Monday, October 26, 2009


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

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

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

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

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

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

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

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

Wednesday, October 21, 2009

Autumn Comforts...

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

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

1. Run through a tall corn field.

2. Let the wind push you down the sidewalk.

3. Fly a kite.

4. Take a hayride.

5. Collect fall leaves.

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

7. Cook s'mores over an open fire.

8. Walk briskly and sniff the fall air.

9. Pop corn.

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

Some other ideas that come to mind are:

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

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

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

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

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

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

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

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

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

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

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

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

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

14. Stamp in a puddle.

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

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

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

Friday, October 16, 2009

What is CF Anyway...?

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

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

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

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

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

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

Photo by Bigstock Photos

Wednesday, October 7, 2009

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

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

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

The table of contents looks like this:

Have a Life!: An Introduction

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

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

A Powerful Healing Combination: Friendship, Resilience & Compassion

The First Steps Toward Self-Knowledge: Debriefing Yourself

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

The Simple Care of a Hopeful Heart: An Epilogue

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

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


Saturday, October 3, 2009

66 Self Care Ideas...

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

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