Spiritual Assessment

Understanding and measuring religion and spirituality (R/S) is essential for psychology and psychotherapy. Over 40 years ago, Strommen (1984), an expert in the psychology of religion and editor of the comprehensive handbook Research on Religious Development (Strommen, 1971), noted that “religious beliefs and values are among the best predictors of what people will say or do” (p. 151). This insight remains relevant today as we observe the profound impact of religion, both positive and negative, on individuals and communities worldwide.

One of the goals of the Bridges Institute is to ensure that high-quality R/S assessment measures are easily available to practitioners and researchers. We believe this is essential for enhancing our understanding of people’s experiences, motivations, healing, and personal growth. Information about the Bridges Institute’s R/S measures is provided below. Researchers and practitioners who would like permission to use these measures should message the Bridges Institute on the “Contact Us” page.

Bridges Institute Intake Measures

When clients present for treatment, therapists should conduct an assessment to gain a comprehensive understanding of the client’s spiritual worldview and current religious status. Even when a client belongs to the same religious denomination as the therapist, such an assessment is still necessary. Out of respect for individual differences, therapists should not assume they understand a client’s religious beliefs and values based solely on religious affiliation. Conducting R/S assessments at the beginning of treatment can inform therapists whether to incorporate spiritual interventions in sessions and help determine if a client’s beliefs contribute positively or negatively to their mental health and overall well-being. Additionally, by gaining insight into clients’ spiritual beliefs and values, therapists can build trust and develop deeper empathy and understanding for them.

Client Religious/Spiritual Intake Survey

Currently, the most effective methods for conducting R/S intake assessments are written intake history questionnaires and clinical interviews that include questions about clients’ religious and spiritual histories and current beliefs. Richards & Bergin’s (2005) Client Religious/Spiritual Intake Survey (available in Chapter 8) provides a list of R/S questions that can be included in a client intake questionnaire or posed by therapists during clinical interviews.

Psychospiritual Themes Interview and Assessment Guide

Richards and Bergin’s (2005) Psychospiritual Themes Interview and Assessment Guide (available in Chapter 8) is based on their theistic model of psychospiritual maturity (described in Chapter 5). The bipolar psychospiritual themes describe tasks or challenges that people confront as they develop and experience life and include: (1) Eternal identity vs Moral Overlay; (2) Agency vs Impairment; (3) Moral Responsibility vs Relativism and Uncertainty; (4) Integrity vs Deception; (5) Benevolent Power vs Authoritarianism; (6) Faithful Intimacy vs Infidelity and Self-focus; (7) Marriage, Family, and Community vs Alienation and Isolation; and (8) Growth and Change vs Stagnation.

Religious Discrimination Scale

The Religious Discrimination Scale (RDS) is an 11-item instrument that assesses three dimensions of perceived discrimination experiences: Perceived Prejudice, Closet Symptoms, and Negative Labels. Psychometric evaluations of the RDS indicate a strong and clear factor structure and good internal consistency reliability. The test of measurement and structural invariance across gender also suggests that the RDS scale is equally appropriate for both men and women.

Bridges Institute Outcome Measures

Monitoring client’s spiritual outcomes during treatment may help psychotherapists better understand how spiritual growth can facilitate meaningful changes in clients’ lives and foster hope and resilience. Research on spiritual outcomes in psychotherapy could also demonstrate that mental health treatment does not necessarily undermine clients’ faith but can enhance it. Such findings could encourage more referrals from religious leaders and increase the willingness of individuals from faith communities to seek mental health support. By assessing the R/S outcomes of treatment, practitioners can more comprehensively evaluate their work and its impact on clients.

Theistic Spiritual Outcome Survey

The Theistic Spiritual Outcome Survey (TSOS; Richards et al., 2005) measures the spiritual outcomes of psychotherapy from a theistic spiritual perspective with subscales that measure the Love of God, Love of Others, and Love of Self. A 17-item version of the TSOS has been found to have good reliability and validity in a sample of college students, a sample of inpatient women with eating disorders, and two samples from inpatient psychological clinics in Germany. Studies to date support the psychometric properties and clinical sensitivity of the TSOS.

CAMOS Spiritual Distress Scale

The Clinically-Adaptive Multidimensional Outcome Survey (CAMOS; Sanders et al., 2017) assesses clients’ levels of distress across six clinically relevant dimensions: Spiritual Distress, Physical Health Distress, Relationship Distress, Psychological Distress, Work/School Distress, and Therapy Progress Concerns. A six-factor intake form demonstrated acceptable model fit and strong internal consistency reliability. Each dimension exhibited moderate to strong convergent validity with measures of similar constructs, providing evidence that the CAMOS is a reliable and valid measure of several important dimensions of psychotherapy outcomes, including spiritual distress.

Bridges Institute Process Measures

Psychotherapy process research involves observing and describing the treatment process, including client and therapist behaviors (e.g., verbal and non-verbal communication, therapist and client intentions, topics or clinical issues discussed, and levels of emotional experiencing). Researchers at the Bridges Institute have developed three process measures that have been utilized in research studies to describe psychotherapy processes, including: (1) Counseling Topic Classification System, a coding system used by trained observers; (2) Therapist Session Checklist, a checklist therapists use to document their in-session interventions; and (3) Therapist Spiritual Interventions Survey, a retrospective survey in which therapists rate how often they implement various spiritual interventions in their work.

Counseling Topic Classification System (CTSC)

The Counseling Topic Classification System (CTCS; Richards & Lonborg, 1996) provides researchers with a standardized method for classifying the nature of 55 topics (including the topics of religion and spirituality) and eight emotional dimensions as they occur moment to moment in therapy. One advantage of the CTCS is its breadth; researchers can code a wide range of topics using this system. Another advantage is that the CTCS does not require raters to have extensive training in psychotherapy, nor does it necessitate adherence to or familiarity with a specific theoretical viewpoint.

Therapist Session Checklist

The Therapist Session Checklist (TSC; Sanders et al., 2015) is a therapist process survey that can be completed in approximately one to two minutes after each treatment session, allowing therapists to record what they did during the session (e.g., the theoretical orientation of the session, clinical topics discussed, secular and spiritual interventions used, therapeutic intentions). The TSC includes a list of 30 spiritual practices and interventions that psychotherapists may encourage or use during treatment (e.g., used spiritual assessment, discussed the spiritual dimensions of problems and solutions, affirmed trusting God, discussed compassion, discussed gratitude, encouraged listening to the heart, encouraged spiritual meditation, explored questions about ultimate meaning, explored religious questions and doubts, listened to spiritual issues, referred to religious community). The TSC is included as one of the assessment measures in the Bridges Assessment System (BAS).

Therapist Spiritual Interventions Survey

The Therapist Spiritual Interventions Survey (TSIS; Richards, Jones, & Sanders, 2025, in press) is an adaptation of the list of spiritual practices and interventions from the Therapist Session Checklist. Instead of asking therapists to rate which spiritual interventions they used after their treatment sessions, the TSIS asks participants to rate how often they used each spiritual intervention during the past month in their treatment sessions on a six-point scale (1 = never, 2 = rarely, 3 = occasionally, 4 = often, 5 = very often, 6 = always). A factor analysis of the spiritual intervention items on the TSIS revealed that the items can be grouped into four general types: (1) Basic S/R Skills (e.g., “used spiritual assessment,” “explored religious questions and doubts”), (2) Encouraging Spiritual Practices (e.g., “encouraged personal prayer,” “encouraged spiritual meditation”), (3) Discussing Virtues (e.g., “discussed humility,” “discussed gratitude”), and (4) Facilitating Spiritual Attachment (e.g., “affirmed client’s divine worth,” “encouraged acceptance of divine love”) (Sanders & Richards, 2022). The TSIS subscales demonstrated good internal consistency reliabilities (standardized Cronbach alpha’s = .94 for Basic S/R Skills, .93 for Encouraging Spiritual Practices, .91 for Discussing Virtues, and .93 for Facilitating Spiritual Attachment.

Other R/S Intake and Treatment Outcome Measures

Measures of Religiosity (Hill & Hood, 1999) is a handbook that includes copies and critical reviews of over 120 measures of various types of religiousness, such as religious beliefs, practices, and attitudes; religious orientation; religious development; religious commitment and involvement; religious experience; religious and moral values; religious coping and problem-solving; spirituality and mysticism; God concept; religious fundamentalism; views about death and the afterlife; religious attributions; and forgiveness. This resource is invaluable for researchers and clinicians. Two other helpful resources regarding religious and spiritual assessment include a review article titled, The Current Status of Measures of Spirituality: A Critical Review of Scale Development (Kapuscinski & Masters, 2010) and a book titled, Assessing Spirituality in a Diverse World (Ai, Wink, Paloutzian, & Harris, 2021).