Raising awareness, one hockey game at a time

(photo from Tema)

A few days ago, my daughter and I caught a public service announcement (PSA) on TV that took our breath away. Maybe you’ve seen it – During the first few frames, cute little kids in various emergency personel uniforms state their career dreams: “I want to be a police officer” says a sweet 6ish year old girl, “I want to be a firefighter” says a gorgeous nine year old boy, and so on. Then, the ad returns to each one and they continue: “But I’m scared…, (and now I am basing the rest on recall) “I’m scared that my job is going to hurt me, I’m scared of the nightmares, the horrible images, of not being able to get them out of my head. I’m scared that helping other people is going to permanently damage me” and gradually you realise that this is an ad about PTSD (the ad was far better that my clumsy attempt at describing it!).

The hockey game were were watching was “Don Cherry Military Night in Kingston” – an OHL game in honour of Canadian military personnel. There were several PTSD awareness-raising messages throughout the night and the aim of the whole evening was clearly to convey to soldiers of all stripes that PTSD is a common problem for military personnel and that help is available.

Having worked with the military for the past decade, I believe that this message needs to be conveyed to military staff in as many ways as possible. There is still a huge stigma about PTSD among the Forces – many military clients have told me that they would never want the label as they see it as a sign of weakness and they fear that if they sought help for it, they might be demoted or, worse, discharged from the military. There is also a perception among many soldiers that it’s a “copout label” – sometimes, they say, used dishonestly to seek a pension and benefits. Perhaps that is true on occasion, but my own clinical experience and the data shows that there are far more genuine cases of PTSD than malingerers and this perception is yet another obstacle for soldiers who really need help.

So with PTSD, we are battling many layers of cultural assumptions, prejudice, institutional dysfunctions and shame. An uphill battle indeed. Meanwhile, the soldiers with undiagnosed PTSD continue to struggle on their own, often using alcohol to numb out, turning their domestic lives into total turmoil, lashing out at their spouses, their children and at themselves.

But let’s go back to the TV ad with the kids:

It turns out the PSA was produced by a Canadian organisation called Tema: the Tema Conter Memorial Trust. Maybe you have heard of it? They are not an organisation I know anything about, so I went to their website to take a look.

Their story is as follows:
The charity was founded by Mr. Vince Savoia, an attending paramedic at the murder scene of Ms. Tema Conter in 1988. Upon coping with post-traumatic stress as a result of this horrible episode, Mr. Savoia created the Tema Conter Memorial Trust. The trust’s purpose is two-fold: to honour the memory of Ms. Tema Conter and call attention to the acute trauma encountered by emergency services workers. These courageous and compassionate individuals are haunted by the scenes they encounter on a regular basis, and they need our help. Because heroes are human.

If you go to their website they also have a very powerful second ad called “Hands”.

On a personal level, it was a great ad as it led my daughter and I into an interesting discussion. She said “That’s the work you do, isn’t it mom? Help people who are hurt by their work?” and I said “Well, yes, and I help the people who help the people who are hurt by their work and that, in turns sometimes hurts them too.” “Wow”, she said “What a strange job you do!” And I thought “Yes, what a strange, painful, moving, wonderful, rewarding job.”

There was a PTSD awareness-raising Major League baseball game this summer. It was for US military personnel and had a similar message: this is common, this is normal, get help, you are no less of a man for suffering from this.

Now, it would be pretty cool if we had a PSA about vicarious trauma one day, but I wonder how it would go over? How would we, the helpers feel? How would the public react to hearing how hard we sometimes find our jobs? A PSA about Vicarious Trauma. How about that?

Book Review: Trauma Stewardship An everyday guide to caring for self while caring for others by Laura Van Dernoot Lipsky (2009)

I am right in the middle of reading this book but wanted to share it with you as it is such a find. The author has over 20 years of trauma work under her belt and brings a very fresh look to vicarious trauma.

She explains the use of the term stewardship in the following way: “As I see it, trauma stewardship refers to the entire conversation about how we come to do this work, how we are affected by it, and how we make sense of and learn from our experiences. In the dictionary stewardship is defined as “the careful and responsible management of something entrusted to one’s care.” (Van Dernoot Lipsky, 2009)

I was instantly grabbed by the book’s introduction, called On the Cliff of Awakening, which articulated something I could completely relate to (so could thousands of helpers I have met along the way.)

To quote from her intro:

“Are you sure all this trauma work hasn’t gotten to you?” He asked.
We were visiting our relatives in the Caribbean. We had hiked to the top of some cliffs on a small island, and for a moment the entire family stood quietly together, marveling, looking out at the sea. It was an exquisite sight. There was turquoise water as far as you could see, a vast, cloudless sky, and air that felt incredible to breathe. As we reached the edge of the cliffs, my first thought was, “This is unbelievably beautiful.” My second thought was “I wonder how many people have killed themselves by jumping of these cliffs.” Assuming that everyone around me would be having exactly the same thought, I posed my question out loud. My stepfather-in-law turned to me slowly and asked his question with such sincerity that I finally understood: my work had gotten to me. I didn’t even tell him the rest of what I was thinking; “Where will the helicopter land? Where is the closest Level 1 trauma center” […] this was the first time I truly comprehended the degree to which my work had transformed the way that I engaged with the world. ” (Van Dernoot Lipsky, 2009)

I will share more about this book as I read on, but so far, it’s very engaging.

Chapter headings are:
Part One: Understanding Trauma Stewardship
Part Two: Mapping your Response to Trauma Exposure
Part Three: Creating Change from the Inside Out
Part Four: Finding your Way to Trauma Stewardship

Update after Yellowknife

I am just back from Yellowknife where I presented at a conference organised by the Federal department of Justice called “Northern Responses and Approaches to Victims of Crime: Building on Strength and Resilience.” Over 250 victim support workers from across Canada met for three days to share ideas, research findings and to connect with each other. This was the first meeting of its kind and it was, in my opinion, a complete success. I had the opportunity to meet victim assistance workers from all areas of Canada, from Whitehorse to Rankin Inlet to Thompson Manitoba to Kuujjuak (my childhood villlage) in Northern Quebec. I have been to many conferences over the years, and this was the friendliest, most well organised of them all.

Why hold a victim support conference with a special focus on the North? Here is some sobering data from the Policy Centre for Victims Issues (PCVI) press release:

“According to the 2004 General Social Survey, residents of the territories were three times more likely than provincial residents to experience a violent victimization such as sexual assault, robbery or physical assault (315 versus 106 incidents per 1,000 population). Residents of the North also experienced higher levels of spousal violence than their counterparts in the provinces.

Approximately 12% of northern residents reported being the victim of some form of violence at the hands of a current and/or previous spouse or common-law partner in the five years preceding the survey. This compares to 7% of the population in the provinces. Residents of Nunavut were also far more likely to have been victims of spousal violence (22%) than residents of the Northwest Territories (11%) and the Yukon Territory (9%).

Similarly, police-reported crime rates in the territories were substantially higher than rates in the rest of Canada. Specifically, in 2005, crime rates in the North were over four times higher than rates in the provinces (33,186 compared to 7,679 incidents per 100,000 population). In 2005, the Northwest Territories had the highest police-reported crime rate among the three territories at 41,245 incidents per 100,000 population. This rate was 1.3 times higher than the rate in Nunavut, 1.8 times higher than that in Yukon and nearly three times higher than that in Saskatchewan, the province with the highest provincial crime rate (14,320).”

We heard a captivating and reflective keynote address by Justice Gerald Morin, Deputy Judge of the Territorial Court of the NWT and creator of the Cree Court in Saskatchewan. We were also were incredibly fortunate to have an evening performance by Leela Gilday, an award-winning Yellowknife singer and songwriter. Leela’s songs were deeply moving and her voice was incredible. I was very glad that my meek keynote address came before her and not after her powerful performance!

Conferences such as this one offer all of us the opportunity to stop for a few days (well not really stop, it was a jam-packed agenda and people were working hard) but certainly the chance to get out of the trenches to connect and reflect on the work that we do. I met some victim support workers who had some significant challenges in their own lives (dealing with fostering several children with fetal alcohol syndrome, to name just one) and the complexity of offering services in a remote community, where everyone knows you and where you are often the end of the line. To all of these workers, I offer my most sincere thanks for their warmth, their open hearts and their willingness to participate in the workshops I offered.

Sidetracked

This was supposed to be a post about positive psychology and learned optimism. I normally mull over my posts all week and write them on Fridays but on Thursday night, I went to a lecture on burnout aimed at new medical students and I was uncomfortable with some of what I heard so I was forced to use my writing time for that instead. (forced by no one but myself, but you know how sometimes you feel strongly about things and so you can’t focus on anything else? That kind of forced. Compelled, I guess, is more accurate.)

Although I enjoy public speaking, writing and blogging on my own terms, I am not very comfortable in the limelight of op-ed. Some people are incredibly good at it. You know: the witty yet caustic artfully crafted letters to the editor, the inflamed yet articulate caller on the radio phone-in show. Neither of those are within my comfort zone (or talent zone). In fact, my last brush with op-ed fame was about 6 years ago. It was a slow news week in the middle of July and a local print journalist became interested in my opinions related to playground safety (a long, boring story). The day after my piece was published, my friend tried to buy all the newspapers in our neighbourhood so I wouldn’t read the incendiary letters to the editor mocking me and the position I had taken on this issue…Not a big deal, but not very comfortable either.

When it comes to public debate, I am more of a muller – when I experience something that troubles or upsets me, it often happens to me in slow motion, and I almost always need time to reflect and chew my ideas over before making a point or jumping into an argument. That does not make me a very strong debater, sadly, (although I am learning over time at the feet of a master of debate, my partner, who win arguments even on topics he knows nothing about! It’s sometimes enraging but also kind of sexy).

But here goes nothing. My op-ed piece.

Dr Patch Adams: A muddled message about burnout

On Thursday night I attended (along with hundreds of young medical students) Dr Patch Adams’ presentation “The Joy of Caring” which was held at the Biosciences complex on Queen’s Campus, organised by the Aesculapian Medical Undergraduate Society. We were invited to hear “an inspirational talk including the exploration of burnout prevention for caregivers, and the power of care, not only in the patient’s life, but also in the caregiver’s life.”

As a compassion fatigue specialist and someone who devotes nearly all of my time to providing education on burnout to health care professionals, I was very interested to hear Dr Adams’ thoughts on this topic.

I was moved and rather awed by Dr Adams’ total devotion to his life’s goal (which is to offer free medical care to all), and the love and acceptance that he conveys towards his patients across the globe, particularly the most neglected members of society.

However, as I heard Dr Adams speak, I grew increasingly uneasy about one aspect of his message.

Throughout his talk, Dr Adams described his routine of working from 7am to 3am daily and having rarely, if ever, taken a day off work in his many years as a physician and therapeutic clown. He also spoke of a twelve year period where he and other physicians lived with their children and spouses in a six bedroom house which they ran as a free hospital, co-habiting with “5 and sometimes 50 patients at one time, sharing bathrooms, living rooms and bedrooms. Having no privacy whatsoever.” Although he was not advocating that we all do the same, I wondered how his lifestyle was coming across to medical students around me – I wondered whether this was seen by some of them as something to aspire to, a gold standard of self-sacrifice – the sign of a truly dedicated doctor.

Then, I was startled by Dr Adams’ main message which was that, in his opinion, “There is no such thing as physician burnout when you offer [the kind of medical care he offers]. Burnout is not possible when you care.” I do agree with Dr Adams that it is often the system that burns us out rather than the patients themselves: the increasing volume of work, insufficient staffing, inadequate referral resources, etc.

But to state that “burnout does not occur when you care” is simply not true.

Based on very strong research (from 1995 onwards, see Figley, Stamm, Saakvitne and many others) the medical and other health care professions are recognising that there are serious problems with burnout that are intrinsic to helping others. It is in fact well established that there are serious consequences to overwork both to patients and physicians. We now know that working with patients can lead to the serious effects of compassion fatigue, vicarious trauma and burnout. Burnout is a term that has been widely used to describe the physical and emotional exhaustion that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work. Compassion Fatigue refers to the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate due to the pace, volume or nature of the patient work they do. Vicarious Trauma has been used to describe the profound shift that workers experience in their world view when they work with patients who have experienced trauma. Helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material. Vicarious Trauma occurs when the stories we hear from our patients transfer onto us in a way where we are secondarily traumatized and have difficulty ridding ourselves of the images and experiences they have shared with us. These problems can degenerate into clinical depression, post traumatic stress disorder, anxiety disorders and lead to alcoholism, suicidality and serious clinical errors, to name a few.

The good news is that there are simple and effective strategies that can protect us and help to mitigate these effects. We can provide care without suffering, and the answer is certainly not to deny or blame ourselves for experiencing burnout.

My concern is that Dr Adams’ take home message to medical students Thursday night was that if you do not devote every waking hour of your life to patient care, you are a failure and possibly also a shallow, selfish, materialistic human being. Dr Adams may be thriving with his own pace of life and is clearly accomplishing wonderful things in the world. But I believe that for the rest of us mere mortals the best way to provide care to others is to first and foremost start within ourselves: Dr Charles Figley, the highly respected founding father of compassion fatigue says it best: “First, do no harm to yourself in the line of duty when helping/treating others. Second, attend to your physical, social, emotional, and spiritual needs as a way of ensuring high quality services to those who look to you for support as a human being. ” (Green Cross Academy of Traumatology, Standards of Self Care Guidelines.)

This isn’t a zero sum game: you do not take away from others by caring for yourself – it is, in fact, quite the opposite. We are far more effective caregivers if we have our own emotional house in order.

Compassion Fatigue Training – Video of 1.5 hour presentation

The original posted video is no longer available.

We do have some fantastic clips of Francoise speaking in San Diego, California and at a recent TEDx event in Kingston, Ontario. Enjoy!

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

 

 

DRAFT – Low Impact Disclosure – How to stop sliming each other

After a difficult session….
Are you sliming your colleagues? Are you being slimed?
Can you still be properly debriefed if you don’t give all the graphic details of the trauma story you have just heard from a client? Would you like to have a strategy to gently prevent your colleagues from telling you too much information about their trauma exposure?

(For those of you who are slightly grammatically challenged, the “iming” in sliming is pronounced the same way one pronounces slime, not limb (therefore slimeing not slimming). This is not about weight reduction though you may lose a few pounds of other peoples’ baggage through this strategy…)

“Helpers who bear witness to many stories of abuse and violence notice that their own beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material.” (Pearlman et al, 1995)

When helpers hear and see difficult things in the course of their work, the most normal reaction in the world is to want to debrief with someone, to alleviate a little bit of the burden that they are carrying. It is healthy to turn to others for support and validation. The problem is that we are often not doing it properly. The problem is also that colleagues don’t always ask us for permission before debriefing their stories with us.

Two kinds of debriefing
Many helpers acknowledge that they occasionally share sordid and sometimes graphic tales of the difficult stories they have heard with one another in formal and less formal debriefing situations. Debriefing is an important part of the work that we do: it is a natural and important process in dealing with disturbing material.There are two kinds of debriefing that take place among helpers: the informal debriefing, which often takes place in a rather ad hoc manner, whether it be in a colleague’s office at the end of a long day, in the staff lunchroom, the police cruiser or during the drive home, and the second form of debriefing which is a more formal process, and is normally scheduled ahead of time (peer consultations, supervision, critical incident stress debriefing).

Part of the problem with formal debriefing or prebooked peer supervision is the lack of immediacy. When I have heard something disturbing during a clinical day, I need to talk about it to someone there and then or at least during the same day. I used to work at an agency where peer consultation took place once a month. Given that I was working as a crisis counsellor, I almost never made use of this time for debriefing (or much of anything else) as my work was very live and immediate. A month was a lifetime for the crises I witnessed. This is one of the main reasons why helpers take part in informal debriefing instead. They grab the closest trusted colleague and unload on them.

A second problem for some of us is the lack of satifactory supervision. If I came and administered a satisfaction scale right after you leave your supervisor’s office, I am sure that you would be able to give me a rating on how satisfying/useful that process was for you. Sadly, the score is often rather low for a variety of reasons (having sufficient time, skill level of the supervisor, the quality of your relationship with them, trust etc).

Are you being Slimed during informal debriefs?

The main problem with informal debriefs is that the listener, the recipient of the traumatic details, rarely has a choice in receiving this information. Therefore, they are being slimed rather than taking part in a debriefing process. Therein lies the problem AND the solution.

Contagion

Sharing graphic details of trauma stories can actually help spread vicarious trauma to other helpers and perpetuate a climate of cynicism and hopelessness in the workplace. Helpers often admit that they don’t always think of the secondary trauma they may be unwittingly causing to the recipient of their stories. Some helpers (particularly trauma workers, policy, fire and ambulance workers tell me this this is a “normal” part of their work and that they are desensitized to it).

Four key strategies to slow the progress of slime

In their book Trauma and the Therapist: Countertransference and Vicarious Traumatization in psychotherapy with incest survivors, Laurie Pearlman and Karen Saakvitne put forward the concept of “limited disclosure” which can be a strategy to mitigate the contamination effect of helpers informally debriefing one another during the normal couse of a day.

I have had the opportunity to present this strategy to hundreds of helping professionals over the past 7 years, and the response has been overwhelmingly positive. Almost all helpers acknowledge that they have, in the past, knowingly and unknowingly traumatized their colleagues, friends and families with stories that were probably unnecessarily graphic.

Over time, we renamed it Low Impact Disclosure (L.I.D.). What does it look like exactly?
Low impact disclosure suggests that we conceptualise our traumatic story as being contained inside a tap. We then decide, via the process described below, how much information we will release and at what pace. Simple as that.

Let’s walk through the process of L.I.D.
It involves four key steps: self awareness, fair warning, consent and low impact disclosure.

1) Increased Self Awareness
How do you debrief when you have heard or seen hard things?
Take a survey of a typical work week and note all of the ways in which you formally and informally debrief yourself with your colleagues. Note the amount of detail you provide them with (and they you), and the manner in which this is done: do you do it in formal way, at a peer supervision meeting, or by the water cooler? What is most helpful to you in dealing with difficult stories?

2) Fair Warning
Before you tell anyone around you a difficult story, you must give them fair warning. This is the key difference between formal debriefs and ad hoc ones: If I am your supervisor, and I know that you are coming to tell me a traumatic story, I will be prepared to hear this information (for more on this read Babette Rothschild’s newest book Help for the Helper, where she explores the concept of trauma exposure and helper preparedness)

3) Consent
Once you have given warning, you need to ask for consent. This can be as simple as saying: “I need to debrief something with you, is this a good time?” or “I heard something really hard today, and I could really use a debrief, could I talk to you about it?” The listener then has a chance to decline, or to qualify what they are able/ready to hear. For example, if you are my work colleague I may say to you: “I have 15 minutes and I can hear some of your story, but would you be able to tell me what happened without any of the gory details?” or “Is this about children (or whatever your trigger is)? If it’s about children then I’m probably the wrong person to talk to, but otherwise I’m fine to hear it.”

4) Low Impact Disclosure
Now that you have received consent from your colleague, you can
decide how much to turn the Tap on (I know this isn’t proper English, but it will do for the time being). Imagine that you are telling a story starting with the outer circle of the story (ie the least traumatic information) and you are slowly moving in toward the core (the very traumatic information) at a gradual pace. You may, in the end, need to tell the graphic details, or you may not, depending on how disturbing the story has been for you.

Questions to ask yourself before you share graphic details:

Is this conversation a:
Debriefing?
Case consultation?
Fireside chat?
Work lunch?
Parking lot chat?
Children’s soccer game (don’t laugh, it’s been done)
Xmas party?
Pillow talk?
Other…

Is the listener:
Aware that you are about to share graphic details?
Able to control the flow of what you are about to share with them?

If it is a case consultation or a debriefing:
Has the listener been informed that it is a debriefing, or are you sitting in their office chatting about your day? Have you given them fair warning?

How much detail is enough? How much is too much?

If this is a staff meeting or a case conference, is sharing the graphic detail necessary to the discussion? Sometimes it is, often it is not. Eg: discussing a child being removed from the home, you may need to say “The child suffered severe neglect and some physical abuse at the hands of his mother” and that may be enough, or you may in certain instances need to give more detail for the purpose of the clinical discussion. Don’t assume you need to disclose all the details right away.

Final words: I would particularly recommend applying this approach to all conversations we have. In social settings, even if it’s a work dinner or something with all trauma workers, think to yourself; is this too much trauma information to share?

Some additional suggestions:
Experiment with Low Impact Disclosure (LID) and see whether you can still feel properly debriefed without giving all the gory details. You may find that at times you do need to disclose all the details which is an important process in staying healthy as helpers. And at other times you may find that you did not need this.

Have an educational session followed by conversation at your workplace about this concept.

Low Impact Disclosure is a simple and easy CF prevention strategy. It aims to sensitize helpers to the impact that sharing graphic details can have on themselves and their colleagues.

I will write more on this concept in the weeks to come, and I welcome your thoughts and comments.

This Work – A poem

This poem was written by a therapist colleague of mine who has worked in this field for many years. She is someone who reflects deeply on the cost of doing this work, on the rewards and the pain that we can experience when our clients suffer terrible losses. She also made some very important changes to her schedule and her work/life balance in a way that now allows her to do this challenging work without being damaged by it. Those changes took an incredible amount of courage and humility, and I think that she will reap the benefits tenfold. If anyone “walks the walk” it’s her. She has asked whether she could share this poem with our CF community, but wishes to remain anonymous.

this work

my ten year old heart imagined
mothering a tidy orphanage
full of grateful kids
with names beginning with J,
carefully cleaned ears,
and brand new matching bedspreads.

thirty odd years later, I would cry out,
why do I do this work, this work
so beyond lists, Q-tips and the Sears catalogue
that I quake
when I open the door to yet another babe
swaddled in such unspeakables,
abandoned with such artifacts:
the chased painting still at last
beside the Barbie shoes below the school bus,
the truck at the bottom of the icy lake
cleared for the grandkids’ hockey games,
the bullet through the crimson pillow
where escape plans had tossed and turned,
the sticks and vegetables that had heard
such pleadings as no plant could imagine,
the seven year old Chapstick tasted
and set back by the ever empty baseball glove,
and today, just today, the cap and gown
to be donned the day after the funeral.

and I buckle and stagger once more
under the weight of this work, this work,
all but forgetting the shared breath,
the symphonic bouquet,
the tender arms of just last week,
wondering why, why
I cannot simply know the rose and the fire
in their exquisite words,
and the importance of keepsakes
in the light of our teal glass inukshuks,
marking the way for us and our followers,
lost and found in snow’s infinite textures
melted and sheening on our souls’ skin
and in our soft open eyes.

Criminal Lawyers and Vicarious Trauma

As I am travelling quite a bit in the next few weeks, I won’t stick to my weekly Sunday post but rather will add things of interest as they come across my “desk” (my desk at the moment is a shaking little table on a train that is running 1.5 hours late which means that I may or may not arrive to my destination in time to present a workshop. The joys of winter travelling continue!)

I would like to thank Dr Charles Figley for bringing the following article to our attention through the Traumatologist forum which is an email listserv. For anyone interested in being part of a compassion fatigue network that occasionally shares new findings/articles/book ideas: https://lists.fsu.edu/mailman/listinfo/traumatologist-forum

Basically, this and other research on VT is confirming what we all know experientially: that exposure to traumatic stories causes profound changes in helpers. This study will be published in the upcoming issue of the journal of Traumatology, and is based on the researcher’s Master’s project.

Crime takes heavy toll on legal minds
March 1st 2008 – By Lynnette Hoffman in The Australian

“SEAN Brown still remembers the details a decade on. From the horrific sequence of events right down to the specific type of bullets that were used; how many there were, where they went in, how long it took the victim to die.

Brown (not his real name) wasn’t a witness, nor was he on the ground at the crime scene, but plenty of grisly stories have been embedded in his memory in 20-odd years as a senior crown prosecutor.

Brown has “seen a lot” over the span of his career, a career that has required him to immerse himself in the intricate circumstances of violent death and homicides, brutal rapes, war crimes, you name it. The sum total of all that, he says, is “not very healthy”.

New research from Macquarie University, to be published in the international journal Traumatology, has found that criminal law work can have profoundly damaging psychological effects.

By and large, Brown has been rather fortunate in that regard. He has not suffered a debilitating depression, nor has he felt the need to seek professional assistance for mental health issues, or fallen into a pattern of abusing alcohol or drugs.

But that’s not to say the work hasn’t taken its toll. His dreams are sometimes affected, as are his relationships. “I tend to get moodier with my family and become more difficult to get on with at home,” he says.”

To read complete article, go to: http://www.theaustralian.news.com.au/story/0,25197,23292980-23289,00.html

Chronic Crises: Working with the toenail of the elephant

I just finished co-presenting a three day crisis intervention workshop (www.crisisinstitute.com) with my colleague Dr Mike Condra. This is a workshop we offer every October in Kingston and we meet dozens of crisis intervention workers from across the country who come to retool and hone their skills.

During this workshop, I am often asked questions related to working with clients who are chronically in crisis.

Most helpers say that they find clients in chronic crisis to be the most draining clients to work with: their seemingly endless demands, high needs, difficulty self-soothing and sometimes poor problem solving skills. The fact that we will work incredibly hard to set up a referral link for them and then the clients will sometimes sabotage the help they are being offered. The self-destructiveness, the splitting…

I have spent a lot of time pondering this challenge and seeking training on working with high need clients, and have the following suggestions for anyone wishing to continue helping such clients and retaining a respectful, helpful stance while not burning out. Read More