5 - Hurt to the Core -  Hurt is probably the most neglected feeling, not even recognized by many people in themselves. A given patient's hurt lies somewhere on the continuum of hurt between:                           

                                                       a nurse's snub<------------------------->  a fatal iatrogenic caregiver mistake

Hurt that is devastating to the human spirit, from such horrible mistreatment as combat, rape, torture, or child abuse of any kind, most often results in spiritual and psychological pathology difficult to treat and even to refer. But lesser hurts generally respond to acknowledgement as significant by an empathetic listener.

4 - Sadness, Discouragement, Despair- The continuum here, as resulting from the reason for seeking health care, runs from:       Missing the dog   <-----------------> Considering termination of dialysis <--------------------> Suicidal Depression

Whatever has discouraged this person may lie so deep within her that  it can only be surfaced with careful listening, like from a friend or a therapist. A spiritual clinician considers taking careful listening seriously, from herself or a more available helper, before rushing to pharmacology for depression, which may prevent the healing to which savvy, focused and calm  conversation and referral might lead.

6-Empowerment - Highly dependent people adamantly resist empowerment of any kind. But regression remains a temporary feature of many more stable patients, taking refuge in an earlier, more helpless developmental stage of life. Some victimized tones of helplessness can be assisted by gentle inquiry into the person's past experience of caring for himself in difficulty.Serious dependence erupts into outright anger with the mention of self pity. The anger can then be easier to stomach than the victim mode.The continuum:

situational regression<----------------------------------------->dependent character disorder/ chemical dependence