Helping the Good Shepherd: Pastoral Counselors in a Psychotherapeutic Culture, 1925–1975

• 2 The Methodology of Clinical Pastoral Education
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• Johns Hopkins University Press
• pp. 40-61
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CHAPTER TWO
The Methodology of Clinical Pastoral Education

If the [minister] is to be restored to his place in the populace which has imbibed deeply of the scientific method, he must drink at the same well.

—HELEN FLANDERS DUNBAR, EXECUTIVE DIRECTOR, COUNCIL FOR THE CLINICAL TRAINING OF THEOLOGICAL STUDENTS, 1930

THE NUMBERS OF clinical training programs for seminary students grew steadily in the years after Anton Boisen and his colleagues formed the Council for the Clinical Training of Theological Students in 1930. Some of the programs followed Boisen’s model for training and his emphasis on the “mental” hospital, but the council also began to establish training programs in other settings, including general hospitals, prisons, and social agencies such as the Judge Baker Guidance Center, a child guidance clinic.¹ For each program, the council established a collaborative relationship with a hospital or social agency and assigned a council-trained theological supervisor to the program. Many times, although not always, the theological supervisor was also the hospital chaplain or was employed by the agency in some similar capacity. In the early years, the council offered training during summer term only. During the academic year, Helen Flanders Dunbar, the first director of the council, advertised clinical pastoral education in seminaries, collected applications for the summer training programs, and assigned students to them.² In the early years, almost all students lived on or near the program site, worked half-days in the wards or offices of the hospital, clinic, or agency to which they were assigned, and received some kind of financial support funded by donations from patrons and provided by the council in the form of room and board. The early programs were small, admitting between four and seven students annually. Of those students, the majority were white, male, and mainline Protestant, although not exclusively so. A substantial portion of both supervisors and trainees believed that the clinical training experience would make the students better and more effective ministers or religious workers.

The summer program at Massachusetts General Hospital (MGH), administered by hospital chaplain and theological supervisor, Russell Dicks, provides a good example of how most of the earliest programs worked. Dicks had trained at Worcester with Boisen and had been invited to MGH by Richard Cabot, who in the early years paid Dicks’s salary. The program in medical social work that Cabot had established earlier, in cooperation with Ida Cannon, made MGH ideal for the sort of collaborative effort early clinical educators envisioned. Seven students enrolled for training at MGH in the summer of 1934. They represented four mainline denominations—Episcopal, Presbyterian, Methodist, and (American) Baptist—and four theological schools—General Theological Seminary and Union Theological Seminary, both in New York; Episcopal Theological Seminary in Cambridge, Massachusetts; and Crozer Theological Seminary in Pennsylvania. Funding for the program came from local patrons, including, again, Richard Cabot. During the first four weeks of the twelve-week program, the students worked half-days as orderlies on the hospital wards and spent the remainder of the day observing in the outpatient department, attending seminars, visiting patients, and reading. Students devoted the last eight weeks exclusively to more patient visitation, reading, and seminars. At the close of his annual report, Dicks, reflecting on the purpose and value of clinical training, noted that “nothing happens in the General Hospital that does not happen outside.” Dicks saw the hospital as a microcosm in which the students could observe all of the kinds of problems that humans might potentially encounter. He went on to comment on the role of religion and the purpose of CPE in this context: “Does religion have anything to contribute to the individual facing those experiences? We assume it does. It is our task during the summer to help the students discover what it is and how they go about bringing the forces of religion into play in such situations.”³

Both the structure and the goals of the summer program at MGH suggest that the medical doctors, social workers, and clergy who joined Anton Boisen in founding the CCTTS to oversee clinical pastoral education programs almost immediately began to envision something different from Boisen’s social scientific study of religion. At least some of them found his particular brand of moralism and his occasional bouts with psychosis embarrassing and exasperating. Nevertheless, they did not discount his contribution. Carroll Wise, who had studied with Boisen at Worcester and taken over the program there when Boisen moved to Elgin, recalled Boisen’s enormous creativity, noting that the clinical training movement was “the child of that creativity.”⁴ At the time, however, most of the early clinical educators were much more concerned with what they saw as the decline of the Protestant ministry and the concurrent rise of the “scientific” disciplines, including medicine, psychiatry, and social welfare. The CPE founders responded by attempting to negotiate a strategic alliance with other professionals in the very disciplines that posed the greatest threat to ministerial authority and the most likely competition for their parishioners’ loyalty and obedience. Although it was professionally advantageous for them to cultivate such alliances, most of the founders also seemed to be genuinely convinced that many Americans were suffering great emotional distress and that their ministers were failing to help them relieve that suffering, because they were inadequately prepared to do so.

The CPE pioneers suggested that the solution to declining ministerial prestige was to make ministers more effective. By “effective” they meant better able to prevent and alleviate “the infirmities of mankind.”⁵ They argued that ministers needed training similar in some ways to that of doctors and social workers, who were also in the business of relieving human suffering and who seemed to enjoy much greater prestige. Professional training for doctors and social workers in the 1920s and 1930s relied on clinical (that is, bedside) observation of the patient or client and discussion of case studies, an approach that CPE founders viewed as more “scientific” because it required careful observation, detailed recordkeeping, and systematic analysis of the data collected. They intended clinical pastoral education to mirror the training offered in related disciplines.

In addition, CPE placed a special emphasis on the minister’s unique contribution to health and healing. Understanding that their association with doctors, social workers, and other health care professionals could hurt them as well as help them, early CPE advocates recommended dividing the responsibility for the study and care of human beings’ mental and physical health among medical doctors, psychiatrists, psychologists, social workers, and ministers, who could then cooperate without threatening one another’s sphere of action. Their training programs reflected their interest in cooperating with a broad spectrum of health care and social service professionals. Clinical pastoral education, with its mix of medical, psychiatric, and theological knowledge, had some unintended results too. The use of the interview—first as a tool to collect scientific data, later as a tool to practice skills they would need in the parish, and finally as a therapeutic tool for solving patients’ problems—made CPE programs the unintended starting point for a boom in pastoral counseling by giving young clergy their first opportunity to counsel.

As Boisen’s work does, clinical pastoral education richly illustrates the prewar liberal moral sensibility, but with significant differences. Like Boisen, his colleagues believed that science and the methods associated with science could transform the world, but where Boisen was engaged in a scientific study of religion and religious experience, his colleagues sought a scientific study of human nature in relation to the work of clergy. Boisen assumed in a general way that the knowledge he accumulated would be helpful in alleviating suffering and that activities similar to occupational therapy would create the right environment for healing. In contrast, his colleagues sought specifically to apply the clinical knowledge they collected to pastoral practice. Boisen’s primary and best site for scientifically studying religion was the psychiatric hospital, but for many of his peers, general hospitals, child guidance clinics, and prisons served their purposes equally well. Clinical educators’ pragmatism and their seemingly limitless faith in the possibilities of professional expertise fitted very well with a Progressive and Social Gospel vision.

Early Troubles

In the early years of clinical pastoral education, the goals and direction of the programs were shaped primarily by Boisen and a handful of his friends, colleagues, and supporters. Anton Boisen, Richard Cabot, Philip Guiles, and Helen Flanders Dunbar had founded the Council for the Clinical Training of Theological Students to facilitate the growth of new CPE programs, but the fledging organization quickly ran into trouble. While all of Boisen’s cofounders, as well as the first generation of theological supervisors, shared his enthusiasm, they did not necessarily share his priorities. Ideological differences about the nature and purpose of clinical training created deep divisions in the movement in its early years. For one thing, training parish ministers quickly became the priority, which was ironic, since among Cabot, Dunbar, and Guiles only Guiles had ever served in a parish. To complicate matters further, each of the founders brought a strong will and a personal agenda to his or her efforts to establish a new kind of ministerial training. The agendas of the other founders, as much as Boisen’s agenda, determined the final shape of CPE. The result was a stormy and tumultuous beginning for the organization.⁶ Almost immediately, personal and ideological differences came to the forefront in the council. By 1934, the original CCTTS had broken into two distinct factions. The one known as the “New England group” included Guiles and Cabot. Dunbar moved CCTTS headquarters to New York and in 1938 renamed the organization the Council for Clinical Training (CCT).

A variety of factors drove the founders apart. Carroll Wise offered the most convincing explanation for the early divisions. In the early 1960s, Wise was president of the board of CCT, a member of the faculty at Garrett Theological School, and one of the most influential theorists of the pastoral counseling movement. In the early 1930s, Wise had found himself in the thick of the founders’ battles. At the time, a he was a young clergyman who had come to Worcester in the late 1920s to study with Boisen before taking up a parish ministry, but he ended up as chaplain at Worcester Hospital after Boisen’s breakdown. As Wise recalled it, the heart of the split between the New York and Boston branches of the council was a disagreement regarding the etiology of mental illness. Cabot and Guiles shared the conviction that all mental illness was caused by organic or physiological factors that could be treated with drugs or somatic therapies—a view shared at the time by the majority of American medical doctors. Boisen and Dunbar, on the other hand, believed that psychological factors could contribute to mental illness in some cases—that mental illness could be psychogenic or, in the terms Boisen embraced, functional.⁷ Most pernicious of all, however, in the view of Cabot and Guiles, was Dunbar’s embrace of Freudian theory. It seems odd that this would be a problem for Guiles, since, according to Wise, he had recently become a “devotee” of psychoanalysis.

This apparent paradox is easily explainable, however. While ideology was extremely important in shaping the movement, other factors were also at work—most of them personal. For instance, although Boisen disagreed with Dunbar on a great many issues intellectually—he was steadfastly anti-Freudian—he remained personally loyal to their friendship. Similarly, Cabot’s professional choices were influenced by his personal estimate of Boisen. It was no accident that the split in the council occurred shortly after Boisen was hospitalized for his second psychotic break. Finally, and probably most significantly, Guiles and Dunbar were locked in an ongoing power struggle for ideological and administrative control of the council. As Wise remembered her, Dunbar “was a woman of very superior abilities and training, and she would not bow to any man. Even though she was only five feet tall, she had a way of making men defer to her.” Equally problematic, from Wise’s point of view, was Guiles inability to defer to Dunbar “simply because of the nature of his personality.”⁸ Cabot, who was loyal to Guiles, apparently simply did not like Dunbar.⁹

Part of the hostility directed at Dunbar came because she was a woman, or, more specifically, a woman who did not know her place. Women played an important and influential role in world of Progressive reform. But even that world was hierarchical and drew clear lines with regard to the roles of men and women. Cabot had worked successfully with female social workers to establish the medical social work program at Massachusetts General Hospital and continued to maintain good working relationships with other professional women. But social work was considered an appropriate realm for women and did not challenge the social hierarchy. Dunbar, in contrast, had earned multiple advanced degrees in fields where men dominated—theology (Union Theological Seminary, B.D., 1927), philosophy (Columbia University, Ph.D., 1929), and medicine (Yale University, M.D., 1930). It probably did not help that she was not especially easy to get along with and apparently engaged in none of the behavior necessary at the time to soothe male egos.¹⁰

In any case, the split in the council created two separate ideological streams. Under Dunbar’s direction, the branch of the council that she established in New York grew rapidly between 1932 and 1941. In 1935 Dunbar appointed recent seminary graduate Seward Hiltner, who later became a pivotal figure in the pastoral counseling movement, as executive secretary of the council. Hiltner had trained with Donald Beatty in a council-administered program in Pittsburgh during the summers of 1932 and 1933. He and Dunbar shared responsibility for tremendous growth in the programs. During his three years as executive secretary, Hiltner recruited students from twenty-seven seminaries that had not previously sent students for training.¹¹ The council worked independently of the seminaries but obviously relied on them to provide students. Meanwhile, the number and kind of programs expanded. The 1937 catalogue advertised summer programs at a variety of locations and facilities, among them the New Jersey State Hospital, the Judge Baker Guidance Center in Massachusetts, and the United States Industrial Reformatory in Chillicothe, Ohio.¹² Responsibility for directing the New York council shifted in 1936 to Robert Brinkman, a psychoanalytically trained minister. Dunbar became less involved in the council in the late 1930s, choosing to devote herself more fully to researching and writing about psychosomatic medicine, serving as founding editor of the Journal of Psychosomatic Medicine, and building a private practice.¹³

In the meantime, the second stream of CPE also prospered. The New England group, under Guiles and Cabot, had reorganized as the Theological Schools’ Committee on Clinical Training. The new organization reflected the belief of the committee that clinical training ought to be under the control of theological schools, and, as a result, it consisted of representatives from Andover Newton Theological School, Harvard Divinity School, and Episcopal Theological School, all clustered in the Boston area. The New England group’s approach contrasted to that of the New York council in which programs were free-standing, without formal affiliation with seminaries. Like their counterparts in New York, the New England group organized summer courses in clinical training at local hospitals. By the time of the first national conference on clinical training in 1944, the New England group, with a much expanded membership, had formally incorporated as the Institute of Pastoral Care (IPC).

A third ideological stream developed independently of the other two. Predating Boisen’s first summer training program at Worcester, the third group placed less stress on hospital training, even though a medical doctor played a crucial role. Physician William S. Keller established a summer program in Cincinnati at an Episcopal seminary called Bexley Hall.¹⁴ The Summer School at Bexley Hall, which in 1925 became the Cincinnati Summer School in Social Work for Theological Students and Junior Clergy, placed seminary students in “general casework programs.” Administrators of the Bexley Hall program argued that social service programs exposed students to problems that were similar to those found in the parish.¹⁵ Occasionally, Bexley Hall students did their training in “specialized programs” or institutional settings, such as family welfare offices, juvenile courts, hospitals, and in union or management personnel programs in industry.¹⁶ Between 1923 and 1936, Bexley Hall summer school administrators aimed their programs at seminary students on summer break. In 1935 the Summer School became the Graduate School of Applied Religion and came under the direction of Joseph Fletcher. Between 1936 and 1943 the program expanded to offer curriculum during the winter months to seminary graduates. Those who completed four quarters of the program were awarded a graduate degree in “applied religion.” As an increasing number of seminaries offered clinical courses of their own under the auspices of either the Council for Clinical Training or the Institute of Pastoral Care, and as clergy enlisted in the armed forces, enrollments at the graduate school declined. In 1944, when Fletcher moved to the Episcopal Theological School in Cambridge, Massachusetts, the graduate program from Bexley Hall moved with him, and at that point it became part of the IPC. Fletcher gained national prominence after World War II for his controversial work in the field of bioethics as well as for his theory of “situation ethics.”¹⁷

For years after the split in the CCTTS, conventional wisdom among clinical pastoral educators identified the New York group as Freudian and the New England group as pastoral. There was some truth in this distinction. CCT leaders Dunbar, Hiltner, and Brinkman probably were more sympathetic to Freudian theories than just about anybody else in the movement. And, undoubtedly, the IPC leaders kept a much greater focus on the parish minister, as their close relationship with theological schools might suggest. At the same time, both groups continued to adhere to certain basic principles. Both groups stressed the importance of the scientific method (by which they meant the case study method), hospital or field experience, teaching ministers skills that they could use effectively in the parish, and cooperating with other professionals, including psychologists, psychiatrists, medical doctors, and social workers. And if the CCT placed more trainees in psychiatric hospitals while IPC turned more often to general hospitals, the fundamental differences were, in reality, negligible.

CPE Programs, the Case Study Method, and Science

In order to encourage interprofessional cooperation (and achieve their goal of enhancing ministerial prestige), CPE leaders pursued several important strategies. First, they emphasized the common ground they shared with doctors and social workers and designed their programs accordingly, accenting the extent to which they were all involved in a scientific endeavor. Second, they sought the support of health care and social service professionals, stressing the importance of cooperation in the interest of the patient’s physical and mental health. From their outset, CPE programs bore a strong resemblance in structure to the training of both medical and social work professionals.¹⁸ The resemblance was intentional. To underline the links of clinically trained ministers to medical doctors and social workers and to the scientific method, most early CPE educators designed programs that required significant amounts of patient contact and observation, taught students the fundamentals of meticulous note taking and recordkeeping, and relied on the case study method as the primary teaching tool. The extent to which the case study could be considered scientific was hotly debated by contemporaries, but at least some social science professionals considered it so.¹⁹

In one sense, CPE programs in the 1930s remained true to Boisen’s vision of the minister as a scientist of religion and to his idea that knowledge about human personality was accumulated most effectively not through the reading of books but through a study of “the living human document.” Most programs gave students extensive opportunity for patient contact. For instance, students who enrolled in the CPE program at Worcester State Hospital (a psychiatric hospital) in the summer of 1935 spent the first two weeks assisting on the wards and familiarizing themselves with the routine of the hospital. At the end of those two weeks, they were assigned four or five patients to follow closely. They were expected to spend some part of each day with those patients, during which time they accompanied them on walks or to the swimming pool or they simply engaged them in conversation.²⁰ Programs varied according to the inclinations of the supervisor and the needs of the program. Those that followed most closely the model established by Boisen at Elgin State Hospital tended to place a greater emphasis on recreation programs. At Rhode Island State Hospital in the summer of 1932, under the direction of theological supervisor Alexander Dodd, students organized baseball games and beach parties, published a hospital newspaper, orchestrated a Fourth of July celebration, and arranged a trip to the state fair for hospital inmates.²¹

At the same time, the needs of the program dictated the kind of patient contact. At Franklin School, for instance, students in the summer of 1933 had direct responsibility for the daily activities of their charges. Franklin was a school for children with behavior problems that included “truancy, stealing, destructiveness, pugnacity, temper-tantrums, and all kinds of negativism.”²² Theology students served as staff and so were responsible for getting the children out of bed in the morning, putting them to bed at night, taking them swimming, accompanying them to meals, and participating in storytelling and play groups. In other words, their contact with patients was, of necessity, much more tied to the daily rhythms of the institution.²³ Massachusetts General Hospital offered a different type of patient contact. At MGH in the summer of 1933, theological students spent half-days working on the wards and then devoted the other half of the day to serving in outpatient clinics, including neurological, psychiatric, and children’s cardiac clinics. Students spent a significant amount of time simply observing but at times were put to work in the clinic setting. One student recalled a morning spent at the well baby clinic at the Pennsylvania Hospital in Philadelphia. It was his duty to “page the babies” when it was their turn to be examined by the doctor.²⁴ Students enrolled in the summer program offered at Syracuse Psychopathic Hospital in 1932 worked in the social service department and, in addition to working on the wards, were required to visit and interview friends and family of patients at their home or place of employment.²⁵ At Judge Baker Guidance Center, students interviewed boys and girls who were patients and their family members and served as “big brothers” or probation officers for the boys.²⁶

While clinical educators stressed the fundamental importance of frequent contacts with patients, they did not intend those contacts to be casual. Rather, as part of their attempt to promote the scientific study of religion and the use of the scientific method, they insisted that patient contact be carefully documented through some sort of note taking or recordkeeping. At Worcester in 1935, for example, students were required to take extensive notes regarding their encounter with patients, recalling as much as possible of any conversation and analyzing any changes in patient behavior.²⁷ But the nature of note taking varied. Programs like the one at Worcester that focused on helping seminarians to understand mental illness tended to follow the format and priorities of the conventional medical case study. In programs where social workers played an important role, not surprisingly, students followed the format and priorities of the social work case study.

Eventually, the CCTTS moved to standardize note taking in councilsponsored programs. They were not entirely successful, because, of course, case study format had to fit the needs of the program, but certain shared priorities emerged. One such format, devised in the late 1930s and apparently intended for use in a boy’s school, divided the case history into three parts. The first section provided a guideline for collecting a personal history of the patient. The opening paragraph was supposed to list the salient characteristics of the patient: age, race, sex, education, occupation, religion, and the reason for commitment. Ideally, the remainder of the first section traced the patient’s personal history and included a description of the patient’s family and their social, cultural, and economic status, the patient’s childhood and adolescent development, and personal “adjustments” both current and in the past with regard to sex, family, and to vocational, social, and religious matters.

Determining the nature of the patient’s adjustment required eliciting a wealth of information from either the patient or the patient’s family and friends. In order to ascertain, for instance, the patient’s “sex adjustment,” the theological student was supposed to determine whether the patient had an “attachment or antagonism for either parent,” what the patient’s attitude was toward the opposite sex and toward sex in general, and what sort of “love affairs” and “sex experience” the patient had encountered in the course of his or her life. In fact, learning about the patient’s “adjustments” required a range of questions that covered every aspect of the patient’s life, from reading habits and preferences in movies to work habits and patterns of church attendance.

Part two of the case study documented the current “personal characteristics” of the patient under categories labeled “state of consciousness,” “field of attention,” “mood,” “speech,” “intellectual functions,” “general behavior,” and “content of thought.” On this last, the student was supposed to describe very specifically how the patient thought about “personal responsibility,” “religious concerns,” and “erotic involvement.” While the first two sections were expected to be wholly descriptive, the last section was intended for interpreting the information that had been collected. Theology students were encouraged to make judgments about the emotional and mental state of the patient and to suggest a diagnosis, a prognosis, and a plan of treatment. This appropriation of medical terminology suggests the extent to which clinical educators were indebted to the medical model.²⁸

Regardless of their format, however, these student-generated notes provided the starting point for the systematic analysis of the information the students had collected. In general, that analysis occurred in the context of either case seminars or individual conferences with the student’s theological supervisor, the patient’s supervising physician, or social work personnel. This meant that, in addition to the time students spent with patients on the wards, they were required to spend a significant number of hours in seminars, usually in the evenings. At Elgin State in 1933, for instance, students attended twenty-two evening sessions in the course of a term, each about two hours long.²⁹ Most of the programs devoted at least one evening session a week—and typically more—to discussion of case studies. In that context, students examined either sample case studies provided by the theological supervisor or the cases to which they were currently assigned.³⁰ In the summer of 1933, when Seward Hiltner was in his second summer of CPE with Donald Beatty at Mayview, he spent the summer interviewing newly admitted patients to build “a library of teaching case records.”³¹ At Greystone Park State Hospital in New Jersey in the summer of 1934, students devoted about a quarter of their seminar time to case studies that illustrated specific types of illness or explored the lives of religious figures such as John Bunyan and George Fox.³²

In many programs, students were also required to attend hospital staff meetings where, again, case material played a central role.³³ In most programs, too, the students met weekly with the theological supervisor and, whenever possible, met individually with medical personnel or social work staff to discuss the cases that had been assigned to them. Weekly meetings seemed to be the ideal, although at least one supervisor was willing to admit that things did not always go as planned. In his report on CPE at Rochester State Hospital in New York in the summer of 1939, Leonard Edmonds acknowledged that he had had trouble “following through” on his weekly supervisor-student meetings and recommended that the meetings be scheduled for some time other than Saturday morning. Edmonds also admitted that, while he had required his students to write at least five case analyses to be submitted by the end of the twelve week period, at least two of his students completed only two; one student had “trouble with interviewing” and the other could not type.³⁴

Interprofessional Alliances

Early clinical educators frequently compared the experience of the minister in clinical training programs with the internship served by medical doctors.³⁵ The CPE founders failed to recognize the flaw in their own reasoning. Doctors were trained in the hospital because eventually they practiced their profession in the hospital. Social workers were trained in social work clinics because eventually they practiced in those clinics. Most ministers who pursued clinical training, however, ended up in a parish. Moreover, it was the express purpose of most CPE supervisors to train ministers for parish work.³⁶ Had clinical pastoral educators wished to create a truly parallel training situation, they would have conducted the training of their students in parish settings. But, because clinical educators really intended to encourage what they saw as a strategic alliance between ministers and health care professionals, they emphasized the applicability of institutional experience for the parish minister.

CPE educators developed an institutional structure that encouraged interprofessional alliances. The boards of governors of the CCTTS and its successor groups always included medical doctors, as did the roster of council members.³⁷ While individuals who served as members or associate members played only an advisory role in council affairs, the board of governors had decision-making power. Its members were drawn in part from CPE graduates but also from organizations such as the Association for Psychosomatic Medicine, the New York Academy of Medicine, and the Commission for Mental Hygiene. The council did not neglect its obligations to the traditional power structure of American Protestantism: its board members were also drawn from the Federal Council of Churches (which in 1950 became the National Council of Churches) and the American Association of Theological Schools. Board members included familiar figures such as prominent liberal clergy: Henry Knox Sherrill, Episcopal bishop and later president of the National Council of Churches; Henry Sloane Coffin, the president of Union Theological Seminary; and Harry Emerson Fosdick, the popular and outspoken pastor of the Riverside Church in New York City.³⁸

The CPE program structure encouraged strategic interprofessional alliances. Most programs, in addition to discussion sessions led by the theological supervisor, included a full slate of lectures by physicians, psychiatrists, psychologists, and social workers and, in some cases, field trips to local agencies.³⁹ This teaching method allowed CPE educators to advance one of their most important goals—teaching young ministers the value of “cooperating” with other professionals to relieve human suffering whether it be mental, emotional, physical, or social. Their understanding of cooperation derived from their understanding of the healthy human being. They believed that human experience had to be viewed both in its constituent pieces—spiritual, physical, emotional, social—and as a whole, to be treated through the cooperation of specialists. And within this model of cooperative healing, the minister played a crucial role.

Clinical educators believed that in order to cooperate with others who were engaged in healing, clergy needed to know certain basic information about what the other professions were doing. It made sense to them to ask specialists in these fields—psychiatry, medicine, and social work—to provide that information. At Greystone Park in 1934, roughly half of the seminars were offered by staff from the hospital and the mental hygiene clinic. Dr. Arthur Garfield Lane, hospital staff psychiatrist, presented a sixteen-lecture series titled “The Biological Approach to Mental Disorder.” Herbert Barry, also affiliated with the hospital and a professor of psychology at Tufts University, presented five additional lectures. In addition, theological students were invited to attend lectures presented by the hospital’s mental hygiene department for its own staff.⁴⁰

In some senses, CPE supervisors were also teaching cooperation by modeling the correct behavior. Theological students who studied at Greystone saw in the example of their theological supervisor, Robert Brinkman, someone who actively cultivated alliances with the medical staff. The program at Massachusetts General Hospital exhibited a similar integration. In the summer of 1933, the theological supervisor, Russell Dicks, cooperated closely with Ida M. Cannon, the director of social services at MGH, to develop a lecture series presented by doctors, social workers, psychiatrists, the hospital librarian, and the chief of occupational therapy. MGH even permitted one of its social workers, Helen Snow, to serve as a consultant to the theological supervisor. In addition, Snow offered lectures on techniques for interviewing and writing social histories.⁴¹

The information provided by fellow professionals had a specific purpose. Theological supervisors wanted their students to be able to refer their parishioners to other professionals whenever necessary. To effectively refer, parish ministers needed to have enough information about human personality to intervene at the proper moment and recognize what sort of care the person needed. As a result, CPE programs offered seminars such as “The Laboratory’s Contribution to Our Understanding of Human Personality,” “The Inadequate Personalities (Simple and Hebephrenic),” “Psychoneurotic Individuals,” and “A Case of Multiple Personality.”⁴² Even programs that were not devoted to the treatment of the mentally ill made certain that their students were introduced to the basics of human personality, through lectures such as “The Physiological Basis for Emotions,” and “Neurotics as Met in Everyday Life.”⁴³

Clinical educators assumed that if they gave their students the proper information during their training, once in the parish they would be able to identify incipient illness or suffering and be able to refer to the appropriate professional. Their beliefs about referral reflected their understanding of illness. First, they saw illness as something that occurred on a continuum. Second, they saw emotional, physical, social, and spiritual suffering as something that could be clearly defined and separated. In other words, they believed it was possible to identify the parishioner’s particular kind of suffering and refer appropriately. Knowing when to refer was important because early intervention, they argued, could prevent the most egregious manifestations of illness. From the perspective of theological supervisors, then, being able to make distinctions between normal and abnormal or healthy and sick was crucial if the minister expected to cooperate effectively to relieve human suffering. The theological supervisor at the Franklin School in the summer of 1933 reported with apparent satisfaction the comments on the program offered by one of his students. This student indicated that CPE training had helped him to distinguish between “mildly difficult behavior and a definite neurosis” and to understand the importance of early intervention for the success of psychiatric treatment.⁴⁴ Robert Brinkman, the theological supervisor at Greystone Park State Hospital saw the “problem of recognizing and treating these situations before they become extreme as the chief pastoral function of the minister.”⁴⁵

In addition, CPE supervisors argued that their students needed to have an equally clear grasp of the resources available: students needed to know not only when to refer but to whom. In the early years, students typically learned primarily about the resources available within the institution where they had enrolled for training. Eventually, in light of their concern about cooperation, CPE educators offered students a broader base of information about community resources. During the summer of 1934, Massachusetts General Hospital scheduled field trips to McLean Hospital, Massachusetts Eye and Ear Clinic, the Judge Baker Guidance Center, and Boston Psychopathic Hospital.⁴⁶ In the summer of 1936, in a program designed by supervisors Seward Hiltner and Richard Parker, theological students at Pennsylvania Hospital learned about a variety of social agencies through lectures from representatives of the Child Guidance Clinic, the Lutheran City Mission, and the Family Society and field trips to the Housing Association, the Franklin Nursery School, and the Department for Mental and Nervous Diseases.⁴⁷

The Unique Contribution of the Clergy

When clinical educators adopted the medical model for training and emphasized professional cooperation and referral, they risked subordinating the role of the clergy and the theological perspective. To avoid this pitfall, they had to make a case for the unique contribution of the clergy to health and mental healing. Fortunately, they were not alone in their efforts to do so. CPE was part of a larger movement among liberal Protestants of the period who were attempting to make an explicit connection between Protestantism and healing, whether physical or mental. In the late nineteenth and early twentieth centuries, as psychology, psychiatry, and psychoanalysis gained prominence and respect, the attempts to delineate the relationship of religion and health became more numerous. Mary Baker Eddy promoted the principles of Christian Science, drawing primarily on a Protestant audience and promising that the mind could heal the body, even as any number of New Thought or “mind cure” movements flourished. Within the mainstream Protestant community, religious educators began to teach the principles of mental hygiene to their seminary students. Worcester’s Emmanuel Movement was located at the confluence of the mind cure movement and mainstream Protestantism. Some denominations, such as the Lutheran Church of America, instituted the practice of supplying their community hospitals with chaplains to visit the sick. Boisen was probably the first chaplain employed full time by an American psychiatric hospital, in order to address the spiritual needs of the mentally ill. Harry Emerson Fosdick and John Sutherland Bonnell, through their radio broadcasts, reached wide audiences with the message of psychology’s importance for religion. Several ministers, including Bonnell, even published works using the terms “pastoral psychology” or “pastoral psychiatry” in the titles.⁴⁸ And by 1937, Norman Vincent Peale and psychiatrist Smiley Blanton had established the Religio-Psychiatric Clinic at the Marble Collegiate Church in New York.⁴⁹

Clinical pastoral educators could be distinguished from other Protestants by their attempts to control and disseminate systematically knowledge about the relationship between religion and health. Their plan to develop schools where they could produce generation after generation of psychologically trained ministers suggests that the founders had a grasp of the bigger picture. They certainly were not the only ones thinking about how to revamp ministerial education.⁵⁰ They were the only ones, however, who shared a common understanding of the strategic importance of professional alliances and of locating ministers in a newly developing matrix of professional culture.⁵¹ In this context, CPE leaders stressed the unique role of the clergy on the health care team. Supervisors and their students envisioned cooperation as something more than a one-way sharing of information in which medical and social work professionals supplied information to theological supervisors and their students. CPE supervisors thought that cooperation ought to include working together with medical and social work professionals in the treatment of patients and clients. Clinical pastoral educators delighted in pointing out cases where the medical doctor, psychiatrist, or social welfare worker had asked for the assistance of the theological student or supervisor. Carroll Wise, in his 1935 report on the Worcester program, included a description of Robert Beaven’s experience. Beaven, a theological student enrolled in the Worcester program, played an integral part in the recovery of a catatonic patient at the hospital. Beaven’s involvement, which included swimming, tennis, and daily walks with the patient, came at the request of one of the hospital psychiatrists, who believed that his young patient needed the companionship of someone who was close to the same age and shared his interests.⁵²

CPE supervisors argued that clergy belonged on the health care team as equals because they brought unique “resources” for the purpose of health and healing. They pointed to research in psychosomatic medicine that suggested that patients who were calm, happy, and relaxed tolerated surgery with fewer ill-effects. Seward Hiltner claimed that the “quiet spirit” enhanced physical healing and could be evoked by the minister’s traditional tools. And, carrying the medical metaphor a bit further, he noted, “Prayer, meditation, the Bible, other literature, listening, quietness, understanding—these are as real as pills and sometimes more helpful.”⁵³

For many educators, one of the most important aspects of the information available in the clinical setting was its implications for parish practice. As one supervisor observed, clinical training was intended to teach ministers how to deal with “ordinary people in their own parishes.”⁵⁴ To that end, clinical educators devoted significant numbers of lectures, case seminars, and supervisor-student conferences to an examination of “pastoral technique.”

For most CPE supervisors the heart of pastoral technique was “therapeutic friendship.” One supervisor, Rothe Hilger, remarked in his 1933 annual report that learning to be a “friend” to boys and girls was one of the primary objectives of the Judge Baker Guidance Center training program.⁵⁵ Russell Dicks, too, in his 1933 report suggested that students both observed and “befriended” patients.⁵⁶ Clinical pastoral educators in the mid-1930s, increasingly stressed the importance of the quality of the friendship shared by ministers and their parishioners. In 1934, Carroll Wise identified as one of his program goals at Worcester that the theological student would ultimately recognize the importance of a “relationship of understanding and confidence between the minister and the persons with whom he is working.”⁵⁷ By 1935 Wise made an even more explicit connection between friendship and the pastorate, equating the theological student’s “capacity for real friendship” with the “capacity to be a pastor.” Wise saw it as his responsibility to teach his students how to be an “intelligent and understanding friend” as well as the “attitudes and techniques for dealing with others.”⁵⁸ The idea that theological students served as “friends” to the patients persisted in new programs, such as the one established at Pennsylvania Hospital in the summer of 1936.⁵⁹

The Interview

If clinical educators viewed therapeutic friendship as the heart of pastoral practice, they saw “patient listening” as the heart of therapeutic friendship. In his 1934 annual report for Greystone Park, supervisor Robert Brinkman described the high value he placed on teaching his students the importance of “daily friendly conversations and cultivated listening.”⁶⁰ The mid-1930s saw increased efforts to use the student-patient interview as a tool for teaching student ministers how to listen well. To improve their listening skills, CCT trainees studied a small number of patients intensively, not just through case studies or observation, but through interviews. Typically, trainees interviewed the patients at least five times per week for at least one hour per interview. At the end of each day, the trainee prepared written reports that included a description of each interview, its content, an interpretation of the interview, and an evaluation of the trainee-patient relationship. Interviews gave students a chance to scrutinize their own behavior in the encounter.

Some theological supervisors used the verbatim method developed by Russell Dicks at Massachusetts General to facilitate his own work with patients in a general hospital setting. In the verbatim approach, students prepared a detailed written preliminary plan prior to each interview. After each visit, they recorded as much of the interview as they could remember, verbatim, on the right-hand two-thirds of a sheet of paper, leaving the left third of the page for the instructor’s comments. Dicks argued that recordkeeping disciplined ministers and allowed them to examine their own behavior in a variety of circumstances.⁶¹

Some CPE supervisors submitted sample “verbatims” with their annual reports, and one, in particular, illustrates how they used the method to hone the student’s listening skills. In the verbatim, the student detailed his encounter with a thirty-four-year-old, divorced woman who had been hospitalized to receive radiological treatments for cancer. The theological supervisor wrote comments in the margin that focused on the student’s listening skills. At one point, when the student refrained from interrupting Mrs. P, the lack of interruption allowed Mrs. P to introduce an idea the supervisor believed she would not have expressed had the student not waited: after commenting on how “dull” she was to talk to, Mrs. P paused and then said, “Don’t you believe that all the hell that there is we make for ourselves?” At another point, however, when Mrs. P said, “Do you think God punishes us directly?” the student launched into a theological explanation of sin. The supervisor commented, “Here you should have listened. You don’t know where her ‘growing edge’ is. You risk missing her completely.”⁶² The supervisor also commented on the student’s use of prayer and scripture. When the student failed to cite in his verbatim the scripture he had used in his encounter with Mrs. P, the supervisor admonished him and compared the oversight to the doctor who used medicine but did not make a note of what kind of medicine.⁶³ In general, the supervisor judged the several encounters between the student and Mrs. P a success, because the student had established such “rapport” with Mrs. P that in the fifth interview she “poured out her heart” to him.⁶⁴ The supervisor noted that the theological problems Mrs. P presented were just the sort the student might expect to encounter in the parish and that his clinical experience had prepared him to handle those kinds of problems should he encounter them again.

By the end of the 1930s a subtle but important shift had begun to occur in the use of the interview in clinical pastoral education. Whereas initially CPE supervisors had required their students to conduct and record interviews in order to collect data and hone their listening skills, increasingly supervisors and their students viewed the interview as a therapeutic tool, a development perhaps presaged by the tendency to compare prayer to pills. Again, a sample verbatim illustrates the changes in the training process. In this case, the student conducted a series of interviews with a seventy-year-old widow named “Mrs. E” who had been hospitalized for a broken hip. As required, the student completed a verbatim report in which he analyzed his encounter with the patient. Unlike earlier students, however, he studied the verbatim in order to ascertain the patient’s needs and what he could do for her, rather than to examine his own listening technique. As a result, at the end of each interview, he wrote a summary of the conversation, attempting to identify Mrs. E’s needs, and suggested a plan to meet those needs.

The comments from the supervisor primarily addressed the trainee’s phrasing in his replies to Mrs. E, suggesting ways in which it could have been more effective. For instance, when the patient described her pipe-smoking roommate and excused the behavior because the woman was lonely, the trainee responded with a “yes,” affirming Mrs. E’s assessment of the situation. The supervisor suggested that the trainee could have said, “We often overlook difficulties if by so doing we give pleasure to another.” In his summary from the first day, the student attempted to determine the reasons for Mrs. E’s reluctance to leave the hospital. He concluded that she needed confidence and that he ought to help her gain it. He also decided that she had not confided completely in him and that he ought to focus on discovering any additional problems that might be “weighing on her mind.”⁶⁵ After the second interview, the trainee drew many of the same conclusions. He wondered, too, if he ought to be more aggressive in offering positive suggestions that would help her to adjust to going home. After the third interview, the trainee worried that he had failed: Mrs. E seemed just as reluctant as ever to go home. The student engaged in an ongoing struggle to identify his “task” in the relationship and finally decided he should just continue being her friend.

Although this student remained within the framework of therapeutic friendship promoted so vigorously by CPE supervisors in the mid-1930s, his experience is an example of the changes regarding the purpose of interviewing that had begun to occur in clinical pastoral education. The changes were subtle but important. The growing interest in using the interview itself as a therapeutic tool eventually caught on in most of the helping professions. CPE shared with its professional allies a commitment to Progressive ideals, including applying the principles of science and establishing professional standards, in the belief that practitioners of their professions could thereby better relieve human suffering. CPE supervisors did manage to carve out a niche for themselves and their graduates among these professionals, by emphasizing a trained minister’s ability to make appropriate referrals but also to make a unique contribution through the use of religious resources, therapeutic friendship, and patient listening. CPE supervisors were wary, however, of the interview’s becoming the means to relieve suffering rather than a tool for training or collecting data. The interview, or “counseling,” as it was increasingly referred to, rapidly gained popularity as a therapeutic mechanism, and clinical educators were not at all sure that they wanted to see that happen, because they feared that doctors, protective of their territory, would withdraw their support of CPE. At the same time, while most theological supervisors disavowed any intention of training clergy to be counselors, their methods probably did as much as anything to fuel the enthusiasm of young clergy for what was now being called “pastoral counseling.”