Managing the Urge to Professionalise

The urge towards professionalism builds up a rigid bureaucracy. Bureaucratic rules become a substitute for sound judgment.

Carl Rogers

When I was a student nurse on night duty there was an elderly man who was blind and hallucinating. He was distressed and spent much of the night yelling “Hold me tight, for Gawds sake!” We would go over and hold his hand and it wouldn’t make much difference, he’d just up the noise, begging for reassurance and containment. In the end he was prescribed sedation which brought him much closer to death but kept him quiet. One night, the registrar came on to the ward as the sedation was wearing off and the elderly man began his painful wailing. The Registrar went over to him, held his hand and asked, “What can I do for you?” “Hold me tight!” said the old man. So the registrar pulled back the covers, got into bed and shifted the old man to recline between his legs, back to chest, and held him tight. A good nights sleep was had by all. Now of course, he’d never consider doing something like this and would be disciplined if he did.

When I first began working with young girls who had been subjected to dreadful abuse and were considered dangerous, one or two of them needed to negotiate physical contact. The rooms we met in had beanbags and some of them sat on the floor cuddled up to me as we lay back, experiencing safe intimacy and basic human connection without which we all go mad. Now of course, I’d never consider doing something like this and would be disciplined if I did.

Chaplaincy is undergoing a process of professionalisation that will result in very well qualified chaplains and no certainty of high-quality work. The only positive result of professionalisation is that it’s easier to fire someone when they work outside of professional boundaries.

Time and again, history demonstrates that when a vocational group enters into the process of professionalisation what actually happens is gross standardisation and a parallel requirement for the individual to stop thinking for themselves. Employers, who may know and care nothing about the internal dialogue within a group of people sharing the same job title, begin to demand that employees have professional qualifications and a very vicious cycle is set up. Creativity is stunted, peer review becomes meaningless, relationship becomes defunct in preference to saying the right thing.

Here in the UK, this means that the most qualified, experienced but not accredited on principle psychotherapist is not as attractive to an employer as someone who has been qualified for 3 years if they are accredited. The less experienced psychotherapist has ticked some boxes, written the right words, perhaps made a few up and paid her money to the British Association of Counsellors and Psychotherapists. Sound research demonstrates that BACP accredited therapists are more likely to have complaints made and upheld against them (1) but employers don’t care and neither do therapists who correctly perceive accreditation to be what employers (rather than clients) want. Two issues become plain here: employers want to reduce their feelings of risk of liability and people who feel strongly about being part of a professional group are likely to be status-led rather than client-led.

Chaplaincy is deep into the process of becoming professionalised. US hospital chaplains are required to have a Masters of Theology which demonstrates that they at least have an interest and background in their own belief systems. This requirement equips the chaplain with the theology she needs to serve her clients in terms of the relationship between deity and person. But a theology qualification doesn’t cover the ethics of the relationship between the chaplain and the patient, or the patient and chaplain with the institution. Various chaplaincy professional bodies are beginning to address these situations as an aside to the process of gaining professional recognition. To me, that phrase ‘gaining professional recognition’ is very telling: we want to be seen rather than ignored by important people. We want to join those important people as peers.

The model we have to guide us is a Christian one, and I have a lot of time for it. Christ was a very ordinary person who chose not to be a priest or to join the Jewish hierarchy or to work for the Roman hierarchy where he could have gained a great deal of power and influence. He visited the sick to bring them comfort rather than to offer an integrated holistic approach to healthcare and related to people as people rather than the relationship being dependent on which social group they were part of.

Meeting with administrators and chief executives is part of the work of the chaplain, as is report writing and collecting statistics. Studying the experience of other chaplains is vital, so that we can learn from their mistakes without having to repeat them and build on their successes. But desiring professional recognition - not because it allows us to deepen relationships, but because it highlights status – moves us away from humility, away from the position of liminality that is central to being a chaplain, and away from empathising with the vulnerable in preference to empathising with shareholders who need prestige to advertise their hospital.

The professionalisation of chaplaincy is inevitable. As we move through it, we would be well served to maintain a private store of cynicism, a way of being that isn’t fashionably sweetness- filled but which protects us from believing everything we’re told, in this case about how important professional status is. ‘Professional’ is very different from ‘accountable’ and the more professionally qualified a person is the more they are trusted to be left alone with vulnerable people: that equation alone should give us pause. The sad cliché of the pedophile masquerading as a Scout Master demonstrates that processes which bestow status facilitate people who want to abuse power.


ps - looking for a picture to illustrate this post I searched 'professional priest' and 'professional'. Google for yourself what comes up for 'professional': young, arms folded, mildly sexually alluring but essentially challenging. It's what we expect from the title, and aspire to.

1 Khele.S, Symons.C, &Wheeler. S. An analysis of complaints to the British Association for Counselling and Psychotherapy 1996-2006. Counselling and psychotherapy research CPR) 8 (2) 2008: p127

Professionalism.

Every job these days now seems to require some kind of qualificational (is that a word? It is now!) route into and through it, and the more organized these groups get the more some individuals will want to be recognized as ‘professional’. The professional counseling and psychotherapy association I belong to, the BACP, was created when individual counselors and psychotherapists decided that the public was suffering because counselors and psychotherapists had no accrediting body. They set up the BACP and approached the government to demand that only qualified counselors and psychotherapists be recognized as such. Today, people who are not qualified as anything can still offer their services as counselors. The government, who once took no notice of us, have now decided that they will only recognize psychotherapists and not counselors, which leaves a great many highly qualified counselors potentially out in the cold, and the BACP running about trying to catch up.

At the same time, the BACP created an accrediting scheme that can only be a box ticking exercise since it’s unworkable to have someone present during actual sessions to observe and assess. The BACP’s own research discovered that the greatest number of complaints are made against accredited practitioners.

http://www.informaworld.com/smpp/content~db=all~content=a792952432

(please cut and paste, my keyboard has no wriggly line!)

Nevertheless, the larger, more prestigious and higher paying employers of counselors and psychotherapists demand that we be BACP Accredited, not because they understand counseling and psychotherapy or because they want the best people for the job but because they believe that qualifications mean they will be getting a better practitioner and because they want people who are content with jumping through hoops in preference to thinking for themselves.

It’s no bad thing to know that a person has completed and qualified from a particular line of study. Pagans want this too, we don’t want someone calling herself Lady BlueBottle, Hereditary Witch Queen of Atlantis to be involved with, well anything really, but particularly not vulnerable people or representing Paganism. We’re all tired of the fantasy-driven pronouncements of too many Pagans and their incredible claims, and we know that this behaviour is not limited to teenagers. In the non-Pagan world we also know highly qualified and experienced professional people who are untrustworthy. Indeed, the more prestigious their status them easier it is for them to be untrustworthy.

What links these things together, from a growing number of US chaplains demanding access to patient notes and counselors and psychotherapists becoming mesmerized and deskilled by professionalism, to the growing number of very honourable and simple jobs becoming dependent on qualifications is status. Pagans are still struggling to have our status as a bona fide religion recognized, and the starting point for many individual Pagan chaplains in hospitals and prisons was the demand that this corporate status was acknowledged. Those Chaplains who overstep meaningful boundaries by demanding access to patients who haven’t requested it and patient notes, are motivated by the desire to have their personal status recognized.

All of which has nothing to do with accountability. We know that human nature is likely to try and get away with what it can, there’s little can be done about that other than the blunt instrument of punishment, and rather than waiting for behaviour to become criminal it’s probably wise to have an agreed standard of behaviour for different professions. Standardised teaching can achieve something like that and yet . . . when teaching establishments have to fulfill quotas in recruitment and pass rates, which all come down to keeping the institution financially above water it all becomes a bit meaningless. But it does keep the money rolling in.

In the US the Association for Clinical Pastoral Education Inc seems to be the largest representative body for hospital chaplains. They talk about people as ‘Living Human Documents’ and have detailed manuals and standards and an accreditation process and bylaws . . . all the stuff that makes an organization look very proper, professional and acceptable – and gives the organization and its officers high status. This is the group that has encouraged chaplains to demand access to patient notes believing chaplains to have the same status as medical professionals. Presumably, therefore, they believe that doctors have the same status as chaplains.

I’d like chaplains to be accountable to their patients and themselves primarily, then the hospital they work in, then their own Pagan community and then the wider world. But I don’t have a Pagan community, I work entirely on my own and so I’m only officially accountable to the chaplaincy office and the hospital which is perhaps good enough. I would really like a chaplaincy supervision group, Pagan or otherwise - almost entirely the same as my psychotherapy supervision group where I could discus in confidence how things are going. But there isn’t one, there aren’t enough Pagan hospital chaplains to create one and UK chaplaincy groups aren’t organized in this manner.

Long manuals and documents and acronyms do little to protect anyone. Libraries filled with complex and weighty tomes of case law and precedent don’t stop people from breaking the law. What does go some way towards curbing the desire to abuse power is mutual respect and support, keeping organizations small and intimate without becoming incestuous. It can be done. And it’s inevitable that such groups will have lower status and less income.

It’s important to know what the law of the land is and what hospital policy is but this doesn’t stop individuals from working – entirely within the letter of their professional standards – in a callous and burned out manner. (Thank you, Mogg) It is infinitely harder to create, maintain and belong to a small group that actually sees you and hears you, is responsible for and to you than it is to hand over your cash to an organization and perform the tricks they require for advancement which gives you a passport to prestige and greater income.

And of course doing things the hard way requires the patience to explain to the people in suits and the people who have been conditioned to trust anyone with a string of letters after their name, that membership of a professional body is no guarantee of a better service.

Status and limitations

Have a look at this article by two medical ethicists clearly declaring that hospital chaplains should not have automatic access to every patient or ever to patient notes. I acknowledged the part of my psyche that objected: “Bah! This is just another way of keeping religion in its lowly place.” But it isn’t. We know that there are individual chaplains who feel the need to impose their religion – they’re likely to perceive it as offering a very important service to vulnerable people. Indeed, we probably know of Pagan friends who found a Christian chaplain at the end of their bed offering their services, and how inappropriate that was. That’s an abuse of power.

I remember being fairly pushy myself when it came to having Paganism recognized in hospitals and I’m grateful for the other Pagan individuals and groups who’ve also made it their responsibility. Wherever there are institutions who have a chaplaincy service and who’re likely to have Pagans amongst them then Paganism should be officially represented on the chaplaincy panel, that’s pretty straightforward. That whole debate is about status, primarily the status of Paganism, but also about the status of chaplaincy.

If this is the case then we need to think hard about what chaplaincy is about and what our role is. Chaplaincy seems to me to be about perceiving a person as unique and as part of their own ‘ecosystem’ – relationships, history, hopes and dreams, fears, desires, abilities, the whole kit and caboodle - rather than simply as their diagnosis, and serving individuals and groups so that they can find meaning and purpose for themselves. I really like this quote

Helping, fixing, and serving represent three different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fixing and helping may be the work of the ego, and service the work of the soul.

Chaplains are not part of the medical team. Although spirituality has a role in wellbeing and health this doesn’t mean that chaplains have the same role as doctors, nurses and radiotherapists. This is no threat to our status: we wouldn’t expect doctors, nurses and radiotherapists to be experts in spiritual care. I know that if I read a patients notes I will form a certain set of beliefs and expectations around those written words, it’s why notes are so confidential and the writing of them always under review. ‘Witty’ shorthand such as ‘FLK’ (Funny Looking Kid) is now recognized as reducing the humanity of the individual and being unethical and unacceptable. So it is that the chaplain – and every other person who isn’t directly concerned with the symptoms and cure of the patient – has no need to know anything about them other than what they see in front of them.

I’d say that the strict adherence to limiting who has access to patient notes is a measure of the quality of care patients receive. I know a very ethical, professional complimentary therapist working in a local mental health hospital who is given access to patient notes. She doesn’t take it but it’s not too surprising that the hospital is well known for the number of patients who abscond.

Certainly, doctors have a godlike status. Nurses are, of course, angels. I’m not sure where in the heavenly hierarchy radiographers might fall but as far as pay and conditions are concerned it’s somewhere above ward cleaners and canteen workers. That’s just the way it is, that’s a matter of society deciding that junior doctors and professional football players should be paid more than experienced nurses and firefighters. Chaplains, well we’re strange altogether, with Deity as our employer and the general public feeling both that they respect us and feel weird around us. For me, that’s just a symptom of our liminality and whilst that’s not always the most comfortable place to be it’s also entirely appropriate. This is not to say that chaplains should be content to creep around being thankful to be allowed into a hospital: that’s to get status and role confused.

Paganism should be given the same status as any other religion. Pagan chaplains should be treated with the same respect that other chaplains are offered, and all chaplains should be treated with the same respect as any other member of the healthcare team. But our role is not to tell people what’s best for them. Neither is it to do things at or to a patient. Although chaplains of all faiths have a responsibility to our gods and the culture of our religions we have a greater responsibility to offer something that other people who work in healthcare cannot: we offer love. We are with patients in a unique manner; we bring the empathy of the professional psychotherapist, the communication skills of mediators, and leadership functions of senior staff. We add a thorough, boundaried and flexible knowledge and understanding of our religion and, on top of it all, the wisdom that whatever a persons religion, spirituality or atheism they are equally worthy of our attention.

High status is lovely but the role of the chaplain is not to compete, it is to Be With people who have requested spiritual input. As long as that is facilitated in a quality manner and chaplains of all faiths are treated respectfully what more do we need, and why?