Missionary care (often known as member care) has come into its own in the evangelical world over the past 40 years. Although there were some writings in the 1970s, in the 1980s missionary care began to flourish. A series of international conferences on missionary kids (held in Manila, Quito, and Nairobi) brought people from different sending groups together to discuss common efforts in caring for missionaries. A conference on mental health and missions was established (and is still meeting) in Angola, Indiana, and two special issues of the Journal of Psychology and Theology were devoted to the topic. A literature began to emerge highlighting the emotional, psychological, and spiritual needs of missionaries.

This literature can be divided into two streams. One stream is intended to educate missionaries on challenges inherent in their chosen path. Books and articles focused on a wide array of issues such as cultural adjustment, spiritual development, missionary families and kids, mental health concerns, and reentry speak directly to missionaries regarding their experiences, generally offering suggestions about how to manage transitions more easily. A second stream is geared toward missionary care specialists, many of whom have a background in mental health, pastoral care, and education. These writings generally emphasize understanding the experience of missionaries from a meta-level and tend to focus on assessment, training, and intervention.

Although this area of study has been around for close to four decades, research on missionary care is relatively sparse. The MK-CART/CORE study and the Reducing Missionary Attrition Project are two examples of large-scale studies, but these are the exceptions rather than the rule.1 I conducted an extensive review of research and discovered that a large portion of the studies were theses and dissertations and that ongoing research threads were virtually nonexistent.2 An examination of the PsychInfo database of publications in this area since my review suggests this trend has continued, although more articles on various aspects of missionary care have surfaced and there appears to be a burgeoning thread on treatment outcomes. However, it is fair to say that the emphasis in the missionary care literature has been on direct care and not on research.

Even if empirical work on missionary care has been sparse, there has not been a shortage of publications devoted to the topic in either stream of this literature. The amount of information available to missionaries and their caregivers is plentiful and has markedly increased with the advent of blogs and websites in recent years. Two examples of this are Missionary Care (http://missionarycare.com) and the Global Member Care Network (http://globalmembercare.org). The former is a website maintained by Ron and Bonnie Koteskey intended for missionaries and containing brief, pragmatic overviews of a wide variety of issues ranging from marriage to mental health. The latter is a website sponsored by the World Evangelical Alliance that serves as a resource clearinghouse for missionary care specialists. In addition to providing links to resources on a variety of issues, this network hosts an international conference for those working with missionaries. These websites are simply the tip of the iceberg; missionary care has become a topic of great interest and there is no reason to believe this trend will shift any time soon.

Clearly, an exhaustive annotated bibliography is beyond the scope of this article. Rather, I have attempted to identify several key sources from each stream of this literature. To help me with this endeavor, I enlisted the help of several missionary care specialists.3 I asked each for recommendations of resources they have found particularly useful in their work with missionaries. The following lists reflects their suggestions combined with my own. To narrow the scope, I have limited annotated sources to books. This by no means implies there are not useful journal articles and dissertations on this subject, but these may be less accessible for many readers of this article. In addition, I have largely included books that focus on missionaries rather than expats in general. There is a substantial literature focused on other sectors of the expatriate community (military, civil servants, corporations, etc.), and there are a number of similarities between their experiences and those of missionaries. However, the lives of missionaries are unique in many other ways and the applicability of more general sources is often limited. I have included a few sources that are not specifically aimed at missionaries because they are frequently recommended but most of the sources below focus solely on missionaries.

Books for Missionary Care Specialists

Andrews, Leslie A., ed. The Family in Mission: Understanding and Caring for Those Who Serve. Colorado Springs: Mission Training International, 2004.

This volume unpacks the most ambitious research on missionary life to date. It describes three large studies conducted by MK-CART/CORE, a coalition of researchers from several sending groups, over a fifteen-year period. The first was a study of boarding schools that sought to identify characteristics of personnel and families associated with success. A second study looked at adult missionary kids (MKs), focusing on their adjustment to adulthood. The third research effort studied missionary families, in particular their levels of family, spiritual, and vocational satisfaction as well as spousal dynamics. Overall, these studies found the experience of missionaries to be generally positive. In addition to identifying key results from the researchers, this book includes chapters from missionary care specialists that seek to apply the findings in ways that are helpful in ministering to missionaries.

Bowers, Joyce M., ed. Raising Resilient MKs: Resources for Caregivers, Parents, and Teachers. Colorado Springs: Association of Christian Schools International, 1998.

A critical influence in the development of missionary care as a field has been international Christian schools. In past generations sending children to boarding schools was a more common experience than it is today, but even without the room-and-board component Christian schools offer an important option for parents who are looking for overseas educational alternatives. This book is a followup to the international conferences on missionary kids held in the 1980s. Like many books in this literature stream, it is an edited volume that draws on many authors who have contributed chapters. The early sections of the book focus on the experiences of MKs and missionary families. It highlights advantages of growing up overseas and focuses on transitions (including reentry) MKs often experience. The latter sections of the book are devoted to educational issues such as curriculum, language learning, and administrative and staff issues. Readers not associated with an educational institution may not find this section especially helpful, but the final section identifies trends in missions and missionary care which could be enlightening.

Bushong, Louis J. Belonging Everywhere & Nowhere: Insights into Counseling the Globally Mobile. Indianapolis: Mango Tree Intercultural Services, 2013.

This book is a valuable resource for mental health professionals who work with missionaries and other global nomads. Bushong is a marriage and family therapist who grew up in an international setting and specializes in working with third culture kids (TCKs). While the book does not specifically focus on the experience of missionary kids and their families, it does address many experiences common to those growing up overseas and seeks to help equip mental health professionals working with this population. In addition to providing a useful overview of what a therapist might anticipate in working with a TCK, Bushong also looks at common diagnoses (mood disorders, adjustment disorder, PTSD, etc.) through a third-culture lens and evaluates current therapeutic theories and techniques as they apply to this population (e.g., attachment theory, cognitive-behavioral models, and structural family therapy).

Hay, Rob. Worth Keeping: Global Perspectives on Best Practice in Missionary Retention. Globalization of Mission. Pasadena, CA: William Carey, 2006.

This book is a follow-up to the ReMAP project on missionary attrition (described below in Too Valuable to Lose). This research, however, focused on missionary retention and best practices associated with maintaining effective workers on the field. It surveys missions agencies in 22 countries on six continents. Factors associated with retention included a strong working relationship between the missionary and sending agency, moderate- to large-sized mission agencies, higher levels of education among missionaries, a selective screening process that results in a good fit between the missionary and the agency, a clear calling, and good physical and mental health. The study drew distinctions between new and old sending countries, finding some differences between countries that have been sending missionaries for a long time and those who started relatively recently.

O’Donnell, Kelly S., and Michèle Lewis O’Donnell, eds. Helping Missionaries Grow: Readings in Mental Health and Missions. Pasadena, CA: William Carey, 1988.

No one has been more prolific in publishing material for mental health providers in the area of missionary care than Kelly O’Donnell. This is the first of several books he has edited or written to address issues pertaining to the care of missionaries. This volume is a compendium of articles drawn primarily from journals such as Evangelical Missions Quarterly, Journal of Psychology and Theology, and Journal of Psychology and Christianity written in the 1970s and 1980s. Sections include missionary preparation, families, adjustment to the field, and special issues such as the role of women and repatriation (including a chapter by Clyde Austin). While the literature included in this book is over 25 years old, it still contains useful information and provides a historical perspective to this area of study.

O’Donnell, Kelly S., ed. Missionary Care: Counting the Cost for World Evangelization. Pasadena, CA: William Carey, 1992.

This edited volume might be considered the first handbook on missionary care. In this book O’Donnell invited a number of people who were recognized as experts in missionary care to write about various aspects of this work. O’Donnell identifies the term member care as synonymous with missionary care; since that time it has become the preferred term in the field. Like other edited volumes in this literature, this book is divided into several sections: an overview of what is meant by missionary care, counseling and clinical concerns, team development, and the collaboration of missionaries with sending agencies. Although it is over 20 years old, Missionary Care remains a vital resource for mental health professionals who work with missionaries.

O’Donnell, Kelly S. ed. Doing Member Care Well: Perspectives and Practices from around the World. Globalization of Mission. Pasadena, CA: William Carey, 2002.

Doing Member Care Well is an extension of Missionary Care. Like the previous book, it is a compilation of articles from experts in the field on issues for missionaries, and it builds on and updates a decade’s worth of progress. However, there are two particular advances that set this book apart. First, it has a distinctly international flavor. O’Donnell acknowledges that not all sending groups are from North America, and a significant part of the book is devoted to how member care is done around the globe, drawing on authors from five continents. Second, the book is structured around a theoretical model for missionary care. In the first chapter O’Donnell lays out a model of care that includes five levels: Master care, self care, sender care, specialist care, and network care. Coupled with the developmental model presented by David Pollock in chapter 2 (“Developing a Flow of Care and Caregivers”), a strong conceptual framework for working with missionaries is provided. The latter part of the book is devoted to providing member care within each of the levels of O’Donnell’s model.

O’Donnell, Kelly S. Global Member Care. Volume 1, The Pearls and Perils of Good Practice. Pasadena, CA: William Carey, 2011.

O’Donnell, Kelly S., and Michèle Lewis O’Donnell, eds. Global Member Care. Volume 2, Crossing Sectors for Serving Humanity. Pasadena, CA: William Carey, 2013.

In this series (a third volume is still in progress) O’Donnell builds on his previous work by broadening member care to include an emphasis on humanitarian aid workers. This seems a natural progression given that humanitarian aid often originates in faith-based groups and that mission efforts are broadening in many parts of the world to include humanitarian efforts. Volume 1 is written by O’Donnell. It includes an overview of the current state of member care around the world; a section on promoting health through unmasking dysfunction, promoting relational resilience, and supporting good management; and a section on ethics in a transcultural context. Volume 2 is an edited book that focuses on the crossover of various sectors serving the international community. Both volumes have a less specific application to missions with a greater emphasis on humanitarian care and global organizations.

Powell, John R., and Joyce M. Bowers, eds. Enhancing Missionary Vitality: Mental Health Professions Serving Global Missions. Colorado Springs: Mission Training International, 1999.

The Mental Health and Missions Conference held each year in Angola, Indiana, has had a huge influence in the development of missionary care, particularly among mental health professionals. Starting in 1980 as a meeting of a few people interested in serving missionaries, it has grown into a conference of several hundred people from across the evangelical spectrum. John Powell, one of the founders of the conference, co-edited this volume, which draws on presenters and topics that have been shared over the years. Sections include the role of mental health professionals in missions, dynamics of serving in a cross cultural context, preventive methods, clinical interventions, and ethical considerations. It is a useful handbook for mental health professionals who are looking for ways to serve missionaries effectively.

Schaefer, Frauke C., and Charles A. Schaefer. Trauma and Resilience: A Handbook. Condeo Press, 2010.

In recent years trauma has taken on a high profile in the mental health world. Nowhere is this more evident than in the missions community where exposure to risk is often higher than the norm. This edited volume is developed around a theology of suffering presented in the first chapter. Building on this, several stories of trauma are presented followed by chapters on normative reactions to trauma, effective community support, and psychological and spiritual resources for managing trauma. The message of the book is that trauma is part of the human experience and is often associated with spiritual struggle. It can be mitigated through a variety of avenues including the support of spiritual communities.

Taylor, William D., ed. Too Valuable to Lose: Exploring the Causes and Cures of Missionary Attrition. Globalization of Mission. Pasadena, CA: William Carey, 1997.

Missionaries leaving the field earlier than anticipated is a concern across the missions world. This edited volume reports on the findings of an ambitious study that sought to determine reasons why missionaries prematurely leave the field and to explore solutions to that problem. The Reducing Missionary Attrition Project (ReMAP) was sponsored by the World Evangelical Fellowship (now Alliance). It is unique in its international perspective in that it drew on missionaries from 14 sending countries. The initial sections of the book deal with the study itself, providing details regarding purpose, methodology, and results. Overall findings indicate that top reasons missionaries return prematurely are related to personal issues, concerns about marriage and family, and unpreventable circumstances. The next section presents more detailed results from a variety of sending countries. The book then turns to preventing unwanted attrition. Chapters from a variety of authors explore ways in which missionary screening, initial training, on-field training, and pastoral care can be improved to help reduce attrition among missionaries.

Books for Missionaries

Brayer Hess, Melissa, and Patricia Linderman. The Expert Expat: Your Guide to Successful Relocation Abroad. Rev. ed. Boston: Nicholas Brealey, 2007.

Written by two diplomatic spouses with twenty-one international moves under their collective belts, this is not a book that is specifically written for missionaries. However, it is a practical guide to making a cross-cultural move. It is chock-full of pragmatic suggestions and tips for managing life in another culture. It includes chapters on language learning, preparing for a move, helping children adjust to a new culture, safety, initial adaptation to a new place, moving pets, and keeping in touch with the folks at home.

Donovan, Kath. Growing through Stress. Rev. ed. Berrien Springs, MI: Institute of World Mission, 2002.

It is perhaps an understatement to say that missionary life is stressful. While stress is often viewed as inherently negative, Kath Donovan points out that it has a positive function and that we can grow through our coping efforts. She suggests that approaches to the study of stress generally neglect a spiritual component. Her purpose in writing this book is integrating secular findings about stress with spiritual insights in order to help people develop more effective ways of dealing with it. The first part of the book seeks to clarify what is meant by stress, giving it clear definitions, debunking common misunderstandings, and providing a biblical perspective. The second part focuses on stress management. It draws on the stress and coping literature from psychology and provides a variety of practical management strategies. Donovan integrates Scripture and biblical examples to support her suggestions for coping. This is a useful resource for any Christian and may be especially helpful for missionaries who are working in a stress-inducing environment.

Elmer, Duane. Cross-cultural Conflict: Building Relationships for Effective Ministry. Downers Grove, IL: InterVarsity Press, 1993.

Elmer has written several books on cross-cultural life in a Christian context. This one explores the differences between western ways of handling conflict and those of people in many other parts of the world. While Westerners tend to approach conflict directly (and have a hard time understanding how it could be done differently), people in other cultures may use an indirect, passive voice, rely on mediators, take one-down positions, and rely on storytelling as a means of resolving differences while saving face. The final section of the book discusses implications for the gospel message inherent in paying attention to how we deal with conflict in a culturally sensitive manner. While the message of this book is direct (in line with western thinking), its suggestions about dealing with conflict indirectly in other cultures may make living in another culture easier.

Jordan, Peter. Re-entry: Making the Transition from Missions to Life at Home. Seattle: Youth with a Mission, 2013.

Although it has a publication date of 2013, this little book has been around for a long time—and for good reason. It is a quick, practical guide to reentry. Using a space shuttle analogy, it describes repatriation in two phases: winding down, or the preparation stage of returning from the field, and reentry, or handling things once the return has occurred. The first section deals with emotional, social, political, and family adjustments that need to be made in getting ready to leave the mission field. It includes practical ideas for leaving including delegating your work, keeping a journal, and returning with gifts. The second section discusses a variety of things returning missionaries often experience but are sometimes surprised by: identity struggles, reverse culture shock, disappointment with church life, and perhaps even hostility or apathy. Once again, the author offers specific and pragmatic suggestions ranging from connecting with the minister to maintaining a routine to ease the cross-cultural shock of reentry. This book may not have amazing insights you have not heard before, but it is an excellent and accessible reminder for overwhelmed individuals and families dealing with reentry.

Pollock, David C., and Ruth E. Van Reken. Third Culture Kids: Growing Up among Worlds. Rev. ed. Boston: Nicholas Brealey, 2009.

Like any parent, missionaries are deeply concerned about the well-being of their children. For many years it has been recognized that growing up in a cross-cultural setting is a different experience for children than if they had been raised in their parents’ passport culture. The term third culture kid (TCK) has been coined to describe that experience. This book is the definitive volume on the TCK experience. David Pollock and Ruth Van Reken are both recognized experts in this area and each have a missions background, although the book is aimed at a wider audience. The book explains the term TCK and how TCKs’ experience differs from monocultural children. It explores both the benefits and challenges of growing up among worlds, describes personal and developmental characteristics often found with TCKs, and identifies common relational patterns and hidden grief associated with the third culture experience. The book also talks about handling transitions such as moving and reentry, using the RAFT model (reconciliation, affirmation, farewells, think destination) that is widely used in the reentry process. In the revised edition, Van Reken expands the notion of the TCK by introducing the term cross culture kid (CCK) to include a wider range of children (e.g., immigrants and international adoptees) who share similar experiences with traditional TCKs.

Savageau, Cheryl, and Diane Stortz. Parents of Missionaries: How to Thrive and Stay Connected When Your Children and Grandchildren Serve Cross-Culturally. Colorado Springs: Authentic Publishing, 2008.

Missionaries come with families, and sometimes the most difficult part of the cross-cultural journey is leaving them behind. Though it can be overlooked, this is also a challenge for parents (and, perhaps especially, grandparents). This book recognizes that reality and seeks to help parents manage the physical distance and stay connected to their kids and grandkids. The initial section of the book addresses the grief often experienced by parents of missionaries as well as typical developmental issues tied to this stage of life. The second section deals with managing transitions, including farewells and furloughs. The final section focuses on ways to stay connected as a family in spite of the miles between family members. Parents of Missionaries is a useful guidebook in an area that doesn’t get a lot of attention.

Storti, Craig. The Art of Crossing Cultures. 2nd ed. Yarmouth, ME: Intercultural Press, 2007.

In this book about adjusting to a foreign culture, Storti begins by saying that many expatriates have a desire to adapt to the local culture, but few actually do. This is an especially critical aspect of missionary life, and his book presents underlying reasons that make cultural adjustment difficult. Essentially, Storti suggests that most of us are egocentric creatures who have a hard time understanding why people in the local culture act as they do, because their behaviors do not fit with our cultural expectations. This tends to lead to withdrawal, discomfort, and, in some cases, attrition. Storti offers a model that encourages people living in another culture to become aware of their negative reactions and to seek other meanings for the actions of locals that, in turn, can shift their expectations. The book does not provide a host of details about making cultural adjustments (as in The Expert Expat described above), but it offers some basic insights that are key for thriving in another culture.

Storti, Craig. The Art of Coming Home. Yarmouth, ME: Intercultural Press, 2001.

As challenging as moving to a new culture can be, reentry into one’s home culture after living abroad can be more difficult. This book is frequently recommended as a practical guide for people who are returning home after living in another culture. It focuses on all types of expatriates, with chapters at the end of the book focused on special issues related to exchange students, peace corps volunteers, military personnel, and missionaries. Initially the book describes common concerns experienced by returnees such as disorientation with what used to be familiar, changed relationships with friends, and loneliness. It identifies a series of stages people frequently progress through in reentry including leave-taking, the honeymoon, reverse culture shock, and readjustment. Finally, it describes experiences that typically occur in the workplace and at home during repatriation and offers suggestions for dealing with them. The Art of Coming Home is an easy read that addresses a difficult transition in a straightforward and understandable manner.

Teague, David. Godly Servants: Discipleship and Spiritual Formation for Missionaries. CreateSpace, 2012.

Often the focus of missionary care is on psychological, emotional, and cultural adjustment. However, spiritual health is vital for surviving and thriving as a missionary. David Teague served for years as a missionary and brings this perspective to bear as he explores spiritual disciplines and developing a deeper life with God. The book is divided into three sections: communion with God, practicing spirituality within community, and impacts on ministry. Teague draws on familiar writers on spiritual disciplines such as Richard Foster and Henri Nouwen, and much of the content is similar to other sources. However, the lens he uses in writing this book makes it particularly useful for missionaries.

Van Reken, Ruth E. Letters Never Sent: A Global Nomad’s Journey from Hurt to Healing. Rev. ed. London: Summertime Publishing, 2012.

Ruth Van Reken has had a critical influence on missionary care in spite of the fact that she has not focused on it directly. As co-author of Third Culture Kids (see above) and founder of the Families in Global Transition conference, she has spotlighted the experience of families living cross-culturally. Van Reken’s professional journey into this world started with this book, but it began long before as an MK growing up in Africa. Sent away to a boarding school at an early age, she encountered many hurts that lasted well into adulthood. Using the format of letters that she would have written but never sent, she creates a poignant memoir of her experiences, from the pain she sustained to her healing process. Originally published in 1988, the revised edition includes an epilogue in which she offers further reflections from the vantage point of someone in her 60s. Although shaped by a different era, Van Reken captures some of the emotional struggle experienced by missionaries today.

This sampling of sources on missionary care reflects both historical and current developments. Efforts in missionary care are expanding as senders increasingly recognize that the importance of supporting those in the field goes beyond providing for financial needs. Undoubtedly, as trends in missions change, the needs of missionaries will shift as well. As they do, missionary care specialists will need to develop new resources and conduct additional research to best address those needs.

Dale Hawley is Program Director of the Marriage and Family Therapy program at the University of Wisconsin-Stout. He also serves as Associate Director of Missionary Care at Missions Resource Network (http://mrnet.org). He has worked with missionaries on and off the field for nearly twenty years.

Bibliography

Andrews, Leslie A., ed. The Family in Mission: Understanding and Caring for Those Who Serve. Colorado Springs: Mission Training International, 2004.

Hawley, Dale R. “Research on Missionary Kids and Families: A Critical Review.” In The Family in Mission: Understanding and Caring for Those Who Serve, ed. Leslie A. Andrews, 277–92. Colorado Springs: Mission Training International, 2004.

Taylor, William D. Too Valuable to Lose: Exploring the Causes and Cures of Missionary Attrition. Globalization of Mission. Pasadena, CA: William Carey, 1997.