Psycho-spiritual Care in Health Care Practice

Guy Harrison

• Publisher: Jessica Kingsley Publishers
• Year: 2017
• Print ISBN: 9781785920394
• eBook ISBN: 9781784502928
• Topic: Theology & Religion
• Subtopic: Christian Ministry

Meeting the psychological and spiritual needs of patients is vital to supporting their wellbeing in health care settings. To develop an effective, holistic and inclusive approach to care within predominantly medical health care models, practitioners across health care disciplines must work collaboratively to understand the complex, significant relationships between their patients' medical, therapeutic and spiritual requirements.

Bridging the gap between care disciplines, the book presents an innovative vision of patient wellbeing enriched by a synthesis of psychological, spiritual and medical approaches. Prominent practitioners from a range of disciplines including nursing and psychiatry demonstrate how their psycho-spiritual approaches meet the individual needs of patients, adapting to their emotional, spiritual and religious requirements.

Accessible and enlightening, this book offers significant practical insight into the role of psychologically informed spiritual care.

PART 1

The Development of
Psycho-spiritual Care

Research and Practice

Guy Harrison

1

The Practice of
Psycho-spiritual Care

Not everyone has encountered or heard of the work of health care chaplaincy, sometimes also known as spiritual and pastoral care, so this first chapter begins with a brief summary of the context of health care chaplaincy in the UK together with an overview of the contemporary role of the chaplain and their potential contribution to the understanding and development of psycho-spiritual care. It goes on to discuss existential, Person-Centred and theological perspectives on care and outlines the relationship between pastoral care and counselling and communities of faith. The chapter also explores the development of the relationship between spiritual care and counselling and psychotherapy as they relate particularly to the role of the health care chaplain.

The role of the health care chaplain

The genesis of the health care chaplain’s role gives some indication of the present context in which chaplains are appointed. It also contributes to an understanding of the health care chaplains’ contemporary contribution to the potential development of psycho-spiritual care. For this reason, what follows is a brief account of the context.

According to Swift (2014), the appointment of clergy to work in hospitals in England is a practice that has been happening for several hundred years. Initially, this was due to the religious character of the medieval monasteries from which they sprang. Within the religious context of the life of a medieval hospital the chaplain was a key figure who would lead daily worship, dispense religious advice and often, in the context of repentance and prayer for forgiveness, pronounce absolution prior to death. By so doing, the chaplain as priest would act as guarantor of God’s salvation for the poor and the weak. Hospitals were institutions that extended the Church’s influence in providing the poor with shelter, food and general care. As Swift points out, the Church was demonstrating a ‘practical social endeavour alongside similar enterprises in education and the distribution of alms’ (2014, p.13). However, following the Reformation, the role of the chaplain changed dramatically. Rather than simply exercising a purely religious role, chaplains became beholden to both the state, in the form of the monarch as head of the Church of England, and the institution in the form of the hospital governors. Swift indicates that this dual accountability meant an emphasis was placed upon upholding moral conduct and moral instruction rather than daily worship and administration of the sacraments.

Further dramatic change came in the Victorian era with the development of workhouses and asylums. Prior to the nineteenth century, the mentally ill were judged to be morally contaminated and their problems were judged to be spiritual in origin and therefore untreatable (Bartlett and Wright 1999). In effect the ‘mad’ were left to roam the streets begging for food and shelter. In theory, the newly built Victorian asylums, often magnificently built with extensive grounds, became places of sanctuary and care. In practice, according to Finnane (1985), they often became warehouses for society’s outcasts at a time when cures for both mental and physical illness were far fewer than the Victorian medical establishment had initially hoped. Each institution had a chaplain who was accountable to the hospital’s Master for the moral and religious welfare of the patients and the staff. They effectively adapted a parochial model to that of the hospital community. This meant conducting marriages, baptisms and funerals and dispensing religious and moral advice as well as ensuring all within the institution regularly attended Sunday services.

Swift (2014) states that at the founding of the NHS in 1948 there were approximately 28 chaplains, all of whom came from and were expected to return to, usually Church of England, parish ministry. With the advent of the 1948 reform, assurance was given that each hospital would have a chaplain and a chapel funded out of the overall hospital budget. Writing in 1966, Norman Autton, who has been described as the father of modern health care chaplaincy in the UK, described the chaplain’s role within the comparatively new NHS as one who comes with ‘spiritual instruments to instil faith, implant courage and create meaningful relationships and open the way for restoration of the body’ (1966, p.6). Perhaps most significantly, Swift quotes Autton as stating that the role of the chaplain ‘must be as meaningful as medicine itself. His [sic] position must be not less professional than that of other members of staff, and his science and skill not less marked than those of the surgeon’ (2014, p.45).

The founding of the NHS meant that chaplains could now ‘relate to a shared body of knowledge, practice and professional standards’ (Swift 2014, p.51). More recently this focus on a more professional approach has paved the way for a significant increase in the development of, and tentative research into, health care chaplaincy. The growing body of research and approaches to professional development includes most notably: the Orchard report on hospital chaplaincy (Orchard 2000); the South Yorkshire NHS Workforce Development Confederation national strategy, ‘Caring for the Spirit’, published in 2003; Department of Health guidance (NHS Chaplaincy Guidelines 2015); and the publication of recent books by, for example, Nolan (2011) and Swift (2014) and a plethora of articles published, for example, in the Journal of Health Care Chaplaincy. Alongside the published material has been the development of professional associations and of ecumenical and multi-faith perspectives. The overall effect has been a significant expansion in the numbers and the professional development and resourcing of chaplaincy in the past few years. At the time of writing, the College of Health Care Chaplains registrar and the Church of England Hospital/Health Care Chaplaincy administrator give the current number of employed chaplains as 407 working full time and 374 working part time.

According to Orchard (2000), today’s health care chaplains would on the whole see themselves as ‘spiritual care professionals’ whose tasks include:

•responding to the religious, spiritual and existential needs of patients, carers and staff

•providing general emotional support to patients, carers and staff

•acting as advocates and mediators

•providing education, training and personal and professional development

•giving advice on ethical issues and more generally on implementing values-based health care.

James Woodward argues that, ‘chaplains might be described as liminal people. They are in-between; and the freedom, or potential freedom, this position imparts gives them the possibility of relating to and interpreting reality in all kinds of creative ways’ (1998, p.268). This freedom enables the chaplains to seek ways in which they can collaborate with other health care professionals in imparting a holistic understanding of whole-person health which, it is hoped, contributes towards a wider vision of greater wellbeing1 for all in society. This holistic approach is evidenced in my job description, the broad outline of which includes the following:

•develop the provision of Spiritual and Pastoral care to all patients, staff and carers across the Trust;

•provide direction, strategic vision and professional leadership for the service;

•manage the Trust’s Spiritual and Pastoral Care and Equality and Diversity services’ resources in collaboration with Heads of Service;

•work with other lead Allied Health Professionals and other professional leads to promote spiritual care for patients, carers and the Trust;

•take a Trust-wide role in supporting the development of staff wellbeing and psychological support, promotion of organizational values, promotion and monitoring of equalities and human rights, mediation and management of bereavement services;

•provide a direct Spiritual Care service to patients and staff with complex needs;

•increase awareness and understanding of the needs of people suffering mental ill health with representatives of local faith communities.

As evidence of the need to incorporate training and experience in spiritual and pastoral care and counselling or psychotherapy at a ‘high level’, the person specification includes in the essential criteria the following:

•training in counselling or psychotherapy;

•recognized qualification in pastoral, spiritual and religious care;

•a high level of psychologically informed knowledge in the complex relationship between human spiritual-religious and mental-emotional development.

While there is clear acknowledgement of the need for a high level of training in ‘psychologically informed knowledge’, there is no attempt to define what is meant by this statement or by the term ‘therapeutic spiritual counselling’. Given that the above is a description of my responsibilities, together with a list of specifications for the role, it is perhaps not surprising. However, it is precisely this lack of clarity that forms the basis for my exploration of the dialogic relationship between counselling and psychotherapy and spiritu...

Table of contents

• Cover
• Title Page
• Contents
• Introduction
• Part 1 The Development of Psycho-spiritual Care: Research and Practice
• Part 2 Aspects of Psycho-spiritual Care in Health Care Practice
• Conclusion
• Subject Index
• Author Index
• Join Our Mailing List
• Acknowledgements
• List of Contributors
• Copyright
• Of Related Interests
• Endorsements