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August 2004 Article of the Month
 
This month's article selection is by Margot Hover, DMin, ACPE/NACC Supervisor,
Barnes-Jewish Hospital Community-Based CPE Program, St. Louis Cluster.
www.stlouiscluster-acpe.org/bjc_community/index.html

 

Dell, M. L. [Departments of Psychiatry and Behavioral Sciences and of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC; dellml@comcast.net]. "Religious professionals and institutions: untapped resources for clinical care." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 85-110.

 

COMMENT AND SUMMARY: Whether labeled "authority issues" or "white coat hypertension," CPE students often find that one of their greatest challenges is relating to physicians. Hospital-trained CPE alumni readily recall early experiences of being displaced at the bedside by clusters of doctors on rounds, as well as the moments when their efforts at assertiveness and initiative bore fruit, as when physicians made referrals or apologized for interrupting an important pastoral moment.

Nevertheless, a growing body of professional literature supports the importance of forming alliances between clergy and medical professionals. In an excellent article aimed at the medical profession, Mary Lynn Dell, MD, MTS, ThM, summarizes surveys describing the effectiveness of clergy in monitoring and maintaining community mental health, particularly in rural areas. An ordained minister and child psychiatrist, Dell speaks to mental health care providers as a peer to familiarize them with the types, backgrounds, and training of clergy. In an effort to encourage psychiatric professionals to utilize that resource, she recounts the history of the pastoral care movement and lists a number of factors supporting clergy availability and attractiveness to rural populations, as well as the roles they play in the lives of their congregants. Easy availability without a waiting list, low cost, flexible hours, home and hospital visits, and willingness to stay long hours during crises make clergy the convenient choice for congregants, and even for non-attenders looking for help. In addition to their role with individuals and families, clergy routinely serve on hospital and community boards and committees that are instrumental in providing client services. Depending on their previous experience, physicians may welcome collaboration with clergy, or may be suspicious that they will give interfering or inappropriate advice. Particularly in her discussion of the training, roles, and services provided by pastoral counselors, Dell advises her psychiatrist readers to review each counselor's professional practices and her/his policies about collaborating with psychiatrists.

Dell's article is a primer, assuming that her audience is not conversant with the typical structures within organized religious groups. She begins with the basic definitions of clergy titles, differing as they do from denomination to denomination. Noting that some clergy come from first careers as counselors of various types, nurses, teachers or attorneys, she advises doctors to inquire about their background. Her discussion is comprehensive, ranging from the traditional roles of pastors (healing, sustaining, guiding and reconciling) to a list of questions families typically ask in searching for a church to belong to. An extensive section deals with the various material services churches traditionally have offered either as congregational outreach or in collaboration with other congregations and civic agencies: food pantries, emergency housing, day care, programs for substance abusers, parish nurses, and senior citizen programs, to name only a few.

In closing, Dell advises her readers to take the time to meet and form collaborations with local clergy, hospital chaplains, and pastoral counselors with whom they are comfortable. She suggests that they include a simple religious assessment at intake, remembering that religion and spirituality are not confined to church attendance, Bible reading, or daily prayer, but may also include inspirational television and radio, motivational books, religious music, and other sources of important meaning. Finally, her list of references is impressive, and invites further reading.


 

Thoughts on the Use of the Article for Discussion in CPE: 

Dr. Dell's article appeared on a Medline search that I made for articles on religion and rural health. As the supervisor of a community-based CPE program for "natural caregivers," including clergy in rural areas outside 50 miles of urban CPE centers, I've found that program participants frequently serve as local resource-for-all-seasons. One student is routinely called by the State Highway Patrol throughout his county whenever they encounter any problem outside their policies. He finds himself arranging for transportation for marooned, mistakenly identified prisoners of any or no denomination, for example. "The thing we like about our pastor," reported one Pastor-Parish Relations committee chair, "is that he comes to all the town celebrations like graduations and homecomings. We want people to know that he cares about us." That has opened the way for their pastor to spearhead an exploration of options for emergency healthcare when the local clinic closed its doors.

But different denominations have different expectations of their clergy, varying job descriptions, and policies. How would those shape your particular ministry in the community? What is tolerated, and what would you have to be careful of?

In the hospital system, what is the "culture" on your unit? ...in your institution? What factors influence referrals?


 

Other Items of Interest: 

This month's featured article is part of a theme issue on Religion and Spirituality. Below are listed the other articles in that same journal issue (in the order of the table of contents). While the overall focus is on psychiatry and diversity concerns and not research per se (though note especially the last article, by Housekamp, Fisher and Stuber: "Spirituality in children and adolescents: research findings and implications for clinicians and researchers"), the articles do tend to be informed by a research-mindedness and may be of general value to chaplains working with children and diverse patient populations.

[Editorís Note: The January 2004 theme issue of Child and Adolescent Psychiatric Clinics of North America was covered in the March 2004 issue of Science and Theology News (ISSN: 1530-6410), in an article headed, "Religion Can Be Big Part of Children's Psychology."]

Josephson, A. M. and Dell, M. L. "Religion and spirituality in child and adolescent psychiatry: a new frontier." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 1-16.

Fowler, J. W. and Dell, M. L. "Stages of faith and identity: birth to teens." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 17-34.

Sexson, S. B. "Religious and spiritual assessment of the child and adolescent." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 35-48.

Moncher, F. J. and Josephson, A. M. "Religious and spiritual aspects of family assessment." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 49-70.

Josephson, A. M. "Formulation and treatment: integrating religion and spirituality in clinical practice." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 71-84.

Mabe, P. A. and Josephson, A. M. "Child and adolescent psychopathology: spiritual and religious perspectives." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 111-126.

Stuber, M. L. and Housekamp, B. M. "Spirituality in children confronting death." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 127-136.

Rube, D. M. and Kibel, N. "The Jewish child, adolescent, and family." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 137-148.

Murrell, K. "The Catholic child, adolescent, and family." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 149-160.

Mercer, J. A. "The Protestant child, adolescent, and family." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 161-182.

Al-Mateen, C. S. and Afzal, A. "The Muslim child, adolescent, and family." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 183-200.

Black, N. "Hindu and Buddhist children, adolescents, and families." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 210-220.

Housekamp, B. M., Fisher, L. A. and Stuber, M. "Spirituality in children and adolescents: research findings and implications for clinicians and researchers." Child and Adolescent Psychiatric Clinics of North America 13, no. 1 (January 2004): 221-230.

 


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