In this article we consider spiritual care uncoupled from formal clergy in Israel. We look to the utilisation of spiritual care by spiritual care providers in various settings, respectively: a private clinic, a nursing home, and the haematology department. Each used one of three religiously neutral methods of spiritual care: connecting with nature, nature and gentle touch, and non-theistic personal prayer in its various forms.
Introduction
The Israeli model of professional spiritual care giving within health has fully uncoupled spiritual care providers from clergy. This decision was made for several reasons, primary among which was the intention to bypass the substantial secular-religious tension resulting from the broad jurisdiction granted to state-religious authorities. In addition, since in most religious denominations in Israel the clergy are men, the reasoning stemmed from the wish not to exclude women. One of the main advantages in having spiritual support that is not exclusively linked to religion relates to the ability to provide the service to varied sub-populations, since many secular people in Israel avoid seeking help from those who are formally religious. Hence, the neutral position of spiritual care providers enables them to cater to all the public sectors and negotiate the boundaries between different religious and secular identities, and between religious beliefs and secular world views.
Currently, there are about 130 certified spiritual caregivers in Israel who graduated from four accredited training programs. These come from a wide variety of professional backgrounds – from vocations closely related to health, such as nurses, social workers, and physiotherapists, but also from professions further removed, such as organisational consultants, lawyers, and scientists. In most cases, these people were driven to this vocation by significant biographical events related to illness and death, which awakened their awareness to the need for spiritual assistance at a time of major distress.
Spiritual care providers in Israel work in a wide variety of settings, including hospitals, senior centres, private homes, hospice units, and private social service organisations. The work is not restricted to palliative care at the end of life. Besides the clients themselves, the work extends to supporting other care givers, including family members and professional staff in hospitals, helping them to maintain their perspective and sense of balance. Spiritual care provider interns must acquaint themselves and be able to connect to the broad cultural diversities that compose the Israeli multi-ethnic culture.
“Bait la-Ruach” (Hebrew for “a home for the spirit”) was established by a group of secular spiritual care providers, in order to promote the relatively new profession in Israel by way of a two-pronged approach: spiritual care provision in the community and support for healthcare workers, who often suffer from burnout and compassion fatigue.
Case Study: Connecting with Nature
I first met Hannah a few years back at a bonfire in a retreat centre by the Jordan river where we were both guests. We shared tea and cookies and a pleasant talk, after which we exchanged Facebook contact details.
One day, years later, she suddenly called me up and requested to meet me at my home clinic due to her distress over what she defined as a “mid-life crisis.” She arrived at our first meeting so restless that she could hardly sit on the chair. I learned that her marriage was teetering at the edge after ten years together, and that at the same time she has to take care of her demented father and two kids, while keeping up her day job to make ends meet. “I don’t know if I have the strength to carry on,” she confessed. While telling me her story, I noticed her legs were trembling, and she kept pacing up and down the room restlessly. Sometimes it can be hard for someone in distress to sit down in one place and it may be easier for them to talk while walking. So I asked Hannah whether she would prefer to step out of the clinic and take a walk in the forest close by. (I suggested this because experience has taught me that the sounds and atmosphere of nature have therapeutic benefits.) With noticeable relief she agreed, and we continued our talk while walking along country roads.
When she arrived for our second visit, she turned off her cell phone, and after two minutes requested to continue our meeting outdoors. She told me that following the first encounter she felt as if nature was embracing her in a way she could not explain, and that the forest soothed her and provided the peace she has longed for. As we walked on, Hannah elaborated about the heavy burden on her shoulders, the enormous pain involved in taking care of her father, how difficult it was for her to transfer him to a nursing home, and about his occasional angry outbursts at her on occasions when he didn’t recognise her any more. On top of it all, she described how difficult it was when her spouse, instead of supporting her, complained that she was inattentive to his needs. He warned her that if she didn’t attend to his emotional needs and those of their kids, he would leave her altogether and let her handle it all on her own. As she was telling me all this, her legs seemed to be carrying her faster and faster, as if she was trying to run away from her troubles. With each item she listed among her burdens, I asked her to pick up a stone that would represent it. After her arms were loaded with stones, she looked at me and wondered: “Now, what do I do with all of these?” I suggested to her to “simply open her arms and let go.” As the stones came tumbling down at her feet, she burst into cheerful laughter.
On our third encounter, she told me that after we ended our previous meeting, she had stayed on and wandered around for a while until she reached a spot where she found a small stone in the shape of a heart hidden under a small sage bush. She took a few sage leaves home and prepared a warm cup of tea that relieved her of the stomach-ache she had suffered with throughout that day. On one of our next encounters, we were caught by a sudden heavy downpour of rain. We took shelter under an old oak tree. Protected by its wide branches, we continued our discussion about the hurtful words she had absorbed from her father and husband, and how they often felt like rain pouring down on her. We sought to find “old oak trees in her soul” that could protect and guard her in such moments.
During our following encounters, winter provided Hannah with opportunities to both stroll in ankle-deep mud, which seemed to represent the emotional “mud” she felt trapped in, and also to happily jump into puddles, bringing back childhood memories.
Spiritual Assessment
Life’s discomforts, along with the burden of taking care of her father, husband, and children, had pushed aside Hannah’s connection to her true nature, to her happy and cheerful side. It had distanced her from the childish inquisitive part that wished to explore life, jump into puddles, smell the scent of flowers, and view life as a journey full of adventures. The great outdoors so present in our encounters reminded her to counter her sense of alienation and loneliness with the broad variety that life has to offer. Our walks on rainy days illustrated the fact that we all get wet without any discrimination. In our earlier sessions, I was the one who led the way, as Hannah was not familiar with the terrain. Later on, I would ask her to choose the path along which we would walk in the forest. That was a new experience for her and a very empowering one. In one particular session, because I know from my own experience and that of others that sometimes lessons for the mind are better learned through the body, I asked her to take off her shoes and walk barefoot for a while. I suggested that she should place her feet only on stretches of ground that felt less painful.
With every step she made, Hannah could physically sense her freedom of choice. She came to realise that she was not a victim, but rather holds formidable spiritual resources that enable her to be there for her husband and father in spite of their behaviour. By using the stones in the second encounter, it felt as if nature was helping her to realise how she was taking on a heavy load of responsibility, but could also let go. No matter what the weather was like on the days when we met, Hannah never relinquished the outdoor session. She wholeheartedly hoped that once spring returned, the sun would warm up her soul and she would experience renewal and growth.
Discussion
In spiritual care giving, we sometimes try to bring the client to nature, or to bring a piece of nature to the patient’s bedside, as the case may be. We do so by using photographs, flowers, rocks, fruit, leaves, etc. Nature may serve as a supportive environment through which we can connect to our inner strength and resources. It represents all existence that is not made or changed by humans, and serves as a source of inspiration and is regarded as eternal. Nature serves as a huge and endless vessel that has the capacity to contain and absorb everything – feelings such as anger, sorrow, frustration, pain, suffering, aggression, and even destruction – and still remain steady and stable. The encounter with nature and the dialogue that accompanies it may generate a powerful experience – an opportunity to learn more about ourselves, to connect to Mother Earth or to the cosmos at large, and may lead to self-empowerment. Such experiences may provide strength and consolation at times of pain and suffering.
Nature presents the harmony of all cycles of life – from rooting and sprouting to wilting, shrivelling up, and decay. Dwelling on nature may revive memories, smells, and sensations from places where we have previously been, connecting us to our personal biography, from which we may draw meaning, and which helps us to reach a sense of acceptance. By observing the rhythmic life movement in nature, we may find our own life forces, a sense of meaning, a sense of belonging, and even healing or acceptance.
