The severely emotionally distressed: A conceptual framework and potential roles for clergy and church

The importance of the clergy in the treatment of emotional distress can not be overestimated. Yet throughout the literature, there is a curious absence of attention to the role of the clergy and church in aiding severely emotionally distressed persons, i.e., those manifesting psychotic symptoms. This study first presents a clinical conceptual framework within which the severely disturbed may be understood. Second, potential roles of the pastor in helping such persons are described, followed by an examination of several common clinical syndromes. Finally, models used by the church on national and local levels to aid the severely distressed are discussed.Dr. Holinger is on the staff of the Psychosomatic and Psychiatric Institute, Michael Reese Hospital, Chicago, Illinois 60616. The research which forms the basis for this paper was done when Dr. Holinger was at the Harvard University School of Public Health, Boston, Massachusetts.     

The church's response to the severely emotionally distressed

The clergy and church are deeply involved in aiding persons who have emotional problems. Many of those seeking help manifest psychotic symptoms. This paper addresses the issue of how organized religion can better understand and minister to the needs of those suffering severe emotional distress. Programs and models at national and local levels are discussed, with an emphasis upon the latter. Local level models include mental health promoting aspects of local church functions, pastoral counseling programs of the local church, the Wholistic Health Center (WHC), Community Organization for Personal Enrichment (COPE), Christian Action Ministry (CAM), and Mennonite Mental Health Services. Clinical vignettes illustrate the functioning of these models.This work was, in part, done at and supported by the Harvard University School of Public Health, Boston, Massachusetts.     

Out of the depths: Pastoral care to the severely depressed

The Judeo-Christian tradition has a unique and important contribution to make to the field of mental health. The knowledge gleaned from such sciences as psychiatry and psychology need not threaten the integrity of that tradition. Instead, a relationship with those disciplines can be mutually beneficial. One such instance is how Psalm 22 enhances our understanding of the experience of depression as well as informing our pastoral response.     

A potential peril of pastoral care: Malpractice

The pastoral counselor may be a full-time counselor trained in pastoral care or a clergyman with a congregation, who from time to time serves his flock as a counselor, ministering to the personal needs of his congregation in a manner designated pastoral care or perhaps, more appropriately, pastoral psychotherapy. Once a therapeutic relationship is established, a congregant acquires certain rights and the clergyman, duties. If these duties are breached due to the negligence of the pastoral counselor and this causes the congregant to be damaged in any way, the pastoral counselor may be liable and may be called upon to respond in damages. The cause of action is called malpractice. This paper isolates areas of actual and potential malpractice.Barton E. Bernstein, M.L.A., J.D., is in the private practice of law with Hochberg, Bernstein & Skor, P. C., Dallas, Texas.He has offered professional workshops throughout the United States and Alaska.     

Discrete varieties of care in the clinical pastoral tradition: continuing the dialogue

In the current cultural context, clinically trained ministers, lay and ordained, offer themselves to troubled souls through at least three distinct varieties of assistance: pastoral care, pastoral counseling, and pastoral psychotherapy. This essay delineates three accepted disciplines, emphasizing the importance of ascertaining, and perhaps re-evaluating, the particular needs and desires of persons who are in physical, mental, or spiritual distress. "Pastoral care," "pastoral counseling," and "pastoral psychotherapy" each play an important role in fulfilling the traditional mandate for "the cure of souls."     

Potential roles of the medical ethicist in the clinical setting

The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of consultant and patient advocate.     

AIDS and ARC: Pastoral issues in the hospital setting

Eight areas of fear for persons with Acquired Immune Deficiency Syndrome and its related conditions are explored: change and stress, uncertainty and the unknown, waiting, the fear of symptoms, fear of contagion, abandonment, dependency and spiritual distress. Some particular issues of sub-populations with HIV infection are detailed. Suggestions for helpful pastoral responses to the common concerns and anxieties of patients and their loved ones are offered.     

The practice of pastoral care: Revisiting the generalist

In a day of reliance on specialists, how can generalist practitioners like clergy be confident of the value of their contributions? The theoretical validity and practical implications of such religious resources as meaning, mystery, providence, values, grace, and community are discussed. Although various psychological schools of thought have also confirmed the importance of these dynamics, the clergy can validate them from within the discipline of religion itself. Thus, ministers as general practitioners in the community can work with self-confidence in cooperation with other mental health workers.     

An analysis of ethics consultation in the clinical setting

Only recently have ethicists been invited into the clinical setting to offer recommendations about patient care decisions. This paper discusses this new role for ethicists from the perspective of content and process issues. Among content issues are the usual ethical dilemmas such as the aggressiveness of treatment, questions about consent, and alternative treatment options. Among process issues are those that relate to communication with the patient. The formal ethics consult is discussed, the steps taken in such a consult, and whether there should be a fee charged. We conclude with an examination of the risks and benefits of formal ethics consults.     

Counselling in a Hospital setting: An introduction to the care project

Various research projects have investigated the efficacy of counselling in medical settings. To date, there is no conclusive proof that counselling is an effective form of therapy. But previous research projects have often been limited in scope and design, and have not represented an appropriate means of making an accurate assessment. The study introduced here seeks to establish whether or not group counselling is a therapy for patients suffering from rheumatoid arthritis. The research aims to use the most effective elements of both scientific and new-paradigm methodologies to determine whether atherapeutic relationship exists. The paper outlines the background to the research and describes its development so far.     

Pastoral care of the dying patient

Conclusion and Summary The ministerial role appears to involve four basic aspects or functions: personal, counseling, pastoral, and theologizing. In order to be a minister, one must be available as a fellow human, with some psychological skill, able to share spiritual or religious activity, and willing to articulate theologically to himself the meaning of his experiences for his personal faith. These aspects of the ministerial role are exemplified in the encounters of divinity students with disabled and dying patients. Because of the challenge that life presents to sincere faith, and because one or more of the four functions are often stressed in an isolated way, offensive stereotypes of the minister are pervasive. p ]Abhorrence of being identified as such a person made the ministerial candidates in this report reluctant to act or even speak in any religious way. The desire to become a psychologist or counselor and avoid theological topics, strong in the beginning, tended to disappear toward the end of the year. These phenomena were seen as natural phases of sequential growth in the struggle to understand the needs of other persons for a minister. As shift from self-concern to concern for the other occurred, the students became more open to learning from the patients how human and religious needs can be served without desecration to either.