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SPIRITUALITY IN THERAPY ASSESSMENT
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First Name: |
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Last Name: |
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Email Address: |
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Phone Number: |
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| 1. | Have you ever had religious
or spiritual beliefs or practices? |
| 2. | Have those been helpful in
any way? Harmful in any way? |
| 3. | Any traumas connected with religion or
spirituality? |
| 4. | What did each of your parents teach or show you
about spirituality or religion? |
| 5. | Who else was an influence on you religiously or
spiritually as you were growing up? |
| 6. | What was your childhood religion, if any?
Describe your sense of God or spirituality when you were a child. |
| 7. | Have you ever felt connected to something more
than yourself, like nature, humanity, the Universe, God, etc.? |
| 8. | What has been your most profound spiritual
experience, if any? |
| 9. | Can you think of a time when you were judgmental
and became more compassionate? |
| 10. | What happened and how did things change? |
| 11. | Do a spiritual genogram tracing family
connections and experiences with spirituality or religion |
 Spiritual resources and
solutions |
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| 12. | What do you do or where do you go to recharge
your batteries when you get a chance? |
| 13. | What kind of artistic activities do you enjoy? |
| 14. | How do you connect with other people? |
| 15. | Where do you contribute or be of service to
others or the world? |
| 16. | Do you think you have a purpose for being alive?
If so, what is it? |
| 17. | Is there any religious or spiritual figure or
activity that you think would be helpful for you in this situation? |
| 18. | If you could write a prayer right now, what
would it be? |
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| 19. | What kind of spiritual or
religious activities would you like to do in the future, if any? |
| 20. | Is there any area of your
inner or spiritual life you would like to develop more? |
| 21. | Is there any spiritual or
religious figure that you would like to use as a model for you? In what way? |
| 22. | Is there some area of your
life or your relationships in which you would like to be or could be more compassionate or
kindhearted towards yourself or others? |
| 23. | What do you think happens to us when we die? |
End of
Questionnaire.
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Bill O’Hanlon, M.S., Possibilities, 551 Cordova Rd.,
#715, Santa Fe, NM 87501
505.983.2843; Fax 505.983.2761;
PossiBill@aol.com
http://www.brieftherapy.com