By Karen Roberts,2014-07-12 10:52
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The Exquisite Witness Grief Care Provider

    (Adapted from: Jeffreys, J. S. (2011). Helping Grieving People When tears are not enough: A Handbook ndfor Care Providers, 2 Edition. New York: Routledge.)

    J. Shep Jeffreys, EdD, FT

    „Exquisite Witness‟ Defined

    The exquisite witness is a health care, pastoral, or volunteer care provider who enters the sacred space between two human soulshaving the deepest respect for the yearning, seeking, wishful hopes of the other to diminish pain and survive in a new world after a loss.

    The term exquisite witness encompasses my beliefs regarding the role of anyone who steps forward to help a grieving person. A medical or mental health professional, a teacher; funeral director; fire, police, or rescue

    personnel; employee assistance counselor; a medical receptionist; or a family member who becomes the home caregiver can assume this role. An exquisite witness might be a friend, someone from the faith community who comes

    to visit the family, or the surgeon who stops by the recovery room after removing a tumor and then proceeds to reassure the waiting loved ones. What distinguishes an exquisite witness is not one’s level of training but one’s

    willingness to approach another human being with compassion and deep respect for that person’s needs, fear, and grief.

    The exquisite nature of the interaction is measured in terms of respect, care, honesty, and the ability to truly hear and understand the grieving person’s anger and confusion. It may take very little time. A gifted psychiatrist whom I

    accompanied on rounds for medically ill patients at The Johns Hopkins Hospital was able, during a ten-minute conversation, to answer patients’ concerns and make them feel cared for, respected, and hopeful. I have also seen a

    member of the housekeeping staff on an inpatient AIDS unit calm an agitated patient with a smile and casual conversation about the Baltimore Orioles’ lineup.

    The term witness directs the care provider to understand that the grief journey belongs to the grieving person

    whether he or she has lost a loved one, has a chronic/terminal illness, has been admitted to the hospital for tests, has a loved one who is ill or dying, or has new job responsibilities in a reorganized workplace. As a witness, we observe

    more than act, listen more than talk, and follow more than lead. Witnessing celebrates the dignity and authority of the

    grieving person.

    Characteristics of the Exquisite Witness . . .

    Has a commitment to self and is attuned to stored personal loss material. Such a care provider can, therefore,

    accompany grieving people into painful places on their journey, confident in knowing where his or her

    limitations in professional and personal availability are. When professional or volunteer care providers do not

    identify their own personal loss issues, they may consciously or unconsciously avoid areas of interaction that

    could have been of help to the grieving person. This care provider also knows how to access the professional

    and spiritual resources available for personal growth.

    Is more than a good listener, more than knowledgeable, and more than a skilled intervener. This care provider can

    join with a person deeply in grief and is generous with time and energy.

    Draws from personal life experience to join with grieving people; whose own grief is healed in part through

    service to others—a “wounded healer.”

    Has a comfortable command of the psychological and sociological phenomena of human grief and its varied and

    changing forms.

    Has a repertoire of intervention skills, including exquisite listening, to facilitate the healing of grieving people.

    Has a commitment to a religious/spiritual pathway or personal growth journey that provides continued resources,

    emotional health, personal growth, and professional development.

    Is not simply a matter of “This is what I do because this is what I have trained to do,” but rather “This is what I do

    because this is part of the meaning of who I am and how I choose to live.”

    The “Heart, Head, and Hands” Dimensions Defined

    An exquisite witness must address personal loss issues (the heart dimension), is knowledgeable about what to expect from grieving people (the head dimension), and has the skills to respond both usefully and reassuringly (the hands dimension).

    The Heart Dimension

    The “heart” dimension represents the process whereby old loss material may rise to the surface and interfere with the ability of a care provider to be available to a grieving person. This recall may be triggered by circumstances of the case that are similar to the care provider’s current or earlier life grief experiences.

    As human beings who attach and bond, we all have loss material, and the grieving person we are working with may trigger some unfinished grief. No one is untouched. The nurse or physician who avoids a particular patient’s

    rooma case worker who limits the depth of information seekinga counselor who keeps the conversation at a

    superficial levelor a hospice volunteer who becomes overly involved with one familymay be dealing with old,

    unfinished loss material.

    To be truly available to grieving people, care providers must examine their own unresolved loss and grief. This is the heart dimension of the exquisite witness care providing.

“Cowbells”—The way unfinished business is stored and its subsequent effects on a provider’s own grief experience is

    illustrated by the following personal story.

    When I was 4 years old, I attended a preschool program in a community center just across the street from where my family lived. Each morning the children would line up and get a tablespoon of cod liver oilall from the same

    spoon! After some indoor games, we were sent outside to the playground. This was an area with a chain link fence separating us from the sidewalk and the street beyond. I could see my apartment building and as soon as we got outside, I would run directly to the fence, stick my little fingers and nose through the fence, and look longingly, yearningly toward my home. The image of my “Mommy” was clearly in my mind, and I missed her and ached to be

    back with her.

    At that same time every day, a junkman with a pushcart filled with old clothes and items he had been collecting came by ringing a cowbell roped to the handlebar of the cart to announce his presence in the neighborhood. The sound of that cowbell and my yearning, grieving feelings became connected.

    Throughout my life when I have had aching, grieving feelings come up, the look on my face prompts my wife to ask, Cowbells? And I answer—“Cowbells.”

    Throughout the years, a symphony of “Cowbells” has rung out. Every one of us has our “Cowbells.”

    They accompany us to the bedside of every patient, to our interactions with counseling or pastoral clients, to parishioners, to staff meetings, to treatment planning, and to every human contact we engage in. As care providers, it is our responsibility to be sufficiently aware of them so that our own Cowbells do not drown out our clients!ask not

    for whom the Cowbells toll; they toll for thee … and me!

    Personal self-awareness exercises are provided throughout Helping Grieving People When tears are not

    enough… to assist with discovering the reader’s “Cowbells” and should be a regular part of all provider training and

    in-service education. Professional health and pastoral care providers are also advised that surfacing personal “Cowbells” can be a valuable means for informing their counseling, therapy and spiritual guidance with grieving people. (For a detailed discussion of countertransference responses in end-of-life and bereavement care, see Katz & Johnson, 2006.)

The Head Dimension

    The “head” dimension refers to knowledge of the phenomenon we know as grief; including its many subcategories as well as its dynamic shifts and changes over time. This includes understanding the biological/instinctual basis for grief reactions, the expected feelings and thoughts of grieving, as well as behaviors derived from our social environment over time.

    Providers also need to appreciate both the traditional and more recent explanations regarding the nature of grief and its predictable patterns. Knowing what can be expected from grieving people will not only enable care providers to give the highest level of service but will also increase provider comfort.

The Hands Dimension

    The “hands” dimension represents what the care provider says and does to help the grieving person engage in the

    process of mourning in the healthiest way possible. It includes the way providers interact, gather information, make decisions and suggestions, and gauge the level of appropriate intervention. Many grieving people in my clinical practice simply want to tell their story to someone who won’t interrupt them, look at their watch, or change the subject. A grieving person may need to be heard over and over again without receiving any advice, interpretations, or words of wisdom.

    The telling and retelling of the story of a grieving person’s loss is an important part of his or her healing. In this context, the provider agrees to be a nonjudgmental exquisite witness. It is more than being a skilled listener. It means

    hearing with the heart and knowing that you, the exquisite witness care provider, are engaged in a healing process with

    another human being and can feel the joy of this healing. When people share their pain and fears, we are on

    sacred ground.


    The “heart, head, and hand” dimensions direct the exquisite witness to know his or her own grief issues, to understand

    the human grief response and its variations, and to have a repertoire of support and/or clinical skills to use for helping grieving people.

    When Adam and Eve were sent from the Garden, they were informed that a gift awaited them outside. They wept and wept as they looked back at the sealed gates and were aware after their weeping subsided that they felt comforted. This was their giftthe tears of healing.

    But . . . sometimes tears are not enough! . . . That’s when grieving people need you.

    (See also: Katz & Johnson, (eds.). (2006) When professionals weep: Emotional and Countertransference

     response in end-of-life care. New York: Routledge.

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