coping techniques for staff working with abuse cases · compassion fatigue (vicarious...
TRANSCRIPT
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Coping Techniques for Staff Working with
Abuse Cases Dr. Karen S. Scott
July 2017
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Self-Care We’re just not good at it!
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Stress
-Is the perception that your demands exceed your resources for dealing with them
-Our bodies don’t know the difference between perception & reality
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Coping With Stress • When you are stressed you need all
your abilities, but when stressed, they are all underperforming
• Develop active coping mechanisms
• Sense of control helps lessen the perception of inability to deal with stress
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Objective: Identify & Practice effective strategies for managing work-related compassion fatigue & grief.
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Confessions of a Self-Proclaimed Type A
Champion Worrier Super-Woman
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Disconnect between Head & Heart
We know we need to take care of ourselves, but we don’t
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Healthcare Workers & Burnout
• Go into the field for patients—then no time left for you
• Intensity of your work & the bonds you build
with people you are caring for = good/bad
• Good to care about patients, but MUST distance yourself at times
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Compassion
• Good News: Compassion makes you good at what you do
• Bad news: When your compassion is stretched too thinly, you become limited in how you are able to care for others, and ultimately, how you care or fail to care for yourself.
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Characters of Helping Professionals that Increase Vulnerability
• Caring nature-put others first
• Don’t think we need to take care of ourselves
• Super Human stigma—self-imposed or expected?
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Compassion Fatigue “Soul Weariness”
• Burnout + Secondary Trauma = Compassion Fatigue
• Both physical & emotional exhaustion
• Vicious cycle of stress, burnout, exhaustion normal daily traumas greater negative impact increased burnout
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Compassion Fatigue
• Both physical & emotional exhaustion
• Develops over time
• Over time, overuse of compassion skills erodes your ability to feel and care for others
• Escalated by traumatic situations & incidents - death of child
When Helping Hurts by F. Oshberf
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Trauma & Vicarious Trauma • Registers in amygdala –triggers fight or flight
sympathetic nervous system • Slower pathway to thalamus-relays info to
neocortex for processing • If non-threatening, parasypthetic nervous
system should shut down process • Presence of Cortisol (present in high stress)
blocks inhibitory process –don’t feel safe even when safe, so remain in chronic stress/trauma
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Compassion Fatigue (Vicarious Traumatization) affects:
• Sense of self • World view • Spiritual life • Affect tolerance • Interpersonal relationships • Imagery System of Memory
Karl LaRowe, Breath of Relief: Transforming Compassion Fatigue into Flow
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Cell Phone Analogy 3 Ways to charge
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We Know What We Need to Do But . . .
• Stay up late to get more done
• Cancel gym membership because never time to go
• Feel burned out so we isolate
• Grab fast food-no time to plan meals
• Sleep
• Exercise regularly
• Social Support
• Eat Healthy
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Barriers: Why don’t we practice self-care?
• Characteristics of helping professionals make us resistant to self-care
• Messages in our heads—What is your self talk?
• Expectations of others—Who? What? • Obligations outside work—What are they?
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Emotional Hygiene • Debriefs – formal & informal • Redefine what is means to be strong and
competent • Know your “tell” – signs that you are
emotionally depleted • Prioritize meaningful connections with
others • INTENTIONAL self-care practices
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Models for Self-Care
To Manage Stress & Increase Resilience
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Quadrants of Self-Care During • Focus on task at hand • Stay focused &
grounded • Awareness-breath &
body • Create protective
distance-take step back
• Leave the trauma when you leave
Before
• Regular physical Care
• Recognize Triggers • Grounding & self-
check-in
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Quadrants of Self-Care Later-Ongoing • Regular
relaxation/exercise • Build & use broad
network of support • Have a life outside of
work • Practice spiritual
renewal • Transitions to & from
trauma; to & from work
Immediately After • Body Awareness-
relaxation techniques • Breathing-Mindfulness
Exercises • Reframe; redirect
thinking • Utilize support • Transitions from Trauma • Transitions from Work
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Breathing Controlled, Purposeful
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COPS • Control—Know what you can & can’t
control
• Outlets for Frustration—need safe place to express (therapist, trusted friend, journal)
• Predictability—depend on & anticipate activities that relieve stress (exercise, mindfulness, fun activities)
• Social support—friends, trusted co-workers, family
Robert Sapolsky- Why Zebras Don’t Get Ulcers
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Self-Care Interventions
• Establish boundaries with others
• Discuss difficult situations with colleagues-listening can clarify your vision & what motivates you
• Communicate/express your needs to family & friends
• Recognize your triggers & signs that self-care is slipping
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Self-Care Interventions Continued
• Learn to say “NO” and not feel guilty about it
• Take time off from caregiving to enjoy your hobbies and personal interests.
• Exercise, Yoga, Meditation, Mindfulness
• Honor yourself and what you do for others.
• Nurture what counts in your life
• Humor
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Behaviors to Avoid: • Do NOT increase your work load –don’t take
on more hours • Don’t self-medicate: alcohol or drugs • Elminate self-deprecating statements • Don’t ignore the problem • Don’t blame yourself or the system • Don’t eliminate time spend with friends or
family. • Don’t neglect your relationships!!
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Mindfulness Meditation
• Non-judgmental, present-time awareness
• Focus on breath or body, stay present & experience bodily sensations, mental & emotional states
• Allows us to remain focused & calm • makes you less emotionally reactive—more
in rest & digest mode instead of fight or flight
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How does mindfulness help? • Increases ability to stay focused in extremely
charged situations.
• Differentiate between a professional situation & your feelings about it.
• Problem-focused coping vs. emotion focused coping—when the two get confused, it is difficult to know how to respond—generates more pain & suffering
• Mindfulness & meditation focus your attention on something available in your present moment –creates stable, resting place for your mind
Kabat-Zinn, Full Catastrophe Living
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Body Awareness
• Major therapeutic tool in prevention & intervention
• Awareness of breath & body is part of mindfulness
• The more aware you are of your body, the faster you will know when something is wrong
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Mindfulness (with chocolate)
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Your Self-Care Plan: • Create workable & helpful self-care plans
• Exercise is one of most effective strategies
• Describe the perfect day of your dreams.
• What one realistic thing could you do for yourself today that would capture the essence of your fantasy day?
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Your Self-Care Plan
• What was your favorite thing to do as a kid? How could you recreate that activity as an adult?
• What is the best compliment you have ever received about your work?
• Who can you talk to about your stressful days?
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Reframing a “Failure” • Stop judging
• Acknowledge your efforts & everything that was done for the patient
• Acknowledge limitations of the “system” & the medical field
• Give yourself credit for all the times your
efforts have been successful
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References • American Counseling Association, “Fact Sheet 9: Vicarious Trauma” • Holdsworth, N., “Compassion Fatigue, Vicarious Trauma Secondary Trauma, Burnout” • Kabat-Zinn, Full Catastrophe Living • Koch, W. J., “Psychological Trauma: A Common Problem • LaRowe, Karl., “Breath of Relief: Transforming Compassion Fatigue into Flow” • Middleton, J., “Addressing Secondary Trauma & Compassion Fatigue in Work with Older Veterans: An Ethical Imperative” • Pross, C., “Burnout, Vicarious Traumatization & Its Prevention” • Oshberf, F., “When Helping Others Hurts”