The History of Spiritual Care

Catherine O’Connor, CSB, Ph.D.

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

2. Participants will name three key

people and their contribution in
shaping the history of spiritual care

3. Participants will be able to name three

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

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

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

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

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

• Where are you?

• What do you want me to do for you?

• Whom do you seek?

• What are you discussing as you go on

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

Seward Hiltner 1958

Four functions of Pastoral Care
1. Healing

2. Sustaining

3. Guiding

4. Reconciling

Clebsch & Jaekle 1975

Eight epochs of Christian Pastoring
1. Primitive Christianity
2. Under Oppression
3. “Christian” Culture
4. The “Dark Ages”
5. Mediaeval Christendom
6. Renaissance & Reformation
7. Enlightenment
8. The Post-Christendom Era
9. Modernity; Post-Modernity
 20th Century Trends

• Shift from classical models of academics

to a more practical model

• Influence of Freud and William James

• Medical Social Work Movement at MASS.

General Hospital, Boston
 20th Century Trends.

• Emmanuel Movement – Rev. Elwood

Worcester at Emmanuel Episcopalian
Church, Boston

• CPE movement in early 1920’s

 Clinical Pastoral Education
(CPE)

• Dr. William Keller

Dr. Cabot Lodge
Rev. Anton Boisen
Dr. Helen Dunbar Flanders
 1930 -1990

1930s - New England Group

- New York 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)
1980’s 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 God’s
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

1990’s - Focus on Competencies-

personal, professional, spiritual
The Illness Narratives: Suffering, Healing and the
Human Condition

• Illness

• Dis-ease

• Sickness
Arthur Kleinman, MD
 20th Century Trends
Shifts:

Pastoral Care - Pastoral Counseling

Pastoral Counseling - Pastoral Psychotherapy

Pastoral Care - Spiritual Care

Individual Spiritual Direction – Group Spiritual Direction

Individual - Systems
 Influences

• DSM - IV

• Rediscovery of Spirituality in the 1990’s

• Differentiation between Spirituality and

Religion
 Themes
• The Diagnostican - Paul Pruyser

• Gardener - Edgar Draper

• Living Human Web – Bonnie J. Miller-

Mclemore

• Wounded Healer – H. Nouwen

• Midwife – B.Gill-Austern
 Definition of Spiritual Care

“Spirituality is the aspect of humanity

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

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

Spiritual Assessment of Patients
and Families
Spiritual Screening

Spiritual History

Spiritual 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 21st Century
• Metrics - what do we measure and how?
• Inpatient to Outpatient Care
• Shortened LOS
• Medical Science and Ethics
• Individual vs. Systemic Thinking
• Cultural Diversity
• Religion and Spirituality
• Training/Compensation for Chaplaincy
• Having “A Voice at the Table”
• Other?
 Sources
Clebsch, W. & C. R. Jaekle (1964) Pastoral Care in Historical Perspective.
New York: Prentice-Hall, Inc.

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

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

O’Connor, T. St. J. “Pastoral Counseling and Pastoral Care: Is There a

Difference” . J. of Pastoral Care & Counseling, Spring 2003, Vol. 57,
No. 1.

www. icsi.org, November 2009

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

Care: The Report of the Consensus Conference” . J. of Palliative Care,
Vol. 12, No 10, 2009