The Great Balancing Act

Maintaining a resilient approach to the helping professions requires balance, not only in our work but in our personal lives as well.  When we experience our work life intruding too much into the personal sphere, we know we are out of balance.  When we feel stressed making routine decisions or because our family members need something from us, we are out of balance.  When our dreams too often become an extension of our work , think “need for balance”.  But finding balance among all the elements of our lives is a real brain teaser!  Where, how?

 Last year I was working with a woman whose elderly mother had suffered a series of health crises.  Her mother’s status precipitated  moving cross country from her familiar home to assisted living here.  Both the mother and the daughter were experiencing tremendous stress as a result.  My client lamented the lack of balance in her life.  I mentioned my dislike of pie graphs in which we sort the areas of our lives into “pie-shaped” segments.  We agreed that the pie itself would bulge as we tried to squeeze in all the competing slices.  What could serve as a better model? 

 My client suddenly recalled a long ago biology lesson about homeostasis: organisms maintain overall stability as their systems respond continually to environmental changes. 

“Dancing in the moment!”  I exclaimed.  “The ability to respond to what is asked of us right here, right now”.  Not a limited space into which we cram everyone’s demands and needs along with our own, we decided, but a flexible, open, variable capability to respond as each moment develops.  We threw out the pie chart and started dancing.

I once saw the word responsible defined by a clever re-spelling:  “response-able”.  Balancing is a “response-able” act.  It never occurs with rigid posturing, but happens best when we can flexibly dance in the moment, just this moment, of our lives.

Optimists rule!

As we know, optimism is beneficial in many ways.  When adversity strikes, it makes sense that optimistic people have an advantage.  Jonathan Haidt documented empirical support for this on page 146 in his book The Happiness Hypothesis (Basic Books, 2006).  Haidt reports that when trauma/crisis occurs, people cope in three primary ways:

1. active coping:  taking action that matters to address the difficulty;
2. reappraisal:  conducting an internal assessment to make sense of the adversity;
3. avoidance coping:  blunting emotional impact by avoiding the difficulty itself, by distracting oneself, or by anesthetising oneself with drugs/alcohol.

Optimists tend to alternate between the first two coping styles while pessimists tend to use the third.  As a result, optimists may actually experience post-traumatic growth.  Pessimists, who are working harder on managing their pain than they are on overcoming the adversity, may get stuck in the trauma impact.

This specific reminder of the difference between how optimists and pessimists cope with trauma is relevant not only for our clients, but for us as well.  If we are fortunate to be optimisitc in our general approach to life, then we can make use of this trait in addressing trauma impact.  If we are, unfortunately, pessimistic, this provides significant impetus for developing greater optimism.  The good news is that optimism, like resilience, can be cultivated.  Now is the time to begin.

 If you want to check your optimism/pessimism status, go to www.authentichappiness.com and take the Optimism Test.  This is based on Dr. Martin Seligman’s work on cultivating optimism, a great resource.

Saving Ourselves

Years ago when I was working at a community mental health center I had a disturbing dream.  Someone was shouting, “Who’s borderline is this?” (read “challenging client”).  With heavy reluctance, I replied “She’s mine.”  In the dream I moved to a building from which I was to remove my client.  I dragged myself up the stairs and found her in a room.  She was an anonymous person, no one in particular, but a symbol of overwhelming challenge and effort.  I felt exhausted as I picked her up, positioning her over my shoulder in a fireman’s carry, and headed down the stairs.  “Heavy” is the operataive word for this dream.  I awoke before I discovered what I was going to do, but the dream was a strong indication to me that I needed to do something! 

 We called it “burnout” at that point in my career.  I remember considering the dream’s message about my current professoinal circumstances.  I knew I needed to look after myself as well as my clients.  I began experimenting in professional self-care.  Interestingly, I didn’t seek out professional support.  I’m sure that I shared the dream with some colleagues, laughing about it.  But there was no discussion about what to do.

A recent NASW (National Associaiton of Social Workers) newspaper article about vicarious traumatization  described it as being similar to secondary smoke.  Doesn’t that give you a visceral feel?  Like the “heaviness” in my dream, the smoke analogy lingers, reaching down into the primitive neural connections of my brain where trauma impact resides, twanging those synapses in a jarring fashion. 

I have this lighter thought:  the potential benefit of this connection to victimized clients is that, with awareness, I can truly, deeply empathize. More importantly, I am capable of traveling back up the brain hierarchy to my cognitive resources and figuring out how to assist my clients toward healing.  But first, I just need to breathe… 

Sometimes it hurts to help…

Last week my psychologist/husband attended a training on assessment of serious bodily injury to children and child fatalities. The trainer showed a 3-4 minute video of actual physical abuse to an 18 month old toddler captured on a “nanny cam”. The trainer explained that the child’s parents had become suspicious when their daughter began to exhibit unexplained fears and unusual behaviors. She assured the participants that the child survived and is physically, if not emotionally, fine now. Still, my husband experienced a horrible visceral impact from watching the film, and, to relieve his own stress, began to observe others’ reactions. He saw seasoned case workers crying; he noticed an experienced attorney flinch, and he observed law enforcement and other child abuse professionals shifting in their seats, looking down or away or covering their faces. Clearly this brief video had a major impact on those who watched it. My husband contracts with the local department of human services to provide critical incident stress debriefings and secondary traumatic stress (STS) support. By the end of that day, he had received requests from several caseworkers to discuss the video’s impact. I found his report about this to be a potent reminder of the nature of trauma work. This wasn’t even a “live” case, the outcome was already known, and yet it was traumatizing to witness.

Here are some reasons trauma exposure can cause STS, identified by the pre-eminent STS researcher Charles Figley. First, empathy is a primary resource trauma responders use to assist trauma victims, and empathy is a key factor in the transmission of the impact of trauma from victim to helper. Also, many trauma responders/helpers have experienced some type of traumatic event in their own lives, and their work with a victim can rearouse their own trauma history. This is especially true if the helper’s own trauma is unaddressed or unresolved. Relevant to the above example, research shows that caregivers report being especially vulnerable to STS when the victim is a child.

So we care about, feel compassion for persons who have been traumatized. We are trained to assist and want to provide that assistance. But what do we do when we find ourselves impacted? Admit it, it isn’t easy to admit! “I’m OK,” we tell ourselves and others. “It was horrific, but I’ll be alright.” We don’t want to know how much our involvement with someone else’s trauma can tear us up, occupy our thoughts and our time, interfere with our usual life. We don’t want to know how vulnerable we can feel as a result. That in itself is a difficult barrier to overcome. Alone, dealing with our own periodic hyperarousal, we begin to loose perspective. This is why a strong and understanding peer group is so important!

Then what? I’ll keep exploring my thoughts about that here. I ‘d like to hear your thoughts and experiences, too. Let’s be sure that we remain compassionate and understanding with ourselves. Take care - really, take care.

Restoring resilience and wellbeing to helping professionals experiencing vicarious traumatization or compassion fatigue

It is now widely recognized that providers in the human services and medical professions often experience specific stress symptoms as a result of the nature of their work. However, coping with this work-related stress remains largely incumbent on the providers themselves.

You care deeply about the people you serve. You value the work you do. You are aware that your caring and commitment can take a toll on your personal life and your overall sense of wellbeing. Yet, it is difficult to know how best to cope with secondary or vicarious traumatization and compassion fatigue, two descriptors for this type of stress.

Are you impacted by stress secondary to your work?

• Do you find your clients’ traumatic experiences lingering with you?
• Are you feeling angry, fearful, overwhelmed, vulnerable, withdrawn and/or distrustful as a result?
• Is the impact of your clients’ trauma negatively affecting your worldview and intruding into your personal life and relationships?
• Do you feel burned out, persistently fatigued and emotionally numb?
• Are you feeling isolated and alone?

Research indicates that the most effective response to regaining perspective, balance and resilience is being part of a peer group where you feel grounded, understood and supported in making changes that matter.

Let’s start here. Share your professional experiences and challenges with vicarious traumatization or compassion fatigue. Let’s talk about it.