The notion that when faced with a loss or diagnosed with a serious illness, people go through a series of “stages” has become widespread in lay and professional circles [24]. There are no invariant rules, and several nomenclatures illustrate the process. Immediately, people tend to experience some sense of shock, denial, or at least disbelief that such a thing could happen. Almost all descriptors convey some sense of anger, which may be one of the most problematic emotions and difficult to deal with, especially if it is displaced, as it often may be, on the person trying to be helpful and responsive. It may be one of the most difficult things for physicians to deal with. Some sort of sadness, depression, and self-pity may follow, especially if open communication of feelings is not encouraged or tolerated. Eventually, one may come to some sort of acceptance, which does not necessarily mean that everything is alright, but rather that the inevitable reality is acknowledged. For physicians and health professionals, the task faced is how to attend to such suffering. How should one enter into conversation with patients? Are there questions to be asked? Comments to be made? A general rule would be to start with open-ended questions, and LISTEN. Let the person narrate his or her own experience. Avoid judging or being prescriptive. These are challenging and sensitive areas because the basis for empathy is our experience even as we realize that others may experience and understand things differently, especially in spiritual matters.

Table 14.1 offers a developmental approach, which places Fowler’s stages of faith alongside stages of psychological (and physical) development. Table 14.2, stages of grief (words for feelings), indicates some of the feelings people often report in the weeks or months after experiencing a loss or health diagnosis. Table 14.3, the FICA Spiritual History Tool, could be adopted for office use and suggests some widely used approaches to thinking of human development [25]. The stages offer the practitioner self-discipline to minimize assumptions about how someone should behave or respond. Developmental and stage theories help expand the assessment of the patient as an empathic aid to understanding what their world might be like. For example, to say that someone is being “childish” can be harsh and judgmental. To realize that in the face of a threatening illness, even an adult may struggle, and to approach their suffering in a sympathetic and helpful manner may be the best that one can offer.