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While the qualifications of a clergyman functioning in a mental health setting may be determined by his peers, professionals from various disciplines, or other persons, his ability to rise to these standards will be influenced to a considerable degree by his motivation. His own involvement in bringing the qualifications into living reality will determine the quality of pastoral care he can offer.

Motivation is a form of anxiety or discontent, as Thomas W. Klink pointed out.( Thomas W. Klink, "Relating Objectives and Educational Procedures toward Motivation," an address. Seminar on Adult Learning, Syracuse University, 1967.) It is a disquiet about things, which, when constructively organized, can prompt a person to enter and pursue the process of learning, and also to actualize his insights. It is recognized that heightened anxiety can be destructive, while mobilized discontent can be creative.

Some motivational questions need to be raised as one looks at an individual’s qualifications, as these relate to effective pastoral care in a mental health setting:

These questions might suggest that if a clergyman renders service in a community mental health setting it can be an awesome responsibility. However, if the pastor clarifies his motivation it can lead to a more effective expression of his person and therefore to more meaningful pastoral care.

Motivation then is a factor for change. It prompts one to be involved in the learning process. At least three levels of change goals are recognized by Edgar W. Mills for effective learning:

1. Change in personal characteristics of the minister: e.g., changed attitudes, greater self-acceptance, growth in insight or knowledge, etc.

2. Change in ministerial role performance: better preaching, counseling, other skills; improved relations with laymen, more effective use of community resources, etc.

3. Change in the social systems of which the minister is a part: e.g., better leader development in the church, closer bonds among clergy in the presbytery, better mental health in the community.( Edgar W. Mills, "Relating Objectives and Evaluation," address, Seminar on Adult Learning, Syracuse University, 1967.)

Such change goals fused into the pastor’s motivation can renew and strengthen his ministry. New vistas will be opened. He will become involved not merely in meeting the qualifications of his position but in enhancing his own growth and pastoral care effectiveness.

Certain minimal qualifications may need to be set as a base pointing the way for the minister’s growth and pastoral care. For the past quarter of a century efforts have been made to establish and clarify such qualifications. The matter has remained in a fluid state, though there has been general agreement in certain areas. This apparently indicates a healthy policy that qualifications are never permanent but are continually in the process of becoming.

The Association of Mental Health Chaplains ("Newsletter," Association of Mental Health Chaplains, 400 Forest Ave., Buffalo, N.Y., Vol. 21, No. 1, p. 8.) has approved standards and a certification process for clergy functioning in mental health facilities. The Association for Clinical Pastoral Education ("Standards," Association for Clinical Pastoral Education, Suite 450, 475 Riverside Dr., New York, N.Y. 10027. pp. 2, 5.) is a certifying and accrediting organization concerned with the proficiency of its training supervisors and with the quality of clinical pastoral education conducted in mental health and other settings. Program objectives and procedures have been established to determine effectiveness. Also, standards for accrediting training centers have been provided. The American Association of Pastoral Counselors ("Manual and Directory," The American Association of Pastoral Counselors, Inc., 201 East 19th Street, New York, N.Y. 10003. pp. 8-10, 22-27.) is similarly concerned with the training and certification of clergy as pastoral counselors, and accredits counseling centers.

These three organizations in a cooperative effort prepared and endorsed "Recommended Guidelines for Clergy Serving in Comprehensive Community Mental Health Centers." These qualifications were formulated in consultation with the College of Chaplains, Division of the American Protestant Hospital Association; the Department of Ministry, the National Council of Churches of Christ in the U.S.A.; the Jewish Chaplains’ Association; and the Division of Chaplaincy Services, United States Catholic Conference.

Recommended Guidelines for Clergy Serving in Comprehensive Community Mental Health Centers

The Mental Health Act of 1963 launched a bold new approach toward meeting the community mental health needs of our citizens.

This approach envisioned a comprehensive and inter-disciplinary involvement of the total community, including the religious sector, to enable people to meet the complexities and stresses of modern life.

In order that the resources of the religious communities be fully utilized, many comprehensive community mental health centers have already employed clergymen on their staffs. In addition, numerous requests have been received for guidelines for the employment of qualified clergymen. The following guidelines are offered to be of assistance to comprehensive community mental health centers, and to clergymen seeking such positions.

II. Functions:

III. Skills:

IV. Qualifications:

V. Implementation:

These job specifications for the pastor in a community health ministry emphasize three primary categories for role development. The staff clergyman would provide consultation for the community minister about pastoral care of persons in crisis, about his counseling process, and his pastoral care of families. The community minister would be recognized as a consultant on occasion to the staff clergyman and to the center’s other professionals.

A second function would be educational. The staff clergyman would offer such opportunities in pastoral care, counseling, and related areas. In some centers he would plan and supervise approved clinical pastoral education. Other similar efforts would involve him in educational efforts with churches, schools, and agencies on the community level.

A third major function focuses on pastoral services for which he would be responsible and/or in which he would participate. Such pastoral services would include worship services, pastoral visiting, intensive counseling, occasional contacts with relatives, and appropriate group work. He would encourage the community minister to provide pastoral services following the parishioner through his crisis experience whether in the home, mental health center, or institution.

In three-fourths of the plans for mental health reported from all the states in a national mental health planning effort a few years ago, the clergyman was listed as a significant helping person. It was noted that little was offered about using of his resources, little was mentioned about the educational opportunities necessary to release his potential, and few qualifications were suggested for a staff clergyman in mental health facilities. The trained, qualified clergyman can contribute out of his uniqueness in the healing community where, with other trained professionals, he assumes a vital role in crisis care to the troubled person.

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.

The development of meaningful relationships between community clergy and mental health professionals is one of several important challenges confronting comprehensive community mental health centers. While the external forms and structures of these relationships vary with each center, all are being made possible by the "new" concepts which centers are bringing to bear upon "old" problems.(Lucy D. Ozarin, M.D., "The Community Mental Health Center: Concept and Commitment," Mental Hygiene, January, 1968, pp. 76-80) Among these new concepts are at least three which have opened new potentialities for the community clergyman.

First, the center views the prevention of illness and the fostering of health as of equal importance to treatment. While treatment facilities are important aspects of the organization, centers are more than super-clinics offering multiple services to the mentally ill and retarded. Staff time and professional resources are legitimately involved in assisting other community agents and agencies engaged in various public service programs.

Second, the concept of comprehensiveness has meant an interdisciplinary approach at all levels and in all facets of the center’s program. There has been a recognition of the resources and assets of many other helping professions and occupations, and a utilization of them in the operation of the center.

Third, the centers have recognized the importance of "community" to the success or failure of their development. They have reaffirmed that mental health and/or illness do not exist in a vacuum nor can they be treated in one. Center personnel are actively working in reciprocal relations with other community helpers so that the full potential of both may be realized. Since community clergy and religious groups are also interested in mental health there are many areas for fruitful collaboration. These areas are more easily discerned when seen in relation to the five "essential services" each center must offer.

Consultation and Education. The service of consultation and education is of key importance in the growth of comprehensive community mental health centers. It represents the means whereby the mental health resources of the center becomes linked to the mental health resources of the community in a complementary manner. Prior to the development of this service many community clergy performed their mental health functions in isolation from other concerned professionals. Referrals were usually from clergyman to mental health facility, and the information accompanying such referrals tended to flow one way, as if the clergymen bad little to offer of practical value to the mental health professional. As centers develop this service they are realizing it must be a two-way process. Because of their involvement in so many community functions, community clergymen possess a wealth of knowledge about the attitudes, feelings, and organizational structures present in the community. Some centers now include clergymen on their ongoing planning committee, which has as its task the responsibility to keep the center relevant.

Consultation also increases the potential value of the clergyman as a care-giver because it affords him professional support. In one center the consultative service was offered each time a clergyman referred a parishioner for treatment. The result was that 80 percent of these parishioners never became clients of the center but were maintained by their pastors.( Frank S. Moyer, ‘Shepherd Without a Fold," The Clergy and Psychiatry, Community Services Division, Nebraska Psychiatric Institute, 1967.)

Community clergy are also being contacted when their parishioners are accepted as clients. Usually these men are able to provide additional information about the client’s lieben sitz so that the treatment plan may be better geared to meet his needs.

Educational programs for clergy in areas of mental health and illness have involved thousands over the years. Some community pastors have spent whole summers in clinical pastoral education programs as well as graduate degree programs in counseling, sociology, and similar fields. Centers have learned that greater effectiveness is achieved when they involve these local clergy in planning local programs. Also, they are learning that many of these clergy may be of value to the center’s own in-service education programs. Few mental health professionals have had courses in theology, comparative religions, or ethics; nor have they had the opportunities to learn the intricacies of their communities as have clergymen.

If consultation and education are done on a reciprocal basis, then a mutuality of concern and involvement is established. In this way the uniqueness of both is respected, and neither runs the risk of being patronized or misused.

Emergency Service. The emergency service facility or unit should enjoy a close working relationship with community clergy. The pastors have long had to deal with emergency situations alone and usually welcome any who offer to relieve their burden.

Emotional crises among members of the community tend to be both fragmented and complicated. They seldom follow classic symtomatology or respond to traditional treatment. Yet many mental health personnel and clergymen are still being trained to deal with these crises by classical methods. Let me illustrate: One area pastor recently reported the situation of a female parishioner who became progressively more disturbed. She had been hospitalized previously for an emotional illness and the family had been told to get early treatment should it recur. Being new in the area, the husband called the community pastor for suggestions and referral resources.

This pastor visited the woman, recognized an acute fulminating psychosis, and called the local center. A "team" was convened to meet with the patient, her family, and her pastor to evaluate what treatment was indicated. This team, which did not have present either a psychiatrist or psychologist, decided she should remain at home under medication and with supportive help from the pastor. The decision was made in the erroneous belief that home would be similar to the institution, which had nurses to supply medication and other staff members to help set limits. This woman became worse, refused to take her medicine, and had the whole neighborhood upset because she went from door to door. Whom did they call? The community pastor, wondering what he was going to do about it! When he called the center they still wanted to continue the first plan. Fortunately, this trained community pastor demanded that more competent help be obtained or he would camp on the doorstep with the patient.

The reasons for describing this are to emphasize the many roles the community pastor plays and why collaborative efforts must be made. Collaboration in planning treatment programs helps to avoid many emergency situations and minimize the trauma in others.

We now recognize that immediate assistance for persons facing emotional emergencies increases the prospects for a healthy resolution. Communities have a long tradition of calling clergymen in such crises. Many centers have recognized this and have joined with clergymen in the development of creative programs for emergency needs. These include twenty-four hour telephone service, suicide prevention programs, after-care programs for released patients, and home visit programs.

Partial Hospitalization. The opportunities for more direct service for the community pastor in the partial hospitalization program are manifold. If this service is to be either a bridge between inpatient service and his home or to provide treatment without leaving the community, the pastor should be invited to participate if the patient indicates a church preference.

In addition to visitation, many community pastors could conduct groups at the day care center or other partial hospitalization programs. These should be not group therapy sessions, but discussions. As a pastoral function he could introduce studies of the religions, or of current situation ethics. If it is conducted as pastoral act, it will be therapeutic.

Some church groups may also wish to operate a partial hospitalization unit as part of the center. This might be a day care facility such as The Threshold in Champaign, Illinois.

Outpatient. The outpatient service is one area where cooperative efforts often have failed. Once the patient is referred for treatment, many pastors are not sure what role to assume. Yet, in between visits the patient-parishioner sees the pastor at worship services and in other areas of activity. Often the pastor is called for little emergencies which need band-aids. Some pastors are told to maintain only a superficially supportive role during this period. This, allegedly, protects the patient from having two therapists who may work at cross-purposes. Others, the majority, are given the green light to continue in whatever manner desired. Here the implication is that the minister’s therapy will be of no consequence either for good or for had.

Neither approach is valid. The hands-off system fails to grasp the pastor’s role as a pastor. It does not understand that to offer only superficial support means he is not able to involve the patient in the strengths of faith -- for faith, to be strong, cannot be superficial. The opposite, or "it’s-of-no-account," approach represents a conceit inappropriate to any community mental health professional.

Any community pastor who makes a referral to the outpatient service should be given the opportunity to join the therapeutic effort in whatever role is effective. Some few may be therapists using the center staff as consultants. Most will be able to contribute to the social history. All will continue to serve the patient as pastor, and that role may be used therapeutically.

Inpatient. The opportunities for the pastor to be involved should continue once the patient enters the residential treatment program. This is assumed because of the short-term nature of treatment and the community involvement concept. Pastors should do the major share of pastoral visitation, conducting worship, and similar functions. Chaplains, if employed, should be used only where their expertise is required. This helps to insure continuity with the community for the patient.

The future of comprehensive centers depends on our ability to grasp the significance of the community and its resources. Centers must learn how to accept the various care-givers in their natural roles. They must let them treat those they traditionally have been treating -- rather than becoming screening agents for them. If they attempt the latter, the manpower needs will never be satisfied.

The community pastor works most effectively when there is open communication, encouragement, mutual trust, respect, and cooperation. If centers will approach the community pastor in that atmosphere, a relationship may develop in which both grow toward more effective service in their community.

Local ministerial associations should initiate communications with their centers offering to serve as professional resource personnel. They should assume responsibility for planning and implementing their own educational programs and use the center’s resources where applicable. The most urgent need, however, is to develop creative means of working together with centers in the areas of prevention. This working together in preventive education not only lightens the burdens for both groups, it establishes that close sense of community that is a powerful resource for health and against illness.

For additional reading

Consultation and Education, Public Health Service Publication No. 1478, N.I.M.H., Washington, D.C.

Moyer, Frank S., "Consultation as a Pastoral Function," Occasional Paper, #681, Lutheran Social Welfare Services of Illinois, January 1968.

Schofield, William, "In Sickness and in Health," Community Mental Health Journal, Fall 1966.

Approximately one-fourth of the comprehensive community mental health centers that were operational in 1968 had clergymen on the staff; another 25 percent had a staff person designated to work with the churches and clergy within the catchment area being served; and the remaining half of the existing centers generally acknowledged that one of their goals was to relate in some helpful way to the churches and clergy, but had not yet formulated any plans for accomplishing this. In a limited study, conducted under the auspices of the Department of Ministry of the National Council of Churches, 18 community mental health centers were specifically evaluated for involvement of clergymen.(Berkley C. Hathorne, unpublished manuscript, "The Role of Churches and Clergy in Relation to Comprehensive Community Mental Health Centers," 1968. The centers selected for study either had existing programs relating to local churches and clergy or had clergymen functioning on the staff. Personal visits and interviews were undertaken at twelve centers while written reports and oral presentations at professional conferences gave sufficient information to include six additional programs.)

Among other aspects of the program of the centers that were evaluated was the nature of relationship and involvement of clergymen with the community mental health centers. There are five ways the clergy were observed being related to centers:

(1) in the planning, organization, and administration of centers;

(2) as ancillary mental health workers; (3) as consultants;

(4) as part-time staff persons; and (5) as full-time staff members.

1. It is apparent that in nearly every instance the clergy has been included in the planning of the community mental health program at the national, state, and local level. Many of the clergy selected for this responsibility were already giving leadership in mental health work through state mental health associations; a smaller number were selected because of their special training and experience in mental health ministries. However, the majority of those involved were ministers, priests, or rabbis who were well known as community leaders, usually in charge of a large influential congregation. Seldom were minority groups represented, and usually the clergy selected were not totally informed concerning current developments in the areas of pastoral care, counseling, or religion and mental health. As the centers themselves have come into being, fewer clergymen have been involved. The majority of the centers are related to existing institutions which already have a board of directors, some of which, of course, have clergymen on the board. Newly constituted centers, organizing a new board, usually include a local clergyman on the board of directors. Again, however, he is usually selected on the basis of community leadership, rather than expertise in matters of mental health, or how representative he is of the community being served.

A small percentage of the functioning comprehensive community mental health centers are sponsored by church-related institutions. In these cases, clergymen are often involved in the administration of the center. For example, the Mennonite Church has established several community mental health centers, and several are adjunctive services of institutions of the Roman Catholic Church. In both cases, professional church workers are largely responsible for the administration. Of course, in all such cases, the centers serve all people within the catchment area without regard to creed, and the professional and supporting staff of the center is representative of all faith groups.

2. The staff members of most community mental health centers view the local parish clergyman as an ancillary mental health worker. It is well established that many people go to their minister, priest, or rabbi with their personal and emotional concerns; therefore, the mental health professionals seek to relate to the clergyman as a "mental health gatekeeper" in order to reach people in need of mental health services. To accomplish this, about one-fourth of the centers have assigned a nonordained staff person to foster relationships with the clergy and the churches. In some cases the person is a psychiatrist (as is the case at the Temple University Mental Health Center in Philadelphia) or a psychologist, but most frequently he is a social worker. One of the major purposes of such a staff member is to relate to the local clergy in order to develop a referral net which makes it possible to reach the people the center is organized to serve.

Dr. Robert H. Felix has termed the parish clergyman "the first line of defense in mental health," and stated that he represents an untapped resource for the early detection, referral, and treatment of persons and families in community mental health. As the effort is made to push mental health back into the neighborhood and the family, the role of the clergyman takes on new importance. He is one of the few professional persons who relates to the individual in the context of his family and community. The staff members of the centers generally recognize the potential of the local clergy and the churches as community resources but express bewilderment as to how to relate to the various clergy and local congregations in a manner that will be mutually helpful.

This frustration is illustrated, for example, by the inability to understand the small number of referrals by clergymen to the mental health centers (approximately 3 percent) , whereas the expectation is that local clergy should be a primary source of referrals. The major reasons for this discrepancy is the fact that the local clergyman feels that (a) there is no one on the staff of the mental health center to whom he can personally relate, and (b) when he refers a parishioner he feels that his concerns are not adequately represented by anyone on the staff of the center, and (c) he feels that his role and relationship with the parishioner or the family is not recognized or utilized as an important part of the experience of therapy either during the treatment time or in the after-care period.

The idea of the clergyman as a "gatekeeper" is, in some ways, not a very flattering concept. Though not intended, it is quite demeaning, for a gatekeeper is, first, one who is outside, and, second, one who screens who goes in and who comes out, and nothing more. Most clergymen want to be seen not simply as gatekeepers, but rather as partners in mental health development and treatment. They want to be more than part of a referral process for the center. Such clergy would suggest that they might be used not simply as gatekeepers, but in programs of primary prevention, in some types of treatment, and in supportive after-care. For example, such things as life adjustment counseling; community social action; marriage and family life education and counseling; social, religious, and therapeutic group experiences; and the after-care of patients by means of a supporting, redemptive fellowship contribute to positive mental health. The clergyman performs a historic and meaningful caring and curative role. His primary orientation is working with people through all the experiences of life. He often sees a spiritual dimension bound up in numerous cases of emotional problems, although it is recognized that "only about ten percent of the problems brought to ministers . . . pertain to religious questions. Marriage and family problems are the most frequent of the problems encountered; psychological stress problems are second in frequency; youth-behavior problems, third; alcoholism, fourth; and problems of aging, fifth." (Research project by Eugene F. Nameche, under the Harvard University Project on Religion and Mental Health, reported in The Ministry and Mental Health, Hans Hofmann, ed. [New York: Association Press, 1960] , p. 225.)

The local clergyman should be involved in mental health in a positive way. He represents a potential for being the first line of offense in mental health. The resources of religion and the religious community have not been utilized in an attempt to foster good mental health. The positive aspects of religion have been generally overlooked, the usual approach of mental health workers being that when some people get emotionally sick they often use religion as one of their many defenses. A shift in focus and due regard for the positive utilization of religious sentiment in mental hygiene can be beneficial and will further the goals of the community mental health program. A partnership between the community mental health center and the local clergy should include consultative services with the clergy to assist them with their own pastoral care and counseling ministry with their parishioners; education and training opportunities in mental health, including evaluative and referral procedures in relation to the local mental health center; and the development and supervision of an after-care ministry with patients originally referred to the center by the local minister, priest, or rabbi. Dr. Gordon Allport states for the clergy what many of them feel. "Instead of two major disciplines demanding teamwork in the interest of mental health, there are clearly three: Religion, psychiatry, and the social sciences. Their interrelations are only now being understood." (Gordon W. Allport, The Person in Psychology[Boston: Beacon Press, 1968] , p. 148.) Partnership, not an ancillary relationship, is what is suggested.

3. In some situations clergymen have been engaged as part-time or occasional consultants in relation to community mental health centers. This has not been a typical or common pattern, but it has much to recommend it. Before attempting to relate to the churches and clergy, or to develop a clergy staff position, a few hours of consultation with an objective but highly competent clergy-consultant should be considered. Such a consultation may simply confirm the program that has already been planned, but in other cases, it could lead to a critical examination, revision, and improvement of the proposal.

At least two states have appointed full-time clergy-consultants on the stall of the state department of community mental health. The pioneer, South Carolina, has provided the consultant to work with local communities and religious organizations in the planning, implementation, and evaluation of programs and projects involving the local center and the clergy and churches. A few individual centers have engaged the services of nationally known experts in religion and mental health, such as a theological professor of related subjects, or officers from national organizations such as the Academy of Religion and Mental Health, the American Association of Pastoral Counselors and the Association for Clinical Pastoral Education. The Department of Ministry of the National Council of Churches is now able to recommend to centers the names of such consultants. In most cases, there will be such an expert within a few hundred miles of the center. In addition, the National Council of Churches can provide direct consultation with national, state, and local church and mental health organizations concerning the involvement of churches and clergy in community mental health centers.

There are no known examples of non-staff clergy-consultants being engaged by a center on a permanent basis. Centers desiring some type of ongoing relationship with a clergyman normally provide for a part-time or a full-time staff position. But it is conceivable that a clergy-consultant might he retained, for example, to attend a weekly clinical staff conference, or to conduct occasional seminars or workshops for the clergy. In a rural setting, where clinically trained clergy are not generally available, such an arrangement has much to commend it.

4. Of the approximately 25 percent of centers that have clergy on the staff, about two-thirds of these are part-time. However, if we add to the one-third full-time the number of centers that have the equivalent of a full-time staff clergyman (having divided the position into two or more part-time positions) , we reverse these ratios. In other words, two-thirds of the centers with clergy staff members have either full-time or the equivalent of full-time staff clergymen. Nationally, this means that one center in every six has provided for a full-time clergy staff position.

Most centers with part-time, rather than full-time clergy staff, have purposely selected this arrangement. In many cases, they have employed two half-time clergymen, usually one Protestant and one Roman Catholic.

This arrangement appears to be working well in such widely separated centers as Lowell, Massachusetts, and Grand Forks, North Dakota. In the first instance the two clergymen have local church responsibilities half-time, and in the latter situation, both are half-time chaplains at local hospitals. Centers that have been organized as a new thrust of existing institutions often share part of the time of the full-time chaplain of the parent hospital. Although these part-time programs were functioning well in most cases, it appeared that there was not as much happening or as many new and imaginative developments taking place as in centers with full-time clergy staff members. Generally speaking, two half-time clergy do not equal a full-time staff clergyman, assuming that they are comparable as far as training and ability is concerned. A director may feel he is getting more for his money this way, and he may in terms of hours of actual work. Also, the fact that he can have two major faith groups represented may appeal to him, although in this age of ecumenism this generally is not necessary. However, if only one clergyman is employed he must be able to relate to all the local clergy on an ecumenical interfaith basis. In actual practice, however, the two tend to duplicate each other’s work. They apparently see their task as serving the patients and relating to the clergy of their own faith group, and they lack the total involvement in the work of the center that is needed to be creative. Further, the part-time clergy tend to see their role in traditional, institutional chaplaincy terms and usually do not have the time to get very deeply involved outside the center. In other words, they are largely center and staff-oriented, rather than church, clergy, and community-oriented.

In a few centers financial considerations dictated a part-time rather than a full-time clergyman on the staff. Where this is the case, would it not be advantageous to explore possibilities of the churches helping with the support of the program? At least one center has a clergy staff person who is supported, in part, by the local Council of Churches. A few of the part-time clergy staff members were engaged to do a particular job -- for example, to do marriage and family counseling. Such a specialized role greatly limits the possibility of developing a comprehensive pastoral services and consultation program at that center.

5. The clergymen serving full-time on the staff on community mental health centers are generally well trained for their work, with a few exceptions, having had a minimum of a full year of special clinical and advanced academic preparation beyond graduate theological school. There is no uniformity of title or functional responsibilities. For example, typical titles are: pastoral services consultant, director of pastoral services, community chaplain, coordinator of pastoral consultation, and mental health specialist in religion.

The role of the clergyman on the staff of the center has not been clearly defined. This is seen in the confusion concerning the function of the pastoral specialist, both on the part of the administration and stall of the center, and on the part of the staff clergyman himself. None of the centers studied was utilizing what might be termed a comprehensive, functional approach. (Berkley C. Hathorne, "Critical Issues in Developing a Pastoral Services Program in the Community Mental Health Center," Pastoral Psychology. May, 1969.) The role is still to be defined and developed, but at this stage it is desirable to keep things flexible rather than prematurely structuring a role model. What can be observed is that the following functions are being performed (this is a composite of what now exists, although no one center is providing all functions) : (a) Pastoral services -- in the traditional sense of pastoral care and counseling, religious services, and religious education. (b) Consultation -- to both the center staff and to the clergy and churches in the community. (c) Administration and community organization -- to develop both the pastoral consultation department and the program of the center. (d) Education and Training -- in such areas as continuing education for local clergy, in-service staff training, clinical pastoral education by qualified supervisors, and educating of clergy and laymen in programs of positive mental health. (e) Therapy -- to provide a religiously oriented therapist on the staff of the center when he is qualified by professional preparation. (f) Research -- to evaluate and improve knowledge of the relation of religion and mental health.

The above functions demonstrate the diversity of roles being undertaken by clergymen on the staff of community mental health centers. For example, at one center, the staff clergyman organized the local clergy and churches in support of a county tax measure that gives permanent support to the mental health program; at another center, the clergy staff member is involved in regular, weekly consultation with local clergymen concerning their own pastoral care and counseling ministry with their parishioners; at another center an extensive training program for clergy has been developed; and at another, a program of therapeutic social action involving local clergy is planned.

Although there is no consensus of what the functions of a clergy staff person should be, what seems to be common is this: The clergyman on the staff of a community mental health center has a dual identity. He is both a clergyman and a mental health specialist, and he should have no confusion about maintaining this dual role. He should attempt to relate to the staff of the center as a mental health specialist in religion and to relate to the local clergy and community churches as a religious specialist in mental health. As long as he maintains this dual identity without negating either dimension he will be able to relate the two facets of his professional role. If the center is seeking to facilitate an interdisciplinary team approach to community mental health in which each professional functions within his own specialty and cooperatively relates to the other team members, then the contribution of the dual-trained, clergy-mental health specialist, should be welcomed.

The above is a report of the use of clergymen in eighteen comprehensive community mental health centers and some of the efforts of the centers and the clergy to relate to each other. An effective, relational bridge can best be provided by a clinically trained clergyman on the staff of the center charged with the responsibility of fostering this relationship. Such a program will be of mutual benefit to the local churches and the mental health center in a local community, for it will mobilize the clergy and the resources of the religious community in a creative partnership of community service and improved health.

For additional reading

Pastoral Psychology. Special issue on "Community Mental Health and the Pastor," May, 1969.

Pattison, E. Mansell, "Functions of the Clergy in Community Mental Health Centers," Pastoral Psychology, May, 1965, pp. 21-26.

A round-faced toddler with wheat-colored hair bounded onto the stage and smiled happily at an audience of about seventy- five people. Behind him, although taller and two years older, his sister walked slowly and edged backward to a chair, sat down, and stared at the toes of her black patent leather shoes. The assembly could not see her face at all, only the perfectly even part in her hair and the twin ponytails tied with blue bows. Now and then she smoothed out her skirt or twisted the bracelet on her arm, but she did not look up.

"What’s your name?" the director asked the small boy, and was rewarded with a grin and the clear announcement that his name was "Tommy" and that he was "free years old." When the question was asked of his sister, she did not indicate any awareness but continued to study her shoes. So Tommy provided the director with her name -- Becky -- and age -- five.

The conversation between director and boy revealed that "yes, he and his sister fought sometimes," and they sometimes hit each other. Momentary contrition clouded the little boy’s face, but he brightened up, telling about the pet dog he had been promised.

As the two left the stage, Tommy was leading as before. The director turned to the audience and commented, "This is an obvious power struggle," then asked, "What’s the story here?"

A grandmotherly type raised her hand and said, "Tommy has found the ‘charm route’ to getting his own way. He’s obviously the boss in that home."

A father with two pre-teen children sitting beside him made the next observation, "He’s clearly the mother’s favorite. The little girl has given up. She’s the one who needs help first."

Some people in the audience remembered the first visit of Tommy and Becky and their divorced mother to the Wesley Methodist Church’s Parent Education Center. They recalled that the mother, trying to handle the overwhelming responsibilities of earning a living; finding competent, warmhearted babysitters; and being a double parent, had sought guidance from the Center. Several suggestions had been made to her at that time, including the director’s guideline: "Don’t interfere with the children’s fights. They are trying to involve you. Let them settle things by themselves, without you being judge."

The mother’s current problem was the difficulty of coping with the little girl, who repeatedly wanted to hug the mother, to follow her around, to literally cling to her apron strings. The consensus of the audience was that the child was conscious of her brother’s charm, his painless method of getting his own way by eliciting attention and smiles and the impulse to love him. She was plainly discouraged, and felt the need for constant reassurance. She should have this reassurance, the audience agreed. Becky must be made to feel secure in her mother’s love, must hear the words and see the approval in her mother’s eyes, but not pity, which would only reinforce her feelings of inadequacy.

After this case, two more parents and their offspring appeared on the stage and set forth their problems -- the parents first and then the children; the parents retiring to a room out of sight and hearing so that the children would not be influenced by their presence or their reaction to what the children said. The problems are varied: bedwetting, impudence, underachievement, exaggerated sibling rivalry, to name a few. How they are solved illustrates in classic simplicity and effectiveness the whole theory of education-plus-counseling at Wesley Church.

It is possible to learn from the mistakes of others as well as from one’s own -- this is the premise on which the Wesley program is founded. For activation of the program, Wesley depends upon an informed and dedicated laity. Over 10 percent of the membership is involved in one or more of the counseling-oriented courses of action fostered by the century-old downtown Minneapolis church.

The Parent Education Center, one of the newest of Wesley’s activities (not yet two years old) , has quickly developed into a community resource that draws observer-participants every Sunday morning and has helped families from all over the Twin Cities area through various problems and conflicts.

Based on the Adlerian theory that problems are best brought out into the open and that those who know will be far less judgmental than the troubled one fears, the counseling and education program has successfully proved that people do care and people will help.

The family with problems is required to attend two sessions of the Parent Education Center (held every Sunday morning, from 9:15 to 12:00, this block of time being divided into two periods to allow for church attendance) before registering and offering its problem for discussion. Sometimes mere attendance and observation will give enough insight so that the family can begin working on its problem.

There is no fee connected with Wesley’s Parent Education Center. The children are placed in the playroom where supervisors make notes on their behavioral patterns and attitudes. This is particularly valuable since the observations are made during a time when the children are not influenced by reacting toward parents.

The parents (or parent) take a comfortable place on the stage, which is raised about fourteen inches above the main floor. The audience is a vital part of this entire procedure. Composed partly of parents with problems, it also has a heavy preponderance of the laity in training which figures so strikingly in all of Wesley’s endeavors. As the parent outlines the problem, the director will ask questions and so will people in the audience. The director of Wesley’s Center is a pediatrician, but if a physician is not available, any member willing to immerse himself in study of today’s child-care and psychology literature, and who is of a mature state of mind, flexible, outgoing, and truly interested in people, can do the job. The director guides the discussion along the lines of sound personality and character development -- with no less an underlying thesis than the Golden Rule.

Parents are urged to develop an atmosphere of mutual respect; to communicate on levels of fun and recreation as well as on discipline and advice; to allow a child to learn "through natural consequences" -- that is, by experiencing what happens when he dawdles in the morning and is permitted to experience the unpleasantness and embarrassment of being late to school; to encourage the child and spend time with him playing and learning (positively) rather than spending time lecturing and disciplining (negatively) , since the child who is misbehaving is often merely craving attention and if he gets it in pleasant, constructive ways, he will not demand it in antisocial ways; to avoid trying to put the child in a mold of what the parent thinks he should do and be, or what other people think he should do and be, rather than what his natural gifts and tendencies indicate; to take time to train the child in basic skills -- to bake a cake, pound a nail, sketch or write or play a melody -- including those things the parents know and do well and are interested in. Even if the child is not talented along the same lines, he will appreciate having the parent share the art, skill, or knowledge with him in a non-demanding way.

If the children are teen-agers, they often appear on stage with the parents and join in the discussion of the problem. But if the children are pre-teen and younger, it is deemed best to present them apart from the parents.

After hearing both sides or all sides (grandparents and the public school teacher occasionally appear, too) , the director and audience offer a number of suggestions to try during the forthcoming week. The Recorder for the Center keeps a written account of these recommendations, along with a progress report. The parent, on subsequent visits, tells what worked and what did not work, and why. From time to time, reference is made to earlier notations, so that the analysis is a comprehensive one.

Misbehavior is generally separated into four goals: the child is striving for attention, power, or revenge, or he feels inadequate and wants to be left alone. Examining the periphery of the problem generally reveals which goal the child is either consciously or unconsciously seeking and the all-important question of why he is seeking it.

The same stage comes into use later in the day as Wesley’s public psychodrama is presented. Again, the laity is in charge here, with directors of psychodramas -- for the most part lay members of the pastoral care program -- conducting these dramatic interpretations of daily problems.

The audience comprises not only Wesley members, but a wide-ranging cross section of the Twin Cities community -- students, housewives, professional men, teachers, and preachers. Again the underlying scope of the program is both counseling and educating. Almost everyone present learns something and takes home some insight to use in interpreting his own life. Later, if problems arise requiring more help and more objectivity than he can muster, he will have a background for the type of counseling done at Wesley and will be more ready and able to benefit from it.

Public psychodrama grew out of Wesley’s group counseling program. The principle of a church-sponsored group-counseling program is quite widespread now, but Wesley’s group counseling dates back more than a decade. It is an outgrowth of the continuing philosophy that church work is done not just by the minister and the official board, but by a committed congregation following a plan of "tithing of time" which can be as meaningful and productive as the tithing of money . . perhaps more so, considered in terms of involvement and in repair of people’s modus operandi.

Helpful as group counseling proved to be, with each troubled person in the group (about ten persons) finding himself strengthened, aided, and cared for by the other members of the group, sometimes there were exasperating dead ends -- psychological impasses where it seemed that the counselee had developed a blind spot and simply could not visualize his problem objectively, or from any other viewpoint than his own. Nor could he state it adequately, sometimes -- whether because he was living inside it and could not, therefore, accurately state its dimensions, or whether he simply lacked the word power to make his fellow group members see what was taking place in his life or what had already taken place.

Public psychodrama was found to be the answer to these and other problem situations. For one thing, it was often found that participating in a psychodrama would give enough insight for a person to begin a practical and progressive onslaught against his own problems.

Psychodrama is a simple device, yet in its very simplicity it often serves many complex human difficulties, doubts, and problems. "God is love" is a simple credo, yet in action its outreach is enough to change the world and every life within it. Putting God’s word to work in as many situations as possible is what the counseling program attempts. Its ways and methods are simple, basic. Help is the key word.

Psychodrama is simply the acting out of a situation, rather than the recounting of it in words. Its principal value lies in its focus. The person with a problem begins to explain the situation as he sees it: "So then my mother-in-law asked my wife, ‘What’s he going to do about the promotion?’ and I’m sitting there like a piece of furniture, wondering why she doesn’t ask me what I’m going to do. Why does she need an interpreter? I speak the language!" The psychodramatist intervenes at this point, "Don’t tell us what happened; act it out. No, don’t you be yourself in this case -- take your wife’s role."

A cast from the audience is quickly assembled so that everyone involved in the original situation is represented on stage -- the man and wife, the mother-in-law, a teen-age daughter. The man in this case may play several different roles, changing them in mid-conversation, so that the question he asks as a daughter is answered by himself playing his own mother-in-law. Sometimes the person with a problem chooses (or is advised) not to play his role at all, but to watch and listen. Through dramatization, he is unequivocally removed from within his problem. He has no choice but to see it from other viewpoints. What he sees may vary all the way from his wife’s childlike dependence upon her mother’s opinion, the mother-in-law’s hesitancy to ask him a question directly for fear of his explosive reaction, to the mother-in-law’s attempt to downgrade him in his daughter’s eyes because of her wish to have a more vital part in her granddaughter’s life. Or it may be a combination of factors. Seeing the problem through other eyes, however, gives a fresh outlook, and the man begins to take the measure of his problem.

Next question: What can he do about it? Again, psychodrama will help him choose a more constructive course of action so that his interpersonal relationships will be more pleasant, more enhancing of individual worth.

During the psychodrama there may be not only role-reversal which means that each person may assume different parts in the life-drama, but there may be, quite often, an alter ego. This person will sit or stand beside the protagonist and will express feelings he may have but hesitates to express openly.

While parent-education, group-counseling, and public psychodrama are performing their life-shaping functions, another phase of the Wesley program is beginning where life ends. The Healing Fellowship of Christian Friends was organized three years ago when it seemed that there was a gap in the ministry of the church after the initial period of mourning had passed. Bereaved persons, assisted through the first few days and weeks of grief, were still in need of sustaining help when relatives had departed for distant homes and friends were not in day-today attendance. A one-to-one new friendship was devised to close this breach in Christian fellowship. A group of fifty volunteers was assembled, trained, and consecrated into this service during a special ceremony at a Sunday morning church service.

When death occurs, a volunteer (or sometimes two) is assigned to the bereaved. His job is to sustain and comfort. He begins by asking the two most therapeutic questions: When did it happen? and, How did it happen? Then, Tell me about it. He encourages talk about the deceased, about the death, about that part of life shared by deceased and bereaved. Only by going back to the beginning of that shared life can the bereaved begin to reclaim the investment in that life and prepare for emotional reinvestment.

The Christian Friend supports the bereaved in the decisions that were made at the time of the funeral services. Did I do the right thing? is a recurring question, and the Friend does his best to assure the bereaved that his decisions were honestly based. Someone to talk to, confide in, and rely on makes grief therapy a personal thing, developed to fit each individual’s needs. A Friend may find himself arranging a birthday outing, helping to fill out insurance claim forms, taking the bereaved to visit the grave site, responding sympathetically to a phone call, helping to find new living quarters for the bereaved.

Throughout all this, the Friends of the Healing Fellowship not only aid sorrowing persons to survive a bereavement without becoming psychologically crippled, but find that they, themselves, in the process of helping others, are finding deeper and more profound interpretations of the Christian life than they could in any other way.

The Healing Fellowship of Christian Friends preceded the establishment of the Academy of the Lay Ministry by about two years and, along with group counselors, formed the nucleus of all the laity interested in forwarding Wesley’s programs. The Academy of the Lay Ministry offers opportunity for service in several categories: volunteer group counselors, grief therapists, coffeehouse workers, teachers of parent-study groups, psychodramatists, pastor’s assistants.

In the letter which volunteers received, it was emphasized that the Lay Ministry involved real dedication and work: "This is not ‘just another committee.’ I hope you will be very honest in the decision I am asking you to make, for I want only those who will be wholeheartedly committed to the tasks of Lay Pastors. Otherwise a polite ‘yes’ on your part will hamper more than help."

Sometimes the Academy has all-member sessions of training; sometimes the sessions are confined to a single area of service (although all members are invited and welcome to sit in) The group counselors will be briefed and have refresher courses by various experts, including members of the staffs of the University of Minnesota. The grief therapists will hear visiting lecturers from one of the local seminaries or perhaps hold discussion sessions on current literature in the field. Coffeehouse workers are trained to encourage reticent, timid people to express their feelings in conversational groups. Teachers of parent-study groups prepare to conduct the small groups which have developed as offshoots of the Parent Education Center’s Sunday morning program. Psychodramatists study new techniques in their work. Pastor’s assistants are coached to do their work more effectively -- that is, devoting one hour a week to visiting in the homes of members and prospective members (a total of 1,080 calls during 1967)

Wesley’s coffeehouse, "The Cup," has been operating for two and one-half years in the basement of the church, with its own private entrance around the corner from the Sanctuary entrance. A dedicated husband and wife manage The Cup, which is open each Sunday from 5:00 P.M. until 11:00 P.M. About twenty-five volunteers serve under their direction as conversationalists with lonely people who come to the coffeehouse for fellowship, or as workers to man the food counter, which serves coffee, tea, hot chocolate, and pastries at a nominal cost.

Almost any time one comes into The Cup, he will find informal discussions going on around the red-and-white checked cloth-covered tables in this dimly lit room. At 7:00 P.M. there is always a program, carefully selected by an imaginative program chairman, who gives many hours each month to contacting speakers and discussion leaders in order to insure a varied program that will appeal to all age groups and interests. An advertisement was placed in the local paper inviting critics of the church to come and voice their criticisms and discuss them at the coffeehouse. A Karate exhibition, folk-singing, representatives of various religious and political affiliations, advisors in budgeting finances are but a few of the programs presented. Everyone’s opinion is important, and people soon learn that it is safe to speak up freely in this permissive atmosphere.

All of Wesley’s outreach has produced a synergistic effect -- many times greater, because of the combination, than the sum total of all the individual programs. People have learned and helped others to learn, and with such learning has come an improved pattern of living, a life-style with Christian reference.

On April 1, 1965, the incoming lines were activated at the Help Line Telephone Clinic in Los Angeles, California. It was the first denominationally sponsored crisis counseling service in the United States to offer help to all areas of human need, caring for the whole man. It is a project of the Los Angeles Baptist City Mission Society, a division of the American Baptist Convention.

Help Line was guided into being through the creative leadership of the Rev. H. Leslie Christie. He was inspired by the pioneering effort of the Life Line Centre in Sydney, Australia, in 1963 at the Central Methodist Mission, led by its superintendent, Dr. Alan Walker. Mr. Christie caught a vision of how the telephone could become the vital link between the masses of troubled people in Los Angeles, and the loving concern of the Christian church with its good news of God’s love and willingness to help. Impressive evidence in this direction was obtained in the summer of 1963 when he led in the training of a battery of telephone counselors. The counselors were being prepared to help those responding to an invitation to discuss their personal needs which was made at the conclusion of a pre-taped telecast of a Billy Graham Southern California Crusade meeting. The response was overwhelming; calls continued coming in until late into the night. This experience convinced Mr. Christie of the potential of such a service. The success of these past three and a half years has vindicated his decision to proceed.

Hopeful of securing a broad ecumenical base of support, the Los Angeles Council of Churches was approached, but the needed funding was unavailable, so it was decided to underwrite the support within the American Baptist structure.

We found that a preparatory period prior to the opening of the service is very strategic. To communicate to your constituency the need, relevancy, and efficacy of such an operation is vital. In most denominations the pastor is the key figure, the one at the local church level who can best determine whether the plan will get a fair reception.

The recruitment of telephone counselors, lay and clergy, also is very important. An open invitation should be made to all who are interested to attend a series of preparatory training sessions. Our policy has been to accept as volunteers only those who have been endorsed by their pastor after they have applied through him. The pastors should be informed of the personal qualities needed to be an effective telephone counselor, such as sensitivity, healthy motivation, concern, stability, cooperativeness, dependability, willingness to learn, and a non-judgmental attitude. They should be accepted into the program on a provisional or probationary basis. This serves at least two purposes. It is a reminder that they remain a member of the team only as long as they continue in the ongoing training program. It also leaves a door open in case a volunteer just does not measure up as an effective counselor after there has been an opportunity to observe and evaluate. We have used the term "enlisted staff," rather than volunteers, a term which might imply that all who apply will be accepted. The final decision as to who was accepted was made by the Director. Another safeguard as to a volunteer’s acceptability could be to require the taking of the Minnesota Multi-Phasic Personality Inventory or some other similar test. Yet another could be the requiring of an autobiographical sketch with questions asked to determine how they have responded personally to stressful situations in the past.

To prepare these potential workers, a series of training sessions was scheduled. Meetings were held once a week for eight weeks prior to the beginning of the service. Resource persons from the specialities of social work, law enforcement, communication (the telephone company) , pastoral counseling, alcoholism treatment, and care for the aging were invited to share their insights, answer questions, and make suggestions. In addition, a field trip was taken to the office of the Los Angeles Police Department where special attention was given to their telephone center through which all incoming calls of a crisis nature are routed. These training sessions were helpful in illuminating vital areas in the wide scope of human problems. It was also decided to have, as a minimum, quarterly training conferences and an annual conference which would include staying overnight at a church conference ground in the mountains.

In the meantime, rapport was being established with the various helping organizations in the community. Information was being gathered as to the names, addresses, telephone numbers, services offered, and eligibility requirements of the various agencies. It was then recorded on Rol-o-dex files, to be kept within easy reach of the person handling incoming calls.

Our professional staff consists of a director (supervisor) who oversees the operation, arranges for publicity, schedules the interpretation of our work to individual churches and other groups, and recruits volunteers. He also supervises the professional staff members and participates in case review sessions periodically to keep a sensitive ear tuned to types of cases we have been handling and then notes their disposition and progress.

The supervisor coordinates various phases of the operation. It is he who ferrets out information regarding the new helping agencies that are forming almost every week in our area. He maintains a liaison with them and sees that our information and file system is kept current while doing the major part of the work of referring our clients to the specialized helping agencies. On a weekly basis he confers with the consultant and the chaplain at the case review sessions, both to review recent cases and to preview those coming up.

The staff consultant counsels almost exclusively over the telephone with those clients who have been referred to him by the intake worker. He also plays a vital part in the ongoing training program for the volunteers. He helps them to be more skillful in handling different types of problems, utilizing some of the "idle" time when they are serving but when the phones are not busy. His responsibility also includes the vital "call backs" to people who have previously contacted us, been helped, and referred to a special helping agency. His friendly call of concern for their current progress and needs is received with appreciation.

The chaplain is assigned those cases that have been referred to the staff consultant because of the depth of the problem, and it has been determined by the consultant that a face-to-face visit from the chaplain is needed. The supervisor obtains consent for a visit by the chaplain, and the appointment is set up. The chaplain’s schedule is usually filled up two or three days in advance. However, occasionally the urgency of a particular problem -- e.g., case manifesting signs of a high suicide potential -- may necessitate the juggling of his schedule. We feel that having a chaplain available for face-to-face home visits is vital for our organization, since it was founded in the spirit of One who incarnated Himself to minister to human needs. The chaplain seeks to be the client’s friend helping him to clarify the causes of his problem, to focus on some constructive alternatives of action, and to be aware of the helping resources available. A brief report is made on each visit and is kept with the original intake sheet.

Two secretaries give a portion of their time for filing, typing, and other miscellaneous tasks.

The public is informed of our services in a variety of ways. We run ads in both metropolitan newspapers on alternate days. Also, we buy space in suburban papers. Free public service time is granted to us by eleven AM and FM radio stations. Occasionally we have been interviewed on radio and television, and special newspaper articles have featured our ministry. In addition, brochures and small business-size cards have been used and distributed by churches and other groups.

As has been noted, Life Line was the first church-sponsored comprehensive crisis counseling center in the world; Help Line was the first in the United States as far as we have been able to determine. At present, The United Methodist Church is establishing some centers like this. Some individual churches and religious groups presently offer services to people who have special problems such as alcoholism, suicide, unwanted pregnancies, narcotic addiction, juvenile delinquency, blindness, old age, illness, and so on.

A good way for a church to proceed in starting such a service is to examine the needs of the community. A survey could be helpful. A committee of concerned and responsible persons could serve to stimulate interest in the membership. A study would help determine the manpower and funds needed. It would be well to project realistic needs for a five-year period to avoid a cutback later because of insufficient funds. The securing of a skilled, competent professional staff is a vital part in the forming operation also. The church willing to give to such a venture the time, effort, and expense required will be repaid manyfold by the knowledge that many people have been helped to better, happier and more purposeful lives.

Like any new venture, we encountered problems and have profited from wrestling with them. Among these has been a difficulty in maintaining an adequate number of competent volunteers. Also, we had a struggle finding an effective training program that would meet the particular needs of all the volunteers with their varying degrees of skill. Again, the churches’ interest seems to lag at times in spite of our sending out periodic progress reports and occasional case summary illustrations. Also, we have had some difficulty in setting down designated areas of responsibility in our "clinical process" within the professional staff, while also trying to have some degree of flexibility in special instances. Some of our volunteers have difficulty operating as members of a team and have caused problems by encouraging some clients to become dependent on them.

Vital to an effective service is a skillful professional staff who work well together. They need to be able to function not only within their own sphere of responsibility, but also to "double" in training the volunteer staff. A maximum of "live" coverage of the telephone should be provided during the week with the electronic recording "secretary" used only when staff members are not available. Another necessity is adequate advertising placed strategically to reach the largest number of people. An added benefit would be to get permission to have the service listed in the front of the local telephone directory with the other recognized emergency agencies, such as police, fire, and ambulance services. Also mandatory is a good working relationship with the other community helping agencies; the referral list must be constantly revised and updated. An effective training program is a requisite, and included should be appropriate recognition and awards given periodically to remind volunteers of their importance and your appreciation. Our training program has inspired several of our volunteers to enroll in college classes in human behavior, suicide preventive seminars, and pastoral counseling courses. Case review sessions scheduled at least weekly are necessary for the professional staff. Records need to be kept and the inactive cases periodically shifted to prevent the files from becoming too cumbersome.

It is imperative to stress the need for the wholehearted backing of your constituency before you begin. We have found it very difficult to make up later what we did not get at the outset in interest and support. It is important to set goals high enough to challenge, yet realistic enough to be accomplished. There should be an understanding with the volunteers that they will have to meet certain standards of involvement in the training program to maintain their active status. Included as a part of these standards should be the serving of a minimum number of hours on the line during a set period, attending a certain minimum number of training conferences a year, and complying with requests to come in for special individual conferences relative to problem areas. We have found that volunteers tend to lose their interest in the program more quickly by idleness than by being overly busy answering calls. To help them avoid boredom, we try to arrange for them to have something useful to do when not on the phone, such as stuffing envelopes or typing records.

It is best to determine and explain to all involved the "clinical approach" to be used. Our method is to have all incoming calls handled by the volunteers; the more serious ones are referred to the staff consultant, and those whom he feels could profit from a home visit are turned over to the supervisor, who arranges an appointment for a visit from the chaplain. This approach avoids confusion, but flexibility even here is necessary, since overlapping in certain cases will be unavoidable. Another lesson that will be learned as one proceeds is what is the appropriate time and method of referral and when it is best to continue in a supportive role until the client is able to accept a referral and not misinterpret it as rejection.

It is hoped that some readers will be encouraged to initiate the formation of a crisis counseling service in their communities. They will find the challenge exciting, the experience rewarding, and the accomplishments fulfilling. God speed you on your way!

For additional reading

National Institute of Mental Health. Manpower: Utilization of Non-Professional Crisis Workers, by Samuel M. Heilig. Planning Emergency Treatment Services for Comprehensive Community Mental Health Centers, 1967.

Pretzel, Paul W. "The Volunteer Clinical Worker at the Suicide Prevention Center." Los Angeles: Suicide Prevention Center, 1968 (mimeographed)

Rioch, Margaret; Elkes, Charmian; and Flint, Arden. Pilot Project in Training of Mental Health Counselors. U.S. Department of Health, Education and Welfare, Public Health Service Publication #1254.

Verah, Chad. The Samaritans. London: Constable, 1965.

Walker, Alan. As Close as the Telephone. Nashville: Abingdon Press, 1967.

"Inmate" is not the usual term to identify a patient in a mental hospital. It is not the familiar term to describe youngsters in correctional institutions or, usually, the term for adult prisoners. But it does have the virtue of being generally applicable to persons who spend some significant segment of life within an institution. This paper concerns the functions of religious communities -- churches and congregations -- in the effective reintegration of inmates into the open community. Thus, this paper deals with the "tertiary preventive" segment of a comprehensive system of care -- that is, those efforts which tend to reduce the likelihood of a recurrence of disorder.(Gerald Caplan, Principles of Preventive Psychiatry [New York: basic Books, 1964], pp. 113-27.)

Inmates discover that returning home can be a complicated and frustrating process. Two collect prayers, products of ministry to inmate congregations, reveal the complexity of the process.

The second prayer reveals the inner experience of being an inmate.

Although there are important differences among inmates, there are two similarities: all have been inmates, and nearly all return home. These similarities frame the opportunity for the religious community in its service to the returning inmate.

The basic study of the inmate’s experience is Goffman’s Asylums: Essays on the Social Situation of Mental Patients and Other Inmates.(Garden City, N.Y.: Doubleday, 1961.) He discusses the situation of those who spend some time in "total institutions." There are five categories of total institutions: (1) for the care of the harmless but incapable (sick, blind, aging, etc.) ; (2) for those threatening to the community (tuberculous, leprous, and some mentally ill) ; (3) for those against whom the community seeks protection (criminals, political or social deviants, and some mentally ill) ; (4) isolated work organizations (including military posts, boarding schools, work camps) , and (5) organized retreats from the world (monasteries, cloisters, and other asylums)

Goffman’s analysis makes evident the similarity of all inmates: they have been isolated from their pre-inmate world, they have been inducted into another world. Meanwhile, in some degree, something has happened to the world "outside." The dogs barking at the returned Ulysses or the children ridiculing Rip Van Winkle are symbols of the invariable changes during a person’s period as an inmate (or wanderer).

The dissociation of streams of events is revealed in an excerpt from a pastoral contact with the wife of a mental hospital patient who seeks marriage counseling:

A comparable insight into the effect of separation is found in the following statement to a parish clergyman by a paroled prisoner returned to his family after eighteen months in an adult correctional institution:

Such quotations illustrate rather than exhaust the significance of the inmate phase of a treatment or correction process. It may be hard to believe -- given our preconceptions about hospitals and prisons -- but, however well-staffed or ill-programmed, such institutions are organized societies. For inmates who have been alienated from the larger society the institutional society may often be more satisfying or secure. The religious community or clergyman who would be of help to the returning inmate or his family needs to be aware -- as in the illustration above -- that a weekend pass at home may be less attractive than responsible participation in a ward project.

If we can understand the positive involvements in an inmate society we may also be able to understand its negative results, the recidivists or chronic inmates. They are a small but important minority who cannot tolerate having their human needs for food, shelter, work, and companionship satisfied unless they can at the same time be mutinously hostile at the personal or institutional provider. The dynamics of such nursing and biting by immature persons makes it clear that pastoral or religious services to inmates must support a redirection of hostility as well as meeting their needs.

Motivation for the clergyman or religious community is important in insuring effective service to returning inmates. Easy and presumptuous compassion, undisciplined pity or guilt, even "love" are poor motivations for significant work. The process of re-adaptation for nearly all inmates involves stressful work which he alone must be encouraged to do. Those who would be of service to him must be willing to administer a tolerable dose of such strong medicine fully as much as they are moved to be "his friend." (See T.W. Klink, Depth Perspectives in Pastoral Work [Englewood Cliffs, N.J.: Prentice-Hall, 1965], p. 58.)

The religious community dare not presume that to be released is an unambiguous occasion of joy or achievement. Ex-inmates need frank, open responses. They need to be free to reveal, for example, "just how crazy-mixed-up I was and what happened to me in the hospital," or "how tempted I am by the non-responsiveness of the new outside world."

An inmate prayer from a psychiatric hospital reveals this desperate need for responsiveness:

Inmates are the butts of very traditional, often derisive humor. Such humor is revealing, not obscene. They have been "drunk," "crazy," "in jail," or "in the clink." Ex-inmates know the quality of humor. Until the religious leader or community can be free to accept such humor we will be as stiff and unhelpful as starched and fearful Gray Ladies passing Kool-Aid across a table at a ward bingo party.

This is a creative pharmaceutical age. Thousands of modern inmates are able to leave hospitals because of regular and often continuing dosages of anticonvulsants, tranquilizers, energizers, hormones, or alcohol-sensitive compounds. I have met a few exinmates back in hospitals because they have heard such wonderful potions derided at church or from the pulpit as evidence of modern corruption, comparable to subway rapes or God-is-dead theology. A minor but not insignificant element in the function of the religious community with the returning inmate is its understanding of the functions of drugs.

The inmate’s situation is fraught with ambiguity. For example, Mr. A. has a serious drinking problem. Once, this was dealt with punitively (a police charge for driving-while-intoxicated) His family was puritanically religious; he knew that they regarded his drinking as a sin. This led him to seek pastoral help to "put down the devil." His enlightened religious leader properly rejected this idea and encouraged him to seek help for a medical-psychological problem. In the alcoholic treatment institution he was exposed to a group-oriented program in which his problem was identified as properly shameful before the official group standards.

Most inmates have experiences comparable to Mr. A’s. They meet an ambiguous or conflicting set of evaluations of their trouble. Hopefully, by the time of their discharge, some dominant judgment has emerged. But as they return to the community they meet the varied or ambiguous judgments again. They need support in maintaining that judgment which has proved most useful for their recovery.

Treatment institutions are intended to change inmates. It is not easy to change, we all know that; inmates are no exception. Inmates resist the power of the treatment institution to effect change. A subtle and universal device for resisting genuine change is to accede to change because somebody or something bigger or stronger is making you change. At least that defers the issue of stable change until the power of the institution is withdrawn at the time of discharge. At that point, when the institutional supports and sanctions, group encouragement, and/or behavior reinforcements terminate, the inmate emerges into the arena of personal choice. Rarely can a clergyman or religious community pick up the change-supporting function of the treatment institution. What can be done is to support and aid the exinmate to make the changes his own rather than those which have been forced on him by the power of law, drugs, confinement, shock therapy, or control of privileges. To be free is never easy, but no group or individuals should be more prepared for aiding others to use freedom than clergymen and religious institutions who teach or preach of the yetzer tov and the "grace of God."

As our cybernetic culture emerges, crisis pastoral care will consume greater portions of the parish minister’s energy and time. His parishioners’ expectations will demand deeper sensitivity about human concerns, and increased understanding and skill about pastoral care.

Emotional disturbance is a crisis situation which commands the attention of the community clergy. As the minister functions pastorally, several obvious factors may be borne in mind. First, the disturbed person is a child of God and a fellow human being. Second, he is experiencing an intense stress situation which may isolate him from himself, others, and God. Third, he may need to recognize his worth and preserve his dignity as a person. Fourth, he may be preoccupied with a way of meeting his needs and what he perceives as life’s demands. Fifth, he may need to become more aware of his God-given potential and realize the actualization of it.

Among mental health professionals it is generally agreed that the clergyman is a significant helping person. In the study, Americans View Their Mental Health,(Gerald Gerin, et. al., Americans View Their Mental Health [New York: Basic Books, 1960], pp. 305-7, 319.) it is reported 42 percent of persons who sought help turned to clergymen, 29 percent went to physicians, 18 percent to psychiatrists or psychologists, and 10 percent to social agencies or marriage clinics. This same report also reveals that of those who sought help 42 percent reported their problems centered around their marriage, 18 percent dealt with personal adjustment difficulties, and 12 percent related problems about their children. It is noted that 65 percent of those who sought assistance from clergymen claimed they received some help. These statistics indicate the significance of the pastoral function in emotional crisis and places upon the clergyman a heavy pastoral responsibility.

Chaplaincy Service in South Carolina State Hospital sponsored a study, "Chaplaincy-Community Clergy Developmental Project," ("Chaplaincy-Community Clergy Developmental Project," S.C. State Hospital Columbia. Mental Heath Project Grant OM-499, National Institute of Mental Health. Emily A. Spickler Program Consultant. J. Obert Kempson, Program Director.) for the purpose of exploring the contacts between mental patients and their churches and clergy in South Carolina, and of offering guidelines to assist community clergy in providing more meaningful pastoral care to mental patients upon their return home. The survey, by interview and questionnaire, explored interactions between pastors and patients before, during, and ‘after hospitalization. Information about the pastoral care skills used by the clergyman and his background was also secured. The social framework of the church as it related to the patient’s experience and the pastor’s outreach in helping the person were also data items.

Among the results secured from the study were several of particular interest. The number of patients in contact with both pastor and church before, during, and after hospitalization remained about the same. Overall, only a small portion of the patients had a long-term relationship with their pastors. Over half the patients of the 438 who supplied information had very little or no contact with their ministers. It was also noted that more than a third of former patients expressed discomfort about being present for or participating in the programs of the church, nor were they able to participate in community activities. About a third of the patients consciously sought help from their ministers. Lack of contact with their pastors or feelings about themselves or their pastors appeared to interfere with their attempts to seek help. Data revealed that 63 percent had never asked for pastoral help, that 27 percent had made no attempt at contact, that 12 percent were ashamed to seek help or felt the pastor would disapprove, and that 12 percent said he was unable to help.

About half the pastors of the 523 supplying data were providing pastoral care for disturbed persons who were not hospitalized, and about 40 percent said they were involved pastorally with hospitalized persons. These ministers were relating with disturbed persons in churches which were stable in membership, with regular worship and a moderate to full program each week.

The pastors’ initial contacts with the emotionally disturbed were ordinarily made by referral from others or because of the pastoral functions of the ministers. Half of clergy felt, as pastors, they must deal with persons’ religious and psychological needs together. The pastors recognized some lack of understanding existed between themselves and the community resources to which they might refer distressed persons. This matter of emotional distance was one of the areas which they felt was open for further exploration.

Some summary comments by Emily A. Spickler, who was Research Consultant of the project, are:

Another part of this particular survey reveals data which point up the clergyman’s functions as he ministers pastorally to emotionally distressed persons. This information was secured from interviews with forty-five pastors, fourteen patients, and two patient groups, one of which was followed over two months. The data describes several categories for pastoral care functioning.

The pastor can foster group-belonging which relates the distressed person to the church. This can be accomplished by the pastor’s maintaining his personal availability and also the availability of the church to people in distress. As several patients said, "We may not need to call on the pastor, but we know he is there. He is available twenty-four hours a day." Building a long-term relationship encourages confidence. This, in itself, would certainly discourage changes and interruptions in pastoral relationship. Fostering continuing contacts with disturbed persons who are unable to make these contacts themselves is a most important aspect of pastoral outreach. Church members also will need to be guided and instructed in making contacts. This kind of education for crisis pastoral care ministry would involve understanding about emotional distress, interpreting what the crisis situation is, preparing the members of the church in giving support, and maintaining relationship with the person in some way while in crisis and later.

The rehabilitation of the distressed person’s participation in the church comes through encouraging and supporting his responses. Acceptance provides an atmosphere for give and take between church groups and the person who may use the church as a family substitute. Furthermore, it is important sometimes that foster roles be provided these persons so as to avoid some of the intense conflicts which they have had in closer relationships with members of their families.

Another function focuses on pastoral care for the disturbed individual. In this supportive ministry the minister watches over the distressed person on a long-term basis but not in an overly solicitous manner, and cooperates with professionals in the treatment effort. The clergyman is available consistently regardless of how the patient responds or behaves. He listens to those who need to talk, and in particular to those who have no one else with whom to talk. Also he guides and interprets the uses of religious processes. Counseling can be provided persons who have expressed their concerns to the minister on levels where he is comfortable and possesses skill. Consultation from professionals can enhance his counseling. He refers, with pastoral skill, those whose situations are beyond his time and training. Sometimes distressed persons are unable to relate to other professionals. Here the minister has an opportunity to provide pastoral care to these persons. The clergyman can serve an important function by enabling the person to make more adequate community adjustments.

In providing for the pastoral care of the distressed person’s family the minister has an opportunity to help them understand their relationship to the person and something of the illness background. He can provide counsel in resolving guilt and in meeting their frustrations. The family needs to maintain hope instead of feeling that little can be done to help the person find a stable place in society again.

The minister guides and educates the membership of the church in understanding and dealing with mental and emotional illness. A long-term process of education needs to be undertaken in the average church to enable people to realize that in crisis they can turn to the pastor to secure help. The minister, representing God and the moral structure of the church, functions to help the family, the disturbed person, and the church understand the stress situation.

Preventive intervention in mental health may also be a facet of the minister’s educational and pastoral function. In his pastoral calling and other activities he can become aware of the need for providing the necessary counsel and guidance in order to prevent more serious trouble from developing. His sensitivity and concern can prompt him to enable the congregation to meet its pastoral care responsibilities as a redemptive community.

The pastor can provide first aid in crisis for both individuals and their families when, for varying reasons, they have been unable to contact or use community resources. Some persons recognize the minister’s availability on a twenty-four-hour basis for emergencies when other resources are unavailable. The minister may be perceived as the advocate of the poor, the dispossessed, and others who, not aware of community resources, need his counsel.

The effectiveness of the clergyman is influenced by his expectations, the expectations of others, the various demands on his time, and his own understanding and skill. His own church’s understanding of emotional illness will have a direct effect upon his efforts and how he functions pastorally. Most people see greater value in matters which the pastor and the church endorse. The minister is expected to be dependable, trustworthy, and to render no hurt. It is generally assumed that the pastor will not turn away from human need or seek to escape it. This places on him a great responsibility, a responsibility that needs to be shared with the total congregation as a caring community.

From the data supplied it becomes evident that a minister, to function more effectively with the emotionally disturbed, needs to formulate his concept of the pastoral function. Some guidelines are therefore suggested. The pastor, as a symbol of God and a symbol of the church, develops with a person a unique relationship characterized by understanding and acceptance of him as a child of God with potential which can be actualized. The pastor can assist in providing an atmosphere for the person to deal more adequately with his basic attitudes toward himself, man, the universe, and God through pastoral care (counseling, visiting, and group work) and worship experiences thereby enabling him to develop a more satisfactory style of life.

The several aspects of pastoral care for the emotionally disturbed described above set forth some principles and structure for the functioning of community clergy as they become involved with crises in the parish and in the community mental health setting. While the minister’s helping role in crisis is generally recognized by both professional and lay persons, he realizes his need for counsel and educational opportunities to develop his potential more fully. His desires, the expectations of his parishioners, and professional recognition stimulate cooperative endeavor on many levels by both religion and mental health leaders for crisis pastoral care intervention.

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.

To raise the question of the pastoral care of the poor at this point in history is something of an embarrassment for the pastoral psychology movement. To raise this question now necessitates the confession that the pastoral psychology movement has not heretofore adequately given it the attention that it deserves.

This book and the essays within it are a product of the so-called pastoral psychology movement. The pastoral psychology movement is a consequence of the relatively self-conscious and systematic attempt to strengthen the ministry of the church by making use of the insights and expertise of the social and psychological sciences. It has concerned itself with many issues and problem areas -- the church’s ministry to marital discord, alcoholism, youth, the elderly, the emotionally disturbed, and the delinquent. But little attention has been given to the poor.

There are specific reasons why the pastoral psychology movement failed to direct its attention to the problems of those afflicted by poverty. The reasons are more sociological than ideological. From the beginning the pastoral psychology movement attached itself to principles which, if consistently applied, would have brought it to an early and fruitful confrontation with the special situation of the economically deprived. But, because of certain reasons related to the sociological origins of the movement, it was often not faithful to its own best motivations and insights.

The pastoral psychology movement was developed by sincere and far-sighted churchmen who were, for the most part, members of the mainline, middle-class denominations in the United States. The first classes in pastoral psychology were taught in those more progressive and liberal seminaries where both the professors and the students espoused middle-class attitudes and values. Its companion disciplines were primarily clinical psychology, psychiatry, and social work, and pastoral psychology itself soon took on the trappings of quasi-professionalism with its emphasis upon the white collar, appointments, structured interviews, and so forth. Much of this was for the good, but it unwittingly led the pastoral psychology movement to isolate itself from the lower classes. Whether we are speaking of pastoral psychology as a more or less loosely organized body of principles which informed the daily work of increasingly larger numbers of ministers educated in the better seminaries, or whether we are talking about pastoral psychology in its more professional manifestations in the form of institutional chaplaincies or church-related counseling centers, the sociological origins of the movement tended to render it ineffective in relating to the specific problems and life-styles of the poor. Just as the ground-breaking book of Hollingshead and Redlich entitled Social Class and Mental Illness demonstrated that the helping professions of psychiatry and clinical psychology, were likely to be less attentive to and less effective with people from the lower socioeconomic strata of our society, a similar book and a similar indictment could be written about the pastoral psychology movement.(A.B. Hollingshood and F.C.Redlich, Social Class and Mental Illness [New York: John Wiley, 1958]). Today, pastoral psychology, just like clinical psychology, psychiatry, and even social work, must admit that it faces a crisis in self-definition -- a crisis which must be resolved before it can break through the barriers which have been limiting it from becoming a positive force for the betterment of the poor of our nation.

From the beginning, the pastoral psychology movement concentrated on the principles of working with individuals and small groups. It borrowed freely from the knowledge about individual counseling, group dynamics, and group therapy which the secular disciplines of psychology and psychiatry had discovered. It transposed, not always uncritically, into its own setting a variety of therapies which had yielded some success in secular psychiatric and psychological clinical settings. Most of these therapies emphasized "talk," "insight," and the so called structured interview. From the beginning it was recognized by the more discerning leaders in all the helping professions that some people did not seem to be able to make much use of these "talking therapies." But this was often thought to be their problem and not necessarily an indictment exposing the implicit shortcomings of these therapies. The poor, the uneducated, the activistic, were often judged to be poor prospects for therapy or counseling. Such people seemed to have high resistances against gaining self-understanding or insight. They seemed unable to keep regular appointments. They often tended to externalize their problems -- something which all good counselors guarded against. They often said such things as "What good does it do to talk about it?" As a consequence, such people were often written off as poor investments for the counselor’s time and energy. Only gradually was it recognized that the talking therapies were really more consistent with the introspective and verbal styles of the middle-class and upper middle-class people they were originally developed to help. It slowly was recognized that lower-class people were less verbal, less introspective, less abstractive and more concrete than most middle-class persons. But this did not mean that the poor could not be helped; it simply meant that help had to come in a different form than most psychological, psychiatric, and pastoral counselors were accustomed to providing.

The question must be asked: who are the poor? This question is a large one and cannot be handled adequately in this essay. Our purpose here is to make a few generalizations which will help us orient ourselves toward a concrete understanding of what pastoral practices with the poor might involve.

First of all, the poor are people without money, or at least, without enough money to live adequately within the context of Western society. But there is more. The poor are also those without power. By this I mean that they have less control over their lives, less latitude in decision-making, and less influence over political, educational, and economic institutions which impinge upon their lives, than is the case with people in the middle classes. It is becoming increasingly clear that to help the poor is not only to solve their shortage of money, it is also to help them develop more responsible control over the direction of their own lives. This last point has great significance for the strategy of pastoral work with the poor.

There are other things to be said about the poor. Certain distinctions should be made. There are different types of poor people. There are certain important differences between rural and urban poor, be they black or white. There are crucial differences between Puerto Rican poor and Appalachian whites. Herbert Gans has developed a typology of the poor and draws distinctions between (1) so-called maladjusted, (2) the routine seekers, (3) those who are striving to get into the working class or into the middle class, and (4) those who are action seekers striving to maximize excitement and gratification within their present status.( Herbert Gans, "A Survey of Working- and Lower-class Studies" in Mental Health of the Poor, ed. by Frank Riessman, et al. [New York: The Free Press, 1966] , Pp. 119-27. Mental Health of the Poor will hereafter be referred to as MHP.) And of course, there are both important similarities and differences between the lower-class poor and the lower-income working class.

In spite of these differences, there are some important general characterizations of the poor which can be made. We will look at these features of the poor both from the standpoint of how they may constitute liabilities for the poor and, at the same time, implicit strengths which can be used in their behalf by the sensitive minister trying to be of help.

Social scientists have learned a great deal about the language patterns of the poor. Certain facts are clear. Their language is more directly attached to concrete action and to practical and immediate problems of everyday living than is the case with the middle-class.( Daniel Miller and C. Swanson, Inner Conflict and Defense [New York: Henry Holt, 1960] , P. 24; Basil Bernstein, "Social Glass, Speech Systems, and Psychotherapy," in MHP, pp. 194-209. Frank Riessman, The Culturally Deprived Child [New York: Harper, 1962]) This is why middle-class talk therapies are inadequate and why the poor may not do well in middle-class- oriented school systems which emphasize verbal skills, abstract reasoning, and knowledge for knowledge’s sake.

Although the language of the poor is more concrete, more action-oriented, and more bound to pragmatic and utilitarian concerns, it is not necessarily more limited. Frank Reissman points out that the language of the poor may be rich and flexible, quite capable of expressing the experiences and attitudes that are real to the poor.(Riessman, The Culturally Deprived Child, pp.1-25.) It is a language somewhat different from that of the middle-class; and middle-class teachers, therapists, and ministers may not be able to understand it. Yet Riessman believes that this language, if taken seriously, can be used to the advantage of the educational and therapeutic process if the proper methods and sensitivities are used.(Ibid., p. 14)

Many poor people have a different attitude toward time than do middle-class people. The poor tend to live more in the present and the past, are less able to tolerate delay, and are less inclined to plan for the future. (John P. Spiegel, "some Cultural Aspects of Transference and Counter-Transference," in MHP, p. 308.) On the other hand, middle-class people tend to live almost completely for the future and have considerable capacity to make sacrifices today in the hope for a better tomorrow. This emphasis upon the present and the past among the poor may be born of a lack of hope; but in some cases it may be a product of an honest cultural difference indicating a more self-accepting and less acquisitive style of life, a style which should be respected and not automatically deemed inferior to the more ambitious future-oriented activities of the middle classes.

Many of the poor are more likely to use and be responsive to punitive and physical expressions of authority than is true with the more permissive middle class.(Melvin Kohn, "Social Class and Parent-Child Relationships: On Interpretation" in MHP, p. 166). They are likely to be more sensitive to the demands of the extended family and are more likely to stay within its jurisdiction. One the other hand, there may be, among the lower classes, more mutual helpfulness between members of the same extended family or even between friends and neighbors.(Riessman, The Culturally Deprived Child, p. 48.) Although this may be true, the effects of this stronger family solidarity are often nullified by the general disorganization of the neighborhoods in which the deprived live and their general reluctance to give political expression to their grievances.

Let us conclude by listing some principles and describing some strategies which should be kept in mind when ministering to the poor.

1. Pastoral work with the poor should take place in the context of a well-integrated total program designed to both (a) integrate the poor into the larger society and (b) transform society to better respond to and encourage the unique contributions which the poor can make to the rest of society. The poor need individual attention and assistance. But individual pastoral care is most meaningful when it takes place in the context of a larger attempt to analyze and correct the social forces which perpetuate poverty. More than this, individual and direct attention to the personal problems of the poor should proceed simultaneously with an effort to stimulate them to become active in analyzing and correcting the conditions which have created and sustained their poverty.

2. To stimulate the poor toward active participation in finding a solution to their own problems means starting where the poor perceive themselves to be. This means taking their everyday problems very seriously. Their problems may vary. For some, their problems may be expressed around difficulties in providing child care for mothers attempting to pursue part-time work. For others, it may involve problems in dealing with the complexities of a welfare system upon which they are dependent but which they cannot comprehend. Other problem areas may center around skill deficiency, substandard housing, household management, and may necessitate job training programs, tenant unions, or homemaking assistance. These are strategies presently being tried in various places with differing degrees of involvement by representatives of the church. The pastoral care movement should be able to add a new dimension to these efforts. Not only is there great promise in such programs for stimulating the poor to increase their own potential for dealing with their problems, (For stimulating discussions of how social action can help develop the human potential of those who participate, see the following articles: Peggy Way, "Community Organization and Pastoral Care: Drum Beat for Dialogue," Pastoral Psychology, March, 1968 pp. 25-36; Rudolph M. Wittenberg, "Personality Adjustment Through Social Action," in MHP, pp. 378-92.) they also provide both an opportunity and a meaningful supportive context for more direct and personal pastoral care if the minister is there to help handle the frustrations, disappointments, and anger which will undoubtedly surface. This is what is often missing from some social action strategies -- the sensitive handling of the personal substratum of meaning and conflict which often is brought to and precipitated by such action. Of course, social action on the part of the poor can be ego-building and therapeutic in itself. But just as ego therapy must generally be accompanied by some attempt to handle deeper anxieties and conflicts, so must social action and the kind of therapy that it provides be accompanied by auxiliary resources to handle the deeper human problems which an unsophisticated program of social action can unwittingly repress and deny.

3. Therapies which emphasize role-playing, dramatic action, and concrete problem-solving are generally more consistent with the cognitive styles of the lower classes. Although the pastoral care of the poor should take place in the context of larger strategies of social action such as community organization efforts, tenant unions, job-training programs, and the general politicization of the poor, there is clearly a place for more direct and person-oriented work with small groups and individuals. As Frank Riessman writes, "low-income people tend to work out mental problems best when they can do things physically." (Frank Riessman "Role-Playing and the Lower Socio-Economic Group," Pastoral Psychology, March, 1968, p. 51.) In his important article entitled "Role-Playing and the Lower SocioEconomic Group" Riessman gives several examples of the successful employment of role-playing in working with the poor. For instance, role-playing can be used to rehearse how an unemployed person might learn to relate to a new employer. It has been used successfully with juvenile delinquents to help them work through problems of handling authority. It has proved exceptionally beneficial in the training of indigenous nonprofessionals who are being used with increasing frequency to help bridge the gap between educational or social service projects and the communities they are attempting to serve. Role-playing involves the total person in a learning process and appeals to cognitive, kinesthetic, emotional, and experiential levels of human existence. For this reason, it is nicely adapted to the more action-oriented, motoric, and concrete styles of the poor. In addition, it can often be used in "marginal situations" in the very midst of other more or less non-therapeutic activities as a learning interlude which should help increase the capacity of a person or group to deal with current problems. It can be used in the context of discussion groups or talk-oriented therapies as the subject matter of group reflection.

Games can also be used with therapeutic efficacy. Rachel Levine tells of her use of family games as a device to stimulate family interaction. (Rachel Levine, "Treatment in the Home: An Experiment with Low Income, Multi-Problem Families," MHP, pp. 329-35.) Pathological or self-defeating patterns of interaction can be readily elicited and identified by such an approach and then can become topics for fruitful discussion and clarification.

In general, the so-called behavior therapies and ego-building therapies, which emphasize decision-making, integrity, and the active synthesis of conflicting impulses, seem most congenial to the styles and needs of the poor.( Howard Clinebell, Basic Types of Pastoral Counseling, pp. 189-205, 222-43; William Glasser, Reality Therapy (New York: Harper, 1965) Perry London, The Modes and Morale of Psychotherapy [New York: Holt, Rinehart, and Winston, 1964]) Any program of individual and small-group counseling with the poor should attempt to minimize red tape, needless professionalization, and other types of structural frustrations often accompanying more standard services -- frustrations such as complex and frightening diagnostic interviews, excessive use of referrals, and delays in the availability of the sought-for service.

4. Whenever possible, structural professional counseling with the poor should be sanctioned and guided by the poor themselves. The poor should have seats on the boards of the counseling centers, be they religious or secular, which attempt to serve their communities. For example, the Woodlawn Mental Health Center on the southside of Chicago has sitting on its board of directors representatives of all the major groups within this predominantly lower-class Negro neighborhood. Although the Center is staffed by highly competent professionals, the basic goals, philosophy, and procedures of the Center are worked out by representatives of the Woodlawn community. In this way, the Center becomes an integral part of the community itself and not just another agency coming in from the outside, competing for power and clientele and in this way further fragmenting an already badly disorganized community.