{"id":1587,"date":"2011-03-01T16:00:25","date_gmt":"2011-03-01T21:00:25","guid":{"rendered":"https:\/\/practicalmattersjournal.ecdsdev.org\/?p=1587"},"modified":"2015-09-29T10:02:20","modified_gmt":"2015-09-29T14:02:20","slug":"something-to-prove-2","status":"publish","type":"post","link":"https:\/\/pmcleanup.ecdsdev.org\/2011\/03\/01\/something-to-prove-2\/","title":{"rendered":"Something to Prove? Pastoral Theology and Practice in the Context of Evidence-Based Outcomes"},"content":{"rendered":"
Download PDF: Blevins_and_Toler<\/a><\/h5>\n
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Introduction<\/strong><\/h3>\n

While there are numerous opportunities to develop new paradigms and shift existing ones in interdisciplinary research in religion and health, there are also challenges involved in such work. One key challenge presents itself immediately in this interdisciplinary (in fact, in any interdisciplinary) work: the disjunction among various scholarly fields as to what exactly “scholarly inquiry” into religion and health is. Is an economic analysis of the distinctions between faith-based and governmental health systems conducted by a health economist an example of this scholarly inquiry? How about an exegesis of the differences between Jesus\u2019s healing miracles as recorded in the synoptic Gospels and the Gospel of John? \u00a0What about an analysis of the responses to gender-based violence understood from the perspective of Shari\u2019a law and from the perspective of post-colonial Asia? How about population-based epidemiological profile of American religious communities? Is a cultural history of American evangelical Protestantism and its influence on the American public health movement such an example? What about an analysis of religion\u2019s role in adolescent sexual health from poststructural philosophy? Would an ethnography of the religious practices of the residents of a South African township who practice a kind of hybridity between African Traditional Religion and Christianity and the ways in which those practices impact HIV risk count as an example? How about a double-blind randomized control trial of the influence of prayer on recovery periods after surgery? In fact, all of these examples count as examples of research into religion and health, but few scholars across the humanities, social sciences, and health sciences can navigate across the theoretical disciplines employed in these fields. The challenges of such navigation complicate efforts at interdisciplinary research into religion and health. And yet, many of us interested in such interdisciplinary research are attempting such navigations, grateful for the critical and technical capacities of our own academic disciplines and also painfully aware of the limitations of those disciplines as we try to find our way.<\/p>\n

This question of epistemology\u2014what counts as knowledge in interdisciplinary research\u2014is not merely a theoretical question. It also impacts practice. This paper explores this kind of question in the context of our practice as pastoral theologians who find themselves in clinical and public health contexts in which the demand of evidence-based practice creates tensions with some of the foundational assumptions of our field. We are trying to navigate between the world of quantitative outcomes and qualitative experiences. And we are trying not to lose our way.<\/p>\n

Beyond the Need for Outcomes<\/strong><\/h3>\n

As pastoral counselors and pastoral theologians, we come from an academic field and a professional discipline not often required to prove outcomes. And yet, this is the world we currently occupy in both clinical and academic settings. In the clinical context, one of us has worked as a pastoral counselor and chaplain in a private, non-profit psychiatric recovery center; funding for that position was secured through a private foundation which required evidence of the efficacy of this pastoral work. In the academic context, one of us works in the field of public health and has to develop procedures for monitoring and evaluating the effectiveness of community-level initiatives that seek to mobilize religious communities to address issues of concern to public health researchers and practitioners. In short, we have to “prove it or lose it.”<\/p>\n

The worlds of grant writing, clinical medicine, and public health research were not ones that either of us initially understood, expected, or knew. But now, the terms and dynamics of projected outcomes, Likert Scales, measurements, samples, goals, and objectives have become central in our work. There was no course in our theological and pastoral counseling training and education that had prepared us in the slightest to negotiate the terrain we were encountering. But a lack of preparation was only the beginning; we have found that the theological and epistemological foundations that we employ in our clinical and academic work are in tension with this emphasis on measurement and outcomes. The complexity of pastoral theological reflection and practice\u2014which includes creating pastoral therapeutic space; utilizing systematic, historical, and practical theology; building interdisciplinary connections between theological perspectives and other fields of knowledge; and empowering women and men in their individual and communal lives\u2014has become crowded with the demands of formulating, administering, maintaining, and compiling measurement tools in order to maintain funding and satisfy grant requirements.<\/p>\n

We want to be clear: we understand the necessity of providing such reports in order to assure that funds are being spent in responsible ways, but we nonetheless question whether a reliance on evidence-based practice and quantifiable outcome measures is sufficient for fully evaluating the impact of our pastoral work. In short, we believe this kind of assessment tells us something, but it does not tell us everything. Further, we believe that the dimensions of our work left unexamined in this approach are critically important and that an over-emphasis on evidence-based practices alone renders such dimensions invisible or irrelevant. This compromises the level of care offered in our pastoral practice or the capacity of practical theologians to be equal intellectual partners in the interdisciplinary research. This article explores the questions that have nagged us in regard to this reliance on evidence-based practice even as we have become part of clinical and academic systems where it is central and necessary. \u00a0We raise these questions in three contexts as practitioners: pastoral counseling, public health programs, and practical theology.<\/p>\n

Pastoral Counseling<\/strong><\/h3>\n

Because pastoral counseling combines theological reflection with clinical practice, it is a discipline that has been directly affected by current trends in the American healthcare system\u2014trends that revolve around questions of finances and funding. Healthcare programs rely heavily on insurance reimbursement for their income, which means that in many cases insurance companies dictate the length and kind of treatment an individual receives. In this broader context, pastoral counseling as a specialized clinical discipline faces pressure in regard to reimbursement rates from insurance, the necessity of licensure as a psychological profession (with no attendant assessment of theological competency), and the need to define the relevance and nuances of the pastoral counseling approach in contrast to other proven “secular” counseling disciplines. In such circumstances, the place of pastoral counseling and other pastoral services is exceedingly vulnerable. In order to secure their place, pastoral services have had to turn to outside grantors to obtain funding. This turn to alternative funding sources has led pastoral counseling as a discipline into the world of “evidence-supported therapies” and “outcome-driven evaluations.” Foundations want positive results for their money, and they want to know how a particular pastoral counseling program is going to prove successful.<\/p>\n

Pastoral counseling practitioners, then, are put in the precarious position of creating categories for measurement. Pastoral counselors have to project an outcome for an individual who engages in pastoral counseling and create a scale that will measure that projected outcome. An example of this can be found in the requirements of a private foundation that was a potential funding source for a pastoral counseling program in a mental health facility where one of us worked. The grant application for this foundation specifically asked: “What impact will your program have\u2014what will change about the situation as a result of your project? What are the goals and outcomes identified for the program?” These goals and outcomes include short-term, intermediate, and long-term projections of discernable knowledge, skills, and behaviors of individuals.<\/p>\n

Such circumstances raise important issues. Although evidence-based practices purport to encourage or even demand practices that make a measurable, positive difference in the life of an individual, how does prioritizing evidence-based practice offer any safeguard from the biases of the practitioner in characterizing “health” or “dysfunction”? Though masked in the objectivity of numbers and scales, “health” and “dysfunction” are in fact understood in subjective contexts that are shaped in large part by the demands of the funder and the opinion and viewpoint of the pastoral counselor creating the measurement.<\/p>\n

One of us wrote a grant to develop and manage the pastoral counseling and chaplaincy program referenced above. In that process we had to develop criteria for measuring the priorities of the foundation that provided the funding for the program. This process gave the foundation tremendous authority to influence a pastoral counseling program to align its priorities with those of the foundation. It also gave one of us, the grant writer, tremendous authority as a potential grantee to define terms central to the project such as health, healing, hope, spirituality, and dysfunction; to name the kinds of perspectives and behaviors that clients would adopt when successfully “treated”; to stipulate the number of participants who would successfully adopt these new behaviors; and to determine the activities that would constitute a “successful” pastoral program. The grant proposal listed the following objectives that were later implemented in the clinical program:<\/p>\n

Short-term outcomes (knowledge and skills)<\/p>\n