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Why It’s Important to Incorporate Spirituality, Sexuality, and Gender in Evaluations and Treatment
By Rev. Edie Weinstein, MSW, LSW

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 to help 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 clients.

Entering Into the Client’s World and Building Trust
An essential part of social work education is the call to meet the client where they are. We are better equipped to do that when we come to know them as more than words on paper or a computer screen. As a career social worker who completed a graduate program in 1985, I take to heart the tremendous honor it is to be present with people at times of their deepest needs and most profound losses. They often struggle with being human, and some wanted to end their corporeal existence as a result. All these years later, I realize that my job is to be present with them as together we sort through the baggage they unpack with me.

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 the word:

• Truth: factual, not relying on perception.
• Reliability: consistency, walking the talk, accountability.
• Understanding: fueled by empathy. Can I walk a mile in your moccasins?
• Sincerity: coming from the heart as an example of true caring about another person.
• Time: trust is developed over a series of moments with proven reliability.

Bringing Taboo Subjects of Sex and Religion Out of the Closet
Two essential elements of the evaluation touch on spirituality and sexuality. They form the foundation of existence, since sex is how we all came to be, and because those who believe in a creator god use that relationship to craft their day-to-day existence. As clinicians, we need to destigmatize talking about these subjects and make them as natural as asking a client what they had for breakfast. Questions related to religious background and current practice help clinicians understand how clients deal with loss and challenge. If a client is in recovery from addiction, attending some form of a 12-step program, they may be familiar with the concept of “the God of their understanding,” or higher power. One question I ask clients who say that they are not religious is, “What sustains you when life gets hard, or it feels like it is more than you can handle?”

Finding Meaning in Spirituality
An article in Social Work Today titled “Spirituality in Social Work — The Journey From Fringe to Mainstream,” indicates, “The combination of spirituality and social work has implications in the areas of trauma, end-of-life issues, aging, illness, cultural competence, addiction treatment, ethics, relationships, forgiveness, chronic mental illness, the meaning of life, and attempting to answer the age old question, ‘Why is this happening?’ Social workers often address these issues in their own lives while helping clients face them. They are increasingly examining how their spiritual values affect practice of the profession, as well as how clients' spirituality impacts world view, coping skills, and ability to manage adversity.”

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 is essential for social workers to hold space for clients to express their feelings on the subject and embrace a culturally competent approach to treatment.

The 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.”

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.”

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 clinician’s 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.

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, 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. 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), who work with clients addressing issues of sexuality and gender 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 life-saving 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 recently presented her first TEDx talk called “Overcoming the Taboo of Touch.”