Compassion Fatigue Solutions

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.

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).