Spiritual care for People Living with Cancer

1. Spiritual care for People Living with Cancer Rabbi H. Rafael Goldstein Board Certified Chaplain Integrative Life Coach

2. What are your goals? • Provide spiritual support • Provide a caring sounding board • Provide compassionate response to illness • Provide connection between the person who is ill and the Holy One.

3. Goals 2 Help the person who is ill • find hope • find inner strength, strength from loved ones, from you, and from G!d. • find resources that can support them • find peace with the journey

4. Know why the person is coming to you! • S/he wants your spiritual guidance trough the biggest of life’s challenges. • S/he needs someone who will hear his/her fears, concerns, sorrows, anger, rage, depression. • S/he needs someone who can represent G!d, a Higher Power, Universal Energy, whatever is beyond. • S/he needs someone like you, who is totally not in the medical field. • S/he needs a caring “other” who can hear and not fear grief.

5. Why you? • You are the spiritual member of the helping team • You have something to offer that can bring healing and hope • You have a unique voice to add for the person who is ill • You are ordained to provide spiritual guidance to your flock • You represent and speak for that which is holy • No one else is in charge of hearing the heart of the person who is ill. • No one else can do what you can do!

6. Stages of grief Kubler-Ross’s 5: Denial Depression Anger Bargaining Acceptance

7. Goldstein’s 6th Stage Gratitude

8. Where to start? Worries: “What do I say?” “I don’t want to say something that will make the situation worse.” “I don’t want to say things that are trite.” “I don’t want to look like I don’t know anything about the particular cancer.” “I don’t have time to do real pastoral counseling.”

9. It’s not what you say that matters - It’s your presence!

10. Presence • You are there • You care • You are listening • You are safe to talk to • You represent G!d • Your conversation is confidential (provided no one else is in the room!)

11. Before you meet • Wash you hands. First of all, it’s good prevention. People living with cancer don’t need your germs. • Secondly, it helps you become focused on the holy exchange you are about to engage in. Wash away everything else you have been working on so you can focus. • Say a blessing asking for G!d to help you be as present as humanly possible, and to help you help the person you are about to see on G!d’s behalf. • Know something about the person, the illness, the possible issues the person is facing.

12. Surprise! • Sometime the looks of the person you see might be different from what you expected. Cancer and cancer treatments make for all kinds of unexpected appearances. Be honest. But recognize that other people get freaked out by the radical changes in the the person’s appearance. That’s not what you’re there for! Try to minimize your reactions as much as possible. No one wants the person s/he is coming to for help to be freaked out by his/her appearance!

13. Listen! • Don’t just do something - sit there! • Listen actively • Open your heart to listening • Reflect back what you hear so the person knows you get it. • Nod, say “oh”, “tell me more” • Ask questions to clarify, go deeper into the feelings

14. Fear • There is no such thing as a person who is sick who is not afraid. • Explore the fears. • Are they real? Validate them. • Are they overly pessimistic? Challenge them! • Are they afraid for others? Who? Why?

15. Denial - a terrific coping mechanism! • Start where a person is, not where you hope s/he will go • Respect the rights of denial - it may be the best way for the person to cope • Listen

16. Who is working harder? • If you are doing all the talking, you’re doing all the work. • Allow the person you are helping to do her/his own work. • Use silence, quiet, calm

17. Tissues and tears • When tears come up allow them. • Do not offer tissues. If s/he wants them, s/he will ask or see them on the table. Offering tissues in our society is a subtle way to say “stop crying”. • Tears are a natural part of experiencing illness.

18. Breathe • When you breathe audibly, the person you are with will calm down, and match your breathing. Take some deep breaths. Suggest it if you need to, but body language will work just fine.

19. Eye contact • Make sure you are on an even plane with the person • Sit • Make eye contact

20. Touch • Ask for permission to hold a hand, touch a shoulder • Only touch in ways and in places that are appropriate.

21. Medical procedures • If you are visiting at a home or hospital, if a nurse or medical professional comes in to do any kind of medical process, step out. When the person you are visiting objects and says you can stay, say you need to go to the bathroom, or make a call, or something, anyway. Your presence is not needed when medical procedures are happening. You are not there for that.

22. Teach • Feel free to call upon your strengths • Your favorite healing Psalm • A meaningful and inspirational scriptural passage • A prayer or poem that fits • You are uniquely suited and the only one who can assure the person who is ill that G!d is there for him/her in this illness, to be a source of healing and hope

23. Theology • G!d is not in the punishment business • G!d is here to help us through illness • G!d is a source of strength, comfort, and hope • Avoid the big G!d cliché. It helps no one!

24. Hope-ology • Is any situation hopeless? • What can you hope for? • What can the person you are counseling hope for? • If they have lost track of what to hope for, your job is to help them figure this out. • Healing does not mean curing. Can you be healed without a cure? How?

25. Forgiveness • One essential way you can help people living with cancer is to help them forgive the hurts they may have experienced, and to let go of bitterness, anger, grief, regret. • Help them seek forgiveness. • Help them forgive.

26. Compartmentalizing and Joy • Teach compartmentalizing • Give permission for there to be joy and laughter, light and happiness even in the midst of illness • Encourage fun and creativity • Finding beauty and connectedness with nature • New experiences • Taking different approaches to the familiar • Start a new project

27. Agendas • Be careful to allow the other person to set the agenda. Let him/her tell you what s/he needs to talk about. • Be open to the possibilities in what you hear. • While I come from a religious/spiritual approach, I try to see that as a bag of resources I have from which I can respond. Be careful about whose agenda is on the table.

28. Watch your language! • Life is a “terminal illness”. Cancer isn’t. • “Patient” turns a human being into a medical problem. • “Victim” means there is nothing else the person is or can do. No one wants to be a victim! • “Person living with cancer” is the only appropriate way to describe a person who lives with cancer among all of the other conditions, experiences, descriptions for his/her life. Cancer is not a be all and end all. • Don’t allow others to use victimizing language.

29. Language 2 • When the end of life seems imminent, think about what it means to “pull the plug.” Terrible misuse of language based on a medical model. This language can torture a loved one who had to make a difficult decision for the rest of his/her life. • Better language: “Allow a natural death.” Now that’s language a survivor can live with!

30. DO NOT • Fill in the silences • End sentences for the other… • Talk a lot about your own needs, issues or experiences • Talk about other people you know who have had a similar cancer, illness, or anything else. • Explain how uncomfortable you might be - it’s not the other person’s job to help you!

31. Do not continued! • Give medical advice • Give financial advice • Give psychiatric advice • Give nutrition advice • Give exercise advice • Give legal advice

32. Still Going on the Do Not’s • Pity - no one needs it, especially not people who are turning to you. No matter how sorry you feel for the situation the person is in, pity is the last thing s/he needs from you! • If you feel yourself welling up to pity or cry, reschedule. The person does not need to be comforting you!

33. Validate feelings • Intense feelings are normal • Fear is normal • Anger is normal • Apprehensiveness is normal • Thinking you’re going crazy is normal • Sadness is normal • Feeling lost is normal • Confusion is normal • Not being able to find your keys is normal • Getting upset by things that never annoyed you before is normal • Losing track of what you can hope for is normal

34. Ending a session Homework? If you will meet again, always make an assignment. Examples: • Blessings every day • Bucket list • Gratitude list • Forgiveness list • Journaling • Collect inspirations • Appointments with self/loved ones

35. Prayer • Ask if you can pray together. • Ask what you should pray for. • Empower prayer by letting the other person say his/her prayer and allowing you to say “amen.” • Choose a good prayer that you know fits in with the conversation. • Dynamics of Hope Prayerbook

36. Reflection • Give yourself some time to reflect on what the session meant to you. • What did you learn? • What did you experience? • How were you affected by it? • How do you think the other person experienced you? • What work do you think remains to be done? • What did you miss? • What insights do you think helped? • What prayers would you say if you had thought of it? • What texts would have been good resources? • How will you do it better next time?

37. After the session • Wash your hands. Watch the other person’s stuff go down the drain. You have to allow yourself to let go of other people’s sorrows, or you will go nuts! Say a blessing for the other person, and for yourself, as you wash your hands.

38. Serenity Prayer G!d, Grant me the serenity to accept the things I cannot change, The courage to change the things I can, And the wisdom to know the difference.