritual orientation of your significant other(s)?
Do you and your significant other(s) share a similar spiritual orientation?
In what do you have faith?
What spiritual beliefs/practices are currently most important to you on a regular basis?
I – Important Life Experiences & Meaning
What gives your life meaning?
How have you mattered to others?
To whom do you currently make a difference?
What is your greatest hope?
What nourishes you or gives you strength?
How do you maintain a sense of hope?
What has been a peak experience in your life?
What do you still hope to get out of life?
What is life still expecting of you?
When do you feel most whole or centered or fulfilled?
How has your life been significant?
What is especially meaningful to you now?
What do you believe your purpose in life is?
R – Religious Practices & Concepts of God
Do you believe in a Supreme Being or Higher Power(s)? What does your belief mean to you?
Do you have a specific religious affiliation? Specify.
What does religion mean to you?
Do you participate in religious activities and practices (i.e., attend services, pray, rituals)? If so, how frequently? What impact do these practices have on your life?
Do you find prayer or other practices helpful/important to you? What do you pray for?
Are your religious beliefs and practices of support to you?
What religious beliefs are currently most important to you?
What is sacred or holy to you?
What do you believe about death?
Do you believe in life after death? What do you believe it will be like?
What religious books, practices, or rituals are important to you?
What lifestyle practices are encouraged or forbidden by your religion?
How would God/higher power/cosmos describe you?
I – Inspiration, Hope & Strength
What is most helpful and beneficial to you about your current spiritual beliefs and practices?
Who or what comforts and encourages you most in life?
Who or what inspires or motivates you?
Do you have any other beliefs or philosophy of life which help you? Describe.
To who or what do you turn for help, strength or hope? In what ways are you helped?
What helps you when you are afraid?
Where or with whom do you feel connected?
What aspects of your religion/spirituality would be helpful for me to know in treating (caring for) you?
What does your faith/belief system say about trials and hope?
Do you have other sources of spiritual/religious supports that I have not yet asked about?
T– Troublesome Concerns
Do any of your spiritual or religious beliefs concern you in any way (i.e., feel restrictive or contribute to guilt, anger, blame)?
Is forgiveness something you need to receive or give at this time?
What spiritual or religious issues, if any, have caused problems/concerns in your life?
What do you fear?
What do you worry about?
Describe the beliefs or practices you do not accept or find helpful.
Do you have other concerns that would be helpful for us to know?
Where do you feel stuck?
Have you thought about what you hope for not occurring? Tell me about that?
L– Link between Spirituality & Health
What has troubled you about being sick (or about what has happened to you)?
How do you answer the question “why”?
What meaning do you give to what has happened to you (or to your illness)?
How has your illness (what has happened to you) impacted your beliefs?
What do you believe will happen to you in the future?
What do your faith/beliefs say about trials, suffering and sickness?
What do you want to accomplish through your illness/what has happened to you?
Tell me about an experience that has stood out for you during your experience/illness?
What does wellness mean to you?
Debra Mattison, LMSW, ACSWBarbara Giles, LMSW, ACSW
University of Michigan Health SystemJewish Home & Aging Services
Ann Arbor, MichiganWest Bloomfield, Michigan
updated 10/2007