Friday, July 15, 2011

Clergy Compassion Fatigue ...


This September 11th, a date which she has contemplated with some wry humour, my youngest sister will be ordained priest in the Anglican cathedral in Whitehorse, Yukon, before taking up a position in her first, two-point parish in Dawson City and Old Crow.

To say that I'm excited for her is a understatement. But, reflecting on the challenges before her, (as well as the possibilities), I can't help but think about the risk of compassion fatigue for her and for all clergy, regardless of faith tradition.

Although unlikely to see themselves in this light, most clergy are trauma workers - and, depending upon their degree of involvement in their partners' ministries or their own professions, so are many clergy spouses.

The clergy work in a wide variety of settings - in parish ministry, as chaplains to the military and to other front line responders, in hospitals, in hospices, in schools, on disaster relief teams, in retreat or counselling centres and in prisons, to name but a few. In these settings, they are likely to be called out at all hours of the day and night to comfort those who are injured, ill, dying, or in spiritual or emotional distress - to say nothing of continuing to support them and their loved ones through often lengthy periods of healing or bereavement. Frequently, the people whose needs they are called upon to tend are folks intimately known to them, thus deepening the emotional impact of the work.

As trauma workers, these clergy are at risk of developing Compassion Fatigue (CF), the posttraumatic stress, "fatigued compassion", diminishing empathy, and increasing disengagement that can arise from secondary exposure to others' suffering and trauma.

Aside from trauma exposure, a number of stressors, some unique to the clergy, can increase clergy vulnerability to CF. Counsellor and United Methodist clergywoman, Sheri Ferguson, pointed out in a 2007 article, Clergy CF, the following factors:

1. Lack of adequate training and experience in pastoral care

2. Isolation
    - expectations of "perfect clergy" that prevent sharing struggles and pain
- frequent moves that prevent maintenance of sustaining relationships
- lack of access to personal mental health support in rural areas
- lack of access to mental health referrals for parishioners in rural areas

3. Personality traits - needs to rescue/caretake, have approval, be "good", be perfect

4. Church culture that reinforces caretaking and perfectionism 

- parishioners' projection of parental issues upon their clergyperson
- parishioners triangulating their conflicts by drawing in the cleric            
    - an expectation that the clergyperson, as God's representative, should be available  

I remember when my husband, also an Anglican priest and spiritual director, became very ill with mononucleosis at the advanced age of 50-something, an unrecognized symptom of his own compassion fatigue. After many weeks away from work, (mono is not an illness you want to get as an older man), and many conversations regarding his true priorities and motivations, he decided to divide each day into 3 parts and to work only 2 of the 3 parts. He also decided to take an unheard of two days off work, consecutively, each week. It took quite a while for some members of the congregation to adjust to that idea, though many saw the sense in good clergy self-care once it was explained and compared with their own lives.

So, what would I suggest to my sister and her classmates as they enter upon their new vocations?

1. That they acknowledge and heal their own personal trauma (past and current) to reduce their CF risk
2. That they engage in exquisite physical, psychological and spiritual self-care - including appropriate respite time
3. That they develop personal and professional support networks who are charged with gently, but firmly, providing feedback regarding CF symptoms and self care - sometimes, whether the clergyperson wants to hear it or not.




Wednesday, July 6, 2011

Self Care Ideas ...


Now that summer is here, the pace of life may slow enough that you can take time to assess and re-jig your self care plans. Here are some self care ideas assembled by the nursing and support staff from Alberta Children's Hospital - plus a few extras for good measure. See if there's anything here you might like to try or to share with your friends and family:


1. Meditate every day / do yoga

2. Meet a friend for coffee

3. Play frisbee with a pet / walk your dog

4. Spend some time in the mountains

5. Have a bonfire at the beach

6. Buy new lip gloss

7. Retail therapy

8. Have a hot bath with bubbles

9. Visit with someone you love by phone or on Skype/iChat

10. Snuggle under a quilt

11. Go to the airport early so you don't have to rush

12. Listen to loud music (or soft music)

13. Walk early in the quiet morning air

14. Get a haircut

15. Eat the samples at Costco

16. Work in a flower or vegetable garden

17. Go to Starbucks with a good book

18. Go for a long drive

19. Turn the TV off

20. Drumming

21. Have a clean house

22. Make popcorn

23. Mow grass or shovel snow

24. Plan a nice dinner

25. Hike or snowshoe

26. Have a family gathering (the functional ones)

27. Start a book club

28. Engage in a hobby - quilting, playing music, singing, knitting, reading, sports, painting, travel, writing, woodwork, car repair, digital photography, dancing, biking

29. Take a nap

30. Go away with friends

31. Clean the junk out of your pantry and buy fresh, healthy food

32. Laugh out loud - be willing to laugh at yourself

33. Notice and be grateful for the little things - your child's laughter, the colour of the sunset, the way your body moves

34. Plan your next vacation

35. Take yourself on a picnic

36. Be willing to receive

37. Make a list of 50 things that make you smile and post it where you can see it every day

38. Create a self care network of people who will encourage you as you improve your self care - your family, a self care buddy, members of a group to which you already belong

39. Spend an evening outside looking up at the stars

40. Explore ways to relax and become an expert

41. Create a special sanctuary at home - a room or a corner - where you can spend quiet time alone

42. Learn something new

43. De-clutter a closet or a drawer

44. Remember to breathe and breathe deeply

45. Make a gratitude journal and write down 5 things for which you're grateful every night before you go to sleep

46. Fly a kite

47. Roll all the way down a big grassy hill

48. Lie in tall grass and look at the sky

49. Pick flowers to make your surroundings look beautiful

50. Do some baking

51. Take a lovely bone china cup to work and have a quiet cup of tea and listen to soothing music for a few minutes every afternoon

52. Spend a day at the spa

53. Ask for a hug

54. Spend quality time with your partner

55. Tell someone you love them



Tuesday, July 5, 2011

Home Again...


It's always good to come home. Particularly in the early summer when the whole of Vancouver is lush and green and everyone is looking forward to a long stretch of summer days.

The Compassion Fatigue Conference in Kingston, Ontario went extremely well. It was great to network and to hear the perspectives of other CF specialists as we continue to refine our ideas about how CF should be defined and about what works in the areas of prevention, recovery and resilience.

We heard wonderful speakers - Laura Lipsky, Jack Truten, Pat Fisher, Gabor Mate and others - and Francoise Mathieu did an amazing job organizing and hosting the whole event. The atmosphere was one of excitement and affirmation and we all left looking forward to another conference next year. Over the summer and fall, I'll share with you some of the ideas and information gleaned from the talks and maybe some of you will decide to join us next year...

One of the really nice parts of the conference, for me, was hearing from three people that they regularly read and enjoy this blog. Helpers, for whatever reason, seem to be uncomfortable leaving blog comments so I was grateful to hear that someone was actually reading the posts!

On my return home, I had a few days to unpack and do the laundry and then it was time to prepare for the last workshop of the season, an evening with the Lions Gate Hospice Society. They are a great group and seemed to find the notion of CF both familiar and helpful.

Tomorrow, I will post the self care ideas from the Alberta Children's Hospital workshop, as promised, and then will be back to regular posts until I go on holiday later in the summer.

A very happy, healthy and refreshing summer to you all!





Sunday, June 12, 2011

What's Up? ...

Hi everyone! Just a quick post as I unpack from a great workshop with the nurses and their colleagues at Alberta Children's Hospital in Calgary and pack again for the Compassion Fatigue Conference in Kingston, ON on the 15th and 16th.

For those of you who have been waiting for the dates, I will be offering the Caring on Empty: Compassion Fatigue Transformation and Resilience workshop on October 21st and the Compassion Fatigue: Going Deeper workshop on November 18th, 2011 here in Vancouver. They will both be open to all helping professionals and will probably be held in the lounge of Shaughnessy Heights United Church. More details will be available through the summer.

I have been following an interesting teleseminar series on trauma put on by Ruth Buczynski at NICABM (The National Institute for the Clinical Application of Behavioral Medicine). She interviews a new trauma specialist such as Peter Levine or Pat Ogden each Wednesday and, so far, the interviews have been very informative. If you're interested in taking a look, give the NICABM website a visit.

That's all for now. Will have lots to tell on my return from the conference (and a small holiday) on June 24th.




Friday, June 3, 2011

How Life Changes ...


Hello again. I'm finally back at the computer after a few weeks of second tier carepartnering for friends learning home peritoneal dialysis at one end of the Fraser Valley and for another friend hospitalized with chest pain and dysrhythmias at the other.

Journeying with these loved ones has reminded me, once again, of the multitude of changes we experience as serious chronic illness or disability enters our lives. (- Often things we don't expect, like no longer having room for our bedroom furniture because the room is filled with cartons of dialysis solution!) Permanent and ongoing change becomes our new reality and we are constantly in the flux of adjustment and readjustment. With each change comes the need for recognition, time to grieve, and a period of reorientation. (Which can be difficult to achieve when one change follows on the heels of another.)

In her excellent and now classic book, Heartmates: A Survival Guide for the Spouse & Family of the Heart Patient, Rachael Freed, (formerly Rhoda Levin), suggests writing down an assessment of the changes experienced by carepartners, saying that it will help to clarify our thinking and validate our emotional responses. She offers a number of specific changes within several categories to guide our assessment:

Sleep
Quantity
Quality
Disturbances
Dreams and nightmares
Frequency of naps

Food
Level of Appetite
Time spent shopping
Time spent preparing food
Frequency of eating out
Primary foods
Priority of food and its preparation in your life

Exercise
Type
Frequency
Quantity
Strenuousness
Regularity
Differences between you and your partner

Work/Career
Degree of involvement
Schedule and hours
Level of satisfaction
Quality of work

Leisure Activities
Types of involvement
Schedule and hours
Level of satisfaction
Quality of work

Financial Responsibilities
Providing income
Budgeting
Allocating funds
Handling banking

Friends & Social Activities
Frequency
Quality of time spent
Level of satisfaction
Initiating activity

And these are just the day-to-day changes. There are also all the life alterations wrought by taking on complex medical tasks at home and managing all the shifts in roles and family dynamics as we accommodate the illness.

Freed goes on to suggest that an objective look at these changes empowers us, allowing us the choice of initiating further change in areas where we are dissatisfied. For example, if we have let a supportive friendship slip, we can plan to invite that person over or have a visit out.

She also reminds us that not all imposed changes are negative. There are positive alterations to diet and exercise, for example, that can benefit both the carepartner and care recipient.

While Heartmates is written specifically for cardiac spouses, I would recommend it to anyone providing care for their life partner. It is clearly written in manageable bites and offers practical, hands-on information for managing life with acute and chronic illness and disability.




Monday, May 16, 2011

The Awesome Gift of Grateful Heart...


This past week has been one of synchronicity with three seemingly unrelated experiences coming together to remind me that, even in the toughest circumstances, there are gifts and joys for which we can be grateful if only we can keep our minds and hearts open to perceive them.

When we teach ourselves to become more aware of these gifts, we begin to develop an 'attitude of gratitude' that can balance or offset some of the more negative impacts of our caregiving.

The three experiences that reminded me to look for the gifts among the hardships were:

1. Taking two friends to a clinic and doctor's appointment at a large downtown teaching hospital where they would receive some important test results. We were all anxious about the results and about how my friend, who was very ill, would manage getting from the "full" second level underground parking garage to the clinic on the sixth floor without collapsing. (They had applied for, but not yet received, their disabled parking sticker.) As we drove into the garage, we found that the "full" sign had been speaking the truth but, wonder of wonders, just as we rounded a corner to reach the tower entrance, there sat a single empty parking spot right beside the door.

My friends stayed in the car while I went into the hospital to look for a wheelchair (a commodity rarer than gold at 1 pm on a clinic day). And, what were the chances? I stepped into the elevator and met the one care aide who had been assigned to do a wheelchair roundup and who, therefore, had a stash of wheelchairs and, better yet, a key to unlock them! Come with me," she said, with a smile. "I 've just collected a few but they're all locked together." Within minutes, we had loaded my friend into a chair and were on our way to the sixth floor, wondering at our good fortune.

Even though the news we received that day was not the best, we will always be grateful for the not-so-small gifts that helped us along the way.


2. Coming across Sara Ban Breathnach's best seller, Simple Abundance, while culling my office bookshelves. In it was a quotation from Melody Beattie:

Gratitude unlocks the fullness of life. It turns
what we have into enough and more. It turns
denial into acceptance, chaos to order, confusion
to clarity. It can turn a meal into a feast, a house
into a home, a stranger into a friend. Gratitude
makes sense of our past, brings peace for today,
and creates a vision for tomorrow.

It was the quotation that had helped motivate my decision to begin a gratitude journal and finding it again this week served as a reminder to begin the practice again.

3. Discovering Neil Pasricha's website, books and TED Talk on things that are awesome. I don't know where I've been, but I hadn't yet heard of this young man's creative response to the hardships in life.

The son of immigrants from developing countries who had taught him to appreciate the small things we can take for granted, Neil started a website called 1000 Awesome Things during a painful period in his life. He was as surprised as anyone when his readership hit the millions and the book deals started to roll in. The result was two books, The Book of Awesome and The Book of (Even More) Awesome, and a TED Talk, The 3 A's of Awesome.

The books are "awesome" (with the exception of a few pieces of adolescent male humour that could have been excluded) and the talk is genuine and heartfelt with the reminders that if we live life with the attitude that we can grieve then face the future in baby steps, with the awareness of a 3 year old seeing life for the first time, and with the authenticity of our true selves, we will be much happier human beings.

So, this week has re-taught me the importance of focusing on the joys and gifts of life (especially the tiny ones) - not to the exclusion of the pain (because that doesn't work), but in an effort to provide more balance and comfort to our caregiving days.








Wednesday, May 4, 2011

Blessing of the Hands ...


May 9th is the beginning of National Nurses Week in Canada. Across the continent, as part of their annual celebrations, many nurses will be experiencing the acknowledgement, affirmation, empowerment and appreciation that come through a ritual called the Blessing of the Hands.

John O'Donohue, author of To Bless the Space Between Us: A Book of Blessings, defines a blessing as a circle of light drawn around a person to protect, heal, and strengthen. In this case, nurses' hands are blessed as a symbol of healing, wellness and strength.

Blessing of the Hands is offered in different ways in different settings, often by the chaplaincy department within the organization, and it is received within the context of each person's faith tradition. In Australia, a dean of nursing joins instructors in blessing the hands of students; in Cape Coral, Florida the hospital chaplain anoints each nurse's hands, palms up, with oil; and at Johns Hopkins Medical Centre hands are ritually washed before anointing with scented oil.

Whatever the actual ceremony, the ritual is brief, lasting only a moment or two, and the service is interfaith with all traditions welcome. In many cases, the blessings are individualized to recognize the specific work done by the hands in each area.

These blessings may be greeted with skepticism or discomfort the first time offered, but staff are generally so touched by observing or participating in the experience that numbers tend to rise exponentially in the following years. Some organizations, recognizing that not everyone can leave a unit to attend a service, now send teams around to each ward, unit and clinic where all who wish a blessing are included.

While I am no longer a practicing nurse, I was moved to the point of tears when I first heard of this blessing ritual. Many others find it to be "the best part of Nurses Week". I hope that many of you will have the opportunity, this year, to receive the healing, affirmation and renewal that are at the heart of this blessing experience.

I'll leave you, today, with the words of Blessing of the Hands adapted from Diann Neu's writings in Waterwheel, Winter, 1989:


Blessed be these hands that have touched life and felt pain.
Blessed be these hands that have embraced others with compassion

Blessed be these hands that have been clenched in anger.
Blessed be these hands that have withdrawn in fear.

Blessed be these hands that have given and taken away.
Blessed be these hands that have assisted those in need.

Blessed be these hands that have anointed the sick and suffering.
Blessed be these hands that have comforted the dying.
Blessed be these hands that have prepared the dead.

Blessed be these hands that may grow stiff with age.
Blessed be these hands, for they are the hands of the Holy One.


Pastoral Care Services
The Johns Hopkins Hospital