Clinical Pastoral Education
Shaping the Pastoral Role

by Hope Andersen

A familiar cartoon depicts a man banging his head against the wall."Why are you doing that?" a passer-by asks. To which he replies, "Because it feels so good when I stop." There are those who would say the same about the Clinical Pastoral Education (CPE) experience: "It felt so good when I stopped." And yet most CPE veterans recognize that pain is a necessary part of spiritual growth.

As Leslie Mott, a PTS senior enrolled in CPE this summer at St. Mary Medical Center in Langhorne, PA, says, "I knew it was going to be hard. Everybody said it would be tough, but worthwhile."

What makes the CPE experience simultaneously "tough" and "worthwhile"?

According to the Reverend Denise G. Haines, regional director of the Association for Clinical Pastoral Education (ACPE) Eastern Region, it is the pedagogical method that the program uses that makes it so challenging. Unlike traditional academic programs, which are based on a more objective approach, the CPE method of learning is grounded in action and reflection. Initially conceived as a method of learning pastoral practice in a supervised clinical setting, the concept of the program was expanded in the 1920s to include the study of "the living human document."

Over the years, the program has evolved and expanded, integrating knowledge of medicine, psychology, and other behavioral sciences into its approach. Most recently, supervisors have come to appreciate the significance of personal awareness, behavioral theory and method, and spiritual development in the formation of healthy pastoral relationships. "Because we minister out of who we are," Haines says, "we need to know who we are." CPE provides participants with the opportunity to explore themselves, their vocations, theologies, attitudes, and fears, and to examine how the "self" both contributes to and detracts from their ministry.

For David Carlson, a PTS senior who spent the summer of 1996 at the University of Louisville Health Science Center, a level one trauma unit in Louisville, KY, the lessons began immediately. "It made 'ER' look like child's play," he says. Everyone who takes CPE seriously gets pushed out of his or her comfort zone.

"I thought that I was afraid of blood," continues Carlson. "My very first patient was a fourteen-year-old boy who had been run over by a tractor. His face was raw, and they had to use leech therapy to keep the circulation going so the skin would remain viable. But I was OK. I talked to the family-his mother, his aunt, him."

By the end of the summer, Carlson's fear of blood was gone. It had been replaced by a deep appreciation for the here and now. "I saw all these people in freak accidents. It made me feel that what we have is a gift. Life is a fragile thing, and yet so important."

Carlson recalls that the first weeks of the program were uncomfortable. He didn't know what to say and didn't feel as though he had anything to offer. "At the beginning, I was trying to do too much," he remembers. And yet he was required to take on a pas-toral identity immediately. Fortunately for Carlson, he had a good supervisor who encouraged him to visit patients and to become known on the floors.

Carlson's supervisor compared the CPE experience to the Chinese word for "crisis," which is made up of two characters: "danger" and "opportunity." Carlson's experience ministering to people in crisis affirmed that comparison. "When people are going through terrible things, they find out that they need God," he says. The opportunity, as Carlson understands it, is "to let people tell their own stories. We are called to listen, particularly when people are suffering."

Though much of the CPE experience does take place on the floors, an equally significant portion of the program occurs in group and individual sessions with the CPE supervisor, and a typical day devotes time to both ministry and education. Since CPE is based on action and reflection, most days include IPR (interpersonal relations), a clinical seminar in which one student in the group presents a verbatim (a highly structured written description of a pastoral visit) to the other members of the group and the supervisor for discussion and feedback.

Mott recalls her first verbatim at St. Mary's. "I thought it was a great visit, but my supervisor pointed out that the patient controlled the visit very well." A later encounter, which Mott assumed had gone badly because the patient had been unresponsive and in denial of his condition, received positive feedback from her supervisor and peers. "My experience is very different from what my peers see," Mott concludes. "Everything is through my filter."

For Mott, the writing and discussing of verbatims provides an opportunity to examine theological, sociological, and psychological assumptions that she was not aware of holding. Such self-awareness is one of the primary objectives of CPE. According to the Reverend Frederick G. A. Sickert ('71M), CPE supervisor at Legacy Health Systems in Portland, OR, the action/reflection experience is an effective way to "help students begin to look at themselves and what they are about. Through individual work and work with peers, students discern their identity. They learn what it means to be a good pastor."

In addition to group sessions, students meet with their supervisors for individual guidance. These meetings can be as significant for the supervisor as for the student. Sickert recalls an experience in which a Catholic student from St. Paul School of Theology in Kansas City, MO, was struggling with how to minister to people who had no religious upbringing. "His challenge," Sickert said, "was how to build a bridge." By week three of the program, the student had come up with his own resolution. He told his patients that his lifestyle was to pray often, and that he would pray for them. Even if they didn't believe in God, he would believe in God for them. He practiced wearing his clericals one day and casual clothes the next, as a way to illustrate both his vocation and his humanness. To Sickert, these were creative solutions and important steps in one student's journey toward a better understanding of himself and his role as minister.

Students benefit from good supervisors. PTS senior Matt Stith made a point of applying to and interviewing for basic CPE at Somerset Medical Center in Somerville, NJ, because he had heard such positive things about the supervisor, the Reverend Cynthia Strickler ('86B), and some pretty gruesome accounts of how difficult the CPE experience can be with a bad supervisor. Stith, who admits that he went into CPE kicking and screaming and only because his presbytery required it for ordination, was pleased with his choice.

"Cindy is a tremendous chaplain," he explains. "She has a lot of experience, and she really knows her stuff. She can direct IPR without dominating it, without being overbearing, and she has a way of making you realize exactly what was going on [in a pastoral visit] that you didn't even know."

A third facet of CPE is the didactic, or teaching seminar, in which supervisors or visiting lecturers address topics relevant to pastoral care. These can range from presentations on active listening skills and the power of story to day-long presentations on focusing (a technique of internal examination), healing massage, or observation of surgery. Sickert uses his early didactics, when students are experiencing the anxiety and experimentation common to the early weeks of CPE, to tell his own story. By making himself vulnerable in sharing something of himself, he hopes to promote trust among the group and to facilitate communication.

Like any situation in which one participates as a member of a group under supervision, the CPE experience is colored by the group dynamic. Thus, in order to create the best possible combination of individuals, supervisors are highly selective in the screening process. At Legacy Health Systems, applications are reviewed by an experienced, ecumenical, gender-balanced team consisting of a Lutheran pastor with a Ph.D. in clinical psychology, a former Episcopal bishop and CPE supervisor, a Methodist pastor, a Presbyterian pastor, and nurse managers. The screening team's goal is to bring together a strong, diverse group capable of supporting one another on the journey.

Not all programs have such a rigorous screening process, but all CPE applicants are required to complete an application that asks personal questions. Candidates are asked to write "a reasonably full account of your lifeŠdescribe your family of origin, your current family relationships, and your educational growth dynamics." In addition, they must describe the development of both their religious and work lives and recount an incident in which they were called to help someone, assess the problem, include the solution, and evaluate the experience. Subsequent to submitting an application, all candidates must be interviewed, either at an ACPE site or by an ACPE supervisor.

PTS is among the seminaries that streamline this process by bringing two dozen or more CPE supervisors to prospective students. Every year in January, supervisors are invited to a PTS healthcare-related continuing education event and a dinner at the Seminary, which is followed by "Meet the Supervisors" evening, sponsored by the Office of Field Education. This provides students with an opportunity to speak with supervisors from a variety of sites, to shop for an interviewer and register for an interview, and to enjoy dessert! Some particularly organized students see this as a time to complete the application process; they arrange to interview with a supervisor during the afternoon and be done with it. Others, like Mott, prefer to interview on site in order to see the facility.

What are supervisors interviewing for? What makes a successful CPE candidate? According to Haines, "the best students are people who have had successful adult experiences." They are the ones who, she believes, are equipped to handle the "very personal nature of the training process, which is both an intimate and a threatening experience." Sickert agrees. "We're a pretty confrontive group," he says. "The candidates who will both contribute the most to and receive the most from the training are those who have already worked hard on themselves." For Sickert, the bottom line is that if the peer group is good, the experience will be good. Not fun, not easy, not relaxing, but good.

"The people who didn't have a good experience are those who didn't want to deal with the things they were going through," says Carlson. He admits that the peer groups were tough, especially in the beginning. "People would break down," he recalls. "Your supervisor definitely finds out where you are and pushes you to the edge. But I found that I could learn a lot if I took what was said and considered it. Group taught me a lot, too, about how people receive criticism. We had some pretty heated discussions."

Group experiences are as diverse as the individuals in them. Mott's group includes PTS alumna Lisa Hess ('96B), who is enrolled in the Ph.D. program at the Seminary, one male Presbyterian from New Brunswick Theological Seminary, two nuns, and one Catholic laywoman, in addition to herself. Stith's group is slightly smaller, but three of the four members are Presbyterians affiliated with PTS; in addition to Stith, Heather Christensen ('97B) and Chris Hammond, a PTS middler, are doing CPE at Somerset. This summer, Sickert's group comprises five theological students, all of whom have left the business world, including a CPA, a music teacher, an advocate for the poor, a member of the military, and an administrative assistant.

For Mott, the group experience has been good, though she admits that it is still early in the process. Through both group and individual supervision, she is learning a lot about herself. "The group and my supervisor have recognized things in me that I hadn't seen. I am nurturing and talented, and I have a good sense of presence."

In addition, her work in group and individual supervision has given her a significant insight: her greatest asset and greatest hindrance are one and the same. "I have a deep, abiding empathy for people," she says, "and if I am not aware of it, I can overstep boundaries."

Like Mott's, Stith's perception of himself and his ministry has changed since beginning CPE. He has learned, he says, that he has a tendency to want to fix situations, to solve them intellectually. "But," he admits, "there are some situations that can't be fixed, that can't be solved."

He also learned very early on that the chaplain is not the only one who ministers to those in crisis. During his first "on call," which took place on the third day of the program, Stith had to accompany a family to the morgue to see the body of their twenty-two-year-old son who had been killed in a motorcycle accident. Stith recalls that the emergency room technician, the nurses, even the security guards were all extremely pastoral in their dealings with the family. "The best that can be said for my performance," he recalls, "is that I didn't faint or throw up."

The CPE program has expanded over the years. Today, the program accepts theological students, ordained clergy, members of religious orders, and qualified laypeople. It offers a variety of sites in which to "practice pastoral care with qualified supervision and peer group reflection," including hospitals; correctional centers; hospice; geriatric and rehabilitation centers; and parishes. There are over three hundred accredited CPE centers in the United States, including Alaska and Hawaii, from which to choose. There is even a new CPE center in Puerto Rico!

In recent years, an increasing number of denominations have required that candidates for ordination complete CPE. Lutherans, Episcopalians, and many Catholics are required to complete the program before being ordained. Many presbyteries in the PC(USA) require CPE of their candidates for ministry. And even if it is not required, most churches strongly suggest that prospective pastors complete the program.

PTS students have the option of doing CPE as an elective or to satisfy one of the two required field education internships. Abigail Rian Evans, PTS's associate professor of practical theology and academic coordinator of field education, says that "awarding academic credit for CPE reflects Princeton's commitment to its importance." Though the Seminary does not require CPE for all of its students, about thirty-five students per year, mostly in the summer, complete a basic 400-hour unit. Those students who are required to do CPE by their denominations generally elect to complete the summer field education unit and their denominational requirement at the same time.

The most compelling advocates for CPE, however, are those who have completed the program. Stith, who entered the program reluctantly, says emphatically, "I really love CPE. I'm a convert. I admit that my presbytery was right, and I think CPE should be required of everybody."

And Mott adds, "I would highly recommend CPE to anyone going into parish ministry. CPE provides a ready-made crisis for you to walk into. Our patients are our teachersŠ.If you're interested in taking an interior journey, CPE will do it for you. It's like professional therapy."

Similar sentiments are expressed by Carlson as he reflects on his summer of basic CPE: "If you look seriously at the way that you have been changed, the way that God has touched you and ministered to you in CPE, you don't do things the same ever again. You'll be looking at ways to minister. That's the way that it helps you. And when a crisis comes in later life, you'll be equipped because you've had experience. You'll be confident that God will give you exactly what you need."

Despite rave reviews from most everyone connected with CPE, not all PTS students are able to take advantage of the program. Regrettably, there is no PTS funding for the program, a fact that presents problems for a number of students because not only must the student pay a site fee of $250 to $600, but also, of course, the student earns no money that summer and must usually pay for room and board besides. Stipended CPE positions are scarce.

"We encourage churches and judicatories that require CPE to assist students with the costs," says Kate Bilis-Bastos, assistant for specialized ministry internships in the Office of Field Education at PTS. "It's a shame," she says, "to reserve CPE for an elite few when every future pastor, not just future chaplain, can benefit from it."

Having listened to the stories of current and past CPE students, that is a statement that is difficult to dispute.

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