Monday, December 15, 2008

Seasonal Comforts...

It's COLD in Vancouver. Or at least it's cold for Vancouver! There is an "arctic outflow", according to our meteorologist, causing cold air, frigid winds and intermittent snow and sunshine to shift from the interior to the coast for the next week.  

Although it wrecks havoc with our driving and causes strained backs and broken wrists, this severe weather also draws our attention back to the rhythms of the seasons and to the comforts and sustenance peculiar to each one. Spring, summer, fall and winter. Each has its own particularly comforting activities, activities that we can pursue to balance and refresh our busy lives.

In The Woman's Comfort Journal,  author, Jennifer Louden, suggests the following winter comforts:

1.  Curl up in flannel sheets with someone you love, human or animal.

2.  Sip hot tea and watch the rain.

3.  Make a snow angel.

4.  Have a snowball fight, then run indoors and sip hot mulled wine or apple cider by a roaring fire.

5.  Roast marshmallows in the fireplace.

6.  Make a steaming pot of soup or a hearty stew of root vegetables.

7.  Bake bread.


To this list I would add:

8.  Curl up in a large chair with your favourite afghan and a good book.

9.  Toast crumpets on the fire and eat them dripping with butter and raspberry jam and with a large mug of hot chocolate.

10. Knit long stripey socks in brilliant colours.

11. Take your camera cross country skiing or for a winter hike.

12. Take a walk around the garden or the neighbourhood and notice that, even in winter, new life is waiting to spring forth in buds and shoots.

13. Design a calendar for the new year and give copies to loved ones for holiday gifts.

14. Take naps - lots of naps - for winter is naturally the season for hibernation. A time to rest and to heal.

15. Play with children or play some games you used to enjoy as a child.

This is not an exhaustive list, rather, just a beginning.  Think of some other specifically winter activities - or non-activities - that restore your life balance. Ask others what they would place on their lists. Do one thing each day or each week throughout the winter. Notice the difference it makes to be in tune with the season and in tune with yourself.   

Monday, December 8, 2008

Christmas Choices...

For exhausted family caregivers and over extended helping professionals, the holidays can feel like adding a 100 pound pack to the running of a marathon. The season of giving becomes one more burden to shoulder rather than the warm, peaceful celebration we all dream about.  If trying to maintain family obligations and holiday traditions is getting you down, try these three suggestions made by Jo Robinson and Jean Coppock Staedheli in their popular book, Unplug the Christmas Machine.

1.  Take stock.  Ask yourself why you feel more wrung out and exhausted during the Christmas season.  Are you trying to see too many people?  Are you working extra shifts to pay for bigger gifts and better trimmings? (Is it worth it?)  Are you trying to spend time with people who don't understand your current situation or with those who are conflictual or badly behaved? Are you expecting yourself to carry on traditions that no longer fit for you and your family?  Or does a busy, crowded holiday just not fit with your values?  Once you have identified the sources of your exhaustion, you can start to do something about them.

2.  Look for practical solutions, even if it means breaking traditions.  When we see the causes of our seasonal tiredness, we can usually see very quickly what we would like to change.  We realize that once enjoyable traditions no longer fit our changed circumstances.

3.  Communicate your wishes to your family and friends.  If at all possible, talk to family members well ahead of time about any major changes and realize that it may take some people longer than others to get used to the fact that Christmas won't stay the same forever.  Don't try to make all your changes at the same time (-unless illness or injury forces your hand).  Planting a seed now can bear fruit for next year.  Most importantly, take the time to explain your feelings and ideas thoroughily and calmly, without blaming others or becoming defensive.  And remember that every change represents a loss so you will need the opportunity to grieve before moving on.

I have always loved Christmas and its traditions and when my husband became ill, I was loathe to give up any one of them.  I worked hard to deep the holidays unchanged not realizing that a change could be a wonderful gift.   The fourth year of his illness, we were forced to realize that we could no longer spend the night before Christmas in the company of loved ones at Midnight Mass.   We grieved in anticipation of our lonely Christmas Eve then made a conscious effort to "light a candle rather than cursing the darkness" and planned our own quiet service at home   It was one of the most beautiful Christmas eves I've ever spent.  Accompanied by one dear friend, we sat around a livingroom table in the soft candlelight and the glow of the Christmas tree listening to the gentle strains of carols as my husband celebrated a simple communion service . I remember the reflection of candles in the 100 year old chalice of an unknown Army chaplain, the simple and familiar prayers and the feelings of deep peace and intimacy.  If we hadn't broken with tradition, we would never have known the gift of that gracious Christmas Eve. 

Monday, December 1, 2008

World AIDS Day...

Today is World AIDS Day, a day set apart for those of us who have lost loved ones to this voracious disease to remember, to grieve, to celebrate, to renew our support and to look forward in hope.

There are more that 33 million people living with AIDS today, including 2.5 million children.  And there are at least as many caregivers, both family caregivers and helping professionals.  

Supporting someone through the roller coaster of any serious illness is difficult but to do so in the presence of ignorance, stigma and judgement is painful indeed.  Research tells us that caregiving within a community that shuns or denegrates the care recipient increases the risk of compassion fatigue in the caregiver.  Just like the Viet Nam vets in the 1970's, we all need support, understanding and appreciation as we fight on.

How can we support people living with AIDS and those who care for them?  Well, we can wear our red ribbons today as a sign of remembrance and solidarity and tomorrow we can take just one action in our local communities to help reduce the stigma and to improve the quality of life for PWA's and their caregivers.  Perhaps we could...

- Take some time to learn the facts - rather than the myths - of living with AIDS.

- Take a moment to write a note of encouragement to someone living with AIDS
or of appreciation to someone who works with people with AIDS.  

- Make a donation to a local AIDS service organization.  This Christmas,  
Loving Spoonful, an organization that improves the nutritional status of 
people with AIDS through free home delivery of nutritious meals and a baby
food program for babies of HIV(+) moms, is selling scarves through 
Vancouver's Capers Community Markets for $20.00.  Each purchase gifts
both the receiver and the families living with AIDS.  

- Volunteer some of our time and talents to local or international AIDS 
organizations.

-  Call someone you know who is living with AIDS or who is a family caregiver
and offer a specific form of help.  A ride to a doctor's appointment.  Grocery
shopping.  Help in the garden.  Assistance with Christmas shopping or writing Christmas             cards or putting up a tree. Housework. Returning library books or videos. A chat over a cup       of tea.  If that form of assistance isn't needed, ask if there is anything else you can do.  
 
Barry and Jack, two dear friends who lived well with their illnesses until their last breaths, did much to counter AIDS prejudice, one in the teaching community and the other within his beloved church.  Both were talented, sensitive, passionate men who gave much to our community and I am grateful to have known them and their partners.              

Sunday, November 9, 2008

Connecting...

This week I will be heading off to Kingston, Ontario for a Compassion Fatigue training and a visit with dear friends and I'm feeling very excited.  (Or at least I will be once the laundry and packing are done...!).

Research tells us that both continuing education workshops and time spent with family and friends contribute to our burnout and compassion fatigue resiliency and I intend to drink deeply of both.

I'm looking forward to meeting new people who are also interested in Compassion Fatigue. (The shift to a home office has been wonderful in many ways - no commute, lake-walks whenever the mood strikes, a fresh cup of tea just footsteps away - but it is easy to become isolated, especially for an introvert who enjoys being alone.  So, as in the days of my family caregiving when I consciously connected with the folks at Lonsdale Quay every Wednesday morning, I'm making a conscious choice to build my professional network through attending workshops and conferences.)

Once the workshop is finished, I will have a few days to spend with my friends, talking, laughing, walking, attending a country concert and, perhaps, driving to Prince Edward County for some crisp, delicious Ontario apples.  And I will definitely take the time to walk to Panchencho's for my annual latte and sticky bun!

What about you?  How are things going on the connecting front?  When was the last time you spent an hour with someone just for the fun of it?  I remember, in the depths of my family caregiving, a wise friend noted how hard it must be for an introverted caregiver to need support and have to reach  into the outer world to get it.  (Introverts are people who, when exhausted, need to retreat to their inner worlds to rest -  so the last thing they want to do when they're tired is connect.)  

But you don't have to spend hours with a crowd of people in order to stay connected. Perhaps you could have a conversation with someone whom you know will respect your need to get off the phone after 10 minutes?  Perhaps you could arrange a 15 minute walk with one quiet friend?  Or maybe you could join a chatline regarding your favourite hobby or activity?  Or maybe even go to a movie where you only have to chat on the way to and from the theatre? 

We human beings are hard wired to connect, some of us a little more or less so than others, and there are as many ways to do it as there are people. The important thing is to determine how much connection you need and then to make a conscious choice to make it happen, even if only a baby step at a time.

        






Tuesday, November 4, 2008

One Day at a Time...

One evening last week, I had the extraordinary privilege of hearing primatologist, Dr. Jane Goodall, speak on  A Reason to Hope at the Center for Performing Arts in Vancouver.

Although her presentation was inspiring and motivating, it was her presence that left the most lasting impression. Although the seventy-four year old was slight and obviously tired after speaking 300 days out of the last 365 to save her beloved chimpanzees, she was deeply grounded, still and quiet in a manner that I've rarely encountered other than in people who spend many hours in prayer or meditation.  Her's was truly an arresting presence.  And when asked from whence came her strength, she replied calmly that she took one day at a time.

One day at a time.  There are so many things we couldn't begin to face if we believed that we had to do them forever.  But one day at a time, that's a different thing altogether.  There's not much that we can't handle a day at a time.

I remember people asking how I coped with caring for my husband, especially during the last three years of his life when he was bed bound.  They couldn't understand how I could keep doing the same tasks day in and day out, to say nothing of dealing with the life-threatening emergencies that occurred on a regular basis.  "How did I keep going?", they asked?  Wasn't it overwhelming?

Well, no, it wasn't overwhelming, not on a regular basis anyway, because we lived our lives one day at a time.  Of course the days after the nights without sleep were pretty tough and the endless tasks were draining and boring and the emergencies were terrifying but each day had a beginning and an end and each morning offered a fresh start.  I found that as long as I worried about today today, and left tomorrow to tomorrow, I managed pretty well.  It was only when I started importing tomorrow's concerns that I got into trouble.

That is not to say that we should bury our heads in the sand.  Contingency planning goes a long way toward reducing anxiety but after the potential problems are identified and the plans made, it is best to store them on a shelf until needed and then return to the present.

As a chronic worrier who has improved with age, work and experience, I keep a card on my freezer that reminds me of the importance of staying in the moment and living one day at a time.  On it is a saying that goes like this:


Worrying
does not empty
tomorrow
of its
troubles.
It empties
today
of its
strength.

A good reminder for all of us. 






 


  

 

Monday, October 27, 2008

Hope...

Hope sees the invisible, feels the intangible, and achieves the impossible.
Charles Caleb Colton

While walking in the sunshine and the frost by the lake this morning, I watched the park gardeners pulling out leggy impatiens and begonias to make room for the spring bulbs.

I love "putting the bulbs to bed" each autumn, admiring the brownish-pink blush of their smooth skins as I drop them deep into their loamy cradles then cover them with a blanket of warm earth.  It always amazes me that they have within them an internal alarm clock primed to waken them at exactly the right moment next Spring.  This dependable budding of beauty and fragrance is, for me, a powerful symbol of hope.

Several times this past week, I have spoken with helpers who are worn to the bone with burnout or compassion fatigue - people who no longer see their situations as hopeful, but impossible. What they don't know, perhaps, is that there can be hope even in the midst of impossible situations.

Does that sound a little delusional to you?  After all, we know when things are impossible.  We know that terminal cancer means death. We know that people and governments don't change. We know that there will never be sufficient resources to teach the way we would like to teach or nurse the way we would like to nurse. And thus, we remain stuck in the quagmire of impossibilities.

But what about people like Christopher Reeve and Michael J. Fox who have believed that a cure can be found for catastrophic injuries and debilitating illnesses?  Have they been delusional or are they living in hope in impossible situations?  And what about all the people living with progressive and degenerative illnesses who have learned that one doesn't have to give up hope, rather, that one can change what one hopes for as the illness progresses?

(I remember how my husband and I hoped, soon after his diagnosis, for one last trip to Holland.  Then we hoped for one more healthy Christmas.  Then for the strength to get him into the wheelchair for Thanksgiving dinner. Then for a night without pain.  And, finally, to be together for a peaceful death. The goals changed but the hope remained.).

In writing about hope from a religious perspective in, Finding Hope, Marcia Ford offers the following reflection which, I think, is applicable to all of us:

Nearly everyone has a story about a time in their lives when something that seemed impossible actually came to pass.  Think about one such time in your life.  Why did you think the situation was impossible?  When did you realize that the situation could change?  What made the difference?  Give the same careful thought to an impossible situation in your life today.


     






Monday, October 20, 2008

Self Care...

Today has been one of those wonderful self care days... 

A few chores done around the house to the classical music of BBC's Radio 3.  A walk-run by the lake during the one hour of golden sunshine this morning (-this is Vancouver, after all).  An afternoon spent drinking London Lady Afternoon Tea and reading Richard Wagamese' beautifully written new memoir, One Native Life. (Truly a triumph of healing and hope.)  

A delicious dinner this evening, if I do say so myself, of vegetarian lasagne made with whole wheat pasta and organic vegetables.  And now I plan to have a hot shower, curl my feet up in a long flannel nightgown and knit away on a sweater for my new great granddaughter, Addison Paige, born Oct 13th.  (A gift of marrying an older man is having great grandchildren while you're still young enough to enjoy them!)   

As an off-the-scale introvert who has spent a busy weekend with family and friends, this is the sort of day that refuels and refreshes me.  I've learned that, as much as I love the people around me, I need regular time alone to lower my level of stimulation and to explore the rich inner world of feelings and ideas.  What kind of day - or hour or few minutes - refreshes you? Do you know? Do you know how to give that gift to yourself without feeling guilty or selfish?  

The truth is that everyone around us benefits when we take time out for ourselves - just as everyone around us suffers when we don't!  I hope that you will find a day this week where there are at least a few hours that you can claim for yourself.  It is truly worth the search.  

       

Tuesday, October 14, 2008

A Retreat for Helping Professionals - Winter 2009...

Are you feeling drained, depleted, in need of renewal?  Do you yearn for time in the quiet of nature to recharge your batteries and gain a fresh perspective?  Would you love to take a nap, uninterrupted, or to curl up by the fire with a good book? 

Why not take the opportunity to gather with 26 other helping professionals at the Bethlehem Retreat Center in Nanaimo, BC to do just that?

Caregiver Wellness will be offering a Retreat for Helping Professionals hosted by the Benedictine sisters at the Bethlehem Retreat Center, February 6, 7, & 8, 2009, and you are most welcome to join us.  The registration fee of $300.00 includes accommodation, meals and snacks, handouts and the self care focused retreat program.  Lower Mainland participants can cross from Horseshoe Bay as foot passengers and then take a $20.00 taxi ride from the terminal to the Retreat Center.

The idea for this retreat came from helping professionals approached to advertise the Family Caregivers Retreat this fall.  I received several emails saying, "Of course, I'd be glad to, but I do wish there was something like this for people like me." 

The retreat will last from 7 pm Friday until after lunch Sunday and there will be periods of silent reflection, short talks and group discussions throughout the weekend.  (With plenty of time to rest as well.)  This not religious retreat though spirituality may come up in group discussion as a source of compassion fatigue resilience.

A registration brochure will be printed within the next few weeks and will be available through me at caregiverwellness@shaw.ca or the Retreat Center at bethret@shaw.ca.  Any questions about practical issues while at the retreat center should be addressed to the retreat center. Any queries about retreat content can be sent to me.

Please consider giving yourself the gift of these restful, restorative days in the midst of winter. I will look forward to seeing you there.

        

 

Sunday, October 5, 2008

The Enneagram ...

One of the most important elements in both preventing and treating compassion fatigue, (the combined impact of personal trauma, burnout  and hearing the trauma stories of others), is self care, and self care flows from self knowledge. The Enneagram is one of the best sources of self knowledge that I have come across in 18 years as a therapist and mental health educator.

I first heard of the Enneagram, a dynamic system of nine distinct personality types, when my husband spoke about it after attending a retreat in Washington State in the 1980's.  At the time I was writing my Masters thesis and had little energy to spare for trying to understand what it meant when he said that he was a "four".  It wasn't until years later, when my grief counsellor suggested that I do some reading to determine my own personality type, that I began to understand his enthusiasm.  I was so impressed with the Enneagram's accuracy, depth and complexity, and its compatibility with current psychological theories, that I enrolled in the Basic and Advanced Enneagram Professional Training Programs offered by Stanford University psychiatry professor, Dr. David Daniels, and psychologist, Helen Palmer, through Enneagram Worldwide.

The Enneagram, (pronounced ANY-a-gram and meaning a nine pointed picture), describes nine different patterns of thinking, feeling and acting.  It explains why we behave the way we do and points to pathways for individual growth.  People of the same type have the same basic motivations and view the world in similar ways.  They also use similar coping strategies.  By working with the Enneagram, we develop a deeper understanding of ourselves and others and learn to break free from our own outdated coping styles. 

Some people object to the idea of being "put in a box" by a personality typing system, but in fact, the Enneagram releases people from the box of their unexamined personalities.

Choosing your type is an evolving process but a good place to start is with a small book by Dr, David Daniels called The Essential Enneagram.  In this book you will find the Essential Enneagram Test, the only scientifically validated instrument for determining your type. 

If you have trouble discovering which of the nine types fits you best, try reading other Enneagram writers including Helen Palmer, Don Riso & Russ Hudson, and Elizabeth Wagele. Sometimes hearing a different author's "voice" can help you to decide.  ( Reading Richard Rohr's description of counterphobic sixes finally helped me to choose between "one" and "six" for myself).

It can be helpful to remember that, because the Enneagram indicates our shadow side as well as our strengths, we may not want to acknowledge our true type.  In fact, people often find that their true type is the one that they least want to be!

Whatever your type, once you have discovered it, it can make a great difference to your relationship with yourself and with others.  It will help you to understand why you "overreact" to certain situations and people, and it will show you how to reduce your reactivity, an  important skill for those involved in the care of others.   

        

Monday, September 29, 2008

Glow 2008 ...

Christmas in September??  No, not exactly.  I have chosen this picture of Christmas lights as a reminder to all of us of the Alzheimer Society's Glow 2008 celebration.  (I have to admit that I had forgotten about it completely until searching their website for other information last week, hence the late reminder.)

Started by two Canadian women, one from the East and one from Vancouver, this celebration acknowledges, supports and increases the visibility of  family caregivers and their thousands of hours of unpaid but crucial care of loved ones with dementia.    

This is the way it works.  On Wednesday, October 1st, you place one string of Christmas lights in a prominent place and turn them on at 8 pm as a sign of affirmation and support for family caregivers.  Then you can log on to www.freewebs.com/alzheimerglowers and sign the guest book.  As word of this celebration spreads from family to family and friend to friend, the glow is spreading around the world.  I understand from the website that the UN will be acknowledging the Glow in some way this year.

I remember driving home after dark a few years ago and wondering why a number of people in my neighbourhood had put their lights up so early.  Now I know and I will be hanging my string of lights in honour of my friend, Janet, and all the other caregivers who pay such a large price to bring dignity and quality of life to their loved ones.

Please join me in spreading the glow ...   

Sunday, September 21, 2008

Carepartners...

There is great, if sometimes subtle, power in the words we choose when we communicate.  This was brought home to me last spring when I attended a Compassion Fatigue workshop in Toronto.

I had been aware, for some time, of a grass roots movement among family caregivers to refer to themselves as carepartners rather than caregivers. The distinction is an important one.  It reminds us that, whenever possible, the care recipient should hold his or her own reins.  The locus of control belongs there, not with us. We who provide support and care, family or professional, are partners who need not and should not carry the reins for those who are capable of doing so themselves. (Not an easy task when a patient or client chooses a treatment plan with which we disagree  or when a loved one wants to get dressed on his or her own and the HandiDart is already waiting at the door!).

The care recipient's locus of control is not the only important consideration in using the term, carepartner.  Toward the end of the Compassion Fatigue workshop in Toronto, during a discussion of factors that build resilience to burnout and compassion fatigue, I mentioned the carepartner-caregiver distinction and wondered out loud whether changing the term would make as much difference to professionals as it does to family carepartners.   I noted that, for me, caregiver  elicits a physiological stress response whereas carepartner elicits a relaxation response. Others tried out their own reactions and agreed.  They found a lightness and relief in the word, carepartner, that wasn't there when they referred to themselves as caregivers. ("I'm just a partner.  I don't have to do and be everything.").

Try it out for yourself.  To begin with, you will probably find that the word feels awkward in your mouth and in your ears but its implicit idea of shared responsibility may give you some relief and some distance from what, at times, can seem like an overwhelming burden.

For myself, I will continue to use caregiver in the blog title so people can find it easily but I will now begin to use carepartner in the blog posts themselves.  Let me know what you think about this small, but perhaps, powerful, change in language.  
 





  



  

Sunday, September 14, 2008

Help ...

In real estate sales, the most important factor for success is said to be, "Location, location, location".  In caregiving -  family or professional - the important factor is, "Help, help, help".

No one can care for others, long term and healthfully, without asking for help, at least on occasion.  But we individualistic, independent North Americans are not always comfortable with asking.  We tend to idealize self sufficiency and it takes most of us a long time to realize that interdependence rather than independence is the true ideal.

But what is interdependence, exactly?  American author, Peggy Collins, says it is, "A place where we're not trying to do it all ourselves, nor are we relying on others to do it all for us." It is a place of balance at the center of the seesaw between self reliance and healthy adult dependence.  It is a flexible position where we can move toward self sufficiency or dependence, given our needs and abilities at the time.

What Peggy is saying is that it is alright to ask for help when you need it - more than alright! Assessing our needs and asking for appropriate help goes a long way toward reducing work stress and building resilience to burnout and compassion fatigue - if we ask for it early enough.

We all have different strengths, limitations and situations and each of us will need different sorts of help at different times.  Whether I am a nurse with 30 patients to settle for the night, a physician who needs a break from call, a therapist who needs a different caseload, or a priest in need of two days off a week, I must ask for the help I need.  Most of us will be surprised to find what a positive response there can be to a direct appeal.

As a young nurse working in a coronary intensive care unit and balancing the needs of a dying father and a seriously ill 2 year old nephew, I didn't ask for help and I had my first encounter with compassion fatigue.  Years later, as a therapist and a family caregiver for my husband, I did ask but I waited too long and met with compassion fatigue a second time. (Some of us take a while to learn life's lessons!).

Now, I have learned to, "Ask soon and ask big.".  The experience of family caregiving has taught me that I cannot always go it alone, and that if I "draw my circle wide" when asking for help, the help will be there.  For me, drawing the circle wide meant contacting people from all areas of our lives - friends, family, acquaintances - and asking them to sign up for either a Wednesday or a Saturday morning so I could get away from home to do errands and to have a rest.  What a profound difference that asking made in all our lives.  My husband's bed bound world expanded through the presence of others.  I could look forward to regular periods of respite.  And those who came to help left with a profound feeling of fulfillment and satisfaction. A win-win-win situation.

So, this week, if you need help at work or at home dare to ask for it.  Start small if asking makes you feel anxious, vulnerable or out of control, but ask, and see what a difference it can make to your life.   



   


Sunday, September 7, 2008

Gratitude...

Today is one of those brilliant autumn days that make you feel glad to be alive!  Bright sunshine.  Blue skies. Crisp air. Leaves changing. Early mist over the lake... 

The beauty of this day has filled me with gratitude and motivated me to return to a practice I have allowed to lapse since my husband died four years ago - that of keeping a gratitude journal.  

Gratitude is a powerful transformative force.  Author, Sarah Ban Breathnach, in her introduction to The Simple Abundance Journal of Gratitude, says that, "Gratitude holds us together even as we're falling apart.  Ironically, gratitude's most powerful mysteries are often revealed when we are struggling in the midst of personal turmoil. When we stumble in the darkness, rage in anger, hurl faith across the room, abandon all hope. While we cry ourselves to sleep, gratitude waits patiently to console and reassure us; there is a landscape larger than the one we can see." 

My husband gave me a copy of Sarah's Journal of Gratitude for Christmas the year after he was diagnosed with viral cardiomyopathy and he also bought one for himself.  Inscribed on the first page of my book were the words, "It would be wonderful to follow the ideas on these pages. Let's try."  And so began six years of gratitude journalling.

For the first several years, we each made daily entries of five things for which we were grateful - the laughter of a dear friend, licorice allsorts, sweetpeas, 19 jars of red plum jam, Mozart's Clarinet Concerto, clean sheets, the movie "Simon Birch", chest pain ending, the ability to walk on the Seawall, financial help after leaving work.  As the years passed, and illness and caregiving ate up time and energy, the entries became fewer and shorter but the intention remained and on the days when we couldn't write, we often shared our gratitude at night in the quiet darkness before going to sleep.

I was glad of the opportunity to focus on the good things of the day, not in a Pollyanna-ish way, but as a means of balancing some of the pain and sadness of our day-to-day existence.  The gratitude journals helped us to live well with Chronic Sorrow and, I believe, to stave off Compassion Fatigue as well.

Now, more than ever, I am glad of those books of gratitude for they provide an intimate and detailed picture of our lives throughout those years and they trigger so many wonderful memories that would have been forgotten otherwise.  ( I don't know about you, but I have a tendency to journal about the crises and hard things in life in order to work them through. When it comes to the good times, I'm far more likely to enjoy them without writing them down.).

So, whether your life is going well or things are in a mess, I encourage you to start a gratitude journal today.  You might want to find a lovely book with a beautiful cover and smooth pages or you might want to use an old scribbler (do they call them that any more?) or you might want to get a copy of Sarah's journal.  Choose whatever suits you best.  Then begin writing down the five things that make you grateful each day.  

(Know that some days your list will expand to ten or fifteen items and other days, as Sarah says, "... the only thing that you might be thankful for is that the day is over."  That's okay. The gift is in the intention, not the number of items on the list.)     




Sunday, August 31, 2008

Autumn Quiet Time...

I've always loved the quickening of fall.  Families preparing for school.  Crisp, cool air.  Vibrant colours. Even the squirrels, picking up the tempo of their gathering and storing.

But as the  s-l-o-w  energy of the summer rises to meet the demands of the fall you may be wondering how to keep some of the s-l-o-w in your autumn days. How to make space for quiet and rest amidst the busyness.  

Well, it takes conscious awareness, conscious planning and a daytimer.  (And, frequently, some requests for help as well.) 

Awareness can show us islands of quiet we hadn't realized were there.  I have always loved pulling weeds, a" busy" occupation but one that leaves me with uninterrupted time for my own thoughts and feelings. Others have found similar quiet space while mowing the lawn, walking the dog, washing the dishes or doing the ironing. Still others find it in their daily showers, while flossing their teeth or while sitting in traffic. When we become aware of this unrecognized time, we can use it, consciously, for taking a few slow breaths, for relaxing tight muscles, for being in the midst of doing.

We can also create space for quiet by actually writing it into our daytimers at the beginning of the week.  Some people get up half an hour early every morning to have quiet time on their own.   Others have discovered that the time it takes to boil potatoes for dinner is a perfect opening for their daily meditation.  Others, still, book regular respite at a retreat center, a friend's cottage or a local bed and breakfast or hotel.  When we block out these times on our calendars, we are more likely to honour them and to give ourselves the quiet we need.

Now, the best laid plans for quiet can go awry because of unexpected circumstances or because of our own unconscious reluctance to be quiet.   If you are dealing with uncertainties like a chronic illness or shifting work demands, try making a "plan B" for the week's quiet time  so you'll have an alternative if circumstances change.  

And, if you find that in spite of a conscious desire for quiet, you consistently "forget about" or are "too busy for" planned quiet time, you might want to consider whether grief is getting in your way. Grief, a common bond among all human beings, is an especially strong presence in the lives of most family caregivers and helping professionals and it is natural that we would want to avoid its pain -  and the quiet that allows it to emerge.  

I remember many months when stepping into the car to drive from my family caregiving at home to my professional helping at the office would trigger a flow of tears. It didn't take long to realize that it was the quiet time that was making room for my sadness.   

So, if you're having trouble creating quiet and grief is the reason, be gentle with yourself.  Wait until you feel ready, and then when the sadness comes, allow yourself to feel it for just a moment or two.  Gradually, you will be able to tolerate longer periods of grief and, as the pain eases,  you will be able to enjoy longer times of quiet and rest.    

        

  

Monday, August 25, 2008

Fall Workshops and Retreats...

Fall is fast approaching so here is a brief reminder about the upcoming Caregivers Retreat:

The Family Caregivers Retreat will be held at the Bethlehem Retreat Center on Westwood Lake in Nanaimo, BC, from 7 pm Friday October 17 until after lunch on Sunday October 19.  The fee of $200 includes meals, accommodation and the retreat program. Registration forms are available through Caregiver Wellness at caregiverwellness@shaw.ca or (604) 297 0609 or through the Retreat Center at bethret@shaw.ca.  Come and join us for some rest, some laughter and some learning!

I've also been asked to say a little more about "informal groups" booking workshops:

Groups of ten or more family caregivers or helping professionals who are not associated with a particular organization are welcome to book a workshop in the same way that a more formal group would.  For example, a group of family caregivers from the same neighbourhood or some helping professionals in the same exercise group might want to book a workshop without going through a formal organization.  The only difference in the booking process is that the speaker fee and travel and accommodation expenses must be paid prior to the workshop date and are not refundable.   If you have any questions, please feel free to call me.  This can be a relaxed and easy way to learn with people you know and the small group situation allows for greater depth in discussion and personal reflection.

Fall workshop bookings:

As you can see from the availability list, September and most of October are fully booked but there are still some dates available in  November and early December.  (I will be away for advanced training for ten days in November but will be available either side of those dates, as shown on the list to the left.)

I am very excited to have opportunities to share my passion for caregiver wellness with you this fall and I look forward to meeting those of you who have phoned and emailed over the past few months.

This lovely photo was taken by Janet Ritchey. 

 








 

Saturday, August 23, 2008

Not So Alone...

This morning, as I took my daily walk around a lake close to my home, I stopped to pick, eat and savour the first delicious wild blackberries of the season.  And I was struck, once again, by the abundance and generosity of the Universe.

So often, when we are caught up in the busyness, exhaustion and isolation of caring for others, we can become constricted and forgetful of the constant sources of support that undergird and uphold us as we move through our daily tasks and routines.  

I was married to an Anglican minister who regularly stopped his worship services at the sound of a siren, to say, "Someone's in trouble.  Let's pray."  He went on to pray for whomever was in trouble, their families and friends and all the people who were on their way to help. Now, years later, members of that congregation are scattered all over the country and the world but when many of them wrote to me at the time of my husband's death, they mentioned that wherever they are, they continue to stop and pray at the sound of a siren and that they've taught their children to do the same.

No one who is prayed for - the person in trouble, their family, police, dispatchers, paramedics, fire personnel, nurses, physicians, crisis counsellors - knows that, in that moment of trauma, someone is thinking of them with heartfelt prayers for their safety and for the healing of wounds that could arise from the situation.  And yet, that support is there.

And how often do we think of the people who dry clean our clothes, stock our grocery store shelves, pick up our garbage, deliver our mail, and farm our food as being part of a huge network, there for our support? (- To say nothing of our friends, neighbours, communities, the abundance of nature and whom or whatever we believe in that is greater than ourselves?)  We are not as alone as we sometimes think and feel.

So, on those days when you feel exhausted, depleted, and alone, it may help to remember that there are sources of support all around you, whether you can see them or not.

In a quiet (quieter..?) moment, today, I invite you to take some time to think about your own particular network of support, seen and unseen.  Allow your heart to recognize supports that may not have been visible before and to fill with gratitude.    

Sunday, August 17, 2008

Chronic Sorrow, A Different Sort of Grief....

Yesterday, while reading the blog posts of parents of children with permanent impairments, I came across some wonderful writing by Emily Perl Kingsley.  (In fact, I came across it several times - an indicator, perhaps, of its accuracy and potency for many family caregivers.)

Emily Kingsley, the mother of a child with Down Syndrome and a long time writer for Sesame Street, describes her understanding of the losses of caregiving in these words:

*Welcome to Holland

I am often asked to describe the experience of
raising a child with a disability - to try to help
people who have not shared that unique experience
to understand it, to imagine how it would feel.  It's
like this......

When you're going to have a baby, it's like planning
a fabulous vacation trip - to Italy.  You buy a bunch
of guide books and make your wonderful plans.  The
Coliseum.  The Michelangelo David.  The gondolas in
Venice.  You may learn some handy phrases in Italian.  
It's all very exciting.

After months of eager anticipation, the day finally
arrives.  You pack your bags and off you go.  Several
hours later, the plane lands.  the stewardess comes
in and says, "Welcome to Holland."

"Holland?!?" you say.  "What do you mean Holland??
I signed up for Italy!  I'm supposed to be in Italy.
All my life I've dreamed of going to Italy."

But there's been a change in the flight plan.  They've
landed in Holland and there you must stay.

The important thing is that they haven't taken you
to a horrible, disgusting, filthy place, full of
pestilence,  famine and disease.  It's just a different
place.

So you must go out and buy new guide books.  And
you must learn a whole new language.  Any you will 
meet a whole new group of people you would never 
have met.

It's just a different place.  It's  slower-paced than
Italy, less flashy than Italy.  But after you've been 
there for a while and you catch your breath, you
look around....and you begin to notice that Holland 
has windmills....and Holland has tulips.  Holland even 
has Rembrandts.

But everyone you know is busy coming and going
from Italy....and they're all bragging about what a
wonderful time they had there.  And for the rest of
your life, you will say "Yes, that's where I was
supposed to go.  That's what I had planned."

And the pain of that will never, ever, ever, ever go
away....because the loss of that dream is a very, very
significant loss.  

But....If you spend your life mourning the fact that
you didn't get to Italy, you may never be free to 
enjoy the very special, the very lovely things...
       about Holland.



Chronic sorrow is the natural, understandable, nonpathological grief response experienced by people with  significant permanent impairments and by those who love them.  Because their losses last a lifetime, so does their grief.

People with chronic sorrow experience a pervasive sense of sadness, sometimes close to the surface, sometimes farther away, with intermittent periods of more intense emotional pain triggered by missed developmental milestones, deteriorations, anniversaries, critical incidents and other occurrences that highlight the difference between what is and what "should have been".  This sadness can look like, and be mistaken for, depression.

Chronic sorrow is a very important concept for family caregivers and for helping professionals yet, it is little known within either population.  I was not formally aware of it as a member of either group and I remember feeling anger, shame and confusion, as a family caregiver, over my seeming inability to rise above, get through, let go of or move beyond my grief in order to "get on with my life".  (An unrealistic expectation stated, externally, by family, friends and colleagues - in the gentlest, most caring of ways - and, internally, by my own inner critic.)  

The truth is that a permanent adjustment to such a dynamic loss is not possible.  We don't "get over" chronic sorrow; we can only learn to get better at living with it.  Thus, many of the usual goals of grief therapy - disconnecting from the source of the loss, increasing recognition of the reality of the loss, expressing anger toward the person who is the source of the loss and facilitating catharsis - are not helpful to us.  

What we can benefit from - even though chronic sorrow is not a pathology - is having someone wise and knowledgable to be a "companion on the journey".  Someone to walk with us through our unique manifestations of grief and posttraumatic stress.  Someone to teach us new skills for managing our aroused nervous systems and for containing and releasing our feelings. Someone to listen as we reflect upon and update our belief systems. Someone to be with us so we can learn to embrace what is. Someone who understands both our need to to grieve the loss of Italy each time it resurfaces and our need to see the wonders that are Holland. Someone to help us to be present, in the moment, no matter where we are.  (It is usually best if this someone is a certified helping professional who knows about, or is willing to learn about, chronic sorrow.)

If you are interested in learning more about chronic sorrow, I highly recommend Chronic Sorrow:  A Living Loss  by Dr. Susan Ross, PhD (2002).  It is a professional textbook but it is written clearly enough for psychologically oriented nonprofessionals to understand it.  And, if you are interested in booking a Caregiver Wellness Chronic Sorrow workshop - for family caregivers or for helping professionals -  please read the column to the left then contact me by phone or by email.

*  I have searched, in vain,  for a contact  email address for Emily Kingsley to request permission to use this piece in workshops.  If you know how to reach her, could you let me know, please?     







 

 
 





Sunday, August 10, 2008

Making time...

This week I've been surprised and delighted to discover an extra hour and a half in my days.  After moving my office from the banks of the Capilano River on Vancouver's North Shore to the sunny den on the south side of my own home, I am no longer fighting traffic twice a day, driving to and from work.  What a gift to find all that time! 

Unfortunately, as family caregivers and helping professionals looking for self care time, it is more likely that we will have to carve it out than that we will trip over it unexpectedly.  At a recent workshop, participants brainstormed ways of reclaiming time for themselves and a number of their suggestions centered on that indispensable, but frequently annoying instrument, the telephone.  Some of their suggestions included:

*  Unplugging the phone or turning it off for specific periods of time every day.  (After 
     telling your family and friends!)

*  Using an answering machine or call display to screen calls so they can be answered
     at a more convenient time.

*  Giving your cell phone number to a circumscribed number of people and asking
     them to use it for emergencies only.  (After all, how many things are so important 
     that they can't wait an hour or two?)

*  During a health crisis or after surgery, leaving a daily update on your voicemail
     so loved ones can call in to hear how "the patient" is doing without disturbing you.

Take a moment to think about your own relationship to the ubiquitous telephone.  Is it eating your self care time?  Might there be a creative way of reclaiming some of that time for yourself?

The workshop participants came up with some other great ideas for reclaiming time:

*  Becoming conscious about TV time.  Making mindful choices about what you want
     to watch then turning off the TV.

*  Doing as much shopping as possible through catalogues or online.  Asking your 
     grocery store about home delivery.  Making a list before you go shopping and 
     sticking to it.

*  Using a day planner to manage your time.  Writing down all your appointments
     and responsibilities then coding them with colours or letters to indicate what 
     must be done today, what should be done today but could wait til tomorrow, 
     and what could wait for another few days.

*  At the beginning of each week, looking ahead to block out some self care time 
    every day, whether it is a "pause that refreshes" or an hour's brisk walk or an 
    afternoon's massage and pedicure.

*  Sharing responsibilities with others.  Carpooling for children's activities.  Having 
    a "fill the freezer" morning with friends - cook together in bulk  then share the food to 
      make frozen dinners for busy nights.
     
  
This is just the briefest of time-saving lists from one workshop.  Try making a "possibilities" list of your own and choosing one thing upon which to take action this week.  Let us know about your successes! 

  
     


   

Sunday, August 3, 2008

Change and transition...

This week I packed up - literally and figuratively -  an eighteen year trauma counselling practice to focus, full time, on teaching wellness oriented workshops to family caregivers and to helping professionals.

As with all changes, it was a time of mixed emotions.  I was quite sad, knowing that I would miss many things - daily conversations with my office partner,  watching the seasons change along the Capilano River outside my window and, most of all,  accompanying the clients with whom I've been privileged to work.  At the same time, I was excited to fully embrace a future in teaching rather than working at it part time, as I'd done for so many years. It was the classical bittersweet time of change.  

Change, the experts say, is the only constant in life.  Author and organizational consultant, Bill Bridges, defines change as an external situational shift - getting a new job, losing a job, becoming ill, having a child, moving.   Transition, on the other hand, is the internal process of adjusting to that change - a process of letting go of what was and of taking hold of something new, with an uncertain limbo, a confusing and potentially creative "neutral zone," in between. This three phase journey of adjustment - ending, neutral zone and beginning - is transition.

When we resist transition, we resist one or more of the three phases - the grieving and letting go of the endings phase, the anxiety and chaos of the neutral zone, or the risks and fears of beginning again.  Why do we resist them?  Well, for many reasons, including the length of the process and its inherent discomfort.  Transition can last much longer than the change, itself, and the losses of the ending phase can resurrect painful experiences of the past. For example, current illness in a loved one can trigger memories and feelings of past losses; a current move can unearth "forgotten" anxieties of a childhood move over which one had no control.

Although we do resist them sometimes, our transition processes are healthy, healing journeys of adjustment and they deserve to be honoured.  Resisting important transitions can lead to consequences ranging from an incomplete adjustment to the change to physical illness to ongoing difficulties with anxiety or depression.  (That is not to say that we should push ourselves to work through transition at the time of every change. Sometimes it is entirely reasonable to set transition aside as we deal with a crisis and then return to it later.  The important thing is that we get back to it eventually.)

The process of transition involves opening - opening to the flow of our adjustment process; opening to the grieving and letting go of the endings phase; opening to tolerating the chaos, uncertainty, and possibilities of the neutral zone; and opening to the risks, fears and demands of the new beginnings.

Whether you are a family caregiver or a helping professional, or both,  your life is probably full of change.  Think back over the past year - 

*  How many situational changes have you experienced, large or small, positive or
    negative?  (Even positive changes involve losses.  Think of all the losses you 
    experienced when you first left home or when you had your first baby.)

*   Where are you in the transition journey for each change? 
   
  *   Is this a good time to make some space for consciously facilitating your transition 
     process?  A time to journal, to talk with a friend or counsellor, or to plan an ending
     ritual to work through some losses?  A time to learn some new skills or to seek
     some support to see you through the neutral zone?  A time to make a baby-step 
     plan to guide you into a new beginning?

If you are interested in reading more about the process of transition, try one of Bill Bridges books -  Managing Transitions, a book about organizational change and transition, or The Way of Transition,  Bill's personal and very honest account of his journey through family caregiving and his bereavement after the death of his wife, Mondi.   




               

      

Sunday, July 27, 2008

Summer Savoury...

A long number of summers ago, I came across these wise words printed on the cover of a wedding bulletin.  They are well worth savouring by any of us who are caring for others:



In this special moment of life...


Think freely.    Practice patience.    Smile often.

Savour special moments.  Live love's message.  Make new friends.  Rediscover old ones.  Tell those you love that you do.  FEEL DEEPLY.  Forget trouble.  Forgive an enemy.    HOPE.  
G   R   O   W.

Be crazy.    Count your blessings.    Observe miracles.  Make them happen.   Discard worry.     Give.  Give in.    Trust enough to take.

Pick some flowers.    Share them.      Keep a promise.    Look for rainbows.
Gaze at stars.    See beauty everywhere. . .

Work hard.    Be wise.    Try to understand.    Take time for people.    Make time for yourself.        LAUGH HEARTILY.        Spread joy.       Take a chance.    
R E A C H  O U T.     Let someone in.      

Try something new.     S   L   O   W    down.     Be soft sometimes.    

Believe in yourself.    Trust others.    See a sunrise.   Listen to rain.    Reminisce.    Cry when you need to.    TRY LIFE.     Have faith.     Enjoy wonder.    Comfort a friend.
Have good ideas.    Make some mistakes.      Learn from them.


. . .  CELEBRATE LIFE!    





Friday, July 18, 2008

A Word About Words...

Some of you have asked about definitions for terms used in the blog so it is my intention today to explain them as clearly as possible.

But before getting to that, I would like to offer a word of thanks to two colleagues and friends without whom this blog wouldn't exist.  The first is to compassion fatigue specialist, Francoise Mathieu (www.compassionfatigue.ca) who introduced me to Blogspot and then patiently and generously responded to all manner of technical questions.  The second is to Janet Ritchey (604 437 9992) of the Burnaby Home Library Service, a talented photographer whose beautiful pictures graced the second and third posts and will appear again from time to time.  Both women are strong supporters of caregivers of all stripes and I am especially grateful for their support in this work.

Now, on to the words:

Burnout:    A concept to describe negative responses to a demanding work environment. Burnout is not just tiredness that can be relieved by a vacation.   Rather, it is a cumulative state of physical, mental, emotional and spiritual exhaustion that develops when there is low job satisfaction, high work volume and the perception of powerlessness in the workplace.  Burnout can occur in any occupation.  

Posttraumatic Stress Disorder (PTSD):     A normal psychological response to an abnormal amount of stress.  Known over the years as "shell shock" or "combat fatigue", it is now recognized as an anxiety disorder that can develop suddenly or over time in response to any traumatic event.  PTSD includes symptoms such as intrusive thoughts, nightmares, avoidance of things that remind one of the traumatic event, a sense of hyperarousal or hypervigilance and disruption of relationships to self, others and the community.

Primary Traumatic Stress (PTS):    Symptoms of PTSD caused by the direct, personal experience of trauma.

Secondary Traumatic Stress (STS):    Symptoms of PTSD caused indirectly by observing or hearing stories of another's traumatic experience.

Vicarious Trauma:  A form of secondary traumatic stress.  A cumulative and permanent negative change in a helper's world view as the result of repeatedly hearing trauma stories.  A natural, fundamental, negative shift in one's beliefs about the world.            

Compassion Fatigue:   Secondary traumatic stress plus burnout, CF occurs when helpers are chronically unable to renew their resources and become profoundly physically and emotionally worn down.  This erosion culminates in an inability to empathize with or feel compassion for others.   CF and VT can occur at the same time in the same person and both are occupational hazards for all helpers.  Most of us experience different degrees of these conditions at different times in our helping careers.   

Chronic Sorrow:    A normal, profound, pervasive, continuing and episodic grief response found in those with significant, permanent impairments and in those who love them.  The grief stems from the discrepancy between how life is and how it 'should have been'.  Because this discrepancy lasts until the end of life, so does the sorrow.

While academics still debate some of these definitions, the descriptions listed here should give you an initial understanding of words that will turn up from time to time in the posts.  

     




 

Thursday, July 10, 2008

Family Caregiver Retreat... October 17-19

You may be wondering if I've had a little too much sun this week, choosing an image of fall foliage for a July post.  But my reasonably clear headed intention was to use that incongruity to draw your attention to the new Caregiver Wellness Family Caregiver Retreat to be held at the Bethlehem Retreat Center in Nanaimo, BC   (Vancouver Island) this October.

This retreat is a response to the oft repeated desire of family caregivers to, "get away somewhere close",  to rest and re-create.  The Bethlehem Retreat Center is a 1 hour and 45 minute ferry trip from Horseshoe Bay to Departure Bay or 2 hours from Tsawwassen to Duke Point.  You can travel inexpensively as a foot passenger and then take a $20.00 taxi ride to the Center on the shore of Westwood Lake.  Or you can take your own car - there are plenty of parking spots.  

The ferry ride provides a perfect natural boundary between the stresses of home and the peace of the retreat, yet it also allows a reasonably quick return should you be needed back on the mainland.

The retreat, itself, runs from 7 pm Friday night until after lunch on Sunday and there will be times of silent rest and reflection, times to connect with other caregivers and times to walk the tree-lined path around the lake,  curl up in a chair by the fire or fit in an extra nap or two.

This is not a religious retreat though the Retreat Center is run by the House of Bread Benedictine community and there is a lovely chapel overlooking the lake where one can sit in quiet prayer or meditation.  Our group discussions will focus on the emotional journey of caregiving and on developing a personalized self care plan to build resiliency to burnout and compassion fatigue.

Every caregiving situation is unique and sometimes it is simply impossible to get away from home, but I encourage you to at least consider treating yourself to this weekend away. Dare to ask for the help you need to make it happen.  (You might be surprised to discover how many friends and acquaintances want to help but don't know how.  Tell them that you need someone to stay with or visit the care recipient.  Someone to drive you to and from the ferry.  Someone to lend you the $200.00 for the registration.   Someone to take your loved one to appointments or to care for your kids.  Whatever you need.  

What's the worst thing that could happen if you asked?  They might refuse?  Try not to take it personally if that  does occur - others have their "stuff" as well.   Then give the gift of being asked to someone else.   And if you're too exhausted to even think about all that organizing, is there someone you trust who could do it for you...?  Or even part of it..?)

Although my husband became anxious and reluctant each time I went away on retreat, we soon discovered that, provided he felt safe with the temporary caregivers, he benefitted as much as I did from these short absences.  He ended up with a much happier carepartner and his world expanded as I shared with him, "...all the places I'd been and all the people I'd seen".  

For further information or to register, please email or phone me or the Bethlehem Retreat Center for a brochure.  My contact information is listed in the column to the left.  (Phone number until August 1st is 604 926 0609).  The Retreat Center can be reached at bethret@shaw.ca or at 250 754 3254.

And if you are a helping professional who would love to attend a similar self care retreat, please email me about your interest and,  if there is sufficient response,  we can look at planning a retreat for professional helpers as well.