Compassion Fatigue Solutions

February is almost over. And what a confusing month in my part of the world. This morning I checked the weather in order to figure out what to wear on my run (it's not always easy to predict these days, is it -14 with a windchill of -23 or 1 degree in which case I'll be sweating buckets?). Well this morning it said "-9 celsius with freezing fog"

Freezing fog? What on earth is that? and can freezing fog actually happen when it's -9?


Have you ever heard of the Headington Institute? No, I didn't think so. Or at least very few helpers say they have when I meet up with them at workshops and meetings. And that's a shame, because the Headington Institute is providing some excellent services to helpers worldwide, and offer online resources that could be useful to all of us out there in the trenches (real and virtual, remember I work with folks who are going and returning from Afghanistan).

They have, on staff, no less than Laurie Pearlman herself, a leading researcher in the field of Vicarious Trauma and coauthor of "Trauma and the Therapist" and "Transforming the Pain" two books that are pillars of the field.

Go visit their site: www.headington-institute.org

I would like to thank the person who pointed me in the direction of this resource
(we met at the Military Base Hospital a few weeks ago and you were sitting at the very front row and provided several very good resources I had not heard of as yet. thank you).

The following excerpt speaks for itself (from the CAMH website: www.supportcamh.ca)

"Seeking help, accepting diagnosis, and overcoming addiction is difficult for anyone, especially a physician. Dr. Michael Kaufmann never thought that he would be the one asking for help, but shortly after opening his own medical practice, Michael’s casual use of prescription drugs turned into a severe addiction. An intervention from caring colleagues started Michael on the road to recovery. As the founding Director of the Physician Health Program for the Ontario Medical Association in Toronto, Michael now helps thousands of other health professionals in similar circumstances.

It’s hard to ask for help when you’re the Doctor, but being a Doctor doesn’t mean you’re immune to mental illness and addiction.

Michael Kaufmann’s predisposition and stress of daily life provoked a rapid escalation into addiction. After receiving his medical degree and opening up his own practice in his small town, Michael’s consumption of prescription drugs turned into an extreme addiction to opiates and other mood altering substances. He thought he had betrayed his patients and colleagues, and began to neglect his marriage, patients, and himself. He even contemplated suicide.

With the loss of respect from his peers, a damaged reputation and the constant fear of losing his license to practice medicine, Michael was trapped by his despair. He felt unable to trust anyone, including his wife who had become fearful and isolated from him. His addiction to drugs had become so consuming that his colleagues had to intervene and in 1986 he was admitted to the former Donwood Institute, now CAMH's Brentcliffe site.

It was difficult for Michael to accept his diagnosis. As a physician, he was trained to be self-sufficient so he believed he could help himself. Nonetheless, Michael learned to accept that addiction was a part of him, and through his recovery he gained a new and better understanding of himself and addiction.

Michael believed that his addicted persona didn’t belong with his doctor persona and as a result found it hard to share his experience early in his recovery. However, guided by his addiction physician, he became an active member of a peer recovery group and community mutual help groups where he learned to talk about his experiences with others and overcome his denial and shame. Eventually he was invited by his addiction physician to speak to classes of medical students about his experience of addiction and recovery.

Michael went on to study addiction medicine and is certified as a specialist in the field by both the American and Canadian Societies of Addiction Medicine. In 1995, he became the founding Director of the new Physician Health Program for the Ontario Medical Association in Toronto. He has written extensively about personal problems of health professionals with the goal of shattering the myth that health professionals are immune to addiction and mental illness. He looks to help others by speaking publicly about his experiences throughout Canada and the world.

“Dr. Kaufmann has transcended a potentially devastating disease to not only help himself but thousands of others, especially those doctors and other health care professionals entrusted to care for others in society,” said Dr. Peter Selby, Michael’s nominator. “He is truly a healer who is healing others as he heals himself.”

Michael has not only the courage to come back, but to bring others with him."

Visit the physician health program: http://www.phpoma.org/php/www/index.html

Here is an excerpt from this website: "Welcome to the Physician Health Program and the Professionals Health Program

The Physician Health Program (PHP) founded in 1995, is a program of the Ontario Medical Association. The PHP provides assistance to physicians, residents, and students experiencing problems ranging from stress, burnout, work-related conflict, emotional, marital and family problems, substance use disorders and psychiatric illness. The PHP also provides supportive services to family members.

In 2002, the PHP began to offer services to Ontario veterinarians with the collaborative support of the College of Veterinarians and the Ontario Veterinary Medical Association under the umbrella of the Professionals Health Program. Based on this collaborative framework in 2005 the College of Pharmacists and the Ontario Pharmacy Association also began to offer the PHP range of services to the pharmacy profession.

The PHP is concerned not only with responding to the problems experienced by physicians and health professionals and their families, but with preventing them.
In this regard, the PHP staff continue to participate in an increasing number of presentations, seminars and workshops, with a focus on healthy lifestyles, work-life balance,and stress management."

(that's an airplane being de-iced, something I witnessed several times in the past few days)

Today's blog entry will be short as I am recovering from crazy weather-induced travelling exhaustion! I had an otherwise wonderful trip to Winnipeg, Manitoba this week, meeting a very dynamic group of school counsellors. Getting there and back was honestly one of the most ridiculous comedy of errors I have experienced: flight delays, train delays, a taxi driver who fell asleep at the wheel on the major highway between Toronto and Kingston where I live as he was driving me home... When I finally got home, Saturday morning at 330am minus my suitcase which Air Canada had lost, I felt the full weight of the rather hectic schedule I had been keeping. So, apologies for the lacklustre entry this week.

Here's what I was reflecting on today, on my morning cross country ski (now that was a treat, unlike the travelling!): I was thinking back to the emails that I have received in the past two weeks, from workshop participants who very kindly take the time to send me their thoughts and feedback. They have all focused on a few key things: how they appreciated having had the chance to connect with other colleagues, felt validated to have (re)discovered that the challenges they face are universal (and normal) among helpers, and that the experience of taking a day out of our busy lives to take stock and reflect on the impact of the work that we do had given them a renewed burst of energy to retool their self care. As one helper wrote to me yesterday: "I have already read three of the books you recommended during your workshop" Now how's that for making a commitment and walking the walk?

Ok, that's all I'm going to write today. Over and out.

Hi, you, out there. How are things? If you are not from my part of the world, you won't necessarily know that we have had the worst weather this week: almost no sunshine except for yesterday (in fact, apparently this has been the winter with the least amount of sunshine so far in my part of the world. This week we had rain, sleet, snow, ice pellets and 90km winds that ripped a branch off the only tree in front of my house. Today (Friday) we are expecting a big snowstorm with 20 cm of snow. Ah, January in Canada. So much fun!

This is a mini book review. Nothing formal.
The book in question is called The Resilient Practitioner: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers and Health Professionals" Author: Thomas Skovholt (2001)

Now, unfortunately, the title of the book is slightly misleading as the book does not speak very much about resiliency per se, so anyone looking for new findings on resiliency in helpers should look elsewhere. But it offers a nice teacher-centered perspective on CF and ways to mitigate the impact of the work.

Skovholt takes a career counsellor approach to looking at the challenges of the work and uses some of the key concepts of the Strong-Campbell Interest Inventory to articulate some of his ideas. He looks at CF on a developmental perspective (the novice practitioner, hazards of practice for the experienced practitioner, etc.)

I liked the fact that he has created a resource that speaks to teachers and other helpers who work in the field of education as so much material out there (not that there is very much but still) is focused on health care and trauma workers. His chapters on sustaining the personal self and burnout prevention are also good.

Movies on CF: I also came across a wonderful independent film called Chalk. Maybe some of you have heard of it already, it was produced with the help of the Supersize Me guy Morgan Spurlock. It is a mockumentary featuring three new teachers in a Texas high school. There are some very funny and some very wry, touching moments. It has won all sorts of awards apparently. www.chalkthemovie.com

January to April are very busy months for people who, like me, are in the business of offering professional development to agencies and government-funded services.

The key operative words are "unallocated funds" which basically means that if you are an agency who gets to March 31st and you haven't spent your whole professional development budget, you won't get as much funding the following year and you lose the leftover money you had, no carryover allowed. So, all of a sudden, around January/February, agencies are scrambling to find high quality workshops to bring to their staff asap.

So this, combined with the fact that caring managers are very concerned about burnout and compassion fatigue means that I am often very busy on the workshop circuit in the winter and early spring and therefore have to be even more aware of self care and life work balance during these hectic times. Of course, talk to me from June to September, and that's a whole other story. So my "ideal schedule" in the winter months is not the same as what works the other 6 months of the year. Shift workers and aid workers who get deployed for months at a time will likely relate to this reality.

The quest for the ideal schedule is an ongoing one, something that we constantly need to tweak and experiment with. When my kids were very young, and just about to start school, I remember grilling my friend whose children were older: "and what do you make them for lunch? how do you deal with homework? what is the best way to structure the time after school?" this was part curiosity and partly my seeking to nagivate this new regime in a way that was successful and allowed me, a full time crisis counsellor at the time, a way to stay sane and healthy.

Through the EAP(employee assistance)work that I do, I have the opportunity to meet workers from all walks of life: from truck drivers to insurance adjustors, nurses to senior ranking officers in the military, donut shop workers and police officers. I am absolutely fascinated to hear how they juggle and what works best for them. Am I alone in being obsessed with this????

Why Nuts and Bolts? Well, first of all, N&B is my favourite insanely oversalted snack, but the real reason is that I feel I have several unrelated matters to mention today (or are they unrelated? they likely are very connected in some part of my brain...)


Bolt #1
During my morning run, I listen to CBC radio (normally in French and sometimes in English) and I often end up racing home to jot down ideas/interesting guests/book titles that I have heard on the morning shows before I forget about them, which will, sadly, happen rather quickly. This week, I heard a fascinating interview with philosopher Ramin Jahanbegloo.

From the CBC The Current Show, January 17th 2008:
"On April 27, 2006, Ramin Jahanbegloo was getting ready to board a plane from Tehran to Brussels when Iranian authorities pulled him aside. The Iranian-born Canadian citizen and political philosopher was blindfolded and sent to the notorious Evin prison -- the same prison where Canadian photographer Zahra Kazemi was tortured and killed. He was locked in solitary confinement and subjected to interrogations for the next 125 days. He didn't understand why he was being held. He had no idea if or when he would be released. And as a philosopher, he faced the daunting task of trying to come up with a constructive way of thinking about his situation just to maintain his sanity. Ramin Jahanbegloo is now back in Canada and teaching at the University of Toronto where he's a research fellow at the Centre for Ethics and a Massey College Scholar-at-Risk. He is the author of more than 20 books including Conversations with Isaiah Berlin and Iran: Between Tradition and Modernity.

From http://www.eurozine.com/authors/jahanbegloo.html:
"Ramin Jahanbegloo was born in Tehran, Iran, and received his PhD in philosophy from the Sorbonne. He is the author of 20 books, including Conversations with Isaiah Berlin (1991), Gandhi: aux sources de la non-violence (1998), and Iran: Between Tradition and Modernity (ed.) (2004). Also a citizen of Canada, Jahanbegloo taught in Toronto, Delhi, and Tehran; he has been responsible for bringing scores of prominent Western intellectuals to Iran, including Jürgen Habermas, Richard Rorty, Noam Chomsky, Toni Negri, and Edward Said."

What so moved me about this interview (and the podcast of the show would render it far more justice than I can) was Dr Jahanbegloo's description of how he decided to deal with his 125 days of captivity, isolation and daily interrogations by recalling his past readings of nonviolence literature (Ghandi, the Dalai Lama, Martin Luther King):

“I was in a very small cell for a very long period of time […] It was very difficult to tell the time […] It was quite tough. That’s why the first thing that I thought was that I had to fight for my mental sanity, more than my physical sanity. To take somehow my mind out of the cells. […] I wrote some aphorisms on life, death, violence, everything which came to my mind. […] There was a lot of reflection [… ] on the fact that human beings seem to need to humiliate each other to show their greatness. So there was a lot of reflection on that […] there are two reactions when you face the evil: you can become very bitter about it […] and the second is where you want to resist it. So I had this bitterness but at the same time I was thinking of an ethical resistance towards the inhuman and the evil I was living. So I got back to the idea of non violence, truth and the idea of whether there should be compassion and I went back to all my readings of the dalai lama, ghandi, martin luther king and all the nonviolent thinkers I had worked on. […] These are lessons which I learned from reading on Ghandi, meeting Dalai lama, and he always talks about compassion. […] I was trying to find my own nature and I was trying to redefine my own nature vs feeling only anger, fear and bitterness. I tried to spend most of the moments of my day not having bitterness and feelings of revenge.”

Bolt #2
I guess that interview does, in some way, connect with the other topic I have been reflecting on, which has to do with war, combat stress and the military as I am preparing a one day compassion fatigue/vicarious trauma workshop for a military base hospital.

A very large portion of my private practice involves working with military personnel and/or their spouses. Many of these clients have been to "hot zones" in the world in the recent past for 6, 9 and sometimes 18 months. Some of them have been on 5 or more tours of duty in the past 15 years. We often discuss the challenge of reintegrating into daily life, relationship challenges, parenting vs giving out orders. We also, of course, discuss the things they have seen in the hot zones.

For the non military partner, we discuss having to accept the return of your spouse when you have been running the house alone for 6 months, the nightmares and odd reactions he/she may have at times and many other challenges.

In addition, I am also one of the employee assistance counsellors that military helpers can turn to for support, debriefing and counselling. So I also get to meet with the nurses, social workers, doctors, chaplains, clerks etc. who assist these clients in reintegrating their Canadian lives.

If you enter the Canadian Forces' operational stress injury peer support organisation (OSISS) website: www.osiss.ca, you will see a stunning photograph of a soldier crouching down, holding his head in his hands. His wire-rimmed glasses are on the ground by his side. The photograph, on its own, is incredibly powerful and evocative. Then you read, when you search the net a bit, that this photograph was taken in Rwanda in 1994 by a lieutenant colonel who himself developed PTSD and turned his struggles into greater good and created the peer assistance program. If you wish, go have a look at the photograph and see what it evokes for you.

When I look at the photograph, wearing my helper hat, I feel deeply moved and concerned for this individual. As a compassion fatigue specialist, I also think "who will he tell his story to? and what will they do to cope with the story he must tell?"

That, in a nutshell, is the challenge of the work that we do as helpers.
I should also add that working with military personnel has been and continues to be some of the most rewarding clinical work I have ever done. The helper's conundrum is there, in a nutshell: the challenge is to take truly excellent care of ourselves in order to be able to continue providing the help that is needed with compassion and an open heart.

Bolt #3
If you are a little bit web-savvy, and would like to see Dr Figley present a one hour talk on CF (in Toronto in 2006) follow this link: www.glucksteinlaw.com
I particularly like the part where he discusses the survivor/victim concept. See what you think. We don't have nearly enough video material on Compassion Fatigue that is easily accessible and free. (although i haven't been on you-tube, maybe it's full of great stuff, I just don't really dare!)

Ok, that's my last salty shreddie/cheerio/pretzel for this week.

Bonne semaine à tous et toutes.

Happy New Year to you all and greetings to new readers!

There is a lot coming up in 2008 and here's a sampling, in no particular order:

-For those of you who live near Kingston, there are still spots available to attend Dr Greenberg's January 25th workshop "Letting Go of Anger and Hurt". Visit website: www.compassionfatigue.ca to learn more.

-In the coming months, I will be interviewing wellness professionals of various types on this blog. We will be speaking with a health and nutrition specialist, a life coach and several other experts in their field. Stay tuned for these monthly posts.

-I will be reviewing new books in the field and interviewing their authors for the blog as well. Please email me if you have a favourite author/book you would like to see featured. I will try my best to get in touch with them and getting an interview.

Here's my post this week:

What is the picture above about? Well, it's my 7 year old completing the 1000 piece puzzle that he and I did (with some help from visitors) during our 2 week xmas holiday. Why is this worthy of mention? It's worthy of mention because it was a deliberate, mindful process to do a puzzle. Let me explain.

Like many of you, I'm sure, I tend to be a fairly driven, A-type person in many areas of my life. Now, I feel that I have made great progress in setting limits, improving self care, exercising regularly etc. but one thing that is a constant challenge is to sit down and not be doing chores all the time. When I'm at home this involves laundry, lunches, cleaning out the fridge, battling the basement mess, the list is endless. At the cottage, I could be chasing mice, sorting through the battered, broken handled pots and pans someone "donated" (ie dumped) to us while we were away. (This happens quite a bit. Friends and family who borrow the cottage enjoy giving us their used treasures -could be useful at the cottage! - actually this is a little message to any of them: please do not donate any more aluminum pots and pans, fondue pots in the shape of a bunch of bananas (we have one of those already), fiesta ware pottery, lead is bad for us just like anyone else and bright orange bedsheets from the 70s. We do NOT need any more of any of these things!)

But I digress...Let me return to the puzzle.

When I pulled out the puzzle at the cottage, my dad, who was visiting us for a few days, said "Wow, 1000 pieces. You are patient! Are you going to have time to finish it in two weeks?" and I replied "Don't know. Don't care really, I just enjoy the process of finding a piece that fits. It's so rewarding." Quizzical look on his face. He walks away, only to ask me, every single morning when he got up "So! Finished the puzzle already?" Laughter. It was cute on day 1 and 2, a bit annoying on days 3 and 4...

Anyhow, I did exactly what I told him, I got up each day, made some coffee and sat down to look for a piece that fit. I did this every day for two weeks. I didn't read edifying psychology books, I didn't read cookbooks, women's magazines, trashy magazines or anything else. I listened to Jack Johnson and Ben Harper on my cd player and worked on my puzzle.

A few days before the end of the holidays, several guests started getting worried that the puzzle wouldn't be finished in time. I really didn't care. But, people being people, it got finished by a team, including my seven year old who had the privilege of popping in the final piece (hence the photo).

So there you go. A rather lengthy explanation of a very mindful process. Not all of you will agree that doing a puzzle is a mindful thing, but I would like to suggest that there are many ways to fit in a mindful ritual/process in your daily life.

One of my favourite self-help books is by Patrick Fanning, entitled "50 best ways to simplify your life: Proven techniques for achieving lasting balance." It contains 50 very creative (and a few rather bold) strategies. The book is simply written - 2 pages per solution and easy to read. The one I enjoyed reading about this week was the following: It suggested picking a daily activity that you already do (his example was brewing coffee in the morning) and using that time to practice a mindful activity. How long does coffee take to brew? 4, 5 minutes? Fanning suggested taking that time to sit on a cushion and meditate.

Patti, a relative of mine, said that she had a similar thought after reading the wonderful book Eat Pray Love by Elizabeth Gilbert. She decided that her mindfulness ritual would be the following: whenever she was stuck in a traffic jam, she would tell herself "Ahead of the traffic jam is a miscommunication. When the miscommunication is resolved, we will start moving again. Until then, I need to breathe and focus on something within me."

What do you think? Do you have a mindfulness ritual of some kind? Could you practice a three minute meditation while lining up for groceries?

I hope you have a lovely week.