5 self care

Ohotaq Mikkigak

Self-care for Mental Healthcare Providers

Allison Crawford, MD, FRCPC

REFLECTION Think of a time‌ You heard a client speak about a traumatic event How did it affect your mood? What were your feelings?

How did you feel in your body?

What were your thoughts? About your self? About the client? about the world?

REFLECTION How did it impact on the way that you think of and feel about your work and about the role you see yourself having in the world? "

Take a moment to write brief answers to these questions in your journal.

Job Stress Leads To‌ Feeling fragmented Feeling overburdened Feeling a sense of time pressure Feeling a lack of control over workplace Feeling isolated or lack of support from team (real or perceived) Lack of supervision or leadership Feeling that skills are inadequate to the demands of the job

Interpersonal/ Community Personal Meaning Aective

Bodily

Cognitive

Cumulative Impact of Adverse Events

Cumulative impact of stress and adverse events

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Job Stress

Compassion Fatigue

Burn Out

Secondary Traumatization

Compassion fatigue A gradual lessening of feelings of compassion toward the plight of others experienced by those who care for people in extreme circumstances (Figley 1995) Often accompanied by negative, critical blaming thoughts towards clients e.g., “blaming the victim”, which leads to stigmatization and lack of responsiveness Can result in “secondary wounding” of clients Can also lead to distorted thoughts about the self (ineffective; no control) and about the world (harsh reality) and have profound effect on system of meaning (Arnold et al 2005)

Compassion Fatigue Self-Test

Click here to access the compassion fatigue self-test

“Burn out” “exhaustion of physical or emotional strength or motivation usually the result of prolonged stress or frustration” Merriam-Webster’s Dictionary Maladaptive response to stress in the workplace: " Chronic fatigue; insomnia" Weight loss or gain" Anger at those making demands; irritability; depression " Cynicism, negativity, hopelessness, helplessness " Self-criticism " (Schwammle 1990)

Secondary traumatization Also referred to as “secondary wounding” or “vicarious traumatization” “vicarious traumatization is the process through which the therapist’s inner experience is negatively transformed through empathic engagement with clients’ trauma material” " (McCann & Pearlman 1990) Traumatic stress symptoms in response to hearing about (or witnessing) the experiences of clients " (Jenkins & Baird 2002; Schlenger 2002; Zimering et al. 2003; ) Controversial: Diagnosis versus normal reaction

Symptoms Re-experiencing (e.g., intrusive thoughts; nightmares) Hyperarousal (e.g., irritability, insomnia, increased startle, panic) Avoidance and numbing (e.g., avoiding work, detachment from others) Distorted cognitions (e.g., worthlessness, helplessness, guilt) Dissociation (e.g., feeling that you or your surroundings are not real) Experiencing some symptoms is very common, but these are usually easily managed; full PTSD is very rare 0-4% (Jenkins and Baird 2002; Adams et al 2001; Wasco and Campbell 2002)

Risks for secondary traumatization Fixed risks: Female gender; previous traumatic event(s); mental health history Aspects of the trauma: Proximity; severity; perceived lack of control; dissociation Identification with victims" Length of job exposure and case load of clients with trauma Lack of support/ isolation in workplace and personal life Inadequate job training" Ongoing stress

(Zimering et al. 2003)

Protective and Resilience Factors Consultation and supervision (Salston & Figley 2003) Adequate training Responsive organization and leadership Positive coping style General resilience Internal locus of control

Self-care

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Minimizing risks"

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Enhancing resilience

If your compassion does not include yourself, it is incomplete

REFLECTION

Make a list of the current ways you cope with stress Circle the ones that work the best What are additional strategies you could use...

Take a moment to write brief answers to these questions in your journal.

Following a crisis DO…

DO NOT…

Expect the incident to bother you.

Drink alcohol excessively.

Maintain good diet and exercise.

Use substances to numb response.

Review acute stress symptoms AND Withdraw from others. remind yourself that they are normal.

Automatically stay away from work.

Spend time with supportive others.

Use time off for post-incident training.

Get extra help, if necessary.

Blame yourself, or think that you are “crazy”.

ABCs of Self Care

AWARENESS: of own needs, limitations, emotions, resources BALANCE: of work & life; self-care & caregiving CONNECTION: to oneself, others, to larger/ spiritual meaning

Establish a regular routine of self-care

Ideas for Effective Self-Care Physical Regular exercise Sleep" Healthy diet" Humor and laughter Limit alcohol Relaxation techniques Massage Repetitive activities

Emotional/ Relational Nurturing relationships" Contact with others Talking" Support groups Reflection (eg journal) Creative activity Outside interests Realistic expectations Counseling

Spiritual Knowing your values Participating in communities of meaning Regular prayer or meditation" Singing/ Music Contact with spiritual counsel Time with art, nature

K.M.Graham

REFLECTION Meaning Making Think of a recent time when you encountered someone in crisis...

Become aware of your cognitive framework. What were your thoughts about: The other person who needed help: "

“He/ she is ______________”

Yourself: "

“I am ___________”

Your work: "

“This job is so _____________”

The world: "

“Life is so ______________”

Foster Constructive Cognitions Validate and normalize your reactions Challenge cognitive distortions About Self: “I should” “I can’t” “It’s out of my control” “It’s my fault” “It’s not my fault” “I can’t change it” About others: “It’s their fault..” “He she is needy/ manipulative” About the world: “Is unfair” “Is hopeless” “Is dangerous”

Set realistic expectations of self and clients

Workplace Culture Adequate training and supervision Create an organizational climate that values self-care Protection of employee safety Balance caseloads Colleagues that check in and out with each other Process of CONSTRUCTIVE debriefing

Seeking help Employee Assistance Program 1-800-663-1142" Free and Confidential Service" Offered to employees, their partners and their dependents" Available 24 hours per day, 7 days per week" Delivered by professional and experienced counselors for a wide range of issues" Available in Inuktitut and Inuinnaqtun with interpreter" Available in English and French" Includes eight sessions per issue" Choice of phone and/or telehealth services

Breathing in…your stomach goes out!

Breathing out…slowly….your stomach goes in.!! !