Carla Cheatham :: Carla Cheatham Consulting Group

Author Archive for Carla Cheatham

The Presence Behind Our Masks

Posted by Carla Cheatham on Wednesday, April 22nd, 2020 in The Power of Presence, Uncategorized

I see and hear many grappling with what it means to be “essential” as a healthcare worker and how to find connection virtually when in-person visits are not ethical, wise, or possible.

To me, this speaks to even deeper conversations about our own esteem, sense of worth, and attachment styles as we seek a greater ability to connect when physical touch or in-person presence is not possible.

What if it’s not the masks that cover our mouths that are the issue, but the masks we wear to protect us from being seen that inhibits our presence with others?

The first time I cared for someone whose HIV had become AIDS with open sores, cough, and death a matter of weeks away, I named the discomfort in the room. I felt awful touching him only with a gloved hand and trying to exude caring presence from behind a surgical mask. I projected that it added to the sense of rejection he had experienced because of others’ homophobia and ignorance-based fear about the disease.

His gracious and genuine response was that the warmth of my wanting to be present with him and hold his hand was more than enough and that the smile he could not see my mouth form made it’s way easily to my eyes, so it was still clear.

Our training as caregivers teaches us to examine our own issues that arise in the care relationship; ways we are projecting our own stuff onto others. Then, we can find peace and grounding to be a calm presence with others, free from distraction.

Yes, this all sucks. Yes, it’s hard. And, perhaps this is a call to deepen our ability to be present without relying on touch or proximity. Perhaps in this time, we can learn an even more authentic and vulnerable way of attuning and connecting, to ourselves first and then to those for whom we care.

So much so that it will matter far less whether we are at the bedside, on-screen, or on the phone; our presence will be so pure that modailty will be of little consequence.

Pandemic By Lynn Ungar

What if you thought of it
as the Jews consider the Sabbath—
the most sacred of times?
Cease from travel.
Cease from buying and selling.
Give up, just for now, on trying to make the world different than it is.
Sing. Pray.
Touch only those to whom you commit your life.
Center down.
And when your body has become still, reach out with your heart.
Know that we are connected in ways that are terrifying and beautiful. (You could hardly deny it now.)
Know that our lives are in one another’s hands. (Surely, that has come clear.)
Do not reach out your hands. Reach out your heart. Reach out your words. Reach out all the tendrils of compassion that move, invisibly, where we cannot touch.
Promise this world your love–for better or for worse, in sickness and in health, so long as we all shall live.

Much peace to us all as we walk this journey together.

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT served in social services for decades and now is a trainer, speaker, coach, consultant, and writer. She focuses on the components of emotional intelligence that allow caregivers to show up well for themselves so they can show up well for others. Building resilience in professionals, family members, leaders, and teams is her greatest passion. She’s the Chair of the National Hopsice and Palliative Care Organization’s Ethics Advisory Council, and an adjunct professor at the Seminary of the Southwest and an Assistant Professor for the MS in Palliative Care at the University of Maryland. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2020.

Resilience and Boundaries to Prevent Compassion Fatigue and Protect Team Health

Posted by Carla Cheatham on Saturday, July 20th, 2019 in Building team resiliance, Spiritual Care Integrity and Excellence, The Power of Presence, Uncategorized

Resilience and Boundaries to Prevent Compassion Fatigue and Protect Team Health (a 4 minute read)

I teach boundaries to caring professionals and volunteers, based on both psychology, research, and my own human goof ups and successes over much of my adult life in social services and healthcare.

For me, the foundation of all healthy boundaries is this:

If I’m empty and need work to fill me up to make me feel okay, then I’ll need something from the interaction with patients and families, which means I’ll make it be about ME rather than what the patient and family need.

But if I’m already full, if I have my own life outside of work where I get acknowledgment and validation and warm fuzzies and love, then I won’t need it from patients and families.

When things don’t go the way I want them to, when symptoms can’t be completely managed. when people make choices that are hard for me to accept, when it isn’t all puppies and ponies, I won’t be as shaken because I don’t NEED things to go a certain way to feel okay.

So instead of giving up my life for this work, I need to first GET a life of my own and then bring the overflow of energy and peace and groundedness to those with whom I work, rather than draining myself to my dregs.

That’s the BEST thing I can do for patients and families, as well as my agency.

Now, I know bosses don’t always agree! We are far too often rewarded for over-functioning and bearing the stress of a system so the system won’t have to. For instance, if the census is too high and the staffing model is off and I work longer hours to compensate, I feel the stress, which means the system does not have to. If the system does not feel stress, it has no motivation to change and grow and become healthier.

We complain about it, but we also contribute by enabling the system, wearing our martyrdom like a badge of honor…to make us feel safe in our position, liked, and “okay”–See the cycle?

Certainly, setting limits and keeping healthy boundaries can be punished in small and large ways. It can feel scary to say, “No” to giving more than we have or more than seems reasonable and far beyond being a “team player”. We may even risk losing our jobs, so please don’t curse my name and ask to come live with me if you try this and it goes amuck!

But another key point of boundaries is this:

We must accept that we are responsible for our choices, even if we do not like our options.

Even if we fear not being able to find another job and not being able to pay our bills and going bankrupt and then being homeless under the bridge, we are still making a choice. Staying with a job that makes us miserable is still what we are choosing rather than facing the risk of life under the bridge.

And being at choice removes our status as a victim; it means we take responsibility for ourselves and let go of blaming everyone else, which feels a LOT better in the short term and is SO much more fun, but it also gives away our power.

We may be powerless to change circumstances or people, but we are not helpless to take action on our own behalf.

Living at choice rather than as a victim can immediately impact our sense of well-being, and greatly alter the lens through which we perceive ourselves and our situations.

So we take responsibility for filling ourselves up, and simply let our work fulfill us. We make good choices on our own behalf and model the good self-care we teach others. We focus on what we can change and how we can be part of a healthy and productive solution.

And we breathe, and we live and, little by little, we will change how healthcare is done by being the change we want to see.

Peace…
Carla

Based on the presentation, “Resilience and Boundaries to Prevent Compassion Fatigue and Protect Team Health” By Carla Cheatham

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization, Chair of NHPCO’s Ethics Advisory Council, and an adjunct professor at the Seminary of the Southwest and an Affiliate Associate Professor at the University of Maryland. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2019.

Resilient Leadership From the Air

Posted by Carla Cheatham on Wednesday, May 29th, 2019 in Building team resiliance, The Power of Presence, Uncategorized

I’ve bragged about Southwest Airlines and their employees before. Here’s another reason to do so!

Finished my gig in Philly and am at the airport juggling flight cancellations and delays due to weather.

It’s meant I’ve been around the very patient, helpful, and kind gate agents more than usual as I waited for my flight plans to be rearranged and confirmed.

I watched as a gentleman walked around to all the gate agents in this part of the Southwest terminal, gave them each a hug and big smiles, did a genuine check in to see if they’re doing ok, and asked if they needed anything.

The interactions were brief, as folks were busy doing their respective jobs, but they were also authentic and connected.

You could tell it brightened the staff and they were equally authentic in the appreciation and respect they returned to him.

I assumed he was a manager, based on his behavior.

As he walked away from one last hug and chat with the gate agent about to board us, I turned to the gate agent and said, “Now that’s good leadership!”

“Who, Mwanza? Oh, he’s not a Station Manager or anything. He’s one of our trainers. Every time he’s down here, that’s just what he does. He’s a good guy!”

I had a few minutes, so I ran over and caught up with Mr. Mwanza Melvin to shake his hand.

I told him I teach and write about resilient leadership (the talk I just gave here in Philly) and how impressed I was with the care he gave his teammates and students.

We talked about service, leadership, and customer service. He says he trains team members to actually SEE every single person that comes though and to treat everything as a customer service moment.

He told me I made his day and that sometimes he wonders if what he’s doing really makes a difference.

I assured him that, based on what I had just seen, and what I know about co-creating healthy teams, it does and so does he!!

We were both all smiles as we parted. I’m sharing this with his permission.

Sometimes, the seemingly simplest things can make a moment, that turns into a day, that becomes a lifetime. Mwanza seems like one of those humans, and it made MY day just to watch him.

The Tissue Effect: 3 Things to Remember When They Cry

Posted by Carla Cheatham on Monday, April 1st, 2019 in Uncategorized

The Tissue Effect: 3 Things to Remember When They Cry ( a 3 minute read)

When I speak via webinars or in person about BE-ing with Suffering, I’m often refer to “The Tissue Effect” and get a lot of questions about it. Below are 3 things to remember when patients, clients, friends, or even the checker at the grocery store, cry in our presence.

1.) Do NOT hand them a tissue.

When someone cries, what do most of us automatically do? Yep. That’s right. We scramble to hand them a tissue. It’s almost as if milk has been spilled and we’re in a hurry to wipe it up. It gives us something to “DO” when sitting with the discomfort of tears feels too much for us.

It even seems like the polite thing to do. To leave someone sitting there with tears (and other fluids) streaming down their face without offering a hankie or Kleenex can feel dismissive and uncaring. That is why counselors are trained to keep plenty of tissue boxes around, within arm’s reach of any seat in the counseling room. That way, they have access to what they need, but we are not put in the position of handing one to them, and here’s why.

Without meaning to, what can we subtly imply when we hand someone a tissue as they cry? Yep. That’s right. “Stop crying!”.

We may not intend to communicate that. But tears still have such a stigma of shame about them in our portion of the world that any hint of our discomfort with tears, added to the person’s own internalized shame about crying, can be enough to shut them down along with the emotions that may be releasing, as well.

2.) Find a way to sit comfortably with your discomfort.

Of COURSE tears make us uncomfortable. It’s hard-wired into our DNA to be on alert to the hint of any threat to the herd or tribe and respond immediately to make certain everyone is safe. The cries of a child signal us that something is needed. The cries of someone in trouble or injured need our quick attention.

But the tears associated with emotional release are a different kind of critter. They do not need to be “fixed”. They need space to move and breathe. When we constrict against them, they can feel even more intense. But when feelings are given room to just BE, the simple freedom can relax the intensity, if even just a bit.

Tending to our own need to tend to others’ emotional expressions instead of BE-ing with them is a huge step in our ability to show up well for others when they’re hurting.

Many fears come up subconsciously for us: What if others think I caused their pain? What if others think I’m a clod for just sitting here and DO-ing nothing? What if others judge me for being a bad (counselor, nurse, physician, social worker, spiritual care counselor, volunteer, friend, human being, etc.) because I’m not “making” them feel better (as indicated by them ceasing to cry)? These are just a few examples.

Another fear is that the tears will go on forever! I’ve heard research that indicates, however, that most persons cry on average of, guess how long…? Only 20 seconds! It can feel like an eternity, but if someone around you starts crying, just remind yourself that you can sit with it for 20 seconds, so just hang on.

Just give them a little room and a little time and a LOT of your non-anxious presence and you will have given them FAR more than you could have ever imagined, I promise!

3.) If you feel you just MUST offer a Kleenex, say something like this…

In the seventh and last post of my series on BE-ing with Suffering I mention the following,

“And please, if you do just HAVE to offer them a Kleenex, make sure you tell them this isn’t code for ‘please stop crying’, but support for them to feel free to continue crying as long as they need without being distracted by snot and tears!”

When I do offer a tissue, I reach it half-way to the person and stop, not in a teasing “psych-out” way, but in a pause that gets their attention. I gently say, “Please know I’m giving you this NOT so you’ll stop crying, but so you can feel comfortable crying as LONG as you need to.”

And then I sit quietly. If I know them well enough to know that touch is welcome, I may reach out a hand at some point, palm up, half-way. They are then welcome to take it and squeeze it in thanks and then let go if it’s not needed, or to grab it and hang on for dear life as long as they need.

If I don’t know them, and it seems appropriate, I sit silently for several minutes. At some point, if my gut nudges in that direction for their sake, not because I need to DO something, I may say, “If a hand would help, I’m here.”

Both of these actions are a matter of being finely attuned, paying attention to them and what they indicate they need and not moving too quickly at the risk of jarring them out of their feelings and back into their heads. Even such a kind offering can be another unwitting invitation to them to “suck it up”, which is the last thing we want to do.

Sometimes, they may welcome the break from their feelings. But other times, we’ve just cut off a faucet that doesn’t open easily or often, yet may need space to be cleared.

It is a subtle and significant art that will vary by personality, relationship, and circumstance, but one we can improve by being more intentional about our presence and noticing what we do and why we do it.

Constantly checking in with ourselves, rather than moving on auto-pilot to offer a tissue for instance, can sometimes reveal that what we are doing is more about tending to our own needs and discomfort rather than theirs.

The better we know, the better we’ll BE, which is most often the very best thing to “do”.

Peace to you…

When They Learn You Work For Hospice

Posted by Carla Cheatham on Tuesday, March 19th, 2019 in Hospice Whispers: Stories of Life, Spiritual Care Integrity and Excellence, The Power of Presence

WHEN THEY LEARN YOU WORK FOR HOSPICE (a 5 1/2 minute read)

“I often joke that if you want to suck all the air out of the room at a dinner party, tell folks you work for hospice…”

I was asked to write more about how to “recover” when we as hospice staff, or any type of caring professionals,
experience various reactions from others when they learn what we do for a living. Whether we’re out socially or
even at the grocery store, we often face *gasps* and looks of sympathy or repulsion or admiration followed by,
“Awww, you work for hospice…?!”.

Below are just a few examples of how others respond to the news and how I work to balance being caring while also caring for myself. Like anything, my strategies are a work in progress, so I look forward to hearing what YOU experience and do, as well.

Taking Time Off…
One self-care ritual I teach to healthcare staff revolves around their name badge. The goal is to avoid thinking
about work until they put their badge on for the day. Then, at the end of their shift, I encourage them to debrief
whatever they need to from their day and then, once their badge comes off, to put their workload and concerns
from their shift down and leave them there.
I have a special place I keep my badge and I leave my work concerns there with it. I do my best to not pick
them back up until I put it on the next time. It seems to help many of us because it’s a tangible boundary we
set for ourselves and a commitment we make to our loved ones to not bring our work, or the energy of it, home
with us.
We need moments when we’re not “on” as a hospice worker, with all the expectations and assumptions that
knowledge can bring up in others. There are times when I literally do tell the friends I go out with, “Tonight, I do
NOT work for hospice. I screw toothpaste caps on toothpaste tubes in the toothpaste factory for a living!”
I honestly do LOVE it when people tell me their stories…most of the time. But there are days I need a break, to
just be Carla and not any of my titles or roles; to not figuratively wear my badge that indicates I’m a helper and
open for business. If I don’t take time off, I become a crispy critter not fit for human consumption. Practicing
what I teach about good self-care is the BEST gift I can give to others, even when they don’t like me having a
boundary, at least not with them.

I do care. I do want to listen. And I also need space to listen to myself, first, so I can hear others from a grounded, centered place from which I can bring my best self, (not a hot-fried mess).

Most often if I or someone else spills the beans about what I do for a living and I see and/or feel people start to
react to the news, I’ll quickly respond as gently as I can, “It’s actually the best gig I’ve ever had, and even the
most fun. But I’m off duty today, so who’s seen the newest Star Wars movie…?” The goal is to politely decline
to go there, to respectfully set a boundary that I’m not up for having that talk today.

Protecting Myself From Being a Pariah…
Holding my boundaries when I’m off duty can also be about refusing to pick up the Grim Reaper scythe,
because the news can be quite a downer for the party’s energy, and it never feels good to be the “buzz kill.”
People sometimes edge away from me and visually scan for the nearest exit or excuse to go talk to someone
else, if they’re uncomfortable with death.
Other times if I face the social obligation of responding to, “What do you do?”, I’ll give the honest answer,
quickly followed by the toothpaste factory line. They usually laugh in relief, as it lets them off the hook from
talking about a squeamish topic and gets me out of having to deal with what I know isn’t rejection of me, but
cumulatively can be wearing.

Putting Down the Halo…
It’s quite an honor to receive persons’ gratitude for this work we do, and to be told so often what “angels” and
“special people” hospice workers are. I never want to verbally or emotionally shove gratitude back at someone
and shut them down. That doesn’t feel good either.
But let’s face it, that freaking halo can get reeaaallly heavy!! Just like we need time to not wear our badges, I
think we also need time to just be human, have a drink, smoke a social cigar, tell an off-color joke, make out on
a date, whatever it is that we would never do in front of patients and families.
The point is to not have to be an “angel” or “special person” all the time. We have to be able to be real and
down to earth and shop for groceries and have a bad day and even have meltdowns and a touch of road rage
without feeling like we’re diving head first off of others’ pedestals.
Besides, we’ve all seen what happens when public figures begin to believe their own press. We don’t want to
fall into the trap of thinking of ourselves as constant heroes or somehow above the rest of humanity and
become pompous arses on one extreme or burned out shells of humans on the other.
So in the face of such admiration, I’ll thank them and then say, “But you know, I missed the first three days of
fractions in 3rd grade and never caught up, so I think it also takes special people to be accountants…” and I
smile. It may take them a moment, but then they get it: We can all do our work in a special way if we just show
up well for others, regardless of what our job title may be.
It levels the playing field and I’ve found it to be an easy and yet connective way to politely decline the invitation
to the top of the medal stand. It helps keep me humble (hopefully), and protects my own neck and back, as
well as my social life, from the weight that comes with special status.

How to Not Listen Without Being an Ogre…
Again, I do love collecting and hearing others’ stories. People fascinate and inspire me. Besides, as an author
I love a good tale. But sometimes people still need a place to process their grief, and when others find out we
regularly play in that sandbox they come running to show us their toys.
Please hear me, I don’t mean to be crass or belittling to those who are in a place of grief and deserve to have
their stories heard again and again as long as they need to tell it. What I do mean to say is that we can softly
decline to be at work when our badge is off.

Cabbies turn off their lights when they aren’t on duty so folks won’t feel abandoned on the side of the street when the yellow car passes them by. We can, too. Just because someone around us has a need, doesn’t mean it is our responsibility to fill it.

We get to have limits. We get to have time off. We get to cry “uncle!” when we’ve had enough. We are not to
be used. We are not here to be taken advantage of, though I am certain that is never the intention of someone
who needs to tell their hospice story.
If I have it to give easily, I will listen to their story and offer words of support. If I don’t have it to give, however, I
owe it to everyone to take care of myself by not trying to give others a drink from my empty well.
So when I do not have it to give, I typically listen for a moment, then place a kind hand on their arm and quietly
say, “I appreciate and want to hear your story, but…(I’m distracted by the gathering, promised my family I
wouldn’t work tonite, am pretty exhausted from my week, etc.). I’d be glad to (have coffee, chat by phone, talk
afterward, find another time) later when I have my full attention to give you.”
That’s just an example of some options. Find what feels genuine and right for you and your personality and
voice. But find something. Make a game plan with a friend before you go out who will agree to come and play
“extract the bereavement counselor/chaplain/CNA/nurse/physician/social worker/staff member/volunteer” and
help you find a way to gracefully exit.
Allowing persons the dignity of finding their own sources of support from loved ones or professionals and not
rescuing them in the moment when they happen to stumble upon a hospice worker does not make you, or me,
a bad guy. We are not abandoning them.
Our title is not an open invitation that means we must listen to anyone, anytime, anywhere anymore than it is
fair or appropriate for me to drag a mechanic out of a cocktail party to change my oil on the spot because I’m
overdue for an oil change.
Again, I don’t mean to be crass about emotional pain, but if I’m cavalier about my own needs, I’ll burn out my
engine and be no good for anyone.

How to Not Take One For the Team…
Other times, a person’s experience with hospice has not been positive. We aren’t perfect. We do make
mistakes and have service failures. Personalities collide, miscommunications happen, values conflict,
expectations go amuck, and grief can get taken out on hospice professionals and agencies. I was verbally attacked by a former friend who had a very negative perception of her experience with hospice surrounding the use of artificial nutrition with her loved one. I don’t know the story. I wasn’t there. But I became a target when I posted an article about end of life choices that hit a tender spot for her, and it was on.
She called my ethics into question and the frustration she felt about her situation came out at me in a flurry. At
first, I listened and tried to be a space of healing for her obviously complicated grief. There came a point,
however, when I had to put down the rope and refuse to play. I simply didn’t have it…and, it wasn’t my job to
fix her experience of pain. I felt for her, but long ago a wise therapist colleague said, “We help no one when we
allow them to be their worst selves, so do not volunteer to be their punching bag.”
Certainly, there are therapeutic exceptions when clinical judgment says we refrain from taking transference
personally and offer others safe space to work through their stuff, but I wasn’t her counselor, nor was I her
chaplain. I wasn’t getting paid and we had negotiated no treatment or care arrangement of any sort. I was not
obligated to hold space for her struggle, because holding such space takes energy that I get to reserve for my
work while using my down time to do just that, let down.
Sometimes, just like listening to others’ grief stories, I’ll listen if I have it easily to give. But if I don’t, I put my own oxygen mask on first before I try to help others breathe.

I don’t know how these will land with you. I’m curious about other scenarios and responses you have found
that work well. I hope you’ll share them, because this work is challenging enough and it helps to know that we
aren’t alone in navigating sometimes choppy waters.

Peace to you…

When a Patient Asks You To Pray: 5 Things To Consider

Posted by Carla Cheatham on Thursday, May 17th, 2018 in Hospice Whispers: Stories of Life, Spiritual Care Integrity and Excellence, The Power of Presence

When a patient asks you to pray: 5 things to consider (a 4 minute read)

Every time I train healthcare professionals about ethical and respectful spiritual care for persons of all faiths, backgrounds, or even no faith, I’m ALWAYS asked this question:

“What do I do if they ask me to pray?”

Nurses, aids, physicians, and volunteers most frequently ask this, and I greatly respect them for doing so! We want to neither neglect persons’ R/S/E (Religious/Spiritual/Existential) needs nor abuse our position of “power” in the caregiving relationship by overstepping boundaries. I train professionals to, among other things, find the “Sweet Spot” in spiritual care.

The “Sweet Spot” is that space in the middle from which we learn what patients and families believe, then help them access their beliefs to find meaning, peace, and comfort.

The fact that they want to handle such moments thoughtfully indicates a humility and compassion in care-giving that bodes well for their professionalism and their ability to avoid either extreme of what I call “spiritual malpractice”.

Even professional, clinically trained spiritual care counselors (chaplains) are taught to tread carefully when offering prayer. We do not want persons to feel obligated to accept because they don’t feel comfortable telling us “No”. So what DO we do in those moments?

1.) Start with a patient-centered view–I believe that merely wanting to prevent harm by respecting a patient or family member’s boundaries and honoring their views is well over half the battle. So we’re already off to a good start!

2.) Let them initiate–Many fear that NOT offering to pray may offend or abandon a person who is in distress, but there is another way.

Even as a hospice chaplain, the member of the team MOST expected to offer prayer, I’ll simply state at the first visit, “Some persons want to talk, others want me to sing or read meaningful texts with them, some just want to sit quietly, some want me to pray, and others just want to play checkers. Whatever it is you would like, I’m happy to do.”

Before I leave, I’ll ask if there’s anything else I can do for them. At that point, some ask me to pray while others do not. I indicate my willingness, and they can choose whether or when to ask. What I am willing to give freely, I must be willing to never have requested.

Since this is their journey, their illness, their process, their life and it IS all about them, I get to have no ego invested here. I trust them to take the lead by asking for what they need. If I offer directly to pray, it can be very hard for them to refuse, even if they absolutely do not want me to do so.

That is why I recommend non-spiritual care professionals allow the request to come from the patient or family. They may have never felt comfortable setting boundaries.

Now, at perhaps the most emotionally and physically vulnerable time of their lives, they may be even more wary of telling the persons bringing the good drugs, help with bathing and Medicare forms, supplies, support for their families, etc. “No” and risk offending us.

There are creative ways to be available without putting them in that awkward position.

3.) Determine your own comfort zone–Some professionals ask me the “do I pray” question with a deer in the headlights look! Praying aloud is not their thing, yet they don’t want to feel like a clod and abandon someone in pain if they ask for prayer.

If you do NOT feel comfortable praying aloud, here is a sample response that can be said apologetically and gently:

“Praying out loud isn’t something I’m (comfortable with / good at / experienced with, etc.) But I’d be happy to sit with you and hold your hand while we both pray in silence or you while pray aloud. And I’ll definitely be holding you in my heart.”

If it feels appropriate, you can also offer to call for one of us! “You know, this is what our spiritual care counselor (chaplain) is trained to do. May I call on him/her?”

4.) Find their words–If you DO feel comfortable praying aloud, make sure you know how to pray in a way that honors the patient / family member’s beliefs. The quickest and simplest way to do that is to ask,

“How do you typically begin and end your prayers?”

Using the language that is comfortable for them honors their right to choose or refuse medical interventions and, since we’re talking about healthcare settings and professional relationships here, that’s what this is! This prayer is for them, not for us, and they deserve to lead the way.

It is also important to ask them what they would like you to pray for. If they ask you to pray for healing, ask them what healing looks like to them. Then, equipped with words from their own heart, you can offer those words back, out loud, as a prayer that respects their needs.

Even if you fumble, most people can tell when we are honestly trying to be respectful, and they so appreciate the heck out of that they can typically overlook imperfect attempts to meet them where they are.

It’s important to note that I’m not asking you to deny your own faith or views. For some, the two are not mutually exclusive. But for others, it is simply too big of a leap from what feels do-able for them. That’s ok! That’s why you have someone on the team who IS trained to be able to care for the needs of persons of all views.

Part of our professional responsibility is knowing when to “refer out”. There is no shame in doing so. The only shame would be to, even if well-intentioned, cause harm to those for whom we are committed to honor and care.

If you do not feel you can comfortably be with them using their words, it is completely acceptable to refer back to #3 above and then call for the spiritual care counselor (chaplain)! There is no reason for anyone, patient or professional, to suffer offense here.

5.) Follow up–It is good practice to touch base with the spiritual care counselor (chaplain) with whom you work. If a patient tells me they’re having a physical symptom, I call the nurse and let him or her know. If they’re struggling with family dynamics, I contact the social worker.

It’s no different if someone expresses spiritual symptoms. Coordinating care with the professional responsible for overseeing that aspect of a patient’s treatment plan is important and respects interprofessional boundaries.

I’ll write more about honoring and finding the “Sweet Spot” in spiritual care another day. For now, I hope something of this is helpful to you as we all seek to care well for that sacred trust placed in us by persons walking a tremendous journey who deserve nothing less than our very best skills.

Peace…

Carla

Don’t Feel Sorry for the First Responder You See Working on a Holiday.

Posted by Carla Cheatham on Sunday, December 31st, 2017 in The Power of Presence

Don’t Feel Sorry for the First Responder You See Working on a Holiday, guest blog by Park “Sparky” Knight (a 3 minute read) —First published on 12/26/17 by the author on a social media post. It was too good not to share, and I am grateful to Sparky for graciously allowing me to do so.

I do not feel sorry at all for the first responders out there working on Christmas Day today. In fact, I’m jealous and I miss the times I did it. For back then I had been welcomed to feasts at fire and EMS stations that you have never seen the likes of and dined with old friends alongside strangers that I just met.

I have sat in a parking lot late at night and exchanged stories of our youth and the presents under the tree through the open window of a car with other officers.

I have raced through the night the blue and red lights of my vehicle dancing off the trees and fog responding with a purpose you may never have felt.

I have walked into dispatch with the decorations, cookies and matching elf hats to be greeted with smiles and warmth and twisted humor you will never experience.

I have been invited into stranger’s homes and seen decorations that range in detail from what they could barely afford to Walt Disney himself must have been involved. All displayed with heart, purpose and soul.

I have had strangers offer to buy me breakfast, lunch or dinner knowing fair well that I could afford it much more than them.

I have been invited to that secret room behind the nurse’s station where hot cocoa with tiny marshmallows and love is served without expectation of anything in return.

I have been present in stranger’s homes when the holiday has turned to panic and explained that my friends and I are here to help.

I have been in attendance at shift briefings where on that special day it is acceptable to openly express the camaraderie that you have an entire second family of very decent people you know you can count on.

I have been first on scene to a tragic situation being the only one there that knows that I am not alone. Soon the area will be filled with my friends and colleagues that are also working that holiday and have the capability of bringing hope and order to the situation.

I have sat late at night in my car and heard the voices of young people caroling from door to door. Sounds of which would make angel’s hearts warm.

So, don’t feel sorry for the first responder you see working on a holiday. A little respect is fine but feel jealous instead. For they have experienced things you never will and felt things you will have no ability to understand.

They don’t have to hear stories about hope, love and renewal. They make them.

As Christmas day slowly becomes the next day I would like to thank all of my friends that are still working to make a difference and wish all of you a Happy New Year.

About the Author:

Park “Sparky” Knight joined the Texas A & M University Police Department in June of 1987 where he served as a Police Officer. He also served as the Faculty Staff Advisor for Texas A&M’s Emergency Care Team, the student medics who served campus events and were the first responders after the Bonfire Collapse in 1999, where he and Carla first met and almost instantly became family. He retired in December of 2015 and now enjoys his leisure time and travels to reconnect with students he met and worked with along the way.

About the blog host:

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest and an Affiliate Associate Professor at the University of Maryland. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2018.

Emotional Intelligence in Healthcare: SEE-ing Grief When Expressed as Conflict or Anger

Posted by Carla Cheatham on Friday, December 1st, 2017 in Building team resiliance, Spiritual Care Integrity and Excellence, The Power of Presence

We do not “treat” grief, we sit with it, so neither should we pathologize it.

One of the most poignant, and challenging, presentations in my training curricula is about Being with Grief Expressed as Conflict and Anger.

It is easy in the caring professions to feel overwhelmed by those who “come at” us with their anger or push back in conflict against the care we are trying to extend.

How often have we heard colleagues, or ourselves, calling a patient or family members “crazy”, “resistant”, “entitled”, “control-freaks”, etc.” when really what we are dealing with, what the patients and families are expressing, is part of the normal, healthy, understandable grief process as they grapple to come to terms with a world that has been turned upside down?

Bereavement isn’t a nice, neat, tidy, linear process that always looks like quiet, dainty tears or even the Oprah “Ugly Cry”. Those expressions of grief can be MUCH easier for us to accept and respond to with compassion than grief that comes out as anger.

And conflict? What we often label as such is usually simply a part of the “bargaining” portion of the process of grief.

Bargaining isn’t just what we often think of as, “Mom, if you get me a puppy I’ll clean my room every day” or, “God, if you’ll let this not be cancer, I’ll be a nicer person.”

Bargaining can also show up around and after a grief-event in the form of “If Only…”

“If only the doctors had paid attention…

“If only she had gone in sooner…

“If only I hadn’t…”

“If only YOU had…”

We think we need to feel as if our world is predictable and under control in order to feel safe. If bothers us to remember that absolute safety is an illusion. Threats to that sense of illusion and sense of orderliness can throw us off kilter.

One easy defense mechanism to feeling in control again is to find some “reason” for why things happened as they did. If there is someone to blame, even ourselves, then we don’t have to feel so threatened by the vulnerability of living this messy, imperfect, often unpredictable life.

So our brains will make bargains to explain away the unexplainable. This can look like conflict amongst families and resistance to treatment.

If we respond with logic or defensiveness to the actual emotion that is being expressed in a thinly-veiled disguise, we miss the boat, and miss the opportunity to serve the true needs being expressed. We miss the chance to care for and resolve the situation effectively.

Now, to be clear, it NEVER feels good to be attacked, especially when we’re trying to help. But if we take these moments personally, and if we are not aware of our own relationship with anger and conflict, then we may get triggered and our defenses come up, making us of no use to anyone–not them, and not our professional role in that moment.

When we are triggered in this way, we also may lose our hold on logic and go into an automatic emotional response of fight, flight, or freeze.

On the exterior, we may SOUND logical, reasonable, explanatory, calm, cool, and collected and professional…but this may just be a very sophisticated defense to protect us from the anger and conflict that scares us!

Our discomfort leads us to distance ourselves from their pain, and from them, which does no one any good, erodes trust and connection, and leaves grief sitting alone out in the cold with only our logic for comfort.

One of my trainers and co-presenters recently shared with a group his own realization about how still and quiet he gets when conflict and/or anger arises near him, but not in a calm way. No, he’s panicked and shut down as a protective measure, which means he checks out and leaves the other feeling abandoned, whether it’s his wife or a patient and family.

Knowing this about himself, he pays attention and notices when this happens so he can work to both take care of his own internal discomfort AND consciously stay present with the situation, even if he needs to step away for a few moments to catch his breath and then come back in a better place.

It was a gift for this respected man to admit this to a room full of colleagues, with acceptance for his own humanness and ownership of his own growth and a lack of shame or self-deprecation.

It led to a rich conversation where participants were similarly vulnerable and honest, with themselves and each other, about their relationship with anger and conflict and how to improve their ability to respond.

Hear me, I do NOT advocate allowing ourselves to be someone else’s emotional punching bag. Supporting someone else in being abusive doesn’t serve anyone. But we can still have boundaries and do good self-care AND show up well for others without pathologizing their grief or the way it is being expressed.

Sometimes, we think we are being damaged by someone else, when actually, we aren’t.

Buddhist teacher, Pema Chodron, tells the following story about what we call heaven and hell, good and bad, etc. It reminds us that many things only exist as the stories we tell ourselves:

“A big burly samurai comes to the wise man and says, ‘Tell me the nature of heaven and hell.’ And the roshi looks him in the face and says: ‘Why should I tell a scruffy, disgusting, miserable slob like you?’ The samurai starts to get purple in the face, his hair starts to stand up, but the roshi won’t stop, he keeps saying, ‘A miserable worm like you, do you think I should tell you anything?’ Consumed by rage, the samurai draws his sword, and he’s just about to cut off the head of the roshi. Then the roshi says, ‘That’s hell.’ The samurai, who is in fact a sensitive person, instantly gets it, that he just created his own hell; he was deep in hell. It was black and hot, filled with hatred, self-protection, anger, and resentment, so much so that he was going to kill this man. Tears fill his eyes and he starts to cry and he puts his palms together and the roshi says, ‘That’s heaven.’”

So what is the story we are telling ourselves about another’s motives and intentions, feelings and facts (the stories they are telling themselves?), and how it really does, or does not, impact us?

How can we let go of those stories in order to not take another’s words or energy or emotions or accusations personally and simply be present without defense, hearing the emotion that needs room to be acknowledged, validated, accepted and even just to move and breathe?

Think of it this way–

How did your parents, or primary adults in your life when you were a child, express their anger and/or handle conflict?

Now, how did each of them respond to the other’s style of expressing anger or handling conflict?

So we have two expressive styles and two receptive styles for anger and conflict.

Which did you adopt?

Because the chances are, you learned and now use one or the other if even to a small degree–it’s pretty hard-wired in after seeing it modeled from birth!

At about this moment, when I use this exercise in trainings, the room grows veeeeerrrrrrryyyyy quiet as lightbulbs go off. A few participants will nod their heads with a knowing smile, because they’ve done this part of their own personal work and they know where they tend to get tripped up by conflict and anger.

Others wriggle in their seats and look at their watches, wishing their phone would ring with an emergency with a patient, giving them an excuse to step outside.

And others sit and breathe and let it sink in.

And then I remind them of this quote that I often use from University of Houston School of Social Work researcher and professor of TED Talk and Oprah fame, Brené Brown:

“Feeling vulnerable, imperfect, and afraid is human. It’s when we lose our capacity to hold space for such struggles that we become dangerous.”

None of us got into this field to become dangerous.

When we are not aware of our own internal struggles, they will unconsciously drive our interactions with and reactions to patients and families with whom we work.

I remind them that none of this is an invitation to shame, but compassionate understanding of ourselves, and others. The goal is not to be perfectly evolved or infallible. The key is to be aware and truly present; to be mindful enough of our own “stuff” that we are aware when it gets stirred up when dealing with others.

If we tend to it, grow with it, and learn to respond rather than react, what an unprecedented difference we will make in the lives for whom we show up…

…starting with ourselves!

Peace,

Carla

Taken from the Presentation “BE-ing With Grief Expressed as Conflict and Anger” (c) 2013 SCIE Publishing and Carla Cheatham Consulting Group, LLC. All rights reserved. Please feel free to share this content with proper attribution and credit given. To learn more about my training and consulting business, go to www.carlacheatham.com

Building Team Resilience: Increasing Support, Community, & Appreciation

Posted by Carla Cheatham on Tuesday, October 24th, 2017 in Building team resiliance, Spiritual Care Integrity and Excellence, The Power of Presence

Building Team Resilience: Increasing Support, Community & Appreciation (a 3 1/2 minute read)

Leadership experts these days agree that employees are our most important customers, and I believe this to be true.

One of my favorite, and one of the most effective, hospice administrators I’ve known often says, “If we take good care of employees, they’ll take good care of patients and families. If we do that, the money will come.” She was so very right, and our profit margins proved it.

Research shows that employees who feel supported and fairly compensated with good support are less likely to experience burnout.

Resilience literature also tells us that feeling connected increases our ability to not only survive but to actually thrive through challenging times.

Given the uncertainty many healthcare organizations are facing these days, we can’t afford to NOT invest time and energy into creating a culture of support, camaraderie, and cohesion, and community amongst our teams.

One practical way we can do this is to identify what is meaningful to team members; how do they feel most appreciated, cared for, and supported? An easy way to begin this conversation is to ask employees to take a simple on-line quiz.

Many are familiar with the popular book, The 5 Love Languages by Gary Chapman. Before rolling eyes and writing this off as too fuzzy woo woo, managers and leaders would do well to at least consider this option.

The 5 Languages, or things that communicate to someone they are cared for, include:

Gifts
Words of affirmation
Quality time
Acts of service
Touch

You can take the quiz on the love languages website by clicking on the “Learn Your Love Language” tab. The site will ask whether you are taking this for yourself or your child, then whether you are in a relationship or single. It will direct you to the correct version of the test for you to take on-line or to download as a PDF and take and score on your own.

I encourage leaders to identify their own and ask their teams to do so, as well. Take a few moments at your next meeting to discuss this as an agenda item. What were everyone’s results? What surprised them about their scores? What surprised them about others’ results?

Typically, one or two styles will stand out as most important and others will score as less so. The way we most like to receive care will often be the way we express it. That’s fine, if others share our preferences but, if not, a major disconnect can occur.

Buying coffee shop gift cards for employees to whom gifts mean little, but for whom words of affirmation mean the world, misses the mark. For the latter, taking a few extra moments to tell the person how much something they did or how they handled themselves in a situation means to you and thanking them for it may mean so much more.

A literal pat on the back, handshake, or hug (depending on your team culture) may mean far more to someone for whom touch communicates connection than will ordering lunch for the team to share before a meeting (quality time).

Since we tend to express care in the language that is most appreciated by and natural to us, many persons unintentionally botch attempts at extending care because they are speaking in the language that means something to them, rather than the intended recipient. Knowing this can a) help us potentially identify someone’s preferred caring style if we do not have their scores and b) help us see others’ attempts to express care to us in ways we might ordinarily miss.

The simple act of asking team members what helps them feel appreciated can mean the world to some teams. Following through on finding creative ways to match your support with their preferred language can mean even more.

When you ask, be prepared to hear about higher compensation and benefits, but remind them we’re speaking of the so-called intangibles of day to day interactions; the things leaders are more likely to be able to control without top leadership approval.

Certainly, advocate strongly for fair compensation, since a sense of fairness can also prevent dissatisfaction, burnout, and turnover, but we cannot forget the seemingly simple but incredibly important compensation we receive when we feel appreciated and valued in ways that extend beyond the paycheck.

Another intangible benefit workplaces can provide team members is the sense that their work is helping them to be better in other areas of their lives. For instance, in starting the conversation amongst your team members about their Love Languages, persons will not be able to help but immediately consider their significant others, children, and other family and friends and what their love languages may be.

One nurse said, “So when my husband mows the yard and expects me to be all impressed, it may be that his love language is acts of service and he assumes his doing that will mean something to me. It’s meant as an act of love, but I miss it because it’s not my language…OHHHHHhhhhhhh!!!!”

Often, they begin to try to figure out, or they even take the time to ask, what is most important to their kids or co-workers. As light bulbs go off and understanding increases, persons can feel more connected, in their personal and work families; they can ask for what is more likely to speak their language and find ways to give that to others, as well.

Imagine the conversations that can take place as we intentionally consider others’ love

languages and a attempt to match our efforts with their preferred styles. Secret holiday gift-giving in the office will never be the same!

Hopefully, the impact will be seen in employees having an increased sense of truly feeling valued, appreciated, and cared for at work.

For what it’s worth.

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest and an Affiliate Associate Professor at the University of Maryland. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

Respecting Grief

Posted by Carla Cheatham on Thursday, October 19th, 2017 in Uncategorized

Respecting Grief, a guest blog by Susanne Slay-Westbrook (a 3 1/2 minute read)

Susanne is a contact through the mental health community who has an interesting take on working with grief using respect as a foundation for connection. I greatly appreciate her willingness to share her insights here.

It may seem odd to consider respect within the context of the grieving process. We typically think of empathy and compassion as the appropriate responses to emotional pain. And they certainly are. However using the construct of respect, I believe, adds yet another layer of understanding and therefore a stronger foundation for healing.

For empathy, or the Greek “en patheos,” means “in feeling” and compassion means to be “with passion” or concern; yet the etymology of the word respect is respectare or respicere, meaning “to look again.” To take another look, to reconsider, is to respect, which involves both cognitive and emotional processing. It also means consideration of the entire person and the entirety of their life experiences, as they have experienced them.

This distinction is particularly germane to grief work because the process of grieving is so very personal and unique for each individual. The more we can help clients honor their grief as a healthy response to painful events and walk with them through some of that grief, the more we allow them to process it in the way they most need, without judgment. All or some of the Kubler-Ross stages of grief may appear in various orders and time spans, as they need to occur for each individual. It is important to allow each person to be the driver of his or her own journey.

Most significantly, the grieving person and process should never be in any way pathologized. Grief is a very normal process that all of humanity experience. The fact that each of us do it differently doesn’t suggest deviation from the norm; it simply expands the concept of “normal.”

According to Dr. Joanne Cacciatore, “Grief isn’t a medical issue. Grief is an existential, deeply human issue.” [the MISS Foundation] Therefore, unless a client is at significant risk of self-harm, medication should not be used at all or if so sparingly as a last resort, i.e. in the case of someone with previously diagnosed mental illness.

If we are willing to step into the darkness with the client, experience with him or her, the sense of despair and suffering, then we begin the process of helping to find a flashlight, not for us to shine on the client, but for him/her to shine onto her/his own darkness. At first, this flashlight will seem to have no batteries, emitting no light, only accentuating the darkness, but also honoring the existing power of it. By doing so, letting the flashlight feature the darkness, the client is more able to show it to us and to perhaps see it for themselves a bit differently, as something separate, not quite so commingled in his/her identity, something to be revered on its own. As you both sit in this darkness, its intensity and disquieting presence create awe. Honor the power that it has. The senses can then begin to adjust. Audio, smell, taste and touch, as well as visual acclamation to the darkness begins to make it more bearable and the flashlight can start to shine dimly, but only after such complete recognition of the darkness is fully realized by both therapist and client.

Susanne Slay-Westbrook has been a in the mental health field for the last 40 years. As a Licensed Professional Counselor-Supervisor and Licensed Marriage and Family Therapist-Supervisor, she has worked with a wide variety of clientele including the intellectually challenged, young children in low income areas, the physically challenged, adults and children with both psychiatric and addiction issues, persons dealing with death and dying and other grief issues, as well as with couples, families and individuals dealing with trauma and interpersonal conflict.

Susanne has written two books related to her work: A World of Respect (2001); and Respect-Focused Therapy (2017, Routledge)

Respect-Focused Therapy (RFT) is a foundation on which all modalities and techniques used in therapy can be strongly grounded, in order to produce sound, effective outcomes. This approach offers clients the opportunity to gain experiential understanding of being respected, possibly for the first time, from the therapeutic relationship and then be able to heal old wounds by creating more respect for self and others in the therapeutic process.