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Interfaith interactions, for most people, proceed from relatively little precedent or practice and are almost always interpersonal ventures fraught with emotional sensitivities, doctrinal complexities, communication pitfalls, and political implications. Nevertheless, health care chaplains regularly find affirmation of the potential for visits with patients and families to be fruitful across lines of spiritual diversity, whether those lines are across differences of broad religious traditions and cultures, differences between denominations, or differences of existential worldviews. Here, interfaith extends to chaplains' care of patients who are without religious affiliation or inclination, including patients whose worldviews are non-theistic. [See the note on the home page.] In all cases, a chaplain seeks to follow a patient's lead and attempts to provide whatever resources--religious or otherwise--that may be appropriate to the patient's values and situation.

In any particular instance, how much can really be accomplished between a chaplain and a patient when there is marked diversity between them? At the outset, that is never known; but the chaplain enters every interfaith encounter with hope, openness, respect, genuine concern, and a desire to connect with others in new and meaningful ways. Such an overall attitude is usually perceived and appreciated by patients, and thus begins a mutual exploration of what may be possible between the two. Interfaith chaplaincy is realistic but perennially optimistic.

 
Following the Lead of the Patient

The dominant model of health care chaplaincy is one of active listening that follows the patient's lead. The chaplain is thereby a resource to the patient's own process of coping with illness or injury and with the attendant questions of religious, spiritual, and existential meaning. This model, developed in light of patient-centered approaches in the field of psychology, holds that people will tend to help themselves in their own productive ways when offered non-directive support. By listening actively, chaplains encourage patients to express feelings and thoughts that are pressing, and pastoral conversation is sometimes characterized as "hearing the patient into voice" about the experience of a crisis and ways of moving through it.

In situations where a patient's capacity to take the lead is inhibited, such as by shock following a trauma or by a critical episode of mental illness, the chaplain may need to be more directive than normal, but always cautiously so, and with the goal of maximizing the opportunity for patient self-empowerment. Also, in cases where patients indicate beliefs that appear to run counter to their physical or mental health and safety, chaplains may work specifically to aid an individual's discernment of whether "risky" decisions and actions are soundly based of their beliefs and value systems or are perhaps the result of other factors like fear or anger or hopelessness that have closed off the full sense of options. Chaplains are routinely involved in the delicate balance of the sacredness of personal beliefs and values and the importance of physical and mental health.

Active listening conveys interest, caring, and relationship; and that experience itself is sufficient to the immediate needs of many patients. However, theologically the act reflects the idea of a compassionate God and implicitly invites theistic patients to engage religious concerns. While chaplains function in an authoritative role as "clergy," they nevertheless should respond to religious issues from a patient-led perspective, negotiating typical clergy-layperson power dynamics and avoiding the interpersonal barriers of traditional religious differences. One aspect of the art of chaplaincy is the challenge of operating out of the role of a professional clergy person in such a manner as to hearten patients to take the lead in the pastoral encounter.

 
A Non-Anxious and Trustworthy Presence

Patients share of themselves deeply with chaplains, often quite quickly, but seldom without some assessment of trustworthiness. Does the chaplain seem nervous, uncomfortable, distant, or judgmental? Does she appear able to hear and understand what the patient wants to communicate? Does he evidence the capacity to handle strong emotions and powerful stories? When patients say, "I guess you've seen it all and heard it all," it is probably out of a longing to normalize something they have found extraordinary and overwhelming: be it a transcendent spiritual experience or a profound personal failing. A chaplain's non-anxious and trustworthy presence establishes the atmosphere in which patients can speak openly and feel heard thoroughly. In the absence of a common religious or cultural basis for clergy-patient interaction, it is the ground upon which an interfaith spiritual care relationship can be built.

 
Limits of the Interfaith Model

While the interfaith model is intentionally inclusive, it does have limits. It may be unacceptable to patients from traditions that discourage religious contact outside of the particular group, or it may just be too unusual a model to feel comfortable. Patients may also desire a specific ritual or action that only certain persons can perform. For these reasons, chaplains develop plans for tradition-specific resources, and the very willingness to bring in clergy from a patient's own tradition is fully part of the interfaith ethic of respect for different traditions, even those with exclusive tenets. In some cases, however, a chaplain may happen to be ordained or authorized by a patient's own religious group, and then the task is to decide whether to shift into that tradition-specific role and to what extent.

 
The Chaplain as a Welcome Stranger

The social and religious differences that can complicate the chaplain-patient relationship, and which the interfaith model attempts to address, can at times also be fortunate for patients, especially as those differences may signify that the chaplain is unconnected to a patient's normal social life. That fact provides some patients with a rare chance to share their thoughts and feelings outside of any perceived constraints of their social networks. While there might be an awkwardness in talking about private issues with a "stranger," there can also be a special sense of freedom and safety in knowing that the chaplain may never be seen again, and that whatever confidential knowledge the chaplain holds will be separated in a very practical way from the patient's world outside of the hospital. It is not unusual for chaplains to hear: "No one else knows this," or "I've never told anyone this before."

The concept of the sacred is based upon the idea of that which is set apart. The bounded circumstance of interfaith hospital chaplaincy -- in which a patient can choose to connect with a spiritual care professional who is otherwise separate from the patient's life -- can bolster the experience of chaplains' visits as "sacred" moments of sharing. The interfaith chaplain can be a most welcome stranger amid the stresses of a health crisis.