The College of Pastoral Supervision & Psychotherapy is a theologically based covenant community, dedicated to "recovery of the soul" and promoting competency in the clinical pastoral field.
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Belief that one is being understood by another is indispensible to confidence-building, problem-solving, and growth—and health. The helpless baby who is picked up and soothingly hugged by parents rather than left to cry. The fearful child who lies in order to get along with threatening adults. The anxious teenager struggling with embarrassing issues of personal identity. The worrying adult out on an economic limb with nowhere to turn. The concerned and angry patient and family for whom treatment has not gone as planned.
A 77-year-old black male Baptist patient, for example, underwent assumed routine surgery, had an unexpected stroke, and was dying. His shocked sisters and nephew expressed considerable anger at a family meeting: “He just came in for this surgery,” one said. “He was all-right when he got here. Now look at him. He’s dying! He may be just a patient to you, but he's our brother and uncle.”
Sympathetic staff persons tried to reassure the family that the medical treatment of the patient was thorough, that strokes after surgery, while uncommon, do occur, and that the patient may have had an unknown medical condition that contributed to the stroke. The intellectual, rational, and probably accurate explanations of what possibly happened did not console the family. What seemed to be helpful in shedding light on their feelings of shock and anger was my reflecting how they must feel in assuming their loved one was undergoing routine surgery, then suddenly seeing him dying from a stroke. The pastoral relationship I already had established with the sisters and nephew evidently contributed to whatever degree of being understood they felt at that family meeting. A primary challenge was to hear and understand and reflect their feelings—which may be more difficult if one’s own feelings are unduly pressuring one to convince a family of one’s best medical efforts.
The importance of understanding is also seen in a family meeting at which three daughters were discussing, with the attending doctor and other staff, their critically ill 82-year-old white mother’s wishes regarding her terminal care. The doctor was very concerned to be guided by the patient’s wishes. But the patient was having difficulty communicating her wishes. In an attempt to be helpful, another staff person talked about his mother’s terminal care in a residential treatment center, and used his experience to suggest the daughters might consider a similar kind of terminal care for their mother. The suggestion led one of the daughters to react, “I find your suggestion offensive. This isn’t about you and your mother.” Unfortunately the staff person put himself in the daughters’ place rather than discovering where they were.
Before ending the family meeting, the attending doctor, who valued and utilized the role of us chaplains, asked if I had any final words. My words were: “The daughters love their mother very much, and are very concerned that the treatment their mother receives is guided by her wishes.”
On another occasion, I had the privilege of observing a doctor talking with a husband about the importance of being guided by the wishes of his 65-year-old white wife, who only had a few months to live. The husband asked if it were more helpful to keep from his wife the amount of time she may have left, to make it easier for her—and for him. The doctor said, ”It is better for her to know how long she has to live. She can then complete what is important for her in the time she has. If she doesn’t know until near the end,” the doctor, continued, “what is important to her will be left undone, and her dying will be that much more difficult for her and for you. She may also feel that she has been deceived.” The doctor’s advice helped the husband to see more clearly what dying meant to his wife, and thus to deal more appropriately with his own feelings about her dying.
The empowerment of patients and their families is enhanced by their realization that they are being understood. Thus pastoral care is about understanding. Understanding where we chaplains are coming from in order for us to know where patients and their families are at.
Being understood is a universal human need. It enables growth and grieving, caring and community.
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Bill Alberts is a hospital chaplain at Boston Medical Center. Dr. Alberts is a nationally known writer and an occasional contributor to Counterpunch. In addition, he is convener of the New England Chapter of CPSP. He can be reached at william.alberts@bmc.org.
Posted by Perry Miller, Editor at July 7, 2010 10:36 PM
