Earlier this month, after a tweet reignited a debate about the inequity of unpaid internships, one corner of the internet pointed out that clinical pastoral education, an unpaid internship that often costs tuition, is an overlooked part of the work-for-free problem.
Through CPE, individuals are placed in hospitals, hospice settings, clinics, prisons, and other community settings to train as chaplains under certified supervisors. The experience, which combines practical experience with group reflection, is often completed by students enrolled in seminary and is required by many denominations for ordination.
“What I love about CPE is that it integrates spirituality and theology with the social sciences,” Tahara Akmal, an Association for Clinical Pastoral Education certified educator, told Sojourners. “The way we learn in seminary is we learn the theory about how to care for people through pastoral care classes, bereavement, and classes like that, but then you come into the clinical environment where you’re working with people face-to-face, of different religions and different expressions of spirituality. It’s not about what you believe, it’s about the beliefs or nonbelief of the people you’re caring for.”
Yet, Akmal, who is also a clinical pastoral education manager at MedStar Washington Hospital Center in Washington, D.C., admits that the cost of CPE is high: It can cost students as much as $1,000 in tuition to participate. During that time, students work as many as 40 hours per week, but usually aren’t paid.
For some students, like those with families, who are attending seminary part-time, or who have to bring in income while in school, CPE poses a practical challenge: Gaining the critical experience of CPE often necessitates working for free.
A valued experience
When Deirdre Jonese Austin, a student at Candler School of Theology, researched the CPE units available to her, she was disappointed: Most hospitals or institutions that offer CPE charge $400 to $500 tuition and Candler students are responsible for paying tuition directly to the CPE site. Candler offers summer internship grants for CPE or other chaplaincy experiences, but only to students who, unlike Austin, are pursuing the chaplaincy concentration.
A CPE brochure on Candler’s website reads: “Students are encouraged to plan ahead for these expenses as you prepare for CPE.”
Though Austin has an academic scholarship from Candler and works part-time, she can’t afford to work for a summer without pay, so she’s opted for paid internships, even though completing a CPE internship would be her preference.
“I know and I understand the value of the CPE experience,” Austin told Sojourners. “For me, it’s just a matter of when will I be able to do it? How do I save up the money to do it?”
Letitia M. Campbell, director of contextual education and clinical pastoral education at Candler School of Theology, agrees that this is a problem. Campbell said that she’s not aware of any CPE programs in the greater Atlanta area that provide stipends for students who are completing a CPE internship.
“This is a huge issue,” Campbell told Sojourners. “Many students do need to work in the summer in order to support themselves, to support their families, to pay for their education. That has meant that we’ve seen more students doing CPE during the academic year, or even after graduation.”
Although completing CPE during the year is an option for Austin, she’s concerned about the toll of the clinical work while completing classroom studies.
“I did recently hear from one student who is currently taking it this semester,” Austin wrote to Sojourners in an email. “She did not recommend it as it has proven to be a lot emotionally on top of her other coursework.”
Transformational, but inequitable
Austin isn’t alone. Although Thomas Burke Jr., associate minister for children, youth, and families at Northfield Congregational Church in Weston, Conn., did complete CPE, he told Sojourners his experience with CPE highlighted this inequity.
When Burke was a student at Yale Divinity School, he received disability payments, his housing was provided by a local church, and he received a monthly stipend through a GI bill program. The financial support, Burke said, made all the difference for him as a student when he completed a semester of CPE.
“I was the only person in my CPE class who was at every Thursday didactic meeting,” Burke said, referring to the weekly meeting during which individuals share their experiences in CPE and learn from mentors. “That had a lot to do with people having to be at another job or provide child care, a variety of different issues that I was privileged enough not to experience. Instead, I got to throw myself into the lives of patients: I could buy into a pedagogical program that is designed to be committed to fully. Being able to commit to CPE allowed me to ultimately be a better support to my congregation.”
Like Burke, many seminary alumni reported that CPE becomes possible when expenses such as housing, food, and tuition are subsidized.
Nathan Albert, associate chaplain at the University of Lynchburg, worked 40-hour weeks peppered with 24-hour shifts while he completed his CPE internship at Rush University Medical Center in 2008.
During that time, Albert was financially buoyed by loans, scholarships, and his own savings. When his family visited, they sometimes helped him buy groceries.
“My CPE internship was very transformational,” Albert told Sojourners. “But it’s still inequitable: If you have a family or you have another job, it’s not possible.”
Rev. Wendy Manuel, a board certified hospice chaplain at Grace Hospice in Minneapolis, moved from her seminary in Austin, Texas to Illinois so that she could live with family while completing her CPE internship at Advocate Good Samaritan Hospital.
“I lived with my brother and his family,” Manuel told Sojourners. “I didn’t have to do the grocery shopping. My sister-in-law had dinner done. It really does take that kind of support to be able to do CPE.”
‘Moving the needle’
According to Rev. Dr. Trace Haythorn, executive director/CEO of the ACPE and co-founder of the Chaplaincy Innovation Lab, the ACPE recognizes “there has been an equity issue.” Haythorn told Sojourners, “There’s a broad recognition that the unpaid model is really not a sustainable model.”
Haythorn said he’s seeing more theological schools and CPE programs seek funding for stipends for who wish to complete the program.
But typically the theological schools that are able to subsidize CPE are “the larger research universities or freestanding seminaries that tend to have really deep endowments,” Haythorn said. “It’s the same sort of inequity.” It’s up to each hospital, prison, or clinic that offers CPE to set its tuition and determine whether they can offer any funding to support students who are completing it.
“Because the actual programs and their operationalization lie with the local institutions, we cannot compel organizations to offer what they cannot support,” Haythorn wrote to Sojourners in an email.
For his part, Haythorn said that the pandemic has compelled ACPE to adopt pedagogies that widen access to online learning. For example, some students have had the option to complete their supervision and group process work via Zoom. Others have had the option to complete CPE as an extended unit, which is conducted over two regular units, making it essentially a half-time program.
Haythorn also feels that students should be paid at least minimum wage for their work in CPE.
According to Wendy Cadge professor of sociology and women’s, gender, and sexuality studies at Brandeis University and founder of the Chaplaincy Innovation Lab, “there’s a lot of talk about equity” in the CPE world, but talk isn’t enough.
Cadge, along with her colleagues at Chaplaincy Innovation Lab, is calling on all organizations that offer CPE, as well as ACPE, to create funding models that will allow all students to have equal access to CPE internships.
“I want to see the dollars,” Cadge said. “Any way that we can raise the experiences of people who are looking to get the training but for whom it’s not possible, in a way that tries to get some of these professional organizations to lead by example, would be wonderful.”
She continued, “I want to see the programs that are actually moving the needle on outcomes.”