A Worked Example of Spiritual Care

One of the significant challenges with ministries such as chaplaincy, pastoral care, spiritual care is defining what soul care is and explaining what it looks like. A colleague and I were talking about this a few days ago, and he asked, “Well, for example, what would spiritual care look like if you were visiting a man who was a victim of a shark attack and had lost both feet?”

As a chaplain, I would meet such a patient on a regular ward round as I regularly visit some intensive care units and several surgical wards. I usually choose not to know the patient’s medical diagnosis before I visit for the first time as it tells you very little about the person or the relationship they have with their diagnosis. I also meet patients following a referral or a specific request for a visit from a chaplain. If the medical staff requests the visit, usually, the request is accompanied by a brief description of the patient’s medical condition.

All soul care begins with an offer to listen or attend to the other and be willing to attune to the matters on their soul and accompany them into their story, initially asking only questions that help the other clarify their thoughts or feelings. As we listen deeply to another, we also listen to ourselves while subconsciously being held within our more extensive webs of meaning. The sensitivity and stability of a more comprehensive web of meaning allow us to enter another person’s story and help bear the weight of their griefs and sorrows without merging them with our own or dissolving ours into theirs.

The carer’s attitude is crucial; it is not enough to be a safe person but to have the ability to engender a feeling of safety within the other that enables enough trust to share what is uppermost on their mind or troubling them in their heart. The skills to connect and listen deeply needs to be developed and honed. Deep listening helps bring forth the metaphors and words of feeling necessary to communicate that which is on the heart or mind.

In the background, a chaplain or soul carer carries many narrative patterns: encoded variously in melody and harmony, themes and variations, rhythms, textures tones and timbre. These narrative threads, in turn, resonate with themes from theology, philosophy, psychology, sociology, literature. They present as accounts of trauma, PTSD, grief and loss, abandonment, isolation, enmeshed or well-differentiated relationships, supportive community, physical, mental and emotional states and spirituality. Spirituality is also seen in feelings and beliefs around justice, guilt, shame and forgiveness, and existential experiences often beyond our control. Narrative threads of spirituality appear through all these themes, expressed through religious observance, practices, habits and the things in which they find peace.

As a chaplain listens with an open-handed curiosity to a person’s story, some aspects will resonate with one or more of the patterns mentioned above. These inklings cause us to notice certain things and wonder if the other is also aware of a link in their story. A point comes where we might respond to ask how something felt or how it seemed to them as we help them form connections from the things they have shared.

To place these carefully chosen reflections, we need to understand what we are hearing and our sense-making frameworks for linking and locating the expressed ideas and impressions.

I wish to return to the hospitalised patient suffering from a shark bite. If the patient had requested a chaplain to visit him, and after greetings, I enquire how I could help him. If I had met him in a surgical ward, I would have explained I was a chaplain doing a ward round and wondering how his hospital stay was going and if anything was on his mind or troubling him or he would like to chat?

A conversation with the patient could go as many different ways as there are people. But suppose I merged this patient who was bitten by a shark with a patient Joshua (identifying details changed for privacy). He was a road cyclist training for an international event when hit by a truck and suffered extensive damage to his legs, requiring amputation of one. In that case, I think it may provide a plausible possible encounter.

I met Joshua two and half weeks after his accident. He began speaking about his accident. He viewed himself as a survivor rather than a victim despite the truck driver being in the wrong. He expressed that he was looking forward to beginning rehab and moving some muscles again. Yet, as he spoke, it became more evident that the loses and griefs he was facing were huge. He was a schoolteacher and was grateful that the school understood and provided him with a leave of absence for an extended period and was eligible for third party insurance to cover many of his costs. As he continued, he then mentioned that he had been married for two years to his childhood girlfriend, and she was also an elite athlete. While she was amazing with the whole accident thing, he had gnawing insecurity voicing a fear that she might not want to live the rest of her life with a disabled person.

Joshua was not religious. He had a philosophical approach to life where he didn’t have a special pass to avoid tragedy. Joshua could not see anything he would have or could have done differently on the day of the accident as he followed his regular training routine.

I commented that he seemed to be carrying a very heavy load and was bearing many losses. He nodded and wiped away a tear with the heel of his hand. After a bit, he said, yeah, some days it’s all too much, then smiled and thanked me for listening. I replied, thank you for sharing; you certainly are going through a lot. I will keep you in my thoughts and prayers.

Following a chaplaincy visit, a chaplain reviews the visit through a spiritual assessment tool. One such tool is a simple and effective assessment developed by two nurses, Highfield and Cassons. It reviews the patient’s meaning and belief, their need to give love and receive love and their hopes and creativity which broadly corresponds to a description of a person’s faith, loves and hopes.
I prefer to review the conversation using a framework of religious, moral, spiritual and existential concerns and the web of relationships in each domain. After listening to Joshua and reflecting on the conversation, my initial spiritual assessment was this.

Joshua was not religious, but his accident disrupted his patterns and habits and separated him from his training and work community. Morally, Joshua was not asking questions of justice around the accident but seemed to be attempting to absorb the impact within himself through the frame of ‘life happens.’ At this early stage, he was not dwelling on the deep wrong that had been committed against him, nor the severe assault against his person and body.

Spiritually, Joshua was experiencing disruption to all areas of his life that filled him up, his relationship with his wife, body, sport, and training teams expressed through absence and grief. Existentially, in an instant, he had lost his leg, his health, his work, his sport, yet he demonstrates a genuine desire to transcend his current sufferings.

As a chaplain, I was in internal prayer for Joshua and prayed that my visit would be helpful to him at this time. I endeavoured to accompany him, staying with his story and going at the same speed he was going. I drew on the stable and secure framework I have around me, working out of the depth of my faith, skills, and training to accompany and scaffold Joshua in his experiences.