The ultimate holistic goal of providing emotional support and therapeutic presence is the intentional facilitation of supporting a person to stay self-compassionate within their own experience of emotional pain. This requires those we care for to become comfortable with recognising and experiencing their whole selves. When people seek care, they rarely start by saying that they want a more intimate relationship with themselves. More often it is a result of a loss or a life change, where their life experience becomes something other than they'd planned, and they want ways of stopping the pain or cycle.


What is ironic is that as we journey with our clients to tolerate more of their experience, they often discover that they can withstand, integrate, and calibrate more than they ever imagined. This process of 'staying with' one's own experience cultivates awareness, coherence of feelings, strength, and the resilience to stay present to self as they mourn and grieve the loss, change and trauma.


As clients begin to inquire more intentionally about their experience, considering their current circumstances, it becomes clear that often the emotional pain they carry has come from relationships with significant others who have not seen, nor responded to their needs, and therefore it is hard to trust any support in their time of greatest need.


Relational betrayal and sabotage occur along a continuum from intrusive to neglectful behaviours. Extensive betrayals and unmet needs leave the individual with a deep sense that they were not important to those around them. Relationships can become unsafe, including their relationship with authority figures or their God, and the physical and psychological discomfort of this core belief can be overwhelming to experience. As a result, individuals often adapt by developing behaviors, symptoms, and reactions to deal with the impact. These can include depressed states, anxiety, inability to rest, somatisation, perfectionism, lack of boundaries, self-reliance, anger, and despair to name a few. These adaptations restrict self-awareness and can leave people afraid of their own experience, disconnecting them from their relationship to self, others, nature and the divine. The foundation of the therapeutic relationship is that the focus of attention is on the client’s present moment experience and as we stay mindfully present to their experience without leaving [as in the previous betrayals], we can begin to restore the safety of the relationship and renew the sense of trust, boundaries, and ability to stay within a safe relationship.


As caregivers, our developed self-awareness is the most important attribute in attunement as a therapeutic skill. Helping us to remain in a postural state of 'ease', fully present and able to apply mindful reactions to comprehend the client’s re-enactment of their world. An intentional commitment to personal reflexive work and the development of our ability to attune is therefore crucial in witnessing and supporting the client's needs, subconscious presentations, and present moment experience as the move towards integration of lived experience and inner healing.


When caregivers work from a posture of 'ease', the matrix of intra and inter-relationship supports and guides the direction and flow within any person-centered encounter. Without attunement to self and others, we develop a power-centered encounter that limits curiosity, makes assumptions about the client's needs, turns empathy into sympathy, disregards the value of their lived experience and dysregulates our nervous system producing high problem-solving, efforting and fatigue.



Definition of Attunement

A definition of attunement ‘is a kinesthetic and emotional sensing of others knowing their rhythm, affect and experience by metaphorically being in their skin, and going beyond empathy to create a two-person experience of unbroken feeling connectedness by providing a reciprocal affect and/or resonating response’. (Erksine 1998). One could say it is our ability to be present to, and with, another’s expression of their experience. Attunement could be thought of as the meta-skill which might have subheadings, such as empathy, mindfulness, immediacy, active listening, presence, experience and knowledge, and cognitive understanding. Any of these skills on their own is not attunement, but at times comes into ‘tuning into’ our clients as we explore with curiosity and connect to them.


The ability to be attuned really comes down to how connected to our clients we are in the moment-to-moment process of providing care, _and_ how reflexive we've become in our own personhood, qualifying us with the ability to connect authentically and fully present to them. Our presence, response and interventions are then a result of this attunement




To be present means to be consciously attuned to the person before you. Naomi Remen describes this kind of attuned presence as being ‘seen by the heart’. It happens when you see the other, listen to and hear the other, and give your undivided attention to the one in your care…. Attunement is a feeling of harmony or oneness with another being, it is both a way of being and a way of doing. It’s the experience of focusing on another person with openness and acceptance.” See Me as a Person Guidebook pg. 50.



Journaling Prompts for Attunement


  • When you were on the receiving end of a relational mis-attunement, how did it feel? Can you remember your body's experience at that time?


  • When you have missed or messed up attuning to another, how did it feel? Knowing what you know now, what would you do differently?


  • How do you consciously attune to the client/patient? Think of the ways - posture, actions, and attitudes you actively employ to engage in the therapeutic relationship.


  • What is your primary goal when attuning to the patient present moment experience?


  • As a patient hold “hopes” for healing, recovery or even a pain-free journey, what qualities both intra & inter-relational are significant in your experience as a caregiver?


  • What brings you away from being fully present in your work?


  • In what ways would you like to develop a greater sense of “being at ease in your chair”, when providing face to face care?


Updated: Apr 3



a brief notepad scribble of a simple yet complex assessment model
Biopsychosocial-spiritual assessment. Natalie Kay 2014



Working in Clinical Chaplaincy, I have encountered many models for assessing human needs, both religious & spiritual, humanistic and also psychological assessments; all thoroughly studied and executed in the provision of spiritual and religious care, yet many are too much or too little when it comes to the ever changing face of spiritual and religious needs and expression in contemporary multicultural Australia.


The biopsychosocial model is a modern humanistic and holistic view of the human being in health sciences. Currently, researchers think the biopsychosocial model should be expanded to include the spiritual dimension as well. However, “spiritual” is an open and fluid concept, and it can refer to many different things.


As I developed my own model of integrating somatic awareness and neurobiological factors into presence-centered spiritual care, I started to play with simple and easy to remember maps (both for myself and for educating caregivers) as I searched for the "map maker" within each of my clients, and that was broad enough to cover all possibilities and align to clinical language in healthcare settings.


Above is one example, a brief notepad scribble to support a new caregiver to quickly identify identity, support, needs and life expression in the patient no matter what medical specialty or scenario, based on the traditional Biopsychosocial-spiritual framework, and inclusive of all living factors.


You can note the words in the illustration above....

ATTUNE relating to their body/somatic presentation,

WONDERING about their psychology, identity and coping,

FOLLOWING their social history, community and needs

HOLDING their expression of spirituality, faith, and worldviews.


These principles for assessment are useful for any caregiver whether a spiritual worker or not to follow and are highly influenced by Values-based Reflective Practice by Dr Ewan Kelly, and the work of Mary Koloroutis, Michael Trout in See Me as a Person: Creating Therapeutic Relationships with Patients and Their Families. Softcover, 464 pages. (2012).


Attuning, wondering, following, and holding are core principles of any caregiving role, and allow for a holistic response to patient needs through the established therapeutic connection; in utilising these values, people feel more open, competent, and hopeful.


Author Mary Koloroutis invites us to cultivate more meaningful connections in our professional relationships, which when integrated into our professional identity help resource ourselves both at work and at home.


Try these four simple practices:


Attuning

We cannot connect meaningfully with others unless we are tuned in to ourselves. When we pause and take a breath, we make space for greater connection with others. Attuning is the practice of being present in the moment and “tuning in” to ourselves and then others. When we attune to patients, we meet them exactly where they are and remember that what might be routine for us is often life-altering for them.


Try this: Before entering a patient room, pause, take a mindful breath and as best you can, slow down. Then connect with the patient/family with a focus on their state of being (physical, emotional, mental, and spiritual).


Wondering

We all bring with us preconceived ideas and expectations about others. Wondering is the practice of bringing an open-hearted curiosity toward others by recognizing and suspending assumptions and judgment. It is the practice of being genuinely interested and understanding that only patients can tell us about themselves. Their input is critical to quality care.


Try this: Be curious about what your patient will teach you. Be curious about your patient’s backstory and how it is impacting their interactions and responses to care. You may not actually hear their backstory – the point is to remember they have one.


Following

When we are watching a movie, we follow the story as it evolves. Similarly, when we practice following patients, we are listening, focusing on their emerging story, and paying attention to what they are telling us that matters most to them.


Try this, Next time you are with a patient or family member, listen to and validate the person with empathic sounds and attuned body language. Pay attention to what they say is most important to them and integrate that into their care.


Holding

When we hold an infant, we instinctively cradle them in our arms. Holding a patient is the same thing but from a psychological perspective. It is the practice of intentionally creating a haven that protects the dignity of an individual. It is the practice of speaking with respect for them as persons.


Try this: Next time you are caring for an angry or distressed patient, experiment with remembering that anger is a normal human response to illness. It comes from feelings of fear and powerlessness. Acknowledge their feelings, remain a sturdy, compassionate presence, and take kind actions to ease their suffering.


Healthcare professionals are all guided by a shared purpose to reduce suffering and bring more heartwarming connections to our skilled work. These four practices of attuning, wondering, following, and holding are critical skills that make a significant impact on the care of our patients and clients, and our own sense of joy in our work.



You can align these principles into your own therapeutic identity and assessment framework through embodied awareness, cultivating curiosity, having an experimental attitude, and creatively exploring the mystery of an individual's spiritual expression; allowing you to transform your spiritual and holistic assessments into responsive, open spaces of genuine connection.



If you would like to explore these concepts within experiential activities for learning, contact me about Reflective Practice sessions for your team.



Links to original works:

Values Based Reflective Practice (VBRP®) | Turas | Learn (nhs.scot)


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750603/


https://chcm.com/thought-leadership/cultivating-connection-magic-attuning-wondering-following-holding/