fear :: Carla Cheatham Consulting Group

Archive for fear

Retaining Emotional Health in Professional Caregiving Part I: Introduction

Posted by Carla Cheatham on Tuesday, March 14th, 2017 in Spiritual Care Integrity and Excellence, The Power of Presence

Every week I receive an email or phone call from a colleague in the professional caregiving field from folks who are worn out, burnt to a crisp, feel helpless and overwhelmed and don’t know what to do about it. I speak to HR Directors and Clinical Managers who are desperate to know how to help their teams.

I’m asked more and more to speak about healthy boundaries, self-care, resilience, compassion fatigue (though don’t put those last two words on most continuing education proposals or they’ll get kicked out for being too froo froo, according to my friends in the know!), and other similar topics.

Certainly, in-person trainings are the best way to approach and care for these needs in organizations and amongst professionals, but I’m going to share a series of posts designed to give more of my content to all of you around these issues. My hope is that it will be of some help to you and your colleagues, save a few bald spots and ulcers (and even suicides), and support managers in keeping good staff.

It stinks to see good clinicians leave a team and walk away from professional caregiving because they’ve been overworked, underappreciated, under-supported, outright mis-used, and/or not trained well in how to take care of themselves and practice resilience while doing some of the toughest of jobs.

At the rate we’re going, I’m surprised more aren’t leaving the field and deciding working for the bomb squad is less dangerous to their health than caregiving. We stay because we love what we do, we’re good at it, we make a difference, and we feel absolutely built for it. Sometimes, though, the problem is that we love it too much, and need someone to pull us back from the edge of unreason by the nape of the neck and nudge us gently but firmly toward greater emotional health.

For the next several weeks, this will be my goal.

I’ll cover the history of burnout and compassion fatigue, signs and symptoms and what the research tells us about its causes and cures. As a sneak preview of the answers to those latter two, I’ll cover boundaries—bad ones lead to us be crispy critters—and resilience—more than just a buzzword, it’s a well-documented source of health, well-being, and longevity.

Part of this conversation involves the stories we tell ourselves and the ways in which we find our own sense of meaning in suffering, not to spoon-feed it to others, but to help us remain grounded and centered in a place of peace and empathy rather than getting caught up into the drama and drug under with them.

I’ll talk about what all of that really looks like in practice, how we off-load grief and manage our counter-transference that naturally arises because we’re human, and how we know when we’ve gone too far. Then we must consider how supervisors and colleagues can handle it when members of a team, the whole team, and/or managers go off the rails and we’re surrounded by dysfunction without contributing to the tangled mess, ourselves.

There’s more, but I hope this is enough of an overview and tease to have you be watching for the rest of the series. Business leaders know this—it costs more to find, recruit, hire, and on-board new staff than it does to take good care of and properly train the ones we already have.

Thankfully, they’re paying more attention to hiring the right fit and supporting them well in their positions so they won’t go anywhere. I give huge kudos to leadership that sees these problems and are seeking to remedy it, willing to go beyond lip-service and put real resources behind these efforts.

One durable medical equipment (DME) company that works with hospices nation-wide has done exactly that—hired me to develop hiring criteria so they hire technicians (drivers who deliver and set up needed items in homes and facilities like hospital beds, O2 concentrators, wheelchairs, etc.) who have the attitude of service to be able to walk into rooms or homes where a loved one has an illness that is terminal. Once they’re hired, they want me to train their technicians to be able to walk into any situation without fear or fumbling. I could have reached through the phone and hugged them when they called with their recognition of need and resulting request!

So, let’s do this! If there’s a particular topic you most want and need, let me know, and I’ll try to make sure to work it in. I’ll look forward to hearing your thoughts as the series goes along.

For what it’s worth.

Peace,
Carla

How Physicians Maintain Their Humanity

Posted by Carla Cheatham on Wednesday, August 31st, 2016 in Spiritual Care Integrity and Excellence

While attending college in my undergraduate years, I had a significant and painful medical issue that required multiple specialists over the course of a year.

Young, scared snotless, with very little support on the journey, I got a crash course in navigating the medical system, medical advocacy, and interacting with physicians and other medical personnel. Many were absolutely amazing! Others, well, not so much.

As afraid and overwhelmed as I was, physically as well as mentally, my emotions were already on the ragged edge. I was also in a small, rural area where respect for women, especially young and outspoken and educated ones, was not at it’s peak in the late 80’s.

To be blunt, misogyny was a daily experience, especially with some of the physicians. Finding my voice was necessary to make certain I got the care and answers I needed. It was awful. And I’m eternally grateful.

I learned a lot about what did and did not work well for me when any medical staff person walked into the exam or treatment room.

I quickly noticed the mannerisms and ways of engaging that made me relax, feel safe and seen and heard; which ones felt condescending, dismissive, shaming, and made me want to finally burst into the tears that were always brimming in my shell-shocked 19 year-old eyes; and which ones felt respectful, reassuring, and filled me with hope and confidence in myself and my provider.

My major was psychology, so I did what I knew to do as a fledgling research geek–I dove into the literature. I found myself studying Norman Cousins’ book, Anatomy of an Illness, the works of Selye, Ader, Cohen, and Felten. I started learning more about the mind-body connection and the burgeoning field of psycho-neuro-immunology. I was hooked. The data was proving what we already instinctively knew. Among other things…

The way a clinician interacts with a patient can be just as healing, or detrimental, as the treatment provided.

For those medical staff who saw me, heard me, and treated me with dignity blended with tenderness and patience, “Thank you” is not a big enough word! As I look back now on that barely-a-young-adult me who could now be my own child, I am filled with gratitude for those who showed up well for me during such a trying time.

One of my greatest lifelines became the pharmacist at the local grocery store. She took time to answer all my questions, helped translate physician instructions that had gone over my deer-in-the-headlights psyche, and was always so gentle and caring. She understood when her kindness finally broke the dam on my hold-it-all-together shell and released my tears.

Over 26 years later, I just teared up while writing this in appreciation for how much of a difference she made in my experience. She probably has no idea how much she meant to me. (Her bosses did. I wrote a letter to corporate thanking them for having someone so compassionate working for them!)

No matter what your role in the medical field, never underestimate how healing your presence can be to someone overwhelmed, in fear, and in pain.

A few years ago, a dear friend invited me to dinner and asked me to consider applying as the chair of the Department of Humanities at the medical school where she worked. I asked her for the 20-second job description. She answered:

“Teaching doctors to be human”

I had never heard a better way of explaining what I feel called to do. Thankfully, it’s what I get to do as I travel to train and equip healthcare staff to show up well when someone is suffering.

The soft skills of caregiving can be taught, and we MUST teach them for the sake of healing, whether a cure is possible or not.

The word “humanism” has gotten a bad rep in some circles as being about an over-focus on humanity to the exclusion of divinity. But those in academia understand a far different definition–the very one my friend gave about the humanities chair position.

It’s simply about being human.

Two years ago, I came across a research article that I hope will get even more airtime called “Attitudes and Habits of Highly Humanistic Physicians” by Carol M. Chou, MD and colleagues (Journal of the Association of American Medical Colleges, Sept 2014). A summary can be accessed here

In short, the study authors interviewed internal medicine residents to find out which physicians they felt best exemplified humanistic patient care. They then interviewed those professionals to identify the habits that contributed to their patient-focused attitudes and their practice of high quality care.

They found that self-reflection, being in a teaching role, and practicing mindfulness were common habits of these exemplary physicians. Even more significant contributors to these clinicians’ effectiveness were maintaining a healthy work-life balance and actively working to develop a meaningful connection with the patient.

The authors also found that not only did the connected relationship help the patient, it helped reduce burnout for the clinician!

Clinicians can be taught, and can improve their ability, to show up well for patients, creating a relationship that is truly healing for all involved. Now, let’s give them the training, and the time, to do just that!

About Rev. Dr. Carla Cheatham:

After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice as a chaplain and bereavement coordinator. She now trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback and as an e-book through Amazon and also as an audiobook through Audible. A companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook based on those stories is set to publish Fall 2016. Follow Carla’s writings through her website blog, her guest blog on hospicetimes.com and also on Facebook or on Twitter @CarlaCheatham.

When They’re Holding Out for a Miracle: Healing Conversations

Posted by Carla Cheatham on Tuesday, July 26th, 2016 in Spiritual Care Integrity and Excellence

In the May 2014 issue of Journal of Oncology Practice I was excited to read an article authored by an interdisciplinary team from John Hopkins titled, “AMEN in Challenging Conversations: Bridging the Gaps Between Faith, Hope, and Medicine”. (Cooper, Ferguson, Bodurtha, & Smith, 2014). It’s brief at just under 3 1/2 pages, so I hope you’ll take a moment to read it. I shared it with my hospice team and they loved it!

What do you do when the patient’s prognosis is medically grim but the patient and family are “holding out for a miracle”? The authors discuss a respectful and easy model for all disciplines to use in handling such conversations using the mnemonic “AMEN” (see below).

I’m especially excited to see the chaplain, Rhonda Cooper, as the lead author! We spiritual care counselors often complain about not feeling respected as a valued member of the Interdisciplinary Team.

But respect is to be found as we empower and equip ourselves to support the team in performing their jobs by sharing our unique skill set.

We must BE the chaplain whom they see as clinically relevant and to whom they want to refer.

AMEN stands for Affirm, Meet, Educate, No matter what and is a conversational tool meant to give the provider an outline to remember to affirm the feelings, meet the patient/family where they are, educate about the medical issues, and assure them of the team’s presence and commitment to them.

It is a “Yes, AND” approach rather than “Yes, BUT” and can meet the needs of the patient and family by honoring their feelings, respecting their beliefs, and guaranteeing the provider will be with them every step of the way. We can do this while also upholding the ethical responsibility to deliver the medical facts of the moment and discuss the next steps in the plan of care.

The hospice team with which I work and I had the opportunity to utilize this approach with a beautiful, talented, precious young teenage woman whose family became increasingly desperate for a miracle as the glioblastoma taking over her brain and body was clearly on its way to ending her life. Asking anyone to face their grief and face medical reality is challenging enough when the patient is older, but when it’s a child…UGH!!

We did not want to deny them the faith that was holding them together and meant so much to them. We did not want to disrespect them by pushing and we did not want to disrespect her by not advocating for her comfort and final wishes. It was a dance no one wanted to do and, frankly, it scared the snot out of all of us.

But we did it, even though her mother was completely furious with us for even hinting at the things about which we were ethically required to educate the family. Several of us were “kicked out” one by one until finally it was only the RNCM and CNA who were allowed to cross their threshold.

The whole team communicated and coordinated care and shared ideas and support behind the scenes as these two women walked into a minefield each day. Thankfully, we had an incredibly mature team who was able to not take things personally and was able to avoid pathologizing their emotional and spiritual pain, labeling them as “resistant” or “crazy”, no matter how hard things became (you can follow the link to another post about handling grief that appears as conflict and anger).

We affirmed their feelings and beliefs. We met them wherever they were each visit. We educated gently but clearly and firmly (that was the hardest part). And we reassured them that they would not have to do this alone because we would be with them every step of the way. And we were, as much as they would allow us.

Almost 2 years after this sweet child died, I ran into her mother in the frozen foods section grocery store shopping for what was needed to make Christmas dinner. I realized I was holding my breath as she tried to place me (in running cap and and clothes, I look a little different!), wondering how she would respond. She asked how she knew me. I finally, softly, reminded her. Her arms flew around my neck as she grasped me and gushed her heartfelt thanks for our patience and unfailing love throughout a sticky, to say the least, situation.

Listening to her share her heart and what it was like to be her on the receiving end, hearing her describe that it was important we kept slowly and gently saying the things that needed to be said, no matter how angry she became, while also affirming her faith and feelings, was a miraculously healing moment for us both.

She had the opportunity to extend thanks she could not at that time. I had the opportunity to lay to rest the one case that had hung over my head for 2 years, wondering if we had done the right thing. It was my favorite present that year.

I often speak about the “sweet spot” between pushing too far and doing too little, neglecting our duties with patients and families in healthcare, especially related to spiritual care. (That series can be found under Guest Articles at HospiceTimes.com). I’m grateful to increasingly hear the “soft skills” of healthcare promoted to (and by) all team members, assisting us in utilizing the research-proven approach of patient-centered communication.

When persons feel heard, validated, understood, and accepted then disagreement about perspectives are much easier to bear.

Connect with my heart and I can more easily accept you disagreeing with my brain.

It can be easy to forget this, and easy to overlook simple techniques that we can all use to connect with patients and families in this way. In a field designed around diagnosis, it can be way too easy to pathologize that which makes us uncomfortable, we do not understand, or for which we feel we do not have time. We may write off patients “praying for a miracle” as delusional or in denial, and it is natural to feel uncomfortable when someone is grieving but acting it out via angry confrontations with staff.

We, the ones with the badges, titles, and uniforms, often forget that we are also human and our own discomfort or “baggage” can get in the way of our truly SEEING the persons with whom we work. Our perception can get cloudy as we label persons in grief as “crazy”, “resistant”, “defiant”, “combative”, etc.

If we can instead see them as well-intentioned humans processing challenging and painful information the best way they can as quickly as they can, and as fellow human beings who deserve our patience, respect, affirmation, and honest connection that still tells the truth, it is the single most ethical, compassionate, and healing thing we could ever do as professionals.

It is a delicate line, but it is possible, and chaplains are well-suited to help lead the way for our colleagues in maintaining that balance.

And so may it be…AMEN.

About Rev. Dr. Carla Cheatham:

After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice. She trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback and as an e-book through Amazon and also as an audiobook through Audible. A companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook based on those stories is set to publish August 2016. Follow Carla’s writings through her website blog and also on Facebook or on Twitter @CarlaCheatham.

The “Sweet Spot”: Ethical Interdisciplinary Spiritual Care–Week 2

Posted by Carla Cheatham on Tuesday, March 15th, 2016 in Spiritual Care Integrity and Excellence

This is the second in a series of posts based on my presentation called “The Sweet Spot: Ethical Interdisciplinary Spiritual Care” (c)2014. This work is copyrighted and all rights are reserved, however, please feel free to share it electronically or even in print with proper credit provided. I want this material to reach as far as possible to help professionals, and the field, as much as possible.–Carla

Last week, in the “Sweet Spot”…

For Week 1 of the Sweet Spot series (click here to read), I wrote about the importance of all members of the healthcare team being prepared to screen for and respond to spiritual distress in the moment, when necessary.

I then shared my own ways of administering, or asking the questions for, Puchalski’s FICA screening tool.

I also spoke of the importance of referring to the trained, clinical spiritual care counselor (aka, “chaplain”) to perform the clinical spiritual assessment, develop the spiritual plan of care, and perform interventions to respond long-term to that spiritual distress.

Last week’s post was the “How”, but some may not yet be clear about the “Why”, and wonder what in the heck makes spiritual care so vital to competent, patient-centered care. Others may fully believe that impeccable spiritual care is crucial, but are not quite able to articulate the “Why”.

So here goes…

Episode 2 of the Sweet Spot series–the “Why” of Ethical Interdisciplinary Spiritual Care

My first point in making the case for ethical spiritual care is, well, the ethical one! I believe all persons deserve access to the benefits spiritual/existential care may provide without fear of judgment, abandonment, or coercion.

I speak about this regularly and wrote about it recently in a post on Hospice Times called, “Manifesto for Competent Spiritual Care: 7 Things That Matter” (click the title to give it a quick read. It’s fairly short!) So, I won’t belabor that point here.

My second point in the case for exquisite spiritual/existential care is based on empirical data and best practices, which I’ll discuss below. Research into spiritual care in healthcare is sorely lacking. Operationalizing the ethereal, making the aesthetic more concrete, can be more than a challenge.

Religion, spirituality, existentialism–these are weighty and heady issues shrouded in much mystery that often feel simply overwhelming to address. For some, this mystery is comforting and peaceful; for others, it can be a mild headache or even grounds for an all out post-traumatic involuntary eye–twitch.

Thankfully, we’re slowly getting more comfortable with the topic of spirituality in healthcare and are developing the empirical data to back it up!

But great strides have been made in recent years thanks to grants from the Templeton Foundation, the work of the Healthcare Chaplaincy Network, publications by Christina Puchalski and Betty Ferrell (one of which I referenced last week), and numerous others.

Even the National Consensus Project for Quality Palliative Care, which lists the 8 Domains necessary for competent palliative care, gave Spiritual, Religious, and Existential Aspects of Care its own whole domain (Domain 5). Instead of being just a paragraph or text box blurb in the midst of some other domain, it got it’s own place in the show and it’s even cross-referenced across multiple other domains in the document (“Clinical Practice Guidelines for Quality Palliative Care, Third Edition”, 2013, https://www.hpna.org/multimedia/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf

We are making tremendous progress in understanding the importance of quality, professional spiritual care in healthcare, but we have a long way to go.

What we’ve learned is that spiritual pain, described as “a pain deep in your soul (being) that is not physical” (Mako, Galek, & Poppito, 2006) appears to be common in healthcare patients and is significantly associated with lower self-perceptions of spiritual quality of life (Delgado-Guay, Hui, et al, 2011).

As I stated last week, the data indicates patients want to talk to their providers about their religious and spiritual concerns, but most often do not get to (Williams, 2011).

When we fail to respond adequately to patients’ spiritual distress, we find depressed mood and a decline in quality of life with persons beginning to wonder whether, for instance, God has abandoned them or even still loves them (Pargament, et al, 2001, 2004).

I call this failure on our part spiritual neglect, one extreme of what I call spiritual malpractice. When I first used this term with a dear and respected friend, who is an M.D., she said, “Don’t use that term in the medical community! It’s a big word that will turn us off an shut us down.”

But I argued that the goal isn’t to incite fear, it’s to make clear that not tending to persons’ religious, spiritual, and/or existential needs is a VERY big deal and one to which we must pay serious attention. An here’s more of “Why”.

When we DO address spiritual distress, we find higher patient and family satisfaction (Astrow, et al, 2007; Daaleman, et al, 2008; Wall, et al 2007), lower rates of hospital deaths (Flannelly, et al, 2012), higher rates of hospice enrollments and patients being less likely to pursue unnecessarily aggressive treatments (Balboni, et al, 2010; Balboni, et al, 2011; Flannelly, et al, 2012).

All of this means that when we tend to their spiritual distress, persons are more likely to die exactly where all the surveys say we want to die–at home surrounded by our things and pets and loved ones with familiar sights and sounds and smells and NOT connected to tubes and wires and beeping machines.

Now, don’t get me wrong…tubes and wires and beeping machines sometimes save our lives. I’m not against them, at all. In fact, I’m a left-handed red-headed Aries, so I know a thing or two about hanging on stubbornly and fighting against the odds. But sometimes we fight far too long and far too much to our detriment, in terms of our dignity and quality of life and the wear and tear it puts on our bodies and our families and our resources.

Surveys also consistently find that our greatest fear isn’t death, it is how we will die that scares the snot out of us. We do not want to be in pain, lose our dignity, or be a burden to our families. I’ll refer you to the amazing work of Dr. Monica Williams-Murphy and her book “It’s OK to Die” for more on this topic, lest this rabbit run too far off the trail.

This whole issue brings me to a point I mentioned last week, and promised to circle back to and address. It can be easy to assume that if a person declares a religious faith and connection (to a church, synagogue, sangha, mosque, etc.) that spiritual care from the healthcare team is redundant and therefore not necessary.

But one critical finding in the research indicates this is not only false, but a possibly dangerous proposition. In the cancer studies performed by Balboni and colleagues listed above, the findings initially showed that those patients who identified as highly religious were MORE likely to pursue aggressive end of life treatments.

Wait…WHAT?!?!?!

That made us all stop for more than a moment. One would expect that those who are highly religious would have hope and comfort in this life and even some form of comfort or hope about an afterlife of some form that comes from their religious faith. We tend to equate those who fight longer and harder, unless they are young and/or otherwise healthy, with those who are afraid or have unresolved issues or grief that leave them not yet ready to let go of this life and face death.

So we were all quite confused.

Then, in the follow-up studies, what Balboni began to tease out from the data is that if persons only receive spiritual support from their faith community, which usually does not understand medical processes and the impact of grief on acceptance of a diagnosis, for example, the patient is more likely to pursue unnecessarily aggressive treatments at the end of life.

But if the healthcare team is ALSO involved in providing spiritual care, that comes with education and grief counseling and knowledgeable support, it appears that effect is mediated–meaning highly religious persons become no more likely to pursue aggressive treatment than other less religious patients.

A well-meaning, well-intentioned faith community may push a patient and family to fight the good fight and trust in G_d’s help if they do not have a seasoned medical team joining them in a way that helps to educate everyone involved and support them through their grief.

So the next time you hear someone on the team say, “Oh, they have their own minister…” pull this out and borrow my soap box to make the case that we cannot leave them without professional, clinical, spiritual care counselors or spiritual support from the medical team!

The next time you hear another discipline say, “The chaplains can handle a bigger case-load…it’s not like they do that much”, avoid the initial visceral reaction toward snatching them nekid and burning their clothes. Instead, point them to the research and best practices listed here, or any of the growing literature that demonstrates the importance of good spiritual care.

It can be easy to sit distraught on the sidelines, claiming the other disciplines won’t let us play at the big kid’s table on the healthcare team, but that helps no one and gives away our power. We can equip ourselves with the data that backs up, and even gives us the language for, why what we do in spiritual care is so important. We can then demonstrate the importance with the way we practice our care…but that’s for another post, later in the series!

For now, I hope this information has been helpful, and I hope you’ll tune in next week as I take the information above and make the third point, that good spiritual care can tremendously impact an organization’s financial bottom line.

After next week’s post, I’m hoping that the next time you hear an administrator say, “We just can’t devote the budget to a stronger spiritual care program”, you’ll just smile and say, “Hang on a second. Let me show you something…”

So stay tuned!

Peace,

Carla

Astrow, A., Wexler, A., Texeira, K., He, M., Sulmasy, D. (2007). Is failure to meet spiritual needs associated with cancer patients’ perceptions of quality of care and their satisfaction with care? Journal of Clinical Oncology, Vol. 25, pp 5753-5757.

Balboni, T., Balboni, M., Paulk, M., et al (2011). Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life. Cancer, V 117, pp. 5383-5391.

Balboni, T., Paulk, M., Balboni, M., et al (2010). Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Journal of Clinical Oncology, Vol. 28, pp. 445-452.

Daaleman, T., Williams, C., Hamilton, V., Zimmerman, S. (2008). Spiritual care at the end of life in long-term care. Medical Care, Vol. 46, pp 85-91.

Delgago-Guay, M., Hui, D., Parsons, H., Govan, K., De la Cruz, M., & Thorney, S. (2011). Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients. Journal of Pain and Symptom Management, 41:6, pp. 986-994.

Flannelly, K., Emanuel, L., Handzo, G., Galek, K., Silton, N., & Carlson, M.(2012). A national study of chaplaincy services and end of life outcomes. BMC Palliative Care, 11:10.

Mako, C, Galek K, & Poppito, SR. (2006). Spiritual pain among patients with advanced cancer in palliative care. Journal of Palliative Medicine, 9, pp 1106-1113.

Pargament, K., Koenig, H., Tarakeswar, N., & Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A two-year longitudinal study. Archives of Internal Medicine, 161, pp 1881-1885.

Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2004). Religious coping methods as predictors of outcomes of psychological, physical, and spiritual outcomes among medically ill elderly patients: A two-year longitudinal study. Journal of Health Psychology, 9, pp. 713-730.

Wall, R., Engelberg, R., Gries, C., Glavan, B., Curtis, J. (2007). Spiritual care of families in the intensive care unit. Critical Care Medicine, Vol. 35, pp.1084-1090.

Williams, J., Meltzer, D., Arora, V., Chung, G., & Curlin, F. (2011). Attention to Inpatients’ Religious and Spiritual Concerns: Predictors and Association with Patient Satisfaction. Journal of General Internal Medicine. DOI:10.1007/s11606-011-1781-y

About Rev. Dr. Carla Cheatham:

After a career in social services, with an MA in Psychology and certification in crisis counseling, Carla received her MDiv. and PhD. in Health & Kinesiology and began serving faith communities. For almost a decade, she has worked as a spiritual counselor in healthcare, primarily for hospice.

After realizing many lacked supportive education in multi-faith spiritual care, Carla and her colleagues created the SCIE (“sky”) curriculum, which expanded to include boundary training and presentations in a multitude of areas. She provides training for all healthcare staff both via webinar and live presentations.

Carla has taken stories from the curriculum and published them as a book of stories called Hospice Whispers: Stories of Life, available here or through Amazon. The Grief Companion Guide to Hospice Whispers designed for both individuals and groups, is set to publish later this Spring. She is also writing her second book on the art of presence with those who are suffering.

The “Sweet Spot”: Ethical Interdisciplinary Spiritual Care–Week 1

Posted by Carla Cheatham on Tuesday, March 8th, 2016 in Spiritual Care Integrity and Excellence

Research indicates patients want to talk to their providers about their religious and spiritual (R/S) concerns, but that they most often do not get to do so (Williams, et al, 2011). The reasons behind why this doesn’t happen are many. The reasons why it is critical that spirituality be included in differential diagnosis and a focus of care for ALL disciplines are even more.

It takes ALL of us to provide competent spiritual care that neither neglects nor abuses patients and families…and it’s easier than you may think!

This series will address that “Sweet Spot”–the perfect middle ground we can walk as we journey with others during medical or emotional crises and help them access their beliefs that help them find meaning, comfort, and peace. All members of the interdisciplinary team can, and must, be engaged in ethical and respectful spiritual and existential care for persons of all faiths, and no particular faith.

Next week, I’ll discuss more of the “Why?”, citing research, best practices, and making the case that quality spiritual care can greatly impact an organization’s financial bottom line. This week, I’ll jump straight into the “How?”.

When I speak, I often joke that when Oprah calls or I win the lottery, I’ll buy copies of Puchalski and Ferrell’s Making Healthcare Whole: Integrating Spirituality Into Patient Care (2010) for every healthcare worker in the country.

It is a terrific overview of the very issue I seek to address as they argue that all disciplines must be equipped to screen for and intervene when patients and families exhibit spiritual distress. Then they must coordinate care with a professional, clinically trained spiritual counselor to assess and treat those sources of distress.

To be clear, Puchalski and Ferrell come largely from the hospital setting, in which the ratio of chaplains to patients is very high. In other settings, such as hospice and palliative care organizations, where those ratios should be much lower (1/40 in hospice, for instance), best practices require the spiritual care counselor (SCC) be involved in the patient’s care from the very first days of admission, introducing spiritual care services and providing the clinical spiritual assessment and coordinating on-going plan of care interventions.

But that is not always the case. Some persons reject spiritual care services because they fear the very idea of a “pastor coming in and preaching” at them, which is NOT what qualified SCC’s do. Others have connections to their own faith community and do not feel the need for an SCC to be involved in their care, which research tells us is actually a dangerous proposition for the outcomes of care–details next week. Other times, an SCC simply isn’t available when spiritual distress is noted.

Regardless of the reasons, having nurses, physicians, social workers, certified nurses aides, etc. all feeling comfortable and competent to respond ethically to needs in the moment, until an SCC can be present, is a critical aspect of quality care.

One quick and easy tool provided by Puchalski (Puchalski and Romer, 2000) to screen for spiritual concerns is known as FICA. It stands for Faith and Belief, Importance, Community, and Address in Care or Action.

There are many ways these questions can be asked. Puchalski’s suggestions for ways of asking the questions may be found on the G-Wish website, here.

Below are ways that I train healthcare staff to ask the FICA questions. Over the years of my practice with patients and families, I’ve found the approach modeled below may increase how comfortable and safe patients feel answering honestly. Not only does it make for a gentler approach to them, it also helps ensure I gain the most accurate information possible, for the benefit of both them and the team navigating their care.

F- Is there any particular faith tradition in which you were raised?

Far better than “What church do you go to?”, which assumes they attend services and assumes they are Christian, the open language indicates acceptance if they answer is “No” or if they are of another faith.

It also can place persons less on guard because, many persons who are sick or have moved to be near family as they age, or are just busy with their every day lives can feel guilty or even ashamed to admit if they do not attend services and fear judgment by the persons providing their care. It’s scary to “disappoint” the people bringing you the good drugs, the therapies, the supplies, the legal and logistical support, etc. Asking if their parents raised them in a tradition can take the pressure off of them, a bit, if they do not attend.

Lastly, what happens when you ask someone the beginning of the story? They will tell you the rest. In this one answer, persons can explain their spiritual journey in 60 second, “I was raised ______, then when I was a teenager all my friends went to _______, then I went to college and, well, you know, that was college, and then I married and he was _______, then we had a falling out with the minister so we went to…”

As they tell us their journey, we’re listening for whether they are spiritual, religious, both, or neither. They may have felt rejected or disillusioned with organized religion and have picked up some spiritual baggage which they may need to address. They may have old images from the faith of their childhood that can return during times of distress and fear, at the end of life for instance.

So we listen for landmines. We listen for spiritual strengths. We listen for the beliefs of other family members that may either support or be in conflict with the patient’s views. We listen for the language that they use to discuss their faith. We are open to hearing if they are non-theists (atheists, agnostics, humanists, etc.) and switch our language to more existential (meaning, love, connection, etc.) rather than religious words to meet them where they are.

Not bad for one question!

I- Which of your current beliefs/ideologies are most valuable or helpful to you right now? What brings you the most comfort?

Asking someone how important their faith is to them can leave persons feeling judged even before they answer if their religion isn’t of particular importance. But asking what is helping them can open up the possibilities to include a favorite rock song that keeps them going or art that speaks to them of peace or a pet that gives them connection. These all can be used to support their spiritual/existential well-being. It doesn’t always have to be a prayer or ritual. We are multi-dimensional creatures, so it’s no surprise if we connect with a deity in multiple ways.

C- If there is a crisis at 2 a.m., whom do you want me to call to come be with you and your family?

For some people, their clergy may be their primary source of support. But for others, it may be another member of their faith community, or a best friend or neighbor. We mustn’t assume.

For one woman who was a conservative Catholic, the answer was her Jewish accountant. He had started as a young, wet-behind the ears CPA when she and her husband started business 30 years before. She trusted him completely and he always watched out for her best interests. They had a spiritual bond that ran very deep. So when I DID need to call on him at 2am, he came and said prayers in Hebrew and English, went through the Rosary with her, and sang Amazing Grace while I sat in humbled silence in the corner and witnessed a beautiful moment of spiritual care unfold.

A- What do we need to know about how your particular culture and beliefs/ideologies will influence your decisions, or to which we should be respectful?

We do not want to offend. We want to provide ethical and respectful care. But if we do not directly ask, we may never know what that looks like for them. Merely asking the question can indicate to them how deeply we wish to honor them, their culture, their faith, their needs, and that they will not be judged by us for whatever they need. Asking ahead of time has saved my kiester on more than one occasion and, more importantly, allowed me to provide competent care.

I’ll tell you a story about that in the midst of this series, when a young CNA knew to ask a question that completely changed the outcome, and quality, of a case.

For now, I hope something of this has been helpful. I look forward to sharing more ideas for ways that all of us can be involved in spiritual care that is respectful, ethical, and makes a difference, and is far easier than you might imagine!

Peace…

About Rev. Dr. Carla Cheatham:

Follow Carla’s writings on her blog at http://carlacheatham.com/CCCG_SiteRevamp/carlas-blog/ and through Hospice Times at http://www.hospicetimes.com/index.php/category/guest-articles/carla-cheatham/

What CAN I Say?: Day 7 of BE-ing with Suffering

Posted by Carla Cheatham on Thursday, January 1st, 2015 in Spiritual Care Integrity and Excellence

The following is the final in a 7-part series of posts to help all of us be there for those we love who are grieving, especially during the holiday season. The content is taken from my presentation, “How Not to (Unintentionally) Say Something Stupid: BE-ing With Those Who Are Suffering” © 2013. All rights reserved. Feel free to share/re-post, but please don’t swipe or present it without my permission.

We made it! We’ve covered some of the top barriers to BE-ing with others’ pain:

Fear saying the wrong thing
Feel the need to fix it
Uncomfortable with pain and tears
Uncomfortable with silence

Now we can cover the last:

Fear not knowing what to say

I spend much of this presentation telling folks what NOT to say, encouraging them to say nothing but to just BE present. I talk about how to find a logical, theological, philosophical, emotional, and physical sense of grounding that will help them let go of the need to DO so they can simply BE.

But many miss the point, or aren’t quite ready for it, yet. They appear somewhat frustrated as they continue to insist I tell them what they CAN say. And I get it.

Pain can be terrifying. Being emotionally available with another’s vulnerability can bring out our biggest “oh crap!” fears. I’d rather do fractions that, since I missed the first 3 days on fractions in 3^rd grade and never caught up, still gives me the hives!

They still can’t quite get it that saying nothing verbally can be done with a sense of presence and grace and compassion that says far more than words ever could. In fact, presence alone can say far more since words aren’t there to get in the way!

But I used training wheels as I learned to ride a bike. I used inflatable bumpers in the gutter when I was five. I learned under the supervision of more experienced professionals as a therapist, pastor, and chaplain until I was a little less green and a little more competent.

To protect myself and others from my novice skills, I find and use support. I got back up on my roller blades not long ago, at the tennis court where I could grab the fence rather than face plant until I get my strength and sense of balance beefed up a bit. And, I pay an accountant not only so I won’t have to take Benadryl for my math hives but also so I won’t make an innocent mistake and go to jail!

My main concern, and why I spend so little time on this part of the series, is that verbal training wheels run the risk of becoming addictive. They give us an out so that we feel we never have to learn this whole presence thing and, instead, hide under our verbal security blankets and leave those hurting out in the cold, untouched by true connection.

And then I find that all I’ve done is given folks a whole new list of pat phrases that will become just as damaging as those old, used-up, dry-as-dirt clichés that do nothing to touch someone’s pain.

So please, if you find yourself REALLY wanting to know what TO say, I ask that you stop for a moment and ask yourself why…what scares you? The answer may help you go a bit deeper in your ability with the art of BE-ing.

No number of slick, skilled, “perfect” words will be of any use if you aren’t settled within, and are using them to distance yourself from the other rather than convey that you are with them and they are not alone.

But again, I know that when we are first learning, some supports are helpful. So here are some phrases to consider if they would be helpful. Whatever you use, find what works for your voice and your personality. Pulling someone else’s words out can sound canned and fail to let someone else feel seen and heard. Find you, and share that. That is always the best gift you have to bring.

What TO Say:

I hear you. (Can be quietly repeated as they talk as much as they need, and they’ll likely talk more if not interrupted by anything you feel the need to say.)

Would you like to tell me about him/her?

Would you like to talk about it?

I wish I had answers. I’m sorry I don’t.

I can only imagine how hard this is.

You’re not alone. We’re with you, as much as you would like.

I love/care about you.

I trust you to make it through this, even when it feels like you can’t.

I am so sorry. (Why not, “…for your loss”?—A loved one who has died did not “pass” like gas; they are not “lost” so we don’t need to put their faces on milk cartons. Euphemisms can be another way of distancing from their pain. Don’t use them!)

Can I please __(mow the yard, do the *laundry, pick up the kids)__ for you? (*ALWAYS ASK FIRST so you do not accidentally mow down the wildflowers she planted that look like weeds or launder his smell out of his favorite shirt.)

I’m here.

That’s it. There may be others, but I think long and hard about using them. Even some of the above, I’m hesitant to suggest, because they can be used in a way that drives disconnection rather than fuel connection, as I once heard Brene’ Brown share. So please, use these carefully. Think them through. Talk about them with a friend and see what feels natural and helpful for you, from your mouth and heart.

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 we can extend the gift of true presence to another, it is priceless, and has absolutely NOTHING to do with our words. It is a very rare gift. But I’m hoping to change that. With your help, we can help each other learn how to BE with suffering in a way that brings comfort and healing, rather than isolation and more pain.

To close this series, I’ll leave you with the words of a talented colleague who shared the following. They are words of challenge for us all, professional and lay person alike. I give thanks to Karl Knox, Director of Bereavement at Gulfside Hospice & Pasco Palliative Care, for his words and the permission to share them:

“As much as it might be helpful for some professionals to have a few key phrases in their back pocket, I would tend look more closely at what drives us – in this profession – to want to try and ‘fix things‘ or ‘make things better.‘ I would look at what makes US uncomfortable personally.

For example, if someone is sobbing uncontrollably, are we tempted to try and ‘fix that’ because we’re personally uncomfortable with deep grief? Do we hand them a tissue and say ‘it’s going to be OK’ even when we know, in our hearts, that at this moment that’s not at all a certain thing?

Sitting with someone’s pain, without trying to intellectualize it with pat phrases, is an art….and a big part of that art is knowing yourself well enough to recognize when you’re actually trying to ‘get something’ from the person you’re working with (praise, thank you’s, a pat on the back). I believe people know when we’re being genuinely present with them, and when we’re trying to get them to make us feel better about our role as a professional.”

Peace,

Carla

More of What NOT to Say: Day 6 of BE-ing with Suffering

Posted by Carla Cheatham on Wednesday, December 31st, 2014 in Spiritual Care Integrity and Excellence

The following is the 6^th in a series of 7 posts to help all of us be there for those we love who are grieving, especially during the holiday season. The content is taken from my presentation, “How Not to (Unintentionally) Say Something Stupid: BE-ing With Those Who Are Suffering” © 2013. All rights reserved. Feel free to share/re-post, but please don’t swipe or present it without my permission.

So far in this series, I’ve covered these barriers to being with others’ pain:

Feel the need to fix it
Uncomfortable with pain and tears
Uncomfortable with silence

Yesterday I started covering one of our greatest fears:

Fear saying the wrong thing

I’ll finish covering this topic today and tomorrow will end the series with what TO say!

Last July, I posted some of the following information under the presentation title “How Not to (Unintentionally) Say Something Stupid: BE-ing With Those Who Are Suffering”. I’ll expand on that content today.

LA Times April 2013, Susan Silk and Barry Goldman

I came across the “Ring Theory” in the LA Times April 7, 2013. Written by Susan Silk and Barry Goldman, it stems from their professional practice and personal experience. (CLICK on image for a clearer view).

It has become one of the most effective tools I use in helping others “get it” that tough times are NOT about us. It helps us to visualize where we need to take our own fears, frustrations, and other forms of processing when someone around is ill.

In the fall of 2012, when I had my own medical scare (I’m fine now) and started making my own list of “The well-intended but stupid things we say when someone is hurting”, I was amazed by the flood of people who needed to tell me their story or their friend’s or sister’s or dog’s story.

I was often too tired and fuzzy-headed from stress to be able to realize what was happening in time to set a boundary, and then I was being emotionally vomited upon…at least, that’s what it often felt like.

Once, a person realized too late into her tale that the young woman she was describing died shortly after surgery. Her face fell in horror as she realized her gaffe. As horrified as I was at her mis-step, I also felt for her. She meant no harm.

But in our jumble of thoughts and words and awkwardness, we stumble—horribly at times. I wanted to help. That’s where my presentation came from, and from which this series is taken.

Yesterday, I discussed the various clichés and theologizing we often use, that distances ourselves from the pain or hopelessness someone else is feeling. I wrote of how such words can minimize or invalidate others’ feelings, essentially telling them to “Trust God and get over it”. I talked about the damage that does as it shuts down the normal grief process that is so necessary for healing.

Today, I’m re-sharing the Ring Theory as a way of helping us know what else NOT to say. In short, is says that the person who is suffering, say a person with cancer, is in the center of the circle. Around them are concentric circles, with their closest loved ones in the first circle, then other friends in the next circle out, then co-workers and acquaintances in the next, etc.

Silk and Goldman suggest that you “comfort in” by speaking only supportive and encouraging words to those who are closer in toward the patient than yourself and, if you feel the need to process your own feelings, you “dump out” by speaking those words only to someone who is in a circle further out from the patient than you.

The patient in the center can vent and gripe anywhere because in that circumstance it really IS all about them. It is a simple and easy tool to visualize where we are in another’s process and how to gauge to whom we can speak of how “awful this is” or process our own story of “my Aunt Maureen had the same thing…”.

Those who are stressed have no space to hear our stories. They’re living their own! They have little energy to set boundaries with well-intentioned but worn out and damaging clichés, unsolicited advice, theological preaching, or the processing of our feelings or old stories.

As I’ve said before, as much as we want to, nothing we say can ever “make it all better.” But our being fully present with them in their pain may help. That means letting go of our stories, our nervously blurted words, our need to talk about how sad or scared we are for them WITH them, or their spouse, etc. We find other places to dump our feelings.

Instead, walk their dog, do a few loads of laundry (but ALWAYS ask first—you don’t want to wash the scent out of a deceased loved one’s clothes if it’s one of the last shirts with “his” smell on it!), take their kids to the park to play for a while, or provide any other sort of practical support. By doing so, we communicate so much more care than most words can convey.

And if we can find it in ourselves to do so, we can sit quietly and calmly with them while they process or feel their feelings, whatever they may be.

We can remember that we need not say ANYthing except, if we feel we just have to say something, “I hear you”, “I wish I had answers”, “I’m so sorry”, and other simple, short, sincere statements that acknowledge their pain while not shutting it down or running from it. I’ll talk about those options more, tomorrow.

For now, please tattoo that picture inside your brain and heart. When someone around you is hurting, find where you are in the diagram. Dump whatever you need to OUT to someone further away from the patient/crisis than you. Then, when you show up, you can really show up WITH and FOR them, with what they need and provide comfort IN to those interior circles.

Such visuals can work for us. One friend called me from up north yesterday afternoon and thanked me for sharing a picture of a dog hugging a woman with the words “We fear silence will indicate apathy…but we can exude presence without making a sound”. She said it was timely, as she received a call that afternoon from a friend in extreme crisis.

“Carla, I was able to just sit and listen for 30 straight minutes without jumping in, because I kept seeing that picture in my head and could remind myself, ‘No. Wait. Just listen.’ It was such a gift.”

THAT is why I do this. I hope you’re finding some helpful information in this series, sharing it with others, and will share feedback with me so that together we can all find a better way to be with pain, our own and each others’!

Peace,

Carla

Clichés, Advice, & Theologizing NO-NOs: Day 5 of BE-ing with Suffering

Posted by Carla Cheatham on Tuesday, December 30th, 2014 in Spiritual Care Integrity and Excellence

The following is the 5^th in a series of 7 posts to help all of us be there for those we love who are grieving, especially during the holiday season. The content is taken from my presentation, “How Not to (Unintentionally) Say Something Stupid: BE-ing With Those Who Are Suffering” © 2013. All rights reserved. Feel free to share/re-post, but please don’t swipe or present it without my permission.

I’ve been working my way through the list of most common barriers to BE-ing with suffering that I hear from professionals and lay persons across the country. I’ve worked through the following in this series:

Feel the need to fix it
Uncomfortable with pain and tears
Uncomfortable with silence

That leaves the following two topics to cover:

Fear saying the wrong thing
Fear not knowing what to say

I’ll conclude the series with things TO say. Today and tomorrow, I’ll cover what NOT to say. In short?

Avoid clichés, any form of theologizing and giving unsolicited advice. Details below.

CLICHÉS Who hasn’t heard (or said!) “Time heals all wounds”, “It’ll be ok”, or “She lived a good, long life” to someone who was hurting? Yes, clichés are so well-used because they contain kernels of truth. But they also are way too easy of a go-to.

They are a verbal security blanket that let us feel like we are doing something positive, even heroic, when all we’re really doing is lazily relying on tired phrases that foster no intimacy or connection, and leave those in pain out in the cold.

They’re also a convenient way to hold people at arm’s length rather than really touch them, or their pain which so threatens us. Cliches can say, “I feel uncomfortable with your discomfort, so I want you to hurry up and feel better now so I can feel better.” I only know this translation because it hid (and still hides) under my words to grievers for much of my life.

It wasn’t all selfish. I truly did want the people I loved to feel better and not hurt. But I wanted it so badly that I neglected to see that they needed, they deserved, the slow and painful process of finding peace that true healing requires.

Here are a few examples and brief thoughts about why they aren’t helpful:

Time heals all wounds.–Generally, yes, but that does nothing for pain they’re in now.
This will fade.–Ditto
It’ll be ok.–We never truly know how things will turn out. It’s easy to say that when we’re not living through it.
She lived a good, long life.–That doesn’t make grief any less painful. Do not minimize their pain.
“Well at least…” —ANYTHING that follows will minimize their feelings. Stop yourself when you hear these words.
It was for the best.–That’s your opinion but may not be theirs. To declare their pain positive is dismissive.

ADVICE They’re stressed, overwhelmed. Life as they knew it has been turned upside down. Suddenly, everyone has an opinion about what they should do, how they should do it, and why.

Advice given, for which we did not ask, can feel insulting and condescending. Besides, it often comes with a sense of judgment if the advice isn’t taken and reeks of blaming the victim, “If you would only do what I suggest, you would be better…but if you don’t WANT to feel better…”

See how that distances us from their pain? The implication is that the pain or problem is easily fixable “if only they would…” That psychological defense helps us feel more in control of suffering and less vulnerable to it.

The person grieving, for instance, “wouldn’t hurt so much” or “could be easily helped” if they would simply do what we tell them. So long as we can believe it’s that easy, we feel less threatened that some day we may be in their shoes and similarly unable to control the circumstances.

So not only can it feel insulting and condescending, as in “I know better than you how you should do your life”, but the lack of understanding can leave the suffering feeling blamed, judged, and even more alone.

When I had a health scare 2 years ago, I suddenly had LOTS of people with LOTS of ideas and stories to share. I did not have the emotional, mental, or spiritual space for it, and every new suggestion simply added to my overflowing plate.

I had so much new information to absorb and process from a half dozen new specialists, and many around me just added to my stress rather than help carry or comfort it.

At rest, the brain consumes a significant portion of our bodies’ resources. Under stress, that number more than doubles, leaving us feeling as if we’ve run a marathon because of the sheer amount of calories, oxygen, and other energy supplies our minds require.

The key to advice, I believe, is to always ask ourselves the question, “Did they ask?”

If they did not, we keep our mouths closed. If we think we truly have some information that could be of huge benefit that we cannot stop ourselves from wanting to share, we can say, “I have an idea of something that might help. If you have space for it, let me know and I’ll share it.” IF they want it and WHEN they have space for it, they can approach you and ask, and you don’t run the risk of being the proverbial straw that breaks the camel.

Here are some examples of some general advice-giving to avoid:

You just have to be strong.
Just focus on the positive.
Your loved one wouldn’t want you to be sad.
You can (marry, have a baby, etc.) again
It’s been a year. Aren’t you over it, yet?
Don’t cry (There’s also something I call “The Tissue Effect” I’ll write about another day)
You’ve got to move on with your life.
To children – You’re the man of the house now.
To children – Be strong for your mom.
“I know a web site to help you meet someone” (Yep, I heard of that one spoken to a grieving widow 3 months after her young husband died).

THEOLOGIZING We each have our own faith or thought systems (i.e., non-theists), the ways we make sense of the world and find meaning in it. What works for us may not work for another and may, instead, leave them feeling similarly judged. Even worse, it can leave them feeling abandoned by or angry with G_d.

If their faith or system of thought provides such answers to them and are helpful to them, that’s fine. But suffering can lead us to question everything we’ve believed because our former ways of seeing the world, the answers that once worked for us, can come unraveled and no longer do so.

Just in case this isn’t what they believe, or if they believe any of the phrases below BUT they are struggling with that belief, don’t try to help explain or justify that G_d has somehow caused this (or failed to prevent it). For many, such ideas make G_d seem neglectful, and even abusive.

All things work together for good.
Everything happens for a reason.
She’s in a better place. (As one woman shared, “What better place is there for my mama than here beside me?!”)
G_d understand(s).
You should count your blessings.
It was just her time.
We’re never given more than we can handle.
G_d needed another angel.
Trust G_d’s plan/will.

One grief counselor said to me,

“As a person of faith, I have seen far too many grievers hurt by well meaning individuals trying to be helpful…The power of consistent presence can say so much more than any phrase. To sit with another in their pain, and not try to fix it is hard, but a real offering to the griever.”

WHEN WE SLIP…

We will not be perfect. We will make mistakes. I still do! So we can go ahead and let go of shame, which does them no good, and resolve now to catch ourselves, apologize, and start again.

May we find space within ourselves to not abandon, or abuse, those suffering with our words but to simply BE with them in the ways that THEY need.

Peace…

What Scares Us About Grief?: Day 1 of BE-ing with Suffering

Posted by Carla Cheatham on Monday, December 22nd, 2014 in Spiritual Care Integrity and Excellence

The following is the 1st in a series of 7 posts to help us be there for those who are grieving, especially during the holidays. The content is taken from my presentation, “How Not to (Unintentionally) Say Something Stupid: BE-ing With Those Who Are Suffering” © 2013. All rights reserved. Feel free to share/re-post, but please don’t otherwise present it without my permission.

Why is it so difficult to be with others when they are in pain? My short list of top reasons:

1) It reminds us of our own vulnerability to the icky things that happen in life.

2) It reminds us of any of our own pain or grief or fears we’ve not resolved and try to avoid looking at and dealing with.

Our discomfort with others’ discomfort can lead us to brush over their pain and emotionally abandon them when they need us the most. I think we all mean well and really WANT to show up for others, but lots of things stop us. Which are your top barriers?

Fear not knowing what to say?
Fear saying the wrong thing?
Feel the need to fix it?
Uncomfortable with pain and tears?
Uncomfortable with silence?
Others_______?

Tomorrow, and over the next week, I’ll share some tools to help us overcome these barriers. But the best foundation I know of is this—

I trust the person to find his or her way through this exactly as they need to, which means I don’t have to fix it!

I don’t need to, and I don’t get to. This journey is theirs, and I can walk with them without taking it on as my own, which disrespects and dishonors everyone involved.

The reading that helps me remember this the most is what I leave you with today. I hope you find it meaningful and helpful.

“Being a Midwife” by Lao Tzu

The wise leader does not intervene unnecessarily. The leader’s presence is felt, but often the group runs itself. Lesser leaders do a lot, say a lot, have followers and form cults. Even worse ones use fear to energize the group and force to overcome resistance. Only the most dreadful leaders have bad reputations.

Remember that you are facilitating another person’s process. It is not your process. Do not intrude. Do not control. Do not force your own needs and insights into the foreground. If you do not trust a person’s process, that person will not trust you.

Imagine that you are a midwife. You are assisting at someone else’s birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening.

If you must take the lead, lead so that the Mother is helped yet still free and in charge. When the baby is born, the mother will rightly say: “We did it ourselves”.

from pg. 33 of Heider, J. (1985) The Tao of Leadership: Lao Tzu’s Tao Te Ching Adapted for a New Age. Atlanta, GA: Humanics Limited.

Peace,

Carla