Caregiver Wellness Workshops

Chronic Sorrow III: 12 Ways to Live More Comfortably With CS

2012-01-25T09:14:00.000-08:00

Welcome to the last in a series of three posts on Chronic Sorrow.

While I don't believe that Chronic Sorrow (CS) can be cured, aspects of it can be healed and we can learn to live more comfortably in its presence. I will share some strategies here that have worked for me and for others in my workshops, hoping that some of you will do the same. The more we share our positive experiences, the more comfortable we can all become.

I do have one caveat though. CS is such a complex and individual experience that what eases life for one will not necessarily work for another. So, please do pick and choose the ideas that feel right for you and adapt them to fit your needs.

1. Acknowledge the natural sorrow that comes with your life situation and treat yourself with all the compassion and care you would a grieving friend.

2. Tell your family and friends about CS so they can have realistic expectations about your sadness and their ability to "fix it". Also, let them know what helps you most when you're grieving. (Personality type and other factors make a difference to what we might find helpful.)

3. Form a support team of two or three trusted people whom you can contact 24/7 for emotional and practical support if your grief or trauma symptoms are intense. (Discuss boundaries around late night calls.) Post their phone numbers by your landline and on your cell and carry their email addresses with you. You may use the individuals on your team rarely, but knowing that they're available can make all the difference.

4. Anticipate predictable grief and trauma stress points and arrange the option of extra support in advance. It is often the days prior to an anniversary date, medical procedure, assessment, or family celebration that are hardest so call your supporters several days ahead with a heads up.

5. Remember that you may have trouble thinking clearly or concentrating when the grief is intense so be particularly careful if you're driving, operating machinery, giving medications or treatments, or making important decisions.

Write down important things in a small notebook so you can remember them. (Where did I put the insurance numbers? Who do I call about respite? Is it time for a physical? ...). Put a hook in the wall and place your keys there every time you enter the house. Never let your gas tank get below 1/4 full. Place a large calendar on the wall by the phone for everyone's appointment and activity times.

6. Exercise regularly to reduce stress and to increase endorphin levels. A daily walk in the fresh air is one of the best gifts you can give yourself, even if it's only around a tree in the garden.

7. Spend time quietly in nature whether in your back garden, at a nearby park or walking in the woods. Allow the changing rhythms of the seasons to give you a message of hope for better hours or days ahead.

8. Consider seeing a therapist who will companion you through the CS - not because you are "sick" and in need of "treatment", but because therapy will afford you an hour of time to focus entirely on yourself with someone who will not be personally affected by your grief. (I found, when my husband was ill, that when I attempted to share my sorrow with family and friends, it often triggered their grief and I ended up comforting them.).

In my opinion, when looking for a therapist, people with CS are well served by someone whose basic orientation is one of parity and companioning; who understands CS (or is willing to learn about it); who has an eclectic theoretical background and experience in grief work, trauma work, and, if possible, bodywork; who is flexible, compassionate and empathic and who can allow the client to determine his or her own goals.

9. Find safe and personally congruent ways to express the sadness. CS is a complex, and often complicated, experience that can carry intense feelings - emotions that sometimes seem overwhelming if felt and expressed all at once, without regulation or pacing.

Some people have had the opportunity to learn healthy ways to self-regulate strong emotions. Others haven't. If you are one of the ones who hasn't, a good grief and trauma therapist, especially one who offers both talk therapy and bodywork such as Somatic Experiencing or Sensorimotor Psychotherapy, can teach you those skills.

Once you know how to regulate and, thus feel safe with, your feelings, choose ways of expressing the sadness (and other emotions) that fit best for you - writing a journal, talking with your loved one or a friend or therapist, painting, poetry, music, dance, prayer. The list is endless.

Sometimes services designed to help us grieve can exacerbate the grief instead. So, if you attend caregiver workshops or retreats, participate only in exercises that feel structured and safe. ie those that approach only a small piece of your loss at a time and that leave you feeling less anxious rather than more.

10. Cry if you want to. In North America, we live in a culture that gives us mixed messages about what to do with our tears. The self-help movement tells us to "feel, feel, feel" and yet many social settings and cultural traditions tell us to hold our tears until we can cry alone - or to be stoic and not cry at all.

As caregivers with CS, we need to be able to chose what to do with our tears each time they surface. Sometimes we will want to cry spontaneously and uninhibitedly in the moment, other times we will want to wait until we are alone, yet other times we will choose to use busyness as a distraction so that we won't cry at all. There will even be days when our chests are bursting with unshed tears and, perversely, we'll find that we can't cry.

There is no single "right" answer to the question of crying. Do what feels right at the time. And if you find you can't cry and want to, try using a sad movie, poem or music that has made you cry in the past, to trigger your tears. (I used the movies, Truly, Madly, Deeply; Shadowlands; and A Rumour of Angels, several times over the years to trigger my own tears and ease the tightness in my chest.)

11. Try writing a gratitude journal. Writing a gratitude journal, (ie writing down 5 things every night for which you've been grateful), will not take the sorrow away but it will help to balance the sadness and, slowly, to balance your perspective.

There is a double "giftedness" in writing a gratitude journal - first, a change in outlook, and secondly, after the care-recipient's death, a recorded history and legacy of many of the small, positive moments in your life with your loved one.

12. Nurture your spirituality. (Here, I define spirituality as one's relatedness to oneself, to others, to the world and universe, and to one's Higher Power.)

If possible, carve out daily time for quiet and stillness; pray or meditate regularly according to your personal practice; use this illness or injury as a time to learn about receiving, making meaning, forgiveness, acceptance, trust, equanimity, gratitude, compassion, peace, grace, hope; discuss the difficult existential issues that arise in care-giving with a wise elder, trusted spiritual leader, or therapist; find ways to tell your story to yourself and others; read or listen to material that nurtures and inspires you; live in the present as much as you can, drawing wisdom from the past and hope from the future.

This short list is just a beginning. We would all like to know what has worked for you as you've learned to live more comfortably with CS. Would you take a moment to share your discoveries with us?

If you would like to learn more about Chronic Sorrow:

1. Read Susan Roos' book, Chronic Sorrow: A Living Loss (This is a psychotherapy textbook and a little dense, but well written by someone who understands CS both personally and professionally.)

2. Read the research of the Nursing Consortium for Research on Chronic Sorrow.

3. Call or email me to inquire about booking a CS talk, workshop, or retreat:

Jan Spilman at (604) 297 0609 or caregiverwellness@shaw.ca

Chronic Sorrow II: Characteristics of CS ...

2012-01-21T15:30:00.000-08:00

Hi everyone - I have to say I've been quietly amazed and very pleased to see the large number of views the first post in this series has received. People seem to have found a strong resonance with their personal experience. Thank you to each of you who commented or emailed, sharing your stories.

Today, I'd like to share with you the 12 characteristics of CS in family caregivers that Dr Susan Roos, PhD shared with me when I first started to learn the theory behind my own Chronic Sorrow:

1. CS is a nonpathological grief response

Chronic sorrow is not about mental illness or pathology. It is a normal grief response to a significant living loss for which there is no foreseeable ending. If CS is not complicated by other issues such as PTSD or depression, there is generally no need for medication. Family caregivers can do very well given information about CS, empathic companioning and, if in therapy, appropriate therapeutic goals.

2. The grief of CS is largely disenfranchised

Disenfranchized grief is grief that is not recognized or acknowledged by others. In CS, this lack of recognition can be found in our families, in our professional helpers and in the wider community. Few people or institutions realize the impact of the catastrophic loss at the core of CS.

There are no formal rituals to help CS sufferers through crises or milestones, no naturally expectable supports for those experiencing CS, no self-help books to explain the symptoms. (Though the positive response to the last post has motivated me to dust off a partially-written manuscript of a small book on CS for family caregivers!)

3. There are 2 types of CS loss: self-loss and/or other-loss

To keep our understanding of CS clear, Dr Roos uses the term self-loss to indicate the grief of those who have lost significant aspects of themselves, and other-loss to indicate the grief of people who mourn a loved one's losses.

4. CS usually has a traumatic onset

Our journey with CS often begins with a traumatic event, whether that event is a traumatic injury or the trauma of receiving a loved one's life-changing diagnosis. Thereafter, people can experience trauma or emotional wounds over the course of a lifetime with a permanent impairment.

We know that at least 10-25% of those who experience a traumatic event go on to develop posttraumatic stress (PTS). When this happens, we say that CS has become complicated by PTS.

Some signs that you might be experiencing traumatic stress include prolonged irritability, exaggerated startle response, restlessness, intrusive thoughts and feelings related to the traumatic event, flashbacks that get triggered by things that remind you of the event (for example, hospital smells, ambulance sirens, certain words or facial expressions, a particular location or person), overuse of substances or activities in order to help your mind and body feel more comfortable, social isolation, or emotional numbing. Each subsequent crisis in the illness/injury can become a trigger for a resurgence of these traumatic stress symptoms.

5. The core loss of CS is ongoing, without foreseeable end

Because the condition causing the grief is unending, so is the sorrow.

6. There are constant reminders of the loss

Reminders of the loss are everywhere - in the medical equipment that fills your home, in the health care appointments that fill your days, in comparisons with the "normal" lives of those you see around you, in the celebrations and milestones you won't enjoy, in the plans and goals you won't accomplish, in the multitude of "small" changes that revise your life, in the photos and memories of "life before".

7. Permanent adaptations or resolutions are not achievable

Because there can always be a deterioration in a care-recipient's condition and because the family is a dynamic, ever-changing system, there can be no final and permanent adaptation to the loss of health. The best adjustment we can hope for is a flexible adaptation to the unpredictability of our new lives.

8. There is a periodic resurgence of the intensity of the grief

Every time our fantasy of what-should-be or what-could-have-been is activated, our sorrow deepens. The disparity between our wished-for dream and the harsh reality is highlighted and we can grieve with all the intensity of the early days of the loss.

9. There are predictable and unpredictable stress points

There are a number of predictable stress points in life with CS, times when stress increases and grief intensifies. They include the time of initial diagnosis, times when your loved one no longer meets developmental milestones, onset of puberty, during discussions about placement in residential settings, at times of deterioration of the chronic condition, and during discussions related to the death of the care recipient or guardianship after the death of the caregiver.

More unpredictable are the crises related to unique aspects of your loved one's condition - the blocking of a hydrocephalus shunt, infection in a dialysis catheter, failure of a cardiac stent and others. As Dr Roos says, these stress points are:

... unpredictable, episodic, and draining, usually mandating decisions and action, and they compete with other priorities of living. They differ from stress points in other types of grief and bereavement, where stress points are nearly always predictable (anniversaries, certain holidays, and so on), and where they can be anticipated and prepared for. Although they can be very upsetting, stress points and emotional resurgence in grief and bereavement relative to death or finality rarely require crisis management, that is, urgent and critical decision making.

10. The affected person continues to function

Despite the ongoing grief and trauma of life with a loved one's permanent impairment, most family caregivers continue to function at a relatively stable level - even when fatigue and sadness are intensified. Their feelings of responsibility for their loved one's care can motivate continued functioning even when the small voice inside them whispers words of exhaustion and the desire to escape.

11. CS is not a state of permanent despair

Contrary to the perception of many who have not been caregivers, CS is not an unrelieved state of hopelessness and pain. In fact, living close to the edge of life with someone you love can be a source of grace, joy, meaning and a deep appreciation of and gratitude for the ordinary experiences of life.

12. Transformational processes are possible within the context of CS

Through the experience of healing (not curing) CS, family caregivers can resolve PTS symptoms, develop wisdom and maturity, create a refined appreciation for life, and grow in spirituality and meaning. Relationships can grow and an exquisite intimacy can flourish.

I hope these 12 characteristics have fleshed out the notion of CS for you. In the third post, we will focus on strategies for living more comfortably with CS - if you have suggestions to offer of things that have helped you live more comfortably, please do add them to that post as a way of supporting others who journey along side you.

Chronic Sorrow I: What it Is & Who is Affected ...

2012-01-17T15:25:00.000-08:00

Early this week, I received two emails from family carepartners asking for more information regarding Chronic Sorrow (CS). As a result, I've decided to expand an earlier post over the next three blog posts, focusing on three particular areas - what CS is and who is affected, the characteristics of CS, and how to live with CS more comfortably. I hope this series will help to normalize the experience of family care-givers and to broaden the understanding of those who support them.

What Chronic Sorrow Is

Chronic Sorrow is the normal, yet often unrecognized or misdiagnosed, recurrent and continuing grief that can be experienced by people with permanent impairments and those who love them. It is my hypothesis that it is also one of the factors (along with primary traumatic stress, secondary traumatic stress, burnout and moral distress) contributing to compassion fatigue in family caregivers.

Many family caregivers describe CS as an ever-present foundation of sadness underlying the ups and downs of everyday life. The sadness sometimes hovers outside our awareness and at other times we are plunged deeply into its intensity, triggered by a new loss, an anniversary date, a missed developmental milestone, a family celebration, an awareness of others' "healthy" lives, or the illness or injury of another loved one.

CS is, essentially, ongoing grief over a continuing living loss. It doesn't resolve over time but lasts, with recurring intensity, until the death of the care recipient. At its core is the aching discrepancy between life as it is and life as it should or could have been.

What Chronic Sorrow Is Not

CS is neither a type of bereavement, complicated grief, nor clinical depression though it will eventually lead to bereavement, and can be the forerunner of complicated grief or depression.

Unlike bereavement, CS is continuing grief about the condition of a living person, grief that does not diminish or lighten over time.

CS is usually pervasive, affecting more areas of our lives than complicated grief. Almost no aspect of life is untouched by CS whereas, in complicated grief, it is likely that the sadness arises from a more discrete aspect of the loss.

CS differs from clinical depression in that the CS sufferer, with a history of a continuing living loss, usually remains relatively functional, lacks biological symptoms like characteristic sleep disturbances, and generally recognizes when he or she has crossed the line into depression.

People with CS also tend to have a range of spontaneous feelings and the ability to express those feelings in their relationships. Their sadness is intermittent and often situationally influenced rather than arising from a consistently depressed mood. Most retain the ability to experience appreciation, gratitude and pleasure, sometimes more than the average person due to the exquisite perspective that can come from companioning a loved one at the edge of life.

Who is Affected?

The concept of CS was introduced in 1962 by American social worker and child advocate, Simon Olshansky, to describe the normal grief responses of parents to their child's severe developmental disability. His compassionate description of their sorrow came at a time when, according to American psychologist, Susan Roos, "... the professional community...often viewed them as difficult, morose, neurotic, self-pitying and unaccepting of their child." Since then, the term has been expanded to include people with a variety of chronic conditions and their family and friends.

Even more recently, (while trying to guard against overuse of the term), mental health professionals have included in this category others suffering a continuing, living loss. These others have included families of MIA's, POW's, runaways, the kidnapped, and the adopted in closed adoptions. Here, families have been left with an ongoing grief and uncertainty regarding their loved one's location and condition.

Now, CS is not found in all families where there is a continuing living loss. For example, in some belief systems and faith traditions, people believe that whatever happens in life is "fate" or "God's will". In such cases, they don't experience the core discrepancy between how life is and how it should or could have been - life is how life was meant to be - and, thus, they don't experience the ongoing grief in the same way.

Growing Weller Than Well: A New Workshop from Caregiver Wellness ... ...

2012-01-12T11:02:00.000-08:00

Caregiver Wellness is delighted to offer a new workshop in 2012, the second of the Compassion Fatigue: Going Deeper series, entitled, Growing Weller Than Well. (The first is the popular, Compassion Fatigue & the Enneagram: A Beginners Enneagram Workshop for Helpers.)

This day-long workshop (or two-day retreat), focused on Compassion Fatigue recovery, is based on Dr Karl Menninger's belief that an experience like CF can offer opportunities to grow more well and whole than we ever thought possible.

In his 1963 book, The Vital Balance, Dr Menninger says:

Not infrequently we observe that a (person) who is in ... recovery ... shows continued improvement, past the point of his former 'normal' state of existence. He not only gets well, to use the vernacular, he gets as well as he was, and then continues to improve still further. He increases his productivity, he expands his life and its horizons. He develops new talents, new powers, new effectiveness. He becomes, one might say, "weller than well".

...transcendence does occur. And perhaps it is not an exception, but a natural consequence of new insights and new concepts of treatment ... Transcendence might happen oftener if we could more frankly acknowledge the possibility of its occurrence, expect it, hope for it ...

What an exciting, hopeful and healing premise for those of us who have become wounded by our work with the suffering and traumatized. Not only can we become well again, but we can become weller than well. We can become stronger and more resilient. We can tap into new inner resources and new external supports that bring fresh energy and enthusiasm. It might take a while - and some hard work - but we have the potential to get there.

This new workshop has a psychoeducational focus, not a therapeutic one. We will use a variety of mediums - timelines, paper and pencil exercises, story-telling, poetry, collage, meditations, and discussions - to review your journey into CF and burnout, to examine your habitual responses to others' pain, to explore new ways to make meaning of suffering, and to discover new tools to deepen and strengthen your self care plans.

If your organization has completed a basic CF workshop (like Caring on Empty: CF Transformation & Resilience) in the past, and would like to reap the benefits of "going deeper", please contact me to return with this exciting new workshop.

If you have attended Caring on Empty as an individual, and are interested in "going deeper", you can watch this space for notice of a Growing Weller Than Well workshop sponsored by Caregiver Wellness later in the spring or you can book your own workshop with a group of friends or colleagues. (See "Workshop Availability" in the column to the left.)

** Please note: No creative abilities are required for this workshop and you will not be asked to participate in any activities that might make you feel uncomfortable. **

Your Special Word for the New Year ...

2012-01-02T14:05:00.000-08:00

Most of us are used to making (and breaking) resolutions with each New Year - I'll lose some weight, I'll exercise more, I'll have a better balance between life and work. This year, my friend, Elaine, told me about a different way of approaching the New Year - a practice of finding a special word to guide your year.

This practice is rooted in ancient times when certain men and women left their homes to live in the desert where they gathered in small communities and dedicated their lives to spiritual and psychological growth. This time in the desert was seen as a threshold time - a time of refining and transformation from which one emerged altered in some way.

As these desert abbas and ammas (desert mothers and fathers) grew in wisdom and wholeness, they were often asked by others for "a word" to guide the others' growth - a word to ponder and reflect upon throughout the year or throughout an entire lifetime. According to spiritual teacher, Christine Painter, PhD, one's word was something "to nourish, to challenge, to wrestle with and to grow into".

The New Year's word is like a seed that invites you to cross a threshold. With continuing attention - through contemplation or prayer, reading, thoughtful reflection, journalling, expressive arts, or conversation - it ripens slowly, changing your life, your attitudes, your beliefs, your feelings, your ways of be-ing.

In modern times, spiritual teachers suggest that, rather than making an intellectual word choice in order to "improve yourself", it can be more helpful to allow your word to choose you. Christine Painter suggests a number of ways of doing this:

1. Discovering your word isn't about a cognitive process of choosing the "right word". Rather, it is an opening of your consciousness to receive an intuitive gift. "The word (or phrase) is one that will work in you rather than you working on it. Remember that a word that creates a sense of inner resistance is as important to pay attention to as one that has a great deal of resonance."

2. Ask a soul friend, spiritual teacher or wise elder for your word, as in the desert tradition. (Remember to give them time to contemplate which word fits best.)

3. Create a retreat of a few hours, uninterrupted, to be still and silent, to journal and to reflect upon the year past. Write about your dreams and desires for the year ahead. Notice whether a word, image or phrase arises in your mind.

4. Go for a contemplative walk. Notice Nature and listen to hear whether she has a word to offer you.

5. Listen to your dreams and consider whether their images hold a word for you. Also, pay attention to the day's synchronicities - are there repeated images or words?

6. Allow time for the word to ripen slowly:

"If you hear a word calling, sit with it for a couple of days. ... Eventually there will be a tugging inside you, where you feel yourself drawn again and again to this word. ... Allow yourself to be in a space of unknowing. ... This is a journey of transformation and the word may not make immediate sense to you, but trust that over time more of its meaning will be revealed."

I'm quite excited to have found "the intuitive gift" of my New Year's word for 2012. My word is act and it has great meaning for me, being one who can be overly cautious in putting my creative ideas into practice. By the end of the year, I hope to have been transformed in some way by my attention to the nuances and levels of meaning in this "word that has chosen me".

If this practice appeals to you as a way to greet the New Year, and if a particular word "finds you", why not drop by and leave a comment here to encourage others to find their own?

Happy New Year, everyone!

References - A Last Post for 2011 ...

2011-12-31T14:25:00.000-08:00

Hi everyone! I hope you're enjoying the holidays. Over the past few weeks I've had requests for compassion fatigue references from three graduate students in three different fields (nursing, social work and journalism) so I've decided to share the resources with you, as well.

The most comprehensive bibliography I know is that of Beth Hudnall Stamm on her ProQOL.org website. This 1,034 article list was last updated at the end of November 2010.

Some more recent studies I would add are:

1. Saint-Louis, Nicole (2010) A narrative intervention with oncology professionals: Stress & burnout reduction through an interdisciplinary group process. Social work doctoral thesis - University of Pennsylvania.

2. Beck, CT (2011) Secondary traumatic stress in nurses: A systematic review. Archives of Psychiatric Nursing, 25: 1-10.

3. Boyle, Deborah (2011) Countering compassion fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, Vol 16 (1).

4. Chavez, Marc (2011) Predictors of compassion fatigue and compassion satisfaction ratings among healthcare workers in critical and non-critical units. Paper and poster presented April 2011 at the 2nd Annual Nursing Research Day in Boise ID.

5. Day, Jennifer and Ruth A Anderson (2011) Compassion fatigue: an application of the concept to informal caregivers of family members with dementia. Nursing Research & Practice, Article ID 408024, 10 pages.

6. De Oliveria, GS et al (2011) High incidence of burnout in academic chairpersons of anesthesiology: Should we be taking better care of our leaders? Anesthesiology, 114: 181-193.

7. Dworznik, Gretchen (2011) Factors contributing to PTSD and compassion fatigue in television news workers. International Journal of Business, Humanities and Technology, Volume 1, No 1, July 2011.

8. Hyman, SA et al (2011) Risk of burnout in perioperative clinicians, Anesthesiology, 114: 194-204.

9. Levy, Hannah et al (2011) Deployment stressors and outcomes among air force chaplains. Journal of Traumatic Stress, Vol 24(3) 342-346.

10. Sabo, Brenda (2011) Reflecting on the concept of compassion fatigue in nursing care. The Online Journal of Issues in Nursing, Vol 16 (1).

11. Slocum-Gori, Suzanne et al (2011) Understanding compassion satisfaction, compassion fatigue and burnout: A survey of the hospice palliative care workforce. Palliative Medicine (online), December 16, 2011. pmj.sagepub.com.

12. State Bar of Wisconsin (2011) The Toll of Trauma. Wisconsin Lawyer, Vol 84 (12) December 2011.

13. Ward-Griffin C et al (2011) Compassion fatigue within double duty caregiving: nurse-daughters caring for elderly parents. Online Journal of Issues in Nursing, Vol. 16(1), manuscript 4.

As is so often the case, the lack of consistent definitions for compassion fatigue, burnout, vicarious trauma and secondary traumatic stress leads to an ongoing lack of clarity in the field. For a good history of the evolution of the term, Compassion Fatigue, see Chris Marchand's excellent article, Compassion Fatigue: A History of the Concept.

I hope this list will help ease the research journey for interested students returning to write Compassion Fatigue projects in the winter semester. Good luck!

Holiday Wishes ...

2011-12-23T19:41:00.000-08:00

The holidays are times steeped in poignancy for caregivers of all sorts. Whether you are a hospice volunteer, a community health nurse, a family court judge, a clergyperson, an addiction counsellor or a family carepartner you will be confronted with the many holiday joys and sorrows of the people for whom you care.

Empathizing with your care recipients will affect you, both positively and negatively, as you go about your work and as you return home to your families. Knowing this, I send you heartfelt wishes for all that you need in order to replenish, restore and refresh your wellness this holiday season. In the words of an ancient Celtic prayer -

May we all have:

Grace for our needs

Strength for our weakness

Light for our blindness

Love for our loneliness

Words for our deafness

Joy for our weariness

Peace for our anxiousness

Wonder for our dullness

Hope for our hopelessness and

Health for our brokenness.

This year, I will be spending Christmas Eve with my family in Vancouver and then taking the 6:30 am (!) ferry to Vancouver Island on Christmas morning to share stockings, carol-singing, turkey and trimmings and, best of all, laughter and good conversation with my dear goddaughter and her family. I will be on holiday until January 3rd and, until then, wish you and yours every blessing of this bright and hopeful season!

Blessing for the Longest Night ...

2011-12-21T15:37:00.000-08:00

Those of you who have attended my workshops will know of my love for the notion of blessing. Blessings, according to Celtic teacher and poet, John O'Donohue, are circles of light drawn around people to protect, heal and strengthen.

In the past, I have shared with you some blessings written by John O'Donohue. Today I would like to offer you a Solstice blessing from the writings of United Methodist minister, Jan L. Richardson. May it be a gift to all who live "long nights" during the holiday season.

Blessing for the Longest Night

All throughout these months

as the shadows

have lengthened,

this blessing has been

gathering itself,

making ready,

preparing for

this night.

It has practiced

walking in the dark,

travelling with

its eyes closed,

feeling its way

by memory

by touch

by the pull of the moon

even as it wanes.

So believe me

when I tell you

this blessing will

reach you

even if you

have not light enough

to read it;

it will find you even though you cannot

see it coming.

You will know

the moment of its

arriving

by your release

of the breath

you have held so long;

a loosening of the clenching

in your hands,

of the clutch around your heart;

a thinning

of the darkness

that had drawn itself

around you.

This blessing

does not mean

to take the night away

but it knows

its hidden roads,

knows the resting spots

along the path,

knows what it means to travel

in the company

of a friend.

So when

this blessing comes,

take its hand.

Get up

Set out on the road

you cannot see.

This is the night

when you can trust

that every direction

you go,

you will be walking

toward the dawn.

Copyright - Jan L. Richardson

An Antidote for the Christmas Blues ...

2011-12-12T11:17:00.000-08:00

Are you feeling exhausted, depleted, and just a little bah-humbuggy?

Tired of adding lists and shopping malls to an already overfull life?

Hearing your voice sounding more irritated than joyful?

Caring so much for others that you've lost the larger picture?

Then, make yourself a nice hot drink, curl up in your favourite chair and watch this wonderful video clip, borrowed from one of Barbara Stahura's latest posts. By the time you're done, I guarantee that your perspective will have shifted and that your nervous system will have begun to calm. (The clip's best viewed in a full screen format.)

And, if you have a little more time - time to spend with your journal or just thinking quietly in your chair - you might want to consider completing one or more of these sentences -

1. The ordinary things for which I'm grateful this holiday season are ...

2. The miracles of life that make my heart sing are ...

3. The things that truly matter this holiday season include ...

4. The experiences that have made me smile this week are ...

5. The things for which I'm hopeful are ...

May this video, the sentence stems, and the thoughts and feelings that spring from them, chase away some of the humbugs and bring you "a really good day".

(This lovely film was made by filmmaker, Louie Swartzberg, with music by Gary Malkin and narration from Brother David Steindl-Rast.)

Holiday Energy ...

2011-12-04T08:09:00.001-08:00

One of the best ways to keep up a good, steady level of energy through the holiday season (and to keep your weight in check) is to remember to eat healthy foods at regular intervals throughout the day, watching your intake of sweets, fat, salt and alcohol.

But with all the wonderful holiday baking and all the gourmet meals around, what's a person to do? ( The intentions are so strong but the body is oh, so weak ....!)

Well, recently I came across a holiday eating challenge on Ruth Buczynski's website, NICABM (National Institute for Clinical Application of Behavioural Medicine), that I think is well worth considering. Based on the research of Dr Brian Wansink, PhD, The Power of Three Challenge encourages us to change 3 mindless habits of eating for a period of 10 days and then see what a difference it makes in our lives. (He is convinced that we will want to continue, thus creating newer, healthier habits.)

Dr Wansink bases his challenge on the research laid out in his fascinating book, Mindless Eating: Why We Eat More Than We Think. He believes that we have a Mindless Margin of caloric intake where we can increase or decrease our calories by about 300 per day without noticing much difference in our feelings of satisfaction. Over time, however, our bodies can tell the difference as we begin to gain or lose weight and to stabilize our energy.

Here is the list of suggested changes. Why not choose the three you would like to work on ( or one, if you do better at changing one thing at a time) and give yourself an energy boost and a rest from weight gain this holiday season? (As always, check with your physician before making changes in a prescribed diet.)

1. Eat in a well lit room. You eat less when you can see what you're eating.

2. Keep the bones. We have a better sense of how much we've eaten when we can see the evidence. This could mean keeping empty beer bottles lined up on the table or hot wing bones on a side plate.

3. Use the 1/2 Rule. Aim for 1/2 as much protein and carbohydrates while doubting your servings of vegetables and fruit.

4. Fill your plate, but keep it small. When you use a smaller plate or bowl, this will naturally reduce portion size.

5. Come up for air. Try to slow down your pace at the table so you can rely on your body's internal cues. Then follow them - stop eating when you start to feel full rather than when your plate is clean or when you're over-stuffed.

6. Downsize rather than supersize. Try ordering a size down from what you would normally order.

7. Pre-plate your food rather than serving it family style. It's easier to make more healthful serving choices when you make decisions before you start.

8. Pass on second helpings.

9. Use taller, narrower glasses rather than shorter, wider ones. You'll end up pouring less, but you probably won't notice the difference.

10. Prepare healthy snacks for when you're on the go (try carrying along an apple or a small bag of carrots).

11. Minimize variety in your snacks. You'll be surprised to find ourself getting bored with the same old cheese curls, and you'll end up eating less.

12. Put your apples on display. Show off healthy foods in a prominent, well-lit area of your eating space, and banish unhealthy foods to the back corner of your cabinets.

13. Keep chips out of reach. When you have to seek out junk food consciously, it gives you a chance to think twice before indulging.

14. Turn off the TV. When distracted, we tend to consume more calories inadvertently.

15. Eat meals with people who eat more healthfully than you do. Studies have shown that we're influenced by the food choices the people around us are making.

16. Keep unhealthy but tempting food in aluminum foil or opaque containers - out of sight is out of mind.

17. Using smaller eating utensils and serving spoons. It's an easy way to slow down how quickly we eat and get back in synch with internal cues.

18. Here's one for the whole family: rename healthy foods to make them sound more appealing. You might turn down a carrot-beet smoothie, but would you refuse a rainforest cocktail?

If you have other ideas to share, we would be happy to hear them!

A New Look ...

2011-11-29T11:31:00.001-08:00

Hi everyone! Welcome to Caregiver Wellness Workshops' new look on the world.

Anyone who follows Caregiver Wellness regularly will have noticed that I have posted a new blog format pretty well every day this week - and, in some cases, even three or four times a day - as I've experimented with new templates for the site.

It's always a big decision to alter the familiar. And that decision then leads to many questions. Does one change the layout or just the colours? Which colours are welcoming, which are peaceful, which are too intrusive or frenetic? Which fonts are easiest to read? Which headers match the existing photos and which tend to clash? (I had decided on a lovely golden colour until I realized that it clashed with almost every photo on the site! And then there were the constraints wrought by the preselected options chosen by the Blogger folks - which were not always my cup of tea.).

All that said, I'm happy with the new look - it's familiar, and clean and clear, and bright and peaceful, and shouldn't be jarring to the tired eyes of helpers who are drawn to the site. So, enjoy!

Holiday Planning Near the End of Life ...

2011-11-22T08:28:00.000-08:00

Whether you celebrate Christmas, Hanukkah or the Solstice, spending the winter holidays with a loved one who is dying feels poignant, fragile and precious.

The last Christmas I shared with my husband was probably the most beautiful ever - partly because of the thought we put into its planning and partly because we became willing to let go of the outcome once the planning was done. Here are a few of the things we learned:

1. Plan in advance but be flexible and hold your expectations lightly, remembering that there's a good chance that the plans will change.

2. Begin your planning with the person who is ill. Have a conversation about:

* his or her hopes and dreams for the holidays

* the themes that underlie those hopes and dreams - time with family, spiritual observances, gift giving, eating special foods, hearing traditional music

* what plans are realistic given their energy and abilities.

And don't forget to consider the same issues for yourself (and other family members living in the home) and share your thoughts with your loved one.

3. Have a conversation with extended family and friends once you know which activities matter most to you and your loved one and which will fit within your physical and emotional limits. Tell them about your limitations and about how you want/need to alter the celebrations this year. Make space to hear their responses with empathy and care. (Imposed change usually brings grief with all its sadness, anger, and efforts to control the uncontrollable.)

If the changes will be extensive, be sure to reassure people that they are still important to you and that it is the illness that is causing the constriction of activities and connection. For example, you might want to say something like:

* We'd love to have you here for the holiday meal but we don't have the energy to host it this year. If it's a particularly good day we might be able to join you for half an hour at someone else's house.

* We'd love to see you but we're moving into a time of quiet visits now. People who want to see Sam can come and sit with him for 5-10 minutes without speaking. On better days he may say something to someone but mostly its time for quiet visits now. If you're comfortable with that, you're welcome to come.

* We love you and wish we could see you but the time has come for us to protect our energy - the illness takes so much that the usual holiday visits aren't possible now.

4. Simplify rather than abandoning your traditions, for traditions are the glue that holds families together during hard times.

If your particular hopes and dreams are no longer possible, look at the important themes and values you identified in your initial conversations and use them as a guide for your new plans.

Going to the Midnight Service with family and friends on Christmas Eve and having our goddaughter and her family with us for Christmas dinner were the two traditions that were most important for my husband and me to maintain. Neither was possible in its usual form so we simplified and had a quiet, Christmas Eve service by candlelight at home in the livingroom on Christmas Eve and we all worked together to create a long, slow Christmas dinner on Christmas Day, so Derrick could go back to bed for a rest between each course.

It wasn't a perfect holiday but it turned out to be perfect in its imperfection, leaving us with cherished, loving, candlelit memories that will last forever. I hope the same will be true for all of you who face the end of life this year.

Remembering the Invisibly Injured ...

2011-11-10T11:36:00.000-08:00

Tomorrow, at the 11th hour of the 11th day of the 11th month, we will remember the thousands of Canadians who have been killed or injured in our wars, past and present.

However, there are some of the fallen whose names will not come to mind so readily, some whose injuries and subsequent deaths have never been acknowledged as being associated with war. Here I'm thinking, specifically, of those with the "invisible wounds" of Mild Traumatic Brain Injury (MTBI), Operational Stress Injury (OSI) or Posttraumatic Stress Disorder (PTSD), and the addictions and suicides that can come in their wake.

It wasn't until the past week, after hearing family stories at the funeral of my uncle, that I began to question the part that war injuries may have played in my own father's early death. A sergeant in the Canadian Army during WW II, he trained hundreds of soldiers in the risky business of bomb demolition. One cold prairie morning, a young trainee accidently detonated a bomb, believing that my Dad had already left the bomb disposal hut. My Dad was blown several feet in the air, lost consciousness, and burst both eardrums.

For the rest of his life, this quiet, kind and gentle man experienced hearing loss, headaches, dizziness, an exaggerated startle response and irritability, nightmares, emotional numbing and disengagement, and ongoing relationship difficulties. He used alcohol to cope with his physical and emotional pain and eventually died of his alcoholism at the age of 58.

With the benefit of hindsight and recent physiological research, I now suspect that my Dad suffered from the complex combination of MTBI and PTSD. He was officially diagnosed with neither and I imagine the same is true for many others, even today.

My father's "invisible wounds" had a profound impact on our family life and, while 12 Step programs were helpful for some of us, they didn't address the impact of the MTBI, itself. Fortunately, there are a growing number of supports available today. One of my favourites is Barbara Stahura's blog, Journal After Brain Injury. Here, one can find original blog posts by the spousal caregiver of a TBI survivor, sentence stems for both survivors and caregivers to use in healing through journalling, and many resources for survivors and caregivers alike.

Tomorrow, as I watch the annual cenotaph service, I will, as always, remember with heartfelt respect and gratitude, our war dead and wounded, our serving military, and the families who care for and support them. This year, though, for the first time, I will include my own dear father, Jack, amongst the soldiers and merchant mariners we are honouring.

A Mindfulness Meditation Alternative ...

2011-11-09T15:33:00.000-08:00

Whenever I teach a Compassion Fatigue workshop and we speak about the benefits of mindfulness meditation in reducing stress and autonomic arousal, there are always a few people who, because of the teachings of their particular faith tradition, feel uncomfortable about participating in the exercises.

My response to this discomfort is generally to offer the alternative of a Centering Prayer practice, which will bring about similar byproducts without the internal conflict. Centering Prayer is, in the words of Cynthia Bourgeault, Episcopal priest, author, and internationally-known retreat leader,

"...a simple form of sitting meditation, rooted in the Christian tradition but spreading its wings toward our universal human oneness."

I'm bringing this alternative to your attention, today, because I've become aware that the folks at the on-line educational organization, Spirituality & Practice: Resources for Spiritual Journeys, are currently offering a four week course called, "Centering Prayer with Cynthia Bourgeault". Cynthia's work is highly respected across faith traditions and she is an excellent educator.

The course has already begun, (the first two sessions of twelve have been completed and the third will be sent out by email on Friday), but there is plenty of opportunity to catch up for those who might be interested. If this includes you, you can find more information in the E-Course section of the S & P website at www.spiritualityandpractice.com.

5 Things Family Caregivers Wish You knew ...

2011-10-31T07:44:00.000-07:00

The joys of family caregiving - yes, there are some joyful times - can be tempered by a lack of understanding within the caregiver's family or support community. No one can completely understand another's journey, particularly when it is as complex and all consuming as family caregiving can be, but what a difference it can make to a caregiver's day when he or she realizes that someone "gets" at least a part of their experience.

Here are a few of the things caregivers at Compassion Fatigue and Chronic Sorrow workshops say they wish others knew:

1. We're not all the same. Family caregiving is a highly individual journey. Caring for a chronically ill or disabled child is vastly different from caring for one's dying spouse and that experience is different again from caring for an aging parent or friend.

There are also differences in the experience of caregivers between people and across the length of the caregiving journey, depending upon their personal history of trauma and loss, their financial status, the quality of the caregiving relationship, the extent of the support system, co-existing stressors, access to appropriate care and respite, and many other factors.

To assume that we know the day-to-day experience and needs of "family caregivers" is quite disrespectful. It is not until we have heard an individual caregiver's story that we can begin to understand, empathize and respond appropriately to their needs.

2. We won't get over it. "Aren't you over it yet? It's been 7 years ..." How many long term caregivers have heard these words, or variations on the theme, over and over again across the years?

The truth is that many family caregivers (and their care recipients) experience chronic sorrow (CS), the intense, recurring and continuing grief that can affect people with permanent impairments and those who love them. This normal grief response arises from the aching discrepancy between how life is and how it could or should have been. It is not so much an anticipatory grief, though that is certainly present, as it is an intense sorrow over current losses, large and small, that accompany the illness or loss of function.

CS lasts from the time of diagnosis until the death of the person with the impairment. Family caregivers don't get over it and and it doesn't diminish over time. Because the core loss lasts a lifetime, so does the grief. The good news, however, is that you can learn to anticipate vulnerable times and to live more comfortably with the grief.

Research shows that chronic sorrow can be mistaken for depression, sometimes causing caregivers to have antidepressants prescribed when what is really needed is education, companioning and/or therapy. CS symptoms differ from those of clinical depression in that the caregivers are able to feel and express a full range of emotion, are usually highly functional and, perhaps even more than the non-caregiving population, can still "feel the joy and see beauty of a sunset".

3. Life is not always so bad. Family caregiving does have agonizing times but it is not always a negative experience. In fact, living close to the edge of life with someone you love can, at times, provide a new perspective, a deep sense of gratitude for the ordinary and an exquisite awareness of all that is good about being alive.

It is as important for supporters to recognize that there are good times, as it is to acknowledge that there are bad ones. Rather than making assumptions about the caregiver's emotional state on a given day, it is important to ask and then listen to the response.

I'll never forget waking on a beautiful spring morning, finding that both my husband and I had slept through the night and realizing that, after a medication change, he was no longer in pain - I was thrilled! A social worker came to see us later that morning and chose to focus intently on all that had been bad about the previous week. I was not thrilled! For the first time in ages, I had wakened feeling truly happy and that happiness was what I needed to have reflected back to me, not the anguish of the previous week. If only she'd asked rather than assuming ...

4. We sometimes choose not to take care of ourselves. Many family caregivers actively choose to "live at risk" for a period of time in order to share life with an ill or disabled loved one. These caregivers have no interest in respite or attending caregiver-oriented programs because they have decided that they want to spend whatever time remains with the person they love.

Caregivers choosing to live at risk do not benefit from continuing messages about how they are not doing what good caregivers must do in order to take care of themselves. Rather, they are more likely to feel supported when others listen and hear their goals and find ways to help them reach them. If you can offer some self care ideas that will fit within the context of their goals, so much the better, but constantly nagging people to "take care of themselves" is far more likely to have the opposite effect.

5. We sometimes have trouble asking for help. For any number of reasons, be they societal norms around self-sufficiency, family programming, belief that the help is not available or dependable, fear of being dependent or beholden, fear of burning out one's helpers, or difficulty identifying needs, family caregivers may have trouble asking for help.

In such cases, supporters can ease the difficulty by regularly offering specific, dependable help - is there something specific I can do for you today? May I take your library books back onFriday morning? Which day may I mow your lawn? May I pick up your groceries every Tuesday? May I drive you to the dialysis centre every other morning? May I make dinner for you next Wednesday night? May I drive you to church every other Sunday? May I wrap your Christmas presents for you? Do you need help with your income tax? May I develop and update a schedule of friends for respite care so you can get out on Monday mornings?

There are probably many other things family caregivers would like their supporters to know. If you can think of any, please feel free to add them.

Photo by BigStock Photos

A New Documentary - Overexposed: The Cost of Compassion...

2011-10-12T16:43:00.000-07:00

On my return from the Thanksgiving weekend I was delighted to find an email from Dr Robert Marshall Wells, the MediaLab Faculty Advisor at Pacific Lutheran University in Tacoma, WA.

Robert had written to tell me about the premier of the MediaLab documentary, Overexposed: The Cost of Compassion, in Seattle on October 8th, a celebration which he described as "an unqualified success". I have had the privilege of watching the development of this documentary about compassion fatigue almost from its inception and I couldn't have been happier to hear about the positive reception that greeted the final product.

A team of PLU students - Elizabeth Herzfeldt-Kamprath, Hailey Rile, and Katie Scaff among others - travelled thousands of miles around North America interviewing more than 60 CF specialists and gathering information and film footage for the project. As they learned more about CF, they realized that it was much more than just the source of diminishing contributions to charitable agencies, (more correctly called donor fatigue or, perhaps, compassion burnout), - rather, that it is a condition of secondary posttraumatic stress that overwhelms many who work with the suffering or traumatized. And, thus, the scope of the film began to grow.

I hope to receive a copy of Overexposed in the near future and am looking forward to the possibility of showing it here in Vancouver sometime in the New Year. (Watch this space!) In the meantime, a heartfelt, Congratulations!, to Robert, Elizabeth, Hailey, Katie, Annika and all the others involved. A job well done.

Thanksgiving ...

2011-10-06T20:27:00.000-07:00

Author, Madeleine L'Engle, wrote the following as she reflected on a scene from the play, Our Town:

In Our Town, after Emily has died in childbirth, Thornton Wilder has her ask the Stage Manager if she can return home to relive just one day. Reluctantly he allows her to do so. And she is torn by the beauty of the ordinary, and by our lack of awareness of it. ... She asks the Stage Manager, 'Do any human beings ever realize life while they live it?' And he sighs and says, 'No. The saints and poets, maybe. They do some.'

Awareness of "the beauty of the ordinary" can become a source of enormous thanks-giving if we can only take the time to be more mindful. As we are able to live more in the moment, we are able to apprehend the beauty in the small things - a baby's smile, the smell of autumn bonfires, the feel of a toddler's hand curled around your finger, the crispness of the air, the laughter of kids playing hockey in the street, the colour of the changing leaves, the warmth of a shower after a cold afternoon putting the garden to bed, the fragrance of a cup of tea as you curl up with a good book... so many things.

May I encourage each of us to notice and share our gratitude for at least a few "ordinary things" as we spend time with family and friends this holiday weekend. And, if you will be on your own, perhaps take a moment to write a list of "ordinary things" for which you're grateful in your journal and notice what a difference it can make to your perspective.

With every blessing for a safe and Happy Thanksgiving to you and yours,

Jan

5 Great Ways to Encourage Each Other ...

2011-10-03T07:38:00.000-07:00

This past week I was surprised, touched and encouraged to receive an email from a workshop participant thanking me for "moving her" with the story of "19 jars of red plum jam" and for "transforming my personal experience of caregiving and compassion fatigue to wisdom that I could pass on to others". I felt very grateful to her for her kindness in taking the time to write those few lines.

Receiving such a generous email got me thinking about the whole notion of encouragement. What, exactly, does it mean to encourage someone? What is it for? How does one do it? Why don't we do more of it when it can literally transform another's day - or life?

The root of the word encourage comes from an old French word, corage, meaning heart. To have courage can be thought of as "to have heart". The prefix en in en-courage means "to make or to put in". To encourage, therefore, can be literally translated as "to give heart or to put heart in someone".

To encourage is to help someone develop courage - courage to continue growing and developing into the person he or she wants to be; to feel free to risk, to make mistakes and to learn from them. It is not so much about praise for something accomplished as about recognition of the effort, the capability and the resilience involved.

There is much about life as a helper that can be dis-couraging or disheartening. (I won't go into them here because you know them as well or better than I do.) The point is that there is always something that we can do to help lift another's discouragement - or to fuel their life energy even if they're not discouraged.

I once attended a church where, held in permanent wooden holders at the end of each pew, were cards printed with the words, Encourage Each Other ... . Below the words was space for writing something encouraging to someone else. I saw people tucking notes in others' purses and pockets or handing them to them directly with a hug. I saw folks quietly reading those notes with smiles or tears of happiness and I know that on the days when I received one of those little cards, I walked out of the church with an extra spring in my step.

So, what are some of the ways we can begin to encourage others?:

1. Listen and empathize:

When someone tells you how they're doing, really listen and empathize accurately. There's nothing worse than trying to share the reality of one's situation with someone who feels the necessity to "cheer you up".

The more we are able to listen deeply, and accurately and nonjudgementally reflect back what we are hearing, the more the person we're trying to encourage will feel heard and accepted. And, as counter-intuitive as it sounds, the more their painful emotions will begin to dissipate.

2. Ask clarifying questions:

Ask questions that invite the person to recognize and build a sense of their choice to use their personal power. Gently use your own curiosity and interest in problem-solving to stimulate theirs'.

3. Use your compassionate presence:

Sometimes the most encouraging thing we can do is simply to "be" with the person we want to encourage - to spend time with them while keeping our mouths closed and simply sending out energetic support.

Sometimes having someone hang-in with us as we struggle to find our balance or solutions, all the while showing their compassion non-verbally through authentic facial expressions or voice tones or continuing presence, can be the greatest of all gifts, for implicit in that inaction is the faith that the person will find their way.

4. Be a good role model:

Applying yourself to a task, even if you fail, will influence another to apply him or herself. Sharing your feelings transparently, as you go, will help the person you are trying to encourage to see that they are not the only one who feels anxious or stuck or worried about imperfect outcomes. If you move forward despite these thoughts and feelings, you can encourage others, by example, to do the same.

5. Give concrete signs of recognition:

Write a hand-written note that can be read again and again, recognizing a person's effort to manage a difficult situation or to take a risk or to just keep putting one foot in front of the other.

Give a small, meaningful gift that specifically acknowledges your affection for the person and your support of their goals and their actions toward those goals - a plant, an appropriate book, a poem, a special picture, a plaque, an ornament or token, a quotation.

Try planning and offering a ritual of encouragement - one that acknowledges an ending and a new beginning such as a new career or the beginning of widowhood, or perhaps one that marks the beginning, mid-way point or ending of a medical treatment or a period of study; or one that celebrates a time of passage such as a graduation, moving away from home, a spiritual awakening or commitment, retirement. Use your imagination...

Consider instituting a program of encouragement in your workplace, your organization or your family similar to the one I encountered in the church years ago. Create encouragement cards that are readily available to all members, from cleaners to CEO's, and give frequent reminders of their availability. Perhaps, offer opportunities for people to speak about how the cards have affected them and the culture of the organization.

So, I have offered some answers to the first three of my questions but I will leave the fourth one to you - Why don't we think to offer encouragement to each other when we know that it can literally transform someone's day, or even their life? ...

Fuel for the Fall...

2011-09-24T14:42:00.000-07:00

Hi everyone! Happy fall! This is my favourite time of year. I'm just back from the Yukon where, at -2 degrees in brilliant sunshine, it felt much more like fall than it does here today in the muggy heat of Vancouver.

Nevertheless, I went off to the Farmers Market and Lonsdale Quay early this morning to pick up a plethora of fresh fruit and vegetables to stow away for the winter. (Whether I'm giving care to others at home or at work or have signed up for double-duty caregiving, having something delicious already prepared in the freezer can make the difference between a healthy dinner and a high fat, high sugar, refined one.)

I thought that today I would share a couple of the recipes I cook up for the winter every year, in hopes that a few of you might be inspired to share your favourites. (Isn't it true that coming up with ideas for dinner is more than half the battle?)

This past week I made a large pot of borscht which is now sitting in the freezer, divided into enough portions for 12 meals for a singleton like me. And tomorrow, I'll use my friend, Janet's, recipe to make winter vegetable stew. Both recipes freeze really well in ziplock bags and if you freeze them flat, you can later line up the bags like files in baskets in the freezer, making them much easier to find. (The bags are reusable as well.)

Borscht (I double this recipe)

6 large beets

1 Tbsp olive oil

2 leeks, finely chopped (include the light green parts)

2 carrots, coarsely chopped

1 head green cabbage, coarsely shredded

1 can (14 oz) diced tomatoes

2 Tbsp tomato paste

2.5 litres water

5 Tbsp red wine vinegar

5 sprigs fresh dill

3 Tbsp packed brown sugar

Salt and pepper to taste

1/2 cup sour cream or Greek yogurt (optional)

1. In a large saucepan, over medium heat, combine beets & water to cover them x 1 inch. Simmer til fork-tender, 45-60 min. Rinse beets under cold water after reserving 2 cups of the cooking water. Peel beets if desired. Cut into 3/4 inch pieces and set aside.

2. In a large soup pot, over medium-high heat, warm 1 Tbsp olive oil. Add leeks and carrots and saute until soft and slightly brown (5-7 min).

3. Add reserved cooking water, tomatoes, cabbage, water, tomato paste, and dill sprigs, stirring to scrape up the browned bits from the bottom of the pot. Bring to a simmer over medium heat, cover partially, and cook about 1 hour.

4. Add reserved beets, vinegar, brown sugar, and salt and pepper and simmer for 5 min longer. Taste and adjust the seasoning. Remove and discard dill sprigs.

5. To serve, garnish with sour cream or yoghurt and freshly chopped dill. Makes 12-16 servings if doubled. (If you have meat eaters in your house, you can brown and add 2 or 3 pounds of stewing beef to the mix in step 3 and cook 1 1/2 hours or til meat is tender.)

Janet's Winter Vegetable Stew - 4 servings (I double or triple this recipe)

1. In a large nonstick sauce pan - heat 1 Tbsp oil over medium heat

- add 2 onions coarsely chopped

- add 1 shallot or a clove of garlic chopped finely

Cook until tender.

2. Clean 2 leaks - cut into 3/4 inch pieces and add to pan.

3. Add, in 1 inch cubes, - 2 carrots, 2 yams, 1/4 rutabaga or turnip, 1/2 large squash. (The recipe calls for 1 potato, as well, but I tend to add another yam because I think they freeze better. Also, it helps to cook the rutagaga a little in the microwave before adding.)

4. Stir in 3 cups vegetable stock and 1 tsp oregano and 1 tsp thyme.

5. Bring to a boil. Cover and simmer x 30 min until vegies tender.

6. Stir in another vegie for colour and texture - ie green beans, snowpeas, broccoli etc - and simmer x 5 min. (I only do this if I'm serving the stew right away, otherwise I add the last vegie later when I reheat the frozen stew.) Add more water as needed. Serve in bowls with chopped parsley and parmesan cheese.

So, there are two ideas for stocking your freezer. I'd love to hear of recipes that work for the rest of you ...

Compassion Fatigue in Foster Parents ...

2011-08-30T08:48:00.000-07:00

I have had touching conversations, this week, with two foster parents who called to ask if they would be considered "helping professionals" and, therefore, permitted to attend the fall compassion fatigue workshops.

My immediate response was, "Yes, of course.", having seen my great aunt and uncle raise several developmentally delayed foster "cousins" over the years of my childhood. While not endowed with university degrees, they had learned through years of experience the skills of attunement, attachment, and empathic behaviour management. My cousins thrived in the safe and loving environment of my aunt and uncle's small Fraser Valley farm but their care left a secondary traumatic stress impact in the lives of both their caregivers.

Foster parents work 24/7 with children who have been traumatized and, while research is still in the early exploratory stages, it does indicate that, because of this high level of secondary trauma exposure, foster parents may be at greater risk for CF than other helping professionals.

What other factors contribute to this increased risk? David Conrad, LCSW, Coordinator of the Secondary Trauma Prevention Project in Colorado, offers 4 possible factors in his article, Secondary Trauma and Foster Parents: Understanding Its Impact and Taking Steps to Protect Them:

1. Empathy: Empathy is needed to care for traumatized foster children but if foster parents over-empathize or over-identify with clients, they place themselves at risk for internalizing the children's trauma.

2. Insufficient Recovery Time: Foster parents may hear similar, horrific stories over and over again, often seven days a week without the respite needed to heal or get some distance from the stories. Thus, an accumulated secondary trauma load builds and can lead to CF.

3. Unresolved Personal Trauma: Many foster parents have had traumatic experiences in their own lives. (eg, loss of a family member, childhood abuse or neglect, accidents, addiction or mental illness in parents, serious illness or disability in their family of origin, immigration trauma and others). To some extent, the pain of their own experiences can be "re-activated" by the trauma stories of their foster children, causing an increased risk for internalizing the children's trauma.

4. Children's Vulnerability: Young children are completely dependent upon adults for their emotional and physical needs. When adults mistreat children, it evokes a strong reaction in any person who cares about children. Foster parents are at risk for these strong emotional reactions and their inability to change the children's situation can make them even more vulnerable to CF.

Early research is also showing that broadbrush training in childhood trauma and general self-care does not have an impact on CF risk in foster parents. As a result, Theda Parker's study of CF in Foster Parents at California State University, Fresno, suggests CF-specific training for all foster parents. (An idea with which I concur wholeheartedly!) Perhaps, even better than attending a general CF workshop, would be the creation of a workshop specifically for foster parents ...?

Fall Workshops 2011 ...

2011-08-18T12:47:00.000-07:00

This morning, I saw the leaves just beginning to change colour in our local park and the message was clear - fall is on its way!

This season, I will be offering two Compassion Fatigue workshops to helping professionals in the Greater Vancouver area, the very popular, Caring on Empty: Compassion Fatigue Transformation & Resilience and the first of the Compassion Fatigue: Going Deeper workshop series, Compassion Fatigue: Going Deeper I: The Enneagram.

You are warmly invited to join us for one or both of these workshops and to bring a friend! The venue is comfortable and cozy for a mid-autumn gathering, the food will be simple but delicious, and the conversation, (if previous experience is any judge), will be both fun and stimulating.

For further information or a registration form, you can contact me at (604) 297-0609 or by email at caregiverwellness@shaw.ca.

1. Caring on Empty: Compassion Fatigue Transformation & Resilience

This is an intriguing, discovery-based workshop for helping professionals interested in learning about Compassion Fatigue, the natural and expectable secondary traumatic stress that can affect anyone who works with the suffering or traumatized. We will look at CF's potential impact on practice, your personal level of CF risk, symptoms and early warning signs, and realistic ways to transform and become more resilient to CF.

When: Friday, October 21, 2011

9:00 - 4:00

(Registration at 8:30 am)

Where: Shaughnessy Heights United Church lounge

1550 West 33rd Avenue, Vancouver, BC

(West of Granville Street)

Cost: $135 (Includes HST, lunch & handouts)

Who Should Attend: Any helping professional working with the suffering or traumatized.

2. Compassion Fatigue: Going Deeper I - The Enneagram

Two of the early warning signs of compassion fatigue are irritability and emotional reactivity. This beginners Enneagram workshop builds on Caring on Empty and will help you to discover your personality type within a group of nine types and to determine the situations that are most likely to "push your type's buttons." You will also learn a form of mindfulness meditation that will help you to become more aware of your type-based responses.

Rather than "putting you in a box" as some might fear, personality typology has the potential to free you from the box of your unexamined personality.

The Enneagram, a mix of ancient wisdom tradition and modern personality theory, is more useful and accurate than any other personality system with which I've worked , primarily because it focuses on the motivations behind our behaviour rather than the behaviour, itself.

Join us to begin a process of self discovery which, at the very least, will make you laugh out loud in recognition and, at best, could change your life!

When: Friday, November 18, 2011

9:00 - 4:00

(Registration at 8:30 am)

Where: Shaughnessy Heights United Church lounge

1550 West 33rd Avenue, Vancouver, BC

(West of Granville Street)

Cost: $145 (Includes HST, book, handouts & lunch)

Who Should Attend: Helping professionals, as above.

3. Heads Up for the New Year

The second of the Compassion Fatigue: Going Deeper Series will be offered in early 2012. With the tentative title of, "Becoming Weller Than Well", this workshop will be highly interactive and will use a variety of modalities- story, collage, mandalas, meditation reflective exercises - to help you explore CF resilience in greater depth.

(Please note: No special skills or creative abilities will be necessary and you don't have to share your creations with anyone else, unless you would like to do so.) Please watch for details later in the year.

Medication Caution ...

2011-08-16T12:29:00.000-07:00

My first workshop for the Fall 2011 season was held this past Saturday for the Association of Advocates for Care Reform. This small but active non-profit group focuses on improving quality of care for older adults living in long term, residential care in BC.

Through advocacy and the development of family councils at residential care facilities, the ACRBC "helps provide a voice for residents and creates an inclusive, supportive environment for family and facility staff to work together".

While I was preparing for their workshop, ACRBC's, Kathleen Hamilton, sent me an article by freelance writer, Rob Vipond, from the June 2011 issue of Focus Magazine called, Crisis Behind Closed Doors. In this article, Vipond cites data obtained through a Freedom of Information request that shows that nearly half of all seniors in long term care in BC are being given antipsychotic medication. This is "... almost twice the average for the rest of Canada and among the highest rates found anywhere in the world. And even though Health Canada warns these drugs cause a doubling of death rates in the elderly, careworkers admit they're mainly being used as chemical restraints in the absence of adequate staffing and proper oversight."

Now, it is unlikely that this number of elders are actually psychotic. It is also unlikely that all healthcare workers choose to use medication, particularly inappropriate medication, to manage behavioural issues in the elderly. The problem, I suspect, lies not so much at the level of the residents or the careworkers but at the policy level, where care decisions are sometimes based on unrealistic fiscal restraint and myths about the care needs of the elderly.

The notion that older adults need less, rather than more, complex care is one that is offensive to anyone who has cared for older adults with multiple chronic conditions and yet, we frequently find large numbers of people cared for by a few care assistants supervised by an RN or LPN who has so many meds and treatments to deliver that he or she cannot be available to share more advanced knowledge and assessment skills with other staff.

And, when compassion fatigue and moral distress among staff members and family caregivers are added to the mix, residents face a very real danger of being treated at the level of behaviour management rather than as complex human beings who deserve to be seen, understood and treated as whole people whose behaviours ultimately make sense in terms of their life experience.

We know how to respond holistically and therapeutically to the often perplexing and frustrating behaviours of older adults in residential care but we need sufficient numbers of adequately prepared staff, uninjured by compassion fatigue and burnout, and with the time to discover and treat the roots of disturbed behaviour. Until that happens, I'm afraid we will be reading more and more articles like that of Rob Vipond.

A Practice of Silence ...

2011-08-02T12:38:00.000-07:00

At the beginning of what would become the last year of my husband's life, I realized that I could no longer continue the marathon of caregiving without some respite.

While the thought of making and coordinating all the necessary arrangements was overwhelming, with the encouragement of family and friends I used my last ounces of strength to plan four nights at a small retreat centre on the Sunshine Coast.

When I finally arrived at the old log house among the trees, the retreat director asked if I would be making a silent retreat (so she could inform the other guests). A little nonplused - I hadn't thought beyond getting myself safely to the door - I answered, "Yes." And thus made one of the most healing choices in seven years of caregiving.

I don't remember much about the ensuing days, and I had little energy for journalling so there remain few written descriptions, but my body remembers being flooded with gratitude for the depth of that silence.

Each morning I woke early and lay in bed soaking in the absence of sound until the dawn chorus began. After a silent breakfast in the cozy, sun-filled dining room, I went outside, wrapped myself in a warm quilt and lay on a lounge chair near the top of a long, gently rolling expanse of lawn. Protected by cool, dark woods on three sides and the house on the other, I lay there in the quiet for hours.

With the silent warmth of the sun seeping through layers of quilting, came a thawing of my tears. I cried for five days. Not the hot, heaving tears of anguish but the quiet, steady flow of years of chronic sorrow.

Later, as I returned home, I reflected upon the gift of silence. It had opened a space for grief, rest, healing and peace. My thinking was clearer, my body was stronger and I believed, once again, that I would have the ability to see the journey to its end.

The gift of silence has been written about by many but by few as eloquently or practically as journalist and author, Anne LeClaire, in her book, Listening Below the Noise: A Meditation on the Practice of Silence (2009). In a style reminiscent of Anne Lindburgh's "Gift From the Sea", Anne LeClaire describes her almost twenty-year experience of practicing silence, all day, on the 1st and 3rd Mondays of each month.

In this beautifully written little book, part memoir and part philosophical inquiry, she explores how silence can make space for us to expand our awareness and achieve inner peace. She describes the joy and difficulties of adjusting to this practice - both her own and that of her family and friends - and she shows how, through silence, we can:

- slow the pace of life,

- learn how to listen,

- become more compassionate,

- ignite and nurture creativity,

- uncover our inner yearnings,

- and, ultimately, find peace and improved well being.

In LeClaire's personal practice, silence means the absence of speech, not being still or without sound. She describes how, relieved from the stress of conversation or being physically or electronically available, her focus became more mindful and her creativity soared. Her body relaxed and her attention turned inward:

This is the first gift.

As I stepped into the shower, the upstairs phone rang

and I jumped reflexively. And then, immediately, I remembered

I was not talking and had no obligation to answer it. My shoulders

dropped and my body released a tension I had not even been

aware of holding. Only minutes from sleep and already my muscles

had been primed to meet the day's demands. I thought of the sign

at a local breakfast spot that reads:

Good morning. Let the stress begin.

I realized that we live our days with ears turned outward,

ready to respond, always on the alert, almost as if we walked

around holding huge ear trumpets to our heads, like figures in

an old cartoon. But for this one day both my ears would be turned

inward. I had only to listen to myself. Within the shower walls, it

felt as if my world had grown smaller and smaller until

all that was left was me.

For those who find the notion of 10 minutes silence terrifying, let alone a whole day, Anne provides a long list of options for beginning a practice of silence slowly and easily. Here are just a few:

1. Turn off the car radio on the commute to work or while running errands.

2. When performing a routine chore - folding laundry, washing dishes, straightening a room, weeding the garden - make it a habit to do the task in silence.

3. When a task is completed, sit in restful awareness for several minutes before running to the next chore on the list.

4. After finishing a telephone conversation, sit quietly for a minute or two. Breathe.

5. Have a meal alone. Without distractions. Without a book or magazine.

6. Set aside a formal silence time for your family.

7. Wake an hour early and spend that hour in deliberate silence.

8. Take the TV out of your bedroom.

However you decide to begin, a regular practice of silence can change the quality of your life and that of those you love. Why not give it a try?

Another Resource for Kids...

2011-07-26T12:43:00.000-07:00

This week I have found a resource for children and young adults who are affected by illness - their own or that of a loved one:

It can be difficult to help frightened young people to understand medical conditions and procedures. Medikidz Comics is a resource that can help.

Medikidz comics are a series of 25 comics (plus 300 more waiting to be written) about five super-heros, the Medikidz, who live on Mediland, a living, moving planet shaped like the human body. Chi, Skinderella, Pump, Axon and Gastro take children on trips through Mediland to explain different conditions and how they are treated.

Written in age appropriate language by professional medical writers and physicians, these comics help to demystify the diagnosis, investigation, treatment and prevention of various medical conditions. A Youth Advisory Council of kids aged 6-16, who are affected by illness, provide the writers with feedback and help to shape the direction of Medikidz.

Medikidz has produced comics on paediatric conditions like epilepsy, scoliosis, leukaemia, autism and cystic fibrosis and also on conditions that could affect a parent/loved one. Some titles include:

a. What's Up With James? Medikidz Explains Depression

b. What's Up With Mom? Medikidz Explains Breast Cancer

c. What's Up With Dad? Medikidz Explains Melanoma

d. What's Up With Grandpa? Medikidz Explains Alzheimer's Disease

If you are interested in learning more about Medikidz, or in purchasing comics, you can go to their website at www.medikidz.com.

Clergy Compassion Fatigue ...

2011-07-15T11:33:00.000-07:00

This September 11th, a date which she has contemplated with some wry humour, my youngest sister will be ordained priest in the Anglican cathedral in Whitehorse, Yukon, before taking up a position in her first, two-point parish in Dawson City and Old Crow.

To say that I'm excited for her is a understatement. But, reflecting on the challenges before her, as well as the possibilities, I can't help but think about the risk of compassion fatigue for her and for all clergy, regardless of faith tradition.

Although unlikely to see themselves in this light, most clergy are trauma workers - and, depending upon their degree of involvement in their partners' ministries or their own professions, so are many clergy spouses. The clergy work in a wide variety of settings - in parish ministry, as chaplains to the military and to other front line responders, in hospitals, in hospices, in schools, on disaster relief teams, in retreat or counselling centres and in prisons, to name but a few.

In these settings, they are likely to be called out at all hours of the day and night to comfort those who are injured, ill, dying, or in spiritual or emotional distress - to say nothing of continuing to support them and their loved ones through often lengthy periods of healing or bereavement. Frequently, the people whose needs they are called upon to tend are folks intimately known to them, thus deepening the emotional impact of the work.

As trauma workers, these clergy are at risk of developing Compassion Fatigue (CF), the posttraumatic stress, "fatigued compassion", diminishing empathy and increasing disengagement that can arise from secondary exposure to others' suffering and trauma.

Aside from trauma exposure, a number of stressors, some unique to the clergy, can increase clergy vulnerability to CF. Counsellor and United Methodist clergywoman, Sheri Ferguson, pointed out in a 2007 article on Clergy CF, the following factors:

1. Lack of adequate training and experience in pastoral care

2. Isolation - expectations of "perfect clergy" that prevent sharing of struggles & pain

- frequent moves that prevent maintenance of sustaining relationships

- lack of access to personal mental health support in rural areas

- lack of access to mental health referrals for parishioners in rural areas

3. Personality traits - needs to rescue/caretake, have approval, be "good", be perfect

4. Church culture that reinforces caretaking & perfectionism -

- parishioners' projection of parental issues upon their clergyperson

- parishioners triangulating their conflicts - reducing tension with each other by drawing in a third person, in this case, the priest, rabbi or imam

- an expectation that the clergyperson, as God's representative, should be available always

I remember when my husband, also an Anglican priest and spiritual director, became very ill with mononucleosis at the advanced age of 50-something, an unrecognized symptom of his own compassion fatigue. After many weeks away from work, (mono is not an illness you want to get as an older man), and many conversations regarding his true priorities and motivations, he decided to divide each day into 3 parts and to work only 2 of the 3 parts. He also decided to take an unheard of two days off work, consecutively, each week. It took quite a while for some members of the congregation to adjust, though many saw the sense in good clergy self-care once it was explained and compared with their own lives.

So, what would I suggest to my sister and her classmates as they enter upon their new vocations?

1. That they heal their own personal trauma (past & current) to reduce their CF risk

2. That they engage in exquisite physical, psychological & spiritual self-care

3. That they develop a personal & professional support network that will gently offer feedback regarding CF symptoms and self care - whether they want to hear it or not!

Self Care Ideas ...

2011-07-06T08:36:00.000-07:00

Now that summer is here, the pace of life may slow enough that you can take time to assess and re-jig your self care plans. Here are some self care ideas assembled by the nursing and support staff from Alberta Children's Hospital - plus a few extras for good measure. See if there's anything here you might like to try or to share with your friends and family:

1. Meditate every day / do yoga

2. Meet a friend for coffee

3. Play frisbee with a pet / walk your dog

4. Spend some time in the mountains

5. Have a bonfire at the beach

6. Buy new lip gloss

7. Retail therapy

8. Have a hot bath with bubbles

9. Visit with someone you love by phone or on Skype/iChat

10. Snuggle under a quilt

11. Go to the airport early so you don't have to rush

12. Listen to loud music (or soft music)

13. Walk early in the quiet morning air

14. Get a haircut

15. Eat the samples at Costco

16. Work in a flower or vegetable garden

17. Go to Starbucks with a good book

18. Go for a long drive

19. Turn the TV off

20. Drumming

21. Have a clean house

22. Make popcorn

23. Mow grass or shovel snow

24. Plan a nice dinner

25. Hike or snowshoe

26. Have a family gathering (the functional ones)

27. Start a book club

28. Engage in a hobby - quilting, playing music, singing, knitting, reading, sports, painting, travel, writing, woodwork, car repair, digital photography, dancing, biking

29. Take a nap

30. Go away with friends

31. Clean the junk out of your pantry and buy fresh, healthy food

32. Laugh out loud - be willing to laugh at yourself

33. Notice and be grateful for the little things - your child's laughter, the colour of the sunset, the way your body moves

34. Plan your next vacation

35. Take yourself on a picnic

36. Be willing to receive

37. Make a list of 50 things that make you smile and post it where you can see it every day

38. Create a self care network of people who will encourage you as you improve your self care - your family, a self care buddy, members of a group to which you already belong

39. Spend an evening outside looking up at the stars

40. Explore ways to relax and become an expert

41. Create a special sanctuary at home - a room or a corner - where you can spend quiet time alone

42. Learn something new

43. De-clutter a closet or a drawer

44. Remember to breathe and breathe deeply

45. Make a gratitude journal and write down 5 things for which you're grateful every night before you go to sleep

46. Fly a kite

47. Roll all the way down a big grassy hill

48. Lie in tall grass and look at the sky

49. Pick flowers to make your surroundings look beautiful

50. Do some baking

51. Take a lovely bone china cup to work and have a quiet cup of tea and listen to soothing music for a few minutes every afternoon

52. Spend a day at the spa

53. Ask for a hug

54. Spend quality time with your partner

55. Tell someone you love them

Home Again...

2011-07-05T18:13:00.000-07:00

It's always good to come home. Particularly in the early summer when the whole of Vancouver is lush and green and everyone is looking forward to a long stretch of summer days.

The Compassion Fatigue Conference in Kingston, Ontario went extremely well. It was great to network and to hear the perspectives of other CF specialists as we continue to refine our ideas about how CF should be defined and about what works in the areas of prevention, recovery and resilience.

We heard wonderful speakers - Laura Lipsky, Jack Truten, Pat Fisher, Gabor Mate and others - and Francoise Mathieu did an amazing job organizing and hosting the whole event. The atmosphere was one of excitement and affirmation and we all left looking forward to another conference next year. Over the summer and fall, I'll share with you some of the ideas and information gleaned from the talks and maybe some of you will decide to join us next year...

One of the really nice parts of the conference, for me, was hearing from three people that they regularly read and enjoy this blog. Helpers, for whatever reason, seem to be uncomfortable leaving blog comments so I was grateful to hear that someone was actually reading the posts!

On my return home, I had a few days to unpack and do the laundry and then it was time to prepare for the last workshop of the season, an evening with the Lions Gate Hospice Society. They are a great group and seemed to find the notion of CF both familiar and helpful.

Tomorrow, I will post the self care ideas from the Alberta Children's Hospital workshop, as promised, and then will be back to regular posts until I go on holiday later in the summer.

A very happy, healthy and refreshing summer to you all!

What's Up? ...

2011-06-12T20:52:00.000-07:00

Hi everyone! Just a quick post as I unpack from a great workshop with the nurses and their colleagues at Alberta Children's Hospital in Calgary and pack again for the Compassion Fatigue Conference in Kingston, ON on the 15th and 16th.

For those of you who have been waiting for the dates, I will be offering the Caring on Empty: Compassion Fatigue Transformation and Resilience workshop on October 21st and the Compassion Fatigue: Going Deeper workshop on November 18th, 2011 here in Vancouver. They will both be open to all helping professionals and will probably be held in the lounge of Shaughnessy Heights United Church. More details will be available through the summer.

I have been following an interesting teleseminar series on trauma put on by Ruth Buczynski at NICABM (The National Institute for the Clinical Application of Behavioral Medicine). She interviews a new trauma specialist such as Peter Levine or Pat Ogden each Wednesday and, so far, the interviews have been very informative. If you're interested in taking a look, give the NICABM website a visit.

That's all for now. Will have lots to tell on my return from the conference (and a small holiday) on June 24th.

How Life Changes ...

2011-06-03T07:09:00.000-07:00

Hello again. I'm finally back at the computer after a few weeks of second tier carepartnering for friends learning home peritoneal dialysis at one end of the Fraser Valley and for another friend hospitalized with chest pain and dysrhythmias at the other.

Journeying with these loved ones has reminded me, once again, of the multitude of changes we experience as serious chronic illness or disability enters our lives. (- Often things we don't expect, like no longer having room for our bedroom furniture because the room is filled with cartons of dialysis solution!) Permanent and ongoing change becomes our new reality and we are constantly in the flux of adjustment and readjustment. With each change comes the need for recognition, time to grieve, and a period of reorientation. (Which can be difficult to achieve when one change follows on the heels of another.)

In her excellent and now classic book, Heartmates: A Survival Guide for the Spouse & Family of the Heart Patient, Rachael Freed, (formerly Rhoda Levin), suggests writing down an assessment of the changes experienced by carepartners, saying that it will help to clarify our thinking and validate our emotional responses. She offers a number of specific changes within several categories to guide our assessment:

Sleep

Quantity

Quality

Disturbances

Dreams and nightmares

Frequency of naps

Food

Level of Appetite

Time spent shopping

Time spent preparing food

Frequency of eating out

Primary foods

Priority of food and its preparation in your life

Exercise

Type

Frequency

Quantity

Strenuousness

Regularity

Differences between you and your partner

Work/Career

Degree of involvement

Schedule and hours

Level of satisfaction

Quality of work

Leisure Activities

Types of involvement

Schedule and hours

Level of satisfaction

Quality of work

Financial Responsibilities

Providing income

Budgeting

Allocating funds

Handling banking

Friends & Social Activities

Frequency

Quality of time spent

Level of satisfaction

Initiating activity

And these are just the day-to-day changes. There are also all the life alterations wrought by taking on complex medical tasks at home and managing all the shifts in roles and family dynamics as we accommodate the illness.

Freed goes on to suggest that an objective look at these changes empowers us, allowing us the choice of initiating further change in areas where we are dissatisfied. For example, if we have let a supportive friendship slip, we can plan to invite that person over or have a visit out.

She also reminds us that not all imposed changes are negative. There are positive alterations to diet and exercise, for example, that can benefit both the carepartner and care recipient.

While Heartmates is written specifically for cardiac spouses, I would recommend it to anyone providing care for their life partner. It is clearly written in manageable bites and offers practical, hands-on information for managing life with acute and chronic illness and disability.

The Awesome Gift of Grateful Heart...

2011-05-16T08:49:00.000-07:00

This past week has been one of synchronicity with three seemingly unrelated experiences coming together to remind me that, even in the toughest circumstances, there are gifts and joys for which we can be grateful if only we can keep our minds and hearts open to perceive them.

When we teach ourselves to become more aware of these gifts, we begin to develop an 'attitude of gratitude' that can balance or offset some of the more negative impacts of our caregiving.

The three experiences that reminded me to look for the gifts among the hardships were:

1. Taking two friends to a clinic and doctor's appointment at a large downtown teaching hospital where they would receive some important test results. We were all anxious about the results and about how my friend, who was very ill, would manage getting from the "full" second level underground parking garage to the clinic on the sixth floor without collapsing. (They had applied for, but not yet received, their disabled parking sticker.) As we drove into the garage, we found that the "full" sign had been speaking the truth but, wonder of wonders, just as we rounded a corner to reach the tower entrance, there sat a single empty parking spot right beside the door.

My friends stayed in the car while I went into the hospital to look for a wheelchair (a commodity rarer than gold at 1 pm on a clinic day). And, what were the chances? I stepped into the elevator and met the one care aide who had been assigned to do a wheelchair roundup and who, therefore, had a stash of wheelchairs and, better yet, a key to unlock them! Come with me," she said, with a smile. "I 've just collected a few but they're all locked together." Within minutes, we had loaded my friend into a chair and were on our way to the sixth floor, wondering at our good fortune.

Even though the news we received that day was not the best, we will always be grateful for the not-so-small gifts that helped us along the way.

2. Coming across Sara Ban Breathnach's best seller, Simple Abundance, while culling my office bookshelves. In it was a quotation from Melody Beattie:

Gratitude unlocks the fullness of life. It turns

what we have into enough and more. It turns

denial into acceptance, chaos to order, confusion

to clarity. It can turn a meal into a feast, a house

into a home, a stranger into a friend. Gratitude

makes sense of our past, brings peace for today,

and creates a vision for tomorrow.

It was the quotation that had helped motivate my decision to begin a gratitude journal and finding it again this week served as a reminder to begin the practice again.

3. Discovering Neil Pasricha's website, books and TED Talk on things that are awesome. I don't know where I've been, but I hadn't yet heard of this young man's creative response to the hardships in life.

The son of immigrants from developing countries who had taught him to appreciate the small things we can take for granted, Neil started a website called 1000 Awesome Things during a painful period in his life. He was as surprised as anyone when his readership hit the millions and the book deals started to roll in. The result was two books, The Book of Awesome and The Book of (Even More) Awesome, and a TED Talk, The 3 A's of Awesome.

The books are "awesome" (with the exception of a few pieces of adolescent male humour that could have been excluded) and the talk is genuine and heartfelt with the reminders that if we live life with the attitude that we can grieve then face the future in baby steps, with the awareness of a 3 year old seeing life for the first time, and with the authenticity of our true selves, we will be much happier human beings.

So, this week has re-taught me the importance of focusing on the joys and gifts of life (especially the tiny ones) - not to the exclusion of the pain (because that doesn't work), but in an effort to provide more balance and comfort to our caregiving days.

Blessing of the Hands ...

2011-05-04T13:16:00.000-07:00

May 9th is the beginning of National Nurses Week in Canada. Across the continent, as part of their annual celebrations, many nurses will be experiencing the acknowledgement, affirmation, empowerment and appreciation that come through a ritual called the Blessing of the Hands.

John O'Donohue, author of To Bless the Space Between Us: A Book of Blessings, defines a blessing as a circle of light drawn around a person to protect, heal, and strengthen. In this case, nurses' hands are blessed as a symbol of healing, wellness and strength.

Blessing of the Hands is offered in different ways in different settings, often by the chaplaincy department within the organization, and it is received within the context of each person's faith tradition. In Australia, a dean of nursing joins instructors in blessing the hands of students; in Cape Coral, Florida the hospital chaplain anoints each nurse's hands, palms up, with oil; and at Johns Hopkins Medical Centre hands are ritually washed before anointing with scented oil.

Whatever the actual ceremony, the ritual is brief, lasting only a moment or two, and the service is interfaith with all traditions welcome. In many cases, the blessings are individualized to recognize the specific work done by the hands in each area.

These blessings may be greeted with skepticism or discomfort the first time offered, but staff are generally so touched by observing or participating in the experience that numbers tend to rise exponentially in the following years. Some organizations, recognizing that not everyone can leave a unit to attend a service, now send teams around to each ward, unit and clinic where all who wish a blessing are included.

While I am no longer a practicing nurse, I was moved to the point of tears when I first heard of this blessing ritual. Many others find it to be "the best part of Nurses Week". I hope that many of you will have the opportunity, this year, to receive the healing, affirmation and renewal that are at the heart of this blessing experience.

I'll leave you, today, with the words of Blessing of the Hands adapted from Diann Neu's writings in Waterwheel, Winter, 1989:

Blessed be these hands that have touched life and felt pain.

Blessed be these hands that have embraced others with compassion

Blessed be these hands that have been clenched in anger.

Blessed be these hands that have withdrawn in fear.

Blessed be these hands that have given and taken away.

Blessed be these hands that have assisted those in need.

Blessed be these hands that have anointed the sick and suffering.

Blessed be these hands that have comforted the dying.

Blessed be these hands that have prepared the dead.

Blessed be these hands that may grow stiff with age.

Blessed be these hands, for they are the hands of the Holy One.

Pastoral Care Services

The Johns Hopkins Hospital

A Different Sort of Caregiving ...

2011-04-28T09:40:00.000-07:00

Hi everyone! I hope you've had a restful and restorative Easter weekend. I meant to publish this post on Earth Day, before leaving for Vancouver Island but, in the cognitive neglect that sometimes accompanies human caregiving, I forgot. So, here it is, a little late:

For the past few weeks, I've had the pure pleasure of visiting with my young friend, Alie Ashbury, who works with the Orangutan Foundation International (OFI). (She is here for the opening of the new 3D IMAX film, Born to Be Wild, which features the work of the OFI and the Sheldrick Wildlife Trust.) Through our conversations, I have learned more about a different sort of care-giving - that engaged in by the dedicated folks working in orangutan rescue, rehabilitation and conservation.

Through Alie's stories, I have learned about mother orangutans on the move due to the deforestation of their natural habitat in favour of palm oil plantations. I have heard of these mothers being killed as they've wandered onto railway tracks or into villages in search of food. I have seen, through Alie's eyes, intelligent, sensitive creatures being hunted for food, poached, or killed by palm oil plantation workers who see them as pests or threats to their daily crop yield.

Regardless the source of their destruction, these mothers leave behind grieving babies, defenceless and unable to care for themselves. Those fortunate enough to be found and rescued by OFI can arrive at the Center "completely traumatized", mothers dead and suffering medical problems but unable to say where it hurts.

The tears in Alie's eyes and voice as she tells these stories are an indication of the emotional impact of caring for these human-like babies and they underline the words of Jon R Conte, PhD in his introduction to Laura van Dernoot Lipsky's Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others -

In the same way that oils splatter on the painter's shirt and

dirt gets under the gardener's nails,

trauma work has an impact.

This secondary trauma effect, often felt by people working with traumatized humans, is also felt by those working in the animal world and for the sake of the planet.

And our response to this effect needs to be the same whether we are working to support people, animals or the environment. We all need to practice exquisite self care and to heal our primary trauma (our own emotional wounds) which can cause us to over-identify with and feel overly responsible for those for whom we care. When we heal our wounds, we can discover the truth in Laura Lipsky's words:

If we can transform ourselves,

we can transform the world.

Photo of Mr Bernie by Alie Ashbury.

Walking the Labyrinth ...

2011-04-11T08:25:00.000-07:00

It has been a while since my last post because I have been helping two dear friends navigate another health crisis in what has been a two year journey of health crises. This last experience has been especially stressful for all of us and we have each needed to draw deeply upon our well of resources to deal with the stress.

One of the resources that was of great help in reducing my own anxiety over the past two weeks was the labyrinth. I have walked the labyrinth in a number of different settings over the years but this is the first time that I have been intentional about using it as a regular calming practice. And I'm happy to say how well it worked!

Walking the labyrinth is a form of walking meditation with its roots in spiritual tradition more than 3000 years old. Evidence of its use has been found in pre-Christian Knossos and Egypt and later, in many of the cathedrals of Europe. The best known labyrinth is that on the floor of the nave of Chartres Cathedral in France, built in the early 13th century.

In the past decade, labyrinths have seen a revival as tools for wellness and their patterns have been placed in hospitals, schools, churches, retreat centers and community parks. The Central Park labyrinth in Burlington, Ontario is the first permanent wheelchair accessible labyrinth in Canada.

The Symbol

The symbol, itself, is a single pathway with switchback turns leading from the outer edge of the circle to the center, and back again. The circular pattern is thought to symbolize healing and wholeness, and the pathway, the inward journey.

How it Helps

Like other forms of walking meditation studied by Harvard Medical School's Mind-Body Institute, walking the labyrinth is thought to reduce anxiety through stimulating our body's relaxation response and, when used as a regular practice, to reduce insomnia, chronic pain, and high blood pressure and to improve concentration.

Walking the labyrinth is an intuitive, right-brain activity that calms and balances - as opposed to a maze, with its many entrances and dead ends, that tends to engage the left brain with problem-solving rather than calming.

The act of walking a complicated, attention demanding pathway focuses our minds. Other thoughts become less intrusive though, as with other forms of meditation, this does not happen automatically and we need to gently and non-judgementally let go of the thoughts that come and return our attention to the walking.

Three Approaches to the Walk

There is no "right" way to walk a labyrinth. The journey is deeply personal. Below are three possibilities:

1. Simply quietening and opening yourself to your own experience.

2. Considering a question. Concentrating on the question as you enter the labyrinth and letting everything else go as you walk. Opening your heart and mind to new information and insights regarding the question.

3. Focusing on letting go of things you want to leave behind or on obstacles that need removing from your spiritual path on the way in. Being present to your innermost self and the presence of your Higher Power in the center. Focusing on what you will bring back from the center and into your life on the way back.

How to Walk the Labyrinth

1. Prepare yourself to walk. Take a few moments to quiet yourself and make the transition from your busy day to the meditation time. Remove your watch. Think or journal about your intention. Place your belongings in a safe place so worry about them doesn't distract you. If possible and safe, remove your shoes for the walk. (This is a traditional sign of respect and is necessary when walking on some painted surfaces.)

2. Begin your journey, pausing at the entrance to take a cleansing breath and focus your attention. Some people like to say a prayer or state an intention or ask a question as they begin; others bow or make another personal gesture to mark the beginning of their walk.

3. Walk the path inward. Walk at your own, comfortable, measured pace. Put one foot in front of the other. Become conscious of your breath without controlling it. Pause when you need to. The center is not the goal. Being present to yourself in each moment is what matters. (If you meet someone coming in the opposite direction, step to one side to let them pass. Take your cue from the person passing and from your own feelings regarding whether or not to acknowledge them with a nod or smile, or withhold eye contact and simply to pass by.)

4. Take time at the center - as much as you need. Meditate, journal, be open to the stillness. Respect the boundaries of others who are using the space.

5. Take the return path. Pause when you need to, as before. Resist the temptation to hurry out - the journey out is as important as the journey in.

6. Reflect on the journey. Pause for an ending ritual - a bow, a prayer, a gesture - if you like. Before leaving, take some time to reflect upon or journal about your insights or experience.

** Be prepared for the possibility that, like other forms of meditation or body work, walking the labyrinth can bring to the surface unexpected feelings or memories. Let your emotions and thoughts flow freely and don't be embarrassed. Others are focussed on their own experience.

** If you feel overwhelmed by any of your responses, follow your walk with counselling by a qualified mental health counsellor.

Where Can I Find a Labyrinth?

You can search the internet for sites close to you. Some BC sites include:

- Fleetwood Park, 80th Avenue, Surrey

- St Paul's Anglican Church, Vancouver (West End)

- Pacific Rim National Park

- Sorrento Center, Sorrento

- St Hilda's Anglican Church, Sechelt

- Bethlehem Retreat Center, Nanaimo

- Sendall Gardens, 50th Avenue & 201A Street, Langley

- Sylvan United Church, Mill Bay

- Trinity United Church, Vernon

- Naramata Center, (North of Penticton)

- Lakeside Park, City of Nelson

- Vancouver School of Theology, UBC

And for those who cannot leave home, it is possible to buy a wooden "finger labyrinth" board or to print one from one of the internet labyrinth sites.

May those of you who give it a try, find walking the labyrinth a healing new mindfulness resource.

Quick & Healthy Dinner Preparation ...

2011-03-28T09:17:00.001-07:00

When you spend the day caring for others' needs, it is more than possible to arrive at dinner time exhausted and uninspired. And, if you're like most of us in that situation, you will be strongly tempted to reach for something highly caloric, high fat, highly salted or sugared, refined and fast! And then to regret it until bedtime or beyond.

Caregiving takes a lot of energy and we all need nutritious meals to fuel us as we do our caring work. Here are a few tips for ensuring healthy eating at the end of the day:

1. Cook twice the recipe whenever you make a favourite meal and freeze the leftovers in individual serving bags for another day. Or, alternatively, plan a big cooking day once every couple of weeks and cook several meals at once for stocking the fridge and freezer. (Put a chicken in the crockpot, a roast in the oven, soup or stew on the top of the stove and make a big bowl of quinoa or bean salad and - hey, presto! - meals for the next two weeks. I usually take a 4-5 hour Sunday afternoon to do this kind of cooking and it saves me so much stress during the week.

2. Simplify your meals. Home made soup, salad and a fresh wholewheat bun can make a great dinner. Some of my favourite quick and healthy recipes come from Jules at the Stone Soup website. Here she offers simple, healthy, 5 ingredient recipes that are ready in a flash. She also has a 5 Ingredient cookbook and a virtual cooking school for the less skilled among us.

3. Add your favourite healthy ingredients to a commercially prepared product. For example, add kale and quinoa or pot barley or chopped-up microwaved yam or beets to a healthy canned soup. (Watch the salt content here.)

4. Learn some simple, healthy sauce recipes to dress up leftover meats or pasta. Jaimie Oliver's Basic Tomato Sauce is one of my favourites. It's available in his Jaimie's Dinners cookbook and on the Internet.

5. Ask for help if you are a family caregiver who is too tired to cook. When friends or family ask what they can do to help, ask them to bring a dinner as a once-off or on a regular basis. Be sure to let them know your preferences, dislikes, and any food intolerances or restrictions.

6. Include your family in meal preparation the night before. (You may have a whole house full of little sous chefs!) Get them to chop vegetables, stir pots, wash dishes - whatever is age- appropriate and within their capabilities. You may have to exercise a little patience to begin with, but soon they will become more skilled and they will feel so proud of their newly acquired skills.

If you have any other ideas that work for you, please add them to the list!

Secondary trauma first aid...

2011-03-19T07:30:00.000-07:00

My heart goes out to all people suffering the direct effects of the disasters we are seeing on TV this week.

How much the world can change in just a few days. Even though I was fairly sheltered from newspapers, internet and newscasts while I was away, just the conversations of those around me and my own naturally hypersensitive empathic responses were enough to raise my heart rate, increase my respirations and create a buzz of anxiety. (Witnessing trauma triggers old trauma responses.)

The current disasters, to say nothing of the trauma we encounter in our workplaces and caring situations at home, can combine to cause acute secondary trauma responses in our own lives even though we are not actual survivors of the disasters. What can we do to lessen the effects of the trauma we witness?

Here are a few practical tips:

1. Monitor and limit your trauma exposure through TV, the internet, newspapers, and conversations.

2. If you begin to feel anxious, stop and take a few deep breaths and relax your whole body, particularly your pelvic floor muscles, as you breathe deeply, pause, then slowly release your breath through pursed lips. (If a medical condition contraindicates this type of breathing, please make adjustments to meet your own needs.)

3. Take a walk in the fresh air every day.

4. Talk about your feelings with someone you trust to listen respectfully.

5. Draw deeply upon your spiritual beliefs and practices.

6. Do something to help someone else. It will lessen your feelings of helplessness. For example:

- Pray for them or hold them in your meditation.

- Send a donation to a reliable disaster relief organization.

- Send a note of support to someone who is directly affected by the disaster.

- Help someone in your family or neighbourhood - drive someone to a doctor's appointment, visit someone who is shut in, do someone's grocery shopping, spring clean someone's garden, do a new mom's laundry, buy some flowers for a friend who's struggling ...

7. Be close to the people who love and support you - either in person or by email, Skype/iChat or phone.

8. Ramp up your usual self care practices - trust the strategies that have worked in the past.

9. If none of these things help, consider seeing a counsellor who specializes in trauma work. There are a number of short term interventions that could be very helpful in reducing your stress.

Vacation ...

2011-03-07T06:46:00.000-08:00

Hi everyone! Just a note to say that I will be off to Vancouver Island in the early hours of tomorrow morning to spend Spring Break with family and friends. (So, I won't be posting here again until after March 17.)

I've written, before, about how important it is for helpers to take breaks before we need them, so this week I'm taking my own advice and having a brief foretaste of what will be a longer vacation in the summer.

As someone who is self employed, I'm always surprised when salaried folks don't take their full allotment of paid vacation. (As a family caregiver, I was even more amazed!) We need these regular breaks from our caring work or we soon find that the well is empty and we have nothing left to give.

Dr David Posen offers some sage advice about taking time off in his book, The Little Book of Stress Relief:

1. Plan to take all the vacation time your employer allows. If you're self-employed, give yourself at least two to three breaks a year.

2. Spread your vacation time over the year. As soon as you return from a holiday, plan the next one.

3. Organize your work so other people can cover for you while you're away.

4. Don't take work-related material with you. This includes professional reading, laptops and cell phones. If you feel naked without that stuff, it's a chance to break your dependency - an added benefit!

5. Don't call the office and don't tell them where they can reach you. Make it a clean break.

6. Plan a light first day back to work (for catch-up and readjustment).

Now, if you're a family caregiver, some of this may not be possible. But, with some planning, most of us can get away for at least a short period. The problem is that we often wait until we're so depleted that the mere thought of making all those arrangements is more than we can handle. If this is the case for you, ask for help. Ask someone who knows your situation well to help you plan some time away. Ask them to do internet searches for locations, to make phone calls, to arrange a list of surrogate carers, to help you write down all the things that need to be done for your care recipient while you are away.

It may seem a lot to ask of someone, but the truth is that people who care about us want to help and are just looking for opportunities to be able to do something concrete. The first time I went away while caring for my husband, I called everyone I knew who was qualified to help care for him and I actually had people crying on the phone because they were so grateful to be able to do something for us.

So, again, get away before you need to and ask for the help you need to make it happen. (You'll always be ambivalent about going, especially if your loved one objects, but you'll come home refreshed and energized and full of stories that will expand and brighten your loved one's world as well.)

And, if it is truly not possible to leave right now, find a way to take small "vacations" during the day. Set the timer on the stove to remind you to go out and sit on the front steps for five minutes, three times a day. Take some slow deep breaths, notice the warmth of the sun on your face, the shape of the clouds, the sound of the rain on the path, the swelling of the buds in the garden with their promise of hope and renewal.

Survival Tips for CF Partners...

2011-03-06T15:14:00.000-08:00

When a traumatic event occurs, the trauma survivor feels the first impact then a ripple of secondary trauma spreads out to affect his or her family and friends. That ripple then travels on to touch the helpers who have responded to the survivor's pain and on to their families and friends. And thus, trauma becomes the gift that keeps on giving.

This week, I have been asked by three different CF spouses, - two clergy spouses and one partner of a paediatrician - about ways of dealing with the impact their partners' compassion fatigue. To my knowledge, there's not been any research done in this area yet - so I spent some time thinking about my experience of my own husband's CF and that of former clients who had had compassion fatigued partners. I also looked at the literature on spouses of persons with depression, chemical dependency and primary posttraumatic stress. From these sources I've drawn together a list of possible "survival tips", some of which could be helpful to you or your partner:

* Educate yourself regarding your spouse's CF. Remember that your partner's CF is not your fault - you didn't cause it, you can't control it and you can't cure it.

* Consider your own trauma history. It is natural to experience a full range of emotions regarding your partner's CF symptoms. However, if you think you are over-reacting emotionally, if you find yourself medicating your emotions, or if you are tolerating verbal or physical assaults or emotional neglect, these may be signs that the current situation is stimulating old trauma. If you have not yet dealt with your personal trauma history, consider seeing a qualified mental health professional in order to understand and resolve your trauma.

* Recognize symptoms of CF (nightmares, flashbacks, irritability, nervousness, sleep disturbance, worry over threats, avoidance of trauma triggers, withdrawal). Ask your spouse how you can best support him or her when the symptoms are activated.

* Plan activities to help the family relax and have fun together.

* Make time for self care. You will probably have to carve out time by giving up something else but you will find it's worth the effort and the loss of whatever you have to put aside.

* Build a support network of family, friends, co-workers, faith community etc for emotional support and occasional help with routine tasks or child care. Teach them about CF.

* Encourage your partner to see a CF or trauma specialist early in the CF trajectory - before CF interferes with daily activities. (Know that it might take several attempts to find the right treatment mode and therapist).

* Take a pre-agreed upon time out when your partner is angry.

* If necessary, have an escape plan to keep you and your children safe.

* Find a family therapist if your family finds it hard to talk to each other.

* Be clear when communicating changes you want your spouse to make. He or she cannot read your mind.

eg - Cutting down drinking or other drug use to x amount

- Total abstinence

- Caring for the children x hours per week so you have time for yourself

- Being less irritable and showing more interest in the children

- Bringing in a reliable income, no matter how small

- Scheduling and showing up for date nights

- No physical acting out

* Recognize that you have options. Almost everyone has options. If we don't recognize them, we may begin to feel trapped, which can lead to emotional numbing, depression, self medicating, paralysis, despair or even suicidal thoughts. If you can't see any options, see mental health professional who can help you to expand your constricted world view.

* Consider asking a CF specialist to facilitate a support or psychoeducational group for CF partners.

These are just a few ideas. Please add to the list if you know of anything else that might be helpful.

1st Compassion Fatigue Conference ...

2011-02-28T10:42:00.000-08:00

Hi everyone! Just a note to make sure that you are all aware of the first Compassion Fatigue Conference which will be held at the Ambassador Conference Center in Kingston, Ontario on June 15-16, 2011.

The conference has been organized by my colleague and friend, Francoise Mathieu whose educational events are always stimulating and very well organized. There will be a number of excellent speakers including Laura van Dernoot Lipsky, the author of Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, plus many opportunities to network.

I am looking forward to being in Kingston, both for the conference itself, and for the opportunity to visit with dear friends in one of my favourite towns. It would be lovely to meet some of you there.

For more information or to register:

First Compassion Fatigue Conference

Photo of Kingston, ON by Bigstock Photos

Shame and Compassion Fatigue ...

2011-02-25T07:41:00.000-08:00

Shame is an experience that has no redeeming features. It is always negative and wounding.

Shame differs from guilt. It is the sense that we are inherently flawed - that we are bad vs having done something bad. It is a feeling that makes us want to hide our real selves for fear that those around us will find us unlovable and abandon us should they discover what we are really like.

So, what does shame have to do with Compassion Fatigue? I've been thinking about that question all week and have come to the hypothesis that shame may be a major factor in maintaining CF.

The impact of shame appears at several points in the CF trajectory:

1. Early on, shame may have helped to motivate our choice of a helping career. For example, if we were shamed in a healthcare or crisis setting while young, we might, consciously or unconsciously, have become drawn to rescuing people in similar situations. If we were shamed for our dependence or weakness as children, we may have chosen work where we could experience a sense of independence, power and control.

2. Later, as we encountered traumatic events and accumulated losses in our work, shame may have kept us from sharing with colleagues our natural human responses to terrible situations. We may have come to believe that one has to appear strong and invulnerable in order to be accepted.

3. As we began to develop symptoms of CF, we may have felt that we couldn't tell anyone about those symptoms or ask for help for fear of being ridiculed or found lacking.

4. As our symptoms increased, we may have begun to realize that we could no longer care for others in the ways that we had in the past. Our capacity for empathy had disappeared. The identity that we had built as particularly caring, compassionate people had crumbled and we may have felt profound shame about no longer being the people we were "supposed to be". Judging ourselves harshly, we may have withdrawn from the very people who could have supported us.

And, thus, shame undergirds and maintains the experience of CF.

The way that most of us deal with shame is to avoid being vulnerable, as you can see above. In our North American culture, any kind of vulnerability is judged as weakness and a potential source of shame. We generally feel much safer when our vulnerability is masked by our "strength" and protected by the armour plating of perfectionism, distancing, and emotional numbing.

However, this kind of protection comes at a cost. We can lose spontaneous expression our real selves, our connection to others and our ability to tap into the strength and support of our spiritual lives. We become lonely, isolated, and empty. And we numb that pain with busyness, workaholism, and the compulsive use of alcohol and other drugs, gambling, spending, sex, exercise, and food.

So, what can we do to increase our tolerance for vulnerability and thus reduce our shame? Social Work researcher and author, Brene Brown, suggests that we can embrace our vulnerability by:

1. Practicing authenticity, courage, connection and compassion

2. Practicing gratitude

3. Honouring the ordinary in our lives rather than the extraordinary - eg nature, children, play, community

4. Allowing joy and love to enter our lives so our reservoirs will be full when bad experiences come our way.

If you would like to learn more about the impact of shame in our lives and how to build shame resilience, there are several good books on the topic:

1. I Thought It Was Just Me by Brene Brown

2. The Gifts of Imperfection by Brene Brown

3. Shame and Guilt: The Masters of Disguise by Jane Middelton-Moz

4. Facing Shame: Families in Recovery by Merle Fossum & Marilyn Mason

5. Shame: The Power of Caring (Revised Edition) by Gershen Kaufman

And if anyone has thoughts about these ideas, please feel free to comment.

Photo by Bigstock Photos

Financial Strain on Family Caregivers ...

2011-02-15T12:23:00.000-08:00

A new poll published by the Canadian Cancer Society this month says that 88% of the 2,231 polled thought that providing care or assistance for a family member would have a negative impact on their financial situation. 57% said that it would have a major impact.

Those of us who have lived the experience might be excused for giving a hollow laugh. Could anything be more self evident? Between lost income, depleted savings, extra expenses not covered by the basic medical plan and money spent on counsellors and respite care in order to stay sane while caregiving, many families will never recuperate their financial losses. This is particularly true of families who face a lifetime of caring for an seriously ill or injured child.

Few of us would give up the opportunity to care for an ill or disabled loved one, but many would be grateful for some compensation for our losses. Family caregivers save our governments millions of healthcare dollars annually at great cost to themselves and their families. According to Statistics Canada, in 2009, the economic contribution of family caregivers in Canada was estimated to be between $25-26 billion and 65% of households with a caregiver report a combined income of less than $45,ooo. (23% reported less than $20,000!).

With an aging population and a federal election in the offing, it behooves each of us to ask pointed questions of our political parties regarding how they would increase government financial support for family caregivers.

The Cancer Society, like many advocacy organizations, has been pushing for better financial support through the federal Compassionate Care Benefit, asking for improvements including:

* Increasing the benefit period from the current 6 weeks to 26 weeks, accessible during a 52 week period.

* Increasing flexibility through allowing benefit claims for partial weeks taken over a longer period rather than blocks of weeks at a time.

* Changing the wording of the eligibility criteria from "significant risk of death" to "significant need of caregiving due to a life threatening illness".

* Amending the Canadian Labour Code to protect the jobs of caregivers.

Special provision also needs to be made for increasing support to family caregivers who are self-employed. Benefits attached to tax credits are of little use to someone who can no longer earn an income due to their caregiving.

It is said that societies are judged by the degree to which they support their most vulnerable. Most family caregivers provide generous and unstinting care for their loved ones. Can we do any less for them?

Please take a moment to call or email your local MP's office to register your concern for family caregivers and to ask what his or her party plans to do, specifically, to support them.

Photo by Bigstock Photos

A Great Nutrition Resource ...

2011-02-11T08:02:00.000-08:00

Last Saturday, I went with my sister and her freezing cold grandson, (what is it about preteen boys and their aversion to coats??), to my first Winter Farmer's Market of the season. Up to this point I'd been eating the fruits of the autumn harvest from my own garden but pickings were getting slim so off to the Market I went with family and half a dozen cloth Market bags.

I came home with red kabosha squash, onions, potatoes, kale, carrots, apples and portabella mushrooms and, inspired by the sight and smell of all those wonderful fruits and vegetables, I've taken the time to cook and eat very well this week. (And when I eat well, I have more energy to put into my exercise routine so I've also enjoyed two yoga sessions and great daily walks at the Lake in the spring sunshine.)

There's no question that a healthy diet and good exercise are at the foundation of good physical and mental health, (to say nothing of being an important part of initial recovery from compassion fatigue), but amid all the marketing hype, how can we be sure that we're making the best nutrition choices?

One great resource I like to use as a guide is the Canadian Nutrition Action Healthletter

published by the Center for Science in the Public Interest. The Center is an independent non-profit consumer health group that advocates honest food labeling and advertising, safer and more nutritious foods, and pro-health alcohol policies. They accept no government or industry funding and are thus able to critique food products and policies honestly.

The Healthletter, which is celebrating it's 40th anniversary this issue, is a colourful, sixteen page magazine that arrives in my mailbox ten times a year full of good nutrition research, Canadian name-brand product evaluation, recipes and tips for healthy eating. It is a quick read and provides huge bang for the buck.

Some of this month's articles include:

* Unexpected: Surprise (Nutrition Research) Findings From the Last 40 Years

* Magnesium & Sudden Death

* Don't Just Walk

* Beyond Bread: Think Thin (Brand-Name Ratings of Thins, English Muffins, Bagels etc)

* Under Wraps: Healthy Fillings for Sandwiches

* Artery Crusts: An Evaluation of Brand-Name Pie Crusts

If you are interested in creating a healthier life style, why not take a look and see if the Healthletter might provide the information and motivation to help you on your way?

A New Project ...

2011-02-04T12:04:00.000-08:00

I'm delighted to have been asked to participate in a new project of Pacific Lutheran University's MediaLab . This award-winning group, based in Washington State, is producing a full length documentary on Compassion Fatigue which is due to premiere in the fall of 2011.

The new film is designed to give a broad look at how first responders, other front line workers, volunteers, family caregivers, and even those who support disaster response organizations financially can become overwhelmed and rendered impotent by their knowledge of others' suffering. It will define CF, discuss it's effects on helpers and their families, and explore strategies for prevention, recovery and resilience.

We are fortunate to have such a skilled group of students taking on the task of raising public awareness regarding compassion fatigue. It will also be wonderful to have this new film as another tool in our CF toolkits.

Other films by the MediaLab group include "Illicit Exchanges", a documentary about the influence of drugs and guns in North America and "Point of Entry", a film which explored immigration in the US and Canada. These films have won numerous national awards including college division Emmy nominations.

86 Self Care Ideas...

2011-02-02T19:11:00.000-08:00

Here are the top self care ideas from a great group of 60 social workers, mental health professionals and family caregiver supporters at today's Compassion Fatigue workshop.

1. Working out at the gym

2. Running with the dog

3. Cooking tasty, healthy food

4. Aromatherapy

5. Small gestures of giving to others

6. Doing nothing

7. Silence

8. Yoga

9. Singing

10. Massage

11. Listening to, and playing music

12. Watching a feel-good movie

13. Morning meditation

14. A bath with candles and music

15. Being in a library

16. Buy yourself flowers

17. Window shopping

18. Gardening

19. Playing

20. Spending time outdoors

21. Journal writing

22. Reading a good book

23. Accepting and honouring your feelings

24. Knitting and crocheting

25. Enjoying your first sip of morning coffee or tea

26. Chatting with a friend

27. Cleaning house

28. Baking

29. Aerobic exercise - biking, cross country skiing, swimming

30. Staying calm

31. Sitting by the fire

32. Living with intention

33. Good dental hygiene

34. Regular health checkups

35. Gratitude journal

36. Last thing at night - identifying the nicest thing that's happened that day

37. Leaving the computer off

38. Avoiding the newscast

39. Laughing and having fun

40. Inspirational reading

41. Being mindfully aware/in the moment

42. Regular meditation

43. Connect with your spiritual side

44. Dancing

45. Craft work

46. Create a support network

47. Eat cookies

48. Prayer

49. Storytelling

50. Travelling and planning it before hand

51. Purposefully doing superficial things

52. Stand-up comedy, sharing a joke

53. Quilting

54. Grouse Grind

55. Candlelight

56. Cooking when not under pressure

57. Being alone and contemplative

58. Going for a sauna

59. Pedicure/manicure

60. Sex

61. Having a facial

62. Debriefing with colleagues

63. Validating yourself to yourself and to colleagues

64. Attending workshops

65. Staying in your dressing gown all am when on a day off

66. Dancing in my kitchen

67. Buying only good wine

68. Long walks on the beach

69. Hikes in the woods with the dog

70. Making photocards

71. Kayaking and sailing

72. Playing a musical instrument

73. Landscaping

74. Sleeping in

75. Pet's unconditional love

76. Driving and road trips

77. Walking to and from work

78. Sitting in a sidewalk cafe, drinking a latte

79. Pausing to breathe

80. Time with your grandchildren

81. Stomping in rain puddles or piles of leaves

82. Validating your colleagues

83. Walking in the grass in bare feet

84. Looking at clouds

85. Letting the warmth of the sun soak into your back or your face

86. Eating chocolate

Resource for Kids...

2011-01-26T09:15:00.000-08:00

Serious compassion fatigue, like other forms of posttraumatic stress and burnout, has a ripple effect on the sufferer's circle of family and friends. Some children are particularly sensitive to this CF fallout.

PTS specialist, Aphrodite Matsakis, (1996), describes the impact this way:

"... the major problems experienced by children in homes

afflicted by PTSD are emotional. If ... PTSD expresses itself

in irritability, outbursts of temper, frequent flashbacks or erratic

behaviour, the children are often frightened and anxious,

not knowing what to expect next."

Children can also grieve as the result of a CF parent's distancing and emotional numbing.

And, while many spouses of compassion fatigued helpers are highly effective parents, some say that they can become so focused upon, and depleted by, their partner's pain that they are less emotionally available to their children than they would like to be.

A result of this stress and distress is that children may cope by suppressing their own feelings, believing that no one will listen or that their emotional responses will make things worse.

One way to counter this kind of reaction is to provide children with information about their feelings and about their wider safety net of helpers. There have been several good children's books written about feelings over the years, but this week I came across a great British website designed for children aged 7 - 10.

The website, www.camsden.co.uk, was set up by Tavistock & Portman NHS Foundation Trust, a mental health trust based in Camden, North London. Here, Cam and his team of sock puppet friends, each named for a different feeling - Happy, Sad, Calm, Confused, Angry, & Sad -, read stories and talk about feelings, learn a feelings song, explore common emotion-laden problems and learn to make their own sock puppet with whom they can share their feelings.

While not specifically focused upon CF or PTS affected families, Cam's Den leaves children with the message that there is always someone available to listen and to help with difficult feelings and problems. (In this case, the NHS mental health clinics, so parents here would have to provide alternate information for their area or country.)

There is also a section for parents, explaining how to recognize emotional problems in their children and when to seek help.

Annabel Venning, a journalist who reviewed the site for one of the British newspapers, reported that her children, aged seven and five, "... were immediately captivated by the puppets while the stories were a great springboard for discussion. After one, about a new girl who is ostracised at school, both vowed to make sure that no one got left out at playtime in the future."

Why not take a look and see if it would be helpful for your kids?

A Problem of Privacy ...

2011-01-17T09:15:00.000-08:00

Have you ever been frustrated by your inability to give (as a helping professional) or receive (as a family caregiver) patient information needed to enhance family caregiving? It is becoming a more frequent problem as family caregivers are asked to take on more responsibility for ill or disabled loved ones at home.

In a 2010 Nursing Ethics article entitled, Information Disclosure to Family Caregivers: Applying Thiroux's Framework, John Rowe of Open University, UK, makes an arguement for " ... seeking a re-balance so that more consideration is given to the rights of caregivers as they are faced with taxing responsibilities". He does not advocate giving open access to patient information but does suggest that we begin to see "the patient" as the family unit and provide family caregivers with information that will directly affect their lives.

Mr Rowe describes the information-sharing problem thus:

Willingness to share information is central to an effective relationship between practitioners and family caregivers. Active and informed involvement of family caregivers can be vital to recovery, even where there is conflict between the needs and wishes of service users and those of their caregivers. For example, a service user's care plan may stipulate attendance at a day centre to take part in occupational or recreational activities and foster community participation. The caregiver is often required to urge attendance, especially when the service user lacks drive and motivation, and believes that he or she already engages in purposeful activities outside the social care system. The caregiver may use this "free" time to shop or see friends and so gain a secondary benefit from the service user's attendance at the day centre. At a day centre review meeting in the absence of the caregiver, the service user's wish to stop attending may be agreed. In this situation the desires and wishes of the service user and those of the caregiver are in conflict.

In the circumstances given above it is central to the service user's recovery plan to attend a day centre, but the service user would not do so without the active urging of the caregiver. The caregiver therefore has a pivotal role in the service user's recovery, but not it seems in the decision-making process. Rethink, a mental health charity and campaigning organization, reported that many practitioners use the principle of confidentiality to block sharing of information, thereby excluding caregivers from care planning and other discussions, with the relationship between caregivers and professionals being the actual root of the problem.

Many caregivers subsequently feel unsupported and excluded from decision making. "Confidentiality smokescreens" thus make things worse: practitioners find it easier and safer to say nothing, and do not take into account caregivers' rights to basic information to enable them to fulfill their caring role. This makes matters worse for caregivers because they are prevented from understanding mental health issues and how to deal with the challenges they encounter and, frequently, service users also suffer.

After using Thiroux's Ethical Framework to provide guidance for practitioners facing these confidentiality problems, Mr Rowe concludes with these words:

An ethical case for disclosure would have to include the nurse as part of the relationship triangle, with the nurse committed to engagement while seeking what is a good outcome. This draws into question the role of the nurse: whether the nurse is for the service user, or for the care context as a whole, with the context including all the major players in practice situations. This latter approach would contradict the accumulated legal and professional rules that still focus heavily on respecting patient autonomy and the rights

of confidentiality.

There needs to be a reappraisal of the rights to confidentiality in situations where one person's rights are supported and upheld at the expense of the rights of others, especially for those who provide significant support to enable a cared for person to have a better life.

Better guidance on when to breach confidentiality that recognizes the level of dependency and the relationship between caregivers and service users is needed. This guidance should acknowledge the ethical imperatives for a specific course of action, taking into account what is good in any particular situation to complement guidance on what is bound by law, professional codes and health care obligations. Nurses should be guided to look for what matters, not what is prescribed.

That helping professionals are looking into the impact of withheld information upon the stress level of family caregivers is encouraging and may contribute to a lessening of vulnerability to compassion fatigue in both groups - by reducing moral distress on the part of helping professionals and by lessening the experience of helplessness in family caregivers.

A Happy and Hope-filled New Year ...

2011-01-06T14:08:00.000-08:00

There is no medicine like hope,

no incentive so great,

no tonic so powerful

as expectation of

something tomorrow.

Orison Swett Marden

A Happy and Hope-filled New Year to each one of you who supports or cares for others, be they patients, clients or loved ones.

Hope is one of the great gifts of a new year. The unwritten days spread out before us - wide open, filled with opportunities and possibilities.

Sadly, the stress of caring for others can diminish hope in many helping professionals and family caregivers. In a 1999 article published by "Health Care for the Homeless Clinicians Network", called Coping With Stress: Creating and Maintaining Hope, ten clinicians working with the homeless from different parts of the US were asked what internal and external sources of hope and inspiration gave their work meaning and how they sustain and renew hope in themselves and others. Here are a few of their answers:

Sources of Hope:

1. Self Knowledge: Knowing, trusting and depending upon your personal strengths.

2. Belief Systems:

- Religious - belief in doing the work through, and sustained by, a Higher Power.

- Philosophical - belief in a philosophy of compassion or The Golden Rule.

- Theoretical - belief in a solution-based, harm reduction model of care.

3. Care Recipients:

The inspiration that comes from the recipient's resilience, creative responses to challenges and appreciation of even the most minimal help.

4. Colleagues:

Colleagues' commitment, empathy, support and lack of condemnation.

5. Mentors & Role Models:

Both the desire to model the values of a beloved mentor and the hope to be a good mentor oneself.

6. Family History:

Working to help people overcome challenges experienced by our own families.

Sustaining & Renewing Hope:

1. Balancing work with personal time:

- "You can't give all the time and stay emotionally healthy."

- "You need time with younger people. They're the ones who renew my hope."

2. Seeking a broader perspective:

- Learning new things, trying new aspects of the work.

- Connecting with others doing similar work at a regional or national level.

- Travelling to other areas to see how they are approaching the work.

3. Taking time out to reduce stress:

- Exercising 30 minutes / day at something you really enjoy.

- Daily meditation or centering prayer, often during your mid-day break.

- Spending time in nature and noticing the endless hope & renewal of the seasons.

4. Having faith that you are making a difference:

- Becoming more philosophical about the work. Taking sustenance from beliefs like the old Chinese proverb that says, "A drop of water, very small and very soft, falling in the same place can make a hole in a rock that is very large and very hard." Or like Mother Theresa's belief that, "God has not called me to be succsessful. He has called me to be faithful." Or like the guidance at the core of Niebuhr's Serenity Prayer - to change what you can, to let go of what you can't, and to be wise enough to know the difference.

5. Focusing on the "small" positives:

- Listening with respect, touching the "untouchable", offering the basics of warmth, presence, focused attention.

- Celebrating and highlighting the baby steps forward with affirmations and creative rituals.

6. Reading inspirational materials:

- Pieces like Desiderata, Native American Prayer, or Water Balloon Fight or stories from your own favourite inspirational writers.

Now, for those of you family caregivers who face new losses every day, the notion of hope can be a distant and painful one at best. For you, I share again what I learned through years of caring for my husband - that the way to maintain the experience of hope, with its sense of destination and its fuel for continuing the journey, is to be willing to change what it is that we hope for.

With each loss we must grieve then reorient ourselves to a new, and often smaller hope - one more remission, one more vacation, one more Christmas dinner, one more night without pain. This can seem a poor substitute for the kind of hope we used to experience but it is still hope and it will carry us through the tough times much better than having no hope at all.

So, for all of you, may 2011 be a year of hope with all the strength and energy that hope can provide.

Holiday Greetings ...

2010-12-13T08:50:00.000-08:00

I am, like many of the rest of you, up to my ears in holiday preparations. The tree is up, likewise the Dickens Christmas Village. My favourite carols fill the air. I have thought about doing some baking, but that's about as far as that's gone!

Next week, I will make my annual trip to Nanaimo, on Vancouver Island, with my car filled with gifts for family and friends and my heart filled with the anticipation of happy hours spent in the warm love and laughter of dear ones. I will be away until December 28th so won't be posting again until the New Year.

In the meantime, I wish you the blessings of peace, joy, healing and comfort this holiday season and leave you with these words from Grace Cathedral, San Francisco, found in this year's Callanish Society Christmas card:

We give thanks for places of simplicity and peace.

May we find such places in ourselves.

We give thanks for places of freedom and beauty.

May we find such places in ourselves.

We give thanks for places of refuge and love.

May we find such places in ourselves.

May we begin to mend the outer world

According to the truth of our inner life.

Self Care Books for the Holidays ...

2010-12-05T15:17:00.000-08:00

Yesterday morning, I spent a few hours looking through books at a friend's bookshop in Vancouver. I was looking for Christmas presents and for some new books that I could recommend to you in today's blog post - and I have to say, I struck it rich. Here are three of the books that topped my list:

1. A Life of Being, Having, and Doing Enough by Wayne Muller (2010)

In this sequel to Sabbath: Finding Rest, Renewal & Delight in Our Daily Lives, Wayne Muller, founder of Bread for the Journey, a nonprofit organization that supports community organizing, explores the notion of sufficiency - not "the cramping fear of scarcity, the bloated saturation of over-abundance, but the gentle, effortless release of easy sufficiency".

He addresses the difficulty we have taking a Sabbath, slowing down, or stopping for replenishment and renewal - the difficulty of allowing our work to feel sufficient for the day. He challenges us to listen to our inner thermostats for signs that we have done enough, signs that it is time to take a break or stop altogether.

Wayne, a heart attack survivor who must now live within the limits of his energy, identifies obstacles to living a life of enough - our to-do lists, the fantasy of getting caught up, our inability to slow down or to handle silence and stillness, our harsh self-judgement and our addiction to endless self-improvement and progress.

He also describes the blessings on the road to a life of enough - the ability to see the value in small things, to have mercy upon ourselves, to see the growth that can emerge from loss, to enjoy the benefits of good company, to recognize the sufficiency of presence, and to see the value of bearing witness.

2. In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Peter Levine (2010)

In this book, American medical biophysicist and psychologist, Peter Levine, shares the essence and underpinnings of his life's work - Somatic Experiencing - a type of body psychotherapy used for healing psychological trauma.

In a style that reads like a mystery novel, Peter clearly and descriptively explains that trauma resides in the "unspoken voices" of our bodies. Using animal ethology (the study of animals in their natural environments), brain research, native healing practices and his lengthy clinical experience, he shows how traumatic experiences result in psychological injuries that can be transformed by paying attention to the natural healing processes deep within our bodies.

In chapters entitled, The Power of an Unspoken Voice, The Changing Face of Trauma, Immobilized by Fear: Lessons Learned from Animals, From Paralysis to Transformation, A Map for Therapy, The Body as Storyteller, and Body, Emotion & Spirituality: Restoring Goodness, Peter leads us through a body-based healing process that acknowledges our frozen trauma responses and safely paces our developing awareness and mastery of our physical sensations and feelings. He teaches us to self regulate and to allow for the completion of survival responses that were inadvertently cut short at the time of the trauma.

The integration of body psychotherapy and "talk therapy" is the new frontier in trauma work and, in my opinion, there couldn't be a better introduction to it than this visionary book.

3. Haiku Mind: 108 Poems to Create Awareness & Open Your Heart by Patricia Donegan (2008)

Patricia Donegan, poet, translator, and promoter of haiku as an awareness practice, has written this lovely commentary on the haiku of many poets, including herself.

She begins the introduction with a haiku by Shiki Masaoka, -

Cutting a pear

sweet drops drip

from the knife

and says-

I wanted to write this book to share the idea of "haiku mind" -

a simple yet profound way of seeing our everyday world and living our lives

with the awareness of the moment expressed in haiku -

and to therefore hopefully inspire others to live with more

clarity, compassion and peace.

A fine haiku presents a crystalline moment of heightened awareness

in simple imagery ... However, this moment is more than

a reflection of our day-to-day life - it is a deep reminder

for us to pause and to be present to the details of the everyday.

Patricia goes on to share 108 haiku, each with a brief commentary and a short biographical note about the poet who had written it. A lovely read with which to begin or end the day or with which to enjoy a restful cup of tea.

I hope you will enjoy some of these books over the holidays and that you will feel free to add to the list any others you think your fellow caregivers/carepartners might like to read.

Holiday Help for Family Caregivers ...

2010-11-23T08:36:00.000-08:00

Family caregivers spend endless time and energy caring for loved ones who are ill, disabled or frail and are often unable to participate in the usual traditions and activities of the season. Thoughtful assistance and gifts from those who love them can make all the difference to the quality of their holidays.

Here are some ways you can help the family caregivers in your life:

1. Ask what's needed or wanted before you shop, bake or make plans. Every caregiving situation is different and the needs of each caregiver are different as well. I remember receiving several lovely packets of bath salts and oils one Christmas while caring for my husband. They would have been wonderful to use had we had a bathtub!

2. Consider that while the gift of an afternoon's concert, play or special event might be much appreciated, it needs to come with the second gift of someone qualified to stay with the care recipient so the ticket can be used.

3. Gifts of food can bring real relief from the monotony and fatigue of cooking, but remember to ask, first, regarding personal preferences, allergies and dietary restrictions. We frequently passed on to others casseroles whose salt content was too high for my husband to eat. (Including a copy of the recipe can help to reduce anxiety in this regard.)

4. Try to avoid gifts that need assembling, that are outside the caregiver's previous experience or that are very complicated (technological devices with multiple functions) unless the caregiver has asked for it, specifically. (Impaired cognitive function is a hallmark of caregiver stress and most caregivers find it hard enough to remember where they put their keys , let alone how a new device works.)

5. Avoid giving anything that will need special care - this includes anything from a delicate plant to "a nice pet to keep you company". Now is not the time to inadvertently add to the caregiver's burden.

6. Consider safety in all gift giving. eg No glass figurines, knife sets, or barbecue lighters for caregivers of children with aggressive or impulsive behavioural disorders, unless there is safe storage space that is out of sight.

7. Consult with the caregiver before buying gifts of perfume or other scented materials that might aggravate allergies or respiratory conditions. (Their own or that of the care recipient.)

8. Consider gifts of your time and presence - "gift certificates" for mowing the lawn or shovelling the walks on a regular basis or for sitting with the care recipient so the caregiver can get out for errands or respite, or for short biweekly or monthly visits for a chat and support. (But be sure that you can follow through with whatever you promise.)

9. Offer to buy and put up the Christmas tree or other decorations - but be sensitive to the loss involved in changing a holiday tradition. Check at each stage in the process to see if that step is something that the caregiver would rather do alone. Perhaps you could buy and set up the tree and lights and then leave the decorating to them or perhaps they will want you to do the whole job. Just keep asking.

10. Offer transportation to shopping malls or to doctors appointments. Return library books or DVD's.

11. Offer to do the caregiver's holiday shopping or wrapping or to help them to navigate shopping on the internet.

12. Talk about plans for holiday dinners well in advance. But be prepared to change plans at the last moment if the care recipient is ill or the caregiver is too tired. Ask what will make life easiest for the caregiver - to have you make and deliver a meal on plates then leave, to eat altogether at your house or theirs, to have a pot luck or share the cooking, to go out for a meal?

13. If you're "going home for Christmas", ask if it would be easier if you stayed in a nearby hotel.

These are just a few possibilities. Please add your own ideas to the list. The important thing is to be thoughtful, empathic and accepting in the face of the caregiver's stress, indecisiveness and desire to hold on to the things that have meant the most to them.

Remembering ...

2010-11-11T09:07:00.001-08:00

Every year on November 11th, sometimes in clear brilliant sunshine, sometimes in blustering winds and sheets of rain, we gather around cenotaphs across the country to honour and show our gratitude to those who have given their lives or their health for our safety. Those who have come home injured, whether with physical wounds or operational stress injuries, have come back with their lives changed forever and their altered lives alter the lives of all who love them, particularly their family caregivers/ carepartners.

These family caregivers are as affected by their loved ones' injuries as their loved ones are themselves. No area of their lives is untouched. And yet, all too frequently, family caregivers are the unsung heros of our wars and peacekeeping missions. They are the glue holding families together during long or repeated deployments and once their partners are injured, they take on a myriad of additional responsibilities as nurses, rehab specialists, psychotherapists, cheerleaders and advocates. It is through their support and daily efforts that the members of our military have as much as they do, in order to recover.

And yet, this support for recovery comes at a cost. Energy and resources that would otherwise have been spent nurturing the growth and development of family life must be diverted to recovery from injuries and, worse, to fighting a bureaucracy that seems to have little access to common sense, empathy or compassion. Already overwhelmed by the enormity of the task of recovery and adjustment, veterans and their family carepartners can face an unwieldy, inefficient and seemingly uncaring response to even their simplest requests.

This week, however, a wide ranging group of deeply caring Canadians, led by the vision and efforts of people like Allan De Genova, took a giant step toward supporting our wounded veterans and other first responders and their families with the opening of Honour House in New Westminster, BC.

Set on a quiet street not far from the New Westminster Armoury and the beautiful Japanese Gardens where I played as a child, Honour House is a fully accessible residence that will temporarily house up to ten families who must relocate to Greater Vancouver for a loved one's treatment and rehabilitation and who, in the past, would have endured long separations at a time when they needed each other most.

The ability to stay together as a family unit during long months of recovery will make all the difference to the quality of that recovery for the whole family. Hopefully Honour House is just the first of at least ten provincial houses that will support these families who have given so much for us. And, hopefully, the federal government will come to understand the importance of such support and add federal funding to the mix for the houses yet to come.

Cumulative Grief in Healthcare Professionals ...

2010-11-01T07:31:00.000-07:00

Earlier in the fall, I mentioned that I believe there is a missing, or at least underemphasized, component in our consideration of compassion fatigue in health care professionals. That component is cumulative grief.

Most of us are familiar with the Baranowsky-Gentry model of compassion fatigue which states that primary traumatic stress (the trauma that happens to us directly or that we witness directly), secondary traumatic stress (the trauma we experience indirectly through knowing about trauma in others' lives) and burnout (the chronic stress of perceived workplace demands exceeding perceived resources) converge in the life of the helper to cause compassion fatigue, a diminished capacity for or interest in being empathic with another's suffering.

As I have worked with family caregivers, I have modified this model a little to say that primary traumatic stress and secondary traumatic stress, in the presence of burnout and Chronic Sorrow, can lead to compassion fatigue. I have have found this change to be helpful in emphasizing that CF is primarily a trauma issue that occurs in conjunction with burnout - not a form of burnout, itself, - and that the grief of Chronic Sorrow, extending from a loved one's diagnosis until his or her death, may also contribute to family caregivers' vulnerability to CF.

Once I had adjusted my CF thinking to incorporate the Chronic Sorrow of family caregivers, I began to wonder about the cumulative grief of healthcare professionals.

Grief is our normal, hardwired, healing response to loss and it will generally heal itself if we stay out of the way and support rather than blocking the natural process. But what if we work in an environment where loss is the norm? What if we form caring attachments to patients and families over and over again only to have the patients die and the families to move on with their lives? What if we work in environments that do not make time and space available to process our own grief or, worse, those that ridicule and shame such "weakness"?

There is a significant and growing literature base, still at the descriptive stage for the most part, focused on cumulative grief, which is defined as:

... our emotional response to the occurrence of multiple deaths,

either at the same time or in serial fashion,

without sufficient time or opportunity to

adequately grieve for each person who has died.

P. Marino (1998) Paraphrased

Phenomenological studies on cumulative grief have emerged from the fields of palliative care, oncology, critical care, paediatrics, gerontology and advanced nursing practice, particularly since the mid-1990's. There are also several professional magazine articles offering advice on how to cope with this accumulated grief, testifying to the importance of the topic at the grass roots level of practice. Last week's episode of CBC's White Coat, Black Art called, "When Your Life is Circling the Drain", reflects the impact of multiple deaths on young medical residents.

Not all work-related losses are considered traumatic, especially when healthcare practitioners have been able to provide "a good death" for both the patient and the family. Thus cumulative grief doesn't fit easily into our currently-held understanding of CF. However, these losses are real and can have a significant impact upon us, especially if left unattended. Do they actually contribute to increased vulnerability to CF? We don't know that yet but it is a rich area for further research.

In the meantime, I will continue to address cumulative grief within the context of CF in my healthcare workshops as it almost invariably and spontaneously comes to the fore.

Photo by BigStock Photos

Companioning through Grief...

2010-10-20T08:20:00.000-07:00

Although it is a bright and vibrant fall morning here in Vancouver, my thoughts are focused on grief. A dear friend's mother died of mouth cancer two nights ago, I have been asked to speak to a group of family caregivers who have lost a loved one to ALS and I am rereading the transcript of a seminal keynote address given by Dr Alan D Wolfelt to the Association of Death Education and Counselling conference in Chicago in 1997 entitled, Companioning vs Treating: Beyond the Medical Model of Bereavement Caregiving.

These three occurrences have combined to return my thoughts to the early days of my own bereavement following the death of my husband and, 3 months later and quite unexpectedly, that of my mother.

During those days I was completely depleted, shell-shocked and bereft. Friends and family surrounded me with love and support but, as is often the case in our North American culture, that support gradually dwindled as time went on. Some, who didn't understand the the notion that grief takes as long as it takes, became impatient and frustrated with their inability to "fix" me. Others, who had walked the path of grief before me, waited patiently for the the cloud of sorrow to lift and stood again and again with hearts and arms wide open as, after periods of "improvement", that cloud of grief descended once more in the face of anniversaries, holidays or family celebrations.

Five things helped me through those months and years of sorrow:

1. The incidental comment of an acquaintance whose husband had died years before mine - "It will take 5 years before you know who you are without him". With this comment she gave me permission to take as long as I needed to grieve. The number of years wasn't important. It was the implicit expectation that my grief would take as long as it took. (For some, a long goodbye has already been said and soon after the death there is a sense of relief and an early readiness to engage with life again. For others, the road is longer.)

2. Moorings, the beautiful writings of Rabbi Vicki Hollander. Vicki had been my grief counsellor for a brief period during my husband's illness and, when she moved away to Arkansas and then to Texas, she left me with these poetic and practical reflections on what I might expect at different times during the first year and a half of my bereavement.

3. The Two of Us: My Life with John Thaw by British actress, Sheila Hancock. This autobiography / biography has been, rather surprisingly, a great source of comfort over the years. Interspersed between stories of her life with actor, John Thaw, (Morse, Kavanaugh QC, Mister Tom) are italicized selections from her journal telling the story of his cancer diagnosis, death and her early bereavement. Reading these segments was the most empathic experience of my bereavement and I will be forever grateful for the intuitive love and generosity of my husband's cousins who left a copy on the bookshelf in my sitting room during a visit to England in the Spring following Derrick's death.

4. The support of my spiritual director / grief counsellor whom I saw on a weekly then bi-weekly basis.

5. The support of family and friends who stayed in for the long haul, waiting until the sun shone again in my life.

What was the experience that linked these five supports? The experience of companioning. As Alan Wolfelt said in his keynote, companioning is different from "treating" or "fixing":

More specifically, for me ...

* Companioning is about honouring the spirit; it is not about focusing on the intellect.

* Companioning is about curiosity; it is not about expertise.

* Companioning is about learning from others; it is not about teaching them.

* Companioning is about walking alongside; it is not about leading.

* Companioning is about being still; it is not about frantic movement forward.

* Companioning is about discovering the gifts of sacred silence; it is not about filling every painful moment with words.

* Companioning is about listening with the heart; it is not about analyzing with the head.

* Companioning is about bearing witness to the struggles of others; it is not about directing those struggles.

* Companioning is about being present to another person's pain; it is not about taking away the pain.

* Companioning is about respecting disorder and confusion; it is not about imposing order and logic.

* Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.

If you would like to learn more about companioning and other aspects of grief recovery you can read more at Alan Wolfelt's Griefwords.

Thanksgiving in the East ...

2010-09-28T16:01:00.000-07:00

If the only prayer you ever say in your entire life

is thank you, it will be enough.

Meister Eckhart

I'm off to Toronto in the early hours of Thursday morning to speak at the ATSS conference and then I will be driving down to Kingston to spend Thanksgiving with dear friends there.

I've been thinking about Thanksgiving and "gratitude" over the past week and was surprised to find an echo of my thoughts in an article in the Winter 2009 newsletter of the Callanish Society.

(Callanish is a wonderful nonprofit organization, worthy of your support, that provides retreats for people living with cancer and their families. A number of years ago my best friend, Linda Vick, attended one of their retreats before dying of lung cancer. It changed her life and touched many of us through her. I still have the journal she kept during her week's retreat - a treasured gift - and I read it from time to time when I need a reminder of what matters most in life.)

Janie Brown, Executive Director of Callinish, wrote these words in the Winter newsletter -

Many of us need to work at feeling grateful when life turns around on us.

A good friend of mine, Roger Hyodo, writes about thankfulness. He speaks about

two kinds of gratitude. The first is one that we cultivate based on our preferences,

beliefs, and values. We like something, we feel grateful. We don't like something,

we feel ungrateful. Our state of internal thankfulness is dependent on the ups and

downs of our lives. There are some people who tell us that we should see

everything as a gift, and that every experience that arrives is meant to be.

This is all very well, but what we cannot do is will ourselves to be grateful. It doesn't

work. All we do then is bypass our sadness, anger and regret, and send those feelings underground. At Callanish we offer a space for people with cancer to have their feelings, to honour the dark emotions by giving voice to them. In time, and it takes time,

I hear people speak not of cancer as a gift, but of life as a precious commodity.

Even in the midst of fiercely rejecting cancer, people can become clear that

there are things worthy of thanks.

The second form of gratitude Rodger speaks of is one that we may sense as a

"field" of thankfulness. I have experienced this many times in our circles at Callanish,

as well as in many other moments of my life. When we deliberately create certain conditions in our living, we become aware of this underling ever-present

quality of thankfulness.

Some of the conditions at Callanish are beauty, silence, real conversation, music,

art and spontaniety. We find ourselves risking expression to speak what is

true for us. In this kind of space, the heart seems to unabashedly open in response to

another's honesty, and we feel thankful. It feels like this thankfulness moves

effortlessly among us.

Perhaps, then, in these times of great uncertainty in our lives, it is up to all of us

to create these conditions for ourselves and each other ... whereby we can touch into

a genuine feeling of gratitude for the lives we are living.

When I hear someone express thanks amidst a life of great struggle, it humbles me to

look at my own life through a different lens. With that view, how could I not say,

"Thank you".

So, for Linda and Derrick and Barry and Mom and Dad and Christopher who, through times of great struggle, taught me about thankfulness, beauty, silence, real conversation, music, art, spontaneity, and mostly, love - I, too, say, "Thank you".

Book Review: After the Tears ...

2010-09-21T12:29:00.000-07:00

Earlier this month, Health Communications published a revised and expanded edition of Jane Middelton-Moz and Lorie Dwinell's 1986 popular classic, After the Tears: Helping Adult Children of Alcoholics Heal Their Childhood Trauma.

This new edition has been almost entirely rewritten to reflect new information regarding trauma, posttraumatic stress disorder (PTSD), delayed grief and newly-discovered brain physiology. Entirely new chapters include those on resilience in children of alcoholics, ACoA's as parents, ACoA's in the workplace, acceptance and forgiveness, and spirituality for ACoA's.

Not surprisingly, the first of the new chapters to catch my eye was one entitled, A Pain Too Deep: ACoA's Taking Care of Elderly Parents. Here, Jane Middelton-Moz describes an issue common to many adult children of trauma - that of caring for elderly parents who have not cared well for you. While for some, therapy and personal growth in the intervening years have meant that parental caregiving is an opportunity to give back, lovingly, to parents who did the best they could, for many, "... the task can be especially daunting ... (when) navigating a minefield of emotional hurts and abuse from the past". Jane goes on to say that -

Adult children frequently end up caring for elderly parents who were not there for them in their growing up years, and who were sometimes physically and/or sexually abusive to them as well. Many alcoholic or codependent parents had lives that resulted in chronic PTSD, and they often were not appropriately cared for themselves as children. As a result, many were suffering from their own developmental losses while raising their children. They may have been neglectful, clinging, dependent, abusive, controlling, ill-tempered, or demanding parents who not only were ineffective as parents but demanded to be parented as well. As a result, many Adult Children also suffered from PTSD most of their lives. Within this framework, these Adult Children are then commandeered one more time to take over the care of their parents physically and emotionally, and for some, to rescue them financially as well; all of this while being their parent's primary caregiver.

Many of the Adult Children who are responsible for elderly parents are themselves in their sixties or seventies and are taking care of parents in their eighties and nineties. For many, this is the time they believed they would finally be able to relax. They have achieved some level of financial security and career satisfaction and often have new and improved relationships with siblings and parents. This tests their limits and can cause some ACoA's to revert to earlier roles and painful interactions with both siblings and parents. While some elderly parents who need care may have gone through recovery, others may be as emotionally difficult as they ever were - or may even be worse. (p 218-219)

Why does all this matter? Because in many jurisdictions, including British Columbia, a Guardianship Act or similar legislation legally binds adult children to the care of their dependent parents. Understandably, when unresolved trauma is in the mix, such situations can hold the potential for elder neglect or abuse and they call for case-by-case assessment and adequate support from knowledgable case managers before a parent is placed in the care of an "unrecovered" adult child.

Another seldom-acknowledged observation made in this chapter is that adult children of alcoholics can find themselves caring, not only for their own children and for their parents, but for adult siblings who have "fallen by the wayside" as the result of their own childhood wounds. When this situation is combined with a lack of psychological separation from family members and an enhanced empathy for others' suffering, (both products of traumatic families), it can lead to a caregiver burden that is on a fast track to burnout and compassion fatigue.

Jane and Lorie offer a number of self-care recommendations for ACoA caregivers including:

1. Developing the ability to define yourself and to set caregiving limits. (This is often best done with the support of a therapist who has expertise in treating both caregiving and childhood trauma issues.)

2. Not expecting siblings to behave differently from their usual roles and patterns under the stress of a parent's illness or infirmity. (Families almost always revert to their original patterns in the face of serious stress.)

3. Remembering that you do have a choice regarding how much caregiving you are willing to undertake. (You may not be able to change your family's response, but you can change your own behaviour.)

4. Planning ahead and formally scheduling self care time. Making it a priority.

5. Giving yourself the gift of support. (Many adult children develop a protective counter-dependence that can cause them to feel shame regarding their natural need for support.) Consider seeking a good therapist or 12 Step support group. If you can't leave home, join an on-line support group run by a reputable organization.

This practical and readable volume has been a gift to ACoA's for almost 25 years and the new, expanded version will enlighten and promote the healing of a whole new generation of adult children.

The "Dr Peter" Tapes ...

2010-09-13T13:47:00.000-07:00

About 20 years ago, I went to church in Burnaby BC one Sunday morning to find that the homily was to be given by a young man named Peter Jepson-Young. My minister had heard the first of the "Dr Peter" tapes on CBC Radio and had immediately called to ask him if he would consider coming to talk to the congregation. That Dr Peter answered, "Yes", was a testament to his grace and courage because the Christian church at that time was frequently less than kind and inclusive in its response to people with HIV/AIDS.

I remember a nervous but thoughtful, articulate, deeply honest and very funny man who, despite failed eyesight, stood alone on the chancel steps to give us a real picture of life with HIV/AIDS. He taught and reassured and made human the face of a little known or understood disease. We laughed and cried as he spoke and many people stayed a long time after the service to speak with him and his family.

That one 20-minute talk changed the hearts and minds and attitudes of people who had previously been frightened to even hug a person who was HIV positive. In the years to come, the minister became a chaplain to our church's support organization for gay, lesbian and transgendered people and the congregation continued to support the Dr Peter Foundation and the Dr Peter Center. We all grieved on the day of Peter's death in 1992.

This September, Vancouver has declared a Dr Peter Week in appreciation of Dr Peter Jepson-Young's contribution to the quality of life of those affected by HIV/AIDS. CBC Radio is marking the 20 year anniversary of the tapes by featuring them on their broadcast and website and there will be fundraising events for the Foundation all around Vancouver. Please take a moment to visit the CBC site and take in the details.

During one of his most poignant broadcasts, Peter shared his Affirmation with his viewers. Let me share it with you today:

I accept and absorb all the strength of the earth

to keep my body hard and strong;

I accept and absorb all the energy of the sun

to keep my mind sharp and bright;

I accept and absorb all the life force of the ocean

to cleanse my body and bring me life;

I accept and absorb all the power of the wind

to cleanse my spirit and bring me life;

I accept and absorb all the mystery of the heavens,

for I am a part of the vast unknown.

I believe God to be all these elements,

and the force that unites them;

And from these elements I have come

and to these elements I shall return;

But the energy that is me will not be lost.

Dr Peter Jepson-Young, MD

Dr Peter AIDS Foundation

Safety in Our Hands: Helping Our Helpers Stay Healthy ...

2010-09-09T09:18:00.000-07:00

Of great interest to anyone in the trauma field this Fall will be the 2010 Association of Traumatic Stress Specialists Conference to be held in Toronto, Sept 30 - Oct 2.

With the theme and focus of keeping helpers well, the conference offers a wide selection of more than 30 workshops including:

Keynotes -

1. Dr Angie Panos - Safety in Our Hands: Helping Our Helpers Stay Healthy

2. Lt Col Stephane Grenier - ( Canadian Operational Stress Injury Special Advisor) - Peer Based Mental Health Services

Workshops -

1. Question & Answer Session: Preventing & Healing Compassion Fatigue

Dr Angie Panos

2. Creative Tools for Transforming Compassion Fatigue and Vicarious Trauma

Francoise Mathieu

3. Caring on Two Fronts: When Helping Professionals Become Family Caregivers

(Chronic Sorrow in the Context of Compassion Fatigue)

Jan Spilman

4. Meditation, Mindfulness, and Right-Brain Healing

Dawn Bret

5. HUGS: Helping Children Understand Grief & Trauma in Six Week Sessions

Christina Derneder Landen

6. CISM in the Correctional Service of Canada

Pamela Scott & Dorothy Reid

7. Voices of Experience

Pricilla de Villiers, Kent Laidlaw, and Edward Leonard

8. PTSD & Addiction Treatment for Occupational Hazard: Strategies for Symptom Reduction

Anne Pepper

... and much more.

I'm particularly pleased to have been chosen to speak at this conference because, for the first time, I will be combining material from the Compassion Fatigue and Chronic Sorrow fields as a means of expanding our understanding of the stress of "caring on two fronts".

Please join us! To register, click here.

Photo by Bigstock Photos

Fall Workshops ...

2010-08-30T09:15:00.000-07:00

After a beautiful summer there is already a hint of fall in the air. The days are closing in, the garden is yielding it's bounty, and although the days are bright and sunny, my furnace has cut in for the first time since spring. I love this time of year! It has an energy and excitement all it's own.

My speaking engagements have begun early this year with an August keynote for the Canadian Society of Transplantation Conference at the Vancouver Convention Center. I was privileged to spend time with a fine group of helping professionals working on both the donor and recipient sides of the transplant equation. Their comments and questions in relation to Compassion Fatigue dovetailed with the thinking and reading I've been doing over the summer and have confirmed some of my thoughts regarding an under-acknowledged piece in our conceptualization of Compassion Fatigue. More about this later in the fall.

This October and November will see me sponsoring two of my own workshops for helping professionals here in Vancouver. The Caring on Empty and Compassion Fatigue, Going Deeper: The Enneagram workshops were so well received last year that I will be co-sponsoring them with St Mark's Anglican Church in Kitsilano and offering them to a broader, more heterogenous group of professionals than one might find in a specific organization. There is usually great richness in such groups with opportunities to think outside the box and to benefit from the wisdom of others outside one's own particular field.

1. Caring on Empty: Creative Tools for Transforming Compassion Fatigue

Friday October 22 9:00 - 3:45 (Registration at 8:30)

St Mark's Church, Kitsilano

1805 Larch Street, Vancouver, BC

Registration fee: $184.80 + HST = $210

This is a workshop designed for all helping professionals who work with the suffering or traumatized, from veterinarians to clergy, from nurses to teachers , from physicians to lawyers and judges, from social workers to physiotherapists to psychotherapists.

You will benefit by:

1. Learning the difference between compassion fatigue, (the secondary trauma we can experience through working with those who have been traumatized), and burnout or vicarious trauma.

2. Gaining an understanding of how CF develops.

3. Recognizing the general signs of CF and your own personal early warning signs.

4. Identifying your current level of CF.

5. Exploring tools for CF transformation and resilience.

6. Beginning to develop a personal recovery and resilience plan.

2. Compassion Fatigue, Going Deeper: The Enneagram (** Postponed until 2011)

Friday evening November 19 7-9:00 pm - and -

Saturday November 20 9:00 - 3:45 pm

St Mark's Church, Kitsilano

1805 Larch Street, Vancouver, BC

Registration fee: $220 + HST = $250

One of the most common signs of Compassion Fatigue is emotional reactivity and the Enneagram can help you to recognize the source of that reactivity and to take steps to reduce it.

The Enneagram (pronounced ANY-a-gram) is an enlightening and powerfully accurate system of 9 personality types based on a combination of ancient wisdom tradition and modern psychology. It differs from other personality typing systems like the Myers-Briggs in that it focuses on the motivation behind our behaviour rather than on the behaviour itself.

Discovering and working with your Enneagram personality type can help you to:

1. Make positive changes in your life, particularly in your relationship with yourself and with others.

2. Clearly recognize the issues that can "push your buttons" and reduce your reactivity.

3. Understand more about your behaviour under stress and when relaxed.

4. Integrate the personal and spiritual aspects of your life, regardless of your spiritual path.

** Registration includes a copy of Stanford University professor of psychiatry, Dr David Daniels' book, The Essential Enneagram.

For a registration form or for more information, please email me at caregiverwellnesshaw.ca or call me at (604) 297 0609.

With every good wish for a healthy and happy fall,

Jan

12 Step Recovery for Helpers...

2010-08-08T09:50:00.000-07:00

Caring for others, whether as helping professionals, volunteers or family caregivers, can be a great source of fulfillment and satisfaction. It can also be a source of tremendous emotional strain. One of the ways that helpers are dealing with this strain is through attending 12 Step meetings and applying the program's principles in their everyday lives.

The 12 Step program was started by two alcoholics in the 1930's as a means of staying sober. They then formed Alcoholics Anonymous (AA) to share the program with others. Since that time the basic principles of the program - the 12 Steps - have been adopted by millions of others with chronic problems as varied as chronic over eating; other compulsive behaviours such as gambling, over exercising, over spending, or over working; and codependence. Many others, drawn by the inclusive, non-religious spirituality of the program, have chosen the 12 Steps as a practical pathway to peace and serenity in a chaotic world.

While not for everyone, the program helps many to relinquish control of the unmanageable, out-of-control portions of their lives to a Higher Power, however they understand that Higher Power to be. In doing so, they become more able to move with the flow of life rather than struggling against it and they learn to lean on their Higher Power for strength and support.

As author and family caregiver, Gail Sheehy, writes in Passages in Caregiving:

I confessed to Dr Pat that I had bottomed out. ... She suggested that I try a twelve step program.

Grateful, but skeptical, I walked thirty blocks down the street from Dr Pat's office to a twelve-step meeting in a large church. I expected a huddle of mournful souls reciting grisly accident reports on the train wrecks they had made of their lives. I had heard such accounts, secondhand, when my mother entered Alcoholics Anonymous for her recovery.

One step into the nave changed everything. Greeters lined the walls. They talked about taking positive steps toward living with gratitude and feeling more joyous and free than before they found the program. They clapped for anyone who announced progress.

I was shocked to find my own behaviour described in some of the stories. Like me, the narrators had attacked their problems guided only by a ferocious self-will. When it didn't work, fear overtook. Or resentment, or both. I realized I had become powerless over my fears. In the fever to "save" my husband, I was losing the ability to manage my own life. I needed to find a way to restore my faith.

This was a spiritual program, but no church affiliation was required. We were encouraged to entrust our wills (or egos) to God, who was introduced with the shrewdly tolerant phrase "as we understand him".

The God I hoped to meet was the source of serenity, the missing force in my life. To my delight everybody else at that meeting had the same idea. At the conclusion, we all held hands and recited the universal serenity prayer by Reinhold Niebuhr:

God, grant me the serenity

to accept the things I cannot change;

the courage to change the things I can;

and the wisdom to know the difference.

"The wisdom to know the difference" was not just a catchy slogan. It sounded like something God would grant if I met him/her halfway, by accepting the things I could NOT change - my husband's life trajectory and my own limitations. That was the road to serenity. But first, I would have to quit Playing God. I was full of compassion for my husband, yes, but my caregiving was spiked with more than a pinch of egotism.

I had to find the courage to change the things I could - especially myself. In the twelve-step group everyone learned how to open up and shamelessly examine our defects and draw support from our fellowship. The best laughs are at ourselves, and we had many laughs at those meetings. The days went better after gathering in the early morning with my fellow pilgrims.

Others have written about the usefulness of 12 Step programs in helping caregivers to care for themselves while caring for others. If you are interested in learning more you might want to read, Self-Care for Caregivers: A Twelve Step Approach by Pat Samples, Diane Larsen, and Marvin Larsen.

If you decide to try out a 12 Step group, remember that a group is only as healthy as it's individual members. If you're not comfortable in one group, try several others until you find one that fits for you.

Also remember that any idea can be taken to an extreme or become rigid or warped from it's original intent. I have discovered this in relation to Chronic Sorrow in some groups. The notion of "the pity pot" (being stuck in self pity) has been applied to the ongoing grief of family caregivers by those who do not understand the concept of unending loss. As with everything one finds at a 12 Step meeting, it is always okay to, "take what works and leave the rest".

Book Review: Passages in Caregiving...

2010-07-20T10:31:00.000-07:00

I have just finished reading Gail Sheehy's latest book, Passages in Caregiving, and recommend it to you with an enthusiastic thumbs up. Whether you are a family caregiver or a helping professional wanting to better understand the family caregiving experience, you will find much to enlighten you in these pages.

Using the turning points of the labyrinth, (a medieval symbol of a single pathway, with several switchback turns, leading to the center of a circle which is used by many spiritual traditions as a form of walking meditation or ritual), Ms Sheehy describes eight turnings in the path around the labyrinth of caregiving:

1. Shock and Mobilization

2. The New Normal

3. Boomerang

4. Playing God

5. I Can't Do This Anymore!

6. Coming Back

7. The In-Between Stage

8. The Long Good-bye

Each of these turnings is a passage in the emotional journey through providing care for a loved one - or a not-so-loved-one.

While drawing extensively and beautifully from her own and others' experiences of spousal caregiving, Ms Sheehy also touches on the experiences of those giving care to parents. Unfortunately, little is said about those caring for children with chronic conditions or about children who are caregivers themselves. Another limitation for Canadian readers is the detailed explanation of the American healthcare system. (Though there are certainly sufficient emotional parallels in our responses to the two systems to make these explanations readable.)

The epilogue is an interesting departure from the usual content of caregiving books with its exploration of sustainable aging and who will care for the aging boomers in a world of smaller and more transient families, fewer resources, and longer lived lives in the presence of complex medical conditions. Gail Sheehy's answer to the latter is an emphatic, "Us!". She offers the model of the "village movement" to those disinterested in an old age of dependence and isolation. This movement uses the yearly fees of members, (paid according to income), and their gifts and talents, to provide each other with the kind of support that small villages and neighbourhoods once offered.

I will write more about this idea, and about the labyrinth, in later posts. For now, suffice to say that Passages in Caregiving is worthy of a place on your summer reading list.

Caveat: Gail's descriptions of her emotional experiences during her caregiving journey with her husband are achingly accurate so, if you are feeling vulnerable or fragile, you might want to try reading just the chapters that currently pertain to you, and then leave the rest for later.

Men as Caregivers ...

2010-07-09T13:38:00.000-07:00

When we think of family caregiving, we often think of women providing the care but in fact, men make up more than 30% of all family caregivers and, in some care contexts, provide the bulk of the care. (For example, 40-53% of all primary caregivers to people with AIDS in the United States are relatively young males. And often, fathers must take on more caregiving responsibilities as their children with disabilities grow older and are harder to manage physically.) How do these men experience caregiving and what are their support needs?

Although originally thought to be less negatively affected by their caregiving responsibilities than women, more recent studies have shown that men who are caregivers experience similar caregiving "burden" to women, similar levels of depression, and higher levels of hostility and work-family conflict. As well, brothers caring for parents experience as much stress and emotional strain as sisters but seem to have more difficulty combining work and family responsibilities. Men also tend to be castigated in the caregiving literature for being more likely to "abandon" their care recipients through separation or divorce but in many cases are tenaciously loyal and persistent in their care.

Now, while I personally tend to think that the differences in caregivers and caregiving have more to do with individual personality, history and experience than gender differences, there is research to say that some male caregivers may need:

1. More opportunities to share their feelings and experiences with other men. (There is a tendency for men to accumulate more acquaintances than confidants and thus to have less opportunity to share their experiences.)

2. The availability of formal respite care services during extended caregiving as their male support system is less likely to offer informal respite.

3. Skill-based educational opportunities - bathing, cooking, laundry, etc.

4. Normalization of and relief from the stigma (internal or external) of doing "women's work".

5. Support in communicating their own needs and feelings within the caring relationship.

Fueled for Caregiving?...

2010-07-03T12:46:00.000-07:00

Like you, I suspect, I learned about the five (or six?) food groups and healthy eating practices way back in 5th grade Health class but it wasn't until I was literally falling asleep on my feet as a family caregiver that the penny dropped and I truly realized the importance of good nutrition in my life.

My husband had been both cook and baker in our home from the day we were married and while he had tried to make sure that he'd taught me to bake bread and to put together our favourite dinners before he became bedridden, the standing joke in our family still prevailed - "If anything ever happens to Derrick, Jan will die of a Cheerios overdose!". It's not that I didn't value healthy food when someone put it in front of me - in fact, I loved it - but I had no interest in producing it from scratch myself.

Flash forward a year or two, and you would have found me cooking very small and frequent nourishing snacks for my husband. And indeed, when his snacks didn't appeal to me, eating Cheerios, (garnished with various kinds of fruit to make them "healthy"). Up all day and half the night caring for Derrick AND eating poorly quickly caught up with me. I couldn't think clearly, I had no energy, my colour was poor and I dropped two dress sizes. I would sit down on the couch "for a minute" after lunch and wake up an hour later. And, worst of all, I was grumpy and irritable at a time when I truly wanted to enjoy the days we had left. Now, there were a number of factors that went into creating these symptoms, not just the Cheerios, but it was amazing how much things improved with a little nutritional intervention.

That intervention started when my younger sister, a real foodie, introduced me to

Barbara Jo's Books to Cooks, a wonderful bookstore close to Granville Market in Vancouver. Only my sister would have guessed that the way to this non-cook's stomach was through a book - especially one with smooth, shiny pages and beautiful photographs. The first one she picked out for me to peruse was Dana Jacobi's, 12 Best Foods Cookbook, and I was hooked. Just by looking at the cover, I learned that there were 12 superfoods which, if I indulged in them, would not only make me feel better but would protect me from some of the health problems inherent in caregiving. Those 12 super stars were:

1. Blueberries

2. Black beans

3. Sweet potatoes (or yams, as we call them on the west coast)

4. Oatmeal

5. Salmon

6. Spinach

7. Broccoli

8. Tomatoes

9. Chocolate

10. Walnuts

11. Soy

12. Onions

I bought Dana's book and began to enjoy making Sweet Potato & Broccoli Shepherd's Pie, Scalloped Sweet Potato with Apple, Greek White Bean Soup, Spinach Salad with Nectarine, Blueberries, & Lime Balsalmic Vinaigrette and more. And, more importantly, my energy improved, my irritability eased and my brain began to work again. I learned through experience that fueling my body with good food bearing high quality nutrients, bought in-season to keep the cost down, was one of the best ways I could sustain myself for the years of caregiving ahead - and indeed, for my whole life. (Now, if only someone could break my cookbook addiction...!).

Summer Reading ...

2010-06-22T09:21:00.000-07:00

I don't know about you, but for me, one of the best parts of summer is summer reading. There's something about escaping into a new book that is, at once, exciting and relaxing.

One on my earliest memories is that of accompanying my father to our local library on a hot and sunny Sunday afternoon. I was barely big enough to carry my books and manage the wide steps at the same time. I remember, vividly, walking from the bright, sticky heat of that wide cement stairway into the cool, shaded, hush of the high-ceilinged, dark paneled, Victorian building. I lay the returning books on the desk then waved to my father and headed off down the dim hallway into the equally hushed and cool Children's Department. There, sitting at the miniature reading table with it's tip-tilted, varnished, mahogany book rests, I was in heaven. It was so quiet and peaceful and there were sooooo many books to choose from. I could barely contain my delight. My Dad could have left me there all day and I would, indeed, have been a happy camper.

Today, I feel the same contentment and pleasure as I pick out books for summer reading. This year's list includes:

1. Poetic Medicine: The Healing Art of Poem-Making by John Fox

2. presentationzen: Simple Ideas on Presentation Design and Delivery by Garr Reynolds

3. Come, Thou Tortoise by Jessica Grant

4. Savor: Mindful Eating, Mindful Life by Thich Nhat Hanh & Lilian Cheung

5. Passages in Caregiving: Turning Chaos into Confidence by Gail Sheehy

6. The latest mystery novels by Anne Perry and by Deborah Crombie

7. A re-read of some of Mary Oliver's poetry

What about you? What can you take from the bookshelf that will relax, restore, and refresh you as you take time out to re-create this summer?

S-l-o-w-i-n-g Down...

2010-06-16T10:34:00.000-07:00

There is a secret bond between slowness and memory,

between speed and forgetting.

Milan Kundera

Yesterday was a busy day and I was rushed. Many phone calls and emails to return. Writing deadlines. Planning for fall workshops. And all the usual minutia of life. During the afternoon I had a great chat with a Vancouver social worker requesting a workshop and, in following up, I sent her a Speaker's Kit by email. Only I forgot to attach the Kit to the email.

It wasn't a big deal. I recognized that I'd forgotten the attachment the second after I hit the Send button - but it reminded me of Milan Kundera's statement about the relationship between speed and forgetting. Why was I in such a hurry? Where was the emergency? If I had approached the task more slowly, I would have taken half the time in the long run. And I would have saved the social worker the time she spent emailing me back to say that the Kit wasn't there.

David Kuntz reflects on the notion of slowing down in one of my favourite books, Quiet Mind: One-Minute Retreats from a Busy World:

As recently as a generation ago, ...

people lived their lives with a conscious realization of the balance

between slowness and remembering, between speed and forgetting.

They knew that leisure was a necessary part of a balanced life.

They knew that if you moved too fast you were bound to forget something.

We know it too, but only if we stop to recollect it.

Contemporary life does not afford us the intuitive awareness of our forebears.

It is, in fact, counterintuitive to a life in balance.

Unthinking acceptance of our culture's rate of speed is a terrible, yet common error.

These ... bonds must now be noticed with full intention,

and more, shouted from the rooftops.

There are many individuals and organizations now focused on "shouting from the roof tops" about our need to slow down. There are internet sites for Slow Food, Slow Travel, Slow Schools, Slow Living, even Slow Money. In fact, there's a whole Slow Movement born of our very human desire to not only avoid forgetting, but to make a deeper connection with ourselves and our lives. We want time to live life. If we run around at warp speed all day long there is no time for the things that matter - our own mental, physical, and spiritual health; our cherished relationships; our neighbourhoods; our environment; the natural rhythms and seasons of our lives.

There is much to be gained by slowing down but how does one do it? First, I think we have to be willing to give up some of our busyness and to grieve the losses that come in consequence. (Do we really have to go out five nights a week? Do our kids really need to be involved in more than one or two activities? Must we work ten hours of overtime every pay cheque?).

Once we've freed up some time, we can make choices about ways in which to slow down or pause during the day:

1. Breathe. Whenever you notice that you're feeling stressed, pause and take three deep cleansing breaths. And, as a form of prevention, pick a trigger - the ringing of the phone, the opening of a door or cupboard, getting into your car - and use it as a cue to take three more breaths.

1. Make a conscious choice to do less. Cut down your "to do" list to what's really necessary and let go of the rest.

2. Add more space. Schedule more time between tasks and appointments and, if you have to travel, leave earlier to get there so you're not rushed.

3. Disconnect from the electronic world. Shut off your mobile devices for a while. Schedule time away from your computer. It is hard to slow down when you're constantly checking your emails or answering your cell phone.

4. Be present. Practice being mindfully present to what you are doing or whom you're with. If your attention wanders, gently return it to the task or the conversation until you are finished. Notice and appreciate the beauty, the humour, the support and the life around you, whatever you are doing.

5. Spend time in nature. Be mindful of the seasons and the rhythms of the natural world. More than anything, these will teach us a healthy pace of do-ing.

6. Eat more slowly. Take the time to grow some of your own food, if that is possible. Prepare fresh food rather than refined meals whenever you can. Share the preparation with loved ones. And when it comes to actually eating, eat mindfully. Turn off the TV. Set the table attractively. Share the meal with others. Chew each bite sufficiently to actually taste its flavour and appreciate its texture.

7. Move more slowly. Unless you are exercising, walk, cycle and drive more slowly. Notice your surroundings. Your field of attention narrows as your speed increases, and widens as you slow down and that is safer for everyone. Try some walking meditation.

8. Consider slow travel. Engage more fully with the communities you visit. Make a "home base" when on vacation and travel by public transportation or other low-impact modes within a defined area. Visit spots enjoyed by local residents rather than following the guidebooks.

9. Explore slow parenting. Plan less for your children. Allow them to enjoy their childhood and explore the world at their own pace. Read books like Elkind's, The Hurried Child, and Carl Honore's, Under Pressure: Rescuing Our Children From the Culture of Hyper-Parenting.

10. For family caregivers. If you are doing long term, 24/7 caregiving and all this seems totally ridiculous, consider asking everyone you know to sign up on a rota to spend time with your care recipient, or to be available in the house, so that you can at least take a nap or read a book - slowly - undisturbed.

Trauma and Aging ...

2010-06-08T12:48:00.000-07:00

Last month The Canadian Press reported that Canadian military chaplains are experiencing high rates of burnout and compassion fatigue. That, in itself, is not news. Military chaplains have been experiencing primary and secondary posttraumatic stress forever. What is new and encouraging is that the problem is being recognized and addressed at official levels.

My husband was a British Army chaplain who, within six months of signing up, was posted to active duty in the Aden conflict as the British withdrew from that country with the populace at their heels. In the years that followed, he occasionally told stories of scanning rooftops for snipers whenever he left his rooms, of comforting boys terribly wounded by the equivalent of today's IED's, of writing personal letters home to their families after they died and of driving exposed through the desert to bury them, protected only by a single gunner on the back of his jeep. (Chaplains were not issued firearms.) Over time, his body succumbed to the effects of the stress and he was sent back to England with chronic pneumonia.

Despite the impact of these experiences, my husband coped quite well, from a psychological standpoint, until his mid-sixties when he developed heart failure after a viral infection. This event, with its traumatic onset, triggered the same feelings of fear and vulnerability he had felt forty years before in Aden. (And as a child in London during World War II.) As his illness progressed, so did his posttraumatic stress symptoms. In fact, during the final months of his life when he experienced increasing sleep apnea, (periods without breathing that occur during sleep), he would vividly "revisit" Aden during the breath-less periods then "return", disoriented and frightened, to the present each time he began to breathe again. This cycle would continue for hours on end, exhausting and terrorizing us both.

Fortunately, I was aware of the "new" research of the mid 1990's, research which helped us to understand and cope with these harrowing episodes. These studies of older combat veterans, holocaust survivors and Dutch resistance fighters showed that trauma survivors who were otherwise functioning well could experience a late onset or worsening of posttraumatic stress symptoms secondary to the stress of physical illness or injury, changes in environment, or medical interventions. This was what was happening to my husband and it is important information for all of us to know for a number of reasons:

1. As World War II and Korean, Vietnam, and Gulf War veterans; immigrants of war torn countries; and other trauma survivors and their families age, we will see increasing numbers of older adults in our health care, addiction and social service systems affected by late onset or exacerbation of PTS symptoms. They deserve, and will require, knowledgable and compassionate trauma-specific diagnosis and care.

2. As more of these trauma survivors enter our support systems, the possibility exists that more helping professionals, volunteers and family caregivers will experience secondary trauma exposure, creating the need for more compassion fatigue resources.

3. As both groups - helpees and helpers - age, there is also concern that cognitive impairment could keep them from identifying the sources of their symptoms and working through their trauma. This could leave numbers of survivors acting out unresolved trauma because they are no longer able to understand or express it directly.

The moral of the story for us as caregivers? As a long term care aide once said, with tears flowing down her cheeks as I finished a talk on "Trauma and Aging"-

"Listen to her. If you have trauma to heal, do it now. You never know when it's going to be too late. I see it in my patients all the time. They're in pain but I can't figure out why or what to do to help because they can't tell me what's happened to them any more."

(Caveat - This doesn't mean that we should sign up to heal our lives during the middle of a caregiving crisis. It just means that we could all do well to recognize that posttraumatic stress can worsen with age and to plan to do some appropriate therapy when the time is right - a time that is preferably sooner than later.)