Abstract
Describes the relationship between practice and theory (praxis) along with an examination of changes in the last 40 years in the praxis of pastoral care and counselling in the Canadian Association for Spiritual Care (CASC) that led to spiritual care and psycho-spiritual therapy. Developments in spiritual practices include growth in multi-faith, evidence-based spiritual care, and spiritually integrated psychotherapy (psycho-spiritual therapy). Suggests further areas of research and reflection including process theology.
The Supervised Pastoral Education (SPE) supervisor who practised in the area of psycho-spiritual therapy sat with his six students as they prepared to end the SPE unit. 1 They had met for 8 months on a weekly basis. Each student was in a clinical placement where they were being supervised in psycho-spiritual therapy (spiritually integrated psychotherapy) with clients according to the CASC standards. Students came from a variety of religious and cultural backgrounds: two were Sunni Muslims with a female wearing a head scarf and the other an Imam; one male student was Unitarian and identified as Wiccan; two students were Christian, one female from the United Church of Canada and a male lay Roman Catholic; one student identified as spiritual but not religious and was open about being lesbian. The group had been challenging and supportive especially in the multi-faith dimension and the learning and practice of evidence-based spiritually integrated psychotherapy. All the students were currently Canadian citizens but country-of-origin included Turkey, Palestine, England, India and Canada. The supervisor who was the oldest in the group thought of his childhood in the 1950s in Northern Ontario where he lived within a Roman Catholic community. In those days, one did not associate with people outside of one’s faith group. Now, the supervisor was mingling with students from very diverse faith traditions. What would his Irish Canadian Catholic mother who had been deceased for over 20 years say about this? Would she “be rolling over in her grave?”
Since the 1950s there have been many changes in society, religions, theology, science, psychology and psychotherapy. Terry Bard (2016), the editor of The Journal of Pastoral Care and Counseling, notes that there have been evolutionary and energetic changes in the discipline “over the last century and even more so over the course of the last few decades.” (p. 15) Here we describe the emergence and development of three interlocking practices in the Canadian Association for Spiritual Care (CASC). First is the emergence and development of the practice of the multi-faith dimension in education. Second is the growth in evidence- based spiritual care and psychotherapy. Third is the emergence and practice of spiritually integrated psychotherapy. We begin by describing the relationship between spiritual practices and spiritual beliefs or theory (praxis) and then examine the context of CASC and its continual evolution in which these three practices have emerged.
Spiritual Practices and Beliefs
Practice is what we do. (O’Connor, 1998; Meakes and O’Connor, 2013) In a professional context like spiritual care and psycho-spiritual therapy, practice is what professionals do with their clients/patients. Spiritual practices are connected to spiritual beliefs. Spiritual practices are what believers do to live out their faith beliefs. Most faith groups have beliefs and spiritual practices. Often the beliefs are strongly connected to the practices; sometimes they are not. Tracy (1981) and others see theology as theory in a spiritual and theological context (Meakes & O’Connor, 2013; Miller-McLemore, 2016; O’Connor, 1998). Theory or theology informs practice and practice also informs theology and theory. (O’Connor, 1998) Spiritual practices express spiritual theologies. Practice is complex and multifaceted and there are often many theories and theologies embedded in practice. (Miller-McLemore, 2016) Being aware of these theologies requires consciousness and critical reflection. Tracy (1981) and Miller-McLemore (2016) call this critical reflection on practice, praxis.
In the field of spiritual care and psychotherapy, the practice includes a conversation between the psycho-spiritual therapist and the client. This usually involves listening, responding, guiding, managing, questioning: a variety of skills and theories. Peter VanKatwyk (2005) divided the practices of spiritual care and therapy into four quadrants in a tool he devised called the Helping Styles Inventory (HSI). The four quadrants are Celebrant, Researcher, Manager and Guide. VanKatwyk (2005) argues that in each of these practices, a multitude of social science theories and spiritual theologies are embedded.
Both Tracy (1981) and Miller-McLemore (2016) note the tension and dialogue between beliefs (theory) and spiritual practices. Spiritual practices have a life of their own and include beliefs and theories not yet fully articulated or examined. We can learn new theories and beliefs from our practices. Embedded in the various spiritual practices are experiences and images of the Divine (Gerkin, 1986; O’Connor, 1998). What do these emerging practices in CASC indicate about the Divine? Some practices of the faith over time reveal the Divine in new ways and can challenge some spiritual beliefs. For example, in care for the sick and suffering, many persons of faith use insights and practices from the social sciences as well as those recommended in the sacred texts. How does the incorporation of the social sciences in the practice of spiritual care and psycho-spiritual therapy affect spiritual beliefs? For some, there may be no effect on their spiritual beliefs; for others there may be change. Miller-McLemore (2016) agrees with Tracy’s understanding that theory and practice are connected and also distinct. She argues that theory should not be viewed as superior to practice. Practice has its own form of knowledge that is complex. Practice is very rich and cannot be contained by theory. Miller-McLemore (2016) adds to Tracy’s understanding by emphasizing the distinct and complicated relationship between practice and theory. She argues that practice trumps theory when, for example, it comes to compassion and reaching out to members of other faith groups who are in need. However, there must be ongoing critical reflection and dialogue between theory and practice (praxis).
Evolving Context of Canadian Spiritual Care and Psycho-Spiritual Therapy in CASC
Spiritual care and psycho-spiritual therapy emerged out of the pastoral care and counselling movement in Canada. The pastoral care and counselling movement was initially rooted in the Judeo-Christian traditions. This movement in Canada developed from a similar movement in the U.S. (MacLachlan, 1991) However, the field of pastoral care and counselling in Canada has changed in the last 40 years. Margaret Clark and Doug Wilson (2016) note in their history of CASC, that the association name “has changed four times. Each change reflected modifications to identity, emphasis and function of the Association.” (p. 32) Looking back, the initial professional organization that trained and educated students in pastoral care and counselling was the Canadian Council for Supervised Education formed in 1965 (Clark & Wilson, 2016; O’Connor, 1998). This was an offshoot of the American organizations. The Canadian name changed in 1974 to Canadian Association for Pastoral Education (CAPE). (Kilbourn, 1991) The name changed again in 1994 to Canadian Association for Pastoral Practice and Education (CAPPE). In 2010, the association changed its name to Canadian Association for Spiritual Care (CASC). (Clark & Wilson, 2016) The reason for the last name change was to reflect more of the multi-faith and multicultural dimensions both in Canadian society and in CASC. By the early 1990s, most Canadian hospitals had changed the name of the “Pastoral Care Department” to the “Department of Spiritual and Religious Care” to be inclusive of diversity (O’Connor, 2014).
These changes in name indicate the changing nature of clinical pastoral education (CPE) and pastoral counselling education (PCE) in Canada. The Canadian professional association from the beginning set standards for PCE and CPE and had various designations for certified practitioners: Specialist in Pastoral Care, Specialist in Pastoral Counselling (Clark & Wilson, 2016). These titles indicated that the bearer had gone through rigorous education and training in the designated specialties. There was also designation for supervisors who trained and educated students in the various streams. With the change of the name to CASC, the names of the clinical specialties also changed: Certified Practitioner of Spiritual Care (formerly Pastoral Care) and Certified Practitioner in Psycho-spiritual Therapy (formerly Pastoral Counseling). With all these changes in nomenclature the theologies embedded in the names also have changed (Clark & Wilson, 2014; Kinast, 2008).
Alongside these changes in the professional association, there have also been changes in university programs related to pastoral care and counselling. Some academic institutions once provided degrees for pastoral care and counselling. Now, they provide degrees for spiritual care and psychotherapy (O’Connor, 2014). For example, in Ontario, three theological schools affiliated with universities now offer degrees in spiritual care and psychotherapy. These degrees are Masters of Pastoral Studies (MPS) at Emmanuel College and Knox College in the Toronto School of Theology at the University of Toronto, an MA in Spiritual Care and Psychotherapy at St. Paul’s University at the University of Ottawa, and an MA in Spiritual Care and Psychotherapy at Martin Luther University College (MLUC) at Wilfrid Laurier University (O’Connor, 2014). These three academic programs are also recognized programs by the College of Registered Psychotherapists of Ontario (CRPO) and meet the theory competencies necessary to become a registered psychotherapist. Students trained in CPE and PCE in Canada can apply for the status of Registered Psychotherapist (RP) in CRPO. Their clinical work with clients in hospitals, counselling centres, prisons, long-term care (LTC) facilities and in private practice under a CASC supervisor who is also an RP supervisor in CRPO can count towards the clinical hours (1000) needed for the RP designation in CRPO.
CRPO is a government college that regulates the practice of psychotherapy in Ontario. It is similar to the College of Physicians and Surgeons and the College of Nurses. Like other regulated colleges, CRPO seeks to protect the public from incompetent and unethical practitioners in the area of psychotherapy. It sets standards for practices and defines competence as “theory, skill and judgment.” (CRPO, Competency Profile, 2014, p. 1) The Ontario legislature passed the Psychotherapy Act in 2007 stating that the practice of psychotherapy is a controlled act under the Regulated Health Professionals Act (RHPA) (1991). From the Psychotherapy Act, a college was created that oversaw the practice of psychotherapy in the province of Ontario. Other Canadian provinces have a College of Psychotherapy or are proceeding with creating one that include spiritual care providers. (See Nova Scotia, Manitoba, British Columbia and Quebec)
Development of Multi-Faith in SPE in CASC
A growing dimension in academic programs and CASC CPE/PCE programs is the rise in the number of students from various spiritual and religious groups. (Clark & Wilson, 2016) This practice of multi-faith education is noted in the opening scenario. Students trained in academic courses and in CASC are educated to respect the faith of someone from a different faith tradition. They are also trained to invite but not demand a conversation about the care seekers’ spiritual and religious concerns. The education encourages respectful dialogue without proselytizing. Also, in hospitals and counselling agencies more and more persons from a variety of spiritual and religious traditions are present. Ontario and Canada, in general, have become a more multi-faith and multi-cultural society. Within Canada, more and more people are identifying as spiritual but not religious, i.e., these people have spiritual beliefs and practices often adopted from a variety of spiritual traditions and do not identify with any one religion. CASC spiritual care and psycho-spiritual therapy students and practitioners need to be able to work within a multi-faith context. How do the spiritual care providers and psychotherapists bridge the gap between their own faith practices and the practices of their clients and patients?
The research of two sociologists, Wendy Cadge and Emily Sigalow (2013), answer this question. They observed chaplains at work in a hospital in Boston, Mass. dealing with multi-faith patients. They saw two practices that chaplains employed to address the gap between them and persons from different faith-groups. One practice is the use of the language of spirituality. The use of spirituality and spiritual care is meant to create a common language and concepts in discussing faith issues with patients. Cadge and Sigalow (2013) call this “neutrality” or lowest common denominator. It stresses what the spiritual care giver and spiritual care seeker have in common in their discussion of the sacred (Pargament, 2007) and seeks points of joining. The second approach is “code switching” where chaplains suspend their own beliefs and work entirely in the language and beliefs of the patient. This requires learning the religious language of the client and putting aside one’s beliefs and values. With both of these approaches, the goal is to serve the spiritual and religious needs of the patient in helping the patient deal with one’s suffering.
An anthropologist, Michael Berman (2018, 2020), working in Japan after the tsunami of 2011, observed multi-faith chaplains training to help victims and family members affected by the tsunami. Most chaplains in the training sessions were Buddhist but there were some Shinto and Christian chaplains. The victims and their families were from a variety of religions. The chaplains were trained first not to proselytize any of their clients/patents. Second, their role was to listen to the suffering with often very few or no words. These chaplains had to suspend their own beliefs and practise being present to people’s suffering. Their motivation for this work was deep compassion for those suffering, an attitude and practice which many religions share. Berman’s observations are similar to Cadge and Sigalow’s code switching. This approach along with the use of the language of spirituality have facilitated the emerging development of multi-faith spiritual practices in SPE.
Evidence-Based Spiritual Care
A second spiritual development in this changing field is the emerging practice of evidence-based spiritual care and psychotherapy. In Canada, evidence-based medicine was developed at the McMaster University Medical program in Hamilton, ON (Djulbegovic & Guyatt, 2017; Snider et al., 2019). This approach advocates using the best research evidence balanced with the needs of the patient and clinical wisdom to help in the care of patients. (Snider et al., 2019) Two chaplains at Hamilton Health Sciences (Chedoke-McMaster) introduced the evidence-based approach in spiritual and pastoral care to Canadians (O’Connor & Meakes, 1998). The evidence-based approach also became part of spiritual care in CASC. There is a growing body of research that fueled evidence-based spiritual care and this had a significant impact on the spiritual care movement and education in Canada.
Research indicated that religious and spiritual practices in most cases could be helpful to patients and clients who were suffering. (Koenig, 2012) Practices like prayer, attending weekly worship in the faith group, reading sacred texts, doing kind deeds for others, avoiding drugs and alcohol which many faith groups promoted and developing friendships in the faith community could help in the well-being of adherents. (Koenig et al., 2012) Numerous researchers published studies indicating the positive association between many religious and spiritual practices and well-being.
The practice of evidence-based spiritual care indicates that the great divide between religion and science (Barbour, 1997) which had severed the two realms in the West during the Renaissance period had lessened. Ian Barbour maintained that starting in the seventeenth century four relationships developed between science and religion. One was conflict where the two realms fought with one another over who was right. The second was peaceful co-existence where a great divide was acknowledged between science and religion and each stayed in its own sphere. Then a third relationship developed in the 20th century where there was some collaboration on points where they agreed such as the role of hope in health. The fourth relationship was integrative where religion and science began to integrate their findings and practices for the benefit of patients. Evidence-based spiritual care is part of this fourth relationship.
The sheer volume of emerging scientific evidence showing that religion and spirituality could be helpful to health gained centre stage. The evidence-based approach impacted and changed spiritual care as well as psychotherapy. Spiritual care providers were now expected to read scientific evidence on spirituality and use what was relevant to help their patients and clients. Spiritual care was now not just based on what was advocated in the sacred texts and traditions; it was also based on scientific evidence. For example, mindfulness meditation developed originally by Buddhism was shown through research evidence to be very helpful with anxiety and depression. Many spiritually integrated psychotherapists became aware of that and utilized mindfulness exercises with their patients and clients to ease anxiety.
Psychotherapy and Spirituality
A third emerging practice is the development of spiritually integrated psychotherapy by CASC certified spiritual care providers and psycho-spiritual therapists. The theory and practice of spiritually integrated psychotherapy was articulated by Ken Pargament (2007) who brought spirituality and psychotherapy together. Canadian researchers and practitioners also published about the theory, practice and integration of psychotherapy and spirituality in the Canadian context (O’Connor et al., 2014). The College of Registered Psychotherapists of Ontario (CRPO) endorsed the evidence-based approach in psychotherapy and in 2018 accepted spiritually integrated psychotherapy as one of its approved modalities (CRPO, Approved Modalities, 2018).
This approval by a secular agency of spiritually integrated psychotherapy is a change from the way psychotherapy was practiced in the first 75 years of the 20th century. Psychotherapy in the 20th century was the child of Sigmund Freud (Stokes, 1985). Through the discipline of psychoanalysis, Freud developed free association and a nonjudgmental therapeutic relationship with clients. His approach spread quickly and many other forms of psychotherapy spun off this approach. Freud had a lot of difficulty with religion. He stripped psychotherapy of its spiritual and religious roots and denied that there was a Divine. In Future of an Illusion, Freud (1962) emphasized that there was no divine and that religion at best was neutral and at worst harmful. Religion was part of the father complex. Marsha Hewitt (2014) in Freud and Religion, however, argues that Freud’s approach to religion is more complex and nuanced. Freud did see some benefit in religion. For many decades in the 19th and 20th centuries, psychotherapy and psychoanalysis carried a negative bias toward religion based on an understanding of Freud. Religion was regarded as unscientific with little basis in fact. There was a huge divide between religion and psychotherapy.
Now, psychotherapy did not start with Freud. It began back with the Greek philosophers BCE. Socrates first coined the word “psychotherapy” which is translated as “the cure (therapy) of the soul (psycho).” (O’Connor & Meakes, 2014) Socrates maintained that medical doctors seek to cure the body and philosophers seek to cure the soul. Socrates used his Socratic method of questioning in search of truth. For Socrates, the pursuit and discovery of truth cured the soul. Many world religions as John McNeill (1951) demonstrates in A History of the Cure of the Soul also utilized their own forms of psychotherapy. Some world religions do not use the concept of soul. However, many religions in the 21st century believe that faith can cure, care and bring healing to distressed believers through religious practices as well as through the pursuit of truth. These religions maintain that the Divine is the one who cures. With the scientific evidence growing that spirituality and religion can be helpful to well-being, many spiritual persons began to explore the origins of psychotherapy (O’Connor et al., 2014). Within many religious traditions, there is a history of caring and curing faith members. The volume of scientific evidence produced in the last fifty years disagreed with Freud that religion at best was neutral and mostly harmful. (Koenig, 2012) For example, religious practices often help persons with chronic illnesses to sustain their level of well-being, maintain hope and not give into despair (Koenig et al., 2012).
How does the shift from an ambivalent or negative attitude between religion and psychotherapy relate to developments in Canadian spiritual care? The fact that the College of Registered Psychotherapists of Ontario (CRPO) accepts spiritually integrated psychotherapy as an approved modality indicates a significant shift. (CRPO, Approved Modalities, 2018) Here, is evidence of Barbour’s fourth relationship between religion and science, i.e., integration. It is an accepted practice by a secular government agency. CRPO has accepted numerous CASC certified spiritual care providers and psycho-spiritual therapists as members into the College and awarded them the designation of registered psychotherapist (RP). With this designation, some CASC certified spiritual care providers have opened private practices. The notion of a spiritual care provider (chaplain) in private practice is new in Canadian society. There are many pastoral counsellors – now psycho-spiritual therapists – who have been in private practice for some time in Canada. That is not a new practice. However, chaplains (spiritual care providers) did not work in private practice. Previous to CRPO, private practice chaplain was an oxymoron. Now, with many chaplains in Ontario receiving the designation of registered psychotherapist (RP-CRPO), private practice chaplains (spiritual care providers) are no longer an oxymoron. Some of these spiritual care providers work part-time in a health-care institution and part- time in private practice. There is a need among many Canadians who have mental health struggles and who are religious/spiritual to have a professional trained in both spirituality and mental health. (Koenig, 2012) Spirituality and psychotherapy often overlap.
Reflections on the Three Emerging CASC Practices
These three emerging practices are part of the change in CASC and Canadian society. Bard (2016) and Clark and Wilson (2016) call the changes an evolution. Where is the evolution headed? Like any evolution, there is a possibility of the changes collapsing. Yet, the fact that different faith groups can work together to help those who are suffering is a positive step. Also, the fact that spiritual care and psycho-spiritual therapy is using science and research to help in the healing is another positive step. Finally, who would ever believe that spirituality could be integrated into psychotherapy after an era where there was a huge split between the two realms? Now, even secular agencies in Canada see spiritually integrated psychotherapy as an accepted modality.
What practical theologies are emerging from these developments? Possibly, process theology with its evolutionary view of the universe could best describe the emerging theology. (Kinast, 1996) Teilhard de Chardin saw the evolution of humanity, and indeed the whole universe accelerating in its rate of change as we move faster to the Omega point (Divine) (Savary, 2007; Teilhard de Chardin, 2001). He saw evolutionary changes in both the physical and spiritual worlds. This accelerating change includes deeper connections, consciousness and compassion. Looking back to the 1950s, it would have been highly unlikely that our SPE supervisor in the opening scenario could have imagined, let alone predicted, all the developments of the last 70 years. The Internet, discovery of DNA, vaccines in one year for COVID-19, man spaced travel to the Moon and the unmanned visit to Mars, bridges between faith groups, science and religion, the practice of spiritually integrated psychotherapy were not common thoughts during the 1950s. Possibly, the evolution could lead to the use of robots and cyborgs in spiritual care and more bridges and integration between science and religion. Certainly, a dynamic theology based in an evolutionary paradigm like process theology could best articulate these changes.
Would the supervisor’s mother be “rolling in her grave” at these changes especially the multi-faith dialogue? Possibly … Maybe she would be standing in her grave, cheering! With the connection and beginning of an integration of spiritual care and psychotherapy, maybe it would be Sigmund Freud who would be rolling in his grave!
Footnotes
Acknowledgement
Thanks to Nazila Isgandarova, PhD and the two anonymous reviewers for reading and giving feedback on a previous version.
