by Phyllis C. Roe, Th.D.
Samaritan Counseling Center of Hawai`i*
He stood beside my bed, a cameo of clarity in the post-surgical haze of anesthesia and confusion. Tubes and other medical paraphernalia prevented me from speaking or moving. He told me that friends had gathered at the hospital the night before to wait through my unexpected surgery. Whatever else he said is lost to memory. But I remember clearly what he conveyed: a calm acceptance of what had happened to me, a willingness to be there in the pain and fear, a confidence--which could only come out of hope and faith--that I would be okay whatever happened, and a reminder that I was surrounded by a community of caring. I was comforted and reassured, not just by a familiar face, but by a sense of fundamental trust his presence embodied. I closed my eyes and rested.
For most of my professional life I have reflected on the question "what is pastoral about pastoral care" as one who is the care giver--as parish pastor, hospital chaplain, director of a seminary-supervised ministry program, and as a pastoral counseling specialist. Two years ago a health crisis, which nearly resulted in my death, gave me the opportunity to ponder this question from the more trustworthy experience of receiving care. What is distinctively pastoral is that the person in crisis experiences God's care for them in their situation of need--that God remembers, loves, forgives, and is present with them.
Background
Pastoral care has always referred to the expression of concern within the Christian community for persons estranged or in distress. Just as God seeks us, so the minister, as shepherd, seeks lost, lonely, ill, troubled persons to bring God's healing, guiding, sustaining, and reconciling presence to them. "Pastoral" has variously referred to the person of the religious leader who gives the care and/or the motivation or attitude in which the care is given.
Pastoral care has to do with ways of understanding our relatedness to God and with efforts to communicate that understanding to persons in crisis or distress. How this is understood and carried out is connected to the basic religious convictions of a particular community as well as to the historical, political, and social milieu of specific time and place.1
John Patton has helpfully distinguished three major paradigms in the history of pastoral care: 1. the classical, with an emphasis on the message of pastoral care, i.e., the caring elements in Christian theology and tradition; 2. the clinical pastoral, which focuses on the persons involved in giving and receiving care; and 3. the communal contextual paradigm, which includes the caring community of clergy and laity and calls attention to the contextual factors affecting both the message of care and those bringing and receiving it.2
All three are necessary perspectives. What is "pastoral" can be understood through these three lenses: tradition and theology, person, context and community.
Tradition and Theology
A pastoral care giver comes to a crisis situation, not just as a generally caring person, but with an identity which has been formed in the interaction with the sacred stories of his or her religious tradition. These narratives and rituals shape a way of seeing the world, of understanding the nature and purpose of human beings and their relationship to God. This way of seeing and being in the world, formed by a particular religious, gives rise to symbols and metaphors which guide the pastoral carer's attitude and approach to persons in crisis. Chris Schlauch demonstrates how his study of New Testament passages has led to the metaphor of "faithful companioning." This refers to the pastoral clinician's fundamental commitment to be present with and to the person in her experiencing, regardless of what unfolds.3
Theology, scripture, and ritual are not simply something we speak of or do with those in crisis; they are what shape why and how we are there to care in the first place. A minister's attitude "bears the imprint of her ministerial-vocational identity and confessional-traditional context."4
The narratives and metaphors of our religious traditions lie implicitly within our approach to pastoral care. For pastoral care to be pastoral, is it necessary that the resources of the tradition--scriptures, prayers, etc.--be made explicit?
Pastoral care relates to the resources of the Christian faith to the person's experiencing. It communicates the inner meaning of the Gospel to the person(s) at the point of their need.5 Charles Gerkin sees the minister as skilled at discerning the story within "the living human document" and its relation to the larger story of the tradition of faith.6 This may or may not be accomplished through the direct use of prayer, scripture, or discussion of God.
In Wendell Berry's novel, A Place on Earth, a pastor visits a family whose only son has recently been reported missing in action in a war. The pastor sits with the family carrying on casual conversation until he feels it is time to get to the real purpose of his visit. He begins to speak of their loss, actual or anticipated, and attempts to offer them comfort.
"The preacher's voice, rising, rides above all the chances of mortal and worldly hope, hastening to rest in the hope of Heaven. In the preacher's words the Heavenly City has risen up, surmounting their lives, the house, the town--the final hope, in which all the riddles and ends of the world are gathered, illuminated, and bound. This is the preacher's hope and he has moved toit alone, outside the claims of time and sorrow, by the notion of desire which he calls faith. In it, having invoked it and raised it up, he is free of this world."
Mat, the fother, listening to the preacher, realizes sadly that he cannot embrace this "last simplifying rest-giving movement of the mind." His need is not of Heaven, but of this earth.
"It is from this possibility of meaninglessness that the preacher has retreated. So that the earth will not be plunged into the darkness, he has lifted up the Heavenly City and hastened to refuge in its gates. And Mat, in the very act of leaping toward that restfullness, turns away from it to take back his pain."7
To be meaningful, the use of religious resources must connect with the person's experience and need, not gloss over pain, loss, tragedy, or despair. In this story, the pastor attempted to offer hope and comfort by sharing his theology, but he failed to connect with the family's need. If the pastor had no "hope on earth" to offer, Mat had no use for "hope of Heaven." In pastoral care, the articulation of our faith must be in response to a person's questions, story, feelings, not be imposed upon the situation.
In our anxiety of how to be with people in crisis we can err in two ways: by turning to religious resources too quickly, thus moving away from staying with a person in what their experience means to them; or by not offering appropriate religious resources when their use might be a source of comfort and hope. This first is more common when the minister is uncomfortable being with persons experiencing ambiguous or difficult situations. The second is more common among ministers overly infatuated with psychological resources or who have embarrassment about their religious affiliations.
Bringing the stories, prayers, and rituals which mediate Christ's hope, love, and forgiveness to a person in crisis requires a process of discernment and dialogue. Distinctively pastoral care is psychologically knowledgeable about human reactions to crisis, spiritually attuned to the meaning of the crisis for that person, and able to creatively offer scripture, prayer, and rituals in a way which responds to that person's need. The best way to learn this is through supervised reflection on actual pastoral events.
Person
The presence of the minister in pastoral care both represents and, ideally, embodies Christ's solicitous and healing concern for all persons. Understanding of the caring role of the minister has evolved from what the minister must do, must know, should say, to what a minister must be.8
In crisis, the mind is often confused and in turmoil, unable to absorb words, especially explanations. In the trauma of my crisis, I found that I responded more to the "felt sense" of persons in my environment than to their words. Those ministers whose presence was gentle, calm, and reassuring were welcome. Others could offer words and prayers meant to be reassuring but I was not reassured because I felt their anxiety about my condition.
While we are all wounded healers, it is our responsibility as ministers to use counseling, spiritual practices, and shared reflections on our ministry to remove as many personal impediments as possible in order to be clearer vessels of God's grace.
Context and Community
Pastoral care occurs, not in isolation, but in particular contexts as an expression of community. For care to be relevant, the care receiver's context must be taken seriously, including ethnic identity, family and social resources, etc. Pastoral care to a Native Hawaiian person may differ from care to a Japanese American because of differences in culture and family structures. An important element in my crisis was that my husband had died unexpectedly just three years earlier. The gender of the care giver and care receiver often affect the style and nature of the care given. Where the crisis occurs is a factor--at home, in a hospital, in a foreign country. A minister must be aware of and responsive to the particular context.
A pastoral care giver goes into a crisis situation in the name of Christ who sends us to care for each other and on behalf of the community gathered in Christ's name. Crisis has the potential for alienating us from or connecting us to community. In my case, my community of care became visible in the crisis through a network of prayer and practical support. My surgeon commented, "When I walked into your hospital room the day after surgery and saw how many flowers had been sent, I knew you were important to many people and I knew that would contribute to your recovery."
In times of personal crisis, some persons withdraw from community. While respecting a person's right to privacy, pastoral care seeks out such persons in non-intrusive ways to let them know the community is remembering them and standing by to help when it is wanted.
Pastoral care in a crisis not only expresses a community's care, but also helps create it. In a hospital, for example, a chaplain may bring together all those who cared for a patient through a crisis in order to grieve together and support each other to to debrief from a traumatic event.
In conclusion, distinctively pastoral care is an art which through discernment and dialogue, word and presence, doing and being, the grace of God, the hope of Christ, and the vitality of the Spirit are manifested in situations of crisis and distress. Care givers and care receivers stand together under the mercy of God to seek and respond to the Light that shines in darkness.
*Phyllis C. Roe, Th.D., is Executive Director of the Samaritan Counseling Center of Hawaii, and an ordained elder in the Nebraska Conference. Phyllis died in 2001. Written for a 1996 issue on "Pastoral Care in Crisis" of Circuit Rider. The text is an edited pre-publication version.
Footnotes
1. Mills, Liston O. "Pastoral Care: History, Traditions and Definitions", Dictionary of Pastoral Care and Counseling, (Abingdon Press, 1990) pp. 836-44.
2. Patton, John. Pastoral Care in Cont1ext: An Introduction to Pastoral Care (Westminster/John Knox Press, 1993) pp. 4-5.
3. Schlauch, Chris R. Faithful Companioning: How Pastoral Counseling Heals (Fortress Press, 1995), pp. 76-85.
4. Ibid., p. 81.
5. Wise, Carroll. The Meaning of Pastoral Care (New York: Harper, 1996).
6. Gerkin, Charles. The Living Human Document: Re-Visioning Pastoral Counseling in a Hermeneutical Mode (Nashville: Abingdon Press, 1984).
7. Berry, Wendell. A Place on Earth (New York: North Point Press, 1983).