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.

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).

...Yes, from the tasty snack, which means I have lots of different things to write about and also means that I ate way too much salty food last night, watching the Oscars. I feel like a block of salt today. ugh. What was I thinking?

First of all, thank you to all the participants who took part in last week's Compassion Fatigue Train the Trainer workshop. I met twenty wonderful people and I think we all enjoyed having the opportunity to slow down and get a chance to talk to each other for two days (and be incredibly well fed, to boot). You were all very much in my thoughts as I visualised each of you making your way back home, either close to Kingston or all the way East. Thank you for your willingness to share in the way that you did, to take risks and to offer us, in turn, the gift of the wisdom of your experiences.

It was a gorgeous sunny weekend in this part of the world. There was much premature celebration of Spring going on in Kingston with many people running outside in, brrr, shorts even though it was only about 5 degrees (we get a bit spring crazy, us Canadians don't we?). My brother - who is also one of my best friends, and his wonderful family were visiting and we took many long walks, talked and ate and and talked some more. There was also a surprise visit from my beloved, gorgeous, super smart, trilingual 23 year old sister Doudou. Doudou is a graduate student in Montreal studying international development. She has lived in Mali, Nicaragua and Kashmir (so far) and is currently planning on returning to Africa and India as soon as her thesis is done. She is very thoughtful and extremely well informed about international aid and the challenges facing developing countries. After three years of living abroad, she is also dealing with reverse culture shock, coming back into our profligate consumer culture.

In Kashmir, Doudou lived for many months with a family that had not one stitch of furniture in their home and very little to eat. Ditto in Nicaragua and in Mali. In Paris, she worked with the homeless for several months. Yesterday, as we were sitting and chatting, she told a story about this wonderful wise homeless man she used to work with and finished by saying "oh, and then one day, he was stabbed 19 times and died. That was really upsetting."

From these experiences, I see, through her eyes, that the world is never going to be quite the same again. There is a richness to what she is learning and a huge passion for the work that is still to come, but, as her older sister, I feel this protective urge to spare her the pain of what she is going to continue seeing. Of course, then, when she starts talking, I realise that she has already seen too much for me to prevent any vicarious trauma from occurring. It has already happened and it is a normal consequence of the work that she has been doing.

One thing that surprises and angers me is that in her preparatory training to deploy to these countries, she did not receive much, if any, VT training from the NGOs. I thought we were doing better than that in this day and age.

Hearing Doudou's stories, I also feel elated to see a young person who is truly a citizen of the world, and who brings a highly knowledgeable perspective to international work. I like to hold on to these encounters to combat the cynicism I sometimes hear from my slightly older friends who often launch into the old litany of "kids these days...." which they follow with a complaint about how entitled, materialistic, self-centered, what have you they perceive kids in their twenties to be. In fact, in my experience, many of the young people I speak to are not spoiled electronic brats who expect immediate gratification for everything. The people I am meeting across the country are really engaged and concerned about the society we live in, the environment, racism and poverty.

I think that sometimes, when we, the older generations, get tired and overwhelmed, we also get defensive and stop being open to the voices of people younger than us.

I, for one, am excited to hear what they have to say.

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.

Last week was very rich and stimulating as I had the opportunity to spend three consecutive days with a small group of helping professionals in the context of a compassion fatigue train the trainer workshop. It is always a real treat to have a small group to work with, as we get to actually talk things through and explore ideas in a way that I don't get to do with larger audiences. (Thank you to all of you for your willingness to take part in this process and for putting up with the many bizarre hotel-induced mishaps which took place during our time together!)

This week, I am off to Ottawa for a one day workshop with victim service workers and then to Cornwall to present to a group of helpers who work for correctional services. The challenges for both of these groups are complex, but one main issue is related to vicarious traumatization - being exposed to difficult client stories, even in a secondary way. If your job is to read crime reports day in and day out, eventually these stories have an impact on how you see the world. They simply do. If you work in a correctional environment, the very air you breathe is filled with trauma stories. What to do with this reality? How do we protect ourselves from trauma content? One suggestion (many more are included in my book, The Compassion Fatigue Workbook) is to read the wonderful book Trauma Stewardship by Laura van Dernoot Lipsky. Laura offers an excellent conceptualisation of trauma work and its impact on us, but also provides strategies, which she anchors conceptually in what she calls the Five Directions: "As we do our work, we continually seek strength by finding our center in the present moment. At the same time, we strive to enhance our self-knowledge by focusing consciously and concretely on the basic elements of our lives. The things we learn at the four outlying points of our compass of trauma stewarship will become the tools we can use to build a daily practice of centering ourselves." If you work with victims of crime or with survivors (who are sometimes perpetrators as well), I encourage you to take a look at her work.

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 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.

(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

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 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.

If you would like to view a 1.5 hour talk on CF/VT, here is yours truly at the Ontario Harm Reduction Conference in Ottawa in March 2008. If you like the content of the video, share it with your pals, and please give my contact information along with it: email: whp at cogeco.ca, blog and website addresses.

www.ohtnmedia.org/ohrdp/conf_2008/video_07/

If you are potentially interested in hiring me to come present to your agency, this will give you an idea of my style although this was not an interactive workshop given that it was really short, and it should also be mentioned that my train was late and I arrived at the conference 8 minutes before starting the talk so I was a little frazzled. The cab driver who picked me up at the train station said to me "Hello! Where are you going?" and I said "Oh, I am SO late, please take me to the Delta, I am supposed to give a talk in 10 minutes" and he turned around in his seat, looked me straight in the eyes and said "I WILL get you there in time, I promise you" and off we went, on the most hair raising taxi ride I've ever had in Ottawa (that's not saying much though, as I used to live in NYC and once had a yellow cab burn all 24 red lights we encountered to get us home). But I digress.

If you know of good multimedia resources on CF out there, email me or write a comment to the blog. My goal is the create a "one stop shop" for Compassion Fatigue Solutions and the more resources we can find and share, the better.

I am going off to Toronto today to attend a workshop (rather than deliver one, which is a nice change). This will be on Trauma Assessment in preparation for the Three day Crisis Intervention training that I offer along with Dr Mike Condra in October here in Kingston: www.crisisinstitute.com

After a difficult session….
Are you sliming your colleagues? Are you being slimed?
Can you still be properly debriefed if you don’t give all the graphic details of the trauma story you have just heard from a client? Would you like to have a strategy to gently prevent your colleagues from telling you too much information about their trauma exposure?

(For those of you who are slightly grammatically challenged, the “iming” in sliming is pronounced the same way one pronounces slime, not limb (therefore slimeing not slimming). This is not about weight reduction though you may lose a few pounds of other peoples’ baggage through this strategy…)

"Helpers who bear witness to many stories of abuse and violence notice that their own beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material." (Pearlman et al, 1995)

When helpers hear and see difficult things in the course of their work, the most normal reaction in the world is to want to debrief with someone, to alleviate a little bit of the burden that they are carrying. It is healthy to turn to others for support and validation. The problem is that we are often not doing it properly. The problem is also that colleagues don’t always ask us for permission before debriefing their stories with us.

Two kinds of debriefing
Many helpers acknowledge that they occasionally share sordid and sometimes graphic tales of the difficult stories they have heard with one another in formal and less formal debriefing situations. Debriefing is an important part of the work that we do: it is a natural and important process in dealing with disturbing material.There are two kinds of debriefing that take place among helpers: the informal debriefing, which often takes place in a rather ad hoc manner, whether it be in a colleague’s office at the end of a long day, in the staff lunchroom, the police cruiser or during the drive home, and the second form of debriefing which is a more formal process, and is normally scheduled ahead of time (peer consultations, supervision, critical incident stress debriefing).

Part of the problem with formal debriefing or prebooked peer supervision is the lack of immediacy. When I have heard something disturbing during a clinical day, I need to talk about it to someone there and then or at least during the same day. I used to work at an agency where peer consultation took place once a month. Given that I was working as a crisis counsellor, I almost never made use of this time for debriefing (or much of anything else) as my work was very live and immediate. A month was a lifetime for the crises I witnessed. This is one of the main reasons why helpers take part in informal debriefing instead. They grab the closest trusted colleague and unload on them.

A second problem for some of us is the lack of satifactory supervision. If I came and administered a satisfaction scale right after you leave your supervisor’s office, I am sure that you would be able to give me a rating on how satisfying/useful that process was for you. Sadly, the score is often rather low for a variety of reasons (having sufficient time, skill level of the supervisor, the quality of your relationship with them, trust etc).

Are you being Slimed during informal debriefs?

The main problem with informal debriefs is that the listener, the recipient of the traumatic details, rarely has a choice in receiving this information. Therefore, they are being slimed rather than taking part in a debriefing process. Therein lies the problem AND the solution.

Contagion

Sharing graphic details of trauma stories can actually help spread vicarious trauma to other helpers and perpetuate a climate of cynicism and hopelessness in the workplace. Helpers often admit that they don’t always think of the secondary trauma they may be unwittingly causing to the recipient of their stories. Some helpers (particularly trauma workers, policy, fire and ambulance workers tell me this this is a “normal” part of their work and that they are desensitized to it).

Four key strategies to slow the progress of slime

In their book Trauma and the Therapist: Countertransference and Vicarious Traumatization in psychotherapy with incest survivors, Laurie Pearlman and Karen Saakvitne put forward the concept of “limited disclosure” which can be a strategy to mitigate the contamination effect of helpers informally debriefing one another during the normal couse of a day.

I have had the opportunity to present this strategy to hundreds of helping professionals over the past 7 years, and the response has been overwhelmingly positive. Almost all helpers acknowledge that they have, in the past, knowingly and unknowingly traumatized their colleagues, friends and families with stories that were probably unnecessarily graphic.

Over time, we renamed it Low Impact Disclosure (L.I.D.). What does it look like exactly?
Low impact disclosure suggests that we conceptualise our traumatic story as being contained inside a tap. We then decide, via the process described below, how much information we will release and at what pace. Simple as that.

Let’s walk through the process of L.I.D.
It involves four key steps: self awareness, fair warning, consent and low impact disclosure.

1) Increased Self Awareness
How do you debrief when you have heard or seen hard things?
Take a survey of a typical work week and note all of the ways in which you formally and informally debrief yourself with your colleagues. Note the amount of detail you provide them with (and they you), and the manner in which this is done: do you do it in formal way, at a peer supervision meeting, or by the water cooler? What is most helpful to you in dealing with difficult stories?

2) Fair Warning
Before you tell anyone around you a difficult story, you must give them fair warning. This is the key difference between formal debriefs and ad hoc ones: If I am your supervisor, and I know that you are coming to tell me a traumatic story, I will be prepared to hear this information (for more on this read Babette Rothschild's newest book Help for the Helper, where she explores the concept of trauma exposure and helper preparedness)

3) Consent
Once you have given warning, you need to ask for consent. This can be as simple as saying: “I need to debrief something with you, is this a good time?” or “I heard something really hard today, and I could really use a debrief, could I talk to you about it?” The listener then has a chance to decline, or to qualify what they are able/ready to hear. For example, if you are my work colleague I may say to you: "I have 15 minutes and I can hear some of your story, but would you be able to tell me what happened without any of the gory details?" or "Is this about children (or whatever your trigger is)? If it's about children then I'm probably the wrong person to talk to, but otherwise I'm fine to hear it."

4) Low Impact Disclosure
Now that you have received consent from your colleague, you can decide how much to turn the Tap on (I know this isn't proper English, but it will do for the time being). Imagine that you are telling a story starting with the outer circle of the story (ie the least traumatic information) and you are slowly moving in toward the core (the very traumatic information) at a gradual pace. You may, in the end, need to tell the graphic details, or you may not, depending on how disturbing the story has been for you.

Questions to ask yourself before you share graphic details:

Is this conversation a:
Debriefing?
Case consultation?
Fireside chat?
Work lunch?
Parking lot chat?
Children’s soccer game (don’t laugh, it’s been done)
Xmas party?
Pillow talk?
Other…

Is the listener:
Aware that you are about to share graphic details?
Able to control the flow of what you are about to share with them?

If it is a case consultation or a debriefing:
Has the listener been informed that it is a debriefing, or are you sitting in their office chatting about your day? Have you given them fair warning?

How much detail is enough? How much is too much?

If this is a staff meeting or a case conference, is sharing the graphic detail necessary to the discussion? Sometimes it is, often it is not. Eg: discussing a child being removed from the home, you may need to say "The child suffered severe neglect and some physical abuse at the hands of his mother" and that may be enough, or you may in certain instances need to give more detail for the purpose of the clinical discussion. Don't assume you need to disclose all the details right away.

Final words: I would particularly recommend applying this approach to all conversations we have. In social settings, even if it’s a work dinner or something with all trauma workers, think to yourself; is this too much trauma information to share?

Some additional suggestions:
Experiment with Low Impact Disclosure (LID) and see whether you can still feel properly debriefed without giving all the gory details. You may find that at times you do need to disclose all the details which is an important process in staying healthy as helpers. And at other times you may find that you did not need this.

Have an educational session followed by conversation at your workplace about this concept.

Low Impact Disclosure is a simple and easy CF prevention strategy. It aims to sensitize helpers to the impact that sharing graphic details can have on themselves and their colleagues.

I will write more on this concept in the weeks to come, and I welcome your thoughts and comments.

This poem was written by a therapist colleague of mine who has worked in this field for many years. She is someone who reflects deeply on the cost of doing this work, on the rewards and the pain that we can experience when our clients suffer terrible losses. She also made some very important changes to her schedule and her work/life balance in a way that now allows her to do this challenging work without being damaged by it. Those changes took an incredible amount of courage and humility, and I think that she will reap the benefits tenfold. If anyone "walks the walk" it's her. She has asked whether she could share this poem with our CF community, but wishes to remain anonymous.

this work

my ten year old heart imagined
mothering a tidy orphanage
full of grateful kids
with names beginning with J,
carefully cleaned ears,
and brand new matching bedspreads.

thirty odd years later, I would cry out,
why do I do this work, this work
so beyond lists, Q-tips and the Sears catalogue
that I quake
when I open the door to yet another babe
swaddled in such unspeakables,
abandoned with such artifacts:
the chased painting still at last
beside the Barbie shoes below the school bus,
the truck at the bottom of the icy lake
cleared for the grandkids' hockey games,
the bullet through the crimson pillow
where escape plans had tossed and turned,
the sticks and vegetables that had heard
such pleadings as no plant could imagine,
the seven year old Chapstick tasted
and set back by the ever empty baseball glove,
and today, just today, the cap and gown
to be donned the day after the funeral.

and I buckle and stagger once more
under the weight of this work, this work,
all but forgetting the shared breath,
the symphonic bouquet,
the tender arms of just last week,
wondering why, why
I cannot simply know the rose and the fire
in their exquisite words,
and the importance of keepsakes
in the light of our teal glass inukshuks,
marking the way for us and our followers,
lost and found in snow’s infinite textures
melted and sheening on our souls’ skin
and in our soft open eyes.

As I am travelling quite a bit in the next few weeks, I won't stick to my weekly Sunday post but rather will add things of interest as they come across my "desk" (my desk at the moment is a shaking little table on a train that is running 1.5 hours late which means that I may or may not arrive to my destination in time to present a workshop. The joys of winter travelling continue!)

I would like to thank Dr Charles Figley for bringing the following article to our attention through the Traumatologist forum which is an email listserv. For anyone interested in being part of a compassion fatigue network that occasionally shares new findings/articles/book ideas: https://lists.fsu.edu/mailman/listinfo/traumatologist-forum

Basically, this and other research on VT is confirming what we all know experientially: that exposure to traumatic stories causes profound changes in helpers. This study will be published in the upcoming issue of the journal of Traumatology, and is based on the researcher’s Master’s project.

Crime takes heavy toll on legal minds
March 1st 2008 - By Lynnette Hoffman in The Australian

"SEAN Brown still remembers the details a decade on. From the horrific sequence of events right down to the specific type of bullets that were used; how many there were, where they went in, how long it took the victim to die.

Brown (not his real name) wasn't a witness, nor was he on the ground at the crime scene, but plenty of grisly stories have been embedded in his memory in 20-odd years as a senior crown prosecutor.

Brown has "seen a lot" over the span of his career, a career that has required him to immerse himself in the intricate circumstances of violent death and homicides, brutal rapes, war crimes, you name it. The sum total of all that, he says, is "not very healthy".

New research from Macquarie University, to be published in the international journal Traumatology, has found that criminal law work can have profoundly damaging psychological effects.

By and large, Brown has been rather fortunate in that regard. He has not suffered a debilitating depression, nor has he felt the need to seek professional assistance for mental health issues, or fallen into a pattern of abusing alcohol or drugs.

But that's not to say the work hasn't taken its toll. His dreams are sometimes affected, as are his relationships. "I tend to get moodier with my family and become more difficult to get on with at home," he says."

To read complete article, go to: http://www.theaustralian.news.com.au/story/0,25197,23292980-23289,00.html