The author (that’s Drexel on the right in the red shirt) with his step-family-to-be.

I was a naive Ph.D. student when I first encountered the concept of family systems. Maybe it was an indicator of my immaturity regarding my own family dynamics that I firmly resisted learning about the concept. I much more liked the notion of dealing with people as individuals, talking to them about what they’d done in their past, dreaming about the future, and offering the wisdom I gleaned from books and stored in my head. I had a hunch that dealing with the reality of families and their systems would involve a lot of messy work. Dealing with ideas in my head and talking about them was so much cleaner!

Lo and behold, I learned that no matter how wise my advice seemed in the individual counseling hour, no matter how cool the ideas were that we discussed, whatever clients had acknowledged when talking with me got profoundly altered, if not completely dismissed, when they got back with their families. Grudgingly I came to realize that when an individual came into my office, ghosts walked in with them. I HAD to acknowledge how profoundly their family systems affected their interactions with me, both in the counseling hour and otherwise.

Family dynamics include all kinds of great history, such as this time a few years back after my daughter, Melissa, directed a play at Radford University.

This dynamic plays with special strength when one proposes a support team to a patient. By definition, this proposes doing some engineering to the system as it exists, and if the system doesn’t have a custom of incorporating extra-familial forces, the persons may politely refuse to cooperate. You see, families want to maintain – here’s the word – homeostasis. They want things to stay the way they’re used to them because that reduces their level of anxiety.

Murray Bowen and Virginia Satir were the first to fully describe this dynamic and scores of therapists have added to this particular body of knowledge. Basically, “homeostasis” refers to a family’s desire for balance and control such that the family can maintain the customary way the family interacts in order to handle challenges and adjust to changes. When an illness occurs, anxiety increases and most families move as quickly as possible to restore their normality as it was before the illness, which will lower their anxiety. Families reflexively apply their customary means of problem solving on the new situation. For families that have maintained a more independent posture relative to extra-familial relationships, the offer of a chaplain to organize a support team introduces the idea of another change, and subsequently raises the family’s anxiety level.  The offer, which the chaplain meant as a kind invitation, instead feels more like a threat.  Even if the chaplain or care-giver can compile a list of objective data that indicate a need for a support team, those factors remain subject to the family’s customs.

Some families, as a component of their customs, include more permeable boundaries. In such cases, the offer of a support team results in an invitation to be one more part of their system, which already includes extra-familial relationships.

In all cases, whether or not a family accepts a support team depends upon the nature of that family’s sense of homeostasis. It will behove the chaplain to spend some time discerning the character of a particular family’s dynamics. When the chaplain has a non-judgmental understanding of a family’s unique style of relating – how they lower their anxiety – then he or she can fashion an approach toward offering the nurturance of a support team.

At this point, gaining the acceptance of a support team becomes more art than science. The chaplain or care giver needs to customize the manner in which they educate families as to the need. Some families see the need for a team straight away and immediately begin to adjust to the presence of an organized regimen of friends and family showing up. Others require more gently applied education so that they arrive at the conclusion that the presence of a support team only strengthens their system in a healthy manner. Again, the level of trust developed between the chaplain and the family plays a crucial role in how a family hears the chaplain (see Lesson #4).

In all cases, families that eventually accept support teams recognize the presence of the team as a sign of strength, wisdom, and health, not as a judgment on their customary manner of doing things, but a means to lower their anxiety.

Ultimately, each family differs to some degree from other families.  What feels right to one family won’t correspond exactly to what feels right with another.  There isn’t a template beyond being what Ed Friedman called “a non-anxious presence” who listens with as little pre-judgment as possible.  What I had a hunch about in graduate school some 30 years ago holds true: it’s a messy process.

In “Viva la Resistance,” I described various shades of resistance I’ve encountered over the last two years in my work with Support Teams. As I said at the conclusion of that post, trust alone stands as the best way to overcome resistance.

We’re fellow travelers, showing other thirsty travelers where we’ve found water. (Photo by DR)

In fact, any effort to nurture a loving and supportive community – which is what we’re up to with Support Teams – involves trust. The Oxford Dictionary defines “trust” as a “firm belief in the reliability, truth, or ability of someone or something.” Indeed, all chaplains (or coaches) want to convey competence and reliability when they converse with a patient and family. They want the patient and family to sense that the chaplain only has the best interest of the patient and family at heart. If patients and families don’t believe this is true for the chaplain they’ve encountered, they certainly won’t invite the chaplain to interact with their family system.

In my experience, however, the kind of trust we value involves mutual vulnerability. It’s not enough for a patient to acknowledge a chaplain’s (or a coach’s) credentials, training, and competence. When you trust someone, at least to some degree, you’re willing to open up more sensitive regions of your life, confident that the person to whom you’ve given your trust will not do you damage in any way.

This kind of relationship rarely develops quickly. Indeed, it takes a bit of time investment and patience to go from not knowing someone to having the permission to interact in a substantial way with the dynamics of the person’s more immediate system of family and friends.

Henri Nouwen (1932-96)

But perhaps the greatest asset one possesses in establishing trust comes from what Henri Nouwen called, “the wounded healer.” When we learn to share out of our own brokenness and convey our own self-assurance that our short-comings are not reasons to be ashamed, we invite others to open up more to the Grace that undergirds every process of creating healing community. I think trust will grow when the people we serve sense that we, too, have hit bumps in life and that we are fellow travelers, showing other thirsty travelers where we’ve found water.

Even though I think Support Teams are fantastic, frequently the very people whom I perceive as needing a team the most nevertheless resist having a team organized. Consequently, I’ve had ample opportunity to reflect on the various shades of resistance I’ve encountered over the last couple of years. In the third of my “Ten Lessons Learned” series, here are five of the resistance dynamics I’ve noticed.

1. Many people resist the idea of a support team because they simply don’t want someone they do not know asking too many questions about their family members’ habits and customs. In other words, sometimes when I start talking about Support Teams, I come off as a nosy trespasser. “Who IS this guy, and what gives him the right to ask these kinds of questions?  HE doesn’t know us!”
2. Some people, in one way or another, make it clear that they like their family just the way it is. When someone in the hospital suggests that they need “help” in putting together support, it sounds like a negative judgment to them. They don’t like to think that someone’s thinking of THEM as emotionally needy, or in need of counsel to improve their family or social system. Their pride throws up a barrier.
3. Some folks feel exactly the opposite of #2 above. They’re ashamed of the dynamics in their family system and don’t want their “dirty laundry” exposed to strangers. Or some folks don’t want people coming into their homes and seeing disorder, or filth, or junk lying around everywhere. They may actually wish for a team, but shame erects a barrier.
4. Frequently, people will resist a support team because they don’t want to “impose on anyone.” I’d need more space to elaborate all the possible roots of this particular weed, but whereas #3 above has to do with shame, this has to do with guilt. People don’t want to feel like they owe anybody anything, so they take a pass on having a Support Team launched for them. I think that this particular dynamic relates directly to the next point. Feeling “obliged” to someone flies in the face of the ideal of being able to handle your challenges yourself. This means that . . .
5. . . . many people do not want to appear like they need anything, even when they do. This seems to me to go right to the heart of one of our culture’s most cherished myths.  In Western society we live with a deeply engrained cultural ideal of the rugged individual. It makes a positive statement, in our culture, when a person can confront challenges without needing help from anyone. On the other hand, it’s a less positive statement when someone cannot face challenges without aid from others. Stated starkly, an independent person is better than a dependent person. Consequently, to accept the support of a team of volunteers is like admitting that one is a lesser kind of person.  (I’ve written about this twice now under the rubric “Community as Medicine.”)

Other forms of resistance crop up, too, but these five seem to me to be the most frequent and the most effective in short circuiting the team launch process. In the next post, I’ll reflect on what I’ve learned about addressing resistance. In a word, it has to do with trust. More on that next time.

Here’s a second lesson I’ve learned over the last two years.

What if I were to tell you that you have a powerful medicine at your disposal? This medicine has the capacity to help heal you or someone you love, make the process of facing the illness easier, and make you or your loved one stronger, if not physically, then certainly in mind and spirit. Additionally, it won’t cost anything but time and an adjustment in thinking. Wouldn’t you want to use that medicine?

Well, that medicine is community. Notice that I didn’t use quotation marks in referring to community as medicine. That’s because the positive health benefits of an intentional, caring community of people surrounding a person has verifiable medicinal effect.

Mark Hyman, MD, Leader, The Institute for Functional Medicine at the Cleveland Clinic.

That’s not just a flowery flight of pastoral speech. In the words of Dr. Mark Hyman, a physician who leads the Institute for Functional Medicine at the Cleveland Clinic in a recent podcast on NPR’s “On Being,” he used the very words: “community is medicine.” Dr. Hyman’s insight into the power of community dovetails very well with the findings of a team of researchers from Brigham Young University’s Department of Psychology. In March, 2015, these researchers published a meta-analysis which concluded – in their words – that loneliness and social isolation will reach epidemic proportions by 2030 unless “action is taken.” In fact, after they surveyed over 70 research projects on the subject, they warned that loneliness is potentially more deadly than grades 2 and 3 obesity. In other words, the BYU researchers have stated the counterpoint to Dr. Hyman’s term: lack of community is disease.

Most of us in health care already know this. Health involves a whole world beyond the hospital or medical clinic. Notice, though, that I don’t suggest that “community” is just any conglomeration of a number of people. As I’ve been learning in my studies on loneliness, one can be “lonely in a crowd.” A healing community is a group of people who are focused, intentional, and coordinated in their efforts to support one another.

Indeed, on our website we define a Support Team as a group of volunteers who use a coordinated team approach to meet practical, emotional, and spiritual concerns of a person with a health care need in order to make the person’s recovery easier and less lonely. Using their particular gifts in caring for that person, they also care for that person’s family and/or care-givers.  The volunteers who comprise a support team work together to offer intentional support to a person with healthcare concerns.

I’ve learned that the vast majority of folks who learn of this effort like it. As we go deeper in exploring the potential of Support Teams, we discover that we’re really talking about nurturing community in a process of strengthening the ties that already exist in a person’s system of relationships. By teaching, coordinating, and organizing the people a person knows, each experiences a caring community. Cooperating as a team serves to encourage the nurturing of basic human skills which people already possess and potentially opens new possibilities for how people experience and perceive their social connections.

So, lesson number two stated another way: Support Teams constitute a potent medicine.

When I look at this picture of the house in Virginia in which I lived longer than any other house, before or since, I think of the following blessing . . .

. . . May your path during this Christmas Season lead you to an open door which swings wide as you step into warmth and light; where a crowd of faces turns toward you, lifts glasses of good drink and calls your name with gleeful loudness; where you can smell the aroma of spiced cider and seasoned meat and the greenery of the garlands and the tree; where you feel the embrace of friends and loved ones, and the soft press of kisses on your cheeks, and yea, even on your lips; where a fire flickers and warms the arches of your socked feet as you sit back and stretch out your legs, your mug cupped in your hands; where squeals of delight follow tears of wrapping paper; where everyone knows that each other’s presence constitutes the true presents. May your path during this Christmas Season lead you to a warm welcome where you can share firm embraces with the ones you love.

Yes, I know . . . that blessing depicts a rather idyllic scene, idyllic for some of us. For my friends from the Southern Hemisphere, Christmas images don’t include scenes of people finding shelter from a harsh winter, rather they think of barbecues on the patio while holding cocktails and wearing Hawaiian shirts and sandals. Indeed, this Christmas of 2015 will be remembered in the eastern third of the USA for its incredibly high temperatures, with numbers in the 70’s for Birmingham and Atlanta, and 60-something in New York City and Washington. Hardly a “Currier and Ives” sort of scene.

And yet, the picture of that house calls to mind something very basic in our humanity: we all long for hospitality in the midst of what Don Henley called “a graceless age.”  The world can turn quite “cold” on us, even when the temperatures approximate May more than December. We can feel shut out and ignored by a gray and grouchy society. The ears of our souls ache from the harsh rhetoric of campaigning politicians and we have to reckon with an economic system indifferent to our personal realities. In the face of all that, our hearts long for welcome, warmth, and well being. We long for the embrace of fellowship where eyes look unflinchingly at us and nonetheless confirm the deepest thing in us, where we know we’re noticed, accepted, understood, and loved.

So, I’ll say it again. May your path this Christmas Season lead you to an open door which swings wide . . . on the warmest welcome you’ve ever had.

Doug Welle, from Birmingham Southern College, looked out of his tent somewhere in Turkey, 9,000+ feet above sea level. The thin, cold air bit him, but he braved it so he could take in the unlikely sight in front of him down at the archeological dig he and his crew had been working for about a month. The relief crew had arrived the previous night after a four hour drive that immediately followed a long flight from the States across Europe and into Ankara. Surely that crew needed rest and, indeed, all of them still slept – all but one.

Dr. Jeannette Runquist

She stood down by the dig site at a table spread with bones, a clip board cradled in one arm, a cup of coffee in the other, and an ash tray filled with cigarette butts on the corner of the table.

Welle shook his head to himself, gathered his coat, and walked to the dig. “Jeannette, is there anything I can do for you?”

She looked up from her notes and said, “I’m out of coffee. You could get me more coffee.” She went back to scribbling notes, then added, “Oh, and you can empty my ash tray.”

That was Dr. Jeannette Runquist, a biology professor at Birmingham Southern College, and according to Welle, because of her brilliant and disciplined professionalism as a crack archeologist, she single-handedly saved that archeological project from being shut down.

But that wasn’t all there was to Jeannette. In her capacity as part of the biology faculty at BSC, she carefully guided countless pre-med students into medical careers with incisive counseling. She taught biology without notes, prolifically writing the salient points on the chalk board. When students didn’t like her, it usually rose from the fact that she didn’t coddle them. She expected them to render their best, but she didn’t just tell them to perform, she gave them the tools to perform. Her course on comparative vertebrate anatomy (CVA to the students) drew rave reviews from some and, of course, derision form those who found it difficult. Indeed, she had a reputation for rigor and toughness that terrified students, but she also had a warmth and tenderness that conveyed love for those same students and especially for her subject. She evinced the essence of being a professor.

I met Dr. Runquist through my work as the Support Team Network Program manager at UAB Medicine. I had received a consult from the outpatient pulmonary unit of The Kirklin Clinic. When I went into the room, I saw an older woman, rather thin and somewhat slumped, tethered to an oxygen tank, with rapid, shallow breathing that typifies many patients nearing the end of the effects of a lifetime of heavy smoking. I confess that my prejudices kicked in. I often find it somewhat difficult to conjure sympathy for someone whose symptoms derive from what I think are poor personal choices. Nevertheless, I engaged her in conversation and after a few minutes, it became apparent to me that I had come into the presence of a very sharp, well informed intellect.

After conversing with Jeannette for about 15 minutes about how our Pastoral Care department offers Support Team follow-up and training free of charge as an aspect of our mission, she surveyed the brochure I’d given her and said, “I’m impressed. This is holistic medicine.” She said she’d like to have a support team organized. When I left the room, I realized – again – that I really need to watch how I prejudge people when I first see them.

Through Jeannette, I met Megan Gibbons and Pete Van Zandt, neighbors and faculty colleagues in the department of biology at BSC. Megan and Pete had already logged hundreds of hours of support for Jeannette, visiting her in the hospital, bringing her meals, looking in on her, and running errands with and for her.  On one occasion, when Jeannette’s sister died, Megan and Jeannette traveled to Maryland, Virginia, and North Carolina to take care of the sister’s affairs.  No wonder Jeannette identified Megan as the one who’d be a great team leader, and Megan hosted a team launch at her and Pete’s house.

As the support team gathered for orientation on that appointed evening, it became clear to me that quite a few people not only respected Jeannette, but loved her and wanted to demonstrate it. Through Megan’s exemplary organizational skills, they divided up how they’d respond to Jeannette’s needs, and by the time our intern, Kortney Sloan, and I left the meeting, they’d launched their care-giving game plan.

Katy Smith (r), a member of Jeannette’s Support Team, speaks at Jeannette’s memorial gathering at Birmingham Southern College.

The team only lasted for a couple of weeks because Jeannette’s medical condition deteriorated rapidly. On November 7th she died after emergency surgery, surrounded by members of her support team. Megan remarked that because of the support team’s efforts, Jeannette saw how much and how many people appreciated and loved her. “And that,” she said, “made the whole thing worth it.” At the memorial gathering on the campus of BSC, standing among a throng of Jeannette’s colleagues, students, and family, I learned that when I met Jeannette, I had rubbed shoulders with greatness.

Recently one of my Facebook “friends” posted a selfie he took on a flight. Clearly in the background, right across the aisle was Bernie Sanders, one of the dozens of current candidates for president. My friend’s caption conveyed that he was impressed Sanders was flying coach, but it was also clear that if it had been just another ordinary bloke, he wouldn’t have taken the picture. There was something cool about rubbing shoulders with greatness, even if it resulted from a chance seating assignment. (In the interest of full disclosure, I would’ve done the selfie, too.)

The fact is, though, that my friend rubs shoulders with greatness every day, and the persons in the seats on HIS side of the aisle more than likely have stories that would astound him if he’d learn them. As my experience with Jeannette illustrates, this holds true for all of us. It’s one of the reasons why I do what I do with the Support Team Network. As we pull together to care for folks and get past the initial impressions by opening our ears and hearts to listen, we often discover rich personal histories only recently masked by a veneer of disease.

I’m extremely thankful that Jeannette Runquist helped unearth that Truth for me again. I feel myself tremendously fortunate to have met Jeannette, Megan and Pete, and a fantastic support team – and for the opportunity to recognize that I’ve been rubbing shoulders with greatness all along.