Basic elements of Clinical Pastoral Education, CPE
Pastor Christina Torre
Clinical Pastoral Education (CPE) is a program of education and formation for the professional work of pastoral/spiritual care practitioners. CPE uses an educational methodology that combines:
- knowledge of theology/spirituality (what we believe)
- knowledge of education (how we learn)
- knowledge of the behavioral sciences (who we are as human beings).
CPE’s methodology utilizes the action-reflection model of learning. The action component entails practical experience in the work of pastoral/spiritual care within an appropriate setting (for example, a hospital or a nursing home). This care acknowledges and attends to the human condition, particularly life’s spiritual dimensions. The reflection component entails the exploration, articulation and integration of the pastoral/spiritual carer’s experience, the dynamics present, and the theological/spiritual implications. This action-reflection process is integral to the CPE participants’ understanding and the formation of their pastoral/spiritual care identity and competence. CPE encourages learning from the “living human document” (Boisen).
The specific content of a CPE unit will depend upon the particular interests and needs of the students/participants and the context in which they offer pastoral/spiritual care. The learning process allows for the addressing of the particular learning goals that each student/participant identifies. The process balances the practical experience of pastoral/spiritual care, small group supervision /interaction, and personal individual supervision in an integrated program of experiential and theoretical education.
These are the main elements of the curriculum:
Spiritual care ministry
The clinical setting (for example, of the hospital) is the primary teacher for students. Each student interacts and provides care in a clinical area which may include patient visits as well as family and staff interactions.
Group supervision
Group provides a time for students to share their thoughts and feelings about working with patients, families, staff, other students, and supervisors. The purpose is to help the student become aware of how they receive and respond to support, clarification, and confrontation with regard to their own attitudes, values, and beliefs. Group supervision includes an Interpersonal Relations (IPR) group, reflection of verbatim or case studies, and the analysis of a sermon to reflect upon verbal and nonverbal communication and theological content.
Didactic seminars
Didactic seminars facilitate a working knowledge of pastoral content (on topics like grief, shame, religious rituals in pastoral care…), personality theory, cultural/gender theory, and ethics.
Individual supervision
This is a weekly time between student and supervisor to individualize, integrate, and plan opportunities for personal/professional growth. As active partners in the learning process, the student is invited to take significant responsibility for initiating issues that are important for learning and seeking feedback/consultation regarding these issues.
Writing requirements
At the beginning of each unit of training, each student sets learning goals for oneself. Verbatim and narrative reports on the student’s spiritual care are written on a weekly basis. These tools of assessment and reflection are submitted for both group and individual supervision as part of the ongoing process of patient care. These serve to strengthen self-awareness, self-confidence, and professional competence in delivering effective spiritual care.
Spiritual Assessment
1. The Holy
Assessment
- What does the patient hold sacred?
- Is there an awareness of the holy? Faith?
- Does the person consider grace, blessings, a sense of generosity?
- Salvation: ability to move from darkness toward light, well being, wholeness?
- Attitude towards death / mortality?
Questions
- Do you have a sense of where God is in all of this?
- Are there spiritual / religious practices that have been especially helpful?
- How has your relationship with God / a higher being... sustained you?
- Repentance: ability to move from anguish / sins toward well-being / forgiveness
Outcomes
- Identify chaplain as a safe person who will support a relationship with the Holy
- Access relationship to a higher power
- Encourage / reinforce their use of religious and spiritual practices
2. Self / Illness
Assessment
- ability to trust
- ability to mourn and re-engage
- ability to create / make meaning
- ability to progress through life’s developmental phase
- What is the true nature of the patient’s relationship to the crisis? victim? conqueror? fear? acceptance?
Questions
- What is giving you strength to cope right now?
- What is the hardest thing about this time for you?
- How do you understand what is going on with you?
- How have you dealt with previous loss, disappointment, illness?
Outcomes
- access inner resources for healing
- access convictions and regain direction and energy for healing
- clarify problem areas
- identify options
3. Support System
Assessment
- significant others
- potential to learn about God, the Holy through personal relationships
- ability to explore significance of difficult relationships such as estrangement, divorce, loss
Questions
- Who is there for you in this time?
- Who do you most miss?
- Where do you feel you most belong?
Outcomes
- person accesses the meaningfulness of their community during hospitalization
- person pinpoints losses in relation to community, moves from grief to love
- experiences support and guidance in summoning resources of community
4. Hope
Assessment
- Is there a future?
- What does it hold for the person?
- Is the hope realistic, or is it a wish?
Questions
- What are you most looking forward to?
- What helps you when you are feeling blue?
- How do you comfort yourself?
- If the patient speaks of fear of dying - What specifically are you afraid of? What do you believe about dying? What will happen when you die?
Outcomes
- patient gains perspectives on the current situation
- patient achieves clarity about problem areas
- patient reaches general sense of well-being
Chaplain name: C
Date of visit:
Hospital: Length of visit: 40 mins.
Supervisor: age: 14, sex: f
CPE unit: relationship status:
Verbatim: ethnicity: Mexican
Date due: religion: Catholic
1. Patient Background
The patient P had come in with a Level II trauma in the early afternoon. She had fallen off a fire escape, trying to enter her parent’s apartment on the second floor through a window. There had been nobody with her, so the trauma-nurse had asked me to witness the treatment and stay with P until her parents arrive. I left when she was in x-ray because her mother (and two of her friends who were on the roof with her, but had then left her without doing anything), who spoke little English, had arrived. The x-rays took a long time, and I got a call for another patient, so I decided to come back later and check on her.
2. Plans for the visit
My plans were to see how P was doing, and to see whether she or her family needed support. Usually visits like this are short, I briefly peek into the cubicle, and usually there is no need for a longer stay. But I was open to whatever would happen.
3. Context of visit / observations
P’s leg was in a bandage and elevated on a pillow. Her father was standing at the head-of the bed; they were not talking. His arms were crossed, P looked somehow indifferent, and her face looked like she was feeling pain.
4. The Visit
C=chaplain; P= patient
C1: Hi, I’m C, the chaplain here in the Emergency Room. I was here when you came into the hospital earlier, so I wanted to come by now, and see how you are.
P1: Thank you for coming.
C2: Hi, I’m C, the chaplain here (I introduce myself to the father, and extend my hand to him. He takes it).
C3: How are you, P?
P2: Ok, they say that my ankle and leg are broken. I probably need surgery. I don’t want to have surgery.
C4: You are probably really scared.
P3: Yeah.
C5: What is it that you are scared of?
P4: I mean, just stuff.
C6: Do you want to tell me a little about it?
P5: (shakes her head, but motions her eyes towards her father)
C7: Would you want me to ask your father if he could step outside for a while so that we can talk?
P6: (nods)
M1: No problem. (leaves the room)
C8: Is it ok if I sit down?
P7: (nods)
C9: Hi. What’s going on?
P8: I just feel that my life is over. I’ve really screwed this up!
C10: Wow. What do you mean?
P9: I play soccer, and I don’t know. I’ve heard that people who have surgery can never run again like they could before. I will miss a lot of practice. And all the games. I feel like I have let down my whole team.
C11: I can hear that soccer is really important to you. And you probably practiced really hard to be in the place where you’re now. With your shape and standing on the team and all. That’s scary then…
P10: Yes. I love soccer. I’m really good at it. And I don’t know if I can back there.
C12: You mean to the place where you are now?
P11: Yeah.
C13: That’s a lot to take in… I can also feel a lot of pressure when you talk about it.
P12: My dad said that I screwed this up. That I gave away all these chances.
C14: Your chances?
P13: In soccer, and at school. I feel like at home I didn’t have these problems. It all started when I came here. It was easy for me in Mexico.
C15: So much going on…
P14: Yes, I’ve tried really hard until now. We came here half a year ago. Me and my sister. I don’t know how my sister is going to take it. She is very sensitive. I just met my father and mother. They left us with grandma in Mexico. I can talk to her. I can’t talk to my parents. I don’t trust them, you know?
C16: So many changes! I can’t believe that you have experienced all of that so recently! It sounds like you’ve been uprooted and planted into into a completely new world. You probably miss so much!
P15: It’s very hard. I miss my grandma. (she cries)
C17: I believe that. (pause) And you can probably feel that especially now that you are here and it would be so nice to have someone around you know and trust.
P16: Yes. My father doesn’t understand. He just says that they let us come here, and gave us all these chances.
C18: Phew…
P17: It’s right, there are a lot more chances here than in Mexico. But I miss my friends and my grandma.
C19: And probably all those people and things you grew up with and are familiar with.
P18: Yes, it’s so hard, you know? I don’t know if I want to stay here. They say for this school year, and then we can decide if we want to stay.
C20: Huh. I can imagine that within a year you can maybe feel out a little more if this is a good place?
P19: I don’t want to disappoint my parents and teachers. But I want to go back. It’s more like my life, I think.
C21: That’s an important thing – that you feel at home in your life and with the people around you.
P20: I think so. I’m just so worried about my sister now. How she is going to take it. She relies on me.
C22: You mean how she will take it that you broke your leg?
P21: Yes, she doesn’t know I’m at the hospital. I always took care of her when we were with my grandma. I don’t want to worry her.
C23: What would you do for her?
P22: Take her to school, help her with homework, make her something to eat, things like that.
C24: That sounds like a lot of responsibility to me, especially when you are busy being a teenager.
P23: Yes, it sometimes was a little too much. It still is sometimes. I still do these things for her. But I like it. My sister and I are very close.
C25: I can see that – you went through a lot together.
P24: Yes… Often I’m angry. I never show it, but the soccer is good. I can let out all of my anger when I practice.
C26: And now that you are not able to practice, what do you think you are going to do with your anger?
P25: I don’t know yet. At least my sister can practice. For her it’s good too. I just hope that I will be able to play soccer again. It will suck to miss all these games. I don’t want to sit on the bench seeing my team play and imagining that it could be me who is playing.
C27: Yeah, that really sucks.
P26: The doctors said that I’m lucky. I could have broken my back or hurt my spine. Then I could be paralyzed.
C28: That’s true… And still…
P27: …it’s not so helpful right now.
C29: I believe it. Since you’r not able to do for a while what you really love.
P28: A couple of hard weeks. Are you going to tell my father what we were talking about?
C30: No. Unless you want me to.
P29: You can tell him. These things are not a secret.
C31: I don’t have to tell him anything. If you want me to, I could tell him something though. Maybe there’s something you would like to tell him and don’t know how?
P30: You can tell him whatever you want.
C32: No, whatever you want.
P31: Ok, maybe that I want him to give me my phone. And maybe you can tell him a little about how I feel.
C33: Ok, maybe I can tell him that you feel a lot of pressure at the moment?
P32: That’s good, yes, a little about that. Thank you for coming. That was good. Can you pray for me?
C34: Yes, sure. You want me to pray with you right now?
P33: No, later, when you are by yourself.
C35: Ok, I’ll do that. Bye P. It was good to talk with you.
P34: Good to talk with you too.
5. Assessment and Reflections
A. The person
- What did I notice about the person?
- What are the most important feelings the person had in my perception?
- What is my assessment of the needs?
- How do I see the person in her context?
B. The relationship
- How did I perceive the relationship between chaplain and the person visited during the visit?
- What happened on a relationship-level during the visit? At which points?
- What was important about the relationship?
C. The chaplain
- How did I feel during the visit?
- Where could I address the person’s needs? Where was I not able to do that and what is my idea about why that happened?
- What did I notice about myself during the visit? How did I feel in the situation / with the person(s) involved / in the setting?
- What did I say / do that I’m proud of? Where are my growing edges?
D. Pastoral/Spiritual Care Planning
- What were the person’s spiritual needs?
- How did I address / not address them?
- What are my plans for future visits?
E. Theological Reflection
- What comes to mind from my theological context and tradition when I think about the visit? (images, passages from scripture…)
- Why did I bring this verbatim for reflection?
- What is my question that I would like to reflect on with my peers?
