Living with Chronic Illness:Finding Resilience
2012 Michigan BCCCP / WISEWOMAN / MCRCEDP Annual Meeting May 2-3, 2012
Debra Mattison, LMSW, OSW-CUniversity of Michigan Health System
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Objectives
• Explore common psychosocial stressors across the illness continuum from diagnosis to end of life
• Identify effective interventions to support and assist patients living with chronic illness
• Acknowledge our own psychosocial stressors as professional caregivers
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Diagnosis of Chronic IllnessA Dark Night of the Soul
• Sadness, Trial, Loss, Frustration, Failure
• Touches the Core
• Pushes to the Edge
• Forces Questions
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Powerlessness
• No Longer Able to Impact Destiny
• Feel Controlled and are Controlled
• Fears
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Regaining Power and Control• Help Patient Confront Fears and Increase Sense
of Control
What are you most worried about or afraid of?What would you like to see yourself be able to do,
to feel, to experience?Let’s explore choices you have…How can you get around, through, above…?What helps you feel more in control or like you
have more power?
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Self- Concept
• Look and Feel Different
• Loose Sight of Self
• Relationships
• I Don’t Matter
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Improving Self-Concept• Focus on the Patient’s Unique Life and
Experience
How do you matter?Who do you make a difference to?What have you done that only you could do?What is life still expecting of you?What do you hope to leave as your legacy?
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Isolation and Loneliness
• Different
• Disconnected
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Increasing Connectedness
• Help the Patient Search for Sources of Significance and Connection
When do you feel most nurtured?Where/with whom do you feel connected?What comforts and encourages you now?
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Hopelessness
• Ambiguity and Uncertainty
• Wear and Tear
• Search for meaning
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Encouraging Hope
• Help Patient Identify Hope as Something that is Always Appropriate and Meaning as Something that is Always Possible
What might you want to hope for today?What do you hope for most?What meaning have you given to your
cancer?How has your illness mattered to others?
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I’m Beyond Tired!
I’m sick of being sick!
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Cultivating Resilience
• Ability to Bend and not Break
Changing Responses (Do)
Shifting Perceptions (Feel)
Experience and Attitude (Meaning)
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Physically Cared For
• Fuel Our Bodies
• Re-Charge
• Non-Abuse
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Mentally Focused
• Realistic View of the World
• Choose between What Is and What Isn’t
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Emotionally Connected
• Healthy Relationships
• Distinguish What We Feel from Who We Are
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Spiritually Aligned
• Purpose and Meaning
• Hope and Comfort
• Being versus Doing
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Allow the Story
• Listen
• A Patient’s World View
• What It Means to Be Well or Sick
• Their Values and How They See Wellness Occurring
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Notice the Words
• Power
• Perspective
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How Would You Feel…..
• “I’m sorry to tell you that you have failed the treatment.”
• “Do you want to try again with another treatment?”
• “We will need you to strictly comply with the protocol. Can you do this for me?”
• “There is nothing more we can do for you.”• “If your heart should stop, would you want
us to do anything to help you?”
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Communicate
• About• To• With
How are things going for you and your family?What has been most difficult for you since we last
met?
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Collaborate and Problem Solve• Address Practical Issues
• Do Advanced Planning
• Involve Family
What practical problems is your illness creating for you?Sometimes people…..is that something you have thought
of/are experiencing?Here’s what we can anticipate and plan for.
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See the Person
• Disease vs. Dis-Ease
• Medical Emergency vs. Human Emergency
• Parts vs. Whole
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• Who are you?
• What is going well?
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Every Patient is
• Like ALL other Patients
• Like SOME other Patients
• Like NO other Patient
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HMO
Healing Meaning Options
• Control and Acceptance • Ask Different Questions• Hope, Purpose and Meaning• Personal Strength and Autonomy
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Our Psychosocial Stressors
• Powerlessness
• Self-Concept
• Isolation and Loneliness
• Hopelessness
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Self-Assessment Questions
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Reflection and Affirmation
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• Frankl, V. (1968). Man’s search for meaning. New York: Washington Square Press.
• Lawlis, G. F. (1996). Transpersonal medicine: A new approach to healing body-mind-spirit. Boston: Shambhala Publications.
• Moore, T. (2004). Dark nights of the soul: A guide to finding your way through life’s ordeals. New York: Gotham Books.
• Puchalski, C. M. (2006). A time for listening and caring: Spirituality and the care of the chronically ill and dying. New York: Oxford University Press.
Selected References
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