A Book Review: 
Chaplaincy and Spiritual Care in the Twenty-First Century
An Introduction
Edited by Wendy Cadge and Shelly Rambo,
Chapel Hill, University of North Carolina Press, 2022

by Raymond J. Lawrence, General Secretary


This collection of essays just off the press purports to represent the current state of institutional chaplaincy in the U.S. The editors’ invitation to the Executive Director of the ACPE, currently the largest clinical pastoral supervision organization in the country, to write the “Conclusion” signals the alleged importance of this volume to institutional chaplains. The principal editor of this collection, Wendy Cadge, is described as “Professor of Humanistic Social Sciences” at Brandeis University. There is no mention of her direction of the Chaplaincy Innovation Lab, which is a curious omission since she has been, for some time, director of that enterprise that has taken on the mission of “transforming chaplaincy.”

After an examination of this volume, as well as earlier Cadge documents, it will be clear to the reader that this reframing or transformation of chaplaincy will consist of a radical overhaul of the role of the public chaplain and a complete repudiation of the foundation of the clinical pastoral movement of Anton T. Boisen exactly a century ago. For those committed to or have a stake in what Boisen created, this transforming chaplaincy movement of Wendy Cadge and company should be a call to arms.


The editors, Cadge and Rambo, inserted a dozen of what might be called brief side-pieces on random pages of this book. One of these inserts was a page-and-a-half written by Chaplain Ylisse Bess, entitled “A Hallway Encounter.” (pp. 6-7) Chaplain Bess is described as a chaplain at Beth Israel Deaconess Medical Center in Boston and surely owns one of the more idiosyncratic names in the English-speaking world. 

Chaplain Bess succeeds in capturing the heart of clinical chaplaincy beautifully in her own words. Essentially all she does is listen fully and attentively and with patience to an anxious Puerto-Rican/Afro-Latina nurse in the corner of a busy hospital hallway. And she does not rush. She demonstrates eloquently that pastoral psychotherapy can sometimes be done standing up, in a corner, and on the run. The troubled nurse herself seems, by her own description, to be in the throes, appropriately or not, of some degree of racially based panic. On the spot, Bess finds a quiet corner and gives her time, carefully listening, without a time boundary, and with deliberate eye contact and compassion, while this nurse unpacks her only marginally rational anxiety. Her anxiety seems driven by her experiences of hostile racism, which has led to her fear of getting vaccinated. By being accessible, carving out space in a busy hallway, and patiently listening, Chaplain Bess seems to have enabled this nurse to get hold of herself in short order and to control her somewhat but not entirely irrational fears of becoming a victim of impinging white supremacy, imagined or not. The nurse eventually departed with seeming clarity of purpose and with a decision to get vaccinated, which she had been resisting. With Chaplain Bess’ help, her marginal panic abated. Pastoral care, or as it should be called, pastoral psychotherapy, was performed in this instance while standing in a crowded hallway, and it doesn’t get much better than what is described by this chaplain. She seemed to know what to do and how to do it - and what not to do. This brief case consists of fewer than 500 words and yet bears more wisdom than all the rest of the words in this monograph of some 300 pages.

Nothing else in this collection of essays so well epitomizes the flexible and spontaneous psychotherapeutic role of the clinical chaplain. Chaplain Bess demonstrates that she knows her principal role is listening rather than talking, an injunction few chaplains these days seem to understand. In her brief contribution, Chaplain Bess was astute, clear, and edifying both for the patient and ultimately for the reader. Blessedly, she did not resort to pious platitudes, religious nostrums, or the worn-out and vacuous spirituality and prayer agenda. There was no need for Chaplain Bass to gild this lily.

Unaccountably, Ylisse Bess’s contribution is not listed in the book’s table of contents, nor does her name appear in the list of contributors at the end of the book. That is a regrettable oversight.


And now to assess the monograph as a whole. I should note here that I read this volume from a particular perspective, which was, of course, the perspective of a pastoral clinician embedded in the historic Boisen movement. That being the case, the only parts of the monograph that captured much of my attention, besides the piece by Chaplain Bess, were the “Introduction” by Cadge and Rambo and a two-chapter section following, entitled “Background and Content.” I also attended carefully to Part 1, Chapter 1, which Ronit Y. Stahl wrote, and entitled “Chaplaincy in the United States: A Short History,” and Part 1, Chapter 2, by Taylor Paige Winfield, entitled “Chaplaincy Work and Preparation across Sectors.” The remainder of the monograph did not seem relevant to the quotidian work of pastoral clinicians.

In the Introduction by the editors, Cadge and Rambo, they contend that the “Protestant theological educators in the 1920s started the CPE (Clinical Pastoral Education) movement.” This is not true. It is a gross and startling mischaracterization of the actual history. The founder of the clinical pastoral training movement was not a group of anyone but was singularly one, Rev. Anton T. Boisen, neither a theological educator nor a promoter of “education.” Boisen created clinical pastoral training out of whole cloth. He was not an educator but a clinician. His acronym was CPT, as in Clinical Pastoral Training, not CPE, as in education. Education and training may be similar and somewhat related, but they are also quite different. One goes to college or university to take classes and acquire an education and a degree. The other goes to a hospital, clinic, or parish to acquire skills through training while working with actual living human beings; this is a hands-on and idiosyncratic process of personal skill development. To confuse education and training, or to use the two as synonyms, as the later clinical pastoral movement has done, leads to great mischief. And the clinical pastoral movement today is rife with such mischief. 

Throughout the latter half of the century, CPE and CPT have unfortunately been reduced to interchangeable labels, obliterating the distinction between training and education. That blurring has left the wider clinical pastoral movement bereft of a coherent theory. And, of course, it has left the movement virtually in total ignorance of what Anton Boisen set out to accomplish. Education is not really what chaplains get when they enroll in an authentic clinical pastoral training program. Instead, they acquire personal skills to function as a therapeutic resource to troubled persons.

However, the editors of this monograph should not take the rap alone for confusing training and education, though they should certainly know better. That blurring well predated them. The seeds of confusion were sown by Richard Cabot early on, but the seeds did not flourish until Boisen was aging and declining in influence in the late 1940s. The total eclipse of Boisen’s heritage finally occurred in 1967, after Boisen’s death, in the formation of the Association of Clinical Pastoral Education (ACPE). This new umbrella organization merged clinical and educational as if they were one thing. Boisen’s clinical training regimen was reconstructed as the ACPE’s educational regimen. Language was used to deceive, not to enlighten. And Boisen was placed on the trash heap of history where he still resides, forgotten and unread.

Neither should the editors be held accountable for the equally perverse disorientation of the profession by the replacement of “pastoral care” with “spiritual care.” That radical shift occurred in 1999 under the informal leadership of Joan Hemenway. She was a bright young colleague and sometime-adversary of mine. She sold the clinical pastoral community on the thesis that “pastoral” was too Christian and needed to be put to rest in limbo, to be replaced by “spiritual.” Unfortunately, she succeeded grandly to the great loss of pastoral clinicians everywhere. Contra Hemenway, “pastoral” is not a Christian invention, as she argued, but is, in fact, deeply rooted first in Judaism and only later adopted by Christianity and Islam, each of the Abrahamic faiths. No writings are more pastoral than the Hebrew Psalms. 

Furthermore, Hindus and Buddhists should take no umbrage in a metaphor featuring a shepherd caring for sheep as a symbol of human beings caring for each other. We should all value shepherding and its derivative, pastoral, and pastoral psychotherapy as what we are called to do. It is a non-sectarian and universal metaphor for human and creature care of all sorts and in no way connotes an exclusive attachment to Christianity or any other religion. The claim that it does is entirely bogus. 

(Though well off-base on the contrived conflict between pastoral and spiritual, Joan Hemenway was a promising young leader who made other considerably more valuable contributions to the clinical pastoral field and died much too young.)  

Most troublesome is the fact that spirituality, pastoral’s replacement in the modern popular religious discourse, has no definition at all. It connotes at once both anything at all and nothing at all, an utterly useless descriptive in contemporary discourse. That spiritual meant something in bygone centuries counts for nothing today. In fact, spiritual was once long ago related to the adjective “enlivening.” Today, however, its closest connotation is “deadening.” Show me someone who wants to be known as “a spiritual person,” and I’ll show you a cookaroo.


In Chapter 1, Ronit Y. Stahl expands on and inflates the Cadge-Rambo error about the origins of the clinical pastoral movement with the assertion that Richard Cabot founded the clinical training movement with the help of Anton T. Boisen. (Apparently, the editors weren’t talking with Stahl.) Stahl got the origin story entirely upside down. I doubt she was standing on her head when she wrote that, but the effect was as if she were. Cabot was indeed a player in the origins of the Boisen movement. He was a great asset to Boisen, who was indisputably the creator of the movement. Cabot was Boisen’s first and principal supporter in the very early years, both financially and morally. However, Cabot detested both Freud and psychiatry, tauntingly referring to it as “sick-a-try.” That fact alone destined Cabot and Boisen for a major collision. And in the fifth year of their collaboration on the creation of The Council for Clinical Training of Theological Students (CCTTS), the train wreck occurred. Cabot moved to oust Boisen and seize the leadership role. Turning on Boisen, Cabot was not able to marshal significant support and withdrew. Boisen and the movement journeyed on without him for the subsequent decades.

Though Cabot was a wealthy Boston blueblood and an esteemed physician and teacher, who invented medical social work, he was strangely closed-minded as regards psychiatry and psychiatric patients whom he considered incurable. Thus, both Boisen’s commitment to psychiatric patients and his psychopathological history presaged that his relationship with Cabot was doomed from the start. 

Furthermore, Cabot’s view of pastoral work was incompatible with Boisen’s. He relished and promoted long and eloquent prayers to be said over patients. Put it concisely, Cabot promoted pastoral work consisting of chaplains praying and patients listening, a position in polar opposition to Boisen. The relationship was doomed; it could not survive. 

I do not mean to suggest that Ronit Stahl, in her error, has been disingenuous in any way. Unfortunately, there are plenty of false histories scattered around in the clinical pastoral movement, and Stahl has clearly fallen into the hands of one or more of them. The accurate— or more accurate— details of the Boisen-Cabot story are recorded in my monograph, Recovery of Soul: A History and Memoir of the Clinical Pastoral Movement. (2017).

Taylor Page Winfield, in Chapter 2, entitled “Chaplaincy Work and Preparation across Sectors,” provides a sociological survey of the wide variety of contexts in which chaplains serve, citing not only health care institutions but also the academic campus, transportation, fire departments, and law enforcement. Unfortunately, Winfield fails to note the organizational and ideological conflict that is the context of this volume. However, she cannot be faulted. No newcomer or bystander reading the rest of this monograph would have a clue that the context is a profound ideological conflict, a virtual war taking place. Winfield, in her innocence, even cites the College of Pastoral Supervision and Psychotherapy (CPSP) as presumably a legitimate entity, thus violating an established taboo in the in-group of Transforming Chaplaincy. 


The remainder of the book, the larger part of the book’s 320 pages, consists of nine chapters, 3 to 11, written by various authors. Those chapters are gathered into two separate groups, Parts 2 and 4. 

Part 2 is dedicated to delineating what needs to be done for patients by the chaplain. Again, the injunction seems to be, don’t just stand there, do something. Among the tasks that need to be done are…“meaning making and spiritual reflection…cultivating spiritual trust…cultivating interpersonal competencies, particularly competencies in spiritual care…and cultivating competencies in contextualizing power dynamics in socially just pastoral care.” 

This entire section sounds like a program to make patients into something new while not even bothering to listen to them. Anton Boisen surely would roll over in his grave if he heard all this. He did not carry to patients a laundry list of external agendas. Like Freud, he went to patients primarily to listen.

Part 4 consists of three chapters, the focus of which is the chaplain’s need for organizational competencies and to assist patients with the same. They are stated as: “Facilitating Resilience: Chaplaincy as a Catalyst for Organizational Well Being.”…  “Through a Multi-frame Lens: Surviving, Thriving, and Leading Organizations,” and “The Emotional Undercurrents of Organizations.”  This agenda seems to be designed to prepare patients to apply for the hospital’s chief executive officer position.

So, where is Part 3? The curious fact here is that Part 3 seems not to exist. A reader, like me, would likely think as I did that they missed something, that it was hidden somewhere in a footnote, or perhaps that his martini had been too strong. I concluded that Part 3 was missing in action. Was this an in-group prank played on the readers to see if they were awake and paying attention? Or is this a case of too many cooks at the copy editor’s table? Or did the copy editor at some point simply have too much wine at lunch? If anyone can find Part 3, please contact me. I paid for the whole book, and it wasn’t cheap!

The nine-chapter sections two and four are heavily dominated by academicians. Even the few who are said to have clinician credentials seem to be entirely in administration or didactic teaching. This is not a book where clinicians have a clear voice, except for one aforementioned Ylisse Bess. And the task of these academicians is not that of listening to patients. They ride certain bandwagons of spirituality, prayer, religion, and community organizing. I predict that the future half-life of chaplains in American public hospitals will be short indeed. The average citizen in this country will not put up much longer with chaplains salaried by public funds who seek to promote religion in any of its iterations. And I include spirituality in that category of religion as well, amorphous and undefined as it is.


At the book’s conclusion, there is a chapter entitled “A Commissioning” by Trace Haythorn, Executive Director of the Association for Clinical Pastoral Education (ACPE), and Jason Callahan, an instructor in patient counseling. Haythorn and Callahan declare that what is being commissioned here is more “evidence-based spiritual care.” Never mind that no one has defined what the evidence might look like, except perhaps that it is somehow related to spirituality, that oblong blur of a word with multiple connotations, including an embrace of ghosts and goblins. 

After posing the question, “Where do we go from here?” Haythorn then credits the John Templeton Foundation for providing the funds to create Wendy Cadge’s “Transforming Chaplaincy” initiative. That is a useful bit of new information, not previously noted in the text and, from my perch, not widely known. And it may be helpful in clarifying and assessing where “Transforming Chaplaincy” is headed. If Cadge succeeds in transforming chaplaincy a la Templeton, we should start digging its grave as deep and as soon as possible. Templeton has a long history of financing right-wing and reactionary religious projects. And in the face of Templeton’s multi-billion-dollar reserves, few have had the courage to stand up straight and speak the truth. In that connection, we should all applaud Professor of Philosophy Jason Stanley of Rutgers University, who had the temerity to say publicly, “I will not take any money from Templeton…or speak at any Templeton event.” Professor Stanley must be in a very small and select group of scholars who have publicly declared that they will not be bought by big money. (This was reported on the internet by Inside Higher Ed.)
As a related case in point, we all remember Templeton’s monumental “Great American Prayer Study” early in the current century, which attempted once and for all to prove scientifically that prayer actually cures physical illness. The study was supported by a Templeton grant of more than two million dollars and was directed by a distinguished Harvard professor of medicine, the late Boston physician Herbert Benson. This multi-year scientific investigation into the effects of prayer on hospital patients focused on a large number of select heart patients in several New York City hospitals. It enlisted a whole army of pious Christians, including a large contingent of nuns, who were directed to pray for hundreds of select patients by name, and, to remain scientific, not to pray for others in the control group. The researchers were confident that they would finally prove something significant about the power of prayer. When the statistical results were tabulated after several years of praying and data collecting, the summary numbers disclosed that patients in the control group of those not prayed for by this army of pious Christians had slightly better health outcomes than those who were. This was followed by a gnashing of teeth and vows to repeat the research project and get it right next time, which they never did. It was also followed by profound regret that millions of dollars were flushed down the drain as a result of such religious fundamentalism and investigatory naiveté.

Since Cadge’s “Transforming Chaplaincy” was and likely still is financed by the largesse of the Templeton Fund, it is not far-fetched to project that the efforts to transform chaplaincy will have results similar to the Great American Prayer Study.

In this last chapter, Haythorn also expresses regret that seminaries today have eliminated many teaching positions in the field of pastoral theology and that the Society for Pastoral Theology has recently lost two-thirds of its membership and has now barely one hundred remaining members. We fully concur with Haythorn that this trend is troubling, even alarming. But we surmise that replacing the identifying label “pastoral” with the label “spiritual” has contributed to the demise of “pastoral theology” that Haythorn and I both regret. “Pastoral theology” is entering a dark age where it seems likely to join the ghost of Boisen.

However, as in old Israel, a remnant does exist. It consists of those who still know what pastoral care is and what pastoral psychotherapy is. Of course, the two are simply different iterations of the same thing. We learned that from Anton Boisen and tangentially from Harry Stack Sullivan, Helen Flanders Dunbar, Wayne Oates, Myron Madden, and others. And we also witnessed it again in the work of the young chaplain, Ylisse Bess. 

But as for spiritual care, it pops up in many conversations, but no one knows quite what it is or what it looks like. And after years of Wendy Cadge pontificating about spiritual care, we still do not know what it might mean. And that’s a problem. 


Should you buy this book? I reserve judgment on that. If nothing else, it is an example of the complex, twisted and flawed history of the clinical pastoral training movement as it has evolved through the later twentieth and early twenty-first centuries. But on the other hand, rather than purchase the book, I suggest you go to the library and photocopy the two half-pages of Chaplain Ylisse Bess’ clinical report and paste the pages on your office wall for all to read. Then your colleagues, friends, adepts, and trainees might read about an example of current and authentic pastoral care in the Boisen mode. Perhaps, we can then hope that the reading might spawn a new golden age in pastoral care and pastoral psychotherapy like in the middle decades of the last century; if we can accomplish that, we will permit Anton Boisen to rest in peace. He deserves nothing less.


Raymond J. Lawrence, General Secretary



Raymond J. Lawrence, General Secretary
[email protected]




The author wishes to express appreciation to Cynthia Olson, Bill Scar, and the members of the Chapel Hill Chapter for vetting this report and proposing many useful edits. The author alone is responsible for the final result.

Please join us for A Town Hall Discussion: Re-focusing on the Boisen Tradition with Raymond Lawrence, General Secretary,
on Sunday, August 7 at 8:00 PM (Eastern) / 7:00 PM (Central) / 6:00 PM (Mountain) / 5:00 PM (Pacific). 

Visit our EVENTS page for more information and the Zoom link.