Compassion Fatigue Solutions

September 30-October 2, 2010, Toronto.

In addition to 30 conference workshops to choose from, ATSS has arranged for opportunities to network and socialize with colleagues and friends. The President's Luncheon will give attendees an opportunity to learn more about ATSS and its future.

A sample of some of the presenters:

Creative Tools for Transforming Compassion Fatigue and Vicarious Trauma - Françoise Mathieu
Meditation, Mindfulness, and Right-Brain Healing in the Trauma Crucible - Dawn Bret
Voices of Experience - Priscilla de Villiers, Kent Laidlaw and Edward Leonard
CISM in the Correctional Service of Canada - Pamela Scott and Dorothy Reid
Question and Answer Session: Preventing and Healing Compassion Fatigue - Dr Angie Panos
Keynote address by Lt. Col. Stephane Grenier MSC, CD -Operational Stress Injury (OSI) - Special Advisor, Ottawa Canada
and many more.

For more information click here.

Summer is here and I am done with workshops for the season. Phew! Although I thoroughly enjoyed meeting wonderful folks all across the country, I am in need of a little R&R after a rather punishing pace since the Fall. I will only be blogging intermittently during the next couple of months as I am taking part of July and the entire month of August off. Being self-employed is not always all it's cracked up to be (no job security, no pension, no sick pay), but one real bonus is having control over your schedule.

Here are some upcoming events that may interest you:

The next Compassion Fatigue Train the Trainer sessions will be held in Ottawa November 4-5th and in Kingston November 16-17th. The pre-requisite course, Walking the Walk, will be offered on October 15th in Ottawa and November 15th in Kingston. For more information on the Ottawa course, please visit Safeguards. For more information on the Kingston event, please visit www.compassionfatigue.ca

Back by popular demand - a workshop just for Managers with Dr Pat Fisher: June 13-14th, 2011 in Kingston. This manager's workshop received rave reviews last May. Please visit my website for more information.

Save the date! The first annual Compassion Fatigue Conference will be held on June 15-16th 2011 in Kingston with Dr Gabor Maté and Laura van Dernoot Lipsky as keynote speakers. Please visit the conference website for more information.

Toronto's Leading Edge Seminars has just published their Fall schedule, and wow, what a great lineup! In particular, I draw your attention to John Briere's workshop on "Deconstructing Trauma: Memory Exposure, Mindfulness and Existential Awareness in Psychotherapy". As many of you know, John Briere has had a great influence on my clinical work and I heartily recommend you go hear him if you have not already done so.

Last week I was at the drugstore with my 10 year old son. I was paying for my things when an elderly man approached the counter. He appeared to be in his late eighties and had deep red bags under his eyes. He looked, in a word, absolutely terrible. With a shaking hand, he took a photo out of his pocket and showed it to us and to the women behind the cash. "This is my wife" he said "She died two days ago, we were married for 58 years. She was the love of my life. Now I can't sleep and the doctor wants me to take these pills" We all fell silent for a minute and then I had a little chat with him. He told me his children all lived out of town, and that he was completely alone. When I left the store with my son in tow, I felt regret that I did not do more. My head was already buzzing with all the community resources I know about, how to link him with the right ones, how we should have taken him out for tea, etc. I was dying to case manage this man into getting support right on the spot but I also had to go home and cook dinner and take care of my family.

This is the constant challenge we face as helpers. Pain and suffering is all around us, it's not just at work. Where do you draw the line? Do you take every elderly widower out for tea? Do you tell every person with a funny-looking mole to go get checked out? Do you rescue every kitty you see? So what we do is we try our best to figure out boundaries. Sometimes we over-correct and we become like Fort Knox, not letting a single person inside our walls. Sometimes we go too far in the other direction and become ambulance-chasers, rescuing every stray dog and baking for every little old lady on our street.

In my workshops, I am always advocating that we need to gain a better understanding of our own warning signs along the continuum of compassion fatigue. Using traffic lights as an analogy, the green zone is where you are when you are at your very best (I sometimes joke that you are only in the green zone when you've been in the field for two weeks or when you have just returned from a 5 month yoga retreat in Tahiti). The yellow zone is where most of us live most of the time. We have warning signs emerging but we often ignore them. The red zone is the danger zone. The extreme end of the red zone finds us on stress leave, clinically depressed or totally withdrawn from others and wracked with anxiety.

We will all visit the less extreme end of the red zone several times in our career - it is a normal consequence of doing a good job.

What suffers first is our emotional and physical health, our family and friends, our colleagues and eventually our clients do pay the price as we become less compassionate, irritable and may make clinical errors.

But back to my story. The reason I am telling you this little anecdote is that I would not have always had this warm compassionate reaction to this man. In fact, my reaction is actually a sign for me that I am well out of the red zone of compassion fatigue (for the time being!). You see, there have been times where I have felt so depleted by all my work demands and difficult stories that I would have hardened myself to this old man's story and not talked to him at all. Not nice, eh? Have you ever noticed that in yourself or am I the only hard crusty person out there? Conversely, for some of you, being in the red zone would mean you would have jumped into rescuing this man and neglected your family's needs for the evening.

Research shows that compassion fatigue hits hardest among those of us who are the most caring. As helpers, we have a homing device for need and pain in others and we have this from childhood onwards (for many reasons: family of origin issues, birth order, heredity, etc.) So often for helping professionals the main challenge in their personal life is setting limits and not being a helper/rescuer to everyone around. But eventually, compassion fatigue makes us detach from others: often our colleagues, family and friends suffer far before our clients and patients. Although I am not proud of it, I know that I always seem to save the best for work and give the remaining crumbs to my loved ones. In my clinical work, I feel present, warm and loving towards my clients, even the most challenging soldier who has never wanted to come to counselling and hates being there. But when I am in the red zone I avoid my neighbours, ducking into my house as quickly as possible to avoid a chat, feeling slightly guilty and irritated at the same time. I avoid the phone: "why is my lovely dad calling me to say hi? grrr"

Each of us will have different warning signs. The key to developing an early intervention plan is getting better acquainted with your own. (If you want more resources on this, consider reading my Compassion Fatigue Workbook).

The fact that I feel ready to give again is a great sign of "green zonedom." Now the trick is keeping it in check and not overcorrecting and becoming depleted again. Keeping the balance, my friends, is a lifetime's work. I'm ok with that.

What do you think when you hear the word "syndrome"?

My first reaction when I hear that word is to think disease or disorder, that something really wrong and it is systemic within a person. Many genetic or chromosomal disorders are referred to as syndromes, often named after the scientist who first discovered the root cause of the anomaly (think of Down Syndrome, for example).

I am noticing that it is being used more and more in the websphere in conjunction with compassion fatigue (as in Compassion Fatigue Syndrome) and for some reason this really goes up my nose.

Compassion Fatigue (CF) is an occupational hazard -it is a normal consequence of doing our work well, it is not a disease or a disorder.

I feel that we helping professionals and caregivers already experience too much guilt and shame around CF without further pathologising it. Words are important, they have an impact on how we perceive ourselves. So can we stop using syndrome in association with compassion fatigue, please?

Your thoughts?

Excerpted from "The Compassion Fatigue Workbook"

Learning to recognise one’s own symptoms of compassion fatigue and vicarious trauma has a two-fold purpose: First, it can serve as an important check-in process for a helper who has been feeling unhappy and dissatisfied, but did not have the words to explain what was happening to them, and secondly, it can allow this helper to develop a warning system for themselves. Developing a warning system allows you to track your levels of emotional and physical depletion. It also offers you tools and strategies that you can implement right away. Let me give you an example.

Say, for example, that you were to learn to identify your compassion fatigue symptoms on a scale of 1 to 10 (10 being the worst you have ever felt about your work/compassion, and 1 being the best you have ever felt).

Then, you learn to identify what an 8 or a 9 looks like for you i.e. “when I’m getting up to an 8, I notice it because I don’t return phone calls, think about calling in sick a lot and can’t watch any violence on TV” or “I know that I’m moving towards a 7 when I turn down my best friend’s invitation to go out for dinner because I’m too drained to talk to someone else, and when I stop exercising.”

Being able to recognize that your level of compassion fatigue is creeping up to the red zone is the most effective way to implement strategies immediately before things get worse.

But look back to what also emerges in this process: you are starting to identify the solutions to your depletion.

If I know that I am getting close to an 8, I may not take on new clients with a trauma history, I may take a day off a week, or I may return to see my own therapist.

In order for you to develop your warning scale, you need to develop an understanding and an increased awareness of your own symptoms of compassion fatigue and vicarious trauma.

I suggest that you begin by reading through the signs and symptoms below, and circle those that feel true to you.

CF and VT will manifest themselves differently in each of us. This is not a diagnostic test but rather a process whereby we begin to understand our own physical and psychological reactions to the work that we do.

Saakvitne and Pearlman (1995) have suggested that we look at symptoms on three levels: physical, behavioural and psychological.

Physical Signs of Compassion Fatigue

Exhaustion – feeling exhausted when you start your day, dragging your feet, coming back to work after a weekend off and still feeling physically drained.

Insomnia

Headaches

Increased susceptibility to illness – getting sick more often.

Somatization and hypochondria

Somatization refers to the process whereby we translate emotional stress into physical symptoms. Examples are tension headaches, frequent stress-induced migraines, gastro-intestinal symptoms, stress-induced nausea, unexplained fainting spells, etc. The ailments are very real, but the root cause is largely emotional and stress related. You may be able to identify which organ/body part is your vulnerable area: many people say it’s their gut, stomach, or head. Someone I know has an upset stomach every time she is anxious or stressed. She used to think it was food poisoning, but finally had to come to the conclusion that not all restaurants in our fine city could possibly have tainted food!

Hypochondriasis refers to a form of anxiety and hypervigilance about potential physical ailments that we may have (or about the health of our loved ones). When it is severe, hypochondria can become a debilitating anxiety disorder. Mild versions of hypochondria can happen to many of us who work in the health care field. A good example of this is a colleague of mine who worked as a physician in a dermatology office and who became convinced that every mole on her body was likely cancer. If you work in cancer care, particularly at the diagnostic end, you may find yourself overworried about every bump and bruise on your child or yourself. The media and the internet can fuel the flames of hypochondriasis. Many people who live in Ontario say that they had some mild phantom symptoms of listeria during the summer of 2008 following a large scale tainted meat recall.

Again, any of these symptoms do not, on their own, constitute a serious problem. The goal here is for you to begin to notice your own vulnerabilities and how the work that you do may be contributing to these vulnerabilities.

Behavioural Signs and Symptoms

Increased use of alcohol and drugs

There is evidence that many of us are relying on alcohol, marijuana or over the counter sedatives to unwind after a hard day. And as I say in my workshops: Have you seen the size of wine glasses these days? Some of them are bigger than my fishbowl. So the “one glass after work” you are having is possibly 1/2 of a bottle of wine…

The difficulty with increased reliance on drugs and alcohol is also that there may be a lot of shame associated with it, and it is not something that we necessarily feel we can disclose to anyone. Is the child protection worker going to tell his supervisor that he smokes a big fat joint every night when he gets home to unwind? Is the nurse going to tell her colleagues that she takes a few Percocets here and there from her mother's medicine cabinet?

Absenteeism (missing work)

Anger and Irritability

I could write an entire book chapter on this topic alone. Along with cynicism, anger and irritability are considered two of the key symptoms of compassion fatigue. This can come out as expressed or felt anger towards colleagues, family members, clients, chronic crisis clients. You may find yourself irritated with minor events at work: hearing laughter in the lunch room, announcements at staff meetings, the phone ringing. You may feel annoyed and even angry when hearing a client talk about how they did not complete the homework you had assigned to them. You may yell at your own children for not taking out the garbage. The list goes on and on and it does not add up to a series of behaviours that make you feel good about yourself as a helper, as a parent or as a spouse.

Try this: spend a full day tracking your anger and irritability. What do you observe? Any themes, recurrences? Any situations you regret in hindsight or where your irritability was perhaps out of proportion?

Avoidance of clients

Examples of this can be: not returning a client’s phone call in a timely fashion, hiding in a broom closet when you see a challenging family walking down the hall, delaying booking a client who is in crisis even though you should see them right away. Again, these are not behaviours that most of us feel proud of, or that we are comfortable sharing with our colleagues and supervisors, but they do sometimes occur and then we feel guilty or ashamed which feeds into the cycle of compassion fatigue.

Many of us work with some very challenging clients. If you do direct client work, I am sure that you can easily conjure up, right now, the portrait of an individual or a family that has severely taxed your patience and your compassion. One telephone crisis worker put it perfectly: “Why on earth is it a thousand times easier for me to talk to 25 different crisis callers in a day than if the same caller calls me 25 times in a row? I am, after all, paid to answer the phone and talk to individuals in crisis for 7 hours a day. That’s my job. What is so depleting about the chronic caller?" And, I would add, why do we start feeling particularly irritated, avoidant and unempathetic towards the chronic caller? More on this below.

Impaired ability to make decisions

This is another symptom that can make a helper go underground. Helpers can start feeling professionally incompetent and start doubting their clinical skills and ability to help others. A more severe form of this can be finding yourself in the middle of an intervention of some kind, and feeling totally lost, unable to decide what should happen next. I once had a mild version of this in the middle of a grocery store after a grueling clinical day (I was working as a crisis counsellor at the time and was dealing with very extreme situations and a very large volume of demand). I remember standing in the middle of the A&P thinking “should I buy the chocolate chip cookies or the oreos?" And being unable to decide between the two for what felt like hours. Difficulty making simple decisions can also be a symptom of depression.

Problems in personal relationships

I am a couple’s counsellor and have worked with hundreds of couples seeking help with communication, parenting, sex and intimacy and other relationship challenges. Many of my clients are helping professionals and when the topic comes to sex and intimacy, many women helpers confess that they have no interest whatsoever in having sex with their partners. When we explore this further, they say they feel spent, “done” by the end of their day, with nothing left to give. Others say they find themselves being impatient with spouse and children, thinking internally: “How dare you complain about that, do you have any idea what I saw today?”

Attrition

This refers to leaving the field, either by quitting or by going on extended sick leave.

Compromised care for clients

This can take many forms: using the label “borderline” for some clients as a code word for “manipulative” is one common example. Whenever a diagnosis is being used in a way that pigeonholes a client, we are showing our inability to offer them the same level of care as to other clients. There is evidence that clients with a BPD (borderline personality disorder) label often do not receive adequate care in hospitals, are not assessed for suicidal ideation properly and are often ignored and patronised. Granted, clients with personality disorders can be extremely difficult to work with, but when we lose compassion for them, and start eye rolling when we see their name on our roster, something has gone awry.

If you ever have the opportunity to go hear Dr John Briere present, I highly recommend that you do. Dr Briere is a leader in the field of trauma treatment and research, with a particular specialisation in working with individuals who have experienced childhood trauma. He is the director of the psychological trauma program at LA County and University of South California medical centre, as well as co-director of the USC Child and Adolescent Trauma Program. During his talks, Dr Briere presents a wonderful perspective on the use (or rather, the misuse) of the diagnosis of Borderline Personality Disorder. He believes that the term is used to label clients who are in chronic emotional distress as difficult and draining (which they can be) but that the field is also misusing it as a dismissive and damaging label. He argues that a very large proportion of clients diagnosed with BPD have in fact complex post traumatic stress disorder, not BPD, and are very damaged because of their trauma experiences. They end up being revictimized by a system that cannot cope with their complex and frequent needs.

There are many other examples of compromised care for clients but I think this is a particularly illustrative one.

Psychological signs and symptoms

Emotional exhaustion

Distancing

You find yourself avoiding friends and family, not spending time with colleagues at lunch or during breaks, becoming increasingly isolated. You find that you don’t have the patience or the energy/interest to spend time with others.

Negative self image

Feeling unskilled as a helper. Wondering whether you are any good at this job.

Depression

Difficulty sleeping, impaired appetite, feelings of hopelessness and guilt, suicidal thoughts, difficulty imagining that there is a future, etc.

Reduced ability to feel sympathy and empathy

This is a very common symptom among experienced helpers. Some describe feeling numb or highly desensitised to what they perceive to be minor issues in their clients or their loved ones’ lives. The old stereotype is the doctor who lets his child walk around with a broken arm for three days before taking him to hospital as he has missed the symptoms and minimised them as a slight sprain, or oncology nurses who deal with patients in severe pain who feel angry or irritated when a family member complains of a non life-threatening injury.

Reduced ability to feel empathy can also occur when you are working with a very homogeneous client population. After seeing hundreds of 20 year old university students come through my crisis counselling office, I noticed two things happening: One, I would silently jump ahead of their story and fill in the blanks (“I know where this story is going”). Two, if I had just seen someone whose entire family had died in an automobile accident, I found it very difficult to summon up strong empathy for a student whose boyfriend had just broken up with her after two weeks of dating.

There are of course inherent risks associated with this reduced empathy and “jumping ahead/filling in the blank”. Clients are not all the same, and we risk missing a crucial issue when we are three steps ahead of them.

We always need to navigate the fine line between not being ambulance chasers who think every single person is a suicide risk, and being numb to the point that we fail to ask basic risk assessment questions to everyone, including the person who looks just fine. The good news is that the solution to this is very simple: vary your caseload to stay fresh.

Cynicism

Cynicism has been called the “hallmark” of compassion fatigue and vicarious traumatization. You may express cynicism towards your colleagues, towards your clients and towards your family and friends. Eye rolling at the brand new nurse who is enthusiastically talking about an upcoming change or idea she has to improve staff morale, groaning when seeing a certain client's name on your roster and cynicism towards your children’s ideas or enthusiasm.

You can probably conjure up an image of the crustiest, most negative and cynical helper that you know. Now think of that person as suffering from advanced CF and VT instead. Does that change the picture somewhat?

Resentment

Resenting demands that are being put on you by everyone. Resenting fun events that are being organised in your personal life. Resenting your best friend calling you on your birthday. Resenting taking an extra shift because your colleague is away on stress leave.

Dread of working with certain clients

Do you ever look at your roster for the day and see a name that makes your stomach lurch, where you feel total anticipatory dread? What if that starts happening with greater frequency?

Feeling professional helplessness

Feeling increasingly that you are unable to make a difference in your clients' lives. Being unable to help because of situational barriers, lack of resources in the community or your own limitations.

Diminished sense of enjoyment/career (i.e., low compassion satisfaction)

Depersonalization

Dissociating frequently during sessions with clients. Again, this is a matter of frequency - many of us space out once in a while, and this is normal, but if you find that you are dissociating on a more frequent basis, it could be a symptom of VT.

Disruption of world view/heightened anxiety or irrational fears

This is one of the key symptoms caused by vicarious traumatization. When you hear a traumatic story, or five hundred traumatic stories, each one of these stories has an impact on you and your view of the world. Over time, your ability to see the world as a safe place is severely impacted. You may begin seeing the world as an unsafe place. Examples of this are: A counsellor who works with children who have been sexually abused becomes unable to hire a male babysitter for fear that he will abuse her children. A physician forbids his children to ever chew gum after seeing a tragic event happen with a child and gum at his work. A prison psychologist develops a fear of home invasion after working with a serial rapist. An acquired brain injury therapist develops a phobia of driving on the highway after doing too many motor vehicle accident rehabs. A recent workshop participant told me that after working at a youth homeless shelter she became obsessed with monitoring her teenage children’s every move, convinced that they were using drugs and having unprotected sex. She finally realised she had gone too far when she started lecturing her 12 year old son’s friends about methamphetamines and condoms, only to see their horrified faces at the breakfast table. The list can go on and on.

Some of this is completely inevitable. We call VT and CF occupational hazards for this very reason: It is not possible to open our hearts and minds to our clients without being deeply affected by the stories they tell us. But what is important to notice is how severe these disruptions have become. We can also sometimes mitigate the impact by doing restorative activities (working with healthy children for example, working on a quilt for AIDS sufferers, etc.)

Problems with intimacy

As I said earlier, I am a couples’ counsellor. I therefore hear many stories about relationship challenges including differences of opinion about money management, parenting, household chores and sex and intimacy. Many helpers confess that they come home completely uninterested in the idea of having sex with their spouses. As one client said to me “I come home, after giving and giving to all of my patients all day. Then I give to the kids, then I clean up and get ready for the next day. Finally, it’s 9:30 pm and all I want to do is collapse in bed with a trashy novel. Then my husband comes upstairs and wants some nookie and I feel like saying “are you kidding me? I’m all done. Please leave me alone” And these are not necessarily couples with significant marital problems or certainly no preexisting marital problems. The depletion caused by the job is the problem. Of course, communication and educating spouses about the realities of CF can help greatly here. If you work with sexual abuse survivors you may also have to deal with the added challenge of intrusive imagery from their stories.

Intrusive imagery

This is another symptom of vicarious trauma: Finding that your clients’ stories are intruding on your own thoughts and daily activities. Examples are: having a dream that does not belong to you; having difficulty getting rid of a disturbing image a client shared with you; being unable to see a rope as a benign rope, after someone has shared a graphic suicide story with you; or having certain foods be unappealing to you after hearing about certain smells or sounds from a war veteran. It is not unusual for those intrusive images to last a few days after hearing a particularly graphic story, but when they stay with you beyond this, you are having a secondary traumatic stress experience. (You can read an excellent description of this in Eric Gentry’s Crucible of Transformation article).

Hypersensitivity to emotionally charged stimuli

Crying when you see the fluffy kittens from the toilet paper commercial; crying beyond measure in a session that is emotionally distressing (welling up is normal, sobbing is not).

Insensitivity to emotional material

I used to know someone who was a family doctor who eventually realised that she was struggling with VT. She used to share, at our dinner table, extremely graphic stories of medical procedures of horrible growths or cancerous tumours (usually in the nether regions) with our 3 and 5 year old children sitting with us. She seemed completely unaware of the children’s horrified looks on their faces, never mind the adults.

Other examples are finding that you are watching graphically violent television and it does not bother you in the slightest while people next to you are cringing. Sitting in a session with a client who is telling you a very disturbing or distressing story of abuse, and you find yourself faking empathy, while inside you are either thinking either “I’ve heard much worse” or “Yup, I know where she is going with this story, I wonder what’s for lunch at the canteen.”

Loss of hope

Over time, there is a real risk of losing hope. Losing hope for our clients (that they will ever get better) and maybe even hope for humanity as a whole.

Difficulty separating personal and professional lives

I have met many helping professionals who, quite frankly, have no life outside of work. They work through lunch, rarely take their vacations, carry a beeper/blackberry at all times and are on several committees and boards related to their work. They also help their families and are the “caregiver extraordinaire” for everyone around them. I once knew a helping professional who carried her work cell phone at all times. I used to see her at daycare, frequently answering client calls at 7:30 am while dropping her children off. I was very curious about this and asked her later what her working hours were and she said “Oh, I start at 9am but clients can reach me any time of day or night.” Now this person worked at the local hospital, and belonged to a large roster of social workers there, with their on-call beepers on a rotating basis. None of the other social workers at the hospital took client calls at 7:30 am unless they were at work or on call.


Failure to nurture and develop non-work related aspects of life

Many of the helpers that I meet confess that they have lost track of the hobbies, sports and activities that they used to enjoy. Some tell me that they collapse in bed at the end of their work day, too tired to consider joining an amateur theatre group, go curling or join a book club. Yet, “having a life” has been identified as one of the key protective elements to remaining healthy in this field.

© Françoise Mathieu 2009

Sources: Saakvitne (1995), Figley (1995), Gentry, Baranowsky & Dunning (1997).

My 9 year old son: "this morning, at my sleepover at Z's house, I woke up at 6am, but I knew I had to let him sleep in, so I lay there until 740am when he woke up".
Me: "wow, that's a long time to lie there. What did you do with all that time?"
My son: "Oh, it was totally fine, I just thought about lots of stuff"
Me: "Oh yeah? Like what - What you are going to do when you grow up? Things that worry you? (ever the shrink...)
My son: "Nah, I thought about all the great moves I could do next time I play on my wii hockey game. Time just flew by!"
Ah, gender differences...

Yesterday, I had a chance to enjoy several peaceful hours doing two of my favourite things: cooking meals for the week while listening to CBC radio's Eleanor Wachtel (this time, I took in an interview Zadie Smith, the author of White Teeth and a very bright and reflective person. Thoroughly enjoyable). Wachtel is a truly gifted interviewer and it is always a treat to listen to her show. These two activities are very restorative practices for me - going into another person's universe for a while (in this case, the authors she interviews), chopping vegetables for the meals of the week and most importantly, doing all of this alone and in silence. For me, a perfect restorative day would start with making bread, I would then go for a long run, come home and make soup and then while the soup is cooking and the bread is baking, lie on the couch and read the entire Saturday newspaper from cover to cover. Ah..., I feel relaxed just thinking about it.

You notice that in my scenario there are no kids, no partner, no friends calling on me. That does not mean that I don't love them and cherish my time with them, but there are times when I need to be completely alone to recharge my batteries.

The work that we do requires us to be 'on' all the time, for our clients, our colleagues and the families we work with. In fact, some of us are so used to being 'on' that we have difficulty switching off and may spend the evening avoiding silence and solitude because we have lost the art of slowing down. Some helpers are never alone because they are so overcommitted in their personal and professional lives that others have access to them 24/7. Some other helpers are so fried that they have no energy left to talk and socialise with others on weekends and evenings - ever - and this can end up feeling lonely and depressing.

In addition, a lot of helpers tell me that they feel very guilty about wanting to spend some time on their own and have no idea where to begin.

My example above (cooking, podcast etc.) may not be your idea of a good time, so I would like to invite you to think about your own restorative practices. What do you enjoy doing to recharge and reconnect with yourself? How do you carve out the time among all your family and work responsibilities?

Photo from: www.flickr.com/photos/mharvey75/374461385

This free webinar came across my google alerts this morning:

March 3, 2010 - Compassion Fatigue
LCDR Pamela Herbig - Psychiatric Nurse Practitioner, Clinical Nurse Specialist and Director, Uniformed Services University of Health Sciences as Director of the PMH-NP program.

I don't know the organisers or the presenter, but Rocky Mountain Learning seems to be a really interesting agency who specialises in bringing training to folks through webinars and other distance learning modules.

As I gear up to leave my young kids for five days (nearly the longest ever), the idea of doing more and more web-based training is highly appealling to me, let alone the significant cost savings for all involved (no travel, no hotels, etc.)

So, if you're free on March 3, consider signing up for this training and let me know what you think, both of the content and the learning medium.

Are you a compassion fatigue/vicarious trauma educator and/or practitioner? Are you interested in sharing your ideas/new approaches to helping other helpers who are facing compassion fatigue and vicarious trauma? The Association of Traumatic Stress Specialists will be holding its annual conference September 29 – October 3, 2010 at the Delta Airport Hotel – Toronto, Canada.

Click here for more information.

"Almost three in every five health-care workers are suffering from "role overload", a situation that is damaging their physical and mental health and putting many on the fast track to burnout, a new study suggest." These quotes (the title quote as well) are from an article by André Picard, published in yesterday's Globe and Mail (January 19, 2010) reports the findings from a recent study by Linda Duxbury on Ottawa area hospitals. To view article click here.

I am glad to hear that health care workers are finally getting the attention they deserve. Anyone working within the system could have told you that this was happening but maybe, just maybe, if the data is there to back it up, something will be done.

I recently came across this lovely little blog: palliativechronicle.blogspot.com

I don't know anything about the author (known on the blog as simply JL), except for what she writes on the heading of her blog: "FROM ANESTHESIOLOGIST TO PALLIATIVE MEDICINE PHYSICIAN" and I take it from her profile that she is currently doing a fellowship training in palliative care.

If you work in end of life care, you may find useful resources and musings there.There are some very good links to other resources, postings of recent articles in the field and JL's posts which recently spoke of mindfulness meditation in connection to keeping CF at bay.

I personally enjoyed visiting and will definitely be going back.

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

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.

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.

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 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?

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.

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

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