Pastoral Contracting and the Hospital Chaplain

by David B. Pettett

In pastoral care training we are taught the importance of contracting. This means setting up clear boundaries and expectations for the caregiving relationship. Where we know that the pastoral care relationship will cover several sessions over weeks, or months or even a year, we can see the value of contracting and we will even spend the whole of our first pastoral session in contracting. But for a hospital chaplain visiting a patient who they are unlikely to see again, is contracting so important?

 

The simple answer is, “Yes, contracting is always important.” The nature of the pastoral session will determine how contracting is done but it is just as important for a hospital chaplain to contract as it is for the pastoral carer who expects to have weekly sessions over the next 12 months.

 

Contracting is the process that ensures both parties understand the purpose, scope, and limits of the relationship. Understanding these three aspects of the pastoral encounter promotes trust and mutual respect. For a chaplain at the bedside of a person in hospital who expects a short-, five-, ten- or 15-minute conversation this process of contracting can happen within the first few sentences of the pastoral encounter. Altogether there are seven steps any pastoral care giver must take when contracting and these apply to a long-term situation or a short encounter to a greater or lesser degree. We will only have space in this blog-post to discuss the first of these steps.

 

The first thing in all contracting is to clarify the purpose and goals of the pastoral encounter. When I was a hospital chaplain, I began by introducing myself and saying, “I’ve just come to see how you are.” These simply words stated my purpose and implied my goal or the limits of our conversation.

 

Within this first step in a long-term pastoral encounter you will discuss intentions. As the pastoral carer you will want to understand the reasons the care receiver is seeking pastoral care. Is it for spiritual guidance, emotional support, or a specific issue? This allows the person seeking pastoral care to clearly state their intentions and hoped for outcomes.

 

For the hospital chaplain who is simply visiting patients as part of the hospital’s care program there is no intention on the patient’s behalf and the visit by the chaplain may be a surprise. This is where, in the contracting process I listened/watched very carefully for the patient’s response to my introductory statement of purpose. The patient’s response, either verbally or in body language, gave me an understanding of whether my visit was welcomed or not. A simple response of, “That’s very kind of you. I’m doing fine,” could mean either, “I’m fine. Go away,” or it could mean, “Yes, I’m open to talking with you.” Body language, a smile, a frown or tone of voice usually alerted to which response was meant. The point is, in these few words the patient and the chaplain have entered a contract. “I’ve come to see how you’re doing.” “That’s kind,” said with a relaxed voice and warm smile. The contract is established and the conversation can proceed. The chaplain had stated his intentions (“to see how you are”) and the patient has stated his or her intentions by indicating, “It’s nice of you to come. I’m open to some conversation.”

 

Part of the process of contracting is to set boundaries.  This clarifies the caregiver's role. In my opening words these boundaries were set by the words, “I’ve come to see how you are.” I had not come to help the patient to think about rehabilitation options for example. Yet, if the patient said something like, “I’m so pleased you’ve come. I have to go to rehab and am anxious about what that will look like,” the patient is renegotiating the contract. He or she is saying to us, “I’m glad you’ve come to see how I am but I want to push the boundary out a bit to talk about my anxiety about going to rehab.” The chaplain needs to respond to this renegotiation of contract by the patient by agreeing they are willing to talk about this (and if they’re not willing, why on earth are they involved in hospital chaplaincy?) and resetting the boundaries. These may include the chaplain’s lack of professional competence in rehabilitation. The chaplain is not qualified to explain the technicalities of what rehabilitation will and will not involve. But the chaplain will be able to listen to the patient’s anxiety and facilitate the patient’s discovery of a more relaxed attitude. In renegotiating this contract the chaplain could say something like, “I don’t know what they will do for you in rehab, but tell me more about being anxious.” A new contract has been set and the conversation can proceed with both the chaplain and the patient clear on how the conversation will proceed.

 

The major point to note here is that we don’t just set a contract in place at the beginning of a pastoral conversation and let it sit. As the conversation proceeds and turns we will need to be constantly recontracting. This may seem tedious and the over simplified examples I’ve used in illustration might seem to be an ordinary part of normal conversations, and indeed they are normal. What the pastoral carer needs to keep in mind with these quite normal parts of conversation is that we are establishing a contract, setting the boundaries, notifying intentions and advising hoped for outcomes.

The importance of contracting is in its demonstration of a true respect for the person seeking pastoral care. If somehow the conversation turns in a direction the person being cared for did not expect, the pastoral carer could actually cause harm rather than give support. The conversation could also end abruptly leaving the person in greater distress than when the conversation started. When a pastoral conversation crosses a boundary into an area not contracted, the pastoral carer must be aware of that crossed boundary and take the time in the conversation to renegotiate the contract. For example, if the patient and chaplain have agreed to talk about the patient’s anxiety with rehab and the patient then begins speaking about the abuse their alcoholic husband gives them, the chaplain needs to renegotiate these boundaries by saying something like, “we began by talking about being anxious about rehab. Are you comfortable to tell me more about your husband?” Of course the patient’s anxiety about rehab may be closely tied with the husband’s abuse and the chaplain may see the introduction of the abuse into the conversation as coming within the boundaries of the anxiety already agreed upon. The point is the chaplain needs to be on their toes. They need to be asking the question, “Are we still in the contract originally negotiated or have we crossed that boundary and need to renegotiate?”

 

Proper contracting is one of the many things pastoral carers need to do well to make sure the person is well cared for. Hospital chaplains need to be aware that they are not exempt from the necessity to contract and must remain vigilant that they stay within the contracted boundaries or renegotiate when those boundaries are crossed.

 

We have not discussed the other six elements of contracting here but hope to consider them in further posts. This first element of contracting is probably the most important and something even a chaplain on an unexpected and limited pastoral visit is not exempt from doing.

Stop Doing and Start Being

Please stop. Please stop doing and start being.

I am a person who believes the Bible is the word of God. The words the authors of the various books of the Bible have written are words that are God breathed. When the apostle Paul, for example, wrote a letter to a church or a group of churches, I am sure members of the church excitedly received such a letter from the apostle and gathered around to hear it read. As they listened, I am also sure that they, knowing these were the words of Paul, equally believed these were the very words of God to them.

 

Our God has worked in history. The Bible does not give us mythical stories about creation or human life, failure and rescue. When God called Abraham, he called a real person to leave his home and family and travel to a new land. When God spoke to Moses, there really was a burning bush that was not consumed. God really did rescue the descendants of Abraham from their slavery in Egypt. A real person was born in Bethlehem, having been conceived by the Holy Spirit of a virgin mother. Jesus really did die on a cross. Jesus really did rise from the dead and ascended to heaven.

 

Some of these historical facts, in which God has acted in our world, are easier to believe than others. Some require an act of faith, others are demonstrably provable historically. Not any of these historical facts, however, tell us anything about God of themselves. The fact that the descendants of Abraham escaped slavery in Egypt is a historical fact. What makes us believe that this was God’s gracious rescue of his chosen people is not the event itself but rather what God says about the event. In the Bible God tells us what this event means. Likewise, the crucifixion of Jesus is, on its own, simply an historical fact. What makes us believe that this one crucifixion, among the thousands of the time, provides the unique act of reconciliation between a holy God and a sinful people, is what God says in the Bible about this one crucifixion. Our God has acted in history and has explained to us what and why He has done what He has done. The facts of history mean that what God has done is real. What God says about those facts of history gives meaning to them.

 

We are so often told by well-meaning preachers that here are the facts of history, here are the facts of what God has done, therefore, this is what we must do. Many a preacher, looking at the book of Amos, for example, will tell us that God’s people, who had been rescued from slavery, were now enslaving others. God’s people, who had been shown the richness of God’s mercy, were now oppressing the poor to gain worldly riches. Then the application is given, telling us what to do. We must fight against slavery. We must work to improve the conditions of the poor among us. Fighting slavery and helping the poor are indeed very good things to be doing, but such an application of Amos misses what God says about these historical facts.

We miss what God says because we are so focused on doing and not being. So focused on action rather than listening to God.

 

The message of Amos is not about anti-slavery or alms for the poor. It is a message that even God’s own people are so desperately corrupt and wicked that they cannot rescue themselves from this nature. They need a Saviour who can do for them what they cannot do for themselves. The book of Amos points forward to this Saviour. When a person comes to know this Saviour our whole perspective on life changes. We become a different person. We no longer live, but Christ lives in us.

 

The problem is that our preachers keep telling us what we must do as though, somehow, having received the grace of God, we can now operate independently from it. No, we can’t. Having received the grace of God in Christ does not mean we are now capable of putting an end to slavery and poverty. Yes, the grace of God will raise our compassion and should stir us to work hard to end such scourges on human life and dignity. But more important than our work, is our being. You and I cannot solve the problems of the world. The poor you will always have with you. What we can, and must, do is point people to Christ who is God’s gracious gift to us to rescue us from this body of death.

 

What do we say to the cancer patient who has been told there is nothing more that can be done medically for them? Do we come in and try to do something the medical profession has been unable to do? Well, frankly, yes. We will pray for the miracle, but sometimes that is just cruel. We have to stop trying to do something and just be someone. That someone is the person who knows the grace of God in the Lord Jesus Christ. There may be no solution after all medical interventions. People die every day. None of us can expect to get out of this life alive (unless the Lord comes first). We will all die. There is nothing we can do about it. But there is something we can be about it. We can be that person who knows the grace of God and that in Christ is the solution to life.

 

We need to stop doing stuff as though it depends on us to solve the world’s problems. We should fight against injustice and poverty and search for cancer curers, but we do it, not for the sake of those solutions in themselves. We do it in Christ. We strive to be there for people as though Christ is there, Christ who has done it all. Bringing justice and health to a hurting world, to hurting people, is to bring Christ into our midst. We should stop trying to solve the world’s problems. Christ has already done that. The best we can offer to the world is to be in Christ and bring Him into this broken and divided world.

Sneaking up on Jesus - A Helpful Look at Psalm 4 on approaching God in Prayer

Joshua was a young man in his mid-twenties. He had been sick for a long time. He had seen many doctors, some of whom were helpful and some not so much. Joshua had also tried all sorts of alternative treatments, but his chronic condition remained. He told the chaplain that in so many ways he felt like the woman with the flow of blood (see Mark 5:25-34). Nothing had cured him, but he really didn’t know how to, “sneak up on Jesus”, as he put it.

Such an interesting expression caused the chaplain to ponder just how a person should approach God. He thought about the Psalms and the raw, honest approach to God the psalmist demonstrates in so many ways. Joshua seemed to be thinking that one had to manipulate God to get one’s way.

 

By actively listening to this young man’s story of chronic illness the chaplain was able to follow the process Joshua was going through. By process, we mean the story a person is telling themselves about what the events of their life mean for them. Ultimately the events are not so important. Each of us reacts to life events in different ways. We will also react to the same events differently at different stages of our life. What is important in pastoral care is to note how those events are affecting a person. It is important to understand what those events mean for the person. What is the story they are telling themselves?

 

By asking the question, “what is the story they are telling themselves?”, we understand that people attribute meaning to life’s events. That meaning will be different for each person. It will be something like, “When you say those words, I feel …” or, “when that event happened, I felt …” The feeling a person has following certain words or events is the story they tell themselves about themselves. To finish those sentences above would look something like this: “I feel sad,” “I felt as though my world had collapsed.” Another person might finish the same sentences differently, such as, “I felt so happy,” or, “I was overwhelmed with joy.”

 

Each of those responses could be to the same words or the same event. That’s why pastoral care focuses on the process. The process is about how a person responds to events that happen to them. Helping a person acknowledge the process they are going through will help them to better cope with the words spoken to them or the events that have happened around them.

 

The story Joshua was telling himself was a story that misunderstood who Jesus is and how we can approach him in prayer. The chaplain’s first task was to help Joshua acknowledge his unhelpful and unbiblical process. The next task was to show him how he does not need to “sneak up on Jesus” but can approach him confidently and boldly.

 

Psalm four provided the chaplain with a basis to show Joshua the confidence he can have in approaching God in prayer. This Psalm begins standing in front of God and making a bold statement, “Answer me when I call”. There is no pleading. There is simply a direction to God from the psalmist to answer his prayer. This boldness is only possible because the God the psalmist appeals to is the “God of my righteousness.” The righteousness of the psalmist does not come from himself. It comes from God. The psalmist is also bold because he has known “relief when I was in distress.” Presumably this is his past experience, and he is therefore confident that God will do it again. And finally in v. 1, it becomes clear that the psalmist is not simply demanding God to do for him what he wants. He recognises that God will answer his bold prayer because of the fact that God is gracious towards His people.

 

In v.2 the psalmist addresses those who are oppressing him. “How long,” is a style of lament yet it is not addressed to God but to the oppressors. It is a cry to the oppressors that they lie in regard to the human condition as it is meant to be in God. Honour is turned to shame. They “love vain words and seek after lies.” Chronic illness falls into this category. While we live in a fallen world and illness and death are realities, the ideal life is one that prospers and knows abundance. Illness and death are things to shake our fist at because they are not the way life is meant to be.

 

Verse 3 also expresses the psalmist’s confidence in God and here provides an answer to the question he put in v. 2, “how long?” The answer is that the Lord has set apart the godly for Himself. The psalmist puts himself in this category of the godly. This is not the self-righteous but simply those who know their God. It is these whose prayers are heard by God. And therefore, the question of, “how long?” falls into insignificance because the godly one belongs to the Lord and therefore their prayers are heard. The question of, “how long?” directed at his enemies is not a plea from the psalmist for them to stop. Rather, it is an expression of ridicule. The psalmist is saying to his enemies, “How long? Don’t you know that God is in charge? You are wasting your breath. Your lies will not stand in the judgement of God.”

 

“Be angry, and do not sin,” are words directed by the psalmist to his oppressors. It’s like he is telling them, “Do your best, but don’t bring your lies before God.” He then tells his enemies to think about this and be silent. In other words, the lies his enemies are speaking against him will not stand up before God. The lies Joshua was telling himself, that he was somehow a lesser person because of his chronic illness, were not words that would stand in the presence of the God who had died for him. Joshua needed to understand that he was a person created in the image of God and his illness had not diminished that image.

 

Verse five is further advice from the psalmist to his enemies. It is positive advice to offer right sacrifices and trust the Lord. To Joshua, in his chronic illness, this advice is a recognition that God is in control. One must approach Him acknowledging His lordship. For Joshua this led to an understanding that the lie he was telling himself in the process of dealing with his illness had to submit to the Lordship of God. He needed to recognise that he was not a lesser human because of his illness, and he had to understand that he could approach God directly, sincerely, confidently and did not need to sneak up on Him.

 

Verses 6 & 7 together are a recognition that joy comes from the Lord. The psalmist has experienced the joy of abundant food and good wine, the good things of this life. He recognises, however, that God gives him so much more joy than these. This is what knowing God achieves. The process and the story that Joshua needed to begin to tell himself is the truth that God is far greater than anything else he might experience in life, whether that be the abundance of a rich life or the pain of chronic illness. Joy in the lord is so much better than these. Knowing the Lord and this joy in Him helped Joshua to begin to tell himself a different and a truer story about his chronic illness.

 

The Psalm finishes with a great confidence that, even though his enemies may still lie at hand, the psalmist will lie down and sleep because the Lord alone keeps him in safety.

 

Changing the story he was telling himself about his circumstances became possible for Joshua when he carefully studied the Scriptures. Doing so focused his attention on God and showed him how much greater He is than any chronic illness. Joshua needed to learn that life is not about sneaking up on God but facing God directly in truth. He came to understand that that truth is honesty about who he is and who God is. It is the truth of facing God realistically.

Triangulation and Process

This post is by David Pettett. The events described here are real. Names and some details have been changed to maintain confidentiality. This story comes from the book, Pastoral Care: the Core of Christian Ministry by David Pettett.

_____________________________

 

Kerry’s husband fell over when he was drunk and broke his leg. In hospital he fell out of bed and broke his arm. Kerry complained about his poor treatment, but the hospital staff seemed to ignore her complaints. Not knowing how to take her complaint further, and being worried for her husband’s safety, Kerry was setting herself up for an unhealthy dose of triangulation.

Kerry fell into the trap of seeing the hospital staff as her persecutor. Consequently, she took on the role of the victim. Kerry went to church the following Sunday and told anybody who would listen how frustrated she was with the hospital staff because they didn’t seem to take her complaints seriously. By talking to anyone who would listen, Kerry was looking for a rescuer. Everybody she talked to obliged her by doing just that. Everybody agreed with her, that she was being treated poorly by the hospital staff. But none of this “rescuing” helped Kerry. The rescuing reinforced for her that she was the victim. As she continued in the role of victim Kerry continued to look for a rescuer. None of the sympathy she got gave her any help.

 

By trying to empathise with Kerry, and agreeing with her that the hospital staff should do something, the people Kerry shared her frustrations with were only reinforcing Kerry’s idea that she was the victim of the hospital staff’s persecution of her. Under normal circumstances trying to help Kerry by giving her some direction on how to approach the hospital staff with her complaint would also be of little help to her. Giving advice confirms Kerry’s role as a child or victim just as much as the rescuing attempts keep her in this role.

 

At one point Kerry’s pastor heard her complaining to another church member. He joined the conversation and when Kerry said how badly the hospital staff had treated her husband and how they were ignoring her complaints, the pastor simply said to her, “Yes, but it really upsets you, doesn’t it?” Rather than agreeing with her, that she was a victim, the pastor focused on how it was all affecting her. She replied, “Yes” and began to cry. From that moment Kerry stopped telling anyone who would listen about her frustration with the hospital. She stopped looking for rescuers because the pastor’s simple words had helped Kerry identify her real problem. She was frustrated with the hospital staff and was probably also angry with her husband because he had been drinking when he first fell. But her real issue was how it was affecting her emotionally. Because Kerry’s pastor didn’t play the role of rescuer but identified what was really upsetting her, she was able to move on.

 

In pastoral care we need to be aware of what role the person is taking on for themselves and what role they may be wanting us to play in their “drama triangle”. The pastoral carer needs to be aware of this and to be careful they do not play an inappropriate and unhelpful role. The pastoral carer must be careful they do not become a rescuer. A pastoral carer should never play a role in a drama triangle.

 

Kerry’s pastor stayed out of the drama triangle because he understood the process that was going on in Kerry’s mind. The hospital staff, while obviously unhelpful, were not persecuting her. She was not a victim, and she certainly didn’t need rescuing. The pastor identified the process in the story Kerry was telling herself. She was upset by all that had happened, but she wasn’t allowing herself to acknowledge this. By identifying her own pain, the pastor had helped her in the process of dealing with the pressure that was on her. The important thing in understanding process is to listen to the story the person is telling themselves. The facts of the incident are almost irrelevant. What matters in process is what the person believes those facts are saying about themselves.

 

I want to suggest that in a very real sense the drama that Kerry is involved in is irrelevant to the pastoral care we can offer her. Rather than get involved in a person’s situation, the pastoral carer focuses on the process.

 

Notice Kerry’s reaction when the pastor made the observation that she was upset. She cried. All previous responses to Kerry’s complaints resulted in people trying to rescue her. The real empathy of her pastor identifying that she was upset gave Kerry such relief that she cried. But it did more than that. After her pastor identified that she was upset, Kerry no longer felt the need to go about telling anyone who would listen about her very frustrating situation. Knowing she was not alone, gave her empowerment. The pastor’s question has helped Kerry identify how she has been personally affected by what’s been happening around her. Up to this point no one had identified what Kerry was feeling, not even Kerry herself. Once that feeling had been accurately identified, Kerry’s attitude to her situation changed.

 

People will often tell you that what helped was, not advice, and not agreeing that these things shouldn’t happen. What really helps is when someone just says, “Yes. That’s how you feel, and that’s OK.” In effect this is what happened for Kerry when her pastor accurately identified that her situation was affecting Kerry’s emotional response. Notice that he did not even identify the emotion. All it took was for him to accurately identify that Kerry was affected emotionally. In all previous encounters, Kerry’s emotional response was not acknowledged.

 

This is what I mean by paying attention to the process rather than the situation. To pastorally care for Kerry in her situation, attention is not given to the events but to Kerry’s response to the events. Attention is paid to what is going on for Kerry. Attention is paid to Kerry’s emotions. This is the process.

 

In paying attention to the process, pastoral care pays attention to the person’s emotions. Pastoral care is all about listening, not just listening to the story but listening for the person’s emotional response to the story they are telling us.

Emotional clusters and spiritual clusters in chaplaincy

Emotional clusters and spiritual clusters in chaplaincy.

By Stuart Adamson (Healthcare Chaplain with Anglicare and Associate Dean, Chaplaincy and Spiritual Care, at Morling College.)

In the last article, we looked at how empathy leads to the identification of the felt need of the person we are caring for, and informs a pastoral response.

Along the way, we considered briefly the notion of what I call “emotional clusters”.

In this article, I want to drill down a bit more on the idea of emotional clusters, and suggest another possible category that is emerging from reflection on my pastoral practice as a chaplain, that of what I call “spiritual clusters”.  

Firstly, to emotional clusters. As we respond empathically to what the people we care for tell us, a range of different emotions can come to the surface for them. But often, on reflection, we can discern a narrow range of more finely nuanced emotions that together combine to suggest the very same pastoral need. 

In the case of Joe, the patient I was caring for in ICU mentioned in the last article, these emotions included the feeling that everything was a huge struggle, a profound sense of physical, emotional and spiritual weakness, and a sense of feeling exhausted, overwhelmed and doubtful about his capacity to persevere.

My visit with Joe is an example of how a number of finely nuanced emotions that are expressed by a person in even a relatively short pastoral encounter can combine to form an emotional cluster. In this case, the cluster pointed me to Joe’s primary felt need of sustenance. The identification of this felt need informed my pastoral response in ways that Joe told me were life-giving for him.

Experience tells me that this idea of clusters has applicability across the full range of needs felt by people who are facing trials. This is not limited to just six functions of pastoral care, but includes all those described with clarity in the gospel accounts of Jesus’ interactions with people he encountered in the course of his ministry.

In many respects, Christian chaplaincy in its various forms and expressions more closely approximates the travelling ministry of Jesus as he makes his way to Jerusalem than any ministry of pastoral care that is centred on caring for a community of Christians associated with a particular church. Chaplains tend to meet people in an unplanned way in the course of their travels.

As Christians in the service of our Lord and Saviour, despite the fact that in our roles we can often feel lonely, it is good and right to remind ourselves that we are not alone. Also, we are amply equipped for the task that the Lord has called us to.

We have his very great promises by which we participate in the divine nature. We have the Spirit of God within us, to guide us into all truth and remind us of the teachings of Jesus. We have his Word which is a lamp to our feet. We have the gift of prayer which we can use at any time and in any circumstance we like. We also have the support of the prayers of the faithful via our support churches, and we have at times the sweetest of fellowship with Christians whom the Lord brings across our path in the public spaces in which we serve.

Our service is kingdom service. Obviously there is a deeply spiritual dimension to our service that involves and centres on bearing witness to the cross, resurrection and the current rule and reign of Jesus, in the power of the Spirit and to the glory of the Father.

Often the people amongst whom we serve have been suffering as a result of human fallenness, or the inevitable consequences of their own choices, or the choices of others, in ways that combine to reinforce the truths of Scripture.

From time to time as I witness in word and deed to the love of Christ in pastoral conversations with people who have been suffering in a variety of ways, I have noticed in the responses of people I am caring for words that have been used by dark forces to undermine the work of the Spirit in the encounter and block my own witness.

 

These words may not have been intended by the person to wound me or undermine my witness. In many cases they have been uttered unwittingly and without any malice towards me personally. But the fruit of these words is clear. They are opposed to God‘s very purposes for that person to find wholeness and assurance of God‘s love for them in Christ. And sometimes, I experience them as a personal attack on my own faith and assurance in Christ.

Let me provide you with an example from my chaplaincy in the context of people living with a mental illness.

Jack, not his real name, is an outgoing personality who has struggled with bipolar disorder coupled with auditory and visual hallucinations for many years. He has a generous spirit and professes a belief in Jesus which I know is genuine. He has many other health issues. He often talks about seeing things in the spirit world, and the things he sees intrude into our conversations in ways that he often finds frightening. 

 

From time to time he will call me at the office out of the blue and describe to me in detail the nature of the things that he has been seeing and hearing. I won’t describe them here. But suffice it to say, there seems to be a deeply spiritual dimension to what he is seeing and hearing. I say this simply because these things rock his faith to the core. 

 

In many circumstances he will only calm down when I am in focussed prayer, thanking and praising the Lord for his victory over sin and death at the cross and resurrection.

 

In addition, at times, Jack will mention things that have direct relevance to my private life that strike at the heart of a faith issue I may be wrestling with. He could have no way of knowing the power of his words to wound me in the moment because he knows nothing of the details. So I take it that this is either coincidence, which is possible, or spiritual attack, which given the immediate context, and what we know from Scripture (See Ephesians 6:11-20), is not only possible, but likely. Indeed the apostle Paul tells us to expect it and prepare for it by checking our spiritual armour.

The expressions and fruit of these conversations with Jack include spiritual anguish, fear, a sense of darkness and threat by evil spirits that are visible to him and speak to him in ways that cause him to doubt both his salvation and the Lordship of Christ. 

 

My instinct is to identify these expressions as a spiritual cluster that points to a need for specific spiritual assurance, and a signal to me to intentionally and more self-consciously check my spiritual armour and keep the Word and prayer close. 

When it first happened, I was rattled. I am not a "demons under the bed" kind of chaplain. But more experience and encounters with others who are going through spiritual suffering have been helpful to me to sharpen my thinking.

I find it helpful to reflect on my pastoral practice and identify learning issues that can be informed and resourced by the Word.

I’d be interested to hear what you think of the above.

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

By Stuart Adamson

 

Empathy is a chaplain’s stock in trade. Combined with a pastoral presence that is focused on the client, and with the ability to do what I call triple listening (listening to the other, listening to self and listening to God in a dynamic internal/external process), the chaplain is equipped with some key skills to begin to care well for others pastorally.

 

There are a number of kinds of listening to the other, but for our current purposes, I want to focus on empathic listening, because of where it leads, namely: to the accurate identification of the felt need of the person being cared for, and consequently, the pastoral function.^[1]

 

Empathic listening involves listening to the heart of the other person as expressed by their words, but also by their body language, their demeanour and their facial expressions. This is because the person the chaplain is caring for pastorally does not just communicate verbally.

 

All of those messages, verbal and non-verbal, are being communicated to a chaplain, who in the best-case scenario, is fully focused on the person they are caring for, blocking out distractions, listening intently and watching closely. The chaplain employing empathic listening will seek to identify the main emotion, or range of emotions, and reflect them back to their client in a way that will communicate that the chaplain appreciates and is accurately assessing the emotional state of the client. In essence, that they are a good listener, and that they care about the person they are with. Such listening has the added effect of building trust very quickly.

 

Let me illustrate from a visit I had today with a patient in ICU.

 

Background: Joe identified as a Christian. When I arrived, he had a thick pipe supplying oxygen to his nostrils, which were plugged. He was sitting up with three pillows behind his back, his bed inclined to support this. His breathing was shallow, he could talk freely, but it was an effort, and from time to time, his eyes would roll back into his head.

 

S1 Hi Joe. (Pause) It’s a real struggle. 

J1 (Nods) It is … I’ve lost so much weight … But I just don’t feel like eating. 

S2 And it leaves you feeling so weak … 

J2 It’s so hard Stuart 

S3 One step at a time … 

 

Analysis: Joe had communicated so much to me without even saying a word, so using all that non-verbal information, I reflected back to him a summary emotion, “it’s a real struggle”.

 

Notice that he responds with a confirmation, both a nod and “it is”. This tells me that I am on the right track. That I am assessing the non-verbals accurately. At S2 I chose to reflect back what I was getting from him, his weakness. But notice he wanted me in J2 to understand that he was being pushed to his limits, “It is so hard”, he said. In other words, “I want you to know that I’m really struggling, and I don’t know how much I can take of this.” At S3 I was responding to this. I offered prayer (which for the sake of brevity is not recorded here) which he welcomed, and I prayed that the Lord would be his strength for the road ahead, and I gave thanks that Joe’s strength would be sustained as he looked to the Lord.

 

The cluster of presenting emotions is: feeling like it is a huge struggle (J1) weak (S2), exhausted, overwhelmed, doubtful about his capacity to persevere (J2).

 

When seen through this framework, it confirms the obvious primary function of sustaining.

 

Relating the above visit to the six functions in a more nuanced way, there are arguably other relevant functions. Joe feels trapped by his circumstance, so liberation is also indicated (Perhaps this is what the prayer addressed in some small way?). He was looking to me. “It’s so hard”. I’m at my limit. How long can I continue? There is a dimension of guidance here as well. “Those who hope in the Lord will renew their strength” might have been appropriate. But hoping in the Lord might sound to him like a lot of effort in his current circumstance. Hence I said Look to Him, (remember the event that John 3:14 refers? The Israelites were to just look at the bronze snake. Num. 21:9). The prayer addressed the wider issue of healing as well, but also mentioned the love of his children, which also reminded Joe of the resources available to him in those who love him. Nurturing comes into its own when people feel weak and need gentle, loving care. Reconciling is only hinted at here, not that Joe was out of relationship with His God, but, like the Psalmist who asks, ‘Will you forget me forever?” (Ps 13:1) Joe needed assurance that God cares for and loves him, truths that were reinforced to him via my presence.

 

Emotional clusters emerge on sustained reflection, and with practice, in the encounter, suggesting a pastoral response in line with the relevant function.

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^[1] In the interests of simplicity, I am treating the six “functions” of pastoral care as the following: guiding, healing, nurturing, reconciling, sustaining and liberating. I don’t think that this list of “functions” is by any means comprehensive, or really adequate, but it is a helpful framework to use for chaplains in training. You may like to see Part One of this short series at http://bloggingchaplains.blogspot.com/2016/09/the-six-functions-of-pastoral-care.html for my thoughts on the model, the six functions. My preference is to think of them more as “pastoral responses” to presenting needs rather than the somewhat mechanical, “functions”.

But I can't forgive myself

By David Pettett

 

James had had a number of positive conversations with Tom about the Christian life. Before he came to prison Tom had been an active member of his church. James, the prison chaplain, wondered why Tom had never been to a chapel service. Tom said he understood the forgiveness of God. He would speak about the thief on the cross and say he understood how Jesus can forgive anyone, “even a criminal like me.” But he would then add, “But I can’t forgive myself.” Such thinking is often the real barrier to truly understanding the forgiveness that Christ brings.

Sometimes the embarrassment of what we have done remains with us. Our sinful actions can have adversely affected others, and we cannot undo their pain caused by our behaviour. This type of situation is sometimes dealt with in the criminal justice system by a process of restorative justice. Restorative justice brings the perpetrator and the victim together. The victim is given opportunity to say how the crime has hurt them and affected their lives. This is very powerful because most criminals have no concept that their crime actually hurts anyone. When the criminal hears and understands their crime has damaged a fellow human being, their sense of guilt can be palpable. After the victim has spoken, the criminal is given the opportunity to speak. If they are touched by the personal impact of their crime on the other person (and they often are), they are able to give a heartfelt and emotional apology.

 

Restorative justice is a very emotional experience. It can only happen where both parties desire to meet and express their emotions. They come into the process with some understanding that it will be very difficult. But that’s what dealing with sin is. It’s difficult. To know God’s forgiveness, we have to willingly enter a difficult process of coming together to understand the terrible cost of sin. The sinner and the victim, who is Christ, come together to listen and to understand.

 

Forgiveness is sometimes difficult to understand because we tend to think forgiveness means everything is O.K. We think forgiveness means the crime, or the sin, doesn’t matter. But that is not what forgiveness means. In understanding that we are completely forgiven in Christ, we are not to think that what we did in our sinful behaviour is therefore somehow made O.K. Sin is never O.K. Sin is a distrust of God. Human distrust of God is highlighted in the Garden of Eden. Doubt about God’s trustworthiness was put into the minds of Adam and Eve. God said, “Don’t eat this fruit. If you eat it, you will die.” That’s a really easy commandment to follow. Especially when the garden is filled with every other tree, bearing all kinds of fruits. Why, on earth, would you want to eat that one fruit God has told you not to eat, when there is so much rich choice in the rest of the garden? Well, you make the decision to eat that one fruit when doubt is placed in your mind that God is trustworthy. Taking and eating that one fruit is a clear statement of unbelief in God’s trustworthiness.

 

Understanding forgiveness is understanding that God is trustworthy. It is understanding that, while my sinful behaviour has demonstrated a lack of trust in God, God has still come back at me with His love in His Son. I sit with God and hear Him tell me about His pain caused by my sinful behaviour and I am moved to ask for forgiveness. I am still left with the memory of my sin, but Jesus and I have come together in a process of restorative justice. We acknowledge the cost of my sin, and we move forward together. I am so astounded by His love and forgiveness I am resolved to live in a way that honours him and demonstrates my trust in him.

 

Not being able to forgive yourself can often mean a lack of understanding of the nature of guilt. Understanding the biblical concept of guilt can be difficult when we live in a shame culture. In the West we talk a lot about shame. We talk about “naming and shaming” people or corporations who, according to general consensus, have done something wrong and seem to be getting away with it. We also talk about the shame bad behaviour brings upon one’s family.

 

Gail had been discovered to have been involved in an extra-marital affair over many years. She said she felt so ashamed of what she had done. But shame and guilt are two very different things. Shame only does half the job that guilt does. Shame is more about the embarrassment we have caused ourselves and others. Shame is not concerned with the sin but only with the consequences of the sin. Guilt is knowing we have offended a holy God. It is recognising the distrust of God we have expressed by the offence. Guilt also then understands the impact our sin has had on us and others.

 

When I read Psalm 51, I am initially a little disturbed by David’s confession of his sin of adultery with Bathsheba and the murder of her husband Uriah. David says to God, “Against you, you only have I sinned” (Psalm 51:4). I find I am angry at David. Has he minimised the impact of his lust? Does he not understand the shame Bathsheba must have felt, not being able to refuse her king’s sexual advances while her own husband was away at war? Does he not have any compassion for Uriah whom he murdered to cover up his despicable behaviour?

 

If David had felt ashamed (rather than guilty) of his sin when confronted about it by the prophet Nathan (see the title of Psalm 51 and 2 Samuel 12:1 – 14), I think we would see in his confession some acknowledgement of the pain he has caused Bathsheba and his disgraceful manipulations to achieve Uriah’s murder. But forgiveness does not come through shame. Forgiveness comes from God. Dealing with sin, even sin that has caused others great loss, is acknowledging that guilt lies in my behaviour which has demonstrated a lack of trust in God.

 

David’s prayer of confession in Psalm 51 acknowledges his sin is first and foremost an exhibition of distrust of God. Where God has made it abundantly clear that we are not to commit adultery, David has said, “No, Lord. I trust my sexual desires more than I trust you. Giving in to my lust will give me more immediate pleasure than you will, Lord.” God has also made it very clear that we are not to commit murder, but David has said, “No, Lord. I can’t trust you to make my sin right. I have to cover up my adultery myself by getting rid of the husband.”

 

Put in these terms, you can see how, when finally confronted with his sin, David turns to the Lord for forgiveness. His behaviour has demonstrated an abject failure to trust God. And so, with his adultery and murder in mind, he turns to God, whom he has offended, for forgiveness. In fact, by acknowledging that it is against God only that he has sinned, David has done so much more than just feel shame for his sin against Uriah and Bathsheba. By seeking God’s forgiveness, David has realised the reason God has told us not to commit adultery and murder is because these behaviours adversely affect all those involved. By acknowledging his distrust of God by breaking these two commandments, David also acknowledges the impact his sin has had on his victims.

 

To understand the nature of God’s forgiveness, and therefore to forgive ourselves, is to understand that all sin is distrust of God. Forgiveness is not about dealing with shame. Forgiveness is understanding God is trustworthy. Forgiveness is knowing our guilt has been laid on Christ and dealt with. Forgiveness does not ignore the impact our sin has had on us and on others. Acknowledging our guilt recognises what we have done to others expresses our distrust of God.

 

Understanding forgiveness is a deeply spiritual process. To understand God’s forgiveness Tom sat with God in a prayerful session of restorative justice. He listened. He understood his sin, his crime, had sent Jesus to the cross. He listened to Christ’s impact statement. He read what the Scriptures say about his sin and as he listened, he was confronted by how much his behaviour had caused Christ’s pain and the pain of other human victims. Being so confronted, Tom sought God’s forgiveness, for he realised, it is against him, him only that Tom had demonstrated a lack of trust. Tom had come to understand the difference between shame and guilt and had learned to forgive himself.