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Tuesday, July 28, 2015

"The Practice of Pastoral Care" (Carrie Doehring)

TITLE: The Practice of Pastoral Care, Revised and Expanded Edition
AUTHOR: Carrie Doehring
PUBLISHER: Louisville, KY: Westminster John Knox Press, 2015, (232 pages).

Pastoral care is a critical part of any Church ministry. The word "pastor" is synonymous with "shepherd." Unlike some places that sees the pastor as the leader-CEO, the true biblical basis of a pastor is to shepherd the flock. How we practice pastoral care however have changed, partly because of changing needs. In this book, the way is to adopt a "postmodern approach" toward the practice of pastoral care. Calling it an "intercultural approach," pastoral care in this book means not just listening to the stories of the people but also to create meaning of them. It means learning to piece together the broken pieces of life. It means learning to help people tell their stories. It means cultivating trust. For Carrie Doehring, it is the heart of pastoral care where people are willing to open up their lives to caregivers. It is about creating opportunities for "care conversations" and relating real-life to theological truths and biblical principles. Doehring goes a step further to advocate for a care that brings back individuals from a de-centered sacred bearings due to suffering and painful circumstances. How can one show compassion and understanding toward those questioning their faith and religious values? This calls for a "theological, cultural, and psychological expertise" that can help care for parishioners and people in such need, what Doehring refers to as "the compassionate art of intercultural care." Carers essentially enter into the lives of others, sharing in their pain, walking with them in the valley of questions and celebrating with them in the answers of joy. It is about intermingling one's lives with another so as to build a bridge that aids integrative moments and shared stories. It is collaborative exploration of new and strange emotional territories. The author attempts to use a "trifocal lens" which comprises of a precritical, a modern, and a postmodern approach.  As a first-order language, a precritical lens looks at the world from a divine perspective. The modern lens is a second-order language that adopts "text critical methods" and social sciences to include empirical analysis and rational judgment of knowledge. The postmodern approach is the third-order language that nuances all of these in the light of present contexts. This approach involves the meaning making and the response of individuals to the earlier two orders of language. She summarizes the book's structure in six parts.

  1. Listening and Responding to the Intermingling of Stories (chapters 1-3)
  2. Establishing the Contract of Care (chapter 4)
  3. Theological Reflexivity (chapter 5)
  4. Listening for Narrative Themes (chapter 6)
  5. Assessing Social Privileges or Disadvantages (chapter 7)
  6. Ongoing Plan of Care (chapter 8)

Part One works on the listening to stories and how one can enter into the narrative of each individual. The word "intercultural" is preferred over cross-cultural or transcultural simply because there is an inter-exchange rather than some transplanted care that can become distant in nature. People want to feel unique and respected, not just a project for another to solve. They do not want to be theological puzzles for theologians but as real people trying to deal with struggles. People will remain where they are, unchanged as long as they do not feel trusted, respected, or cared for. The goal is to integrate one's care into another person's frame of emotions. Doehring's openness to psychotherapy, psychospiritual, and non-Christian spiritualities enables her to be free to include unconventional practices. She uses Buddhist practices as well as moralistic theologies. One example is the use of Buddhist teachings on suffering to learn how to deal with serious PTSD cases, like being able to accept that suffering is a "normal part of life."  She shares about the basic ingredients of caregiving relationships: 1) able to take the perspective of the other; 2) able to experience what the other person is going through; 3) able to regulate self no to be overwhelmed by the other. Embodied listening is about learning to understand the level of shame one feels and the crippling emotions experienced. Readers will be exposed to a range of listening skills and how to sustain a spiritual care conversation. Caregivers need to avoid premature judgment or being too enthusiastic about prescribing solutions. Caring is very different from curing.

Part Two establishes a "contract of care" that draws up guidelines of accountability for the caregiver and the commitment for the one being cared for. Many rely on national and state laws to establish the code of ethics. Larger religious organizations would have their own set of principles and guidelines. What about the limits of confidentiality? What about sexual harassment and misconduct that are due to power positions in the clergy-client relationship? What about the limits and separation of pastoral care, psychotherapy, and professional healthcare? While it is important to create greater openness, there are also risks involved with regards to abuse and neglect. Readers will learn how to draw up a care contract that can be customized according to age, roles, resources available, and beliefs.

Part Three is an interesting "Theological Themes and Reflexivity" for those of us who are comfortable with theology and the practice of pastoral care from a theological angle. It is about being God's agent of hope and encouragement, to share grace, truth, and love with people who need help in dealing with their fears, their guilt, their shame, and other debilitating emotions. Using film as a case study, we as movie-goers will be drawn into the "relational space" that the characters in the movie can help draw out. It is a chance for embedded theology to come alive through grappling with the emotional issues theologically.

Part Four is about coping with loss, violence, and coping with one's narratives. Every individual is unique and brings along narratives of both certainty and mystery. Three key themes are described. The first is loss, a common source of human suffering. It can be material losses, relational losses, intrapsychic, functional, role loss, and systemic losses.  The second is violence where power dynamics play along both physical and non-physical means. We read about people at risk feeling psychologically overwhelmed or lack the ability to cope. Care must be needed to guard against premature triggering of traumatic memories. The third theme deals with other problems like dependence, codependence, addiction, substance abuse, and problems in coping with stress. For caregivers, they need to be able to respect the limited theological abilities of the people they care for. Doehring urges us to be aware of and to be respectful about the "moral stress generated by life-limiting lived theologies - personal, familial, communal, and cultural." Referrals are recommended after about three or four counseling sessions. Suicide is also an important topic.

Part Five covers the systemic assessment to find ways in helping others deal with social oppression such as immigrant status, racism, sexism, classism, and the emotions that come with them. We can also identify resources that are available. Part Six is about planning the kind of care to liberate people from emotional enslavement via three overlapping care phases:
  1. Phase One - Building trust through compassion, and establishing safety
  2. Phase Two - Mourning Losses and Fostering Accountability
  3. Phase Three - Reconnecting with the Goodness of Life
One of the major problems in pastoral care is to be able to enter into the lives of people and not knowing when to stop or get out. Sometimes, caregivers can get trapped. With clear understanding of the risks of pastoral care, this book can be a powerful resource to prepare caregivers on what they can do; what they cannot do; what people can or cannot do; and what only God can do. Carrie Doehring is Professor of Pastoral Care and Counseling at Iliff School of Theology in Denver, Colorado.  She is also a licensed psychologist in Massachusetts and Colorado. Ordained in the Presbyterian Church in Canada back in 1978, she is very familiar with the pastoral care environment in North American circles. This book gives us a wealth of knowledge and resources from Dr Doehring's vast experience in this field of pastoral care. Written with penetrating insight and deeply felt empathy with patients and individual narratives, she writes with academic prowess and pastoral sensitivity to the cases mentioned. At the same time, she hones her teaching skills to help readers understand her thoughts. The diagrams are clearly framed to enable readers to follow the different phases and models. Examples are rich and real. Some of the cases are so painful that readers may feel lost on how to deal with it. Thankfully, the exercises at the end of each chapter are designed to help us prepare for them as best as we can.

Every pastoral counseling case is unique because every individual is unique. Life has both stories as well as mysteries and the key is to learn to respect the limits of both. In order to know what are the constraints of self and the limits of pastoral care, one must also be self-aware. This single ability is critical. If the pastor or counselor does not know him or herself, how best can they know others? If one does not practice self care, how can one care for others? This is one reason why I would recommend a complement to this book: Soulcare or care for one's soul. Studied side by side, the reader would be much better equipped than simply having a postmodern approach. One more thing. I am aware some reader may be uncomfortable with Doehring' use of non-Christian methods, especially the Buddhist or alternative therapies. For such cases, do not abandon this book just because there are references to them. If it does not work for you, just ignore those parts.There are a lot more material in this book that can benefit Christian leaders. Trust me. This book is worth reading, especially for those of us called to the pastoral care ministry.

Rating: 4.5 stars of 5.


This book is provided to me courtesy of Westminster John Knox Press and NetGalley in exchange for an honest review. All opinions offered above are mine unless otherwise stated or implied.

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