A Review of Robert G. Anderson’s “The Search for Spiritual/Cultural Competency in Chaplaincy Practice: Five Steps that Mark the Path"

by Danny Fisher


In Robert G. Anderson’s “The Search for Spiritual/Cultural Competency in Chaplaincy Practice: Five Steps that Mark the Path,” the author’s primary concern is the potential contribution of clinically-trained and professionally certified chaplains to “today’s increasingly pluralistic and global health care context with diverse religious, spiritual and cultural values, beliefs and practices.” In his view, chaplains have a special responsibility to increase what he terms “spiritual/cultural competency,” or the ability to respond to the “concerns and distresses expressed in uniquely spiritual and cultural ways by the person, family and kin in life transitions and crises.” With a heavy reliance on the paradigm of clinical training, Anderson outlines five steps for competency assessment that are explaining using two extensive case studies.

The ground from which the author derives a path towards greater spiritual/cultural competency is the patient’s “web of meaning,” or the ways in which one’s cultural background and values merge with the uniqueness of their life experience. He writes:

    Only the person in transition or crisis can describe the elements that comprise identity and meaning in their life. Assumptions about ethnic, religious, and age groups distort the understanding of a particular person and are often the presuppositions of the dominant religious or cultural view regarding those different from the prevailing custom and culture…To meet the challenge of the pluralistic and globalized health care context, chaplains must first grasp their own spiritual/cultural constellation, what might best be described as a web of meaning, through self-assessment and definition. Second, chaplains need to develop a capacity to assess and understand the spiritual/cultural constellation, the web of meaning of the person with whom they are professionally relating…[this] dual professional capacity [is called] “spiritual/cultural competency.”

Anderson goes on to articulate the ways in which meaning is “shaped by internalized collective and communal elements.” This is a complicated dynamic that Anderson feels is not often acknowledged by spiritual care providers in the healthcare profession. He writes:

    The chaplain’s religious, ecumenical or even interfaith perspective, tailored to the hospital’s reliance upon the efficacy of acute diagnosis and treatment can combine as a formidable veil, a barrier whereby caregivers overlook the differing worldview of a frightened, disoriented and isolated person and family.

With this in mind, Anderson sets about to find ways of helping professional healthcare chaplains broaden their clinical sensitivity and awareness.

Using Anton Boisen’s terminology, Anderson considers the patient as a “living human document,” a source for research into meaning and the life narrative. He points to past case studies of patients in spiritual care/counseling relationships, which indicate “internalized religion was identified with universal and individual features, but less for particular cultural dimensions.” This is problematic for Anderson, who believes that “the cultural and spiritual factors when viewed in a more integrated way enrich the life narrative of the living human document and shape unique meaning…[they are] just as primary as psychological and developmental features to explain and interpret [life narrative and meaning].” The author emphasizes the need to understand the patient’s life narrative as an “interwoven” fabric: “…we need to see the web of meaning as comprised of universal, individual, cultural, spiritual, and religious elements…a fabric of interwoven strands…” Without such a view, he argues, we run the risk of making the kinds of aforementioned assumptions and minimizations that are not in the best interests of our patients. “‘Spiritual/cultural competency’ is the capacity to read the cloth [of interwoven fabric], to know one’s own life narrative and hear the narrative of another,” he writes with great passion.

Anderson next outlines the sources that mark the path of competence. The author elucidates the valuable role of Clinical Pastoral Education (C.P.E.) training in developing the chaplain’s “correlation of heart and head.” He further argues that pastoral care and what is learned in the clinical education of chaplains has much to offer the field of multicultural counseling, particularly as it makes “an effort to integrate spirituality.” Anderson considers biases in the counseling, pastoral care, and anthropology disciplines that keep the unique insights of chaplains from being shared and absorbed by those in other fields. Additionally, he considers ways that clinically-trained and professionally certified chaplains can help to bridge such gaps. “The growing contention about the appropriateness of ‘pastoral’ as the primary identity of the field, rooted in Christian biblical imagery, exemplifies the boundaries that need to be continually evaluated and re-aligned,” he writes.

At this point, the five steps for spiritual/cultural chaplain competency are outlined. The first step is “the capacity to know and explain one’s own ‘spiritual/cultural set,’ one’s own spiritual/cultural groundedness.” Anderson sees this as important because if the chaplain is able to “grasp [her own] values and basic assumptions, [then she is] able to see [herself] in context and how [she is] distinguished from others both within and outside [her] family and community.”

The second step is “the capacity to identify experiences and information that are outside of one’s own spiritual/cultural references, to identify and learn about ‘otherness.’” What this means, he explains, is that when a chaplain “place boundaries around [her] web of meaning, [she is then] able within the context of a pastoral relationship to recognize the distinctive grounding of another person, the otherness of the human being in front of [her].” Anderson sees this a particular important step, for “if [the chaplain expresses] common bonds too readily, [she] may be exercising presumption and power, interpreting as common what is distinctive or unique for someone else.”

The third step is “the capacity to demonstrate multi-spiritual/cultural attitudes, approaches, and skills leading to effective communication and relating to those with other cultural sets.” The author believes “an attitude of acceptance and respect is essential to see the other person’s vantage point, through open-ended communication skills where the other person defines reality.”

The fourth step is “the capacity to identify contextual or relational barriers, as well as one’s own limitations, in communications and pastoral practice.” Here, Anderson makes the case that if the chaplain is able to identify her “comfort zone and the boundaries around it, [then she has] the possibility to identify the discomfort zone that surrounds it.” This, he says, is “an essential step in my practice learning.”

The fifth and final step is “the capacity to demonstrate respect within and willingness to learn from and evaluate the process of multi-spiritual/cultural interaction.” Sounding a note that might seem familiar to Buddhist chaplains, Anderson writes, “ultimately the other person is my teacher.” But, he adds: “A context for group/case consultation and/or supervision by a person with more multi-spiritual/cultural counseling experience can provide enriched competency, in mutual development and accountability and in measuring the attainment of learning.”

Anderson concludes his article with some case study verbatim reports. These reports illustrate perfectly the importance of the five points he outlines for spiritual/cultural competency in healthcare chaplaincy. In the end, he presents us with a model for spiritual/cultural competency that “integrates elements of self-awareness, understanding, and interactive skill that acknowledges caring and commitment to relationships in which learning leads the way.”

In terms of the approach taken by the author to this material, Anderson holds a ThM degree, is ordained as a Presbyterian minister, and has worked as a hospital chaplain in New York City for over thirty-two years. In addition, he is an A.C.P.E. supervisor, guiding future chaplains through their clinical training. Although he draws on more technical sources from the fields of multicultural counseling, psychotherapy, and anthropology, his interest seems to be in writing a more practical, accessible guide for working professional chaplains and chaplains-in-training. Anderson practices what he preaches, as well: concerned about the linguistic and cultural barriers that can be created in chaplaincy, his own language in this article is careful and never exclusivist. This piece would be hugely valuable to a chaplain of any religious persuasion—Jewish, Christian, Hindu, Buddhist, Muslim, etc. Anderson uses what he knows, but never once does a particular religious view dominate the conversation.

I was left wondering about some specifics, however. I wanted to know what private and professional organizations and other kinds of caregivers (doctors, nurses, therapists, and so on) were doing about developing the type of competency Anderson discusses. America is, as Diana Eck points out, the most religiously diverse nation in the entire world. This cannot have escaped everyone notice but those working in the field of spiritual care. I wanted to hear more about how multiculturalism and religious pluralism are addressed and understood in the training of healthcare providers of all kinds. Just how at odds with “the norm” is Anderson’s thesis? Is it at all? Or is he really speaking to chaplains and, to a lesser extent, those working in the disciplines that might have a stereotypical bias against the contributions of spiritual caregivers? It is possible that Anderson’s article would have benefited from a more pointed, precise critique of the ethos around multiculturalism and religious pluralism in healthcare.

In the end, though, I think that what has been offered in “The Search for Spiritual/Cultural Competency in Chaplaincy Practice: Five Steps that Mark the Path” is extremely valuable. Anderson masterfully outlines and underscores the importance of spiritual/cultural competency in healthcare chaplaincy. I am left excited at the prospect of being a caregiver in the mold he believes I can be.