Advances in Psychiatric Treatment (2007), vol. 13, 212–219 doi: 10.1192/apt.bp.106.

002774

Taking a spiritual history

Larry Culliford

Abstract The rationale for assessing the spiritual needs of psychiatric patients is examined as a prelude to
addressing the question of how to do this. A number of approaches are considered. The emphasis is
on varieties of practical history-taking suitable for the repertoire of every psychiatrist in training and
those engaged in CPD. Finally, some of the consequences of identifying spiritual needs in psychiatric
patients are discussed.

Spirituality links the deeply personal with the antecedents (or lack of them), but this is only one
universal (Culliford, 2002b). It has a lot to do with component.
individual subjective experience and, according
to the researcher David Hay, it is rooted in human
aware­ness (Hay & Nye, 2006). On the basis of Why take a spiritual history?
extensive studies involving both adults and children,
Hay reports persuasively that, rather than being a A few years ago in the pages of APT I discussed
social or cultural construction, ‘It is really there’ the relevance of spirituality to mental healthcare
(p. 18). ‘It’ can be thought of as a spontaneous and (Culliford, 2002a). The reasons for taking a spiritual
consistently operating communicating principle, history in psychiatry are complex. The more obvious
connecting individuals to one another via a seamless include:
and indivisible whole. This entirety exists as a • the very nature of spirituality as a source of
kind of sacred unity, and is referred to by some as vitality, motivation and a healthy sense of
‘creation’. The faculty of spiritual awareness appears belonging and being valued
better developed (or, according to David Hay, less • the long historical relationship between
completely atrophied) in some than in others. religion, medicine and mental healthcare
Unlike religion, which tends to be associated with • the patient’s needs and wishes
particular buildings, artefacts and scriptures, with • the epidemiology of spirituality/religion and
rules and commandments, with trained officials, mental health
repetitive ceremonies and dogma, spirituality might • the influence of spirituality/religion on the
be experienced as warmer and more spontaneous, attitudes and decisions of psychiatric staff.
associated rather with love, inspiration, wholeness,
depth and mystery; with personal devotion and Spirituality is universal, unique to every person.
meditation, rather than with collective prayer and It is essentially unifying and involves everyone,
worship. A person’s sense of spiritual connection is including those who do not believe in God or a ‘higher
with humanity at large, rather than with exclusive being’. Ellison has suggested that spirituality
or partisan groups. ‘enables and motivates us to search for meaning and
Spirituality and religion are obviously vitally purpose in life. It is the spirit which synthesises the
linked, and Hay uses metaphors to describe the total personality and provides some sense of energising
dynamic interaction between them: spirituality direction and order. The spiritual dimension does not
as a journey with the religions as different modes exist in isolation from the psyche and the soma. It affects
of transport; spirituality as the fuel enabling the and is affected by our physical state, feelings, thoughts
and relationships’ (Ellison, 1983).
machinery of religion to operate; spirituality as
the roots and trunk of a tree, of which the different Spirituality is thus supraordinate to, and an
religions are the branches and leaves. A spiritual integrating force for, the other hierarchically arranged
history should include details of a person’s religious dimensions of human life: physical, biological,

Larry Culliford is a consultant psychiatrist with the Sussex Partnership NHS Trust (Brighton Community Mental Health Centre, 79
Buckingham Road, Brighton BN1 3RJ, UK. Email: [email protected]) and a popular author as ‘Patrick Whiteside’
(see: http://www.happinesssite.com). A practising Christian with wide ecumenical and inter-faith interests, he is a member of the Scientific
and Medical Network (http://www.scimednet.org) and the International Thomas Merton Society (http://www.merton.org).

212
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 Taking a spiritual history

psychological and psychosocial (Culliford, 2002a,

2007). Nevertheless, it is a dimension that has, until Box 1 Key elements of spiritual care from the
recently, been neglected in both physical and mental patient’s perspective
healthcare (Swinton, 2001). This neglect can largely be • An environment fostering hope, joy and
ascribed to the secularisation of the culture in which creativity
the mainly science-based discipline of psychiatry • Being valued and trusted, treated with
has developed. respect and dignity
Secularisation is a complex word that in Western • Sympathetic and confidential listening
culture initially referred to the divorce of personal • Help to make sense of, and derive meaning
spirituality from organised religion. This initial from, illness experiences
position then led to secularisation of the intellect, • Receiving permission, encouragement (and
and in turn gave reason primacy over other major sometimes guidance) to develop spiritually
mental faculties: actions, sense perceptions, emotions
(Adapted from Nathan, 1997)
and, particularly, intuition.
This division, and the resulting imbalance among
these seamlessly and dynamically interrelated
faculties, became more extreme and entrenched, Box 2 Benefits of spiritual care
partly in response to the perceived conflict between • Healthy grieving of losses (letting go)
religion and science, for example in regard to • Improved self-esteem and confidence
evolutionary theory. In medicine and psychiatry, • Maximisation of personal potential
dualistic ‘either/or’ thinking continues to prevail • Improved relationships (with self, others
over the more holistic ‘both/and’ style (Culliford, and with the Absolute/God)
2007). Renewed balance is called for. • Renewed sense of meaning and purpose
Although opinion polls indicate that religious • Enhanced feeling of belonging
beliefs and practices are in decline, spirituality • Improved capacity for solving problems
remains strong (Hay & Hunt, 2000). The relevance • Insoluble problems, continuing distress and
of this for healthcare professionals and especially disability are more easily endured
for psychiatric staff is that at times of emotional • Hope renewed
stress, illness, loss, bereavement and death people (Adapted from Nathan, 1997)
confront what Buckley (1987: p. 360) has called ‘the
great issues of life’, that lie ‘far beneath the formal
separation of the sciences, and of the sciences from
the humanities’. the most important elements of ‘spiritual care’ and
In dealing with these weighty matters, mental the potential benefits such care may bring. Their
health professionals can best help themselves, their responses are summarised in Boxes 1 and 2.
colleagues in other disciplines and their patients A spiritual history is most clearly necessary when
by using ordinary language rather than religious spiritual or religious issues are part of the presenting
terminology. In this way they will hit spontaneously problem, for example in religious delusions, feelings
on what Nolan & Crawford (1997) call a ‘rhetoric of rejection (by God or a faith group) and excessive
of spirituality’. Taking a spiritual history involves guilt or shame. Although it is acknowledged that
engaging people as equals in enquiry and discussion, religion can have negative effects, confidence
using their own words, about what – at the deepest is growing in the benefits to both physical and
level – makes sense to them and what puzzles mental health of spiritual beliefs and practices. This
them, what motivates them and what holds them confidence is based on substantial epidemiological
back. This is the most direct way to get quickly to research of improving quality (Koenig et al, 2001;
the heart of whatever is troubling the patient. It Levin, 2001). These authors suggest that, whereas
coincides with the essence of good medical practice: 20% of studies report negative effects, 80% identify
two people, doctor and patient, engaged in genuine spiritual/religious beliefs and practices as beneficial,
and meaningful communication about what matters not so much part of the problem as part of the remedy
most. It seems worth adding that both may gain (Box 3).
from the encounter. The influence of spirituality/religion on the
It is not surprising that, where spirituality is attitudes and decisions of psychiatric staff is also
concerned, patients’ needs and wishes coincide complex. Although curricula exist (Puchalski &
(Faulkner, 1997). As Greasley et al (2001) note, Larson, 1998), in the UK the topic has seldom been
spirituality is a vital concern for most service users. taught as part of professional training as it needs
In a study of spiritual care in mental health practice, to be: in terms of knowledge, skills and attitudes.
Nathan (1997) asked psychiatric patients to describe When individual views on the subject have been

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 Culliford

approach is recommended. More than one

Box 3 Positive effects of spirituality and conversation may be necessary.
religion on mental health
• In addictions (e.g. Alcoholics Anonymous Brief screening
and similar groups using the 12-step
method) Notwithstanding the ideal of thoroughness, it is
• Enabling of inner resources (e.g. sources of sometimes necessary to make rapid assessments of
hope and calm) psychiatric patients. At such times, two main types
• Connecting or reconnecting with external of question are useful:
resources (e.g. within the person’s faith
• ‘Are you particularly religious or spiritual?’
community)
• ‘What helps you most when things are difficult,
when times are hard?’ (for example when
facing big problems, major losses or important
challenges).
canvassed, it is not surprising that mental healthcare
professionals’ attitudes towards spirituality have The first question might lead the psychiatrist
tended to be negative (Neelman & King, 1993). to ask the patient more directly whether they are
At one extreme, any expression of religiosity or atheist, agnostic, unsure, religious or ‘spiritual but
spiritual awareness might automatically be deemed not religious’ (Box 4).
psychopathological. Routinely taking patients’ The patient’s reply to the second question usually
spiritual histories, and becoming more skilful at points to the principal values they hold and to what
doing so, will provide staff with both information is most meaningful in their life, and is indicative
and material for reflection. The experience and of their major spiritual concerns and practices
knowledge thus gained will help correct any (Box 5).
previously held attitudinal bias. Supplementary non-directive questions may be
At the other extreme, caring efficiently and necessary, for example ‘Would you like to say more
compassionately for disadvantaged others can about that?’
legitimately be experienced vocationally, as part
of a sacred and undeniable calling. Many mental
health workers consider themselves to some degree
Box 4 Suggested definitions for spiritual
spiritually guided. For these, the taking of spiritual
identities
histories will be an expression of spiritual caregiving,
and therefore fulfilling in itself, as well as being a Atheist To be atheist is emphatically to deny
necessary preparation for dealing appropriately with the existence (even the possibility)
patients’ spiritual needs. The benefits of assessing of a sacred being, supreme reality,
spirituality are therefore many and widespread. god or other deity
Agnostic To be agnostic is to assert that we
cannot truly know about the exist-
How to take a spiritual history ence or otherwise of a sacred being,
supreme reality, god or other deity
Taking a spiritual history is best thought of as a Unsure To be unsure is not to know what
clinical skill to acquire and hone, rather than as an one believes about a sacred being,
activity to be performed by recipe or rote. It is a skill supreme reality, god or other deity
that requires empathic engagement with the patient, Religious To be religious is to believe and have
which therefore sanctions the judicious use of both faith in a sacred being, supreme
intuition and initiative on the part of the assessor. reality, god or other deity, and/or
This may lead, for example, to sensitive exploration to belong to and practice within an
of what the patient only hints at or seems to be organised religion (people might
avoiding. Such exploration is to honour and uphold see themselves as both religious
the spiritual values of truth and truthfulness, the and spiritual)
enemy of which is concealment, whether conscious Spiritual To be spiritual (but not religious) is
or otherwise. It is important to seek to avoid witting to believe and have faith in a sacred
or unwitting collusion with the patient. It is therefore being, supreme reality, god or other
wise always to be reasonably systematic and, thereby, deity, but to be independent and
thorough. not belong to or practise within an
The interview works best in a comfortable, quiet organised religion
and confidential setting, and a gentle, unhurried

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 Taking a spiritual history

Box 5 Common spiritual practices Box 6 Some types of spiritual experience

Mainly religious • Mystical experiences (broadly defined)
• Belonging to a faith tradition, participating • Near-death experiences
in associated community-based activities • Twelve-step spirituality (as in Alcoholics
• Ritual and symbolic practices and other Anonymous and similar programmes)
forms of worship • Dreams
• Pilgrimage and retreat • Psychedelic (drug-induced) states
• Meditation and prayer
• Reading scripture
• Sacred music (listening to, singing and
playing), including songs, hymns, psalms an aides-memoire rather than exact prescriptions.
and devotional chants Here I will mention only five of these.
In the first, published by the Spiritual Competency and
Mainly secular
Resource Centre (http://www.spiritualcompetency.
• Acts of compassion, in everyday life and as
com/assess_spirit/ASrshx.asp), questions focus
part of one’s work, especially teamwork
on: religious background and beliefs; spiritual
• Deep reflection (contemplation)
meaning and values (e.g. spiritual practices (Box
• Yoga, tai chi and similar disciplines
5) and spiritual experiences (Box 6)); and prayer
• Engaging with and enjoying nature
experiences.
• Contemplative reading (of literature, poetry,
Second, in her guide to the assessment of spiritual
philosophy, etc.)
concerns in mental healthcare, Eagger (2005) lists
• Appreciation of the arts and engaging
some simple, non-intrusive questions that can
in creative activities, including artistic
inform the care team’s approach. These look, for
pursuits, cookery, gardening, etc.
example, at the place of spirituality or religion in the
• Maintaining stable family relationships and
patient’s past and present, the nature of its influence
friendships (especially those involving high
(positive or negative, supportive or excluding) and
levels of trust and intimacy)
whether they affect the patient’s acceptance of and
engagement in treatment
Third, the leaflet Spirituality and Mental Health
An appropriate next step, even in a brief screening, (Royal College of Psychiatrists, 2006) suggests five
would be to ask in more detail about spiritual prac­ broad areas of questioning: setting the scene; the past;
tices. Regularly engaging in such activities identifies the present; the future; and remedies. These gather
a person as spiritually engaged as much as does a picture of how patients see themselves, their place
holding and expressing spiritual or religious beliefs. and purpose in life and their future, and ask whether
Listing one or more ‘mainly secular’ spiritual practices spirituality or religion are part of the problem and
may give cause to people who describe themselves could be part of the solution.
as atheist, agnostic or unsure to reconsider their self- Fourth, in an article aimed at healthcare pro­
assessment, and – whatever beliefs they have – to fessionals in general, Puchalski & Romer’s (2000)
begin to accept themselves as in some way ‘spiritual’ guide to taking a spiritual history uses the mnemonic
and therefore spiritually influenced. FICA:

• Faith and belief (what gives the patient’s life

Taking a more detailed spiritual history: meaning)
• Importance (how important this is to their
five approaches situation)
A brief screening will often indicate that a more • Community (their place in any social or
detailed history is required to establish relevant religious group)
aspects of the patient’s background, specific problems • Address in care (how they would like their
related to spirituality or religion, available spiritual beliefs to be addressed in their healthcare).
supports and additional spiritual needs.
Finally, another tool for spiritual assessment is the
Various authorities have separately designed
HOPE questions (Anandarajah & Hight, 2001). The
guidance on assessing the religious and spiritual
mnemonic HOPE directs the assessor’s attention to
aspects of people’s lives. However, they are fairly
four areas of the patient’s life:
uniform regarding the topics covered. This allows
practitioners to pick the style with which they feel • sources of Hope, meaning, comfort, strength,
most comfortable. Guides tend to take the form of peace, love and connection

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 Culliford

• Organised religion primary concerns and motivating factors – deepens

• Personal spirituality and Practices rapport and improves its quality. Feeling valued as
• Effects on medical (psychiatric) care, and End- individuals, patients often relax and invest further
of-life issues. trust in the doctor, thus improving the therapeutic
alliance.

After taking a spiritual history, Clarifying psychotic symptoms

what next?
There are two main ways in which taking a spiritual
Formulation history can help clarify psychotic symptoms.
First, it helps distinguish ‘spiritual emergence’ from
Formulation is the term used in psychiatry for
psychosis. Originally called ‘spiritual emergency’,
summarising and making sense of information
this refers to a destabilising period of rapid spiritual
gathered and observations made while taking a
growth (Vega, 1989; Grof, 2000; Slade, 2004).
history, examining the physical and mental state of
Second, existential questions such as ‘What is the
the patient and conducting specific biophysical and
purpose of my life?’ are conundrums that become
psychological tests. Formulation is not a goal or end-
problematic for many. Religious grandiosity of
point. Its primary purpose is to assist the patient.
delusional strength may be a powerful but immature
Formulation is a skilled process that helps clarify
defence against meaningless insignificance. As
where an assessment is incomplete and therefore
part of a psychotic reaction, such symptoms may
what useful information remains to be gathered.
be common to those feeling particularly unworthy
Most formulations are therefore provisional, and
or unloved, and their religious content hints at a
should be revised regularly as observations continue
spiritual solution.
and information develops.
To be psychotic and consider oneself divine is
The simplest type is the diagnostic formulation.
satisfying only narcissistically, through a false inner
Once the diagnosis is reasonably established,
sense of supremacy. It does get people’s attention,
short-term treatment plans can be devised and
however, in a way that, often accompanied by
implemented. Depending on their outcome and other
corresponding feelings of persecution, may foster
developments, medium- and long-term treatment
the individual’s sense of grandiosity. It is better that
plans will follow. Some refer to this diagnosis–
such a person, when well enough, is encouraged to
treatment approach as invoking the medical model
understand the true origins of their distress and work
of mental healthcare.
towards more modest, mature and acceptable ways
A more comprehensive, and therefore preferable,
of gaining meaning, recognition and satisfaction in
approach involves the bio-psychosocial type
daily life. This mirrors the cognitive–behavioural
of formulation, in which problems and their
therapy approach but with an extra dimension. Only
solutions are sought under headings involving three
what may be called ‘spiritual sustenance’ will be
dimensions of human experience. This is a big step
effective against the degree of insignificance and
towards holism, towards considering the symptoms
all-consuming meaninglessness that can be at the
and problems in the context of the whole person,
heart of psychotic and other disorders. Pastoral or
and the person in the context of family, community
spiritual support and spiritual practices may both
and culture. Including a spiritual history allows
appropriately be recommended in such cases.
this process to be completed, through what may
be referred to as a bio-psychosocio-spiritual (BPSS)
formulation (the terms psychospiritual, person- ‘Psychoneuroses’
centred and holistic are also used).
The BPSS formulation still has as its primary Anxiety and depression are key elements in a range of
purpose the well-being of the patient, acting as a non-psychotic psychiatric disorders, particularly the
guide to clinicians’ planning and execution of helpful ‘psychoneuroses’. Another universally experienced
interventions. existential problem derives from emotional
attachments. As soon as these are formed, they
render people vulnerable to the threat of loss and
How may a spiritual approach to loss itself.
Anxiety, bewilderment and doubt are emotions
contribute to patient welfare? associated with the threat of loss. Anger, the emotion
Better rapport of resistance, arises as loss becomes more likely and
imminent. Depressive emotions – shame, guilt and
Clinicians regularly discover that taking a spiritual sadness – emerge when a loss increasingly becomes
history – enquiring attentively about patients’ an acknowledged reality (Culliford, 2007).

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 Taking a spiritual history

Box 7 Useful websites and webpages

• Spiritual Competency Resource Center http://www.spiritualcompetency.com/index.asp
• Royal College of Psychiatrists’ Spirituality http://www.rcpsych.ac.uk/spirit
and Psychiatry Special Interest Group
• George Washington Institute for http://www.gwish.org/index.htm
Spirituality and Health
• American Academy of Family Physicians: http://www.aafp.org/afp/20010101/81.html
Anandarajah & Hight’s (2001) paper on
using the HOPE Questions
• Alcoholics Anonymous http://www.alcoholics-anonymous.org.uk
• Narcotics Anonymous http://www.ukna.org
• Gamblers Anonymous http://www.gamblersanonymous.org.uk
• University of Minnesota’s Center for http://www.csh.umn.edu/modules/index.html
Spirituality and Healing (online learning
about spirituality in healthcare and free
module on taking a spiritual history)

Taking a spiritual history involves enquiry about a The heart of a programme of personal recovery
person’s primary attachments, whether to a spiritual is contained in twelve steps that describe the
reality, to family and other loved ones, to places and experience of the earliest members of Alcoholics
objects, or to ideas and ideals. Identifying the major Anonymous (http://www.alcoholics-anonymous.
attachments, and the spectrum of emotions arising in org.uk/geninfo/05steps.shtml).1 Newcomers are
response to threatened and actual loss, encourages not required to accept or follow the twelve steps
emotional flow towards acceptance and resolution. in their entirety if they feel unwilling or unable
Taking a spiritual history is therefore intrinsically to do so. The key step for addicts is to recognise
therapeutic. It helps to clarify for the patient that and respect some form of spiritual reality, manifest
these emotions are normal and healthy, part of their particularly as a higher power: ‘Soon we came to
pathway to psychological growth and maturity believe in a power greater than ourselves’ (http://
through the acceptance of losses and resolution www.gamblersanonymous.org.uk/young.htm).
of the emotional healing process (Culliford, 2007).
This reflects another principle of spirituality, that
personal growth results more often through facing
Others disorders
and enduring adversity, rather than from trying to Psychiatrists see a number of other conditions that
avoid it. might have a spiritual element in their aetiology.
In some cases of severe anxiety and/or depression, Absence or removal of meaning and sense of purpose
there is a profound sense of meaninglessness and affect drive and motivation. Having a damaged sense
personal insignificance, as described above. Spiritual of belonging affects self-esteem and a person’s true
advice and support may again appropriately be and healthy sense of identity. These elements may
recommended, and spiritual practices helpful. occur, for instance, in personality disorder, eating
disorder and chronic fatigue syndrome, as well as
in disorders already mentioned here. There may be
Addictions
persistent psychological resistance to loss, in the form
The value of a spiritual approach is specifically of intense anger, often denied and either repressed
acknowledged by those who advocate or follow or more consciously suppressed. Enquiry into these
the twelve-step method of dealing with addiction. central and vital aspects of a person’s life is part of
The best known organisations to use this approach spiritual history-taking, and it offers an important
are Alcoholics Anonymous (where it originated), opportunity to reframe the problem in terms that
Narcotics Anonymous and Gamblers Anonymous. may lead to reintegration and healing.
Narcotics Anonymous, for example, describes itself
as ‘a non-religious fellowship, encouraging each 1. The twelve steps of Alcoholics Anonymous have been
member to cultivate an individual understanding, published in a previous issue of APT: see Luty, J. (2006)
religious or not, of a spiritual awakening’ (‘What is What works in alcohol use disorders? Advances in Psychiatric
Treatment, 12, 13–22. Ed.
NA?’, http://www.ukna.org).

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 Culliford

Involving chaplaincy services In answer to Hay’s question then, what is ‘really

there’ is a spiritual dimension of human experience
Sensitive enquiry is in itself helpful for patients whose that provides the context for everything else. For
needs and problems have a spiritual dimension, those with any measure of spiritual awareness,
and it may allow them with greater clarity and this is both the source and the goal of existence.
efficacy to fulfil their own needs and find their own To take systematic and detailed spiritual histories
solutions. However, they may seek spiritual support regularly will enable practitioners to rekindle mythos
and guidance, and therefore be in need of pastoral in medicine and put the psyche back into psychiatry.
care. Referral to a chaplain or pastoral care advisor The psyche, of course, is our soul.
is often appropriate. Such a referral is necessary if
more complex issues such as spirit possession are
involved. Declaration of interest
L.C. is on the Executive Committee of the Royal
Chaplaincy College of Psychiatrists’ Spirituality and Psychiatry
Special Interest Group.
After psychiatric staff have taken a spiritual history
from a patient, a well-informed and experienced
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†
Collaboration between psychiatric and religious professionals Puchalski, C. & Romer, A. (2000) Taking a spiritual history allows
has been discussed briefly in an earlier APT article: Dein, S. clinicians to understand patients more fully. Journal of Palliative
(2004) Working with patients with religious beliefs. Advances Medicine, 3, 129–137.
in Psychiatric Treatment, 10, 287–294. Ed. Royal College of Psychiatrists (2006) Spirituality and Mental
Health. Royal College of Psychiatrists. http:/www.

218 Advances in Psychiatric Treatment (2007), vol. 13. http://apt.rcpsych.org/

https://doi.org/10.1192/apt.bp.106.002774 Published online by Cambridge University Press
 Taking a spiritual history

rcpsych.ac.uk/mentalhealthinformation/therapies/ 4 Practical ways of taking a spiritual history include:

spiritualityandmentalhealth.aspx a� the HOPE questions
Slade, N. (2004) Heavenbound. In Spirituality and Mental Health:
b� the Minnesota Multiphasic Personality Inventory
Breakthrough (eds P. Barker & P. Buchanan-Barker), pp. 167–
190. Whurr. c� the Royal Free Interview for religious and spiritual
Swinton, J. (2001) Spirituality and Mental Health Care: Rediscovering beliefs
a Forgotten Dimension. Jessica Kingsley. d� the Mini-Mental State Examination
Tacey, D. (2006) Spirituality and the future of health. Journal of e� The twelve-step method.
the Scientific and Medical Network, 91, 7 –10.
Vega, S. (1989) Spiritual Emergence or Psychosis? http://www.
spiritmoving.com/papers/SpiritPsychosis.htm
5 A psychospiritual assessment may help patients by:
World Health Organization (1998) WHOQOL and Spirituality, a� resulting in a miraculous and instantaneous cure of
Religiousness and Personal Beliefs: Report on WHO Consultation. symptoms
WHO. b� encouraging them to pray regularly
c� identifying specific spiritual practices that they should
undertake regularly in addition or as an alternative
MCQs to prayer
d� leading to an appropriate referral for pastoral care and
1 Spirituality:
spiritual support
a� is something that applies only to a few special
e� encouraging passive acceptance in the face of divine
people
will.
b� comes to the fore at times of emotional stress, loss and
the threat of loss
c� bears limited relationship to a person’s physical state,
feelings, thoughts and relationships
d� usually divides people and is a source of conflict
e� depends on holding strong religious convictions.

2 Taking a spiritual history:

a� serves no useful purpose
b� does not require empathic engagement
c� concentrates on a person’s beliefs
d� should only be undertaken by chaplains or ministers
of religion
e� can be therapeutic for the patient. MCQ answers
3 Spiritual practices:
1 2 3 4 5
a� are mainly religious activities
a F a F a F a T a F
b� do not include everyday activities such as gardening
or walking in the country b T b F b F b F b F
c� tend to heighten a person’s spiritual awareness over c F c F c T c F c F
time d F d F d F d F d T
d� require repetition and ritual to be effective e F e T e F e F e F
e� can only be undertaken in groups.

Advances in Psychiatric Treatment (2007), vol. 13. http://apt.rcpsych.org/ 219

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