Chapter 22: The Staff Clergyman’s Role in a Comprehensive Mental Health Service by Lloyd E. Beebe
People using the services of a comprehensive community mental health center may and often do express their concerns in religious terms. There is a religious dimension to coping with the conflicts of emotional disturbances. For many it is important that they try to find some meaning or purpose in their struggles or to evaluate, perhaps for the first time, the implications of their faith in their crisis situation. It is at this point that the role of the clergyman can be most clearly seen. The clergyman on the staff of a mental health center must not only define his role in relationship to the person having difficulty, but he must also define his role in relationship to the center’s staff members, who are also interested in helping this person overcome his difficulties.
The clergyman represents a point of view about the nature and destiny of man. He represents a professional group which is very close to the problems of people, and he also represents a community of people who are interested in the implications of their religious point of view for their daily lives. From this perspective it is imperative that ways be found to share insights on the understanding of man and of helping him to deal with his life, by a cooperative effort between clergymen and mental health professionals. This chapter will present some ways in which the role of the staff clergyman is being worked out at the Hennepin County Comprehensive Community Mental Health Center with the hope that it will offer some suggestions for developing clergy roles in other centers.
While the clergy staff person represents the religious dimension of living, he is not a pastor in the usual sense of the word. He does not function or have the same responsibilities as the pastor of a church or temple. He does not have a group of people who have called him to be their religious leader, nor does he have an identifiable flock for whom he is the shepherd. He must necessarily be concerned about the care of all the people regardless of their particular religious affiliation or non-affiliation. He is not interested in converting a person to one particular religious viewpoint. The staff clergyman may perform some traditional pastoral functions (e.g., administering the sacraments) , but his main function is to help the patient to identify and use his own religious resources. This role may be difficult for both the staff and the patients to adjust to, because both tend to view the staff clergyman in terms of their experience with his traditional role in the community.
Some community clergy may have their difficulties, also, in understanding his role. It is very important that they understand and support the role of the staff clergyman and not view him with suspicion when his religious views are different from their own or when his goals in working with people seem to be different from their goals. The staff clergyman’s job is to help them be more effective in their work with people.
In reality, then, the most helpful stance from which the work of the staff clergyman can be viewed is that of the "religious expert" -- to use a helpful phrase introduced by E. Mansell Pattison. This describes his field of interest, his scope of activities, and his relationship to the other staff people and to the patients. By training and experience, the staff clergyman’s expertise is in the area of religious knowledge and understanding. While he certainly possesses communicating skills and a basic understanding of social and psychological functioning, he is not a social worker, psychologist, or psychiatrist. His primary job is to bring what resources he can to the total understanding of the person who is experiencing emotional difficulty. This may mean helping a patient deal with the implications of his faith for his problems, raising the issue with the staff regarding the effect of the religious dimension of a patient’s life on his present behavior, or in helping the staff to deal with their own religious feelings or understanding.
From this basic role of the staff clergyman as the religious expert, a number of different functions can develop, because his area of competence is recognized and he is not seen as competing with other staff members. Working along with the other staff members, he is free to help develop and implement the philosophy and program of the mental health center. His functions may include:
A. Counseling. How much and what kind of counseling the clergyman does will probably depend to some extent upon his own interest and training. It will also, however, depend upon how he wants the staff to understand his functioning, and this is the crux of the matter. Relationships to individuals are still important even though ideas are changing as to how much time is spent in therapy with individuals, with groups, and with the total social milieu. While I have tried to describe rather carefully the pastoral role of a clergyman working in a mental health center as contrasted to that of a parish pastor, I think it is important that some aspects of his pastoral role be maintained diligently -- his openness to all levels of pastoral conversation, his availability at all times, his understanding of and empathy with the deep yearnings of people for a sense of purpose and meaning in life, forgiveness, moral clarity, the sense of the holy, and the importance of confidentiality and continuity in relationships. The staff clergyman is uniquely equipped to function in these areas with people, and he must learn how to use this uniqueness as creatively as he can. Gordon Allport believes that the reaching out for life may be as important as the reaching back into life. He makes the remarkable statement "that what a man believes to a large extent determines his mental and physical health. . . . Religious belief simply because it deals with fundamentals often turns out to be the most important of all."
All this is to say that if the staff clergyman has confidence in the uniqueness of his role and the other staff members begin to understand this role, his counseling will take on a kind of helpfulness that can be very supportive to the staff. When a patient’s problems are related to religious or moral conflict, the staff clergyman would be the most likely person for the patient to see because of his authority in this area and because he may be perceived by the patient to be the most appropriate person to deal with these problems.
B. Consultation. Consultation may become a primary function of the entire mental health center staff as more is learned about how to use the resources of community caretakers more effectively. Of the five services considered essential by the Department of Health, Education and Welfare to the functioning of a comprehensive community mental health center, the statement on consultation alone discusses the role of a clergyman. This may be an indication of the importance placed upon consultation, but it may also indicate uncertainty about other possible roles for the clergyman, an uncertainty which needs to be worked out.
Within the center itself, the clergyman may be the consultant for the staff in regard to religious conflicts being expressed by their patients. Questions of a particular religious culture or theological position may be important to understand. Religion can often be a powerful motivating force in people’s lives or instrumental in forming attitudes toward illness, conflict, or suffering. The staff clergyman can be helpful in dealing with these areas and in helping the patient to mobilize his religious resources constructively. During staff conferences the influence of religious values is sometimes overlooked. The clergyman can remind the staff of this factor and help to interpret it. The Chief of our Clinical Psychology Department, Dr. Thomas Kiresuk, has noted that once he lets his patients know that he is interested in their religious concerns, his patients frequently will be more expressive in using religious language than when using the language they think he wants to hear. The clergyman can help the staff feel more comfortable in discussing religious material and understanding this religious language.
Community clergy have important information about and relationships to patients being seen by the mental health center. The staff clergyman can keep the center alert to this resource and encourage the involvement of the pastor in the treatment program. Sometimes this clergyman is the key person in the follow-up work with the patient upon discharge from the center. The staff clergyman can help to interpret the work of the center to the patient’s pastor so that he will understand more clearly the problems of his parishioner and be able to help more effectively.
Many community clergyman feel inadequate when it comes to helping with the emotional problems of some of their parishioners. A vast resource is available here through developing more effective consultative techniques for use with these clergymen. It is the job of the staff clergyman to help to develop these techniques.
C. Education. There is a good deal of information available in a mental health center that is important for the clergyman to know. It is the responsibility of the staff clergyman to help to make this information available to the community clergymen. He may do this through conducting continuing educational programs, clinical pastoral education, or by leading seminars on special topics such as suicide, grief, or alcoholism. At Hennepin County, for example, seminary students in our clinical pastoral education program have learned a good deal about suicidal people and crisis intervention by participating in our Suicide Prevention Service under the supervision of that staff clergyman. They have learned about the community resources which are available for help and how to use these resources. It is important that the staff clergyman assume the responsibility for the education of his own professional group. The staff clergyman understands the work of the clergy and can relate his information directly to their concerns. This does not mean, of course, that other staff people are not involved, but it does mean that the staff clergyman can help to integrate and focus the information so that the community clergyman is functioning as an effective clergyman and not as a clergyman with some mental health information.
D. Special Activities. The staff clergyman may be involved in any number of therapeutic activities. At Hennepin County he has worked closely with the problem drinker and Alcoholics Anonymous. Patients are often referred to him for evaluation and recommendations to the proper resource for help. He has also helped to mobilize the community toward a cooperative approach to the treatment of the problem drinker.
At the Day Treatment Center one group was formed specifically to deal with religious problems. Many patients were expressing religious conflicts, and it was felt that a group should be formed to deal with these conflicts. The group is called the "Philosophy of Living Group," and all patients currently at the Day Center are required to come, as they are to all other group meetings.
The intent of the group is to deal with the cognitive level of helping the patient to integrate what he is learning about himself with his religious values. Some of the group meetings will center around one of the Ten Commandments. We have often explored the meaning of "honor your father and your mother" with patients who are having difficulty with their parents. What does the teaching "to turn the other cheek" mean to the patient who is always being manipulated by others? Sometimes the question is raised about the expressing of anger, because some patients have been taught that this is a sin. Sometimes religion can be used by the patients as an effective defense against facing their problems realistically, but at other times it can be a powerful motivating and integrating force. It is important to understand the difference and help the patient to use his religious resources meaningfully.
I have been trying to describe the role of a clergyman in a comprehensive community mental health service. There is much more to be learned. I have felt the struggle and the uncertainty as I have attempted to organize my thoughts. Mental illness and the facing of emotional crises are much too prevalent for any one group to work with alone. By working together some progress can be made. I believe that the climate is right for a cooperative effort toward our common goals of a more meaningful and productive life for as many people as possible in our society. The staff clergyman can help to make the resources of the religious community available to the mental health center, and he can help the community clergyman use the mental health center more effectively.
Specifically, both the clergy and the mental health professional can work together at the local, state, and federal levels of government in emphasizing the importance of including a well trained clergyman on the staff of each community mental health center.
For additional reading
Allport, Gordon W. The Individual and his Religion. New York: Macmillan, 1950.
Caplan, Gerald. Principles of Preventive Psychiatry. New York: Basic Books, 1964.
Clebsch, W. A., and Jaekle, C. R. Pastoral Care in Historical Perspective. New York: Harper Torchbook, 1967.
Consultation and Education. Public Health Service, N.I.M.H., Bethesda, Maryland.
McCann, Richard V. The Churches and Mental Health. New York: Basic Books, 1962.
Pastoral Services Through the Comprehensive Community Mental Health Center Program. South Carolina Department of Mental Health, Columbia, S.C., 1968.
Pattison, E. Mansell. "Functions of the Clergy in Community Mental Health Centers," Pastoral Psychology, May, 1965, pp. 21-26.
Pruyser, Paul W. "Religion and Psychiatry: A Polygon of Relationships," Journal of the American Medical Society, Jan., 1966, pp. 135-40.