ATTENDING WITH BODY, SPEECH AND

MIND: THE PRACTICE OF BASIC

ATTENDANCE

Elaine Yuen, PhD

Associate Professor

Master of Divinity Program

Department of Religious Studies

Naropa University

Association of Professional Chaplains

Orlando, Florida, June 28-30, 2013

PRESENCE IN THE CLINICAL ENCOUNTER

Patients who are ill must often face difficult clinical

decisions with uncertain outcomes.

Spiritual practices have the ability to articulate this

uncertainty

Provide a context where anxieties may be faced, felt

and understood.

These understandings may support patients and

their families

increased clarity of clinical facts, diagnoses, prognosis

Increased acceptance of emotional content in

decisions.

THE KNOWN AND THE UNKNOWN

Key to spiritual practice is the inclusion of the

“unknown” or “liminal space” within the clinical

encounter.

In healthcare encounters, we often deny we are

standing at the threshold of the unknown.

Steps for accessing an applied spirituality which

allows practitioners to attend to this liminal space

are described

2. Co-sensing:

observe, observe, observe

connect with divers people and places

to sense the system from the whole

4. Co-creating:

prototype the new

in living examples to explore

the future by doing

3. Co-inspiring:

connect to the source of inspiration and will go to the place of silence and allow

the inner knowing to emerge

U-Process: 1 Process, 5 Movements

1. Co-initiating:

uncover common intent stop and listen to others and to

what life calls you to do

5. Co-evolving:

institutionalize the new in practices

by linking micro, meso, macro change

THE PRACTICE OF BASIC ATTENDANCE

Utilizes a contemplative practice of mindfulness and

awareness.

This practice supports observations of physical,

communicative, and cognitive aspects of the

client/patient as well as one’s own personal

perceptions.

By engaging in this way, a greater appreciation and

understanding of the physical, emotional and

environmental aspects of a pastoral encounter can

be developed.

BASIC ATTENDANCE: ESTABLISHING AN

ENVIRONMENT OF SANITY

Attentive care

Based on needs at hand

Not necessarily a solution or a “fix”

Experiences of patients and their families

Moving/thinking at different pace – slowing down

Memory loss / confusion

Uncertainty and fear

Creating a sane atmosphere

Physical aspect: reflects personality and possessions

Emotional aspect: where patient could “let go” -

experience full texture of emotions

THE WINDHORSE COMMUNITY

Basic Attendance is a fundamental skill practiced by

Windhorse clinicians

Boulder CO and Northhampton MA

Team approach

Attending during daily, ordinary activities

Focuses awareness on the immediate needs of the moment.

Has the integrative effect of gently grounding attention in

physical reality and strengthening the empathic bond

between client and staff.

Cultivates moments of clarity, humor, and relaxation

found in even the most confused states

These "islands of clarity", when recognized and valued,

become the seeds of recovery.

CLINICAL PRACTICE OF BASIC ATTENDANCE

Subtle combination of being with the person

skill and understanding of a pastoral caregiver

warmth and empathy of a friend.

Engaging with the person in ordinary activities of

daily living.

accomplishing problematic tasks

expanding into areas of interest

scheduling sane rhythms of activities

furthering personal awareness.

In groups / teams of caregivers or by sole team

member.

ROLES OF THE CHAPLAIN: BEING AN ALLY

Acknowledge reality of situation – comfortable with

clinical details

Mitigate harshness

Ability to enter patient’s world – rather than impose

ours on them

Sensitivity to own physical approach, emotions

Awareness of own limits – not pretending to be

benevolent

OBSERVING BODY, SPEECH AND MIND

Patient, family, as well as own perceptions

Individuals as well as energetic quality of

environment(s)

Body: physical descriptions

Appearance, ethnicity, gait and movement, family,

living situation

Speech: communicative qualities

Verbal and emotional expression, relationships

Mind: cognitive aspects

How s/he sees and understands the world, are

thoughts organized, confused, colorful, dull?

TEN SKILLS OF BASIC ATTENDANCE:

DISCOVERY AND OBSERVATION

1. Being Present: Basic mindfulness-awareness in the

present moment.

2. Letting In: Deep empathic resonance. Cultivated through

tonglen practice.

3. Bringing Home: Basic synchronization of body, mind, and

environment.

4. Letting Be: Dropping therapeutic ambition and accepting a

person as they are.

Duerr, Maia. Creating the Contemplative Organization. (Center for Contemplative Mind in Society, 2004), pg.58 http://www.contemplativemind.org/programs/cnet/contorgs.pdf., pg. 58

TEN SKILLS OF BASIC ATTENDANCE:

CONNECTING WITH INSPIRATION

5. Bringing Along: Inviting and encouraging a person to

venture out into the world/community. Can include sharing our

own world (i.e. family, home) with client.

6. Recognizing: Noticing and encouraging "islands of clarity".

Everyone has a basic spark of intelligence and wakefulness

and a history of expressing it. We can focus on this rather

than pathology and failure.

7. Finding Energy: Finding a passionate point of sensory

contact with the world. Opening to beauty.

Duerr, Maia. Creating the Contemplative Organization. (Center for Contemplative Mind in Society, 2004), pg.58 http://www.contemplativemind.org/programs/cnet/contorgs.pdf., pg. 58

TEN SKILLS OF BASIC ATTENDANCE:

COMPASSIONATE ACTIVITY

8. Leaning In: Encouraging people to take responsibility for

their own lives. Discipline and exertion.

9. Discovering Friendship: Relationship becomes genuine,

more than just therapeutic. We call this the "therapist-friend

dilemma".

10. Mutual Learning: Doing basic attendance is not just a

way to help others recover. It provides opportunities for our

own personal growth and recovery.

Duerr, Maia. Creating the Contemplative Organization. (Center for Contemplative Mind in Society, 2004), pg.58 http://www.contemplativemind.org/programs/cnet/contorgs.pdf., pg. 58

STUDENT OBSERVATIONS

“M is spacious and elegant. She is not necessarily organized,

but she is light. In everything she does, the gestures she

makes, expressions, conversation, etc there is a lightness,

indeed, a buoyancy. She smiles often and is prone to laughter

given the appropriate cues. She likes to laugh, and even when

the language gap is perhaps to far to breach, she laughs

anyway because she has the keen sense to know that

something worth laughing about is taking place, because she

would like you to feel comfortable, or otherwise because her

sense of humor defies the boundaries of language and after

all, she knows what you mean.”

STUDENT OBSERVATION & REFLECTION

“When I arrived at her house I noticed her body posture right

away because she was sick. She was bundled up and drinking

tea. I could tell by her tight body language and droopy facial

expressions that she was feeling well.”

“We sat in her home for a while, and soon I noticed that every

time asked her a question she immediately was asking me a

question first. Although flattering at first, I began to feel a little

nervous because I felt like her quick speech and rapid fire

questions were keeping me from being able to get to know her

or do my basic attendance work.. ..I felt some stiffness in my

shoulders as I worried that wouldn’t be able to get to know her.”

“Shifting between each level of interaction seemed to flow

easier when I would become aware of a rise in my own

internal dialogue, stop and breathe fully, and return to

attending [my partner] with this process of body, speech and

mind. Beginning with breath, then body, then speech and

finally to mind and meanings gave a much richer context for

exchange. I was aware that this exercise was not unlike

meditation in its use of moment to moment awareness, breath,

distraction, awareness, acknowledgment, release and

returning.”

STUDENT REFLECTIONS