Removing pain’s barriers to healing

How do we open the window to let the air in?

Katherine Amphlett

Katherine is a counsellor based in the West Midlands.

A window sheds light through locked bars into a dusty and dark room,

Denny Müller on Unsplash.

One of the trickiest situations you can encounter if you’re a counsellor is having a client you can’t reach. They sit there in front of you, pain in their eyes, but somehow every approach you make meets with resistance. It’s like trying to touch someone through a closed window – you can see them, but you keep bumping into the glass.

I have two at the moment. One is Cypriot; I’ll call her Androulla, and she scares me rather as she is a doctor and never smiles and knows everything. ‘Yes, I have tried that,’ she says. ‘Yes, I am familiar with that book/ line of thinking/ philosophical method – it hasn’t worked for me.’

And I know that we’ve found the poisonous plant in the heart of her heart and pulled it up by the roots. I am as sure as I can be that she will get better now.

Yet she is dreadfully sad. Her mother died out in Cyprus, and she couldn’t get there in time. Her grief is eating her. She glares at me, desperate to be helped but bristling with gun turrets. Hmm.

Eventually I remember something Jane Goodall said. Jane Goodall is one of the world’s wonderful people… her work with chimpanzees back in the 60s dramatically changed our relationship with animals, and she still travels the world at the age of nearly 90 encouraging young people to take action on climate change. In her lovely Book of Hope she describes how when she’s completely knackered or stuck with something, she sort of hands herself over to an outside power. ‘I just relax and decide to appeal to the source of hidden strength,’ she writes. ‘There’s a wisdom that’s far, far, far greater than my own.’ When she surrenders in this way, she often gives her best lectures she says.

I think I might give it a try with Androulla. As a gradually-learning-to-be-more-trusting Christian, it seems most appropriate to follow in the footsteps of St Francis. So just before our next session I shut my eyes and say, ‘Help Lord, I don’t know what to say to her. Please take over and use me as a channel – she could really do with your peace and grace, and I seem to be in the way’. I’m quite a controlling person normally so I feel a bit reluctant… but if it works for Jane Goodall and for St Francis, I’m not going to argue!

To my surprise, I find myself asking Androulla what her understanding of the word ‘mercy’ might be – not a very usual counselling question. Even more surprising, her eyes fill with tears and suddenly she says that the last time she saw her mother, she told her she hated her, and had a physical fight with her and hurt the skin on her old arms. Crying properly now, the poor woman says she doesn’t deserve forgiveness after that, and I find myself telling her how mercy sees everything with utter clarity and loves and accepts it whatever is deserved or not deserved. And I know that we’ve found the poisonous plant in the heart of her heart and pulled it up by the roots. I am as sure as I can be that she will get better now.

Something compassionate has breathed on these locks, and the stuck windows have suddenly yielded and opened to let the air in.

Then today the same thing happens again – with Bella, my other client who cannot forgive herself, in this case for the fact that her violent alcoholic husband drank even more after she finally left him and died of organ failure in a homeless shelter. We’ve gone over and over her guilt for weeks, and she has remained shiny and brittle and artificially bright and fine. We’ve got nowhere. Until now. ‘Dear Lord,’ I say before I ring her, ‘help me find a way through to her. Let me remove myself and all my assumptions, so that your healing can flow through to her and give her some rest.’ I do my best to relax into our conversation, just to let what wants to come, come. And out of nowhere, I am suddenly inspired to ask her whether she’d feel guilty if her husband had died of some terrible illness like cancer.

‘No,’ she says.

‘Well… you’re a medical secretary. You’ll know better than me that alcoholism is an illness,’ I say.

There’s a very long silence.

‘Doesn’t that mean you’ve both been suffering from this terrible illness?’ I ask eventually. ‘Dave because it drove him crazy and then killed him; you because it blighted your life, and is blighting it still? Isn’t it time you said, “No, enough!” to this pestilence?’

I can see it in my mind’s eye, the alcoholism, like a swarm of red locusts or a scarlet dragon, devouring both Bella and Dave. I don’t feel that’s an image I came up with, it’s just there in my mind. I can feel this lodging in Bella’s mind too… a whole new way of thinking, a great big shift in emphasis, a transfer of responsibility from her to the monster.

I don’t know whether the idea is fully rooted yet, whether we can rely on it to grow and flourish and bear good fruit. But I sense that it is at least planted and watered. A bit more sunshine, some careful tending… and probably a lot more trusting would seem to be the way forward.

It’s not in the training manual, this technique. You won’t hear the British Association of Counselling and Psychotherapy recommending that therapists hand themselves over to Jane Goodall’s ‘outside power’. But something compassionate has breathed on these locks, and the stuck windows have suddenly yielded and opened to let the air in.

Article

Change

26 July 2024

6 min read

Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?"

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.