Secondary trauma first aid...

My heart goes out to all people suffering the direct effects of the disasters we are seeing on TV this week.

How much the world can change in just a few days. Even though I was fairly sheltered from newspapers, internet and newscasts while I was away, just the conversations of those around me and my own naturally hypersensitive empathic responses were enough to raise my heart rate, increase my respirations and create a buzz of anxiety. (Witnessing trauma triggers old trauma responses.)

The current disasters, to say nothing of the trauma we encounter in our workplaces and caring situations at home, can combine to cause acute secondary trauma responses in our own lives even though we are not actual survivors of the disasters. What can we do to lessen the effects of the trauma we witness?

Here are a few practical tips:

1. Monitor and limit your trauma exposure through TV, the internet, newspapers, and conversations.

2. If you begin to feel anxious, stop and take a few deep breaths and relax your whole body, particularly your pelvic floor muscles, as you breathe deeply, pause, then slowly release your breath through pursed lips. (If a medical condition contraindicates this type of breathing, please make adjustments to meet your own needs.)

3. Take a walk in the fresh air every day.

4. Talk about your feelings with someone you trust to listen respectfully.

5. Draw deeply upon your spiritual beliefs and practices.

6. Do something to help someone else. It will lessen your feelings of helplessness. For example:

- Pray for them or hold them in your meditation.

- Send a donation to a reliable disaster relief organization.

- Send a note of support to someone who is directly affected by the disaster.

- Help someone in your family or neighbourhood - drive someone to a doctor's appointment, visit someone who is shut in, do someone's grocery shopping, spring clean someone's garden, do a new mom's laundry, buy some flowers for a friend who's struggling ...

7. Be close to the people who love and support you - either in person or by email, Skype/iChat or phone.

8. Ramp up your usual self care practices - trust the strategies that have worked in the past.

9. If none of these things help, consider seeing a counsellor who specializes in trauma work. There are a number of short term interventions that could be very helpful in reducing your stress.

Vacation ...

Hi everyone! Just a note to say that I will be off to Vancouver Island in the early hours of tomorrow morning to spend Spring Break with family and friends. (So, I won't be posting here again until after March 17.)

I've written, before, about how important it is for helpers to take breaks before we need them, so this week I'm taking my own advice and having a brief foretaste of what will be a longer vacation in the summer.

As someone who is self employed, I'm always surprised when salaried folks don't take their full allotment of paid vacation. (As a family caregiver, I was even more amazed!) We need these regular breaks from our caring work or we soon find that the well is empty and we have nothing left to give.

Dr David Posen offers some sage advice about taking time off in his book, The Little Book of Stress Relief:

1. Plan to take all the vacation time your employer allows. If you're self-employed, give yourself at least two to three breaks a year.

2. Spread your vacation time over the year. As soon as you return from a holiday, plan the next one.

3. Organize your work so other people can cover for you while you're away.

4. Don't take work-related material with you. This includes professional reading, laptops and cell phones. If you feel naked without that stuff, it's a chance to break your dependency - an added benefit!

5. Don't call the office and don't tell them where they can reach you. Make it a clean break.

6. Plan a light first day back to work (for catch-up and readjustment).

Now, if you're a family caregiver, some of this may not be possible. But, with some planning, most of us can get away for at least a short period. The problem is that we often wait until we're so depleted that the mere thought of making all those arrangements is more than we can handle. If this is the case for you, ask for help. Ask someone who knows your situation well to help you plan some time away. Ask them to do internet searches for locations, to make phone calls, to arrange a list of surrogate carers, to help you write down all the things that need to be done for your care recipient while you are away.

It may seem a lot to ask of someone, but the truth is that people who care about us want to help and are just looking for opportunities to be able to do something concrete. The first time I went away while caring for my husband, I called everyone I knew who was qualified to help care for him and I actually had people crying on the phone because they were so grateful to be able to do something for us.

So, again, get away before you need to and ask for the help you need to make it happen. (You'll always be ambivalent about going, especially if your loved one objects, but you'll come home refreshed and energized and full of stories that will expand and brighten your loved one's world as well.)

And, if it is truly not possible to leave right now, find a way to take small "vacations" during the day. Set the timer on the stove to remind you to go out and sit on the front steps for five minutes, three times a day. Take some slow deep breaths, notice the warmth of the sun on your face, the shape of the clouds, the sound of the rain on the path, the swelling of the buds in the garden with their promise of hope and renewal.

Survival Tips for CF Partners...

When a traumatic event occurs, the trauma survivor feels the first impact then a ripple of secondary trauma spreads out to affect his or her family and friends. That ripple then travels on to touch the helpers who have responded to the survivor's pain and on to their families and friends. And thus, trauma becomes the gift that keeps on giving.

This week, I have been asked by three different CF spouses, - two clergy spouses and one partner of a paediatrician - about ways of dealing with the impact their partners' compassion fatigue. To my knowledge, there's not been any research done in this area yet - so I spent some time thinking about my experience of my own husband's CF and that of former clients who had had compassion fatigued partners. I also looked at the literature on spouses of persons with depression, chemical dependency and primary posttraumatic stress. From these sources I've drawn together a list of possible "survival tips", some of which could be helpful to you or your partner:

* Educate yourself regarding your spouse's CF. Remember that your partner's CF is not your fault - you didn't cause it, you can't control it and you can't cure it. Make age-appropriate explanations of your partner's behaviour to your children.

* Consider your own trauma history. It is natural to experience a full range of emotions regarding your partner's CF symptoms. However, if you think you are over-reacting emotionally, if you find yourself medicating your emotions, or if you are tolerating verbal or physical assaults or persistent emotional neglect, these may be signs that the current situation is stimulating old trauma in your own life. If you have not yet dealt with your personal trauma history, consider seeing a qualified mental health professional in order to understand your responses and gain support.

* Recognize symptoms of CF (diminished capacity for empathy, less compassionate behaviour, dreading/ feeling trapped at work, pushing oneself to keep working despite signs that it is proving harmful, nightmares about work, flashbacks, irritability, nervousness, sleep disturbance, exaggerated worry over threats to self or loved ones, avoidance of trauma triggers, physical or emotional withdrawal, emotional and physical exhaustion, self-medicating). Ask your spouse how you can best support him or her when the symptoms are activated.

* Plan undemanding, low stress activities to help the family relax and have fun together.

* Make time for self care. You will probably have to carve out time by giving up something else but you will find it's worth the effort and the loss of whatever you have to put aside.

* Build a support network of family, friends, co-workers, faith community etc for emotional support and occasional help with routine tasks or child care. Teach them about CF.

* Encourage your partner to see a CF or trauma specialist early in the CF trajectory - before CF interferes with daily activities. (Know that it might take several attempts to find the right treatment mode and therapist).

* Find a family therapist if your family finds it hard to talk to each other.

* Be clear when communicating changes you want your spouse to make. He or she cannot read your mind.

eg - Cutting down drinking or other drug use to x amount

  - Caring for the children x hours per week so you have time for yourself

- Acting less irritable with the children and showing more interest in them

- Once recovered physically, bringing in a reliable income, no matter how small

- Scheduling and showing up for date nights

- No physical acting out

* Take a pre-arranged time-out if you or your partner's reactivity begins to escalate.  

* Have a safety plan in place if your partner has a history of aggressive behaviour or if substance use makes his or her behaviour unpredictable. 

* Recognize that you have options. Almost everyone has options. If we don't recognize them, we may begin to feel trapped, which can lead to emotional numbing, depression, self medicating, paralysis, despair or even suicidal thoughts. If you can't see any options,      see mental health professional who can help you to expand your constricted world view.

 * Consider asking a CF specialist to facilitate a support or psychoeducational group for CF partners.

These are just a few ideas. Please add to the list if you know of anything else that might be helpful.

1st Compassion Fatigue Conference ...

Hi everyone! Just a note to make sure that you are all aware of the first Compassion Fatigue Conference which will be held at the Ambassador Conference Center in Kingston, Ontario on June 15-16, 2011.

The conference has been organized by my colleague and friend, Francoise Mathieu whose educational events are always stimulating and very well organized. There will be a number of excellent speakers including Laura van Dernoot Lipsky, the author of Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, plus many opportunities to network.

I am looking forward to being in Kingston, both for the conference itself, and for the opportunity to visit with dear friends in one of my favourite towns. It would be lovely to meet some of you there.

For more information or to register:

First Compassion Fatigue Conference

Photo of Kingston, ON by Bigstock Photos

Shame and Compassion Fatigue ...

Shame is an experience that has no redeeming features. It is always negative and wounding.

Shame differs from guilt. It is the sense that we are inherently flawed - that we are bad vs having done something bad. It is a feeling that makes us want to hide our real selves for fear that those around us will find us unlovable and abandon us should they discover what we are really like.

So, what does shame have to do with Compassion Fatigue? I've been thinking about that question all week and have come to the hypothesis that shame may be a major factor in maintaining CF.

The impact of shame appears at several points in the CF trajectory:

1. Early on, shame may have helped to motivate our choice of a helping career. For example, if we were shamed in a healthcare or crisis setting while young, we might, consciously or unconsciously, have become drawn to rescuing people in similar situations. If we were shamed for our dependence or weakness as children, we may have chosen work where we could experience a sense of independence, power and control.

2. Later, as we encountered traumatic events and accumulated losses in our work, shame may have kept us from sharing with colleagues our natural human responses to terrible situations. We may have come to believe that one has to appear strong and invulnerable in order to be accepted.

3. As we began to develop symptoms of CF, we may have felt that we couldn't tell anyone about those symptoms or ask for help for fear of being ridiculed or found lacking.

4. As our symptoms increased, we may have begun to realize that we could no longer care for others in the ways that we had in the past. Our capacity for empathy had disappeared. The identity that we had built as particularly caring, compassionate people had crumbled and we may have felt profound shame about no longer being the people we were "supposed to be". Judging ourselves harshly, we may have withdrawn from the very people who could have supported us.

And, thus, shame undergirds and maintains the experience of CF.

The way that most of us deal with shame is to avoid being vulnerable, as you can see above. In our North American culture, any kind of vulnerability is judged as weakness and a potential source of shame. We generally feel much safer when our vulnerability is masked by our "strength" and protected by the armour plating of perfectionism, distancing, and emotional numbing.

However, this kind of protection comes at a cost. We can lose spontaneous expression our real selves, our connection to others and our ability to tap into the strength and support of our spiritual lives. We become lonely, isolated, and empty. And we numb that pain with busyness, workaholism, and the compulsive use of alcohol and other drugs, gambling, spending, sex, exercise, and food.

So, what can we do to increase our tolerance for vulnerability and thus reduce our shame? Social Work researcher and author, Brene Brown, suggests that we can embrace our vulnerability by:

1. Practicing authenticity, courage, connection and compassion

2. Practicing gratitude

3. Honouring the ordinary in our lives rather than the extraordinary - eg nature, children, play, community

4. Allowing joy and love to enter our lives so our reservoirs will be full when bad experiences come our way.

If you would like to learn more about the impact of shame in our lives and how to build shame resilience, there are several good books on the topic:

1. I Thought It Was Just Me by Brene Brown

2. The Gifts of Imperfection by Brene Brown

3. Shame and Guilt: The Masters of Disguise by Jane Middelton-Moz

4. Facing Shame: Families in Recovery by Merle Fossum & Marilyn Mason

5. Shame: The Power of Caring (Revised Edition) by Gershen Kaufman

And if anyone has thoughts about these ideas, please feel free to comment.

Photo by Bigstock Photos

Financial Strain on Family Caregivers ...

A new poll published by the Canadian Cancer Society this month says that 88% of the 2,231 polled thought that providing care or assistance for a family member would have a negative impact on their financial situation. 57% said that it would have a major impact.

Those of us who have lived the experience might be excused for giving a hollow laugh. Could anything be more self evident? Between lost income, depleted savings, extra expenses not covered by the basic medical plan and money spent on counsellors and respite care in order to stay sane while caregiving, many families will never recuperate their financial losses. This is particularly true of families who face a lifetime of caring for an seriously ill or injured child.

Few of us would give up the opportunity to care for an ill or disabled loved one, but many would be grateful for some compensation for our losses. Family caregivers save our governments millions of healthcare dollars annually at great cost to themselves and their families. According to Statistics Canada, in 2009, the economic contribution of family caregivers in Canada was estimated to be between $25-26 billion and 65% of households with a caregiver report a combined income of less than $45,ooo. (23% reported less than $20,000!).

With an aging population and a federal election in the offing, it behooves each of us to ask pointed questions of our political parties regarding how they would increase government financial support for family caregivers.

The Cancer Society, like many advocacy organizations, has been pushing for better financial support through the federal Compassionate Care Benefit, asking for improvements including:

* Increasing the benefit period from the current 6 weeks to 26 weeks, accessible during a 52 week period.

* Increasing flexibility through allowing benefit claims for partial weeks taken over a longer period rather than blocks of weeks at a time.

* Changing the wording of the eligibility criteria from "significant risk of death" to "significant need of caregiving due to a life threatening illness".

* Amending the Canadian Labour Code to protect the jobs of caregivers.

Special provision also needs to be made for increasing support to family caregivers who are self-employed. Benefits attached to tax credits are of little use to someone who can no longer earn an income due to their caregiving.

It is said that societies are judged by the degree to which they support their most vulnerable. Most family caregivers provide generous and unstinting care for their loved ones. Can we do any less for them?

Please take a moment to call or email your local MP's office to register your concern for family caregivers and to ask what his or her party plans to do, specifically, to support them.

Photo by Bigstock Photos

A Great Nutrition Resource ...

Last Saturday, I went with my sister and her freezing cold grandson, (what is it about preteen boys and their aversion to coats??), to my first Winter Farmer's Market of the season. Up to this point I'd been eating the fruits of the autumn harvest from my own garden but pickings were getting slim so off to the Market I went with family and half a dozen cloth Market bags.

I came home with red kabosha squash, onions, potatoes, kale, carrots, apples and portabella mushrooms and, inspired by the sight and smell of all those wonderful fruits and vegetables, I've taken the time to cook and eat very well this week. (And when I eat well, I have more energy to put into my exercise routine so I've also enjoyed two yoga sessions and great daily walks at the Lake in the spring sunshine.)

There's no question that a healthy diet and good exercise are at the foundation of good physical and mental health, (to say nothing of being an important part of initial recovery from compassion fatigue), but amid all the marketing hype, how can we be sure that we're making the best nutrition choices?

One great resource I like to use as a guide is the Canadian Nutrition Action Healthletter

published by the Center for Science in the Public Interest. The Center is an independent non-profit consumer health group that advocates honest food labeling and advertising, safer and more nutritious foods, and pro-health alcohol policies. They accept no government or industry funding and are thus able to critique food products and policies honestly.

The Healthletter, which is celebrating it's 40th anniversary this issue, is a colourful, sixteen page magazine that arrives in my mailbox ten times a year full of good nutrition research, Canadian name-brand product evaluation, recipes and tips for healthy eating. It is a quick read and provides huge bang for the buck.

Some of this month's articles include:

* Unexpected: Surprise (Nutrition Research) Findings From the Last 40 Years

* Magnesium & Sudden Death

* Don't Just Walk

* Beyond Bread: Think Thin (Brand-Name Ratings of Thins, English Muffins, Bagels etc)

* Under Wraps: Healthy Fillings for Sandwiches

* Artery Crusts: An Evaluation of Brand-Name Pie Crusts

If you are interested in creating a healthier life style, why not take a look and see if the Healthletter might provide the information and motivation to help you on your way?