 2/16/2005
Vol. 2, No. 2
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Professional
Practice |
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The
Rev. John Brewer
on facing up
to one's ghost
The
Unthinkable…With
a Face
Helping
children
die, you
say? “Oh,
that’s
one kind
of chaplaincy
I couldn’t
do.”
Ring
a bell? Pediatrics
comes with
its own set
of difficulties,
which most
can easily
list: the unthinkable
with a face,
a name, and
loving parents.
Besides the
obvious problems,
like “Children
shouldn’t
die before
their parents,”“How
could an all
powerful, benevolent
Being allow
this to happen”, “What
part have I
played as parent
in what is
happening here?”or “Why
is the Almighty
punishing me?”….
there is a
more fundamental
question in
regards to
working in
pediatrics
which chaplains
need to address
if their ministry
is to be whole.
Chaplains
commonly say
to me: “I
could never
do that work.”
Hmm….
Do I sense
fear here?
Why do so many
say it, sometimes
even CPE supervisors?
Have you ever
said it? It
seems people
say it more
about cancer
kids than trauma
kids. Why is
that? It reminds
me of my days
as a naturalist
in Jackson
Hole, Wyoming,
when there
was one question
I was most
commonly asked.
It always started
with “How”–and
I knew how
they would
finish –“did
you land this
job?”It
is interesting
that some kinds
of jobs bring
forth certain
common responses
from others.
“Oh,
that’s
one kind of
chaplaincy
I couldn’t
do.”Maybe,
just for a
moment, you
have pictured
in your mind
a perfect baby
who was abused,
raped and/or
killed. You
envisioned
the act –you
let it flash
in your mind
for only a
moment –then
you quickly
blocked it
out because
of the horror.
But it still
lingers somewhere
in the comment, “Oh,
I could never
do that kind
of chaplaincy. “
Most
of us live
in an orderly
world, intervening
to help with
the chaos of
sickness as
abnormal and
something to “help
people through.”We
are trained
to help connect
them with their
strength in
order to cope,
knowing that
in time, things
will get better,
even if death
occurs. We
search for
order, for
human causes,
for ”reasons”if
you will, often
without knowing
it. We want
to know that
life’s
experiences
aren’t
random, that
there is a
Force which
somehow allows
difficulties,
and in our
search for
answers it
is easier if
we can find
human cause
for a child
suffering.
We can often
find human
neglect, inexperience,
abuse and inattention
at the root
of general
pediatric admissions.
But, where
is the ultimate
ghost?
The ultimate ghost lurks in a seemingly more benign place. It is a child
with whom we have developed a relationship with over the years; a child
who presents initially as very healthy, and then, in the end, proves us
wrong in our supposed ability to muster emotional boundaries.
Our
ultimate challenge?
It is the child
dying for no
human cause
or reason we
can name and
it leads us
to an uneasy
feeling of
randomness.
Pediatric ICU
may have reasons
and it may
not. But, we
just can’t
get away from
randomness
in pediatric
oncology. It
seems counter-intuitive
to even entertain
the possibility
that it is
easier to work
with an abuser
or abusee than
with a pediatric
cancer patient.
However, abuse
we can at least
name. It is
not much of
a reason to
say it was
an abuser,
an accident
or neglect
that did it.
But, it actually
gives us a
certain satisfaction
if we can blame
a human for
this death.
The thought
of a random
child death
can deeply
challenge even
a strong believer’s
faith in the
Almighty.
If
this in some
sense is true
for me, then
there is a
very real way
in which I
as chaplain
am subtly attempting
to “explain”and
in some sense ”control”the
world I am
experiencing.
Behind the
search for
reasons may
be the fear
of randomness.
And it is this
fear which
may be lurking
behind the
words, “I
could never….”I
must be prepared
to not search
for reasons
if I am to
be fully present
as a chaplain,
for the Almighty
exists in the
randomness,
too.
Am
I being too
hard? Maybe.
But this area
is in need
of chaplains
as much or
more than any
other, and
is filled with
magical moments
of grace, mercy
and providence
in spite of
the challenges.
Comments?
Rev.
John Brewer, M.Div.,
BCC has a BS in
Forestry and has
experience as a
Bridger-Teton Naturalist.
He was a Grant-
writer/Manager
for the Department
of Natural Resources’Minnesota
Young Adult Conservation
Corps, and Director
of the Indianola
Conference Center
(Washington). John
has specialized
in Emergency Department
chaplaincy and
currently is Pediatric
Chaplain at Sacred
Heart Medical Center,
Spokane, Washington.
He was ordained
by the Conservative
Christian Congregational
Church.
Do
you have thoughts
about professional
practice you’d
like to share with
your colleagues?
Send an e-mail info@PlainViews.org.
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Advocacy |
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Chaplain Jim Rowland
on a professional effort toward the
process at life's end
Hospital
Chaplaincy and Hospice Chaplaincy:
A Comparison
It is not unusual for people who
are approaching the end of their
life because of a terminal illness
to experience abandonment for a number
of reasons. Sometimes this abandonment
comes from a sincere desire not to
interfere or detract from the precious
short time that the patient has left
with their immediate family and/or
spouse. Sometimes it might be a subconscious
abandonment related to our very human
fear of death and/or avoidance of
intense or stressful situations.
In either case, it is a time when
a specific training and understanding
is called for especially in the context
of Pastoral Care. This specific training
and knowledge is standard for any
certified hospital chaplain, but
this is not currently the case for
hospice chaplains.
There is pain and destruction happening
all around families in the end-of-life
experience, but these same families
have been in “the experience”so
long that it frequently becomes a
weird form of “normal.”Those
around them however, in order to
enter into that world, must go through
these intense emotions and stresses
of the dying process in order to
be “with”the dying and
their family. Being “with”these
families is not an easy or pleasant
task for either clergy or laity.
This is why I believe hospice chaplains
need training and certification similar
to that of a hospital chaplain to
prepare them properly.
Hospice chaplains are frequently
local parish clergy persons who have
no prior training beyond the typical
pastoral care classes offered in
completing their Master of Divinity
degree at seminary, which isn’t
usually very much at all. Many times
it is some prior experience with
a terminally ill person or family
member which has led them to volunteer
for hospice work. These same clergy
persons represent a variety of denominations,
some of whom might see this ministry
as an opportunity for evangelism.
Finally, it is true for the most
part, that these well-intended persons
also have little or no training or
tools for “processing”their
own emotions and issues that working
with the terminally ill are sure
to produce within them.
When I first worked as a hospice
chaplain volunteer, I was barely
beginning seminary, was serving as
an associate pastor to a large congregation
in North-Central Arkansas, and had
completed only one course in crisis
counseling in seminary, which had
taught me “active listening”skills.
I did not yet have the knowledge
or ability to “process”my
own emotions, thoughts, and experiences
with these patients and their families.
In addition, I had no knowledge or
training in the dying process, nor
had I even begun to develop a theology
that incorporated the idea of a “good
death.”How could I assist another
toward having a “good death”experience
if I wasn’t even familiar with
the term, let alone the theology
behind it?
Finally, I believe it is time that
we give as professional an effort
toward the process at life’s
end as we give to those in the middle
of the journey of life. Human beings
need “meanings”to experience
harmony in their living and they
are just as needy for “meanings”in
preparing for having a harmonious
end. The assistance given must be
focused, trained, and intentional,
which is what professional training
and certification will prepare hospice
chaplains to do. It will give the
hospice chaplains the tools for processing
their own emotions and thoughts related
to their ministry, which will keep
them healthy and effective in their
caring with others.
Chaplain Jim
Rowland is Director of Pastoral
Care Services for Wadley Health
System in Texarkana, TX. He
has a B.A. in History from University
of Texas at Arlington, and a Master
of Divinity degree from Phillips
Theological Seminary in Tulsa,
OK. Jim is an Elder in the
Arkansas Conference of the United
Methodist Church and has served
continuously under appointment
in the local parish and beyond
since 1979.
Do you have thoughts about advocacy
you’d like to share with your colleagues?
Send an e-mail to info@PlainViews.org.
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Education & Research |
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The Rev. George F. Handzo
and Dr. Kevin J.
Flannelly on research
by chaplains for chaplains
An
Opportunity to Participate
in Chaplaincy Research
A pioneer in pastoral
research, the Rev. Dr.
Larry VandeCreek, once
expressed concern that
the rising interest in
research on spirituality
among health professionals
would eclipse the influence
of chaplains in their
own area of expertise,
if they did not conduct
more research. [1] It
is certainly evident
that the number of articles
on religion and spirituality
that have been published
in healthcare journals
has surged in recent
years. [2] It is also
evident that the number
of studies about chaplains
has not kept pace [2],
and it is unlikely to
do so unless chaplains
do more studies themselves.
But we do not anticipate
the dire consequences
that Rev. VandeCreek
envisioned. A recent
review of research in
the Journal of Pastoral
Care & Counseling and
other journals of particular
interest to chaplains
found that the quantity
and quality of research
in the field increased
substantially during
the last decade. [3]
Over the past several
years we have worked
with dozens of our staff
and resident chaplains
to help them develop
and conduct studies on
topics of interest to
them, including studies
on spirituality and depression,
and religious beliefs
and fear of death. [4]
The professional satisfaction
obtained from engaging
in their first research
project has inspired
a number of our colleagues
to pursue other research.
While some chaplains
are naturally reluctant
to delve into the research
realm, the eminent pastoral
researcher, George Fitchett,
and his colleagues found
that even a one-day workshop
can change some chaplains’attitudes
from anxiety and reluctance
to confidence and enthusiasm.
[5] It is far less easy
to turn around the attitudes
of those who feel that
science has no place
in the practice of ministry.
But science and ministry
are different enterprises,
and neither of them is
an end in itself. [6]
Yet science can work
in the service of ministry,
especially in the current
era of healthcare in
which numbers drive administrative
decision making. [7]
With this in mind, we
and our colleagues at
The HealthCare Chaplaincy
have conducted a series
of studies on administrators’perceptions
of chaplains’roles,
and we are designing
studies to help us better
understand the perspectives
of patients and their
families. As part of
this process, The Chaplaincy’s
Research Department developed
a scale of patients’spiritual
needs. The scale currently
consists of 29 items
that cover seven major
spiritual constructs
derived from an extension
review of the healthcare
literature. [8]
To help us in this important
and challenging work,
we are asking you to
give us the benefit of
your professional experience
by filling out the questionnaires
at the web sites listed
below. The questionnaire
at the first web site
asks about the spiritual
needs of your patients/clients.
The nearly identical
questionnaire at the
second web site offers
you the opportunity explore
your own spiritual needs.
Each survey should take
less than 10 minutes
to complete. Your participation
is completely anonymous.
A summary of the results
of each survey will be
posted at The Chaplaincy’s
web site in late March.
We deeply appreciate
your assistance in this
important work. We believe
this research will advance
the professional field
of chaplaincy, aid in
the training of student
chaplains, and be extremely
useful for clinical practice.
Patient’s Spiritual
Needs  Click
Here
Self-evaluation of Spiritual
Needs Click
Here
[1] VandeCreek, L. (1988). A
Research Primer for
Pastoral Care.
Decatur, GA: Journal
of Pastoral Care Publications,
Inc.
[2] Weaver, A.J., Flannelly, K.J., & Oppenheimer J.E. (2003). "Religion,
spirituality, and chaplains in the biomedical literature: 1965-2000." International
Journal of Psychiatry in Medicine, 33(2) 155-161.
[3] Flannelly, K. J., Liu, C., Oppenheimer, J.E., Weaver A.J., & Larson,
D.B. (2003). "An evaluation of the quantity and quality of empirical research
in three pastoral care and counseling journals, 1990-1999: Has anything changed?" The
Journal of Pastoral Care & Counseling, 57(2), 167-178.
[4] Flannelly, K.J., Weaver, A.J., Smith, W.J., & Handzo, G.F. (2003). "Psychologists
and health care chaplains doing research together." Journal of Psychology
and Christianity, 22(4), 327-332.
[5] Fitchett, G., Bradshaw, A.K., & Gibbons, G.D. (2003). "Chaplains
and research: 'I feel a little excited.'” Ministry, Society, and
Theology, 17 (1, 2), 90-104.
[6] Handzo, G.F. (2002). "Science and ministry: Confusion and reality." Journal
of HealthCare Chaplaincy, 12(1, 2), 73-79.
[7] Handzo, G.F. (2004). "Bridging diversity: President’s address
to the 2004 APC conference." Chaplaincy Today, 20(2), 31-35.
[8] Galek, K., Flannelly, K.J., Vane, A., & Galek, R.M. (2005). "Assessing
patients’spiritual needs: A comprehensive instrument." Holistic
Nursing Practice, 19(2), 62-69.
The
Rev. George F. Handzo
is The HealthCare Chaplaincy’s
director of clinical
services and institutional
relations. He has spent
nearly three decades
in the field of multifaith
clinical pastoral care.
A certified healthcare
chaplain and Lutheran
Pastor, the Rev. Handzo
served as president
of the Association
of Professional Chaplains
(APC) from 2002-2004.
He also served until
recently as chair of
the Council on Collaboration,
which is comprised
of the six major pastoral
care organizations
in the United States
and Canada.
Dr.
Kevin J. Flannelly
is the Associate Director
of Research at The
HealthCare Chaplaincy
in New York City, where
he has worked since
2001. He has
published over 100
studies in various
area of psychology
and has been actively
involved in research
on religion and spirituality
since 1996. He
recently published
a review and analysis
of the methodological
quality of research
on religion and health
in the Southern
Medical Journal.
Do you have thoughts
about education & research
you’d like to share with
your colleagues? Send
an e-mail to info@PlainViews.org. |
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Spiritual
Development |
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Chaplain
David Fries on wonder
that is not glorious
Wondering
as Prayer
The patient,
as many do, said, “No,
thank you, I am fine,”to
my invitation to talk.
I lingered and made complimentary
niceties. She soon opened
up. “I did everything
right. So how come these
three babies died?”The
young ones were developed
enough to have been dressed
by the staff and placed,
for a while, into her
arms. They were named.
One of the things that
we considered was what
the children had done
for her. Then I asked
what she had been wondering
herself, “What
have you done for them?”This
was an important question.
We wondered together.
Later that day I was
in The Addiction Institute.
One of the patients in
our weekly conversation
group was skeptical about
G_d being good or loving.
He had been clean of
heroine for seven years.
Before some surgery he
informed his doctor that
he was an addict. The
doctor said that he was
going to give him a low
dose of morphine and
it would not set off
his addiction. The doctor
was wrong. He wondered, “Why
did G_d allow this to
happen? After all,”he
said, “I had been
doing my part.”
Both had done their
parts in creating and
making a good new life.
Had G_d done G_d’s
part? If so how? How
do you know? These questions
disturbed my day. Where
is the evidence of a
loving G_d doing G_d’s
part when all evidence
seems mean, I wondered.
Tragedy makes people
wonder. Wonder is a state
of being that I associate
with being in the presence
of G_d. Proximity to
the Holy induces wonder.
That wonder is glorious.
But in tragedy wonder
is not glorious. When
I begin a visit I almost
never begin with the
subject of G_d. G_d is
too divisive to be an
opening. G_d will enter
when (and if) the spirit
moves. If G_d is to be
a friend in time of need
and a resource for future
strength then the worth
and the good of G_d has
to be made recognizable.
Recognizing personal
beauty is a way that
I am learning to find
an appreciable safe ground
for discussion. In both
of those situations I
opened up the subject
of personal beauty. Both
responded readily.
Through intrinsic beauty
that each individual
has, their worth and
resource for understanding
securely increases. The
powerless feel inner
resource. Inner beauty
may be the place to begin
seeking access to possible
worlds not yet comprehended.
G_d is behind all beauty,
an assumption that for
the sake of discussion
is usually granted. The
creating process (G_d’s
as well as the individual’s)
is an ongoing process.
Ever, unstoppable, opening
beauty is the evidence.
A person can still, maybe
eventually will, cast
the fateful event into
a new light. “G_d
doesn’t give me
anything that I can’t
handle,”said the
man, a fellow addict,
next to the heroin addict.
Like so many, he sought
to find a meaning that
he could have a fashioning
free hand in. He wanted
to have reconstructive
part.
There is aesthetic potential
mixed with G_d’s
will and my loss. “How
will they take it?”is
a health care question
that artists also ask.
There is a beauty that
passes understanding.
The new mother understood.
She sadly said she recognized
it when she held those
three beautiful, named
and dressed children
in her arms, between
them was a beauty, which
passed the understanding
of others. She gave them
her beauty.
Chaplain David Fries
is a volunteer chaplain
artist at St. Luke’s-Roosevelt
Hospital Center, New York
City. He was artist in
residence for the department
of spiritual care at St.
Vincent’s Hospital
in New York City from 1998-2001.
His article “Signs
and Wonders”has been
published in Chaplaincy
Today, the Journal of the
Association of Professional
Chaplains, Vol.18 Number
1. Summer 2002.
Do you have thoughts
about spiritual development
you’d like to share with
your colleagues? Send
an e-mail of any length
to info@PlainViews.org.
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EthicsWalk |
EthicsWalk addresses
spiritual
care
as
an
ethical
enterprise.
It
explores
why
relationships
between
spiritual
care
providers
and
those
they
serve
need
protection,
and
examines
what
that
protection
entails. PlainViews invites
our
readers
to
share
their
responses
to
each EthicsWalk column,
which
will
be
published
in
the
following
issue.
If
you’d
like
to
respond
to EthicsWalk,
please
send
a
comment
of
no
more
than
100
words.
You
can
use
the
e-form
below
(click
on "hearing
from
you," link)
or
submit
your
commentary
to
the
editors
in
the
body
of
an
e-mail
(or
as
a
Microsoft
Word
attachment)
sent
to Info@PlainViews.org.
Please
put
the
phrase
“EthicsWalk”
in
your
subject
line.
We look forward to hearing
from you.
Tending
the Spiritual Care Provider’s
Space
Monitoring
internal
signals
that
caution
a
spiritual
care
provider
when
one’s
own
needs
and
wants
challenge
healthy
boundaries
was
the
focus
of
last
month’s
discussion.
This
month’s
acknowledges
that
boundaries
can
be
pushed
subtly
and
inappropriately
by
those
being
served.
It’s
fine
to
negotiate
a
boundary
with
self-aware
and
non
self-serving
intentionality
if
it
benefits
the
spiritual
care
relationship
and
does
no
harm
to
the
person
served
or
the
provider.
The
danger
is
superficial
awareness
of
self
and
other
or
grandiose
assumptions
about
the
special-ness
of
either.
Hence,
the
wisdom
of
practical,
professional
boundaries.
Pirkei
Avot 1:6 advises —“get
yourself a teacher, find someone
to study with.”[1] For
spiritual care providers, this
applies to work as much as study.
Spiritual care providers need
a mentor, supervisor, spiritual
director, or therapist; preferably,
a licensed professional with
whom one can enter into a “privileged
and confidential”relationship.
This will be a person from whom
no secrets are hid; who is present
as the spiritual care provider’s
own “trusted
professional.”Additionally
(not instead of), one should
engage regularly in peer supervision.
Having
such
professional
relationships
helps
one
discern
and
direct
one’s
responses
to
one’s
own
desires
as
well
as
recognize
potential
miscues
coming
from
others.
There are sexually
aggressive
and
emotionally
abusive
colleagues,
patients,
students
and
congregants.
There
are
sexual
and
psychological
predators
among
people
who
seek
the
counsel
and
services
of
spiritual
care
providers.
One
must
exercise
self
care
while
caring
for
others.
Healthy
boundaries
provide
safe
space
for
appropriately
intimate
spiritual
care
relationships.
Before
allowing
a
boundary
to
be
negotiated
differently,
ascertain why someone
wants
your
additional
time
or “irregular”attention.
Until
motives
are
clear,
be
careful
about
divulging
more
than “directory”information
about
yourself
or
your
work
habits.
Be
circumspect
about
meeting
times
and
locations —stick
to
the
norms
and
practices
of
the
institution
and
profession.
In
the
daily
routine,
spiritual
care
providers,
as
do
all
professionals,
need
to
pay
attention
to
the
World
of
Reality
for
the “other”person.
The impact of
the
care
provider’s
attentions
and
normal,
appropriate
affection-born-of-concern
may
be
very
different
for
the
other
than
the
provider’s intent. Perception
is
reality for
the
preceptor;
and
it
is
the impact of
the
transaction,
not
the intent,
by
which
any
misunderstandings
will
be
judged
when
emotional,
physical
or
sexual
exploitation
are
experienced
or
alleged.
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