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CAMH Stories Centre for Addiction
and Mental Health

Treating the soul: a history of spiritual care

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 Boisen
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 medical training.

“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 healthcare environments.

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
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 training.

“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 harmful one. 

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.”

Spiritual Care series
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. 

Joan Chang

Also in the Spiritual Care Series:

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