Companioning through Grief...

Although it is a bright and vibrant fall morning here in Vancouver, my thoughts are focused on grief. A dear friend's mother died of mouth cancer two nights ago, I have been asked to speak to a group of family caregivers who have lost a loved one to ALS and I am rereading the transcript of a seminal keynote address given by Dr Alan D Wolfelt to the Association of Death Education and Counselling conference in Chicago in 1997 entitled, Companioning vs Treating: Beyond the Medical Model of Bereavement Caregiving.

These three occurrences have combined to return my thoughts to the early days of my own bereavement following the death of my husband and, 3 months later and quite unexpectedly, that of my mother.

During those days I was completely depleted, shell-shocked and bereft. Friends and family surrounded me with love and support but, as is often the case in our North American culture, that support gradually dwindled as time went on. Some, who didn't understand the the notion that grief takes as long as it takes, became impatient and frustrated with their inability to "fix" me. Others, who had walked the path of grief before me, waited patiently for the the cloud of sorrow to lift and stood again and again with hearts and arms wide open as, after periods of "improvement", that cloud of grief descended once more in the face of anniversaries, holidays or family celebrations.

Five things helped me through those months and years of sorrow:

1. The incidental comment of an acquaintance whose husband had died years before mine - "It will take 5 years before you know who you are without him". With this comment she gave me permission to take as long as I needed to grieve. The number of years wasn't important. It was the implicit expectation that my grief would take as long as it took. (For some, a long goodbye has already been said and soon after the death there is a sense of relief and an early readiness to engage with life again. For others, the road is longer.)

2. Moorings, the beautiful writings of Rabbi Vicki Hollander. Vicki had been my grief counsellor for a brief period during my husband's illness and, when she moved away to Arkansas and then to Texas, she left me with these poetic and practical reflections on what I might expect at different times during the first year and a half of my bereavement.

3. The Two of Us: My Life with John Thaw by British actress, Sheila Hancock. This autobiography / biography has been, rather surprisingly, a great source of comfort over the years. Interspersed between stories of her life with actor, John Thaw, (Morse, Kavanaugh QC, Mister Tom) are italicized selections from her journal telling the story of his cancer diagnosis, death and her early bereavement. Reading these segments was the most empathic experience of my bereavement and I will be forever grateful for the intuitive love and generosity of my husband's cousins who left a copy on the bookshelf in my sitting room during a visit to England in the Spring following Derrick's death.

4. The support of my spiritual director / grief counsellor whom I saw on a weekly then bi-weekly basis.

5. The support of family and friends who stayed in for the long haul, waiting until the sun shone again in my life.

What was the experience that linked these five supports? The experience of companioning. As Alan Wolfelt said in his keynote, companioning is different from "treating" or "fixing":

More specifically, for me ...

* Companioning is about honouring the spirit; it is not about focusing on the intellect.

* Companioning is about curiosity; it is not about expertise.

* Companioning is about learning from others; it is not about teaching them.

* Companioning is about walking alongside; it is not about leading.

* Companioning is about being still; it is not about frantic movement forward.

* Companioning is about discovering the gifts of sacred silence; it is not about filling every painful moment with words.

* Companioning is about listening with the heart; it is not about analyzing with the head.

* Companioning is about bearing witness to the struggles of others; it is not about directing those struggles.

* Companioning is about being present to another person's pain; it is not about taking away the pain.

* Companioning is about respecting disorder and confusion; it is not about imposing order and logic.

* Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.

If you would like to learn more about companioning and other aspects of grief recovery you can read more at Alan Wolfelt's Griefwords.

Thanksgiving in the East ...

If the only prayer you ever say in your entire life

is thank you, it will be enough.

Meister Eckhart

I'm off to Toronto in the early hours of Thursday morning to speak at the ATSS conference and then I will be driving down to Kingston to spend Thanksgiving with dear friends there.

I've been thinking about Thanksgiving and "gratitude" over the past week and was surprised to find an echo of my thoughts in an article in the Winter 2009 newsletter of the Callanish Society.

(Callanish is a wonderful nonprofit organization, worthy of your support, that provides retreats for people living with cancer and their families. A number of years ago my best friend, Linda Vick, attended one of their retreats before dying of lung cancer. It changed her life and touched many of us through her. I still have the journal she kept during her week's retreat - a treasured gift - and I read it from time to time when I need a reminder of what matters most in life.)

Janie Brown, Executive Director of Callinish, wrote these words in the Winter newsletter -

Many of us need to work at feeling grateful when life turns around on us.

A good friend of mine, Roger Hyodo, writes about thankfulness. He speaks about

two kinds of gratitude. The first is one that we cultivate based on our preferences,

beliefs, and values. We like something, we feel grateful. We don't like something,

we feel ungrateful. Our state of internal thankfulness is dependent on the ups and

downs of our lives. There are some people who tell us that we should see

everything as a gift, and that every experience that arrives is meant to be.

This is all very well, but what we cannot do is will ourselves to be grateful. It doesn't

work. All we do then is bypass our sadness, anger and regret, and send those feelings underground. At Callanish we offer a space for people with cancer to have their feelings, to honour the dark emotions by giving voice to them. In time, and it takes time,

I hear people speak not of cancer as a gift, but of life as a precious commodity.

Even in the midst of fiercely rejecting cancer, people can become clear that

there are things worthy of thanks.

The second form of gratitude Rodger speaks of is one that we may sense as a

"field" of thankfulness. I have experienced this many times in our circles at Callanish,

as well as in many other moments of my life. When we deliberately create certain conditions in our living, we become aware of this underling ever-present

quality of thankfulness.

Some of the conditions at Callanish are beauty, silence, real conversation, music,

art and spontaniety. We find ourselves risking expression to speak what is

true for us. In this kind of space, the heart seems to unabashedly open in response to

another's honesty, and we feel thankful. It feels like this thankfulness moves

effortlessly among us.

Perhaps, then, in these times of great uncertainty in our lives, it is up to all of us

to create these conditions for ourselves and each other ... whereby we can touch into

a genuine feeling of gratitude for the lives we are living.

When I hear someone express thanks amidst a life of great struggle, it humbles me to

look at my own life through a different lens. With that view, how could I not say,

"Thank you".

So, for Linda and Derrick and Barry and Mom and Dad and Christopher who, through times of great struggle, taught me about thankfulness, beauty, silence, real conversation, music, art, spontaneity, and mostly, love - I, too, say, "Thank you".

Book Review: After the Tears ...

Earlier this month, Health Communications published a revised and expanded edition of Jane Middelton-Moz and Lorie Dwinell's 1986 popular classic, After the Tears: Helping Adult Children of Alcoholics Heal Their Childhood Trauma.

This new edition has been almost entirely rewritten to reflect new information regarding trauma, posttraumatic stress disorder (PTSD), delayed grief and newly-discovered brain physiology. Entirely new chapters include those on resilience in children of alcoholics, ACoA's as parents, ACoA's in the workplace, acceptance and forgiveness, and spirituality for ACoA's.

Not surprisingly, the first of the new chapters to catch my eye was one entitled, A Pain Too Deep: ACoA's Taking Care of Elderly Parents. Here, Jane Middelton-Moz describes an issue common to many adult children of trauma - that of caring for elderly parents who have not cared well for you. While for some, therapy and personal growth in the intervening years have meant that parental caregiving is an opportunity to give back, lovingly, to parents who did the best they could, for many, "... the task can be especially daunting ... (when) navigating a minefield of emotional hurts and abuse from the past". Jane goes on to say that -

Adult children frequently end up caring for elderly parents who were not there for them in their growing up years, and who were sometimes physically and/or sexually abusive to them as well. Many alcoholic or codependent parents had lives that resulted in chronic PTSD, and they often were not appropriately cared for themselves as children. As a result, many were suffering from their own developmental losses while raising their children. They may have been neglectful, clinging, dependent, abusive, controlling, ill-tempered, or demanding parents who not only were ineffective as parents but demanded to be parented as well. As a result, many Adult Children also suffered from PTSD most of their lives. Within this framework, these Adult Children are then commandeered one more time to take over the care of their parents physically and emotionally, and for some, to rescue them financially as well; all of this while being their parent's primary caregiver.

Many of the Adult Children who are responsible for elderly parents are themselves in their sixties or seventies and are taking care of parents in their eighties and nineties. For many, this is the time they believed they would finally be able to relax. They have achieved some level of financial security and career satisfaction and often have new and improved relationships with siblings and parents. This tests their limits and can cause some ACoA's to revert to earlier roles and painful interactions with both siblings and parents. While some elderly parents who need care may have gone through recovery, others may be as emotionally difficult as they ever were - or may even be worse. (p 218-219)

Why does all this matter? Because in many jurisdictions, including British Columbia, a Guardianship Act or similar legislation legally binds adult children to the care of their dependent parents. Understandably, when unresolved trauma is in the mix, such situations can hold the potential for elder neglect or abuse and they call for case-by-case assessment and adequate support from knowledgable case managers before a parent is placed in the care of an "unrecovered" adult child.

Another seldom-acknowledged observation made in this chapter is that adult children of alcoholics can find themselves caring, not only for their own children and for their parents, but for adult siblings who have "fallen by the wayside" as the result of their own childhood wounds. When this situation is combined with a lack of psychological separation from family members and an enhanced empathy for others' suffering, (both products of traumatic families), it can lead to a caregiver burden that is on a fast track to burnout and compassion fatigue.

Jane and Lorie offer a number of self-care recommendations for ACoA caregivers including:

• 1. Developing the ability to define yourself and to set caregiving limits. (This is often best done with the support of a therapist who has expertise in treating both caregiving and childhood trauma issues.
• 2. Not expecting siblings to behave differently from their usual roles and patterns under the stress of a parent's illness or infirmity. (Families almost always revert to their original patterns in the face of serious stress.)
• 3. Remembering that you do have a choice regarding how much caregiving you are willing to undertake. (You may not be able to change your family's response, but you can change your own behaviour.)
• 4. Planning ahead and formally scheduling self care time. Making it a priority.
• 5. Giving yourself the gift of support. (Many adult children develop a protective counter-dependence that can cause them to feel shame regarding their natural need for support.) Consider seeking a good therapist or 12 Step support group. If you can't leave home, join an on-line support group run by a reputable organization.

This practical and readable volume has been a gift to ACoA's for almost 25 years and the new, expanded version will enlighten and promote the healing of a whole new generation of adult children.

The "Dr Peter" Tapes ...

About 20 years ago, I went to church in Burnaby BC one Sunday morning to find that the homily was to be given by a young man named Peter Jepson-Young. My minister had heard the first of the "Dr Peter" tapes on CBC Radio and had immediately called to ask him if he would consider coming to talk to the congregation. That Dr Peter answered, "Yes", was a testament to his grace and courage because the Christian church at that time was frequently less than kind and inclusive in its response to people with HIV/AIDS.

I remember a nervous but thoughtful, articulate, deeply honest and very funny man who, despite failed eyesight, stood alone on the chancel steps to give us a real picture of life with HIV/AIDS. He taught and reassured and made human the face of a little known or understood disease. We laughed and cried as he spoke and many people stayed a long time after the service to speak with him and his family.

That one 20-minute talk changed the hearts and minds and attitudes of people who had previously been frightened to even hug a person who was HIV positive. In the years to come, the minister became a chaplain to our church's support organization for gay, lesbian and transgendered people and the congregation continued to support the Dr Peter Foundation and the Dr Peter Center. We all grieved on the day of Peter's death in 1992.

This September, Vancouver has declared a Dr Peter Week in appreciation of Dr Peter Jepson-Young's contribution to the quality of life of those affected by HIV/AIDS. CBC Radio is marking the 20 year anniversary of the tapes by featuring them on their broadcast and website and there will be fundraising events for the Foundation all around Vancouver. Please take a moment to visit the CBC site and take in the details.

During one of his most poignant broadcasts, Peter shared his Affirmation with his viewers. Let me share it with you today:

I accept and absorb all the strength of the earth

to keep my body hard and strong;

I accept and absorb all the energy of the sun

to keep my mind sharp and bright;

I accept and absorb all the life force of the ocean

to cleanse my body and bring me life;

I accept and absorb all the power of the wind

to cleanse my spirit and bring me life;

I accept and absorb all the mystery of the heavens,

for I am a part of the vast unknown.

I believe God to be all these elements,

and the force that unites them;

And from these elements I have come

and to these elements I shall return;

But the energy that is me will not be lost.

Dr Peter Jepson-Young, MD

Dr Peter AIDS Foundation

Safety in Our Hands: Helping Our Helpers Stay Healthy ...

Of great interest to anyone in the trauma field this Fall will be the 2010 Association of Traumatic Stress Specialists Conference to be held in Toronto, Sept 30 - Oct 2.

With the theme and focus of keeping helpers well, the conference offers a wide selection of more than 30 workshops including:

Keynotes -

1. Dr Angie Panos - Safety in Our Hands: Helping Our Helpers Stay Healthy

2. Lt Col Stephane Grenier - ( Canadian Operational Stress Injury Special Advisor) - Peer Based Mental Health Services

Workshops -

1. Question & Answer Session: Preventing & Healing Compassion Fatigue

Dr Angie Panos

2. Creative Tools for Transforming Compassion Fatigue and Vicarious Trauma

Francoise Mathieu

3. Caring on Two Fronts: When Helping Professionals Become Family Caregivers

(Chronic Sorrow in the Context of Compassion Fatigue)

Jan Spilman

4. Meditation, Mindfulness, and Right-Brain Healing

Dawn Bret

5. HUGS: Helping Children Understand Grief & Trauma in Six Week Sessions

Christina Derneder Landen

6. CISM in the Correctional Service of Canada

Pamela Scott & Dorothy Reid

7. Voices of Experience

Pricilla de Villiers, Kent Laidlaw, and Edward Leonard

8. PTSD & Addiction Treatment for Occupational Hazard: Strategies for Symptom Reduction

Anne Pepper

... and much more.

I'm particularly pleased to have been chosen to speak at this conference because, for the first time, I will be combining material from the Compassion Fatigue and Chronic Sorrow fields as a means of expanding our understanding of the stress of "caring on two fronts".

Please join us! To register, click here.

Photo by Bigstock Photos

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".