Pastoral Diagnosis

Bukal Life Care2017

Consider 6 Possible Therapeutic Directions for Psycho-emotional

Problems1. Biophysical. Problems stem from problems with the

physical body.

2. Intrapsychic. Problems stem from bad mental processes going on within the mind.

3. Behavioral. The problem is bad learned habits that must be unlearned/replaced.

4. Socioeconomic. The problem is the environment the person is in. Setting change is needed.

5. Meaning. The problem is that the individual has failed to gain a sense or purpose or meaning in life.

6. Morality. The problem is conflict between actions and sense of moral obligations and social responsibilities.

Who are the Specialists in these Problem Areas?

Psychiatrists specialize in the first area (biophysical) Psychologists specialize in the 2nd (intrapsychic) and 3rd

(behavioral) areas Social workers specialize in the 4th area. But who specializes in the 5th (meaning) and 6th (morality)

areas?

These areas would normally be thought of as the specialization of chaplains and other pastoral counselors.

(Mahony, 1975)

Psychological Diagnosis deals with the patient's physical, behavioral, socio-economic

and intrapsychic characteristics.

Pastoral Diagnosis, however, focuses more on meaning and ethics/morality. These two are more in the realm of spiritual or religious or

theological concerns

<Note: Pastoral Diagnosis may also be termed pastoral or spiritual assessment>

“The Minister as Diagnostician: Person Problems in Pastoral

Perspective” by Paul W. Pruyser (1963)

This book gives 7 dimensions consider in a client/parishioner.

− The Holy− Providence− Faith− Grace/Gratefulness− Repentance− Communion− Vocation

We will look at them Somewhat Differently

Bottom Tier: Faith (Sources of Change)

“The Holy”/Sacred Communion/Community Providence/Trust

These are the relationships and support system outside of ourselves that can motivate us to change, and sustain us through difficult times.

Bottom Tier: Faith

These are the concerns that a chaplain should investigate on the initial visit.

• Who or what is god in the patient's life?• Who are able to provide a support structure for

the patient (family, friends, church, etc.)?• How important are each of these to the patient?

“The Holy”

Who or what is sacred to the client? What does he or she revere? Does the person have a sense of awe for

something beyond him/herself? Does the individual have a sense of being a

limited (created) being?

“The Holy”

This matters because it seeks to discover “idols” in the persons life. Such an idol may include:

• A specific person, idealized• A personal dream or goal• Anything that one places one's energy and

resources... one's personal treasure.Recall: Where one's treasure is, is where one's

heart is also.

Communion/Community

Communion “has to do with embeddedness, reaching out, caring, and feeling cared for.”

• How connected or disconnected/estranged from others.

• “Others” can include specific individuals, groups, mankind as a whole, nature as a whole, and God.

• While estrangement (disconnectedness) may be bad... connection to the point of being “encapsulated” can be bad as well.

Communion

Communion is tied to SHAME and ALIENATION.

Shame leads to feelings of disconnection from others.

Feelings of alienation from others often means that the support network that can help the client grow and heal is missing.

Providence/Trust

What does the person believe is God's (divine) purpose with respect to him or her?

Is the universe a benevolent place or a cruel one? Do things happen because of Luck? Justice? Natural forces? Fickleness?

Does God have a plan or not?

Providence/Trust

Providence ultimately is a question of TRUST.

• Can I trust God?• Can I trust the pastoral care giver?• Can I trust those around me?• Can I trust that there is something to place my

hope in?Trust in the Lord.... and He will make your paths

straight.

Note:

The bottom tier tends to line up with what is often called “Spiritual History.” This is a series of simple questions that are used in the hospital (particularly) to quickly evaluate the patient.

Spiritual History Example: FICA

F -- Faith and Belief . "Do you consider yourself spiritual or religious?" or "Do you have spiritual beliefs that help you cope with stress?" IF the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes patients respond with answers such as family, career, or nature.

I -- Importance. "What importance does your faith or belief have in our life?" "Have your beliefs influenced how you take care of yourself in this illness?" "What role do your beliefs play in regaining your health?"

FICA

C – Community. "Are you part of a spiritual or religious community?" "Is this of support to you and if so, how?" "Is there a group of people you really love or who are important to you?" Communities such as churches, temples, and mosques, or a group of like-minded friends and family can serve as strong support systems for some patients.

A -- Address in Care. "How would you like me, your chaplain/pastoral care provider, to address these issues in your care?"

“FIC” are the foundational tier or sources of change. The “A” is the transition to the 2 nd tier.

Spiritual History: HOPE

H – Hope Sources (meaning, comfort strength, peace, love). What gives the patient internal strength, support, and meaning. Who are what does the patient turn to in times of difficulty or crisis?

O – Organized Religion. What is the patient's organized religion (if any)? How important is it in the patient's life. What aspects of this religion are helpful? Unhelpful? Is the patient involved with a religious or spiritual community? Is it helpful?

Spiritual History: HOPE

P – Personal Religion/spirituality. Does the patient have personal beliefs that are independent of organized religion or divergent from his/her own religion? What are they? What is the patient's view of God and relationship with God (if any)? What specific personal spiritual/religious practices does the patient find helpful?

E-- Effects on Medical Care and End of Life Issues. Has the patient's situation had an effect on doing things that shape him/her spiritually? Is there anything the pastoral care provider can do to help with spiritual/pastoral/religious concerns? Are there conflicts between medical care and the patient's religious beliefs?

Spiritual History: FAITH

F Do you have a Faith or Religion that is important to you?

A How does your faith/beliefs Apply to your health?

I Are you Involved in a faith group or community?

T How does your faith/beliefs affect your Treatment?

H How can I Help you, especially regarding pastoral concerns?

The Second Tier is About Hope

Openness Vocation/Plan

What limits do we place on ourselves that keep us going in one direction or limiting ourselves to one place or plan?

How much flexibility will we allow ourselves to consider something new?

Openness

<Pruyser calls this “Faith” but this is not about “saving faith.” It is more to do with one's stance regarding life. It is more about hope.>

• Does the client embrace life and experience or shy away from it?

• Does the client have the courage to explore, learn, and grow... or not?

• What self-imposed boundaries does the person place on his/her life?

Openness

• Are they open to change... the unknown?• Are they able to leave their comfort zone?• Can they overcome doubt?

Recall Peter walking on the water...

Vocation/Plan

This term is a bit misleading. The point here is not about having a career. Rather it is the feeling that one is part of God's plan in the world-- having, perhaps, a feeling of “divine calling.”

• One feels part of an overall movement by God to make the world more right... better.

• Life is a pilgimage... having meaning and direction.

Vocation/Plan

One's plan or path has to do with purpose or pilgrimmage or calling. What is the client's sense of what they are meant to become. Path is an important Biblical concept. Psalm 23 describes sheep following the Lord on the “paths of righteousness” even if it involves going through the “valley of the shadow of death.” Jesus' call to His disciples was to “Follow Me.” Jesus further speaks of the Wide and Narrow Paths. In fact, early Christians described themselves as being members of “The Way.”

Third Tier: Love (or Tools of Change)

Grace Repentance

Both are primary tools of change in the life of any person.

Grace/Gratefulness

Grace, ultimately is about “kindness, generosity, gifts, the beauty of giving and receiving, or 'getting something for nothing.'”

Grace involves giving grace or receiving it (gratitude).

It can involve God, others, or self.

Grace/Gratefulness

This factor is strongly related to GUILT and FORGIVENESS.

• How does one handle guilt?• How easily does one forgive? How easily does

one accept forgiveness?• Is the client able to forgive him/herself.

Repentance

Repentance has a moral sense... correction from wrong to right. More generally, it is the intention and action of going to a place of greater well-being.

• Is the client aware of his/her own role (call it sin or something else) in the problems faced?

• Does the client have remorse, a desire to correct, and to fix what went wrong?

Repentance

Repentance is strongly connected to CHANGE, or the willingness to change. A desire to change, a recognition of the need and ability to grow.

Note: many want things “to be better” but are not willing to repent... take responsibility for one's own role, correct what was wrong, and do better.

How to Diagnose?

Actively listen!!Don't push “churchspeak.” Their thoughts will

come out in normal conversation.

”No God-talk is needed in the pastoral diagnostic interview although there should be no ban on it. What is needed is theological alertness-- the tacit guidance the pastor receives from his basic discipline while he deals with a concrete individual who may talk about bereavement or anger or great disappointments.” (p. 63)

Additional Terminology

Going back to the Three-tiered diagram:

• As noted before, the bottom Tier (Faith) essentially lines up with what is sometimes called “Spiritual History” such as is often done by a chaplain in a hospital.

• All three Tiers (Faith, Hope, and Love) essentially lines up with what is sometimes called “Spiritual Assessment” such as done by a pastoral care provider in a counseling center.

Systematic Versus Pastoral Theologies

For many there is a seen a huge difference between systematic theology and pastoral (or practical theology) .

Yet, ideally, they are linked. Consider several major branches of systematic theology (Reference: Dr. Doug Dickens)

Theology Proper (Trinity) Anthropology (Study of Man) Ecclesiology (Study of the Church) Eschatology (Study of Last Things) Soteriology (Study of Salvation) Cosmology (Study of Creation) Epistemology (Study of Knowledge/Revelation)

Systematic and Pastoral Theology

Systematic Versus Pastoral Theologies

Rather than systematic and pastoral theologies competing or being disconnected, systematic branches can provide insight for pastoral theology questions... especially for self-reflection.

Theology Proper (Who or what matters most to me?) Anthropology (How can I be more human or genuine?) Ecclesiology (Who or what is my community?) Eschatology (What happens when I die?) Soteriology (How can I change?) Cosmology (How should I understand the world? Safe?

Scary?) Epistemology (How can I know what is true or what matters?)

Pastoral/Spiritual Assessment Using the Beatitudes

For diagnosis, the 8 characteristics are looked at in terms of characteristics of healthy people:

--Poor in Spirit Identity (shame)

--Mourn Vulnerability

--Meek Discipline

--Hunger... Righteousness Motivation

--Pure in Heart Integrity (guilt)

--Merciful Empathy

--Peacemakers Community

--Persecuted... Courage

You may have noticed:

There is NO ONE WAY to diagnose or treat in pastoral counseling.

There is also no single set of clearly defined diagnoses.

Rather, there are basic principles drawn, primarily from theology, centuries of pastoral care experience, and, to a lesser extent, the social sciences.

References

Pruyser, Paul W. The Minister as Diagnostician: Personal Problems in Pastoral Perspective.” Westminster Press, 1963.

Additionally

Pargament, Kenneth, et al. “The Many Methods of Religious Coping: Development and Initial Validation of the RCOPE” Journal of Clinical Psychology, April 2000

Townsend, Loren L. “Best Practices: Rethinking Pastoral Diagnosis” Dickens, Doug. Notes from class “Pastoral Theology,” ABGTS, 2015/2017.Larocca-Pitts, Mark. “FACT, A Chaplain's Tool for Assessing Spiritual Needs in an Acute Care

Setting.” Chaplaincy Today. Vol. 28 No. 1, Spring/Summer 2012, 25-32.Malony, H. Newton. “The Demise and Rebirth of the Chaplaincy” Journal of Pastoral Care, Vol. 29

(1975).