So Many Straws: Reflections on Self Care, and the Lack Thereof

“You’d better be careful, Sam. You’re going to burn out like this.”

These were words from my CPE supervisor several years ago. At the time I was a bit taken aback. After all my schedule certainly seemed manageable, and I felt I was doing OK at work and at home. Sure I had my struggles, but found a way to pick up and keep going every time. This March I realized he was right. Continue reading

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Life Review and Meaning-Making in Hospice Care

**update 9/5/17** Meredith Rogers passed along an excellent resource on depression she wrote on GeriatricNursing.com. I’ve linked it here – it’s well worth your time and is a good summary of types of depression and various treatments.

This article came through my LinkedIn inbox recently and I wanted to pass it along. While it refers to “Dignity Therapy” as a new tool it certainly seems as if many of the tools discussed are open to us already. Good reading after the jump:

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The Dying Art of Pastoral Care

I may have said this before, but I think pastoral care is a dying art.

The evidence for this is overwhelming, at least from my vantage point. Seminaries demand multiple years of attention to developing skill and knowledge in exegesis, languages, hermeneutics, and preaching, but I doubt if most require more than a semester devoted to pastoral care issues such as counseling and crisis management. I’m thankful that at Yale Divinity School I was able to focus my attention on this area, and that it offered several different courses on pastoral care and counseling to different groups. I had a great deal of freedom to do this in that I was not tied to denominational requirements. I didn’t take any languages because I never saw myself as an exegete to that degree. However most of the other students there were following programs to meet their respective denominations’ requirements. In some cases this required a semester of pastoral care or CPE, but I don’t know if that was across the board.

When did ministry become an academic exercise, focused primarily on sermon writing and exegesis? When did ministry become a business for that matter? When did pastoral care become something that only happens in a couple marriage counseling sessions or when talking with a family about what songs or scriptures they want at their dad’s funeral? When did pastoral care get assigned to lay volunteer prayer and care groups, who may get little if any training or support beyond a space and time to meet at the church? When did clergy become too busy managing the church to provide care to the people in that church? Continue reading

Why I’m a Chaplain – III: “The Church” and the wandering path

At one point in my life I had wandered away from my faith. Not wandered, more like stormed out to be honest. That’s a whole other issue. I came back though, and a big reason I came back was I attended a Christmas service at a large megachurch here in Pittsburgh that changed my perspective on myself and my relationship with God. I started attending and joined about a year later. Continue reading

Mixed Messages

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. Continue reading

What counseling others reveals about yourself

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.
P9: eh..
C10: eh…
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.

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Choosing a career in Chaplaincy: 8 steps to take

On one hand, planning for a career as a Chaplain is easy – get board certified and get a job. Well it is that easy, sort of (if you consider about two extra years of career training easy), but getting to the place of “I want to be a Chaplain” is much harder.

Personally, I did not plan on becoming a Chaplain. I had a background in undergraduate and graduate level psychology from a religious college, had interned and worked in heath care settings after that, and while in seminary developed a passion for pastoral care. However Chaplaincy was never in the picture. Now I see that my path led me right to this career. Continue reading

Up for comment: when is doing “enough” too much?

I have a particularly hard case that I wanted to share. It’s hard not only due to the nature of the disease but to the difficulty of how to approach it. I thought it would be a good ground for discussion.

This particular case is a man in his with Huntington’s Disease who lives in an assisted living community, which is comprised of much older adults. He has adult children and is married. He has a history of some suicidal ideation and has had two attempts that both failed. This disease claimed his father so he is well aware of what is in store for him. He is currently receiving medication to help with his depression and this seems to be helping. I see him twice monthly and our hospice social worker visits regularly for support as well. His wife is recovering from a traumatic injury that nearly killed her. He tends to keep to his room watching TV and movies most of the day. He doesn’t go to activities and has few if any friends at the facility.

The disease is the big elephant in the room. He refuses to talk about it and the family refuses to talk about it. They acknowledge it but it is not a topic to be discussed. This gentleman also never really opens up about anything. For some time I felt that it was me, but after a conversation with his wife this is his norm – he has never been that open about his feelings or thoughts. In fact neither has she or anyone else in the family. During most of my visits we sit in his room and watch TV or movies, maybe talk a little sports. I brought him some Christian music once and he gave it back to me the next visit. My thought was that he didn’t like it, but his wife told me he loved it.

I spoke with his wife yesterday to follow up on a visit and to check in as to how a visit with his psychiatrist went. It didn’t go well at all. The psychiatrist wanted to talk about the “elephant in the room” which was the disease and this man’s eventual death, and he wanted everyone to talk about it. Nobody did of course, and the end result was that everyone left angry and offended, and this man’s children felt even less like going to see him (as they are also prone to the disease). His wife told me that nobody in the family talks about things, especially their feelings, and that they are fine with this.

Hearing this was a bit difficult for me. I agreed with the psychiatrist that the family did need to talk about the elephant in the room! However the push-back made me rethink this position.

Personally this reminded me of the fine line we walk sometimes between managing our own agendas against – or along with – our patients. Even when my agenda is valid and helpful, at least as I see it, it’s important to remember that it is still my agenda. This psychiatrist wanted to use a more Rational-Emotive methodology to break through barriers that he saw and bring the family to his own picture of health. Is this family healthy? Well that depends on your picture of health. Is it functioning? That depends on your picture of functioning.

This story also touches on a key element of chaplaincy – that the chaplain both is and isn’t a psychotherapist. As I have a background in both psychology and ministry I feel this tension strongly. In chaplaincy, the primary agenda is set by the other, where as in psychotherapy it is often set by the therapist. In my own experience of receiving counseling, I’ve had periods of strong resistance and anger that I had to work through, and my therapist (as well as my CPE instructors) had to hold my feet to the fire while holding me up at the same time. I understand the resistance to resistance this family feels. I feel my own resistance as well, and question my motives as well as my actions at times. Am I doing enough or is my version of “enough” too much? I feel that I want to be helping, but it is hard to know when you are helping in this situation. It makes me feel caught in a bind, sad and frustrated. Plus this man’s life stage is much closer to my own than are my other patients’!

So let me know what you think. Use this as a jumping off point for discussion. Feel free to comment below and see where this goes. What do you see here? What would you do? Was the psychotherapist wrong, right or neither?