Dancing with Depression (4)

BY KARL LA ROWE - PUBLISHED: 07/28/2014 - SECTION: ARTICLES & BLOGS, HEALTH & WELLNESS, PERSONAL DEVELOPMENT

Introduction

This is the fourth in a series of articles to help bring depression “out of the closet,” to demystify it, remove the sense of shame or defect for having it and provide some accurate information about what depression really is and ways to learn to “dance” with it rather than fight it. In the first three articles we looked at the experience of depression, how it feels, the effect it can have on our thinking and perceiving process, what some of the causes of depression are, how trauma can impact the experience of depression including self-harm and suicide risk. In this final article we will look at how to “dance” with depression rather than fighting it, to learn to accept it and manage it on terms you can live with.

Accepting Depression

Accepting that I have depression was one of the most difficult things I have done. I grew up in a family in which I was suppose to be in control of my emotions even though my parents repeatedly demonstrated they were not in control of theirs. Despite our so-called modern, enlightened attitudes towards mental illness, only one if four people will seek treatment for depression. Prevailing attitudes towards mental illness including depression still blame the person who is suffering from the illness who is expected to “snap out it,” and “stop feeling sorry” for themselves.

Accepting that you have depression begins with accepting your “good enoughness.” Good enoughness is accepting who you are, as you are is always, always, good enough. Trying to hold a flame to your feet to meet an idealized version of who you believe (others think) you should be only results in an ever increasing gap between self image and reality. As famous psychologist Carl Rogers said: “The curious paradox is only when I accept myself just as I am, then I can change.” Accepting your good enoughness is the acknowledgement that while you are not perfect, you are always deserving of love and respect.

Accepting your depression is giving in, not giving up. Surrendering to the reality that you have an emotional vulnerability to depression allows you to be more aware of the kinds of stressors that can precipitate a depressive reaction and to be prepared to soothe, comfort and positively energize yourself when the need arises. In many ways, accepting and working with your depression can develop your emotional sensitivity to your moods as well as those around you. It can increase your empathy, self-understanding, kindness and forgiveness. Those who have worked with their depression and learned to to be kind, patient and tolerant toward themselves are much more in touch with their feelings and are understanding of the feelings of others.

Dancing with Depression

Dancing with depression is a skill and an art that requires practice and patience. Learning to dance begins with being open and receptive towards how and when your depression moves. This means listening with the “felt-sense” to the natural rhythm of your emotions. The felt-sense is a type of intuitive focusing on your internal experience that lets you sense and feel your emotions as they are forming. When you become skilled at quieting the mind chatter and allowing your attention to focus inwardly towards your heart, you will begin to pick up subtle signals that precede the outward expression of depression. These subtle signals are the “opening moves” of dancing with depression.

In paying attention these subtle shifts of energy within your heart you are able to attune your awareness to the intensity, tone and direction of your emotions or energy in motion. Like a skilled martial artist, you do not directly resist the energy. Resisting the energy of your emotions (as I have done countless times) only serves to add to their force while upsetting your center and balance and causing you to trip over your emotional feet.

Instead, you create a “vacuum” or emotional opening for your energy to be drawn to you. This is much like joining with your partner and smoothly taking a step backward so they will naturally follow you. In terms of dancing with depression this means creating an open, receptive, stillness within you. Rather than the initial, reactive, knee-jerk denial and withdrawal or angry “no not again!” reaction, surrender to the reality that energy in motion is being activated within you. Remain as open, receptive and aware as you are able as you allow the energy to be what it is.

As you allow your awareness to center inside you, focus on your heart region. Imagine that your awareness can surround your heart with a sense of loving kindness. As you breathe long, slow, deep, even breaths visualize this soothing energy as light and sound that is being breathed right into your heart. The light can be any soothing or enlivening color you can imagine and the sound can be waves, wind a song or a mantra that feeds your heart with positive emotions like love, kindness or gratitude.

With each breath, “invite” your depression to come dance with the energy of your heart. You cannot force it, only invite it. The energy of depression is often embedded with painful thoughts, memories, perceptions and sensations that have coalesced around the emotions of loss, anger, guilt and shame which form what we call depression. The energy of your loving heart is embedded with the emotions and experiences of love, forgiveness, kindness and gratitude. With each dance, as you feed your loving heart and allow the hidden pain of your depression to be seen, accepted and embraced with kindness and forgiveness, it transforms from your opponent to your partner.

Dancing with Depression (3)

Introduction:

This is the third in a series of articles to help bring depression “out of the closet,” to demystify it, remove the sense of shame or defect for having it and provide some accurate information about what depression really is and ways to learn to “dance” with it rather than fight it. In the first two articles we looked at the experience of depression, how it feels, the effect it can have on our thinking and perceiving process and what some of the causes of depression are. In this article we will examine how trauma can result in severe and persistent depression that sometimes leads to self-harm and suicidal thoughts and impulses.

Trauma and Depression

As mentioned in the last article there are many types and multiple possible causes of depression. Trauma particularly what is known as complex trauma is often associated with severe and persistent depression. People who have endured personal violation such as rape, physical, sexual and/or emotional abuse and neglect, particularly repeated episodes as children often develop complex trauma and are more likely to suffer from severe and persistent depression. This type of depression also seems more resistant to treatment and is more likely to be accompanied by suicidal thoughts, impulses and actions. This is the type of depression I’ve become very familiar with.

Repeated violations to physical and emotional safety and integrity especially at an early age is highly disruptive to developing a coherent sense of self and stable self-esteem. Trauma is a highly energetic, disruptive intrusion into the developing self that often prevents the consolidation of a whole and integrated sense of integrity and identity. Rather, a person may experience themselves as “weak,” “fragile,” or “incomplete.” They often experience intense instability, even volatility in their emotions and can repeatedly find themselves in chaotic relationships. There may also be difficulties controlling impulses and are prone to intense feelings of self-loathing and at times self-harming behaviors.

The depression experienced by people who have experienced complex trauma is often severe and persistent. The depth of pain and anguish experienced is usually difficult for others to understand. There is often the sense of a “bottomless pit of pain,” that threatens to swallow the person whole or to fragment their fragile sense of self into pieces. There is an authentic sense of victimization and helplessness that cannot be abated by being encouraged to “snap out of it.” The resulting sense of inadequacy, self-blame and hopelessness places these individuals at a much higher risk for self-harm and suicide.

Self-harm and Suicide Risk

Self-harming behavior is not the same thing as a suicide attempt although it places the individual who repeatedly harms themselves at a higher risk for injury and/or death. Many people inflict harm on themselves in a myriad of ways; from substance abuse to getting repeatedly involved in hurtful relationships to cutting, burning even swallowing razor blades. As a mental health examiner I’ve personally worked with many individuals who repeatedly harm themselves for a variety of reasons other than to die by suicide including; punishing, distracting, stimulating, releasing, even arousal. For many people who have chronically dissociated or disconnected from their physical/emotional sense of self as a protection from the pain of past traumatic injuries, the stimulation of self-harm is sometimes all that can be felt; and to feel pain is better than to feel nothing.

Suicide risk is measured more in relation to the frequency, intensity and duration of suicidal thoughts, intentions and plans in combination with known risk factors. There is often a progression of depression leading to suicide that is sometimes not apparent to others because it may be concealed, particularly in the final phase. People who are at higher risk for suicide often express suicidal thoughts and intentions that are frequent sometimes obsessive, very intense that they have endured “past their limit.” They have created a specific plan that they have prepared and rehearsed. In the last phase of their depression called the “6 day amazing reversal” they have made their mind up to suicide and may appear to have “improved.”

Risk factors are known identifiers associated with people who have taken their lives by suicide including: Currently suffering from Major Depressive Disorder or Bipolar Affective Disorder, alcohol and/or drug abuse and dependence and Schizophrenia, Others include past trauma and/or PTSD, eating disorders, Borderline and Antisocial personality disorders. The one risk factor that stands out far more than all of the others is previous attempts.

Previous suicide attempts – not gestures, particularly those that would have resulted in death if not discovered and stopped is the single most powerful predictor because a person who has actually attempted suicide and did not expect to be rescued crossed a line. Its a line I remember crossing many years ago. The experience is still fresh. It is the experience that something inside of me broke. The depression was so severe and unbearable, something literally “snapped.” I can still remember the sensation. At the point of the snap, something within the foundation of my sense of self gave way. It was both defeat and relief. The fight was over. I remember thinking “clearly” for the first time in months: “of course, suicide IS the solution – how could I have missed it before?”

At that time I was living with a roommate, a childhood friend I knew very well. I knew when he left for work, his typical pattern in the morning and when he got back in the evening. I was working shifts in the emergency room and had a great deal of flexibility in my schedule. I planned it all out calmly and carefully. I waited until Monday morning – a morning I had off and I knew he had to drive a long distance to get to his work. After he pulled his car out of the garage and was gone for thirty minutes I pulled mine in. I taped the door shut with plastic. It was a small garage and the fumes would fill up fast. I knew the fumes would irritate my eyes and make me choke so I stole medication I took from a patient I saw in the emergency room who attempted suicide by overdose. I estimated there weren’t enough left to kill me, but would certainly put me in a deep sleep. I swallowed the medication, turned on my car and went to sleep.

Next article will be on "dancing" with depression.

Dancing with Depression (2)

What is Depression?

BY KARL LA ROWE - PUBLISHED: 06/25/2014 - SECTION: ARTICLES & BLOGS, CONTENT IN A BOX, HEALTH & WELLNESS, HELP & INSTRUCTIONS, KARL LAROWE, PERSONAL DEVELOPMENT

Introduction:

This is the second in a series of articles to help bring depression “out of the closet,” to demystify it, remove the sense of shame or defect for having depression and provide some accurate information about what depression really is and ways to learn to “dance” with it rather than fight it.In the last article depression was presented from a first hand account from having experienced it. This article will focus on what depression is, and what can cause it.

What is Depression?

There are many opinions about depression – what it is and isn’t, how you get it and what to do about it. The following explanation is based upon my personal experience as an individual who has lived with depression since childhood, as a client who has received therapy and medication for depression, as a mental health investigator and examiner who has evaluated people with depression in court commitment hearings, as a clinician providing counseling for people with depression and as a speaker, trainer and consultant who has explored alternative explanations for, and approaches to, understanding and transforming depression.

There are many kinds of depression. In the “old days” depression used to be categorized as exogenous and endogenous with endogenous being believed to be more a function of hereditary disposition and exogenous or “reactive” being more of a result of life circumstances. It was also believed that endogenous depression exhibited certain vegetative symptoms such as sleep and appetite disturbances, loss of pleasure and energy.

Today it is recognized that depression cannot be so neatly categorized and that there are many forms of depression. There is also much debate about the causes of depression, how much is hereditary and how much is environmental and how effective antidepressant medication actually is in treating depression. There is also lively discussion about the role trauma and traumatic stress plays and how re-exposure to another person’s suffering can trigger our own (unresolved) pain.

In very general terms, depression can be seen as a mental and emotional response to internal and/or external stressors or triggers that can result in a mild to severe sadness, depressed mood and/or loss of pleasure that can last for days, weeks, months, even years. It can be a one time occurrence, “single episode,” or it can be recurring. It is usually assessed as a “major depressive disorder” if it lasts more than two weeks. It is very often precipitated by an external loss or other event that can trigger the emotion but not always. It is often accompanied by changes in sleep, appetite, energy level, crying spells, difficulty concentrating and sometimes a desire to isolate yourself. In acute or severe depression there may be suicidal thoughts and impulses.

What Causes Depression? 

While the exact cause(s) of depression is still unclear, the development of depression can be seen as a combination of genetic factors, personal history, family dynamics, social and cultural influences and life circumstance. There are also numerous medical conditions that can present as depression and a medical screening is always warranted especially in the development of sudden and severe depression in someone with no history or family history of depression and no clear precipitating event. Depression can also be part of other emotional and mental conditions and enduring personality traits.

In my personal experience as a client and as a therapist, depression is most often precipitated by a sudden loss such as the death of a loved one or an important relationship, loss of a job, finances, of position/prestige or some other significant injury to one’s sense of self. The precipitating external event often initiates or re-engages an internal process of emotional pain often accompanied by self-depreciating thoughts that can become intertwined and mutually reinforcing. Painful emotions can lead to self-depreciating thoughts that can trigger more painful emotions. While there is still much debate about which comes first, the thought or the emotion, I personally don’t think it matters. To me they seem like heads and tails of the same coin.

When depression is a result of the activation and intensification of an internal process that becomes self-perpetuating and self-reinforcing, there are often unresolved emotional issues at play; past personal trauma being one of the most common. The relationship between Post Traumatic Stress Disorder and depression is well known. When past trauma is re-activated by current loss and/or traumatic stress, sudden and intense feelings of depression, hopelessness and helplessness are often activated.Unraveling the tentacles of trauma that are wrapped around depression can be complex and challenging and will be discussed in more depth in the next article.

In most cases, depression is “caused” by a triggering event that is personally painful, even overwhelming to the person experiencing it. The event usually triggers thoughts of worthlessness and self-depreciation and feelings of hurt and loss. In more severe cases previous trauma, old memories and self-defeating mental schemas are activated that can trigger intense feelings of hopelessness and helplessness and a downward spiral is set into motion. Left untreated this kind of depression can become severe and require intervention.

Next article will examine severe depression often associated with trauma, suicidal thoughts and impulses.

Dancing with Depression (1)

Introduction:

Dancing with Depression will be a series of articles written to let depression "out of the closet." It is estimated 350 million people world wide suffer from depression and that only two in ten people are receiving treatment. The shame and stigma associated with having depression especially among professional and family care givers often prevents us from seeking the help we need.

In Dancing with Depression I will share my experience as a consumer and a clinician who has had a life long struggle with depression, - nearly lost to suicide, received traditional treatment including medication and counseling and has discovered and developed non-traditional approaches including Qigong, meditation, somatic experiencing, visualization, Focusing and others to transform depression from a life-endangering fight into a dance.

I will describe how depression feels from the inside and share my clinical experience as a therapist working with hundreds of people who have suffered from depression. I am also writing this article for professional and family care givers. There is a close relationship between compassion fatigue and depression. Those of us who are repeatedly exposed to the suffering of people we care and provide treatment for are particularly vulnerable to depression.

The Roar of Depression

It’s sometimes the case in my life that I come to a point of understanding far removed from the place I originally expected to go. When Lean-Gaik - my wife - and I planned our trip to Maui 8  years ago I was certain this would be a joyful journey of clarity and enlightenment. Memories of the magical sojourn I made thirty years ago to the Seven Sacred Pools – at that time an enchanting and secluded place in Maui – filled me with anticipation and expectation. I was not prepared for the painful trek that was to unfold.

Our accommodations at the Sheraton resort near Lahaina were quite pleasant. We settled into a spacious room on the fifth floor overlooking the ocean. From our balcony the island of Molokini looked like a water color painting sketched on the horizon with cotton ball clouds floating across the mountain tops. The turquoise sea was alive with its continual motion, flickering white caps and soothing songs. Two large palm trees danced outside our window swaying to the rhythm of the wind.

On our first morning Lean and I drove into the town of Lahaina for breakfast and some shopping. The morning air was cool and the traffic was light. We enjoyed ourselves leisurely strolling through one shop and then another. The pace of life is so much easier in Maui. It almost seemed as though people even walked and talked slower than the more hurried pace of Portland, Oregon. At about noon we decided to drive back to the hotel to make some plans for the rest of our trip. Little did I know this would be the beginning of one of the most emotionally excruciating holidays that I can remember taking.

Lean and I had known each other for over 18 years and married for 16 of those years. We met by way of divine synchronicity next to a Mayan pyramid in Merida, Mexico. I was in the Yucatan recovering from a failed marriage, depression and burnout in my job as an emergency room mental health therapist. A Chinese citizen from Singapore, Lean was completing her Masters degree in Science and Education at the University of Iowa. We met on a tour of the ruins in Chichen Itza and fell in love Christmas Eve. She has been my lover, teacher, soul mate and on certain rare occasions, my tormenter. This was one of those occasions.

It started with a silly, senseless, even stupid argument that triggered a cascade of raw emotion drowning out sensitivity and sensibility. Before I knew it, I was out of the car walking down the side of a busy highway going absolutely nowhere. I vaguely remember asking myself; “where the hell was I going in this burning mid-day sun at least 10 miles from the hotel?” I knew I would have to return to the car and face Lean’s anger – I kept walking. After an hour my cell phone rang and it was Lean, crying, angry and scared. I had abandoned her and she was terrified.

I walked back to the car and saw her sitting frozen in the seat like I left her two hours earlier. I looked into her eyes and sensed her fear, anger and sadness. I felt sick. We drove back to the hotel without saying a word. I don’t even remember how I got there. In the room she began to sob and scream. Why did I leave? Where was I going? What was she going to do? How could I do this to her? She wanted to leave, to go home – back to Singapore, she was going to abandon me.

I suddenly felt something inside of me give way.  The very foundation that I was standing on collapsed. There was a soft roar in my ears as I felt myself free-falling, twisting and turning into the bottomless pit of agony and despair I thought I had left behind years ago with the attempt I made to end my life.  But, here it was again, the same emotional black hole that shattered my sense of self into a million little pieces that day I learned of my mother’s suicide.

Bits and pieces of fragmented memories began to flood my consciousness; walking home from junior high school where I had just started seventh grade, cutting through the neighbors lawn to see my little sister sobbing in the kitchen window, walking in through the sliding glass door to find my father sitting in a darkened living room staring coldly out the window, and the icy words that tore through my soul and etched themselves forever in my memory: “Mommy’s dead.” Nothing more; no reason, no explanation, no preparation, just; “Mommy’s dead.”

As these and other memories surfaced, emerged and then disappeared under the radar of my conscious awareness, I could feel an emotional shift at a cellular level. Rather than feeling the flow of energy and awareness freely circulating through my body and mind, I could sense the residue of traumatic memories freezing thought, energy, motion - even time. I was captured, held prisoner in the cold, timeless hell of acute depression.

Depression is not an unfamiliar experience for me. It's been an un-welcomed companion for much of my life. From seeds sown in early childhood, depression has its roots buried deep into my body and mind sprouting sharp, thorny, poisonous thistles when the ground was fertile with loss or abandonment; both real and imagined. 

It sprang up several times in my work as an emergency room mental health therapist co-experiencing the trauma of my clients. It nearly took my life as my marriage failed and career tumbled. It was my Sifu – my Qigong teacher and mentor who taught me to dance with depression rather than fight it, to make it my partner – not my opponent.

This time I was caught, blindsided by depression. I had not seen it coming. Even though I had thrown away my Prozac 15 years ago after learning Qigong, I still have episodes of sadness, decreased energy and enthusiasm. The difference is, rather than sinking into a bottomless black hole for months without end, these ferocious beasts had been transformed into tamed pets. Today my depression roared. (To be continued...)

Building Resilience with Positive Psychology

How Focusing on Strengths and Positive Emotions Can Make You Stronger

BY KARL LA ROWE - PUBLISHED: 09/10/2014 - SECTION: ARTICLES & BLOGS, HEALTH & WELLNESS, PERSONAL DEVELOPMENT

Introduction

Building Resilience with Positive Psychology is a presentation that was delivered for the Trauma Recovery and Corporate Solutions conference: Understanding Human Resilience sponsored by Changi Hospital, Singapore August 15, 16, 2014. This conference featured international speakers and presenters on the theme of how the new Positive Psychology can be utilized to develop resilience in healthcare professionals.

What is Resilience?

Resilience, is defined by Fred Luthans as “the developable capacity to rebound or bounce back from adversity…is arguably the most important positive resource to navigating a turbulent and stressful workplace.” [1] It is recognized that healthcare is one of the most demanding and stressful professions today. Resilience is the ability to rebound from stress and adversity even stronger than before. According to Everly, et.al., [2] there are seven characteristics of highly resilient people including:

1. Presence of calm, innovative, non-dogmatic thinking;
2. Decisive action (Courage: not afraid to fail);
3. Tenacity;
4. Interpersonal connectedness and support (may be single most important predictor);
5. Honesty;
6. Self-discipline and self-control; and,
7. Optimism and a positive perspective on life.

Positive Psychology

According to Dr. Martin Seligman one of the founders of Positive Psychology, “The aim of Positive Psychology is to catalyze a change in psychology from a preoccupation with only repairing the worst things in life to also building the best qualities in life.” [3] Since 1997 Positive Psychology as an academic and research science has investigated personal strengths and positive emotions that are the hallmarks of resilience.

Character Strengths

Character strengths are the hallmark of Positive Psychology and are defined as: “A preexisting capacity for a particular way of behaving, thinking, or feeling that is authentic and energising to the user, and enables optimal functioning, development, and performance.” [4] In this definition character strengths are capacities we already have and often utilize without being fully aware of it. These capacities are authentic, that is they represent who we are at our core and energizing, we feel good when we utilize them.

There are obviously many advantages to knowing and utilizing our strengths including:

• Utilizing your strengths activates personal resources that are already present.[5]
• Developing and maximizing personal strengths builds self-confidence and self-efficacy [6]
• Recognizing and synergizing strengths with others builds personal and organizational resilience. [7]

 Positive Emotions

A second pillar of Positive Psychology is the development of positive affect or emotions. It is noted by researcher Barbara Fredrickson that: “People experiencing positive affect show patterns of thought that are notably flexible, creative, integrative, open to information and efficient. In general terms, positive affect produces a broad, flexible cognitive organization and ability to integrate diverse material.” [8]

In her research she describes this “broaden and build” theory which states that when people feel more positively, their thought process changes. In essence greater positivity:

• Broadens our perspective and builds enduring personal resources; [9]
• Facilitates “approach behavior” that prompt individuals to positively engage with others; [10]
• Positive emotions “undo” negative emotions; [11]
• Facilitates faster recovery from adversity; and. [12]
• Helps develop greater tenacity at work. [13]

Building Resilience

Building more resilience then is a process of becoming more aware of and consciously utilizing our strengths and positive emotions. By discovering and consciously utilizing our character strengths more in our work and personal life we tap inner resources we already have but may not be fully utilizing to increase our sense of confidence, self-efficacy and build personal and organizational resilience. By learning to cultivate positive emotions we develop greater tenacity at work by broadening and building our perspective, being more willing to positively engage others and recover faster from adversity by overcoming our negative emotions.

The U.S. Army became so interested in this approach it hired Dr Seligman to develop a training program to help soldiers more resilient. [14] The critical components to this training include:

• Self-Awareness: Identifying counterproductive thoughts, emotions and behavioral patterns.
• Self-regulation: Develop the ability to delay acting on negative impulses: Stop! Relax. Breathe. Reflect.
• Focus on the positive, develop optimism. Challenge counterproductive beliefs.
• Mental agility: flexibility and openness in thinking.
• Focus on strengths to overcome challenges
• Connection: building strong relationships through positive, effective communication. 

Conclusion:

Resilience is one of the most important capacities that we have in being successful at work and happy in our personal lives. According to the science of Positive Psychology we can develop resilience by learning to focus on our strengths and positive emotions. In the words of Albert Bandura one of the most famous and quoted psychologists of our time: “In order to succeed, people need a sense of self-efficacy, to struggle together with resilience to meet the inevitable obstacles and inequities of life.”

References:

1. Luthans, F., (2002). The need for and meaning of positive organizational behavior. Journal of Organizational Behavior 23, 695-706
2. Seven Characteristics of Highly Resilient People: Insights from Navy SEALs to the “Greatest Generation” Int J EmergMent Health. 2012;14(2):87-93.
3. Seligman, M., Csikszentmihalyi, M., (2000). Positive psychology: An introduction. American Psychologist 55, 5-14.
4. Linley, A. (2008). Average to A+: Realising Strengths in Yourself and Others . CAPP Press, United Kingdom
5. Carver, C. (1998). Resilience and Thriving: Issues, Models and Linkages. Journal of Social Issues, 54, 2, 245-266.
6. Peterson, C. & Seligman, M.E. Strengths of Character and Well-Being. Journal of Social and Clinical Psychology, Vol. 23, No. 5, 2004, pp. 603-619
7. Sutcliffe, K.M., & Vogus, T.J. (2003). Organizing for Resilience. In K. Cameron, J.E. Dutton, & R.E. Quinn (Eds.), Positive Organizational Scholarship (pp. 94-110).
8. Fredrickson, B. (2001). The Role of Positive Emotions in Positive Psychology. American Psychologist 56, 3, 218-226”
9. Fredrickson, B., Positivity: Top-Notch Research Reveals the 3-to-1 Ratio That Will Change Your Life. Three Rivers Press, New York 2009.
10. Fredrickson, B., Positivity: Top-Notch Research Reveals the 3-to-1 Ratio That Will Change Your Life. Three Rivers Press, New York 2009.
11. Fredrickson BL. What good are positive emotions? Review of General Psychology. 1998;2:300–319.
12. Ibid
13. Ibid
14. Barry M. Staw, Robert I. Sutton and Lisa H. Pelled: Positive Emotion and Favorable Outcomes at the Workplace. Organization Science, Vol. 5, No. 1 pp. 51-71
15. Seligman, M.E.P, et.al (2011). Master Resilience Training in the U.S. Army. American Psychologist Vol. 66, No 1 23-34

Special Report: Transforming Compassion Fatigue: Regain your Passion for Compassion!

Introduction

Transforming Compassion Fatigue: Regain your Passion for Compassion, is a special report written for the social workers who work at family service agencies, on the front line with clients who are experiencing financial, social and family hardship, the counselors working with mental health organizations providing care and guidance to thousands of people struggling with the emotional challenges of a rapidly changing society, the doctors and nurses in a rapidly changing and demanding healthcare profession and the many others who work in education, corrections, and other public and private organizations.

The essence of Transforming Compassion Fatigue: Regain your Passion for Compassion is about how to regain and maintain your positive energy as a healthcare provider. We will examine what compassion fatigue is and how you can become more aware of how it affects you before it drains your energy and robs you of your passion for your work.

What is Compassion Fatigue?

Compassion fatigue has been defined as: “The reduced capacity or interest in being empathic or ‘bearing the suffering of clients’ and is ‘the natural consequent behaviors and emotions arising from knowing about traumatizing events.’” [1]

Compassion fatigue is a state of physical and emotional exhaustion from repeated empathic engagement with people who are suffering. It is both tired from caring and even tired of caring. It is the “natural consequent emotions and behaviours” that often result from the work we do.

Compassion fatigue, also called vicarious traumatization or secondary traumatization is the emotional residue or strain of exposure from working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Risk for Compassion Fatigue

Research indicates: “Healthcare professionals working with traumatized patients were at greater risk for CF, controlling for demographic factors, personal trauma history, social support and work environment factors…We suggest that the important variables in predicting CF include degree of exposure, personal history, social support, and work environmental factors.”[3]

Why would working with traumatized patients increase your risk for compassion fatigue?

Personal Trauma

It is believed that the secondary exposure to trauma from having an empathic, helping relationship with someone who is experiencing physical, medical, emotional or situational trauma can unconsciously trigger responses within your brain through a neural-psychological mechanism known as mirror neurons.[4] In essence, your brain and nervous system can literally mirror the physical and emotional responses of your client.

What the studies on mirror neurons also showed was, the more similar life experiences you have with your client, the more you are likely to mirror their responses.

What this means is, if I have personally suffered physical or emotional abuse I am much more likely to mirror my client who is suffering abuse in a more intensive way than someone who hasn’t had the same experiences.

In fact, personal trauma history is one of the most important factors in predicting a person’s vulnerability to compassion fatigue. It’s a two-edge sword. Personal history of trauma can make helpers much more empathic with their clients and effective as helpers, it can also render us more vulnerable to compassion fatigue.

Degree of Exposure

Other factors brought out by the research that have a bearing on how much helpers are vulnerable to compassion fatigue are degree of exposure, social support and work environment.

Degree of exposure refers to how many clients who are suffering from trauma you are working with in a day, a week, over the course of a career. It also refers to the intensity of the trauma one is exposed to.

Social Support

Social support refers to how much support you receive from your professional, personal and family network. It is now being recognized how crucial it is to have a professional support network because it can be difficult for family and friends to understand the nature of trauma that you are exposed to at work.

Working Environment

This brings us to the work environment which is one of the most critical and yet overlooked factors that can either contribute or mitigate and prevent compassion fatigue.

Research now shows that a safe, supportive working environment is crucial to mitigating and preventing compassion fatigue. As Rosenbloom, et.al [5] states:

“Prevention of potentially harmful effects from CF involves attention to both concrete issues, such as provision of supervision and adequate time off, as well as to less tangible sources of support, such as the organizations attitude toward the impact of trauma on helpers.”

Transforming Compassion Fatigue

Transforming compassion fatigue requires both awareness and action. Awareness begins with becoming conscious of those situations in which we are more likely to mirror the emotions of our clients so that we can take effective action to transform rather than internalize the stress.
Self-awareness is a core competency of emotional intelligence [6] and is defined as: “recognizing the feeling as it happens.” This means that we begin to follow some of the advice that we so readily give to our clients and start listening to our own feelings before, during and after we sit with our clients.

Prepare for Each Session

Preparing for each session with every client regardless of who they are or what their presenting problem might be is essential to being effective as well as maintaining our own emotional health. The simple fact is we don’t know what is going to happen in any given encounter with another person.

Preparing for each session means taking a moment to pause, relax and reflect before engaging. It means “having your head in the game” before you encounter your client. We are most vulnerable to mirroring and absorbing stress from our clients when our mind is somewhere else and we are not conscious, present and focused on what we are doing.

Being “Present”

Next, is to be conscious and present when you are with your client. This may seem like a “no-brainer” but you might be a little shocked by how often we actually “check-out” as we are “listening” to our clients.

This may be because we have already had a stressful day and have absorbed as much as we can take for one day and are not in a receptive frame of mind. Everyday stress can and does accumulate in our body and mind to the extent that it can affect how open and receptive we are to hearing other people’s problems.

Discharge and Re-charge

One of the strategies taught in the workshop is how to discharge the accumulation of daily stress. Day after day of “ordinary” stress in combination with secondary traumatic stress from our clients is a recipe for compassion fatigue and burnout. After each session take a couple of minutes to “discharge” the “energy residue” of the session and “re-charge” your energy through stretching, breathing, relaxing or some other conscious self-care activity (for more see articles on Techniques for Transforming Compassion Fatigue).

Conclusion

Compassion fatigue is a natural reaction to the work that we do. It is not pathological. It does not mean that we don’t care. It is the result of empathic engagement with people who are suffering. Over time, it can result in being “tired from caring, even tired of caring.”

We can learn to transform compassion fatigue by recognizing the signs and taking action by preparing for each session, being more present when we are with clients, discharging the energy residue and recharging our energy. By learning to care for ourselves we become more effective in caring for our clients.

Notes:

1. Compassion Fatigue Following the September 11 Terrorist Attacks: A Study of Secondary Trauma among New York City Social Workers: International Journal of Emergency Mental Health, Vol. 6, No. 2, 2004
2. Figley C.R., “Compassion Fatigue, Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized.
3. Ibid
4. The Mirror-Neuron System: Annual Review of Neuroscience (2004) 27: 169-192
5. Rosenbloom, et al: Helper’s response to trauma work: Understanding and intervening in an organization
6. Goleman, D. “Emotional Intelligence: Why it can matter more than IQ.” Bloomsbury (1995).
7. A term coined by Dr Peter Levine in Waking the Tiger, Healing Trauma for accumulated trauma energy that takes root in the nervous system.

Principles for Transforming Compassion Fatigue

Introduction:

In my seminars on: “Transforming Compassion Fatigue Into Flow and Peak Performance,” I share three basic governing principles of the Healer-Warrior philosophy. These principles provide the foundation for each seminar and have been a guiding light for my own personal transformation; Self-honesty, personal responsibility, and self expression.Each of these principles contains elements essential to the process of personal transformation.

Courageous Self-honesty

Self-honesty is the key. It is the primary, essential process that allows a depth of access into parts of your personal self that cannot be attained any other way.

In this context, self-honesty means self-transparency—the ability to look inward to cultivate “in-sight.” Self-honesty is both a process and a skillful activity that can be learned and nurtured.

What is most essential to developing self-honesty is a courageous willingness to suspend judgment, to halt the automatic response of immediately categorizing a concept or idea according to an already existing category of what may be right or wrong, good or bad, possible or impossible.

It’s not an easy thing to do; it requires courageous willingness. Temporarily suspending your belief systems can cause you to feel uneasy, even lost. This is because most people rely on their unquestioned beliefs to try to make sense out of a world that becomes ever more unpredictable and traumatic.

Unquestioned beliefs have remarkable powers to shape our perception. What we attend to physically, mentally, and emotionally is selected and shaped to a great extent by what we unconsciously expect to experience.

To become aware of and suspend these beliefs is to invite you to look clearly and intently inside yourself as you read the words written in this article with as much courageous transparency as possible. Resist the temptation to immediately judge and classify the ideas shared before you have the chance to “try them on.”

Personal Responsibility

Personal responsibility is the continual willingness to take ownership of my personal experience. The problem I usually run into with personal responsibility is my willingness to surrender the need to be right.

The need to be right is one of our strongest and most strongly defended intentions. This is because the need to be right supports and enforces the ego-illusion that I alone am special, different, and somehow more entitled than others. It is the basis of our misguided concept of what it means to be independent.

Personal responsibility is the degree of my willingness to take both individual and collective ownership for my perceptions, thoughts, beliefs, emotions, and behaviors; my communication with self and others; all my relationships; and the conditions of my life that I am now experiencing.

This is not self-blame. To blame myself I must split myself into both; the part of me that is doing the blaming and the part of me that is getting blamed. This splitting of my self into opposing parts weakens my sense of self and distorts my perception of others.

The action of personal responsibility is looking, listening, and letting go. This is the art of surrendering.

Surrendering is the Warrior’s art. To surrender is to give in, not give up. Giving in is accepting the reality of the situation as it is without meeting my ego’s demand to be right. To surrender means, to bring my ego-perception more into alignment with my here and now, in the moment— in my body experience.

Authentic Self-Expression

Self-expression is the magic of transformation. When you become clear and open to the intuitive signals— the music of your Natural Self—you will begin to experience a deep sense of enjoyment and empowerment. Self-expression is the dance of energy and enjoyment of the Authentic Self when allowed to play.

The Authentic Self is that place of connection between mind, body, Energy in MOTION, intuition, and insight that is in a constant state of flow; it is both in the heart and from the heart. To express myself honestly and with responsibility is to engage and empower my Natural Self to create and re-create itself spontaneously in my life.

The Authentic Self is a wise, gentle, powerful, and playful being inside each of us that is usually invisible to the ego’s eye. This is mostly because the Authentic Self lives in the heart and the ego lives in the head. The Authentic Self perceives the world in terms of “us,” while the ego sees the world in terms of “me.” The Authentic Self senses connection and commonality while the ego notices separation and specialness.

Self-expression becomes the action of clearly tuning into the music of the authentic Self and allowing that music to move you moment to moment as you dance in ever-growing harmony. Self-expression is the spontaneous alignment of who you are with what you are doing.

Compassion Fatigue: Professional Risk for Counselors

Introduction

Compassion Fatigue – also known as secondary traumatic stress and vicarious trauma – is pervasive in the counseling profession; particularly with care giving professionals who have a high degree of exposure to patients who are experiencing some form of psychological, medical or social trauma and who are trauma survivors themselves. In a 2004 article called “Compassion Fatigue Following the September 11th Terrorist Attacks: A Study of Secondary Trauma Among New York City Social Workers,” it is noted that: 

“…[M]ental health professionals working with traumatized clients were at greater risk for CF, controlling for demographic factors, personal trauma history, social support and work environment factors…We suggest that the important variables in predicting CF include degree of exposure, personal history, social support, and work environment factors.”

While this article focuses on the mental health professional, I believe compassion fatigue is not exclusive to mental health professionals and is found in virtually every healthcare specialty, particularly those who engage in counseling.

Degree of Exposure

Degree of exposure to another person’s trauma may be a little more difficult to estimate than one might think. How many of our patients are trauma survivors? Which diagnostic categories are most associated with trauma? Is trauma limited to clients with a formal diagnosis of PTSD or is trauma present in other diagnostic categories such as depression, family violence, marital discord, personality disorders and substance abuse to name a few? What about social and medical trauma?

Degree of exposure may also include the nature, length, frequency and intensity of contact with trauma survivors. I recently gave a workshop on compassion fatigue to counselors working in a correctional facility. In this closed environment where the frequency and intensity of contact was high, these counselors experienced frequent symptoms that are associated with vicarious trauma such as abuse of chemicals, spending less time with clients, tardiness and absenteeism, making professional errors, being critical of others and depersonalizing clients.

Personal History

One of the questions I almost always ask in my workshops is: How many of us in the counseling profession have experienced personal trauma? The answer I hear back most often is 85%, which is actually higher than the 66% for psychotherapists as estimated by Pearlman and Saakvitne in their book “Trauma and the Therapist,” which focuses on countertransference issues in psychotherapy with incest survivors. How can a personal history of trauma place a counselor at higher risk for compassion fatigue?

In “The Body Bears the Burden” by Dr. Robert Scaer, the concept of “emotional kindling” is introduced which he describes as a: “self-sustaining feedback circuit” to explain a type of emotional “spontaneous combustion.” Those of us with a personal history of trauma may be more susceptible to spontaneous emotional combustion when working with trauma survivors, whether that is in the form of an explosion or implosion, because we have a built in, emotional hyper-sensitivity to traumatic stress; particularly if our patient’s trauma is similar to what we have experienced in our own past personal history.

Social Support

One of the first jobs I had right out of graduate school was working as a crisis counselor in a very busy inner-city emergency room. I can still recall trying to explain to my family and friends some of the experiences I had working with acutely traumatized patients and the blank look that would come over their faces or the outright exclamation that I must be mistaken or exaggerating. After a while I stopped trying to explain my experiences and would spend most of my leisure time either alone or with co-workers, as we would descend at times into dark humor about our patients.

Isolation and withdrawal from our support network is a telling sign of compassion fatigue. As we begin to unconsciously internalize the traumatic experiences of our clients, our frame of reference begins to change, from inclusion to exclusion. In a workshop I gave for outreach crisis workers that was co-sponsored by the police department, one of the officers shared that over a period of time police officers would often experience a progressive sense of isolation excluding everyone else from their circle of trust except other officers. The same is often true for counselors.

Work Environment Factors

Are there certain conditions at work that can either contribute to or help ameliorate compassion fatigue? In an unpublished report called “Vicarious Traumatization and Burnout Survey Report” Mary Louise Gould, Med., author and consultant states: “Wherever trauma work is happening, the setting itself is another crucial variable. This is true for the professional as well as for the survivor, both of whom need to feel safe and supported within the work environment.”

How often are survivor counselors attracted to work environments that may (unconsciously) resemble their family of origin? Freud said: “You will repeat instead of remember.” As I look back now I realize I should have been somewhat alarmed at the ease in which I slipped into the chaotic, unpredictable and at times even dangerous conditions that accompanied my role as a crisis counselor in an inner-city emergency department; a perfect fit for a survivor of physical and emotional abuse. My awareness was limited only by my willingness and ability to be honest with myself, to accept ownership for my thoughts, feelings and behavior and to express who I deeply felt myself to be.

Three Principles for Healing

From the forward of my book, “Breath of Relief: Transforming Compassion Fatigue into Flow,” I outline three principles that I believe are essential for healing and transformation. They are: Self-honesty, personal responsibility and self-expression. These principles will be the subject of my next article: Compassion Fatigue: Principles for Transformation.

Bibliography

Herman, Judith. Trauma and Recovery. Basic Books. New York, New York. 1992.

Keidel, Gladys Catkins. “Burnout and Compassion Fatigue Among Hospice Caregivers,” The American Journal of Hospice and Palliative Care. May/June 2002; 19(3); 200-205.

LaRowe, K. Breath of Relief: Transforming Compassion Fatigue into Flow. Sidran Press, Boston Mass. 2005

Levine, Peter. Waking The Tiger: Healing Trauma. North Atlantic Books. Berkley, California. 1997.

Pearlman, Laurie Anne and Karen W. Saakvitne. Trauma and the Therapist. W.W. Norton & Co. New York, New York. 1995.

Scaer, Robert. The Body Bears The Burden: Trauma, Dissociation And Disease. The Haworth Medical Press. Binghamton, New York. 2001.