Palliative Chaplaincy at PACE

In 2009, Palliative Chaplaincy had not yet emerged as a specialty to be certified. Chaplains in a variety of settings had some occasion to provide Palliative Chaplaincy. Some settings call primarily for Palliative Chaplaincy. One setting that requires only Palliative Chaplaincy is a program called “PACE” – “Program for All-inclusive Care for the Elderly.”

PACE Centers work with people who are elderly, frail and poor. The goal is to keep them living in the community as long as possible. Besides spiritual support, PACE provides comprehensive care: medicine, social work, nutrition, transportation, and recreation.

PACE attempts to create the kind of natural community in which people care for one another through natural bonds. A Cambodian community in San Francisco, On Loc, provided the model. People who feel a sense of community tend to live longer. People who live independently tend to need less costly care. PACE promotes caring that makes good sense to everyone involved.

We call the people in the program “Participants.” The term “patient” implies passivity and denotes people to whom things happen. The term “participant” implies freedom of choice and denotes people in charge of their own lives. Our members participate in all phases of the program: d\Do I want to join? Do I want to come to the Center? How often? Do I want to join in any, some or all of the activities? 

The National PACE Association describes the average PACE Participant in this way:

In order to qualify for PACE, a person must be 55 years of age or older, live in a PACE service area, and be certified by the state to need nursing home-level care.

The typical PACE participant is very similar to the average nursing home resident.  On average, she is 80 years old, has 7.9 medical conditions and is limited in approximately three activities of daily living.  Forty-nine percent of PACE participants have been diagnosed with dementia.  Despite a high level of care needs, more than 90% of PACE participants are able to continue to live in the community.

http://www.npaonline.org/website/article.asp?id=50&title=Who_Does_PACE_Serve_

The PACE Center where I was Chaplain served Participants ranging in age from 58 to 101. Most chose to stay in the program until they died. This gave us an average of about 2.8 years to work with each of them. It also required us to deal often with death and bereavement.

The program was called “Finishing Well.”

The frail elderly we serve tend to experience their lives as in retreat: physical health wanes, mental acuity dims, social relations fade. Even those with strong family support tend toward depression and are tempted to despair. They may feel they are losing slowly the last battle, with death. They could see themselves Finishing Well the last phase of life.

PACE can help transform this worldview. Our colonial forebears called it Dying Well. I prefer “Finishing Well” to make clear to our generation what was obvious to theirs: the last phase of life is only partly something that happens to us, but also something we do, and can do well. The tasks of the last phase of life include:

Cultivating gratitude resting from labor reflecting on what “is very good” savoring an inventory of memories Making peace forgiving oneself forgiving others asking forgiveness, directly or symbolically preparing to meet one’s Maker Providing legacy passing on property to do no harm passing on stories as heritage family stories community stories Passing on character as blessing dispensing wisdom reflecting on life lessons distilling wisdom in story or saying Offering wisdom to those who will hear dying well arranging the Family Vigil tradition expressing the Last Words tradition

We may not help any Participant achieve all of these, but we can help every Participant achieve some of these.

We look pro-actively for opportunities, and work as a team, to fulfill the spiritual/religious component of our “all-encompassing care for the elderly.” As your Chaplain, I will serve you any way I can.

The Finishing Well program was well received by the Staff. National PACE Association selected it for presentation at the National Meeting in 2010.

To implement Finishing Well, I developed four programs:

I am like I AM– for individual spiritual care

Songs and Stories– for corporate spiritual care

Finding Meaning in Suffering- for end of life counseling

We Remember– for bereavement

While doing so, I began to wonder what programs in Palliative Chaplaincy were being developed at other PACE Centers across the nation. Were each of us trying independently to invent the wheel?

From the National PACE Association I obtained a listing of all PACE Centers in the country. (There were then 77, and are now 92). I e-mailed “Chaplain” at each Center. Results were spotty. I then e-mailed the Director of each site requesting the name of the person in charge of spiritual care. After several rounds of correspondence, about half the PACE Centers were found to have chaplains. About a quarter had someone else – a social worker, the compliance director, whomever – tasked with handling spiritual care in addition to their full-time responsibility. About a quarter provided no spiritual care to speak of, or at least mentioned none.

National PACE Association sponsors a Colloquy for each profession to promote collaboration and excellence. Through National PACE, I sent to all known PACE chaplains an invitation to share their best practices for palliative chaplaincy.

Several dozen “best practices” arrived. Some seemed a little sketchy. From those chaplains, I requested a program description detailed enough that another chaplain who valued the program could replicate it. I offered this framework for presenting best practices:

Dear Fellow PACE Chaplains:

Thank you each for responding. Having read through your ideas, it seemed helpful to find a way to order them. The definition of spirituality published in The Journal of Palliative Medicine offers a foundation:

“Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”

“Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference”

The Journal of Palliative Medicine, Volume 12, Number 10, 2009

This definition refers to meaning and belonging.

PACE can benefit Participants as much spiritually as medically. Many of our folks spent their days mostly alone, watching TV. As one of them told me, “Those people on TV talk a lot, but they never listen.” Coming to PACE can help Participants to have friends, community, and encouragement. Some lost fifty or a hundred pounds that needed to be lost. Some learn to walk again. They get a life.

Their experience in PACE can be described as

Getting a life (joining)

Living the life (participating), and 

Finishing their life (dying).

Combining this timeline with the definition of spirituality creates this structure for spiritual care:

Getting a Life Living the Life Finishing their life

Meaning: _____________ ______________ __________________

Belonging: ____________ ______________ __________________

In trying thus to organize the spiritual practices you so generously sent to me, I soon learned that I simply don’t understand them well enough to do this. Mostly, your responses listed spiritual practices without detail about how you do what you do.

Would you be willing to send me your best practices in detail? You can use the format above. You don’t have to detail all you do, just pick the few you think you do the best.

I will share the results with all known PACE chaplains.

Thank you! I’m looking forward to seeing the specifics of your best practices.

Blessings,

Fred

All submitted “Best Practices” were forwarded to all chaplains. Each chaplain could learn what wheels were rolling elsewhere, and innovate rather than invent to meet the need at their center.

I asked for volunteers to serve on a Selection Committee to select the best practices from among the submissions. Several chaplains volunteered. They considered several means of recognizing Best Practices. The first option would select a first, second and third place winner. This would make the adoption of standards a matter of competition rather than achievement, so was rejected. The second option would select a winner in each of several categories, such as Spiritual Assessment or Bereavement. This had the appeal of specificity, but the danger of becoming too fragmented, like the Oscars – “best supporting actress in a black-and-white documentary.” The third option would be to honor each submission that had sufficient detail to be replicated as a Best Practice. The committee met by conference call and selected options two and three.

St. Martin’s Cloak

A vigorous discussion ensued about what to call the Best Practice Awards. Etymology lifted the winner: St. Martin’s Cloak. In the IVth Century, a young Roman cavalry officer named Martin was entering the gates of Tours when he saw a freezing beggar. Martin cut his heavy crimson cavalry cape in half for the poor man. His act gives us our title as Palliative Chaplains.

He cloaks – Latin palliare– gives us the verb Palliate.

His cloak – Latin capella– gives us the noun Chaplain.

St. Martin’s Cloak was printed on tabloid paper (11x17). It looks like this.

National PACE Association framed and sent the awards to the chaplains who had developed the Best Practices.

The PACE Center where the chaplain worked usually arranged a formal presentation by a senior official, done in the presence of the Participants. This encouraged the Participants by knowing the spiritual care they were receiving was some of the best in the nation.

Hopefully, this also may encourage the senior officials to appreciate the value of their own chaplain in particular and the need for full-time professional chaplaincy in general.

Looking Ahead

Lessons learned from this project might include the following:

1. Collegial Collaboration improves the quality of palliative chaplaincy. Rather than inventing the wheel, we can innovate to adapt and improve proven designs. 

2. The Analytic Grid combining a standard definition of spirituality with phases of care could be useful in any institution – hospice, for example – that involves joining, participating, and leaving.

3. St. Martin’s Cloak could be extended to chaplains in other institutions or societies to recognize and encourage excellence in palliative chaplaincy. For example, the Virginia Chaplains’ Association is considering its use. Anyone interested is invited to contact me: fredpoorbaugh@stanfordalumni.org.

Palliative Care has become the first Board Certified Specialty for chaplains. Various certifying bodies are developing programs to that end. The College of Pastoral Supervision and Psychotherapy has in 2013 allowed Board Certified Clinical Chaplains working primarily in palliative care to earn Board Certification as Fellows in Hospice and Hospital Palliative Care.

As our population ages and technology improves, people will be living longer with chronic diseases. They will require palliative care. Palliative care was first recognized as a specialty for doctors only in 2006. Now, interdisciplinary teams of professionals certified as palliative doctors, nurses and social workers will need chaplains who are peers.

___________________________________________________

Frederick Poorbaugh

fredpoorbaugh@stanfordalumni.org

Following education in Philosophy (Stanford), Theology (Yale) and training in Psychology (Jung Institute), he spent ten years serving a dirt-poor parish (Appalachia) where God made him into something usable. Current palliative care tries to help patients in crises and at End of Life find meaning in their suffering.

He belongs to the Hampton Roads Chapter of CPSP, and is certified as Clinical Chaplain, Pastoral Counselor, and Fellow in Hospice and Hospital Palliative Care.

The more time I spend in the world of chaplains, the more I hear that the chaplain’s job is to “show up…(dead stop).” That’s it.

I continue to hear, “Our job is to just be there with them and be present to them." I lean forward expecting to hear more, but the punch-line has already been delivered. Needless to say, this phenomenon has seemed quite strange to me.

What I am more surprised of is that we expect to get paid for this. What other profession presumes that all they have to do is show up and they should be paid a decent middle-class wage?

Even more, when we hear the woes of chaplains who do not feel as though they are given enough authority and responsibility as part of the Inter-Disciplinary Team, there seems to be a cognitive dissonance of the highest order.

Picture this--perhaps the physician says, “Ok, chaplain. We understand that your feel that your work is very important. What will your role be on the team? What is it that you do with the patient?”

“Oh,” says the chaplain, “I plan to show up.”

Can you feel the expectant stares from the rest of the IDT? “What else, chaplain?” They all seem to wonder. (End scene.)

And if we were to show up and have all this responsibility and authority on the IDT, what would we use it for? If a world would be better if chaplains had more of a spot at the table, more responsibility and authority regarding the patient’s plan of care, how would we exercise that authority? Such a role would require an intervention and leadership, not just presence.

You likely are wondering, “who is this jerk writing this?” Well, maybe I am. Or maybe it is that our patients need more than presence. Maybe what they need is healing. But for us to bring them that, we have to risk something by going beyond mere presence.

I write this piece with only part of my tongue in my cheek because most of us chaplains have a 3-year masters degree. Many of us have done 4 units of Clinical Pastoral Training, perhaps completed a residency. Then, there is all the experience that many have beyond that formal training.

I have to imagine that it didn’t take 3 years of masters degree coursework (not to mention the 10’s of thousands of dollars), a year-long residency, and Lord knows what else you have laid at the altar in order to become a chaplain—you didn’t have to do all of that just to learn how to show up.

I propose that we put a moratorium on saying that all we do is “just show up.” That is absolutely something that we do, and we do that much better than other professions precisely because we have been forced to deal with our own “stuff.” But what I am really curious about, where I want the dialogue to go, is “what do we do after we show up?” “How do we bring healing to people in deep pain?” “How are their (and our) lives transformed?”

I think we would be surprised to uncover that a lot of us are already doing it; we just aren't talking about it.

________________________

Matt Rhodesis a chaplain resident at Capital Health in New Jersey. He is a graduate of Princeton Theological Seminary and was recently ordained to the Ministry of Word and Sacrament in the Presbyterian Church (USA).

Currently he is enrolled in Doctorate of Psychology in Clinical Pastoral Supervision with The Institute for Psychodynamic Pastoral Supervision.

matthew.m.rhodes@gmail.com

The Rev. Doctor Steven Voytovich, a CPSP Diplomate in Psychotherapy and Clinical Pastoral Supervision, was recently appointed dean of St. Tikhon’s Orthodox Theological Seminary, effective August 18.

Bishop Michael, Ph.D., Rector of St. Tikhon’s Seminary and Bishop of the Diocese of New York and New Jersey, made these comments:

“I am well pleased that Fr. Steven will be joining St. Tikhon’s Seminary as our Dean. His pastoral, leadership, academic and work related credentials are superb and we look forward to Fr. Steven moving St. Tikhon’s to new heights. On behalf of the board of trustees, faculty, staff and students we welcome him and offer our prayers for his new ministry.”

When the Pastoral Report made contact with Dr. Voytovich about this development he remarked:

"This represents a new chapter in my vocational journey that I am excited about, including some dimension of clinical training in the Orthodox Church that I have represented in the greater pastoral care and counseling community for fourteen years.

Though I attended St. Vladimir's Seminary for my own theological formation, this represents a form of a homecoming to bringing my chaplaincy journey to be accessible to those preparing to serve as pastors."

St. Tikhon’s Seminary appointment of Dr. Dr. Voytovich whose major professional strengths are in the clinical pastoral care and counseling field is refreshing.

We of the College of Pastoral Supervision and Psychotherapy wish both Dr. Dr. Voytovich and St. Tikhon’s Seminary well in this new and exciting partnership.

Perry Miller, Editor

Steven Voytovich can be contacted at: voytsc@earthlink.net

After retiring, in 2011, as a chaplain at Boston Medical Center, I was later rehired to provide coverage, as needed, for the present chaplains. My most recent work led to an encounter with a person that brought to the fore the transforming power of human love. The interaction was not with a patient, but with a staff person.

She is a white woman, about to retire after many years of service to the hospital. As we reminisced about our relationship over the years, she said, “Would you like to see a picture of my new granddaughter?” “Sure,” I replied. With that, she took an album from her purse, and proudly showed me photos of a beautiful little black baby. She then handed me pictures of her white daughter and black son-in-law. As I admired the photos, she lovingly said, “Mixed children are beautiful.” I enthusiastically agreed—marveling at the power of her love that transcended the once- traditional non-black enclave in which she lives.

This proud grandmother reminded me of certain retired ministers in the New England Conference of The United Methodist Church, who, in 1998, formed a Conference-wide group called Reconciling Retired Clergy—with their number growing to 100 over the years. Their mission: to work for the full inclusion of lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) persons in the life of The United Methodist Church. It meant challenging The Church’s Book of Discipline’s belief that “homosexuality is incompatible with Christian teaching.” They supported ministers who were brought to church trial for being gay or lesbian, and those brought to trial for performing same-sex marriages. They also began performing same-sex marriages, and called for the ordination of LGBTQ persons. Their work, and that of other reconciling ministerial and lay groups in Methodism, has made performing same sex marriages more tolerated. They have helped to turn United Methodism’s exclusionary policies into a state of flux, with their influence also seen in several United Methodist bishops now openly challenging the Church’s anti-homosexual doctrine—enabled, no doubt, by the influence of same sex marriages becoming legal in several states.

What led some of these Bible verses-influenced, culturally-conditioned, United Methodist Book of Discipline-believing ministers to change their minds? In time, certain of them discovered that they, themselves, had a son who is gay, or a daughter who is lesbian—or the son or daughter of a relative, or ministerial colleague, or family friend. The issue had hit home—or close to home. It was now about bonding, not The Bible or The Book of Discipline. Their heart told them that sexually “mixed children are beautiful .” Just as “beautiful and loved and worthy and creative and moral as any other child—or adult. 

Appreciation is expressed to friend and colleague Rev. Richard E. Harding, founder of the New England Conference’s Reconciling Retired Clergy, who contributed information for this article

___________________________________________

Bill Alberts, CPSP diplomate and member of the Concord, NH chapter, was a hospital chaplain at Boston Medical Center from December 1992 until he retired in July 2011. His book, A Hospital Chaplain at the Crossroads of Humanity, based on his visits with patients at BMC, is available on Amazon.com. An occasional contributor to Counterpunch, the ramifications of the gay marriage he performed at Boston’s Old West United Methodist Church in 1973 are detailed in “Easter Depends on Whistleblowers: The Minister Who Could Not Be ‘Preyed’ Away,” Counterpunch, March 29-31, 2013) The photograph is of Bill and his almost two-year-old granddaughter, Aoife.

Email: wm.alberts@gmail.com

NCTS-West is just a month away. We are pleased to announce that Jack Lampl and Charla Hayden, international leaders in group relations theory and practice from the A.K. Rice Institute, will be presenting and consulting to the September 8-10 seminar in Citrus Heights, California, just outside Sacramento.

Those who attended the 2013 CPSP Plenary in Las Vegas have already met Jack and Charla. Jack is the president of the A.K. Rice Institute. Charla is co-author of the foundational introduction to group relations process, The Tavistock Primer.

This NCTS will be especially valuable to new Chapters and those looking to improve their chapter life, as well as to those involved in offering training such as CPE supervisors and SITs.

Registration is limited. Register at: http://copsap1.wildapricot.org/events?eventId=693207&EventViewMode=EventRegistration

-David Roth

_______________

For more Information: -David Roth

Francine Hernandez, NCTS-East Coordinator, announced that the National Clinical Training Seminar-East will meet Nov. 11-12, 2013 at San Alfonso Retreat Center, Long Branch, New Jersey. She encourages all to mark these dates on your calendar and plan to attend.

Check back with the Pastoral Report for further information as it becomes available. 

For additional information, contact Francine Hernandez, NCTS-East Coordinator.
fhernand@ehs.org

On June 20, 2013 Frederick Memorial Hospital and the Pastoral Care Department hosted Clinical Pastoral Education (CPE) day, sponsored by the Baltimore Chapter, College of Pastoral Supervision and Psychotherapy. Approximately thirty six participates attended from four accredited CPE sites and two satellite centers attended. 

Also participating was a 50 hour Clinical Pastoral Orientation program at Western Maryland Hospital Center led by the Rev. Richard Bower.

The morning presentation was Responding When the Family Wants a Miracle, Presenter: Phil Pinckard, Chaplain, Meritus Medical Center, Hagerstown, MD . The afternoon presentation was The Ethics Committee as a Venue for Pastoral Care, Presenter: James Michaels, Director of Pastoral Care, Hebrew Home of Greater Washington, DC . The morning and afternoon presentations were followed by 90-minute small groups of students, diplomates and supervisors-in-training in which students presented case presentations.

Kay Myers, PhD
Director, Pastoral Care Services
Frederick Memorial Hospital
GMYERS@fmh.org

The Institute for Psychodynamic Pastoral Supervision ) met for its second annual Summer Intensive week of study at Avila Retreat Center in Durham, NC. Present were the four faculty members: David Franzen, Joel Harvey, Cesar Espineda, and Mac Wallace, four doctoral student in the first cohort, and five doctoral students in the second cohort. These students are enrolled in the Doctor of Psychology or Doctor of Ministry degree program in pastoral supervision offered by IPPS and the Graduate Theological Foundation (GTF).

The first cohort of doctoral students focused on cultural understandings and misunderstandings that are inevitable working with international and intercultural students. The second cohort focused on understanding and using Tavistock methods of group leadership. Additionally, the daily Group Relations Seminars involved both cohorts and the faculty members. These were rich and intense sessions that provided the participants an opportunity to work with some intimate, interpersonal dynamics along with consultation from the faculty.

Following this Summer Intensive Week of Studies, each cohort will meet weekly for 2-hour videoconferences for 16 weeks in the fall semester and 16 weeks in the spring semester. These classes will use classical texts and case studies to study psychoanalytical theories of human development, theory and practice of psychodynamic supervision, theological integration, and will emphasize the integration of theory and practice.

The first cohort will complete its coursework with IPPS in May of 2014. Then they will take a prescribed course of studies with GTF and complete their doctoral project with materials they will use to present for certification as a Diplomate in CPE/T supervision. The second cohort will have its second Summer Intensive week of study in August of 2014 along with a group of new students to be selected for the next (third) cohort. Applications are currently being received for the third cohort, and the deadline for these applications is June 1, 2014.

The IPPS and GTF doctoral degree program began as a dream of David Franzen, the late John Edgerton. The Chapel Hill chapter and provides doctoral students a constant source of support and consultation. After several years of planning, it has become a reality, and the chapter continues to provide consultation for the faculty around student selection and curriculum development along with assistance with review of applications for admission. Interested applicants to IPPS should contact Dr. David Franzen, 12 Winthrop Court, Durham, NC 27707; phone, 919-493-7177; email, drdavidfranzen@gmail.com. 

____________________________

H. Mac Wallace, D. Min.
CPSP Diplomate
Board Certified Marriage and Family Therapist and Clinical Supervisor
hmacw@yahoo.com

I never would have believed I would be grateful to see a hand rail beside a toilet seat. Or feel cared for by a woman’s voice somewhere in telephone never never land instructing me on how to fix my TV. Nor could I have imagined the comfort felt in a nurse’s touch. 

Such are the surprises when you fall and break your hip. Surprised by facts you knew long before but which must be lost and found again and again. 

Six weeks after the “accident” it is hard to write about what happened, difficult to visit the scene, and remember again the details. It is nothing that dramatic really- a fall on the cement walk resulting in a clean break in the hip. Far worse things befall us. Nevertheless there is a darkness about it, images the mind resists. It is as if your system has been frightened and is trying to protect itself, still wanting to be done with the whole thing. Put it all out of mind. 

Coupled with this reluctance, however, there is also the embarrassment of it all, the difficulty of facing the fact of your own carelessness. One old man in a rain storm on a step ladder. Could disaster be far off? It will be referred to as an accident but in your own mind you know it wasn’t; it was carelessness. And however many times you go over the details the end of the story is always the same. So you put on your hair shirt and beat yourself up about it. 

But time passes and if you watch there are other moments, openings that arise as if by chance, that will not be sent away.

By good fortune Norma was able to get me gathered up off the walk, into the car and to the emergency ward where the system worked –chaotically but superbly. In retrospect we should have called an ambulance but we didn’t. Within 24 hours, however, I was through surgery and repaired -pin, plate and all, forever after able to set off the beepers at security and give all the little folk in charge reason to be suspicious and feel useful. A live 77 year old terrorist. Even more fortuitously after a few days the hospital needed my bed and it was suggested I be shipped out to a physio program. Done. And here I am home -all in just over 3 weeks, getting better. Recovering to some state of normalcy will take longer but it will happen.

I wouldn’t recommend the experience to anyone but now that it has happened and I have time to reflect on events there are stories to be told. There are three that I would share with you.

1.Throughout the hospital stay and since then, besides expert medical attention, perhaps the most reassuring aspect of the treatment was what I would term the intimacy that prevailed at unexpected moments. That is to say nurses, doctors, physios, family members, yes and the cleaning lady and the barber, were able to come close, speak and most importantly touch, in ways that lifted the spirit. 

The young doctor in the emergency room who came close, put his hand on my shoulder and looked me in the eye and said “I think it’s broke but we will make sure and fix you up”, the nurse in the night who stood by the bed and rubbed my arm and asked what I needed, visitors who sat near my bed, hand outstretched to stroke my hand, the presence of my family –confirmed what I had known and talked about and even tried to teach but now knew as if for the fist time. 

When you are lying in your bed in the night, troubled by what has happened and wondering how healing will occur, when you can’t take care of basic functions on your own and there is no alternative but to call for help, it seems to me you are returned to a state of early childhood. Certainly you are afraid, feel alone. One of the things that occurs on the battlefield is that a wounded soldier will be heard to call out for his mother. I don’t want to suggest that my state was near that severe but something of the same atmosphere prevailed. The usual layers of protection, bravado, assumptions about one’s dignity, were peeled away and like an infant in the arms of its mother I was grateful for a nurse stroking your hand and calling me by name.

2. Soon after discharge from the physio program there was a dinner to which we had been invited honoring a friend for her accomplishments in the community. There was some doubt I would be mobile enough but, with a walker and some caution, we loaded up and departed. I should say that in an event like this suddenly little things assume an importance you don’t realize under normal conditions. Getting over a door step, up a stair or two and above all, navigating toilets become issues. How do you go to the toilet with some degree of dignity? The basic issue is how do you lower yourself onto a toilet seat and then raise yourself from it. Under normal conditions nothing to it. But in a public washroom with your pants at half mast and your hip complaining bitterly and with no nurse to give you a hand it’s different.

As we entered the dining facility I at once took note of the toilet signs and decided to check things out to be on the safe side. It was with relief when I managed to get through the door and encountered a spacious room in which there was situated four toilets, one of which was reserved for wheel chairs. More than that in the wheel chair stall there was a toilet, raised a few inches higher than normal, beside which there was anchored a hand rail. How lovely is thy dwelling place, O lord of hosts. Under normal conditions such things don’t register, objects of interest in someone else’s world, but now you see them in a whole new light. With a handrail you can sit down with some confidence and in time raise yourself up, find your balance, and restore yourself, your pants in place and your dignity intact. 

3. The first evening after arriving home I was all set to watch a football game only to discover that the TV was on the fritz, the settings out of order. There was no alternative but to phone the satellite company and get help. At the best of times this can be an ordeal. To begin with you often make contact with someone on the other side of the world whose English is often on a par with your ability in their native tongue. Or, equally difficult, you are greeted by a computer geek who speaks computerese well but English is quite another matter. 

To my delight, akin to seeing a toilet with a hand rail, I was greeted by a woman’s voice, middle age I would say and who I could understand perfectly. She asked a question or two and then said to go to the machine and turn off the power. I told her she would have to bear with me as I had just returned from hospital with a broken hip and movement was an issue. As if she had just graduated from a course in pastoral care she stopped and asked what had happened, a note of concern in her voice, and went on to enquire as to how I was and to reassure me that I would not have to move again. She didn’t know what she had done and I did not try to tell her. 

So what am I to conclude from all this? I could wax eloquent on the meaning that lies here. The theological openings, the opportunity to put in a good word for God, are endless. But I will spare you that. Rather I wish to express gratitude for friends and family, for professionals with a job to do, who were there, able to come close and touch and give expression to that inexpressible other that lies between us.

______________________

Ron Evans is a CPSP Diplomate living in Saskatchewan, Canada is a a published author. He has frequently presented his poetry and prose at meetings of the CPSP Plenary as well as contributed articles for publication in the Pastoral Report.

The following are two of his recent book publications:

Coming Home: Saskatchewan Remembered

From the website: 

The Prophetic Voice is always in our midst. It calls us to reach for action and peace - to sustain that which brings us hope, well-being, dreams, and renewal.  Like a seed caught in the wind - quiet and inconspicuous. It may be in disguise and mistrusted, yet it endures the foul weather and seasons to prove true. When acknowledged, it grows into a wise tree to shelter, nourish and teach us.

(The 2013 logo represents this quieted seed.)

Regardless of faith tradition, Pastoral Care Week celebrates those who provide pastoral care to others. It is endorsed by the Congress on Ministries in Specialized Settings (COMISS), whose members provide pastoral care in specialized settings such as hospitals, prisons, businesses, industries, long term care facilities, pastoral counseling centers, hospices, military settings, nursing homes, congregations of sisters, priests and brothers, schools, universities, and seminaries throughout the world. CPSP is a proud member of COMISS.

Educate your community, colleagues, institutions and friends - many resources, including governmental proclamations, artwork, seminars and merchandise, are available for local celebrations. For more information, visit www.pastoralcareweek.org.

*The last date for ordering is this weekend - September 13th! Make your plans today.

_____________________________________

Chaplain Linda Walsh-Garrison
revlindawalsh@yahoo.com

We are excited about the fall meeting of the National Clinical Training Seminar-East on Nov. 11-12, 2013 at San Alfonso Retreat Center, Long Branch, New Jersey.

Our is presenter is Dr. Dwight Sweezy. He is a Diplomate with CPSP and a member of Princeton Chapter. Dr. Sweezy is an ordained elder Free Methodist Church of North America. He has 12 years of parish experience. He holds a Master of Divinity from Asbury Theological Seminary and a Doctor of Ministry degree from the Graduate Theological Foundation. He attended a Summer Theology program at Oxford University. Ten units of his CPE training was in two mental health settings. He recently retired as the Director of Pastoral Services, Trenton Psychiatric Hospital (33 years). There he developed a dynamic equivalent clinical pastoral program that has become a CPE extended resident program. He continues to supervise CPE Training Residents and Supervisors-in- Training. He is a retired US Army Reserve Chaplain (L TC) – 26 years. He is married to his high school sweetheart, Linda, who is a retired ordained United Methodist minister. For fun, he likes motorcycling, sailing, camping SCCA Solo racing, reading and bicycling.

For three years, Dr. Sweezy served as a consultant for the supervisors in training at Episcopal Health Services, Inc. Far Rockaway, New York.

As always, the National Clinical Training Seminar-East is a working conference built around psychodynamic small group process. Participants are to bring clinical work and life material for reflection and review with in the group process.

Click here for additional information and online registration.

Please make your plans to attend as together we address the theme: Mental Health Issues Impact Pastoral Care.

http://www.cpspoffice.org/the_archives/2013/08/national_clinic_11.html#

We faced another crisis in the Middle East as we recently marked 9/11 -- with outcome uncertain.

Last month I attended the dedication of a labyrinth I helped to build. Afterward, the pastor invited me to his Friday morning service when I told him I liked small churches (mine has 12,000). As we few men gathered the word "shul" popped into my head along with the memory of a dimly-lit room where I formed minion for two Jewish friends.

I value Sacramental reconciliation and religious practices such as Yom Kippur and labyrinths that aid inner healing. We can help people with spiritual healing by accepting the efficacy of their own reconciliation, in words and in silence. A few years ago I found a kind of inner healing in my first labyrinth and visiting the grave of my fallen brother in France. We each heal differently. To require a standard of silence or word reconciliation could mean judging others who may already harshly judged themselves. The only standard for a labyrinth is in its own construction, not what goes on inside the person who walks it. I would like to become a conduit like that.

As for the use of words, I rationalized my shul memory by retrieving an old review of Walker Percy's The Thanatos Syndrome: "Perhaps the single most important idea in Percy's epistemology, expressed again and again in his essays and interviews ... is his conviction that impoverishment in the power to name experience causes a subsequent impoverishment of consciousness ... since it is only through language transactions with others that the self locates who and where it is."

Percy struggled with unresolved loss for many years, as I did. Nations, too, struggle with grief and loss, as we did after 9/11 and still do after two long wars in the Middle East. If as individuals we struggle to name our experiences, we also struggle as a nation in our attempts to reconcile our losses. We use words and the silence of our being to locate ourselves among other "living documents" to whom we minister. I pray that nations will continue to do the same.

_________

Dominic Fuccillo is a CPSP Clinical Chaplain in Littleton, Colorado. Josefina's sculpture has been placed in the ruins of Coventry Cathedral and copies are in the Hiroshima Peace Park, among other locations.

Tolerance and Encouragement: Making Room for Divine Presence – instead of “Paging” Him or Her Interfaith? Multi faith? Engaging Others in Their Faiths

Robert Charles Powell, MD, PhD

care, counseling, and psychotherapy 
become “pastoral” – or even “theological” – 
when there is “trialogue” – 
when the discussion between a clinician and 
a suffering, bewildered, or vulnerable soul 
allows enough silence for both to 
be aware of divine presence and
be open to divine insight.

Such was the view of Wayne Edward Oates, PhD (1917-1999), a fascinating chaplain who knew the works of Sigmund Freud as well as he knew the books of the Bible. The notions of “interfaith” and “multifaith” chaplaincy probably did not mean much to him. Certainly the Rev. Dr. Oates worked with those who did not share his religious tradition – yet I have trouble believing that he would have considered such care, counseling, or psychotherapy as either “interfaith” – focusing on commonalities – or “multifaith” – focusing on differing beliefs. His work with others just “was” – just was work valued by both. Whether it was the chaplain who made room or it was the patient who made room for the Deity probably did not matter much to either of them – as long as there was “trialogue” – as long as there was Divine Presence in the midst of their work.

In a nutshell, this is why I have very mixed feelings about the recent book, Paging God: Religion in the Halls of Medicine, by sociologist Wendy Cadge, PhD. She is able to observe clinical chaplains trying quietly “to … create … sacred spaces …” in their work. She is able to observe hospital chaplains trying to assist “people at their most vulnerable” times. However, throughout the book, she somewhat scornfully rues the day that clinical pastoral chaplaincy was wooed down a bland interfaith path while she half-heartedly envisions that medically-immersed chaplaincy might embrace a multifaith approach. It is hard to be sure whether she does or does not respect professional chaplains – and one is left with the lingering suspicion that she does not. It would appear that she views professional chaplains, in their efforts toward political correctness, as having created the bureaucratic morass in which they now frequently find themselves. Furthermore, rather than respect that clinical chaplains are embedded within specific religious traditions, she would re-embed them within large (usually secular) universities having schools of medicine, theology, and public health, modeling their training and education more along the lines of that provided in nursing and social work. Only vaguely does she appear to recognize that financial issues have channeled – and still channel – the nourishment of professional chaplaincy.

Cadge’s comments reflect, unfortunately, an almost entirely “New England Brahmin” view of the world – a fact of which she appears quite unaware. There is much not to like in this book – and I cannot really recommend it – but its wrong-headedness does stir up some thoughts. The good news is that the core chapters of the book are reasonably well-written. The bad news is that the two ends of the book are not. For me, bad grammar is distracting – as is voluminous name-dropping. “ ‘Paging’ God?” I certainly hope that the Deity – whatever one calls Him or Her – does not have to put up with the generally nerve-grating squeal of a pager. The title’s mildly sacrilegious tone did bother me. It is altogether another matter, for example, in my opinion, to have the gentle tingling of bells respectfully invite and welcome Divine Presence.

Cadge’s book – intentionally or unintentionally – does end up framing the question of “interfaith chaplaincy” versus “multifaith chaplaincy” – or of the two versus “none of the above”. She chronicles the efforts, within the interfaith approach, to avoid offending anyone by emphasizing somewhat generic-content “spirituality” in contrast to emphasizing this or that specific-content religion. She also notes the rareness with which, within the multifaith approach, the beliefs and practices of different theological traditions actually are engaged.

Some might say that hospitals tend to become more “real” in the wee hours of the night, as healers and those hoping to be healed are

thinking and feeling together about
the things that matter most, …
[coming] through with
a deepened sense of fellowship and
a religious faith which …
[comes] alive for them.

Those, of course, are the words of Anton Theophilus Boisen (1876-1965), founder of the movement for professional chaplaincy. Cadge, too, suggests that, when most of the chaplains have left for the day, interfaith and multifaith concerns seem to fall by the wayside, as those of differing beliefs live out their individual religious commitments – usually with others’ tolerance and encouragement. The question remains: Has not much of professional chaplaincy, in allowing a growing emphasis on an areligious, secular, “meaning-making” notion of “spirituality,” ended up creating a clinical environment that “glosses over rather than engages religious differences”?

Making “space for one another,” as “The Covenant” of The College of Pastoral Supervision and Psychotherapy encourages, is one thing. Standing “ready to midwife one another in our respective spiritual journeys” – as it also encourages – is a bit harder – and something else. Can clinical pastoral chaplaincy move beyond “interfaith” and “multifaith” toward actual engagement of our brothers’ and sisters’ faiths – back, truly, to Boisen’s “thinking and feeling together about the things that matter most”?

Endnotes:
The following are the bibliographic details of the cited items:
The reference in the opening highlighted comment and in the first paragraph is to 

Wayne Edward Oates, The Presence of God in Pastoral Counseling (Waco, TX: Word Books, 1986). See also, Robert Charles Powell. “Calling Wayne Oates! Southern Baptist Theologues Need You! Letter to the Editor of the Pastoral Report.” 24 Feb 2005.

http://www.cpspoffice.org/the_archives/2005/02/calling_wayne_o.html 

The reference in the second paragraph is to Wendy Cadge, Paging God: Religion in the Halls of Medicine (Chicago: The University of Chicago Press, 2012); the specific citations are to pages 76 and 201.

The highlighted comment in the fifth paragraph is from Anton Theophilus Boisen, Out of the Depths: Autobiographical Study of Mental Disorder and Religious Experience (New York: Harper & Brothers, 1960), pages 179-180. The Cadge citation at the very end of the paragraph is from page 196 of her book.

“The Covenant” can be found at http://cpspoffice.org/covenant.html .

See also, Robert Charles Powell, “Religion in Crisis and Custom: Formation and Transformation – Discovery and Recovery – of Spirit and Soul.” 

http://www.icpcc.net/ [click on “Materials”]; 

http://www.cpspoffice.org/the_archives/2006/01/formation_and_t.html#

http://www.cpspoffice.org/the_archives/Formation%20and%20Transformat.pdf 

(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”;

http://www.metro.inter.edu/facultad/esthumanisticos/coleccion_anton_boisen/case_study/Religion%20en%20Crisis%20y%20en%20Costumbre.pdf .)

______________________________

Robert Charles Powell, MD, PhD is the leading historian of the clinical pastoral movement. Many of his published writings are posted on the Pastoral Report. Readers can use the PR's search engine found on the left side-bar to locate his articles. As a practicing psychiatrist, his writings reflect his daily investment in his clinical practice of providing psychotherapy and care to his patients. Contact Dr. Powell by clicking here. 

Orlo C. Strunk, Jr., Ph.D., former Managing Editor of The Journal of Pastoral Care and Counseling (JPCP) died September 24, 2013.

Dr. Strunk's contribution to and leadership in the clinical pastoral field was considerable.

In April of 2011 the College of Pastoral Supervision and Psychotherapy (CPSP) honored him with the prestigious Helen Flanders Dunbar Award with Dr. Robert Charles Powell, MD, PhD presiding over the occasion.

The Pastoral Report published Dr. Powell's presentation. Embedded in the following remarks was Dr. Powell's keen observation and appreciation of Dr. Strunk's uniqueness and ability:

To say that our honoree has been open to new ideas – and new ways of knowing – about a great number of things – would be an understatement. A “comprehensive and authentic understanding of religious experience and behavior requires a broad and inclusive kind of perspective.” Specifically, today’s honoree has discussed, with courageous persistence, open-mindedness versus closed-mindedness within the fields of religion and psychology, as well as concern about an uncritical/ unexamined acceptance of the Zeitgeist and various “isms”. Complexity, in this view, should be embraced, not avoided or rejected. “After all, there is no such thing as a unified psychology; and certainly to think of religion generically strains credibility. What we have, of course, are psychologies of religions.” Thus the newest Dunbar honoree, with courageous persistence, promoted and defended the formulation of new views, even if these were not popular. An episode ten years ago especially stands out, but there were others: an early book [1982], for example, was dedicated to “those adversaries who unwittingly reminded” today’s honoree of a core value – privacy. 

For many of us in the CPSP community and beyond take heart in Dr. Powell's assertion that Orlo C. Strunk ... with courageous persistence, promoted and defended the formulation of new views, even if these were not popular.

Perry Miller, Editor
Perry Miller, Editor
PASTORAL REPORT

UPDATE: Hundreds of survivors were moved to Manila, where the local churches are now overwhelmed. They quietly lament “we have lost everything”. There was a report of a woman whose family members survived Haiyan, the worst typhoon on record; but then later died from starvation. The little island they lived on was completely devastated and no help arrived in time to bring them food or water.

Our CPSP colleagues have been training chaplains in Baguio to be ready to go to Manila to provide support. The needs are endless.

Many generous donations have been coming in and we thank those who have already donated but we need additional support. Please consider sending a donation today. Any amount you can afford will make a BIG difference.

The New Amsterdam Chapter, New York with the Philippines team is committed to bringing help and healing to our typhoon Yolanda (Haiyan) survivors. 

_____________________________________

Relief For The Philippines

The stories coming out of the Philippines are unimaginable. Rushing water and wind tearing children away from their parents' arms. 

Haiyan was one of the most intense typhoons on record. This storm left catastrophic and unimaginable destruction behind.

Emergency Support

The New Amsterdam Chapter is organizing a relief effort along side our CPSP Philippines colleagues. The CPSP Philippines will distribute funds collected along with non-perishable items to the places where they are most needed.

The New Amsterdam CPSP Chapter requests your assistance by donating canned goods, clothing, toiletry items (shampoo, medical supplies, etc.), along with cleaning supplies, learning materials for children, or monetary donations.

Please bring or mail clothing, and non perishable items to:

Questions? Call Barbara at: 516-316-5629

All checks need to be made out to:  CPSP (Philippines Relief Fund)

Mail checks to:

All donations are greatly appreciated and will go directly to the people via our CPSP Philippines colleagues.

Thank you!

The New Amsterdam Chapter: 

Barbara A. McGuire, Cesar Espineda, John Jeffery, Geof Tio, Susan McDougall, Sergio Manna

Barbara A. McGuire
barbara.a.mcguire@gmail.com

Clinical Chaplaincy is relational, neutral and non-judgmental. It is a patient centered approach in keeping with the person centered model as advocated by Carl Rogers, integrating the arts and sciences relative to psychodynamic theory in pastoral practice.

Around any illness is a collection of stories. The chaplain endeavors to be present to the patient as a fellow human being, as the patient’s stories unfold; bearing witness to the patient’s dilemma- not judging the patient for what they say or how they choose to express themselves. This narrative approach places the chaplain in the unique role as the interpreter of metaphors, assisting the patient in making the connections to their story.

At times these stories are confessional in nature, as a patient, through narrative seeks to reconcile themselves with the life that they have lived. At other times, the stories they relate represent more a review of their life inextricably interwoven with finishing the business of living.

Consequently, clinical chaplaincy is a patient centered narrative approach. Integral to that, is the patient’s family. Working with the stories that patients and families share, the clinical chaplain can begin to assess how the family approaches illness, and in particular, this hospitalization.

The Clinical Chaplain also assesses how the patient utilizes their religious experience or their philosophy of life as a means of support as they seek to come to terms with their diagnosis and its attendant ambiguities of living each day.

Extensive clinical training and a proactive integration of the social sciences, especially in the fields of counseling and psychotherapy is essential to the work of the Clinical Chaplain. 

George Hankins Hull, Dip.Th, Th.M.
Director of pastoral care and clinical pastoral education at UAMS Medical Center. He is a Diplomate in the College of Pastoral Supervision & Psychotherapy and a board-certified clinical chaplain.
JHull@uams.edu

Now "hear" this... The issue is not about getting too comfortable. The issue is so impressive upon our consciousness that we must ease into it and take a bit of a circuitous route.

Cyber technology and social media have conspired with some practical constraints to stimulate numerous changes in the practice of psychotherapy. Many people expect, or are prepared for, different dynamics from professional helpers than the usual 50 minute hour in an office that is rather emotionally plastic, even if the seating is wool and leather. There are movements to involve active computer interaction and diagnosis, as well as remote treatment, such as using Skype, etc. Insurance companies and clinical ethicists are striving to provide guidelines that are economically self serving and avoid undue liability. And of course, this is all in the name of providing the best care to patients and clients. Oh, Sigmund...

I have always delighted in the fact that he was born Sigismund Schlomo Freud. Just the sound of that name is stirring and evocative, and even joyful... As my own hearing has deteriorated a bit over the past several years, sounds are increasingly treasured. Over the years I wondered, as we often do, which sense I would rather be without, my sight or my hearing, and I usually concluded I would prefer to lose my hearing; I could not contemplate the question if the matter was considered a condition from birth. I then remember my first CPE supervisor, a man who had lost his sight as an adult and was a marvel to watch as he ministered throughout the large hospital where he was in charge of pastoral care.

Sigismund Schlomo...The sight of the words means little, but the sound of them is marvelous. And is it not also the case when people want to be "heard"? No one yells at their partner that the problem is that the dumbbunny didn't "see" him or her...no, you are a jerk because you didn't "hear" me!

Neurologists and neurophysiologists have remarkable opinions about the operations of the brain. Is the occipital cortex more complex than the auditory cortex? The occipital cortex seems to be better understood, but the auditory cortex may be far more complex in many ways. I would suggest in simple terms that the ears "see" far more than the eyes "hear". I believe that to be true.

In the therapeutic interaction, some have tried to include other senses such as touch, which has been heralded by many women as important. Documented abuse has addressed both men and women as perpetrators, and in any case, physical touch has been essentially proscribed from the professional psychotherapeutic interaction. Touch is out... Taste is out... Smell is ambiguous... So, we are left with sight and hearing.

In 1998 I began providing psychotherapy to persons who were not physically in my office. I had very specific conditions for this activity, which have eventually been incorporated into the standards of practice that are present today for pastoral counselors, marriage and family therapists, and a variety of clinical fields where such encounters are considered.

What became especially interesting was the experience of phone therapy vs. the emerging experience of therapy facilitated by developing technologies for video-conferencing and the evolution of widely available tools such as Skype. I began to observe an apparent contradiction. The supposed transparency and intimacy and engagement provided by the union of simultaneous audible and visual communication was not effective. It was illusory at best. The cases that used this advancing technology were less effective and intimate and engaging than the cases that relied on phone contact alone. The cases that employed only phone contact were more intensive, more transformative, and the patients sought to continue more in their exploration of their issues.

Could it be that, despite my need to raise the volume a bit, the cases that relied entirely on our non-visual interaction were more effective and productive and intimate and therapeutically significant? What about the importance of trying to "read" the non-verbal indices that are part of the visual portion of the vaunted audio-visual encounters?

When I presented this material in my collegial supervision and consultation, it became apparent that I had been putting more emphasis on MY ability to perceive what was presented through the screen and speakers in front of me, instead of experiencing the patient's revelation of personal and transferential information. I seems I had lost my therapeutic perspective; something about the media had seduced me or misdirected my attention.

There are several cartoons in my office that depict caricatures of clinical practice, including one where Schlomo is sitting behind a fainting couch. The caption is irrelevant but the image is a priceless reminder of the power of evoking the free expression and transference of the patient. No visual contact was required or desired. The transactions were oral and audible and unfettered by the body language of the patient or the visage of the therapist. Yes, "unfettered"...

I currently have patients in several parts of the United States and in Germany and Italy. In every case I utilize only the audible expression of content and interaction. In these clinical engagements I am as close to the "couch" as is possible in today's world. In my current office visits with local patients, I am beginning to encourage less and less face to face interaction. More content is being elicited in this shift, which I find amazing despite my journey as a clinician for over 35 years. I am ready, for many reasons, to make the "case for the couch".

I could go on for many paragraphs with more evidence, but all I would be doing is promoting truths there were evident over a century ago. Yes, it is not the patient who resists, it is the therapist, and therapist resistance is furthered by the ego of the clinician who needs to believe he or she is a real person in the process that heals the patient. We are functionaries, albeit ones that must be as well prepared and crafted as is possible. In the Christian tradition, we are at best the fit vessels of spiritual forces greater and more vital than we can ever imagine. We are most effective when we are an extension of the ego of the patient in crisis as he or she becomes the patient in process and the patient in victory. Schlomo the Jew did it in the context of his own belief or non-belief, and we can certainly strive to do as well.

____________________

William Scar
Diplomate, CPSP
Diplomate, AAPC
Approved Supervisor, AAMFT
Program Director, Good Samaritan Counseling Center/SCIC

The gathering of the CPSP Community for its 24th Annual Plenary will occur March 30 through April 2, at the Sheraton Oceanfront Hotel in Virginia Beach, Virginia.

A block of rooms has been re-served at a special rate of $119, single or double, per night. Reserve your room online today by clicking on this link: Sheraton Oceanfront Hotel, or call 800-325-3535 or go to the Sheraton Oceanfront website.

Please download the 2014 CPSP Plenary Brochure listed below for detail information.

Make your reservations now!!

Please contact Krista Argiropolls if you have questions.
krista@cpsp.org

Finding Our Way As Midwives

It seems to me that people who feel unsafe retreat to extremes. When uncertainty surrounds us, it is preferable to run to one end or the other, to have a wall against which you can put your back, to have a group whose identity and number can be a support. I don’t think I need to name the number of arenas in public life where this occurs—we are all too painfully aware of it. But what has surprised me is how pervasive such dynamics and divisions can be in chaplaincy. 

Dividing Line: Presence or Surgery

While such a description of a very common divide in chaplaincy will no doubt be overly-reductionistic, the divide seems to go something like this—many chaplains view their work as primarily about presence, heart, and empathy. Then, some seem to think that supervisors care only about “surgery”, the head, and maintain a critical (or safe) distance. 

More than being a struggle between two groups within our organization, it might be best understood as a struggle within each one of us. And yet it is easier to suspend the struggle and run to one camp or the other.

“I’m presense. I won’t fail. I’ve made sure of it by not taking risks. I don’t make interventions and lead the patient somewhere new because if I do, they might reject me.” 

Or, “I’m a surgeon. I take risks, but the risk is really owned by the other person. I don’t get close enough to feel the pain of it myself. That’s why I keep the mask on.”

With presence alone and no intervention, we don’t risk failure. With surgery alone and no presence, we protect ourselves from feeling the failure. I want to propose that if we can offer anything prophetic as chaplains, it is a willingness to fail. And on these terms, both of these extremes fail.

Co-People or Chaplain-Patient

Given this split vision, what has struck me most is the insistence among some chaplains that we really aren’t chaplains; rather we are “co-people”. “There really is no chaplain or patient—instead, we are just present together.” If I grasp the intended beauty of this statement, they seem to be asserting that no one is better than anyone else and that our work should not be paternalistic. If so, I can respond with a resounding “Amen!”

However, this line about being “co-people” falls short of reality when viewed from a patient’s perspective—they see you as their chaplain. I dare say that this vision of “co-people” thus falls short of being “patient-centered” because it is not how the patient sees it. It is more about our idealized anthropology than about the patient.

Honesty, Power, and Owning Our Role

As everyone reading this is likely in the choir, I imagine we all know the danger of a young priest who begins wearing the collar before he understands how much power is attributed to this symbol. He or she is too fresh to realize that such accouterments actually require gentler movements because whatever is said is likely multiplied in the hearing because it comes from a collar. 

Similarly, when we walk into a room and disclose our role as that person’s chaplain, we are no longer “co-people” in their experience. From the moment we introduce ourselves, we have become their chaplain. In their hearing, we are differentiated; that is inevitable, and it is even good! We certainly don’t want to think of ourselves as better than our patients or as an uncaring professional, but that is never what being a chaplain meant. Being a chaplain is to be a differentiated professional who does care.

The role even means something whether we feel our pastoral authority or not. Even if we don’t exercise the “power” overtly that comes with the role, that reality does not prevent our authority from being felt in the patient. We know this when our people apologize for using 4-letter words in our presence, assuming they have offended someone whose mere presence demands an apology. 

Put another way, as we all know from our clinical training, the supervisee-trainee relationship is asymmetrical. So is the chaplain-patient relationship. In fact, it is the very particularity of our role with the patient that allows so much of our encounter to occur on sacred ground. 

It is good that when we go into the room, we don’t do so as a physician. We are not these to stand (and not sit), to cross our arms, to listen to the heartbeat and then cut the patient off as they share their experience of the illness. (Of course, all physicians are not like this, but you get the point.) However, I also don’t think we are there just to be “co-people” either; many of our people are looking to be led somewhere, and we are the ones they look to.

Transcendence: The Role of the Midwife

There must be some middle way between these extremes—between presence and professionalism, between heart and head, between empathy and critical distance. We are both professionals and we are people who care deeply in our souls. We aren’t there to do the work for the patient, but we also aren’t there to do no work. So what are we?

I suggest that our answer lies closer to home than we imagine—it is in our covenant. In our common work together, we commit to midwife one another in our respective spiritual journeys.

A midwife doesn’t sit in the corner inactive, but she also doesn’t administer an epidural, shielding the mother from the pain that is her own. The midwife doesn’t deliver the baby on her own while making the laborer become more passive. She listens to the breath of the laboring mother, becoming attuned to her contractions, and connected to her spirit.

The midwife puts a hand on the mother’s back, supports her in her pushing, in her pain, and through this transformational journey, helps the mother to discover that her pain has given way to a new life that is precious and sacred beyond measure. Ultimately, she leads the mother and invites her to trust the bidding of her own body. I could offer a translation of what this embodied process means for those of us who work with the soul, but you no doubt already know.

The midwife seems to me to be the way between and beyond these polarized options. It seems to be what we all have in common. It seems to be how we do our work when we do it well. I know I set this article up as if I have something new to say—sorry to disappoint because the reality is that I don’t. It is the tradition that can serve us; perhaps by moving back to it, we will move forward.

We won’t always get the right balance, but it is balance that we are after. When we walk out the door as a midwife, the patient won’t be in withdrawal, lacking their co-person, nor is the patient untransformed just thinking how great the professional was that just walked out the door. Instead, she thinks—or better, she feels—“What a gift this new life is. Look at what I’ve done.” 

After this work of presence and precision, attainment and intervention, the midwife does what is most essential—she disappears…

________________________________________________________

Rev. Matthew Rhodes is the Director of Religious Ministries with the University Medical Center of Princeton at Plainsboro. He is currently enrolled in the Doctorate of Psychology Program in Clinical Pastoral Supervision with the Institute for Psychodynamic Pastoral Supervision. You can reach him at mrhodes@princetonhcs.org.

NCTS is a unique group.  We meet twice a year.  It's an opportunity to get together with a diverse representation of chaplains of all denominations and types of work places.  It's also a chance to get away from it all and  to spend quality time at a quality place.  Old friends meet up and catch up.  

New chaplains find a place where they can learn from their peers and find mentors who share their years of expertise, skills and knowledge. We always have a one of a kind professional development opportunities in a relaxed environment surrounded by the wonders of nature.  

This past November 12 and 13 we met at a new facility, the San Alfonso Retreat House in Long Branch, NJ which is right on the Atlantic Ocean.  It was large and had spacious views of the water to inspire us.  We got to see the work they have had to do since being hit by hurricane Sandy. There were 60 people present and about a third were first time attendees. 

Everyone had an opportunity to bring a case that they presented to their small group. With ten groups, feedback abounds and thumbnail reports give us all a chance to catch the jest and then seek out the presenter if it peaks our interest to learn more in a one on one conversation.  

This time around the presentations were on the topic of mental health and were presented by long standing member, Dr. Dwight Sweezy, who just retired after 33 years at Trenton Psychiatric Hospital.  He presented in a style that gave insight to the population of people that we serve everyday in some way or another and could identify with in our experiences.  He told us quips and quotes. 

There was a 90 minute Tavistock that got things rocking and rolling the first night followed by a social with refreshments and a chance to let your hair down and hang out with your chapter members and new and old friends.

We couldn't have such a great event without a committee that works like a well oiled machine and is led by Dr. Francine Hernandez.  Thanks to all who took part to make it another success.

Time flies and we leave relaxed, refreshed and ready to take our new found information and skills back to our work with contacts to call on at anytime.  Looking forward to the next one in early May at Loyola Retreat House in Morristown, NJ.  You won't want to miss it. 

___________________________

Claire Jones, ABCCC
Hospice Chaplain
Robert Wood Johnson/Visiting Nurse Association
cjwork@comcast.net