chaplaincy

Dealing with Anger

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One of the challenges some chaplains face, myself included, is the need to be liked and avoid conflict.  We want people to feel good and comforted, and this is what often leads us into the profession.  We’re the Rogerians in the room: providing that unconditional positive regard to all comers. Trouble is that when conflict takes place, it can feel like failure. So when conflict is on the horizon we dodge it. I can talk myself into twists trying to avoid or minimize whatever the problem is. Which tends to make the problem worse. Then when that conflict does erupt I tend to look at myself as the cause of it, as if conflict and anger are wrong and my fault. In doing so I take responsibility for their feelings and reactions, which isn’t healthy or logical.

One of the harder parts of my own development as a chaplain is raising that emotional boundary between myself and others. It’s easy in the caring professions to open one’s self up too much and to care too much for the other person, which neglects ourselves. This isn’t just chaplains but nurses, social workers, and on down the line. Sometimes this self-neglect takes the form of taking on what the other person needs to do – the “fix-it” or “savior” mentality, an outward focus that neglects the self’s boundaries. However I also see that this self-neglect can be inward focused as well, where I don’t try to fix the other person as much as make their problem my own – their problem is a bad reflection on me, so I take it personally. This can happen a lot with handling anger. This still avoids the problem though, and all I end up doing is taking their anger and internalizing it because it’s directed at me.

What I fail to do though is see that even though it’s directed at me it is still their anger, their emotion. How they choose to express it is their issue, not mine.

Overcoming Nature

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I watched the film Temple Grandin with my wife over the weekend.  My wife works with autistic children and their families, and had been looking forward to seeing this movie for some time.  Grandin is a PhD and expert in animal husbandry, as well as autisitc.

Part of the story revolves around how she seeks to revolutionize the cattle industry by reorganizing slaughterhouses to make them more amenable to cows actually behave, making the whole process more humane as well as efficient.  For example, rather than forcing cows into insecticidal dips with prods and slick  chutes, which occasionally result in drowning, Grandin’s model uses curves to lead the animals to a stepped platform, where the animals simply walk into the dip, swim through, and back out.  It’s all pretty amazing in how simple the design and process appears, yet how complex the behavior is that the process is built upon.

What else is interesting is her reason for doing so.  Most of us would think that her affinity for cattle and the desire to limit their suffering would have led her to denounce the whole industry, but that wasn’t the case.  She understands and respects the life that is present in each animal (in the film, after a cow is killed before her she asks “where did it go?”), but doesn’t have the deep emotional connection that we would expect due to her autism.  The reason she sees for treating the animals humanely is simple but deep: “Nature is cruel, but we don’t have to be.”

I thought about this in light of hospice care.  This same thinking guides a lot of our care and judgment regarding care for those we care for.  We see nature at it’s most cruel sometimes.  I recently had a patient whom I was close to pass away.  He had struggled with pulmonary fibrosis for several years, struggling to breathe continually and leashed to an oxygen tank.  He gradually grew weaker and more dependent, to the point where he could only walk short distances.  Then he had a serious stroke, taking most of whatever he had left.  He could talk, though slurred, and could understand, but was otherwise unable to move.  Even his head had to be propped up with a neck pillow.  It was tremendously sad to see the cruelty of nature at work here, and our job was to make sure that cruelty was dealt with as best we could.

The physical pain was manageable, but the psychological and spiritual pain was tremendous. I spent time with him the day he died in his home, holding his hand and praying for him along with our staff and his wife and daughter.  Some of his grief was directed at God, and I can’t say that I blame him.  You can’t go through an illness like that, or accompany someone along that road, without wondering why.

There are plenty of answers out there for sure: the fallen world, suffering as part of life, the stripping of everything to increase our dependence on God, the work of the devil, the work of God, and so on.  Yet I found Grandin’s insight to be one of the simplest and maybe truest at the moment.  Nature is cruel in many ways, and we can’t overlook or overcome that cruelty.  Sin and death are, at least for now, permanent fixtures in the world.  However part of realizing the kingdom of God in the here-and-now is to see that while these can’t be overcome, we don’t have to fatalistically succomb to it.  Jesus reminds us, over and over again, that he has “overcome the world”, and even though that cruelty is still there in the world, we can overcome it as well.  Nature is cruel, but we don’t have to be.

Timing

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What a long trip it’s been!  Next week I’ll be finishing up my fourth unit of CPE – fourth consecutive unit I might add.  I’ve been spending my Tuesdays in CPE, getting up at 5:30am or worse, since last fall.  I said today that I felt like I was in a marathon with the end finally in sight.  The start was full of excitement but a lot of trips until I caught my pace.  Then I ran steady for a long time.  Then, this term, I hit my wall.  Now I feel like the “runner’s high” has kicked in as I finally realize the end is really in sight.

I am looking harder at not trying so hard.  I tend to feel that so much depends on me in order to keep up my own standards.  I’ve seen though that my own standards still can be unnecessarily high.  I felt very alone a few weeks ago, because I just couldn’t keep up with my own expectations and wanted someone to rescue me.  I was a fairly miserable person.  I realized that my priorities were so messed up – the things that I saw as important were really distracting me from the things that were important: my kids, my wife, personal time and so on.

I feel freer and happier.  How often are we our own worst enemies!

Calling

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The term “calling” is a serious topic, both for ministers and the people who call on them.  It implies not simply a “hiring”, but an endowment of purpose beyond what the minister and the congregation have.  It brings in a third party, the Holy Spirit, who acts as the one who inspires and confirms the direction of this person to that place for those people.  It’s pretty strong stuff.  It often brings up a lot of reflection and anxiety on the part of clergy: “What am I called to do?”  “Is this my own desire or God’s?”  “How can I be sure?”

Perhaps the most troublesome is the question that occasionally comes up after a call to a position of ministry, “did I just mess up?”

After I graduated from seminary I was “called” to a position right away.  It seemed ideal – it was a church I knew, where I wanted to work, doing what I wanted to do.  It was like a gift was just dropped in my lap.  To confirm my call the senior pastor and dozens of others laid their hands on me and prayed over me.  It was  a spiritually and emotionally charged moment.  I felt like everything was right.

However very soon I discovered that everything was not right.  I immediately was bashing into other leaders in the church who didn’t want to hear what I had to say.  I felt marginalized.  I found myself not in agreement with how things were done but had no outlet within the church to hear me out.  After a while, it got so bad that my wife actually quit attending the church where I was an assistant pastor!  I remember thinking, “did I mess this up?”  I wondered if I had mistook God’s calling for my own desires.

Looking back at it now I can see that I was called to that place for that time, but that the calling wasn’t what I expected it to be.  I don’t think that God makes mistakes, nor do I think that this was somehow out of God’s plan.  I was called to be there, but I think it was to show me that I was called to do something other than what I intended.  God used me, and when that particular call was over He called me back out again to hospice ministry.  That doesn’t invalidate the prior call at all.  In fact, I don’t think I would be doing what I’m called to do now if I hadn’t been called into that mess.

I faced a similar paradigm shift last week.  I found myself really struggling, both in CPE and my job.  I felt stuck, frustrated, tired and emotionally drained.  When I started CPE over a year ago, someone asked how long I was going to do that.  I thought I could do it as long as I could foresee.  I didn’t see any changes on the horizon, and didn’t really see the need to change.  However as I began growing through CPE, I found myself getting worn out with the status quo at work.  I wasn’t “feeling it” anymore.  I still had passion for my work, just not passion for that part of my work.  Like I told the group, “I’m just tired of all the ___ dying.”  One member of the group later commented that it looked like I was in mourning.  Indeed I was!

With the help of my CPE supervisor and the group I was able to see that I really was just stuck in this corner, unable to turn left or right.  I needed to see that I had lost my passion and needed to refocus.  In the past my instinct was just to try harder and push through.  However there was no more pushing through.  I had to back out and try a different direction.  In doing so, I was able to see a new focus for ministry: the people I work with.  I’d already moved into much more of a managerial role, and needed to cut loose some of what I was holding on to.  When I did that, I found renewed energy and depth.

Had my calling been wrong?  Absolutely not.  God put me there for that purpose for that time.  And I could not be doing what I am doing now if I hadn’t been there.  My calling changed, and now I can even see that it is not a huge a change.  The hard part in making that adjustment was seeing that I needed to make it – I couldn’t try harder, it was done.

Surviving Hospice

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I often hear people, when I tell them what I do, respond with something akin to “I don’t know how you do it”.  Some days I can respond with “I enjoy what I do” or “I meet so many interesting people” or something similar.  Other times I think “I don’t know either!”  So I brought up this question to myself – how does one survive working in hospice?

Self-care self-care self-care self-care…

Easy to say and harder to do!  But that’s precisely the core of survival here.  There’s lots of good material out there on ways to take care of yourself to avoid burnout: art, time off, reframing, maintaining good boundaries, etc.  All of these are good and beneficial.  However two other things are required and are even more important.

First, you have to know you need to take care of yourself.  More often than not, it takes a meltdown or crisis situation to show me that I need to take care of myself.  When I’m stressed I tend to pull in and try to shove through whatever storm is blowing in my face.  My concentration is usually on going forward, not stopping to rest.  In the middle of stress I think our tendency is to do just that – get out of it as quickly as possible by surging onward even when we’re exhausted.  I’ve read more than one account, though, of mountaineers who ignored their own internal warning signs of exhaustion and fatigue and, rather than stop to rest, pushed on through the stress only to walk off the mountain.  I can fall in to that same trap.  But it’s amazing how even just a brief adjustment – for me it was a day working at home rather than the office – can rejuvenate and reframe.

Self awareness comes only with time and honesty with yourself.

Second, I must actually do what I need to do to take care of myself.  There are many times where I’ve stopped and said, “boy I’m exhausted!  I need a break!” and then never do so.  This is the pain of inertia that hits when we know we need to stop but don’t for fear of never starting up again.  I think that fear, rather than pride, keeps us from doing those things that we recognize that we need to do.  I fear letting things go, I fear appearing lazy while others (who aren’t taking care of themselves) push on, I fear lots of things.  Overcoming that fear again only comes with time, honesty, and practice.

When the world doesn’t fall apart when I let go of it, or when I stop caring what others think of me, or when I stop comparing myself to the “saints” around me, that itself is self-care!

Sound like grace to anybody?

Know, Be, Do

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The biggest part of CPE is the process itself.  It’s not a matter of learning something new and then showing that you’ve learned it, as in a typical classroom.  You are the classroom and you are the textbook.

In fact, CPE and chaplaincy depend very little on knowledge.  Rather it depends on wisdom, developed over time and only through experience.  Many enter in to CPE thinking that either it will be like a college class or a small-group devotional.  In my experience, that couldn’t be further from the truth.  The CPE group develops in a dymanic way, with each member of the group giving and taking with the ultimate goal of building pastoral identity and wisdom.  That wisdom is not gained easily though, not just through navel-gazing or drum-beating.

John Patton in Pastoral Care: The Essential Guide writes “Pastoral wisdom involves our knowing, being and doing.”  Sound profound?  Yeah, did to me to.  However it’s true, but here’s how I understand it.

Knowing involves not simply knowing a fact.  In pastoral care, this knowledge is not just knowledge of scripture or doctrine.  It is the knowledge of your self – strengths, weaknesses, history, pain, story, shames, successes and so on.  CPE involves a great deal of this self-identification, which is sometimes easy and sometimes hard.  I think lots of folks have experiences in CPE because they try hard to maintain false selves while the group or supervisor try even harder to tear that false self down.

Being involves accepting those things we are aware of through self-knowlege.  Too often self-awareness leads to self-rejection, I think.  The hard parts of my life are just a part of me as the good parts, yet I find I tried for so long to judge those hard parts as things to be set aside or avoided.  I reject negative parts of myself as not really me, but that only sets up a false knowledge of who I really am.  However when I accept my past and my self and my past without judgement I can use them both to work with others in the midst of their own story and pain, and also help them to see their own true self without judgement.  This is not saying that sin isn’t sin or that “I’m all good”.  It involves seeing myself as I truly am, not how I view myself or how I want others to view me – it is how God sees me.  And in Christ, God sees me without judgement.  I think that’s what grace is.

Doing is the acting upon that knowledge of who I really am, putting my self fully into interaction with others.  This is the essence of pastoral care, but it can only happen after the knowing and the being.

Sample CPE Verbatim: A bit of what Clinical Pastoral Education does

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I thought I’d throw in a sample verbatim that I presented in CPE a few weeks ago.  These are presented in class and are a pretty significant part of what we do.  After a patient visit we write it up similarly to what you see below, although there are a lot of different ways to do it.  The main reason is to have the group look at what you did, ask questions, and look at the visit from a number of different angles.  Plus, the writing down of the visit and reflecting back on it afterward is very helpful in your own education.  I don’t write up every visit obviously, and while I used to look to try and find the “perfect visit” you can pretty much find something interesting in every visit you do.

Names and places have been changed obviously.  This references the Association of Professional Chaplains’ Common Standards, available here.  And pardon the weird formatting but I’m not fixing it on Monday morning.

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Theology of Practice II

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“…And what does the LORD require of you?  To act justly, and to love mercy and to walk
humbly with your God.” Micah 6:8

“To act Justly”

In my ministry, right action is not something that is set in stone.  Every encounter is new and involves no fewer than three people: myself, the other, and God.  Imposing my own plan based merely on what I think is necessary or important may hinder the process of that encounter and denies the needs of the other, as well as the working of God.  This does not mean that I am a passive observer, but that I act based not on my own preconceived notions but on what is revealed in the moment  encounter both God and the other.  Freeing myself from my own “should’s” beforehand will make me more open to what “could” be as well as to what God or the patient is telling me “could” be.  Acting justly, in the context of hospice chaplaincy, refrains from judgment and instead seeks to discover and celebrate meaning when possible, and to walk with
them in the silence when it isn’t.  The dying also may not have basic spiritual, emotional or physical needs met, and acting justly also requires that I advocate for them during those times.

“and to love Mercy”

Mercy can mean loving in spite of circumstances, not simply the putting aside of justice.  Just action will be merciful.  If action toward the dying is not merciful, it is not just.  My patients may be dealing with guilt and shame resulting from past wrongs, or a past injury to their self, that makes them feel outside of God’s mercy.  In other cases, they may be at peace and fully holding on to God’s mercy as I sign of His love and acceptance.  As chaplain I am not only a conduit of God’s mercy through prayer and counseling, but through my presence.  God’s mercy can be present to them because I am present to them.  In a similar way, because God is working through those I encounter in my life as well, God’s
mercy is shown to me in the lives of my patients and families.  In the same way as they receive mercy through me – I receive mercy and am reminded to be merciful to myself – through them.

“and to walk Humbly with your God.”

Humility is not self-abasement; rather it is fully recognizing my value through God’s gift of acceptance.  True humility then is not a matter of valuing myself more or less than another.  Instead it looks at life as inherently valuable and worthy, worthy enough for salvation through the sacrifice of Jesus on the cross.  Humility comes from recognizing that this value is not from my own doing or work, but through
Jesus’ mercy and action first.  This is something that is very much in process for me, but “walking” implies a journey rather than a destination.

Hard Lessons

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This has been a tremendously taxing last month and I’m glad it’s over.  July seemed long and tedious, and the fact that the AC on my car has been dead for some time didn’t help matters.  Neither did the “check engine” light that just won’t go off.  Neither did the fact that I traded territories with another chaplain as she was doing far too much traveling, only to find now that I’m doing a lot more traveling than I like now.

I kept up with everything and CPE was going great.  But last week killed me.  I had a very busy week with my new caseload and also had to manage the house and kids on my own as my wife was out at a conference.  I plugged through because I had this big goal at the end that I was looking forward to – being an extra in the new Batman film.  But then that got yanked and I felt like I ahd just run a marathon for nothing.

I got really mad and was emotionally all over the place.  Then I felt that I should just never count on anything good happening – that maybe I was holding on to things too hard anc counting on outside things too much.

And that was when I realized that I was exhausted and not taking care of myself.

This was why I was having such a big reaction to something that would have been disappointing but not a crisis event.  Self care for me is really hard, as I just don’t feel like I have the time to do so.  However failure to do so just makes me burn out faster.

Today I had trouble with one of my CPE reflection papers, as I found it really hard to “reflect” on the visit that I was supposed to be writing about.  What was going on spiritually during the visit?  Hard to tell, because right now I don’t feel spiritually connected to myself or anything else, just the stored-up pain in my shoulders that I can’t neck-crack away.

So all this to serve as the reason why I’m taking the rest of the afternoon off!

Grief

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I think grief has less to do with whatever is lost and more to do with the change it makes in our lives.

I meet so many people in my job who are truly accepting and realisitic when it comes to the death of someone they love.  Especially when that person has dementia, has been due to a long and drawn out illness, death has been otherwise anticipated and even welcomed.  People often are ready for their loved one to die and therefore feel their grief will be short.

However I find so many times that even when the loss of someone is expected, the loss of everything associated with that person isn’t.  Suddenly the family member is faced with not having to visit the nursing home on Sunday afternoons, like they have for the past 8 years.  No more doctor’s appointments.  No more visits with the visiting nurse after the bedsheets are changed.  These are the unexpected losses, and these are the focus of all the denial, bargaining, anger and depression associated with grief.

Mourners can accept the loss of the person, but they can’t accept the fact that that loss has changed them irrevocably and they can’t accept the feelings that accompany that loss.  They don’t deny the death, they deny that things have changed and that they have changed.  They don’t bargain with God to get them back, they pretend that if they don’t go by the nursing home or the hospital they won’t be sad.  They aren’t guilty that they didn’t do more, they feel guilty because they can do more, and that change bothers them.

When I turn from considering grief to only be about a body in a casket to being about the global change in my world, I can really grieve and grow.