Tuesday, August 30, 2011

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 ...?

Thursday, August 18, 2011

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.

Tuesday, August 16, 2011

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.

Tuesday, August 2, 2011

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?