Dismiss, Delay, or Distract – Client Autonomy and the Desire to Discuss the Unspeakable

"Could we speak...?" (No, means no.)

I am currently teaching “Bereavement Intervention Skills” for Mayers Memorial Hospital. It’s the third time I’ve done so, and there continue to be adjustments to the course content and presentation. But one thing that I have recognized in the course of Hospice chaplaincy (probably having originally learned it from instructors with American Academy of Bereavement) is the importance of allowing the patient and/or family member to discuss what they want to discuss, when they want to discuss it. Especially with regard to those who volunteer to offer services to the bereaved, the assumption that our “best time to talk” always matches theirs can prove disastrous.

The Three Ds

And so, I remind my students at least once in each of our six sessions that our clients have the right to “dismiss, delay, or distract” when we arrive with an offer or support, encouragement, or assistance, or even at any subsequent point while we serve them.

"Would this be a good time to...?"

Dismiss: A client may dismiss us by saying, “No, I’m fine. Really.” There are variations on that theme, and it may occasionally be stated somewhat vaguely. Sometimes it even turns out that they mean, “I’m fairly sure I do want some help with this, but I have no idea who you are. I hope you leave a card or brochure. I may call if I start to feel more desperately in need.” But our polite compliance with “Please leave” is essential to any hope of future assistance to that client. (Still, I’ve been known to ask, “Are you sure?” Not that I should, though.)

Delay: More often, a client may delay our assistance. We may hear, “Now really isn’t a good time,” or “I don’t think I’m quite ready to discuss that yet,” or even “That’s already being taken care of, thank you.” On this last point, we need to remember that clients are sometimes mistaken about the resources and support think will be available or adequate. When the client chooses to delay, we should always seek an opportunity to “check-in on them” at a (not very much) later time.

"Can we get to the subject at hand?" (Not yet.)

Distract: Most often, even before “getting down to business” in a scheduled session with a client, s/he  may want to distract the conversation from the topic at hand (i.e., the effects of and efforts toward dealing with a significant loss). “Could we talk about anything else but that?” is a frequent request. Why? Because, it seems, every coworker, classmate, friend and/or family member feels compelled to put on a pained expression and ask, “So, how are you doing?” (to which there is rarely a ready answer). Any other topic can be a welcome relief from the constant analysis and expression of their moment-by-moment experience of bereavement, grief, and mourning.

An Example

I was recently asked to speak to an early-adolescent domestic violence refugee. (If you need a clearer definition of that, feel free to email me at deathpastor@frontier.com.) When I asked her if she wanted to talk, she declined. My first inclination was to accept this as a dismissal. But it wasn’t an outright, “Go away,” so I said, “Okay,” and continued to sit across from her.

Let the client determine the direction and timing.

She began showing me what she’d like to order from her school’s most recent book-order form. When she noted that a boxed set of six books was thirty-five dollars, she added that if there were seven books they would be five dollars each. I asked if she was always able to do math that quickly, and she ran to her room to get her math homework. It was done and graded, and she was clearly doing well. I said so. But then she asked, as long as I was there, if I would help her with her spelling homework. I agreed.

There were some wonderful opportunities to explain the I before E rhyme—especially since the word “weird” also appeared on her list. She almost has it memorized now. But she seemed especially interesting in another word on the list. “Mourn,” she explained, was not the time of day when the sun arose. It had to do with feeling sad, she told me, but she wasn’t sure quite how.

In due course, I was able to explain the connection between bereavement (the condition of having experienced a significant loss—not always by death, but including the kinds of upheavals she had been experiencing), grief (the reactions we have to bereavement), and mourning (the proactive response we make to our grief, primarily through discussing its elements and effects aloud).

(For those wondering how to express these concepts to a hurting eleven year-old, I would first suggest simpler vocabulary, of course. But again, I’d be willing to pass along some ideas for developmentally-appropriate bereavement care. Feel free to let me know.)

There is still a lot for my young friend to process, and her circumstances continue to shift and spiral. But my point in sharing this brief experience is to note what can happen when we honor the client’s autonomy—allowing them to dismiss, delay, or distract, in order to be available to them when they do decide it’s time to discuss what we might know about the process in which they find themselves.