The Therapeutic Use of Self in Pastoral Care

An argument has been raging for more than a century. It has taken on different forms and has had different combatants, but the issue is still the same:

What form of psychotherapy works best?

The question is generally broached in terms of psychotherapy as applied to the use of psychology-based therapies for individuals. (A very separate but similar battle exists in models of family therapy.) This is not a trivial issue. There are close to 200 identifiable psychotherapeutic models out there, of which perhaps 20 or so could be considered mainstream. These may be based on different philosophies or theories as to how change occurs. It seems quite reasonable to think that one should be right, or at least best, while the others are wrong, or at least less than the best.

The problem is that testing hasn’t really demonstrated this to be true. There have been attempts to create objective tests to see the rates of positive outcomes of different therapeutic models. In these research activities, the goal is to test the model itself, so the role therapist is sought to be eliminated as a variable. This has proven to be a problem. It seems as if the difference between therapists is greater than the difference between models. Suppose two therapists “1A” and “1B” utilize therapy method #1, and two therapists “2C” and “2D” utilize therapy method #2. Even if one could determine that that method #1 is theoretically more effective than #2, there is no real certainty that therapists 1A and 1B are more effective than 2C and 2D. The effectiveness of the two methods have such a range that there is huge overlap in the success rates of the two methods. The competence of the individual is a more important factor than the actual method used. This, however, is not to say that models are useless. Some models may be inherently flawed and should be avoided. Additionally, a mediocre model may be a more effective model in therapy than simply “winging it” because it provides structure and goals in the therapeutic process.

Val Wosket speaks of this in her book “The Therapeutic Use of Self:  Counselling Practice, Research and Supervision. ” Miller, Duncan, and Hubble in 1997 (in “Escape from Babel: Toward a Unifying Language for Psychotherapeutic Practice.”) notes that there seems to be four main factors that guide whether one improves or not in therapy:

  • Extratherapeutic factors associated with the client or the client’s environment.
  • The relationship between the client and therapist
  • The therapeutic techniques used
  • The emotional state of the client (hope, expectation, placebo effect, etc.)

Looking at this, the therapeutic techniques used (or models) constitutes only one of the four. Two of the four the therapist does not have any control over. If one could eliminate the factors that the therapist has no control over, one is left with the techniques used and the relationship between the client and therapist. And within this, it seems as (if one is using a recognized therapeutic model at least) the relationship is more important than the specific model.

An added problem is that a particular therapy may work better for one type of problem than another. And even for the same type of problem, it is quite possible that different therapies may work best for different personalities of client. It is also further possible that different therapists may match up particularly well with certain models. Therapist A may work better with therapy #1 while Therapist C may work better with therapy #2.  One size may not fit all in terms of problem, client, or therapist.

This is not to say that therapy models do not matter. But one finding is the importance of the counselor and the counselor’s use of self in the therapeutic process.

After reviewing many different studies, Wosket states:

“I strongly suspect that maybe it is not so much that all psychotherapies are equivalent. Instead (and this is a crucial difference) it may be that the most consistently effective therapists are in many respects equivalent and that equivalence derives more from factors such as clinical wisdom and the enlightened use of self, than from the utilization of techniques and systematic treatment procedures.  …

Perhaps as well as considering ‘what approach is most effective and what can we learn from it?’ it might have been profitable for more researchers in the last few decades to have asked ‘which therapists are more effective and what can we learn from them?’         -p. 19

In the same book, Wosket quotes from Luborsky, McClellan, Woody, O’Brien, and Aurbach (in the 1985 article “Therapist Success and its Determinants”),

“…that the effectiveness of a given therapy can vary considerably depending on the group of therapists providing the treatment. This in turn suggests that the therapist is not simply the transmitter of a standard therapeutic agent. Rather, the therapist is an important, independent agent of change with the ability to magnify or reduce the effects of a therapy.”

So how does this apply to Pastoral Counseling?

Here are a few suggestions:

  • Training of Pastoral Counselors should focus less on techniques than on developing the (counselor’s) self, and how to develope a healthy therapeutic relationship between the counselor and the client. Techniques do have some value, as well as models. But training that focus primarily on these may create a knowledgeable, yet spiritually, psychoemotionally, and socially impoverished, counselor. Training that takes seriously the therapy of the counselor needs to be taken seriously, even if it means a lessening of focus on classic competencies in therapy.
  • Pastoral Counselors are in need of healthy supervision and peer support. As Lawrence LeShan stated (in “Beyond Technique: Psychotherapy for the 21st Century”) “A therapist who is not in supervision should be regarded either with suspicion or awe.” Pastoral Counselors are not automatons or therapeutic machines. They need these relational bonds and support for their effectiveness.
  • Pastoral Counselors should not “fall in love” with one model or technique. No technique (or model) is likely to be the best for all situations. And even if a pastoral counselor becomes very comfortable and effective with one form of care, evangelistically promoting that technique to others may not be helpful to the others.
  • Pastoral Counselors (should) draw more from their pastoral theology than from psychological techniques. Since pastoral theology is reflective and iterative (wrestling with the twin poles of theological tradition/perspective and personal experience), the counselor should always consider their models and techniques as tentative at best and part of a larger process of growth and change.

One final thing. In recent years there has been a growth of interest in empirical outcome-oriented research into chaplaincy (especially) and pastoral counseling (more generally). There certainly is value to this, since bad ideas can perpetuate in practical theologies such as is in pastoral care, when there is no analysis of results. That being said, the (still somewhat tentative) results in psychology should lead us to not be surprised if the same results will come to pastoral care— that the therapeutic self is more critical to care than a specific technique.

 

The Issue of Authenticity

Article by Dr. Simplicio Dang-Awan Jr., Diplomate CPSP-Philippines

There are many people who may be unreal 19575304_10209712303177499_2038709745623943356_oor inauthentic. One way to understand the word is to talk about inconsistencies in one’s life-way. When one smiles on the outside but angry on the inside– one is not authentic. One who says he is a Christian, but his actions insult Christ whom he claims as his Lord,  or one who says I ‘m humble and modest, but shows pride and arrogance to others is indeed not authentic.

Authenticity is one goal of Clinical Pastoral Education (CPE), because one is to subject himself/herself to self-awareness. This is like seeing your face through the mirror. Your group members will help you understand why you talk or behave the way you do with their feedbacks. This is called processing in CPE. We need to process ourselves as to

  • Why we tell a lie.
  • Why we behave the way we do.
  • Why we cannot express ourselves.
  • Why we get angry even for small things.
  • Why we become intolerant and feel angry if our wish is not followed.
  • Why do we easily cry when scolded.

Has crying became our coping mechanism or not? There is a cause for every issue that we grapple with in life. We need someone who can mirror to us our behavior.

Example: Why are we angry with some elders who are of the same age as our father. This was the behavior of Pablo. His CPE Supervisor asked him to recall where that anger started out. The Supervisor suspected transference. Pablo then told a story about his dad, who enjoyed ridiculing him for urinating on his bed when he was 12 years old. He could not fight his father, of course, when he was young. When he became a person with authority, he shouts at elderly for little or no reason. He is transferring his hatred for his father to another person who is as old as his father then regrets after hurting the elderly. There was transference indeed as suspected. So Supervisors, and Pastoral Counselors in general, should be suspicious.

Another example is a Pastor who was delivering a sermon in a Church, when suddenly he saw a member texting while others are listening to him. He then burst into anger and castigated the person who was texting. He regretted showing his temper before his congregation. When he went into CPE he was encouraged by his Supervisor to look back into his upbringing, if there was any incident that may have triggered his anger. Then he recalled, “When I was in grade 6, I was scolded by my Teacher when I was reading a note passed by my classmate about a girl I like very much. Then he stopped lecturing and singled me out as one who does not listen to him when he is teaching us. I was so embarrassed in front of  my classmates– especially the girl who laughed with the others at me.” That boy hated his teacher and when he became a Pastor he did the same to someone in his congregation. Why? Yes because that anger was not processed. In 2 Cor 5:17 says, “He who is in Christ is a new being, the old was gone and the new has come.” This is easier said than done. Unless the old and dirty behavior is processed and identified and thrown in the garbage, the old behavior may come back sooner or later.

Pastoral Care Reflections

Pastoral Care Week is coming. This October 16-22, 2016

With this in mind, here is an article that is from the webpage of Pastoral Care Week.

Home Page of Pastoral Care Week345_PCW_Round_300

Page of Article

The article below addresses the argument (particularly in the West) as to whether chaplaincy is better defined as carrying out Spiritual Care or Pastoral Care. We at CPSP-Philippines accept both terms. However, each have their own nuances. Pastoral suggests a broader range of ministry than Spiritual. On the other hand, it also points to a long history that would then suggest a more narrow range regarding faith. That is, the term “pastoral” has deep roots in Judaism and Christianity. Metaphorically, it can also resonate with Islam, Hinduism and some other faiths as well. But for those who seek to disconnect spirituality from religion, or to disconnect chaplaincy work from the roots of historical pastoral care, the term spiritual care may seem more appropriate.

Ultimately, it is a matter of personal conviction which one is better… at least until a third option comes along.

 

And the Nominees Are . . . Spiritual Care – Pastoral Care

Father Joseph J. Driscoll
President and Chief Executive Officer
National Association of Catholic Chaplains

Heads turned at the sound of the raspy voice of the old man as he began speaking while he glared at me on the dais from his place dead center in the packed auditorium.

You say that the language is changing from pastoral care to spiritual care because it better defines who we are and what we do as chaplains. Well, let me tell you, I was around 30 years ago when we changed from spiritual care to pastoral care for precisely the same reason!

Spiritual care was too confining; it seems to connote religious concerns, but chaplains did more than that. We provided support and comfort to religious and non-religious people alike. Pastoral care came from a tradition that reflected this broad-based professional care at times of healing and opportunities of reconciling.

I remember thanking him for the history of which I had no knowledge. I went on to indicate that I think language needs to be contoured to the time and situation and what might best express the reality as it needs defining now. I noted that I believe this is one of those times for a change in language just as he and his colleagues did some 30 years before.

I then returned to my argument that spiritual care better focuses on the dimension of a person’s being that the chaplain’s skills are uniquely intended to address. Spiritual care may or may not include religious care. At a time in society where spirituality and spiritual issues are at the fore, it seemed to me that spiritual was the word we need to claim for our profession.

Actually it was not my thinking alone. In the early 1990s, the Catholic Health Association, through Father Joe Kukura and Larry Seidl, had convened a “summit” of pastoral care leaders a few months before the above incident wherein we spent hours arguing the merits of both expressions. It was quite a representative group and the dialogue was lively. We went home from that Chicago meeting pretty much in agreement that—to use a timely metaphor—when our colleagues opened the sealed envelope the declared winner would be . . . spiritual care.

And so a lot of us began writing and speaking about spiritual care, and many of you locally would change the name of your institutional departments from pastoral care to spiritual care.  I am smiling now almost a decade later. Do you know why? I think we should return to pastoral care.

During my sabbatical while working on a manuscript for an upcoming book on spirituality and medicine, I was delineating a “menu of spiritual care services” so that others on the health care team could understand exactly what we offer to our patients, residents, parishioners, or clients. When I came to choose a term for “patient visitation,” the regular interaction with those to whom we minister (in contrast to more specialized services such as “ethical consultation” or “ministry to staff”), I realized the power of the term pastoral care.

Here’s what I wrote.

 . . . I would like to distinguish pastoral care provided by the professional chaplain from spiritual care provided by all members on the health care
team. Pastoral care is specific in its history, ecclesiastical or congregational authorization, training, skill sets, licensure, and patient focus. Spiritual care is general in that all have some greater or lesser responsibility for the spiritual
dimension of the person’s well being and health. Pastoral care is one specific kind of spiritual care.

I also reference the theological tradition out of which the term pastoral care has grown. Orlo Strunk, the managing editor of The Journal of Pastoral Care, in giving a history of pastoral counseling noted the three-fold dimension of ministry, “poimenics, homiletics and catechetics,” corresponded to the caring, preaching, and teaching dimensions of the Christian mission.* Pastoral care has deep roots in the tradition.

In addition to history and tradition, I have come to realize that if everyone is offering spiritual care, then what defines what the chaplain does that others on the team are neither called nor skilled to perform? For a long time some of us spoke of professional spiritual care in contrast to a general concept of spiritual care. My recent experience, however, particularly with the Harvard program, Spirituality and Medicine, is that the nurses, and now even physicians, will strongly claim that they are doing spiritual care, and further, at times, will not even reference the chaplain, never mind his or her unique competence in the field.

On the other hand, none of these professions can or do lay claim to pastoral care. Pastoral care emerges from the religious traditions, historically Christian, but now clearly interfaith in the ranks of the professional bodies.

Pastoral care is also highly symbolic. It is not simply the tending to the spiritual needs of a person. The pastoral care person, the chaplain, represents the religious tradition before he or she ever says a word or offers a gesture of support. The patient, resident or client (or even parishioner who is inactive or alienated), whether religious or not, knows that the provider is not merely a single individual with listening and responding skills, but the provider is also a whole community with traditions and rituals.

Our departments could still remain spiritual care departments for pastoral care is one specific mode of offering spiritual care, albeit at the level of the professional chaplain. We still oversee the spiritual care resources for the institutions in which we serve, that is, volunteers, Eucharistic ministers, and so forth. Certainly all of this needs ongoing discussion at this time in our history.

Our departments could still remain spiritual care departments, for pastoral care is one specific mode of offering spiritual care, albeit at the level of the professional chaplain. We still oversee the spiritual care resources for the institutions in which we serve, that is, volunteers, Eucharistic ministers, and so forth. Certainly all of this needs ongoing discussion at this time in our history.

So perhaps we need not wait the 30 years for the next change. Perhaps we need to realize that the ongoing challenge is to keep our minds and hearts open and lively in thinking, reflecting, and dialogue.

I indicated above that I smiled as I found change happening in my own thinking, reflecting, and dialogue. Though I don’t want to admit it, I think I was a bit smug when I was responding to the old man. I felt quite self-assured. After all I was a participant in this “summit” and we thought we had the answer. I also thought I handled his comment well—unspoken—that was good then, time to move on.

But I didn’t realize my own words would boomerang a few years later. The answer then may not be the answer now. And perhaps the term should remain spiritual care, though I am no longer of that opinion. Living in the optimism of the 1960s of great change and great hope in the Church and in society, many of us struggled with those that refused to change. A shadowy fear in my life has been that one day I could be that resister to change. I have always marveled at older men and women whose hearts and minds are still having visions and dreaming dreams. Men and women whose hands never cling and claw back to a rock-solid golden time, but rather whose hands let the waters of innovation and creativity flow over them and wash them anew

One of our priests in the association is that kind of person. Now in his late 70s, he has probably been a part of the fight for spiritual care, then pastoral care, then back to spiritual care. But he will read this and probably say, “You know, it is time to change again.” Do you know why? He’s a man who in his retirement contracted for spiritual direction with a lay woman, something unheard of in his earlier formation and priesthood. His enthusiasm and enjoyment are evident as he shares how rich the gift of insight and inspiration he feels he receives from the perspective of a woman guiding him and his life of prayer.

And perhaps 30 years hence—or even 10—that old man on the dais may be me standing there telling the same story as the next generation puts forth spiritual care with confidence and conviction.

And the envelope, please.

Pastoral Counseling Training at Central Philippines U

A new program is being started as a partnership between Central Philippines University (CPU), CPSP, and CPSP-PI. It is a doctor of ministry program in pastoral counseling and clinical pastoral supervision. The program is modular and done with instructors from both CPU and CPSP.

For more information, please see the Brochure at the following site:  BROCHURE

Clinical Pastoral Education and the Theological Training Institution

Clinical Pastoral Education/Training (CPE/T) seeks to integrate sound Psychological and CPE Baguio Batch Sept 2012Counseling principles with Theological insight and tools. As such, it is well suited to be part of the curriculum of theological schools. In fact, many religious denominations and schools require CPE/T as part of their ordination or graduation process. What are some of the options?

1.  Full Unit CPE/T Intensive. This is 400 hours over 8-12 weeks. This is full-time obviously, and can be done during summer break in most schools.

2.  Half Unit CPE/T. This is approximately 200-240 hours over 4-8 weeks normally. This is on the edge between part-time and full time. Generally, however, it will dominate the schedule of the trainee and so should be done with no other classes or requirements. Half-unit is suitable for schools that have a CPE requirement, but do not require the Full Intensive. CPE/T. This is commonly done during summer break, but can also be done other times of the year as well.

3.  Full Unit CPE/T Extended. This program is 400 hours over 16-26 weeks (depending on the agreement between trainees and supervisor). This program is primarily designed for professionals, allowing them to maintain their work/ministry while doing CPE/T. However, if extended over 26 weeks, the hours required per week end up under 20. Therefore, it can be an option for some theological students to do CPE/T while being an active student with other classes. If this is being done, it is beneficial that the CPE program and the theological school are in communication to ensure that there are no conflicts.

4.  Clinical Pastoral Orientation (CPO). This program is approximately 60 hours and designed to fit into a slot as a regular class at a theological school. In some ways, it is similar to a regular class in Pastoral Care and Counseling. The differences are the addition of Group process, Individual supervision, and practical chaplain work in hospital or other ministry point. The goal is to follow the learning objectives and methodology of CPE/T. To do so provides the self-growth found in regular CPE/T. It also allows a student to get a taste of CPE/T to determine if it might be of value to him or her.

NOTE: The first three programs are certified by CPSP (www.pastoralreport.com). The last one (CPO) is not certified by CPSP, however, it is being standardized by CPSP-PI, to ensure standards are being maintained at different school settings.

Embracing All We Are

We are blessed with a guest article. It is given to us by Barbara A. McGuire, the Registrar for the College of Pastoral Supervision and Psychotherapy. The original article is at http://www.pastoralreport.com, date July 5, 2011.

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Embracing All We Are —by Barbara A. McGuire

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“Sadness is not the opposite of happiness. It is one of the myriad ways in which we respond from our whole self to what life brings. It is a path toward healing life’s hurts. Let the anguish in your heart be heard”. A. Quezada

When someone we love dies, the body reacts with shock. The circulation slows, breathing is shallow and we become disoriented. After the numbness wears off, our bones ache and our muscles are sore. We have no interest in food and although we might feel exhausted when we go to bed, we often can’t sleep; or we sleep too much. This is how the body grieves. Grief affects our body, mind and soul.

Nonetheless, expectations are put upon the grieving within our Western society that encourage people to deaden their pain, avoid it or worse pretend it is not there. We are socialized to believe that when a loved one dies we are suppose to ‘get on with our lives’, ‘get back to normal’ or ‘get over our grief.” These mistaken beliefs create an environment for the grieving that is unrealistic. Yet these myths perpetuate throughout our society because they become part of the cultural belief system about the grieving process; they are inaccurate and wrong.

People will compare grieving to living through a long winter; where life lies dormant in those long, dark, cold months; feeling it impossible that one day there will again be spring. Despite the fact that many people have gone through this winter; they continue to devalue the importance and value of expressing feelings that accompany grief. Grieving and supporting the grieving involves work.

Societies unrealistic expectations and inappropriate response to normal grief reactions can make the experience worse than it needs to be. When a loved one has died and the person grieving hears unhealthy suggestions, it creates more confusion. The griever would have fewer conflicts about expressing their grief if those around them would promote the expression of these feelings. Promotion of feelings would allow for more realistic expectations about the grief process and acceptance of the expression of these feelings would help in the healing; creating less conflict for the griever. Dr. Candace Pert, a neuroscientist and pharmacologist, confirms the necessity of all emotions when she says, “…all emotions are healthy, because emotions are what unite the mind and body. Anger, fear, and sadness, the so-called negative emotions, are as healthy as peace, courage, and joy.” It is time for all clinicians to become a support to grievers, not an obstacle.

Why do we avoid this pain? As a culture we have been taught to run from the ‘bad’ feelings, which hold just as much if not more value than the ‘good’ feelings. My client’s fight back their tears, hold their breath and ‘suck it up’. Our culture teaches us that expressing our feelings is a sign of weakness. Yet the opposite is true! Clinicians need to encourage their clients to cry, shriek, scream, and wail. Our hearts are broken and it is in that weeping where our healing will begin.

Wouldn’t it be wonderful if we could openly express all the emotions we have been fortunate to receive? In conversation with psychotherapist and colleague, Perry Miller, I mentioned how, “As a culture we run from the ‘bad’ feelings which hold just as much, if not more, value than the ‘good’ feelings”. Perry replied, “I wish clinical chaplains and psychotherapists could embrace that truth rather than having to support and encourage at the expense of the substance of genuine expression of humanity and suffering from those whom they extend their care”.

I couldn’t agree more, this tension of opposites; your body tells you one thing and culture teaches something else. We want to cry but we hold back our tears. We feel one way but are taught to act in another.

Jung encourages us to, “Go into your grief for there your soul will grow”. As clinicians it is our role to assist clients in recognizing the soul work of grieving, just as nature’s work of renewal, cannot be rushed. Sometimes it is enough to bear witness. Or as T.S. Eliot eloquently said: “The faith and the hope and the love are all in the waiting.”

As clinicians it is our job to invite our clients into something new. We can only do so if we ourselves believe it. So let us not shrink from the darkness but rather, gathering strength from nature’s example, wait patiently and faithfully for spring.
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Barbara A. McGuire, LCSW works as a bereavement counselor for Hospice Care Network (HCN) in New York. She provided individual and group support to patient families at HCN. Barbara also provides these supports for members of the local community. Barbara is the registrar for CPSP.