Denial...

One of the most insidious dangers to all helpers of the suffering or the traumatized is denial - denial of the impact of secondary traumatic stress in our work and denial of the primary traumatic stress that may have drawn us to our work in the first instance.

Denial is an unconscious defense against knowing that which is too threatening to know. It is denial that allows us to remain unaware of our compassion fatigue until we grind ourselves into the ground, no longer able to ignore our own symptoms.

Denial comes in different forms including minimizing. To minimize means to trivialize a painful situation by comparing it with another that we deem to be worse. In Trauma Stewardship, author Laura van Dernoot Lipsky says,

"This coping strategy is at its worst when you've witnessed so much that you begin to downplay anything that doesn't fall into the most extreme category of hardship ... internally, you are thinking something like, 'I cannot believe this conversation is taking 20 minutes of my time. There wasn't even a weapon involved.' "

Denial is also evident when we intellectualize or rationalize our pain, stripping a traumatic experience of it's emotional impact or explaining away our responsibility for it.

Some degree of denial (functional denial) is healthy when it helps us through situations that would be otherwise overwhelming but deep, prolonged denial can cause us to ignore symptoms that are potentially psyche-threatening or even life-threatening.

So, how are we to deal with our denial so that we can recognize and heal our compassion fatigue? The first answer is, "gently". It rarely helps to wrench away the protective layers of denial. It is usually best to come at it obliquely, within a context of safety and support.

To come through our denial of primary traumatic stress, secondary traumatic stress, burnout or compassion fatigue, we need to move through a process of validating our trauma and loss experiences and acknowledging the feelings associated with those experiences. We need to reclaim the details of our trauma story, in our current work and in the past, and as we reclaim our truth, we can move on from denial and pain to transformation and resiliency.

Autumn Comforts...

My most favourite time of year is the fall. It's the time when I feel most grateful and most grounded. A time when the rhythms of nature lead me away from all that drains my energy and remind me of all that sustains and nourishes me.

In her now-classic, The Woman's Comfort Journal, Jennifer Louden offers some comfort ideas for those who can't remember the last time they smelled fresh air or felt the rain (well, this IS Vancouver) on their faces:

1. Run through a tall corn field.

2. Let the wind push you down the sidewalk.

3. Fly a kite.

4. Take a hayride.

5. Collect fall leaves.

6. Make it a fall ritual to travel somewhere, even if it is only a few miles, to see leaves changing.

7. Cook s'mores over an open fire.

8. Walk briskly and sniff the fall air.

9. Pop corn.

10. Dress up for Halloween and go trick-or-treating with children. Or put on a haunted house for adults only.

Some other ideas that come to mind are:

1. Rake huge piles of leaves and jump in them.

2. Buy fresh root vegetables at the last of the farmers markets and take them home to make and freeze big pots of soup. (Great nutritious and economical on-the-go meals!)

3. Bake luscious loaves of whole grain bread - and eat a slice or two warm with a little butter.

4. Stop and really look at the shape, veins and colours of a changing leaf.

5. Tidy the garden and put the bulbs to bed. (As you dig, breathe deeply of the humus that speaks both of decay and new birth).

6. Come in from the garden, cold, stiff and rosy-cheeked, to curl up by the fire with a favourite book, soothing music and a steaming cup of tea.

7. Have a Thanksgiving potluck dinner with family, friends and perhaps a stranger or two. (It's past Thanksgiving, you say? Who's to say we can't have a "thanksgiving" meal every month?)

8. Buy new purple mittens, a yellow umbrella or shiny red gumboots and wear them.

9. Learn a new creative art - knitting, carving, weaving, potting, painting, singing...

10. Collect horse chestnuts and enjoy their deep, warm, browns and their smooth, shiny skins. Consider using one, held in your hand, as a focus for your meditation/contemplation practice.

11. Go to the beach and watch the waves spray the shore.

12. Take off your hat and feel the wind in your hair.

13. Watch for the next time a storm is brewing and the sky turns indigo, the sunlight deepens to gold and a rainbow arcs across the heavens. Then make a wish.

14. Stamp in a puddle.

15. Trace the ice swirls on an old window or a frozen puddle.

16. Watch and listen to the skeins of geese heading south for the winter.

So many possibilities if we'll only stop to notice and enjoy.

What is CF Anyway...?

I don't spend a lot of time at my computer but, in order to keep up with new writings about Compassion Fatigue, I receive regular Google alerts citing blog posts, articles in the popular press and more scholarly articles from academic journals. Something I've noticed lately is an increasing diffusion and fuzziness in the understanding of CF, particularly in the blogs and the popular literature, and it concerns me a little because I don't want to see compassion fatigue go the way of codependence.

Codependence was a very specific and useful term within the context of addiction treatment and then it "grew like Topsy" to be applied to anyone who ever "enabled" anyone else to do anything and even to those who were merely practicing kindness. Codependence became a term that no longer had clear meaning because it was being applied to everyone.

As I've read various blog posts and articles lately, I have noticed that as uninitiated people are drawn to and identify with the notion of CF and want to spread the word, they are writing about the condition as "chronic weariness" or "feeling stressed" or being otherwise depleted. While all these experiences are true of most CF sufferers, they do not define compassion fatigue itself.

CF is a serious but natural consequence of working with suffering or traumatized people or animals, or with our wounded planet. It is, first and foremost, a response to secondary trauma exposure. We must have been exposed to the trauma in others' lives and have been negatively affected by it before we can say that we have compassion fatigue. We must have developed secondary posttraumatic stress symptoms culminating in a diminishing capacity for, or interest, in being empathic with others' suffering, hence "compassion fatigue".

And while burnout is almost always a precursor of CF, CF is not a form of burnout. Nor is it clinical depression. I have seen it called both, possibly because people reading about this young and quickly evolving term may not have realized that we have moved on from a particular understanding of the phenomenon.

We are probably still a way away from a "final" definition of this phenomenon but if we can be as clear as we can be in defining our terms, we are more likely to reach the people who deserve support and treatment and to offer them the most useful assistance. ie good trauma treatment and improved resiliency skills.

Photo by Bigstock Photos

Book Review: Bounce: Living the Resilient Life...

I'm currently reading Robert J Wicks' new book, Bounce: Living the Resilient Life and am delighted to recommend it to you. (It is so new that the copyright by Oxford University Press is 2010!).

This book, like The Resilient Clinician (2008) and Overcoming Stress in Medical and Nursing Practice (2006), focuses upon transforming stressful situations into opportunities to live a more meaningful, self-aware and compassionate life. It offers principles and techniques of self awareness, stillness, mindfulness, daily debriefing and self care to everyone, not just the professional caregivers for whom Dr Wicks has written for over 30 years.

The table of contents looks like this:

Have a Life!: An Introduction

Navigating Life's Rough Waters: Riding the Crest of Chronic and Acute Stress

Personal Renewal: Creating and Tailoring Your Own Self-Care Protocol

A Powerful Healing Combination: Friendship, Resilience & Compassion

The First Steps Toward Self-Knowledge: Debriefing Yourself

Solitude, Silence & Mindfulness: Centering Yourself In a Driven World

The Simple Care of a Hopeful Heart: An Epilogue

And if that's not enough inducement to find a copy, it is short, well written, easy-to-read and, more than anything, useful, practical and profoundly compassionate. As the friend who recommended Bounce to me said, one reads this book and feels known and understood.

Currently a professor at Loyola University in Maryland, Dr Wicks is a recognized expert in preventing secondary traumatic stress and has been involved in debriefing relief workers from the Rwandan civil war and health care professionals caring for multiple trauma survivors from the war in Iraq.

Enjoy!

66 Self Care Ideas...

I spent this morning with a great group of helpers intent on identifying compassion fatigue in their lives and on learning new prevention and resiliency skills. Here are the self care strategies that came from their brainstorming sessions:

1. Playing with pets

2. Listening to, or making music

3. Walking/hiking outside in Nature

4. Yoga

5. Spontaneous dance with my child

6. Reading for fun

7. Chatting with friends

8. Taking time to eat without distraction 3 times a day (ie mindfully)

9. Going out on a motorcycle every weekend

10. Swimming

11. Gardening

12. Positive thoughts in sessions

13. Doing puzzles

14. Knitting

15. Painting

16. Shopping for yourself

17. Going to the museum or art gallery

18. Cultivating faith

19. Sleeping in

20. Watching cats playing

21. Holding pet every morning

22. Dream interpretation

23. Aerobics

24. Driving alone in the car

25. Book clubs

26. Girls' night

27. Playing/reading with the kids

28. Dressing up and going out

29. Going on a roller coaster

30. Making a list to get things out of your head

31. Cleaning my room

32. Cooking healthy food

33. Having someone cook for you

34. Taking part in social action

35. Photography

36. Karaoke

37. Regular massage

38. Leisure time - going for coffee or window shopping

39. Aromatherapy at home

40. Taking time to debrief with a supervisor or colleagues

41. Learning to say no

42. Lighting a candle

43. Trying a new recipe, kneading dough

44. Writing in a joy/gratitude journal

45. Write an email or in a journal to "get things out"

46. Go to a different place/ space, even in the work setting

47. Take a bubble bath, shower or swim - "aquatherapy"

48. Watch a funny TV show, youtube a comedian like Seinfeld or The Vinyl Cafe

49. Spend time with someone you know will lift your spirits

50. Take care of plants, nurture "at risk" plants

51. Remind myself that not everyone is going to get better; accept reality and respect other peoples' processes and their personal journeys

52. Sing in a choir / sing in the car / SING!

53. Do crafts

54. A quiet cup of tea

55. Reading something inspirational

56. Watching a bird feeder

57. Raking leaves on a sunny day

58. Meditating or praying

59. Sitting still (doing nothing)

60. Join a Laughter Yoga Club

61. Be in the moment - not thinking about the past or the future

62. Don't attach to stressful thoughts

63. Ritual

64. Change out of work clothes after work

65. Let go - leave perfectionism behind

66. Eat well

Have a Good Bad Day...

We all have days that feel like this.

In her website, The Happiness Project, Gretchen Rubin offers an antidote, listing Tips for Feeling Happier Right Now. Each tip is guaranteed to lift your mood, as will the mere fact that you've tackled and accomplished some concrete goals.

1. Boost your energy. Pace while you talk on the phone or, even better, take a brisk ten-minute walk outside. Even a small amount of exercise elevates your spirits.

2. Listen to a great song. Research shows that listening to music you love is an extremely effective way to improve your mood.

3. Reach out to friends. Make a lunch date or call a friend. Having warm bonds with other people is a key to happiness. Perhaps surprisingly, it turns out that socializing boosts the moods not only of extroverts, but also of introverts.

4. Rid yourself of a nagging task. Answer a difficult email, purchase something you need, or call to make that dentist's appointment. Crossing an irksome chore off your to-do list will give you a big rush of energy and cheer.

5. Create a calm environment. Clear some physical and mental space around your desk by pitching junk, stowing supplies, sending out quick responses, filing, or even just straightening up your piles. Outer order contributes to inner serenity.

6. Lay the groundwork for some fun. Order a book you've been wanting to read (not something you should read) or plan a weekend excursion. Studies show that having fun on a regular basis is a pillar of happiness. Try to involve friends or family , as well; people enjoy activities more when they're with other people than when they're alone.

7. Do a good deed. Make a helpful email introduction, set up a blind date, or shoot someone a piece of useful information or gratifying praise. Do good, feel good - this really works. Also, although we often believe that we act because of the way we feel, in fact, we often feel because of the way we act. When you act in a friendly way, you'll strengthen your feelings of friendliness for other people. And that's a happy feeling.

8. Go outside. Research suggests that sunlight stimulates brain chemicals that improve mood and increases focus. For an extra boost, get your sunlight first thing in the morning.

9. Save the life of a stranger. Every day, seventeen people die while waiting for a donated organ, and just one donor can save or improve the life of as many as 50 people. Most Americans say they approve of organ donation, but not many actually sign a donor card. Register and tell your next of kin you want to donate. Imagine the joyous faces of the people who will one day get a call from a hospital, to tell them that their prayers have been answered. That will make you feel pretty darned happy.

Are there other ideas you could add to personalize this list? Try adding them and then copying the list and posting it on the fridge or above your desk as a reminder that we can sometimes make choices that will lift the gloom and tiredness and allow a better day.

Forgiveness or Reconciliation...

Anger and resentment can be a great drain on the energy of anyone with compassion fatigue or chronic sorrow. And forgiveness or reconciliation can bring equally great renewal.

Forgiveness is different from reconciliation. As marriage and family therapist, Tom Moon, says, "Forgiveness means letting go of the past, but reconciliation is about committing to a future."

Forgiveness means letting go of anger, resentment, hurt, judgment and condemnation. It means giving up the victim role and the desire for revenge. It is something we do on our own, for ourselves, to prevent these feelings and actions from poisoning our own lives.

Reconciliation, on the other hand, is a process where both parties own and acknowledge their parts in the problem, without excuse or blame, and strive to restore trust in the relationship. It's something we do together for the sake of the relationship.

We are free to choose forgiveness or reconciliation as our goal in any situation. And, oddly enough, when we know that we don't have to reconcile, we can often be more generous with our forgiveness. (Fear of being hurt again by an unrepentant person can be a legitimate reason for forgiving but not reconciling.)

Both forgiveness and reconciliation are processes, often lengthy ones, so they can take patience and persistence. In considering forgiving someone, Tian Dayton, PhD, author of The Magic of Forgiveness, suggests writing the answers to the following questions:

1. What is the forgiveness issue I'm working with?

2. Where am I stuck?

3. What will I gain if I forgive?

4. What will I need to give up if I forgive?

5. Why am I afraid to forgive?

6. What feelings keep coming up when I contemplate forgiving?

7. What do I feel angry about?

8. What do I feel sad about?

9. What, if anything, am I holding against myself?

10. What, if anything, am I holding against someone else?

11. What do I think forgiving myself or this person will mean?

12. What do I want it to mean?

13. What am I afraid it might mean?

14. What do I imagine forgiveness can give me that I don't have now?

Reflecting on these questions can help to ready us for the steps to forgiveness listed on the website for Zen Habits by therapist, Allison Mupas, MFT:

1. Journal or talk to someone about what happened, your feelings, and let it all out.

2. Look at your side of the event, disagreement, or problem. How did you participate? Do you have anything to clean up? ("Clean up" means take responsibility for.)

3. Consider whether you're even willing to forgive yet. If not, take some steps to work through the underlying feelings.

4. Make the decision to forgive anyone involved in the situation. Don't forget yourself, if you need it. Decide if you need to say or write anything to anyone involved to get your feelings out and be heard.

The person you are forgiving does not need to be willing to receive them or to be present for you to complete this process. You can ask an objective person to be on the receiving end if you don't feel safe or comfortable going to the person with whom you're upset. You can visualize that you are speaking to that person when you are speaking to a friend or objective listener.

5. Let go! Keep in mind that you are choosing to forgive. If you are holding on to a belief that the other person has to do something before you forgive, you may be choosing to remain stuck. If you find situations re-stimulating the old feelings of hurt, you may need to repeat step 1.

Keep in mind that this process is not easy but it is very rewarding and can be very freeing...

If you are having difficulty with your forgiveness or reconciliation process, you might want to contact a counsellor, spiritual advisor or professional coach for help.