Henry G. Heffernan (6th, 2007)


Helen Flanders Dunbar Presentation to the 2007 CPSP Plenary

by Henry Heffernan

Posted on Pastoral Report, 2007

What would Dr. Helen Flanders Dunbar say if she were here today, speaking from this podium? This is the question I asked myself two months ago when Raymond laid this responsibility on me.

One topic I think she would have comments on is the current relationship of CPSP with the other associations in healthcare institution-based pastoral care and counseling.

A second topic I think she would also comment on is the broad range of associations and professional societies whose work is relevant for the roles and responsibilities of CPSP members.

A third topic I am confident that she would address is that of systematic cooperative development of a knowledge base of pastoral care realities, based on encounters with our clients and patients. Flanders Dunbar herself made her life’s work the systematic compilation of the available evidence on the efficacy of psychodynamic therapies for specific types of problems experienced by patients. She most likely would urge us to undertake the same for pastoral care, counseling, and theologically informed psychotherapy. She might well propose this effort as the unique contribution that CPSP could make to pastoral care and counseling.

Let us explore briefly these three topics:

Concerning the current relationship of CPSP to the ACPE and the other member associations of the Council on Collaboration -- or whatever its current name may be -- I think Helen would smile sweetly and briefly recount her own initiative years ago in rescuing the pioneering work that Boisen had done. She removed it from the hands of those in New England who were reducing and bureaucratizing his insights and his approach to what was approaching a fairly mechanical training practice routine. She separated Boisen’s activities in order to preserve his original work from becoming soulless and bureaucratized.

Today CPSP and its members find themselves separated from the other pastoral care and counseling associations for much of the same reasons. Robert Powell has commented on the change that took place in CPE toward the middle of the last century. There was a shift away from focusing on the religious needs of the patients to a focus on the psychological development of the CPE student. The “living human document” became the student and the student’s psychological hang-ups. The patient’s religious experience was reduced to the status of a “means” for the student’s learning rather than the end and purpose of a patient encounter. The patients served only as the information sources to enable the student to write up verbatims for the weekly sessions with the supervisor. The goal of CPE for the student was to “pass the course” that the CPE unit had become, and the focus of effort was on writing (creatively?) the papers required. The “hidden curriculum” was to figure out what the supervisor considered the correct way to conduct patient visits, and then to fit what one wrote into that pattern, regardless of how actual patient encounters had been experienced.

The ‘bottom line’ issue was to “pass the CPE course.” Developing the verbatims and the other paper writing assignments became the focus of the student’s attention and effort, instead of the deep religious needs of the patient, and the transformative theological growth of both the patient and the student that the encounters could foster. Dr. Powell can provide historical details on this shift in perspective.

The second topic Flanders Dunbar very likely would address would be the number and variety of associations and societies that are addressing issues relevant to spiritual and pastoral care, along with many informal organizations at the local and regional levels, as well as various educational programs in colleges and other organizations. These societies and the individuals making contributions to the programs of these associations are quite open to the discussion and sharing of their knowledge and experience, and do not erect barriers of self-professed exclusive expertise and professionalism.

For example, a short list of some of these other societies and associations would include the Society for Pastoral Theology, the Association of Practical Theology, the Society for the Study of Christian Spirituality, the Association for Theological Field Education, the College Theology Society, the American Academy of Religion and the many theological study groups that cooperate in the national and regional activities of the AAR. In addition, I don’t have to mention the American Psychological Association’s many special interest activities, and those of the counseling associations. The sociological and anthropological fields as well as others also have much to offer. The members of these societies and associations are intellectually active with open and inquisitive minds, in contrast to what many CPSP members have found in the self-professed professional chaplaincy groups.

In the fourth edition of her classic 1954 book, A Survey of Literature on Psychosomatic Interrelationships, 1910-1954, Helen observed that specialization in a field can be a barrier to understanding:

“. . . we have reached a point where progress in the specialties themselves is being blocked by a lack of understanding of the relationships between them. Scientists commenting on the tremendous gain which has accrued to us during the last decades of specialization, are calling attention to the fact that many of the most vital of our problems lie between the sciences and cannot be perceived without going beyond the confines of a specialty. One of the major problems of the ‘between fields’ is the question of psychosomatic interrelationships, and here, as so often happens, we know more than we know we know; in other words, the actual scientific information available, having been achieved along the lines of the several specialties, has never been gathered together, correlated, and evaluated.” (page vii)

The gathering together, correlating and evaluating of this information became Helen Flanders Dunbar’s life’s work. She would suggest that we broaden our perspective on the people we should be talking to and the fields we should be learning from.

The third topic that Helen Flanders Dunbar almost assuredly would address is that of how CPSP members can make a significant historical contribution to the pastoral care movement. Her life’s work was in psychiatry, and the legacy she left in her books provides a blueprint of what she would suggest. The 1,192 pages of her 1954 Survey, that we already mentioned, offer an example of the systematic, cooperative, cumulative development of a knowledge base on psychosomatics, derived from a wide variety of psychiatric, neurological, medical, and social science sources.

In her Psychiatry in the Medical Specialties, she emphasized the fundamental need for adequate psychosomatic case histories, that would specify explicitly and in detail the types of conflict and other problems found in these cases. (p. 411) She would urge us to develop pastoral care case histories, even when the encounters with patients were quite brief, as is often the reality in acute care chaplaincy. Through cooperative development and the sharing of explicitly recorded descriptions of pastoral encounters, both extensive and brief, a knowledge base of experience can be developed.

Rodney Hunter and his collaborators, in the eight-year effort during the 1980s to develop the Dictionary of Pastoral Care and Counseling, began the effort to develop an unambiguous terminology that could be used for the communication of pastoral care and counseling insights, observations, and findings from pastoral caregivers’ experience. The Dictionary was a major part of a foundation for further cooperative work. But to date no building or even scaffolding has been erected on that foundation. Helen Dunbar might well become quite animated in urging that this partial foundation of terminology be extended, and that the knowledge base of pastoral care and counseling be erected on that foundation, just as she had done for psychosomatic medicine. The systematic compilation of empirical data on psychosomatic phenomena, based on the observations, insights, and measurements of psychologists, physicians, psychiatrists and other scientists, was Flanders Dunbar’s distinctive contribution to the fields of psychiatry, psychology, and counseling. Her life’s work is laid out before our eyes in the books she wrote. I think she would state that CPSP members can define themselves and their contribution to pastoral care and counseling through their cooperative development of an empirical knowledge base of pastoral and spiritual care experience.

Finally, as a postscript, I think Helen would end with words similar to what she stated in her book Mind and Body: Psychosomatic Medicine. She observed that: “the inability to relax is one of the most widely spread diseases of our civilization, and one of the most infrequently recognized. Most victims do not even suspect that they have it until it has been complicated by some other ailment.” (p. 146) I think she would urge each of us to help one another to find a way to relax during the hours we have together these next days here. She offered an example of how to do so a few pages later in that same book, describing how a pet dog, coming into a room to find its master, will circle once or twice and then flop down on the rug, rest its head on its paws, close its eyes, and sigh. (p. 156) Let’s try some human equivalent of that in our group sessions.