COMPASSION FATIGUE: CARING FOR OURSELVES WHILE WE CARE FOR OTHERS
Laura Basili, PhD presented on "Compassion Fatigue: Caring for ourselves while caring for others" at a chaplaincy-hosted presentation on September 20th.
Rev. Mary Martha Thiel introduced her as a clinical psychologist who works with children and families living with chronic and terminal illnesses at Children's
Hospital for the past 10 years. Dr. Basili opened the presentation remarking that when the date was chosen for the presentation she wondered about the timing.
The academic year would be just starting and staff would be in a period of 'relative high energy' coming off of summer vacations. Given the terrorist attacks
of September 11th, this is a particularly timely topic for all healthcare and helping professionals. As hard as our work is on a day to day basis, there is
usually a distinction between what our 'clients' are experiencing and what we as 'helpers' are experiencing. In the wake of the terrorist attacks this
distinction is nonexistent. We, like our clients, are experiencing feelings of shock, sadness, pain, and grief yet are called to help others with their feelings
and reactions. Which can lead to feelings of stress, compassion fatigue, and burn-out. She noted that she was going to present information that we already know,
but that we shouldn't underestimate the value of being reminded. She wondered how the group was coping and managing in light of events in the world and invited
sharing of coping strategies throughout the presentation. A consistent theme in the presentation was to be aware of your own coping style and strategies and to
make intentional choices and decisions based on them. Dr. Basili used slides throughout of quotes, artwork and humor. Copies of slides and bibliography and additional
handouts are available from the CRC - contact Ellen.
Dr. Basili opened with the following quote about the work we do here at the hospital:
She selected this quote because she felt it captured the essence of the life and spirit sustaining work we do here at the hospital. However, she shared that in doing
this work there is an impact on our lives and discussed the work of Charles Figley, who writes extensively about compassion fatigue. She shared his words,
Dr. Basili suggested that given the nature of the clinical work we perform along with the traumatic events of September 11th, that many might be experiencing some
level of compassion fatigue. She discussed the notion that compassion fatigue represents a continuum of experience which can include mild stress at one end with sleep
disturbances and intrusive thoughts representing the extreme of secondary traumatic stress or vicarious traumatization. The first steps in dealing with stress,
addressing compassion fatigue and preventing burnout is to conduct a stress audit. Things to notice include our driving patterns - are we being inconsiderate, getting
annoyed, driving recklessly; eating patterns; life pace - are we in constant motion?; are we making time to enjoy leisure time with family and friends? What is our
communication style - are we shutting down? And are we experiencing inner turmoil?
Other signs may clue us in that we are stressed. The physical signs of stress include headaches, diarrhea or constipation, rapid heart rate, change in appetite, flare
of chronic conditions, lowered resistance to illness and irregular menses and/or decreased libido. Dr. Basili noted that in her experience health providers are very
aware of these signs in their patients, but often among the least aware of them in themselves. Cognitive-behavioral signs of stress include forgetfulness, distractibility,
being overly critical of self or others, feeling unlikable, feel like others are making life difficult, stubborn/rigid interactions, little humor or use humor with more of a
sarcastic/cynical edge. Emotional signs of stress include persistent sadness/crying, irritability or angry outbursts, withdrawal, increased need for reassurance/support,
lethargy - decreased motivation, feeling overwhelmed and focus on vague aches and pains.
Once we recognize that we are stressed we can consciously utilize a variety of coping strategies to address it. Dr. Basili presented a framework of four broad areas to explore
coping strategies: psychological, spiritual, professional and workplace. As part of the psychological coping strategies, the first was to take care of yourself physically (e.g.
to exercise, eat, sleep). Another was to strive for life balance by knowing your limits, setting boundaries on bringing actual or emotional work home. She reminded us that this
is a life-long struggle to create a balance that works! As she quoted "We cannot direct the wind but we can adjust our sails." We chose this work, but we owe it to ourselves to
do periodic checks of how we are coping and adjust our sails accordingly. Dr. Basili presented Angeles Arrien's Fourfold way for living your life as a frame-work to consider:
At this point we reached the end of the planned presentation. Dr. Basili had only made it about halfway through the presentation. She will be returning on November 8th at noon to give the second
half of her presentation which will discuss spiritual, professional and working place coping strategies for managing stress and compassion fatigue. Space is limited so social service staff should
RSVP to Ellen Forman.
-Many thanks to Dr. Laura Basili for her inspirational presentation and for co-writing/editing of this article.
"Bless them who wait with us, who labor with us, who cry out with us. Bless them who know our limits, who push us beyond them, who see us through. Bless
them who call us to our strengths, who tend us in our weakness, who dress each ragged wound. Bless them who laugh in the face of convention, who weep for our
own pain, who bid us come and live."
~Jan Richardson from Night Vision
"There is a cost to caring. Professionals who listen to patient's stories of fear, pain, and suffering may feel similar fear, pain, and suffering
because they care. Sometimes we feel we are losing our sense of self to the patients we serve."
~Charles Figley, Compassion Fatigue
Other suggestions included remembering relaxation & using creative expression as important whether playing music, creating art, cooking or any activity that engages your creativity.
Julia Cameron in the Artist's Way suggests an "artist date" which is an appointment you set with yourself every week for 2 hours (Dr. Basili suggests starting at a half hour and working
up if this seems too intimidating) to nurture your creativity. This might include reading a book, taking a walk, going to a museum, or creating something - the important thing is to do
it alone and maintain it as a ritual with yourself. Another creative expression Cameron suggests is to journal three pages without stopping, just "brain drain" as a way to get to one's
underlying creativity. Also exploring hobbies, as we often forget our hobbies as stress increases. Many people used to play an instrument or some other creative endeavor that they've gotten
away from. Giving yourself permission to explore these again or new hobbies is very nurturing to our spirit and our creativity. Another coping strategy is to seek support. Who is your
community, who do you share with? Are there ways to build in formal or informal time with colleagues since most people outside of the caring professions can't understand, tolerate, or be
helpful with the work we do. Remember humor and consciously seek it out as we can become very serious in our work. Seek out joy, lightheartedness, and play! As a helper one needs to
practice self-awareness, exploring your motivations as a helper and how you are doing with maintaining clarity and perspective as stress increases. One suggestion is to recognize or develop
decompression routines either during the day, or as a transition between work and home, and to cherish them. Dr. Basili reminded us to never underestimate the power of rituals, whether it is
the last cup of coffee during the day or listening to music on the drive home or selecting a point beyond which you don't think about work or do work. The important thing is to be intentional
about your rituals and routines that nourish your soul.
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