Understanding “Spiritual Care”
The concept of “spiritual care” has its roots in the concept of “pastoral care”, which refers to the traditional role of Christian priests, or pastors, in counseling and supporting members of their church or community. Rev. Dr. Seward Hiltner, a Presbyterian minister who was a leader in the field of pastoral care and a former professor at the Princeton Theological Seminary, further explains the concept as:
The ministry of the cure of souls, or pastoral care, consists of helping acts, done by representative Christian persons, directed towards the healing, sustaining, guiding, and reconciling of troubled persons whose troubles arise in the context of ultimate meanings and concerns.
With this kind of foundation, CPE developed in the mid 20th century under the strong influence of Protestant theologians Paul Tillich, Reinhold Niebuhr, and Karl Barth and their understandings of pastoral care and counseling. “These theologians helped frame the existential suffering and spiritual longing of the persons chaplains encounter on a daily basis.” However, increasing cultural diversity in the U.S. in the 1970s and 1980s forced an expansion of these understandings in CPE to incorporate modern psychology, educational theory, and group dynamics as well as grapple with a growing diversity of different religious standpoints. In this way, the concept of pastoral care had to be developed into something more encompassing, which is what many refer to now as “spiritual care”.
While spiritual care still carries undertones of Christian theology in the sense of a spirit or soul in relation to a creator God, the concept of “spirituality” has greatly evolved in the U.S. as seen in this definition by palliative care specialists:
Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.
In this definition, we see no reference to a spirit or soul, nor any reference to God. Indeed, “spirituality” is now often used by agnostics as an alternative word to “religion” to refer to their own personal belief systems.
This expanding notion of “spirituality” and “spiritual care” was echoed by the CPE summer interns with whom we spoke at Johns Hopkins Hospital, all of whom are being trained as Christian ministers. Here is a sampling of their responses to our question, “What is spirituality to you?”:
- From a Catholic priest in training: “Spirituality to me is a concrete lived relationship with God through Jesus Christ, which takes all kinds of different expressions. The CPE program offers a deepening of who I am as a man, as a Christian, and as a minister.”
- From a male Episcopalian minister in training: “I see spirituality in a broad way as a connection to the divine or transcendent, whether that be our personal connection, our connection within each other, or the world around us. The unknown component of CPE has been how much I have come to see my own pastoral identity unveiled. It was there, but I didn’t know it existed until this process.”
- A female minister in training from the Reformed tradition for whom chaplaincy is a second career after being a social worker. “For me spirituality and faith is an acceptance and recognition of the existence and meaningfulness of God, of something external to ourselves that we cannot necessarily see physically but is present in all of creation and humanity.”
- A female Episcopalian minister in training who was raised Roman Catholic, used to be a scientist, and has practiced Buddhist meditation: “For me, spirituality is about connecting with that piece of myself that is beyond, the divine. Making this connection is probably the most meaningful thing that I do and finding it in other people.”
- A Lutheran minister in training taking CPE to become a military chaplain: “Spirituality is about the human connection to the divine, but it has both individual and communal components.”
- Chris Brown, the Manager of Clinical Pastoral Education and director of these interns’ summer program, who is southern Baptist: “For me, spirituality is the spark of being connected to other human beings. So the central core of my spirituality is being in relationship not just with God but with others and myself.”
Despite the notion of connection with a single creator God, which is alien to Japanese, the core sensibilities of connection to an external source of divinity and to other human beings are very similar to key Japanese notions of religion—such as the Buddhist concept of interconnection with all sentient life (en) and with a source of divinity such as compassionate and protective gods in the Shinto pantheon or buddhas (Amida) and bodhisattvas (Kannon). From this basis, we will examine how American Buddhists further expanded the concept of “spiritual care”.
Go to: Part 3: Introducing “Contemplative Care”
 Hiltner, Seward. Preface to Pastoral Theology. Nashville: Abingdon Press, 1958. pp. 89-172.
 Cobb, Mark & Puchlaski, Christina M. “Theoretical Foundations (of CPE)” in The Oxford Textbook of Spirituality in Healthcare. Oxford, UK: Oxford University Press, 2012. p. 431.
 “Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference” Journal of Palliative Care, Vol. 12, No. 10, 2009.