Tuesday, July 1, 2014
Pastoral Formation: From Theory to Action
Theory is great. Action informed by theory is even better. In the Clinical Pastoral Education classroom environment ideas on how human developmental theory applies to chaplaincy can get very tiresome. Applying this knowledge in the field, however, is very energizing! This essay will include both theory and its application. In the course of my CPE research I discovered the works of John Bowlby, Carl Rogers and Harvey Chochinov provide a basis for my understanding of human development theory. The writing of Ira Byock, a hospice physician, provide an almost devotional aspect to this study. So as not to totally bore the reader, I will briefly state a focus of each of the theorists. Bowlby’s writing is exceptionally challenging to read, but he informs my ministry in that he suggests the Safe Haven. Since relationships are the foundation of hospice chaplaincy, I find it fundamental to establish a Safe Haven for those that I serve. There has to be a place of safety, a relationship of safety for the hospice patient. A lot is going on in the heart and soul of a hospice patient that is longing to come out. Consider the inner suffering of a patient I served who bottled up 64 years of pain caused by sexual abuse at the hands of 3 men when she was but a child. She swore herself to silence until decades worth of pain gushed forth during a pastoral encounter with her. She felt the relationship with this Chaplain a safe haven to unload this heavy baggage. I can’t state it enough that hospice chaplaincy is based upon relationships. The Chaplain must be adept at creating ‘instant’ relationship by his or her demeanor characterized by kindness, sincerity, heart-felt concern, non-judgmental and non-condemning terminology and body language that affirms genuine care. Carl Rogers is well known for his person-centered approach. His belief in the importance of empathically understanding a client's emotional experience and reflecting it back in a way that orders and distills it informs my work daily. Patients (persons in general) need to feel heard. Rabbi Maurice Lamm adds his thoughts regarding empathy, “Do not tell me you have empathy, show me you have empathy. Empathy is not something you talk about, it is something you do.” Rogers wrote in Experiences in Communication, “I hear the words, the thoughts, the feeling tones, the personal meaning, even the meaning that is below the conscious intent of the speaker. Sometimes too, in a message which superficially is not very important, I hear a deep human cry that lies buried and unknown far below the surface of the person. So, I have learned to ask myself, can I hear the sounds and sense the shape of this other person's inner world? Can I resonate to what he is saying so deeply that I sense the meanings he is afraid of, yet would like to communicate, as well as those he knows?” The Chaplain, of all persons on the Interdisciplinary Team, must be the one to express and consistently express empathy to the hospice patient’s plight and suffering. Chochinov is of particular interest to me as he developed a theory of care called Dignity Therapy. Dignity Therapy assists a patient tell the story of their life. The Chaplain works with the patient listening to the stories that matter most about their life. As the patient tells these stories, the Chaplain either records or takes copious amounts of notes to capture the patient’s stories. The stories are transcribed, presented to the patient for editing, until the document is completed. This legacy document is then passed on to the family at the patient’s death. “I didn’t that!” “Really? Wow!” “I didn’t know he felt that way about me. I love him more now.” These are some of the reactions of loved ones who read these legacy documents. Again, hospice chaplaincy has much to do with relationships. Ira Byock writes in The Four Things That Matter Most, “Please forgive me. I forgive you. Thank you. I love you. These four simple statements are powerful tools for improving your relationships and your life. As a doctor caring for seriously ill patients for nearly 15 years of emergency medicine practice and more than 25 years in hospice and palliative care, I have taught hundreds of patients who were facing life’s end, when suffering can be profound, to say the Four Things. But the Four Things apply at any time. Comprising just eleven words, these four short sentences carry the core wisdom of what people who are dying have taught me about what matters most in life.” It has been a humbling and rewarding experience of mine to work with fathers, husbands and others to right relational wrongs and to pass from this world into eternity with inner peace. So, there you have it, from theory to reality. Clinical Pastoral Education provides many skills for the hospice Chaplain to use in providing excellent spiritual care.