The Silencing Response - A Symptom of Compassion Fatigue

Working in highly charged, disturbing environments and with people who have been seriously injured, ill or traumatized, exposes us to experiences, stories, thoughts and feelings that are potentially overwhelming because they are beyond our scope of comprehension, our desire to know or our sense of competency. When we become overwhelmed in this way, our ability to remain present and to listen to the pain of others is compromised and we are likely to draw on the Silencing Response (SR) for our own protection.

The Silencing Response is defined by traumatologists, Anna Baranowsky and Eric Gentry, (2006), as "a reaction ...which guide(s) the caregiver to redirect, shut down, minimize or neglect the disturbing information brought by an individual to the caregiver." In other words, when we are already emotionally overwhelmed, we find ways to silence others' painful stories so that their pain doesn't add to our trauma load. This is an effective form of self protection in one sense but in another, it can add to our feelings of guilt and shame as we realize that we are not the empathic listeners we used to be. And it keeps us from being effective helpers.

Here are some signposts, taken from the work of Baranowsky and Gentry, that can help us to determine whether we are using the Silencing Response as a defense in our conversations:

1.  Changing the subject away from painful material

2.  Avoiding a topic

3.  Providing pat answers

4.  Minimizing others' distress

5.  Wishing/suggesting that the other would "just get over it"

6.  Being angry or sarcastic with care recipients

7.  Using humour to change or minimize the subject

8.  Faking interest or listening

9.  Fearing what the client has to say or feeling numb before an interaction

10.Blaming or not believing others for their circumstances

11.Not being able to pay attention to what the person is saying or feeling bored

The up side to behaviours like the Silencing Response is that they act as smoke detectors to warn us of the need for action before the fire of Compassion Fatigue gets out of control. When we use this warning to motivate an investment in extreme self care and some good trauma therapy we can begin to recover, both for ourselves and those we serve.   

 

 

Community...

I am back, refreshed, from a wonderful retreat at the Bethlehem Retreat Center in Nanaimo, BC. The weather was crisp and sunny and Westwood Lake was covered with ice. I balanced my time between being quietly alone at the guest house and attending community prayers and dinner with my friends at the House of Bread Benedictine Monastery. As always, my body and mind relaxed completely in the quietness and the concerns and busyness of life in the city seemed far away.

Early on my last morning there, I sat by the window watching the sun rise to bathe the peak of Mount Benson and to awaken the three llamas sleeping under the bare fruit trees in the field behind the guest house. I drank a cup of tea and thought about the community of women who had created this lovely place of peace and about the importance of community in all our lives.  

Some people define  community as a group of interacting people in a common location (this was obviously prior to the internet!) and others define it as a group that is organized around common values. Whatever our definition, we all belong to a number of communities -  our personal community of friends, the soccer community, our faith community, the caregiving community, the university community, the equestrian community, the environmental community, and so on.  

We are hardwired for community, for belonging, and when we lose our sense of community our health suffers. Dean Ornish, MD, President and Director of the Preventive Medicine Research Institute at the University of California's School of Medicine in San Franscisco, spent his life studying heart disease and wrote a book called, Love and Survival: The Scientific Basis for the Healing Power of Intimacy (1997). In an interview with Bill Moyers, he said, "I am coming to believe that anything that promotes isolation leads to chronic stress and, in turn, may lead to illnesses like heart disease. Anything that promotes a sense of intimacy, community and connection can be healing."

So, what do we do when life's busyness makes connecting with loved ones seem difficult or impossible? How do we maintain this piece of our mental, physical and spiritual health?

The first step is intention; we become clear that we want to maintain certain relationships (- and that we may need to let go of others  for a while). Then we make a realistic plan for keeping in touch. My husband developed what he called his Keeping in Touch (KIT) List. On it were the names of the 4-6 people with whom he wanted to stay in touch, even if life was very busy. He kept the list on his desk and made sure that every 10 days to 2 weeks, he sent them a note or called them on the phone or had lunch or a cup of tea with them. Sometimes, all he had time for was a quick voice mail message or a quicker prayer but he honoured his intention to stay connected.

Family caregivers in the Well Spouse organization in the US send each other round robin letters or emails with short or long entries written when they have a free moment and then sent on around the circle. It doesn't have to be much, just as long as whatever you do allows you to feel connected with your community. As the Sufi poet, Rumi, said in the thirteenth century:

There is a community of the spirit.

Join it, and feel the delight

of walking in the noisy street, 

and being the noise...

Why do you stay in prison

when the door is so wide open?

Sharing life, no matter how difficult, eases the stress and lightens the load. Try it and see.... 

 

   

Going on Retreat...

Tomorrow I leave Vancouver for a four day personal retreat and I can't wait to go. There's nothing better than taking time apart from the busyness of day-to-day life to rest, to reflect, to clarify, and to renew.

I've been answering an inner call to retreat since I was very young. Whenever life became too hectic at home I would take an apple and my book and wander into the woods where I could spend hours walking my favourite paths, sitting in my favourite tree and just be-ing in the quiet. Eventually, I would return to the world, centered and at peace once more. 

Retreats come in all shapes and sizes. An hour pulling weeds in my rose garden. A few moments in the quiet darkness of my front porch, staring up at the night sky. A few days apart from my normal environs, surrounded by the beauty of nature, either with a pack on my back or in the comfort of a comfortable retreat house. Years ago, my husband had a regular arrangement with an elderly friend to spend a morning, once a month, in her spare room, resting, thinking, meditating and writing. At noon, Doris would tap on the door to announce that she'd made him a bowl of soup and a sandwich. They would have a quiet lunch together and then my husband would leave, refreshed, to go on with his life.

There are many times in life when a retreat can be helpful. During times of transition or celebration when we want to fully experience the moment. At times when we yearn for space apart to refresh and renew. During times when we seem to have lost our true selves and need to reconnect. When we feel stuck in making a decision or finding the right path. When we are longing for room for creative expression and inspiration. When our God seems far away. When we need time to grieve and to heal.

Whatever our reason for wanting a retreat, the major obstacle to accomplishing our intention is often in our own minds. How many of us have known, deeply, that we needed some time apart only to follow that thought with one of the following:

- I can't afford it.

- It would be selfish or irresponsible to take time for myself right now.

- My friends would think I'm crazy.

- I don't have the time!

- I haven't been alone for so long that it feels a little scary.

- If I leave my husband (child, wife, parent), something terrible might happen.

My personal experience is that if I commit to taking time away -ie choosing dates- I am able to find my way through most barriers that may arise. There will always be the fears of the unknown, but in the all years that I feared leaving my husband to get the rest I needed, nothing catastrophic happened. And if it had, it wouldn't have been because I had gone on retreat, but because he had severe heart disease.

So, take some time today to examine your own life.  Do you need a rest, some quiet moments to think or a geographical change to gain some objectivity? If you do, consider the type of retreat you would be able to undertake, choose a date and then make a commitment to follow through.  You might find, as I did, that after the allotted days are over you are still wanting more.

Photo by Janet Ritchey    

  

  

 

The Peace of Wild Things...

This has been a sad week.  A dear friend, who has had three strokes in ten days, is now paralyzed down her left side and is fighting valiantly against pneumonia. I grieve for her many losses and I grieve for her family and friends who can no longer communicate with her in familiar ways. I grieve for the possibility of life without her.

Normally, I would go and walk by the Lake to ease the sadness, knowing that Nature would draw me from my grief into her quiet embrace. Unfortunately, I have developed either a bone contusion or stress fracture in my right foot so I won't be walking at the Lake for a while. I yearn for the exercise, for calming scenes of beauty and for the healing peace of water and trees.

Thankfully, there is more than one way to connect with Nature. I have just finished reading one of my favourite poems, one that sustained me again and again as my husband was dying. Let me share it with you:

The Peace of Wild Things

When despair for the world grows in me 

and I wake in the night at the least sound

in fear of what my life and my children's lives may be,

I go and lie down where the wood drake

rests in his beauty on the water, and the great heron feeds.

I come into the peace of wild things

who do no tax their lives with forethought

of grief.  I come into the presence of still water.

And I feel above me the day-blind stars

waiting with their light.  For a time

I rest in the grace of the world, and am free.

Wendell Berry

For me, this is a poem of trust - trust that, regardless the complexities and pains of human existence, the peace of wild things is always available to soothe us, either in actuality or in memory. Trust that the day-blind stars are waiting with their light even, or perhaps especially, when we cannot see them in the daylight sky. Trust that even in our busiest, most grief-stricken days, if we breathe, and breathe again, we can return to rest in the grace of the world, and be free. 

 

     

Low Impact Disclosure...

Stories have great power, both to heal and to wound. When we hear and see difficult things in the course of our professional work or as we care for loved ones, we feel a natural desire to debrief the stories we've just heard. This debriefing helps us to diffuse the emotional impact of our work. However,  if we don't do it carefully, we run the risk of wounding those who take the time to listen to us.

In her 2008 article, Low Impact Disclosure - How to Stop Sliming Each Other, my friend and colleague, Francois Mathieu, describes how helpers can slime listeners inadvertently as we attempt to reduce the burden of our work.  When we debrief disturbing material, formally or informally, without asking permission or without thought to its impact on listeners, we can slime colleagues, family members, friends, acquaintances, and even strangers on the bus (!) with our stories. 

Research tells us that sharing graphic details of traumatic situations can spread psychological trauma effects to others and yet we need to tell our stories to keep ourselves well.  What's to be done?  

Authors, Laurie Pearlman and Karen Saakvitne, coined the term, "limited disclosure", in their book, Trauma and the Therapist, and that term later became, "low impact disclosure".  Low impact disclosure, (LID), is a strategy for limiting the impact of our stories on others.  It involves four steps:

1.  Increasing Our Self Awareness

Use self observation for a week to notice all the ways you debrief difficult material. Do you attend formal debriefings at work? Do you journal? Do you chat online? Do you talk over lunch in the cafeteria? Do you attend a support group? Do you share with people at conferences or workshops? Do you go for peer or professional supervision? Do you see a counsellor? Do you tell your spouse when you get home? Or your kids? What is the most helpful way for you to deal with painful stories?

2.  Giving Fair Warning Before Debriefing

Giving  fair warning that you have a difficult story to tell allows the listener to prepare him or herself for its impact.

3.  Obtaining Consent to Tell Our Stories

Francoise Mathieu suggests simply saying, "I need to debrief something with you.  Is this a good time?", or "I heard something really hard today...Could I talk to you about it?". This gives the listener the opportunity to decline or to set limits on the disclosure. For example, the listener might say, "I have fifteen minutes to listen but could you please tell me about it without all the gory details?" or "Is it about children (abuse, abandonment, a car accident, war or whatever is a trigger for you)? If it's about children, then I'm probably the wrong person to talk to, but otherwise I'm fine to listen."

4.  Low Impact Disclosure

Once you've received consent, you can decide how much to disclose. Francoise describes LID this way. "Imagine that you are telling a story starting with the outer circle of the story, (ie the least traumatic information), and you are slowly moving in toward the core, (the very traumatic information), at a gradual pace. You may, in the end, need to tell the graphic details, or you may not, depending on how disturbing the story has been for you."

 It is best to err on the side of more limited disclosure in social situations. Think to yourself, "Is this too much trauma information for this situation?"

Using LID is a simple strategy for reducing the harmful effects of difficult stories. We need not minimize our emotional responses but limiting "the gory details" of the story to an appropriate situation can save family, friends and colleagues  from unnecessary secondary traumatization.   

   

           

Trauma First Aid...

As family carepartners and helping professionals, we are exposed to secondary trauma, or indirect wounding, through witnessing or hearing of the traumatic experiences of others.

Whether we discover a loved one collapsed on the floor after a heart attack, assist a patient suddenly hemorrhaging from his gastrointestinal tract, respond to a serious motor vehicle accident or preside at the funeral of a four year old child, we are vulnerable to secondary traumatic stress. How do we practice good self care in such situations? How do we help ourselves to reduce long term trauma effects?

Peter Levine, PhD,  in his books, Healing Trauma and Waking the Tiger, gives first aid guidelines for helping adults who have experienced traumatic events. From these guidelines, I have drawn the following suggestions:

Stage I:  Immediate Action:

As soon as possible after ensuring the immediate safety of the primary victims and your own safety:

1.  Rest, lying down if possible. (This may go against your natural inclination to "do something" or to deny the impact of the trauma but it is essential to be still so the trauma energy can be discharged from your body.)

2.  Have a trusted person stay with you quietly.

3.  Allow yourself to fully experience your body sensations. These may include adrenalin rush, numbness, shaking and trembling, feeling hot or chilled.

4.  Remind yourself or allow others to remind you that it is not only okay to shake, it is good and will help you to release the shock. You will feel a sense of relief after the shaking is completed and may feel warmth in your hands and feet. Your breathing should be fuller and easier. This initial stage of discharge could easily take 15 - 20 minutes.

5.  Stay quiet and resting until the acute shock reaction is over.

Stage II:  Later

1.  Allow time for processing the traumatic experience. Always take a day or two off work or rest more than usual if you are at home in order to reintegrate. This is important even if you don't perceive your situation to justify staying home or resting. (This resistance can be a common denial mechanism and defense against feelings of helplessness). As Peter Levine says, "A day or two is good insurance".

2.  Allow your emotions to be felt without judgement. You may experience feelings such as anger, fear, guilt, sadness and anxiety. There may also be continuing body sensations such as shaking or chills. This is often the case.

Stage III:  Begin to Access and Renegotiate the Trauma: (Often coincides with Stage II)

1.  Work with someone who understands the body effects of trauma to recall both the direct and peripheral images, feelings and sensations experienced during the traumatic event. Work slowly, one step at a time, to bring up and discharge the trauma energy.

Dealing with a traumatic event at the time that it happens goes a long way toward preventing long term trauma reactions. If you would like to understand more about the importance of processing traumatic events and the physiology behind the process above, I recommend Peter Levine's two books and his CD collection, Healing Trauma.

 (As always, use your own best judgement to assess your particular circumstances before using the guidelines above.)

New Year 2009...

This week, as I prepared to dig myself out of the snow one more time and return to work, I found myself reflecting upon our traditional January greeting of "Happy New Year!".

For very many people, the New Year is a time of bright hopes and possibilities, of fresh starts and clean pages. However, for family caregivers and helping professionals overwhelmed with compassion fatigue or chronic sorrow, this is rarely the case. The thought of another year stretching into the distance brings exhaustion, anguish and unanswerable questions.  Can I keep going? How? When will the losses and suffering end?

For these folks, the New Year means summoning yet more strength and courage from a well long dry.  It asks of those already drained to "go over the top" one more time like soldiers in trenches from wars gone by.

If you are facing the New Year from such a depleted place, I invite you to make this time of beginnings an opportunity to ask for help. To call a trusted friend, a case manager, a spiritual advisor, a grief counsellor, or another caregiver to ask for support. Choose someone who will listen without judgement or "fixing" and who will help you to clarify what it is that you need. Let your New Year begin with the glimmer of hope that can come when we honestly acknowledge our situations and surrender to asking for help.

John O'Donohue, one of my favourite Celtic writers, wrote a beautiful book of blessings called, The Space Between Us, before his untimely death in mid 2008.  His Blessing for a New Year could easily have been written especially for caregivers.

A Blessing for the New Year

On the day when

The weight deadens

On your shoulders

And you stumble,

May the clay dance

To balance you.

And when your eyes

Freeze behind

The gray window

And the ghost of loss

Gets into you,

May a flock of colours,

Indigo, red, green

And azure blue,

Come to awaken in you

A meadow of delight.

When the canvas frays

In the curragh of thought

And a stain of ocean

Blackens beneath you,

May there come across the waters

A path of yellow moonlight

To bring you safely home.

May the nourishment of the earth be yours,

May the clarity of light be yours,

May the fluency of the ocean be yours,

May the protection of the ancestors be yours.

And so may a slow

Wind work these words

Of love around you,

An invisible cloak

To mind your life.

John O'Donohue  (2008)

Blessings to you in 2009!

Warmly,

Jan