Monday, August 06, 2007

You don't have to go home, but you can't stay here

At hospitals throughout the country, Clinical Pastoral Education (CPE) summer programs are starting to come to an end this week. After 11 intense weeks walking the halls of a hospital and talking with patients about life and death and suffering (and where God might dwell amid all of that) many students are feeling deeply attached to their summer "homes".

But they will soon have to let go. The hope is that this summer will end up being more than just a source of "war stories" for them to tell in the years to come about the overwhelming intensity of it all -- the hope is that the students will be able to take the transformation and learning of the summer with them and that they will use it to have a positive impact whatever work they may choose to do in future (whether it be from the pulpit, in chaplaincy, or somewhere else). I have the same hope for myself -- this was my first unit supervising students. I was overwhelmed much of the time, but I hope that I will be able to move past feeling overwhelmed and instead be able to focus to identify and consolidate my points of learning.

My supervisor talked to our students, today about part of this task of consolidating this learning (otherwise known as making "closure"). He used a useful metaphor from one of his supervisors -- a metaphor of investment and making sure to get your return on your investment (ie, interest).

In the CPE context, the investment you make is in the time and energy you put into various relationships. Few if any of those relationships will continue after you leave the program, so if you don't withdraw the investment you will lose it (and the interest -- learning in the CPE context -- that you earned on it). Closure is about making these withdrawals from your CPE relationships.

The way you do it is by seeking out the staff and peers, etc. with whom you formed relationships that had meaning to you. You ask them if they are willing to have a conversation with you. And then you tell them:

  • What it meant to know them.
  • What you gained from knowing them (ie, what you learned from knowing them).
  • What you missed (ie, your regrets of what you weren't able to do with them or learn from them).
Then you listen and see what they say back to you. That is, you give them an opportunity to do the same withdrawing, etc. you are trying to do with them.


This approach to closure can also be understood through Mueller and Kell's three-part framework (from their classic work Coping with conflict; supervising counselors and psychotherapists):
  • 1) Anxiety approaching
    • This would be the person who is willing to face up to the task (of saying goodbye) and all the concerns, anxieties and grief associated with it. Mueller and Kell consider anxiety approaching to be the healthiest approach.
  • 2) Anxiety avoiding
    • This would be the person who tries to avoid the task altogether. A typical way of doing this would be "slipping out" early before anyone has a chance to say goodbye to you. (I have often been guilty of this one!!)
  • 3) Anxiety binding
    • This would be the person who denies there is any anxiety or change at all. A typical anxiety binding behavior around saying goodbye would be to pretend nothing has changed ("Don't worry, we're not really saying goodbye; we'll stay in touch all the time"). Anxiety binding is the worst approach according to Mueller and Kell. The problem regarding the task of saying goodbye is that all the energy that went into the (now ending) relationship gets binded there and thus cannot be withdrawn to reinvest in building new relationships. Put another way, this person is not able to "move on".


One of the things I have been learning over the course of the summer is about the expected pattern of a CPE unit over time. Students at the very beginning of a unit, for example, are likely to try and reassure themselves (in the face of the unknown and the anxiety they are facing) by trying to reassure the supervisor -- that is, by telling the supervisor how wonderful the program and the supervisor are and how impressed they are by it, etc. A week or two later, some kind of push-back and resistance ("you're asking me to do too much!!!!!") can be expected. This manifests somewhere later in the unit in the "point of peak frustration". How a student copes with that crisis often is the key determiner of what their most important learnings will be for a unit.

Here are some posts I made that commented on the development of these sorts of things during a unit:

And here are some other posts that came out of the work we did this summer:


It really has been a great summer. My prayer is that my students will be able to take the Torah we imparted to them this summer and carry it within their hearts to help foster healing wherever they go. May it be the will of the Blessed Holy One that their congregants, patients, clients, families and friends will all be enriched by their spiritual care and growth.

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