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Experiences and utilization of member care in an international missionary sample.

Soldiers who return from the frontline are expected to "report that the battle was terrible, that they were anxious [and] discouraged" (Koteskey, n.d., para. 9). Missionaries, however, may not feel the freedom to even acknowledge the nature of the battles they face, let alone how defeated they may feel at times. Yet many face not only spiritual battles, but also physical battles with illness or living conditions, and relational battles, both within teams, mission agencies and with nationals. In addition, many young people today come with "baggage" such as past drug problems or childhood abuse (Richardson, 2007). They often welcome a recognition of problems and the need for grace (Lundy, 2007). With mission teams more frequently being multicultural, as Cerny II and Smith (2002, p. 490) and Roembke (2002, p. 253) claim, it is imperative for member care workers to be aware of the needs of missionaries who come from different cultural backgrounds. Asian missionaries, for instance, often experience stress due to the expectation to financially support their parents or to submit to an arranged marriage (Lim, 2002; Wiarda, 2002). Teams and team leaders may be able to alleviate this by acting as family and parents to these missionaries, even to the extent of helping a single missionary find a mate (Lim, 2002). With African missionaries it may be important to especially consider the needs of children and women, in particular widows, as they are traditionally overlooked in African society (Famonure, 2002). In addition, other stressors, such as, increased exposure to violent trauma (Bagley, 2003), leadership issues (Hay, Lim, Blocher, Ketelaar, & Hay, 2007), marriage and family problems, team dynamics (O'Donnell, 1995), and burnout (Carter, 1999; McKaughan, 2002) provide ample reasons to make member care readily available.

The rate of missionary attrition has been used as a measure of member care efforts (Hay, 2004; Hay et al., 2007). While such attrition has been shown to be an ongoing issue (Taylor, 1997, 2002) there has been an encouraging reduction in attrition, particularly for "Newer Sending Countries" (NSC), such as Nigeria, Brazil, and Korea (Hay, 2004; Hay et al., 2007). Blocher reports that while "OSC [Old Sending Countries] agencies invest 7% of their total staff time (in the home office and on the field) in member care, ... NSC agencies dedicate double the amount of staff time to member care (14.4%)" (Hay et al., 2007, p. 183). He points out that this "recognises the relational structure in the majority world" (p. 183). Therefore, at least for NSCs, the increased time devoted to member care efforts seem to be paying some dividends.

However, attrition alone does not tell the whole story. For example, a survey given to 55 Protestant missionaries serving in East Africa showed that the respondents "were only slightly satisfied with the member care services they received and expressed wide variability in their experiences" (Rosik, Richards, & Fannon, 2005, p. 36).

It is not clear from the current literature, however, exactly which aspects or models of member care missionaries find helpful, and which need ongoing attention. Therefore the answers and experiences shared by the missionaries who responded to the survey that forms the basis for this article can help provide valuable insights. Much information was gained, much more than can be shared in one article. Nevertheless, more research is needed concerning various aspects of member care in order to help mission leaders and mental health practitioners develop strategies to meet the mental health needs in missions (Hunter, 2002), particularly for culturally diverse teams (Cerny II & Smith, 2002; Eriksson, 2012; Roembke, 2000, 2002).

Sources and Models of Member Care

O'Donnell (2002) defines member care as "the ongoing investment of resources by mission agencies, churches, and other mission organizations for the nurture and development of missionary personnel" (p. 4). He goes on to specify that "it focuses on everyone in missions (missionaries, support staff, children, and families) and does so over the course of the missionary life cycle, from recruitment through retirement" (p. 4). Koteskey (n.d.) further suggests the following words to describe the concept of member care: "friendship, encouragement, affirmation, help, and fellowship as well as sharing, communicating, visiting, guiding, comforting, counseling and debriefing" (para. 2).

We also see member care as encompassing activities such as counseling, crisis care, conflict resolution, and debriefing, but also preventive care in the form of, for example, personnel development and mutual care. All of these aspects are addressed to some extent in this study.

Member care can be said to come from two basic sources, informal (friends and colleagues) and formal (any person available for the purpose of providing member care). These services, in turn, can be combined into different "models" of member care, as shown in the diagram developed by the first author in Figure 1 as a way to summarize categories that appear in the literature. Various other models of member care have been presented in recent years (for example, Hoffman, 2012; Lindquist, 2008; Gamble, 2002). Pollock and O'Donnell's newly revised model (O'Donnell, 2002, 2011) is referred to frequently and is arguably one of the most influential and comprehensive models.

Informal sources of member care include the sense of community and the mutual care expressed within a group of missionaries on the field (O'Donnell, 2002), here called "colleague (in-house)." Mutual care may also take place informally through external friendships with, for instance, individuals from other agencies, or nationals outside of the missionary community.

The same informal care may take place in the home nation through a colleague with similar experiences and a listening ear, here also called "colleague (in-house)," or through a friend unrelated to both the agency and missionary work in general. If the technology is readily available this care may take place online and, as Dao (2011) points out, the communication may be very frequent, possibly having both a positive and negative impact. In short, informal care is basically "built in" to the missionary's regular interactions, to a more or less satisfying extent. It is any support, or care, that is not formally labeled as such.

Formal care, on the other hand, is intentional and uses terms such as, "care," "support" or "development." It may be offered by the sending agency, or may at times be sought by a missionary independent of the agency. Sometimes this occurs because the agency does not offer the services needed, or the missionary may have other reasons to seek help elsewhere. Rosik (1993) found that missionaries who had faced major problems on the field often preferred counselors not affiliated with their agency.

When organized by the agency there are two basic formal approaches, in-house or external (see Figure 1; Steere, 2002). If offered on the field, the care may be provided by a member care worker/mental health professional who either lives in the region and may be available on a more ongoing basis, or may be visiting from abroad for a limited time (Cerny II & Smith, 1995, 2002; Powell, 2002).

Increasingly, formal care is also offered online, through self-help resources made available on websites such as MemCare by Radio (http://membercareradio.com), Koteskey's Missionary Care (http://www.missionarycare.com), and International Training Partners (http://www.relationshipskills.com), or via email or real-time services such as skype. rosik and Brown (2001) and Brent Lindquist (personal communication: August 11, 2009) warn against legal and ethical issues that may arise when providing services via the Internet. Many care providers thus prefer to limit this kind of care to individuals they previously have met with in person (personal communication: e.g., R. Brennan, July 12, 2009; J. Certalic, July 17, 2009; D. S. Smith, July 18, 2009). Mental health organizations in the United States, such as The National Board for Certified Counselors, strive to keep abreast with ethical guidelines for distance counseling (National Board for Certified Counselors [NBCC], 2012). They recognize that the "use of technology by counselors continues to evolve" and that "counseling through distance means presents unique ethical dilemmas to professional counselors" (The National Certified Counselor, 2013, p. 6).

Current Study

The current study focused primarily on the pastoral and counseling aspects of member care, both in the form of sender care and specialist care as defined in O'Donnell (2002, 2011) and Pollock's member care model. However, the study also included what O'Donnell calls mutual care, as well as specialist/special care in the form of training, retreats, and career counseling. The sample consisted of both single and married missionaries of varying ages and from different cultural backgrounds. Of interest were what services they have utilized, how they perceived both the formal and informal care they received, and what features of this care they perceived as most important. The main objective was to help build a more solid foundation for the development of member care to serve missionaries from a variety of ethnic backgrounds by listening to the experiences of those currently serving on the field.

Participants were self-selected through enlisting the help of their sending organizations. A list was compiled of those recorded as having 500 or more missionaries in the Mission Handbook (Welliver & Northcutt, 2004). Nine other, equally large organizations were added (1), after which agencies with fewer than 50 non-North American missionaries were eliminated from the list. The agencies were thereafter selected at random, and contacted in turn until four agencies had agreed to participate.

The primary researcher asked the contact person from each participating agency to send out an invitation to their missionaries to complete the survey. Each contact person was given the opportunity to adapt the invitation as they saw fit. With the invitation was included a link to the online version of the survey as well as the option to request an email with the Microsoft Word version attached.

The survey used was a modification of the one constructed and used by Rosik et al. (2005) in "Member care experiences and needs: Findings from a study of East African missionaries." Care was taken to request the same demographic information, with the same wording and categories, as Rosik et al. (2005) had, except where they suggested an adjustment or where the online survey format imposed limitations, so that comparisons between the current study and Rosik's study could be more easily made. in the introductory paragraphs of the survey used in the current study, member care was therefore defined in the same way as in Rosik et al.'s survey, that is, "the provision of pastoral and psychological resources to missionaries and their organizations through such avenues as consultation, workshops, counseling, and research."

The survey consisted of a demographics section, five Likert-type questions with sub-categories, an open-ended question regarding the quality of care, and an opportunity to provide any additional comments. it was made available online via http://FreeOnlineSurveys.com in either a regular version or in a version using secure language according to the wishes of each agency. The option was also given for requesting a Microsoft Word version (regular or secure language) sent as an attachment directly from the researcher. Fourteen individuals took advantage of this offer. All versions of the survey are available upon request from the first author.

The completed surveys were analyzed according to the frequency of responses to the various demographic and Likert-type questions. Frequencies of different levels of ratings on the Likert-type questions were noted. Topics that occurred several times in the open questions, in support of or in disagreement with the responses on the Likert-type questions, were also taken into account.

Results

The results are presented by first providing an overview of the demographics of the sample. The findings from the Likert-type questions are then provided, beginning with the value given to both informal and formal member care, and followed by the frequency of use, the level of satisfaction, and ending with the importance these missionaries place on different features of member care.

Demographics

Four inter- or nondenominational mission agencies participated in this study with a total number of 364 missionaries, serving in a wide range of roles, responding to the survey. The data was collected between October 2009 and August 2010.

A little over 62% (n = 227) of participants were women and 36.5% (n = 133) male. Four participants (1.1%) did not give their gender. The majority was between 30 and 49 years of age (n = 211; 58%). Almost a fourth (n = 85; 24%) were 50-59 years of age, 8% (n = 29) 60-69, 10% (n = 36) 18-29, and 0.5% (n = 2) were 70 years of age, or older. The mode for years of affiliation with their mission agency was 3-6 years (n = 94; 25.8%).

Most of the missionaries reported being married (n = 227; 62.4%), 31.9% (n = 116) had never been married, 4.1% (n = 15) were divorced or separated, while 0.8% (n = 3) were widowed. A majority (n = 215; 59.1%) stated that they have children. Of these 63.3% (n = 136) have 2 or 3 children and 17.2% (n = 37) have 4 children.

When inquiring about ethnicity almost 85% (n = 309) identified themselves as "white." (This term was used due to the suspicion by Rosik et al. [2005] that some in their international sample were not familiar with the term Caucasian.) Close to 7% (n = 25) were of an Asian ethnicity, 3 of the missionaries (0.8%) called themselves black, 1 (0.3%) Hispanic and 18 (4.9%) identified themselves as "other." The nationality of the missionaries was divided by continent or region. The majority reported carrying a North American passport (n = 224; 61.5%). There were 45 (12.4%) Europeans, 39 (10.7%) Asians, 25 (6.9%) from Australia/New Zealand and the Pacific islands, while 17 (4.7%) came from Africa, and 6 (1.6%) from South America. Eight missionaries (2.2%) declined to answer the questions of ethnicity and nationality.

About one third of the participants (n = 126; 34.6%) took the opportunity to expound on their cultural identity. These answers included, "Having lived overseas many years--I don't [completely] identify with people at home or the people I serve" and "I consider myself a Third Culture Adult."

In contrast to Rosik et al.'s (2005) study, which focused on missionaries serving in East Africa, these participants serve in many different regions. The largest group gave their location of service as "urban Asia" (n = 106; 29.1%). Twenty-five missionaries (6.9%) gave their location as rural Asia. in Africa 43 individuals (11.8% of N) work in an urban setting and 21 (5.8% of N) in the countryside. Close to 15% serve in Europe (n = 29, urban; n = 25, rural), 7.4% in South America (n = 21, urban; n = 6, rural), 6.6% in Australia/New Zealand and the Pacific Islands (n = 17, urban; n = 7, rural), 4.9% in North America (n = 12, urban; n = 6, rural), while 44 missionaries (12.1%) gave their location of service as "other."

The Value Given to Informal and Formal Care

As explained above, member care service providers were categorized into informal and formal care. The questions pertaining to the member care providers (Table 1), the services offered (Table 2), and the features of these services (Table 3), were all measured on a Likert-type scale. The scale ranged from 1 to 6 to avoid supplying the participants with the option of giving an undecided answer. Tables 1 and 2 are further divided between services and care received while on the mission field or while visiting home.

Informal. Table 1 shows that the informal care provided by a colleague, on the field (n = 299, 82.1% of N) and while visiting home (n = 152, 41.8% of N), other local friend on the field (n = 228, 62.6% of N), and friend while visiting home, n = 260, 71.4% of N), was utilized by more missionaries than the formal services were. (The exception was in the home nation where colleagues were consulted less frequently than were pastoral workers or pastors [n = 190, 52.2% of N]) We will call these most utilized service providers "category 1," (as seen in the right hand column in Table 1).

Almost 73% (f = 217) of those who sought help from a colleague on the field gave them a high rating, and 75% (f = 195) gave a high rating to the help received through a friend while visiting home. Only between 1.9% (f = 5) and 8.5% (f = 13) gave their friend or colleague a less than satisfied rating (1 or 2). This seems to indicate a higher satisfaction than with any of the formal service providers.

Formal care. Table 1 shows that the three most used formal providers were pastoral worker/pastor from my sending church, while visiting home (n = 190, 52.2% of N), missions committee member from my sending church, while visiting home (n = 140, 37.9% of N) and member care provider from my organization, visiting from abroad, utilized while on the mission field (n = 138, 38.5% of N). These service providers, who are either from within the organization, or from the home church, we will call "category 2." Table 1 shows which other service providers also are included in this category. The category 2 providers are all utilized less than the informal providers of category 1.

Least utilized are the member care providers that are external to the organization. These, who often are mental health professionals, we will call "category 3."

In summary then, category 1 comprises informal care from colleagues and friends, category 2 formal care from member care workers from within the organization or pastoral workers from the missionary's sending church, and category 3 consists of formal care from mental health professionals and other member care providers from outside of the organization.

The formal service providers from category 2 that received the largest percentage of high ratings (5 or 6) were pastoral workers (63.9% of n, f = 69) and mission committee members (59.4% of n, f = 54) visiting the missionary on the field, as well as internal member care providers, both those resident in the region (57.0% of n, f = 69) and those in the home nation (57.0% of n, f = 73). Of these, the internal member care provider resident in the region received the overall best satisfaction score--a rating of 4, or above, given by 79.3% of those who utilized this service.

Those from category 3 that received the largest percentage of high ratings (5 or 6) were external member care provider independent from my organization, employed while visiting home (66.7% of n, f = 62), external member care provider from member care center in the region, unrelated to my organization, made use of while on the mission field (64.7% of n, f = 55), and external member care provider made available by the organization, whose help was received while visiting home (64.3% of n, f = 36).

Interestingly enough, there appears to be a dichotomy among category 3 providers in how the help was perceived that was offered by external member care providers who were made available by the organization. Of the three kinds of external member care providers made available by the organization, all received high ratings while they also received the largest percentages of low ratings (19.6% of n, f = 11; 18.8% of n, f = 12; and 16.8% of n, f = 14, respectively).

Both informal and formal service providers were accessed online. Almost 24 percent of the participants (n = 87, 23.9% of N) had utilized help online while on the mission field, from member care websites, friends, family, missions committee members, member care workers, mental health professionals, and others. Close to three quarters of these (n = 63, 72.4%) gave these providers a high rating (5 or 6). Only 93 percent (n = 34) connected with these providers while visiting home.

Frequency of Use and Level of Satisfaction With Various Services

Table 2 shows that all member care services were used by more missionaries on the mission field than while they were visiting home. Retreats (n = 182, 50.0%), help with conflict resolution/relational issues (n = 151, 41.5%), and personal counseling (n = 138, 37.9%) were most frequently utilized. Also commonly employed were training (n = 131, 36.0%) and debriefing after crisis/trauma (n = 116, 31.9%). When visiting home the largest number of missionaries who had sought help had received personal counseling (n = 113, 31.0%).

The service that most missionaries were satisfied or very satisfied with (a rating of 5 or 6) was personal counseling, both when received on the field (68.2% of n, f = 94) and at home (76.1% of n, f = 86). Retreats were also highly valued, slightly more so on the field (63.8% of n, f = 116) than in the home nation (62.7% of n, f = 57). Training, on the other hand, received a larger percentage of high ratings when taken in the home nation (64.4% of n, f = 29) than when taken on the field (61.8% of n, f = 81), though only about a third as many missionaries had utilized this service while visiting home (n = 45) as compared to on the field (n = 131).

Debriefing after crisis/trauma and conflict resolution/relational issues were two frequently used services on the field (n = 116, 31.9% of N and n = 151, 41.5% of N). For this very reason it seems important to point out that there appears to be a dichotomy in how these services were perceived. Conflict resolution/relational issues received the second highest percentage of low satisfaction ratings (23.8% of n, f = 36) while debriefing after crisis/trauma was given a low rating of 1 or 2 by 20 individuals (17.3% of n). The percentage of high satisfaction ratings (5 or 6) given to these services when provided on the field were on the low end (55.2% of n, f = 64 for debriefing after crisis/trauma), while conflict resolution/relational issues received the lowest percentage of high ratings of all the services on the field (49.0% of n, f = 74). In the home nation only career counseling received a lower percentage of high satisfaction ratings than conflict resolution/relational issues (45.7% of n, f = 16 and 47.4% of n, f = 27). The apparent dichotomy may be seen also in that debriefing after crisis/trauma when received in the home nation was given a rating of 5 or 6 by 64.2% (f = 52) of those who used this service. Only personal counseling and training superseded this level of high ratings.

Features of the (Provided) Care

As seen in Table 3, I felt heard was the most valued feature of member care. Almost 83% (82.8% of n, f = 255) of those who answered this question (n = 308, 84.6% of N) rated it 5 or 6 on the 6-level Likert-type scale. The second most valued feature was competence of the member care worker rated above average (5 or 6) by 232 missionaries (81.4% of n). These were followed by confidentiality (75.5% of n, f = 215), prayer (75.3% of n, f = 225), and I felt strengthened in my spiritual life (73.2% of n, f = 208) in close order. The feature that the lowest number of missionaries placed value on (a rating of 5 or 6) was I felt empowered (54.3% of n, f = 141).

Discussion

Category 1--The Pros and Cons of Informal Service Providers

The responses from the participants of this study indicate that most missionaries faced with an issue first tend to seek help from a friend or a colleague (category 1, an informal source) before going to a member care worker or mental health professional (category 2 or 3, formal sources). The informal sources of care are overall also more appreciated by the missionaries.

This confirms O'Donnell's (1995) findings from an international sample of frontier personnel working with Youth With A Mission in India, and should not be surprising. informal sources, particularly friends and colleagues who are close at hand, often live under similar circumstances, are more readily available than formal service providers, and a basic level of trust is already established. One missionary wrote, "Most of the help and [encouragement] I have received has been on the field through colleagues, both national and expats," and another wrote, "Local friends I made helped me through tough times." Also in the humanitarian sector the value of peer support and its "potential for preventing chronic and acute post-crisis distress" (Porter & Emmens, 2009, p. 32) has become more recognized in recent years.

However, these informal member care sources have limitations. As one participant points out, "when a crisis does occur [missionaries on the field] often do not have the knowledge or experience to deal with the situation." Use of friends and colleagues in an informal way may in effect work as a "filter," helping to sort out minor issues before they escalate. When these category 1 sources no longer prove helpful, more formal means of care may be sought out in categories 2 and 3.

Categories 2 and 3--The Pros and Cons of Formal Service Providers

In a member care model organized by the agency the in-house member care worker (category 2) is available to assist with issues for which the friends and colleagues of category 1 are either not able or are not asked to help. Or, if no in-house care is provided by the agency, the missionary may be referred to an external service provider (category 3). These in-house category 2 providers may or may not be trained mental health professionals. They serve as a resource to the missionary and the organization in dealing with issues which are too complicated or delicate for peers to be able to help. intervention at this level can also prevent situations from becoming so serious that external mental health professionals (category 3) need to be called in for longer-term care, or to help determine when external help might be the best route to take. When ministering on the field the in-house providers were the most frequently utilized of the formal service providers. Those in-house providers who are resident in the region also received the highest frequency of above average ratings of all category 2 providers. One missionary wrote, "I was able to get excellent support from the on field counseling group that helped me grow and thrive on the field."

Several of the participating missionaries expressed a preference for formal care to involve assistance from people with missionary backgrounds who are familiar with their living conditions and the culture of the host nation. One missionary wrote, "in my experience it is difficult (though not impossible) for people who have not lived on the mission field to give good counsel to those in the midst of it." This also speaks to the benefit of regional member care workers, whether they are in-house (category 2) or outsourced (category 3). Both types of regional providers meet these missionaries' desires for familiarity with the local culture while being distant enough from the situation to allow for greater objectivity than a nearby colleague might be able to offer. The in-house regional providers (category 2) have the added advantage of understanding the organization, although this benefit may be offset by some loss of objectivity.

Disappointments with in-house workers were also expressed. For instance, some respondents expressed a feeling of being "member cared" rather than there being a genuine concern, not feeling heard, a lack of follow-up, a lack of confidentiality, and a tendency to take sides with those in positions of authority. Allegations/assertions such as these are very unfortunate, but also a great opportunity to evaluate current in-house care. Adequate training, equipping, and supervision of member care workers is of the essence so that they can fulfill their call to serve the missionaries and the organization in the best possible way, and hear responses such as this one: "it was great to meet and talk over our transition time--very valuable. Our member care person is a trained counselor and an experienced missionary."

The informal and formal member care providers of categories 1 and 2 potentially help prevent the need to employ a category 3 provider, that is, an external mental health professional, or longer-term therapy. One missionary comments, "For almost 30 years my husband and I have trusted leadership over us and [benefited] greatly from mentors, but it seems like when an actual 'big' issue arises which you need help with, only the professional counselors have been helpful," and another, "Many of [our agency's] counselors know us too well and we were uncomfortable with sharing our lives with them." These comments confirm the previously mentioned conclusions made by Rosik (1993) that when missionaries encountered major problems on the field they often preferred counselors unassociated with their agency.

It seems natural and appropriate that the external member care providers of category 3 were least often utilized. The friends and colleagues of category 1 and the formal providers of category 2 helped to filter out issues before they had a chance to escalate.

External providers independent from the agency, i.e., those from a regional member care center on the field and those employed in the home nation (category 3), received the largest percentage of high scores (5 or 6) of all the formal providers (categories 2 and 3; 64.7% of n and 66.7% of n, respectively). However, as mentioned earlier, the category 3 external providers in general, especially those made available by the organization, also received more low ratings than did the internal member care providers (category 2). in other words, missionaries either perceived formal care that was external to their mission organizations (category 3) as extremely satisfactory compared to other types of formal care (category 2), or extremely unsatisfactory. Perhaps the dissatisfaction was related to a lack in some of the other features that missionaries found helpful. For example, the official qualifications of the provider were found by several missionaries to be less important than their experience. Other participants emphasized the significance of the care provider having spent years on the mission field, and of having walked through similar issues. if these features were lacking it is possible that missionaries could be dissatisfied with the external care they had received. specific reasons for dissatisfaction would merit further investigation so that good matches can be made between missionaries and such external providers.

Features of Member Care and Degree of Satisfaction With Member Care Services

The ranking of conflict resolution as the second most utilized member care service on the field confirms the findings of Johnson and Penner (1988), and Carter (1999) and McKaughan (2002) that various relational issues are some of the most common problems facing missionaries. Yet less than 50 percent found this service helpful or very helpful (5 or 6) and almost 24 percent found it less than helpful or not helpful (1 or 2). A discrepancy was also found with debriefing after crisis/trauma where 31 (26.7%) out of 116 missionaries gave it a rating of 3, or below. This confirms the disparity in satisfaction with debriefing after trauma found by Rosik et al. (2005) in their survey of missionaries in East Africa. it would be helpful to further investigate why there is not a greater level of satisfaction with such services, particularly as they are frequently offered and utilized, so that adjustments potentially can be made to improve these resources.

A fairly large percentage of the missionaries also found several of the other services unhelpful, such as, psychiatric medication, career counseling, child received counseling, and marriage counseling. Even though some of them were used by as few as 22 missionaries the ratings appear to show a relatively wide range of satisfaction with these services.

The member care service feature that most missionaries (84.6% of N) found important was I felt heard. it was also this feature that received the largest percentage of high ratings (82.8% of n rated it 5 or 6). A mutual benefit can be drawn from this as Hay (2004, October) asserts that "each [member] needs to be heard for the good of the organization" (p. 5).

Implications

Providers. The informal providers of category 1--friends and colleagues--in effect intercept many issues making it unnecessary for missionaries to pursue further help. When more help is needed the formal member care providers of category 2--usually in-house and with various levels of training--help resolve a wide range of situations before they otherwise might have required the assistance of external mental health professionals (category 3).

The individuals in each of these categories have an important role to play in caring for the missionary in need. The findings from this study show that more training for individuals of all categories would likely benefit the missionary force, and help prevent minor issues from escalating and possibly lead to premature attrition. such training might do well to focus on the areas found most important by these missionaries, for instance, basic listening skills, confidentiality, and appropriate application of prayer.

Various trainings, such as, "Sharpening Your interpersonal skills" (sYis; Williams, 2002), are available worldwide to missionaries in both categories 1 and 2, and are also utilized by many (http://relationshipskills.com/aboutitp.html). For the member care providers in category 2 any need for advanced training should be evaluated, especially concerning those services that received many low ratings, such as, debriefing, conflict resolution, and career counseling. Those features of care where missionaries expressed having had bad experiences with member care workers would be important to pay serious attention to, and the need for personal growth and training evaluated. These areas include a lack of genuine concern, lack of follow-up, and lack of confidentiality, as well as a sense of not feeling heard, and a tendency to take sides with those in positions of authority. churches would also likely enhance their ability to meet the felt needs of their missionaries by utilizing training opportunities and promoting personal growth in the above mentioned areas. For the mental health professional in category 3 specialized training in the same areas would likely be profitable, but personal long-term experience from the mission field is even more sought after. This confirms the assessment made already in the 80's by psychologists working with missionary care, "that the more time one could spend overseas, the better equipped he or she would be for work in mental health and missions" (O'Donnell, 1988, p. 123).

On all levels of care it would thus seem most advantageous to focus the equipping on those individuals who already have extensive experience on the mission field and who have successfully walked through many of their own issues. One person expressed their felt need thus, "I think it is less important that one is a 'professional' counselor and more important that it is someone who has been where I have been and walked many of the same steps that I have walked."

Considering the apparent increasing frequency of multicultural teams it would be all the more valuable for the member care provider to have extensive cross-cultural experience. Member care addressing unique challenges and relevant to missionaries from newer sending nations is needed, as highlighted by voices from different parts of the world in O'Donnell's Global Member Care (2011). All levels of care providers could benefit from training in culture-specific issues, for instance, how conflict is dealt with in different parts of the world.

In a very helpful book chapter, Gardner and Gardner (1992) list personal characteristics they would like to see in member care providers as well as experiences and preparation they recommend for these providers. They also offer tips to mental health professionals for how to operate within a missions setting. Even though over 20 years have passed, most of their advice is still valid.

Services. Due to the high disparity in satisfaction with both debriefing and conflict resolution it is important to further develop how these subjects are taught, and how those in need of this help can best be served. it could further be of great value for agencies and course facilitators to elicit feedback from current and past participants in these courses in order to learn how to improve this training and/or how to best implement the service.

It is important to also evaluate how to improve other services that received a larger number of low ratings, such as, career counseling, family counseling, and counseling of a child. As mentioned earlier, a good fit between counselor and missionary may be essential.

Limitations

Even though the sample was larger than those of many other member care related studies (e.g., Bagley, 2003; Rosik et al., 2005) the fact that about 85% were caucasian and most of these were north Americans limited the possibility of detecting any significant relationships between cultural background and utilization and experiences of member care. The fact that the survey was distributed primarily through north American offices of each agency, as well as only being available in English likely contributed to this.

The question pertaining to the quality of the received services appears to have been misread by some. These participants included qualities they would have appreciated but did not necessarily experience. Thus the responses can only be taken as a tentative indication of which qualities were missing.

A couple of questions that would have been helpful to ask were what issue(s) the missionaries had faced that had led them to seek the particular service they rated, and when (or within what time frame) they had utilized the particular service(s). This would have given an indication of the severity of the issue(s) as well as how frequently these missionaries employ member care services.

Suggestions for Further Research

A multilingual and multicultural team of researchers using multiple language versions of a similar survey could achieve what this study did not. They might, for instance, explore why Caucasians, although they by far dominated the sample, represent the smallest percentage of missionaries within their ethnic group who sought assistance from an other local friend while on the mission field. One hundred percent of the three black participants reported seeking assistance from a local friend, 75% (n = 3) of Korean Asians, 67% (n = 14) of other Asians, and 61% (n = 189) of Caucasians. A larger and more international sample might show if this is a significant finding that should influence our member care strategies. Hoffman (2012) alludes to this interaction with local believers. Whereas Hoffman emphasizes the member care worker's ministry to locals, and the need for training of locals to care for each other, this study seems to indicate that locals (also) minister to the missionaries and thus could benefit from training to do this even better. Perhaps then it might be profitable for the retention rate of the growing number of non-Caucasian missionaries (if not for other, more missional reasons) to offer the same training in basic relationship and counseling skills to interested local believers as we offer to our missionaries. A sample with more representatives from newer sending nations would also aid in the development of culturally appropriate member care, as well as the training of all three categories of care providers from these nations.

In order to promote higher satisfaction with debriefing after crisis/trauma and help with conflict resolution/relational issues future research studies might focus on which aspects have been helpful and not helpful for different people, and what kinds of situations these individuals had experienced. it may also be worth researching what the differences are between these services when offered on the field and when offered in the home nation.

Two missionaries, one widowed and one divorced, were dissatisfied with the counseling their child(ren) had received, largely in contrast to those who reported being married. is this typical? In my literature search I found no journal articles dealing with single parents and long-term missionary work. With today's divorce rate it would be valuable to see some research studies being conducted concerning the need for, and experience of, member care by single parents.

Conclusion

it is clear that the participating missionaries desire to be heard by individuals they can trust and who know what it is like to serve in a cross-cultural setting. This survey sought to complement ReMAP I and II by giving missionaries an opportunity to express their views on member care and to be heard. Findings from the current study have indicated the need for training in relationship and counseling skills at all levels of member care. On the grassroots level, the most utilized care, that of friends and colleagues, can help prevent the need for in-house member care workers to deal with smaller issues which have escalated over time. Appropriate training for these workers, in turn, will equip them to yet better care for their missionaries and to discern when to refer to outside mental health professionals. Training for all three of these categories, or levels of care, is needed and would greatly benefit the missionaries as they seek competent help. some specific training programs are already available, such as sYis. Other types of training may need to be developed or re-evaluated based on some of the findings in this study.

It could be valuable for those of us involved in missionary care and counseling to generously share and openly receive of available resources, across organizational and denominational boundaries. Perhaps we could ask God to show us what it would look like to function as the true body of Christ in the area of member care, so that missionaries all over the world may be strengthened and encouraged.

References

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Carter, J. (1999). Missionary stressors and implications for care. Journal of Psychology & Theology, 27, 171180.

Cerny II, L. J., & Smith, D. S. (1995). Short-term counseling on the frontiers: A case study. International Journal of Frontier Missions, 1 2(4), 189-194.

Cerny II, L. J., & Smith, D. S. (2002). Field counseling: Sifting the wheat from the chaff. In K. O'Donnell (Ed.), Doing member care well: Perspectives and practices from around the world (pp. 489-499). Pasadena, CA: William Carey Library.

Dao, J. (2011, February 16). A year at war: Staying in touch with home, for better or worse. The New York Times. Retrieved from http://www.nytimes.com

Eriksson, C. B. (2012). Practical integration in cross-cultural member care. Journal of Psychology & Theology, 40, 112-115.

Famonure, N. (2002). Member care for African mission personnel. In K. O'Donnell (Ed.), Doing member care well: Perspectives and practices from around the world (pp. 95-107). Pasadena, CA: William Carey Library.

Gamble, K. (2002). Intersections of physical and mental health. in J. R. Powell & J. M. Bowers (Eds.),

Enhancing missionary vitality: Mental health professions serving global mission (pp. 265-274). Palmer Lake, CO: Mission Training International.

Gardner, R., & Gardner, L. M. (1992). Training and using member care workers. In K. O'Donnell (Ed.), Missionary care: Counting the cost for world evangelization (pp. 343-359). Pasadena, CA: William Carey Library. Retrieved from: https://sites.google.com/site/membercaravan/test/ mc-counting-the-cost-book

Hay, R. (2004). Why they go, why they stay...: Global studies on the attrition and retention of evangelical missionaries. Connections, 8 (2), 4-8.

Hay, R. (2004, October). The toxic mission organisation: Fiction or fact? Encounters Mission Ezine, 2. Retrieved from http://www.redcliffe.org /standard.asp?id=665

Hay, R., Lim, V., Blocher, D., Ketelaar, J., & Hay, S. (2007). Worth keeping: Global perspectives on best practice in missionary retention. Pasadena, CA: William Carey Library.

Hoffman, H. (2012, April). GMCN Conference - Thailand 2012. Report from the Global Member Care Conference, Chiang Mai, Thailand. Retrieved from http://www.globalmembercare .org/index.php?id=187&L=cxtemaqs

Hunter, W. F. (2002). Research in mental health and missions. In J. R. Powell & J. M. Bowers (Eds.), Enhancing missionary vitality: Mental health professions serving global mission (pp. 475-483). Palmer Lake, CO: Mission Training International.

Johnson, C. B., & Penner, D. R. (1988). The current status of the provision of psychological services in missionary agencies in North America. In K. S. O'Donnell & M. Lewis O'Donnell (Eds.), Helping missionaries grow:

Readings in mental health and missions (pp. 458-465). Pasadena, CA: William Carey Library. Retrieved from: https://sites.google.com/site/membercaravan/test/helping-ms-grow-book

Koteskey, L. R. (n.d.). What missionaries ought to know about member care. Retrieved from http://www.missionarycare.com/brochures/br_me mbercare.htm

Lim, A. K. (2002). Field care for Asian missionaries in South Asia. In K. O'Donnell (Ed.), Doing member care well: Perspectives and practices from around the world (pp. 87-94). Pasadena, CA: William Carey Library.

Lindquist, B. (2008). Bringing member care home: Member health? Thoughts about contextualizing care. Fresno, CA: Author.

Lundy, D. (2007). Good leadership is servant leadership. In R. Hay, V. Lim, D. Blocher, J. Ketelaar, & S. Hay (Eds.), Worth keeping: Global perspectives on best practice in missionary retention (pp. 257-259). Pasadena, CA: William Carey Library.

McKaughan, P. (2002). What mission CEOs want from mental health professionals. In J. R. Powell & J. M. Bowers (Eds.), Enhancing missionary vitality: Mental health professions serving global mission (pp. 201208). Palmer Lake, CO: Mission Training International.

National Board for Certified Counselors. (2012). Policy regarding the provision of distance professional services. Retrieved from http://www.nbcc.org/ethics

NBCC adopts revisions to ethical standards. (2013, winter). The National Certified Counselor.

O'Donnell, K. (1988). A preliminary study on psychologists in missions. In K. S. O'Donnell & M. Lewis O'Donnell (Eds.), Helping missionaries grow: Readings in mental health and missions (118-125). Pasadena, CA: William Carey Library. Retrieved from: https://sites.google.com /site/membercaravan/test/helping-ms-grow-book

O'Donnell, K. (1995). From rhetoric to reality: Assessing the needs and coping strategies of frontier mission personnel, International Journal of Frontier Missions, 12(4), 201-208. Retrieved from: http://www.ijfm.org/archives.htm# Volume12

O'Donnell, K. (2002). Preface and Introduction. In K. O'Donnell (Ed.), Doing member care well: Perspectives and practices from around the world (pp. ix-x, 1-10). Pasadena, CA: William Carey Library.

O'Donnell, K. (2011). Global member care: The pearls and perils of good practice. Pasadena, CA: William Carey Library.

Porter, B., & Emmens, B. (2009). Approaches to staff care in international NGOs. Retrieved from http://www.peopleinaid.org/publications /StaffCarelnternationalNGOs.aspx

Powell, J. R. (2002). Brief counseling and therapy during overseas visits. In J. R. Powell & J. M. Bowers (Eds.), Enhancing missionary vitality: Mental health professions serving global mission (pp. 277-286). Palmer Lake, CO: Mission Training International.

Richardson, S. (2007). Third dimension teams. In R. Hay, V. Lim, D. Blocher, J. Ketelaar, & S. Hay, Worth keeping: Global perspectives on best practice in missionary retention (pp. 167-171). Pasadena, CA: William Carey Library.

Roembke, L. (2000). Building credible multicultural teams. Pasadena, CA: William Carey Library.

Roembke, L. (2002). Team building. In J. R. Powell & J. M. Bowers (Eds.), Enhancing missionary vitality: Mental health professions serving global mission (pp. 253-258). Palmer Lake, CO: Mission Training International.

Rosik, C. H. (1993). Mission-affiliated versus non-affiliated counselors: A brief research report on missionary preferences with implications for member care. Journal of Psychology and Christianity, 12, 159-164.

Rosik, C. H., & Brown, R. K. (2001). Professional use of the Internet: Legal and ethical issues in a member care environment. Journal of Psychology & Theology, 29, 106-120.

Rosik, C. H., Richards, A., & Fannon, T. A. (2005). Member care experiences and needs: Findings from a study of East African missionaries. Journal of Psychology and Christianity, 24, 36-45.

Steere, O. (2002). In-house staff vs. outside consultants: A comparison. In J. R. Powell & J. M. Bowers (Eds.), Enhancing missionary vitality: Mental health professions serving global mission (pp. 185-190). Palmer Lake, CO: Mission Training International.

Taylor, W. D. (1997). Prologue. In W. D. Taylor (Ed.), Too valuable to lose: Exploring the causes and cures of missionary attrition (pp. xiii-xviii). Pasadena, CA: William Carey Library.

Taylor, W. D. (2002). Revisiting a provocative theme: The attrition of longer-term missionaries. Missiology: An International Review, XXX, 67-80.

Welliver, D., & Northcutt, M. (Eds.). (2004). Mission

handbook: U.S. and Canadian Protestant ministries overseas 2004-2006(19th ed.). Wheaton, IL: EMIS. Wiarda, G. (2002). Challenges and care for Asian missionaries. In K. O'Donnell (Ed.), Doing member care well: Perspectives and practices from around the world (pp. 47-60). Pasadena, CA: William Carey Library.

Williams, K. (2002). Training missionaries in how to relate well: Pay a little now or pay a lot later. In J. R. Powell & J. M. Bowers (Eds.), Enhancing missionary vitality: Mental health professions serving global mission (pp. 245-252). Palmer Lake, CO: Mission Training International.

Notes

These came out of communications with Steve Moore, President and CEO of The Mission Exchange (Formerly EFMA), and Marvin J. Newell, Executive Director for CrossGlobal Link.

K. Elisabet Hogstrom

Heather Davediuk Gingrich

Denver Seminary

Correspondence concerning this article should be addressed to Elisabet Hogstrom, c/o Heather Gingrich, Denver Seminary, 6399 South Santa Fe Drive, Littleton, CO 80120. E-mail: HogstromE@ywamnsi.org or Heather.Gingrich@denverseminary.edu

K. Elisabet Hogstrom, has an M.A. in Community Counseling from Denver Seminary. She is Swedish and a naturalized American citizen. She has worked cross-culturally with Youth With A Mission for over 25 years. Elisabet currently serves with them as a member care provider. Special interests include pastoral care for missionaries, recovery from trauma, and the promotion of healthy organizational structures and communication in mission agencies.

Heather Davediuk Gingrich, Ph.D., is Professor of Counseling at Denver Seminary. She and her husband Fred are Canadians who were missionaries in the Philippines for 8 years where they taught in a seminary counseling program, and also counseled missionaries. Dr. Gingrich has authored two books: Dissociation in the Philippines: A Study of Trauma, Coping, and Culture in a Student Sample, and Restoring the Shattered Self: A Christian Counselor's Guide to Complex Trauma.

Table 1
Utilization and Degree of Satisfaction With Member Care

Survey questions                                    Satisfaction
                                                    Ratings
                                                    (1=not helpful,
                                                    6 = very helpful)

                                                    1-2

                                                    f      % of n

While on the Mission Field
  M. care provider (a) from my organization,
  resident in the region (b)                        11     9.1
  M. care provider (a) from my organization,
  visiting from abroad (b)                          19     13.7

  External m. care provider (a) made available by
  my organization, resident in the region (b)       12     18.8
  External m. care provider (a) made available by
  my organization, visiting from abroad (b)         14     16.8
  External m. care provider (a) from member care
  center in the region, unrelated to my
  organization (b)                                  13     15.3

  Pastoral worker/pastor visiting from my
  sending church (b)                                15     13.9
  Missions committee member visiting from my
  sending church (b)                                13     14.3

  Colleague (c)                                     13     4.3
  Other local friend (c)                            12     5.3

  Other                                             3      5.8
  Any of the above online, rather than in person    4      4.5

While Visiting Home
  M. care provider (a) from my organization (b)     19     14.8
  External m. care provider (a) made available by
  my organization (b)                               11     19.6

  External m. care provider (a) independent from
  my organization (b)                               12     13.0
  Pastoral worker/pastor from my sending
  church (b)                                        29     15.3
  Missions committee member from my sending
  church (b)                                        24     17.1

  Colleague (c)                                     13     8.5
  Friend (c)                                        5      1.9

  Other                                             2      5.1
  Any of the above online, rather than in person    2      5.9

Survey questions                                    Satisfaction
                                                    Ratings
                                                    (1=not helpful,
                                                    6 = very helpful)

                                                    5-6

                                                    f       % of n

While on the Mission Field
  M. care provider (a) from my organization,
  resident in the region (b)                        69      57.0
  M. care provider (a) from my organization,
  visiting from abroad (b)                          77      55.8

  External m. care provider (a) made available by
  my organization, resident in the region (b)       34      53.1
  External m. care provider (a) made available by
  my organization, visiting from abroad (b)         42      50.6
  External m. care provider (a) from member care
  center in the region, unrelated to my
  organization (b)                                  55      64.7

  Pastoral worker/pastor visiting from my
  sending church (b)                                69      63.9
  Missions committee member visiting from my
  sending church (b)                                54      59.4

  Colleague (c)                                     217     72.6
  Other local friend (c)                            143     62.7

  Other                                             37      71.2
  Any of the above online, rather than in person    63      72.4

While Visiting Home
  M. care provider (a) from my organization (b)     73      57.0
  External m. care provider (a) made available by
  my organization (b)                               36      64.3

  External m. care provider (a) independent from
  my organization (b)                               62      66.7
  Pastoral worker/pastor from my sending
  church (b)                                        98      51.6
  Missions committee member from my sending
  church (b)                                        65      46.4

  Colleague (c)                                     103     67.8
  Friend (c)                                        195     75.0

  Other                                             32      82.0
  Any of the above online, rather than in person    26      78.5

Survey questions                                    Satisfaction
                                                    Ratings
                                                    (1=not helpful,
                                                    6 = very helpful)

                                                    Total (1-6)

                                                    f       % of n

While on the Mission Field
  M. care provider (a) from my organization,
  resident in the region (b)                        121     33.2
  M. care provider (a) from my organization,
  visiting from abroad (b)                          138     37.9

  External m. care provider (a) made available by
  my organization, resident in the region (b)       64      17.6
  External m. care provider (a) made available by
  my organization, visiting from abroad (b)         83      22.8
  External m. care provider (a) from member care
  center in the region, unrelated to my
  organization (b)                                  85      23.4

  Pastoral worker/pastor visiting from my
  sending church (b)                                108     29.7
  Missions committee member visiting from my
  sending church (b)                                91      25.0

  Colleague (c)                                     299     82.1
  Other local friend (c)                            228     62.6

  Other                                             52      14.3
  Any of the above online, rather than in person    87      23.9

While Visiting Home
  M. care provider (a) from my organization (b)     128     35.2
  External m. care provider (a) made available by
  my organization (b)                               56      15.4

  External m. care provider (a) independent from
  my organization (b)                               93      25.5
  Pastoral worker/pastor from my sending
  church (b)                                        190     52.2
  Missions committee member from my sending
  church (b)                                        140     38.5

  Colleague (c)                                     152     41.8
  Friend (c)                                        260     71.4

  Other                                             39      10.7
  Any of the above online, rather than in person    34      9.3

Survey questions                                    Category

While on the Mission Field
  M. care provider (a) from my organization,
  resident in the region (b)
  M. care provider (a) from my organization,        2
  visiting from abroad (b)

  External m. care provider (a) made available by
  my organization, resident in the region (b)
  External m. care provider (a) made available by
  my organization, visiting from abroad (b)
  External m. care provider (a) from member care    3
  center in the region, unrelated to my
  organization (b)

  Pastoral worker/pastor visiting from my
  sending church (b)
  Missions committee member visiting from my        2
  sending church (b)

  Colleague (c)                                     1
  Other local friend (c)

  Other
  Any of the above online, rather than in person

While Visiting Home
  M. care provider (a) from my organization (b)     2
  External m. care provider (a) made available by
  my organization (b)

  External m. care provider (a) independent from    3
  my organization (b)
  Pastoral worker/pastor from my sending
  church (b)
  Missions committee member from my sending         2
  church (b)

  Colleague (c)                                     1
  Friend (c)

  Other
  Any of the above online, rather than in person

Note. f = frequency of this range of ratings; n = the total number of
participants who utilized this particular service; N = the total
number of survey respondents (N = 364); M. care = Member care.

(a) counselor, or other mental health professional/pastoral worker.
(b) formal service provider. (c) informal service provider.

Table 2
Utilization and Degree of Satisfaction With Member Care Services

Survey questions                                   Satisfaction
                                                   Ratings
                                                   (1 = not helpful,
                                                   6 = very helpful)

                                                   1-2

                                                   f    % of n

While on the Mission Field
  Personal counseling                              15   10.9
  Debriefing after crisis/trauma                   20   17.3
  Conflict resolution/relational issues            36   23.8
  Training in ...                                  12   9.2
  Marriage counseling                              11   20.7
  Counseling for family issues                     9    15.8
  Child received counseling                        6    20.7
  Career counseling                                13   23.7
  Retreat, as a(n) (l)family, (2)couple, or (3)
  individual                                       11   6.0
  Psychiatric medication                           8    32.0
  Other                                            2    10.0
  Any of the above online, rather than in person   2    8.3

While Visiting Home
  Personal counseling                              7    6.2
  Debriefing after crisis/trauma                   7    8.6
  Conflict resolution/relational issues            10   17.6
  Training in ...                                  3    6.7
  Marriage counseling                              5    11.4
  Counseling for family issues                     8    19.0
  Child received counseling                        6    25.0
  Career counseling                                9    25.7
  Retreat, as a(n) (l)family, (2)couple, or (3)
  individual                                       9    9.9
  Psychiatric medication                           6    27.3
  Other                                            5    22.7
  Any of the above online, rather than in person   2    20.0

Survey questions                                   Satisfaction
                                                   Ratings
                                                   (1 = not helpful,
                                                   6 = very helpful)

                                                   5-6

                                                   f     % of n

While on the Mission Field
  Personal counseling                              94    68.2
  Debriefing after crisis/trauma                   64    55.2
  Conflict resolution/relational issues            74    49.0
  Training in ...                                  81    61.8
  Marriage counseling                              28    52.9
  Counseling for family issues                     36    63.1
  Child received counseling                        18    62.0
  Career counseling                                28    50.9
  Retreat, as a(n) (l)family, (2)couple, or (3)
  individual                                       116   63.8
  Psychiatric medication                           15    60.0
  Other                                            12    60.0
  Any of the above online, rather than in person   18    75.0

While Visiting Home
  Personal counseling                              86    76.1
  Debriefing after crisis/trauma                   52    64.2
  Conflict resolution/relational issues            27    47.4
  Training in ...                                  29    64.4
  Marriage counseling                              28    63.7
  Counseling for family issues                     26    61.9
  Child received counseling                        12    50.0
  Career counseling                                16    45.7
  Retreat, as a(n) (l)family, (2)couple, or (3)
  individual                                       57    62.7
  Psychiatric medication                           12    54.5
  Other                                            11    50.0
  Any of the above online, rather than in person   6     60.0

Survey questions                                   Satisfaction
                                                   Ratings
                                                   (1 = not helpful,
                                                   6 = very helpful)

                                                   Total (1-6)

                                                   n     % of N

While on the Mission Field
  Personal counseling                              138   37.9
  Debriefing after crisis/trauma                   116   31.9
  Conflict resolution/relational issues            151   41.5
  Training in ...                                  131   36.0
  Marriage counseling                              53    14.6
  Counseling for family issues                     57    15.7
  Child received counseling                        29    8.0
  Career counseling                                55    15.1
  Retreat, as a(n) (l)family, (2)couple, or (3)
  individual                                       182   50.0
  Psychiatric medication                           25    6.9
  Other                                            20    5.5
  Any of the above online, rather than in person   24    6.6

While Visiting Home
  Personal counseling                              113   31.0
  Debriefing after crisis/trauma                   81    22.3
  Conflict resolution/relational issues            57    15.7
  Training in ...                                  45    12.4
  Marriage counseling                              44    12.1
  Counseling for family issues                     42    11.5
  Child received counseling                        24    6.6
  Career counseling                                35    9.6
  Retreat, as a(n) (l)family, (2)couple, or (3)
  individual                                       91    25.0
  Psychiatric medication                           22    6.0
  Other                                            22    6.0
  Any of the above online, rather than in person   10    2.7

Note. f = frequency of this range of ratings; n = the total
number of participants who utilized this particular service;

N = the total number of survey respondents (N = 364).

Table 3
Degree of Importance Placed on Features of Member Care Services

Survey questions           Satisfaction Ratings (1 = not important,
                           6 = very important)

                           1-2            5-6            Total (1-6)

                           f     % of n   f     % of n   n     % of N

I felt heard               11     3.6     255    82.8    308    84.6
I felt empowered           25     9.6     141    54.3    260    71.4
I felt strengthened in     11     3.9     208    73.2    284    78.0
  my spiritual life
Prayer                     10     3.3     225    75.3    299    82.1
Confidentiality            14     5.0     215    75.5    285    78.3
Accessibility              18     6.4     180    64.3    280    76.9
Competence of the member    7     2.5     232    81.4    285    78.3
  care worker
Other                       1     2.9     31     91.2    34     9.3

Note. f = frequency of this range of ratings; n = the total number of
participants who rated this particular feature;

N = the total number of survey respondents (N = 364).
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Author:Hogstrom, K. Elisabet; Gingrich, Heather Davediuk
Publication:Journal of Psychology and Christianity
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Date:Sep 22, 2014
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