Ministry of Presence and Presence of the

Spirit in Pastoral Visitation

Janet Stokes, Ph D

[Janet Stokes, who died January 1, 1998 at her home in Philadelphia at the age of
66, was on a spiritual journey
Well acquainted with numerous religious traditions, Janet found her home in the
Society of Friends about ten years ago and gradually became recognized as a
"weighty friend" (a phrase applied to members of her community whose spiritual
depth and wisdom had gained recognition and respect) Yet no one tradition fully
captured her openness to the Divine At the time of her death, Janet was working
as a Hospice Chaplain and studying Spiritual Direction with the Shalom Institute in
Washington, D C Coming from England as a young woman, she earned her
Masters Degree in Sociology at Columbia University and worked as a sociologist and
researcher During her nearly 20 years as a medical administrator at HUP, she
earned "on the side" her Ph D at the University of Pennsylvania in the field of the
History of Art
In her sixth decade of life, inspired and challenged by her work as Pastoral
Overseer in the Society of Friends, she enrolled in a part-time unit of Clinical
Pastoral Education And to further prepare herself for ministry in the seventh
decade of her life, she left a secure job to enter a full-time CPE residency at HUP
In the following essay, the result of her research into the meaning of "ministry of
presence," Janet Stokes offers us two important insights into the complex issue of
spirituality and illness Each is a witness to her generosity of spirit and her desire to
really be open to the healing work of the Spirit
First of all, her interviews point out that it is the experience of the patient that
must be uppermost in clinical pastoral care The challenge of ministry to the ill is
to be ready to give what the patients need—this is not necessarily what the pastor
or the hospital staff thinks he or she may have to offer'
Secondly, the ultimate goal of pastoral visitation of the sick should be the
increase of the presence of the Spirit Janet's research indicates that ill people who
have already experienced the presence of the Spirit are more likely to be brought
back to this state by a pastoral visit, this leads her to a reflection on the need for a
definition of "ministry of presence" that emphasizes true presence and emotional
depth
Janet loved her cats, her books, her music, gardening, and photography Janet's
life was a journey of openness to Spirit, to challenge and to change At the time of
her death, she was completing revisions on the following article developed out of a
research project during her Clinical Pastoral Education Residency at the Hospital
of the University of Pennsylvania in 1995 It would be her hope, we feel sure, that
this essay would lead other chaplains and pastoral counselors to pursue similar
research on this important theme It is a privilege to share this creative work, and a
sense of this inspiring colleague, with the readers of The Journal of Pastoral Care ]
Ralph C Ciampa, S Τ M E Ann Matter, Ph D
Director of Pastoral Care and Education R Jean Brownlee Term Professor
University of Pennsylvania Health System Department of Religious Studies
Hospital of the University of Pennsylvania University of Pennsylvania
3400 Spruce Street Philadelphia, PA 19104
Philadelphia, PA 19104

The Journal of Pastoral Care, Summer 199% Vol. 53, No. 2

191
A s a Quaker for the past ten years, accustomed to reverently seeking and
invoking the presence of the Spirit in Meeting for Worship, I am struck
by the casual way in which the phrase "ministry of presence" is some-
times employed by members of the pastoral care profession
True, authontive voices among us have spoken powerfully of the presence of
the Spirit in pastoral visitation For instance, in 1954 Wayne Oates wrote
The pastoral task is the participation in the divine human encounter The
sovereignty of God, the principle of incarnation whereby the Word was made
flesh the activity of the Holy Spirit in contemporary living, and the function of
the church as the body of Christ—these are the realities that the pastor symbol
îzes and represents In pastoral care and personal counseling they become fune
tional realities rather than theoretical topics of discussion
But others—to be fair, perhaps particularly those in training in pastoral
care—are apt to describe as "ministry of presence" a conversation with a
patient which seems to have no deep or specific content In such cases the
phrase "ministry of presence" is devalued, becoming a way to describe visits
which serve to remind the patient more of the pastor's availability, than of the
presence of the Holy
It seems to me that the view expressed by Oates is incompatible with casual
references to "ministry of presence", moreover, their simultaneous existence
implies a divided understanding among us of the nature of ministry of pres-
ence which goes beyond a simple misuse of phraseology
As a chaplain in basic training, I sought to disentangle for myself what true
ministry might consist in ("true" in the sense of honest, powerful, connecting,
Spirit-led) As a chaplain resident, working on an Advanced Project, I noted
these two definitions in the Dictionary of Pastoral Care and Counseling
Ministry of Presence A form of servanthood characterized by suffering, alongside
of and with the hurt and oppressed Ministry of presence in the pastoral office
means vulnerability to and participation in the life-world of those served

Presence of the Holy Spirit in Pastoral care An activity authorized and empowered by
the Divine Spirit and so spirited praxis This view of pastoral care is grounded in
the authorization to forgive sins and so to release the neighbor from the power of
brokenness and bondage
Both definitions accord to pastoral ministry a deeper sense of the presence
of the indwelling Spirit than does the more casual use of the phrase "ministry
of presence" referred to above There are, however, substantive differences
between these two definitions in the Dictionary, in addition to the differences
we noted between those of Oates and more casual references If the nature of
ministry of presence were to be clarified, it seems likely that a comparison with
"presence of the Spirit" might be helpful
As a former sociologist, I eventually came to think that an empirical investi-
gation might offer fresh insights I was anxious also to expand on Avery's work
he had used the perceptions of chaplain residents as his sole data base, and it
seemed to me that patients might well have an opinion about the visit also
Perhaps the opinions of patients could help elucidate what presence in pas-
toral visitation is all about
Thus it came about that I developed an Advanced Project to measure—not
of course the presence of the Spirit (the hubris even of sociologists has limits)—
but perceptions of patients and chaplains concerning the presence of the Spirit
in concrete pastoral encounters Some purposes and results of the ensuing
study are reported here in this article

192
 Purpose of the Study
The purpose of this study was to obtain information for patients and chaplain
residents on the following issues:
• Are "ministry of presence" and "presence of the Spirit" perceived as occur-
ring in specific pastoral visits?
• Are "ministry of presence" and "presence of the Spirit" seen as the same,
or as different?
• Do chaplain residents and patients differ in their evaluations of specific
pastoral visits with regard to ministry of presence or presence of the Spirit?
• What are some of the correlates of "presence of the Spirit"?

Design of the Project and Its Completion

Our residency group consisted of four chaplain trainees in addition to myself
I proposed to obtain 40 interviews from patients visited by my colleagues,
preferably ten per resident. I was willing to refer additional patients to the
study from among those I visited, and in these cases another resident would
interview the patient. In addition, each resident was asked to complete before
beginning the study a questionnaire asking generally his or her views on theo-
logical issues and ministerial praxis relevant to the issues of concern. The pur-
pose of the resident interviews was to examine whether individual variations in
belief or praxis influenced the degree of presence perceived by chaplains or
patients during visits.
For each patient referred, the resident was asked to fill out a brief checklist
indicating the levels of "presence of the Spirit" and "ministry of presence" in
the visit as he or she perceived them. Residents were asked to refer to the study
patients with whom they had experienced different levels of spiritual presence
so that a broad picture of the correlates of presence might be obtained. In
practice, residents tended to refer enthusiastically those patients with whom
they felt they had had a significant encounter, probably hoping that less signif-
icant visits could be fitted into the study later; as time for interviewing (and the
other responsibilities of the residency) grew short, it became more difficult to
obtain any referrals and these "less interesting" visits were no longer obtain-
able. In all, 25 patient interviews with corresponding checklists were obtained;
one of the residents completed the pre-interviewing questionnaire. Five of the
25 interview subjects were my patients with matching patient interview com-
pleted by a colleague. Considering that we were in the winter and spring units
of residency training, this degree of completion constitutes a major investment
of effort for which I am grateful.
All patients approached for interview agreed without demur. Five patients
referred by chaplains could not be interviewed for various reasons: some had
been discharged before the interviewer arrived to do the interview, some were
out of their rooms for treatment whenever the interviewer visited. In two
instances, a patient was referred with whom I had had a significant encounter
in an earlier unit of training, and I felt unable to switch roles from minister to
interviewer.

Measures
Presence of the Spirit was measured in two ways. The chaplain's checklist for each
referral included the question: "What level of presence of the Spirit did you
perceive in this visit?" (Permitted answers were: none, some, a lot). Patients

193
were asked: "Did the chaplain do anything during the visit that made the pres-
ence of the Spirit seem real to you?" If the answer was "yes," patients were
asked: "What was that?"
Ministry of Presence was more difficult to measure. For chaplains, a question
on the checklist was asked in a format that parallelled the question on presence
of the Spirit. For patients, however, it did not seem appropriate to ask this ques-
tion directly. The majority of patients would have required an explanation.
Essentially, this explanation was standardized by asking patients the following
series of questions: "What was most on your mind during the visit?" "Did you
feel that the chaplain heard these concerns?" "Did you feel that you were heard
by a person of faith who cared?" "How did you feel about that?" Responses var-
ied in length and ministry of presence was assessed as "none," "some," or "a lot"
on the basis of qualitative codes. Examples of responses fitting each category
are given below; they were recognized as appropriate by my colleagues at the
time the project was reported.
Examples of codes for answers on Ministry of Presence
None: Gives you a good feeling; I enjoyed it—I was surprised she even
stopped today. There wouldn't be any point in talking if I wasn't being heard.
Some: I get a warm feeling talking to X—she listens and cares; I felt good after
she left—we shared and boosted each other. Good to talk to someone sort of
from outside who understands. Good to talk to someone who has a really
strong unwavering faith because mine wavers. Confident I could talk with
someone who understood what I'm going through—just as comfortable as my
own pastor.
A lot: I felt like I was humbled. It was (patient cries) very moving—that she
took the time. Definitely—like I told her, before she came into the room, I felt
I had 50 pound weights on my shoulder, and when she left, they were lifted.
That really made me feel like I was somebody—somebody listened and not
gave orders and tell me what to do. Made me feel like a whole person.

Results and Analysis

1. Are ministry of presence and presence of the Spirit perceived as occurring in specific
pastoral visits f
There was a broad range of responses from both chaplains and patients on
both "ministry of presence" and "presence of the Spirit" during pastoral visits
(see Tables 1 and 2). While no chaplain reported a visit without at least some
ministry of presence, five visits were j u d g e d by chaplains to have involved no
presence of the Spirit; the majority of answers by chaplains assessed "some" of
both types of presence; however, a fair proportion of visits were assessed as
involving "a lot" of presence.

Table 1
Distribution of Chaplain's Ratings
on Ministry of Presence and Presence of the Spirit

Ministry of Presence Presence of the Spirit

None 0 5
Some 17 16
A Lot 8 4

194
 Table 2
Distribution of Patient Ratings
on Ministry of Presence and Presence of the Spirit

Ministry of Presence Presence of the Spirit

None 2 9
Some 13 13
A Lot 10 3

Patient's answers ranged more widely, falling into every possible category
While the majority again were rated "some" for both types of presence, 40% of
patients reported a lot of ministry of presence and a slightly lower percentage
(36%) reported no presence of the Spirit
2 Are ministry of presence and presence of the Spirit seen as the same or different?
From the foregoing, clearly both chaplains and patients perceive some dif-
ferences between the two types of presence Table 3 compares the chaplain's
report of ministry of presence, with his or her report of presence of the Spirit
in the same visit In the majority of cases (n=15) the level of both types of pres-
ence was seen as the same However, in a significant minority of cases there was
disagreement In all cases but one, disagreement was by only one step (from
some to none, or from some to a lot), however, on one occasion the chaplain
reported a lot of presence of the Spirit despite no ministry of presence

Table 3
Correspondence Between Ministry of Presence and
Presence of the Spirit: Chaplain's Report

Ministry of Presence
None Some A Lot
Presence of the Spirit None 4 1
Some 12 4
A Lot 1 3

Table 4 presents the parallel relationship for the patient Here, there is less
agreement In only eight cases out of the 25 was the level of ministry of pres-
ence seen as equal to the level of presence of the Spirit In another eight
patients, "a lot'Of ministry of presence accompanied only "some" presence of
the Spirit, and in six cases some ministry of presence was felt, but no presence
of the Spirit

Table 4
Correspondence Between Ministry of Presence and
Presence of the Spirit: Patient's Report
Ministry of Presence
None Some A Lot
Presence of the Spirit None 2 6 1
Some 5 8
A Lot 2 1

195
3. Do chaplain residents and patients differ in their evaluation of specific pastoral visits
with regard to ministry of presence or presence of the Spiriti
Residents and patients are more likely to agree on the level of ministry of
presence than on the level of presence of the Spirit. Table 5 presents a com-
parison between the chaplain's and the patient's view of the level of ministry or
presence in the visit. In 15 of the cases there is agreement; and in no case is
there disagreement greater than one step (some-none, some-a lot).

Table 5
Ministry of Presence:
Correspondence Between Chaplain's Report and Patient's Report

Patient's Report
None Some A Lot
Chaplain's Report: None
Some 2 10 5
A Lot 3 5

Table 6 presents the same comparison for assessments of presence of the Spirit.
There is agreement in 12 cases between chaplain and patient—slightly less
than half of our cases. Eleven cases show disagreement on one step in the rat-
ings, while two show a difference of two (none-a lot).

Table 6
Presence of the Spirit
Correspondence Between Chaplain's Report and Patient's Report

Patient's Report
None Some A Lot
Chaplain's Report: None 2 2 1
Some 6 9 1
A Lot 1 2 1

4. What are some of the correlates of "presence of the Spirit"?

Reports here are on the two correlates of presence that seemed most likely
to be significant: behavior of the chaplain and previous experience of the
patient.
Answers to the question What did the chaplain do? (that made the presence of
the Spirit seem real to you) were coded as listed below (and these codes were
again validated by my colleague at the time of presentation of the report) :
Prayer: Just the way she said the prayer and what she said; she prayed a beauti-
ful prayer; her prayer was very good, very comforting.
Had faith: I already have a faith but when you're talking with a person of faith
you can tell; she gave me faith to hold on...she has faith and I got strength from
her.
Read Bible: She read me some Psalms.
Demeanor: Her general demeanor showed someone in tune with God; just her
serenity—she's got a definite peace about her.
Other: He spoke of God's love and gave me a bigger picture—there's more to
this pilgrimage than we see in the world.

196
 Results are listed in Table 7 from which it is evident that prayer and appro-
priate demeanor are the most common behaviors for invoking presence of the
Spirit during visits

Table 7
Distribution of Responses to the Question:
What did the Chaplain do that made the Presence
of the Spirit seem real to you?

Prayed 6
Had faith 2
Read Bible 2
Spiritual
Demeanor 4
Other 3

Previous experience of the patient was determined by answers to the ques-

tion Have you at any time sensed the presence of the Spirit (Spirit of God) in
your life? Table 8 presents patients' responses In 15 of the cases, patients who
reported that the chaplain had brought the presence of the Spirit during the
visit stated they had experienced that Presence on another occasion in their
life Six patients who had previously experienced the presence of the Spirit did
not experience it during the visit There were no patients who had not previ-
ously experienced the presence of the Spirit who experienced it during the
visit

Table 8
Prior Experience of Presence of the Spirit
by Experience of the Spirit During Pastoral Visit
(Patient's Report)
Experienced Spirit During Visit
No Yes
Ever experienced Presence of the Spirit
No 3
Yes, during visit only
Yes, on other occasions 6 15

N=24 ("Don't know" to question on previous experienced)

It is noteworthy that a patient had the option to say that the chaplain
brought the presence of the Spirit just because he or she listened to me and I
felt heard This option would have been clearly present in their minds since the
question, Did the chaplain to do anything that made the presence of the Spirit
seem real to you? followed immediately upon the series of questions inquiring
about ministry of presence Only one person essentially repeated what she had
said in response to the previous question

Discussion and Conclusions

Neither patients nor chaplains had difficulty in assessing ministry of presence
or presence of the Spirit in specific visits Although it appears that the majority

197
 of responses fell into middle categories of "some presence," this is statistically
normal. Both patients and chaplains were quite able to distinguish cases in
which "no presence" or "a lot of presence" had occurred, from these middle
range situations.
Both chaplains and patients see ministry of presence and presence of the
Spirit as different: one may occur without the other. It is more common, how-
ever, for presence of the Spirit to "follow" strong ministry of presence than it is
for presence of the Spirit to occur without ministry of presence.
Clearly patients and chaplains differ a fair amount in their assessment of
presence of either type during the visit. This indicates that studies of ministry
of presence that rely solely on the perceptions of chaplains may not be address-
ing the issues adequately.
The chaplains' behaviors most highly correlated with presence of the Spirit
were prayer and a spiritual demeanor. This conclusion was surprising to my col-
leagues. As trainees at a research-oriented , tertiary care hospital forming part
of a major Ivy League university, we learned and tried out many tactics of visi-
tation and became involved in many discussions with patients, occasionally to
the detriment of these apparently quite basic tasks of visitation: prayer and an
appropriate demeanor. Our patients were not deceived. I recall having three
lengthy discussions with one patient who, after a lifetime of kidney disease, was
contemplating suicide if her kidney transplant failed. I did not initially recall
praying with her. When interviewed about my visits, however, she said that my
prayer had been significant in making the presence of the Spirit real to her. I
then recalled that on my very first, somewhat routine visit to this Catholic
patient she had been uncommunicative but had requested prayer, and not
knowing her well, I had done the best I could at the time and offered a prayer
which to me seemed perfunctory. Yet to her, it was worth more, spiritually, than
all our discussions. Another patient complained that the chaplain had not
prayed with her: "Is she a real chaplain? Then why didn't she pray with me?"
The patient had tears in her eyes, and the interviewer hastened to repair the
chaplain's omission.
It is clear that the most obvious source of "presence" during the visit is a char-
acteristic of the patient, not the chaplain. Table 8 is enlightening in several
respects. In every single case in which the patient stated that the chaplain made
the presence of the Spirit seem real, this patient had at least some, often con-
siderable, previous experience of the presence of the Spirit. In no case was the
chaplain able to convey the sensation of presence to a patient who had not pre-
viously experienced it. This is a chastening finding, and those of us who harbor
a wish to transform patients might do well to accept that this is likely to be a
rare accomplishment. It is noteworthy also that there were instances of a
patient with previous spiritual experience which was not tapped by the chap-
lain during the visit. Do we underestimate our patients' spiritual experience?
Ministry of presence and presence of the Spirit are both viable, although
somewhat separate, realities occurring during pastoral visitation. Ministry of
presence is clearly defined by patients more in the sense of accompanying the
patient in distress than in "passing the time of day" (although this may well be
an artifact of our queries). Nonetheless, perhaps pastoral caregivers might stop
using the phrase "ministry of presence" to refer to shallow visitation, and
instead recognize such shallowness for what it is more likely to be: a visit that
does not bring or reveal the power of the Spirit, for a variety of reasons (includ-
ing, but not limited to, the reason that the patient is not prepared by prior

198
experience). T h e n we could reserve "ministry of presence" to refer to more
graced and mutually experienced ministry."^

Λ
A JPCP Publication

A cademic courses, clinical training, and

super\ision ha\e been the major areas of
emphasis in the pastoral
care and counseling movement
Research, although often given
astically indulge their curiosity in this wav It is for
those who love to tinker with numbers as well as
for those who look for patterns in the kind oí
documentation we excel at gather-
ing—verbatims,
lip service, has tended to be anecdotes, case
neglected \s the movement histories
moves into the 21st centurv —from the Fornuord
and as pastoral caregivers
interact more and more with this volume will
caregivers in other profes­ encourage pastoral
sions, research will become caregivers to consider
an integral part of the research an integral
pastoral arts and sciences part of their ministrv,
This volume provides a and in so doing will not
perspective and a practical onlv ameliorate the
guide in the doing of literature in the pastoral
research, and in doing so arts and sciences, but
Vl,il
it remains faithful to the ''''aiii,. i„ contribute as well to the
neh interdisciplinary healing, well-being, and
nature of the move­ growth of their clients,
ment Stressing the pauents, and parishioners
need for both quantita­ —from the Introduction
tive and qualitative
approaches to re­ "Diverse conceptions of
search, the volume research methodology are
expresses the pastoral necessary in human science
care and counseling research A key issue is
movement s long- what the best possible fit is
held conviction that between the research problem
an authentic understanding of our and the research methods to
human condition needs the contributions spring­ be utilized As pastoral
ing from both the scientific and theological caregivers venture more coura-
communities geously into using research to expand knowledge
and practice in our field, they will experience a
This is truly a book for all seasons—for those led benediction to their creativity and rigorous qualirv
apprehensive and even kicking and screaming into in using diverse methodologies "
pastoral research as well as for those who enthusi­ —from the Epilogue

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