Combining theological counseling and social work for hospice care

When I first started my chaplain training, I treated social workers as rivals. They seemed never to understand exactly how chaplains served patients and their families. The fact that I did not understand the role of social workers didn’t help much, either.

Perhaps this animosity came from the fact that our roles seemed so similar. Like social workers, chaplains offer counseling to those in crisis. We use similar listening skills, similar approaches to getting to the root of problems, and hold similar ethical values such as confidentiality, professional boundaries, and creating a safe space for healing conversations.

Like chaplains, social workers use community resources to provide assistance to those in need. Social workers provide access to services provided by government agencies, nonprofits, and even churches in order to find solutions to crises. Often, social workers are motivated from deeply held faith and religious beliefs. This only adds to the ambiguity and temptation to rivalry. “Look, we don’t need you,” a social worker once told me. “I can pray with the patient if she wants prayer!” My response was equally harsh.

Thankfully, both time and job experience have changed my understanding of the relationship between social workers and chaplains. As I progress in my field, I realize that while yes, there are similarities between the two fields, and they often appear to be asking the same questions, the strengths of one complement the limitations of the other. By working together, the two fields bring far more benefit to the patient than they ever could by themselves.

I experienced this firsthand while working for a hospice agency. Whenever a new patient is admitted to hospice care, several assessments are required from medical, social work, and chaplaincy departments. As our social worker was new and did not know the area where our new patient lived, I offered to drive her to the location. We could then do our assessments simultaneously.

The assessments required both of us to ask questions about the funeral arrangements of the patients. But here our fields diverged. Our social worker wanted to know if arrangements had been made with a funeral home. Was there a burial plot purchased, or was the patient to be cremated following her death? Was everything paid for? Was there a will written and power of attorney named so that her plans would be honored? The goal here was to make sure that important details were not overlooked and to avoid the added pain that this would cause during a time of great grief. And if there were problems with planning, or affording the needed services, our social worker provided details and possible solutions.

While these issues are extremely important, the chaplain approaches this situation differently. One question I always ask is, “How does talking about all of this make you feel?” Although one might think the response would be a sarcastic version of, “How do you think it makes me feel!?!” I find that asking open ended questions not necessarily centered around the primary illness sheds light on the patient’s concerns. “Where is God for you in all of this?” or even “What do you believe happens to us when we die?” are other questions I use to open up end-of-life discussions. My role is not to gather information; my job is to be present and listen to the concerns of the person in front of me. The social worker’s questions also open up possible avenues of conversation regarding the patient’s relationships. A question about wills or power of attorney might result in the patient naming a previously unmentioned relative. This in turn might lead to the patient telling a story of family conflict. As the role of the chaplain is very much involved in stories and reconciliation, this information might illuminate an unhealed wound that needs tending.

Whereas I once was irritated when I visited a patient and found the social worker already there, I now see these moments as opportunities. Both fields are concerned with the care of the patient; both fields are concerned with healing and well-being. And both fields, I believe, are at their best when they work together, sharing and using information to illuminate needs that have not been given voice. There is great healing that can take place during the last days of a patient’s life, be it reconciling with family and friends, facing fears regarding the dying process, or having someone be present to hear and honor one’s life story. These are powerful and holy moments, and are best facilitated when social workers and chaplains work closely together.

The Rev. Scott Fuller is a D.Min. student at Pittsburgh Theological Seminary and is a chaplain at Life Pittsburgh.