Coming Home to Secondary Traumatic Stress

Someone looking into car rear view mirror with sunset in background

I recently had a challenging week managing my secondary traumatic stress reactions.

What happened felt long past and yet familiar – I had not experienced symptoms this strong since leaving full-time clinical work. It kind of caught me by surprise, although, in hindsight, it shouldn’t have, and I think I know why it happened:

I had been working long hours in the office and sleeping less than I needed  – because summer is short in Canada, and the sun was shining, and the nights were balmy, and there was live street music to be enjoyed, and late-night conversations with dear friends to be had, and BBQs to be cooked and shared with my wonderful children and their friends.

I had also been reading a beautiful, but deeply disturbing, fiction book before bed (I know, I know) and had spent six hours on a drive listening to a podcast about a con artist who ruins people’s lives. (I KNOW – “What the heck?!” right?)

Basically, I was doing all the things that I tell other people not to do – lack of sleep, extraneous trauma exposure, poor pacing…and my fatigue and vulnerability sort of crept up on me.

Then, in rapid succession during that same week, I heard a series of terrible trauma stories at work. If you work in this field, you know the ones that I mean: those that bring up another case that you thought you had long forgotten and had stored far in the recesses of your brain; or an image that sends a chill right up your spine; or stories that make you stop breathing for just a second as you lean towards the pain and suffering of the person in front of you, in a state of deep empathy.

To top it all – and this is important – one of these stories wasn’t something that I heard at work: I was visiting with a friend, having a lovely catch-up, sitting in the garden, and forty minutes into our chat, she shared, without warning, a terrible story that had just happened to someone in her life on this very same day. She shared all of the sounds and images of the accident as people do when they are processing trauma. I don’t blame her for doing that, she was traumatized and needed my support and that is absolutely fine, but because we were chatting casually and I didn’t know the story was coming, it caught me off guard and hitched a ride with me for a few hours. 

 

Coming Home

 

When there is a lot of secondary traumatic stress (STS) in me, I tend to withdraw from my family or steer all conversations towards hard topics related to my work. I still “show up” and cook and clean and do groceries and hug my kids, but I have very little mental energy left to engage in non-trauma conversation – especially if the topics are “civilian” concerns (the latest Congressional hearing? Blah) or one of my family’s three favourite topics (politics, gender politics, college basketball – someone save me). I normally enjoy a good smart debate about all of these topics, but when I’m full of STS, I just wish everyone would talk about cute puppies OR trauma.

This, in and of itself, is a solid warning sign for me, and I noted it as it occurred.

At the end of that week, my partner and I went on a lovely drive to visit some friends who live upstate New York – lush rolling hills and great music playing in the car.

I was quiet and reflective for the first hour. Finally, I told him – “This was a hard week for me. I heard a lot of difficult things, and although I won’t slime you with the content, it made me reflect on how it used to be for you when I did front-line trauma work full-time.”

He looked far off into the distance, took a deep breath, and replied: “Those times were really hard.” 

Ok, so he’s a man of few words, but I knew what he was saying because we have been together for 30 years, and he has been a witness to my entire journey as a trauma clinician. We have discussed, in the past, my sometimes difficult transitions back into our home life, my irritability and lack of engagement in things that he is passionate or interested in. The way I sometimes withdraw to bed at 8pm because I am completely maxed out.

What is it like to be in a relationship with us? What is it like to be our friend when we don’t return calls for weeks or show up at birthday parties and tell a trauma story we think is hilarious but no one else does?

 

Resetting our Foundation

 

So yes, I hear a lot of hard things in my job – and I am sure you do too – and it’s normally fine because I have a whole arsenal of tools to pace and reset myself, but that week, because of my “summer 2019 extravaganza” behaviours, I wasn’t as prepared and grounded as I usually am. I was working with a shakier foundation.

Since I teach and write about secondary trauma for a living, I also watch myself very carefully and take mental notes:

  • “Feeling very anxious for no reason”

  • “Decreased appetite”

  • “Hmm, interesting choice of night-time reading…”

  • “Check me out picking a fight with my son before I even put my briefcase down –  even though I had told myself ALL THE WAY HOME not to talk about this immediately as I walked in the door.” (Awesome parent of the year award…)

By Friday midday, I was feeling completely out of sorts. However, because I know my STS symptoms so well, I didn’t let these things go on for very long.

I decided to call it a day and took myself offline for a bit. I went to do some non-trauma related stuff for myself (insert your favourite self-care activity here) which, on that day, involved a pedicure and buying a tool at the plumbing supply store.

(And, yes, both things can co-exist in a person – a pedi and some bad-ass DIY.)

Yet during this mini-break, I noted my persistent level of hyperarousal. Throughout the afternoon, I was unable to shut off the overactive thinking and the list making. 

So, I took a deep breath, went home, put the terribly sad fiction book away, watched an episode of Queer Eye (I LOVE THEM) and went to bed early for a proper night’s sleep.

Coming home to STS is an ongoing process – we need to remain self-aware, take notes of shifts in our behaviours, pace ourselves and listen to our loved one’s feedback when they say “you are not yourself today” (without biting their heads off). We also need to rest and restore our bodies and our brains, so that we can continue being present to all aspects of our lives. 

Coming home to secondary traumatic stress is an ongoing process. We need to remain self-aware, take notes of shifts in our behaviours, pace ourselves, and listen to our loved one’s feedback. Click To Tweet

This leads me to asking you the following questions:

  1. If you are a trauma-exposed professional, have you asked your loved ones/friends what it’s like to live/hang out with you when you are in the Yellow zone?

  2. What would they say about how you transition from work to home?

  3. What would they say about the impact hard stories and cases have on you? On them?

  4. Have you developed a keen self-awareness about your warning signs and when it’s time to take stock and reset yourself?

As I finish writing this post, I am sitting in my garden on a cool Sunday morning. There is a light breeze blowing and my daisies are gently bending in the wind. The raccoons that live under my shed just came home from their night of carousing and gave me a nod as they crawled back in their den (we have an understanding – they don’t bother me, I don’t bother them).

I feel strong and rested, but I am also keeping a close watch on my thoughts, behaviours and choices that I make about taking care of myself. I love trauma work, but it can’t dominate every aspect of our lives if we are to continue providing high quality, ethical care.

There are so many things that we have no control over in our work – but how we take care of our bodies and our brains must remain at the top of the list.


Recommended Resources:

[Online course] Window of Tolerance Framework (WTF) – Strategies to keep helping professionals grounded and centered

[Online Course] – Compassion Fatigue 101 

Conversations on Compassion Fatigue with a Family Physician

compassion-fatigue-family-physician-conversations

Conversations on Compassion Fatigue is a series where we interview professionals from high-stress and trauma-exposed environments to discuss issues around compassion fatigue, organizational health, vicarious trauma, moral distress and self-care. 

This time, we sit down with a Family Physician to discuss her thoughts on compassion fatigue and burnout and how it shaped her practice.


 

Can you tell us a bit about your work as a Family Physician?

 

“I have been working for 24 years now as a family physician. I have a varied practice, including working in a cancer clinic and attending labour and childbirth. I’ve been at my current job for about 9 years working in a higher needs area of the city.

Many of my patients have complex mental health issues, struggle with addictions and/or living below the poverty line.

When I took over this practice from the previous doctor, many of my patients were on high doses of opioid prescriptions. I recognized that there was a need for tapering of their prescriptions – and there was a lot of resistance to this idea. This was before opioid tapering was a typical or well-known practice.” 

 

What has been your experience with compassion fatigue?

 

“In order to get buy-in from my patients to reduce their medication, I had to learn about them and understand their histories. As I was doing this and talking to patients more and more, I uncovered stories of abuse, trauma, and violence. 

I heard from many who were presently suffering from chronic pain that they had endured childhoods with a lot of adversity. Listening to story after story of child neglect, abuse and household dysfunction was intense and upsetting.

This process resulted in me experiencing a significant burn out.

I was the classic story of someone experiencing vicarious trauma and compassion fatigue. I started to break down in tears or lose my calm. When someone would ask a simple “How are you?”, I would respond by getting teary. I am usually quite a positive person who is not prone to depression, so this was a new and distressing experience. 

In order to overcome this, I looked for people who could understand what I was going through. It helped to have someone who could understand why hearing all of these stories had negatively impacted me. Speaking to those who knew about compassion fatigue was really helpful as I was able to put a name to what was going on.

I did stay at my current job and ended up going full circle with this group of patients, even though they were being tapered and initially resistant. Now these patients are a place of strength for me. Many of them coped very well with the tapering and ended up feeling better.” 

 

What did you learn from your experience with compassion fatigue?

 

“I have discovered that you can learn to care – and your patients do need to feel like you care for them in an unconditional way – but its important to have your personal limits and boundaries. There is a cost in overly empathizing with your patients and feeling as though you have to “rescue” them from their issue.

I have a term for this – compassionate disinterest. This is when a caregiver should have unconditional positive regard and acceptance of a patient in order to establish a deep empathy. However, one must also develop a level of disinterest so that there is a clear avoidance of “rescuing” the patient.

One can have deep wishes and hopes for a patient – but there has to be a confidence that the best approach for self efficacy and improved health comes when a person motivates themselves.

Over time, people will respond to your confidence in them. There is a subtle way to navigate this, and it is hard to learn – but it is very important for both the patient and the health care provider. 

In the end, getting overly invested in your patients or clients is not helpful to them or to you.”

 

What does your self-care practice look like?

 

“For my own self-care, I try to exercise regularly, eat well, get good sleep and have a sense of when I’m taking on too much stuff.

I am more aware now of when there is a”tug-of-war” that starts to happen between what I need and what my patients’ need. I try to prioritize my needs as much as theirs – believing firmly that people need to help themselves. My role is not to take over care. It should be more like a coach – supporting people to make personal improvements and then helping them take responsibility for their health and well being. 

It is a constant battle to achieve a balance – but things have been a lot easier now since I’ve fine-tuned how I connect with my patients and my family practice is a source of strength.”

 

Has your work encouraged you to do self-care?

 

“My workplace has tried to be supportive. We do have an allowance of personal days and paid vacation time.

It is a good place to work – but like many health care settings, we are doing a lot of work with limited resources which makes it often feel like an overwhelmed work setting.There is a lot to do with very little money and resources and often front line providers are feeling that stress the most.”

 

In your field, what do you think could be done to help mitigate the effects of compassion fatigue?

 

“In healthcare, we need to start thinking and talking more about the root causes of health issues. We need to work on improving housing, food security, early childhood supports etc.

I know that those are bigger issues, but we need to stop this “putting out fires” style of healthcare and instead focus on prevention of diseases and ill-health.

Another important issue that I try to teach my patients about is ACEs or Adverse Childhood Experiences. I talk to them about the effects that their early childhood experiences can have on their health and how these negative experiences can have even changed the development of one’s brain.

We know that exposure to early childhood toxic stress can affect things like your impulse control and decision making skills which will impact one’s ability to adapt to certain situations. These early childhood negative experiences predispose may you to making decisions later in life that may not be in your best interest.

This education is so important for two reasons. First of all, it helps to remove the sense of self-blame. Behaviour change can’t happen if your patient is struggling with feelings of intense self-loathing and guilt. The second reason is it allows forgiveness. Understanding the past can help patients make a plan for the future and move on.

Guilt, shame and other negative emotions lose their power when you understand where they come from.”

We need to stop this 'putting out fires' style of healthcare and instead focus on prevention. Click To Tweet

 

What do you find challenging about your work? Most rewarding?

 

“The systemic issues in the healthcare system are on-going and challenging. Managing that can be very frustrating and difficult. However, when you can find a way to gain strength from your patients and build a healthy relationship, this can fuel your energy for this work.

I am inspired daily by my patients who persist in overcoming multiple barriers to improve their health and well being. When my single mom comes to my clinic with her two children after taking two buses to get there AND she arrives on time, I’m amazed and inspired.

People have a lot of resilience if we look for it and support it. 

 

Are there any resources you would recommend?

 

Trauma and Recovery by Judith Herman

The Body keeps the Score by Bessel van der Kolk

Trauma Stewardship by Laura van Dernoot Lipsky

The Deepest Well by Nadine Burke Harris


 

 

Balancing Your Life – an interview with law professor Lawrence S. Krieger

A statue of lady justice between two books

Professor Lawrence S. Krieger co-directs the Externship Program and supervises criminal justice externships at the Florida State University College of Law in Tallahassee, Florida. His teaching focuses on litigation skills and the sources of lawyer professionalism.

Professor Krieger practiced criminal, civil, and administrative law for 11 years, serving most recently as chief trial counsel to the Florida Comptroller. Alongside his law career, he has also been a meditation teacher for 38 years.

In this interview, Professor Krieger shares some of his thoughts on success, well-being and happiness. 


Lawrence S. Krieger: “The first paper I wrote was in 1998, and it was called “What we’re not telling law students – and lawyers – that they really need to know,” and it was published in the Journal of Law and Health. This was before I started focusing on research, however I had already done the practical research by practicing law for 11 years.

My research focuses on a central theme – understanding why lawyers and law students are not happy. Although I work in the legal profession, the results of this research apply to any high stress profession in which one would reasonably assume the person to be doing well.

These are the jobs that people should be happy in – they are intelligent people working in meaningful jobs – but for some reason there is a lot of stress and a lot of unhappiness.

In my two roles of doing research and teaching law students, one of my goals is to bridge the gaps in knowledge. On the research side, we know what makes for a healthy and happy person. On the teaching side, my aim is to translate that information into something meaningful that my students can use to build a satisfying life and career. 

There are three key concepts that I teach my students:

 

No. 1 – Be firmly in touch with reality

 

Here are a few questions to consider:

What are your attitudes and relationship to the world? Are they realistic?

Who do you think you are and who do you think you SHOULD be?

What are your boundaries and limits?

If your goal in life is to solve child trafficking and you will only feel good once you’ve achieved that goal, you’re going to be deeply unhappy. 

We need to be realistic about what we can actually accomplish as flawed, complex human beings. 

 

No. 2 – Appreciate your good motives

 

In many high-stress jobs, I believe that a lot of that stress comes from having a sort of “god complex.” I don’t mean this in a derogatory way. What I mean is that the people who work in these intense jobs often have a need to fix and to save people.

This need to fix and save is also the same need that inspires people to go into nursing, medical school, and law school in the first place. It’s important to appreciate that your motive is good.

However, you can’t save people. Nobody has done it yet. And sometimes you can’t even help people – at least, not in the ways you wanted to.

But, you can always try to help people. And its the trying that you should focus on in your work. That’s a good, realistic motive with healthy boundaries of which you can be proud. 

 

No. 3 – Redefine Success

 

If you define success in such a way that requires certain things to happen that are beyond your control, you will always fail. 

One of the critical pieces of learning to change your definition of success is to closely examine a stressful situation. Here’s an exercise that I often use with my students: 

Look at any stressful situation that you’re in and make a chart with three columns.

In the first column, write down all of the important things that are contributing to or relate to this situation.

In the second column, list all of the things from the first column that you have control over.

In the third column, list all of the things that you have no control over whatsoever.

A diagram with three columns that outline the instructions for redefining success

 

The second column will always be the same short list. It might include things like:

  • Did I approach the situation with honorable motives, intentions and values?
  • Did I make a reasonable and consistent effort toward my goal?
  • Was I respectful including dressing appropriately, being on time, etc.?

Everything else will go in the third column including:

  • The attitudes and beliefs of other people involved
  • The choices that other people make
  • Any outcomes

 

An important element of this exercise is to notice that the outcome of any situation will always be in the last column. The outcome might be the judge’s decision, whether or not your client likes you, whether your patient lives or dies, etc. The things that you do in the second column can influence the things in the third column, but everything in the last column is outside of your control.

Now, the simple (but not so easy) prescription for happiness is to only stress about the things that you can control. 

So, let’s say you’re in an absolutely awful situation as a lawyer. Your client hates you, you’re about to lose your case, and your boss is a control freak and a rageaholic. Everything is going to hell in a handbasket.

However, once you closely examine the situation, you’ll realize that you have no control over your client’s feelings, the situation they are in, or your boss’s behaviour. Your success will only be defined by whether you did the best you realistically could with honourable intentions. 

Even though the situation is terrible, you can still give yourself an A+ as a human being. 

 

Learn to Look Inward

 

In 2015, Dr. Ken Sheldon and I published a paper in The George Washington Law Review entitled “What Makes Lawyers Happy?: A Data Driven Prescription to Redefine Professional Success.” We studied 6200 practicing lawyers and judges and did a factor analysis of several well-being factors.

The four strongest indicators of attorney well-being were: authenticity, relatedness, competence and internal motivation for your work – that you enjoy it and it fits your values.

The results of the study showed that as the human factor increased, so too did overall happiness. Happiness is a result of balancing our outward, external values with our inward, internal values. 

The things that you can put on your résumé – the money, the accolades, making partner – research has shown over and over again that these things aren’t going to make you happy. And if you examine the situation using the exercise mentioned above, you’ll also notice that they are things that you have no control over. If you are too outward focused, your life will be a constant stress challenge. 

The things that you can put on your résumé - the money, the accolades, making partner - research has shown over and over again that these things aren't going to make you happy. Click To Tweet

However, when we consider the strongest indicators of well-being from the study, there is one underlying factor to them all: connectedness. 

To be connected means that we are focusing inward – we are in touch with our own values, our work has meaning, we have a good relationship with our boss, and belong to a community. 

Well-being and happiness are feelings – and feelings aren’t “out there.” What is out there is a place to express and extend what is inside.

But life, energy, joy, love, inspiration are all inside. That’s where your life is – and I encourage you to begin looking inward to find these things.” 


Professor Krieger has a revised, self-published booklet – The Hidden Stresses of Law School and Law Practice.

More than 100,000 of these booklets have been used with lawyers and students at over 100 law schools across the United States, Canada, and Australia since 2005 to assist law students towards optimal performance and well-being in school and beyond. If you’re interested in this resource, you can contact him directly at lkrieger@law.fsu.edu

Professor Krieger's booklet "The Hidden Stresses of Law" lying on a table

Recommended Resources

[Article] “Lawyers With Lowest Pay Report More Happiness” article from The New York Times.

[Book] Learned Optimism: How to Change Your Mind and Your Life by Martin Seligman

[Book] Breaking Murphy’s Law: How Optimists Get What They Want from Life – and Pessimists Can Too by Suzanne C. Segerstrom 


 

The ABCs of Stress

 

amanda-muhammad-meditation-stress
 
Amanda Muhammad, MA, DMCT is a Mindfulness Based Stress Management Consultant in Dallas, TX. She is currently pursuing her Ph.D. in Business Psychology, holds a Masters in Organizational Leadership, and a Bachelor’s Degree in Management and Leadership.
 
After several years of experience in corporate America and education, she found love in teaching others and helping them maximize their potential. Amanda now spends her days teaching accessible ways to take a preventative approach to stress management.
 

 
Have you ever been stuck in traffic and while you’re sitting comfortably listening to your podcast, another person is blaring on their horn, and a third driver sits in a pool of anxiety because they’re going to be late? How is it that we can take the same exact situation and react in such different ways?
 
We have a tendency to think it’s the adverse event that causes us to react sub-optimally, however, today I’d like to introduce an alternative reason we respond differently – our perspective.  
 
As a Stress Management Consultant, something I often have my clients do is look at their stressors and take an inventory of how many of their common stressors are internal vs. external.
 
What they will typically find is that the majority of their stressors are actually outside of their control. Ironically, those stressors tend to be the things in our lives that are controlling us. 
 
Psychologist Albert Ellis came up with a model for stress called the ABC’s. He says that each adversity we face has three components: the “A” or Activating event, the “B” or your belief about the event”, and “C” which is the consequence that results. The model looks like a math equation, “A+B=C”. What we discover is that the “A” tends to be uncontrollable, so if we want to change the “C” we have to examine the “B”.
 
Take the following example:
 
Your friend turns you down for dinner (A). 
Now, you believe no one likes you (B). 
As a result you feel sad, rejected, and alone (C ). 
 
We have a tendency to unrealistically distort our experiences which can lead us down a rabbit hole of negative emotions like in that example. If we want to change our emotions, we have to change our beliefs. To change our beliefs, we must examine them.
 
When you find yourself in a pickle like this, I want to challenge you to practice shifting your perspective by asking yourself questions like – Why do I think no one likes me? Does one person turning me down actually mean that no one likes me? Does this one event mean that no one will ever like me? Does everyone have to like me? 
 
When we challenge our thoughts and beliefs about ourselves, our situations, and others, we open the door to new perspectives and greater resiliency.
 
 
Check out this video I made about the ABC’s and how you can actively use this tool anytime! 
 
 
Create a great day, 
 
Amanda
 

 
 
 
 
 

Viewing the Classroom Through a Trauma-Informed Lens

kay-glidden-trauma-informed-teachers-classroom

Kay Glidden and her colleague, Beth Reynolds Lewis, have trained over 3,000 professionals in the fields of healthcare, education, law enforcement and more. They have worked extensively in classrooms  – with teachers, providing education on compassion fatigue, burnout and vicarious trauma; and with students, teaching mindfulness and emotional regulation techniques. 

They are also the newest additions to our TEND team of associates!

In this blog post, Kay shares about their experiences working with teachers and the importance of viewing the classroom through a trauma-informed lens. 


A principal who had attended one of our trainings told us that she was seeing more and more students with emotional trauma in her office. She gave the example of a teacher who had became so frustrated with a student that she told him to “get out of my classroom and go to the principal’s office.”

Fortunately, this particular principal understood trauma-informed care. When the student arrived at her door, she asked what he needed to do to feel safe. He told her: “I need to build a fort.” So, she helped him build a fort in her office and sat down with him to share crackers and to talk. Once he was calm, he was able to return to the classroom, ready to learn.

She understood that he wasn’t a “bad” kid who needed to be disciplined. He was a student with emotional trauma who needed help getting regulated.

 

Trauma-Informed Teaching

 

The National Child Traumatic Stress Network has found that 1 out of 4 children attending school have been exposed to a traumatic event. Teachers go to college to learn how to teach math, science, and reading – not mental health therapy. Thus, they are not often prepared to teach children who have emotional trauma.Teachers can also become quickly overwhelmed if they do not understand the impact of trauma on their students.

Viewing the classroom through a trauma-informed lens can give clues as to why some students are triggered during fire drills or by a loud noise; why some students can’t sit still or stare out the window; or why some students are even triggered by going home during a school break.

Teachers report that they are seeing more and more children with Adverse Childhood Experiences (ACE’s) in their classroom. Many students with trauma have also been misdiagnosed with ADHD. 

Giving teachers effective classroom management strategies to employ at the beginning of the school year can help to keep the classrooms under control. Strategies might include arranging the classroom in such a way to promote emotional regulation (considering noises and lighting) or using movement and mantras. Teaching students mindfulness skills can provide them with a toolbox for self-regulation including breathing techniques, meditation, mindful walking and eating. 

kay-glidden-beth-reynolds-lewis-mindfulness-classroom-teachers

Beth Reynolds Lewis (left) and Kay Glidden (right) teaching mindfulness in an elementary classroom setting. Images shared with permission.

 

Self-care for Teachers

 

Teachers look a lot different in August (fresh and perky) than they do in April (total exhaustion). Many teachers are overwhelmed and many are, unfortunately, leaving the education field.

Like many caregivers, teachers tend to help everyone else before themselves. At school, teachers hit-the-door running and are responding all day long. At home, they are parenting and grading papers. How can they find the time to practice any kind of self-care?

In some classrooms, teachers may also be exposed to daily doses of traumatic stories from students and their families. One teacher told us that she had a high number of refugee students in her classroom. She was shocked to hear about the trauma they had endured. She often worried about her students, both at school and at home, and it had taken a toll on her emotional and physical health.

Educators need to learn the difference between compassion fatigue, secondary trauma and burnout. This way they can understand their symptoms and then create a strategy to maintain their health and build resiliency throughout the school year. 

 

Trauma vs. Drama

 

During a tornado drill at a middle school, one student often cried and got into a fetal position under her desk. This student absolutely refused to go into the hallway for the drill.

The teacher got frustrated with what she perceived as “drama” – but after talking individually with the student, she learned that the student’s home had been severely damaged in a tornado. The tornado drill was actually triggering a past traumatic event.

A difficult behaviour that appeared to be drama was actually the result of trauma. 

As “disciplinary approaches”, students with trauma are often sent out of the classroom to a solitary room, recess is taken away, or behavior charts are used. These are not effective strategies. A better alternative may be providing a “calming corner” or “peace chair” in the classroom where students can go to get regulated or to do breathing exercises.

Unfortunately, some teachers tell us that they do not have time for this “fluffy” approach of coddling students. However, we know that if teachers learn to apply these effective strategies for all students, they will have more time to teach –  in a calmer and less stressed-out classroom.

When teachers see students through a trauma-informed lens, the question isn’t “What’s wrong with them?” –  but rather “What’s happened to them?” This perspective, combined with a positive relationship with the student, makes all the difference. 

 

When teachers see students through a trauma-informed lens, the question isn’t “What’s wrong with them?” – but rather “What’s happened to them?” This perspective makes all the difference. Click To Tweet

Interested in training? Contact us!

 


Resources for working with students with trauma:

[Book] Help for Billy: A Beyond Consequences Approach to Helping Challenging Children in the Classroom by Heather Forbes (Read the first chapter here)

[Book] The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris

[Book] Fostering Resilient Learners: Strategies for Creating Resilient Learners by Kristin Souers (Read the first chapter here)

[Book] Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal by Donna Jackson Nakazawa  (Read an excerpt here) 

[Children’s Book] A Terrible Thing Happened by Margaret Holmes (children’s book about emotional trauma) 

Self-Care Resources:

[Workbook] The Compassion Fatigue Workbook by Françoise Mathieu

[Book] The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma by Bessel van der Kolk

[Book] The Age of Overwhelm: Strategies for the Long Haul by Laura van Dernoot Lipsky

Conversations on Compassion Fatigue with a Mental Health Advocate

conversations-compassion-fatigue-mental-health-advocate

Conversations on Compassion Fatigue is a new series where we interview professionals from high-stress and trauma-exposed environments and discuss issues around compassion fatigue, organizational health, vicarious trauma, moral distress and self-care. 

In this first installment, we sit down with a Mental Health Advocate to discuss her real world experience of compassion fatigue on the job.


Can you describe to us what you do as a Mental Health Advocate?

“My day-to-day has a lot of variety but most of my time is spent talking on the phone and meeting with patients, their families and/or their substitute decision maker.  I speak with them to ensure that they know their rights, their liberties and to help them to understand what is happening in terms of their treatment plan. My job is to support the patient and advocate for their wishes concerning what medications they take, what procedures they under-go, etc.

I work separately from the staff at the various hospitals that I visit throughout the region. This is a deliberate model so that I can take my patients’ issues forward to the hospitals without the fear of repercussions that, say a nurse or doctor, may face in a similar situation.

Many of my clients I work with have experienced many obstacles throughout their life; childhood trauma, poverty, unsafe housing,etc.

People who struggle with mental health issues can be very vulnerable – and the medical staff have huge power over their patients (and often rightly so). However, by the time my patients and their families end up with me, they have had years of bad things happening to them and are very angry at the system. I often hear things like – “Why is this happening to me?”

I also do quite a bit of public speaking in my job – ensuring that new and in-coming staff have education around patients’ rights.”

 

Have you heard about compassion fatigue before?

“Learning about compassion fatigue was, for me, a real light bulb moment. I first encountered the term during a workshop at an annual staff training. I was new on the job – just a few years in – when I first learned about it.

A big take away for me was the idea that “if you have compassion, you will have compassion fatigue.” It was also really helpful to learn that compassion fatigue was a normal experience.

I used to think to myself “How do people get so mean?”,“You didn’t start off by being awful to your patients – so what happened?”  Now I see compassion fatigue all over the place.

I think the problem is that, if there isn’t a culture of supporting or recognizing that compassion fatigue happens, it can fester. I’ve seen this manifest in the form of disrespect and staff being dismissive of the people that they are here to care for. If this culture is left unchecked, it can start to taint even the “good” staff.

Learning about compassion fatigue has also been really helpful for me in situations when I’m dealing with staff. It helps keep me from “getting on my high horse” about things. I have more empathy towards the staff. It helps me to re-frame the situation and keeps me from dehumanizing them (which is interesting since that “dehumanizing” is what caused the situation in the first place).”

 

Have you personally experienced compassion fatigue in your work?

“Absolutely. There was a time in my life when a bunch of things had happened – not just work-related. But I was so tearful and I remember always making the excuse of going to the bathroom just to get a break. Anything would set me off.

I did go for counselling but found the experience to be unsatisfactory. Overtime things got better as I paid more attention to my self-care. However, the experience bothered me because of how it manifested. I felt so weak. It was frustrating.”

 

What does your self-care practice look like? Has your work encouraged you to do self-care?

For self-care, I take it solely upon myself. My work pays lip service to it, but it really is up to me. I am, however, lucky that my manager is incredibly accommodating. If I needed to take time off, I could.

In my down time I love to run and I play piano too.

Another thing that helps me is to find the humour in things – even though the work that I do is serious, there are moments that can be quite funny. I look for those.

I also collect quotes – those really help me.

I do think that work-life balance is a bit of myth – it always seems to be skewed one way or the other.

Photo of a quote in her office. It reads: “The Secret to Change is to focus all your energy – Not on fighting the Old: But on Buildling the New – Socrates”

 

In your field, what do you think could be done to help mitigate the effects of compassion fatigue?

“Oh I have lots of ideas for this! *laughs*

One thing that I think would be really effective is to have a rotation system for front-line staff. This way, staff wouldn’t be seeing the same people over and over again, year after year. Everyone needs a change of pace.

The idea that you’re stuck in one place for the rest of your career is really hard. Perhaps we could move people to research projects, professional development, etc. This would give everyone a break – including the patients.”

 

What do you find challenging about your work?

“My job is to advocate and act on what the patient wants – not what I think is the best decision for the patient. This can be really hard when I know that a certain medication or treatment would really benefit them – however, as much as I wish I could help them, that’s not my job.

Another thing that can be hard with this job is navigating the barriers in the system. So, here’s a small example and one that happens a lot – I wish that I could give my clients a drive. Sometimes it will be miserable outside and we’re going to the same place, however, due to liability issues, I can’t offer them a ride. I feel so bad about that.”

 

What do you find rewarding about your work?

When you do work that you feel is meaningful, you don’t realize how much you grow along with it.  After doing this work, I’m so different from who I used to be.

Even though it can be challenging, my job is a blessing. I consider myself to be very lucky. Speaking with my patients and being even a small part of their life is such a privilege.”

 

Are there any resources you would recommend?

“I highly recommend the work of Dr. Patricia Deegan.”


You can find a list of Dr. Deegan’s work here.

Selected articles:

Deegan, P.E. (1996). Recovery as a Journey of the Heart. Psychiatric Rehabilitation Journal 19, 3, p. 91–97.    [PDF available here, provided by the Toronto CMHA]

Deegan, P.E. (1988). Recovery: The lived experience of rehabilitation. Psychosocial Rehabilitation Journal, 9, 4, 11-19.   [PDF available here, provided by the Toronto CMHA]

 

Addressing Compassion Fatigue – An Ethical Mandate

 

 Addressing Compassion Fatigue – An Ethical Mandate

Webinar Roundtable – American Bar Association, aired September 30, 2015


Working with clients in trauma can impact lawyers who represent children in the child welfare system, both personally and professionally.  Prolonged or repeated exposure to the abuse and neglect suffered by child victims can result in an acute form of burnout called compassion fatigue.

However, child lawyers, unlike other helping professionals, rarely have language for this loss of capacity nor support systems in place to combat it.  Large caseloads, inadequate resources and systems that sometimes re-victimize instead of rehabilitate, leave practitioners feeling ineffective, incompetent and lacking compassion. These conditions compromise the child lawyer’s ethical duty to provide competent representation.

Speakers focus on preventative and responsive strategies for solo practitioners, agency lawyers and leaders who manage child lawyers, as well as the ethical implications of compassion fatigue on child representation.

Speakers:
Trenny Stovall, Esq., DeKalb County Child Advocacy Center, Decatur, GA (moderator)
Alexandra Dolan, MSS, LSW, Support Center for Child Advocates, Philadelphia, PA
Josh Spitalnick, PhD, ABPP, Adjunct Asst. Professor in Psychiatry and Behavioral Sciences, Emory University SOM, Atlanta, GA
Françoise Mathieu, M.Ed., CCC., Co-Executive Director, TEND, Kingston, Ontario, Canada
Danielle Lynch, Esq.,  Supervising Attorney. DeKalb Child Advocacy Center, Decatur, GA

Source

Basic Ingredients for a Healthy Staff with Laurie Barkin

 

basic-ingredients-healthy-staff-laurie-barkin-comfort-garden

Laurie Barkin, RN, MS has worked as a staff nurse, head nurse, nurse manager, instructor, and psych liaison nurse.

Her book, The Comfort Garden: Tales from the Trauma Unit, won the American Journal of Nursing Book of the Year Award and a Nautilus Award for excellence in writing.

In this guest blog post, Laurie shares personal insights into caregiver stress and the role of institutional support from her years of working with trauma survivors. You can find out more about Laurie on her website.


 

How can those of us who bear witness to trauma make sense of the violence inequity, injustice, and waste of human potential that confronts us daily? What should we do with the feelings we feel?

I needed to talk about how awful it is to come face to face with evil in the world. I asked for what I needed. That was hard enough. Did I violate a taboo by asking?…Other trauma programs incorporate time each week for staff to talk about such things. Why can’t we?”

– adapted from The Comfort Garden: Tales from the Trauma Unit 

 

Too many front-line healthcare clinicians are struggling with burn-out, compassion fatigue, and moral distress at work. Contributing factors include high patient acuity, fear of making medical errors, unrelenting exposure to human pain and suffering, and inadequate staff resources.

When front-line staff are stressed, the entire system is negatively impacted. The solution is a combination of “self-care” and institutional support.

I came to this conclusion after attending a psychological trauma conference in the late 90s where I heard the phrases “vicarious traumatization” and “secondary traumatic stress” for the first time. Back then, I had been working as a psych nurse consultant on the trauma unit of a large hospital for a few years.

Many symptoms described by presenters resonated with me: nightmares and intrusive images related to my patients’ stories, palpitations, shortness of breath, excessive worry for my children’s safety, and emotional fatigue, to name a few.

I knew I wasn’t the only one. Each week, all of us on the psychiatric consult service were hearing horrific stories of abuse and neglect. Several of us had requested support groups for staff. Each time we did, our administrator politely turned us down and made the same suggestion:

“Do it on your own time.”

At the conference I learned that the antidotes to caregiver stress were staff support groups and a commitment to good self-care practices. In speaking with other trauma professionals, I learned that many trauma programs provided time each week for staff to process and reflect. These practitioners were incredulous that our program—affiliated with a major teaching hospital—did not.

Months later, after listening to a particularly vicious story from a survivor of sexual violence, I requested time in our staff meeting to talk about it. Again, I was turned down.

That’s when I decided that, because my mental health was worth protecting, I had to resign my position. 

 

The Caregiving Personality

 

Since then, I’ve been writing about the experience of bearing witness to others’ pain and suffering. One of the questions I’ve considered is this: Is caregiver stress solely attributable to the work itself or do aspects of the caregiver personality play a role?

Most people who decide to pursue caregiving careers are naturally empathic. From where does this wellspring of empathy originate?

In my decades as a psych nurse, I’ve spoken to many nurses (and other healthcare clinicians) about why they chose their professions.

Many grew up in families that provided fertile ground for caregiving experiences. In families battered by addictions and trauma or stressed by disability and illness, these future caregivers often assumed responsibility for younger siblings, grandparents, parents, or themselves when adults were unavailable. In this way, they learned to be responsible caretakers, sensitive clinicians, conflict managers, and family administrators.

Because of the skills honed in our families, we are good at what we do. However, if the emotional pain of the family crucible still lives within us, i.e. our feelings remain “unresolved,” we may be especially prone to caregiver stress.

 

The Institutional Role

 

So, in addition to self-care practices such as yoga, meditation, journaling, exercising, maintaining adequate sleep and good nutrition, etc., I’m all for people pursuing individual psychotherapy as another tool in one’s self-care practice.

But since the antidote to caregiver stress is both personal and institutional, hospital administrators and executives also have an important role to play in decreasing job stress among clinical staff.

In addition to limiting mandatory overtime, creating a safe environment, paying competitive salaries, and improving general work conditions, they could, for example, provide on-site childcare and banking services, host farmers’ markets on campus, champion support groups, and sponsor staff wellness centers.

Additionally, they could offer regular staff retreats, on-site mini-massages, and an on-call confidential counseling service for work-related issues, to name a few.

Nurses and physicians who value caring want to provide excellent care for their patients. Actual caring—as opposed to performing tasks associated with caring—requires time and emotional labor. When clinicians are bolstered by self-care practices and supported by administrative practices, they are energized by their work, not burned out by it. 

Actual caring requires time and emotional labor. When clinicians are bolstered by self-care practices and supported by administrative practices, they are energized by their work, not burned out by it.  Click To Tweet

 

Here are my questions to you:

Do you have a regular self-care practice at home and at work? If so, what does this include? If not, what prevents you from doing so?

How does your workplace support your work as a caregiver?


 

Mental Health and the Classroom – with Dr. Mike Condra

 

“Mental Health and the Classroom” with Dr. Mike Condra

 

 

Presented as part of a panel discussion on mental health in Kingston, ON, April 11, 2015. 


TEND Associate Dr. Mike Condra is an Adjunct Assistant Professor in the Department of Psychology at Queen’s University and has taught in the undergraduate and graduate programs in the Department of Psychology and in the faculties of Education and Law. 

If you’re interested in having Dr. Condra speak at your organization, contact us at info@tendacademy.ca.

Learn more about Dr. Condra’s live training.

Mental Health: Awareness, Anti-stigma and Helping Skills

Compassion Fatigue and Secondary Trauma – Essentials

Contact us for a customized training for your workshop.

Breathe, Reset, Refuel. Rinse, Repeat.

francoise-mathieu-breathe-reset-refuel-self-care-compassion-fatige

 

I have been thinking a lot about energy and pacing lately.

More specifically, I have been reflecting on the fuel that we put in our tanks with the aim to do our best at work, to care for our loved ones and to get a few (or many) of the grown-up things off our list.

I don’t know about you, but I think that, although being an adult has many perks  – like eating what we want, when we want (toast for dinner! Popcorn for breakfast!) and going to bed early or staying up too late to watch our favourite shows (ok, maybe I watched Pippi Longstocking too many times. My goodness, I loved her so…) –  sometimes being a responsible grown-up can feel really overwhelming.

At this very moment, I can hear my washing machine rattling like an airplane taking off. The repair person told me it’s finished, and we need a new one. Well, ok, he told me that in August and that if I didn’t do anything, one day it would leak all over the place. But I got busy, and so it’s on the List.

My furnace too, apparently needs replacing  – on the List.

I have 93 unread emails that all say “TIME SENSITIVE!” – on the List.

Today, my son lost his dorm keys and is asking me to find them in his bedroom at home and ship them to him urgently. My daughter just called. She needs me to call our insurance company about something ASAP. On the List!

A friend just had very upsetting news, and I deeply care about him, so he’s on my mind right now, too.

That’s probably only 1% of my list, but it all rattles around in my head, trying to prioritize and make sure I don’t drop too many balls.

Can you relate to this?

(Note that there is nothing on that list about self-care, it just gets pushed to the bottom, because, you know, it can wait, right?)

 

Are you “the General” in your life?

 

I recently pinched something in my arm which caused this weird impingement all the way from my shoulder, into my elbow and into my hand. It wasn’t horrible, but it was very uncomfortable. I wasn’t able to use my arm to drive or do yoga or carry things or sleep properly.

“Poor posture” was the physio’s diagnosis. (Wow. Thanks!) When that didn’t help, I went to see a great massage therapist and he hummed and hawed and tapped and poked and prodded. After a solid hour of this, he said to me: “Are you the General in your life? At work and at home?”

I paused.

Well, yes, as a matter of fact I am.

I think of myself as an ultra-responsible, reliable, loving, caring person (read “Disappoint Someone Today” for more on this, if you want). I have two members of my family who live with ADHD which can lead to some very interesting and sometimes intense situations for them and for the rest of our family. I think of them as neuro-exceptional as they are super bright, passionate, high energy people – but they also struggle with lost items, low frustration tolerance, intense irritability and a need for order to manage the chaos that frequently enters their brain.

We openly talk about this in my home, and we have developed many strategies over the years to help reduce stress for all of us. But sometimes, it’s a lot.

At the end of our session, the massage therapist gave me this advice: “Less planning, less thinking, more rest, more quiet, long walks, and more expressive arts – use the part of your brain that doesn’t require thinking and being in charge all the time.”

He was basically saying “Slow down! Quiet that mind a bit!”

 

How much is enough?

 

We were training a wonderful group recently, and one participant asked us: “How much self-care is the recommended amount?” This is a surprisingly tough question to answer.

My amazing co-facilitator replied something like this: “I don’t think that the aim is to race through our days at rocket speed and then collapse in a heap at the end of the day on our couch or yoga mat and call that “self-care”. I think that self-care needs to be a moment by moment process, where we notice, we pause, we breathe, and then we keep on doing what we’re doing, if we have to, or we take some time out to refuel and reset.”

I don’t think that the aim is to race through our days at rocket speed and then collapse in a heap at the end of the day on our couch or yoga mat and call that “self-care”. I think that self-care needs to be a moment by moment process Click To Tweet

 

I drove my son back to university yesterday. It’s a stressful 3-hour drive on a major highway. Lots of trucks, freezing rain, bad drivers … you know the kind of drive I’m talking about.

After dropping him off, I drove another 45 minutes through even worse conditions and went to my favourite airport hotel on my way to a gig out-of-province. And, get this – that hotel has a wicker swing in the lobby! You know those big egg-shaped swings from the 70s? I swear, if they get rid of that swing I’m never going to that hotel again.

Anyhow, I sat cross legged in that swing for three hours, answering emails, reading a book and just rocking gently and resting. I could feel my nervous system calming right down and after this lovely pause, I felt completely refreshed. I texted a friend and said “I don’t need a week long trip to the beach, I just need three hours in a swing!”

So, for all of us, what are micro-moments that we can integrate in our days so that we can reset, refuel and take pause when we don’t have a three-hour blissful break from everything?

And yes, I’m going to work on my posture too 😉

I wish you a happy, restful and refueling start to 2019!


Recommended Resources:

[Online course] WTF – Strategies to keep helping professionals grounded and centered by Diana Tikasz, MSW, RSW

[Book] Busy: How to Thrive in a World of Too Much by Tony Crabbe

[Website] calm.com