Compassion Fatigue Solutions

(Françoise's desk Sunday April 5th, 2009)

Before you start reading this post, I would like to describe to you my current working conditions on this lovely Sunday morning: we recently had a flood in our basement which wiped out the children's play area which means that they immediately invaded my home office with millions of tiny plastic toys that crunch underfoot and never seem to go back in their storage tubs. Defeated, I temporarily migrated to the dining room table, waiting for the basement to be back in use. So, while trying to write this post I have had: 1) a 30 minute fashion show by my 11 year old who just unpacked a bag of hand-me-downs from her cousins 2) two 8 year old boys eating peanut butter straight from the jar with gigantic spoons 3) a skunk walking in our backyard and 4) a sibling dispute to break up! But truth is, the house feels very empty when they are not here, and I will step on a crunchy plastic toy quite happily. The benefits far outweigh the costs.

During the past two weeks, I have presented to oncology and palliative care workers in a large Montreal hospital, nurses from Corrections and staff at a busy community mental health agency. The workshops offered were half day presentations on compassion fatigue and vicarious trauma.

I wish I could find the right words to accurately describe the energy that is present during these workshops. I think the reason for this intensity and engagement from participants has to do with all of us helpers being given an opportunity to reflect on and talk about the cost of caring. Being able to take a few hours out of our incredibly fast-paced work lives to take stock and look at the impact that this work has on us.

Reflecting on the past 7-8 years, I have often asked myself "why does this always feel like a brand new workshop, each time I offer it?" I think that this energy from participants is really the only way to explain that presenting the same workshop five times in two days remains a replenishing experience for me.

I think the same can be true of clinical work: Have you ever looked at a day's worth of client appointments and felt anticipatorily drained, only to wrap up the day feeling energized and think to yourself "wow, that went by very quickly." Yes, client work can be draining, but it can also offer us incredible rewards and opportunities for renewal. Laughter is one source of replenishment in our work ( I think there is probably more laughter in counselling work than outsiders might imagine, even in terrible situations), and so is watching someone make an amazing change in their life, take a risk, big or small, gain an insight, take a stand. I have sat in session many, many times, filled with admiration for the courage of the person in front of me, filled with awe and feeling honoured to be the holder of their testimonial. That is why we do this work, isn't it?

I feel the same way about facilitating CF/VT workshops. I also think that combining the two is a good blend: working with clients part time and offering workshops part time. I wonder what your ideal blend would be?

This week, I am going to Ottawa to offer a Vicarious Trauma retreat to Crown Witness Coordinators (CWCs). CWCs provide Northern victims/witnesses with assistance throughout the court process. CWCs travel the North West Territories, the Yukon and Nunavut along with what is called "Circuit Court" - a travelling court of justice that goes from region to region, offering court services across the north. I am very much looking forward to meeting these CWCs.

Till next time, happy Passover and happy Easter for those of you who observe these holidays, and happy Spring to you all.

Change One Thing
by Bill O'Hanlon, 223 N. Guadalupe #278, Santa Fe, NM 87501 USA
www.billohanlon.com, PossiBill@aol.com

[You have permission to reproduce this handout as long as you keep my contact information on it and do not use it for money-making purposes without obtaining my explicit permission.]

Sometimes we don't make changes because they are too difficult of daunting or we are "fixin' to get ready," as my friend Helen says. One way to get change going is to consider the smallest change you can make and begin. Often inertia will continue to take you in the direction of change once you start. If not, at least you are moving forward a little. As Milton Erickson used to say, "If you fall on your face, at least you are heading in the right direction."

Identify the smallest change you can make and begin
If you want to write a book and aren't getting it done, try writing one word a day. I used to recommend five minutes a day (which is fine if that works for you), but if even five minutes seems too much, start with one word a day. Clean up, organize, or toss one piece from that stack of papers/mail/magazines cluttering your house or office.

Commit to a limited period of time for the change
You could commit to walking for five minutes a day for the next week. Or de-cluttering that pile of papers for the next three days. Forever is too daunting for most. Time-limited often works better.

Focus on only one thing at a time
Stop multi-tasking and experiment with doing only the thing you are doing. Or attend only to the person or experience you are with at the moment. Listen to and watch the person you are conversing with (rather than texting, glancing at the television, thinking about what you will do or say next, etc.). Eat when you are eating. Drive when you are driving.

Build a new habit one day at a time
Do the new habit for 5 minutes each day until it becomes ingrained, then expand the time or effort you put in.

Dismantle an old, unhelpful or unhealthy habit one piece at a time
Change one small thing about the old habit. Drink half a soda and half a glass of water with a meal instead of a soda. Park a little farther away from the store or your workplace and walk a little. Eat everything that is unhealthy with your non-dominant hand.

In this workshop, participants are introduced to the principles and methods of James Flaherty's New Ventures West successful approach to coaching and to human development (see www.newventureswest.com). The program allows for coaching experience that is applicable to the participants' work place or current coaching practive, and their broader lives. Through structured exercises, demonstrations and simulations, we will explore together what it takes to evoke long-term excellence in others.

Who would benefit from this course?

This course is designed for:
-Anyone intrigued by the possibility of having a positive impact on others through coaching;
-Managers, Human Resource professionals and Organizational Development practitioners who are regularly called upon to solve problems that could be more effectively handled by developing others' competence;
-Independent professionals, consultants and coaches interested in bringing greater skill to their one-on-one conversations with clients;
-Therapists and social workers interested in building coaching competence;
-People considering applying for the Professional Coaching Course.

For more information contact Hélène Beauchemin at belaylen@hotmail.com or Barbara Best at barbara@virtualworks.ca
Phone: 613-236-4847.

Hi dear reader,
(This is a photo of a beaver-chewed log taken by the shores of a frozen lake in the Laurentians)
I am back from a week off where I had a chance to read novels, do some spring cleaning and watch my increasingly independent children take a ski lift by themselves (gasp). It was a sun-filled week, which was great. The break was much needed for my whole family, I think.

I have been reading and thinking exclusively in French for the past few weeks, preparing for a two day visit with oncology staff at the CHUM (Centre Hospitalier de l'Université de Montréal) so I now have to put my English hat back on to write this post. I have come across some interesting French resources on Compassion Fatigue (que je mettrai bientôt sur mon site web).

One English resource was a series of podcasts produced by the CMA (Canadian Medical Association) called "Healthy Practices: A podcast on physician health" hosted by psychiatrist Dr Mamta Gautam. Follow this link to hear the podcasts.

This week, I will also be visiting a group of nurses who work in Correctional facilities near Kingston to offer them a much deserved half day on self care.

It's officially Spring! Time to dust off your rusty bike, rollerblades or snow shoes if you live up North and get out and get moving. We live in a crazy country really, (the snowiest in the world, I found out this morning, and the second coldest) so let's celebrate the arrival of Spring by making a renewed commitment to taking care of our bodies and souls.

This is a picture of a garden shed, as you can see.

Well, this garden shed is about the same size (or slightly bigger) than the Washago train station. I kid you not! I was there today, on my way back from a training session with Corrections Canada in a beautiful ymca camp. I wish I had my camera. If someone has a photo of the actual train station, send it my way please.

My dad earned his pilot’s licence before the start of World War 2 and, when I was a kid, he would often tell me stories about his flying days. When he enlisted he became an instructor and spent thousands of hours in the back seat of a Harvard aircraft “teaching young hopefuls to fly”.

After a student learned the basics of safe flying, it was necessary for them to know where the dangers were highest… how to recognize a potential problem and how to correct for it before it was too late.

Night flying meant learning to fly with instruments, not their eyes, and not just relying on their own sense of well-being. This is the core of the message that he taught me which would surface many years later when I became his caregiver during his journey through dementia. “Flying by the seat of your pants” became a wonderful metaphor - an image of how I needed to care for myself in order to continue to give quality care to him.

The lesson that I remember from him was that flying an airplane by instruments is very different from flying by our human senses. When we can see clearly, our eyes and our inner ear, which measures our sense of balance, reinforce and correct each other to ensure that we maintain proper orientation to the world around us. We can control ourselves by our senses or as the pilots say “Fly by the seat of our pants”. The pilot knows the sensation of what a safely operating airplane feels like.

At night there’s an additional challenge. The pilot’s eyes don’t give reliable information so the pilot is left with their sense of balance. Our amazing human bodies have limits of what can be detected. Although sudden or large changes are easy to recognize, one of our body’s weaknesses is identifying very gradual change. A pilot who tries to fly by the seat of his or her pants at night can’t detect if the airplane is very slowly going into a spin or a dive. Their body’s motion detector in their inner ear can’t be reoriented because their eyes can’t see in the dark. Their body might tell them “You’re level, you’re OK” but they are not…. dangerously not OK. Only the instruments can give them the feedback that tells them “Your feelings, your sensations, are getting confused. The instruments are correct. Make changes now for your safety and the safety of those with you.”

So what’s “Flying by the Seat of your Pants” got to do with being a caregiver for someone living with dementia? Caregiving means taking on additional challenges. Although we can see the changes in the person living with dementia for whom we are caring… the good days, the bad days, the losses in their capabilities… what we miss are the changes in ourselves, the constantly increasing changes in the demands on us as caregivers. It sneaks up on us. “I’m OK. I’m handling this fine” is such a common reaction… and usually it’s not true. Like the pilots, our bodies don’t detect those little changes that accumulate and our bodies and minds are not good at telling us that we’re not taking good enough care of ourselves… that we’re actually headed into a fatal dive. We tell ourselves that we’re doing fine when in reality we should be asking others for help.

So what’s the key to safety of the caregiver? How do we observe the necessary warnings so that we can ensure that we don’t do damage to ourselves by “Caregiving by the seat of our pants”? The answer is our “Instruments”. What are those external measurements telling us that we need to pay attention… information that doesn’t agree with how we feel but will help us change from a dangerous spin? There are many. Our friends telling us that “You’re looking tired” or “We’ve missed you” or “I’m concerned about your level of stress” are messages that we need to heed. Checklists for measuring Caregiver Burnout are another. The Alzheimer Society, the Victorian Order of Nurses, and several other groups have them. But don’t just measure yourself alone. Have a friend who understands the demands of dementia, knows you and will be honest with you, help you through the checklist. Listen to their opinions about how they think you are doing. If you become a damaged caregiver, then your setbacks limit the quality of care that you are able to give. Taking care of yourself means taking better care of the one living with dementia.

And if you catch yourself saying “No, really, I’m doing fine”, then you’re probably flying by the seat of your pants. It’s a good time to believe your instruments, change how you are taking care of your own needs, and stop your undetected fatal dive.

Jack Henderson, a former caregiver.
Been there… done that. And I also needed several family and friends to tell me “Listen Jack, you’re NOT doing OK. We know the signs. You’re headed for burnout. Take better care of yourself.”

©Jack Henderson, 2009 Feb 26

Benoit Duguay is a professor at the ESG Business School in Montreal. He is an expert in consumer trends and a critique of overspending and overconsumption. Dr Duguay writes French and english blogs on consumer trends. The French blog is called "Causerie sur la consommation" and is updated regularly. The English blog is a little less information packed but has some interesting reflections nonetheless. It's worth a visit.

One of my good friends celebrated his 40th birthday last night. I was deep in conversation with a guest at the party, when I mentioned something that had happened in 1989 and he said to me "Um, I was three in 89, I don't really remember that event" which made me gasp and take a little step backwards. 1989? Wasn't that yesterday? Time just mercilessly keeps on moving forward doesn't it. Here's a special hello to all of you out there who think 1989 was two years ago.

This week, I am running the two day train the trainer and then going to run a one day retreat for a group of mental health professionals who work in a psychiatric setting. Sunday I am going north to present in a prison. I really enjoy the variety among the trades that I meet, it makes this work so live and interesting.

Bonne semaine à vous tous et toutes