Basic Attendance: Full Presence Caregiving

The practice of basic attendance is as old as the human experience itself—one individual caring for another in a time of need, caring with body, mind, and spirit—wholly present. The “whole presence” in caregiving is at the heart of the vision and discipline of basic attendance as practiced in the Windhorse approach to care. This approach to caring for the dying, aging, or people experiencing extreme states, is inspired by the contemplative traditions as taught at Naropa University in Boulder, Colorado. Eastern and Western traditions and practices that synchronize one’s body, mind, and environment provide
the ground and path for cultivating this presence. In particular, mindfulness-awareness meditation has been key in the development of this ability to be present with warmth and awareness.

The Socratic adage “know thyself” is inherent in basic attendance as a method of caregiving. There are many forms
of meditation. Some are focused on relaxation and calming oneself.
Others, like mindfulness, are
focused on being present with whatever arises in the moment
on an inner or outer level of
experience. This practice of nowness strengthens our ability
to return to our immediate
experience with a sense of openness, curiosity, and expanded awareness. Another Socratic adage is “befriend thyself.” What can occur as we get to know ourselves better is that we see
both our wisdom and confusion more clearly. Making friends with oneself is the basis for basic attending as well as for befriending the world.

One might ask how this applies to working with elders and the dying. As caregivers in such situations, we may experience our own deep, core issues, such as our own fear of losing control of our minds, bodies, and lives. We can have visceral experiences of tasting our own death and coming face to face with the reality of dying. The poignant and potentially painful vigils held with one who is dying can dissolve the barriers between us and can cause us to either recoil or open to the inevitable.

If we have spent time with ourselves plumbing the depths and textures of
our fears regarding aging and dying, we are more likely not to react out of that fear when offering care to a loved one or client. If we can acknowledge our own feelings and fears like an old friend, breathing out the tension and struggle, we can then respond to or simply be
with the person we are caring for in a more skillful and compassionate way.
The practice of mindfulness can help cultivate clarity during those moments when we can either react, suppress, or respond to our world. Through this befriending, we can experience a feeling of warmth toward ourselves and the other person. This process of coming back to our experience in the moment can foster qualities of openness, clarity, and warmth towards ourselves, towards others we serve, and towards the world.

Other vivid expressions of this approach and attitude toward caregiving are expressed in teaching slogans such as “no escape, no problem.” In other words, taking whatever we might preconceive as an unworkable situation, rife with claustrophobia, and bringing an attitude of workability to it, based on our intention to come back to the moment. Everything we encounter becomes part of this intention to be present.

This approach is embedded in the name and symbol of “Windhorse,” a term widely referenced in eastern cultures
to represent a fundamental energy inherent in the human experience that can be evoked, cultivated, and roused to heal ourselves and others. This energy is likened to the term “chi” in eastern traditions. Through the practice of synchronizing body and mind in a contemplative discipline—i.e., mindfulness meditation, yoga, tai chi—the possibility of being present in groundless and uncertain moments is more likely to occur.

Our experiences with others can serve as beacons on our own path of awakening to these qualities.

Basic attendance has been practiced in contemplative settings and was named and developed further under the late Edward Podvoll, MD, whose book Recovering Sanity: A Compassionate Approach to Understanding and Treating Psychosis includes a chapter entitled “Learning Basic Attendance.” This chapter includes a description of the 10 skills of basic attendance. These are not necessarily linear or intended as a recipe, but rather as guideposts: 1) being present, 2) letting in, 3) bringing home, 4) letting be, 5) bringing along, 6) recognizing, 7) finding energy, 8) leaning in, 9) discovering friendship, and 10) learning. These expanding skills can arise from being present in attending our loved ones and clients.

As we deepen the process within ourselves and find openness, clarity,
and warmth—fundamental qualities
to the human experience and named
in Buddhist teachings as an “awakened noble heart”—our awareness can help
us to be more available to another’s suffering, confusion, or need. We then can move toward such experiences rather than shying away from them to protect ourselves.

Our experiences with others can serve as beacons on our own path of awakening
to these qualities. At Windhorse, we
often talk about the mutual path of “care giving and care receiving” as part of basic attendance work, as coined by one of our staff members. We become teachers for one another on our shared journey. In eastern teachings, generosity is defined as a giving and receiving practice.

◈ Being present is the on-going touchstone as one practices basic attendance. When I am with an elder or a dying person, I can notice the contrast between my speed of mind and the slowed down and potentially spacious process of the person I am attending. Making conscious note of this contrast brings me back to the moment. Entering the environment of a dying person invites an attunement to the ever-present nowness of the situation. For example, while I was attending my dying mother, I returned to the rhythm of her breathing, the temperature in the room, her level of pain as a way of cultivating an opening rather than a closing down

◈ Letting in speaks to
the natural process of
touching another’s state
of mind. For example,
after feeling the contrast
of my speedy mind, I
can open to another’s
quality of mind—whether
it is slow, spacious, anxious, fearful,
or depressed. Or I can retreat further
into my mental speed and my need
to distance. Letting in is the practice
of opening to another person’s felt experience. As a person is dying, her state of being can be highly agitated. I was present at a family member’s dying as she went through this process. Two days prior to her passing, she was accepting and open-hearted about her impending death and even named the day she would pass. As the days unfolded, she moved into an agitated phase. A group of us surrounded her during her last hours, holding her and the space for her karmic unfolding. It was as if we were a mandala of open hearts breathing with her, letting in and letting go.

◈ Bringing home refers to the practice of including mundane activities in
the discipline of basic attendance, synchronizing body, mind, and environment in any activity such as doing the dishes, attending to a client’s personal care needs, preparing meals, or taking out the trash. There is no limit to the opportunities for practice. Again, the environment is a reflection of the mind and the mind is a reflection of the environment. I have witnessed family members attending to a deceased patient’s environment with precise care and attention, such as folding the ancestral blanket around the body as they prepared their beloved for a prayer vigil. These acts were imbued with meaning.

◈ Letting be has to do with a sense of equanimity in one’s care, not being
so attached to an outcome that we are focused on results, but rather remaining open to the unknown of the situation—which can be chaotic, groundless, and changeable—and also suspending judgment about one’s effectiveness. It is challenging to practice this middle path and, again, is cultivated through contemplative disciplines and the letting go of one’s agenda.

◈ Bringing along speaks to the possibility of bringing one’s world into the caregiving and not restricting one’s actions to be task-driven alone. When possible, you can include your interests as well as elements of your life—family stories, favorite books, hobbies, and so forth. One particular client of mine enjoyed having my daughter play her cello when possible, especially during the last few hours of her life.

◈ Recognizing refers to the possibility of wisdom and sanity being present in the most painful and confused states of mind and body. One 85-year-old elder with whom I worked—who wasn’t particularly known for her kindness to her own family and who had significant dementia—would often give us advice about our own lives when asked and shared a wisdom that reflected her deep concern, caring, and understanding. The ability to recognize moments to allow for a client to share their wisdom can lead to rare moments of kindness toward oneself.

◈ Finding energy has to do with the possibility of connecting with sounds, smells, tastes, visual perceptions, and touch as a means of expanding the client’s world. Even when a person is in significant decline, the sense perceptions can be soothing and relaxing. One staff member working with a woman with severe depression started taking walks through the neighborhood and tasting the fresh fruit from the trees along the way. The senses of smell and taste helped her awaken from the narrowed world of her client’s depression.

◈ Leaning in refers to the
compassionate skill of sensing when to lean into rousing a person and when to let the person be, based on your perception that the person needs or chooses to withdraw. Again, this occurs within the practice of being present and attuning to another person’s rhythm in the moment.

◈ Discovering friendship can arise within the context of caregiving intimacy and is marked by practicing honesty. The fruits of this friendship can create an environment of relaxation. Often our clients and their families feel that we are extended family. Authenticity in relationships fosters a deep trust and bond as we experience a threshold like death as we live life.

◈ Learning is about the mutual path of practicing quality caregiving. We learn as much or more from our clients when we consciously pay attention to the moments of transmission. In practicing openness to our present experience, the journey shared informs our path as we face our own uncertainties about life and death. We have had clients share themselves with us through writings and videos.

The journey shared informs our path as we face our own uncertainties about life and death.

These are the skills of the practice of basic attendance, which arise out of the mindful and aware sense of presence. They are not considered techniques. The result of meeting one’s inner and outer experiences with a sense of openness, clarity, and warmth can manifest this way. Although the practice of basic attendance is profound, it is also practical and easily accessible to everyone.