Whatever Happened to "CPE" -- Clinical Pastoral Education? by Robert Charles Powell, MD, PhD

08 Mar 1999 8:50 PM | Perry Miller, Editor (Administrator)

Entire draft manuscript: copyright, 1999, Robert Charles Powell.
webpage circulation.

Whatever Happened to "CPE" -- Clinical Pastoral Education? 

Robert Charles Powell, MD, PhD 
keynote address honoring 
Anton Theophilus Boisen 
3/18/99, Virginia Beach, Virginia, at the Ninth Plenary Meeting, of the 
College of Pastoral Supervision and Psychotherapy

Whatever happened to CPE? Good question. Let me enunciate several other good questions up front. Whatever possessed you, such that the College of Pastoral Supervision and Psychotherapy decided to invite an MD-psychiatrist/PhD-historian to address a room full of theologues? Were you out of your minds? Whatever possessed me, such that I decided to accept? Surely you've handed me an impossible task with which I am doomed to fail. That being the case, in the manner of the Rev.Mr. Anton Theophilus Boisen (1876-1965), the spiritual progenitor of CPE, I have opted to embrace failure, to fail openly with, as he would say, "hope and courage."1 I do not, however, want to fail alone. Nor would he. [Please -- if you will -- please find a pencil or pen and some paper, to jot down notes -- not about what I say, but about what thoughts and associations you have about what I say. The CPSP "Covenant" asks you to "make a space for one another and stand ready to midwife one another. . . ." Please hear me out -- but not passively. Stand ready to expand my presentation.] I accept responsibility for tossing out "half-baked" ideas, but, as I lead you "down the garden path" in this essay, I ask you to commit yourselves to helping me get these ideas "more fully-baked."

In 1976 I addressed what was then the Association of Mental Health Clergy 2 on Boisen's 100th birthday, exploring in depth his delusion about "breaking a hole in the wall between religion and medicine." 3 As delusions, beliefs not initially shared by others, go, that was an easy one for the chronically sane to absorb, and the AMHC distributed or sold about 2,000 copies of my "Boisen Booklet" on this theme. Just as Boisen exhorted us to attend to the whole of a human being, as a "living human document" of theology, some twenty years ago I challenged those working in pastoral care to take Boisen himself entirely seriously, delusions and all. No one that I know of, however, took the bait when I outlined, in the voluminous footnotes of the "Boisen Booklet," a second of Boisen's key delusions. 4

Throughout the latter half of his life Boisen puzzled over a delusion about the "family of four." Five days before having the insight about religion and medicine, Boisen sat down to revise his theological "statement of belief." He first alluded to the death of Jesus on the cross, "where he died, . . . the perfect for the imperfect, the strong for the weak," then felt suddenly compelled to conclude that the weak and the imperfect should no longer accept this sacrifice and that they should be willing to give their lives, the imperfect for the perfect and the weak for the strong, that the divine may be freed from its prison house of infirmity and be able to come into the world in beauty and power. . . . He envisioned these types of people, the perfect, the imperfect, the strong, and the weak, as a forever intertwined, unified "family of four." He later added that "the essence of this idea was that of . . . setting the best types free from the appeal of those whose love was based on need." 5

On the theological level and on the strictly personal level, Boisen considered many interpretations of this idea across time. On the practical level, this delusion determined Boisen's mission within the CPE movement from 1930 until his death in 1965. The "family of four," on one level, included both Helen Flanders Dunbar, BD, PhD, MD, MedSciD, Medical Director of the Council for the Clinical Training of Theological Students, and Austin Philip Guiles, BD, PhD, Field Secretary of the CCTTS and later supervisor in the rival Institute for Pastoral Care. Boisen interpreted the delusion, on one level, as instructing him to "give Dunbar over to Guiles" -- that is, that he, Boisen, was to keep fostering a relationship between the so-called "New York" and "Boston" poles of the movement, despite their natural tendency to mix like water and oil. 6 As outlined in his classic sociology treatise, Religion in Crisis and Custom . . . (1955), Boisen considered the splitting and unifying of groups to be a non accidental significant norm. 7 While he did not want the factions of CPE to be antagonistic or assimilated, he did want them to be productively confronting of each other and engaged in dialogue.

For those of you who read footnotes, the cryptic footnote number 151 in my "Boisen Booklet" concerns one consequence of this second key delusion alluding to but not mentioning the rumor that Dunbar asked and Boisen told Guiles to accompany her, Dunbar, on a tour of the healing center in southern France at Lourdes -- a research trip that led to one of Dunbar's most poetic, beguiling articles. Whether the rumor was true or false, the point is that Mrs. Guiles believed it and became furious, which added, shall we say, to creative tension within the movement. As much as anything else, this rumor, driven by Boisen's delusion, led to the break between the "New York" and "Boston" camps. At a crucial juncture Mrs. Guiles, backed by the wealth of her father's "Earhart Foundation," encouraged Guiles to seize hold of the training centers he had supervised, while Dunbar literally seized hold of the Council, snatching its charter off the table at a board meeting and whisking it to New York. 8

You may have noted how I keep using phrases like, "the theological level," "the strictly personal level," "the practical level," etc. Both Boisen and Dunbar had this notion of multiple levels of meaning constantly on their minds. Boisen believed that patients' symptoms "are not merely the results of past causes," but "also attempts at a new synthesis" -- attempts at reconciliation -- attempts at cure. 9 These attempts at synthesis, reconciliation, and cure -- at achieving healing and wholeness -- are, he and Dunbar believed, powerfully mediated through symbols. Dunbar, still world renowned for her first book, Symbolism in Medieval Thought . . . (1929), drew a crucial distinction between three levels of symbolism:

(1) the association, extrinsic, or arbitrary symbol 
(this stands for that) -- more properly called "the sign";

(2) the comparison, intrinsic, or descriptive symbol 
(this resembles that) -- more properly called "the simile"; and

(3) the semblance, interpretative, or insight symbol 
(this reveals many thats) -- the symbol proper, 
upon which she was to place her attention. 10

Dunbar spoke of the insight symbol as that which reaches "out toward the supersensible," toward "a Reality . . . greater and truer than the symbol in all its aspects." A "true insight symbol," she believed and you need to understand, "depends on the continual re-creation and expansion of its meanings." Therefore, with an insight symbol, "all meanings are true," and they "are often all intended at once." Dunbar considered insight symbols as mediators between a person's inner and outer worlds, and that much in the realm of healing and wholeness could be achieved through "careful handling of symbolism." 11

Many know of Dunbar's epoch-making volume in psychosomatic medicine, Emotions and Bodily Changes . . . (1935), whose "Part One" constitutes a subtle philosophic essay on the integrative aspects of the human organism, specifically on the unifying power of emotion. 12 Few realize, however, that another volume was funded to explore these integrative, unifying powers from the religious rather than the medical point of view. The companion volume supposedly never appeared -- yet it did. In 1971, following the money trail, and noting the brilliance with which he had developed his own understanding of the role of religious symbolism, I asked the Rev.Dr. Carroll A. Wise, Boisen's assistant then successor in the original CPE program, if the first of his books, Religion in Illness and Health (1942) was perhaps the missing text. He answered, "Yes." He went on to add that Dunbar, ever aware of political realities, was "reticent in having too much recognition of her influence . . . " upon his work.13

Let us go back now to Boisen's intriguing notion about the "family of four," made up of forever intertwined weak, strong, imperfect, and perfect people. I emphasize this delusion because it both defines my predicament -- the necessity of sacrificing myself, the theologic weakling, such that you, the stronger ones, may thrive -- and defines what I see as CPE's challenge -- the necessity of speaking with authority and presence from a position of accepted vulnerability. This is also a stance some of us have become increasingly clear about encouraging our patients to consider. I call this notion "acceptance without surrender" -- the acknowledgement of one's imperfection without allowing that as an excuse -- the acknowledgment of one's imperfection while searching there for insights and understandings of potential value to both oneself and those outside. 14 Take, for example again, the crucifixion of Jesus. If there ever was a classic case of someone getting little but lemons yet still managing to make lemonade -- of speaking with authority and presence from a position of accepted vulnerability -- the story of Jesus has got to be it. Not far behind would be the thought-provoking story told by Andre Schwarz-Bart in The Last of the Just (1959)--of doomed Jews conveying redemptive power through their personally unexpected courage in the face of unsought death. 15

So whatever did happen to CPE? That was the question you posed to me primarily, I suspect, because at the 50th anniversary conference of the Association for Clinical Pastoral Education in 1975 I delivered an address entitled, "Questions from the Past (on the Future of CPE)," in which my narrative explored eight questions I thought Boisen would have asked were he there. 16 These questions, which I encourage you to ponder as I note them, were:

"Whatever happened to pastoral social work?"
". . . to religious diagnosis?"
". . . to preventive pastoral care?"
". . . to 'everyday,' or 'maintenance,' pastoral care?"
". . . to the theology of pastoral care?"
". . . to religious rituals and symbolism?"
". . . to religious research within CPE?" and
". . . to the development of a critical tradition within CPE?"

Perhaps you quite reasonably hoped for a reprise and update of that presentation. The question, however, "Whatever Happened to CPE?" can still be taken several different ways. Do we mean

(a) "How has CPE developed since its 50-year mark in 1975?" or

(b) "Where did it go? To where did CPE disappear?" or

(c) "Whatever happened to Boisen's vision within CPE?"

I will spend a minuscule amount of time noting how CPE developed over the last almost twenty-five years, reassuring us in passing that it did not disappear, but I will devote the remainder of my comments to evaluating "Whatever happened to Boisen's vision?" as suggested by the Boisenesque questions above.

Overall reaction to my presentation in 1975 was polite but defensive. Respondents implied that CPE had moved beyond the "old myths," the original concerns, and that the cutting edge of CPE thought was to be found in full-length books, not in the shorter articles upon which I had focused my review. 17 Others, however, had apparently already keyed into my concerns, as within only several years a number of publications appeared speaking to themes I had raised. Without attempting to be comprehensive, I nonetheless want to draw your attention to the following:

Paul Pruyser's The Minister as Diagnostician (1976); 18

Donald Denton's Religious Diagnosis in a Secular Society (1997); 19

George Fitchett's Spiritual Assessment . . . (1993); 20

Kenneth Pargament's edited Religion and Prevention in Mental Health (1992); 21

Thomas Moore's Care of Soul . . . (1992) 22

Paul Holinger's Pastoral Care of the Severe Emotional Disorders . . . (1985); 23

Charles Gerkin's The Living Human Document . . . (1984); 24

John Patton's From Ministry to Theology . . . (1990); 25

Charles Lopez's dissertation on developments in CPE from 1950 to 1985 (1986); 26

My own article which serves as a preface to empirical theology (1976); 27;

I also recommend several recent articles:

Joanne Greer's "Linkages between Theological Reflection and Empirical Research" (1995) (envisions "empirical research as . . . ongoing self-reflection" and reminds that "after the data has been coded and its impact assessed, the last step is to reflect upon and try to appreciate what God has wrought"); 28

Robert Duffett's "The Intellectual Foundations of Pastoral Counseling: A Perspective on the Future of the Profession" (1995) (re maintaining integrity in the so-called "managed care" environment); 29 and

Rodney Hunter's ". . . Postmodernism and the Future of Pastoral Care" (1997) (calling for a "psychologically informed turn to committed religious practice" within a "covenant community"). 30

One of the main reactions possibly to my presentation was a concerted effort to nourish in-house investigators and historians, an effort that brought scattered success. The annual Abstracts of Research in Pastoral Care and Counseling, begun in 1971, was really flying by 1982. Two award programs arose, in 1982 and 1983, honoring original investigations. The ACPE published a Research Primer . . . 31 in 1988, and launched the ACPE Research Network Newsletter in 1989. Nonetheless, "A Systematic Review of the Quantity and Quality of Empirical Research Published in Four Pastoral Counseling Journals" observed that while pastoral counseling had "integrated the clinical skills of the other mental health disciplines," it had been "far less successful in adopting the scientific method." 32 In stark contrast is the fact, discovered while preparing this paper, that Boisen's now ancient research is cited ubiquitously, with appreciation and serious analysis, in texts on the psychology of religion.

On the historical side, while Allison Stokes' Ministry After Freud . . . (1985), builds cleanly upon my earlier work, almost as if adding extra chapters, several other attempts at historical commentary stand as detriments to understanding. Without noting the culprits' names, let me bluntly set straight the record:

(1) Boisen's diagnosis was NOT of manic-depressive disorder; despite the article by a medical student, later psychiatrist, who had suffered psychosis; observations by Wise and Pruyser, among others, make it quite clear that Boisen definitely had schizophrenia. The article cited seemed to want to diminish the magnitude of Boisen's illness and his attempts to overcome it. The wonder is that he lived so long, and through so many episodes, with the mortality rate for acute agitated catatonic states being as high as it is. 33

(2) Milton Erickson, MD, talented therapist that he later became, was NOT the "grandfather" of CPE as one author alleged, especially if the grounds for this claim are that he, as Boisen's assigned ward psychiatrist supposedly enabled Boisen's recovery and further work; both Boisen and Wise made it clear that Erickson, at that phase of his career, was clueless regarding how to approach psychosis, and that it was Dunbar who, by means not specifically known, popped Boisen out of his 1930 episode of psychosis. The article cited seemed to want to extract some of Boisen's glory as "father" to the CPE movement and place it one step back, somehow allied to magical therapy.

The far more important point is that it was something about the power of pure and simple love -- "the love that moves the sun and the other stars," he tells us via a cryptic reference to Dante -- that revived and steadied Boisen. While we know that Dunbar flirted, not necessarily on a conscious level, and we know from the apparently ever-truthful Boisen that he got only to the brink of physical intimacy, it adds to the poignancy of his accomplishment that he did not shy away from struggling with the nature of love even from within the essential loneliness of schizophrenia. 34

(3) Dunbar did NOT commit suicide, despite a reviewer's comments upon Stokes' words and others' suggesting that. Coroners' data support a diagnosis of coronary arterial spasm, leading Dunbar to drown in her private pool; Dunbar's daughter had been with her minutes before and found her minutes after, which underscores the happenstance nature of the death. The article cited seemed to want to suggest some aura of failure at the end of Dunbar's career. On the contrary, while she indeed suffered from others' mischaracterization of her theories in psychosomatic medicine, one of her best-written volumes, Psychiatry in the Medical Specialties (1959), came out on the eve of her death. 35

Am I the only one who finds it disturbing that a disproportionately large sample of the CPE movement's so-called historical commentary over the last twenty years is not only just plain wrong but also denigratingly biased? As noted in the first issue of the infamous ACPE Underground Report, which arrived in various mailboxes around Christmas week of 1987, "There seems not much more left of Boisen in ACPE than his cane." 36 It was at the 50th anniversary celebration in 1975 that the custom began of handing down "Pappy's" cane to the Association's incoming president. At that very time it had struck me as odd, for, as I had noted in my keynote address earlier that day, Boisen's name appeared nowhere on the program. So, yes, by the time CPSP was getting itself founded some fifteen years later, that cane seemed to have become a spiritless artifact, an empty symbol that, much to what should have been everyone's horror, was whittled down, emasculated in 1991 into, heaven help us, a magical wand! 37

While reviewing the literature I came across another "smoking gun," displayed without embarrassment or chagrin, as a 1982 editorial in the Journal of Pastoral Care. 38 Revealing, supposedly for the first time publicly and in writing, the "secret" of CPE, the editor noted that the soul of CPE had been in that supervisors' goal was "not education but transformation -- transformation of themselves first of all and ultimately of their students." The editor then went on to opine that the "central mythic enactment," "the mystery of the laying on of CPE hands," the secret soul of traditional CPE was dead -- that the field had matured, moving on toward "objectification, quantification, and verification," a more rigorous albeit soul-less existence! While that editor subsequently rediscovered a personal spiritual life, the editorial stood unchallenged, as far as can be seen, as a most curious proclamation in the movement's flagship publication. Can one do other than cry out in paraphrase, "Father, forgive them, for they know not what they say"?

While that editor, without sorrow, tried to consign CPE to a soul less existence, he nonetheless provoked at least two important questions about the enterprise. First, how are we actually preparing the next generation in this clinical pastoral field? Second, how does what we call this enterprise shape our vision? Boisen and Dunbar clearly thought in terms of "facts first" -- that the novice needed to gain a knowledge base, needed to learn something, know something, specifically, about a few specific human beings -- that the novice had to do some original "research," so to speak, and be "trained," before he or she could move on to the more interactive processes of education and supervision. 39 During the 1970s and somewhat subsequently, most CPE appeared to have thought it could skip over the "training phase," in which both sacrosanct human documents, real people in crisis, and experts spoke with authority, to an interactive "education and supervision phase" that soon overshadowed the "transformation phase" that should come next, the never ending phase of growth. Beginning with the 1970s, most CPE appeared to have become preoccupied with producing an educated and supervised product. While the literature became overflowing with admonitions about theological reflection, this, too, appeared to be envisioned as an add-on, as in "Oh, yes, this certificate attests that I theologically reflected on January 13, 1983," etc., etc. Although the specter of so-called "managed care" and decimated budgets initially accelerated this focus on "the theologue as product," it eventually encouraged re-focus on "the pastoral service as product," which once again allowed consideration of the unique theologue delivering the service. It is well worth asking the degrees to which we want this pastor to be trained, then educated and supervised, and then transformed. Should we be calling this clinical pastoral training? clinical pastoral education and supervision? or clinical pastoral transformation ? I have argued elsewhere that mature theological reflection does not come early, and that many students are not ready for it. 40 While the seminary student tends to focus on his or her own internal problems and theological identity, the more established pastor or chaplain might be more able to endure the emotional discomfort of working with the distressed, and more free to participate in exploring the theological issues involved. The CPSP seems to grasp this, and perhaps its programs, let me suggest -- especially its latest one for established pastors and chaplains -- might best be characterized as programs supporting ongoing "clinical pastoral transformation." 41

So, getting back on track, whatever happened to CPE? After an initial fifty years of development, whatever happened to clinical pastoral education? You know the awful answer: By 1980, if not before, clinical pastoral education had lost its soul. That is my conclusion, just as it was yours. Through the Underground Report, however, supervisors called a spade a spade and tried to get that soul back. It is no wonder, then, that the "Covenant" of the College of Pastoral Supervison and Psychotherapy focuses, front and center, on the "recovery of soul."

Allow me to quote in mere chronological order some of the "cries in the wilderness" recorded in early issues of the Underground Report. A lot of wisdom appeared in those letters to the editor, as the writers called out for

that something that "feeds and fosters growth"; 42

"the discernment-of-spirits model of decision-making instead of the majority-rules model . . ., engaging in prophesy instead of strategic planning"; 43

"a fecund movement. . . . viable, creative, growing, fertile, surrounded by semen or manure and life-giving"; 44

something "life-giving and energizing"; 45

the "values of 'chaos and faith' "; 46

"more of a small group/ tribal atmosphere"; 47

"a better way to be theologically serious"; 48

"the awareness that we are a peculiar people, in desperate need of generous professional peers who can be a professional resource for our living and loving in the practice of our ministry"; 49

"attention to the larger communal issues of value"; 50

"a redemptive community"; 51

"a supportive and challenging community of fellow pilgrims." 52

Out of such sentiments grew the eventual College of Pastoral Supervision and Psychotherapy in March 1990, nine years ago this week. 53

The CPSP and its members almost immediately had to tackle, even embrace, the necessity of speaking with authority and presence from a position of admitted vulnerability. One could argue that what you had to do as a community powerfully and positively transformed your lives and your pastoral care. The challenge is how to continue the "recovery of soul." I have been leading you "down the garden path" -- a long and winding one through the past -- because I believe that rediscovery of some of the old notions as you revitalize CPE.

Along with other writings thus far noted, I recommend that you take another look at Wise's magnum opus, Pastoral Psychotherapy . . . (1980). 54 Wise seems to suggest that pastors be firm, yet humble, to listen and to be there. The pastor, he believes, "is called upon not to do but to be." He reminds us that the "religious ideas of a person, if listened to carefully, become a form of symbolic communication" and "are more than ideas in the abtract." In language similar to that used fifty years earlier by Boisen and Dunbar, Wise reminds us that the parishioner's religious ideas "have a vital relationship to the inner life . . . and to his interpersonal experiences," and "are symbolic in form since they express intangibles like meaning, value, and relationships." Without mentioning per se the concept of the insight symbol, that true symbol that reaches "out toward the supersensible," and that "depends on . . . continual re-creation," Wise nonetheless notes that "religious symbols pick up . . . goals from deep, instinctive dimensions . . . and transform them into higher, creative goals." "Growth requires the constant expansion of the meaning of religious symbols. . . ." Through appreciating the depths and potential heights of the "living human document" in front of him or her, the pastoral therapist "faces the experience of learning, unlearning, and relearning theology." 55 That whole thought bears repeating: "religious symbols pick up . . . goals from deep, instinctive dimensions . . . and transform them into higher, creative goals." "Growth requires the constant expansion of the meaning of religious symbols. . . ." Through appreciating the depths and potential heights of the "living human document" in front of him or her, the pastoral therapist "faces the experience of learning, unlearning, and relearning theology." The CPSP, let me suggest, has much to gain from assuming a stance that has authority and presence yet is open and humble, constantly eager for rebirth.

Ending somewhat as I began, but by now on what I hope you perceive as a more affirmative tone, let me again ask: Whatever did possess you, such that you decided to invite a non-theologian to address a room full of theologues? Were you out of your minds? Maybe you were. Then again, perhaps it is now clear that maybe you should try being out of your minds a bit more often -- as long as you have trusted colleagues to help you find your way back. Boisen would probably argue the importance of being comfortable with madness and open to its potential insights, theological and otherwise. Whatever did possess me, such that I decided to accept this impossible task? Heaven only knows, but I'm glad that I did. Preparing this essay has been an important, reflective experience for me. Possibly I, too, have had some "recovery of soul." Possibly you, too, with "hope and courage," will not shy away from tackling the apparently impossible task. Since I am a physician, let me leave you with two images relating to this theme from "my side of the tracks":

(1) During medical school, I once at 3am, because I could not get an i.v. into a patient's arm, woke up an intern. With wisdom not anger he sleepily gave me a crucial bit of insight that has served me well. He said, "If the task is impossible, what makes you think I can do it any better than you?" Remember that. I went back to the patient, and somehow he and I got the i.v. into his arm.

(2) Early in my career, I developed a knack for working with psychotic patients and normal adolescents -- sometimes it's hard to tell the difference -- essentially by entering into the person's system with an open mind, admitting my ignorance, but refusing to entertain unsupported conclusions. This approach irritated one of my colleagues. Not with wisdom but anger he unknowingly gave another bit of insight that has served me well. He said, "Your patients get better because you have the delusional belief that they will!" Think about that one: my patients get better because I'm willing to be considered deluded. I can live with that. Can you? Perhaps CPE will recover its soul precisely because you are willing to tackle the apparently impossible task and not worry about being considered deluded, espousing beliefs not initially shared by others. Is this not the true legacy of the Rev.Mr. Anton Theophilus Boisen? Thank goodness he undertook the exploration of the inner world, leading us out of the depths, insisting that even the weak and the imperfect had a forever intertwined role to play, assisting the strong and the perfect, "breaking a hole in the wall between religion and medicine." 56

It is now long past time for me to stop talking. I did ask you up front to commit yourselves to helping get some of my "half-baked" ideas "more fully-baked," to "make a space" for me yet to "stand ready to midwife" my nascent thoughts. Now it is your turn to talk, even to argue a bit, about what has become of CPE, and especially about your progress in recovering its soul.

__________ 

+ See "Afterword" regarding others' valuable contributions to this manuscript after suggestions and comments were solicited at the CPSP webpage. Dr. Powell may be contacted at 847/ 441-8283; 1520 Tower Road, Winnetka, Illinois, 60093-1627. __________ 

Endnotes

1
This is an allusion to Boisen's hymnal for use in mental hospitals. It was initially called Lift Up Your Hearts . . . , Boston: Pilgrim Press,1926, but was reissued in three revised, enlarged editions as Hymns of Hope and Courage, Boston: Pilgrim Press,1932, 1937, and Chicago: Chicago Theological Seminary, 1950. [Back to text]

2
Now part of the Association of Professional Chaplains since merger in May 1998 with the College of Chaplains. The address was published as: Robert Charles Powell, Anton T. Boisen (1876-1965): "Breaking an Opening in the Wall between Religion and Medicine" , pp.47, special supplement to the AMHC Forum, 29(1), October 1976 [Back to text]

3
Anton T. Boisen, Out of the Depths: An Autobiographical Study of Mental Disorder and Religious Experience, New York: Harper & Brothers, 1960, p. 91. 

For review of the history of the clinical pastoral training/education movement, see: Robert Charles Powell, C.P.E.: Fifty Years of Learning, through Supervised Encounter with "Living Human Documents." booklet, 32pp. New York: Association for Clinical Pastoral Education, 1975, reprinted, 1987; reviewed in J. Pastoral Care 36(4): 210, 1982. 

Edward E. Thornton, Professional Education for Ministry: A History of Clinical Pastoral Education. Nashville: Abingdon Press, 1970. Allison Stokes, Ministry After Freud. New York: The Pilgrim Press, 1985. [Back to text]

4
See Powell, Anton T. Boisen (1876-1965): "Breaking . . .," pp. 27-28. 

For the phrase "living human documents" see Anton T. Boisen, The Exploration of the Inner World: A Study of Mental Disorder and Religious Experience, Chicago: Willet, Clark & Co., 1936. reprinted, New York: Harper & Brothers, 1952, and Philadelphia: Univ.of Pennsylvania Press, 1971. p.185: ". . . I have sought to begin not with the ready-made formulations contained in books, but with the living human documents and with actual social conditions in all their complexity." [Back to text]

5
Boisen, Out of the Depths . . . , pp. 88, 89,104, 106, 115, 118-119. [Back to text]

6
See Powell, Anton T. Boisen . . ., pp. 35- 36. [Back to text]

7
Anton T. Boisen, Religion in Crisis and Custom: A Sociological and Psychological Study, New York: Harper & Brothers. 1955. [Back to text]

8
See Powell, Anton T. Boisen . . ., p. 36. H. Flanders Dunbar, "What Happens at Lourdes? Psychic Forces in Health and Disease," Forum 91: 226-231, 1934. 

Robert Charles Powell, Healing and Wholeness: Helen Flanders Dunbar (1902-59) and an Extra-Medical Origin of the American Psychosomatic Movement, 1906-36 , PhD dissertation, Durham, NC: Duke Univ., 1974, [reprint available via University Microfilms, order # 75-2415, on the "web" at www.umi.com] p. 224, fn. 4. The Council's charter was among Dunbar's papers at the time of her death. [Back to text]

9
Anton T. Boisen, "Personality Changes and Upheavals Arising Out of the Sense of Personal Failure," Amer.J.Psychiat.5: 531-551, p. 559

10
H. Flanders Dunbar, "The Sun Symbol in Medieval Thought," Master's Thesis, New York: Columbia Univ., 1923 

H. Flanders Dunbar, Symbolism in Medieval Thought and Its Consummation in the Divine Comedy, New Haven: Yale Univ.Press, 1929 [= PhD dissertation, New York: Columbia Univ., 1929] reprinted New York: Russell and Russell, 1961, and again by Atlanta, GA: SOLINET, 1994.

11
Dunbar, Symbolism . . . , p.11. Dunbar, "The Sun . . .," p. 4. Dunbar, Symbolism . . . , p.14. H. Flanders Dunbar, "Mental Hygiene and Religious Teaching," Ment.Hyg. 19: 353-372, 362.

12
H. Flanders Dunbar, Emotions and Bodily Changes: A Survey of Literature on Psychosomatic Interrelationships: 1910-1933. New York: Columbia Univ. Press, for the Josiah Macy, Jr. Foundation, 1935. revised and enlarged in 1938, 1946, and 1954.

13
Powell, Healing and Wholeness . . . ,pp. 240-241, fn. 4; Carroll A. Wise, Religion in Illness and Health. New York: Harper's Brothers, 1942.

14

Robert Charles Powell, "Acceptance without Surrender: An Attitude within which We -- the Mentally Ill, the Family, and the Psychiatrist -- Might Work Together." invited address presented before the 3rd Annual Conference on Family Support & Advocacy, Alliance for the Mentally Ill - Northwest Suburban, Arlington Heights, Il., October 1993.

15

Andre Schwarz-Bart, The Last of the Just. original French, 1959; translation, New York: Atheneum Publishers, 1960.

16

Robert Charles Powell, "Questions from the Past (on the Future of Clinical Pastoral Education). Invited keynote address, presented before the 50th Anniversary Conference, Association for Clinical Pastoral Education, Minneapolis, October 1975. 1975 Conference Proceedings: 1-21, 1976.

17

Edward E. Thornton, "The Meaning of History for Today and the Future: A Response to Robert C. Powell," 1975 Conference Proceedings: 22 27, 1976 

Robert A. Preston, "Watch Out How You Are Listening. Consider What You Are Hearing," 1975 Conference Proceedings: 28-32, 1976

18

Paul W. Pruyser, The Minister as Diagnostician. Philadelphia: Westminster Press, 1976. Pruyser's questions concern "communion," "awareness of the holy," "providence," "faith," "repentance of sin," "grace," and "sense of vocation"; they must be compared to Boisen's on "sense of the mysterious and the uncanny," "sense of peril," "sense of personal responsibility," "erotic involvement," "philosophy of life" (about God), " religious concern," and "plans for the future." See Robert Charles Powell, "Anton T. Boisen's 'Psychiatric Examination: Content of Thought' (c.1925-31): An Attempt to Grasp the Meaning of Mental Disorder," Psychiatry 40: 369-375, 1977. Boisen refers to these questions in his The Exploration . . ., but this is the first publication other than by mimeograph of the original full set. See note 19 below.

19

Donald Denton, Religious Diagnosis in a Secular Society: A Staff for the Journey. Lantham, MD: Univ. Press of America, 1997. He uses three axes, "the concrete feeling of guilt," "the religious concept of sin," and the cosmic theme of defilement." see note 18 above.

20

George Fitchett, Spiritual Assessment in Pastoral Care: A Guide to Selected Resources. Decatur, GA: J. Pastoral Care Publications, 1993.

21

Kenneth I. Pargament, Kenneth I. Maton, and Robert E. Hess, eds., Religion and Prevention in Mental Health: Research, Vision, and Action. New York: The Haworth Press, 1992.

22

Thomas Moore, Care of Soul: A Guide for Cultivating Depth and Sacredness in Everyday Life. New York: HarperCollins, 1992.

23

Paul C. Holinger, Pastoral Care of the Severe Emotional Disorders: Principles of Diagnosis and Treatment. New York: Irvington Press, 1985. This is a revision of two meaty articles; see Pastoral Psychology 27: 136-150, 1979, and J.Pastoral Care 34 (3): 177-189, 1980. Holinger is a psychiatrist with a Master of Divinity degree.

24

Charles V. Gerkin, The Living Human Document: Revisioning Pastoral Counseling in a Hermeneutical Mode. Nashville: Abingdon Press, 1984.

25

John Patton, From Ministry to Theology: Pastoral Action & Reflection. 

Nashville: Abingdon Press, 1990.

26

Charles J. Lopez, Jr., Pastoral Counseling: Changes and Development, 1950-Present. ??PhD dissertation, Columbia Pacific Univ., ?1986.

27

Robert Charles Powell, "Empirical Theology, 1916-1946: A Note on the Contribution of Anton T. Boisen." invited address, presented before the Autumn Convocation, Chicago Theological Seminary, September 1976. Chicago Theological Seminary Register 67: 1-11, 1977.

28

Joanne Greer, "Linkages between Theological Reflection and Empirical Research." Abstracts of Research in Pastoral Care and Counseling. Columbia, MD: Congress on Ministry in Specialized Settings, 1995. pp. [xii-xiii]

29

Robert Duffett, "The Intellectual Foundations of Pastoral Counseling : A Perspective on the Future of the Profession." J. Pastoral Care 49 (3): 255-263, 1995.

30

Rodney Hunter, "Guest Editorial: A Bird's Eye View: Postmodernism and the Future of Pastoral Care." J.Pastoral Care 51(4): 373-375, 1997.

31

Larry Vande Creek, A Research Primer for Pastoral Care and Counseling. Decatur, GA: Journal of Pastoral Care Publications. 1988.

32

John Gartner, David B. Larson, and Carole D. Vachar-Mayberry, "A Systematic Review of the Quantity and Quality of Empirical Research Published in Four Pastoral Counseling Journals." J. Pastoral Care 44 (2): 115-129, 1990, p.123.

33

Carol North and William M. Clements, "The Psychiatric Diagnosis of Anton Boisen: From Schizophrenia to Bipolar Affective Disorder." J.Pastoral Care 35 (4): 265-275, 1981. Dr. North's autobiography, focusing on her successful treatment by dialysis, is of interest even if her diagnosis of Boisen is incorrect. See Carol North, Welcome Silence. New York: Simon & Shuster, 1987. 

Chaplain L. George Buck, just after my oral presentation of this manuscript told me of, then later supplied copies of, two documents concerning Boisen's admission in late 1935 to the Sheppard-Enoch Pratt Hospital, Maryland: the "Abstract" of his medical record (slightly over two typed pages, single-spaced) and the verbatim minutes of the "Staff Conference" "for Diagnosis" dated 11 November 1935 (slightly over 3 typed pages single-spaced). Let me note that when I sought permission in 1975 to quote from the case records concerning Boisen's hospitalizations in Massachusetts permission was denied because his one remaining relative would not provide consent; that impediment no longer remains.

From the "Abstract": "His present illness is similar to his previous ones, except that in his relationship this time he believes himself to be on top, whereas formerly he was on the bottom. His ideas center about the family of four  weak accepting from the strong. Time for the weak to do something for the strong -- classifying himself as the weak one. He thought the informant was a Jewess betraying him and then believed he was John the Baptist. . . . He identified himself with Mary Magdalene, referred to Dr. Cabot as being the 'dead Center' of things. . . . He talked about changes going on in the moon, thought the world cold be saved if twins were born every birth because Christ lost his life everytime someone was born."

From the "Staff Conference": [Boisen:] "I started in despair and began to sing and then felt better. . . . When I began to sing I began to get some hold of myself . . . ." [Physicians:] "Diagnosis -- schizophrenia. Good outlook for this attack. He has recovered from his previous attacks, and this is exactly the same, with the one difference, and that is, when he described the relationship between himself and other people of always putting himself at the bottom and the other people on top, and this time he puts himself on top, which may be a better prognostic significance than the former ones. . . . I try to be optimistic about the outcome, but I am afraid it may not work out that way."

34

[Helen Flanders Dunbar] "Certificate of Death [August 21, 1959]." Hartford: Connecticut State Department of Health, August 22, 1959. 

Flanders Dunbar, Psychiatry in the Medical Specialties. New York: McGraw-Hill, 1959.

35

Underground Report 1

36

"Male Bashing at Breckenridge [the Association for Clinical Pastoral Education annual conference, 1991]," Underground Report 29 : 1-4, 1992, p.3.

37

Edward E. Thornton, "The 'Secret' of Clinical Pastoral Education" [editorial], J. Pastoral Care 36 (3): 145-146, 1982, p.146

39

Anton T. Boisen, "Clinical Pastoral Training in Retrospect and Prospect: Remarks at Faculty Luncheon -- Union Theological Seminary. October 30, 1957. 5 pp, lithographed. copy in Boisen's case record at Worcester [Massachusetts] State Hospital; other copies have been seen, and a copy is probably in the ACPE archives.

40

Robert C. Powell, "Anton Boisen and Theological Reflection: The Importance of Being 'Still Crazy After All These Years." presentation at Chicago Theological Seminary, 1987

41

For more regarding the CPSP program for mature pastors and institutional chaplains, see the "web" at www.cpsp.org

42

Underground Report 1 (5): 2, 1988.

43

Leonard I. Sweet, Underground Report 1 (6): 4, 1989.

44

Robert M. Claytor, Underground Report 1 (6): 4, 1989.

45

Lyle Grainer, Underground Report 1 (8): 2, 1989.

46

Nick Ristad, Underground Report 1 (8): 3, 1989.

47

Carl Brand, Underground Report 1 (9): 4, 1989.

48

Raymond Lawrence, Underground Report 1 (17): 2, 1991.

49

Perry N. Miller, Underground Report 20: 2, 1991.

50

Charles Gerkin's book quoted, Underground Report 23: 3, 1991.

51

Raymond Lawrence, Underground Report 22: 2, 1991.

52

Perry N. Miller, Underground Report 35: 1, 1992.

53

As best I can tell, the meeting that led to the birth of the CPSP opened on March 17, 1990, as the "College of Pastoral Counselors and Supervisors," and closed on March 19, 1990, as the "College of Pastoral Educators and Psychotherapists." Seven months later, on October 19, 1990, it became the "College of Pastoral Supervision and Psychotherapists," later, at some date unclear to me, becoming the "College of Pastoral Supervision and Psychotherapy." The March 1991 issue of ACPE News finally acknowledged the existence of the Underground Report and its offspring. The first plenary meeting of the CPSP occurred March 12-15, 1992.

54

Carroll A. Wise, Pastoral Psychotherapy: Theory and Practice. New York: Jason Aronson, 1980.

55

Wise, Pastoral Psychotherapy. . . , pp. 27, 16, 17, 276, 57, 62.

56

These are allusions, of course, to Boisen, The Exploration of the Inner World. . . and Boisen, Out of the Depths . . . , etc.