The History of Spiritual Care

Catherine OConnor, CSB, Ph.D.

Covenant Health Systems
Lexington, MA
Objectives
1. Participants will understand three
historical events which influenced the
development of Spiritual Care

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

3. Participants will be able to name three
current strand in the ongoing
development of spiritual care
Scripture
The Lord God has given me the tongue of a teacher, that I
may know how to sustain the weary with a word.
Morning by morning he wakens me to listen like a
disciple(Isaiah 50:4)

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

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

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

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

Scripture
Where are you?

What do you want me to do for you?

Whom do you seek?

What are you discussing as you go on
your way?


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

Seward Hiltner 1958
Four functions of Pastoral Care
1. Healing

2. Sustaining

3. Guiding

4. Reconciling

Clebsch & Jaekle 1975
Eight epochs of Christian Pastoring
1. Primitive Christianity
2. Under Oppression
3. Christian Culture
4. The Dark Ages
5. Mediaeval Christendom
6. Renaissance & Reformation
7. Enlightenment
8. The Post-Christendom Era
9. Modernity; Post-Modernity


20
th
Century Trends

Shift from classical models of academics
to a more practical model

Influence of Freud and William James

Medical Social Work Movement at MASS.
General Hospital, Boston
20
th
Century Trends.
Emmanuel Movement Rev. Elwood
Worcester at Emmanuel Episcopalian
Church, Boston

CPE movement in early 1920s
Clinical Pastoral Education
(CPE)

Dr. William Keller
Dr. Cabot Lodge
Rev. Anton Boisen
Dr. Helen Dunbar Flanders
1930 -1990
1930s - New England Group
- New York Group
1940s - Institute of Pastoral Care (ICP)
New England
- Council of Clinical Training
New York
- Southern Baptist CPE
- Lutheran Advisory Council



1930- 1990
1950 Development of Standards
1965 Canadian Council formed
1967 Strands merged and the Association of
Clinical Pastoral Education formed
(ACPE)
1970 - National Association of Catholic
Chaplains formed (NACC)
1980s NAJC
1988 COMMISS
2007 Common Standards
2009 - Spiritual Care Collaborative (SCC)
Anton Boisen
Brush Clearing

Fragmentation Learning from Failure

Living Human Document

Case Study Methodology

Pastoral Diagnosis

The Self as The Instrument of
Healing
Vulnerability

Anxiety

Story
Praxis Methodology

Think Learn Do

Do - Think - Learn
Diagnosis
Dia gnosis


The meaning we give to the
knowledge available


Carl Jung
Hermenutical Approach
Allow people to disclose their word,
their meaning
Reverence for the text, the word of the
person, as we have reverence for the
Word, the text of Scripture
Sometimes interpreter of the person to
themselves, of their story; sometimes
the interpreter of the Story, of Gods
saving events of salvation
The Minister as Diagnostican
Paul Pruyser, MD
Awareness of the Holy
Providence
Faith
Grace
Repentance
Communion
Vocation
Themes
1930s What must I do to be of help?

1940s What must I know to be of help

1950s What must I say to be of help

1960s Who must I be to be of Help

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



The Illness Narratives: Suffering, Healing and the
Human Condition
Illness


Dis-ease


Sickness
Arthur Kleinman, MD
20
th
Century Trends
Shifts:

Pastoral Care - Pastoral Counseling


Pastoral Counseling - Pastoral Psychotherapy


Pastoral Care - Spiritual Care


Individual Spiritual Direction Group Spiritual Direction


Individual - Systems



Influences
DSM - IV

Rediscovery of Spirituality in the 1990s

Differentiation between Spirituality and
Religion


Themes
The Diagnostican - Paul Pruyser

Gardener - Edgar Draper

Living Human Web Bonnie J. Miller-
Mclemore

Wounded Healer H. Nouwen

Midwife B.Gill-Austern


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

J. of Palliative Care, Vol. 12, No 10, 2009
Spiritual Assessment of
Patients and Families
Spiritual Screening


Spiritual History


Spiritual Assessment
www. icsi.org, November 2009


Who does Spiritual Screening?
Spiritual Screening: Nurse/Social Worker/
Admissions

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

Spiritual Assessment: Chaplain
Spiritual Assessment Tools
H.O.P.E


F.I.C.A.


S.P.I.R.I.T.
Spiritual Assessment Tools
www.icsi.org 11/2009
H: Sources of Hope, meaning, comfort,
strength

O: Member of organized religion

P: Personal Spirituality

E: Effects of beliefs on medical care, end of
life
(Anandarajah, 2001 [R])
Spiritual Assessment Tools
F: Do you have spiritual beliefs or faith
that helped you cope in the past?
I: How do these beliefs influence you?
C: Involvement in religious community
or church?
A: How would you like your health care
providers to be with you in addressing
spiritual issues and concerns?
(Puchalski, 2000 [R])
Spiritual Assessment Tools
S: Spiritual belief system
P: Personal spirituality
I: Integration with a spiritual community
R: Ritualized practices and restrictions
I: Implications for medical care
T: Terminal events planning
(Maugans, 1996 [R])
Documentation
Where?


Who?
Clebsch & Jaekle



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


Sources
Clebsch, W. & C. R. Jaekle (1964) Pastoral Care in Historical
Perspective. New York: Prentice-Hall, Inc.

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

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

OConnor, T. St. J. Pastoral Counseling and Pastoral Care: Is There a
Difference . J. of Pastoral Care & Counseling, Spring 2003, Vol. 57,
No. 1.

www. icsi.org, November 2009

Improving the Quality of Spiritual Care as a Dimension of Palliative
Care: The Report of the Consensus Conference . J. of Palliative Care,
Vol. 12, No 10, 2009