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TRANSCRIPT
7/28/2011
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We are the MedicineAssessing and Healing Spiritual Pain
Presented by
Richard F. GrovesSacred Art of Living Center
www.sacredartofliving.org
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July 28, 2011
APC Professional Chaplaincy Webinar
WORKING WITH SPIRITUAL PAIN―Transforming Suffering in Ourselves
and Those we Serve‖
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SACRED ART OF LIVING CENTER
MISSION Healing the Healers
MESSAGE Connecting the ―soul & role‖ of caregivers
VISION Transforming the next hospice generation
Founded in 1997
Mary & Richard
Groves
15th Anniversary
Mary & Richard Groves
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THE SACRED ART OF LIVING & DYING
EDUCATIONAL UNITS
UNIT ONE
Understanding
Spiritual Pain
UNIT TWO
Diagnosing
Spiritual Pain
UNIT THREE
Responding to
Spiritual Pain
UNIT FOUR
Transforming
Spiritual Pain4
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SACRED ART OF LIVING & DYING
Graduates from the Program Series
2000-03 2004 2005 2006 2007 2008 2009 2010
Students
2000
1000
500
18,890
Students
3550
500
North America Europe/Asia Australia/Africa
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SACRED ART OF LIVING
INTERNATIONAL
Stan & Ann Tomandl
Jim & Carol Sack
S. Hinohara
Barbara Lin Liu
Umpok Choe
Nirund Jivasantikarn
Bal Mount
Fionn Tulach
David Beddgelertt
Andreas Müller Francisco Feliciano
Hans Schreier
John
O‘Donohue
Lori Collins
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OUR MENTORS
Richard Rohr
Thomas
KeatingRabbi Zalman
Frank
Ostaseski
Bede Griffiths
Bede
Griffiths
Cicely Saunders
Parker Palmer
Dr. S. Hinohara7
St Christopher's Hospice
51-59 Lawrie Park Road
Sydenham
London, England
SE26 6DZ
August 15, 2004
Dear Richard and Mary:
It is my privilege once again to commend your superlative programs.
Since you visited St. Christopher’s Hospice last year, I have continually
made efforts to enlighten others both in Europe and North America
about these excellent training courses. I indeed share your passion and
conviction that the…
Sacred Art of Living and Dying
is essential because…
spirituality is the most
overlooked factor in pain relief. 1913 - 20058
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CAREGIVER‘S PAIN
TOTAL PAIN
WHOSE PAIN IS IT ANYWAY?
PHYSICAL
SOCIAL
EMOTIONAL
SPIRITUAL
Dr. Cicely SaundersHenri Nouwen
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WE ARE THE MEDICINE
―The way in which care is given
can touch the most hidden places…‖ Dr. Cicely Saunders 10
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28% 10-15 yr. olds = highest ADHD dx in the world
42% Ages 45-60 suffer with chronic pain
82% Hospitalizations are “lifestyle related”
91% Institutionalized elderly are clinically depressed
Pain in AmericaNovember, 2010 by Last Acts, a national coalition
to improve health care for the chronically ill
Pain in AmericaNovember, 2010 by Last Acts, a national coalition
to improve health care for the chronically ill
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Spiritual Care is in the lowest 10% of patient
satisfaction indices
The average patient ─ chaplain visit is 8
minutes or less
<10% of patients have a “significant
encounter” with a spiritual caregiver
Pain in AmericaPress-Gainey Scores, 50 Best Hospitals In America 2/09
Pain in AmericaPress-Gainey Scores, 50 Best Hospitals In America 2/09
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>2X more Vietnam Vets have committed
suicide than were killed in battle
Returning Iraq War Vets already have triple
PTSD than Vets in previous wars
Pain in AmericaUS Air Force Chaplaincy Report 1/10
Pain in AmericaUS Air Force Chaplaincy Report 1/10
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Richard Groves Richard Groves
Henriette A. Klauser“Texts reveal ancient-modern wisdom…”
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Ten Speed Press
INTERNATIONAL TRANSLATIONS…
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STORIES OF HEALING
Angie
Andrew
Dorothy
Myako
Marie Elena
Park
Larry
Henry
Sarah
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‖ARS MORIENDI‖
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DIAGNOSING & ADDRESSING
SPIRITUAL PAIN
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Medical-Spiritual Manuscripts
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Sacramentary
of Fintan
Sacramentary
of Fintan
ca. 1082 A.D.
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LESSON FOR CAREGIVERS
May you have the
commitment to know
what has hurt you,
To allow it to come closer
to you
And in the end, become
one with you.
May you have the
commitment to know
what has hurt you,
To allow it to come closer
to you
And in the end, become
one with you.
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PAIN & SUFFERING
PAINPAIN
VS.VS.
SUFFERING
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Defining Pain
Pain is an unpleasant sensory experience associated with actual or potential tissue damage, or described in terms of such damage.
International Association for the
Study of Pain, Geneva, 1990
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SUFFERING
A unique human
capacity
to endure pain
‗for the sake
of another‘
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Limitations of
Biological Health
Reality:
Our medical records are problem-based
Problem:
People come to doctors only with problems
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Problem-Oriented Medicine
Woe to the
Intern
who suggests
a therapy
NOT
on the
medical
problems list!
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MEDICAL MODEL
PAIN
SUFFERING
Focus of Interventions
Unresponsive to interventions
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HOW IS IT THAT
PAIN & SUFFERING HEALS?
Alleviation of suffering is
good… but not the
Ultimate Good
From time to time a person
finds him/her self better off
because of tragedy
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1 2 3 4 5 6 7 8 9 10
WORST
PAINNO
PAIN
PHYSICAL PAIN SCALE
VISUAL ANALOG SCALE
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EMOTIONAL PAIN SCALEHAPPY FACE - SAD FACE
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SPIRITUAL PAIN SCALE
COMPLETELY GENERAL EXTREME
PEACEFUL WELL-BEING ANXIETY
1 2 3 4 5
HOW ARE YOU WITHIN YOURSELF?
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FOUR QUALITIES OF SPIRITUAL HEALTH
MEANING
HOPE
RELATEDNESS
FORGIVENESS
JUDGMENTJUDGMENT
VS.
COMPASSIONCOMPASSION
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PATTERNS OF SPIRITUAL PAIN
(Collateral Data)
FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
BASED ON SELF EVALUATION OF PATIENTS DURING
PASTORAL CAREVISIT
Based on 2780 patients from 18 North American Health Care Organizations
2006-08
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PATTERNS OF SPIRITUAL PAIN BY GENDER
(Collateral Data)
FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
Based on the responses
of 422 women between
the ages of 45-65 in nine
hospice programs
representing various
regions of the U.S.
Based on the responses
of 379 men between the
ages of 45-65 in nine
hospice programs
representing various
regions of the U.S.
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PATTERNS OF SPIRITUAL PAIN
(Combat Vets)
FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
Based on the responses
of 422 men who served in
the armed forces and
were engaged in active
combat [ages 35-82] from
all branches of the military
service.
Based on the responses
of 379 men between the
ages of 45-65 in nine
hospice programs
representing various
regions of the U.S.
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FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
PATTERNS OF SPIRITUAL PAIN
(Combat Vets)
FORGIVENESS 44%
MEANING 22%
RELATEDNESS 21%
HOPE 14%
Based on the responses
of 422 men who served in
the armed forces and
were engaged in active
combat [ages 35-82] from
all branches of the military
service.
Same focus group of men
with nuances data related to
Forgiveness Pain based on
additional question
regarding the nature of non-
forgiveness at the end of
life. 36
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OUR CULTURAL DEMONS
• BUSYNESS
• SPEED
• INDIVIDUALISM
• ARROGANCE 37
WHY AM I HERE?
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PATIENT _______________________
CAREGIVER _______________________
DATE _______________________
CIRCLE THE FEELINGS THAT MOST ACCURATELY DESCRIBE ―HOW YOU ARE
WITHIN YOURSELF‖ TODAY. PLEASE FEEL FREE TO ADD A MORE PERSONAL
COMMENT AFTER EACH SCALE.
MEANING SCALE
1 2 3 4 5
Life is filled with purpose I feel generally Life has become
and meaning. motivated. meaningless.
PERSONAL COMMENTS:
_____________________________________________________________
PATIENT _______________________
CAREGIVER _______________________
DATE _______________________
CIRCLE THE FEELINGS THAT MOST ACCURATELY DESCRIBE ―HOW YOU ARE
WITHIN YOURSELF‖ TODAY. PLEASE FEEL FREE TO ADD A MORE PERSONAL
COMMENT AFTER EACH SCALE.
MEANING SCALE
1 2 3 4 5
Life is filled with purpose I feel generally Life has become
and meaning. motivated. meaningless.
PERSONAL COMMENTS:
_____________________________________________________________
Spiritual Health Assessment
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MEANING THERAPY
―We should look at – and even try to
measure – what gives us meaning
as seriously as we look at our
cholesterol levels or blood
pressure.‖Dr. Larry Dossey
Healing Words
―We should look at – and even try to
measure – what gives us meaning
as seriously as we look at our
cholesterol levels or blood
pressure.‖Dr. Larry Dossey
Healing Words
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Meaningfulness Meaningfulness
Makes Us WellMakes Us Well
MeaninglessnessMeaninglessness
Makes Us SickMakes Us Sick
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Rabbi Zalman Schachter-ShalomiRabbi Zalman Schachter-Shalomi
“The most critical issue in measuring
the health of any community…”
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Demon of Busyness
DE-PERSONALIZED CARE
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ISOGASHII = BUSY
KOKORO
=
MIND
HEART
SOUL
NAKU
=
LOSE
DIE
GO AWAY FROM44
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A GAP BETWEEN THE WAY THINGS ARE
AND THE WAY WE KNOW THEY MIGHT BE…
Parker Palmer
EXPLORING THE TRAGIC GAPEXPLORING THE TRAGIC GAP
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• IN YOUR LIFE, WHERE DO YOU FIND YOURSELF ‗STANDING IN A TRAGIC GAP,‘ — THAT PLACE WHERE THERE IS A DIFFERENCE BETWEEN ‗THE WAY THINGS ARE‘ AND THE WAY YOU KNOW THEY COULD BE.
• OR— THE WAY YOU INTENDED THEM TO BE WHEN YOU COMMITTED TO THIS WORK,RELATIONSHIP, COMMUNITY, FAITH TRADITION, PROFESSION, ETC.?
A COURAGEOUS QUESTION
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WHAT DO I NEED
TO LET GO OF?
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PATIENT _______________________
CAREGIVER _______________________
DATE _______________________
CIRCLE THE FEELINGS THAT MOST ACCURATELY DESCRIBE ―HOW YOU ARE
WITHIN YOURSELF‖ TODAY. PLEASE FEEL FREE TO ADD A MORE PERSONAL
COMMENT AFTER EACH SCALE.
FORGIVENESS SCALE
1 2 3 4 5
I feel a deep sense There are no outstanding areas I feel a strong
of reconciliation that are calling for forgiveness sense of
towards myself and in my life. unforgiveness
others. towards myself
and/or another.
PATIENT _______________________
CAREGIVER _______________________
DATE _______________________
CIRCLE THE FEELINGS THAT MOST ACCURATELY DESCRIBE ―HOW YOU ARE
WITHIN YOURSELF‖ TODAY. PLEASE FEEL FREE TO ADD A MORE PERSONAL
COMMENT AFTER EACH SCALE.
FORGIVENESS SCALE
1 2 3 4 5
I feel a deep sense There are no outstanding areas I feel a strong
of reconciliation that are calling for forgiveness sense of
towards myself and in my life. unforgiveness
others. towards myself
and/or another.
Spiritual Health Assessment
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FORGIVENESS THERAPY
Any attempt to access the
human capacity for
forgiveness is guaranteed to
enhance the immune
system… thereby enhancing a
person’s state of body-mind-
spirit balance.”
Joan Borysenko PhD
―Seventy Times Seven‖
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SPIRITUAL ECONOMYSPIRITUAL ECONOMY
OF FORGIVENESSOF FORGIVENESS
“Forgive us our faults
as we forgive others…
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END-OF-LIFE
FORGIVENESS ISSUES
ISSUE PRESENTING
ISSUE REPORTED TO BE RESOLVED
APPARENT LACK OF RESOLUTION
WITH SELF
66% 50% 16%
WITH OTHERS*
17% 15% 2%
WITH GOD
6% 1% 5%
MULTI-LEVEL
11% 3% 8%
* PERSONS STILL ALIVE: 65%, PERSONS DECEASED: 35% (Based on 500 patient database SALC/RFG)* PERSONS STILL ALIVE: 65%, PERSONS DECEASED: 35% (Based on 500 patient database SALC/RFG)
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Demon of Speed
OVER MEDICATION
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TOTAL PAIN MANAGEMENTClinical Care Research
ACHIEVING A ‗MIDDLE WAY‘
BETWEEN TOO MUCH AND TOO
LITTLE TREATMENT
“By providing a more human understanding of
the context of a patient’s distress, the voluntary
use of analgesics always decreases.”
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PRAYERS & HEALING
Rapid heart pounding or palpitations Forgetfulness or difficulty concentrating Frequent falling, stumbling Shortness of breath Bone pain Frequent constipation Dizziness, weakness, faintness Blurred vision Pain or swelling in any joint
64 60 68 50 56 41 30 18 15
92 91 88 86 82 55 55 40 42
96 94 92 91 86 60 60 45 50
% Based on 500 Patients — 1998-2002
Symptom:
WHEN CONSCIOUS OF ANOTHER’S PRAYER
NOT AWARE OF INTERCESSORY PRAYER
SYMPTOMS ALLEVIATED - PRAYER NOT A FACTOR
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Celtic Tradition
You are healed through your wound… 55
HEALING RELIGIOUS
& SPIRITUAL ABUSE
―Our Images of God‖56
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James Fowler
“SPIRITUAL ABUSE is the act of making people believe—whether by stating or merely implying—that they are going to be punished in this life and/or tormented in hell-fire forever for failure to live life good enough to please God and thus earn admission to heaven.”
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CAN HEALER BE TOO
WOUNDED TO HEAL?
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Meister Eckhart
“I BEG TO
RELIEVE ME OF GOD.”
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MARTIN LUTHER
―The world cannot
survive without faith
but religion
has made it
inaccessible for the
average person.‖
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POPE JOHN XXIII
I wonder if after all
is said and done,
whether religion
isn’t mankind’s
despair for not
having found God.
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WHAT AM I COMMITTED TO
IN LIFE AND DEATH?
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PATIENT _______________________
CAREGIVER _______________________
DATE _______________________
CIRCLE THE FEELINGS THAT MOST ACCURATELY DESCRIBE ―HOW YOU ARE WITHIN
YOURSELF‖ TODAY. PLEASE FEEL FREE TO ADD A MORE PERSONAL COMMENT AFTER
EACH SCALE.
RELATEDNESS SCALE1 2 3 4 5
I feel a strong sense of Most important areas of I feel seriously alienated
connection with the my life seem balanced. from someone/thing that
persons and things that is important to me.
matter most to me.
Spiritual Health Assessment
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BELL‘S THEOREM
OF RELATEDNESS
Whenever two particles of matter (no matter how small) have been connected, even should they be separated to the opposite ends of the universe, whatever is done to one occurs to the other exactly at the same moment and to the same degree.
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Ilya Priogene‘s
LAW OF DISSIPATIVE STRUCTURES
Whenever any system in the
universe breaks down, it
always reorganizes into a
higher order…
The spiritual life needs
dissipative breakdown from
time to time. 65
BALANCING ENERGY FIELDS
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HEALING ENERGY WOUNDS
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Demon of Individualism
NON-COORDINATED CARE
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QUANTUM ETHIC OF CAREGIVING
CURING HEALING
&
“Because there is no differentiation in the energetic field
between Healer and Healee, there is a huge responsibility
to be clean…” Dolores Krieger, PhD
“Because there is no differentiation in the energetic field
between Healer and Healee, there is a huge responsibility
to be clean…” Dolores Krieger, PhD69
WHAT DOES THE
FUTURE HOLD FOR ME?
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PATIENT _______________________
CAREGIVER _______________________
DATE _______________________
CIRCLE THE FEELINGS THAT MOST ACCURATELY DESCRIBE ―HOW YOU ARE WITHIN
YOURSELF‖ TODAY. PLEASE FEEL FREE TO ADD A MORE PERSONAL COMMENT AFTER
EACH SCALE.
HOPE PAIN SCALE
1 2 3 4 5
I feel hope-filled and I generally trust what the I am experiencing
optimistic. future holds for me. deep depression
and hopelessness.
Spiritual Health Assessment
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HOPE THERAPY
“The degree to which hope
plays a role in the progress or
remission of cancer is
undeniable… yet there is a
reluctance to admit its power
due to a health care system
that is excessively focused on
the physiology of cancer.”
O. Carl Simonton MD
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COMA THERAPY
Chart used with permission of Coma Communications 73
CHANNELS OF COMMUNICATION
VISUAL
(upper chest breathing)
AUDITORY
(mid-trunk breathing)
SENSORY
(lower abdomen breathing)
MOTION
(full respiration)
VISUAL
(upper chest breathing)
AUDITORY
(mid-trunk breathing)
SENSORY
(lower abdomen breathing)
MOTION
(full respiration)
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Demon of Arrogance
INACCURATE DIAGNOSES
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DIE BEFORE DIE BEFORE
DIE, YOU WILL DIE, YOU WILL
DIE BEFORE DIE BEFORE
YOU DIE…YOU DIE…
SO THAT SO THAT
WHEN YOU WHEN YOU
DIE, YOU WILL DIE, YOU WILL
NOT DIE!NOT DIE!
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“When people are overwhelmed by illness,
we must give them physical relief, but it is
equally important to encourage the spirit
through a constant show of love and
compassion. It is shameful how often we fail
to see that what people desperately require is
human affection. Deprived of human warmth
and a sense of value, other forms of
treatment prove less effective. Real care of
the sick does not begin with costly
procedures, but with the simple gifts of
affection, love, and concern.”
His Holiness, The Dalai Lama and
Mother Theresa of Calcutta
Joint Statement to the United Nations 77
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TOOLS FOR HEALING
MODULE 1
Total Pain Management
Breath Work
Journaling
Men’s & Women’s Grief
Centering Prayer
MODULE 2
12 Steps & Forgiveness
Creative Religious Ritual
Logo [Meaning] Therapy
Healing Spiritual Abuse
Tonglen Meditation
MODULE 3
Guided Visualization
Coma Communications
Dream Work
Music Therapy
Metta Meditation
MODULE 4
Energy Therapies
Creative Arts
Ignatian Discernment
Vigil/Release Rituals
Non-Local Healing
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SALC IN JAPAN
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SALC IN THAILAND
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PROFESSIONAL DEVELOPMENT
The Association for Clinical Pastoral Education
NHPCO 83
PILOT SITE HOSPICES
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OTHER PILOT SITES…
Art of Dying TaskforceCommunity of
Santa Barbara
Washington Oregon Alaska
SOUTHWEST
OREGON
COLUMBIA GORGE
COMMUNITYTEXAS
PARISH
NURSES
JEWISH RENEWAL
COMMUNITIES
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TEACHING COMMUNITY
RITUAL PRACTICUM86
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“Book of Life”
87
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Sacred Art of LivingCenter for Spiritual
Formation
www.sacredartofliving.org
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