Ambiguous Loss

A friend loaned me this wonderful book (Ambiguous Loss: Learning to Live with Unresolved Grief, by Pauline Boss), and it has been helpful both as I provide care in the hospital and as I deal with my own losses. Pauline Boss explores a variety of ambiguous losses, including family members emigrating overseas, dementia, terminal illness, and missing persons. I am reflecting on how my life is touched by each of these kinds of loss. I'm coming to understand that these losses have colored the way I grieve, and the way I relate with my family. Some of these patterns are healthy and enrich my life, such as my attempts to insure my dad's independence and ability to live at home even as he ages and becomes frail, and some have been limiting, such as my distance with my mother around the time of her mortal illness.

I've come to wonder whether most losses are in some way ambiguous. Even sudden, definite losses, such as losing a spouse to a heart attack, can lead to patterns of denial and uncertainty. Joan Dideon's The Year of Magical Thinking is an excellent portrayal of just that situation. Grief is a process by which we make new lives that include loss; grief takes time. Whether the loss is sudden or gradual, grief takes time.

DBT as Spiritual Practice

Yesterday, I attended a one-day training on Dialectical Behavior Therapy, which we use at the hospital to treat patients with various mental illnesses, including borderline personality disorder, depression, and anxiety. As a chaplain, I see many of these patients as they try to understand their illness in terms of their religious beliefs. I've encountered DBT in conversations with these patients (many of whom love to call it Diabolical Behavior Training).

DBT was created by Marsha Linehan, who drew methods from Zen Buddhism to treat suicidal patients. The Buddhist strands are apparent in this therapy. A significant focus of DBT is mindfulness training, learning to focus the mind and attend to one thing at a time. A koan-like 'both-and' aspect is the core of many messages given patients (this is the dialectic part): 'You are doing the best you can' and 'you can do better', or 'I can insist on my rights' and 'I am still a good person'. The Buddhist concept of 'skillful means' runs through the components on skills development and skillful execution.

DBT participants are required to keep a weekly diary card, on which they record numerous aspects of their feelings and behaviors, including use of the skills and abusive or harmful behaviors. The idea is to use the recording to identify patterns and linkages between feelings and behaviors, and then work to modify them.

What strikes me is that DBT looks like spiritual practice, and I mean that in the highest sense. There is an expectation (clearly stated) of mindful attention to the skills and practices. Modifications of lifestyle, such as healthy eating and sleep patterns, are expected of each participant. One is expected to apply an almost devotional repetition to the daily activities through the use of the diary card. These techniques have been shown to be helpful for patients in randomized trials; could they be helpful for all of us, whether healthy or ill? And if DBT can be seen as spiritual practice, does this not support the benefit of spiritual practice (in all forms) for all?

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Mind-Body Medicine

Last week, another chaplain resident and I attended a five-day training presented by the Center for Mind-Body Medicine. What a phenomenal experience. It was a sold-out event, with well over two hundred people in attendance, including over twenty from the hospital system that I am part of. We're talking doctors, nurses, psychotherapists, hospice workers, and the rare chaplain or two.

I have encountered many of the healing and self-care tools presented, including meditation, relaxation, biofeedback, movement, and guided imagery, these have been presented in the past as alternatives to science-based medicine. I loved that this training presented significant scientific evidence supporting these tools, including many controlled double-blind studies. The fact that my hospital system and the Veteran's Administration, among others, is beginning to adopt these tools is most promising. As a chaplain, I know that mind and body and spirit are deeply interconnected.

Much of our time was spent in small process groups: eight sessions of two hours each. My co-worker and I noted how these groups compared to the group we have in our Clinical Pastoral Education residency, and how difficult it was for many people, especially mental health workers, to get comfortable being a group participant. Perhaps they are used to leading groups, and not being a participant, or perhaps they just focus on one-on-one client meetings. Part of my hope is that this work may begin a renaissance of group therapy as part of the overall treatment plan for people dealing with mental health issues.

Chaplincy Residency: The First Week

I've just completed the first week of Chaplaincy Residency at United Hospital in St. Paul. It's been maybe a category II hurricane of change for me, windy, calm, then windy again, and maybe (just maybe) the promise of blue sky ahead, or other weather on the way. Most of the gusts this week were due to outside events, such as the Republican National Convention, which delayed the residency start date and complicated many new employee procedures. But now there are five of us working together as resident chaplains for this 450 bed hospital.

It's an exciting group of residents, with folks from a variety of religious backgrounds: Catholic, Presbyterian, and Buddhist. I feel less like an outlier in this group than in the larger group of my previous CPE experience, where all were Protestant. The group dynamics are promising too. The group is willing to work together to solve problems and sort out things. An example: we had to decide who was going to staff the various units. This resolved very quickly and creatively, as we each got what we wanted, or more wisely, what we resisted.

In my case, I struggled with counseling and supporting people dealing with mental illness in my parish internship, and wonder if I avoided truly engaging in that work. Yet there was a call to this, a sense I needed to go deeper in this. I volunteered to take the Psychotherapy area, along with Neuroscience, which is mostly involved in treatment of epilepsy. Since no one else desired or needed these areas, the choice seems right on multiple levels.

Photo: United Hospital, Allina.com