Questionnaire

Map of the Spirit:

QUESTIONNAIRE

Michael F. Cantwell MD, MPH

Question 1: Seeking

How important to you (or to your health) are matters concerning spirituality, or whatever does or doesn’t exist that is greater than or beyond human experience?

0 1 2 3 4 5 6 7 8 9 10

V. Low Low Moderate High V. High

Question 2: Spiritual Satisfaction

2. How satisfied are you with the extent to which you have been able to explore or pay attention to matters concerning spirituality, to date?

0 1 2 3 4 5 6 7 8 9 10

V. Low Low Moderate High V. High

Question 3: Resistance

3. What blocks or holds you back from exploring or paying attention to matters concerning spirituality or whatever does or doesn’t exist that is greater than or beyond human experience?

Sources of Resistance

Question 4: Spiritual Stress

4. Calculate your degree of Spiritual Stress by taking your degree of Seeking (from Question #1) and subtracting from it your degree of Spiritual Satisfaction (from Question #2).

Spiritual Stress = Seeking – Spiritual Satisfaction

                    < 0        1           2           3           4           5           6          > 7

                 None         Low              Moderate               High             Very high

Spiritual Stress Rating

Question 5: Spiritual Experiences

5. Briefly describe any experiences you have had that increased your awareness or understanding of and/or your relationship with whatever does or does not exist that is greater than or beyond human experience.

Description of Spiritual Experiences Type of Spiritual Experience (Circle)

	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union
	Awareness Commitment Union

Question 6: Stage of Spiritual Development

6.1: Do you have any knowledge or awareness about what you believe in spiritually?

                                   YES                                            NO
                    Awareness Stage or higher             Pre-awareness Stage
                         (GO ON TO #6.2)                         (SKIP TO #6.4)

6.2: Have you internally committed to following your spirituality, deciding to let it take priority over your or your ego’s desires, in at least some aspects of your life?

                                    YES                                           NO
                    Commitment Stage or higher              Awareness Stage
                         (GO ON TO #6.3)                        (SKIP TO #6.4)

6.3: Have you manifested or fulfilled your internal commitment to your spirituality in at least some aspects of your life?

                                    YES                                           NO
                             Union Stage                           Commitment Stage
                         (GO ON TO #6.4)                      (GO ON TO #6.4)

6.4: Current Stage of Spiritual Development

Note below your current stage(s) of spiritual development. If you are at a “Mixed" Stage of Spiritual Development, with different aspects of yourself at different stages of spiritual development, note below which aspects of yourself are at which stages of spiritual development.

Single Stage Stage of Spiritual Development (Circle)

Current Stage

Pre-awareness Awareness Commitment Union

Mixed Stage – Aspect(s)

1.	Pre-awareness Awareness Commitment Union
2.	Pre-awareness Awareness Commitment Union
3.	Pre-awareness Awareness Commitment Union
4.	Pre-awareness Awareness Commitment Union
5.	Pre-awareness Awareness Commitment Union
6.	Pre-awareness Awareness Commitment Union

Question 7: Diagnosis of the Spirit

7. How much do you want to progress to next Stage of Spiritual Development?

0 1 2 3 4 5 6 7 8 9 10

V. Low Low Moderate High V. High