Hot Walk and Talk Protocol

Protocol for the Hot Walk and Talk

©2012 Patricia Fisher, Ph.D.

This protocol applies when there has been no physical injury and the person is stable enough in the aftermath to proceed. In the event that the individual has been physically injured or is in shock you would need to follow emergency procedures and get the appropriate immediate medical resources.

This protocol is designed to provide helpful first aid immediately after a team member experiences a particularly distressing or disturbing incident and is undergoing a completely normal stress reaction. This is something either supervisors or peers can offer each other and you will consider what would work best for you in your particular circumstances.

Remember that when we are experiencing a high stress response our body is in the flight, fight or freeze state and we are flooding with stress hormones and all the physical, emotional and cognitive responses that go with that. So, our first response introduces safety and containment for the person.

The following steps in the process are typically helpful:

  1. Go to the individual, ensure that they are physically out of danger, and ask them to come walk with you.
  2. Walk away from the area where the incident occurred and toward a neutral or safe area (if you can get outside that can be even more grounding).
  3. Walk beside them and set a pace that is brisk enough to engage the individual and help them discharge some of the distress… as the walk proceeds you may find that they naturally slow the pace – let them progressively have more control over the pace as the debriefing proceeds.
  4. Bring a bottle of water and have them drink the water as you walk
  5. Let them know that they are safe now and you are here to support them as they move through this absolutely normal response to high stress.
  6. Ask them to tell you what happened in their own words, if they seem stuck in the incident, prompt them to move on with the narrative by asking “and then what happened”. You want to help them move through the whole narrative from beginning to the end – until they get to the present where they are walking with you in safety and are no longer at risk.
  7. After you have gone through this initial debrief you may work in an environment where you are required to complete an incident report. If this is the case, go with the individual and ask them how you can help in completing the report. They may want you to type in the information as they dictate it, or they may simply appreciate your presence while they complete the report.
  8. Remember to remind them to focus on their breathing and open posture to help them deescalate from the stress response – especially after you have stopped walking and may be standing or sitting.
  9. After the initial debrief and report (if required), ask the person what they would find helpful now? Do they want to phone a family member, get a sandwich, take a break, go back to work? They need to have control over their choices while attending to their needs.
  10. Let the individual know that you will remain available to them and encourage them to access addition supports that may be available if they would find them helpful (e.g., Employee Assistance Programs, counselling, other community resources)

Following, and sometimes parallel to, this immediate first aid response, there may be additional steps needed from an institutional perspective. These may include:

  • 􏰃  The debriefer stays with the affected person, and asks a colleague to notify the supervisor about the incident. The debriefer can provide updates to the supervisor as needed.
  • 􏰃  The supervisor speaks with the affected person(s) and assesses whether the person should remain at work following the incident. The debriefer or supervisor assists with making travel arrangements if the affected person is not in a condition to drive home. If the affected person goes home early, the supervisor phones the affected person to ensure that they arrived home safely.
  • 􏰃  The debriefer emails a summary of the incident to the supervisor, based on the information gathered from the affected person. The supervisor may also be responsible for submitting paperwork.
  • 􏰃  The supervisor updates other staff in the office about the incident, as needed.
  • 􏰃  The supervisor works with the affected person(s) to discuss any case management or other relevant

    decisions in relation to the incident.

  • 􏰃  The supervisor will check-in periodically with the affected person and continue to offer support in the weeks that follow.

#JustTryingToHelpSomeKids

Words of Wisdom from Karen Hangartner of the Huntsville CAC

 
We have had the immense privilege of working with several Child Advocacy Centres (CACs)  in Canada and the US over the past several years. CACs were created to be as the main point of contact for a child and their family who have experienced child abuse and trauma. The aim of the CACs since their inception has been to reduce the negative and potentially retraumatizing impact on children who have to attend numerous different sites and professionals in order for them to offer their testimony and receive the care and treatment they need and deserve. The National CAC in Huntsville, Alabama is one of the leading organizations providing education, treatment and consulting to agencies who work with children who have experienced trauma across the nation. Last week, our dear colleague Karen Hangartner of the Huntsville CAC wrote a powerful piece on managing our own wellness while dealing with our difficult and challenging political landscape.
#JustTryingToHelpSomeKids
 

It has been a tough couple of weeks for our country and for those of us who work with child trauma daily. My immediate, innate response has been to immerse myself in the media coverage of what has been happening on our borders. Watching newscasts has been the first thing I have done in the mornings and the last thing I do before bed. I have been angry, despondent, sad, and have felt powerless to help these children. I assume that my responses are not that much different than most CAC professionals across our country. While many Americans have also been saddened and outraged by the family separation policy, I believe child abuse professionals, in particular, are at an increased risk of being more negatively impacted. We know how wrenching it is for a child to be removed from their family. We know what child trauma looks like. We know the long-term impacts. We did not have to wait to see the images that were finally released to the public to visualize what these kids have been going through. We already had those images in our heads. While the faces might be different, make no mistake, we are all too familiar with the anguish on the faces of children who are experiencing trauma.

Read the rest of the article:

Link to Article : Secondary Trauma and Family Separation

 

Reducing Unnecessary Trauma Exposure in Service Providers

by Françoise Mathieu, M.Ed., CCC., RP

Many years ago, when my dear friend Robin Cameron and I developed our very first compassion fatigue workshop, we came across the term “limited disclosure” in Laurie Anne Pearlman and Karen Saakvitne’s book Trauma and the Therapist.

The authors, who were well ahead of the curve on all matters related to VT and Compassion fatigue solutions, suggested that we, as professionals, should consider taking a careful look at “how much detail about the violence or abuse [we] want to share [with one another].” (Pearlman, personal communication)

This concept of “limited disclosure” rang so true to us that we immediately integrated it in our training. We called it Low-Impact Debriefing in a cheeky nod to the aerobics craze of the 80s and also because it formed the acronym L.I.D. The idea of low impact debriefing is twofold: to be able to share the information that we need to, while at the same time not having a highly negative impact on the listener. We were not suggesting that we should keep a lid on difficult things but wanted to suggest that we should all perhaps take a careful inventory of how much graphic information we need to be sharing when debriefing difficult stories or consulting on cases with colleagues. Perhaps a better analogy is that of a pressure cooker that lets the steam out little by little rather than in one giant burst with potentially negative consequences.

Over the past decade, my team has received many invitations to present at trauma trainings: child abuse symposia, conferences for parents of murdered children, workshops for sex crimes investigators, courses on the Dark Net and cybercrime, and many similar other conferences. We are often struck by the extremely graphic details that are almost invariably shared during these events: gruesome photos shown on a giant screen during a lunch time keynote, detailed descriptions of a murder or assault on a child, minute details about the smells, sounds and sights of a crime scene and even, at times, graphic audio and video footage. Some of these scenes can be very difficult to forget.

When is Trauma Exposure Gratuitous and When it is Necessary?

I think that we can all agree that many media outlets share an excessive amount of potentially disturbing images in their coverage (and in fictional shows, but that’s for another post). I remember listening to CBC news radio on my headset a few years ago while I was out for a run, and suddenly, without warning, the host played an actual audio of a child being victimized. I remember tearing the earpieces away from me and thinking “WTF just happened? Why was this necessary during a midday radio show? And I that instance, I don’t think that the now overused customary warning “content may be disturbing to some” was enough to justify airing that footage.

I am also well aware that at times, graphic details are essential to a trauma training – if you are a forensic examiner or an investigator of any sort, you must be able to recognise and differentiate between an accidental injury and one that has been deliberately caused by another person, or you may need to learn how to assess a crime scene and the related details that are present. You may need to learn how to interview a criminal in order to develop better investigative or clinical skills. Sometimes, we need videos, photos and details in order to do our job properly.

But here is my question to you: how much detail is too much? Even at a trauma conference, are all details required at all times? Is it enough to give people a warning at the start of our talks “this may disturb you” or do we all have a responsibility to reassess what we are sharing and how much detail is enough?

We were recently asked to create a brand-new course called “The Things We Can’t Unsee: Reducing the Impact of Secondary Trauma Exposure” which we have had the privilege of offering to legal professionals, child abuse investigators and victim service providers across North America this year. The response has been extremely positive and has led to some powerful discussions and reflection among participants. A good place start addressing this issue is to perform a personal “trauma audit” for ourselves and see how much extraneous trauma stories we are sharing with one another. To go further, please read The four steps to Low Impact Debriefing as discussed in my book (Click here).

“I’m not bothered by these stories”

Now, I have been in the field long enough to know that some of you will say “I have been exposed to thousands of stories, they don’t bother me anymore” and perhaps this is true. We all have a different level of sensitivity to difficult images and traumatic details based on a whole host of personal factors. But it would be interesting to be able to measure our stress hormones and see whether that is actually true, or to be able to perform a brain scan and see how our limbic system responds to repeated exposure. As psychiatrist Dr. John Bradford so eloquently explained in his testimonials a few years ago, after 30 years of exposure to gruesome images, he also thought that he was immune, until, one day, he was not: http://www.ottawacitizen.com/health/Tough+forensic+John+Bradford+opens+about+PTSD/9152171/story.html

To Learn More:

 

Sources:

Mathieu, F. (2012) The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Trauma. New York: Routledge.

Pearlman, L. A., & Saakvitne, K.W. (1995). Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton. pp. 383-384.

 

Becoming Trauma-Informed – A Key to Sustaining Compassion and Offering High Quality Care

by Françoise Mathieu, M.Ed., CCC. RP.

Every single helping professional I have ever met has told me that, at some point in their career, they had the following reflections:

1) Why wasn’t I properly trained to work with difficult clients/patients?

2) If I knew then what I know now, maybe I would have been more patient and compassionate with this particular client/patient

 and they have also asked themselves a variation of this question:

How do I stay compassionate with the “non-compliant”, difficult, “manipulative” clients?

Those of you who know me will know why I put those two terms in brackets – I utterly dislike those two words “non-compliant” and “manipulative” and I have tried to never use them in my own practice when referring to clients I have worked with. Would you not agree that they are words laden with our own judgment and feelings of frustration –  us, the exasperated service providers who feel that the folks we serve are not behaving according to the plan that would make our work so much easier? Or, at times, that those words are a reflection of our sadness for what we see as self-destructive sabotage on our clients’ part, and that this understandably upsets us?

A diabetes nurse recently said to me: “it’s so frustrating, our patients need to do some basic things – check their sugars, eat right, move their bodies, take their insulin, and so many of them don’t – with dire consequences. I can’t seem to get through to them, and then, they get worse. I have run out of ideas and energy to help them!”

I have heard the same from so many different helping professionals: domestic violence workers who see a person return to a terrible situation, addiction counselors, judges, police officers who work with victims of sex trafficking, paramedics who roll their eyes at “frequent flyers” … the list gets longer each time I meet a new group of helpers.

If you’re like me, and you’ve been in the helping field for 20 years or more, the odds are that you didn’t learn a lot or anything about the long term consequences of childhood trauma and neglect back when you were studying to become a professional. Although I went to two excellent graduate schools, my training programs barely touched on trauma at all, except for a brief class on PTSD, but that was mostly in relation to soldiers, and not much else was said about it.

But that has changed now. We have solid research and tools to allow each one of us to become more trauma-informed and this knowledge can allow us to work with challenging clients (and colleagues) with a better understanding of the reasons for some of their actions and choices. This, in turn, can allow us to remain compassionate and to be more helpful to them during their challenging and brave journeys through life.

Here are some resources to become more Trauma-Informed and continue the journey towards compassion for others and for ourselves.

TED TALK: Watch Dr. Nadine Burke-Harris’ amazing presentation on the Adverse Childhood Experience Study for a 16-minute overview. A must-watch!

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime/up-next

BOOKS:

Childhood Disrupted: How your Biography becomes your Biology and how you can Heal” by Donna Jackson Nakazawa

“In the Realm of the Hungry Ghosts: Close Encounters with Addiction” by Gabor Maté

Webinar to stay compassionate: Compassion Fatigue 101

Websites:

Trauma Informed Care Project http://www.traumainformedcareproject.org

ACES too High website: https://acestoohigh.com

What is Organizational Health?

Organizational Health

Downloadable PDF to share with your organization

It is widely accepted that many jobs are stressful. Anyone working in fast-paced, high-pressure environments can attest to the wear and tear that they can experience over time when the demand outweighs their capacity to deliver, or when the work is dangerous or numbingly repetitive, when the hours are long, and the pay is low, or when they work in a service industry where dissatisfied customers use staff as a lightning rod for their frustration or even, at times, their rage.

Ask any airline customer service agent what it is like to handle a horde of angry travellers when all flights have been delayed by an unexpected storm and this poor person’s power to solve the dilemma is limited, or even non-existent. Ask the factory worker operating a dangerous machine for 12 hours a day on a line with poor working conditions and a hostile climate. Ask the call centre operator (call centres have one of the highest turnover rate of any job at the current time) where you are underpaid, monitored for the length of your calls (“that was too long” “you said the wrong thing, take the next call, go go go!”), and sometimes they don’t even have the right to go to the bathroom during a shift without being penalized. The speech writers working to deadline, the day trader, the server in a diner who is on their feet for 12-hour shifts, air traffic controllers … the list is long, and most of us have worked in such settings at some point in our lives.

The term organizational health refers to the varied and often complicated factors that affect the capacity and performance of an organization. Work hours, type of work, stress levels, budgets, workload, turnover and so many other factors all have an impact on the health of an organization.  At the very core of this is the health of each individual including: how they feel about their jobs, how they perform them, how committed they are to their roles and how their jobs are affecting them personally.

How Does Workplace Trauma Exposure Affect Organizational Health?

Stress has an enormous impact on the health of an organization, and when the added element of secondary and/or direct trauma exposure is present, balancing workplace wellness becomes far more complicated, and we would argue, even more critical. High-stress, trauma-exposed work environments such as health care, law enforcement, mental health services, child welfare and many other related fields have unique and specialized organizational health needs.

 

Why Don’t Employee Wellness Initiatives Always Work?

Many human resource companies have become interested in staff wellness over the past two decades and have explored ways to reduce burnout, increase employee satisfaction and eliminate workplace grievances, disability claims and attrition. Some of those initiatives have been effective, but the generic “in-the-box” workplace wellness programs have not always been successful in the complex settings that we, at TEND, work in: hospitals, correctional facilities, child welfare, law enforcement, anti-human trafficking, refugee boards and similar challenging work environments. Over the years, we have been approached by leadership in these workplaces who are extremely concerned about the emotional and physical health of their staff and are witnessing high turnover rates, low morale, and difficulty attracting and retaining skilled labour.

 

A Framework to Understand Organizational Health in Trauma-Exposed Settings

 TEND’s Co-Executive Director, clinical psychologist and trauma specialist Dr. Patricia Fisher, became very interested in the truly unique characteristics of workplaces that have regular exposure to a combination of high stress, high volume of work, diminished resources and trauma. Dr. Fisher has spent the past two decades developing a framework to understand these workplaces which she refers to as “high-stress, trauma-exposed” work settings.

Dr. Fisher developed the Organizational Health Model for Complex Stress environments that can assist leadership in developing a better understanding of best practices and effective interventions to support their teams.

Dr. Fisher’s model has demonstrated that we need to start with the foundation elements which are Leadership, Succession Planning and Health and Wellness.

Leadership: Leaders are people too, and they are powerful role models for their staff. Leaders are also often working under extremely high stress burdens themselves. We also need to remember that leaders are often promoted into their roles with very little training or experience managing other people, and we need to give them the time, support and training to get competent in their new role.

Succession planning refers to several factors: addressing the inevitable loss of staff through retirement (a very large demographic shift that we are in the midst of, with many Baby Boomers retiring), illness and job change, and the critical need to attract and retain new hires such as Millennials who often have different priorities and values in terms of work-life balance. As the proportion of new workers in teams increases, we often find that the more experienced staff are depleted and have sometimes become disillusioned and are, as a result, unable to perform the crucial role of supporting and guiding their more junior team members.

Health and wellness is also an essential element. New research on the impact of toxic stress has clarified how trauma-exposed work creates a unique climate with increased risk for serious stress and burnout effects for individuals, leaders and teams. These can inevitably lead to a rise in sick time, low morale, lack of team cohesion and high turnover. These consequences can, in turn, seriously limit a team’s ability to work effectively and efficiently.

 

Where to Start?

The good news is that there are some excellent resources to help high-stress, trauma-exposed organizations assess their functional capacity and decide where to begin in implementing effective strategies to support their teams.

 

1) The Secondary Traumatic Stress Informed Organization Assessment Tool (STSI-OA)

Dr. Ginny Sprang, from the University of Kentucky and some of her colleagues (Sprang et al, 2014) developed a free Organizational assessment tool: the Secondary Traumatic Stress Informed Organization Assessment Tool (STSI-OA). The STSI-OA is an assessment instrument that can be used by any organizational member at any level to evaluate the degree to which their organization is STS-informed, and able to respond to the impact of secondary traumatic stress in the workplace.

To access this test, go here: http://www.uky.edu/CTAC/STSI-OA

Click Here to read an article on the psychometric properties of the STSI-OA

 

2) Organizational Health in Trauma-Exposed Environments – Online Course

This intensive online course was designed by Dr. Patricia Fisher for managers and supervisors of teams working in high stress, trauma-exposed environments. The course supports participants to be effective leaders and to build strong, resilient and productive teams by exploring their vital role in Organizational Health and recognizing the impact of chronic stress on individuals, teams and organizations.

LINK to the COURSE Here

 

3) The Organizational Health Roadmap

Dr. Fisher also developed the Organizational Health Roadmap to meet the needs of the thousands of individuals from so many trauma-exposed fields who have taken our Organizational Health and Leadership training and who asked for more resources to take them beyond the basics. The Organizational Health Roadmap provides a guided 10-module program that supports your Implementation Team as you develop a practical and sustainable action plan to meet the specific need and circumstances of your team.

While trauma-exposed organizations share a range of specific risks and resiliency factors, the Roadmap program recognizes that each workplace experiences a unique profile. You are the experts in your own workplaces – and the Roadmap is designed to guide you as you first evaluate your own unique resiliency and risk profile, and then build a custom set of practical solutions and implementation plans to fit your specific circumstances.

Organizational Health, wellness

Learn more about the Roadmap here
Books by Dr. Patricia Fisher

 

Sources:

 Fisher, P. (2016) Building Resilient Teams: Facilitating Workplace Wellness & Organizational Health in Trauma-Exposed Environments. Kingston, TEND ACADEMY.

 Sprang, G., Ross, L., Blackshear, K., Miller, B. Vrabel, C., Ham, J., Henry, J. and Caringi, J. (2014).  The Secondary Traumatic Stress Informed Organization Assessment (STSI-OA) tool, University of Kentucky Center on Trauma and Children, #14-STS001, Lexington, Kentucky.

The Edge of Compassion – Françoise Mathieu giving a TEDTalk for TEDxQueensU

For the past 15 years, Secondary Trauma specialist and compassion fatigue educator Françoise Mathieu has been exploring tools to help all of us navigate the challenges of sustaining compassion and empathy towards others – both as individuals and professionals.

This talk explores ways to find the right balance between caring for others while staying healthy and empathic. Françoise is a Registered Psychotherapist and a compassion fatigue specialist. Her experience stems from over 20+ years as a mental health professional, working as a crisis counsellor and trauma specialist in university counselling, military, law enforcement and other community mental health environments.

Françoise is co-executive director of TEND, whose aim is to offer consulting and training to helpers on topics related to secondary trauma, compassion fatigue, burnout, self-care, wellness and organizational health. Since 2001, Françoise has given hundreds of seminars on compassion fatigue and secondary trauma across North America to thousands of helping professionals in the fields of health care, child welfare, the criminal justice system and other similar high stress, trauma exposed professions.

Françoise is the author of “The Compassion Fatigue Workbook” which was published by Routledge in 2012 as well as several articles and publications.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community.


 

compassion-fatigue-workbook-francoise-mathieu

“Françoise Mathieu’s writing is wonderful: she speaks from the heart, practitioner to practitioner, about the stressors and strains of human service work, particularly those that come from prolonged regular work with traumatized patients and clients. This is a book you help write by yourself and about yourself. That’s why it is the workbook for trauma work.” – Charles R. Figley, Tulane University, Louisiana, USA, and author of Treating Compassion Fatigue

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Balancing our Work and Life while Staying Well – Five Essential Tools

By Françoise Mathieu

This post was initially published on the Oregon OEA Choice Trust website: http://oeachoice.com/5-essential-tools-for-balancing-your-work-and-life-while-staying-well/

I grew up in a family of educators. My parents moved from Montreal to the high arctic in the early 1960s and worked in a variety of schools in very remote Inuit communities for the following decades. Over the years, my father was a teacher and then became school principal, then superintendent and eventually director general of an entire region. He travelled extensively for work, visiting numerous villages for a third of each year, dealing with labour disputes, financial cutbacks and the complex societal challenges facing First Nations communities. My mother co-developed one of the very first teacher training program for Inuit women in Canada.

Needless to say, my parents were very dedicated and hard-working. Education reform and the challenges of the work was daily conversation in our household. Working as educators in small communities presented many challenges and rewards: our house was often the informal hotel, food bank and shelter, and villagers would frequently knock on our door for advice or support.

Are you living in the community that you serve?

If you live and work in the same community, you may have experienced something similar: you go to the grocery store on a Saturday in your sweatpants, and a parent accosts you for advice on their child’s problematic learning difficulties. You go to a party and are immediately grilled on your thoughts about educational policies or the best ways to beat the SATS.

How do you find balance between work and your private life?

I would say, in hindsight, that my parents were frequently completely exhausted at night, and did not know a thing about work-life balance. Being from the War Generation, born in the 1940s, their cohort had not learned about the importance of balance and self-care. For them, you worked until you fell down, and then you got up again and worked some more. They had very little time for themselves. This was the norm among the educators that I knew.

Burnout Research

So how can we find balance working in the education field? How do we learn to set limits so that we can bring our best selves to work and yet not burn out? How do we juggle the competing demands of our home lives and careers?

Notions of self-care are fairly new to the education field. In fact, it wasn’t until the late 1980s that researchers started investigating the concept of work-related burnout among mental health professionals and nurses.  Compassion fatigue, the emotional and physical exhaustion that can lead to a shift in our ability to experience empathy for others is a concept that emerged in the 1990s and lead to the growth of an entirely new field exploring provider wellness.

Here’s what we now know: we cannot expect to work in highly demanding and frequently under-resourced environments without taking some active steps to maintain our emotional and physical health. Some workplaces have implemented some very successful workplace wellness initiatives and we have featured them in our article “Beyond Kale and pedicures” (https://www.tendacademy.ca/wp-content/uploads/2016/01/BEYOND-KALE-AND-PEDICURES-Article.pdf)

The good news is that we now have over 25 years of research that map out what works and steps that we can each take to stay well. I have written extensively on this topic in my book The Compassion Fatigue Workbook and related articles.

Here are my top five favourites:

What works? 5 Key steps

Step one: Take stock

Cheryl Richardson wrote an outstanding book called Take Time for your Life in 1990 which provides a great self-assessment checklist called “What’s draining you?”. Richardson invites readers to identify the main drains on their energy: relationships, environment, body mind and spirit, work and money. Completing this checklist allows you to decide where to begin. Which of these areas is causing you the most stress at the moment? Which area shows the most possibility of improvement?

Step two: Identify your warning signs

How do you know you’re headed for trouble? What are your most recurrent physical warning signs? What about emotional reactions? Have you noticed some predictable behavioural patterns that show up when you’re overloaded? Learning to recognise your top three warning signs can help you catch things early before you become too depleted.

Step three: Pick your battles at work

The field of education is complex, and frequently under-resourced. Some of us deal with these realities more successfully than others. If you work with a colleague or a team that is frequently negative or engage in constant office gossip or naysaying, consider making more strategic alliances in the workplace. Venting once in a while is fine, daily gripe sessions bring nothing constructive to the workplace.

Step four: develop a community of support

Research has shown that social support is one of the best strategies to address compassion fatigue and burnout. Who are your accountability partners? Who do you spend time with at work and at home? Can they be there to help you stay on target with your self-care goals?

Step five: Reassess where you are at regularly

I recently wrote a new year’s resolution blog post on my website: www.tendacademy.ca where I discuss my lack of enthusiasm for new year’s resolutions. Rather than making big commitments once a year, I prefer to have weekly tweaks and adjustments. On Sundays, each week, I take gentle stock: how am I doing? What needs more attention? What needs tweaking?

Conclusion

My parents excelled in their careers, but it took a significant toll on their health and their personal lives. I look back on their work with admiration but also see a cautionary tale of working without balance. We know better now. Where will you start?

The Junk in the Driveway – A reflection on Dual Relationships

I’ve been thinking a lot about conflicts of interests, boundaries and dual relationships lately.

This wasn’t actually prompted by the appalling abuses of power we have seen in news headlines in the past few months (and, what a long list we could make…) of people in positions of trust or influence who violated some fundamental rules about power dynamics and respect.

And it wasn’t really triggered by questions I regularly get from new professionals in health care or the legal system, as they try to sort out the grey zones in their Codes of Conduct between what is right and what is wrong when we engage with other human beings: maybe get closer to our clients emotionally, or know of something that could really help them out but is a breech of the rules we are governed by. Or we find something out in our work that has an impact on another aspect of our lives but we are bound by confidentiality.

No, this all started with a pile of junk blocking a driveway.

Dual relationships – the fairly benign ways in which we are all put in potentially tricky situations when we wear several hats personally and professionally.

This happens frequently when we live in small communities of course – when your in-law is also your dentist, or your hairdresser, or your best friend is also the town’s police officer or the women’s shelter worker or land developer or when you hire your sister’s kid to mow your lawn.

But let me go back to the pile of junk.

Imagine that I have hired your daughter Holly to help me with yard work. You and I are close friends, and we also work together. But I’m also your supervisor at the office.

We have an agreement, I pay your kid x amount for the work that she does and Holly knows when she is supposed to come. Great. I am getting my junk cleared and your child gets some pocket money and some work experience.

But what if I’m not happy with Holly’s work? It may be that I’m really comfortable being a direct communicator and we just sort it out between ourselves, Holly and I. All good.

It may also be that Holly’s shy and I am worried about hurting her feelings so I don’t say anything because she’s your kid and you’re my friend and I’m also your boss.

Now imagine that one day, you are driving by my house, and you notice that the junk hasn’t been removed when it clearly should have. What happens next? Do you text your child and say “get your butt over there”? Do you get out of your car and do the junk removal yourself ? (don’t laugh, I have done this in the past, I confess! Shame shame!).

What happens next? Let’s say I, the boss, get to work, and I am frustrated with Holly’s work. In fact, I wasn’t able to get my car out of the driveway because she didn’t do her job and I’m late for a meeting with you, her parent.

Ok let’s try another scenario: You are selling your house, it’s on the market. A dear friend wants to buy the house and says “let’s do it privately, we’ll save a ton on real estate fees.” Is that ok? Is it a dual relationship?  What if you agree and there turns out to be a huge problem with your sewer system, that you didn’t know about or failed to disclose? What happens to the friendship? Does your best mate have to sue you? How do we handle this?

A few years ago, I was contacted by a woman who urgently wanted me to see her adult daughter for counselling. Although this mother did not know me, I knew exactly who she was – and the odds of us ending up at a private function or dinner party were extremely high. I told her that I wasn’t comfortable seeing her child but that I would recommend other excellent therapists. The mother insisted: “why can’t you see her? I don’t know you, and I would not be in any way uncomfortable seeing you at a dinner party.” And I realized that in this case, the discomfort was that this would potentially encroach on my privacy – what if the patient and I don’t get along? What if I, at some point, have to report her to child protective services of have her hospitalized? So I politely turned the mother down and, in the end, it was the right call, as things unraveled and I would have been in the middle of a mess that overlapped between my personal and professional life. Not good for them, not good for me.

None of these examples are situations where people abused their power, or violated any ethical or moral codes. But they are examples of dual relationships, and I think that we all encounter these at various times in our lives, especially if we live in small communities, no matter what profession we’re in.

Registered health professionals receive training on ethics and codes of conduct and we all know the sacrosanct rules about confidentiality, duty to report and that we’re not supposed to date our patients (Ugh. I hope everyone knows that one). But I think that all of us encounter more subtle challenges in our daily lives that, unaddressed, can lead to conflict, awkward misunderstandings and a myriad of other problems.

I am not suggesting that you shouldn’t hire Holly to do your yard work. But I am thinking that clear agreements ahead of time can prevent upset and strife.

The real estate deal is partly a true story, although we didn’t have any hidden sewer problems. How we handled it was through very clear communication about all the ways in which this could be tricky, and I spent a great deal of time writing a full disclosure document about all things down the road and we shared information with the vendor about things that were potentially wrong with our house. This process was about transparency and communication and it was essential, in my mind, to prevent future conflict or damage to our friendship.

Dual relationships are sometimes inevitable, but I always take a pause when I see one in the offing and I try to reflect on the cost of ignoring the potential pitfalls for the sake of saying yes or being a pleaser.

How you navigate them in your life?

Helpful Online Tools to Manage Stress and Compassion Fatigue

Following my last two posts on favourite books (link here) and podcasts (link here), here are a few helpful online apps to manage stress, compassion fatigue, trauma exposure and help us reset after challenging days.

There is now strong evidence suggesting that body-centered approaches are among some of the most effective ways to manage trauma exposure and stress. For some of us, that includes a regular yoga or meditation practice, vigorous physical exercise or other therapeutic techniques such as EMDR (eye movement desensitization and reprocessing) or EFT (emotional freedom technique), to name a few.

But if your schedule or personal preferences do not lean towards incorporating some of these practices into your every-day life, what can you do? Even if you already practice yoga or mindfulness, here are some easy to use, portable techniques that you can include in your self-care arsenal.

Here are some of our favourite apps:

The 7-minute workout:  https://7minuteworkout.jnj.com/

Stress Reduction Activities: https://www.calm.com/  

Headspace Mindfulness app: https://www.headspace.com 

Ichill – Stress Reduction App by the Trauma Resource Institute:  http://www.ichillapp.com

Digital use manager: http://www.qualitytimeapp.com

Emotional Freedom Technique (Tapping to reduce stress and anxiety)

http://eft.lifecoaching4u.net/products-2/go-eft-tapping-2/

 

Interested in more training? 

TEND Associate Diana Tikasz, MSW. has created a new one day workshop called WTF: The Window of Tolerance Framework and other Strategies to Keep You Grounded in High Stress Situations. This training has received rave reviews from participants. WTF will also soon be available as a web-based course on our site!

Brief description of the WTF course: The pace, content and competing demands of the modern workplace has left many of us operating in constant stress and overdrive. Frequently this elevated stress state is challenged further with added pressures and trauma exposure. Eventually we can find ourselves shutting down and numbing out because our bodies are not built to function in this high-energy state for extended periods of time. As a result, we see many negative physical, emotional, behavioural and relational consequences in the workplace.

WTF stands for “Window of Tolerance Framework”. This one-day training provides skills to move helping professionals out of states of reactivity or avoidance and into the place of possibility where we are centered amongst the chaos and can choose how we wish to respond. It is ideally suited for front-line workers and others working with forensic evidence, investigations, court, with witnesses and victims and those working with individuals who have experienced difficult and traumatic experiences.

Please contact us for more information about Diana’s live training.