References - A Last Post for 2011 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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 ...

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. And this year, for the first time, I will include my own dear father, Jack, amongst the soldiers and merchant mariners we honour.

A Mindfulness Meditation Alternative ...

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 ...

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...

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 ...

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 ...

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...

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 ...

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 ...

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 ...

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 ...

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...

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 ...

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, Clergy CF, the following factors:

1. Lack of adequate training and experience in pastoral care

2. Isolation

    - expectations of "perfect clergy" that prevent sharing struggles and 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 and perfectionism 

- parishioners' projection of parental issues upon their clergyperson

- parishioners triangulating their conflicts by drawing in the cleric            

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

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 to that idea, 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 acknowledge and heal their own personal trauma (past and current) to reduce their CF risk

2. That they engage in exquisite physical, psychological and spiritual self-care - including appropriate respite time

3. That they develop personal and professional support networks who are charged with gently, but firmly, providing feedback regarding CF symptoms and self care - sometimes, whether the clergyperson wants to hear it or not.

Self Care Ideas ...

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