Chaplaincy and Pastoral Ministry

Chaplaincy and Pastoral Ministry

Monday, 23 January 2017

Christian pastoral care and multi-culturalism

David Pettett

In a recent post on the value of measuring outcomes of pastoral interventions in hospitals I asked the question about what is meant by ‘the spiritual needs of the patients’? What are ‘spiritual needs’? How are spiritual needs defined? When pastoral carers and healthcare professionals speak of ‘spiritual needs’, do they mean the same thing? Are we speaking the same language?

I suggested that we are not speaking the same language but that Christians who engage in pastoral care in public institutions never the less have a vital role to play. Ultimately the ‘outcomes’ of Christian pastoral care cannot be measured with any scientific accuracy. This is not to say that pastoral intervention has no ‘value’ or benefit. When patients are surveyed about how they feel after a pastoral intervention they generally report a positive outcome. These can sometimes be seen in shorter hospital stays, improved pain management and better cardiovascular outcomes.[1]

A survey conducted after a pastoral care intervention may record these measurable benefits but in fact Christian pastoral care brings a whole lot more. However, as the term ‘pastoral care’ itself is used more and more in a secular context, the distinctiveness of Christian pastoral care risks losing its unique focus and benefit. In another earlier post, I argued that a biblical understanding of the human condition, of who God is and of where the world is heading is the necessary basis for bringing real compassion and empowerment to suffering people in hard places. Pastoral ministry that relies only on psychological insights into the human condition and does not bring a biblical understanding is not pastoral ministry as Jesus brought it to those he encountered in their suffering and it is not the legacy Jesus left us.

My fear for pastoral ministry in the public square is that the unique insights into the human condition which a Christian understanding brings is at risk of following the secular agenda in an attempt to remain active and relevant in the public sphere. Yet if Christian pastoral carers lose the uniqueness of the Christian message in secular institutions, Christianity will lose its prophetic call to a world in need.

Pastoral care is not simply ‘intentional friendship’. In trying to work out how people from different faith backgrounds can work together in pastoral care David Oliphant claims to have developed the ‘philosophy’ of ‘intentional friendship’[2]. He offers this idea as the lowest common denominator by which people of different faiths and none can work alongside each other to bring ‘pastoral care’ to those who are suffering.

I must admit I do not understand why Christians see a need to lose their unique and prophetic voice in the face of multi culturalism and because they life in a multi faith community. Isn’t this the very context in which, to be faithful to our God and to be respectful of others, we must speak more of the uniqueness of Christ? If all our pastoral care is doing is achieving shorter hospital stays, better pain management, better cardiovascular outcomes, and respecting people of other faiths, then we fail as Christians in the world.

I am not advocating for disrespect of anyone of another faith. I am arguing for Christians to do better at working out how to be Christian in a multi-faith context. And I am arguing that this does not mean reaching an agreement on what we have in common and leaving the rest behind. What a grey world that would be. Multi-culturalism allows and celebrates our differences. It is the job of Christians to work out how we can best bring our unique message into a multi-faith, multi-cultural context in a way that respects both the demands of the government institutions in which chaplains minister and also respects people of other faiths and none who are created in the image of God.

To that end my future posts will explore how this can be done.

[1] See for example, Duncan Blake. Clinician and Carer Both Help Suffering, in Australian Journal of Pastoral Care and Health Vol. 5, No. 1 March 2011. pp. 11-14.

Sunday, 8 January 2017

Empathy, emotional clusters and the accurate identification of the functions of pastoral care.

by Rev. Stuart Adamson

In the first section of this three part series on blogging chaplains back in September 2016, I looked at the way integrating pastoral experience and ongoing reflection on scripture can enhance our pastoral practice, and how, with an encouragement to enjoy learning and play with ideas, teaching resources can be modified and enhanced.

In this second section, I look at empathic listening and my concept of what I call "emotional clusters". After explaining what I believe emotional clusters are, I will outline how I believe they can help chaplains more accurately identify the pastoral need in the person they are caring for.

It is an act of love and respect to patients, parishioners, people we might be caring for, even a friend, if we take the time to listen to their heart - to really listen to what is going on for them.

But empathic listening is no exercise in parroting - merely restating and obvious emotion in another.

I call effective empathic listening "exegeting hearts".

We are big on exegesis of scripture in the Anglican diocese of Sydney. And for good reason. We have a high view of scripture as the Word of God and its power to change hearts. But I wonder if we might not be more effective pastors if we were less ready to jump to conclusions, and more ready to listen to people's hearts. The mouth speaks of what the heart is full.

I spent some time with someone today who I was determined to listen to.

As I listened and reflected back his emotions to him I developed an appreciation of his whole emotional state.

He was utterly exhausted. He was torn between private and work responsibilities. He felt he couldn't go on any longer. That he was approaching burnout. But he was highly motivated by a sense of duty, a desire to do the right thing and to be seen to do the right thing to the extent that he was prepared to keep working to his ongoing detriment.

In my early teaching of the six functions of pastoral care (or eight, as they have become in my training sessions (see the previous instalment in this three part series)), I taught that sustaining is the relevant pastoral function when someone is feeling overwhelmed.

The concept of emotional clusters brings greater nuance to the chaplain’s in-the-moment assessment of the one they are caring for.

Exhaustion. Feeling like he had come to the end of his rope. Physical depletion and personal illness. These were the words and phrases that came up in our discussion.

Together they cause the word overwhelmed to spring to mind.

In addition, an intense feeling of wanting to shout out in frustration, to be at a loved one's side, and an agreement that he was wanting to clear the decks and be there for them, but felt he could not leave his post. Added into the mix was a self loathing and an anger.

Together these finely nuanced expressions of emotion combine to build a strong feeling of being trapped. The function? Liberation.

Care that was both sustaining and liberating was needed.

But those needs were arrived at after much listening, after a patient identification of nuanced emotions that together formed emotional clusters that suggested two of the pastoral functions.

We prayed. He determined to raise the matter then and there with his employer.

He needed to give himself permission to stop and take practical steps to ensure the gathering vortex of unhealthy levels of stress did not draw him down to ongoing illness and burnout.

Empathic listening led to the identification of emotional clusters. Those clusters suggested two functions of pastoral care which facilitated, under God, ministry that was both sustaining and liberating.

Monday, 5 September 2016

The six functions of pastoral care – thinking pastorally, biblically and creatively to improve on a helpful model

by Stuart Adamson

Chaplains who know the value of empathic listening in getting to the heart of the matter in pastoral encounters may also be familiar with what is called in the trade, if I may call chaplaincy that, the functions of pastoral care. I was taught a model that introduces six functions, namely: guiding, healing, nurturing, reconciling, sustaining and liberating. Some say there are six, and that will do, others, such as Andrew Purves, in the early pages of his impressive “Reconstructing Pastoral Theology”, have been very critical of limiting areas of pastoral practice to an arbitrary number. I must say I have some sympathy for his view, and have done for some time.
As a chaplain in training, I remember the six functions being presented to me as framework for pastoral care. It was never presented to me as prescriptive, and I was encouraged to play with the model, test it out and see if it might need tweaking. I did so with reference to both my pastoral practice and to scripture. Now, as a lecturer in pastoral care, I encourage my students to do this with everything I teach, once they understand the concepts. And I did tweak the six functions model.
Over the years I discovered in my pastoral ministry that there are times when people want to celebrate with me. They actually host me with great love and enfold me in the most intimate and sweet times of celebration. Like the time the spinal patient who was admitted to the hospital where I serve. He came in unsure of who God was and six months later walked out a man sure that his name was written in the book of life. Or the leukaemia patient whose transplant went well and their immune system rebuilt and they went into full remission. Just like Zacchaeus, just like the loving Father, they wanted to celebrate. Experience and Scripture. So I added celebrating to the model and they became seven functions of pastoral care in my teaching.
Then, through a similar process, I discovered that some people I came across just wanted to pour out their sadness in the face of great tragedy. I remember a couple I sat with as we watched the life of their little one just ebb away. They just wanted to pour out their hearts to God. Yes they had the hope of heaven, but they needed to lament, along with the Psalmist. (I do wonder sometimes if we ever came across someone as expressive in their grief as the Psalmist that we would tell them to “suck it up” or regard him as weak or of questionable faith). So I adjusted the model to include lament, and it became the eight functions of pastoral care.
Then I went to Mark’s gospel and spent time reflecting on my own ministry as chaplain in light of scripture and I saw what Jesus did with new eyes. He forgives (reconciles), heals and liberates a paralysed man, yes, but he also rebukes, warns and cautions. He calls, appoints, sends out and delegates authority to his disciples and nurtures and explains patiently. He calls forth faith, and resurrects. He has compassion, provides food, nurtures and cares.
On one level, you could argue that the functions of pastoral care are as many and varied as the responses in human relationships and almost defy categorisation in Jesus’ ministry. On another, it is helpful for chaplains and pastors to reflect on their pastoral experience in light of Scripture if it results in clarifying our thinking about how best to respond to the people in need we meet every day.  
To come:
Part 2 Empathy, emotional clusters and accurate identification of the functions of pastoral care.
Part 3 The links in the chain - How empathic listening leads to good pastoral interventions. 

Tuesday, 2 August 2016

Chaplaincy – speaking the language of suffering

Kate Bradford

"Trauma fractures comprehension as a pebble shatters a windshield. The wound at the site of impact spreads across the field of vision, obscuring reality and challenging belief." - Jane Leavy

I speak with theological students and medical students about caring for people who experience deep suffering. These students think widely and deeply about how to resolve problems, using highly disciplined cognitive framework. 

Patients and people requiring pastoral care in general, struggle to make sense of these difficult situations. They are deeply affected by what is happening to them. Cognition is altered and information based communication is frustrated.

Unless the medico or the theologian learns to speak the language of the sufferer effectively, communication is scrambled by the sufferer’s inability to hear clearly, as they are trapped behind the “shattered windshield”.

How do we learn to communicate with those who are struggling behind the shattered windshield?

A team working with palliative care patients concluded that a sensory model of spiritual care worked best,[i] expressed through hearing, sight, speech, touch and presence.

The authors of the article describe effective communication as an embodied experience that engages all the senses of both the professional, and the patient.

They describe hearing as listening intuitively, by paying particular attention to the tone of the conversation, the silences and the subtext. Deep listening requires humility and being alert to the possibility of hearing but not understanding.

They described sight as seeing soulfully, that is seeing the whole person ─ someone who bears God’s image ─ a person with dignity and a person who has a history and a narrative before I entered their life. Soulful sight takes in a person’s surroundings, their relationships and connections, it is not only see, but perceive.

Speech involved the art of taming the tongue, subduing our speech to engage with the patient’s perspective, that is the world through the patient’s understanding and language, building on their understanding, avoiding superficial clichés and hollow scripts of comfort, and avoiding language that minimises their pain, denies their losses or catastrophes and terrifies them.

Touch provides for a physical means of pastoral care, appropriate physical contact can communicate things that words cannot. This may be through a hand that briefly rests on a shoulder, or a forearm, or holding a hand when someone is distressed, or laying on of hands (with permission) while praying. These allow for a physical conduit of care that connects at a deep level.

Presence is the activity of being truly present and available in body, mind, and spirit. So much is communicated by how we are ─ posture and positioning ─ through power, pity, gender, health, status, age, education, language and professional roles. To be present is to be wholly available to the other; we give the gift of self. Presence can convey professional vulnerability, where we do not need to be the expert on another’s experience. When we are truly present, focus spiritually and pray for another in Jesus’ name, we communicate God’s infinite love and concern to the sufferer.

The Gospels describe Jesus as a person who ministered to sufferers through sensory care.

Jesus always engaged at a spiritual level and when talking with people he employed a vast array of communication styles.  When engaging with well people, Jesus asked many questions – perceptive questions, which cut to the heart of the matter.[ii] When speaking to crowds he used parables and metaphors, and enigmatic statements that overturned preconceptions. When talking with teachers of the law and Pharisees he was blunt and to the point rebuking and challenging points of law, which had been torn from their original moorings in scripture.  However, when Jesus was with people who were suffering, he had an approach that was insightful, gently spoken and often involved touch. He gave his complete attention and was willing to be pulled away from his travels to attend personally to those who suffered various forms of illness and disability. [iii]

Below I have listed a number of Jesus’ engagements with people who were suffering from physical disabilities. A strong pattern emerges when the accounts are viewed together. When Jesus is with a sufferer or their family, he gives them his complete attention. He listens deeply to their account of their suffering, expresses pity and acts compassionately. He often goes to the sufferer or takes them by the hand to some quiet place. His words are gentle. He does not preach to the sufferer even if he is making a theological point to someone else (i.e. Pharisees or other on-lookers) and on a number of occasions he commends people for their faith or their willingness to ‘try’ him.

In summary Jesus’s example of spiritual/pastoral care with people in the midst of suffering includes:

a) Careful listening to the event from the point of view of the sufferer

b) Seeing the entire person, inside and out. But he does not presume. He treats them with dignity, love and respect.

c) He speaks gently, offering only words of comfort and reputation. He uses simple language, without hyperbole or parables and does not use these opportunities to preach.

d) Jesus uses touch. This a constant theme as he meets with sufferers; he does not fear their illnesses or diseases. His ‘cleanness’ flows out of his body through physical contact.

e) Jesus is entirely present during these encounters even if there are crowds nearby or looking on. The sufferer has his full attention and he is at their service.

These are critical observations, because although we are not Jesus, we are instructed to have the same attitude of Christ Jesus. Jesus was, on many occasions, an engaging orator ─ questioning, provoking and challenging ─ but when he was with people who suffered he seemed to come to their level and saw things through their eyes. His response restored their shattered world in ways that were meaningful to them.


Quick notes and Bible (ESV) references of evidence of Jesus’ style of engagement with people who had physical ailments.

·         Moved with pity, Jesus stretched out his hands and touch him (leper), saying, “I will; be clean.”  Mark 1:41, Matt 8:3; Lk 5:13

·         And he (Jesus) said to him, “I will come and heal him” Matt 8:7

·         And when the Lord saw her he had compassion on her, he went up to her and said, “Do not weep,” then he came and touched the bier…. And said “Young man, I say to you arise,’ … and Jesus gave him to his mother.  Lk 7:13-16

·         He touched her hand and the fever left her Matt 8:13

·         To the paralytic, “Take heart my son, your sins are forgiven” Matt 9:2

·         Then he touched their eyes Matt 9:29

·         He went in and took her by the hand, and the girl arose, Matt 9:25

·         Take heart daughter, your faith has made you well. And instantly the woman was made well.  Matt 9:22

·         And taking him aside from the crowd, privately he put his fingers in his ears and after spitting touched his tongue Mk 7:33

·         And he took the blind man by the hand and led him out of the village Mk 8:23

·         And he laid his hand on her and immediately she was made straight Lk 13:13

·         And he touched his ear and healed him Lk 22:50

·         Jesus said to him, “Do you want to be healed?” The sick man answered him, “Sir, I have no one to put me in the pool when the water is stirred up, and while I’m going another steps down before me.” Jesus said, “Get up take up your bed and walk.” And at once the man was healed Jn 5:6-9

·         He spat on the ground and made mud with saliva. Then he anointed the man’s eyes with mud, and said, “Go and wash in the pool of Siloam.” Jn 9:6,7


[i] Adapted from “Spiritual Care: how to do it” Sinclair, Bouchal, Chochinov, Hagen and McClement, BMJ Supportive & Palliative Care 2012/2 319-327.
[ii]  An article that summarises the way Jesus uses questions in conversations as recorded in the Gospels.
[iii] A webpage that lists 31 biblical references for accounts of Jesus’ healing.

Thursday, 30 June 2016

Sin, Grace, Freedom & Service

by Rev Stuart Adamson

I find in my sinful nature I am always seeking to justify my sinful actions. It is a testimony to the fact that I agree that sin is a problem that needs to be dealt with one way or another.

Pretending that sin does not exist will never work, though it may make our consciences feel good for a while. If we spend time in the Bible we are confronted and rebuked by the truth of Gods Word, Christian or not. 

But for the believer, and the believing chaplain, indeed for anyone serving the Lord with the gifts He has given them, if we pretend that our sin is not real, or if we are unaware of it, we will grieve the Spirit, or worse, as the writer to the Hebrews calls it, "trample the Son of God under our very feet." (10:29) Effectively, we will be trying to live our lives in a way that inherently denies that Jesus died the second death in our place when he died for us on the cross. 

Grace is in effect the unmerited favour of God. Cheap grace is the idea that we do not need to respond to the demands of grace (is grace entirely undemanding?) or the favour that God has bestowed on us in Christ. That is, we can keep on sinning as though there is no need to repent.

The phrase that Paul uses "God cannot be mocked" (Gal 6:7) basically means that we can't pull the wool over God's eyes. He knows our hearts, he knows our conscience and if we intend to continue in our sin, there is no forgiveness. (Hebrews 10:26) 

A right response to God's grace to us in Christ is sorrow for sin, for the recognition that the offence is not just against another human made in the image of God, but also against God himself. But further, a right understanding of grace leads to a desire to change, to turn away from sin. 

When Peter, seeking to justify himself, asks Jesus how many times should he forgive the brother who sins against him, he thinks he is being very big hearted when he says "seven". Imagine his surprise and disbelief when Jesus responds with "seventy times seven." (Matt 18:22).

In underscoring the boundless nature of God's forgiveness toward repentant sinners, and that we should have the same attitude towards those who wrong us, Jesus is challenging Peter's sinful desire, even in the midst of his right service and seeming right thinking, to seek his own justification.

I have a lot of sympathy with Peter. Isn't Jesus setting the bar impossibly high? This is the chief apostle who was with Jesus from the beginning, who preached the first gospel sermon in Acts 2. 

If he hasn't  got it together, what chance do we have? 

But that is the wrong question though isn't it? Jesus deals graciously with Peter's sinful desire that says, look at me, aren't I great for doing the right thing? So should we when we see it in others, or in ourselves. He calls out the error and calls for repentance. Because grace expects a right and Godly response from sinners who know that while it is undeserved favour, it was not cheap, it does not invite further indulgence of the sinful nature. 

Paul dealt with cheap grace very deftly and devastatingly in his letter to the church in Rome. He has been emphasising Jesus' very point to Peter in Matthew's gospel referred to above. He had been saying, where sin abounds, grace trumps it. In other words, grace beats sin every time. And what's more, true grace does not lead to license, that is, permission to keep on living a life of sinfulness. 

True grace leads to a desire to turn away from sin and to serve the Lord with thankfulness and real devotion, more and more.

Listen to this from Paul in Romans 6:1-3. "What shall we say then? Shall we go on sinning so that grace might increase? May it never be! We died to sin, how can we live in it any longer? Or don't you know that all of us who were baptised into Christ Jesus were baptised into his death? We were therefore buried with him through baptism into death in order that just as Christ was raised to new life through the glory of the father, we too may live a new life. "

We have been spiritually raised with Christ to live a new life with him right now. To sow for the Spirit in the power of his grace.

Further, Paul says in 1 Cor 15:10 "But by the grace of God I am what I am and his grace to me was not without effect. No I worked harder than all of them. Yet not I but the grace of God that was within me."

Grace issues forth in hard work. 

If I am trying to justify myself in my work, I am not working hard because I have been set free to serve, I am working hard out of a sinful refusal to accept Jesus as my Lord, even in my day to day service of Him!

But Paul goes even further to help us have a right perspective. He says the hard work that God has for us to do is a gift of his grace.

Ephesians 2:10

" For we are God's workmanship, created in Christ Jesus to do good works which God prepared in advance for us to do. "

There is great freedom if we serve in response to and because of His grace. We serve in love, in the power of the Spirit and to the glory of God in Christ, because we have no obligation to the sinful nature.

Monday, 20 June 2016

Powerful Words - The Role of Chaplains in the Public Sphere

Report from David Pettett

At a conference recently in Sydney several chaplains presented papers on various aspects of prison, hospital and community chaplaincy. Organised by New College at the University of New South Wales the conference was titled Powerful Words.
Papers from the conference have now been published in CASE No.44/2016 (A Quarterly Publication of the Centre for Apologetic Scholarship and Education at New College, University of New South Wales.) You can see the issue here where you can download some of the papers for free or buy a PDF of the whole issue for $AU7.95 here The issue is entitled “Soul Care” and, in an interesting mix with chaplaincy in the public sphere, includes articles on gender complexity by the renowned Patricia Weerakoon and her son, Kamal. Patricia Weerakoon is a medical doctor turned Sexologist and Writer. She is an evangelical Christian, married to Vasantha and her son Kamal is a Presbyterian minister. As a Sexologist Patricia has translated her passion to bring good holistic sexual health to all people into practical sex education, sex research and sex therapy. This issue also includes a contribution from Dan Anderson, Chaplain at Menzies College, Macquarie University, on Chaplaincy in a Residential College.
The keynote speaker at the chaplaincy conference was Dr Rhys Bezzant, Dean of Missional Leadership and a Lecturer in Christian Thought at Ridley College, Melbourne. Rhys encouraged us to have God’s timeframe when encountering suffering. He spoke from Psalm 102 and the lament, “How long O Lord?” “Our days may be short, so ultimately we need to understand them in the light of God’s own timing, his years.” This is the God who has broken into history, who does not remain distant from the human condition but makes a covenant with his people.
With acknowledgement of the uniqueness of the Christian tradition of pastoral care and its distinctive message that God has spoken in his Son, Rhys says, “Using the Scriptures when appropriate is a sign that there is a venerable tradition of soul care which predates the chaplain’s labours, and will outsurvive him or her as well.”
“Psalm 102 has taught us to value words, to care for people by connecting their story of God’s purposes for history, and to value our own unique creatureliness despite our suffering or sin. … God’s care of us is ultimately located in the Lordship of Christ, in whom every part of our life finds meaning.” Rhys argues that the chaplain must have good conversational skills if he or she is going to bring God’s ultimate care by speaking one on one with a person who is suffering.
David Pettett spoke on his experiences of being a prison chaplain in two very different maximum security settings. He highlighted the questions prisoners ask, speaking to those questions of life that most trouble them. While on remand and going through the legal processes of arrest, charge, hearings, court, judgement and sentencing a prisoner is in a high state of anxious uncertainty. In this context the question most often asked is, “Where is God?” Often the prisoner translates this question into a reflection on their own behaviour that got them into trouble, “Why did I leave God out of my life?”
Once sentenced the prisoner’s question will sometimes turn to, “How can I be forgiven?” Acknowledging that their crime has caused significant harm that cannot be undone, the criminal is confronted by painful, unrelenting reality.
These are the questions prisoners have. As a prison chaplain, David came to understand that these questions were more prompted by the Holy Spirit than anything or anyone else. The chaplain’s role here is to simply engage in conversation. It is the Holy Spirit who continues His work in the life of the questioner. “Prison is a unique context, and chaplaincy in prisons is intense and rewarding. People are forced to face matters that are easily brushed aside in the busyness of normal life – the meaning of life, sin, judgement, repentance, forgiveness – matters that point questioners to God. … Christian chaplains have the privilege of being part of the work of God, bringing the good news of Jesus into this often hidden part of the public sphere.”
Peter Frith spoke about his role as a chaplain during and after the Lindt Café siege in Sydney where people were taken hostage and held for hours by a lone gunman before he began shooting in the small hours of the morning. The gunman and two hostages were killed. “What did you say?” friends asked after Peter had spent the night with relatives and then with rescued hostages. “This was a daunting job”, Peter says. “The tension was high and emotions raw. … [m]y training kicked in – not just disaster response training, but also the basic training any chaplain must undergo. … What was not said was more significant. “How are you feeling?” is not helpful. Often, after I introduced myself and invited someone to tell me of their experience, the rest was about listening.”
Peter Ellem as a hospital chaplain recognises that hospital chaplaincy takes place in the face of human suffering. It is a ministry at the cross roads because suffering has crossed a person’s path and brought them to a hospital within which God might be discovered. This is ministry that is present both with the patient and with God. This presence is a great gift. Peter says that chaplaincy is grounded in three realities. 1. The character of God. 2. Chaplaincy is cross shaped, standing in the movement of God towards a broken world. 3. Chaplaincy is about liberation. “Chaplains … see, hear, and show concern, but it is God who liberates. … Faithfulness to the cross of Christ means, in part, being able to bear with the suffering of the world and to stay there with it when everyone wants to flee.”
Kate Bradford spoke to us about the story of Job and in a creative way, at the end of the day, presented, with the help of others, a dramatic demonstration of the interaction between Job and his friends. Kate says that what Job’s friends got wrong provokes us to ask what good care might look like. Because Christian care usually takes place in relationship there is the need to listen to the other. Good listening does not necessarily mean that we agree with what the other is saying. It means that we give our time and provide an affirming presence, acknowledging the reality of the experience for the person who has the experience. At the same time Christian care listens to God. We know God’s word and what He says about human experience. At the same time we are sensitive to the prompting of the Holy Spirit and what He might be directing us to say or not say. Thirdly we listen to ourselves. Kate says, “It is critical to become aware of thoughts and responses that arise within ourselves. We all have an inclination to project what we feel onto others, things we think and feel ourselves, be they strong sympathetic responses, or feelings of revulsion or condemnation. … Reflective practices call the carer to dwell on their own internal and external responses.”
This conference on Powerful Words and the role of chaplains in the public sphere attracted participants from all over Australia. It was clear there is a need for those engaged in this ministry to have opportunity to continue to reflect together on how to do this well. Blogging Chaplains welcomes contributions on evangelical chaplaincy in the public sphere. Please send contributions for consideration to

Tuesday, 22 March 2016

Scientific outcomes and pastoral care. They need each other.

David Pettett

Research into healthcare outcomes indicates that when the spiritual needs of patients are met there are further tangible benefits. These benefits include shorter hospital stays, improved pain management and better management of cardiovascular needs. It is not surprising that a recent Deloitte’s report into the economic and social benefits of hospital chaplaincies in New South Wales, Australia showed that for every dollar the New South Wales government spends on subsidising hospital chaplaincies there is close to a seven dollar benefit. That is, given that the New South Wales government spends $2.5 million each year on subsidising chaplaincy services provided by Christian churches and other Faith groups, it would have to spend seven times this amount to achieve the same results if it did not subsidise chaplaincy.

When I was reading some of this research I was excited to see the benefits and outcomes of chaplaincy being measured. But I began to ask myself, “What do they mean by ‘the spiritual needs of the patients’?” What are ‘spiritual needs’? How are spiritual needs defined? When pastoral carers and healthcare professionals speak of ‘spiritual needs’, do they mean the same thing? Are we speaking the same language?

In a similar vein of concern about what is being measured in the pastoral encounter John Swinton asked the question, ‘what actually constitutes acceptable evidence, who decides and why?’[1] While acknowledging the important role of scientific measurement, even in pastoral encounters, Swinton then says, ‘I want to suggest that science, or at least a narrow definition of science, is only one dimension of the professional role of chaplaincy. On its own our current definition of ‘science’ cannot provide an adequate basis for the theory and practice of chaplaincy.’ This is because, on its own, the spiritual ‘outcomes’ of the pastoral encounter cannot be measured. If a pastoral encounter is primarily about relationship, it is only secondary outcomes such as a feeling of wellbeing, which can be measured scientifically in a manner that might satisfy those who are seeking to measure the length of stay in hospital in terms of economic benefit. Swinton further suggests that pastoral ministry has a place in informing scientific outcomes in that it moves beyond empirical measurement to speak of the human condition.

The research on the outcomes of pastoral interventions speaks of things like ‘meaning’, ‘comfort’, ‘hope’ and ‘community’. That is, when a person’s spiritual needs are met they report that they have a greater sense of meaning, comfort, hope and belonging. Spiritual Care Australia defines the value of spirituality as something that increases resilience within a person, helps to positively embrace experiences and outcomes and to celebrate life. The Mayo Clinic Pastoral Care Services defines its work as assisting people in using strengths in coping with their medical condition.

These views seem to place the idea of spirituality within a holistic view of humanity. Within the health care context particularly, a person is viewed as having, not only physical and mental health needs, but also spiritual needs. Within this view of the whole person, just as solutions can be applied to the fixing of a broken leg, or the resolution of an eating disorder, so can solutions and resolutions lead to a person finding meaning, comfort, hope and community. Certainly this is the view in a large body of literature on pastoral care that speaks of the ‘functions of pastoral care’. Kate Bradford has addressed this issue in her earlier post on this site in “Chaplaincy a Ministry not a Function”.

Following on from Kate’s work I want to ask, “If Chaplaincy or pastoral care is not a function but a ministry, how then does it fit into the sphere of public healthcare?” In other words, if the New South Wales government sees the value of subsidising chaplaincy in its public hospitals as achieving better health outcomes and therefore saving money, how does a ministry that does not seek to serve these functions fit into modern health care?

These questions highlight the dichotomy between Christian ministry and the desire in a modern results driven economy to have measurable outcomes. Someone has said, “What cannot be measured has no value.” This statement begs the question about value. In Christian ministry we are not seeking an economic value. It is well and good for government to know that its hospital patients feel better and have better, measurable health outcomes as a result of the ministrations of the chaplains it subsidises. But Christian ministry, which is not a function, has no measurable outcomes, at least in a scientific sense. It does not have an immediate economic value. At its best Christian chaplaincy and pastoral care is an activity where two human beings, the patient and the chaplain, encounter the true human, Jesus.

Government may well want to keep subsidising chaplaincy in its hospitals and prisons because of the measurable positive but secondary outcomes and the economic benefit they bring. Christian denominations, while not denying these tangible benefits and the positive impact they have on society generally, must, never the less, maintain the primary focus of pastoral care as fellowship with the risen Christ. Government must recognise that this ministry is an activity Christian chaplains will focus on. At the same time the Christian chaplain must recognise that in a public institution he or she is there as a guest. They are not ministering to their parishioners, those who come to church of their own free will. In public institutions the chaplain encounters people from every Faith and none, and therefore must show due respect.

As much as the Christian chaplain’s role is to listen with the patient to the Christ who is present, their role in a public institution is not as an evangelist. But as the chaplain listens to the Christ who is present, the patient also, who experiences the listening of the chaplain, will also begin to listen to the Christ. They may or may not respond to this listening but those who do have the opportunity to move into fellowship with Christ, the giver of life. This is no scientific measurable outcome but health managers and other professionals must recognise that this is the real work of pastoral care. When it is done at its best, they may well also see measurable, secondary positive health outcomes.

Chaplaincy and pastoral care in our public institutions must be allowed by government to be chaplaincy and pastoral care. The desire for measurable outcomes must not overtake the real ministry that is happening. If it does, and begins to shape and dictate what a chaplain can and cannot do, it will lose the secondary outcomes government and healthcare professionals are looking for. At the same time chaplaincy must bring its unique contribution to bare on the professional business of healthcare. This will hopefully shape healthcare to be more patient focused than outcome focused. It will remind healthcare professionals that patients are not economic outcomes. It will focus on the human condition and see science and pastoral care working together for the full physical, mental and spiritual health of the patient.

[1] John Swinton. ‘Reclaiming Mystery and Wonder: Towards a narrative based perspective on chaplaincy.’ Journal of Healthcare Chaplaincy. 2002. pp. 223-236