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Spiritual Psychology and the Hospice Death Journey: The Chaplain's Challenge

by Tom McQueen MDiv
 
APC Forum, February 2019, Vol. 21 No.1
 
 
It takes a special person to embrace the vocation of a hospice chaplain. Experiencing the deep-seated joy of uniting a couple in marriage, baptizing a newborn infant, or partying at a church festival isn’t a routine occurrence for those whose everyday ministry manages the reality of death and grief.

But ask the most competent, committed, and compassionate chaplains and they will tell you that they wouldn’t trade their calling in life for anything else in the world. Being a co-traveler on each patient’s death journey and offering caregiver and family support in those critical days, weeks, and months following the loss of a loved one is more of a joy than it is a job, a genuine blessing of unparalleled proportion.
           
Having said that, the work isn’t easy. Some patients want to die a peaceful death with a loving partner, family, and friends by their side. Many are in denial and don’t want to talk about their limited life expectancy. Still others want to sleigh down the slope of anger, bitterness and resentment, regretting that they are alive and pushing everyone away as they near the last days, hours, and minutes of life, leaving in their wake a family overcome with tears, sadness, and desperation.
           
Complicating the chaplain’s goal to be a valued partner on the patient’s death journey is the reality of time on hospice service. While typical counselors may have weeks, months, and sometimes even years to make an impact on a patient’s spiritual and emotional pain that has accumulated over generations, the average length of stay at hospices nationwide is diminishing.
           
Given the reality of a short time on service and the potential volatility of a patient’s personal and family dynamics, how can the chaplain address the challenge of making every day count while at the same time accomplishing the care plan of minimizing and hopefully eliminating the individual’s spiritual pain and suffering? The dynamics of spiritual psychology offers us a common sense, yet powerful resource.
           
Simply stated, spiritual psychology is a dynamic blend of the principles of spirituality and science designed to enable individuals to frame experiences and events in their lives in a manner that will promote positive help and healing.
           
As one example, applying the work of the social psychologist, Kurt Lewin, to the spiritual pain of a dying hospice patient, consider an adaptation of Lewin’s Force Field Analysis below, The Spiritual-Emotional Care Plan.
           
In the case of a 73yo male patient, a proposed care-plan goal that a chaplain wanted to facilitate was to resolve the patient’s spiritual pain so that he could die a peaceful death. During the patient’s initial assessment, both patient and chaplain identified four tasks (forces for change) that would accomplish the goal and those are listed on the left side of the Spiritual-Emotional Care Plan below:
  1. Making peace with my son.
  2. Leaving a legacy that family members would remember in a positive way.
  3. Reconciling past mistakes with my ex-wife.
  4. Experiencing God’s forgiveness for often being miserable and mean.
     
Once the chaplain processed the opportunities with the patient, they examined those forces resisting change, barriers that were seen as obstacles to a peaceful death journey. They are noted on the right-hand side of the diagram:
  1. My son hasn’t spoken to me in three years and he lives in another state.
  2. No one in my family really cares about me anymore.
  3. My ex-wife is remarried and doesn’t want anything to do with me.
  4. I haven’t been to church since I was 15 years old.
 
 
The prognosis for this patient was three-four months according to the medical staff. At the conclusion of the initial assessment the chaplain reiterated the main goal they had both agreed to: to reach a state of spiritual and emotional peace before death. What the chaplain needed was for the patient to become a partner in the plan rather than just a passive bystander. Once the partnership invitation was extended and the commitment obtained, the chaplain went to work.
           
The immediate task was to identify the resisting force that would have the most positive impact when overcome. In this case, it was restoring communication between father and son. Within a month, the chaplain arranged a visit for the two of them. As a result of that visit, there was an additional meeting with the ex-wife and a subsequent family gathering celebrating the patient’s birthday, one week before he passed.
           
While the patient was never able to visit a church or see a minister, he expressed to the chaplain that the prayer and scripture they shared at each one of their six visits enabled him to feel God’s love and forgiveness.
           
The chaplain’s decision to employ the principles of spiritual psychology in establishing a relationship with this patient was instrumental in achieving a positive death journey outcome. Specifically, in addition to the prescribed tasks inherent in every hospice chaplain’s role, this chaplain recognized the importance and urgency of defining and executing a care plan that addressed the patient’s spiritual and emotional pain. As a result, the chaplain:
  • Engaged the patient as a partner in the care plan
  • Defined SMART (Specific, Measurable, Achievable, Relevant, and Time-related) action steps that would result in emotional and spiritual peace
  • Collaborated with the patient in articulating the obstacles to achieving that peace
  • Identified the one force for positive change that would achieve the most immediate and powerful result in an expeditious manner
  • Affirmed the patient’s spiritual worthiness in the absence of local resources
And what was the chaplain’s reward for guiding this father and his family to a greater sense of harmony and happiness? When he received a thank-you note from the patient’s son a few weeks after his dad passed, the chaplain was reminded that there is no greater gift than to be an instrument of God’s peace and healing during a time when death is near and hopelessness grips the heart and soul. Is there any vocation that offers a more meaningful experience?

Tom McQueen MDiv is Director of Spiritual Care and Bereavement at Gulfside Hospice & Pasco Palliative Care, in Land O' Lakes, Florida.

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