Spiritual care exercises

The following exercises involving poetry/literature are taken from Caring heart and soul: uncovering the path to the heart and a study day for health care professionals run by Dudley Group Healthcare NHS Foundation Trust.

Exercise: the space between

The psychoanalyst Donald Winnicott wrote a book with guidelines for the caring interactions of social workers. In the title, he used the phrase ‘the facilitating environment’ (Winnicott, 1965) which refers not just to the room and physical environment, but to the carer through whose presence a person is helped. The writer Michael Jacobs also describes this as the ‘space between’ (Jacobs, 1985). Soulful, professionally artistic, practice would be the creation, holding and maintaining of this space in each of our encounters as carers. Spiritual care is founded on soulful practice.

Reflections:

When do you create a space between for patients and visitors?
What helps? Time? Setting?
What hinders?
What are you doing when it is there the most?
What does it feel like?

Recognising the space between

The space between is a meeting at the level of humanity. There are many uniforms in health care and especially in the hospital setting - nurse, physiotherapist, doctor, chaplain - and each professional group may have a distinctive uniform. Even patients have a kind of uniform; pyjamas and dressing gowns.
Uniforms signify something about our role and what others might expect of us. They are introductory, opening sentences to deeper exchanges.
When we meet at the level of humanity, carers reach from behind their uniform and see beyond the surface of the other person.

Reflections:

If you really want to help somebody, first of all you must find where they are and start from there. This is the secret of caring.
If you cannot do that, it is only an illusion if you think you can help another human being.
First you must understand what the other person understands. If you cannot do that, all your understanding (and knowledge) will be of no avail (Kierkegaard, 1856).
The more you think of yourself as therapist/nurse, the more pressure there is for someone to be a patient (Das and Gorman, 1985).

Jean Vanier, Tears of silence (1979)

A meeting is a strange and wonderful thing,
Presence one with another,
Present one to another,
Life flowing one to another
But we can be together and not meet.

The space between is a ‘safe place’ where people can ask the ‘slow questions’. Slow questions are the deeper questions that people are wanting to ask, but are often frightened to ask. This may be because they are frightened of the answer, or imagine what the answer might be. The slow questions often need the right person, and the right time and the right place. Sometimes people ask the slow questions not to get answers but just to be understood.

Reflections:

When have you responded to a patient’s request for some simple need to be met and found that this was a prelude to something deeper?
What was your response: to the patient and to yourself?

The slow, slow questions, Mark Stobert

The slow, slow questions wait,
In hiding.
They wait until they perceive that
Once exposed in the open they
Won’t be dropped or damaged.
Even a ‘space (opened) between will suffice
Only after delicate testing
Emerging from the shadows
The slow, slow questions search for
Somewhere to alight.
A bird flying to a perch

Does it matter that the song
Is not replied to?
The slow, slow questions
Sing as sing they must.
The reply? Ah! The slow, slow, slower answers
Reach and embrace the questions,
Not with words
Not in song
But as dance
The dance of love.

The space between can contain and embrace the chaos. Where pain and suffering can exist and find their place.

We suffer because
We suppose that there should
Be no fear or loneliness
No pain or doubt.
The chaos of these
Sufferings
Become creative when we
Understand them as wounds
That are part of being
Human.
If we can embrace
The chaos of pain
With compassion
We will give it space
Within us.
Then liberation starts
And there is a new creation.

“So at some level, we care with all our heart …and then we finally let go. We give it all that we have … and trust the rest to God, to Nature, to the universe. We do everything we can to relieve someone’s suffering – our dearest’s, our beloved’s, anyone’s – but we are willing to surrender attachment to how we want things to be, attachment even to the relief of suffering. Our heart may break … and then we surrender that too” (Dass and Gorman, 1985).

Meetings at the edge is a book containing a series of conversations Stephen Levine had with people who were dying, being healed, or caring for the dying as carer or friend or relative. These were people who were brought to their edge of what they thought was their capacity for entering into unexplored life and growth. It’s a book about the exploration of the unexpected and often unprepared for, and the fear and doubt and courage and faith with which it is faced.

Stephen Levine describes the journey as: “...a high wire act where the heart is kept open in hell, to maintain some loving balance in the face of all our pain and confusion; to allow life in; to heal past our fear of the unknown” (Levine, 1984).

In the space between, the search for meaning can be replaced with the experience of it: “People are searching not so much for a meaning in life, but an experience of being alive, so that our life experiences on the purely physical plane will have resonances within our own innermost being and reality, so that we feel the rapture of being alive." (Campbell, 1988)

It is possible that spiritual care, through the soulful practice of an understanding other, may prove to be transformative for the patient. “The roots of resilience are to be found in the sense of being understood by and having the sense of existing in the heart of a loving, attuned and self possessed other.” (Fosha, 2003)

These experiences are not one way. Carers may themselves experience meaning in the same encounter. It may help to sustain them. And that’s OK.

Reflections:

What have been the most memorable experiences in your work? Have you let them nurture you?
The space between is created, held and maintained by our own inner space, or empathetic space.
It can be helpful to imagine an inner space set aside and nurtured for the task of caring.
Creating and maintaining boundaries makes this empathetic space safe for us to be affected by those we care for.

Reflections:

How do you create an inner space with boundaries for your caring work?
Surround yourself with your: skill, experience, support, supervision, training, faith, beliefs, drivers, 'being', role, place, time.

It is important to nurture the space by caring for yourself and developing a ‘menu of refreshment’.

Reflections:

What’s on your menu?

The magic hour

If you could have an extra hour every week just for you and for your refreshment, how would you spend it? The top three choices in one NHS Trust were:
• a relaxing bubble bath
• reading a good book
• going for a walk.

Try and make your own magic hour! Remember, you are worth it!

References:

Campbell J (1988) The power of myth, New York: Doubleday.
Dass R and Gorman P (1985) How can I help? London: Rider.
Fosha D (2003) ‘Dyadic regulation and experiential work with emotions and relatedness’, in Wilkinson M (editor) (2010) Changing minds in therapy: emotion, attachment, trauma and neurobiology, London: Norton.
Jacobs M (1985) Swift to hear: facilitating skills in listening and responding, London: SPCK Publishing.
Kierkegaard S (1856) Sickness into death: a Christian psychological exposition for upbuilding and awakening (volume 19, version 19), Princeton: Princeton University Press.
Levine S (1984) Meetings at the edge: dialogues with the grieving and the dying, the healing and the healed, Dublin: Gateway.
Vanier J (1973) Tears of silence, London: Darton, Longman and Todd.
Winnicott DW (1965) The maturation process and the facilitating environment, London: Hogarth.