Pastoral Report Articles 

  • 29 Mar 2017 2:37 PM | Perry Miller, Editor (Administrator)

    CPSP’s National Clinical Training Seminar-East (NCTS-E) will be held May 8–9, 2017 at the Loyola House of Retreats located in Morristown, NJ. The Coordinator of the event is the Rev. Dr. Francine Hernandez. 

    The theme for this gathering is “Transference and Countertransference in Pastoral Care, Counseling & Supervision,” with Dr. David Franzen as presenter. 

    The NCTS-East is open to all who are invested in the clinic pastoral field: Clinical Chaplains, CPE Trainees, CPE Supervisors, Pastoral Counselors and Psychotherapists, Parish Pastors and others seeking to explore the field. 

    In keeping with CPSP’s tradition and commitment to clinical acuity and consultation, all participants are to come prepared to present in a small working group a clinical case or something of of their life and/or work for consultation. 

    NCTS-East Schedule

    Register for NCTS-East, May 8–9, 2017

  • 27 Mar 2017 12:54 PM | Perry Miller, Editor (Administrator)

    Dear Friends and Colleagues -

    I am pleased to say that we, the CPSP, are truly progressing. And this is not "fake news"!  At a time when truth is at a premium in so many areas of life, we are actively addressing the factors that affect true quality of care for the many children of God, the living human documents, we encounter every day.

    In clear terms, our progress is measurable in different areas other than our internal discipline and nurture.  Our collegial outreach, the Commission on Accreditation of Pastoral and Psychotherapy Training, has been actively reviewing many of the programs that deserve scrutiny and review.  Our CPSP leadership has been in ongoing communications with our historical cognate groups, the ACPE, the AAPC, and the AAMFT, and many opportunities for growth and relationship are possible.  It should be noted that all three of these organizations are experiencing major restructuring…and all three are in the process of adopting local and regional structures that are analogous to the Chapters and Chapter Life patterns that the CPSP established 27 years ago.  We knew then that we were embarking on the future that would become essential to the survival of our missions.  And, we have invited more communication with the emerging Spiritual Care Association, evidenced by our invitation this week to its President, the Rev. Eric Hall.

    As a guild devoted to clinical pastoral care, collegial support and supervision are our most basic tasks as an organization, and we have stepped forward with more accountability for training programs and greater clarity for the paths to certification. A guild carries the torch for the beliefs they share and the skills they bring forward.  A guild also advocates for its worth in the community and points out the challenges faced by the people whom it serves.  At this time in our history, it is important to reflect again on our place in the field of specialized pastoral care, and our role in the culture of those we serve.

    When I was installed as your President two years ago, I said that I had two major goals/priorities/responsibilities in my tenure. The first was to support the implementation of the new governance model adopted by you. The second was to address the lingering concerns described variously as a lack of transparency and openness about how we do what we do, and how decisions are made, in the CPSP.

    Yes, these ultimately concerned the issue of trust, the trust of the members in our leadership and the trust of our leadership in the commitment of our members. The governance itself addressed some of this in the ways that more and more members were involved in Chapter development and the effectiveness of supervisors. Part of the governance was to be the Chapter of Chapters, and another part would be the Chapter of Diplomates. The third leg of the leadership stool would be the Executive Chapter, which would properly formalize what was sometimes called the leadership team. This new structure assured more total participation, and also provided greater accountability for these representatives and their efforts.  Our new governance is working better and better at fulfilling our duties to serve and represent our members.

    I also saw that I could take direct action by establishing regular communication from my positon as President to all of our members, while also inviting direct responses from every one of you. I also promised to reply to each and every response from you. Thus was born "NOTES from the President", and I have sent one of these out to you every few weeks for this entire time. I have brought forth various types of issues that bear upon our ministries as well as our organization.  Since I, too, must be accountable, every single NOTES was vetted for its legal implications and for its accuracy.  I have indeed received many responses, and I have responded to every one, to the best of my ability.  What remarkable discussions we have had, from total agreement to great disagreement and everything in between. We succeeded in creating more communication.  This is gradually building more trust among us.

    I want to lay to rest the word "transparency".  In my experiences as President, and in my observation of members with various levels of authority and responsibility, that word no longer applies negatively, if it ever truly did.  Over the years there have been some personality conflicts, which is to be presumed.  Many times the information is already out there and members just did not read our website. There are also people who don't ask and still expect to be given an answer. And then, and this is no surprise, there are those who are never satisfied, no matter what you say or how much time you spend with them.  Sound familiar?

    I must also say that there are many questions or misunderstandings that have come to me involving information that is the responsibility of the individual chapter to provide as part of its nurture and support. Again, this is despite our documents that describe chapter behavior, the responsibilities of the Convener, and the role of the Mentor in the advancement of members.

    Transparency and openness are open doors, open doors that are of no benefit if people do not walk through them.  And ultimately, every person involved with the CPSP, every Diplomate, every beginning trainee, was already a professional and mature adult before joining with us. Ultimately, professional applicants are themselves responsible to read, seek, research, and initiate inquiry into the credentials they seek. And of course, our standing committees are there to answer questions that others are unable to. Openness also means access, which we are here to provide.  The members of the Chapter of Chapters, the Chapter of Diplomates, and the Executive Chapter make this commitment to all of us.

    NOTES from the President was an essential resource to me in staying close to the needs of our members. Another significant development is our utilization of cyber resources in the past two years to enhance communication, as well as conserve both time and money. As we learned to utilize this asset, we had two very successful fall cyber meetings of the Governing Council.  Across our organization, there have been many video conferences that served to enhance our trust and decision-making, and this technology has been used all over our membership for chapter meetings, supervision, and conferences.  I am sure this will continue, but we are already seeing the limits cyber tools; these are the lack of in-person, face-to-face meeting, especially in the areas of training and supervision.  Our clinical values must continue to be met, and this cannot happen unless we spend sufficient time in the same room together.  This applies equally to our organization as a whole, and this Plenary is yet another example of being able to share both time and space.  What we “know” about each other as colleagues is always primarily in relation and in respect to the individual we have seen, felt, heard, and smelled, as well as valued in person or prayed with.

    Yes, we will continue to pursue greater accountability in all facets of our training and supervision, and our committees that oversee certification and accreditation will enhance their efforts on our behalf.  We forget that the origin of the CPSP in 1990 was not the search for license and lack of accountability…it was the search for ways of assuring better training and more effective accountability for all our ventures in the field of specialized pastoral care.  The founders of the CPSP were not seeking to lower the standards of our field and make it easier to become certified.  We were seeking the better ways to fulfill standards, and also hold individual members more accountable for their spiritual and intellectual formation.  We wrote a Covenant that would be our profession to ourselves and the world about who we strive to be and what we strive to do.  We chose to “travel light” in contrast to the expensive and obtrusive structures of the then prevailing corporations that certified and accredited persons in pastoral care. We used Boisen as an inspiration for renewing a psychoanalytic foundation for the care and counseling that are needed by the children of God when going through medical crises, in prison, in the military, and struggling in communities of poverty and chaos.  We prize being truly prepared as we encounter the living human documents wherever we serve.

    Our goals were difficult to achieve…we chose the harder and better way.  These efforts would need structures of support and nurture.  The CPSP chose the Chapter model as fundamental to these values.  Professional pastoral caregivers would engage and support one another in local groups of 12 or fewer persons.  The Chapter is the first place where accountability really happens, and if it does not happen, our entire model is in jeopardy.  That is why we are of course paying great attention what is happening in Chapters today.

    Our beloved CPSP is going in the right direction…  we have the ability to continue our prophetic and practical ministries, and make them better and more effective.  It is not our time to crow.  It is not our time to settle for less than what we believe in.  It is our time to rally and be the leader we have been for over 25 years.

    Bill Scar

    Bill Scar, CPSP President 2015-2017

  • 20 Mar 2017 6:36 PM | Perry Miller, Editor (Administrator)


    Robert Charles Powell, MD, PhDEach structured effort within
    the clinical pastoral tradition has sought to
    respond intelligently and wisely to

    the perceived needs of an historic period.

    One may suggest that

    pastoral care in any age can be
    described as
    a response both to

    the anxiety paramount in that period,
    and simultaneously to

    the pastors’ own very real anxiety
    . 1

    It may be fair to say that clinical pastoral chaplaincy has been “under siege” for at least five years – maybe longer. When I spoke over a two-day period in Malibu in 2012, I also was listening. 2 The “anxiety paramount in that period” already concerned a disintegrating health care system. The “pastors’ own very real anxiety” already concerned their being asked to minister in a manner nourishing to those who were suffering, bewildered, or vulnerable – while feeling emotionally malnourished themselves.

    Ninety years earlier, as the movement for a professional chaplaincy was just getting off the ground, Anton Theophilus Boisen and [Helen] Flanders Dunbar sensed that something had been amiss. Many pastors and many physicians were feeling rather ineffective. They had felt useful addressing the severe crises of the First World War and of acute disease, but they were feeling useless addressing the more mundane problems of religion and of medicine.

    The Thirties, Forties, Fifties, and Sixties were exciting times during which both those who were ministering and those who were being ministered to felt they were getting something out of the interaction. The clinical pastoral movement – and its corollary psychosomatic view – emphasized an ideal and hopefully real connection in the midst of the healing process. “Healing and Wholeness” concerned both parties in the relationship.  Transference and counter-transference were meaningful notions because the suffering, bewildered, or vulnerable persons were considered as impacting their healers as much as their healers were impacting them. 

    The Seventies weren’t too bad – but by the Eighties it was becoming clear that “things were falling apart” – that “the center could not hold”. 3 The centrality of the relationship was being squeezed out of the picture. The Nineties, on the theological side, saw the rise of The College of Pastoral Supervision and Psychotherapy – as a “back to Boisen” – “back to Dunbar” movement. “Recovery of soul” was viewed as a goal for both sides of the clinical pastoral relationship.

    Those in CPSP have championed as ideal the notion that “persons are always more important than institutions”. Those in CPSP have acknowledged as real – whether they have wanted to or not – the rather impersonal world in which we now seem to live. During the two-day seminar in Malibu five years ago, I heard clinical pastoral chaplains struggling to provide care and counseling – for which they were not paid – over and above and around the filling out of computer check-lists – for which they were paid. Chaplains were trying to hang onto their own souls as they tried to help the suffering, bewildered, and vulnerable to do the same.

    Over the past five years, CPSP, as an organization, has re-created itself – one piece at a time. It survives and thrives – for now. The question is: “What happens after ‘now’?”

    After Boisen’s and Dunbar’s writings in the Thirties, Forties, and Fifties, there was no one wanting – voluntarily – to go back to an earlier view of care, counseling, and therapy. Boisen and Dunbar – both outsiders – made an ideal real. They took the field of healing and wholeness to a place it never before had been. The question is: “How do we take meaningful healing relationships into the next decades?”

    Let’s be blunt. A clear answer about professional chaplaincy’s long-term future has not arisen from within. 

    In 1975 I asked, at length, “Questions from the Past (on the Future of Clinical Pastoral Education)”. 4 

    In 1999 I asked, at length, “Whatever Happened to ‘CPE’ – Clinical Pastoral Education?” 5

    Ten years ago I pondered how a clinical pastoral chaplain might “function as a knowledgeable professional AND retain one’s soul”. 6

    In 2012 I asked “What about Pastoral Supervision of the Field of Clinical Pastoral Chaplaincy?” 7

    Almost exactly one year ago there wandered onto the scene someone who seems to have considered similar questions. Boisen and Dunbar – as outsiders – productively shook up the world of healing and wholeness. Thirty years ago, a band of insiders became outsiders – principled renegades – putting together what became CPSP.

    A new outsider now has tried to discern the essence – the commonality – of what the various clinical pastoral organizations have been trying to accomplish. This new outsider has tried to see and to hear “in between the lines” – toward positioning the field for the future – toward repositioning the ideal vis-à-vis the real.

    No, we do not know how all this is going to turn out. Yes, we do know that the clinical pastoral community has needed – and still needs – assistance – and encouragement – in discovering – and inventing – the needed changes.

    On this 90th anniversary of Dunbar’s graduation from theological seminary – and on this 30th anniversary of the first inkling that a CPSP was about to be formed – please join me in welcoming the newest outsider into our ranks – the 16th recipient of The Helen Flanders Dunbar Award for Significant Contributions to Clinical Pastoral Training, Eric J. Hall.

    1.    These comments are a paraphrase of p.41, note 150, from Robert Charles Powell, 1975, C.P.E. [Clinical Pastoral Education]: Fifty Years of Learning, through Supervised Encounter with “Living Human Documents.” booklet, 32pp. New York: Association for Clinical Pastoral Education, 1975; the initial print run was for 10,000 copies; reviewed in J. Pastoral Care 36(4): 210, 1982; reprinted, 1987; translated into Spanish, 2009, by Chaplain [Maria] Magdalena Garcia [Orozco], at the request of Chaplain [Romulo] Esteban Montilla as Clinical Pastoral Education (CPE): Cincuenta Años de Aprendizaje: A través del Encuentro Supervisado con Documentos Humanos Vivos; revised edition prepared, 2014; (specifically cited in Marty, Martin E., ed. The Writing of American Religious History. Ridgewood, NJ & Munich: K. G. Saur, 1992; p.266, [“In 1975, on CPE’s 50th anniversary, a flurry of retrospective articles appeared. Several were written by historians who had been commissioned for the occasion, including Robert C. Powell, a psychiatrist and historian. Powell’s dissertation on psychosomatic medicine {Healing and Wholeness …} contains much material about both {Anton} Boisen and {Helen} Flanders Dunbar.”]) (per, JUL-15, 25 libraries hold copies of the booklet) [appears to be the most cited Powell booklet]

    2.      The “Malibu Lectures” (2012, National Clinical Training Seminar - West) were presented again (only slightly condensed), at the “Chicago Boisen Conference” (2015, CPSP Plenary). Not yet published, the two lectures were titled, “Anton Theophilus Boisen (1987-1965), Clinician. I. Assessment:  Persistent and Provocative ‘Co-operative Inquiry’: Empathic and Enlightening ‘Exploration of the Inner World’; II. Therapy:  Patient and Creative ‘Co-operative Interpretation’: ‘Thinking and Feeling Strongly Together about Things that Matter Most’.”

    3.      These comments are a paraphrase of the famous third line of William Butler Yeats’ poem, “The Second Coming” (1919); the entire memorable third and fourth lines are, “Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world …”.

    4.      “Questions from the Past (on the Future of Clinical Pastoral Education)” invited keynote address, presented before the “50th Anniversary of Clinical Pastoral Education” conference, Association for Clinical Pastoral Education, Minneapolis, 16-19 October 1975. 1975 [ACPE] Conference Proceedings: 1-21, 1976; the initial print run was for 10,000 copies; revised edition prepared, 2013.

    5.    “Whatever Happened to ‘CPE’ – Clinical Pastoral Education?” keynote address honoring Anton Theophilus Boisen”; delivered March 1999, at the Plenary Meeting of The College of Pastoral Supervision & Psychotherapy, Virginia Beach, VA. on the internet at ; revised edition prepared, 2014.

    6.   “How to Function as a Knowledgeable Professional AND Retain One’s Soul”; delivered March 2007, at the Plenary Meeting of The College for Pastoral Supervision & Psychotherapy, Raleigh, NC. on the internet [under “Robert Powell, MD, PhD”] at & at .

    7.   “What about Pastoral Supervision of the Field of Clinical Pastoral Chaplaincy?”; delivered March 2012, at the Plenary Meeting of The College of Pastoral Supervision & Psychotherapy, Pittsburgh, PA. on the internet at



    Robert Charles Powell, MD, PhD


    PRESS RELEASE (3/21/17): CPSP names the Rev. Eric J. Hall recipient of 2017 Helen Flanders Dunbar Award

    Photo credit: Charlie Spruell

  • 01 Mar 2017 8:28 PM | Anonymous

    Diane Peterson, a member of CPSP, Board Certified Clinical Chaplain and Pastoral Counselor, is a recent recipient of the President's Lifetime Achievement Award, for her lifelong commitment to building a stronger nation though volunteer service. While numerous Americans have been awarded some degree of the President's Volunteer Service Award, very few have been awarded the highest honor - the President's call to Service Award (also referred to as the President's Lifetime Achievement Award). 

    Diane Peterson has volunteered more than 4,000 hours of her time to help first responders who come face-to-face with the unspeakable. 

    Chaplaincy Alive! host, Susan McDougal talks with Diane Peterson about her work, accomplishments and goals. 

  • 27 Feb 2017 10:28 AM | Perry Miller, Editor (Administrator)

    What are our responsibilities regarding the world that corrupts and wounds the people we serve?  Despite our embracing differences and human rights, there was a bit of a hubbub (so archaic but so fitting...) when the CPSP expressed its support of the LGBTQ concerns. And now there have been some interesting letters to me regarding Raymond's recent comments about the Lord's Prayer as a political tool. 

    The CPSP does not back candidates or contribute to political parties. However, we are citizens and religious leaders, and we do have the obligation to speak truth to power. Our priesthood is not reclusive but out in the highways and byways, reaching into places of suffering and imprisonment, providing therapy to individuals and families in deep crisis and chaos. When cruel politics hits us and our ministries, when the state seeks to tear down our chapels of care, we have every reason to resist and speak. 

    Do we already forget that our new President has filed for candidacy in 2020?  The rally in Florida where Mr. Trump had his wife recite the Lord's Prayer, was entirely political and received tax advantages, the ones we all pay for. The Prayer of our Lord (I speak as a Christian) was used for specific effect and not a reverent act; we should all be offended and even frightened. 

    The word "narcissist" has been thrown around lately by both professionals and lay people. I am impressed by the “borderline" quality of the actions and attitudes of Mr. Trump. Things like "let's you and him fight" (furthering the differences between evangelicals and progressives), blatant lies, the denial of any error, all things either black or white, impulsivity and inconsistency, the rejection of boundaries (laws and conventions do not apply) and discipline, no concern for consequences, the use of any tactic in the moment, and the need to have an enemy to attack.  He is also brilliantly intuitive about the weaknesses of others, which forms the basis for his nicknaming his enemies.

    I lived for 20 years in Palos Verdes, CA.  The Los Angeles Trump National Golf Club was built literally in my neighborhood by the ocean; as is his pattern, he took over a failed enterprise already under construction. Mr. Trump continually broke agreements and contracts with our city, which had granted him many concessions to begin with. The art of the deal is pure borderline...make an agreement, break it, make threats, mockingly beg for forgiveness, force concessions, then break that agreement. This caused dissension and sorrow in our community, and most of us wished the thing would fall into sea, which one hole did do. We could call his behavior callous or dishonest or untrustworthy or reprehensible...he calls it business.  He assumes the stances of a demagogue. It is also patently clinical…so I say it is a duck. 

    When a parent acts in these ways, it leads to lots of business for us therapists. We provide care to children and "adult children" that embraces every resource to help the patient cope with that destructive world they were raised in, and find the healthy boundaries that lead to the hope of a good life. Then there are those who cling to this parent and themselves deny and ignore every abuse and lie...they project themselves onto the abusive parent so that any criticism of the parent is an attack on them, thus protecting the authoritarian abuser. And some of us still wonder how the German people could deny the holocaust as it was happening…it could happen anywhere.
     We are chaplains and therapists grounded in a psychoanalytic awareness of the human condition. You and I serve in the places where people don't want to be...the hospitals, prisons, nursing homes. You and I serve in the emotional prisons of addiction, depression, physical and emotional abuse, psychosis, acute and chronic distortions of the reality we believe to be true. 

    You and I are in a here and now that needs our very best care.  Our skills, beliefs, and commitment bring peace and comfort and hope. And, once in a while we must speak truth to power and point out the public actions that harm the soul.


    Bill Scar, CPSP President

  • 19 Feb 2017 8:17 PM | Anonymous

    Donald Trump assigned his wife Melania lead the Melbourne, FL rally on February 18, in the Lord's Prayer, which was followed by a loud, raucous, football-crowd-type cheer. Some of the news outlets which are likely part of the Trump gang have reported that liberals and atheists have protested this action. It is not only liberals and atheists who should be alarmed. This cynical ploy on the part of Trump should send a chill down the spines of every thoughtful Christian in this country. And for all non-Christians, this cynical political ploy should keep them awake at night.

    I do not recall any American political leader in my lifetime so blatantly co-opting Christianity for political purposes. The founders were unrelentingly opposed to any actual or implied relationship between the new government and any particular religious tradition. 

    We do recall that Adolf Hitler in the 1930's co-opted the Roman Catholic Church with a treaty, the infamous Concordat. And he also co-opted the Protestant Church, establishing the so-called German Christian movement, which Dietrich Bonhoeffer, Karl Barth and Paul Tillich resisted. Bonhoeffer was hanged. Barth and Tillich escaped with their lives, the former to Switzerland and the latter to the United States.

    We in CPSP, as the religious leaders that we are, are obliged to resist this obscene  degradation of religion in the service of a political agenda. And those of us who identify as Christian are even more obliged to expose this travesty. In publicly linking the Lord's Prayer with his regime, Trump implicitly sets every Christian over against every non-Christian in the country. 

    Trump has used prayer - and the principal prayer of Christianity - to inflict a malediction on the entire religious community in this country. We will all be hard-pressed to bring healing in the face of such an abomination. We must do everything in our power to resist this execrable, sinister action on the part of the President.


    Raymond Lawrence

  • 13 Feb 2017 2:02 PM | Anonymous

    The first bi-lingual CPSP event, National Clinical Training Seminar-Central, was held January 14–15, in San Antonio, Texas. At this historical event, forty-five attendees, consisting of members of CPSP, non-members and seminarians joined together for a group relations seminar, case studies, and to listen to guest speaker and CPSP General Secretary, Raymond Lawrence. 

    The first bi-lingual CPSP event, National Clinical Training Seminar-Central, was held January 14–15, in San Antonio, Texas. At this historical event, forty-five attendees, consisting of members of CPSP, non-members and seminarians joined together for a group relations seminar, case studies, and to listen to guest speaker and CPSP General Secretary, Raymond Lawrence. 

    "Over 40 participants, from the United States and Puerto Rico, attended this history-making event," CPSP Diplomate, Juan Loya, stated in a recent letter, "In their evaluations, the overwhelming majority of participants highly praised this training event. As a participant and as the Convener of the Alamo Chapter, I concur with their astute observations."

    The principal organizer for this event was Patty Berron, a member of the CPSP Certification Committee. Patty worked with members of the local chapters to facilitate the event, including the scheduling of fifteen certification candidates, and nine panel members, for a certification review panel on January 13. The candidates approved for certification will receive their certificates at the 2017 Plenary, on March 21, in Orlando, Florida. 

    "This was the first Spanish-English bi-lingual NCTS we've done and it was very well organized by Patty Berron. It seemed to be a success from my observation and reports I have received ," stated Raymond Lawrence. 

    Plans are in the works for a second NCTS-Central event, to be held in the near future. 

    Photo credits: Charlie Spruell and Patty Berron
  • 27 Jan 2017 12:12 PM | Anonymous

    Raymond J. LawrenceA very useful study was reported in the journal Palliative and Supportive Care in May, 2016, entitled "Documenting presence: A descriptive study of chaplain notes in the intensive care unit." The research was completed in September, 2015. The authors of the report were Brittany M. Lee, B.S.; Farr A. Curlin, M.D.; and Philip J. Choi, M.D. The setting of the research was Duke University Hospital, Division of Pulmonary and Critical Care Medicine, in Durham, North Carolina. The study was done with input from the Director of Pastoral Services, Jim Rawlings.

    The researchers proposed that the recent emphasis on evidence-based practice may be leading chaplains to the use of a reduced, mechanical language insufficient for illuminating patients' individual stories.

    Whatever the cause may be, it is clear that the chaplains in this study are at sea on the matter of what should be appropriately reported in patients' charts.

    The researchers in this study reported that the patients' charts in this particular hospital unit contained both an 18-point checklist section and a free-text section. The checklist section consisted of the following:

    Compassionate presence

    Meaning-oriented presence

    Life review

    Continued presence and follow-up

    Supported patient's sources of spiritual strength

    Inquiry about spiritual beliefs, values, and practices

    Open-ended questions to elicit feelings

    Advocated with staff for patient/family needs

    Used story telling

    Reflective listening, query about important life events

    Facilitated communication with interdisciplinary team

    Facilitated expressions of lament

    Referral to spiritual care provider as indicated

    Celebrated/offered thanksgiving with patient/family

    Advance directive information given

    Spiritual support groups

    Spiritual practice interventions

    Reconciliation with self/others

    This research project did not focus on the checklist above, but on the section of the patient chart where the chaplain was asked to make free-text comments. There were such chaplain comments made on 109 patients in the survey. The free-text opportunity would in fact seem to be the only useful kind of clinical chaplain reporting.

    The summary conclusions of these researchers were not flattering. The chaplains' free-text comments consisted mostly of information already available in the charts. The notes seldom included what would be considered an assessment of needs and resources. The notes rarely referred to any plans or expected outcomes. And the notes did not convey a deeper connection that clinical chaplains, in fact, often have with patients. Chaplain interactions with patients appeared to the researchers more as "products for delivery." The researchers viewed the checklist as actually conveying to chaplains that their work consisted of delivering so many product units of "compassionate presence" and other such ambiguous objectives.

    The research team concluded that chaplains frequently resorted to code language that signified nothing more than the chaplain was present. Many of the free-text notes repeated vague terms already in the checklist itself. Chaplains typically described what they observed rather than interpreting its clinical significance. Chaplains generally indicated passive follow-up plans, waiting for patients or family to initiate further interaction.

    The chaplains often described in the free-text section simply what they observed, such as "family is quite large," or "patient's mother standing and holding patient's hand," observations bereft of any useful interpretation.

    The researchers also found that chaplains' free-text notes often recapitulated what was documented elsewhere in the chart, or readily available elsewhere, such as "patient has lung cancer and has been in hospice." Chaplains rarely made what would be considered a pastoral assessment. And the researchers concluded that the chaplains seldom incorporated in their notes what might be interpreted as "spiritual assessments." The chaplains' notes did not convey the deeper spiritual––or pastoral––connection that chaplains often have with patients and families.

    The free-text notes often described patient's spiritual and religious characteristics without any interpretation of significance, such as stating that "patient is a Presbyterian."

    On the other hand, the researchers found that chaplains did in fact provide what they considered a pastoral or spiritual assessment in three of the 109 cases. In one the chaplain wrote: "I believe the family is aware of the seriousness of their mother's situation." In another the chaplain described an upset wife determined to focus on assisting her ill husband. In the third the chaplain wrote a long note about each of three children of a dying mother and their differing postures toward the dying process. The researchers found such clinical observations promising, though few and far between.

    The researchers also found that follow-up plans for patients were mostly passive, indicating that the chaplains would be available if needed. Of the 109 free-text chaplain notes, only two referred to any prior chaplain visit, suggesting that there was a paucity of follow-up work with patients.

    The researchers argued for chaplains providing clinically relevant communication.

    This study should be examined by all serious pastoral clinicians. I believe that the results of this study are not idiosyncratic to Duke University Hospital. In my travels I have found that clinical chaplains are generally at a loss as to what appropriately belongs in a patient's chart. It should be a fairly easy task to decipher what is important and to orient chaplains to just that.

    We should be clear however, that there are systemic problems in chaplain reporting stemming from the very recent shift in language use, a shift that has resulted in obfuscation of the chaplain's role. I refer to the substitution of "spiritual" for "pastoral" that has been in process on a wide scale for two decades now. (It is heartening to see that Duke still retains a "Department of Pastoral Services.") If chaplains simply can remember that they are pastors or in the pastoral arena and not spiritual gurus, they will be able better to describe what they do. The pastor, like the shepherd of a flock, actually needs to do neither more nor less than to see that the animals and crops are safe, healthy, and in all respects progressing. It is a broad-spectrum task. Much of the time that means doing nothing more than paying close attention. Thus the chaplain can write in the chart, "made myself known to the patient and will follow up as needed." No need to add any fancy new-age language. No need to parse the new fad of "spiritual but not religious." Just present oneself in a pastoral––like a shepherd––posture, establish a potential new relationship, and return later if possible.

    In any case, it is advisable for chaplains to present themselves as pastoral professionals if they want to be understood.

    Thus, in the typical hospital a high percentage of chaplain visits would likely be appropriately charted as "pastoral visit." That is to say, nothing much of significance occurs beyond the simple dramatization of the chaplain's availability. This is, of course, no small matter. Informing the patient by way of a brief visit, rather than by a written announcement, that there is a chaplain available for consultation or counseling, is an important contribution to a typical patient's sense of institutional well-being.

    Paradoxically, the clinical chaplain in making routine visits to patients will find that some of the most receptive and needy patients, in terms of pastoral counseling, are not those with acute medical emergencies in play, but rather those with routine, everyday medical problems. And generally such patients have the luxury of time for talking, unlike those facing critical emergencies. In my own experience through the years, I have found that the most significant pastoral counseling I was able to do was with patients (and staff) who had time on their hands and were happy to encounter a trained person willing to listen to them.

    [Having said that, we should note in seeming contradiction, that it is not unusual for a routine patient courtesy visit to morph quickly into what should be properly labeled pastoral psychotherapy. A competent clinical chaplain is always nimble and ready for surprises.]

    For a minority of patients, where something of note emerges in the chaplain's visit, or a crisis is underway, charting is especially important as a way to notify the staff of what specific action the chaplain is taking. The staff needs to know.  

    Clinical chaplains everywhere should take note of this credible and well-done piece of research. It should be considered a warning shot announcing the danger of the trend toward the irrelevancy of institutional chaplaincy. To counter this impending danger I recommend the following:

    1.     Clinical chaplains move away from "spiritual" as the supposed arena of the chaplains work, seeing it as a recently invented poorly defined category, and move back to the more concrete "clinical pastoral."

    2.     Clinical chaplains recognize that one-time pastoral visits are less likely to accomplish much more than introduction and minimal trust building. Effective pastoral work generally––but not always––comes from repeat visits, after which the patient has learned that the chaplain at least is able to get in and get out of a room and listen, without doing something foolish.

    3.     Clinical chaplains, more than any other professionals, take interest, theoretically, in the whole person, medical, social, mental, physical, et alia.

    4.     Clinical chaplains avoid all flowery language in defining their role, such as "compassionate presence," especially any that is similarly self-aggrandizing.

    5.     Clinical chaplains avoid any prefabricated "outcomes." Any chaplain-patient outcome should be rooted in the idiosyncratic needs and values of the particular patient. Not every patient seeks the same outcome. And most patients seek only an intelligent caring listener to hear his or her story. Most patients want to live, and to live fulfilling lives, but only they know what such a life might look like.

    On a given day most patient visits would likely qualify for a simple documentation of "pastoral visit." Beyond making him- or herself known and available, there typically is not much else to offer on a first visit. In a few cases, especially repeat visits, the chaplain may move into the role of counselor, therapist, confessor, or guide––cases in which persons expose their lives to an intelligent other, with the unspoken hope for both care and wisdom. A competent chaplain has the time, and hopefully the expertise, to fulfill that role where most other medical staff must keep moving. Such in-depth pastoral visits need to be documented for the benefit of the other staff members.


    Raymond J. Lawrence, General Secretary

  • 29 Dec 2016 3:36 PM | Anonymous

    "I'm creating a safe space for people to tell the truth and tell their own stories without judgement and with respect..." –Michael Eselun

    The fourth edition of our podcast, Chaplaincy Alive!,  is now available. In this poignant interview, host Susan McDougal talks with Oncology Chaplain Michael Eselun about his work with hospice and palliative care patients, his TEDx talks, and his background working in the entertainment industry. 

  • 23 Dec 2016 6:37 AM | Anonymous

    This special season is dedicated to declarations that give expression to the best of the human spirit such as, "light that shines in the darkness", "good will to all", "peace on earth", etc. 

    It is a season when we want to hold love ones close, remember those we loved but lost, notice the homeless beggar on the corner with genuine compassion in our hearts. We want to give to agencies that feed the hungry and serve the desperate souls who live in the margins of life, relationships and love. Even TV ads that reminds us that abused and abandoned dogs and cats need our help and care touch cords of compassion.

    It is a tender season. It opens our hearts to both hurt and love. 

    Ultimately this season reminds us how desperately we need love and we need to give our love as the core of life that gives meaning and purpose to our being in this world as fragile yet courageous creatures on this earth. 

    Be of good spirit!


    Perry Miller, Editor