In any kind of Clinical Pastoral Education experience, you will probably hear this phrase at least once: “trust the process”. I know I heard it several times in my own CPE classes, and it was never spelled out what it meant to “trust the process”.
That is part of trusting the process.
Many seminarians enter CPE because they have to, because they want to enhance their pastoral care toolbox, or enhance their resume. I’m not going to pan these reasons at all. They are all good reasons to take a CPE unit. However this is only part of what CPE does. The tools and materials used in CPE to help develop interpersonal caregiving skills – books, group work, role-play, writing essays and reports, films – are also designed to work intrapersonally as well. When entering in to the work at first, the focus is outward. We come to learn to help others, to manage others’ crises better, and see how caregiving fits in to our theological and scriptural paradigms. Continue reading
At my recent CPSP meeting I presented this verbatim and got some new insights from the group. I’m going to shorten it a bit just to make it easier to read.
This happened quite some time ago and when my colleagues asked why I brought it up I responded that it deals with things that I still deal with today: self-care, tiredness, and burnout.
The patient in this visit, Mrs. S, is 67 years old and has been on hospice now for a few months. She has a history of alcoholism and is on hospice for chronic pain and malnutrition. She is extremely thin and emaciated even though she eats fairly well. She smokes regularly 3-4 times a day. She is a widow and has children but they are not involved with her and she does not want them contacted. Mrs. S is Roman Catholic but has not attended church in some time. She maintains her own prayer practices and she says that she finds these comforting. She almost always presents herself as happy and content unless she is in pain, and even then she tends to minimize her pain. Her pain is regularly 8 out of 10. She is very friendly but not always open regarding her own feelings, family and past. She tends to use humor to divert attention and make light of her situation. She is frequently in bed as this is most comfortable for her. Continue reading
One of the things I learned through reflecting on and getting feedback to pastoral encounters through verbatims is that many times I am counseling myself without knowing it. It’s only in reflection, sometimes long after the fact, that you start to hear yourself talk to yourself. I decided not to go the whole CPE verbatim route, buyt I like this format for reading.
For an example I included part of a dialogue I had with one of my regular patients, an older woman on hospice. She typically has a lot of pain but rarely tells anyone about it. She puts on a pleasant front but typically doesn’t let much out. I decided one day to press her a bit.
C8: So how’s you’re back been? Better or worse or about the same.
P8: No, about the same.
C9: About the same? Just not a good day today.
P10: (pause) I’m not complaining too much. Stick around though.
C11: You’re not too much of a complainer though.
P11: Seems like I’m always complaining.
C12: Really? I’ve never seen you as much of a complainer.
The following is an excerpt from a Level II verbatim I did several years ago to give you an example of how I wrote toward the Level II standards.
This case ended up being one of my most difficult, in that the patient was a child and I was good friends with his mother. His death was hard on all of us. As I have children this child’s age, it cut very close for me. Perhaps a bit too close. This visit is a follow-up regarding her son’s death. I think you’ll see several themes at work:
- who is caring for whom?
- recognizing defensiveness
- allowing space for authenticity and giving permission to be authentic
- theodicy – how does God work things out for the good when a child dies?
- self care
While I see these themes at work, I don’t think I touched on all of them in the conversation.
Feel free to comment!
As important as self care is for Chaplains and other caregivers, it’s probably one of the most neglected parts of our job. And self care is part of our job, because if we don’t care for ourselves we will be unable to do our job.
image: Amy Corron Power
Donald Miller recently wrote in his blog, “I don’t connect with God by singing to Him.” Well Don, I don’t either.
That doesn’t mean that I don’t sing to God. But I find that the only time I do is in church on Sunday for about 20 minutes. At times I find myself being drawn closer to God by music, including Christian music, but those songs somehow never make their way into the worship center.
Plus I don’t sing well. While I knew this all along, it became glaringly obvious to me when I attended a Reformed Presbyterian church in college. At RP services no hymns are sung, and there is no musical accompaniment. The congregants sing the Psalms a-capella, often breaking into multiple lush harmonies as the verses change. I just stood and listened. It was beautiful, but I was a spectator, not a participant.
Being in hospice means having to travel quite a bit some days. I’ve learned all the places – grocery stores and gas stations especially – that have places to sit down and eat my brought lunch on the go. I remember walking in to a grocery store to sit down and have lunch during a particularly hectic day. I still had my ID on and when the person at the counter noticed that I worked for hospice, he said “you must have a very fulfilling job”.
I remember thinking for a minute, saying “yes it is”, paying for my coffee and sitting down, knowing that I wasn’t sure if I meant what I said.
The truth is that this is a very fulfilling job, some days. But not always, and not often most. Personally, many days are filled with anxiety beforehand about how I’m going to get done what I need to, planning my route so that I don’t end up downtown after 3pm and so on. Some days I can see half a dozen people and feel like I accomplished little else but meet the medicare requirements for my position. Other days I hear of a death of a patient and my first thought is “well at least that’s one stop off my list today!”
Does all this point to burnout? Maybe. Hospice has a high rate of burnout among staff and I’ve seen it happen. Individuals are drawn to hospice work because they are caring and want to make a difference no matter what the cost. This can mean crossed boundaries, late night calls, and overextension. And more often than not it’s those individuals that get the rewards and Kudos – rightfully so for putting themselves out there, but it can also feel to those that try to guard their boundaries and time that they are getting the short end of the stick.
I also feel that sometimes chaplains especially can feel that what they do doesn’t matter all that much in comparison to other disciplines. Nursing runs the show and calls the shots. Social workers can provide counsel and care as well as crisis intervention. Everyone can pray with and for their patients. Medicare doesn’t even necessitate that there is a chaplain on staff – only that spiritual counseling be available. This can make a chaplain feel as if he or she is a bit of a wallflower.
But can chaplaincy be a fulfilling job? Absolutely. The flip side of this myth is also a myth – that what I do doesn’t matter that much. When chaplains do what they are specifically trained to be good at – being present spiritually with another – this can be the most fulfilling job on the planet. Even when you’re sitting at a comatose patient’s bedside for an hour, or taking a demented patient outside for a breath of fresh air that he hasn’t had in probably six months, when it’s done in the proper mindset these can be incredibly fulfilling.
But the day-to-day often gets in the way. Being mindful of my own cares and worries and trying to put them aside when I’m with a patient makes a big difference in terms of how I perceive my contribution to their care.
I chaplain friend of mine passed this article along from the LA Times:
How not to say the wrong thing
It works in all kinds of crises – medical, legal, even existential. It’s the ‘Ring Theory’ of kvetching. The first rule is comfort in, dump out.
Susan Silk and Barry Goldman
April 7, 2013
When Susan had breast cancer, we heard a lot of lame remarks, but our favorite came from one of Susan’s colleagues. She wanted, she needed, to visit Susan after the surgery, but Susan didn’t feel like having visitors, and she said so. Her colleague’s response? “This isn’t just about you.”
“It’s not?” Susan wondered. “My breast cancer is not about me? It’s about you?”
The same theme came up again when our friend Katie had a brain aneurysm. She was in intensive care for a long time and finally got out and into a step-down unit. She was no longer covered with tubes and lines and monitors, but she was still in rough shape. A friend came and saw her and then stepped into the hall with Katie’s husband, Pat. “I wasn’t prepared for this,” she told him. “I don’t know if I can handle it.”
This woman loves Katie, and she said what she did because the sight of Katie in this condition moved her so deeply. But it was the wrong thing to say. And it was wrong in the same way Susan’s colleague’s remark was wrong.
Susan has since developed a simple technique to help people avoid this mistake. It works for all kinds of crises: medical, legal, financial, romantic, even existential. She calls it the Ring Theory.
Draw a circle. This is the center ring. In it, put the name of the person at the center of the current trauma. For Katie’s aneurysm, that’s Katie. Now draw a larger circle around the first one. In that ring put the name of the person next closest to the trauma. In the case of Katie’s aneurysm, that was Katie’s husband, Pat. Repeat the process as many times as you need to. In each larger ring put the next closest people. Parents and children before more distant relatives. Intimate friends in smaller rings, less intimate friends in larger ones. When you are done you have a Kvetching Order. One of Susan’s patients found it useful to tape it to her refrigerator. Continue reading
This morning I was having breakfast and skimming through the latest Christian book catalog that came through our mail when my son noticed the title of one of the books was on learning to “pray better”. He asked, “How do you pray better? Don’t we pray good enough already?”
I think this question goes to the heart of a lot of the problems we face as Christians, and maybe especially as Americans. We have such a tendency to find ourselves, no matter how much we talk about grace, looking at our faith as a matter of how much effort we put in to it. Sometimes that work is actual “work” – penance, good deeds, giving financially or of time. All these things in themselves are good, but we can easily fall into the trap of seeing these things as preliminaries and prerequisites for God’s grace to happen.
The Protestant mourns for his fellow Catholic brother, whom he sees as “works based” regarding salvation. Yet Protestants are just as trapped by the need to “do more” and “do better”. A glimpse through any Christian book catalog or bookstore shelf of popular Christian “inspiration” will prove my point. So much seems to be about doing more, doing better, gaining and striving. I think this comes out also in theology with the insistence that one’s theology be “right”. I remember growing up that faith wasn’t just about knowing Jesus, but knowing Calvin. You had to know the right things in the right way – not just Biblical truth but the correct interpretation of Biblical truth.
This, I think, is just another form of works. Grace is something we accept without any merit on our part, and to make that grace beholden to anything we do (and I think belief can be a form of works as well) negates that.
Can I pray better, read more, give more? Surely. I stink at all of these. But I gave up worrying for Lent.
Ok, maybe my grammar is a bit sketchy title-wise, but I like it.
I never fasted in my life, save for bloodwork or the occasional operation. Most of this came from my Presbyterian/Calvinist upbringing, which saw fasting as something a bit too “Catholic”, which is code for works-oriented. It was spiritually good but unnecessary at best, idolatrous at worst. Lent tends to be interesting at times because, as I’m the hospice chaplain in a secular company, I’m seen by some as this pillar of sacredness. Especially by our Catholic staff. It freaks them out when on a Lenten Friday I pull out a ham sandwich and dig in. It has provided some opportunites to teach what I know about grace and works.
But I’m rethinking things a little this year. Not so much about abstaining from food or drink or whatever. I understand why fasting from things that are pleasurable is supposed to connect us with the suffering of Christ. However there have been plenty of folks who, rather than fast from something, try to increase the good that they do. I think that’s a good way of looking at things and not quite so self-centered. But I was thinking today that if I’m going to fast, I’d rather fast from the things that pollute my life…worry, fear, self criticism. Life without chocolate only promotes misery and desire. But life without worry for 40 days? Hallelujah! What would it be like to not be afraid for 40 days, or critical of myself or others, or anxious? What can be more enriching and spiritual than that?
So I’m going to fast from worry. What are you fasting from?