Compassion Fatigue: How do we lay the foundation for wellness?

[…] by developing the deep sense of awareness needed to care for ourselves while caring for others and the world around us, we can greatly enhance our potential to work for change, ethically and with integrity, for generations to come.

Lipsky, 2009

Last week, I had the honour of co-presenting with Dr Gabor Maté at a workshop organised by Gluckstein Law of Toronto – Dr Maté was doing the bulk of the day, and I was closing the event. It was wonderful to have the opportunity to hear the presentation based on his book “When the Body Says No” a second time – I always find that I get something different out of each time I reread a great book, or hear a thoughtful, inspiring speaker present. In fact, the second iteration is often the one where I learn the most. I can’t wait to have Dr Maté present at the Compassion Fatigue Conference in June.

One of the key messages in Dr Maté’s work is on the importance of self awareness – not just being aware of our current feelings, actions and reactions, but also being aware of the dynamics from our past that influence the every day choices we make. Dr Maté also emphasizes the importance of gaining an understanding and an awareness of how we deal with anger, hurt and resentment. In my clinical training, I often heard the saying that depression is “anger turned inward.” Given the incontrovertible evidence we now have of the connection between our physical health and our emotional states, imagine what happens to our immune system when we push our emotions away? (Please read his book for a far more eloquent explanation of this phenomenon.)

Throughout Dr Maté’s talk, I was reflecting on how we, as helping professionals, can apply his wisdom to our work and to the cost of caring.

I see four key areas that require our focus, to ensure that we are not damaged by the work that we do: self awareness, mindfulness, managing traumatic exposure and physical exercise.

I now invite you to take a few minutes to reflect on where you are at in each category (feel free to write me a comment, too, on what is hard about this, or what you have found helpful).

1) Self awareness

What does self awareness actually mean?

•Self awareness means being in tune with your stress signals. Do you have a good sense of how your body communicates to you when it is overwhelmed? Do you get sick as soon as you go on vacation, develop hives, get a migraine when you are stressed? Many of us live in state of permanent overload and are dimly aware of it. What happens when you feel angry? Do you explode or do you swallow your rage? Where in your body do you feel your anger?

•Self awareness means being aware of how your past influences your current life and work choices – Why did you choose to go into this field and not another? Did you pick this profession because of a trauma or loss you experienced in your own life? Were you already a helper in your family of origin? Are you the go-to person in your personal life? Do you feel empty or unimportant unless you are in a helping role?

•Self awareness also means understanding how your own childhood history affects your reactions to your clients’ stories (this is also known as countertransference).

•Are you aware of the ways in which you sabotage your self care? (by saying yes to requests you don’t have time for, by taking on more responsibilities, by drinking excessively, by cancelling a therapy appointment…)

2) Developing a mindfulness practice – living in the present moment

Think back to your last lunch break at work (did you even take one?) Did you eat your meal mindfully or mindlessly?

Did you shovel in last night’s stir fry while reading your emails, trying not to get sauce on the keyboard? Did you inhale the chicken wrap while driving and talking on your bluetooth or did you sit back and enjoy every bite, perhaps sitting in a park, staring at the leaves falling from the trees?

We spend a great deal of our time anticipating the future and ruminating on the past, but how often do we live in the present?  Mindfulness meditation is a practice developed by Jon Kabat-Zinn which emphasises the importance on focusing on the present and on the breath. This practice is called a “sitting meditation” and can be 10 minutes or 40 minutes in length. Of course, your mind will be filled with thoughts and distractions, which is completely normal. Kabat-Zinn suggests simply noting that those thoughts are present, and returning to the breath. There is no special breathing technique involved, in fact you are encouraged to simply breathe normally, and sit calmly, being present in the here and now.

Research on the effectiveness of MBSR is highly conclusive: over 25 year of studies clearly demonstrate that MBSR is helpful in reducing emotional distress and managing severe physical pain. In fact, MBSR has been used successfully with patients suffering from chronic pain, depression, sleep disorders, cancer-related pain and high blood pressure. (Cohen-Katz et al, 2005) Based at Toronto’s CAMH, Zindel Segal has developed a mindfulness-based cognitive therapy program for treating depression that has shown to be highly effective.

However, many people find that being mindful is extremely challenging …

3) Making meaning of the stories we hear

One of the most insidious consequences of compassion fatigue is isolation from our colleagues. Work overload, cynicism and negativity in the workplace means that a lot of us have lost that crucial opportunity to debrief and support each other.

Working in this challenging field, we need a way to process difficult experiences, to make meaning of the stories we hear. This is a process that Laura Van Dernoot Lispky calls “trauma stewardship”. Lipsky says that trauma stewardship allows us “to meet these challenges in an intentional way – to keep from becoming overwhelmed by developing a quality of mindful presence.” (Incidentally, Laura will be our second keynote speaker at the compassion fatigue conference in June).

Similarly, in her book “Help for the Helper” Babette Rothschild says that helpers need to find the optimal level of empathic engagement, where we are still connected with the client but where we are also not losing touch with our own body: […]  be able to find ways to balance her empathic engagement, regulate her ANS arousal and maintain her ability to think clearly.” (Rothschild, 2006)

If you do trauma work, I highly recommend that you read both books as they are full of helpful tools to manage our trauma exposure.

4) Regular physical exercise

Making sure you exercise hard enough to sweat, four times a week – whatever works for you. Taking a brisk walk in your neighbourhood counts just fine although let me digress for a second to share with you something I have recently observed – lazy nordic walking…Nordic walking is a great way to get fit – you walk energetically with two special ski poles in your hands which gets your arms moving up above your heart and thereby increases your heart rate (like a cross country skier). What I see all over town, however, are people limply walking around with two poles only slightly moving up and down along their body (some people even seem to be dragging the poles behind them). I always resist the urge to walk over and say “higher, just a bit, that’s it!” I mean, what’s the point in spending $50 on a pair of poles if you’re not going to lift your arms! Anyhow, that’s just me. It’s a bit like the folks who go to the gym and sit on the reclining bikes, pedaling leisurely while reading a magazine. I think it’s great that you came out to play, but if you’re not sweating, your heart is likely not pumping very hard.

Conclusion

I am frequently asked “beyond the basics of self care, what else helps with compassion fatigue – what are the key tools?” I am happy to expand on that, and do so in a regular basis but to be honest, I don’t think it’s that complicated. Well, no, it is complicated of course as we have a whole lifetime of resistance and avoidance strategies designed to keep us in denial. In addition, many of us work in very unhealthy environments that leave us depleted and overwhelmed, but in truth, once you have self awareness, the rest is not that difficult to do. In her book Take Time for Your Life, Cheryl Richardson says it best: “Do not confuse difficult choices with no choices”. Talking to a good therapist can be a wonderful way to start exploring this process.

Want to read more on this? Here are some resources I would recommend:

Gabor Maté “When the Body Says No”

Jon Kabat-Zinn “Full Catastrophe Living”

Jon Kabat-Zinn “Stress reduction” Available on You tube in six short episodes

Elizabeth Gilbert “Eat Pray Love”

Cheryl Richardson “Take time for your Life”

One Response to Compassion Fatigue: How do we lay the foundation for wellness?

  1. Pingback: Compassion Fatigue Revisited « Spirituelledivas’s Weblog

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