Introducing “Contemplative Care”
One of the first impressions in talking with Buddhists in the U.S. about chaplaincy is the use of the term “contemplative care”. This term—along with others such as “contemplative intervention” and “contemplative practice”—is now commonly being used among Buddhist groups, as seen in the names of two of the most established programs: the New York Zen Center for Contemplative Care founded by Revs. Chodo Campbell and Koshin Ellison and the Being with Dying Professional Training Program in Contemplative End-of-Life Care founded by Rev. Joan Halifax in New Mexico. The term’s usage, however, tends to be for engaging not with fellow Buddhists but with two disparate groups in the field: 1) the still predominantly theistic culture of the United States, principally Christianity; 2) medical professionals, whose scientific backgrounds tend to make them averse to religious teachings and culture.
The roots of Buddhist oriented “contemplative care” begin with the pioneering research done on the scientifically verifiable effects of meditation by Jon Kabat-Zinn in the 1980s at the Massachusetts Institute of Technology (MIT). Using a Buddhist framework, Kabat-Zinn created a structured eight-week course called Mindfulness-Based Stress Reduction (MBSR). The aspect of Buddhist meditation that he isolated as the key component for scientifically verifiable, therapeutic interventions was “mindfulness”, which he defined as “paying attention in a particular way; on purpose, in the present moment, and non judgmentally.” Mindfulness is a core component of classical Buddhist meditation, found specifically in the shamatha-vipassana (止観shikan) tradition of Theravada Buddhism and principally in the Tendai and Zen schools of Mahayana Buddhism. With such empirical data, Kabat-Zinn’s work began gaining wide spread notoriety in the 1990s. Over the last decade, “mindfulness” has become a buzzword and its practice a growing trend in many sectors of American public life.
However, in clinical contexts, both the term “meditation” and its Buddhist roots have been downplayed for their religious connotations. Thus, new terms like “contemplative intervention” (i.e. the teaching of mindfulness meditation) and “contemplative care” started being developed in the 1990s. As the therapeutic benefits of meditation for patients are becoming more widely accepted, there has been a greater demand for such meditation teachers in a variety of clinical environments. The term “contemplative” is also used as a more inclusive term that recognizes the meditative-like benefits of forms of practice prominent in other traditions—such as “contemplative prayer” in the Abrahamic traditions as well as mantra-like recitation in Hinduism and even in Buddhism itself like Pure Land Buddhism. In the important new survey of Buddhist chaplaincy development in the United States called The Arts of Contemplative Care, the editors provide a helpful explanation of this popular new term:
The term “contemplative care” has its roots in the movement of Buddhist chaplains, care providers, and ministers that are beginning to turn their passion for Buddhist practice and view into a meaningful living. It is a close cousin to the term “spiritual care” … and yet we would like to distinguish (them) … We understand spiritual care to refer to a wide swath of practitioners who provide emotional and spiritual support in a variety of contexts, both professional and informal. Contemplative care, on the other hand, refers to a kind of care that is informed by rigorous training in a meditative or contemplative tradition … Contemplative care is the art of providing spiritual, emotional, and pastoral support, in a way that is informed by a personal, consistent contemplative or meditation practice.
In this way, we can see how “contemplative” is being used to express the importance of meditation practice for not only the patient (as is widely assumed or expected) but also for the caregiver—both medical and spiritual. In fact, in Jonathan Watts’ continuing research, which includes Buddhist priests in Japan doing suicide prevention, he has found that greater emphasis is placed on meditation practice by the caregiver rather than by the patient.
As such, the development of “contemplative care” is not simply Buddhists trying to be different or creating their own “brand” of spiritual care. Three certified CPE chaplains trained by the New York Zen Center for Contemplative Care explained to us this point and the meaning of “contemplative care” and “contemplative practice” for them:
- A male chaplain who is beginning his third year with the palliative care team at Mt. Sinai Hospital on the upper East Side of Manhattan: “I am going to relate the difference between spiritual care and contemplative care to practice, of meditation practice and overall Buddhist practice. This means being embodied in a way that perhaps other chaplains may not be trained. Because of our practice, we can engage in contemplative care with an inner awareness of how to be with our bodies and ourselves. I find this most meaningful with patients in terms of them opening up and connecting in ways they never imagined. I find that many in the pastoral care and palliative care staff have never had that happen to them before with patients.”
- a female chaplain who did CPE training in psychiatry and substance abuse as well as palliative care for five years at Beth Israel Hospital in lower Manhattan: “Contemplation to me equals curiosity, which means to be very aware of what is coming up for me and then opening to this elegant listening, just listening. So I try to imagine, ‘What is the message that I am receiving from this other person?’ This does not mean to let go of the foundation that is supporting me, but through contemplation to open up to what the person is telling me so that I can be aware of how we are influencing one another. From that place, I can begin to wonder, ‘Where is this person suffering? What is this person’s strength that they might not be seeing?’ The posture of the Buddha acts as a model for my own posture and attitude in dealing with others so that I can serve them.”
- a female chaplain who worked in palliative care for seven years at Beth Israel Hospital and now does home hospice care outside of New York City for the Hospice of Orange and Sullivan County: “Offering contemplative care means to be really grounded in our bodies. This allows for sensitivity. It also helps to open up a field of feeling to know what is happening in myself and to become very attuned to the person I am with. I think this is what really allows for spontaneity, to be able to move here or there, for whatever seems to be needed.”
Means vs. Ends or Presence vs. Salvation
The ability to develop embodied presence in the face of suffering is something that distinguishes “contemplative care” from “spiritual care”. What is perhaps surprising is not that there is a difference in what the caregiver is focusing on in the patient (a spirit vs. a consciousness or mind) but rather the comportment of the chaplain themselves. Clinical Pastoral Education (CPE) was developed in the 1920s by Rev. Anton Boisen, a Congregationalist minister, and Dr. William A. Bryan in part as a response to the narrow minded way Christian priests often acted as chaplains in clinical environments. Too often they were seeking to inculcate patients with proper faith rather than experience them first as who they were and what their real suffering was. In this way, CPE at its core attempts to train ministers of all religious backgrounds to cultivate more fully in themselves their respective traditions in order to better attend to the suffering of patients, rather than as way to bring patients to a minster’s sense of their own respective tradition.
What this new generation of Buddhist chaplains appears to be contributing to CPE is the power of a non-theistic “contemplative care” that manifests in the ability of Buddhist chaplains to translate the practice of sitting with their own suffering in meditation to the practice of sitting non-judgmentally with patients in their suffering—a practice known as “presence”. Roy Remer, who trains volunteer hospice staff for the Zen Hospice Project at Laguna Honda Hospital, spoke to us of the tendency in theistic spiritual care, especially common among Christian chaplains, to be more focused on active altruism, doing good, and getting tangible results—ideally in the patient coming to an awakening or confirmation of faith and salvation. Buddhists, on the other hand, focus on the act of simply being present with the patient, seeing what arises, and remaining unattached to outcomes. As the late Rev. Issan Dorsey, founder of Maitri Hospice also in San Francisco, emphasized, “You have to meet people where there are and not where you want them to be.” Remer concludes that, “This seems to result in greater longevity among our volunteers as opposed to others who burn out when they don’t see tangible results. We emphasize giving up any notions of fixing things, to just serve with an open heart and be with suffering.”
Revs. Chodo Campbell and Koshin Ellison, founders of the New York Zen Center for Contemplative Care, both did their CPE training in Judeo-Christian contexts and found there was no such practice as “bearing witness” or “being with”. While there might have been a sense of deep listening, it usually was goal oriented. For them, sometimes there is a goal, but it involves something less tangible without an agenda—such as getting someone to a place where they feel comfortable enough to open up and tell their story.
Kirsten Deleo, a trainer in the Rigpa Spiritual Care Program founded by Sogyal Rinpoche and Christine Longaker, explains in greater detail how meditation practice translates into a style of caring for others: “The premise of the contemplative approach is that, if you want to be useful to others, the place to start is with yourself, beginning with your own mind. Meditation practice gives us a window into observing and understanding the mind and its nature … Meditative practice can help us preserve our sanity and connect to our basic goodness … Contemplative practices are an effective and profound way to cultivate the ability to be non-judgmentally open with all that arises; to be compassionately present.”
Rev. Jennifer Block, former Bereavement Manager at Zen Hospice Project and Co-founder of the Buddhist Chaplaincy Training Program at the Sati Center for Buddhist Studies, defines what “spiritual care” looks like from a Buddhist standpoint: “Spiritual support from a Buddhist perspective can be defined as: willingness to bear witness, to help others discover their own truth, and to sit and listen to stories that have meaning and value; (as well as) helping another to face life directly; welcoming paradox and ambiguity into care (and trusting that these will emerge into some degree of awakening); and creating opportunities to awaken to their True Nature.”
In conclusion, the development by American Buddhists of the new term of “contemplative care” to expand the understanding and practice of “spiritual care” to incorporate the physical embodiment of meditation and mindfulness practice appears to have brought a revolutionary shift in the practice of chaplaincy in the United States. The Rinbutsuken Institute seeks to create a similar revolution in care in Japan. However, we feel we cannot repeat the same mistake in the initial development of “spiritual care” in Japan by simply incorporating the American concept of “contemplative care” and using it as a borrowed term that has no meaning to the average person. In the ongoing attempt to learn from other countries while developing an indigenous Japanese model, Rev. Jin has begun to use the term “life care” (いのちのケアinochi-no-kea), instead of “spiritual care” (スピリチュアルケアsupirichuaru-kea). The Japanese term for “life”, inochi, can be spelled using the Chinese character 命, but this is more physical life, one’s actual life span. Using the Japanese hiragana script いのち offers a broader meaning, encompassing existential aspects, like the Buddhist term dharma. As an indigenous terms, it is evocative and leads to deeper reflection on its meaning, rather than the empty sound of a transliterated foreign word.
 Kabat-Zinn, J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 1994. p. 4.
 Giles, Cheryl A. and Miller, Willa B, eds. The Arts of Contemplative Care: Pioneering Voices in Buddhist Chaplaincy and Pastoral Work. Boston: Wisdom Publication, 2012. p. xvii.
 Watts, Jonathan S. “Journey through Dukkha: The Suicide Prevention Priests of Japan Enter into Structural Violence and Connect to Social Change.” Yokohama: International Buddhist Exchange Center (IBEC). April 15, 2014.
 Watts, Jonathan S. and Tomatsu, Yoshiharu, eds. Buddhist Care for the Dying and Bereaved. Boston: Wisdom Publications & Tokyo: Jodo Shu Research Institute, 2012. p. 7.
 Buddhist Care for the Dying and Bereaved. p. 233.
 The Arts of Contemplative Care, p. 244.
 The Arts of Contemplative Care, p. 7.