Creating A Safe Space

Presenter: Chaplain Bob Coberly

Bereavement Services Manager

VITAS Innovative Hospice CareHouston, Texas

April 26, 2014

CreatingA Safe Space

Exploring that space where patients and their families

feel safe

Creating A Safe Space Objectives

* Recognize the importance of feeling safe in the environment of the healthcare visit

* Discuss the potential dangers of an unsafe emotional environment

* Explore redemptive language that defines a Safe Space

* Redefine excellence in spiritual care

* Demonstrate how we may create a safe space

Recognize the importance of feeling safe in the environment of

the healthcare visit

1. Identify the vulnerability of Hospice

patients and their families

2. Recognize the need for trust

Identify the vulnerability of hospice patients and their families

• Vulnerability of being ill

• Vulnerability of end-of-life issues

Feeling safe In the Environment of The Healthcare Visit

“The need for interpersonal trust relates to the vulnerability associated with being ill”

“Trust relations in health care—the new agenda”Rosemary Rowe & Michael CalnanEuropean Journal of Public Health

Feeling safe In the Environment of The Healthcare Visit

“Does my life have meaning?”

Recognize the need for trust

• The healthcare visit is a relational experience

• Trust is essential in the patient’s role in the healing process

Recognize the need for trust

To scan a ghost is faint,

But grappling conquers it.

Emily Dickinson

The healthcare visitis a relational experience

Relationships are Healing

Oscar and Lenny

What are the Dangers?

“There is no reason for them to feel unsafe with me.”

In reality, it may not be about you or me.

Discuss the potential dangers of an unsafe emotional environment

• End-of-life Fears and the Meaning of Life

• Spiritual Identity

End-of-life Fears and the Meaning of Life

• Fears will not be taken seriously

• My personal stories

will not be valued

What are the Dangers?

You won’t take my fears seriously

You will smother me with Answers

You will prescribe pills

You won’t listen to me

What are the Dangers?

You won’t understand me

You won’t be interested

I will feel minimized

I will feel ashamed

You don’t have time for my story

What are the Dangers?

“We quantify ‘human behavior’ and develop programs of therapy and treatment, and yet the procrustean trimming of the soul to fit our programs of science doesn’t have much effect. We still encounter the soul briefly, as a set of problems, rather than as a creative and constructive source of life.”

Thomas Moore

What are the Dangers?

“…the procrustean trimming of the soul to fit our programs…”

Procrustean:“…trying to establish conformity by using any and all means, including violence”

In Greek mythology, Procrustes was a son of Poseidon with a sadistic streak

What are the Dangers?

• Religious faith will be seen as superstitious

• Non-religious spirituality will be ignored

What are the Dangers?

I am Hindu. I fear

you will not value my faith;

You will think I am superstitious.

What are the Dangers?

I have no traditional faith;You see me as an “Atheist”;

Sometimes I am.You will not recognize my

meaning.I don’t care that you condemn me;

I fear, though, that you will not hear me.

What are the Dangers?

When you need to save me,

I don’t feel safe.

Creating A Safe Space

Exploring Redemptive Language

Exploring Redemptive Language

“Will this be a pointless death,or will we redeem it in some way?”

Rodney Bolejack“Grief: A Spiritual Journey”

Explore redemptive language that defines a Safe Space

• Ancient Hebrew word root of the term “Salvation” – YASHA

• 3 Contexts of the YASHA

Ancient Hebrew word root of the term “Salvation” – YASHA

• “To be wide or spacious; to develop without hindrance”

• Movement from narrow danger to spacious safety

Yasha

Hebrew YESHUWAH is translated

1. “healing”- Ps 42:11, Ps 43:5, Ps 67:22.“overcoming adversary”-Ps 18:50, Ps 44:43. “religious redemption” - Ps 91:16

“When hard pressed, I cried to

the Lord; he brought me into a spacious place.”

Psalm 118:5 New International Version

In the King James Version the metaphor reads:

“…set me in a broad place”

Paradox of Ethical Living

• Spiritual healing may be the movement from fear to trust -- in a safe space where they can develop without the hindrance of judgment or false hope.

• They may now reenter the narrow way, the dangerous vulnerability, with confidence.

Paradox of Ethical Living

Just as the therapist must release their client to leave the safety of the counseling office to the vulnerability of the street,…

RedefineExcellence in Spiritual Care

• Spiritual care and the safe space

• Spiritual care offers room to grow

Spiritual Care and the Safe Space

• Where the fearful experience trust

• Where the lonely find companionship

Spiritual care offers room to grow

• Fear is the restriction of hope

• Courage is the outgrowth of trust

Creating A Safe Space

Demonstratehow we may create a safe space

sitting vs standing

“statistical analysis showed significant difference between the amount of time patients perceived the physician as being in the room when he sat versus when he stood…. perceived him being in the room longer when he sat.”

journal: Patient Education and Counseling

Demonstratehow we may create a safe space

sitting vs standing

“…physicians should ask patients for their preference for sitting or standing during interviews.”

Journal of Pain and Symptom Management

Demonstratehow we may create a safe space

Mediators of Conflict Resolution

• “…as mediators, we have noticed that, when we are feeling at peace with ourselves and the world around us, we are better able to bring peace into the room.”

Bringing Peace Into the Room

Daniel Bowling and David A. Hoffman

Demonstratehow we may create a safe space

1. Consciously think about

emotional safety

2. Add it to your care planning

Consciously think about emotional safety

We consciously prepare for clinical issues;

we assume that we are safe persons…

NOW…

• Make a conscious shift to Think about patient & family vulnerability

• Consider potential emotional issues

• Expect new issues to be expressed

How We May Create a Safe Space

“…if you have ready-made answers in your head you will not be able even to listen to the question. You will be so full of your answer, you will be incapable of listening. You will not be available.”

Osho Indian mystic, guru, spiritual teacher

Add it to your care planning

• “Patient/Family will express uncomfortable feelings…. I will remain calm”

• “Patient/Family will tell personal stories…. I will be attentive”

How we may create a safe space

VALUE THE OUTCOME THAT

THEY WILL FEEL HEARD

How we may create a safe space

NOTICE EMOTIONAL GESTURES

BODY LANGUAGE

STRAIN IN FACIAL EXPRESSIONS

TEARS

EXUBERANCE

How we may create a safe space

And, finally,We will let them go….

Bibliography� “The Art of Doing ‘Nothing’,” David F. Wehlage, M.D., The Journal of the Indiana

State Medical Association, Oct. 1981, pp 670, 671� Bringing Peace Into the Room, Daniel Bowling & David A. Hoffman; Wiley, John and

Sons, Inc., 2003, p. 14.� Care Of The Soul In Medicine Healing Guidance for Patients, Families, and the People Who Care for

Them, by Thomas Moore, Hay House, 2011

� Companioning the Bereaved, Alan D. Wolfelt, Companioning Press, Fort Collins, CO 2006

� Creating A Safe Space, Edited by Howard L. Millman, University Press of America, Washington, D.C., 1979, p. 5

� Creating Safe Space / Violence and Women’s Writing, Tomoko Kuribayashi

� The Dalai Lama at Harvard, Lectures on the Buddhist Path to Peace, by H.H. the Dalai Lama; translated by Jeffrey Hopkins, Shambhala Publications, Boston, 1988, p. 37 and p. 76

� The Disney Movie “Shark Tale”� “Effect of sitting vs. standing on perception of provider time at bedside: A pilot study” by Kelli J.

Swayden, Karen K. Anderson, Lynne M. Connelly, Jennifer S. Moran, Joan K. McMahon, Paul M. Arnold, in the journal Patient Education and Counseling / Elsevier, No 86, 2012, pp. 166-171.

� “Grief: A Spiritual Journey”, workshop presented at the March 2013 Texas and New Mexico Hospice Organization annual convention by Rodney Bolejack

� “Inter-religious Dialogues--Christians and Buddhists,” Yoichi Kawada, Director of The Institute of Oriental Philosophy, Tokyo, Annals of the European Academy of Sciences and Arts, Vol. 31, NR XI, MMI (2001)

Bibliography� Safe Space: Gay Neighborhood History and the Politics of Violence, Christina B. Hanhardt� A Theological Word Book of the Bible, Ed. by Alan Richardson, Collier Books MacMillan

Publishing Company, NY, 1950, Pp 219, 220

• “Trust Relations in Healthcare—The New Agenda” European Journal of Public Health, Rosemary Rowe & Michael Calnan, Volume 16, Issue 1, February 2006, Pp 4 – 6

• The Wounded Healer, Henri J.M. Nouwen, Image Books/Doubleday, New York 1979 (1972)