In pastoral care, counseling, and psychotherapy, has there been a paradigm "shift," as suggested by Hunter (Christian Century October 17, 2001), following Patton (1993), following Kuhn (1962)? Or has there been, rather, a "wandering," across the last thirty or more years, of the core working assumption? I would like to suggest the latter. Most authorities and thoughtful non-authorities would agree that the movement for specifically clinical pastoral training of the clergy indeed broke new ground between 1925 and 1930, first in the United States, with steady spread to religious communities worldwide. To be sure, "pastoral care," of a generally dry, intellectualized, universalized variety, existed sparsely much earlier, but few would confuse exhortations and visitations with the richness of what is considered the best of pastoral care today.
After Anton Theophilus Boisen's sudden, creative insight, however initially delusional, about "breaking a hole in the wall separating religion and medicine," pastoral care could never be the same. Boisen's arresting consideration of suffering souls as the "living human documents" of theology forced a true paradigm shift. All roads in clinical pastoral education, no matter how much some may wish to deny it, lead back to Boisen's "Challenge to Our Seminaries" (1926), his Exploration of the Inner World (1936), and his notion of "cooperative inquiry." All else is commentary.
Boisen knew he was leading a revolution. "What is involved is a thoroughgoing shift of attention and a new method of attack and then, in the end, a new authority [for the clergy], grounded not in tradition but in experience." Boisen called for an "internship" year of supervised field training during which young clergy might deal with "living human documents and with actual social conditions in all their complexity" (1926). That shift from books to the nitty-gritty world had something intrinsically compelling about it, sparked by a patient turned clinician on behalf of suffering patients. Subsequent wanderings however valuable and well intentioned have had a tone of forced embellishment, prompted more by social maneuvers on behalf of those offering than on behalf of those receiving care. "Applying" family systems theory and narrative theory sounds all well and good, but Boisen simply knew he was working side-by-side with a person, an individual "text." Moving toward "communal-contextural" concerns (Patton, 1993) eg, of "gender, race, ethnicity [and] aging, together with their associated forms of oppression, abuse and violence" (Hunter, 2001) may have helped clergy broaden their vision toward actually seeing more suffering persons, but it is debatable as to whether it offered anything further for the suffering persons themselves.
Boisen tossed his students into the fray, the "communal context," asking them to join with another person's nascent curiosity about his or her "beliefs amid the complex entanglements of actual life" (1936). His later Outlines for the Co-operative Study of Personal Experience in Social Situations (1946) emphasized that "actual service to human beings in need," getting close enough to view life through their individual eyes, was what held out the hope of "true understanding" that could allow even more specifically "effective service." The image was not of preaching to, ministering to, shepherding, or showing concern. The image was of two sincerely curious investigators the one with specialized clinical pastoral training sitting side by side, struggling to comprehend, to repeat, their "beliefs amid the complex entanglements of actual life" (1936). This was "cooperative inquiry" neither "too personal" nor "too impersonal" as firmly embedded in the social milieu as one could imagine. Boisen's colleague, Helen Flanders Dunbar, later spoke of this as avoiding fancy theories of cause or purpose and of simply working closely, intelligently with the person in need, toward discerning "a point of effective intervention" for the problem at hand (1943).
Remembering Boisen's work helps illuminate Hunter's comments, wherein he calls for an "integrative, praxis-oriented, theological form of inquiry," and for "plumbing the depths of meaning involved in caring, [as well as] in the humanity . . . and in the divinity" "thus disclosed"(2001). Boisen proposed dealing "at first hand with the raw material of some definite segment of human life," so that "we may be able to arrive at some valid generalizations regarding the meaning of the idea of God, the nature and function of religion, and the conditions under which maximum self-realization is likely to be achieved" (1936). Like Hunter, Boisen would grieve that a "generation of pastoral counselors has been theologically educated but not clinically formed in theologically based, pastorally defined programs." He would second the call for "a distinctly pastoral, therapeutically informed art of spiritual and moral counsel" (2001). Hunter's overview of the current confusion allows us to follow the "wandering paradigm" back to its origins: Boisen's vision of "cooperative inquiry."
Robert Charles Powell, M.D., Ph.D., a psychiatrist and historian is one of the leading authorities on Anton Boisen, Flanders Dunbar and the early beginnings of the pastoral care movement.