compassion fatigue

Calmfidence: Developing Calm Confidence to Face Life’s Challenges

In the interview podcast with Tami Simon of Sounds True, Patricia Stark discussed some of the exercises and tools covered in her book that provide ways to develop Calmfidence – calm confidence in the face of life’s challenges. Patricia’s book Calmfidence addresses barriers to confidence including personal past history, perfectionism and the issue of negative self-talk (or the “inner critic” as she calls it).

Her book tracks her own journey to achieving calm confidence as well as provides very practical approaches to creating Calmfidence in our own life. The focus of her book is on situations where we are placed in the limelight such as public speaking, presentations, being interviewed for a job or performing in a public arena. While these situations are the primary catalyst for her book, the principles and practices she shares are relevant to challenges in everyday life. Fundamentally, in her view, you cannot have genuine and sustainable confidence without inner calm.

Exercises and tools to develop calm confidence

Patricia discussed several exercises and practices that could be used in a variety of situations to be able to approach the inherent challenges with calm confidence. Some of these are:

Managing nerves – Patricia like many other authors and commentators contends that nerves help you be more aware and to prepare properly so as to reduce (but not eliminate) the unknown and unpredictable. Nerves indicate that you care and care enough to be worried about the outcome for the people you are helping. When we are not nervous, we may have stopped caring which may be the result of ”compassion fatigue”. Even highly accomplished professionals become nervous before an event. Alfie Langer, an Australian Rugby League legend, used to become quite nervous and nauseous before a match, even in his latter playing days.

So the challenge Is to manage your nerves, not eliminate them altogether. Patricia recounts the comment of a professional performer who told her that “our job is to get the butterflies flying in formation”, not to do away with them. Patricia maintains that what is necessary is to have the courage to reflect on the uncomfortable feelings and what they say to you and about you. She suggests that failure to address the fear and discomfort will “work against you”. In her words, you have to “start to feel the butterflies” which can help you to become “desensitised” to their presence.

Simultaneously, with facing your nervousness and its bodily manifestation, it is important to reaffirm why you are undertaking the public activity and what people can gain from it. You can reinforce this positive thinking by being grateful for the experience of helping others through utilising your unique mix of experiences, acquired skills and resources.

Snow Globe exercise – during the podcast, Patricia led listeners in this exercise. Basically it involves envisaging your mind as a snow globe and viewing your troubled thoughts as the snow flakes descending slowly to the bottom so that they appear as “fallen snow”. This can be accompanied by taking a deep breath and holding it briefly and releasing it in time with the falling snow and the settling of your troubled thoughts. Patricia asserts from her own experience, that this exercise can clear your mind and slow your heart rate so that you can “think straight” and respond to challenges more appropriately.

Visualising Success – this is not success in materialistic terms but with regard to achieving what you set out to do in terms of helping people. Patricia suggests that you start with deep breathing and as you breathe in envisage absorbing calmness and confidence and as you breathe out envisage letting go anxiety and stress. The next step is to visualise your public activity going really well and people providing feedback that is very positive and affirming. She suggests too that you envisage our voluntary audience as ”allies” who are “eager to learn” rather than uninvolved critics with nothing better to do than critique your offering and/or performance.

Sack of potatoes exercise – with this exercise you envisage your body as a “sack of potatoes” with each lumpy potato (uncomfortable feeling) confined by the sack (the mind) that holds them together and contains them. The next step is to envisage taking a pair of scissors and cutting open the lower part of the sack so that the potatoes (uncomfortable feelings) fall out “one by one”. Then you can envisage the sack of potatoes crumpled in a corner, empty of its ingredients. Tami from Sounds True reinforced the value of this exercise by sharing her own experience of undertaking the “sack of potatoes” practice.

Retreating when you hit a rough patch – Patricia describes a period during the pandemic where she was feeling overwhelmed by the book commitments/deadlines and the need to “protect herself and her family”. She decided that she would “have to retreat” in order to “keep her head above water”. She consciously made the choice to give herself some slack and “do nothing”. Patricia was then able to emerge from this period with renewed energy and heightened insight.

Reflection

I have found in the past that what helped me to calm my nerves before a public activity such as a presentation or a workshop, was to revisit a successful prior event and recapture the positive feelings and audience response and use that as an anchor for a forthcoming event. This taps into your sense of self-efficacy – your belief, based on experience, that you are capable of competently undertaking a specific task.

I also found when I was writing my PhD dissertation that I needed to take a break from it in the latter stages. I achieved this by going away to Stradbroke Island with my family for a few weeks. It was while I was sitting on the bank of Brown Lake, watching the boys play in the water, that I gained new insights in to a model that would effectively integrate the focus and findings of my doctoral research. There are times when we need to take a break, change our focus (from self-absorption to other-focused) and absorb the calmness and healing power of nature.

Patricia’s book contains many personal stories of how “Calmfidence” has played out in her life and offers other exercises and tools besides those mentioned here. If you access her book’s sales page, you can view and download the first 10 pages of her book (in PDF format) where she explains six “Calmfidence Boosters” to help you develop the calm confidence needed to manage life’s challenges.

As we grow in mindfulness through nature, meditation, reflection or other mindfulness practices, we can achieve a calm confidence, gain increased understanding and insight and manage life’s challenges more effectively.

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Image by Ana_J from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Balancing Compassion with Equanimity

Diana Winston, Director of Mindfulness Education at MARC UCLA, offers a meditation podcast on the theme, The Balance of Compassion and Equanimity. This is one of the weekly meditations provided by the Mindful Awareness Research Centre (MARC). Currently, the meditations are offered via the Zoom platform and are recorded and uploaded for ongoing access. They are also readily available via the UCLA Mindful app which provides “meditations for well-being”.

Guided meditation on balancing compassion with equanimity

In these challenging times it is easy to experience “compassion fatigue” or burnout. The pandemic alone has brought death and grief, pain and suffering, job losses, homelessness, suicides, mental illness, business rundown/closure, family separations and divided communities (around issues such as border closures, vaccination distribution, mask wearing and mandatory vaccination). Many places are experiencing natural disasters including earthquakes, wild fires, floods and tornados. There are international conflicts creating an endless stream of refugees as well as people who are trapped in a violent and inhuman environment. We do not have look too far to be surrounded by pain and suffering in this world of conflict and challenge.

In her guided meditation Diana maintains that in these times, it is common for people to experience a lack of balance and overwhelm. She suggests that one way through the dilemma of finding a balance between compassion and equanimity is to take refuge in meditation. Her recommended meditation practice involves both expression of compassion and a retreat into equanimity. This can be a once-off approach. However, if we are dealing with considerable imbalance and/or overwhelm we can repeat the process on a regular basis. This will also be necessary if we find ourselves in a state of compassion burnout where we can longer feel for others who are in pain and suffering.

Diana begins the mediation by having us take a few deep breaths to release tension we may feel as a result of experiencing strong feelings of compassion. She suggests that we become conscious of our posture and the groundedness provided by our feet on the floor or our body on the ground (if lying down outside in nature). Initially, she encourages us to identify physical points of tension so that we can consciously release them. Diana then progressively moves us through the process of exploring several anchors for our meditation – our breathing (movement in our abdomen or chest), external sounds or some bodily sensation.

Compassion meditation

Diana starts with a focus on compassion and invites us to bring to mind a particular group of people or an individual who we know are in pain and suffering. She suggests that we start with something that is not a source of overwhelm (so that we can manage the emotions involved). Diana then encourages us to find some words that enable us to express our compassion towards the chosen group or individual, e.g., “May your suffering be alleviated”. If we can find our own words to express compassion, it will enable us to genuinely feel that we are extending kindness to others.

Equanimity meditation

Following the focus on compassion, Diana suggests that we take a form of refuge in equanimity meditation. In this context the retreat to equanimity is achieved by refocusing on our chosen anchor. It might be our breathing or sounds or a particular bodily sensation. I have frequently focused on my fingers joined on my lap during meditation – feeling the warmth, the tingling and the flow of blood and energy. In times when I am waiting or experiencing strong emotions, I can resort to this practice and simultaneously tap into my breathing. The combination of these anchors – joined fingers and breath – are achieved by regular practice creating the association between them. Each person has their own way of becoming deeply grounded and restoring balance and equanimity.

Reflection

Diane calls the meditation practice she facilitated, the “black belt of meditation” – it can be extremely difficult to deal with the attendant emotions, achieve balance and restore equanimity. What we are trying to achieve is acceptance of what is, while offering genuine compassion to those who are suffering. There are so many things that are outside our control that acceptance, along with taking compassionate action where possible, is the way forward. As mentioned earlier, a “rinse and repeat” process may be required to achieve a consistent level of equanimity.

Allyson Pimentel, another MARC meditation teacher, offers an alternative guided meditation on focusing on the elements of nature to achieve equanimity – calmness can be achieved by connecting with the elements of earth, water, fire, air and space. Martin Brensilver, in a different MARC meditation, maintains that equanimity can also be strengthened by widening our perspective, reducing our focus on evaluative thinking (e.g., resorting to absolutes of right and wrong) and intensifying our sensory experience (which increases our groundedness). Gratitude meditation can also help us to restore our balance and calmness.

As we grow in mindfulness through alternating compassion and equanimity meditation practice, we can progressively gain emotional regulation, develop a balanced compassion and experience equanimity and the ease of wellness. We can also find creative ways to provide compassionate action for others who are experiencing pain and suffering. Meditation and mindfulness practices enable us to access the deep well within ourself to provide strength and support to others.

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Image by John Hain from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Self-Care for Mental Health Professionals

In his book, Trauma Informed-Mindfulness With Teens, Sam Himelstein stresses the need for self-care for mental health professionals dealing with traumatised teens. His final chapter is devoted to self-care and professional practice. Dr. Cirecie West-Olatunji, counsellor educator, also stresses the need for self-care for professionals working with people experiencing traumatic stress. Her video presentation is available as part of the courses provided by the Mental Health Academy. Both experts in the area of counselling for trauma highlight the impact of vicarious trauma, especially the risk of mental health professionals experiencing compassion fatigue.

Mindfulness for self-care

Sam himself experienced trauma in his early 20s when he lost his sister through suicide. He makes the point that most health professionals will have experienced trauma of some kind and that this experience leaves them open to triggering their own traumatic response through exposure to the trauma stories of other people. Cirecie highlights the fact that the trauma stimulus can be exacerbated where the professional has previously experienced combined or cumulative trauma.

Sam emphasises the role of mindfulness in helping the professional to deal with their own re-traumatisation as a result of interaction with others and their emotionally draining stories. He stresses the role of a personal mindfulness practice in helping him deal with the trauma of his sister’s suicide.

Sam suggests that a personal approach to mindfulness as a protective mechanism could involve the following:

Silent retreat(s): Sam found these exceedingly helpful because they enable you to fully experience your emotions, gain a deep insight into your inner landscape and develop strategies to maintain or regain your equilibrium.
Formal practice: this entails inculcating a regular mindfulness practice (either sitting, standing, or walking) where you engage in some form of formal meditation. This helps to build your concentration to enable deep listening, empathetic response, and the ability to promote wise action. It also assists you to deal with your own difficult emotions (such as anger, resentment, or frustration), challenge self-defeating narratives and develop resilience in the face of challenging interactions.
Beyond meditation: Sam suggests that bringing mindfulness into your everyday life (in daily activities such as walking, washing clothes, eating, shopping), is effectively “mindfulness-in-action”. It is particularly relevant to your relationships and interactions with others, especially in times of conflict. One way to develop the necessary calmness and equanimity in the face of emotional challenges is to practice reflection-on-action to eventually cultivate the capacity to reflect-in-action, in the course of something adverse happening to you (whether that adversity is real or imagined). Sam stresses the importance of daily mindfulness practices in controlling the “ego” which can get out of hand when it perceives a threat (physical, emotional, or intellectual).

Professional development

Both Sam and Cirecie stress the importance of professional development to build competence and confidence to enable you to operate effectively within your chosen arena of professional practice. For Sam this is the arena of traumatised youth, especially those who have been incarcerated. He offers specialised training for health professionals through his Center for Adolescent Studies. Cirecie’s professional arena includes trauma stress service delivery and training professionals who provide counselling in different countries following disasters such as earthquakes and pandemics. She conducts research and training through her Xula Center for Traumatic Stress Research.

Cirecie stresses the need to gain control over your workload and, where necessary, seek to negotiate a lighter load (for your psychological welfare and that of your clients). She maintains that every mental health professional, irrespective of their level of experience and training, has their window of tolerance beyond which they are unable to function effectively. She gave an example of how a racist client triggered her and how her experience in working in South Africa with a community where people were consistently dying from AIDS took her outside her window of tolerance and led to a severe illness. In both cases, she sought professional counselling and recommends this form of professional development for other mental health professionals.

Cirecie highlights the importance of self-knowledge and self-awareness as critical factors in professional counselling, particularly understanding your own negative triggers. She encourages too the development of your own professional support network that you can draw on for knowledge, experience, resources, and emotional support.

In Cirecie’s view, personal and professional development extends to conscious awareness of the physical and psychological health risks inherent in the role of a mental health professional. She urges appropriate preparation for the role through education which will provide motivation for health self-care (e.g., exercise, stretching (to release physical tension), diet, and drinking water).

Reflection

There are many reasons why mental health professionals do not undertake adequate self-care. When working with clients who have suffered trauma or are currently experiencing trauma, it is critical that the health professional takes time for self-care to enable them to function at their best for the sake of their clients, as well as for their own welfare. Mindfulness practice is recognised as a key component of this necessary self-care. As mental health professionals grow in mindfulness, they are better able to identify personal triggers, develop resilience for their challenging work and build the capacity to engage in deep listening. However, mindfulness practice needs to be supported by an appropriate lifestyle.

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Image by Vanessa Kenah from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Carers Need Self-Care

Much of the focus in the resources on mindfulness is on ways to help people who are suffering from conditions that are debilitating such as mental illness or chronic pain. Very little of the resources focus on ways to help carers in their role – ways to manage the physical and psychological toll of caring for someone else on a constant and extended basis. Carers are the overlooked group – forgotten by others and themselves.

Carers: people who care and support others

Carers come in all shapes and sizes – adults looking after ageing parents who may be suffering from Alzheimer’s disease; siblings caring for a family member who has a mental health condition such as schizophrenia, anxiety or depression; or anyone caring for someone suffering from a physical condition such as paraplegia, chronic pain or cancer. According to Carers Australia, carers are people who provide unpaid care and support to family members and friends who have a disability, mental illness, chronic condition, terminal illness, an alcohol or other drug issue or who are frail aged.

The toll of caring

The “burden of care” can be felt both physically and psychologically. The physical toll for carers can be excessive – they can become exhausted and/or accident-prone, suffer from sleep disorders or experience bodily symptoms of stress such as irritable bowel syndrome, chronic fatigue or related conditions like fibromyalgia. The physical toll of caring can be experienced as cumulative stress and lead to chronic conditions that adversely affect the carer’s long-term health.

The psychological toll of caring can also be cumulative in nature and extremely variable in its impact. Carers can experience negative emotions such as resentment or anger, despite their compassion towards the person who is being cared for. They can become extremely frustrated over the paucity of time available for themselves, the opportunity cost in terms of inability to travel or to be away for any length of time, the lack of freedom (feeling tied down), the lack of improvement in the condition of the person being cared for or the financial impost of caring (preventing desired savings/purchases or home improvements).

Carers do not have inexhaustible personal resources – physical, psychological and financial. They can suffer from compassion fatigue which can be hastened by emotional contagion resulting from close observation of, and identification with, the pain of a loved one. Hence, carers can experience depression, anxiety or grief – reflecting the emotional state of their loved ones who are suffering.

The toll on carers has been the subject of extensive research. For example, Emma Stein studied the psychological impact on older female carers engaged in informal aged care. Sally Savage and Susan Bailey reviewed the literature on the mental health impact on the carer of their caregiving role and found that the impact was highly variable and moderated by factors such as the relationship between caregiver and receiver and the level of social support for the carer.

Being mindful of your needs as a carer

The fundamental problem is that carers become so other-focused that they overlook their own needs – their need for rest, time away, relaxation and enjoyment. Normal needs can become intensified by the burden of care and the associated physical and psychological stressors. Carers tend to neglect their own needs in the service of others. However, in the process, they endanger their own mental and physical health and, potentially, inhibit their capacity to sustain quality care.

Carers can inform themselves of the inherent physical and psychological consequences of being a caregiver, particularly if this involves intensive, long-term caring of a close loved one (where feelings are heightened, and the personal costs intensified). Mental Health Carers Australia highlights the fact that people who care for someone with a mental health illness are increasingly at risk of “developing a mental illness themselves”.

Self-care for the carer

One of the more effective ways that carers can look after themselves is to draw on support networks – whether they involve family, colleagues or friends; broad social networks; or specific networks designed for carers. Arafmi, for example, provides carer support for caregivers of people with a mental illness and their services include a 24-hour carer helpline, carers forum, blog, educational resources, workshops and carer support groups. Carers Queensland provides broader-based carer resources and support groups.

Carers tend to go it alone, not wanting to burden others with “their” problem(s). They are inclined to refuse help from others when it is offered because of embarrassment, fear of dependency, concern for the other person offering help, inability to “let go” or any other inhibiting emotion or thought pattern – in the process, they may stop themselves from sharing the load.

Carers could seek professional help from qualified professionals such as medical doctors or psychologists if they notice that they are experiencing physical or psychological symptoms resulting from carer stress.

Mindfulness for carers

Carers can use mindfulness practices, reflection and meditation to help them cope with the physical and emotional stresses of caregiving. Specific meditations can address negative feelings, especially those of resentment and the associated guilt. Mindfulness practices can introduce processes that enable the carer to wind down and relax – such as mindful breathing, mindful walking, mindful eating or using awareness as the default when caught up with “waiting” (a constant companion of the carer role).

Carers can employ techniques such as body scan to relax their bodies and release physical tension. Deep, conscious breathing can also help in times of intense stress such as when experiencing panic. For people who are religious, prayer can help to provide calm and hope.

Dr. Chris Walsh (mindfulness.org.au), offers a simple mindfulness exercise for self-care by carers in his website article, Caring for Carers. The exercise involves focusing, re-centering, imagining and noticing (thoughts, feelings and bodily sensations).

As carers grow in mindfulness, they can become more aware of the stress they are under and the physical and psychological toll involved. This growing awareness can lead to effective self-care through social and professional support and meditation and/or mindfulness practices. Mindfulness can help carers develop resilience and calmness in the face of their stressful caregiver role.

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Image by Sabine van Erp from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

Can You Experience Compassion Fatigue?

Kelly McGonigal in her presentation for the Mindful Healthcare Summit challenged the widely held belief that you cannot experience compassion fatigue. Many people contend that compassion fatigue does not occur because the heart is capable of endless kindness and love for others. Kelly maintains that motivation and goodness of heart are not sufficient to prevent the depression and burnout that can result from compassion fatigue. She asserts that compassion has to be supported by adequate self-care if it is to be sustained.

Compassion and the stress response

Kelly argues that compassion is like the stress response when viewed physiologically. Compassion floods the body with hormones such as dopamine and marshals the body’s energy to relieve the suffering of others. However, while this can be very energising and exciting in the short term, compassion takes its toll in the longer term both bodily and mentally, as we do not have endless physical and mental reserves.

The possibility of compassion fatigue can be increased where a helping professional or carer experiences vicarious trauma or moral distress – the latter being defined as being required to do things that clash with a person’s values or moral perspective, a frequently occurring ethical dilemma within the medical profession.

Kelly suggests that compassion fatigue occurs when a person lacks the energy and resources to pursue their motivation to care in such way that it achieves personal satisfaction (activates the reward system). Outcomes achieved fall short of personal expectations and/or the expectations of others, despite the strength of the caring intention. The compassionate person feels exhausted and feels that the more they give the less they experience satisfaction – the gap between input of energy/time and the expected satisfaction increases, leading to burnout. The depletion of energy and satisfaction could be the result of factors outside the helper’s/carer’s control – such as structural blockages, breakdown in information exchange, overwork or under-resourcing.

Compassion needs nourishment

One of the issues that exacerbates the problem of compassion fatigue is the belief in the endless capacity of an individual to be compassionate through the goodness of their heart or the purity of their intentions. As a result of this false belief, helpers/carers fail to take the necessary actions to nourish themselves (and their compassionate action) and/or are reluctant to accept compassion extended to them by others.

Personal nourishment can take many forms – getting adequate sleep, meditation (especially self-compassion meditation), listening to relaxing/inspiring music, prayer (whatever form it takes) or drawing strength and healing from nature. It also requires an openness to receiving compassion from others – challenging false beliefs such as “no one else can do this”, “I will be seen to be weak if I accept help from others”, “I really shouldn’t pander to my own needs by having that short break or having a reasonable period for lunch”, “I can’t afford to become dependent on others for assistance”. Additionally, positive social connection– to offset the tendency to withdraw under extreme stress– is a critical source of self-nourishment.

As we grow in mindfulness through meditation our awareness of others’ suffering and our motivation to help are heightened. The capacity for compassionate action is not limitless and needs nourishment. Central to this nourishment is self-compassion.

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Image by DarkWorkX from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.