Every so often you’ll come across a case that’s difficult because of competing messages and needs. For example I have one patient that had declined spiritual support for several months. He was always on the forefront of people’s minds though, because of the many needs he had. He had alienated his entire family and been through most of the assisted living homes in the area, burning his bridges in the process. He suffered from a great deal of depression and anxiety, never seemed satisfied or comfortable (even after massive doses of pain medication), and seemed to be always wanting to change things in his care plan – though nothing made a difference. He had declined chaplain services for months (he was Catholic) but the team thought that he would greatly benefit from support, if only to give him someone else to vent to other than the on-call staff.

So I tagged along with the social worker one day and paid him a visit. The room was pitch black; windows covered and drawn, no lights on, the only illumination coming from his digital clock. After my eyes adjusted I saw that even in that darkness he wore a sleep mask. After some hesitation he opened up to me a bit. He was Catholic but had not attended for many years. He did not want to reconnect with the church but thought that some “religion” might do him some good. He was open to prayer at the end of the visit and I was hopeful that this might open things up a bit.

However since that first visit he hasn’t been open at all. He had wanted me to call before visiting, and every time he did he said he did not want a visit then. A couple times I just dropped in and still no luck. “No, not today. I don’t feel up to it. Come back another day.” I asked questions, I sat in silence. Staff continued to urge me to visit as they felt that he needed help, but that wasn’t the message I was getting from him.

Chaplains, as well as other disciplines, have to deal with competing and mixed messages. What our client says they need may not jive with what others say they need. Good counseling follows the lead of the client, but when these mixed messages come up it is difficult to assess what is going on and how to respond. Is the client being honest or are they covering? Is my team seeing something that isn’t there?

One response is to simply address it openly. “My team seems to think that you need my help, but I wanted to see what you thought. How can I best help you? Would you like me to come by just for support?” This gives the authority completely to the client and brings concerns out to the open. Yes they might be covering up real spiritual needs, but hammering away at defenses is often unproductive. Sometimes the patient might be uncomfortable opening up about spiritual issues even when they are present. Simply keeping the door open through offering support and showing up is enough in these situations. When the client doesn’t have a need but the team thinks there is one, discuss this with the team and find ways to support the supporters. It may be that the needs are located somewhere else and the patient has become the focus of concern.