Is There a Distinction that Needs to be Drawn Between a Practicioner’s Playing the Role of Pastor or that of Chaplain?
I was a bit bemused by the persistence of the tendency to Bible-thump one’s way through any such discussion
I recently engaged several colleagues on the question of chaplaincy or pastoring. I was a bit bemused by the persistence of the tendency to Bible-thump one’s way through any such discussion, while advocating an interfaith approach as advanced by the adherents of the CPE agenda. I thought I’d share my contribution to the discussion.
It is my contention that we should not advance the notion of a “versus” or “as opposed to” when discussing chaplaincy or pastoring. While it is true that some traditions, the Hebrew and Islamic, for example, eschew the notion of “pastor” or “shepherd” for cultural or traditional, even ethical reasons, in the broader sense all chaplains are in fact “pastors,” while all pastors (in the conventional sense) are not necessarily “chaplains” (or critically speaking, even pastors!). In fact, I object in principal to the biased terminology we so frequently use in our vocations, “pastoral care” department, because it tends to be exclusive. I personally prefer spriritual care provider (although in my professional materials I do use pastoral care). Moreover, most people, even those in the vocation, tend to associate pastoral with pastors and thus with some sort of clergy or ordained service provider (usually with no questions asked and we all know about the profanation of ordination); that in itself is a misfortune for all concerned. But the much-touted CPE doesn’t do much to clarify the issues for interns or residents, and we still see chaplains “certified” by the self-proclaimed arbitors of chaplaincy who are just as ignorant after several years of “education” as they were before.
A case in point is taken from the scenario presented by the initiator of the discussion who describes walking into a Jewish patient’s room with a Christian clerical collar, which I characterized as benign “ignorance” but in reality was outright insensitive and would indicate that the “chaplain” in question did not do any initial preparation before launching out on rounds or visitations. I might fraternally suggest that in future, whether you are a chaplain or a pastoral care associate, to check the chart briefly or dialogue with the nurse assigned to that patient before you visit. The offending chaplain actually says that he was aware that the patient was dying and had no family, so it seems rather odd that the chaplain did not appreciate the patient’s faith tradition and, if it wasn’t in the chart, that he didn’t consult with the immediate caregiver (nurse or LPN).
I also questioned the fact that the visiting chaplain was aware that the man was “Jewish”. Being Jewish immediately identifies one as being associated with a certain cultural, socio-religious tradition, after all, one does not call one’s self “Jewish” except to identify one’s self as a Jew. So this also raises the question of whether the chaplain in question was indifferent to the possibility that this dying man might have welcomed a visit by a rabbi, or that the chaplain did not make or offer to make a referral. Such sensitivity may have been a great comfort to the man, who might have found great refuge in his tradition and prayers. So I identify a boundary issue in this behavior, too; an issue of knowing one’s limits.
This situation also sends up red flags in that it clearly indicates that the institution did not do a spiritual assessment of this patient, much less a spiritual evaluation or history, which also reveals a glaring ignorance of the now widely inaugurated JCAHO and HIPA scoring categories relating to patient spiritual care.
The scenario I describe above should be instructive to us all and I thank the so-called chaplain for the inadvertent teaching/learning moment he has provided.
Finally, in the dying process I don’t feel there’s a heck of a lot of “pastoring” left to be done, unless it’s for the survivors. In my experience, in end-of-life situations I am more of a presence and spiritual guide/companion. While that may arguably be part of pastoring in a general sense, I feel that the actual mission of pastoring contrasts in praxis with the mission of spiritual accompaniment at end-of-life or in an existential crisis.
It’s rather like the difference between evangelization and catechesis, if you have that in your tradition. One takes care of the basics and gets the seed started (evangelization), the other (catechesis) ends in the care and nurturing to harvest time.
Another colleague mentioned in a rather cliché fashion with which we are all familiar when listening to the CPE crowd, that CPE trains one to listen. I disagree with such responses such as “CPE “teaches” one to listen.” I’m not quite sure how that works but in my divinity training and three years of supervised pastoral formation, and my participation in and disappointment with a rather popular CPE program in a large trauma center in Albany, New York, which fell far short of even my minimum aspirations, I don’t think that people can be “taught to listen” they may listen, but they don’t listen deeply. I know that from experience the deep listening skill comes from deep within one’s self, once one is comfortable with one’s self, and can leave one’s self for the time it takes to absorb and process the patient’s narrative. It’s that kind of listening that might be part of qualifying an aspirant to be spiritual care provider but it certainly isn’t the be all and end all.
Deep listening is the act of sinking into a serene quiet place, and awakening a receptive awareness of the other. By entering quiet and becoming aware of the other, we move out of and beyond our ego-driven chaos to become open to the divine messages within us and shared with us by the other. Imagine the irony here is that we so often complain of the pain of not having been heard, but we are so guilty ourselves of being deaf to, not hearing the innate wisdom from within ourselves and shared with us by others. When we learn to accept emptiness, when quiet, we instinctively trust in the guidance of sacred voices far more profoundly than what our bullying brains and the busy buzz of life would have us hear. And we listen, respond with silence.
In fact, having examined quite a number of CPE curricula and having developed continuing quality improvement curricula for the healthcare chaplaincy department, I find that the current CPE programs and their associated certification elements serve only to promote a burocratic and very branded form of “pastoral” care, and that branded product falls short of most suffering persons’ real needs. It’s the proprietary nature and standardization (viz. uniformization, homogenization) of the learning that deals the death blow to an appreciation (1) of the universal truths and values shared by all human beings, (2) the beauty in the diversity of traditions and how to appreciate and be enriched by a certain mutuality, (3) the possible pitfalls of an interfaith approach to faith traditions that may adhere very loyally to their dogmas. There are other reasons I could enumerate but regrettably (or fortunately for the readers) space is limited.
I think that an overwhelming majority, too, of CPE students come with excess baggage and too little self-death–I’ve observed interns, residents, even certified chaplains who have a great potential to do considerable damage…and do. The situation is not unlike seminary, you can do much to scrutinize, to form, to standardize but Whoa! when you turn them loose on the world, watch out! (A Roman Catholic diocesan priest, who also serves in the chancery tribunal, remarked ironically to me one day, “They’ll ordain anybody these days.” Which is probably true given the shortage of priests today.)
The so-called supervisors of the CPE programs almost invariable have their own biases and agendas, and these tend to impair good formation.
In some, not all instances, too, CPE programs have become “pay-to-work” programs in which minimally screened individuals, wet behind the ears and green, are turned loose on the floors to deal with sophisticated staff and human beings in existential crisis. I don’t feel that’s right. And I have also observed that interns are exposed to the same curriculum content for three or four years, and unless they have the academic predisposition to independently advance their armamentarium of experience through narrative and study, many don’t build their foundations. Some interns do not have theology or pastoral studies to help them through the necessary processing, and almost all have a depraved Western bias to their spirituality that tends to act as a speed bump when offering care to Non-western recipients. These programs tend to be “chaplain mills.” CPE does not fit the bill on its own to form professional, well-rounded spiritual care providers, but does excel in churning out multitudes of volunteers for greedy institutions. That may be one of the reasons it has survived this long.
On another level, some practitioners involved in the discussion advocated that the “Gospel” or, by extension, holy scriptures, has no firm place in chaplaincy. I do differ in that the fundamental ethics of the “Gospel” (not as understood principally by the evangelicals or fundamentalist among us) is a major part of chaplaincy. I cite particularly the beatitudes and the teaching of discipleship and servant leadership (chaplaincy is certainly not limited to the sick and dying but to the suffering generally). While I abhor the notion, and even more so the practice of proselytizing to captive audiences, and would hasten to emphasize that evangelization and catechization is not a fundamental role of the chaplain, ethics, discipleship, and servant leadership all play a special role in the myriad activities of the professional chaplain. (Note also that I do distinguish between the “professional chaplain”, the pastoral/spiritual care associate, and the visitor providing spiritual support.) To advocate that the truths and values espoused by the “Gospel”, the holy scriptures of any faith or spiritual tradition might have no place in chaplaincy is to advocate a position, I believe, of a chaplaincy practice devoid of ethics (and religion) (I do realize that this is a particularly “Christian” approach and my Judaic, Islamic and Buddhist colleagues may not necessarily agree with the religion-ethics statement, but I make the statement here somewhat loosely for convenience sake).
I’m not judging colleagues in chaplaincy or Clinical Pastoral Education too severely at all. In fact, I’m simply sharing my own observations and opinions based on personal experience. I am not a bit surprised when some readers tend to take these observations personally, as if they were meant to make an ad hominem stab at the straw[wo]men of CPE; I usually anticipate that persons in our line of work have a bit more self-awareness not to take every facially severe remark as a lancet thrust to the heart, however.
Rather than play an offended person’s role, perhaps we all would benefit by admitting that we may have learnt something about one’s self as through another’s eyes.
Our role is to humbly respond, not to knee-jerk react. After all, to paraphrase the prophet Martin Luther King, Jr.: ‘We are all wrapped in the same cloth…when we directly hurt another we indirectly hurt ourselves.” (I do hope I did that statement justice!). So, when one party to the conversation called such a response arrogant, and a failure to simply accept some responsibility in relationship to colleagues’ responses, I merely responded, “My point indeed. The mouth loves the feel of words.” Instead we minimize, rationalize and justify our behavior, making certain to protect one’s self. This particular correspondent insists that “our patients have thick enough skins to handle a collar.” My response was tantamount to the fact that I don’t think that we have any right to expect patients to have “thick skins.” Some practitioners in pastoral care seem to admit patients’ strengths but underestimate their sensitivity and vulnerability. Many of the patients I see have lost their thick skins and in fact are pretty bruised in terms of dignity, autonomy, fortitude, patience, etc. I see no reason to add another straw to the pile. And Yes! It’s not about us, it’s about patient-centered, family-focused, inter- and multi-disciplinary care.
When we adopt such an approach we appreciate that, whereas many of our colleagues practice their spiritual care ministry in acute care settings or in crisis settings, many colleagues may find themselves–particularly in the scenario of the long-term care setting–in the position of playing both the role of chaplain and pastor to some residents in those longer-term care facilities. Regrettably, many of these residents lived their lives unchurched or churched with infrequent interaction with their faith community; more regrettably, some faith communities have disappeared or simply no longer continue a ministry of visitation of the sick and homebound who were once part of their faith community. It’s in such situations that the chaplain may very well become the pastor, and have to function in both roles. I don’t feel that this should be a major stumbling block nor even a concern to the well-formed spiritual care provider, who is responding to a true call to spiritual care ministry.