Companioning: A Hospice Essential

1. Companioning:A Hospice Essential Rodney Bolejack, D.Min. American Hospice, Denton TX RBolejack@American-Hospice.net

2. When one of his classmates died, an eight-year-old friend visited the boy’s home one day after school. “What did you say?” asked the mother gently when the child returned. “Nothing,” he replied. “I just sat on his mom’s lap and helped her cry.” --Dan Zabra Forever Remembered

3. Objectives • Value the need for companioning the hospice patient. • Relate the tenets of companioning to patient care.

4. A Few First Thoughts • Everyone must make this journey through life and death alone • No one should make this journey without a companion • Breakfast with Jo • “What are your biggest fears for the future of hospice?”

5. NEEDED: A strong, deep person wise enough to allow me to grieve in the depth of who I am, and strong enough to hear my pain without turning away. I need someone who believes that the sun will rise again, but who does not fear my darkness. Someone who can point out the rocks in my way without making me a child by carrying them. Someone who can stand in thunder and watch the lightning and believe in a rainbow. Fr. Joe Mahoney This is companioning.

6. What is Companioning? • Companioning is a willingness to be present with another, wherever they may be in their journey, and walk with them through their personal and often “unchartable territories” without having the need to say the right thing or to fix the unfixable. • Companioning creates a safe place for those who are hurting to find their own answers.

7. Creating a Safe Place • Creating a free, empty space where a stranger may enter and become a friend instead of an enemy • It is the space in the relationship between me and thee • I have created that safe place when you are free to be you -- Henri Nouwen

9. To love means not to impose your own powers on your fellow man but offer him your help. And, if he refuses it, to be proud that he can do it on his own strength.--Elizabeth Kubler-Ross

10. Companioning Essentials

11. I want to be with you • Presence • Non-anxious • I will not abandon you Sue W • Physically • Spiritually • Emotionally • You can tell me to stay away, but you cannot push me away • Joe H

12. I want to be with you • Creating relationship that allows the other to risk the courage to trust you. • How? Short time! • Faithful presence and responsiveness • I didn’t think God could find me • Promises fulfilled • Physical • Spiritual • Kindness and care • Knowledge and skills

13. I want you to teach me • “Behold, I stand at the door and knock and say to myself, ‘I am about to meet my teacher.’” • Curiosity • Being teachable • Believing that this “other” knows how they wish to approach death & dying • They may not have words to describe it • May need a companion to explore values with them

14. I want you to teach me • Believing that this “other” has life-gifts to give to anyone who would learn • What did you learn about life? • What gives you peace? Meaning? Joy? • How do you wish to approach death & dying? • What do you fear most about the days ahead? • What would a “good death” look like for you? • It was horrible. Noisy. Crowded. Not at all peaceful

15. I want to hear you Its not that we all have stories that need to be told …..rather…. We are stories that need to be heard.

16. I want to hear you • Listening to empathize • To see the world through another person’s eyes • Listening’s primary purpose • Listening to reflect • As a mirror • Allows them to hear their own story • Remembers that most of the answers are within them • Listening to learn each one’s uniqueness • Unique story • Unique perspective on life, illness, & death • Unique coping

17. Being comfortable with just listening • The hardest part of listening is getting comfortable just listening • Being just a listener allows us to be a catalyst that helps them react to their feelings in a more comfortable way that allows them to establish significance with their loss

18. By-products of Listening Remember: These are not the primary purpose of listening • Insight • Insight happens when people talk and someone listens • Connecting the dots for a full picture • Emerging solutions • Validating and processing emotions • Showing acceptance • Finding meaning • Learning • fears, struggles, joys, hopes, comfort

19. I accept you • I am not here to judge or critique • He who gets labeled is he who gets dismissed • You will not be labeled as a good or bad patient • He who gets labeled is he who gets dismissed! • Non-compliance and other frustrations • No blaming the patient (even when I return to the office) • Creative caring • Arlon

20. Demonstrating Acceptance: Acceptance of another person is a matter of “deep, empathic understanding,” as Carl Rogers terms it, which allows you to see the world the other person inhabits through his or her eyes. “It means a respect and liking for [the person] as a separate person….It means an acceptance of and regard for his [or her] attitudes of the moment, no matter how negative or positive.”

21. Demonstrating Acceptance: • Meet the person where he or she is. • Trying to move your interaction with a hurting person to any other level is merely singing songs to a heavy heart. • Focus on here and now rather than there and then. • Meet with me in the moment not in the future: it’s a waste of time telling the hurting individual, “You’ll feel better as time goes on.” • Acknowledge the feelings. • Respond to that hurting individual and their negative feelings in a feeling way rather than an intellectual way. Don’t Sing Songs to a Heavy Heart - Kenneth Haugk, Ph.D

22. Acceptance doesn’t need to: • Judge • Advise • Rescue • “Preach To”

23. I want to know you • So I can be with you on your journey • Not so I can analyze and label you in IDT • If I find words to describe you it is so I can better walk with you; never to dismiss you • Your story • Past, present, and future • Your struggles, fears, hopes, grief, anger, joys , comfort, peace, values • Because you are dying and not someone else

24.   I want to walk alongside you • I will go where you go • Into the struggles of your body • Into the mix of emotions that come • Into the wilderness of your soul • Into the sanctuaries of your heart • Into the celebrations of your life • Into the time of your good-byes • Into the reverent silence of letting this world go

25. I want to walk alongside you • Together we will discover and learn • What works for your body • How to bring creation from chaos • Meaning for this journey • Finding a path in the wilderness • Sacredness in the stillness • The joy of a shared journey • The Ultimate

26. Stages/Phases/Tasks/Touchstones of Grief/Mourning • Stages: Elisabeth Kubler-Ross • Phases: Colin Murray-Parkes • Tasks: J. William Worden • Touchstones: Alan D. Wolfelt • Don’t memorize and then use them to try to analyze people into a category • You don’t need to be a counselor to be a companion to the dying

27. I believe you • You can believe me • Its about trust • Mutual trust • Open • Truthful • Physical needs • Emotional- Spiritual needs

28. I see you as a fellow-pilgrim • We travel the same road, you and I….. …..the difference is that, today, you’re just a bit further down the road than I. • Brothers and sisters in the human condition • Equals • Not healthy and unhealthy • Not expert and apprentice

29. I see you as a whole person • Body and soul • One with a past, present, and future • One with relationships and a self • Not broken because you are dying

30. I want to honor your spirit • I am your advocate • I will be your voice (at IDT) • I will honor your spirit to your family and friends • This is about you.

31. I want to bring all my skills & all of my self to comfort you • Medical training • Hospice training • Life experiences • My self

32. The more you are able to understand a suffering individual and value him or her as a unique person with a unique life history, a unique set of circumstances, and a unique set of resources to draw on, the more likely you will be able to relate effectively with that person. Come as a guest to the suffering person’s house of pain—without assumptions, without judgment. Come with a heart open to understanding. “Don’t Sing Songs to a Heavy Heart” Kenneth Haugk, Ph.D.

33. Don’t try to be too wise; don’t always try to search for something profound to say. You don’t have to do or say anything to make things better. Just be there as fully as you can. And if you are feeling a lot of anxiety and fear and don’t know what to do, admit that openly to the person you are with and ask for their help. --Sogyal Rinpoche The Tibetan Book of Living and Dying

34. CONCLUSION

35. What’s in their bucket ? Fear Grief Pain Love Questions Anger Frustration Hope Abandonment Celebration Helplessness Hopelessness Their buckets are full!

36. What’s in your bucket ? THE NEED TO: Fix Cheer Say Something Make them feel better Be Needed Be Liked Be Smart Be Profound Be Right

37. Who’s Bucket Needs Carrying? Can we fit our needs into their already filled buckets ???? We need to empty our bucket to be able to get into theirs—then we can help them as a companion – carrying some of their load.

38. HEAL-ing People • Here. Present for you when you need them • Empathetic. No one else can truly understand what you’re feeling, but with empathy they’ll do their best to understand and let some of your pain touch them. • Accepting. They don’t judge you, try to change you, or tell you what you should do or how you should think or feel. • Listening. They really focus on what you have to say. They let you share your feelings and know how important it is for you to tell your story again and again.

39. From a Prayer ofSt. Francis of Assisi Grant that I may not so much seek to be consoled as to console, To be understood as to understand, To be loved as to love, For it is in giving that we receive…

40. Hail guest! Not only the door, but the heart of my owner lies open to you. AVE HOSPES! NONSOLUM IANUA SEDET CORDOMNIMEO PATET TIBI From a stone wall in Assisi, Italy

41. Questions???

42. Tenets of CompanioningAlan Wolfelt • Being Present • Going to the wilderness of the soul with another human being • Its not about finding a way out of the wilderness • Honoring the spirit • Not focusing on the intellect

43. Tenets of CompanioningAlan Wolfelt • Listening with the heart • Not analyzing with the head • Bearing witness to the struggles of others • Not judging or directing the struggles • Walking alongside • Not leading or being led • Discovering the gifts of sacred silence • Not filling the moments with words

44. Tenets of CompanioningAlan Wolfelt • Being still • Not constant busy-ness • Respecting disorder and confusion • Not imposing order and logic • Learning from others • Not always being the teacher • Curiosity • Not expertise

45. Resources • Wolfelt, Alan D. Companioning the Bereaved: A Soulful Guide for Caregivers. Companion Press. 2006. • Nouwen, Henri J.M. Our Greatest Gift: A Meditation on Dying and Caring. Harper Collins Publishers. 1994. • Nouwen, Henri J.M. Reaching Out: The Three Movements of the Spiritual Life. Image Doubleday. 1975.