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
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
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
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 lifedescribe 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
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
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
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
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
teachers.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
"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
Having listened to the stories of current and past CPE students, that is a statement
that is difficult to dispute.
in the Field