Barbara Moser, MD WISE Advisory Board Barbara@preventsuicidemke.com Building Our Compassion Resilience 3rd Bienniel Youth Services Conference: Building a Framework for Youth May 2, 2017 Barbara Moser, MD WISE Advisory Board Barbara@preventsuicidemke.com

Building Our Compassion Resilience Intended Topics for Our Conversation: Understanding of the language used One way to look at professional compassion Losing and rebuilding compassion, for others and ourselves Building Compassion Resilience for ourselves, and the youth we serve

In YOUR Work Recently---

Vocabulary Compassion Satisfaction Compassion Fatigue Burnout Positive aspects of working as a helper Compassion Fatigue Negative aspects of working as a helper Burnout Inefficacy and feeling overwhelmed Work-related traumatic stress Primary traumatic stress direct target of event Secondary traumatic exposure to event due to a relationship with the primary person

CS-CF Model Professional Quality of Life Compassion Satisfaction Compassion Fatigue Burnout Secondary Trauma Professional Quality of Life relates to the balance of compassion satisfaction (good stuff) and compassion fatigue( Bad stuff)

Compassion Satisfaction The positive aspects of helping Pleasure and satisfaction derived from working in helping, care giving systems May be related to Providing care To the system Work with colleagues Beliefs about self Altruism Ability to receive gratification from caregiving

Compassion Fatigue The negative aspects of helping The negative aspects of working in helping systems may be related to Providing care To the system Work with colleagues Beliefs about self Burnout Work-related trauma

Burnout and Secondary Traumatic Stress (STS): Co-Travelers Work-related hopelessness and feelings of inefficacy STS Work-related secondary exposure to extremely or traumatically stressful events Both share negative affect Burnout is about being worn out STS is about being afraid Inefficacy with either dealing with work, or doing one’s job effectively © Beth Hudnall Stamm, 2009. Professional Quality of Life Scale (ProQOL). www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made without author authorization, and (c) it is not sold.

Complex Relationships Professional Quality of Life Compassion Fatigue Compassion Satisfaction (ProQOL CS) Work Environment Client Environment Personal Environment Traumatized by work Secondary Exposure (ProQOL STS) Primary Exposure Frustration Anger Exhaustion Depressed by Work Environment (ProQOL Burnout)

Helpers Bring Their Own “Stuff” Helpers include people with all types of education, training and income Some helpers bring with them histories of difficult lives that may include trauma Some helpers have difficult family, economic, or other personal situations

Measuring CS & CF: The Professional Quality of Life Scale (ProQOL) The ProQOL is free A 30 item self report measure of the positive and negative aspects of caring The ProQOL measures Compassion Satisfaction and Compassion Fatigue Compassion Fatigue has two subscales Burnout Secondary Trauma

Not a Medical Test Helps understand the positive and negative aspects of helping Not a “psychological test” Not a “medical test” Can be viewed as a screening for stress-related health problems

For More Information: www.proqol.org

Compassion Fatigue Awareness project http://www.compassionfatigue.org/pages/selftest.html In addition to the PROQOL, look at these additional measures: LIFE STRESS TEST http://www.compassionfatigue.org/pages/lifestresstest.pdf EMPATH TEST http://www.tarameyerrobson.com/empath-test/

What do we believe about human behavior?

How do you think about behavior? A matter of motivation OR A matter of ability and supports

Kids/parents/adults do well if they want to … Manipulative Just wants attention Not motivated Doesn’t care Kids/parents/adults do well if they can … Coping in the way they know how Lack skills required Something in their way Together we can figure it out There are two very different mindsets on this slide. Below them are words that we might hear used to describe a child’s behavior or motivation. The first four fit with the belief that kids would do well if they just wanted to. The last four fit with the belief that kids would do well if they could.

Compassion Fatigue: a barrier to our effectiveness and happiness Gradual lessening of compassion over time Avoid trying to understand what people face Perspective shifts from “people do well if they can” > “people do well if they want to” 18

Compassion Fatigue’s Path Leave Profession Zealot Compassion Resilience Renewal vs Pathology Irritability Withdrawal Zombie

How does compassion fatigue show up? In you? Where do you see it in your organization? What population or with whom are you most challenged to approach with compassion? What is your physical experience of compassion fatigue?

Resiliency Planning Individual, personally Organizational planning The ProQOL can help you plan where to put your energy to increase our resilience Organizational planning Can help organizations find ways to maximize the positive aspects and reduce the negative aspects of helping Supportive Supervision The ProQOL can be used as information for discussions

Building Our Compassion Resilience The power to return to a position of empathy, strength, and hope after the daily witnessing of the challenges people face in our community.

Building Compassion Resiliency! Expose yourself to recovery/resilience Compassionate boundaries - understand your role and your limitations Connect with colleagues and others in the community Self-care, including Self-Compassion

Compassionate Boundaries

Five Tips for Setting Compassionate Boundaries   1. Know what you want to say “Yes” to in your life (values and priorities). 2. Just say it! Don’t make them guess. Reinforce by pointing out the violations or near violations IN THE MOMENT. 3. Have “meetings” to discuss boundaries. Structure offers safety for both sides. 4. Give explanations that are specific, relevant to the other person, and offer shared solutions. 5. Plan your offense and defense to match your values.

Care for Self Balance Social Physical Spiritual Intellectual Emotional Creative

Mindful Self-Compassion Kristin Neff: http://self-compassion.org/h Chhttp://self-compassion.org/ttpmpassion.org/ Christopher Germer: http://centerformsc.org/ Basic Principles Self-Compassion Break

Out of Balance? Your first clue Physical Emotional Avoid New perspective Adjust lifestyle Listen to the clues your body and emotions send you. If we can pick up on the clues our body sends us, we can use the mind/body connection to control the stress reaction. (Ask audience for example of a physical clue they experience that tells them they are stressed. An emotional clue?) I would like to propose 3 different management options that may be used once you begin to feel yourself “stressing out.” (or if you anticipate a stressful event.) 1. How could you avoid the situation? If you know the stressful situations, then when possible, don’t put yourself there. Of course, we all realize that this is not always the most practical answer. 2. Another way of thinking about the situation? If imagination drives human fears as we saw in the modern day fight or flight stress response to imagined lack of control, then why not let your imagination drive your sense of wellbeing? 3. What changes in your lifestyle could help the make the situation less stressful? The rest of this program will present ideas for how we might intervene to deal with stress when we are in the midst of it as well as how making decisions according to our life priorities can help us to to be proactive so we can avoid it in the first place.

The Bigger Picture My compassion resilience Do I model resilience? How do I engage my youth?

Reflective Questions What is my belief about the potential for positive outcomes for youth facing our community’s challenges? What level of hope do I project in my conversations with children, families and my peers?

Dr. K. Ginsberg’s 7 C’s of Resilience Confidence Connection Competence Character Contribution Coping Control

Avoidance, anger and apathy “If I really wanted to do something, I would be able to.” self esteem I am not good. sense of efficacy I am not able. Avoidance, anger and apathy So, why try! Feelings of Shame

Interactions in Context of Trauma Prefrontal Lobes Rational thoughts What can I learn from this?   Limbic Emotions Am I loved? Brain Stem Survival instinct Am I safe?

What Does Trauma Look Like? Sensitive to noise Avoid touch Heightened startle reflex Demand lots of attention Perfectionism Aggression/Defiance Confused - What is dangerous? Who can help? Resist separation from familiar people and safe places Reactive and impulsive

Possible Perspectives of People Impacted by Trauma: Basic mistrust of adults/ inability to depend on others Belief that the world is an unsafe place/ bad things will happen and they are usually my fault Assumption that others will not like them Fear and pessimism about future Feelings of hopelessness and lack of control 35

We can interrupt the cycle! The Cycle of Trauma We can interrupt the cycle! 36

How do you think about your behavior? A matter of motivation OR A matter of ability and supports

Reversing Shame and Blame I care for myself & others When I am Known, Included and Supported I am able ✗ I am good Compassion fatigue I care for myself & others

BUILDING COMPASSION RESILIENCE!

Reflection

Thank-you for the relationships you build and the strategies you implement that improve the present and future lives of children, adults, parents and staff. WISE Wisconsin.org Resilience clips at: RogersInHealth.org