1. Melissa Soll, Ph.D. Clinical Psychologist dr.melissa.soll@gmail.com

2. “A syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do people work of some kind.”  Emotional exhaustion – feeling overextended emotionally by your work environment  Depersonalization - responding to colleagues and patients in an impersonal manner  Lack of personal accomplishment – lack of positive feelings from success and accomplishment at work (Maslach & Jackson)

3.  Professional Quality of Life Scale (ProQOL; Hudnall Stamm, 2009) http://proqol.org/ProQol_Test.html http://proqol.org/ProQol_Test.html  Compassion Satisfaction  Compassion Fatigue  Burnout

4. Healthcare professionals respond to patient emotions with their own emotions:  Desire to rescue the client  Feelings of powerlessness against the illness, its symptoms, and associated losses  Grief  Desire to separate from and avoid clients to escape such feelings (Meier et al., 2011)

5.  Personal factors  (e.g., family stressors, health issues, trauma history)  Workplace factors  (e.g., unmanageable workload, lack of diversity in caseload)  Client factors  (e.g., chronicity, acuity, complexity)  Vicarious trauma (Maslach, 1982; Maslach & Jackson, 1981)

6.  Cumulative job stressors  Pre-existing risk factors  Major Life Events (Kinzie, OHSU presentation) Cumulative Job Stressors Pre-existing Risk Factors Major Life Events THE PERFECT STORM (Kinzie, OHSU presentation)

7.  Ethical misconduct related to patient care was evident to a greater extent in those who reported burnout  Boundary violations were more common in those who reported burnout  You are less vulnerable to ethical violations if you are self-aware and engage in self-care (Dyrbye et al., 2010; Brazeau et al., 2010 )

8.  Time?  Money?  We want to talk the talk without walking the walk

9. Dimensions of self-care:  Physical – Exercise, diet, sleep, hydration, lifestyle  Emotional/Mental – Self-compassion, mindfulness/self-awareness (see below)  Social – Who provides you with support? Who helps you refill your cup when it is nearing empty?  Creative – What are you good at or what do you love to do? Cooking, parenting, painting, sculpting, writing… Find at least one creative thing you want to do and cultivate that  Spiritual – Can you find some universality in suffering? How do you connect with nature? How do you make sense of things outside of our control?

10.  Intentional and nonjudgmental awareness of the present moment  Examples  Mindful walking  Mindful eating  Mindful listening  Mindful breathing  Body scan

11. Self-compassion – Extending compassion to the self for one’s failings, inadequacies and experiences of suffering  Associated with less burnout and compassion fatigue  Provides the emotional resources needed to nurture others  Acknowledging how difficult care-giving can be, reduces anger and resentment  By opening our hearts to human imperfection, we can accept others as they are (Neff et al., 2007)

12. Components of self-compassion :  Self-kindness (vs. self-judgment)  Mindfulness (vs. over-identification)  Connect to humanity (vs. isolation) (Neff et al., 2007)

13. The practice of self-compassion is: 1. to NOTICE a moment of suffering 2. Pause 3. Ask yourself, “What do I need in this moment?” 4. See if you can meet your need ***Self-care happens later, self-compassion happens now***

14. Reflective writing (Spann, 2004):  Keep the pen moving  Welcome everything  Don’t worry about errors  Let the subject choose you  Write for your eyes only  Feelings, feelings, feelings and details, details, details! (Barnett, Johnston, & Hillard, 2006)

15.  Mindful meditation *  Reflective writing *  Adequate supervision and mentoring  Sustainable workload  Promotion of feelings of choice and control  Supportive work community  Meaning-centered intervention for the team * Good evidence base for these approaches (Kearney et al., 2009)

16.  What if you drove your car on a flat tire for 3 days before replacing the tire?  We don’t have to literally run ourselves into the ground and THEN attempt to make up for that neglect.  The alternative?  Awareness  Noticing moments of suffering  Doing something about it now AND later

17.  YOU (yes YOU!) can be more resilient and move toward more balance - “Self-care enables healthcare professionals to care for their patients in a sustainable way with greater compassion, sensitivity, effectiveness, and empathy.”  You are vulnerable to professional missteps or ethical violations when you experience professional burnout and do nothing about it  It is an ethical imperative to have a working self-care plan in place (Kearney et al., 2009)

18. Germer, C.K. (2009). The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. New York: Guilford Press. http://www.mindfulselfcompassion.org/meditations_downloads.php http://www.mindfulselfcompassion.org/meditations_downloads.php Jon Kabat-Zinn: http://www.mindfullivingprograms.com/resources.php http://www.mindfullivingprograms.com/resources.php http://www.onbeing.org/program/opening-our-lives/138 Kristen Neff: http://www.self-compassion.org/video-clips/self- compassion.htmlhttp://www.self-compassion.org/video-clips/self- compassion.html Leiter, M.P., Maslach, C. Banishing burnout: Six strategies for improving your relationship with work. 2005. Joffrey-Bass: San Francisco, CA.