CURRICULUM PROJECT

A CURRICULUM

Basic Supervised Pastoral Education

An Introduction

Supervised Pastoral Education (SPE), including the two streams of clinical pastoral education (CPE) and pastoral counseling education (PCE), is couched in Anton Boisen’s gripping image of the living human document. Originally this document was both autobiographical, telling the story of how Boisen examined the madness of his psychotic delusions to find his life’s meaning, and educational, how caregivers can learn pastoral care and theology in clinical, disciplined contact with their patients in the hospital. SPE has found its identity in these twin roots of self-awareness in concert with deep respect for the sacred texts present in the living human document of those encountered in the practice of spiritual care and counselling.    

With the present development of a curriculum for basic clinical education in spiritual care and counselling, critical questions may well arise whether a written curriculum takes away from the primacy of the living human document and the pastoral relationship. Is the curriculum reversing the order in the clinical pastoral education (CPE) tradition of learning from the patient rather than from authoritative textbooks, and caring through the pastoral relationship rather than following the dictates of professional practice and expertise? Is the curriculum designed to be a corrective to a supposedly anti-scientific bias and culture of neglect and suspicion for written texts and professional directives in CPE?

The curriculum does reflect significant changes in The Canadian Association for Spiritual Care(CASC/ACSS) linked to recent trends in scientific and professional procedures in health care. Several forces that drive these current changes impacting SPE have been identified:

• Canadian privacy and public safety legislation can put institutional chaplains and pastoral counsellors at risk in losing access to clients.
• Chaplains and pastoral counsellors face the potential of having to affiliate with existing, legislatively endorsed, secular professional organizations to practice their primary or specialist counselling ministry.
• Health care institutions expect their chaplains to demonstrate enhanced theoretical and practice competencies in keeping with a highly professionalized, evidence-based workplace.
• Spiritual care, no longer reserved for chaplain ministry, has been increasingly claimed as a specialty of care by other health care professionals as their legitimate professional territory, both in terms of research and practice.

The curriculum, however, intends to be more than a defensive and reactive response to these forces in health care reform. The focus and main intent of the curriculum is to facilitate students in the course of their clinical education, and to do so in the context of the realities of the present health care system. The curriculum will identify an essential knowledge base and skills for the practice of spiritual care in conjunction with fostering the development of personal characteristics in helping relationships.
The research that shapes the curriculum comes from the 2006 CASC/ACSS sponsored DACUM workshop where Certified Spiritual Care Providers provided the information for a profile of major areas of responsibility and related tasks required for their profession. This workshop was preceded by the PALLIUM Project (2005) that, following the same DACUM format, developed a profile of major areas of responsibility and related tasks for the Professional Hospice Palliative Care Spiritual Care Provider. The two job profiles complement CASC/ACSS’s own practice and certification standards in specifying and clarifying the practice of spiritual care.

Both profiles delineate spiritual care under three distinct categories. Taking the DACUM Job Profile as example, a three-dimensional picture of spiritual care comes out in the following table:

Table 1.1
DACUM JOB PROFILE

It is remarkable to note that CPE itself has evolved in a similar triadic fashion. Rather than a smooth, linear development CPE has played with, and fought about, its different dimensions. In its history, the CPE movement has performed on three main stages that highlight its theology and practice of ministry.   The first stage centered on what to do with an emphasis on personal skills in supporting people in distress. Dr. Richard Cabot, a medical leader in the formation of CPE, and Russell L. Dicks, a chaplain/supervisor, who published several books on pastoral care and counseling and introduced the verbatim in CPE, were prominent voices who defined the chaplain’s role as primarily one of sustaining and comforting the patient.  Anton Boisen, having learned from the Freudian concepts of a dynamic psychology, believed that the chaplain’s role included a theological understanding of mental illness. Speaking from his own experience he advocated a more direct role for the chaplain in the interpretation of psychological forces and providing spiritual guidance for the patient. He introduced the case method in theological education as the hermeneutical tool for the interpretation of the living human document. This led to the what to know stage in CPE, holding that spiritual care is not restricted to supportive action but includes a theological understanding that ministry could bring to human suffering. Late in the 1950’s the focus changed to what to be, emphasizing the helping relationship as the key to healing.  In this view spiritual care came of age when it disavowed both expert knowledge and clinical expertise as the primary tools in care. From this perspective, knowledge of self in relation to others rather than theoretical knowledge, and the use of the helping relationship rather than of practical helping skills, become the hallmarks of spiritual care and counselling.

The three-dimensional job profile of the spiritual care provider in the DACUM and the PALLIUM project reflect these three performance stages of CPE. By casting doing, knowing, and being in interaction of three helping roles, the three are not ranked in a hierarchical order nor put in competition. Rather, the three constitute an animated composite, startling in its variety of variables and possibilities. This is the caring triangle pursued in the curriculum, the three way interaction of theory (knowing), practice (doing), and the helping relationship (being).

Figure 1.1 

The Caring Triangle

     What to Know

What to Be     What to Do

  The helping relationship has been developed in CPE in the humanistic tradition of person-centered caring with an emphasis on self-awareness in a disciplined, sensitive and compassionate ministry of presence with the other. This is the identity highlighted in the DACUM report under the attitudes/attributes of the spiritual care provider: “sensitivity to the distinction between client-focused care and provider-driven care.” In the caring triangle the helping relationship retains its primacy as it coordinates and attunes theory (knowledge) and practice (skills) to a particular situation and clinical context. It is a primacy in the context of a playful interaction and collaborative process among equals.

To further develop an understanding of and appreciation for the curriculum it is helpful not only to study both the DACUM Report and the PALLIUM Project but also to contrast their differences. As the DACUM Job Profile explains the areas of knowledge, skills, and attitudes were identified “not in a formal manner, but as the result of comments or thoughts expressed throughout the course of the DACUM Profiling session.” In contrast, the PALLIUM Project is more specific in listing essential knowledge, skills and personal characteristics. Put in simplistic terms, while the DACUM Profile generalizes, the PALLIUM Profile particularizes. This contrast is demonstrated in the following table of comparing how each respective profile defines the knowledge base.

Table 1.2
A TABLE OF COMPARISON

The meaning of the contrast is not that one is superior or inferior but that there is a difference. While the DACUM participants represented a diversified group of spiritual care providers from a variety of health care settings, the PALLIUM group shared the same workplace setting as spiritual care providers in a professional hospice palliative care setting. It makes sense that the specificity in spiritual care setting is a main reason for the job profile also becoming more specific.

This has implications for this curriculum. The curriculum is not intended to be a comprehensive and definitive training manual covering all aspects and contexts of spiritual care. Both the DACUM and the PALLIUM group described their respective Job Profile chart as a “living document” that represents a “snap shot” at a particular time of a particular representative group of spiritual care providers in a diversified and reforming health care movement. As these DACUM-generated “living documents” come primarily from the life experience of active spiritual care providers rather than from the professional literature, these two documents present as “living human documents.”

This is the purpose of the curriculum: to be a “living human document,” an in-process, working document welcoming the unique experiences of the various CPE and PCE centers and students. The curriculum will outline the knowledge, skill and personal/relational attributes areas as identified by their peers in spiritual care and invite students and supervisors to do their own research and rewrite the text in terms of their own specific workplace and personal challenges. In this way the curriculum will be constantly revised, refined, refitted, transformed to a “living human document.”  

The curriculum covers a broad overview of what has been presently identified as essential learning areas in SPE for the professional practice of spiritual care. The resulting landscape is mapped or formatted in educational modules - concise units of study capable of integrating theoretical and practical content with the personal characteristics that shape the helping relationships in spiritual care. The curriculum reflects an integrated system of the practice of spiritual care and as such there is not a requisite or orderly sequence with a beginning and an end. SPE centers and students need to develop their own table of contents, organizing the materials along the specifics of their distinctive context and the particularities of their own questions and interests.

Since educational modules are about personal integration, educational content never stands by itself but participates in the process of experiential learning. Educational modules seek to connect the what and the how of learning. The curriculum will punctuate the presentation of contents with experiential interruptions for group discussions, role-play exercises, case studies and multimedia resources in recordings, literature and film – the common tools of SPE. These process interruptions intend to prompt and provoke the creative imagination of the student, the group interaction and the engagement of resources in the particular educational site.       

The curriculum materials differentiate between pastoral care and spiritual care. There are good reasons in the current multifaith world to go beyond the adjective pastoral, the traditional term rooted in the Jewish-Christian heritage of religious care. In a world that is ever more transformed into a pluralistic and global community, hospitals reflect this new reality in shifting the description of their chaplaincy services from providing Pastoral Care to Spiritual and Religious Care. Another reason for reconsidering the adequacy of the term pastoral is the phenomenal rise of the concept of spirituality in the health sciences. Similarly in the area of clinical psychology and therapy, the concept of spirituality has gained prominence. The words soul and spirit have re-entered the world of therapy, highlighting the spiritual dimension of the healing process. The term pastoral will be used in the curriculum when it has a specific reference such as to traditional/historical contexts or to the pastoral care and counselling literature.

The curriculum adheres to inclusive language throughout except in quotations from earlier professional literature where “man” language has been left unchanged. “God” language is used in the curriculum but placed in an inclusive and clinical context, i.e. how patients and clients experience and talk about God. This is in line with the tradition of the care of souls where the troubles of the day are addressed in the “context of ultimate meanings and concerns.” The curriculum will use the term “theological” as the spiritual depth dimension of human existence inclusive of but not confined to a theistic or a particular religious context. This is similar to the meaning of the term in academic institutions when they speak of “theological” studies and “theologians.” The curriculum will continue to refer to the traditional discipline of “theological reflection” in addition to some of the newer terms such as “faith-based” reflection and “praxis-based” learning.      

            In summary, this curriculum for basic SPE provides a map of the territory explored in the DACUM processed workshops of 2005 and 2006, while its primary focus is on the objectives stated in CASC/ACSS’s Handbook on the Consultation for Admission to Advanced Education.  The curriculum provides a general overview of essential dynamics in the professional practice of spiritual care. CPE and PCE programs with their students and supervisors will continue the work of the curriculum as they construct specific road maps of how best to navigate their way, searching out novel pathways in the ever changing, often uncharted landscape called spiritual care.