UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

The chaplain in health and welfare services: a study of his role in the general hospital with special… MacRae, Robert Daniel 1962

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1962_A5 M2 C4.pdf [ 7.66MB ]
Metadata
JSON: 831-1.0105788.json
JSON-LD: 831-1.0105788-ld.json
RDF/XML (Pretty): 831-1.0105788-rdf.xml
RDF/JSON: 831-1.0105788-rdf.json
Turtle: 831-1.0105788-turtle.txt
N-Triples: 831-1.0105788-rdf-ntriples.txt
Original Record: 831-1.0105788-source.json
Full Text
831-1.0105788-fulltext.txt
Citation
831-1.0105788.ris

Full Text

THE CHAPLAIN IN HEALTH AND WELFARE SERVICES  A Study of h i s Role i n the General H o s p i t a l with s p e c i a l reference to the Vancouver General Hospital and recent developments i n the C l i n i c a l Pastoral Training Movement by ROBERT DANIEL MAC RAE  Thesis Submitted i n P a r t i a l Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work  Accepted as conforming to the standard required for the degree of Master of S o c i a l Work  School of S o c i a l Work  1962 The University of B r i t i s h Columbia  -ivABSTRACT  This study was undertaken (a) to examine some areas where the t r a d i t i o n a l role of the chaplain has undergone s i g n i f i c a n t changes, (b) to determine the present r o l e of the chaplain i n a general h o s p i t a l and (c) to study the C l i n i c a l Pastoral Training Movement, and i t s significance to the t r a d i t i o n a l chaplaincy and to s o c i a l work. After a discussion of the h i s t o r i c a l background of the chaplaincy i n the C h r i s t i a n Church and i n some selected s o c i a l i n s t i t u t i o n s , there i s an examination of the role of the chaplain i n the general h o s p i t a l and a discussion of some r e l i g i o u s needs of patients. To gain information from chaplains at Vancouver General H o s p i t a l each was interviewed and a questionnaire was completed. The chaplains also kept s t a t i s t i c s of some aspects of t h e i r work for a two-week period. There i s an examination of the chaplain's backgrounds, t h e i r counselling practices and r e f e r r a l patterns. The l a t t e r are compared to r e f e r r a l patterns made by t h e o l o g i c a l students and s o c i a l work students i n three b r i e f case i l l u s t r a t i o n s . The C l i n i c a l Pastoral Training Movement, and i t s l i t e r a t u r e are examined i n some d e t a i l . Standards and curriculum are outlined and references made to the rapid expansion of the movement. Implications are drawn for the Churches, the Vancouver General H o s p i t a l and s o c i a l work. Some specific suggestions are made for these three areas a r i s i n g from these findings.  TABLE OF CONTENTS Chapter 1. The Emerging Role of the Chaplain The Problem. The Development of the Chaplaincy i n the Church. The M i l i t a r y Chaplain. The Chaplain i n Correctional I n s t i t u t i o n s . The Chaplain i n the Mental I n s t i t u t i o n . Other Areas of Specialized M i n i s t r y . The Chaplain i n the General H o s p i t a l . The Chaplain and the r e l i g i o u s needs of the Patient. The Scope of the Study  j  Chapter 2. A Case Study of the Chaplaincy at the Vancouver General H o s p i t a l H o s p i t a l Procedures. Interpretation of the •word ' C h a p l a i n 1 . Denominational P r a c t i c e s . Preparation of the Chaplain. The Chaplain at Work. Counselling Practices. Referral Patterns with other Professions. Referral Patterns indicated i n three case examples Chapter 3 . The C l i n i c a l Pastoral Training Movement Origins and development. The Council for C l i n i c a l T r a i n i n g . Varying emphases. The I n s t i t u t e of Pastoral Care. Co-operation between the Council and the I n s t i t u t e . The Literature of Pastoral Care. Standards and Accreditations Chapter •+.  Implications  of Recent Developments  Implications for the Churches. Implications for the Vancouver General H o s p i t a l . Implications for S o c i a l Work Appendices: A. Sample questionnaire to H o s p i t a l Chaplains and Official Visitors. B. Sample case h i s t o r i e s . C. S t a t i s t i c a l ' f o r m . D;-Sample^Questionnaire of Student backgrounds. E . Sample application form for V i s i t i n g Chaplain. F . Standards for the Work of the Chaplain i n the General H o s p i t a l . (American Protestant H o s p i t a l Association) G. Standards for C l i n i c a l Pastoral Education. H. Bibliography.  -iii-  TABLES IN THE TEXT Page Table 1.  Number of Patients by Religious Denomination Admitted to the Vancouver • General H o s p i t a l For the two-week Period, March 11-24-, I962  Table 2. Table 3.  Table 4-.  Table 5.  Number of P a t i e n t - V i s i t s  38  by Chaplains  March 11-2-+, 1962 Number of Referrals of Vancouver General H o s p i t a l Patients to Parish Clergy by Chaplains or V i s i t o r s , March 11-24-, I962 Number of Working Hours of Chaplains at the Vancouver General Hospital March 11-24-, 1962 Number of Patients seen for Counselling by the Chaplains During two week period March 11-24-, 1962  39  40  4-1  -+5  ACKNOWLEDGMENTS  To Dr. Leonard Marsh of the School of S o c i a l Work, University of B r i t i s h Columbia, who gave the encouragement needed to pursue t h i s topic i n the i n i t i a l stages and to Professor William Dixon, Director of the School of S o c i a l Work, without whose help and constructive c r i t i c i s m s t h i s study could not have been completed. To the Reverend Canon T . D. Somerville for his ever present advice and help. To the chaplains and o f f i c i a l v i s i t o r s at the Vancouver General H o s p i t a l who gave so f r e e l y of t h e i r time to answer questionnaires  and participate  i n interviews.  THE CHAPLAI1 IN HEALTH AND WELFARE SERVICES  CHAPTER I  THE CHAPLAINCY OF THE CHRISTIAN CHURCH  The Problem I t i s a favorite t r i c k with those who pretend to read the palm or the handwriting to say, with s p e c i a l emphasis and secrecy to each customer: "I can see i n your hand that the deepest and best of you has never yet found expression. Half unconsciously you are repressing a flood of power which pushes ever for freedom. To set i t free w i l l he the deepest joy of your l i f e . " l So observed Dr. Richard C. Cabot who, i n 1905, had had the genius to introduce s o c i a l workers to the Massachusetts General H o s p i t a l for the purpose of improving the o v e r - a l l medical care of patients. the palmist  Dr. Cabot went on to observe about  that:  The beauty of this ever-successful t r i c k i s that what the sharper pretends to discover i n this i n d i v i d u a l , he knows to be true of every l i v i n g being. We are piteously unexpressed. We d i f f e r only i n the means that can set us f r e e . 2 What Doctor Cabot had r e a l i z e d about s o c i a l work i n the medical setting was that the boundaries of professionalism had t o be broken to let s o c i a l work enter the medical setting and set i t free to serve the patient.  I t was only twenty years  l a t e r that this same man recognized the same p r i n c i p l e 1 Cabot, Richard C , What- Men Live By, Houghton M i f f l i n : Boston and New York, 191*4-, p. 2bb\ 2 Ibid  -2-  operative i n the C h r i s t i a n ministry. to set i t free was necessary.  He could see that a means  He wrote a plea for a c l i n i c a l  year i n the course of t h e o l o g i c a l s t u d y . 1  As he observed  t h e o l o g i c a l students he wondered whether t h e i r c a l l to the ministry has meant i n every case a c a l l to preach or whether to many i t i s not rather a c a l l to carry the Gospel of Christ to fellow men i n trouble of mind, body or s p i r i t and i f so, whether t h e i r future service to individuals i n t h e i r parishes i s not very l i k e what the doctor actually does....when he v i s i t s a patient. 2 Considerations such as t h i s led Dr. Cabot to speculate on the p o s s i b i l i t i e s  of ministers becoming "members of the  health team" i n a manner not unlike his pioneering i n bringing the s o c i a l worker into the s t a f f  of the hospital.-^  His 'plea*  did not go unanswered and today i n Canada and the United States several thousand Ministers of R e l i g i o n have benefited by " C l i n i c a l Pastoral Training" even as several thousand trained s o c i a l workers are now employed i n h o s p i t a l s . Each of the well-established professional  disciplines  accepted today as an e s s e n t i a l member of the c l i n i c a l team has had i t s unique struggle i n attempting to establish the p a r t i c u l a r contribution i t has to make i n the t o t a l and treatment of an i l l person.  diagnosis  This has been p a r t i c u l a r l y  1 Cabot, Richard C . , "Adventure on the Borderland of E t h i c s , " The Survey, V o l . IV, No. 5, December 1, 1925. 2 I b i d . , p. 275. - 3 Belgum, David, C l i n i c a l Training for Pastoral Care, The Westminster Press: Philadelphia, 19^5, p. j o .  -3true of c l i n i c a l psychology, psychiatry and s o c i a l work.  Even  today, however, these d i s c i p l i n e s are not accepted to the same degree.  Now another profession,  the ministry, and p a r t i c u l a r l y  the i n s t i t u t i o n a l chaplaincy, which i s also concerned with the adjustment of people, both emotional and s o c i a l , has begun to extend i t s interests and contributions beyond i t s established  long-  r o l e into c l i n i c a l work.  With i t s introduction of medical s o c i a l workers i n 1912 the Vancouver General H o s p i t a l was a pioneer i n B r i t i s h Columbia i n making s o c i a l work a partner of the healing professions.''" By contrast  the h o s p i t a l chaplain, f i f t y years l a t e r ,  generally considered part of the hospital team.  i s not  Today the  chaplaincy comes to the Vancouver General H o s p i t a l as an outside • a u x i l i a r y ' service supported by various  denominations.  The evolution of the chaplaincy since Dr. Cabot's i n s p i r a t i o n has i n many places been very remarkable.  In  countless ways the t r a d i t i o n a l role of the chaplain has been changed and modified. hospitals,  As a r e s u l t ,  the chaplain i n many general  as w e l l as welfare i n s t i t u t i o n s of various kinds, i n  the United States and to a limited extent i n eastern Canada, has become an i n t e g r a l part of the healing team.  I t i s of  p a r t i c u l a r note that i n B r i t i s h Columbia, medical and welfare agencies, as w e l l as the Churches, have been among the last to  1 See: C o l l i e r , E l i z a b e t h A . , The S o c i a l Service Department of the Vancouver General H o s p i t a l : Its h i s t o r y and Development, 1902-19^9, Thesis for Masters Degree i n S o c i a l Work, The University of B r i t i s h Columbia, 1950.  see the value of the recent developments i n the t r a i n i n g of the chaplaincy, p a r t i c u l a r l y that a r i s i n g out of the c l i n i c a l pastoral training movement. The Development of the Chaplaincy i n the Church The modern minister follows i n a path marked out by r e l i g i o n ' s t r a d i t i o n a l concern for sickness and healing. P r i m i t i v e s o c i e t i e s , as w e l l as the cultured Greeks, considered priest and medicine man synonymous.  Healing was one of the  p r i e s t l y functions i n Greek temples. Although the Hebrews were a nomadic people, and therefore not i n c l i n e d , as were the Greeks, to e s t a b l i s h permanent temples i n the early part of t h e i r h i s t o r y , there was a moral attitude toward the sick and the stranger which can he considered as antecedent to the i n s t i t u t i o n a l care of the sick i n hospitals. The Jews were anxious to provide for the needy, such as the stranger, the fatherless and the widow. provided for by segregation; and lived i n the h i l l s .  Often the sick were  lepers were c l a s s i f i e d  as "unclean"  I t was l e f t for later times to  integrate the idea of h o s p i t a l i t y and segregation (that  is  " h o s p i t a l i z a t i o n " ) , with the needs of the s i c k , and combine the two elements into the h o s p i t a l as an i n s t i t u t i o n . The healing miracles of Jesus indicate a change i n attitude toward sickness.  Instead of merely protecting the  community hy segregating the s i c k , the unfortunate v i c t i m was to be ministered t o , healed and cared f o r .  The parable of the  Good Samaritan portrays the wounded man treated with utmost consideration, brought to an i n n , and cared for u n t i l he recovered.1  When Jesus healed lepers, he sent them to the  p r i e s t s to have t h e i r healing c e r t i f i e d .  The Great Physician  i n s t i t u t e d healing as a regular part of the work of the disciples:  "They s h a l l lay t h e i r hands on the sick and they o  s h a l l recover."  When Christ sent out the Seventy, he Instructed  them to " h e a l the sick that are i n the way and say unto them, the Kingdom of God i s come nigh unto y o u . " ^ Peter's reputation for healing became so great, "That they brought f o r t h the sick into the streets and l a i d them on beds and couches, that at the least the shadow of Peter passing by might overshadow some of them."  A method of caring for the s i c k ,  described i n the E p i s t l e of James 5, f i n a l l y grew i n t o the sacrament of unction. Is any siek among you? Let him c a l l for the elders of the church; and let them pray over him. anointing him with o i l i n the name of the Lord; And the prayer of f a i t h s h a l l save the s i c k , and the Lord s h a l l raise him up; and i f he have committed s i n s , they s h a l l be forgiven him. 5 According to Talcott Parsons the most d i s t i n c t i v e feature of early C h r i s t i a n i t y was i t s r e l i g i o u s " i n d i v i d u a l i s m , " i t s  1 St.  Luke,  10:30-35. -  2 S t . Mark, 16:18.  (King James Version used i n a l l references.)  3 S t . Luke, 10:9. h Acts of the Apostles,  5 Epistle  of James  5.15.  5;1-+, 15.  -6concern with the fate of the i n d i v i d u a l s o u l . Since the problem of health i s also—however much i t i s s o c i a l l y conditioned—a problem of the state of the i n d i v i d u a l , i t i s not surprising that early C h r i s t i a n i t y was permeated with concern with health, and that r e l i g i o u s healing was one of i t s c e n t r a l bases of i t s v a l i d a t i o n . The impact of the Gospels would c e r t a i n l y have been greatly diminished had t h i s element been removed. 1 As the Church became more completely organized, care of the sick was also i n s t i t u t i o n a l i z e d .  It took a s p e c i a l c r i s i s  to bring the needs of the sick into the open.  "Naturally i t  was t r a v e l l e r s attacked by i l l n e s s that c a l l e d for the greatest p i t y and anxiety.  This was the o r i g i n of h o s p i t a l s . . . . t h e  first  of which was founded i n the last quarter of the fourth century, A. D . , on account of a famine which had caused a deadly p epidemic." About MOO A . D . , Chrysostom established seven different hospitals which would be considered by modern welfare agencies to be quite comprehensive i n t h e i r coverage of human needs. There was an inn for strangers and t r a v e l l e r s , a h o s p i t a l for the treatment of acute i l l n e s s , another h o s p i t a l f o r chronic patients,  and homes for orphans, the aged, the reception of the  poor, and another for a l l kinds of d e s t i t u t e s .  1 Parsons, T a l c o t t , "Mental I l l n e s s and ' S p i r i t u a l M a l a i s e ' : The Role of the P s y c h i a t r i s t and the Minister of R e l i g i o n . " i n The Ministry and Mental Health, edited by Hans Hofman, Association Press: New York, 1900, p. 2h. 2 Bonet-Maury, G , , " H o s p i t a l i t y ( C h r i s t i a n V i n James Hastings, (ed.) Encyclopaedia of R e l i g i o n and E t h i c s , V o l . VI p. 80H-.  -7-  During the Middle Ages numerous monastic orders and laybrotherhoods cared for the s i c k . 1  Monastic orders were  established to meet the health c r i s e s of the great crusades, and a series of migrant wars which left wounded along the way and spread disease.  The Knights of St. John of Jerusalem  (founded c.1210) established many hospitals and ministered to the sick along the way.  John of A v i l a , i n Spain, pioneered the  work among the sick that became famous as the Hospitalers. Sometimes a h o s p i t a l would be founded by an order, and i n other cases a r e l i g i o u s order would be horn from an unusually successful  h o s p i t a l program, so that branch hospitals would be  sponsored by the mother i n s t i t u t i o n . It i s illuminating to notice that the s p i r i t u a l care of patients  i n the Hotel Dieu (a t h i r t e e n t h century h o s p i t a l i n  Paris) was quite complete and elaborate. was done to maintain the patient's  Everything possible  spiritual life.  On entering the h o s p i t a l , the patient, i f a C h r i s t i a n , went to confession and received Holy Communion, i n order that peace of mind might benefit bodily h e a l t h . . . . According to t h e i r a b i l i t y , the sick performed the duties of prayer, attendance at Mass, and reception of the sacraments. They were especially recommended to pray for t h e i r benefactors, for the a u t h o r i t i e s , and for a l l who might be i n d i s t r e s s . At n i g h t f a l l a sort of l i t a n y was r e c i t e d i n the wards, each verse of which began: "Seignors malades. proies por," etc. They were often cheered by the v i s i t s of persons of high s t a t i o n or of noble rank and charitable d i s p o s i t i o n , l i k e Catherine of Sweden; Margaret, Queen of Scotland: Margaret, Duchess of Lorraine; King Louis IX of France.^ 1 For example: The Order of Our Lady of Mercy, Spain (Founded 1218); The Hospitalers of St. John of God, Portugal (Founded 1 5 3 7 ) ; The Congregation of Alexian Brothers, Germany (Founded c.1250). 2 Walsh, James J . , " R e l i g i o n and H e a l t h , " Catholic Encyclopaedia, 1910, V o l . V I I , p. 466.  -8The two roles of 'physician to the body' and 'physician of the s o u l ' were often combined i n that of the priest or chaplain.1  In many instances the roles would be d i f f i c u l t to  distinguish. With the advance of science i n the 17th to 19th centuries and i t s a p p l i c a t i o n to the study and practice of medicine the two roles became more d i f f e r e n t i a t e d .  The study  of medicine became almost exclusively the concern of the l a i t y and the "cure of souls" became the unique role of the h o s p i t a l priests.  The h o s p i t a l was the chaplain's "parish" and the  patients were his " p a r i s h i o n e r s . "  He ministered to the  patients  i n a manner not unlike that of any parish p r i e s t . The extra-parochial ministry i n the h o s p i t a l setting was not the only specialized ministry to evolve i n the Church. There has developed a vast ministry pertaining to other i n s t i t u tions and organizations. The M i l i t a r y Chaplain The m i l i t a r y chaplain today f a l l s long t r a d i t i o n .  heir to an office of  The i n s t i t u t i o n of the chaplaincy has a history  as old as the story of m i l i t a r y operations.  The chaplain's  t i t l e goes back to a legend concerning Martin of Tours (335-397 A. D . ) , 2  who gave half of his cloak, or mantle, to a shivering  1 Fox, A. H . P u r c e l l , The Church's Ministry of Healing, Longmans: London, 1959, Chapter 19, "Co-operation Between Clergy and Doctors," pp. 101-107. 2 Oxford Dictionary of the Church, edited by F . L . Cross, Oxford U n i v e r s i t y Press: London, 1958.  -9beggar.  The half that he kept, known as " C a p e l l a , " became an  object of veneration at Court.  French kings began to apply the  t i t l e "Chappelains," keepers of the cloak, to the clergy who ministered to them.  In centuries to follow, "chappelains" were  found wherever kings went to war and soldiers fought b a t t l e s . In times of peace they served at court, giving aid and comfort to a l l i n need. As history ran i t s course, new nations developed on t h i s side of the A t l a n t i c .  Here, too, the t r a d i t i o n of service and  s a c r i f i c e was carried on.  In the United States there were  chaplains attached to many of the forces engaged i n struggles against the Indians and the French.  In fact i t was quite  natural for the town clergyman to march off to b a t t l e with units of the revolutionary m i l i t i a and become the chaplain.  At the  outset of the American Revolutionary War, each colony had a separate plan for procuring and maintaining the chaplain. only consistent  The  p r i n c i p l e at the time was the b e l i e f that the  chaplain should represent the r e l i g i o u s sentiment of the troops he served.  The legal o r i g i n of the chaplaincy as part of the  American m i l i t a r y service is found i n a r e s o l u t i o n of the Continental Congress, dated July established  2, 1775.1 An act of that date  the m i l i t a r y chaplaincy.  In time the Continental  Army had h o s p i t a l chaplains, a German chaplain-at-large,  a  chaplain-missionary to the f r i e n d l y Indians, and one d i v i s i o n  1 The A i r Force Chaplain, A i r Force Manual Number 165-3, Department or the A i r r o r c e , Washington, D, C . , March 195*+, p. 1.  -10chaplain at Headquarters.  During World War II there were  8,896  ministers, priests and rabbis serving as chaplains to United States  forces. In Great B r i t a i n and Canada, Army and A i r Force chaplains  are given permanent or temporary commissions, and rank equivalent to captain or above according to s e n i o r i t y ; i n the Navy they do not hold o f f i c i a l rank.  The chaplains are drawn from a l l the  larger r e l i g i o u s bodies. paid by the s t a t e .  Chaplains appointed by the state are  There are approximately 200 chaplains serving  Canadian armed forces at the present time. The Department of Veterans 1 Affairs i n Canada attaches sufficient  importance to patient care that they employ chaplains  on a f u l l - t i m e b a s i s . 1  Bach of the D.V.A. hospitals i n Canada  has one or more chaplains. The Chaplain i n Correctional I n s t i t u t i o n s The chaplain also ministers i n c o r r e c t i o n a l I n s t i t u t i o n s . Gaols, o r i g i n a l l y for the safe-keeping  of prisoners awaiting  t r i a l — a function they s t i l l serve—and houses of c o r r e c t i o n , o r i g i n a l l y "for the setting of the Poore on Worke, and for the avoiding of ydleness," came into general use as places for the i n c a r c e r a t i o n of convicted offenders  early i n the 17th century.  However, as early as 5^7 the Council of Orleans declared i t the  1 K i r k , T . £ . , "The Role of the Chaplain i n a H o s p i t a l , " Medical Services Journal, V o l . XVII, No. 10, November I96I,  PP. 765-767.  2 There are Roman C a t h o l i c , Anglican and United Church f u l l - t i m e chaplains at the Shaughnessy M i l i t a r y H o s p i t a l , Vancouver. One of them holds the degree M.S.S.W.  -11duty of archdeacons to v i s i t a l l prisoners every Sunday.  1  Several r e l i g i o u s brotherhoods were s p e c i f i c a l l y organized to minister to c r i m i n a l offenders.  This interest  i s common to a l l  r e l i g i o u s denominations, each of which, with i t s own emphasis, recognizes a r e s p o n s i b i l i t y towards imprisoned offenders. Mabel E l l i o t t , a contemporary sociologist  interested i n  criminology writes, Religious leaders have supplied the basic concepts of modern penology...the d i g n i t y of human p e r s o n a l i t y . . . the redemptive power of love and the f u t i l i t y of b r u t a l and v i n d i c t i v e punishment...it i s to the r e l i g i o u s leadership within the prison that we must look to help the prisoners understand the creative and regenerative powers of love. 2 There are penal i n s t i t u t i o n s where the one bright spot i n an otherwise drab and hopeless s i t u a t i o n i s the office of the chaplain.  There are others where the inadequacy and hypocrisy  of the chaplain render his work worse than f u t i l e .  In some the  chaplain i s about the only person who t r i e s to gain the confidence of the inmates or i n t e r e s t s himself i n the welfare of t h e i r families or even i n preparing the s i t u a t i o n on the outside to which the inmate must return on release.-^ The Director of the United States Federal Bureau of Prisons i s reported to have stated at the I n s t i t u t e for  1 Correction Research, edited by Albert Morris, A P u b l i c a t i o n - o f the United Prison Association of Massachusetts, November 1961, p. 2. 2 E l l i o t t , Mabel A . , Crime i n Modern Society, Harpers and B r o s . , 1952, p. J6&3. 3 Finnegan, Hugh, The Chaplain and His Work, American P r i s o n Association Proceedings, 1934-, pp. 2bl-2b5.  -12Catholic Prison Chaplains, held i n 1940, i n Washington, D. C . , that . . . f r e q u e n t l y the chaplain i s the one o f f i c i a l who can e s t a b l i s h a personal contact based on understanding and good w i l l . He has no product to manufacture, no marks or grades to give, no demerits to assess, no p i l l s to offer; his sole objective i s the s p i r i t u a l welfare of the prisoner. In an organized r e l i g i o u s program, this relationship i s based on the understanding engendered i n the i n i t i a l interview i n which the chaplain carefully explores the a t t i t u d e s , the r e l i g i o u s convictions or philosophy, the motives and the goals which underlie not only the prisoner's c r i m i n a l l i f e , but his whole existence. 1 The i d e a l chaplain from some wardens'  point of view i s ,  among other things, a man who w i l l not interfere with discipline.  Some chaplains have agreed that such matters are  none of t h e i r business even i f they think the punishments I n f l i c t e d c r u e l or undeserved, while occasionally a courageous chaplain c a l l s  attention to abuses.  Some chaplains cooperate  e f f e c t i v e l y with other staff members i n those modernized prisons where good c l a s s i f i c a t i o n  and case work are being done.  Others  speak a language inconsistent with s c i e n t i f i c methods i n prisons.^ I t i s perhaps i n the c o r r e c t i o n a l setting that the new r o l e of the chaplain has evolved to the greatest extent.  A  unique phase i n this evolution has been described by Robert M. 1 Belanger, Rev. E . J . , "Evaluation of the I n i t i a l Interview," Proceedings of the 83 Annual Congress of Correction. American Prison (now Correctional; Association, 1953. 2 Herron, James W., The Ideal Chaplain from the Superintendent's Point of View, American Prison Association Proceedings, 1928, p. 264-. 3 T a f t , Donald R . , Criminology, A C u l t u r a l Interpretation, MacMillan: New York, Revised e d i t i o n , 1950, p. 218.  -13-  Gluckman, p s y c h i a t r i s t at the I l l i n o i s State Training School for Boys.1  I t concerns the chaplain as a member of the  c l i n i c a l team.  diagnostic  This experiment has shown that the dual role of  the chaplain as diagnostician and t h e r a p i s t ,  on the one hand, and  r e l i g i o u s leader on the other has not proved c o n f l i c t i v e .  On the  contrary, t h i s new r o l e has been mutually b e n e f i c i a l to both aspects of the chaplain's work and the t o t a l treatment team. The  s i g n i f i c a n t thing about Dr. Gluckman's a r t i c l e  is  that the administrative and c l i n i c a l s t a f f are aware that these a d d i t i o n a l members of the c l i n i c team could not be just any graduate theologians.  In addition to specialized  clinical  pastoral t r a i n i n g , certain personality c h a r a c t e r i s t i c s  were  necessary that would qualify the chaplain for the type of r e l a t i o n s h i p needed.  The most important t h i n g , Dr. Gluckman  claims, i s i n t u i t i v e understanding of the needs of the emotionally maladjusted boy. Chaplains serving i n Canadian prisons are often chosen on the basis of previous experience as chaplains i n the m i l i t a r y forces.  None of the chaplains so employed i n prisons i n B r i t i s h  Columbia has taken C l i n i c a l Pastoral T r a i n i n g . In B r i t i s h Columbia there are two f u l l - t i m e chaplains on s t a f f of the Department of the Attorney-General. 2  One of these  1 Gluckman, Robert M . , "The Chaplain as a Member of the Diagnostic C l i n i c a l Team," Mental Hygiene, V o l . 37, No. 2, A p r i l 1953, pp. 278-282. 2 Annual Report of the Director of Corrections for the Year Ended March 31, 19bl» B r i t i s h Columbia, Queen's P r i n t e r : V i c t o r i a , p. 179.  -14i s the "Senior Chaplain" and the other, the chaplain at Haney Correctional I n s t i t u t i o n .  Two part-time chaplains serve Oakalla  Prison Farm, and the Prince George Gaol.  Three voluntary  chaplains (two of whom are t h e o l o g i c a l students) serve at the Chilliwack Forestry Camp, Oakalla Prison and the Women's Gaol. At the federal l e v e l two f u l l - t i m e chaplains minister at the B r i t i s h Columbia Penitentiary, New Westminster, and two parttime chaplains minister at Agassiz and Williams Head. The Chaplain i n the Mental I n s t i t u t i o n The twentieth century has brought something genuinely new into the r e l a t i o n of the Church to i l l n e s s and health. Nowhere has t h i s been more true than i n the work of the mental h o s p i t a l chaplain.  The stimulus for t h i s new awakening has been  the tremendous growth i n the psychological, psychiatric and s o c i a l sciences.  Although sharp differences  continue to exist between  p s y c h i a t r i s t and minister, the tension i s waning as each comes to understand more f u l l y the concepts and roles of each discipline.  "It might be pointed out here that there i s no  more c o n f l i c t between the concepts of psychology and those of theology than there i s between c e r t a i n schools of t h e o l o g y . " 1 This has been one of the r e s u l t s of the development of the c l i n i c a l pastoral t r a i n i n g movement i n the United States.  The  c a l l for chaplains i n state mental i n s t i t u t i o n s represents the  1 Wise, C a r r o l l "The Place of C l i n i c a l Training i n the Department of Pastoral Theology," The Journal of Pastoral Care, Spring 1951, V o l . V, No. 1, p. hW.  -15community's awareness that t h i s role must become a part of the therapeutic community. Chaplains are represented i n most mental i n s t i t u t i o n s i n Canada.  In B r i t i s h Columbia one Roman Catholic and one  Protestant  chaplain minister to the s p i r i t u a l needs of the  patients i n Essondale and Crease C l i n i c .  During 1961 another  Protestant  chaplain was appointed to minister to the patients 1 7 i n Valley View H o s p i t a l . The "Ross Report" of 1961 recommends  p  continued appointment of the chaplaincy at Essondale. The primary function of the mental h o s p i t a l chaplain i s to provide a s p i r i t u a l ministry to patients; i n addition he i s expected to interpret the function of the chaplain i n the h o s p i t a l and the meaning of r e l i g i o n to other h o s p i t a l personnel; to interpret to the community (church and c i v i c groups) the work of the h o s p i t a l and the relationship of r e l i g i o n to the problems of mental health; to encourage, where 1 possible, programs for the c l i n i c a l pastoral t r a i n i n g of seminarians and clergy, and to offer opportunities for clergy to obtain specialized t r a i n i n g i n the ministry to the mentally i l l person; and to u t i l i z e what community resources are available for the extension of t h i s ministry. 3 Among the standards for q u a l i f i c a t i o n as a mental h o s p i t a l chaplain approved by the Association of Mental H o s p i t a l 1 Mental Health Services Annual Report 1 9 6 1 , Department of Health Services and H o s p i t a l Insurance, Queen's P r i n t e r : Victoria, 1962. 2 Survey of Mental Health Needs and Resources of B r i t i s h Columbia. E d i t o r : Matthew Ross, Medical D i r e c t o r . American P s y c h i a t r i c Association, I 9 6 I , p. 1 2 6 . 3 Standards for Mental Hospital Chaplaincy, adopted by the Association of Mental H o s p i t a l Chaplains at t h e i r annual meeting i n Washington, D . C . , A p r i l 30, 1 9 5 3 . (A mimeographed brochure obtainable through the National Council of the Churches of Christ i n the U . S . A . )  -16Chaplains i s that he s h a l l have completed a period of specialized t r a i n i n g i n C l i n i c a l Pastoral T r a i n i n g .  None of the  chaplains serving i n B r i t i s h Columbia mental hospitals  i s so  qualified. Other Areas of Specialized Ministry The foregoing discussion of the chaplaincy i n various i n s t i t u t i o n s does not describe a l l specialized m i n i s t r i e s . Full-time and part-time chaplaincies are often assigned to church-sponsored homes for the aged, T . B . S a n i t o r l a , 1 9 universities, missions to seamen, treatment centers and c l i n i c s for a l c o h o l i c s ,  i n s t i t u t i o n s for the care of c h i l d r e n , and homes  for unmarried mothers.  For example i n a Lutheran maternity home  i n Minnesota: . . . s i g n i f i c a n t results are being demonstrated through close teamwork of chaplain, caseworker, and n u r s e . . . . Where g u i l t , anxiety, and h o s t i l i t y are present, redemptive r e l i g i o u s f a i t h with i t s restorative power i s off ered, through i n d i v i d u a l pastoral care and group worship. * 1 The University of B r i t i s h Columbia has four f u l l - t i m e chaplains (Anglican, Lutheran, Roman C a t h o l i c , United Church) and three part-time chaplains (Baptist, Presbyterian, Lutheran.) They are sponsored by t h e i r respective church a u t h o r i t i e s . 2 There are four f u l l - t i m e chaplains i n Vancouver, North Vancouver, and New Westminster serving i n "Mission to Seamen" hostels. 3 The Alcoholism Foundation of B r i t i s h Columbia hires a f u l l - t i m e Priest-Counsellor, and makes s p e c i a l r e f e r r a l to some c i t y clergy on a part-time b a s i s . h Whiting, Henry J . , "Current Emphases i n Casework under Religious Auspices: Integration of Casework and other Programmes," S o c i a l Welfare Forum, 1951, National Conference of S o c i a l Work, Columbia University Press, New York, p. 217.  -17The  Chaplain  i n the G e n e r a l H o s p i t a l  Something o f the Church's m i n i s t r y t o the p h y s i c a l l y i l l has  a l r e a d y been d e s c r i b e d under the development o f h o s p i t a l s  and  the h o s p i t a l c h a p l a i n .  M i n i s t r y t o the  s i c k has  a primary o b l i g a t i o n o f the C h r i s t i a n Church, and f o l l o w s the example and  charge of her Founder.' ' 1  s i c k i n t h e i r homes are s t i l l one p a r i s h m i n i s t r y , but  of the f i r s t  always been  i n this i t V i s i t s to  the  charges upon the  today a v a s t p o r t i o n o f the people i n  s e r i o u s i l l n e s s are t o be found i n h o s p i t a l s , so t h a t i n e v i t a b l y the m i n i s t r y t o the s i c k i s concentrated h o s p i t a l s throughout the c o u n t r y . c h a p l a i n i s not new,  B r i t a i n the M i n i s t r y o f H e a l t h the c h a p l a i n has t o play i n the whole work of h e a l i n g , and  l e v e l s of Government.  recognizes  the important  l i f e of a h o s p i t a l and  p r o v i s i o n f o r chaplains  h o s p i t a l s i s i n s i s t e d on by the  but  of the h o s p i t a l  approach t o t h i s whole q u e s t i o n by  Church, the h o s p i t a l and v a r i o u s  relevance  calling  but m i n i s t r y t o the s i c k i n a l a r g e modern  h o s p i t a l i n v o l v e s a new  The  The  i n the great network of  In part i n the  in a l l  Ministry.  of r e l i g i o n t o the h e a l i n g a r t i s s l o w l y ,  s t e a d i l y , gaining recognition.  T h i s has been marked by  statement approved by the B r i t i s h M e d i c a l which recommends that there  a  A s s o c i a t i o n i n 194-7,  should be a c l o s e r  cooperation  between m i n i s t e r s o f r e l i g i o n and m e d i c a l p r a c t i t i o n e r s . ISt.  the  2  Matthew 4-:23; S t . Matthew 25:36; S t . Mark 16:18.  2'Medicine and the Church," a statement approved by the C o u n c i l of the B r i t i s h M e d i c a l A s s o c i a t i o n , B r i t i s h M e d i c a l J o u r n a l , November 8, 19-+7, V o l . i i , p. 112.  -18The Council of the B r i t i s h Medical Association is of the opinion that there i s no e t h i c a l reason to prevent medical practitioners from cooperating with the clergy i n a l l cases and more especially those i n which the doctor i n charge of the patient thinks that r e l i g i o u s ministrations w i l l conduce health and peace of mind or w i l l lead to recovery. often necessary and desirable,  Such cooperation i s  and would help to prevent abuses  which have arisen through the a c t i v i t i e s  of irresponsible and  unqualified personnel. Two movements have led to t h i s recognition.  On the one  hand there has been a development of psychological medicine which has revealed the intimate relationship of mind, body and s p i r i t , showing that underlying psychological and s p i r i t u a l disorders frequently play a great part i n the causation of many kinds of i l l n e s s ,  physical and mental.  On the other hand, there  has been a re-awakening of the Churches to the f u l l  significance  of the ministry to the sick and of t h e i r r e s p o n s i b i l i t i e s those i n h o s p i t a l .  to  These two movements have developed  simultaneously i n the twentieth century and are finding a common meeting ground. The functions of the minister are within certain areas overlapping those of the doctor and the s o c i a l worker, and the problem i s to find the most effective means of cooperation. The opportunity for t h i s cooperation i s nowhere better provided than i n the modern h o s p i t a l , where the chaplain finds himself working i n close association with numbers of men and women devoted  to the service of the s i c k .  The better he understands  the  functions and roles of other d i s c i p l i n e s , the more i n t e l l i g e n t l y • w i l l he be able to cooperate with them.  But he w i l l not, however,  gain the respect and confidence of members of the health team unless he i s himself as competent i n his own sphere as they are in theirs.  He must, therefore, be afforded the t r a i n i n g  necessary for t h i s specialized work. The Chaplain and the Religious Meeds of the Patient The chaplain no less than the s o c i a l worker i n the medical h o s p i t a l often finds that questions  and problems which  c l i e n t s have regarding themselves and others come to focus i n the very process of admission to the h o s p i t a l .  I f the problems  are not discovered on admission, they may come to l i g h t during the patient's  stay i n hospital or just p r i o r to discharge.  I l l n e s s presents unusual opportunities, too, for consideration of the s p i r i t u a l needs of the patient, who i s stripped of many of the interests that normally absorb his time and energy.  His  peculiar circumstances of i s o l a t i o n i n a strange i n s t i t u t i o n can be s t r e s s f u l for a patient and thus precipitate responses i n d i c a t i n g deep s p i r i t u a l needs. One of the most common responses i n i l l n e s s i s that of grief, grief."  either as a result of bereavement or as  "anticipatory  The l a t t e r i s a term used by Dr. E r i c h Lindemann, who  1 Stroup, Herbert Hewitt, S o c i a l Work, an Introduction t o the F i e l d , American Book Company: New York, 1946, pp. 3b*+-375.  -20has written a descriptive account of some of the dynamics of g r i e f i n a paper presented to the American Psychiatric Association i n 19*+1f.  In his paper Dr. Lindemann says:  We were at f i r s t surprised to f i n d genuine g r i e f reactions i n patients who had not experienced a bereavement but who had experienced separation, for instance, with the departure of a member of the family into the armed forces. Separation i n this case i s not due to death but i s under the threat of death. 1 There are many kinds of g r i e f response.  There i s that  which follows the loss of a member of the family by i l l n e s s or f a t a l accident.  This i s especially severe when death comes  without warning for there are many after  effects.  There i s the  g r i e f response which comes from a n t i c i p a t i o n of possible  death,  as with the admission to the armed services during wartime. There i s the more subtle g r i e f response which i s associated with the loss of love of husband or wife, even though they continue to l i v e with each other.  And there i s the g r i e f  response which i s caused by the concern of parents over a c h i l d who has got into trouble at school, or i n s o c i a l l i f e , or with the law; and the response which accompanies loss of self-respect, prestige, status, income, or any other part of s e l f or family which i s held to be e s s e n t i a l for l i f e and well-being. A great deal of l i f e loses meaning when a loved one dies,  and i t i s necessary to b u i l d new habits and new a c t i v i t i e s  which are appropriate to the relationships that are s t i l l a part 1 Lindemann, E r i c h , "Symptomatology and Management of Acute G r i e f , " American Journal of Psychiatry, V o l . 101, V)kk  pp. 1H-1-1U6.  9  -21of l i f e .  The chaplain can help the patient to accept the pain  and give support -when a patient encounters some of the common fears that are a part of bereavement.  He can give opportunity  to confess where there was f a i l u r e or hurt i n the r e l a t i o n with the loved one, and a s s i s t i n formulating what the r e l a t i o n w i l l be to the loved one.  future  The chaplain has the  resource of a vast number of parish clergy to which to refer a patient when discussing  plans for the patient's continuing l i f e  and his moving back into the community. Helping the dying patient and his family has long been a concern of many professions.  Despite t h i s , there i s a dearth  of l i t e r a t u r e on the topic within the various ministering to t h i s need.  disciplines  The s o c i a l worker, no less than the  minister, must face the bereaved c l i e n t .  Helping the dying  patient and his family can be a most distressing the s o c i a l  experience  for  caseworker.  It i s an area of practice that demands the highest c a l i b r e of professional d i s c i p l i n e and s k i l l . Paradoxically, i t can also be a most gratifying experience, since i n offering this kind of help the caseworker i s c a l l e d upon to give as u n s e l f i s h l y of himself and his service as at any point i n his professional l i f e . 1 There are a number of patients who seem to be unable to r e t u r n to t h e i r church or community u n t i l they have talked over 1 Kennedy, Nathalie, Helping the Dying Patient and His Family, National Association of S o c i a l Workers: New York, I960, p . 23. See a l s o : Benda, Clemens E . , "Bereavement and Grief Work," The Journal of Pastoral Care, Spring 1962, V o l . XVI, No. i .  -22some of the things that are concerning them.  The h o s p i t a l  chaplain i s on the front lines of the church's ministry and i s given an excellent opportunity to care for people who want to belong to the fellowship of the church and need i t badly but are unable without help to take the steps toward belonging. One of the c h i e f purposes of the ministry i s to nurture wholesome family l i f e .  It i s often found that for some patients  family d i f f i c u l t y is an even greater cause of anxiety than i s the i l l n e s s .  Such anxiety often i n h i b i t s the patient's recovery.  Discussion with the chaplain about family problems can bring r e l i e f to the anxious patient.  The chaplain must be sensitive  to t h i s opportunity to enable the patient to view r e a l i s t i c a l l y the stresses i n his home and his family l i f e . Often the patient w i l l not be far enough along i n s p i r i t u a l development to u t i l i z e many of the  sacramental  resources, and at the beginning of the relationship  listening  i s probably the most important instrument of the r e l i g i o u s worker. To make an accurate s p i r i t u a l diagnosis one must know enough facts of the s p i r i t u a l condition, i t s development, expressions, and where possible,  something of i t s  characteristics origins.  In  some instances, simply the opportunity to t a l k f r e e l y w i l l be of sufficient  help to the patient so that he can go on to work out  his s p i r i t u a l concern largely by himself.  Great help to the  patient may come through the process of thinking through his r e l a t i o n s h i p with various members of his household or community. By t h i s means the admonition " I f . . t h y brother hath aught  -23agalnst thee, way, f i r s t  leave there thy g i f t before the a l t a r ,  and go thy  be reconciled to thy brother, and then come and offer  thy g i f t , " 1 w i l l be more meaningful. Another common concern of the sick person which i s of interest to the chaplain i s that of grudge-hoIding and of unresolved grievances. deserve t h i s ? "  The question "What have I done to  is often found i n the person who either i n act  or feeling has wished some harm on someone else and has become i l l himself.  instead  This problem i s as old as the Book of Job  and i s no less a concern of psycho-analysts  2  and medical s o c i a l  workers today. One of the e a r l y church fathers c a l l e d the Holy Communion "medicine for the s o u l . "  Patients often mark the reception of  the Communion as the turning-point of t h e i r i l l n e s s .  It  is  c e r t a i n l y the Church's chief "medicine," and i t helps to sum up a l l that i s good i n the patient's r e l a t i o n to God and to other people. One of the values of the sacramental action i s that helps to bring the patient's  attention and interest  outside  himself, overcoming the withdrawal that i s c h a r a c t e r i s t i c many patients following operation.  it  of  The Sacrament of Holy  Communion or private prayer i s one of the greatest forces of support to the patient who must face an operation. 1 S t . Matthew  It  is  5s24-.  2 See: Stephen, Karin, The Wish to F a l l 111, Cambridge U n i v e r s i t y Press: London and New York, I960 (Paper Back edition).  -24-  important to the patient whose body image i s i n jeopardy that he have continuing support from the community and from his church. It i s important too, that the patient r e a l i z e the r e a l meaning of the Sacrament, that i t is not invested with magical significance or made a substitute for necessary medical care. The chaplain must be alert to the p o s s i b i l i t y that the patient who has not expressed g u i l t , f e a r , or resentment i s l i k e l y to interpret the administration of Holy Communion without any discussion of his s p i r i t u a l condition as a sign that "everything is a l l right."  One of the factors found i n i l l n e s s i s the  evasiveness of the patient i n facing his l i f e  situation.  R e l i g i o n and i t s sacraments may be a powerful force i n helping the patient meet a d i f f i c u l t s i t u a t i o n with courage and reassurance.  Therefore, careful preparation, which takes into  account both the objective meaning of the Sacrament and the subjective needs of the patient,  is necessary.  As the Book of  Common Prayer sayss "For as the benefit is great i f with a true penitent heart and l i v i n g f a i t h we receive that Holy  Sacrament,...  so is the danger great i f we receive the same u n w o r t h i l y . " 1 In summary i t may be said that the h o s p i t a l chaplain finds many opportunities to help patients with s p i r i t u a l problems.  Such problems as loneliness, fear, bitterness  and  grudge, the sense of g u i l t , boredom, physical pain and mental suffering are a l l encountered by the chaplain.  1959,  He must be  1 "The Exhortations," Book of Common Prayer, Canada, P. 8 9 .  -25-  sensitive to the need of patients to come to some satisfactory answer to the problems of e v i l , of ignorance, and of f u t u r i t y . A l l of this the chaplain must combine with his unique resources of prayer, sacraments and Bible reading and pastoral  counselling.  As a member of a helping profession i n the h o s p i t a l setting he works with a vast team devoted to serving the patient and a s s i s t i n g him on the road to recovery.  The relevance of these  areas of concern to the chaplain is perhaps best summarized i n The Modern H o s p i t a l , J u l y , I9U6: As the knowledge of psychosomatic medicine emerges, the r o l e of h o s p i t a l attendants i n the treatment of i l l n e s s w i l l grow i n importance. It has long been recognized that the emotional tone of medical and nursing staffs and of nonprofessional h o s p i t a l workers i s i n some way related to the q u a l i t y of h o s p i t a l care. This r e l a t i o n s h i p , as i t turns out, i s direct and s i g n i f i c a n t ; good emotional tone is an e s s e n t i a l of good psychic environment, the patient's recovery i s aided: i f the environment is unfavorable, i t i s retarded.1 Scope of the Study Some attempt w i l l now be made to look at  existing  conditions of the chaplaincy at the Vancouver General H o s p i t a l . Personal interviews were conducted with each f u l l - t i m e chaplain and each f u l l - time " o f f i c i a l h o s p i t a l v i s i t o r . "  By means of  1 See also: Barry, Kevin, "The Catholic Chaplain," The Canadian Nurse, The Canadian Nurses' Association; Montreal, V o l . 57, No. 12, December, 1961, pp. 114-2-3. See a l s o : McKnight, Earle T . , "A Chaplain Interprets His Work," The Canadian Nurse, The Canadian Nurses' Association: Montreal, V o l . 57, No. 12, December 1961, pp. 1339-13^1,  -26a questionnaire and an interview, data regarding the chaplain's  1 work were gathered.  Each chaplain also kept some s t a t i s t i c s  regarding his work for a two-week period, March l l - 2 M - t h , 1962. Although these s t a t i s t i c s are not exhaustive,  i t i s believed  they show current trends and conditions. Volunteers from the Bachelor of S o c i a l Work class and from members of the graduating classes of Anglican Theological College and Union College completed a short questionnaire^ and outlined t h e i r responses to the situations outlined i n three b r i e f case h i s t o r i e s .  These responses were i n answer to three  questions concerning the case h i s t o r y : reaction to the presenting situation?  (1) What i s your i n i t i a l (2)  Do you f e e l  competent to handle the situation? and (3) To whom might you refer the people i n question for further help i f needed? student each gave written answers and completed the during the period of one hour.  The  questionnaires  The three "case h i s t o r i e s " were  also given to the five hospital chaplains and two o f f i c i a l v i s i t o r s at the Vancouver General H o s p i t a l .  Verbal answers to  the same three questions were given by each chaplain and recorded by the interviewer. There w i l l be an attempt to find who sponsors the chaplains and what i s the background t r a i n i n g or education of each.  The study w i l l t r y to find answers to these  questions:  What sorts of problems does the chaplain face i n the hospital 1  See Appendix A.  2  See Appendix C.  3 h  See Appendix D. See Appendix B.  -27setting?  What are his r e f e r r a l patterns?  and What are his  counselling practices? In Chapter Three there w i l l be an attempt to describe the development of the C l i n i c a l Pastoral Training Movement. F i n a l l y , the implications of the findings w i l l be examined and suggested areas for further exploration o u t l i n e d .  CHAPTER II  A CASE STUDY OF THE CHAPLAINCY AT THE VANCOUVER GENERAL HOSPITAL  The pastor Is deeply and inevitably involved i n problems of human welfare. Not only does his work take him intimately into the l i f e s i t u a t i o n of many f a m i l i e s , but i t i s deep i n the t r a d i t i o n of r e l i g i o u s i n s t i t u t i o n s that people should bring their problems to the pastor, and he i s expected to help resolve them. The fact that a person i s hospitalized and separated from his community does not mean that his l i f e ' s anxieties are left behind i n the community.  problems and  He brings them  with him—his s o c i a l and psychological problems, and his r e l i g i o u s and s p i r i t u a l problems.  Indeed, often the anxieties  f i e d because of his h o s p i t a l i z a t i o n .  are i n t e n s i -  In many instances these  unresolved problems hinder his return to health of body and mind. But because the patient Is i n s t i t u t i o n a l i z e d he cannot seek help beyond the h o s p i t a l , and the resources of the professions  must  be brought to him. Today the modern h o s p i t a l brings many d i s c i p l i n e s together to form a "treatment team" to serve the patient.  The  1 Cayton, H. R . , and N i s h i , S. M. Churches and S o c i a l Welfare, V o l . I I , The National Council of the Churches of Christ i n the U . S . A . : New York, 1955, p. l6*t.  -29-  Vancouver General H o s p i t a l i s no exception. nurses,  s o c i a l workers, p s y c h i a t r i s t s ,  Medical doctors,  psychologists,  therapists  and teachers pool t h e i r learning and experience i n ministering to the s i c k . The one exception outside t h i s team at the Vancouver General H o s p i t a l i s the minister of r e l i g i o n .  It i s true that  he i s to be found v i s i t i n g the sick i n wards of the h o s p i t a l but he does not come as a representative of the hospital nor as a member of the "team." hospital.  He is sent by the community outside the  This has not always been so at the Vancouver General  Hospital. In 1919 a group of Vancouver c i t i z e n s , recognizing the need for a r e l i g i o u s ministry, asked the Reverend C e c i l C. Owen to become "Host" at the H o s p i t a l . 1  "Padre" Owen, as he was  affectionately known, had been Dean of Christ Church Cathedral, Vancouver, for some 15 years and his r e l i g i o u s counsel was sought by hundreds of people.  The c i t i z e n ' s committee raised funds for  h i s stipend and i n 1920 he began what was to be a 30 year ministry to the sick at Vancouver General H o s p i t a l . During the early years of the depression following 1929 the committee sought assistance from the Board of Trustees of the h o s p i t a l to help pay for Padre Owen's services.  The Board  recognized his invaluable service to the patient and took 1 The c i t i z e n s committee was headed by Dr. Malcolm MacEachern, Medical D i r e c t o r , Vancouver General H o s p i t a l , 1912-1922. I t was under Dr. MacEachern that the S o c i a l Service Department was begun at V . G . H .  -30-  complete r e s p o n s i b i l i t y for his salary.  This arrangement continued  u n t i l his retirement i n 1950 at the age of 85 years. The position of "Host to the Vancouver General H o s p i t a l " has never been f i l l e d since Padre Owen's retirement.  Ministers of  r e l i g i o n , however, continue ministering to the s i c k .  The answer  to the question "Who are the chaplains at the Vancouver General Hospital?" would seem i n i t i a l l y to be a r e l a t i v e l y easy task. Upon examination, however, t h i s i s not the case,  any answer to  t h i s question must consider three things: varying definitions of the word " c h a p l a i n , " the h o s p i t a l procedures respecting the chaplain, and denominational practices. D e f i n i t i o n of the Word 'Chaplain* The Vancouver General H o s p i t a l makes no d i s t i n c t i o n between " O f f i c i a l H o s p i t a l V i s i t o r " and "Chaplain." hospital's  Indeed, the  o f f i c i a l r e g i s t r y of " V i s i t i n g Clergymen" may include  ordained Pastors, P r i e s t s , M i n i s t e r s , Commissioned Salvation Army O f f i c e r s , Rabbis, Deaconesses, and both male and female Lay Workers.  The expressions " C h a p l a i n , " " O f f i c i a l H o s p i t a l V i s i t o r "  and " V i s i t i n g Clergyman" are used inter-changeably.  Prom the  Churches' standpoint "Chaplain" generally refers to an ordained clergyman especially appointed to work i n a h o s p i t a l setting or i n s t i t u t i o n or with a s p e c i a l group of people. refers to a f u l l - t i m e lay representative.  "Hospital V i s i t o r "  In this paper "Chaplain"  refers to both the ordained minister and the f u l l - t i m e lay worker unless the context indicates  otherwise.  H o s p i t a l Procedures The Vancouver General H o s p i t a l Administration has made an attempt to keep a r e g i s t r y of the " V i s i t i n g Clergymen."  This  was compiled by asking the various denominations to have t h e i r o f f i c i a l representative(s) leave t h e i r name and address with the c e n t r a l administration offices  of the h o s p i t a l .  This practice  began i n 1959 as a r e s u l t of a decision of the Board of Trustees upon the recommendation of the Medical Board of the H o s p i t a l . Upon the completion of an a p p l i c a t i o n form 1 the v i s i t i n g clergyman i s issued with a card signed by the H o s p i t a l Director which indicates that the clergyman may "conduct  appropriate  r e l i g i o u s r i t e s and r i t u a l s within the H o s p i t a l . "  There are 33  " V i s i t i n g Clergy" l i s t e d as at March, 1962. No set of standards of education or t r a i n i n g are necessary to qualify as a " V i s i t i n g Clergyman."  I t i s left  to  the denomination to select the person(s) to represent the church or s e c t . It has been found d i f f i c u l t , however, to keep the up to date.  list  The h o s p i t a l has not formulated procedures to  assure this i s done as occasion necessitates.  Thus some who  are l i s t e d have left Vancouver but t h e i r successors have not been r e g i s t e r e d .  Each denomination must take the i n i t i a t i v e of  registration.  At the present time one of the major denominations  (Presbyterian)  which hires a f u l l - t i m e h o s p i t a l v i s i t o r i s not  registered with the h o s p i t a l administration.  In sharp  contrast  to t h i s , the Salvation Army i s o f f i c i a l l y registered with 18  1 See Appendix E  -32-  representatives although none i s exclusively engaged i n h o s p i t a l chaplaincy or v i s i t i n g .  This seems to indicate that for this  denomination each parish or congregation of the Salvation Army i s " o f f i c i a l l y " represented and registered. Not only clergy l i s t e d with the administration v i s i t the H o s p i t a l ,  office  Almost without exception the parish  minister's duties include the " V i s i t a t i o n of the S i c k . " the boundaries of Vancouver c i t y there are an estimated clergy.  Within 200  In the course of any one week these clergy may v i s i t  t h e i r parishioners who are patients at the Vancouver General Hospital.  For example, an estimated twenty parochial clergy 1  v i s i t patients i n the Centennial P a v i l i o n each day of the week. In some instances these clergy perform " r i t e s and r i t u a l s "  but  have no o f f i c i a l sanction to do so from the h o s p i t a l administration.  There i s no procedure for registering these  clergy as " V i s i t i n g Clergymen." Denominational Practices Five denominations hire seven f u l l - t i m e h o s p i t a l chaplains or v i s i t o r s to v i s i t patients i n medical hospitals  in  p Vancouver including the Vancouver General H o s p i t a l .  The  Anglican Church and Roman Catholic Church each have one Chaplain working exclusively at the Vancouver General H o s p i t a l .  The  United Church supports two f u l l - t i m e r e l i g i o u s workers. One of 1 T a l l y taken by secretaries at the Information,Desk, Centennial P a v i l i o n , Vancouver General H o s p i t a l . 2 I t should be noted that three f u l l - t i m e Chaplains are on staff of Shaughnessy M i l i t a r y H o s p i t a l ; one at St. Paul's H o s p i t a l ; one at S t . Vincent's H o s p i t a l .  -33these i s a woman " H o s p i t a l V i s i t o r ; " the other is a r e t i r e d minister.  In both cases their time is divided between Various  hospitals.  The Presbyterian Church hires a Deaconess who v i s i t s  a l l hospitals i n Vancouver.  The Lutheran Church has two Pastors  who v i s i t a l l general hospitals In Vancouver, Burnaby and New Westminster and also other i n s t i t u t i o n s and the B . C .  such as Oakalla Prison  Penitentiary.  The salary or stipend of four chaplains and v i s i t o r s comes from sources outside Vancouver.  To a limited extent,  however, these four salaries are derived from Vancouver and B r i t i s h Columbia congregations through contributions  to  "Missionary Apportionment" or "Home Missions" which are by the c e n t r a l headquarters of the respective  collected  denominations.  Salaries for Chaplains at the Vancouver General H o s p i t a l are sent from the following sources: (1) The Women's Missionary Society, Toronto, Church of Canada.  Presbyterian  ( 2 ) The Home Mission Board of the United Church of Canada, - Toronto. (3) The J o i n t Committee of the two Vancouver Presbyteries, The United Church of Canada, Vancouver. (4) The Department of C h a r i t i e s , American Lutheran Church, - Minneapolis, Minnesota, U . S . A . (5) The Anglican Synod of the Diocese of New Westminster, Vancouver. (6) The A l b e r t a - B r i t i s h Columbia D i s t r i c t of the Missouri Synod of the Lutheran Church, Edmonton, A l b e r t a . (7) The Society of the Sacred Sacrament, Vancouver.  -3-+Preparation of the Chaplains The t r a i n i n g and educational background of the chaplains vary widely.  Both women v i s i t o r s have completed high school and  one has taken a two year course i n psychiatric nursing and one year of Normal School.  Neither has received any i n s t r u c t i o n i n  h o s p i t a l v i s i t i n g or any formal courses i n counselling, case work or the s o c i a l sciences. One of the chaplains spent two years i n a seminary completing the "Pre-Seminary" course.  He has taken two short  courses (each two weeks i n length) on "Family and M a r i t a l Relations" and "Mental H e a l t h . "  Another Chaplain holds the  degrees of B . A . , B . D . , and D.D.  His major study was philosophy  and h i s t o r y .  He has taken one class i n psychology but no other  courses i n the s o c i a l sciences.  His t h e o l o g i c a l courses did not  include "Pastoral Counselling" and he found the t r a i n i n g given for  t h i s work to be  "inadequate."  One of the chaplains holds the following degrees and titles:  A.Mus. T . C . L . ,  A . T . C . L . , and LTh. His t h e o l o g i c a l  course included courses i n "Pastoral Counselling" which he found "helpful."  The Roman Catholic chaplain received seven years of  Seminary t r a i n i n g with emphasis on philosophy and h i s t o r y .  His  courses included "Pastoral Theology" but he did not think this included what i s known today as "Pastoral Counselling." said he found Pastoral Theology " h e l p f u l " In meeting the problems he encountered i n his ministry.  He  -35Another chaplain has the degree of B.Sc. a Diploma i n Theology.  (Chemistry), and  He has taken "one quarter"  (3 months) of  C l i n i c a l Pastoral Training at Chicago. The position of chaplain at the Vancouver General H o s p i t a l was a new experience for six of the seven chaplains.  One  chaplain served as a voluntary chaplain on a part-time basis to a home for the aged.  This was for a period of two years while  he was i n charge of a parish.  None of the other chaplains had  previous experience as a h o s p i t a l chaplain except that gained i n a parish by regular v i s i t s to hospitalized parishioners.  Two  chaplains received a limited o r i e n t a t i o n to the Vancouver General H o s p i t a l from t h e i r predecessors.  When he began work at Vancouver  General Hospital one chaplain was taken on a 'tour 1  of the  h o s p i t a l by the Assistant Medical D i r e c t o r . A l l of the chaplains and v i s i t o r s thought that a course i n " h o s p i t a l chaplaincy" should be given i n the Vancouver area. None, however, has c l e a r l y defined ideas about t h i s .  Their ideas  respecting the scope of such a course ranged from a "few days o r i e n t a t i o n course on hospital work," through a course j o i n t l y sponsored by t h e o l o g i c a l colleges i n Vancouver, to a two year course i n C l i n i c a l Pastoral Training integrated into the h o s p i t a l services and administration.  The Roman Catholic  chaplain thought i t would be d i f f i c u l t to combine a l l Churches i n such a course but he f e l t  his own denomination should make  more provision for t r a i n i n g of i t s clergy who are h o s p i t a l chaplains.  None of the Protestant  chaplains contemplated any  denominational boundaries but rather stressed that such a course should be inter-denominational.  -36-  The Chaplain at Work At the time of admission to hospital each patient to state his r e l i g i o u s of the patient  preference.  i s asked  A card which gives d e t a i l s  i s placed at the disposal of the chaplain the  day following the patient's admission.  These cards are  sorted  according to denomination by the "Information Desk Secretary" i n Heather P a v i l i o n .  The cards of the following denominations  are sorted: Anglican, B a p t i s t , Lutheran, Presbyterian, Roman C a t h o l i c , United and Jewish.  The remainder of the cards are  destroyed. The cards are placed i n f i l e cases i n a small room behind the Heather P a v i l i o n Information Desk and the are free to make what use they wish of them.  chaplains  This room, i n  which the chaplains sort t h e i r cards and plan t h e i r day's work, i s shared by the Woman's H o s p i t a l A u x i l i a r y which uses the room to cut and arrange flower bouquets.  There are no  facilities  for hanging coats, no telephone, no c h a i r s , no cupboard for storage or safekeeping of supplies. chaplains elsewhere.  A desk may be used by the  i f they obtain a chair from the Information Desk or T h i s , of course,  i s dependent on whether the desk  i s being used by the Woman's A u x i l i a r y l a d i e s . One of the chaplains  prefers to sort his cards i n the  main foyer of the Centennial P a v i l i o n where desk and chair are available.  Another chaplain prefers to return to his study at  home to sort his cards.  A l l the chaplains are loath to use the  "Prayer Room" i n the Centennial P a v i l i o n for the purpose of  -37sorting cards.  This has been done on occasion by some chaplains  but they found that patients or v i s i t o r s were prevented from using the Prayer Room when they found the chaplains were using the room. Each card indicates the following information about the patient:  name, age, address, when admitted, location i n the  h o s p i t a l , employer, next of k i n , denomination. diagnosis i s omitted.  The medical  Four of the chaplains said emphatically  that i t would a s s i s t t h e i r work i f they knew something of the medical diagnosis and prognosis.  One of them s a i d , "This would  prevent the temptation to give f a l s e assurances when you can't be sure of the medical s i t u a t i o n . "  Another remarked that the  diagnosis "would help especially i n making i n i t i a l approach to the patient and especially when there had been attempted or when the case was t e r m i n a l . "  Two chaplains f e l t  diagnosis could be helpful but not always.  suicide  that the  One of these  remarked that he generally knew the diagnosis through his own experience i n h o s p i t a l work, the location of the patient i n the h o s p i t a l and often because the patient t o l d him, although he never asked.  One chaplain said that he did not wish to know  anything of the diagnosis.  Generally speaking, the chaplains  were very pleased with the card system i n use at the Vancouver General H o s p i t a l .  The cards are similar to that kept by the  S o c i a l Service Department i n t h e i r f i l e of o f f i c i a l active cases. S t a t i s t i c s of the r e l i g i o u s denominations of each patient were taken for a two week period from the S o c i a l Service record  -38of d a i l y admissions. in this  Approximately 1,800 patients were admitted  period.  Table 1.  Number of Patients by Religious Denomination Admitted to the Vancouver General H o s p i t a l For the two-week Period, March 11-24, 1962 •  Denominat ion Anglican Baptist Lut her an Pentecostal Presbyterian Protestant  I | Denomination  No. Admitted  Uo. Admitted _ 263 -12 460 •+7 119 120  Roman Catholic Salvation Army United Church Jewish Other Groups No denomination  333 7? 104 30 117 131  1809  Total Patients l i s t e d under "Pentecostal" who indicated t h e i r r e l i g i o u s " E v a n g e l i c a l " or "Gospel."  include a l l those  preference as  "Pentecostal,"  Those included under the heading  "Other Groups" are patients who indicated t h e i r  religious  preference as one of the following: Greek Orthodox, Methodist, 7 t h Day Adventist, Jehovah Witness, Apostolic, U n i t a r i a n , Brethren Russian Orthodox, Plymough, Wesleyan, Mohammedan, Mormon, Doukhobor, S i k h , Ukrainian Orthodox, L i b e r a l C a t h o l i c , C h r i s t i a n Science, and Mennonite.  Of the 120 who are  under "No denomination," half indicated t h e i r preference as "Protestant-Non  listed  religious  Practising."  Not a l l patients are v i s i t e d by the chaplains.  Indeed,  each chaplain remarked on the d i f f i c u l t y of finding enough time to v i s i t the members of his own denomination.  -39Table 2.  Number of P a t i e n t - V i s i t s „ b y Chaplains March 11-24, 1962  Anglican Lutheran 1 Presbyterian j  200 25  Roman Catholic United 1 ]  841  T o t a l of sample  The above s t a t i s t i c s represent  207 377  1  only the members of the  chaplain's denomination who were v i s i t e d by him.  However, each  chaplain remarked that he would not leave a ward without speaking a moment with each patient.  Four chaplains v i s i t e d  the out-of-town patients more frequently than those from Vancouver.  These l a t t e r they referred to parish c l e r g y .  The r e f e r r a l to parish clergy i s done i n a v a r i e t y of ways.  One chaplain prefers to phone each parish minister and  give each a l i s t of patients from his parish.  Another chaplain  sorts the admission cards according to parishes and leaves them i n a f i l e cabinet for the parish minister.  S t i l l another  chaplain writes duplicate cards and sorts the cards according to postal zone.  These cards are then placed i n an index  cabinet and the parish clergy from each particular postal zone sort out t h e i r own parishioners.  1 This includes both chaplains for this denomination.  -40Table 3.  Number of Referrals of Vancouver General H o s p i t a l Patients to Parish Clergy by _ Chaplains or V i s i t o r s , March 11-24, 1962  Denomination  No. of Referrals  Anglican Lutheran Presbyterian  272 22  Denomination Roman Catholic United Church  1  2 307  604  T o t a l Number of r e f e r r a l s •  No. of Referrals  !  One of the ministers of a large Baptist Church obtains the l i s t of the members of his congregation who are patients by telephoning the Information Desk at Heather P a v i l i o n .  Many of  the smaller sects depend on r e f e r r a l s from the patients themselves or from t h e i r r e l a t i v e s , friends  and members of the  congregation. The number of v i s i t s which a chaplain makes i s dependent on the time he may spend i n any one week at the Vancouver General H o s p i t a l .  Five chaplains have duties  elsewhere and two work exclusively at the Vancouver General Hospital.  -4-1Table 4-.  Number of Working Hours of Chaplains at the Vancouver General H o s p i t a l March 11-24-, I962  Denomination  Days per Week  Anglican C h a p l a i n 1 Lutheran 1. Chaplain 2. Chaplain Presbyterian V i s i t o r . Roman Catholic C h a p l a i n 1 United 1. Chaplain 2. V i s i t o r  Hours per Week  6 2 2 2£  32 6  6  14 23  10  ?  7-  2  5  Except i n the cases where counselling i s  requested  (either d i r e c t l y by the patient or i n d i r e c t l y by r e f e r r a l ) where s p e c i a l church " r i t e s and r i t u a l s " are performed  and  (e.g.  circumcision, baptism or Holy Communion), the usual length of time for a chaplain's v i s i t i s 5 to 15 minutes. visits  Rarely do  exceed t h i s time although no arbitrary time l i m i t is  set.  When occasion demands a chaplain may spend as much as an hour with a patient.  In the case of long-term patients,  chaplains often make weekly v i s i t s .  hospital  Most patients, however,  are  not i n hospital long enough to allow for more than one v i s i t . In the case of grave i l l n e s s and when requested by the his r e l a t i v e s  or members of the professional staff  patient,  of the  h o s p i t a l , chaplains w i l l often make d a i l y v i s i t s to patients.  1 These chaplains work exclusively at the Vancouver General H o s p i t a l .  -4-2One chaplain wrote at length: Regarding hours: no priest i s ever " o f f duty" and his hours are as e l a s t i c as a doctor's. My note on Saturday, 1 March 17th reminds me that I spent the afternoon and part of the evening v i s i t i n g and counselling the widow of a man who was a patient i n the Vancouver General H o s p i t a l i n February, but who died i n White Rock H o s p i t a l early i n March. I was asked to conduct the funeral and did so. This raises a point that may be worthy of consideration. The r e s p o n s i b i l i t y of the h o s p i t a l ends with the death of a patient; but there i s s t i l l the family to consider. They may be transient as this widow and her late husband were. They may have the most casual of church connections; i n which case, the man who ministered to a deceased member of the family i n his last i l l n e s s may have the r e s p o n s i b i l i t y of doing something about the s p i r i t u a l l i f e of his survivors. In time the parish priest takes over—and the sooner the better; but meanwhile the chaplain must carry on. I have not been able to show on your form the time thus spent with bereaved families— some of i t i n h o s p i t a l corridors and i n the Prayer Room, some i n t h e i r homes. In addition I have spent about four hours i n these two weeks with r e l a t i v e s of seriously i l l patients. One also does what one can by providing h o s p i t a l i t y i n one's home for r e l a t i v e s from out of town who have no friends i n the city—we have had one such this past week. I have also driven two elderly r e l a t i v e s (old age pensioners) to t h e i r homes i n Burnaby after they had v i s i t e d near r e l a t i v e s i n the Vancouver General H o s p i t a l . These are things which to my knowledge a l l the chaplains do from time to time. This gives some i n d i c a t i o n of the variety of tasks performed by chaplains, and i l l u s t r a t e s  the d i f f i c u l t y inherent  i n the attempt to ask for precise time s t a t i s t i c s from any professional group. Counselling  Practices  It i s equally d i f f i c u l t to get a precise description or reasoning as to the purpose of the Chaplain's v i s i t and what i t i s he feels he brings to the patient.  I f more time could have  1 This refers to the s t a t i s t i c a l forms for March 11-24-, I962 which the chaplains completed. See Appendix C.  -4-3-  been used i n the interview i t l i k e l y would have produced more considered answers.  Dr. Richard Cabot expressed the same  difficulty: The doctor seldom makes a swift and f i n a l diagnosis, seldom produces a triumphant remedy and departs i n a blaze of glory. He does what he can professionally; but the larger part of his c a l l i s often s o c i a l , he aims to encourage, to console, to amuse and d i s t r a c t , occasionally to instruct or to w a r n . l The chaplains were each asked, "What do you consider to be the most valuable aid(s) you bring to help the h o s p i t a l patient on the road to recovery?"  The answers varied from  "cheerful presence;" to "Prayer and moral support;" to a more t h e o l o g i c a l d e f i n i t i o n as "the vehicle of the Grace of God, that i s , the ministry of r e c o n c i l i a t i o n . "  One chaplain who had  received C l i n i c a l Pastoral Training thought that the " l i s t e n i n g ear" was the most valuable aid he brought to the patient. described this  He  ' a i d ' as also part of what every s o c i a l worker  brings i n the casework r e l a t i o n s h i p . One chaplain found i t necessary to be assured that he was understood about the ' a i d ' he brought to the patient.  He had  said i n the interview that his ministry was one of reconciliation."  Later he wrote a l e t t e r i n which he s a i d ,  I could have s a i d , "the ministry of healing" which i s also correct but susceptible of being misunderstood as the application i n some form of f a i t h healing—which, by the way. should not be ruled out altogether. I prefer to think of the word "heal" i n i t s older meaning of "to make whole," since our L o r d . . . i s concerned for t n e whole man, his s o u l , his mind, his body—and the bringing of the whole man into a proper relationship 1 Cabot, Richard C . , "Adventures on the Borderland of E t h i c s , " The Survey, V o l . IV, No. 5, December 1, 1925, p. 275.  -44with God. Since i n t h i s endeavor the whole hospital— medical, nursing and s o c i a l service personnel may be concerned—the hospital chaplain must work with them to the best of his a b i l i t y as circumstances permit, and must have them d a i l y i n h i s prayers. And by the way, the past two weeks have l e f t far too l i t t l e time for personal prayer and devotional study! Some chaplains were unable to be precise about a similar question, "Do you think the chaplaincy has any s p e c i a l s k i l l or knowledge to help the treatment team of the Hospital?" chaplains answered i n the affirmative.  All  When asked to describe  t h i s s k i l l or knowledge, however, t h e i r answers were quite v a r i e d : " s p i r i t u a l reassurance;"'prayer;"  "the parish church i s  a great resource;" " p h y s i c a l well-being i s c l o s e l y related to s p i r i t u a l well-being—anxieties and tensions cause some physical conditions."  One chaplain suggested that the "parish experience  gave an outlook which had breadth."  This outlook, he thought,  was akin to that of the s o c i a l worker.  He suggested t hat ,  " s p e c i a l i s t s have b l i n d spots i n the t o t a l picture whereas the chaplain and the s o c i a l worker are often perceptive."  Another  chaplain s a i d , "the chaplain i s neither a s o c i a l worker nor a doctor but he i s uniquely q u a l i f i e d to diagnose, understand and help with s p i r i t u a l problems.  S p i r i t u a l health often affects  p h y s i c a l recovery." What constitutes different meanings.  people.  "counselling" means many things to  This study cannot deal with a l l the possible  C a r r o l l A. Wise, i n Pastoral Counselling, Its Theory  and P r a c t i c e , suggests that "counselling seeks to u t i l i z e the resources of personality, to work through tension-producing  -45experiences  and to help the person grow to a new l e v e l of strength  and m a t u r i t y . " 1  To what extent the chaplains have helped the  patients through counselling there i s no way of knowing.  However,  there i s evidence that counselling is requested hy the patients from the chaplains. Table 5.  Number of Patients seen for Counselling by the Chaplains During two week period March 11-24-, 19622  Number of  Denomination Anglican Chaplain Lutheran Chaplain Chaplain Presbyterian V i s i t o r Roman Catholic Chaplain United Chaplain Visitor Total  1  |  Patients  20 2 12 0 10 452  One of the chaplains i n commenting on his completed s t a t i s t i c a l form said that under the column "Patients seen for Counselling" he, "included only those patients with problems such as the domestic inconvenience and upset occasioned by h o s p i t a l i z a t i o n and s p i r i t u a l problems such as several terminal  1 Wise, C a r r o l l A . , Pastoral Counselling, Its Theory and P r a c t i c e , Harpers: New York, 1951, p. 38. 2 During the same period 18 of the 1,800 admissions were referred to the S o c i a l Service Departments for casework services.  -46-  cases, and a man who fears he may become a paraplegic.  I have  not included, he s a i d , "the f a i r l y numerous cases of people who ask for straightforward answers to questions regarding the Church and the B i b l e , even where these cases involved a f a i r l y long conversation."  The d i f f i c u l t i e s i n defining the boundaries  of counselling are abundant. A l l of the problems l i s t e d on the questionnaire have been dealt with by one or other of the chaplains at the Vancouver General H o s p i t a l .  Some of the 'problems', of course, are more  often brought to the chaplain than others. a problem which each chaplain had to face.  "Bereavement" was Cases of bereavement  were usually seen i n the "family context" whereas a l l other problems were seen i n the i n d i v i d u a l context.  One chaplain  attempts to refer to the parish clergy a l l cases where a death has taken place.  He did not encourage the practice of a chaplain  taking funerals and counselling the bereaved.  He f e l t this to  be beyond the h o s p i t a l chaplain's bounds of duty.  Because of  the continuing work with the family he concludes t h i s to be the parish pastor's r e s p o n s i b i l i t y . The most commonly dealt with problem was that of "Grave Illness."  Six of the seven chaplains have had to deal with  t h i s problem and three of these indicated i t s high incidence among the problems with which they had to d e a l .  The only one  who had not dealt with t h i s problem was one of the women visitors. "Religious Support" of various kinds received the most attention of the chaplains but was generally not regarded as a  -H-7'problem 1 . prayer.  A l l chaplains at one time or another, make use of  The more Catholic t r a d i t i o n s make the greatest use of  the Sacrament of Holy Communion whilst the more Protestant traditions  lay emphasis on the S c r i p t u r a l Reading, and  extemporaneous  prayer.  An interesting change over the years i n the problems confronting the chaplain was given by one of the older chaplains. He remarked that the f i n a n c i a l need of patients was the prominent problem a number of years ago and e s p e c i a l l y the worry caused through large h o s p i t a l and medical b i l l s .  He noted that h o s p i t a l  and medical payment schemes have v i r t u a l l y erased t h i s problem from those facing the chaplain. R e f e r r a l Patterns with Other  Professions  The s t a f f of a modern h o s p i t a l i s often greater i n number than the patients i t serves.  This large s t a f f  consists,  not only of nurses and doctors, but also of administrators and s o c i a l workers, physiotherapists  and r a d i o l o g i s t s ,  engineers and  laboratory technicians, a vast array of domestic workers and a multitude of students of medical-oriented d i s c i p l i n e s .  With  many of these the chaplain r a r e l y , i f ever, comes i n t o contact. They work i n the same b u i l d i n g , serve the same people, but seldom cooperate i n plans for the benefit of the patient. The Vancouver General H o s p i t a l i s a complex organization employing some 2,500 people for i t s capacity of 2,700 patients. Many professional d i s c i p l i n e s cooperate as members of a "team" to serve the patient.  Although none of the chaplains  is  -46-  considered a member of t h i s team, they are c a l l e d upon from time to time to give service to a patient.  In turn they refer  patients to various d i s c i p l i n e s . Six of the seven chaplains have discussed with his medical doctor at one time or other the patient's condition. has not so done i s one of the women v i s i t o r s .  The one who  The chaplains  reported th a t, although these discussions with the doctor were not frequent, they, did involve some joint planning.  One chaplain  reported that he i s c a l l e d i n occasionally when "medicine has given u p . " The attempt to find the number of r e f e r r a l s chaplains and other professions statistics.  to and from  has not produced accurate  Some chaplains recorded on the s t a t i s t i c a l form  that they had received a r e f e r r a l from another profession but f a i l e d to say which profession or how often. trend can be indicated.  Thus only a general  By far the greatest number of  referrals  X were to the c i t y clergy. On an interprofessional b a s i s , the nurses cooperate most often with the chaplains.  Before proceeding to a ward the  chaplains u s u a l l y speak with the head nurse at the nursing s t a t i o n regarding the patients on h i s l i s t . t e l l them something of the patient's  The head nurse w i l l  general condition and w i l l  often suggest when the patient has been p a r t i c u l a r l y depressed and what seems to be the cause.  They also advise the chaplain  when the patient should not be disturbed. 1 See Table 3, p. kO>.  When a patient  is  -49-  c r i t i c a l l y i l l the head nurse may also telephone the operators at the Information Desk i n either the Centennial or Heather Pavilion.  These c l e r k s , i n t u r n , w i l l telephone the chaplain.  Referrals of t h i s type are u s u a l l y only made to the Anglican and Roman Catholic chaplains who have requested that t h i s be done. I t i s seldom that chaplains of other denominations are c a l l e d i n t h i s manner and usually only at the request of the patient or a member of h i s family. The next most frequent contact between the chaplains and another profession i s that with the s o c i a l worker.  A l l chaplains  expressed t h e i r pleasure of the interprofessional r e l a t i o n s which exist between themselves and the S o c i a l workers i n the S o c i a l Service Department.  From November 19&1 to A p r i l 1962  bi-monthly meetings between the S o c i a l Service Department and the chaplains has meant greater mutual understanding and cooperation between the two professions. mutual problems and concerns such as referrals, for  They have discussed  interprofessional  welfare resources i n Vancouver and joint planning  boarding home care for e l d e r l y patients. A l l chaplains agreed that they would be w i l l i n g to share  "personal and s o c i a l information" about a patient with another profession.  The chaplains said they would have to withhold  information i f i t was "given i n secret" or i f they were bound by the " s e a l of the confessional."  Generally speaking, the  chaplains' thinking about t h i s subject reflected the professional code of ethics for s o c i a l workers:  -50-  Respect and safeguard the right of persons served to privacy i n t h e i r contacts with the agency, and to c o n f i d e n t i a l and responsible use of the information they g i v e . 1 One chaplain spelled out t h i s r e s p o n s i b i l i t y i n these words: "The s o c i a l and personal information which i s given to a chaplain by a patient not just anybody."  i s intended not to be t o l d to nobody, but  The chaplains usually preface t h e i r state-  ments i n t h i s regard by saying that they would not mind sharing information with other professions so long as i t would be h e l p f u l i n leading to the patient's recovery.  The chaplains  did not say who would decide whether the information would be helpful but the implication seemed to be that they themselves would have to see the relevance of information possessed before sharing would be possible. R e f e r r a l Patterns Indicated i n Three Case Examples The answers given i n the three case examples to the question "To whom might you refer t h i s case?" have shown that the chaplains are primarily Church-oriented with respect to referrals.  They suggested the use of a v a r i e t y of Church  agencies (including parish minister, home for unmarried mothers, men's clubs, Church Matrimonial Bureaus and Marriage Counsellors, the Chancery Office and "down town Churches").  Among the  community s o c i a l service agencies which the chaplains suggested for r e f e r r a l were the Departments of S o c i a l Welfare at both p r o v i n c i a l and municipal l e v e l s ,  Children's Aid Society, Family  1 "Code of E t h i c s , " i n Standards for the Professional Practice of S o c i a l Work, New York: American Association of S o c i a l Workers, 1951, p. 5.  -51Service Association, Vancouver General H o s p i t a l S o c i a l Service Department, Department of Immigration, R.C.M.P., and Catholic Charities. An examination of the f i r s t r e f e r r a l i n each case example suggested by each chaplain indicates that 14 r e f e r r a l s were made to Church-sponsored agencies (including parish clergy) and 7 r e f e r r a l s were made to secular s o c i a l agencies.  This same  r e f e r r a l pattern i s indicated i n the suggested r e f e r r a l s made by the t h e o l o g i c a l students.  Twice as many f i r s t r e f e r r a l s were  made to church agencies than to secular welfare agencies. The Bachelor of S o c i a l work students on the other hand, made 21 of t h e i r " f i r s t choice" r e f e r r a l s to secular  agencies  and 9 "to church organizations. The chaplains suggested a t o t a l of 50 different  agencies  or professional people to whom they would refer the three cases. Of these, 29 were church-sponsored and 21 were secular  agencies.  The t h e o l o g i c a l students mentioned 40 possible r e f e r r a l s to church agencies and 3"+ to welfare agencies.  The Bachelor of  S o c i a l Work students gave a t o t a l of 60 possible agencies to which they would consider r e f e r r a l of the three cases. these, 40 were to secular welfare  Of  agencies.  This indicates that for chaplains and t h e o l o g i c a l students the frame of reference for i n t e r p r o f e s s i o n a l or inter-agency r e f e r r a l i s decidedly church-oriented. The secular agency i s used only h a l f as much as the church agency. students,  The s o c i a l work  on the other hand, are oriented to secular  agencies.  -52Both d i s c i p l i n e s f e e l that t h e i r own s p e c i a l t i e s can handle adequately and e f f e c t i v e l y the problems i l l u s t r a t e d i n the case histories. There i s evidence on the other hand, that no small amount of consideration i s given to inter-professional  referral.  Each profession has a regard for the contributions which the other can make.  CHAPTER III  THE CLINICAL PASTORAL TRAINING MOVEMENT  Only the Sham knows everything; the trained man understands how l i t t l e the mind of any i n d i v i d u a l may grasp and how many must cooperate i n order to explain the very simplest things. 1 It was Mary Richmond who observed this i n her c l a s s i c description of the casework process at the beginning of the twentieth century.  What the emerging profession of s o c i a l work  had to show was that s o c i a l problems could not be handled i n just any haphazard fashion.  In order to meet e f f e c t i v e l y the  increasing amount of s o c i a l problems i t was necessary that  social  workers have the facts of the s o c i a l s i t u a t i o n so that they might make an objective assessment and diagnosis.  It was  necessary to have a method i n t h e i r work which incorporated a body of s c i e n t i f i c knowledge of human and s o c i e t a l dynamics with a set of values and goals.  S o c i a l workers were not "bornj' they  had to be trained i n t h i s method of dealing with s o c i a l problems. Even today, f i f t y years l a t e r ,  the urgency and necessity of  1 Richmond, Mary E . , S o c i a l Diagnosis, R u s s e l l Sage Foundation, 1917, from the f l y l e a f , tQuoting from Hans Gross, Criminal Investigation, translated by Adam and Adam, A. Krishnamachari: Madras, India, 1906.)  - 5 H - -  t r a i n i n g for s o c i a l work i s  repeated.1  T h i r t y years ago a minister received a t r a i n i n g which had changed l i t t l e i n the previous hundred years. and teachings  The t r a d i t i o n s  of the Church were handed on to ministers through  an educational process which departed hut s l i g h t l y from such subjects as History, Theology, L i t u r g i e s , Greek, Hebrew and B i b l i c a l studies.  The graduate from these courses was considered  prepared to meet the problems that parish.  lay ahead for him i n the  From the turn of the 2 0 t h Century, however, the  increasing complexities  of l i f e and the revolution i n the pace  of l i v i n g precipitated many new situations which had to be faced by the minister.  Now he found himself faced with stresses  i n human l i f e caused by a world war, a vast depression,  and a  widespread bureaucracy i n almost every walk of l i f e a l l of which had led to a depersonalization of much of i n d i v i d u a l life.  Many people had broken under the s t r a i n .  There was a  need for ministers s p e c i a l l y trained i n understanding the s o c i a l and psychological factors that wreck mind and nerves and character. Origins and Development In 1925 Dr. Richard C. Cabot had seen the unique opportunity which the clergyman had i n coming into fact-to-face contact with many of these problems.  Further he saw the dire  1 Morgan, John S., " S o c i a l Welfare Services i n Canada," i n S o c i a l Purpose for Canada, edited by Michael O l i v e r , University of Toronto Press: Toronto, p. 1 6 5 . I  9  6  I  ,  -55need for " c l i n i c a l t r a i n i n g " to augment the t h e o l o g i c a l students' education.  "When we urge a t h e o l o g i c a l student to get  'clinical  experience'  outside his lecture rooms and his chapel, to v i s i t  the s i c k , the insane, the prisons and the almshouses," he said, " i t i s not because we want him to get away from his theology but because we want him to practise his theology where i t i s most needed, i . e . ,  In personal contact with individuals i n t r o u b l e . " 1  Dr. Cabot was suggesting that every student for the ministry be given a c l i n i c a l t r a i n i n g for his pastoral work similar to the c l i n i c a l t r a i n i n g a medical or s o c i a l work student  receives  during his professional education. Although t h i s essay of the renowned Dr. Cabot i n Survey Graphic was one of the most i n f l u e n t i a l writings of the time i n promoting c l i n i c a l pastoral t r a i n i n g , i t Is not to be supposed that he was alone, nor even the f i r s t , idea.  i n thinking of the new  Few people r e a l i z e that the idea of providing seminarians  with a c l i n i c a l experience was f i r s t  set f o r t h i n 1913 at the  General Convention of the Protestant Episcopal Church by the Reverend William Palmer Ladd.  I t was not u n t i l 1922 that  anything was i n i t i a t e d , however, and i t Is perhaps  significant  that the proponent t h i s time was another physician, Dr. William S. K e l l e r , of C i n c i n n a t i .  He offered to accept a few  seminarians and to provide them with f i r s t  hand experiences  with people, under professional supervision, and primarily 1 Cabot, Richard C . , "Adventure on the Borderline of E t h i c s , " The Survey Graphic, December 1, 1925, V o l . 25, No. 5, p. 276.  -56within the framework of existing community services. 1923 the C i n c i n n a t i Summer School was launched.  Thus i n  By 1936 t h i s  program was expanded into one year of t r a i n i n g . In yet another person, a contemporary of Dr. Cabot, the Reverend Dr. Anton T . Boisen, there was also the attempt to think through t h i s new concept i n t h e o l o g i c a l student t r a i n i n g . Boisen, a middle-aged minister, had come through a serious nervous breakdown that had confined him for several months i n a mental h o s p i t a l .  He had studied his own case and those of  his fellow patients and upon h i s release he enrolled at Harvard University to pursue the subject of mental i l l n e s s .  At Harvard  he found a group headed by Dr. Cabot—eminent men such as Macfie Campbell, William McDougall and Elwood Worcester—all deeply interested i n the mentally i l l .  With t h e i r help he  prepared himself for a ministry to the mentally i l l and, at the same time, for further research which would be used to t r a i n future ministers.  It i s thus that Anton T. Boisen has been  c a l l e d the "Father of the C l i n i c a l Pastoral Training Movement." The f i r s t  opportunity to test the new thinking came when  the Worcester State H o s p i t a l (2,200 Mental patients) the Protestant  chaplaincy to Boisen.  offered  He soon demonstrated  that  a chaplain giving f u l l time to an i n t e l l i g e n t , d a i l y ministry  1 Eastman, Fred, "Father of the C l i n i c a l Pastoral Movement," The Journal of Pastoral Care, Spring 1951, V o l . 5, No. 1, p. 3.  -57to mental patients i n d i v i d u a l l y and i n groups was far more effective  than the plan i n most hospitals which simply consisted  of having pastors of l o c a l churches come i n on Sundays to conduct a worship  service.  That t h i s opportunity for Dr. Boisen was not only possible but amazingly successful i s due i n large part to Dr. William A. Bryan who was (as Miss Ida Cannon has so aptly  1  described work) the  him i n her account of pioneering i n medical s o c i a l 11  extraordinarily u n i n s t i t u t i o n a l i z e d  Superintendent"  of the Worcester State H o s p i t a l . In June of 1925 four Theological students came for the summer course given under Boisen 1 s d i r e c t i o n i n cooperation with the medical s t a f f .  The number of students who came for the  c l i n i c a l t r a i n i n g increased r a p i d l y .  By 1929 a t o t a l of *+l  students had taken the summer course. The Council for C l i n i c a l Pastoral Training The growing demand for " c l i n i c a l t r a i n i n g " needed firmer foundation and on January 21, 1930, "The Council for  Clinical  Training of Theological Students" was incorporated with the p  adoption of a c o n s t i t u t i o n .  The founders  made i t clear  to  every student that he must not think that he was being trained as a junior psycho-analyst  or p s y c h i a t r i s t .  The Council aimed  to accomplish three things: 1 Cannon, Ida M . , On the S o c i a l Frontier of Medicine, Harvard University Press, 1952. 2 The-founders included: Richard Cabot, Henry Wise Hobson, Samuel E l i o t , William A. Healy, and Ashely Day L e a v i t t .  -58-  1. To open his (the student's) eyes to the r e a l problems of men and women and to develop i n him methods of observation which w i l l make him competent as an investigator of the forces with which r e l i g i o n has to do and of the laws which govern these forces; 2. To t r a i n him i n the art of helping people out of trouble and enabling them to find s p i r i t u a l health; 3 . To bring about a greater degree of mutual understanding among the professional groups which are concerned with the personal problems of men. 1 Very soon after i t s incorporation, the Council began experimenting with t r a i n i n g programs i n i n s t i t u t i o n s other than the three mental hospitals  i n use.  There was a tentative  movement into the area of delinquency, with centers f i r s t  at the  Judge Baker Guidance Center i n Boston, and later at both the Norfolk, Massachusetts, Prison Colony, and at the I l l i n o i s State Training School for Boys at St.  Charles.  In the summer of 1932  two students were placed at the Massachusetts General H o s p i t a l i n Boston under the joint supervision of Dr. Austin P h i l i p Guiles and Miss Ida M. Cannon, Supervisor of the S o c i a l Service Department.  The Reverend R u s s e l l L . Dicks, Chaplain at  Massachusetts General Hospital worked closely with Dr. Cabot and piloted the general h o s p i t a l t r a i n i n g through i t s stages.  formative  Later (1936) the two men (Dicks and Cabot)  collaborated on writing The Art of Ministering to the S i c k . 2  1 Eastman, Fred, "Father of the C l i n i c a l Pastoral Movement," The Journal of Pastoral Care, Spring 1951, V o l . 5 , p. 5 . 2 Richard C. Cabot and Russell L . Dicks, The Art of Ministering to the S i c k , MacMillan: New York, 1936"T  -59In 193*+ the Federal Bureau of Prisons approached the then Federal Council of Churches with the request that i t t r a i n and nominate for appointment candidates service for i t s  system.  for a r e v i t a l i z e d chaplaincy-  Both organizations turned to the Council  for C l i n i c a l Training for assistance and i n January first  1936 the  trained chaplain was appointed to the s t a f f of a  correctional i n s t i t u t i o n . 1  Two students were assigned to the  Federal Reformatory at C h i l l i c o t h e , Ohio, that summer. Bureau soon became the f i r s t  The  c o r r e c t i o n a l system to require a  period of in-service training for a l l Protestant Chaplains before permanent appointment, i n addition to previous academic and c l i n i c a l preparation. Although the founders agreed upon the major objectives C l i n i c a l P a s t o r a l T r a i n i n g , they differed on others.  of  Cabot  thought that the main emphasis of the t r a i n i n g of students should be placed upon developing a b i l i t y and s k i l l i n dealing with persons a f f l i c t e d with bodily disorders—the i l l or dying, the deaf or b l i n d , the other disabled.  He, therefore,  that most students be trained i n general  advocated  hospitals.  Boisen, on the other hand, was c h i e f l y interested i n mental hospitals where the minister-to-be would come into contact with patients suffering from mental i l l n e s s .  His  thinking was that a minister i n the parish i s dealing a l l the time with mental health problems and that he meets a large number of persons i n the i n c i p i e n t stages of mental trouble.  1 The Training School at St. Charles, I l l i n o i s .  -60-  Therefore, he argued, the student should be trained to recognize the i l l n e s s and help the person i n his struggle for mental health. Meanwhile the movement for the c l i n i c a l training of t h e o l o g i c a l students grew r a p i d l y .  Boisen went as Chaplain at  the State H o s p i t a l at E l g i n , I l l i n o i s .  From there he was able  to continue offering courses i n r e l i g i o n and mental health at the Chicago Theological Seminary and also make E l g i n H o s p i t a l , not only a t r a i n i n g centre for the Council, but a base for fundamental  research.  Varying Emphasis In i t s b r i e f history there have been at least four emphases i n c l i n i c a l pastoral t r a i n i n g .  The Council attempted  to answer the question as to how i t might best t r a i n the minister to be of help to individuals i n trouble.  The different  phrasings  of the question i t s e l f symbolize these changes. In the i n i t i a l phrase the wording was "What must I do to be of help to the patient or inmate?" participated i n the usual a c t i v i t i e s  Thus students  of the Chaplain's  department,  but also i n a number of other things considered as i n t e g r a l part of c l i n i c a l t r a i n i n g .  They worked on wards, and they organized  talent shows i n the i n s t i t u t i o n .  They supplemented the  inadequately staffed s o c i a l service departments visits.  They worked at patient recreation.  by making home  However, i t was  not long before the limitations of t h i s were recognized.  The  patients were confused hy the student's quick changes i n r o l e , as were the students  themselves.  -61Many l e f t the t r a i n i n g center with the concept of the good pastor as a loosely organized combination of s o c i a l worker, recreation leader, choir director and preacher. 1 The question then became "What must I know to be of help to the patient?"  At t h i s time the emphasis was on c o l l e c t i n g  information about the patient and writing case h i s t o r i e s . •case h i s t o r y ' approach showed short-comings too.  The  Knowledge  alone did not help. Then the interests switched to pastoral counselling and the question was phrased "What must I say to be of help to the patient?"  So the students  learned the techniques of recording—  "verbatim" and "process"—which were subsequently used i n intensive supervision with the Chaplain Supervisor.  They studied  many techniques—the psycho-analytic, the non-directive, and their variations. enough.  Again i t was discovered that t h i s was not  The patients often responded d i f f e r e n t l y to the same  words. The f i n a l phase came i n answer to the question "What must I be to be of help to the patient?"  This era concentrated on  the r e l a t i o n s h i p between the patient and the student.  They had  r e a l i z e d that, although patients come and go, the one constant was the chaplain or student. Thus, the c l i n i c a l pastoral t r a i n i n g programs of the Council today center upon the interpersonal relationships between the student and his  patients.  1 Kuether, Frederick C . , "The Council for C l i n i c a l T r a i n i n g , " Pastoral Psychology, October 1953, V o l . h, No. 3 7 , p. 1 9 .  -62-  Because the student, rather than the patient, is the one who wishes to learn how to be of help, the major concern of the t r a i n i n g program i s with the student. He i s asked, and given help, to bring under the closest scrutiny a l l of his r e l a t i o n s h i p s ! to the patients who are i n h i s care; to his fellow students and the associates with whom he must cooperate; and to his staff and the Chaplain Supervisor to whom he i s responsible. To t h i s end a l l the resources of the t r a i n i n g center are put at his disposal: the intense personal needs of the patient, the insights and techniques of a l l of the healing a r t s , and the maturity, experience and s k i l l of the The varying emphases or stresses on objectives  and goals  by the eminent leaders of the c l i n i c a l pastoral movement lead ultimately to two fundamental differences.  Some saw the  greatest contribution of c l i n i c a l t r a i n i n g to be the insight the student gained i n t o his own personality and his r o l e as a r e l i g i o u s worker.  In t h i s sense the t r a i n i n g was not only a  preparation for an i n s t i t u t i o n a l chaplaincy to serve people i n severe c r i s i s situations but also "therapeutic" for the student himself.  Other leaders emphasized t r a i n i n g i n terms of the usual  parish ministry.  The Council favored the former emphasis.  The I n s t i t u t e of Pastoral Care The l a t t e r emphasis found expression i n the incorporation of the " I n s t i t u t e  of Pastoral Care" i n 19^.  The " I n s t i t u t e "  i s a non-sectarian educational foundation which, under the d i r e c t i o n of a Board of Governors, sponsors "Summer Schools of Pastoral Care." As i t s primary goal, the I n s t i t u t e seeks through i t s t r a i n i n g programs to strengthen contemporary r e l i g i o u s 1 Kuether, Frederick C . , op. c i t . , p. 20.  -63-  leadership so that the s p i r i t u a l needs of people can be served more adequately.  It s t r i v e s to help clergymen gain insights and  s k i l l s which w i l l make t h e i r ministry more meaningful. Secondarily, i t provides a coordinated program which helps i n dividuals meet the c l i n i c a l pastoral t r a i n i n g requirements,  (1)  prescribed for some seminary students, (2) specified for c e r t i f i c a t i o n as a Professional H o s p i t a l Chaplain, and ( 3 ) needed for accreditation as a Chaplain Supervisor. -1The I n s t i t u t e ' s f i r s t Summer School of Pastoral Care was offered at the Massachusetts General H o s p i t a l i n Boston. I n s t i t u t e ' s curriculum follows the t r a d i t i o n a l c l i n i c a l t r a i n i n g course with a s l i g h t shift i n emphasis.  The pastoral  In d i s t i n c t i o n  to the Council's orientation to preparation of the i n s t i t u t i o n a l chaplain, the I n s t i t u t e emphasizes the parochial ministry and the need of ordained clergymen to benefit from such t r a i n i n g . The I n s t i t u t e sees i n c l i n i c a l pastoral t r a i n i n g a means of preparing clergymen to serve t h e i r parishioners more e f f e c t i v e l y i n t h i s modern day.  At the same time they express a concern and  recognize t h e i r r e s p o n s i b i l i t y for t r a i n i n g for the i n s t i t u t i o n a l ministry and the student-minister wherever i t i s  possible.  The work of the I n s t i t u t e has now expanded to f o r t y - n i n e 2 i n s t i t u t i o n s across the United States—general medical hospitals, mental hospitals, 1 2 Training Pastoral  c o r r e c t i o n a l i n s t i t u t i o n s and state schools.  See Appendices F and G. "Council for C l i n i c a l T r a i n i n g , I n c . , C l i n i c a l Pastoral Programs and Member Seminaries by-Region," Journal of Care, V o l . XV, No. 4, Winter 1 9 6 1 , pp. 2 2 5 - 2 3 0 .  -6hEach school i s , to a l l p r a c t i c a l purposes,  an autonomous  self-  sustaining unit under the d i r e c t i o n of a Chaplain Supervisor accredited by the I n s t i t u t e of Pastoral Care.  Most of the  courses offered are six weeks i n length but many are twelve weeks. The Council, on the other hand, has expanded to include fifty-three i s offered.  i n s t i t u t i o n s at which c l i n i c a l pastoral training Training i s available i n quarterly periods,  months i n length. period of t r a i n i n g .  The f i r s t  quarter is  three  seen as an "Introductory"  Increasing numbers of q u a l i f i e d  are being accepted for one year "General Practice"  applicants  Internships.  A few students qualify each year to continue a second year of "Supervisory Training" residencies.  Thus Council centers  are  open throughout the year to accommodate the growing number of pastors and students who are seeking supervised experience.  clinical  More than 3,000 persons have been trained by the  Council since i t s inception. Cooperation between the Council and the I n s t i t u t e There i s a good deal of cooperation and r e c i p r o c i t y between the I n s t i t u t e of Pastoral Care, I n c . , and the Council for C l i n i c a l T r a i n i n g , I n c . , as w e l l as the member t h e o l o g i c a l seminaries and the t r a i n i n g centers.  There have been attempts 1  to merge the Council and the I n s t i t u t e and organic union i s  1 Burnes, James H . , "The I n s t i t u t e for Pastoral Care," Pastoral Psychology, October 1953, V o l . •+, No. 37, p. 23.  -65desired by some.  However, the main obstacle i s f i n a n c i a l as  the t r a i n i n g programs are subsidized by the secular  institutions  where t r a i n i n g takes place. There i s , none-the-less,  cooperation and agreement between  the Council and the I n s t i t u t e respecting the goals of C l i n i c a l Pastoral T r a i n i n g . The following four goals for t h i s t r a i n i n g are agreed upon by the two organizations: 1. To enable the student to gain a f u l l e r understanding of people, t h e i r deeper motivations and d i f f i c u l t i e s , t h e i r emotional and s p i r i t u a l strengths and weaknesses. 2. To help the student discover more effective methods of ministering to individuals and groups, and to intensify his awareness of the unique resources, r e s p o n s i b i l i t i e s , and limitations of the clergy. 3. To help the student learn to work more cooperatively with representatives of other professions and to u t i l i z e community resources which may lead toward more effective l i v i n g . 4. To further the knowledge of problems met i n pastoral care by providing opportunities for relevant and promising research. 1 I f C l i n i c a l Pastoral Training achieves these goals i t helps the students see how to make available the resources of r e l i g i o n , i t s f a i t h and p r a c t i c e , to people i n  crisis-situations.  The student gains a wealth of information as to what people are l i k e i n t h e i r interpersonal r e l a t i o n s , and how his contribution as a r e l i g i o u s worker can be meaningful and h e l p f u l to them i n just such experiences.  The t r a i n i n g provides the student with  1 "Opportunities for Study, Training, and Experience i n Pastoral Psychology - 1955," Pastoral Psychology, V o l . 5, No. 50, January 1955, pp. 22-40.  -66an opportunity to become aware of how he approaches  people,  what his r e a l attitude toward people i s and what r o l e he performs for them.  It enables the student, as can nothing e l s e ,  to see people as people, and to see how they handle t h e i r difficulties  in living.  It i s a concentrated experience i n the  laboratory of interpersonal problems. The L i t e r a t u r e of Pastoral Care Cooperation between the " I n s t i t u t e "  and the "Council"  is  also manifested i n the joint publication of The Journal of Pastoral Care.  On the twenty-fifth anniversary of the C l i n i c a l  Pastoral Training Movement i n 1950 The Journal of C l i n i c a l Pastoral Work and The Journal of Pastoral Care merged i n one publication.1  It i s "published" monthly i n the interests  of  sharing experiences and interpretations of pastoral work, i n t e r p r o f e s s i o n a l r e l a t i o n s h i p s , the theology of pastoral care,  p and c l i n i c a l pastoral t r a i n i n g . Another journal related to the c l i n i c a l  pastoral  movement i s Pastoral Psychology which f i r s t appeared i n February 1950.  This monthly journal "grew out of an awareness of a  deeply f e l t need on the part of the minister for insights and s k i l l s of dynamic psychology and psychiatry." 1 Both of these journals f i r s t  3  It was thought  appeared i n 19*+7.  2 From the inside cover of the Journal of Pastoral Care, published at Andover H a l l , Cambridge 38, Massachusetts. 3 Pastoral Psychology, E d i t o r i a l , V o l . I, No. 1, February 1950, p. 1.  -67-  that these insights and s k i l l s could be presented i n a way that had immediate and p r a c t i c a l application to the minister's work, and within the r e l i g i o u s frame work of the pastor's point of view.  The f i r s t  e d i t o r i a l advisory committee included Otis  Rice, Charles Holman, C a r r o l l Wise, Paul Maves, Karen Horney, K a r l Menninger and Margaret Mead. Other journals which are related to the subject of pastoral care include: Marriage and Family L i v i n g , a quarterly journal published by the National Council on Family Relations, Chicago, I l l i n o i s ; the Journal of Psychotherapy as a Religious Process, published annually by the I n s t i t u t e for Rankian Psycho-analysis,  I n c . , Dayton, Ohio; and The Journal of R e l i g i o n  and Health, a quarterly journal of the Academy of Religion and Mental Health, New York 16, N . Y . 1 The Journal of Pastoral Care and Pastoral Psychology are the two most significant pastoral minister.  journals to the chaplain and the  The former journal i s closely  integrated  with the t r a i n i n g centers of the Council and the I n s t i t u t e . For this reason the emphasis of the l i t e r a t u r e i s on the r o l e of the chaplain i n various i n s t i t u t i o n s . articles  There are also some  interpreting the dynamic needs of the patient or  parishioner.  The " s e t t i n g " for many of the a r t i c l e s  h o s p i t a l and t h e i r subject matter bears on s p e c i a l  i s the  problems  1 For a more complete l i s t i n g to p e r i o d i c a l l i t e r a t u r e see: Index to Religious P e r i o d i c a l L i t e r a t u r e , distributed by the American t h e o l o g i c a l Library Association, Princeton Theological Seminary, Princeton, New Jersey.  -68-  of physical and mental i l l n e s s . also contains a r t i c l e s on basic  The Journal of Pastoral Care research.  Pastoral Psychology i s not s p e c i f i c a l l y designed to meet the needs of clergy who specialize i n c l i n i c a l pastoral work, but rather for a l l who study the psychology of r e l i g i o n .  Thus  the journal i s not only of value to the minister, whatever his r o l e or p o s i t i o n , but to p s y c h i a t r i s t s , counsellors.  s o c i a l workers, and  The subject matter of the a r t i c l e s i n Pastoral  Psychology indicates a broad range of topics written by eminent men i n the f i e l d s of r e l i g i o n , psychiatry, medicine and, to a limited extent, s o c i a l work.  A r t i c l e s appearing i n Pastoral  Psychology are repeatedly welcomed for republication i n such journals as The Modern H o s p i t a l and Mental Hygiene. The l i t e r a t u r e of any profession, and e s p e c i a l l y that of i t s o f f i c i a l journals, is the best guide available to those outside the profession to grasp a working knowledge of a p a r t i c u l a r profession.  The l i t e r a t u r e records the history of the  profession and i t s struggle for i d e n t i f i c a t i o n , for relevance, for expertise i n i t s subject matter and something of standard of research.  its  The professional writing describes the  developing methods, techniques and s k i l l s of the profession and i t s particular contribution to human l i f e and knowledge. Something of the contribution of the l i t e r a t u r e of the C l i n i c a l Pastoral Training Movement i n developing the new 1  profession' role of the chaplain has already been alluded to  i n the previous chapter.  However, so that the implications  -6 9  of t h i s Movement might be made more a r t i c u l a t e , to examine c l o s e l y some of t h i s l i t e r a t u r e .  i t i s expedient  A particularly  relevant publication for t h i s purpose i s The Journal of Pastoral Care, Volume X, Number 4, (V/inter) 1956. An a r t i c l e by Archibald F . Ward, J r . ,  Ph.D., Chaplain,  Eastern State H o s p i t a l , Williamsburg, Virginia., articulates "therapeutic r o l e " of the c h a p l a i n . 1  the  In the a r t i c l e e n t i t l e d  "Therapeutic Procedures for the Chaplain" Dr. Ward qualifies' the term "therapeutic procedures" as r e f e r r i n g to the non-medical practices and processes which aim at the "treatment" of the person who i s (mentally) i l l or emotionally disturbed—hopefully to cure, but also to make endurable what i s nox yet curable; and whenever possible, to receive the grace that redeems the weakness i n i l l n e s s and transforms the person i n such a way that he can transcend his d i f f i c u l t y even i f he cannot escape i t . 2 He prefers to think of procedures rather than "techniques" f o r fear of implying some kind of manipulation. adjective therapeutic  S i m i l a r l y , the  i s used i n his a r t i c l e rather than such  nouns as therapy and therapist because the l a t t e r two enjoy, and even promote, an extremely ambiguous status.  "The adjective  therapeutic properly focuses attention upon the nature and q u a l i t y of the p r i n c i p l e s i n any a c t i v i t y which aims at p a r t i c i p a t i o n i n the healing p r o c e s s . " J  1 Ward, Archibald F . , "Therapeutic Procedures for the Chaplain," The Journal of Pastoral Care, V o l . X, No. h (Winter) 1956, p. 208". 2 Ibid. 3 Ibid.  -70Dr. Ward suggests that the chaplain, l i k e the psychotherapist,  can succumb to the culturally-conditioned trap of  the doctor-patient relationship wherein the doctor i s the active participant and the patient the passive recipient of  treatment.1  A great many attitudes must be unlearned before either the chaplain or the psychiatrist  (or the s o c i a l worker for that  matter) can do adequate therapy. The pastor-parishioner  r e l a t i o n s h i p , l i k e the doctor-  patient r e l a t i o n s h i p , may be summarized i n the pastor (or doctor) saying, "What you need to do i s thus and s o . . . . " or p s y c h i a t r i s t ,  The chaplain  on the other hand, i s aware that most sick  people have not suffered from any lack of being t o l d what they ought to do or even need to do.  The question i s pre-eminently  one of being able to do what i s needful.  The r o l e of the  chaplain then, becomes one of helping the patient to become able as w e l l as to a s s i s t i n the d e f i n i t i o n and c l a r i f i c a t i o n of goals.  To enter into this kind of therapeutic relationship  with the patient involves the active p a r t i c i p a t i o n of the patient himself and an absence of the "I am the doctor" attitude on the part of the chaplain. But what i s i t that the chaplain does with his  patient?--  and what i s the nature of the process that hopefully results i n healing? Dr. Ward begins by stating the general proposition that the efficacy of the procedure consists i n the relationship and 1 Ward, Journal of Pastoral Care, p. 2 0 9 .  -71-  the consequent process of i n t e r a c t i o n between two or more persons.  But, he notes, some interactions and reactions can be  harmful and some h e l p f u l .  "So we must ask ourselves now, what  i s the goal of t h i s relationship? i n t e r - a c t i o n do we want to make  What kind of action and possible?"1  What can hopefully take place i n t h i s relationship Is communication.  Communication i s at the very heart of the  therapeutic process,  he claims.  In some senses a person becomes  i l l because communication has broken down—communication that about the s i g n i f i c a n t events and meaning i n l i f e .  What usually  needs to be communicated involves a painful experience. simply the experience i t s e l f ,  Not  but the i n d i v i d u a l ' s response to  that experience and the meaning which i t has for him. The author makes clear that not a l l of the painful d e t a i l s need to be rehearsed. after  patient's  What the chaplain i s  i s understanding the pattern of response to l i f e rather  than the i n f i n i t e examples from the past.  What i s i n very  s p e c i a l need of communication i s f e e l i n g .  Very often the  chaplain can handle the " f a c t s " or content of past painful events more adequately than the feelings which are associated with them.  Some of the feelings may be of g u i l t or shame.  What may be much more d i f f i c u l t for the chaplain to handle are feelings almost u n i v e r s a l l y present of h o s t i l i t y , resentment and b i t t e r n e s s . 1 I b i d . , p. 209  is,  -72But what does the chaplain communicate?  F i r s t of a l l ,  the chaplain communicates understanding, or more properly, the attempt to understand.  What the chaplain needs i s not simply  knowledge (though he indeed needs a l l the knowledge he can acquire) but rather an attitude and perceptive s k i l l . chaplain also communicates a degree of permissiveness. q u a l i t y he communicates i s acceptance.  Permissiveness  The Another concerns  a particular act, whereas acceptance concerns primarily a person. The concept of acceptance, claims Dr. Ward, i s so vast that, " l i k e the love of God, the more we experience i t or participate 1 i n i t , the i n f i n i t e we discover i t to be."  To accept the  person means also to accept what he i s attempting to communicate, and to explore this communication with him at the r i g h t time. Perhaps the most d i f f i c u l t part of acceptance i s that we can scarcely accept i n others what we cannot accept i n ourselves. "The beam i n our own eyes hinders the removal of the s p l i n t e r 2 i n the eye of our brother." I f the chaplain can communicate an attempt at understanding, an appropriate amount of permissiveness, and that acceptance which i s love, then i t becomes possible for the patient to communicate those feelings and experiences which need to be communicated i f healing i s to take place. 3 Dr. Ward then discusses the question of goals and values and what i t i s the c l i e n t wishes to be. 1 I b i d . , p. 213. 2 I b i d . , p. 21*r. 3 Ibid.  -73At t h i s time both the patient and the chaplain w i l l be asking what values are adequate and on what basis do we determine what values are adequate. And what resources are available to help one achieve these v a l u e s ? . . . . Once again, when we reach t h i s stage of the r e l a t i o n s h i p , the question of freedom and r e s p o n s i b i l i t y assumes a new importance. A person who i s b l i n d has neither the freedom to see nor the r e s p o n s i b i l i t y of seeing; but once we see what we are actually doing, we become free to ask ourselves whether t h i s i s what we want to continue—a question which would be quite meaningless so long as we were b l i n d . In other words, we become at last free to accept r e s p o n s i b i l i t y for ourselves. I suppose that the question we naturally ask now i s something l i k e thiss How does t h i s process d i f f e r from other therapeutic relationships? Not that so much, perhaps, as: What i s the unique factor about the chaplain's entering into t h i s sort of relationship with his people? When I say chaplain, I also refer to what the chaplain represents. And here we must t a l k primarily about what he represents to the s i c k . Every person who enters into a therapeutic r e l a t i o n s h i p responds at least i n part to what the t h e r a p i s t . . . r e p r e s e n t s or symbolizes for him. And at various phases i n the therapeutic process, the therapist may come to represent.various s i g n i f i c a n t persons i n the patient's past. •• By virtue of his profession, the chaplain has a two-fold symbolic meaning: he represents the d i v i n e , and he represents the church or synagogue; both God and man. Not merely man i n general, but the culture i n which man l i v e s ; more p a r t i c u l a r l y , the judgmental and condemnatory part of man's culture as well as, or even more than, the means of grace. Many sick people have been seriously hurt by t h e i r experiences i n churches. Some have been seriously hurt by t h e i r distorted views about God, or, more properly, by the views about God which have been imposed upon them 1 by others. When such persons are able to communicate t h e i r deepest feelings to the chaplain (which means also that the chaplain's attitude is of such a q u a l i t y as to make possible such communication), something happens which i s different from what happens i f the same feelings were communicated to some other person. In f a c t , the what  1 I b i d . , p. 216.  varies with the to whom; though the same external facts may be communicated, I think we have to say that tne feelings which are communicated about the facts or events depend greatly upon the person to whom they are communicated; and we have to say also that the meaning of the communication i s d i f f e r e n t . So far as the therapeutic efficacy i s concerned, i t i s reasonable to expect, as our own experience has demonstrated, that acceptance by "a man of God" can open the way to the acceptance of God's acceptance of us, and that acceptance by a representative of the church can lead to the hopeful p o s s i b i l i t y that our fellow men can likewise come to accept us and that indeed we can accept our fellow men. 1 The above account of one a r t i c l e i n the l i t e r a t u r e of c l i n i c a l pastoral t r a i n i n g c l e a r l y indicates that the emerging r o l e of the chaplain i s receiving considerable scholarly attention. In many similar a r t i c l e s  the chaplain's relationship with the  patient has undergone close s c r u t i n y .  A sincere attempt i s being  made to assess the dynamics of the relationship and where t h i s relationship may be improved to assist the patient. But lest the new roles of the " I n s t i t u t i o n a l Chaplain" and the "Pastoral Counsellor" form an " i s o l a t i o n i s m " apart from the Church, the E d i t o r i a l i n t h i s issue of The Journal of Pastoral Care sounds a timely warning.  The editor takes t h i s  cautionary measure i n view of the suggestions of H . Richard Niebuhr and his associates who had just made a survey of American t h e o l o g i c a l education.  The editor notes the necessity  to hammer out a theology for pastoral  care,  that i s rooted i n h i s t o r i c a l r e v e l a t i o n . At the same time the c l a s s i c a l theologian can w e l l use the help of those whose interests l i e i n the f i e l d of pastoral care i n facing up to the relevant questions being akked 1 I b i d . , p. 217.  -75by our fellow members of the healing team, i . e . , s o c i a l workers, physicians, psychoanalysts, etc. The time i s r i p e for us to accept the warning of Niebuhr and return i t i n the form of a challenging i n v i t a t i o n to a creative fellowship of c o r r e l a t i o n . 1 Paul T i l l i c h i n his a r t i c l e , "Theology and Counselling," 2  does just such "hammering."  He describes theology and  counselling as functions of the Church.  "Theology, i n i t s  doctrine of the Church, t r i e s to give the t h e o r e t i c a l foundations of theology i t s e l f and of c o u n s e l l i n g . " ^ In the same issue of The Journal of Pastoral Care there i s an interesting a r t i c l e by Cordelia Cox, "The Church's 1+  Relation to S o c i a l Service Students."  The purpose of the  a r t i c l e i s to discuss some of the elements entering into the r e l a t i o n s h i p of the established  Church to students receiving  professional t r a i n i n g i n schools of s o c i a l work.  Miss Cox  discusses some motivations students have when choosing s o c i a l •work.  She claims that motivations for the choice of any  profession are exceedingly complex, with component parts sometimes at variance with one another. 1 " E d i t o r i a l , " The Journal of Pastoral Care, V o l . X, No. h (Winter) 1956, p. 23b . 1  2 T i l l i c h , P a u l , "Theology and Counselling," The Journal of Pastoral Care, V o l . X, No. h (Winter) 1956, pp. 193-200. 3 Ibid. h Cox, C o r d e l i a , "The Church's Relation to S o c i a l Service Students," The Journal of Pastoral Care, V o l . X, No. 4 , (Winter) 1956, pp. 201-207.  -76It may even be that, lost behind an outworn concept, a ready phrase, or a p l a t i t u d e , the true reason for his (the student's) professional choice i s not f u l l y understood by the i n d i v i d u a l h i m s e l f . 1 The author suggests that many students i n schools of s o c i a l work are searching eagerly for a "personal and professional philosophy of l i f e which i s great enough to encompass the world o unfolding before them. H < i In the same issue of The Journal of Pastoral "Care there i s a reprint of an a r t i c l e from Marriage and Family L i v i n g . 3 The author i s Maurice J . Karpf, Consultant on Family and Psychol o g i c a l Problems, Beverly H i l l s , C a l i f o r n i a .  In his a r t i c l e ,  "Some Guiding P r i n c i p l e s i n Marriage Counselling," Dr. Karpf l i s t s some sixteen aims and p r i n c i p l e s i n the counselling process.  Dr. Karpf elaborates each p r i n c i p l e and s p e l l s out  relevant d e t a i l s  respecting the handling of s p e c i a l  circumstances  i n marriage counselling. Another a r t i c l e describing an o r i g i n a l research  project  i s written by Samuel Southard, T h . D . , Professor of Pastoral k  Care, I n s t i t u t e of R e l i g i o n , Texas Medical Center.  The  purpose of his paper, "Religious Concern i n Psychoses," i s to indicate something of the significance of r e l i g i o n i n 170 1 Cox, The Journal of Pastoral Care, p. 202. 2 I b i d . , p. 207. 3 Karpf, Maurice J . , "Some Guiding P r i n c i p l e s i n Marriage Counselling," The Journal of Pastoral Care, V o l . X, No. h (Winter), 1956, pp. 219-225.  h Southard, Samuel, "Religious Concern i n Psychoses," The Journal of Pastoral Care, V o l . X , No. h (Winter), 1956, pp. 226-233.  -77-  patients at Central State H o s p i t a l , Kentucky. patients seen on t h e i r f i r s t  These were  admission by one of the Protestant  chaplains i n the period 1951-1953.  Dr. Southard concludes that  neither the particular Protestant denomination of a patient nor the fact of church membership as such was s i g n i f i c a n t i n the psychiatric diagnosis  of the 170 f i r s t  interviews by the Protestant chaplain. he draws from his study i s  admission patients Among other conclusions  that,  Certain persons who have been exposed to r e l i g i o u s teachings or to church fellowship over a period of time may use r e l i g i o u s teachings i n the expression of t h e i r psychoses or may come into open c o n f l i c t with a church group as the f i r s t break with society. Religion may be the language through which the patient seeks to communicate his emotional disturbances. 1 This b r i e f review of the l i t e r a t u r e i l l u s t r a t e s  that  The Journal of Pastoral Care attempts to give an objective and s c h o l a r l y treatment to the subject matter of pastoral care both for the I n s t i t u t i o n a l Chaplain and the parochial minister.  Any  of the a r t i c l e s might w e l l be found i n journals of s o c i a l work. Standards and Accreditation  ,  C l i n i c a l Pastoral Training may be termed a supervised experience which provides t h e o l o g i c a l students and clergy with opportunities for Intensive c l i n i c a l study of problems i n interpersonal r e l a t i o n s h i p s .  Or, as Professor R o l l i n Fairbanks  defines i t , " C l i n i c a l t r a i n i n g i s the performance of pastoral  1 Southard, The Journal of Pastoral Care, p. 233.  -78work under competent supervision, such work being recorded and submitted for evaluation and c r i t i c i s m . " I t  seeks to make  c l e a r , i n understanding and p r a c t i c e , the resources,  methods,  and meanings of r e l i g i o n as these are expressed through pastoral care. There are three levels of t r a i n i n g a v a i l a b l e : 1.  "The Student Chaplain" or "Introductory Period of T r a i n i n g . " This consists of the twelve week f u l l - t i m e period of  t r a i n i n g and is generally considered the norm by both the Council for C l i n i c a l Training and the I n s t i t u t e of Pastoral Care. t h e o l o g i c a l student or clergyman who takes part i n t h i s i s required to participate Department of the H o s p i t a l .  i n a l l the a c t i v i t i e s  The  course  of the Chaplain's  I f at a l l possible the student  encouraged to l i v e i n residence.  is  The courses are designed to be  part of the student's preparation for a parish ministry or an i n s t i t u t i o n a l chaplaincy depending on the p a r t i c u l a r emphasis of the t r a i n i n g establishment.  The course i s structured so that  the student w i l l gain some understanding of the mentally or physically i l l person, the administrative procedures and problems i n dealing with such people, and above a l l , both the pastoral and r e l i g i o u s concerns i n any ministry to them.  In  the process of the t r a i n i n g experience there i s a major focus on the dynamics of interpersonal processes e s p e c i a l l y as these involve the student. l H i l t n e r , Seward, E d . , C l i n i c a l Pastoral T r a i n i n g , The National Council of Churches, New York, 19^5, p. 38.  -79In order to be accepted for any such program of t r a i n i n g , a student must have his Bachelor's degree, have completed at least one f u l l year i n a recognized theological seminary,-1- and have been interviewed and recommended by such an accrediting and c e r t i f y i n g body as the " C o u n c i l " or the " I n s t i t u t e . " 2.  "The Chaplain Intern" or "General Practice Internships" The second l e v e l of t r a i n i n g i s concerned with men  interested i n specialized t r a i n i n g for a ministry to the physically or mentally i l l .  It i s recognized and stressed by  standard-making bodies such as the Council for C l i n i c a l Training I n c . , The Association of Mental H o s p i t a l Chaplains, and the H o s p i t a l Chaplains' Association of the American Protestant H o s p i t a l Association, that t h i s ministry requires intensive preparation.  Hence a period of at least one year i n  the h o s p i t a l i s demanded for accreditation. It i s required that candidates for t r a i n i n g s h a l l have been ordained to the ministry with f u l l college and seminary preparation.  No candidate i s accepted for t r a i n i n g who has not  been personally interviewed and recommended. 3.  "The Chaplain Resident" or Supervisory Training Residencies" The t h i r d l e v e l represents an a d d i t i o n a l f u l l year of  t r a i n i n g i n the h o s p i t a l following the i n i t i a l year as Chaplain 1 Preference i s given to students enrolled i n t h e o l o g i c a l colleges or seminaries which are " a c c r e d i t e d , " "associated," or " a f f i l i a t e d " members of the "American Association of Theological Schools i n the United States and Canada." There are lh such colleges i n Canada including Union Theological College, Vancouver, B. C . , and the Anglican Theological College. Vancouver, i s presently negotiating for a f f i l i a t i o n with the A . A . T . S . See: She Twenty-Second B i e n n i a l Meeting of the American Association of Theological Schools i n the United States and Canada, B u l l e t i n 24, June i960, for complete l i s t i n g of accredited Colleges and Seminaries.  -80Intern.  Candidates for t r a i n i n g are usually men intending to  s p e c i a l i z e not only i n an i n s t i t u t i o n a l ministry, but also to obtain accreditation as "Chaplain Supervisors" pastoral t r a i n i n g programs.  of c l i n i c a l  In some instances men seek t r a i n i n g  i n order to prepare themselves to teach i n the pastoral theology department of a t h e o l o g i c a l seminary.  Such t r a i n i n g requires  a d d i t i o n a l experience i n working with physically and mentally i l l patients  and an understanding of teaching s k i l l s i n order  to interpret the basic implications of the ministry to the h o s p i t a l patient. It must be remembered that t h i s modern emphasis on the approach to pastoral work developed i n the secular  institutions  outside the seminaries before i t was brought within them.  It  is  only recently that c l i n i c a l pastoral t r a i n i n g has had close t i e s with the curriculum of t h e o l o g i c a l colleges or seminaries,  A  very few schools, V i r g i n i a Theological Seminary for example, require the c l i n i c a l training course for a l l seminary students. Many schools make i t optional for students as one unit of the f i e l d work requirement.  Any course credit i s given by the  schools, not by the Council or the  Institute.  Some c l i n i c a l training programs i n the seminaries  are  d i r e c t l y connected with courses offered by the seminary and the d i r e c t i o n i s shared hy a member of the f a c u l t y .  The course i n  group therapy at the University of Southern C a l i f o r n i a , for example, includes formal course work, the organization of the students i n a group therapy program and work i n group therapy  -81i n a h o s p i t a l under the d i r e c t i o n of a p s y c h i a t r i s t . One of the most outstanding examples of the cooperation between the seminaries and the training centers i s that at Houston, Texas.  In 195k the I n s t i t u t e of Religion was  established  at the Texas Medical Centre which united the resources of the Baylor U n i v e r s i t y School of Medicine and- f i v e Texas  seminaries.  These are: Austin Presbyterian, B r i t e College of the B i b l e , Episcopal Theological Seminary of the Southwest, Perkins School of Theology, and Southwestern B a p t i s t .  The work of the Institute  of Religion i s an i n t e g r a l part of the pastoral care department of each of these f i v e seminaries.  Students from each seminary  receive t h e i r " c l i n i c a l pastoral education" i n Houston, but receive credit i n t h e i r own seminaries for courses taken i n the Institute.  Provision i s made for obtaining B . D . , T h . M . , S . T . M . ,  and Th.D. degrees.  Members of the I n s t i t u t e faculty are chosen  by mutual s e l e c t i o n and become members of the f a c u l t i e s of the f i v e seminaries.  of each  The t r a i n i n g programs are not only  for ministers but also for medical students, nurses and doctors. They offer an opportunity for developing working understanding among a l l the professions  concerned with persons i n need of  healing.  1 See Niebuhr, H. Richard, Williams, Daniel D . , and Gustafson, James M . , The Advancement of Theological Education, Harpers and Brothers: wew xorfc, 195V, PP. J ^ i - i ^ y . See a l s o : H i l t n e r , Seward and Z i e g l e r , Jesse H . , " C l i n i c a l Pastoral Education and the Theological Schools," The Journal of Pastoral Care, V o l . 15, No. 3, F a l l 1961.  -82Curriculum The content of these courses given i n C l i n i c a l Training Centres can be described b r i e f l y . 1 personnel.  There are lectures by s t a f f  These present the necessary material to help the  student gain some understanding of the patient, and what the h o s p i t a l does to help him get w e l l .  Along with these  lectures  the student attends staff conferences and i n t h i s way has an opportunity to see and hear the therapeutic team at work. focus of the program i s personal contact with patients, through actual interviewing as a chaplain.  The  primarily  I t comes also i n  supervised s o c i a l and r e c r e a t i o n a l contacts inside the h o s p i t a l and at the community l e v e l .  There are regular  seminars  conducted by the chaplain supervisor and medical personnel i n which the pastoral and r e l i g i o u s concerns of a h o s p i t a l ministry, the c h a r a c t e r i s t i c s  of physical and mental i l l n e s s ,  and the dynamics of personality development are discussed.  The  1 The curriculum of The I n s t i t u t e of Pastoral Care, at Emmanuel H o s p i t a l , Portland, Oregon (June 5 - August 25, 1961) requires six book reviews of such books as: Rollo May, The Meaning of Anxiety; Seward H i l t n e r , The Counsellor i n Counselling; J l . Glanders Dunbar, Mind and Body—Psychosomatic Medicine. Lectures include such subjects as: "Goals i n Planning C a l l s , " "Procedures to be Avoided i n C a l l i n g upon the S i c k , " "Emotional and S p i r i t u a l factors i n H o s p i t a l i z a t i o n , " "Ministering to the C r i t i c a l l y 111, the Chronically 111, the Bereaved," "Preoperative C a l l i n g , " " E t h i c a l Problems i n Pastoral C a l l i n g , " and " A l c o h o l Problems." A minimum of 21 interviews is required of each student followed by verbatim recording for use i n supervision periods. Each student must submit a written selfevaluation (following a suggested outline) and an evaluation of the course at the end of his period of t r a i n i n g .  -83-  course usually includes a required amount of reading to supplement the h o s p i t a l experience, but such reading i s recognized as secondary i n importance to the c l i n i c a l experience  itself.  F i n a l l y , regular personal conferences or supervisory periods held with each student.  are  These give him the necessary  opportunities for further exploration of concerns that could not be dealt with i n the more formalized parts of the program. Expansion of the Movement The growth and expansion of the C l i n i c a l Pastoral Movement i n the United States has already been described.  This  growth has only recently begun to expand to other countries. In 1958, c l i n i c a l t r a i n i n g achieved mention for the f i r s t time i n a report of a committee of the Lambeth Conference, not as something f a m i l i a r , or to be commended, but merely i n these terms: The Committee has taken note of the experiments which have been u n d e r t a k e n . . . i n the United States i n providing courses of c l i n i c a l pastoral t r a i n i n g , i n which doctors and psychiatrists have been found ready to cooperate. 1 In England the f i r s t  c l i n i c a l pastoral t r a i n i n g course  was undertaken at the Deva H o s p i t a l i n Chester, a psychiatric h o s p i t a l of approximately two thousand patients.  I n previous  years short orientation courses of seven or ten days' duration had introduced hundreds of t h e o l o g i c a l students to h o s p i t a l life,  but the name " c l i n i c a l pastoral t r a i n i n g " should not be  used for such b r i e f orientation courses. The Lambeth Conference, 1958, S . P . C . K . : Part 2, p. iu4.  London, 1958,  -84In New Zealand the f i r s t 1959.  six weeks' course was held i n  I t has "been impossible to determine when c l i n i c a l  t r a i n i n g began i n India but i t i s known to have started before 1958. India.  It was pioneered at the Clara Swain H o s p i t a l i n B a r e i l l y , In A u s t r a l i a the f i r s t course i n c l i n i c a l t r a i n i n g was  introduced i n February I 9 6 I , at Melbourne. In 1958 the I n s t i t u t e of Pastoral Training was begun i n Nova S c o t i a .  The cooperating  colleges included Acadia  U n i v e r s i t y , Pine H i l l D i v i n i t y H a l l , University of King's College, The Faculty of Medicine at Dalhousie U n i v e r s i t y , the Presbyterian College, and Andover Newton Theological School, Newton Centre, Massachusetts.  The annual six week course i s  interdenominational i n scope, and open to a l l pastors and t h e o l o g i c a l students.  The course i s given at the Nova Scotia  Sanatorium, K e n t v i l l e , Nova S c o t i a .  CHAPTER IV  IMPLICATIONS OF RECENT DEVELOPMENTS  The Greek physicians are quite right as far as they go; but Zamolxis.. .says further, 'That as-you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul; and this i s the reason why the cure of many diseases i s unknown to the physicians of H e l l a s , because they are ignorant of the whole, which ought to be studied also; for the part can never be w e l l unless the whole i s w e l l ' . 1 The complexity of the psychological, p h y s i c a l , s o c i a l and s p i r i t u a l i l l s to which human beings are exposed today demands the s k i l l s and resources of a l l those engaged i n the helping professions.  No longer can the community's needs be  served without due regard to the contribution of each profession and i t s  inter-relatedness  with each other profession.  Perhaps  no profession more than s o c i a l work i s aware of t h i s and i t behoves the student of s o c i a l work or the ministry to be keenly aware of t h i s inter-dependence.  1 The Dialogues of Plato (Jowett T r a n s l a t i o n ) , Random House: New York, 1937, V o l . I, pp. 6-7.  -86Imp l i e at ions for the Churches It i s i n the context of the Churches that the implications of this study have s p e c i a l relevance.  Too long  has the Church attempted to answer the needs of men without the help of the younger professions experience.  and their knowledge and  These younger professions  have arisen partly  because needs of mankind were not being met by t r a d i t i o n a l i n s t i t u t i o n s such as the family and the Church.  The Churches,  thus, must examine the relevance of s o c i a l and psychological sciences to t h e i r ministry.  The t h e o l o g i c a l student needs the  understanding of the dynamics of personality no less than the student of s o c i a l work.  This was reiterated by Frank Weil  when he said that: S o c i a l workers often f e e l that pastoral counselling i s not s u f f i c i e n t l y grounded i n knowledge of the s o c i a l sciences and methods of s o c i a l work; that there i s not sufficient understanding to i d e n t i f y a personality problem of the i n d i v i d u a l or the nature of a family problem. Hence there i s lack of r e f e r r a l from church to s o c i a l agency and v i c e versa. 1 The Church ought to make opportunity available to the t h e o l o g i c a l student for a study of the dynamics of personality. In order to do t h i s the Churches have much to gain from the teaching practices used i n s o c i a l work education.  The  p r a c t i c a l t r a i n i n g " i n the f i e l d " should have i t s c o r o l l a r y i n t h e o l o g i c a l education.  There is a  dissatisfaction  1 Weil, Frank L . , "Co-operation of Church and S o c i a l Work," Proceedings of the 76th National Conference of S o c i a l Work, 19M9, Columbia University Press: New York, 19M9, p. 125.  -87-  generally on the part of clergymen and t h e o l o g i c a l students regarding t h e i r t r a i n i n g i n counselling and pastoral S o c i a l work education offers  care.  a vast l i t e r a t u r e and p r a c t i c a l  experience i n such techniques as interviewing, casework, recordi n g , supervision and evaluation.  Although s o c i a l work i s a much  younger profession i t has systematically examined these techniques and i t s experience and knowledge are not to be l i g h t l y regarded by the Churches. Although t h i s knowledge and experience can be gained by embracing many of the contributions which the s o c i a l work profession can make to the ministry, i t must be remembered that schools of s o c i a l work do not find t h e i r raison d'etre i n the t r a i n i n g of ministers or chaplains. t r a i n i n g s o c i a l workers.  They are concerned with  The Church, then, must look at more  appropriate resources for t r a i n i n g . It i s i n the C l i n i c a l Pastoral Training movement where such resource i s to be found.  Church authorities may l i g h t l y  regard t h i s "up-start" movement i n the Church because i t has departed from t r a d i t i o n a l forms and patterns of t r a i n i n g for the ministry.  But what has changed i s the s o c i a l and economic  pace of a l l people and the Church must provide appropriate t r a i n i n g to her ministers so that t h i s ministry may be made relevant.  The- high standards and professional competence of  the C l i n i c a l Pastoral *. Movement commends i t s e l f to the considered scrutiny by the authorities of the Churches.  -88-  It i s of particular significance to the Church that students who have taken C l i n i c a l Pastoral Training have almost u n i v e r s a l l y applauded the advantages of t h i s training.' 1 ' For many ministers who have had years of parish experience, the c l i n i c a l t r a i n i n g has r e v i t a l i z e d t h e i r ministry.  They have  found the t r a i n i n g has answered many of t h e i r problems respecting counselling and a s s i s t i n g parishioners.  For younger clergymen,  the c l i n i c a l t r a i n i n g has equipped them to function as Chaplains i n the complex organization of the modern i n s t i t u t i o n with competence and effectiveness. them to define t h e i r r o l e objectives  The t r a i n i n g has helped  and to determine t h e i r p a r t i c u l a r  i n the context of the goals of the t o t a l i n s t i t u t i o n .  The heart of the c l i n i c a l pastoral t r a i n i n g program l i e s i n the supervised minister-patient relationship which takes place within the i n t e r d i s c i p l i n a r y professional setting of a modern treatment i n s t i t u t i o n .  The c l i n i c a l student  (seminarian  or minister) i s confronted by the patient and his needs and also by his own feelings about the patient.  In t h i s process  he i s confronted, often to his own amazement or pain, by feelings  and questions about himself, the relevance of his  C h r i s t i a n f a i t h , and the meaning and v a l i d i t y of his r o l e as a C h r i s t i a n pastor.  Those responsible i n the Church for  1 Thomas, John Rea, "Evaluations of C l i n i c a l Pastoral Training and 'Part-time' Training i n a General H o s p i t a l , " Journal of Pastoral Care, V o l . XII, No. 1 Spring, 1958; and Bruder, Ernest E . , and Barb, Marian, "A Survey of Ten Years of C l i n i c a l Pastoral Training at Saint Elizabeth's H o s p i t a l , " Journal of Pastoral Care, V o l . X, No. 2, Summer 1956.  -89-  teaching "Pastoral Theology" may w e l l examine t h i s  experience  i n r e l a t i o n to what i s presently taught and experienced through t r a d i t i o n a l education courses. There i s ,  i t seems, only a limited f i e l d work experience  i n the t r a d i t i o n a l pattern of education of the ministry.  There  i s , too, almost no emphasis on student experience i n face-toface counselling and interpersonal r e l a t i o n s .  The s t e r i l e  academic pursuits of the class room must be made relevant by a process of v i t a l personal encounters i n the parish or institutional setting. theology" (as  Pastoral theology or " p r a c t i c a l  i t i s sometimes known) cannot do j u s t i c e to the  seminarian's t o t a l preparation except i n the context of the supervised minister-patlent (or minister-parishioner) relationship. Experience i n a l l professions  has shown that  special  s k i l l s and t r a i n i n g i n personal r e l a t i o n s i s required of those charged with r e s p o n s i b i l i t y to supervise students.  "Age" or  "Experience" does not necessarily result i n the a c q u i s i t i o n of this a b i l i t y .  It requires t r a i n i n g i n human r e l a t i o n s ,  casework, and dynamics of personality. must f i r s t  Just as the "leader"  have been a " f o l l o w e r , " so the "Supervisor" must  have been "supervised" before he can e f f e c t i v e l y f u l f i l l  this  role. The prerequisite, then, for the Church i s to equip h e r s e l f with clergy who have been trained i n the established schools of C l i n i c a l Pastoral T r a i n i n g .  These clergy must then  -90be placed i n the strategic teaching  posts of the Church including  the seminary and the i n s t i t u t i o n a l chaplaincy.  In Vancouver,  example, there i s need for c l i n i c a l l y trained chaplains at general h o s p i t a l s , prisons, and mental h o s p i t a l s . institutions  all  These  could then be used as training centers for  work placements for training theological students.  for  field  The pattern  of f i e l d work placement might w e l l follow that established by the School of S o c i a l Work at the University of B r i t i s h Columbia. That i s ,  two days per week " i n the f i e l d " during the academic  term. A further  implication of t h i s study i s the need for a  C l i n i c a l Pastoral Training Centre i n B r i t i s h Columbia.  The only  t r a i n i n g centre i n Canada at the present time is i n the Maritimes, and there is a dire need for a similar centre i n western Canada.  There i s much to be said for establishing such  a centre i n Vancouver.  Not only are there two large seminaries  located i n Vancouver which t r a i n clergymen for B r i t i s h Columbia and western Canada, but there are an unusually large number of treatment centres located near by.  Some of the treatment centres  that could be used for c l i n i c a l t r a i n i n g are: The Vancouver General H o s p i t a l , Oakalla Prison, Haney Correctional Institution,  Essondale Mental H o s p i t a l , Crease C l i n i c , St.  H o s p i t a l and Shaughnessy M i l i t a r y H o s p i t a l .  Paul's  There i s also  proximity to the University of B r i t i s h Columbia (to which the Theological Colleges are already a f f i l i a t e d ) which can offer  the  f a c i l i t i e s of an extensive l i b r a r y and the Department of R e l i g i o n .  -91-  There is the p o s s i b i l i t y of using the resources of the School of S o c i a l Work and especially for the teaching of Human Growth and Development. It  i s recognized that these implications require lengthy  consideration by the Churches and the respective mentioned above.  institutions  However, i t behoves the Churches of B r i t i s h  Columbia to "come to grips" with the potential resources of C l i n i c a l Pastoral T r a i n i n g , i n the t r a i n i n g of t h e i r  ministers.  Implications for the Vancouver General H o s p i t a l The h i s t o r i c influence which the Church has had i n the nurture and development of hospital f a c i l i t i e s world does not require further elaboration. to say that,  throughout the  It i s  sufficient  although the administration of hospitals  largely changed from church d i r e c t i o n to secular,  the church  continues to minister to the s p i r i t u a l needs of the In most hospitals  has  patient.  t h i s ministration i s at best "surface,"  lacking coordination and having v i r t u a l l y no accountability to hospital administration,  at the Vancouver General H o s p i t a l  under the present regulations  anyone may f u l f i l l the  chaplain's  r o l e so long as they are recommended by a church authority. There needs to be a close examination of administrative p o l i c y and procedure to enable that the hospital personnel make appropriate  and effective use of the chaplain.  The Vancouver General H o s p i t a l may also examine the facilities  i t offers to the chaplain to "perform r e l i g i o u s  -92r i t e s and r i t u a l s . "  Much of the chaplain's time i s spent i n  counselling but no office space i s provided.  There i s no  c e n t r a l office to f a c i l i t a t e r e f e r r a l from the doctors, workers and nurses.  social  None of the chaplains suggested that a  chapel be provided i n the h o s p i t a l but a l l of them mentioned the extreme d i f f i c u l t y occasioned by the lack of  office  facilities. The chaplains expressed pleasure at the recently i n s t i t u t e d bi-weekly meetings between themselves and some members of the Department of S o c i a l Service at the Vancouver General H o s p i t a l .  They f e l t there was much to gain from the  s o c i a l workers and expressed the hope that t h i s i n t e r professional contact would continue.  Similar meetings between  chaplains and medical doctors, psychiatrists and nurses could be patterned i n l i k e manner.  This would increase understanding  of each other's contributions and of one another's  inter-  professional r o l e . The main implication of the study for Vancouver General H o s p i t a l , however, i s the focus i t draws to the advantages to the h o s p i t a l and patient which might result from having a f u l l y trained c l i n i c a l chaplain on the s t a f f .  Such a chaplain  at Vancouver General H o s p i t a l would have to be f u l l y  integrated  into the administrative structure and with the professional services given at the h o s p i t a l (See appendix F ) .  Not only  would a trained chaplain be valued as a competent resource for r e f e r r a l from various professions but he would be an agent for  -93coordination of a l l chaplaincy services at the h o s p i t a l . could give orientation to new chaplains and conduct t r a i n i n g " to present chaplains.  He  "in-service  This latter t r a i n i n g may w e l l  follow that used i n many s o c i a l work agencies i n t r a i n i n g the non-professional s o c i a l worker. chaplain-supervisor  He might also be used as a  for t h e o l o g i c a l students doing " f i e l d work"  at Vancouver General H o s p i t a l , and as a resource for s o c i a l work students studying s o c i a l agencies and community services i n Vancouver.  This would necessitate integration of a Chaplain's  Department with courses and t r a i n i n g offered at the School of S o c i a l Work and the Theological Colleges a f f i l i a t e d University of B r i t i s h Columbia,  with the  A greater expansion of such a  program would be the i n s t i t u t i o n of a C l i n i c a l Training Centre at Vancouver General H o s p i t a l .  Pastoral This might be  designed to meet the c l i n i c a l t r a i n i n g needs of B r i t i s h Columbia clergy and possibly as a t r a i n i n g centre for western Canada. Although implementation of the foregoing  implications  for the Vancouver General Hospital-would no doubt encounter difficulties  they are not insurmountable.  has been done i n various general hospitals and i n some state-operated hospitals  The "ground work" i n the United .States  i n Canada.  Implications for S o c i a l fork It may w e l l be asked what relevance the preceding chapters have to the profession of s o c i a l work.  Is not the  r o l e of the chaplain of peculiar interest to r e l i g i o u s bodies? The answer to this l i e s i n the basic " h o l i s t i c " concept of man  -9>+t o which the s o c i a l worker attaches much s i g n i f i c a n c e .  Man  cannot be seen from the point of view that he i s a "segmented being."  He i s not just ' p a r t s ' .  He i s the sum of the parts.  Man i s a t o t a l i t y and the "part can never be w e l l unless  the  whole i s w e l l . " Such considerations as' these lead the enquirer into the realm of goals or objectives  of s o c i a l work.  It i s said that  s o c i a l work seeks to assist i n d i v i d u a l s , groups, and communities to reach the highest possible degree of s o c i a l , mental, and physical w e l l b e i n g . 1  The methods that s o c i a l work applies  achieve t h i s goal d i f f e r from those of other professions,  to  such  as medicine, law, the ministry, nursing, and teaching, because s o c i a l work operates i n consideration of a l l s o c i a l , economic and psychological factors that influence the l i f e of the p individual.."  Such an attempt to consider a l l factors  influencing the l i v e s of people cannot ignore some of the factors i n l i f e or the d e f i n i t i o n becomes i n v a l i d .  Moral,  r e l i g i o u s and e t h i c a l values are inevitably part of s o c i a l , economic and psychological factors.  Nor can s o c i a l work ignore  the problem which i s posed i n the question, "What i_s the highest possible degree of well-being to which s o c i a l work aims?" Or, "What i s l i f e ' s  purpose?"  1 United Nations Economic and S o c i a l Council, Training for S o c i a l Work: An International Survey, 1 9 5 0 , p. 1 0 . 2 Friedlander, Walter A . , Concepts and Methods of S o c i a l Work, Prentice-Halls Englewood C l i f f s , New Jersey, 1 9 5 8 , p. 7 .  -95"For c l i e n t s , for workers, for young people just emerging to manhood and womanhood, for adults i n the prime of l i f e , the old i n t h e i r declining years, t h i s searching question of purpose p e r s i s t s .  life's  To i t s o c i a l work must somehow find some  answer, else the saving of l i f e and of material goods, and the release of personality from i n h i b i t i o n and from c o n f l i c t w i l l s t i l l leave empty, r e s t l e s s , unsatisfied  individuals."1  Does s o c i a l work, then, consider man i n his  totality?2  Man has a mind and a body; has he a s p i r i t and a soul?  And  i f he has, how often i s i t taken into account i n s o c i a l work practice? There has been, for the most part, cooperation between psychiatry and s o c i a l work.  S o c i a l work has an indisputable  place among mental health professions.  Likewise, s o c i a l work,  since the beginning work done by Dr. Richard Cabot, has been an important member of the medical h o s p i t a l team.  There i s  more and more r e a l i z a t i o n of the contribution that s o c i a l work can bring to human problems. There i s ,  however, an inconsistency, an a l i e n a t i o n  between the church and s o c i a l work.  Because of the  scientific  emphases of medicine, psychiatry and s o c i a l work, these d i s c i p l i n e s have tended to discount the s p i r i t u a l aspects of man's 1 Lenroot, Katharine F . , "Fundamental Human Needs Facing the S o c i a l Worker Today," The Family, V o l . XVI, No. h  (1935), p. 102.  2 Sladen, Kathleen, The Question Arises, Master of S o c i a l Work Thesis, The U n i v e r s i t y of Toronto: Toronto, 1957, p. 5.  -96being.  As one man has put i t , The a l i e n a t i o n of the church and s o c i a l work may be attributed i n large measure to the fact that t r a i n i n g for s o c i a l work i n the established s c h o o l s . . . i s t i e d to those s o c i a l sciences that claim l i t t l e connection with r e l i g i o u s philosophy.1 This is not imply, however, that there i s a gulf  between the professions cannot be crossed.  of the ministry and s o c i a l work that  The roots of s o c i a l work go too deeply into  the Judeo-Christian heritage to suggest that.  But recently  much more has been said about the relevance of r e l i g i o n to s o c i a l work.  Charlotte Towle believes  that,  . . . s p i r i t u a l needs of the i n d i v i d u a l must also be recognized, understood, and respected. They must be seen as d i s t i n c t needs and they must also be seen i n r e l a t i o n to other human need.2 And herein l i e s the crux of the matter. needs of the person must be recognized.  The s p i r i t u a l  The s o c i a l worker must  be able to perceive the s p i r i t u a l need of the c l i e n t even as he is trained to perceive the bio-psycho-social needs of the client.  For "society owes him, through the s o c i a l worker, the  help he t r u l y needs, rather than the help he s p e c i f i c a l l y asks."^  The s o c i a l worker does not f u l f i l l h i s  professional  1 W e i l , Frank L . , "Co-operation of Churches and S o c i a l Work," The S o c i a l Welfare Forum, National Conference of S o c i a l Work, 1949, Columbia University Press: New York, 1950, p. 126. 2 Towle, Charlotte, Common Human Needs, National Association of S o c i a l Workers: New York, 19^7 ( O r i g i n a l publication 19^5), p. 8. 3 Pray. K . , "Restatement of General P r i n c i p l e s of S o c i a l Casework P r a c t i c e , " Journal of S o c i a l Casework, V o l . XXVIII, No. 8, p. 286.  -97competence i f he does not recognize the s p i r i t u a l needs of his c l i e n t , and does not offer interpretation and the opportunity for appropriate s p i r i t u a l help. "see"  The fact that a c l i e n t may not  his need i n i t i a l l y i s hardly a v a l i d reason for  v i r t u a l negation by the s o c i a l worker.  its  Sometimes i t would appear  that so great has been our concern for c l i e n t  self-determination  that the fear of imposing something upon the c l i e n t has prevented us from f u l f i l l i n g  as w e l l as we might the educational r o l e  inherent i n s o c i a l work goals. ^ Gordon Hamilton says, "We believe i n the wholeness of individuals and the interdependence of society, national and i n t e r n a t i o n a l , c u l t u r a l , economic and s p i r i t u a l . " 2 Most s o c i a l work l i t e r a t u r e ,  however, denies the l a t t e r ,  although some  s o c i a l workers view the r e l i g i o u s need as the most v i t a l of a l l . S o c i a l workers may agree that the immediate extrinsic end of t h e i r work is a better adjustment of the i n d i v i d u a l to a l l parts of the environment, but the statement i s meaningless outside the context of what is 'better'. That i s a question which i n the f i n a l analysis must perforce be answered i n terms of some meaning, some purpose to human l i f e . There can be no standards of adjustment or adaptation to an environment, there can be no bad, better or best, there can be no measure or evaluation without an answer to the fundamental question: To what end does man l i v e i n t h i s or any environment? What i s the purpose of human l i f e ? E s s e n t i a l l y t h i s i s a r e l i g i o u s question and ultimately s o c i a l work must find the answer In 1 Bowers, Swithun, " S o c i a l Work as a Helping and Healing Profession," S o c i a l Work. V o l . I I , No. 1 (January 1957), p. 58. 2 Hamilton, Gordon, Theory and Practice of S o c i a l Case Work, Columbia U n i v e r s i t y Press: New York, 1951, p. k.  -98the sphere of r e l i g i o n . For t r y as we w i l l , we cannot divorce the ultimate objectives of society from the question which i s basic to a l l r e l i g i o n — What i s man? Where l i e s his d e s t i n y ? 1 S o c i a l work, by i t s very nature as a helping profession, must necessarily consider the t o t a l nature of man. basic to i t s p r a c t i c e .  This is  For s o c i a l work's s p e c i f i c goals w i l l  vary d i r e c t l y with i t s view of the "wholeness of man." 2 What, then, are s o c i a l work's ultimate objectives? Canadian s o c i a l workers have apparently done too l i t t l e i n examining'their philosophy^ and "...perhaps  more time and  attention should be given to r e l i g i o n as a factor i n human l i f e , . . . i n s o c i a l organization and In s o c i a l work p r a c t i c e . . . . " 1 4 " The t r a i n i n g for t h i s practice begins at a School of S o c i a l Work.  It i s here that f i r s t  consideration can be made  to make available to the student the t r a i n i n g necessary for the s o c i a l worker to perceive the s p i r i t u a l needs of a c l i e n t . Just as the s o c i a l worker i s trained to recognize  social,  physical and psychological needs, so he must be able to recognize s p i r i t u a l needs.  This l a t t e r recognition cannot  be assumed nor taken for granted any more than the former. 1 Bowers, Swithun, "The Nature and D e f i n i t i o n of S o c i a l Casework," Part I I , Journal of S o c i a l Casework, V o l . XXX, No. 9, p. 375. 2 Sladen, Kathleen, op. c i t . , p. 10. 3 a series Regional 1953, p. V o l . I,  Touzel, Bessie, The Moral Foundations of S o c i a l Work, of two lectures delivered at the Fourth Western Conference of S o c i a l Work, Regina Saskatchewan, J u l y ,  3.  h Spencer, Sue, "Religion and S o c i a l Work," S o c i a l Work, No. 3, July 1956, p. 26.  -99Training i s needed.  This is a f i r s t  implication of the  c l i n i c a l pastoral t r a i n i n g movement.  That i s , these ministers  of r e l i g i o n , physicians, and psychiatrists  ( i n the C l i n i c a l  Pastoral Training Movement) have shown that s p i r i t u a l problems can be dealt with more e f f e c t i v e l y with a method of  diagnosis  but only when there i s a clear perception of the needs expressed. These methods may w e l l be examined with a view to being incorporated into the t r a i n i n g of the s o c i a l workers. C l i n i c a l Pastoral Training has given a new dimension to i n t e r - p r o f e s s i o n a l r e l a t i o n s i n terms of the confidence the health professions  have i n the c l i n i c a l l y trained chaplain.  His t r a i n i n g i n human growth and development, the p r a c t i c a l experience and intensive supervision, the methods of recording, the conscious use of his relationship as chaplain i n an i n s t i t u t i o n , and his awareness of i n t e r - p r o f e s s i o n a l team work, gives the chaplain a competence which recognized by the health professions.  He i s regarded as a member of the treatment  team. In B r i t i s h Columbia, i t i s of particular importance that s o c i a l workers give l i v e l y consideration to what they may gain for t h e i r c l i e n t through the a v a i l a b i l i t y of the c l i n i c a l l y trained chaplain.  The s o c i a l worker would be assured of a  competent handling of the c l i e n t he referred to the  latter.  Much pioneering work needs to be done. Not only has s o c i a l work something to gain, i t has something to give.  S o c i a l workers and the School of S o c i a l  -100-  Work are the main agents i n t h i s province through which the s o c i a l sciences f i n d p r a c t i c a l and tested a p p l i c a t i o n . The s o c i a l worker's education and his profession i s one of s o c i e t y ' s main i n s t i t u t i o n s answering human need.  The resources of s o c i a l  work education might be made available to the t h e o l o g i c a l student. Without t r a i n i n g the l a t t e r cannot adequately assess the needs of people any more than s o c i a l workers can assess s p i r i t u a l needs without t r a i n i n g .  Those engaged i n the training of ministers  must take due regard of the techniques of s o c i a l work t r a i n i n g . The t r a i n i n g of the minister would be e f f e c t i v e l y enhanced by t r a i n i n g techniques such as the p r a c t i c a l interview, supervision, recording and self-evaluation.  Because s o c i a l services  are so  diverse and complex, the minister of r e l i g i o n needs some introduction to t h i s wide t o p i c .  The chaplain's  referral  patterns indicate scanty appreciation of the agencies available to serve his " p a r i s h i o n e r s . " The Church and i t s ministry has begun through C l i n i c a l Pastoral Training to search out the contributions which s o c i a l and medical science can make to understanding of Individuals and t h e i r society.  The Church to a limited extent i n c l i n i c a l  t r a i n i n g has applied some techniques of t r a i n i n g including the c l i n i c a l conference. are given.  Herein the contributions of each d i s c i p l i n e  Not only does the " h o l i s t i c " view of man find  expression i n t h i s technique, but there are decided advantages for the patient i n terms of understanding of his case.  In view  of t h i s i t i s not surprising to learn that there i s a very r e a l  -101rapport being established between some medical doctors, psychiatrists  and ministers.  So much so that the editor of  the B r i t i s h Medical Journal of January 2H-, 1959, was moved to remark that medical practice i n B r i t a i n must consider "Catching up with Cabot." The survey of l i t e r a t u r e respecting the two  professions  of s o c i a l work and the ministry indicates that the church is exploring s o c i a l work to a considerable degree. suggested by Miss Skenfield i n her recent s t u d y . 1  This i s also She had  discovered more l i t e r a t u r e from Church sources than from s o c i a l work.  Although this trend cannot be completely accounted for  i n the C l i n i c a l Pastoral Training Movement, i t s influence must be recognized.  The a r t i c l e s  published i n Pastoral Psychology  and the Journal of Pastoral Care are of high standard.  Social  workers may use these journals as resource material i n coming to a better inter-professional understanding between the ministry and s o c i a l work. To take advantage of the implications of this study one must not lose sight of the fact that a l l professions  exist to  serve the " c l i e n t , " the " p a t i e n t , " and the " p a r i s h i o n e r . "  The  obstacles which limit inter-professional cooperation must not be allowed to deter efforts cooperation.  to seek ways and means of  The perfection of the service offered to the  patient should be the constant goal of a l l  professions.  1 Skenfield, Alfreda, S o c i a l Worker and Minister i n . Welfare Services, Master of S o c i a l Work Thesis, University of B r i t i s h Columbia, i960.  -102-  APPENDIX A HOSPITAL CHAPLAINS AND O F F I C I A L V I S I T O R S  QUESTIONNAIRE  IDENTIFICATION Name a n d T i t l e Name o f d e n o m i n a t i o n Are  represented  you a Hospital Chaplain;Part-time  Are you paid f o r t h i s If  ;Half-time  t  ;Full-time  work?  ' y e s ' , "by whom?  '  When d i d y o u "begin work a t t h i s  hospital?  Do y o u v i s i t o t h e r h o s p i t a l s ? ;Which? . Were y o u a ( f u l l / h a l f / p a r t - t i m e ) C h a p l a i n i n a n o t h e r i n s t i t u t i o n coming to this hospital? ; I f ' y e s ' , where? D i d you r e c e i v e any o r i e n t a t i o n t o t h i s here? . I f ' y e s , f r o m whom?  before  h o s p i t a l when y o u b e g a n work  1  Name o f t h i s  hospital  EDUCATION AND TRAINING A.  '., " ;  Academic ( c i r c l e h i g h e s t y e a r High School 1 2 3 4 U n d e r g r a d . C o l l e g e 1 2 3 4-  completed) Undergraduate Undergraduate  Graduate E d u c a t i o n i n Theology Seminary y e a r s 1 2 3 4 Year Ordained Other Graduate P r o f e s s i o n a l S c h o o l  From  ma.jor degree  "  To(dates)  Degree/Dip. .  B.  D i d your undergraduate o r t h e o l o g i c a l education i n c l u d e courses i n Pastoral Counselling? • I f ' y e s ' , do y o u c o n s i d e r t h i s t r a i n i n g : adequate helpful inadequat e  C.  Have y o u t a k e n C l i n i c a l P a s t o r a l T r a i n i n g ? I f ' y e s ' , how l o n g was t h e c o u r s e S j  ; Where h e l d ?  D. Have y o u r e c e i v e d s p e c i a l t r a i n i n g i n a n o t h e r d i s c i p l i n e ? Psychology ; Casework ,° S o c i o l o g y , ' other E . Do y o u t h i n k a c o u r s e the Vancouver area?  (check)  i n H o s p i t a l C h a p l a i n c y s h o u l d be g i v e n i n P l e a s e comment s  -103APPENDIX A ( C o n t i n u e d ) COUNSELLING A.  How  many p e o p l e  d i d you  visit  Bo  How  many p e o p l e  d i d you  see  C.  What was  the  focus  of  i n h o s p i t a l i n one  recent  month?_  i n hospital f o r counselling?  counselling during this  period?; I  "I"  Considered  F  Housing V o c a t i o n a l 'Training Occupational Prospects F i n a n c i a l Need Marital Relations Parent-child Relations Schooling/educational Memtn.1 H e a l t h Recreational activities 0ther(please describe)  Alcoholism Bereavement Drug A d d i c t i o n Grave I l l n e s s _ Religious Instruction Religious explanation. R e l i g i o u s support: before operation prayer sacramentstbaptism _ M a s s o r H o l y Comm' n  Individually;  "F" C o n s i d e r e d  i n a Family  D.  From t h e above l i s t , you have had c o n t a c t  E.  What do y o u c o n s i d e r t o be t h e most v a l u a b l e a i d ( s ) y o u h e l p t h e h o s p i t a l p a t i e n t on t h e r o a d t o r e c o v e r y ?  F.  Do y o u t h i n k y o u diagnosis  F,  W o u l d y o u be w i l l i n g t o s h a r e p e r s o n a l and s o c i a l a patient with another profession? I f ' y e s ' , w o u l d y o u h o l d any l i m i t s { c o m m e n t ) ?  G.  Do y o u t h i n k t h e C h a p l a i n c y h a s any s p e c i a l h e l p t h e T r e a t m e n t Team o f t h e H o s p i t a l ? b r i e f l y °.  Context  p l e a s e s e l e c t t h e t h r e e most common p r o b l e m s w i t h ; l i s t i n order of predominance:  could help  the  p a t i e n t more i f y o u  skill  bring  to  knew h i s m e d i c a l ___________  informationebowt  or knowledge t o . I f yes', describe  APPENDIX A (Continued) REFERRAL A.  Did you r e f e r If  a n y p a t i e n t s t o o t h e r p r o f e s s i o n s l a s t month?  'yes' ,  TO WHOM?  HOW  IOAUY?  Psychiatrist Medical Dr. Nurse Teacher S o c i a l Worker Lawyer Other  (konth  Specify  B. D i d y o u r e c e i v e a n y r e f e r r a l s i n t h e a b o v e month f r o m o t h e r ions? . I f 'yes', HOW MANY? FROM WHOM?  C. Have y o u e v e r d i s c u s s e d doctor? D. Do y o u r e f e r  patients  )  xhe p a t i e n t ' s  to their  profess-  i l l n e s s o r problem with h i s  parish minister?  If,'yes', ( a ) Who d o e s t h i s ? : s e l f ; wiige ;volunteer jsecretary ( b ) How i s - t h i s done? : l e t t e r ^telephone ^personal v i s i t ( c ) A b o u t how many r e f e r r a l s a r e made i n one month? ( d ) How much o f y o u r t i m e d o e s t h i s t a k e ? h o u r s p e r week. JOB  DESCRIPTION  A. How many h o u r s  do y o u s p e n d  a t y o u r work i n one week?  B. How many h o u r s  do y o u s p e n d  at this  C. Bo y o u h a v e p r o f e s s i o n a l d u t i e s What D. Where  i n o n e week?  elsewhere?  are they? i s your  study o r o f f i c e  E . Do y o u c o n d u c t If  hospital  Public  Worship  ' y e s ' , Where?  F. Do y o u v i s i t  patients  located? Services? .When?  outside  y o u r own d e n o m i n a t i o n ?  C A S E  0 N B  APPENDIX B  -105-  SAMPLE CASE HISTORIES  Mrs. A., a 28yrs. o l d mother, has just given b i r t h to her t h i r d c h i l d , but expects to be i n the h o s p i t a l f o r seme time because of a Caesarian Section and further medical complications. Her mother has been lmoking after the other children while she i s h o s p i t a l i z e d . Mrs. A. has ask6d you to coma to see her as she wanted to speak to you about her husband who has been drinking excessively. Ker husband i s coming to see her tomorrow afternoon and she wonders whether you w i l l speak to him. She says that her husband's well-paying job w i l l be l o s t i f he doesn't 'straighten up' as h i s Company has given the l a s t warning. This i s more serious as the marriage i s also l i k e l y to break up because Mrs. A. says she doesn't know how she can carry on under the s t r a i n and e s p e c i a l l y now with the new baby. Mrs. A. states,"You see i t r e a l l y goes back to before we were married. I was brought up i n Church and my parents were very much against me marrying someone who was nominally of another f a i t h . But I went ahead anyway." The Church had been very meaningful f o r her but she l e f t i t behind on the assumption that marriage came f i r s t . They have never attended church since marriage and now the oldest children are of school age they are of age to be attending Sunday School and Church i n s t r u c t i o n . This issue about the children attending Church a c t i v i t i e s has been raised mostly by Mrs. A.'s parents who are now i n town looking after the children. Mr. A. resents t h e i r interference. I t has been during t h i s recent period that Mr. A. has resorted to more drinking than ever. CASE TYO Gordon, age 2£yrs., has been a patient i n the hospital for almost f i v e months but has i n no way i d e n t i f i e d h i s r e l i g i o n . However, he has just requested you t o come to see him and he t 6 l l s you that he has been receiving physio-therapjr on his foot and i s now almost ready to leave the h o s p i t a l . H6 mentions that he has had a l o t of time to think about l i f e but now wants some advice. When you ask . him what i t i s he t e l l s you that when he returned from Germany(where he served with the Canadian Army and where he hurt h i s foot) he brought back a German g i r l f r i e n d whom ho was going to marry when he got out of h o s p i t a l . However, since then he says he has found he does not love her and she has b e 6 n suggesting the same thing on her part. However, she i s almost six months pregnant by him and he doesn't know what to do. The g i r l f r i e n d has been working i n a small cafe i n the kitchen department and has not learned English. Although Gordon has a f a i r l y good paying job to go to when discharged, he has not any money saved up at the moment. He e s p e c i a l l y wants to know how he can help h i s former fiancee. He appears genuinely distressed about this whole situation and asks you i f you think God w i l l ever forgive him f o r t h i s mistake. CASE THREE Whilst returning one morning to a men's ward i n which you had l e f t your b r i e f case the day before, you are requested t o come to the bedside of an o l d man, Mr. B., age 7 1 > who has been admitted since you were l a s t there. He t e l l s you that he was knocked down by a car late l a s t night just before he was to board the bus f o r h i s home at Aldergrove. (about 5>0 miles from Vane.) He i s now V 6 r y worried about h i s wife as she does not know how to f i l l the o i l burner, which i s a daily task , and they have no telephone so he cannot contact her. This i s even more complicated because h i s leg i s broken and he wont be able t o leave the hospital for at least two months. Although he has been getting the Old Age Security pension his wife i s only 6 4 yrs. old and i s not e l i g i b l e . Mr. B. t e l l s you t h a t he has been supplementing h i s income by part-time janitor work at h i s Church i n Aldergrove but he says he can't expect to get this w hilo he i s i n h o s p i t a l . Tilhen you ask him what Church i t i s , he indicated a denomination other than yours. He i s quite distressed by t h i s whole situation and wonders whether you can help i n any way.  -106APPENDIX C NAME DENOMINATION  H O S P I T A L C H A P L A I N ' S S T A T I S T I C S  N.3. THESE STATISTICS APPLY ONLY TO THE VANCOUVER GENERAL HOSPITAL ( G i v e the t o t a l numbers f o r each day i n t h e a p p r o p r i a t e spaces p r o v i d e d ) DATE MARCH  R e f e r r a l s Ref. t o Hours ( R e l i g i o u s S e r v i c e s , iNo. o fP a t i e n t s Ref. from spent Inter-Prof.,Denom., ' v i s i t s seen f o r to P a r i s h o t h e r * other * I V.G.H.C o u n s e l l i n g C l e r g y P r o f e s s i o n s P r o f e s s i o n s a t VGH 1 J.meetings ( D e s c r i baet)t e n d e d . 1  SUNDAY 11th MONDAY 12 th TUESDAY 13th "WEDNESDAY 14th THURSDAY l^th FRIDAY 16th SATURDAY 17th  1  i i  1 1  1  SUNDAY 18th  1 1  i MONDAY 19th TUESDAY 20th WEDNESDA Y 21st THURSDAY 22nd FRIDAY 23rd  •  SATURDAY 24th  1  ,  t TOTALS 1  * L i s t 'which p r o f e s s i o n s r e f e r r e d t o : r e f e r r e d from:  R e t u r n t o : R.D.MacRae 6o£0 C h a n c e l l o r B l Vancouver 8, B.C. Phone: C A s t l e 4-9020  ,-107-'  APPENDIX D COMPARISON OF STUDENT BACKGROUNDS (Social Work, Theology) 1.  IDENTIFICATION: Faculty M F you have  2.  Are you married .  Age last birthday ; If 'yes', How long  :  ; How many children do  EDUCATION: A.  Academic (circle highest year completed) High School 1 2 3 4 Undergraduate University Major Undergraduate College 12 3 4 Undergraduate Degree Post Grad. years 1 2 3 4 From To (date) Degree Theology Social Work Other Graduate or Professional Training  B.  Content (1) Did your theological education include courses in Pastoral Counselling? Yes No If 'yes' do you consider this training: adequate Helpful inadequate . (2) Have you taken Clinical Pastoral Training? Yes No If 'yes , how long was the course? Where held? (3) Have you received special training in another discipline? Yes psychology ; casework ; sociology ; other? 1  3.  No  CASE EXAMPLES: A. Theology Students answer cases in the order: 1, 2, 3. Social Work Students answer cases in the order: 3, 2, 1. B.  Mark each case clearly:  e.g. "case #1."  C.  Read only one case at a time, and complete your remarks before proceding to the next case.  D.  Treat each case as a separate entity, and write down a l l remarks applicable to each case.  E.  Assuming that you are a Social Worker or Chaplain at the Vancouver General Hospital comment how you would handle each situation, with specific reference to: (1) Your i n i t i a l reaction to the presenting problem. (2) How confident or qualified you feel in discussing this problem with the individuals involved. (3) The agencies or persons that may be consulted, including consideration of possible referrals and other people or agencies.  Form M-128  ,„ _  -108APPENDIX E THE VANCOUVER GENERAL HOSPITAL APPLICATION  AS VISITLNG CLERGYMAN  I hereby apply to be named a Visiting Clergyman at The Vancouver General Hospital: Name: Address: Phone: Denomination: Service you plan to render patients in this Hospital?  If accepted Hospital, I Hospital at promulgated  as a Visiting Clergyman at The Vancouver General agree to abide by the rules and regulations of the present in force and those which may be subsequently by the Board of Trustees,  Signature: Date: Endorsed by Superior: (For Departmental Use Only)  5C  4-59.  -109-  APPENDIX F  STANDARDS FOR THE WORK OP THE CHAPLAIN IN THE GENERAL HOSPITAL O f f i c i a l l y Approved 1950 by the AMERICAN PROTESTANT HOSPITAL ASSOCIATION 1 ^  INTRODUCTION  It i s the intention of the Committee on Accreditation to state the minimum training and experience required of a clergyman seeking appointment as a f u l l time chaplain, and to describe goals and practices normally expected of him. This statement i s prepared for hospital administrators, boards of directors, medical staffs, and church authorities who desire a high quality of religious work within their institutions and wish to strengthen and improve their chaplaincy service. A. THE ACCREDITED CHAPLAIN It i s essential that anyone who i s to serve as a chaplain should be properly qualified. In order to assist hospital administrators and others charged with the responsibility for selection hospital chaplains the AMERICAN PROTESTANT HOSPITAL ASSOCIATION has established the following minimum standards for accreditation of chaplains: 1.  \  College and seminary degrees or their accepted denominational equivalent.  " 2 . Ordination or appropriate ecclesiastical endorsement and evidence of current good standing within a denomination. 3«  A significant period of c l i n i c a l pastoral training such as a minimum of twenty-four weeks (960) hours or i t s equivalent and written recommendation by the instructor of the center attended. This training to have been obtained i n a general hospital with a psychiatric service or i n a general hospital, mental and/or correctional institution. "Equivalent" may be i n terpreted by the Committee on Accreditation to mean (a) graduate academic degrees i n Pastoral Psychology, Pastoral Counseling, C l i n i c a l Psychology, Social Relations and other related fields, (b) publication of significant books in the f i e l d of ministering to the sick and (c) other outstanding contributions. Until January, 1955* latitude in interpretation rests with the Committee on Accreditation. Training centers which subscribe to the general objectives l i s t e d below and provide acceptable courses of training may seek recognition by a committee to be created for that purpose. s o m e  ko  Three years of parish experience or i t s equivalent. "Equivalent" may be interpreted by the Committee on Accreditation to mean a total of five years' experience i n such position as the following: Chaplain i n the Armed Services; student pastor, or student religious worker; teacher, lawyer, doctor, social worker, or counselor.  1 Johnson, Paul E . , Psychology of Pastoral Care, A b i n | t o n Press: New York and N a s h v i l l e , 191?3, Appendix A, p.  337.  -110Members o f t h e APHA may a p p l y f o r a c c r e d i t a t i o n b y s u p p l y i n g e v i d e n c e t o t h e E x e c u t i v e D i r e c t o r o f t h e APHA. ( o r whomever he may d e s i g n a t e ) t h a t t h e y have complied w i t h t h e Minimum Standards f o r A c c r e d i t a t i o n l i s t e d above, o r b y January 1 , 1 9 5 0 have s e r v e d n o t l e s s t h a n f i v e y e a r s a s a h o s p i t a l chapl a i n and have f u l f i l l e d a l l b u t one o f t h e " S t a n d a r d s " . Non-members o f t h e APHA s h a l l pay a n A c c r e d i t a t i o n F e e o f t e n d o l l a r s . An i n d i v i d u a l who f u l f i l l s p a r t o f t h e r e q u i r e ments f o r a c c r e d i t a t i o n and has made arrangements t o complete them may a p p l y f o r a temporary endorsement e n t i t l e d , " I n Process of A c c r e d i t a t i o n " . The g e n e r a l o b j e c t i v e s o f c l i n i c a l p a s t o r t r a i n i n g c e n t e r s a r e a s f o l l o w s : 1.  To e n a b l e t h e s t u d e n t t o g a i n a n u n d e r s t a n d i n g o f p e o p l e t h e i r deeper m o t i v a t i o n s and d i f f i c u l t i e s , t h e i r e m o t i o n a l and s p i r i t u a l s t r e n g t h s and weaknesses.  2.  To h e l p t h e s t u d e n t d e v e l o p e f f e c t i v e p a s t o r a l methods f o r m i n i s t e r i n g t o p e o p l e , and r e c o g n i z e h i s unique r e s o u r c e s , r e s p o n s i b i l i t i e s , and l i m i t a t i o n s a s a r e l i g i o u s worker.  3.  To h e l p t h e s t u d e n t l e a r n how t o c o o p e r a t e w i t h r e p r e s e n t a t i v e s o f o t h e r p r o f e s s i o n s and u t i l i z e community r e s o u r c e s f o r a c h i e v i n g more e f f e c t i v e l i v i n g .  4.  To encourage i n t h e s t u d e n t a d e s i r e f o r t h a t f u r t h e r unders t a n d i n g which i s t o be o b t a i n e d b y a p p r o p r i a t e and p e r t i n e n t research.  f B.  THE APPOINTMENT OF THE CHAPLAIN  The c h a p l a i n s h o u l d b e a p p o i n t e d b y t h e h o s p i t a l Board o f D i r e c t o r s on t h e recommendation o f t h e h o s p i t a l a d m i n i s t r a t o r . The t h r e e most common ways o f s e l e c t i n g a c h a p l a i n f o r appointment a r e : 1.  A c h u r c h a u t h o r i t y nominates a n a c c r e d i t e d c a n d i d a t e . In a denominational h o s p i t a l , t h e denominational authori t i e s make t h e n o m i n a t i o n . In a non-sectarian or statesupported h o s p i t a l , the l o c a l o r s t a t e church f e d e r a t i o n o r c o u n c i l o f churches o r o t h e r a u t h o r i z i n g agency make the nomination. The h o s p i t a l a d m i n i s t r a t o r and Board o f D i r e c t o r s t h e n a p p o i n t o r r e j e c t t h e nominee.  2.  A s p e c i a l c h a p l a i n c y committee i s a p p o i n t e d t o nominate an a c c r e d i t e d c a n d i d a t e . The h o s p i t a l a d m i n i s t r a t o r t h e n a c c e p t s o r r e j e c t s t h e nominee.  3.  The h o s p i t a l a d m i n i s t r a t o r p r e s e n t s a c a n d i d a t e t o h i s Board of D i r e c t o r s . j  \  -IllF i n a l appointment i s made b y t h e h o s p i t a l Board o f D i r e c t o r s o n l y a f t e r a c c r e d i t a t i o n and c h u r c h endorsement have been obtained.  i  Whether t h e c h a p l a i n i s p a i d e n t i r e l y o r o n l y i n p a r t b y t h e h o s p i t a l o r h i s s a l a r y i s f u r n i s h e d b y a n o u t s i d e o r g a n i z a t i o n , t h e h o s p i t a l s h o u l d have t h e f i n a l a u t h o r i t y t o accept o r r e j e c t a candidate f o r h o s p i t a l chaplaincy; the a p p r o p r i a t e e c c l e s i a s t i c a l a u t h o r i t y s h o u l d b e a r t h e r e s p o n s i b i l i t y f o r nomi n a t i n g the candidate. C.  THE CHAPLAIN'S RESPONSIBILITY TO THE ADMINISTRATOR  Because o f t h e complex r e l i g i o u s s i t u a t i o n i n any community t h e h o s p i t a l chapl a i n c y s h o u l d be c a r r i e d on b y t h e c h a p l a i n i n c l o s e r e l a t i o n s h i p w i t h t h e a d m i n i s t r a t o r and a s p e c i a l committee on r e l i g i o u s a c t i v i t i e s composed o f two o r more members o f t h e h o s p i t a l B o a r d o f D i r e c t o r s . R e g a r d l e s s o f t h e s o u r c e o f t h e c h a p l a i n ' s s a l a r y he s h o u l d be answerable t o t h e h o s p i t a l a d m i n i s t r a t o r a n d t h e R e l i g i o u s A c t i v i t i e s Committee f o r t h e q u a l i t y o f h i s work a n d t h e e x p e n d i t u r e o f h i s s c h e d u l e . The c h a p l a i n a s t h e head o f a r e c o g n i z e d s e r v i c e i n t h e h o s p i t a l o r g a n i z a t i o n s h o u l d have t h a t p e r s o n a l a c c e s s t o t h e h o s p i t a l B o a r d o f D i r e c t o r s p o s s i b l e f o r t h e head o f any o t h e r service. The c h a p l a i n s h o u l d p r e s e n t w r i t t e n d e s c r i p t i v e r e p o r t s o f h i s a c t i v i t i e s t o t h e a d m i n i s t r a t o r and t h e R e l i g i o u s A c t i v i t i e s Committee a t s t a t e d i n t e r v a l s . D.  COOPERATION WITH OTHER HOSPITAL PERSONNEL  The c h a p l a i n works b e s t as a n i n t e g r a t e d member o f a team headed b y t h e a t t e n d ing physician. As s u c h he i s b e t t e r a b l e t o d i r e c t h i s s k i l l s and r e s o u r c e s toward t h e s p i r i t u a l needs o f a p a t i e n t t h a n when working a l o n e . Although the c h a p l a i n s h o u l d a c q u a i n t t h e p h y s i c i a n w i t h any p e r t i n e n t i n f o r m a t i o n which may have come t o h i s a t t e n t i o n , n e v e r t h e l e s s t h e c h a p l a i n r e s e r v e s t h e r i g h t t o r e s p e c t t h e c o n f i d e n t i a l n a t u r e o f i n f o r m a t i o n g i v e n by a p a t i e n t i n t h e s p i r i t of confession. While n o t e v e r y p a t i e n t seen b y t h e c h a p l a i n needs t o be d i s c u s s e d w i t h t h e p h y s i c i a n , such c o n s u l t a t i o n between p h y s i c i a n and c h a p l a i n w i l l often occur. As a r u l e , t h e c h a p l a i n w i l l spend most o f h i s time w i t h t h o s e p a t i e n t s who a r e under s e v e r e p h y s i c a l o r m e n t a l s t r e s s , o r have e s p e c i a l l y d i f f i c u l t p e r s o n a l , s o c i a l , o r s p i r i t u a l problems; t h e r e f o r e t h e major p o r t i o n o f h i s energy and e f f o r t w i l l n o r m a l l y be d e v o t e d t o a s e l e c t e d number o f p a t i e n t s . E . SOURCES OF REFERRAL I n a g e n e r a l h o s p i t a l t h e c h a p l a i n c a n m i n i s t e r i n t e n s i v e l y t o about f o r t y p a t i e n t s ; some o f whom he w i l l see d a i l y , o t h e r s on a l t e r n a t i v e d a y s , t h e r e s t perhaps once a week. T h i s means he makes a n average o f f i f t e e n p a s t o r a l c a l l s e v e r y day, i n a d d i t i o n t o s p e a k i n g w i t h s c o r e s o f i n d i v i d u a l s . E x p e r i e n c e has shown t h e f o l l o w i n g s o u r c e s o f r e f e r r a l t o be most common:  -1121.  The physician asks the chaplain to c a l l on his patient. These should "be selective referrals: that i s , persons with definite and, usually, acute need. Some hospitals have found that when the chaplain makes rounds- periodically with the attending physician, he i s not only introduced i n his professional role,^but i s shown persons i n need of his care who might otherwise have been missed.  2. A nurse, social worker, or other hospital employees asks the chaplain to c a l l on a patient. While i t would be best to have the physician request the chaplain to c a l l upon his patient, i t has been found that „ other personnel also have opportunity to observe a patient's spiritual condition and refer the patient to the chaplain, who, i f the need arises, discusses the patient with the attending physician. 3.  \  A relative or friend asks the chaplain to c a l l on a patient. On such occasions the relative becomes a part of the chaplain's professional responsibility.  k.  The patient's parish minister asks the chaplain to c a l l . Courtesy requires the chaplain to report to the referring minister that the c a l l has been made. Cooperation between " the hospital chaplain and the local clergy i s helpful not only to the patient, but also to the hospital as a means of fostering the confidence of the patient and family.  5«  The patient asks to have the chaplain c a l l . A letter or folder distributed to patients after they are admitted stating that the hospital has a chaplain who w i l l c a l l on anyone who asks for him, and announcing the place and time of scheduled religious services within the hospital may lead to this request.  6.  The chaplain i s notified i n cases of c r i t i c a l illness (DL) and death.  In addition to calling on and ministering to the patients referred to him, chaplain can take the i n i t i a t i v e and discover many patients who need his care. The admitting officer i s usually the f i r s t person to see the patient o f f i c i a l l y . If the chaplain has a good working relationship with this officer, information on the admission slips can often be most helpfully interpreted to the chaplain. For example, a patient from a distance may not be visited frequently by the family and friends, a patient facing surgery, especially when i t may mean severe illness, prolonged convalescence, or a d i f f i c u l t post-operative adjustment needs special care; and an aged, isolated or indigent patient may face peculiarly complicated problems. Some patients w i l l have courage to reveal their spiritual needs only i f they have had opportunity ,to observe and get acquainted with the chaplain while he i s doing general v i s i t i n g .  -113F.  THE CHAPLAIN'S RECORDS  Detailed records enable the chaplain to minister more effectively, facilitate research aimed at improving and enhancing the value of his work, form the oasis of confident and effective teaching, and become the indispensable source of his periodic reports to the hospital administrator and Religious Activities Committee. They may take the following forms: 1.  The entry may be made on a sheet filed in the medical record folder. This may consist of a notation of the day, hour, and length of the call, or i t may be a brief note of the principle topics of conversation.  2.  The chaplain may keep a notebook or card index record. This may contain information which helps him identify patients and recall significant data about them.  \  3« More elaborate records are filed in the chaplain's office. Such records are detailed, and usually follow a standard \ outline. They are designed to help objectify the patient's needs to the chaplain's mind, to show him what gains have been made, or what strengths and resources have been tapped, and to point up his mistakes and failures. G.  WORSHIP IN THE HOSPITAL  Patients in a hospital need the best ministry the community can provide. A l l scheduled religious services should be either led by the chaplain or arranged through him. Young people's societies and missionary groups should only be brought into • the hospital under careful supervision and for the purpose of making a recognized contribution to the patient's welfare. Ordained persons, commissioned workers, and recognized qualified and responsible visitors should be permitted to call upon the patients of their acquaintance. A l l other "religious' workers should be directed to the chaplain's office for screening. Some of them should be encouraged, instructed, and supervised so their efforts will be constructive; others should be tactfully discouraged. In a l l general or open services denominational emphasis should be avoided since highly ritualistic programs, proselyting, and fervid revivalism (especially in a hospital setting) f a i l to serve the larger Christian goals. In order to make general services available to a large number of patients, some means of broadcasting the services to the bedside is needed. Then, i f the patients wish to listen, they may do so by turning on the broadcasting system or earphones. The preaching should be simple, conforting, dignified, and practical. In any case, worship conducted at the bedside is usually more important and meaningful than a service a patient attends. The chaplain's office should be equipped with a Communion Set, Bibles, prayer and other devotional books and pamphlets, so that the chaplain can give the patient whatever ministry is needed. H. CONCLUSION Where sickness and suffering are concentrated, spiritual needs are felt moro acutely. In ministering to patients and their families the chaplain is concerned with aiding recovery i f he can; nevertheless, restoration of physical health is not his major field. Rather, his mission is to personalize the vitality of the Christian religion.  -XX *1  Although the chaplain's main function i s ministering to patients and their famil i e s , this i s not a l l he contributes to the hospital. While the administrator forms the attitudes of the workers and the general atmosphere of the hospital, the chaplain can have a definite influence on the morale and well-being for many members of the staff and employees and i n special circumstances may serve as the o f f i c i a l personnel counselor. In addition he can be useful as counselor for student nurses, advisor on religious activities for the School of Nursing and classroom lecturer. As an unofficial good-will ambassador, the chaplain can be valuable to the hospital as a builder of v i t a l public relations. He w i l l endeavor to minister to the spiritual needs of a l l who enter the hospital. If because of differences i n Faith or for other reasons his ministry i s not acceptable to a person, he w i l l be prepared to c a l l i n who-ever i s needed. Through his understanding and poise, word and deed, he seeks to encourage one, relieve another cf worry, aid a third to bear suffering, break the grip of despair for a fourth, gain serenity for one facing death, and to comfort the bereaved; so that individuals may be led to personal growth, deeper understanding of their fellows, and increasing consciousness of God. COMMITTEE ON ACCREDITATION James H. Burns, Chairman Carl J. Scherzer, Secretary L. B. Benson, exofficio John M. Billinsky Albert G. Hahn Everett R. Plack Bryce L. Twitty  -115-  APPENDIX G Standards for C l i n i c a l Pastoral Education Adopted by the National Conference on C l i n i c a l Pastoral Training^ October 1, 19i?2 1 I.  DEFINITION OF CLINICAL PASTORAL EDUCATION  C l i n i c a l pastoral education i s an opportunity for a t h e o l o g i c a l student or pastor to learn pastoral care through interpersonal r e l a t i o n s i n an appropriate center, such as a h o s p i t a l , correct i o n a l i n s t i t u t i o n or other c l i n i c a l s i t u a t i o n , where an integrated program of theory and practice is i n d i v i d u a l l y supervised by a q u a l i f i e d chaplain-supervisor, with the collaboration of an interprofessional s t a f f . II.  QUALIFICATIONS OF THE CHAPLAIN-SUPERVISOR  1. Graduation from an accredited t h e o l o g i c a l school upon the completion of a three-year graduate course beyond the bachelor's degree or i t s equivalent. 2. An adequate period of pastoral experience, with ordination and denominational approval. 3. At least one year f u l l time of c l i n i c a l pastoral education, and i n addition three months of supervised c l i n i c a l teaching. h. Professional competence including graduate studies, past experience, and demonstrated performance. Graduate degrees i n appropriate f i e l d s with c l i n i c a l orientation are recommended and may be evaluated as follows: Six months' credit toward c l i n i c a l education may be given for an appropriate doctor's degree. Three months' credit may be given for an appropriate master's degree. 5 . Personal q u a l i f i c a t i o n s to be appraised by an accrediting committee i n a face-to-face interview. III.  REQUIREMENTS FOR THE CLINICAL TRAINING CENTER  1. A chaplaincy service which i s w e l l established and recognized as a functioning part of the center, with a chaplain accredited as a supervisor (see I I ) . 2. A progressive i n s t i t u t i o n , oriented toward therapy or r e h a b i l i t a t i o n , serving an adequate number of patients or inmates accessible to the chaplain's program, maintaining an interprofessional staff available for continuous^ teaching of t h e o l o g i c a l students. a. General appreciation within the i n s t i t u t i o n of the r o l e of a chaplain, recognition of theological students as functioning members of the chaplain's department, and adequate opportunity for them to work i n s i g n i f i cant and appropriate c l i n i c a l tasks. 1 Johnson, Paul E . , op. c i t . , Appendix B . , p. 337.  S -116b. An alert and cooperative administration and s t a f f , who w i l l be ready to assume r e s p o n s i b i l i t y for implementing the c l i n i c a l program. 3 . Maintenance should be provided for students i n t r a i n i n g , or such provisions as may be comparable to the internship programs of other professional groups i n the i n s t i t u t i o n . IV.  MINIMUM ESSENTIALS OF CLINICAL PASTORAL EDUCATION  1. A supervised practicum i n interpersonal r e l a t i o n s . 2. Writing of c l i n i c a l notes for consultation with the chaplain-supervisor. 3. A continuing evaluation of the student's experience and growth to be offered during the t r a i n i n g period. k. Frequent association with an interprofessional staff who are genuinely interested and q u a l i f i e d to teach students. 5. Adequate provision for group discussions, seminars, and other group experience for a l l students. 6. A continuing concern for an integration of psychologicale t h i c a l , and t h e o l o g i c a l theory with p r a c t i c a l understanding of the dynamics of personality and f a c i l i t y i n interpersonal relations. 7 . A written evaluation of his experience to made by the s tudent to his chaplain-supervisor at the end of the t r a i n i n g period. 8. A f i n a l summary evaluation of the student's work and capacities to be written at the end of the t r a i n i n g period by the chaplain-supervisor, discussed with the student, and with his knowledge made available to the appropriate responsible parties. V.  MINI MM PROGRAM RECOMMENDED FOR CLINICAL PASTORAL EDUCATION.  1. For the theological student who i s preparing for the parish ministry : a. An introductory course to c l i n i c a l pastoral care during the entire academic year, with one ;day per week at an accredited center and under the d i r e c t i o n of an accredited chaplain-supervisor who is a functioning member of the s t a f f of the center; and b, C l i n i c a l pastoral education for twelve weeks, f u l l time. 2. For the student who is seeking a master's degree i n pastoral care, at least s i x month's c l i n i c a l pastoral education, f u l l t ime. 3. For the advanced student preparing for the teaching of pastoral theology and pastoral care, an appropriate doctor's degree with at least nine months, f u l l time, of c l i n i c a l pastoral education, and i n addition three months of supervised teaching of pastoral care.  -117-  VI.  SPECIAL CONSIDERATIONS  1. F o r pastors and other r e l i g i o u s workers seeking training:  additional  a. F u l l - t i m e p a r t i c i p a t i o n i n c l i n i c a l p a s t o r a l education f o r s i x t o twelve weeks i s recommended. b. Where t h i s i s not p o s s i b l e , p a r t i c i p a t i o n i n o r i e n t a t i o n programs at an a c c r e d i t e d center i s recommended. 2. F o r c h a p l a i n s s e r v i n g f u l l time, at l e a s t twelve months' f u l l - t i m e c l i n i c a l p a s t o r a l e d u c a t i o n i s recommended, s i x months o f which are t o be i n the type o f i n s t i t u t i o n which he s e r v e s . Where t h i s standard has not y e t been a t t a i n e d , h o s p i t a l a d m i n i s t r a t o r s are encouraged t o r e l e a s e t h e i r c h a p l a i n s p e r i o d i c a l l y f o r the necessary t r a i n i n g .  -118APPENDIX H BIBLIOGRAPHY Books The A i r Force Chaplain. Department of the Air Force, 1). U . , A i r Force Manual No. 165-3.  Washington,  Belgum, David, C l i n i c a l Training for Pastoral Care. Press: Philadelphia, 1 9 5 ° .  Westminster  Book of Common Prayer Canada 1959. Cambridge University Press: Cambridge, 1 9 5 9 . Cabot^ Richard C . , What Men Live By. and New York, IJtT.  Houghton M i f f l i n :  Boston  Cabot, Richard C . , and Dicks, R u s s e l l L . , - T h e Art of Ministering to the Sick. McMillans New York, 1936 (He-issued 19^7). Cayton, H . R., and N i s h i . S. M . , The Churches and S o c i a l Welfare. V o l . 2, National Council or the (Jhurches of Christ i n the U . S . A . ; New York, 1955. Cannon, I d a M . , On the S o c i a l Frontier of Medicine. University Press: Harvard, 1 9 5 2 .  Harvard  Cross, F. L . , The Oxford Dictionary of the C h r i s t i a n Church. Oxford University Press: flew York, Toronto, London, 1 9 5 8 . The Dialogues of Plato (Howett T r a n s l a t i o n ) . New York, 1937. E l l i o t t . Mabel A . , Crime i n Modern Society. Brothers: New York, 1 9 5 2 .  Random House: Harpers and  Friedlander, Walter A . , Concepts and Methods of S o c i a l Work. P r e n t i c e - H a l l : Englewood C l i f f s , New Jersey, 1958. Fox, A. H . P u r c e l l , The Church's Ministry of Healing. Green and Company: JNew York, 1 9 5 9 .  Longmans,  Hamilton, Gordon, Theory and Practice of S o c i a l Case Work. Columbia University Press: Wew York, 1 9 5 1 . H i l t n e r , Seward, (Editor) C l i n i c a l Pastoral T r a i n i n g . National Council of Churches: New York, 1 9 ^ 5 . Hofmann, Hans, The Ministry and Mental Health. Press: New York, 1 9 0 0 .  The  Association  -119-  Index to Religious P e r i o d i c a l L i t e r a t u r e . Princeton Theological Seminary, Princeton. ^Biennial publication.) The Lambeth Conference 1958. S . P . C . K . , London, 1958. Niebuhr, H . Richard; Williams, Daniel D . . and Gustafson, James M . , The Advancement of Theological Education. Harper and Brothers: New York, 1957. Maves, P a u l B . , ( E d i t o r ) , The Church and Mental Health. Scribner's Sons: New York, London, 195.3. O l i v e r , Michael, S o c i a l Purpose for Canada. Toronto Press: Toronto, 1901. Richmond, Mary E . , S o c i a l Diagnosis. New York, 1917.  Charles  University of  Russell Sage Foundation:  S o c i a l Welfare Forum. National Conference of S o c i a l Work, Columbia University Press: New York, 1951. Standards for the Professional Practice of S o c i a l Work. American Association of S o c i a l Workers: New York, 1951. Stephen, Karin, The Wish to F a l l 111. Cambridge University Press: Cambridge, 19JJ (.Paper back e d i t i o n i960). Stroup, Herbert Hewitt, S o c i a l Work, An Introduction to the F i e l d . American Book Company: New York, 194tS, T.aft, Donald R . , Criminology, A C u l t u r a l Interpretation. MacMillan: New York (Revised edition) 1950. Towle, Charlotte, Common Human Needs. National Association of S o c i a l Workers: New York, 191?7 {Original publication 19V?). United Nations Economic and S o c i a l Council, Training for S o c i a l Work: An International Survey. United Nations: New York, Wise", C a r r o l l A . , Pastoral Counselling, Its Harpers and Brothers: New York, 1951.  Theory and P r a c t i c e .  Witmer, Helen L . , S o c i a l Work: An Analysis of a S o c i a l Institution, £"arrar and Rinehart: New York, 194-2.  -120Articles A n n u a l R e p o r t of- t h e D i r e c t o r o f C o r r e c t i o n s f o r t h e Y e a r M a r c h 3 1 , 19bl. ( . B r i t i s h C o l u m b i a ; , queen's P r i n t e r : V i c t o r i a , 1961.  Ended  7  B a r r y K., "The C a t h o l i c C h a p l a i n . " The C a n a d i a n N u r s e , The C a n a d i a n N u r s e s ' A s s o c i a t i o n : M o n t r e a l , V o l . L V I I , No. 12 (Dec emb e r ) , 1961. B e n d a , Clems E . , "Bereavement a n d G r i e f Work." The J o u r n a l o f P a s t o r a l C a r e , V o l . X V I , No. 1 ( S p r i n g ) , I962: B o n e t - M a u r y , G., " H o s p i t a l i t y ( C h r i s t i a n ) . " E n c y c l o p a e d i a o f R e l i g i o n and E t h i c s , James H a s t i n g s , E d i t o r . B o w e r s , S w i t h u n , " S o c i a l Work as a H e l p i n g Profession."  S o c i a l Work, V o l .  and  Healing  I I , No. 1 ( J a n u a r y ) ,  1957.  B o w e r s , S w i t h u n , "The N a t u r e and D e f i n i t i o n o f S o c i a l Casework P a r t I I . " J o u r n a l o f S o c i a l C a s e Work, V o l . XXX, No. 9 ( S e p t e m b e r ) , 19^9. B u r n s , James H., "The I n s t i t u t e o f P a s t o r a l C a r e . " P s y c h o l o g y , V o l . I V , No. 37 ( O c t o b e r ) , 1953.  Pastoral  C a b o t , R i c h a r d C., " A d v e n t u r e o n t h e B o r d e r l i n e o f E t h i c s . " The S u r v e y , V o l . I V , No. 5 ( D e c e m b e r ) , 1925. "Council f o r C l i n i c a l Training, Inc.,C l i n i c a l Pastoral Training P r o g r a m s and Member S e m i n a r i e s b y R e g i o n . " - T h e J o u r n a l o f P a s t o r a l C a r e , V o l . XV, No. h ( W i n t e r ) , 1961": Cox,  C o r d e l i a , "The C h u r c h ' s R e l a t i o n t o S o c i a l S e r v i c e S t u d e n t s . " The J o u r n a l o f P a s t o r a l C a r e , V o l . X, No. h ( W i n t e r ) , 1956.  E a s t m a n , F r e d , " F a t h e r o f t h e C l i n i c a l P a s t o r a l Movement." T h e J o u r n a l o f P a s t o r a l C a r e , V o l . V, No. 1 ( S p r i n g ) , 1951. F i n n e g a n , Hugh, "The C h a p l a i n and H i s Work." P r i s o n A s s o c i a t i o n P r o c e e d i n g s , 193^. Gluckman, R.,  "The C h a p l a i n  C l i n i c a l Team."  Point  as a Member o f t h e D i a g n o s t i c  M e n t a l H y g i e n e , V o l . I I , No. 37 ( A p r i l ) ,  "Helping the Dying P a t i e n t . " W o r k e r s , New Y o r k , i960. H e r o n , James W.,  National  "The I d e a l C h a p l a i n  o f View."  The American  American P r i s o n  Association  1953.  of S o c i a l  from the Superintendent's Association  Proceedings,  1928.  -121H i l t n e r , Seward, and - i e g l e r , Jessie H . , " C l i n i c a l Pastoral Education and the Theological Schools." -The Journal of Pastoral Care, V o l . XV, No. 3 ( F a l l ) , I96T: "The Institute of Pastoral Care, I n c . , C l i n i c a l Pastoral Training Centers."- The Journal of Pastoral Care, V o l . XV, No. 4- (Winter), 1961": Karpf, Maurice J . , "Some Guiding P r i n c i p l e s i n Marriage Counselling." The Journal of Pastoral Care, V o l . X, No. 4- (Winter), 1956. Kennedy. Natalie.'Helping the Dying Patient and His Family, Part 3." National Association o f - S o c i a l Workers: New York, I960. K i r k , T . E . , "The Bole of the Chaplain i n a H o s p i t a l . " Medical Services Journal, V o l . XVII, No. 10 (December), I96IT" Kuether, Frederick C . , "The Council for C l i n i c a l T r a i n i n g . " Pastoral Psychology, V o l . IV, No. 37 (October), 1953. Lindemann, E r i c h , "Symptomatology and Management of Acute G r i e f , " American Journal of Psychiatry, V o l . X I , 194-4-. Lenroot, Katharine F . , "Fundamental Human Needs Facing the S o c i a l Worker Today." The Family, V o l . XVI, No. 4-, 1935. McKnight, E . T . A . , "A Chaplain Interprets his Work." The Canadian Nurse, The Canadian Nurses' A s s o c i a t i o n : Montreal, v o l . L v l i , JNo. 12 (December), 1961. "Medicine and the Church." A Statement Approved by the Council of the B r i t i s h Medical Association, B r i t i s h Medical Journal, November 8, 1947. Mental Health Services Annual Report Department o f Health Services and h o s p i t a l insurance, Queen's P r i n t e r : V i c t o r i a , 1962. I  9  6  I  ,  Morgan, John S . , " S o c i a l Welfare Service i n Canada." Social Purpose for Canada, Edited by-Michael O l i v e r , University of Toronto Press: Toronto, I96I. Morris, Albert, ( E d i t o r ) , "What's New i n the Work of the Church and the Chaplain i n Correctional Institutions?" Correctional le.search, A Publication of the United Prison Association of Massachusetts, Boston, B u l l e t i n No. XI (November), 1961. "Opportunities for Study, Training and Experience i n Pastoral Psychology." Pastoral Psychology, V o l . V, No. 50 (January), 1955.  -122Parsons, T a l c o t t , "Mental I l l n e s s and " S p i r i t u a l M a l a i s e ' : The Role of the Psychiatrist and the Minister of R e l i g i o n . " i n The Ministry and Mental Health, Edited by Hans Hofmann, Associated Press: New York, 19b0. Pray, K . . "Restatement of General P r i n c i p l e s of S o c i a l Casework P r a c t i c e . " Journal of S o c i a l Casework, V o l . XXVIII, No. 8 , 19^7. Ross, Matthew, (Editor) Survey of Mental Health Needs and Resources of B r i t i s h Columbia, Queen's P r i n t e r : V i c t o r i a , . Southard, Samuel, "Religious Counselling In Psychoses." The Journal of Pastoral Care, V o l . X, No. h (Winter), 195bT~ Spence, Sue, "Religion and S o c i a l Work." No. 3 ( J u l y ) , 1956.  S o c i a l Work, V o l . I ,  Strunk, Orlo, and Reed, Kenneth E . , "The Learning of Empathy: A P i l o t Study." The Journal of Pastoral Care, V o l . X I ,  No. h (Winter), 19~57T  T i l l i c h , Paul, "Theology and Counselling." The Journal of Pastoral Care, V o l . X, No. h (Winter), 1^5^ Touzel, Bessie, The Moral Foundations of S o c i a l Work. Fourth Western Regional Conference of .Social Work, Regina, Saskatchewan, J u l y , 1953. The Twenty-Second B i e n n i a l Meeting of the American Association o^" TQeoXogical Schools i n t fie"United States and Cana5aT B u l l e t i n zh, June 190O-, Union Theological Seminary: Richmond, V i r g i n i a , i 9 6 0 . Walsh, James J . , " R e l i g i o n and H e a l t h . " Encyclopaedia, V o l . VII, 1910.  The Catholic  Ward, Archibald, F . , "Therapeutic Procedures for the Chaplain-;-" : The Journal of Pastoral Care, V o l . X, No. h (Winter), 1956. Weil, Frank L . , "Co-operation of Churches and S o c i a l Work." The S o c i a l Welfare Forum, National Conferences of S o c i a l Work I 9 * 9 , Columbia University Press: New York, 1 9 5 0 . L  Whiting, Henry J . , "Current Emphasis i n Casework Under Religious Auspices: Integration of Casework and other Programs." S o c i a l Welfare Forum, National Conference of S o c i a l Work 1951, Columbia University Press: New York, 1951. Weiss, David, "The Ontological Dimensions i n S o c i a l Casework." The S o c i a l Worker, V o l . XXX, No. 1 (January), 1962.  -123-  Wise, C a r r o l l . S., "The Place of C l i n i c a l Training i n the Department of Pastoral Theology." The Journal of Pastoral Care, V o l . V, Wo. 1 (Spring), 1951. Unpublished 'Works C o l l i e r , Elizabeth A . , The S o c i a l Service Department of the Vancouver General H o s p i t a l ; Its history and Development 1902-19H9: Master of S o c i a l Work t h e s i s , University of B r i t i s h Columbia, 1950. Sladen, Kathleen, The Question Arises: & study on S o c i a l Work and R e l i g i o n . Master of S o c i a l Work t h e s i s , University of Toronto, 1957. Skenfield, Alfreda, S o c i a l Worker and Minister i n Welfare Services. Master of S o c i a l Work t h e s i s , University of B r i t i s h Columbia, i960. Standards for Mental Hospital Chaplaincy, Association of Mental Hospital Chaplains, 19P3 (Mimeographed Brochure).  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0105788/manifest

Comment

Related Items