In 1967, Elizabeth Kubler-Ross developed a well-known grief framework based on her studies of people going through anticipatory grief. She discovered that people experienced different stages of grief: denial, anger, bargaining, depression, and acceptance. I, like most counsellors, no longer see these aspects of grief as stages that we pass through. For myself who find it helpful to use an Internal Family System (IFS) lens, I see these aspects of grief as parts of our personality within our soul. The purpose of this blog is to highlight the ways I use the IFS framework in providing spiritual care, from a Christian perspective, to people on the dying journey. As a Spiritual Care Provider and Psychotherapist, the therapeutic relationship with the client and their family is key. Through my counselling training I have been taught to hold my client’s experience with unconditional love, with no judgement, similar to how we, as Christians, imagine Jesus holding the experience of all the people he met in his healing ministry. But as a Christian, I try to take this therapeutic relationship one step further: to not only treat my clients as Jesus would treat them but to be with my clients in the same way Jesus was with the people in his ministry. When we hold people in this way, clients become more open to noticing the dynamics of God's spirit in their experience. Holding my Client’s Experience from an “Abiding in Christ” Place To understand this place of Being, I have been captured by the words that the gospel writer John records Jesus teaching his disciples. Jesus stressed the importance of being connected to the spiritual vine of Christ. We experience this connection to the vine when we “abide in Christ as Christ abides in us” (John 15: 4) I have spent a great deal of time seeking to understand what these words means. I have come to realize that “abiding in Christ as Christ abides in me” refers to a state of prayerfulness, a state where I am centred and fully aware of my experience of life. When I am in this place of Being, my mind is open, my heart is sensitive, and my will is free. Here, in this place of Being, as I listen to my client’s experience, I notice different fruits of God’s spirit arising in my soul in response to what I am hearing, seeing, and sensing. These spiritual fruits include a sense of curiosity where I want to understand more what my client is feeling, a sense of compassion in response to the pain or difficulty my client is undergoing, a sense of grace that allows me to experience no judgement to what my client may share, a sense of truth or insight that helps me find words that resonate to what my client is sharing and experiencing, etc. Within Internal Family System, one of the primary healing modalities I work with, this experience of “abiding in Christ” is called the experience of Self, with a capital “S”. This Self is the centre of the human soul found within every person whether it be the counsellor or client. Each person has a Self, or Divine Self as I prefer to call it, the centre within a human soul that allows everyone to experience what Christian would call the indwelling Christ or God’s Holy Spirit. However, as we all know, it is easy to lose touch with this prayerful centre when we are abiding in Christ, and Christ is abiding in us. This is also true for Spiritual Care Providers like myself when we lose touch with our curious open mind or gracious compassion heart. When this happens, I can easily find myself judging my clients for having negative thoughts, feelings, and behaviors, or find myself trying to fix my clients through giving advice I expect them to follow, or become very frustrated by my client's lack of positive change and healing. All of these experiences are signs that I am not centred in my experience of Christ but rather following the ways of my fallen self. When I work with a palliative client, I seek to hold my client’s experience from this place of Being, where I am abiding in Christ and Christ is abiding in me, where I am centred in my Divine Self. When I visit a client and their family in their home, which is where most of my ministry happens, I find that people have often lost this place of centreness in their Divine Self. Instead, they are lost in their experience of grief and pain around, their illness if they are the dying person, or the illness of their loved one if they are the person caring for their loved one. My goal as a Spiritual Care Provider is to help them regain this spiritual centre in their DIvine Self and the sense that God is holding and ministering to them in their grief. Working with Kubler-Ross Grief Framework but from an Internal Family System’s Lens To understand better this grief journey that dying people and their family travel, I have learned the grief framework that Elizabeth Kubler Ross developed based on her research of anticipatory grief. Anticipatory grief is grief that dying people and their family suffer before death happens. Her research indicated that people tend to pass through five stages of grief beginning with denial, then anger, then bargaining, then depression, and finally acceptance. I, like many counsellors, no longer see these aspects of grief as stages that we pass through. For myself who finds it helpful to use an Internal Family System lens, I see these aspects of grief as parts of our personality in our soul. In this blog, I plan to focus on three common parts within our soul that arise as we grieve…namely the Denial part, the Angry part, and the Depression part. My goal is to hold each part as it expresses itself from a place of prayerfulness where I am abiding in Christ and Christ is abiding in me. When we hold our client’s grieving parts in this way, spiritual care begins to happen for my client. Let me explain how I do this “abiding in Christ” holding with each grieving part. Holding the Denial Protector When people first learn that they have a palliative prognosis, they are often in shock. Frequently, people have been living with their disease like cancer or Multiple Sclerosis or other health issue for many months or years before this palliative decision is made, a sign that the current chemotherapy, radiation, or immunotherapy is no longer working, or not anticipated to bring about healing. For other people, there is little warning. They go to their doctor with a health issue expecting it to be easily treated but after tests and scans discover they have a late stage of cancer that is beyond treatment. This experience of shock, and the coping pattern of denial that goes with it, is a Protector part designed to keep clients from feeling overwhelmed by their emotions. I remember clearly my first visit with a couple who had been married for over 65 years. They had been very blessed financially and lived a life of privilege all of their life building many homes and having travelled all over the world. When the wife learned that she had cancer that was too advanced to be treated and was deemed palliative, her husband and her were in totally shock. This couldn't believe this was possible. As a Spiritual Care Provider, my goal is not to take away my client’s experience of shock and denial. Rather, my task is to hold their shock experience in such a way that I am able to feel their shock with them, to join with their Denial Protector and its shock. This is how Jesus abided with all the people he met. He allowed himself to feel their experience of suffering in life. For this to happen, I allow myself to nurture a spirit of curiosity toward my clients' Denial Protector, and asked them open ended questions that allowed them to begin to share with me what was so shocking to them. As I become curious about their sense of shock, it allows my client's sense of Divine Self to develop their own divine curiosity toward their own shockness…“why am I so shock?” For this couple, it meant realizing that they had always been in control of their life: everything they wanted, they could always get or make happen. To hear their doctor say that nothing could be done was unfathomable for this had rarely happened before in their life. They had seldom been in a place of powerlessness and thus didn’t know how to live with this reality when life was outside their control. Furthermore, this senior couple believed that death happened quickly, often within a few days or instantly. The idea that most people lived through the dying process for weeks or even months right up to the death was beyond their comprehension. They could not, would not, let themselves imagine going through the dying process, and yet this was the place they found themselves. What further complicated things was that this woman with cancer was an introvert and very private person. The thought of sharing her emotional experiences with anyone, even her husband, was totally outside her comfort zone, and so this Denial Protector performed many levels of protecting her. As I explored their story of shockness with them, I began to really appreciate why their Denial Protector within their personality was so active. It was protecting them from experiencing the painful vulnerability and powerlessness that went with their dying process. As my appreciation of their shockness deepened, I began to feel much compassion for my clients and to their individual Denial Protectors who were working so hard to protect them from their pain. As I validated and expressed compassion to the wife and her husband, it helped them also to feel some of this Divine Compassion flow from their deeper sense of Divine Self to their Denial Protectors. This story of shock reminds me of the shock the Bible tells us that the rich young ruler experienced when he heard Jesus’ response to his question about how he could inherit eternal or fullness of life. Jesus told him to sell everything he owned and give it to the poor. We also read that Jesus looked upon with man with loving compassion and sadness just before he told him this response for he knew how shocking it would be for him to hear this. This is how spiritual care can happen when the Denial protector is very active for people due to the shock that arises from learning that they are palliative. Let us turn now to the Anger Protector around grief. Holding the Anger Protector Shock arises from the client’s belief that this suffering cannot be happening. In contrast, anger emerges when clients believe this suffering should not be happening. In many ways, the Anger Protector within people fights with the reality of dying with the goal of trying to keep death from happening. For some people, this Anger Protector means fighting death at every turn, trying every possible treatment option even if the possibility of cure is low and the side affects are severe. As a Spiritual Care Provider, my goal is to help people become curious about their Anger Protector with the hope that we learn why this Protector is working so hard. This means that I need to nurture a curious spirit within me toward this Anger part so that it keeps me in an open, nonjudgemental place of being with my clients. As you hold a client’s Anger Protector with a graceful stance, you, along with your client, soon begin to appreciate why this Anger part is so dominant. One thing you learn quickly is how Anger is a Protector feeling. When we feel anger, we often feel strong inside, instead of weakness. However, in feeling this anger, we lose touch with our vulnerability. When we explore what our Anger Protector fears will happen if it stops being angry at life, or at God, or at the reality of death, or at the medical professionals, we soon discover that their Anger Protector fears vulnerability. It does not want us to experience helplessness or guilt or shame or weakness or being out of control. And yet, without allowing us to enter this place of vulnerability, it is not possible for us to sense the experience of Being and all the different movements and qualities of God’s spirit. I remember one client I visited where his Anger Protector caused us to spend many visits processing the Why question. He had experienced many health issues throughout his life but with a serious cancer hitting him in his 60’s, he knew he couldn’t beat this illness. And so he wanted me to help him answer the why question. He believed that he had already suffered enough in life. Why was it necessary, from God’s perspective, for him and his family to suffer more due to an early death? Why? Through processing the two brothers’ death from HIV/AIDS in the 1990’s, I have sought answers to the why question many times. Intellectually, I have come to appreciate the gift of suffering and pain, and even death within life. If we lacked the ability to feel pain and suffering, we would not be compassionate and sensitive to the pain and suffering of others. If physical death was not possible, that we could physically live forever, we would discover life would have no meaning, no purpose…there would be no reason to love or care or protect anyone. All the things that make humans special, the way we think and feel and love, would disappear from the face of the earth. The experience of suffering and death is what causes our soul to grow and mature. From the head’s perspective, I understand fully what 2 Cor 4 is teaching when it says, “do not lose heart. Even though our outer nature is wasting away, our inner nature is being renewed day by day. For our slight, momentary affliction is producing for us an eternal weight of glory beyond all measure, because we look not at what can be seen but at what cannot be seen, for what can be seen is temporary, but what cannot be seen is eternal.” But my heart rebels against such thinking for it still believes that it was not right for my brothers to die…it was unjust, not fair. And I have come realize that God experiences pain, suffering, and death in the same way we do...this ability of feel pain and suffering is part of our Divine Nature. This is why our hearts will always feel the wrongness of suffering and death. While pain and suffering and death is a necessary part of life, they are not the purpose or goal of life. So my heart has lots of room to feel and hold the Anger Protectors of my client who are asking God why: "Why is this happening to me or my loved one?"; "This is painful, this is not right”. In holding this anger in this way, I help my client’s Divine Self to hold their Anger Protector within them in a similar compassionate and nonjudgemental way. I have a lot of compassion toward those who have strong Anger Protectors and why these Anger Protectors are working so hard. There is a rightness in these Anger Protectors within our clients and ourselves as spiritual caregivers that we need to validate and honour, and God wants us to honor too. One could see these Anger Protectors like the prophets in the Old Testament who were often anger at God and at the injustices within life and the world. I have found that once my client’s Anger Protectors feel validated by both myself and by their Divine Self, they soften and allow my client to move into more vulnerable territories with their experience. Holding the Despair Exile Part I have indicated that our Denial and Anger parts of our personality are Protectors. The reason Internal Family Systems calls them protectors is because they are protecting us from feeling another part within us, a part these Protectors don’t want us to feel. This is why this rejected part within us and our clients is called an Exile part. Our Denial and Anger Protectors are trying to keep this part in exile, hidden away from our awareness. When our client’s Denial Protector and Anger Protector have been held well by a Spiritual Care Provider, that is, they have experienced curiosity, compassion, and validation from me, these protectors soften for they begin to trust the Divine Self that they are experiencing from within me and possibly also from within my client. Through befriending these Protectors, I learn a lot about the Exile part they are protecting within each of my clients. I have learned that these Exile parts are often quite young. This means that these Despair Exiles are carrying not only the pain from their current grieving process but also from all the traumas this person has experienced throughout their lives. These Protectors didn’t just appear when my client discovered they were palliative and dying. No, these Protectors formed early in my clients' lives due to past painful experiences and now they are active again due to the experience of dying and grief. One of the big revelations in my palliative care work is that dying is a traumatic experience. Trauma, by definition, arises from any experience that threatens our survival. Often, we associate trauma with different forms of abuse, physical, emotional, and sexual, or post-traumatic stress disorder that happens through witnessing war, violent deaths or acts, or other scary events. But the process of dying, especially to our Egoic Self, is also experienced as trauma. Furthermore, because dying is often experienced as traumatic, it touches into a person’s previous times of trauma for within the human soul, these traumas are all emotionally connected. Now, you can appreciate even more why the Denial and Angry Protectors are so active when death enters the picture. These young Despair Exiles, being triggered again by the trauma of dying, are often overflowing with many negative emotions, and so the Denial and Anger Protectors work overtime to keep everything under wrap so our soul does not become overwhelmed and traumatized again. This explains why our clients’ protectors of Denial and Angry Protectors are so busy. But there is something else that is really important to notice. The Despair Exiles these parts protect are very lonely for they are constantly being denied, dismissed, shunned, criticized, sometimes even emotionally abused by their Protectors, and hidden away in exile in their unconscious. When I, as a Spiritual Care Provider, have earned the trust of our client’s Denial and Anger Protectors, and they allow me to access the young Despair Exiles, I hear many stories of despair, disillusionment, depression, guilt, shame, fear, and pain. Since these stories have been rarely told, there is often a lot of pent-up energy and emotion that needs to be shared. When these types of visits happen, they are often emotionally intense, and often long for there is much that this Despair Exile of my client wants to share. Again, my role as a Spiritual Care provider is to hold them as Christ would hold them and to allow the spirit of curiosity, compassion, graciousness, insight, etc. to arise in me as I listen, support, and interact with them. It is not uncommon to hear this Despair Exile express words that echo of Psalm 22, words that Bible scholars believe Jesus uttered when he died on the cross, “My God, my God, why have you forsaken me? Why are you so far from helping me, from the words of my groaning? I cry by day, but you do not answer; and by night but find no rest “(Ps 22:1-2). The client’s Exile part has felt abandoned by others, life, and God. And this is very true. This is why I always validate this experience and share words of compassion and grace. Because the client’s protectors of Denial and Anger have been so active, the client has rarely entered the vulnerable space of Being where the spirit of God could interact with his/her Despair Exile and all the pain it carries. It was not possible. This Exile part has felt truly abandoned by God. Realizing this, you can appreciate why there is such relief when this Despair Exile finally gets a chance to share its pain, and why it is often in such a rush to share it. The Despair Exile fears being abandoned again by God, others, and the Protectors who are trying to keep these negative energy and emotions contained. Accepting The Reality of Dying and Death Throughout this blog, I have highlighted the importance of the Spiritual Care Provider holding and validating the different personality parts of the dying client or their family, to hold and be with the Denial Protector, the Anger Protector, and Despair Exile parts of grieving people in the same way Christ would hold and be with them. In doing so, something mysteriously happens. As the client's Denial Protector feels held, validated and understood by the Divine Self located within the Spiritual Care Provider and the client, it softens and begins to trust that maybe it does not need to protect the young Despair Exile so much, that possibly the Divine Self within the SCP, client, others, even life itself, can provide the healing, support, and guidance necessary to transform and calm the Despair Exile. The same is true around client's Anger Protector. As it feels held, validated, and understood by the Divine Self with the SCP and client, it too softens and begins to realize that it possibly does not need to protect the Despair Exile so much...that possibly the Divine Self within the SCP, client, others, even life itself, can provide the healing, support, and guidance necessary to transform and calm the Despair Exile. As the Denial and Anger Protectors risk trusting the Divine Self of SCP and their client by stepping back from their protective roles, the Despair Exile within the client finally is able to share its painful experiences and story including its fears, concerns, and hopes around their dying and death. When this sharing happens and the Despair Exile part of the clients feels heard, validated, and cared for by the Divine Self within the SCP and the client and others, much pain is released, understanding emerges, and healing happens. As this healing gradually occurs, dying clients and their families slowly move into what Kubler-Ross called the acceptance stage of grief. Questions to Ponder:
1. Reflect on your times of loss and grief in your life. How did you experience the dynamic of shockness and denial in your life around this loss or these losses? What were the different ways you practice denial in your life...numbing, avoiding, distracting, being busy, medicating, etc. What did your Denial Protector fear would happen if it didn't deny the reality of the loss? 2. How did you experience anger around your loss or losses? What or who were you angry at? How did this anger express itself? What why questions did you process? What did your Anger Protector fear would happen if it stop being angry and allowed yourself to be more vulnerable? 3. Explore you Despair Exile, that part of you that the Denial and Anger Protectors shield you from encountering. What difficult feelings and experiences of trauma are hidden within this Exile part? 4. When you have felt heard, held, and validated by another person? When have you experienced the gentle curiosity, compassion, validation and guidance from someone listening to you? What was it like to be held by the Divine Self of another? How did that experience help you become centred in your own experience of Divine Self and thus able to unblend from your Denial Protector, Anger Protector, and Despair Exile parts?
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