Journal of Psychology and Chrisiianity

Copyright 2012 Christian Association for Psychological Studies

2012, Vol. 31, No.3, 233-266

ISSN 0733-4273

Clinical Appraisal of Spirituality:

In Search of Rapid Assessment Instruments
(RAIs) for Christian Counseling
Stephen P. Greggo
Karyn Lawrence
Trinity Evangelical Dimntty School
Counseling that strives to be intentionally Christian inspires hope of faith enhancement and spiritual
enrichment. Mental health professionals (MHPs) who offer services within an explicitly Christian worldview
require sufficient and strategic assessment techniques to direct helping endeavors towards such pivotal
goals. Redemptive validity (RV) is the effectiveness of an assessment tool that samples behavior or attitudes
to provide insight into wise living in conformity with the reality and truth of Scripture for those who desire
to grow in reliance on the Creator. This effort demonstrates the benefit of RV to guide theological reflection
within a measurement tool utility review to locate rapid assessment instruments (RAIs) of spirituality for clinical application. The authors contend that MHPs who purport to offer services with a Christian foundation
would do well to adopt both standardized and interview techniques into customary clinical practice to
address mental health concerns with greater specificity, demonstrate outcomes, and pursue spiritual formation. The following RAIs of spirituality are identified and reviewed: Brief Multidimensional Measure of Religiousness and Spiriaiality (BiVIMRS), Religious Commitment Inventory-10 (RCI-10), Brief RCOPE, Santa Clara
Strength of Religious Faith Questionnaire (SCSORF), Spiritual Well-Being Scale (SWBS), Springfield Religiosity
Scale (SRS), Revised Religious Orientation Scale (RROS), Religious Support Scale (RSS), Duke Religion Index
(DRI), and Spiritual Assessment Inventory (SAI).
Counseling that strives to be intentionally
Christian invites expectations beyond problem
resolution. It inspires hope of faith enhancement
and spiritual enrichment. Given these core values for both clients and clinicians, it is worthwhile to adopt routine methods to locate
common understandings, establish objectives,
and track outcomes. Mental health professionals
(MHPs) require strategic assessment techniques
in order to direct helping endeavors towards
such pivotal goals.
RAIs are semi-standardized measures with
value for clinical practice due to accessibility, efficiency, and effectiveness. This investigation
locates RAIs of spirituality and considers potential
application in Christian counseling. This extended utility review routine is termed redemptive
validity (RV) as the intent is to examine psychometrically sound assessment instruments through
the lens of a theologically grounded Christian
worldview. RV is the benefit derived from the

use of assessment technology to promote wise

living and foster change consistent with a client's
Christian identity.
Utility investigations match instruments to
specific purposes. Our objective is to locate
select measures that blend seamlessly with a
Christian worldview, add benefit to counseling
that encourages faith maturation, and establishes markers to evaluate growth. The following
assumptions guide this process. First, the
implementation of spiritually-oriented assessments allows for the identification of clients
with a clinically significant religious impairment (CSRI). A clinically significant religious
impairment (CSRI) is the reduced functional
ability to perform religious activities, achieve
religious goals, or to experience religious
states due to interference by the presence of a
psychological disorder (Hathaway, 2003). Surfacing a CSRI makes an explicit link between
spirituality and a mental health diagnosis.
Beyond problem identification, a second reason is that clients with underlying faith values
and traditions tend to invest more in counseling services when the process and goals align
with their spiritual journey narrative (Turton,
2004; Worthington, Kurusu, McCullough, &
Sandage, 1996). Therefore, the implementation of spiritually-oriented assessments, which

Correspondence concerning this article should be

addressed to Stephen P. Greggo, Department of
Mental Health Counseling, Trinity Evangelical
Divinity School, 2065 Half Day Road, Deerfield, IL
60015; sgreggo@tiu.edu. This paper was presented
on March 31, 2012 at the Annual Meeting of the
Christian Association for Psychological Studies
(CAPS) in Washington, DC.
253

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CLINICAL APPRAISAL O F SPIRITUALITY

acknowledge and utilize the spiritual experiences and resources of the client, will likely be
appreciated by clients with Christian convictions; thus, contributing to positive therapeutic
outcomes. Finally, clinical assessment done
well enriches the therapeutic alliance as concerns are defined, values are clarified, and the
direction for the partnership is developed (Sullivan, 1954). This survey identifies RAIs of
spirituality that have the potential to reveal and
organize information regarding CSRI functioning, contribute to the development of mutually
defined outcomes, and offer a baseline from
which to evaluate treatment progress.
Regrettably, counselors may underutilize standardized assessment due to restrictions on the
use of psychological testing and role confusion
related to the purpose. MHPs who are not psychologists may manifest ambivalent attitudes
toward structured assessment. Further, heightened resistance to applied psychological assessment may be present amongst MHPs w h o
practice within a Christian worldview. Regarding
adoption, there may be suspicions regarding the
validity of measures with a service population
dedicated to traditional Christian views and values. In terms of evaluating outcomes. Scripture
teaches that spiritual formation is exclusively
under the domain of the Holy Spirit and gains
are indications of divine grace (e.g.. Gal. 5:2226). The protest may then follow that an objective measure is, at best, a human work; but at its
worse is judgmental, intrusive, condescending,
and arrogant. The purpose of this exploration is
to face such concerns with integrity through the
application of a uniquely Christian utility review
procedure. The RV procedure addresses the
false dichotomy that spiritual formation is "Spiritled," while assessment is "man-led." By actively
bringing the Holy Spirit into assessment selection, implementation, and interpretation, Christian MHPs can adopt both standardized and
non-standardized measures of spirituality into
customary clinical practice. This important venaire may result not only in demonstrating gains
in mental health outcomes with greater specificity, but also in greater intentionality regarding the
pursuit of spiritual formation.
The Necessity for a Christian Assessment of
Spirituality
These guidelines display the necessity for
focused assessment in faith-attuned counseling.

EstahUsh a Common Language and Clarify

Theological Priorities
Talk therapy with intentions to be overtly religious according to Christian conventions necessitates respectful and thoughtful elucidation of
differences in perspectives between the counselor
and client. Not only does the global descriptor of
"Christian" require a precise location within a doctrinal tradition and identifiable community, but
the individual peculiarities of the client's faith
identification and spiritual story need exploration.
The era is past when a religious label or denominational affiliation can portray with reasonable
accuracy a client's belief system, standards of spiritual maturity, or community-based behavioral
practices. It is important to specify the meaning of
religious terms, surface the underlying motivation
for this faith pursuit, and identify preferred pathways to spiritual enrichment. For example,
which, if any, of these reasonable objectives actually fits the intention of the client: achieving spiritual health (i.e., adaptability and optimal
functioning), movement towards sanctification
(i.e., progression in holy living), or advancement
in Christian maturation (i.e., increased conformity
to the image of Jesus Christ)? In contrast, a client
may initially express an inclination to incorporate
faith values within mental health treatment, but
ultimately communicate that there be no disruption or destabilization of a familiar and personalized spiritual status quo.
Learning a client's spiriaial history, faith preferences, and commitments is a critical assessment
priority. However, Plante (2009) asserts that most
MHPs do not adopt a systematic protocol to gather
religious information. Without a solid grasp of the
client's religious-spiritual history and recent habits
obtained from intake forms or interview queries, it
is impractical to select an appropriate instrument of
spirituality. According to Plante (2009), clients with
substantial religious history and devoutness require
a detailed spiritual assessment pnior to any incorporation of faith perspectives into the treatment
approach. These important claims have critical
ethical implications for MHPs whose niche population is decidedly Christian. When gathering routine
information from clients, Christian counselors must
also learn to thoroughly investigate spiritual history
(Plante, 2009; Speny, 2011).
Consider this quick mnemonic to prompt a basic
interview sequence for gathering such information.
Follow the acrostic FICA: faith, importance, community, address (Pulchalski, 2006). Do you consider yourself to be a person of faith and how do

GREGGO AND LAWRENCE

you describe your faith tradition? What importance does your faith have in your life? Are you
participating in a church or faith comrrtunity! How
would you like me to address these spiriaial matters in your care?
Specify Expectations for Christian Counseling
Clients who express inclinations toward Christian counseling have exceedingly diverse ideas
about what such a request represents (Greggo &
Sisemore, 2012; Johnson, 2010; McMinn, Staley,
Webb & Seegobin, 2010). This request may be a
declaration that all recommendations and helping
techniques must rest directly on a biblical chapter
or verse. Alternatively, the client might desire the
grace associated with unconditional positive
regard or perceive the therapist in a priestly or
pastoral role. Phrases heard on a radio program,
from a trusted friend, family member, or pastor
may be parroted. The client's contention may
indeed be that unless therapy is from a distinct
brand the process itself is not trtistworthy. Thus,
given the diversity of these anticipations, it is
essential to the therapeutic process that the MHP
determine the unique expectations of the client.
Such expectations might be addressed by asking
the following questions: given the importance of
your walk with Christ, what hopes and expectations do you have for our counseling efforts?
Have you given thought to what distinctively
Christian counseling will look like as we work on
your particular concerns? The MHP is also likely
to hold deep convictions about the implications of
the Christian counseling label for treatment priorities, curative processes, and reliance on the triune
Godhead. Therefore, during early clinical encounters, the MHP seeks to understand the client's
expectations, strives to obtain sufficient agreement
in procedure and outlook to enable a therapeutic
partnership, and communicates to achieve reasonable informed consent (Turton, 2004).
Identily Faith-linked Resources and Liabilities
There is recognition within a broad range of psychiatric and mental health services that spirituality,
manifested in private or public religious formulations, is both potentially a source of conflict and a
client resource (Pargament, 2007). Current perspectives describe spirituality as a combination of
values (i.e., passions and moral convictions), vision
(i.e., mission, calling, and purpose), and lived
experience (i.e., subjective and emotional states)
shaped and stimulated by an awareness of a transcendent force that may or may not include a distinct deity (Aten & Leach, 2009; Frame, 2003). The

255

past decade has been marked with extensive

development of evidence-based opportunities
along with ethical parameters to incorporate a
client's sacred woddview and cherished relationships into treatment (Aten, McMinn, & Worthington, 2011; Gold, 2010). The openness of MHPs to
the recognition of persons as bio-psycho-social and
spiritual is a refreshing shift for those who understand that achieving mental health, living out the
tenants of Scripture, and demonstrating the fruits of
the Spirit are mutually reinforcing pursuits.
Beyond openness to therapy that addresses spiritual enhancement, there is a growing awareness
among MHPs regarding our clinical responsibility
to consider how beliefs about the sacred are operating for better or for worse (Pargament, 2007).
An assortment of credible measures exists to aid
in investigating the dimensions of spiritual and religious themes and experience within a client's story
(Hill & Pargament, 2008; Hill, Kopp, & Bollinger,
2007; Hill & Kilian, 2003; Standard, Sandhu, &
Painter, 2000). The majority are tools designed to
measure religiousness and spiriaiality throughout
the lifespan, across traditions, and cultural and ethnic communities. The intended reporters are
research participants who may hold individualistic
or syncretistic conceptions of transcendence and
moral experience. Inclusiveness and broad applicability in a measurement tool is indeed a virtue in
research designs intended to expand understanding of religious experience or tease out the consequences of belief for health and Wellness. As a
result, such tools require additional scrutiny before
their application within the narrow sub-specialty of
counseling that by mutual agreement between
counselor, client, and setting Is unequivocally
Christian. Given the broad range of core theological convictions and how these inform professional
practice, the authors will clarify their assumptions.
The Christian faith holds that God speaks through
Scripture and in the Word made flesh. The triune
God is no mere impersonal, transcendent force.
The centerpiece of Christianity is a personal and
self-revealing Creator who invites human beings,
made in his image, into a transparent and authentic
relationship with himself (Gen. 1:26-27; Jn. 3:l6,
10:10; Rom. 1:16-17; 1 Jn. 1:1-9). When the adjective "Christian" becomes the qualifier that defines
counseling, there is an intentional linking between
worldview, theological beliefs, psychological perspectives, and values for living. The RV procedure
is proposed to bring quality tools into helping relationships grounded in a robust Christian tradition.

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CLINICAL APPRAISAL O E SPIRITUALITY

Table 1
Comprehensive List of Measures of Spirituality and Religiousness
Description
Measure
A 38-item multidimensional measure of both dispositional and functional
Brief Multidimensional
religiousness/spirituality, evaluating domains such as community or
Measure of Religiousdenominational affiliation, public and private practices, values and beliefs,
ness/Spirituality
coping and social support.
A l6-item measure of dispositional religiousness/spirituality, which specifiDaily Spiritual Experically evaluates spiritual maturity through ideas such as perceived relationences Scale
ship with and experiences of God, peace and harmony, and compassion.
A 5-item measure of functional religiousness/spirituality that assesses three
Duke Religion Index
religiosity subscales: organizational/public, non-organizational/private, and
intrinsic.
A 12-item measure of dispositional religiousness/spirituality, focused on the
Faith Maturity Scale
evaluation of spiritual maturity via behavior, and vertical and horizontal
relationship domains.
A 10-item measure of functional religiousness/spirituality, evaluating reliIntrinsic Religious
gious motivation through extrinsic/intrinsic framework.
Motivation Scale
Mysticism Scale
A 32-item measure of dispositional religiousness/spirituality focused on
the evaluation of mystical experiences through two subscales: general
mysticism and interpretation of mystical experiences.
Religious Commitment
A 10-item measure of dispositional religiousness/spirituality assessing reliInventory-10
gious commitment via consistency between religious belief and practice.
A 105-item measure of functional religiousness/spirituality that evaluates
RCOPE
religious coping via 17 factors.
A 35-item brief version of the RCOPE, measuring religious coping through
Brief RCOPE
two domains, positive and negative coping.
A 3-item measure of functional religiousness/spirituality focused on the
Religious Background
assessment of religious behaviors and practices.
and Behavior Scale
Religious Doubts Scale
A 10-item measure of dispositional religiousness/spirituality, which evaluates individual religious doubt.
Religious ProblemA 36-item measure of functional religiousness/spirituality that assesses
Solving Scale
religious coping through identification style of approach (i.e. active v.
passive) and attribution (i.e. internal v. external).
Religious Support
A 21-item measure of functional religiousness/spirituality, assessing reliScale
gious support through three dimensions of support: religious community,
church leader, and God.
Revised Religious OriA l4-item measure of functional religiousness/spirituality, evaluating relientation Scale
gious motivation using extrinsic and intrinsic subscales.
Santa Clara Strength of
A 10-item measure of dispositional religiousness/spirituality, assessing
Religious Faith Quesgeneral depth of religious faith.
tionnaire
A 54-item measure of dispositional religiousness/spirituality that measures
Spiritual Assessment
spiritual maturity using an object relations and attachment theory frameInventory
work. The SAI examines two primary dimensions: awareness of God
and quality of the vertical relationship.
A 23-item measure of dispositional religiousness/spirituality, evaluating
Spiritual Experience
spiritual maturity using two subscales: spiritual support and spiritual openIndex-Revised
ness.
Spiritual TransformaA standardized assessment tool that evaluates spiritual development using
tion Inventory 2.0
a relational model. The STI 2.0 contains 31 scales within the five domains
of Hall and Edwards' Connected Life model.
Spiritual Well-Being
A 20-item measure of dispositional religiousness/spirituality that assesses
Scale
spiritual well-being through two well-being subscales: existential and religious.

(continued)

GREGGO AND LAWRENCE

257

Table 1 (cont.)
Comprehensive List of Measures of Spirituality and Religiousness
Measure
Springfield Religiosity Scale
Ways of Religious
Coping Scale

Description
A 35-item measure of functional religiousness/spirituality that evaluates
participation in a religious community or organization.
A 40-item measure of functional religiousness/spirituality, specifically assessing
religious coping through two subscales: internal/private and external/social.

Locating RAIs of Spirituality and Religiousness

The instruments selected for application into
clinical practice meet the basic criteria for RAIs
proposed by Fisher and Corcoran (2007). In direct
therapy, a RAI is a semi-standardized measure that
provides a concise, convenient, and credible
means of capturing discrete data on an indicator
related to the broader presenting concern. RAIs
do not replace, but compliment other assessment
methods such as behavioral observations, client
logs, individualized ratings scales, physiological
measures, or standardized self-report questionnaires (e.g., NEO Personality Inventory- 3, the MilIon Clinical Multiaxial Inventory III, or the 16
Personality Factor Inventory). The divide between
RAIs and other standardized measures is a matter
of focus, pragmatics, and the availability of normative data. Generally, RAIs quantify observations,
but do not produce standard scores for comparison with a broader norming sample. RAIs are
short, quick to complete, transparent in focus,
easy to score, and clinician friendly self-report
measures. Additionally, RAIs are not unilateral in
their theoretical orientation. Ultimately, they provide a structured opportunity to collect data in
order to define an issue and make comparisons
(Fisher & Corcoran, 2007). RAIs make it possible
to meet contemporary clinical accountability standards by demonstrating treatment outcomes either
directly to clients or other invested parties. Fisher
and Corcoran's (2007) two-volume RAI collection
spans neariy 900 pages with 471 measures for children, adults, and families on diverse issues from
procrastination to threat appraisal to eating patterns to sexual attitudes. Remarkably, despite the
scope of problems and concerns represented in
these volumes, no RAIs of spirituality or religiousness are included.
A preliminary investigation located 21 measures
of spirituality and religiousness with reasonable
psychometric qualities and clinical potential (see
Table 1). This list is the result of gleaning from
existing reviews (Gold, 2010; Pargament & Krumrei, 2009; Plante, 2009; Hill & Pargament, 2008;
Hill, Kopp, & Bollinger, 2007; Hill & Kilian, 2003;

Hill & Hood, 1999). The procedure is a noteworthy deviation since the convention is to consult the
Mental Measurements Yearbook (MMY). Only one
measure was in the MMY database, suggesting that
currently, tools that capture and categorize spiritual features are not tightly standardized nor commercially marketed. Therefore, it was necessary to
browse the broader literature and locate comprehensive measurement reviews. Alternative lists
and recommendations are located in Plante (2009);
Gold (2010); HUl, Kopp, and Bollinger (2007); and
HiU & Hood (1999).
The second phase took the identified measures
through a utility screening procedure with four
general considerations in mind: fit within the
parameters of an RAI, acceptable to favorable psychometric properties, availability and accessibility,
and the potential for application with a population
that holds a Christian theological worldview.
These tools reflect diverse operational definitions
that quantify complex, emotionally-charged, multidimensional phenomena; namely religious and
spiritual experience. Gauging which tool is a best
fit for a given population requires careful consideration of the features of the client population and
maintaining awareness for how particular MHPs
are inclined to blend results into treatment.
The clinical setting prototypes were those with
which the authors are affiliated. The first is a
long-standing, outpatient mental health practice
with
an
explicit
Christian
identity
(www ccahope.com) and the other, a counseling
center at a denominational
university
(http://^vww teds edii/cnmmiiniry-life/.studpnt-.sf'rvices/coiinseling dot) Both settings have an
established clientele who express a preference for
counseling that reflects an evangelical, biblical,
and wholly Christian foundation. The same
screening procedure when undertaken with other
agencies in view might result in a different selection of RAIs of spirituality. After all, a utility
review looks beyond psychometric properties to
consider these questions: what does this instrument add to the assessment process and will its
results be beneficial to our clients? A utility search

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CLINICAL APPRAISAL O F SPIRITXIALITY

is not solely about the quality of the instrument.

Rather, it is about locating the best fit between the
measure, assessment purpose, resources, and
client population.
In order to sharpen our grasp of construct validity and increase our appreciation for the distinct
purpose of each instrument during the selection
procedure, a categorical grid from an earlier
research review was applied (Hill, Kopp, &
BoUinger, 2007). This grid clarifies what each of
the measures intends to accomplish. Eight
dimensions of religiousness and spirituality fall
under two overarching headings that essentially
mirror the customary trait (i.e., long-term) and
state (i.e., current experience) designations common in assessment discussion. Dispositional measures aim to uncover persistent patterns and
leanings. The following are sub-dimensions
under this heading: general scales, commitment
inventories, and measures of developmental spiritual maturity. Functional measures capture
everyday coping mechanisms, behaving, and feeling. Five sub-dimensions with a temporal focus
follow: religious motivation, social and faith community participation, spiritual private practices,
religious support, and spiritual coping. Each of
these eight categories was represented by at least
one measure in our secondary selection process.
This procedure erisured a respectable range of
measures representing diverse definitions of spirituality and religiousness.
This is the selected list of RAIs of spirituality and
religiousness: Brief Multidimensional Measure of
Religiousness and Spirituality (BMMRS), Religious
Commitment Inventory-10 (RCI-10), Brief RCOPE,
Santa Clara Strength of Religious Faith Questionnaire (SCSORF), Spiriaial WeU-Being Scale (SWBS),
Springfield Religiosity Scale (SRS), Revised Religious Orientation Scale (RROS), Religious Support
Scale (RSS), Duke Religion Index (DRI), and Spiritual Assessment Inventory (SAI).
In Search of RAIs with Redemptive Validity
Potential
Counselors can incorporate a proposed validity
subtype into their evaluation of measurement tools.
MHPs are encouraged to take measurement theory
to theology and then into clinical efforts that honor
the Lord. Redemptive validity (RV) is the effectiveness of an assessment instrument that samples
behavior or attitudes to provide insight into wise
living in conformity with the reality and truth of
Scripture for believers who desire to grow in

reliance on the Creator. Specific criteria to consider in the RV rubric will vary according to faith tradition, doctrinal convictions, the therapeutic
context, and the extent of the mutually determined
spiritual life objectives. The recommendation is
that when matters of faith are clinically relevant
that iVIHPs identify RV factors and apply them with
intentionality in assessment selection.
The authors' intent is to demonstrate the benefit
of RV for routine instrument utility review. The
Clinical Assessment Instrument Christian Evaluation Form (CAICEF) is a guided procedure to stimulate theological refiection on a psychological or
behavior measure applied in Christian counseling
(Greggo & Lawrence, 2012). It coaches users to
follow the steps of a typical psychometric review.
Namely, unless a measure displays satisfactory
psychometric characteristics (reliability, validity,
and normative data) it is unlikely to have any substantial research or clinical application. The
CAICEF then moves further to ponder the theological implications of a measure's construct, content,
and criterion-related validity features. RV is not a
characteristic of the measure itself. Instead, it is a
method to weigh the client experience, addressing
the items as well as the language, underlying values, and data obtained by the measure against the
Gospel story of creation, fall, redemption, and
restoration. Previous reviews of these RAIs of
spirituality and religiousness focus on the essential
features and psychometric aspects of the instruments. The following summaries report RV and
utility observations generated by comprehensive
CAICEF reviews.
Brief Multidimensional Measure of
Religiousness and Spirituality (BMMRS)
Features. The BiMMRS is a general scale of both
dispositional and functional religiousness and spirituality and is highly effective as research instrument. It has appeared in many investigations on
how diverse religious and spirituality (R/S) pathways influence health and well-being (Fetzer,
1999). The stand-out feature is its multifaceted
coverage of critical domains such as community or
denominational affiliation, public and private practices, values and beliefs, coping, and social support. This measure is the product of extensive
collaboration between social science and medical
epidemiology experts. Thus, the BMMRS gleaned
considerable benefit from psychometric investigations conducted on other measures for both its
items and interpretive guidelines.

GREGGO AND LAWRENCE

Utuity and Redemptive Validity. There is

validity support for the BMMRS factor structure. In
addition, the measure is suitable for adults, college, and adolescent clients (Masters et al., 2009;
Harris et al., 2008; Fetzer, 1999). Its multidimensional breadth and inclusive appeal are notable
strengths that transfer well into clinical settings.
Yet, these same features have a downside. As a
RAI, the scoring and interpretation are not entirely
forthright due to the number of subscales with differing methods of scaling. Further, while it does
collect an impressive amount of information in 36
questions, it compromises specificity in what it
measures. This may result in considerable ground
for MHPs to cover in a follow-up interview. In
terms of RV, several concerns surfaced. First,
while the items can signal spiritual distress if negatively endorsed, they do not necessarily suggest
adherence or resemblance to Christian orthodoxy
if positively endorsed. Second, the intentionally
pluralistic wording of certain items (i.e., "mediation"; "life as part of a larger spiritual force";
"working together with God as partner") may be
off-putting or easily misunderstood by evangelical
Christians. This has the potential to skew results
within our target population. Third, while the private religious practice subscale does have items
that evangelical Christians are likely to endorse
(i.e., prayer and Scripture reading), the subscale
has a narrow focus and is prone to a ceiling effect.
It would be difficult to distinguish between highly
religious evangelical Christians (i.e., those who
engage in additional spiritual disciplines) and average discipleship practices (i.e., those who engage
solely in the listed practices). Overall, despite its
clear initial appeal for its comprehensiveness, the
BMMRS in Christian counseling may tend to
extend or distract, rather than focus follow-up
client conversations.
Santa Glara Strength of Religious Faith Questionnaire (SCSOKF)
Features. The SCSORF, a 10-item scale with a
viable option to use only five items, quantifies a
client's general faith intensity (Plante, 2009; Freiheit, Sonstegard, Schmitt, & Vye, C, 2006; Plante &
Boccaccini, 1997a; 1997b). It rates the declaration
of religious faith that can anchor one's identity. It
has relatively few items that address everyday practice. Given its brevity and direcmess, the SCSORF
is a model method to discern and document that a
client is both suitable and amenable to counseling
that explicitly incorporates a Christian worldview
and spiritual resources.

Utility and Redemptive Validity.

259

The

SCSORF quickly supplies a self-report on one's

depth of faith. Given its inclusive language, minimalist style, and ease of scoring, it could certainly
blend easily into initial paperwork. Administration can be repeated to track religious faith as an
outcome when counseling intentionally addresses
this factor. The beauty of this tool is indeed its
simplicity. Stul, it may not be best choice for highly committed evangelicals who may desire items
that allow for a more robust expression of priorities, degree of devotion, and cherished practices.
It is a great fit for a religiously affiliated college
setting where students might display a wide range
of faith commitment.
Religious Commitment Inventory (RCI-IO)
Features. As its name plainly states, the RCI-10
is a commitment yardstick that provides a quantified score for the degree of adherence between
internalized religious beliefs and daily faith practice
(Worthington et al., 2003). It is a prototypical RAI
with a single focus, easy scoring, and plain interpretation. As is evident by the psychometric
research that operationalizes this construct and
reduces the item count from 64 to 10, the RCI displays adequate data to support its use in research
and clinical practice. Normative data is available to
differentiate low/high religious commitment using
means and standard deviations. It is possible to
compare obtained scores with a range of comparable populations, including clients in Christian counseling agencies.
Utility and Redemptive Validity. One objective of the RCI-10 developers was to tailor a psychometrically valid measure with utility for
religiously committed clients (Worthington et al.,
2003). Given its tight focus, uncomplicated format, and normative data, it offers considerable
potential for clinical application in Christian settings. It does not appear that any specific item
would cause difficulties with an evangelical Christian population. However, the frequent use of
"religious" might be less than ideal given the
recent rejection of this term by younger evangelicals who prefer the use of words such as "faith" or
."spiritual journey." This may be a matter of face
validity, yet acceptance of a measure by the service population is always a significant consideration. In regards to interpretation, a low score
might indicate individuals who lack a faith tradition and reject religious beliefs or individuals with
low consistency between reported convictions and
behavioral commitments. Thus, the RCI-10 does

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CLINICAL APPRAISAL O F SPIRITUALITY

yield data useful to identify clients with CSRI even

though the reasons for a low score require further
investigation. The RCI-10 measures the degree to
which an individual puts faith into action (Jas.
2:14-26). After clarification of the meaning of a
low, midrange, or high score, the RCI-10 provides
identifiable material to ground faith interventions
that could increase the link between belief and
action (i.e., fellowship, tithing, prayer, worship,
etc.). This is critical. The RCI-10 provides a snapshot of only one spiritual dimension: consistency
between belief and routine activity. Nonetheless,
having a concrete, quantified sample of such
behavior could readily result in a productive conversation with clients who desire an authentic
walk with Jesus Christ.
Spiritual Well-Being Scale (SWBS)
Features. The SWBS is a general dispositional
measure of spirituality and religiousness (Hill,
Kopp, & Bollinger, 2007). It is the one instrument
formally reviewed in the MMY (D'Costa, 1995;
Schoenrade, 1995) and is available for bulk purchase (http//^vw\v lifeadvanre rom) Reviewers
have cited one concern, namely that the measure
has a ceiling effect when used with devoted religious people, which may indeed be an undesirable factor given our identified settings
(Schoenrade, 1995; Boivin, Kirby, Underwood, &
Suva, 1999). Its exceptional feature is the subscale
division that separates religious well-being (RWB;
e.g., "I believe that God loves me and cares about
me.") and existential well-being (EWB; e.g., "I feel
good about my future."; Plante, 2009). This tool
has a substantial basis in theory and the constructs
originally were explored on population samples
with traditional Christian values (D'Costa, 1995;
Boivin, Kirby, Underwood, & Silva, 1999). While
the specificity of the puot population could be a
deficit for general research purposes, it is an asset
given our target service population. In its long
history, the measure has been a significant
research tool with well-established ties to CAPS
(Ellison, 1983; Paloutzian & Ellison, 1982).
Utility and Redemptive Validity. The SWBS is
an efficient measure to estimate an individual's
sense of spiritual well-being (SWB). The two subscales, EWB and RWB, may further identify and
clarify spiritual distress. Having such information
could function as a platform for dialogue on how
the presenting problem may or may not be affecting SWB. Several items would function well as
treatment outcome evaluation benchmarks in
intentionally Christian counseling (e.g., "I don't

find much satisfaction in private prayer with God";

"Life doesn't have much meaning"; "I believe there
is some real purpose for my life").
Springfield Religiosity Scale (SRS)
Features. The SRS is a functional measure that
aims to ascertain participation in a religious community or organization (Hill, Kopp, & Bollinger,
2007). The SRS took shape as a research tool for
use with a geriatric population, although there is
support for its broader use. Given the existing
published information, the generalizability of the
SRS is questionable given its nearly exclusive use
with geriatric clients. At face value, this is an
apparent strike against the measure for general
practice. Developers set out to form a measure
that would find a warm welcome in a population
associated with Judeo-Christian traditions and
where 90 percent of users were either Protestant or
Catholic (Koenig, Smiley, & Gonzales, 1988). By
design the instrument visibly reflects Christian
beliefs and activities.
Utility and Redemptive Validity. The dimensions of religion included in the SRS are beliefs, rituals, experiences, knowledge, communal
participation, spiritual well-being, and intrinsic religiosity. Unique to the SRS is that belief is associated with Christian orthodoxy. The measure
contains four items to assess core positions on
one's concept of God, the divinity of Jesus Christ,
biblical authority, and the existence of the Devil.
This feature alone increases its RV with the target
population. Overall, the SRS provides clinicians
with a multifaceted portrait of Christian spirituality.
It would be suitable for adoption, with slight
updating, as a formalized questionnaire. As such,
the SRS would function as a conversation starter
with discrete items as topics for consideration. In
order to gain benefit from its factor structure, modification would be necessary to specify and streamline scoring procedures.
Revised Religious Orientation Scale (RROS)
Features. The RROS is a revised questionnaire
based on Allport and Ross's (1967) Religious Orientation Scale, deriving its items from long-standing
research that divides religiosity into extrinsic and
intrinsic components (Plante, 2009; Gorsuch &
McPherson, 1989). This is a functional measure
that has acceptable psychometric properties and
seeks to classify the motivation underlying faith
(Hill, Kopp, & Bollinger, 2007; HiU, 1999b). It is a
reasonable and brief RAI with clear-cut scoring.
Utility and Redemptive Validity. In terms of
RV, its framework of extrinsic versus intrinsic

GREGGO AND LAWRENCE

motivation is unimpressive. The items press to

uncover motives, but item endorsement in a particular direction would not reveal enough information to draw firm inferences. For instance,
when answering an item on the importance of
spending time in prayer, one might do these
things because of a secure attachment to the Lord,
a desire to be more Christ-like, or to display obedience. Another might do these things because of
one's upbringing. The RROS builds on the
assumption that one demonstrates a mature faith
by endorsing intrinsic items. This assumption is
too simplistic for a contemporary, culturally
diverse clinical context.
Religious Support Scale (RSS)
Features. The RSS, with its 21 items, succinctly
measures a single aspect of spiritual distress, namely religious support (Plante, 2009; Lazar & Bjorck,
2008). The item arrangement taps into three prime
sources of support: religious community, spiriaial
leadership, and divine intervention. The language
is intentionally inclusive, but no phrases appear
troublesome for an evangelical population.
Utility and Redemptive Validity. The target
construct of religious support would indeed be
useful for select clients with particular clinical
issues (i.e., depression, isolation, or social anxiety).
Thus, with its pointed application, this measure
may be a best fit when applied to specific cases,
such as when an increased perception of
social/spiritual support is an identified outcome in
the treatment plan. The support aspect of faith,
though critical and essential, may not be broad
enough to warrant adoption of the RSS as a routine
assessment tool.
Duke Religion Index (DRI)
Features. The 5-item DRI, designed for largescale epidemiological research, rapidly captures
estimates of three religious dimensions: organizational (i.e., one item on frequency of attendance
at religious services); non-organizational (i.e., a
single item on prayer and religious study); and
intrinsic (i.e., three items from Hoge's (1972)
Intrinsic Religiosity Scale measuring one's experience of the presence of the Divine). The psychometric evidence is supportive and extensive
(i.e., 100 published studies; availability in 10 languages). It has been the key method to catalogue religious data on thousands of research
participants across the entire span of adult development (Koenig & Bussing, 2010; Storch et al.,
2004; Hill, 1999a). The authors caution against
calculating a total score, although alternative

261

scoring methods can generate a total score. For

clinical use, the preferred approach would be to
follow the authors' recommendation and look at
each of its three scales separately. Use the first
item to assess organizational participation, the
second to gauge private devotional activity, and
combine the last three to capture how the client
merges faith into life as a whole. Given the
brevity of the measure, it would be reasonable to
collect results to evaluate change following counseling intervention.
Utility and Redemptive Validity. The language on this measure is broadly compatible
with Christian traditions. Still, when applied in
an explicit evangelical setting, the phrase "private
religious activities" may be supplemented with
"spiriaial disciplines" to better capture an individual's solitary engagement in prayer. Scripture
reading, and personal worship. Given its survey
use design, the DRI could be tied to demographic forms and other information gathering techniques prior to the initial consultation or near the
outset of the intake process. The clinician could
then explore responses in an early interview.
This compact tool is up-to-date, efficient, and
shows promise as a basic objective method to
launch further discussion into spiritual history
and present experience.
Brief RCOPE
Features. The brief RCOPE is a l4-item
abridgement of a comprehensive measure of religious coping that addresses five faith functions:
search for meaning, control, spiritual comfort, spiritual intimacy, and life transformation (Pargament,
Koenig, &. Perez, 2000). This measure applies to
the aftermath of an adverse event or significant
season of illness or stress. An important assumption within the measure is that clients may demonstrate positive religious coping (PRC) or negative
religious coping (NRC). This dispels the myth that
all spirituality and religious activity is constructive
and healthy. This measure identifies the dark side
or dysfunctional forms of religious coping such as
feeling punished or abandoned by God, attributing an experience to the devil's control, or questioning the power of God.
Utility and Redemptive Validity. In terms of
RV, the Brief RCOPE has much to offer for clients
who are in the midst of spiritual distress. Specifically, either low scores on PRC or a high score
on NRS identifies spiritual distress. This may
indicate the lack of dependence on or attachment to the Lord or ignorance of biblical truths

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CLINICAL APPRAISAL O F SPIRITUALITY

(i.e., forgiveness, the character of God, etc.).

Since this measure has a definitive functional
aim and assumes adversity or suffering, it is not
appropriate for all clients.
Spiritual Assessment Inventory (SAI)
Features. The SAI examines spiritual maturity
by considering two primary dimensions: quality of
relationship with God and awareness of God
(Hall, Reise, & Haviland, 2007; Hall & Edwards,
2002; Hall & Edwards, 1996). It achieves a portrait of psychospiritual development through five
subscales: awareness, realistic acceptance, disappointment, grandiosity, and instability. Using theoretical concepts from object relations and
attachment theory, the SAI looks at spiritual maturation by investigating one's relationship with
God. The norming population leans heavily on
religiously committed college students, yet psychometric investigation supports its structure and
items (Tisdale, 1999).
Utility and Redemptive Validity. The measure is 54 items and would be relatively easy for a
client to complete. On the other hand, the effort
and time a clinician would have to invest to calculate subscale scores and responsibly interpret
the measure is more demanding. Upon close
examination, it is misleading to classify the SAI as
an RAI. It is a slightly more sophisticated tool
that may be well worth the learning curve and
additional assessment effort. Yet, with its theoretical underpinnings, complexity, and impression
management scale, the SAI is a notch above the
typical RAI in terms of standardardization. It is
not a "pick-up and go" style instrument, the haUmark feature of an RAI.
Nevertheless, Hall and Edwards (1996) developed the SAI from a Judeo-Christian perspective
with specific New Testament themes in mind. Its
biblical relational view, based upon the imago Dei
(Gen. 1:26), is its underlying theological and theoretical premise. Further, the authors build upon
the theme of "love" based on the greatest commandment in Mk. 12:28-31. These features dramatically impact its RV. Therefore, the information
gathered from the SAI is likely to be more informative concerning an individual's spiritual status, particularly in terms of one's security of attachment
with the Lord. This SAI is a measure to apply with
select clients when exploring critical spiritual formation and relational themes. Its value may
become evident in settings where therapy tends to
extend beyond crisis intervention and basic cognitive behavioral approaches.

Limitations and Best Practice

These general statements refiect consistent comments across the ten CAICEF reviews.
Follow-up interviewing is necessary on noteworthy responses to address the origins and
reasoning beneath the item content.
An adequate assessment of spiritual history
should accompany these assessments to identify
faith affiliation, specific beliefs and practices, and
noteworthy turning points (negative and/or positive). The clinician must probe and evaluate the
immediate context of the Stressors and their relationship to the client's spiritual state.
Most RAIs lack detailed directions for interpretation. The responsibility for any explanation of
content is the direct result of the astuteness of
the counselor. Clinicians may require training
on how best to blend spiritual matters ethically
into counseling, especially when a spiritual/faith
background of the client is not an identical
match with the clinician. This is likely to be the
case more often than not. Christianity has a
wide range of distinctive formulations, cultural
expressions, and ethnic traditions. RV is a way
to line-up a measure to a target population. The
next level of application is matching an instrument to a unique client.
Given the transparency of RAIs, there is concern over potential response style distortions
common to all self-report measures (i.e., faking good/bad; making a positive impression,
etc.). The exclusive check for whether or not
the assessment results are a valid representation of the individual comes from the judgment of the clinician.
The concentrated focus of functional spiritual
assessments means that the aim is to sample a
specific domain. Thus, the results signal only a
slice of actual spiritual distress. The counselor
must pursue the concern via conversation to
obtain a comprehensive perspective, ascertain
the precise nature of the spiritual condition, and
evaluate the extent of any distress.
The normative data for these RAIs is limited.
Sample size populations are characteristically
small and there is no attempt to match the
diversity ratios with recent census data. This
raises a concern especially when these RAIs are
put to use with racially and ethnically diverse
clients such as international or ESL students.
Developing local norms is a good procedure as
well as remaining vigUant to the expression of
cultural differences.

GREGGO AND LANITOENCE

Spirituality Focused RAIs and

Christian Counseling
A reasonable assortment of spiritually-focused
RAIs is indeed available. Several have remarkable
potential for application in counseling partnerships
that by mutual agreement will be explicitly Christian. We conclude with four recommendations to
adopt select RAIs. For the sake of illustration, after
each recommendation there is discussion on how
the results of this CAICEF review will inform the
assessment protocols for the two agencies immediately relevant to the authors.
J. Document the appropriate flt of an overtly Christian approach by using an RAI to record the client's
general religious and spiritual values, preferences,
and presenting concerns.
A dispositional, spirituality-focused RAI could
blend smoothly into the personal information
forms that a client completes within customary
intake procedures. Alternatively, RAI responses
could be gathered when other standard assessments are administered or at the time of an initial
consultation. An RAI of spirituality could be utilized in Christian counseling like a heath checklist
functions prior to a primarily care visit. Such a
decisive step would tie the client's request for service with a preference for a spiritually integrated
approach. Three of the instruments reviewed are
well suited for such a purpose (i.e., DRI, RCI-10,
SCSORF). The choice for both the community
practice and the university counseling center under
consideration here is the DRI. Its wide application
on national surveys lends it credibility, its quick
five-item format makes it efficient, and its three
subscale categories offer a neat bridge to key topics when taking a spiritual history. The RCI-10
does have the advantage of probing consistency
between belief and practice, yet it lacks the conciseness and style to fit seamlessly with other
intake forms. The causal but useful approach of
the SCSORF would make it the optimal choice for
the university counseling center if the population
were primarily undergraduates. However, given
the age and ethnic diversity of graduate students
and staff who are frequently seen, the DRI was
determined to be a better fit.
2. Select an RAI to assist in the establisbment of
quantifiable benchmarks regarding faith resources
that will help to organize information regarding a
client's spiritual journey and identify options to
include in a treatment plan.

263

The use of scaling questions to establish clarity

on disturbing issues or on the frequency of a
behavior pattern is a common technique in early
interviews. Once the means for rating a behavior
is in place there is a method to track it over time.
In Christian counseling, insight into religious commitment and practice is foundational. Thus, having
a starting set of reliable items to obtain scaling
information would be extremely constructive. Further, the procedure of posing sequenced questions
about spiritual practices to clients serves as a
prompt to take a closer inventory regarding these
everyday routines. Several of the RAIs could
launch this effort (i.e., SCSORF, DRI, SWBS, RCI10). The selection of the DRI for both target settings intentionally dovetails with this second
objective. The DRI establishes a sense of organization participation (i.e., attendance at a religious service), personal faith practices (i.e., prayer and bible
saidy), and a client's intent to have religious beliefs
regulate one's lifestyle. Thus, it offers a tangible
introduction to explore and track select faith related matters in subsequent interviews.
3. Build a short list of "ready-to-roll" RAIs to
addressfunctional areas associated with a counseling agency's typical symptom proles and presenting concerns. Utilize a focused instrument to
heighten awareness of resources or to identify
potential ways to expand support.
RAIs are a means to assess functioning in a circumscribed domain (i.e., depression, anxiety, procrastination, parenting style, etc.) to gain insight
into the individual's unique manifestation of a concern or to objectively demonstrate progress (Fisher
& Corcoran, 2007). In Christian counseling, it is no
less important to address presenting concerns, yet
there is often client interest in nurturing one's spiritual life in the midst of addressing the critical issue.
It makes sense to identify areas of spiritual functioning that could help relieve the reason for referral or build resources to reduce its impact. Thus,
clinicians may have measures readily accessible to
expand insight on religious coping (i.e.. Brief
RCOPE), spiritual flourishing (i.e., SWBS, SAI), and
supportive fellowship (i.e., SRS, RSS).
For our target Christian community mental
health practice, the SRS could be a useful means
to rapidly obtain an immediate impression of
Christian orthodoxy and determine alignment with
a faith community. This will require slight adjustment in the wording of SRS items and reorganizing the format for ease of review. It is legitimate
to ask if the development of a fresh tool would be

264

CLINICAL APPRAISAL O F SPIRITUALITY

preferable. However, given the extensive effort to

establish a reliable and valid measure for research
purposes, it is reasonable to make modest modifications on a proven tool to extend its usage into
clinical practice.
As is typical of a Christian university setting, our
clinic commonly sees numerous clients who
struggle with issues of sexual purity. Often the
associated behaviors evoke shame, isolation, and
avoidance of intimate Christian settings where
accountability is readily available. The RSS identifies engagement with support areas such as one's
faith community, spiritual leadership, and divine
conversations. Therefore, the RSS could be a
rapid means of tracking progress on counseling
efforts to increase support in fellowship settings.
Both of our target clinical settings could readily
make use of the SAI with its focus on one's relational attachment to God. Clients enter counseling with a stated problem focus. Nevertheless, it is
common to explore the relational and spiritual
reverberations more broadly in the context of an
established therapeutic relationship. The community practice has a staff of veteran therapists who
are disposed towards depth psychology and interpersonal cognitive approaches. In our Christian
university clinic, identity and developmental transitions often bring relational/spiritual matters front
and center. It is reasonable to explore this instrument fully by pilot use with select clients.
4. Use quantified ratings made evident in an RAI
(i.e., total score, subscale, or single item) to identify
and pursue specific faith development targetsfor
intervention.
When client and counselor set an agenda to
merge a desire for change with a call to holy living
or deeper biblical obedience, then it is reasonable
to have at least one therapeutic goal that relates
directly to faith development. Any of these RAIs
could be helpful in directing a counseling conversation in a productive direction for spiritual formation. Look closely at extreme ratings on select
items or subscales that highlight an underutilized
resource. In clinical dialogue, build off the language and item intent to arrive at a collaborative
goal. For example, should the DRI reveal on its
initial item that a client has no existing or vital
community for worship, teaching, or fellowship, a
treatment goal could be formulated that will
explore and address this gap. There will likely be
practical, relational, or clinical reasons for the
absence of involvement in Christian community.
Nevertheless, a redemptive aspect of counseling

could be to realize participation in the living body

of Jesus Christ (Heb. 10:23-25). In short, it may
not be necessary or even productive to re-administer an entire RAI as an outcome measure. An
increase in one's total score may not reveal spiritual maturation. It is utteriy practical to use RAI
results to establish specific and productive treatment objectives. This quality, mutually endorsed,
and obtainable goal becomes a customized means
to consistently track progress.
In conclusion, assessment is indeed an essential
aspect of quality mental health service. Despite
the dependence in Christian helping on the
movement of the Holy Spirit and the experience
of Divine grace, there is no reason to avoid the
use of instruments that increase wise understanding and clarify behavioral change. What is imperative is that counselors learn to select the best
measures possible. This begins as a technical process to explore psychometric strength and clinical
utility. It reaches fulfillment in Christian counseling when a client is encouraged and blessed in
their spiritual journey.
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Auhor Info
Rev. Stephen P. Greggo, PsyD, Psychologist, Professor of
Mental Health Counseling at Trinity Evangelical Divinity
School, and co-editor of Counseling and Christianity: Five
Approaches (IVP, 2012). Dr. Greggo is invested in the intersection of pastoral care, contemporary counseling and
evangelical Christian theology. He is currently exploring
how mental health professionals can use assessment to promote quality clinical care that is distinctively Christian.
Karyn Lawrence, MA, Professional Counselor. Ms.
Lawrence completed her clinical internship at the Trinity
Intemational University Counseling Center with a focus on
assessment and spiritual formation.

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