Enhancing Spiritual Care “ I ’ d like to do more than just tick a box ” Dr Monika Wilson ReConnections Counselling Service www. reconnectionscounselling. com

“ The task of spiritual care is not one for my mechanic, not one for my friends, not one for my care giver. All of these people may help me on this journey – sometimes consciously and deliberately, sometimes unconsciously and unintentionally – but the essential responsibility, the first step and the last step, must be mine ” ( Kellehear, 2002)

Not something that we do to others Rather something we do with others Spiritual care is determined by the attitudes and qualities of being with the person, rather than something that is done for or to the person Spiritual carer as facilitator or enabler

Wholeness Reconciliation Belonging Trust Worth / affirmation Hope Meaning Transcendence Integration / self development Journey / quest Healing Nourishment “ At - Onement ”: a feeling of peace with all that exists in the universe Connectedness Love

Holism / Wholism A.Physical, social, psychological, spiritual B.Biological, sociocultural, individual, transpersonal Holistic thinking and concepts understand the specific parts of a system ( human ) to be all interrelated. The part can not fully be understood independent of the whole system.

Asklepios : the Greek god of healing Asklepian Healing : a journey to a sacred place ( temple ) Time to rest Preparation and purification ( eg fasting and washing ) Practices and rituals Dream work A divine remedy Hippocratic medicine : rational and effective approach to treating illness Plato : A disease could not be treated without a knowledge of ‘ the whole ’ ( Kearney, 2009)

“ I know that the spiritual work is of paramount importance and while it goes hand in hand all the time with our medical work, it is the only lasting help that we can give to our people ” ( Dame Cicely Saunders, 1962)

Diversity / pluralism Traditions / sociocultural factors Multiple & individualistic meanings Misunderstandings / fundamentalism Definitional uncertainty / ambiguity : “ spirituality is about connectedness, but also about incompleteness. It is about knowledge, but equally about what we do not know. It is about coherence and integrity, but also about vulnerability. It is about belief, but equally about doubt ” ( Rumbold, 2002)

Spirituality involves relationships ( connections ): With places and things ( spatial ) With self ( intra - personal ) With others ( inter - personal ) Among people ( corporate ) With transcendence (‘ God ’, ‘ Something There ’) ( Lartey, 1997)

Spirituality is the often undefinable, intangible element of human existence that joins the intellectual and the experiential in an understanding of a deeply personal internal world as it is held in relationship with human experience that is unbounded by the physical constraints of the body. As such, it is the deeply unique personal experience of merging of, and connectedness to understandings of self, others, of the environment and / or the sense of eminence of a force beyond ( cont….)

Yet, while a deeply personal element of existence, spirituality often propels a person to seek relationship with others, the environment, or that force beyond. It often involves a sense of veneration and wonder, and goes beyond the understandings of the cognitive or psychological dimensions, yet it remains influenced by and, in turn, influences, these other dimensions ( cont….)

However, unlike these other dimensions, the sense of spirituality is often heightened by a willingness to experience, and the surrendering of the need to explain or control the experience, providing a place of openness to encounter and awareness. Consequently, it can be heightened during times of adversity, through the personal pursuit of meaning, fulfilment and purpose, through practices and rituals or creative pursuits that may or may not involve a religious observances, or through an openness to the totality of a sensory experience or human relationship ( Murray & Wilson, 2007).

Signs or expressions of spiritual distress ?

Assessment The word assessment scares people as it is tinged with the sound of some kind of judgment on the spiritual life of another of some ‘ expert ’ opinion Assessment is simply hearing the story of the spiritual life that has gone before and is now More formal spiritual assessment is simply systematic attempts to hear this story Observation Conversation / stories Interviews Measures ( tools )

The HOPE Assessment H Sources of hope, meaning, comfort, strength, peace, love and connections O Organised religion P Personal spirituality and practices E Effects on health care

Connections Spheres Helpful Relationship Lost Relationship ( disrupted ) Unhelpful Relationship Self : Intra - personal Others : Inter - personal Among people : corporate Transcendent : The Other Places & things : spatial

Observe, hear, acknowledge and document patterns in the screening map Discuss patterns with the person and / or family / friends Explore possibilities and needs with the person and / or family Develop strategies and / or practices

Responses Acknowledging, hearing, witnessing, silent presence Create a healing space / holding a secure place ( safe haven, secure base ) The art of spiritual companioning Revive, restore relationships and connections

Goal of Spiritual Support ( Rumbold ) To maintain wherever possible the connecting strands important to the person To support the person in grieving the loss ( or disruption ) of connections that have been important To encourage the person to revive neglected connecting strands or look for new connections

It is our role to help people to make connections in their lives ( not to make connections for them ); to make connections between their human experiences and the deep longings of their spirit, to make connections between their relationships with others and their struggles within, the make connections which lead to the integration of the psychological, emotional and spiritual dimensions of self. This is best accomplished through listening ( McNamara, The Power of Compassion, 1983).

The Bio - psycho - social - Spiritual Model of Health Care ( Sulmasy, 2002) A model of care based on the understanding that illness is a disruption of relationships in which the homeostasis of the human being is disrupted Restoration of Right Relationships : What genuinely holistic health care means then is a system of health care that attends to all of the disturbed relationships of the ill person as a whole, restoring those that can be restored …

Asklepian Healing The process of holding secure space for the one who suffers ( containment ) Enabling that person to go with rather than against his or her experience It demands a trusting by the carer of the profound, natural healing powers within the psycho of the one who suffers ( Kearney, 2009)

Sheila Cassidy : “ So the spirituality of those caring for the dying must be the spirituality of the companion, of the friend who walks alongside, helping, sharing, and sometimes just sitting empty handed when they would want to run away. It is a spirituality of presence, of being alongside, watchful, available, of being there. We must therefore go into the darkness, go with them at least part way along their lonely, frightening road. This is the meaning of compassion : to enter into the suffering of another, to share in some small way in their pain, confusion and desolation ”

The Art of Spiritual Companioning Is an attitude reflecting deep respect, which Requires deep listening and concentrated attention Will only be effective if you are free of an ‘ agenda ’ or predetermined outcome Is meant to support, not rescue or control Uses receptive silence and questions skilfully Requires trust in the other ’ s processes.

Spiritual practice as ‘ alive moments ’ The ability to be in touch and at ease with one ’ s own spirituality and at the same time to be able to connect with another person ’ s spiritual world ( nurturing one ’ s own spirituality ) How do you do this ?

Spiritual Qualities Humility Gratitude Compassion Stillness and silence Calmness Mindfulness Forgiveness Patience Acceptance – ‘ suchness ’ Optimism Humour Self awareness Tolerance Truthfulness Trust – ‘ surrender ’ Contentment Egolessness LOVE

Summary  Revere : appreciate it as significant  Reflect : seek to understand, develop a language  Recognise : seek the signs and expressions, assess and understand  Respond : external, internal  Road Blocks : break down hindrances