Research informed CPE: Transforming indeed!
By Judy Ragsdale, ACPE Supervisor  | December 2016


Since the significant research and argument for research presented by Larry VandeCreek, research has become a subject of interest for some in the fields of chaplaincy and CPE. George Fitchett took up the banner with a commitment equal to Larry’s, and has made connections with a wide variety of researchers in multiple fields on several continents. Research has been scary to many people of faith. Science and religion have historically held an adversarial, suspicious relationship with each other. In reflecting on this, I wonder whether the creation story of God, Adam and Eve, and the forbidden Tree of Knowledge led many of the faithful to fear knowledge as a temptation away from faith. I’m thankful our discipline is growing willing to not just become research literate, but to engage in our own explorations of answers to relevant questions. Research is a form of disciplined reflection consistent with our action/reflection method of learning. Qualitative research has been an intuitively good fit for me. It involves collecting data via deep listening in interviews, and doing careful analysis of the interview text, often in small groups of colleagues.

 

Maybe all research is motivated by a burning question, something of great importance to the researcher. My burning question was how to do supervisory CPE well. The burning nature of this question came about because in my ignorance, I had caused pain to a student. The study of supervisory CPE led me to study several aspects of supervisory education – Supervisors named as especially adept at providing supervisory CPE (with Ivy and Holloway, 2009); newly certified Associate Supervisors (with Steele-Pierce, Bergeron, and Scrivener, 2012); and finally, ACPE Certification Commissioners (with Orme-Rogers, Bush, Stowman, and Seeger, 2016). In the course of these studies, I came to understand that our primary focus in supervisory education is the development of integration. I also learned that sustaining and improving the quality of our supervision requires continuing to use the CPE process - presenting vulnerable work to colleagues.

 

Another learning I’ve had doing research in Supervisory CPE is that our focus is primarily on developing the integration of the supervisory student by continuing to invite the SES/Candidate to focus on her/his own theology. This focus is one we in CPE have had for many years, and it may not be possible to shift our gaze. For many reasons, we may not want to. I’d like to make a case that we should, and I base that case on research in the use of Religion and Spirituality in healthcare.

 

Research in Religion/Spirituality (R/S) in healthcare has been steadily growing. This research is primarily done by psychologists, sociologists, physicians, and nurses who understand that religion and spirituality are major forces in many people’s lives. In a way, this is like a JoHari Window moment in the evolution of our profession. Our colleagues on the interdisciplinary team, clinically and academically, are telling us that our discipline is an influential one for many patients and families. However, we are not equipping ourselves as supervisors or as chaplains to be proficient in assessing the ways people use their faith beliefs in the service of making meaning, coping, and decision-making. The outcomes in our ACPE Standards and the competencies of the Association of Professional Chaplains at no point require demonstration of the ability to assess a faith belief outside our own (such a faith belief may well be within our own faith tradition), the ability to provide interventions that help patients or congregants use their faith in the service of their challenges, or the ability to articulate the substance and function of patients’ R/S to the interdisciplinary team such that it can impact the treatment plan.

 

While we do have one paper identifying a list of chaplaincy interventions (Massey et al., 2015), the strongest interventions were active listening, providing a pastoral presence, and demonstrating care and concern. This series corresponds to the findings Wendy Cadge had in her study published in the book Paging God (2012). Cadge found that members of the interdisciplinary team thought chaplains were experts in religion. Chaplains and directors of Spiritual Care departments thought they were experts in relationship and presence. If we are not adept at exploring and helping patients articulate their ways of using R/S, we are less than useful in two realms: First, we may not be directly supporting the R/S needs and resources of patients and families because we may not be proactively asking them what their R/S needs and resources are. Second, we may not be providing the healthcare team with input that for a large fraction of patients and families may be key to their understanding and coping and, most importantly to the interdisciplinary team, to their decision-making.

 

In the 2015 Pew Research Center report U.S. Public Becoming Less Religious, 97% of people in the United States believed in God in 2007, and 97% believe in God in 2014. The percentage of those who describe themselves as religiously affiliated has shrunk – from 83% in 2007 to 77% in 2014. This report is drawn from the 2014 Religious Landscape Study. People in older generational cohorts are increasingly relying on religious teachings and beliefs to answer questions of right and wrong: 41% of those born between 1928 and 1945; 38% of those born between 1946 and 1964; 33% of those born between 1965 and 1980; 26% of those born between 1981 and 1989; and 23% of those born between 1990 and 1996. This report is drawn from a survey of 35,000 US adults. While R/S may be decreasing, it is certainly a vibrant aspect of many people’s lives. Those people, when they are hospitalized, may well benefit from chaplaincy focused on their R/S.

 

While we in ACPE are guiding students toward personal integration, we are not helping CPE students learn to focus on how patients/families/congregants/prisoners/agency members are using R/S. We need to be educating ourselves to be experts in what different religions teach; Stephen Prothero’s excellent book God is Not One (2010) should be essential reading in chaplaincy programs. We should be guiding students to focus on how practitioners are using their R/S specifically to cope, to make meaning, and to guide medical/psychiatric decision-making. In our CPE Program at Cincinnati Children’s, we have converted one of our weekly IPR sessions to “group,” weekly sessions where we ask the Chaplain Residents to talk about how their R/S is helping them cope with the pain they experience in pediatric chaplaincy. My colleague Rabbi Ruth Alpers who is currently supervising our CPE Residents in this endeavor, added this comment: “An additional important component of ‘group’ is the Residents’ sharing when their own beliefs are challenged by an encounter with a patient/family either because of the prognosis or because of the R/S of the family. Having a space to process this has been important.” As the Residents listen to one another, we hope they will not only grow in their ability to use their own R/S for resiliency, but that they will learn to listen deeply to how others use their R/S. We want to guide them to become comfortable exploring the use of R/S with families for whom this is important.

 

We are fortunate to be in a medical center that supports research not only in CPE supervision but also in chaplaincy. One member of our staff, Chaplain Amy Simpson, is participating in one research study and in one quality improvement project. Both projects include lists of specifically R/S questions to ask patients/families. In conversation just today, Chaplain Simpson reported a change in her practice. She could see the questions themselves working as interventions. This experienced chaplain reported that she is getting into much deeper R/S conversations, and is able to bring much more relevant reporting and advocacy to the interdisciplinary team.

 

The role of pastoral care research is to explore what happens on the edge of new understanding. The risk is that we might discover religious/spiritual experiences that are inconvenient and unwelcome in our CPE world. For instance, I was once participating with Dr. Daniel Grossoehme in one of his studies of families of children who have cystic fibrosis. Each of the 15 parents we interviewed said some version of “God never gives us more than we can bear.” Dr. Grossoehme published this study in his article We Can Handle This: Parents’ Use of Religion in the First Year Following Their Child’s Diagnosis with Cystic Fibrosis (2010). This finding led me to realize I had been disrespectful to a very useful belief system. What I had arrogantly categorized as denial instead proved to be a very uplifting, strengthening belief system.

 

Connecting what we’re learning in research to our practices of chaplaincy and supervision is essential. Research literacy, developing the discipline of regularly reading research done in or about our field, is the first step toward evidence-based practice. For those who are interested in developing relationships with new knowledge in our field, which means reading written documents created by other living human documents, we have an incredible guide diligently helping us do this. Chaplain John Ehman selects a relevant research article each month and posts it on the ACPE Research Network. These articles are easily accessed by going to the ACPE website at www.acpe.edu, going to the Directories tab, going to the Network link at the bottom, and pressing the website link at the bottom of the first entry, ACPE Research Network. For those of us who believe God welcomes us using as much knowledge as we can gather, this is our opportunity to be in community and support one another on this research path.


The Rev. Judith R. Ragsdale is an ACPE Supervisor at Cincinnati Children's Hospital Medical Center in Cincinnati, OH. She may be contacted at judy.ragsdale@cchmc.org.