Psychology Professor Develops New Model For Collaboration Between Clergy And Clinicians

ScienceDaily (Jun. 2, 2008) — Many of the clergy who lead America's 260,000 religious congregations turn to psychologists who share their religious values when they refer congregants to social workers. However, this approach could impede people from getting the care they need, maintains Dr. Glen Milstein, Professor of Psychology at The City College of New York (CCNY).

For the past decade, Professor Milstein has led a multidisciplinary team of researchers in developing a new model for relationships between clergy and clinicians that is religion inclusive rather than faith based. Known as C.O.P.E. (Clergy Outreach and Professional Engagement), the approach is design to reduce burdens on both professions. It was described in detail earlier this year in the American Psychological Association's journal "Professional Psychology: Research and Practice."

The key to the C.O.P.E. model is the recognition that mental illness is a chronic disease with which patients sometimes can function and other times can not, Professor Milstein explains. "Clinicians and clergy perform distinct, complementary functions in treating these syndromes. While clinicians provide professional treatment to relieve individuals of their pain and suffering and move them from dysfunction to their highest level of function, clergy and religious communities provide a sense of context, support and community before, during and after treatment."

The program aims to improve care of individuals by facilitating reciprocal collaboration between clinicians and members of the clergy, regardless of either's religious affiliations. It is based on two principal ideas: The first is that clergy and clinicians can better help a broader array of persons with emotional difficulties and disorders through professional collaboration than they can by working alone, and secondly, that the program's success is predicated on collaboration easing the workload for both groups.

Professor Milstein describes the approach as "religion-inclusive" since it calls upon the therapist to both assess the role of religion in the patient's life and to educate themselves about the patient's religious tradition. Often that education includes contact with the patient's clergy.

Faith-based approaches, which call for the individual to be referred to a clinician from his or her own faith, can restrict care by excluding access to professionals best able to treat the condition, he maintains. Professor Milstein cites a research study comparing the work of religious psychotherapists with the work of nonreligious psychotherapists in treating religious Christians. The study found that nonreligious therapists who provided religiously informed psychotherapy achieved the best clinical outcomes for this group.

Working from the National Institute of Mental Health's four prevention categories, Professor Milstein and his team developed two handouts, one for mental health professionals and the other for clergy. They provide descriptions in a hierarchal format of the four care stages and illustrate when it would be appropriate for clergy to contact clinicians and for clinicians to contact clergy.

The goal of C.O.P.E., Professor Milstein explains, is for clergy and clinicians to provide a continuum of care, whether the person is fully functional, is under stress, requires treatment or is trying to avoid relapse. The approach has been used to facilitate collaboration between expert clinicians and clergy from a variety of faiths including: Armenian Orthodox; Roman Catholic; Ethical Culture; Hindu; Muslim; Judaism, as well as evangelical and mainline Protestant denominations.

Because clergy tend to see people throughout their lifetimes and in different circumstances, they often are in a better position to identify whether or not someone is functioning properly, Professor Milstein points out. For example, they are likely to distinguish between someone who has lost a loved one and is going through a normal bereavement process and someone who could be clinically depressed. "Recommending an intervention for someone who may be depressed relieves their (clergy) burden," he adds.

Similarly, religious communities can relieve the burden on the clinician by helping people reenter everyday life, Professor Milstein adds. "Religious communities are primary areas of social support for most people. If religion is an important part of an individual's life, the clinician needs to make that connection. They should contact the clergy and let them know to look out for and welcome the person back."

Conversely, he points out that the approach would not be helpful for patients who have had negative associations with religion or religious leaders. "The model is not a panacea, but, rather, an option to engage the whole person. Patients need to be assessed and treated individually without judgments about whether religion is good or bad."

Professor Milstein's research collaborators were: Amy Manierre, an American Baptists minister currently pursuing as Master of Social Work Degree at University of Houston; Virginia L. Susman, M.D., Associate Medical Director and Site Director at New York Presbyterian Hospital and Associate Professor of Clinical Psychiatry at Weill Medical College, and Dr. Martha L. Bruce, Professor of Sociology in Psychology at Weill Medical College.

The research was supported by grants from: the DeWitt Wallace-Reader's Digest Research Fellowship Program in Psychiatry; the National Institute of Mental Health; the American Psychological Association and the Professional Staff Congress – CUNY.

Counseling Resource Recommendations

Counseling resource recommendations are hard for me to make without a sense of what skill level the person has. As a general rule of thumb, however, the very first thing to bear in mind is that we ought not to enter into a counseling relationship that is beyond our comfort level. So for example, even if I'm comfortable and competent (different things by the way, the former not being in anyway a predictor of the latter) in a therapeutic setting deal with this or that issue, I often find that I need to refer the person to a therapist who has more time and access to greater social service resources then I do in a parish.

What I'm getting at is this: The best resource we have in counseling is a sense of our own personal and technical limitations.

What studies that have been done on the effectiveness of counseling relationships suggest that the quality of the relationship between counselor and client is what is most important. Second on the list are the personal internal and social resources of the client. The specific therapeutic orientation and skill set of the counselor is relatively low down on the list of predictors for a successful counseling relationship. This doesn't mean professional competence is unimportant, only that it is not the primary predictor of success.

So, looking at the first element, the relationship between counselor and client, you might want to read Adrian van Kaam's The Art of Existential Counseling: A New Perspective in Psychotherapy. I have found this and a number of van Kaam's books to be very helpful and very accessible. You also might want to look at Dynamics of Spiritual Direction
also by van Kaam. The Art of Spiritual Guidance by Carolyn Gratton might also be of use to you. (Having studied with both authors I can testify to both their professional competency and commitment to Christ.)

As for the second element, before getting involved in any type of ongoing counseling relationship, it is important to have a sense both of the person's internal, moral strength as we well as what kind of social support they have to encourage and sustain change. People without these internal and social resources are generally not good candidates for counseling, at least without enlisting significant support from social services. In a parish setting we simply can't work with people who lack these personal and social resources. Again, this isn't a reflection on our commitment to Christ or His People, but rather of the whole range of resources we can bring to bear.

BUT, even if I cannot enter into a formal counseling relationship with someone, I certainly can refer them to a professional therapist and commit to being a support for them as they go through counseling. This works most effectively if I have a pre-existing professional relationship with area therapists (and this is one of the things on my "to do" list when I come to a new parish) who can act as potential partners when I refer folks. Also a relationship with a therapist is good to help me get a sense of when people bring me things about which I'm not in a position to help them.

Two resources that address the technical aspects of counseling that you might find helpful are Basic Types of Pastoral Care and Counseling: Resources for the Ministry of Healing and Growth by Howard John Clinebell and A Minister's Handbook of Mental Disorders by Joseph W. Ciarrocchi. Together these will give you a sense of the therapeutic lay of the land and help you recognize when you are passing from a spiritual/pastoral matters to more psychological/mental health issues.

In my own ministry I have some general rules that I follow.

First, I divide my counseling ministry into three basic areas:

1. PASTORAL counseling for those who are still functional (i.e., can love and work successfully) and whose basic concern is to find meaning in Christ for themselves or their life.
   
2. PSYCHOLOGICAL counseling is for those who are not able to function or only marginally functional. As a rule, these I refer to a professional therapist though I do try and offer what pastoral support I can give and they can receive.
   
3. POLICE matters pertain to anything criminal. Here all I can really do is support the victim in making the best of the situation they find themselves in. As for perpetrators, these folks I encourage to turn themselves in. Any instance of actual or threatened physical violence is a police matter.
   

Second, I need to realize that I can't deal with every person who comes to me looking for help. While some times what they bring me are outside my area of technical competence, generally and for most part the issue is one of time management. I have limits on my time and energy. If I spend several hours in a series of high stress counseling sessions (which sometimes happens), I'm useless for much of anything else for DAYS.

Third, counseling in a parish setting is often crisis oriented--clergy are good first responders, but we are not in a situation to do long term, or even short term, counseling. The further we get from a pastoral relationship the more danger we are in of malpractice, malfeasance, misconduct or personal burn out.

Fourth, when in doubt about my abilities or if I don't have the time/energy to help someone I refer them to a professional therapist. Yes, this comes with a commitment to support them in therapy—but as their priest who will help them bear the cross of mental illness.

Fifth things which are clearly PSYCHOPATHOLOGICAL (e.g., depression, schizophrenia, bipolar disorder) I refer to a clinical psychologist. Pastoral support here means checking in with the person from time to time and seeing how they're doing. Oh, yes, I also will ask them about medication usage--basically, "Are you taking your medication(s)?"

Sixth, PHYSICAL VIOLENCE (either ACTUAL or THREATENED) is NEVER something that I work with as the primary caregiver. Instance of physical violence, like all crimes, are POLICE MATTERS. Yes there is a pastoral dimension to say domestic violence, but it is fundamentally a legal matter and I need to respect that even if my parishioner is not willing to report the crime.

Finally, I think one of the best things I have ever done for my own counseling ministry was to be in therapy. I have seen a therapist several times in my life. The old psychoanalytic model (now increasingly ignored) was clear: You must undergo analysis to become do psychoanalysis. Being in counseling has been most helpful for me learning what my limits are.

Let me know if the above is of any help to you. Of course you can always invite me to come and speak and do a clergy training workshop.

In Christ,

+Fr Gregory