What Do I Say?

Talking with Patients about Spirituality

Elizabeth Johnston-Taylor

• Publisher: Templeton Press
• Year: 2011
• ISBN:
  9781599472591
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Health care professionals, clergy, chaplains, social workers, and others who counsel people in medical crisis often find themselves faced with deeply painful questions: Why is this happening to me? Am I dying? Why should I live? I'm just a burden to others. Here is a workbook that suggests healing verbal responses to such expressions of spiritual pain. The author, an internationally recognized expert in spiritual caregiving, points out that wanting to help is one motivation for learning these skills, but there are also evidence-based reasons: helping patients express their innermost feelings promotes spiritual healing; spiritual health is related to physical and emotional health; spiritual coping helps patients accept and deal with their illness; and patients tend to want their health care professionals to know about their spirituality. Lessons, tips, and exercises teach how to listen effectively, with guidelines for detecting and understanding the spiritual needs embedded in patients' conversations. Suggestions are provided for verbal responses to patients who express spiritual distress, including tips for building rapport, using self-disclosure, and praying with patients. A FAQ section deals with frequently asked questions and miscellaneous information, such as: •What do I do when a patient talks on and on and I have to leave?
•How do I answer a "why" question?
•What do I say to a patient who believes a miracle will happen to cure them?
•What if I'm not religious? How can I talk about it? By practicing and using these healing techniques, Taylor explains, healthcare professionals will be able to provide patients responses to their questions that allow them to become intellectually, emotionally, and physically aware of their spirituality so they can experience life more fully.

1 Let’s Begin!

You’ve heard it:

“Why is this happening to me?”

“Am I dying? Am I going to be okay?”

“Why should I live? I’m just a burden to others.”

“If I just pray harder, a miracle will happen”

“I did this to myself—I just can’t forgive myself.”

Whether patients are expressing a need to make sense of tragedy, find hope for the future, ascribe purpose and worth to living, trust religious beliefs, or relate to self and others with love, they are telling us about their inner spiritual needs. These needs are often deeply painful.

Such painful expressions of the human spirit often perplex and overwhelm the listener. This spiritual pain is often too hard to hear. Undoubtedly, when you have listened, you’ve heard patients—and even your friends and family—say things that left you wondering, “What do I say?”

This workbook will help you to answer this very question. In addition to providing you with suggestions for how to form healing verbal responses to expressions of spiritual pain, this workbook offers exercises for practicing and applying your newfound knowledge. Learning these communication skills are fundamental, but they will not be helpful unless you practice them. The adage “practice makes perfect” applies!

Why should I learn this skill?

The inner discomfort you have when patients express their spiritual pain may be motivating you to complete this workbook. There are, however, evidence-based reasons why health care professionals (HCPs) should learn this skill.

Emotional expression promotes spiritual healing.

Emotional expression is an avenue for accessing and expressing one’s spirituality. “Opening up” and sharing deep emotions has been shown to contribute to physical as well as to emotional healing.¹ By helping patients express their innermost feelings and spirituality, health care professionals promote healing.

HCPs, furthermore, are in a unique position to help patients. Not only do they often meet patients during times of chaos and challenge, they meet patients as strangers. Strangers don’t have the “baggage” that family and friends have. With HCPs, patients do not have a history of relating within established rules, so they often feel it is safer to share unspoken fears and secret feelings with health care professionals.

Spiritual health is related to physical and emotional health.

Hundreds of research studies have suggested a relationship between religiosity or spiritual health and physical health.² Although these studies vary significantly in quality and methodology, the evidence tentatively supports the longstanding theoretical models that link body, mind, and spirit. Science appears to verify Plato:

As you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul … for the part can never be well unless the whole is well…. And therefore, if the head and body are to be well, you must begin by curing the soul.³

Spiritual coping promotes adaptation to illness.

Patients frequently use spiritual coping strategies to manage their illness experience.⁴ These coping strategies, like prayer, meditation, scripture reading, and clinging to comforting religious beliefs, are usually considered very important and meaningful to patients. While evidence suggests that use of positive religious coping is directly correlated with health outcomes, other evidence indicates that patients recognize that these coping strategies do not magically cure or substantially reduce symptoms. By facilitating patient use of healthful spiritual coping, clinicians promote adaptation.

Patients want their health care professionals to know about their spirituality.

Many patients appreciate having HCPs show concern for their spiritual health.⁵ Patients with a serious or life-threatening condition, patients who are religious, and patients who perceive they have some relationship with the clinician are especially receptive to inquiries about their spiritual health. Although nurses and physicians are not viewed as primary spiritual caregivers and patients often do not want to be explicitly asked about their beliefs or invited to participate in intimate religious practices, most patients do want their health care professionals to know about their spirituality.

A nonempirical reason for learning to provide spiritually healing responses to patients is that, in addition to helping patients, we help ourselves. Psychotherapist John Sanford wrote that “by making a mature response in a difficult situation we become more mature … you are what you do”⁶ As you complete this workbook, you may discover the journey is more about answering your own spiritual questions rather than those of patients.

About this workbook

This workbook is designed for HCPs—nurses, physicians, and allied health professionals, especially. Social workers, chaplains, clergy, and others who may get some training in counseling may also find this workbook beneficial. This curriculum is intended for those who provide care to primarily adults without mental illness. Although the content can be useful in some pediatric and mental health contexts, caring in such settings requires additional knowledge and skills that are not addressed here.

This workbook will require about ten hours to complete. Racing through the workbook, however, is not recommended. Allow yourself time to enjoy the process and to reflect on how you will integrate the knowledge and skills into your life. You may choose to complete one chapter a month, for example.

This book integrates knowledge from several disciplines, including psychology, psychiatry, pastoral counseling, nursing, chaplaincy, and spiritual direction. Although Western and Judeo-Christian experience typically influences the thinking on this topic, the workbook keeps the varied spiritual experiences of patients and HCPs in mind. Although institutionalized religion is an expression of human spirituality and an aid to spiritual formation, it is distinct from the broader concept of spirituality. Spirituality is universal, innate in all individuals. Kenneth Pargament, for example, defined spirituality as “a search for significance in ways related to the sacred.”⁷

“God” language is used in this book. It is not intended to confine the reader to a prescribed Judeo-Christian orientation. Readers can substitute words and ideas that represent the transcendent for them, the sacred or holy (e.g., Spirit, Ultimate Other, Sacred Source, Higher Power). Patients, of course, often use th...