Compassion Fatigue Solutions

That's me, baking Christmas cookies...I realised a few years ago that I am a bit of a cookie tyrant around this time of the year as the cookies are gifts for the guitar teachers, caregiver etc. My family sometimes ask "can we have one little cookie?" and I glare at them and say: "maybe, once I've made all the gifts, you can have the broken ones." Nice, eh? Now I am aware that this is not a lovely trait of mine. So this year I'm going to make a second batch just for them...

I am taking a few weeks off with my family. I will post again in January (likely January 11th or thereabouts). Thank you for your readership this year. I wish you and your loved ones a peaceful and restful holiday season.

Françoise

I have been travelling backwards on a train for the past hour. We were about an hour away from Toronto when something went wrong with the train in front of us. I don’t know the details (as none have been communicated to us) but it means that we have had to travel backwards and now have to wait to connect with the broken train and tow them all the way to Toronto. This, we were told, is going to take “a very long time”. Since then, we have gone backwards, forward, backwards again for long stretches of time.

This means that I have missed my connecting train and that every minute that goes by, I am travelling further and further away from my destination.

Now this is a good time to be mindful! One of my best friends has told me that I am “the queen of the positive reframe” and she wasn’t feeling warm and fuzzy when she said it, as she felt very irritated by a contretemps we were experiencing and I was telling her "look on the bright side, at least we don't have to climb THAT hill over there!."

So, here is the positive reframe, (Just for you, Mary, ☺). Five good things about this mishap:

1) No one is waiting for me at the station if and when I arrive so I'm not putting anyone else out.
2) One of my dearest friends gave me a cd for my birthday with 89 songs on it, many from our days as punk rockers in Montreal. So I’m having a very enjoyable walk down memory lane. (Thank you Jimmy!)
3) I could be on the other train, the broken one, where there has been no heat and no washrooms for the past hour and a half...
4) I could have two toddlers with me
5) It might turn out that I am sitting on my connecting train as this train changes identity once it gets to Toronto. Which will mean I have not missed my connection at all.

Plus, what the heck can I do and what is the point of making it a miserable time for myself?

So there you go, that’s my positive reframe. Talk to me again in a couple of hours and see if I’m still feeling perky.

Safeguards Training for Children and Adult Services is sponsoring four of my Compassion Fatigue workshops this Winter: Two in Markham and two in London. If you are a member of CMHO, OARTY, ONTCHILD/YPRO, ANCFSAO or Community Living Ontario, the price of these workshops is extremely low.

In addition, a non-sponsored version of these training sessions are being offered in Kingston. Visit my website for more details.

Walking the Walk: Creative Tools for Transforming Compassion Fatigue

January 18, 2010 - Holiday Inn & Suites, Toronto (Markham)
or
March 29, 2010 - Delta London Armouries, London, On.

Description
Françoise Mathieu, M.Ed., CCC.Certified Counsellor, Compassion Fatigue Specialist and Director of WHP will present this one day training (this will be followed by the Trainer-the-Trainer session so you can take this valuable training back to your agency.)

Compassion fatigue 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 compassion fatigue a helper experiences can ebb and flow from one day to the next, and even very healthy helpers with optimal life/work balance and self care strategies 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.

Compassion fatigue is a normal consequence of working in the helping field. The best strategy to address 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 Compassion Fatigue. This is a highly interactive one day workshop, incorporating a combination of solo, small group and whole group activities.

Registration Details & Fee(s):
Members: Training Fee: $0 plus $50 Admin Fee+GST
Non Members: Training Fee: $99 plus $50 Admin Fee+GST

To register click here

Compassion Fatigue Train the Trainer: 2 day course

January 19-20, 2010 - Holiday Inn & Suites, Markham
or
March 30-31, 2010 - Delta London Armouries, London

Description
Françoise Mathieu, M.Ed., CCC.Certified Counsellor, Compassion Fatigue Specialist and Director of WHP has designed a two day, intensive train-the-trainer retreat on Compassion Fatigue.

This train the trainer workshop offers tools, handouts, strategies, training material and marketing strategies to adapt Walking the Walk to your agency's specific needs (and to your own presentation style).

The train the trainer workshop is designed to take you deep first, to gain a true and thorough understanding of your own relationship to CF. Then you will learn the didactic details (what to teach, how to teach) and finally talk about the mechanics of the whole process (how to customize this for your own work needs/goals etc.).

Spaces limited to a maximum of 20 participants.Certificates of Completion will be provided

PREREQUISITES**
Prior attendance to the full day or half day workshop Walking the Walk is required. (You may have attended a session at your workplace, or in a different community in the recent past). For those who have not attended this workshop in the past, Walking the Walk will be offered on the day prior to this training. If you have attended Walking the Walk at an earlier date, please indicate when that was on your registration form.

Outcomes
You will Learn:
·How to use the Compassion Fatigue Workbook
·What are Compassion Fatigue, Caregiver Stress, Vicarious Traumatization and burnout
·Signs and symptoms of CF/VT/Burnout
· Assessment tools
· Warning signs
· Resiliency skills
· Self Care Strategies
· Academy of traumatology standards of Ethics
· How to offer psychoeducation on this topic
· Experiential activities that work with audiences
· How to design your own workshop: what is your target audience

Pricing
Member fee $52.50
Non-member fee $260.40

To register click here

For more information contact:
Contact Name: Donna Stevens
Contact Phone: (905) 889-5030
Contact Fax: (905) 889-7155
Contact Email: donna@safeguards-training.net

Gabor Maté's workshop in Toronto last week attracted so much interest that the location had to be changed: Within days of posting the event, five hundred participants had signed up. The organisers had to scramble and find a new location for the event and settled on a movie theatre. I was a bit sceptical when I settled myself in for the talk: there were no visual aids, just a gaunt man dressed in black standing at the front of the theatre with a few newspaper clippings in his hands. And then, the day began and I lost track of everyone else in the room. Dr Maté is a gifted and riveting speaker.

Instead of trying to explain his message in my own words, here is an excerpt from his website which describes the message in the book and in his workshop:

"Can a person literally die of loneliness? Is there a connection between the ability to express emotions and Alzheimer's disease? Is there such a thing as a "cancer personality"? Questions such as these have long surrounded an often controversial debate regarding the connection between the mind and the body in illness and health. As ongoing research is revealing, repressed emotions can frequently lead to stress—which, in turn, can lead to disease.

Provocative and beautifully written, When the Body Says No provides the answers to these and other important questions about the effects of stress on health. In clear, easy-to-follow language, Dr. Gabor Maté lucidly summarizes the latest scientific findings about the role that stress and individual emotional makeup play in an array of diseases, including heart disease, diabetes, irritable bowel syndrome, multiple sclerosis, arthritis, cancer, and ALS, among others.

Offering profound insights into the link between emotions and disease, When the Body Says No explores the highly debated effects of stress on health—particularly of the hidden stresses we all generate from our early programming. Dr. Gabor Maté explains how, when the mindbody connection is not optimal, various illnesses can crop up—everything from heart disease and eczema to irritable bowel syndrome and ALS. He presents the scientific evidence that a connection exists between the mind and the immune system—along with illuminating case studies from his years as a family practitioner that reveal how one’s psychological state before the onset of disease may influence its course and final outcome.

As Dr. Maté wrote in The Globe and Mail: “When we have been prevented from learning how to say no, our bodies may end up saying it for us.” When emotions are repressed, this inhibition disarms the body’s defenses against illness. And, in some people, these defenses go awry, destroying the body rather than protecting it. Despite a rapidly accumulating body of evidence attesting to the mind-body unity, most physicians continue to treat physical symptoms rather than persons. When The Body Says No argues persuasively that we must begin to understand the mindbody link in order to learn more about ourselves and take as active a role as possible in our overall health.

Dr. Maté explains how the dynamics of self-repression operate in all of us. With the help of dozens of moving and enlightening case studies and vignettes drawn from his two decades as a family practitioner, he provides poignant insights into how disease is often the body's way of saying "no" to what the mind cannot or will not acknowledge.

Above all, When the Body Says No promotes learning and healing and helps improve physical and emotional self-awareness—which, Dr. Maté asserts, is at the root of much of the stress that chronically debilitates health and prepares the ground for disease." from www.whenthebodysaysno.ca.

Dr Maté will be returning to Toronto for an encore in June.

**Addenda: I have just received the flyer for Dr Maté's next presentations: June 28th 2010 at the AGO in Toronto and June 29th at the Cinémathèque in Montreal. For more information visit the Hinks Dellcrest Centre.

I am posting a bit late this week - I was in Toronto yesterday, attending Dr. Gabor Maté's workshop on stress. I will write more on this later as it was a very rich day of learning and Dr Maté deserves his very own post.

Last week, I had the privilege of sharing the podium with Dr David Kuhl at a conference hosted by the Elizabeth Bruyere Continuing Care Centre in Ottawa. Dr Kuhl is both a physician and a psychologist and he is the director of the Centre of Practitioner Renewal (CPR) at Providence Care in Vancouver. The CPR was created several years ago to offer support to staff members of the hospitals of the Providence Care network. At the CPR, Dr Kuhl and his colleagues offer counselling and education to health care workers and carry out research related to compassion fatigue and helper wellness. They work with individuals and also with entire teams to try and improve staff relationships and enhance the quality of care.

Dr Kuhl is a very erudite and skillful presenter and his session was inspiring and illuminating. I really appreciated the focus he puts on teams and the challenges they are facing in health care.

Conference participants had many questions for us about organizational challenges and expressed their frustration at the current state of affairs in health care. Their anger and exasperation towards the system was expressed strongly throughout the day. This is not an isolated case: I have the opportunity to meet hundreds of health care professionals each month from across the country and the evidence is overwhelming: physicians, nurses, allied health professionals and hospital managers are struggling. Health care workers all over Canada describe having to do more with less resources and trying to deliver quality of care when staffing has been cut beyond what is realistic. Last week, one nurse told me about mandatory overtime where nurses are not allowed to say no when the hospital calls. She talked about nurses who work in remote communities who get a knock at their door when they don't answer their phone - in order to force them to come to work.

Taking a step back, how can quality patient care be delivered when you have been coerced to come to work for an additional shift? It simply does not make sense.

What happens, of course, is that we all suffer, patients and health care workers alike: we turn on our colleagues, we resent any extra time off they take (I call it the "must be nice phenomenon"), we blame our managers whom, we feel, "don't understand". Perhaps that is sometimes true, but I meet with different managers weekly and they say they feel like "the peanut butter in the sandwich", squeezed between upper management, ministry demands, staff needs and concerns and patient care. A very difficult position.

So, what to do about all this? Sometimes we can try going the advocacy route, protesting to the upper echelon in various ways, not voting for a government that doesn't value health care workers (and also doesn't believe in a restorative justice system, but I digress). But sometimes we feel that we do not have a voice. We feel stuck.

In my opinion, to find our voice within this deeply flawed system, we need to gain a better understanding of organizational health. This is what my esteemed colleague Dr Pat Fisher does. Dr Fisher is an organizational psychologist as well as a trauma specialist and she has spent the last two decades working within our system. She has developed an approach to diagnosing and enhancing organizational health and the results are very convincing: a year after her interventions, agencies report a significant improvement in decreased absenteeism, productivity, decreased job stress and employee wellness. Pat has developed the 4 tier, 12 factor model of organizational health. I invite you to go read more on her important work.

Not by my own choosing, mind you, but my computer crashed last weekend. It was kaput, finito, dead as a doornail. Apparently the hard drive was damaged and "could have gone at any moment" said the repair person. The good news is that I have been pretty good about backing up my files (not perfect, though and not unlike a break-in, it's only weeks later that you think "where's that thing? I haven't seen it in ages" only to realise it was part of what went missing.) But I'm in pretty good shape, all things considered.

So, for those of you who are lackadaisical about backing up your files, a word to the wise. My computer savvy hubby says we should all back up our computers every single night at the end of a day's work. He also recommends using gmail as an email server, as it will store both received and sent mail from your computer and you will never again lose your sent mails (which is a big issue for me as it is where I do the bulk of my work). I am sure some things will fall through the cracks though, so if you emailed me recently and have not heard back from you, can you write again? Thanks and sorry in advance.

Last week was rather training-intense, with two half day sessions with oncology and palliative care staff in Montreal, and three days with York Region's community and health services. I had a lot of fun. I enjoy meeting new people and hearing about the work that they do, with its challenges and rewards and pitfalls along the way. I particularly appreciated the training space at York Region's Newmarket site. When you do a lot of training, you become pretty attuned to group dynamics and the impact that a training space has on people who are, after all, kind of trapped together for a whole day. This space had a ton of natural light (big windows), high ceilings, carpet on the floor (good acoustics), comfortable chairs and enough space to move around. It really makes a difference to the whole experience. Thank you to Nancy Hogue for driving me all over the GTA and not laughing at my geographical dismay!

Now I am back in quiet little Kingston where driving my boys to the football game took approximately 1.5 minute (go gaels go) and getting front row seats to the santa claus parade meant arriving 5 minutes early and sitting in a local restaurant with front row (warm) seats for the show. I cannot say enough about the quality of life offered by living in a small community.

On the menu this week: The two day Compassion Fatigue Train the Trainer workshop (if you are interested in attending this training down the road, please visit my website and also note that there are only 20 seats per session and that this course fills up very quickly) I will not be offering a June session this year as I cannot get the training space that I want, so after the March session, I will likely not be offering this course again until the Fall. I am then going to Elizabeth Bruyere in Ottawa for a palliative care conference.

Have a great week, don't forget to tell your computer that you love it, and after giving it a big wet kiss, back it up right away.

Hi, how are you? Have you started your Christmas shopping yet? :-)

I had a very interesting week and had the pleasure of presenting at the stunning Dundurn Castle in Hamilton to professionals working in developmental pediatrics at Hamilton Health Sciences and in the community. Thank you for your warm hospitality and for tolerating my big booboo at the train station (basically I made someone wait for me for 1.5 hours due to a comedy of errors...so sorry...)

The week ahead is a busy one: I will be presenting at the CHUM in Montreal on Tuesday, working with health care staff from palliative care and oncology. Then, it's off to Newmarket to work with Ontario Works staff from York Region, for three days of training. Next week is the two day Compassion Fatigue Train the trainer back home in Kingston. For those of you who may be interested in attending the next Train the Trainer, which is being held in March, please note that there are only 20 spots available and that registrations are coming in fairly steadily, therefore to avoid disappointment, please consider registering soon. Please also note that from March onwards, there will be a prerequisite to attend the Train the Trainer workshop: you must have completed a full day or half day "Walking the Walk" session at some point in the past or simply attend the one day training being offered on the day prior to the Train the Trainer session. For more information click here.

Something new: I will be offering an e-learning session for a private group in a couple of weeks via a process called Fireside Chat: it's a very simple and affordable process whereby participants use their laptop and a phone line to take part in a teleconference while being able to view the power point slides. If I like it, I might use this to start offering some distance learning sessions in the new year.

I am changing decades in two weeks. Gulp.

Finally, if you are building a christmas wish list for yourself, I would like to recommend some good old standbys from my library:

Take time for your life by Cheryl Richardson
Mindfulness-based stress reduction cd package by Jon Kabat-Zinn
50 ways to simplify your life by Patrick Fanning

In peace,

Françoise

I received several emails this week from people who read this blog. It was very nice as it puts faces to my readers and I'm never sure who is "out there" actually reading these posts. So, Hello dear friends and colleagues (Hi Deb - it was lovely to have tea yesterday, we should do that more often. Go write that book, it's going to be a fantastic resource!).

I am posting my blog post early this week as I am taking Monday off - it's been a hectic past few weeks with a lot of travelling and presenting, and it's time for a bit of self care for this workshop presenter.

This was an interesting week: I presented a one hour talk on PTSD to a second year Abnormal Psychology class at Queen's University (weird timing given the Texas shooting, I'll return to that in a minute) and offered an evening and a one day session for the Alzheimer's Society here in Kingston. The evening session was for family caregivers and the day for helping professionals. I learned a lot during both events. I can tell you one thing: when I am elderly and in need of long term care, I hope to receive care from people such as the ones on the panel. These folks, most of whom have been looking after elderly patients with dementia for 20-30 years, radiated with compassion for their clients. When they described why they love their work, their faces started lighting up. I can't quite capture it now, as it is 6am and I'm about to take my son to play hockey, but it was something very moving. Everyone on the panel also spoke of their self care strategies and it was clear that they have remained compassionate and resilient because, in part, they had learned to care for themselves both physically and emotionally. All of them exercise on a regular basis, try to eat well and have a strong support network.

It was also wonderful to present to family caregivers. These folks have been caring for a loved one with for years, often on their own, often in their homes until they can no longer do it. I hope I was able to offer a little bit of support to them, in my limited ways. It was certainly an honour to meet you all.

I will not wade into the massive speculation that took place in the media this week surrounding the psychiatrist who went postal and killed a dozen military personnel in Texas. If you have google alert you will have been deluged with posts discussing and speculating on whether this man suffered from vicarious trauma and whether that is what led him to kill. The problem with the internet, of course, is that there is a lot of rubbish being written by pretty much anyone who can type, and there is some good stuff in among all that. I found a good discussion on the topic, written by Drs Figley and Pearlman and other solid sources, so I invite you go read this to if you want a sensible analysis of the few facts that are known at this time.

As for me, I'm off to Hamilton this week to present to helpers who work in developmental pediatrics. I also want to rake leaves, make soup and go for a run in the crisp November air. I hope you also have a good week and can fit in some time to exercise, stretch and breathe.

Namaste.

Last week, both my children came down with the flu (likely the most popular strain currently deluging the media). So my husband and I juggled: we shared the home care for the week (I was co-teaching a three day Crisis intervention course) and washed our hands like mad and tried to resist giving hugs and kisses to them (now, that was hard). They are back in school and seem to be on the mend and we are trying to catch up on missed deadlines and the lot.

It was nothing very serious, but it reminded me of the incredible stress of having younger children and getting the dreaded call from the daycare, which normally meant that not only Poopsie was sick today, but he/she was going to be banned from daycare for the following day, until they were deemed to have been fever-free for a full 24 hours. As soon as I would see the daycare number on call display, my mind would start racing, thinking about coverage for the following day, what was I going to do with the suicidal client I had just safety contracted with (the deal being that they would come back to see me on the next day), who would see the couple who had travelled 2 hours to come for a session who were already on their way to the office, and where would I fit in all the people who had been moved to the following day. Of course, it always worked out, somehow, but the stress involved was significant. And I'm talking about minor ailments here, not the catastrophic illnesses that so many people cope with.

Working as a front line worker has many rewards but the challenging reality is that you have to be "on" when you're at work. You were up all night with a sick family member? Too bad, you have to be 100% focused right now. There are no half measures really. Of course, there are many ways to help each other out - family and friends can step in, if they live nearby, but the stress of the unkwown never really goes away when you are a front line health care worker.

Of course, with the flu outbreak this week, hospital and public health workers are facing a mounting workload and having to deal with many stressors all at once - the hours-long lineups for vaccination speak for themselves, as do the crowded flu clinics.

This morning, I heard a very topical radio interview on CBC's The Current on the impact of the pandemic on health care workers. On the show was Dr Robert Maunder, a psychiatrist at Mount Sinai Hospital in Toronto who is part of a team who have developed The Pandemic Influenza Stress Vaccine, an online course for health care workers to help us develop resiliency skills while facing the pandemic. He said that several studies found that health care workers who were in the thick of things during the SARS epidemic were found to have lasting psychological effects from working in the SARS environment (more fearful of contamination for long periods of time following the end of the SARS outbreak).

Let me quote from their press release: "A computerized course for health-care workers worldwide to build their resilience during a pandemic. Based on the SARS outbreak in 2003, Mount Sinai experts understand that the spike in health-care workers' stress-related absenteeism results from fear of contagion, concern for family health, job stress, interpersonal, isolation, and perceived stigma. That's why Mount Sinai researchers Dr. Robert Maunder and Dr. William Lancee led a pilot study of computerized training for 150 Mount Sinai health-care workers in 2009. The results suggest that the training improves health-care workers' belief that they can handle the changes a pandemic brings, confidence in support and training, and interpersonal problems. This also suggests that the training may be able reduce stress-related absenteeism. From these findings, the researchers are launching The Pandemic Influenza Stress Vaccine course, which will be an education tool and also the basis of pandemic resilience research.

The course is available over the Internet making it widely accessible at no cost for the health-care workers. The goal is to reach 3,000 health-care workers worldwide.

The course is now live. It is part of a randomized control trial. Hospital-based health-care workers can register at
www.msh-healthyminds.com/stressvaccine. The pilot study was funded by Canadian Institutes for Health Research."

I have not yet had time to go take a look at the course, but Dr Maunder suggests that if you are a health care worker facing the onslaught right now, it may be very worth your while to take a few minutes out of your day to take the course now, rather than wait until you are not in the eye of the storm.

(photo from Tema)

A few days ago, my daughter and I caught a public service announcement (PSA) on TV that took our breath away. Maybe you've seen it - During the first few frames, cute little kids in various emergency personel uniforms state their career dreams: "I want to be a police officer" says a sweet 6ish year old girl, "I want to be a firefighter" says a gorgeous nine year old boy, and so on. Then, the ad returns to each one and they continue: "But I'm scared..., (and now I am basing the rest on recall) "I'm scared that my job is going to hurt me, I'm scared of the nightmares, the horrible images, of not being able to get them out of my head. I'm scared that helping other people is going to permanently damage me" and gradually you realise that this is an ad about PTSD (the ad was far better that my clumsy attempt at describing it!).

The hockey game were were watching was "Don Cherry Military Night in Kingston" - an OHL game in honour of Canadian military personnel. There were several PTSD awareness-raising messages throughout the night and the aim of the whole evening was clearly to convey to soldiers of all stripes that PTSD is a common problem for military personnel and that help is available.

Having worked with the military for the past decade, I believe that this message needs to be conveyed to military staff in as many ways as possible. There is still a huge stigma about PTSD among the Forces - many military clients have told me that they would never want the label as they see it as a sign of weakness and they fear that if they sought help for it, they might be demoted or, worse, discharged from the military. There is also a perception among many soldiers that it's a "copout label" - sometimes, they say, used dishonestly to seek a pension and benefits. Perhaps that is true on occasion, but my own clinical experience and the data shows that there are far more genuine cases of PTSD than malingerers and this perception is yet another obstacle for soldiers who really need help.

So with PTSD, we are battling many layers of cultural assumptions, prejudice, institutional dysfunctions and shame. An uphill battle indeed. Meanwhile, the soldiers with undiagnosed PTSD continue to struggle on their own, often using alcohol to numb out, turning their domestic lives into total turmoil, lashing out at their spouses, their children and at themselves.

But let's go back to the TV ad with the kids:

It turns out the PSA was produced by a Canadian organisation called Tema: the Tema Conter Memorial Trust. Maybe you have heard of it? They are not an organisation I know anything about, so I went to their website to take a look.

Their story is as follows:
The charity was founded by Mr. Vince Savoia, an attending paramedic at the murder scene of Ms. Tema Conter in 1988. Upon coping with post-traumatic stress as a result of this horrible episode, Mr. Savoia created the Tema Conter Memorial Trust. The trust’s purpose is two-fold: to honour the memory of Ms. Tema Conter and call attention to the acute trauma encountered by emergency services workers. These courageous and compassionate individuals are haunted by the scenes they encounter on a regular basis, and they need our help. Because heroes are human.

If you go to their website they also have a very powerful second ad called "Hands".

On a personal level, it was a great ad as it led my daughter and I into an interesting discussion. She said "That's the work you do, isn't it mom? Help people who are hurt by their work?" and I said "Well, yes, and I help the people who help the people who are hurt by their work and that, in turns sometimes hurts them too." "Wow", she said "What a strange job you do!" And I thought "Yes, what a strange, painful, moving, wonderful, rewarding job."

There was a PTSD awareness-raising Major League baseball game this summer. It was for US military personnel and had a similar message: this is common, this is normal, get help, you are no less of a man for suffering from this.

Now, it would be pretty cool if we had a PSA about vicarious trauma one day, but I wonder how it would go over? How would we, the helpers feel? How would the public react to hearing how hard we sometimes find our jobs? A PSA about Vicarious Trauma. How about that?

I am right in the middle of reading this book but wanted to share it with you as it is such a find. The author has over 20 years of trauma work under her belt and brings a very fresh look to vicarious trauma.

She explains the use of the term stewardship in the following way: "As I see it, trauma stewardship refers to the entire conversation about how we come to do this work, how we are affected by it, and how we make sense of and learn from our experiences. In the dictionary stewardship is defined as "the careful and responsible management of something entrusted to one's care." (Van Dernoot Lipsky, 2009)

I was instantly grabbed by the book's introduction, called On the Cliff of Awakening, which articulated something I could completely relate to (so could thousands of helpers I have met along the way.)

To quote from her intro:

"Are you sure all this trauma work hasn't gotten to you?" He asked.
We were visiting our relatives in the Caribbean. We had hiked to the top of some cliffs on a small island, and for a moment the entire family stood quietly together, marveling, looking out at the sea. It was an exquisite sight. There was turquoise water as far as you could see, a vast, cloudless sky, and air that felt incredible to breathe. As we reached the edge of the cliffs, my first thought was, "This is unbelievably beautiful." My second thought was "I wonder how many people have killed themselves by jumping of these cliffs." Assuming that everyone around me would be having exactly the same thought, I posed my question out loud. My stepfather-in-law turned to me slowly and asked his question with such sincerity that I finally understood: my work had gotten to me. I didn't even tell him the rest of what I was thinking; "Where will the helicopter land? Where is the closest Level 1 trauma center" [...] this was the first time I truly comprehended the degree to which my work had transformed the way that I engaged with the world. " (Van Dernoot Lipsky, 2009)

I will share more about this book as I read on, but so far, it's very engaging.

Chapter headings are:
Part One: Understanding Trauma Stewardship
Part Two: Mapping your Response to Trauma Exposure
Part Three: Creating Change from the Inside Out
Part Four: Finding your Way to Trauma Stewardship

Hi! Here I am, after a bit of a silence. Last week was Thanksgiving and thus no Monday post.

I am just back home after a long weekend in Chicago. Once every two years or so, I try to arrange childcare (my wonderful friend and I have a great arrangement where we help each other out) and get enough air miles to join my partner as he attends a scientific conference. The kids and I teasingly call him and his friends "neuronerds" as they are all neuroscientists and really into their science. The nerd quotient was fairly high this time around (25 000 attendees). But nerds can let their hair down with the best of them, I assure you.

Chicago is a beautiful city with stunning architecture. We walked a lot, visited the Art Institute of Chicago and ate one of the best meals I have ever had (no joke) at Topolobampo. If you love authentic mexican cuisine and are going to be in Chicago consider booking a table (way ahead of time) at this spot.

Upon my return, I had an interesting exchange with my eleven year old daughter. She reported feeling upset about all my travelling, and said that she liked it better when I didn't do so many speaking engagements, but rather stayed home all the time. I said to her "but sweetie, when I was doing clinical work 5 days a week, I often came home exhausted and grumpy, I was short-tempered with you, and I never had time or energy for anything. Now when I am not travelling, I am home a lot more, I can pick you up from school, we bake cookies, we have time for crafts, for errands...things are way better now." and she turned to me and said: "You were never grumpy. I never noticed that." Now, I don't think that is actually true, as her only goal at this time is to make her mother never leave the house again, but I thought "maybe I faked it better than I thought."

Ah, the joys of being a parent - guilt on tap every time you turn around.

In actual fact, I am home far more than I am away, and this is by far the best career choice I have ever made (and the most professionally satisfying choice to boot.) But it did make me think about the juggling most of do between all of the demands on our time.

It's never simple to simplify our lives. Ironically.

by Robert J. Wicks, Oxford University Press

This short, reflective book was written specifically for clinicians: psychologists, mental health counsellors and social workers. It will be most useful to those with a background in clinical psychology who do face to face work with clients on a regular basis.

Dr Robert Wicks is a psychologist and a professor at Loyola College in Maryland. "A recognized expert in the prevention of secondary stress, in 1994 he was responsible for the psychological debriefing of relief workers evacuated from Rwanda during that country's bloody civil war." (from his book bio)

I was thrilled to see that Dr Wicks centers his approach on the use of positive psychology and mindfulness.

Robert Wicks explains his goal in writing the book as: "to introduce and highlight those areas that can help renew clinicians in today's challenging climate. It is amazing how little it can take to change the emotional tide in favor of such a beneficial move. Small alterations can sometimes jumpstart a positive step to a healthier attitude more than disputing dysfunctional thoughts ever can."

Chapters headings are:

Sensing the dangers: Chronic and acute secondary stress
Enhancing resiliency: strengthening one's own self-care protocol
Replenishing the self: Solitude, silence and mindfulness
Daily debriefing; Mindfulness and positive psychology

My conclusion: A lovely erudite book on self care for clinicians who are ready to reflect on their own journey of compassion fatigue and self care.

I am just back from Yellowknife where I presented at a conference organised by the Federal department of Justice called "Northern Responses and Approaches to Victims of Crime: Building on Strength and Resilience." Over 250 victim support workers from across Canada met for three days to share ideas, research findings and to connect with each other. This was the first meeting of its kind and it was, in my opinion, a complete success. I had the opportunity to meet victim assistance workers from all areas of Canada, from Whitehorse to Rankin Inlet to Thompson Manitoba to Kuujjuak (my childhood villlage) in Northern Quebec. I have been to many conferences over the years, and this was the friendliest, most well organised of them all.

Why hold a victim support conference with a special focus on the North? Here is some sobering data from the Policy Centre for Victims Issues (PCVI) press release:

"According to the 2004 General Social Survey, residents of the territories were three times more likely than provincial residents to experience a violent victimization such as sexual assault, robbery or physical assault (315 versus 106 incidents per 1,000 population). Residents of the North also experienced higher levels of spousal violence than their counterparts in the provinces.

Approximately 12% of northern residents reported being the victim of some form of violence at the hands of a current and/or previous spouse or common-law partner in the five years preceding the survey. This compares to 7% of the population in the provinces. Residents of Nunavut were also far more likely to have been victims of spousal violence (22%) than residents of the Northwest Territories (11%) and the Yukon Territory (9%).

Similarly, police-reported crime rates in the territories were substantially higher than rates in the rest of Canada. Specifically, in 2005, crime rates in the North were over four times higher than rates in the provinces (33,186 compared to 7,679 incidents per 100,000 population). In 2005, the Northwest Territories had the highest police-reported crime rate among the three territories at 41,245 incidents per 100,000 population. This rate was 1.3 times higher than the rate in Nunavut, 1.8 times higher than that in Yukon and nearly three times higher than that in Saskatchewan, the province with the highest provincial crime rate (14,320)."

We heard a captivating and reflective keynote address by Justice Gerald Morin, Deputy Judge of the Territorial Court of the NWT and creator of the Cree Court in Saskatchewan. We were also were incredibly fortunate to have an evening performance by Leela Gilday, an award-winning Yellowknife singer and songwriter. Leela's songs were deeply moving and her voice was incredible. I was very glad that my meek keynote address came before her and not after her powerful performance!

Conferences such as this one offer all of us the opportunity to stop for a few days (well not really stop, it was a jam-packed agenda and people were working hard) but certainly the chance to get out of the trenches to connect and reflect on the work that we do. I met some victim support workers who had some significant challenges in their own lives (dealing with fostering several children with fetal alcohol syndrome, to name just one) and the complexity of offering services in a remote community, where everyone knows you and where you are often the end of the line. To all of these workers, I offer my most sincere thanks for their warmth, their open hearts and their willingness to participate in the workshops I offered.

This will be a short post as I am just touching down in between trips, coming in from Charlottetown, doing my laundry, kissing the kids and heading straight back out to Yellowknife. (Well, I did bake some banana-bran muffins too, in a probably futile attempt to have my kids eat healthily while I am away, and, yes, I know I have control issues...). This week, I will be taking part in a large conference for professionals who work with victims of crime, organised by the Department of Justice for the North West Territories and Nunavut.

During my pit stop in Kingston, I had a chance to go hear some music. Live music can be so good for the soul (when it's good, I heard some pretty awful stuff last night) but I also heard the fantastic Canadian folk duo Dala. They can harmonize like nobody's business and have a great sense of humor and wonderful musical sense. It was such a treat.

I'll write more when I am back from Yellowknife. I hope you all have a good week, with a bit time to listen to some music perhaps?

Photo from MNR

Vous connaissez l'initiative d'art thérapeutique montréalaise des "Impatients," dont la porte-parole est Clémence Desrochers? Sinon, lisez un peu et voyez ce que vous en pensez...Quelle superbe projet!

Voici une citation du site web des Impatients:

"Le centre Les Impatients est un lieu d’expression et d’interprétation de l’art thérapeutique et de l’art brut. Il a comme double mission :

-D’offrir un lieu d'expression artistique aux personnes atteintes de problèmes de santé mentale.

-De favoriser les échanges avec la communauté par la diffusion de leurs réalisations.

Historique

En 1989, la Fondation des maladies mentales, de concert avec l’Association des galeries d’art contemporain de Montréal, expérimente un atelier d’art-thérapie à l’Hôpital Louis-H. Lafontaine sous la direction de madame Suzanne Hamel, art-thérapeute.

En 1992, la Fondation des maladies mentales appuie la mise sur pied de la Fondation pour l’art thérapeutique et l’art brut du Québec qui ouvre un nouvel atelier à Pointe-aux-Trembles.

En 1999, la Fondation pour l’art thérapeutique et l’art brut du Québec choisit de se faire connaître sous l’appellation Les Impatients et ouvre ses portes en plein cœur du centre-ville afin de permettre à un plus large public de bénéficier des ateliers d’art-thérapie et de musicothérapie. Ces nouveaux locaux offrent des espaces pour la diffusion des œuvres des Impatients en présentant une programmation riche et diversifiée d’événements.

Parle-moi d’amour, événement principal de l’année, est une exposition-encan réunissant des artistes en arts visuels et des Impatients. Cette campagne de financement, qui a lieu au mois de février, est une source de revenus essentielle à la poursuite des ateliers qui sont offerts gratuitement aux participants. À cet événement s’est ajouté l’édition du coffret Mille mots d’amour."
Fin de la citation

Mille Mots D'amour

"[...] Cette année, Mille Mots d’amour en lecture en est à sa cinquième édition et on y trouve des lettres aussi prestigieuses que celles de Clémence DesRochers, Fred Pellerin, Rita Lafontaine, Lise Dion, Carole Laure, Nancy Huston, Leonard Cohen, même une inédite de Jacques Brel adressée à Clairette, son amie.

Mille Mots d’amour en lecture est un coffret qui regroupe 141 lettres d’amour de célébrités, journalistes, médecins, jeunes du secondaire et «impatients» qui profitent des ateliers de création de la Fondation Les Impatients. Grâce à la vente du coffret, cet organisme peut continuer d’offrir ses services à quelque 300 personnes atteintes de maladie mentale chaque année. On espère cette année amasser 80 000 $." Agnès Gaudet, Extrait du journal de montreal, 18-01-2009

Pour ma part, après avoir entendu une lecture d'une lettre d'amour au futur de Jacques Attali, j'ai immédiatement commandé mon coffret des lettres de 2009. Cette lettre m'a complètement bouleversée. J'aimerais bien quelle soit lue le jour (très lointain) de mes funérailles, mais je m'inquiète que dire cela à mes proches sera perçu comme une requête sinon inquiétante, du moins bizarre! Enfin, c'est l'effet que ça m'a fait - c'est une lettre pleine d'espoir et j'aimerais bien que ça finisse comme ça, quand j'aurai 100 ans.

I recently asked an audience of about 100 people how many of them practiced or had ever tried relaxation training and/or meditation. Approximately 10 people raised their hands.

This is not an anomaly, it's the usual response I get. It's similar to the response I get when I ask groups how many of them would say that they:

1) Get enough sleep on a regular basis
2) Eat 3 healthy meals per day, with lots of fruit and vegetables, reducing caffeine, saturated fats and salt.
3) Exercise 3-4 times a week
4) Take breaks during the day to refuel and just chill out

Last time I asked this question, one person out of 150 said yes.

hmmm.

For those of you who are regular readers of this blog, you know that I feel very strongly about the importance of eating healthily for many reasons (cancer prevention, keeping diabetes at bay, increasing our immunity, weight control, the list goes on) but I am also very aware of the many obstacles we face: time crunch, financial constraints, food dislikes to name a few.

The exercise piece is tricky. A lot of people say to me "I'm not in good enough shape to go to the gym, I feel very self-conscious" and I totally respect that. A friend of mine (who went on to lose a significant amount of weight and run a marathon) could not walk around the block with me without having to stop to catch her breath. But she persevered, walked a bit faster each week, then started alternating running with walking (10 minutes of running, one minute of walking), an approach to running that is highly recommended by coaches at running clinics. It took a long time and a lot of hard work, but she started out small and eventually the results were life-changing.

Isn't that always the best way? To take small, realistic steps?

I invite you to reflect on the four categories above and see whether there is an area that you can celebrate. Is there something you are feeling particularly pleased with, in terms of self care? These can be very small steps (increasing my vegetable intake by one serving, taking 5 minutes off each day for the past week, etc.).

What would you commit to working on that is realistic and achievable for the week to come?

I heard about this great blog yesterday called 1000 awesome things. The author's goal is to compile 1000 every day activities that bring you joy: "1000 Awesome Things is just a time-ticking countdown of 1000 awesome things. Launched a few months ago and updated every weekday."

So, take a break from your work and go read this hilarious blog. I really liked #679 Old School Sugar Cereal and #722 Watching seniors do water aerobics.

This was supposed to be a post about positive psychology and learned optimism. I normally mull over my posts all week and write them on Fridays but on Thursday night, I went to a lecture on burnout aimed at new medical students and I was uncomfortable with some of what I heard so I was forced to use my writing time for that instead. (forced by no one but myself, but you know how sometimes you feel strongly about things and so you can't focus on anything else? That kind of forced. Compelled, I guess, is more accurate.)

Although I enjoy public speaking, writing and blogging on my own terms, I am not very comfortable in the limelight of op-ed. Some people are incredibly good at it. You know: the witty yet caustic artfully crafted letters to the editor, the inflamed yet articulate caller on the radio phone-in show. Neither of those are within my comfort zone (or talent zone). In fact, my last brush with op-ed fame was about 6 years ago. It was a slow news week in the middle of July and a local print journalist became interested in my opinions related to playground safety (a long, boring story). The day after my piece was published, my friend tried to buy all the newspapers in our neighbourhood so I wouldn't read the incendiary letters to the editor mocking me and the position I had taken on this issue...Not a big deal, but not very comfortable either.

When it comes to public debate, I am more of a muller - when I experience something that troubles or upsets me, it often happens to me in slow motion, and I almost always need time to reflect and chew my ideas over before making a point or jumping into an argument. That does not make me a very strong debater, sadly, (although I am learning over time at the feet of a master of debate, my partner, who win arguments even on topics he knows nothing about! It's sometimes enraging but also kind of sexy).

But here goes nothing. My op-ed piece.

Dr Patch Adams: A muddled message about burnout

On Thursday night I attended (along with hundreds of young medical students) Dr Patch Adams' presentation "The Joy of Caring" which was held at the Biosciences complex on Queen's Campus, organised by the Aesculapian Medical Undergraduate Society. We were invited to hear "an inspirational talk including the exploration of burnout prevention for caregivers, and the power of care, not only in the patient’s life, but also in the caregiver’s life."

As a compassion fatigue specialist and someone who devotes nearly all of my time to providing education on burnout to health care professionals, I was very interested to hear Dr Adams' thoughts on this topic.

I was moved and rather awed by Dr Adams' total devotion to his life's goal (which is to offer free medical care to all), and the love and acceptance that he conveys towards his patients across the globe, particularly the most neglected members of society.

However, as I heard Dr Adams speak, I grew increasingly uneasy about one aspect of his message.

Throughout his talk, Dr Adams described his routine of working from 7am to 3am daily and having rarely, if ever, taken a day off work in his many years as a physician and therapeutic clown. He also spoke of a twelve year period where he and other physicians lived with their children and spouses in a six bedroom house which they ran as a free hospital, co-habiting with "5 and sometimes 50 patients at one time, sharing bathrooms, living rooms and bedrooms. Having no privacy whatsoever." Although he was not advocating that we all do the same, I wondered how his lifestyle was coming across to medical students around me - I wondered whether this was seen by some of them as something to aspire to, a gold standard of self-sacrifice - the sign of a truly dedicated doctor.

Then, I was startled by Dr Adams' main message which was that, in his opinion, "There is no such thing as physician burnout when you offer [the kind of medical care he offers]. Burnout is not possible when you care." I do agree with Dr Adams that it is often the system that burns us out rather than the patients themselves: the increasing volume of work, insufficient staffing, inadequate referral resources, etc.

But to state that "burnout does not occur when you care" is simply not true.

Based on very strong research (from 1995 onwards, see Figley, Stamm, Saakvitne and many others) the medical and other health care professions are recognising that there are serious problems with burnout that are intrinsic to helping others. It is in fact well established that there are serious consequences to overwork both to patients and physicians. We now know that working with patients can lead to the serious effects of compassion fatigue, vicarious trauma and burnout. Burnout is a term that has been widely used to describe the physical and emotional exhaustion that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work. Compassion Fatigue refers to the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate due to the pace, volume or nature of the patient work they do. Vicarious Trauma has been used to describe the profound shift that workers experience in their world view when they work with patients who have experienced trauma. Helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material. Vicarious Trauma occurs when the stories we hear from our patients transfer onto us in a way where we are secondarily traumatized and have difficulty ridding ourselves of the images and experiences they have shared with us. These problems can degenerate into clinical depression, post traumatic stress disorder, anxiety disorders and lead to alcoholism, suicidality and serious clinical errors, to name a few.

The good news is that there are simple and effective strategies that can protect us and help to mitigate these effects. We can provide care without suffering, and the answer is certainly not to deny or blame ourselves for experiencing burnout.

My concern is that Dr Adams' take home message to medical students Thursday night was that if you do not devote every waking hour of your life to patient care, you are a failure and possibly also a shallow, selfish, materialistic human being. Dr Adams may be thriving with his own pace of life and is clearly accomplishing wonderful things in the world. But I believe that for the rest of us mere mortals the best way to provide care to others is to first and foremost start within ourselves: Dr Charles Figley, the highly respected founding father of compassion fatigue says it best: "First, do no harm to yourself in the line of duty when helping/treating others. Second, attend to your physical, social, emotional, and spiritual needs as a way of ensuring high quality services to those who look to you for support as a human being. " (Green Cross Academy of Traumatology, Standards of Self Care Guidelines.)

This isn't a zero sum game: you do not take away from others by caring for yourself - it is, in fact, quite the opposite. We are far more effective caregivers if we have our own emotional house in order.

Here are three upcoming events that have come across my desk. Please note that I am passing these along for information purposes only. I am not involved in these events and cannot endorse them as such. But, if you do end up attending one of these events and want to recommend them or write a brief feedback for others, please email me: (whp at cogeco dot ca).

Beautitude: Where Beauty and Attitude Meet
This one day workshop is designed for women of all ages to begin taking better care of themselves. Through interactive activities, tools for self-discovery, media comedy and take-home materials you will learn strategies for refueling those empty tanks and enjoy a day of pampering and fun.

Where: Spa on Adelhi - 186 Adelphi Street, Napanee
When: Saturday, November 7, 2009; 9:30am-3:00pm. Morning refreshments and lunch included
Fee: $50 includes refreshments, lunch and materials
For more information or to register please contact:
Cheryl Shurtliffe at 613-358-2571 or beautitude@roomtomove.com

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Practical Tools – Addiction and Trauma Tools for General Helping Professionals

With Tom Regehr, Director CAST-Canada
Date: 20 Nov 2009 - 09:00
Where: Kingston ON
Cost: $140.00 + GST = $147.00 CAD
Click here for more information

Since 2004 CAST Canada has held 49 Consumer Panel discussions around central Ontario. Over 1,800 frontline workers have worked directly with CAST Canada volunteer consumers to identify these special ideas as valuable and work together with them to create relevant, practical tools. The ideas were then workshopped further in the ToolBuilder series of small groups of workers around the province. The product is a set of finely tuned, extremely practical tools.

Tom Regehr began offering speeches about his healing from trauma, addiction and homelessness in 2003 while promoting a self-help group he founded named “Come And Sit Together” (CAST). After noticing high energy and emotion in the questions around these issues he held events with several friends healing from the same issues to answer this need.

“We call ourselves addicts usually, but it is more than that, you might say ‘Addicts, healing and helping.’ “

Audiences include frontline helping professionals, universities and corporations. From this process has evolved specialized trainings and workshop based on women’s issues, youth and homelessness.

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Providing Therapy for Adult Survivors of Childhood Abuse

Mondays, September 28 - December 15, 2009
5:30 pm to 8:00 pm
Location: 234 Concession St, Suite #200
Fee: $600 for 12 Weeks

This course is intended for professionals who work with, or want to work with, clients who are adult survivors of childhood abuse. It will provide practical training in various aspects of how to do this specialized therapy. Each class includes explanations of the main topic and what to do about it in session with the client. It is organized as a small group, in a comfortable setting, to encourage maximum participant involvement in questions and discussing the course material.

This training will cover topics including:

* How this work changes you as a therapist
* How it is different to be raised by abusive people, by rapists
* Why children blame themselves
* Traumatic bonding
* Adult symptoms of child abuse
* Problem therapies and problems with some therapies
* Why & how therapy works
* The practical details of how to conduct client-centred therapy through the three main stages of good child abuse therapy

Class for the first session begins Monday, September 28 to Monday, December 15/2009.
12 weekly evening classes are from 5:30 pm to 8:00 pm at the Centre’s office.
The cost for all 12 classes is $600. This is an introductory price for the first ever offering of these classes. Space is limited.
Certificates will be presented upon completion, and this course can be used as a tax deduction.

Download a registration form here
For more info email: therapycentre@cogeco.ca

Mindfulness-Based Stress Reduction (MBSR) is a holistic mind/body approach developed by Jon Kabat-Zinn at the University of Massachussets Medical Center in 1979. MBSR is "[...] based on the central concept of mindfulness, defined as being fully present to one’s experience without judgment or resistance". (Cohen-Katz et al, 2005) The MBSR program recommends using meditation, yoga, relaxation training as well as strategies to incorporate these practices into every day life.

Research on the effectiveness of MBSR is highly conclusive: over 25 year of studies clearly demonstrate that MBSR is helpful in reducing emotional distress and managing severe physical pain. In fact, MBSR has been used successfully with patients suffering from chronic pain, depression, sleep disorders, cancer-related pain and high blood pressure. (Cohen-Katz et al, 2005) Based at Toronto's CAMH, Zindel Segal has developed a mindfulness-based cognitive therapy program for treating depression that has shown to be highly effective.

MBSR and Compassion Fatigue

Researchers recently turned their attention to the interaction between MBSR and compassion fatigue (CF), to see whether MBSR would help reduce CF symptoms among helpers. One study of clinical nurses found that MBSR helped significantly reduce symptoms of CF, as well as helping the subjects be calmer and more grounded during their rounds and interactions with patients and colleagues. (Cohen-Katz et al, 2005) Another study investigated the effects of teaching mindfulness-based stress reduction to graduate students in counseling psychology. The study found that participants in the MBSR program "reported significant declines in stress, negative affect, rumination, state and trait anxiety, and significant increases in positive affect and self-compassion." (Shapiro, 2007)

The Full MBSR Program

"The MBSR is taught as an 8-week program that meets approximately 2.5 hours a week and includes a 6-hour daylong retreat between the 6th and 7th weeks. Participants are asked to practice the mindfulness techniques 6 days a week as “homework” and given audiotapes to facilitate this. Group sessions include a combination of formal didactic instruction on topics such as communication skills, stress reactivity, and self-compassion and experiential exercises to help participants integrate these concepts. The program is described in detail in Kabat-Zinn’s textbook “Full Catastrophe Living: Using the Widsom of Your Body and Mind to Face Stress, Pain and Illness.” (Cohen-Katz et al, 2005)

As you are reading this, you may be thinking: "I don't have time to take part in a 2.5 hour, 8 week program!" Nor do you have to - let's extract the main features of MBSR and see how you might integrate them in your own life routines.

Incorporating MBSR into Your Life

The key strategies of MBSR mirror the best compassion fatigue reduction techniques described in my book The Compassion Fatigue Workbook: developing self awareness, self-regulation (how to cope when events are overwhelming and/or stressful) and how to balance the competing demands in our lives. (Shapiro, 2007)

In the Shapiro study with counseling students, five mindfulness practices were taught, adapted from Kabat-Zinn's program:

1) Sitting meditation: This is the cornerstone of MBSR - To develop, over time, a sitting meditation that is done daily, if possible. It involves the "concentration of attention to the sensations of breathing, while remaining open to other sensory events, and to physical sensations, thoughts and emotions."

2) Body scan: A very effective exercise from the field of relaxation training and stress reduction. The full version of the body scan encourages you to focus on each part of your body one after the other, to identify where you are holding tension. This process is normally done lying down, in a quiet room. If time does not allow you to do the full scan, you can also carry out a modified version of the body scan:

Sitting in a quiet, peaceful room, close your eyes and focus on your breathing. Notice what is happening in your body: Working your way down from the top of your head, notice how your jaw, neck and shoulders are feeling at this moment. Remember to keep breathing and, if your mind wanders, gently bring it back. If that is all the time you have, take three, slow deep breaths through your nose and gently open your eyes. If you have more time, work your way down your body, noticing how your shoulders, arms, stomach, calves and toes feel right now.

Where to find the full body scan exercise:

Web: Through Google, I was able to find several audio and scripted body scan exercises in a matter of seconds. Here is a free body scan exercise script and audio.

CD: Creating Inner Calm by Mark Berber (only available at Indigo/Chapters, not Amazon)

Books: The Anxiety and Phobia Workbook by Edmund J. Bourne (2000)

3) Hatha Yoga consists of "stretches and postures designed to enhance mindful awareness of the body and to balance and strengthen the musculoskeletal system." (Shapiro, 2007)

4) Guided loving-kindness meditation: A meditation practice which focuses on developing loving acceptance towards oneself and others. You can find examples of loving-kindness meditation on the web.

5) Informal practices: Exploring ways to bring mindfulness into our everyday life (while waiting in line at the grocery story, stuck in traffic, dealing with a challenging patient, etc.)

Want to know more? Where to start?

You can learn more about MBSR on your own or by taking a course or attending a workshop.

On your own

Audio Cds: Kabat-Zinn has produced a collection of mindfulness meditation CDs that can be purchased on his website and on amazon/indigo. Your local library may also have them. Kabat-Zinn's site also has a useful FAQ which describes the different CDs and guides you on which one to buy. He also has an informative blog and resources.

Reading:
Kabat-Zinn, J. (year) Full Catastrophe Living: Using the Widsom of Your Body and Mind to Face Stress, Pain and Illness.

Kabat-Zinn, J. (1995) Wherever you go, there you are: Mindfulness Meditation in Everyday Life.

Segal, Z. et al (2002) Mindfulness-Based Cognitive Therapy for Depression.

Video:
If you can get your hands on it, a good introduction to MBSR is offered in Bill Moyers' 1993 PBS Special "Healing and the Mind" featuring Kabat-Zinn in the Stress Reduction Clinic.

Courses/Workshops
Many mid to large sized cities offer MBSR programs several times a year. Contact your local meditation/yoga centers to see if one is being offered in your community.

Final thoughts

If you are new to meditation practice, the most important thing to remember is that you cannot fail at meditation. There will be times where you can meditate with ease, and other times where your mind will be racing and you will have great difficulty focusing on being mindful. (You may also fall asleep). All of those are part of the process of mindfulness practice. Try not to judge your meditations. Simply try to refocus on your breath and on the meditation itself. It takes time and practice but it could literally save your life.


Sources:

Cohen-Katz, J., Wileys, S.D., Capuano, T., Bakers, D.M., Kimmel, S., & Shapiro, S. (2005). The effectis of mindfulness-based stress reduction on nurse stress and burnout, Part II: A quantitative and qualitative study. Holistic Nursing Practice, 19, 26-35.

Shapiro, S., Brown, K.W, & Biegel, G.M., (2007) Teaching self-care to caregivers: effects of mindfulness-based stress reduction on the mental health of therapists in trainining. Training and Education in Professional Psychology, Vol. 1, No. 2, 105-115.

photo from freedigitalphotos.net

Whether or not we have children returning to school, many of us make resolutions in September. They often have to do with our lifestyle: to eat more fruit and vegetables, to sign up for a class, to go to the gym more often, to make menus and plan for the week ahead, etc.

Some of these resolutions become incorporated in our lifestyle, and others quickly fall by the wayside because they were either unrealistic, too ambitious or we got caught up in the busyness of life again and ran out of time. (Or, the therapist in me would suggest, we have not yet done the necessary emotional prep work to make this change possible.)

Suggested Activity:
Before the Fall gets too hectic, I would like to invite you to take a few minutes today to take stock of one of the following areas of your life:

Physical health
Physical exercise
Clutter
Finances

There are many other good categories we could explore, but this will do for today.

Take a blank sheet of paper and a pen (or your laptop) and select the first category that jumps out at you. Write this category down at the top of your sheet. Now, write down whatever thoughts or words come to your mind in reaction to this category. For most of us, these initial jots will likely be negative or "shoulds" e.g.: Physical health - haven't been to doctor in three years, back is sore, worried about mole on back, etc.

Write as many items down as can fill a sheet. Now turn the sheet over and write down all the positives about that category - your strengths or things that you have improved on.

Once you have written as many things as you can, have a think about one micro-movement you could make towards improving that area of your life. Micro-movements are a concept put forth by SARK in her book Make your Creative Dreams Real. It can be as small as you want. Examples would be: "I will book a doctor's appointment by the end of the month", "I will eat one more fruit per day starting tomorrow", "I will clean out one drawer in my messy office on Friday".

Once you have this mini resolution, write it down in your daytimer, agenda or calendar. To make this resolution even more solid, ask a friend of yours to be your accountability buddy or, if you want, you can post your commitment on this blog (it can be anonymous) in the comments section.

I am quite pleased with my own Fall resolution: I decided to delegate lunch making in my home. My children now make their own lunches - I still make the sandwich and they do everything else. I'm not sure how I ended up winning the easiest job but they both seemed really pleased with themselves when I said "ok, I'll do the sandwich and you do the three peanut-free, garbage free snacks which includes having to rummage through the plastic container cupboard in a futile search for the corresponding lid. Ok?" So I have now gained a full thirty minutes each morning (yes, that is how long it was taking me, don't ask, I don't know why, but it was).

Have fun with the resolution and make it realistic and achievable.

I've always liked the French term for the start of the school year. It's called La Rentrée. For me, it evokes shiny red apples, plaid skirts and brand new, rather stiff black patent leather shoes. Of course, I'd always end up wilting in the heat of the school yard during the first weeks of September, but it felt important to start the year with Fall stuff.

Actually, I am not going back to school, but the whole world around me seems to be heading back next week. I am back at work however, and so this is my own little Rentrée. I took a long break this summer, working part-time, doing a lot of reading and spending time with my family. Every summer, my kids and I endeavour to make some new food product from scratch (my own little contribution to "Where Things Come From"). Last year we made butter and ice cream and this summer we tried our hand at yogurt, sprouts and mozzarella. My husband laughed himself silly when he found out that a small ball of mozzarella required 8 litres of milk but the kids enjoyed the process and the degustation. Now I need my own dairy cow I guess...

I am looking forward to this coming year and wanted to begin by telling you about upcoming events.

Upcoming workshops

This Fall, I will be offering the two day Compassion Fatigue Train the Trainer retreat in Kingston November 24-25th. This workshop is designed for individuals who have not yet attended a full day or half day Walking the Walk workshop. If you are interested in the Train the trainer but already have Walking the Walk under your belt, please consider the March 3-4th session which has been designed for those with past Walking the Walk experience (there is also the option to attend Walking the Walk the day prior to this training, on March 2nd, 2010). For more information on these workshops click here.

I am also co-teaching the three day Crisis Intervention Institute from October 26-28th 2009 in Kingston. The emphasis of this course is on developing a thorough understanding of crisis-intervention and crisis management and the development of effective, concrete crisis-intervention skills. It is suitable for professionals in the field of mental health (psychologists, social workers, nurses, counsellors, physicians, crisis workers), and students in these disciplines. Dr Mike Condra and I have been offering this workshop for the past 6 years every Fall.

Invited lectures/workshops

I will be travelling all over the country this Fall, from Yellowknife to Prince Edward Island. In fact, I am nearly fully booked until December. If you are interested in booking an event, please email me and I can either offer you a Winter/Spring date or one of my associates can come to your agency in the Autumn: I am now working with three highly talented compassion fatigue educators who work in the field and have received rave reviews during past workshops.

What's in the works?
I am currently working on the following projects:

The Compassion Fatigue Workbook: I am currently in discussion with a public agency and we are exploring turning this program into a web-based course. As some of you know, the Compassion Fatigue Workbook is now available for sale at our online bookstore.

I am also working on the Stories from the Frontlines book, based on interviews with helping professionals.

This Blog: I will be posting strategies and book recommendations every Monday starting next week. If you want to receive notification of new posts, consider registering as a follower of this blog (you will see a sign up box in the upper left corner of the page called "Subscribe to Blog").

Please do not hesitate to drop me a line via email or through this blog. I wish you a great Rentrée.

(photo courtesy of www.freedigitalphotos.net)

As I wrote in a prior post on preventive medicine, Dr Béliveau has carried out a great deal of reseach on the link between cancer and the foods we eat.

Dr Béliveau is a biochemist who works as a research scientist at two Montreal Universities. He is an expert in cancer prevention and is also a gifted communicator who aims to bring his lab findings to our dinner tables. He has written three books on cancer prevention and nutrition: Foods to Fight Cancer, Cooking with Foods that Fight Cancer and his most recently released Eating Well, Living Well: Everyday Preventive Medicine which will be available in English in the Fall of 2009.

He was interviewed by Yannick Villedieu on Radio Canada in February 2009. I had the opportunity to hear it rebroadcast last Sunday. If you speak French, I recommend you follow the links to hear this highly informative interview.

If you don't speak French and you missed my original post, I invite you to return to read it. You will find the same take-home message in the post.

(free photo from Pediant, wikicommons)

I am going to be posting off and on this summer. I will not be posting every Sunday as I have been doing for the past year and a half but rather going to "summer hours". To receive information about new posts, I invite you to subscribe (see left column of the blog). You will then receive an email notification once I post again.

I am spending most of July working half time. I am able to do this thanks to an "x over y" plan that teachers are familiar with: you save part of your monthly salary each month in order to be able to take time off later. Being self employed offers no benefits, no unemployment insurance and no job security whatsoever, but it does offer the flexibility of being able to work or not work as you decide.

So I am spending the month dealing with home improvement projects that have been lingering for years (that darned basement..., the leaky taps, the paint jobs that have been waiting, many trips to the local charity dropoff and Habitat for Humanity to get rid of all the clutter that we have accumulated, god knows how.)

I am also simply taking time to enjoy the all too brief summer we have in this part of the world. One of the things I most enjoy is to bike down to the shores of lake Ontario and go watch the windsurfers on Richardson beach. This is nearly olympic-level surfing - a very wild patch of the lake, and I love watching them fly in the air and flip themselves around. I like to pretend to myself that I too, have the upper body strength and the skill to be there with them (I don't doubt my abilities to do other things, such as run a half marathon, but I seriously doubt my capacity to windsurf on this crazy lake! But it's fun to dream...)

I hope you have some time to breathe this month, and are able to carve out a bit of time for you.

peonies from my garden. A brief burst of colour to start the summer.

Walking the Walk: Creative Tools for Transforming Compassion Fatigue
March 2nd, 2010 Donald Gordon Centre, Kingston, On., 8:30am-4:00pm

Instructor: Françoise Mathieu, M.Ed. CCC. Compassion Fatigue Specialist

Workshop Description: Compassion fatigue is a normal consequence of working in the helping field. The best strategy to address 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 Compassion Fatigue. This is a highly interactive one day workshop, incorporating a combination of solo, small group and whole group activities.

Topics covered will include: Understanding compassion fatigue and vicarious trauma. Symptom checklist, targeting areas for strategic planning; Evaluating self-care, identifying triggers; Developing a personalised strategic plan for identifying and treating compassion fatigue.

*This workshop is also a prerequisite for the two day CF Train the Trainer workshop which will be offered immediately following the March 2nd training.

Who should attend? Helping professionals in the fields of mental health, health care, education, emergency services, corrections and law enforcement, volunteers and caregivers.

Cost: $165.00 (incl gst) includes lunch, breaks and handouts.


Compassion Fatigue Train the Trainer Retreat
March 3 & 4th 2010. Donald Gordon Centre, Kingston

Instructor: Françoise Mathieu, M.Ed. CCC. Compassion Fatigue Specialist

Workshop Description: This workshop offers tools, handouts, training material, strategies and marketing tips to adapt the one day Compassion Fatigue Workshop Walking the Walk to your community's specific needs (and to your own presentation style).

**Prerequisite: This workshop is aimed at helping professionals and educators in the helping fields. Prior attendance to full day or half day Walking the Walk is highly recommended. Walking the Walk will be offered on March 2, 2010. Please email whp at cogeco.ca for more information.

Cost: $598.00 (incl gst) which includes lunch, breaks, training manuals, power point presentation and handout templates. **Space is limited to 20 participants for this retreat.

More information and registration forms will be posted on the website next week

I came across this speech on the blogosphere. It was written by the Jeremy Adam Smith, senior editor of the Magazine Great Good, an online publication whose mission is described as follows on their site: "Greater Good highlights ground breaking scientific research into the roots of compassion and altruism. It fuses this science with inspiring stories of compassion in action, providing a bridge between social scientists and parents, educators, community leaders, and policy makers."

This speech was given as a talk to nurses of UC Berkeley Health Services on surviving compassion fatigue.

Low impact disclosure: Just a warning before you read it: the first portion of the speech describes a brief but violent attack (the author was mugged which is the beginning of the story) and some of you may not want to read it for that reason.

(Photo: Late June in Umea, Sweden)

I have just finished a busy past two weeks. I offered a full day training in Toronto, a shorter presentation at a PTSD conference and at a conference for community social services and finally the two day Compassion Fatigue Train the Trainer. I also had the opportunity to hear Babette Rothschild present grounding techniques from her very useful book "Help for the Helper". I have also been processing orders for the new Compassion Fatigue Workbook which I am very happy to now have available for helpers who are looking for more resources to work through CF strategies on their own or as a team.

Now, thankfully, there is a bit of time to process and digest it all, (and weed the garden a bit.)

I had a widely varied group of participants at the train the trainer workshop: veterinarians, managers from homeless and women's shelters, hospital social workers, addictions counsellors, to name a few. In our discussions, we discovered that the challenges we face are far more similar than they are different - whether you are working with pet owners or with humanoid patients, there is a strong human factor in the work: people are grieving, people are angry (often at us, for a flawed system, for a lack of resources, maybe for errors we make or errors they perceive we made). Dealing with loss, grief and anger takes its toll on us, and so does having to turn people away when we simply do not have the resources to help them.

Having a two day retreat with a small group of helping professionals is a rare opportunity to talk and reflect (in a very lovely environment - the centre where I hold these workshops is beautiful) and that alone is worth its weight in gold, in giving us all the opportunity to replenish ourselves.

I think that we need to look at small ways to create retreats for ourselves even if we do not have the time or money to go to a train the trainer workshop or an actual retreat. Here are some suggested steps:

A Retreat plan for yourself

1) Get your daytimer and book a day off (two is even better). Make sure that the entire day is free. If you have more financial resources, consider booking yourself into a local B&B and make this retreat an overnight event. You can also buddy up and plan the retreat with a colleague or two, but make sure they are committed to making this a replenishing experience and not talk shop.

2) Plan your day, making sure that you will include three key components: Stress Reduction, Relaxation and Resilience. What does this mean?

(The following text is excerpted from The Compassion Fatigue Workbook. If you would like to receive an excerpt of the book, please send me an email: whp at cogeco.ca or visit my website and click on Resources and Links.)

Eric Gentry, compassion fatigue scholar and co-developer of the Accelerated Recovery Program (ARP) for helpers with compassion fatigue, wrote a powerful article in 2002 called The Crucible of Transformation. I highly recommend that you read it. To obtain a pdf of the article, simply Google: Gentry crucible of transformation and then download the article from his website: www.compassionunlimited.com. (Make sure you do not download the one from the website Gift from Within as it is incomplete. For some reason, visiting his website directly does not work but googling does.)

In this article, Gentry offers two important principles that are critical to remaining healthy in the face of the challenges of our work:

“These two important principles, which have become the underlying goals for our work in the area of compassion fatigue, are: (1) the development and maintenance of intentionality, through a non-anxious presence, in both personal and professional spheres of life, and (2) the development and maintenance of self-validation, especially self-validated caregiving. We have found, in our own practices and with the caregivers that we have treated, that when these principles are followed not only do negative symptoms diminish, but also quality of life is significantly enhanced and refreshed as new perspectives and horizons begin to open.” (Gentry, 2002)

Let us highlight the two key concepts from that paragraph:

“(1) the development and maintenance of intentionality, through a non-anxious presence, in both personal and professional spheres of life, and

(2) the development and maintenance of self-validation, especially self-validated
caregiving.”

What does this mean exactly?

A non-anxious presence refers to the ability of being in the room with the client’s pain and suffering and being able to express empathy and compassion without taking on the other person’s suffering. In both the personal and the professional realm, it is about mindfulness, the ability to notice and control your physical symptoms of stress and anxiety, and your breathing. It is a concept that is explored in depth by Babette Rothschild, author of Help for the Helper: the psychophysiology of compassion fatigue and vicarious trauma (2006).

“Self-validated caregiving” refers to self-care that is guilt-free, self-care that is prioritised as a means of remaining healthy in this line of work.

So, reflect on this for yourself:

What stress relief strategies do you enjoy? Examples of stress relief are taking a bath, sleeping well or going for a massage.

What stress reduction strategies work for you? Stress reduction means cutting back on things in our lives that are stressful (switching to part time work, changing jobs, rejigging your caseload, etc.)

What stress resiliency strategies can you use? Resiliency strategies are relaxation methods that we develop and practice regularly, such as meditation, yoga or breathing exercises.

Ok, now let's return to our Retreat plan:

Step one (a discussed above): Carve out some protected time for yourself, either on your own or with a good friend/colleague.

Step two: Make sure that your day has the five following elements:

1- Plenty of unstructured time to rest, nap, read (something unrelated to work), sit, swing in a hammock, lie on your bed...

2- A physical component: sign up for a fitness class, go swimming, stretch, run, go for a long walk around your neighbourhood or if you need a change of scenery, take public transit or drive to a completely different part of your community. If you can afford it, book a massage for your retreat day.

3- A relaxation component: Consider downloading a relaxation tape from itunes, or purchase a relaxation cd from your local bookstore (I recommend Mark Berber's Creating Inner Calm, which is available at Chapters/Indigo) and trying out one or two relaxation or deep breathing activities.

4 -A stress resiliency activity: Consider taking a yoga class or trying out a brief meditation tape from itunes.

5-During this day, eat healthy, simple food, try to avoid caffeine and any other stimulants. If not drinking caffeine is a problem for you in terms of withdrawal, try and have just one cup in the morning and reduce the rest of your day's caffeine intake.

What may happen during this day: You may feel wonderful at the end of your mini retreat, or you may find that it was a very dificult day for you. This is important information. First of all, slowing down and letting go of our daily concerns takes time and practice. Secondly, working in this field, and having to live with compassion fatigue and vicarious trauma within us, sometimes stopping and slowing down means that we are letting our guard down. This guardedness is actually something we use as a protection mechanism during our daily working lives. So you may find that your day off is filled with images, thoughts about work or about certain clients etc..

If you find that this is very strong, and difficult to deal wtih, I strongly recommend that you consider seeking the support of a trained counsellor or psychotherapist who understands compassion fatigue.

You may also find that you need to practice being in a retreat mode and that it takes a few times to get it right. I recall the first time I ever tried mindfulness meditation was at an all day mindfulness retreat (no half measures for this gal...) and it was a very uncomfortable day for me. I felt twitchy, bored, restless and eager for the day to end. As we were walking out of the retreat day, my colleague who had come with me looked totally relaxed and blissed out. I said "so, how was it for you?" She replied "oh, wonderful, refreshing, so relaxing. I feel fabulous." I was lucky enough to experience the replenishing qualities of mindfulness meditation a few years later, but I learned that meditation takes practice and a lot of kindness towards ourselves: we can't necessarily speed our way through it.

Your retreat will be whatever it is - easy, hard, challenging, replenishing - set the bar low. The main step is to actually carve out time away from work and other family and life commitments. From there on, it's all gravy.

Let me know how it goes.