Compassion Fatigue: Worn Out, Warn Down and Wanting to Renew

Transcription

Cordelia Anderson, MA
www.cordeliaanderson.com
Sensibillities, Inc. Cordelia@visi.com
"I rise in the morning
torn between a desire
to improve the world
and a desire to enjoy
the world. This
makes it hard to plan
the day.“ e.b.White
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‘80’s Impact on sexuality/health of RCC/DV
workers
Erotica or pornography
“Burnout” “Self-Care” as part of prevention &
prevention work as part of self-care
Educators, Prosecutors, Therapists, Clinicians
Advocates, Analyst
Investigators of CSI
Kenwood Therapy Center
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 Exposure to Trauma has an impact
on the most highly skilled
professionals
“Trauma stewardship” is ethical
issue (Laura van Dernoot Lipsky)
Occupational hazard of the work
◦ “toxic stress”
Organizational & Individual Strategies both
matter
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No magic pill; No ONE thing
There are symptoms: Pay attention
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Figure out your current level of stress:
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◦ to what “degree” - normal to ‘feel it’ –
◦ “NORMALIZE the difficulty of the topic & situation”
◦ Stress (helpful/good stress or at least not
harmful)
◦ Over stressed (Pay attention)
◦ Burnout
◦ Dis-ease (Crispy, Crossed Over) (TOXIC)
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As a catalyst to do what you can
about any toxic conditions
Define the extent of the problem, restoration
or transformation & practicing prevention
Important to start with yourself
Did You Know??
"They say that falling coconuts kill 145 people
in the tropics every year...
They also say that stress-related heart attacks
on the mainland kill 450,000 people each year.
I think I can deal with the coconuts...“
(K-Man news)
“If
your compassion does not
include yourself it is
incomplete”
Jack Cornfield
 If
one in ten people
complain of discomfort
from the work, you need to
start a program.
 What is your ratio?
 How many have 1 in 10?
Death by overwork
(Japanese)
Inability to just say
“NO!!”
• Concept of
“Trauma
Stewardship”
&Resource
• Look for more
resources on
traumastewardship
.com
Cordelia@visi.com
Issue: What is an individual
vs situation/systemic
problem?
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Most “stress” from
organization/political/systemic issues
Toxic exposure
Overload from multiple sources
 The
exhaustion of physical and
psychological resources caused
by excessive striving for
unrealistically high
expectations
(Update on Human Behavior,
Vol 7, No. 4, 1987)
Burnout is a grief response
Grief that you aren’t as
effective as you want to be
Preoccupation with work-related problems or
job security
* a depressed immune system
* stomach problems
* lack of appetite
* insomnia
* high blood pressure
* Irritability
* sadness
•
Anxiety
* chemical excuse/abuse
*
*
*
*
*
*
Overtime
Negativism
Cynicism ***
Pessimism
Hopeless is hip
If "seasoned", then cynical
Oklahoma (25 years ago)
Workers and Search dogs
Find success
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Burnout & Secondary Trauma =
Compassion fatigue
(Figley)
◦ Empathy is key to induction
◦ Response is to shut down
emotionally
Intrusive symptoms
Avoidance symptoms
Arousal symptoms
(Figley, 1995)
Use to need adaptive
reaction that’s now a
maladaptive response
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Release of powerful chemicals
Only intended to be used for extreme
emergencies
Not intended to experience repeat life threats
PTSD = constant/chronic release of brains
emergency warning system
 Learned response to warning signs &
associations
 Reflex happens from sensory
stimuli in absence of real threat
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The closer the threat, the more fear
Freeze response is to orient yourself and take
in information/situation
With heart rate, blood pressure, etc elevated
can’t consciously “play dead” – calm it down;
With real or perceived entrapment, tonic
immobility is an actual PLUNGING of heart
rate, blood pressure…
38-41% of SA Victims experience this; with
children it is higher
Muscles paralyzed
 Opiates released:
don’t feel the pain at the moment
 Can develop a hyper-reactive nervous
reaction; and it takes longer to get
back to the baseline once the nervous
system is reset for an environment of
chronic threat
◦ Brain becomes hypersensitive &
hyper-reactive to trauma cues
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 When
traumatized there is an
effect on memory – can be clear
fragments but not necessarily in a
coherent, linear narrative
 Stress
interferes with
memory (VIDEO)
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Toxic stress is hardwired into our
communities and culture and into the cellular
level of our bodies
Impact on how our bodies work, how we
experience life, how our brains filter
information, in and out depending on if we
BELIEVE we are in a threatening situation
We all experience life in a different way, not
just a CHOICE about how we behave
Dr. David McCollum
“Is what is coming at me
really coming from me?”
Lo Lo
Sensibillities, Inc. 2005
Cordelia@visi.com
Public health definition of prevention:
◦ A constant redefinition of
UNACCEPTABLE
◦ What we do collectively to assure the
conditions that people can be healthy
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Solutions must be multi-factorial
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(MDH Commissioner Ed Ehlinger)
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1995-1997 data collection, 17K, 1st
published in ’98; 2013 MN ACES Data
“What creates health and life success?”
Develop a common language about the
problem, risks, protections and compassion
ACES, neurobiology, stress and resilience
Plan together in a new way
Adversity add up & creates enduring effects
ACES are common, UNACCEPTABLE, the earlier
exposure the more the harms, yet they do NOT
define us
ACES tend to cluster, to
pass on to next
generation by the biological
reaction to stress
 This is where we can help to educate,
mobilize intervention and prevention
 THEME: holding ourselves accountable; this
is not about “others” with ACES this is about
all of us; professionals PLUS clients/students,
not only “the clients”
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SCHOOLS: Need to recognize TRAUMA
TRIGGERS:
◦ Reality some folks can’t be rational in the
highly emotional state so why do we
attempt discipline at that moment asking
“Why are you making this choice? You
should be making a better choice”
…when the behavior is a normal
response to trauma
We all hold ACES and hand
them to our own children
 You can reduce this in your children
 People with ACES:
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◦ Want to help others
◦ Want to give back
◦ In doing so help heal themselves when they are
of service to their community
◦ INNOVATION through the EMPOWERMENT MODEL
with those directly affected
◦
Clients/Students you
work with
You/Other Staff
 Do
you prioritize
time/energy/relationships?
◦(partner, friends)
 What
is the affect/effect on
intimacy?
Are you suspicious of
everyone?
Do your children wish they had
a “normal parent” that didn’t
always see/expect the worst?
Are you increasingly
“protective?”
Diminished emotional
responsiveness to a
negative or aversive
stimulus after
repeated exposure to
it.
- To make less
sensitive
- NUMB
 Does
classic therapeutic
response make sense for
this?
◦ Rank most disturbing fears, responses
◦ Techniques to relax
◦ Exposure to the stimuli?
 OR
◦ Positive stimuli, supports, protective
factors – reconnecting with HeART!
Impact of Technology
T Mychael Rambo’s Aunt
Point to yourself
 Be
Intentional
 Ecological/
Strategic
 Personal
&Institutional
 Not a Technique but a way of life
 “CHANGE OF HEART”
 Pay
attention to your strengths
Organizationally & personally
Reflect upon areas where work
is needed
Exploited Child Unit
 Study of Impact;
 Proactive weekly group meetings
Opportunities for private sessions
 Hiring assessment based on learnings
 Debrief at departures
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 (Occupational Hazard)
www.shiftwellness.org;
 Research shows the impact
 Innocent justice Foundation with
OJJDP, ICAC’s and MH expert in CSA
Images developed “Supporting Heroes
in MH Foundational Training (SHIFT)
 ICAC BCA MN – Own Program
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28 federal LE who investigate Internet CP
High % of STSD (secondary traumatic stress
disorder) & Cynicism
 STSD & burnout scores related to:
◦ Increased protectiveness of family
◦ Turnover intentions
◦ Reliance on co-workers (not outside
of work)
◦ General distrust
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 Those
with:
◦ Supportive relationships scored
lower on both STSD and Burnout
◦ High professional efficacy – feel work
makes a difference
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Cultivation of Organizational Support:
◦ Training prior to entry & supplemented
◦ Attention to cohesive collegial unit
(COMMUNITY MATTERS)
◦ Enhanced support network
◦ Recruitment willingness and screening
(wrong reasons for willingness)
◦ Past trauma, addressed
◦ Escape other duties
What fits? What doesn’t? What else?
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Is the environment one in which the health,
self-care of those who work in it is LIKELY?
◦ Why or why not?
◦ Who is responsible?
◦ What can you do?
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Are systems in place to help
individuals/groups bounce back after harm?
Are processes restorative/transformative?
Is it Solution focused?
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Counter Professional
Negativity and Fatigue ask:
◦What are your successes?
◦What do you have to
celebrate?
 (Do you mostly talk
about your challenges?)
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Review of workplace practices and policies
 Do they include proactive measures at employee /
volunteer health & well-being & organizational support
for the reality of trauma?
 Are there reactive supports (debriefings, counseling
support)
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Assessment upfront, proactive check-in’s,
exit interviews
Check for signs of health: moral, tone of
‘humor’ collaboration/support/creative
thinking, physical wellness, mental health
 “Make
their day”
 Be present
 Choose your
attitude
 Play > Have Fun
Detaching
 Feeling Effective On The Job
 Past Childhood Experiences With
Bonding
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Cordelia@visi.com
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Genuiness and Authenticity
Inner Locus of Control
Tolerance for Ambiguity
Humor
Nonjudgmental
Stance
Potency
Enthusiasm
Androgyny
Cordelia@visi.com
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Effective Communication Skills
Empowering
Problem Solving Skills
Conflict Resolution Skills
Accountability
Skills for Connecting
Cordelia@visi.com
“If you don’t develop the skill of
enjoying what you have, than you
won’t be happy with more.”
Real Moments
Cordelia@visi.com
 Name
It
 Make a plan to change
 Make the change
 Build a team
 Evaluate
 Celebrate Success
 SIGN:
Loose our ability to be
present so we do not know the
harm to self or others
 NOTE:
How do we not add to
the trauma we see?
Focus and Identify what you can
do to feel better at the really hard times;
 Impact can be TRANSFORMED by layering in
new positive experiences;
 Mindfulness, Meditation & the neurobiology
of trauma
◦ - studies show increased activation of
frontal and pre-fontal cortical areas
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Laughter is an instant vacation.
Laughter:
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Reduces the level of stress hormones
Perks up the immune system
Relaxes muscles
Clears the respiratory tract
Increases circulation
Eases perceived pain
Feel good endorphins flow
Laughter both stimulates and soothes
Cordelia@visi.com
Stress hormones cortisol
and epinephrine lower
when we laugh and rise
when we’re anxious
contributing to heart attacks. Dr. Berk
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Saranne Rothberg, diagnosed with advanced
breast cancer, at 35, single mom.
 Founded the Comedy Cures Foundation to bring
the humor strategies that worked for her to
others. Choosing to laugh puts you in control.
Cordelia@visi.com
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“Laughter seems to help people think
more broadly and associate more
freely; it is the ha ha ha to aha effect”
All mental stimulation boosts brain
functioning.
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We burn out because we’ve allowed our
hearts to become so filled with loss that we
have not room left to care.
Grieving is a way of self-care, the antidote to
professionalism. Health professionals don’t
cry. Unfortunately.
 Human
being is more a verb than
a noun. Each of us is unfinished, a
work in progress.
 All hope is based on progress
 Bobby Brown Story
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Survival may depend on seeking and finding
meaning. Personal meaning can change the
experience of work , of relationships and
even of life.
Story: Roberto Assagioli
The difference between stumbling blocks and
stepping stones is how you use them
~ Source Unknown ~
 Life
is not what it is suppose
to be, it is what it is. The way
you cope with it is what makes
the difference.
Virginia Satir
 Cordelia
Anderson
 Cordelia@visi.com
 www.cordeliaanderson.com;

Compassion Fatigue: Worn Out, Warn Down and Wanting to Renew

Transcription

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