10. Spiritual Counseling in Health Care (p.

90)
1. Trust
Persons who are ill are faced with potentially serious problems:
a. They may fear suffering and death.
b. They may face the uncertainties of diagnosis and prognosis and fear about the pain or
embarrassment of various testing or treatment procedures either unfamiliar to them or all too painfully familiar.
c. They may face the tedium of a long stay in the health care facility under circumstances they find
either boring or excruciating.
d. They suffer separation from their regular work, friends, and family and are not comfortable in the
new situation.
e. They may be worried and perhaps feel guilty about the various responsibilities at home that they
cannot handle.
f. They suffer from a sense of deprivation of privacy and of freedom, almost as if they were
imprisoned.
g. They may feel puzzled about Why has this happened to me? and may interpret their sickness as
punishment for moral guilt or experience the “silence of God.” They may also anticipate further guilt through
failure in courage and hope.
h. They may feel alone and deserted in meeting all the foregoing, and their sense of dignity, worth,
and membership in the human community may be diminished by real moral guilt for which God’s forgiveness
is truly needed.

Spiritual ministers role are called to help patients in these struggles and may also be called on to help
members of the health team who are faced with similar problems both in their personal lives and in their
professional involvement with patients. The first task of the spiritual guide is to establish trust, but this trust
differs from that on which most professional relations are based because it has a type of ultimacy . People often
seek out a spiritual minister to confide in when they can no longer trust their lawyer, physician, or even their
psychiatrist.
Yet many patients do not even trust a minister, and when the chaplain visits them they are thinking,
What is his or her game? Is she trying “to save my soul,” to make a convert out of me? Is he looking for an
offering’ Or for a confession? Thus chaplains must build up trust on the foundation not of words but of
behavior.
A chaplain must keep promises, maintain contact, and be available to help in whatever difficulty is
bothering the patient or to look for someone who can help.
A chaplain must also be nonjudgmental, empathetic, and very careful about confidentiality.
Finally, a chaplain’s care is expected to extend beyond the patient to the patient’s family.

... Thus chaplains should explain that:

(1) they cannot work miracles at will, or change structures, or get the patient out;
(2) they cannot be continuously present and can give only limited time to any one patient; and
(3) their role is primarily that of a listener, counselor. All this should become clear in the implicit or
explicit counseling contract. …

2. Objectives of Pastoral Care

As a spiritual adviser, the minister’s primary task is really a very simple but not easy one. It is to say,
as much or more by presence, attitude, and nonverbal symbols as by the exhortatory Word, that God is
present to sick persons in their fear or suffering, that God as loving, caring Father, as co-suffering Lord Jesus, as
Healing Spirit is present and acting, but this presence is in mystery.

That is, it exceeds human rational empirical comprehension because it leads to an open future. This
implies a spiritual awe before the mysterium tremendum. The sick person, as did Job, feels guilty and yet is not
clear how he or she is guilty. There is a sense of judgment. The minister should not deny this. Indeed, a minister
symbolizes this judgment. The minister also overcomes judgment, however, by being a sign of mercy and
reconciliation (Hoist, 1985).
Sickness may be the time of genuine conversion in which persons truly find God for the first time in
their lives or after a long time of forgetfulness and separation. The minister must affirm the reality of this
invitation of divine mercy, but that is not the whole of the minister’s responsibility. Conversion is the
beginning of a new life, but that life has to be lived authentically or it will be lost again. Consequently , one of
the chief aims of spiritual counseling is to assist converts to begin to grow daily in the Christian life and to
plan practically to continue that growth once they have returned to the routine situations of everyday life.

D. Celebrating the Healing Process

1. Word and Sacrament
The specific spiritual task of pastoral care, however, is not exhausted simply by the counseling situation.
It must not be confined to talking about the presence of God, but it must deepen into experiencing that presence
in prayer, worship, celebration, and communion (CCC, 1135 ff.).
Today, when most chaplains and other ministers as well are training in clinical pastoral education (CPE)
programs, they sometimes feel a tension between the model of the chaplain as a pastoral counselor, whose
main task is to engage in a therapeutic psychological process with the patient, and the former model of the
pastor as the one who reads the Scriptures, prays with and exhorts the patient, and administers the sacraments
(Holst, 1985).
These two models seem opposed to each other: In particular, one seems aimed at removing feelings of
guilt and giving feelings of interpersonal warmth and confidence and getting clients “in touch with their
feelings,” whereas the other tends to generate guilt and to impose a formalized religious response that covers up
a patient’s real experience.
Actually the two models, when they are well understood, are complementary and can reinforce each
other. We have already shown how pastoral counselors by their own presence are already a sacrament. That is,
a sign of the presence of God. The Word of God first came to human beings not in the text of the Bible that
records his coming, but in the incarnation of Jesus Christ, who came to the sick and suffering, shared their
suffering, and healed them by his touch (Schillebeeckx, 1981b).
Ministers, because they are sent by Jesus, are the living witnesses, “other Christs,” and a sign of
Christ’s care for the patient. Therefore, everything that the minister does to witness this tender concern, this
ability to empathize, to listen, and not to judge, is a sacrament of Jesus’ presence. Even humor and light
banter, if their purpose is precisely to establish real communication, resemble the wit that Jesus constantly
displayed in his preaching and parables. Above all, the down to earthiness,--the freedom from stuffiness, self-
righteousness, and elitism that can be the curse of the clerical state—is imitation of Jesus, who did not hesitate
to eat with sinners in simple fellowship.