S. Ghamari-Tabrizi 2012, ACPE Research Network Fall Newsletter

Looking for Excellence in Supervision:A Researcher's Reflection on Her First Unit of CPE

Sharon Ghamari-Tabrizi, PhD2012, ACPE Research Network Newsletter. Fall. http://www.acperesearch.net/Fall12.html

Last summer I had the privilege of taking my first unit of CPE at the National Institutes of Health under the supervision of Rev. Ellen Swinford. Her skills as a chaplain, pedagogue, and supervisor are remarkably fine. In comparing my experience with other chaplain interns at CPE Day mid-way through the unit, I learned that not everyone was lucky enough to train under the guidance of a master pedagogue.

The fact that my CPE experience was so productive as a result of landing an excellent supervisor was a matter of dumb luck triggered my curiosity about the pedagogical model in CPE.

What is distinctive about CPE’s pedagogical method is:

the instructional material is the individual case in all its particularity and detail in group and individual supervision, the CPE student explains the sequence of

observation, interpretation, reasoning behind her words and actions. the CPE student’s peer group -- at the same level of expertise -- as well as more

advanced clinicians -- listen to the case, and then offer comments regarding her thoughts and actions

Group feedback is the means by which the presenter learns:

to identify his/her own blindspots, errors, assumptions, biases. that being accountable to one’s profession for one’s action is normative and

productive. (In other words, this process socializes the novice into the professional norms of sharing case material and seeking feedback non-defensively.)

that there are multiple ways of interpreting the same data.

There is no single best way or right way to interpret a case. In medicine, a gathering of physicians can be persuaded by a medical examiner undertaking an autopsy as to the proximate cause of death. But even here, data can be interpreted by competing interpretative frameworks from different specialties. In the case of psychosocial-spiritual suffering there are countless ways to observe, interpret and respond to someone in pain.

The ACPE has chosen clinical experiential learning as the medium for developing a novice’s practical reasoning as a chaplain. If experiential learning is the basis for Clinical Pastoral Education, with the case study method in verbatim form established as the ideal for chaplaincy education, then one must have normative ideals as guidelines. The whole point of clinical case study -- in contrast to generalizations from textbooks -- is to maintain focus on the individual details and specificities of the persons in view.

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S. Ghamari-Tabrizi 2012, ACPE Research Network Fall Newsletter

The pedagogical approach in the history of chaplaincy was two-fold: the central feature of training was, and remains, the case study. Let’s break this down into its parts.

1. One learns by case study. The student learns by exposing his/her practical reasoning and interpretation to his/her peers and supervisor and invites critique, discussion. One is exposed to alternative interpretations and behaviors.

2. Public presentation of the case is the means by which the chaplain learns to be accountable for his/her reasoning. One writes chart notes (as well as verbatims) in order to be accountable for one’s actions to oneself and to one’s peers, and by extension, to the patients and staff with whom one engages. Since, by definition, one can never know the contours and make-up of one’s own blindspots, one requires the assistance of others to learn what one cannot see and know intuitively and internally.

The chaplain intern/resident’s models are her CPE supervisors as well as the staff chaplains in her training hospital, speakers at professional conferences, and authors of articles and books. However, for student applicants, there is essentially only the interview process and hearsay reports of reputations to indicate whether a supervisor is among the best of the best or a mediocre practitioner. The professional community agrees that there is a range of skill among CPE supervisors in the United States. Therefore, how shall the professional community find its model of excellence?

The ACPE promulgates standards, but these are normative. While the ACPE is accredited by the US Department of Education, the provision of CPE is not offered to chaplain interns and residents through the medium of post-graduate degree-granting institutions. Decades ago, the decision was made by the professional organizations that preceded the ACPE to keep clinical pastoral education separate from university settings. The locus of control would be highly decentralized.

While the professional organization evolved standards for defining the required skills and comportment of a hospital chaplain, the interpretation of these standards remained firmly the prerogative of the individual supervisors in hospital settings. In other words, an institutional structure was put into place that guaranteed considerable autonomy to the individual supervisors. Indeed, as the ACPE Presidential Task Group on Training and Certification remarked in August 2006, "While our organization excels at developing thoughtful standards to guide supervisory practice, it remains a challenge to embed the standards into actual practice, given how practices evolve differently from center to center and supervisor to supervisor." The variation is considerable. The task group noted, "Our educational methods are often developed autonomously, and … they often reflect diverse practices across the organization." [Report of the ACPE Presidential Task Group on Training and Certification, August 2006: 2; accessed from the ACPE website on 8/24/12]

The organizational structure of limited external oversight of individual supervisors could plausibly be tied to the experiential, process-oriented, and empirical basis of clinical chaplaincy’s pedagogy. The primary consequence of this arrangement is not only the simple fact of diversity in supervisory style and skill across the nation, but more significantly, the invisibility to the

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S. Ghamari-Tabrizi 2012, ACPE Research Network Fall Newsletter

larger community of the range of skills, ideas, behaviors that are modeled to CPE students by supervisors across the country. Unless a supervisor chooses to write and publish, the only outsiders permitted to see/learn/know about a supervisors’ skills and behavior are members of the ACPE certification and accreditation committees and specific peer groups. The principle of confidentiality blocks the possibility of other chaplains learning anything about the specific skills of a supervisor.

What is confidentiality meant to protect? If there is a complaint of alleged unethical behavior, confidentiality can protect the dignity and reputation of the alleged malefactor. BUT by insisting on confidentiality in evaluating a supervisor, those who are excellent cannot be known to the wider professional community. They remain unknown to their peers.

It has long been the tradition that unlike the case study method in medicine, Clinical Pastoral Education has put a premium on keeping the chaplain intern/resident small group’s discussion of case studies entirely confidential. The result is that the field of interpretation is limited to a handful of people.

If the ACPE pedagogical principle is unvaryingly individualistic, then the normative paradigm for chaplaincy must also be individual examples. But if one has the bad luck of encountering a mediocre supervisor, how shall novice chaplains learn what excellence looks like in the particular? I speak not only a consumer of Clinical Pastoral Education but as a career researcher quite new to the ACPE, and I believe the organization and its future students would benefit from a wider and more transparent methodology for describing and evaluating supervisors and identifying best practices

[Dr. Ghamari-Tabrizi was the 2011 David B. Larson Fellow at the Kluge Center of the Library of Congress. She may be contacted at sharon_ghamari-tabrizi@mail.harvard.edu.   --J.E.]

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