Taking a ‘Spiritual History’ Appropriate, Social Workers Told

NEW YORK—Integrating spirituality into oncology social work practice is appropriate, feasible, and necessary, said Mary Ellen Summerville, CSW, MDiv, program coordinator of the Spirituality Program at Cancer Care, Inc. She told oncology social workers attending a Cancer Care seminar that they can and should help their clients with these issues.

“If we listen closely, all of us can hear the spiritual concerns of our patients woven in and out of the things they talk to us about,” she said. “They’re struggling with the reality of emotional and physical suffering, death, and issues of meaning. ‘Why am I suffering?’ ‘Why are all these other people I see at radiation treatment suffering?’ ‘Is there a purpose for all of this?’ ‘What is the nature of God?’”

Defining Spirituality

If social workers are not trained to deal with questions like these, she said, “then our only response is, ‘Somebody call the chaplain.’ That is an appropriate response, but there are other things we can do before, or in addition to, calling for the chaplain.”

Ms. Summerville defined spirituality as the need for and the experience of meaning, purpose, and connection. Social workers should focus on how each individual meets or does not meet these needs, and can start by taking a “spiritual history,” she said.

She discussed two levels of assessment that she developed based on the work of J.W. Fowler (Stages of Faith: The Psychology of Human Development and the Quest for Meaning, Harper & Row, 1981). Fowler suggested that there are developmental stages of spiritual growth and that growth occurs, in part, through crisis.

The first routine assessment should be done with all clients: What are the person’s spiritual beliefs and values? What spiritual or religious groups do they belong to, and do they have spiritual practices that help them cope, such as attending worship services, reading, meditating, watching religious programming, or taking nature walks?

The second assessment examines the person’s spiritual outlook in more detail: What were the patient’s early religious and spiritual experiences? What is the person’s understanding of key spiritual concerns such as the ultimate meaning and purpose of life, mortality, and good and evil? Which part of the person’s religious or spiritual outlook means the most to them and which may be causing confusion during their illness?

The ultimate goal of these assessments, Ms. Summerville said, is to come to some overall impression of the resources that a patient’s spirituality provides for coping, and to help reduce their suffering if they are in spiritual crisis. But she cautioned that not all cancer patients will have a spiritual crisis. Even though their life may be in crisis because of the cancer, they may be secure in their spirituality.

Most social workers already have enough training to deal with a patient’s spiritual concerns, she said. They should use their basic psychosocial skills of empathic listening, exploration, clarification, and validation of feelings. They can educate their clients that spirituality, broadly defined, is a widespread human need and that crisis can be a part of a person’s spiritual development.

Social workers should also be open to sharing spiritual experiences such as prayer, meditation, guided imagery, and ritual, she said, and they should try to reframe spiritual conflict in terms of a more adaptive aspect of a client’s tradition. “For example,” she said, “if a client tells me he can’t be angry with God, I would tell him about the biblical story of Job and how he contended with God. Or if he is a Christian, we can talk about Jesus asking why God has forsaken him.”

Most important of all, a social worker should be authentic and truly able to empathize with a clients’ struggles, Ms. Summerville stressed, and not offer easy answers.

Social workers must also be able to manage their own feelings about spiritual issues. “Spirituality is not just for our patients. It is important that we pay attention to our own spiritual beliefs, needs, and development,” she said.

Ms. Summerville said that, in some ways, many oncology social workers have an accelerated rate of spiritual development. “We start to be confronted with a heavy dose of crisis at a young age,” she said. “We may go through periods where we are feeling tremendously upset and angry, and we may question our own spiritual beliefs. ‘How can this be happening to people?’”

Some people withdraw from the field at that point or they withdraw emotionally from patients in order to cope, Ms. Summerville said. “But if we are going to stay in there with people, we are going to have to find a way of making meaning out of suffering, and, like our clients, we are going to have to go through stages of spiritual development.”