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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/

Symbols, barriers, and bridges: Where it all began!

Posted by Carla Cheatham on Tuesday, February 23rd, 2016 in Uncategorized

In 2012, I began Carla Cheatham Consulting Group, LLC to deliver my training curriculum, called SCIE™ (pronounced “sky”) Spiritual Care Integrity & Excellence, to spiritual care counselors and other healthcare workers. As the business grew, I became increasingly clear about how to communicate my vision and product to others. Whether meeting with my lawyer, CPA, graphic artist, business coach, potential clients, or colleagues, I had a very clear picture in my own head and heart but needed to find a way to clearly articulate and represent it to each of theirs!

Designing my business’ logo was one of the most exciting and daunting parts of that process. Would others judge it as too stiff?….too fru-fru?…too amateurish?…too (insert insecurity here!) Once I got over myself (mostly) about this, I then grappled with how it would “land” inside others’ hearts and minds. Would it communicate my desire for professionalism combined with down-to-earth openness to all…deep spirituality that’s free of judgment or pressure on others…a passion for full-on peace and joy in life even in the midst of struggle and sometimes death?

In my trainings, I challenge participants to be mindful of the items they wear. I, personally, do not wear a cross when I’m working as a chaplain. I fear that doing so could serve as an instant barrier to anyone of another faith or to those for whom Christianity has been a harsh word of condemnation rather than a liberating word of radical acceptance and grace. Besides, unlike my work as clergy of a faith community, my work as a chaplain prohibits promoting my own religion, as ethical and regulatory guidelines require me to be present with patients and families and help them access their own beliefs, not mine, to find as much peace and meaning and comfort as possible.

I’m always a bit surprised by how difficult it is for some to let go of their “uniforms” or symbols. One described feeling the collar gave her a sense of professional credibility in the hospital surrounded by doctors, nurses, social workers, etc., who sometimes consider the chaplain to be “less than” a clinical professional or equal colleague. Another asked, “Well, how will folks know I’m a Christian if I don’t wear a cross?”

And I get that response. I get how much we desire to be acknowledged and respected professionally; to be able to express our own beliefs. So my response is to gently (hopefully) open a dialogue, “If ours is a clinical role, then is it appropriate for us to lead with our faith rather than making more open and safe space for patients and families to share theirs, free of fear of our rejection of who they are or how they believe? Will they tell me their deepest worries or struggles or baggage if I’ve established myself as being of a particular faith? Would their stereotypes, for good or for ill, get in the way of our relationship before it even begins?”

I choose to not risk an unintended barrier to that relationship. (SIDE NOTE: To be clear, this desire to build a relationship of trust and rapport is NOT about performing a “bait and switch” by trying to get them to feel safe enough with me or “inspired enough” by me that they ask me about my faith so I feel I have a loophole through which to proselytize–that’s opportunistic, coercive, and abusive of my position of power in the relationship relative to their vulnerability.)

But…I wanted something to wear, because I’m not above feeling “safer” and “more complete” with a “uniform”! About 10 years ago, I came across exactly what I was looking for (see pic above) in Austin at the Pecan Street Arts Festival in the booth of local artist, Amy Kappler, whose company is called Hippos Eating Alligators. Amy was one of the first-generation dichroic fused glass artists and she created the above necklace.

Lights shone and choirs sang as soon as I saw it, because I knew it was exactly what I was looking for. It captured the spiritual but non-religious nature I wanted to communicate to help offer open space to folks who may be skittish of “pastors” or may have baggage about religion they would not share with me if they did not feel safe. Besides, I think it’s pretty freaking gorgeous! I’ve worn it almost every single day since then.

Each day, I get no less than a half-dozen compliments on it, and as folks comment on or I ask them about what they see in it, they always say, “the Tree of Life”. They also often go on to tell me their stories. It’s always a gentle and spiritual exchange that leaves both of us smiling and feeling more peaceful, with our shoulders relaxing and dropping away from our earlobes where the stressors of life often take them, and our hearts are reminded of love and goodness and a power greater than ourselves.

So as the business began and my graphic artist and I brainstormed about my logo, we had a simultaneous “duh!” moment as I took off my necklace, which she scanned and began working into a digital version for my business logo (many thanks to Amy for granting me full permission for it’s use!)

Since then, the necklace became my book cover for Hospice Whispers: Stories of Life as a friend painted it in acrylic and added one small yellow leaf (to be consistent with the “life” theme). As of last December, Amy has recreated the piece for me to sell through my website so that now others can have access to it.

I was clear that image was the bridge I want to clearly communicate to patients, “You are accepted”, and to professionals in the healthcare field, “You can create sacred and safe space for others to find their way”. It is what I hope to bring to each interaction with patients, families, colleagues, workshop or conference attendees, agencies for whom I consult, and my readers.

Now, to let all of my life communicate that as clearly and constantly…

Peace

For more information, visit http://carlacheatham.com/CCCG_SiteRevamp or http://carlacheatham.com/CCCG_SiteRevamp/products/ to order. For the audio or e-book version of Carla’s book, go to Amazon. To schedule Carla for training live or via webinar for your group of 1 to 1,000 or for consulting for your practice or agency, contact her by clicking here.

Manifesto for Competent Spiritual Care: 7 Things That Matter

Posted by Carla Cheatham on Tuesday, February 2nd, 2016 in Uncategorized

As a spiritual caregiver, I regularly hear persons ask, “Why?”, so I understand the power of that simple question sometimes whispered in anguish, sometimes forced out through teeth gritted in anger, and other times stammered out in shock.

But a couple of years ago, I was reminded of the power of the stated “Why” to motivate others and inspire change in the world. It came in the form of a TED talk by Simon O. Sinek called “How Great Leaders Inspire Action”.

Sinek reminds us that Dr. Martin Luther King inspired hundreds of thousands with his “I Have a Dream”, not his “I Have a Plan”, speech! We’re inspired by the clearly stated “Why” that resonates inside of, and speaks to, us. The goal is to find and connect with people who believe as we do in business and allow those connections to change our world.

Much of the success of the SCIE (“sky”–Spiritual Care Integrity & Excellence) curriculum to promote competent Spiritual Care for all healthcare disciplines came because we were clear about the “Why”. As the SCIE curriculum begins to reach and inspire others to higher quality spiritual care, that message must still be clear. So here goes:

1.) I believe all persons have the right to the powerful and protective benefits of faith, whatever that may be for them, especially during times of struggle and illness.

2.) I believe all persons deserve well-trained caregivers to be with them just as they are as they access and explore their own beliefs to find meaning, peace, and comfort.

3.) I believe that if we fail to provide competent spiritual care then we are subtly engaging in spiritual neglect, because we fail to treat the whole person.

4.) I believe when persons invite a spiritual care counselor (“chaplain”) or other healthcare worker into their home and life to care for them at one of the most vulnerable times imaginable, they deserve that care to come without judgment or coercion, whether unintentional or direct, which can equate to spiritual abuse.

5.) I believe that well-meaning and well-intentioned healthcare workers desperately want to serve patients and families well and simply need the support and training necessary to be able to do so without unwittingly committing either extreme of spiritual malpractice.

6.) I believe when we are personally developed well enough to BE with the suffering of others and trust them to find their way, we will be able to accept them, their path, and their pain without needing them to be different so we can feel better.

7.) I believe the greatest honor, dignity, and act of service we can give others is our ability to sit well-enough with our own pain so that we can be comfortable sitting with them in theirs until they find their own way, their own meaning, and their own answers.

It sounds deceptively simple to care for others this way, yet it is one of the most challenging and humbling jobs I’ve ever had the privilege of doing. I am so humbled and grateful that I now get to walk with others as they learn how to do the same. We WANT to do better. When we know how, we will.

That is WHY I do what I do. I regularly see persons struggling to reconcile old baggage or trauma or woundedness when they face the end of their life, because it just feels better to have the laundry put away and dirty dishes out of the sink before we leave on a trip. Dying, or even the fear of dying, is no different. We seek resolution.

We all deserve competent and ethical spiritual support to be with us as we find healing at the end of life, and to protect us from further damage.

Open-hearted healthcare staff are striving every day to learn and grow into even better versions of ourselves so we can provide exactly that kind of care. If this resonates with you, please let me know, and please help me help others make changes in the way we go about providing spiritual care, in healthcare and beyond.

~Peace…

About Rev. Dr. Carla Cheatham:

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 the book, for 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.

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

Silence With Others: Day 4 of BE-ing with Suffering

Posted by Carla Cheatham on Monday, December 29th, 2014 in Uncategorized

The following is the 4^th in a series of brief 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.

Of “The 5 Most Common Barriers to BE-ing with Others’ Pain” that I hear from lay persons and professionals alike, we’ve now covered 1) feeling the need to “fix” their pain and 2) feeling uncomfortable with pain and tears.

In the last post, I discussed 3) discomfort with silence, namely about finding comfortable silence within ourselves. Today, I’ll address being silent with others.

My favorite professor in seminary was teaching us about pastoral counseling one afternoon and said to a room full of eager-to-help-the-world ministry students, “Remember, Job’s friends got it right…until they opened up their damn mouths!”

As we simply “sit Shiva” with others in the midst of their sackcloth and ashes, we provide a comforting presence, reminding them they are not alone as they sit with their pain. But then comes our need to wax eloquent, to believe that we have something of God to say to them about their suffering.

We want so badly for their suffering to end. We feel so anxious to make it hurry up and feel better. And of course we do! But most often our words ring hollow and leave them feeling overwhelmed, unseen, and even more alone. Even worse, our words can do damage.

We’ll cover what NOT to say and what TO say in the next few days. But for now, how do we find comfort with simply saying nothing?

In classes on the “Art of Presence” and “Communication”, I have participants do several exercises. In pairs, they practice listening without responding—no head nods, no “uh huhs”, no smiles or raised eyebrows. They learn to just sit and exude being fully open and present, not shut down and coldly non-responsive, but silently engaged without imposing on the process.

The speaking partner is often surprised by how much more space they find to speak openly and vulnerably when they know they won’t be interrupted. They all are amazed that without sounds, movement, or facial expressions, the listener can still ooze warmth and presence out of their pores.

You may be naturally comfortable with silence. But are you just as comfortable in silence WITH someone else, especially when they are hurting?

We practice silence to keep us sane and pleasant to be around, but also so that we can sit with our own discomfort and be better able to sit silently with others’ pain. Can we do so without needing to fix it, change it, or gloss it over with words that serve as a verbal security blanket for us and leave them feeling left out in the cold?

When we are uncomfortable with pain and/or uncomfortable with silence, we’ll do with others what we do when we’re alone—we’ll seek to escape it, stuff it, drown it out, or brush by it. Our friends, loved ones, and patients with whom we work deserve better, and so do we.

We think we have to have something profound or “helpful” to say, but we really don’t. Nothing will take the pain away. The only way truly out of it is through it. Platitudes and theologizing are bandaids at best and do damage at worst.

Telling them “It’s going to be ok”, even when we know that’s not always the case, or “You just have to trust…” which is easy for us to say as an armchair quarterback, can dofar more damage than saying nothing at all.

As one bereavement specialist shared with me of her own time of grief,

“I remember vividly hearing someone say, ‘I don’t know what to say’ so they said nothing. They said it with such regret in their voice that I reframed their comment to, ‘I have no words to tell you how sorry I am.’ This seemed to help, especially when the awkwardness of ‘having the correct thing to say’ could potentially translate to…avoidance/a lack of concern.”

We may fear that silence will indicate apathy, but I assure you that you can beam presence and connection without ever having to utter a sound. Often, that’s the best and safest way to do so.

A sense of connection with the living and breathing warmth of others that says “You are not alone” is often the best we have to give, and it is enough.

Please don’t misunderstand, I do not ask us to be robots and have no emotion or no response at all. I simply ask that we get over our own need to DO something, which is about us. Only then will whatever words we do happen to say come from a place that is about truly showing up and BE-ing with them.

Peace…

Sitting with Pain: Day 2 of BE-ing with Suffering

Posted by Carla Cheatham on Tuesday, December 23rd, 2014 in Spiritual Care Integrity and Excellence

The following is the 2^nd in a series of 7 brief 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 most frequently hear these barriers to BE-ing with others’ pain:

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

Hopefully yesterday’s post helped us move a bit further away from needing to “fix” others’ pain, since that understandable desire of ours can actually lead us to harm them with ill-chosen words or abandon them by saying nothing.

Today, I’ll quickly cover some of the Dos and Don’tsto help us find more comfort with discomfort and provide the caring presence we WANT to be when others are hurting.

I joke that this is the guardian angel in charge of monitoring my mouth. None of us wants to do harm, so here are some simple tools:

Provide Presence

Follow Their Lead

Normalize vs. Minimize

Avoid “Reason”

Provide Presence—When computers first came into the workplace, co-workers thought I was a tech guru. I’m far from it! All I did, was stand beside their desk with a gentle hand on their shoulder as I peered at the screen with them. I breathed slowly and spoke calmly as I got them to talk through the issue.

As they relaxed, they found the solution they needed with whatever program they were working on. They just needed to know they weren’t alone and to have the comfort of someone with them while they found quiet space inside themselves to discover exactly what they needed.

I did nothing more than just BE with them and help create safe space as they go through the journey they need to make to find their way through.

Follow their Lead—A friend recently reminded me that in the Jewish tradition of sitting Shiva, the period of mourning and prayers following the death of a loved one, those coming to “sit” with the bereaved are not to initiate conversation.

They simply sit, and if the mourners wish to talk about the deceased or the weather or football or nothing the visitors follow their conversational lead wherever they do or don’t want to go.

By the picture I do not mean to infantilize those suffering, but I do mean to challenge us to be willing to be a little uncomfortable, feel a little foolish, in order to be with them exactly where they are. This is THEIR process (remember the Lao Tzu midwife quote?) and not ours to impose our own ideas or needs upon.

Normalize vs Minimize—This is one of my favorite movie shots of all time as the T-Rex in Jurassic Park is bearing down on the SUV. My fears get much bigger when I’m in pain. Everything feels scarier to me and greatly out of proportion.

The temptation is to try to make people feel better by minimizing their pain. The trouble is, it’s not our pain to categorize, size, frame, or try to tamp down. Any hint that their pain isn’t warranted will only shut others down (or piss them off!) It’s an understandable defense mechanism we humans have, but it leaves grievers feeling not seen, not heard, and even more isolated and alone than before.

So we accept that their pain makes sense. We validate their feelings. Of COURSE they feel the way that feel! It’s normal! Their grief is THEIR grief and NO ONE should tell them how they should be feeling or responding.

And never start a sentence with “Well at least…” As one bereavement counselor I know said, “No matter what follows that opening line, you are minimizing the griever’s feelings.”

Avoid “Reason”—One of my greatest default defenses is intellectualizing. My close friends know there are times when I launch into logic to avoid uncomfortable feelings, and lovingly call me out on it!

Sometimes, logic isn’t readily available to us. When we are under extreme duress, our pre-fontal cortex, the area that controls executive function and decision-making, can get flooded with stress hormones that leave us not thinking clearly. Trying to get someone to “reason” through their feelings is impractical and doesn’t honor their process. So we, again, acknowledge and validate their feelings, giving them plenty of space to feel safe being exactly where they are.

We also are best served to not expect them to be able to answer, “How can I help?” The brain gets fuzzy and it’s hard to know what to even ask for. Questions can feel overwhelming.

So think of some concrete and practical ways you can be of support and then ask their permission to do it. Part of the asking is about respect and allowing them to maintain some sense of control in the chaos.

The other part of asking is to make certain you don’t wash “his shirt” that still had his scent on it or mow down “her wildflowers” that she planted the last time she could garden and loved looking at each morning from the kitchen window over coffee. It may seem like a good idea to get the kids out of the house to go play, but their laughter may be the one thread holding the mourner together in that house. So always ask permission.

After all, we are here to sit WITH them on their journey, and though it may not seem like enough, I assure you it is more than enough.

Tomorrow, we’ll talk about a topic many may choose to skip, because it often scares the snot out of us! (Hint: It’s the opposite of “noise”)

Peace…

SCIE (“sky”) national launch and “The Art of Asking” by Amanda Palmer

Posted by Carla Cheatham on Wednesday, July 3rd, 2013 in Uncategorized

A dear friend who is also a business coach told me of this TED Talk by alt-rock icon, Amanda Palmer, who surprised everyone when she asked for $100,000 on Kickstarter, but broke all records when her fans quickly raised $1.2 million. In her TED talk, Amanda discusses the discomfort, beauty, and vulnerability of “asking” as a way of reciprocal giving, because in the exchange we let ourselves see one another and participate in something!

It reminded me of one of my favorite reads, “Take This Bread: A Radical Conversion” by Sara Miles. As a journalist, she was curious and walked one day into an Episcopal Church where she experienced an “open” communion table for the first time. In that moment, she felt something radically changed. (For her, it happened to take place within the Christian tradition.) She went on to become the director of that church’s food pantry, which was one heck of a ride!

Sara found that, whether in the sharing of bread and wine at communion or in the work of the food pantry, we engage in a reciprocal act of reaching toward one another in giving and receiving. In these acts, we are all transformed because our hunger is about more than needing to be fed, but also about a “hunger to give”.

So I have long been increasing my comfort with “the ask”, letting myself be seen, and acknowledging a need. Amanda Palmer’s TED talk finally helped call me over the edge when she stated “Don’t make people pay for music. Let them.” And so I’m asking…

My Carla Cheatham Consulting Group, made up of members of the Texas New Mexico Hospice Organization’s Chaplain Development Committee, is officially launching nationally the training we have researched and developed for over 3 1/2 years, under the umbrella term of SCIE (“sky”) Spiritual Care Integrity Excellence: Training and Support for Healthcare Workers.

The flier may also be downloaded from our website carlacheatham.com (The “pro” version of the site should be up within the week).

So here’s the ask…Please forward this to others you know who work in healthcare or spiritual care or have an interest in either! We need as much momentum and “branding” as possible to help persons know about this rich and affordable resource available, and we’d love to bring a training to your area.

We rolled out the 2-Day version of our training in Austin last week with not only chaplains but also social workers and nurses from hospitals, hospices, and palliative care programs from across Texas, West Virginia, Ohio, Oklahoma, New Mexico, and California. So far, the evals have been glowing. One participant said, “I’ve been a social worker for 20 years and we do lots of conferences. This has been by far the best thing I have ever been to. Thank you!” One nurse came to me at lunch and said, “I can’t believe I’m actually getting CEUs for this!! It’s amazing and I’m enjoying it so much.”

So please forward this to at least 5 others, even now. I won’t promise your wishes will be granted if you do or that you’ll grow a uni-brow over night if you don’t! But maybe, just maybe, by seeing my open-hearted ask and meeting it with your own, we’ll all experience the gift and healthcare will be just a little more transformed.

Peace…