From Chapter One (pre-publication version): The Changing Times: A Case for Brief Pastoral Counseling
Howard W. Stone
Tony Hillerman, best-selling author of mysteries set in the American southwest, tells the true tale of Black Jack Ketchum, the most successful train robber Folsom, New Mexico, had ever known. Black Jack figured out that, while chugging up the old horseshoe curve southeast of Folsom, the Colorado and Southern train had to slow down so much that a horseman could hop out of the stirrups and onto the train without even having to gallop his horse. It was, apparently, like snatching candy from a baby. The system worked for him over and over again, so brilliantly that he saw no reason to change it.
Eventually the Colorado and Southern Railroad management figured out what he was doing. They packed the train with guards. The next time Black Jack rode up in his usual style, they shot and captured him and quickly brought him to trial after which, Hillerman adds, he was consequently and subsequently hanged over at Clayton with such enthusiasm that his head came off. Ketchum had a method that worked perfectly for a time, but the times changed.
The times are changing for health care and pastoral care just as they changed for Black Jack Ketchum. Long-term therapy was the underpinning of pastoral counseling in the early days of the twentieth century, and remains so for some practitioners in the twenty-first century. It was appropriate then because it was based upon the best information available at the time. Today new information is available. This new data not only favors brief approaches but suggests that, except in a few select cases, long-term counseling is no longer practical. The medical profession has gotten the word. So have mental health researchers, the United States Department of Health and Education, insurance companies, and mental health providers. If the Colorado and Southern Railroad were still operating today, its managed health care organization most likely would mandate some version of brief counseling (in combination with pharmaceuticals, when appropriate) for the treatment of employees mental health problems.
The fact is, congregational ministers, priests, and rabbis traditionally have practiced brief counseling for many generations in the parishes they serve. As a variety of other helping professionals discover brief counseling with its many advantages it is effective, enduring, economical, and humane the time has come for parish pastors to reclaim it as the preferred strategy for helping troubled parishioners who come to them for guidance in resolving their difficulties.
The basic premise of this chapter is that brief pastoral counseling methods should be the primary mode of operation for pastoral caregivers parish pastors and chaplains as well as pastoral counseling specialists.
Focus on Research
When choosing methods to use in your counseling, what do you take into consideration? Your training? Readings in the field, amply illustrated with individual case studies? Past experience? How we go about counseling parishioners certainly grows out of our own experience, but it also needs to rely on the demonstrable experience of others and the outcomes of their counseling. Well-constructed research documents the work of others in a controlled way and helps to mitigate the unavoidable bias of the helper who is doing the counseling. Pastoral counseling needs to pay more attention to such research, especially to outcome studies, than the field traditionally has done.
My personal physician is a fine family practitioner named Joseph Cappel. When I go to see him, I expect him to have read all of the current journals and bulletins that apply to his area of medicine. If I have a physical ailment, I want him to use state-of-the-art procedures that are based on the best and latest research in the field. Let us say he has two choices of therapy for my condition, and both have been shown in research to be equally effective but one is more invasive, takes longer, and is more expensive than the other. I trust (and my HMO demands) that he will consider those findings when he prescribes my treatment.
Surely clergy have a similar obligation to their parishioners. We have been trained to give heed to revelatory personal experience; however, carefully designed qualitative and quantitative research may be equally revelatory. We need to stay abreast of sound research in our field, and to consider it in choosing how we offer care to those who trust us with their well-being.
Most people who come to us for help are not on a quest for self-discovery. They seek to resolve a specific problem and move on as quickly as possible, not to overhaul their personality. Even though many counselors who are in therapy themselves appreciate and value their personal journey of discovery, for the most part their counselees do not. After the first session, most people do not return for many additional sessions, if they return at all. The pastoral counseling process is by default if not by design a short one. People tell us by their actions that, along with alleviation of their troubles, in counseling they want brevity.
There was a time when insurance companies tacitly condoned the long-term therapy bias by at least partially covering its costs. That is no longer the case. Today many health maintenance organizations and insurers reimburse only the more cost-effective brief therapies. The change to short-term modalities has sent ripples throughout the mental health community and set off controversy between proponents of the two approaches.
Is brief counseling a sign of the times? In our fast food, instant coffee, crash diet, microwave age, have people lost their patience to work toward long-term solutions to their problems? Is the desire for a quick fix part of their pathology? Or is it a sign of health, of a willingness to tackle a problem head-on and promptly do what is needed to get on with the business of living?
