In this ongoing series, every two weeks the ACPE Research Committee will publish reviews focused on Level I and Level II CPE. 

Research Committee Review: Instruments to Measure the Effects of CPE
By Angelika A. Zollfrank, ACPE Research Committee  |  December 10, 2018

What are the effects of CPE? How can we measure these effects? A large part of the research related to these questions focuses on how students change in CPE, assuming that increased self-awareness leads to improved pastoral ministry. Another way to tackle the question is to identify patients’ spiritual/religious needs and look at how CPE helps spiritual caregivers to develop the competencies necessary to effectively address patients’ needs. 

The following summarizes one article representative of each of these two approaches. The first article, written by Derrickson and published in 1990, reports on multiple instruments used to measure changes in CPE students. 

Derrickson, P.E., Instruments used to measure change in students preparing for ministry: a summary of research on clinical pastoral education students, J Past Care 44, no. 4 (1990): 343-356.

The second article is recent and much less comprehensive. Here the authors sought to identify effective spiritual care with a specific patient population, namely dementia patients. From that vantage point they ask about the education needed to develop the necessary competencies.  

Kiesskalt, L., et. Al., Klinikseelsorge mit Menschen mit Demenz. Eine qualitative Interviewstudie mit professionellen Klinikseelsorgern, Z Gerontol und Geriat, doi.org/10.1007/s00391-018-1396-6, May 2018. 

Let’s start with Derrickson’s article. He evaluated the usefulness of several instruments employed to measure the effectiveness of CPE. What kinds of changes were the instruments used designed to measure and did it work? 

The Minnesota Multiphasic Personality Inventory (MMPI) for example, seeks to ascertain a person’s “public impact on others as well as one’s underlying character structure” (p. 345). Unfortunately, for those who think that CPE has its biggest impact here, the MMPI was unhelpful because its results were inconsistent.

In contrast, Derrickson saw Shostrom’s Personality Orientation Inventory (POI) as useful, particularly in measuring self-actualization defined as “inner-directedness, existentiality, feeling reactivity, spontaneity, acceptance of own aggression, and capacity for intimate contact” (p. 347-348). Positive changes, however, appeared to backslide when measurements were repeated a month after CPE. Scoring differed between women and men, indicating perhaps a need to adjust curricula to CPE students’ gender. Unfortunately, the POI fails to conceptualize how greater self-actualization improves effectiveness in spiritual care. 

Another instrument to measure change in CPE is the Adjective Check List (ACL). Use of this tool revealed changes in CPE students’ view of themselves as more complex, more confident, “more independent, more aggressive, and less deferential” (p.350). Interestingly, experienced ACPE Certified Educators had more impact – both positively and negatively. 

Yet another instrument, the Carkhuff test, focused on assessing listening skills, measuring the “levels of discrimination and communication” (p. 354). It appeared to be a useful instrument, though limited in its focus on one skill only.

What do you think about changes, which these instruments are designed to measure? If you were to develop a validated tool to measure change in CPE, what would you focus on? 

On to Kieskalt’s study and a more patient-centered approach. The question here was how chaplains (and community clergy) can reach and spiritually care for dementia patients. Kieskalt’s team interviewed ten predominantly Roman Catholic chaplains who had two to sixteen years of experience in dementia care. Pastoral caregivers described using rituals and symbolic actions, biblical text and prayer, music and hymns, biographical work, touch and presence, as well as pictures, cards, and fragrances. 

While the study lacked inter-coder reliability and communication with patients could not be validated, Kieskalt and team concluded that pastoral ministry tends to relationships through ways of communicating that are possibly unique. Chaplains should therefore be more included in medical teams. The article also calls for spiritual care concepts specific to this patient population and inclusive of the above-mentioned interventions. What would your colleagues say about skills learned in this area in CPE? Or, what do they wish they had learned in CPE, but did not? 

As a result of this literature review, it may be useful for us to tackle the following questions:
  • How might we build consensus regarding the key changes CPE aims to bring about?
  • What instruments measure accurately the changes effected by CPE?
  • How do the measured changes conceptually connect with improved pastoral functioning?
  • What would data gathered from pre/post- and one-year follow-up questionnaires in ACPE centers across the country reveal?

The Rev. Angelika Zollfrank is an ACPE Certified Educator and serves on ACPE’s Research Committee. She may be contacted at azollfrank@icloud.com.
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