This is an assignment I wrote for Midwifing Death training. What I write about presence here is equally relevant for working with traumatised people. Presence is an invaluable skill for professionals wanting to provide trauma informed care.
Mother Teresa said she “would rather make mistakes in kindness and compassion than work miracles in unkindness and hardness”
Fear of saying the wrong thing when sitting with someone who is dying can be more about protecting us rather than them. If we come from the heart, connecting to our love and compassion we won’t be wrong and we can find the words to say or sit in silence. The most essential thing we can bring to someone who is dying is our presence.
Presence for me is about totally being with the other, listening without formulating my own response, allowing silence without discomfort and feeling connected. It is also having the courage to sit with the suffering of the other person which can have a profound impact on both people. In this space the dying person can experience the peace and relax a little. The dying person (and equally a traumatised person) is extremely intuitive and sensitive and easily picks up on our capacity to be present or not. Their mirror neurones are highly tuned.
It is important to be mindful and considerate of the fatigue level of the person who is ill or dying. If our intention is to support and create a healing presence then we don’t want them feeling like they need to entertain us. What I have observed is they give subtle verbal or non-verbal messages which can be easily missed.
Bearing witness is a gift to all of us and especially at the end of life. Having a safe space to be able to speak what needs to be said and to have it acknowledged without judgement is a significant act of compassion. Every life matters! A lack of witnessing can leave the person emotionally isolated (Evans & Davison, 2014). Being genuinely curious about what is happening for the person who is dying allows you to ask open questions which may deepen the communication and open the possibility of witnessing at a deeper level. Questions that are closed only require a yes or no response and are not very useful. Be guided by the responses to your questions, as they will help you to gauge how willing the person is to look into their illness or death.
Our non verbal behaviour accounts for 60-70% of meaning making in an exchange (Evans & Davison, 2014). Respectfully allow the person to remain in denial or choose to not to talk about their suffering, if that is where they need to be. If your intention is truly to be present to the other then there is no need to probe. It is my belief and experience that if you remain fully present, whatever is needed, will come. It’s like the person who is dying or very ill knows if you can hold space for them or not. Be careful not to assume you understand what has been said, it is helpful to feedback what you have understood to the other, which will allow them to correct any misunderstandings. It also shows them you are really listening and wanting to understand them.
Part of healing a life limiting illness often seems to include the refusal to consider death, instead focussing on positivity at all costs. For me, this is a mistake! Firstly the presence of an illness is an opportunity to listen to the body, it has something to tell you. Secondly to have an aversion to any emotion is a recipe for disaster. Dr Malcom Parker says, “Healing occurs when both polarities, positivity and negativity (looking at death) are allowed. A patient who feels distress can end up feeling much worse if the therapeutic focus is on the positive…because this may be interpreted to mean that negative feelings are unacceptable, and so they must be more deeply buried” J Law Med 2011;19(1):36-42.
I love Michael Barbato’s explanation of healing – Healing doesn’t necessarily mean curing especially in relation so life limiting illnesses. Curing usually means making better and involves someone doing something to you, such as doctors administering treatments. Healing on the other hand relates to the emotional and spiritual dimensions, where a person sits with and ultimately transcends their suffering (Barbato).
To be a healing presence you don’t need to be holding someone’s hand or be sitting next to them. Everyone is so very different and this is also true when we die. I remember being with one man who came back to the city to be with relatives to die. He was used to being on his own and in his death this was also true. When I went to visit him he would be in his room and I would be in another room for my whole shift. He didn’t need me to be sitting by his side. I can’t remember where I heard this, and it has always stayed with me, ‘people die how they live’ and from my experience this is very true.
“Love is the optimum condition for healing. The healer uses whatever he intuits will be of the greatest aid, but his energy cannot come from the mind. His power comes from the openness of his heart. He senses something greater than the body’s predicament. He goes to the source out of which all healing occurs, not attempting to disturb or obstruct that which may allow the next perfect step. He does not second guess the universe.” (p. 202 Stephen Levine, Who Dies?)
Holding space is another term used together with presence. It can be described as “being willing to walk alongside another person in whatever journey they’re on without judging them, making them feel inadequate, trying to fix them or trying to impact the outcome. When we hold space for other people, we open our hearts, offer unconditional support and let go of judgment and control” (Plett, 2015). Anyone can hold space for another. Plett offers eight ways to do it well:
- Give people permission to trust their own intuition and wisdom;
- Give people only as much information as they can handle;
- Don’t take their power away;
- Keep your own ego out of it;
- Make them feel safe enough to fail;
- Give guidance and help with humility and thoughtfulness;
- Create a container for complex emotions, fear, trauma etc;
- Allow them to make different decisions and to have different experiences.
In conclusion, we cannot know death until it is happening to us (Halifax, 2008). To be a healing presence and have an understanding of healing we do need to work on ourselves. James Miller says in his book The Art of Being a Healing Presence, “The depth to which you can go within yourself corresponds directly to the depth at which you can connect intimately with another.”
What we can do is have the courage to look at our own mortality so we can sit with others who are facing theirs. We can practice active listening and learn to be comfortable with silence. We can learn to have compassion for ourselves and then in turn have compassion for others. His Holiness Dalai Lama starts his day with words like “If this is the last day of my life may I be of service to others”. By holding our own death at the forefront of our mind, we can live our life more fully.
Barbato M. (2015) Healing. Article
Evans S., Davison A. (2014) Caring for the Dying: A practical and pastoral guide.
Halifax, J. (2008). Being with dying: Cultivating compassion and fearlessness in the presence of death.
Levine, S. Who Dies?
Miller, J. The Art of Being a Healing Presence.