Training for Caring Communities: A Roundtable

June 1, 2011
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Michele Prince: There has been a recent explosion of attention to the field of pastoral care. Let’s start this discussion with a question about how best to train our future Jewish leaders to meet the needs of the community. What are the legitimate expectations of the community — of our synagogues and organizations — for our leaders who serve people encountering illness and loss?

Mollie Cantor: I hear that question posed often. We’ve all heard this story: When my mother died, the rabbi came to our house and spent two hours with us; or, the preschool teacher called us and it was really great to feel connected — but that was it.

Sara Paasche-Orlow: Rabbis serving large congregations need to have some basic good listening skills and sensitive responses to real life issues. But they cannot be the only ones responsible for all the care needs. A rabbi’s role is to create the fiber of a caring community, where there are many people in place to respond to need. Some rabbis who have been in the pulpit a long time have set themselves up in some way to be the caring souls for the whole community; some need and want that role. A much more effective approach is to create a community committed to chesed with a group that is charged with learning better how to care for individuals in need. Rabbis might think about how their teaching, their resources, feed into an environment where people are cared for and where they inspire other leaders to emerge.

Michele Prince: An entrepreneurial opportunity exists to place clinical pastoral education (CPE) students as interns in synagogues and other Jewish organizations beyond the standard health-care sites. I imagine multiple tiers of what our students need to learn. First, they need to learn how to assess an individual, a couple, or a family — and then to understand when to ramp up that response. As Mollie mentioned, we also need to help our leaders anticipate the needs of the community — creating, as Sara mentioned, a fiber of connectivity so that both the lay leadership and individual members know that they need to step up when someone is in need. Everyone knows how much counselling goes on in the hallway or at a kiddush. It contributes to compassion fatigue in our professionals. We need to teach our students about enduring strategies for self-care.

Michelle Friedman: Students in any Jewish leadership training program need to understand themselves as fully as possible. A facilitated process group offers opportunities to explore experiences that touch Jewish professionals in both negative and positive ways. Students can then better confront their own vulnerabilities as well as recognize that everybody’s got core vulnerabilities, strengths, feelings of frustration, outrage, dismay, disappointment, and delight.

Sara Paasche-Orlow: Rabbis can become incredibly lonely down the road in their careers. They need an ongoing safe place with colleagues where they can open up and share the struggles and range of emotions. Rabbis are viewed as though they inhabit the top rungs of the ladder and can’t seek supervision or guidance, which is unfortunate. Those with CPE training can arrange for an ongoing group with a CPE supervisor to continue to learn and grow as a pastoral counselor.

Mollie Cantor: One of the fascinating aspects about seminary education is that students spend so much time in their heads poring over Jewish texts. But when we’re faced with somebody who is dying, or a mother who’s just had a pregnancy loss, or an individual who has just heard a devastating diagnosis, it’s very hard to reach into a text to find the right pastoral response. We don’t learn a practice of just being spiritually available to the sufferer. Many students in CPE training begin to suffer at that moment.

Michelle Friedman: Rabbis and caregivers really need to appreciate the power of being quiet and present. They generally think in action terms: “What can do I do? What text do I pull out? What shall I say?” But being present is incredibly powerful. People are nourished by that presence.

Bruce Feldstein: About strategies for self-care — when I started out as a chaplain, I received the advice of a rabbi that has served me well. To stay openhearted and avoid burnout, one needs to maintain five key relationships. I wish I had learned this as a medical student. The first is a relationship with one’s self; we can only do what we can do, even though we really can do quite a bit. We must recognize and accept our limitations. Second, is a relationship with a soul friend, someone with whom we can speak about anything, who will listen without judgment. Third, is with a therapist, to process the range of emotions and grief we inevitably encounter. Fourth, is with a colleague or mentor, who can appreciate what we’re going through, having been there themselves. And finally, a relationship with the Transcendent, however we may engage, whether through worship, text, a walk in nature, moments of solitude, or other activities.

Sara Paasche-Orlow: We also might want to acknowledge that we can’t deal with all patients. Sometimes, leaders fall into the trap of thinking they’re irreplaceable, and they’re not. Part of caring for oneself is to recognize a situation in which we are not the appropriate caregiver.

Michele Prince: Bruce suggested that a relationship with a colleague or mentor could be an
opportunity to revisit issues that surface. Do your programs include guest speakers who have modeled positive coping strategies while sharing their expertise?

Michelle Friedman: In Manhattan, there is a tremendous pool of experts. But our students really want continuity in supervision — a makom and z’man kavuah, a place and time that is fixed.

Mollie Cantor: Last summer, we invited [Jewish Theological Seminary] faculty to talk to our CPE student groups. The professors didn’t talk about their own fields of expertise, but rather shared their relationships with prayer, sharing moments of transcendence that weren’t always easy. The experience gave our students permission to have doubt. When they are in the field and faced with challenging congregational or hospital ministry, they will know it is okay if it doesn’t feel just right to pray. They’ll also know that one can still maintain a relationship with God.

Michelle Friedman: I’ve found that bringing in musmachim, graduates and rabbis, from the field to teach from their personal experiences in the rabbinate is very helpful. The visiting rabbis talk about what they found hardest personally and how they overcame their challenges — what Jewish resources they turned to, what personal resources. The students appreciate hearing about what happened and what was learned through tough pastoral situations.

Bruce Feldstein: At a luncheon celebrating the ten-year anniversary of our Jewish chaplaincy, rabbis from across the religious spectrum in our community gathered and shared their experiences, their best practices in bikur cholim, visiting the sick. It was very well received. In another type of group experience, I gather every six weeks for a “Chaplaincy Chat” with our Jewish spiritual care volunteers who visit patients at the hospital. We reflect on visiting patients, the impact upon us, experiences of holiness, doubts about faith, etc. These two hours in sacred space are rich with learning and mutual support.

Sara Paasche-Orlow: We offer an ongoing monthly supervision for any alumni of our program that has been quite effective. It creates a safe space for people in the field to come back to — a place where they can share challenging experiences and understand themselves as continuous learners and reflectors. I also want to put in a plug for CPE placements in long-term care, rehab, and continuing care communities. Hospital placements don’t necessarily give students clinical experience in longer term relationships. This skill development is more applicable to the pastoral care needed in most congregational communities.

We do rounds where the full team comes together to review the social, health, and pastoral aspects of a complicated patient case. It’s been a very useful tool — not only pedagogically. It also allows people to share their emotions and get support, and it provides a measure of closure so they can be ready for the next case.

Michele Prince: We spend a lot of time in pastoral education thinking about illness and responses to illness, and while we need to ensure we are training our leaders to do that well, we also must embrace the concept of health and wellness. How might our communities approach wellness to create vibrancy and health in our schools, among congregation staff, and in chaplaincy and hospitals?

Michelle Friedman: Rabbis can make powerful interventions. An example is the place of alcohol in Jewish life. We hear about problematic kiddush clubs in synagogues as well as the use of alcohol to lure young people to programs. Rabbis can be change agents in bringing the complex issues of alcohol to the fore by speaking, teaching, and also attending to pragmatic details, such as making sure that grape juice is available for people in recovery at events where kiddush is made.

Mollie Cantor: In New York, the culture is to be busy — rushing and always on the move toward accomplishment. Is this the healthiest model? The Jewish spirituality movement and meditation groups are bringing healthier habits into our lives.

Bruce Feldstein: Busyness is so pervasive. I am struck by the Chinese word for “busy” which is comprised of two characters: “heart” and “killing” — “heart killing.” Doesn’t that hit you in the kishkes?

In preparing for this call, I asked several rabbis in my community: “What do you wish you knew as a rabbinical student that you’ve now learned about spiritual care, pastoral care, and self-care?” One responded: “Am I taking care of myself, exercising, eating healthy? Am I processing my emotions? Am I venting in a healthy way?” Another pointed out, “We must be able to move from a sad funeral to a moment of simcha and then to an intellectually involved teaching. What do we do to avoid emotional whiplash?” This brings us to the practice of making healthy transitions and grounding ourselves.

Mollie Cantor: We might also look toward interdisciplinary teams with other professionals.

Sara Paasche-Orlow: We cultivate public images and protect our inner self. But we need a more integrated self. How do we protect someone’s integration of self through this particular career path?

Michele Prince: The interdisciplinary team concept resonates so strongly with me. My clinical area of practice is oncology social work, and through that work and chaplaincy, I’ve had such positive team experiences that are not being embraced within Jewish communal life.

Bruce Feldstein: There is another model from medical education that may be useful to adapt to rabbinical education — a course for medical students called The Healer’s Art, developed by the physician and author Rachel Naomi Remen at the University of California, San Francisco and offered now at more than 70 schools. It is a discovery model of learning that explores topics not covered in the standard curriculum: Discovering and Nurturing Your Wholeness, Sharing Grief and Honoring Loss, Beyond Analysis: Allowing Awe in Medicine, and Care of the Soul. The process is facilitated by practicing physicians who participate in the course right along with the students.

On another note, I wonder how we could teach students to articulate the Jewish values that guide and ground us in providing spiritual care in different settings. I’d also like to hear about the practices others use in such settings, and the array of responses to different situations including acute care, aging, addiction, and trauma as well as other kinds of loss.

Michele Prince: That certainly makes me think about modalities of teaching. What works in your settings?

Mollie Cantor: A model of peer working groups that come together during a clinical experience to discuss what’s happening, the space to discuss theological issues. We ask our students to write theological reflections and think theoretically about the different fields that influence the pastoral care encounter. I would love to see every rabbinic student, or every potential Jewish leader, do a unit of clinical pastoral education.

Sara Paasche-Orlow: CPE training is essential for rabbis who will serve as pastoral counselors. We need to get to a place where those hiring rabbis understand that it should be a requirement for jobs with pastoral care responsibilities. Currently, many of those hiring do not yet understand that rabbis do not necessarily have pastoral care training.

Michelle Friedman: We also need to help our community support our rabbis and other Jewish professionals in the field. In addition to parsonage and a pension plan, communities should offer clinical pastoral supervision. A candidate for a Jewish communal job must feel free to say, “I take counseling my congregants seriously and I want to make sure this is supported by the community.”

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Rabbi Mollie Cantor is training to become a clinical pastoral education supervisor at the Jewish Theological Seminary in New York, where she also works in the pastoral education and hospice training program.

Chaplain Bruce Feldstein, MD, is the founder and director of Jewish chaplaincy at the Stanford University Medical Center, which provides spiritual care and education at Stanford Hospital, Lucile Packard Children’s Hospital, and the Stanford University School of Medicine. Formerly, he was an emergency medicine physician for 19 years.

Michelle Friedman, a psychiatrist, is the founding director of the program in pastoral counselling at Yeshivat Chovevei Torah — a Modern Orthodox rabbinical school in New York.

Rabbi Sara Paasche-Orlow serves as the director of religious and chaplaincy services at Hebrew SeniorLife, a geriatric research center, that is the largest provider of elder care in the Boston metropolitan area. She also runs a Jewish geriatric clinical pastoral education program. Michele Prince, director of the Kalsman Institute on Judaism and Health at HUC–JIR in Los Angeles, moderated the conversation.

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