Christmas Peace ...

Hello, Everyone,

I've finished the cards, the gift wrapping, the baking and the house-cleaning and I'm now looking forward to a few lovely days of sparkly lights, familiar carols, shared meals and the warm hugs of family and friends.

To each of you, whether anticipating a happy Christmas or one of weariness and stress, I wish a deep sense of peace, the peace that transcends understanding and that is so well described by Goethe in his beautiful poem, Peace:

Peace

There is only silence

On the mountain tops

Among the tips of the trees

You perceive barely a breath

Even the birds in the forest

Keep still and are silent

Wait then

Just a little while longer

And you too

will find peace at last.

                   (JW von Goethe translated by Patrizia Collard) 

May each of us find the peace we seek this holiday season, whether in the quiet of Nature, the beauty of a religious ritual, the arms of a friend or at the bedside of a loved one.

With love and deep peace to you all,

Jan

Welcoming What Is ...

Hello, everyone,

How are you feeling today?

The winter holidays are times when we can experience a wide range of emotion from excitement, anticipation, hope, pleasure and joy to guilt, loneliness, anger, regret and sorrow. It is our natural human tendency to embrace the joyful feelings and to ignore, push away or brace against the painful ones. Unfortunately, resisting our painful feelings only makes them stronger.

So, what if we made the counter-intuitive decision to stay present to whatever we feel, whatever is, and even to welcome our painful feelings? What if we decided to practice a kind of "inner hospitality", responding to each painful feeling as we would a small child -  noticing it, acknowledging it, welcoming it, letting it be but not letting it overrun the house? Paradoxically, what we might find if we engaged in such a welcoming practice is that the painful feelings would begin to soften or shift of their own accord.

This notion of "welcoming" is found in different forms in many schools of psychology and spirituality. Basically, it comes down to a few simple, though not necessarily easy, steps:

1.  Focus and sink in. Feel the feeling. Don't ignore it, run away from it or fight it. Stay with the experience until you really feel a connection to the physical sensations of the feeling in your body. 

2.  Accept and welcome the feeling. In the midst of your upset, accept and welcome how you feel. Embrace your feeling with love, kindness and warmth. Say, "welcome", to it and experience the welcoming home of this part of yourself.  "Welcome, fear." "Welcome, anger." "Welcome, sorrow." 

Remember that you're not welcoming an event or circumstance but rather your feeling response to it. For example, the welcoming practice is not about welcoming an illness or injury or losing your job or being abused but about welcoming your feelings about those circumstances.

3.  Swing gently and slowly, back and forth between sinking into the experience and welcoming it, until the feeling softens or shifts or, as one writer says, "until the knot begins to dissolve".

This welcoming practice is not about analyzing or justifying our feelings. It's not about trying to change or fix them. It's about be-ing with them and welcoming them home so we can receive their messages and make them part of our wholeness. When we welcome our feelings in this way, we can stay present to ourselves and what is, no matter what our circumstances. And, as we stay present, we will find that even our painful feelings are ultimately transient.

The 13th Century poet, Rumi, seemed to understand this idea of "welcoming what is", into our lives. Here's how he described it in his poem, The Guest House:

This being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,

some momentary awareness comes

as an unexpected visitor.

Welcome and entertain them all!

Even if they are a crowd of sorrows,

who violently sweep your house

empty of its furniture,

still, treat each guest honourably.

He may be clearing you out

for some new delight.

The dark thought, the shame, the malice,

meet them at the door laughing and invite them in.

Be grateful for whatever comes

because each has been sent

as a guide from beyond.

If you would like to know more about the idea of welcoming painful feelings, from a couple of different perspectives, you could read Eugene Gendlin's book, Focusing, or Cynthia Bourgeault's writing on the Welcoming Practice in Centering Prayer.

  

Caveat:  This welcoming practice is probably not the best practice for anyone who is acutely traumatized, actively misusing substances, in early recovery, clinically depressed or with a history of psychosis or difficulty tolerating their own feelings. If you fall within one of these groups, talk to your family physician or therapist before beginning an ongoing welcoming practice.

My Favourite Comfort Books ...

Hello, everyone!

My apologies for the hiatus in posting. It's been a particularly busy month with workshops and talks interspersed with treatment for my recently diagnosed normal-tension glaucoma. I'd forgotten, (with the same kind of denial a mom uses to "forget" the pain of labour so she can do it again), how time-consuming specialists' visits, tests and treatments for chronic conditions can be. While I have some vision loss in one eye, my pressures have stabilized, I've managed to avoid surgery and I have time, once again, to enjoy writing some holiday posts (and perhaps, some new workshops for 2015).

Reading has always been one of my favourite comfort activities so I thought I'd share with you a list of my favourite "comfort books" for your own reading pleasure and, perhaps, for holiday gift-giving:

1.   The Guernsey and Potato Peel Pie Society by Mary Ann Shaffer and Annie Barrows (2009)  I hugged this book when I finished reading it for the first time in 2009 and I've read it at least twice since. Set in 1946 and beyond, the story is revealed through a series of letters between an author, Juliet Ashton, who is searching for ideas for her next book and members of the Guernsey Literary Society. Fascinated by the people she is meeting through the letters, Juliet decides to go to Guernsey to meet her new friends. This book describes both life in WW II, German-occupied Guernsey and the invincible spirit, humour  and honour of the people who lived through those times.

2.  The Two of Us: My Life With John Thaw by Sheila Hancock (2004) This wonderful biography/autobiography of British actor, John Thaw, (Morse, Kavanaugh QC, Goodnight, Mr Tom) by his wife, Sheila, (also a well known British actor) provided me with unceasing comfort and the affirmation that I wasn't losing my mind through the early years following my husband's death and I still pick it up from time to time ten years later. It, in concert with its sequel, Just Me, is the best book on spousal grief I've read. Interspersed with stories of their early lives are moving, emotionally honest, italicized segments from Sheila's journals, tracing John's diagnosis with cancer, Sheila's caregiving and her early struggles with bereavement. A sometimes painful but ultimately heartwarming story of strength, hope and deep spousal love.

3.  Listening Below the Noise: A Meditation on the Practice of Silence by Anne LeClaire  (2009)  This eloquent little book sits on my bedside table and I dip into it from time to time just to enjoy the beauty of the writing, let alone the wisdom of the words. Anne LeClaire, a novelist and journalist, shocked her husband, children and friends by deciding to spend every 1st and 3rd Monday in silence. To say that it disrupted the pattern of their lives is an understatement and there was plenty of pushback. But eventually, they  began to learn what she was learning - that in silence lies joy and a much deeper connection with oneself, with others and with Nature.

4.  Kitchen Table Wisdom: Stories That Heal by Rachel Naomi Remen, MD  (1996/2006) My husband read this wonderful storybook before I did and couldn't resist interrupting what I was doing to read lengthy excerpts out loud. Rachel Remen, a physician, medical educator and patient with a severe chronic illness, writes stories of hope, humour and joy that remind us that even the worst circumstances can bring us experiences of mystery and growth. These stories were a source of comfort and healing as I recovered from my second bout of compassion fatigue.

5.  To Bless the Space Between Us: A Book of Blessings by John O'Donohue (2008) I love this book of blessings and have quoted it often in my workshops and in this blog. John O'Donohue describes a blessing as a circle of light drawn around a person to strengthen, heal and protect. His blessings, steeped in Celtic spirituality, offer comfort and encouragement in situations as varied as beginnings, desires, thresholds, homecomings, states of the heart, callings and endings. 

6.  Enchanted April by Elizabeth von Arnim (1922/2014) This is a gentle story of four very different women from 1920's London who travel to Italy to escape loneliness, sorrow, dreariness and the dissatisfaction of exploitative and overbearing relationships. Once away from the unending winter and greyness of their lives in England, they settle into the sunny warmth, simplicity and undemanding rhythms of a country guesthouse and slowly begin to come to life. I love the book and the British movie by the same name and return to both again and again.

7.  Winter Solstice by Rosamunde Pilcher  (2000) Written in Rosamund Pilcher's warm and evocative style, this story of later-life love, loss and healing weaves through difficulties and tragedy to a thoroughly satisfying Christmas ending in a rambling house in Northern Scotland. If you're looking for an easy and predictable but heartwarming read to help you transition to the spirit of the holiday season, this is it.

8.  Why I Wake Early: New Poems by Mary Oliver (2004) Anything by Mary Oliver is comfort reading for me. I especially like this volume which includes poems on crickets, toads, trout, lilies, goldenrod, bears, greeting the morning, watching the deer and lingering in happiness. Reading Mary Oliver is like going for a silent walk through woods and meadows with a very dear friend - absolutely perfect.

9.  Girl of the Limberlost by Gene Stratton-Porter (1909) I first read this inspiring book when I was about ten or twelve years old. It tells the story of Elnora Comstock, an impoverished girl living in the Limberlost who, despite her father's tragic death and her mother's strict and bitter parenting, manages to "lift herself above her station", excel at school and become a gifted violinist. Any time I feel discouraged about life, I go back and reread the story of this spunky young woman who overcame so much to find the happiness she sought.  

10.  Christmas With Rosamunde Pilcher by Rosamunde Pilcher  (1997)  I'm not sure why I love this book so much but every year I bring it down from the bookshelf on the last Sunday in November to mark the beginning of the holiday season. I settle in front of the fire with a glass of eggnog and with Marty Hagen's Night of Silence playing on the stereo and carefully turn the shiny smooth pages taking in exquisite photos of winter in Scotland and of the Pilcher family preparing for and enjoying their family Christmas. Then I snuggle more deeply into the chair to read from the last third of the book, a lesser-known Pilcher short story, Miss Cameron's Christmas. This gentle tale of family caregiver, Miss Cameron, and of the kindness of neighbours at Christmas time never fails to lift my heart and to begin the season on exactly the right note.

So, these are ten of my favourite comfort books. What about you? Are there stories you might like to re-read yourself or to give friends, children or grandchildren as a gift of comfort this holiday season?

Which Wolf Will You Feed? ...

It's been a hard few weeks. Our lives have been shaken by the deaths of 24 year old Canadian Forces Cpl Nathan Cirillo and 53 year old Warrant Officer Patrice Vincent. Many of us have been feeling the effects of secondary traumatic stress as we've been exposed, again and again, to the details of their deaths and the aftermath.

Those of us who know about secondary traumatic stress have tried to respond by focusing on good self care and on gathering with loved ones for comfort or to talk about our thoughts and feelings (though, hopefully, without re-traumatizing each other through the sharing of "gory details"). We've exercised in order to shift some of the trauma energy from our bodies and we've used spiritual practices like meditation and yoga to lower our general level of fight/flight arousal. We may even have tried to teach others to do the same.

But how do we go deeper in our responses, now, now that a little time has passed, the initial shock is wearing off, the funerals and commemorations are done and the families and friends are settling into their long bleak journeys of bereavement? What can we do in our own lives to help prevent such incidents from happening again?

In the months after 9/11, a wisdom story circulated widely that may shed some light on how we can begin to make the changes we would like to see in the world:

A Native American grandfather was speaking to his grandson about violence and cruelty in the world and how it comes about. He said it was as if two wolves were fighting in his heart. One wolf was vengeful and angry, and the other wolf was understanding and kind. The young man asked his grandfather which wolf would win the fight in his heart. And the grandfather answered, "The one that wins will be the one I choose to feed."

And here lies the challenge. Which wolf will we choose to feed as we continue to respond to the events of the past weeks?

Pema Chodron, an American Buddhist teacher living at Gampo Abbey, Cape Breton, reminds us that if we want to see change, we must be the change we want to see in the world. She offers us the following pathway for recognizing how our own words and actions may be causing suffering and leading to aggression and violence. She shows us a simple, though always not easy, way of "feeding the kind wolf":

1.  Make a commitment to ourselves to let go of old grudges, to not avoid people and situations and emotions that make us feel uneasy, to not cling to our fears, our closedmindedness, our hardheartedness, our hesitation. 

 2.  Be honest with ourselves. Most of us have gotten so good at empowering our negativity and insisting on our rightness that the angry wolf gets shinier and shinier, and the other wolf is just there with its pleading eyes. But we're not stuck with this way of being. When we're feeling resentment or any strong emotion, we can recognize that we are getting worked up, and realize that right now we can consciously make the choice to be aggressive or to cool off. It comes down to choosing which wolf we want to feed.

3.  Experiment with interrupting our automatic reactions to the things that push our buttons and make us angry. Learn to pause. Pausing creates a momentary contrast between being completely self-absorbed and being awake and present. We just stop for a few seconds, breathe deeply, become present and move on. Practice this several times every day and then when highly charged situations come along, we can shake up our ancient fear-based habits by simply pausing and waking up. 

4.  Access the 3 basic qualities of being human, natural intelligence, natural warmth and natural openness to help us to feed the kind wolf. When we are angry, when someone says something we don't like, when we want to get even or when we want to vent, we can use our natural intelligence to help us solve problems rather than making them worse,  we can use our natural warmth to love, have empathy, laugh, feel gratitude and appreciation and tenderness, and we can use our natural openness to think expansively, flexibly, curiously and within a stance of pre-prejudice. (Adapted from Pema Chodron)

We can each make a difference in our individual lives and relationships and those individual actions can  add up to make a difference in our society. Each time we choose to feed the kind wolf over the aggressive one, we take one more step toward peace.

If you would like to read more of Pema Chodron's thoughts on choosing new ways of being, try reading her 2009 book, Taking the Leap: Freeing Ourselves from Old Habits and Fears.

Memories of Thanksgiving...

If the only prayer you ever say in your entire life is

 thank you,

it will be enough.

Meister Eckart

Happy Thanksgiving, everyone! 

I hope you've had a richly happy holiday weekend no matter where you've been - gathering with loved ones, caring for an ill relative alone at home or working shift at a local hospital or firehall keeping us all healthy and safe.

For me, one of the highlights of Thanksgiving weekend is going to the big Cathedral downtown with family and friends to sing generations-old harvest hymns and see (and smell) the colourful displays of flowers and produce lining the chancel steps. The intentional focus on gratitude, particularly for fruits of the earth to share with others, is grounding and revitalizing. 

This Thanksgiving, theologian, The Rev Dr Ellen Clark-King, drew our attention to how easy it is to become focused on the stresses of life and lose sight of the enormous number of things for which we can be grateful:

When were you last truly thankful? Not just thankful because it was the appropriate social response, not just saying the words with your lips, but feeling that deep gratitude within the centre of your being. When was that? What provoked it? How did it feel? Who did you share it with? What difference did it make to your day or your week or your life? Revisit that feeling, hold it again.

To be honest, I couldn't immediately bring to mind the particular time I'd last felt that grateful. I did get there after a few moments but for someone who writes a gratitude journal most nights, I was surprised at the pause in my remembering. So surprised, in fact, that when I got home, I made a point of pulling out gratitude journals from years past and reminding myself of the particular things for which I'd been whole-heartedly grateful for over the years. The first journal I read was from 1998, the year after my husband, Derrick, was diagnosed with viral cardiomyopathy (progressive weakening of his heart muscle).

Despite watching his diminishing strength and abilities and grieving for the many changes in our lives together, the journal entries of that year reflected the joy of simple things - a slow walk by the lake on a fall morning, a quiet cup of tea together in the mid-afternoon, a short visit with friends, the discussion of a new book. My entries for Thanksgiving Day 1998 included more simple gifts, each one worthy of re-membering:

1.  The beauty of the first frost and the leaves beginning to change

2.  A lovely country Thanksgiving service at little St Oz even though I had to go alone

3.  The feel of Derrick's hand on my face

4.  Derrick feeling strong enough to help with dinner and the fun we had in the kitchen.

5.  Thanksgiving dinner with all of us around the table.  

Being truly grateful is both a spontaneous heart response and a habit of mind. Learning to open ourselves to deep gratitude, intentionally taking in the good of those experiences, and then making time to remember our thankfulness can do much to shape the quality of our lives. For some whose circumstances are painful or exhausting or feeling hopeless, though, it can be hard to imagine such an upsurge in thankfulness as Ellen describes. For you, especially, may the last words of her address hold true:

So hold again that memory of a time when you were truly thankful. Open yourself again to that feeling. Take that with you into this holiday and into the week ahead. Let it live in you and through you, let it touch those around you ... so a thanksgiving day can become a thanksgiving life.

A New Book for Your Fall Reading:

Hi Everyone!

I'm just back from a walk at the lake where I could see my breath for the first time this fall and where I wished I had thought to bring along a pair of gloves! As I walked in the early morning light, I was thinking about compassion fatigue and chronic sorrow resilience and how important basic information is to our ability to heal and come back from the secondary trauma and accumulated grief of our helping work.

In the early 1980's, complex trauma author, Jane Middelton-Moz, called basic information about trauma and grief healing, a cognitive life raft. A cognitive life raft is an intellectual understanding of the healing process that acts as a secure base when the experience, itself, feels overwhelming. It reminds us that our feelings and responses are natural and understandable within the context of our experience.

This week, an excellent book by Boston-based psychiatrist and trauma expert, Bessel van der Kolk, became available, adding a new source of information for building our cognitive life rafts. The book is called,  The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. I'm about half way through it and couldn't wait to let you know how good it is.

Reading like a novel, this well-reviewed book (the "Advance Praise" pages read like a Who's Who of the trauma and mindfulness worlds) covers Dr van der Kolk's evolution in understanding of trauma over 30 years as a clinician and researcher. It explores the world of trauma healing under headings such as:

1.  The Rediscovery of Trauma

2.  This is Your Brain on Trauma

3.  The Minds of Children

4.   The Imprint of Trauma

5.   Paths to Recovery

The chapter on recovery includes sections on trauma language, the legacy of inescapable shock, EMDR, trauma-sensitive yoga, self-regulation, rewiring the brain, finding your voice through theatre, and making choices about trauma treatment as a society. There is an emphasis on the individual nature of treatment - one size does not fit all and psychopharmacology, in particular, should only be an adjunct to a larger individualized recovery plan.

This book is a great starting place for trauma survivors, their families and support systems. It offers a clear "big picture" of current trauma understanding and treatment practices in language that is utterly accessible and pleasurable to read. It is a great synthesis of history, research, neuroscience and story, written in the voice of a true story-teller. It begins like this:

The Tuesday after the Fourth of July weekend, 1978, was my first day as a staff psychiatrist at the boston Veterans Administration Clinic. As I was hanging a reproduction of my favourite Breughel painting, "The Blind Leading the Blind", on the wall of my new office, I heard a commotion in the reception area down the hall. A moment later a large, disheveled man in a stained three-piece suit, carrying a copy of Soldier of Fortune magazine under his arm, burst through my door. He was so agitated and so clearly hungover that I wondered how I could possibly help this hulking man. I asked him to take a seat, and tell me what I could do for him.

His name was Tom. Ten years earlier he had been in the marines, doing his service in Viet Nam. He had spent the holiday weekend holed up in his downtown Boston law office, drinking and looking at old photographs, rather than his family. He knew from previous years' experience that the noise of fireworks, the heat, and the picnic in his sister's backyard against the backdrop of dense early-summer foliage, all of which reminded him of Viet Nam, would drive him crazy. When he got upset he was afraid to be around his family because he behaved like a monster with his wife and two young boys. The noise of his kids made him so agitated that he would storm out of the house to keep himself from hurting them. Only drinking himself into oblivion or riding his Harley-Davidson at dangerously high speeds helped him to calm down...  

and the last page includes these words:

Trauma constantly confronts us with our fragility and with man's inhumanity to man but also with our extraordinary resilience. I have been able to do this work for so long because it drew me to explore our sources of joy, creativity, meaning and connection - all the things that make life worth living. I can't begin to imagine how I would have coped with what many of my patients have endured, and I see their symptoms as part of their strength - the ways they learned to survive. And despite all their suffering many have gone on to become loving partners and parents, exemplary teachers, nurses, scientists and artists...

... Trauma is now our most urgent public health issue, and we have the knowledge necessary to respond effectively. The choice is ours to act on what we know ... 

Go out and buy or borrow a copy of this book. You won't regret it.

  

A New Study: Mindfulness for Mothers of Severely Disabled Children ...

Mindfulness is like that - it is a miracle which can call 
back in a flash our dispersed mind and restore it

to wholeness

so that we can live each minute of life.

Thich Nhat Hanh

Are you caring for a child with severe disabilities? Family caregiving can be hard work at the best of times but caregiving for a child or adult child with a severe disability takes an extra toll. Mothers of children with autism or other neurodevelopmental disabilities report high levels of stress, burnout, compassion fatigue, chronic sorrow, depression, and anxiety, all of which can have an impact on your wellness and resilience and on the way you care for your child.

A new study in the journal Pediatrics suggests that both mindfulness and positive psychology techniques can help to reduce your stress. Researcher, Elisabeth Dykens, and her colleagues randomly assigned 243 mothers to a six-week group treatment program employing either mindfulness techniques like deep-belly breathing or to a group using positive psychology exercises focused on building virtues like gratitude and patience. Trained mentors who also had children with disabilities led the weekly hour-and-a-half sessions. The mothers completed mental health assessments before, during and up to six months after the study. 

Before the study, 85% of the mothers reported significant levels of stress. Forty-one percent suffered from anxiety disorders and forty-eight percent were diagnosed as clinically depressed. (Chronic sorrow was not assessed perhaps altering the number seen as depressed.) 

In the mindfulness group, mentors used the Mindfulness-Bassed Stress Reduction Program (MBSR) developed by Jon Kabat-Zinn to teach breathing awareness, movement and meditation techniques. The specific techniques taught included breathing exercises, self-observation without self-judgement, loving-kindness meditation and Qigong (an ancient Chinese health care system integrating gentle movement, breathing techniques and focused attention) among others.

The positive psychology group learned techniques for dealing with feelings of guilt, worry, and pessimism. The techniques included exercises for identifying character strengths and fostering gratitude, forgiveness, grace and optimism.

Both treatments worked. Participants reported fewer feelings of anxiety and depression and fewer unhealthy parent-child interactions. Mothers slept better and experienced greater life satisfaction during and after the six week groups.  Some continued to improve over time.

Some differences were also noted in the effectiveness of the two groups. The mindfulness group showed more immediate improvement in anxiety, depression and insomnia, possibly due to the immediacy of the autonomic nervous system shift from fight-flight-freeze response to relaxation response. The positive psychology group, on the other hand, took longer to show results but the improvements in life satisfaction and depression were greater.

The study concluded that because both groups saw significant improvement, programs integrating both meditation and positive psychology should be developed.

I think this study provides evidence of a hopeful and practical means of calming the nervous systems of family caregivers, building resilience and improving quality of life. But many of you will look at it and say, "So, who has time to fit this into my already crowded day?!" And you will be right. Few caregivers can "find" the time for new practices like these. It will be more a matter of "carving out" time - giving up something else in order to make room, doing two things at once (eg meditating for the 20 minutes it takes to cook your potatoes), or asking a friend to be with your child as you practice.) However you do it, I think the benefits of adding practices like these to your life might just be worth a try...

*** Caveat:

Please remember that there are those who should not practice mindfulness meditation without first being assessed by their family physician or therapist. They include those who:

• have a history of mental illness or posttraumatic stress
• with thoughts of suicide
• misuse alcohol or other drugs
• are in the first year of addiction recovery
• are troubled by trauma triggers
• have difficulty maintaining a strong sense of self when quiet or alone.

The Rhythms of Nature ...

(

The summer ends and it is time

to face another way.

Wendel Berry

Hi everyone!

It's a beautiful autumn day here in Vancouver - warm and sunny but with a edge to the breeze that reminds me of cooler days to come. This week, I've been taking an online course on the relationship between nature and spirituality and I was struck by this description of the rhythm of the seasons:

When we pay attention to the rhythm of the seasons we learn a great deal about the rise and fall of life, about emptiness and fullness. Spring invites us to blossom forth, summer calls us to our own ripening, autumn demands that we release and let go, and winter quietly whispers to us to rest, to sink into the dark fertile space of unknowing, releasing the demands of productivity and calendars and to do lists and to simply be.

                                                                                                      Christine Paintner

I don't know about you, but that's not the normal pattern of things for me. Autumn and winter are far more likely to be times of compressed do-ing than quiet be-ing. And yet, what a gift we would give to our spirits and bodies if we could follow the natural rhythms of nature and allow a time of fallow, a period of rest that restores our ability to bear fruit.

What if the fall and winter months brought with them an invitation to be less busy, to move inward to a time of quiet, introspection and re-creation?  What if we decided to hibernate, to restrict our kids to a single outside activity per season, said no to recreational screen time and graciously refused a few of our social invitations. What if we made more time for quiet reading, conversation, long walks in the woods and hot drinks by the fire? What if there was sufficient spaciousness for deep reflection, heart connection and even the odd nap?

Now, for some of us, a season of surrender and hibernation could be terrifying. I heard in a CBC radio interview this week that someone had done a study offering participants the choice between a mild electric shock and the boredom of fifteen minutes in a quiet environment and a large percentage actually preferred the electric shock! Are we becoming a society hooked on busyness and stimulation? Perhaps a return to the patterns of nature might allow us to shift our nervous systems back from chronic sympathetic ("flight or flight") arousal to a calmer relaxation response.

I wonder which season would describe your life experience this fall? Are you in sync with the natural flow? Can you be? What (if anything) might you want to change to create a closer parallel between your life and the seasonal rhythm?

Summer Harvest: Or What I (Re)Learned On Summer Vacation ...

Hello, everyone!

I'm back from an unexpectedly busy summer and enjoying the quickening of heart and mind that always seems to accompany this time of year. As the days of summer shorten and I gear up for fall workshops, I find myself reflecting upon the things I've learned (or re-learned) this summer -  the fruits of my summer harvest.

1.  Remember to rest: 

This year's vacation began with two wonderful weeks at Kahshe Lake in northern Ontario. There, my body relaxed and I was reminded, once again, of the importance of rest and respite. Sitting on the deck, doing nothing, wrapped in the piney fragrance of sun-warmed trees is one of the most restorative things I can imagine and yet I can lose track of my need for this deep rest once I move into the busyness of the teaching season.

This year, I've decided to build rest days into the calendar in advance. On these days, I will stay at home by the fire, be silent, avoid screen and phone time, eat pre-prepared meals, perhaps read bits of poetry or fiction, and mostly, just rest. (I did learn this lesson more than ten years ago when my husband was ill but it seems that it takes intentionality and commitment to remember to use it during my busiest times.)

Perhaps you'd like to join me in honouring our universal need for rest and re-creation this fall? If your life won't accommodate a full rest day, perhaps a half day, or a couple of hours, or 30 minutes every morning or a 10 minute power nap in the afternoon would be a place to start ...? The important thing is to choose what works for you and then protect the time to do it.


2. Recommit to a spiritual practice:

As I've said elsewhere, most people believe that we have a spiritual life to tend as well as physical and psychological ones. After a very full late summer with considerable family caregiving and much writing, I found that I had lost the rhythm of two of my much-needed spiritual practices. I was falling asleep during (or sleeping right through) my early morning meditation/prayer time and I was skipping my treasured walks at the lake. (Not a good sign when fall's busyness hadn't yet begun!) Fortunately, I was able to get some rest, and with rest came the desire to refocus on this vital piece of self-care.

Research tells us that developing and maintaining a regular spiritual practice is important for our wellbeing if we want to work with people who are traumatized. Spiritual practice creates space - space for healing and transformation and space for building resilience. Whether you meditate, practice centering prayer, commune with nature, write a gratitude journal, read inspirational writings, dance or sing, or practice a nightly examen, consciously attending to your spiritual life can go a long way toward mitigating compassion fatigue.

If you have had a regular spiritual practice in the past but have let it slip away, why not consider beginning again this fall? First, take some time to consider why you are not practicing now. Has your life changed? Did you become bored with the practice? Was it not a good fit in the first instance?  Once you know why you stopped, begin again or do some exploring to discover new possibilities. Be sure to choose a practice congruent with both your personality and your current life circumstances.

As I re-learned when I returned to my regular practices last week, taking the time to deepen your spiritual life positively affects every other aspect of your being.


3.  Make heart connections with supportive people:

Isolation is both a source and consequence of compassion fatigue. When we hide painful emotional responses to our work, either in the name of strength and stoicism or because there's no energy left to connect with our support systems, we increase the likelihood of being traumatized. And when we become traumatized, we are likely to isolate and hide our trauma for all the same reasons. Isolation becomes entwined in the experience of compassion fatigue and healing involves connecting or reconnecting with loving, responsive supporters.

I felt a measure of this isolation recently, first as I supported an elderly friend for five weeks following emergency surgery and then, as I companioned extended family following a loved one's life-threatening post-transplant lung infection. In the days before I knew about compassion fatigue, I might have spiralled into a state of exhaustion and depletion. Fortunately, these days I can recognize when my early warning signs are saying, "Enough!"  One of those early warning signs is realizing that I haven't had contact with anyone on my KIT (Keeping In Touch) List.

My husband introduced me to the idea of keeping a KIT list. He kept a list of 6 or 8 good friends front-and-centre on his desk and committed to contacting each one at least once a month so that his important relationships could be regularly nourished. Sometimes, he wrote them "proper letters" with envelopes and stamps; sometimes they had coffee or lunch; sometimes they went for walks, hikes or a bike rides; and sometimes they just enjoyed short or protracted phone conversations. The point was that he was intentional about having regular heart-to-heart connection with people who mattered to him. It is this kind of connection that reduces stress and protects both our physical and emotional health. If the idea appeals to you, why not give it a try?


So, these are a few of the summer's lessons for me. What about you? What has been your summer harvest?

Mid-Summer Messages 2014 ...

Hello, everyone,

Just a brief midsummer note to pass along some important messages and to say that I hope you have been able to enjoy some respite time for rest and re-creation these lovely sunny days. Often, as I re-discovered this week, it's our willingness to look outside the box of our usual activities and schedules that allows us to carve out a little space for ourselves.

This is always a busy time of year for me - writing to do, workshops to advertise, handouts to update, registrations to organize. On top of that, for the past 5 weeks I've been carepartnering an 81 year old friend who had emergency surgery while I was away at the cottage this summer. It's been hectic and I find that I can get so caught up in the organized chaos that I can forget that the sun is shining out there and that I need to take advantage of this beautiful city before the rains come. That thought came to me (once again) in the early hours of yesterday morning and so, when my friend, Sandra, mentioned going to see Walking the Camino: Six Ways to Santiago at the VanCity Theatre last night, I bit the bullet and asked to go along.

What a great decision and what a wonderful evening! Not only was the VIFF-selected film beautifully photographed, written and edited, (and the theme of slowing down didn't hurt either!) but our walk through Granville Island, the ride across False Creek on the Aquabus as the sun was setting, and the further walk up Hornby, down Davie and up Seymour gave us the opportunity to see a broad cross-section of Vancouver's eclectic summer life. The trip back was just as lovely and made more so by our stop at the GI Gelato and Coffee House for a carmel ripple gelato cone to lick as we walked along the seawall and talked. It was such a good choice to make space for feeding my senses and spending time with a good friend, even though I thought I was "too tired"and "too busy".  This morning, I feel re-energized and ready to take on the world.

That said, I have some news for you:


1.  David Daniels (see my previous post) has done extremely well following his open heart surgery and is already attending Enneagram meetings so thank you so much for all the prayers and positive intentions that helped to carry him and his family through.


2.   Unexpectedly, I have had to change venues for my fall workshops and the change has caused an alteration in the workshop scheduling. The great folks at Christ Church Cathedral, in the midst of downtown Vancouver, at Burrard and Georgia Streets, have come to my rescue with the offer of their beautiful Park Room, but scheduling has suffered a little:

a.  The October 3rd family caregivers workshop will be moved to the New Year. (Date and venue tba)

b.  The Caring On Empty Workshop for Helping Professionals will be held on Saturday November 8 rather than Friday November 7 as previously scheduled.

c.  The Introduction to the Enneagram Workshop will still be held on Friday November 28.

I'm very sorry for the inconvenience for any of you who have already made plans around the original dates.


Brochures for the fall workshops will be available by the end of the month. If you wish to be added to the mailing list, please email me your personal email address at caregiverwellness@shaw.ca

Intentions for David Daniels ...

Hello, everyone,

A few posts ago, I wrote about the new Enneagram website at Enneagram Worldwide. In that post, I mentioned Dr David Daniels, professor of clinical psychiatry and behavioural sciences at Stanford School of Medicine, one of my beloved Enneagram teachers and mentors, and the author of The Essential Enneagram.

This evening I received an email from Terry Saracino, President of Enneagram Worldwide, sharing the news that David will be having a mitral valve replacement on Tuesday July 15th, his second open heart surgery in two years.

Terry has asked for our prayers and positive intentions for David and his family and I echo that request here. David is enormously grateful for the support already beginning to pour in from around the world. His family have requested that those of you who know David follow his progress in the journal entries on CaringBridge rather than contacting him directly. Just use the CaringBridge link and type in David Neil Daniels to reach his private webpage. (There are two David Daniels webpages so be sure to type in his middle name.)

David has touched many, many lives over the years through both his writing and teaching. Those of us in the Narrative Tradition community of Enneagram teaching have benefitted beyond words from his quiet wisdom, wry sense of humour and consummate skill at interviewing panel participants. Having had the honour of being a participant on two of his panels, I can say that they are nothing short of life-changing. We need many more years of his warm and loving presence among us.

Thank you so much for your support for David and his family,

Jan

ps I think the whole core team at Enneagram Worldwide - Terry, Helen Palmer, Peter O'Hanrahan, Marion Gilbert and Renee Rosario - could do with our warm intentions as well. David is one of the co-founders of Enneagram Worldwide and an important component in the glue that holds the team together.

Summer Camping for Family Caregivers ...

Hi everyone!

I'm back from a wonderful two weeks at the cottage and am beginning to take on the tasks of real life again. While standing in line at the grocery store this morning, I heard the mom of a disabled child commenting to a friend that camping was great but not exactly a rest for moms. Then, later in the morning, I received an email containing the following poem written by Luci Shaw from her book, Water Lines:

Camping

The river rushes along in a hurry
to get somewhere. Our tent is pitched close;
above the oxymoron of its noisy hush
we, in folding chairs on the bank,
wait to slow down, to let the mind wander,
to to turn primitive. Simplicity
is what we say we want - the current's
single-mindedness, even its monotony.

A week goes by. It would be so good
to be aimless. To be content to be aimless.

But we are mothers, keepers of homes.
At the campsite we work to keep the firewood dry,
the butter cool, the food secure from bears.
the tent zipped against mosquitoes,
the water heating for coffee.

We are caught - neither civilized or wild.
Even in the deep forest the houses in town call us,
the families, the phone messages, the bills to be paid,
the laundry; our guilt is alive and waiting.

Out in the centre of the riverbed a single boulder,
embedded in a pebble shoal, sun-washed, gleams.


The message I took from the busy mom's comment, and the poem that followed, is that trying to maintain a normal life for families while caring for an ill or disabled loved one is hard work, even - or especially - during vacation and holiday times.

The picture above was taken of my goddaughter and her mom while we were camping at Porteau Cove many years ago. Her mom, a carepartner extraordinaire, managed to do everything mentioned in the poem and more, but I'm sure that, given half a chance, she would have hired a caregiver's caregiver to come along and allow her some time to taste the simplicity and monotony she was creating so generously for us.

So, if you're camping with a family caregiver this weekend, perhaps you could offer to cook a meal or cut some firewood or do a round of dishes so she can rest awhile in one of those folding chairs ...? She (or he) certainly deserves it!

Books For the Cottage ...

Hi everyone,

I was in the midst of packing this morning when I realized that I hadn't posted my usual summer reading list. Instead, I'll offer you the the titles I'm taking with me to the cottage. I hope something here tweaks your interest:

1.  Poemcrazy: Freeing Your Life With Words by Susan Goldsmith Wooldridge (1997) This wee book is a lovely, joyful collection of meditations and techniques for approaching the art of poetry writing. (And I love the picture on the cover!)

2.  Meeting the English by Kate Clanchy (2013) This "bright story about dark subjects" begins with the main character answering an ad - "Literary Giant seeks young man to push bathchair. Own room in Hampstead, all found, exciting cultural milieu. Modest wage. Ideal 'gap year' opportunity. Apply Prys Box 4224XXC."  This book was placed in every room of the small boutique hotel in London where my good friend, Elaine, spent the last night of her British vacation last year. She says its an easy, moving read.

3. River Flow: New and Selected Poems by David Whyte (Revised edition 2012) This is the description of River Flow copied from its back cover - River Flow contains over one hundred poems selected from five previously published works, together with 23 new poems, including a tribute to an Ethiopean woman navigating her first escalator, a meditation of love and benediction for a young daughter and a cycle of Irish poems that convey a deep love of the land and a lifelong appreciation for its wisdom.

4.  Learning to Walk in the Dark by Barbara Brown Taylor (2014)  This is a spiritual exploration of the positive aspects of darkness from the New York Times best selling author of Leaving Church. She writes: Darkness is shorthand for anything that scares me - either because I am sure that I do not have the resources to survive it or because I do not want to find out. 

If I had my way, I would eliminate everything from chronic back pain to the fear of the devil from my life and the lives of those I love. At least I think I would. The problem is this: when, despite all my best efforts, the lights have gone off in my life, plunging me into the kind of darkness that turns my knees to water, I have not died. The monsters have not dragged me out of bed and taken me back to their lair. 

Instead, I have learned things in the dark that I could never have learned in the light, things that have saved my life over and over again, so that there is really only one logical conclusion. I need darkness as much as I need light.

5.  Hunting Shadows by Charles Todd (2014) This is the latest in the Inspector Ian Rutledge mystery series, set in post WW I England. Inspector Rutledge has returned from war suffering from severe posttraumatic stress and the series investigates the usual number of murders and other crimes in tandem with the process of Rutledge's emotional suffering and healing. This edition is set at Ely Cathedral in Cambridgeshire, a community I know well from visits with my husband's dear cousin, Evelyn. I will enjoy reading the descriptions of familiar haunts.

That's it for me. Off to finish packing! Again, happy summer to you all!





    

A Summer Vacation ...

Hello, everyone!

It's hard to believe that half the year has passed already and that, after a busy month of workshops, the summer stretches before me like a warm invitation.

On Tuesday morning, I'll board a plane to Toronto and then drive a couple of hours to a cottage on Kahshe Lake for a two week visit with dear friends. The cottage is my "safe place" - you know, the one you're asked to picture at stress reduction workshops? (All I have to do is imagine the scent of the sun-warmed pines surrounding the deck and I'm flooded with a full-on relaxation response.) I can hardly wait to settle into my deck chair with a mug of tea and a great book.

I probably won't read much of the book during the first week but just having it on my lap will help to hold space for gazing at the water and allowing the busyness of the spring to fall away. I'll bask in the warmth of the sun as I watch the eaglets in the tall tree across the bay and, as I watch, I'll feel the muscles of my neck and shoulders ease into a softness they haven't felt since this time last summer.

I am enormously grateful to have friends who are willing to share this little piece of paradise with me. But what about those of you who are unable to go on vacation this summer - those caring for ill or frail loved ones, beginning new jobs that won't accrue vacation time until next year, and those so burnt out or compassion fatigued that the mere thought of arranging a vacation is overwhelming? How can you take a refreshing break this summer?

I learned one woman's answer to this question while browsing through Living Artfully a lovely book by art therapist, Sandra Magsamen. Perhaps her answer, or some reasonable facsimile, might work for you ...

... after I read Under the Tuscan Sun - a captivating book about an American woman's soulful, life-changing adventure moving into and refurbishing an aging villa in Tuscany, Italy - I wanted so badly to pick up and travel to the Italian countryside to experience all that I had read, but that wasn't possible. So I reactivated my make-believe skills and, for an entire summer, acted "as if" I were a fresh transplant in my home away from home - Italia! My physical body was living responsibly in Maryland, but my mind and heart were otherwise happily Italian.

Over the course of several months, I learned to make all sorts of pastas and bruschettas, and immersed myself in the historical "stories" behind the recipes when I could find them. I discovered (and drank a few glasses of) Italian wines - the point was having fun, no? - while the aroma of roasting garlic and simmering tomato-basil sauce wafted beyond my home and into the surrounding neighbourhood. 

I visited local vineyards to continue my Italian-style reverie. Friends and family asked me about my sudden interest in opera and Italian films, and enjoyed the adventure I provided in the many Italian meals I cooked and wines I served. My journey became their journey, too, and all of our lives were enriched. We weren't anywhere near Europe, but it was great fun just the same! 

So, why not take your imagination in hand and, even if you can't travel physically to the place of your dreams, enjoy an "as if" summer vacation in your mind and in your own neighbourhood. Eat the meals of your favourite country or region, read its literature, listen to its music and watch its films. Immerse yourself in the culture and enjoy the journey. Happy Summer!

A New Enneagram Website ...

Hi everyone!

If you've been to any of my workshops, you'll have heard me speak about the Enneagram, an empowering system of 9 personality types that we can use to help understand ourselves (including our patterns of reactivity when we're becoming compassion fatigued or burned out), to understand others and to create a pathway for our personal growth and development.

There are several different "schools" of Enneagram study. The one in which I'm trained, and that I like best as a starting point, is The Enneagram in the Narrative Tradition. As you might guess from the name, the Narrative Tradition focuses on learning about the strengths, difficulties and life patterns of each type through listening to individuals of that type as they describe themselves. It is a deeply authentic way of studying personality type, one that spawns both self-compassion and compassion for others, particularly others quite different from us.

This week, I received an email from Enneagram Worldwide, my Enneagram trainers, with the exciting news that they have published a completely new website including Dr David Daniels' validated and reliable Enneagram Test and descriptions and videos of each type. You can find it at www.enneagramworldwide.com.

I hope you enjoy the process of discovering your type. Contrary to what some might fear, your type will not "put you in a box" but, instead, will allow you to escape the box of your unexamined personality. If you would like to attend an Enneagram beginners workshop that will help confirm your personality type and allow you to explore your type's response to change, I will be offering a Beginners Enneagram Workshop on November 28th, 2014. So, mark your calendars and if you are not already on the mailing list, and would like to be included on the list for registration forms later in the summer, just email me at caregiverwellness@shaw.ca.

(Note:  If you work for a BC health authority, it's better to give me your personal email address as many of the authorities are blocking access to emails regarding continuing education workshops.)

Incivility and Compassion Fatigue ...

Life is not so short but that there is always time

for courtesy.

Ralph Waldo Emerson

Hi everyone!

This morning I read an excellent article on incivility, published by the Ontario Medical Association Physician Health Program this spring. As I read it, I was reminded that uncivil behaviour can be an important early warning sign of compassion fatigue. When our nerve endings are frayed through secondary trauma exposure and burnout, we can find it difficult to rub up against others without creating sparks.

Reflecting on this article, I was reminded of many situations where I'd witnessed helping professionals treating colleagues, students, co-workers or patients/clients and families in ways that Miss Manners would find appalling. (And I was surprised at how clearly some of those uncivil memories were etched in my mind.)

I remembered a family physician who threw a stack of charts on the floor of the nurses station because he couldn't find a needed lab result and an ophthamologist who berated a nurse in full view of patients, visitors and staff because she couldn't find a functioning ophthalmoscope. I also remembered students  shamed during departmental grand rounds for daring to offer a different viewpoint from the traditional and a social worker who made caustic, belittling remarks to a female patient who had chosen to return home with an abusive husband. And then there was the cardiologist who arrived on the ward to see his patients during the nurses' shift-change report. Instead of asking for help, he sat within 3 feet of the nurses' meeting, with his feet propped on the table, singing loudly until someone left the report to accompany him on his rounds.

Unfortunately, I was also forced to remember my own reactive rudeness with an emergency nurse who called thirty minutes before the end of an exhausting 12 hour day shift to say that she was transferring a patient with a possible heart attack to our coronary care unit before the end of the shift. (Meaning that I would have to stay overtime to admit and settle the patient while the night nurses received shift-change report from my partner.) I was not a happy camper but I needn't have been quite so terse and irritated in expressing that unhappiness.

Civility is defined by the US Institute for Civility in Government in this way:

Civility is about more than just politeness, although politeness is a necessary first step. It is about disagreeing without disrespect, seeking common ground as a starting point for dialogue about differences, listening past one's preconceptions, and teaching others to do the same.

 Civility is the hard work of staying present even with those with whom we have deep-rooted and fierce disagreements. It is political in the sense that it is a necessary prerequisite for civic action. But it is political, too, in the sense that it is about negotiating interpersonal power such that everyone's voice is heard and nobody's is ignored.

Civility is claiming and caring for one's identity, needs and beliefs without degrading someone else's in the process.

Incivility, on the other hand, is a stressor causing both the recipients and witnesses to experience distress, anxiety, and depression and contributing to the development of psychosomatic illness, burnout and compassion fatigue in the workplace. People on the receiving end of incivility frequently feel either an immediate or a slow-burning desire to retaliate, leading to widespread conflict in and attrition from organizations.

We human beings need civil behaviour in order to build healthy communities and safe workplaces. It is a necessary prerequisite for psychological safety both in relationships and in working environments. A culture of unhappiness and under-performance will grow very quickly when incivility is allowed to take root.

So, how do we go about creating a civil workplace or community? Basically, it's a matter of good self-care and following the Golden Rule, "Do unto others as you would have them do unto you."

1.  Pay attention to your feelings and patterns of behaviour. If you're normally kind and compassionate in your dealings with others and you find yourself increasingly irritated by situations or acting out your feelings rather than talking them out, it may be time to take a break or to schedule an appointment with your trauma or grief counsellor.

2.  Practice exquisite self care and self compassion. As they say in the 12 step programs, don't get too hungry, angry, lonely or tired (HALT). When your personal needs are unmet, you are more likely to overreact to situations or act out your feelings. 

3.  Use the civil language you were taught in childhood - please, thank you, you're welcome, would you mind, excuse me, I'm sorry. Avoid obscenities, degrading or harsh language and sarcasm.

4.  Be a good steward of the environment. Clean up after yourself. Make the next pot of coffee when you take the last cup. Arrange for repairs if you break something. Replace supplies you use. Offer to pick up supplies for others when you go to a supply room or to another department. Return things you borrow. 

5.  Show respect for others. Learn people's names. Recognize others' contributions and don't take credit if the credit doesn't belong to you. Respect deadlines. Show up for meetings or to help other colleagues at the agreed-upon time. Acknowledge requests and give a time frame for your response. Recognize difficult periods in your co-workers' lives. If you've finished your work, offer to help others. 

6.  Avoid invading people's personal space.  Keep music, phone conversations and strong odours to yourself. Knock and await permission to enter. Try not to interrupt others when they're talking or working. Don't come to work with a contagious illness. Share the air at meetings.

7.  Praise in public, admonish in private. 

8.  Avoid gossip and contentious topics of conversation. ie religion, politics and sex.

9.  Be sensitive to cultural differences. Ask questions and learn more if you lack awareness. 

10.  If, in spite of your best efforts, you become aware that you have been uncivil with someone, be sure to  apologize, authentically, to the person involved to rebuild the interpersonal bridge between you.      

"Turn to the Sun" for Mother's Day ...

Hi everyone!

There's nothing better than having a positive purpose when it comes to building compassion fatigue resilience and Vancouver's Suzy Coulter has one.

In 2005, Suzy, a community nurse in the Downtown Eastside, volunteered for four months in Kismu, a city in Kenya with one of the highest HIV prevalence rates in that country. Conditions in the hospital where she worked were sketchy at best and, on returning home, she decided to raise money to help change those circumstances through establishing the Turn to the Sun project. She decided to raise and sell sunflower seedlings after meeting a Kenyan woman living with AIDS whose income generating activity included growing sunflowers for seeds. Chickens were fed the seeds and the income from selling the chickens and eggs helped support her family.

Every year since, Suzy and her friends have held sales of sunflower plants on Mother's Day weekend and donate the money to the Stephen Lewis Foundation which distributes it to grassroots projects focusing on direct care and programs for HIV/AIDS affected families.

I heard Suzy interviewed on CBC this afternoon and loved her energy, the name of her project and the great work they're doing.  If you'd like to support her and her work, why not attend one of the sales this weekend and buy a plant (or 6) for your Mom? Or even decide to join Suzy's happy band of volunteers?

Sunflower plants and a limited supply of Turn to the Sun T-shirts will be sold at:

Saturday, May 10 (10-3)
East Vancouver - 2133 7th Avenue, Vancouver
(Live music at 11:30)

Saturday, May 10 (9-1)
Chilliwack - Gwynn Vaughan Park
(Corner of Hope River Road and Williams Rd North)

Saturday, May 17 (12-3)
Sunshine Coast - 1163 Cedar Grove Rd, Roberts Creek


If your weekend's full and you just can't get there, at least take a look at the great website at:
www.turntothesun.org

Happy Mother's Day!!

The ABCD's of Compassion Fatigue ...

Hi everyone!

Despite having spent a number of years teaching compassion fatigue workshops, I'm always surprised to discover how many people believe that compassion fatigue is "a form of burnout" to be "cured" with relaxing bubble baths and hikes in the woods. So, in today's post, I'd like to spend a little time going back to the ABCD's, the basics of compassion fatigue:

A definition:  

Compassion fatigue is exactly what the words say it is:  fatigued compassion. It is the symptoms of posttraumatic stress, diminishing empathy and emotional disengagement that arise from helpers' exposure to others' suffering and trauma.

CF occurs when primary traumatic stress (the trauma we experience directly in our own lives) converges with secondary traumatic stress (the trauma we experience indirectly through knowing about trauma and suffering in others' lives) in the presence of burnout (the chronic stress of perceived workplace demands exceeding perceived resources).

Compassion fatigue is essentially a trauma issue, a normal and expectable response to caring for others in pain. It is a condition of people who care deeply about the suffering of others and who work hard to alleviate it. (You don't find compassion fatigue in people who don't care.)

Compassion fatigue lies at the far end of the stress continuum. If left unattended, can lead to physical and mental illnesses including clinical depression.

 Beware of these warning signs:

The warning signs of compassion fatigue include, but are not limited to:

• loss of sense of humour 
• emotional numbness
• incivility / emotional reactivity (compulsive or impulsive reactions to perceived threats) 
• difficulty relaxing 
• difficulty separating work from personal life
• lowered frustration tolerance / increased outbursts of anger or rage
• dread of working with certain individuals
• negative changes in worldview - tendency to see the world as an unsafe place and others as "victims" or "predators"
• ineffective or self-destructive self-soothing behaviours (eg overuse of alcohol or other drugs, compulsive spending/exercising/eating etc)
• hypervigilance (constantly scanning the environment, looking for danger to self or others)
• decreased feelings of work competence
• diminished sense of purpose/enjoyment in career
• diminished functioning in nonprofessional areas of life (eg marriage, parenting etc)
• silencing response (consciously or unconsciously preventing others from sharing painful information with you because you just can't bear to hear it anymore)
• feeling depressed
• loss of hope 

  Any one of these warning signs could indicate the presence of compassion fatigue.

Create coping skills:

Because compassion fatigue is a trauma issue, healing and resilience-building must focus on helping us cope with the intersection of primary traumatic stress, secondary traumatic stress and burnout, at home (family caregivers) and in our workplaces (helping professionals and volunteers). Empowering compassion fatigue resiliency skills can be developed in each of the following areas:

• Self-regulation:  learning to intentionally control the activity and intensity of our fight/flight/freeze response while engaged in daily living.
• Intentionality:  learning to respond intentionally (vs reacting compulsively or impulsively), in keeping with our personal values and beliefs, in response to perceived threats.
• Maturing perceptions:  learning to shift the degree of perceived threat we see in the working environment.
• Connection and support:  developing an environment or network where we feel supported, heard and cared about by colleagues.
• Self-care and revitalization: becoming stronger and more mature so we are not diminished by witnessing and absorbing the pain of those for whom we care.

 Do something about CF resilience:

If you recognize yourself in these descriptions of compassion fatigue, NOW might be the time to do something about it. Why not JOIN US for the following workshop in Vancouver, BC to discover more and to build your own resilience plan:

• Caring On Empty: Creative Tools for CF Resilience (For helping professionals and volunteers):  June 16th and Nov 8th, 2014 

 You can email me for a brochure and registration form at caregiverwellness@shaw.ca  

          

The Promise of Beginning Again ...

Hi Everyone,

A Happy Easter weekend to you all! I was thinking about Easter and Spring and the promise of new beginnings as I lay in bed this morning listening to a happy and vocal little chickadee calling for his mate.

Many of you have attended the Caring On Empty Compassion Fatigue Resiliency workshop, or have done some reading about compassion fatigue recovery and resilience, and have made plans for the small but important lifestyle changes needed to build your personal wellness. For at least a while, you were excited and enthusiastic about your plans, happy to be following ideas like "put the oxygen mask on yourself first" and "never give from the depths of your well, only from the overflow".

And then life happened. Your loved one had another health crisis. Your thesis was overdue. Your teenager got caught cheating on an exam. Your elderly mother-in-law moved in downstairs. An edict came down about working more overtime. You got sick yourself. Or you just got bored with the routine. Despite the best of intentions, your self care lapsed, quickly followed by a lapse in your self compassion. Self critical thoughts filled your head and, filled with shame at your "failure" to follow your plan, you distracted yourself by becoming busier still. Many of us can become lost in that fog of busyness and shame, forgetting that we always have the possibility of beginning again.

Beginning again has been a theme of poets and spiritual writers over the centuries. Poet, Rainer Maria Wilke, writes, Resolve to be always beginning - to be a beginner.  Jennifer Ritchey Payette says, It's humbling to start fresh. It takes lots of courage. But it can be reinvigorating. You just have to put your ego on the shelf and tell it to be quiet.  Buddhists speak of practicing "beginners mind" and the Benedictines follow what St Benedict called "a little rule for beginners". Those of you who practice yoga may be aware of tapas, meaning fire or heat, the discipline of showing up to practice again and again. 

Beginning again involves humility. Remembering that we will never be perfect at anything and forgiving ourselves for not being so. All we will ever need to be is human (by definition, imperfect) and all we will ever need do is to practice beginning again - and again and again and again ...

So, when it seems that life conspires against you and your plan, forgive yourself for giving up, re-assess, and begin again. We can begin again every day. In fact, every "failure" is a starting point. The only real failure occurs when we don't take the opportunity to start over.

John O'Donohue, one of my favourite poets, captures beautifully the feltsense of beginning again each morning in these few selected verses from his poem, Matins:


Somewhere, out at the edges, the night
Is turning and the waves of darkness
Begin to brighten the shore of dawn.

The heavy dark falls back to earth
And the freed air goes wild with light,
The heart fills with fresh, bright breath
And thoughts stir to give birth to colour...

May I live this day

Compassionate of heart,
Clear in word,
Gracious in awareness,
Courageous in thought,
Generous in love.


And may these words and images bless your beginning again - today, this Spring and all through the year.

With love,

Jan

A Kinder, Gentler Medical Curriculum ...

Hi everyone!

At the end of the month, one of my dear friends will retire from his position as an anesthesiologist and medical educator at Queens University School of Medicine. A warm, compassionate and highly skilled clinician, he has made important contributions to his field by promoting and modelling teaching excellence, developing a resident logbook, and designing and implementing professionalism training for medical students.

Over the years, Ted and I have had many conversations about how to reduce pressure and create a safe learning environment in medical schools, believing that we cannot foster civil, humane, compassionate practitioners in education systems that overwhelm, disrespect, and shame their students. While many educators are beginning to understand the importance of systems that promote student mental health and compassion fatigue resilience, there are still many places where lip service is paid to such notions while educators continue to transmit less-than-helpful values through the "hidden curriculum" of unkind teacher-student interactions and inhuman expectations.

This week, as Ted prepared for retirement, we had another chat about medical education, this time spurred by a new study by Dr Stuart Slavin, MD, MEd, associate dean for medical curriculum at St Louis University, a Jesuit institution in the US.

The paper, published in the April edition of Academic Medicine, looks at the well-being of first and second year medical students before and after changes to SLU's medical school curriculum, changes designed to prevent depression, stress and anxiety. (There is strong evidence that the seeds of these mental health problems are planted in medical school.) Student mental health was measured in 5 classes of 175-178 students - two before the changes and three after - at the medical school orientation, the end of year one and the end of year two.

Slavin says that the study showed a dramatic improvement in the mental health of the students. Depression rates in first year students went from 27% to 11% and anxiety dropped from 55% to 31%. At the same time, test scores increased, showing improved student performance. Slavin said, "Our students know more, and will be in a better situation, emotionally, to care for our patients."

In planning the study, SLU administrators asked students why they felt anxious and depressed and then designed and implemented curricular changes that would directly address the identified stressors. Without sacrificing critical educational components, SLU changed the curriculum to remove unnecessary stressors, (a far cry to the traditional wisdom of seeing stress as an inevitable part of the path to becoming a doctor), and added a required class that teaches strategies for stress reduction.

Students were taught to better manage energy by taking breaks, sleeping, eating properly and exercising; being mindful or paying close attention to what's happening in the present moment; reframing their perspective to be more realistic; recognizing negativity; controlling their reactions to situations; and cultivating a positive and optimistic outlook that ultimately leads to more happiness and personal satisfaction.

In reporting his findings, Slavin pointed out that it is important to the health care system to address depression and stress among physicians.  "Physician depression and burnout are significant problems and may rightly be viewed as a substantial public health problem, particularly given the evidence of the negative impact that mental health can have on clinical care by reducing physician empathy and increasing rates of medical error."

As we talked about this timely paper, Ted and I agreed that it was sad that such a study needed to be undertaken in the first instance but that it was hopeful and encouraging to see that long-needed changes are finally being made as he comes to the end of his teaching career. We spoke about congruence between course content and the behaviours modelled by educators and how integrity between the two makes for a mentally healthy learning environment. We also shared the hope that this sort of congruence will continue to grow as other programs modify their curriculae.

Before leaving you today, I'd like to take a moment to say congratulations, great job(!) and every good wish for a happy and healthy retirement to my friend, Ted Ashbury. Thank you for all you've done for so many years to try to make medicine a kinder and gentler profession.