Industry Perspectives: Why It’s Important to Incorporate Spirituality, Sexuality, and Gender in Evaluations and Treatment
When social workers sit with new clients to perform an intake evaluation, they are accustomed to asking questions that would fall under the categories of bio-psycho-social status. These include demographics, medical and mental health history, recent symptoms and concerns, education, current employment and work history, household makeup, developmental milestones, legal concerns, substance abuse history, hobbies, and interests. All of the above queries are intended to assist the clinician in having a preliminary understanding of the person in front of them and what has them seeking treatment.
The evaluation also begins the process of helping to meet the psychosocial needs of the client in the systems in which they exist. The Law Insider dictionary definition of psychosocial needs is: “Any combination of mental health, emotional, spiritual or behavioral needs, concerns or aspects” that are meaningful to the individual. We are only able to create a foundation for treatment when we have a grasp of what matters most to our client.1
Entering Into the Client’s World and Building Trust
When clients trust the clinician, they are more likely to be vulnerable in their sharing. I developed the following acronym to describe the meaning of trust:
• Truth: Factual, not relying on perception.
Bringing Taboo Subjects of Sex and Religion Out of the Closet
Finding Meaning in Spirituality
I ponder the meaning of spirituality, which I differentiate from religion. To me, the former is about the connection between my heart and mind and the god of my understanding, and the latter is about the structure, dogma, and doctrine that, at times, seems meant to control and prevent freedom of thought. In my 40s, I was ordained as an interfaith minister after graduating from a two-year program called The New Seminary that was founded by a rabbi, priest, imam, and minister, which sounds like the opening line to a joke. When I contemplate my own spiritual beliefs, they come in the form of seeing all as one. They are reflective of “the Force” in Star Wars, the life force energy that permeates everything. While faith, religion, and spirituality are considered some of the “taboo subjects” that people are reluctant to discuss at the dinner table, it’s essential for social workers to hold space for clients to express their feelings on the subject and embrace a culturally competent approach to treatment.
NASW defines cultural competence in social work as “the process whereby people and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, spiritual traditions, immigration status, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each.”3 The Society for Spirituality and Social Work also addresses the intersection of the two realms. According to its founder, Ed Canda, “The human spiritual quest for a sense of meaning, purpose and morally fulfilling relationship is integral to our own professional and personal attempts to understand and alleviate suffering and injustice. … I believe that the magnitude of suffering and the significance of spirituality in dealing with it are so great that social workers of all diverse spiritual views need to work together in cooperation and common purpose.”4
Another aspect of cultural competence is sex. When clinicians are comfortable exploring this subject in their own lives, they’re better equipped to be solid supports for their clients who may bring up uncomfortable issues that might not be in alignment with the clinicians’ experience or values system. Many of our clients may be questioning their gender identity or sexual orientation and the ways in which those realities affect their mental health. Being an affirming presence or ally may make the difference between life and death.
Clients may feel uncomfortable with questions related to sexuality and gender and need to be assured that their answers will only be used for therapeutic purposes. Vanderbilt University has a helpful primer on the types of questions that could be of assistance in providing informed care for clients.5
In my practice, clients are usually willing during the intake to share that their concerns revolve around sexuality and/or gender. On occasion, the topic arises after months of treatment. An example is that of a couple I have been working with on something unrelated who revealed to me that their sexual proclivities and activities were not in the mainstream and went on to tell me in detail what that meant and how it impacted their relationship. Because trust had been built, they felt safe sharing this with me.
An addition to my office décor is a rainbow flag that lets clients know that my office is a safe space for everyone who enters and that I am an affirming and sex-positive therapist.
Another useful resource is a documentary film called Angels and Saints-Eros and Awe, which elegantly touches on the conjoined subjects of sex/gender and spirituality.6 It addresses the psychic pain and damage that traditional institutional religions and American culture have for so many years inflicted by teaching that “the spirit is good” but the “body is evil.” The interview subjects represent a gender matrix and identify as cis-gender, heterosexual, nonbinary, gay, lesbian, trans, or “OtherWise,” and are clergy, therapists, and sex educators. The filmmakers, Rodney Whittenberg and Vic Compher, a licensed social worker, have experienced feedback from clinicians and communities, including NASW (the film was screened at the October 2022 conference in Pennsylvania), that work with clients addressing issues of sexuality and gender indicating that this film has positive application for those they serve.
Incorporating sexuality and spirituality into our practices will create a more open, affirming, accepting, and potentially lifesaving environment for those we serve.
— Rev. Edie Weinstein, MSW, LSW, is a licensed social worker, psychotherapist, interfaith minister, journalist, speaker, and author (www.opti-mystical.com). She calls herself an Opti-Mystic who sees the world through the eyes of possibility. She is also the founder of Hugmobsters Armed With Love, which offers FREE HUGS worldwide. Weinstein just presented her first TEDx talk called “Overcoming the Taboo of Touch.”
2. Weinstein-Moser E. Spirituality in social work — the journey from fringe to mainstream. Social Work Today. 2008;8(2):32.
3. National Association of Social Workers. Standards and Indicators for Cultural Competence in Social Work Practice. https://www.socialworkers.org/LinkClick.aspx?fileticke
4. Society for Spirituality and Social Work website. https://spiritualityandsocialwork.org/
5. How to ask about sexuality and gender. Vanderbilt University website. https://www.vanderbilt.edu/lgbtqi/resources/how-to-ask-about-sexuality-gender
6. Angels and Saints — Eros and Awe website. https://www.angelsandsaints-erosandawe.com