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"Unto one he gave five talents, to another two, and to another one; to every man according to his several ability." (Matthew 25:15) The findings of intelligence tests are not new. Men like Plato, Plutarch, and Galton recognized individual differences and the presence of genius long ago. What is new is the perfection of instruments by which mental ability can be measured with a fair degree of accuracy.

When large segments of the population, like the children in a school system, for example, are tested, it is found that their abilities are distributed fairly consistently along what has been called the normal, or bell-shaped curve. Why this is so we do not know, but it has been established again and again.

We are concerned here with those persons who are at the two extremes of this distribution -- those who are unusually bright and are known as gifted, and those who are quite limited and are known as retarded.

Statistically speaking we are talking about approximately one percent who score 130 or above on a standard mental ability test, and those who score 70 or below on the same or a similar test.

These are the gifted, and these are the retarded. One percent does not sound like a very large figure until you take into account the population of America; then you realize you are talking about several million in each category.

For all practical purposes these figures have to be enlarged. To consider how it relates to the church, the school, the community and the home, we must include the top 5 or 6 percent, those above 120 or 125 I.Q. These are called "rapid learners" by the schools. Their problems are essentially the same as the few who happened to score five or ten points higher. At the other end of the scale we must add a like number, the borderline retarded, the "slow learners." Now we have increased our figure many times, and have included every community and almost every congregation.

These two groups, so very different in many ways, have some similar problems. Each can be understood better by comparing and contrasting it with the other.

Both groups have been misunderstood. Until recently both have been largely neglected by the church; in fact, the gifted still are. Even though many, provisions have been made for the retarded, such as special church school classes, camps and conferences, confirmation classes, and so forth, they only reach a small percentage of the number that could benefit from such help.

Let us compare and contrast them in terms of four areas of a person’s life which have a great bearing on community mental health.

Let us consider two boys. One we will call boy A and the other boy B. Boy A has an I.Q. of 133. This puts him in the gifted range. Boy B has an I.Q. of 67 and would be considered retarded. A grasps ideas quickly. He does abstract reasoning easily. He is well in advance of his years. B is just the opposite. He cannot do abstract reasoning; ideas come slowly; he has to struggle to keep up and then usually cannot make it. It becomes very graphic when we speak in terms of mental age rather than I.Q.

Let us assume that both A and B are the same chronological age. When A is five years old he will have a mental age of six years and six months, but when B is five years of age he will have a mental age of three years and four months. When they have reached the age of ten years, the division will be even greater. A will now have an M.A. of 13 years and four months, but B will have attained an M.A. of only six years and eight months. When they reach the high school age of 15, A will now be thinking with those who are 20 years of age, but B will only be able to compete with those of 10 years. How this affects them academically is obvious. They live in two different worlds intellectually. They have a different vocabulary, different interests different levels of attainment and possibility. A’s problem in school is boredom and lack of interest. Much of the material he is already familiar with, for gifted children invariably do a great deal of reading. He finds it so easy to compete with his peers that he has no challenge. He may cause trouble, develop poor work habits, and look down on others. B’s problem is just the opposite. He is under constant strain just to keep up. Pressured by home and a system which rewards the able, he is in a constant state of frustration. He never attains the satisfaction of achievement, recognition, or approval.

The schools recognize this problem and through special education classes and projects attempt to provide the opportunity for each person to function at the maximum level of his capacities. At least this is the ideal. Not every school attains it, but in principle this is what they try to do. When this is accomplished, the children are provided with learning tasks commensurate with their ability. They gain not only knowledge from academic experience, but satisfaction, challenge, and self-fulfillment as well. It is the latter which have so much to do with mental health. Except in a few noteworthy instances the church and church school have done relatively little.

When A and B have completed their education and move on into the vocational world, we again see the contrast. It begins long before they finish school. It begins as they make plans, select courses, decide on college, graduate and professional school. For A there are so many things he could do and do well that vocational choice is difficult for him. His interests invariably are wide; his abilities are such he could not only succeed but excel in more than one area. In these days of specialization and longer and longer training, he must make a choice.

Say, for example, A is active in the church. He is interested in becoming a medical missionary. He also is interested in scholarship -- he would like to teach in a seminary. Both fields appeal to him. His professors and his vocational and mental ability tests indicate he could do either. Both are long and expensive training programs. One requires an M.D.; the other, a Ph.D. His life will be very different if he finds himself in a missionary hospital in Africa, or in a seminary classroom in America. This is but one example. We see gifted young persons who are interested in the arts and in science, who are drawn to a career in social work or a career in the church. Some have great skills in the laboratory and equally significant talents for public service. A choice must be made -- it is not easy.

B, however, has a different problem. His choices are very limited. There are so few things he can do and do well that he should be helped to make his choice early and receive training. The problem is more complicated if he is in the borderline group. His friends may be going on to college, but with today’s standards he cannot be admitted. He may even think he wants to enter one of the professions. Many such persons express a desire for a vocation which requires training they could not possibly master.

Even so, B’s situation is much brighter than it was just a few years ago. Many who were once left in almost complete inactivity are now living useful lives, doing useful things. The retarded, contrary to what was once thought, can be productive vocationally. Some of them, it is true, are limited to sheltered workshops, but it has been found that many can be trained to do routine tasks in industry and do them well. This not only gives them income but also a sense of belonging, of usefulness and importance. To be able to earn one’s living in our culture is a mark of maturity and worth.

All of this has a direct bearing on community mental health. Nothing is more important for mental health than for the people in the community to find satisfaction, meaning, and purpose in their work. One’s vocation has implications far beyond the income that is involved, as important as that is. When one sees his job as something that he enjoys, something to look forward to each day and in anticipation in the years ahead, if he sees the thing he is doing as meaningful and important and worthwhile, then his whole life has meaning.

Unfortunately not many people are so fortunate, and some have an experience that is quite the opposite. The thing they do each day and look forward to tomorrow is dull, uninteresting, and offers no real challenge or purpose. In this sense it is a mental health problem for people of all levels of intellectual ability, but the very brilliant and the very limited do have special problems finding meaning and satisfaction in their vocations.

While A and B have been going to school, preparing for vocation, going to church, playing on the playground, they have been associating with other children and with various adults. This, too, has a bearing on mental health. Psychological literature in recent years has been saturated with such words as "acceptance," "identity, rejection, estrangement," "self-actualization." All of which is to say that the person who feels accepted by his peers, loved by his family and other persons who are significant to him is most fortunate. Those who are not must find some means to compensate for this lack. It is absolutely essential for mental health.

Both A and B may have a similar problem at this point. Both may be misunderstood by adults and rejected by their peer group and for the same reason -- both are different from the norm. For the child or the teen-ager there can be no greater evil. This accounts for such problems as a very gifted person who feels very inadequate. It accounts for some of the delinquent and antisocial-behavior of the retarded. At least in this way they can gain some recognition and acceptance from those in their age group.

We hasten to add that this does not mean that all gifted children feel inadequate, rejected, or hostile; on the contrary; many are well adjusted and well liked. It certainly does not mean that all retarded children are delinquent. Most of them are not. It does emphasize the fact that while both A and B do have differences from the norm in terms of ability, both also have the same need of acceptance, attention, affection, and love.

Both A and B conceivably might belong to the same church. It certainly is not unusual to have a youngster with an I.Q. of 130-plus and a youngster with an I.Q. of 70 in the same congregation. I have known cases where they were in the same church school class. Both also have spiritual needs. If the Christian faith, the fellowship of the church, the significance of prayer and worship, the challenge of Christian service are important for that large segment of the population that fall in the range between 80 and 120, then it is important for these two youngsters who happen to be above and below that group.

Here again we see the contrasts. If we go back to the difference in mental age, it will shed some light on the problem of their religious development and training. A will be asking questions much sooner than B, even than those in the middle range. His mind is inquiring, and it inquires about spiritual matters quite as much as any other. The problem is that he is so seldom helped. Parents, church school teachers, and pastors find he can ask questions nobody can answer. They may discourage him, brush him off, evade the issue, tell him to wait until he is older. The result is that he gets the impression it is wrong to ask questions, or adults do not have the answers.

B’s problem is quite the opposite. The things that are discussed in church, or even in a graded church school class, are in advance of him. He does not understand. It does not mean he cannot understand some religious concepts. It does not mean he cannot have religious feelings. He can, but he needs to be helped by people who have infinite patience, who can simplify, who will explain, repeat, and explain again.

All of religion is not knowledge. It is also feeling, worship, challenge, fellowship, trust. Both boys need these for mental and spiritual health, but each must be helped in his own way.

The challenge of working with A is his great potential. If he can be helped to work through his frustrations, to attain a humble but realistic conception of his own capacities, to dedicate and commit himself to a life of service and faith, the whole future may be affected. The challenge of B is that his needs are so great; the problems he faces are so many that to be able to help him surmount just a few of them is most worthwhile.

I began with a verse of Scripture. I conclude with two more. "Every one to whom much is given, of him will much be required" (Luke 12:48 RSV) "Truly, I say to you, as you did it to one of the least of these my brethren, you did it to me" (Matt. 25:40 RSV)

For additional reading

Ayrault, Evelyn W. You Can Raise Your Handicapped Child. New York: Putnam’s, 1964.

Copa, Cornell, Retarded Children Can Be Helped. New York: Channel Press, 1955.

Kemp, Charles F. The Church; The Gifted and the Retarded Child. St. Louis: Bethany, 1957.

Palmer, Charles E. Religion and Rehabilitation. Springfield, Ill.: Charles C. Thomas, 1968.

Petersen, Sigurd D. Retarded Children: God’s Children. Philadelphia: Westminster, 1960.

There is no time when the minister is more sorely needed than during the crisis of grief. He is usually the first one to be called. He officiates at the funeral. He visits the family after the service. In Erich Lindemann’s words, the clergyman may be instrumental in emancipating the survivors from their bondage to the deceased, assisting them in their readjustment to the environment in which the loved one is missing, and aiding them in the formation of new relationships.

The pastor is most effective when he acts as a pastor, not as an amateur psychiatrist. He should not forsake his own traditional resources and spiritual functions. His is a fellowship with a past, a present, and a future tied together by rites, theology, and a religious ethic. He has his own unique framework of viewing and handling guilt, forgiveness, conflict, suffering, and hostility. The practice of psychotherapy as the only real ministry to their congregation has led the Suffragan Bishop of Washington, Paul Moore, Jr., to write: "Too many priests forget their priestliness when they learn some of the basic skills of counseling -- or perhaps they have not been trained properly in the use of priestly techniques and therefore are not confident in their exercise. These clergy become ‘clinical therapists’ who happen to have the prefix ‘Reverend’ in front of their name."

The clergyman may be of unique assistance to the bereaved. He represents a concerned religious community. His truest function is revealed in terms of years and decades, as he watches children grow, marries them, and teaches their children in turn, and as he stands beside loved ones around the deathbed of a patriarch whom he has come to admire and respect. In addition to crises of faith, people turn to him because of marital questions, parent-child problems, and a variety of inter- or intra-personal needs. He is minister, pastor, counselor to individuals and families in joy and adversity.

When a death occurs the pastor ascertains the emotional state of the bereaved not through cross-questioning but rather through empathy and understanding. The spirit of caring and compassion must communicate itself to the bereaved. Very often the most effective counseling comes after the funeral service. Before the ceremony itself, there may be incredulous disbelief and the needed expenditure of time for the physical arrangements of the burial.

The funeral offers an opportunity to comfort the mourners. It is the rite of separation. The "bad dream" is real. The presence of the corpse actualizes the experience. The process of denial is gradually transformed to the acceptance of reality.

When the funeral is over, the religious leader has the task of reconciling the bereaved to his loss. In the process, he should pay particular attention to possible grief reactions which could lead to personal disintegration and mental illness. When the grief work is not done, the person may suffer morbid grief characterized by delayed and distorted reactions. He may show great fortitude at the funeral but later develop symptoms of somatic disease or agitated depression. This may include the actual denial of the death, with schizophrenic tendencies, or psychosomatic disease such as hypochondriasis, ulcerative colitis, rheumatoid arthritis, or asthma. Obsessive-compulsive behavior may manifest itself where the bereaved appeases his guilt through extreme cleanliness, or an unwillingness to terminate the effects of the funeral service -- e.g., "Tell me the eulogy again." There may be self-punitive behavior detrimental to his social and economic existence.

It must be noted that the line of demarcation between normal psychological aspects of bereavement" and "distorted mourning reactions" is thin indeed, just as is the hiatus between "normality" and "neurosis." Each symptom must be viewed not as a single and decisive entity but in the framework of the total composition and of the schematic formulations.

The family way still feel guilty and very much to blame even after a terminal illness. The guilt may take the form of self-recrimination, depression, and hostility. A tendency is to look for a scapegoat -- e.g., the minister, physician, or funeral director. Inwardly the indictor may accuse himself, but he turns anger outward in the attempt to cope with his own guilt.

In this area, the clergyman can be extremely effective. The helplessness that assails the grief-stricken often leads them to envisage the role of the religious leader in a symbolic aspect as the representative of God. As such, the clergyman can assuage intense feelings of guilt by offering a meaningful concept of forgiveness as well as help them transform the errors of the past into a loving memorial by more noble living in the future.

The importance of ritual is dramatically portrayed in the French film, Forbidden Games. A girl’s parents died in an air raid. She received comfort by constantly playing a game of "funeral" and providing every dead creature with an elaborate interment of flowers and ornate casket. "Playing" at burying things helped her to relive, digest, and ultimately master the shock of her parents’ death. The child had succeeded in doing something for the dead and bringing relief to herself.

Ceremonials play an important part in helping people of all ages face death and face away from it. Religious rituals are community rituals. They are performed only by those who share a religious sameness and by no one outside it. The traditions create a sense of solidarity, of belongingness, the feeling that one is a member of the group with all the comfort, gratification, pride, and even pain that such a sense brings. For the ceremony is the same for all. It is definite and prescribed. Here he can be made to understand in clear-cut, unmistakable terms what is desired of him. Perhaps by carrying out the religious ceremonials, he will feel that he has regained the love he has lost, that he comes to peace with his own conscience which could personify for him the highest internal ideals. Even rituals which might seem irksome and pointless to others may be heartily welcome. They could be the sought-for punishment, the neutralizer, the deprivation that could balance off the imagined indulgence at the bottom of the guilt.

Certainly, the one-to-one relationship between person and pastor is necessary and beneficial. However, this is not the only approach. Grief work in groups is also therapeutic in assisting the bereaved to overcome their separateness and abandon the prison of their aloneness. Just as there is a Golden Age Club for the aged, an Alcoholics Anonymous for the inebriate, why not a place for those who have suffered the grief and dislocation of death? Especially do they need to share with like-minded people their feelings, troubles, and hopes.

A pilot program is being pioneered in Boston as a result of the efforts of Dr. Gerald Caplan, Director of Harvard Community Mental Health Program. He has enlisted an ecumenical bereavement team where clergymen of all faiths meet to discuss their own varied experiences with grief and death.

A widow-to-widow program has been established. Women whose husbands have died within the past year meet periodically to participate in discussions of their personal losses. To assess the accomplishment, one must first remember how they appeared at the first meetings. Their faces were drawn. Most were nervous and shy. Some just sat and stared and were totally uncommunicative. As one of the leaders, I observed an amazing metamorphosis. They became animated. They discovered that one touch of sorrow had made them all kin. They were able to participate with others who were also suffering the emotional trauma of bereavement. They belonged to the largest fraternity in the world -- the company of those who had known suffering and death. This great universal sense of sorrow helps to unite all human hearts and dissolve all other feelings into those of common sympathy and understanding. Problems may be singular to each person but there are others present who have faced similar troubles and together they seek to work them out. Each gives of her own understanding, compassion, and supportive concern.

I have met with widows of varying faiths and even participated with women of particular denomination, for example, at Catholic Retreat Houses. I am convinced that each church and synagogue could well form an organization to assist widows and widowers in reconstructing their lives and their homes. Together with interested members of his congregation, the clergyman could be of inestimable value in personal as well as group counseling during their difficult period of loss and aloneness. The bereaved should be claimed for the useful citizens that they are and their talents utilized as part of the larger fellowship of their respective faith and house of worship.

The religious leader’s primary objective is to aid in the emergence of a new self which has assimilated the grief experience and grown because of and through it. With the aid and encouragement of a pastor who is kind, sympathetic, and understanding, the bereaved may be helped to accept death through a more profound and meaningful religious approach to life. By the clergyman’s evaluation of the experience, by catharsis, confession, remembrance, and release, the members are guided to new purposes. Their introspection may bring new value judgments of life and love and meaning. Even the synagogue or church will no longer be an impersonal entity, since the members have extended their hands in warmth and affection. But most important is the comfort they will gain from a new and abiding concept of God: "Even though we cry in the bereavement of our hearts when our beloved are taken from this earth, may it be as a child cries who knows his father is near and who clings unafraid to a trusted hand. In this spirit, O Thou who art the Master of our destiny, do we commit all that is precious to us into Thy keeping."(The Union Prayerbook, newly revised, Part I,p.367.)

Thus, the clergyman has an important part to play in grief counseling. As he helps others, he is himself helped in his dialogical exchange. The I-Thou relationship is, according to Martin Buber, "a religious experience" beyond the most knowledgeable theology and psychology. In the parable of the Chassidic Rabbi, Moshe Leib of Sasov: "How to love man is something I learned from a peasant. I was at an inn where peasants were drinking. For a long time all were silent until one person, moved by the wine, asked a man sitting beside him, ‘Tell me, do you love me or don’t you?’ The other replied, ‘I love you very much.’ The intoxicated peasant spoke again, ‘You say that you love me but you do not know what I need: if you really loved me, you would know.’ The other had not a word to say to this and the peasant who put the question fell silent again. But I understand the peasant; for to know the needs of men and to help them bear the burden of their sorrow, that is the true love of man."

For additional reading

Allport, Gordon W. The Individual and His Religion. New York: Macmillan, 1960.

English, O. Spurgeon, and Pearson, Gerald H. Emotional Problems of Living. New York: W. W. Norton, 1963.

Feifel, Herman, ed. The Meaning of Death, New York: McGraw-Hill, 1959.

Freud, Sigmund. Mourning and Melancholia. Collected Papers, Vol. IV. London: Hogarth Press, 1925.

Fulton, Robert ed. Death and Identity. New York: John Wiley & Sons, 1965.

Gorer, Geoffrey. Death, Grief, and Mourning. Garden City, N.Y.: Doubleday, 1965.

Jackson, Edgar N. For the Living. New York: Channel Press, 1964. Johnson, Paul E. Psychology of Pastoral Care. Nashville: Abingdon Press, 1953.

Liebman, Joshua L. Peace of Mind. New York: Simon and Schuster, paperback, 1965.

Lindemann, Erich. "Symptomatology and Management of Acute Grief." American Journal of Psychiatry. No. 101, 1944, pp. 141-48.

Lino, Louis and Schwartz, Leo W. Psychiatry and Religious Experience. New York: Random House, 1958.

Osborne, E. When You Lose a Loved One. New York: Public Affairs Committee, 1958.

Ostow, Mortimer, and Scharfstein, Ben-Ami. The Need to Believe. New York: International Universities Press, paperback 1969.

Charlie Johnson is a big man, well over six feet tall, with coarse, rugged-looking features.

He had come to the Suicide Prevention Center in Los Angeles because his physician had told him to, but he had little hope of being helped. He even doubted that he wanted help. His life had been unsatisfying for years, and now with this latest stress there was no reason or desire to go on. He was forty-seven years old, married for twenty years to a woman whom, he felt, offered him no warmth. His two children were now grown and gone, and he seldom heard from either of them. He had no close friends and few interests. The one thing he did well, he felt, was his work. For seventeen years he had driven a truck for a Los Angeles firm, and he took some pride and felt his self-esteem increased because his near-perfect work record.

Two weeks ago, after a fight with his wife, he had gone to a local bar and begun drinking. Driving home, he was arrested for drunk driving, and since this was a second offense he was sure he would lose his license. Without a driver’s license and therefore without his job, he did not want to live. Charlie’s plan was to wait until he received the final court decision, then drive his car to a deserted place and sleep his life away with carbon monoxide. It was a lethal plan. He had the car, the necessary length of hose, and the location already selected. All that was left was for the time to run out, and next Monday, after the court hearing, was the time.

The pastoral counselor to whom Charlie spoke at the Suicide Prevention Center recognized him as a high suicidal risk. Having temporarily lost the ability to deal with the conditions of his life and to cope with the stress that he was facing, he was in a state of emotional crisis. He felt that life no longer held any satisfaction for him and there was only one solution that he could now see -- only one way out -- suicide.

The experienced crisis counselor, in this case a pastoral counselor, although recognizing Charlie as a serious suicidal risk, also knew that the situation was not as hopeless as it first appeared. Although the person in an emotional crisis is overwhelmed and feels as though his situation will never improve, experience indicates otherwise. Acute feelings of hopelessness, helplessness, and depression are seldom of long duration. They usually abate within a few weeks. In addition, the person in crisis, because he is overwhelmed by his own feelings, may magnify the difficulties that he is facing and, at the same time, underestimate the possibilities and resources that he has. The crisis counselor makes an important contribution by more realistically assessing both the dangers and the possibilities inherent in the crisis situation and adding the elements of perspective and stability.

Crisis theory, as developed by Erich Lindemann and Gerald Caplan, holds that when a person is in a state of crisis, he is especially vulnerable to change. This change may take either a negative or a positive direction, depending, in part, on the influences that affect the individual when he is in crisis. Crisis intervention has to do with exerting the type of influence which will encourage personal growth.

Crisis intervention takes place whenever one person responds to another human being who is overwhelmed by his own feelings and is unable to function in his normal manner. The alert parish clergyman routinely functions as a crisis counselor when his people come to him at times of stress in their lives. Most clergymen have many experiences in dealing with people who are reacting to a crisis by expressing psychological panic, paralysis, or depression, which is distorting their judgment and leading them either into inappropriate action or into an inability to make any response at all. The clergyman who is familiar with the theory and techniques of crisis intervention is well equipped to help his parishioners turn their crises from disaster into creative solutions where personal growth can take place.

Although the long-term result of good crisis intervention is often a significant improvement in the individual’s overall adaptation to life, the specific goal of crisis intervention is to help the individual to deal with the specific stress that has brought about the crisis. Whenever the crisis counselor deviates from this goal, he is no longer involved in crisis counseling. In Charlie’s case, the goal which the crisis counselor adopted had to do with the immediate suicide feelings springing from his fear of losing his driver’s license.

Method of Crisis Intervention

The method of crisis intervention can be organized into four steps: the assessment of the problem, planning the nature of the intervention, the intervention itself, and the resolution and withdrawal.

1. The assessment of the problem. When first faced with a crisis situation the counselor needs to make two kinds of assessments.

a. First he must determine whether or not there is an immediate physical emergency. Relevant questions are: Has the person already ingested pills? Has he already cut his wrists? Has he already wounded himself with a gun? If the counselor determines that there is a physical emergency, then he must respond to it by providing what is needed. In some cases, he will help the patient get to an emergency hospital; in other instances he may involve the help of the police.

b. If the counselor decides, however, that there is no imminent physical emergency then he will be free to move into the second kind of assessment and determine, in detail, what kind of crisis is now in effect, what the stresses are, and what they mean to this person at this time. If the person has experienced similar kinds of crises in the past the counselor will want to know how they were resolved.

At the same time that the counselor is assessing the nature of the crisis, he will also be assessing the strengths of the person’s resources. The resources will be of two kinds. (1) The internal characteriological resources -- the ego strength and the rationality that the patient still possesses. (2) The external resources. The counselor will want to know something about who the person has in his life who can be counted on to help at such a time. Does he have a family? Is he married? Does he have a doctor, a therapist, a clergyman, an employer, a drinking friend? Does he have money? Is he employed?

In the case of Charlie Johnson, it was clear to the pastoral counselor that there was no physical emergency. Charlie had not yet done anything to harm himself, nor was he chaotically out of control. Upon inquiry, he found that Charlie had never been suicidal before, and that this was a new and frightening experience for him. He had no idea of how to cope with such feelings. His resources seemed tenuous. His ego strength was low, and there seemed to be few people in his life who cared for him. It was only after questioning that the counselor discovered that Charlie’s mother and father lived locally and might be of some help.

2. Planning the Intervention. Once the assessment of the problem has been made, the counselor begins discussing with the person what might be done to alleviate the stress or otherwise adapt to the stressful situation. Thus the patient begins to have the feeling that stress is something that can be dealt with, and there grows in him the hope that the situation is not as overwhelming and as hopeless as he had at first experienced it. The counselor and the counselee explore the possibilities and alternatives, turning them over and over, discussing ins and outs while taking all the limitations of the situation seriously. At this point, there is a commitment being made by the counselor that a solution will be found and that the discussion will continue as long as it takes to find a solution. If this cannot be accomplished in one interview, then appointments are made for subsequent interviews.

The role of the person in the intervention into his own crisis needs to be carefully considered. The person should be encouraged to do everything that he can realistically be expected to do for himself. It is only when he has reached the limits of his own present ability that the counselor will take the initiative to perform some action. When it is clear that the person is temporarily unable to function in some area for himself, the crisis counselor will take responsibility. It is not unusual, for example, for a crisis counselor to take the initiative to speak with some significant other person in order to mobilize help for his counselee.

The important thing is that whatever decision is made about intervention should be carefully planned. The temptation is to overemphasize the need for speed and to begin intervention without careful planning. This frequently has the effect of confusing an already confused and involved situation. It is important, therefore, that the crisis counselor take whatever time is necessary to gather the information he needs and to carefully evaluate the situation, working out an intervention plan with the person that seems to stress economy of movement and yet promises maximal results.

Although Charlie represented a high suicide risk, the counselor felt, at the end of the first hour, that there was time to work and that Charlie had been able to involve himself enough in the problem-solving process that there was no need for urgent action. A subsequent appointment was set up for three days later.

3. The Intervention. Crisis intervention can take such a variety of forms that it is impossible to list them all. Each individual situation carries within itself the seeds of its own resolution. The process of crisis work consists of carefully and doggedly sifting through the possible alternatives until the intrinsic solution is discovered. Sometimes it is enough for the person to be able to redefine his own problems with a different perspective. Failures that he now experiences as being monumental often diminish in importance when compared to other important factors in his life, and he may then find himself able to cope with them. At other times crisis intervention is carried on by helping the person to gain cognative control of his own thought processes -- by helping him to structure, to outline, to list in an organized and rational way the different elements of his life. Sometimes crisis intervention can take place simply by the counselor reminding the person that he has experienced similar crises in the past, and that the way he resolved them then may still be applicable now.

At other times, crisis intervention calls for more direct activity, either on the part of the counselee or the counselor or both. If the counselee is immobilized to the point of inaction, the crisis counselor will take the responsibility to contact resource persons in the counselee’s life -- a spouse, parent, a friend, or doctor -- and facilitate their involvement in the crisis situation.

In Charlie’s case, although the counselor stood ready to phone his wife or his parents, if necessary, it was decided that Charlie could do this for himself, and he decided that what he should do was to attempt to reestablish his relationship with his parents, which he did with some success.

4. Resolution and withdrawal. Crisis theory holds that the counselor begins to plan his withdrawal from the situation as he enters it. Crisis intervention is never a long-term activity, and the counselor must continually be aware that although he will become intimately involved in the person’s life for a short time, he must be prepared to withdraw from it at the earliest possible moment. Usually, this will be when the counselee or one of the resource people is able to take responsibility for the situation. Premature withdrawal from a crisis situation, especially a suicidal situation, can have disastrous results. In such cases, the clergyman should have the benefit of competent consultation and good coordination with other helping persons. In some cases, the counselor will want to maintain contact with the particular person over a long-term period, but when he does this, he should be aware that he is no longer fulfilling the function of crisis intervention, but has moved into a different role -- one of ongoing emotional support or of helping the person deal with underlying problems.

The resolution of Charlie’s crisis came when he reestablished his relationship with his parents and made plans to enter counseling to work through his marital difficulties. He discussed these plans at length with the crisis counselor, who was able to help him by suggesting a qualified therapist. Once Charlie began this new relationship the crisis counselor withdrew from the situation.

Crisis Intervention as a Tool for the Clergyman

Crisis theory has some important characteristics which make it especially applicable for the use of clergymen, both those who function in a local parish and those who function in other kinds of settings.

a. Crisis intervention calls for minimal knowledge about personality theory. Long and detailed psychiatric histories have no place in crisis intervention, and the crisis counselor finds that he can function in an effective way with minimal theoretical or psychiatric knowledge. What is needed in place of this is what most clergymen already have -- an intense interest in helping someone who is in trouble, the ability to conceptualize a problem, and the ability not to be overwhelmed by the person’s feelings of depression or confusion.

b. Crisis theory affords a way of providing significant help to people, while demanding a minimum of long-term commitment. The clergyman who is interested in being a counselor is continually being frustrated by the great time demands that the counseling normally takes. Crisis intervention is by definition time limited, and offers the advantage of producing maximal results with minimum time involvement.

c. Clergymen have an almost unique access to certain resources that can be mobilized on a person’s behalf. Whereas it is very difficult for certain professional therapists to learn to take initiative by contacting people on a patient’s behalf, the clergyman usually is very much at home in taking such initiative. In many communities it is expected that when the clergyman hears of somebody in crisis he will take the initiative to seek them out and offer what help he can, and he is used to mustering community support for people in need. Such activity is integral to crisis intervention and is particularly pertinent to the normal functioning of the clergyman.

d. In crises where suicide is an issue, the clergyman is frequently the recipient of the cry for help that suicidal people customarily make prior to their suicide attempt. This places the clergyman in an important position in that if he can recognize the existence of an emotional crisis in one who is communicating to him, he can often take the initiative and begin his work of crisis intervention early in the developing crisis and often forestall serious suicidal behavior.

For additional reading

Caplan, Gerald. Principles of Preventive Psychiatry. New York: Basic Books, 1964.

---------An Approach to Community Mental Health. New York: Grune & Stratton, 1961.

Farberow, N. L. and Shneidman, E. S. The Cry for Help. New York: McGraw-Hill, 1961.

Lindemann, Erich. "Symptomatology and Management of Acute Grief," American Journal of Psychiatry, September, 1944.

Parad, Howard J., ed. Crisis Intervention. New York: Family Service Association of America, 1965.

Shneidman, E. S. and Farberow, N. L. Clues to Suicide. New York: McGraw-Hill, 1957.

There is no institution more community-centered than the church. The church’s capacity to involve itself in every aspect of community life has served as a model for the development of certain aspects of the community mental health centers. There has been a growing awareness that the effective church has identified with the total culture of a community and all of its people. Her history has shown involvement and identification with poverty, discrimination, illness, loneliness, imprisonment, persecution, as well as with wholeness.

In the Judeo-Christian tradition, the church has never separated its message of salvation from its concern for concrete service to human beings, including the healing of sickness. At present, community mental health brings a new set of challenges and possibilities to the church. Cooperative efforts of the church and the community mental health center will bring about a better utilization of the new healing powers and methods available for dealing with human ills.

McNeill in A History of the Cure of Souls mentions that one of the difficulties in the effective correlation of "religious and scientific psychotherapy" has been the lack of the institutional means of cooperation. (John T. McNeill, A History of the Cure of Souls [New York, Harper, 1951] , p. 322). The comprehensive community mental health centers, to a large extent, may furnish the institutional means and thus provide a new pathway to cooperation.

Community mental health programs are being built on the concept of a necessity for an integrated fabric of mental health services in which all the available and appropriate resources of the community are mobilized for prevention, diagnosis, treatment, and rehabilitation of mental and emotional disorders. The focus is on the community where the individual, regardless of age or socioeconomic status, quickly and easily can obtain the services needed without transferring to institutions located in other communities.

In the development of the comprehensive mental health center, the entire community is being involved in identifying and taking action with respect to its own problems. The emphasis is on cooperative and collaborative work among the various groups in the community to the end that they may develop the capacity to work together in dealing with mental health problems. There is increasing attention to the concept that mental health and mental illness can be best understood when there is focus upon the relationship between the individual and the community in which he lives. The centers are not to be just central repositories of professional skills, waiting passively for patients to appear, but will reach out to identify illness in all its psychic and social variants and bring it within the centers’ therapeutic orbit through consultative, educational, and preventive efforts.

The clergyman is related to the field of community mental health primarily on three levels: promotional, supportive, and therapeutic. Through recreational, social, and family education programs, he helps promote and maintain mental health.

Through pastoral care and counseling, the clergyman functions in a supportive or sustaining role, and often a therapeutic one. Such a ministry is geared toward early help with minor emotional disturbances, crisis situations, parent-child relationships, and critical life experiences such as birth, death, illness, marriage, school, and work adjustment. Most of our population can be classified in the essentially well group. Often, however, even the healthy person may be in need of practical mental health information and assistance. If the person gets help during crisis periods in his life, a chronic disturbance may be avoided. Caplan has shown that the poor handling of a life crisis often sets the stage for a more inadequate handling of the next crisis by the individual.(James A. Knight and Winborn E. Davis, A Manual for the Comprehensive Mental Health Clinic[Springfield, Ill.: Charles C. Thomas, 1964]) Thus, the path of breakdown may begin with a poorly handled crisis.

In the configuration of mental health services in the community, efforts are made to identify the clergyman’s therapeutic skills. He can provide spiritual support to emotionally disturbed people in times of stress and crisis; counsel on religious matters, applying all the psychological insight at his disposal; listen and identify cases with problems outside the religious framework, and refer them to proper community resources; counsel on personal or interpersonal problems with little emotional content if his training in pastoral counseling is limited; counsel persons with more serious mental and emotional problems if he has had training in clinical practice under expert supervision.

A clergyman’s degree of effectiveness in counseling will depend, to a considerable extent, upon his ability to relate to people; his sensitivity and insight in recognizing the nature of the problem; his non-judgmental acceptance of the person in distress; and his knowledge of whether, when, and where to involve other helping resources.

The complex and flexible nature of the community mental health program calls for fully trained persons in all disciplines. Comparable competency among the professions helps dissolve artificial hierarchies and helps relate responsibility to talent. (Gerald Caplan, An Approach to Community Mental Health [New York: Grune & Stratton, 1961]) The diversity of local demands and problems underscores ability and accomplishment more than professional background. Particular abilities and talents do not necessarily follow professional stereotypes in hierarchical fashion, nor should functions in mental health programs be rigidly defined by profession. Commendably, there has been less strict division of rules and responsibilities among professions in this type of program because generalization is frequently required on the part of the staff.

The congregation is an instrument of therapy. The message in the Gospels discloses that an intimate relationship was taken for granted between physical, mental, moral, and religious health. Incidents are recorded in which a physical affliction was healed and sins were forgiven in one and the same act. Nobody attempted to split human health into a multiplicity of functions, and likewise nobody attempted to promote the welfare of one individual in abstraction from the salvation of the community. Each person saw and felt the spirit of God working through the religious community and knew himself to be a part of the priesthood of all believers.

In the Gospels of the New Testament more attention is devoted to the healing ministry of Jesus than to any other subject except the passion story of the last week of Jesus’ earthly life. One may ponder why the art and practice of healing, central to the biblical record, has until recent times been peripheral to theological education and to the central concerns of the organized church.

In studying the biblical healing stories one discovers several basic conditions operative in almost all the cases described. Among these, none is more appropriate for emphasis in a discussion of community mental health than the observation that healing seems to have taken place almost invariably in some corporate context. An example of this is the story of the sick man who had to be let down through the roof into the room Jesus occupied because the door was blocked by large numbers of people (Mark 2:1-5) It is significant that apparently the friends and not the patient himself sought the healing and had the expectant trust. The group atmosphere in the New Testament healing episodes was a most significant factor in the preparation and support of the healing process. In the life of the early church, where healing became more and more associated with the corporate worship and the sacramental life of the believing community, the element of group atmosphere became a factor of major importance.

The implications of this are obvious for the pastor who opens channels of communication between his church and the mental health center. A neglected area of church activity is the use of the congregation as an instrument of therapy. The church as a therapeutic and redemptive community can have profound influence upon the health of the individual and the group. It would not be difficult to show how the congregation could function in a variety of healing capacities. Consider what a great force the congregation would be if it functioned with the devotion and dedication of Alcoholics Anonymous, for the group life in this organization is similar to the group life which the church could furnish to many people with a variety of problems and illnesses.

The mental patient is lonely and isolated, desperately needing to feel a sense of community with others. The congregation has within its very structure the ability to heal his isolation, to rescue the alcoholic, to answer the cry for help of the suicide candidate, to give direction and fellowship to the adolescent. The church also has a great opportunity with the "marginal" person who is living on the edge of life and who is in danger of dropping out of his family and out of society. By recognizing the "marginal" individual and including him in its group life, the church may well ‘‘rescue" him who lives on the borderline between sickness and health. Also, the church can function as one of the finest stabilizing forces for senior citizens, providing a sense of purpose and significance to their lives and incorporating them meaningfully and creatively into the religious group life of the church and community. And above all, as the individual in psychotherapy moves from an analysis of his condition to a synthesis regarding his value system, he runs head on into the religious question. He often turns to the church, especially if encouraged to do so, to explore fundamental questions related to the nature and destiny of man and his ever-present existential anxiety and guilt.

In the church one finds many people who have suffered severe adversities. Some have healed scars; others have open wounds. Often there is healing in these people as beautifully illustrated in Thornton Wilder’s one act play, The Angel That Troubled the Waters, based on the biblical story of John 5:1-4. The play tells of a physician who comes periodically to the pool of Bethesda, hoping to be the first in the water and healed of his remorse when the angel appears and troubles the water. Everybody at the pool also hopes to be the first in the water and thereby healed of his malady. The angel appears but blocks the physician at the moment he is ready to step into the pool and be healed.

Angel: "Draw back, physician, this moment is not for you."

Physician: "Angelic visitor, I pray thee, listen to my prayer.

Angel: "Healing is not for you."

Physician: "Surely, surely, the angels are wise. Surely, O Prince, you are not deceived by my apparent wholeness. Your eyes can see the nets in which my wings are caught; the sin into which all my endeavors sink half-performed cannot be concealed from you."

Angel: "I know."

. . . . . . . . . . . . . . . . . . . . . . . . .

Physician: "Oh, in such an hour was I born, and doubly fearful to me is the flaw in my heart. Must I drag my shame, Prince and Singer, all my days more bowed than my neighbor?"

Angel: "Without your wound where would your power be? It is your very remorse that makes your low voice tremble into the hearts of men. The very angels themselves cannot persuade the wretched and blundering children on earth as can one human being broken on the wheels of living. In Love’s service only the wounded soldiers can serve. Draw back." (Thornton Wilder, The Angel That Troubled the Waters, and Other Plays [New York: Coward-McCann, 1928] , pp. 147 ff).

The person who was healed rejoiced in his good fortune and turned to the physician before leaving and said: "But come with me first, an hour only, to my home. My son is lost in dark thoughts. I -- I do not understand him, and only you have ever lifted his mood. Only an hour . . . my daughter, since her child has died, sits in the shadow. She will not listen to us."(Ibid.,p. 149)

Since mental health planning authorities foresee every geographic area in the country being served by a comprehensive center, the opportunities for collaborative endeavor now exist. The pastor should get involved in the activities of the center and become a part of its leadership. He should spell out in some detail what he would like from the center, what the mental health needs of his people are, what training and educational experience he would like to receive, his ideas of cooperative projects between his church and the center, and the time and talents he has to offer. A clergy consultation service is already evolving as an important function of the mental health center, and such a program should not be overlooked in planning.

Remember that the pastor and the staff members of a center have something very much in common in that they are all submerged in the immediacy of caring for a host of broken or potentially broken people. The community center is not a theoretical ivory tower where hairs are split lovingly, but is primarily a clinical setting where the delivery of specific services takes place.

As for reading material, the Director of the National Institute of Mental Health will send on request a packet of the latest material on comprehensive centers. If particular areas of interest are pinpointed for the Director, an effort will be made to send material dealing specifically with one’s interests.

Too often, pastoral counselors are like a group of men at the bottom of a cliff. People are stumbling off the cliff and getting hurt. Some come miraculously away from the fall without serious injury -- perhaps a sprained ankle -- and need a little assistance that can easily be given. Others, however, are more seriously injured and require a great deal of attention because of broken limbs. A few are quickly hustled away because of even more serious injuries. The whole scene is such a busy one, and the men so preoccupied with their healing tasks, that no one seems to be able to give any attention to what would seem a logical move: to build a fence at the top of the cliff to keep the people from falling off.

Until very recently, psychiatry has been concerned primarily with "bottom of the cliff" activity -- that is, treating the mentally ill and the emotionally crippled. Appropriately, then, much of the effort in psychiatry has been devoted toward elaborate description of the pathology and categorization of the problems to insure treatment in as systematic a fashion as possible. Psychiatrists, as physicians, have been specially trained to recognize, diagnose, and treat mental and emotional illness, and have made a major contribution with their skill.

What has happened in the 1960s is a rapid shift of attention from healing the brokenness at the bottom of the cliff to trying to build preventive fences at the top. The whole mental health movement is an example of this shift. However, all one need do is pay close attention to the precision with which a psychiatrist can define mental illness, and the fuzziness with which he defines mental health, and one becomes aware that our problems are not going to be solved entirely by that profession.

The real significance of this confusion is that psychiatrists have started acting like clergymen and clergymen have started acting more like psychiatrists. I am not one to get terribly upset by this. In many cases where the clergyman is specially trained or usually sensitive and perceptive, he may be able to provide healing in many cases of functional mental illness as well as, or better than, many psychiatrists. On the other hand, many psychiatrists with a religious desire to save men and nations can help us interpret what goes into the full, rich, and abundant life.

In our training programs for community clergymen at the Pennsylvania Hospital Community Mental Health Center we have been interested in mutual exchange: (1) We believe that psychiatry and its allied professions can help the clergyman do a better job with his healing ministry (at the bottom of the cliff) (2) We believe clergymen have something unique to contribute to psychiatry in the whole business of prevention (building fences at the top of the cliff)

It is widely accepted that psychiatry can contribute to the clergyman’s ministry to troubled people. The real question is, How can a community mental health center and community clergymen work together toward the prevention of emotional disturbances? Resistance comes from both sides -- from clergymen who would prefer to talk about schizophrenia than talk about how their Christian education program might be more effective from a mental health standpoint, and from some psychiatrists who have considerable difficulty in visualizing how religion could prevent any of the problems they deal with. In the latter case, the problem is not that these psychiatrists believe that religion is harmful; but rather having themselves grown up in a culture where religion was innocuous, they cannot see the significance of religion for good or ill. We have worked very hard over the last fifteen or twenty years to establish a good working relationship between clergy and psychiatrists in healing troubled people at the bottom of the cliff. If we think, however, that having solved the problem of cooperative effort at the bottom of the cliff we also have solved it at the top -- in prevention -- we are greatly mistaken.

The first step toward a good program of prevention is to establish a relationship of trust between the community mental health center staff and community clergy. Once some mutual sharing begins to occur, it is amazing what happens.

The clergyman may begin to realize that the mental health professional has a contribution to make to his total pastoral ministry. This may be more important than the mental health professional’s help in strengthening his pastoral counseling techniques, especially if the clergyman can realize his unique position of contact with people when problems are just beginning to become serious. We have discovered that the clergyman will often see only those problems for which he knows a solution. By broadening his knowledge of community resources, we broaden his vision. For example, in the beginning of the program one clergyman reported that he simply did not see people with problems. His visitation amounted to administering the sacraments and leaving as soon as possible. However, once he became aware of the help that he could receive from the mental health center for both consultation and referral, he started overwhelming us with calls about the troubled people he was visiting.

Second, the clergyman may find support and encouragement for his own unique style of intervention. In our program we had a black store-front clergyman from the ghetto who was viewed by our mental health staff with some suspicion because of his lack of credentials. He was self-educated and self-ordained. He lacked any formal clinical training, although many troubled people were turning to him for help. It was unexpected that he would become one of our best teachers. His lesson of how to prevent suicide in the ghetto is a classic. One of his lay leaders had made a serious suicidal attempt and had been hospitalized. The man was a puzzle to the hospital staff because of his depression; the staff was reluctant to discharge him or to move toward a long-term confinement. The usual approaches of individual and group psychotherapy seemed to be pointless with this man, who neither appreciated nor respected "all this talk-stuff." When allowed, the black clergyman moved in with some very direct intervention. He had discovered that the man’s two teen-age daughters were pregnant by him and that there was some community knowledge of this fact. He said his goal with the man was to give him a choice whether he would live or die. Right now, he said, the man will have to die. After having first arranged abortions for the two girls, he brought the layman in front of the congregation and asked the congregation: "Should he die?" The congregation responded in a booming voice: "No." The clergyman repeated the question, and the congregation echoed its response. The clergyman then directed the congregation toward a healing ministry to the man and his family but with a heavy emphasis on the man’s "sin." While we might question this clergyman’s techniques, it is obvious that he is able to use the resources available to him, and his style seems to be very effective with his people. It is with active intervention like this that some crises are contained rather than allowed to explode with more destructive consequences.

Finally, we have learned that prevention of mental and emotional problems must include concern for the economic, social, and environmental problems which trouble entire communities and form the foundation for specific instances of mental illness and breakdown. In terms of the figure of the cliff, we found that it was not enough to concern ourselves with building fences, even though in the beginning this was the way we defined our task. Far too many of the people who were ending up in the brokenness of life were being driven off the cliff by dogs yelping at their heels. An ideal program of prevention would imply cooperation between the mental health center staff and community clergy in attacking these wider community problems. In the long run this aspect of prevention is probably more important than all the rest.

Community clergymen can therefore move into action in the prevention of mental and emotional disturbances in each of these three areas: (1) by using the mental health center resources to make their total pastoral ministry more effective in the early detection of problems; (2) by becoming more comfortable in the use of their own style of helping troubled people so that some crisis situations can be contained; (3) by using the rich resources of social concern in the churches to attack the wider problems out of which so many individual cases of emotional disturbance arise.

For additional reading

Action for Mental Health (by the Joint Commission on Mental Illness and Health) gives the background for the development of mental health programs and suggests the importance of clergymen in the mental health field. For a more specific treatment of preventive programs, see Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964) For the application of these principles of prevention to the role of the clergyman, see J. A. Snyder, "Clergymen and Widening Concepts of Mental Health," Journal of Religion and Health, July, 1968.

What has been the experience of a government addiction program in its use of clergy as members of the professional team? The program of the Ontario Addiction Research Foundation illustrates one approach.

The Foundation is an agency of the Province of Ontario and receives most of its budget through the Department of Health. In turn, it is accountable for its program to the government and people of the province.

A multi-million-dollar research and clinical institute is under construction in Toronto, and plans for joint appointments of senior staff with the University and the Institute are underway; a great portion of the Foundation’s current program is dispersed throughout the province. Programs in thirty cities and towns seek to serve the nearly 7,000,000 population with treatment, education, research, and community development resources. These services range from highly sophisticated diagnostic and treatment centers to smaller community clinics and one-man information and development programs.

Among the more than 200 professional staff members, 10 clergy representing the major denominations are at work side by side with psychiatrists, physicians, social workers, psychologists, nurses, and others. There is common consent -- perhaps in this field the one area of real consensus -- that there will never be enough services and professionals to meet all the needs of the alcoholics and the drug addicts. In recognition of this, a great deal of the emphasis on the role of clergy to be detailed here refers to the development and mobilization of concern, competence, and care-giving capacity on the part of the community as a whole. This is based on direct service experience and demonstrated skill at the secondary and tertiary (treatment and rehabilitation) levels of prevention. Its ultimate objective, however, goes beyond the proliferation of specialized services to the improvement and ultimate change of the community climate which produces the problems. The method is to move to the level of secondary prevention by providing more skilled early intervention by community helpers in the health and social services. Ultimately the aim is to achieve the primary level of prevention by effecting the kinds of social change necessary to reduce the problems of alcoholism or drug dependency.

In all these efforts, hard questions continue to be asked, program achievement is assessed and evaluated, new directions are identified and new emphases explored. This research base is balanced by the need to share our experience with others through programs of training, consultation, undergraduate, graduate, and continuing professional education.

Let us, then, describe briefly what the clergy do and endeavor to fit these activities and experiences into the total rationale for their involvement.

The first full-time appointment for clergy in the Foundation was that of the pastoral counselor. The primary task, five years ago, was to identify and validate the role of the pastor in a multi-professional therapeutic milieu. Given the more than forty-year history of clinical pastoral training in North America, this was hardly a pioneering effort. It was, however, a "first" for the Foundation and included responsibilities not only in the treatment field but in the areas of professional education and consultation as well.

The validation of the role of the clergy in a multi-professional treatment setting is challenging to both the personal and professional relationships involved. However, it is even more difficult to duplicate in the community outside. While a great deal has been said about the interprofessional team, it is inevitably more successful when relationships are sustained, visible, and viable within the closed circuit of an institution. The so-called community team has a long way to go to establish and improve its effectiveness. There is still abundant evidence of tendencies among the health and social service professionals to close ranks against the clergy. Priests and ministers are often the victims of stereotyping by other professionals and seen as irrelevant, untrained, even highly suspect in their motivation. As sources of referral and prospects for ongoing supportive care, they are often overlooked or only reluctantly given gestures of approval by the "professionals."

To overcome this state of affairs, one of the major tasks of the Foundation’s clergy is not only to meet the needs of individual patients in treatment, and to contribute to the case conferences in consultations with other staff. The pastoral counselor must also continually work to bridge the gap between the community -- including the clergy -- and the treatment resources. To this end then, he aims not only at the needs of the patients, but at the needs of professionals with whom he works, to whom he relates both within and beyond the therapeutic setting.

A major deficiency in recognizing the spiritual component in the field of addictions has been the lack of clearly defined criteria, based on hard data, that measure up to social, psychological, and medical standards. The Foundation’s pastoral counselor, a member of the staff of Toronto’s medical unit, has contributed to the overall design of a measuring instrument providing total medical records by computer. The instrument has a religious and spiritual portion, along with medical, psychiatric, psychological, and social histories. Ultimately, this research will answer 6,000 questions of more than 1,200 patients each year. We see this making an important contribution to a clearer definition of what we mean by the "spiritual component" in the cause, course, and consequences of alcoholism. As experience in this field develops and further research is undertaken, we look for clearer guidelines in measuring the role of religion -- as asset and liability -- in developing effective treatment and rehabilitation programs.

As suggested earlier, the direct service of our treatment resources to alcoholics and other addicted persons is limited numerically by the staff and facilities available. However, we believe these services can be multiplied effectively if the existing resources in the community are motivated, mobilized, and supported by specialized experience. Background information, training resources, and the ongoing coordination of services is undertaken by agents or field representatives of the Foundation engaged in community development.

In several communities professionals have been appointed to such tasks. In three such communities the person selected is a clergyman. The qualities sought in such an individual represent not only the traditional trust and expectations of the community, but also the very special flexibility and skills that the persons have demonstrated in providing a focus for joint action on the part of the community’s professional and volunteer helpers. This "agent" role appears to work best in communities of 25 to 50,000 where the visibility and competence of one individual can be reinforced by frequent and informal contacts with professionals in the community care-giving services.

While Foundation clergy in this role are full-time appointees, there is no reason why partnership programs of more modest scale should not provide for part-time appointments to the same end.

Two of the Foundation’s clergy serve important and demanding roles as directors of pilot projects. The Foundation’s Bon Accord Farm is a rural rehabilitation project located at a splendid century-old farm northwest of Toronto. Here the hard-core alcoholic is brought for long-term (six- to ten-month) rehabilitation. A choice of activities is available including routine farm maintenance, woodworking and metal working shops, and regular domestic and household chores.

In the city, the Foundation’s Halfway House program is also supervised by a clergyman. Responsibilities for this work include not only the administration of the large residential center in Toronto, but a consulting role with church and community-sponsored halfway houses throughout the province. When caring, flexible, and diligent staff persons were needed to get these programs off the ground, the church provided them. Not only the leadership, but the rationale and philosophies of the reinforced family, the supporting community, the corrective living experience, come through with theological as well as sociological bases in these programs.

To many in the field of addictions, the history and the role of the temperance movement remains a curious and increasingly irrelevant phase in society’s attempt to cope with alcoholism. To the Foundation it represents an authentic and legitimate attempt to meet a problem head-on. One of the Foundation’s clergy, for some years deeply involved in the temperance movement in Canada, is writing a history to be published under our auspices.

The information being gathered, both anecdotal and statistical, represents a major and significant contribution to the field. It is, moreover, a task being undertaken barely in time to avoid the irretrievable loss of direct contact with some of the few remaining great personalities identified with this phase of social change.

The largest regional program for professional education and training in the province is under the direction of a clergyman. This involves the development of seminars, workshops, professional internships, and community consultations, together with the ongoing flow of information and experience to the agencies and organizations serving the community.

Two of the Foundation’s clergy are responsible for the direction of comprehensive regional programs embracing the three thrusts of treatment, education, and research. One of the regions thus directed represents the largest portion of the province s population and the greatest single program investment in terms of manpower and money.

It must be said that only part of the multi-faceted involvement of the clergy in our program is the Foundation’s recognition of individual and professional competence. A good portion of the involvement must also be attributed to the ferment and change within the church and the current search for new and relevant ministries. In discussions with the Foundation clergy it has been agreed that the object of this search is not to establish an elite cadre of specialists. Nor is it simply to suggest a rejection of the church and its traditional systems and structures. Rather it is a reconnaissance -- perhaps too a renaissance -- a rediscovery of’ the role of the church in society with a particular and urgent emphasis on the cure of souls. The task will not be complete with the discoveries, the identification of roles, the development of

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skills and insights, or even with the clarification of status and relationships with the other professions in partnership programs and community care-giving services. This is only the beginning.

The task approaches a useful point of measurement when the experience gained is interpreted and relayed back to the church to effect modifications in its attitude, structure, and service. The introduction of courses at the undergraduate level in colleges and seminaries, the promotion of graduate seminars, together with more than a decade of specialized training for clergy sponsored by the Foundation, reinforce this experience of ours by adding to the experience of others.

Major shifts in church policy and programming will come, however, only when the religious community, historically opposed to tyrannies of all kinds, recognizes the nature of one of the more subtle and insidious tyrannies of our time -- the tyranny of the chemical age. Those of us who are privileged to be on the firing line with our professional partners have a duty to help the church community articulate a message that meets this need.

What has been described thus far has largely been functional -- the way the clergy work in a government addictions program as counselors, administrators, educators, consultants, teachers, and field workers. Perhaps our greatest role is still being shaped by our experience -- that of the prophet -- to be spokesmen out of our experience, insight, and concern, to "tell it the way it is" to the church and, through the church, to the world.

The most natural structure for the church to work with is the small group. Most of the significant work of the churches is done through its committees or its study classes or its action projects. When people come together in the life of the church they expect to meet in small groups and feel comfortable in such a setting. But the level of interpersonal interaction in most church groups leaves a great deal to be desired. The potential of church groups for aiding in personal growth is seldom recognized and even less often utilized. The possibility, however, of making use of small groups in the church as a resource for positive mental health is very great.

In order for small groups to be significant resources for growth, personal sharing needs to he a chief characteristic. Whatever else is carried on in the group, there needs to be a real place for the kind of sharing that leads to a feeling of support and closeness out of which relationships are deepened. For example, in one church a group of young mothers, each having small children, was organized for a study class with an expert from the psychological world. After meeting for several weeks for lecture and discussion, the young mothers were asked if they would be interested in continuing to meet in a small sharing group in which they could support each other in their efforts at being adequate mothers. The leadership would be provided by the associate minister. In response to their eager request for such a group, the first meeting was scheduled.

As the young mothers gathered for the first session of their sharing group, meeting in the library of the church, the leader set the mood for their work together. He asked each member what first name she liked to use, inquired into the ages of the children represented, introduced himself, and then said: "Well, how do you feel about being here in this group?" The sharing group had started. The basic pattern of its interaction had been indicated and the tone for the sessions had been set. By meeting in the church, the concerns of religious commitment were implied. By acknowledging each person in turn as a participating member, the focus on individuality had been stressed. By noting the ages of the children, the common bond of being young mothers had been indicated. By posing the opening question in terms of present feelings the orientation of the group had been established and the focus of the group had been indicated.

The expectant waiting of the leader made it clear that the work of the group would be carried out not by him but by the members. In the opening few minutes, as the leader refused to be cast in the role of answer man, and as interaction among members was encouraged, it became clear that this was a new kind of group experience. The members discovered that they were authorities on their own feelings, that their feelings were quite similar to those shared by others, that they did not need to be ashamed of their feelings. Sensing acceptance from the leader, and recognizing support from the other group members, they quickly learned that they could look deeper into themselves and reveal even more of their feelings. Hearing experiences from other young mothers, they discovered new ways of functioning in the mother role. Sensing the support of the group, they could dare to risk experimenting in new patterns of dealing with their children.

Such a sharing group has as its goal the facilitating of personal growth. It is not a treatment group, although it has some of the features of such a group. It is not a study class, although it has some of the features of study. Its distinctive characteristic is that it combines both of these emphases. It draws on research findings from the field of group therapy, and it makes use of the small group as a facilitator of learning. Indeed, the first distinguishing characteristic of the sharing group is that it combines the therapeutic with the educational.

Since the sharing group as we have described it centers on a sharing of feelings, the emphasis is more therapeutic than it is educational. But because the church group is always concerned with assisting the growth of its members toward Christian goals, it always has an educative function. Of course, any meaningful educational experience takes into account the deeper needs of the learner. There is always resistance to any new ideas which might imply a need for new patterns of thought, and until this resistance is taken into account, little learning takes place. Any educational process has a primary responsibility to master a body of knowledge, but this responsibility can be carried out only in an environment which is constantly alert to therapeutic needs.

A second characteristic of the sharing group is its emphasis on communicating feeling. One of the most significant learning experiences that takes place in a sharing group comes when communication of feelings is given a priority over mere socialization. It is characteristic of most groups that communication is conceived of as being at a fairly high level. Even in a large group we like to feel that we have a basic understanding of what the other person is trying to convey. In smaller classes or in committees or in training groups we are even more ready to assert that we are, in truth, a comfortable sort of group in which the flow of ideas and decisions is carried on in an atmosphere of good fellowship. When group activity is analyzed carefully, however, it becomes apparent that some groups have achieved far greater facility in communicating in a fundamental way than others, and that, indeed, some of the groups seldom reach a point where interaction is on a meaningful level.

A large part of the uniqueness of the sharing group lies in the experience of communicating freely, without defensiveness, in as personal and emotional a manner as one desires. Ideally the sharing group is one in which it is possible to be perfectly honest about emotions present as they are recognized in the self and shared with others. One student in a sharing group writes of what the experience meant to him:

A third characteristic of the sharing group is found in the kind of involvement which the leader permits for himself. Whether one subscribes to the orthodox psychoanalytic pattern of a passive therapist or not, it is very clear that no leader can really encourage sharing until he is willing to share himself. Granting that the leader needs to maintain objectivity in order to function in the leadership role, it is equally important that he involve himself as a participant.

The point is that the able leader is willing to let the group see him as a real human being struggling with problems. One seminary teacher tells of being at his greatest effectiveness during the days that he shared with his students the blow-by-blow account of his dealings with real estate people as he sold his house to a member of a minority group and tried, at the same time, to act responsibly toward his neighbors. In my own experience with group leadership, I believe I was closest to the group with which I shared my anxiety over a long weekend as I waited for a pathologist’s report on a tumor taken from my daughter.

A fourth principle for the sharing group makes the present situation the focus of attention. The situation of the moment, the here and now in this room and around this table, is never lost sight of. This means that investigation into past behavior is not only not encouraged but is even consciously discouraged. By keeping the focus on the present, many of the unfortunate excesses of a confidential nature about past events are avoided and one of the chief complaints against sharing groups in the church is eliminated. Excursions into the past are entered into only to clarify the present. The real interest centers in the immediate, current scene, and past relationships or past events are of only incidental interest.

To keep the focus on the present calls for considerable activity on the part of the leader. I recall a group situation where one of the group members, a mature woman, dominated the first part of the group with a fascinating account of her recent trip to Europe. After permitting her to go on for a short time, I interrupted to say that although what she was saying was interesting it was inappropriate for our task. Later she wrote me a letter in which she demonstrated that she had learned a good deal:

A fifth characteristic of the sharing group in the church stresses personal sharing as opposed to probing for answers. There is a common tendency in any group that is working with feelings to probe for underlying motivation. The inclination is thus to focus attention on other members with the intent of pushing for an answer as to why a person acts the way he does. I am proposing, however, that a far more productive pattern is to develop the capacity to share in a personal way with increasing freedom. Thus the attention turns from why someone else functions the way he does to sharing the way a person, himself, feels.

It is obvious that the leader plays a major role in helping groups to share their own feelings rather than to probe for underlying motivation. Thus the leader appropriately asks: How do you feel when Tom keeps pressing you for an answer?" but he does not ask Tom: "Why do you press so hard for an answer?" The principle here is that the exploration of motives is not the task of the sharing group, but the disclosure of feelings present always is appropriate.

There is at least one more principle which characterizes the sharing group in the church. Observations are always welcomed, but attacks are avoided. Whereas the natural inclination is to fix blame for feelings on someone else, the sharing group encourages a recognition of the feeling without ascribing a responsibility for it. Thus instead of saying: "You have a very annoying way of interrupting me" (in which the blame is placed on the other person) , the group member is encouraged to share his feeling without attaching blame by saying: "I find myself getting annoyed whenever I am interrupted." Here is an observation about personal feelings which leaves open the question of whose fault it is, and which makes possible an exploration of the meaning behind the feeling in a freer and less defensive manner.

I do not mean in this principle to deny the existence of strong negative feelings or to prohibit their expression. I do mean to suggest that negative feelings are dealt with best in an atmosphere in which a person is not on the defensive. A major advantage of the group situation is that support can be so real that angry and fearful feelings can really be recognized and explored. It is my experience that such recognition and exploration seldom take place in the presence of attack.

To recognize sharing groups in the church as a resource for positive mental health does not imply that everyone in the church should be organized into a group. Sharing groups call for a special interest in a personal kind of sharing. Not everyone is prepared to share his feelings, and so not everyone is interested in participating in a sharing group. A more exact way of putting it is that many do not want to risk involvement in a group that will ask for sharing at a personal level. Hence some kind of screening is needed in order to bring together those who are eager to share without raising resistance from those who are too anxiety-ridden to share. To attempt to organize a whole parish into small sharing groups overlooks this important factor and dooms the program to failure before it even gets started.

The kinds of groups in the church in which personal sharing is possible are almost unlimited. High school seniors in one church met for breakfast each week throughout the spring to talk with their minister about their place in life and their feelings about the future. Some churches have sharing groups for parents of teenagers, for retired men, for divorced women, for parents of retarded children. We have already noted the possibility of an educational program out of which smaller, more intimate groups can be formed for sharing on a more personal basis. One church held an all-day conference in September for single parents and then announced a continuing group (or groups) to meet weekly during the fall until Christmas. In a similar pattern one church has an annual Marriage Clinic with outside speakers for four consecutive weeks and then provides opportunity for couples to meet together on a less formal basis in small sharing groups over a period of ten to twelve weeks. In each case the goals are the same: to provide an intimate, supportive group in which personal attitudes and feelings are talked out and in which supportive friendships are developed.

For additional reading

Anderson, Philip A. Church Meetings That Matter, Philadelphia: United Church Press, 1965.

Casteel, John L., ed. The Creative Role of interpersonal Groups in the Church Today. New York: Association Press, 1968.

- -, ed. Spiritual Renewal Through Personal Groups. New York: Association Press, 1957.

Clinebell, Howard J., Jr. "Mental Health and the Group Life of rise Church," Mental Health Through Christian Community. (Nashville: Abingdon Press, 1965, pp. 149-70.

A Crisis Approach to Pastoral Care

The church or synagogue as a caring community should be concerned about people at all ages and stages of life. Religious ministry should he relevant to the needs of individuals, families, and communities. The growth and welfare of persons should he important at all times. Our religious traditions and contemporary studies in mental health recognize however, that there are certain critical times in life which are particularly significant for the emotional and spiritual growth of persons. Religious ministry has long recognized the importance of such experiences as birth, puberty, marriage, sickness, and death. Empirical studies by men like Gerald Caplan and Erik Erikson have brought new understanding of the significance of life crises.

We now have an opportunity to bring together the historic wisdom of our religious traditions and customs with the findings and insights of the behavioral sciences. The religious leader is a key person in this process. Ministry to persons in crisis has long been part of his role, and now he has new understandings and resources to help him. Our opportunity includes the development of more effective approaches to the care of persons in crisis and also the development of programs to prepare people to meet the inevitable crises of life more effectively. Pastoral care, as the total ministry of the religious community to individuals and families in crisis, should include both ministries of healing and comfort and ministries of preparation.

The strategic significance of a crisis-oriented ministry becomes apparent to the hospital chaplain or the student in clinical pastoral education. The minister or rabbi of a local congregation may also experience the readiness of some persons in a crisis situation to reexamine the meanings and values of life and the nature of close interpersonal relationships. Pastoral experience bears evidence that a crisis experience may mean a real effort to change and grow or it may mean a reinforcement of old patterns which limit and distort health and growth.

Gerald Caplan’s studies in community psychiatry confirm pastoral observations and add new evidence of the influence of crisis experiences on interpersonal relationships in the family. Caplan describes a crisis as a time

Caplan goes on to say, "The important point . . is that disturbances of interpersonal relationships between mothers and children, and also within the total field of forces in a family, can often be seen clinically to originate during a certain crisis period, or subsequent to a certain crisis period." (Gerald Caplan, An Approach so Community Mental Health[New York: Grune and Stratton, 1961], p. 18.)

Dr. Caplan talks about periods of crisis which are of relatively short duration (four to six months) which are related to significant losses or threats of loss, such as experiences related to birth and bereavement.(Ibid., p. 41) Erik Erikson, on the other hand, has developed a theory of crisis which is related to personality development through various stages of life. Erikson emphasizes the interaction between the developing individual and his social environment and identifies crucial points and stages of such interaction.( Erik Erikson, ‘Growth and Crises in the Healthy Personality," in Identity and the Life Cycle: Psychological Issues, Monograph 1, Vol. I, No. 1 [New York: International Universities Press, 1959] , pp. 50-100.) Both the crises noted by Caplan and those defined by Erikson are important in the development of mental illness, according to studies of family diagnosis conducted by Grunebaum and Bryant. (Henry Grunebauns and Charles Bryant, "The Theory and Practice of the Family Diagnostic, Part II. Theoretical Aspects and Resident Education," in Irvin Cohen, ed., Family Structure, Dynamics, and Therapy [Psychiatric Research Reports of the American Psychiatric Association, Washington, D. C., 1966] , p. 151.)

In a crisis approach to pastoral care it is important to include both the situational and the transitional forms of crisis which occur in families, since both may exert significant influence on the direction of growth of family members and of the family as a whole. Such crises, which happen to most families, include experiences related to birth, adolescence, vocation, marriage, middle age, old age, sickness, and death. Many other crises may occur and may be significant for pastoral care, but it is important to focus the program of the church or synagogue on what might be called the "normal crises" of life. These are the times which influence the life and health of most members of the congregation. Pastoral care which is oriented primarily toward the pathology in the congregation tends to be a quick and inadequate response to emergency situations and has little effect on the welfare of congregation and community. Even a focus on normal crises of families is not sufficient expression, in itself, of a community which really cares about what happens to persons. To care about persons means to care about the social problems which influence their lives, such as poverty, war, discrimination, and political corruption. Pastoral care may need to emphasize personal and family crises because of their significance for the mental and spiritual health of congregation and community, but a total program of caring goes beyond individuals and families to the conditions in the world which interfere with the growth of persons.

Dimensions of a Life Crisis

Each of the normal crises of life which has been mentioned needs careful study in order to identify the nature of the crisis and the resources for preparation and treatment. The analysis of one such crisis may serve to illustrate the many dimensions which need to be considered and the implications for the life and work of the local congregation.

One of the common tasks of a congregation and its leadership is the provision of an appropriate wedding ceremony for a young couple. This is such a familiar occurrence that little thought may be given to it beyond the necessary details of a "lovely wedding." If, however, a congregation really cares about the young couple and what happens to them in their marriage and what happens to the family which is established by the marriage, then much more thought needs to be given this particular marriage and to the responsibilities of the congregation for marriage and family life in the community. The marriage ceremony, as a symbol of God’s concern about marriage and of the congregations’ concern about this couple, should symbolize a total program of guidance and support for marriage and family living. A focus on the wedding ceremony is strategically important, because the wedding marks the beginning of a new family. This is one of the crucial places to begin with the development of a comprehensive program of pastoral care.

Some observations about marriage and preparation for marriage can be summarized briefly as a background for discussing a comprehensive pastoral care approach to the crisis of marriage. These observations are based on a variety of reading and experience.

1. Preparation for marriage begins at birth and is influenced by many things. Some of the more significant influences -- expectations of marriage and attitudes toward marriage that the couple have developed in their own families, the ability to give and take they have learned at home, their social adjustment outside the family, the opportunities they have had for gradually increasing experience with the opposite sex before this courtship, and their understanding of facts, values, and attitudes related to love and sex.( For a brief introduction to some of the problems involved in preparation for marriage see Evelyn Duvall, David Mace, and Paul Popenoe The Church Looks at Family Life [Nashville: Broadman Press, 1964])

2. Approaching marriage arouses anxieties, and sometimes guilt, about personal adequacy for marriage, closeness with another person, sexual adjustment, ties to parents, new responsibilities, etc. Such anxieties (and guilt) need to be faced as openly as possible before marriage.

3. Preparation for marriage is much more than the readiness of two individuals to participate in a ceremony. The couple prepare themselves for marriage by the kind of relationship they develop with each other before marriage. Most important are the patterns of interaction they are developing in sharing positive and negative feelings, facing conflicts, making decisions, and handling their relationships with other people (especially their future in-laws)

4. Our society tends to foster unrealistic attitudes and expectations about courtship and marriage and confusion about husband and wife roles.

5. Many couples, whether or not they have grown up in a religious community, have little idea of the religious meaning and significance of marriage (as well as the psychosocial realities).

6. The wedding ceremony is often seen as a social occasion for which it is nice to have a religious service. Meaningful participation in the ceremony as an act of worship of the religious community requires education of the congregation as well as preparation of the couples requesting the marriage service.

7. Adjustments to marriage is an ongoing process, and many important problems cannot be faced realistically until after marriage. Before marriage the couple may be helped to face the problems and resources they have in their courtship, particularly the potentialities and limitations of their own relationship. The couple may also need help after marriage to face problems they could not realistically anticipate before marriage.

8. Marital and premarital problems often involved the interaction of unconscious attitudes and habit patterns which a couple cannot recognize or change without outside help.

9. Marital problems are interwoven with social problems such as education, medical care, housing, employment, race and war.

Such observations could be documented in detail. They do not constitute a total picture of the problem of marriage in our day. Much more needs to be said about that problem; but these brief observations do suggest some of the things a congregation that is concerned about people and about the significance of its wedding ceremony needs to consider. A number of implications for a program of pastoral care emerge.

1. The congregation needs to develop a climate of concern about people and about their marriages. This climate needs to be based on facts about the problem of marriage in our day, the various dimensions of the problem, and the role of the religious community in dealing with this problem.

2. The congregation needs to understand the religious significance of marriage and the meaning of the marriage ceremony.

3. Policies and procedures need to be developed to protect the marriage ceremony from being used by persons who do not accept its meaning or being exploited by those who want to put personal or social values above religious values.

4. The congregation needs to develop a program of family life education which will strengthen families in their efforts to prepare their children for coping with the realities of life (including marriage and family living)

5. Single congregations need to join with other congregations and other concerned groups to develop community programs of education for marriage. Such programs are needed to counteract the unrealistic values and expectations fostered by our society and to provide resources for couples to face the issues of courtship and marriage before they are involved in the actual details of the wedding ceremony.

6. Policies and procedures for pre-marital counseling need to be developed which can use the skills of competent lay members of the congregation as well as those of the professional leaders. Such counseling needs to begin early enough and last long enough to help the couple assess and strengthen their relationship in crucial areas. In some cases the potential in-laws may need to be included in the counseling process. Group pre-marital counseling is a valuable resource which needs more experimentation.

7. Careful attention should be given to the actual marriage ceremony in order to enhance its worship aspects and to make use of the historic and contemporary resources of the religious community.

8. Programs of marital guidance for young married couples should be developed to help them in their adjustment to problems encountered after marriage.

9. Resources for competent marriage counseling should be made available to those couples who cannot, on their own or with the help of information and guidance, develop adequate patterns of coping with marriage and family crises.

10. Congregations and individual members of congregations should join with other concerned individuals and groups to work for the alleviation of social conditions which are threatening marriage and family life.

11. In view of the complex problems of marriage and preparation for marriage, which have been suggested here, and the need for competent professional resources to assist the local congregation, congregations should join together in sponsoring agencies which can provide such professional resources.

A Comprehensive Program of Pastoral Care

Marriage is but one of the many crises which are important for the emotional and spiritual health of individuals and families. The brief analysis of a pastoral care approach to couples requesting to be married in a religious community is only one illustration of the comprehensive approach which is needed to persons in every crisis of life. It is obvious that such an approach goes beyond pastoral care in the limited sense which is often understood. It does not, however, go beyond the kind of care for persons which should characterize a religious community in our Judeo-Christian tradition.

Both the needs of persons in our day and the new resources for mental health which are available to us challenge us to develop more adequate approaches to pastoral care. We, in our religious traditions, have something valuable to offer to the community mental health movement, particularly in our resources for life crises. We also have much to learn.

For additional reading

For some readings on premarital counseling and marriage education see Pastoral Psychology, December 1959, and Pastoral Psychology, May 1968. See also Aaron Rutledge, Pre-marital Counseling [Cambridge, Mass.: Schenkman Publishing Co., 1966] , and J. Kenneth Morris, Pre-marital Counseling, A Manual for Ministers[Englewood Cliffs, N.J.: Prentice-Hall, 1960])

Mental health is a central and inescapable concern for any church or temple that is alive to its mission with and for people. Churches and temples collectively represent a sleeping giant, a huge potential of barely tapped resources for fostering positive mental health. Specialized ministries such as chaplaincies, pastoral counseling centers, and clergy staff members in community mental health programs make invaluable contributions to the mental health renaissance developing in our nation. But even broader contributions await release in the priests, pastors, rabbis, lay leaders, and grass-roots members of religious communities (i.e., congregations) Approximately 124 million members of 320,000 churches and temples are served by 246,000 clergymen and rabbis. The immense mental health contributions of organized religion will be released only as increasing numbers of churches and temples become centers of healing and growth -- centers for healing the brokenness of individuals and relationships, and settings where persons find stimulation for lifelong growth toward their fullest humanity.

There should be an increasing reciprocity between churches and community mental health programs. One function of a community mental health center is to help develop the latent mental health resources of all its areas’ churches and temples. On the other hand, these congregations have an opportunity and an obligation to give vigorous moral support to comprehensive community mental health programs. The functioning of an ecumenically oriented, clinically trained clergyman on the mental health center staff is essential to the bridge-building process by which such reciprocity grows.

Clergymen counsel more troubled people than any other helping profession. This is a major contribution to the therapeutic dimension of mental health. However, a larger contribution by ministers and churches is in the area of prevention of mental ill health by fostering positive human fulfillment. This growth ministry is at the center of the church’s mental health mission.

Unique Contributions of Churches and Temples

Mental health professionals have a right to press the crucial question, What are the unique contributions of religious groups to positive mental health? Vigorous churches and temples are instruments for feeding those basic heart hungers which, when starved, result in personality crippling, and, when satisfied, produce strong, creative, loving people. The positive mental health function of religious groups is to perfect their methods for meeting these personality needs:

1. The need for an opportunity to periodically renew basic trust is satisfied by religious groups through corporate worship, symbolic practices, sacraments, and festivals. Erik Erikson declares:

Erikson holds that the infant develops a sense of "basic trust" or "basic distrust," depending on the quality of the mother-child relationship. The core feeling that life is trustworthy becomes the foundation for all subsequent need-satisfying relationships. For those whose ability to trust is limited as a result of early experiences (which means all of us to some degree) , organized religion offers a way of reestablishing trust. The mental health significance of this is far-reaching, e.g., it is likely that many forms of mental illness are rooted in a massive disintegration of trust.

2. The basic need for a sense of belonging is provided by meaningful involvement in religious groups. The sense of solidarity with persons joined by common commitments and similar ideologies increases group cohesion. Satisfaction of this need is particularly crucial in our fragmented, transient, urban society where rootlessness and loneliness are epidemic. Churches and temples often serve as substitutes for the missing "extended family"; this is an invaluable resource when crises strike. Having or lacking support of a network of relationships can be the difference between coping or collapsing under pressure.

Alongside Freud’s will-to-pleasure, Adler’s will-to-power, and Frankl’s will-to-meaning, is another, more basic human striving and need -- the will-to-relate. Man is his relationships; the quality of his relationships determines the quality of his mental-spiritual health. Only through relationships can he satisfy his will to pleasure, power, or meaning. When one is blocked in the ability to relate in mutually satisfying ways, alienation, loneliness, rage, and sickness (mental and physical) follow. The "distanced" person is cut off from both the potential riches within himself and those in relationships. (This understanding of man illuminates the importance of relationship-centered approaches to pastoral care and counseling.) A creative church, through its small groups, offers many opportunities for families and individuals to satisfy their will-to-relate.

Because of their vertical frame of reference, religious groups can help satisfy the will-to-relate to the ultimate dimension, the dimension of Spirit. The longing to belong in some ultimate sense, to feel an at-homeness in the universe is satisfied for many in worship which reawakens the awareness of "the mystical unity which underlies all human life" (Cyril Richardson) This experience is energizing, feeding, and healing; it overcomes the sense of cosmic loneliness, the feeling expressed by a mental hospital patient: "I’m an orphan in the universe." One may relate such experiences to Jung’s collective unconscious or to findings in parapsychology. However understood, they change one’s existence from a "world of walls without windows" to a connectedness with life.

3. Religious groups also provide an opportunity and resources for meeting the crucial need for a viable philosophy of life. The religious community’s tradition and belief-system offer ethical guidelines within which (or even against which) individuals can develop their own functional value hierarchies. Erikson points to the crucial role of values in ego strength. One of the major mental-social health functions of organized religion is to stimulate persons to discover authentic values to which they can commit themselves. The proliferation of character disorders in our society underlines the imperative nature of this function. The frequent presence of a "value vacuum" (Frankl) in the personality and relationship problems brought to counselors emphasizes Erich Fromm’s conviction that every human being needs a "system of thought and action shared by a group which gives the individual a frame of orientation and an object of devotion." (Psychoanalysis and Religion (New Haven: Yale University Press, 1950, p. 21.) Organized religions provide the most accessible and most traveled (though not the only) route to this goal. In the search for the unique contributions of the religiously and philosophically oriented counselor, Gordon Allport’s question provides a clue: "May not (at least sometimes) an acquired world outlook constitute the central motive of life, and if disordered, the ultimate therapeutic problem?"( Rollo May, ed., Existential Psychology [New York: Random House, 1961], p.98.) Religious groups satisfy the need for "an object of devotion," or what Tillich calls "the dimension of ultimate concern." The need to find a worthy, non-narcissistic focus of self-commitment is compelling; only by such a self-transcending commitment rooted in a vital philosophy of life can one cope creatively with existential anxiety. By existential anxiety I mean the non-neurotic anxiety which is inescapable (and incurable psychotherapeutically) and which results from man’s awareness of the abyss of death, including the living death of meaninglessness. This anxiety is a stifling, paralyzing force unless one has developed a functional philosophy of life; a life style of "generativity" (Erikson) , i.e., self-investment in the ongoing human race; and relationships of trust with at least one other person and with the Ground of Being. If one has these, existential anxiety becomes a stimulus to creativity. For many persons, coping with this anxiety is facilitated by devotion to the God of justice, love, and truth, and to the realization of his kingdom. For many others, traditional theological symbols are blocks to the discovery of their own object of devotion and workable philosophy of life. Relevant religion seeks not to defend old orthodoxies but rather to aid persons in spiritual discovery, encouraging them to be as true to their own light as the prophets and Jesus were to theirs.

The uniqueness of pastoral counseling is derived in part from the minister training as an expert in spiritual growth. As the only helping professional with systematic training in philosophy and theology, he should be particularly helpful in facilitating growth in the area of meanings, values, and relatedness to God. As a theological counselor (or counseling theologian) he can integrate theology and psychology in the spiritual growth-stimulating process. Counseling methods can be useful in working through blocks to growth in the spiritual life.

4. A related need is for a humanized view of man, i.e., a doctrine of man which emphasizes his capacity for decision, inner freedom, creativity, awareness and self-transcendence. The existentialist perspective in psychotherapy provides us with a fresh spring of resources for meeting this need.(See H.J. Clinebell, Jr., Basic Types of Pastoral Counseling [ Nashville: Abingdon Press, 1966], pp. 263-64.) The man who asked, "Am I only an organic computer?" reflects the impact of dehumanizing social forces and reductionistic (and mechanistic) views of man which are among the causes of psychopathology. The Hebrew-Christian view that man is formed in the image of God and has a basic uniqueness in the animal kingdom is, therefore, much needed in our situation.

5. Religious groups can help satisfy the universal need for experiences of transcendence, providing vacations from the burden of finitude (the sense of being caught in nature with its sickness and death) , and the tyranny of time. Attempts to escape from a flat, two-dimensional spiritual universe are involved in the widespread search for instant transcendence through drugs, particularly the hallucinogenic drugs. Religion is a sounder path to moments of transcendence. It can restore the sense of wonder which, in our worship of the golden calf of technological cleverness, often gets trampled underfoot like a delicate flower. In the rites, myths, and dramas of religious groups, the symbolic and the artistic are regularly renewed. Thus contact with the depths in man which Freud plumbed, and the heights which he did not, is restored helping to strengthen one’s relationship with the whole self and the world. Mental health values in religious practices are realized as by-products of participating as the spontaneous celebration of life and of experiences of depth relating to God, other persons, and self.

6. Support of individuals and families in both the developmental and accidental crises of living is another need-satisfying function of religious groups. At the various growth stages churches have rites of passage, for example, confirmation. These are group-supported and symbolic ways of coping with the anxiety resulting inevitably from loss of old securities and the threat of the unknown stage ahead. Natural subgroups within healthy churches spontaneously provide emotional support of those in accidental crises such as hospitalization. Group nurturance allows persons to use the crisis as an opportunity for growth. Thus, their coping muscles are strengthened for meeting the next crisis.

7. Religious groups can meet the need to move from guilt to reconciliation utilizing the time-tested pathway to forgiveness -- confrontation, confession, forgiveness, restitution, and reconciliation (restoration of the broken relationships) Organized religion has centuries of experience in this area. When integrated with recent confrontational counseling approaches, e.g., Glasser’s "reality therapy," this heritage can make a unique contribution to mental health. The pervasive pall of guilt in much psychopathology underlines the importance of this resource. Appropriate, reality-based guilt responds to the traditional forgiveness process. Neurotic guilt often calls for counseling skills to resolve the hidden conflict at its roots.

8. Religious groups can help meet the need of persons to be instruments of personal growth and social change. They do so by providing motivation, training, and opportunities to be change agents. When all of existence is discovered to be sacred and one’s life is viewed as a trust to be invested in enhancing human values, motive-power for significant involvement is created. There are two styles of change agent ministries, the prophetic and the pastoral care -- educational. The former focuses on changing the structures of injustice in society through social action; the latter on changing individuals through counseling, nurturing, and educative relationships. Both are shared responsibilities of laymen and clergymen. Mental health is a useful bridge concept for a much needed wedding of prophetic and pastoral. By pastoral care and counseling, blocked, self-absorbed persons can be "set free to minister." A person is mentally healthy to the degree that he is free enough from his own hang-ups to be able to he responsive and responsible in his relationships. If he is this, he will be a growth agent in others’ lives and he will continue to grow.

Implications for the Church’s and Temple’s Programs

There are many implications of this perspective for developing church and temple programs. These needs of people could be met much more fully than they are now in most churches.( In Joy, Expanding Human Awareness [New York: Grove Press, 1967], William Schutz declares: "Our institutions, our organizations, the ‘establishment’ -- even those we are learning to use for our own joy. Our institutions can be improved, can be used to enhance and support individual growth, can be re-examined and redesigned to achieve the fullest measure of human realization." P. 223.) Some innovative religious groups are learning to release their mental health resources. Here are some of the thrusts of such creative churches and temples.

There is a kind of research and development climate produced by continuing to seek better answers to, How can this church meet the growth-healing needs of its congregation? and of its community? Regular evaluation of existing groups and programs and continuing experimentation with new approaches are present. Both inreach and an outreach (fellowship and mission) are major thrusts in the programs of such churches. Furthermore, there is systematic reflection on how each aspect of the program can become more productive of healing, growth, and social change.

Several church program areas are particularly rich in mineable mental health ore. One is the small group program. A group in which depth relationships can grow through transparent dialogue is like an oasis in the usual desert of superficial relating. There is wisdom in having two parallel sets of groups -- the ongoing network of "normal" church groups, and small ad hoc groups aimed at personal growth through depth communication and enhancing interpersonal skills. Many types of groups exist, e.g., a depth Bible study group to stimulate the maturing of functional theologies; groups to aid preparation for normal crises such as retirement, middle age, marriage, childbirth (Caplan calls these "emotional innoculation groups"). Growth groups for persons with particular problems in living, such as handicapped children, singleness, or chronic health problems, are valuable. Mental health professionals in the church or temple and community can be recruited as leaders or co-leaders (with the clergyman) of groups, and to help train lay leaders for all kinds of groups -- e.g., supportive, growth, inspirational, study, and action groups. The ultimate impact on persons of "normal" church groups and of growth-healing groups is determined by the skills, sensitivity, and caring of leaders. Therefore, participation in an ongoing interpersonal skills group under the most competent leader available should be expected of all group leaders. The goal of every church and temple should be to have a constellation of small groups varied enough to meet the special needs of every age grouping and major life circumstance.

Another fruitful program area is dynamic marriage and family life training. The churches and temples have a direct entree to more pre-parents and parents of children under six (when personality foundations are laid) than any other institution in our society. Thus, they hold the major key to developing a comprehensive program of primary prevention through enriching family relationships and enhancing parental effectiveness in meeting their own and their children’s personality needs. The emotional climate of families can be enhanced profoundly by the nurturing relationships within a dynamic, caring church in all the light and the shadows of a family’s life cycle.

Education which strengthens parents and families is designed on the emotional growth model utilizing small sharing groups as a major instrument. The most vital groups of my parish ministry was an ongoing child study-nursery group for mothers of preschoolers. Films, lectures, and field experiences were blended with sharing of the fears, hopes, and joys of being parents of young children. Emphasis was on creative ways of satisfying one’s own needs in relationships (especially marriage) and on recognizing and satisfying the particular inner hungers of each child. This group would have been even more effective if the fathers could have been involved frequently.

Growth groups for adolescents can be useful in the identity struggle, providing the adult leaders are secure in their adulthood and reasonably comfortable with youth. Parents of adolescents need a growth and nurture group to deepen marriages, resolve conflicts about releasing their teen-agers, and cope with the compound crises of middle age (the pressures of death of parents, menopause, and the grief of the emptying nest). Interpersonal skill groups for young adults (married and unmarried) help them lower barriers to interpersonal intimacy, their life task in that stage. Marital growth groups for couples in each of the major phases of marriage can be highly productive. Rapid changes in male-female roles and the search for depth companionship in marriage make such groups essential in a church program oriented around unmet needs. Groups for pre-married and young married couples also are productive. In addition to groups for individuals and couples, groups for whole families -- e.g., family camps and retreats -- are invaluable.

Relationship-centered preaching and teaching is another thrust in churches and temples with the growth-healing commitment. Teacher training by the use of interpersonal relationship groups increases the growth potential of church school classes. Preaching maximizes personality values when it is dialogic (with opportunities for talk-back) and when it presents the religious message in ways that are life-affirming. The message is communicated best in a relationship in which acceptance, caring, and confrontation are blended. The quality of the teaching or preaching relationships determines the effectiveness of communication -- the "medium is the message."

Religious communities with growth-healing motifs frequently are found to be experimenting with innovations to make corporate worship more alive and meaningful. New structures of involvement and participation are emerging. Several California churches are experimenting with dividing their worshiping congregations into groups of six for guided interpersonal encounter and awareness training during a part of the service.

Pastoral care and counseling are a vital aspect of the growth program of churches. Two developments of particular mental health significance are the clergy specialist in pastoral care and group development as a part of a multiple ministry, and the growing use of lay "pastoral care teams." Well trained clergymen in specialized ministries of counseling (in local churches, denominational programs, and pastoral counseling centers) are an important new resource for mental health. Their functions include making available new training opportunities in counseling for parish clergymen.

The discovery that certain laymen are natural therapeutic persons opens a fresh dimension in congregational pastoral care. When carefully selected, trained, and supervised, such persons can triple a church’s ministry to those in crises and to the chronically dependent. Working closely with their clergyman, two laymen from a "grief team" quietly surround a bereaved family with caring as long as they are needed. Trained laymen can be of practical and emotional help to the family of those hospitalized for mental or physical illness. With earlier releases from treatment facilities, a few churches and temples are responding to the need for after-care by sponsoring halfway houses staffed by trained laymen. New methods of pastoral counseling which stress short term, reality, and relationship-oriented approaches and crisis intervention techniques are good news for both the general parish minister and the lay pastoral care team member. All these new developments can help to make churches or temples what they should be -- caring communities. When persons become "members one of another," their positive mental health flourishes.

For additional reading

Clinebell, H. J., Jr. Mental Health Through Christian Community. Nashville: Abingdon Press, 1965.

McCann, Richard V. The Churches and Mental Health. New York: Basic Books, 1962.

This chapter is addressed to clergymen who wish to improve their ability to engage in social action, not by themselves -- a mistake that can be fatal! -- but as leaders of men, their congregations, other groups. It is written in the hope that laymen will read it, too. The way that it is set forth must be taken by the clergyman and a group of concerned laity. It is a way of shared concern, shared leadership and above all, shared risk.

The first part has to do with what it takes to initiate and to continue significant social action. The second part tries to answer the question, How can I, a clergyman, get started? Both parts are based on experiments in training at Case Western Reserve University in the Internship Program for Clergy. Both parts draw on other research, including that which is in process at CWRU in Cleveland, the Urban Training Center in Chicago, and the Metropolitan Urban Service Training Facility in New York City.

The Support the Clergyman Needs

Significant social action requires four supporting groups. By "significant social action" I mean that which is aimed at changing the structures of society. Most of the action churches engage in is symptomatic relief, not structural change. Symptomatic relief is any action which relieves suffering without altering the system which produces it. Tutoring in the slums is an example. To be sure, it is significant in that it helps an individual child, and that should not be discounted. But it is relatively insignificant, because it does not alter the system which is producing millions of such needy children. Significant social action works for alteration in the contents, methods, personnel, policies, and tax structures which make that educational system what it is -- a ghetto school. Changing the teacher-pupil ratio might prove to be a significant social change.

To initiate and sustain this change the clergyman needs help. He must have sustaining relationships of various sorts inside and outside the religious organization.