Part Two: Does Self Care Work?
This week, we bring you an all-new feature article in five parts. To read Part One, click here. Come back for Part Three tomorrow. On Friday, you will be able to download the piece in its entirety.
By Françoise Mathieu, M.Ed., CCC.
Pioneers in the field of compassion fatigue and secondary traumatic stress research say that they were caught off guard by the enthusiastic response that they received when they published their initial findings in the 1990s. One colleague recently told me: “It was a bit like trying to put the toothpaste back into the tube – people were very excited about this new idea of compassion fatigue, and the notion of self-care caught on like wildfire but meanwhile, the field was still in its infancy. There wasn’t even agreement on a name for this phenomenon, let alone what really worked to prevent or reduce it.” In fact, to this day, terminology continues to be hotly disputed: is it burnout, compassion fatigue, vicarious trauma, secondary trauma, compassion stress, moral distress, empathic strain? Are they one and the same or are they clearly distinct concepts? The debate rages on. Meanwhile, back in the trenches, helping professionals of all stripes were trying to do the best they could while working within an increasingly compromised system.
In the past few years, new research has emerged which suggests that it is time for a more sophisticated understanding of the best ways to manage and reduce CF and STS – one that goes beyond healthy eating and massages.
Intrigued by the field’s growing focus on wellness practices to reduce CF and STS, Toronto-based researchers Ted Bober and Cheryl Regehr investigated whether self-care was in fact effective in reducing STS in trauma counselors. Their 2006 study found that although their subjects believed that leisure activities and self-care would reduce their secondary trauma symptoms, that was not in fact the case: therapists did not engage in these self-care practices more often when they believed in them, and when they did take better care of themselves, it unfortunately did not reduce their trauma scores. Essentially, self-care was not working in reducing STS, in spite of agencies spending tens of thousands of dollars on workplace retreats and work-life balance workshops. In fact, Bober and Regehr argued, organizations were beginning to unwittingly blame their staff for not managing their lives better – the message was now “if you had better work-life balance, you wouldn’t be so overwhelmed with the workload and the trauma stories.” Meanwhile, the workload continued to increase, and the resources to disappear. As one social worker recently told me: “They tell us that overtime is no longer allowed, and that this is for our own wellness. I suspect it’s really about budget cuts, to be honest, and that they are using the self-care excuse to encourage us to stop working at closing time. But in truth, our caseloads are so huge we can’t get all the work done in a regular workday. So, what are we supposed to do? Let children die so that we can go all home at five?”
This week, we bring you an all-new feature article in five parts. Come back for Part Two tomorrow. On Friday, you will be able to download the piece in its entirety.
By Françoise Mathieu, M.Ed., CCC.
Part One: Beyond Kale and Pedicures
I have been locked out of the seminar room.
Peering through the glazing, I can see two dozen Operating Room nurses in scrubs, milling about inside the auditorium. The space is nearly full, and they are chatting and eating lunch. The session on compassion fatigue and self-care is about to begin, but the door is locked and I can’t get in. I knock once, and then again a little bit louder. They can see me, but no one comes to unlock the door.
Problem is, I am the presenter, and this isn’t starting out particularly well.
After a few minutes, the caterer, who has just delivered sandwiches to the team, unlocks the door from the inside and whispers to me on his way out: “I’m warning you, it’s worse than high school in there.” It turns out that this group has just learned that all of their summer leave has been cancelled, due to cutbacks, but this session is mandatory, so there they are, steaming mad, and not particularly inspired to discuss sleep hygiene and breathing with me.
Luckily, this isn’t my first rodeo, so I am not too rattled. I am also lucky to rarely encounter such hostile audiences, but I do specialize in delivering training to high stress, high trauma-exposed helping professionals: prison guards, child welfare workers, trauma nurses and docs, and so many others who are trying to care for patients and clients in an increasingly challenging and under-resourced climate. But at this point, in 2011, I am starting to ask myself whether what I am teaching them is at all effective.
Many of my audiences express growing frustration at working in a system that feels broken, and no amount of kale and yoga can fix that overnight.
by Françoise Mathieu, M.Ed., CCC.
This post was originally written for the hospice and palliative care website Life & Death Matters (see blog post here in its original form).
As a compassion fatigue specialist, I have the privilege of travelling across North America each month, meeting helping professionals of all stripes: nurses, social workers, physicians, police officers, lawyers, and a myriad of others who work in high touch situations with individuals with complex needs.
Sometimes I’m offering a lunchtime keynote, and in other instances a half or full day workshop. During these trainings, participants explore the many-layered challenges of their jobs, exploring their struggles with insufficient resources, inadequate pay, secondary trauma exposure, compassion fatigue and the risks of burnout. Working in this field can be tough when there isn’t enough to go around, and we acknowledge that in our work together.
Understandably, overwhelmed and depleted helping professionals also want solutions when they come to our training and they frequently ask challenging questions: “can we prevent this?”, “What about my workplace, aren’t they responsible for providing a healthy work environment?”, “What can I do when my caseload has doubled in the past three years?”
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Many people were directly impacted by the events in Ottawa last week – most affected, of course, was the victim’s family, the perpetrator’s loved ones, the good samaritans who rushed to Cpl Nathan Cirillo’s help, the paramedics and police officers who responded to the scene, all of the individuals inside the Parliament building who witnessed the gun fight, and everyone else who was on the Hill: those who spent hours in lockdown, the tourists and passersby who witnessed the attack, the media and a whole host of other people I am probably forgetting. Some of these individuals were directly exposed to a trauma while others experienced a more indirect form of traumatic exposure.
As one moves away from the epicentre of the tragedy, we can list millions of other individuals who were deeply affected by the shooting – Ottawa citizens, Canadian viewers who watched it on the news and of course the global community. These folks were not exposed to direct trauma, but were potentially secondarily traumatized all the same: If you watched some of the raw media footage which was shown on our TV screens minutes after the shooting, you may have noticed some very graphic, rather disturbing images centered around the victim. I noticed that as the day progressed, while the footage was being shown in a continuous loop, it was slightly altered to mask some of the more disturbing elements of the scene. (You may not have noticed that, but I have a homing device for trauma exposure in the public sphere and how it’s done, call it my own personal mission and obsession). However, with YouTube, and dozens of passersby able to film the scene with their smart phones, it won’t be hard to see that raw footage somewhere on the net, if one looks hard enough. I am not sure why the media outlets decided to stop showing the more graphic details – was it out of respect for the victim’s family? A decision to spare the viewers? Maybe a bit of both, and that’s a good thing. Too bad it doesn’t happen more often.
Thankfully, our degree of understanding of traumatic stress has significantly improved over the past decade – most people are now fairly familiar with the concept of Post Traumatic Stress Disorder (PTSD) and have no difficulty understanding that those at the centre of a tragic event like the Ottawa shooting might be significantly affected for weeks and perhaps months to come. We also know that some individuals are more vulnerable to traumatic stressors and may develop more significant psychological distress as a result of this event: the severity of the reaction is determined by a prior trauma history, a history of mental illness or addiction, a person’s personality and coping styles, whether or not they were able to seek good quality debriefing afterwards, the quality of their social supports and several other factors.
One thing is clear – when we experience a traumatic event, many of us have a strong need to talk about it with others. This is a very good thing. Talk, write, share with your loved ones, with your work colleagues and your friends. This urge to connect and tell our story can also happen to us during very intense happy events – talk to any new mother about her birth story hours or days after the delivery, and she will give you the play-by-play of each cube of ice she chewed on and what centimetres of dilation she was at. Talk to her again a year later, and she will likely tell you, in a nutshell, that “it hurt like hell and took 26 hours” but unless it was a very traumatic birth, she will no longer need to share minute by minute account of what happened. This is completely normal. With traumatic events that involve a criminal act, the need to share and the trauma experienced may be more potent. An “act of God” is very different from one human being’s deliberate decision to cause harm to others, even if the perpetrator is deeply psychologically troubled. So let’s talk about it, absolutely.
However, we should take care to share what is necessary vs “all the gory details” unless those are extremely central to our experience. After 9/11, the Globe and Mail (and many other news outlets) shared some incredibly graphic photos that I will never be able to remove from my mind – I was quite traumatized by those images, and there were not necessary – I did not need to view these to be compassionate and profoundly distressed by the collapse of the Twin Towers. Fourteen years later, those photos of 9/11 still haunt me whenever I hear mention of the World Trade Centre. The same is true for the Bernardo trial, some 20 years later. Click here to read more about “Low Impact Debriefing”
As the events in Ottawa recede, some of you may remain greatly shaken and very affected by the sounds, images and emotions surrounding the shooting. If, a few weeks from now, you feel that you are more distressed than you should be – maybe you are more upset than your colleagues, are having difficulty sleeping or focusing on other things, perhaps you are experiencing intrusive images or nightmares – please seek some support. Let’s take good care of one another.
Canadian Mental Health Association: Getting Help
CMHA Website on PTSD
© Françoise Mathieu 2014
Photo credits: Michel Loiselle
“Listening can be an act of social justice” beautiful, inspiring, a call to action
The University at Buffalo School of Social Work has developed an excellent self-care starter kit aimed at social work students and other professionals. They have an extensive bibliography, readings, checklists and other resources. They also have a great infographic called “How To Flourish in Social Work” which you can view here.
It’s very exciting to see such good quality resources emerging from the trenches. If you are an educator, preceptor or supervisor, please share this resource with your folks. This is a great tool for all helping professionals.
Here’s a quick post for you today with three items: new reads, a recipe and an invitation…
It’s finally summer! This is hopefully a time for you to slow down a bit, enjoy the beautiful weather, have a picnic, maybe go to a local market or outdoor music festival on your day off.
June was a very busy time for me, starting with the wonderful Care4You conference (photos will be posted next week!), a work trip the Florida Panhandle, and a trek to England to visit family and friends.
Needless to say that by July 1st, I felt the need for a little r&r after all of this excitement.
Whenever I finish a hectic time and need to refuel, I try to go back to the basics: get more sleep, eat more greens and less carbs, ditch the caffeine and get more exercise. Those simple things help keep me grounded, and when I go too long without them I start feeling tired, unwell and irritable. So I went back to read my favourite healthy eating blogs and spent a bit more time in the kitchen juicing and making homemade meals. I came across this weird and wonderful gluten-free bread recipe that I will share with you below. There are also some newly published compassion fatigue articles to recommend, for your time in the hammock!
1) New Reads on Compassion Fatigue
I just had two new articles published and a book chapter which I co-wrote with my colleague Leslie McLean from Capital Health Cancer Care, in Halifax.
For Family Caregivers: When the Juggling Act Isn’t Working: 5 Key Strategies to Reduce Compassion Fatigue and Burnout. Click here
For nurses: Occupational Hazards: Compassion Fatigue, Vicarious Trauma and Burnout. Click here.
New Book Chapter: Managing Compassion Fatigue, Burnout and Moral Distress in Person and Family Centered Care Click here
2) Healthy Eating, Cool Gluten-Free Bread Recipe
If you read this blog regularly, you’ll know that I am a big fan of healthy eating and enjoy reading food blogs for pleasure. My two current favourites are Choosing Raw by Gena Hamshaw, a New York nutritionist, and My New Roots, a beautiful whole food blog by Sarah B. a Canadian who now lives in Denmark but recently spent 6 weeks in Bali (yes, I know, tough). What I like about these bloggers is that they propose easy, fresh recipes without dogma.
Sarah B. posted a crazy-sounding gluten-free bread recipe last year, called “The Life Changing Loaf of Bread” which may seem like a rather bold statement. I was intrigued, but did not have time to gather the ingredients to try it out until yesterday. Well, what a success! This produces a very dense, toastable seed bread. Not suitable for sandwiches but perfect for toasting. Fantastic! Click here for a the link to the recipe.
3) Join the anti-spam brigade, and make sure you stay on our mailing list!
Finally, an important note to any of you on my mailing list. If you are a Canadian reader, you will likely have been deluged by emails lately from all sorts of businesses asking you to confirm that you wish to continue receiving their emails. A new anti-spam legislation became effective july 1st, 2014 and if you do not confirm your desire to receive emails from us, we will have to remove you to comply with the regulation. So please take a minute to click on the “confirm” button in the email we sent you recently. Thanks!
Now, I’m going to go watch some tennis and World cup soccer and drink some romaine, cucumber fennel juice. (It sounds weird but it tastes great.)
Here’s wishing you a lovely summer!
What a wonderful two days! thanks to all of you who joined us at last week’s Care4You Compassion Fatigue Conference in Kingston. In the coming weeks, we will post photos as well.
In the coming days, we will be posting the slides from the conference here. Come back if the talk you are looking for isn’t posted yet, and we hope to see you next year!
Compassion Fatigue 101 with Françoise Mathieu – Click here for slides
Care4Your Body Care4You with Lynda Pedley – Click here for slides
Rethinking Compassion as Moral Stress with Donna Forster – Click here for slides
Nutrition: The Fuel for Mental Health with Jess Sherman – Click here for slides
Managing Compassion Fatigue with Mindfulness and Self Compassion with Robin Beardsley - Click here for slides
Riding the Emotional Roller Coaster with the Patient with Jennifer Juneau – Click here
Embracing Gratitude with Cathy Mosole – Click here for slides
Irest, Yoga Nidra with Bill McLaughlin – Click here for slides
Oxygen for Caregivers with Simon Fox – Click here for slides and here for handouts
Improving Morale by Supporting Each Other with Romney Pierog – Click here for slides
Improv your Outlook with Mary Harvey – Click here for slides
Education for Next-Generation Frontline staff with Karen Mayer – Click here for slides
Here are several exciting training events coming up in the next few weeks!
Walking the Walk – Toronto, May 27, 2014
Françoise Mathieu will be in Toronto on May 27, 2014 offering the one day workshop Walking the Walk: Creative Tools for Transforming Compassion Fatigue for the Hincks Dellcrest. Registration for this event is now open. Registrants will receive a copy of Françoise’s book: “The Compassion Fatigue Workbook” at registration. For more information, please click here
Laughter Yoga – Kingston, June 2, 2014
A full day “Playshop” with Laughter Yoga Practitioner Sylvie Dagenais-Douville where participants will learn the value of laughter as an exercise that can enhance energy levels and keep you cheerful and fit. To laugh without any reason and to be able to practice laughter exercises at any time. How to change their mood by doing these laughter exercises, thereby bringing a change in their attitude towards others. This will also help them to cope with difficult and challenging situations with a positive frame of mind. To release negative emotions and bring about an emotional balance for better relationships with colleagues in the workplace and with family at home. How to apply the wisdom of laughter yoga to bring more laughter and joy in their workplace. No yoga experience necessary to participate!
Click here for more information and click on “Preconference Events”
Care4You: The Fourth Annual Compassion Fatigue Conference, Kingston, June 3-4, 2014
This year, we have a record number of registrants! Join us for two days of connection, learning and refuelling. Keynote speakers Meaghan Telpner, Nutritionista and author of “Undiet: Eat Your Way to Vibrant Health” and Dr David Posen, author of “Is Work Killing You?” and “The Little Book of Stress Relief.” Limited seats are still available. Click here for more information
Every day this week, we are sharing with you some highlights of the upcoming Compassion Fatigue Care4You Conference June 3-4th, 2014
Workshop: Transforming Trauma – The Journey of one Woman
with Deborah A. Sinclair, Social Worker
In her 35 years of practice with trauma survivors and the allies who support them, Deborah Sinclair has witnessed the deep emotional and cognitive impact on our bodies, hearts, minds and spirits, and the pervasiveness of vicarious traumatization (VT) for helpers/clinicians/allies. She has also noted, as with trauma survivors, that this vicarious traumatization can lay the foundation for vicarious resilience and posttraumatic growth. This is a good news story that can provide hope to all of us in our moments of quiet despair.
In this presentation, Deborah Sinclair will present the latest research findings that have relevance for mitigating vicarious traumatization in our personal and our professional lives and deepen our understanding of what facilitates vicarious resilience and post-traumatic growth. What inspires each of us to perform as our best selves in the pursuit of excellence?
Deborah Sinclair is a social worker in independent practice in Toronto, ON. Over her 35 year involvement in social justice work, Deborah has worked in many different capacities – clinician, writer, speaker, trainer, researcher, and expert witness. Deborah is a founding member of the Emily Stowe Shelter for Women, Women We Honour Task Force on Intimate Femicide and Luke’s Place. In January 2003, she was appointed to the Domestic Violence Death Review Committee (DVDRC), an expert advisory committee of the Ontario Chief Coroner’s office that reviews all intimate partner homicides/suicides in Ontario. Deborah works as a resource to assist professionals and advocates working with high risk populations to deal with vicarious trauma and resilience in their work settings including crown attorneys, family law lawyers, police officers, paramedics, health care providers, teachers, child welfare workers and shelter staff. Deborah facilitates debriefings for individuals and groups experiencing a critical incident, and mediates to resolve staff conflicts, manage staff expectations and transform work settings into supportive, high performing sites of excellence. Deborah is the YWCA 2010 Woman of Distinction for Social Justice and is currently a Ph.D candidate at the Factor-Inwentash Faculty of Social Work, University of Toronto.
Click here for more information about the Care4You Conference