Adaptive Caring: Care for Self and Others When Responding to - - PowerPoint PPT Presentation

Adaptive Caring: Care for Self and Others When Responding to Personal Suffering

Ted Bowman Family and Grief Educator www.bowmanted.com tedbowman71@gmail.com

Plan for the Time

• Self-awareness – Key Starting Point
• Loss as Broad Concept
• Resilience and Ministry
• Empathy Fatigue & Compassion

Satisfaction

• Palliative (Pastoral) Care at Their Best
• Case Studies, Stories, Discussion

Essentially, the only instrument we bring to the helping process is ourselves. Hence, the more self aware we are the more present we can be in the helping exchange.

Paraphrased from comments by Virginia Satir

Self Awareness

The expectation that we can be immersed in stressful work daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. The expectation that we can leave stresses in our personal or work lives and not bring them to the

• ther is also unrealistic.

The way we deal with distress and loss shapes our capacity to be present to life more than anything else.

The Things We’ve Handed Down

Will you laugh just like you mother Will you sigh like your old man Will some things skip a generation Like I’ve heard they often can Are you a poet or a dancer A devil or a clown Or a strange new combination of The things we’ve handed down Marc Cohn

• The way we “see” someone or their

condition will determine the kind of remedy we offer.

• The direction in which we look will

determine what we see.

Loss as a Broad Concept

L O S S Refers To Being Deprived Of Or Ceasing To Have Something That One Formerly Possessed Or To Which One Was Attached LOSS can and does disrupt past, present and future stories

Can We Protect Children Or Families From Change, Loss And Grief? “The greatest gift you can give children and parents is not protection from change, loss, pain,

• r stress, but the confidence and

tools to cope and grow with all that life has to offer them.”

(Harpham,2004, p.13)

The Guest House

This being human is a guesthouse. Every morning is new arrival. A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor. Welcome and entertain them all!

Beginning lines of a poem by Rumi

Dehumanization Of Loss

Repeated experiences of unacknowledged and unmourned loss contribute to the dehumanization of loss…It’s one thing to lose something that was important to you, but it is far worse when no one in your universe recognizes that you lost it.

Kenneth Hardy

Transference

THE RELIVING of PAST or CURRENT INTERPERSONAL RELATIONSHIPS in CURRENT SITUATIONS A tool that allows one to bring material from the past into conscious awareness A way to work through issues so that they are not repeated in destructive ways

Countertransference

The totality of feelings experienced by the volunteer toward the client-whether conscious or unconscious, whether prompted by the client's dynamics or by issues or events in the volunteer's own life

Renee Katz

Countertransference

• Natural, Appropriate, Inevitable
• Crucial Source Of Information
• Positive And Important Therapeutic Tool
• Basis For Empathy And Deeper

Understanding

• Indispensable Instrument In Our Work

Identity Contingencies

Things one has to deal with in a situation because you have been given a social identity because you are old, young, gay, a white male, a woman, black, Latino, politically conservative or liberal, diagnosed with a bipolar disorder, a cancer patient, and so on

• From Whistling Vivaldi by Claude Steele

Our Work versus Their Work

Challenges Honoring self determination Distinguishing what people want versus what we think they need Do you have the skill set? Assist people to know for themselves what they want based on “what they can have” Being clear about scope of practice

Scope of Practice

What is your role with this individual and family? Pastoral Care: therapy or support? Pastoral Care: how are boundaries set or honored?...with board chairs, with staff? When asked to do family work or when you choose to do family work, is that within your scope of practice?

Boundaries

Boundaries are the limits that allow for a safe connection based on the participant's

• needs. When these limits are altered, what

is allowed in the relationship becomes

• ambiguous. Such ambiguity is often

experienced as an intrusion into a sphere

• f safety.

Spectrum of Boundary Difficulties

Distancing Over-identification Avoidance Over-involvement Detachment Enmeshment Repression Self Revelation Denial Identification Withdrawal Reciprocal Dependence

What are Your “Red” Flags?

• What sorts of situations are hard for you

for whatever reason?

• What behaviors or words get to you?
• What erodes your ability to do good

work?

• And what do you routinely do that seems

inconsistent with your internal self- image?

Empathy

Seeing with the Eyes of Another Hearing with the Ears of Another Feeling with the Heart of Another

Empathy denotes an affective response to the directly perceived, imagined, or inferred feeling state of another person Empathy Distress (stress connected to exposure to a sufferer and the intent to do something) Empathy Fatigue (state of exhaustion resulting from prolonged exposure to and efforts to alleviate empathy distress)

Empathy Fatigue Seems To Have More To Do With The Agendas We Bring (Rescue, Cheer Up, Make It Better, Say The Right Words, Fix-It, Lift The Spirits) Than The Stories We Hear

Stress and Caring

Stress or Distress?? The Product of Task Demands Associated With the Care Provision and the Personal Resources Available to the Caregiver to Meet Those Demands

Cumulative Stress

• Personal stress or loss accumulation

refers to the period between the moment

• f your birth until this very hour
• Workplace stress accumulation refers to

the period between your first work or starting work in medical settings

• Stress or loss overload refers to the last

months (6-15)

Addressing the Stress of Empathy Fatigue

• 1. self-care
• 2. nurturing activities
• 3. escape
• 4. recognition (formal and informal -

spontaneous and planned)

• 5. talking about it/being heard
• 6. taking something off your plate

Resiliency

• The capacity to spring back, rebound, and

successfully adapt to adversity – Bowman from

many sources

• Also the capacity to spring forward…
• Resilience is the process of, capacity for,

and outcome of successful adaption despite challenging or threatening circumstances – Masten

• Prevent/Reduce/Restore/Add

• The ability to connect, reconnect, and

resist disconnection in response to hardships, adversities Relationships are a primary source of

• ne's ability to be resilient in the face of

personal and social hardships or trauma. Furthermore, relationships are a primary source of experiences that strengthen the individual characteristics commonly associated with resilience.

Relational Resilience

Staff Support

One And All Attend Staff Support Sessions Because Today May Be The Day One Of Our Colleagues Will Need/Want Support

Martin House (a children's hospice in England)

What Resilience Is Not

• Resilience is not just a theory - it’s a

quality, behavior, or action

• Resiliency isn’t only for big problems -

it’s also helpful for day to day demands

• Resiliency isn’t limited to a few - it’s

accessible to all

• Resiliency isn’t assured - it can

come and go

• Resiliency isn’t only for distress - it’s

also for health promotion and life satisfaction

Factors That Promote Resiliency

• Stable, emotional relationships
• Social support
• Active involvement in coping
• Problem-solving skills
• Sense of hope
• Ability to make meaning
• Rituals, stories, traditions
• Secure attachment

Compassion optimally involves a quality of presence that conveys stability and resilience, with a balanced concern and heartfelt connection, but is not depleting

• r overwhelming to either person.

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Dual-processing model

(Stroebe and Schut 2001)

Loss Orientation Grief work Intrusion of grief Denial and avoidance of restoration changes Restoration Orientation Attending to life changes Doing new things Distraction, denial, avoidance of grief New roles, identities, relationships

From Grieving: A Beginner’s Guide (2006) by Jerusha Hull McCormick. Brewster, MA: Paraclete Press, pp. 114-116

GROWING YOUR WORLD SHRINKING GRIEF

Addressing Erosion of the Spirit

• 1. Create meaning/maintain the value-based

reasons for what you do

• 2. Infuse a current activity with meaning (find

resiliency, hope, plant seeds, do your best)

• 3. Address countertransference tendencies
• 4. Recognition (formal and informal -

spontaneous and planned)

• 5. Challenge your negative beliefs and

assumptions (e.g. nihilism, cynicism, and despair)

• 6. Participate in community-building activities,

especially in workplace teams or groups

Compassion Satisfaction

• The positive aspects of helping

– Pleasure and satisfaction derived from working in helping, care giving systems

• May be related to

– Providing care – To the system – Work with colleagues – Beliefs about self – Altruism

Cultivate Your Internal Supervisor

What does this mean to you?

• What practices do you utilize so that
• thers get your best self, not your

depleted self?

• How easy is it for you to ask for help?
• Do you truly know your “red flags”?
• What are some of your methods for

dealing with momentary distress and anxiety?

Responses

• Awareness
• Acknowledgement - Name
• Process
• Limit Setting
• Letting Go
• Grieving
• Practicing Self-care Daily
• Tend To Personal Relationships
• Cultivate Your Internal Supervisor

Measures That May Help

Reflective Writing Adequate Supervision and Mentoring Sustainable Workload Promotion of Feelings of Choice and Control Supportive Work Community Training in Communication Skills Development of Self-Awareness Skills Practice of Self-Care Activities Continuing Education Mindfulness Practices

Storying And Restorying After Loss

Involves Grieving The Old Story Before Creating The Next (Not Necessarily New) Story

• Listen For

Major Components/Themes/Values Of The Old Story How Can They Be Reframed In The Next Story

THE VERY ACT of storytelling,

• f arranging memory and invention

according to the structure of the narrative, is by definition holy. We tell stories because we love to entertain and hope to edify. We tell stories because they fill the silence death imposes. We tell stories because they save us.

• James Carroll, author, in Notre Dame Magazine (Autumn 2001)

Spirituality

Spirituality refers to the interpretative story and ensuing values of an experience that is regarded as both human and

• ultimate. Spirituality is not necessarily

anchored in religion.

Rachel Stanworth

Sorrow and Solace: Neglected

Those who study bereavement seem to be biased toward optimism Long-term grief is overlooked Some live with on-going sadness that may not get better Solace: when one consoles another Trauerbegleitung – walking alongside or accompaning

Dennis Klass

Reasonable Hope Characteristics

• Reasonable hope is relational
• Reasonable hope is a practice
• Reasonable hope maintains that the future is
• pen, uncertain, and influenceable
• Reasonable hope seeks goals and pathways to

them

• Reasonable hope accommodates doubt,

contradictions, and despair Weingarten