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From the Townsend Letter for Doctors & Patients
May 2004
Pathways to Healing
by Elaine Zablocki
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Spiritual Care Supports Patients and Providers
Rosa Kocher, CMT, a full-time massage therapist in San Francisco, works with many patients who have serious illnesses. She's able to maintain her own energy level, she says, and offer her patients consistent help, due to Tibetan meditation and compassion practices.

The Tibetan Book of Living and Dying Kocher first learned these practices in 1994, when she read The Tibetan Book of Living and Dying. The book, by Tibetan teacher and meditation master Sogyal Rinpoche, offers basic instructions on meditation as well as advice on many aspects of life, illness and healthcare.

"The first thing that caught my attention," Kocher recalls, "was the practice of the 'three noble principles.' This practice gave me a way to contain my work in a very practical way. It allows me to be present with potential pain and suffering, and helps me maintain the physical and mental energy I need in order to do this work."

Before starting any session with a client, Kocher does a short meditation practice and reminds herself that her goal is to benefit her patient, and all beings."During the session, whatever arises, I just return again to calmness and kindness and clarity within myself. At the end of the session, I dedicate my efforts and pray they will benefit all beings. This allows me to let go of whatever happened during the session, and reenter a clear state."

Kocher frames her day with half an hour of meditation practice, morning and evening. In recent years, she has started to learn ways to share these practices with her patients, through the Spiritual Care Program founded by students of Sogyal Rinpoche. She says these methods can make a significant difference in patient's lives, and in their experience of illness.

One woman she knows has been dealing with metastatic breast cancer for a dozen years. "Recently she has been so hard on herself, questioning some of her own choices. When you live with cancer, you always face the possibility it may come back, and so you want to make the best use of your life," Kocher says. "I reminded her of the enormous courage she's shown in living with cancer. I encouraged her to do the practices of loving-kindness and self-forgiveness described in The Tibetan Book of Living and Dying. Through those practices, she's been able to develop more spaciousness, an ability to hold her situation more lightly, and to transfer that courage to the other decisions she needs to make in her life."

Methods of Meditation and Compassion
Kirsten DeLeoWhat are these methods that can be so enriching and revitalizing for healthcare providers and for their patients? The first is meditation, which means watching the breath, or repeating a short mantra, to calm the mind. "Especially for people who've been coping with illness for years, who are experiencing suffering, frustration and exhaustion, it is remarkable to be able to find peace and a place of rest in the midst of that confusion and pain," says Kirsten DeLeo, a full-time educator in the Spiritual Care Program. (For more information on meditation, see Chapter 5 of The Tibetan Book of Living and Dying.)

Then there are practices designed to help us develop compassion for others. "People who experience physical suffering often ask 'why me?'" DeLeo says. "A sense of hopelessness and meaninglessness magnifies the suffering. Compassion practice can open our eyes to the world around us, and give us a larger focus. Even though the pain doesn't go away, our experience of that pain can shift." (For more information on compassion practice, see Chapter 12 of the same book.)

DeLeo recalls a comment from the Dalai Lama. "He says that when you open your heart and cultivate compassion, who is the beneficiary? It's you. These practices open us up so we connect with other people's suffering. We see we're really not alone and isolated; instead, our mind and heart can be filled with love and compassion."

Training Available for Providers and the Public
To share these ideas about the importance of spiritual care for patients and providers, for several years DeLeo and Annie Eichenholz, BS, RN, CRNH, have been offering training in spiritual care to healthcare professionals and the general public, in a variety of settings. Eichenholz is a hospice nurse at Sutter VNA and Hospice in Sonoma County, California and is certified as a nurse educator in end-of-life care by the End-of-Life Nursing Education Consortium.

Annie EichenholzThe Spiritual Care Program offers weekend or one-day workshops as well as inservice trainings in hospitals, hospices and nursing homes. These programs qualify for continuing education credit, and are usually geared to people working in end-of-life care, including doctors, nurses, social workers, massage therapists, hospice volunteers and other caregivers. The training is offered "wherever people invite us" Eichenholz notes; organizations that could benefit from this training should contact the Spiritual Care Program.
In addition, the program offers weekend and one-day workshops for the general public, for people who are coping with chronic illness as well as others who want to use meditation and compassion practice in daily life. The suggested donation for a daylong program usually runs about $80; for a weekend program, about $175.

During the 2003-2004 academic year, Eichenholz and DeLeo served as instructors in a certificate program for healthcare professionals called "Contemplative End-of-Life Care." Offered through Naropa University, in Boulder, Colorado, it combined meditation and other contemplative practices with the skills and best practices of hospice and palliative care. The program included three residential sessions in Boulder, totaling 16 days, plus on-line lectures, discussions and journals. It will be offered again in fall, 2004.

"This program offers a special opportunity for people who are often experts in their own fields to hear views from people with different experience and training, so our discussions have been really rich," Eichenholz says. "It's been very fruitful for people who are searching for a new approach to take within their professions."

In some cities, Spiritual Care study groups are forming. For example, in the San Francisco Bay Area people who work in healthcare and human services meet on second and fourth Tuesdays of each month to study the spiritual dimensions of caregiving and offer mutual support. Topics include caregiving as spiritual practice, meditation, working with difficult situations, compassion in the workplace, preventing burnout, communication, and responding to the needs of the dying.

Don't Give Up
Eichenholz often recalls the story of an emergency room doctor who studied meditation, but found he could not sit in the traditional upright posture, due to severe back pain. "He discovered he could lie on the floor, in the most comfortable position possible, and meditation could happen while he was lying on his back. This story is so important for us to remember, when we are in physical pain. These contemplative practices of meditation and compassion can be useful in whatever way works best for each of us. Don't give up, because the most important point isn't the physical posture, but what happens in your mind and heart."

For more information, email or visit
For information on the Naropa program, call 303-245-4800 or visit
For books and other materials on Spiritual Care, visit

Elaine Zablocki is the editor of CHRF News Files, a bimonthly emailed newsletter about the emerging integrative medicine industry, published by the Collaboration for Healthcare Renewal Foundation.



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