Spiritual Direction With the Terminally Ill
by Patricia Conneen

Uncharted Territory

As we train to become spiritual directors, we make apt use of the metaphor journey when referring to the process of spiritual growth or formation. We hope to become trustworthy traveling companions as we rely on the Holy Spirit to guide the course of our directee’s life. In terms of spiritual maturity, we may be only a step or two ahead of those we meet in spiritual direction, and certainly there are many times we seem to be walking side by side. If the directee’s life is a journey along the road of spiritual formation, his receiving a terminal medical diagnosis is like the sudden appearance of a “BRIDGE OUT” sign on a dark abandoned road. We thought we knew where we were going and how to get there, but now we are forced to make a decision—play it safe and drive back the way we came or cautiously venture ahead down a dark, unknown road via the only detour offered. There is a strong temptation to turn around and go back home the way we came. At least we know the way and know it to be relatively safe. But now we become acutely aware that it is the directee who is in the driver’s seat. We can get out at the next stop or we can accompany him into the darkness.

Does our role as director change once we learn that our directee is driving directly into the “valley of the shadow of death?” How do we care for a soul that is seemingly going on, with or without us, into the dark, uncharted territory of his own death? How do we care for his soul and ours so as not to be overcome by the darkness?

The goal of this article is two-fold: first to address these questions and in doing so, alleviate some of the discomfort, if not outright anxiety, directors may experience as they accompany the dying; and second, to offer an invitation to the director to examine her own stance on death and dying. It is my desire that the director, in coming face-to-face with her deeply internalized beliefs, fears and doubts, will authentically be able to offer her directees the hope that is truly her own for this life and for the next.

What We Know Can Help—or Not

When a spiritual director finds that he is called to care for the soul of a directee who has received a terminal medical diagnosis, many anxieties may arise but, hopefully, with his background, training, and dependence on the Holy Spirit, he will be able to help the dying person gather meaning and value from a situation in which many find only despair. The believer’s body may be temporarily headed for the grave but the soul’s destination is ultimately heaven’s gate, not death’s door. This is not a euphemism. Scripture makes it abundantly clear that death of the body cannot separate the believer from the love of God (Rom 8:38,39). For Paul, the departure of his soul from his body meant being in Christ’s presence (Phil 1:23). As he was dying on the cross, Jesus himself assured the repentant criminal that they would be reunited in paradise on that very day (Lk 23:43). Scripture assures us that those who are in Christ will never be abandoned in their dying or in their death: “And surely I am with you always, even to the very end of the age” (Mt 28:20). We take great comfort in Jesus’ declaration to Martha at the death of Lazarus: “I am the resurrection and the life. He who believes in me will live, even though he dies” (Jn 11:25).
A good theology regarding the afterlife certainly matters, and at the right time, calling to remembrance what we have studied and known intellectually may offer much consolation. However, once we come face-to-face with death, we may very likely discover that our own confidence and trust in God is not as unshakable as we once believed it to be. For example, your mother dies of cancer and even though you are confident that she died “in Christ,” you are haunted by the questions: “Where are you, Mom—where are you really? How is it for you now?” God’s power, love, goodness, mercy, and justice—even His very existence—can all be called into question as pain, fear, grief and the unanswerable and the seemingly unstoppable whys chink away at our theological foundations. In an existential encounter with death and dying, the mystery of theodicy will always trump even our most coveted theological positions.

Though a directee’s theology may at times be a source of great comfort to her, this is not always be the case—it can also be the source of emotional pain and turmoil. If the directee has internalized a distorted theology and thus believes her illness to be God’s punishment for her sins, she may be stuck in the same hell in which Job’s friends believed him to be stuck. If she believes that God has allowed her illness to teach her some valuable, yet seemingly unsearchable lesson, she may begin to sink in a quagmire of unanswerable questions or develop dead-end strategies of discovery, in hopes that her finally getting it will reverse the disease process by staying the hand of her teacher. If she believes that God has allowed her suffering so that some future good will be accomplished, she may wonder why she has to be singled out to be the catalyst of such a “good.” She may also begin to wonder why an omnipotent God would require her health and even her very life to accomplish His earthly purposes. If the mystery of theodicy can trump a good theology, it can wreak absolute havoc and destruction in the soul that has internalized these distortions. This is where the director must, with the utmost care and grace, offer God’s truth and pray that the Holy Spirit will illumine that truth to the heart of the suffering soul.

The director must … offer God’s truth and pray that the Holy Spirit will illumine that truth to the heart of the suffering soul.

If we are not care-full in direction, our theology may, consciously or unconsciously, subvert the very process or presence for which the directee’s soul is longing. Like the parent of a child who cries out because he is afraid of the dark, we may instinctively reach for the closest theological switch in order to bring relief to our own quaking souls. Our theology can surface as a defense mechanism extricating us from the dark communion the dying person needs and longs for. Sensing our departure, the directee’s fears are affirmed: “No one has the strength, courage or desire to be with me now. I am alone.” Entering into and remaining in the darkness, without the dim “night light” of theology takes resolve and courage. We may stumble and bloody our shins as we bang into our own doubts, fears and heartaches. We need sound theology, but we also need to learn to embrace the obstacles that bruise us in the dark. Like a blind man who has no idea of what has been placed before him, we must reach out and embrace our own doubts (or surrender to their embrace) and trace the contours of our own fears with trembling fingers, all the while suspecting that our touch might quicken the unknown to life. In this dark exploration, we open our souls to be touched back—touched back by a grief that knows little of theology, a grief that is simply longing to be shared or at least witnessed. We instinctively recoil from this touch. “The pain and suffering of another,” author Gerald Sittser writes, “threatens to undermine our personal quest for happiness.” How do we journey with the terminally ill? We allow their anguish to touch the most vulnerable places of our own souls. We sacrifice our own self-comfort and self-theological soothing. If we are unable or unwilling to drop our defenses, we will not be touched at all.

The directee may also be using theology as a defense mechanism, but it is for her a blessed mechanism of grace and truth that can buoy up the languishing heart when all else seems to be sinking away. It should, therefore, never be diminished or undermined by the director. The caution here is to carefully discern between our own defenses and those of our directee’s. We follow our directee’s lead; we do not compel her to follow ours. As her pain and suffering increase, the hope and trust she has placed in her theology will likely begin to falter, and as it does, her faith will begin to take on the shape of the man Christ Jesus. She will instinctively come to the realization that she can no longer cling to her thoughts about God but must be carried by God Himself.

Prayer and the Sacraments

A directee may or may not have had a disciplined prayer life prior to his illness but once he becomes aware of the gravity of his prognosis, prayer will likely take on a life of its own. Praying Psalms of Lament or Petitionary Praise may be especially helpful at this time. Dennis Bratcher writes that the function of these psalms is to provide a structure for crisis, hurt, grief, or despair; to move a worshipper from hurt to joy, from darkness to light, from desperation to hope. (Bratcher, “Patterns for Life: Structure, Genre, and Theology in Psalms”) Other forms of prayer may be helpful as well. The rhythm and simplicity of the Jesus Prayer or a Breath Prayer may help the directee relax and move the focus of his suffering from himself to God, thus relieving his stress and potentially diminishing his physical pain as well. Words may fail him altogether, so he may find the Holy Spirit most ministers to his soul in Centering Prayer. Simply groaning before the Lord, or if he is accustomed, “praying in tongues” or his own prayer language may best articulate the deep cries of his heart.

A sacrament is an outward or visible sign of an inward grace or spiritual reality. These tangible signs may serve as a particular source of comfort to the dying. In his day-by-day, moment-by-moment experience, physical pain may clamor for attention to the extent that it seems to be the only reality. Baptism, Communion or Eucharist, Confession, and the Anointing of the Sick remind the body that though outwardly it is wasting away, inwardly the spirit is being renewed (2 Cor 4:16). With great care and sensitivity, I believe it is appropriate for the director to remind the directee that these sacred resources are available for his strengthening and comfort.

Once the directee becomes aware of the gravity of his prognosis, prayer will likely take on a life of its own.

A word about anointing the sick: In the gospels, we are introduced to at least two episodes of Jesus being anointed. In the first, it is by a ‘sinful woman’s’ tears and perfume. This anointing culminates in Jesus forgiving her sins, for as he said, “she has loved much”(Lk 7:47). On another occasion, Mary, Lazarus’ sister, anoints Jesus’ head and feet with an expensive perfume. Jesus’ affirmation of her gesture was that she was ‘preparing him for burial’, ‘doing a beautiful thing for him’ and that ‘she did all she could’ (Mt 26:12; Mk 14:8, Jn 12:7). If Jesus could be touched and comforted by these anointings, surely others may be as well. I believe it is appropriate for the director to anoint the directee’s forehead with oil “in the Name of the Father, the Son, and the Holy Spirit,” but again, this must be prayerfully offered and approached with the utmost sensitivity to the directee’s desires. The directee can also be reminded that he can ask the elders of his church to anoint him (Jas 5:14). If the director anoints with oil or not, I would suggest that the attitude and intentions that moved the women to anoint Jesus are what we should seek—this is where the emphasis should be. If the director deeply desires to ‘do all she can do’ to ‘prepare someone for burial’—this in itself is a ‘beautiful thing,’ if, and only if, she ‘loves much.’ It is very likely that all she will be able to do is provide a calm, compassionate, prayerful presence that bears witness to the other’s anguish, but this presence can, in and of itself, body forth the anointing of love.

Gethsemane

By the time Jesus reached Gethsemane, he had forewarned the disciples of his impending death. He had prayed for himself and for them. He asked them for only two things: to stay and to pray. Perhaps he knew that this was the only comfort they could provide. A watchful presence proved to be more than the disciples could handle. They fell asleep. Mark tells us that when Jesus returned to them the second time the disciples “did not know what to say” (Mk 14). He exhorted the disciples to watch and pray so that they would not fall into temptation. When the subsequent temptation to anger (and perhaps the temptation to play the savior) came, Peter cut off the ear of the high priest’s servant (Mat 26:51) Later, when the temptation to fear came, he denied even knowing Jesus (Mat 26:69-75).

Though the disciples were not Jesus’ spiritual directors, he asked them to care for his soul (and theirs) by keeping watch at an appropriate distance and by praying. Perhaps this could be Jesus’ prescription for attending someone who is in great distress over his or her own impending death. Like the disciples, the director will not know what to say unless he has been perceptively watching and persistently praying, even as he allows the directee the safe space needed to express her own agony before God. If the director is watching and praying, he will be less likely to react by forcing his own theological positions, or by acting as savior, or by reacting fearfully and withdrawing into his own passivity.

Jesus exhorted the disciples to watch and pray so that they would not fall into temptation.

When the disciples failed to attend to Jesus’ profound needs, the Father sent a ministering angel to strengthen him (Lk 22:43). The writer of Hebrews tells us that Jesus was comforted by the joy that was set before him and was thus able to endure the cross and scorn its shame (Heb 12:2). Perhaps it was in part the angel’s ministrations that served not only to strengthen but also to affirm Jesus’ future hope—we are not told. But before the dying can be strengthened by the hope of heaven they must be given the opportunity to express their own anguish—their overwhelming feelings of anger, guilt, fear, shame, pain, disappointment, sadness, grief and any sense of abandonment, even to the point of echoing Jesus’ cry from the cross, “My God, my God, why have you forsaken me!” (Mk 15:34) They must be allowed to name their losses. They must be allowed their own Gethsemane. Only then can the director possibly function as a ministering angel (messenger) as he holds forth the hope and promises of heaven.

A View of Pain and Suffering

If a director leans towards an Irenaean view of theodicy, she may be tempted to convince the dying person that there is always a purpose in everything God allows and since God has allowed him to suffer, God must intend an even greater good than the person’s health and wellbeing. Personally, I would hesitate to offer this view to the dying, not only because I believe it to be somewhat distorted, but also because I believe it to be potentially wounding. This is not to say that God cannot work great good, even in the midst of horrific circumstances—he certainly can and often does.

In his book Where is God When it Hurts? author Philip Yancy offers an explanation of how God’s redemptive work in the hellish experiences of our lives serves as a safeguard against despair by giving our suffering meaning: “Although God does not always take away our pains, he fills them with meaning by absorbing them into his own suffering.” If the dying person can allow this in-corporation of their pain into Christ’s suffering, it will increase the soul’s capacity for darkness and for light, for pleasure as well as for pain, for hope as well as dejection, and the soul can grow larger through suffering. Indian Christian missionary Sadhu Sundar Singh (1889-1929) seemed to hold the view that death comes as the soul outgrows the body: “The material body cannot keep company forever with the spirit. After fulfilling its purpose for some time as the instrument of the soul for its work in the world, the body begins to refuse, through weakness or old age, to go along with the spirit any further. This is because the body cannot keep pace with the eternally growing soul.”

Elisabeth Kübler-Ross and most secular psychologists believe that people who receive a terminal medical diagnosis pass through the stages of denial, anger, bargaining, depression and sadness, which eventually give way to the final stage of acceptance. In contrast to mere acceptance or resignation, which is the best secular psychology has to offer, the believer may experience his final days as a time of profound spiritual growth. As he fixes his eyes more and more on the unseen realities of heaven and union with God, the darkness fades, the day dawns, and the Morning Star rises on the horizon of his hope.

Facing Our Own Fears

Like a single pastor or counselor who, despite the fact that she has never been married, is nonetheless able to give sound advice to married couples, I believed that I could write this article without venturing too deeply into my own beliefs about death. It seemed that as a director I should be able to be with a dying person in the same way that I am able to be with a person who is not dying (though we all are in reality on a journey toward the grave.) However, after weeks of research and note-taking, my every attempt to write was met with great resistance. A friend suggested I pour out my soul by writing stream of consciousness. As I did this exercise, my own fear of death surfaced. With that fear came a myriad of other questions. Why am I afraid to die, despite what I believe to be true? Do I really believe that all of my sins have been forgiven or do I unconsciously believe that my soul is still perilously perched between heaven and hell? Do I believe in heaven? Do I believe in hell? I assumed the hardest questions were theological rather than psychological in nature, but in the midst of my quandary, an even more primal fear surfaced—the fear of abandonment. I believe that what undergirds this fear is likely a developmental deficit that has resulted in my grossly underestimating my own sense of worth. Speaking through the prophet Isaiah, the Lord asks a somewhat rhetorical question: “Can a mother forget the baby at her breast and have no compassion for the child she has borne” (Is 49:15)? If your first reaction to this question is, “Yes, of course she can,” questions regarding your own self-worth very likely mirror my own. If I underestimate the value of my soul in life where I can do only a little but can at least do something, how much more will my perceived value be diminished once I am dead and can do nothing? Lord, if you don’t come to me in life, how will you ever come for me in my death?

These are a few of the questions with which I have wrestled and to some extent am still wrestling with. I offer them here only as examples of what might arise once we submit to the One who searches our anxious hearts. It seems to me that in order to proceed in a spiritual direction relationship with someone who has received a terminal diagnosis, it is essential that we not only become aware of our own resistance and avoidances, but that we also open ourselves as fully as possible to the Spirit of God in these most fundamental questions of life. As we come face-to-face with death, it is not only for the directee’s growth but also for the director’s that the Spirit brings this conversation into being.

It is essential that … we also open ourselves as fully as possible to the Spirit of God in these most fundamental questions of life

A spiritual director cannot accompany a person through the valley of the shadow of death unless he is willing to take the journey himself—the journey is God’s calling on the director to die himself, to his fears, his controls, his ability to make a difference, to die to his own ego. It is a call to utter dependence—to move closer and closer to God. The only way to do that is to die to one’s own vision of ministry and prepare for one’s own death in a way we could not and would not have done otherwise.

Conclusion

Just prior to his arrest, Jesus looked toward heaven and prayed, “Father, the time has come” (Jn 17:1). Perhaps Jesus was able to pray this way because he was filled with the Holy Spirit and had also been strengthened by a ministering angel. If a directee has had time to prepare for his own death, it is my hope that he would be able to pray this same prayer, not in resignation but in an embracement— not of an outcome, but of a Savior. In doing so he will also be prepared to pray as Jesus prayed: “Father into your hands I commend my spirit” (Lk 23:46).

After receiving news of her friend’s terminal diagnosis, a grief-stricken and bewildered friend asked me, “How do you walk with a friend to her grave?” As I relayed this question to Larry Warner, spiritual director and the founder of “b” ministries, he offered the following response:

After much consideration of this pain-filled question, I’ve come to the conclusion that the question of how to walk with a friend to their grave is largely unanswerable until we’ve made the sacrificial commitment to walk. Ultimately, it is the director’s presence, and not her know-how that will comfort and sustain. Thus our best ideas and inclinations, our intentions and egos, must be laid on the altar of absolute dependency—dependency on the Holy Spirit who can and will, illuminate the directee’s, and one day our own, passage through the valley of the shadow of death, one step at a time. As the director and directee approach the veil that separates this embryonic stage of life from eternity, they will both become more and more aware that they are standing on holy ground.

As we abide in Christ, the Spirit sensitizes us to the directee’s moment-by-moment needs. When illness has dashed all of their earthly hopes and smudged out all of their future dreams, we can still provide an attentive, compassionate presence in the darkness—a presence that weeps with those who weep over the profundity of their tragic loss—a presence that assures them that God has not forgotten them, that they are loved, that they are not alone, that they will not be abandoned—a presence that confidently affirms that God’s grace and mercy will sustain their soul even in the darkest hour.

© Copyright 2013 ● Patricia Conneen. Used with permission. All rights reserved.

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