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Symposium: Clinical Pastoral Education
By Joseph Fletcher
Reading through Brooks Holifield's account of clinical pastoral education in America during the past century affects me like the smell of smoke to an old fire horse. My own modest part in the movement, first in Cincinnati and then in Cambridge, was beyond any doubt the seed and source not only of my growth as a person and as an ethicist, but also of many of what Abraham Maslow came to call "peak experiences."
My new life lies now outside the pastoral ministry, in the field of medical education and biomedical ethics, but in earlier decades spent as professor in a theological school I was always close to "pastoralia," even when my academic role lay in Christian ethics and moral theology. This rootedness in practice was due to clinical pastoral education, and I can only hope that its realism and person-centeredness still exerts an influence on at least some of the academic moralists today, to correct their congenital drift towards absolutes and universal (non-clinical) imperatives.
I
Holifield's paper sent me to my file, where I found lots of things to confirm his thesis about the mutual influences of ethics and clinical pastoral practice. Perhaps the most widely discussed example lies in how my exposition of situation ethics was shaped by "clinical." As I once expressed it (in the Journal of Pastoral Care, June, 1971), "It was the insights of clinical pastoral education and counseling that led me directly to situation ethics. The case method and clinical approach provided me with the model."
What I learned from pastors, physicians, social caseworkers, and people generally in the helping professions convinced me-contrary to the doctrinaire and a priori methods of my theological training and of classical Christian ethics-that general principles are sometimes helpful in deciding what is right or good or desirable, but what always counts is the reality situation and its rich variables. This ethical breakthrough was a serendipity in pastoral theology.
A graduate of the University of West Virginia , Berkeley Divinity School, and London University, Joseph Fletcher was for many years Professor of Social Ethics at the Episcopal Theological School, Cambridge, Mass. In recent years, he has been associated with the Program in Human Biology and Society, the School of Medicine, University of Virginia. His extensive bibliography was published in the January 1977 issue of THEOLOGY TODAY, and it reveals his wide-ranging interests, across more than a half-century, in applying the Christian faith to the ethical and moral dilemmas of contemporary culture.
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The fact is, of course, that while situation ethics ran at once into a great deal of resistance among church people still oriented to classical Christianity and the conventional wisdom (rule ethics), the adoption of case (or clinical) ethics has evolved a method of moral judgment much more acceptable in medicine, psychiatry, social work, government, and often even in legal circles.
I first made this explanation of the source or motivation of situation ethics in an address in 1970 to a joint conference of the American Association of Pastoral Counselors and the Association for Clinical Pastoral Education. (They gave me a "distinguished contribution" award.) As I looked out on 850 heads, awed by the huge conclave, I remembered how once we were proud to get as few as fifteen people to a national meeting in the thirties. The old Committee of Thirteen, which worked many years on a merger of the Institute of Pastoral Care and the Council for Clinical Training, sometimes had no more than eight present; we lacked the funds to travel.
II
There were two problems in the movement which concerned me personally. (1) Can the pastoral task of the ministry be coupled with the prophetic task? (2) How can ethics, with its imperatives, be reconciled to the non-judgmental and therapeutic nature of clinical pastoral theory? (Reductively, they could be seen, perhaps, to be one and the same problem.)
The truth is that a concern for social justice-the hallmark of prophecy-virtually disappeared from clinical education, which Seward Hiltner called a "lamentable hiatus," and I gather that this is close to being the case in the churches at large these days, at least as compared to the period 1920-1960. When Edward E. Thornton published his history of clinical pastoral education in 1970, he urged a remarriage of the pastoral and prophetic ministries, of caring for both individuals and their society, but the proposal still lies null. I recall that my social action comrades felt I was a "whitecoat turncoat" and my clinical comrades thought I was "too controversial to be a neutral counselor."
With respect to the therapy-morality problem, the tension was possibly less polarized, but still too much so. Against neutrality some of us used to quote Karen Horney's view that we should deal as candidly with moral issues as with sexual deviations or failures. The subject, she said, "can take a stand toward them only after having faced them squarely." We all took J. C. Flugel's opinion seriously, that an individual "is fundamentally a moral animal," and that ethical neutralism in therapy and counseling was an outmoded bit of pseudo-scientific doctrine. I still recall vividly how Howard Clinebell complained because James Gustafson in one of his books on Christian ethics was guilty, in Clinebell's opinion, of "separating the ethical and the therapeutic ministries" and thus of making ethical discussion "often sterile and irrelevant" (Pastoral Psychology, December, 1971).
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We understood how it is that even though conscious conscience can be minimized or even obviated, unconscious conscience never is.
III
No better, or at least no more succinct way occurs to me to speak out of my experience to Holifield's paper than to quote the following conclusions of an address of mine on "Concepts of Moral Responsibility" to a national conference on clinical pastoral training at Boston University (October, 1951):
(1)Conscience is a universal quality of human personality. (2) We may disregard or minimize it only at our peril. (3) Psychiatric research reveals a more radical conception of conscience as an unconscious dynamic. (4) Ethical "neutralism" in therapy is outmoded. (5) Religious counselors actually lag behind in clarifying the moral components of their work. (6) Our goal in therapy should be to help clients "take a stand" on morals. (7) Responsibility depends upon the response of clients, and this presupposes self-acceptance and ego-security. (8) In the realm of morals, clients must internalize their value-choices, and free themselves of external (i.e., compulsive) moral decisions of a customary or authoritarian kind. (9) The cardinal virtues, which are almost universally respected in western culture, are actually egoistic. (10) The theological virtues are altruistic, which means they are less conformist but more mature, more creative and based on greater faith or greater security.
Some observers used to suggest that the clinical pastoral movement's acceptance of depth psychology undermines morals and ethical concern. This opinion had as its premise the notion that morality and psychology are not compatible. It's an idea which most of us never took seriously. Yet it persists, as in some (but not all) Skinnerians, and is defended on altogether other grounds by such critics as Martin Gross in his recent book, The Psychological Society. We had little more to say about it except that it was a simplistic idea out of a very primitive psychoanalytic theory. As far back as 1928, when Dr. Richard Cabot told Anton Boisen and Philip Guiles, in the early days of clinical training for seminarians, that he did not accept the psychogenic theory of mental and emotional disorders, it was not because he feared the theory would undermine what he liked to call "ethical adventuring." His reason was that as a physician he leaned toward a more biological and biochemical explanation. (And medical systems diagnosis, joined by somatic therapy, has tended to justify him.)
Holifield is as shrewd as he is well informed. There is, as he says, an ,,ethical context for clinical pastoral education." What I would like to add, to round out the whole thing, is that there is also a clinical context for ethical education. Getting down to cases, to use the old familiar phrase, is how to do ethics just as much as it is how to do clinical counseling.
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My first reaction to Professor Holifield's article is one of gratitude. He has undertaken a review and an analysis that is long overdue. The thrust of clinical training (as it was originally known) has been predominantly on practice, with little effort until recent years on reflection. This was probably inevitable because an emerging sub-discipline understandably concentrates first on establishing itself within the context of the professional education of which it seeks to be a part. Also, the accumulation of the recorded experience and wisdom of clinical pastoral practice was slow in forming during those early years of this demonstratively important branch of theological education. It was not until the introduction of professional journals that such data began to be published. (Incidentally, Professor Holifield, for some inexplicable reason, fails to mention the original Journal of Pastoral Care [except in his footnotes] which was launched in 1947 at the same time as the Journal of Clinical Pastoral Work. The Journal of Pastoral Care was published by the Institute of Pastoral Care. Later the two journals were merged, retaining the title Journal of Pastoral Care but published by the Council for Clinical Training.)
I
In view of Professor Holifield's focus, it might be interesting to note in passing that in academe there is now emerging a strong, renewed interest in moral philosophy, specifically the various dimensions of ethics. The late Willard Sperry, Dean of the Harvard Divinity School and a founder and first president of the Institute of Pastoral Care, raised some of the difficult life-and-death questions emerging from real-life situations, thus laying the ground work for bioethics. Further development has been carried out by Joseph F. Fletcher in his Situation Ethics, seminars, and lectures throughout the country. Sissela Bok, wife of the President of Harvard University, has taught a very successful seminar on truth-telling, and last year she published an excellent book on lying, which has been reviewed very favorably.* Moral theology has been forced to move from theory to confronting the problem of applying ethical principles as exemplified in the case study approach. This whole renaissance in the study of behavioral problems and their social
*Lying (Pantheon, 1978).
Rollin J. Fairbanks retired in 1977 as the Robert Treat
Paine Professor of Pastoral Theology at the Episcopal Divinity School in Cambridge,
and he is currently pastor of the Emmanuel Church in Manchester, Massachusetts.
As Professor Holifield's article makes clear, he has been a pioneer in the development
of clinical pastoral education, especially in his crucial role in the founding
of the Institute of Pastoral Care, succeeded by the Association for Clinical
Pastoral Education. Following his education at the University of Michigan and
the Episcopal Divinity School, he held two pastorates in Michigan, served as
a part-time chaplain for a Navy Air Base in World War II, and for seven years
he was Protestant chaplain at the Massachusetts General Hospital in Boston.
He is widely known through his writings and his lecturing to religious, academic,
and military audiences, as well as mental health associations.
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significance was given further impetus by the highly critical and challenging comments of Solzhenitsyn last year at the Harvard commencement when he was awarded an honorary doctorate.
As an early participant in what is known today as clinical pastoral education, I find that, with a few exceptions, Holifield's essay is remarkably accurate within the period best known to me. A primary historical correction has to do with his attributing to Philip Guiles as well as to myself the formation of the Institute of Pastoral Care. Actually Guiles remained largely outside of the organizational efforts. Prior to the formation of a Theological Schools Committee on Clinical Training, Dr. Guiles (with the financial assistance of his wife's family) created the Earhart Foundation which sponsored several early clinical training centers. At least in most cases, these were directed by chaplain supervisors who had studied with Dr. Guiles. Unsuccessful in attracting local or community support, these centers gradually withered on the vine, so to speak, and Guiles with David R. Hunter (successor to Russell L. Dicks as chaplain at the Massachusetts General Hospital) put together the Theological Schools Committee, a short-term and relatively inactive group. The theological schools involved consisted of four seminaries in the metropolitan Boston area: Andover Newton Theological School; Boston University School of Theology; the former Episcopal Theological School (now Episcopal Divinity School); and the Harvard Divinity School.
In 1944 when, after considerable consultation, I organized the Institute of Pastoral Care, Dr. Guiles' interest-aside from his teaching-was largely with the Cabot Club, a case study group which met monthly to hear and to discuss clinical presentations. He did, however, serve on the Board of Directors of the Institute at the very beginning as the faculty representative for the Andover Newton Theological School but was relatively inactive. His successor as faculty representative, John M. Billinsky, was far more active and as treasurer reorganized the financial structure of the Institute, thereby giving that growing educational enterprise greater stability. The then president of Andover Newton Theological School, Dr. Everett Herrick, was one of the founders of the Institute and very active in its development.
II
It would appear to me that in his article Professor Holifield is so committed to his categorization of "progressives" and "progressivism" that he fails to acknowledge adequately the tremendous influence of psychiatry on the clinical training of theological students and clergy. It must be remembered that nearly all of the early clinical training centers were mental hospitals or psychiatric institutions. Although Cabot's influence, as a non-psychiatric physician, cannot be slighted, the fact remains that during the early, formative years it was Helen Flanders Dunbar, psychiatrist, psychoanalyst, and an authority on psychosomatic medicine, who had the greater influence on the emerging
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discipline within the realm of theological studies. I stress this because psychiatry (which Cabot insisted incorrectly should be pronounced "sick-iatry"!) encouraged the focus on feelings or emotions and their non-ethical nature, contrary to scriptural admonition (Matthew 5:28). The importance of moral neutrality upon the part of the therapist, the non-judgmental attitude in pastoral counseling, led to two difficulties.
First, moral neutrality was in conflict with the traditional role of the clergy, namely that of the moralist. Leaders in conservative religious groups, already suspicious of psychiatry, saw neutrality as being amoral and thus encouraging amoral or immoral behavior. Freud's emphasis upon the importance and naturalness of heterosexual behavior resulted in a permissiveness (which he had not intended) that was at times tolerated if not encouraged and which became a focal point of debate, concern, and condemnation within religious or church circles and in the clinical training movement itself. This withholding of judgment in favor of growth and healing was further echoed and espoused by the psychologist, Carl Rogers, in his advocacy of non-directive counseling.
The second difficulty has been the fact that the professed moral neutrality actually exists in only a limited form, despite disclaimers to the contrary in psychotherapy and pastoral counseling. Value judgments are made. Such adjectives as "good," " bad," "weak," "poor," "strong," "healthy," "pathological," "immature," and "insensitive," are used to describe competence, practice, and behavior. On the other hand, "right" or "wrong" are admittedly seldom heard or used. The eagerness and even compulsion to pass judgment does cause many moralists unknowingly to reward neurotic individuals who have strong masochistic needs, and growth or emotional health is thereby impaired. This unintended dynamic is frequently present in auricular confession as well as in ministerial counseling.
III
One final observation: the clinical and professional insecurity of the clergy in America today is rightly mentioned by Holifield as an influential factor which has led to an unconscious over-identification with other more popular and respected healing professions. The struggle to retrieve or to re-create a unique professional identity or self-image continues.
In summary, I congratulate Professor Holifield for undertaking and carrying out an important, thorough and responsible investigation of a significant area or dimension of not only clinical pastoral education but also pastoral counseling as well.
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As one who lived through the early days of clinical pastoral education from 1932, 1 am astounded at the understanding of even the subtle aspects of that history that Brooks Holifield has achieved. With minor exceptions to be noted, I am almost completely persuaded by the original and imaginative thesis of his article, namely, that while both of the groups in the early movement were activated primarily by moral, reformist, and progressivist concerns, the primary differences between them involved their respective conceptions of what is moral.
I
Holifield puts the views of Richard C. Cabot clearly at the center of the New England early group, while acknowledging that all the other leaders of that group differed with Cabot about specifics. Because of the unusual prestige and influence that Cabot had in many circles, this choice is partly correct. Within the movement, Cabot did support the first general hospital center, provide the prod for the verbatim method, and perform important public relations for the movement. But I am less convinced than Holifield that his general philosophy and view of morality (which the article summarizes very well) had much influence upon the New England group. Russell L. Dicks disclaimed much of this privately, years before he did so directly to Cabot. A. Philip Guiles was probably a bit closer to Cabot, but the kind of clinical experience he continued to have made him wary of Cabot's absolutes. The permanent contribution of the New England group, in addition to the verbatim method, was its concern for pastoral work in ordinary church settings.
The other group, with headquarters in New York, was indeed influenced by the dynamic psychiatry that was then emerging under the influence of psychoanalysis. The founder, Anton T. Boisen, insisted that the central task was studying theology through living human documents. Not until Robert E. Brinkman assumed a good deal of control of the movement for a period of years in the 1940s was the theological concern more or less tabled, and the "therapy" for students lifted up. Edward E. Thornton's history of the movement is on target in showing what happened, and how the New York based group moved away from that dangerous position.
Seward Hiltner for several decades has been one of the most influential voices in the field of clinical pastoral education and pastoral theology. He is Professor of Theology and Personality at Princeton Theological Seminary and serves on the Editorial Council of THEOLOGY TODAY, as well as many other journals. He is the author and editor of seventeen books, but he is perhaps best known to a generation of ministers as the author of Pastoral Counseling (1949) and Preface to Pastoral Theology (1958). He attended Lafayette College and the University of Chicago, where he taught from 1950 to 1961. Among his varied activities in the clinical pastoral education movement, he was the founder of centers for clinical pastoral education at the Pennsylvania Hospital in Philadelphia in 1936 and at the University of Michigan Hospital in Ann Arbor in 1937. In his writing and teaching, he has strongly argued for placing pastoral care and Counseling in a theological context.
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II
In appraising the Holifield thesis, it is important to recognize how small the entire movement was before World War II, and how rapidly it grew in the following years under the demands of people whose war-time experience led them to value a personal ministry. Centers were established in all parts of the country. Students and supervisors came from a wider range of backgrounds than before. Lutherans and Southern Baptists became quickly and seriously interested, and established centers of their own. Generally, as Thornton has shown, all these factors combined to legitimate the idea of a student's gaining personal insight in training, but with the larger aim of the movement as improving pastoral care in the local church and elsewhere.
The two early positions about what is moral are characterized by Holifield as "formation" and "freedom." New England emphasized examination of the self operating in professional situations, learning from failure as well as success. New York stressed "liberation" through insight into the self. While the former seems true to me, and has continued in the whole movement, the latter by itself, separated from concern for pastoral education, was true only of the Brinkman period and even then only with some of the supervisors.
Holifield notes, but does not explore, a similarity between Cabot and Boisen in the unqualified or almost absolute views both had about the content of morality. But he also correctly suggests the radical difference between them. To use William James's terms, Cabot was concerned with "once-born" people, and Boisen with "twice-born."
III
It would horrify Cabot to think that he had given aid and comfort to the current movements declaring that salvation requires only finding the self. As Holifield's account makes clear, however, there is a strong connection at a level deeper than particular content. If the greatest human obligation is growth, then one is moral if the growing edge is followed, and immoral if one does not face up. Patrician Cabot could sympathize effectively with suffering only when assured that its origin was not moral weakness. Except for specific content, is it so different with the more recent Carl Rogers? The underlying or implicit theology in Cabot may indeed be called "liberal," as Holifield does, referring to particular historical trends. I believe it was also a "works" theology, rejecting the depth of the human predicament particularly as the Reformers had viewed it. Certainly it was full of "hybris."
Boisen, in contrast, was primarily concerned for people who had done their best to be moral but had landed in mental illness. He held that the processes they then went through were, at the same time, the mental illness and the struggle of religious forces to break through and get the upper hand. If the person emerged with a higher integration, the religious forces had won. If not, they had failed in their desperate effort. In Boisen's theory, there is room for sin and not just moral weakness, for
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received forgiveness and not simply attention to a growing edge, for acknowledging grace rather than just pride in moral responsibility. Even though I cannot accept much of Boisen's theology, I believe he was much closer to the truth of the Christian tradition than Cabot. I see the theological difference between him and Cabot as underlying the differences in conceptions of morality.