Thursday, January 22, 2009

Low Impact Disclosure...

Stories have great power, both to heal and to wound. When we hear and see difficult things in the course of our professional work or as we care for loved ones, we feel a natural desire to debrief the stories we've just heard. This debriefing helps us to diffuse the emotional impact of our work. However,  if we don't do it carefully, we run the risk of wounding those who take the time to listen to us.

In her 2008 article, Low Impact Disclosure - How to Stop Sliming Each Other, my friend and colleague, Francois Mathieu, describes how helpers can slime listeners inadvertently as we attempt to reduce the burden of our work.  When we debrief disturbing material, formally or informally, without asking permission or without thought to its impact on listeners, we can slime colleagues, family members, friends, acquaintances, and even strangers on the bus (!) with our stories. 

Research tells us that sharing graphic details of traumatic situations can spread psychological trauma effects to others and yet we need to tell our stories to keep ourselves well.  What's to be done?  

Authors, Laurie Pearlman and Karen Saakvitne, coined the term, "limited disclosure", in their book, Trauma and the Therapist, and that term later became, "low impact disclosure".  Low impact disclosure, (LID), is a strategy for limiting the impact of our stories on others.  It involves four steps:

1.  Increasing Our Self Awareness

Use self observation for a week to notice all the ways you debrief difficult material. Do you attend formal debriefings at work? Do you journal? Do you chat online? Do you talk over lunch in the cafeteria? Do you attend a support group? Do you share with people at conferences or workshops? Do you go for peer or professional supervision? Do you see a counsellor? Do you tell your spouse when you get home? Or your kids? What is the most helpful way for you to deal with painful stories?

2.  Giving Fair Warning Before Debriefing

Giving  fair warning that you have a difficult story to tell allows the listener to prepare him or herself for its impact.

3.  Obtaining Consent to Tell Our Stories

Francoise Mathieu suggests simply saying, "I need to debrief something with you.  Is this a good time?", or "I heard something really hard today...Could I talk to you about it?". This gives the listener the opportunity to decline or to set limits on the disclosure. For example, the listener might say, "I have fifteen minutes to listen but could you please tell me about it without all the gory details?" or "Is it about children (abuse, abandonment, a car accident, war or whatever is a trigger for you)? If it's about children, then I'm probably the wrong person to talk to, but otherwise I'm fine to listen."

4.  Low Impact Disclosure

Once you've received consent, you can decide how much to disclose. Francoise describes LID this way. "Imagine that you are telling a story starting with the outer circle of the story, (ie the least traumatic information), and you are slowly moving in toward the core, (the very traumatic information), at a gradual pace. You may, in the end, need to tell the graphic details, or you may not, depending on how disturbing the story has been for you."

 It is best to err on the side of more limited disclosure in social situations. Think to yourself, "Is this too much trauma information for this situation?"

Using LID is a simple strategy for reducing the harmful effects of difficult stories. We need not minimize our emotional responses but limiting "the gory details" of the story to an appropriate situation can save family, friends and colleagues  from unnecessary secondary traumatization.   



Monday, January 12, 2009

Trauma First Aid...

As family carepartners and helping professionals, we are exposed to secondary trauma, or indirect wounding, through witnessing or hearing of the traumatic experiences of others.

Whether we discover a loved one collapsed on the floor after a heart attack, assist a patient suddenly hemorrhaging from his gastrointestinal tract, respond to a serious motor vehicle accident or preside at the funeral of a four year old child, we are vulnerable to secondary traumatic stress. How do we practice good self care in such situations? How do we help ourselves to reduce long term trauma effects?

Peter Levine, PhD,  in his books, Healing Trauma and Waking the Tiger, gives first aid guidelines for helping adults who have experienced traumatic events. From these guidelines, I have drawn the following suggestions:

Stage I:  Immediate Action:

As soon as possible after ensuring the immediate safety of the primary victims and your own safety:

1.  Rest, lying down if possible. (This may go against your natural inclination to "do something" or to deny the impact of the trauma but it is essential to be still so the trauma energy can be discharged from your body.)

2.  Have a trusted person stay with you quietly.

3.  Allow yourself to fully experience your body sensations. These may include adrenalin rush, numbness, shaking and trembling, feeling hot or chilled.

4.  Remind yourself or allow others to remind you that it is not only okay to shake, it is good and will help you to release the shock. You will feel a sense of relief after the shaking is completed and may feel warmth in your hands and feet. Your breathing should be fuller and easier. This initial stage of discharge could easily take 15 - 20 minutes.

5.  Stay quiet and resting until the acute shock reaction is over.

Stage II:  Later

1.  Allow time for processing the traumatic experience. Always take a day or two off work or rest more than usual if you are at home in order to reintegrate. This is important even if you don't perceive your situation to justify staying home or resting. (This resistance can be a common denial mechanism and defense against feelings of helplessness). As Peter Levine says, "A day or two is good insurance".

2.  Allow your emotions to be felt without judgement. You may experience feelings such as anger, fear, guilt, sadness and anxiety. There may also be continuing body sensations such as shaking or chills. This is often the case.

Stage III:  Begin to Access and Renegotiate the Trauma: (Often coincides with Stage II)

1.  Work with someone who understands the body effects of trauma to recall both the direct and peripheral images, feelings and sensations experienced during the traumatic event. Work slowly, one step at a time, to bring up and discharge the trauma energy.

Dealing with a traumatic event at the time that it happens goes a long way toward preventing long term trauma reactions. If you would like to understand more about the importance of processing traumatic events and the physiology behind the process above, I recommend Peter Levine's two books and his CD collection, Healing Trauma.

 (As always, use your own best judgement to assess your particular circumstances before using the guidelines above.)

Monday, January 5, 2009

New Year 2009...

This week, as I prepared to dig myself out of the snow one more time and return to work, I found myself reflecting upon our traditional January greeting of "Happy New Year!".

For very many people, the New Year is a time of bright hopes and possibilities, of fresh starts and clean pages. However, for family caregivers and helping professionals overwhelmed with compassion fatigue or chronic sorrow, this is rarely the case. The thought of another year stretching into the distance brings exhaustion, anguish and unanswerable questions.  Can I keep going? How? When will the losses and suffering end?

For these folks, the New Year means summoning yet more strength and courage from a well long dry.  It asks of those already drained to "go over the top" one more time like soldiers in trenches from wars gone by.

If you are facing the New Year from such a depleted place, I invite you to make this time of beginnings an opportunity to ask for help. To call a trusted friend, a case manager, a spiritual advisor, a grief counsellor, or another caregiver to ask for support. Choose someone who will listen without judgement or "fixing" and who will help you to clarify what it is that you need. Let your New Year begin with the glimmer of hope that can come when we honestly acknowledge our situations and surrender to asking for help.

John O'Donohue, one of my favourite Celtic writers, wrote a beautiful book of blessings called, The Space Between Us, before his untimely death in mid 2008.  His Blessing for a New Year could easily have been written especially for caregivers.

A Blessing for the New Year

On the day when
The weight deadens
On your shoulders
And you stumble,
May the clay dance
To balance you.

And when your eyes
Freeze behind
The gray window
And the ghost of loss
Gets into you,
May a flock of colours,
Indigo, red, green
And azure blue,
Come to awaken in you
A meadow of delight.

When the canvas frays
In the curragh of thought
And a stain of ocean
Blackens beneath you,
May there come across the waters
A path of yellow moonlight
To bring you safely home.

May the nourishment of the earth be yours,
May the clarity of light be yours,
May the fluency of the ocean be yours,
May the protection of the ancestors be yours.

And so may a slow
Wind work these words
Of love around you,
An invisible cloak
To mind your life.

John O'Donohue  (2008)

Blessings to you in 2009!