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Journal of Religion & Spirituality in Social Work: Social Thought

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Developing cultural competence with LDS clients: Utilizing spiritual genograms in social work practice

Gordon E. Limb, David R. Hodge, Kaitlin Ward, Alissa Ferrell & Richard Alboroto

To cite this article: Gordon E. Limb, David R. Hodge, Kaitlin Ward, Alissa Ferrell & Richard Alboroto (2018) Developing cultural competence with LDS clients: Utilizing spiritual genograms in social work practice, Journal of Religion & Spirituality in Social Work: Social Thought, 37:2, 166-181, DOI: 10.1080/15426432.2018.1448033

To link to this article: https://doi.org/10.1080/15426432.2018.1448033

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Developing cultural competence with LDS clients: Utilizing spiritual genograms in social work practice Gordon E. Limb a, David R. Hodgeb, Kaitlin Ward a, Alissa Ferrella, and Richard Alborotoc

aSchool of Social Work, Brigham Young University, Provo, Utah, USA; bArizona State University, Phoenix, Arizona, USA; cUniversity of Hawaii at Manoa, Honolulu, HI, USA

ABSTRACT In recent years, social work has increasingly focused on spiri- tuality and religion as key elements of cultural competence. Consequently, specific strategies have been developed to pro- vide the most appropriate interventions for religious clients. The Church of Jesus Christ of Latter-day Saints (LDS) is the fourth largest and the fastest growing church in the United States and is one of the fastest growing churches worldwide. In an effort to facilitate cultural competence with LDS clients, a spiritual assessment tool was developed based upon the gen- ogram. Evaluation of this tool was facilitated through a survey of 100 practitioners. Participants liked the idea of using a spiritual genogram and felt it would be a useful tool in therapy. In general, they thought the questions associated with the spiritual genogram were appropriate and consistent with LDS culture, although numerous suggestions for improvement were offered.

ARTICLE HISTORY Received 18 September 2017 Accepted 28 February 2018

KEYWORDS spirituality; religion; clinical; mental health/health

Cultural competence is highly emphasized in both the National Association of Social Workers (NASW) Code of Ethics (2008) and the Council on Social Work Education’s (CSWE) Educational Policy and Accreditation Standards (2015). Moreover, spirituality and religion are increasingly addressed in the literature as important components of cultural competence (e.g., Canda & Furman, 2010; Harris, Ellor, & Yancey, 2017; Hodge, 2015a; Whitley, 2012). The Church of Jesus Christ of Latter-day Saints, commonly known as the Mormon Church (“the LDS Church”), now represents the fourth largest church in the United States, with a worldwide membership of over 15 million The Church of Jesus Christ of Latter-day Saints, 2017a; (Lindner, 2012).

Additionally, it is estimated that over half of the LDS Church’s member- ship live outside of the United States, increasing the likelihood that LDS members could be found among social work clientele worldwide (Petersen, 2013). Despite the hundreds of thousands of individuals joining the LDS Church each year (The Church of Jesus Christ of Latter-day Saints, 2017a),

CONTACT Gordon E. Limb [email protected] BYU School of Social Work, 2190A JFSB, Provo, UT 84602

JOURNAL OF RELIGION & SPIRITUALITY IN SOCIAL WORK: SOCIAL THOUGHT 2018, VOL. 37, NO. 2, 166–181 https://doi.org/10.1080/15426432.2018.1448033

© 2018 Taylor & Francis

very little published material is available to aid social workers as they seek to provide culturally competent services to LDS clients. Therefore, the purpose of this study was to examine a spiritual assessment tool as it has been modified for use with LDS clients.

Spirituality and religion

As social workers attend to a variety of issues presented by clients, conduct- ing comprehensive bio-psycho-social-spiritual assessments is a critical part of their ability to adequately administer mental health treatment (Hodge, 2015a). Indeed, attending to clients’ religion and spirituality (RS) can posi- tively affect mental health outcomes, such as the ability to cope with stress, increase positive emotions, and increase well-being and quality of life (Koenig, King, & Carlson, 2012; Prieto Peres, Kamei, Tobo, & Lucchetti, 2017). Additionally, implications for health and well-being can arise if RS is a source of distress or internal conflict (Park et al., 2017).

Spirituality can be defined as a personal entity, construct, or a relationship with the sacred (Boyatzis, 2005). Religion, on the other hand, is often defined in the literature as personal beliefs as well as communally affirmed beliefs and practices (Hodge, 2015b). For many, RS can be a cultural worldview through which reality is experienced, similar to that of race or ethnicity (Madsen, 2016). Additionally, RS can be a fundamental component of clients’ identities (Hodge, 2015a). Therefore, it is critical that practitioners work to expand their cultural competency and understand clients’ unique experiences with RS.

In fact, the CSWE’s Educational Policy and Accreditation Standards (2015) require that social work students in accredited programs understand how varying dimensions of diversity, including RS, affect human experience and identity formation. Furthermore, the NASW Standards for Cultural Competence in Social Work Practice (NASW, 2015) emphasize the ethical responsibility of social workers to engage in culturally competent practice and interventions that address the importance of RS in clients’ lives. Given these obligations, it is apparent that RS is an important aspect of many clients’ lives that should be assessed and possibly incorporated in treatment interventions.

The focus on cultural competence and the recognition of RS as key factors in cultural understanding has led to an increased interest in using spiritual assessments to identify clients’ strengths and address treatment/intervention strategies (Canda & Furman, 2010; Hodge, 2015a; Tracey, 2017). Moreover, spiritual assessments have become mandated in many settings across the United States. The Joint Commission, the largest health care-accrediting organization in the United States, requires the administration of spiritual assessments in many settings frequented by religious clients, including

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hospitals, agencies providing addiction treatment, and other settings where mental health services are available (Hodge, 2015a). The current study examined a distinct cultural group of religious clients—those who belong to the LDS Church. Following a brief introduction to LDS beliefs and culture, the next section examines a spiritual assessment tool that may be particularly useful with this commonly overlooked population—spiritual genograms.

LDS beliefs and culture

Building on a strength-based approach for those working with this popula- tion, knowledge of basic LDS beliefs and cultural values are essential for conducting an appropriate therapeutic assessment and selecting the best intervention approach. Established in 1830, the LDS Church combines Judeo–Christian traditions with modern prophetic leadership. Members of the LDS Church believe the founder and first modern-day prophet to be Joseph Smith, a man members believe was visited by God the Father and the resurrected Lord, Jesus Christ. Joseph Smith is believed to have “restored” Jesus Christ’s original church that was lost from the Earth after Christ’s resurrection and ascension to heaven and the death of the apostles (The Church of Jesus Christ of Latter-day Saints, 2012). This claim, like many others, sets the LDS Church apart from other Christian denominations.

LDS Church members consider many of their beliefs, attitudes, and beha- viors similar to those of other Christian faiths (Ulrich, Richards, Hansen, & Bergin, 2014). However, LDS Church members differ in some important ways. LDS Church doctrine posits that God the Father, Jesus Christ, and the Holy Spirit are three separate and distinct personages. Although LDS doc- trine teaches that Jesus Christ is Savior and Redeemer, many denominations hesitate to recognize Latter-Day Saints as Christians because of this belief in three distinct members of the Godhead (Davis, 2006). Another difference between the LDS Church and other Christian religions is the belief that the LDS Church is led by a living prophet who receives revelations directly from God and Jesus Christ (Mason, 2015). In terms of attitudes and behaviors, LDS Church members tend to have higher-than-average levels of education but, unlike other religions, higher education tends to be correlated with increased religiosity (Pew Forum, 2012).

Marriage and family life are central to LDS beliefs and culture. Religious teachings and LDS Church programs frequently focus on ways to strengthen the family (Ulrich et al., 2014). Temple worship, which is separate from Sunday worship services, are holy places of worship where individuals make sacred covenants with God (The Church of Jesus Christ of Latter-day Saints, 2017b). Temples have an important family component where LDS Church members believe that, through promises made in the temple, a husband and wife can be together and with their children—even after

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death. Temples are also places where faithful LDS members perform proxy saving practices (like baptisms) for deceased ancestors (The Church of Jesus Christ of Latter-day Saints, 2017c). Consequently, LDS Church members are expected to engage in temple worship and genealogical research, as well as other family-centered activities (Walton, Limb, & Hodge, 2011).

The families of practicing LDS Church members often include extensive kinship networks, and these members are likely to be quite familiar with their ancestral heritage (Walton et al., 2011). Likewise, the most frequently mentioned reason for local LDS Church leaders to refer members to mental health providers is marriage and family problems (Barlow & Bergin, 1998). Because of the focus on ancestors and extended kinship networks, the genogram can be an effective tool to leverage an existing resource for assessment and intervention. Further, social work is about offering people options and alternatives and the spiritual genogram is an assessment tool that may help generate options and alternatives for those social work serves.

Spiritual genograms

Genograms are consistent with the person-in-environment perspective and help both practitioners and clients understand the flow of histori- cally-rooted patterns through time (Hodge, 2001). Genograms can serve as a tracking mechanism for defining the intergenerational family struc- ture and outline relationships, roles, resources, and strengths (McGoldrick, Gerson, & Petry, 2008). Here, genograms are tools for assessment as well as intervention. Creating a genogram as part of the therapeutic process is a meaningful way of engaging clients and initiat- ing therapeutic interventions.

The most important elements of a client’s culture are those that are uniquely passed down through the generational transmission of family values, traditions, and practices (Sutton, 2000). Considering this importance, genograms have been used for the past three decades to help social workers become more culturally competent (Hardy & Laszloffy, 1995; Limb & Hodge, 2010). Traditionally, however, social workers have not been encouraged to delve into RS, which represent important aspects of culture for many clients (Beyers, 2017; Dunn & Dawes, 1999; Hodge & Limb, 2014). Indeed, even within the same denomination, clients can express their RS in very different manners. Nevertheless, in most cases, families are successful in passing on their values and beliefs to succeeding generations (Hodge, 2001). Religious and spiritual values, as transmitted through the family, are the ones that are likely to be most relevant to the client—regardless of whether it is the perpetuation of values or intergenerational conflict resulting from those values.

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Spiritual genograms provide social workers with a graphic representation of complex illustrations of spirituality and religiosity over at least three generations. When initiating a spiritual genogram assessment, the basic family system is demarcated in keeping with standard genogram conventions (Frame, 2000). Color coding can be used to provide a “color snapshot” of the overall spiritual composition of the family system. In addition, symbols drawn from the client’s perspective can be used to describe spiritually mean- ingful events or relationships. These symbols and short summary statements can also be used to denote significant events, personal strengths, and other important information. This approach allows for both the stability and fluidity of the client’s beliefs over time. Figure 1 gives an example of what a spiritual genogram might look like for an LDS couple within the confines of a noncolor medium.

In addition to drawing the spiritual genogram, the assessment tool includes a question-set broken up into two sections: historical components and present spiritual functioning. These two sections are designed to help social workers facilitate the construction of spiritual genograms with LDS clients. Therefore, the purpose of this study was to examine a spiritual assessment tool as it has been modified for use with LDS clients by examin- ing two questions. First, how congruent are spiritual genograms with LDS culture and what are its strengths and weaknesses? Second, how consistent are the historical and present spiritual functioning sample questions with LDS clients, and how might they be improved or changed to be more valid, relevant, and consistent with LDS culture?

Nominal Inactive 18-25yrs attender Active 25yrs--

Fred Sarah David Stacy Reggie Carol Jane

[17]

82

Karen

Strict! [21]

married in their early 30s

Kevin Rachel Frank Hannah Sue Bea

Mark Alice Beth

Married five years—frequent marital conflict

Beth hospitalized for anxiety

1st

19

28 mission

Strengths Prayer Scripture Study Church and Temple Attendance Home and Visiting Teaching

Figure 1. Spiritual genogram.

170 G. E. LIMB ET AL.

Method

Participants

Participants for this mixed method online study included social workers with extensive practice knowledge of and experience with LDS culture. A hybrid purposive/snowball sampling method was used to recruit participants. One of the authors, being LDS and professionally associating with a number of potential experts in LDS culture, contacted practitioners via e-mail, including a family service organization composed of therapists dedicated to serving LDS clients. After the purpose of the study was explained, contacted professionals were asked to identify other professionals or practitioners with extensive knowledge of LDS culture.

Practitioners with more than 5 years practice experience with LDS clientele and who had a social work degree were asked to participate in the study. This group included 125 professionals, of which 100 (80% response rate) completed the online survey instrument. As part of the selection process, the percentage of social workers and practitioners included from a given area was proportional to the national LDS population percentage residing within the same area. One exception was made in the southwest region, however, due to a shortage of responding participants (i.e., one additional expert was included from the Northwest and Midwest regions). Population percentages were obtained from the LDS Church’s Almanac (Deseret News, 2007). Table 1 gives a brief demographic background of the participating experts.

Table 1. Characteristics of LDS participants and perceptions of consistency with LDS culture.

% N M SD

Gender Male 55 55 Female 45 45

Race White 89 89 Other 11 11

Religion LDS 98 98 Other 2 2

Region West 59 59 Southwest 10 10 Northwest 8 8 Midwest 9 9 East 14 14

Age 43.76 9.92 Years in Profession Conceptual Overview

13.27 7.69

Spiritual genograms in general 8.28 1.89 Constructing Spiritual Genograms Historical Components 8.74 1.52 Present Spiritual Functioning 8.93 1.26

Note. LDS = The Church of Jesus Christ of Latter-day Saints.

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As can be seen in Table 1, the experts vary in age, experience, gender, and geographic location. Participants consisted of 55% male and 45% female practitioners, almost all were LDS members. More than half of the sample resided in the Western United States.

Instrument development

The assessment tool was modified by the authors to remove obvious incon- sistencies with LDS culture. The mixed-method survey instrument consisted of four sections. The first section included a brief general conceptual over- view of spiritual genograms. Participants were shown an illustrative example of one individual’s spiritual genogram (see Figure 1) and asked to assess the consistency of the spiritual genogram assessment tool with LDS beliefs, lifestyle, and culture. The second and third sections, designed to operationa- lize the drawing of the spiritual genogram, outlined a number of sample questions to help practitioners facilitate the construction of a spiritual geno- gram with LDS clients in the historical component and present spiritual functioning areas. The final section solicited demographic information.

Within each sample question-set, a quantitative question was posited to solicit participants’ evaluation of the consistency of the sample questions regarding LDS beliefs, lifestyle, and culture. The quantitative question used a 0 to 10 response rating, with 0 corresponding to a complete absence of consistency with LDS beliefs, lifestyle, and culture, and 10 equating to complete consistency with LDS beliefs, lifestyle, and culture. Two open- ended questions followed each question-set. The first dealt with the strengths and limitations of spiritual genograms with LDS clients, and the second inquired how the questions could be improved to be more valid, relevant, and consistent with LDS clients.

After institutional review board approval was received, the survey instru- ment was placed online and the URL link was e-mailed to participants. Research suggests that response rates for paper- and web-based surveys are comparable, and the data produced are generally similar in content (Kaplowitz, Hadlock, & Levine, 2004). Participants were given a modest remuneration upon completion of the survey instrument as compensation for the length of time taken to complete the survey instrument.

Data analysis

All data analyses were calculated in SPSS version 23. Means, standard devia- tions, ranges, and modes are reported. Tests of associations were conducted between the dependent variables and the demographic variables reported in Table 1. A constant comparative method and expert validity analysis were used to examine similarities and common themes for qualitative data

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(Glasser & Strauss, 1967). Common themes for each question-set were continually compared to similar phenomena across the survey instrument in a recursive process. Representative quotes were used to illustrate these themes from the participants. The results of the data analysis are presented in the following two sections.

Results

General conceptual overview

In response to questions regarding the conceptual overview of the spiritual genogram, the participants generally thought the survey items were consis- tent with LDS beliefs, lifestyle, and culture (M = 8.28, SD = 1.89, see Table 1). Tests of association suggested that perceptions were stable across demo- graphic variables. Here, gender, geographic region, age, and years in profes- sion were all unrelated to perceptions of cultural consistency. Analyses of the qualitative items help shed light on the relatively high cultural consistency score.

A few specific themes emerged as overall strengths. These included visual clarity of the nature, relationship, and history of the family’s spirituality and important information on how religion impacts or influences several genera- tions. One participant thought the spiritual genogram “gives a pictorial view of the family system, which is quite enlightening.” Another typical response was “The spiritual genogram would be a great tool for understanding pat- terns and familial trends.” Also, an advantage of using the spiritual genogram is that “you get double information (all the traditional information and how spiritual life plays out in the system).” It was also noted that the spiritual genogram “provides insight into a client’s spiritual background, as influenced by immediate and extended family.”

When asked about the weaknesses or limitations of the assessment tool, participants were mainly concerned with clients’ ability to recall information from past generations. Some noted that spiritual genograms might be con- fusing when clients come from a large family, where detailed information might be overwhelming. A few participants also suggested that figures and symbols were difficult to interpret. One commented, “Sometimes if family information is perceived as negative, it can be overwhelming to the client. For an LDS client, that can bring on feelings of guilt, shame, and in a spiritual measurement it can mean the perception of unworthiness.” Another expert noted, “Some people may procrastinate because they don’t want to uncover painful memories. However, I think this may be less painful for most because it’s more factual.” Finally, another expert mentioned that:

LDS families tend to have a lot of kids. This is an assignment that may require significant time and energy that they may not have. It may also produce some guilt

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for not knowing much about one’s ancestry since knowing is a significant concept in the LDS church.

A respondent was especially sensitive to clients who have special needs: “Those who are vision impaired will have difficulty using this tool.” This participant went on to suggest that in order for the clients to understand what the symbols are, the worker needs to be clear as he/she explains the assessment tool. Another participant feared that some practitioners may incorrectly interpret the significance of the assessment and intervention method and suggested that adequate training is needed prior to using the assessment tool. Another expert mentioned that, “it should be incorporated into other intervention techniques [as well].”

Operationalizing the spiritual genogram

Historical components The first set of questions in the instrument focused on religious history. They were designed to facilitate the client’s personal disclosure. The participants were directed to rank each question’s consistency with the LDS culture on a scale ranging from 0 (completely absent of consistency with LDS culture) to 10 (completely consistent with LDS culture).

Among the 100 participants, the range was from 3 to 10 (M = 8.74, SD = 1.52, see Table 1). Participants were then asked to provide feedback on how best to improve the relevance, validity, and consistency of the sample questions. The most common responses were affirmations that the questions were consistent, relevant, and comprehensive (the mode was 10). However, some practitioners expressed concerns about the wording of some of the questions. For example, one noted the “vagueness” of the words “spiritual walk.” One participant commented, “I think the term ‘spiritual or religious walk’ might be confusing to an LDS individual.” Some suggested that “spiri- tual walk” be replaced with “spiritual development” or “spiritual path.” Another mentioned that the “clinician would need to explain congruent.” Finally, a participant commented, “I think [if] these instruments are geared for the LDS client, you can be straightforward in asking about religious practices by name: temple attendance, church meeting attendance, priest- hood blessings, sacrament, teaching, etc.”

Present spiritual functioning The second set of questions dealt with the present spiritual functioning of the client. In this stage of the assessment, practitioners help clients explore how past history has shaped their present spiritual functioning. Participants gen- erally thought these questions were consistent with LDS culture (M = 8.93, SD = 1.26, see Table 1).

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The most common responses were “questions were very good,” “excel- lent,” “no changes necessary,” “no further suggestions,” and “no concerns.” However, a few expressed some concerns that the questions were “repeti- tive,” “redundant,” or “too many.” One suggested, “I think there is a bit of overkill in these questions, too complex.” Other words appeared proble- matic for the experts. One expert mentioned using the word “motivated” or “what led you to make” instead “prompted.” Finally, one expert noted that “How does your present spirituality intersect . . .?” could be replaced with “How have past religious patterns in your family shaped your current practice of religion?”; “How does your religion or spirituality. . .” could be worded “How do your religious beliefs assist you in dealing with difficul- ties?”; and the second-to-last question could begin with “Are there meth- ods . . .” Other respondents suggested using “connect or inspire you” instead of “touch you” and using “align or fit in with” instead of “inter- sect.” Finally, one participant noted “good questions, but too many questions.”

Discussion

The purpose of this study was to examine a spiritual assessment tool that was modified for use with LDS clients. Specifically, we wanted to know how congruent a spiritual genogram was with LDS culture, and what its strengths and weaknesses were. We also wanted to determine how consistent the historical and present spiritual functioning sample questions with LDS clients were, and how might they be improved or changed to be more valid, relevant, and consistent with LDS culture.

This study responds to the lack of research on culturally validated assess- ment tools for work with LDS clients by providing an initial evaluation of the spiritual genogram. Two prominent themes emerged from the study’s results. First was the consistency of the spiritual genogram assessment tool with LDS clientele. Second was the wording given in the sample questions used for operationalizing spiritual genograms?

Regarding the consistency aspect, while prior research (Frame, 2000) worried about the client’s ability to recall information from past generations, participants generally liked the idea of using a spiritual genogram and sustained its usefulness as an assessment tool in therapy. Results suggest that participants approved of the inclusion of both historical and present functioning elements. Participants voiced that spiritual genograms would help the client and practitioner better understand patterns and familial trends. In general, participants thought the sample questions associated with the spiritual genogram were appropriate and consistent with LDS culture as evidenced by the high mean scores and the overall mode of 10 (complete consistency).

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Regarding the wording given in the sample questions, most comments were positive. There were, however, a number of suggestions for improving the assessment tool. Some comments reflected a discomfort from a few participants with using genograms in therapy. Counselors saw the process as “overkill” or thought it would be overwhelming to clients. The suggestions for improvement primarily involved changes in the wording so as to be more consistent with common word usage among LDS clients (Walton et al., 2011).

Finally, a few participants noted that the sample questions used in both the historical and present spiritual functioning were too cumbersome. There were 24 sample questions given in the historical section, while 18 questions were listed in the present spiritual functioning section. In these two sections, participants suggested that there should be fewer sample questions and those included should be simpler, shorter, and be more client driven (McGoldrick et al., 2008).

Implications for practice, future research, and education

With regard to implications for practice, Table 2 includes an updated sample question-set for social workers to consider when operationalizing spiritual genograms with LDS clients. It now includes 15 updated sample questions for the historical components section and 13 present spiritual functioning questions. It is important to understand that the question-sets featured in Table 2 represent a working, rather than an absolute, assessment framework. It is suggested that social workers modify the questions for LDS clients in accordance with individual needs and then incorporate them into the conversation and exploration of key spiritual beliefs, supports, and strengths depicted on the genogram (Hodge, 2001). While common LDS beliefs and practices should be infused, utilizing language that is familiar with the client’s worldview should be incorporated into the therapeutic dialogue.

When examining appropriate interventions with the spiritual genogram, two questions can help guide the practitioner (Hodge, 2001). First, how has the client used various resources from his/her past difficulties to address and/ or overcome challenges? Second, what untapped resources are available that can be used to address or overcome current challenges? (Hodge, 2001). These questions begin the process of moving from assessment to appropriate and effective intervention strategies. They also enable clients to be active partici- pants in this therapeutic process. After termination, clients can be encour- aged to use the spiritual genogram to identify cognitive-behavioral patterns and appropriate intervention strategies that were effective in therapy.

Regarding implications for future research, given the growth of the LDS Church world-wide, future studies examining this population should seek

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to include a larger sample of participants, be more representative of the world-wide LDS culture, and explore the relevance of the spiritual geno- gram across these different cultures. It would be important to see if current findings would hold up with this larger, more diverse sample. Future research should also explore efficacy of treatment of clients after practitioners use the updated sample question-set.

Finally, with regard to implications for education, social work should strive to produce future social workers who mirror our diverse commu- nities. Here, promoting curriculum development and training of new social workers about assessments that take into account clients’ RS are important and necessary to show cultural humility, as well as competency. It is also important for LDS social workers to be trained in evidence-based treatment options that include more racially/ethnically diverse samples. Effective treatment not only includes the bio-psycho-social but also the spiritual. Curriculum and treatment modalities need to promote explora- tion and inclusion of this important aspect.

Table 2. Sample questions to operationalize spiritual genograms with LDS clients. Historical components What type of religious affiliation characterized each member of your family, going back to your grandparents? How meaningful was their relationship with their church/faith? With members of their church?

To what extent were their personal beliefs consistent with the teachings of their Church? What was their level of participation (e.g., serving in the Church, regular attendance)? How were spirituality and religion assets in their lives? How did their faith or religious beliefs help them make sense of trials or life difficulties they encountered?

What spiritually significant events (e.g., baptisms, marriage, changes in affiliations, temple attendance, promptings from the Holy Ghost) have occurred in the family? How did these events affect the individuals involved? How did other members react to these changes?

What were the differences and similarities among various family members in their beliefs, and practices? How were differences and conflicts managed? Who was the spiritual leader of the family?

What spiritual practices and/or experiences stand out to you in your childhood years (e.g., prayer, church attendance, scripture study)? Which members of your family have had the most influence on your spiritual development?

Present spiritual functioning How have your beliefs (practices/feelings) changed since childhood (adolescent)? How have past religious patterns in your family shaped your current practice of religion?

How comfortable/content are you with your own level of spirituality and your relationship with Heavenly Father and Jesus Christ? To what extent do you experience conflict and/or harmony with family members over your religious or spiritual beliefs? What have you accepted and rejected from your family’s spiritual history? What motivated these decisions?

How does your faith or religious belief help you make sense of trials or life difficulties? Does the severity of your problem(s) decrease or disappear when you engage in certain religious or spiritual practices? What do your spiritual beliefs teach about forgiveness? How have you been able to apply this teaching in your own life?

Are there spiritual strengths in your family’s history that you can draw upon to help you deal with problems? Are there examples of dealing with problems that you might be able to adapt from others? What sort of Gospel insights can you draw from your spiritual genogram that might help you to address your current difficulties?

Note. LDS = The Church of Jesus Christ of Latter-day Saints.

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Limitations

Limitations of the present study include the sampling method, strategy, and operational definitions of spirituality and religiosity. Using a nonprobability sampling method prevents generalizing results to all LDS members. Also, the relatively small sample size may be characteristic of sampling error among the LDS participants. While the study attempted to ensure a regional repre- sentation of the larger LDS population in the United States, participants only approximated the American LDS population, not the world-wide population. Utilizing a purposive/snowball sampling strategy, although concluded by the authors as the most appropriate approach, may have excluded a number of potential LDS experts with substantial experience and varying perspectives from participation. Finally, operational definitions of spirituality or religios- ity were not provided to participants. This necessitated individual interpreta- tion of what these two words mean and how they might be applied.

Conclusion

Social work is about offering people options and alternatives for effective treatment and the spiritual genogram is an assessment tool that can help generate critical options and alternatives for clients. Given the mandates by the Joint Commission, CSWE, and NASW to provide culturally competent practice by incorporating RS into assessments, this study assists practitioners in advocating for culturally competent spiritual assessments to LDS clients. This study confirmed the usefulness of adding a spiritual dimension to genograms when working with LDS clients; however, results underscored the importance of making the tool specifically relevant by using terms most familiar to the LDS population. Given the growing LDS population and the lack of spiritual assessment approaches generally, this study fills an important gap in the literature by helping practitioners provide more effective, cultu- rally competent services to their clients.

Notes on contributors

Gordon E. Limb, PhD, is Professor and Director, Kaitlin Ward and Alissa Ferrell were MSW students, School of Social Work, Brigham Young University.

David R. Hodge, PhD, is Professor, School of Social Work, Arizona State University and a senior nonresident fellow at University of Pennsylvania’s Program for Research on Religion and Urban Civil Society.

Richard Alboroto, PhD, School of Social Work, University of Hawaii at Manoa.

178 G. E. LIMB ET AL.

ORCID

Gordon E. Limb http://orcid.org/0000-0003-4539-3381 Kaitlin Ward http://orcid.org/0000-0003-0780-2359

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