Friday, December 18, 2009

Peace...

Peace, according to a variety of dictionaries, means freedom from war, mental calm, quiet tranquility, and living harmoniously in relationships and in society.

At this time of year it is easy to lose track of our sense of peace so I leave you for the next two weeks with the gift of two poems - poems that I hope will help you to rest in the moment, to b-r-e-a-t h-e out the stress and to b-r-e-a-t-h-e in the peace. The first is an adaptation of an old Celtic prayer and the second was written by Mattie Stepanek, a 10 year old boy with muscular dystrophy whose writing touched the hearts of thousands during his short life.


Deep Peace

Deep peace of the running wave to you.

Deep peace of the flowing air to you.

Deep peace of the quiet earth to you.

Deep peace of the shining stars to you.

Deep peace of the infinite peace to you.



December Prayer

No matter who you are,
Say a prayer this season.
No matter what your faith,
Say a prayer this season.
No matter how you celebrate,
Say a prayer this season.
There are so many ways
To celebrate faiths,
There are so many faiths
To celebrate life.
No matter who
No matter what,
No matter how...
You pray.
Let's say a prayer
This season,
Together, for peace.

Mattie Stepanek, December, 1999


Warmest blessings and deep peace to you and yours this holiday season,

Jan



Tuesday, December 8, 2009

Healing Compassion Fatigue...

Every year, I drive across Vancouver on the first Saturday morning in December to attend the Open House at the Vine & Fig Tree, a small bookshop owned by my friend, Elaine Perry. As I drive, I happily anticipate the twinkling fairy lights, the spicy aroma of mulled cider, the home baking donated by grateful customers, Elaine's welcoming hug and, of course, her eclectic mix of books, (eastern and western spirituality, current fine fiction and poetry, children's books), and gifts, ( Advent calendars, fair trade African bracelets, beeswax candles, Buddhist singing bowls, journals, and Chor Leone and Electra CD's , among others). The air hums with holiday greetings and wide ranging conversations and there's a sense of happy "community" throughout the shop.

This year, I was fortunate to meet a lovely woman, a fellow adult educator, while pausing between purchases to sip a cup of cider. She is involved in teaching instructors to be better educators and she generously shared her philosophy of teacher development with me - in a nutshell, that learning the theory and technique of teaching is much less important than our individual development as human beings. That it is our healing and wholeness, our individual growth and development, that make us into good and credible educators. I was very grateful for this conversation, and for a similar one (by email) with CF Specialist, Eric Gentry, PhD, for I believe that both have a light to shine on the paths of those of us seeking to build compassion fatigue resiliency.

As with the process of creating better educators, the process of building CF resilience must, to my mind, focus first on the individual health and wholeness of the helper. There is no question that systemic issues and toxicity in the workplace must be addressed wherever found, but, ultimately, it is our individual wellness, our capacity to regulate our traumatic stress, that determines our CF resilience.

CF is, primarily, an individual trauma issue. We are secondarily traumatized in our work because our personal trauma and loss history has taught us to perceive personal threat where none exists. ie Due our previous personal trauma, our autonomic nervous systems mistakenly activate upon hearing stories of threat to others and we become symptomatic.

So, if trauma is the core problem in compassion fatigue, the solutions must center around the healing of that trauma. If we work successfully on our individual trauma recovery, we will ultimately make better systemic decisions and our workplaces will improve.

Some will object to this viewpoint, believing that in stating it, I am "blaming the victim". I do not believe this to be so. As Eric Gentry says, "People in recovery have resolved this paradox better than anyone: Addicts are not responsible for having the disease of addiction but are responsible for their recovery from it." In the same sense, we who experience CF are not responsible for developing CF, but we are responsible for our own recovery.

So, what am I saying here? Just that if we are to solve a problem, we must be able to state that problem clearly. Once we've done that, we have the resources of the universe at our disposal for our healing, growth and development. The grace that is recovery is available to each of us if we can find the courage to seek it out. There is a light in the darkness beckoning each of us to a place of greater wholeness and wellness this holiday season.





Tuesday, December 1, 2009

Book Review: The Housekeeper and the Professor...

I have just finished reading a lovely book called, The Housekeeper and the Professor. It's a wonderful, gentle read for anyone interested in relationships and how they develop, but particularly wonderful for anyone interested in the subtleties of the caregiving relationship.

The story, itself, is that of a Japanese housekeeper and her 10 year old son who care for an aging mathematics professor with a traumatic brain injury. As the result of the injury, the Professor has a short term memory of only 80 minutes, requiring a re-introduction to the Housekeeper every morning as she arrives to do her work.

Behind foreground themes of mathematics and baseball, Yoko Ogawa's spare but beautiful writing explores the caregiving relationship in all it's complexity. Themes of love, loyalty, fierce protectiveness, vulnerability, denial, humanity, respect, perseverance, and caring are all dealt with in a lean and sometimes poetic hand. We are drawn into the chronic sorrow that is a part of all permanent injuries, the joys and difficulties of life's simplest things, and the day-to- day creativity required for adjusting to lost abilities.

If you are someone who requires action and excitement to make "a good read", this is not the book for you. If, on the other hand, good writing, keen observation and the gift of story telling are the elements of a good book, you will find them here.

Monday, November 23, 2009

A Simple Holiday...

I've always loved the holiday scenes in Louisa May Alcott's, Little Women. Financially impoverished and yet rich in love and mutual support, the March family enjoy a Christmas filled with simple pleasures - carols sung around the piano; oranges, books, and small, token gifts; laughter and leisurely companionship around the fire. Many of us long for just such simple celebrations and yet, year after year, we find ourselves exhausted and struggling under the weight of complicated and expensive holiday seasons.

Why do we continue with traditions that wear us out when we could pare back our activities to create the peaceful and refreshing celebrations about which we dream? Well, partly because we are surrounded with commercial messages to make the holidays as expensive, elaborate and busy as possible. Have you ever seen a TV commercial exhorting you to relax and enjoy the holiday? The economic pressure seems unending, one to which we must respond if we're to make our loved ones happy.

And then there are family obligations. How do we go away to the beach or to mountain cabins when loved ones are ill or dependent upon us for their holiday plans?

And what about our own ambivalence? On one hand, we want a simpler and less commercial holiday and yet on the other hand, we don't want to give up the rich memories and comforts of well loved childhood rituals.

One way to begin looking at this issue is to take a look at our holiday values. What means most to us this year? Just being together at home? Spending time outdoors? Religious rituals? Music? Sharing time, talents or resources with others? Getting some rest and respite? Giving gifts? Travelling to be with extended family or friends? The traditional holiday feast? Do our activities reflect our values? What if we chose the three most important components of the holidays and let the rest go for this year? We could always change back again next year if we don't like the experience.

If we find that one or more of our "top three" is impossible to enjoy because someone is working shift or someone is ill, is there a way that we could still enjoy a part of that experience? (ie Going for a family walk in the park rather than driving to the mountains or having one friend in for a simple lunch rather than 23 for a four course meal.)

Now in many cases, it may be a little late to make major changes in family traditions for this year, unless circumstances demand it, but it might be a good time to start talking about next year. You might want to try discussing possibilities such as one of the suggestions made by Jennifer Louden in The Woman's Comfort Journal:

1. Turn the pressure of corporate America off and declare a no-shopping holiday season. Practice the Native American tradition of giveaways during the holiday by giving away useful or loved possessions instead of buying new.

2. Create new holiday rituals to replace painful or empty ones. You don't have to keep family traditions that don't make you feel good anymore. Try celebrating Winter Solstice.

3. Do something you wish you had done as a child. Organize friends and put on a holiday play. Or have a potluck dinner... with non-traditional foods. Consider serving foods you always wanted to eat as a child.

There are are many options. The important thing is that we tune in to what matters most to each person, then caringly negotiate with family and friends to reduce the annual stress and exhaustion and increase the peace, joy and comfort of the holiday season.


Photo by BigStock Photos





Tuesday, November 10, 2009

The Halfway Night Tradition...

Recently I was reminded in Gretchen Rubin's blog, the Happiness Project, of a tradition I'd learned about many years ago - that of The Halfway Night.

The man who first told me about The Halfway Night was a chaplain to seamen, seamen whose travels took them away from family, friends, community, and culture for months at a time, often in the most rudimentary and bleak of conditions. In a time before cell phones and the Internet, these men often went weeks without news of home or access to the support of loved ones.

In an effort to make these long voyages more tolerable, sailors' families would pack shoebox-sized packages and give them to the Captain or Chief before departure. On the night that marked the halfway point to their destination the Captain would distribute the boxes to the seamen. Each had its own unique gifts and keepsakes - letters from wives and girlfriends, pictures of children, a favourite food, a book to pass the time, razor blades, candy, cigarettes, reminders of activities enjoyed at home. The comfort brought by these packages was immeasurable, both in their usefulness and in their meaning. If you had made it to the halfway point, you were over the worst and could begin counting the days until the voyage was over.

As caregivers, family or professional, we all have long voyages to withstand, be they helping loved ones through painful bouts of chemotherapy or other medical regimens, getting through a particularly trying stretch of night shifts, or tackling a continuing education program after your job has been cut. How nice would it be to have someone turn up on Halfway Night to celebrate and encourage you? And how good would it feel to offer that gift to someone else? Sometimes, all it takes is a little love and acknowledgment to get through even the worst of times.

Photo by BigStock Photos

Wednesday, November 4, 2009

Anniversary Reactions...

Recently, I taught a brief Chronic Sorrow workshop at a local rehabilitation hospital. When I'd scheduled the talk several months earlier, I had been concerned only with pacing my presentations and not overfilling the work week. (Good self care,
right?).

Unfortunately, I had forgotten that September 8th was the anniversary of the day my husband stopped his cardiac medication in order to allow his heart failure to take it's natural course. That day hadn't gone well and he had reacted poorly to the new palliative care medication, losing his pain control and becoming very confused. Rather than beginning a peaceful process of dying at home, as he'd wished, he was taken by ambulance to hospital where he died 3 weeks later. It was a horrible, traumatic day though the wonderful palliative care staff at the hospital worked hard to find the right medication combination and gradually made him both comfortable and oriented again.

I tucked away the memory of that day, (or it was subsumed by the grief of the days, months and years that followed), and I rarely thought about it until I went to the hospital to give the Chronic Sorrow presentation on September 8th. I didn't make the anniversary connection consciously, but my body "remembered" for me, leaving me a little breathless, lightheaded, sad and anxious as I walked through the lobby and causing me to briefly lose my train of thought (a "dissociative moment") during the presentation, itself. Fortunately, I was the only one who noticed and I went home to do some detective work, looking through my old journals until I made the connection between the two September 8th's, in hospital settings, focused on the sorrow of chronic illness. I had had an anniversary reaction.

An increase in distress around the anniversary of a traumatic event is known as an anniversary reaction. They can be mild, as mine was, or they can constitute a more severe reaction with significant psychiatric or medical symptoms. These reactions can involve a few days of mild distress or many weeks of anxiety, anger, nightmares, flashbacks, depression or fear. They can be triggered by specific, conscious reminders of the event or they can seem to come out of the blue. Anniversary reactions may begin days or weeks before the anniversary and may continue for days or weeks afterward.

Common anniversary reactions include:

1. Experiencing increased grief and sadness around the anniversary of the death of a loved one. This may be mild or may extend to clinical depression and suicidal thoughts.

2. Symptoms of posttraumatic stress including:

- Re-experiencing symptoms: Reactivation of the feelings, physiological responses or thoughts that occurred at the time of the event. These may occur as dreams or flashbacks or repeated images of the traumatic event and they may be as vivid on the anniversary as they were at the time of the trauma.

- Avoidance symptoms: Avoiding anything that might remind you of the trauma - people, places, situations.

- Arousal symptoms: Feeling nervous and on edge. Having difficulty sleeping. Feeling more on guard. Being more irritable and jumpy.

3. Panic attacks, specific fears or worry about one's own safety or that of loved ones.

4. Physical symptoms like fatigue, pain, headaches, GI disturbances.

5. Guilt reactions including survival guilt.

As you can see, there is no standard pattern to the symptoms of an anniversary reaction. In most instances, they will vary according to the type of traumatic incident, the personality of the person affected and their previous trauma history.

The good news about anniversary reactions is that they are normal responses to trauma and will usually subside over time. If they don't, they provide us with opportunities to do some deeper healing work that will make us stronger and more resilient in the long run. Doing some trauma therapy can make a significant difference to the distress of anniversary reactions. (It is not uncommon for trauma survivors to wait months or years to ask for mental health support because they are ashamed to admit that they "haven't got over it yet". The fact that we're waiting to ask for help can in itself be an avoidance symptom, a signal that we do actually need the help).


There are some things that we can do to to ease the pain of anniversary times:

- Mark important anniversaries on your calendar so you're not taken by surprise.

- Ask for the support you need at anniversary times - family, friends, or professional support.

- Make specific plans for the anniversary date so you have things other than the memories of the event to occupy your mind. Leave quiet periods to acknowledge your feelings if that helps.

- Honour the memory of loved ones with rituals like lighting a candle, sharing favourite memories and stories, sharing a meal with family or friends, visiting the grave, making a charitable donation, helping others, planting a tree, engaging in an activity your loved one enjoyed or attending a worship service.

- If the traumatic event was one shared in the workplace, consider planning an anniversary ritual or further debriefing that the group can share.

- Engage in activities to reduce your level of arousal - meditation, walks in nature, prayer, breathing practices, pelvic muscle relaxation, guided imagery.


Recovery from a traumatic event takes time. With patience and perseverance and support we can gradually reduce our trauma symptoms (including anniversary reactions) and move on to a life of renewed hope and meaning.


Photo by BigStock Photos

















Monday, October 26, 2009

Denial...

One of the most insidious dangers to all helpers of the suffering or the traumatized is denial - denial of the impact of secondary traumatic stress in our work and denial of the primary traumatic stress that may have drawn us to our work in the first instance.

Denial is an unconscious defense against knowing that which is too threatening to know. It is denial that allows us to remain unaware of our compassion fatigue until we grind ourselves into the ground, no longer able to ignore our own symptoms.

Denial comes in different forms including minimizing. To minimize means to trivialize a painful situation by comparing it with another that we deem to be worse. In Trauma Stewardship, author Laura van Dernoot Lipsky says,

"This coping strategy is at its worst when you've witnessed so much that you begin to downplay anything that doesn't fall into the most extreme category of hardship ... internally, you are thinking something like, 'I cannot believe this conversation is taking 20 minutes of my time. There wasn't even a weapon involved.' "

Denial is also evident when we intellectualize or rationalize our pain, stripping a traumatic experience of it's emotional impact or explaining away our responsibility for it.

Some degree of denial (functional denial) is healthy when it helps us through situations that would be otherwise overwhelming but deep, prolonged denial can cause us to ignore symptoms that are potentially psyche-threatening or even life-threatening.

So, how are we to deal with our denial so that we can recognize and heal our compassion fatigue? The first answer is, "gently". It rarely helps to wrench away the protective layers of denial. It is usually best to come at it obliquely, within a context of safety and support.

To come through our denial of primary traumatic stress, secondary traumatic stress, burnout or compassion fatigue, we need to move through a process of validating our trauma and loss experiences and acknowledging the feelings associated with those experiences. We need to reclaim the details of our trauma story, in our current work and in the past, and as we reclaim our truth, we can move on from denial and pain to transformation and resiliency.











Wednesday, October 21, 2009

Autumn Comforts...

My most favourite time of year is the fall. It's the time when I feel most grateful and most grounded. A time when the rhythms of nature lead me away from all that drains my energy and remind me of all that sustains and nourishes me.

In her now-classic, The Woman's Comfort Journal, Jennifer Louden offers some comfort ideas for those who can't remember the last time they smelled fresh air or felt the rain (well, this IS Vancouver) on their faces:

1. Run through a tall corn field.

2. Let the wind push you down the sidewalk.

3. Fly a kite.

4. Take a hayride.

5. Collect fall leaves.

6. Make it a fall ritual to travel somewhere, even if it is only a few miles, to see leaves changing.

7. Cook s'mores over an open fire.

8. Walk briskly and sniff the fall air.

9. Pop corn.

10. Dress up for Halloween and go trick-or-treating with children. Or put on a haunted house for adults only.

Some other ideas that come to mind are:

1. Rake huge piles of leaves and jump in them.

2. Buy fresh root vegetables at the last of the farmers markets and take them home to make and freeze big pots of soup. (Great nutritious and economical on-the-go meals!)

3. Bake luscious loaves of whole grain bread - and eat a slice or two warm with a little butter.

4. Stop and really look at the shape, veins and colours of a changing leaf.

5. Tidy the garden and put the bulbs to bed. (As you dig, breathe deeply of the humus that speaks both of decay and new birth).

6. Come in from the garden, cold, stiff and rosy-cheeked, to curl up by the fire with a favourite book, soothing music and a steaming cup of tea.

7. Have a Thanksgiving potluck dinner with family, friends and perhaps a stranger or two. (It's past Thanksgiving, you say? Who's to say we can't have a "thanksgiving" meal every month?)

8. Buy new purple mittens, a yellow umbrella or shiny red gumboots and wear them.

9. Learn a new creative art - knitting, carving, weaving, potting, painting, singing...

10. Collect horse chestnuts and enjoy their deep, warm, browns and their smooth, shiny skins. Consider using one, held in your hand, as a focus for your meditation/contemplation practice.

11. Go to the beach and watch the waves spray the shore.

12. Take off your hat and feel the wind in your hair.

13. Watch for the next time a storm is brewing and the sky turns indigo, the sunlight deepens to gold and a rainbow arcs across the heavens. Then make a wish.

14. Stamp in a puddle.

15. Trace the ice swirls on an old window or a frozen puddle.

16. Watch and listen to the skeins of geese heading south for the winter.

So many possibilities if we'll only stop to notice and enjoy.


Friday, October 16, 2009

What is CF Anyway...?

I don't spend a lot of time at my computer but, in order to keep up with new writings about Compassion Fatigue, I receive regular Google alerts citing blog posts, articles in the popular press and more scholarly articles from academic journals. Something I've noticed lately is an increasing diffusion and fuzziness in the understanding of CF, particularly in the blogs and the popular literature, and it concerns me a little because I don't want to see compassion fatigue go the way of codependence.

Codependence was a very specific and useful term within the context of addiction treatment and then it "grew like Topsy" to be applied to anyone who ever "enabled" anyone else to do anything and even to those who were merely practicing kindness. Codependence became a term that no longer had clear meaning because it was being applied to everyone.

As I've read various blog posts and articles lately, I have noticed that as uninitiated people are drawn to and identify with the notion of CF and want to spread the word, they are writing about the condition as "chronic weariness" or "feeling stressed" or being otherwise depleted. While all these experiences are true of most CF sufferers, they do not define compassion fatigue itself.

CF is a serious but natural consequence of working with suffering or traumatized people or animals, or with our wounded planet. It is, first and foremost, a response to secondary trauma exposure. We must have been exposed to the trauma in others' lives and have been negatively affected by it before we can say that we have compassion fatigue. We must have developed secondary posttraumatic stress symptoms culminating in a diminishing capacity for, or interest, in being empathic with others' suffering, hence "compassion fatigue".

And while burnout is almost always a precursor of CF, CF is not a form of burnout. Nor is it clinical depression. I have seen it called both, possibly because people reading about this young and quickly evolving term may not have realized that we have moved on from a particular understanding of the phenomenon.

We are probably still a way away from a "final" definition of this phenomenon but if we can be as clear as we can be in defining our terms, we are more likely to reach the people who deserve support and treatment and to offer them the most useful assistance. ie good trauma treatment and improved resiliency skills.

Photo by Bigstock Photos

Wednesday, October 7, 2009

Book Review: Bounce: Living the Resilient Life...

I'm currently reading Robert J Wicks' new book, Bounce: Living the Resilient Life and am delighted to recommend it to you. (It is so new that the copyright by Oxford University Press is 2010!).

This book, like The Resilient Clinician (2008) and Overcoming Stress in Medical and Nursing Practice (2006), focuses upon transforming stressful situations into opportunities to live a more meaningful, self-aware and compassionate life. It offers principles and techniques of self awareness, stillness, mindfulness, daily debriefing and self care to everyone, not just the professional caregivers for whom Dr Wicks has written for over 30 years.

The table of contents looks like this:


Have a Life!: An Introduction

Navigating Life's Rough Waters: Riding the Crest of Chronic and Acute Stress

Personal Renewal: Creating and Tailoring Your Own Self-Care Protocol

A Powerful Healing Combination: Friendship, Resilience & Compassion

The First Steps Toward Self-Knowledge: Debriefing Yourself

Solitude, Silence & Mindfulness: Centering Yourself In a Driven World

The Simple Care of a Hopeful Heart: An Epilogue


And if that's not enough inducement to find a copy, it is short, well written, easy-to-read and, more than anything, useful, practical and profoundly compassionate. As the friend who recommended Bounce to me said, one reads this book and feels known and understood.

Currently a professor at Loyola University in Maryland, Dr Wicks is a recognized expert in preventing secondary traumatic stress and has been involved in debriefing relief workers from the Rwandan civil war and health care professionals caring for multiple trauma survivors from the war in Iraq.

Enjoy!

Saturday, October 3, 2009

66 Self Care Ideas...

I spent this morning with a great group of helpers intent on identifying compassion fatigue in their lives and on learning new prevention and resiliency skills. Here are the self care strategies that came from their brainstorming sessions:

1. Playing with pets
2. Listening to, or making music
3. Walking/hiking outside in Nature
4. Yoga
5. Spontaneous dance with my child
6. Reading for fun
7. Chatting with friends
8. Taking time to eat without distraction 3 times a day (ie mindfully)
9. Going out on a motorcycle every weekend
10. Swimming
11. Gardening
12. Positive thoughts in sessions
13. Doing puzzles
14. Knitting
15. Painting
16. Shopping for yourself
17. Going to the museum or art gallery
18. Cultivating faith
19. Sleeping in
20. Watching cats playing
21. Holding pet every morning
22. Dream interpretation
23. Aerobics
24. Driving alone in the car
25. Book clubs
26. Girls' night
27. Playing/reading with the kids
28. Dressing up and going out
29. Going on a roller coaster
30. Making a list to get things out of your head
31. Cleaning my room
32. Cooking healthy food
33. Having someone cook for you
34. Taking part in social action
35. Photography
36. Karaoke
37. Regular massage
38. Leisure time - going for coffee or window shopping
39. Aromatherapy at home
40. Taking time to debrief with a supervisor or colleagues
41. Learning to say no
42. Lighting a candle
43. Trying a new recipe, kneading dough
44. Writing in a joy/gratitude journal
45. Write an email or in a journal to "get things out"
46. Go to a different place/ space, even in the work setting
47. Take a bubble bath, shower or swim - "aquatherapy"
48. Watch a funny TV show, youtube a comedian like Seinfeld or The Vinyl Cafe
49. Spend time with someone you know will lift your spirits
50. Take care of plants, nurture "at risk" plants
51. Remind myself that not everyone is going to get better; accept reality and respect other peoples' processes and their personal journeys
52. Sing in a choir / sing in the car / SING!
53. Do crafts
54. A quiet cup of tea
55. Reading something inspirational
56. Watching a bird feeder
57. Raking leaves on a sunny day
58. Meditating or praying
59. Sitting still (doing nothing)
60. Join a Laughter Yoga Club
61. Be in the moment - not thinking about the past or the future
62. Don't attach to stressful thoughts
63. Ritual
64. Change out of work clothes after work
65. Let go - leave perfectionism behind
66. Eat well


Monday, September 21, 2009

Have a Good Bad Day...

We all have days that feel like this.

In her website, The Happiness Project, Gretchen Rubin offers an antidote, listing Tips for Feeling Happier Right Now. Each tip is guaranteed to lift your mood, as will the mere fact that you've tackled and accomplished some concrete goals.

1. Boost your energy. Pace while you talk on the phone or, even better, take a brisk ten-minute walk outside. Even a small amount of exercise elevates your spirits.

2. Listen to a great song. Research shows that listening to music you love is an extremely effective way to improve your mood.

3. Reach out to friends. Make a lunch date or call a friend. Having warm bonds with other people is a key to happiness. Perhaps surprisingly, it turns out that socializing boosts the moods not only of extroverts, but also of introverts.

4. Rid yourself of a nagging task. Answer a difficult email, purchase something you need, or call to make that dentist's appointment. Crossing an irksome chore off your to-do list will give you a big rush of energy and cheer.

5. Create a calm environment. Clear some physical and mental space around your desk by pitching junk, stowing supplies, sending out quick responses, filing, or even just straightening up your piles. Outer order contributes to inner serenity.

6. Lay the groundwork for some fun. Order a book you've been wanting to read (not something you should read) or plan a weekend excursion. Studies show that having fun on a regular basis is a pillar of happiness. Try to involve friends or family , as well; people enjoy activities more when they're with other people than when they're alone.

7. Do a good deed. Make a helpful email introduction, set up a blind date, or shoot someone a piece of useful information or gratifying praise. Do good, feel good - this really works. Also, although we often believe that we act because of the way we feel, in fact, we often feel because of the way we act. When you act in a friendly way, you'll strengthen your feelings of friendliness for other people. And that's a happy feeling.

8. Go outside. Research suggests that sunlight stimulates brain chemicals that improve mood and increases focus. For an extra boost, get your sunlight first thing in the morning.

9. Save the life of a stranger. Every day, seventeen people die while waiting for a donated organ, and just one donor can save or improve the life of as many as 50 people. Most Americans say they approve of organ donation, but not many actually sign a donor card. Register and tell your next of kin you want to donate. Imagine the joyous faces of the people who will one day get a call from a hospital, to tell them that their prayers have been answered. That will make you feel pretty darned happy.

Are there other ideas you could add to personalize this list? Try adding them and then copying the list and posting it on the fridge or above your desk as a reminder that we can sometimes make choices that will lift the gloom and tiredness and allow a better day.


Wednesday, September 16, 2009

Forgiveness or Reconciliation...

Anger and resentment can be a great drain on the energy of anyone with compassion fatigue or chronic sorrow. And forgiveness or reconciliation can bring equally great renewal.

Forgiveness is different from reconciliation. As marriage and family therapist, Tom Moon, says, "Forgiveness means letting go of the past, but reconciliation is about committing to a future."

Forgiveness means letting go of anger, resentment, hurt, judgment and condemnation. It means giving up the victim role and the desire for revenge. It is something we do on our own, for ourselves, to prevent these feelings and actions from poisoning our own lives.

Reconciliation, on the other hand, is a process where both parties own and acknowledge their parts in the problem, without excuse or blame, and strive to restore trust in the relationship. It's something we do together for the sake of the relationship.

We are free to choose forgiveness or reconciliation as our goal in any situation. And, oddly enough, when we know that we don't have to reconcile, we can often be more generous with our forgiveness. (Fear of being hurt again by an unrepentant person can be a legitimate reason for forgiving but not reconciling.)

Both forgiveness and reconciliation are processes, often lengthy ones, so they can take patience and persistence. In considering forgiving someone, Tian Dayton, PhD, author of The Magic of Forgiveness, suggests writing the answers to the following questions:

1. What is the forgiveness issue I'm working with?

2. Where am I stuck?

3. What will I gain if I forgive?

4. What will I need to give up if I forgive?

5. Why am I afraid to forgive?

6. What feelings keep coming up when I contemplate forgiving?

7. What do I feel angry about?

8. What do I feel sad about?

9. What, if anything, am I holding against myself?

10. What, if anything, am I holding against someone else?

11. What do I think forgiving myself or this person will mean?

12. What do I want it to mean?

13. What am I afraid it might mean?

14. What do I imagine forgiveness can give me that I don't have now?

Reflecting on these questions can help to ready us for the steps to forgiveness listed on the website for Zen Habits by therapist, Allison Mupas, MFT:

1. Journal or talk to someone about what happened, your feelings, and let it all out.

2. Look at your side of the event, disagreement, or problem. How did you participate? Do you have anything to clean up? ("Clean up" means take responsibility for.)

3. Consider whether you're even willing to forgive yet. If not, take some steps to work through the underlying feelings.

4. Make the decision to forgive anyone involved in the situation. Don't forget yourself, if you need it. Decide if you need to say or write anything to anyone involved to get your feelings out and be heard.

The person you are forgiving does not need to be willing to receive them or to be present for you to complete this process. You can ask an objective person to be on the receiving end if you don't feel safe or comfortable going to the person with whom you're upset. You can visualize that you are speaking to that person when you are speaking to a friend or objective listener.

5. Let go! Keep in mind that you are choosing to forgive. If you are holding on to a belief that the other person has to do something before you forgive, you may be choosing to remain stuck. If you find situations re-stimulating the old feelings of hurt, you may need to repeat step 1.

Keep in mind that this process is not easy but it is very rewarding and can be very freeing...

If you are having difficulty with your forgiveness or reconciliation process, you might want to contact a counsellor, spiritual advisor or professional coach for help.





Saturday, September 12, 2009

Bits 'n' Pieces...

I have a number of bits 'n' pieces of things buzzing around in my head this afternoon, and rather than letting them use up my precious cognitive space, I'll write them down for you now, rather than waiting until next week's post.

So, here goes:-

1. One knows that a concept has really hit the tipping point when you see it in Oprah's, O Magazine! Did you all see the Compassion Fatigue article, (page 141), in this month's issue? It is a short but well written article entitled, "Do You Have Compassion Fatigue?", by Tom Jarvis and I was particularly pleased to see that he had acknowledged CF as a problem of both helping professionals and family caregivers.

2. I'm reading two great books on mindfulness this weekend:-

a) Letting Everything Become Your Teacher: 100 Lessions in Mindfulness by Jon Kabat-Zinn, Delta Trade Paperbacks: NY (2009)

b) You Are Here: Discovering the Magic of the Present Moment by Thich Nhat Hanh, Shambala Publications, Inc: Boston, Mass (2009)

The first is a nicely laid out small book of excerpts from Full Catastrophe Living (2001), designed to "inspire you to embrace what is deepest and best and most beautiful in yourself". It's the perfect sort of book for exhausted people with short attention spans because the excerpts are brief, pithy and very easy to read.

The second is, again, a small book, this time written by the renowned Zen monk and meditation master, Thich Nhat Hanh, based on a retreat he led for Westerners, explaining a range of simple practices for cultivating mindfulness. It reminds me a little of his earlier book, Peace is Every Step, in that it is restful and calming just to read its pages.

3. My own little ebook on Chronic Sorrow has been coming along nicely but, because BC will be embracing the Harmonized Sales Tax in April, I will hold off on publishing the book until the sales mechanism on the website can be set up for the new tax. So expect to see the ebook in about mid 2010. My apologies to those who have been waiting patiently...

4. I am currently looking for a lovely, clean, quiet, peaceful, meeting space, with kitchenette, to rent occasionally for Saturday workshops in the Greater Vancouver area. If you know of such a space, I would be grateful to hear about it at caregiverwellness@shaw.ca.

That's cleared my head for the moment, so I'll leave you with warm wishes for happy and restorative moments this beautiful autumn weekend.

Cheers!

Jan


Wednesday, September 9, 2009

Spiritual Renewal...

Most people believe that we have a spiritual nature as well as a physical, mental and emotional one. In living through compassion fatigue and chronic sorrow, we can become spiritually spent and we need - and often yearn for - spiritual renewal as well as physical exercise and emotional support.

But how do we go about enriching our spiritual lives? Frankly, there are as many ways as there are people. The spiritual path is a highly individual one, without a rule book or standard curriculum that fits all. That said, there are some practices that have emerged through the years and across faiths, that can lead to a richer spiritual life:

1. Set aside time every week to nurture your spirit. (Eventually, you may find this time so nourishing that you want to set time aside every day.) During this established time, you might want to:

* Spend time in silence or prayer with Whom/Whatever you believe in that is greater than   yourself - God, Love, Nature, Truth, Beauty,The Universe.
* Visit different places of worship, paying attention to the music, the architecture, the difference in the sermons or teachings. Or, conversely, visit at a time when the place of worship is empty to pray or meditate alone. There is a wonderful peace to be found in sitting in a sanctuary where others have prayed before you.
 * Read inspirational writings and reflect on them. They needn't be "holy" writings, rather, anything that inspires you, be it poetry, a novel, autobiography or spiritual writings of your own or another faith.
* Write a poem or story for or about your Spirit.
* Write a prayer that celebrates your relationship to your Spirit or Higher Power.
 * Write a spiritual autobiography, noting times of spiritual insight through nature, relationships, and events. What are the stages through which your spiritual growth has progressed? Has your faith been helpful to you in times of strain and stress? Are there beliefs that frighten you or seem nonsensical and need reconsideration?
* Study an aesthetic discipline.
* Attend a meditation or prayer group.
* Begin a "Seeker's Group" to discuss spiritual issues.
* Attend a retreat.
* Spend time in contemplation of beauty, kindness, compassion, nature.
* Listen to uplifting music - dance to it.
* Create a spiritual journal for quotations, reflections, recording the spiritual happenings of your life.


2. Practice peace and reconciliation. The irritability and unmet needs that accompany both CF and CS easily lead to situations where forgiveness and/or reconciliation are needed. The topics deserve more space than I have today. Watch for more next week.

3. Practice mindfulness. Mindfulness is a form of meditation but, more, it is a way of life. A way of be-ing. It is a way of becoming intentionally aware of the present, in this moment and this moment and this moment... A way of living life deeply and fully.

4. Practice gratitude. Open your awareness to the gifts of this world - large and small. Becoming consciously grateful for the fact that you step on to a carpeted floor when you get out of bed, that you drink clean water, that you have someone to love, that you're surrounded by the beauty of nature, that you have eyes to see and ears to hear, can do a lot to balance the pain of compassion fatigue and chronic sorrow.

I could say much more here but this is a good start. Think about your spiritual wellness this week. If it could use a tune up, perhaps try one of these ideas - or one of your own - to begin a process of spiritual renewal.






Sunday, September 6, 2009

Who Inspired You?...

September and the return to school never fail to remind me of the wonderful people who inspired me to become the helper I am today. Some were family, some friends, some therapists, some famous persons I would never meet. But most were the teachers who wove a golden thread through the tapestry my life from kindergarten through graduate school. Each of them in-spired, or breathed into me, the desire to learn and then to support the learning of others.

Miss McIntosh, my third grade teacher, taught me the importance of empathy, warmth and compassion in creating an emotionally safe space for learning. Barry McDell, my highschool English and Journalism teacher, taught me that a painfully shy teenager could do more than I ever dreamed possible - even edit the school yearbook! And Dr Selma Wassermann and Lin Langley showed me that respectful teacher-student interactions are at the core of all good teaching. They demonstrated again and again that content matters less than the learning experience - that the medium truly is the message.

Without these deeply human and caring mentors, I could never have become the teacher I am today and I will be forever grateful.

What about you? Who inspired you to become the helper you are today? How did they do that? What did they say? What did they do? Perhaps you could share your story of inspiration here so it can, in turn, inspire others?



Photo by BigStock Photos

Wednesday, August 26, 2009

A Reminder About Grieving...

This week, I received a touching email from a young friend who had remembered that the anniversary of my husband's death is approaching.

She has given me permission to share part of that email with you as a reminder that what we do teaches healthy grieving as much as, or more than, what we say.

"...on the topic of how we learn to not talk about and express our grief: one thing that I think is so cool about you and about being at your house/with you, is how it's totally ok to talk about derrick anytime. it's never a hush hush subject or something that shouldn't be brought up, just in case somebody gets sad. in the middle of breakfast or in the car or whenever, it's ok to just suddenly laugh or cry or just talk about derrick and something that he would have liked or something he did, or whatever. i think that's really cool. your home has always been a safe place for all kinds of emotions, and i like that that holds true for any emotion having to do with derrick, even though it may be difficult to talk about.

i think that's really cool and healthy ... thank you."

At a time when we still seem so afraid of death that we can't even say the word comfortably, (- he passed, she passed on, he passed away -), it's good to know that an effort to break the "don't grieve" rule with which I grew up, and to provide the young people in my life with support for healthy grieving, has borne fruit. I will take my young friend's email to heart and will continue to try to "walk the walk" as well as talking the talk.


(Photo by BigStock Photos)

Wednesday, August 19, 2009

Harvest...

Here I am, back from a truly restful and happy vacation and full of energy for the possibilities of the fall.

The last thing I did before returning to work on Monday was to drive out to Fischer's Farm in Richmond where I bought my annual 80 pounds of "Big Blue" blueberries to stock the freezer. As I bagged the big, sweet berries I thought about how satisfying it is to recognize and acknowledge our "harvest", the fruits of our labours, be they 160 bags of blueberries or making a dying loved one comfortable or helping a client to live life to its fullest.

We all have a harvest that is worth acknowledging and the more space we make to remember the times when we've made a difference, the more resilient we become to burnout and compassion fatigue. The knowledge that we've done something that matters, even something small, helps to cushion us on the days when we feel exhausted, incompetent or overwhelmed.

Two of my colleagues make a point of calling each other every Friday afternoon to talk about the things that went well that week. Another friend keeps a scrapbook of all the cards and thank you notes he's received over the years as a family physician. Yet another keeps the newspaper clippings regarding successful rescues made by his Search and Rescue team. And still another re-reads her gratitude journal regularly to remind herself that what she does does make a difference.

What about you? What is your harvest this week? How can you keep track of that harvest in a way that will nourish and sustain you in the days ahead?

Sunday, July 26, 2009

Vacations...

Tomorrow morning I leave Vancouver for Nanaimo where I will spend the next ten days in a small guest house on Westwood Lake, relaxing on my own throughout the day and spending evenings with dear friends.

I have packed good books, good music, walking shoes, and paper and pencils but I most look forward to slow, easy hours of doing nothing. It is healing to be apart from the busyness of life at home. There's something about being geographically away from familiar environs that refreshes and restores, providing a new perspective on the life left behind.

Whether you're a family caregiver enjoying respite or a helping professional taking this year's quota of holiday days, there are benefits to be accrued through getting away on vacation:


1. You live longer. A State University of New York study of men ages 35 - 57 suggests that men who take vacations every year reduce their overall risk of death by about 20% and their risk of death from heart disease by almost 30%.

2. Your mental health is better. Women who vacation frequently are less likely to become tense, depressed or tired and are more satisfied with their marriages according to a study published in the Wisconsin Medical Journal in 2005. Vacations provide a break from everyday stressors, allowing release of built up tension.

3. You can enrich your relationships. Vacations provide time to reconnect with yourself and with friends and loved ones who may take second place to workload, on- call shifts, emergencies or deadlines during the rest of the year.

4. Your creative side has space to emerge. Once you have had a chance to catch up on your rest, there is energy and space for the right side of your brain to find some expression in creative pursuits - art, building, music, crafts, writing, dancing.

5. You have the opportunity to play. Away from the responsibilities and pressures of your daily work schedule, the child lurking within finds permission to come out to play. Whether playing cards on the deck of your cottage, windsurfing at the beach, throwing a frisbee or exploring new fields or villages, vacations give you the uninterrupted freedom to play.

6. You can be more productive. Taking regular breaks to rest and renew your strength allows you to become more efficient in your caregiving work, to problem solve outside the box and to enjoy the process more. Life looks different when you're rested - there seem to be more options and possibilities.


Now, these benefits are available only if we do actually take vacations. A 2006 survey by Harris Interaction and Expedia found that 36% of workers didn't plan to use all their paid vacation and 37% never took more than a week off at a time. So, think about when you last had a good break. Was it more than six months ago? Then it's time to start planning, start saving, start asking for help so that you too can experience the joy and refreshment of a good vacation.

See you in August!




Monday, July 20, 2009

Mindfulness...

I took a picture of this lovely rose two summers ago while in the garden of Rochester Cathedral in England. I had walked back and forth along the garden path several times that morning but hadn't noticed the single blossom's deep apricot hue or it's perfect state of openness. As I settled on a wooden bench nearby I, an avid rose gardener, wondered at my lack of awareness, my "mindlessness".

It is so easy, with the busy pace we set, to run through life without noticing things that matter. Have you ever arrived home without recollecting the last few miles of your journey? Have you missed out on a Sunday dinner conversation while preoccupied with thoughts of work on Monday? Have you been oblivious to the sweet weight of a toddler on your lap as you've watched the hockey game?

Mindlessness is like living on automatic pilot. You may get things done but you miss out on important information - information that gives life richness or that keeps you safe or well. How often have you noticed the beginning of a headache and wondered, "Where did that come from? When did my neck muscles start feeling tense? When did that tension turn into pain? What happened to make me tense in the first place?" You may not find the answers to these questions if you haven't been present and aware in the moment. If you haven't been mindful.

Mindfulness means paying attention to things as they actually are in any given moment. (Not how they were in the past and not how they might be in the future.) And it means doing so non-judgmentally.

You can learn to be more mindful by practicing mindfulness meditation. You can ground yourself in the present by sitting quietly and noticing the sensations of your breath moving in and out. You might want to notice that the breath going into your nostrils is cold and that the breath coming out is warm. Or you might want to focus on the movement of your abdomen, just below your belly button, noticing its rise and fall with each breath. If your thoughts disrupt your focus on your breath, gently return your attention to your nostrils or your belly without judging your thoughts or yourself for having them.

Practice this meditation for a few minutes, morning and night, and gradually increase your time until you are meditating for 20 minutes a day. It will take lots of practice to develop this new skill, so don't give up for at least 8 weeks. And don't expect to experience instant peace. Our minds are notorious for increasing their chatter when we try to quiet them. Just notice when you've gone off on a thinking tangent and return, without judgment, to your breathing. Over time, you will develop a more mindful, centered, and de-stressed life.

If you're interested in learning more about mindfulness meditation, try Jon Kabat-Zin's books, Full Catastrophe Living or Wherever You Go, There You Are or listen to his meditation CD's, Guided Mindfulness Meditation Series 1, 2 & 3. You might also like to try the meditations of Thich Nhat Hanh, the Buddhist priest and founder of Plum Village in France. (www.plumvillage.org or www.learnoutloud.com).

Sunday, July 12, 2009

Self Care for Physicians...

It's nice when my teaching pace slows down for the summer, leaving time to read and reflect. This week, I read an interesting article from the Journal of the American Medical Association entitled, Self-care of Physicians Caring for Patients at the End of Life: Being Connected ... A Key to My Survival. (JAMA 2009, 301(11):1155-1164).

This article is one of the clearest and richest articles on Compassion Fatigue that I've read in a while. It defines and contrasts burnout and CF and delineates the causes and symptoms of each. It then goes on to specify self care suggestions, including those employed by the writers of the article. These strategies are well worth sharing regardless the field of people-helping in which we're engaged. (I have taken the liberty of paraphrasing for the sake of brevity and have added a few comments and sources in italics.):

1. Ground yourself by attending carefully to the sensation of your feet on the ground as
you walk through your workplace.

2. Set your watch alarm for a certain time each day to remind you to perform a simple act of centering. eg taking 4 slow, deep breaths, thinking of a loved one, reciting a line of a favourite poem or prayer, imagining weights around your waist and repeating the words, "ground, down".

3. Reward yourself after completing a task. eg an early coffee break, a walk outside or a quiet moment in the chapel or quiet room.

4. Call a "time out" after a traumatic incident in order to deal with emotional flooding. (See the Trauma First Aid post - January 12, 2009).

5. Stop by a window in your workplace and consciously notice something in nature for a
few moments.

6. Open team meetings with a moment of quiet and a reading of a poem or quotation.

7. Pause to take 2-5 breaths, ground and refocus before entering the room of your next
patient.

8. Take a healthy snack between meals.

9. Don't be afraid to ask the question, "Is it time for a break?"

10. Deliberately make connections with colleagues and patients as you go through the day. eg use humour, notice a birth date, comment on something special in the room.

11. Keep a notebook in which to write notes on traumatic or meaningful encounters and
events; occasionally take time at interdisciplinary meetings to share this material.

12. Find an opportunity to touch your patient during the visit, if that is appropriate.

13. Practice daily mindfulness meditation before leaving the office for rounds or clinic.

14. As you wash your hands between patients, say to yourself, "May the universal life-force enable me to treat my patients and colleagues with compassion, patience and respect." (And myself, as well).

Sunday, July 5, 2009

Farmers Markets...

One of the things I love best about summer is the return of the Farmers Markets. I love everything about them - the brilliant displays of young fruits and vegetables, the happy chatter of folks lined up to buy delicious and decadent cookies, the comforting scents of fresh bread and hot coffee wafting from their respective stalls.

But most of all, I love the vitality of the atmosphere. The sense that one can grow more alive just by being there. An energy and a nurturing that soaks in through one's pores.

Early in recovery from compassion fatigue, we need to find experiences that will fill us up, gently, without asking anything in return. (Most of us are too exhausted and empty, initially, to give anything to anyone or anything else.) Visiting the Farmers Market is just such an experience, as is walking quietly at the beach at sunset or listening to a chickadee's call early in the morning, or holding a sleeping child or sitting in silence to welcome the day.

Can you think of any other undemanding but nurturing experiences that might help to fill the hole left by caring for others? Can you choose one to do this week?

Monday, June 22, 2009

Healing Hobbies...

Happy summer! With our longer days and, if we're lucky, a stretch of vacation time finally in sight, our hearts and minds can turn to activities that ground us in joy and refreshment - our favourite hobbies.

Some people think that hobbies are a waste of time or a way of avoiding the responsibilities of life. For hobbyists, their favourite passtimes are anything but. For us, hobbies are emotional releases, creative outlets, sources of life long learning, ways of building community, ways of contributing to community and means of keeping minds and hands active. They are also a source of Compassion Fatigue recovery and a route to achieving overall wellness.

Most hobbies provide an ideal way to relax and to manage stress. Twenty minutes unwinding with knitting needles, your guitar, or an ax and a pile of wood can make an excellent transition from work to home. An hour's yoga, painting or reading (depending on the content!) can stimulate a relaxation response that will help you to sleep. Focusing on the intricacies of sculpting, cooking a gourmet meal or building a doll house with your daughter can distract you completely from worries over things you cannot change. Planning a quilt, poring over seed catalogues or choosing colourful yarns for a new project bring a sense of peace and hope.

For those of us whose work is always in process, baking a loaf of bread, finishing a wood carving or hearing a motor run smoothly after hours of tinkering provides an end result, a finished product, to balance the ongoing nature of our work.

This weekend, I discovered a great blog for hobbyists called, Craft to Heal, by Nancy Monson, an author, editor and avid quilter and crafter. In her November 22, 2008 post, she writes about how to reap the benefits of hobbies:


"To tap into the healing power of hobbies, follow these guidelines:

Match your hobby to your personality. If you're a detail-oriented person, you might like hobbies that require precision, such as quilting or decorative painting. If you're more spontaneous and like to make a mess, activities that make you do a lot of measuring will cause frustration rather than relaxation. You might prefer ceramics, gardening or photography.

Try rhythmic and repetitive activities such as knitting or sewing. The act of doing a task over and over again breaks the train of everyday thought and relieves stress by evoking the relaxation response, a feeling of bodily and mental calm that's been scientifically proven to enhance health and reduce the risk of heart disease, anxiety and depression.

Make time for your hobby every week, and ideally every day. Experts advise meditating for at least 20 minutes a day, so try to do the same with your hobby to get continuing benefits.

Create a space just for your hobby. Set up a dedicated hobby area in your home, so you can play whenever you have a few moments to spare. If you don't have a whole room or office to putter in, put your supplies in a basket or the car for easy access.

Take a class or join a club to meet other people. Human beings are social animals and research shows that socializing with others helps release stress. Plus: Life-long learning and having a strong social network are two keys to healthy, happy aging.

Enjoy the process. Many people rush to finish a project, but the fun and the healing benefits are in the process. That's when you push worry, anger, anxiety and everyday worries out of the way.

Don't be a perfectionist. Give yourself permission to enjoy your hobby without expecting you projects to be masterpieces. If you make your hobby another chore that you have to accomplish perfectly, you'll lose the therapeutic benefits and the fun.

Don't compare yourself to others. If you're a beginner, let yourself be a beginner. Persevere with your hobby because you love it, and whether you ever become a master at it or not, it will bring you joy. You don't even have to finish your projects if you don't want to. The point isn't to make a ton of stuff. The point is to find what makes you happy, and what helps to relieve your stress.

Be bold! Pursue your hobby for yourself and yourself alone, and to express yourself. Don't worry what other people think of your projects. As Mary Tyler Moore was once quoted as saying, "What other people think of me is none of my business." "

To these wonderful suggestions I would add:

Give yourself permission to change. If you've never had a hobby, allow yourself to try several before settling on something you like. And, if you tire of that, try something else. Having a hobby is not about making a lifelong commitment, rather, about finding what works for you for now.

This week, why not choose a project and take the first steps toward getting started?




Thursday, June 11, 2009

Summer Comforts...

Every season has it's particular comforts and rituals. Summer is no exception. When we take time to become mindful of the natural rhythms of the season, we open ourselves  to an almost inexhaustible source of support and nourishment.

With summer almost upon us, why not take a few moments to close your eyes and remember the joys, large and small, of summers past. What are the activities and experiences that brought you the most happiness, the most peace, the most refreshment? Try making a list and choosing one thing to enjoy each week through the summer.

Stuck for possibilities? Maybe you could try...


1.  Reading a whole series of mysteries by your favourite author.

2.  Building sand castles at the beach - borrow a child if it feels odd to do this alone!

3.  Eating cherries and spitting the pits as far as you can.

4.  Getting hot while cutting the lawn then jumping off  the dock into the clear, 
      cool water.        

5.  Making orange popsicles.

6.  Going to a drive-in movie or showing a movie in your back yard and inviting the
     neighbours.

7.  Eating breakfast out in the fresh air.

8.  Playing hopscotch in the driveway.

9.  Filling a wading pool or large bucket with water and splashing in it.  Or running under                the sprinkler.

10. Eating strawberries warmed by the sun.

11. Celebrating the summer solstice with friends.

12. Going for a bike ride or a run really early in the morning and listening to the dawn                       chorus.   

13. Having a picnic at the beach.

14. Lying on your back in the grass and watching the clouds.

15. Exchanging responsibilities with a friend so you can each get away for a few days.

16. Going to the farmers market and sipping a latte while you choose fresh vegies.

17. Picking blackberries, dandelion greens and other free stuff to enjoy for dinner.

18. Listening to the Beach Boys while you clean the kitchen or wash the car.

19. Smelling a rose.

20. Making a batch of red plum jam.

You may be surprised to find that the best of these pleasures are the simple ones...         

 
*  Photo by Bigstock Photos  

       

Saturday, June 6, 2009

Calm...

While walking in Santa Barbara, CA earlier this spring, I was surprised to see that the street banners, rather than announcing a local festival or naming a given neighbourhood, bore the outline of a little girl's face, a heart, a home and the single word, "Calm".

"What a wonderful idea!", I thought, as the tension melted away from my neck and shoulders. Had it been that city's conscious intent to create an atmosphere of peace in the downtown core? I don't know. But I do know that every time one of the banners caught my eye over the next few days, I experienced the same quiet sense of calm.

What, exactly, does it mean to be calm and how do we achieve this illusive state? To answer these questions fully, I will direct you to Babette Rothschild's excellent book, Help for the Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma and Peter Levine's seminal work, Waking the Tiger: Healing Trauma. To give you the short answer, I invite you to read on.

The Autonomic Nervous System (ANS) is the part of the nervous system that prepares us to fight, flee or freeze in response to a demand or threat and then to calm down afterward. The ANS has two branches, one that creates arousal to meet the threat (the Sympathetic Nervous System) and one that reinstates calm once the demand or threat is dealt with (the Parasympathetic Nervous System). Working in tandem, these branches create the arousal cycle described by Peter Levine:

- "We are challenged or threatened
then aroused;
- the arousal peaks as we mobilize
to face the challenge or threat
- then, the arousal is actively brought
down, leaving us relaxed and satisfied."

It is important for anyone who has experienced trauma personally, or through caring for others, to be aware of the signs of ANS arousal (fast shallow breathing, quicker pulse, dilated pupils, pale skin, sweating) and the signs of ANS calm (slower deeper breathing, slower pulse, flushed, dry, warm skin). Learning to be aware of our increased arousal is the first step toward reinstituting calm.

Some strategies that can help us to return to a state of calm after a period of arousal include:

1. Arousal awareness

Learn to become mindful of your level of arousal by carefully noticing your internal physical state - the signs listed above, areas of tension etc. Then, practice noticing how that baseline changes when you remember something pleasant in your life or when you anticipate something mildly unpleasant. Move back and forth between the two states, a few seconds at a time, until you get a sense of how varying levels of calm and arousal feel in your body. Use this knowledge to assess your arousal whenever you're feeling uncomfortable. ("Calm" post-it notes, placed strategically at home and in your office, can be a good reminder to check in.)

2. Reducing general arousal

You can reduce your overall level of arousal, over time, through meditation practices, centering prayer, reducing your trauma input (ie how much trauma you see on TV, in the newspapers, in your work), engaging in personal therapy to resolve past traumas, and keeping your muscles fit. ("Relaxed" or lax muscles and "calm" are not necessarily the same thing. We may need a degree of "friendly tension" in order to manage our stress.)

3. Learning to put the brakes on

It is important to know different strategies for "putting the brakes on" when your level of arousal gets uncomfortably high. (This level is different for each of us.) A couple of these include:

(a) Using Peter Levine's instructions for Trauma First Aid to complete the arousal cycle and calm yourself after confronting a traumatic situation. (January 12 ,2009 post)

(b) Finding a Sensory Anchor to which you can retreat when feeling too aroused.

A sensory anchor is an internal image of a safe place/situation. Choose a memory of something pleasant that makes you feel safe and calm. (Don't look for the perfect memory because almost everything can have a negative association if you look hard enough.) Awaken your sensory memory of that place or situation. How does it look, smell, feel, sound, taste? Notice your body responses - has your calm increased? If so, practice switching from mildly unpleasant memories to your safe anchor until you can switch quickly from arousal to calm. (Be patient. As with any skill development, this will take time.)

These are just a few of the ways we can return to the calm I experienced in Santa Barbara. I invite you to try them out and to continue looking for ways to increase your own calm as you care for others.