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Stories Interrupted: Weaving Creativity, the Sacred and Meaning at the End-of-Life. Brenda Kenyon, LCSW St.Vincent Hospice, Indianapolis, IN Tony Pinto, MDiv , CT Indianapolis, IN. Learning Objectives. Articulate three loss oriented outcomes

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Stories interrupted weaving creativity the sacred and meaning at the end of life

Stories Interrupted: Weaving Creativity, the Sacred and Meaning at the End-of-Life

Brenda Kenyon, LCSW

St.Vincent Hospice, Indianapolis, IN

Tony Pinto, MDiv, CT

Indianapolis, IN


Learning objectives
Learning Objectives Meaning at the End-of-Life

  • Articulate three loss oriented outcomes

  • Identify four components of a holding environment

  • Articulate three constructs defining creativity

  • Define refuge as a function of the sacred

  • Identify four methods of interdisciplinary creative collaboration


Contemplative exercise
Contemplative Exercise Meaning at the End-of-Life

  • Engage audience in using concentration through centering

  • Introduce breath & voice modulation techniques


Blueprint for today
Blueprint for Today Meaning at the End-of-Life

3 Clinical Frameworks to assess, intervene, and provide care to those whose stories have been interrupted.

  • First provide a panoramic view of two stories interrupted.

  • Then we set the stage for the Holding Environment.

  • Explore the frameworks of meaning, creativity, and the sacred.


The box experiential exercise
The Box Experiential Exercise Meaning at the End-of-Life

  • Reduced capacity/capability

  • Diminished treatment options

  • Collateral losses associated with terminal diagnosis

  • Shift from external to internal

  • Approaching death


Your blessing box
Your Blessing Box Meaning at the End-of-Life

  • Use today to capture ideas, thoughts, and

    Interventions that will bless your work in the future.


Two case studies
Two Case Studies Meaning at the End-of-Life

  • PTSD, adjustment counseling, interdisciplinary themes, twelve-step model and hospice graduation

  • Terminal awareness, family dynamics, interdisciplinary ritual, creativity, religious imagery and hospice graduation


Motorcycle mamma
Motorcycle Mamma Meaning at the End-of-Life

  • 81 year old Caucasian female

  • Enrolled in hospice 13 months

  • Diagnosed with Rectal Cancer 5 months prior

  • Radiation treatments caused extreme weakness

  • Highly independent until her diagnosis

  • Currently bedbound, unable to move legs

  • Prided herself in being able to ride a motorcycle until age 80


Motorcycle mamma s threads
Motorcycle Mamma’s Threads Meaning at the End-of-Life

  • Loss of identity (loss of independence and increased dependence)

  • Loss of personal narrative (will not live to 92)

  • Disenfranchised grief around significant love relationship.

  • Dissolution of social network (square dancing & motorcycle clubs)

  • Matriarch and protector unable to assist her children with their restlessness

  • Trauma associated with terminal diagnosis/hospice placement


Catherine of sienna
Catherine (of Sienna) Meaning at the End-of-Life

  • 89 year old Caucasian female

  • Enrolled in hospice for 9 months

  • Diagnosed with End-Stage Ovarian Cancer

  • Long term care resident since 2006

  • In harmony with her own self narrative

  • Matriarch of her multigenerational family

  • Devoted Roman Catholic with a deep sense of mystic spirituality


Catherine of sienna s threads
Catherine of Sienna’s Threads Meaning at the End-of-Life

  • Used sense of humor to cope

  • “I ordered homemade chicken noodle soup and got canned tomatoes instead.”

  • Relied on her multigenerational family

  • Verbalized her sense of resolution

  • Support to family to address anticipatory grief issues and recognition of her terminal awareness


The components of weaving

Story Interrupted Meaning at the End-of-Life

(Patient)

Other Weavers

Holding Environment

Thread-maker (Clinician)

Weaving

The Components of Weaving


Clinical components of the interrupted narratives
Clinical Components of the Interrupted Narratives Meaning at the End-of-Life

  • Suffering

    • Suffering can be defined as an actual or perceived threat to the integrity or continued existence of the whole person. (Cassell, 1982)

  • PTSD

    • Our observation indicates that the persons’ interrupted stories tend to mimic the signs and symptoms of PTSD.

    • When we implement interventions that address PTSD patients can experience a significant benefit.

      (Boss, 2006)


Clinical components of motorcycle momma s interrupted story
Clinical Components of Meaning at the End-of-LifeMotorcycle Momma’s Interrupted Story

  • Disruption of the Personal Narrative

    • Loss of identity

    • Loss of meaning

    • Loss of purpose

  • Interruption of the Family Narrative

    • Generational threat

      (end of tradition, end of the future line)

    • Leaderless clan

    • Emerging responsibilities

      (concrete and psychodynamic)


Clinical components of catherine s family story interrupted
Clinical Components of Catherine’s Family Story Interrupted

  • Stability of the multigenerational family unit

  • Validation of her terminal awareness

  • Need to address impending loss with her grieving daughters

  • To die a happy and peaceful death as opposed to the traumatic memory of her aunt’s dramatic death

  • Recognition that she has lived a long and productive life of faith and family


Characteristics of catherine of sienna s story interrupted
Characteristics of Catherine of Sienna’s Story Interrupted Interrupted

  • Urgent desire for supportive creativity and spiritual imagination (Fox, 1979)

  • Strong spiritual path transcendent of religious affiliation

  • Strong sense of creativity and “play”


The components of weaving1

Story Interrupted Interrupted

(Patient)

Other Weavers

Holding Environment

Weaving

Thread-maker (Clinician)

The Components of Weaving


Holding environment
Holding Environment Interrupted

  • Borrowed extrapolation from A. Modell’s (1976) ideas around the therapeutic relationship as he applied D. W. Winnicott’s theoretical constructs of “the Holding Environment”

  • Gives a basis for understanding boundaries and components to acknowledge, as well as, to leverage for positive patient/family outcomes in the journey


Holding environment1
Holding Environment Interrupted

  • Intention

    • Filter and Clear Distractions

    • Single Pointed Focus/Presence

  • Therapeutic Alliance

    • Developing trust

    • Becoming the safe object

  • Stabilization

    • Normalize reactions to absurd events

    • Name the interruption and its effects


Interventions to create a holding environment
Interventions To Create A InterruptedHolding Environment

  • Scanning of the physical environment

    • Search of obstacles and chaos

    • Identify the sacred

    • Engage the immediate family and the patient in the creation of the holding environment

    • Facilitate the transformation of the holding environment

  • Cultivation of the psychodynamic “holding”

    • Trust (consistent, information sharing, mediate communication with team and family)

    • Honesty (remain objective, establish boundaries/limitations)

    • Reassurance of hope

    • Reframing of the experience (redirect to opportunity)

    • Reinforce strenghts and meaning


The components of weaving2

Story Interrupted Interrupted

(Patient)

Other Weavers

Holding Environment

Weaving

Thread-maker (Clinician)

The Components of Weaving


Weaving 3 clinical frameworks
Weaving 3 Clinical Frameworks Interrupted

  • Meaning Making (R. Neimeyer, T. Attig)

    • Search for purpose/naming

    • Achieving Resolution/Maintaining Resolve

    • Coherence/Making Sense

    • Reframing

  • Creativity (R. May, S. Langer, D.W.Winnicott, A. Modell)

    • Congruent Forms

    • Holding Environment/Field of Play

  • Sacred/Symbolic Immortality (M. Fox, E. J. Cassel, J. Halifax)

    • Refuge practice

    • Power of Intention

    • As transcendence


Meaning making
Meaning-making Interrupted

The Hierarchy of Hope by Helen Wong


Meaning
Meaning Interrupted

  • Making sense of the experience is coping with emotional, physical, social, spiritual and intellectual consequences…..by transforming the CHAOS into a newly meaningful order.

    (Machin, 2009)

  • “Narrative methods can play a role in restoring or re-storying a sense of autobiographical coherence that has been disrupted by loss (Neimeyer, 2007)

  • Significant life losses, bring forth spiritual awareness; and yearning for meaning that transcends everyday explanation.

    (Martin & Doka, 2000)


Meaning making1
Meaning-making Interrupted

  • Meaning can refer to a spiritual sense of purpose in life, which centers around the capacity of an individual to feel the worth of his/her individual life (story).

    (Marcia Lattanzi-Licht, “Religion, Spirituality and Dying”, 2007)

  • Victor Frankl offers three avenues for discovering meaning: Creating a work/doing a deed; Experiencing truth, beauty and love; and the Attitude we assume towards unavoidable suffering. (Frankl, 1959)


Meaning making interdisciplinary interventions
Meaning Making InterruptedInterdisciplinary Interventions

  • Grasping and naming emerging themes

  • Use of visualization and creative imagery to reconstruct meaning

  • Name the fragments, find congruent forms, reframe language


Creativity
Creativity Interrupted

  • Is a means of finding cohesion and integration in the midst of chaos

  • A force inextricably linked to the sacred

  • Creativity is a way of living, a spirituality just as compassion is (Fox, 1990)

  • It is the energy of hope


Creativity1
Creativity Interrupted

  • Creativity is about overcoming fears by entering into them and spiraling out of them. It takes courage to create. (Fox, 1979)

  • Creativity is a supportive field to begin the necessary work of transformation, re-integration and meaning finding. It is also a significant component of the holding environment. (Kenny, 1989)


Creativity2
Creativity Interrupted

  • Congruent Forms (Langer, 1972)

    • Humans must have “congruent forms of feeling” to be completely subjectively understood.

    • When the helper reflects to the patient, images and themes that find resonance, then the patient is able to perceive the congruent form of feeling. As a result of finding the congruent form, the patient experiences the feeling of being profoundly understood.


Creativity3
Creativity Interrupted

  • This yearning for form is a way of trying to find and constitute meaning in life. The creative process is the struggle against disintegration, the struggle to bring into existence new kinds of being that give meaning and integration. (May, 1975)


Creativity4
Creativity Interrupted

  • The helper, meets the patient in this space. The helper enters through intention, active listening (presence) and evidencing the congruent form (naming).

    The patient enters through perceiving the congruent form and embracing the emerging force of creativity.


Creativity5
Creativity Interrupted

  • “The point is that when people are experientially moved by feelings evoked through the creative process, they are in a place where change is less frightening and relational revisions become more possible.” (Boss, 2006)


Creative interventions
Creative Interventions Interrupted

  • Rituals (Angel Cards, Blessing Box)

  • Honoring /Celebration of Life Ceremonies

  • Art therapy techniques (“I Am A Tree”, These Hands, family art carts, pillow cases, “Land of Grief”)

  • Music interventions (CD Compilation, music and art sessions, comfort music)

  • Legacy projects (“words of wisdom”)

  • Creative writing projects (poetry-writing, memory pages, favorite scripture pages)


Sacred
Sacred Interrupted

  • The Sacred is Present in the Story Interrupted

  • The Sacred emerges in the Story Renewed

  • The Sacred is weaved through underscoring symbolic immortality in the emerging post traumatic self


Sacred1
Sacred Interrupted

  • One is frozen in the moment of traumatization. The disruption of memory in trauma is a corollary to the disruption of self. (Kauffman, 2007)

  • We use the Sacred as means of reintegrating self as it is weaved into the emerging self narrative.


Sacred2
Sacred Interrupted

  • Life is threatened when death is not transcended. (Lifton,1979)

  • Humanity needs reassurance about the eternal survival of the self. (Rank, 1958)

  • The approach to the interrupted narrative must include an element of belief in the sacredness of the story.


Symbolic immortality as sacred
Symbolic Immortality as Sacred Interrupted

  • Biological Immortality: the sense that one continues to live through one’s descendants

  • Theological Immortality: a reunion with the Divine in the afterlife

  • Works Immortality: the feeling of having created an enduring contribution

  • Natural Immortality: the satisfaction of one’s continuation in the cycle of life

  • Transcendent Immortality: the psychic depth that sees the cessation of time, space, life and death and only perceives a continuous present (Lifton, 1979)


Sacred3
Sacred Interrupted

  • One of the congruent forms we lift is reflected by T.S. Elliot when he says: “What we call the beginning is often the end, and to make an end, is to make a beginning; the end is where we start from” (Elliot, 1936)


Sacred4
Sacred Interrupted

  • Young and Erickson see trauma as disrupting the sense of continuity, leaving one alienated and isolated. The trauma disturbs experience so severely that the pre- and post- traumatic self are discontinuous. (Young & Erickson, 1989)

  • The introduction of the Sacred into the Holding Environment becomes a congruent form symbolizing continuity.


Refuge ritual
Refuge & Ritual Interrupted

  • Sacred is found as we seek and discover refuge. Refuge is also a practice, a mental exercise that requires creative imagery and freedom to feel.

  • Rituals and ceremonies evoke a cognitive means of making sense of our traumatic losses. (Richards, 2001)

  • Ritual provides a way to release the chaos of the story interrupted. (Golden, 1996)


Spiritual practice
Spiritual Practice Interrupted

  • A spiritual practice can give us a refuge, a shelter in which to develop insight as to what is happening outside us and within our minds and hearts. (Halifax, 2008)

  • It can cultivate wholesome mental qualities such as compassion, joy, non-attachments--qualities that give us resilience to face and possibly transform suffering. (Halifax, 2006)


Sacred5
Sacred Interrupted

  • This meeting in the holding environment “can be looked upon as sacred to the individual, in that it is here that the individual experiences creative living.”

    (D.W. Winnicott, 1971)


Sacred interventions
Sacred Interventions Interrupted

  • Commendation/Sending Off Ritual

  • Contemplative Prayer

  • Mandala making

  • Creation and claiming of symbolic spaces

  • Music

  • Rosaries and mantras


The components of weaving3

Story Interrupted Interrupted

(Patient)

Other Weavers

Holding Environment

Weaving

Thread-maker (Clinician)

The Components of Weaving


Other weavers
Other Weavers Interrupted

  • Family

  • Significant Others

  • Facility Staff

  • Community

  • Hospice Team


The story ends
The Story Ends Interrupted

Encourage to widen your creative horizons

Embrace the risk taker in you

Engage in creative paths that thrust you to a new level of experience

Cultivate presence in the holding environment

Open your eyes to congruent forms

Weave


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