"Arts, Faculty of"@en . "Social Work, School of"@en . "DSpace"@en . "UBCV"@en . "MacRae, Robert Daniel"@en . "2011-11-24T00:58:41Z"@en . "1962"@en . "Master of Social Work - MSW"@en . "University of British Columbia"@en . "This study was undertaken (a) to examine some areas where the traditional role of the chaplain has undergone significant changes, (b) to determine the present role of the chaplain in a general hospital and (c) to study the Clinical Pastoral Training Movement, and its significance to the traditional chaplaincy and to social work.\r\nAfter a discussion of the historical background of the chaplaincy in the Christian Church and in some selected social institutions, there is an examination of the role of the chaplain in the general hospital and a discussion of some religious needs of patients.\r\nTo gain information from chaplains at Vancouver General Hospital each was interviewed and a questionnaire was completed. The chaplains also kept statistics of some aspects of their work for a two-week period. There is an examination of the chaplain's backgrounds, their counselling practices and referral patterns. The latter are compared to referral patterns made by theological students and social work students in three brief case illustrations.\r\nThe Clinical Pastoral Training Movement and its literature are examined in some detail. Standards and curriculum are outlined and references made to the rapid expansion of the movement.\r\nImplications are drawn for the Churches, the Vancouver General Hospital and social work. Some specific suggestions are made for these three areas arising from these findings."@en . "https://circle.library.ubc.ca/rest/handle/2429/39257?expand=metadata"@en . "THE CHAPLAIN IN HEALTH AND WELFARE SERVICES A Study of his Role i n the General Hospital with special 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 in Par t i a l Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK i n the School of Socia l Work Accepted as conforming to the standard required for the degree of Master of Social Work School of Social Work 1962 The University of B r i t i s h Columbia - i v -ABSTRACT This study was undertaken (a) to examine some areas where the tradi t ional role of the chaplain has undergone significant changes, (b) to determine the present role of the chaplain in a general hospital and (c) to study the C l i n i c a l Pastoral Training Movement, and i t s significance to the t radi t ional chaplaincy and to socia l work. After a discussion of the h i s tor i ca l background of the chaplaincy in the Christian Church and in some selected socia l inst i tut ions , there is an examination of the role of the chaplain i n the general hospital and a discussion of some religious needs of patients. To gain information from chaplains at Vancouver General Hospital each was interviewed and a questionnaire was completed. The chaplains also kept s tat i s t ics of some aspects of their work for a two-week period. There is an examination of the chaplain's backgrounds, their counselling practices and re ferra l patterns. The latter are compared to re fe r ra l patterns made by theological students and socia l work students in three brief case i l lus t ra t ions . The C l i n i c a l Pastoral Training Movement, and i t s l i terature are examined in some deta 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 Hospital and socia l work. Some specific suggestions are made for these three areas arising from these findings. TABLE OF CONTENTS Chapter 1. The Emerging Role of the Chaplain j The Problem. The Development of the Chaplaincy i n the Church. The Mil i tary Chaplain. The Chaplain i n Correctional Institutions. The Chaplain i n the Mental Inst i tut ion. Other Areas of Specialized Ministry. The Chaplain in the General Hospital . The Chaplain and the religious needs of the Patient. The Scope of the Study Chapter 2. A Case Study of the Chaplaincy at the Vancouver General Hospital Hospital Procedures. Interpretation of the \u00E2\u0080\u00A2word 'Chaplain 1 . Denominational Practices. Preparation of the Chaplain. The Chaplain at Work. Counselling Practices. Referral Patterns with other Professions. Referral Patterns indicated in 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 Training. Varying emphases. The Institute of Pastoral Care. Co-operation between the Council and the Institute. The Literature of Pastoral Care. Standards and Accreditations Chapter \u00E2\u0080\u00A2+. Implications of Recent Developments Implications for the Churches. Implications for the Vancouver General Hospital . Implications for Socia l Work Appendices: A. Sample questionnaire to Hospital Chaplains and O f f i c i a l V i s i tor s . B. Sample case histories . C. Stat i s t ical ' form. D;-Sample^Questionnaire of Student backgrounds. E. Sample application form for Vis i t ing Chaplain. F . Standards for the Work of the Chaplain in the General Hospital . (American Protestant Hospital Association) G. Standards for C l i n i c a l Pastoral Education. H. Bibliography. - i i i -TABLES IN THE TEXT Page Table 1. Number of Patients by Religious Denomination Admitted to the Vancouver \u00E2\u0080\u00A2 General Hospital For the two-week Period, March 11-24-, I962 38 Table 2. Number of Patient-Visits by Chaplains March 11-2-+, 1962 39 Table 3. Number of Referrals of Vancouver General Hospital Patients to Parish Clergy by Chaplains or V i s i to r s , March 11-24-, I962 40 Table 4-. Number of Working Hours of Chaplains at the Vancouver General Hospital March 11-24-, 1962 4-1 Table 5. Number of Patients seen for Counselling by the Chaplains During two week period March 11-24-, 1962 -+5 ACKNOWLEDGMENTS To Dr. Leonard Marsh of the School of Socia l Work, University of B r i t i s h Columbia, who gave the encouragement needed to pursue this topic in the i n i t i a l stages and to Professor William Dixon, Director of the School of Social Work, without whose help and constructive crit icisms this 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 tors at the Vancouver General Hospital who gave so freely of their 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 It i s a favorite t r i ck with those who pretend to read the palm or the handwriting to say, with special 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 socia l workers to the Massachusetts General Hospital for the purpose of improving the over-a l l medical care of patients. Dr. Cabot went on to observe about the palmist that: The beauty of this ever-successful t r ick is that what the sharper pretends to discover i n this individual , he knows to be true of every l iv ing being. We are piteously unexpressed. We dif fer only i n the means that can set us free. 2 What Doctor Cabot had realized about soc ia l work i n the medical setting was that the boundaries of professionalism had to be broken to let soc ia l work enter the medical setting and set i t free to serve the patient. It was only twenty years later that this same man recognized the same principle 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 Christian ministry. He could see that a means to set i t free was necessary. He wrote a plea for a c l i n i c a l year i n the course of theological s tudy. 1 As he observed theological students he wondered whether their 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 sp i r i t and i f so, whether their future service to individuals i n their parishes is not very like what the doctor actually does....when he v i s i t s a patient. 2 Considerations such as this led Dr. Cabot to speculate on the poss ib i l i t ies of ministers becoming \"members of the health team\" i n a manner not unlike his pioneering i n bringing the soc ia l worker into the staff of the hospital.-^ His 'plea* did not go unanswered and today i n Canada and the United States several thousand Ministers of Religion have benefited by \" C l i n i c a l Pastoral Training\" even as several thousand trained soc ia l workers are now employed i n hospitals. Each of the well-established professional discipl ines accepted today as an essential 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 particular contribution i t has to make i n the to ta l diagnosis and treatment of an i l l person. This has been particularly 1 Cabot, Richard C . , \"Adventure on the Borderland of E th ic 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. jo . -3-true of c l i n i c a l psychology, psychiatry and socia l work. Even today, however, these discipl ines are not accepted to the same degree. Now another profession, the ministry, and particularly the ins t i tu t iona l chaplaincy, which i s also concerned with the adjustment of people, both emotional and soc ia l , has begun to extend i t s interests and contributions beyond i t s long-established role into c l i n i c a l work. With i t s introduction of medical soc ia l workers i n 1912 the Vancouver General Hospital was a pioneer i n B r i t i s h Columbia i n making soc ia l work a partner of the healing professions.''\" By contrast the hospital chaplain, f i f t y years later , i s not generally considered part of the hospital team. Today the chaplaincy comes to the Vancouver General Hospital as an outside \u00E2\u0080\u00A2auxi l iary ' service supported by various denominations. The evolution of the chaplaincy since Dr. Cabot's inspirat ion has i n many places been very remarkable. In countless ways the t radi t ional role of the chaplain has been changed and modified. As a result , the chaplain i n many general hospitals, as wel l as welfare institutions of various kinds, i n the United States and to a limited extent i n eastern Canada, has become an integral part of the healing team. It i s of particular note that i n B r i t i s h Columbia, medical and welfare agencies, as wel l as the Churches, have been among the last to 1 See: C o l l i e r , Elizabeth A . , The Social Service Department of the Vancouver General Hospital : Its history and Development, 1902-19^9, Thesis for Masters Degree i n Socia l Work, The University of B r i t i s h Columbia, 1950. see the value of the recent developments i n the training of the chaplaincy, particularly that arising 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 re l ig ion ' s t radi t ional concern for sickness and healing. Primitive societies , as wel l as the cultured Greeks, considered priest and medicine man synonymous. Healing was one of the priest ly functions i n Greek temples. Although the Hebrews were a nomadic people, and therefore not inc l ined , as were the Greeks, to establish permanent temples i n the early part of their history, there was a moral attitude toward the sick and the stranger which can he considered as antecedent to the ins t i tut iona 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. Often the sick were provided for by segregation; lepers were class i f ied as \"unclean\" and lived i n the h i l l s . It was left for later times to integrate the idea of hospitality and segregation (that i s \"hospital izat ion\") , with the needs of the sick, and combine the two elements into the hospital as an ins t i tu t ion . The healing miracles of Jesus indicate a change i n attitude toward sickness. Instead of merely protecting the community hy segregating the sick, the unfortunate victim was to be ministered to , healed and cared for . The parable of the Good Samaritan portrays the wounded man treated with utmost consideration, brought to an inn , and cared for u n t i l he recovered. 1 When Jesus healed lepers, he sent them to the priests to have their healing cer t i f i ed . The Great Physician instituted healing as a regular part of the work of the disc iples : \"They sha l l lay their hands on the sick and they o sha l l recover.\" When Christ sent out the Seventy, he Instructed them to \"heal the sick that are i n the way and say unto them, the Kingdom of God is come nigh unto you.\"^ Peter's reputation for healing became so great, \"That they brought forth the sick into the streets and la id 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 sick, described i n the Epist le of James 5, f ina l ly grew into 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 sha l l save the s ick, and the Lord sha l l raise him up; and i f he have committed s ins, they sha l l be forgiven him. 5 According to Talcott Parsons the most dis t inct ive feature of early Christ ianity was i t s rel igious \" individualism,\" i t s 1 St . Luke, 10:30-35. (King James Version used i n a l l - references.) 2 St. Mark, 16:18. 3 St . Luke, 10:9. h Acts of the Apostles, 5.15. 5 Epis t le of James 5;1-+, 15. -6-concern with the fate of the individual soul. Since the problem of health is also\u00E2\u0080\u0094however much i t i s soc ia l ly conditioned\u00E2\u0080\u0094a problem of the state of the indiv idual , i t is not surprising that early Christ ianity was permeated with concern with health, and that religious healing was one of i t s central bases of i t s val idation. The impact of the Gospels would certainly have been greatly diminished had this element been removed. 1 As the Church became more completely organized, care of the sick was also inst i tut ional ized. It took a special c r i s i s to bring the needs of the sick into the open. \"Naturally i t was travellers attacked by i l lness that called for the greatest pity and anxiety. This was the or igin of hospi ta l s . . . . the f i r s t 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 their coverage of human needs. There was an inn for strangers and travel lers , a hospital for the treatment of acute i l lne s s , another hospital for chronic patients, and homes for orphans, the aged, the reception of the poor, and another for a l l kinds of destitutes. 1 Parsons, Talcott , \"Mental Il lness and ' Sp i r i tua l Malaise ' : The Role of the Psychiatrist and the Minister of Rel ig ion. \" i n The Ministry and Mental Health, edited by Hans Hofman, Association Press: New York, 1900, p. 2h. 2 Bonet-Maury, G , , \"Hospital ity (ChristianV i n James Hastings, (ed.) Encyclopaedia of Religion and Ethics , V o l . VI p. 80H-. - 7 -During the Middle Ages numerous monastic orders and lay-brotherhoods cared for the s i c k . 1 Monastic orders were established to meet the health crises 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 hospital would be founded by an order, and in other cases a religious order would be horn from an unusually successful hospital program, so that branch hospitals would be sponsored by the mother ins t i tut ion . It i s illuminating to notice that the sp i r i tua l care of patients i n the Hotel Dieu (a thirteenth century hospital i n Paris) was quite complete and elaborate. Everything possible was done to maintain the patient's sp i r i tua l l i f e . On entering the hospital , the patient, i f a Christian, 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 their 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 their benefactors, for the authorities, and for a l l who might be i n distress . At n ight fa l l a sort of l i tany was recited 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 station or of noble rank and charitable disposit ion, l ike 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 1537); The Congregation of Alexian Brothers, Germany (Founded c.1250). 2 Walsh, James J . , \"Religion and Health,\" Catholic Encyclopaedia, 1910, V o l . VII , p. 466. -8-The two roles of 'physician to the body' and 'physician of the soul' were often combined in that of the priest or chap la in . 1 In many instances the roles would be d i f f i cu l t to dist inguish. With the advance of science i n the 17th to 19th centuries and i t s application to the study and practice of medicine the two roles became more differentiated. The study of medicine became almost exclusively the concern of the la i ty and the \"cure of souls\" became the unique role of the hospital priests . The hospital was the chaplain's \"parish\" and the patients were his \"parishioners.\" He ministered to the patients i n a manner not unlike that of any parish priest . The extra-parochial ministry i n the hospital setting was not the only specialized ministry to evolve i n the Church. There has developed a vast ministry pertaining to other ins t i tu-tions and organizations. The Mil i tary Chaplain The military chaplain today fa l l s heir to an office of long t rad i t ion . The ins t i tut ion of the chaplaincy has a history as old as the story of military 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. Purce 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 University Press: London, 1958. -9-beggar. The half that he kept, known as \"Capella ,\" 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 battles. 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 this side of the At lant ic . Here, too, the tradi t ion of service and sacr i f ice 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 battle 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. The only consistent principle at the time was the be l ie f that the chaplain should represent the religious sentiment of the troops he served. The legal origin of the chaplaincy as part of the American mil i tary service is found i n a resolution of the Continental Congress, dated July 2, 1775.1 An act of that date established the mil itary chaplaincy. In time the Continental Army had hospital chaplains, a German chaplain-at-large, a chaplain-missionary to the friendly Indians, and one divis ion 1 The Air Force Chaplain, Air Force Manual Number 165-3, Department or the Air rorce, Washington, D, C . , March 195*+, p. 1. -10-chaplain at Headquarters. During World War II there were 8,896 ministers, priests and rabbis serving as chaplains to United States forces. In Great Br i ta in and Canada, Army and Air Force chaplains are given permanent or temporary commissions, and rank equivalent to captain or above according to seniority; 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 rel igious bodies. Chaplains appointed by the state are paid by the state. There are approximately 200 chaplains serving Canadian armed forces at the present time. The Department of Veterans1 Affairs i n Canada attaches sufficient importance to patient care that they employ chaplains on a full-time 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 Institutions The chaplain also ministers i n correctional Institutions. Gaols, or ig inal ly for the safe-keeping of prisoners awaiting t r i a l\u00E2\u0080\u0094a function they s t i l l serve\u00E2\u0080\u0094and houses of correction, or ig inal ly \"for the setting of the Poore on Worke, and for the avoiding of ydleness,\" came into general use as places for the incarceration 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 rk , T. \u00C2\u00A3 . , \"The Role of the Chaplain i n a Hospi ta l , \" Medical Services Journal, V o l . XVII, No. 10, November I96I, PP. 765-767. 2 There are Roman Catholic, Anglican and United Church full-time chaplains at the Shaughnessy Mil i tary Hospital , Vancouver. One of them holds the degree M.S.S.W. -11-duty of archdeacons to v i s i t a l l prisoners every Sunday. 1 Several religious brotherhoods were speci f ica l ly organized to minister to criminal offenders. This interest is common to a l l rel igious denominations, each of which, with i t s own emphasis, recognizes a responsibi l i ty 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 dignity of human personality. . . the redemptive power of love and the f u t i l i t y of brutal and vindictive punishment...it is to the rel igious leadership within the prison that we must look to help the prisoners understand the creative and regenerative powers of love. 2 There are penal institutions where the one bright spot i n an otherwise drab and hopeless situation is 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 tr ies to gain the confidence of the inmates or interests himself i n the welfare of their families or even in preparing the situation 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 Institute for 1 Correction Research, edited by Albert Morris, A Publication-of the United Prison Association of Massachusetts, November 1961, p. 2. 2 E l l i o t t , Mabel A . , Crime in Modern Society, Harpers and Bros. , 1952, p. J6&3. 3 Finnegan, Hugh, The Chaplain and His Work, American Prison Association Proceedings, 1934-, pp. 2bl-2b5. -12-Catholic Prison Chaplains, held i n 1940, i n Washington, D. C . , that . . . frequently the chaplain is the one o f f i c i a l who can establish 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 is the sp i r i tua l welfare of the prisoner. In an organized religious program, this relationship i s based on the understanding engendered i n the i n i t i a l interview in which the chaplain carefully explores the attitudes, the religious convictions or philosophy, the motives and the goals which underlie not only the prisoner's criminal l i f e , but his whole existence. 1 The ideal chaplain from some wardens' point of view i s , among other things, a man who w i l l not interfere with d i sc ip l ine . Some chaplains have agreed that such matters are none of their business even i f they think the punishments Infl icted cruel or undeserved, while occasionally a courageous chaplain cal l s attention to abuses. Some chaplains cooperate effectively with other staff members in those modernized prisons where good c las s i f ica t ion and case work are being done. Others speak a language inconsistent with sc ient i f ic methods i n prisons.^ It i s perhaps i n the correctional setting that the new role of the chaplain has evolved to the greatest extent. A unique phase in 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 Taft , Donald R., Criminology, A Cultural Interpretation, MacMillan: New York, Revised edit ion, 1950, p. 218. -13-Gluckman, psychiatrist at the I l l i n o i s State Training School for Boys . 1 It concerns the chaplain as a member of the diagnostic c l i n i c a l team. This experiment has shown that the dual role of the chaplain as diagnostician and therapist, on the one hand, and religious leader on the other has not proved conf l ic t ive . On the contrary, this new role has been mutually beneficial to both aspects of the chaplain's work and the to ta l treatment team. The significant thing about Dr. Gluckman's ar t ic le is that the administrative and c l i n i c a l staff are aware that these additional members of the c l i n i c team could not be just any graduate theologians. In addition to specialized c l i n i c a l pastoral t ra ining , certain personality characteristics were necessary that would qualify the chaplain for the type of relationship needed. The most important thing, Dr. Gluckman claims, i s intuit ive 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 military forces. None of the chaplains so employed i n prisons i n Br i t i sh Columbia has taken C l i n i c a l Pastoral Training. In B r i t i s h Columbia there are two full-time chaplains on staff 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\u00C2\u00BB B r i t i s h Columbia, Queen's Printer: V i c t o r i a , p. 179. -14-is the \"Senior Chaplain\" and the other, the chaplain at Haney Correctional Inst i tut ion. Two part-time chaplains serve Oakalla Prison Farm, and the Prince George Gaol. Three voluntary chaplains (two of whom are theological students) serve at the Chilliwack Forestry Camp, Oakalla Prison and the Women's Gaol. At the federal level two full-time chaplains minister at the B r i t i s h Columbia Penitentiary, New Westminster, and two part-time chaplains minister at Agassiz and Williams Head. The Chaplain in the Mental Inst i tut ion The twentieth century has brought something genuinely new into the re lat ion of the Church to i l lness and health. Nowhere has this been more true than i n the work of the mental hospital chaplain. The stimulus for this new awakening has been the tremendous growth i n the psychological, psychiatric and socia l sciences. Although sharp differences continue to exist between psychiatrist and minister, the tension i s waning as each comes to understand more f u l l y the concepts and roles of each d i sc ip l ine . \"It might be pointed out here that there i s no more confl ict between the concepts of psychology and those of theology than there i s between certain schools of theology.\" 1 This has been one of the results of the development of the c l i n i c a l pastoral training movement i n the United States. The c a l l for chaplains i n state mental institutions represents the 1 Wise, Carro 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. -15-community's awareness that this role must become a part of the therapeutic community. Chaplains are represented in most mental institutions i n Canada. In B r i t i s h Columbia one Roman Catholic and one Protestant chaplain minister to the sp i r i tua l needs of the patients in 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 Hospital . The \"Ross Report\" of 1961 recommends p continued appointment of the chaplaincy at Essondale. The primary function of the mental hospital chaplain i s to provide a sp i r i tua l ministry to patients; i n addition he i s expected to interpret the function of the chaplain i n the hospital and the meaning of re l ig ion to other hospital personnel; to interpret to the community (church and c iv ic groups) the work of the hospital and the relationship of re l ig ion to the problems of mental health; to encourage, where 1 possible, programs for the c l i n i c a l pastoral training of seminarians and clergy, and to offer opportunities for clergy to obtain specialized training 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 this ministry. 3 Among the standards for qual i f icat ion as a mental hospital chaplain approved by the Association of Mental Hospital 1 Mental Health Services Annual Report 1961 , Department of Health Services and Hospital Insurance, Queen's Printer: V i c t o r i a , 1 9 6 2 . 2 Survey of Mental Health Needs and Resources of Br i t i sh Columbia. Editor : Matthew Ross, Medical Director. American Psychiatric Association, I 9 6 I , p. 126 . 3 Standards for Mental Hospital Chaplaincy, adopted by the Association of Mental Hospital Chaplains at their 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.) -16-Chaplains i s that he sha l l have completed a period of specialized training i n C l i n i c a l Pastoral Training. None of the chaplains serving i n B r i t i s h Columbia mental hospitals i s so qual i f ied. Other Areas of Specialized Ministry The foregoing discussion of the chaplaincy i n various institutions does not describe a l l specialized ministries. Full-time and part-time chaplaincies are often assigned to church-sponsored homes for the aged, T .B . Sanitorla, 1 9 univers i t ies , missions to seamen, treatment centers and c l in ic s for alcoholics , institutions for the care of children, and homes for unmarried mothers. For example i n a Lutheran maternity home i n Minnesota: . . . s i gn i f i cant results are being demonstrated through close teamwork of chaplain, caseworker, and nurse . . . . Where gu i l t , anxiety, and hos t i l i ty are present, redemptive rel igious f a i th with i t s restorative power i s off ered, through individual pastoral care and group worship. * 1 The University of B r i t i s h Columbia has four full-time chaplains (Anglican, Lutheran, Roman Catholic, United Church) and three part-time chaplains (Baptist, Presbyterian, Lutheran.) They are sponsored by their respective church authorities. 2 There are four full-time chaplains i n Vancouver, North Vancouver, and New Westminster serving in \"Mission to Seamen\" hostels. 3 The Alcoholism Foundation of B r i t i s h Columbia hires a full-time Priest-Counsellor, and makes special re ferra l to some c i t y clergy on a part-time basis. h Whiting, Henry J . , \"Current Emphases i n Casework under Religious Auspices: Integration of Casework and other Programmes,\" Soc ia l Welfare Forum, 1951, National Conference of Social Work, Columbia University Press, New York, p. 217. -17-The Chaplain i n the General H o s p i t a l Something of the Church's ministry to the p h y s i c a l l y i l l has already been described under the development of hospitals and the h o s p i t a l chaplain. Ministry to the sick has always been a primary o b l i g a t i o n of the C h r i s t i a n Church, and i n t h i s i t follows the example and charge of her Founder.'1' V i s i t s to the sick i n t h e i r homes are s t i l l one of the f i r s t charges upon the parish ministry, but today a vast portion of the people i n serious i l l n e s s are to be found i n hospitals, so that i n e v i t a b l y the ministry to the sick i s concentrated i n the great network of hospitals throughout the country. The c a l l i n g of the h o s p i t a l chaplain i s not new, but ministry to the sick i n a large modern ho s p i t a l involves a new approach to t h i s whole question by the Church, the h o s p i t a l and various levels of Government. In B r i t a i n the Ministry of Health recognizes the important part the chaplain has to play i n the l i f e of a h o s p i t a l and i n the whole work of healing, and provision for chaplains i n a l l hospitals i s i n s i s t e d on by the Ministry. The relevance of r e l i g i o n to the healing art i s slowly, but s t e a d i l y , gaining recognition. This has been marked by a statement approved by the B r i t i s h Medical Association i n 194-7, which recommends that there should be a closer cooperation between ministers of r e l i g i o n and medical p r a c t i t i o n e r s . 2 I S t . Matthew 4-:23; St. Matthew 25:36; St. Mark 16:18. 2'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, 19-+7, Vol . i i , p. 112. -18-The Council of the B r i t i s h Medical Association is of the opinion that there i s no ethical 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 religious ministrations w i l l conduce health and peace of mind or w i l l lead to recovery. Such cooperation is often necessary and desirable, and would help to prevent abuses which have arisen through the act iv i t ies of irresponsible and unqualified personnel. Two movements have led to this 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 lne 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 their responsibi l i t ies to those i n hospital . 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 soc ia l worker, and the problem is to find the most effective means of cooperation. The opportunity for this cooperation is nowhere better provided than i n the modern hospital , where the chaplain finds himself working i n close association with numbers of men and women devoted to the service of the s ick. The better he understands the functions and roles of other disc ipl ines , the more inte l l igent ly \u00E2\u0080\u00A2wil 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 i n theirs . He must, therefore, be afforded the training necessary for this specialized work. The Chaplain and the Religious Meeds of the Patient The chaplain no less than the soc ia l worker i n the medical hospital often finds that questions and problems which cl ients have regarding themselves and others come to focus i n the very process of admission to the hospital . I f the problems are not discovered on admission, they may come to light during the patient's stay i n hospital or just prior to discharge. I l lness presents unusual opportunities, too, for consideration of the sp i r i tua 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 solat ion i n a strange ins t i tut ion can be stressful for a patient and thus precipitate responses indicating deep s p i r i t u a l needs. One of the most common responses i n i l lness i s that of gr ief , either as a result of bereavement or as \"anticipatory gr ie f . \" The latter i s a term used by Dr. Er ich Lindemann, who 1 Stroup, Herbert Hewitt, Social Work, an Introduction to the F i e l d , American Book Company: New York, 1946, pp. 3b*+-375. -20-has written a descriptive account of some of the dynamics of grief in 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 find genuine grief 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 in this case i s not due to death but i s under the threat of death. 1 There are many kinds of grief response. There is that which follows the loss of a member of the family by i l lness 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 grief response which comes from anticipation of possible death, as with the admission to the armed services during wartime. There is the more subtle grief response which i s associated with the loss of love of husband or wife, even though they continue to l ive with each other. And there i s the grief response which i s caused by the concern of parents over a chi ld who has got into trouble at school, or i n socia 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 sel f or family which is held to be essential 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 is necessary to build new habits and new act iv i t ies 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 Gr ie f , \" American Journal of Psychiatry, Vo l . 101, V)kk9 pp. 1H-1-1U6. -21-of 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 fai lure or hurt i n the relat ion with the loved one, and assist i n formulating what the future re la t ion w i l l be to the loved one. 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 th i s , there i s a dearth of l iterature on the topic within the various discipl ines ministering to this need. The soc ia l worker, no less than the minister, must face the bereaved c l i ent . Helping the dying patient and his family can be a most distressing experience for the soc ia l caseworker. It is an area of practice that demands the highest calibre of professional disc ipl ine 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 is called upon to give as unselfishly of himself and his service as at any point in his professional l i f e . 1 There are a number of patients who seem to be unable to return to their 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 Social Workers: New York, I960, p. 23. See also: Benda, Clemens E . , \"Bereavement and Grief Work,\" The Journal of Pastoral Care, Spring 1962, V o l . XVI, No. i . -22-some of the things that are concerning them. The hospital chaplain i s on the front lines of the church's ministry and is 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 chief purposes of the ministry i s to nurture wholesome family l i f e . It is often found that for some patients family d i f f i cu l ty is an even greater cause of anxiety than i s the i l lne s s . Such anxiety often inhibits 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 this opportunity to enable the patient to view r e a l i s t i c a l l y the stresses in his home and his family l i f e . Often the patient w i l l not be far enough along i n sp i r i tua 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 rel igious worker. To make an accurate sp i r i tua l diagnosis one must know enough facts of the s p i r i t u a l condition, i t s development, characteristics expressions, and where possible, something of i ts origins. In some instances, simply the opportunity to talk freely w i l l be of sufficient help to the patient so that he can go on to work out his sp i r i tua l concern largely by himself. Great help to the patient may come through the process of thinking through his relationship with various members of his household or community. By this means the admonition \" I f . . t h y brother hath aught - 2 3 -agalnst thee, leave there thy gift before the a l tar , and go thy way, f i r s t 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 is of interest to the chaplain i s that of grudge-hoIding and of unresolved grievances. The question \"What have I done to deserve this?\" is often found i n the person who either i n act or feeling has wished some harm on someone else and has instead become i l l himself. This problem i s as old as the Book of Job and is no less a concern of psycho-analysts and medical socia l 2 workers today. One of the early church fathers called the Holy Communion \"medicine for the soul . \" Patients often mark the reception of the Communion as the turning-point of their i l l n e s s . It i s certainly the Church's chief \"medicine,\" and i t helps to sum up a l l that is good i n the patient's re lat ion to God and to other people. One of the values of the sacramental action i s that i t helps to bring the patient's attention and interest outside himself, overcoming the withdrawal that i s characteristic of many patients following operation. The Sacrament of Holy Communion or private prayer is one of the greatest forces of support to the patient who must face an operation. It is 1 St . Matthew 5s24-. 2 See: Stephen, Karin, The Wish to F a l l 111, Cambridge University Press: London and New York, I960 (Paper Back edit ion) . -24-important to the patient whose body image is i n jeopardy that he have continuing support from the community and from his church. It i s important too, that the patient real ize the rea 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 poss ib i l i ty that the patient who has not expressed gu i l t , fear, or resentment i s l ike ly to interpret the administration of Holy Communion without any discussion of his sp i r i tua l condition as a sign that \"everything i s a l l r i ght . \" One of the factors found in i l lness is the evasiveness of the patient i n facing his l i f e s i tuation. Religion and i t s sacraments may be a powerful force in helping the patient meet a d i f f i cu l t s ituation 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 iv ing fa i th we receive that Holy Sacrament,... so is the danger great i f we receive the same unworthi ly . \" 1 In summary i t may be said that the hospital chaplain finds many opportunities to help patients with sp i r i tua l problems. Such problems as loneliness, fear, bitterness and grudge, the sense of gu i l t , boredom, physical pain and mental suffering are a l l encountered by the chaplain. He must be 1 \"The Exhortations,\" Book of Common Prayer, Canada, 1 9 5 9 , 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 futurity. 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 hospital setting he works with a vast team devoted to serving the patient and assisting him on the road to recovery. The relevance of these areas of concern to the chaplain is perhaps best summarized i n The Modern Hospital , July, I9U6: As the knowledge of psychosomatic medicine emerges, the role of hospital attendants i n the treatment of i l lness 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 hospital workers is i n some way related to the quality of hospital care. This relationship, as i t turns out, is direct and s ignif icant ; good emotional tone is an essential 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 Hospital . Personal interviews were conducted with each full-time chaplain and each f u l l - time \" o f f i c i a l hospital 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, Vo l . 57, No. 12, December, 1961, pp. 114-2-3. See also: 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, -26-a questionnaire and an interview, data regarding the chaplain's 1 work were gathered. Each chaplain also kept some stat i s t ics regarding his work for a two-week period, March l l - 2 M - t h , 1962. Although these s tat i s t ics are not exhaustive, i t i s believed they show current trends and conditions. Volunteers from the Bachelor of Social Work class and from members of the graduating classes of Anglican Theological College and Union College completed a short questionnaire^ and outlined their responses to the situations outlined i n three br ie f case histories . These responses were i n answer to three questions concerning the case history: (1) What i s your i n i t i a l reaction to the presenting situation? (2) Do you feel competent to handle the situation? and (3) To whom might you refer the people in question for further help i f needed? The student each gave written answers and completed the questionnaires during the period of one hour. The three \"case histories\" were also given to the five hospital chaplains and two o f f i c i a l v i s i tors at the Vancouver General Hospital . 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 training or education of each. The study w i l l try 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 See Appendix D. h See Appendix B. -27-setting? What are his referra 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 outlined. CHAPTER II A CASE STUDY OF THE CHAPLAINCY AT THE VANCOUVER GENERAL HOSPITAL The pastor Is deeply and inevitably involved in problems of human welfare. Not only does his work take him intimately into the l i f e situation of many families, but i t is deep i n the tradi t ion of religious institutions that people should bring their problems to the pastor, and he i s expected to help resolve them. The fact that a person is hospitalized and separated from his community does not mean that his l i f e ' s problems and anxieties are left behind i n the community. He brings them with him\u00E2\u0080\u0094his socia l and psychological problems, and his religious and sp i r i tua l problems. Indeed, often the anxieties are intensi-fied because of his hospital ization. In many instances these unresolved problems hinder his return to health of body and mind. But because the patient Is inst i tut ional ized he cannot seek help beyond the hospital, and the resources of the professions must be brought to him. Today the modern hospital brings many discipl ines together to form a \"treatment team\" to serve the patient. The 1 Cayton, H. R. , and Nishi , S. M. Churches and Socia 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. - 2 9 -Vancouver General Hospital is no exception. Medical doctors, nurses, socia l workers, psychiatrists , psychologists, therapists and teachers pool their learning and experience in ministering to the sick. The one exception outside this team at the Vancouver General Hospital i s the minister of re l ig ion . It i s true that he is to be found v i s i t ing the sick i n wards of the hospital but he does not come as a representative of the hospital nor as a member of the \"team.\" He is sent by the community outside the hospital . This has not always been so at the Vancouver General Hospital . In 1919 a group of Vancouver cit izens, recognizing the need for a religious ministry, asked the Reverend Cec 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 religious counsel was sought by hundreds of people. The c i t izen ' s committee raised funds for his stipend and i n 1920 he began what was to be a 30 year ministry to the sick at Vancouver General Hospital . During the early years of the depression following 1929 the committee sought assistance from the Board of Trustees of the hospital to help pay for Padre Owen's services. The Board recognized his invaluable service to the patient and took 1 The citizens committee was headed by Dr. Malcolm MacEachern, Medical Director, Vancouver General Hospital , 1912-1922. It was under Dr. MacEachern that the Socia l Service Department was begun at V.G.H. -30-complete responsibi l i ty 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 Hospital\" has never been f i l l e d since Padre Owen's retirement. Ministers of r e l i g ion , however, continue ministering to the s ick. 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 re lat ively easy task. Upon examination, however, this is not the case, any answer to this question must consider three things: varying definitions of the word \"chaplain,\" the hospital procedures respecting the chaplain, and denominational practices. Definit ion of the Word 'Chaplain* The Vancouver General Hospital makes no dis t inct ion between \" O f f i c i a l Hospital V i s i tor \" and \"Chaplain.\" Indeed, the hospital 's o f f i c i a l registry of \"Vis i t ing Clergymen\" may include ordained Pastors, Priests , Ministers, Commissioned Salvation Army Officers , Rabbis, Deaconesses, and both male and female Lay Workers. The expressions \"Chaplain,\" \" O f f i c i a l Hospital V i s i to r \" and \"Vi s i t ing Clergyman\" are used inter-changeably. Prom the Churches' standpoint \"Chaplain\" generally refers to an ordained clergyman especially appointed to work in a hospital setting or ins t i tut ion or with a special group of people. \"Hospital V i s i tor \" refers to a full-time lay representative. In this paper \"Chaplain\" refers to both the ordained minister and the full-time lay worker unless the context indicates otherwise. Hospital Procedures The Vancouver General Hospital Administration has made an attempt to keep a registry of the \"Vi s i t ing Clergymen.\" This was compiled by asking the various denominations to have their o f f i c i a l representative(s) leave their name and address with the central administration offices of the hospital . This practice began i n 1959 as a result of a decision of the Board of Trustees upon the recommendation of the Medical Board of the Hospital . Upon the completion of an application form 1 the v i s i t ing clergyman is issued with a card signed by the Hospital Director which indicates that the clergyman may \"conduct appropriate religious r i tes and r i tua l s within the Hospital . \" There are 33 \"Vi s i t ing Clergy\" l isted as at March, 1962. No set of standards of education or training are necessary to qualify as a \"Vi s i t ing Clergyman.\" It is left to the denomination to select the person(s) to represent the church or sect. It has been found d i f f i c u l t , however, to keep the l i s t up to date. The hospital has not formulated procedures to assure this i s done as occasion necessitates. Thus some who are l i s ted have left Vancouver but their successors have not been registered. Each denomination must take the in i t i a t ive of registrat ion. At the present time one of the major denominations (Presbyterian) which hires a full-time hospital v i s i tor i s not registered with the hospital administration. In sharp contrast to th i s , the Salvation Army i s o f f i c i a l l y registered with 18 1 See Appendix E - 3 2 -representatives although none i s exclusively engaged i n hospital 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 ted with the administration office v i s i t the Hospital , Almost without exception the parish minister's duties include the \"Vi s i ta t ion of the Sick.\" Within the boundaries of Vancouver c i ty there are an estimated 200 clergy. In the course of any one week these clergy may v i s i t their 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 Pavil ion each day of the week. In some instances these clergy perform \"rites and r i tua l s \" but have no o f f i c i a l sanction to do so from the hospital administration. There is no procedure for registering these clergy as \"Vi s i t ing Clergymen.\" Denominational Practices Five denominations hire seven full-time hospital chaplains or v i s i tors to v i s i t patients i n medical hospitals i n p Vancouver including the Vancouver General Hospital . The Anglican Church and Roman Catholic Church each have one Chaplain working exclusively at the Vancouver General Hospital . The United Church supports two full-time religious workers. One of 1 Ta l ly taken by secretaries at the Information,Desk, Centennial Pavil ion, Vancouver General Hospital . 2 It should be noted that three full-time Chaplains are on staff of Shaughnessy Mil i tary Hospital; one at St. Paul's Hospital ; one at St. Vincent's Hospital . -33-these is a woman \"Hospital V i s i t o r ; \" the other is a retired 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 institutions such as Oakalla Prison and the B.C. Penitentiary. The salary or stipend of four chaplains and v i s i tors 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 collected by the central headquarters of the respective denominations. Salaries for Chaplains at the Vancouver General Hospital are sent from the following sources: (1) The Women's Missionary Society, Toronto, Presbyterian Church of Canada. ( 2 ) The Home Mission Board of the United Church of Canada, - Toronto. (3) The Joint Committee of the two Vancouver Presbyteries, The United Church of Canada, Vancouver. (4) The Department of Charities , American Lutheran Church, - Minneapolis, Minnesota, U.S .A. (5) The Anglican Synod of the Diocese of New Westminster, Vancouver. (6) The Alberta-Brit i sh Columbia Distr ict of the Missouri Synod of the Lutheran Church, Edmonton, Alberta. (7) The Society of the Sacred Sacrament, Vancouver. -3-+-Preparation of the Chaplains The training and educational background of the chaplains vary widely. Both women vis i tors have completed high school and one has taken a two year course in psychiatric nursing and one year of Normal School. Neither has received any instruction i n hospital v i s i t ing or any formal courses i n counselling, case work or the soc ia 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 in length) on \"Family and Marital Relations\" and \"Mental Health.\" Another Chaplain holds the degrees of B . A . , B .D . , and D.D. His major study was philosophy and history. He has taken one class i n psychology but no other courses in the soc ia l sciences. His theological courses did not include \"Pastoral Counselling\" and he found the training given for this work to be \"inadequate.\" One of the chaplains holds the following degrees and t i t l e s : A.Mus. T . C . L . , A . T . C . L . , and LTh. His theological course included courses in \"Pastoral Counselling\" which he found \"he lpfu l . \" The Roman Catholic chaplain received seven years of Seminary training with emphasis on philosophy and history. His courses included \"Pastoral Theology\" but he did not think this included what i s known today as \"Pastoral Counselling.\" He said he found Pastoral Theology \"helpful\" In meeting the problems he encountered in his ministry. -35-Another chaplain has the degree of B.Sc. (Chemistry), and a Diploma i n Theology. 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 Hospital 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 in charge of a parish. None of the other chaplains had previous experience as a hospital chaplain except that gained i n a parish by regular v i s i t s to hospitalized parishioners. Two chaplains received a limited orientation to the Vancouver General Hospital from their predecessors. When he began work at Vancouver General Hospital one chaplain was taken on a 'tour 1 of the hospital by the Assistant Medical Director. A l l of the chaplains and vis i tors thought that a course i n \"hospital chaplaincy\" should be given in the Vancouver area. None, however, has clearly defined ideas about th i s . Their ideas respecting the scope of such a course ranged from a \"few days orientation course on hospital work,\" through a course jo int ly sponsored by theological colleges i n Vancouver, to a two year course in C l i n i c a l Pastoral Training integrated into the hospital services and administration. The Roman Catholic chaplain thought i t would be d i f f i cu l t to combine a l l Churches i n such a course but he fe l t his own denomination should make more provision for training of i t s clergy who are hospital chaplains. None of the Protestant chaplains contemplated any denominational boundaries but rather stressed that such a course should be inter-denominational. - 3 6 -The Chaplain at Work At the time of admission to hospital each patient is asked to state his religious preference. A card which gives details of the patient is 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 Pavi l ion. The cards of the following denominations are sorted: Anglican, Baptist, Lutheran, Presbyterian, Roman Catholic, 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 Pavil ion Information Desk and the chaplains are free to make what use they wish of them. This room, i n which the chaplains sort their cards and plan their day's work, i s shared by the Woman's Hospital Auxiliary which uses the room to cut and arrange flower bouquets. There are no f a c i l i t i e s for hanging coats, no telephone, no chairs, no cupboard for storage or safekeeping of supplies. A desk may be used by the chaplains i f they obtain a chair from the Information Desk or elsewhere. This , of course, is dependent on whether the desk i s being used by the Woman's Auxil iary ladies. One of the chaplains prefers to sort his cards i n the main foyer of the Centennial Pavil ion 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 Pavil ion for the purpose of -37-sorting cards. This has been done on occasion by some chaplains but they found that patients or v i s i tors 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 hospital , employer, next of k in , denomination. The medical diagnosis i s omitted. Four of the chaplains said emphatically that i t would assist their work i f they knew something of the medical diagnosis and prognosis. One of them said, \"This would prevent the temptation to give false assurances when you can't be sure of the medical s i tuat ion.\" Another remarked that the diagnosis \"would help especially in making i n i t i a l approach to the patient and especially when there had been attempted suicide or when the case was terminal.\" Two chaplains fe l t that the diagnosis could be helpful but not always. One of these remarked that he generally knew the diagnosis through his own experience i n hospital work, the location of the patient i n the hospital and often because the patient told 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 in use at the Vancouver General Hospital . The cards are similar to that kept by the Socia l Service Department i n their f i l e of o f f i c i a l active cases. Stat i s t ics of the rel igious denominations of each patient were taken for a two week period from the Socia l Service record -38-of dai ly admissions. Approximately 1,800 patients were admitted i n this period. Table 1. Number of Patients by Religious Denomination Admitted to the Vancouver General Hospital For the two-week Period, March 11-24, 1962 Denominat ion No. Admitted I | Denomination \u00E2\u0080\u00A2 Uo. Admitted Anglican 333 Roman Catholic _ 263 Baptist 7? Salvation Army -12 Lut her an 104 United Church 460 Pentecostal 30 Jewish \u00E2\u0080\u00A2+7 Presbyterian 117 Other Groups 119 Protestant 131 No denomination 120 Total 1809 Patients l i s ted under \"Pentecostal\" include a l l those who indicated their religious preference as \"Pentecostal,\" \"Evangelical\" or \"Gospel.\" Those included under the heading \"Other Groups\" are patients who indicated their rel igious preference as one of the following: Greek Orthodox, Methodist, 7 t h Day Adventist, Jehovah Witness, Apostolic, Unitarian, Brethren Russian Orthodox, Plymough, Wesleyan, Mohammedan, Mormon, Doukhobor, Sikh, Ukrainian Orthodox, L ibera l Catholic, Christ ian Science, and Mennonite. Of the 120 who are l isted under \"No denomination,\" half indicated their rel igious preference as \"Protestant-Non Pract is ing.\" Not a l l patients are v i s i ted by the chaplains. Indeed, each chaplain remarked on the d i f f i cu l ty of finding enough time to v i s i t the members of his own denomination. -39-Table 2. Number of P a t i e n t - V i s i t s \u00E2\u0080\u009E b y Chaplains March 11-24, 1962 Anglican 200 Roman Catholic 207 Lutheran 1 United 1 ] 377 Presbyterian 25 j Total of sample 841 1 The above s tat i s t ics represent only the members of the chaplain's denomination who were vis i ted by him. However, each chaplain remarked that he would not leave a ward without speaking a moment with each patient. Four chaplains v is i ted the out-of-town patients more frequently than those from Vancouver. These latter they referred to parish clergy. The re ferra l to parish clergy is done i n a variety 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 their own parishioners. 1 This includes both chaplains for this denomination. -40-Table 3. Number of Referrals of Vancouver General Hospital Patients to Parish Clergy by _ Chaplains or V i s i to r s , March 11-24, 1962 Denomination No. of Referrals Denomination No. of Referrals Anglican 272 Roman Catholic 2 Lutheran 22 United Church 307 Presbyterian 1 Total Number of referrals \u00E2\u0080\u00A2 ! 604 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 Pavi l ion. Many of the smaller sects depend on referrals from the patients themselves or from their re lat ives , 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 Hospital . Five chaplains have duties elsewhere and two work exclusively at the Vancouver General Hospital . -4-1-Table 4-. Number of Working Hours of Chaplains at the Vancouver General Hospital March 11-24-, I962 Denomination Days per Week Hours per Week Anglican Chaplain 1 6 32 Lutheran 1. Chaplain 2 6 2. Chaplain 2 10 Presbyterian Vi s i tor . 2\u00C2\u00A3 2? Roman Catholic Chaplain 1 7-United 1. Chaplain 6 14 2. Vis i tor 5 23 Except in the cases where counselling i s requested (either d i rect ly by the patient or indirect ly by referral) and where special church \"r i tes and r i tua l s \" are performed (e.g. circumcision, baptism or Holy Communion), the usual length of time for a chaplain's v i s i t is 5 to 15 minutes. Rarely do v i s i t s exceed this time although no arbitrary time limit is set. When occasion demands a chaplain may spend as much as an hour with a patient. In the case of long-term patients, hospital chaplains often make weekly v i s i t s . 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 lness and when requested by the patient, his relatives or members of the professional staff of the hospital , chaplains w i l l often make daily v i s i t s to patients. 1 These chaplains work exclusively at the Vancouver General Hospital . -4-2-One chaplain wrote at length: Regarding hours: no priest is ever \"off duty\" and his hours are as elastic 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 ing and counselling the widow of a man who was a patient in the Vancouver General Hospital i n February, but who died i n White Rock Hospital 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 responsibil i ty of the hospital ends with the death of a patient; but there is 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 lness may have the responsibi l i ty of doing something about the sp i r i tua l l i f e of his survivors. In time the parish priest takes over\u00E2\u0080\u0094and 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\u00E2\u0080\u0094 some of i t in hospital corridors and i n the Prayer Room, some i n their homes. In addition I have spent about four hours i n these two weeks with relatives of seriously i l l patients. One also does what one can by providing hospital ity i n one's home for relatives from out of town who have no friends in the city\u00E2\u0080\u0094we have had one such this past week. I have also driven two elderly relatives (old age pensioners) to their homes i n Burnaby after they had v i s i ted near relatives i n the Vancouver General Hospital . These are things which to my knowledge a l l the chaplains do from time to time. This gives some indication of the variety of tasks performed by chaplains, and i l lustrates the d i f f i cu l ty inherent in the attempt to ask for precise time s tat i s t ics from any professional group. Counselling Practices It i s equally d i f f i cu 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 ike ly would have produced more considered answers. Dr. Richard Cabot expressed the same d i f f i cu l ty : 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 is often soc ia l , he aims to encourage, to console, to amuse and distract , occasionally to instruct or to warn.l The chaplains were each asked, \"What do you consider to be the most valuable aid(s) you bring to help the hospital patient on the road to recovery?\" The answers varied from \"cheerful presence;\" to \"Prayer and moral support;\" to a more theological def init ion as \"the vehicle of the Grace of God, that i s , the ministry of reconci l ia t ion. \" One chaplain who had received C l i n i c a l Pastoral Training thought that the \" l i s tening ear\" was the most valuable aid he brought to the patient. He described this ' a id ' as also part of what every soc ia l worker brings in the casework relationship. One chaplain found i t necessary to be assured that he was understood about the ' a id ' he brought to the patient. He had said i n the interview that his ministry was one of reconc i l i a t ion . \" Later he wrote a letter in which he said, I could have said, \"the ministry of healing\" which is also correct but susceptible of being misunderstood as the application i n some form of fa i th healing\u00E2\u0080\u0094which, 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 soul, his mind, his body\u00E2\u0080\u0094and the bringing of the whole man into a proper relationship 1 Cabot, Richard C . , \"Adventures on the Borderland of E th ic s , \" The Survey, V o l . IV, No. 5, December 1, 1925, p. 275. -44-with God. Since i n this endeavor the whole hospital\u00E2\u0080\u0094 medical, nursing and socia l service personnel may be concerned\u00E2\u0080\u0094the 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 dai ly i n his prayers. And by the way, the past two weeks have left 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 special s k i l l or knowledge to help the treatment team of the Hospital?\" A l l chaplains answered i n the affirmative. When asked to describe this s k i l l or knowledge, however, their answers were quite varied: \" s p i r i t u a l reassurance;\"'prayer;\" \"the parish church i s a great resource;\" \"physical well-being is closely related to sp i r i tua l well-being\u00E2\u0080\u0094anxieties 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 soc ia l worker. He suggested that, \"special ists have bl ind spots i n the tota l picture whereas the chaplain and the social worker are often perceptive.\" Another chaplain said, \"the chaplain i s neither a social worker nor a doctor but he i s uniquely qualif ied to diagnose, understand and help with s p i r i t u a l problems. Sp i r i tua l health often affects physical recovery.\" What constitutes \"counselling\" means many things to different people. This study cannot deal with a l l the possible meanings. Carro l l A. Wise, i n Pastoral Counselling, Its Theory and Practice, suggests that \"counselling seeks to u t i l i z e the resources of personality, to work through tension-producing -45-experiences and to help the person grow to a new level of strength and maturi ty . \" 1 To what extent the chaplains have helped the patients through counselling there i s no way of knowing. However, there is 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 Denomination Number of Patients Anglican Chaplain 20 Lutheran Chaplain 1 2 Chaplain 12 Presbyterian Vis i tor | 0 Roman Catholic Chaplain 10 United Chaplain Vis i tor 4-Total 52 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 hospital ization and sp i r i tua l problems such as several terminal 1 Wise, Carro l l A . , Pastoral Counselling, Its Theory and Practice, Harpers: New York, 1951, p. 38. 2 During the same period 18 of the 1,800 admissions were referred to the Socia l Service Departments for casework services. - 4 6 -cases, and a man who fears he may become a paraplegic. I have not included, he said, \"the f a i r l y numerous cases of people who ask for straightforward answers to questions regarding the Church and the Bible , even where these cases involved a f a i r l y long conversation.\" The d i f f i cu l t i e s i n defining the boundaries of counselling are abundant. A l l of the problems l isted on the questionnaire have been dealt with by one or other of the chaplains at the Vancouver General Hospital . Some of the 'problems', of course, are more often brought to the chaplain than others. \"Bereavement\" was a problem which each chaplain had to face. Cases of bereavement were usually seen in the \"family context\" whereas a l l other problems were seen in the individual 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 fe l t this to be beyond the hospital chaplain's bounds of duty. Because of the continuing work with the family he concludes this to be the parish pastor's responsibi l i ty . The most commonly dealt with problem was that of \"Grave I l lness . \" Six of the seven chaplains have had to deal with this problem and three of these indicated i t s high incidence among the problems with which they had to deal. The only one who had not dealt with this problem was one of the women v i s i t o r s . \"Religious Support\" of various kinds received the most attention of the chaplains but was generally not regarded as a -H-7-'problem 1. A l l chaplains at one time or another, make use of prayer. The more Catholic traditions make the greatest use of the Sacrament of Holy Communion whilst the more Protestant traditions lay emphasis on the Scriptural 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 inancia l need of patients was the prominent problem a number of years ago and especially the worry caused through large hospital and medical b i l l s . He noted that hospital and medical payment schemes have v i r tua l ly erased this problem from those facing the chaplain. Referral Patterns with Other Professions The staff of a modern hospital i s often greater i n number than the patients i t serves. This large staff consists, not only of nurses and doctors, but also of administrators and social workers, physiotherapists and radiologists , engineers and laboratory technicians, a vast array of domestic workers and a multitude of students of medical-oriented disc ipl ines . With many of these the chaplain rarely , i f ever, comes into contact. They work i n the same building, serve the same people, but seldom cooperate i n plans for the benefit of the patient. The Vancouver General Hospital i s a complex organization employing some 2,500 people for i t s capacity of 2,700 patients. Many professional discipl ines cooperate as members of a \"team\" to serve the patient. Although none of the chaplains i s - 4 6 -considered a member of this team, they are called upon from time to time to give service to a patient. In turn they refer patients to various disc ipl ines . Six of the seven chaplains have discussed with his medical doctor at one time or other the patient's condition. The one who has not so done i s one of the women v i s i to r s . The chaplains reported that, although these discussions with the doctor were not frequent, they, did involve some joint planning. One chaplain reported that he i s called in occasionally when \"medicine has given up.\" The attempt to find the number of referrals to and from chaplains and other professions has not produced accurate s t a t i s t i c s . Some chaplains recorded on the s t a t i s t i c a l form that they had received a re ferra l from another profession but fa i led to say which profession or how often. Thus only a general trend can be indicated. By far the greatest number of referrals X were to the c i t y clergy. On an interprofessional basis, the nurses cooperate most often with the chaplains. Before proceeding to a ward the chaplains usually speak with the head nurse at the nursing station regarding the patients on his l i s t . The head nurse w i l l t e l l them something of the patient's general condition and w i l l often suggest when the patient has been part icularly depressed and what seems to be the cause. They also advise the chaplain when the patient should not be disturbed. When a patient i s 1 See Table 3, p. kO>. - 4 9 -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 in either the Centennial or Heather Pavi l ion. These clerks, i n turn, w i l l telephone the chaplain. Referrals of this type are usually only made to the Anglican and Roman Catholic chaplains who have requested that this be done. It is seldom that chaplains of other denominations are called i n this manner and usually only at the request of the patient or a member of his family. The next most frequent contact between the chaplains and another profession is that with the social worker. A l l chaplains expressed their pleasure of the interprofessional relations which exist between themselves and the Social workers i n the Social Service Department. From November 19&1 to A p r i l 1962 bi-monthly meetings between the Social Service Department and the chaplains has meant greater mutual understanding and cooperation between the two professions. They have discussed mutual problems and concerns such as interprofessional referrals , welfare resources i n Vancouver and joint planning for boarding home care for elderly patients. A l l chaplains agreed that they would be wi l l ing to share \"personal and social information\" about a patient with another profession. The chaplains said they would have to withhold information i f i t was \"given in secret\" or i f they were bound by the \"seal of the confessional.\" Generally speaking, the chaplains' thinking about this subject reflected the professional code of ethics for socia l workers: - 5 0 -Respect and safeguard the right of persons served to privacy in their contacts with the agency, and to confidential and responsible use of the information they g i v e . 1 One chaplain spelled out this responsibil i ty in these words: \"The socia l and personal information which i s given to a chaplain by a patient is intended not to be told to nobody, but not just anybody.\" The chaplains usually preface their state-ments i n this regard by saying that they would not mind sharing information with other professions so long as i t would be helpful in 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. Referral Patterns Indicated in Three Case Examples The answers given in the three case examples to the question \"To whom might you refer this case?\" have shown that the chaplains are primarily Church-oriented with respect to referrals . They suggested the use of a variety 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 soc ia l service agencies which the chaplains suggested for re ferra l were the Departments of Social Welfare at both provincial and municipal levels, Children's Aid Society, Family 1 \"Code of Ethics , \" in Standards for the Professional Practice of Socia l Work, New York: American Association of Socia l Workers, 1951, p. 5. -51-Service Association, Vancouver General Hospital Socia l Service Department, Department of Immigration, R.C.M.P., and Catholic Charit ies . An examination of the f i r s t re ferra l i n each case example suggested by each chaplain indicates that 14 referrals were made to Church-sponsored agencies (including parish clergy) and 7 referrals were made to secular socia l agencies. This same referra l pattern is indicated in the suggested referrals made by the theological students. Twice as many f i r s t referrals were made to church agencies than to secular welfare agencies. The Bachelor of Social work students on the other hand, made 21 of their \" f i r s t choice\" referrals to secular agencies and 9 \"to church organizations. The chaplains suggested a to ta 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 theological students mentioned 40 possible referrals to church agencies and 3\"+ to welfare agencies. The Bachelor of Socia l Work students gave a to ta l of 60 possible agencies to which they would consider re ferra l of the three cases. Of these, 40 were to secular welfare agencies. This indicates that for chaplains and theological students the frame of reference for interprofessional or inter-agency re fe r ra l i s decidedly church-oriented. The secular agency is used only half as much as the church agency. The soc ia l work students, on the other hand, are oriented to secular agencies. -52-Both disciplines f ee l that their own specialties can handle adequately and effectively the problems i l lustrated in the case histor ies . There is evidence on the other hand, that no small amount of consideration is given to inter-professional re ferra l . 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 individual may grasp and how many must cooperate in order to explain the very simplest things. 1 It was Mary Richmond who observed this i n her classic description of the casework process at the beginning of the twentieth century. What the emerging profession of socia l work had to show was that socia l problems could not be handled i n just any haphazard fashion. In order to meet effectively the increasing amount of socia l problems i t was necessary that socia l workers have the facts of the soc ia l situation so that they might make an objective assessment and diagnosis. It was necessary to have a method i n their work which incorporated a body of sc ient i f ic knowledge of human and societal dynamics with a set of values and goals. Soc ia l workers were not \"bornj' they had to be trained in this method of dealing with soc ia l problems. Even today, f i f t y years later , the urgency and necessity of 1 Richmond, Mary E . , Social Diagnosis, Russell Sage Foundation, 1917, from the f ly lea f , tQuoting from Hans Gross, Criminal Investigation, translated by Adam and Adam, A. Krishnamachari: Madras, India, 1906.) - 5 H - -training for socia l work is repeated. 1 Thirty years ago a minister received a training which had changed l i t t l e i n the previous hundred years. The traditions and teachings of the Church were handed on to ministers through an educational process which departed hut s l ight ly from such subjects as History, Theology, Liturgies , 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 lay ahead for him in the parish. From the turn of the 20 th Century, however, the increasing complexities of l i f e and the revolution i n the pace of l iv ing 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 in almost every walk of l i f e a l l of which had led to a depersonalization of much of individual l i f e . Many people had broken under the s t ra in . There was a need for ministers specially trained in understanding the soc ia 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 in coming into fact-to-face contact with many of these problems. Further he saw the dire 1 Morgan, John S., \"Socia l Welfare Services i n Canada,\" i n Socia l Purpose for Canada, edited by Michael Ol iver , University of Toronto Press: Toronto, I 9 6 I , p. 165. -55-need for \" c l i n i c a l training\" to augment the theological students' education. \"When we urge a theological student to get ' c l i n i c a l experience' outside his lecture rooms and his chapel, to v i s i t the sick, the insane, the prisons and the almshouses,\" he said, \" i t is 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 in 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 training for his pastoral work similar to the c l i n i c a l training a medical or soc ia l work student receives during his professional education. Although this essay of the renowned Dr. Cabot in Survey Graphic was one of the most inf luent ia l writings of the time i n promoting c l i n i c a l pastoral tra ining, i t Is not to be supposed that he was alone, nor even the f i r s t , in thinking of the new idea. Few people real ize that the idea of providing seminarians with a c l i n i c a l experience was f i r s t set forth i n 1913 at the General Convention of the Protestant Episcopal Church by the Reverend William Palmer Ladd. It was not u n t i l 1922 that anything was in i t i a ted , however, and i t Is perhaps significant that the proponent this time was another physician, Dr. William S. Kel ler , of Cincinnati . 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 th ic s , \" The Survey Graphic, December 1, 1925, Vo l . 25, No. 5, p. 276. -56-within the framework of existing community services. Thus i n 1923 the Cincinnati Summer School was launched. By 1936 this program was expanded into one year of training. In yet another person, a contemporary of Dr. Cabot, the Reverend Dr. Anton T . Boisen, there was also the attempt to think through this new concept in theological student training. Boisen, a middle-aged minister, had come through a serious nervous breakdown that had confined him for several months i n a mental hospital . He had studied his own case and those of his fellow patients and upon his release he enrolled at Harvard University to pursue the subject of mental i l lnes s . At Harvard he found a group headed by Dr. Cabot\u00E2\u0080\u0094eminent men such as Macfie Campbell, William McDougall and Elwood Worcester\u00E2\u0080\u0094all deeply interested in the mentally i l l . With their 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 ra in future ministers. It i s thus that Anton T. Boisen has been called 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 Hospital (2,200 Mental patients) offered the Protestant chaplaincy to Boisen. He soon demonstrated that a chaplain giving f u l l time to an inte l l igent , daily 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. -57-to mental patients individually and in groups was far more effective than the plan i n most hospitals which simply consisted of having pastors of local churches come in on Sundays to conduct a worship service. That this opportunity for Dr. Boisen was not only possible but amazingly successful i s due in large part to Dr. William A. Bryan who was (as Miss Ida Cannon has so aptly 1 described him i n her account of pioneering i n medical social work) the 11 extraordinarily uninstitutionalized Superintendent\" of the Worcester State Hospital . In June of 1925 four Theological students came for the summer course given under Boisen 1 s direction in cooperation with the medical staff . The number of students who came for the c l i n i c a l training increased rapidly . By 1929 a to 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 training\" needed firmer foundation and on January 21, 1930, \"The Council for C l i n i c a l Training of Theological Students\" was incorporated with the p adoption of a constitution. 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 psychiatrist . The Council aimed to accomplish three things: 1 Cannon, Ida M . , On the Social 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 Leavitt . - 5 8 -1. To open his (the student's) eyes to the rea l problems of men and women and to develop in him methods of observation which w i l l make him competent as an investigator of the forces with which re l ig ion has to do and of the laws which govern these forces; 2. To t ra in him i n the art of helping people out of trouble and enabling them to find sp i r i tua 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 training programs in institutions other than the three mental hospitals in 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 Hospital i n Boston under the joint supervision of Dr. Austin Phi l ip Guiles and Miss Ida M. Cannon, Supervisor of the Social Service Department. The Reverend Russell L . Dicks, Chaplain at Massachusetts General Hospital worked closely with Dr. Cabot and piloted the general hospital training through i t s formative stages. 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 Sick, MacMillan: New York, 1936\"T -59-In 193*+ the Federal Bureau of Prisons approached the then Federal Council of Churches with the request that i t t ra in and nominate for appointment candidates for a revi ta l ized chaplaincy-service for i t s system. Both organizations turned to the Council for C l i n i c a l Training for assistance and i n January 1936 the f i r s t trained chaplain was appointed to the staff of a correctional i n s t i t u t i o n . 1 Two students were assigned to the Federal Reformatory at Chi l l icothe, Ohio, that summer. The Bureau soon became the f i r s t correctional 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 of C l i n i c a l Pastoral Training, they differed on others. Cabot thought that the main emphasis of the training of students should be placed upon developing ab i l i ty and s k i l l in dealing with persons aff l icted with bodily disorders\u00E2\u0080\u0094the i l l or dying, the deaf or b l ind , the other disabled. He, therefore, advocated that most students be trained i n general hospitals. Boisen, on the other hand, was chiefly 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 is dealing a l l the time with mental health problems and that he meets a large number of persons i n the incipient stages of mental trouble. 1 The Training School at St. Charles, I l l i n o i s . - 6 0 -Therefore, he argued, the student should be trained to recognize the i l lness 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 theological students grew rapidly. Boisen went as Chaplain at the State Hospital at E lg in , I l l i n o i s . From there he was able to continue offering courses in re l ig ion and mental health at the Chicago Theological Seminary and also make E lg in Hospital , not only a training centre for the Council, but a base for fundamental research. Varying Emphasis In i t s brief history there have been at least four emphases i n c l i n i c a l pastoral tra ining. The Council attempted to answer the question as to how i t might best t ra in 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?\" Thus students participated i n the usual act iv i t ies of the Chaplain's department, but also i n a number of other things considered as integral part of c l i n i c a l training. They worked on wards, and they organized talent shows i n the ins t i tu t ion . They supplemented the inadequately staffed socia l service departments by making home v i s i t s . They worked at patient recreation. However, i t was not long before the limitations of this were recognized. The patients were confused hy the student's quick changes i n ro le , as were the students themselves. -61-Many left the training center with the concept of the good pastor as a loosely organized combination of soc ia 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 this time the emphasis was on collecting information about the patient and writing case histories . The \u00E2\u0080\u00A2case history' approach showed short-comings too. 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\u00E2\u0080\u0094 \"verbatim\" and \"process\"\u00E2\u0080\u0094which were subsequently used i n intensive supervision with the Chaplain Supervisor. They studied many techniques\u00E2\u0080\u0094the psycho-analytic, the non-directive, and their variations. Again i t was discovered that this was not enough. The patients often responded differently 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 relationship between the patient and the student. They had realized 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 training 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 Tra ining , \" Pastoral Psychology, October 1953, Vo l . h, No. 37 , p. 19. -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 training program is with the student. He is asked, and given help, to bring under the closest scrutiny a l l of his relationships! to the patients who are i n his care; to his fellow students and the associates with whom he must cooperate; and to his staff and the Chaplain Supervisor to whom he is responsible. To this end a l l the resources of the training center are put at his disposal: the intense personal needs of the patient, the insights and techniques of a l l of the healing arts , 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 training to be the insight the student gained into his own personality and his role as a rel igious worker. In this sense the training was not only a preparation for an ins t i tut ional chaplaincy to serve people i n severe c r i s i s situations but also \"therapeutic\" for the student himself. Other leaders emphasized training i n terms of the usual parish ministry. The Council favored the former emphasis. The Institute of Pastoral Care The latter emphasis found expression in the incorporation of the \"Institute of Pastoral Care\" in 19^. The \"Institute\" i s a non-sectarian educational foundation which, under the direct ion of a Board of Governors, sponsors \"Summer Schools of Pastoral Care.\" As i t s primary goal, the Institute seeks through i t s training programs to strengthen contemporary religious 1 Kuether, Frederick C . , op. c i t . , p. 20. - 6 3 -leadership so that the sp i r i tua l needs of people can be served more adequately. It strives to help clergymen gain insights and s k i l l s which w i l l make their 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 training requirements, (1) prescribed for some seminary students, (2) specified for cer t i f i ca t ion as a Professional Hospital Chaplain, and (3) needed for accreditation as a Chaplain Supervisor. -1-The Institute's f i r s t Summer School of Pastoral Care was offered at the Massachusetts General Hospital i n Boston. The Institute's curriculum follows the tradi t ional c l i n i c a l pastoral training course with a slight shift i n emphasis. In dis t inct ion to the Council's orientation to preparation of the ins t i tut ional chaplain, the Institute emphasizes the parochial ministry and the need of ordained clergymen to benefit from such training. The Institute sees i n c l i n i c a l pastoral training a means of preparing clergymen to serve their parishioners more effectively i n this modern day. At the same time they express a concern and recognize their responsibil i ty for training for the ins t i tut ional ministry and the student-minister wherever i t is possible. The work of the Institute has now expanded to forty-nine 2 inst i tutions across the United States\u00E2\u0080\u0094general medical hospitals, mental hospitals, correctional institutions and state schools. 1 See Appendices F and G. 2 \"Council for C l i n i c a l Training, Inc . , C l i n i c a l Pastoral Training Programs and Member Seminaries by-Region,\" Journal of Pastoral Care, V o l . XV, No. 4, Winter 1961, pp. 225-230. -6h-Each school i s , to a l l pract ical purposes, an autonomous self-sustaining unit under the direction of a Chaplain Supervisor accredited by the Institute 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 institutions at which c l i n i c a l pastoral training is offered. Training is available in quarterly periods, three months in length. The f i r s t quarter is seen as an \"Introductory\" period of tra ining. Increasing numbers of qualified applicants are being accepted for one year \"General Practice\" 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 c l i n i c a l experience. More than 3,000 persons have been trained by the Council since i t s inception. Cooperation between the Council and the Institute There i s a good deal of cooperation and reciprocity between the Institute of Pastoral Care, Inc . , and the Council for C l i n i c a l Training, Inc . , as wel l as the member theological seminaries and the training centers. There have been attempts1 to merge the Council and the Institute and organic union i s 1 Burnes, James H . , \"The Institute for Pastoral Care,\" Pastoral Psychology, October 1953, Vo l . \u00E2\u0080\u00A2+, No. 37, p. 23. -65-desired by some. However, the main obstacle is f inancia l as the training programs are subsidized by the secular institutions where training takes place. There i s , none-the-less, cooperation and agreement between the Council and the Institute respecting the goals of C l i n i c a l Pastoral Training. The following four goals for this training are agreed upon by the two organizations: 1. To enable the student to gain a fu l ler understanding of people, their deeper motivations and d i f f i c u l t i e s , their emotional and sp i r i tua 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, respons ib i l i t ies , 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 in 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 ion , i t s fa i th and practice, to people i n cr i s i s-s i tuat ions . The student gains a wealth of information as to what people are l ike in their interpersonal relat ions, and how his contribution as a religious worker can be meaningful and helpful to them i n just such experiences. The training 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. -66-an opportunity to become aware of how he approaches people, what his r ea l attitude toward people is and what role he performs for them. It enables the student, as can nothing else, to see people as people, and to see how they handle their d i f f i cu l t i e s in l i v i n g . It is a concentrated experience in the laboratory of interpersonal problems. The Literature of Pastoral Care Cooperation between the \"Institute\" and the \"Council\" i s 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 publ i ca t ion . 1 It i s \"published\" monthly i n the interests of sharing experiences and interpretations of pastoral work, interprofessional relationships, the theology of pastoral care, p and c l i n i c a l pastoral training. 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 in February 1950. This monthly journal \"grew out of an awareness of a deeply fe l t need on the part of the minister for insights and 3 s k i l l s of dynamic psychology and psychiatry.\" It was thought 1 Both of these journals f i r s t appeared in 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 sk i l l s could be presented i n a way that had immediate and pract ical application to the minister's work, and within the religious frame work of the pastor's point of view. The f i r s t ed i tor ia l advisory committee included Otis Rice, Charles Holman, Carro l l Wise, Paul Maves, Karen Horney, Kar l Menninger and Margaret Mead. Other journals which are related to the subject of pastoral care include: Marriage and Family Living, 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 Institute for Rankian Psycho-analysis, Inc. , Dayton, Ohio; and The Journal of Religion 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 journals to the chaplain and the pastoral minister. The former journal is closely integrated with the training centers of the Council and the Institute. For this reason the emphasis of the literature is on the role of the chaplain in various inst i tut ions . There are also some art ic les interpreting the dynamic needs of the patient or parishioner. The \"setting\" for many of the ar t ic les is the hospital and their subject matter bears on special problems 1 For a more complete l i s t ing to periodical l iterature see: Index to Religious Periodical Literature, distributed by the American theological Library Association, Princeton Theological Seminary, Princeton, New Jersey. -68-of physical and mental i l lne s s . The Journal of Pastoral Care also contains art ic les on basic research. Pastoral Psychology is not speci f ica l ly 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 re l i g ion . Thus the journal i s not only of value to the minister, whatever his role or position, but to psychiatrists , soc ia l workers, and counsellors. The subject matter of the art ic les i n Pastoral Psychology indicates a broad range of topics written by eminent men i n the f ie lds of re l i g ion , psychiatry, medicine and, to a limited extent, soc ia l work. Art ic les appearing i n Pastoral Psychology are repeatedly welcomed for republication in such journals as The Modern Hospital and Mental Hygiene. The l iterature of any profession, and especially 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 particular profession. The l iterature records the history of the profession and i t s struggle for ident i f icat ion, for relevance, for expertise i n i t s subject matter and something of i t s standard of research. The professional writing describes the developing methods, techniques and sk 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 iterature of the C l i n i c a l Pastoral Training Movement in 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 this Movement might be made more articulate, i t i s expedient to examine closely some of this l i terature. A particularly relevant publication for this purpose is The Journal of Pastoral Care, Volume X, Number 4, (V/inter) 1956. An ar t ic le by Archibald F. Ward, J r . , Ph.D., Chaplain, Eastern State Hospital , Williamsburg, Virginia., articulates the \"therapeutic role\" of the chapla in . 1 In the ar t i c le entitled \"Therapeutic Procedures for the Chaplain\" Dr. Ward qualifies' the term \"therapeutic procedures\" as referring to the non-medical practices and processes which aim at the \"treatment\" of the person who is (mentally) i l l or emotionally disturbed\u00E2\u0080\u0094hopefully to cure, but also to make endurable what is nox yet curable; and whenever possible, to receive the grace that redeems the weakness in i l lness and transforms the person in such a way that he can transcend his d i f f i cu l ty even i f he cannot escape i t . 2 He prefers to think of procedures rather than \"techniques\" for fear of implying some kind of manipulation. S imilar ly , the adjective therapeutic i s used in his art ic le rather than such nouns as therapy and therapist because the latter two enjoy, and even promote, an extremely ambiguous status. \"The adjective therapeutic properly focuses attention upon the nature and quality of the principles i n any act iv i ty which aims at participation in the healing process.\" 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 Ib id . 3 Ib id . - 7 0 -Dr. Ward suggests that the chaplain, l ike the psycho-therapist, 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 social worker for that matter) can do adequate therapy. The pastor-parishioner relationship, l ike the doctor-patient relationship, may be summarized in the pastor (or doctor) saying, \"What you need to do is thus and s o . . . . \" The chaplain or psychiatrist , on the other hand, is aware that most sick people have not suffered from any lack of being told what they ought to do or even need to do. The question is pre-eminently one of being able to do what i s needful. The role of the chaplain then, becomes one of helping the patient to become able as wel l as to assist in the def init ion and c l a r i f i ca t ion of goals. To enter into this kind of therapeutic relationship with the patient involves the active participation of the patient himself and an absence of the \"I am the doctor\" attitude on the part of the chaplain. But what is i t that the chaplain does with his patient?--and what is 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. 209. -71-the consequent process of interaction between two or more persons. But, he notes, some interactions and reactions can be harmful and some helpful . \"So we must ask ourselves now, what i s the goal of this relationship? What kind of action and inter-action do we want to make possible?\" 1 What can hopefully take place in this relationship Is communication. Communication is at the very heart of the therapeutic process, he claims. In some senses a person becomes i l l because communication has broken down\u00E2\u0080\u0094communication that i s , about the significant events and meaning in l i f e . What usually needs to be communicated involves a painful experience. Not simply the experience i t s e l f , but the individual '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 patient's painful details need to be rehearsed. What the chaplain i s after is understanding the pattern of response to l i f e rather than the in f in i te examples from the past. What is i n very special need of communication is feel ing. Very often the chaplain can handle the \"facts\" or content of past painful events more adequately than the feelings which are associated with them. Some of the feelings may be of guilt or shame. What may be much more d i f f i cu l t for the chaplain to handle are feelings almost universally present of hos t i l i ty , resentment and bitterness. 1 I b i d . , p. 209 -72-But 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 is 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 . The chaplain also communicates a degree of permissiveness. Another quality he communicates is acceptance. Permissiveness 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 in f in i te we discover i t to be.\" To accept the person means also to accept what he is attempting to communicate, and to explore this communication with him at the right time. Perhaps the most d i f f i cu l t part of acceptance is that we can scarcely accept i n others what we cannot accept in ourselves. \"The beam i n our own eyes hinders the removal of the splinter 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 is 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 is the cl ient wishes to be. 1 I b i d . , p. 213. 2 I b id . , p. 21*r. 3 Ib id . -73-At this 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 values? . . . . Once again, when we reach this stage of the relationship, the question of freedom and responsibi l i ty assumes a new importance. A person who is blind has neither the freedom to see nor the responsibil i ty of seeing; but once we see what we are actually doing, we become free to ask ourselves whether this i s what we want to continue\u00E2\u0080\u0094a question which would be quite meaningless so long as we were b l ind. In other words, we become at last free to accept responsibil i ty for ourselves. I suppose that the question we naturally ask now i s something like thiss How does this process differ from other therapeutic relationships? Not that so much, perhaps, as: What is the unique factor about the chaplain's entering into this sort of relationship with his people? When I say chaplain, I also refer to what the chaplain represents. And here we must talk primarily about what he represents to the sick. Every person who enters into a therapeutic relationship responds at least in part to what the therapist. . .represents or symbolizes for him. And at various phases i n the therapeutic process, the therapist may come to represent.various significant persons i n the patient's past. \u00E2\u0080\u00A2\u00E2\u0080\u00A2 By virtue of his profession, the chaplain has a two-fold symbolic meaning: he represents the divine, 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 ive s ; more part icular ly , 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 their experiences in churches. Some have been seriously hurt by their distorted views about God, or, more properly, by the views about God which have been imposed upon them by others. 1 When such persons are able to communicate their deepest feelings to the chaplain (which means also that the chaplain's attitude is of such a quality as to make possible such communication), something happens which is different from what happens i f the same feelings were communicated to some other person. In fact, 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 is different. So far as the therapeutic efficacy is concerned, i t is 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 poss ib i l i ty 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 ar t ic le i n the l iterature of c l i n i c a l pastoral training clearly indicates that the emerging role of the chaplain is receiving considerable scholarly attention. In many similar art icles the chaplain's relationship with the patient has undergone close scrutiny. A sincere attempt is being made to assess the dynamics of the relationship and where this relationship may be improved to assist the patient. But lest the new roles of the \"Inst i tut ional Chaplain\" and the \"Pastoral Counsellor\" form an \"isolationism\" apart from the Church, the E d i t o r i a l i n this issue of The Journal of Pastoral Care sounds a timely warning. The editor takes this cautionary measure i n view of the suggestions of H. Richard Niebuhr and his associates who had just made a survey of American theological education. The editor notes the necessity to hammer out a theology for pastoral care, that i s rooted in h i s tor i ca l revelation. At the same time the c la s s ica l theologian can well use the help of those whose interests l i e i n the f i e l d of pastoral care in facing up to the relevant questions being akked 1 I b i d . , p. 217. -75-by our fellow members of the healing team, i . e . , soc ia l workers, physicians, psychoanalysts, etc. The time is ripe for us to accept the warning of Niebuhr and return i t i n the form of a challenging invitat ion to a creative fellowship of correlat ion.1 Paul T i l l i c h in 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 ies to give the theoretical foundations of theology i t s e l f and of counselling.\"^ In the same issue of The Journal of Pastoral Care there i s an interesting ar t ic le by Cordelia Cox, \"The Church's 1+ Relation to Socia l Service Students.\" The purpose of the ar t ic le is to discuss some of the elements entering into the relationship of the established Church to students receiving professional training in schools of socia l work. Miss Cox discusses some motivations students have when choosing soc ia l \u00E2\u0080\u00A2work. 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. 23b1. 2 T i l l i c h , Paul, \"Theology and Counselling,\" The Journal of Pastoral Care, V o l . X, No. h (Winter) 1956, pp. 193-200. 3 Ib id . h Cox, Cordelia, \"The Church's Relation to Socia l Service Students,\" The Journal of Pastoral Care, V o l . X, No. 4, (Winter) 1956, pp. 201-207. -76-It may even be that, lost behind an outworn concept, a ready phrase, or a platitude, the true reason for his (the student's) professional choice is not fu l ly understood by the individual h imsel f . 1 The author suggests that many students i n schools of soc ia l work are searching eagerly for a \"personal and professional philosophy of l i f e which is 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 ar t ic le from Marriage and Family Living.3 The author i s Maurice J . Karpf, Consultant on Family and Psycho-logica l Problems, Beverly H i l l s , Cal i fornia . In his a r t i c l e , \"Some Guiding Principles i n Marriage Counselling,\" Dr. Karpf l i s t s some sixteen aims and principles i n the counselling process. Dr. Karpf elaborates each principle and spells out relevant details respecting the handling of special circumstances i n marriage counselling. Another ar t ic le describing an or ig inal research project i s written by Samuel Southard, Th .D . , Professor of Pastoral k Care, Institute of Religion, Texas Medical Center. The purpose of his paper, \"Religious Concern i n Psychoses,\" i s to indicate something of the significance of re l ig ion 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 Principles i n Marriage Counselling,\" The Journal of Pastoral Care, Vo l . X, No. h (Winter), 1956, pp. 219-225. h Southard, Samuel, \"Religious Concern i n Psychoses,\" The Journal of Pastoral Care, Vo l . X, No. h (Winter), 1956, pp. 226-233. -77-patients at Central State Hospital , Kentucky. These were patients seen on their f i r s t 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 significant in the psychiatric diagnosis of the 170 f i r s t admission patients interviews by the Protestant chaplain. Among other conclusions he draws from his study is that, Certain persons who have been exposed to religious teachings or to church fellowship over a period of time may use religious teachings i n the expression of their psychoses or may come into open confl ict 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 brief review of the l iterature i l lustrates that The Journal of Pastoral Care attempts to give an objective and scholarly treatment to the subject matter of pastoral care both for the Inst i tut ional Chaplain and the parochial minister. Any of the art ic les might well be found i n journals of socia l work. Standards and Accreditation , C l i n i c a l Pastoral Training may be termed a supervised experience which provides theological students and clergy with opportunities for Intensive c l i n i c a l study of problems i n interpersonal relationships. Or, as Professor R o l l i n Fairbanks defines i t , \" C l i n i c a l training i s the performance of pastoral 1 Southard, The Journal of Pastoral Care, p. 233. -78-work 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 clear , i n understanding and practice, the resources, methods, and meanings of re l ig ion as these are expressed through pastoral care. There are three levels of training available: 1. \"The Student Chaplain\" or \"Introductory Period of Training. \" This consists of the twelve week full-time period of training and is generally considered the norm by both the Council for C l i n i c a l Training and the Institute of Pastoral Care. The theological student or clergyman who takes part i n this course i s required to participate in a l l the act iv i t ies of the Chaplain's Department of the Hospital . I f at a l l possible the student is encouraged to l ive i n residence. The courses are designed to be part of the student's preparation for a parish ministry or an ins t i tu t iona l chaplaincy depending on the particular emphasis of the training 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 religious concerns i n any ministry to them. In the process of the training experience there is a major focus on the dynamics of interpersonal processes especially 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 Training, The National Council of Churches, New York, 19^5, p. 38. -79-In order to be accepted for any such program of training, 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 certifying body as the \"Council\" or the \"Inst i tute .\" 2. \"The Chaplain Intern\" or \"General Practice Internships\" The second level of training is concerned with men interested in specialized training 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 Inc . , The Association of Mental Hospital Chaplains, and the Hospital Chaplains' Association of the American Protestant Hospital Association, that this ministry requires intensive preparation. Hence a period of at least one year i n the hospital is demanded for accreditation. It i s required that candidates for training shal l have been ordained to the ministry with f u l l college and seminary preparation. No candidate is accepted for training who has not been personally interviewed and recommended. 3. \"The Chaplain Resident\" or Supervisory Training Residencies\" The third level represents an additional f u l l year of training i n the hospital following the i n i t i a l year as Chaplain 1 Preference is given to students enrolled i n theological colleges or seminaries which are \"accredited,\" \"associated,\" or \" a f f i l i a t ed \" 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, is presently negotiating for a f f i l i a t i o n with the A .A.T .S . See: She Twenty-Second Biennial Meeting of the American Association of Theological Schools in the United States and Canada, Bu l le t in 24, June i960, for complete l i s t ing of accredited Colleges and Seminaries. -80-Intern. Candidates for training are usually men intending to specialize not only in an ins t i tut ional ministry, but also to obtain accreditation as \"Chaplain Supervisors\" of c l i n i c a l pastoral training programs. In some instances men seek training i n order to prepare themselves to teach i n the pastoral theology department of a theological seminary. Such training requires additional experience in 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 hospital patient. It must be remembered that this modern emphasis on the approach to pastoral work developed in the secular institutions outside the seminaries before i t was brought within them. It i s only recently that c l i n i c a l pastoral training has had close t ies with the curriculum of theological colleges or seminaries, A very few schools, Virginia 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 is 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 rect ly connected with courses offered by the seminary and the direction is shared hy a member of the faculty. The course i n group therapy at the University of Southern Cal i fornia , for example, includes formal course work, the organization of the students i n a group therapy program and work i n group therapy -81-i n a hospital under the direction of a psychiatrist . One of the most outstanding examples of the cooperation between the seminaries and the training centers is that at Houston, Texas. In 195k the Institute of Religion was established at the Texas Medical Centre which united the resources of the Baylor University School of Medicine and- five Texas seminaries. These are: Austin Presbyterian, Brite College of the Bible , Episcopal Theological Seminary of the Southwest, Perkins School of Theology, and Southwestern Baptist. The work of the Institute of Religion is an integral part of the pastoral care department of each of these five seminaries. Students from each seminary receive their \" c l i n i c a l pastoral education\" i n Houston, but receive credit in their own seminaries for courses taken i n the Institute. Provision is made for obtaining B .D. , Th .M. , S . T . M . , and Th.D. degrees. Members of the Institute faculty are chosen by mutual selection and become members of the faculties of each of the five seminaries. The training 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 also: Hi l tner , Seward and Ziegler , Jesse H . , \" C l i n i c a l Pastoral Education and the Theological Schools,\" The Journal of Pastoral Care, Vo l . 15, No. 3, F a l l 1961. -82-Curriculum The content of these courses given in C l i n i c a l Training Centres can be described b r i e f l y . 1 There are lectures by staff personnel. These present the necessary material to help the student gain some understanding of the patient, and what the hospital does to help him get wel l . Along with these lectures the student attends staff conferences and in this way has an opportunity to see and hear the therapeutic team at work. The focus of the program i s personal contact with patients, primarily through actual interviewing as a chaplain. It comes also in supervised socia l and recreational contacts inside the hospital and at the community level . There are regular seminars conducted by the chaplain supervisor and medical personnel in which the pastoral and religious concerns of a hospital ministry, the characteristics of physical and mental i l lne s s , and the dynamics of personality development are discussed. The 1 The curriculum of The Institute of Pastoral Care, at Emmanuel Hospital , Portland, Oregon (June 5 - August 25, 1961) requires six book reviews of such books as: Rollo May, The Meaning of Anxiety; Seward Hi l tner , The Counsellor in Counselling; J l . Glanders Dunbar, Mind and Body\u00E2\u0080\u0094Psychosomatic Medicine. Lectures include such subjects as: \"Goals in Planning Ca l l s , \" \"Procedures to be Avoided in Calling upon the S ick , \" \"Emotional and Sp i r i tua l factors in Hospital izat ion,\" \"Ministering to the C r i t i c a l l y 111, the Chronically 111, the Bereaved,\" \"Pre-operative Ca l l ing , \" \"Ethica l Problems in Pastoral Ca l l ing , \" and \"Alcohol 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 self-evaluation (following a suggested outline) and an evaluation of the course at the end of his period of tra ining. -83-course usually includes a required amount of reading to supplement the hospital experience, but such reading is recognized as secondary i n importance to the c l i n i c a l experience i t s e l f . F i n a l l y , regular personal conferences or supervisory periods are held with each student. 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 in 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 training achieved mention for the f i r s t time i n a report of a committee of the Lambeth Conference, not as something familiar , or to be commended, but merely i n these terms: The Committee has taken note of the experiments which have been undertaken...in the United States i n providing courses of c l i n i c a l pastoral training, 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 training course was undertaken at the Deva Hospital i n Chester, a psychiatric hospital of approximately two thousand patients. In previous years short orientation courses of seven or ten days' duration had introduced hundreds of theological students to hospital l i f e , but the name \" c l i n i c a l pastoral training\" should not be used for such brief orientation courses. The Lambeth Conference, 1958, S .P .C.K. : London, 1958, Part 2, p. iu4. -84-In New Zealand the f i r s t six weeks' course was held in 1959. It has \"been impossible to determine when c l i n i c a l training began i n India but i t i s known to have started before 1958. It was pioneered at the Clara Swain Hospital in Bare i l ly , India. In Australia the f i r s t course i n c l i n i c a l training was introduced i n February I 9 6 I , at Melbourne. In 1958 the Institute of Pastoral Training was begun i n Nova Scotia. The cooperating colleges included Acadia University, Pine H i l l Divinity H a l l , University of King's College, The Faculty of Medicine at Dalhousie University, 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 theological students. The course is given at the Nova Scotia Sanatorium, Kentvi l le , Nova Scotia. 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 is the reason why the cure of many diseases is unknown to the physicians of Hellas, because they are ignorant of the whole, which ought to be studied also; for the part can never be well unless the whole is w e l l ' . 1 The complexity of the psychological, physical, socia l and sp i r i tua 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 ts inter-relatedness with each other profession. Perhaps no profession more than socia l work is aware of this and i t behoves the student of socia l work or the ministry to be keenly aware of this inter-dependence. 1 The Dialogues of Plato (Jowett Translation), Random House: New York, 1937, Vo l . I, pp. 6-7. -86-Imp l i e at ions for the Churches It i s in the context of the Churches that the implications of this study have special relevance. Too long has the Church attempted to answer the needs of men without the help of the younger professions and their knowledge and experience. These younger professions have arisen partly because needs of mankind were not being met by t radi t ional institutions such as the family and the Church. The Churches, thus, must examine the relevance of socia l and psychological sciences to their ministry. The theological student needs the understanding of the dynamics of personality no less than the student of soc ia l work. This was reiterated by Frank Weil when he said that: Social workers often fee l that pastoral counselling is not suff ic iently grounded i n knowledge of the soc ia l sciences and methods of soc ia l work; that there is not sufficient understanding to identify a personality problem of the individual or the nature of a family problem. Hence there i s lack of re ferra l from church to soc ia l agency and vice versa. 1 The Church ought to make opportunity available to the theological student for a study of the dynamics of personality. In order to do this the Churches have much to gain from the teaching practices used i n soc ia l work education. The pract ica l training \" i n the f i e l d \" should have i t s corollary i n theological education. There is a dissatisfaction 1 Weil , Frank L . , \"Co-operation of Church and Socia l Work,\" Proceedings of the 76th National Conference of Social Work, 19M9, Columbia University Press: New York, 19M9, p. 125. -87-generally on the part of clergymen and theological students regarding their training in counselling and pastoral care. Socia l work education offers a vast l iterature and practical experience in such techniques as interviewing, casework, record-ing, supervision and evaluation. Although socia l work is a much younger profession i t has systematically examined these techniques and i ts experience and knowledge are not to be l ight ly regarded by the Churches. Although this knowledge and experience can be gained by embracing many of the contributions which the socia l work profession can make to the ministry, i t must be remembered that schools of socia l work do not find their raison d'etre in the training of ministers or chaplains. They are concerned with training socia l workers. The Church, then, must look at more appropriate resources for tra ining. It i s in the C l i n i c a l Pastoral Training movement where such resource i s to be found. Church authorities may l ight ly regard this \"up-start\" movement in the Church because i t has departed from tradi t ional forms and patterns of training for the ministry. But what has changed is the soc ia l and economic pace of a l l people and the Church must provide appropriate training to her ministers so that this 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 universally applauded the advantages of this training.' 1 ' For many ministers who have had years of parish experience, the c l i n i c a l training has revi ta l ized their ministry. They have found the training has answered many of their problems respecting counselling and assisting parishioners. For younger clergymen, the c l i n i c a l training has equipped them to function as Chaplains i n the complex organization of the modern inst i tut ion with competence and effectiveness. The training has helped them to define their role and to determine their particular objectives i n the context of the goals of the tota l ins t i tut ion. The heart of the c l i n i c a l pastoral training program l ies i n the supervised minister-patient relationship which takes place within the interdiscipl inary professional setting of a modern treatment ins t i tut ion. The c l i n i c a l student (seminarian or minister) is confronted by the patient and his needs and also by his own feelings about the patient. In this process he is confronted, often to his own amazement or pain, by feelings and questions about himself, the relevance of his Christ ian f a i th , and the meaning and va l id i ty of his role as a Christian 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 in a General Hospita l , \" Journal of Pastoral Care, Vo 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 Hospi ta l , \" Journal of Pastoral Care, V o l . X, No. 2, Summer 1956. - 8 9 -teaching \"Pastoral Theology\" may well examine this experience i n re lat ion to what is presently taught and experienced through tradi t ional education courses. There i s , i t seems, only a limited f i e ld work experience in the t radi t ional pattern of education of the ministry. There i s , too, almost no emphasis on student experience in face-to-face counselling and interpersonal relations. The s ter i le 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 ins t i tut ional setting. Pastoral theology or \"pract ica l theology\" (as i t is sometimes known) cannot do justice to the seminarian's to ta l preparation except in 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 training i n personal relations is required of those charged with responsibil i ty to supervise students. \"Age\" or \"Experience\" does not necessarily result i n the acquisition of this a b i l i t y . It requires training in human relat ions, casework, and dynamics of personality. Just as the \"leader\" must f i r s t have been a \"follower,\" so the \"Supervisor\" must have been \"supervised\" before he can effectively f u l f i l l this ro le . The prerequisite, then, for the Church is to equip herself with clergy who have been trained in the established schools of C l i n i c a l Pastoral Training. These clergy must then -90-be placed in the strategic teaching posts of the Church including the seminary and the ins t i tut ional chaplaincy. In Vancouver, for example, there is need for c l i n i c a l l y trained chaplains at a l l general hospitals, prisons, and mental hospitals. These institutions could then be used as training centers for f ie ld work placements for training theological students. The pattern of f i e ld work placement might well follow that established by the School of Social 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 this study is the need for a C l i n i c a l Pastoral Training Centre in B r i t i s h Columbia. The only training centre in Canada at the present time is in the Maritimes, and there is a dire need for a similar centre i n western Canada. There is much to be said for establishing such a centre in Vancouver. Not only are there two large seminaries located in Vancouver which t r a in clergymen for Br i t i sh 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 training are: The Vancouver General Hospital , Oakalla Prison, Haney Correctional Inst i tut ion, Essondale Mental Hospital , Crease C l i n i c , St. Paul's Hospital and Shaughnessy Mil i tary Hospital . There is also proximity to the University of Br i t i sh Columbia (to which the Theological Colleges are already aff i l iated) which can offer the f a c i l i t i e s of an extensive l ibrary and the Department of Religion. - 9 1 -There is the poss ib i l i ty of using the resources of the School of Social Work and especially for the teaching of Human Growth and Development. It is recognized that these implications require lengthy consideration by the Churches and the respective institutions mentioned above. 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 Training, in the training of their ministers. Implications for the Vancouver General Hospital The historic influence which the Church has had i n the nurture and development of hospital f a c i l i t i e s throughout the world does not require further elaboration. It is sufficient to say that, although the administration of hospitals has largely changed from church direction to secular, the church continues to minister to the sp i r i tua l needs of the patient. In most hospitals this ministration is at best \"surface,\" lacking coordination and having v ir tua l ly no accountability to hospital administration, at the Vancouver General Hospital under the present regulations anyone may f u l f i l l the chaplain's role so long as they are recommended by a church authority. There needs to be a close examination of administrative policy and procedure to enable that the hospital personnel make appropriate and effective use of the chaplain. The Vancouver General Hospital may also examine the f a c i l i t i e s i t offers to the chaplain to \"perform religious -92-r i tes and r i t u a l s . \" Much of the chaplain's time is spent in counselling but no office space is provided. There is no central office to f ac i l i t a te re ferra l from the doctors, socia l workers and nurses. None of the chaplains suggested that a chapel be provided in the hospital but a l l of them mentioned the extreme d i f f i cu l ty occasioned by the lack of office f a c i l i t i e s . The chaplains expressed pleasure at the recently instituted bi-weekly meetings between themselves and some members of the Department of Social Service at the Vancouver General Hospital . They fel t there was much to gain from the socia l workers and expressed the hope that this inter-professional contact would continue. Similar meetings between chaplains and medical doctors, psychiatrists and nurses could be patterned in l ike manner. This would increase understanding of each other's contributions and of one another's inter-professional ro le . The main implication of the study for Vancouver General Hospital , however, i s the focus i t draws to the advantages to the hospital and patient which might result from having a fu l ly trained c l i n i c a l chaplain on the staff . Such a chaplain at Vancouver General Hospital would have to be f u l l y integrated into the administrative structure and with the professional services given at the hospital (See appendix F ) . Not only would a trained chaplain be valued as a competent resource for re ferra l from various professions but he would be an agent for -93-coordination of a l l chaplaincy services at the hospital. He could give orientation to new chaplains and conduct \"in-service training\" to present chaplains. This latter training may well follow that used in many social work agencies in training the non-professional socia l worker. He might also be used as a chaplain-supervisor for theological students doing \" f i e l d work\" at Vancouver General Hospital, and as a resource for socia l work students studying socia l agencies and community services in Vancouver. This would necessitate integration of a Chaplain's Department with courses and training offered at the School of Soc ia l Work and the Theological Colleges a f f i l i a ted with the University of Br i t i sh Columbia, A greater expansion of such a program would be the inst i tut ion of a C l i n i c a l Pastoral Training Centre at Vancouver General Hospital . This might be designed to meet the c l i n i c a l training needs of B r i t i s h Columbia clergy and possibly as a training centre for western Canada. Although implementation of the foregoing implications for the Vancouver General Hospital-would no doubt encounter d i f f i cu l t i e s they are not insurmountable. The \"ground work\" has been done i n various general hospitals in the United .States and i n some state-operated hospitals i n Canada. Implications for Social fork It may well be asked what relevance the preceding chapters have to the profession of socia l work. Is not the role of the chaplain of peculiar interest to religious bodies? The answer to this l ie s in the basic \"ho l i s t i c \" concept of man -9>+-to which the soc ia l worker attaches much significance. Man cannot be seen from the point of view that he is a \"segmented being.\" He is not just 'parts ' . He is the sum of the parts. Man is a to ta l i ty and the \"part can never be well unless the whole is w e l l . \" Such considerations as' these lead the enquirer into the realm of goals or objectives of soc ia l work. It is said that socia l work seeks to assist individuals , groups, and communities to reach the highest possible degree of soc ia l , mental, and physical wel l be ing . 1 The methods that social work applies to achieve this goal differ from those of other professions, such as medicine, law, the ministry, nursing, and teaching, because soc ia l work operates in consideration of a l l socia l , economic and psychological factors that influence the l i f e of the p i n d i v i d u a l . . \" Such an attempt to consider a l l factors influencing the lives of people cannot ignore some of the factors in l i f e or the definit ion becomes inva l id . Moral, rel igious and ethical values are inevitably part of soc ia l , economic and psychological factors. Nor can socia l work ignore the problem which is posed in the question, \"What i_s the highest possible degree of well-being to which socia l work aims?\" Or, \"What is l i f e ' s purpose?\" 1 United Nations Economic and Social Council, Training for Social Work: An International Survey, 1950, p. 10 . 2 Friedlander, Walter A . , Concepts and Methods of Socia l Work, Prentice-Halls Englewood C l i f f s , New Jersey, 1958, p. 7 . -95-\"For c l ients , for workers, for young people just emerging to manhood and womanhood, for adults in the prime of l i f e , the old in their declining years, this searching question of l i f e ' s purpose persists . To i t socia 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 inhibit ion and from conflict w i l l s t i l l leave empty, rest less , unsatisfied ind iv idua l s . \" 1 Does soc ia l work, then, consider man in his to t a l i ty ? 2 Man has a mind and a body; has he a sp ir i t and a soul? And i f he has, how often is i t taken into account in soc ia l work practice? There has been, for the most part, cooperation between psychiatry and socia l work. Social work has an indisputable place among mental health professions. Likewise, socia l work, since the beginning work done by Dr. Richard Cabot, has been an important member of the medical hospital team. There i s more and more real izat ion of the contribution that social work can bring to human problems. There i s , however, an inconsistency, an alienation between the church and socia l work. Because of the sc ient i f ic emphases of medicine, psychiatry and socia l work, these dis-cipl ines have tended to discount the sp i r i tua l aspects of man's 1 Lenroot, Katharine F . , \"Fundamental Human Needs Facing the Social Worker Today,\" The Family, V o l . XVI, No. h (1935), p. 102. 2 Sladen, Kathleen, The Question Arises, Master of Soc ia l Work Thesis, The University of Toronto: Toronto, 1957, p. 5. -96-being. As one man has put i t , The alienation of the church and socia l work may be attributed in large measure to the fact that training for social work in the established schools . . . i s t ied to those social sciences that claim l i t t l e connection with religious philosophy.1 This is not imply, however, that there is a gulf between the professions of the ministry and soc ia l work that cannot be crossed. The roots of socia l work go too deeply into the Judeo-Christian heritage to suggest that. But recently much more has been said about the relevance of re l ig ion to soc ia l work. Charlotte Towle believes that, . . . s p i r i t u a l needs of the individual must also be recognized, understood, and respected. They must be seen as distinct needs and they must also be seen in re la t ion to other human need.2 And herein l ies the crux of the matter. The sp i r i tua l needs of the person must be recognized. The social worker must be able to perceive the s p i r i t u a l need of the c l ient even as he is trained to perceive the bio-psycho-social needs of the c l i ent . For \"society owes him, through the soc ia l worker, the help he truly needs, rather than the help he speci f ical ly asks.\"^ The social worker does not f u l f i l l his professional 1 Weil , Frank L . , \"Co-operation of Churches and Social Work,\" The Social Welfare Forum, National Conference of Social Work, 1949, Columbia University Press: New York, 1950, p. 126. 2 Towle, Charlotte, Common Human Needs, National Association of Socia l Workers: New York, 19^7 (Original publication 19^5), p. 8. 3 Pray. K. , \"Restatement of General Principles of Social Casework Practice,\" Journal of Social Casework, V o l . XXVIII, No. 8, p. 286. -97-competence i f he does not recognize the sp i r i tua l needs of his c l i e n t , and does not offer interpretation and the opportunity for appropriate sp i r i tua l help. The fact that a c l ient may not \"see\" his need i n i t i a l l y i s hardly a val id reason for i t s v i r t u a l negation by the social worker. Sometimes i t would appear that so great has been our concern for cl ient self-determination that the fear of imposing something upon the cl ient has prevented us from f u l f i l l i n g as well as we might the educational role inherent i n socia l work goals. ^ Gordon Hamilton says, \"We believe in the wholeness of individuals and the interdependence of society, national and international, cul tura l , economic and s p i r i t u a l . \" 2 Most socia l work l i terature, however, denies the latter , although some socia l workers view the religious need as the most v i t a l of a l l . Social workers may agree that the immediate extrinsic end of their work is a better adjustment of the individual to a l l parts of the environment, but the statement is meaningless outside the context of what is 'bet ter ' . That i s a question which in the f i n a l analysis must perforce be answered in terms of some meaning, some purpose to human l i f e . There can be no standards of adjustment or adaptation to an environ-ment, 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 ive in this or any environment? What is the purpose of human l i fe? Essential ly this is a religious question and ultimately socia l work must find the answer In 1 Bowers, Swithun, \"Social Work as a Helping and Healing Profession,\" Social Work. V o l . I I , No. 1 (January 1957), p. 58. 2 Hamilton, Gordon, Theory and Practice of Social Case Work, Columbia University Press: New York, 1951, p. k. -98-the sphere of re l ig ion . For try as we w i l l , we cannot divorce the ultimate objectives of society from the question which is basic to a l l religion\u00E2\u0080\u0094 What is man? Where l ies his destiny? 1 Social work, by its very nature as a helping profession, must necessarily consider the to ta l nature of man. This is basic to i t s practice. For soc ia l work's specific goals w i l l vary d irect ly with i t s view of the \"wholeness of man.\" 2 What, then, are soc ia l work's ultimate objectives? Canadian socia l workers have apparently done too l i t t l e in examining'their philosophy^ and \"...perhaps more time and attention should be given to re l ig ion as a factor in human l i f e , . . . i n socia l organization and In social work practice. . . . \" 1 4 \" The training for this practice begins at a School of Social Work. It is here that f i r s t consideration can be made to make available to the student the training necessary for the soc ia l worker to perceive the sp i r i tua l needs of a c l i ent . Just as the social worker is trained to recognize socia l , physical and psychological needs, so he must be able to recognize s p i r i t u a l needs. This latter recognition cannot be assumed nor taken for granted any more than the former. 1 Bowers, Swithun, \"The Nature and Definition of Social Casework,\" Part I I , Journal of Social Casework, V o l . XXX, No. 9, p. 375. 2 Sladen, Kathleen, op. c i t . , p. 10. 3 Touzel, Bessie, The Moral Foundations of Socia l Work, -a series of two lectures delivered at the Fourth Western Regional Conference of Social Work, Regina Saskatchewan, July, 1953, p. 3. h Spencer, Sue, \"Religion and Social Work,\" Social Work, V o l . I , No. 3, July 1956, p. 26. -99-Training i s needed. This is a f i r s t implication of the c l i n i c a l pastoral training movement. That i s , these ministers of r e l i g ion , physicians, and psychiatrists ( in 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 effectively with a method of diagnosis but only when there is a clear perception of the needs expressed. These methods may well be examined with a view to being incorporated into the training of the soc ia l workers. C l i n i c a l Pastoral Training has given a new dimension to inter-professional relations in terms of the confidence the health professions have i n the c l i n i c a l l y trained chaplain. His training in human growth and development, the pract ical experience and intensive supervision, the methods of recording, the conscious use of his relationship as chaplain i n an ins t i tu t ion , and his awareness of inter-professional team work, gives the chaplain a competence which recognized by the health professions. He is regarded as a member of the treatment team. In B r i t i s h Columbia, i t is of particular importance that soc ia l workers give l ive ly consideration to what they may gain for their c l ient through the ava i l ab i l i ty of the c l i n i c a l l y trained chaplain. The socia l worker would be assured of a competent handling of the cl ient he referred to the latter . Much pioneering work needs to be done. Not only has soc ia l work something to gain, i t has something to give. Social workers and the School of Socia l -100-Work are the main agents i n this province through which the soc ia l sciences find pract ical and tested application. The soc ia l worker's education and his profession i s one of society's main institutions answering human need. The resources of soc ia l work education might be made available to the theological student. Without training the latter cannot adequately assess the needs of people any more than soc ia l workers can assess sp i r i tua l needs without tra ining. Those engaged in the training of ministers must take due regard of the techniques of socia l work tra ining. The training of the minister would be effectively enhanced by training techniques such as the practical interview, supervision, recording and self-evaluation. Because socia l services are so diverse and complex, the minister of re l ig ion needs some introduction to this wide topic. The chaplain's re fer ra l patterns indicate scanty appreciation of the agencies available to serve his \"parishioners.\" 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 soc ia l and medical science can make to understanding of Individuals and their society. The Church to a limited extent in c l i n i c a l training has applied some techniques of training including the c l i n i c a l conference. Herein the contributions of each discipl ine are given. Not only does the \" h o l i s t i c \" view of man find expression i n this technique, but there are decided advantages for the patient i n terms of understanding of his case. In view of this i t is not surprising to learn that there is a very r e a l -101-rapport 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 Br i ta in must consider \"Catching up with Cabot.\" The survey of l iterature respecting the two professions of socia l work and the ministry indicates that the church is exploring soc ia l work to a considerable degree. This is also suggested by Miss Skenfield i n her recent s tudy. 1 She had discovered more l iterature from Church sources than from socia 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 art ic les published i n Pastoral Psychology and the Journal of Pastoral Care are of high standard. Social workers may use these journals as resource material in coming to a better inter-professional understanding between the ministry and socia 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 \"patient,\" and the \"parishioner.\" The obstacles which limit inter-professional cooperation must not be allowed to deter efforts to seek ways and means of cooperation. The perfection of the service offered to the patient should be the constant goal of a l l professions. 1 Skenfield, Alfreda, Social Worker and Minister in . Welfare Services, Master of Social Work Thesis, University of B r i t i s h Columbia, i960. -102-APPENDIX A HOSPITAL CHAPLAINS AND OFFICIAL VISITORS QUESTIONNAIRE IDENTIFICATION Name and T i t l e Name of denomination r e p r e s e n t e d Are you a H o s p i t a l C h a p l a i n ; P a r t - t i m e ;Half-time t ; F u l l - t i m e Are you p a i d f o r t h i s work? I f 'yes' , \"by whom? ' When d i d you \"begin work at t h i s h o s p i t a l ? Do you v i s i t o t h e r h o s p i t a l s ? ;Which? . Were you 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 another i n s t i t u t i o n b e f o r e coming t o t h i s h o s p i t a l ? ; I f 'yes', 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 h o s p i t a l when you began work here? . I f 'yes 1 , from whom? Name of t h i s h o s p i t a l EDUCATION AND TRAINING '., \" ; A. Academic ( c i r c l e h i g h e s t y e a r completed) High S c h o o l 1 2 3 4 Undergraduate ma.jor \" Und e r g r a d . C o l l e g e 1 2 3 4- Undergraduate degree Graduate E d u c a t i o n i n Theology From T o ( d a t e s ) Degree/Dip. 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 B. D i d your undergraduate o r t h e o l o g i c a l e d u c a t i o n i n c l u d e c o u r s e s i n P a s t o r a l C o u n s e l l i n g ? \u00E2\u0080\u00A2 I f 'yes', do you c o n s i d e r t h i s t r a i n i n g : adequate h e l p f u l inadequat e C. Have you tak 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 'yes', how l o n g was t h e c o u r s e S j ; Where h e l d ? D. Have you 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 another d i s c i p l i n e ? (check) P s y c h o l o g y ; Casework ,\u00C2\u00B0 S o c i o l o g y , ' o t h e r E. Do you t h i n k a course 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 the Vancouver area? P l e a s e comment s -103-APPENDIX A (Continued) COUNSELLING A. How many people d i d you v i s i t i n h o s p i t a l i n one r e c e n t month?_ B o How many people d i d you see i n h o s p i t a l f o r c o u n s e l l i n g ? C. What was the f o c u s of c o u n s e l l i n g d u r i n g t h i s p e r i o d ? ; A l c o h o l i s m Bereavement Drug A d d i c t i o n Grave I l l n e s s _ R e l i g i o u s I n s t r u c t i o n R e l i g i o u s e x p l a n a t i o n . R e l i g i o u s support: b e f o r e o p e r a t i o n p r a y e r s a craments tbaptism _ Mass or Holy Comm' n Housing I F V o c a t i o n a l 'Training O c c u p a t i o n a l P r o s p e c t s F i n a n c i a l Need M a r i t a l R e l a t i o n s P a r e n t - c h i l d R e l a t i o n s S c h o o l i n g / e d u c a t i o n a l Memtn.1 He a l t h R e c r e a t i o n a l a c t i v i t i e s 0 t h e r ( p l e a s e d e s c r i b e ) \" I \" C o n s i d e r e d I n d i v i d u a l l y ; \"F\" C o n s i d e r e d i n a F a m i l y Context D. From the above l i s t , p l e a s e s e l e c t the t h r e e most common problems you have had c o n t a c t w i t h ; l i s t i n o r d e r of predominance: E. What do you c o n s i d e r t o be the most v a l u a b l e a i d ( s ) you b r i n g to h e l p the h o s p i t a l p a t i e n t on the r o a d to r e c o v e r y ? F. Do you t h i n k you c o u l d h e l p the p a t i e n t more i f you knew h i s m e d i c a l d i a g n o s i s ___________ F, Would you be w i l l i n g t o share p e r s o n a l and s o c i a l informationebowt a p a t i e n t w i t h another p r o f e s s i o n ? I f 'yes', would you h o l d any limit s {comment)? G. Do you t h i n k the C h a p l a i n c y has any s p e c i a l s k i l l o r knowledge t o h e l p the Treatment Team of t h e H o s p i t a l ? . I f y e s ' , d e s c r i b e b r i e f l y \u00C2\u00B0. APPENDIX A (Continued) REFERRAL A. D i d you r e f e r any 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? I f 'yes' , TO WHOM? HOW IOAUY? (konth ) P s y c h i a t r i s t M e d i c a l Dr. Nurse Teacher S o c i a l Worker Lawyer Other S p e c i f y B. D i d you r e c e i v e any r e f e r r a l s i n the above month from o t h e r p r o f e s s -i o n s ? . I f 'yes', HOW MANY? FROM WHOM? C. Have you ever d i s c u s s e d xhe p a t i e n t ' s i l l n e s s or problem w i t h h i s do c t o r ? D. Do you r e f e r p a t i e n t s t o t h e i r p a r i s h m i n i s t e r ? I f , ' y e s ' , (a) Who does t h i s ? : s e l f ; wiige ; v o l u n t e e r j s e c r e t a r y (b) How i s - t h i s done? : l e t t e r ^telephone ^ p e r s o n a l v i s i t (c) About how many r e f e r r a l s are made i n one month? (d) How much of your time does t h i s take? hours per week. JOB DESCRIPTION A. How many hours do you spend at your work i n one week? B. How many hours do you spend at t h i s h o s p i t a l i n one week? C. Bo you have p r o f e s s i o n a l d u t i e s elsewhere? What are they? D. Where i s your study o r o f f i c e l o c a t e d ? E. Do you conduct P u b l i c Worship S e r v i c e s ? I f 'yes', Where? .When? F. Do you v i s i t p a t i e n t s o u t s i d e your own denomination? -105-C A S E 0 N B APPENDIX B SAMPLE CASE HISTORIES Mrs. A., a 28yrs. old mother, has just given birth to her third child, but expects to be i n the hospital for seme time because of a Caesarian Section and further medical complications. Her mother has been lmoking after the other children while she is hospitalized. 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 is 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 lost i f he doesn't 'straighten up' as his Company has given the last 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 strain and especially now with the new baby. Mrs. A. states,\"You see i t really 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 for 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 instruction. This issue about the children attending Church act 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 their interference. It has been during this recent period that Mr. A. has resorted to more drinking than ever. CASE TYO Gordon, age 2\u00C2\u00A3yrs., has been a patient i n the hospital for almost five months but has i n no way identified his religion. However, he has just requested you to 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 hospital. 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 his foot) he brought back a German g i r l friend whom ho was going to marry when he got out of hospital. 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 friend has been working i n a small cafe in 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 especially wants to know how he can help his 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 for this mistake. CASE THREE Whilst returning one morning to a men's ward in which you had l e f t your brief case the day before, you are requested to come to the bedside of an old man, Mr. B., age 7 1 > who has been admitted since you were last there. He t e l l s you that he was knocked down by a car late last night just before he was to board the bus for his home at Aldergrove. (about 5>0 miles from Vane.) He is now V 6 r y worried about his 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 is even more complicated because his leg i s broken and he wont be able to leave the hospital for at least two months. Although he has been getting the Old Age Security pension his wife is 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 that he has been supple-menting his income by part-time janitor work at his Church in Aldergrove but he says he can't expect to get this w hilo he i s i n hospital. Tilhen you ask him what Church i t i s , he indicated a denomination other than yours. He is quite distressed by this whole situation and wonders whether you can help in any way. -106-APPENDIX C NAME H O S P I T A L DENOMINATION 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 ( Give the t o t a l numbers f o r each day i n the appropriate spaces provided) DATE iNo. of MARCH ' v i s i t s I V.G.H. P a t i e n t s seen f o r Counselling R e f e r r a l s to P a r i s h Clergy Ref. to other * Profes sions Ref. from other * Professions Hours spent at VGH ( R e l i g i o u s S e r v i c e s , 1 Inter-Prof.,Denom., 1 .meetings attended. SUNDAY 11th J (Describe) MONDAY 12 th TUESDAY 13th \"WEDNESDAY 14th THURSDAY l ^ t h FRIDAY 16th SATURDAY 17th 1 i i 1 SUNDAY 18th 1 1 1 1 i MONDAY 19th TUESDAY 20th WEDNESDA 21st Y THURSDAY 22nd FRIDAY 23rd SATURDAY 24th \u00E2\u0080\u00A2 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 : Return t o : R.D.MacRae 6o\u00C2\u00A30 Chancellor B l r e f e r r e d from: Vancouver 8, B.C. Phone: CAstle 4-9020 ,-107-' APPENDIX D COMPARISON OF STUDENT BACKGROUNDS (Social Work, Theology) 1. IDENTIFICATION: Faculty Age last birthday : M F Are you married ; If 'yes', How long ; How many children do you have . 2. EDUCATION: A. Academic (circle highest year completed) High School 12 3 4 Undergraduate University Major Undergraduate College 12 3 4 Undergraduate Degree Post Grad. years 12 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 'yes1, how long was the course? Where held? (3) Have you received special training in another discipline? Yes No psychology ; casework ; sociology ; other? 3. 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 all remarks applicable to each case. E. Assuming that you are a Social Worker or Chaplain at the Vancouver General Hospi-tal comment how you would handle each situation, with specific reference to: (1) Your in 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 , \u00E2\u0080\u009E _ -108-APPENDIX 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 as a Visiting Clergyman at The Vancouver General Hospital, I agree to abide by the rules and regulations of the Hospital at present in force and those which may be subsequently promulgated 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 Officially Approved 1950 by the AMERICAN PROTESTANT HOSPITAL ASSOCIATION 1 ^ INTRODUCTION It is 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 is 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 chap-laincy service. A. THE ACCREDITED CHAPLAIN \ It is essential that anyone who is 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\u00C2\u00AB A significant period of clinical pastoral training such as a minimum of twenty-four weeks (960) hours or its equivalent and written recommendation by the instructor of the center attended. This training to have been obtained in a general hospital with a psychiatric service or in a general hospital, mental and/or correctional institution. \"Equivalent\" may be in-terpreted by the Committee on Accreditation to mean (a) graduate academic degrees in Pastoral Psychology, Pastoral Counseling, Clinical Psychology, Social Relations and other related fields, (b) publication of significant books in the field of ministering to the sick and (c) other outstanding contributions. Until January, 1955* s o m e latitude in interpretation rests with the Committee on Accreditation. Training centers which subscribe to the general objectives listed below and provide acceptable courses of training may seek recognition by a committee to be created for that pur-pose. ko Three years of parish experience or its equivalent. \"Equi-valent\" may be interpreted by the Committee on Accreditation to mean a total of five years' experience in such position as the following: Chaplain in the Armed Services; student pastor, or student religious worker; teacher, lawyer, doctor, social worker, or counselor. 1 Johnson, Paul E . , Psychology of Pastoral Care, Abin|ton Press: New York and Nashville, 191?3, Appendix A, p. 337. -110-Members of the APHA may apply f o r a c c r e d i t a t i o n by supplying evidence t o the Executive D i r e c t o r of the APHA. (or whomever he may designate) that they have complied with the 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, or by January 1 , 1950 have served not l e s s than f i v e years as a h o s p i t a l chap-l a i n and have f u l f i l l e d a l l but one of the \"Standards\". Non-members of the APHA s h a l l pay an A c c r e d i t a t i o n Fee of ten 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 part of the require-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 apply f o r a temporary endorsement e n t i t l e d , \"In Process of A c c r e d i t a t i o n \" . The general objectives of c l i n i c a l pastor t r a i n i n g centers are as fo l l o w s : \ 1. To enable the student t o gain an 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 develop e f f e c t i v e p a s t o r a l methods f o r mi n i s t e r i n g t o people, and recognize h i s unique resources, 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 as a r e l i g i o u s worker. 3. To help the student l e a r n how to cooperate with representa-t i v e s of other professions and u t i l i z e community resources f o r achieving more e f f e c t i v e l i v i n g . 4. To encourage i n the student a desire f o r that f u r t h e r under-standing which i s t o be obtained by appropriate and pertinent research. f B. THE APPOINTMENT OF THE CHAPLAIN The chaplain should be appointed by the h o s p i t a l Board of D i r e c t o r s on the recommendation of the h o s p i t a l administrator. The three most common ways of s e l e c t i n g a chaplain f o r appointment are: 1. A church a u t h o r i t y nominates an ac c r e d i t e d candidate. In a denominational h o s p i t a l , the denominational author-i t i e s make the nomination. In a non-sectarian or s t a t e -supported h o s p i t a l , the l o c a l or state church f e d e r a t i o n or c o u n c i l of churches or other a u t h o r i z i n g agency make the nomination. The h o s p i t a l administrator and Board of D i r e c t o r s then appoint or r e j e c t the nominee. 2. A s p e c i a l chaplaincy committee i s appointed to nominate an a c c r e d i t e d candidate. The h o s p i t a l administrator then accepts or r e j e c t s the nominee. 3. The h o s p i t a l administrator presents a candidate t o h i s Board of D i r e c t o r s . j - I l l -F i n a l appointment i s made by the h o s p i t a l Board of Di r e c t o r s only a f t e r a c c r e d i t a t i o n and church endorsement have been obtained. i Whether the chaplain i s p a i d e n t i r e l y or only i n part by the h o s p i t a l or h i s s a l a r y i s furnished by an outside organization, the h o s p i t a l should have the f i n a l a u t h o r i t y t o accept or r e j e c t a candidate f o r h o s p i t a l chaplaincy; the appropriate e c c l e s i a s t i c a l a u t h o r i t y should bear the r e s p o n s i b i l i t y f o r nom-i n a t i n g the candidate. C. THE CHAPLAIN'S RESPONSIBILITY TO THE ADMINISTRATOR Because of the complex r e l i g i o u s s i t u a t i o n i n any community the h o s p i t a l chap-l a i n c y should be c a r r i e d on by the chaplain i n close r e l a t i o n s h i p with the ad-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 of two or more members of the h o s p i t a l Board of D i r e c t o r s . Regardless of the source of the chaplain's s a l a r y he should be answerable t o the h o s p i t a l administrator and the Religious A c t i v i t i e s Committee f o r the q u a l i t y of h i s work and the expenditure of h i s schedule. The chaplain as the head of a recognized s e r v i c e i n the h o s p i t a l organization should have that personal access to the h o s p i t a l Board of Directo r s p o s s i b l e f o r the head of any other s e r v i c e . The chaplain should present w r i t t e n d e s c r i p t i v e reports of h i s a c t i v i t i e s t o the administrator and the Religious A c t i v i t i e s Committee at stated i n t e r v a l s . D. COOPERATION WITH OTHER HOSPITAL PERSONNEL The chaplain works best as an integrated member of a team headed by the attend-i n g p h y s i c i a n . As such he i s b e t t e r able t o d i r e c t h i s s k i l l s and resources toward the s p i r i t u a l needs of a pa t i e n t than when working alone. Although the chaplain should acquaint the physi c i a n with any pertinent information which may have come t o h i s a t t e n t i o n , nevertheless the chaplain reserves the r i g h t t o respect the c o n f i d e n t i a l nature of information given by a patient i n the s p i r i t of confession. While not every p a t i e n t seen by the chaplain needs t o be discussed with the physician, such c o n s u l t a t i o n between phys i c i a n and chaplain w i l l o ften occur. As a r u l e , the chaplain w i l l spend most of h i s time with those patients who are under severe p h y s i c a l or mental s t r e s s , or have e s p e c i a l l y d i f f i c u l t per-sonal, s o c i a l , or s p i r i t u a l problems; therefore the major p o r t i o n of h i s energy and e f f o r t w i l l normally be devoted t o a s e l e c t e d number of p a t i e n t s . E. SOURCES OF REFERRAL In a general h o s p i t a l the chaplain can 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 of whom he w i l l see d a i l y , others on a l t e r n a t i v e days, the r e s t perhaps once a week. This means he makes an average of f i f t e e n p a s t o r a l c a l l s every day, i n a d d i t i o n t o speaking with scores of i n d i v i d u a l s . Experience has shown the f o l l o w i n g sources of r e f e r r a l t o be most common: -112-1. The physician asks the chaplain to call 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 is not only introduced in his professional role,^but is shown persons in need of his care who might otherwise have been missed. 2. A nurse, social worker, or other hospital employees asks the chaplain to call on a patient. While i t would be best to have the physician request the chaplain to call upon his patient, i t has been found that \ \u00E2\u0080\u009E 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 call 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 call has been made. Cooperation between \" the hospital chaplain and the local clergy is helpful not only to the patient, but also to the hospital as a means of fostering the confidence of the patient and family. 5\u00C2\u00AB 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 will call 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 is notified in cases of critic a l illness (DL) and death. In addition to calling on and ministering to the patients referred to him, chaplain can take the initiative and discover many patients who need his care. The admitting officer is usually the f i r s t person to see the patient officially. 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 difficult post-operative adjust-ment needs special care; and an aged, isolated or indigent patient may face peculiarly complicated problems. Some patients will have courage to reveal their spiritual needs only i f they have had opportunity ,to observe and get ac-quainted with the chaplain while he is doing general visiting. -113-F. 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\u00C2\u00AB 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. All sch-eduled 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 \u00E2\u0080\u00A2 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. All 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 all general or open services denominational emphasis should be avoided since highly ritualistic programs, proselyting, and fervid revivalism (espec-ially 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 chap-lain 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. -XX1*-Although the chaplain's main function is ministering to patients and their fami-lies, this is 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 in special circumstances may serve as the official 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 vital public relations. He will endeavor to minister to the spiritual needs of a l l who enter the hospital. If because of differences in Faith or for other reasons his ministry is not acceptable to a per-son, he will be prepared to call in who-ever is 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 des-pair for a fourth, gain serenity for one facing death, and to comfort the be-reaved; 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 is an opportunity for a theological student or pastor to learn pastoral care through interpersonal relations in an appropriate center, such as a hospital , correc-t iona l inst i tut ion or other c l i n i c a l s ituation, where an integrated program of theory and practice is individually supervised by a qualified chaplain-supervisor, with the collaboration of an interprofessional staff . I I . QUALIFICATIONS OF THE CHAPLAIN-SUPERVISOR 1. Graduation from an accredited theological 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 in appropriate f ields 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 qualifications to be appraised by an accrediting committee in a face-to-face interview. III . REQUIREMENTS FOR THE CLINICAL TRAINING CENTER 1. A chaplaincy service which is wel l established and recognized as a functioning part of the center, with a chaplain accredited as a supervisor (see I I ) . 2. A progressive ins t i tut ion, oriented toward therapy or rehabi l i tat ion, serving an adequate number of patients or inmates accessible to the chaplain's program, maintaining an interprofessional staff available for continuous^ teaching of theological students. a. General appreciation within the inst i tut ion of the role of a chaplain, recognition of theological students as functioning members of the chaplain's department, and adequate opportunity for them to work in 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 -116-b. An alert and cooperative administration and staff, who w i l l be ready to assume responsibil i ty for implementing the c l i n i c a l program. 3. Maintenance should be provided for students in training, or such provisions as may be comparable to the internship programs of other professional groups i n the ins t i tut ion . IV. MINIMUM ESSENTIALS OF CLINICAL PASTORAL EDUCATION 1. A supervised practicum in interpersonal relations. 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 training period. k. Frequent association with an interprofessional staff who are genuinely interested and qualified 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 psychological-ethical , and theological theory with practical understanding of the dynamics of personality and f a c i l i t y in interpersonal relations. 7. A written evaluation of his experience to made by the s tudent to his chaplain-supervisor at the end of the training 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 training 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 is 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 direction of an accredited chaplain-supervisor who is a functioning member of the staff 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 in pastoral care, at least six 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. - 1 1 7 -VI. SPECIAL CONSIDERATIONS 1. For pastors and other r e l i g i o u s workers seeking add i t i o n a l t r a i n i n g : a. Full-time p a r t i c i p a t i o n i n c l i n i c a l pastoral education for s i x to twelve weeks i s recommended. b. Where th i s i s not possible, p a r t i c i p a t i o n i n orientation programs at an accredited center i s recommended. 2 . For chaplains serving f u l l time, at least twelve months' f u l l - t i m e c l i n i c a l pastoral education is recommended, s i x months of which are to be i n the type of i n s t i t u t i o n which he serves. Where this standard has not yet been attained, h o s p i t a l administrators are encouraged to release th e i r chaplains p e r i o d i c a l l y for the necessary t r a i n i n g . -118-APPENDIX H BIBLIOGRAPHY Books The Air Force Chaplain. Department of the Air Force, Washington, 1). U . , Air Force Manual No. 165-3. Belgum, David, C l i n i c a l Training for Pastoral Care. Westminster Press: Philadelphia, 1 9 5 \u00C2\u00B0 . Book of Common Prayer Canada 1959. Cambridge University Press: Cambridge, 1959. Cabot^ Richard C . , What Men Live By. Houghton M i f f l i n : Boston and New York, IJtT. Cabot, Richard C . , and Dicks, Russell L. ,-The Art of Ministering to the Sick. McMillans New York, 1936 (He-issued 19^7). Cayton, H . R., and Nishi . S. M . , The Churches and Socia 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 Social Frontier of Medicine. Harvard University Press: Harvard, 1952. Cross, F. 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Unpublished 'Works C o l l i e r , Elizabeth A . , The Social Service Department of the Vancouver General Hospital; Its history and Development 1902-19H9: Master of Social Work thesis, University of Br i t i sh Columbia, 1950. Sladen, Kathleen, The Question Arises: & study on Social Work and Religion. Master of Social Work thesis, University of Toronto, 1957. Skenfield, Alfreda, Social Worker and Minister in Welfare Services. Master of Social Work thesis, University of B r i t i s h Columbia, i960. Standards for Mental Hospital Chaplaincy, Association of Mental Hospital Chaplains, 19P3 (Mimeographed Brochure). "@en . "Thesis/Dissertation"@en . "10.14288/1.0105788"@en . "eng"@en . "Social Work"@en . "Vancouver : University of British Columbia Library"@en . "University of British Columbia"@en . "For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use."@en . "Graduate"@en . "The chaplain in health and welfare services: a study of his role in the general hospital with special reference to the Vancouver General Hospital and recent developments in the clinical pastoral training movement"@en . "Text"@en . "http://hdl.handle.net/2429/39257"@en .