It was 1925, the midst of the roaring twenties, when Anton T. Boisen
initiated the first clinical pastoral training program at Worcester State
Hospital in Massachusetts.
The previous year Boisen had been appointed as chaplain to the state
psychiatric hospital by Dr. Richard Cabot, physician and teacher at Harvard
Medical School. Over the next several years, Boisen and Cabot collectively
created the foundation for what is now widely known as Clinical Pastoral
Education (CPE), the accepted standard of spiritual care in North America,
Europe, and Australia.
The fact that the practice of modern spiritual care was born in a psychiatric
hospital is no coincidence. In 1920, Boisen experienced a psychotic episode and
was hospitalized for nearly a month. He was 44.
Anton T. Boisen is recognized as the father of Clinical
Pastoral Education (CPE).
While in recovery, the Indiana University-educated Presbyterian minister
began to think through how patients might benefit from clergy who also had
“When he was hospitalized, Boisen noticed that the local clergy would only
come on Sundays and the advice they would give patients often tended to be more
harmful than healing,” says Shawn Lucas, Manager of CAMH’s Spiritual Care
Services. Boisen observed that while both medical and theological experts were
dealing with crises of the “inner world,” there was virtually no connection in
practice – a gap he was keen to close.
The practice of spiritual care at CAMH
Fast forward to 2015 and CAMH’s
Spiritual Care Services is in full swing. In the 90 years since Boisen led
his theological students through the first CPE program, the practice and
profession has evolved to reflect a more diverse and comprehensive understanding
of spirituality -- one that is tied less to a particular faith and more to
individual meaning and identity. Education has also grown and CAMH experts help
train dozens of spiritual care providers who will go on to work in a variety of
While all spiritual care providers at CAMH are registered psychotherapists,
moving away from the “friendly vicar” image can still present a challenge, says
CAMH Spiritual Care Provider Brian Walsh who works closely with clients
and clinical units across CAMH.
“Taking into account a person’s beliefs, in whatever form they take, is a
natural part of providing holistic care,” says Jane Paterson, Director of
Interprofessional Practice at CAMH. “Spiritual care providers are no longer
peripheral to the treatment team, they are integral to it. Being registered with
the College of Registered Psychotherapists of Ontario recognizes the depth of
their knowledge and training.”
Boundaries of belief
Determining and respecting the boundaries between a patient’s and a
therapist’s religious and spiritual beliefs has been controversial. In the
1980s, famed American psychologist Albert Ellis wrote that participation in
religion was not only a manifestation of mental illness but also a cause of
future mental illness. Psychiatrists on either side of the coin proselytized
their religious or anti-religious beliefs with clients, compelling the American
Psychiatric Association (APA) to publish guidelines in 1990. The statement
firmly placed patient beliefs at the centre of practice.
APA Guidelines regarding possible conflict between psychiatrists' religious commitment and psychiatric practice. American Journal of Psychiatry, 1990 Apr; 147(4):542]
While the APA guidelines addressed the issue of actively imposing beliefs in
a clinical relationship, spiritual care providers and other healthcare providers
must also be trained to manage more subtle boundaries. For students studying
CPE, understanding countertransference -- the phenomenon whereby a therapist’s
beliefs or emotions can become entangled with a client’s -- is a key focus of
“The more we can be aware of our own emotions and their source, the more able
we are to understand our own countertransference reactions,” says Shawn.
Evolving practice: toward quantitative research
Spiritual beliefs, whether religious or not, are fundamental to how many
people view the world and their place within it. In the context of mental
illness, there is potential for these beliefs to be both harmful and curative.
One key challenge of the spiritual care worker is to help clients who may be
religiously pre-occupied to discern a healthy or helpful experience from a
To this end, Shawn and colleagues are hoping to develop and evaluate an
external tool that will help clients differentiate experiences.
“As a profession, we’ve been very good at using reflection and qualitative
forms of evaluation,” says Shawn. “But there is certainly a lot to be gained in
our practice by incorporating more quantitative analysis and continuing to
collaborate with colleagues in other fields.”
This is part two of a
series dedicated to CAMH Communications Coordinator Joan Chang, a talented and
passionate communicator who appreciated the value of spiritual care. Joan
developed a story framework to shine the spotlight on spiritual care at CAMH,
and completed some interviews for the series. She died suddenly in June, 2015. A
tribute to Joan is included
on the CAMH Foundation website.
Also in the Spiritual Care Series: