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As I sat through the first couple of the weekly rounds on patients, I heard powerlessness and frustration in the tone and manner of staff discussing patients impacted by alcoholism. I was a new staff person to this cancer outpatient program, but the chaplain was only one small personnel change among many. The Medical Director was retiring, a search was on for a new manager, and both the Clinical Nurse Specialist and the corporate Vice President for Oncology were new. I volunteered to sit with these patients, being with them throughout the treatment process.
The offer provided an occasion for the V.P. of Oncology to ask if I could help the staff have more compassion. The Director of Spiritual Care had shared with her my experience in the field of alcoholism and mental illness. It was clearly a timely and serendipitous opportunity, but there were significant risks for pastoral care. I remembered, from the Lutheran DMS prophetic movement in Pittsburgh in the early 1980s, that change will not occur if it is at all avoidable. This situation was wrought with potential ways to avoid change, including discrediting the weakest link among clinical staff: me!
But we took up the challenge. We would do an inservice for an hour and a quarter, including lunch, to address how to have more compassion toward outpatient cancer patients impacted by both alcoholism and mental illness. The approach needed to be interesting and engaging, the concepts simple due to time constraints, and any suggestions practical and achievable due to the demands on the staff. I was to watch for parallels between staff and patients, role model hospitality, keep communication and authority issues clear, and be willing to be surprised about other ways that personal lives are touched. But the top goal was to create an experience that would result in empathy with this population that would motivate and inform this competent staff to make needed changes.
I sought a metaphor from my experience. At the time I was taking Swing Dance lessons. Several of the dynamics experienced in class struck me as similar to or even paralleling what a person beginning CA treatment might feel. Initially, one might be self-conscious, even at times ashamed, of a lack of rhythm or responsiveness, and the need for repetition. Even though the teacher was competent, trust remained an issue. Often questioning or quitting were a bow to the natural resistance to change that is involved in learning. A person with a compulsion or disability in addition to cancer would therefore be bringing an additional dynamic that his or her medical staff would need to address.
I added two more dynamics to our inservice: those who wore glasses were asked to take them off, while others were instructed, within the first five minutes, to do a 360-degree turn. The hope was that this would mimic the dynamics that the staff saw in the patients' behavior. Staff had been were clueless about the origins of the behaviour, and it impacted them emotionally in much the same way as it did the patient.
To emphasize hospitality and the value of role modeling, we gathered in an open space, with an incredible view of the Puget Sound. The group of about twenty had been previously divided into teachers and learners of Swing Dance. The reluctance was profound, on many levels, as they stood in two concentric circles, one of learners, one of teachers. Then three pairs stepped into the middle to follow through on the exercise. When the remaining participants formed a circle around the pairs, the experience was set in motion. I felt a welcome epiphany at that moment; “this is going to work!”
After the exercise, we ate our box lunches and recorded reactions, responses, and questions that emerged. The responses to the experience made up an outline for the presentation. The processing began on a good note when the Medical Director said, “I feel ashamed that I can’t dance.” As the group tried to guess the motives behind the unpredictable twirls of a few, the fun began. One doctor decided, even before the exercises began, that he would not be participating nor disclosing his internal responses. Toward the end of the inservice, he did. This paradoxically paralleled how the population upon whom we were focusing would respond. It also showed how, at a point and in a way congruent with his own process, he did disclose his experience.
To me, this shows how metaphors can be used to balance complex technical and emotional needs through serious and even humorous moments as challenging dynamics are discussed. More inservices were requested, indicating how metaphors can build rapport as well.
Barker (1985) says, “They [Metaphors] can entertain as well as inform. They can suggest something without actually confronting those to whom it is addressed. They are indirect and ambiguous and so can have various meanings at different levels. They are flexible and can be use to embed messages. They often assist in the establishment of rapport” ( p. 24). This experience will be retold within and outside of work many times, multiplying it value in the service of professional education about compassion. The opportunity was particularly satisfying and gratifying because it used fully seemingly disparaging experiences and skills in the field of alcoholism, mental illness, and A.C.P.E. supervisory education in a clinical area totally new to me, Oncology. Imagine that!
Barker, Philip. (1985) Using metaphors in psychotherapy. Brunner/Mazel.
Jack Evert, M.Div., is the Director of the Art of Renewal in Minneapolis and Seattle. He is a gifted potter, a graduate of Luterna Theological Seminary, and a member of the Religious Society of Friends. He is a former Chaplain at the Center for Mental Health, Good Samaritan Hospital, in Downers Grove, Illinois, and at the Renewal Center at the Hazelden Foundation.