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Nine Weeks of Must-Read Books: Week 6–Spiritual & Multi-faith Care

Posted by Carla Cheatham on Saturday, February 18th, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 6—Spirituality and Multi-faith Care

With the cold weather, it’s more tempting to curl up and read, so I’m posting the books and videos I most recommend to caring professionals and to which I refer in my trainings. It’s not an exhaustive list and does not necessarily contain the latest titles, but they’re what I know works to support us while we prepare ourselves to support others. I hope you find these helpful.

Spirituality and Multi-faith Care

Making Healthcare Whole, Christina Puchalski & Betty Ferrell

I tell others that if Oprah calls and my business takes off or if I win the lottery, I’d buy a copy of this book for every single person in healthcare. Two gurus of palliative care, Puchalski and Ferrell know how important spirituality is for persons going through a life crisis.

Their book lays out an impressive argument, with supporting research, for the respectful inclusion of spirituality into healthcare. They provide a model and tools that make it more accessible for patients and families by making it more comfortable for professionals to include it in their daily practice of care. Definitely a worthy read!

Paging God: Religion in the Halls of Medicine, Wendy Cadge

A professor of sociology, Cadge brings these skills to this fascinating look behind the veil, exploring the visible and invisible ways professional care providers in hospitals include religion in their practice of medicine. Through interviews and observation, she gains keen insights and provides an interesting viewpoint of the ways healthcare integrates patients’ and professionals’ spiritual lives into the daily ups and downs in the sterile, yet human, environment of healthcare. An intriguing book I highly recommend.

How to Be a Perfect Stranger: The Essential Religious Etiquette Handbook, Stuart Matlins & Arthur Magida, Eds.

I keep this book available for my colleagues in whatever healthcare setting I find myself, and recommend others do, too. Think of it as “quick flips” for many of the major religions and denominations or sects of those religions one may find in the U.S. It’s written to help persons know how to dress and act in order to be respectful when visiting houses of worship different than your own.

However, it had brief explanations about beliefs and rituals, including around the end of life, that can help all disciplines in healthcare feel a bit more prepared to engage with persons from other cultures and faiths in a way that is respectful and comfortable for all. Keep this text handy!

The Little Book of Atheist Spirituality, Andre Comte-Sponville

A philosopher and former religious believer, Comte-Sponville moves past the angry rhetoric and debate over religion that often exists, and provide a gentler voice to discuss the often contentious question of God. As I teach respectful care for the existential needs of non-theists (atheists, agnostics, and humanists) to healthcare staff, including chaplains, I urge them to consider this delightfully compassionate book.

My goal is not to convince others to alter their beliefs, and neither is Comte-Sponville’s. The goal is to increase understanding and improve the ability to have respectful, even compassionate, dialogue around what can be a very charged topic for many. The more we understand, the less we fear; the less we fear, the more likely we will be to show up well for patients and families who do not share a theistic belief system. Give this one a try. You’ll be all the better for it.

Stages of Faith, James Fowler

After conducting hundreds of interviews with persons about their faith journey Fowler, a developmental psychologist, developed a stage theory, based on Piaget’s stages, of how our faith matures. While some have criticized Fowler’s work as being too Christo-centric, others point out that it can be applied to persons of any faith or ideology. The more we understand faith as a multi-faceted, often evolving part of an individual’s life the better we can truly meet them where they are at any given time.

I find this text appropriate for spiritual care providers, social workers, and other counselors, but nurses and physicians could also benefit from a deeper understanding of how our faith develops, ebbs, and flows over the course of our life experiences. You’ll learn about yourself and gain greater insight into others with this text.

Relating to People of Other Religions: What Every Christian Needs to Know,Thomas M. Thangaraj

In a very sweet and engaging way, Thangaraj reveals his own struggles and thoughts when getting to know someone of another faith and how the journey strengthened his own. For those being asked to care respectfully for persons of another faith or belief system, this can be challenging at first.

Many whom I’ve taught have resonated with the reflections and struggles the author openly admits in the book and benefit from his ways of reconciling his love for his neighbors and his previous views. This book will help you clarify your own faith while opening up to have more respect for others’.

If Grace is True: Why God Will Save Every Person, Philip Gulley & James Mulholland

Another text I recommend to trainees is this one written by two Quaker ministers on their view of universal salvation. In their view, if grace is grace, then grace must really be full on grace, no exceptions. Sharing their own struggles with scripture, tradition, reason, and experience, Gulley and Mulholland make their case for a grace that is bigger than we can even comprehend and they do so in a gentle way that makes it easier for the readers to follow and consider.

Again, I do not ask folks to read this to change their beliefs, but to help them wrestle with their views to hopefully widen them enough to make room for others’ faith, so that they may provide professional and respectful care for persons of all backgrounds and ways of believing.

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to Grief and Meaning. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

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

Nine Weeks of Must-Read Books for Professional Care Providers: Week 5–End of Life Care

Posted by Carla Cheatham on Friday, February 10th, 2017 in Uncategorized

Nine Weeks of Must-Read Books for Professional Care Providers

Week 5—End of Life Care

End of Life Care

Videos

1.) Dying Wish (DVD), Karen Van Vuuern, Wise Word Productions

A physician with cancer makes the choice to Voluntarily Stop Eating and Drinking (VSED) and allows his journey to be documented to share with others. A simple, powerful introduction to the concept, currently considered legal in all 50 states. It will make you think, wrestle with your own views, and find greater clarity.

Learn more at http://www.dyingwishmedia.com/

2.) A Family Undertaking (DVD), Elizabeth Westrate, Five Spot Films

The home funeral movement has grown in recent years, with many wanting to reclaim a natural connection with death. This documentary follows the stories of those who’ve made the choice for a home funeral and burial in a touching and personal look behind the veil that seems such a mystery to so many.

Available for purchase through PBS http://www.pbs.org/pov/afamilyundertaking/

3.) New Rules for End of Life Care (DVD), Barbara Karnes

From the author of the “little blue hospice book” called Gone From My Sight, this DVD goes even deeper into providing information that can be helpful to both clinicians and lay persons. Covering what to expect, medications, hydration, nutrition, and much more, this video will help everyone feel more comfortable with and prepared for caring for someone at the end of life.

Available at https://bkbooks.com/shop/new-rules-end-life-care-dvd-kit-guide-stages-death

Books

4.) Being Mortal, Atul Gawande

This surgeon certainly took the country by storm with his brilliant critique of both society and medicine’s approach to death, the practice of medicine, and end of life care. With a clear style and articulate arguments, he explores our current state and lays out a path for us all to follow to make the changes necessary for a better outcome for us all.

5.) It’s OK to Die, Monica Williams-Murphy & Kristian Murphy

An ER physician who grew tired of running full codes on 97-year old grandmothers, cracking every rib in their body with the first chest compression, because of our fear of letting go, Dr. Monica Williams-Murphy decided to do something about it! I first heard Monica speak a few years ago at a national hospice conference and fell in love with her spirit, immediately. Feisty and passionate, with brilliance and charm, she writes a book that is easy for anyone to grasp but that also provides great insight to professionals about having those dreaded end of life conversations with patients and families. It will make you think and make you cheer.

Learn more at: http://www.oktodie.com/

6.) Notes from Theme Park Earth: A Hospice Nurse’s Personal Journey of Life, Loss and Everlasting Love, Nancy Butler.

What does it look like when a hospice nurse experiences hospice from the other side of the bed? My friend and former colleague opened her still-grieving heart to share stories and insights with all of us about the journey with her husband through diagnosis, decline, and a lot of life and music and love.

As a seasoned hospice nurse, Nancy was in a unique position to see themes and lessons that many may have missed. She weaves them together for us by sharing many glimpses behind the veil of grief and her own professional service. Touching on many levels, it is far from a depressing read and is, in fact, truly inspirational. As Nancy says, “Dying is sad, but it doesn’t have to be grim.”

Learn more at: https://www.chandlerdesignslimited.com/store/index.php?main_page=product_info&cPath=96_97&products_id=237

7.) Hospice Whispers: Stories of Life, Carla Cheatham.

Okay, I won’t practice false modesty; I’m truly proud of this book. Based on examples shared in a training curriculum for hospice and palliative care professionals, this collection of 38 stories was published to help persons increase their comfort with hospice and decrease their fear of death.

The unintended by-product has been that it has helped persons fear their own death less, learned more about how to show up better for patients and families (including their own), and has helped persons process their grief around their own story of life in the face of death. As one reader recently stated, “While reading this book, I laughed, I cried, and I heaved a huge sigh of relief!”

Learn more at: http://hospicewhispers.com

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to Spirituality and Multi-faith Care. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Nine Weeks of Must-Read Books for Professional Care Providers: Week 3–Boundaries, Family Dynamics, and Team Health

Posted by Carla Cheatham on Friday, January 20th, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 3—Boundaries, Family Dynamics, and Team Health

In honor of the highest-selling month for books, and the cold weather during which it’s more tempting to curl up and read, I’m posting those books and videos I most recommend to caring professionals in practice and to which I refer in my trainings.

Boundaries, Family Dynamics, and Team Health

We professional care providers deal with persons and families who are often in crisis, which is when all of their best and worst defense mechanisms and even most dysfunctional patterns can arise, tapping into our own!

The more we understand these dynamics, the better we can notice and heal them in ourselves, keep our own stuff from entering unhealthily into the situation before us, and even be healthier members of our teams and own families.

If we are hesitant to explore and consider these things, we must ask ourselves from where is our resistance coming? Why would we want to avoid the healing journeys we encourage those persons with whom we work to engage in?

These books will empower you to be better and healthier in every arena of your life, so the discomfort of what you might find if you start looking is definitely worth the price of admission!

Generation to Generation: Family Process in Church and Synagogue, Edwin Friedman. This helpful classic helps not just faith leaders but clinicians and leaders of any group to recognize family systems dynamics that can arise when we humans gather with all of our imperfections. The more we are aware of these dynamics, the more likely we will be to recognize them and avoid getting in the nasty middle of them.

With its simple, straightforward language, it helps even non-counselor types gain important knowledge, insight, and skills. Just read this. Trust me!

The Five Dysfunctions of a Team: A Leadership Fable, Patrick Lencioni. Written in an engaging story-telling style, this latest work from Lencioni portrays hurdles teams commonly face that hold them back from being cohesive and effective, as well as action plans for overcoming them. Any member of a team can benefit from having their eyes opened to the dynamics that can tear teams apart and the ideas that may help them pull together to success. A helpful read!

The Gentle Art of Verbal Self-Defense, Elgin Suzzette Haden. This is still a classic. Over 25 years ago, I was 19 and in college, dealing with a very challenging loved one with mental illness who knew no boundaries. A wise therapist recommended this book to me and it helped change my life. Subtle and not-so-subtle put downs come at us on a daily basis, and we likely make them ourselves. This practical, easy to grasp book is full of tools you can use from tone of voice, assertive scripts, body language, and more to help you recognize and navigate challenging conversations. A must read for caring professionals.

Please Understand Me: Character and Temperament Types, David Keirsey & Marilyn Bates. This easily accessible explanation of 16 different personality types includes a self-test to learn your 4-letter type (ENTJ, for example) and includes a great explanation of each types strengths, challenges, and ways of showing up in relationships. When we understand that the way our colleagues, clients, and even friends and loved ones act as they do as part of who they are, it can be easier to speak their language and be more patient with their unique way of being in the world. This is an important piece that will help you professionally and personally in more ways than you can begin to understand until you read it and the lightbulbs begin to go off!

How Al-Anon Works for Families & Friends of Alcoholics, Al-Anon Family Groups. Professionals in all capacities would benefit from even a basic understanding of the impact the family disease of alcoholism can have on all of its members. Issues of trust, esteem, boundaries, control, and so much more can arise for persons who have been impacted by addiction and being aware of them can help professionals notice and navigate these dynamics in their work. Besides, who amongst professional caregivers wouldn’t benefit from a reminder to maintain healthy boundaries and loving detachment in their work?! Prepare to have your eyes opened in ways you never expected.

Facing Codependence: What It Is, Where It Comes From, and How It Sabotages Our Lives, Pia Melody. Many people roll their eyes at the very word, which became incredibly over-used in the 1980s. Nonetheless, it does exist and makes life harder than it needs to be for many, even if they only have small traits of this way of engaging in relationships, as most of us do! Using a simple framework, Melody helps persons identify such patterns, including 5 symptoms and early roots of the behavior and helpful information for healing those patterns. This book will surprise many with its insights and gentleness.

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to General Healthcare. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

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.

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.

“Hospice Whispers” Necklace On Sale NOW!

Posted by Carla Cheatham on Thursday, December 3rd, 2015 in Uncategorized

Friends,

After numerous requests the past few years, and months of working with the artist, the necklace I wear every day that became the book cover for Hospice Whispers: Stories of Life is now available!

Each piece is a replica of my necklace but, because of the nature of the glass and firing technique, will have it’s own unique look and character.

You will receive the pendant with silver-plated bell, silk chord (clasp not included), gift box, and the story of the Hospice Whispers necklace for $39.95 plus 8.25% tax ($43.25 total per necklace).

In the Austin area, I’ll hand deliver it to you. Outside of the Austin area, please add $3.50 S&H.

Payments can be made by clicking this PayPal link

4417 Banister Ln

Austin, Texas 78745

Please included your shipping address and phone number, in case I need to reach you about your order or so I may arrange hand delivery!

Items will be delivered once payment is received. All sales are final. Email me at carla@carlacheatham.com for more information.

I hope you enjoy this beautiful piece, with a long story of love and life behind it. I look forward to sharing it with you!

Peace,

Carla

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…