עִמּוֹ אָנֹכִי בְצָרָה אֲחַלְּצֵהוּ וַאֲכַבְּדֵהוּ
|I will be with him in distress; I will strengthen him and honor him.|
We offer our presence to people in need by accompanying them, by offering encouragement and sometimes concrete help, and by simply witnessing their suffering and their resilience. We ensure that they are not alone in those moments of need, and we help them transcend their suffering. The principle for how this is done is found in the story of Ishmael and Hagar.
וַיִּשְׁמַע אֱלֹהִים אֶת־קוֹל הַנַּעַר וַיִּקְרָא מַלְאַךְ אֱלֹהִים אֶל־הָגָר מִן־הַשָּׁמַיִם וַיֹּאמֶר לָהּ מַה־לָּךְ הָגָר אַל־תִּירְאִי כִּי־שָׁמַע אֱלֹהִים אֶל־קוֹל הַנַּעַר בַּאֲשֶׁר הוּא־שָׁם:
|God heard the cry of the boy, and an angel of God called to Hagar from heaven and said to her, “What troubles you, Hagar? Fear not, for God has heeded the cry of the boy where he is.” [Emphasis added]|
To listen to someone else is hard work. It requires full attention to the other person as well as awareness of one’s own feelings. Otherwise we might subconsciously steer the flow of conversation with the questions we ask (or don’t ask) and the comments we make, with the result that the conversation follows our own line of thinking instead of uncovering and addressing the concerns of the person we’re visiting.
|In the chapter “How to Create a Listening Environment” in Giving Counsel: A Minister’s Guidebook,[i] Donald Capps describes how anxiety inhibits effective listening and what the conditions for a good listening environment are. You may want to read this entire chapter on your own.|
On pages 16–19 of that reading, Capps identifies the following sources of anxiety that can occur within a conversation. Think of examples you have encountered for each, and discuss with your group or hevruta.
- The subject matter itself produces anxiety.
- The subject matter produces anxiety when this particular person talks about it.
- A particular person produces anxiety, whatever the subject matter.
- The anxiety is due to anticipatory dread, or worrying over what the conversation is leading to.
- The anxiety is due to an inability to understand what the other person is saying.
- The anxiety is due to one’s awareness of differing points of view.
- The anxiety is due to the volunteer’s current emotional or psychological health.
The Skills of Attending
Meeting people “where they are” (ba’asher hem sham)—in what they are experiencing—you try to understand their suffering and acknowledge their experience of suffering. You bring yourself to the encounter—your life experience and your skills. By carefully listening to the other person, you will most likely be able to help. Your help is in the relationship as such because it shatters the isolation and provides the opportunity for reflection.
You may want to read the chapter “How to Construct a Conversation” in Giving Counsel, by Donald Capps.[ii] He quotes Howard Clinebell’s six typical ways of responding:
All of these responses have a place in bikkur holim, depending on the needs of the person visited and the specific circumstances. For most situations that involve volunteers, the “supportive” and “understanding” approaches will probably be the most appropriate. However, that doesn’t mean that the other forms of responses are reserved only for therapists or clergy.
You may also want to read the chapter titled “Communications Skills I: Attending and Listening” from Gerard Egan’s book The Skilled Helper.[iii]
- Asking effective questions. Open-ended questions, rather than questions that illicit a yes or no answer, can be useful. For example: “How are you feeling today?” “What are you most concerned about today?” “How can I be most helpful to you today?”
- Reflecting back the content and feelings of what we hear people say. For example: “It sounds like waiting for the test results is scary.” “I hear that when you don’t receive any phone calls from your family for a few days, you feel aggravated.”
Also of relevance to bikkur holim volunteers is what he refers to as attending behavior,or what we might think of as body language.This is the way you orient yourself physically in relation to the person you are visiting, as well as the way you respond to what the other person is saying.
Here are some tips from Egan about eye contact, body posture, nonverbal behavior, verbal responses, and managing appropriate silences.
Eye contact. Meeting a person’s gaze expresses your interest in what is being communicated. Eye contact also signals understanding and encouragement, as well as provides feedback. It is natural to sometimes break eye contact—for example, when thinking.
Body posture. Crossed arms and legs may be interpreted as holding back or reluctance on your part. Leaning slightly forward can communicate involvement, but be aware that some people see a more “laid back” posture as appropriate.
Nonverbal behavior. Be aware what your face communicates: you can use your facial expressions to encourage further communication and express empathy, but they can also communicate that you are nervous, distressed, or anxious. Nervous habits such as tapping your foot, drumming your fingers, or playing with a pencil might be interpreted as impatience, boredom, or tension.
Verbal responses. Speaking in a natural and warm voice and at a normal pace communicates involvement. Follow up on what the other person is saying without changing the topic or interrupting.
Silence. It is okay to let the other individual sit silently. One possibility is that the person might be looking for ways to express him- or herself.
Physical Issues and Communication
Communication might require some extra effort if physical limitations are present.
Communicating with Elderly Individuals
It is important to remember that older people are as diverse as the rest of the population. Do not fall into stereotypes about aging. Remember the student’s essay in unit 3 about her encounter with “Susan, the youngest 80-year-old”? Old age does not cause illness, and neither does it automatically mean a person lives in pain and discomfort. Nevertheless, physical limitations do become more common with age.
When setting out to visit older members of your congregation, be aware of potential issues:
- The person you visit might suffer from multiple illnesses.
- In the flow of your conversation, sensitive topics might be touched upon, such as assisted living, hospice care, or decreased independence because of loss or impending loss of driver’s licenses.
- The person might suffer from memory loss or confusion.
- He or she might have temporary or permanent hearing or vision impairment.
- Any of these situations might also be present in younger people you encounter as a bikkur holim volunteer.
When you are engaging with a person who is suffering from hearing impairment, here are some things you can do:
- Say it is important to you to be able to communicate with the person because you value the person and what he or she has to say. Ask whether the person is using a hearing aid and whether it is working.
- Keep a notebook and pen handy, so you can write down what you say if needed, especially dates, times, and names.
- Do what you can to minimize background noise, because it can muffle the sound of your voice and make it even harder to hear you.
- Place yourself where your face and lips can be seen clearly. This makes it easier for the person to pick up nonverbal cues from your facial expressions and possibly to read your lips.
- Keep your hands away from your face. This too makes it easier to read your lips, and it avoids blocking the sound of your voice.
- Talk slowly and clearly but in a normal tone of voice. Shouting distorts voices and comes across as angry. At the same time, if the person asks you to speak up, be sure you do; it’s common for a speaker to experience a very small increase in volume as larger than it really is.
- Speak distinctly and slightly more slowly than you might be used to. A person with hearing loss experiences words as running together and becoming indistinct, even when the voice itself is seemingly loud enough.
- If you are changing the subject, give cues—for example, by pausing, asking a question, or gesturing toward the object you want to discuss.
- When seating yourself, try to choose a spot where your face has light falling on it and isn’t in shadow—for example, opposite a window or other source of light.
- Inquire whether the person uses glasses and whether they are available.
- If you bring notes for the person to read, such as printed information about medication, it might help to have the instructions enlarged before you make the visit.
- When indicating something nearby, describe it and its location verbally rather than just pointing.
תלמוד בבלי מסכת ברכות דף ח:
|Babylonian Talmud, Berakhot 8b|
רבי יהודה אומר . . . והזהרו בזקן ששכח תלמודו מחמת אונסו דאמרינן לוחות ושברי לוחות מונחות בארון
|R. Yehudah says: ”One should be careful [to respect] an old person who forgot his knowledge through no fault of his own, for it was said, ‘Both the whole tablets and the fragments of the tablets were placed in the Ark.’”|
תלמוד בבלי נדרים מא.
|Babylonian Talmud, Nedarim 41a|
כָּל־מִשְׁכָּבוֹ הָפַכְתָּ בְחָלְיו
– אמר רב יוסף: לומר, דמשכח למודו. רב יוסף חלש, איעקר ליה למודיה, אהדריה אביי קמיה. היינו דבכל דוכתא אמרינן אמר רב יוסף: לא שמיע לי הדא שמעתא, א”ל אביי: את אמריתה ניהלן, ומהא מתניתא אמריתה ניהלן.
|“You shall wholly transform his bed of sickness” (Ps. 41:4).
Rav Joseph said: “This means he forgets his learning.” Rav Joseph took ill and his learning was removed. Abaye restored it to him. Thus it is often stated, “Rav Joseph said: ‘I have not heard this particular lesson,’ and Abaye would say, ‘You yourself taught it to us and derived it from this particular baraita.’”
Individuals can be confused for different reasons: They might be cognitively impaired by a disease such as Alzheimer’s, or temporarily confused because of medication. Hearing problems or vision problems might increase confusion. The National Institute on Aging provides a number of tips, adapted here from its booklet Talking with Your Older Patient: A Clinician’s Handbook.[iv]
- Address the person directly, even if the cognitive capacities are impaired.
- Sit in front of the person, maintain eye contact, and gain the person’s attention.
- Resist the temptation to speak louder unless you know that the person has a hearing problem.
- Speak at a normal rate of speed and articulate clearly, using simple sentence structures and words.
- Help orient the person by introducing or reintroducing yourself and why you have come.
- It might be helpful to have a family member or familiar caregiver present to orient the person.
- Support and reassure the person by acknowledging the person’s responses.
- If a person is lost for words, gently provide assistance in helping to find the right word.
- Although open-ended questions are preferable in most conversations, they can be too difficult for people with cognitive difficulties to handle.
- If you came to provide specific assistance with a task or came to inform the person about something that will happen, you should also provide written information as a reminder for later.
|Rabbi Dayle E. Friedman’s “Seeking the Tzelem: Making Sense of Dementia,” in Jewish Pastoral Care,[v] is specifically on the topic of giving spiritual care to individuals with dementia. You might want to find the book and read the chapter on your own.|
[i] Capps, 11–53.
[ii] Capps, 55–69.
[iii] Gerard Egan, The Skilled Helper: A Problem-Management Approach to Helping, 5th ed. (Pacific Grove, CA: Brooks/Cole, 1994), 90–104.
[iv] National Institute on Aging, Talking with Your Older Patient: A Clinician’s Handbook. Bethesda, MD: National Institutes of Health, US Department of Health and Human Services, October 2008. NIH Publication No. 08-7105. Although this handbook is aimed toward medical professionals, it provides excellent background to the specific issues and challenges of communicating with the elderly.
[v] Dayle E. Friedman, “Seeking the Tzelem: Making Sense of Dementia,” in Jewish Pastoral Care: A Practical Handbook from Traditional and Contemporary Sources, 2nd ed., edited by Dayle E. Friedman (Woodstock, VT: Jewish Lights, 2005), 75–91.
|Unit 6: Systems in Families, Congregations, and Communities||Unit 8: Confidentiality, Boundaries, and Self-Care|