A national survey of health care administrators' views on the importance of various chaplain roles

A random sample of hospital administrators throughout the United States was surveyed about their views on the importance of eleven chaplain roles and functions. The 494 respondents fell into three categories: (1) directors of pastoral care departments (N = 132); (2) administrators of hospitals that have a pastoral care department (N = 180); and (3) administrators of hospitals that do not have a pastoral care department (N = 182). All three groups considered all eleven roles to be relatively important, although administrators of hospitals that do not have a pastoral care department gave lower ratings, overall. Meeting the emotional needs of patients and relatives were seen as chaplains most important roles, whereas performing religious rituals and conducting religious services were seen as least important by all three groups. In all but a few instances, the level of importance that administrators assigned to the various roles were positively related to their ratings of their own religiousness and spirituality (r's = .11 to .26, p < .05).     

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."     

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.     

Pastoral care and AIDS: Assessing the stress and satisfaction from caring for persons with AIDS

Members from religious communities in New York City (17 men, 8 women) who volunteer pastoral care to persons with AIDS completed and returned through the mail the (AIDS) Caregiver Scale and the Attitudes toward AIDS Scale. Results indicated that satisfaction from providing care was related to pastoral training, an understanding of the spiritual nature of death, and a positive attitude toward persons with AIDS. Self-reported stress from providing care was inversely related to pastoral training to deal with death. The pastoral volunteers also reported greater satisfaction and lower stress from caregiving than volunteer buddies from upstate New York.     

Where there's life,There's hope,and where there is hope,there is...

Using the Hearth Hope Index, we describe the level of hopefulness among hospital patients and compare it to that reported by community persons and family members in a surgical waiting room. We also correlate these results with depression and self-esteem scores. As measured by these selected instruments, the results suggest that the level of hopefulness is not significantly different among the three samples, that it is positively correlated with self-esteem and negatively associated with depression, and that, among the demographic variables, only the respondent's age and frequency of attendance at worship significantly influence hope scores. The results suggest that pastoral caregivers can encourage hopefulness among those under their care by bolstering self-esteem and giving attention to depressive symptoms. They also suggest that those who need the most pastoral support are younger adults with limited education. Pastoral caregivers can use these results, we think, to inform their work in giving pastoral care.     

Providing Pastoral Care for the Elderly in Long Term Care Facilities Without a Chaplain Utilizing Coordinated Congregational Resources

Elderly persons living in long term care facilities are often separated from or have no pastoral care sources. Spiritual care by chaplains was not available in any of the six nursing homes in Wausau, Wisconsin. Twelve Lutheran congregations in the area worked out a plan to provide the necessary pastoral care. The congregations formed a coordinating agency, Greater Wausau Christian Services, Inc. Through the services of one staff person, the director, who enlisted the lay and pastoral resources of the participating congregations, pastoral care was provided. Worship led by the pastors, meaningful visits made by trained and supervised lay people, and the availability of a trained chaplain became a reality for nearly seven hundred residents in the six long term care facilities.     

Mapping the terrain of pastoral psychology

Pastoral psychology has, over the course of the past century, undergone substantial transformation. Changes in the territory warrant, if not require, a thoroughly revised map. This essay approaches pastoral psychology as an interdisciplinary enterprise, a bridge discipline unifying three diverse, integrally related angles of vision: as a specialized field of theology (or theological studies), a specialized field or kind of psychology (or psychological studies), and a practical-clinical enterprise. The need to systematize the field as well as demonstrate its complex relations with cognate areas recommends approaching pastoral psychology, ultimately, as theological: as a dimension of pastoral theology, a kind of practical theology, which integrates practice-theory (praxis) and research; involves religious-theological and psychological domains of experiences, patterns of behavior, and forms of reflection; and maintains a focus on the understanding and care of persons across intrapsychic, familial, community, and cultural levels.     

Praying with those who might forget: pastoral considerations with memory impairment

This article gives an account of a person who had memory impairment and received pastoral care, with an emphasis on pastoral needs and prayer. The author provides a first-hand account addressing both sides of the pastoral care interaction. She experienced years of memory impairment comparable to mild to moderate Alzheimer's Disease. Now, however, she is a seminarian. She provides a detailed account of pastoral care received during the time of memory impairment and considers both the visiting pastor's intent and the author's recollection of the prayer and pastoral care received. Part of the uniqueness of this account is that persons with memory impairment do not usually regain their cognitive functioning and then also obtain pastoral education from which to provide the guidance gained as both patient and pastor.     

Connection to Early Church Theologians: Canadian Ethnographic Study on the Similarities and Differences between Prayer and Theological Reflection in Pastoral Care and Counseling

What are the similarities and differences between prayer and theological reflection in the praxis of pastoral care and counseling? This qualitative study is ethnographic in design. A review of the literature is summarized. Researchers interviewed 75 participants in four cultures: (1) chaplains and (2) pastoral counselors in the Canadian Association of Pastoral Practice and Education (CAPPE), (3) community clergy and persons in lay ministry, and (4) students after internship in a theological reflection course. Interviews were audiotaped, transcribed and then coded for themes. Findings include seeing more similarities than differences between prayer and theological reflection. One of the differences is that prayer is more affective and theological reflection is more cognitive. There are also some areas of ambiguity. Discussion includes what ought to be normative or the orthopraxis for prayer and theological reflection in pastoral care and counseling. Limitations and areas for future research are outlined.     

Dual Relationships and Pastoral Counseling: Asset or Liability?

Dual relationships are proscribed in the standards of ethical conduct for most professional groups that provide counseling or psychotherapy. Dual relationships are thought to be unethical because they cloud the clinical judgment of the counselor and may present conflicts of interest that prevent the counseling relationship from being beneficial. Pastors frequently provide counseling for troubled persons or families, yet they often maintain other roles and relationships with these persons and families. This article addresses the issue of the inevitability of dual relationships in pastoral counseling. Courses of action for handling dual relationships in pastoral counseling are identified.     

Same-sex attraction, homosexual orientation, and gay identity: a three-tier distinction for counseling and pastoral care

Given recent prevalence estimates most pastoral caregivers and counselors will work with persons who experience same-sex attraction (SSA). Many of the people who experience SSA will report such a consistency in the directionality and intensity of their attractions that they think of themselves as having a homosexual orientation. Others will integrate their experiences of SSA into a gay identity. What can facilitate pastoral care and counseling is an intentional use of this three-tier distinction: experiences of SSA, homosexual orientation, and gay identity. A discussion of this three-tier distinction is followed by specific suggestions for utilizing this conceptual framework as a resource in pastoral care and counseling.     

An adttechment-dtheoretical perspectice on the use of splitting defences

The present investigation examined relationships among childhood emotional bonds with parents, current stress, adult attachment styles and the tendency to employ splitting defences within a nonclinical sample of college students. Our jindings indicated that (a) participants' childhood recollections of parental care and warmth had a significant, although modest, direct effect on splitting scores and (b) controlling for early parental care, both current Stress levels and adult attachment styles had significant direct and interactive effects on splitting scores. In general, secure and dismissive students evidenced significantly lower splitting scores than did their preoccupied and fearful peers; however, when the splitting scores of distressed and nondistressed participants within each attachment style group were compared, only distressed persons in the three insecurely attached groups exhibited modestly to prominently elevated splitting scores. Implications of our findings to counselling practice are discussed.     

The clergy as advocates for the severely demented

The author sets forth the argument that pastoral caregivers ought to consider expanding their traditional role of ministering to dementia patients by pressing the issue of whether appropriate medication might significantly lessen the suffering of these persons. After discussing and documenting the current understanding regarding the nature of pain, the author outlines several advocacy, ethical, and procedural issues that could be included in providing pastoral care to this population, at the same time not miminizing more traditional faith-based activities.     

Erikson's life cycle theory and images of God

Human life is a God-ordained pilgrimage by which persons travel toward ever-expanding images of God that emerge from the universal pattern of developmental crises. Using the work of Erik Erikson on the human life cycle and the work of Donald Capps on human sin, the author presents a way to conduct pastoral diagnosis and to provide pastoral care. By accurately tracing a person's images of God back to their potentially unresolved developmental crises, the pastoral caregiver can reopen opportunities for further and healthier resolution of the crises.     

Roles for the Black pastor in preventive medicine

In recent years, a new role for Black pastors has emerged. As agents of health-related social and behavioral change, Black ministers have taken active roles in preventive medicine at the tertiary, secondary, and primary levels of prevention, succeeding despite resistance by some physicians. The literature detailing these new health-related pastoral roles is reviewed, with special reference to the place of the Black Church in health care and to the place of the Black pastor in the Black experience. It is concluded that Black ministers are ideal people to take part in planning, promoting, and delivering preventive health care in the Black community.The author wishes to acknowledge Dr. John W. Hatch of the University of North Carolina School of Public Health, who supervised the preparation of an annotated bibliography upon which this paper is based.     

A Jungian Perspective on Therapy at the End of Life

This paper explores the insights of Carl Gustav Jung with respect to pastoral care and counseling. Particular focus is given to a reading of the theorist that raises the possibility for, and challenge of, pastoral psychotherapy at the end of life. Jung's writing offers an important lens for examining a critical challenge of our age–the means by which pastoral caregivers assist persons to live fully and meaningfully even at life's end. The author asserts that the role of the pastoral caregiver is crucial for helping people to bring their own lives to completion. has served as hospice chaplain, parish pastor, and campus minister. Currently, he is a Ph.D. student and CPE supervisor-in-training at Claremont School of Theology and Methodist Hospital of Southern California.     

Representing the Good: Pastoral Care in a Secular Age

In ‘a secular age’ (Taylor 2007), pastoral care is no longer exclusively associated with specific religious traditions and communities. Pastoral caregivers who work in secular institutions provide care to religious and nonreligious people alike, and in several Western societies the term pastoral care is used in relation to nonreligious (humanist) care. In secular contexts, the term ‘pastoral care’ is often replaced by the term ‘spiritual care.’ Spiritual care, however, is provided by various professionals, so pastoral caregivers face the challenge of developing adequate and convincing language to explain what is distinctive about their work. In this article, the authors turn to philosophical language in order to develop a conceptual understanding of pastoral care that does not depend on the specific worldview—religious or nonreligious—of either pastoral caregivers or receivers of pastoral care. Using the work of Taylor (1989, 2007) and Murdoch (1970), we explain pastoral care as engaging with people’s attempts to orient in ‘moral space’ and the distinctive quality of pastoral care as ‘representing the Good.’ Murdoch associates ‘the Good’ with a secular idea of transcendence that is both a movement beyond the ego and an engagement with the reality of human vulnerability, suffering, and evil. We argue that pastoral caregivers who ‘represent the Good’ have the task not only of supporting the existential and spiritual processes of individuals but also of promoting dialogue and social justice and of critiquing dehumanizing practices in the organizations in which they work and in society at large.     

Pastoral Care of Political Discourse: Shepherding Communication

I argue that the tradition(s) of pastoral care contributes to our understanding of Christian discipleship vis-à-vis political discourse. In particular, I understand pastoral care, in part, as shepherding political discourse. To care for and about political discourse involves a radical openness to the Other, which is made possible by the virtues of hospitality, compassion, humility, and forgiveness. The primary pastoral aim in shepherding political discourse is not the realization of political power or the realization of Christian beliefs through rhetorical coercion, evangelical assimilation, or consensus. Positively, the aim of pastoral political discourse is to shepherd the communicative processes such that there is a possibility of real meetings.     

Spiritual advisors and old age psychiatry in the United Kingdom

This survey investigates the role and views of NHS spiritual advisors across the United Kingdom on the provision of pastoral care for elderly people with mental health needs. The College of Health Care Chaplains provided a database, and questionnaires were sent to 405 registered NHS chaplains/spiritual advisors. The response rate was 59%. Quantitative and qualitative analyses were carried out. Spiritual advisors describe their working patterns and understanding of their roles within the modern NHS, and their observations of the level of NHS staff awareness of the importance of spiritual issues in the mental health care of older adults. They provide insights into possible negative and positive perceptions of their roles at a service level, and contribute suggestions of topics relevant to shared education between pastoral care and clinical services. This survey further highlights ethical and operational dimensions at the point of integration of the work of spiritual advisors and multidisciplinary teams.     

The Abuse of Power: A View of Sexual Misconduct in a Systemic Approach to Pastoral Care

The article explores the dynamics of transference and countertransference in hierarchical relationships which exist between clergy and lay persons, both in the parish setting, as well as in the pastoral counseling relationship. It is of utmost importance that the power differential be consciously acknowledged by pastoral caregivers so that appropriate boundaries can be exercised. All too often it is the negligent, careless, or unconscious disregard for this power dynamic by individuals providing pastoral care that has led to the sexual violations recently surfaced within our religious institutions. Acknowledgement of the imbalance of power, and its consequences for both clergy and parishioner, is essential in a systemic model of pastoral care.