Long Review of a Short Book

Review of: NINE MORE CLINICAL CASES: Case Studies in Clinical Pastoral Care, Counseling and Psychotherapy, by Raymond Lawrence (General Secretary of CPSP)

Reviewer: Robert Munson (Bukal Life Care, CPSP-Philippines)

Raymond Lawrence’s book, Nine More Clinical Cases: Case Studies in Clinical Pastoral Care, is a short book. The main body of it is just 70 pages, with additional pages of introductory material. This is his second book that served as a response to a book by George Fitchett and Steve Nolan

Book by George Fitchett and Steve NolanCritique by Raymond Lawrence
First Book CycleSpiritual Care in Practice: Case Studies in Healthcare ChaplaincyNine Clinical Cases: The Soul of Pastoral Care and Counseling
Second Book CycleCase Studies in Spiritual Care: Healthcare Chaplaincy Assessments, Interventions & OutcomesNine More Clinical Cases: Case Studies in Clinical Pastoral Care, Counseling and Psychotherapy

For both of these critiques, Lawrence chose nine of the cases in the book, and in so doing is critiquing some underlying themes that are found in the clinical pastoral training movement today. This critique should be seen neither as “punching up” nor “punching down.” Lawrence, Fitchett and Nolan are very much respected in pastoral care/spiritual care, within their respective camps These nine cases presumably chosen specifically because the author had strong views on them, both positive and negative. His reasons, however, are his own.

Lawrence repeats in this book a number of themes that are common to several of his works. Among them are:

  • Expressing his preference of the term “pastoral care” over “spiritual care.” Lawrence notes Nolan at least is aware of problems associated with the term spiritual care. Lawrence quotes Nolan on page 65 of, As Nolan writes, “The lack of an agreed and articulated definition for spiritual care means that, as a profession, chaplains struggle to explain clearly the nature of the work.” Lawrence sees value in the use of the term religious care— providing care in terms of sacraments, religious symbols, and faith tradition. But for other care he strongly prefers “pastoral care” which he sees as clinical, non-religious (or at least not limited to a specific religious tradition) and grounded in the broadly understood metaphor of the shepherd as a caregiver.
  • Seeing the clinical pastoral training movement as having degraded in moving away from the ideals of its founder, Anton Boisen, and becoming more attached to his former partner in the movement, Richard Cabot. Interestingly however, Lawrence praised Fitchett and Nolan for bringing back emphasis on case studies as an educative tool. Case studies used in clinical pastoral care was developed through the interaction of Boisen, a theologian by training, and Cabot, a medical doctor.
  • Identifying clinical pastoral care as grounded very much in Freudian psychology. This reviewer would prefer that the author would say smething to the effect of seeing clinical pastoral care as taking seriously the insights found in “psychodynamics” rather than referring so much back to Freud. For many Sigmund Freud is championed as a great innovator in the field of psychology and the “talking cure.” Many others, both inside and outside of religious circles, know him more for what he was wrong about than what he was correct. This reviewer believes that Lawrence’s referencing of Freud and Boisen doesn’t suggest an uncritical return to early 20th century theories of the human mind, but rather presents them as founders of two important movements. Lawrence invites the reader to embrace a thoughtful integration of care drawn from the best of theological and psychodynamic insights.
  • Questioning the long-standing tradition of praying to end the pastoral care visit. Some of this question returns to the conflict between Boisen and Cabot, where Cabot saw physicians as those who heal the body, and chaplains as religious experts who pray. Much of Lawrence’s concern, however, stems from the question of who the prayer is really for. While a pastoral care provider may say that the prayer is for the client/patient, quite often this is not the case— especially in multi-religious and somewhat secularized places like the United States. In these places a prayer may not be welcome, or perhaps only welcome from someone within the patient’s own faith community. Here in the Philippines, however, prayer is almost always uncritically welcomed by the patient. Part of this desire comes from the common presumption here that the pastoral care provider has a special relationship with God that makes his/her prayers just a bit more powerful than their own. (That view may be comforting to the care provider but really is something that shouldn’t be promoted.) Regardless of the wishes of the patient, prayer is all too often done for the benefit of the care provider. This person often prays with the unspoken message, “I don’t think there is very much I can do, but at least I can pray.” This sells one short in the possibility of truly providing critical therapeutic care for the patient. Additionally, praying almost always is used as a signal. The signal is, “Well, I have run out of things to say and I really want to leave, so let’s do a prayer so I can go.” (It should be noted that in a conversation with Raymond Lawrence a couple of years ago, he made it clear that he was not opposed to prayer. But he said that prayer should be requested by the patient, not pushed by the care provider. Also, if prayer is asked for, the care provider should utilize this to draw more out of the patient— “What would you want me to pray for?” “Tell me more about this?” In doing this, the patient actually crafts the prayer and the care provider simply puts the patients prayerful longing into verbal form.)

Much like his previous book critique, this book avoids unnecessary wordiness. Generally it makes its point and moves on. Yet it is also written so that if one had not read the book it critiques, one can still understand the case well enough to follow the points well. That is quite useful. Cases also have the advantage of enlivening interest and the imagination where traditional exposition fails.

This book is not a polemic, but invites dialogue. Powell’s well-written Foreward does well in framing this book in this light for the first-time reader of Lawrence’s works. Lawrence sees growth in the clinical pastoral training movement through this sort of dialogue and critique. Page xi of the Introduction sums this up well when comparing two major streams within this movement:

Let the reader decide which is more representative of the authentic clinical pastoral training movement. Let the reader decide which position is more therapeutic. Let the reader determine what posture most accurately speaks for Anton Boisen, the founder of the clinical pastoral training movement. And let the reader decide whether some new direction should be called for at large. But no one is beyond the reach of criticism. Criticism is the lifeblood of the clinical pastoral training movement.

That being said, the Epilogue of Lawrence’s book does serve as a direct challenge to Glenn Fitchett’s work promoting “Evidence-Based Outcomes” as it relates to Clinical Pastoral Care. While I find Lawrence’s arguments weighty, this is another area where some back and forth dialogue is needed in the coming years.