SHIFTS IN CHAPLAINCY 1 Paradigm Shifts in Chaplaincy & The Implementation of Spiritual Assessment Tools Corinna H. Chung Buddhist Chaplaincy Training Program, Upaya Zen Center, Santa Fe, NM Spiritual Care, Christus St. Vincent Regional Medical Center, Santa Fe, NM Email: [email protected] SHIFTS IN CHAPLAINCY 2 TABLE OF CONTENTS PAGE Abstract 5 I. Introduction 6 II. Christian Chaplaincy Model 8 A. Historical and Traditional Chaplains 8 B. Theology Science Dichotomy 9 C. Rome Gaia Dichotomy 10 III. Integrated Chaplaincy Model 11 A. Professional Chaplains 11 B. Secular Chaplaincy 13 C. Defining Patients’ Needs 14 i. Secular 15 ii. Existential 15 iii. Humanist 15 iv. Spiritual versus Religious 16 D. Dangers of Interpretation 18 E. Expanding Chaplaincy Services 19 SHIFTS IN CHAPLAINCY 3 IV. Science Friendly Chaplaincy: Implementing Spiritual Assessment Tools 19 A. Holistic Medicine 19 B. Reasons for Using Assessment Tools 21 C. Types of Tools 24 i. Self-Assessment Tools 24 ii. Quantitative Assessment Tools 25 iii. Qualitative Assessment Tools 25 iv. Outcome Measure Tools 27 D. Bias and Limitation 31 E. Levels of Assessment 32 i. Screening 32 ii. Structured Quantitative Assessment 34 iii. Structured Qualitative Assessment 34 (The Integrative Assessment Tool) iv. Unstructured Qualitative Assessment 43 V. Palliative Care Chaplaincy 44 VI. Chaplaincy Skills and Challenges 49 SHIFTS IN CHAPLAINCY 4 A. Listening and Communication Skills 49 B. Silence 50 C. Power Imbalance 51 D. Authority 51 E. Intimacy 52 F. The Midwife 52 G. Wounded Healer in the Valley of Shadows 53 H. The Human Condition 54 I. Knowing One’s Mind 54 VII. One Objection to “The Consensus Conference Report” 55 VIII. Interventions 58 IX. Conclusion 59 A. End of Life Care Chaplaincy 59 B. Environmental Chaplaincy 60 Acknowledgements 62 References 63 Appendices 1 - 7 70 - 86 SHIFTS IN CHAPLAINCY 5 Abstract Reflecting on the changing role of chaplains interrelated with Church history, the theology science dichotomy and cultural paradigm shifts in society at large, the author outlines how in the current model of chaplaincy, science has become an ally by endorsing the effectiveness of spiritual care. This paper explores the use of spiritual assessment tools to enhance hospital chaplaincy by monitoring quality through outcome measures, and fostering skills other than intuition in chaplains. The new “Integrative Assessment Tool” created by the author includes a section to address end-of-life planning and is followed by a discussion on palliative care chaplaincy. Chaplains’ skills needed to properly implement spiritual assessment tools emphasizes the importance of self-knowledge. The chaplains’ role has widened in response to the reshaping of their profession, which is now rooted in both spiritual and fundamental human values and, as another paradigm shift emerges, also encompasses environmental chaplaincy. SHIFTS IN CHAPLAINCY 6 I. Introduction The changing role of chaplains mirrors broad shifts in the social and cultural arenas that took place in the Western world. As values and thought systems evolve, so do understanding and expectations of chaplaincy. When chaplaincy was still nested within the Christian Church, other faiths, atheism and science were seen as antagonists. The interfaith model of contemporary chaplaincy is inclusive of, but distinct from its Christian interpretation, and therefore more attuned to the pluralistic religious landscapes of the ‘global village’. Particularly since the turn of the 20th century, conceptual frameworks changed within institutions and in society at large. Theosophy popularized the perspective that each religion presents only one of different roads to the truth. Rudolf Steiner infused Waldorf pedagogy with implicit spirituality. Vatican II greatly impacted the Roman Catholic Church by opening up dialogue with other faiths, empowering congregations to participate in mass in their own languages opposed to Latin, and making it legitimate for people born into Catholic culture to find personal interpretations of what it means to be Catholic ‘in spirit’. The modern world has become more secularized and atheist, agnostic, existentialist and humanist movements are reflected today in the change in patients’ needs. The shifts in chaplaincy might have been more gradual than the dramatic paradigm shift in physics initiated by Einstein’s special relativity; some nonetheless consider it revolutionary. The indignant refusal of a New York Times reader1 to embrace the idea that ministry to the sick and dying could not only be nonsectarian, but secular, exemplifies the barriers to see beyond a model of chaplaincy which has integrated other faiths, but not the lack thereof. SHIFTS IN CHAPLAINCY 7 Today’s model of hospital chaplaincy must be attuned to the needs of patients who consider themselves spiritual, but not religious. When the Western world achieved materialistic success and saturation, the thirst for satisfaction, inner peace and meaning failed to be quenched. In terms of Maslow’s hierarchy of needs, it was maybe because the basic needs of satisfying physical survival and safety was met, that a large population was free to pursue Eastern philosophies, which lead to meditation and yoga no longer remaining ‘avant garde’ and accessible to few but becoming mainstream, as did therapy and other self-esteem and self- actualization techniques, the two highest needs in the Maslow hierarchy. Many titles in the top- selling book lists over the past decades reflect interest in self-transformation and finding purpose and peace. The 1960’s movement opened different ways to perceive reality and consciousness2 (Huxley, 1954), and not all were brought about by the use of psychedelics; the neurosciences continue to puzzle over the nature of consciousness till today. Key elements of the 60’s became integrated by society at large and are expressed in more women becoming chaplains, the critical questioning of standard values and the continued search for alternatives to a purely materialistic worldview. This could at least partly explain why chaplaincy services are growing in response to an increasing number of people accepting chaplains’ visits1. A new paradigm of chaplaincy has emerged which embraces scientific research. In spite of its historical role as antagonist, science surprisingly has become an ally providing empirical evidence for the efficiency and value of spiritual care. On one hand, scientific studies were precipitated by an increasing interest to overcome the split between science-based and holistic medicine and to prove the positive correlation between spiritual care and physical health. On the other hand, pastoral research was necessitated by health care facilities demanding accountability and hard facts, not anecdotal data, to justify the cost of spiritual care departments by showing SHIFTS IN CHAPLAINCY 8 measurable outcomes, for example, shorter hospital stays or less use of pain medication. Critics argue against chaplains becoming full-fledged members of heath care teams or having full access to medical files and contend that spiritual care is but the emperor’s new clothes.3 Overcoming historical confrontations, science and spirituality can converge in a chaplaincy model that is a higher synthesis with patients being the beneficiaries. II. Christian Chaplaincy Model A. Historical and Traditional Chaplains Saint Martin of Tours (319-397 AD) aspired to serve God when in his childhood. However, it was required of him to join the army at age 15 and he remained a soldier until he was 20. In the winter of 337 AD, riding near the city gates of Amiens, Gaul, he noticed a beggar destitute of clothing. He cut his military cloak into two equal halves and gave one to the shivering beggar. As Severus (360-425 AD), his friend and biographer, writes further, “Martin, that man full of God, had nothing except his arms and his simple military dress. Some by- standers laughed at him because the cloak was now an unsightly object. Those of sounder understanding groaned because they had done nothing similar.” The following night Martin was rewarded with a vision of Christ wearing his half cloak and making known to the angels his act of mercy. St. Martin was acclaimed Bishop of Tours in 371 AD. Cappellanus (Latin) denoted a cleric who was the custodian of the sacred cloak of St. Martin under the Frankish kings. The first chapel4 was a sanctuary to preserve St. Martin’s cloak. Later, clerics officiating in the chapel of a sovereign or in settings where the people did not have free, frequent access to a regular cleric, such as in a hospital, were called chaplains. Prior to the appointment as chaplain, a cleric first has to thoroughly train and serve in his own faith SHIFTS IN CHAPLAINCY 9 community. The use of the word ‘chaplaincy’ probably only began when General Orders issued in 1776 provided a chaplain for each US regiment. The traditional chaplain ministered and sought to guide others to his own faith group5. B. Theology Science Dichotomy One cannot ignore that the 18th century is also the time of the Roman, and fourth manifestation of the Inquisition since 1184, leaving a long legacy of forced conversions, witch- hunts, torture and execution of purported heretics. As it happens, St. Martin, who gave chaplains their name, intervened – albeit unsuccessfully – when the Priscillianists became the first Christians executed for heresy in 385 AD. For centuries the relationship between theology and science was characterized by struggle more than by dialogue. St. Augustine, the contemporary church father of St. Martin, regarded scientia, scientific knowledge, as spiritually barren and misleading. Because it was inferior to sapientia, theological wisdom, the Church considered theology ‘the queen of sciences’ for centuries. Thomas Aquinas, the 13th century Roman Catholic philosopher, also saw theology as a science. He stated that it is a confluence of faith and reason that allows knowledge of God. During the Reformation Martin Luther and John Calvin opposed the view of theology being a science and defined it as the practical study of the relationship between God and human beings6 (VandeCreek, 2008).