First I want to thank those of you who read my posts. I have two blogs that I write on, and while this is the one which I update the least (until recently) it is definitely the more popular one. That said I am going to look in to ways to make posts easier to find and rework the design a bit in the process.

That said, I wanted to post another CPE verbatim as an example. This is one that I wrote in my 3rd unit at the Pittsburgh VA which I took at level II.  I chose this particular one because I think some might find it helpful to see how to write toward the competencies (I used footnotes) and also because of the context. Most chaplain interactions are seen within the chaplain-patient context, but this one happened within a supervisor-supervisee context. So I also wanted to include this an example of how you can use the CPE environment to look at many different areas. It also included several people, so it was pretty complicated. Feel free to comment.

I don’t deal well with conflict and my main question going in was “did I handle myself appropriately?” If you’re interested in familial roles, handling personal and professional authority, trust and handling conflict you’ll find this interesting. Oh – and I later on ended up firing this person (ok, if you ask her she resigned before I could fire her but that was only because she hadn’t made it back in to the office that day). Intrigued? Read on-

Reasons for Presentation:

This verbatim deals with conflict management, clinical management of chaplain support for hospice patients, professionalism, and use of administrative authority. Level II CPE outcomes which are discussed include 312.1, 312.2, 312.3, 312.5, 312.6, 312.7 and 312.9. Managing conflict has been difficult for me in the past, as my family of origin did not have open conflict. I learned to avoid it and anger tends to arouse feelings of guilt due to toxic shame. I have been working on being more open in expressing emotions without labeling them as negative, which is something that was pointed out on my Level II consultation.

I also present this because my role as a manager is new to me. In the past I have had leadership positions, but these have largely been in the role of organizer. Working as a middle-manager in a corporation is new to me, though I had some similar experiences in my prior job ministering at a church. I oversaw several programs in that position but these were volunteers or outside-contracted counselors.

I would like feedback in terms of how I handled the situation, if I should have been more confrontational, or if there were other options to addressing the situation available that I was not aware of.

Initially I did not want to present this verbatim as it was rather complicated and I felt that I wouldn’t capture it well enough. But I also recognized this as perfectionism on my part and also recognized that conflict is a major area I need to work on.

Preliminary Information:

Date of visit: 7/1/11

Length: about 40 minutes

Subject: Caucasian female, single, late 40’s, a chaplain whom I supervise. She is ordained Lutheran, has completed 4 units of CPE, 1 at Level II. She’s been employed at Gateway Hospice about 7-8 months, and has a very wide range of experiences in her past though this is her first hospice experience.

This encounter involves myself (C), one of the chaplains which I supervise (“Susan”: S), the Director of Social Services (“Maggie”: M), and my direct supervisor, the Director of Clinical Services (“Laura”: L). I called this meeting as there have been several problems presented to me indirectly about this particular chaplain since her hire. Most of the problems focused on difficulties between her and the members of her interdisciplinary team (RN case managers, LPN’s, aides, social workers). Early on I was told that she tended to go “overboard” in her role of chaplain, including praying loudly with patients, focusing only on religious issues, and inappropriate self-disclosure that came across as self-centeredness. A problem I have had is that I have not witnessed any of these problems, and when they have happened I have heard only third or fourth-hand. Most of the problems seemed to happen on one particular team where I had been the chaplain before. I felt that some of the problems and negativity were directed at her simply because she was not me, but this couldn’t account for everything and I didn’t believe, as she stated, that they wanted her to quit.

Prior to this meeting I had participated in her sixth month evaluation, which was just over a month prior, which addressed some of these concerns but only minimally. I was not her direct supervisor at this point, and her supervisor (Heather) was rather non-confrontational. I sat in on her IDT team on one occasion and also followed her in the field for one day and did not witness any particular problems. Because of this I surmised that the problems were more interpersonal in nature.¹ Susan takes a much more openly religious role than I do, and the team in particular is one in which I had served on prior. I felt that it was possible that her teammates, who were openly more comfortable with my less religiously-focused role, were simply having trouble getting used to this new role.

On one prior occasion I had confronted Susan with a particular problem I had heard about and she became very defensive, stating that the problem stated never happened and that people were spreading lies about her. This made me feel very upset and guilty. I felt that I had done something wrong as I brought up a problem without having concrete proof, and felt responsible for her feeling unsupported.

As I kept hearing occasional grumblings about Susan I had asked the RN case managers whom she works with to let me know of any problems or concerns that they had directly. I felt that this would provide concrete proof of issues and hear first-hand about concerns. I didn’t hear anything back from them. I also met several times with Susan to discuss her own understanding of her role as chaplain, her approach to counseling (which uses a lot of self-disclosure), and use of religious resources²

This particular encounter came about because I heard from one of our former chaplains who was at the office a few weeks prior doing some education on chaplain’s roles to our staff that people thought she forced her beliefs and religious practices on others. Also on one occasion it was said that she had refused to contact a priest for a patient because she said it didn’t need to be done. I received this information just prior to leaving for a week-long vacation, which made me even more upset. I set the matter aside until I came back.

When I returned I sent her an email stating that whenever a patient or family requests outside religious support our job is to follow through and try to make the contact. I advised her that even if it isn’t religiously necessary, we should try as this is a comfort to the patient and family, regardless of our opinion.³ She once again became very defensive and accused others of spreading lies about her. I confronted her face-to-face a few days later and had a fairly heated argument with her where I detailed how I thought she was being overly sensitive and taking things too personally. She asked for a meeting to clear the air and I formed a meeting with my supervisor Luann, our director of Social Work, Maggie, who works directly with Susan and has concerns about her professionalism, Susan and myself.⁴

Prior to Visit:

Even though I tried hard during the week not to focus on this meeting (it occurred on a Friday) I found myself thinking about what I might say and rehearsing the situation over and over in my head. This is something I tend to do especially when I think there’s going to be conflict or chaos. I wasn’t angry, but felt tired and emotionally detached. Prior to the meeting I spent a lot of time looking over old emails to her, talking with our HR people as well as with Maggie and Luann, and with her RN case managers. I asked for any specific, documented details about concerns and didn’t get any.⁵ At the time of the meeting Susan brought pastries from Panera, which I took as a way in which she “heaps burning coals upon [our] heads” (in her own words but referring to another context).

Visit Transcript:

C1 (myself): Well, I wanted to get us together to some issues Susan’s been having. There was a concern raised that she had been asked to have a patient anointed and I was told that she hadn’t done so. I looked in to things, looked at documentation, and talked with people who were involved. And I don’t think that this was a case of her doing something wrong. I think it was a case of miscommunication.

S1 (Susan): There’s been a lot of weird things going on. When I started here there was that message through the web that directly attacked my ministry and what I did. And then there are these vague accusations that are just untrue!

L1 (Laura): What are you talking about with this web thing?

M1 (Maggie): Yeah, I have no idea what you’re talking about.

S2: Well back when I first started, I had only been here about 3 months, and I got this notice that someone complained and put up on our website that said that I had sent them a bereavement letter. And the thing was that I hadn’t sent any letters – I didn’t even know how to make letters! I was just doing calls to folks like Sam had told me to do (saying this sarcastically). I told Heather about it and she was looking in to it. But she never got back to me about what they found out. She said that she was going to ask Craig (the IT manager) to look in to it and I never heard anything back. I really wish I had heard something. I wonder sometimes if it was someone from Heartland where I used to work.

C2: (I’m already flustered and angry) Yeah, anyway I looked in to this situation and I saw that in Susan’s notes it said that she talked with the daughter and you asked her if you’d like to have her mother anointed and she said yes, so you looked in to it.

S2: It was actually Amber (the RN case manager) who asked me. She told me to have her anointed. I have the texts to prove it.

C3: I’m not really concerned about that (I’m angry that she’s so defensive and accusatory). What I wanted to say was, and I told this to you before, is that I think there was miscommunication between you and your team.

S3: I don’t see how you can say that.

M3: What happens is that you’re hard to approach and talk to. I think that if people were more comfortable talking to you then we wouldn’t have these problems! But you get so defensive – What happened was that in IDT (our meeting where we discuss patient status and concerns) someone asked if so-and-so had been anointed and you went on with this long explanation about how she didn’t need to be and blah-de-blah…

S4: No – that didn’t happen! Amber asked me to have them anointed and I said I would. I can prove it!

C4: Susan, Maggie’s right. You tend to take things way too personally. I think what happened here was that Amber asked you to have the patient anointed and you took care of it without communicating that back to her. Then when she brought it up in team you felt that you had to engage in a long explanation of why it didn’t need to be done now. And I think the team could have just been told that it was done.

M4: Right! They don’t care why. They don’t need all the religious reasons.

C5: And keep in mind that this is not the first time this has happened. I mean, our people get that people can be anointed and that they don’t need to be seen again by a priest. We’ve had that talk before.

M5: And when you give this long reason as to why it just seems like you’re not interested.

S5: Well I think of anyone I’m the most sensitive to the needs of our Catholic patients. I mean I was baptized Catholic! And Lutherans and Catholics are not that far off! I’m very sensitive to the religious needs of people.

M6: (angrily) But things don’t always have to be about religion! People get the impression sometimes that you’re shoving religion down their throats! And you’re not always the most sensitive person. In fact you told me one time that you thought I wasn’t a committed Christian.

S6: That’s not true. I would never say that!

M7: Well you did.

S7: I just can’t see how I would ever say something like that.

M8: You did.

(silence)

S8: Well if I did say that then I’m sorry. I just don’t think I would say something like that.

C8: (I feel tired and frustrated)To get back to the problem, I know you have this feeling that people are out to get you and that just isn’t the case (she had related this to me in several prior conversations).

S9: Well I don’t know. There’s been a lot of accusatory stuff out there. Like that web-

C9: (I’m angry) I don’t want to talk about that. Chances are we will never find out what that was all about. In fact it kinda reminds me of what I call the “Judge Judy principle”. Ever watch Judge Judy? She’ll hear something and say “well that just doesn’t make sense…that’s not logical!” Well guess what – people aren’t always logical! We do things that don’t make sense. That’s the Judge Judy fallacy. It could have been that you called this person for support and they also got a letter. They get your name from the call, connect it with the letter, and then it’s “Susan sent me this damn letter!” (group laughs a little) Do you see how that can happen? But just let it go. You can’t keep hanging out back there in the past on something that will never get fixed. Chances are you’ll never know what happened. Forget about it.

L9: Right.

C10: And I think you need to work on your communication. You have a tendency to overexplain things.

S10: That’s my parentification issues coming up from CPE (smiling). I’ll own that.

C11: Right. And people don’t like being talked to like you’re the parent and they’re the idiot.

M11: Right! When you go on and on about something, people turn off and they quit listening. Then it’s no wonder that people don’t communicate well or find you hard to approach.

S11: It’s something I’m trying to work on…

C12: I know, I know. But…one thing that I wanted to make clear is that I don’t think you have to prove anything to anyone. We are on your side. Amber likes you. Your patients like you. You work well with the staff at facilities. I went around with you and saw that. And Karen (her other RN case manager) said that things were rocky at first but got a lot better.

S12: Yes, I’ve gotten to have a really good relationship with Sue (another RN) as well.

C13: I know. But I think that you’re just trying so hard to prove yourself to people that it ends up backfiring. That’s when you can get into this downward spiral I talked with you about: I don’t think people like me, so I act like they don’t, and then they don’t.

M13: Right – and I like you too. I just think you need to communicate better and not be so defensive.

(pause)

C14: Anyway, just to clarify as I wanted to wrap this up. I didn’t see anything that would require disciplinary action. I was trying to think of an action plan but honestly I had a hard time thinking of one. But I also wanted to make sure that you felt that you had your concerns addressed. What was your concern?

S14: That it was said that I was asked to do something and it was said that I didn’t do it.

C15: And do you think we’ve addressed that?

S15: Well, I think

C16: Do you think we addressed that to your satisfaction?

S16: Yes.

C17: Ok. Thanks.

S17: And thank you for having this so I could get this solved. It makes me feel a lot better.

C18: That’s ok.

L18: Yes – thanks for coming.

Relational/Pastoral/Theological Reflection:

Pastorally, I felt that I handled the situation in a proper biblical manner, first bringing up concerns to her and then bringing in other authorities. I hadn’t done this consciously, but was aware of it afterward and saw the value in it. I had some struggles pastorally as I know that our two understandings of our roles are very different. Susan takes on a much more clerical role, more typical of what I would consider seeing in a pastor functioning in a church. My own understanding is more informal and relational in nature, relying less on tradition and sacrament.⁶ I know that some patients are more comfortable with her approach, and others are more comfortable with mine. But I also know that many on our staff are more comfortable with my approach. Susan feels that explaining her approach will help in raising their comfort level, and I have given her the opportunity to do so with our chaplains and social workers, but I don’t believe that further explanation will be helpful. This is because it comes off as defensive and from a posture of superiority to me and to others. I’ve tried to make this clear to her and she says that she is aware of it and seems to be making some gradual changes. However I don’t feel that the defensiveness will stop.

Relationally I wondered in retrospect if I went too easy. But I also felt that I simply didn’t have anything concrete to hang my hat on in terms of performance issues. I felt that I couldn’t expect her to act the same way that I do and needed to respect that boundary.⁷ Maggie was much more open in her anger than I was, which is pretty typical for her. She is my right-hand person, and I knew that she would be more vocal in her anger than I would be, which would give me a bit of a break. In the visit I wanted to be focused on the problem at hand which was her defensiveness and poor communication and tried not to let her hijack it into blame-shifting (C2, C3, C8). When I did get angry I hedged it with humor, which is something I often do (C9). I tried to be empathetic but this was hard again due to her defensiveness. I just couldn’t understand it and it made me feel angry, confused and distant. I didn’t want to connect with her. I also felt that if I let myself be angry openly with her then her defensive spiral would go out of control making things worse. Prior to this meeting I expected things to either go as they did or else she would become defensive to the point of belligerence and then either be fired on the spot (which is one reason I wanted Laura there) or else quit.

I felt in control and authoritative, and understood that I was running the meeting and whatever path it would go down. I also felt supported by Maggie, less so by Laura but she is much quieter and reserved, tending to be non-confrontational. I took her silence as consent to run the show, whether she meant it to be or not. After the meeting Maggie thanked me and said that I was “very diplomatic”. This was intended as a compliment but at the time I questioned if I should have been diplomatic. I have recognized my familial role as peacekeeper and conflict-avoider and am trying to shake that up a bit. I felt that I leaned toward the peacekeeping end of the spectrum, but did so with authority and felt that given the defensive posture on Susan’s side that an authoritative, calm posture would be best accepted by her. She needed and wanted desperately to be affirmed, something which has probably been lacking in her life. I struggled with this as I felt caught between affirming her as a person and affirming her as a defensive porcupine with all quills out. I tried to do this in the encounter and I feel that I was somewhat effective.⁸ I say somewhat in that I don’t know what kind of lasting change will come as a result of this awareness that she has.

I also recognized in her some of the “drowning man” behavior that I expressed and felt in the past. A drowning man may try so hard to be rescued that they drown their rescuer. I recognized in past dating relationships that I often tried so hard to be acceptable and wonderful that I drove the other person away, which made me try all the harder to get them back. I think in this way I connected empathetically with her, but it was more sorrowful to me and reminded me of my own past pain and toxic shame so much that I wanted to draw a boundary around it and keep my emotional distance – I didn’t want that pain and shame anymore.⁹

Theologically, I value her religious perspective and ways in which she is more aware of the nuances of more traditional faiths, such as the liturgical calendar, particular readings and prayers, and so on. I occasionally even get the “should”s around her, as in “I should have known it was Ash Wednesday!” However I also believe that she uses her religious role to point to herself, again due to the need for external sources for self-acceptance. How I can – and even if I should – challenge this is a question that still remains.

There were also theological themes of trust involved here. Initially I felt as if this was an exercise in finding out who was lying to me. My CPE supervisor, who had dealt with her in the past as well, advised me to be on my guard.¹⁰ I was torn between trusting myself, trusting what I heard from others, and trusting Susan. In this situation I felt that I could only trust myself and my own intuition, and rely on the wisdom of the Holy Spirit to guide me through.¹¹

I realized in retrospect that I didn’t “stop and pray” before, during or after this visit. While I certainly do stop to formally pray, I tend to hold loose conversations with God, holding to the fact that He is there whether I call on Him or not.¹²

Conclusion:

Prior to this meeting I had decided to move Susan off one of the team she was having the most difficulty with. I did this for two reasons, one being the need to consolidate her cases in one geographic area (she was very spread out geographically, which was the source of other problems) and the other was to simply solve this problem.¹³ The other team she works on seems much more comfortable with her and her style now than they were at the beginning, and she is more comfortable with them. I am going to take over that team and give the bulk of my other patients to another chaplain. Susan was very appreciative of this move but still wanted to maintain some of the connections she had to facilities in that area, as she had set up several Bible studies and ongoing services there. I told her that she could complete her responsibilities to these facilities but then needed to transition over to my being their chaplain again. I also wrote up a summary of the meeting and sent it to all those who attended as well as our general manager. I have begun keeping a hefty paper trail of emails concerning Susan – to, from, and about her – and feel that I’ll need to do so for some time until I feel more comfortable trusting her.