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


 

 

The ABCs of Stress

 

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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

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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. 

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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]

 

Basic Ingredients for a Healthy Staff with Laurie Barkin

 

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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?


 

Breathe, Reset, Refuel. Rinse, Repeat.

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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


 

Lessons in Resiliency from Military Families

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The oak fought the wind and was broken. The willow bent when it must and survived.”

– Robert Jordan, The Fires of Heaven

 


by Amanda O’Handley, article suggestions by Françoise Mathieu

The Canadian military currently has about 88,000 active personnel serving our beautiful country. We are fortunate to have such a dedicated and well-trained force of people ensuring the safety of our country. 

For each of those 88,000 military personnel is a network of family members and loved ones who support them on a daily basis. While members are away on deployments, trainings and exercises, these are the family members who stay behind to look after children, make sure the bills are paid, ensure that houses are maintained, to mow, rake and shovel.

These are the people who hold down the proverbial fort so their loved ones can serve.

One of the biggest challenges for military families is the reality of being posted every few years. With some postings as short as a year, this means quickly packing up a life – including furniture, children, careers, hopes and dreams – and moving them across the country. 

Add to that a myriad of compounding factors including those more common stressors (financial strain, unpredictable housing markets, increasing debts) and those unique stressors of military life (combat-related illnesses and injuries, higher than average rates of depression and generalized anxiety disorder) and you may wonder how these families manage to stay healthy and connected through multiple postings.

Despite the unpredictable and stressful world that military families navigate, they are some of the most resilient people I have ever met. These are the women, men and children who love someone in the military. And these are the women, men and children who continue to thrive and grow despite the constant upheavals to their lives. 

In my professional life as a music therapist, I’ve had the pleasure of working with military children and getting to know their unique struggles.

In my personal life, I am a military spouse. And as a new-comer to the military family lifestyle, I’ve found myself in a world of exciting opportunities – and overwhelming obstacles. People would often tell me: “There’s no life like it.”

They were right.

I won’t lie – it’s been hard. And I’ve struggled. However, I’ve met many military families who are not only making it work, but thriving!

So, I decided to do some psychological sleuthing on how they managed to stay so resilient through tough times. Here’s a few lessons about resiliency I have learned from the military family community:

 

Lesson #1 – All You Have is Today

 

A few weeks ago, I saw a magazine at the local military family centre with a headline that read: “Live today like they deploy tomorrow.” Although ominous, it was a good reminder. We can make all the plans we want, however the truth is that we only have today.

Military families understand how important it is to live in the present moment. Deployments and trainings can happen unexpectedly. So it is important to make good use of the time that you have together. 

Research has shown that living in the moment is an important part of staying healthy and it can help to increase our resilience. Check out this great post by Grace Bullock on how being present can help buffer the effects of stress.

There is a quote that a military spouse told me once that I think about often. For me, it’s the perfect reminder of the futility of predicting the future and the dangers of ruminating on the past: 

 “The good news is that nothing lasts forever. The bad news is that nothing lasts forever.”

 

Lesson #2 – Choose Optimism

 

I was working with a young boy whose father was deployed. Every week he would remind me that his father was returning in X number of days. Although I knew that he was anxious about his father being away and that he had been cautioned about how unpredictable deployments could be, he always chose to be hopeful about his father’s return.

Even though the situation may be scary or uncertain, military families know that optimism about the future is the best option. 

This area of psychology is called “Positive psychology” and was originally developed by Dr. Martin Seligman who showed that optimism is not always a natural predisposition but – and here’s the good news – it can be learned.

It’s important to avoid getting caught up in things outside of our control (see Stephen Covey’s work on circles of concern and influence). If we do not have influence over something, the feelings that we have about it (whether we’re excited and hopeful, or terrified and anxious) are irrelevant to the outcome. 

So, if we don’t know what’s going to happen, why not choose to be hopeful about it? At the very least, it makes for a better sleep at night.  

 

Lesson #3 – Don’t Be a Lone Wolf

 

Upon arriving at a new posting, we always receive a folder stuffed with resources and information from our local Military Family Resource Center. As a military family, we’re fortunate to have access to a large network of people and services built around providing support.

Military families know that being a lone wolf is not a sustainable or healthy option. Research has shown that loneliness hurts and –  at its worst – being lonely can be dangerous. A study by Holt-Lunstad, Smith & Layton (2010) concluded that people were more likely to die from loneliness than physical inactivity and obesity.

Child Trauma expert Dr. Bruce Perry has famously said that “There is no more effective neurobiological intervention than a safe relationship.” Humans are social animals and we thrive through connection.

Finding supportive relationships can be a challenge for more introverted military family members who do not have the built-in social structure of work that their serving spouses do. But making connections is essential for everyone’s physical and emotional well-being. Military families know this and that’s why its always one of the first steps of a new posting.

 

Lesson #4 – Who YOU are matters

 

I’ve met military spouses with some of the most amazing and interesting skills – writers, bloggers, some who are bilingual and trilingual, musicians, artists, world-travelers – and all of this in addition to their careers and their parental roles. 

For those who have a family member whose life is inextricably linked to their job – whether that be military, police, justice, EMS – it can be easy to lose your identity in the role of military wife or police husband. These are titles that are worn with pride – however, it can be easy to get swept away by your supporting role.

Research has shown that having a sense of purpose and meaning to your life is linked to positive health outcomes. Check out this great article by Amy Morin about finding purpose and meaning.

Military families know that in order to stay healthy and sane during difficult times, they must carve out their own niche and find time to focus on their own growth and happiness.

 

Lesson #5 – Practice Gratitude

 

I recently met a military spouse who had just returned from a particularly rural posting. Despite the challenges of being posted to a more isolated base (including lack of family support, few job opportunities, etc.), she proceeded to tell me how grateful she was for that posting because it gave her time to re-connect with her children.

If you’ve never been to Happy Valley-Goose Bay, Labrador, let me paint you a picture. At a population of a whopping 8,000, it is considered to be the largest population centre in its area. The weather forecast predicts snowfall in 10 out of 12 months of the year.

And yet, despite these challenges, this spouse was grateful for her time there. 

I’ll admit that gratitude has never been my forte. Luckily, there is a wealth of resources to teach us how to cultivate gratitude. Author Gretchen Rubin wrote a fascinating book called “The Happiness Project” where she reports on a full year commitment to tracking and focusings on happiness and gratitude. Learn more on her blog

 —

As a military spouse, these are lessons that I’m still learning. And they are lessons that I hope to one day master.

Speaking of gratitude, I am grateful that resiliency is a skill that can be learned. I like to picture it as a life-long workout. After each new posting, I get a chance to flex my flexibility muscle and show up just a little stronger and more resilient than before.


 

 

Three Simple Guidelines for Healthy Living

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We were recently visiting beloved old friends for a rare weekend away. Sitting together over a leisurely breakfast, we could see the warm Fall sunshine pouring into the dining room through the windows  – fresh fruit, yogurt and croissants offered on a beautiful table made of reclaimed wood. Delicious coffee, warm hearts. Real talk.

One them said: “Now that I am almost 60, I have high blood pressure, some other health concerns and I am worried. I know that I need to make changes to my lifestyle, but I don’t know where to start! How do I introduce more plant foods in my diet? I hate veggies. My mom used to boil the life out of veg and I have never liked them. I feel stuck.”

Another friend said to me, just last week: “We are bombarded by information about what we need to do to stay healthy, 50 ways to lose weight, 75 ways to sleep better… and a great deal of the information actually contradicts the previous studies. I feel overwhelmed – Should we fast? Should we eat only protein? No protein? Bubbly water? Flat water? It’s too much!”

They are right – it’s confusing out there.

So many research papers, reports and books on healthy living, weight loss, anti-ageing, debt reduction, decluttering… it’s a multi-million dollar industry for a reason. Nothing sticks and some of the fads are so extreme that very few people can adhere to them for more than a few weeks.

However, there is a way to simplify the body of research to a few essential guidelines. I recently attended a very interesting training on the connection between gut health, the brain and the body. They explored the most recent science on chronic inflammation and its toxic impact on our entire body and soul and how it can have a powerful influence on our immune system, mental health and increase vulnerability to disease.

Here’s a cheat sheet for my two friends (and for you if you are feeling the same way). 

 

 Guideline #1 – Eat more plants. Every day

Try to gradually increase your fresh vegetable consumption – add chopped peppers, cherry tomatoes, carrots, cucumbers or whatever raw veg you enjoy to your lunches and snacks. Bring a small tub of hummus or tzatziki to dip them in if that helps. Add a fresh green salad or lightly steamed vegetables to your dinner. Make a simple dressing from oil and vinegar, not the stuff in the bottles.

Focus on colourful vegetables: beautiful squash, rainbow chard, sweet potatoes, fresh peas, and eat lots of leafy greens, the darker the green the better. If you’re not a fan of plain cooked vegetables, steam them briefly and lightly saute them in a small amount of olive oil and garlic. Start with a small serving and increase over time. Go to the farmer’s markets and try a new vegetable each week.

My family became huge fans of spiralized zucchini this summer (a spiralizer is a little hand-cranked machine that grates vegetables into spaghetti strands). We throw the “zoodles” into a bit of garlic and olive oil in a pan, toss around for about 5 minutes and serve with fresh tomato sauce or pesto I made from the garden with whatever I had around: fresh basil, spinach, arugula, or a mixture, walnuts, almonds or cashews, (doesn’t matter), garlic and nutritional yeast instead of parmesan for my dairy-free daughter, oil, salt and pepper and you’re off to the races. Add some shrimp for the meat eaters or pork tenderloin on the side or tofu for the vegetarians and vegans.

Voila.

By the end of summer, my kids were eating one of those baseball bat-sized zucchinis each. Yes, each. That’s a lot of zucchini, but when the markets are full of them, it’s a cheap and quick source of vegetables.

 

Guideline #2 – Reduce sugar, go for simpler foods

Refined carbs are one of the main sources of inflammation-causing foods. Eating foods in their least transformed states will help you avoid refined carbohydrates, which are often full of sugar, trans-fats and excess salt (breakfast cereal, most store-bought breads, white pasta, crackers, for example) and avoid white sugar in drinks such as pop and anything sweetened with high fructose corn syrup (HFC). If you don’t eat stuff out of a package, can or a box, you don’t need to worry about this so much.

If you crave something sweet and transformed and full of refined carbs and other goo, go for it! Have a small serving of it. Just don’t do it at every meal.

 

Guideline #3 – Move at least 45 minutes a day

I have a friend who doesn’t seem to age. It’s weird. I know that she is in her fifties, but in the decade that I have known her, she has not changed at all. And, no, it’s not what you think – no weird injections and creepy fillers.

Her answer: she walks. A lot.

(Ok, and she most likely has great genes, probably avoided the sun and didn’t smoke).

But she makes a point of walking every single day, rain or shine. If she is somewhere where she can’t walk outside – like a hotel in the middle of an overpass (don’t laugh, that’s my weekly lot in life when I am on the road), she will do a few sessions up and down the stairs. If she’s in an airport, she takes the stairs instead of the escalators. During breaks, she walks through the hospital where she works.

How much walking? The recommended daily minimum is 45 minutes of walking each day – it doesn’t have to be all at once. You could do two or three shorter walking sessions a day if that works better for you. But you need to walk vigorously enough to be a bit out of breath and not able to carry out a conversation comfortably while you are doing it. So that’s pretty active walking for most of us.

My friend also has another trick: She always wears comfortable shoes that she can walk in. So, no stiletto excuses. Personally, I carry super comfortable little shoes in my briefcase at all times. So then I can switch out of my fancy shoes any time I want to walk.

 

How to stick to it

So that’s it. Three things: more plants, less refined carbs and sugar, more walking. 

But please if you are new to this, don’t go all New Year’s resolution on yourself, just take a look at your daily habits and make one small change each day.

A study by Woolley and Fishbach (2016) explored why many resolutions – which they call “Long Term Goals” – don’t seem to work. They concluded that most of us mere mortals need immediate rewards to stay motivated. An immediate reward, the study explained, could be simply feeling a sense of enjoyment during or immediately after the activity.

An example of this could be listening to your favourite music while doing your power-walk or your favourite book on tape. I like to listen to a great podcast series while I prepare my veggies and healthy lunches for the week ahead. It has become a Sunday ritual and I look forward to it. When I am trying to solve a problem at work and I feel stuck, I make myself leave my desk and go for a walk down to the lake close to where I live. I always come back refreshed and ready to crack the problem that was stumping me.

So that’s it – to riff on Michael Pollan’s famous recommendations:

“Eat real foods, mostly plants and not too much, walk briskly at least 45 minutes per day, not necessarily all at once, and reduce/avoid refined carbs, white sugar and HFC from your diet as much as possible. Do these things while doing something else that you enjoy.”

—–

Good Reads:

Blackburn, Elizabeth & Epel, Elissa (2017) The Telomere Effect

Hamshaw, Gena (2015) Food 52 Vegan: 60 vegetable-driven recipes from any kitchen

Liddon, Angela (2014) Oh She Glows Cookbook: Over 100 Vegan recipes to Glow from the Inside out  – (try the lentil sloppy joes, amazing).

Pollan, Michael (2008) In Defense of Food: An Eater’s Manifesto

 

Websites for more plant-based cooking:

Oh She Glows  – This Canadian author wrote her first cookbook to introduce her meat eating partner to vegan cooking. Therefore the recipes are highly accessible for omnivores as well as vegans and anyone in between.

The Full Helping – Gena Hamshaw is my favourite vegan food blogger but her recipes are a little more “intermediate” level than Liddon’s. Gena does a lot of batch cooking on Sundays for the week ahead. Her sweet potato hummus is fantastic.

 

 

A Fresh Start for Fall

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September is always a welcome reset time for me. I know that not everyone feels that way about the Fall, and I have some friends who openly talk about it being a rather melancholy time for them, with the weather shifting and the lighter schedule of summer ending, but I love it all.

The farmers’ markets are filled with beautiful late summer produce, which motivates me to start cooking more; the light is changing, which makes for better photos; and I have more energy when the temperature cools. I like getting organised and back to a bit more of a sensible daily routine.

This is the first September without my lovely son at home as he has just gone off to university. There it is – the proverbial and much-discussed “empty nest”.  I coped with this wrenching loss (and excitement for him, of course) by doing a massive declutter of the house. Anyone else out there manage sadness, anger, irritation, lack of control etc. by cleaning? I find it very therapeutic.

When I was driving him to drop-off last week, I told my son that I wasn’t sure if I was more upset about him leaving or more excited about finally getting into his room to give it a deep clean. (I found about 50 single socks under his bed. Impressive).

I was only half-kidding of course.

These are profound life transitions and anyone who has been through it likely knows what I mean. A complex roller-coaster of melancholy, happiness about more free time, worry about my kids being safe and well, missing them, happiness about more free time, (wait I said that already right?) a much tidier house, and the need to make some major adjustments or just sit with this gigantic life event and maybe not change anything at all.

But even if you’re not going through such a profound life transition this Fall, we all need a reset once in a while. I have written a lot about self-care on this blog about the importance of regular good quality sleep, exercise, healthy eating, meaningful social connections and restorative time.

Here are a few things that I am doing this September to reset and get in a healthy place before my busy travel schedule starts.

 

Going on a digital mini-diet

I deleted my Facebook a few months ago (no judgement if you love FB, it was just a time-wasting vortex for me). Instead, I have committed to reading a book before bed rather than watch “just one more episode” of whatever on Netflix. I fall asleep faster and sleep better. (Of course, the truth is that I watched 33 episodes of Inspector Morse this summer, so I sound more virtuous than I really am.)

I’m probably just between shows right now, but I find it a better routine for me. I have been enjoying Tina Brown’s Vanity Fair Diaries, a book which was given to me a bit sheepishly by a lovely senior physician at our local hospital as a thank-you for a talk that I gave. He said “sometimes, we just need something decadent and completely superficial” and he was so right. I am almost through the entire brick and love tucking into it once my day is done.

 

Clean up my finances

I have enjoyed several personal finance/frugality blogs in the past. If you haven’t had the pleasure of reading financial guru Gail Vaz-Oxlade in the past, I highly recommend her book Debt-Free Forever:

Here is a link to Gail’s website which is full of resources.

Here are a couple of financial blogs I have been reading recently. You don’t need to aspire to their extreme money-saving beliefs to enjoy these. “Our Next Life” has a great blog post about being a road warrior if you fly a lot for work.

Frugalwoods (and they also have a book): 

Our Next Life 

Eat more vegetables

My partner switched to a primarily plant-based diet several years ago for health reasons and became a fantastic cook. Although I am not vegetarian, I have enjoyed lightening my diet (and having a happier gut) by adding more gorgeous fresh vegetables to our meals. Here are some of the cookbooks and foods blogs we like to check out regularly:

Cookbooks

Food 52 vegan: 60 Vegetable-Driven Recipes for Any Kitchen by Gena Hamshaw

A Modern Way to Eat by Anna Jones

Whitewater Cooks Pure, Simple and Real Creations from the Fresh Tracks Cafe by Shelley Adams

Food Blogs

The Full Helping 

Smitten Kitchen

Food52

From the TEND resource page – A chat with Deb Thompson from Your Nourished Life – “the Elephant in the room — how so many of us use food for comfort against the general wear and tear of life.” 

Exercise

I had hip surgery several years ago to repair a torn ligament and had to completely stop my beloved long-distance running. It took time to find a replacement for this stress-relieving and creative protected time in my day. I now do a combination of cross-training 2-3 times a week and yoga 1-2 times a week when I’m feeling really dedicated. I try to fit in a long walk at least twice a week.

My dear colleague Diana, who is far more disciplined than I am, ensures that she walks 45 minutes each and every single day, rain or shine. My challenge is that when I’m on the road (which is a lot), I get more sedentary and I don’t do as much as I should. I am going to try to add some walking to my schedule. We know it’s good for us and it requires no equipment.

Books

The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer by Elizabeth Blackburn & Elissa Epel

Video

23 and 1/2 hours: What is the single best thing we can do for our health? by Dr. Mike Evans

 

Improve my Sleep

Some people seem to be able to drink coffee right up until bedtime and are totally unaffected. I started feeling “revved-up” when I got to work this summer and was having difficulty falling asleep or would wake up at 3am unable to fall asleep again.

I realised that I had started increasing my caffeine consumption and needed to take it down a notch. Therefore, I have cut back on coffee by using a really good quality decaf coffee bean. I feel much better overall.

That’s it! Those are my Fall commitments to myself. What are you going to do to reset and take good care this September?