Coping Techniques for Staff Working with

Abuse Cases Dr. Karen S. Scott

July 2017

Self-Care We’re just not good at it!

Stress

-Is the perception that your demands exceed your resources for dealing with them

-Our bodies don’t know the difference between perception & reality

Coping With Stress • When you are stressed you need all

your abilities, but when stressed, they are all underperforming

• Develop active coping mechanisms

• Sense of control helps lessen the perception of inability to deal with stress

Objective: Identify & Practice effective strategies for managing work-related compassion fatigue & grief.

Confessions of a Self-Proclaimed Type A

Champion Worrier Super-Woman

Disconnect between Head & Heart

We know we need to take care of ourselves, but we don’t

Healthcare Workers & Burnout

• Go into the field for patients—then no time left for you

• Intensity of your work & the bonds you build

with people you are caring for = good/bad

• Good to care about patients, but MUST distance yourself at times

Compassion

• Good News: Compassion makes you good at what you do

• Bad news: When your compassion is stretched too thinly, you become limited in how you are able to care for others, and ultimately, how you care or fail to care for yourself.

Characters of Helping Professionals that Increase Vulnerability

• Caring nature-put others first

• Don’t think we need to take care of ourselves

• Super Human stigma—self-imposed or expected?

Compassion Fatigue “Soul Weariness”

• Burnout + Secondary Trauma = Compassion Fatigue

• Both physical & emotional exhaustion

• Vicious cycle of stress, burnout, exhaustion normal daily traumas greater negative impact increased burnout

Compassion Fatigue

• Both physical & emotional exhaustion

• Develops over time

• Over time, overuse of compassion skills erodes your ability to feel and care for others

• Escalated by traumatic situations & incidents - death of child

When Helping Hurts by F. Oshberf

Trauma & Vicarious Trauma • Registers in amygdala –triggers fight or flight

sympathetic nervous system • Slower pathway to thalamus-relays info to

neocortex for processing • If non-threatening, parasypthetic nervous

system should shut down process • Presence of Cortisol (present in high stress)

blocks inhibitory process –don’t feel safe even when safe, so remain in chronic stress/trauma

Compassion Fatigue (Vicarious Traumatization) affects:

• Sense of self • World view • Spiritual life • Affect tolerance • Interpersonal relationships • Imagery System of Memory

Karl LaRowe, Breath of Relief: Transforming Compassion Fatigue into Flow

Cell Phone Analogy 3 Ways to charge

We Know What We Need to Do But . . .

• Stay up late to get more done

• Cancel gym membership because never time to go

• Feel burned out so we isolate

• Grab fast food-no time to plan meals

• Sleep

• Exercise regularly

• Social Support

• Eat Healthy

Barriers: Why don’t we practice self-care?

• Characteristics of helping professionals make us resistant to self-care

• Messages in our heads—What is your self talk?

• Expectations of others—Who? What? • Obligations outside work—What are they?

Emotional Hygiene • Debriefs – formal & informal • Redefine what is means to be strong and

competent • Know your “tell” – signs that you are

emotionally depleted • Prioritize meaningful connections with

others • INTENTIONAL self-care practices

Models for Self-Care

To Manage Stress & Increase Resilience

Quadrants of Self-Care During • Focus on task at hand • Stay focused &

grounded • Awareness-breath &

body • Create protective

distance-take step back

• Leave the trauma when you leave

Before

• Regular physical Care

• Recognize Triggers • Grounding & self-

check-in

Quadrants of Self-Care Later-Ongoing • Regular

relaxation/exercise • Build & use broad

network of support • Have a life outside of

work • Practice spiritual

renewal • Transitions to & from

trauma; to & from work

Immediately After • Body Awareness-

relaxation techniques • Breathing-Mindfulness

Exercises • Reframe; redirect

thinking • Utilize support • Transitions from Trauma • Transitions from Work

Breathing Controlled, Purposeful

COPS • Control—Know what you can & can’t

control

• Outlets for Frustration—need safe place to express (therapist, trusted friend, journal)

• Predictability—depend on & anticipate activities that relieve stress (exercise, mindfulness, fun activities)

• Social support—friends, trusted co-workers, family

Robert Sapolsky- Why Zebras Don’t Get Ulcers

Self-Care Interventions

• Establish boundaries with others

• Discuss difficult situations with colleagues-listening can clarify your vision & what motivates you

• Communicate/express your needs to family & friends

• Recognize your triggers & signs that self-care is slipping

Self-Care Interventions Continued

• Learn to say “NO” and not feel guilty about it

• Take time off from caregiving to enjoy your hobbies and personal interests.

• Exercise, Yoga, Meditation, Mindfulness

• Honor yourself and what you do for others.

• Nurture what counts in your life

• Humor

Behaviors to Avoid: • Do NOT increase your work load –don’t take

on more hours • Don’t self-medicate: alcohol or drugs • Elminate self-deprecating statements • Don’t ignore the problem • Don’t blame yourself or the system • Don’t eliminate time spend with friends or

family. • Don’t neglect your relationships!!

Mindfulness Meditation

• Non-judgmental, present-time awareness

• Focus on breath or body, stay present & experience bodily sensations, mental & emotional states

• Allows us to remain focused & calm • makes you less emotionally reactive—more

in rest & digest mode instead of fight or flight

How does mindfulness help? • Increases ability to stay focused in extremely

charged situations.

• Differentiate between a professional situation & your feelings about it.

• Problem-focused coping vs. emotion focused coping—when the two get confused, it is difficult to know how to respond—generates more pain & suffering

• Mindfulness & meditation focus your attention on something available in your present moment –creates stable, resting place for your mind

Kabat-Zinn, Full Catastrophe Living

Body Awareness

• Major therapeutic tool in prevention & intervention

• Awareness of breath & body is part of mindfulness

• The more aware you are of your body, the faster you will know when something is wrong

Mindfulness (with chocolate)

Your Self-Care Plan: • Create workable & helpful self-care plans

• Exercise is one of most effective strategies

• Describe the perfect day of your dreams.

• What one realistic thing could you do for yourself today that would capture the essence of your fantasy day?

Your Self-Care Plan

• What was your favorite thing to do as a kid? How could you recreate that activity as an adult?

• What is the best compliment you have ever received about your work?

• Who can you talk to about your stressful days?

Reframing a “Failure” • Stop judging

• Acknowledge your efforts & everything that was done for the patient

• Acknowledge limitations of the “system” & the medical field

• Give yourself credit for all the times your

efforts have been successful

References • American Counseling Association, “Fact Sheet 9: Vicarious Trauma” • Holdsworth, N., “Compassion Fatigue, Vicarious Trauma Secondary Trauma, Burnout” • Kabat-Zinn, Full Catastrophe Living • Koch, W. J., “Psychological Trauma: A Common Problem • LaRowe, Karl., “Breath of Relief: Transforming Compassion Fatigue into Flow” • Middleton, J., “Addressing Secondary Trauma & Compassion Fatigue in Work with Older Veterans: An Ethical Imperative” • Pross, C., “Burnout, Vicarious Traumatization & Its Prevention” • Oshberf, F., “When Helping Others Hurts”