Tuesday, July 8, 2014

Keeping on the right path … The Safety-net of Healthy Boundaries

It is required of a hospice Chaplain to function in a manner that respects the physical, emotional, and spiritual boundaries of others. Len Sperry, MD, PhD, in his book, Sex, Priestly Ministry, and the Church, 2003, page 10 gives a vivid definition of boundaries: “Boundaries are norms, rules or codes that characterize an individual’s personal space or environment and his or her sense of security and safety. Healthy boundaries provide a nurturing and safe physical, emotional, sexual and spiritual environment for individuals.” Drawing from an earlier blog, “Pastoral Formation: From Theory to Action,” I noted Bowlby’s Safe Haven. Healthy boundaries create the safe haven. Violations of boundaries lay waste a healthy pastoral relationship. The key enemies of healthy boundaries are pride, overconfidence, and embarrassment. Pride believes the Chaplain is above even having boundaries because chaplaincy suggests a high degree of integrity and the Chaplain certainly must be a person of that level of integrity and would never have a problem with boundaries. Overconfidence is the twin of pride. It speaks of arrogance, “I can handle it;” “Rules are legalistic. I live in grace;” “Rules drown my creativity;” etc. Embarrassment cries out, “My God, what have I done? I can’t tell anyone. I’ll be fired. My reputation is ruined. I’m done. I can’t tell anyone, they’ll hate me…” Firm boundaries must be set around the issue of sexuality, for sure; however, the necessity of boundaries includes other areas, such as: borrowing or lending of money from a patient or patient family member; abuse of pastoral authority/power; violations of confidential discussions (unless it involves self-injury or injury to others) to name a few. The issue of pastoral authority or power plays into the discussion of boundaries. When a Chaplain, the one in a position of power, interacts with a patient who is subject to that power or position, then the person with power should honor and support the boundaries of the other person. In hospice care we often talk about the patient being in charge of the Plan of Care. If that is the case, then respecting the boundaries the patient sets is the norm. Respecting these boundaries and keeping true to one’s own boundary set lends dignity to the pastoral care relationship. How all of this functions in the hospice setting can be seen in the following events:  Spiritual Boundaries: I was called upon to visit a patient who was a follower of Wicca. I gained insight into the sensitivity she possessed regarding her faith. Her brother denigrated her beliefs. She took that as a personal attack. Therefore, I sought to respect her faith choice by not challenging it and by allowing her to express how Wicca benefited her. I focused on her story and what she considered were her greatest spiritual needs. This has been my pattern in all spiritual care encounters. The patients I provided care for do not need a Chaplain to condemn, judge, or otherwise marginalize their belief system at this most vulnerable time in their lives.  Physical Boundaries: Respecting the physical boundaries of the patients I serve is evidenced in three ways: I respect the patient’s space. I do not carelessly touch any patient. Personal space is much like a bubble encircling the patient in a three foot radius. As interested as I am in the story the patient is telling, or as closely as I need to get to hear the hoarse whisper of a patient, I respect that radius.  Emotional Boundaries: Patients in hospice care are vulnerable emotionally. It was my privilege to serve a patient who felt safe enough with me to share her story of childhood abuse at the hands of several of her male neighbors. She lost dignity and a blow to her personhood through those violent acts. Creating sacred space through active listening and a safe haven for her to unpack the pain of decades of self-loathing were the only goals I had in providing spiritual care. There was never any prying or leading questions which would have violated her personhood. After all of the pain tumbled out, this patient needed the assurance that her sharing this dark portion of her past was safe with me. Together we negotiated how we would proceed. She gave me permission to refer her to our counseling staff so that her emotional wounds might find treatment. In the weeks that followed, she received emotional care from counselors trained in this type of abuse. I noticed a marked improvement in her emotionally and spiritually. It was agreed that the counselors would counsel and I would provide spiritual care. Again, another boundary was respected. This is simply how it must be. There are general guidelines for a hospice Chaplain that will hold him or her in good stead: 1. The Chaplain is always responsible to safeguard the relationship. 2. The Chaplain must always act and talk in such a way as to prevent harm to the other. 3. The Chaplain is not a surrogate: not a father, not a mother, not a spouse, not a child, not a therapist, not an accountant, not a lawyer. 4. Be sensitive and honest with yourself about your sexuality and personal needs. 5. Be responsible for proper self-care. Give adequate attention to your spiritual, emotional and physical well-being. 6. The Holy Writings or Scriptures to which you adhere do not justify, minimize or rationalize misconduct. 7. Consider every pastoral relationship like a body of water - don’t get in over your head. Drowning in poor judgment is still drowning.

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