Fall Workshops ...

After a beautiful summer there is already a hint of fall in the air. The days are closing in, the garden is yielding it's bounty, and although the days are bright and sunny, my furnace has cut in for the first time since spring. I love this time of year! It has an energy and excitement all it's own.

My speaking engagements have begun early this year with an August keynote for the Canadian Society of Transplantation Conference at the Vancouver Convention Center. I was privileged to spend time with a fine group of helping professionals working on both the donor and recipient sides of the transplant equation. Their comments and questions in relation to Compassion Fatigue dovetailed with the thinking and reading I've been doing over the summer and have confirmed some of my thoughts regarding an under-acknowledged piece in our conceptualization of Compassion Fatigue. More about this later in the fall.

This October and November will see me sponsoring two of my own workshops for helping professionals here in Vancouver. The Caring on Empty and Compassion Fatigue, Going Deeper: The Enneagram workshops were so well received last year that I will be co-sponsoring them with St Mark's Anglican Church in Kitsilano and offering them to a broader, more heterogenous group of professionals than one might find in a specific organization. There is usually great richness in such groups with opportunities to think outside the box and to benefit from the wisdom of others outside one's own particular field.

1. Caring on Empty: Creative Tools for Transforming Compassion Fatigue

Friday October 22 9:00 - 3:45 (Registration at 8:30)

St Mark's Church, Kitsilano

1805 Larch Street, Vancouver, BC

Registration fee: $184.80 + HST = $210

This is a workshop designed for all helping professionals who work with the suffering or traumatized, from veterinarians to clergy, from nurses to teachers , from physicians to lawyers and judges, from social workers to physiotherapists to psychotherapists.

You will benefit by:

1. Learning the difference between compassion fatigue, (the secondary trauma we can experience through working with those who have been traumatized), and burnout or vicarious trauma.

2. Gaining an understanding of how CF develops.

3. Recognizing the general signs of CF and your own personal early warning signs.

4. Identifying your current level of CF.

5. Exploring tools for CF transformation and resilience.

6. Beginning to develop a personal recovery and resilience plan.

2. Compassion Fatigue, Going Deeper: The Enneagram (** Postponed until 2011)

Friday evening November 19 7-9:00 pm - and -

Saturday November 20 9:00 - 3:45 pm

St Mark's Church, Kitsilano

1805 Larch Street, Vancouver, BC

Registration fee: $220 + HST = $250

One of the most common signs of Compassion Fatigue is emotional reactivity and the Enneagram can help you to recognize the source of that reactivity and to take steps to reduce it.

The Enneagram (pronounced ANY-a-gram) is an enlightening and powerfully accurate system of 9 personality types based on a combination of ancient wisdom tradition and modern psychology. It differs from other personality typing systems like the Myers-Briggs in that it focuses on the motivation behind our behaviour rather than on the behaviour itself.

Discovering and working with your Enneagram personality type can help you to:

1. Make positive changes in your life, particularly in your relationship with yourself and with others.

2. Clearly recognize the issues that can "push your buttons" and reduce your reactivity.

3. Understand more about your behaviour under stress and when relaxed.

4. Integrate the personal and spiritual aspects of your life, regardless of your spiritual path.

** Registration includes a copy of Stanford University professor of psychiatry, Dr David Daniels' book, The Essential Enneagram.

For a registration form or for more information, please email me at caregiverwellnesshaw.ca or call me at (604) 297 0609.

With every good wish for a healthy and happy fall,

Jan

12 Step Recovery for Helpers...

Caring for others, whether as helping professionals, volunteers or family caregivers, can be a great source of fulfillment and satisfaction. It can also be a source of tremendous emotional strain. One of the ways that helpers are dealing with this strain is through attending 12 Step meetings and applying the program's principles in their everyday lives.

The 12 Step program was started by two alcoholics in the 1930's as a means of staying sober. They then formed Alcoholics Anonymous (AA) to share the program with others. Since that time the basic principles of the program - the 12 Steps - have been adopted by millions of others with chronic problems as varied as chronic over eating; other compulsive behaviours such as gambling, over exercising, over spending, or over working; and codependence. Many others, drawn by the inclusive, non-religious spirituality of the program, have chosen the 12 Steps as a practical pathway to peace and serenity in a chaotic world.

While not for everyone, the program helps many to relinquish control of the unmanageable, out-of-control portions of their lives to a Higher Power, however they understand that Higher Power to be. In doing so, they become more able to move with the flow of life rather than struggling against it and they learn to lean on their Higher Power for strength and support.

As author and family caregiver, Gail Sheehy, writes in Passages in Caregiving:

I confessed to Dr Pat that I had bottomed out. ... She suggested that I try a twelve step program.

Grateful, but skeptical, I walked thirty blocks down the street from Dr Pat's office to a twelve-step meeting in a large church. I expected a huddle of mournful souls reciting grisly accident reports on the train wrecks they had made of their lives. I had heard such accounts, secondhand, when my mother entered Alcoholics Anonymous for her recovery.

One step into the nave changed everything. Greeters lined the walls. They talked about taking positive steps toward living with gratitude and feeling more joyous and free than before they found the program. They clapped for anyone who announced progress.

I was shocked to find my own behaviour described in some of the stories. Like me, the narrators had attacked their problems guided only by a ferocious self-will. When it didn't work, fear overtook. Or resentment, or both. I realized I had become powerless over my fears. In the fever to "save" my husband, I was losing the ability to manage my own life. I needed to find a way to restore my faith.

This was a spiritual program, but no church affiliation was required. We were encouraged to entrust our wills (or egos) to God, who was introduced with the shrewdly tolerant phrase "as we understand him".

The God I hoped to meet was the source of serenity, the missing force in my life. To my delight everybody else at that meeting had the same idea. At the conclusion, we all held hands and recited the universal serenity prayer by Reinhold Niebuhr:

God, grant me the serenity

to accept the things I cannot change;

the courage to change the things I can;

and the wisdom to know the difference.

"The wisdom to know the difference" was not just a catchy slogan. It sounded like something God would grant if I met him/her halfway, by accepting the things I could NOT change - my husband's life trajectory and my own limitations. That was the road to serenity. But first, I would have to quit Playing God. I was full of compassion for my husband, yes, but my caregiving was spiked with more than a pinch of egotism.

I had to find the courage to change the things I could - especially myself. In the twelve-step group everyone learned how to open up and shamelessly examine our defects and draw support from our fellowship. The best laughs are at ourselves, and we had many laughs at those meetings. The days went better after gathering in the early morning with my fellow pilgrims.

Others have written about the usefulness of 12 Step programs in helping caregivers to care for themselves while caring for others. If you are interested in learning more you might want to read, Self-Care for Caregivers: A Twelve Step Approach by Pat Samples, Diane Larsen, and Marvin Larsen.

If you decide to try out a 12 Step group, remember that a group is only as healthy as it's individual members. If you're not comfortable in one group, try several others until you find one that fits for you.

Also remember that any idea can be taken to an extreme or become rigid or warped from it's original intent. I have discovered this in relation to Chronic Sorrow in some groups. The notion of "the pity pot" (being stuck in self pity) has been applied to the ongoing grief of family caregivers by those who do not understand the concept of unending loss. As with everything one finds at a 12 Step meeting, it is always okay to, "take what works and leave the rest".

Book Review: Passages in Caregiving...

I have just finished reading Gail Sheehy's latest book, Passages in Caregiving, and recommend it to you with an enthusiastic thumbs up. Whether you are a family caregiver or a helping professional wanting to better understand the family caregiving experience, you will find much to enlighten you in these pages.

Using the turning points of the labyrinth, (a medieval symbol of a single pathway, with several switchback turns, leading to the center of a circle which is used by many spiritual traditions as a form of walking meditation or ritual), Ms Sheehy describes eight turnings in the path around the labyrinth of caregiving:

1. Shock and Mobilization

2. The New Normal

3. Boomerang

4. Playing God

5. I Can't Do This Anymore!

6. Coming Back

7. The In-Between Stage

8. The Long Good-bye

Each of these turnings is a passage in the emotional journey through providing care for a loved one - or a not-so-loved-one.

While drawing extensively and beautifully from her own and others' experiences of spousal caregiving, Ms Sheehy also touches on the experiences of those giving care to parents. Unfortunately, little is said about those caring for children with chronic conditions or about children who are caregivers themselves. Another limitation for Canadian readers is the detailed explanation of the American healthcare system. (Though there are certainly sufficient emotional parallels in our responses to the two systems to make these explanations readable.)

The epilogue is an interesting departure from the usual content of caregiving books with its exploration of sustainable aging and who will care for the aging boomers in a world of smaller and more transient families, fewer resources, and longer lived lives in the presence of complex medical conditions. Gail Sheehy's answer to the latter is an emphatic, "Us!". She offers the model of the "village movement" to those disinterested in an old age of dependence and isolation. This movement uses the yearly fees of members, (paid according to income), and their gifts and talents, to provide each other with the kind of support that small villages and neighbourhoods once offered.

I will write more about this idea, and about the labyrinth, in later posts. For now, suffice to say that Passages in Caregiving is worthy of a place on your summer reading list.

Caveat: Gail's descriptions of her emotional experiences during her caregiving journey with her husband are achingly accurate so, if you are feeling vulnerable or fragile, you might want to try reading just the chapters that currently pertain to you, and then leave the rest for later.

Men as Caregivers ...

When we think of family caregiving, we often think of women providing the care but in fact, men make up more than 30% of all family caregivers and, in some care contexts, provide the bulk of the care. (For example, 40-53% of all primary caregivers to people with AIDS in the United States are relatively young males. And often, fathers must take on more caregiving responsibilities as their children with disabilities grow older and are harder to manage physically.) How do these men experience caregiving and what are their support needs?

Although originally thought to be less negatively affected by their caregiving responsibilities than women, more recent studies have shown that men who are caregivers experience similar caregiving "burden" to women, similar levels of depression, and higher levels of hostility and work-family conflict. As well, brothers caring for parents experience as much stress and emotional strain as sisters but seem to have more difficulty combining work and family responsibilities. Men also tend to be castigated in the caregiving literature for being more likely to "abandon" their care recipients through separation or divorce but in many cases are tenaciously loyal and persistent in their care.

Now, while I personally tend to think that the differences in caregivers and caregiving have more to do with individual personality, history and experience than gender differences, there is research to say that some male caregivers may need:

1. More opportunities to share their feelings and experiences with other men. (There is a tendency for men to accumulate more acquaintances than confidants and thus to have less opportunity to share their experiences.)

2. The availability of formal respite care services during extended caregiving as their male support system is less likely to offer informal respite.

3. Skill-based educational opportunities - bathing, cooking, laundry, etc.

4. Normalization of and relief from the stigma (internal or external) of doing "women's work".

5. Support in communicating their own needs and feelings within the caring relationship.

Fueled for Caregiving?...

Like you, I suspect, I learned about the five (or six?) food groups and healthy eating practices way back in 5th grade Health class but it wasn't until I was literally falling asleep on my feet as a family caregiver that the penny dropped and I truly realized the importance of good nutrition in my life.

My husband had been both cook and baker in our home from the day we were married and while he had tried to make sure that he'd taught me to bake bread and to put together our favourite dinners before he became bedridden, the standing joke in our family still prevailed - "If anything ever happens to Derrick, Jan will die of a Cheerios overdose!". It's not that I didn't value healthy food when someone put it in front of me - in fact, I loved it - but I had no interest in producing it from scratch myself.

Flash forward a year or two, and you would have found me cooking very small and frequent nourishing snacks for my husband. And indeed, when his snacks didn't appeal to me, eating Cheerios, (garnished with various kinds of fruit to make them "healthy"). Up all day and half the night caring for Derrick AND eating poorly quickly caught up with me. I couldn't think clearly, I had no energy, my colour was poor and I dropped two dress sizes. I would sit down on the couch "for a minute" after lunch and wake up an hour later. And, worst of all, I was grumpy and irritable at a time when I truly wanted to enjoy the days we had left. Now, there were a number of factors that went into creating these symptoms, not just the Cheerios, but it was amazing how much things improved with a little nutritional intervention.

That intervention started when my younger sister, a real foodie, introduced me to

Barbara Jo's Books to Cooks, a wonderful bookstore close to Granville Market in Vancouver. Only my sister would have guessed that the way to this non-cook's stomach was through a book - especially one with smooth, shiny pages and beautiful photographs. The first one she picked out for me to peruse was Dana Jacobi's, 12 Best Foods Cookbook, and I was hooked. Just by looking at the cover, I learned that there were 12 superfoods which, if I indulged in them, would not only make me feel better but would protect me from some of the health problems inherent in caregiving. Those 12 super stars were:

1. Blueberries

2. Black beans

3. Sweet potatoes (or yams, as we call them on the west coast)

4. Oatmeal

5. Salmon

6. Spinach

7. Broccoli

8. Tomatoes

9. Chocolate

10. Walnuts

11. Soy

12. Onions

I bought Dana's book and began to enjoy making Sweet Potato & Broccoli Shepherd's Pie, Scalloped Sweet Potato with Apple, Greek White Bean Soup, Spinach Salad with Nectarine, Blueberries, & Lime Balsalmic Vinaigrette and more. And, more importantly, my energy improved, my irritability eased and my brain began to work again. I learned through experience that fueling my body with good food bearing high quality nutrients, bought in-season to keep the cost down, was one of the best ways I could sustain myself for the years of caregiving ahead - and indeed, for my whole life. (Now, if only someone could break my cookbook addiction...!).

Summer Reading ...

I don't know about you, but for me, one of the best parts of summer is summer reading. There's something about escaping into a new book that is, at once, exciting and relaxing.

One on my earliest memories is that of accompanying my father to our local library on a hot and sunny Sunday afternoon. I was barely big enough to carry my books and manage the wide steps at the same time. I remember, vividly, walking from the bright, sticky heat of that wide cement stairway into the cool, shaded, hush of the high-ceilinged, dark paneled, Victorian building. I lay the returning books on the desk then waved to my father and headed off down the dim hallway into the equally hushed and cool Children's Department. There, sitting at the miniature reading table with it's tip-tilted, varnished, mahogany book rests, I was in heaven. It was so quiet and peaceful and there were sooooo many books to choose from. I could barely contain my delight. My Dad could have left me there all day and I would, indeed, have been a happy camper.

Today, I feel the same contentment and pleasure as I pick out books for summer reading. This year's list includes:

1. Poetic Medicine: The Healing Art of Poem-Making by John Fox

2. presentationzen: Simple Ideas on Presentation Design and Delivery by Garr Reynolds

3. Come, Thou Tortoise by Jessica Grant

4. Savor: Mindful Eating, Mindful Life by Thich Nhat Hanh & Lilian Cheung

5. Passages in Caregiving: Turning Chaos into Confidence by Gail Sheehy

6. The latest mystery novels by Anne Perry and by Deborah Crombie

7. A re-read of some of Mary Oliver's poetry

What about you? What can you take from the bookshelf that will relax, restore, and refresh you as you take time out to re-create this summer?

S-l-o-w-i-n-g Down...

There is a secret bond between slowness and memory,

between speed and forgetting.

Milan Kundera

Yesterday was a busy day and I was rushed. Many phone calls and emails to return. Writing deadlines. Planning for fall workshops. And all the usual minutia of life. During the afternoon I had a great chat with a Vancouver social worker requesting a workshop and, in following up, I sent her a Speaker's Kit by email. Only I forgot to attach the Kit to the email.

It wasn't a big deal. I recognized that I'd forgotten the attachment the second after I hit the Send button - but it reminded me of Milan Kundera's statement about the relationship between speed and forgetting. Why was I in such a hurry? Where was the emergency? If I had approached the task more slowly, I would have taken half the time in the long run. And I would have saved the social worker the time she spent emailing me back to say that the Kit wasn't there.

David Kuntz reflects on the notion of slowing down in one of my favourite books, Quiet Mind: One-Minute Retreats from a Busy World:

As recently as a generation ago, ...

people lived their lives with a conscious realization of the balance

between slowness and remembering, between speed and forgetting.

They knew that leisure was a necessary part of a balanced life.

They knew that if you moved too fast you were bound to forget something.

We know it too, but only if we stop to recollect it.

Contemporary life does not afford us the intuitive awareness of our forebears.

It is, in fact, counterintuitive to a life in balance.

Unthinking acceptance of our culture's rate of speed is a terrible, yet common error.

These ... bonds must now be noticed with full intention,

and more, shouted from the rooftops.

There are many individuals and organizations now focused on "shouting from the roof tops" about our need to slow down. There are internet sites for Slow Food, Slow Travel, Slow Schools, Slow Living, even Slow Money. In fact, there's a whole Slow Movement born of our very human desire to not only avoid forgetting, but to make a deeper connection with ourselves and our lives. We want time to live life. If we run around at warp speed all day long there is no time for the things that matter - our own mental, physical, and spiritual health; our cherished relationships; our neighbourhoods; our environment; the natural rhythms and seasons of our lives.

There is much to be gained by slowing down but how does one do it? First, I think we have to be willing to give up some of our busyness and to grieve the losses that come in consequence. (Do we really have to go out five nights a week? Do our kids really need to be involved in more than one or two activities? Must we work ten hours of overtime every pay cheque?).

Once we've freed up some time, we can make choices about ways in which to slow down or pause during the day:

1. Breathe. Whenever you notice that you're feeling stressed, pause and take three deep cleansing breaths. And, as a form of prevention, pick a trigger - the ringing of the phone, the opening of a door or cupboard, getting into your car - and use it as a cue to take three more breaths.

1. Make a conscious choice to do less. Cut down your "to do" list to what's really necessary and let go of the rest.

2. Add more space. Schedule more time between tasks and appointments and, if you have to travel, leave earlier to get there so you're not rushed.

3. Disconnect from the electronic world. Shut off your mobile devices for a while. Schedule time away from your computer. It is hard to slow down when you're constantly checking your emails or answering your cell phone.

4. Be present. Practice being mindfully present to what you are doing or whom you're with. If your attention wanders, gently return it to the task or the conversation until you are finished. Notice and appreciate the beauty, the humour, the support and the life around you, whatever you are doing.

5. Spend time in nature. Be mindful of the seasons and the rhythms of the natural world. More than anything, these will teach us a healthy pace of do-ing.

6. Eat more slowly. Take the time to grow some of your own food, if that is possible. Prepare fresh food rather than refined meals whenever you can. Share the preparation with loved ones. And when it comes to actually eating, eat mindfully. Turn off the TV. Set the table attractively. Share the meal with others. Chew each bite sufficiently to actually taste its flavour and appreciate its texture.

7. Move more slowly. Unless you are exercising, walk, cycle and drive more slowly. Notice your surroundings. Your field of attention narrows as your speed increases, and widens as you slow down and that is safer for everyone. Try some walking meditation.

8. Consider slow travel. Engage more fully with the communities you visit. Make a "home base" when on vacation and travel by public transportation or other low-impact modes within a defined area. Visit spots enjoyed by local residents rather than following the guidebooks.

9. Explore slow parenting. Plan less for your children. Allow them to enjoy their childhood and explore the world at their own pace. Read books like Elkind's, The Hurried Child, and Carl Honore's, Under Pressure: Rescuing Our Children From the Culture of Hyper-Parenting.

10. For family caregivers. If you are doing long term, 24/7 caregiving and all this seems totally ridiculous, consider asking everyone you know to sign up on a rota to spend time with your care recipient, or to be available in the house, so that you can at least take a nap or read a book - slowly - undisturbed.