Fuel for the Fall...

Hi everyone! Happy fall! This is my favourite time of year. I'm just back from the Yukon where, at -2 degrees in brilliant sunshine, it felt much more like fall than it does here today in the muggy heat of Vancouver.

Nevertheless, I went off to the Farmers Market and Lonsdale Quay early this morning to pick up a plethora of fresh fruit and vegetables to stow away for the winter. (Whether I'm giving care to others at home or at work or have signed up for double-duty caregiving, having something delicious already prepared in the freezer can make the difference between a healthy dinner and a high fat, high sugar, refined one.)

I thought that today I would share a couple of the recipes I cook up for the winter every year, in hopes that a few of you might be inspired to share your favourites. (Isn't it true that coming up with ideas for dinner is more than half the battle?)

This past week I made a large pot of borscht which is now sitting in the freezer, divided into enough portions for 12 meals for a singleton like me. And tomorrow, I'll use my friend, Janet's, recipe to make winter vegetable stew. Both recipes freeze really well in ziplock bags and if you freeze them flat, you can later line up the bags like files in baskets in the freezer, making them much easier to find. (The bags are reusable as well.)

Borscht (I double this recipe)

6 large beets

1 Tbsp olive oil

2 leeks, finely chopped (include the light green parts)

2 carrots, coarsely chopped

1 head green cabbage, coarsely shredded

1 can (14 oz) diced tomatoes

2 Tbsp tomato paste

2.5 litres water

5 Tbsp red wine vinegar

5 sprigs fresh dill

3 Tbsp packed brown sugar

Salt and pepper to taste

1/2 cup sour cream or Greek yogurt (optional)

1. In a large saucepan, over medium heat, combine beets & water to cover them x 1 inch. Simmer til fork-tender, 45-60 min. Rinse beets under cold water after reserving 2 cups of the cooking water. Peel beets if desired. Cut into 3/4 inch pieces and set aside.

2. In a large soup pot, over medium-high heat, warm 1 Tbsp olive oil. Add leeks and carrots and saute until soft and slightly brown (5-7 min).

3. Add reserved cooking water, tomatoes, cabbage, water, tomato paste, and dill sprigs, stirring to scrape up the browned bits from the bottom of the pot. Bring to a simmer over medium heat, cover partially, and cook about 1 hour.

4. Add reserved beets, vinegar, brown sugar, and salt and pepper and simmer for 5 min longer. Taste and adjust the seasoning. Remove and discard dill sprigs.

5. To serve, garnish with sour cream or yoghurt and freshly chopped dill. Makes 12-16 servings if doubled. (If you have meat eaters in your house, you can brown and add 2 or 3 pounds of stewing beef to the mix in step 3 and cook 1 1/2 hours or til meat is tender.)

Janet's Winter Vegetable Stew - 4 servings (I double or triple this recipe)

1. In a large nonstick sauce pan - heat 1 Tbsp oil over medium heat

- add 2 onions coarsely chopped

- add 1 shallot or a clove of garlic chopped finely

Cook until tender.

2. Clean 2 leaks - cut into 3/4 inch pieces and add to pan.

3. Add, in 1 inch cubes, - 2 carrots, 2 yams, 1/4 rutabaga or turnip, 1/2 large squash. (The recipe calls for 1 potato, as well, but I tend to add another yam because I think they freeze better. Also, it helps to cook the rutagaga a little in the microwave before adding.)

4. Stir in 3 cups vegetable stock and 1 tsp oregano and 1 tsp thyme.

5. Bring to a boil. Cover and simmer x 30 min until vegies tender.

6. Stir in another vegie for colour and texture - ie green beans, snowpeas, broccoli etc - and simmer x 5 min. (I only do this if I'm serving the stew right away, otherwise I add the last vegie later when I reheat the frozen stew.) Add more water as needed. Serve in bowls with chopped parsley and parmesan cheese.

So, there are two ideas for stocking your freezer. I'd love to hear of recipes that work for the rest of you ...

Compassion Fatigue in Foster Parents ...

I have had touching conversations, this week, with two foster parents who called to ask if they would be considered "helping professionals" and, therefore, permitted to attend the fall compassion fatigue workshops.

My immediate response was, "Yes, of course.", having seen my great aunt and uncle raise several developmentally delayed foster "cousins" over the years of my childhood. While not endowed with university degrees, they had learned through years of experience the skills of attunement, attachment, and empathic behaviour management. My cousins thrived in the safe and loving environment of my aunt and uncle's small Fraser Valley farm but their care left a secondary traumatic stress impact in the lives of both their caregivers.

Foster parents work 24/7 with children who have been traumatized and, while research is still in the early exploratory stages, it does indicate that, because of this high level of secondary trauma exposure, foster parents may be at greater risk for CF than other helping professionals.

What other factors contribute to this increased risk? David Conrad, LCSW, Coordinator of the Secondary Trauma Prevention Project in Colorado, offers 4 possible factors in his article, Secondary Trauma and Foster Parents: Understanding Its Impact and Taking Steps to Protect Them:

1. Empathy: Empathy is needed to care for traumatized foster children but if foster parents over-empathize or over-identify with clients, they place themselves at risk for internalizing the children's trauma.

2. Insufficient Recovery Time: Foster parents may hear similar, horrific stories over and over again, often seven days a week without the respite needed to heal or get some distance from the stories. Thus, an accumulated secondary trauma load builds and can lead to CF.

3. Unresolved Personal Trauma: Many foster parents have had traumatic experiences in their own lives. (eg, loss of a family member, childhood abuse or neglect, accidents, addiction or mental illness in parents, serious illness or disability in their family of origin, immigration trauma and others). To some extent, the pain of their own experiences can be "re-activated" by the trauma stories of their foster children, causing an increased risk for internalizing the children's trauma.

4. Children's Vulnerability: Young children are completely dependent upon adults for their emotional and physical needs. When adults mistreat children, it evokes a strong reaction in any person who cares about children. Foster parents are at risk for these strong emotional reactions and their inability to change the children's situation can make them even more vulnerable to CF.

Early research is also showing that broadbrush training in childhood trauma and general self-care does not have an impact on CF risk in foster parents. As a result, Theda Parker's study of CF in Foster Parents at California State University, Fresno, suggests CF-specific training for all foster parents. (An idea with which I concur wholeheartedly!) Perhaps, even better than attending a general CF workshop, would be the creation of a workshop specifically for foster parents ...?

Fall Workshops 2011 ...

This morning, I saw the leaves just beginning to change colour in our local park and the message was clear - fall is on its way!

This season, I will be offering two Compassion Fatigue workshops to helping professionals in the Greater Vancouver area, the very popular, Caring on Empty: Compassion Fatigue Transformation & Resilience and the first of the Compassion Fatigue: Going Deeper workshop series, Compassion Fatigue: Going Deeper I: The Enneagram.

You are warmly invited to join us for one or both of these workshops and to bring a friend! The venue is comfortable and cozy for a mid-autumn gathering, the food will be simple but delicious, and the conversation, (if previous experience is any judge), will be both fun and stimulating.

For further information or a registration form, you can contact me at (604) 297-0609 or by email at caregiverwellness@shaw.ca.

1. Caring on Empty: Compassion Fatigue Transformation & Resilience

This is an intriguing, discovery-based workshop for helping professionals interested in learning about Compassion Fatigue, the natural and expectable secondary traumatic stress that can affect anyone who works with the suffering or traumatized. We will look at CF's potential impact on practice, your personal level of CF risk, symptoms and early warning signs, and realistic ways to transform and become more resilient to CF.

When: Friday, October 21, 2011

9:00 - 4:00

(Registration at 8:30 am)

Where: Shaughnessy Heights United Church lounge

1550 West 33rd Avenue, Vancouver, BC

(West of Granville Street)

Cost: $135 (Includes HST, lunch & handouts)

Who Should Attend: Any helping professional working with the suffering or traumatized.

2. Compassion Fatigue: Going Deeper I - The Enneagram

Two of the early warning signs of compassion fatigue are irritability and emotional reactivity. This beginners Enneagram workshop builds on Caring on Empty and will help you to discover your personality type within a group of nine types and to determine the situations that are most likely to "push your type's buttons." You will also learn a form of mindfulness meditation that will help you to become more aware of your type-based responses.

Rather than "putting you in a box" as some might fear, personality typology has the potential to free you from the box of your unexamined personality.

The Enneagram, a mix of ancient wisdom tradition and modern personality theory, is more useful and accurate than any other personality system with which I've worked , primarily because it focuses on the motivations behind our behaviour rather than the behaviour, itself.

Join us to begin a process of self discovery which, at the very least, will make you laugh out loud in recognition and, at best, could change your life!

When: Friday, November 18, 2011

9:00 - 4:00

(Registration at 8:30 am)

Where: Shaughnessy Heights United Church lounge

1550 West 33rd Avenue, Vancouver, BC

(West of Granville Street)

Cost: $145 (Includes HST, book, handouts & lunch)

Who Should Attend: Helping professionals, as above.

3. Heads Up for the New Year

The second of the Compassion Fatigue: Going Deeper Series will be offered in early 2012. With the tentative title of, "Becoming Weller Than Well", this workshop will be highly interactive and will use a variety of modalities- story, collage, mandalas, meditation reflective exercises - to help you explore CF resilience in greater depth.

(Please note: No special skills or creative abilities will be necessary and you don't have to share your creations with anyone else, unless you would like to do so.) Please watch for details later in the year.

Medication Caution ...

My first workshop for the Fall 2011 season was held this past Saturday for the Association of Advocates for Care Reform. This small but active non-profit group focuses on improving quality of care for older adults living in long term, residential care in BC.

Through advocacy and the development of family councils at residential care facilities, the ACRBC "helps provide a voice for residents and creates an inclusive, supportive environment for family and facility staff to work together".

While I was preparing for their workshop, ACRBC's, Kathleen Hamilton, sent me an article by freelance writer, Rob Vipond, from the June 2011 issue of Focus Magazine called, Crisis Behind Closed Doors. In this article, Vipond cites data obtained through a Freedom of Information request that shows that nearly half of all seniors in long term care in BC are being given antipsychotic medication. This is "... almost twice the average for the rest of Canada and among the highest rates found anywhere in the world. And even though Health Canada warns these drugs cause a doubling of death rates in the elderly, careworkers admit they're mainly being used as chemical restraints in the absence of adequate staffing and proper oversight."

Now, it is unlikely that this number of elders are actually psychotic. It is also unlikely that all healthcare workers choose to use medication, particularly inappropriate medication, to manage behavioural issues in the elderly. The problem, I suspect, lies not so much at the level of the residents or the careworkers but at the policy level, where care decisions are sometimes based on unrealistic fiscal restraint and myths about the care needs of the elderly.

The notion that older adults need less, rather than more, complex care is one that is offensive to anyone who has cared for older adults with multiple chronic conditions and yet, we frequently find large numbers of people cared for by a few care assistants supervised by an RN or LPN who has so many meds and treatments to deliver that he or she cannot be available to share more advanced knowledge and assessment skills with other staff.

And, when compassion fatigue and moral distress among staff members and family caregivers are added to the mix, residents face a very real danger of being treated at the level of behaviour management rather than as complex human beings who deserve to be seen, understood and treated as whole people whose behaviours ultimately make sense in terms of their life experience.

We know how to respond holistically and therapeutically to the often perplexing and frustrating behaviours of older adults in residential care but we need sufficient numbers of adequately prepared staff, uninjured by compassion fatigue and burnout, and with the time to discover and treat the roots of disturbed behaviour. Until that happens, I'm afraid we will be reading more and more articles like that of Rob Vipond.

A Practice of Silence ...

At the beginning of what would become the last year of my husband's life, I realized that I could no longer continue the marathon of caregiving without some respite.

While the thought of making and coordinating all the necessary arrangements was overwhelming, with the encouragement of family and friends I used my last ounces of strength to plan four nights at a small retreat centre on the Sunshine Coast.

When I finally arrived at the old log house among the trees, the retreat director asked if I would be making a silent retreat (so she could inform the other guests). A little nonplused - I hadn't thought beyond getting myself safely to the door - I answered, "Yes." And thus made one of the most healing choices in seven years of caregiving.

I don't remember much about the ensuing days, and I had little energy for journalling so there remain few written descriptions, but my body remembers being flooded with gratitude for the depth of that silence.

Each morning I woke early and lay in bed soaking in the absence of sound until the dawn chorus began. After a silent breakfast in the cozy, sun-filled dining room, I went outside, wrapped myself in a warm quilt and lay on a lounge chair near the top of a long, gently rolling expanse of lawn. Protected by cool, dark woods on three sides and the house on the other, I lay there in the quiet for hours.

With the silent warmth of the sun seeping through layers of quilting, came a thawing of my tears. I cried for five days. Not the hot, heaving tears of anguish but the quiet, steady flow of years of chronic sorrow.

Later, as I returned home, I reflected upon the gift of silence. It had opened a space for grief, rest, healing and peace. My thinking was clearer, my body was stronger and I believed, once again, that I would have the ability to see the journey to its end.

The gift of silence has been written about by many but by few as eloquently or practically as journalist and author, Anne LeClaire, in her book, Listening Below the Noise: A Meditation on the Practice of Silence (2009). In a style reminiscent of Anne Lindburgh's "Gift From the Sea", Anne LeClaire describes her almost twenty-year experience of practicing silence, all day, on the 1st and 3rd Mondays of each month.

In this beautifully written little book, part memoir and part philosophical inquiry, she explores how silence can make space for us to expand our awareness and achieve inner peace. She describes the joy and difficulties of adjusting to this practice - both her own and that of her family and friends - and she shows how, through silence, we can:

- slow the pace of life,

- learn how to listen,

- become more compassionate,

- ignite and nurture creativity,

- uncover our inner yearnings,

- and, ultimately, find peace and improved well being.

In LeClaire's personal practice, silence means the absence of speech, not being still or without sound. She describes how, relieved from the stress of conversation or being physically or electronically available, her focus became more mindful and her creativity soared. Her body relaxed and her attention turned inward:

This is the first gift.

As I stepped into the shower, the upstairs phone rang

and I jumped reflexively. And then, immediately, I remembered

I was not talking and had no obligation to answer it. My shoulders

dropped and my body released a tension I had not even been

aware of holding. Only minutes from sleep and already my muscles

had been primed to meet the day's demands. I thought of the sign

at a local breakfast spot that reads:

Good morning. Let the stress begin.

I realized that we live our days with ears turned outward,

ready to respond, always on the alert, almost as if we walked

around holding huge ear trumpets to our heads, like figures in

an old cartoon. But for this one day both my ears would be turned

inward. I had only to listen to myself. Within the shower walls, it

felt as if my world had grown smaller and smaller until

all that was left was me.

For those who find the notion of 10 minutes silence terrifying, let alone a whole day, Anne provides a long list of options for beginning a practice of silence slowly and easily. Here are just a few:

1. Turn off the car radio on the commute to work or while running errands.

2. When performing a routine chore - folding laundry, washing dishes, straightening a room, weeding the garden - make it a habit to do the task in silence.

3. When a task is completed, sit in restful awareness for several minutes before running to the next chore on the list.

4. After finishing a telephone conversation, sit quietly for a minute or two. Breathe.

5. Have a meal alone. Without distractions. Without a book or magazine.

6. Set aside a formal silence time for your family.

7. Wake an hour early and spend that hour in deliberate silence.

8. Take the TV out of your bedroom.

However you decide to begin, a regular practice of silence can change the quality of your life and that of those you love. Why not give it a try?

Another Resource for Kids...

This week I have found a resource for children and young adults who are affected by illness - their own or that of a loved one:

It can be difficult to help frightened young people to understand medical conditions and procedures. Medikidz Comics is a resource that can help.

Medikidz comics are a series of 25 comics (plus 300 more waiting to be written) about five super-heros, the Medikidz, who live on Mediland, a living, moving planet shaped like the human body. Chi, Skinderella, Pump, Axon and Gastro take children on trips through Mediland to explain different conditions and how they are treated.

Written in age appropriate language by professional medical writers and physicians, these comics help to demystify the diagnosis, investigation, treatment and prevention of various medical conditions. A Youth Advisory Council of kids aged 6-16, who are affected by illness, provide the writers with feedback and help to shape the direction of Medikidz.

Medikidz has produced comics on paediatric conditions like epilepsy, scoliosis, leukaemia, autism and cystic fibrosis and also on conditions that could affect a parent/loved one. Some titles include:

a. What's Up With James? Medikidz Explains Depression

b. What's Up With Mom? Medikidz Explains Breast Cancer

c. What's Up With Dad? Medikidz Explains Melanoma

d. What's Up With Grandpa? Medikidz Explains Alzheimer's Disease

If you are interested in learning more about Medikidz, or in purchasing comics, you can go to their website at www.medikidz.com.

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.