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October 21, 2006

Can I Talk With You? A Chaplain's Complex Clinical Case By Chaplain Bill Smith

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College of Health Care Chaplains
Annual Study Course Durham 2006
Short Paper for Submission
Rev. Bill Smith

Salisbury Health Care NHS Trust –Working at South Wiltshire Mental Health Services, Fountain Way, Salisbury


Can I talk to you?

A frequent question from patients, which could lead to a whole range of requests for pastoral care and friendship.

On several occasions I found myself giving extended time to patients who had complex issues to process, and the facility of offering pastoral listening led to me seeing them weekly.

It soon became clear that this work was entering the field of counselling and psychotherapy and my concern was that although I was not fully equipped to offer this role, there was no other provision for this kind of service in the trust.

I could either assume that pastoral care was a different service offered to patients and the more traditional roles of providing for religious needs, offering prayer and friendship were the limit of my role, or I could decide that a chaplain could also offer counselling as part of the remit of chaplaincy.

Why should a chaplain not also be a counsellor? The 2 professions could be complementary, rather than in conflict.
It was then that I decided to undertake counselling training myself to enhance my pastoral role.

Back to Study
The first step was to do a Certificate Course in Counselling
This gave me grounding in 3 counselling approaches to work with rather than just one.
1.Humanistic (or Person Centred)
2.Cognitive (or Cognitive Behavioural Therapy)
3.Psychodynamic
The value of this soon became evident.

The advantage of being able to offer a range of counselling models to mental health patients became obvious.
1. The Humanistic approach – dealing with the “Here and Now” sits very well with the everyday work in the hospital – being able to engage in active listening and responding to people who are very much living in the “Here and Now”.
2. The Cognitive approach helps greatly with those patients who need to challenge their learnt behaviour in order to learn more effective coping strategies
3. The Psychodynamic approach allows the patient to explore the past with the aim of using it to make sense of the present.

It now became clear to me that an Integrated Model of Counselling would be the best for my work, and the best for the people I was attempting to serve. I therefore enrolled in a 2 year Diploma Course in Therapeutic Counselling.
There was, however one missing ingredient in the 3 approaches I had been adopting up till now, namely the spiritual dimension. It was for this reason that I chose a Diploma course, which included the Transpersonal element. This would help when patients would want to explore their spirituality.

I completed training up to Diploma level in just less than 3 years. Through additional training in my personal therapy I now am able to offer Integrated Counselling consisting of the following approaches:
Humanistic
Cognitive
Psychodynamic
Transpersonal
Gestalt
This allows me to match the approach to patient need.

All the usual professional systems are in place, and I am a member of the British Association of Counselling and Psychotherapy (BACP)

Into Practice
A requirement for the Diploma training was a workplace placement. With the help of Senior Hospital staff I began working with patients – these being referred to me to assess suitability for counselling, and then to offer counselling if appropriate. Patients were seen on the wards, in private. To date I have worked with 8 people over a period of 2.5 years. The number of sessions each patient was seen ranges from 2 to 79. The number of hours offered to date is 260.

A Strange Twist?
When I began counselling work in the hospital I assumed that I would work with patients of “working age”. This has not been the case. I have been welcomed into the wards for those patients of “Non working age” and my work has been with the age range 70 – 85. Rather like when I went for my chaplaincy interview 9 years ago, expecting to work at the General Hospital and finding I had been recruited for the Psychiatric Hospital, I wondered whether the work would be out of my depth.

However, as before, I have been pleasantly surprised. The work with older patients has been well received and the weekly meeting becomes a very special part of their care plan. They can express themselves and tell their story in a private and safe setting.

Where appropriate, objects and personal items are brought into the counselling work to help the patient process their issues.
Undertaking counselling with people whose lives are in the final stage brings a richness of experience and exploration into the therapeutic alliance of counsellor and counsellee.

Presenting issues conceal past personal history and in many cases the talking therapy, which never was offered in the patients’ younger years, allows some of the shortcomings of service provision to be redressed.

Even at this late stage in life, some of the clues to why the illness happened begin to emerge and there is still time to process these issues and work towards resolution.

Ending
All counselling has a beginning, middle and ending phase. Without the pressure of time, the ending can come when the patient is ready. No short term offer of 5-6 sessions here. In any case, as Inspector Morse said, “The end is where we start from”.

Bill Smith
15.05.2006

LAURENCE: A CHAPLAIN'S COMPLEX CLINICAL CASE – Durham 2006

1. The Therapeutic Relationship
BACKGROUND
Laurence is an older age day client referred to counselling in March 2004 because care staff in the psychiatric hospital felt he had a problem of anger management. All day sessions are group-based, and Laurence was felt to be altering the dynamic of the groups to the point of concern. He was seen for assessment and explanation about the nature of counselling, and with the agreement of all concerned, counselling began immediately. Sessions are weekly in principle though there are breaks for holidays and client sickness absence.

THE BEGINNING
The first session revealed a person with a gruff, brusque exterior whose opening remark was that today was “no better than any other”. A request for elaboration led to a narrative about a recent stay in hospital where a sharp reproach by a male nurse of oriental ethnic origin caused Laurence to lunge at him with a dinner knife, which was to hand. “It brought it all back” was the explanation offered, which then went on to describe “it all”: WW2 experiences in the Far East theatre where no prisoners were taken on either side and the local population, he alleged, “wanted the Japs”. The whole reason for his being there appeared to be flung in his face by the islanders.

Laurence then continued with his story. His wife had died of cancer 9 years ago last month. She became very angry in the closing months and this upset him. He felt his present anger was due to the difference in mood he had experienced in the years following the death of his wife. Physical and emotional health had been poor during this time.

It seemed to me that the very recent hospital stay and his referral to day care had been at the time of the anniversary of his wife’s death and this could well have been a time when his own mood resulted in anger, fuelled by past memories, both good and bad.

I felt I had encountered a situation of diversity of age and experience and so I described the first session in my journal thus:

“First meeting with new client who is said to be very difficult and angry. I tend to avoid conflict - possibly out of fear of being hurt myself. So I wait for the client very tense and awkwardly. Client comes in very offhand and uptight but session takes its own course. I go away shocked, numbed and overwhelmed by what has been related. I am not afraid now but moved to the depths of my being. What have I experienced? Somebody else as afraid as I am? I appear to have been a foil to someone else’s story. I feel confused - I am still intact, but shattered by their narrative - can I see him again? The fear has moved from self to empathy.

Reflection

Before the session at the referral when I am told that this client is difficult and angry I mentally record the information but wish he were not like this. If he is like this in a day group then what will he be like with me? My pulse is faster, my heart beating. What I am experiencing is anticipated threat; fear, not wanting to stay. My physical body affects my mind and I am less clear in mentally arranging my methodology. I describe this as exam panic - like 40 years ago (i.e. worked 7 years for finals and now can’t remember how to begin) I am reliving past events where there was fear of being hurt, not good enough. Fight or flight is a clear experience for me in such moments.

Client came in venting anger at “the authorities”(of which I am part) - feel cornered, under attack, searching for “right” thing to say as much for self-preservation as well as being helpful to client. Back to my implicit need of being accepted, good enough, approved of, useful, friend. (Perhaps what I am sensing in my own being is a reflection of how the client feels and part of the reason for his behaviour)

Client slips into narrative, which shows some history to his anger - I feel less threatened - possibly because here I am on familiar ground as I often find myself escaping into narrative when things get too close.

Client relates horrific detail of his story, showing when he was in constant physical danger. With active listening and careful responding, we both reach a safer place from which to begin a relationship. We are both afraid and have a need to be valued. We can work together from here.”

The beginning phase concentrated on Laurence’s wartime experiences as an infantry soldier in the Far East. Although the edges of this phase are blurred, this exploration and work together lasted some 6 further sessions (it probably transcended into the middle stage when we worked with his badges – see (4)). There was an issue of neglect – he had been in 3 regiments, passed from one to another by apparent whim, and recognition of their role and atrocious conditions and suffering had been absent. “Wouldn’t go again. No recognition. Forgotten”: were his remarks. At this point I felt very close to his feelings. His voice became softer, he seemed to become very small in stature in his chair and I found myself mirroring his tone and posture as I listened. My response was now empathy and not fear of what seemed a very fierce man -which had been my initial preoccupation.

Through some research of my own on the Far East campaign and my own interest in WW2 I was able to listen and respond and the alliance began to form. He agreed to continue after the first session – to my combined panic and relief, and we worked through this first phase. He appeared to be retracing his campaigns to recover some dignity and value where the country he served had offered none.

THE MIDDLE

As we left the wartime issues and moved on to present day Laurence would often appear very exhausted and in pain at the beginning of a session. This usually changed as he talked about what was on his mind, but he did often – both verbally and non-verbally express LOSS, FEAR and HATRED.

These 3 – LOSS, FEAR and HATRED have been key issues to deal with and to process.
“LOSS”- some of the losses in his life:

• Hatred of war – loss of 2 brothers & 2 sisters in WW2
• Fear of going into hospital – might not come out- Loss of 1brother 1sister through medical treatment
• Hatred of foreigners – more specifically those nations who unofficially sided with the Axis in WW2 while at the same time were being liberated by the Allies (in his estimation collaborators) provoked him to anger and then tears
• Clear view of what was right / wrong therefore hatred of what is not good
• Loss of contact -Bad relationships with his own children
• Loss of his roots -Bad experiences at school – never returned to village post war – family had moved

The WW2 work was fairly compact at the beginning but it still surfaces even now – not in the same depth.
What has happened in the Middle phase is that the process has worked through the issues above in a generally chronological framework and now we are in the “here and now” rather than the “there and then”.

One of my difficulties was leaving the WW2 material behind as Laurence “moved on” – I was fascinated to hear of his account and had to hold this in tension with being in a therapeutic alliance. My own interests in military history and those of the client were in conflict here and so when the badge work had been completed I moved on with him as his process developed.

TRANSFERENCE AND COUNTERTRANSFERENCE

Laurence seems to regard me not as a health care worker, but more as a younger neighbour. He has often complained that he never sees anyone in his street except one neighbour who is as old as he. I sometimes get the feeling I am like a son who has stayed with dad as opposed to the real son who never calls. I would be happy to accept this transference – it would be very touching.

For me, Laurence is like my favourite uncle, who died some 20 years ago. Small, wiry, witty and very down to earth. Some one I admired for being a real person who had seen real life. I suppose my obtaining badges from the past for Laurence was in a way like my wanting to do the best for my uncle. I admired his manner and character and wanted to make sure that anything I did for him was of the highest standard.


THE ENDING

We have not reached this yet as we are still working through the depression, which has arisen again due to Laurence’s daughter being out more, and him spending more time alone. A key care worker is also retiring and a new one is being put in place and this transition needs to be managed. We will continue to work together at least until the summer. Frequent reviews have indicated that he wishes to continue the sessions and this is possible. I will need to prepare both of us for an ending, which will affect us at a soul level.

2. Theoretical Models
Original hypothesis

At the time of referral I was just beginning to appreciate the Gestalt approach – from my own personal therapy – and to begin to look at psychosynthesis as a development of the course’s integrative training in humanistic, psychodynamic and transpersonal approaches.

Laurence’s overt aggressive stance managed to put most of this out of my mind but as I reeled under his outrage with authority, I began to think that some kind of exploration of his story and possible soul (or primal) wound would be a fruitful avenue.

From a humanistic perspective, the presenting issue of anger could be seen as an attempt to meet the needs of recognition and self worth.

The psychodynamic model could have some mileage in the Oedipal desire to dispose of the rival (eliminate the enemy and achieve peace).

The transpersonal approach could lead me to think that there was some deep wound in the past, which if encountered, might be the basis of self-healing and growth.

In short, here was a man who could benefit from an integrative approach, if he were willing to form a therapeutic alliance.

Developing the hypothesis.

Through the initial work with the exploration of WW2 issues my hypothesis distilled into thinking that there was a basic primal wound, which seemed to crop up in all aspects of Laurence’s life.
Going back into the past and unpacking all the raw events would expose the raw wound and begin the healing process.


The wound’s history:

• Early days at school – being forced into relationships out of fear “Bunk off with us to the river this afternoon or get beat up.” Subsequent brutal treatment by head. First conflict with authority.
• Military Service in WW2 – shunted from one regiment to another – feeling undervalued – no supplies – being forced to kill any prisoners to remain part of a fighting unit –“those who didn’t learn died”
• Disintegration of family post WW2 –parents die, all but one sibling out of 7 perish
• Post war employment – constant friction with bosses
• Later years – 10 years wife’s illness and death
•10 years after wife’s death and recent admission to day hospital to be with people and receive treatment

Rather than opt for a particular approach, I let him tell his story and all the above events came to light. I used several approaches within this time, but focussed on the wound and its healing.

Strategies and techniques(See also below under “The Transpersonal”)

One strategy that I used was to go through his WW2 campaigns historically.From the Internet I found printouts of all Far East campaigns 1942-45 and we worked through these to see where he had served. Laurence began to relive the places and helped me with the correct pronunciation of the names. I also brought in several WW2 illustrated books and we worked through the various pictures.

He showed a real sense of pride when he recognised the names of the places he had been. He “lit up” and became very confident and full of knowledge. I felt I was like a GCSE student who had been sent to research WW2 experiences in a pensioners’ home- and the fears of Adrian Mole in the Book “Adrian Mole’s Diary(I hope mine isn’t a dud) had been put aside because this gentleman was a very interesting narrator.

On a more practical note, I decided that I was not going to represent the authority he hated. Partly out of self-preservation but also out of a need to be ethical here and try to practice the core conditions.

The core conditions of the humanistic model were vital here.

Empathy – I attempted to see the conflict in Laurence’s life from his perspective – how would I feel if my life had been like his?

Congruence- Being genuine about my own feelings and not colluding. I experienced numbness and horror when he told of the summary killing of all the enemy. Nevertheless I needed to be an attentive listener even with my own internal responses. This was not easy.

Unconditional positive regard –Accepting the client as he is.

There was also at the back of my mind a model from psychosynthesis: to move from the past through the present to the future. If I could help Laurence to unblock the past, and move in the present from what he knew to that which he does not yet know, then there could be a transformation – a shedding of old skin and emerging into new forms – for the future.

This I attempted via the WW2 process for him to gain some recognition, then for him to move to understand that he was also very much valued here – in the day groups where he had initially been a real pain- and towards some new dimension of his personality which would enhance his life and that of others.

3. Process

This is about change, movement and activity- seen in the phases of beginning, middle and ending.

In the beginning phase what was seen explicitly was the Laurence’s anger and hatred which revealed the implicit patterns of fear and loss in his story and being. Laurence wanted some recognition for what his life had been about, and I believe that the process began when he felt that I was listening. I would say that this happened towards the end of the first session. As the beginning phase continued, he was able to process his own history and use the therapeutic alliance to begin to manage it. At the outset I would even have concluded that Laurence had the residue of PTSD and these wartime experiences had never been processed to the point of being filed away as part of “managed life experience”. I believe the filing has now been effected by his willingness to work on the memories and flashbacks. This is an example of change, movement and activity.

My own process might well have been the encountering of my own anger, fear and loss through Laurence’s process. There were many parallels – especially the post war life experience.

I responded to Laurence in an active way – obtaining his “lost” regimental badges and I set out with Laurence’s permission to obtain the badges with the help of a friend – a medal and badge dealer -who spends most of his life selling such items to servicemen who want to process and complete their sense of identity).

The middle phase of the process has dealt more with such issues as loss of female companionship (which I related to as my wife works away in a boarding school –10 years now – which is the time elapsed since the death of Laurence’s wife). Also there has been a further opportunity to process Laurence’s anger – at one point he was attending another day centre and having severe friction with the clientele. I worked with another of our staff members and Laurence to manage the difficulties and obstacles. Together we made an extra day available at our own facility and he no longer needed to go to “that other place”. I worked with the senior member of staff who had referred Laurence to me on this. Laurence was with us as we talked it through. This was a breakthrough in turning his energies away from aggression and frustration to compassion and participation.

One year on I notice that Laurence is not regarded as one of the “problems” in our facility. He is welcomed and valued and is able to attend for his own benefit and well-being. Perhaps the ending of his present process via the therapeutic alliance is nearer.


4. The Transpersona
l
BADGES

The regiments Laurence served with seemed important to him. These groups of men- alive or dead-were the symbolic representation of his own personal value and dignity.

He showed me his tattoos. He explained that he had lost all his regimental badges and because the authorities would not carry his worth for him, he now carried his identity and worth on his arm. (A real sense of expression as he rolled up each sleeve to proudly show the tattoos- what does an arm symbolise? The instrument of personal expression and personhood?). He subsequently expressed the wish to recover his cap badges. With his permission, I managed to obtain all 3 original regimental badges over 3 successive weeks and we worked through his responses to each one at a time. There were pauses, silences, and tears. I asked what was going on. A sense of loss, of comrades, recognition, purpose in going. During this time he brought in a plastic replica of his badges that he had been given. With a “Here you are – this is what they gave us” he threw it past me across the room. The originals, which I had obtained, he has polished and displayed on his mantelpiece. I was lost for words and felt deep emotions during these weeks as I saw him smiling, holding his brass badges and glowing with pride. Yet in all this there was a very real sense of gain and loss. Something about the worth of a person and what could be felt in the soul, which no government could acknowledge. A badge is the essence of the soul of a person. I was reminded of what people place on coffins to mark the value and essence of a life (badges, photos, insignia, realia).

DREAMS

In the beginning phase Laurence stated he had had a dream about his life and it all “came to pass”. Later he was able to narrate his dream –possibly when we had worked together for a little longer and the alliance was secure. At the age of 9 years he saw himself in military service through the war up to his later life, but not the end of his life. Here he only saw the edge of a cliff. He interprets this as a kind of foretelling that he would serve in the army –his father did in WW1. The “edge of the cliff” appears for him to be the end, which he cannot see.

Laurence does not look so much for a transpersonal or symbolic meaning of dreams. He sees them as reinforcing what will happen in life or what has happened. It has been a more factual aspect of the work, which I would have liked him to explore more. But was that just my “stuff”?

My own thoughts are that the dreams are foretelling. And in particular the edge of the cliff represents not only the end of life but also the limit of coping resources in his being (being pushed to the edge) which has surfaced at times when he has mentioned that he felt like giving up.

SPIRITUAL EXPECTATION

A few times a year Laurence goes to a holiday home. Early this year he said, “I wondered why no vicar called”. When asked if he could say more, he said that when he was ill in hospital he valued the chaplain’s visits and the ward services. He has no time for organised “parish” religion, yet has a spiritual outlook. He believes in life after death and the value of being able to pray. In the Far East theatre where Laurence served the padre was highly regarded by him. “He mucked in with the rest”. This is the highest accolade that Laurence can bestow on anyone and it reveals his estimation of a human being who is acceptable to him.

Laurence does not know my “other” job(i.e Hospital chaplain). He has never asked me. But I value my being able to accept his use and work with Symbols, Dreams and Spirituality. I suppose it is because I use them too. I am also quite free to pray for Laurence through my own spirituality and bring the whole relationship into the divine dimension in my own personal devotions – part of caring for people by praying for them.

I also value the training, which allows me to work in these approaches.

Laurence’s comments about spiritual things occurred at a time when he was thinking about his wife. He began to recount her life in detail, with warmth and affection; wearing the pullover she had bought him. He has a real need for companionship, female companionship in particular. He seems to look for replacements for his wife in the caring professions; nurses, his Community Psychiatric Nurse, the day hospital staff( all female) and a female chaplain he met. He comes alive when he talks of females he values. He chuckles, his face wreathed in smiles and he gives the impression of being the kind of elderly man that people would love to be with. His limbs begin to animate and he becomes the life and soul of the party. There seems to be a real loss of continuing female presence in his life now.

SOUL (PRIMAL) WOUND

This goes back to school experiences, and continues throughout the war years, but it has emerged again with the death of his wife 10 years ago. This is when “it all started to go wrong” and “I never took a tablet till then”. Exhaustion and frustration at the physical and mental demise of his wife brought him to the point where he could not bring himself to administer her medication. She went into hospital, he went home to get a night’s rest and in that night she died (“the next day she was gone”). There followed depression, which finally resulted in his present admission. We have worked through this wound – not chronologically -but as and when. The goal would be that the wound teaches healing.

5. Developing the Transpersonal Thread
A DRAMA IN THE MAKING

• Laurence has been given the walk on part in a drama where he should have been billed as a central character
• He ought to be Dick Whittington (that makes me the Cat – and I will settle gladly for this role-though I would fantasise more of being Antonio Banderas playing the cat in Shrek 2)
• His challenge is to “turn again” and become a person of recognition
• This is now possible – because his badge(s) of office have been rediscovered
• He now has – at the end- his rightful place in the world

INSIGHTS ALONG THE WAY

• I came to this encounter with severe misgivings – I hate conflict and anger. This says a lot about me and my past – the fight or flight technique which prefers to go towards flight every time. However, I cannot avoid conflict every time, especially as I tend to perceive it on the basis of an irrational belief; i.e. he’s angry = I get chewed up. I don’t know this to be true, so I should find out for myself.
• I suppose I am also capable of being angry and aggressive so there is a fear at the first encounter that I see myself in Laurence and I won’t like what I see.
• Laurence’s character is of a robust, dependable person who is fiercely loyal to his own (phenomenological) world
• He is likeable when he is at one with himself and others
• He is very scary when he is in disagreement
• He has probably joined the group with the intention of being a key player- and of being centre stage
• He will always respond to able, caring females – he likes their attention
• This means that even if you are one of his male mates – you will have you realise that he plays Fred Flintstone and you are meant to be Barney. You could challenge this of course but I don’t feel the need. I can be Fred with my own set of females. There is a lot of Laurence in me.
• What has happened to me is that I am OK being in the same room as him now and at the outset I was very dubious.
•What has happened to Laurence is that he is now unlikely to destroy the whole day’s programme and seems more compassionate to others – especially those who have more acute dysfunctions.
• My main insight is that all of this takes time – over a year now – and there have been things, which have been a good contribution to the process. There probably have been several sessions where all that happened was “it’s nice to have somebody to talk to” – where it would have been difficult to find more than a basic counselling skill at work. I don’t see this as invalid in the whole process. It still goes on.

6. Professional Development
Ethical Awareness

As regards the placement, I am bound by 3 codes of ethics in all that I do- BACP, College of Health Care Chaplains (which has a counselling code of ethics) and that of the NHS trust which employs me.
I also have my workplace clinical supervision from the Senior Clinical Nurse. The only diversity issues are those of age and active military service.

Counselling Supervision

I have had 2 supervisors during this case study. The first supervisor was keen to support me regarding the impact of the nature of the combat details I have listened to at the outset. I also needed to check out what I was experiencing. The second supervisor was more inclined to get me to explore the primal wound in the client. This I have tried to do. The work with the badges and books was upheld as being useful to the client’s process. I have valued the supervision and the chance to just share how I am doing with the client and myself. My present supervisor says, “Every client brings a gift for your own process”.I believe this to be true. Laurence has given me the gift of his trust and courage.I wonder what I might have given him in return?


7. Summary

Laurence has moved from being perceived as an angry man who will not reveal the source of his anger to a more integrated being who is at home with others.This does not mean that all his issues of anger are resolved. The “Forgotten Army” of WW2 has a right to righteous indignation. To remove this would be to compromise human morality.

Fear and loss are managed to some extent in Laurence’s process, but the loss of his wife still causes a yearning for female company. The key female workers and his stays in the home help him to manage this loss.

What has gone on for me is that Laurence has provided for me the accounts of WW2, which I never heard from my own father and relatives. This has helped with my own process in managing what has been and what is lost in my own story. He told his story and I listened as one who had a deep need to resolve my own past.

There has been a healing of the primal wound in both of us as we journey together. And it goes on.

Postscript

It is now over a year since this was written. All I can add is that the work goes on and discharge from psychiatric care has now happened. I am still in touch with the client but as a friend who will probably visit him occasionally for the rest of his life.
I see all the work done as a valid part of the pastoral care of a hospital chaplain and minister of religion, enhanced by the counselling training which has formed part of the toolkit of that care.

Bill Smith
August 2006

____________________

The Reverend Bill Smith serves as a clinical chaplain at Salisbury Health Care NHS Trust where he works at South Wiltshire Mental Health Services, Fountain Way, Salisbury. He is an member of the College of Health Care Chaplains located in the United Kingtom.

The PR reported on this Study Course that took place in Durham, England this past July. If you search out the College of Health Care Chaplains website, you will be able to listen to Bill Smith's presentation as well as many others who presented during the event.

Posted by Perry Miller, Editor at 10:21 PM

October 20, 2006

SIXTH ANNUAL CPSP/AAPC FALL JOINT CONFERENCE HELD AT TIFF SCHOOL OF THEOLOGY

Nov. 2-3
The Iliff School of Theology
Denver, Colorado

The American Association of Pastoral Counselors and the College of Pastoral Supervision and Psychotherapy are pleased to present our 2006 Joint Conference on the theme of “Choosing Life on a Journey Called Aging” with Reverend Henry C. Simmons, Ph.D. on Friday, November 3 from 8:00 a.m. to 5:00 p.m., at the Iliff School of Theology. Cost for the c

Dr. Simmons is a dynamic speaker and enthusiastic advocate for one of the most compelling and significant opportunities of our times: spiritual growth in adult life. He is the author of Soulful Aging: Ministering through the Stages of Adulthood with Jane Wilson and Thriving Beyond Midlife. In addition to being an author and gifted speaker, Dr. Simmons is an ordained Minister and Professor of Religion and Aging at Union Theological Seminary and Presbyterian School of Christian Education in Richmond, Virginia.

Dr. Simmons will also be speaking on “Soulful Aging in the Twenty First Century” on Thursday, November 2 at 7:00 p.m. at Washington Park United Methodist Church, 1905 E. Arizona Avenue in Denver. This evening of creativity and hope with Dr. Simmons will include a dessert social and informal gathering. The cost will be $20.00.

For information on both events, contact Mary Ann Van Buskirk at 303-692-8006 or email Jane Keener and/or phoine her at 303-444-3541.

Posted by Perry Miller, Editor at 4:36 PM

October 12, 2006

THE CPE HISTORY IS REPEATING ITSELF by L. George Buck

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As one who has been involved in pastoral training and education for over forty years (certified as a “Chaplain Supervisor” by the Council for Clinical in 1964), I have experienced a good deal of change in the pastoral education movement. It now seems that history is repeating itself.

The present friction between CPSP and ACPE is not unlike that of the Council for Clinical Training and the Institute of Pastoral Care. The Council folk looked at the Institute folk as a bunch academic heads who overlooked the psycho-dynamic approach to “CPT”. One of my first supervisors, Tom Klink, once stated that the Institute super-visors needed to get acquainted with Sigmund Freud. On the other side of the fence, the Institute super-visors saw the Council supervisors as a bunch of feelers who refused to think. This war of words, so to speak, went on for several years.

In the mid-sixties, I supervised CPT students in up-state New York. When the New York supervisors would get together, we would often discuss the “qualifications” of the Institute supervisors and wondered how they could possibly do quality CPT. We were convinced that none of them could make it if they had to meet a Council Certification Committee. No doubt, the Institute folk felt the same way. This seems to be the present rub between CPSP and ACPE: CERTIFICATION!

For approximately nine years (three as chair), I served on the ACPE Certification Committee—later called Commission. When I first went on the Committee, it was called the C & A Committee (Accreditation Committee). Some of us were against the separating Certification and Accreditation, but the compulsive folk won out.

My certification experience allowed me to be involved with a lot of candidates. Many who were certified were well qualified and many who were certified were not very qualified. The biggest stumbling block came down to emotional maturity. I don’t know if that is the case now. Some seem to want to objectify the certification process so much that the human element (subjectivity) is no longer a factor---what a shame.

Will CPSP and ACPE ever get together and dialogue about the strengths and limitations of both organizations? Who knows? I often tell my students that, if you accuse another of having a problem, that person will react defensively. But if you say I have a problem with your behavior, you open it up for dialogue. That’s just common sense behavioral dynamics.
___________________

George Buck is a CPE Supervisor in the Department of Pastoral Care & Clinical Pastoral Education at the UAMS Medical Center in Little Rock, Arkansas.

Posted by Perry Miller, Editor at 9:47 PM

October 9, 2006

Whose Needs Are Being Met? by Mary Davis

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CPE programs in institutional settings have always grappled with giving to God what is God’s and to Caesar what is Caesar’s. The balance has been at different percentages in our history; at present, Caesar is winning.

The classic CPE question,” Whose needs are being met?” might best be answered today: JCAHO’s. DOE’s. QM’s. Press-Ganey’s. Providing an educational program in the midst of today’s highly regulated standards lends to training students to be pastorally functional before their pastoral identity is sufficiently integrated. “Use of self as a resource in ministry? Maybe later, after I figure out this interdisciplinary charting tool, and attend this patient-satisfaction committee meeting, and study these “smart” cards in case JCAHO visitors ask me a question.”

The challenges of providing Summer and Extended CPE units given the high level of professionalism required by the complexity of our clinical setting and my recent communal assessment of residents entering their third and fourth units led me to reflect on these issues. The students and residents are competent, caring ministers. They can peer with other disciplines. They can effectively use a spiritual assessment tool and make a passable pastoral plan. Their understanding of self as the principal resource in ministry (CPSP 230.2), their awareness of themselves as minister (ACPE 240.1), and integration of personal and pastoral identity (NACC 350.34) are less developed. The action-reflection-integration model of CPE becomes rather one-dimensional in the fast-paced, high acuity environment of our CPE Center. Action is the operative word. Time for reflection and integration becomes a challenge and luxury in the immensity of needs and the accompanying documentation required.

Many of us know the truism that it was only after “getting through” the certification process that we could finally be the whole person we were called to be in our ministry of supervision. There’s a lot of truth to that – social conditions, systems and structures demand a certain type of response. The very structures and systems guiding and supporting CPE programs today are contributing to a change in how we formerly preferred to form ministers. We previously focused on CPE units one and two to provide integration of personal and pastoral identity, while the latter units focused on pastoral functioning and specialization. Given the need to get students up to speed in settings with high acuity, technology, and administrative expectations has led to a reversal of sorts.

I don’t think this is necessarily bad. Perhaps that’s because I view CPE in a developmental way, and recognize that learning can be valuable prior to the realization of the personal meaning of such learning. I continue to come to greater understanding of who I am and how that affects my ministry, 27 years post my CPE beginnings. I continue to find new depths of meaning and application to the theories, practices and standards I have followed for years.
I trust that our present and future students and programs can find ways to integrate personally and professionally within the social conditions, systems and structures we serve. It will require continued engagement with the agencies which seek to define our training, careful and prayerful discernment of the effects of institutionalism on pastoral formation, and a willingness to find a soul-enhancing balance of law and gospel in our ministry of supervision.
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Mary D. Davis, NACC and CPSP CPE Supervisor is located in CHRISTUS Santa Rosa Health Care, San Antonio, Texas.

Posted by Perry Miller, Editor at 10:45 AM

October 4, 2006

2007 CPSP Plenary Announcement

The 2007 CPSP Plenary will meet March 28-March 31 in Raleigh, North Carolina. We will be at the Holiday Inn Brownstone in the Raleigh downtown area. This is a prime location in the heart of Raleigh adjacent to North Carolina State University. It's five minutes from the downtown business center and includes Art Museums, art galleries and the BTI Center for Performing Arts. The Cameron Village Shopping Center considered Raleigh's finest is two blocks from the hotel. The southeast premier entertainment and sports center featuring superstar performances is only four miles away. The airport is located twelve miles away and it is the Raleigh/Durham International Airport.

The room rate for this conference is $79 for a standard room. The address of Holiday Inn Brownstone is 1707 Hillsborough Street, Raleigh, North Carolina 27605. You can call toll-free (800) 331-7919. You can call locally at (919) 828-0811. You can fax at (919) 834-0904 and view their website at http://www.brownstonehotel.com/. The Brownstone completed a $4 million renovation in 2002. It has a 190 newly appointed guest rooms. It has junior and executive suites. It has non-smoking floors and high-speed Internet access. All rooms have fresh-air balconies.

On March 29th, which is a Thursday, Dr. John Kenny, who is the dean of Virginia Union Seminary, an African-American seminary in Richmond, Virginia, will be our speaker. Dr. Kenny has been the dean at Virginia Union for many years and is an African-American Baptist pastor in Richmond, Virginia. At the banquet on the 29th, Dr. Estaban Montilla will speak to us concerning counseling and supervising Latinos. We look forward to hearing his sharings since he is well versed in this arena. On Friday morning, Dr. Carol Schweitzer, professor of Pastoral Care at Union Theological Seminary, will be sharing with us concerning her most recent book publication.

Scheduled in this event are our small groups where we will be consultant with each other. We remind everyone that we need to bring some case presentations or personal events of our lives that need consultation. Finally, if you desire to do a two hour pre-conference workshop between 3:00 p.m. and 5:00 p.m., e-mail John Edgerton by November 1, 2006.

George Hankins Hull, Director of Pastoral Care & Clinical Pastoral Education at the UAMS Medical Center in Little Rock, Arkansas, will be the scholarship chairperson for this event.


-John Edgerton, 2007 CPSP Plenary Coordinator

Posted by Perry Miller, Editor at 11:54 PM

October 2, 2006

Partnership & Nonabandonment in the Care of the Dying

The 8th Annual Helen Flanders Dunbar Memorial Lecture and Luncheon will be offered under the auspices of New York-Presbyterian and Columbia Medical Center in NYC. Timothy E. Quill, MD, nationally recognized for his ongoing work and study of palliative care and end of life issues, will be the guest lecture.

The event will be held Friday, October 6, 2006 from 9:30 AM-1:00 PM. Contact Maria Villanueva, Department of Pastoral Care, at 212-305-5817 or email her for additional information.

Posted by Perry Miller, Editor at 9:31 PM