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“They Had to Beg Us to Pray” Reflections on the Undesirability of Clinical Pastoral Education

Critiques certain assumptions and procedures of Clinical Pastoral Education and offers an alternative view designed to provide the pastoral caregiver with assessment and conceptual stances which would lead to an understanding of a client’s situation. Claims that such an alternate understanding would allow power to religious texts and traditions as interventions leading to psychological stability and growth, whether or not such interventions match the client’s manifest material or expectations.
Near midterm in introductory pastoral counseling course, I pose the seemingly benign question, “What was said last week?” No checking of notes, this is not a quiz. It is a hands-on introduction to the importance of establishing focus during clinical interactions. Each student responding with a recollection is asked the follow-up, “Anything else?” One by one each pauses in amazement to report that there is definitely more to be said, except that it is not quite in focus.

This live demonstration illustrates that, due to features of psychic structure which need not be discussed here, the pastor must assume that the client will retain essentially one theme following a clinical encounter. (Perhaps a second theme will be retained, but may well be partly misconstrued.) Ideally, whatever the client happens to retain should be roughly congruent with something that actually transpired. Consequently! after allowing for such factors as nonverbal subtleties and independent client insights, something is amiss in the interaction if the client’s retentions habitually mystify the counselor.

So far so good. The class, like this essay, begin innocuously enough. Yet, as we shall see, the implications of these remarks will eventually collide with basic training approaches in the field of Clinical Pastoral Education.

Next on the class agenda is an attempt to account for habitually peculiar client retentions. The most promising strategy is to review first what was actually said. Students can readily cite multiple factors limiting client capacities to retain insight (e.g., “not ready for it”). Usually a more basic question, “What has been said?” prompts the realization that what the counselor hoped would be retained has never been said in the first place. “This client,” reports a student, “complains that her mother mistreated her growing up, but what’s really going on is that when her mother makes overtures to understand, the client won’t talk to her and keeps accusing her of not caring.” Very well, is this theme out in the open where the client could possibly know it? “Sure,” says the counselor, “I already said to her, ‘Do you think your mother is trying to be uncooperative’?” Slowly the students see the challenge and are then invigorated by it. The pastor may actually say something clearly-which has not yet occurred in working with this estranged daughter. The plan now is for all members of the class to return to the original’ verbatim to practice locating where and how this might be accomplished-except that we are usually interrupted.

During twelve years spent conducting pastoral counseling courses in seminaries and a postgraduate training program, I have come to expect a familiar interruption: “I’m confused. We were taught in CPE not to say anything to the client.” This archetypal student has not yet said what he meant exactly, but with encouragement this will become possible. His archetypal confusion has been brought on by discontinuity between this class and his experiences in CPE. He retains the impression that anything he might say that diverges from the client’s material must stem from his own anxiety and that his clinical task is to present open-ended hints or questions that allow clients to arrive at insights themselves. He pipes up here, as others have over the years, because he is earnestly concerned that these basic truths might be missed by his classmates and the hapless teacher.

So far, this essay has been unfocused, much like a poor counseling intervention. Because it is vaguely suggestive and lacks a definitive voice or intelligible point, it contains precisely the sorts of errors one hopes students will learn to avoid. As a corrective, here is a direct statement of thesis: The principles commonly retained from Clinical Pastoral Education (CPE) so inefficiently promote clinical grounding or skill that its contribution to a pastor’s clinical functioning may be undesirable. The emphasis must be on what students retain, regardless of training philosophy, and on the question of efficiency. Since most pastors will receive only elementary education for ministries that will make substantial clinical demands, the alternate training approach which is discussed later will more readily orient pastors to clinical needs and enable them to formulate interventions accordingly.

I now ask the reader’s patience as I proceed to share personal experience and opinion-testimonials are a familiar format for professional discussions in CPE literature. Twenty years of intermittent reflecting on my own four quarters of CPE mitigate against simple reactivity on my part, but there would be no need for this polemic were it that my encounters with students today reveal CPE experiences so similar to mine that whatever changes have occurred in the interim are too small to enjoy. If my remarks seem unminced, it is because they are offered on behalf of these students who have been needlessly misled. I grow weary of cleaning up somebody else’s mess and am no longer silenced or bedazzled by the countercharge that all this is just one of my “issues.”

It’s a long Story
I was duly awed and invigorated by my first months ofCPE as I learned that human needs are palpably real and quite distinct from the metaphors I had absorbed from books. I was awakened to my inadequacies in responding to those needs. I learned to be suspicious of my theologies in clinical situations and to avoid religious language not prompted by the’ client. For a while I thought I had learned that I was crazy, but that turned out to be sloppy diagnosis. Most important of all, I learned to respect the interplay between knowledge and skill-which is the more complicated topic that will not go away.

It was not uncommon to report encounters with clients in which I understood something about what was occurring but seemed to have no skills for responding. Nor was it unusual to report instances of apparently helpful responses without any clear knowledge of the dynamics of the situation. So I blundered along. I counted on supervision, verbatim analyses, and group feedback to clarify the specific types of growth needed. A retrospective increase ill knowledge of clinical dynamics held the promise of opening new avenues of skill by revising interventions to match expanded understanding. A retrospective scrutiny of my interactions held the promise of broadening knowledge of clinical dynamics which had been incompletely grasped before.

These promises were to be revealed as wishful thinking. Because practicum and supervisory investigations of my work were ad hoc (i.e., to this client this time) and ex post facto (i. e., based on assigning whichever understanding fit the result), no amount of them could compensate for the emerging fact that the training “insights” retained did not pertain to other encounters. The prospect that future interactions would be clinically and pastorally worthwhile (as opposed to merely benign, or vacuous) did not change much over four quarters.

This realization, which might otherwise have cast doubt on the whole venture, was deemed to reaffirm the value of CPE after all. According to the collective feedback, CPE had identified both my childish expectation that authorities could help, plus the underlying element interfering with worthwhile clinical ministry – (or more technically, me and my shadow). Apparently in my long-standing myopic, defensive style, I was a person out of touch with my needs and feelings, an instrument out of tune with the needs and feelings of others, just one more of your basic clerical types who shows up already closed to growth.

To an ordinary neurotic, this ersatz logic made eminent sense. Had I not felt for years that I was not all I should be? Had I not from time to time surprised, mystified, or disappointed myself? Did I not worry that there were aspects of my deepest interior that I did not understand? I was ripe for the suggestion that these secrets had now fermented into visible results portending failure in ministry and damage to others. This logic was ersatz because it did make grammatical sense, but only as a substitute for the more straightforward conclusion that the training regimen was not helping the training needs it identified. The advice to undertake personal psychotherapy bypassed this conclusion on the manifest level but confirmed it on the latent by proposing a substitute player.

This advice made a vital, albeit left-handed, contribution to my eventual profession and ministry. With a senior analyst, I experienced being talked to – not questioned or repeated. This subtext became a critical theme in its own right. If I could be talked to, then I must be able to talk, too. If I was benefitting from being talked to, then it was not axiomatic that my own clients benefitted most if I merely questioned or repeated. Certainly I had neurotic interferences to contend with, but I was being treated differently than I was being trained to treat. Another being was telling me things different from anything I had said before, things that made sense and helped.

This remarkable phenomenon simply could not be accounted for by assuming that my analyst was free from interfering anxieties. Something called “knowing more” about the patient than the manifest material in the room had to be possible. My longstanding frustration that I did not know enough about what I was hearing to be able to respond helpfully had been considered “resistance” to the CPE experience. Meanwhile my own experience was convincing me that inadequate clinical knowledge was compromising my ministry after all. Some of my sense of insufficiency could still be explained as the defensive anxiety of a badly tuned instrument, but not all of it. There had to be a chicken and an egg. I was no longer convinced that all my inadequacies came from being chicken, for I was also missing the egg-the foundational knowledge of the nature of psychic functioning established by a host of neglected professional ancestors.

To risk this thought, that worthwhile clinical ministry involves both clinical knowledge and the person of the counselor, was to be forced into the realization that CPE was undermining my chances of becoming able to talk to clients. With this hope in my throat, I then embarked upon what was to become thirteen years of further graduate school and institute training. The beginning of that training is the denouement in this long story, which will be over shortly.

Because of my unusual background, I was asked to provide a sample of previous clinical work-a verbatim-along with my application for psychoanalytic training. The interviewer wanted to talk about it. “I congratulate you,” she said, “on how hard you work to stay tuned to this patient’s feelings.” (The compliment is most welcome, but if this is what we’re going to talk about for years, I am still in the wrong place.) “You really don’t understand her, do you?” (I have never agreed with more relief) “This is what would be considered a hysterical personality disorder. No matter, you’ll learn it later.” (So far this hour I have learned that hysteria is something more than symptoms with a nonorganic basis.) “If I read her right, I’d figure that the more you’ve supported her feelings, the more chaotic they’ve become.” (That’s it! But how could you know?) This was the first feedback confirming my sense of a problem in my clinical work, expanding my understanding of that problem, but remarkably without reference to the relevance of my own interior. Thereafter I would receive extensive commentary about the relationship of that interior to my work, but never as a matter of “pointing it out” without ‘accompanying hypotheses of explicit interior conflicts to examine in the service of improvement.

So What’s Wrong With This Picture?
It is possible that my testimony is idiosyncratic in the extreme, without applicability to the larger field, yet this no longer seems probable to me. There is a CPE approach to clinical training, one not dependent on particular decades, geographies, or supervisors, an approach that Japser Keith, a former president of ACPE, has summarized this way: “The genius of CPE has been focusing on process learning rather than the infusion of content, valuing the learner’s present experiencing and enabling the learner’s own unique struggle for identity and authority.”

We are talking about the same training. My editorial spin connotes criticism, just as others who publish testimonials are entitled to a positive spin. Of the 300 pastoral counseling students I have been involved with since my own training days, the overwhelming majority of those exposed to CPE (about two-thirds) spin their personal stories of “process learning” and “struggle” as variations on two themes of disillusionment. With the aid of their testimonies, I offer a more direct assessment of what is going wrong.

Disillusionment Type I arises as soon as pastors are awakened to the fact that useful knowledge of psychic functioning existed while they were busy faulting themselves (egged on by group feedback) for failing to invent it wholly on their own during each daily encounter. “I thought it was me, but it didn’t have to be that way. After all that, was this trip necessary?” At the core of CPE training is the importance of the student’s struggle to formulate personally meaningful and clinically viable ministry responses on the basis of holistic assessments of human need (see verbatim formats). Psychological need is included, except that the training regimen omits actual exposure to principles of psychic functioning. Sooner or later students recognize the similarity to making bricks without straw. Lingering resentment (“Was this trip necessary?”) is based on the impression that CPE considered such knowledge irrelevant to clinical competence, since it smacked of reliance on external authority, and a distraction from self-authentication, supposedly revealing the student’s anxiety – ridden attempts to cop out.

A grounded understanding of the psychological component of client needs cannot be generated by process learning. “My sense is that he’s actually angry at the wife for visiting him all the time.” Very well, but the rest of the class does not see this yet. What could be pointed to here to clarify how this assessment came about? “Well, nothing really, but it’s my sense of what he’s saying.” This student is serious about the use of self-awareness and self authentication to derive understanding of the psychic situation and his clinical responses. He is not to be mocked for his various misconceptions, since he has no idea how else to go about his clinical work. His ciders, on the other hand, should have known that “Pastor, invent thyself … ex nihilo, “is heretical, illusory, and impossible.

Clinical training that omits principles of psychic functioning misdirects students toward increasingly self-directed, self-authenticated interventions that are nonetheless uninformed by the specific psychodynamics of their clients. Redoubled efforts in the former domain cannot correct misunderstandings of the latter. Coincidental success in one domain does not reduce the likelihood of criticism in the other. Nor can self-awareness, conscience, calm, and confidence (plus flexible attunement to the contributions of Moses, jesus, Calvin, Tillich, and the doctrines of creation, redemption, and trinity) actually help a student recognize and respond to psychodynamics involving paranoia, psychopathy, bulimia, melancholia, or narcissism. (I reject without comment any notion that a proper listening stance can correct this structural disparity.) Thus, the inexorable “pointing out” of the student’s inevitable clinical misfirings becomes easy, pointless, and deflating-all in all worthy of its reputation as sadistic. “When you’ve been taught that everything that happens was caused by you, it’s liberating to be reminded that the client’s problems were already there.”

When not so reminded, students inadvertently begin shaping their ministries to protect themselves from humiliation in the aftermath. The quotation in the title of this essay does not reveal a questionable religious commitment. It illustrates a sadder but wiser student’s realization that he would be defenseless against charges of closed-mindedness and anxiety-ridden intrusiveness were he to report some praying with any client whose material failed to provide adequate protection for him during the verbatim analysis. (Actually, begging might not be enough, since praying could then be viewed as an anxiety-ridden collusion.) Even sadder was a student who had managed to create a partial haven against trauma by restricting his interventions to variations on the sentence, “I care about your problems and I am here for you.” The tragi-comedy of this iatrogenic quest to avoid humiliation was finally unmasked when he said this in response to a client’s question, “Can we find a more private place to talk?”

Dillusionment Type II stems from the realization that all that confronting of student feelings did not result in greater insight, stability, flexibility, or skill. Nor could it. In order to foster such growth, awareness of feelings must be followed at a minimum by clarification of a recurring pattern of conflict involving specific impulses, defenses, representations, and compromise formations. Certainly a student’s ministry may be plagued by some recurring pattern of unresolved personal issues-such as fearing the client’s illness, resenting ineffetuality, despairing or retaliating in the face of resistance, and so forth. Nevertheless, ad hoc confrontations only confound accurate assessments of pertinent dynamics. Everyone could be convicted of every imaginable personal problem on the basis of transitory interchanges, but no student could possibly suffer from them all as a recurring pattern. (In this regard it is worth mentioning that to demonstrate from time to time every type of personality disturbance could be nominated for that elusive definition of “normal. “)

Process learning neither differentiates transitory feelings from recurring dynamics nor contributes to a deeper understanding of conflicted patterns. It can only circle regressively in upon itself. Students who attempt to break the circle by seeking clarity about what (if anything) some unresolved feeling means are trapped by the rule of process, in which this seeking then reveals some other unresolved feeling-and so forth. “We spent the first half being told we were blocking our feelings about being there and the second half was all about blocking our feelings about leaving. Nothing we were feeling ever got dealt with. I think there was a rule against it.”

Memories of CPE as uninvited psychotherapy are common enough to conclude that CPE intends more treatment than training. Jasper Keith would seem to confirm this inadvertently in noting that “liberation, self-fulfillment, inner- or self-direction, even self-transcendence are the testimonies of folk regarding the transformations they have experienced in CPE.” Similarly, the value of tossing students into enigmatic clinical dramas in order to promote their personal growth is discussed as normative in CPE literature. An articulate appreciation and defense of this central aim has been provided by Toni Tollerud, who nevertheless deconstructs this positive testimony on the penultimate page in one sentence: “The rub comes when pastors are not trained in theories of individual and family dynamics and so are unable to use effective strategies and interventions to help people change and grow.”

The collision has finally occurred. Promoting personal growth is distinct from promoting worthwhile clinical ministry to clients. Such training aims as self-awareness, openness, tolerance of anxiety, and acceptance of limitaions earn their relevance only in accordance with their respective contributions to quality of ministry. Even if personal growth is deemed an essential prerequisite to clinical ministry, substantial questions abound concerning the potential harmfulness of purporting to foster interior change within any training regimen that camouflages the intent to treat, obfuscates the right to accept or decline the terms, compromises confidentiality, evaluates progress on paper, and holds explicit or implicit power over the professional future of the student-well, patient. This issue cannot be discussed further here, except to note that, psychoanalytically speaking, such a confluence is expected to drive the patient crazy-or away. More directly pertinent to the issue of CPE’s undesirability is the prospect that clients who consult, congregations that hire, and the church itself as a responsible governing body would not truly desire their pastors to pursue the personal-growth enterprise of CPE at the expense of any recognizable training in principles of psychic functioning. (At the very least the impression must be corrected that the C and E in CPE stand for such grounding.) When client welfare is the referent criterion, then CPE is inefficient because gains in the quality of clinical ministry can be accomplished more directly.

Basic Change
Hiding in plain sight is the negative correlation between the difficulty of a task and the suitability of the tools. In both religion and mental health, the foundational tool for care giving is a baseline fluency with the texts validated in community. Neither religion nor mental health endorses caregiving invented dyadically, ad hoc, or in disregard of these texts. Each tries to weed out loners who want to use their community’s mantle to follow some personal drummer. Primary authors in each field are dead, but their legacies live on precisely because these are not ad hoc, not obvious, and rarely discoverable through introspection. Were this not so, the theological enterprise itself would be impossible.

In the basic change illustrated here, the encounter with foundational principles of psychic functioning comes first. Processing these materials in order to formulate a ministry response comes second, along with personal growth possibilities. The aim is a ministry approach commensurate with each client’s state of psychic need. Therefore, foundational principles pertain to the psychic situations pastors must comprehend and respond to most often. They include elementary distinctions between chronic and acute situations as well as between psychosis (perhaps 20 % of a clinical or congregational population), personality disorders (perhaps 30%), and problems of living. Issues like the meaning of being a person are not principles of psychic functioning. (Another CPE student, seeking to integrate her contemporary theology and personal identity, ministered to a homeless woman with alcoholic psychosis by encouraging her to organize a demonstration at City Hall. She was aided further in this misdirection by two seminary professors-which permits the incidental observation that even liberal seminaries can be downright phobic about this grounding.)

It takes me about an hour to present to a class of pastoral students the most rudimentary dynamics of psychosis, the impossibility of functioning as a primary caregiver on an informal basis and a few elementary guidelines for a helpful counseling approach. (It takes about twelve clock hours to present rudimentary coverage of the psychic positions that confront pastors most often, and another twelve to introduce rudimentary features of special situations, such as crisis or family counseling.) In cases of psychosis one guideline is, “Be simple, simplistic if you can.” This will allow the client to venture a connectedness (however fragile) and will avoid the accidental intrusiveness of thoughts that carry unforseeably bizarre connotations for the client. Another is, “Don’t fuel bizarre thoughts or feelings by supporting, challenging, or inquiring into them.” Barring impending dangers, benign neglect of the bizarre promotes a stabilizing, integrative experience that may allow the client to neglect the bizarre in return. No minor outcome. There are others, but this is the prelude to the purpose for this illustration.

Near the end of this presentation I borrow an old verbatim from some student’s work with a client not originally recognized as psychotic. Without coaching, virtually all counselors will be able to identify half of their detrimental interventions, explain why, and transform them 011 the spot into more effective responses. Usually some interventions criticized before are recognized as valuable after all. The other half will be transformed by the class. (Students do still have blind spots to work on, but there are half as many as they were led to suspect before.)

In the most recent instance, a CPE student who visited a psychotically paranoid man had previously been criticized on the grounds that her verbatim revealed the harmful intrusion of personal anxieties. Supposedly, anxiety accounted for her failure to inquire further into his fear of a relative’s “voice” which accused him of being a “pirate and a wimp” and her failure to confront the dubious theology contained in his recurring references to the hymn, “What a Friend We Have in Jesus.” In our class, she had no difficulty reappraising the client’s psychic need state. The hymn contained an elemental resource to counter his vigilant attention to unmanageable ideas and feelings. The words contained the prospect of safe haven in a psychically menacing world and they contained hope that tormenting threats might yet be mastered inwardly somehow.

The purpose for reporting this vignette is to emphasize this pastor’s induced sense of failure and induced plan to alter her approach in the future. The client was not harmed this time-but will be if the_ feedback the pastor received in CPE is allowed to stand. Her anxieties may well be real, but they are not relevant to quality of ministry. More CPE-type scrutiny of her own interior “issues” will perpetuate an erroneous focus on the “voice” and discredit a key religious aid in the client’s attempt to get well. Lest this now seem obvious, remember that the pastor originally knew nothing about psychosis and was flying blind on the basis of the client’s manifest material.

In under two hours, and without the need for inquiry into any student’s personality, all participants can be taught clinical principles that will recur relevantly with new clients, be enabled to formulate interventions congruent with those principles, and be grounded in an elementary grasp of the interrelationship between the two. The importance of self-discovery comes into play wherever the student gets stuck, never before or in place of a presentation of the clinical principles to be digested. This avoids inefficient rumination by giving interior work, when needed, specific focus, and differentiates it from demonstrated competencies that most assuredly should not be toyed with. More than these two hours will be needed to integrate both into an overall approach to clinical ministry. Quantity of time spent, however, contributes little unless the needed growth of knowledge and skill is focused, comprehensible, and relevant.

These reflections have been primarily intended to clear away debris from CPE training that confuses the pastor’s intents and compromises effectiveness in clinical situations. As an unexpected bonus, grounding in foundational principles of psychic functioning permits a revival of the pastor’s religious focus.

The Punch Line
When the pastor is equipped to make even a rudimentary assessment of the client’s psychic situation, then religious text and tradition can he used to generate interventions that foster psychological stability and growth, whether or not those interventions match the client’s manifest material or expectations.

This limited aim, pastoral interventions that foster psychological stability and growth, may not be all that pastors desire to achieve with their clients, but it is at least manageable for most students. If it is somehow contradicted or contraindicated by theology, then the field as a whole has an invigorating topic to explore. In the meantime this punch line permits a modest increment of freedom for pastors and benefit to clients.