Healthcare chaplains’ conflicting and ambivalent positions regarding meaning in life and worldview

Abstract

Western society is increasingly a spiritual society, but not so much a society that draws on clearly delineated religious or worldview pillars anymore. Within healthcare, there’s a growing attention to the spiritual dimension of health and the collaborative spiritual care that is needed for person-centered care. This changing religious/worldview and healthcare landscape is influencing healthcare chaplaincy. In this case study in-depth interviews were conducted with a chaplaincy team within a large healthcare organization in The Netherlands. Dialogical Self Theory was used as the theoretical framework in the narrative analysis of these stories. This provided insights into how these chaplains negotiate their professional identity within a changing healthcare landscape. It is concluded that there are multiple and often contradictory and conflicting positions within and between chaplains and that it is a challenge for healthcare chaplains to integrate the “old” and “new” representations of chaplaincy.

Keywords:

• Dialogical self theory
• healthcare chaplaincy
• narrative analysis
• professional identity
• religion and worldview

Introduction

Over the last decades, the influence of religious and other worldview traditions and organizations amongst people born in The Netherlands has been strongly reduced (De Hart et al., 2022). At the same time, the diversity of—also not institutionalized—worldviews and religions has grown. Globalization and immigration have led to a plurality of worldviews and religious and spiritual traditions; and also secular people are searching for meaning in their lives although no longer relying on singular traditional religions or worldviews. This is an interesting but also challenging paradox of many Western societies at the beginning of the twenty-first century (Heelas & Woodhead, 2005).

Chaplaincy as traditionally a worldview/religion based profession and mission providing care in the context of specific religious traditions is located at the heart of this change (Cobb, 2007). Spiritual care increasingly becomes loosened from worldview-based frames (non-religious or religious) and more and more attached to professional frames of reference, such as person-centered care and a positive view on health (Brady et al., 2021; Huber et al., 2011). This is contributing to a diffuse identity because there is as yet no new social representation (Jovchelovitch, 2019) of the profession, and to ambiguity in how chaplains understand and name themselves (Glasner et al., 2023). As stated by Nolan and MacLaren (2021) in the introduction to a special issue on the developments within chaplaincy:

‘In fact, the next big change is already underway: the evolution of chaplaincy from a purely religious ministry to what it must become if it is to adapt to the “secular age” (Taylor, 2007). What began as a Christian ministry is visibly morphing into a secularized form of therapeutic service, at least within the context of healthcare.’ (Nolan & MacLaren, 2021, pp. 1–2)

In this regard, Zock (2008) refers to the “split professional identity” of the chaplain: on the one hand, many chaplains still have a religious or humanist mission and in that sense are representatives of a worldview tradition; on the other hand, they are “spiritual care professionals,” who, like other professionals and in collaboration with them, contribute to the holistic care of all clients within their department or neighborhood. Although this may seem a minor change, in fact, it involves a reorientation of the professional identity of chaplaincy in all its aspects. This reorientation includes reviewing the role of one’s humanist or religious views (Dollarhide & Oliver, 2014); enhancing the ability to provide care for people from diverse worldview and religious backgrounds (Swift, 2004); collaboration with other healthcare professionals in spiritual care; and repositioning themselves within healthcare institutions (Cadge et al., 2019; Swinton, 2003). Moreover, this shift also raises questions about the competencies required for effective chaplaincy in the twenty-first century and the ways to educate chaplains (Cadge et al., 2019; Cadge & Rambo, 2022; Jacobs et al., 2021).

The aim of this study is to explore how healthcare chaplains negotiate their professional identity amidst these changes. In The Netherlands, the focus on meaning in life and worldview in Dutch healthcare chaplaincy underlines the evolution of chaplaincy as spiritual care based on a clearly delineated religious or worldview framework of the chaplain; toward professional spiritual care oriented at meaning in life of clients as an integral dimension of healthcare. Meaning in life—the Dutch word “zingeving”—is broadly regarded as the new common goal and ground of spiritual caregiving, including chaplaincy (VGVZ, 2015).^1,2 Meaning in life is more commonly used than spirituality (“spiritualiteit”) in The Netherlands, but it refers to the same process:

“Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.” (Puchalski et al., 2009, p. 887)

Worldview then is an overlapping construct that refers to people’s spiritual beliefs, including secular or religious affiliations that can be multiple and fluid (Alma & Anbeek, 2013).

A case study (Yin, 2017) was conducted with one chaplaincy team within a healthcare organization. Dialogical Self Theory was used as it allows to accommodate multiplicity and ambiguity in (professional) identity, regarding the self as relational, contextual, and dynamic. Next, we will outline this theory, followed by an explanation of the narrative methods used. In the results section we present several themes, with a focus on the conflicting I-positions and I-other positions. We then discuss these results and their implications for research and practice.

Dialogical self theory

The theory of the Dialogical Self in psychology (Hermans & Hermans-Konopka, 2010) offers a dialogical approach that understands the self as multiple and even contradictory, and as constructed within relationships and contexts. However, it does not, like postmodernism, see the self as fully determined by societal forces or fragmented. From a dialogical view, a polyphony of voices expresses the multiplicity of the self, i.e. the different positions within the self that engage in conversation with each other. I-positions can be for example I-as-chaplain, I-as-father, I-as-employee, or I-as-friend. These positions reflect societal voices (the external domain of the self, e.g. the chaplain as professional in policy documents), the voices of concrete others (also called the extended domain of the self, e.g. the nurses’ or children’s voices that impact upon the chaplain) and voices belonging to the internal domain (e.g. I-as-modest or I-as-a-change actor); therefore, the self is always a social and relational self. Although inherently multiple, so called “meta positions” in which the chaplain takes a bird’s eye perspective, enables to deal with differences between the I-positions without losing a sense of self, providing a certain “unity” and “continuity” amongst differences and change (Akkerman & Meijer, 2011; Hermans & Hermans-Konopka, 2010). This polyphony of voices implies that there may be conflicts within or between voices and domains. For example, the I-position of “my parents” in the extended domain of self, may not recognize the internal position of I-as-chaplain. This perspective also allows to theorize how professional self-understanding and reconstruction of professional identities take place in interprofessional collaboration. This may take different forms, for example by owning certain I-positions and leaving or disregarding others; by extending the self by allowing new I-positions; and by “othering” or disowning negatively valued I-positions (Hermans & Hermans-Konopka, 2010).

The theory of the Dialogical Self has been applied extensively in the field of teacher professional identity and teacher education (see e.g. Akkerman & Meijer, 2011; Vloet et al., 2012), but not so much in the field of chaplaincy. An exception is a study conducted by Grimell (2022) into the culturally contrasting identities navigated by hospital and military chaplains, which indicates the potential of the Dialogical Self Theory and a narrative analysis for studying professional identity. In the next part, we will outline how we used this theory as an analytical framework.

Methods

A small qualitative case study was conducted into the narrative professional identity constructions of one chaplaincy team working in a large healthcare organization in the Netherlands within a still mainly Christian region. A case study is used to develop an in-depth understanding of a complex phenomenon—i.e. professional identity construction—in its real-life context (Yin, 2017). This approach is different from the single-case study approach used by Fitchett (2011), which aims at developing insight into the goals and practices of chaplaincy based on the narrative about a chaplain-client contact. The main research question of the current case study is: How do chaplains narrate their professional identity in terms of meaning in life and worldview?

Participants

The participants are the five chaplains on the healthcare chaplaincy team (two females, three males, ages 35–65). Their participation in the interviews was requested in a team meeting, where the researchers were present. Two chaplains adhere to a humanist worldview (Jenny and Michael), two to the Protestant religion (Peter and Marc), and one chaplain has a Catholic background, but is practicing without a mission as officeholder (called “unaffiliated” chaplain in this text) (Monica). Up until recently, the chaplains had been working rather isolated in different departments of the healthcare organization, both in long-term care facilities (nursing homes) as well as acute care (hospitals). At the time of interviewing, they have formed a team, under the supervision of the director Long-term Care.

Data collection

The third author, who has some previous experience acquired in interviewing in a research master, conducted in-depth interviews with the chaplains on the team, with supervision from the first and second authors. The interviews took place individually with each chaplain in a quiet room in the health care institute. They are based on a list of topics decided by the research team, including the meaning given to “meaning in life” in the chaplains’ work; chaplains’ own sources of meaning in life; what chaplaincy work entails; the place of chaplaincy within the organization; collaboration within the team and with other caregivers (such as nurses, psychologists, paramedics); and the future of chaplaincy. As the interviewer was rather new to the field of chaplaincy, this helped her to ask (follow-up) questions freely. The interviews lasted between 55 and 75 min approximately. The interviews were audio recorded and fully transcribed, with informed consent from the chaplains. The raw data, transcripts, and analyses were stored on a secured research-disk at the university. Ethical review and approval were waived for this study, as ethics approval for this type of study is not required according to the Medical Research Involving Human Subjects Act (“Wet medisch-wetenschappelijk onderzoek met mensen”) in The Netherlands.

Data analysis

A dialogical analysis was conducted by the first author and checked by the second and third authors to reconstruct the different voices or I-positions in the stories by using the theory of the Dialogical Self (Hermans & Hermans-Konopka, 2010) and the dialogical analysis method proposed by Aveling et al. (2015). This is a method for qualitatively analyzing multivoicedness which includes three steps: (a) identifying the I-positions from which someone speaks; (b) identifying the “inner-others,” by searching for the persons and groups that play—explicitly or implicitly—a part in the dialogue constituting the “self,” such as fellow chaplains, other healthcare workers and managers; (c) identifying the interactions between the different I-positions, both within the internal (I-positions) and extended and external domain (I-Other positions) of the self. In our analysis, we were especially interested in the contradictory or conflicting I-positions and I-Other positions, also called “dialogical knots” (Aveling et al., 2015) toward meaning in life and worldview. These can throw light on how chaplains negotiate their professional identity within a changing healthcare landscape. Because the analysis included only five interviews, no software was used to derive themes from the data.

Results

Several themes were constructed in the analysis regarding the chaplains’ positioning toward meaning in life and worldview. The first set of four themes (“strategies toward meaning in life;” “chaplaincy as sanctuary or integrated profession;” “spiritual and practical care work;” and “chaplaincy as world view or professional work”) refers to the conflicting I-Other positions chaplains experience with their colleagues and other professionals in presenting themselves. The second set of three themes refers to conflicting I-positions in the chaplains’ self (the internal domain) regarding meaning in life and world-viewing (“Religious but being too free and flexible;” “Relating to clients with a different worldview;” “Incorporating and widening religious positions”). The quotes used are originally in Dutch and translated by the author. The participants were given a pseudonym.

Conflicting I-other positions

Strategies toward meaning in life: owning, disowning, and transforming

The first theme has to do with the change toward meaning in life as an integral healthcare task that is taken on by chaplains and other healthcare workers collaboratively. How do the chaplains relate to this?

The humanist and unaffiliated chaplains in the study start to talk with eagerness when raising the question what it means to them. For them, meaning in life is something they relate to in a positive way. They see it as a very basic process in life:

“Meaning in life emerges in daily activities, arranging flowers gives meaning or if someone’s having rice with their meal.” (Monica)

The attractiveness of this concept is its potential to connect different dimensions of life, from the daily to the existential task of leading a meaningful life.

“Personally for me it means that it has to do with how well you get through the day and then how do you get through life well […] the frameworks from which you live; your values and norms; connections.” (Jenny)

This shows that the humanist and unaffiliated chaplains own the concept of meaning in life; they see it as an essential part of their job to support meaning in life on all these dimensions. These chaplains support meaning in life by enabling the other person’s telling of their story which may help them to narratively reconstruct meaning in life. This involves not providing answers to the questions people pose, but to remain present (Jenny & Michael):

“So that question may not be answered for a while. So that you join in the search, deepen your search, and also the recognition that life is not going the way you want it to. […] So that you try to ensure that people can be authentic and be searching, so that in such a conversation you also make space to look at all the fragments of life, the misery, make a kind of overview, and then often something bubbles up again.” (Michael)

Here we see the chaplain as a counselor who supports the other person in their search for meaning, without coming up with their own perspective on meaning in life.

For the Protestant chaplains in the team meaning in life is something they have to relate to as well, but they feel much more negative toward it. We see two strategies. First of all, they disown “meaning in life” by arguing that it stems from philosophy and not from theology; therefore they feel that this concept is disconnected from a person’s relationship to God:

“I don’t even like that term meaning in life, I think. I rolled into this job. Still the core of the story I work with, is that it is about God’s story with the people. That is the core from which I work.” (Peter)

Disowning is a strategy of “othering” in Dialogical Self Theory (Hermans & Hermans-Konopka, 2010); in this case, the concept of meaning in life is regarded as not belonging to their work.

The other strategy these Protestant chaplains employ is to transform “meaning in life” into the experience of meaning and relate this experience to the relationship with God. As a chaplain argues:

“The point is that you experience that you can be here in the way you are now and that that is possible, in my view, is because every person has a relationship with God. With a reality bigger than ourselves. That is the core commitment of my work.” (Peter)

For Peter, meaning in life is always associated with a vertical transcendence, even if that is not the case for the client. By transforming its meaning, this chaplain can incorporate the concept of meaning in life in his work. This also influences the narrative work they conduct with clients in that they relate the clients’ personal stories “to the story of God:”

“So giving meaning has to do with a quest in life, together with others. I tell stories from the Bible about that and I listen to stories. Because stories help me to shape that quest.” (Marc)

The strategy of transformation thus is used in the narrative work as well as in relating to the concept of meaning in life. The client’s personal and existential stories are related to the word of God and by doing this, take on a different meaning compared to how humanist/unaffiliated chaplains work with stories.

Chaplaincy as sanctuary or integrated profession

A second theme relates to the position of the worldview within the profession. The chaplains in the team differ in their view on being/becoming an integrated profession for different reasons. Some feel that the sanctuary role of chaplaincy, meaning that clients can and may express themselves in confidential encounters with chaplains without the chaplains’ obligation to share information within the healthcare organization, should not be abandoned, since it offers a critical space. This seems especially the case for the Protestant chaplains, as one of them tells us:

“We can also critically relate to the organization when they do things to people that they are not justified to do. Everyone can be critical of course, but we have a very free role in this.” (Peter)

The humanist and the unaffiliated chaplains are more ambivalent in how they position themselves. For them, the sanctuary function conflicts with the movement to integrate chaplaincy within healthcare (Michael). They feel it is important that conversations with clients are confidential and that clients feel safe, another aspect of the sanctuary role which stems from religious care (Monica). However, they also feel that it threatens the integration of spiritual care if chaplains do not share information with other disciplines. At the same time, chaplains become increasingly dependent on caregivers for referrals and collaboration, therefore not providing any information will isolate them within the department and disable them from doing their job:

“Ideally, I shouldn’t be allowed to say anything to anyone. That’s how it should be. Then I wouldn’t have the consultation with the care staff. Yet I desperately need the care workers to get access to the people and support them. It is a constant circle of links that you need in providing spiritual care.” (Monica)

Taking a more integrated professional role within the healthcare organization is proposed more by the humanist and unaffiliated chaplains in the team, although they feel ambivalent about the growing dependency on other care staff, such as nurses. This presents a conflict between the chaplain-as-integrated position and the chaplain-as-dependent position within the healthcare organization.

Spiritual and practical care work: the relationship to caregivers

When relating to other health care professions, such as nurses or paramedic practitioners, the chaplains mention the difference between spiritual and practical work. Humanist and unaffiliated chaplains seem to be more engaging with this difference then the Protestant chaplains in the study, maybe because their religious background already makes the difference apparent between them. But all chaplains see caregivers as practical, task and solution oriented; and they regard themselves as professionals who give attention to meaning in life: “Asking an in-depth question is not always possible [for the caregivers]. That’s what I'm here for. And that is also a different profession.” (Michael)

According to the chaplains, spiritual care requires from care workers to listen and hold back their answers, i.e. “not acting.” They wonder whether care workers are able to do this because they are supposed to give active care: “but how then [can they] become silent and be present, withhold oneself?” (Michael) At some points they argue that spiritual care work is difficult for care workers, such as nurses, because they do not have “an antenna for spiritual care” (Peter), but at other points they state that care workers do have the ability to give attention to the clients:

“But I absolutely do not recognize the image that is sometimes painted of uninterested care employees who do not pay attention to the resident, all those specters you sometimes hear about nursing homes. Not really. […]The attention to meaning in life can be raised, but it is certainly present. It’s not even basic, it’s just there.” (Monica)

Nevertheless, all chaplains feel that there is a basic difference in the provision of spiritual care by chaplains and other caregivers, such as nurses, which probably can be seen as a strategy of trying to secure their professional identity. They argue for competence development of caregivers, starting with consciousness raising regarding spiritual issues:

“. a piece of awareness in the care work and that they see that meaning is actually an issue at many moments and that by seeing it they can deal with it more consciously; and that they can also distinguish between what they can do themselves and when, for example, they call in the chaplain.” (Jenny)

We thus see a double movement of requesting spiritual care competencies of caregivers and stressing the differences between the spiritual work conducted by chaplains and the practical work conducted by caregivers. This creates an ambivalent I-Other position: on the one hand, caregivers, such as nurses are highly needed in providing collaborative spiritual care; on the other hand, they are potential threats to the chaplains’ professional identity and position as spiritual caregivers within the organization.

Worldview and professional work

Related to the previous themes, the role of worldview/religion in the work of chaplains turns out to be highly contested. We find strongly conflicting positions between the Protestant chaplains in the study on the one hand and the humanist and unaffiliated chaplains in the study on the other hand. A Protestant chaplain in the team tells us:

“And of course in my work as a Protestant chaplain, even as a minister, it’s another bit that differs from some other chaplains, that I have religious meetings. Church services in which I tell a story from the Bible and then I bring kind of a message.” (Marc)

However, a humanist chaplain strongly opposes “bringing a message” because that is not helpful in tuning in to the client’s life issues and their worldview:

“I think that’s also the big misconception about chaplaincy. Chaplaincy has no mission. A chaplain is not there to propagate humanism - in my case - or to propagate faith in another’s case. That’s not what we’re here for. Our first scope is on the life questions of the residents and that these questions draw from their philosophy of life.” (Jenny)

This humanist chaplain argues that church services or praying should not be done by chaplains; it should be left to the church, possibly facilitated by the chaplains. She strongly disagrees with chaplains who also practice as a minister and do not keep these positions separate.

The chaplains know they hold different positions but the—at some points strongly—conflicting positions regarding worldview/religion are not openly discussed. A Protestant chaplain says:

“If you start to discuss them, at some point you get into an argument. Or you can look where those visions meet and sometimes very large areas turn out to be the same. We only name things from this or that perspective, but it’s actually the same.” (Peter)

Further on in the interview, this chaplain states that he fears the moment that a colleague on the team proposes they should all do the same: “As long as we don’t talk about that, I'm fine with that, but I'm afraid of that conversation.” (Peter) This chaplain does not want to talk about the religious/worldview differences in the team.

However, other chaplains actively try to find some common position for chaplaincy within the healthcare organization, like Marc:

“The beauty of the term chaplaincy is that it applies to all of us. It has been chosen as a collective term. And to me that also indicates that it is the same profession that we practice. So in that we are equal.” (Marc)

Jenny, a humanist chaplain, feels that a shared name is not enough; she is looking for a shared vision and practice: “There has to be a basis that we agree on. A basis about conversation and what role faith or worldview plays in it or not. We do need to have a certain agreement, also in tasks.” (Jenny)

This theme of worldview and professional work expresses the chaplains’ struggles to find a meta-position, which might help to incorporate diversity and multiplicity, and even conflicting I-positions within the self-narrative of chaplaincy.

So far, we have presented some key conflicting and ambivalent positions that are situated between chaplains within the team and between chaplains and other caregivers in the organization. However, our analysis also brought some strong conflicting I-positions within the chaplains which relate to worldview/religion.

Conflicting I-positions regarding worldview/religion

There are three themes that express conflicting positions within the internal domain of chaplains. These all refer to conflicting positions regarding religion or worldview. The themes are summarized in Figure 1 and we will discuss them next.

Figure 1. Conflicting I-positions regarding worldview/religion.

Religious but being too free and flexible

A first conflict is present with the unaffiliated chaplain in the team, who presents herself as Catholic, but also as too free and flexible:

“What I got from that is that I'm Catholic, which gives me a certain foundation. I practice my religion in my own way, because I am too free - not only raised that way, it’s also in my personhood - not to fix myself in a frame.” (Monica)

Being free has its drawbacks: the chaplain cannot lead religious ceremonies. Being Catholic also causes difficulties within a region that is dominated by the Protestant Churches, as well as by the cultural differences in this region where people’s attitude is more direct and rigid. This conflict shows the ambivalent positionings chaplains may experience who have loosened their connection to the church, but still identify themselves as religious.

Relating to clients with a different worldview

Another important area of conflict for the humanist and unaffiliated chaplains in the study is to relate to clients who are religious; and for the Protestant chaplains to relate to non-religious clients. This is a recurring issue in the interviews, however, most chaplains in the team seem to find a way to stay rooted in their worldview but also to connect to the other person. For example, a Protestant chaplain explains that he does not talk about God with secular clients, but “translates” God into “desire for something larger than this life:”

“But if at some point you discover that desire itself has always kept you going, determined your own worth, then you can suddenly look at it very positively. […] I am valuable in my life. That is the creative power of God, God is busy everywhere. In this way I also get along very well with people who do not believe in God.” (Peter)

A humanist chaplain in the team does not pray with her clients, but offers other spaces for practicing one’s religion, e.g. by reading Bible texts and asking what they mean for the person, or by staying present when the client prays. (Jenny). This chaplain tries to soften the inner conflict by finding a compromise between her wish not to pray, and the client’s longing for religious expressions and rituals.

Incorporating and widening religious positions

Conflicting I-positions also become clear in the different ways chaplains present themselves to others, thereby sometimes incorporating “old” religious identities. Depending on the context or the person they meet, they present themselves as spiritual caregiver, as pastor (e.g. with persons with dementia, for whom the title “chaplain” is unknown), or even by their first name. The positions can shift and rejecting religious positions as strategy is alternated with using them to express one’s identity. The unaffiliated chaplain speaks about the double bind she experiences. The chaplain is not comfortable with the association of chaplaincy with religion, because that causes non-religious clients to abstain from contact with “the pastor.” However, clients may also regard the chaplain as the “non-religious one” who cannot counsel religious clients. So although working as an unaffiliated chaplain, to get access to clients this chaplain nevertheless uses the “religious position” sometimes if felt necessary:

“Sometimes, with people with dementia, then I sometimes say: ‘I am the pastor’. But I don’t do that often. In doing so, I do not do justice to who I am, also not to the ministry. But sometimes I do it because it’s easier.” (Monica)

For a Protestant chaplain, the main question is how to affiliate with everyone: religious and non-religious persons:

“So that’s what I tell them; I am a preacher to all denominations and also to those who have no religion. That’s how I often introduce myself to people with dementia.” (Peter)

In presenting their work to healthcare workers, the chaplains also refer to past religious identities, even if they are not religious and even though they know that the current social representation of chaplaincy is a professional one. The following quote shows the hesitancy to use this strategy, possibly because it strengthens the image of chaplaincy as religious while trying to counter it. The unaffiliated chaplain says about this:

“I tell the care workers: ‘you always used to have a minister or Catholic priest in the care home. Now I am here, but not working from the church’. I always try to come up with something to explain myself in not too many words.” (Monica)

This theme shows that chaplains struggle with naming themselves and with having a recognizable profile, without referring to “old images” of religion. Whereas the old representation of chaplaincy as a religious office and sanctuary does not fit anymore, there is no new strong and collective representation yet.

Discussion

In this last part, we will reflect on the meaning of life and the role of worldview/religion within the professional identity of chaplains. Worldview/religion also influences the narrative approach used by chaplains, which we will discuss next. We finally formulate some thoughts for chaplaincy to establish a professional identity in a changing healthcare landscape.

Meaning in life as the key concept in healthcare chaplaincy

Spirituality (“meaning in life”) is increasingly receiving attention in Dutch healthcare. It is related to the increasing secularization and pluralization of Dutch society and other Western societies, and the trend for chaplains to provide spiritual care to all people. A questionnaire study into the professional identity of chaplains conducted in The Netherlands (N = 433) showed that there is some resistance against this change, and that chaplains feel that the core identity of their profession, which is about worldview, is threatened (Glasner et al., 2020, 2023). The current narrative study also shows that this change is not unequivocally embraced; it sheds light on the ways chaplains negotiate their identity by using different strategies. Different positions are taken by humanist and unaffiliated and Protestant chaplains; the latter disowning or transforming the concept of “meaning in life.” This is also in line with the findings by Glasner et al. (2020) who found that the institutionally unaffiliated chaplains attach less value to working from a particular worldview or religion and seem to be more positive toward a “universal” chaplaincy. More debate is needed about this central concept of “meaning in life” and how to approach it as a chaplain to be able to take one’s professional role as a “specialist in meaning in life” amongst other care workers, without losing one’s professional identity.

Dominance of religion

Although Dutch society is increasingly becoming a secular and simultaneously spiritual society, we found that religion is still very much dominating the self-understanding of spiritual care givers, causing conflicting, shifting, and alternating I-positions. These conflicting positions did not only exist between the chaplains in the team (the extended domain of the self, Hermans & Hermans-Konopka, 2010) but also within each chaplain, i.e. the internal domain of the self. However, this did not result in chaplains having a split identity (Zock, 2008), consisting of two separate parts. The stories showed a multiple and hybrid identity in which old and new language and practices go together and are changed in the process of using them. The new social representation of chaplaincy is reconstructed and transformed in practice into a much more complex and multiple positioning. This is similar to the way I-positions are united, sometimes with tension and numerous plotlines, through a personal story of who one is as a chaplain in the study conducted by Grimell (2022). It also reflects the dual professional identity of clinician-scientists in the study conducted by Kluijtmans et al. (2017), in that chaplains can be brokers between healthcare and worldview/religion.

It is remarkable though that also the humanist and unaffiliated chaplains in the study sometimes rely on “old” religious positions to present themselves to clients or caregivers. They also make use of religious rituals, texts, or symbols, such as reading from the Bible or lighting a candle. Their argument for doing this was that they wanted to be recognizable to clients, who grew up in a religiously compartmentalized society. This raises the question of whether the current changes proposed by the government and professional association of chaplaincy are concurrent with older clients’ and caregivers’ positions regarding chaplaincy and how to take these stakeholders’ positions into account in the evolution of chaplaincy. A combination of microanalysis and macroanalyses of the ambiguities chaplains face could contribute to the knowledge in this area (Akkerman & Meijer, 2011).

Narrative approach as shared identity?

All chaplains showed their commitment to make an effort to relate to clients with other worldviews/religions, and they all use a narrative approach in their work. Still, they turned out to do so in different ways, and this difference was not openly discussed within the team. The humanist and unaffiliated chaplains support the exploration of the client’s story, using narrative strategies. The Protestant chaplains relate the clients’ personal stories to God’s story, seemingly without articulating this to non-religious clients. They also tell stories from the Bible, thereby bringing a message to the client. This “missionary” work was strongly objected by the humanist and unaffiliated chaplains, who state that the client’s worldview should be central in the conversation.

This raises questions about the ethics of using one’s own religious (or worldview) frame to listen to stories and narrate stories. The power that is involved in helping relationships, including chaplaincy, so far is an underexposed issue of study, for chaplains of all denominations (De Lange & Jacobs, 2022). By conducting studies into chaplaincy using conversation or interaction analysis, more knowledge can be gained about the co-construction of meaning within chaplaincy relationships, and the role of religion or worldview in this. This kind of research will add to the insight about chaplains’ professional profile, their commonalities, and differences.

Chaplains as brokers

The chaplaincy team showed strong processes of “othering,” which becomes manifest in the disowning of negatively valued positions. Examples are the “practical work” conducted by caregivers, the “missionary” work of the Protestant chaplains, or the integrated position of chaplaincy as health care profession amongst the other professions. Only at some points, a meta position was taken that helped to find commonalities or a joint effort. “Othering” is opposed to boundary crossing (Akkerman & Meijer, 2011) in which “other positions” are incorporated into the self as valuable adaptations. Also, under new circumstances, new I-positions are stimulated and positions that were previously in the background may come to the surface (Ligorio & Tateo, 2007). This leads us to question whether the strong processes of “othering” in this chaplaincy team may point to chaplaincy being in crisis and toward a regressive movement of the self (Hermans & Hermans-Konopka, 2010), as opposed to a progressive development.

However, this case study was about only one chaplaincy team in one healthcare organization, so we need to be cautious in characterizing this team and can certainly not extrapolate these findings to chaplaincy in healthcare in The Netherlands or in other Western countries. In the meantime, the team has worked on their profiling within the organization and started discussing their conflicting positions regarding worldview/religion. The new social representation of chaplaincy offers new possibilities if chaplains develop their ability to be brokers. Brokers do not simply adapt to new policy or practice, nor resist the evolution; they work on boundaries within their teams and organizations. In this way, chaplains could develop a rich, multiple, and socially relevant professional identity. Being able to take a meta-position combined with a context that facilitates this dialogue, will enable this development.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 Chaplaincy is defined by the Dutch Professional Association of Spiritual Caregivers as providing professional counseling, support, and consultancy concerning meaning in life and worldview. https://vgvz.nl/wp-content/uploads/2018/07/Beroepsstandaard-2015.pdf (p. 7).

2 For example by The Netherlands Organization for Health Research and Development. https://www.zonmw.nl/nl/onderzoek-resultaten/kwaliteit-van-zorg/programmas/programma-detail/zingeving-en-geestelijke-verzorging/.