Seeing the Unseen: Pastoral Insights Drawn from James Turrell’s Artwork

According to Charles Sanders Peirce’s framework of semiotics, an individual’s life can be regarded as a work of art that as a sign continuously generates meaning by using various life experiences as its art materials. Here the individual plays a role both as an artist and as a viewer of his or her life. This semiotic implication of one’s life reshapes the general goal and function of pastoral care and counseling. In terms of art, the pastoral caregiver’s role is defined as that of a curator who facilitates the overall environment for aesthetic experience by helping an individual to see the unseen in his or her life as a work of art and does so in a didactic but unobtrusive way. As an example, a series of James Turrell’s art installations suggests how the role and function of the pastoral caretaker can be redefined. This aesthetic perspective also reflects the existential and psychospiritual dimensions of pastoral care and counseling.     

Phenomenology and pastoral care

The author discusses phenomenology as a potential resource for pastoral care generally and then illustrates its implications in two specific areas of pastoral care. After a brief discussion of the development of phenomenology, he defines pastoral care and identifies its methodological problem. Phenomenology, it is argued, offers potentially helpful methods and interpretative categories in its attitude, its attempts at self-aware, ordered discernment, and its anthropology. It serves to militate against the temptation in pastoral care to understand human problems in terms of individual and social pathology, in the case of individuals, and to illumine the ways the community functions as a dimension of pastoral care.He is the author ofEcclesial Man.     

The interactive effects of request form and speaker status on judgments of requests

The interactive effects of request form and speaker status on judgments of requests were investigated in a laboratory study of metapragmatics. College students (N=132) read scenarios in which speakers made requests of them. Speakers were higher in status, peers, or lower in status than the subjects, and the requests were imperatives with semantic aggravators, embedded imperatives, or permission directives with semantic softeners. Subjects rated the speakers with respect to how rude/polite, humble/arrogant, and powerful/weak they were being. Significant interactions were obtained for the first two ratings, indicating that the speaker status effect was stronger with permission directives than with the other requests. These findings suggest that listeners view unexpectedly indirect requests as more impolite and sarcastic than requests used in other situations and, more generally, that language meaning is a function of both form and context.     

Linda

We tend to define pastoral care and medical intervention in very limiting terms. Too often we are more concerned with the delivery of the product than we are with the manner in which it is received. This paper looks at the experiences of a young woman with cancer and how she sought a certain personal component to the pastoral care she received and the medical treatments she was willing to accept. She fought to be treated as an individual, to be respected as a person with her own values, and to be given the right to make her own choices. This paper is presented from the patient's perspective.     

What Makes Care Pastoral?

This essay argues for including two principal foci in both research and practice within pastoral theology. These foci include the care of souls (soul care) and care offered against the backdrop of “the Christian story.” The distinctiveness of pastoral care, as compared with other types of care, is also discussed.     

Routine HIV testing of hospital patients and pregnant women: informed consent in the real world

The Centers for Disease Control and Prevention (CDC) has recommended that HIV testing be routinely offered to certain patients in hospitals with a high prevalence of HIV infection and on all pregnant women. The CDC does not, however, offer implementation level guidelines for obtaining informed consent. We provide a moral justification for requiring informed consent for HIV testing and propose guidelines for securing such consent. In particular we argue that genuine informed consent can be secured without elaborate counseling, such as that currently used at Counseling and Testing Sites, provided that sufficient written notice is given to the patients before testing and that they are specifically asked for permission.     

Resource dilemmas with environmental uncertainty and asymmetric players

Groups of subjects participated in a series of 30 noncooperative independent single-trial resource dilemmas. On each trial the subjects in each group requested privately a number of points from a common pool. Individual requests were granted if and only if the total group request was equal to or smaller than the pool size. The pool size on each trial was sampled randomly from a uniform distribution that was common knowledge. Asymmetry in payoff was induced by assigning to each group member a different points-to-money exchange rate. The results show that as the uncertainty about the pool size increases subjects (1) overestimate the pool size, (2) increase their requests, and (3) expect others to increase their requests. In addition (4) individual requests and expectations regarding others' requests are inversely related to the exchange rates, reflecting attempts to equate payoffs across group members.     

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

Protection of children's rights to self-determination in research

Federal guidelines require that informed consent be obtained from participants when they are enrolled in a research study. When conducting research with children, the guidelines utilize the term permission to describe parents' agreement to enroll their children in a study. The basic components of consent and permission are well described and identical, with the exception of the person for whom the decision to participate is being made (i.e., oneself as opposed to one's child). Beyond permission, when enrolling minor participants in research, affirmative agreement to participate in research or assent must be obtained from the child participants themselves. The concept of children's assent to research, however, is poorly defined, resulting in inconsistency in its pursuit and consequently, in its utility. The interface between cognitive development, emotional, and social development must be examined as its pertains to this special situation of decision making. For this process to meaningfully protect minors, the assent process must be clarified, decisions regarding parental veto power must be more convincingly justified, and researchers must be better educated and held accountable for the valid execution of this process. Strategies for implementing the assent process more effectively are presented.     

Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

Therapeutic turn

This paper offers a systematic and critical exploration of contemporary theology of pastoral care in the Evangelical Lutheran Church of Finland in light of the history of the practice of care-giving and Western cultural change. Currently, pastoral care is characterized by a therapeutic approach that aims to offer sincere help for earthly suffering and to promote the good things that the individual chooses to reach for. This has been drastically different than historical models from Luther to the early twentieth century that were spiritual and paternalistic in nature. The therapeutic turn connects to the therapeutic culture that has set self-actualization as a central idea determining Western cultural ethos. The therapeutic approach calls into question how the spiritual task of the church is carried out. The prevailing pastoral-psychological theology of pastoral care proves to be problematic. The spiritual task of pastoral care should be based on the basic Lutheran theology of God as objective and not conditioned upon the human mind. Yet, the therapeutic aim should still be maintained as the basic approach of care.     

Should protections for research with humans who cannot consent apply to research with nonhuman primates?

Research studies and interventions sometimes offer potential benefits to subjects that compensate for the risks they face. Other studies and interventions, which I refer to as “nonbeneficial” research, do not offer subjects a compensating potential for benefit. These studies and interventions have the potential to exploit subjects for the benefit of others, a concern that is especially acute when investigators enroll individuals who are unable to give informed consent. US regulations for research with human subjects attempt to address this concern by mandating strict protections for nonbeneficial research with subjects who cannot consent. Typically, humans who cannot consent, such as children, may be enrolled in nonbeneficial research only when it poses low risks and has the potential to gather information of sufficient value to justify the risks, an appropriate surrogate gives permission on the individual’s behalf and the individual agrees (assents). In contrast, US regulations for nonbeneficial research with nonhuman primates do not include these protections, even though it too involves subjects who cannot consent and who face risks for the benefit of others. Is this difference in regulatory protections justified? Or does the principle of fairness—treat like cases alike—imply that regulations for nonbeneficial research with nonhuman primates should include protections similar to those that apply to nonbeneficial research with humans who cannot consent?     

The Pastor and Bioethics

This essay presents bioethics or ethics in health care as a challenge to pastors. Common professional struggles are experienced by pastoral and health professionals. Thus, first, we need to consider the meaning of being a professional especially as pastors. Second, pastors might explore at least four specific medical issues: namely physician-assisted death or euthanasia, complementary or alternative treatments, the exercise of consent to medical procedures by patients or parishioners and families, and the crucial need for the donation of vital organs to save lives. Embedded within all four issues, there is a significant religious concern which requires the pastor's expertise.     

Pastoral counselling in Britain: an introduction

A brief historical survey is given of the development of pastoral counselling in Britain. The positive contribution and qualities of the British pastoral counselling movement are acknowledged, but it is also recognised that the pastoral counselling scene in Britain is deeply fragmented and the causes of this fragmentation are briefly discussed. The articles in this symposium are welcomed as a sample of current thinking within British pastoral counselling. Four of the articles are fundamentally concerned with the nature and identity of pastoral counselling as a discipline, and another two explore specific elements of therapeutic practice (namely, prayer and forgiveness) that are historically associated with pastoral care. The presentation of original empirical research within some of these articles is also welcomed as a constructive development in the context of British pastoral literature.     

Eavesdropping on the 50-minute hour: managed mental health care and confidentiality

This article discusses managed care, recent case law developments, and the legal basis of confidentiality in the patient-therapist relationship. It discusses how managed care intrudes into the confidential treatment relationship with prospective and retrospective utilization reviews. Some of the areas adversely impacted include public policy, the patient-therapist relationship, and informed consent. In order to be a program in the interest of patients and not simply cost containment, managed care must accommodate patients' reasonable expectations of confidentiality. Suggestions are delineated for the protection of confidentiality by managed care, including expanding the duty of confidentiality to managed care, obligating managed care to secure patients' informational privacy, obtaining informed consent to disclose as little information as necessary, and involving the patient in the cost containment and quality assurance process.     

Poetry as a therapeutic avenue

The significance of poetry in the context of pastoral psychology has not, as yet, received the attention it has in professional psychoanalytic literature. The authors of this series (eventually to be published at book-length) provide a terse but extensive review of such research, underscoring the therapeutic value of symbolic,intrapsychic artistry. Religious ideation, as well as other intrapsychic expressions, are incorporated by means of personal therapeutic situations focused on a patient's or client's poetry. With permission, these poems are quoted directly. From this data and their clinical experiences, the authors set forth two modes for considering unconsciously defensive or consciously self-disclosive uses of written poetry in and during psychoanalytic pastoral counseling or psychotherapy.Dr. Christensen is in the private practice of psychiatry, Northbrook, Illinois. He holds senior academic positions at the medical schools of Northwestern University and the University of Illinois, Chicago, as well as the post of Consulting Psychiatrist to The Community Pastoral Counseling and Consultation Center, Lutheran General Hospital, Park Ridge. Dr. Moss is the Executive Director of The Seabury Institute for Pastoral Psychotherapy, Atlanta. He is also the co-editor ofThe Organization and Administration of Pastoral Counseling Centers, Book Review Editor of theJournal of Religion and Health, and Editor of Artistic Photography forPilgrimage: The Journal of Existential Psychology. Reprint requests should be directed to: All Saints' Episcopal Church, 634 West Peachtree Street, N.W., Atlanta, GA 30308.     

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.     

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.     

The Theological Contributions of Bishop K. H. Ting to Christian/Pastoral Counseling

As China enters an era of urbanization and change, mental health issues are increasingly becoming a concern of the Christian church. Pastoral counseling is taking new shape as people of faith respond to those in their midst in need of care. Bishop K. H. Ting, a long-time leader of the Chinese church, has stressed the importance of an indigenous Chinese Christianity. This article is based on an examination of Bishop Ting’s theological writing with the aim of eliciting themes that might be foundational in the construction of inherently Chinese models of pastoral counseling. Based on a survey of his work, six themes emerge with particular importance for pastoral counseling: the Three-Self church, God is Love, the Cosmic Christ, ethical responsibility, theological reconstruction, and religion in society. These themes are explored within their uniquely Chinese context and suggestions for application to the practice of pastoral counseling are discussed. Original publication: Wang, P. (Ed.) (2006). Seeking Truth in Love. Nanjing, China: Nanjing Seminary Press. This essay was originally published in a collection of essays honoring Bishop K. H. Ting on his 90th birthday. Bishop Ting has been the head of the Chinese Protestant church for over five decades and his leadership has profoundly shaped Chinese theology and church life. The purpose of this essay is to explore how his collected theological writings might inform a uniquely Chinese approach to pastoral counseling. This article is published with the permission of the original publisher.