Dear CPE Students: Leave Your Assumptions at the Door

Someone about to start her first Clinical Pastoral Education unit (CPE; a chaplain training program) emailed me some provocative questions recently: “What would you have said to your younger self when she started this course to train healthcare chaplains? What would it have benefited her to know sooner? What needs to be in place in one’s life besides a close walk with God, and a burning desire to help the hurting and the sick in their darkest hour with the ministry of presence?”

Another such student wrote me, “What can I expect from CPE? I feel insecure about not having much ministry experience and feel like my theological and biblical background is not as strong or deep as most people’s.”

I told both of them that CPE is full of paradoxes. First, what is more important than the factual content of their questions is what the questions reveal about the students themselves. Thus when we think we are communicating one thing, we are implying another, often deeper one. CPE instructors (called “supervisors”) might zero in for instance on the first student’s concern about what “needs to be in place in one’s life.” She might in turn ask the student, “How important is it for you to feel that things are ‘in place’ for you?” As for the second student, she might focus on his word “insecure” and ask why not having much experience would make him feel that way. (It is not a given that all people who do not have much ministerial experience would feel the same. They might be excited by starting fresh for instance.)

Now such reactions from a supervisor would not imply a judgment of any kind, but rather a way to get their students to become more self-aware. This is the name of the game of the educational philosophy of CPE. The more we are aware of our assumptions and feelings, the better we can serve our patients. The less we are self-aware, the bigger the blinders are that will interfere with our understanding what a patient needs. Suppose for example you grew up with a lot of criticism from one of your parents. So when a patient says something about you such as how your hat looks, you might erroneously interpret that as a criticism, even when it is not. Such a misunderstanding would naturally throw off the conversation and perhaps make you act as you did when your parent criticized you, such as by emotionally hiding. (Dear readers who are CPE supervisors: Yes, I am aware that my examples are not random and are letting you in on my own issues.)

Another paradox I am fond of pointing out is a Zen-like adage: chaplains help patients the most when they are not helping. Part of what this means is that one of the prime rules of good chaplain care is NOT to give advice or try to “fix” a patient’s problem. Nope, not even when they ask for it! Often the very best thing to do, which requires restraint and no wish to say something clever, is to listen as undistractedly as possible until the patient is clearly finished venting. Chaplains are not there to give answers, but to pose questions. We are there to give the patient a safe sacred and nonjudgmental space for them to talk about whatever they need to talk about, from golf to God, from divas to death. The emptier we are of our own agendas, including assumptions about what we ourselves think patients should be discussing, the more they will convey what they most need for us to hear. And if I may tuck in one last paradox, our goal is to do all that exhausting intense listening and be what supervisors refer to as a “non-anxious presence.” To paraphrase that CPE mantra, you have to be connected with your patients yet maintain a distance from them at the same time.

If you are a CPE beginner, do not stress about how much knowledge you have or “what to say” in a given instance to a patient. Rather, you will get “points” for how much you are willing to be vulnerable, thus narrowing the divide between the well and the sick.


5 thoughts on “Dear CPE Students: Leave Your Assumptions at the Door

  1. liz Adams says:

    This is a wonderful post, Karen, and reflects just how you helped me, though in fact after my husband’s death. Yes, that detachment but with caringness, delicate balance which you achieved. I thank you every day for the strides you helped me make. Liz A.


  2. Consuelo M Beck-Sague, MD says:

    Loved it… but why just CPE students? Advice for JUST CPE students? Isn’t this all wonderful advice for, say, medical students? Psychologists? Parents? Adult daughters? This is not even advice. So little a word. More like words to live by. “Order my steps”.

    Liked by 1 person

  3. “Chaplains are not there to give answers, but to pose questions. We are there to give the patient a safe sacred and nonjudgmental space for them to talk about whatever they need to talk about, from golf to God, from divas to death.”

    Beautifully stated my friend. Yes. That is what we do to the best of our humble abilities. Beautifully stated.


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