As part of the ordination process, I was required to enroll in Clinical Pastoral Education or CPE for short.  The main purpose of CPE is to provide clergy an experience of hospital chaplaincy while at the same time equipping them to be more aware of the psychological impact of ministry.  Clinical hours typically take place in a hospital under the supervision of a certified, licensed counselor. 
 
During my program at Duke University Hospital, I was assigned to the Obstetrics & Gynecology floor.  The most uncomfortable aspect of my rotation (of which they were a number)  turned out to be the weekly discharge meetings with the charge nurse and staff.  It was not easy asking questions about hysterectomies to a room full of women.  Not a single nurse friended me during those three months (Zuckerberg had not invented Facebook).
 
During my semester in CPE, the supervisor shared what they considered to be “best practices” for patient rotations.  They instructed us on how to enter a room.  They even gave us specific directions on who to stand next to in the room.  They would ask, “Who do you stand with when you enter a hospital room?  The family or the doctor?”  And then they answered their question.  “You never stand next to the doctor!  You always stand next to the family.  You are there for the family.  If you stand with the doctor, the family will see you as hospital staff, and you will weaken your effectiveness as clergy.”  That’s not verbatim (if you have been in CPE, that’s a pun), but it’s close enough.  It certainly was one way to deal with triangles in a hospital.  At the time, it seemed like a good idea.  I lacked enough experience to question this idea that doctors are suspect and patients are deserving. 
 
The directive to stand with family members came out of the supervisor’s experience and frustration.  I was unaware at the time of not only the triangle between doctor, patient, and clergy but also I was unaware of the interlocking triangles between my supervisor, nurses, doctors, patients, and other trainees.  The supervisor did not elaborate on their problematic past with doctors which is ironic because this is how the CPE program works – recount experiences and feelings.  My hunch is the dislike of doctors came out of experiences in which they were pulled aside by nurses and doctors whenever the staff was trying to get the family to agree on a specific course of action.  In other words, the doctors and nurses would enlist the clergy person to pile on if the family was resistant or being problematic. 
 
Hospitals are anxious institutions.  When families gather under stressful conditions, it can increase chronic levels of anxiety.  Each staff person (doctor, nurse, tech, administrator, social worker, etc.) has a level of functioning that is grounded in their family of origin.  For those at a higher level of functioning (raised in families with higher levels), they can manage and, in most cases, decrease their level of anxiety.  For those at lower levels of functioning (raised in families with lower levels), with a challenged prefrontal cortex to down regulate reactivity, anxiety increases automatically during stressful situations.  All of this is to say that families and patients will vary in their capacity to engage anxious situations.  Some do better than others.
 
The relationship system helps humans balance out the perceived pressures of anxiety.  We do this through the concept of what Dr. Murray Bowen described as the triangle.  When two people are anxious, a third person is typically brought in to relieve the tension.  The third person takes sides which will put one person of the triangle in an outsider position.  Depending on the level of tension between the original twosome, the outsider position is advantages if tension is high.  The insider position is desirable when the tension is low.  The triangle is the way anxiety travels through the relationship system.
 
When a patient’s condition is serious, or if the relationship with the doctor is tense, clergy may be unaware they are in a triangle with the patient (perhaps an interlocking triangle which also includes family members) and the doctor.  There are several factors or variables that can influence the outcome of anxiety traveling through these triangles.  
 
Things that create tension in a hospital room:

• A doctor who is anxious about giving a patient and family members a prognosis and recommended treatment options.
• A nurse who is uncomfortable providing a specific kind of treatment or care.
• A patient or doctor who struggles to relate to the other based on a bias.
• Conflicting ideas among hospital staff or between patient, family, and doctor about next steps.
• A patient who lacks confidence in choosing a course of action or who needs more information.
• The family leader not being available for a decision.
• A recent birth, death, divorce, or life challenge in the family of the doctor, nurse, or patient.

 
The medical insurance companies researched why some doctors were more likely to be sued for malpractice and while others were not.  The research concluded that it was "bedside manners."  Doctors that had good bedside manners did not get sued, even if they made a mistake!  What are bedside manners?  Excellent question.  It's not clear, but there are some vague ideas out there.  I think this research says more about the role of anxiety.  I'd put my money on the fact that doctors who had better self regulation of their anxious reactivity were able to relate better to their patients and the patients can tell the difference. 

If clergy are not thinking triangles, they can easily get caught up in the emotional process between the patient, family, doctor, and nursing staff.  If clergy are not aware of their position in these triangles, they may even perpetuate problems.  A good leader who is thinking systems can turn a reactive, decision-making process into a more reflective and thoughtful effort with better outcomes. 
 
Clergy are at their best when they stand on their own, taking neither the side of the family nor the doctor.  By sides, I’m referring to emotional sides:  either trying to take control of a situation or keeping a distance.  I can always tell how anxious I am when I either try to tell someone what to do or when I stop engaging someone.  By focusing on being more of a self in the hospital room, not taking emotional sides, clergy function better in relationship to both doctor and patient (and family).  It requires an effort to regulate one’s anxiety, thinking clearly, and being available to think with anyone who is willing to engage thinking.  It involves asking good questions.  For example, who has the greatest capacity to think about what is happening and what to do?  Who is the decision maker and what does it look like to make a responsible decision?
 
Inevitably, during a hospital visit, I become aware of how uncomfortable I am.  It may happen in reaction to the behavior of the patient or the doctor.  It may happen in reaction to a decision or the way someone is treated.  If I’m not able to engage my thinking, I can quickly go down the road of blaming others or myself.  In these instances, after a few minutes in the car on the way home, I can sometimes pull up enough self to think about where I see this same situation happening in my family.  Where are the examples of this problem in my own family?  From there I begin the important work of thinking about the family emotional process, how I predictably participate in it, how others predictably participate in it, and what I can do to change my part in the relationship system.  Doing this important work allows me to function at a higher level the next time I enter a hospital room.
 
Over the years, I’ve learned to ask myself these questions before entering a room:

1. What is my purpose for this visit?  What is my goal?  How do I stay the course with my goal?
2. What does it mean to be adaptable and flexible during my visit?  What am I willing to do and what am I not willing to do?

 
When I leave, I often ask myself, what have I learned from this visit about relationship systems?
 
A final word about the word “patient.” Dr. Bowen refused to use this word.  In fact, he saw diagnosis as part of the problem.  When a person in the family is identified as having a problem (the patient with a diagnosis) everyone in the family calms down.  But it is always at the expense of the person who is labeled.  Dr. Bowen saw the diagnosis, not as something in the person but, as something in the whole family as a single unit.  He even went so far as to say that there was a little bit of schizophrenia in all of us.  My use of the word "patient" in this blog post is to identify which person I am talking about in the hospital room.  I suppose I could have used words like “perceived patient,” or “the focus of the family projection process,” but I chose to use patient instead.  In my day to day work, I do not identify people as a patient or problem.  I am less interested in a diagnosis and more interested in the emotional process that leads to someone accepting a diagnosis.

​Let’s be honest.  Nothing is working like it used to.  In the Christian faith, clergy and their supervisors are desperate to get people back into worship.  A little history might be useful.
 
I went to college in the late 80’s, and after discerning a call to ministry, I headed right to seminary.  While I was in school for those seven years, "church" began to look different; reflecting some of the cultural changes that started in the 60’s and 70’s.
 
One example is contemporary worship.  Thanks to the glorious success of places like Willow Creek, baby boomers were flocking to contemporary services.  My training in contemporary worship came, not in seminary, but later while serving a congregation who took up an interest in it.  I have nothing against my formal training.  Most of it was good. 
 
Around the time I graduated seminary, denominational leaders were starting to wake up to the fact that declining membership numbers were not turning around.  The solution was to introduce every four years a new conference-wide program to address the decline.  In fact, I can’t remember at a time in my career that we weren’t trying to address the decline.    
 
As far as I can tell, the response has been rooted in anxiety; a fear based response.  It’s difficult to know what is driving the decline today: shifting cultural dynamics, or an anxious church.  There is a difference.  The former is a problem to be solved.  The latter is a self-fulling prophesy.  Anxiety has a way of making our perceived fears come true. 
 
Our inability to reverse the decline has not been from a lack of trying.  My goodness!  We have tried all kinds of things.  We brought in this consultant, and that consultant, and introduced this program, and that program, and offered this training, and that training.  There was a time when local congregations could make money if they were attracting new members.  If a congregation was having success, they simply organized a conference on site and congregations from all over the world would flock to find out how they did it.  While there are a few places that continue to offer this model of "what works for us", it does not work for everyone else.
 
The problem was implementation.  You can’t take what works in one congregation and transfer it to another.  The ideas and concepts did transfer, but the results did not.  This approach had its roots in the franchise business model.  Not unlike McDonald's where you can set up a franchise anywhere and guaranty customers the same experience and results in every location.  The latest craze is the satellite church model where you try to reproduce what you do in multiple sights.  This works if everyone is being directed by the mother ship.   And, to be fair, while those who lead the training I attended over the years never explicitly said they wanted us to reproduce their success, those who attended did make a go of it.  

The effort to embrace developing business models geared towards consumerism missed the fact that our biggest commodity is relationships.  What every congregation offers is a transformed life rooted in relationships.  In our pursuit of anything that will work, we were blind to the relationship process of human behavior and failed to train our leaders in the developing, scientific research.  We weren't able to see at the time that the content we were trying to implement was being undermined by an emotional process.
 
After completing seminary, I was excited to be ordained and felt ready to lead and develop congregational life.  I began introducing new ideas and worked to foster creativity in the congregation.  It became clear that I was spending more time addressing challenging behavior then I was implementing new ideas.  It was as if there was a connection between my pursuit of implementing change through new ideas and the reactivity I received from certain members of the congregation.  I was clearly missing something, and I needed a framework for thinking about it.
 
I attended a conference back in the mid 90’s that helped me transform my leadership.  The presenter said, “Good leadership rises above the anxiety of the group.”  I’ll never forget it.  I wrote that sentence down and taped it to the dashboard of my car!  That presenter was Rev. Peter Steinke and what he was teaching was a systems model of human behavior.  It had its roots in Bowen Family Systems Theory.
 
Bowen Theory (its shorter title) is a theory of human behavior.  The concepts are based on the family as an emotional unit.  Each person plays their part, but the family operates as a whole.  If you want to understand the behavior of one person, you look at the relationship system.  People like Pete, who studied Dr. Murray Bowen's ideas, began to realize that the same concepts that applied to families applied to other relationship systems, like the church (which is usually made up of families).  Sometimes the problems people are having with family members spill over to their relationships in the church, or the school, or the government, or any other social agency.  Leaders of these institutions become the lightning rod of an anxious, relationship process.
 
I’ve spent almost 20 years researching Bowen Family Systems Theory.  For me, it provides a way to think about congregations.  It just makes sense.  If the church is ever going to be vibrant, it will need to think systems.  Understanding behavior in the context of relationship systems is what leaders will need to do to be successful in their calling.  So, instead of complaining about the state of the church and the decline of mainline congregations, I decided to do something about it.
 
For the past two years, I’ve offered a program called Clergy Consultation Group.    Once a month I teach the basic concepts of Bowen Theory and help participants learn how to apply it to the congregation, and yes, even the family. 
 
This fall I will be offering the program again.  This time, I’m excited to announce that there will be two options: an in-person option and, new this year, an online option.  In both options, the program is offered for 2 ½ hours once a month.  Most of the time is spent with me teaching one of the eight concepts of Bowen Theory.  Each month, one participant will have the opportunity to apply the theory either to their congregation or family. 
 
What can you hope to gain from this program?  The answer comes from Dr. Murray Bowen who developed the theory.  I’ve reworked the word "family" and applied the quote to congregations.  The meaning remains:
 
A congregational leader is someone who has “the courage to define self, who is invested in the welfare of the [congregation] as in self, who is neither angry or dogmatic, whose energy goes to changing self rather than telling others what they should do, who can know and respect the multiple opinions of others, who can modify self in response to the strengths of the group, and who is not influenced by the irresponsible opinions of others. . . [A leader] automatically generates mature leadership qualities in other[s] who are to follow.” Family Evaluation, 342-3
 
To register for the Clergy Consultation Group or to learn more, go to https://www.thecenterforfamilyconsultation.com/programs/clergy-consultation-group/

 
71,450: the number of words I published over the last twelve months.  71,450 words!  I seriously couldn’t believe it.  Henry David Thoreau’s “Walden” had 114,634.  So close, and yet so far away.
 
Now, I know what you are thinking.  John, when do you think you’ll receive your Pulitzer?  If only it were a quantitative exercise!  I’m not aware of any prizes for blog posts.  I checked.  My Google returns included “how to give prizes away using a blog post.”  I have no interest in giving away prizes.  Sorry.
 
I decided to spend this first blog post of a new blog year (that’s not actually an official thing) writing a reflection on what I’ve learned and perhaps what I still need to learn.
 
 
Lesson #1
 
I’ve learned that I’m ready to write a book.  I’ve dreamed of writing a book since I was young.  The problem has always been me.  I was never a solid writer.  And by solid, I mean disciplined.  I’ve learned the importance of being disciplined through a consistent effort and focus.  I’ve learned that self-discipline pays off.  I talk more about this in Lesson #4. 
 
My discipline includes getting up early every morning to write.  And for the most part, I was faithful.  It helped me gain a level of confidence in my ability to brainstorm, write, and edit.  And while I’m still developing and growing, the dream of writing books is, in my mind, a possibility.  Stay tuned to learn more about the book idea.
 
 
Lesson #2
 
If you really want to force yourself to learn something, spend a year writing about it.  I’m clearer in my understanding of Bowen Theory and its application. I was not able to see a year ago the things I see now. For example, I see now that we cannot solve issues in the broader relationship systems of government, communities, and congregations until leaders are willing to work on differentiation of self in their own family.  The finger pointing, name calling, blaming, and the rest of the subjective thinking that people participate in reflects a level of cutoff in the family.  The inability of leaders to sit down at a table and create a compromise rooted in collaboration mirrors the struggles of their own families.  If you can’t sit down with your family (and the extended family) to work out problems, you sure aren’t going to be able to do it in other relationship systems! (See, this last sentence is a good example of why I need to be more disciplined in my writing.)
 
 
Lesson #3
 
I have no idea what makes a blog popular.  #Truth.  I thought it was the number of words.  That didn’t hold up.  I took a blogging class that recommended using catchy titles.  That didn’t seem to work either.  I propose that my most popular blog posts were just clearer and represented my best thinking.  So, here is a list of the ones that were “off the charts” so to speak.
 
Welcome to Thinking Congregations
This was my first blog post (which I reposted last week).  People were excited and interested to see what I was up to.  For the next four months, my readership tanked.  Not a joke.  It was sort of depressing.  But I kept pushing forward.  I’m not going to lie; the words of encouragement were helpful.  Plus, I decided I’d give it a year.  So, I pressed on.
 
How to Decide to Be a Sanctuary Congregation
Congregations are not only divided about becoming a sanctuary congregation, they don’t know how to engage in a conversation about it that isn’t polarizing.  Several of you shared that this post was helpful.
 
6 Things to Consider Before Taking a Stand
This was an attempt to use a creative title (from that one blog class I took), which appeared to work at first.  It was also the first blog post to include a picture of me from a family trip to the Pacific Coast.  For whatever reasons, it was a popular blog.
 
And the most popular post was:
 
Are We Regressing?
I originally published this on November 13, 2016, and it immediately doubled my readership.  People read it and shared it all over the world.  I wrote it just after the election, about the tenor of the country.  It was very popular.  I reposted it later in the year with the same results.  It seemed to connect with all of you in important ways, particularly those of you who think about Bowen Theory and our society.
 
 
Lesson #4
 
What goes into an effort to write a blog?  Writing, like many any other activities, can be an effort for self.  While others may participate in the editing process, the hard work of writing requires self-discipline.  Inherent in this effort is the ability to depend less on the motivation of others, to identify an internal drive, and to manage one’s reaction to the reactivity of others. 
 
First, becoming less motivated by others.  While encouragement is useful at times, it has its limits.  Anyone with children knows that, while initially, it may be fun to motivate a child to do a new activity, it quickly grows old if the parent continually motivates a child to perform routine behaviors.  We may be unaware of how much we depend on the motivation of others or how others rely on our motivation.  Yesterday at the gym I watched a very large father struggle to motivate his very large son to use the gym equipment.  Motivation is best when it comes from within.
 
Second, identifying an internal drive.  I don’t know where it comes from in the brain, this internal driver that gives us the life energy to push forward.  I think our options in life are to focus our attention on others, focus our attention on ourselves, or find a way to do both without impinging either.
 
Third, managing one’s reaction to the reactivity of others.  Whenever one attempts to do an activity that is more about the self, the relationship system always responds.  It’s designed to do this because it is sensitive to the emotional attention it receives from others.  If you redirect your emotional attention away from the family and towards the self, the family takes notice and will often disapprove in the form of interruptions, being needier, drawing attention, etc.
 
 
One Final Note
 
It took me several years to get to a place of consistently writing every day.  This from a person who was always last minute in writing that college paper, or seminary thesis, or that monthly church newsletter article from the pastor!  I was always motivated by the negative implications of being late.  But this blog is different.  What changed?
 
I changed.  It’s taken time, but I’ve changed.  It was a slow process that went something like this:

• It began with the realization (thanks to Bowen Theory) that all families function as an emotional unit with each person playing a part.
• Anxiety is real, not inside a person’s head, but in between people and the ways they relate to each another.  The summation of the interactions in a given family is the emotional process.
• People, in general, have limited awareness that most of our behavior is driven by reactivity to anxiety, and the way anxiety is played out in the behavior of others.
• I began to see how this was playing out in the family.
• At first, I could only see how others were participating in it.  I was not able to see my part.
• I began to research my family history, with an effort to understand the emotional process that has been passed down from generation to generation.
• Over time I discovered that the way I function is rooted in the automatic behaviors that were passed down from one generation to the next.  I saw patterns.
• I began to see my part in the patterns of the family emotional process.
• I started to take responsibility for my behavior.  Disrupting my automatic tendencies.  Pushing forward with efforts rooted in differentiation.
• I started to think about life principles, core values, beliefs, and goals.
• I worked to stay focused on my life principles, core values, beliefs, and goals while at the same time staying connected to the family.  I worked not to let my effort disrupt my relationship with others and not to let my relationship with others disrupt my life direction.
• I continue to discover as much of this as I can in every aspect of my life. 

 
It has been a seventeen-year journey resulting last year in the creation of Thinking Congregations.  There is still so much to learn and discover about myself, my family, the human as a species, natural systems, and faith.  I now see clearly the challenges that are inherent in this endeavor.  But I also see the enormous possibilities.  There is so much exciting territory that is yet to be explored and discovered!  For those who are willing to pick up this effort, you will not be disappointed!