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The tripod of recovery

July 20, 2009
by Phillip L. Lovin
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A spiritual assessment can help ensure equal weight with biological and psychological factors in treatment

A photographer who wants the best possible picture will use a tripod for the precision shot. Like a tripod for a photographer, what I call the “tripod of recovery” offers the best chance of success for patients. The three legs of the tripod of recovery address the physiological side of addiction and recovery, the psychological side, and the side that far too often is neglected—the spiritual aspect. We all know that addiction is a spiritual disease, but we often fail to address the spiritual aspects of recovery properly. This shortchanges our patients.

Just like any other facet of an assessment, a clinician can check the “spiritual quotient” (SQ) of a potential patient. If done properly, this will elicit foundational information that will allow for the inclusion of the third leg of the recovery tripod in the treatment plan. The treatment plan will then address spiritual issues that could affect recovery. I have created my own SQ assessment tool. Professionals can customize one to fit their own facility and its patient population needs. The types of questions that could be asked in an SQ assessment include:

1. When you are facing a challenging situation, do you seek the advice of others? Worry incessantly? Pray about it?

2. In Christianity, who are the writers of the four Gospels? (This type of question allows clinicians to see if patients have an awareness of themselves, the system of faith they follow, and other systems.) 3. When life here is over, what next? 4. Do you feel that there is a purpose in life, or is life just a series of incidents linked together by time? 5. Do you feel a closeness to God when you pray? Walk in the park? Visit friends? 6. Are you bothered with feelings of guilt? How do you deal with that? What would help you deal with it better?

Proceed cautiously

There are four areas of caution that a clinician needs to be aware of when testing a patient’s spiritual quotient:

• Don’t project yourself and your beliefs upon the patient. This is about the patient, not you. You should listen to the patient and never be drawn into a religious debate. This is easily avoidable when you simply ask questions. The assessment is not a forum for debate or for converting a person to one faith or another. It is not the place to correct an attitude that you feel is wrong. It is the time to gain information that will provide you with better insight about the spirituality of the patient. • Use open-ended questioning and provide for fragmented responses, as people often cannot articulate a belief, much less where they are in that belief system. Provide some multiple-choice questions along with the open-ended questions. This will help the patient to feel more comfortable during the assessment. • Don’t address issues during the assessment. You don’t do treatment during an assessment, and you should not address spiritual issues during an assessment either. • It might seem like a no-brainer, but you should have a qualified person conduct the assessment. A facility staff member who has received training could conduct it, although a chaplain might be a better choice. Spirituality is a complex aspect in an individual and should be assessed by a competent person.

The spirituality aspect is critical to a real and lasting recovery. If we neglect this third leg of the tripod, we simply cheat our patients out of the recovery they deserve. Try taking a high-quality photo with a tripod with one leg that is broken or not properly engaged. The result will be the same in a recovery program that fails to address the spiritual side of this disease.

There are several options available to address patients’ spiritual needs. They range from having a fully ordained chaplain on staff to contracting for chaplain services to using a local minister who is properly educated in recovery and has a heart for people in recovery. There is a difference between a chaplain and a minister. A minister or pastor has a denomination such as Baptist, Catholic, Presbyterian, etc. A chaplain is non-denominational, using broader brushstrokes in spiritual care issues than a pastor does. There are several good chaplain training programs. The skill level of chaplains can quickly be assessed by learning how many CEUs they have. A hospital chaplain typically will have four CEUs that reflect a good level of competence and experience as a chaplain.

Effect on patients

It has been my experience that once a patient starts using a chaplain, he/she will become more willing to discuss critical issues. As the patient further addresses spiritual issues, the clinician will be able to see a clear change in the patient. I concur with the 12-Step notion that the disease is too big to deal with alone and that God (as you understand Him) will help to provide the power/discipline/love needed to break the chains of addiction. There will be patients who are resistant to addressing the spiritual side of addiction and recovery. This reluctance might be based in an underlying feeling of guilt. Other factors might include the patient having felt that he/she was let down by organized religion. It will require a skilled and sensitive chaplain or member of the clergy to navigate these waters without having the patient completely shut down on the subject. A well-trained chaplain will quickly be able to identify when guilt is contributing to the patient’s reluctance to communicate, and will be able to address this in a passive but effective manner. The most spiritually resistant patient I ever had ended up using chaplain services more than the average patient. It’s all about taking the time to assess properly the spiritual quotient of the patient and to use appropriately the tripod of treatment.