FULL ESSAY TITLE: Write a 3000 word essay on the importance of regular pastoral visitation in homes, hospitals and places of work and/or leisure.  Include an explanation of the place of an active presence, empathetic listening and intentional follow-up in visitation ministry.  Provide significant evidence of reading of substantial course texts.  Convince the marker of the theological viability of the pastoral skills and methods being discussed.

Background

In discussing issues of pastoral visitation and care, it is helpful to have some understanding of its background, because this demonstrates God’s practical concern for his people.  Gerkin (1997, 23) says, “Pastoral care as we know it today did not spring forth out of the shallow soil of recent experience.  Rather, it has a long history….”

Beginning in the Old Testament we find evidence of God’s care for the well-being of his people.  He says there were three classes of leaders who were to care for Israel: the priests, who had responsibility for worship and ceremonial life; the prophets, who spoke for Yahweh on moral issues; and wise men and women, who offered counsel on life and conduct.  He then shows that “the shepherding image takes its place ‘as a primary grounding image for ministry’” following the coming of Jesus who identified himself as “the good shepherd”, and from then until the present the term “shepherd of the flock” has been applied to pastors and ecclesiastical leaders (Gerkin 1997, 23)

Willimon outlines a brief history and description of the various ways the Church has exercised pastoral care since the early Church down to the present, a history which is fairly rocky.  For example: “The Reformation destroyed the Roman synthesis between speculative theology and practical guidance, between penitential piety and visible means of grace.  It attacked the old calculus of sin and penance, stressing the radical nature of human sinfulness, the impossibility of salvation by works, and the sovereignty of God’s grace.  But the Reformation inevitably produced its own brand of legalism”.  (Willimon 2002, 171-176).

He shows how this history has culminated in Clinical Pastoral Education (CPE), a development of modern American Protestantism in the 1920’s, which is the “adoption….of the medical model by pastoral care and the close methodological relationship between pastoral care and psychology”.  Freudian psychoanalytic theory was extremely popular at the time Anton Boisen developed his CPE, and it has become part of the CPE program.  By the 1950’s, CPE was a “major part of the seminary curriculum in nearly every Protestant seminary….and continues to be a significant component in the training of the clergy”.  Willimon states that CPE training has been “of immense help” to pastors, but finishes with the statement “however, CPE may have left its trainees with a very limited concept of ‘pastoral care’” (drawn from p176-177). 

The reason for this is perhaps, not hard to understand.  Stairs (2000, 3-5), states that “Protestants have historically resisted the sacerdotal churches” use of “spiritual direction as a one-to-one means of caring for the soul” because it is perceived as contrary to the principles of “scripture alone” or “Christ alone”, and have developed instead a pattern of mutual care, which is in keeping with the priesthood of all believers.  This has not had lasting success because “in many cases, the community is no longer caring for the soul”. 

However, Benner would disagree with Stairs’ assessment of Protestants, for he speaks very highly of spiritual direction.  He calls it “the jewel in the crown of soul-care relationships” and sees it “rather than being simply a context for dispensing spiritual advice, it is a relationship of co-discernment.  The ‘director’ acknowledges the Spirit as the true spiritual director and seeks to help the other discern and submit to the leading of the Spirit” (Benner 2003, 22).

He also shows that the congregation is very involved, contrary to what Stairs maintains, and actively provides valuable support for the pastoral carer and counselee, in the form of support groups such as those which focus on specific problems, (e.g. alcohol or drugs, sexual abuse etc.) or more generally (e.g. parenting, grief and loss, etc.), or even more fundamental and general such as bible study, fellowship, and other ministry groups.

Stairs then says “Another more modern reason Protestants remain guarded about formal spiritual direction is their historic enchantment and ongoing relationship with the field of psychology”.  She says “Protestant clergy and their parishioners now find themselves enmeshed in behavioral patterns and practices that mirror these struggles of the past decade” of training in “counseling methods that incorporated psychological theories and principles”.  These two practices have “contributed immeasurably to the dislocation of the soul as central to pastoral care”.

Hunt goes even further in explaining why pastoral care using CPE has had limited success.  The very foundation of CPE, Freudian psychology, is the problem.  “It is important to know that it was through ‘memories’ of past experiences aroused in their patients under the influence of ancient shamanic practice of hypnosis…..that Freud and Jung developed their primary theories (1985, 185).

Thus, the history of the Church shows that the pastoral counselor must be cautious in developing a method of care.  Many mistakes have been made, and all these at the expense of the one most in need, the counselee.  The scriptures need to be our guide in this field, just as in every other.

Pastoral visitation

This is a key element of pastoral care.  It “encompasses home and hospital visits for purposes of education, nurture and care, evangelism, organization and discipline.  Of all professionals, the pastor has the unique privilege and responsibility of relating to persons in their home environment, which is the best place for observing human interaction” (Jackson 1990, 115). 

It is, of course, necessary occasionally for pastoral visitation to be made to the counselee in their places of work and/or leisure because this is also part of their own environment where they will feel more at ease than in a one-to-one encounter in the pastor’s office.  “One of the most important ways that pastors differ from mental health professionals is that pastors have the freedom, indeed the obligation, to intervene in the lives of troubled souls within their congregations…..One of the reasons why people are in trouble is that they cannot take that first long step toward admitting that they need help” (Willimon 2002, 177).

Thus we have two important reasons why pastoral visitation to the homes or other places where the counselee is comfortable is vital, (a) the counselee is in his own setting and comfort zone, and relating to those who are a part of his everyday life, and (b) the pastor, by visiting, has the opportunity to initiate counseling where the proposed counselee is reluctant to. 

Jackson (1990, 116) says of pastoral calling that it has several advantages now because of contemporary training.  The pastor is able to observe stressful conditions, identify and deal with emerging problems by wisely directed queries before they become critical, and thus deliver the benefits of a formal counseling session informally.  This could involve anything of interest or concern to a family.

Regular pastoral visitation

Pastoral visitation need not be for reasons occasioned by crisis only, indeed ought not to be, if possible.  “Thus pastoral counsel is more than merely tending the wounded, lifting up the brokenhearted.  It is also a matter of teaching, guiding and admonishing the well and the well fixed, the satisfied and the content” (Willimon 2002, 185).

The role of pastoral carer is to be a guide.  Willimon expresses concern over the danger that pastoral carers, in order to listen without appearing to be threatening or judgmental, become ineffective through failure to give good biblical guidance and direction (p184).  He is, after all, the one the counselee looks to for such help, because he is the representative of Christ and the Church.

Peterson makes a helpful distinction between counseling and visitation.  He says, “Counseling is usually initiated by a person asking for help and takes place in the pastor’s study at his or her convenience; visitation is usually initiated by the pastor and takes place in a parishioner’s home at his or her convenience.  In counseling, the pastor ordinarily has more control; in visitation, the parishioner has more control” (Peterson 1992, 89).

He is pointing out that the aim ought not to be a matter of control but of enabling the counselee to tell their story, and the pastor to collaborate with the one telling it.  He says “the primary interest is in getting at usable truth so that there is confidence and freedom to be creative with the material” (Peterson 1992, 92). 

Thus Willimon and Peterson identify two important aspects of counseling.  There is a need to be alongside the counselee and allowing them to tell their story, but the pastor ultimately needs to be able to give direction because often the counselee is unable to see the way out of their problem.  However it is very important that the pastor be a pastor, not simply a secular counselor.  He is a shepherd, according to scripture, representing Christ, and his role is to direct people in their relationship to God, using secular methods and means where helpful but keeping all in subordination to scripture.

Presence in pastoral visitation

Musgrave, in so few words gets to the heart of the issue of visitation.  She says, “Because it is at the heart of ministry and the core of empathetic response, presence is the most important gift a visitor can bring to the sick and to the dying” (Musgrave 2003, 70).

Job 2:11-13 (NRSV) beautifully illustrates this.  After Job has been absolutely devastated by Satan’s attacks and is sitting, in great pain and sorrow in the ashes, three of his friends visit him to “console and comfort him”.  When they saw him they wept and mourned with him; “they sat with him on the ground” for a full week, day and night; and significantly, “no one spoke a word to him, for they saw that his suffering was very great”.  It is a beautiful picture, and so instructive for the pastoral carer, as most of the elements of pastoral care after a loss are there. 

The motivation of Job’s friends was comfort and consolation.  Fogg (2003, 45) says “Offering this support is one of the greatest acts of loving kindness, because the exchange always occurs on uncomfortable, often painful terrain”.  Importantly, she says, “You do not come as one who knows how to fix deep grief with a few well-chosen words and techniques.  To do so would be to betray the truth…” (Fogg 2003, 45).

It is so easy to get this wrong.  The one mourning the loss of a loved one doesn’t need advice, they need someone to be there, someone who will put their arm around them and weep with them.  This is presence.  Words, advice, counsel, however well-meaning or appropriate, are simply inadequate.

Presence is also important to those who are lonely, such as the aged or the sick.  Koenig says, “ In counseling elders who complain of feelings of loneliness, it is important to listen to them and validate their feelings.  Let them talk about their health problems, the death of loved ones, the changes in their lives……there is no need for the pastoral counselor to talk, since these people need someone to listen to them more than they need someone to give them advice” (Koenig 1998, 66).

Musgrave (2003, 70) points out that a person who has just suffered a loss or been diagnosed with terminal illness can find it difficult to believe Jesus’ promise “I am with you”.  It is when the caregiver is present and offers “the gift of compassionate presence” that the divine presence breaks through.  And this is the thrust of Musgrave’s argument, that it is Jesus Christ who is present in our lives, to bring comfort, strength, whatever is needed, for those who turn to him in faith.  It is often through someone willing to be present with a sufferer that Christ’s presence is felt or realised.

Empathetic listening

Clinebell (1984, 77) says “Empathetic listening is active listening demanding an emotional investment in the other and relative openness to one’s own feelings”; while Capps (2001, 29) says that “the objective” of empathetic listening “is to enter, insofar as possible, into the other person’s own world of experience, to know and feel it as though I were the one who is troubled, confused, upset, vulnerable, content, happy, overjoyed”.

Clinebell (2001, 29) helpfully points out that a pastoral counselor can have his sensitivity to the counselee’s feelings blocked by prematurely trying to think of solutions; he simply needs to “concentrate on understanding and being with them caringly in their inner world”.  It is this desire to understand that communicates caring acceptance to the counselee, and which is all important.

However, a hospital situation changes the dynamics of visitation.  Faber makes a pertinent point that when visiting someone in hospital whom one has never met, a pastoral counselor needs to make clear that he has not just come to chat but to discuss needs, and must have the counselee’s permission in order for a fruitful discussion to occur.  But empathetic listening still needs to underlie the discussion.  He says, “  Good pastoral contact demands that you recognize and react to signals sent up by the other person.  It demands that you listen with a third ear to the feelings of which you become aware in and behind the words spoken by the other” (Faber 1968, 130).

Further, Patton (1990, 537) observes that a pastoral visit to a patient in hospital “should ordinarily not be very long; fifteen or twenty minutes is often sufficient, and more can easily become a burden to the patient”.  Therefore pastoral visitation should not be seen as a time for counseling but as “simple, symbolically rich opportunities for being present …..in a concerned and supportive way”.  Thus he brings in the idea of “presence” to hospital visitation, and furthers this by saying that the patient and/or his family are cheered, not because he brought any from outside but because of his “being with them where they are”.

Follow-up pastoral visitation

Pastoral visitation occasionally requires only the one visit, but frequently, regular visits, particularly to follow up and continue counsel, are necessary.  Empathetic listening is vital to pastoral visitation and counseling, but also essential is the need to make sure that the counsel is being followed.  It is here where the pastoral counselor’s guidance is brought into play.

Adams shows from Zechariah 11:15-17 and Jeremiah 23:2 that it is the “worthless shepherd” (NRSV) that does not conduct pastoral visitation.  However he also states that the “biblical emphasis of pastoral visitation has been missed by many ministers of the church, who have equated visitation with making house calls”…..“The prayer and Bible reading exercises….the small talk, the superficial inquiries….” are no longer seen as adequate because they are not biblical.  He shows that there is a vital sense in which the ideas of visitation and shepherding are connected, and they reflect God’s concern for his people.  He says the idea of visitation is “to look after”; it requires action, modeled on the “God who cares enough to visit” (Adams 1974, 75-78). 

From this it can be seen that pastoral care and visitation are not simply mechanical duties that have to be performed in order to earn a wage, or keep people quiet.  They require a genuine concern for the one in need, even if that person is not known personally by the pastoral carer, such as a hospital patient.  The pastoral carer is to demonstrate the love and concern that God has for the suffering; to be Christ to them, with them. 

Benner (2003, 42, 48, 97) suggests that pastoral counseling and visitation be (a) limited to short-term counseling as it is equally as effective as long-term counseling (p 42) and (b) that it be limited to 5 sessions because “the clock is ticking from the first contact, and both the pastor and the parishioner are forced to work continuously at maintaining focus and direction” (p 48).  He points out that “God does not depart at the end of the fifth session.  He will continue to be present as the parishioner goes on with life” (p 97). This advice, of course, does not apply to visitation of elderly parishioners confined to their home or Nursing Home.

Another form of follow-up ministry is simply the sending of birthday or other type of anniversary cards.  This is an act of nurture and care which can be a great encouragement to parishioners provided it is not the only contact they have with the pastor or congregation.  Especially valuable would be a visit or call from the pastor on the anniversary of the death of a loved one.  It is an encouragement to the bereaved that the one they loved, and still love, is not simply a forgotten name; acknowledgment of the deceased, and encouragement to keep their memory alive, could be a hugely heartening and reassuring gesture, if done with suitable empathy.

Conclusion

Pastoral care is a gift of God to his people (Eph 4:11-13; 1 Pet 5:2); it expresses his heart to them.  In the history of the Church, pastoral care has been expressed in many ways, often with different aspects being emphasised by different groups.  But fundamental to pastoral care is a sincere and heartfelt concern for the one requiring that care.  It requires an ability to listen empathetically, active engagement, and a structure to the care.  But more than this, it has as its goal the restoring of the sufferer to a right relationship with God and thus with their world.  Pastoral care requires that the carer be involved with the sufferer but still able to direct them to a resolution of their problems in a biblical way.  It cannot be done mechanically because every person is unique, and their problems are unique; therefore pastoral care can be emotionally difficult and costly for the carer. 

However, with the advent of secular psychology, it has become more effective when used in concert with, and in subjection to, scripture.  Roberts says, “The careful adaptation of the secular material is designed to guarantee, as far as possible, that these personal changes will conform to Christian standards of personality development, and not subvert such development”.  (Roberts 2001, 134).

And he warns of the danger of allowing non-Christian therapy, when integrated with Christian pastoral counseling, to dominate.  “In this case, integration is like a destructive infection in the life of the church that perverts our understanding of ourselves, weakens our devotion to Christ, and replaces the kingdom of God in the hearts of his people with such aims as individuation, self-esteem, feeling good, congruence and satisfaction with life” (Roberts 2001, 134-135).

Christian pastoral care, because it is of God, is the only care and counseling which can bring true healing and wholeness by bringing a person into right relationship with God and with their world.

References

Adams, J. 1974, Shepherding God’s Flock, Presbyterian and Reformed, Nutley, New Jersey

Benner, D.G. 2003, Strategic Pastoral Counseling, Baker Academic, Grand Rapids, Michigan

Clinebell, H. 1984, Basic Types of Pastoral Care and Counselling, SCM Press, London

Faber, H. 1968, Pastoral Care in the Modern Hospital, SCM Press, London

Fogg, S.L. 2003, “Visiting Those Who Mourn”, in Partners in Healing; Bringing Compassion to People with Illness or Loss, ed. B. A. Musgrave, Paulist Press, Mahwah, New Jersey

Gerkin, C.V. 1997, An Introduction to Pastoral Care, Abingdon press, Nashville, Tennessee

Hunt, D. and McMahon, T.A. 1985, The Seduction of Christianity, Harvest House, Eugene, Oregon

Jackson, E.N. 1990, “Calling and Visitation, Pastoral”, in Dictionary of Pastoral Care and Counseling, ed. R.J. Hunter, Abingdon Press, Nashville, Tennessee

Koening, H.G. 1998, Pastoral Care of Older Adults, Augsburg Fortress Publishers, Minneapolis, Minnesota

Musgrave, B.A. 2003, “Presence, An Active Silence”, in Partners in Healing: Bringing Compassion to People with Illness or Loss, ed. B. A. Musgrave, Paulist Press, Mahwah, New Jersey

Patton, J. 1990, “Hospital Visitation”, in Dictionary of Pastoral Care and Counseling, ed. R.J. Hunter, Abingdon Press, Nashville, Tennessee

Peterson, E.H. 1992, Five Smooth Stones for Pastoral Work, Eerdmans, Grand Rapids, Michigan

Roberts, R.C. 2001, “Outline of Psychotherapy”, in Care for the Soul, ed. M.R. McMinn and T.R. Phillips, InterVarsityPress, Downers Grove, Illinois

Stairs, J. 2000, Listening for the Soul, Fortress Press, Minneapolis, Minnesota

Willimon, W.H. 2002, Pastor, Abingdon Press, Nashville, Tennessee