7.     What is the Efficacy of Clinical Pastoral Education in Teaching Resiliency and Coping Skills for Clergy? --update from Beth Jackson-Jordan, Supervisor, Carolinas Medical Center NorthEast, Concord, NC

ACPE Supervisor Beth Jackson-Jordan (Carolinas Medical Center NorthEast) is continuing her research on clergy health, which she originally shared at our meeting during the Salt Lake City conference:

I am developing a research project to study the impact of CPE on the emotional, physical and spiritual health of clergy. A 2008 Duke Divinity School Clergy Health Initiative survey of over 1,700 United Methodist clergy in North Carolina revealed higher than average rates of serious physical and mental health conditions as well as increased numbers of young clergy leaving the profession within the first five years. My research question is What is the efficacy of Clinical Pastoral Education in teaching resiliency and coping skills for clergy? Please contact me if you are interested in collaborating on this project.

She also has written an article, "Clergy Burnout and Resilience: A Review of the Literature," which has been accepted for publication by the Journal of Pastoral Care and Education.

Rev. Jackson-Jordan may be contacted at Beth.Jackson-Jordan@carolinashealthcare.org or 704-403-3335.

 

8.      Looking for Excellence in Supervision: A Researcher's Reflection on Her First Unit of CPE, by Sharon Ghamari-Tabrizi, PhD

Last summer I had the privilege of taking my first unit of CPE at the National Institutes of Health under the supervision of Rev. Ellen Swinford. Her skills as a chaplain, pedagogue, and supervisor are remarkably fine. In comparing my experience with other chaplain interns at CPE Day mid-way through the unit, I learned that not everyone was lucky enough to train under the guidance of a master pedagogue.

The fact that my CPE experience was so productive as a result of landing an excellent supervisor was a matter of dumb luck triggered my curiosity about the pedagogical model in CPE.

What is distinctive about CPE’s pedagogical method is:

• the instructional material is the individual case in all its particularity and detail
• in group and individual supervision, the CPE student explains the sequence of observation, interpretation, reasoning behind her words and actions.
• the CPE student’s peer group -- at the same level of expertise -- as well as more advanced clinicians -- listen to the case, and then offer comments regarding her thoughts and actions

Group feedback is the means by which the presenter learns:

• to identify his/her own blindspots, errors, assumptions, biases.
• that being accountable to one’s profession for one’s action is normative and productive. (In other words, this process socializes the novice into the professional norms of sharing case material and seeking feedback non-defensively.)
• that there are multiple ways of interpreting the same data.

There is no single best way or right way to interpret a case. In medicine, a gathering of physicians can be persuaded by a medical examiner undertaking an autopsy as to the proximate cause of death. But even here, data can be interpreted by competing interpretative frameworks from different specialties. In the case of psychosocial-spiritual suffering there are countless ways to observe, interpret and respond to someone in pain.

The ACPE has chosen clinical experiential learning as the medium for developing a novice’s practical reasoning as a chaplain. If experiential learning is the basis for Clinical Pastoral Education, with the case study method in verbatim form established as the ideal for chaplaincy education, then one must have normative ideals as guidelines. The whole point of clinical case study -- in contrast to generalizations from textbooks -- is to maintain focus on the individual details and specificities of the persons in view.

The pedagogical approach in the history of chaplaincy was two-fold: the central feature of training was, and remains, the case study. Let’s break this down into its parts.

1. One learns by case study. The student learns by exposing his/her practical reasoning and interpretation to his/her peers and supervisor and invites critique, discussion. One is exposed to alternative interpretations and behaviors.

2. Public presentation of the case is the means by which the chaplain learns to be accountable for his/her reasoning. One writes chart notes (as well as verbatims) in order to be accountable for one’s actions to oneself and to one’s peers, and by extension, to the patients and staff with whom one engages. Since, by definition, one can never know the contours and make-up of one’s own blindspots, one requires the assistance of others to learn what one cannot see and know intuitively and internally.

The chaplain intern/resident’s models are her CPE supervisors as well as the staff chaplains in her training hospital, speakers at professional conferences, and authors of articles and books. However, for student applicants, there is essentially only the interview process and hearsay reports of reputations to indicate whether a supervisor is among the best of the best or a mediocre practitioner. The professional community agrees that there is a range of skill among CPE supervisors in the United States. Therefore, how shall the professional community find its model of excellence?

The ACPE promulgates standards, but these are normative. While the ACPE is accredited by the US Department of Education, the provision of CPE is not offered to chaplain interns and residents through the medium of post-graduate degree-granting institutions. Decades ago, the decision was made by the professional organizations that preceded the ACPE to keep clinical pastoral education separate from university settings. The locus of control would be highly decentralized.

While the professional organization evolved standards for defining the required skills and comportment of a hospital chaplain, the interpretation of these standards remained firmly the prerogative of the individual supervisors in hospital settings. In other words, an institutional structure was put into place that guaranteed considerable autonomy to the individual supervisors. Indeed, as the ACPE Presidential Task Group on Training and Certification remarked in August 2006, "While our organization excels at developing thoughtful standards to guide supervisory practice, it remains a challenge to embed the standards into actual practice, given how practices evolve differently from center to center and supervisor to supervisor." The variation is considerable. The task group noted, "Our educational methods are often developed autonomously, and … they often reflect diverse practices across the organization." [Report of the ACPE Presidential Task Group on Training and Certification, August 2006: 2; accessed from the ACPE website on 8/24/12]

The organizational structure of limited external oversight of individual supervisors could plausibly be tied to the experiential, process-oriented, and empirical basis of clinical chaplaincy’s pedagogy. The primary consequence of this arrangement is not only the simple fact of diversity in supervisory style and skill across the nation, but more significantly, the invisibility to the larger community of the range of skills, ideas, behaviors that are modeled to CPE students by supervisors across the country. Unless a supervisor chooses to write and publish, the only outsiders permitted to see/learn/know about a supervisors’ skills and behavior are members of the ACPE certification and accreditation committees and specific peer groups. The principle of confidentiality blocks the possibility of other chaplains learning anything about the specific skills of a supervisor.

What is confidentiality meant to protect? If there is a complaint of alleged unethical behavior, confidentiality can protect the dignity and reputation of the alleged malefactor. BUT by insisting on confidentiality in evaluating a supervisor, those who are excellent cannot be known to the wider professional community. They remain unknown to their peers.

It has long been the tradition that unlike the case study method in medicine, Clinical Pastoral Education has put a premium on keeping the chaplain intern/resident small group’s discussion of case studies entirely confidential. The result is that the field of interpretation is limited to a handful of people.

If the ACPE pedagogical principle is unvaryingly individualistic, then the normative paradigm for chaplaincy must also be individual examples. But if one has the bad luck of encountering a mediocre supervisor, how shall novice chaplains learn what excellence looks like in the particular? I speak not only a consumer of Clinical Pastoral Education but as a career researcher quite new to the ACPE, and I believe the organization and its future students would benefit from a wider and more transparent methodology for describing and evaluating supervisors and identifying best practices

[Dr. Ghamari-Tabrizi was the 2011 David B. Larson Fellow at the Kluge Center of the Library of Congress. She may be contacted at sharon_ghamari-tabrizi@mail.harvard.edu.   --J.E.]

 

9.     Gerald Gundersen's "Challenge to Promote Shared Learning in Pastoral Care"

Chaplain Gerald Gundersen (currently at the Psychiatric Institute of Washington, DC) is an experienced researcher and a member of the Research Task Force of the National Association of Catholic Chaplains. In the summer of 2012, he contacted our Research Network about a paper which he had developed for the NACC: "The Challenge to Promote Shared Learning in Pastoral Care," In this, he proposes that "shared learning can...move pastoral care initiatives forward through applied research by putting useful pastoral care strategies to the test" [paper p. 1]. His vision includes a web-based resource for sharing pastoral interventions that practitioners have found successful, with one possible result being the "development of a broadly based reservoir of data containing precious seeds for growth, insight, and applied research" [paper p. 7]. He comments on our own site's section for the SCIPE project:

Right now, there are very few ways for pastoral care providers to contribute to shared learning through an interactive process. The Association for Clinical Pastoral Education (ACPE) Research Network identifies the "Spiritual Care Initiative for Professional Excellence" as a useful resource. The section on Knowledge Base of Spiritual Care Samples documents and organizes over 350 "best practices" that include the experiences of professional chaplains. This is a valuable approach to broader-based sharing of information. [paper p. 6]

His paper is available for download. As with the NACC, Chaplain Gundersen invites comments from the ACPE, and he may be contacted at jgundersen1@verizon.net.

Note: The NACC's "Strategic Plan 2012-2017" includes the following two objectives: "Assess and communicate current research on the value of professional chaplaincy to members and other stakeholders/constituents" and "Partner with associations and clinical research faculties to engage our members in research" [under Goal II].

 

10.     Harold Koenig on the "Role of the Chaplain on the Medical-Surgical Team"

Our Network often cites the work of Harold G. Koenig, MD. His original research is voluminous, and his reviews and commentaries are well known for putting the complex field of spirituality & health into clear perspective. Our August 2012 Article-of-the-Month was, in fact, one of his commentaries, highlighted for its potential value to new CPE students. Now Dr. Koenig has written a brief but robust piece for the journal of the Association of Perioperative Registered Nurses on the "Role of the Chaplain on the Medical-Surgical Team" [AORN Journal 96, no. 3 (September 2012): 330-332]. It advocates strongly for chaplains and makes a case in part on the basis of research. For example:

By addressing the spiritual and emotional needs of patients, chaplains can affect patients’ physical health and surgical outcomes. There is a rapidly growing research base that indicates that the emotional, religious, and spiritual needs of patients influence their health outcomes. This includes affecting basic physiological processes, such as immune, endocrine, and cardiovascular functions. [p. 331]

He goes on immediately to mention the speed of wound healing, mortality rates, hospital length of stay, and the prevention of futile treatment, arguing that "chaplains play an important role in patients’ physical outcomes, as well as their spiritual and emotional ones" [p. 331].

The piece is not comprehensive, and it may understate the interfaith nature of chaplaincy and give a less than precise description of the process of becoming a chaplain, plus it unfortunately includes that weak citation of Bliss, et al., "Chaplain intervention reduces costs in major DRGs: an experimental study," [--for more on that citation, see the note at the bottom of our June 2011 Article-of-the-Month page]. Nevertheless, as an enthusiastic and research-minded championing of chaplaincy, this short article is worth a look.