One of the occupation hazards that chaplains face on an almost daily basis is mistaken identity. Chaplains are seen as stand-ins for God or a representative of the God-squad; they can be the visiting vicar or the proselytising preacher; and they are the bearers of bad news, and friends with death. This problem of identity is not helped by the inherent uncertainty of what chaplains deal with, the sacred of which there are but hints and intimations, and the occasions in which chaplains become involved with patients can often be ambiguous and unspecified. Consequently, in trying to explain themselves, chaplains tend to revert to metaphors of which there is a rich legacy including the (biblical) shepherd, Henri Nouwen's ‘Wounded Healer’, and Alistair Campbell's ‘Wise Fool’. Robert Dykstra (Reference Dykstra2005), in his book Images of Pastoral Care, makes the pertinent observation that, ‘It is hard to conceive of persons in other lines of work … bothering to concoct so steady a diet of metaphorical equivalents to their chosen fields …’ (p. 3). He suggests that what this demonstrates is an essential insecurity, necessary for those who engage in this field, which lies at the heart of this highly personal book by Steve Nolan that seeks to address what it means to be a palliative care chaplain.

Nolan approaches this question through a small qualitative study of palliative care chaplains that provides him with the data from which to derive a model of spiritual care particular to chaplains and their role. Nolan proposes that the core of a chaplain's work is being present to a dying person within a relationship that has the developmental potential to be hope enhancing. This movement towards hope is expressed through four modes of presence that Nolan considers to be ‘discernible, organic moments rather than definite stages through which the relationship passes’ (p. 124). In Nolan's scheme these are described as evocative, accompanying, comforting and hopeful presence, and he devotes a chapter to each. These chapters provide windows into the particular ways that Nolan understands how chaplains relate to patients, and significantly he adopts a psychotherapeutic frame to what he presents. This enables him to ground description in substantive psychological theory: so, for example, in the chapter on evocative presence he asserts that ‘people relate to the chaplain, at least initially, as a transferential projection … of their unconscious imagination’ (p. 43). This guiding theory provides Nolan with the possibility that the relationship can develop, in this case meaning that once the chaplain has dealt with the patient's projection the chaplain can become an accompanier, with potential to become a comforter and one who can foster hope.

This book is highly populated with patients, in the form of clinical vignettes, quotations from study participants and extracts from patient – chaplain conversations, all woven around Nolan's journey of trying to make sense of his role and his mortality. As such this is a book that articulates something about the humanity of care and the humanity of chaplains. It will be engaging for those curious about what chaplains do, and for chaplains in a similar situation of uncertainty to Nolan. It is also a book populated by a familiar line-up of serious psychological figures including John Bowlby, Donald Winnicott and Carl Rogers, many of whose concepts are pivotal to Nolan's arguments. However, for some readers this will also be a limitation, as Nolan does not offer a critical or contextual approach to his subject and he illustrates his thinking and insights within a very particular discourse that is not attentive to wider fields of study and writing such as pastoral theology or medical humanities. Perhaps more significantly, this richly storied presentation discloses little about how texts have been chosen, recalled, edited and interpreted, or how the ethical obligations of representing the experience and meaning of others have been addressed – all of which may frustrate researchers. Similarly, but at a practical level, there is no attempt made to address the implications of this model for the organisation and delivery of spiritual care, or the selection, training and formation of palliative care chaplains. In the end, whether or not you find Nolan's proposals about the purpose of spiritual care and the role of the chaplain convincing, it is difficult to deny that in Nolan's struggle with these issues he has shown us something valuable of the human spirit: that in the face of death there is the possibility for transformation and hope.