The History of Spiritual Care

Catherine O’Connor, CSB, Ph.D.

Covenant Health Systems

Lexington, MA

Objectives

1. Participants will understand three historical events which influenced the development of Spiritual Care

2. Participants will name three key people and their contribution in shaping the history of spiritual care

3. Participants will be able to name three current strand in the ongoing development of spiritual care

Scripture“ The Lord God has given me the tongue of a teacher, that I

may know how to sustain the weary with a word. Morning by morning he wakens me to listen like a disciple”(Isaiah 50:4)

“I was ill and you cared for me” (Mt. 25:36)

“I came that you may have life and life to the full” (John 10:10)

“..And he had compassion for them” (Mark 6:34)

“Is there anyone sick among you? He should ask for the presbyters… They in turn are to pray for him, anointing him in the name of the Lord” (James 5)

Scripture

• Where are you?

• What do you want me to do for you?

• Whom do you seek?

• What are you discussing as you go on your way?

“Ministry of Cure of Souls”

“The ministry of the cure of souls, or pastoral care, consists of helping acts, done by representative Christian persons, directed towards the healing, sustaining, guiding and reconciling of troubled persons whose troubles arise in the context of ultimate meanings and concerns.”

Seward Hiltner 1958

Four functions of Pastoral Care

1. Healing

2. Sustaining

3. Guiding

4. Reconciling

Clebsch & Jaekle 1975

Eight epochs of Christian Pastoring

1. Primitive Christianity

2. Under Oppression

3. “Christian” Culture

4. The “Dark Ages”

5. Mediaeval Christendom

6. Renaissance & Reformation

7. Enlightenment

8. The Post-Christendom Era

9. Modernity; Post-Modernity

20th Century Trends

• Shift from classical models of academics

to a more practical model

• Influence of Freud and William James

• Medical Social Work Movement at MASS. General Hospital, Boston

20th Century Trends.

• Emmanuel Movement – Rev. Elwood Worcester at Emmanuel Episcopalian Church, Boston

• CPE movement in early 1920’s

Clinical Pastoral Education(CPE)

• Dr. William Keller

Dr. Cabot Lodge

Rev. Anton Boisen

Dr. Helen Dunbar Flanders

1930 -1990

1930s - New England Group - New York Group1940s - Institute of Pastoral Care (ICP) New England

- Council of Clinical Training New York

- Southern Baptist CPE - Lutheran Advisory Council

1930- 1990

1950 – Development of Standards1965 – Canadian Council formed1967 – Strands merged and the Association of

Clinical Pastoral Education formed (ACPE)1970 - National Association of Catholic Chaplains formed (NACC)1980’s NAJC1988 – COMMISS 2007 – Common Standards2009 - Spiritual Care Collaborative (SCC)

Anton Boisen

• Brush Clearing

• Fragmentation – Learning from Failure

• Living Human Document

• Case Study Methodology

• Pastoral Diagnosis

The Self as The Instrument of Healing

• Vulnerability

• Anxiety

• Story

Praxis Methodology

Think – Learn – Do

Do - Think - Learn

Diagnosis• Dia – gnosis

• The meaning we give to the knowledge available

• Carl Jung

Hermenutical Approach

• Allow people to disclose their word, their meaning

• Reverence for the text, the word of the person, as we have reverence for the Word, the text of Scripture

• Sometimes interpreter of the person to themselves, of their sstory; sometimes the interpreter of the Story, of God’s saving events of salvation

The Minister as DiagnosticanPaul Pruyser, MD

• Awareness of the Holy

• Providence

• Faith

• Grace

• Repentance

• Communion

• Vocation

Themes

1930s What must I do to be of help?

1940s What must I know to be of help

1950s What must I say to be of help

1960s Who must I be to be of Help

1990’s - Focus on Competencies- personal, professional,

spiritual

The Illness Narratives: Suffering, Healing and the Human Condition

• Illness

• Dis-ease

• Sickness Arthur Kleinman, MD

20th Century Trends

Shifts:

Pastoral Care - Pastoral Counseling

Pastoral Counseling - Pastoral Psychotherapy

Pastoral Care - Spiritual Care

Individual Spiritual Direction – Group Spiritual Direction

Individual - Systems

Influences

• DSM - IV

• Rediscovery of Spirituality in the 1990’s

• Differentiation between Spirituality and Religion

Themes

• The Diagnostican - Paul Pruyser

• Gardener - Edgar Draper

• Living Human Web – Bonnie J. Miller- Mclemore

• Wounded Healer – H. Nouwen

• Midwife – B.Gill-Austern

Definition of Spiritual Care

“Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred”.

J. of Palliative Care, Vol. 12, No 10, 2009

Spiritual Assessment of Patients and Families

Spiritual Screening

Spiritual History

Spiritual Assessmentwww. icsi.org, November 2009

Who does Spiritual Screening?

Spiritual Screening: Nurse/Social Worker/

Admissions

Spiritual History: Physician, Nurse, Social Worker, other clinician

Spiritual Assessment: Chaplain

Spiritual Assessment Tools

H.O.P.E

F.I.C.A.

S.P.I.R.I.T.

Spiritual Assessment Tools www.icsi.org 11/2009

H: Sources of Hope, meaning, comfort, strength

O: Member of organized religion

P: Personal Spirituality

E: Effects of beliefs on medical care, end of

life(Anandarajah, 2001 [R])

Spiritual Assessment Tools

F: Do you have spiritual beliefs or faith that helped you cope in the past? I: How do these beliefs influence you?C: Involvement in religious community or church? A: How would you like your health care

providers to be with you in addressing spiritual issues and concerns?

(Puchalski, 2000 [R])

Spiritual Assessment Tools

S: Spiritual belief system

P: Personal spirituality

I: Integration with a spiritual community

R: Ritualized practices and restrictions

I: Implications for medical care

T: Terminal events planning(Maugans, 1996 [R])

Documentation

• Where?

• Who?

Clebsch & Jaekle

Four guidelines during times of transition

Issues and Challenges of the 21st Century• Metrics - what do we measure and how?• Inpatient to Outpatient Care• Shortened LOS• Medical Science and Ethics• Individual vs. Systemic Thinking• Cultural Diversity• Religion and Spirituality• Training/Compensation for Chaplaincy• Having “A Voice at the Table”• Other?

Sources Clebsch, W. & C. R. Jaekle (1964) Pastoral Care in Historical

Perspective. New York: Prentice-Hall, Inc.

Dykstra, R.C. (Ed). (2005) Images of Pastoral Care: Classic Readings St. Louis: Chalice Press.

McNeill, J.T. (1951) A History of the Cure of Souls New York: Harper & Row.

O’Connor, T. St. J. “Pastoral Counseling and Pastoral Care: Is There a Difference” . J. of Pastoral Care & Counseling, Spring 2003, Vol. 57, No. 1.

www. icsi.org, November 2009

“ Improving the Quality of Spiritual Care as a Dimension of Palliative

Care: The Report of the Consensus Conference” . J. of Palliative Care,

Vol. 12, No 10, 2009