Front Porch Essay

Spirituality In The Clinical Setting
Virginia McDonough, LCSW

Most of us have not been trained to consider spirituality in our overall assessment of our clients. This is changing. Since 1996, the NASW Code of Ethics has included the assessment of our client’s spiritual life as one of several aspects of the client’s overall psychosocial history. This may seem an intimidating mandate. But let us not confuse spirituality with religion. Religion can be thought of as the bridge to spirituality. Joseph Campbell suggests that today we are seeking new myths by which to give meaning and purpose to our lives. Whether through a formal structure such as religion or an informal process, the spiritual quest deepens our experience as humans and provides a web of connection to the community, the earth, each other, and ourselves.

By suggesting that we, as social workers, assess the spiritual dimensions of our client’s lives, the NASW Code of Ethics is acknowledging the impact that the spiritual life has on the individual, couple, family, and group. The spiritual aspect can have the same if not more influent on our clients as their physical, mental, and emotional life.

What does this look like in practice? Reviewing a national managed care company’s Out-Patient Treatment Report from, sixty-five symptoms are listed. Fully nineteen of the symptoms listed can be seen as spiritual issues. These include excessive guilt, destructiveness, suicidal or homicidal ideation, hopelessness, etc. Although not labeled under the heading of "spiritual issues," we can agree that at the core, these issues are spiritual. So how do we approach this issue with our clients? We begin with where the client is at!

First, we allow the client to show us their personal spiritual domain—is this a resource of strength and courage to them or is it a source of guilt and frustration? By listening carefully, we can help the client shift to a more compassionate and accepting view of themselves.

Second, clients are not generally interested in our (social worker’s) spiritual life other than to be reassured that we have one. Just as we do not try to influence cultural or physical aspects of our client’s experience, we do not try to influence our clients regarding their spiritual experience. We can and should trust our clients to know what is right for them. We help our clients move to wholeness and wellness within their own frame of reference. Our task is to empower our clients to ask questions, feel their feelings, and explore options available to them and make appropriate choices. Those options might include prayer, meditation, intuition, ritual, ceremony, or service.

Third, we cannot expect to take clients where we have never gone. Our responsibility is to broaden ourselves to be ready to work in this area with comfort. This may mean that we are reading, working in a peer group, doing spiritually-based retreats, or meditating and experiencing the seekers' path. Clients will resonate with a clinician who is familiar on a personal level and at ease discussing the deeper meaning of life.

Fourth, the client has the answer—simply respect that and a great deal of work is already completed. Many clients are looking for permission to question their experiences and feelings. "Is this okay? Do I have the right to question what I was taught or what I believed all my life?" Our role is to validate the right of our clients to have their own thoughts, feelings, and experiences regarding spirituality. We know that the client is finding the right answer when we see the esteem level rise, the ability to affirm themselves is present, and the client moves from guilt and shame towards compassion for themselves and others. This is a process which, at its best, takes a lifetime for all of us.


Larry Dorsey, Healing Words

Stephen Levine, A Gradual Awakening

Lewis Mehl-Madrona, Coyote Medicine

Thomas Moore, Care of the Soul and Soul Mates


Virginia McDonough, LCSW, is in private practice in Illinois. She speaks nationally on spirituality and social work. She co-leads a Vision Retreat in Canada for social workers.