trauma page 5
Bearing witness to loss or trauma
Whoever battles with monsters had better see that it does not turn him into a monster. And if you gaze long into an abyss, the abyss will gaze back into you.Friedrich Nietzsche
We shield our heart with an armour woven out of very old habits of pushing away pain and grasping at pleasure. When we begin to breathe in (our) pain instead of pushing it away, we begin to open our hearts to what's unwanted. When we relate directly in this way to the unwanted areas of our lives, the airless room of ego begins to be ventilated. Pema Chodron
Compassion Fatigue is the cumulative outcome of caring – caring too much and for too long with no end to be seen.
You are absorbing the trauma from the eyes and ears of your clients.
A natural consequence of working with people who have experienced extremely stressful events. (Figley, 1995).
Vicarious traumatization defined
When people exposed to trauma experienced by those in their care become so overwhelmed that they themselves experience feelings of fear, pain, and suffering including intrusive thoughts, nightmares, loss of energy, and perception of threats at home or at work.
An extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper.
When a carer with previously benign yet pre-existing traumatic injury, experiences onset of their own trauma symptoms when exposed to the trauma of those in their care. This is a synergistic relationship between primary traumatic stress, secondary or vicarious trauma and burn out.
Compassion Satisfaction and Fatigue (CSF) Test
Here is the test dowloadable in word document format, where yoiu will find scoring criteria.
12 Self-care strategies from Norcross & Guy
12 Self-Care Strategies: A Précis
Although research on psychologist self-care has not progressed to the point where randomized controlled trials (RCTs) have been conducted, there is a robust and growing body of empirical research. The research results, generated by diverse methodologies and numerous investigators, converge on 12 effective self-care strategies for psychologists (Norcross & Guy, 2007). And these same strategies probably prove effective for ordinary people as well; contrary to rumor, psychologists are people too. Below we outline these 12 strategies (see Norcross & Guy, 2007, for amplification and self-care checklists for each).
12 Self-Care Strategies
1. Valuing the Person of the Psychotherapist. Self-care begins with self-awareness and personal commitment. Assess your self-care as you would a patient’s. Identify your vulnerabilities and sabotages. Writing, journaling, logging, or self-monitoring can track your progress. Secure honest feedback from loved ones and coworkers. Build on your successful self-care as opposed to simply adding new items onto the list. Make self-care a priority, not an indulgence.
2. Refocusing on the Rewards. Re-experience the privileges of the profession. Notice the life rewards associated with clinical work. Feel the career satisfaction. Practice the mental set of gratitude. Recall Emerson’s words: “It is one of the most beautiful compensations of life that no man can sincerely try to help another without helping himself.”
3. Recognizing the Hazards. Begin by saying it out loud: Clinical work is a demanding and often grueling enterprise. Affirm the universality of occupational hazards by sharing with colleagues. Beware the classic stressors of the “impossible profession”: emotional isolation, distressing patient behaviors, inhumane working conditions, physical exhaustion. Practice acceptance of the inevitable stressors. Cultivate self-empathy. Adopt a team approach.
4. Minding the Body. Don’t overlook the bio-behavioral basics. Protect your sleep. Insist on bodily rest. Secure adequate nutrition and hydration during the day. Engage in regular physical exercise. Arrange for contact comfort and physical gratification. In your quest for sophisticated self-care, return again and again to the physical fundamentals.
5. Nurturing Relationships. Cultivate a support network at the office: Clinical colleagues, supervision groups, clinical teams, office staff, community professionals, and mentors. Equally important, secure nurturance away from the office: spouse/partner, family members (including pets), friends, spiritual advisors, and Colleague Assistance Programs. Ask yourself repeatedly, “Who has my back?” Expectedly, psychotherapists find help relationships both deeply satisfying and highly effective for self-care.
6. Setting Boundaries. Maintain boundaries (a) between self and others as well as (b) between professional life and personal life. During the day, schedule breaks, restrict caseload, refuse certain clients, insist on a livable income. Consider the 90% rule: only schedule up to 90% of desired hours to allow time for emergencies, family demands, and self-care. Balance client desires and self-preservation by saying “no” to patients, such as no shows, late cancellations, unpaid bills, and non-emergency intrusions in your life. Demarcate a boundary between work and private life with a transition ritual.
7. Restructuring Cognitions. Monitor internal dialogue by your preferred method. Identify corrosive expectations about your performance as a clinician; for example, “I must be successful with my patients practically all of the time,” “I should not have problems; after all, I am a psychologist!” Manage problematic counter-transference reactions by self-insight, self-integration, empathy, anxiety management, and conceptualizing ability. Be gentle with yourself; shed the heavy burden of perfectionism that psychologists carry.
8. Sustaining Healthy Escapes. Beware the prevalent unhealthy escapes of substance abuse, isolation, and sexual acting out. Practice absorbing errands and healthy diversions away from the office, e.g., travel, hobbies, humor, relaxation, exercise. How do you play? Restore yourself with vital breaks, days off, personal retreats, vacations, and mini-sabbaticals.
9. Creating a Flourishing Environment. Harness the power of your work environment, thereby avoiding the fundamental attribution error (FAE) that your distress is solely your fault. Take an environmental audit of practice setting/office. Evaluate your work environment in terms of 6 key dimensions: work load, control, reward, sense of community, respect, and similar values. What is unsatisfactory and what can be done? High work demands plus high constraints is a toxic combination. Enhance the comfort of your work safety, privacy, lighting, ventilation, furniture, and aesthetics.
10. Undergoing Personal Therapy. Practice what you preach by seeking personal psychotherapy. Confront your resistances not to pursue personal treatment. Return to personal psychotherapy periodically throughout the lifespan without shame. Supplement psychotherapy with self-analysis. As an alternative, obtain an annual satisfaction checkup. Integrate with other forms of self-development, such as creative arts, meditation training, yoga.
11. Cultivating Spirituality and Mission. Reclaim your “mission” in life and in entering the profession. Cultivate wonder at the human spirit; it will enable you to pull hope from hell. Connect to the spiritual sources of your hope and optimism regarding behavior change. Confront squarely your own yearnings for a sense of transcendence and meaning. Become a citizen-therapist by merging your vocation with social activism. Let your life speak – manifest your core values in and outside the office.
12. Fostering Creativity and Growth. Strive for adaptiveness and openness to challenges – the defining characteristics of passionately committed psychologists. Involvement in diverse professional activities (e.g., psychotherapy, assessment, teaching, research, supervision) balances your workload and expresses the full array of skills. Attend clinical conferences, read literature, and form study groups to access the life springs of continued education. Expect a lifetime of struggle for awareness and growth; self-renewal is an ongoing process, not a CE workshop. Source
Some thoughts from Bill O'Hanlon on writing about life crises
How to do the writing ritual:
Bill O'Hanlon, M.S., Possibilities
Ancient Pali texts liken meditation to the process of taming a wild elephant. The procedure in those days was to tie a newly captured animal to a post with a good strong rope. When you do this, the elephant is not happy. He screams and tramples, and pulls against the rope for days. Finally it sinks through his skull that he can’t get away, and he settles down. At this point you begin to feed him and to handle him with some degree of safety. Eventually you can dispense with the rope and post altogether, and train your elephant for various tasks. Now you’ve got a tamed elephant that can be put to useful work. In this analogy the wild elephant is your wildly active mind, the rope is mindfulness, and the post is our object of meditation, our breathing. The tamed elephant who emerges from this process is a well-trained, concentrated mind that can then be used for the exceedingly tough job of piercing the layers of illusion that obscure reality. Meditation tames the mind. Henepola Gunaratna, 'Mindfulness in Plain English'
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