Pastoral Report Articles 

  • 22 Aug 2018 4:45 PM | Perry Miller, Editor (Administrator)


    On August 16, the Boston Medical Center nurses on the Newton Pavilion celebrated their long, rich history as they prepare for the closing of the Pavilion in October, when they will move to the expanded Menino Pavilion next door.  The Newton Pavilion was the former University Hospital, and in 1996 merged with the Boston City Hospital to become Boston Medical Center, comprised of the Newton and Menino campuses.  The Newton Pavilion has been home for many years for hundreds of nurses.  Thus the August 16 event marking the closing of their workplace was a sad as well as a celebratory occasion.

    The speakers included Kate Walsh, President & CEO of Boston Medical Center, Nancy Gaden, Chief Nursing Officer and Karen Kirby, former Chief Nursing Officer of University Hospital.

    Having been hospital chaplain at University Hospital and then the Newton Pavilion from 1992 to 2011, I was invited to give the Blessing at the event, called “Celebrating Nursing at Boston Medical Center: Past, Present and Future.”  Following is the Blessing I presented.

    I’m honored to be giving today’s blessing for you, the nurses of Boston Medical Center’s Newton Pavilion.  Actually, I have been blessed to have been hospital chaplain at University Hospital and then at BMC’s Newton Pavilion for over 18 years, from 1992 to 2011 – and another five years of per diem work.  And it is your blessings that greatly assisted my chaplaincy work with patients over the years – as you have also blessed and enabled the chaplaincies of Drs. Sam Lowe and Jennie Gould, Sr. Mary Ann Ruzzo,  Fr. Roger Bourgea, Fr. Ray Bonoit, Sr. Claire Hayes, Rabbi Paul Levinson, Imam Salih Yucel, Rev. Les Potter, and others, and their devoted pastoral care volunteers.

    There are also the countless blessings you have provided for patients and their families from all walks of life.  Based on my work with you, I want to recall just a few of the blessings you nurses have bestowed on patients and their loved ones.  

    On one occasion, a daughter, who was diabetic, came to visit her mother in the old MICU on 6N.  Unable to eat anything before she arrived at the hospital and feeling somewhat ill, the daughter asked me if there were a place on the Unit where she could make toast for herself.  I said I’d go ask her mother’s nurse.  Without a moment’s hesitation, the nurse replied, “I’ll make it for her.  What does she want on it?”  That’s exceptional care without exception.

    After MICU on 6N moved to 8 North, I visited a 42-year-old man there who was withdrawing from alcohol and preoccupied with finding his laptop computer.  He would sit up, pull on the restraint that was keeping him from falling out of bed, point across the room as if his computer might be there.  In the midst of this preoccupation, he said he did not know where he was.  I responded that he was at Boston Medical Center.  His pre-occupation and confusion led me to tell him that I would share his concern with his nurse. 

     His nurse was just outside the room, and overheard our conversation.  When I told her of his pre-occupation with his computer, she replied, “So that‘s the latest thing he’s obsessed about.  He has a lot of things like that on his mind,” adding, “He’s withdrawing from alcohol and doesn’t know where he is at.”  She then said, “I’m waiting for the valium I gave him to hit him so I can relax.”  

    The nurse then said, with a smile, “Could you say a prayer for me?  I need it.”  I smiled in return and replied, “Sure.  May you have a good day.  And may all that is loving bless you very much.”  “Thank you.  I needed that,” she said smiling.  She then said, “When the patient’s mother and father come to see him, I will ask them about the computer.”  It was great to see that nurse again today.

    More blessings.  I visited a dying mother in SICU and her family of two daughters and two sons, all four adults.  I was with them for an extended period of time, together with their nurse.  The one daughter thanked the nurse and me for “hanging in there” with them.  You could tell how closely the family had bonded with the nurse by the way the daughter said her name, “Carline.”  You could also tell by the way Carline responded.

    As we sat around this dying mother’s bedside, her daughters and sons began to reminisce about her being a school teacher, and, at different ages, she was each one’s classroom teacher when they were children.  They mused about having their mother as their school teacher: saying how difficult it was to feign sickness or play hooky.  Who would write their excuse?  Who would read it?  Loving memories shared with a nurse who had become like family. 

    A final blessing to recall.  Do you remember Rose?  A woman in her eighties.  For Rose, the Newton Pavilion cafeteria was about family.  Her mother died at Boston Medical Center many years earlier, which evidently led her to keep coming back to the place where she last saw her mother alive.  Instead of the cemetery, she visited BMC’s familiar cafeteria, filled with the living.  She adopted BMC staff as her family – whether we wanted to be adopted or not.

    Every day at lunchtime, Rose would sit at the same table in this cafeteria.  She played the role of hostess: making the rounds and greeting various staff, straightening the chairs under the tables, refilling the napkin holders and plastic containers.

    Rose was very outgoing.  And underneath was a sensitive and caring woman, looking for and finding a family – at noon each day, here, in this cafeteria, before going home to be alone.

    Rose’s need and Boston Medical Center’s inclusive mission are perceptively captured in a birthday card a wise nurse gave to her, which Rose proudly showed to others and to my wife, Eva, and me.  The nurse wished Rose a happy birthday, wrote that she was a very special person, and ended her note with, “Thank you for taking care of us.”  What a blessing for Rose.

    The Newton Pavilion has been a second home, an extended family.  You nurses have made it so for each other and for many others of us staff and patients.  So there is sadness here as we face the closing of the Newton Pavilion.  Sadness born of years of sharing with each other and caring for patients. Sadness also in recalling, with gratitude and love, the nurses, no longer living, with whom you shared your work and your lives. 

     As the closing of the Newton Pavilion nears, its halls, once busy with routine, will become hallowed – filled with your precious memories.  And, across the street, there are other halls and rooms filled with patients who will need your nursing expertise and caring.  Halls that will also become hallowed by your presence, skills and empathy.

    Halls and rooms with all kinds of patients, which reveal that the hospital is a crossroads of humanity, a global neighborhood – populated by patients -- and staff -- of various beliefs, nationalities, races and sexual orientations. In the hospital, there is the diversity of divinity, and the divinity of diversity, and the commonality of humanity.  And you nurses are the ambassadors of exceptional caregiving without exception.  

    You have provided untold blessings.  May all that is loving bless all of you very much.


    ----------------------

    Dr. William Alberts is an emeritus member of the Concord Chapter of the College of Pastoral Supervision and Psychotherapy.  He is author of A Hospital Chaplain at the Crossroads of Humanity, which “demonstrates what top-notch pastoral care looks like, feels like, maybe even smells like,” states the review in the Journal of Pastoral Care & Counseling.  The book is available on Amazon.com.  He also is a regular contributor to Counterpunch.   His e-mail address is wm.alberts@gmail.com.


  • 12 Jul 2018 12:05 PM | Perry Miller, Editor (Administrator)


    No one who is seeking to become a board certified clinical chaplain (BCCC) should meet a certification panel and leave disappointed. This is my firm conviction and has been the commitment of the Nautilus Pacific Chapter since it was founded. We have always held that there is simply no good reason for a candidate to meet the panel and walk away unsuccessful. 

    In recent years I have had the sad experience of sitting on panels and having to tell some candidates that they had not met the Standards for certification and would not be certified. I don’t think it’s a message anyone likes to deliver and it’s one I believe no one should have to hear.

    Why people fail at certification
    The primary reason someone gets turned back is that they didn’t fulfill the clearly articulated expectations set out in the CPSP Standards. Too often, mistakenly, individuals and their chapters will decide for any number of reasons that “it’s time” without considering what makes it time – when a candidate is truly ready – to meet a certification panel. In other words, the vast majority of those who fail at certification do so because they simply weren’t ready and didn’t know what “ready” means.

    Certification is never based upon whether you have been in a chapter “long enough” or are liked by your chapter members or you are an active participant in chapter activities. These are important aspects of our professional life together but they are not what demonstrate competence as a clinical chaplain or pastoral counselor.  Similarly, having worked in a position with the title chaplain for an extended period isn’t sufficient. The word “chaplain” can be applied to anyone who does ministry outside the congregational setting. In fact, most people who bear the title – college chaplains, police and fire chaplains, many prison chaplains, and others – are not and could not become board certified. Even in healthcare many are not board certified. And even having completed four units of CPE is not in itself sufficient to merit board certification.  

    What does it take to be certified?
    The CPSP Standards spell out the necessary competencies (Section 730) for certification as well as what is expected – the 13 objectives – to be achieved as a result of CPE training (Section 230). 

    If someone fails, this typically means that they likely haven’t had an informed, capable mentor to work with them though the certification process.  It certainly means their chapter hasn’t considered the set expectations that apply to all of us. In a really rigorous CPE program there will be those who are nearly ready by the end of four units, but this is the exception, not the rule. The healthy chapter is a place of peer support as well as peer review and input. While a lot can be accomplished in 1600 or more hours of clinical training, most often the finishing work of preparation – as in any guild – will be the responsibility of that of the chapter’s more competent, experienced, certified chaplains. 

    The Litmus Test
    When a candidate meets the certification panel, those on it will have reviewed at least three major documents: the candidate’s autobiography, their theory paper and two case studies. Reading closely these documents alone and without ever having met the chaplain, an astute reviewer is usually able to make a good assessment of the competence and readiness of the candidate. If each of the documents seems congruent with the others it is most likely the candidate will be certified. One’s theory of pastoral care should make sense given key aspects of the person’s life story, and one’s theory and life story should inform and be visible, if sometimes obscurely, in the cases.  It is this integration, along with evidence of the basic competencies set out in the Standards, that assures certification. 

    How to succeed (or when to plan the party)
    Certification should never be a crapshoot. I don’t think it should even be a gamble. With the right preparation and responsible chapter involvement in the process meeting the certification panel should be a pleasurable and affirming experience. 

    What is key is that chapters take responsibility for mentoring certification seekers so they’re prepared, paying close attention to meeting the Standards, and helping the seeking member thoughtfully to prepare and assemble the required documents. 

    ----------------

    David Roth is the director of spiritual care and clinical supervisor for chaplaincy training at Kaiser Permanente in the Napa/Solano Area and a member of CPSP’s Nautilus Pacific Chapter. Visit his website at ClinicalPastoralTraining.org or email him at drdavidroth@gmail.com.

    Download: "A Concept and Function of a Mentor in the CPSP" by The Rev. Dr. William Scar, CPSP Diplomate, Pastoral Report, 31 July 2008.

  • 03 Jul 2018 8:14 PM | Perry Miller, Editor (Administrator)

    To become proficient in the practice of pastoral care, pastoral counseling and pastoral supervision one must always move back and forth between reflection on theory and reflection on practice.  De facto, the way one practices regularly implies a theory that is being enacted, whether the practitioner is conscious or unconscious of this fact.  Conversely, the theory one espouses implies particular kinds of practice, whether or not these practices are actually being followed.  A person who lacks knowledge of any theory at all will engage in practice that is willy-nilly and incompetent.

    Historically, clinical pastoral training has focused on the practice of our arts through study of actual clinical cases, both in group seminars and individual supervisory sessions.  Anton Boisen instituted Clinical Pastoral Training as reflection on practice in reaction against the exclusively didactic pedagogy of theological seminaries that failed to help seminarians develop the relational competence necessary for effective ministry.  For Boisen, the cognitive dimensions of theological education had to interface with human experience.  Theory must inform and be integrated with practice. 

    He derived this tenet from his study of William James, and his work at Union Theological Seminary with George Albert Coe, both of whom championed “the empirical study of religious experience.”1 In 1921 Boisen’s friend, Fred Eastman sent him a copy of Freud’s Introductory Lectures, a book that greatly excited him.  Boisen’s next mentor was Richard Cabot, M.D. who “shared…the vision of including a clinical year as a part of theological study.”2 He further refined his position while working during 1923-24 in the Social Service Department of Boston Psychopathic Hospital.  There he became acquainted with the methodology of the social workers who made “a careful study of all aspects of a person’s situation, including his or her religious experiences.”3   

    Working in each of these situations where medical and social work education was combined with clinical residencies, Boisen developed and refined his vision of interfacing academic theological and psychological concepts with the practice of ministry in clinical settings.  In this way a curriculum was formed that moved between theory and practice, and the supervised reflection upon these experiences.  Content was balanced with process.

    Today, CPSP remains committed to this balance of content with process, theory with practice.  To this end, last year I developed a bibliography for pastoral care, counseling and supervision.  Now, at the request of CPSP leadership, I am offering an annotated bibliography of core psychodynamic readings – a kind of storehouse of theory to be paired with our practice.  It is hoped that these readings will enhance an informed focus on our practice. 

    DOWNLOAD: Annotated Bibliography for Pastoral Care, Pastoral Counseling and Diplomates in Training - by David Franzen


    __________________________________________________  

    1Vision from a Little Known Country: A Boisen Reader, Glenn H. Asquith, Jr., Ed.,

                Journal of Pastoral Care Publications, Inc., 1992, pp. 4-5.

    2Ibid., p. 7.

    3Ibid., p. 7

    --------

    David Franzen
    drdavidfranzen@gmail.com

  • 28 Jun 2018 8:01 PM | Perry Miller, Editor (Administrator)


    Given the current political environment and the public innuendo thatMuslims generally are a threat to our political well-being, I want to state publicly and unambiguously that we in CPSP stand firmly in opposition to such blanket denigration of any of the great religious traditions of the world or its members.  
     
    I call on all my colleagues in CPSP to be sensitive and caring toward ourMuslim colleagues, to do all in our power to support them in this dark time, and to stand firmly in opposition to any blanket denigration of any religious group. 
     
    Raymond J. Lawrence
    General Secretary

  • 01 Jun 2018 8:38 PM | Perry Miller, Editor (Administrator)


    We tend to look back as we move forward, examining those encounters that may apply to the present.

    An exact application is elusive. Today’s challenges differ from yesterday’s as  much as my own pale against those of working chaplains. Retired folk mostly set our own pace. Except when another person sets an appointment. A stress test (canceled because we ate chocolate). Cataract surgery. Time for a hearing check, a dentist visit.  In other words, the need to maintain and repair.
     
    Yet, what do we really know about coping?  We may examine the actions of those we have visited who have coped with problems much larger than ours. Sitting beside a younger man suffering from end-stage liver disease. He was the most “up” person I have ever met. He spoke of his family, especially his kids of whom he was proud. Accompanying a mentor to a locked ward to visit a young woman who listened to a long story, accepted quietly, as a respite from her confusion.
     
    My scheduled visits fade to black as these actions compel imitation.
     

    ------------------

    Dom is a retired Clinical Chaplain who lives in Littleton, Colorado. He can be reached at dominic.fuccillo@gmail.com.


  • 25 Apr 2018 3:34 PM | Perry Miller, Editor (Administrator)


    Left to Right: David Roth, Pamela Cooper-White, Kerry Egan, and Raymond Lawrence.


    Lost Wisdom, Found Wisdom, Shared Wisdom:
                            You Can’t Pray Gibberish. You Can’t Write Gibberish Either.
                            The Importance of Writing for Clarifying Your Thoughts. 1

    by Robert Charles Powell, MD, PhD

    Finding “a point of effective intervention” –
    a phrase favored by Helen Flanders Dunbar, theologian, philosopher, and psychiatrist –
    spirals through wisdom
    even as we probably have needed to spiral through knowledge and understanding to get to wisdom.2

    In many ways, The College of Pastoral Supervision and Psychotherapy has been viewed as a “back to Boisen” movement – and it is. This year’s plenary, however, helps to clarify the ways in which CPSP also should be viewed as a “back to Dunbar” movement – for she wrote on many currently important themes between 1923 and 1959 – that is, some six to nine decades ago. Think about that for a moment.

    As early as at age 21, Helen Flanders Dunbar already was sorting out what now tends to be called “intersubjectivity” – the creation – and re-creation – of multiple simultaneous shared meanings through multiple layers of interrelationships.  Rather than focus on the “dynamics” or the “mechanismics” of relationships, Dunbar focused on what then was called the “organismics” – the constantly moving, mutually involving holism of the relationships going on within and between our minds – as well as within and between our environments – as we work with someone in a healing way. 3

    I spoke of this at the Chicago plenary in 2015 – of the psychological and the sociological as enmeshed in the Boisen-Dunbar “world” – as well as at the Salt Lake City plenary in 2016 – of “personal experiences in social situations” – and vice versa. Boisen and Dunbar did not view pastoral care, counseling, and psychotherapy as some kind of “method” in which one person “does” something to another, but as a complex evolving process of what goes on between “helper” and “helpee”. 4

    [quote:]

    through pushing both the
                psychodynamic and the
                crucial public health aspects

    of professional chaplaincy, …
    Dunbar was among the first to
    focus on both

                the personal body and
                the social body
                            simultaneously. 5

    [quote:]
    our internal relationships … mirror
    our external relationships.

    We are –
                each of us is –
    our brother’s and sister’s keeper.

    The goal is
                to reflect on all this –
                to carry out all this –
    with
                tolerance and
                encouragement. 6

    Years ago, mentors taught me that writing – like speaking – works best when one tries to answer a clearly formulated question. That is part of our topic today – how important it has been – and will be – for this field, that individuals wander through knowledge and understanding to wisdom – and that they communicate with their colleagues along the way. Speaking and writing are essential for clarifying your thoughts.

    I got into this whole world of Dunbar 50 years ago when I asked, “Why did the literal founder of the American psychosomatic movement pursue a Bachelor of Divinity degree first?” The budding psychiatrist part of me said that there had to be a reason why. 7

    Apparently, Dunbar got into the beginning stages of her life’s work when she wondered, “How do symbols work? – in religion, in medicine, in everything?  How is everything – the outer and inner environments, the personal and the social worlds – bound together – with everything constantly impacting everything else?” Dunbar’s Bachelor of Divinity thesis indeed focused on “the therapeutic values of the various forms of worship – liturgy and hymnody, the exercise of private devotions, and the contemplation of religious symbols and architecture”. 8

    Apparently, Boisen got into the final stages of his life’s work when he wondered, “What if some forms of mental disorder and some forms of religious experience attempt to work out similar issues? – what if serious “cooperative inquiry” by, so to speak, mentor and mentee, could assist both kinds of exploration? 9

    A Dunbar Awardee apparently asked, “What if the profound sometimes lies right in front of us – wisdom wanting to be found – if we can be patient enough to wait for it to become manifest in the healing presence?”

    A Dunbar Awardee apparently asked, “What if the complex layers of communication between helper and helpee evolve constantly as a shared wisdom? – as the two parties engage in a kind of Boisenesque “cooperative inquiry,” trying to ascertain a kind of Dunbaresque “point of effective intervention?” 10    

    Dunbar herself almost single-handedly reinvigorated a mostly lost font – and fountain – of wisdom – the “insight symbol” – as understood by the late medieval world’s deepest thinkers. In her first book – in a thinly veiled description of herself – Dunbar noted that “Had a medieval thinker of the first rank been equipped with modern psychological background and technique, he [or she] would no doubt have maintained that the deepest meaning behind each of the interpretations given was the attempt to make that adjustment to the Infinite which Dante represents fully accomplished in the last four lines of the Paradiso”. The individual’s relationship to his or her internal and external environments was a concern of the organismic approach to medicine; the individual's adjustment to his or her spiritual environment, the Infinite, was the same process on a different level. In either case, Dunbar considered an adequate handling of symbolism as “fundamental” to the “integration of the individual within … [him- or herself] and in his [or her] environment”.

    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

    A Dunbar Awardee focused on
    “the wisdom to be found in stories” shared within a healing “peaceful presence,”
    as those dying try to rediscover the meaning of their living.

    Whatever story is told, whatever story is held, it may well be open to multiple meanings on multiple levels as insight evolves between supposed healer and supposed healee. One can be both. 12

    As a result of found wisdom – even some found in the awardee’s own life – the awardee learned to be “not so quick to reject ideas of what might be possible”. 13

    Can we be open to expanded meanings beyond our first impressions? “There is only becoming,” as this awardee phrased it. 14 Boisen said about the same thing. Boisen spoke of having faith in “the Love … in whose eyes no one is condemned who is in the process of becoming better”.  Again, as in the wisdom this awardee found, “We are becoming who we already are [ -- ] up until the moment we die”, 15

    Let us go back for a moment to that notion of healing “peaceful presence”. Dunbar spoke of something similar in terms of parenting. She wrote three books on the theme. 16 This awardee, in terms of chaplaincy, explained, “ ‘I take a deep breath before I enter the room, and I ask G-d for help. I remind myself why I am there, and I let go of everything else in my mind.” 17

    Hmm. That also sounds a little bit like the psychodynamic “free floating attention,” doesn’t it? It is an attitude – without presumptions – that is open to whatever meaning – or meanings – arise – in the supposed healer – in the supposed healee – and in the space between them.

    This “sitting in the silence,” the awardee reminds us, prepares us
    to recognize when the moment arrives,” when,
    if we just wait in silence,
    if we just hold the line,
    “no matter how hard that is,
    somehow the patient will find the courage ….
    to say the unspeakable” –
    to acknowledge
    the “deep hole of meaninglessness” that he or she carries inside. 18

    Thank G-d, the awardee assures us, the supposed healer and the supposed healee always find their way out of the depths.

    Yes, these are the awardee’s own formulations – but I believe that echoes of Boisen’s and Dunbar’s writings can be heard.

    A Dunbar Awardee focused on
    “a shared wisdom that grows and is held between helper and helpee in the [clinical] pastoral relationship” –
    on a wisdom drawn “from the shared exploration of meanings that arise … [within “the intersubjective dyad”] and are co-created uniquely in … [that specific helping] relationship.” 19

    “The process of meaning-making is not … viewed as moving toward some single, incontrovertible truth or concrete certainty. The ‘truth’ of an experience … [is viewed as] usually become increasingly rich, complex, and multiple over time.” 20

    Indeed, as that awardee has suggested, “mental health may depend as much on … the ability to entertain multiple meanings as it does on unity, integration, and a capacity to synthesize.” 21

    Within this notion of a shared wisdom, “The role of the therapist … [is] as a companion in the patients’ efforts to tell the stories of their lives and to come to deeper contextural understandings of how these stories shape daily choices, relationships, and current behavior.” 22

    This notion of a shared wisdom also emphasizes the importance of the therapist’s ability “to maintain a consistently exploratory stance [,] … moving the … process from the realm of action back into symbolization, verbalization, and [,] ultimately, comprehension.” 23

    There are layers upon layers in a life – and this is even more so true within a healing relationship – as the layers upon layers of healer and healee interact.

    Yes, these are the awardee’s own formulations – but I believe that echoes of Boisen’s and Dunbar’s writings can be heard.

    On this 10th anniversary of the convening of “A Task Force to Assess CPSP and Its Future Direction,”
    please join me in welcoming the 17th recipient – and the other 17th recipient – both of them – of
    “The Helen Flanders Dunbar Award for Significant Contributions to the Clinical Pastoral Field,”
    Chaplain Kerry Egan and Doctor Pamela Cooper-White.



    **********

    Now, let me note that it is most unusual for us to bestow an award before the honoree gives his or her presentation – but just as you packed the audience for Doctor Cooper-White’s speech, I urge you to pack the audience tomorrow for Chaplain Egan’s speech. She has a fantastic way with words – which reinforces the subtitle and the sub-subtitle that I gave to this introduction:

                the subtitle: You Can’t Pray Gibberish. You Can’t Write Gibberish Either.”
                and
                the sub-subtitle: “The Importance of Writing for Clarifying Your Thoughts.”

    I hope that all three authors – Dunbar, Cooper-White, and Egan – will have inspired you to write your own essays, your own articles, and your own books.  

    #

    Endnotes:

    1. Twenty years ago – in 1998 – is when Raymond Lawrence first asked this author to speak at The College of Pastoral Supervision and Psychotherapy. “Whatever Happened to ‘CPE’ – Clinical Pastoral Education?” http://www.cpsp.org/pastoralreportarticles/3778818

    2.         “I have filled each with
                the spirit of G-d,
                in wisdom, and
                in understanding, and
                in knowledge … .”  [Exodus 31:3]
                “By wisdom the earth’s foundations were laid;
                by understanding the heavens were set in place;
                by knowledge the deeps were divided …. .”  [Proverbs 3:19-20]

                “Through wisdom a house is built;
                through understanding it is established; 
                 through knowledge its rooms are filled … .”  [Proverbs 24:3-4]

    3. Powell RC. “Helen Flanders Dunbar (1902-1959) and a Holistic Approach to Psychosomatic Problems. I. The Rise and Fall of a Medical Philosophy,” Psychiatric Quarterly 49: 133 -152, 1977. abstract on the internet at www.pubmed.gov ; a revised edition will be published soon.

    4. Powell RC. “ ‘Amid the Complex Entanglements of Actual Life’: How Are Clinical Pastoral Chaplains to Gain Perspective?” 2015; on the internet at http://www.cpspdirectory.org/pastoralreportarticles/3779026 .

    Powell RC. “From Emotions and Bodily Changes … – in the Personal Body – to Bodily Changes and Emotions – in the Social Body: The Organism in Its Environments: Both Inner and Outer.” 2016; on the internet at http://www.cpsp.org/pastoralreportarticles/3929569 .

    5. Powell, 2016.

    6. Powell RC. “Religion in Crisis and Custom: Formation and Transformation – Discovery and Recovery – of Spirit and Soul.” 2005; on the internet at http://www.cpspdirectory.org/pastoralreportarticles/3778881 ; translated [2011] by Chaplains Rafael Hiraldo Román & Jesús Rodríguez Sánchez, with the assistance of Chaplain R. Esteban Montilla, as “Religión en Crisis y en Costumbre: Formación y Transformación - Descubrimiento y Recuperación - de Espíritu y Alma”;  on the internet at   http://www.metro.inter.edu/facultad/esthumanisticos/coleccion_anton_boisen/case_study/Religion%20en%20Crisis%20y%20en%20Costumbre.pdf ; a revised edition will be published soon.

    Powell, 2016.

    7. Powell RC.  “Emotions, Bodily Changes, and Symbolism: The Early Writings, 1924-1936 of Helen Flanders Dunbar, BD, PhD, MD.” 1969; The Josiah C. Trent Prize Essay in the History of Medicine, 1970.

    8. Powell, 2005.

    9. Powell RC. “’Cooperative Inquiry’ in Pastoral Care: Some Thoughts on Dr. Rodney J. Hunter’s Article [“Spiritual Counsel: An Art in Transition.” Christian Century 118: 28, 2001].” 2001; on the internet at      http://www.cpspdirectory.org/pastoralreportarticles/3778829 ; a revised edition will be published soon. This author been intrigued by one of Boisen’s questions, “What does G-d think of you?” – as well as by the question, “For what does G-d pray for you?”

    10. Boisen AT. ““Cooperative Inquiry in Religion,” Relig. Ed. 40:290-297, 1945.
    Dunbar F. Psychosomatic Diagnosis. New York, Hoeber, 1943 [the whole book].

    11. Powell RC. “Helen Flanders Dunbar (1902-1959) and a Holistic Approach to Psychosomatic Problems. II. The Role of Dunbar's Nonmedical Background,” Psychiatric Quarterly 50:144-157, 1978; abstract on the internet at www.pubmed.gov ; a revised edition will be published soon.

    Powell RC. “Emotionally, Soulfully, Spiritually ‘Free to Think and Act’.” The Helen Flanders Dunbar Memorial Lecture on Psychosomatic Medicine and Pastoral Care, delivered November 1999, at the Columbia Presbyterian Center of the New York Presbyterian Hospital, New York, New York.  Journal of Religion & Health 40(1): 97-114, 2001. on the internet at http://www.cpspdirectory.org/pastoralreportarticles/3778841 ; added, January 2016, to EthxWeb: Literature in Bioethics, a digital collection maintained by Georgetown University, Washington, DC:  https://repository.library.georgetown.edu/handle/10822/944171 . revised edition to be published soon.

    The following is a brief review what Dunbar meant by “insight symbol” – a phrase she introduced to academic literature. She 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 that’s) – the symbol proper, 
                upon which she was to place her attention.

    12. Egan K. On Living: Dancing More, Working Less and Other Last Thoughts from the Dying. New York: Riverhead Books, 2016; p.17. [London: Penguin Life, 2017]

    13. Egan, 2016, p.103.

    14. Egan, 2016, p.113.

    15. Egan, 2016, p.113.

    16. Dunbar F. Your Child’s Mind and Body: A Practical Guide for Parents. New York: Random House, 1949.
    Dunbar F. Your Pre-Teenager's Mind and Body. [edited by Benjamin Linder]. New York: Hawthorn Books, 1962.
    Dunbar F. Your Teenager’s Mind and Body. [edited by Benjamin Linder]. New York, Hawthorn Books, 1962.

    17. Egan, 2016, p.14.

    18. Egan, 2016, p.19. This phenomenon was described in neurologic terms in 1964 as “contingent negative variation” – a reference to a shift in the electroencephalograph (EEG) pattern – “response anticipation” – suggesting that the brain “knows” what a person wants to do some seconds or minutes before that person has any conscious awareness of intent to do something. This current author long has been aware of this phenomenon as part of countertransference during a psychotherapy session – as when the therapist, for example, has a definite internal sense of anxiety, depression, anger, or fear – and then waits silently some seconds or minutes longer for the patient’s upcoming verbalizations relating to that sensed emotion; in other words, in some ways the therapist knows through countertransference in the session what is coming before the patient knows what is coming. Walter WG, Cooper R, Aldridge VJ, McCallum WC, Winter AL. “Contingent Negative Variation [CNV]: an electric sign of sensorimotor association and expectancy in the human brain.” Nature. 25 Jul 1964;203(4943):380-384;

    19. Cooper-White P. Shared Wisdom: Use of the Self in Pastoral Care and Counseling. Minneapolis: Augsburg Fortress Publishing, 2004: p.vii.

    20. Cooper-White, 2004, p.52.

    21. Cooper-White, 2004, p.54.

    22. Cooper-White, 2004, p.159.

    23. Cooper-White, 2004, p.175.

    Also see Pastoral Report article: http://www.cpspoffice.org/the_archives/2012/01/

  • 14 Apr 2018 7:30 PM | Perry Miller, Editor (Administrator)


    We had word this morning of the death of J. Harold (‘Hal’) Ellens yesterday at age 85. He had been suffering from congestive heart failure for some time but had remained active to the very end.
     
    Hal was the 2014 Helen Flanders Dunbar awardee, after which he requested to be certified as a CPSP Diplomate. He was a prolific writer and a supporter of many other writers. He had deep connections in the publishing world, especially at Praeger Press. Hal was also a large influence in the religious community, particularly Biblical studies, psychology, and the clinical pastoral field. Hal had some 180 books published under his name as author or co-author. He was a key leader in the Society for Biblical Literature, nationally and internationally.
     
    On a personal note, I heard from Hal last month. He reported that his heart was failing him more rapidly than he anticipated. He wrote in reference to his ongoing help for me with publishing. I was last with Hal at the Society for Biblical Literature meeting in Vienna in 2014, which he attended with his vivacious teen-age granddaughters and adopted son. Astonishingly, he was popping nitroglycerin pills at that time to keep his heart functioning and keeping up his usual fast pace.
     
    I had been introduced to Hal by Donald Capps some twenty years ago, who thought he could help me get published, as indeed he did. Hal will be greatly missed by me personally, both as a dear friend and as a theological ally. Our community has lost a strong advocate for the values to which we are committed.

    May he rest In peace.  


    ---------
    Raymond J. Lawrence
    General Secretary


  • 21 Feb 2018 9:27 PM | Perry Miller, Editor (Administrator)


    On February 1 of this year, the Pastoral Report published my “A NEW PROPOSAL: THREE LEVELS OF CHAPLAINCY AND PASTORAL EXPERTISE.” The result was considerable serious conversation from several quarters that led to a significant rethinking of the issue that I had broached. Brian Childs was particularly helpful in these conversations. The result is a significant revision of the original document and the creation of what I believe is a more substantive and more accurate delineation of the varieties of clinical chaplaincy roles. Thus I offer for your consideration the following revision of the “Three Levels...”  RJL

    A NEW CONSTRUCT
    Raymond J. Lawrence

    THREE AXES OF CHAPLAINCY AND PASTORAL EXPERTISE IN THE PUBLIC ARENA

    I propose three axes of chaplaincy and pastoral work, but there is no absolute or fixed boundary between the three. Each axis defines a general emphasis rather than a clear distinction or separation.

    AXIS 1: The Chaplain or Pastoral Clinician as Symbolic Figure

    A wide variety of institutions, organizations, and social clubs appoint or elect “a chaplain,” sometimes for cursory or ad hoc functioning and sometimes for long term and more significant functioning. Here the chaplain’s role represents a kind of liturgist. The death of a president or a natural catastrophe typically becomes the occasion for public memorials of some kind, and typically a religious or quasi-religious leader is summoned to preside over such grieving. The Axis 1 role is generally symbolic and dramatic rather than interpersonal. For an example of this from my own experience, when the World Trade Center was attacked, I was called on as director of chaplains at Columbia-Presbyterian Hospital, in New York, to preside over a memorial service for the entire medical community. It was the first and last time I was called upon to preside over a religious or quasi-religious gathering of the entire community, or at least the members of the community who elected to attend the memorialization of the World Trade Center attack. My burden as a chaplain at that moment was to represent the highest and broadest values of the culture in that context, and I certainly could not appear to represent any particular religion, ideological faction, or subgroup. Such is an Axis 1 role: to present as a religious functionary in the broadest, inclusive sense. Such inclusiveness must embrace even the non-religious, paradoxical as that may appear.

    Such a religious functionary provides the philosophical basis on which a variety of organizations and institutions, large and small, appoint chaplains. Such appointments are generally brief and quite limited in scope. For example, Congress has its own chaplain. Police departments typically have one or more chaplains. Social clubs often appoint or elect chaplains. Almost invariably, by necessity in such contexts, the role is detached from any particular religious tradition. The role is largely formal and temporary, certainly not extensive or with many defined tasks. Typically the duties consist of opening meetings with a prayer or some form of invocation. In some instances the role may extend to attending a crisis situation with the purpose of providing some kind of comfort, and in that limited context the role may border on the clinical. 

    Seldom if ever is there any sort of training for such a role. In those contexts the chaplaincy role is mostly symbolic, formal, and often impersonal.

    The burden in functioning at that level is to represent consensual elements of religion or quasi-religion without giving the appearance of lobbying for or endorsing a specific religious tradition or ideology. Chaplains in Axis 1, and pastoral work insofar as it is conducted in contemporary public contexts, must be universalist and non-sectarian.

    Axis 2: The Chaplain or Pastoral Clinician as a Therapeutic Presence

    A second axis of chaplaincy or clinician pastoral work posits that the chaplain or pastor assumes a therapeutic role, sometimes in relation to a group but more often in a one-to-one context. That role typically carries the additional label of “pastoral care” and/or more recently and with less clarity, “spiritual care.” The chaplain’s role should be a clinical one, that is attending to and focusing on the specific data at hand as distinct from any ideological concerns. The chaplain as clinician always begins and ends not from a position of ideology, religious or otherwise, but by responding specifically and dynamically to the presenting data.

    In this axis the chaplain or pastoral worker attends primarily to transferential data, that is data that gives evidence of unconscious as well as conscious material at play, in the patient, in the chaplain him/herself, and between the two of them. Transference, that is to say the insertion into relationships of unconscious material, can be observed both in the therapist-patient (or parishioner) relationship and in the clinical supervisor-trainee relationship. Both arenas invite, even command, reflection and exploration.

    Such clinical chaplaincy, and the clinical pastoral field generally, owns a large corpus of literature that typically includes a significant training regimen in the arena of attending to the unconscious life of persons and groups. The quality and intensity of training at that level will bear similarities to the clinical training for psychotherapy that psychologists and psychiatrists undergo.

    This approach to chaplaincy (this axis) follows the philosophy and practice of Anton T. Boisen, who inaugurated the clinical pastoral training movement early in the twentieth century. Boisen presented himself as a non-medical pastoral psychotherapist in the general tradition and practice of the psychoanalytic movement begun by Sigmund Freud. 

    Axis 3: The Undifferentiated Chaplain or Pastoral Clinician (The Blurring of Axes 1 and 2)

    A third axis of chaplaincy is a condition wherein the chaplain or pastoral clinician blurs the boundary between Axes 1 and 2. This blurring stems in part from harboring the illusion that the clinical chaplain can perform both functions with the same patient or patients at the same time. But a clinician cannot take the role of religious authority, teacher, and dispenser of religious rituals such as prayer without abdicating the therapeutic posture.

    For example, at the patient’s bedside the chaplain may abandon the therapeutic role and assume the role of a religious authority, teacher of religion, or a dispenser of religious rituals, like prayer. But such action renders the chaplain clinically ineffective. It is probably not a stretch to say that most currently functioning chaplains and pastoral clinicians in the U.S. fall into this trap most of the time.  

    The principal problem for the pastoral clinician is learning the demands of the agnostic posture requisite to competent pastoral counseling and psychotherapy. Most clergy strongly resist abandoning their roles as religious authorities. In congregational leadership such authority is useful to some extent. However, in the clinical setting such organizational religious authority is irrelevant and in fact corrupts the clinical pastoral role. This is abundantly clear in contemporary public institutions with their religiously diverse populations. But it is also true in institutions governed by particular religious organizations. The clinical chaplain cannot simultaneously promote any particular form of religion and at the same time remain clinical and therapeutic.

    In recent decades this issue has been blurred by a clever deception, that of presenting the pastoral clinician as an authority in the amorphous arena of spirituality that is alleged to incorporate all religions. In fact it embraces none. This ploy has been bankrupt from the start simply because “spirituality” as a category means most anything one wants it to mean, and therefore means actually nothing. Communication always breaks down when words lose their definition. Similarly prayer has been commodified in such a way as to give the appearance of being applicable to any god and any form of religion at any time. Most, but not all of this commodification has been promoted by non-theologians, a curious recent secular usurpation of theology by secular authorities. But if it matters not which of the many gods are being addressed, why pray at all?

    In practice, patients and clients will themselves tempt chaplains to confuse and violate the boundary between Axes 1 and 2. But it is the responsibility of the pastoral clinician to be alert to such temptation. The temptation is an intrinsic fruit of resistance to the therapeutic opportunity, and resistance is universal. How many are there among the patient population who would prefer to avoid dealing with their own personal reality? And how many chaplains prefer not to do the therapeutic work? It is quite easy to tempt the chaplain to recite a prayer and go away, not only entirely voiding the work of reflecting on inner turmoil and interpersonal discomfort but also avoiding the benefit of the chaplain’s potential therapeutic role. Chaplains insofar as they are clinicians must understand resistance and be attentive to it, an essential part of clinical practice. To grasp this temptation the chaplain must of course be disciplined in the art of declining the pedestal of religious authority, that most temptingly irresistible plum.

    Contemporary pastoral clinicians must decide whether they seek to function as administrators of whatever religion or cult pays their salary, including the newly created “spirituality cult,”  or whether they are going to function as theologically informed and psychoanalytically informed therapists in the tradition of the clinical pastoral training movement.

    -----------------

    Raymond J. Lawrence, General Secretary
    lawrence@cpsp.org





  • 01 Feb 2018 7:17 PM | Perry Miller, Editor (Administrator)


    At the recent meeting of COMISS in Washington, DC, David Roth and I discussed at length the signs of strife amongst the various chaplaincy organizations, and attempted to imagine together what new constructs might be introduced that would have some prospect of assuaging some of the rivalry and animus that attended the differences among the various chaplaincy and pastoral care and counseling groups. David and I came to the conclusion that a way to begin might be to recognize that each tradition has its own way of functioning, and its own idiosyncratic goals and values. Furthermore, we concluded that such differing goals should be acknowledged and accepted without derogation. In the broad field of chaplaincy, pastoral care and counseling there should be no “one size fits all” approach. After reflecting on our COMISS conversations, I present the following proposal for a possible reframing of the ways we think about the respective work of the various chaplaincy, pastoral care and counseling traditions. I invite others to join this conversation. 

    ***

    Level 1:

    A wide variety of institutions, organizations and clubs appoint or elect “chaplains.” For example, Congress has its own Chaplain. Police departments typically have one or more chaplains. Social clubs often appoint or elect chaplains. Generally in such contexts, the role is detached from any particular religious tradition. The role is largely a formal one, but not extensive nor with many defined tasks. Typically the duties consist only of opening meetings with a prayer or some form of invocation. In rare instances the role may extend to attending a crisis situation with the purpose of providing some kind of comfort. Seldom if ever is there any sort of training for such a role. 

    Level 2:

    A second level of chaplaincy, typically more finely defined as pastoral functioning, posits that the chaplain or pastor assumes a professional role. That role typically carries the additional label of “pastoral care” and/or more recently, “spiritual care.” In many but not all instances this role is considered a clinical one, that is, attending to and focusing on the data at hand as distinct from ideological concerns. The clinician as clinician always begins not from a position of theory or ideology, but by responding to the presenting data.

    Such clinical chaplaincy and the clinical pastoral arena generally owns a large corpus of literature and typically includes a significant training regimen. The quality of training at this level may or may not have some

    resemblance to social work training and/or psychotherapy training, depending on the focus and intensity of the training itself. 

    As distinct from the clinical posture, this level of training may also involve training in specific religious practices and doctrines to be introduced into the work of caring for persons. For example, there are Jewish, Catholic, Hindu, Buddhist and Muslim associations for pastoral care and/or chaplaincy. While there is or should be a clear disconnect between the clinical and the promotion of specific religious practices, this distinction is not always adhered to in practice. Some chaplains attempt to straddle the clinical and the specifically programmatically religious agenda. 

    At this level of chaplaincy the role of the chaplain is typically a broad spectrum one, and may involve a complex mix of clinical care and  counseling along side religious rites and rituals. In specifically religious hospitals, for example, we will find a predominance of chaplains from the religious group that owns the hospital. Chaplaincy at this level is generally seen as promoting religion of one sort or another and consequently tends to dilute or even nullify the clinical dimension of care. Such chaplaincy becomes complicated when, as often occurs, the patient and chaplain subscribe to widely differing religious traditions from that of the institution itself. This level of chaplaincy is exemplified generally in certifying organizations such as Neshama: Association of Jewish Chaplains (NAJC) and the National Association of Catholic Chaplains (NACC). The Association of Professional Chaplains (APC) sees itself as a proponent of this perspective.

    In this level of chaplaincy, the training regimen for chaplains is generally seen as “education” for “students.” The largest training institution for this level of training at present is the Association for Clinical Pastoral Education (ACPE).

    Level 3:

    A third level of chaplaincy is a specialization level extending beyond level 2. This level of chaplaincy posits the chaplain as a religiously-based - generically speaking - pastoral counselor and/or pastoral psychotherapist, but one who does not promote any particular religious sect. In this philosophy of chaplaincy the overt religious doctrines and various religious philosophies fall into the background, and the chaplain assumes a universalist posture. In this approach to chaplaincy the patient will not be aware, optimally, of what particular religious tradition the chaplain subscribes to, if any. This approach to chaplaincy, or pastoral care, gives attention solely to the patient and the patient’s predicament. Listening to the patient and attempting to reach a pastoral diagnosis, and to offer a therapeutic relationship is the principle burden of the chaplain. Such a pastoral diagnosis will transcend the doctrines of any particular religious tradition and function on a universalist level. The focus of attention is entirely on the patient. The training of chaplains in this modality is generally referred to as “clinical pastoral training,” following the medical model, as opposed to “education,” following the academic model.

    This approach to chaplaincy follows the philosophy and practice of Anton T. Boisen, who instituted clinical pastoral training early in the twentieth century. Boisen presented himself as a non-medical pastoral psychotherapist in the general tradition of Sigmund Freud. This level of chaplaincy is generally represented by the College of Pastoral Supervision and Psychotherapy (CPSP).

    ----------

    Raymond J. Lawrence
    CPSP General Secretary
    lawrence@cpsp.org

  • 29 Jan 2018 9:18 PM | Perry Miller, Editor (Administrator)



    Editor's Note: As we remember Dr. Martin Luther King, Jr., who with great courage, dignity and wisdom, fought against racism and its destructive forces on humanity, I encourage you to listen to this interview with Isabel Wilkerson, author of The Warmth of Other Suns: The Epic Story of America’s Great Migration. Listening to this interview, I hope will warm your heart with human compassion, as well as pierce your heart knowing the pain racism has inflicted. 

    Perry Miller, Editor
    perrymiller@gmail.com