Mitigating Existential & Spiritual Distress: Part III Listening & Assessment Tools
- Jun 6, 2025
- 8 min read
Spiritual Direction in the Journey of Illness
Person As Patient: Though I stand at heaven’s gate, holding onto a remembrance yet feeling far from it waiting for a miracle, within the chalice of pain I encounter God as my brokenness longs in longing to be redeemed from this immanent of experience.
Person As Spiritual Director Caregiver: Traveling into the inner world of unknown darkness of another, I hold onto the light of life, keeping a vigil listening for the far off rumbles and catching the echoes of their past hopes for Thy to be resurrected again in our hearts.
GOAL FOR HEALING
Reconnecting, Reassessing, Renewing, Regenerating.
Listening & ASSESSMENT TOOLS
These assessment tools, though used as a checklist - for example logged into a patient chart by a chaplain, for the spiritual directors its use is as an internal framework to notice and discern what’s emerging in your directee’s story over time. Here is where the goal is not diagnosis but deep listening, accompaniment, and discernment.
Assessment tools are designed to elicit what are beliefs, values, practices that are supportive to the patient that have been and or are meaningful.
• Spiritual screening - Do you need to see a priest, chaplain, spiritual director?
• Spiritual history - the process of interviewing a person, those who have become a patient, to have a better understanding of their needs and resources (FICA)
• Spiritual assessment –is defined as the ongoing process of active listening to the patient's story as it unfolds in the relationship and summarizing the needs and resources that emerge in the process, and summarizing a care plan with expected outcomes to address spiritual distress to support well-being.
INFORMAL SPIRITUAL ASSESSMENT
Informal spiritual assessment can occur at any time during an encounter with a a person, those who have become a patient. People use symbolic and metaphorical language when expressing their spiritual thoughts. The spiritual assessment often involves listening carefully to the stories regarding their lives and illness. The themes that emerge are the search for meaning, feelings of connection versus isolation, hope versus hopelessness, and fear of the unknown, which are clues that they may be struggling with spiritual issues.
FORMAL SPIRITUAL ASSESSMENTS
INITIAL 'HOPE' ASSESSMENT
Categories and Suggested Questions:
H – sources of hope – meaning, comfort, strength, peace, and connection
O – organized religion
P – personal spirituality and practices
E – effects on medical care and end of life issues
H: Sources of hope, meaning, comfort, strength, peace, love and connection
• We have been discussing your support systems. I was wondering, what is there in your life that gives you internal support?
• What are your sources of hope, strength, comfort and peace?
• What do you hold on to during difficult times?
• What sustains you and keeps you going?
• For some people, their religious or spiritual beliefs act as a source of comfort and strength in dealing with life's ups and downs; is this true for you?
• If the answer is “Yes,” go on to O and P questions.
• If the answer is “No,” consider asking: Was it ever? If the answer is “Yes,” ask: What changed? O:
Organized religion
• Do you consider yourself part of an organized religion?
• How important is this to you?
• What aspects of your religion are helpful and not so helpful to you?
• Are you part of a religious or spiritual community? Does it help you? How? P: Personal spirituality/
Practices
• Do you have personal spiritual beliefs that are independent of organized religion? What are they?
• Do you believe in God? What kind of relationship do you have with God?
• What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, meditation, reading scripture, attending religious services, listening to music, hiking, communing with nature)
E: Effects on medical care and end-of-life issues
• Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?)
• Is there anything that I can do to help you access the resources that usually help you?
• Are you worried about any conflicts between your beliefs and your medical situation/care/decisions?
• Would it be helpful for you to speak to a clinical chaplain/community spiritual leader?
• Are there any specific practices or restrictions I should know about in providing your medical care? (e.g., dietary restrictions, use of blood products)
HOPE ASSESSMENT MULTI- MODEL
Four areas for Assessments, Questions, Outcomes
1. Concept of the Holy
2. Self/Illness
3. Support System
4. Hope
HOPE SUMMARY
HOPE: Assessment
• Is there a future?
• What does it hold for person?
HOPE: Questions
o What are you most looking forward to?
o What helps you when you are feeling blue?
o How do you comfort yourself?
o If the patient speaks of fear of dying…What specifically are you afraid of?
HOPE: Outcomes
• Gains perspective on current situation
• Achieves clarity about problem areas
• Reaches general sense of well-being
'CONCEPT OF THE HOLY' ASSESSMENT
THE HOLY: Assessment
• What does person as patient hold sacred. Or is in awe of.
• Is there an awareness of the holy. Faith.
• Does person consider grace, blessings, and sense of the generous.
• Salvation: ability to move from darkness toward light, well-being, wholeness
THE HOLY: Questions
o Do you have a sense of where God is in all of this?
o How has your relationship with God sustained you?
o Are there spiritual or religious practices that have been especially helpful?
THE HOLY: Outcomes
• Repentance: ability to move from anguish/sins toward well-being and forgiveness
• Identify chaplain as a safe person who will support a relationship with the Holy
• Access relationship to God/The Holy/the higher power
• Encourage/reinforce their use of religious and spiritual practices
'SELF/ILLNESS' ASSESSMENT
SELF/ILLNESS: Assessment
• Ability to trust
• Ability to mourn and re-engage
• Ability to create/make meaning
• Ability to progress through life’s developmental phases
• What is the nature of patient’s relationship to the crisis
Victim? Conqueror? Fear? Acceptance?
SELF/ ILLNESS: Questions
o What is giving you strength to cope right now?
o What is the hardest thing about this time for you?
o How have you dealt with previous loss, disappointment, illness?
SELF/ILLNESS: Outcomes
• Access inner resources for healing
• Access convictions and regain direction and energy for healing
• Clarify problem areas
• Identify options
'SUPPORT' SYSTEM
SUPPORT SYSTEM: Assessment
Significant Others
• Potential to learn about God, the Holy, through personal relationships
• Ability to explore significance of difficult relationships such as estrangement, divorce, loss Community
• In which person finds meaning in relationship to ultimate values
• Spiritual home-place of comfort
• Accountability-place to matter in the larger world
• Significant religious/spiritual practices
• Place to be prayed for, remembered, mourned
SUPPORT SYSTEM: Questions
o Who is there for you in this time?
o Who do you most miss?
o Where do you feel you most belong?
SUPPORT SYSTEM: Outcomes
• Person accesses the meaningfulness of their community during this crisis
• Person pinpoints losses in relation to community, moves from grief to love
• Experiences support and guidance in summoning resources of community
FICA MODEL
F- Faith and Belief:
o Do you consider yourself spiritual or religious?
o Do you have spiritual beliefs or practices that help you cope with stress?
o If no – What in your life gives you meaning or strength?
I – Importance:
o What importance does your faith or belief have in your life?
o Have your beliefs influenced how you take care of yourself in this illness?
o What role do your beliefs play in regaining your health?
C – Community:
o Do you have a community where you feel you belong and are cared for?
o Are you part of a religious or spiritual community?
A – Address
o How, if at all, would you like me to address these issues in your healthcare?
7x7 Spiritual Assessment Model
Here is a 7x7 Model of Spiritual Assessment adapted specifically for spiritual directors. This version maintains the integrity of the original model while applying it to the contemplative and pastoral context of spiritual direction, where the goal is not diagnosis but deep listening, accompaniment, and discernment.
I. The 7 Spiritual Dimensions (explored as things emerges over time)
An invitation to explore deeper one’s inner world. Example questions based upon the 7x7 Model.
Belief and Meaning
What gives your life meaning today?
How do you understand God’s presence or absence in your life?
Have your beliefs shifted over time?
Vocation and Responsibility
How do you sense a call in your life now?
How do you see your mission in your life?
Are there desires and or responsibilities that feel spiritually significant?
Spiritual Experience and Emotion
Are there memories when you felt deeply connected to God or distant?
What was that experiences like for you?
How shape your prayer life?
Courage and Spiritual Growth
At time of difficulty how have you moved towards prayer?
Where have you seen shifts in your spiritual life?
How have you grown?
Ritual and Practice
What particular prayers or traditions nourishes you?
Do you feel drawn to a certain spiritual discipline?
How has the sacraments brought you peace?
Spiritual Community and Belonging
Do you have a trusted companion, mentor or a faith community?
Where do you feel most supported in your spiritual life?
Authority and Guidance
What sources (Scripture, saints, Church teaching) offer you guidance?
How do you discern which direction and who is there guiding you?
II. The 7 Contextual Domains (Held as Background Awareness by the Director)
These help the director understand the total context of the directee’s life, influencing spiritual growth and prayer.
Physical/Medical
Are there health concerns or physical limitations affecting spiritual life or practices?
Has an illness or injury prompted new questions of meaning, purpose, or mortality?
Psychological
How is the directee’s emotional life shaping their sense of God and self?
Are there recurring patterns of fear, shame, or desolation?
Social
What relationships are life giving?
What challenges in prayer are they experiences?
Is there a sense of isolation, loneliness or a desire for deeper connection?
Family
What role does family history play in their image of God or spiritual growth?
Are there intergenerational wounds affecting their journey?
What blessings are they carrying though?
Have they done a Blessed History?
Ethical/Moral
Are there moral dilemmas or decisions being brought into prayer?
How does the directee wrestle with conscience, sin, or justice?
Remembering directors are not to inquire into any particulars and are to honor one’s conscience.
Cultural
What cultural identity and traditions shape their spirituality?
Are there tensions between culture and faith?
Spiritual
What is the directee's overall sense of their relationship with God right now?
Where is God drawing them in this season of life?
OTHER ASSESSMENTS
1. FACIT-Sp-12
2. Spiritual Injury Scale (SIS)
3. SPIRIT
4. FAITH
5. FACT
SUMMARY
o Be Authentic
o Offer Presence
o Hold a safe space
o Empathetic Listening
o Asking open non-judgmental questions
o Allow the other to be other in their unfolding
o And to let ourselves be changed by the life of another
Reflection Questions for Part III Assessment Tools
Spiritual Listening and Assessment
When have you sensed that someone was expressing spiritual distress symbolically or indirectly?
Imagine Jesus responding to them. Matthew 11:28–30 – The Gentle Mastery of Christ
“Come to me, all you who labor and are burdened, and I will give you rest.Take my yoke upon you and learn from me, for I am meek and humble of heart;and you will find rest for yourselves.For my yoke is easy, and my burden light.”
How do you balance informal listening with structured tools like HOPE or FICA in your own ministry, recognizing that both have value in understanding a person's spiritual landscape?
The Church emphasizes the importance of both personal accompaniment and sound guidance.
What helps you remain attuned to subtle shifts in a directee’s story or language that reveal unspoken needs? James 1:19 “Know this, my dear brothers: everyone should be quick to hear, slow to speak.”
Compassionate Inquiry
When you feel hesitant to ask, consider that love covers a multitude of sins. 1 Peter 4:8
“Above all, let your love for one another be intense, because love covers a multitude of sins.”
How do you discern when a question about God, meaning, or hope might offer light—and when silence is more healing? Ecclesiastes 3:7 “A time to rend, and a time to sew; a time to be silent, and a time to speak.”
Reflect on a time when someone’s response to a spiritual assessment surprised you or revealed something deeper than expected, recognizing that God's ways are not our ways.Isaiah 55:8–9
“For my thoughts are not your thoughts, nor are your ways my ways—oracle of the Lord.For as the heavens are higher than the earth,so are my ways higher than your ways ,my thoughts higher than your thoughts.”
Encountering the Holy
Consider questions that encourage reflection on past experiences of God's presence during difficult times.
“Can you recall a time when you felt God’s presence most strongly during a challenging period?”
“How has your understanding of God evolved through your experiences of suffering?”
“In what ways does prayer sustain you during this time?”
Consider cont'd Ask:
“How does your faith inform your understanding of this illness, grief, or loss?”
“In what ways does the suffering of Christ resonate with your own experience?”
Consider how their beliefs about the afterlife or divine justice shape their perspective.
These are basic models—tools to be used as an internal guide as one shares, allowing answers to emerge over time.
“What gifts or blessings have emerged in your life despite the challenges you face?”
Integration and Self-Reflection
Which aspects of assessment (hope, community, meaning, suffering) most deeply resonate with your own spiritual experience? Consider how your own experiences of hope have shaped your faith and resilience.
Consider specific instances where a directee’s story has profoundly impacted your own spiritual growth. How have you been growing as a Servant of Prayer?
Catechism of the Catholic Church,
§2690” The Holy Spirit gives to certain of the faithful the gifts of wisdom, faith and discernment for the sake of this common good which is prayer (spiritual direction). Men and women so endowed are true servants of the living tradition of prayer. According to St. John of the Cross, the person wishing to advance toward perfection should“ take care into whose hands he entrusts himself, for as the master is, so will the disciple be, and as the father is so will be the son.”And further: “In addition to being learned and discreet a director should be experienced. ...If the spiritual director has no experience of the spiritual life, he will be incapable of leading into it the souls whom God is calling to it, and he will not even understand them.”
— St. John of the Cross, The Living Flame of Love, stanza 3,30, in The Collected Works of St. John of the Cross, eds. K. Kavanaugh OCD and O. Rodriguez OCD (Washington DC: Institute of Carmelite Studies, 1979), p. 621
About this Series
*This 6-Part Series is for spiritual directors who accompany individuals facing life-altering illnesses, as well as those who serve as caregivers. It draws from presentations I have given to spiritual direction interns, nursing students, nurses, and parishioners involved in ministry to the sick and homebound. The content is shaped by my background in family practice as a chiropractic physician, my years of service as an on-call chaplain at Yale New Haven Health, and my work as a patient advocate and spiritual director accompanying individuals through illness and suffering, and years of collecting notes from various sources. I take no personal credit for the work as original.
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