What Do I Say?: Talking with Patients about Spirituality [With DVD]

by Elizabeth Johnston-Taylor, Christina Puchalski

Overview

Health care professionals, clergy, chaplains, social workers, and others who counsel people in medical crisis often find themselves faced with deeply painful questions: Why is this happening to me? Am I dying? Why should I live? I'm just a burden to others.
Here is a workbook that suggests healing verbal responses to such expressions of spiritual pain. The accompanying DVD helps reinforce the lessons and exercises that integrate psychology, psychiatry, pastoral counseling, nursing, chaplaincy, and spiritual direction for whole person care.
The author, an internationally recognized expert in spiritual caregiving, points out that wanting to help is one motivation for learning these skills, but there are also evidence-based reasons: helping patients express their innermost feelings promotes spiritual healing; spiritual health is related to physical and emotional health; spiritual coping helps patients accept and deal with their illness; and patients tend to want their health care professionals to know about their spirituality.
Lessons, tips, and exercises teach how to listen effectively, with guidelines for detecting and understanding the spiritual needs embedded in patients' conversations. Suggestions are provided for verbal responses to patients who express spiritual distress, including tips for building rapport, using self-disclosure, and praying with patients. A FAQ section deals with frequently asked questions and miscellaneous information, such as: •What do I do when a patient talks on and on and I have to leave?
•How do I answer a "why" question?
•What do I say to a patient who believes a miracle will happen to cure them?
•What if I'm not religious? How can I talk about it?

By practicing and using these healing techniques, Taylor explains, healthcare professionals will be able to provide patients responses to their questions that allow them to become intellectually, emotionally, and physically aware of their spirituality so they can experience life more fully.

Product Details

ISBN-13:	9781599471174
Publisher:	Templeton Press
Publication date:	05/01/2007
Pages:	160
Product dimensions:	7.00(w) x 10.00(h) x 0.60(d)
Age Range:	18 Years

About the Author

Elizabeth Johnston Taylor has a Ph.D. in Nursing and an M.S.N. in Oncology Nursing from the University of Pennsylvania, as well as training in chaplaincy and spiritual direction. She has authored or co-authored more than fifty publications and has been awarded eight funded research projects. She lectures frequently on spirituality and health and is currently associate professor, School of Nursing, at Loma Linda University in California. She lives in San Marino, California.

Read an Excerpt

What Do I Say?

Talking with Patients about Spirituality

---

By Elizabeth Johnston Taylor

Templeton Foundation Press

Copyright © 2007 Elizabeth Johnston Taylor
All rights reserved.
ISBN: 978-1-59947-117-4

---

CHAPTER 1

Let's Begin!

You've heard it:

"Why is this happening to me?"

"Am I dying? Am I going to be okay?"

"Why should I live? I'm just a burden to others."

"If I just pray harder, a miracle will happen"

"I did this to myself—I just can't forgive myself."

Whether patients are expressing a need to make sense of tragedy, find hope for the future, ascribe purpose and worth to living, trust religious beliefs, or relate to self and others with love, they are telling us about their inner spiritual needs. These needs are often deeply painful.

Such painful expressions of the human spirit often perplex and overwhelm the listener. This spiritual pain is often too hard to hear. Undoubtedly, when you have listened, you've heard patients—and even your friends and family—say things that left you wondering, "What do I say?"

This workbook will help you to answer this very question. In addition to providing you with suggestions for how to form healing verbal responses to expressions of spiritual pain, this workbook offers exercises for practicing and applying your newfound knowledge. Learning these communication skills are fundamental, but they will not be helpful unless you practice them. The adage "practice makes perfect" applies!

Why should I learn this skill?

The inner discomfort you have when patients express their spiritual pain may be motivating you to complete this workbook. There are, however, evidence-based reasons why health care professionals (HCPs) should learn this skill.

Emotional expression promotes spiritual healing.

Emotional expression is an avenue for accessing and expressing one's spirituality. "Opening up" and sharing deep emotions has been shown to contribute to physical as well as to emotional healing. By helping patients express their innermost feelings and spirituality, health care professionals promote healing.

HCPs, furthermore, are in a unique position to help patients. Not only do they often meet patients during times of chaos and challenge, they meet patients as strangers. Strangers don't have the "baggage" that family and friends have. With HCPs, patients do not have a history of relating within established rules, so they often feel it is safer to share unspoken fears and secret feelings with health care professionals.

Spiritual health is related to physical and emotional health.

Hundreds of research studies have suggested a relationship between religiosity or spiritual health and physical health. Although these studies vary significantly in quality and methodology, the evidence tentatively supports the longstanding theoretical models that link body, mind, and spirit. Science appears to verify Plato:

As you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul ... for the part can never be well unless the whole is well.... And therefore, if the head and body are to be well, you must begin by curing the soul.

Spiritual coping promotes adaptation to illness.

Patients frequently use spiritual coping strategies to manage their illness experience. These coping strategies, like prayer, meditation, scripture reading, and clinging to comforting religious beliefs, are usually considered very important and meaningful to patients. While evidence suggests that use of positive religious coping is directly correlated with health outcomes, other evidence indicates that patients recognize that these coping strategies do not magically cure or substantially reduce symptoms. By facilitating patient use of healthful spiritual coping, clinicians promote adaptation.

Patients want their health care professionals to know about their spirituality.

Many patients appreciate having HCPs show concern for their spiritual health. Patients with a serious or life-threatening condition, patients who are religious, and patients who perceive they have some relationship with the clinician are especially receptive to inquiries about their spiritual health. Although nurses and physicians are not viewed as primary spiritual caregivers and patients often do not want to be explicitly asked about their beliefs or invited to participate in intimate religious practices, most patients do want their health care professionals to know about their spirituality.

A nonempirical reason for learning to provide spiritually healing responses to patients is that, in addition to helping patients, we help ourselves. Psychotherapist John Sanford wrote that "by making a mature response in a difficult situation we become more mature ... you are what you do" As you complete this workbook, you may discover the journey is more about answering your own spiritual questions rather than those of patients.

About this workbook

This workbook is designed for HCPs—nurses, physicians, and allied health professionals, especially. Social workers, chaplains, clergy, and others who may get some training in counseling may also find this workbook beneficial. This curriculum is intended for those who provide care to primarily adults without mental illness. Although the content can be useful in some pediatric and mental health contexts, caring in such settings requires additional knowledge and skills that are not addressed here.

This workbook will require about ten hours to complete. Racing through the workbook, however, is not recommended. Allow yourself time to enjoy the process and to reflect on how you will integrate the knowledge and skills into your life. You may choose to complete one chapter a month, for example.

This book integrates knowledge from several disciplines, including psychology, psychiatry, pastoral counseling, nursing, chaplaincy, and spiritual direction. Although Western and Judeo-Christian experience typically influences the thinking on this topic, the workbook keeps the varied spiritual experiences of patients and HCPs in mind. Although institutionalized religion is an expression of human spirituality and an aid to spiritual formation, it is distinct from the broader concept of spirituality. Spirituality is universal, innate in all individuals. Kenneth Pargament, for example, defined spirituality as "a search for significance in ways related to the sacred."

"God" language is used in this book. It is not intended to confine the reader to a prescribed Judeo-Christian orientation. Readers can substitute words and ideas that represent the transcendent for them, the sacred or holy (e.g., Spirit, Ultimate Other, Sacred Source, Higher Power). Patients, of course, often use the term God. The word "patient" is used in this workbook to denote any recipient of care, including family members.

Not only does a person's culture greatly influence how he or she experiences and expresses spirituality, culture also influences how patients talk about their spirituality with an HCP. A thorough description of how culture can affect conversations about spiritual matters is beyond the scope of this book. However, the following general principles for conversing with a patient from a culture other than your own should be remembered:

• Maintain an attitude—and, consequently, behaviors—of respect. This should begin the moment you meet a patient, when you use his or her proper name.

• Mirror patients' communication behaviors. Remain sensitive especially to the use of touch and eye contact, as their meaning varies between cultures. For example, Hispanics usually welcome handshakes and hugs, whereas many from Southeast Asia minimize touching.

• Follow a patient's lead on a topic. While some persons from Western, future-oriented cultures like to get to the point, others cultures may practice subtle and slow approaches to discussing concerns. Likewise, while some will want to talk openly about sensitive issues like dying, others may believe such topics are to be avoided.

• The bigger the crisis, the less culture will affect clinician-patient interaction. For example, Asians who normally restrain strong emotions will likely want someone to pour out their soul to if they are in crisis.

This book addresses the question of how to form healing verbal responses to patients' expressions of spiritual pain. Although offering healing verbal responses is a fundamental skill for health care professionals, it is not the only approach for nurturing the spirit. Being silently present, reading inspirational materials, offering prayer, and encouraging journal writing or dream analysis are examples of other approaches. To learn about these and other spiritual care therapeutics, consult a text on spiritual care for HCPs.

Assumptions

Many assumptions underlie the content of this workbook. They include:

1. Spirituality is an innate, universal dimension that integrates all humans.

2. Healing is about promoting health, even if in only incremental and immeasurable amounts.

3. Healing involves attending to the health of the body, mind, and spirit. Because the body, mind, and spirit are interrelated, spiritual healing can affect physical and emotional health—and vice versa.

4. The goal of healing, ultimately, is to assist persons to experience existence more fully; to die living, rather than to live dying.

5. Living fully requires self-awareness. Self-awareness involves intellectual, emotional, and bodily awareness; these forms of self-awareness allow spiritual and God awareness—and a state of being at ease (instead of dis-ease). Self-awareness allows one to unblock distressing feelings and sort things out for oneself to surmount challenges. Many recognize self-awareness and healing as a God-given grace.

6. "Whether he is called or not, the God will be present" (quote purportedly displayed in Carl Jung's office).

7. The ability to heal reflects the degree of personal self-awareness and compassion experienced by the healer. Healers' spiritual awareness motivates them toward compassionate responses to patients.

8. Healers recognize healing results from "God's work through the relationship rather than from their own purely autonomous efforts." Consequently, healers carry no burden of responsibility for patients' healing.

The goal of this workbook, therefore, is to teach HCPs to provide responses to patients that allow patients to become intellectually, emotionally, and physically aware of their spirituality so that they can experience life more fully. Figure 1.1 illustrates this framework and identifies where in this workbook you will learn about various approaches to increasing awareness.

EXERCISE 1.1

Think about a time when you were with a distressed patient and you found yourself asking, "What do I say?" Write the incident down here by writing word for word, as best as you can remember, what the patient said or did that prompted the question. Be sure to protect the anonymity of the patient by using a pseudonym.

____________________________________________________

____________________________________________________

____________________________________________________

CHAPTER 2

Preparing the Healer

Only wounded health care professionals can heal. This centuries-old idea has been argued by many, for example:

One's own hurt, one's sensitive openness to the patient, gives the measure of one's power to heal

Who can save a child from a burning house without taking the risk of being hurt by the flames? Who can listen to a story of loneliness and despair without taking the risk of experiencing similar pains in his own heart and even losing his precious peace of mind? In short: "Who can take away suffering without entering it?"

Health care professionals (HCPs) cannot hear, never mind respond, to a patient's spiritual pain unless they hear and respond to their own pain. Thus, the purpose of this chapter is to help you recognize your own spiritual pains and appreciate that your pains parallel those of your patients. Valuing your woundedness is a necessary foundation for listening and responding to patients in ways that are healing.

What are my spiritual pains?

You may be thinking, "But I don't feel any spiritual pain!" Or, you may be overwhelmed by pains and be wondering how any of them could possibly help you to heal. The next two exercises are designed to help you become more aware of your spiritual pains.

EXERCISE 2.1

This exercise is an adaptation of one that Dr. Henry Lamberton uses with medical students at Loma Linda University. Check the answers that best reflect your innermost wants and how well these desires are satisfied. Circle the wants that you think most people would check.

How similar are your responses to those you assume others would give?

Consider what might be your most unsatisfied, or most pressing, innermost desire. This could be your primary spiritual theme or need.

• How does it affect your interactions with others?

• How does it affect where you place your time and energy?

• How would you relate to a person who has the same spiritual theme?

EXERCISE 2.2

"Practicing soul inquiry" exposes the heart and allows one to become more spiritually selfaware. Complete at least two of the following phrases; choose ones that unsettle you the most:

What is dying in me is _______________________________________________

This death is an intrusion in my life because _______________________________________________

What I want to scream about is _______________________________________________

My faith is challenged because _______________________________________________

I weep for _______________________________________________

What I need to be unbound from is _______________________________________________

What paralyzes me, makes me indecisive is _______________________________________________

What embitters me is _______________________________________________

What I fear losing control of most is _______________________________________________

How do my spiritual pains affect my responses to patients?

Your spiritual pains or woundedness can affect your care of patients either positively or negatively. You can choose the outcome.

A negative outcome can occur when an HCP who has not reflected on his or her inner experience tries to address the spiritual pain of a patient. Such HCPs may be unaware of, afraid of, or misunderstand their deeper feelings, so they are unable to accurately identify and explore patients' spiritual pains. When patients realize an HCP does not understand them, they clam up, change the topic, give superficial responses to queries, or in other ways indicate disinterest in continuing to talk about their spirituality. This type of experience can increase patients' mistrust of health care providers.

Your woundedness, instead, can become a bridge or tool for healing communication. A healing response requires recognizing a patient's innermost feelings. Awareness of your own deeper feelings—your own spiritual themes and inevitable woundedness—is requisite to being able to hear another's. Thus, an HCP's life story, with its joys and wounds, becomes a source of information for interpreting a patient's story. For example, a nurse who is frustrated because she thinks she has not made a difference in the life of a "noncompliant" patient can begin to understand the experience of a parent whose "noncompliant" diabetic teen enters the emergency department with ketoacidosis. Or the clinician who can recognize the death and finality of every moment can be a healing companion for a dying patient.

EXERCISE 2.3

Healers do not need to have had the same experiences as patients but, to be compassionate, they do need to recognize how they have shared similar emotions. Complete the empty boxes to learn how you and patients share deep emotions. Examples are provided.

But if I'm always being wounded, won't I die?

By now, you may be wondering how can I be a wounded healer in the face of so much suffering? When I see so many human tragedies during my forty hours a week, week after week, how can I not weary of it? Being a health care provider to those who suffer can be overwhelming; their pains can suck us into a black hole of despair, and make us burn out!

(Continues...)

---

Excerpted from What Do I Say? by Elizabeth Johnston Taylor. Copyright © 2007 Elizabeth Johnston Taylor. Excerpted by permission of Templeton Foundation Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---

Table of Contents

Contents

Foreword,
Acknowledgments,
1. Let's Begin!,
2. Preparing the Healer,
3. Listening: Beginning the Healing Response,
4. Making Sense of What You Hear,
5. Verbal Responses to Spiritual Pain: Micro-skills,
6. Verbal Responses to Spiritual Pain: Macro-skills,
7. FAQs,
8. Putting It All Together,
Answers for Exercises,
Notes,