1. Compassion Fatigue: What is it? What do I do about it? Early On Conference November 5, 2009 Ypsilanti, Michigan Presenter: Janice Fialka Special Projects Trainer EOTTA ruaw@aol.com

2. As a community, we can begin by acknowledging that compassion fatigue exists.

3. Breathe

4. Listen: Making of a Nurse by Tilda Shalof (2007) What full blown case of ______________ have you or other’s caught?

5. All emotions can be contagious Help for the Helper: Self-care strategies for managing burnout and stress by Babette Rothschild

6. All careers and jobs involve some kind of labor

8. Emotional Labor - Arlie Hochschild “Managing the Heart” Managing strong emotions while staying connected to the client/family

9. Learning outcomes Define empathy, compassion fatigue, vicarious trauma, and burnout Recognize common symptoms of compassion fatigue (c.f.) ~Second Half~ Identify strategies to deal with compassion fatigue. Renew our commitment to self-care Feel a sense of resiliency.

10. What does resiliency look like?

11. Bibliography The content of this workshop is based on: Help for the Helper: Self-care strategies for managing burnout and stress by Babette Rothschild (2006) Francoise Mathieu, Certified Canadian Counsellor & Compassion Fatigue Specialist www.compassionfatiguesolutions.com www.workshopsforthehelpingprofessions.ca

12. Empathy … the action of understanding, being aware of, and vicariously experiencing the feelings & thoughts of another... WITHOUT having the feelings & thoughts FULLY in an objective explicit manner. - Babette Rothschild

13. Two components to empathy (Heinz Kohut, founder of the movement of self- psychology – 1970’s) 1. Having a sense of or an understanding of the feelings of another AND 2. Being able to demonstrate in accurate verbal or non-verbal reflection the feelings of the another. Resulting in that glorious experience “I feel understood!”

14. Watch “Lorenzo’s Oil”

15. Small groups of 4 people 1. Did you feel empathy with the mother? If yes, how do you know? What signs did you experience physically? emotionally? In other ways? 2. What are the benefits of empathy? What does it allow you to do in your work? 3. What are some of the potential downfalls for you/providers to empathy?

16. Neurology of empathy Neuro-physical component of empathy -Help for the Helper by Babette Rothschild Mirror Neurons: brain cells that reflect the activity of another’s brain cells. Researchers at Univ of Parma in 1996 (Gallese, Fadiga, Fogassi & Rizzolatti) Investigating which individual neurons fired when a monkey reached out to grasp a raisin. Used electrodes connected to a monitor.

17. Same neurons fired in both the action and the observation. A connection between the sender and the receiver. A strong somatic (body) connection. The feeling is there, even when there is not the action.

18. Compassion Fatigue - Francoise Mathieu, www.compassionfatiguesolutions.com First used in an article in 1992 re: nurses In 1995, Charles Figley wrote “Compassion Fatigue” “…is a natural outcome of working with people who experience extreme stressful events.” “cost of caring” An occupational hazard

19. “Chronic exposure to really tough circumstances…….” -Dr. Doebbeling, Indiana School of Medicine

20. The expectation that we can be immersed in suffering or loss daily and not be touched by it…. it is as unrealistic as expecting to be able to walk through water without getting wet. - Rachel Naomi Remen, author of “Kitchen Table Wisdom”

21. We burn out NOT because we don’t care, but because we don’t grieve. We burn out because we allowed our heart to become so filled with loss that we have no room left to care. -Rachel Naomi Remen

22. Vicarious Trauma Experience someone else’s trauma You are not the victim Your brain registers it as if you are the victim A profound shift in your world view of something

23. Burnout Exhaustion Low job satisfaction More about the work environment Role conflict Role ambiguity  Hoffman, Palladino & Barnett

24. Signs of compassion fatigue Difficulty concentrating Intrusive imagery Loss of hope Exhaustion (tired in such a way that no amount of sleep will help) Irritability Isolating self Cynical Excessive complaining Excessive blaming Anxiety Others?

25. Small group sharing Which signs fit for you? What other signs?

26. Strategies: You CAN do something!

27. THREE TYPES OF STRATEGIES to manage compassion fatigue #1. With colleagues #2. With the families (clients) we support #3. With ourselves: (Self-care strategies)

28. #1. Strategies with colleagues while at work (not a complete list!!!) Debriefing and/or reflective consultation Formal Informal

29. A specific strategy to use with colleagues called: Limited Disclosure or Limited impact disclosure 1. Be aware of the need to debrief 2. Offer a fair warning 3. Obtain consent 4. Disclose with intention -Francoise Mathieu, www.compassionfatiguesolutions.comwww.compassionfatiguesolutions.com

30. Begin sharing at the parameters of the circle. Give fewer details. More like the headlines of the story. Event Set the norm at your work site! 4.(cont) Disclose with intention and in phases. Check in: Is this okay?

31. #2. Strategies while supporting families: Unmirror the mirror -Babette Rothschild Know thyself (breathing, physical changes, heart beat, changes in skin, face, muscles, posture & triggers) Soften the connection (empathy engagement not entanglement) Tap (don’t slam) on the brakes: Feet on floor, cross legs, sip water, breathe slower. Take yourself out of the movie and put yourself in the audience. Use objects: A foot stool, a rug, a kleenex near the phone

32. # 3. Self-care strategies (partial list) You KNOW the essential basics!!! Eat well, exercise regularly, sleep, spend time Journaling Everyday do NOTHING for 5 minutes (Cheryl Richardson) Every week do one NEW thing (Bill O’Hanlon) Use of transition rituals from work to home with intention. Intentional breathing (Nitric acid at the back of your nose.) Sometimes we need to go IN THE BOX!

33. What would you put in the box?

34. Andrew Weil, M.D. founder and director of the Arizona Center for Integrative Medicine, ten million copies of his books have been sold www.dr.weil.com Relaxing Breath Exercise: 4-7-8 Exercise

35. We are born with the capacity... to experience what others experience and participate in their experience by virtue of the way we are grabbed by their nervous system. One of the real questions is NOT, “How in the world does this happen.” We are beginning to have a really good idea (of how this happens.) The real question is, “How do we stop it from happening so that we are not the prisoner of someone else’s nervous system all the time.” There have got to be a lot of brakes in the system……a very interesting area of research which has not been addressed so far. -Daniel Stern

37. Resources: Books & Articles Help for the Helper: Self-care strategies for managing burnout and stress by Babette Rothschild The age of empathy by Frans De Waal Wherever you go there you are by Jon Kabat Zinn “Compassion fatigue as a theoretical framework to help understand burnout among special education teachers” by S. Hoffman, J. Palladino & J. Barnett, in Journal of Ethnographic & Qualitative Research, 2007. Vol 2, p15-22.

38. Resources: Web sites Francoise Mathieu, Certified Canadian Counsellor & Compassion Fatigue Specialist www.compassionfatiguesolutions.com www.workshopsforthehelpingprofessions.ca Other great web sites www.giftfromwithin.org www.compassionfatigue.org www.takingcharge.csh.umn.edu/activities/body-scan www.drweil.com **************************************** I welcome your ideas, suggestions, resources, and feedback. Janice Fialka, Special Projects Trainer, EOTTA-CCRESA ruaw@aol.comruaw@aol.com or 248-546-4870 or www.danceofpartnership.com