The Use of Self as a Guide toThe Use of Self as a Guide toSensitive and CompassionateSensitive and Compassionate

CommunicationCommunication

Eva MatussekEva MatussekChartered Counselling PsychologistChartered Counselling Psychologist

Lelanie SmookLelanie SmookCounselling Psychologist in TrainingCounselling Psychologist in Training

Clinical Health Psychology DepartmentClinical Health Psychology DepartmentCross Street Health CentreCross Street Health Centre

DudleyDudley

What we plan to discuss What we plan to discuss todaytoday• Ideas about compassionIdeas about compassion

• The role of active listeningThe role of active listening

• Stress and how it affects compassionStress and how it affects compassion

• The role of self awarenessThe role of self awareness

• Mindfulness as a tool to practice Mindfulness as a tool to practice

compassion towards self and otherscompassion towards self and others

• What is compassion?What is compassion?

• Why is compassion important in healthcare?Why is compassion important in healthcare?

• Can it affect your interactions with patients and Can it affect your interactions with patients and the outcome of treatment?the outcome of treatment?

• What happens to patients when there is What happens to patients when there is “compassion fatigue” “compassion fatigue”

• How can compassion towards yourself influence How can compassion towards yourself influence your behaviour towards patients?your behaviour towards patients?

• How can we remain compassionate whilst How can we remain compassionate whilst avoiding burnout?avoiding burnout?

How do we listenHow do we listen

Lelanie SmookLelanie Smook

Counselling Psychologist in TrainingCounselling Psychologist in Training

Aims for this presentationAims for this presentation

• Client process in illnessClient process in illness

• How they receive informationHow they receive information

• How do we react and respond to How do we react and respond to support clientssupport clients

• Awareness of our roles in illness Awareness of our roles in illness information sharinginformation sharing

Word associationsWord associations

• SickSick

• IllIll

• CureCure

• DiagnosisDiagnosis

• PatientPatient

Role of diagnosisRole of diagnosis

Diagnosis

Self

Medical

Close relationships

ExpectationsExpectations

• What does a diagnosis imply?What does a diagnosis imply?

• Role of medical professionalsRole of medical professionals

• Stages of illness: Stages of illness: crisiscrisis

stabilizationstabilizationresolutionresolution

integrationintegration

MessagesMessages

• Receiving diagnosis (crisis/onset)Receiving diagnosis (crisis/onset)

ExerciseExercise

• Role play: client and doctorRole play: client and doctor

• Feedback Feedback

How do we respond?How do we respond?

• Client: reject or defend self: rigid Client: reject or defend self: rigid responseresponse

• Medical professional: healer vs. Medical professional: healer vs. enemyenemy

• EpocheEpoche

Active listeningActive listening

• ““Tell me what to do Tell me what to do you are the expert”you are the expert”

Desperate client

Making decisions

Give advice

Encourage

What does listening mean?What does listening mean?

• Invest in person’s experienceInvest in person’s experience

• Hold own ideas and interpretationsHold own ideas and interpretations

• ‘You can learn to be a better listener, but learning it is not like learning a skill that is added to what we know. It is a peeling away of things that interfere with listening, our preoccupations, our fear, of how we might respond to what we hear’.

Reflections on listeningReflections on listening

• What interferes with good listening?What interferes with good listening?

What happens when we or What happens when we or our patients get stressed?our patients get stressed?

STRESS- STRESS-

The Mind – Body The Mind – Body InteractionInteraction

What happens in the brain when we get stressed?What happens in the brain when we get stressed?

• When a patient receives bad news (or no When a patient receives bad news (or no news!) or is due to have an operation, threat news!) or is due to have an operation, threat systems activated. systems activated.

• Natural, evolved, human state.Natural, evolved, human state.

• However, unable to think or communicate However, unable to think or communicate clearly at this point.clearly at this point.

• The patient will attempt to use behaviours The patient will attempt to use behaviours that normally help them regulate their affectthat normally help them regulate their affect

When met with threat based behaviour When met with threat based behaviour

(patient’s expression of anger or fear in (patient’s expression of anger or fear in

reaction to difficult medical news), we find reaction to difficult medical news), we find

also it harder to think clearly, also it harder to think clearly,

so we react instinctively to the “threat” of an so we react instinctively to the “threat” of an

angry or anxious patient with threat based angry or anxious patient with threat based

behaviour (“telling patients off” to deal with behaviour (“telling patients off” to deal with

our own frustration at them not listening to our own frustration at them not listening to

us!)us!)

• To prevent these difficult situations To prevent these difficult situations from escalating it is important that from escalating it is important that we treat both ourselves and the we treat both ourselves and the patient with compassion.patient with compassion.

• But how?But how?

Awareness!Awareness!

• Awareness of our reactions to others:Awareness of our reactions to others:

We have “Mirror Neurons”We have “Mirror Neurons”

• Awareness of self – MindfulnessAwareness of self – Mindfulness

MindfulnessMindfulness

• What is itWhat is it

• What is it notWhat is it not

• Why is it importantWhy is it important

• What it does to our What it does to our bodies/minds/arousal levelsbodies/minds/arousal levels

• A quick mindfulness exerciseA quick mindfulness exercise

“Window of Window of Tolerance”Tolerance”

Moderate, Moderate, regulated regulated arousalarousal

Flat affect, numb, “feel dead”, cognitively Flat affect, numb, “feel dead”, cognitively dissociated/slowed/disabled, submissive responsesdissociated/slowed/disabled, submissive responses

Disabled defensesDisabled defensesHypoarousal: CollapseHypoarousal: Collapse

Sympathetic ArousalSympathetic Arousal

Hyperarousal:Hyperarousal:

Emotionally reactive, impulsive, Emotionally reactive, impulsive, hypervigilant, hypervigilant, hyperdefensive, intrusive hyperdefensive, intrusive images and affects, images and affects, obsessive or racing thoughtsobsessive or racing thoughts

Mindfulness as a way of Mindfulness as a way of practicing loving-kindnesspracticing loving-kindness

• How to put this into practice – find ways of How to put this into practice – find ways of getting within “window of tolerance”getting within “window of tolerance”

• Some examples: “Un-mirroring”, Some examples: “Un-mirroring”, awareness of own thoughts, emotions, awareness of own thoughts, emotions, physiology, behaviourphysiology, behaviour

Be your ideal carer!Be your ideal carer!

• Imagine a person with following qualities:Imagine a person with following qualities:WisdomWisdomStrengthStrengthWarmthWarmthResponsibilityResponsibility

• When were you treated this way? How did When were you treated this way? How did it feel?it feel?

• When did you want to offer help and When did you want to offer help and support? How did that feel?support? How did that feel?

Why compassion?Why compassion?

• Kindness to self and othersKindness to self and others

• We are here, not always a choice in We are here, not always a choice in what happenswhat happens

• Understanding and acceptanceUnderstanding and acceptance

• Small daily practiceSmall daily practice

Questions or comments?Questions or comments?

• What will you take away from today’s workshop?What will you take away from today’s workshop?

• Feedback questionnairesFeedback questionnaires

• How to contact us:How to contact us:

Clinical Health PsychologyClinical Health PsychologyCross Street Health CentreCross Street Health CentreCross StreetCross StreetDudleyDudleyDY1 1RNDY1 1RN

Tel: 01384 366 249Tel: 01384 366 249

Email Eva: eva.matussek@bcpft.nhs.ukEmail Eva: eva.matussek@bcpft.nhs.ukEmail Lelanie: lelanie.smook@bcpft.nhs.ukEmail Lelanie: lelanie.smook@bcpft.nhs.uk

ReferencesReferences

• Degrees of active listening retrieved from Degrees of active listening retrieved from http://upload.wikimedia.org/wikipedia/commons/thumb/8/82/http://upload.wikimedia.org/wikipedia/commons/thumb/8/82/Active-listening-chart.png/400px-Active-listening-chart.pngActive-listening-chart.png/400px-Active-listening-chart.png

• Diagrams developed using principles of sensorimotor Diagrams developed using principles of sensorimotor psychotherapy: www.sensorimotorpsychotherapy.orgpsychotherapy: www.sensorimotorpsychotherapy.org

• Gilbert, P. (2010). An introduction to the Theory and Practice Gilbert, P. (2010). An introduction to the Theory and Practice of Compassion Focused Therapy and Compassionate Mind of Compassion Focused Therapy and Compassionate Mind Training for Shame Based Difficulties retrieved from Training for Shame Based Difficulties retrieved from www.compassionatemind.co.ukwww.compassionatemind.co.uk

• Rogers, C.R. and Farson, R.E. (1987). Active listening. In R.G. Rogers, C.R. and Farson, R.E. (1987). Active listening. In R.G. Newman, M.A. Danzinger and M. Cohen (Eds). Communicating Newman, M.A. Danzinger and M. Cohen (Eds). Communicating in Business Today. Lexington, USA: D.C. Heath.in Business Today. Lexington, USA: D.C. Heath.

• Robertson, K. (2005). Active listening. More than just paying Robertson, K. (2005). Active listening. More than just paying attention. attention. Australian family physicianAustralian family physician , Vol. 34 No. 12, 1053- , Vol. 34 No. 12, 1053-1055.1055.