Tag: vicarious trauma

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.

Insights Into Meditation Practice

Tami Simon from Sounds True interviewed world-renowned meditation teacher, Sharon Salzberg, about the nature of meditation.  The interview podcast titled, Beginning Anew, provided some valuable insights into meditation practice and its outcomes.  By way of illustration of the many applications of meditation, Sharon spoke of her meditation work with the Garrison Institute helping to develop a “culture of wellness” amongst domestic violence health care workers.  She also mentioned her meditation work with nurses and international refugee workers who experience vicarious trauma because of the trauma of others that they experience every day and feel isolated because of their inability to talk about the truly disturbing things they encounter.  Some of the insights into meditation practice from her interview are summarised below.

Insights into how we can become renewed through meditation practice

Sharon’s interview podcast provided considerable insight into the nature of meditation and its personal impacts – the longer and more consistently we practise meditation, the more profoundly we will experience these impacts:

  • Seeing possibilities – when we are caught up in our difficult emotions and seemingly trapped, we tend to experience “tunnel vision”.  In the face of disruptive change, which is ever-present, we tend to focus on the “endings” rather than the “new beginnings”.  We can also become obsessed with projecting an adverse future onto our mind’s screen.  We become locked in, unable to see possibilities and the potential for new beginnings – the ability to “begin anew”.  Meditation stills the mind and enables us to identify creative options – it releases our creativity in times of change and challenge.
  • Gaining understanding – Sharon highlights this dimensionof meditationby focusing on the difference between guilt and remorse.  Guilt in her words is a form of “lacerating self-hatred” where we beat up on ourselves for our mistakes, deficiencies and harmful behaviour.  We convince ourselves that we will never change but will continue to be hurtful towards others.  Remorse, on the other hand, is genuine sorrow for causing hurt to others together with the ability for self-forgiveness.   Understanding, developed through meditation, releases us from being “mired in the pain and exhaustion of guilt” and enables us to have the energy, motivation and will to change.  Sharon describes understanding as “a tremendous tool”.
  • Changing our perspective – if we focus only on the things that are wrong or missing in our lives, we will miss the things in front of us that generate well-being and possibilities.  If we get locked into a pattern of negativity, we will lack the ability to “see clearly” – we will not be in a position to “serve ourselves or others”.  Research at the HeartMath® Institute demonstrates that negative emotions creates chaos in our nervous system while positive emotions “can increase the brain’s ability to make good decisions”.  Sharon points out that focusing on the negative in any situation disables us while insight gained through meditation can “create change and the context for change”.

Reflection

We can become trapped in a created, negative reality with the perception of no way forward, and become trapped in guilt about our past words and actions.  Sharon maintains that as we grow in mindfulness through meditation, we can open our eyes to possibilities, gain a real understanding of the difference between disabling guilt and enabling remorse and develop a perspective on change that enables us to move from negativity to positivity and sound decision making.  Sharon’s Insight Meditation Kit, developed with Joseph Goldstein, provides the tools and resources to help us remove hindrances to personal growth and develop the energy for personal change.

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Image by Ioannis Ioannidis 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.

Compassion fatigue

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.

Accessing Our Inner Resources to Cope With Trauma

Mindfulness through “resourcing meditation” can help us to cope with trauma.  It does not replace the need for therapeutic assistance but complements therapy and facilitates the process of dealing with deeply held fear or grief.

The causes of trauma

Trauma can be experienced by anyone at any stage of life.  The associated experience of profound psychological distress can result from a natural disaster such as a cyclone or earthquake; a personal life event such as the death of a parent. life partner or a child; being involved in a serious car or transport accident; the experience of going to war or being a prisoner of war; experiencing a vicious relationship break-up; being a person displaced by war; experiencing a toxic work environment over an extended period; being a refugee attacked by pirates when trying to flee a war-torn country by boat (the experience of Anh Do).

People in helping professions can experience vicarious trauma by virtue of supporting others who have had a traumatic experience. So midwives in a hospital can experience trauma when a mother and/or baby dies; professionals providing access to legal aid can be overcome by constant exposure to the recounting of traumatic experiences by clients; police, ambulance drivers and paramedics can experience vicarious trauma as a result of the work they do with victims of crime or serious car accidents; and police and their life partners, too, can experience trauma vicariously as a result of the death of a colleague through violence.

The effects of trauma

Just as the causes of trauma can be many and varied, so too are the effects experienced by people who have been traumatised.  Some people experience Post Traumatic Stress Disorder (PTSD).  This usually occurs when a person experiences an event that is personally life-threatening to themselves or others and is more likely in situations where a pre-existing mental illness is present, and/or a series of traumatic events are involved, such as sexual abuse.  People who have PTSD will experience “feelings of intense fear, helplessness or horror” and tend to replay the traumatic event(s) over and over, so that their intense anxiety condition becomes locked in.

The spectrum of responses to the experience of trauma is very wide – from numbness and inertia to aggression and violence.  People who experience trauma can become withdrawn and avoid interactions; experience de-sensitisation to the people and situations they have to deal with; experience on-going depression; become cynical or distrustful in their interactions; or experience a profound and enduring sadness.  They may question their self-worth and accomplishments; experience difficulty in relaxing and sleeping; or be overcome by a deep sense of grief (where someone significant to them has died).

The psychological effects of a physical injury, car accident or injury as a child can easily be overlooked.  In their Guide, How Trauma Affects the Brain,  the Lanier Law Group provides a comprehensive discussion of the psychological effects of such traumatic events and discusses various modalities for healing from trauma.  Their Guide also covers PTSD after an injury and following service in combat areas.

Accessing our internal resources

In a previous post, I wrote about how to use the R.A.I.N. meditation process to deal with fear and anxiety.  However, in cases of trauma and intense grief, we may not be able to plumb the depths of our feelings because the experience would be too painful and/or cause flashbacks to the traumatic event(s).

Tara Brach, in the course on the Power of Awareness, described how to access internal resources to cope initially with the psychological pain experienced with trauma.  Drawing on her own experience with trauma victims and sound research in the area, she suggests a number of ways to resource ourselves:

  • Physical grounding – this involves getting in touch with the feeling of our feet on the ground and our buttocks on the chair.  The physical sensation of contact with the ground or chair is important because it enables us to link the sense of safety and security through sitting or standing with our psychological experience.
  • Breathing deeply and slowly – this could begin with lengthening our in-breath and out-breath and move to mindful breathing, which includes paying attention to the space between.
  • Touch – touching our heart or stomach with some loving gesture that brings warmth to relax our body.
  • Talking to ourselves – we can use comforting and supportive words while engaged in conversation with ourselves.
  • Envisaging our allies – there may be relatives or friends in our life who provide very strong emotional support and constant affirmation of our self-worth.  There are others such as members of a support group for a chronic illness or for loss of a child or loved one.  Bringing these people to mind together with the feelings of kindness and encouragement they engender, can build our inner resources to cope with trauma.
  • Revisiting a place of peace or relaxation – we can do this physically or just by visioning what it was like to be in our favourite place.  It could be by the bay or at the seaside, in the mountains or on the deck in our home-anywhere that gives us strength, renews our spirit and intensifies our feelings of security.

Whatever process we use for inner resourcing, it is important to get in touch with what positive effects we are feeling in our body, as well as in our minds.  Tara Brach, in the Power of Awareness course, encourages us to use resourcing meditations based on the above listed pathways to tap into, and strengthen, our inner resources.   She argues that these meditations are a true refuge, unlike the false refuges of drugs or alcohol.

Being able to deal with trauma through the R.A.I.N. meditation process (plumbing the depths of our fear or grief) may take months of resourcing ourselves before we can confront the depths of our emotions, but Tara’s own counselling experience with people who have suffered trauma (including PTSD) confirms that it is possible to emerge from the depths to live a balanced and happy life.

As we grow in mindfulness through resourcing meditations, we strengthen our inner resources to cope with the profound psychological effects of a trauma and build up our capacity to deal with the resultant debilitating emotions.

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

Image source: courtesy of Maialisa on Pixabay

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.