Compassion Fatigue Solutions

This will be my last blog entry until mid January as I will be taking two weeks off for Christmas. I will be heading to Quebec's Laurentian "mountains" to visit with family and friends. I put mountain in quotes as the Laurentians are very old and therefore quite eroded gentle little hills. (Friends from Western Canada, I hear you laugh!) But the Laurentians offer beautiful and serene forests, wonderful cross country skiing and even one half decent downhill slope.

We (my children and husband and I) are all very much looking forward to being somewhere that isn't wired to the tv, internet or voice mail. I have several new board games that I pretend I purchased for the kids but I'm dying to play them (although apparently I get a bit too competitive when I play Clue, I've been told. I am ashamed to admit that last year I got a little excited trying to beat the 6 year olds!)

Apparently there has been a huge spike in the mouse population however, so we may have to devise some clever new strategies to deal with our little friends. I have a rather embarrassing mouse phobia which once found me sitting on the kitchen counter, phoning my father in law for emergency assistance as one mouse had gotten into the huge bag of dog food and was bouncing around like mad in there...I guess I have something to work on in 2008! (that and learning how to drive standard and how to windsurf and play hockey in a women's league but that's for another day)

What I would like to share with you today before I sign off to go eat and drink and play Risk is a very exciting new venture that I am embarking on.

But first, an update you on WHP's work stuff

The Walking the Walk workbook is almost done. I received one permission to reprint a testing scale that I absolutely needed and so I can now forge ahead in January and finalise my 'camera-ready' text.

I am looking forward to visiting several different cities in January-March, including Winnipeg, Manitoba (last year the temperature in February dipped to -41.7 celsius one day!), Hamilton, Toronto and Montreal. I will be working with agencies such as: a school board, an acquired brain injury clinic, Children's Aid, Military hospital staff, helpers working with high risk infants and youth, a large group of hospital social workers, a burn unit, an oncology ward and possibly a group of staff working with spinal chord injured patients. I am really excited about the opportunity to spend some time with such a varied group of helpers and look forward to learning from them and sharing ideas and strategies.

New Projects - Going deeper with the CF Solutions work

In the New Year, I will be embarking on a new partnership that I would like to describe a little bit here. I greatly enjoy the work I do in the field of CF (in fact, I could easily spend three times as much energy on it every day as my interests far outweigh the time available) and I have been looking for material that goes beyond "day one" of my CF workshops. I have developed several presentations on the topic, but had not yet found some truly excellent organizational resources that addressed the very specialised needs of my helper clientele, until now.

A few months ago, I came across the work of Dr Pat Fisher, CEO of Fisher and Associates. Dr Fisher is a psychologist with a wealth of expertise in the areas of organizational health and wellness. She created an organizational health and wellness company that operates out of Victoria, B.C. and New York and has offered in depth training to staff in the fields of justice and corrections, children's aid and the civil service to name a few.

Dr Fisher and I connected and talked at length about our vision, our values and our programs and came to the conclusion that her work was very complementary to mine. I therefore decided to become an associate of Dr Fisher's which will allow me to retain my independence and also be in the position to offer Fisher and Associate's programs to any of my clients seeking more in depth organizational training and assessment strategies for their agency.

Fisher & Associates offers organizational health and wellness programs using thorough, empirically tested assessment tools that will benefit managers, staff and the organization as a whole. If your agency has already participated in WHP's one day or half day workshops on Compassion Fatigue and self care and wants to look at Stage Two tools for the organization as a whole, there are several different programs being offered by Fisher and Assoc. to meet those needs.

Pat Fisher has developed several workbooks and training courses for health care and human service workers. She co-wrote "When Working Hurts: Stress, burnout and trauma in human, emergency and health services" A workbook designed to accompany the 2 day workshop she offers to agencies; and "The Manager's Guide to Stress, burnout & trauma in human, emergency and health services" which is a companion workbook to a 2 day training program aimed at managers in health services.

If you would like to know more about Fisher, you can visit their website: www.fisherandassociates.org or feel free to email me: whp@cogeco.ca

Here is an excerpt from the company website:

"Fisher and Associates Solutions is an international company based in both Canada and the United States. We are a dedicated team of psychologists, social workers, executive coaches, and mental health professionals specializing in helping organizations, managers, and employees cope with workplace stress and job trauma, including vicarious trauma and compassion fatigue.

We are Organizational Health and Employee Wellness specialists who provide comprehensive, research-based training programs and services. We work with high stress workplaces and occupational groups who are exposed to traumatic stress due to the nature of their work.

Our programs work! Recent follow-up studies with two large organizations that completed our Core Workplace Wellness programs found measurable positive impacts including:

* decreased absenteeism
* improved productivity
* decreased job stress
* better physical and mental health

Wellness programs and educational services offer a significant return on your investment including cost savings in areas such as long and short term disabilities, absenteeism and staff retention! Research tells us that workplace stress and trauma are extremely costly to individuals and organizations. You can lower incidence of workplace stress, burnout and trauma through intervention and education. This can result in increased work performance, higher staff morale, greater employee engagement, less absenteeism and improved overall health of employees. Organizational health and employee wellness are paramount foundations to both high quality work and quality of life"

In the New Year, I will provide more concrete information on the way this training can be offered to your agency, should you be interested to know more about this.

On that note, I would like to wish you all a happy New Year and some time to rest and replenish yourselves.

Françoise

That is the title of a book written by Wayne Muller (1999). It was recently sent to me by Jan Spillman, a colleague based in British Columbia who works with caregivers experiencing compassion fatigue. Here's a quote that struck me:

"Charles is a gifted, thoughtful physician. One day were were discussing the effects of exhaustion on the quality of our work. Physicians are trained to work when they are exhausted, required from the moment they begin medical school to perform when they are sleep-deprived, hurried and overloaded. "I discovered in medical school," Charles told me, "that if I saw a patient when I was tired or overworked, I would order a lot of tests. I could see the symptoms, I could recognize the possible diagnoses, but I couldn't really hear how it all fit together. So I got into the habit of ordering a battery of tests, hoping they would tell me what I was missing. "But when I was rested - if I had an opportunity to get some sleep, or go for a quiet walk - when I saw the next patient, I could rely on my intuition and experience to give me a pretty accurate reading of what was happening. If there was any uncertainty about my diagnosis, I would order a single, specific test to confirm or deny it. But when I could take the time to listen and be present with them and their illness, I was almost always right." (p5-6)

I really resonated with this quote, as I know for a fact that I have been more directive with clients when I have felt overwhelmed with other work requirements (a full waiting room on a Friday afternoon for example vs an empty one on a slow day). That is not something I am proud of, but I can look back with compassion now and realise that I was not rested enough to be able to problem solve with creativity.

Wayne Muller's book adopts a multifaith perspective and encourages the reader to re-explore the concept of taking time out of our weekly schedule for rest and renewal.

I had to take a week off from my weekly posts as there was a death in my family (my aunt, who had been ill with cancer for the past two years). Although we knew she was ill, her death came more quickly than expected. I therefore had to do some last minute fancy footwork to get back to Montreal for the funeral and I am very glad I did. Connecting with loved ones is definitely a wonderful way to replenish ourselves when we are facing difficult life events. I enjoyed seeing relatives that I had not seen in many years.

Then, work-wise, I had the pleasure of presenting to a team from a Montreal hospital and got to offer the workshops in Frenglish as the staff was bilingual and made up of some English speakers and some French speakers. To be honest, Frenglish is my preferred language of choice in spite of years of hard work on my mother's part to instill a clear discipline in sticking to one language at a time! I may have to go to French boot camp and then to English reform school to get the bad habits out of my system. But it was so much fun...

These are all asides, what I wish to tell you about relates to a book I was recently sent by a colleague. I'll write about that now in my official Sunday post for this week.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And a few more strategies…

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

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

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

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

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

Recommended books on Compassion Fatigue and Vicarious Trauma:

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

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

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

Self-Care books for Helpers:

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

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

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

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

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

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

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

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

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

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

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

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

What do you do to refuel?

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

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

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

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

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

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

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

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

Feedback from reviewers of Dr Greenberg’s publications:

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

Marsha M. Linehan, PhD, University of Washington

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

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

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

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


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

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

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

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

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

Lunch: (on your own)

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

This workshop is designed to help you:

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