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 other 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, or 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 of 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 of 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
Relational Resilience • The ability to connect, reconnect, and resist disconnection in response to hardships, adversities Relationships are a primary source of one'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.
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 or overwhelming to either person.
32 Dual-processing model (Stroebe and Schut 2001) Restoration Orientation Loss Orientation Attending to life changes Grief work Doing new things Intrusion of grief Distraction, denial, Denial and avoidance of grief avoidance of restoration changes New roles, identities, relationships
SHRINKING GRIEF GROWING YOUR WORLD From Grieving: A Beginner’s Guide (2006) by Jerusha Hull McCormick. Brewster, MA: Paraclete Press, pp. 114-116
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
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