spirituality - oregon hospice · low to moderate personal achievement—16-79% – chopra et al,...

9/8/2014

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Caregiver Self-Care:

Understanding Compassion

Fatigue and Burnout

Dean Sharpe MHA, MD

Facilitator, Sacred Art of Living Center, Bend, OR

What are we going to talk about?

Spirituality

Caregiver-care receiver relationship

Pain and suffering

Compassion fatigue and BurnoutPrevention

Treatment

Spirituality

“Spirituality is that aspect of

humanity that refers to the way

individuals seek and express

meaning and purpose, and

experience their connectedness to

the moment, to self, to others, to

nature, to the significant, or sacred.”

Purchalski et al 2009

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www.sacredartofliving.org © 2010 Sacred Art of Living

Center for Spiritual Formation

Spiritual Element #1

AWARENESS OF “THE OTHER”

What is valued or “sacred”?




SENSE OF RESPONSIBILITY

How am I responsible for the

world around me?




SENSE OF VOCATION

What is my reason for being?

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SENSE OF COMMUNITY

Is there a sense of caring and being

cared for?




SENSE OF REPENTANCE

What is my capacity for

reconciliation with self and others?




ABILITY TO BE PRESENT

Is my focus past, present or future

oriented?

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FAITH

What is the relationship between my

story and the Great Story”?



TOTAL PAIN MODEL

CAREGIVER PAIN

TOTAL PAIN

WHOSE PAIN IS IT ANYWAY?

PHYSICAL

SOCIAL

EMOTIONAL

SPIRITUAL

MIRRORING: NEUROBIOLOGY

OF EMPATHY

• Mirror neurons: A mirror neuron is a neuron that

fires both when an animal acts and when the animal

observes the same action performed by another.

• “…these same anterior cingulate neurons that

respond to my thumb being poked will also fire

when I watch you being poked.”

• We have no conscious control over their activity

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THE “MIND” IS RELATIONAL

The mind can be defined as

an embodied process that

regulates the flow of energy

and information. The mind

emerges in the transaction of

at least neurobiological and

interpersonal processes.

Energy and information can

flow within one brain, or

between brains. Dan Siegel, MD

“Mindsight:

The New Science of Personal

Transformation”

Everything Is Waiting For You

David Whyte

“Everything is

Waiting for You”

www.sacredartofliving.org © 2008 Sacred Art of Living Center & Institute

WE ARE THE MEDICINE

“The way in which care is given

can touch the most hidden places…”

Dr. Cicely Saunders

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PRESENCE



PAIN & SUFFERING

&

Life

Life is hard

Life is hard work

Everything changes

Everyone gets sick, old and dies

Everyone desires something and

everything is impermanent

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DEFINING PAIN

Pain is biological. It is an

unpleasant sensory and/or

emotional experience.

Physical pain is a body

experience. Emotional pain

can be primary, or secondary

arising from another

dimension of total pain.

SUFFERING

Suffering occurs when we

assign meaning to the

experience of physical or

emotional pain... OR



When we generate physical or emotional

pain from our thoughts or stories.

Suffering is linguistic.

A GAP BETWEEN THE WAY THINGS ARE

AND THE WAY WE KNOW THEY MIGHT BE…

Parker Palmer

EXPLORING THE TRAGIC GAP

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A COURAGEOUS QUESTION

IN YOUR LIFE, WHERE DO YOU FIND YOURSELF ‘STANDING IN A TRAGIC GAP,’ — THAT PLACE WHERE THERE IS A DIFFERENCE BETWEEN ‘THE WAY THINGS ARE’ AND THE WAY YOU KNOW THEY COULD BE.

OR— THE WAY YOU INTENDED THEM TO BE WHEN YOU COMMITTED TO THIS WORK, PROFESSION, WORKPLACE, ETC.?

ALL SUFFERING IN LIFE COMES

FROM…

RESISTING LIFE AS IT IS

A Definition of Healing

Coming to right

relationship with what

is.

Able to find a larger

container to hold

reality.

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“Pain in life is

inevitable…

Suffering can

be optional”


Celtic Tradition

“You are healed through your wound… ”

Always lean into the pain…


ARS

MORIENDI

Creating

the

Sacred

Sace

…where someone can suffer the suffering that they

have always needed to experience… “Carl Jung quoting the Ars Moriendi

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Tibetan

BuddhistParallels

The value of suffering is that it has the potential to connect us to

each other… in this place I am no longer separate from you



Wisd m Insight

If you get rid of the

SUFFERING

before you answer its question, you get rid of

SELF*

along with it.

*Self = Psyche = Soul

PAIN WHICH IS NOT

TRANSFORMED

IS ALWAYS TRANSMITTED

Richard Rohr, OFM

http://www.spiritcommunity.com/dreams/jung.jpg

http://www.spiritcommunity.com/dreams/jung.jpg

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AN INSTRUCTION FOR

CAREGIVERS

“May you have the

commitment to know what

has hurt you,

To allow it to come closer to

you

And in the end, become

one with you.”Celtic Book of Living & Dying



FOUR QUALITIES OF SPIRITUAL PAIN

MEANING

HOPE

RELATEDNESS

FORGIVENESS

JUDGMENT

VS.

COMPASSION

Caregiver’s Taught Approach

to Suffering

Denial

Disassociation

Disconnection

Objectivity

Closed boundaries

Denial of own experience

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Compassion Fatigue

and Spiritual Pain

Meaning: What I do here makes no

difference. I can’t change anything.

Forgiveness: My mistake/omission/etc

caused…. This patient, co-worker,

organization hurt me.

Relatedness: When I signed up for this

I thought things would be like….

Hope: Things will never get better.

So compassion fatigue is not about

callousness, indifference, or uncaring; it’s

about people who care too much, who

expect too much from themselves, who

give more than they can afford to give until

they can give no more. The result is

physical, emotional and spiritual

exhaustion.

Symptoms

Abusing substances

Anger

Blaming

Cynicism

Chronic lateness

Depression

Decreased sense of

accomplishment

Exhaustion

Headaches

GI upset

High self expectations

Hopelessness

Irritible

Decreased sense of joy

Low self esteem

Sleep disturbances

Workaholism

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Silencing Response

Avoid the topic or change the subject

Give pious canned answers or imply that

hurting person lacks faith

Belittle distress and suggest they “just get

over it”

Angry or sarcastic with people in pain

Blame the victims

Fake interest, inattentive or even visibly bored

Doubt people’s stories

Why Caregivers Get

Compassion Fatigue?

Caring and empathy

Empathic hyper-arousal

Fix-it mentality

Control

Wounded healer

That which is not healed, is

transmitted and received

Path of Compassion Fatigue to Burnout

Vital exhaustion, compassion fatigueSecondary trauma—dysfunction from prolonged exposure to

suffering and pain

Moral distress—inability to do the right thing

Horizontal hostility—behavior that controls, devalues,

disrespects or diminishes another peer group or

group

Structural violence—institutional discrimination

against a group

Burnout—cumulative work demands and stress

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Prevalence of Components of Burnout

Emotional exhaustion (compassion

fatigue)—46-80%

Depersonalization—22-93%

Low to moderate personal

achievement—16-79%

– Chopra et al, “Physician Burnout”, JAMA, 2004, pp 291

Response to Suffering: Two Pathways

Empathic concern

Other focused congruent emotion when

witnessing another’s suffering

Tenderness, sympathy, compassion

Personal distress

Freeze—numbing, addiction

Flight—abandonment, avoidance

Fight—moral outrage

Batson et al, J Pers 1987;55:pp19-39

Compassion vs. Empathy

Empathy: the action of

understanding, being aware of,

being sensitive to, and vicariously

experiencing the feelings,

thoughts, and experience of

another. Empathy of biologic.

Compassion: sympathetic

consciousness of others' distress

together with a desire to alleviate

it. Compassion is linguistic.

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Compassion

Referential

Biologically based

Identification

Reasoned

• Ethically based

• Conceptually based

Non-referential

Joan Halifax

Non-referential Compassion

Universal compassion

Non directed toward self or other beings

Recognizes that nothing is separate

Respond to all suffering to transform or

end

Complete unattachment to outcome

Joan Halifax

Enemies of Compassion

Far enemy: cruelty

Near enemies: fear, grief, pity, anxiety,

righteous anger all which will destroy us

Joan Halifax

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Why Caregivers Get

Compassion Fatigue?

Caring and empathy


Fix-it mentality

Control

Wounded healer



Most painful truth of all…

YOU CAN’T FIX IT

Why Caregivers Get

Compassion Fatigue?

Caring and empathy


Fix-it mentality

Control

Wounded healer



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Wounded Healer

Pain not healed is

transmitted

We empathize most strongly

with pain we too have

experienced

Our experience sensitizes

us

Preventative Practices

Exquisite Empathy

Self knowledge

Self empathy

Dual awareness

Mindful awareness

Contemplative awareness

Seek helpMichael Kearney MD

Experienced Meditators

Greater capacity for self regulation

Increased cardiovascular response and

enhanced brain activity i.e. more

intense responses to suffering

Increased compassion

Higher discernment of self vs. other

Increased curiosity

Lutz et al, Neuroimage 2009;301:1155-1164

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Mindfulness

Focused attention

Capacity to have a sustaining, vivid, stable,

effortless and nonjudgmental attention

Creates presence

Cognitive Control

Ability to guide thought and behavior in

accord with ones intention and emotional

balance

Contemplative Dimension

Insight practices

Presencing pain and suffering

Develop prosocial mental states (kindness,

compassion, sympathetic joy, equanimity,

altruism, and empathy)

Open presence

Contemplative

Dimension

Compassion meditation

Mindful attention to present moment

Mindfulness

• Creates a stable mental state where insight

about the distinction between self and other is

possible, without which we would experience

empathic overarousal and distress

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Mindfulness

Welcome everything, push

nothing away

Bring your whole self

Don’t wait

Rest in the middle of things

Cultivate “don’t know” mind

Frank Ostaseski

Breathe

Practices

Daily spiritual practice

Meditation

Mindfulness

Yoga

Zen, Metta, Tonglen

Centering prayer

Journaling

Spiritual direction

Nature

Gratitude exercises

Spiritual geography

Dream tending

Psychotherapy

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Summary

Name the demon

Clear your space/do your own work

Gather your tools

Face the demon/lean into the pain

Claim your strength

Affirm your own real contribution

Remember to ask for support

The Guesthouse

spirituality - oregon hospice · low to moderate personal achievement—16-79% – chopra et al,...

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