Trauma Informed Spiritual Assessment
After reading Shelly Rambo’s Spirit and Trauma (2010), I have been reading about spirituality and trauma, especially in terms of spiritual care’s effect on mental health. One of the studies I read compiles some research showing spirituality is related to various improvements and resiliencies in mental health. The protective function of spirituality is measured in decreased in negative mood, a greater sense of personal growth and resolution of interpersonal violence “by mediating pathways of hope and self-acceptance,” decreased depressive symptoms, decreased suicidal thoughts and behaviors, decreased substance abuse behaviors, “increased psychological well-being including life satisfaction, positive affect, and higher morale” (Hipolito et al, 2014). Spirituality is “empowering,” they declare. Empowerment from a trauma-informed perspective “reflects people’s ability to successfully access the skills and resources needed to effectively cope and grow in the post-trauma period (Johnson, Worell, & Chandler, 2005)” (Hipolito et al, 2014).
The problem is that there’s not a lot of research as to how “spirituality influences well-being in the post-trauma period” (Hipolito et al, 2014). I wondered this myself. It sounds nice to say that spirituality helps, but how does it help? There are various theories and measures of spiritual fitness, often referencing connection to transcendence, morality, and an increased ability to construct hope. The Encyclopedia of Trauma: An Interdisciplinary Guide describes the five components of spiritual intelligence as “the capacity to transcend the physical and material, the ability to experience heightened states of consciousness, the ability to sanctify the everyday experience, the ability to use spiritual resources to solve problems, and the capacity to be virtuous” (Figley, 2012).
In the study I’m referencing here, they measured participants’ spirituality by their responses to questions like, “How often do you pray?” and their perception of the “transcendent (God, the divine) in daily life by reviewing statements like, “A feeling of deep inner peace or harmony (Hipolito et al, 2014). Both the Encyclopedia’s definition and the study’s way of analyzing spirituality are problematic however. First, they seem explicitly biased toward Christian spirituality. Can we compare Buddhist meditation, Muslim salah, and praying a Catholic rosary? Is the mere act of commitment to prayer the beneficial part or is there something intrinsic to the type of prayer that is beneficial? Furthermore, they qualify the perception of the transcendent in terms of experiences of “peace” and “harmony,” which just sounds like an extremely limited understanding of transcendent experiences.
It just seems clear that the frameworks have been designed ahead of the research. There are numerous models for spiritual assessment, but I don’t know of any that are specifically related to mental health outcomes. First it seems necessary to research the influence of spirituality on specific mental health issues (e.g., moral injury, depression, anxiety, PTSD, etc.), rather than broadly to mental health. Second, we need to find ways of assessing why prayer and meditation are effective so that spiritual caregivers can know what sorts of spiritual practices to encourage.
All of this will be extremely useful for chaplains creating a spiritual care plan. Once the spiritual assessment has been made, the chaplain needs to decide how to best support this person, and this needs to come from a place of peer-reviewed research that is also trauma informed.
An example of trauma informed spiritual care would be resisting the urge to ask the careseeker to retell their trauma history. Part of being a chaplain is offering a non-judgmental presence, and this presence may encourage a person to open-up. The chaplain may unknowingly encourage a survivor to re-tell their story and may unwittingly re-traumatize them. Chaplains may also encourage patients to close their eyes or they my try to hold their hand while praying, unaware that this might be an unsafe physical action for them.
All to say, it is encouraging that spirituality is correlated with resilience and improvements in mental health, but there is much research to be done. We need to know what aspects of or what types of spirituality are most effective, assess why they are effective, and then use that data combined with trauma informed care in order to provide chaplains the most effective form of spiritual assessment and care planning.
Bibliography
Figley, C., & Ebrary. provider. (2012). Encyclopedia of trauma an interdisciplinary guide (Gale virtual reference library). Thousand Oaks, Calif.: SAGE.
Hipolito, E., Samuels-Dennis, J., Shanmuganandapala, B., Maddoux, J., Paulson, R., Saugh, D., & Carnahan, B. (2014). Trauma-Informed Care: Accounting for the Interconnected Role of Spirituality and Empowerment in Mental Health Promotion. Journal of Spirituality in Mental Health, 16(3), 193-217.
Rambo, S. (2010). Spirit and trauma : A theology of remaining (1st ed.). Louisville, Ky.: Westminster John Knox Press.