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March 2022 Article of the Month
by John Ehman, Editor, ACPE Research Article-of-the-Month
and Manager for Pastoral Care, Penn Presbyterian Medical Center, Philadelphia PA


Vanderstelt, H., van Dijk, A. and Lasair, S. "Transformational education: exploring the lasting impact of students' clinical pastoral education experiences." Journal of Health Care Chaplaincy (2022): online ahead of print, 2/21/22

[Editor's Note: Because this article is available ahead of print, no final page numbers can be cited. References are to manuscript [MS] page numbers.]

SUMMARY and COMMENT: This month's research, out of Clinical Pastoral Education in Canada, seeks to contribute new data to the "vigorous discussion" these days "regarding whether CPE adequately prepares chaplains and other spiritual care professionals to competently practice in their workplaces" [MS p. 1]. By focusing on "lasting impact," the authors provide "substantial insights from students' perspectives concerning what CPE accomplished successfully" [MS p. 13], at least at one educational center. This is by no means a conclusive response to the "current discussions about how best to train spiritual care professionals" [MS p. 12], but it should help to stir and steer debate along constructive lines; and chaplaincy students may well benefit from some knowledge of how those who have come before them have found particular value in the process of CPE --in Canada, one stream of Supervised Pastoral Education (SPE), to be differentiated from Pastoral Counseling Education (PCE).

This qualitative study used a convenience sample of 88 graduates from a program at "a healthcare institution in a mid-sized Canadian city" [MS p. 12]. These were former students of three Certified Supervisor-Educators there, between 2004-2018, invited by email to complete a 22-item online survey. Four emails were returned as undeliverable, and 34 people ultimately participated. The survey was developed by the authors, drawing from previous published research in this area [--see Related Items of Interest, §I, below] and included the following questions pertaining to impact [MS p. 4]:

  • What insights, practices or skills did you learn in your unit(s) that you continue to use today?
  • What has been the lasting impact of your unit(s) on your relationships (personal and/or professional)?
  • In what ways have your CPE/PCE unit experiences helped you in your ability to function within groups?
  • In what ways has your clinical experience in your unit(s) influenced who you are as a caregiver today?
  • What, if any, has been the lasting impact of your unit on your faith/spiritual life?
  • What has been the lasting impact of your unit(s) on your personal life?
  • Do you still practice spiritual/theological reflection today? Explain.
  • Reflecting back on one of your units, can you share the story of one learning moment (omitting any identifiers) that has contributed to your current functioning?
  • Which of the following components from your educational experience has had the most significance/lasting impact? (Please select your TOP THREE only.): Didactic learning, Written reports (verbatim, case studies, journals, etc.), IPR/peer support group, Individual supervision, Clinical experience, Informal interactions with peers, Meditations, or Interdisciplinary interactions.

Among the results: "97% of the students reported lasting growth as a result of participating in CPE" [MS p. 5]. The components of CPE that were rated the most significant were Clinical experience, Interpersonal Relations/Peer Support Group, and individual supervision, respectively [--see MS p. 12]. The authors observe that these are the same top three components that had been identified in a 2000 study [--see Trothen in Items of Related Interest, §I, below], though in a different order. The lowest rated components were meditation, informal interactions with peers, and didactic learning [--see Table 4, MS p. 12]. One participant responded with consistently negative answers to the survey, and three others gave negative appraisals of their experience, but their negative responses were "less all-encompassing" [MS p. 12]: e.g., how "there were disappointments" or how there may have been "gentler way[s] of helping individuals in a CPE course to learn more about themselves" [MS p. 12].
It is interesting to note that when asked directly if they would recommend taking a CPE course at this teaching centre to others, of the thirty-four students who responded to the survey, one elected not to respond to the question, one indicated that they would not recommend a CPE course, and the remaining thirty-two students (94%) indicated they would recommend CPE at this teaching centre.

Inductive analysis of the survey's short answer questions yielded 21 themes [--see Table 3 on MS p. 6]. These were "organized into six categories for which data saturation was achieved" [MS p. 5], though the authors comment, "The coding process used for data analysis did not lend itself to identifying a clear point of saturation" [MS p. 14]. The authors map and address these categories according to how they connect to overarching constructs of the Relational Self and the Knowledgeable Self.

THE RELATIONAL SELF -- "...the impact of CPE on the Self-in-relation-to-Self (Self-Intra), Self-in-relation-to-Other (Self-Inter), and the Story/Narrative being the medium through which the Self-in-relation-to-Self and the Self-in-relation-to-Other is expressed" [MS p. 5].

Self-intra --
"Self-intra refers to the growth a student experienced related to their understanding of themselves and how they relate to their own self. ...Developing Self-Awareness (53% reported growth in this area), including gaining new insight into one's self, was frequently developed through the skill of self-reflection and developing insight into biases, triggers and prejudices. ...Self-Awareness also included awareness of blind spots, avoidances, growing/learning edges, and the ability to self-regulate more effectively. ...26% reported an increase in...Emotional Intelligence: the ability to identify one's own emotions, and the ability to manage those emotions. ...The formational experience of CPE in combination with the ability to self-reflect...produced a stronger sense of one's Personal Identity. This included the ability to more clearly engage the question, 'Who am I?' ...[R]eported Personal Growth...included increased confidence (n=9), increased compassion (n=7), increased patience (n=6), overcoming fears (n=4), finding/claiming the student's own voice (n=4), increased resiliency (n=2), and experiencing personal healing through the experience of CPE (n=3), among a list of other areas of personal growth that were only reported once." [MS pp. 6-7]

Self-inter --
"Self-Inter refers to the growth of a student in their own understanding of their relation to and with the Other. ...At the core of this category, students acknowledged the diversity of human experience and the need to create space for this diversity to be honoured. ...In therapeutic relationships students indicated CPE influenced their ways of approaching others..., their ability to connect and remain present to others..., and their experience of growth in interpersonal skills.... Peer group sessions in particular provided a unique opportunity to learn about how others experienced them and how their actions impacted others.... ...Thirteen participants (38%) reported that CPE supported the development of their Professional Identity...and an increased sense of privilege or sacredness into which this identity invited students as they engaged with patients and staff. ...Students also reported that CPE had a positive impact on the ability to integrate feedback. Twenty-five examples were provided of students demonstrating their learning to 'be open to constructive critique/criticism'...from others." [MS pp. 7-8] Learning about transference and countertransference is part of this theme.

Story/Narrative --
"The Story/Narrative was the medium through which students communicated portions of themselves to their clients. It tied the student's story together with the narrative of the Other they encountered. ...[M]utual sharing and reflexive space within the context of a therapeutic relationship and the students' ethical practice of SEUS [Safe and Effective Use of Self] facilitated the integration of personal and professional selfhood." [MS p. 9]
THE KNOWLEDGEABLE SELF: -- " CPE impacts the students' Spirituality, their knowledge of Psychotherapy, and their own Agency. It is important to note that when using the word Knowledge, it is intended to be inclusive of practical and propositional knowledge" [MS p. 9].
Spirituality --
"94% of the respondents indicated that they have continued to engage in Theological Reflection since completing a course in CPE. ...While coding at nearly half the rate of Theological Reflection, the statements related to Spiritual Growth demonstrated greater observable impact. As a result of their CPE experiences, students reported increased awareness of the divine and the sacred, which was often attributed to 'expanding my sense of what is sacred'.... Students also reported an expanded sense of Multi-Faith Awareness that supported growth in 'overcom[ing] fear of different points of view.'" [MS p. 10]

Psychotherapy --
"[T]he category of Psychotherapy, broadly defined to include the psychotherapeutic modalities within the academy of psychological study, noted the significant number of skills that were developed through engaging in a CPE course. Communication...was the most frequently coded skill that experienced growth. Communication is further broken down into sub-skills like use of feedback, use of open-ended questions, ability to engage difficult conversations, and documentation and charting. ...Closely related to Communication was the theme of developing Active Listening Skills...that improved students' ability to listen with intentionality and paying attention to non-verbal cues. ...Students reported learning skills related to a wide variety of Interventions including: presence, creation of safe space, exploration of various themes (for example, grief, pain, joy, and other emotions), theory-based approaches (including narrative therapy), developing treatment plans and prayer. ...Students' ability to engage within a group context more effectively as well as being able to manage group dynamics were also reported to have been impacted positively. ...Conflict resolution within groups was also frequently named due to the experience of engaging group processes within CPE." [MS pp. 10-11]

Agency --
The term is "used to describe the students' intentional actions in taking what they learned from various components of the CPE program into their specific vocation paths." This is a "more global outcome of students' learning processes," and the analysis aligns it with the Knowledgeable Self "as it speaks to the praxis of the learning acquired through the CPE experience." "The Transferability of Learnings from CPE to other contexts demonstrated the lasting impact of what was learned beyond the context of the CPE course. There were 29 coded responses identifying the transferability of the learning by 17 (50%) students. This included the ability to utilize learnings within different contexts (e.g., parish, community outreach, other clinical contexts, other provinces) as well as within other non-professional relationships (with friends and family). At the junction between Spirituality and Agency there was evidence of nine students developing a philosophy or theology of spiritual care as a result of engaging in CPE." Five respondents indicated that "CPE assisted to direct their career path." [MS p. 11]

Each of the above themes is nicely illustrated with original quotes from the surveys.

The authors' thematic analysis leads them to propose a somewhat complex model -- a layered thematic map -- for students' growth in terms of the Relational Self and the Knowledgeable Self, to express what they describe as the unique "alchemy" [MS p. 13] of the CPE/SPE modality of education. The model (diagrammed on MS p. 7), worthy of debate, is one way to draw together different yet overlapping dynamics among the themes rooted in core program elements. Moreover, it suggests how clinical pastoral education has been "transformational precisely because of its scope --it affects students' formation as persons in addition to their professional identities" [MS p. 13].

From our thematic map, the Relational Self seems to align with the focus for Basic CPE (ACPE Level I), and Advanced CPE (ACPE Level II) would consist of the addition of the Knowledgeable Self map (Association for Clinical Pastoral Education, 2021). However, in practice, both layers seem to be developing in tandem. Rather than the focus being on one layer or the other at these different levels, the data instead reflected an expansion of the knowledgeable themes as one progresses through their CPE training. For example, the majority of students who participated in this survey did not progress beyond the basic level, hence we observed more impact statements related to self-awareness, listening, and communication. We surmise that emphasis on assessment and intervention would come with advanced units which may be supported by the fact that there were fewer coded responses for each of these psychotherapeutic skill sets. [MS p. 13]

Further research is, of course, necessary to substantiate and refine these results and the interpretations behind them. The authors envision a replication of their project "across Canada once there is agreement on national curriculum content" [MS p. 14]. This reader would point out that future research with a much larger sample size, might well benefit from a breakdown of CPE alumni/ae perspectives of according to the length of time since their training. Data collection for the current study occurred 9/4/18 to 10/15/18 [--information from a personal communication by the principal author], meaning that the time frame of participants' perspective on "lasting impact" ranged from 14 years to just months. The age of students at completion of their first unit of CPE might be a worthwhile factor to investigate as well, since the sample in the study may have been older than would be typical in many programs (i.e., a mean age of 42). Also, additional research will have to contend with how the experience of CPE during the COVID-19 pandemic might not be comparable to the experience of students from even the recent past, as well as how some current trends in CPE curricula -- like the increasing emphasis on empirical research or use of remote learning -- might affect the educational paradigm.

Overall, the present research supports the position that CPE is a transformational experience. "Not only did [students] acquire lasting knowledge and skills; but, more fundamentally, it shifted their very ways of being in the world" [MS p.14]. That strikes this reader as a much greater thing to contemplate than whether CPE prepares chaplains to practice competently in workplaces. A final note: the impact questions from the survey could be adapted for use in regular program exit interviews, over and above any retrospective alumni/ae surveys.

*Note regarding Table 3, MS p. 6: The table lists 22 items under Themes because "Emotional Intelligence" appears under both the Self-intra and Self-inter catergories. Spirituality/Agency is listed in the Categories column, but it is not meant to suggest a seventh category, rather it is meant to indicate how the theme of "Developing a philosophy/theology of spiritual care" seemed to the authors to develop "at the junction between Spirituality and Agency" [MS p. 11]. The category of Narrative/Story does not have a corresponding theme in the Themes column because it was assessed to be an identifiable aspect of the data in and of itself, hence the way it is depicted in the Thematic Map [MS p. 7] on the line between Self-intra and Self-inter as "the medium" [MS p. 5] through which those two are expressed. [--This note is informed by a personal communication with the principal author.]


Suggestions for Use of the Article for Student Discussion: 

This month's study would obviously be useful to chaplaincy educators and those in certification, to assess the educational experience they oversee now or help to shape in the future; and it should be of interest to any professional chaplain by prompting reflection on the lasting impact of their training. However, for current students, even those with only moderate experience of CPE might appreciate the perspective offered here on the potential value of their program. Discussion might involve both staff chaplains and students, together. If the discussion were to occur months into a program, students could be asked if they can identify personally with any of the points in the article. It may help some students involved in a second or third unit of a residency to think about how they have been affected by their past units, and what growth or knowledge from past units they may be effectively carrying over into new units. Short-term impact might signal long-term implications. Some themes in the study's analysis may be more relatable to their experience than others: for instance, how narrative is understood to play into the chaplain-patient relationship. The diagrammed "Thematic Map" [MS p. 7] could be too abstract to engage discussion, but the idea of layering relational growth with advancement of knowledge might lead to conversation that could help students see their program from a theoretical vantage. The finding that didactic learning was given a low rating in the survey of the one institution used for the study could spark ideas about what didactics students would desire most in their present curriculum. Finally, the group could think about the idea of the "alchemy" of CPE and how this modality of education may be different from other forms they've known --or even unique to their experience.


Related Items of Interest:

I.  The creation of the survey for this month's study was aided by previous methods of older research:

O'Connor, T., Healy-Ogden, M., Meakes, E., Empey, G., O’Neill, K., Edey, L. and Klimek. S. "The Hamilton SPE Evaluation Tool (HSET): Is it any good?" Journal of Pastoral Care 55, no. 1 (2001): 17-34. [(Abstract:) Presents the Hamilton Supervised Pastoral Evaluation Tool (HSET). HSET is a self-report that evaluates student learning in a basic SPE unit utilizing six areas: supervisory relationship, personal growth, professional growth, theological reflection, learning context, and overall growth. Reviews statistics involving seven regional units consisting of 18 SPE units with 101 students. Utilizes methodological, investigator, and data triangulation by drawing on qualitative study and CAPPE accreditation review. Discusses strengths and weaknesses of HSET and makes recommendations for further use.]

Trothen, T. J. "Students' perspectives: a Canadian study of supervised pastoral education." Journal of Pastoral Care 54, no. 3 (2000): 325-337. [(Abstract:) Summarizes and analyses the findings of a research study that was commissioned and supported by CAPPE and The Churches' Council on Theological Education in Canada. Surveys students who were completing a basic unit in Supervised Pastoral Education (SPE) to identify the self-perceived effects of the unit on pastoral functioning. Utilizes qualitative and quantitative methods, focus group sessions, consultations, and a literature search to develop a questionnaire which was distributed to eligible students via the Internet. Draws several conclusions that suggest re-examination, further study or program changes, and validates the central focus of SPE basic units on self-awareness and experiential learning.]


II.  Our featured study's authors draw from research that is 15-20 years old. However, even older research about the "Lsting Effects of CPE" might be of interest:

Derrickson, P. and Ebersole, M. "Lasting effects of CPE: a five year review." Journal of Pastoral Care 40, no. 1 (March 1986): 5-15. [Fifty-five graduates of the ACPE program at the Hershey Medical Center (Hershey, PA) were surveyed (out of a sample of 60, for a response rate of 91.6%) to see how their CPE experience may have had a lasting effect. Among the findings: Data indicated that CPE is learning through encounter with the living human document. Students remembered contact with patients most, supervision next, and peer group experiences third. Students were more sensitive to direct parallels between CPE experiences and current functions in ministry. That is, they are more likely to use their CPE training in situations which are similar to the training experiences. Emotionally charged situations seem to have a stronger impact on memory and recall. They also seem to impact students because they are new experiences and they are most open to intellectual learning around these topics. Timing in didactic presentations seems crucial to long term retention and recall. The data also suggested differences between Basic Full-time and Basic Extended students.] [This research was featured as a "Legacy Article" for a special June 2018 Articles-of-the-Month feature, paired with an article by Jankowski, K. R., et al, which our current monthly article's authors cite.]


III.  Our authors were guided in their analysis of the qualitative data by the following article:

Braun, V. and Clarke, V. "Using thematic analysis in psychology." Qualitative Research in Psychology 3, no. 2 (2006): 77-101. [(Abstract:) Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.] [This article is available online.]


IV.  Our article mentions "propositional knowledge" [MS pp. 9 and 13]. For more on the issue of the relationship between "propositional knowledge" and the development of self-awareness and interpersonal skills, see:

Clevenger, C., Cadge, W., Stroud, I. E., Palmer, P. K., Haythorn, T. and Fitchett, G. "Education for professional chaplaincy in the US: mapping current practice in Clinical Pastoral Education (CPE)." Journal of Health Care Chaplaincy 27, no. 4 (October-December 2021): 222-237. [(Abstract:) In light of questions that have been raised about education for professional healthcare chaplaincy, we examined the skills and know- ledge Clinical Pastoral Educators believe students need to perform the essential tasks and responsibilities of a chaplain. At 19 recently re-accredited ACPE centers across the country, we asked educators about the knowledge chaplains need to be effective, the specific content areas they teach, and how didactic education is planned and organized within their programs. Beyond a focus on religious diversity, we found little consensus among educators regarding a core knowledge base that should be taught during CPE. While most respondents in our study recognize the importance of didactic education in preparing students to become chaplains, there is a lack of consistency in didactic curricula across programs. Our findings suggest the need for broader conversation and collaboration among educators, national chaplaincy organizations, and theological schools regarding the goals, priorities, and outcomes of CPE.] {This research was featured as our October 2021 Article-of-the-Month.]


V.  In light of this month's article, chaplains outside of Canada may be interested in the Canadian Association for Spiritual Care and its web page regarding research.



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