Chapter 15: The Clergyman’s Role in the Treatment of the Alcoholic by George P. Dominick
About a year ago, on the night before Christmas, I answered the phone at my home in Atlanta. The caller was a local clergyman asking for help with a woman who was drunk and sick in an Atlanta hotel room. The story, as it unfolded, had a distinctly ecumenical flavor. Ill and alone in a hotel, this woman had called a friend in London. The English friend immediately called the only American he knew -- a Catholic priest in Baltimore. The Baltimore priest then called an Atlanta priest who, in turn, called me. Nor was this the end of the broad web of involvement. Within the next eighteen hours, operating around the key role of the local priest, we involved a physician, a hotel clerk, a member of Alcoholics Anonymous, and the facilities of a hospital emergency room. Obviously, not all clergy contacts with alcoholics are so dramatic or so ecumenical. More often contact comes in the form of the familiar plea of the alcoholic’s wife: "Please see if you can talk to him. He knows he needs help but he just won’t do anything about it." Or, again, it may be the late-night call from the alcoholic himself. Lonely and remorseful in the midst of his drinking, he may just want to talk to somebody. Sick and scared, he may demand immediate relief from what he feels is a life-or-death crisis.
These common experiences pose questions with regard to the clergyman’s attitude and role. Is the clergyman willing to be involved with the alcoholic? How does the clergyman begin to become an effective helping person? How can he sink his roots into that sense of professional competence so necessary for dealing with the crisis pleas of the alcoholic? How can he learn to recognize the alcoholic’s tremendous capacity to stir up anxiety, frustration, and anger without at the same time throwing up his hands in despair? How can he offer compassion without becoming overly protective or manipulative? And, finally, shall the clergyman offer himself to the alcoholic as one who is only incidentally a representative of religion or as one who recognizes the significance and value of his specifically religious heritage and role?
These questions are the same as those to which we have addressed ourselves in a five-year National Institute of Mental Health Research and Training Project for the training of clergymen in the field of alcoholism conducted at the Georgian Clinic (1964-69) ("Pilot Project for Clinical Training of Clergymen in The Field of Alcoholism" NIMH Grant #8589, staffed by: George P. Dominick, Co-Director; John M. Crow, Coordinator of Training; Melvin B. Drurker, Clinical Psychologist for Evaluation.)
The Georgian Clinic, having developed an interdisciplinary staff over a period of fifteen years, recognized the clergyman’s potential. This has come into focus through the extent to which the Clinic has used clinically trained clergymen in its treatment program. These clergymen were equipped for, and took seriously the responsibility of relating to these isolated people (alcoholics) in such a way that the alcoholic became aware of his own capacity to relate. These clergymen were equipped to accept this responsibility as a long-range project (perhaps a lifetime) They helped to conceptualize the illness as expressing a feeling of "caughtness" about life which called for a pastoral or shepherding response. They saw the treatment process as the opportunity to provide patients with a "community of concern," a microcosm of healing forces which would offer the patient regular opportunities for facing those issues of human existence which lie below his alcoholic symptoms. The key issues were and are:
1. The alcoholic’s struggle between living and dying -- whether or not to make a commitment to life.
2. The patient’s struggle to trust or to have faith in himself, in others, and in God -- as opposed to the temptation of hopelessness.
3. The patient’s struggle to find some worthwhile and attainable meaning or purpose for life -- versus flight into an anesthetized purposelessness.
4. The patient’s struggle to step out into the mainstream of life -- as opposed to his shrinking back in face of the anxiety, guilt, and tension of the human situation.
The clergyman with training, therefore, brings to the field of alcoholism an awareness of the person behind the bottle, an awareness of the central existential question behind the long list of situational questions and pleas. He brings this orientation to the crisis demand of the immediate situation and to the slow process of growth which is the lifelong business of the alcoholic and his family.
The most graphic, although obviously limited, characterization of this pastoral role is the familiar shepherd image. Implied in the shepherding role and function are a perspective, a life-style, and a healing orientation.
The shepherding perspective is based on the search for the troubled person beneath a plethora of symptoms and diagnostic labels. This perspective takes seriously that fundamental sense of lostness which echoes through so much of the alcoholic’s conversation, and it accepts as fundamental reality the alcoholic’s struggle between life and death. Shepherding involves an attitude which takes seriously man’s responsibility for his own choices, yet maintains faith in man’s capacity to grow and change. It is an active calling which sees its work as a lifelong relational process. It is a professional stance which puts less emphasis on "gaining insights" and "making adjustments" while putting more emphasis on a supportive "standing with."
The shepherding function also implies a life-style. The shepherd does not stand apart from his sheep, offering suggestions from another plane of life. Nor does the effective pastor. The effective pastor is one who has learned as a result of his own involvement in the human predicament and can admit to his own experience of "caughtness." He is a person who needs neither to flee nor to explain away the basic anxiety involved in human existence. A good pastor may, for instance, be considerably more at home with the alcoholic’s ever-present death wish than is the physician. The physician tends to react to death exclusively as the alien intruder, whereas the pastor looks upon it as a part of the bundle of human existence -- an inevitable dimension of the life process which is to be faced with realism and faith. One of the pastor’s basic contributions, in fact, lies in his ability to accept the life/death ambivalence in the alcoholic -- particularly during the initial struggle for sobriety.
Finally, the shepherding function involves a rather distinct healing orientation. This healing orientation concerns itself with caring rather than curing. Caring accepts a person where he is and as he is. It is an offer which refuses to be contingent on mutual agreements to change or to improve. The offer contains possibilities for growth but remains a valid offer even if every possibility is refused.
The shepherd’s healing orientation finds its focus in understanding rather than in adjusting another person. Understanding is seen as a broader offer, aimed at promoting a sharing and an interaction at depth. Understanding may lead to change, but its thrust is relational -- increasing the capacity of two human beings to stand together.
The essence of this healing orientation is the pastor’s offer to support the alcoholic’s inner strengths -- even those strengths which the alcoholic may not yet have recognized in himself. Such support may begin on as rudimentary a level as literal hand-holding whereby the pastor accepts the alcoholic’s present weakness and supports the only strength that is available -- his potential strength. Further along in the process, this same support may be offered by a total refusal to intervene or to reassure, thus affirming to the disbelieving alcoholic his own capacity to endure tension and to shoulder his own burdens. The operational principle is identical in both cases -- the pastor’s acceptance of present weaknesses and his support of potential and emerging strengths.
As an important postscript to the pastor’s healing orientation -- his acceptance of the alcoholic’s inalienable right to procrastinate or even to fail totally -- needs to be mentioned. This is one of the tough tenets of theology which in actual clinical practice becomes a liberating therapeutic principle not only for the pastor but for the alcoholic as well.
My thesis has been that, given adequate clinical training, the clergyman can become the key member in a team approach to alcoholism. The obvious discrepancy between clergy potential and practice has been traced to the minister’s attitudes toward the illness and to his own inhibiting insecurity about his professional competence. His definitive contribution, nonetheless, lies in his capacity, however dormant at present, to respond to the alcoholic’s demonstrably pastoral needs. Building on this thesis, let me suggest some rather particular contributions which may be made by parish clergy.
Early Intervention. The clergyman who is alert to his pastoral responsibilities has the opportunity, as well as the responsibility, to know in considerable detail the pulse of his community. He still enjoys the respect of the citizenry. He is seen as one who is concerned about the preservation and implementation of the ethical and human values in community life. He is, in addition, a person who has an entree into the homes and family life of his parishioners, as well as many other persons in the community. He is looked up to as a person who can give guidance, counsel, and genuine concern from a perspective that transcends the relative values of present-day culture.
This means that the pastor -- to the extent that he has eyes to see and ears to hear -- can pick up the early signs of problem drinking. Along with the family physician, be finds himself in a unique position to work at early intervention. Sometimes this intervention will take the form of direct efforts to motivate the alcoholic toward early treatment and care. Frequently, it will mean helping the family of the alcoholic relate to him (or her) in such a way that he will be confronted with the reality of his alcoholism at an early stage.
Too often, however, the pastor becomes a person whom we might describe as the "happy fixer" or, on the other extreme, the "finger pointer." The happy fixer is the pastor who sees the solution for the alcoholic in terms of solving his immediate problems. His thinking is that he is thereby really aiding in a recovery from alcoholism. The happy fixer stays busy getting the alcoholic out of jail or out of jams. He works at getting him a job to replace the one he lost last week and labors at patching up quarrels between husband and wife. What the happy fixer fails to understand, of course, is that the alcoholic lives by a series of crises and dependency demands. Thus, the happy fixer unwittingly perpetuates the alcoholic’s sick patterns of living.
The finger pointer is the pastor with all the answers. His answer may be a hell-fire-and-brimstone condemnation or it may be a very enlightened explanation of the latest theories on alcoholism. At either extreme, the idea is that handing the addictive drinker the right answer will do the job. The difficulty, of course, is that the alcoholic’s problem is precisely his inability to translate other people’s answers into his actual scheme of living.
Early intervention actually begins with the pastor’s ability to accept the alcoholic where he is without making unrealistic demands, while setting firm limits. The alcoholic needs to know that our concern is genuine, but he has to learn that we will consistently refuse to make his decisions for him. He needs to experience our respect for his potential strength. Such respect comes through in our willingness to let him face the consequences of his own behavior. The task is to offer compassion without getting bogged down in sympathy, to offer consistent limits without falling into moralizing judgments. It is the task, also, to recognize both the child and the adult within the alcoholic.
One aspect of early intervention is what might be called the availability of the minister -- meaning more the attitude than the situation. There is no other profession that advertises its offer to be used in the sense that the clergy does. Frequently, however, we associate this being used with our experience of being made an easy touch. The rather natural human reaction is to become angry, resentful, and suspicious of persons who dare to accept our invitation -- who dare to attempt to use us.
I am convinced, therefore, that we need to take a long, hard look at what it means to be "used" so we can begin to set it in its positive perspective. It is obvious that nothing significant is going to happen between us and the alcoholic if we attempt to change his way of life without at the same time permitting ourselves to become genuinely involved. This brings us to the question: How does the alcoholic seek involvement with us? The alcoholic’s first move is frequently to try to manipulate us, to make us a patsy who will meet his sick dependency needs. We need, therefore, to be aware that these attempts at controlling us are the alcoholic’s characteristic way of asking for involvement. Any real relationship with the alcoholic, therefore, inevitably opens us to a whole series of manipulative demands. But this behavior, including even his acts of drinking, is basically his sick, desperate attempt to relate to other people.
Our role then becomes, first, to learn to recognize the ways in which the alcoholic tries to involve us, and, second, to make some constructive use of that involvement. The criterion is whether we are being used appropriately or inappropriately. It becomes the responsibility of the minister to utilize the involvement for growth away from sick dependency and toward the mobilization of potential strength and responsibility.
Treatment. In order to understand the treatment role of the clergyman, we must determine our basic pastoral goals in relation to the alcoholic. It is my belief that both long-term and short-term goals are best viewed as the development of a relationship rather than as a process of problem-solving. The development of a relationship marked by (1) mutual respect, (2) an acceptance of the alcoholic as he is, and (3) a response to the person beneath the mask is basic to effective counseling with the alcoholic. Such a relationship is also basic to help him accept the fact that he has an illness; it is essential to an eventual referral process and to an ongoing or follow-up pastoral care.
The alcoholic, however, regularly complicates the situation by asking us to solve his problem. He frequently seeks us out during a crisis, bringing a great hunger for dependency: "Take care of me," he says. Unless we understand that he is really asking for a relationship, we will miss the key factor. To solve his problem -- to fulfill his dependency needs on his terms -- will inevitably lead him to find some excuse for becoming very angry with us. Dependency simply works that way.
The answer, of course, is a realistic relationship of respect in which we accept our responsibility for determining the appropriate and inappropriate use of our involvement. Once such a relationship has been established, the next step is that of referral. To refer an alcoholic to other helping agencies should never be seen as ducking our pastoral responsibilities. On the contrary, it is a recognition of our professional responsibility in the team approach to alcoholism.
Meaningful referrals must be based on a genuine knowledge of community and regional resources. We need to know more than just the name and telephone number of a clinic or a member of A. A. As the minimum essentials for adequate referrals the pastor should have a firsthand, working knowledge of available detoxification facilities, local A. A. groups, nearby rehabilitation centers, and those social agencies which can render service to the alcoholic and his family.
Successful referrals are never simply the handing out of information or the making of telephone calls. Timing is extremely important. A premature referral to A. A. or to a hospital or rehabilitation center will be interpreted by the alcoholic as rejection.
Once a satisfactory referral has been made, the pastoral function becomes one of following through as a member of the helping team. Here again we see the pastor’s need for some real knowledge of the rehabilitation program to which the alcoholic has been referred. It is the pastor’s responsibility to keep in touch, to keep the lines of communication open, and to offer his support even though some other person or agency has assumed the primary role in treatment.
Another important aspect of the pastor’s referral work is the support and interpretation he can offer the alcoholic’s family during the rehabilitation process. Resident patient care for a breadwinner may place additional pressure on the family’s financial squeeze. A slip during the rehabilitation process may seem to the family to wipe out all their earlier hopes. Even when rehabilitation is most successful there are the strains of accepting the alcoholic as he experiments with new patterns of relating to his wife and children. In all these cases the clergyman can be a key member of the treatment team as he responds to alcoholism as an illness involving the whole family.
The clergyman also needs to bring to his referral efforts the attitude which says: "If one approach doesn’t work, we’ll try something else." The pastor cannot afford the luxury of putting all his eggs in one basket. There simply is no such guaranteed basket available. No one facility, resource, or approach has all the answers to this particular disability. If at first you don’t succeed, join the club and try again.
In addition to those services which the pastor can render personally, there are the resources of his church. Sermons, church-school groups, and youth groups offer regular opportunities for the pastor to state his interest in and support of the alcoholic and his family in their struggle for sobriety and meaningful living. Larger churches or clusters of smaller churches might even form special groups for alcoholics, their spouses, or their families. Alanon and Alateen have shown very clearly that the spouses and children of alcoholics have a special need for support during the strains and stresses of the long rehabilitation process.
Finally, there are specifically religious resources which the clergyman has to offer the alcoholic. But a word of caution is needed here. Most alcoholics in the early stages of treatment and care have difficulty in the appropriation of the traditional resources of Scripture, prayer, sermons, and worship. Out of their deep feelings of guilt and their fear of rejection, they back away from these resources -- feeling more threat than comfort. It is not uncommon, however, for these same alcoholics to begin, at a later point in their rehabilitation process, to seek the answers and resources of their faith. The best rule of thumb at this point is to wait patiently -- listen more and talk less.
Education. Few people in the community occupy so favorable a position as the minister in terms of opportunities to aid in education about alcoholism. Each week he enters into a series of dialogues with individuals and groups, each dialogue offering an opportunity for speaking to the facts and attitudes involved in this aspect of the human condition. Unfortunately, ministers have tended to sit back and wait for other professionals to take the lead. My suggestion is that ministers should take the lead in educational efforts. Where other professionals of a community are indifferent or disorganized, the minister can work toward arousing an interest in the team approach to alcoholism. In those communities where the professionals are already engaged in a team approach, the minister can be of real service in interpreting these professional resources to the community at large. In many of our smaller communities the place for the clergyman to begin is to develop a line of communication about people with problems of alcoholism with at least one local doctor. Out of this working relationship other doctors and ministers can gradually become involved. Bear in mind that doctors, like pastors, get lonely and discouraged, and begin to wonder what they really have to offer the alcoholic. The two should sit down together and talk. As a team, these two members of the helping professions can find endless opportunities to transmit the message of the alcoholic’s need -- and his hope.
Prevention. The prevention of alcoholism is a function in which clergymen are already involved. Every effort made by a pastor or a church group to strengthen the roots of personal or family living is an effort toward the prevention of alcoholism. To put it another way, our traditional calling to make men whole and our traditional ministry of reconciliation constitutes a fundamental effort in the area of prevention of alcoholism.
The alcoholic, even before he takes his first drink, is a fragmented person, plagued by guilt and ever fearful of rejection. Thus, even in the nursery department of the church school the teacher who genuinely accepts and cares for a little toddler makes a significant contribution to the future life of a man or woman. Honest and straight-shooting youth leaders can help young men and women to break through their incipient shells of isolation and to know the value of sharing their feelings with others. Warm, accepting groups of members in any local church can provide a constructive alternative to the alcoholic’s flight into the bliss of the bottle.
Thus, each time we communicate good news to persons oppressed by the fears of bad news, we have joined the fight against alcoholism. We can help our congregations to move beyond the structures of a burdensome, legalistic morality. We can lower the barriers of prejudice and judgment against the weaker brother. By so doing we contribute to the prevention of alcoholism.
For all the dangers of simplification the principle is clear: a person either learns constructive ways of handling the stresses of life, or he is tempted to learn destructive escape techniques. Alcoholism is one such escape technique. And persons learn these constructive alternatives from other people -- family, teachers, minister, friends. The clergyman is in a key position to teach men and women, boys and girls, that real living comes to us when we give up hiding and begin to turn toward other people, toward life, and toward God.
All I have said points directly and unmistakably to the fact that parish clergy desperately need expanded training opportunities in the field of alcoholism. The potential is great. Unfortunately, however, most of this potential presently lies dormant. It is my conviction, moreover, that this will continue to be the case until increasing numbers of clergymen can receive additional training within a clinical setting.
In a five-year period the training project at the Georgian Clinic has exposed approximately 1,300 pastors and seminarians to the problem of alcoholism. A small number of these, approximately 30, entered into six or more months of full-time training. We used the clinical training model in which trainees primarily work directly with alcoholic patients under close pastoral supervision.
We have visualized the dynamic nature of the training process -- where the heart of learning and teaching of pastoral care lies -- by seeing the trainee surrounded by: (1) the community of patients, (2) the staff (representing all other helping professions) , (3) a peer group of trainees, and (4) the chaplain supervisors. Our aim was to equip the clergyman to become involved in a more meaningful way with alcoholics and their families. Evaluation studies have indicated that we have effected such change.(A more complete description of these areas of involvement is contained in a three-year report "Pilot Project for Clinical Training of Clergymen in the Field of Alcoholism," which may be obtained in writing Georgian Clinic Division, 1260 Briarcliff Road, NE, Atlanta, Georgia 30306.)
For additional reading
Alcoholism, A Source Book for Priests. Indianapolis: National Clergy Conference on Alcoholism, 1960.
Clinebell, H. J., Jr. Understanding and Counseling the Alcoholic. Nashville: Abingdon Press, rev. ed., 1968.
Keller, John E. Ministering to Alcoholics. Minneapolis: Augsburg, 1966. Shipp, Thomas J. Helping the Alcoholic and His Family. Philadelphia: Fortress Press, paperback, 1966.