Spiritual Care in the 21st Century – Chapter 6 excerpt

Establishing spiritual trust

In this chapter we describe three interpersonal competencies—spiritual self-differentiation, spiritual empathy, and spiritual reflexivity—that help chaplains establish spiritual trust, which is the relational foundation unique to spiritual care. Spiritual care, as we define it, is an integrative process that begins with exploring calming spiritual practices that help people to experience spiritual trust. We use the term spiritual as a simple way to describe complex and diverse relational experiences of transcendence. Many people experience and name transcendence through sacred texts, music, symbols, and rituals from religious and/or spiritual traditions. When spiritual practices help people feel held within compassionate and trustworthy relationships, they will be ready to explore what their suffering means (an essential function of spiritual care described in the chapters on meaning-making). When they feel overwhelmed by suffering, they can rest in practices that instill trust.

Chaplains become spiritually trustworthy when they convey respect for the unique ways people experience and name incarnational and/or transcendent aspects of their lives that mediate a deep sense of mystery, awe, beauty, goodness, holiness, and/or the sacred. Chaplains may be especially helpful when people experience religious and spiritual struggles that disrupt practices previously connecting them to transcendence. Chaplains may invite people to collaboratively explore any sorts of calming practices that help people feel self-compassion when physiological, emotional, and moral stress overwhelms them. Calming practices help people re-experience that deep sense of connection that instills a sense of trust. In a parallel fashion, chaplains trust the process of learning spiritual care when they use spiritual practices that center and calm them when they feel overwhelmed by suffering. We illustrate the importance of spiritual self-care in the following case study used throughout our chapter.

Case study: Angie

Our chapter’s case study describes Angie, a 25-year-old, single African American woman with advanced Hodgkin’s lymphoma, who is expected to die during this hospitalization. She is unresponsive and medical examinations suggest that the systems of her body are shutting down in a way that is typical at the end of life. The chaplains on the floor have been making brief daily visits. She receives no other visitors. The walls are bare of cards, and there are no flowers in the room. You know from the prior visits by chaplains on this floor and the chart notes that Angie is alienated from her family and distances herself from people she says were “bad influences” before her cancer diagnosis and earlier recovery from addiction. She credits a return to the Pentecostalism of her youth as the reason she has remained clean and sober.

“It was just me and God dancing together up there in the corner.”

Angie has been unresponsive for more than a week. You are a student chaplain new to the oncology unit today. You had spoken with other chaplains about Angie. The nurses tell you today that Angie has had moments where she is more alert. One nurse, who is very experienced with end of life care, tells you that it is common for patients who are dying to experience perceptions or sensations that are comforting to them. Sometimes there is no clear medical explanation for these experiences. You were anticipating that she would still be unresponsive, and you would simply need to offer a silent prayer. Before going into Angie’s room, you take a deep breath and realize how anxious you are. If she has a conversation with you, you will have to chart your visit and report back to your chaplaincy colleagues and summarize your visit at rounds with the medical team. When you begin your conversation with Angie, she is eager to tell you about an “amazing experience of God” when she was unresponsive. Her voice is low and quiet. She invites you to sit close to her so you can hear what she says, “It was just me and God dancing together up there in the corner. I had on a red dress. The prettiest red dress. I’ve never worn anything like it. We danced and danced. You know, people always say, ‘God is this’ or, ‘God is that.’ God isn’t anything we know about, even if he is a darned good dancer. It’s just, ‘God is.’ [She pauses. There are tears in her eyes.] Not even, ‘God is.’ Just, ‘IS.’”

Angie goes on to tell you that she received a blessing and a healing; that even though she will die with the cancer, she has been made whole.