Compassion Fatigue Solutions

A little update on what WHP has been up to in the last week:

Serious stuff:
-I have been making sugar cookies with kids and went to see the new disney movie Enchanted (actually a fun movie and excellent self care. Patrick Dempsey is a nice addition to the movie for us adults who enjoy his...acting)

Fun stuff:
-I had a very interesting and stimulating dinner conversation with Dr Pat Fisher who is a clinical psychologist and workplace wellness consultant based in NYC and Vancouver. Pat Fisher is the CEO of Fisher and Associates. Her company specialises in helping agencies address the health of their organization from a systemic approach. Over the past 10 years, she and her team have developed solid, empirically tested tools and a manualised approach to helping individuals, teams, managers and the organization as a whole face the challenges of CF, burnout and other major organizational transitions and stresses. I found her work to be of the highest quality and it has real depth and substance (unlike, to be honest, much of the workplace wellness material I have come across so far). This is material developed by helping professionals who are able to go deep and make a real impact. I look forward to future conversations with Pat.

-I have been making steady progress on the Compassion Fatigue Workbook, which is nearing completion. The most time consuming part is obtaining permissions to reprint certain testing scales and tools from publishers of other works. One such conversation has already been going on for one year. A typical email goes like this:

Publisher: "how many copies of this manual will you be printing on your first round?"
Me: I email an answer
two months pass....
Publisher: "will you be selling this on your website or in bookstores?"
Me: I email an answer (even though I told them all of this in the initial email)
two months pass...
Publisher: "do you prefer apple pie with ice cream or with cheese?"
two months pass...

So, at this rate, I may have to leave out a few tools or invent new ones myself!

I am also finishing a booklet on "how to run a workshop in your community" and the train the trainer manual. However, since the TtheT manual hinges on the WtheW workbook, I will focus on WtheW first and then complete the rest.

I hope you are well and taking some time to bake cookies with children or whatever is your equivalent self care activity (maybe buying cookies and eating them without a child in sight, that might also be very relaxing).

This week, I would like to offer you an article I recently wrote for my professional association's newsletter. It is currently being considered for publication.

Compassion fatigue (CF) is characterized by deep emotional and physical exhaustion and by a shift in a helping professional’s sense of hope and optimism about the future and the value of their work. It has been called “a disorder that affects those who do their work well” (Figley 1995) The level of CF a helper experiences can ebb and flow from one day to the next, and even very healthy helpers with optimal life/work balance can experience a higher than normal level of compassion fatigue when they are overloaded, are working with a lot of traumatic content, or find their case load suddenly heavy with clients who are all chronically in crisis.

The best strategy to mitigate the impact of Compassion Fatigue is to develop excellent self care strategies, as well as an early warning system that lets the helper know that they are moving into the caution zone of CF.

If would you like to assess your current level of Compassion Fatigue, visit Dr Beth Stamm’s website and take the compassion fatigue self-test: www.isu.edu/~bhstamm/tests.htm. This test not only looks at CF, it also assesses helpers’ level of compassion satisfaction which is “the pleasure you derive from being able to do your work well.” (Stamm, 1999)

For the past 7 years, I have been working as a compassion fatigue specialist, offering training and counseling to helpers through workshops and individual counseling work. Here are some of the top strategies that workshop participants have identified as being most protective:

1.Take Stock: Check-in with yourself on a regular basis. I have my clients draw a dinner plate on a piece of paper and list every demand/commitment/concern they currently carry with them inside the plate. Then, I ask them to identify the demands that may be changeable, even by one percent. Participants often comment that they rarely take the time to take stock, let alone try to identify areas where improvement is possible. This can become an important and useful tool in monitoring your level of work and home stress.

2. Find time for yourself every day: Whether it’s 5 minutes or one hour, time for yourself allows you to regroup and refuel. Aim to rebalance your workload if you can, by spreading out your most challenging clients, or having short breaks between sessions to take a walk, do some paperwork, talk with colleagues or visit a fun, non-work related website.

3. Have a transition from work to home: Aim to leave work behind and start fresh at home. This can mean changing out of your work clothes when you get home, walking twice around the block before walking into your house or some other mindful ritual that allows you to transition and leave the work-related worries and difficult stories back at work, where they belong.

4. Learn to say no (or yes) more often: Many helpers tell me that they realize they now say no to friends and family all the time as they feel too tired or depleted to give any more. Others say that they are caregivers in all aspects of their lives, and walk in the door from work only to get phone calls from family members in need, or a pager from work or from the numerous committees they are on. Explore ways to set better limits at work or with demanding family members or friends or, conversely, try to say “yes” to something each week that is time-limited. Learning to set limits is a key tool in optimal self care.

5. Assess your Trauma Inputs: Do you read about, see photos of, and are generally exposed to difficult stories and images at your work? Take a trauma input survey of a typical day in your life. Starting with the moment you get up in the morning, note how many traumatic images and stories you absorb through the media, newspaper and/or radio. Now look at your work. Not counting direct client work, how many difficult stories do you hear, whether it be in a case conference, around the water cooler, debriefing a colleague, or reading files? Now look at your return trip home. Do you listen to the news on the radio? Do you watch TV at night? What do you watch? If you have a spouse who is also in the helping field, do you talk shop and debrief each other? There is a lot of extra trauma input that we do not need to absorb or to hear about. We can create a “trauma filter” to protect ourselves from this extraneous material. This requires mindfulness and an awareness of what is coming at us.

And a few more strategies…

-Attend Workshops/Professional Training Regularly: Further professional development has been identified as one of the top protective factors against CF by researchers in the field. It makes sense: the more competent and confident we feel doing our work, the less stressful the work is, and the less depleted we become.

-Consider Joining a Supervision/Peer Support Group: This can be very informal and involve only two or three colleagues or friends. Debriefing and connecting with others is a significant way to protect ourselves from burnout and compassion fatigue.

-Consider working part time (at this type of job): It has been found that the optimal number of days of doing direct client work is three days per week. If you would like to investigate ways to make this financially possible, there are some excellent books on this topic, such as Your money or your life by Joe Dominguez and Marsha Sinetar’s Do what you love and the money will follow. You can also explore the possibility of job sharing direct client work and taking on other duties that feel complementary and interesting to you on the other two days.

-Learn more about Compassion Fatigue and Vicarious Trauma: Read books (see below), visit websites and attend educational sessions on CF and VT. Workshops can be validating experiences where you meet other helpers and learn new strategies.

-Start small: You may not notice it right away, but making one small change to your daily routine can have tremendous results in the long term. Imagine if you started walking up two flights a stairs per day instead of using the elevator, what might happen after three months?

Recommended books on Compassion Fatigue and Vicarious Trauma:

Figley, C.R. (Ed.). (1995) Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York: Brunner/Mazel.

Saakvitne, K.W.; Pearlman, L. A., & the Staff of the Traumatic Stress Institute (1996): Transforming the pain: A workbook on vicarious traumatization. New York: W.W. Norton.

Stamm, B.H. (Ed.). (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators, 2nd Edition. Lutherville, MD: Sidran Press.

Self-Care books for Helpers:

Borysenko, J. (2003) Inner peace for busy people: 52 simple strategies for transforming your life.

Fanning, P. & Mitchener, H. (2001) The 50 best ways to simplify your life

O’Hanlon, B. (1999) Do one thing different: 10 simple ways to change your life.

Posen, D. (2003) Little book of stress relief.

Richardson, C. (1998) Take time for your life.

SARK, (2004) Making your creative dreams real: a plan for procrastinators, perfectionists, busy people, avoiders, and people who would rather sleep all day.

Weiss , L. (2004) Therapist’s Guide to Self-care.

Not as in art restoration, but as in refueling the self.

I had a very busy October, and now I am chilling out a bit, taking some time to listen to music, run, think, and do some yoga (while of course still driving kids to soccer, hockey, doing laundry and cooking meals, I am, after all, still the mother of two active youths but I've decided to let myself off the hook in terms of nonessential chores. My messy basement can remain messy for another month (or year) non? Do I really need to start Christmas shopping? I went to bed at 9pm last night which to me is incredibly decadent and restorative. I really think that there are lots of ways to carve out some restoration time even if you are buried in family demands. You have to start small. As a workshop participant said a few weeks ago: "My goal is to drink an entire cup of coffee from start to finish without being interrupted by family demands!"

I have also decided to book a day off a week from my private practice to finish several writing projects related to Compassion Fatigue Solutions. I will post some more on this in the coming weeks.

Music to accompany restoration: anything by Ben Harper or Jack Johnson will do the job. Amos Lee has a beautiful touching song called "long line of pain" that brought tears to my eyes when I first heard it: "I come from a long line of pain, my family suffered greatly for my gain. (you can buy it from itunes for 99 cents). One would think this would not be a song that takes me away from thoughts related to CF, but for some reason I love the music in that song and his smoky, sultry voice.

Web: Visiting a non-work related site such as "A photo a day from Planet Earth" planetearthdailyphoto.blogspot.com

What do you do to refuel?

Widely published author and internationally respected researcher, Dr. Greenberg is one of the primary developers of emotion focused therapy (EFT) for individuals and couples. This workshop will teach clinicians practical and specific interventions to help clients resolve feelings of anger and hurt in their relationships with others.

Using a combination of lecture, videotape demonstration and focused Q&A periods, Dr Greenberg will present three major resolution processes with an emphasis on the importance of accessing and working through emotions related to the injury: Holding the other accountable, Letting Go, and Forgiving. Dr Greenberg will also explore the differences in the process of resolving injuries in individual and couples therapy.

Dr. Greenberg’s workshops are designed to provide participants with techniques they can readily integrate into their everyday practices. His workshops are highly praised and are renowned for their atmosphere of authenticity and warmth.

Topics covered will include: Steps of an empirically supported set of interventions for facilitating the process of resolution; The therapeutic tasks of exploring the impact of the injury; Processing the pain; Changing representations of self and other in adaptive ways; Accessing compassion and empathy for self and injurer.

About the Presenter:
Leslie Greenberg, Ph.D. is Professor of Psychology at York University in Toronto, Ontario. He is the Director of the York University Psychotherapy Research Clinic and is the developer of an Emotion-Focused approach to therapy (EFT). He was awarded the 2004 Distinguished Research Career award of the International Society of Psychotherapy Research.

He has authored all the major texts on emotion-focused approaches to treatment. These include Emotion in Psychotherapy (1986), Emotionally Focused Therapy for Couples (1988), Facilitating Emotional Change (1993). Working with Emotions in Psychotherapy (1997), Emotion-focused therapy: Coaching clients to work through emotions (2002), and most recently, Emotion-focused Therapy of Depression. He was recently funded by the Campaign for Forgiveness Research to study the process of forgiveness in couples and individuals.

Dr. Greenberg is a founding member of the Society of the Exploration of Psychotherapy Integration (SEPI) and a past President of the Society for Psychotherapy Research (SPR). He has been on the editorial board of many psychotherapy journals, including currently the Journal of Psychotherapy Integration, Journal of Constructivist Psychology, the Journal of Marital and Family Therapy.

Dr. Greenberg’s workshops are renowned for their atmosphere of authenticity and warmth. His workshops have brought him critical acclaim throughout Canada and the United States, and in the United Kingdom, France, Germany, Austria, Italy, Spain, Portugal, Finland, Norway, Sweden, Argentina, Brazil, Chile, South Africa and Australia.

Feedback from reviewers of Dr Greenberg’s publications:

“There is no doubt that Les Greenberg is both a pioneer and the field's premier investigator in the important work of applying the basic research on emotions to the process of psychotherapy. The focus on primary emotions and their change is what distinguishes this book. It is a fabulous compendium of strategies for working with emotions and draws from both behavioral and experiential therapies.”

Marsha M. Linehan, PhD, University of Washington

"In a refreshing blend of clinical sensitivity and compelling research findings, the authors have done a masterful job of explaining why an emotion-focused intervention is central to therapeutic change, and describing how this may be implemented clinically. Their lucid, jargon-free exposition of conceptual and therapeutic issues proves an invaluable resource for practicing therapists of any orientation. This indeed is a landmark contribution to the field."

Marvin Goldfried, PhD, Professor of Psychology and Psychiatry, SUNY, Stony Brook

“... at the frontier of contemporary marital and family therapy”

Alan S. Gurman, Ph.D., Professor of Psychology, University of Wisconsin Medical School


Workshop Fees (lunch on your own):
$155 before December 1, 2007: $169 after December 1, 2007
Students: $120 if registered before December 1, 2007; $145 after December 1, 2007

To Register:
By phone: (613) 547-3247 (leave message for Françoise Mathieu)
By Fax: (613) 547-0655
By email: whp@cogeco.ca
By mail: 837 Princess St., Suite 300, Kingston, On., K7L 1G8
To Download registration form: www.compassionfatigue.ca

Method of payment - Please note: full registration fee is due prior to start of workshop.
Payment must be made by cheque only, payable to
Workshops for the Helping Professions.

**Cancellation Policy: An administrative fee of $30 will be charged for all cancellations 15 days or more prior to the workshop. After this cancellation deadline, no refunds will be available. If you cannot attend, you may send a substitute but must notify us ahead of time.

Workshop Outline:
Emotional injuries
• Emotion and self-organization
• Emotional change processes
Video Demonstrations
• Letting go & Forgiving
• Emotion-focused treatment of emotional injury
• Working with Injury as Unfinished business using empty chair dialogue
Resolving Emotional Injury
• Acknowledging the impact of the injury
• Working through painful emotions
• The emotional process
• Letting go of anger and hurt
• Accessing and restructuring emotional memories
Video Tape Demonstrations

Lunch: (on your own)

The Change process in working with injury in individuals
• Imagining the other
• Empathy
• The role of self-affirmation and self-forgiveness
• Change in view of the other
• Letting go and forgiveness
• Reconciliation
Video demonstration
The process of resolution of emotional injuries in couples
• Key steps
Video demonstrations
Comparing individual and couples work for resolving emotional injuries
• Common elements
• Differences
Discussion

This workshop is designed to help you:

1. Understand the phenomenon of emotional injury and forgiveness
2. Discriminate different emotions
3. Learn steps to promote forgiveness or letting go
4. Understand different emotional change processes