Chapter 3: Preparing to Care 47 Working from a Therapeutic Distance—the Metaphor of the Family Dance A “family dance” is one way to describe the dif- ferent ways that family members interact with one another. A family dance—the music, the steps, and the rhythm—is unique to a family. The family dance evolves over generations as family members respond to joy, sorrow, change, and loss. Every step of the dance has a reason and a history. Do not as- sume, however, that the family understands what they are doing and why they are doing it. When one participant in the dance sits or lies down on the dance floor because of illness or death, the family has to change its dance to accommodate the loss. The dance must change instantly, which creates confusion and chaos. As the family struggles, it is tempting to get onto their dance floor and teach them your family dance steps! However, your dance steps may not work on their dance floor. You also lose the unique and valuable perspective that staying at the edge of the dance floor provides. When you stay at the edge of the dance floor, you maintain your therapeutic boundaries, thereby decreasing the risk of becoming overinvolved and lost in your work. When you stay on the edge of the dance floor, you can: • Observe from a neutral place, without judgment • Explore—consider what you know and need to know to understand this person or the situation • Imagine what a helping, healing, and validat- ing response might look like • Preserve the integrity of the family dance But, staying on the edge of the dance floor is dif- ficult, as the border is often fluid and not easy to identify. In addition, everyone has “hooks”— people or situations that touch them in some deep, unconscious place. For example, when you care for someone who is your age, or whose father reminds you of your father, or whose child is the same age as your child, it is easy to be “hooked.” Before you even know what’s happening, you may find yourself hooked onto someone else’s dance floor, wondering how on earth you got there. People who care for the dying have an obligation to do this work with awareness. It is important that you do your “homework” by identifying your own hooks and paying attention to signs that you may have stepped onto someone else’s dance floor. It is also important to acknowledge that, at some time, all HCPs are likely to become overinvolved with a person or family in their care. Knowing the signs of overinvolvement is crucial. Work hard to maintain your boundaries and stay off the dance floor of the dying person. Being aware of your own hooks can help you work from a therapeutic distance. (Causton, 2016) Establishing and Maintaining Self-Care Practice Self-care is an essential best practice for nurses and all other members of the health care team who provide care for the dying. Burnout can occur and is a reality for HCPs who connect and disconnect from people and families time and time again in their work. It is worth repeating that Davies and Steele identify self-care as integral to best practice (Davies et al., 2016) and Butot identifies self-care as part of love in professional practice (Butot, 2005). In addition, it is significant and worth restating that Davies and Steele found that health care professionals who en- gaged in best practice experienced no or little burnout. Strategies for self-care are the focus of Chapter 8, “Caring for You!”