Spirituality Assessment Questionnaire

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Your Spirituality Score: 41 Questions By Daniel Keeran, MSW, Victoria, Canada www.counsellorpublishing.com

an exploration of your beliefs about non-material reality  Your Spirituality Score: 41 Questions  Personal and Group Identity Short-Form Questionnaire  Counseling Assessment Self-Healing Questionnaire  Cultivating Love As Your Identity

Peace Press Victoria, Canada 2014


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Copyright 2014 by Daniel Keeran, MSW Permission is hereby granted to anyone for the full reproduction and distribution of this assessment questionnaire.

ISBN-13: 978-1502521859 ISBN-10: 1502521857

Printed in Canada.


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Dedicated to everyone in pursuit of spiritual growth and awareness.

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Table of Contents Your Spirituality Score: 41 Question s

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Personal and Group Identity Short-Form Questionnaire

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Counseling Assessment Self-Healing Questionnaire

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Cultivating Love As Your Identity

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Your Spirituality Score Spirituality provides: values and beliefs for making healthy choices, a foundation of hope and meaning for direction and optimism, and support and encouragement to face major life difficulties. Strengthening your spiritual growth and awareness can set you on a path to find inner peace, physical and mental healing, and personal fulfillment. Your Spirituality Score is based on how many questions of the total for which you can provide a confident answer, rather than saying, “I don’t know.� Responses can be written, verbal, or mental, but written may be beneficial for most people. 1. What is your age, gender, and ethnic/race origin? 2. What were the spiritual/religious views of your father? Your mother? 3. How has your spirituality changed from your childhood until now? 4. Is there anything more than the material universe? Explain. 5. Do you believe intelligence and creativity exist in the universe? Explain. 6. Do you believe in the existence of a transcendent intelligence or superior reasoning power? Explain why or why not. 7. Do you see evidence of creative intelligence in the design and complexity of the universe or do you lean toward a material natural explanation?

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8. Do you believe all human beings have equal worth and value? Explain why or why not? What are the implications? 9. Do you believe the human species has greater or superior value or greater importance or more responsibility compared to other life forms? Why or why not? What are the implications? 10. What is the meaning or purpose of human existence? 11. How do you know what is right and wrong? 12. What is the most important thing you can do with your life? 13. Is hope important? Explain. 14. What happens after you die? Does your individual identity or consciousness continue to exist? What are the implications? 15. Is the idea of the meaning of human life essential to the idea of hope? Explain. 16. Is the idea of right and wrong essential to the idea of meaning? Explain. 17. What have been some of the most important influences on you for what you value and believe? 18. What spiritual practices do you have? Prayer, centering prayer, meditation, scripture reading, worship, singing, other. 19. Does moral accountability only happen within the legal systems of nations? Is there ultimate accountability in a venue after death? What are the implications? 20. If people are reborn into new lives, what if anything determines the nature or quality of their existence? What are the implications? 21. Comment on this statement: “Many people think only tangible things are real, yet the same people admit intangible 8


things are most important: love, compassion, empathy, justice, morality, consciousness, wisdom, human value, meaning of life, and eternity... for without these, life is void and vain, and aspirations mere illusions.” 22. Have you ever experienced what you believe to be a sign or communication from God or other spiritual being? 23. What is your view of this statement? “Humans are spiritual beings existing in physical bodies.” 24. Do you believe you have convincing evidence of spiritual reality? 25. What is your idea of an ideal society? World? Life? 26. When does an individual human life begin? 27. What is the essence of the self? 28. Do you believe angels and demons exist? 29. Do you believe everyone after death goes to heaven or to hell? 30. Do you believe the superior reasoning power has ever communicated with humanity? 31. How open are you to exploring different aspects of spirituality? 32. If you saw someone raise the dead, what would you think or do? 33. If you saw a person die and then you saw him alive again a few days later, what would you think or do? 34. Comment on the statement: “Humans are a parasite infestation of the earth.” 9


35. How can you prove to anyone else that you are aware of yourself, your own consciousness? 36. Describe a healthy relationship. 37. How important is your spirituality to your life? And do you want your spirituality to increase or decrease? 38. If we are made in the image of God, what qualities do we share with God? 39. Read Isaiah, chapter 53, written in 700 BC. Who is being described? See other amazing examples of future-telling here. 40. Do you now belong to or have you thought of joining a spiritual community to strengthen values and beliefs for making healthy choices, to acquire a foundation of hope and meaning for direction and optimism, and to receive support and encouragement to face major life difficulties? 41. How has this questionnaire affected your awareness of your spirituality? Final instructions: Count the number of questions for which you struggled to give a sincere answer, and then subtract the number from the number 40. The answer is your Spirituality Score. How to use this assessment: Whatever your score may be, give further consideration to questions you are unsure about or for which you have difficulty giving a response.

Calculating Your Spirituality Score 1. Make a mark indicating any question for which you feel unable to give a satisfactory answer or that you find especially challenging. 10


2. Add the number of marks in #1 and subtract this number from 40. 3. The answer to #2 is your Spirituality Score. NOTE: This score and your answers to questions are to be used only by you and anyone to whom you grant permission.

Total number of questions

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Number of difficult questions Your Spirituality Score To arrange an interview in person or through skype, email collegemhc@gmail.com

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Personal and Group Identity Short-Form Questionnaire The identity of an individual or group can be clarified and supported by exploring factors related to the existence of the entity. Included in the short-form questionnaire are items pertaining to historical and current factors as well as future goals. Memories are major contributors to identity as well as values and beliefs as a foundation of vision formation. 1. Historical: Who Were You? (For individual identity, see also the Counseling Assessment Questionnaire and the Curriculum Vitae example.) Origin: date and place, names and identifying characteristics of the members; purpose, practices, values and beliefs of the group. Who are the ancestors, before the origin, and what have they contributed to identity? What trauma, conflict, and loss have occurred since the origin? How have the values and beliefs changed since the origin? Who and what have been most influential? What historical photographs, writings, interviews with senior members, and other materials are available?

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2. Current: Who Are You? What are the current demographics: ages, ethnicities, genders, family characteristics, occupations? What are the current values and beliefs? Who and what are most influential? 3. Vision: Who Do You Want To Be? Based on your historical and current values, beliefs, and demographics, what are your goals for the future? for the coming year? for the next five years? for the next ten years? for the next fifty years? What is your vision or hope for future generations? Who and what do you hope will be most influential?

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Counseling Assessment Self-Healing Questionnaire Prepared by Daniel Keeran, MSW, President College of Mental Health Counselling www.collegemhc.com

Introduce Yourself 1.What is your first name? 2.What is your age and gender? 3.What is your marital status? Single, married, separated, or divorced? How long? Explain the reasons for separation(s) or divorce(s). What happened? 4.What is your race, ethnic, or cultural background? Caucasian, Chinese, East Indian, Aboriginal, Other? 5.What are your children's genders and ages? If they are adults, give their occupations and marital situation. 6.Do you live alone or with someone? How long? What Happened? 7.What problems and concerns do you have now? 8.What emotions have you been having and what is each one about? Fear, anger, frustration, guilt, sadness, low self-worth, despair, other feelings? 9.How long have you been feeling this way? (for each feeling or problem) What happened at the time you began feeling this way? 10.When have you felt like this in the past and what happened? 11.Any health problems? E.g. epilepsy, diabetes, etc. 12.Any counseling or hospitalized for emotional reasons? How old were you? Please give the reasons.

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The Family You Grew Up In and Your Childhood 13.How many brothers and sisters do you have? Give each person's gender, age, occupation, and marital situation. 14.Which one are you in the line of birth? First, last, second or third, etc. How many years separate you from the others nearest you? 15.Who were you closest to when growing up? 16.Are your parents still living? What was your age at their death? 17.Have your experienced any other deaths of family members or friends? What was your age? 18.Describe your father's (and step-father's) personality and your relationship to him when you were growing up. Were you close, not so close, distant, affectionate? Give an example of something that happened that shows this and how old you were. 19.Talk about how your relationship with your father (or father figure) during childhood may have affected you in both positive and negative ways. 20.How have the negative experiences with your father figure(s), come up again in your relationships with other people up to now? 21.Describe your mother's (and step-mother's) personality and your relationship to her when you were growing up. Were you close, not so close, distant, affectionate? Give an example of something that happened that shows this and how old you were. 22.Talk about how your relationship with your mother (or mother figure) during childhood may have affected you in both positive and negative ways. 23.How have the negative experiences with your mother figure(s), come up again in your relationships with other people up to now? 16


24.What were your spiritual or religious beliefs before age 10 and how have your beliefs changed since then? 25.What was your role in the family when you were growing up? Think of a word, e.g. peacemaker, black sheep, victim, outsider, assistant parent, invisible, baby, etc.? Give an example of what happened. 26.Describe your parents' relationship. Were they affectionate? How did they deal with conflict? Give an example of what happened. 27.Was anyone in the family or extended family ever hospitalized for emotional reasons or commit suicide? Any mental retardation? 28.How did family members relate to each other when you were growing up? Give an example. 29.How were feelings of anger, sadness, fear, and guilt expressed? Give an example. 30.Describe a time when you were disciplined that was most painful for you. How old were you? What happened? 31.What personality features do you have which your parents also have? 32.Who was there for you when you were hurt as a child? 33.What messages about your worth and the worth of others, was communicated by each parent both verbally and nonverbally? 34.How old were you when you left home, and why did you leave? 35.If you had miraculous power to change your family when you were growing up and your childhood in any three ways, what would you choose? 36.If your family experience had been different in the ways you mentioned above, how do you imagine your life might be different today? 37.Do you know if your mother had any problems with your birth?

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Your School Experience and Friends 38.What was the first day of school like? 39.How many moves and school changes occurred during school years? How old were you, what grades did you move and why? 40.Describe your relationships with teachers. 41.Describe your relationships with peers. 42.Do you believe you achieved your best in school? Why? What grade or education level did you complete? What happened? 43.Did you have a group of friends during the first six grades? If not, why? 44.Did you have one or two very close friends as a teenager? If not, why? 45.Did you tend to be a follower or a leader with friends as a teenager? 46.How old were you when you first started go out with someone (or dated)? 47.Do you have a satisfactory network of friends, family, groups? Describe these briefly. 48.How would you describe the types of people you associate with? (What is your role with friends and acquaintances? Helper, victim, other?) Your Work Experiences 49.How old were you when you first went to work? 50.What types of jobs have you had and how many? Why did you leave each job? 51.What has been your role at work? Helper, invisible, responsible, victim, other? And how have you gotten along with bosses? Your Social Life and Relationships 52.What was your first date like for you? 18


53.How old were you with your first sexual experience? And first intercourse? 54.How many sexual partners have you had over time? And what is your sexual preference or orientation? (heterosexual, homosexual, bisexual) 55.Describe your partner’s personality and your relationship. Aggressive, passive, abusive, caring, other? And describe previous meaningful relationships, their personalities, and why they ended. Your Legalities, Use of Substances, Financial Situation 56.Have you had any past arrests, warrants, charges, suits against you? How old were you and what were they about? 57.What amount of debt do you have? 58.Any drug or alcohol use? Why do you use it? Has anyone complained that you use too much or too often? Your Mood 59.Have you ever had suicidal thoughts at any time in your life? How old were you? What happened? 60.What is your mood right now on a scale of zero (0) to 10, with zero meaning ‘life is not worth living’ and 10 meaning you are very optimistic and life is wonderful? What number do you give your mood? 61.Any thought of wanting to harm yourself or anyone else? Your Final Thoughts and Understandings 62.What are your greatest strengths? And what skills or abilities do you currently have the most confidence in?

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63.Having looked at your life from early days until now, what do you think may have contributed most to your present difficulties? 64.Of all the questions above, what has been most difficult for you to think about or answer? 65.If you were to continue on a path of change and growth what would you hope to achieve or what would be your goals in counselling? 66.What has it been like completing your Life Story Questionnaire?

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Cultivating Love As Your Identity If God is love, and if humans are made in the image of God, what are the implications? It means love is the essence of our true self, so that when we show caring for others, our conduct is aligned with our true self and we feel fulfilled and happy. Conversely, when we ignore others in trouble or when we do violence to others (as in war) our true self becomes misaligned and violated and we become anxious and depressed. Love is the essence of who you are because you are created in the image of God who is Love. You feel most fulfilled when you show interest in and take action to care about what happens to the troubled and lost. If everyone is broken, we must bring caring and compassion to all of our relationships and human interactions. Believing you are love, just as God is love, is better than not believing you are love. To cultivate a stronger self-identity of love, meditate about these words: “A new command I give you: Love one another. As I have loved you, so you must love one another. By this everyone will know that you are my disciples, if you love one another.� - John 13:34-35 21


"Love does no harm to a neighbor. Therefore love is the fulfillment of the law." - Romans 13:10 “…walk in the way of love, just as Christ loved us and gave himself up for us as a fragrant offering and sacrifice to God.” – Ephesians 5:2 "We know that we have passed from death to life, because we love each other. Anyone who does not love remains in death." - 1 John 3:14 "Dear friends, let us love one another, for love comes from God. Everyone who loves has been born of God and knows God. Whoever does not love does not know God, because God is love. This is how God showed his love among us: He sent his one and only Son into the world that we might live through him. This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins." - 1 John 4:7-10 To take the next step in your spiritual life, email Daniel at collegemhc@gmail.com

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THE GOD WHO IS LOVE, LOVES YOU http://www.box.com/lovegod

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