The parish clergy as a mental health resource

Summary This paper presents observations on the assets and liabilities of the parish clergy as a mental health resource within the community. These observations are drawn from a ten-year program of continuing education for cleargy in mental health, which focuses on daily pastoral experience. The parish setting is similar in many respects to the service area of a community mental health center. The clergy's assets often include availability, experience, tradition, and the special significance of the religious leader. Inadequate training in mental health skills and the complex demands of parish life are among the problems confronting the clergy in this area. On the whole, the pastoral role offers a unique and highly useful opportunity for positive psychological intervention.The work described in this paper has been supported in part by National Institute of Mental Health grant no. MH-11929-01 and by grants from the Cleveland Foundation and the Grant Foundation, Inc., and the Cuyahoga County Board of Mental Health and Mental Retardation.     

A Cross-Cultural Case for Convergence in Pastoral Thinking and Training

This article argues for convergence of pastoral training models as a consequence of the pluralistic nature of contemporary life. It proposes a more active partnership between pastoral disciplines in an attempt to bring wholeness to pastoral service and to pastoral education in a multicultural context. Pastoral counseling, pastoral care and pastoral ministry are presented as mutually complementary and as under girded by the same pastoral theological principle of genuine encounter. Since pastoral theology is informed by personal experience, the author illustrates his points by reference to personal cross-cultural experience. This article is an adaptation of a paper delivered at a multicultural conference in Seoul, Korea in November 2008.     

Environmental risk factors in hospital suicide

Suicide of hospitalized patients is the most common sentinel event reviewed by The Joint Commission on Accreditation of Healthcare Organizations. Shorter lengths of stay, sicker patients, and higher patient to staff ratios challenge the ability of the hospital to maintain safety. Risk factors associated with the physical environment of the inpatient psychiatric unit, cited as the most common root cause of inpatient suicide, may be neglected because evaluation of these factors is generally not included in medical education and training. Minimization of fixtures that can facilitate strangulation and other high risk aspects within the hospital environment is an important element in the prevention of suicide on psychiatric units.     

Can pastoral counselling recover its roots in madness?

Modern pastoral counselling had its origins in North America in the experience of people, who suffered from psychiatric illnesses and who believed them to be spiritual crises, which would respond to pastoral care. In the United Kingdom many of those involved in the foundation of the pastoral care and counselling movement also worked in psychiatric hospitals. In both Europe and America pastoral counselling has largely forsaken its roots in psychiatry. However, recent research amongst mental health service users/survivors reveals how important spiritual care and counsel are and how few resources are available to provide this service from psychiatry, religious organisations or secular counselling services. The results of three research projects in Somerset are described and the significance of the recovery of pastoral counselling to fill the vacuum of spiritual care is explored.     

Helpline: suicide prevention at a suicide site

In an effort to reduce the number of suicides from the Mid-Hutson Bridge in Poughkeepsie, New York, the Dutchess County Department of Mental Hygiene and the New York State Bridge Authority jointly established a suicide prevention phone on the bridge, which is directly connected to a 24-hour psychiatric emergency service. This program is the first known one in which a dedicated suicide prevention helpline has been installed at a site of known suicides and linked with a mental health service. After 2 years of operation, the phone has been used 30 times; the data suggest that most would-be jumpers are ambivalent enough about dying that they will reach out for help/contact if the opportunity exists, and, as a consequence, can be saved.     

Pastoral counseling training: training goals in a changing environment

Pastoral counseling training is redefining itself in a changing environment. Theological education and ordination and church relatedness once was the crucible that shaped pastoral counselors. Today that formation process is being redefined as an increasing number of non-theologically trained students who are not seeking ordination come to increasingly fewer pastoral counseling training programs for formation in integrating spirituality and psychotherapy. This article outlines a statement of who an ideal intern would be in one pastoral counseling training program, lists fourteen goals of the training program along with the method of achievement, and who in the training program is responsible to see that the goals are accomplished.     

Fieldwork Journal at F.E.G.S.

SUMMARY

The challenge of working with the mentally ill population on the first Level I fieldwork exposure is often experienced in a setting where the on-site supervisor is a therapist from another discipline. Many skilled mental health professionals can offer a rich learning experience and assist students in mastering generic clinical skills in relating to and understanding the psychiatric population. Occupational therapy students bring to this clinical relationship the opportunity to demonstrate the effectiveness of occupational therapy interventions through group work, and individual evaluation and treatment, which benefits both the clients and the larger program. This article recounts the journal of a Level I student's journey through a setting that provided a receptive environment for fostering growth in the process of becoming truly comfortable and effective in the skills and roles of an occupational therapist in a mental health environment.     

Genetic Counseling Supervisors’ Self-Efficacy for Select Clinical Supervision Competencies

Supervision is a primary instructional vehicle for genetic counseling student clinical training. Approximately two-thirds of genetic counselors report teaching and education roles, which include supervisory roles. Recently, Eubanks Higgins and colleagues published the first comprehensive list of empirically-derived genetic counseling supervisor competencies. Studies have yet to evaluate whether supervisors possess these competencies and whether their competencies differ as a function of experience. This study investigated three research questions: (1) What are genetic counselor supervisors’ perceptions of their capabilities (self-efficacy) for a select group of supervisor competencies?, (2) Are there differences in self-efficacy as a function of their supervision experience or their genetic counseling experience, and 3) What training methods do they use and prefer to develop supervision skills? One-hundred thirty-one genetic counselor supervisors completed an anonymous online survey assessing demographics, self-efficacy (self-perceived capability) for 12 goal setting and 16 feedback competencies (Scale: 0–100), competencies that are personally challenging, and supervision training experiences and preferences (open-ended). A MANOVA revealed significant positive effects of supervision experience but not genetic counseling experience on participants’ self-efficacy. Although mean self-efficacy ratings were high (>83.7), participant comments revealed several challenging competencies (e.g., incorporating student’s report of feedback from previous supervisors into goal setting, and providing feedback about student behavior rather than personal traits). Commonly preferred supervision training methods included consultation with colleagues, peer discussion, and workshops/seminars.     

Provision of spiritual and pastoral care facilities in a high-security hospital and their increased use by those of Muslim compared to Christian faith

The relationship between religion and psychiatry remains controversial amongst British psychiatrists. We looked at the provision of spiritual and pastoral care facilities in a high-security hospital and the role of faith chaplains with particular reference to the Muslim minority group. There was a significantly higher uptake of pastoral care services amongst those of Muslim faith compared to Church of England and Roman Catholic Christians. Possible reasons for this are discussed. Resources allocated for the Muslim faith group were limited and heavily dependent on the availability of the Muslim faith chaplain. Our study highlighted the need for clearly defined standards for the provision of spiritual and pastoral care within high-secure psychiatric hospitals, and by implication other NHS psychiatric settings, a re-examination of the role of the faith chaplain in relation to the clinical team, and raised questions about the equitable allocation of resources between various faith groups within the hospital.     

Dragon talk: providing pastoral care for Chinese immigrants

This article describes how cultures and pastoral care education processes can be barriers between the patient, the pastoral caregiver, and the Clinical Pastoral Education (CPE) student. By providing sketches of interviews with Chinese patients, the author tries to explain why the attempt to unveil Chinese patients' feelings and needs through conversation can be a frustrating experience. Moreover, the author argues that the pedagogy of pastoral care education ought to be more culturally sensitive in regard to the diverse cultural backgrounds of both patients and CPE students.     

Family interaction and acting-out behavior of adolescent psychiatric patients

Although the literature has described how families reinforce and contribute to acting out by adolescents, this phenomena has not previously been studied within the psychiatric hospital. The present study systematically investigated whether family interaction influences the acting-out behavior of hospitalized adolescent psychiatric patients. Data was collected from the clinical charts of 94 adolescents, each hospitalized for over 30 days. The results supported the contention that families do contribute to acting out in the hospital. However, a majority of the acting out was not directly related to family contact. The research highlights how the hospital can serve to offset negative influences by engaging the family in treatment and by considering family contact during treatment planning.     

The role of the church in the community based care of the chronically mentally disabled: Reclaiming an historic ministry

The perplexing circumstance of the chronically mentally disabled in the community poses both a challenging ministry and significant learning opportunity for the church. Historically the church once served as a primary resource in their community life. When care shifted to the hospital in the nineteenth century, chaplains then ministered on behalf of the church. The institutional setting later spawned the clinical training and pastoral care movement, the mental patient an essential teacher and beneficiary. With the locus of care having recently returned to the community, the church can now provide social, pastoral and spiritual resources, collaborate in deinstitutionalization with the mental health delivery system, and return to a ministry of learning with the less resourceful.The Reverend Anderson serves as Chaplain Supervisor, Connecticut Mental Health Center, Box 1842, New Haven, Connecticut 06508, and as a Lecturer in Pastoral Theology at Yale Divinity School. The author wishes to thank Dr. Donald H. Williams and Fr. Henri Nouwen for their advice and encouragement during the preparation of this article.     

Training in clinical ethics: launching the clinical ethics immersion course at the Center for Ethics at the Washington Hospital Center

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. "Immersion" refers to a high-intensity clinical ethics experience in a busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients' charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants' evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics.     

Reflections for Clinical Pastoral Education Students in Psychiatric Settings

This article focuses on Donald Capps’s books on mental illness. In doing so I highlight three key insights from Capps that I have applied in my own ministry with persons with mental illness in various psychiatric hospitals. These insights, together with my own experience as a chaplain, lead to three practical lessons for clinical pastoral education students in psychiatric settings. I provide some context for my interest in mental illness and my friendship with Capps, as well as some background regarding how Capps’s writings on mental illness fit with certain broader themes in his own work as a pastoral theologian. This essay is personal throughout.     

Getting lost

This paper seeks to explore the process, challenges and journey of setting up counselling within a boys’ public school setting, as an independent practitioner. It looks at the structure and way in which the service was set up and what had to be changed and adapted as time went on. The school had a strong reputation for pastoral care but had come to recognise that there were some issues that it was neither possible nor appropriate for school staff to deal with. So, whilst the school could and did provide containment for many of its pupils, there were those who got lost or were outside of the culture. This seemed to get reflected in my own experience. Setting up counselling in a school is not straightforward, and like the process of therapy itself, it takes time and is not a linear process. Although the service grew steadily, there were factors that led to my finally resigning from the post – I also got lost in the system. There is also a comparison with setting up a service under the auspices of an organisation at the same time.     

内科实习医生医患沟通经历的调查分析

实习医生在医院里扮演着特殊角色,既要作为学生在临床实践中学习医学知识,又要作为医生在患者面前从事医疗工作。因此,培养医学生医患沟通能力,引导其建立和谐的医患关系,成为临床带教老师面临的一项严峻而又刻不容缓的任务。本研究针对内科实习医生在医院沟通中的典型案例进行了调查,从而了解实习医生在医患沟通中的经历,以及他们对原因的分析、处理方法及对自身的影响,进而了解实习医生对沟通技能培训的需求。     

Social skills training with hospitalized adolescents: an evaluative experiment

The effectiveness of social skills training on adolescent males admitted to a psychiatric hospital was evaluated through the use of empirically derived anger scenarios, blind raters, matched experimental and control treatment groups, and a repeated measures analysis. Results indicated that the social skills training effectively improved the dimension of verbal response and eye contact. Facial expression did not show measurable improvement. The use of specific skills components and scoring criteria in the social skills training was emphasized. Overall, support was found for the efficacy of social skills training for hospitalized adolescents.     

The making of a group psychotherapist: Needs and goals for graduate and postgraduate training

Group therapy is a widely practiced, effective, but underrated specialty. Unfortunately, group therapy seems to be taught more haphazardly, with less attention to quality, than is individual therapy. Group therapy has a technique, history, and literature of its own and should be taught independently from individual psychotherapy. The training of psychiatric residents is particularly crucial for group therapy to prosper and be seen as more prestigious. A common core of experience is vital for training in group therapy, whether the trainee's background is psychiatry, psychology, social work, pastoral counseling, or nursing. This core consists of: 1) clinical experience doing group therapy; 2) supervision; 3) a professional training group experience; 4) observation of experienced group therapists; 5) exposure to current thinking in the field; 6) personal group therapy; and 7) a didactic course in theory and technique. Clinical experiences involving cotherapy and combined individual and group treatments are especially useful, both as training and as treatment modalities.He is on sabbatical leave from John Jay College of Criminal Justice where he is Professor of Psychology and was founding Chairman of the Psychology Department.The authors wish to thank Arnold Rachman, Ph.D., Michael Lapidus, M.D., Fayek Nakhla, M.D., Nyapati R. Rao, M.D., and Dorothy Gartner, Ph.D., for their helpful comments on earlier versions of this paper, and Ms. Deloris J. Johnson for her typing and editorial assistance.