This template is designed to assess individuals. If members from a single community can be assessed, then a pattern may emerge. If abuses occur within the community, there will be people who have not known or have executed a basic psychological defense mechanism of denial–they are referred to diagnostically as secondary victims.

Rule out or fill out categories as information becomes available in the assessment stage and in subsequent re-evaluations and when new information becomes available.

Church or religious involvement (specify type, name, location, parachurch groups, charities, and so on):

  • Church
  • Synogogue
  • Mosque
  • Temple
  • Spiritual circle
  • other

Family History:

  • Divorce or affairs in the family
  • Incest
  • Addictions
  • Eating and exercise habits
  • Adopted
  • Under medication
  • Trouble sleeping


  • obsessive thoughts
  • hears “voices”
  • foul thoughts about God during devotions or in church
  • suicidal thoughts
  • reading materials, movies, TV programmes
  • devotional life of prayer and study of scriptures
  • religious but displays violent tendencies
  • the spirit of the law is important
  • the letter of the law important
  • fears
  • self-concept
  • experiencing troubling thoughts during interview


  • able to give instead of receive
  • able to forgive others
  • can forgive oneself
  • can identify personal errors and choose to change
  • able to receive help or gifts
  • pride is in the way of receiving help
  • able to quieten the self-talk of the mind
  • lingering feelings of bitterness, resentments from the past
  • able to pray
  • what happens when subject attempts to pray

Mental Attitude

  • constucts daily activities to feel satisfied with accomplishments at end of day
  • long-term goals
  • response to not meeting goal(s)
  • looks forward to being with co-workers, school-mates, family
  • flexible enough to change routine without too much difficulty
  • calmly goes for lengths of time without the distractability of noise

Coping skills

  • develops and follows through with successful coping and self-care strategies
  • beliefs and practices are in an integrated goal-directed whole
  • relates to others in a flexible, dfferentiated, assertive manner to develop a more rational, efficient way of perceiving and managing situations differently
  • life experiences seem managable
  • able to seek out challenges
  • able to express empathy, the ability to understand another person’s meaning and not overlook it
  • applies himself/herself in an assertive, non-aggressive manner
  • feels unappreciated and exploited


  • less or more than body requirements
  • nutrient malabsorption (drug induced?)
  • deficits in body awareness, body organization, lack of right/left cerebral balancing, and/or self-healing


  • potential for chronic disease
  • full-spectrum light deficit
  • noise pollution
  • privacy deficit

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