soma psyche ethos - professional...

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An opportunity to focus on what is really important.

Fred Grewe, D.Min., BCC

© Fred Grewe, 2017

1. Gain an increased knowledge on the basis and symptoms of end-of-life existential suffering

2. Learn specific verbal and non-verbal skills to enhance difficult end-of-life conversations

3. Learn non-pharmaceutical therapies to ameliorate end-of-life existential suffering

© Fred Grewe, 2017

soma

ethospsyche

Erik EriksonThe Life Cycle Completed, 1997


© Fred Grewe, 2017

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Irvin YalomExistential Psychotherapy, 1980


MeaningMeaning

AlonenessAloneness

DeathDeath

FreedomFreedom

© Fred Grewe, 2017

“Although the physicality of death destroys man, the idea of death saves him.”



© Fred Grewe, 2017

Why me?Why now?What did I do to deserve this?Why won’t God take me?There must be some purpose for

me?Is their hope?Can I be forgiven?What happens when I die?How long will this last?How will I be remembered?

Why me?Why now?What did I do to deserve this?Why won’t God take me?There must be some purpose for

me?Is their hope?Can I be forgiven?What happens when I die?How long will this last?How will I be remembered?

© Fred Grewe, 2017

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� Pain is a great change agent

� Pain teaches us we are alone

� First step in 12 Steps

� A call to wake up

� Existential pain can shatter our false illusions of self importance

� Existential pain can provide an opportunity to focus on the truly important

� It is also normal at life’s end!








© Fred Grewe, 2017

The English word reflect has two primary meanings – to see ourselves as in a mirror, and also to look inward in a contemplative way.[1] In my own search for meaning, I’ve found the two to be intimately connected.

[1] Robert Solomon, "Lecture 16: Heidegger on the World and the Self," No Excuses: Existentialism and the Meaning of Life, (Chantilly, VA: The Teaching Company, CD, 2000).

© Fred Grewe, 2017

Philosophers (particularly the existentialist ones like Heidegger and Sartre) believe it’s impossible to know ourselves apart from being in relationship. The existentialists teach it is by getting feedback from others about who we are (mirror reflection) that we can then truly look inward to contemplate our being (contemplative reflection). “By linking ourselves (who can’t be very objective) with others (who can be more so), we gain access to ourselves.”[2] Therefore, the only way I can truly come to know myself and create any sense of meaning is by being in relationship with others.

[2] David Biro, The Language of Pain : Finding Words, Compassion, and Relief, 1st ed. (New York: W.W. Norton, 2010), 153.

© Fred Grewe, 2017

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• To be healed means to regain wholeness in the physical, emotional, intellectual, social, and spiritual aspect of human experience (WHO)

• Healing is independent of illness, impairment, cure of disease, or death (Kleinman /

Pilch)

• Healing is the personal experience of transcendence of suffering (Hauerwas)

© Fred Grewe, 2017

� Don’t just do something – sit there!

� Communication is more than 85% non-verbal

� Silence is often therapeutic

� Appropriate touch

� Allow yourself to be human and feelemotion

� Follow the Patient’s lead

� Honor the Patient’s story

© Fred Grewe, 2014

In the long run it is the persistent nurturing role of the therapist who has dealt with his or her own death complex sufficiently that helps the patient overcome the anxiety and fear of his impending death.

- Dr. Elisabeth Kübler-Ross

© Fred Grewe, 2014

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� Try to specifically reflect back to Patients where their life had meaning

� And how they have brought meaning to you – what they have taught you

� Treat the dying person as normal

� Reframe vulnerability as an invitation to intimacy

� Suggest they bless their loved ones

� Give the gifts of affirmation and acceptance

© Fred Grewe, 2014

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

- Maya Angelou

© Fred Grewe, 2014

And remember, there is no cure for existential pain at the end of life. There is only temporary relief – but that is enough.

© Fred Grewe, 2014

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Compassion is hard because it requires the inner disposition to go with others to the place where they are weak, vulnerable, lonely, and broken. But this is not our spontaneous response to suffering. What we desire most is to do away with suffering by fleeing from it or finding a quick cure for it … Our ability to enter into solidarity with those who suffer [is our greatest gift].

© Fred Grewe, 2014

May you have the

commitment to know

what has hurt you, to

allow it to come close

to you, and in the end

to become one with

you.- Gaelic Blessing

© Fred Grewe, 2014

Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred.

Pulchalski & Ferrell Making Healthcare Whole, 2010

Pulchalski & Ferrell Making Healthcare Whole, 2010

© Fred Grewe, 2016

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Three Significant

ApproachesDignity Therapy -Harvey Chochinov

Individual Meaning-Centered Psychotherapy-William Breitbart

22 Questions for Ethical Wills- Cohen-Mansfield et al.

© Fred Grewe, 2016

MyApproach

1. Connecting with Your Soul2. Connecting with Your Story3. Connecting with Your Role4. Connecting with the Divine5. Connecting with Others6. Exploring Areas of Forgiveness7. Connecting with Your Mortality

The Soul’s LegacyDiscerning Your Life’s Meaning and Passing It on to Your Loved Ones

The Soul’s LegacyDiscerning Your Life’s Meaning and Passing It on to Your Loved Ones

© Fred Grewe, 2016

I am using the term soul to mean all of one’s values, morals, dreams, hopes, doubts, insecurities, experiences, wounds, fears, successes, loves, wisdom, ego, id, suffering, pain, persona, authentic Self – the totality of one’s being. It is the composite of a person’s genetics, life experiences, and distinctive qualities. “Soul is the font of who we are.” (Thomas Moore) It is what makes me Me and you You.

© Fred Grewe, 2016

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We weave our self narrative out of the threads of our:

• Life Experiences

• Family Role(s)

• Social Habitus

• Concept of the Divine

© Fred Grewe, 2016

Five Elements of a Blessing

•Meaningful Touch•Spoken Words•Expressing High Value•Picturing a Special Future•An Active Commitment to see that Future Materialize

Gary Samlley & John TrentThe Gift of the Blessing

Gary Samlley & John TrentThe Gift of the Blessing

© Fred Grewe, 2016

• Prior to the seminar fourteen participants indicated they were either “sad” or “scared” when considering their own mortality. That number decreased to five after completion of the seminar, a decrease of 64 percent.

• A decrease of difficulty in communicating feelings by 50 percent (from ten to five).

• An increase in ambivalent feelings about life choices, which more than doubled (from four to nine).

© Fred Grewe, 2016

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• The most surprising aspect of this project was the deep bonding that took place among participants in the three groups.

© Fred Grewe, 2016

Possible Explanations

1. The groups naturally achieved the necessary conditions for a growth-promoting atmosphere in human development: there was a transparent genuineness exhibited by the participants in the groups, a non-judgmental, “unconditional positive regard” gifted each participant with the feeling of being accepted, and the groups afforded an empathetic understanding to the members.

Carl RogersA Way of Being

Carl RogersA Way of Being

© Fred Grewe, 2016

Possible Explanations

2. The power of story sharing

3. The comfort of the facilitator with his owndeath.

© Fred Grewe, 2016

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1. Program for Clinics

2. Program for Long Term Care Facilities

3. Project for the bed bound dying patient

© Fred Grewe, 2016

I have always known That at last I would Take this road, but yesterday I did not know that it would be today. - Narihira (9th century)

© Fred Grewe, 2016

Breitbart, W., S. Poppito, B. Rosenfeld, A. J. Vickers, Y. Li, J. Abbey, M. Olden, et al. "Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients with Advanced Cancer." J Clin Oncol 30, no. 12 (Apr 20 2012): 1304-9.

Chochinov, Harvey Max. Dignity Therapy : Final Words for Final Days. Oxford ; New York: Oxford University Press, 2012.

Cohen-Mansfield, J., N. G. Regier, H. Peyser, and J. Stanton. "Wisdom of Generations: A Pilot Study of the Values Transmitted in Ethical Wills of Nursing Home Residents and Student Volunteers." Gerontologist 49, no. 4 (Aug 2009): 525-35.

Erikson, E. H., & Erikson, J. M. (1997). The life cycle completed (Extended / ed.). New York: W.W. Norton.

Hauerwas, S. (1990). God, medicine, and suffering. Grand Rapids, Mich.: Wm. B. Eerdmans.

© Fred Grewe, 2016

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Kleinman, Arthur. Patients and Healers in the Context of Culture : An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Comparative Studies of Health Systems and Medical Care. Berkeley: University of California Press, 1980.

Moore, T. (1992). Care of the soul : a guide for cultivating depth and sacredness in everyday life (1st ed.). New York, NY: HarperCollins.

Pilch, J. J. (2000). Healing in the New Testament : insights from medical and Mediterranean anthropology. Minneapolis: Fortress Press.

Puchalski, C. M., & Ferrell, B. (2010). Making health care whole : integrating spirituality into patient care. West Conshohocken, PA: Templeton Press.Rogers, C. R. (1995). A way of being. Boston: Houghton Mifflin Co.

Smalley, G., Trent, J., & Smalley, G. (1998). The gift of the blessing / the gift of honor (Updated and expanded ed.). New York: Inspirational Press.

Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.© Fred Grewe, 2016

© Fred Grewe, 2016

An opportunity to focus on what is really important.

Fred Grewe, D.Min., BCC

© Fred Grewe, 2016

12

Why me?Why now?What did I do to deserve this?Why won’t God take me?There must be some purpose for me?Is their hope?Can I be forgiven?What happens when I die?How long will this last?How will I be remembered?

© Fred Grewe, 2014








© Fred Grewe, 2014

The English word reflect has two primary meanings – to see ourselves as in a mirror, and also to look inward in a contemplative way.[1] In my own search for meaning, I’ve found the two to be intimately connected.

[1] Robert Solomon, "Lecture 16: Heidegger on the World and the Self," No Excuses: Existentialism and the Meaning of Life, (Chantilly, VA: The Teaching Company, CD, 2000).

© Fred Grewe, 2014

13

Philosophers (particularly the existentialist ones like Heidegger and Sartre) believe it’s impossible to know ourselves apart from being in relationship. The existentialists teach it is by getting feedback from others about who we are (mirror reflection) that we can then truly look inward to contemplate our being (contemplative reflection). “By linking ourselves (who can’t be very objective) with others (who can be more so), we gain access to ourselves.”[2] Therefore, the only way I can truly come to know myself and create any sense of meaning is by being in relationship with others.

[2] David Biro, The Language of Pain : Finding Words, Compassion, and Relief, 1st ed. (New York: W.W. Norton, 2010), 153.

© Fred Grewe, 2014

Brian O’TooleHealth Progress, 1998

PrinciplePrinciple

Virtue

Character

Virtue

Character

Moral

Sentiment

Moral

Sentiment

ConsequenceConsequence

© Fred Grewe, 2014

� Don’t just do something – sit there!

� Communication is more than 85% non-verbal

� Silence is often therapeutic

� Appropriate touch

� Allow yourself to be human and feelemotion

� Follow the Patient’s lead

� Honor the Patient’s story

© Fred Grewe, 2014

14

In the long run it is the persistent nurturing role of the therapist who has dealt with his or her own death complex sufficiently that helps the patient overcome the anxiety and fear of his impending death.

- Dr. Elisabeth Kübler-Ross

© Fred Grewe, 2014

� Try to specifically reflect back to Patients where their life had meaning

� And how they have brought meaning to you – what they have taught you

� Treat the dying person as normal

� Reframe vulnerability as an invitation to intimacy

� Suggest they bless their loved ones

� Give the gifts of affirmation and acceptance

© Fred Grewe, 2014

I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

- Maya Angelou

© Fred Grewe, 2014

15

And remember, there is no cure for existential pain at the end of life. There is only temporary relief – but that is enough.

© Fred Grewe, 2014

Compassion is hard because it requires the inner disposition to go with others to the place where they are weak, vulnerable, lonely, and broken. But this is not our spontaneous response to suffering. What we desire most is to do away with suffering by fleeing from it or finding a quick cure for it … Our ability to enter into solidarity with those who suffer [is our greatest gift].

© Fred Grewe, 2014

May you have the

commitment to know

what has hurt you, to

allow it to come close

to you, and in the end

to become one with

you.- Gaelic Blessing

© Fred Grewe, 2014

16

© Fred Grewe, 2014

soma

ethospsyche



© Fred Grewe, 2016



MeaningMeaning

AlonenessAloneness

DeathDeath

FreedomFreedom

© Fred Grewe, 2016

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