PATHWAYS:  A Self-Directed Program for

Compassion Fatigue Resiliency & Prevention

Overview

We have found, in our Accelerated Recovery Program for Compassion Fatigue, that attention to specific areas of the caregiver's life greatly enhances recovery from the symptoms of Compassion Fatigue and burnout.  Often times we find ourselves frustrated, exhausted and bewildered by our efforts to change situations that are simply out of our control. Complaining, blaming, antagonizing and giving up are not effective actions towards resolving the effects of stress in our lives. 

While we all work under some circumstances that are stressful and difficult, some more than others, the quality of our personal and professional lives are our own responsibility.  Dis-stress almost always negatively affects the quality of our lives and it is up to us to do something about it. 

In the next few pages you will find five categories that, if addressed with intention and hard work, can help the caregiver to resolve and prevent the unwanted effects of Compassion Fatigue and burnout in our personal and professional lives.

Take a few minutes to address each area and decide how you can improve in each of these areas, thereby creating your own "Pathway To Healing".

PATHWAYS:  A Self-Directed Program for

Compassion Fatigue Resiliency & Prevention

Compassion Fatigue (Figley, 1995) is the result of the effects of cumulative traumatic stress (primary and secondary) and burnout in the professional and personal life of the service professional.  This program is designed to help you in the Accelerated Recovery Program (ARP) develop and implement interventions which stand a good chance of diminishing the effects of this painful phenomenon in your life.  If applied and practiced regularly, the development of skills in each of these areas will also assist you in achieving resiliency and immunity to high-stress /high-demand situations.

The most important information that the authors wish to pass on to the participants of the ARP comes from years of research of the effects of stress upon humans.  It has long been known that stress has negative physical and emotional effects and that ongoing high levels of stress can produce or increase the chances of developing many physical and emotional illnesses including heart disease, cancer, alcoholism/addiction, depression, hypertension, and the list goes on and on.  Recent research has shown that individuals with high levels of stress and anxiety experience a reduction in brain neo-cortical functioning, specifically, in Werneke's Area and the hippocampus.  These two parts of the brain are absolutely necessary for the individual to retain his or her thinking and rational abilities.  A person who is experiencing chronic high levels of stress and anxiety has great difficulty accessing and utilizing his/her skills for living, working and functioning.  If you are in this program, then you have probably had one or more experiences during which you felt significantly de-skilled and overwhelmed only to later review these experiences knowing that you can normally do a much better job of handling these types of situations.

The good news is that by developing and implementing good self-management and self-care skills, you can lower your stress levels and regain higher levels of functioning.  Pathways is designed to assist you in this important goal.  This work, in conjunction with the work in the Accelerated Recovery Program, represents a "pathway" to peace-of-mind, hope, health and a lifestyle which includes personal satisfaction and professional mastery.

Below are listed five (5) areas which we have found and which research supports to be instrumental in the development of healthy lifestyles with minimal dis-stress and optimal satisfaction.

1.   Resiliency Skills

2.   Self-Management & Self-Care

3.   Connection with Others

4.   Skills Acquisition

5.   Conflict Resolution

1.   RESILIENCY SKILLS

This area of skills development represents current research findings from studying the stress management and self-care skills of successful corporate executives from several Fortune 500 companies. 

i.    Internal locus of control -  this skill/approach is concerned with the individual's ability to see problems and solutions in terms of what he/she can do to change situations/perceptions and not become ensconced in problems that are beyond the individual's scope of control and influence.  The Serenity Prayer is a helpful filter through which one can view these situations:

                                    God,

Grant me the serenity to accept the things I cannot change,

Courage to change the things I can, and

Wisdom to know the difference.

Resiliency Skills:  Internal locus of control

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ii.   Problems = challenge -  Instead of viewing problems as overwhelming or impediments to happiness, these successful executives seemed to view problems as an opportunity to be successful.  These situations provide us with an opportunity to practice our skills and do the best that we can.  Related to this was the ability of the individual to evaluate her/his performance on the work that was accomplished instead of the outcome.

Resiliency Skills:  problems=challenge

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iii.  Positive mental attitude - Originally from Norman Cousin's work, this remains an important part of successfully navigating through high-stress/high-demand situations.  Attitudes are so much easier to change than other people.

Resiliency Skills:  positive mental attitude

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iv.  Non-reactivity to emotions - This important skill involves the individual's ability to remain mindful of but not reactive to emotional states.  States like anger, fear, grief, and resentment require attention and resolution through positive action but not emotional reactivity.  Reactivity to emotionality often results in behaviour that fails to match our intentions thus producing shame and guilt and diminishing our efforts toward growth.  Thus, it is important to master self-soothing and self-regulation skills while remaining non-reactive.

Resiliency Skills:  non-reactivity to emotions

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v.   Non-reactivity to other's reactivity - This area is related to the above, however, many people are easily triggered by anxiety, anger, fear, grief in others.  We are not suggesting that the participant develop cool aloofness and cut-off from others.  On the contrary, as one develops the skills to remain non-reactive to others, the individual finds that they can care on a deeper level and actually become closer to others without fear of becoming overwhelmed or overtaxed by emotionally volatile others.  Again, this skill is contingent upon the individual's ability to self-regulate anxiety and emotions.

Resiliency Skills:  non-reactivity to other's

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vi.  De-triangulation - This important skill is concerned with not further transmitting anxiety and negativity.  Gossip, bad-mouthing and complaining are all examples of triangulation: the involvement of a third party to maintain problems between two sources.  De-triangulation involves working with others toward a solution instead of propagating the problem.

Resiliency Skills:  De-triangulation

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vii. Spirituality - This final area is one of extreme importance.  It is not the same as religious involvement, although it may include this. Instead, this area of resiliency skill is involved with the individual's ability to make positive meanings from events.  It also involves the person's connection with a Higher Power which is a source of benevolence, comfort and empowerment.

Resiliency Skills:  Spirituality

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Resiliency Skills:  Other

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2.   SELF-MANAGEMENT & SELF-CARE

This dual "pathway" of self-management and self-care compose the core skills recommended for optimal health and effective living.  More than any others, the participant who is suffering the effects of Compassion Fatigue needs to master and utilize many of these skills in his/her daily life. 

i.    Self-Management - Self-management skills refer to the ability of the individual to lower his/her anxiety and minimize reactivity in vivo, or "in the moment."  It is crucial that the participant develop and implement effective anxiety reduction and self-regulatory skills so that they can retain optimal neo-cortical functioning and minimize the effects of stress.  Some of these skills include:

•  Deep breathing

•  Positive self-talk/reprogramming internal language
•  Relaxation skills
•  Mindfulness
•  Posturing
•  Movement

Self-Management Skills

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ii.   Self-Care - As important as the skills addressed above, this area of skills involves all the activities and behaviours that the individual utilizes to care for and replenish the self.  Many people find that when they are overwhelmed they work even harder to keep up, meet performance objectives and deadlines as their bodies, spirits, family life and quality of life suffer.  In addition, people on this treadmill often find that as they work faster and harder they fall farther behind, becoming less effective.  There are diminishing returns as we become depleted.

      If you are suffering from Compassion Fatigue and have embarked upon this program, then you have been confronted with an opportunity to re-establish balance, peace and abundance for and with yourself.  Many people who have undergone this process have found themselves needing to re-evaluate priorities and make some significant changes in their lifestyles. 

      Since the developers of the Accelerated Recovery Program have roots in systemic therapy, we believe that by addressing one part of the system, that changes are made throughout the system.  In keeping with this theoretical approach, we are challenging participants to identify areas of their lives, outside of their workplaces, where changes can be made which replenish and revitalize the individual in all areas of his or her life.  Some of these areas are identified below:

•  Diet

• Exercise
• Quality time with family/loved ones
• Solitude/Meditation
• Hobbies
• Sports
• Minimizing alcohol/tobacco/caffeine consumption
• Arts/Music
• Community involvement
• Nature

Self-Care Skills

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3.   Connection With Others

Traumatized individuals almost all share feelings of isolation and being cut-off from others.  In our own experience with Compassion Fatigue, the developers of the ARP have noticed that this isolation increases as the symptoms progress.   In extreme cases, clinicians and service personnel have found themselves completely immersed in their work, with little outside contact and feeling persecuted by their peers, friends and family.  This is not healthy living.

Creating and maintaining a wide variety of positive relationships with others has long been identified as a method of mitigating the negative effects of stress.  We advocate that the participant begin to cultivate a small number of relationships with people with whom they can share themselves honestly.  This is a huge step and requires a great deal of courage - to reach out and ask for help. 

i.    Connection with Others -We challenge participants to develop important relationships through good choices and helpful communication.  Thus, mutually supportive relationships are established through reciprocal support, respect and tolerance.  The ARP participant is advised to be clear about their relationship needs and communicate this clearly and responsibly with their support network.  These relationships should be ones in which the participant has sufficient trust to share his/her secrets, fears, inadequacies.  This is taken from the Twelve-step Fellowships (AA) model of "sponsorship" in which one recovering alcoholic provides help to another.  In addition to these "special" relationships with peers, it is also important for the participant to broaden his/her contact and connection with others.  Some possible suggestions are listed below:

• Study/support groups
• Service to others through church or civic group
• Sporting groups (fishing, golf, hiking, etc.)
• Taking a class
• Social activities

Connection With Others

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4.   Skills Acquisition

This area is seemingly self-explanatory.  The more skills that you have in your career the more choices you will have to address and resolve difficulties.  This will increase experiences of mastery and minimize experiences of being overwhelmed, underskilled and stressed-out. 

i.    Skills Acquisition - What pivotal skills could you learn, over the course of the next few months, which would greatly enhance your performance and potency in your career?  What steps can be taken to move toward this training?

Skills Acquisition

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5.   Conflict Resolution

This final area is three-fold.  First, it suggests that you inventory and evaluate how much resentment and conflict you maintain toward others.  (Remember:  Resentment is the acid that eats its container).  Maintaining these resentments has diminishing returns.  Much of the time, these resentments can be resolved by journaling and discussing with trusted others your desire to resolve this resentment (not triangulating).  Often it requires a confrontation with the person while maintaining a sincere desire to resolve the resentment and the negative effects that it is causing you.  There are many methods for the resolution of conflict and resentment.  If you would like assistance with this area, please discuss it with your ARP attendant and s/he can suggest some techniques and/or readings to assist you.

The second equally important area of conflict resolution is internal conflicts with the self.  Second guessing, negative self-referencing beliefs, self-critical self-talk and internal polarities all divide and weaken the individual.  Often these negative thoughts are attempting to provide us with a kernel of truth and help (usually in the form of warnings or protection) but once their utility is recognized and acknowledged then they are no longer necessary.  It is our hypothesis that these conflicts with the self lower the individual's resiliency to stress and compassion fatigue, making us more susceptible to its effects, leading to increased conflict with ourselves.  This is clearly a vicious circle.

Finally, the third area involves resolution of primary traumatic memories.  This encompasses all experiences that have had a negative impact on our lives and have impaired our ability to function at our best level.  Addressing and resolving these parts of the story hold the promise of greater energy and increased ability to achieve the goals, hopes and dreams that pilot us to fulfilling aspirations.

We will address some specific ways to approach and resolve internal conflicts in the Accelerated Recovery Program.  However, in the meantime you can begin to notice the ways in which you talk to yourself and decide whether you wish to continue communicating with yourself in this manner.  After all, who else would you address in this way?

i.    Conflict Resolution (external)

Conflict Resolution (external)

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ii.   Conflict Resolution (internal)

Conflict Resolution (internal)

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iii.  Resolving Primary Traumatic Memories - If you have had previous traumatic experiences, please discuss these with the ARP attendant.  Since Compassion Fatigue symptoms mirror those of posttraumatic stress disorder, or if you are experiencing Compassion Fatigue symptoms, it is possible that you have unresolved traumatic stress.  Compassion Fatigue is very responsive to treatment, however, if an individual has an unresolved primary traumatic experience the work in the ARP may stagnate or even exacerbate these symptoms resulting from a previous trauma.  The ARP attendant is a trained specialist in helping others resolve traumatic stress and can help you design a program to address and resolve these symptoms.  Or we would be glad to help you "contain" this memory so that you can complete the ARP.  But we need to know about any unresolved primary traumatic experiences so as soon as you feel comfortable enough with us, please let us know about earlier traumas.

Resolving Primary Traumatic Experiences

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Other Skills/Activities

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