Author: Laura Hawley, Lic Ac, LCSW

Accepting help, building community

Posted on March 18, 2020 by Laura Hawley, Lic Ac, LCSW - No Comments

Fifth in a series of five posts

In Trauma Stewardship, Laura Van Dernoot Lipsky discusses trauma mastery as one motivation for engaging in caregiving professions. “We seek to turn a traumatic situation in which we once felt powerless into a new situation where we feel competent and in charge….This is a sophisticated coping mechanism, and largely it is done unconsciously. If we are conscious that we are seeking trauma mastery, and if we navigate with insight, mindfulness and honesty, this mechanism may contribute to our healing.” We cannot do this alone, preferring always to care rather than be cared for. We are in this work for our sakes, to learn to accept as well as to provide.

Consider the spirals and circles in your own experience as a giver of care. We spiral into impatience and despair when we feel cut off from support. We circle back to hope and purpose with the help of other people.

Look at the acknowledgements page of a book you rely on in your own work and life. Choose the work of an author you admire. You will almost always find a long list of names, and the comment that there are too many people who have helped them do what they need to do. Even to write and then to publish this short series of posts took the time and kindness of many people besides me, a book mentioned by a new client, the final push from a coach and friend, and the steady patience of my web support person.

In part one of this series I suggested that caregivers often start out unskilled at accepting help and care from other people. What brought us into these professions is not enough to support us in them. Good caregivers can become good care receivers, but we have to learn to include ourselves in our caregiving practice. Self compassion is a vital component of sustainable compassion. Here’s wishing us all growth and wisdom on our paths.

(5)Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, Laura Van Dernoot Lipsky, Berrett-Koehler Publishers, Inc 2009

Finding our Way Home

Posted on March 11, 2020 by Laura Hawley, Lic Ac, LCSW - No Comments

Fourth in a series of five posts

Only connect! … Live in fragments no longer.
E.M. Forster, author

How do we pull out of the spirals large and small that are part of the human experience in general and the caregivers path in particular? We do this through that of awareness and connection.
We can start with connecting with our mind, body and heart and with the people around us.

Become aware of your frame of mind at work

What do you think you are doing there?

As a young social worker I had a great job working with people with major mental illnesses. I cared a lot about them and I liked and respected my coworkers. I had a wonderful, caring boss. But my frame was off. I began to suffer on the job. I wanted to solve every injustice the people I worked with encountered, and felt it was my fault that I couldn’t. I had the unconscious notion that the more I suffered, the less the people I worked with would suffer. This frame did not serve me well, to put it mildly. But I wasn’t at all aware of my frame. It was the air that I breathed.

There were other important things I didn’t notice. I paid too little attention to how the people I worked with endured, and too much to what they endured. I gave a great deal of thought to what I could do little about – to what was crazy about the systems that oppress people. I gave less attention to how we all find hope, and growth and connection.
In two years I had exhausted myself. I ached all the time. I walked around saying “This job is eating me for breakfast.” It took me a long time to see that it wasn’t the challenge of the job that was eating me. What burnt me out was the way I framed it to myself. I didn’t know how to see the strength in the people I sought to give care to. I didn’t know how to seek support, or how to care for myself.

Here are some suggestions of how to bring awareness to yourself and your caregiving work.

Stay with the body

Notice what happens in your body. Do you hold your breath at work? Are you eating when you are hungry and drinking when you are thirsty? Does your blood pressure go up around certain people? Do you lose sleep over certain interactions or ongoing conflicts at work?

The body holds our experience. The emphasis with body focussed therapy tends to be on the trauma and tension the body holds, but it also includes the body’s experience of safety and peace in the here and now. Notice where the body feels supported and grounded. I offer a practice I call sitting all the way down. It makes the concept of accepting support very tangible. It’s just this. SIt comfortably in a chair. Breathe in and notice where your body is making contact with the surface underneath and behind it. Breathe out, and invite yourself to accept a little more support from the chair. That’s all, just breathe in and notice, breathe out and accept more support.

Give your own heart your consideration

Does your heart sink when you picture yourself at work? Does it feel tight or tired a lot of the time? Is it somewhat unfamiliar to you? How open or closed does it feel? Are you as open as you used to be to people whom you love, or does your home life seem like a hassle, just one more obligation?

There’s connecting with others and there’s connecting with the self. Sometimes the stressful events we deal with cut us off from our inner support and resources. I worked with a dedicated doctor who was in a spiral of anxiety and feelings of unworthiness triggered by the death of a patient. The doctor felt she could have done more. She wasn’t sure that this would have prevented the death. Indeed, a thorough review by the hospital board had exonerated her. Still she was preoccupied with guilt and with the sense that she was now undeserving of happiness. It was hard for her to engage with her work and the rest of her life the way she had before.
We worked with a practice from Somatic Experiencing called pendulating. I asked her to notice a place in her body that felt safe and relaxed. She described a warm, relaxed feeling in her belly and lower body. We spent some time being curious about that feeling. Then I asked her to notice where in her body she felt agitated and anxious. She moved her awareness to her heart. She said, “I had no idea how sad I am.” She spent some time just noticing this, how sad she was in her heart. Then at my suggestion, she turned her attention again to her warm, calm stomach. We noticed that again with care. When she turned her attention back up to her heart, now placing her hand over her heart to support herself, she said, “Now I feel sad, but grounded at the same time.”

She was on her way back to herself. She was on her way back to including herself in her care.

Cycles versus Spirals- Developing the skill of sustainable compassion

Posted on March 4, 2020 by Laura Hawley, Lic Ac, LCSW - No Comments

Third in a series of five posts

Compassion provides us the breathing room we need to keep on keeping on.
Laura Van Dernoot Lipsky, trauma social worker and educator

How can we learn to cultivate the skill of sustainable compassion as we engage in caregiving work? In the rest of this series of posts, I suggest ways to attend to this vital aspect of caregiving by becoming aware of what I call cycles and spirals through the lens of body, heart and mind.

A cycle moves from one phase to another around a point of balance. There’s the respiratory cycle, for example. We breathe in and out, keeping ourselves in equilibrium. There is the sleep wake cycle. In a holistic sense, life itself can be understood as an interdependent web of cycles. There are also social cycles. Some are as simple as: I say hello to you, and you respond to me, saying hello in return. Or as complex as: I recognize you as separate from me, and you recognize me in turn. Humans tune in to social cycles readily, noticing with some tension if a greeting is not returned in kind. We evaluate the quality and equality of social exchanges with close attention, even if not on a conscious level. Significant and complex imbalances in the social cycles are the stuff of conversations with close friends, letters to the advice columnists and the subject of many hours in therapy. We seek to understand what went wrong, and to achieve a new equilibrium.

A spiral is a trajectory that spins away from equilibrium. We talk of spiralling into depression, for example, or a situation spiralling out of control. We watch with uneasy fascination as an Olympic skier loses their center of gravity and falls in a sickening spiral down the mountain.
Caregiver burnout, or compassion fatigue, takes the form of a spiral. There’s the loss of a center of gravity. There may be a focus on how systems frustrate our mission, making it seem hopeless or overwhelming. We may focus on perceived deficits in our clients or in ourselves. Over time, what once was a cycle of effort made and satisfaction achieved becomes a spiral of increasing withdrawal and decreasing satisfaction.

Recognising spirals of fatigue in body, heart and mind

We learn compassion through awareness of the body, the mind and the heart. Consider these three aspects of being in addressing spirals that lead to burnout.

In the body we may feel:
-Exhaustion
-Fatigue
-Tearfulness
-Pain
-Tension
-Tinnitus
-Blurriness
-Changes in appetite or sleep
-Inertia – coming home from work and collapsing on the couch
-What a friend calls “going feral”- pop tarts for dinner, for example, only washing the top layer of dishes in the sink, dressing from the pile of laundry on the chair
-Feeling rundown
-Getting sick more easily and staying sick longer

A physical example of a burnout spiral might be inertia and poor eating leading to achiness and thus to more inertia and more poor eating. Darryl heads home very tired from working as an administrator of a nonprofit. They skip shopping for groceries, skip going to the gym and sit on the couch eating pizza and drinking diet soda. They feel tired and achy the next day too, and discouraged by having made that choice, but work is exhausting again, and they find themselves again choosing to eat pizza and veg out. After a couple weeks of this, it is harder than ever to get to the gym after work.

In the mind we may notice:

-Negative self talk
-Difficulty focussing, planning, initiating and or decision making
-Feeling overwhelmed
-Feeling irritable
-Difficulty seeing a way back into real engagement with the work, or a way to get out of work that is damaging us
-Holding grudges against yourself or other people
-Feeling too tired to say no to requests

If you have read this far, you may have enough experience with burnout to draw your own spiral, but here’s one; Jerome feels overwhelmed by the volume of patients at the clinic where he works as a nurse. He is asked to take on some administrative tasks. He feels too tired to negotiate the process of declining this request from his overworked boss, and then feels more overwhelmed at the prospect of these extra duties.

In the heart we may notice:
-Heartache
-Indifference
-Discouragement
-Resignation
-Grief
-Guilt
-Despair
-Decline in imagination, creativity, sense of humor, spontaneity
-Difficulty caring
-Withdrawal

A spiral may be one of withdrawal leading to guilt and to more withdrawal. Joanne decides that she won’t go home for the holidays because she’s so worn out from her work as a doctor at a hospice. She feels guilty about it, and stops telling her sisters as much about her worries when they call, reasoning that, “I wasn’t there for them, why should they be there for me?”

Understanding Compassion

Posted on February 26, 2020 by Laura Hawley, Lic Ac, LCSW - No Comments

Second in a series of five posts

If your compassion does not include yourself, it is incomplete.
Jack Kornfield, American Buddhist monk and educator

In my experience, compassion is not defined correctly in the concept of compassion fatigue.
The word compassion is used to include other emotional stances, ranging from empathy to sympathy to pity and even to despair. Compassion, on the other hand, recognizes the suffering of another as a reflection of our own pain. Our desire to alleviate the suffering of others must come from a balanced place if it is to be sustainable.

Sustainable compassion for others includes both me and the other person. My compassion for other people arises from my own compassionate self acceptance. When I don’t have compassion for myself, then what arises from me in response to another’s suffering maybe sorrow, or empathy, or pity, but it is not compassion. Buddhists train in compassion because it is a skilled state, requiring us to discern it from other states that may imitate and undermine it. As a skilled state, “compassion is viewed as a power for purifying the mind of confusion, for inner healing, and for protection of self and others.” Thus true compassion replenishes itself, and does not get fatigued.

This skill of cultivating sustainable compassion in caregiving professions is rarely taught. Leading traumatologists suggest that people who are attracted to care giving often “hail from a tradition of other-directed care giving. Simply put, these are people who were taught at an early age to care for the needs of others before caring for their own needs.” As children, we may have been praised for being nice and listening well to other people. Our own need to be seen, listened to and cared for may not have been as well met. It may have made sense to be seen as caring if we wanted to be seen at all.

Caring for others is a calling, but it can also be driven by a creative adjustment, a largely unconscious defensive strategy that allows the giver to avoid awareness of grief and trauma related to early disappointment, neglect or abuse. We may come to caregiving professions with a distinct lack of compassion for our own selves. We may be using other directed care partly to avoid painful aspects of our own needs. This is the path to burnout. The journey of the caregiver must include confronting the limits of this avoidant strategy. It must include coming to love ourselves as much as we love other people.

(2)Bringing Home the Dharma: Awakening Right Where You Are, Jack Kornfield
(3)Compassion in Buddhist Psychology, John Makransky, PhD Chapter Four in Compassion and Wisdom in Psychotherapy, edited by Christopher K. Germer and Ronald D. Siegel, Guilford Press, 2012
(4)J. Eric Gentry and Anna B. Baranowsky

Reframing Compassion Fatigue in Caregiving Work- Spirals and Cycles

Posted on February 19, 2020 by Laura Hawley, Lic Ac, LCSW - No Comments

First in a series of five posts

Compassion Fatigue is defined as “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”
Dr. Charles Figley, author, Secondary Traumatization and Compassion Fatigue

Chronic compassion fatigue can lead to burnout: physical, emotional and mental exhaustion experienced after a time of intense effort. The word implies a state arrived at from a place of passion. Once engaged and excited, the burnt-out person finds themselves less capable of raising a spark of interest, never mind a flame. It’s not that the person doesn’t care as much, it is that they can’t care as much as they used to. There is a risk of this in all caring professions: educational, medical, nonprofit, political, activist, veterinary, social work, therapy, law enforcement, journalism and ministry, just to begin the list.

People in caring professions ourselves live under systemic oppression related to race, class, gender identity and expression, immigration status, sexual orientation and other aspects of being in a society that is increasingly polarized. We all live with governing and economic systems that undermine our citizenship and our value as human beings. We all live in awareness of climate change and environmental crisis. In this context it is vital that we build our understanding of the compassion that can sustain us in these difficult times.

In this series of posts, I offer some conceptual frames for defining compassion and recognizing and addressing burnout. My aim is to provide new ways of understanding self care and support for people who do such important and challenging work.