Is surviving thriving? Seeking pastoral care’s future both in the US and Israel

In the North American non-Orthodox Jewish world, we well know the debate about whether surviving and thriving are in tension. “Intermarriage is killing us,” some cry; “we’re disappearing!” But others respond, “it’s _you_ that are killing us with all your anxiety about intermarriage; you should be focusing on making Jewish life intense and meaningful, especially for young people; forget about counting heads!”

Both sides seem discouraged by the aging of the Jewish community and are almost obsessed with the lives of young Jews and their education.

It turns out that things are not too much different in the rest of the American liberal religious world, including in the field of Clinical Pastoral Education (CPE), which is the main way of training chaplains and other spiritual caregivers in America. Trace Haythorn, the dynamic chief executive of the ACPE, was only minutes into his talk to a large gathering of CPE educators in Albany last week, when he raised the specter of ‘disappearing’ in the form of the struggling American Association of Pastoral Counselors. That group once had the kind of robust business of granting certification to its practitioners that the ACPE does in its field. But as business and insurance changes increasingly eroded the economic value of pastoral counselor certification, the AAPC was tossed into economic crisis.

Under the Haythorn’s leadership as executive director and CEO, the ACPE is instituting a variety of changes meant to make the organization and field more competitive. The changes raise a variety of questions about the nature of the field and its future, including the tension between its history as a spiritual “movement” birthed by clergy people primarily concerned about the state of suffering people’s souls, to its present as a profession seeking to solidify its place as a normal, integrated and expected part of today’s highly technical, evidence-based and documentation-intensive hospital healthcare system.

As most CPE takes place in hospitals and is thus dependent on gaining the approval of hospital administrators conscious of both the bottom line and the importance of customer satisfaction, the ACPE is emphasizing strengthening its professional elements in its new initiatives, although some longtime educators are concerned about also keeping focus on ACPE traditions like a commitment to process as opposed to outcomes-focused education.

Two primary elements of the current changes are 1) reforms to the process for certifying CPE educators and 2) the dissolving of the ACPE’s regional bodies in favor of a national governance structure.

The certification reforms are a sort of ‘focus on youth’ for the ACPE. In Albany, Haythorn pointed out that the median age of the association’s members is 61. “We have a lot of retirements coming and not enough bodies to fill” the resulting openings for Certified Educators, he said.

The lack of national uniformity and the unpredictable nature of the length of the certification process has been one of the major challenges for the ACPE in its effort to certify more educators. While many students have been able to finish the process in three or four years others have not been able to pass the hurdles — which include personal appearances of an hour or more before committees of senior educators — after as much as twice that time. Such ‘stragglers’ face painful uncertainty about whether they will able to finish the process. This is a sharp contrast to other professions like medicine or law where the length of time required to finish the education is predictable under normal circumstances. While the ACPE reforms will not set such a regular time period, they are meant to end the situation of having a large number of people lagging years behind. “People will be counseled out of the process . . . so we don’t have this huge pool,” said one Certified Educator.

In Israel, where we are for the first time setting up regular programs for educating and certifying CPE educators, we are trying to address these problems by making CPE education more like a regular course of education.

At the Schwartz Center for Health and Spirituality, I and center director Eli Sharon have designed a two-year course that meets for a full day session with its five students once every two weeks. In the long tradition of the CPE “action-reflection” learning model, the educational time is dominated by the participants presenting their own work teaching and supervising spiritual care students. They receive feedback, support and guidance from each other and from the faculty during these clinical presentation seminars. While many US educators receive their training in a kind of consortium environment where faculty from all over a region take turns leading seminars and giving lectures, all elements of the Schwartz Center program are under our close and direct supervision, so we are able to ensure a high quality of all elements and make sure they make work together.

Thus, for example, the theoretical lectures closely relate to what is happening in the students’ teaching assignments at the same time; for example, when students are getting ready to start their own educational programs, we are able to focus the lectures on the educational and relational issues raised by the start of a program. This kind of close integration of the theoretical material and the practical work is a fundamental best practice in CPE education.

Following the ACPE’s own ambitions for its upcoming reforms, we have been able to make our program competency and portfolio based. The core of this effort is a monthly grid/report that students prepare on each of the 40 some-odd  ‘competencies’ they are responsible for; the competencies are inspired by the ACPE standards for certifying educators. Students are thus able to track and record their own progress towards the standards they will be held responsible for when they apply for certification.

Most importantly, this grid is a way of merging process and outcomes approaches to education instead of having them be in tension. Most people are used to thinking of education in an outcomes oriented way. You send a kid to a math class that has the educational goal of teaching a kid to multiply fractions. The outcome is, “at the end of this class the student will be able to multiply fractions.” If they really can do that at the end of the class, you’ve achieved your goal.

But caring for people who are sick or dying in a hospital bed, or wrestling with ‘big questions’ like why God would let their child get cancer is not like multiplying fractions. Some people might believe that the only good spiritual caregivers are “naturals” who are born that way. But CPE by its nature, in contrast, is based on the belief that people can learn to be good caregivers and can learn to improve in their caregiving.

Eli Sharon and I, for example, believe that CPE is a transformative process that it is most helpful to think of as an אורח חיים/Orach Hayim, a way of life, as opposed to an educational way of acquiring some set of tools or skills. It is spiritual practices, including prayer and meditation that help bring about the personal and spiritual transformations that CPE hopes to engender. But it is one particular kind of spiritual practice — one that also brings in insights from secular fields like psychology — that characterizes CPE’s unique approach to transformative education. And that is the disciplined reflection on one’s personal experience, particularly the experience of talking with hospital patients about their own experience of suffering, including their fears and anxieties.

In CPE, we do this reflection in intensive small groups or in individual meetings with a Certified Educator. We call this approach to process learning, the action-reflection method. First comes the action (ie, meeting with the patient), then comes the reflection, which, hopefully leads to improved ‘action’ with the next patient.

Since, what we are talking about here in this ‘process’ of education is really a holistic approach to personal, spiritual and professional growth, the process becomes quite individual to each student and it can be difficult to measure and assess.

The monthly report/grid is meant to meet these challenges. For example, one of the 40 some-odd competencies is “supervising clinical work of students, esp. relating to pastoral identity formation.” Each month, the students in our education course can write about what new work and challenges they have faced in their work with their students, especially in terms of helping their students with their own transformative processes (this is what we mean by pastoral identity formation). In another box on the report/grid right next to this one, the student can reflect on how this last month of experiences relate to their own personal assessment of whether they have achieved the level of competency that would be expected of a certified professional. Finally, in another box they can write about what their “growing edges” are in this area — that is, what they think they still need to learn. Through the student’s use of this educational tool process and outcomes approaches to learning are merged.

It remains to be seen whether the ACPE will create clear tools like this that combine process and outcomes approaches, and help guide its aspiring educators through their educational and certification process; much of the reforms — which are supposed to start going into effect as of the first of the year — are, nonetheless, still “in process,” so extensive details are not yet available.

What is clear is that, while there will be no set time span for the process, the hope is that each student will take only one or two years to complete each of its two phases. The process is meant to be more relational and less academic. For example, the “theory paper” requirement in the middle of the process that has been so difficult for so many students will be reformed so that students can give a presentation instead of writing an academic paper. They will also be assigned a Certified Educator to work with them as a mentor throughout the process.

Additionally, entry requirements to the process will be toughened up, and the national ACPE will have to give its approval for a student to enter the process to become a certified educator.

This final requirement is part of the ACPE’s effort to give some uniformity and quality assurance to the whole endeavor of training CPE educators. A core curriculum is also being prepared that will probably be taught out of the national office by ZOOM (a video conferencing tool similar to Skype).

This drive for greater uniformity and quality assurance is also behind the ACPE’s decision to close its regions, and the ACPE meetings I went to over the last week — one in Albany and one in N. Andover, MA, outside of Boston — were the final meetings of Eastern and Northeastern regions, respectively.

There was a lot of grief and confusion at these two meetings. For some educators, the regions were one of the main opportunities they had to interact with other educators and to keep current in their field. They were also a way to get experience in leadership and to prepare for leadership positions in the national organization.

To try and fill the gap left by the dismantling of the regions, the ACPE is instituting something called Communities of Practice. These could be a regional group (so that one of the disappearing regional organizations could reconstitute itself as a Community of Practice and still hold bi-annual meetings of Certified Educators and of students in the area. Or, they could be thematically organized, like a community of practice of people interested in using the arts as a tool in CPE education. The national organization has already received applications — usually consisting of about a paragraph of written description — for some communities of practice. All Certified Educators will be required to be part of at least one community of practice.

In the Israeli spiritual care community, we are carefully watching these developments, including the development of the core curriculum for educators. While I am sure the Schwartz Center curriculum will be strongly affected by the choices the APCE makes, I have some doubts about the decision to centralize the teaching of the curriculum. Doing so, for example, makes it impossible to schedule elements of the curriculum around events in the students’ clinical work in the way we have done in the Schwartz Center program.

My valued colleague Rabbi Valerie Stessin, one of only a small handful of chaplains certified in both the States and in Israel, once gave me the gift of the image of the US CPE world as a 100-year old grandmother full of wisdom and experience, and of the young Israeli Spiritual Care community as a teenager, eager to learn from grandma, but also full of inquisitive energy and curiosity that leads to experimentation that can help invigorate and renew grandma. I would be eager to dialogue with the ACPE leaders working on the details of reforming the ACPE certification process and share what we have accomplished at the Schwartz Center.

CPE was founded by a man eager to learn more about himself and about God’s relationship to the world and human beings. That man, Anton Boisen, worked, and — believe it or not — was also sometimes a patient in a Massachusetts mental hospital. Sometimes people refer to the “CPE Movement”, using the same word — movement — that the Jewish world uses to describe its denominations (eg, the Reform Movement). This use of the word movement shows CPE’s roots in spirituality, and its practitioners’ hopes — both the practitioners of the past and those of today — to encounter the Divine, especially as it is expressed in the compassion, humility and humanity we witness in our encounters with patients.

As it is in with the Jewish world, my hope for the CPE world is that the focus will be on thriving, not just surviving. Yes, we need to be a profession that can communicate with the rest of the healthcare team and work closely with them. But we cannot forget our roots with the prophets. Sometimes the Divine calls for us to risk fearlessly speaking truth to power. Sometimes we are the only person in a room who can remember the need to treat the patient, and the patient’s loved ones, holistically and with a recognition that they are created in the spark of the Divine. I have known those holy moments when I stood before power with nothing more than God behind me. That’s when I knew I was part of a movement and not merely a profession. My prayer is that my educator students will also come to feel they are part of a movement and not just a profession. And that we will continue to find our way to forging a field that is uniquely Israeli and that is appropriate to the unique cultural and historical circumstances of Israel, while still open to hearing ‘grandma’s’ wisdom.