Confrontation Testing

Confrontation for Certification – Testing Personal and Professional Integration

by Gordon J. Hilsman

The phenomenon and art of confrontation is vital for the certification of chaplains and even more so, in the certification of budding clinical pastoral educators. Both of these professions, in very different ways, require a degree of personal integration beyond what most professions require. To enter the arenas of human pain, spiritual belief and religious practice with people who are under considerable pressure and even alarm from illness, injury, or chronic conditions, not to mention the threat of dying, calls for a significant knowledge, calming maturity, and facile and timely self-disclosure. Nobody is born with that kind of personal integration. It needs to be developed over time with practice, feedback from others, and experience. It is sustained then by a natural interest in the aspects of life that cannot be controlled or sometimes even influenced (Our best definition of spirituality) (Hilsman, 2017).

There is a long history in the clinical ministry professional associations of members intensely interested in the quality of spiritual care of deeply troubled people. One aspect of that history is how to decide who is ready to practice spiritual care in public institutions within the context of pluralistic society. The story would be one of the “why” and “how” of certification and the primary criteria for that, personal and professional integration.

In the twelve years I served on the national certification commissions for my professional organizations that certified clinical supervisors of spiritual care providers, the following scenario was very common. Five colleague reviewers would assemble with the applicant for certification as a supervisor for 90 minutes, prepared for by a written presenter’s report fashioned by one committee member. The meeting would begin with the applicant using the written presenter report to address the group. As the candidate talked about their supervision, the committee listened intently and quietly noted what they liked on the one hand and what they had questions about on the other. Typically, the candidate (We’ll call them C.) would describe a specific student and how they had assessed and supervised that student. Any committee member would draw attention to some incongruency or lacuna they had noticed, such as:

M1 – I liked your writing. You describe things well and even colorfully. And I wondered how you saw DD’s (a member of their presented group) marked reticence to disclosure in the group.
C – She was reticent. I wondered about that early on. But never was able to bring her very far into the fray.
M2 – Did you ever confront her habit of remaining peripheral to group interaction and individual supervision
C – To some degree I did. Remember she has MS and seemed fragile most of the time. She never risked much in the group nor very deeply with me in individual supervision. But I thought she did enough with patients and staff, and some in the group, to qualify for credit.
N2 – I don’t think you answered M2’s question. How did you confront her reticence?
C – I guess I never did. Not sure why now that I think about it. Maybe she resembles somebody in my past.
N1 – What was there about her that kept you away from her emotionally?
C – Just her apparent vulnerability, I guess. I never really pressured her to participate.
Q – How does your theory give you guidance in this complex situation? What does it tell you about supervising a student who frequently seems palpably vulnerable and communally reticent?
C – As I hear myself talking about this, I surmise Freud or some Freudian would wonder about transference, maybe reaction formation – you know, unconsciously doing the opposite of what you feel. Avoiding the intensity of your affect.
N1 – Do you mean in her or in you?
C – Wow. Both I guess.
Q – How about educationally? What was your educational theory perspective on her?
C – My theory of education honors human boundaries fiercely. My primary published theorist says it’s better to not do too much inviting of group members to participate because it tends to foster their continued dependence on you….

Thus, it would continue. The applicant talking seriously about themselves, their thinking about their presented students, their feelings about them, their learning about and from them, and how all that related to their stated, written theory of clinical pastoral education. The members of the certifying committee, all veteran educators interested in maintaining the unique quality of clinical ministry, were quietly evaluating the integration of that candidate, seeking to convince themselves that the applicant was skilled and competent enough to have a supervisory perspective on almost any person they would accept into a clinical education program for the extent of a career. Was this applicant ready to be an autonomous practitioner developing, leading, and maintaining accredited clinical education programs in a variety of health care settings on a regular basis?

The purpose of certification is to authorize people to function as caregivers in a given professional organization. The clinical ministry movement that began in New England in the mid-1920s injected new skills and identities of clergy caregivers into the care-giving world. As caregivers began to see strong emotions, and subtle ones, as the heart of the matter of care, they found they needed to invest much more in intentional awareness and understanding of their own emotions. The small group encounter milieu grew as educational experience for spiritual caregiving that was real, stark, direct, and professionally intimate. Religious teaching in those situations and venues was reduced to only one, though major, component of care, as chaplaincy fostered interpersonal focus on a new kind of listening, to the inner experiences of troubled people. It was soon clear that such care required a new kind of preparation.

Real listening differs exponentially from the cognitive, academic, moral thinking approach that had dominated pastoral care up to that point. It was recognized that the changes needed to practice clinical spiritual (then called pastoral) education were inside those practitioners. They are fundamental. Everyone who aspires to a career as a clinical pastoral educator would need to change personally. The need to assess when educators were competent enough to practice as professionals produced a new kind of certification process that featured considerable confrontation to get beneath the surface of practitioners’ practice. Over time, a unique culture developed in group certification of new educators (then called supervisors).

How to best assess competence is still an open question in my clinical spiritual education organizations and I assume in other certifying bodies as well. One approach is to use the concept of integration as a somewhat observable yardstick.

There are essentially three kinds of personal integration needed. They still challenge anyone who takes clinical care of other people seriously as an endeavor and as a career. They are: 1) cognitive/affective integration, necessary for authenticity and depth of care for the spirits of very troubled people; 2) theory/practice integration, to determine whether an applicant tended to get stuck in either rationalized theory or ungrounded practice; and 3) integration of one’s personal history into educational practice, forming a clinical educator identity.

Assessing Integration in Potential Clinical Pastoral Educators

Integration etymologically means “making one”, (as in the emblem on U.S. coins—e pluribus unum, “from many, one”). The underlying theory is that most of us grow up with a conglomeration of quirks and defects to our personalities that serve as functional and even interesting and colorful in ordinary conversations all our lives. However, such idiosyncrasies will emerge as inconsistent and ineffective in a professional practice that clinically educates highly diverse academically educated religious leaders, charged with caring for human spirits in public institutions of a pluralistic society. Those troubling idiosyncrasies will likely be exposed within the context of personal encounter in experiential education in small process groups of group clinical supervision. There is no simple way to do that. But the process will include careful, powerful confrontation.

Clinical spiritual care and education is best led by an educator who functions with a degree of professional integration, which includes, even presupposes, a fair amount of personal integration. A group leader can be straightforward with the group and each of its members, to the degree that that educator can be open, clear, and congruent in the crucial moment. Certification asks “Can this applicant for certification say what they mean, mean what they say, and not say too much.

Can they do so with consistency, authenticity, sensitivity, and an adequate use of various approaches based on the personalities and previous experience of very diverse students? That identity and practice stretches every applicant, no matter their previous education and life experience.

An entire book could be written on this unique method of assessing integration through a variety of interventions. At great risk of being reductive, one way of organizing the process of assessing integration in certification is to confront supervisory students in the moment regarding their affect, cognition, behavior, and communication all in the same conversation. Can they talk clearly about what they think about a student, how they are feeling immediately about the student’s care efforts, and what they remember having done in that attempt to carefully educate. In ACPE certification history, there have developed questions that can serve as examples of interventions that manifest either adequate competence or need for further education as outcomes of the certification meeting, i.e., certification or denial of certification. All are necessarily confrontative.

  1. 1. Cognitive/Affective integration:
    Integration of one’s thinking, emotions, and active behavioral choices ordinarily happens mostly in highly emotionally charged situations that require vigorous use of several interpersonal functions, in such arenas as psychotherapy, grieving major losses, falling in love, and group process work such as clinical pastoral education. We don’t smoothly evolve our integration, but rather are shaken into it by unavoidable circumstances, uncontrollable events, and overwhelm, in combination with the personal and interpersonal help we get in the midst of the chaos those emotionally charged situations can precipitate. Our personality adaptations to the painful aspects of our life experience are just too strong to go away simply because we recognize them and want to rid ourselves of them . We need solid and caring confrontation to pull the disparate aspects of our personalities together into a relatively congruent whole. Clinical pastoral education itself and certification events tend to contribute to that process.

  2. In the certification context, certifiers are asking themselves, “Can this applicant talk about their emotions about a student in vignettes, distinguishing between the basic emotions of anger, sadness, hurt, fear, joy, and regret (guilt/shame). And can they switch with some facility and apparent authenticity to their thinking about that same student. A few examples of many questions and immediate direct observations typically used during that one ninety-minute certification meeting may be:
  • How did you feel in general about them (a specific student)?
  • How were you feeling when they said/did that (a specific response or event)?
  • What were you feeling besides annoyed? (Hurt? Fear? Sadness? Shame?….)
  • What do you think was behind your excessive anger at that point/student?
    (transference, projection, rationalization, justifying?)
  • It seems like you’re getting a bit riled right now.
  • You seem to be withdrawing emotionally from this committee right now.

    2. Theory/ Practice Integration
    The flexibility of a clinical supervisor to shift focus from concrete descriptions of a student to theoretical conceptualizations allows them to better decide how to supervise that student. Certification tests whether an applicant has done enough serious talking about students to begin working as an educator with that flexibility to carry a nimble presence in group supervision. Getting stuck in principles makes one pedantic, dampening, and boring in the group. And it prevents learning “in the moment”. On the other hand, getting stuck in immediate observations of group dynamics robs group members of the opportunity to learn concepts that make conversing about caring relationships more efficient and communicable. Identifying adequate flexibility in switching between these two perspectives convinces a certification group that an applicant’s theory is really a theory – a collection of intertwining principles that gives direction in situations of great complexity – and that that theory is really theirs in practice, not merely a series of rationalizations in order to get certified.

Some certification confrontations that test the relative integration between theory and practice of a candidate for certification can be, for example:

  • I hear your description of DS in that vignette. What aspects of your theory serve you in supervising them?
  • I hear your theoretical assessment of DS. Can you give an example of how you actually used that theory in supervising them?
  • What do you mean in your theory by the term (any concept, from ego to grace).
  • When your primary theory fails to address group issues, as with JK, what secondary theory of group dynamics serves you?

    3. Integration of One’s Personal History into Educational Practice Forming a Clinical Educator Identity
    Early clinical educators noted that a person who was validated by a group of peers for functioning relatively consistently as an authentic caregiver, and could talk about themselves and their care relationships clearly, seemed to have become personally different. Their convincing new confidence was recognized as a new identity, as if there was a new person inside them. Early Christians called that same phenomenon “putting on Christ”, military people grasp the phrase, “Once a soldier always a soldier”, and physicians know when a person does not just “impersonate a doctor” but actually is one. Those early educators called it a “pastoral identity” when they saw it in a developing student and could count on that student to genuinely and skillfully care for most any deeply troubled person to whom they were assigned to care. One component of that identity is extensive experience of having been confronted repeatedly about their care efforts enough to gain that confidence-combined-with-competence that constitutes a new identity.

  • Competence without confidence remains reticent, fledgling, and maybe courageously trying. Confidence without competence is mere bravado and theater (playing church is the old term), and can be dangerous when officially authorized to practice as a professional. The two together can be seen as a solid pastoral identity.

  • At least two things are different in that new person: humility, i.e., a self-understanding that knows and accepts both one’s own gifts and limitations, and a clinical perspective on care.

  • Clinical in this context refers to an approach to helping people that features direct observation, objective discernment, and use of established but evolving frameworks of understanding people, relationships, and their human interactions. Clinical education is designed to develop a caregiver’s trust of their own direct observations and impressions of people’s difficulties, combined with some conceptual language of psychology, theology, and other helping disciplines that facilitate professional dialogue about those difficulties. Clinical spiritual care proceeds from a place of one’s own direct observation rather than pervasive belief, religious conviction, or pop psychology. Medicine and spiritual care are being increasingly reshaped to work together in such integrative caregiving efforts as palliative care, addiction recovery, professional chaplaincy, and spiritually informed psychotherapy. All of them rely on empathic confrontation as key interventions in their care.

  • A professional identity in this context is shaped by a supervisory candidate’s being sufficiently confronted on how their own personal history affects their relationships with students to allow them to maintain as objective perspective as possible in their educational work. Reflecting on one’s reactions to specific students and how one feels in various situations with them gradually forms the new identity, that of supervisor, on top of the chaplain identity that was developed in chaplaincy education. This is especially true when a budding educator has strong emotions that seem out of proportion to what one might expect in a specific interaction. Tracing those emotions and impulsive actions to one’s personal history often enough informs an educator about how to intervene more helpfully to various educational opportunity moments with peers and students.

  • A small group arena works best for this because it allows direct feedback from several peers at once to help one another see themselves more as patients see them, than relying on their own impressions only. Learning how to use this powerful group confrontation is a primary early learning of chaplaincy students, and becomes even more crucial in forming a supervisory identity for leading and managing programs of clinical education.

  • The professional certification interview is essentially a testing of whether a person has learned from being confronted enough to be allowed to officially confront others in person and in the writing of official student evaluations that will persist in files to verify clinical education competence. The ability to confront others with piercing accuracy, perspicacious timing, courageous initiative, and deep empathy still stands as a fundamental skill in the certification of both chaplains and clinical spiritual educators.

  • Therapy/Education Distinction
    Besides these aspects of integration, certifiers of clinical educators are accustomed to test the applicant’s distinction between clinical education and therapy or counseling. It takes deft confrontation after careful observation to make this determination in a few certification minutes. Does this applicant for certification keep the sometimes-blurry lines as clear as possible between therapy and education? There seems to be a strong temptation on the part of budding educators to practice group therapy rather than group clinical education. Therapy in this context means helping another person recognize and heal aspects of their personality and relational functioning to improve the success and satisfaction of their lives. Clinical education here is helping caregivers to improve their care relationships through actual experience of caring for people and communal reflection on that improving care. The one is about getting help for oneself, the other about helping people improve their care of others. Even when an applicant has incorporated that distinction into their theory, there is still a tendency to engage in curative interventions in the group instead of recognizing and referring them to counseling or therapy. Some certification interventions intended to confront the slide into therapy can be, for example:
  • It seems like you lost sight for a time, of the educational goals of student CW.
  • What was the primary goal of your own that seemed so important?
  • How did you deal with WG’s current and historical indicators of a drinking problem/co-dependence?
  • Are you satisfied with how you met GR’s apparent OCD ‘freezing’ in that second week group?
  • How did you feel during BG’s rage event in that pivotal group session?
    On occasion it becomes prescriptive to ask an applicant for distinctions between their definitions of therapy, education, and consultation vs. certification as well. Keeping these clear in one’s mind can be a milestone in becoming a clinical educator.

  • Clinical education as a chaplain is transformative for those who choose to engage and even embrace it in supervised group education. Training formation for a career of supervising, organizing, and maintaining that kind of experiential group education is even more shaking and transformative. Weak education as an educator has great potential to do harm to students if they are prematurely certified, as well as dilute the depth of their clinical supervision for their career. If they then find their way onto certification committees the process of diminishing the entire field ensues. It takes considerable care to make the decisions of a person’s readiness for such a career in certification meetings. Sorting the capacity of applicants for both certification as chaplains on the one hand, and as clinical pastoral educators on the other, will only be done with consistent, persistent confrontation by those who have gone before. And it is extremely sensitive, intricate, and important work.