Collaborative Spiritual Care Conversations

Collaborative Spiritual Care Conversations

Collaborative Spiritual Care Conversations Prompt:

Please respond to the contentment you have read in Craigie Chapter 9

1) What are your thoughts on the Collaborative Spiritual Care Conversations presented in Craigie?

2) Do you think this conversation framework to possibly be applicable in your practice?

3) What do you perceive as challenges with the conversation, and where do you see your competencies?

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you think of this and from whatever tradition you come… gives meaning, dignity, direction and passion to life.

As I speak with people about spirituality, I often hear a con- nection between being spiritually engaged and being fully and meaningfully alive:

T.S. was a 34 year old female who complained of a complete loss of libido. At the time of presentation the insufferable complaint had been going on for greater than 3 years without any improvement. Over the course of two years her complaint was not found to be secondary to a hormonal imbalance, an anatomical condition, any metabolic or organic problem, or a primary depression. Psychotherapy, couples counseling, and sensate focus were also tried unsuccessfully. Some time later, I had the opportunity to follow-up with her and she had finally experienced a resolution of her symptoms after 5-6 years of suffering. She explained that she had come to realize that several life events had occurred simultaneously that had left her feeling “spiritually dead” and completely detached from her spiritual self and the “experience of God” that she had always known.

Apparently, she was not able to realize this previously and no amount of talking or suggestions had led to her reconnecting with her spiritual self. She began her journey of healing after listening to an audio-tape on intuition and love. A suggestion was made to experience getting in touch with all of her senses through self-guided imagery. She began to re- awaken and also began nurturing herself through nature and rest while creating experiences to connect with her senses. Eventually this exploration allowed her to redefine a sense of spiritual connection and “being present” in her life. This allowed her to feel whole again and spiritually alive. Her libido followed.

In the framework of this patient, there is a clear distinction drawn between being spiritually “dead” and spiritually “alive,” and this distinction has profound implications for her health and for the ways that she lives her life.

The last eighteen or twenty years have witnessed a substantial increase in the interest in spirituality and health care. When I

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presented a seminar about spirituality at a Society of Teachers of Family Medicine national conference in 1986,2 and when I published (with the late David Larson) what I believe was the first article about spirituality in the Family Medicine literature in 1988,3 there was clearly a feeling that people interested in this subject were part of a small, ragtag band outside of the mainstream of organized medicine.

How much has changed in the intervening years. One can go to STFM conferences these days and find that seminars and interest group conversations about spirituality consistently spill out into the halls. Thanks to the efforts of Dr. Larson, Dr. Christina Puchalski (Founder and Director of the George Washington Institute for Spirituality and Health), the Templeton Foundation, and many others, there are now educational curricula about spirituality at a majority of American medical schools, a number of postgraduate programs, and at least one program (several fellowships in Integrative Medicine at the Arizona Center for Integrative Medicine) addressed to mid-career physicians.

Dr. Herbert Benson’s Harvard conference on Spirituality and Healing in Medicine has been packing them in for many years. The number and quality of re- search projects about the incorporation of spirituality in health care has increased substantially, as we shall see later, and there have been significant research initiatives (sponsored by the Fetzer In- stitute, among others) in a number of ancillary subject areas such as forgiveness, gratitude, hope, and love. And at a personal level, I talk about this subject with medical students who are applying to our residency program and find lively and engaged interest, in contrast to the quizzical and worried expressions of years past.

Still, there is much more work to be done, and many questions remaining to be explored. What is the larger picture… what does it mean to incorporate spirituality in health care? Where are the points in patients’ lives and in the process of health care where conversation about spirituality may be helpful? How do we best enter this arena with patients? How can we best approach spirituality in an

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inclusive and respectful way with our patients? As we encounter or elicit spiritual issues in our relationships with patients, what do we as providers of health and wellness care do? What is our unique role… as physicians, nurses, acupuncturists, naturopaths, psychologists, physical therapists, medical assistants and others in the health care world… in strengthening patients’ spiritual resources and ameliorating spiritual suffering? How can we best collaborate with pastoral care professionals, drawing on their skills and expertise and also being legitimate players in this arena ourselves? How is our own spirituality related to what we do as health care professionals?

PERSPECTIVES ON SPIRITUALITY What do we mean by “spirituality?” Why do we speak of “spirituality,” rather than “religion?” What is the relationship of spirituality and religion? Does reference to “spirituality” imply a particular world view?

Good questions, all. It would certainly be sensible to lay out a clear definition of spirituality, as we embark on an exploration of spirituality and health care.

This is, however, not so easy. My observation is that the word “spirituality” rolls frequently and smoothly off the tongue, but takes on a broad variety of meanings to different people. If you tell me that spirituality is an important part of your life, I may make some assumptions about your having some cherished values or beliefs, or perhaps assume that you engage in some centering or grounding practices. But I would be guessing… and I would certainly need to have a conversation with you about this before I began to have some real appreciation of what this meant to you.

For me, the most succinct statement of the overarching picture of spirituality comes from former Surgeon General Dr. C. Everett Koop. Speaking in 1994 at the annual Maine symposium on spirituality and health that I coordinate, he defined spirituality as

The vital center of a person; that which is held sacred.4

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Along with the observation from John the Apostle, I think that this points to themes that can be profoundly helpful as we care for patients. What is “the vital center” for a middle aged man who has had a serious heart attack? What sustains a grade school teacher who feels overwhelmed and depressed? What is sacred enough for a young mother to energize her efforts to stop smoking? When are the times when a retired person feels really alive? What keeps a high school student who has had suicidal ideas from carrying them out? When, indeed, do we experience something sacred in our professional lives? What sustains and re-orients us when we become overextended and demoralized?

As we understand… for our patients and for ourselves… what “gives life” and what is “vital and sacred,” we glimpse the foundation that underlies the personal meaning of health and wholeness. We understand better the personal nature of suffering. We understand better the personal motivation for change. And we are given the opportunity and the honor of engaging the personally-understood life force that sustains all of us as people on our life journeys.

DEFINING SPIRITUALITY Before we consider further the “content” of spirituality… the aspects of human experience that this broad word embraces… I would like to suggest several ideas about the process of approaching a definition.

Spirituality is personal Spirituality is uniquely experienced and understood by individual people.

There may be common beliefs and practices among groups of people, but ultimately the understanding of what is vital and sacred is uniquely our own. Mennonites may share beliefs about adult baptism. Southern Baptists may share beliefs about the literal interpretation of biblical texts. Hasidic Jews may express their faith in common ways in terms of ritual and celebration. Participants