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  • Amy Agape

The Flow of Support in a Team Made of Rings


My patient was an elderly man, Hank, who had been living with his son, Steve, for years. They were very close, and Steve was a phenomenal caregiver for his dad. He helped him bathe and dress, cooked for him, was present for every visit from a member of our hospice team, and spent nearly all his time with Hank, listening to his dad’s stories and keeping him socially engaged.


What I began to realize, though, was that Steve provided care not only for his father, but for their entire extended family. In fact, during almost every one of my visits, I noticed that one relative or another would call or stop by, seeking emotional support from Steve. They were all experiencing grief about Hank’s decline, and they looked to Steve to help them.


He always did. He offered his compassionate listening, he guided them through tricky relational issues, he even helped with logistical problems -- all related to his father, the man whose care had occupied his time and energy for years.


It was natural for friends and family members to turn to Steve for support, because he was so very good at it.


But as I watched the pattern continue for weeks, I realized that Steve was becoming increasingly drained -- not only from the physical and emotional demands of caring for his father but from the physical and emotional demands of caring for their entire family. Almost every time someone called or appeared at the door, it seemed they did so in order to dump their burdens on Steve. They departed looking lighter and leaving Steve looking more exhausted.


This situation is not unique. Indeed, I have witnessed it happen many times in both my professional and personal worlds. The person or persons most in need of support become the source of support for others.


Psychologist Susan Silk noticed the same phenomenon and created The Ring Theory to teach all of us how to offer and receive support by paying attention to one simple element: the flow of support. Silk specifically focuses on the words we say to one another during times of crisis, which she divides into two categories: dumping and comforting. However, I like to use her Ring Theory to conceptualize every type of support, including but not limited to conversations. Indeed, I utilize her method frequently when creating and managing my own Healthcare Team and those of others.


You can read more about Susan’s creation of the theory here:


Here’s a brief outline of how it works:

  1. Picture the person at the center of the crisis (this can be any type of crisis of any degree of severity). That person occupies a circle. (my patient Hank would be here)

  2. Around that circle are rings of ever increasing size

  3. The closest ring to the innermost circle is held by the person nearest to the center person (Steve, in our example).

  4. As the rings grow larger, they include people in decreasing degrees of closeness to the person in the center.

  5. Dump In/Comfort Out -- we offer support to those in rings that are smaller than ours, and we seek support from those occupying the larger rings than ours.


I find it useful to actually draw this ring image and label it for every patient, client, and family in my care. It helps me visualize the flow of support that is optimal, and it enables me to discern when there need to be changes to that arrangement.


I also use it in my own life to help remind me of my responsibilities in regard to the other Healthcare Teams on which I serve, those of my family members and friends. It’s an easy visual to keep in mind as I consider who are the ideal people for me to seek comfort from and where I should refrain from dumping.


My invitation is to play with Silk’s Ring Theory as you navigate all your Healthcare Teams, both the one at which you are the center and those on which you serve. If you’re willing to share, I would love to learn more about the rings in your life!

© 2018 by  Amy Agape

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