© 2006

Patricia Berendsen, M.T.S., RMFT maintains an active private practice in Individual, Couple and Family Therapy and Clinical Supervision in London, Ontario. Patricia also provides clinical services as a Clinician with the Clinical Supports Program at the Centre for Children and Families in the Justice System of the London Family Court Clinic. Additionally she is an Approved Supervisor with OAMFT/AAMFT. She can be contacted at patricia@patriciaberendsen.com

I had just returned from a meeting, feeling rather discouraged. Yet again, I painfully observed several professionals losing sight of the best interests of clients, because they were too busy “strutting their stuff” and “stroking their egos” in a public forum. Too much time and effort was used to be distinguished as superior; more intellectual, more caring, more dedicated, more research driven, more fiscally responsible… more, more, more. The regrettable result was the silence of other important voices. They would not be able to ‘compete’ with such grandiosity displayed before them. Some group dynamics appear childish, reminiscent of children playing in a sandbox, jockeying for the position of “top dog” and protecting their turf, all the while forgetting that the sandbox is common ground and that they actually like each other! Unfortunately, grandstanding is not an uncommon occurrence and more often than not, makes working together more toxic than productive and life-giving.

How, then, can we keep the soul in our work, TOGETHER?

Allow me to share with you some strategies that have proven to be helpful in promoting cohesiveness, improving morale and all the while, keeping the soul in our work.

1. Check your ego at the door. Coming together and seeking to determine the ‘best interests of the client’ means that we must truly put aside our own agendas. I have participated in meetings and observed professionals approaching situations from a fear based perspective- with the agenda of protecting the agency’s often minimal funding or its status in the community. Although we wouldn’t like to admit it, sometimes, decisions are made, based on the needs of the agency and not the clients.

2. Believe the best in one another. Keeping the soul in our work, means focusing on the positive and the well meaning intentions of others. It can be tempting to notice and highlight weaknesses and be critical of colleagues or community partners, but it is usually not helpful. It only serves to weaken working relationships, fostering a lack of trust. Believing the best in one another can increase our collective power knowing that we are in this together and that together we are stronger.

3. Take your time and stay with the issue long enough to reach a breakthrough. Some people will refer to this as “trusting the process.” I have participated in several agency and community meetings where resolutions to challenges have been difficult to achieve. Over and over again, I have witnessed the ‘process’ at work…but only if the people involved were able to ‘hang in there’ long enough for the outcome to reveal itself. I have found that the most creative and influential solutions seem to come at the point when we would like to give up. This is often the time when someone will throw out a wishful thought or an offhanded comment. Paradoxically, this seemingly flippant comment can get the ball rolling and within minutes a potential solution emerges. And remember, successful process takes time.

4. Compliment efforts. Working within social service settings is difficult enough. We often have to deal with obstacle and are under the watchful eye of funders and supervisors. Taking the time to compliment one another is fuel for more success. When we “catch one another doing good” we are more likely to want to repeat our performance. Genuine compliments create the fertile ground in which strong working relationships can grow.

5. Utilize the diversity and strengths that are brought to the table. Those of us who like being in control may struggle with this point. Teams are eroded when only one or two people do the lion share of the work. It is essential that everyone participates in the solution. Contributing as a group means that the buy-in is greater, more people get on board and everyone can have more ownership not only of the problem, but especially, the solution. Using diversity and strengths allows for skills and abilities that may have been somewhat hidden to come to the forefront. The outcome is often a sense of satisfaction and a realization of competency that contributes to increased confidence for the future.

6. Have fun. Do you ever feel guilty when you are making a raucous during a meeting while other colleagues glance curiously as they pass by the conference room window? Have we bought into the myth that we can only be serious if we are to get our work done? Some of the most productive meetings I have attended did not look like much was getting done from the “outside looking in.” However, what wasn’t noticeable to passersby’s was that deeper relationships were being forged; time was passing by quickly, and all the agenda items were tended to (and more besides). All of us involved looked forward to the next meeting. An atmosphere that lends itself to levity when it presents itself can be inspiring and usually promotes team cohesiveness and a positive working environment.

7. Examine the effectiveness of the project and working relationships. Making time for reflection is crucial. One of the most utilized tenets of solution focused work is to notice what one is doing well and then doing more of it. It also includes analyzing and highlighting what went into a job well done and to ascertain what improvements can be made for the next time. When we have completed a project, we are usually so relieved “to get it over with” that the last thing we are interested in doing is sitting down and evaluating our work. I would argue that reflecting upon and evaluating our work is one of the most cost efficient practices at our disposal. Through evaluation, we can evolve as team players, grow in professional knowledge, and develop closer working relationships and partnerships.

Patricia Berendsen, M.T.S., RMFT maintains an active private practice in Individual, Couple and Family Therapy and Clinical Supervision in London, Ontario. Patricia also provides clinical services as a Clinician with the Clinical Supports Program at the Centre for Children and Families in the Justice System of the London Family Court Clinic. Additionally she is an Approved Supervisor with OAMFT/AAMFT. She can be contacted at patricia@patriciaberendsen.com.

Absract: What constitutes a Transformational Leader? The authour describes characteristics of a Transformational Leader using the unique strategy of a job posting. The criterion and patterns of an ailing agency are illustrated by the subsequent job description.

Transformational Leader Wanted: A courageous person dedicated to self-knowledge and utilizing the workplace as a passage of self-discovery knowing that in and through our work, we are actually forming ourselves. A visionary who looks to the future yet is committed to embarking on an unscripted journey. A judicious person who does not confuse leadership with a position, title or role and being other focused, shares power freely and willingly. A perceptive individual who values, appreciates and nurtures the inherent potential in every human being. A co-creator of life-giving relationships and interdependent connections which can be sustained during tumultuous and stressful experiences. A thoughtful person who listens carefully to the arguments of resistance in order to hear the inner voice of the organization and then who dares to disturb the system as an advocate for transformational change. A model of vulnerability who moves beyond self-preservation, sharing fears, insecurities and growth areas, yet is confident to act and humble enough to learn simultaneously and attracts others to do the same. An unguarded leader who encourages feedback and welcomes criticism of what he/she is doing. A creative thinker and do-er who embraces failure, honours risk-taking and takes time to reflect on both collective success and collective failure. One who is internally directed and dedicated to purpose finding instead of problem solving. A leader who inspires and invites others to choose transformational leadership for themselves.

Job Description: The selected Transformational Leader will be required to lead a team within an agency directed by self-interested, highly developed egos and extremely hierarchical senior executives. The Transformational Leader will need to navigate the torrential waters of manipulative strategies imposed upon its members by managers, under the guise of “participating conversations,” that serve to only increase distrust of the system. As a Transformational Leader, you will be faced with finely filtered and polished narratives presented at management meetings that do not remotely reflect the reality of the challenges facing front line staff. You will be asked to pierce the bubble of denial – the tightly held belief that the organization is a healthy, thriving environment when all the evidence points to a series of deception and a slow death process that is occurring. You will encounter normative and accepted behavour such as petty jealousy, dishonesty, backstabbing, arrogance, withholding imperative and critical information, “do as I say not as I do” hypocritical mentality, incompetence, intolerance of initiative followed by blaming and shaming tactics. Additionally, you will be working within a team divided against itself with a reputation for swallowing up prospective leaders as well as its own members, particularly anyone attempting to make changes to the status quo.

Please respond to this invitation to Transformational Leadership with your passion for excellence and a hope for a preferred future with this ailing agency.

Transformational Leadership applications can be sent to:

Sinking Ship Human Services
911 Mayday Blvd.
Stormy Seas, Ontario
SOS SOS

© 2007 Patricia Berendsen

I want to know if you approach each day every day with passion in your heart, knowing that you are about to impact my life, not only for a shift, or a day but for a lifetime. Do you have the fire in your belly that will drive you to professional excellence and integrity?

I want to know if you will trust my innate wisdom leading you to new frontiers that may defy the empirically supported treatment of the day. Will you dare to embark on a road less traveled, and risk the potential criticism and ridicule of your peers to spearhead new and innovative strategies that give voice to my needs? Will you go out on a limb for me?

I want to know if I can see in you, a role model of fairness, equality and respect instead of someone who is completing a shift. Will you dare to bridge the gap between us created by your hastily made decisions or inconsistent consequences? Will you accept responsibility (as you would expect of me) and apologize when you make a mistake? I want to know if you will fan into flame the waning embers of my self-esteem, remnants from the raging fires of trauma, abuse and neglect.

I want to know if you can see my preciousness beneath my iron-clad armour that protects my vulnerability. Will you tread respectfully and carefully on the sacred ground of my woundedness to bring me closer to recovery and healing? I want to know if you have enough power in your own life so you don’t need to have power over mine.

I want to know if you can “be with” my intense emotions presented before you, often disguised by my behaviour. Will you stay with me and be the container I need for big feelings instead of running away and avoiding them because you are afraid?

I want to know if you will discard the sometimes convenient and familiar garment of judgment and harshness, for a cloak of compassion and understanding. I need you to deal with your own shadow so that you can know that there is more to me than mine. Will you face your own demons so that you won’t demonize me?

I want to know if you can take up this challenge. Your example is important to me because if I can see you doing it, then I know there is hope for me!

This piece was inspired by Oriah Mountain Dreamer’s prose poem entitled The Invitation.

Abstract
Supervision is a journey for both the supervisor and supervisee. It balances tenuously between letting go and the temptation to rescue on the part of the supervisor. As a supervisee, the tension is between dependence and autonomy. This organic process can occur in predictable stages in the supervisee’s development. Vanderheyden illustrates the importance of these stages from a developmental perspective. She emphasizes the necessity of self-awareness and the use of self needed to create a safe place for enriched learning to take place. Ideally, supervision is a co-created experience in which it is sometimes difficult to tell who is the teacher and who is the student. It is essential that both supervisor and supervisee have “a beginners mind” and remain open to the lessons that are awaiting them in the supervision journey together.

Definition of Supervision
Hess (1980) defines supervision as “ a quintessential interpersonal interaction with the general goal that one person, the supervisor, meets with another, the supervisee, in an effort to make the latter more effective in helping people.”

Loganbill, Hardy and Delworth (1982) describe supervision as “an intensive, interpersonally focused, one-to-one relationship in which one person is designated to facilitate the development of therapeutic competence in the other person.” The British Association of Counselling states that the “primary purpose of supervision is to protect the best interests of the client.” Others suggest that supervision is a structure that facilitates the “development of clinical and professional competence.” (Haynes, Corey & Moutlon (2003). Feminist authour’s Porter and Vasquez (1997) comprehensively define supervision as “a collaborative, respectful process, personal but unintrusive, balanced between supervisory responsibility and supervisee autonomy. [Feminist] supervision emphasizes an open discussion and analysis of power dynamics, and targets the best interests of the supervisee. It is a process that remains focused on the social context of the lives of the client, supervisee, and supervisor.

Qualities of a Good supervisor
Carifo and Hess (1987:244) describe qualities of an ideal supervisor as similar to that of a good psychotherapist. They are: empathy, understanding, unconditional positive regard, congruence, genuineness (Rogers, 1957), warmth and self-disclosure (Coche, 1977); flexibility, concern, attention, investment, curiosity and openness (Albott, 1984: Aldridge, 1982); Gittermann and Miller, 1977; Hess, 1980).

Brigid Proctor (1988) emphasizes the importance of the atmosphere created by the supervisor. The task of the supervisor is to help the supervisee feel received, valued, understood on the assumption that only then will s/he feel safe enough and open enough to review and challenge him/herself, as well as to value him/herself and her/his own abilities. Without this atmosphere, s/he is unlikely to be open to critical feedback or to pay close attention to administrative details.

It will also be the case that a beginning therapist often comes to supervision stressed, anxious, angry, and perhaps afraid. It is the assumption that only if s/her feels safe enough to talk about these uncomfortable feelings, and fully acknowledge them for him/herself will s/he be ‘cleared’ [available] to re-evaluate practice. “The belief in the inner beauty of each and every human being is at the heart of being human. As soon as we start choosing and judging people instead of welcoming them as they are– with their sometimes hidden beauty, as well as their more frequently visible weaknesses– we are reducing life, not fostering it. When we reveal to people our belief in them, their hidden beauty rises to the surface where it may be more clearly seen by all.” (Vanier, 1998, p. 23)

Process of Supervision
As a supervisor, the roles can range from that of a coach, facilitator, supporter, instructor, educator, and colleague. Initially, as with any psychotherapy, contracts need to be established and boundaries set for the supervision process to proceed. There needs to be a ‘fit’ of some sort which is mutually determined. Although it may be preferred, it is not necessary that the supervisor needs to espouse the same treatment philosophy per se as the supervisee or vice versa. What is important is the desire to grow in his/her profession and to be able to dialogue comfortably about and appreciate the differences that arise during the supervision process.

Supervision is just that. A process. Certainly, it does have a beginning and an end. However, what occurs between those times can range from being magical to exasperating and frustrating. In this sense, isomorphism (Doehrman, 1976 and Mcneill, 1989) can be seen very clearly. Oftentimes, as the supervisee is struggling with a client, the supervisor is struggling similarly with the supervisee. The responsibility is two-fold …but rests primarily on the supervisor to model self-awareness. The supervisor may additionally consult with colleagues about how transference and counter transference may be impacting the supervision process (although not always negatively) and highlighting psychotherapeutic issues. The supervisee as well, cannot abdicate responsibility when this situation arises, as self awareness is one of the essential elements of becoming a good psychotherapist.

Feminist theory which has deeply impacted the transformation of supervision models suggests collaboration “working with” as an alternative to strictly hierarchical models of supervision looking over” or ”being above” another. This collaborative style requires a demonstration of trust and reciprocity. “Reciprocal visibility” (Turner and Fine, 1996) between the supervisor and therapist demystifies and diminishes the inherent power dynamics and creates opportunities for mutual transparency. “Covison” is a term that is used as a means of addressing implied hierarchy in therapeutic language of “supervision” (Porter and Vasquez, 1997). Turner and Fine argue that even when power issues are addressed, “the supervisory relationship can be more or less level but never flat.” (in Todd and Storm 2002 p.230)

Supervision is also impacted by gender, age and cultural background. The greater the disparity, the greater the need for the supervisor to work doubly hard to facilitate ‘joining’ in the supervisory relationship and to determine and explore how the supervisor and supervisee’s background and attitudes are affecting how one sees and works with the client, the supervisory relationship and within the clinical setting.

Ekstein’s (1969) unique description encourages the consideration of blind spots, deaf spots and dumb spots. Blind spots are where one’s own personal patterns and processes get in the way of seeing the client clearly. Deaf spots are those where the therapist not only cannot hear the client, but cannot hear the supervisor either [and vice versa]. Dumb spots are those where supervisees and supervisors are ignorant about what it is like to be in the position of the client, understanding what it means to be in someone else’s shoes.

A Developmental Perspective
From a developmental perspective supervisees (and supervisors alike) go through stages. The first stage is usually characterized by the supervisee’s dependence upon the supervisor and feelings of insecurity. Although the supervisee is highly motivated, s/he often is anxious about his/her skill, insight and ability. The notion of needing to be objectively self-aware (through the use of video/audiotape, live supervision) can be unnerving to some. Similarly, the supervisor may also experience an isomorphic phenomenon displaying or feeling similar types of anxiety. The supervisor knows all too well, that the supervisee is carefully scrutinizing his/her behaviour and supervision style. This stage of the supervisee’s development is usually focused on concrete reporting of information contained within the file, behavioural descriptions of what occurred in the session. Sometimes, premature conclusions are made without a thorough evaluation of the context and/or systemic factors. Keeping the format structured and positively focused at this phase of development assists the supervisee with the containment of anxiety, uncertainty, and the emotional impact of sessions with clients. This will support the supervisee to grow in confidence and competence in developing clinical formulations and counselling skills.

The next developmental phase of the supervisee is often characterized by a vacillation between dependence and autonomy and between over-confidence and overwhelmed. Personal experience leads me to propose that longer placements (6-9 months) are more conducive to enhanced learning and integration for the supervisee. The supervisee can settle into the agency and/or the program and go through the “seasons of therapeutic influence”. When the placement is too short (2-4 months), the supervisee risks leaving the placement in the overwhelmed phase of his/her development and may experience a pivotal professional crisis. The supervisee may subsequently question his/her suitability to the field and doubt whether s/he has the skills and qualities to do the job well. Unbeknownst to the supervisee, this experience is normative and passes during the longer placement. Most supervisees come to find their “therapeutic footing” and their confidence is restored during a lengthier placement. Over and over again, I have witnessed the power of the ‘supervision process’ …but only if the both the supervisor and supervisee are able to ‘hang in there’ long enough for the outcome to reveal itself.

The third developmental juncture often includes more autonomy and is more collegially focused on the part of the supervisee. This phase tends to be more process-oriented. The supervisee is more confident and begins to integrate theory and practice with more accuracy. The supervisee is often more adept at matching the needs of the client with the various modalities available. Similar to the analogy of a person attempting to drive a standard (versus automatic) car, in this stage, there is considerably less jerking when one changes gears and the ride is much smoother! The supervisee begins to learn to observe him/herself and the client from multi-level (helicopter approach) and multi-systemic perspectives. The supervisee can see the bigger picture more easily. During this stage, the supervisee begins to take more risks in “the use of self” during supervision and counselling sessions. Oftentimes, the personal issues that may impact therapy arise and cannot be ignored. Ideally, at this developmental stage, the supervisory relationship, strengthened through collaboration mutuality and trust, allows and supports the supervisee in exploring these personal/professional issues more comprehensively.

It is important that the supervisor resist the temptation to rescue the supervisee. The supervisor needs to be the container of strength, encouragement and support. At this stage, the supervisor is required to hold the tension of the challenging circumstances the supervisee may be experiencing. This process is often difficult- not unlike the experience of a butterfly trying desperately to free itself from the cocoon. One might wish to speed up the process by ‘breaking open the cocoon’. However, it is the struggle of the butterfly to free itself from the cocoon that is the necessary action which ultimately strengthens the emerging butterfly’s wings to fly. If the cocoon is opened prematurely, the butterfly will emerge with wings that are not capable of supporting the butterfly’s urge for flight. Thus, rescuing the supervisee, may unintentionally cripple the unfolding development of the emerging therapist.

The last developmental stage could be characterized by integration and synthesis. Theory and practice co-mingle more easily and accurately. The stage is defined by allowing the experience and knowledge that has been acquired to deepen and take root. An Unknown Sufi Teacher once said, “Knowledge without wisdom is like an unlit candle.”

Observing supervisees at this stage of their growth and training can be magical. The supervisor is a witness of synthesis- as things seem to “come together” for the supervisee. Their education, life, professional, and therapeutic experiences, merge, creating something bigger and better than the supervisee could have imagined. It is at this stage of development that the supervisee’s professional identity becomes more visible and defined. Often a comfort level with seeing him/herself as a professional emerges.

Reflection and Self-Awareness
The role of supervisor is both an honour and a privilege. It is not everyday that one gets to impact the inner workings of another with the knowledge that the influence of a supervisor may resonate into infinity. My personal view is that the “strategic use of self” is undoubtedly one of the most powerful tools one has within any context, both as a supervisor or as a therapist. I also believe that although the use of self is a gift to share with others, the weight of responsibility is equally as great, so as to “do no harm.” As part of ethical practice, self-awareness, reflection and evaluation is essential. To refrain from this practice is to make oneself a liability to the profession. To this end, engaging in awareness of personal issues that may intersect with one’s professional life and work with the assistance and support of chosen and trusted colleagues is paramount.

Conclusion

Although supervision is an organic process, it tends to unfold in somewhat predictable patterns in the development of the supervisee. The first stage: dependence upon the supervisor and insecurity. The second stage: vacillation between dependence and autonomy and vacillation between over-confidence and overwhelmed. The third stage: autonomy and collegiality. Finally: integration and synthesis, where theory and practice co-mingle more easily and accurately.

Ideally, strength-based supervision is a co-created supervisory experience in which it is sometimes difficult to tell who is the teacher and who is the student. Collaboration and mutuality assist in the unfolding development of the supervisee. Since, both supervisor and supervisee are influenced by the supervisory process, it is imperative that self-awareness be optimized to enable enhanced learning to occur. It is important that both supervisor and supervisee have “a beginners mind” and remain open to the lessons that are awaiting them along the supervision journey together. Our effectiveness as supervisors is related to being “present with all our experiences as they are, in a fresh, open-minded way.” (Welwood, 2000, p. 141)

The integrity of our profession is inextricably linked with the education, training and supervision of its potential members. The bottom line is- that as supervisors, we are charged with the responsibility of being the gate keepers!

Bibliography

Albott, W. (1984). ‘Supervisory characteristics and other sources of supervision variance’, The Clinical Supervisor, 2, 27-41.

Aldridge, L. (1982). ‘Construction of a Scale for the Rating of Supervisors of Psychology’. Unpublished Masters thesis Auburn University.USA

Carifo, M.S. and Hess, A.K. (1987). ‘Who is the ideal supervisor?’ Professional Psychology: Research and Practice, (USA), 18, 244-50.

Coiche, E. (1977). ‘Training of group therapist’, in Kaslow, F. W. (ed.) Supervision, Consultation and Staff Training in the Helping Professions. San Francisco, Jossey Bass.

Doehrman, M.J. (1976). Parallel Processes In Supervision and Psychotherapy. Bulletin Of The Menninger Clinic, 40, 1-104.

Ekstein, R. (1969). ‘Concerning the teaching and learning of psychoanalysis’ Journal of the American Psychoanalytic Association (USA), 17(2). 312-32.

Fine, M., & Turner, J. (2002). ‘Collaborative Supervision: Minding the Power’ in Todd T. & Storm C. (Eds.) The Complete Systemic Supervisor: Context, Philosophy and Pragmatics. New York: Authors Choice Press, 229-240.

Gittermann, A. and Miller, I. (1977). ‘Supervisors and educators’ in Kaslow, F. W. (ed.) Supervision, Consultation and Staff Training in the Helping Professions. San Francisco, Jossey Bass.

Hawkins, Peter and Shohet, Robin. 1989. Supervision in the helping professionals. Philadelphia: Open University Press, pp. 43.

Haynes, R., Corey, G., & Moulton, P. (2003). Clinical supervision in the helping professions: A practical guide. Pacific Grove, CA: Brookes/Cole.

Hess, A.K. (ed.) (1980). Psychotherapy Supervision: Theory, Research and Practice. New York, Wiley.

Hess, A.K. (1987). ‘Psychotherapy supervision: stages, Buber and a theory of relationship’, Professional Psychology: Research and Practice (USA), 18 (3), 251-9.

Loganbill, C., Hardy, E. and Delworth, U. (1982). ‘Supervision, a conceptual model’, The Counselling Psychologist, USA, 10(1), 3-42.

Mcneill, B. W., And Worthen, V. (1989). The Parallel Process In Psychotherapy Supervision. Professional Psychology, 20, 329-333.

Porter, N, and Vasquez, M. (1997). ‘Covision: Feminist Supervision, Process, and Collaboration’ in Worell, J. and Johnson, N.G. (eds). Shaping the future of feminist psychology. American Psychological Association: Washington.

Proctor, B. (undated) ‘Supervision: A co-operative exercise in accountability’; Marken, M. and Payne, M. (eds), Enabling and Ensuring, Leicester National Youth Bureau and Council for Education and Training in Youth and Community Work.

Rioch, M. J., Coulter, W. R., and Weinberger, D. M. (1976). Dialogues for Therapists. San Francisco, Jossey Bass.

Rogers, C. R.. (1957). ‘The necessary and sufficient condition of therapeutic personality change’, Journal of Counseling Psychology (USA), 21, 95-103.

Searles, H. F. (1955). The Informational Value Of The Supervisor’s Emotional Experience. Psychiatry, 18, 135-146.

Turner, J., & Fine, M. (1996). Postmodern evaluation in family therapy supervision. Journal of Systemic Therapies, 14, 57-59.

Vanier, Jean. (1998). Becoming Human. Toronto, ON : Anansi Press.
Welwood, John. (2000). Toward a Psychology of Awakening. Boston: Shambhala Publications, Inc.

Patricia Berendsen, M.T.S., RMFT maintains an active private practice in Individual, Couple and Family Therapy and Clinical Supervision in London, Ontario. Patricia also provides clinical services as a Clinician with the Clinical Supports Program at the Centre for Children and Families in the Justice System of the London Family Court Clinic. She can be contacted at patricia@patriciaberendsen.com

It may be my imagination, but it seems to me that winters are becoming lengthier as the years go by. Yes, summer is here and is the season for planned vacations, day trips, beaches, pools, camping, fishing, boating, gardening and my favourite- sleeping in. Outdoor sports like soccer and baseball create gatherings of small communities of parents and friends cheering on their son or daughter. Lawn mowers are purring, chainsaws are buzzing and whipper snippers are zinging. Parents are planning for their children’s time away from the routine of school. Others utilize their time honing their golf swing and lowering their scores.

The warmth and sunshine beckons us from the darkness and solitude of winter to the out of doors. Oftentimes I find that peoples’ spirits seem lighter and their energy seems to be more positive once the temperatures increase and the sun is shining. Summer presents numerous invitations to refreshment and rejuvenation. Going to the beach, walking in the park and feeding the ducks, taking in community festivals…all offer a banquet of food for the soul.

“So what’s this got to do with work?” you might ask. “Everything”, is my reply. Keeping the soul in our work requires us to take advantage of the refreshment that each season of the year brings to us. Refreshment is essential in our fast paced life. I am reminded of proponents like David Elkind who long ago predicted that even children may experience burnout before puberty because of the added pressures and activities that so clutter their young lives. The child’s developmental task of free play has often been replaced by organized sports, music lessons and the like. So, too, as adults, we need time to decompress…to “play” in order for our minds and bodies to establish and maintain equilibrium that is necessary for our mental health. This means that we need to take the time to nourish ourselves so that we don’t burn out.

I am remembering a plaque that I saw a long time ago. The picture displayed a mother and father hen talking to their brood of young chicks with the caption reading, “Ain’t momma and poppa happy, ain’t nobody happy!” As members of teams, as management, as workers in the classroom or on the floor, our disposition does affect the people around us, especially those we serve, our clients. We all know too well the devastating impact of just a couple of grumpy, critical people who can demoralize a whole team or send negative shock waves throughout an agency. Our ability to re-connect with ourselves and take the time to rejuvenate is foundational to our longevity and stability in our field of practice. Hey, if we are happy, likely those around us are happier too!

In my case, the past few months have been filled with challenges that have left my energy tank “on empty”. I was in much need of refreshment. I decided to spend some time outside in the hope that I might experience once again what I have known to be true about nature’s healing qualities. Sitting beneath a canopy, sheltered from the ultra violet rays I absorbed the sounds, sights and smells of summer. Before me was a vast array of nature’s glory in the form of forest and perennial plants well into their summer bloom. Cardinals, finches and hummingbirds were enjoying their feast of birdseed as well as nectar from bright crimson and fuchsia flowers. I spotted baltimore orioles attracted to the prepared orange fruit slices for their enjoyment. Every so often a waft of a skunk scent would reach my nose. Butterflies were flitting around bushes named after them as well as taking delight in the array of colours and fragrances.

Interestingly and predictably, I found myself breathing more evenly and deeply. My shoulders relaxed and enjoyed the burden free moments. The cares of work seemed to fade from my mind. This experience of re-creation is right at my finger tips, yet often forgone because “I have work to do” or I am taxi-ing my children somewhere. Or the daily routines of life like weeds, seem to choke out these simple pleasures.

And as it often happens, nature offered some perspective to my usual musings.
I was somewhat surprised that quietly observing nature would have such a profound impact on me. Time is an interesting concept because each of us has the same amount available to us, yet most of us complain that we never have enough. I found that by being outside, time seemed insignificant and had the illusion of multiplying itself. Minutes seemed fuller and time appeared to move more slowly giving me the space I needed to ‘just be.’

The other day I met my friend for a walk in the park. What struck me was how I felt so refreshed after our time together. The flowing river, huge trees offering shelter from the humidity, bicycle paths providing space for wheeled enthusiasts, families of geese wading…all I could think about was when I would make the time for myself to do it again.

I was noticing that the trees in their entire splendor just ‘do their thing’. They bend and blow with the gusts of wind. They join in a chorus of rustling yet each has its own sound. They remain still, standing proud when the winds die down. A pine tree does not compete with the abundance of the maple or oak. Each knows its purpose and grows to fullness in the right environment.

Even the plants just ‘bloom where they are planted’. A yellow primrose does not try to become the blue cornflower. They grow alongside other births of bloom with each shade complimenting that of the other. Some flowers and plants require more space than others, but really, they are very focused on their mission of growth and blooming at their appointed time.

Nature reminds us of her inherent cycles: a time for planting, gestation, tilling, harvesting and eventually dying. Likewise, we have cycles and seasons in our lives and careers. Setting aside time allows us to observe these cycles. In doing so, we can take stock of our lives-professionally and personally, becoming more grounded in our purpose. Rest and relaxation allows us to re-create ourselves and bring replenished energy to our being. Consider nature’s invitation to a time of refreshment and renewal. Say, “Yes!” Create space for yourself, sink into the moment, breathe deeply, and enjoy!

Patricia Berendsen, M.T.S., RMFT maintains an active private practice in Individual, Couple and Family Therapy and Clinical Supervision in London, Ontario. Patricia also provides clinical services as a Clinician with the Clinical Supports Program at the Centre for Children and Families in the Justice System of the London Family Court Clinic. She can be contacted at patricia@patriciaberendsen.com

© 2006

Abstract
Purposeful/Intentional Interactions can revolutionize the “ordinary and routine things” that we do or say into moments that can be transformative, healing experiences for clients. The authour describes three components essential to purposeful/intentional interactions and uses authentic anecdotal material to demonstrate the importance of making each interaction count!

“You never know the moment in a child’s life when you will make a difference for a lifetime.” This plaque in my office is a constant reminder of the importance of making every interaction intentional and purposeful. Every interaction counts. I have learned through experience that it is often the small and seemingly insignificant things that we do or say that most clients remember. Let me digress for a moment and share with you a couple of examples.

A goodbye celebration was being planned for a staff person and a cake had been carefully and thoughtfully made and decorated by the children from the residential treatment program. A newly admitted child asked, “Who was the person getting the cake?” A staff person overheard a more senior resident’s emphatic reply, “Oh, you’ll know her…She’s the one who has a big smile every time she sees you! And she tells you good things about yourself!”

Another child who was leaving the residence shared his first impressions. He talked about how it meant so much to him that everyone was friendly when he first came to the residence. He especially liked the welcome sign on his door, the homemade afghan on his bed that he could keep after his discharge, and the security he felt when one particular staff hung out with him for a couple of days until he was more comfortable. He fondly remembered that on his first night in his new surroundings, the staff team cooked his favourite meal (tacos with lots of hot salsa sauce).

These examples clearly illustrate how the seemingly “ordinary and routine things” that we do or say can be transformative, healing experiences for clients.

Every interaction, every encounter contains the possibility of healing. I am reminded of Mahatma Ghandi who said, “Be the change you wish to see in the world.” In this sense, I believe that as professionals we are charged with the responsibility and privilege to be positive examples and change agents in our world and especially in our work. I would suggest that everything we do and say…matters.

What are the criteria of “Purposeful or Intentional Interactions?”

1. Foster Human Contact and Connection: “The belief in the inner beauty of each and every human being is at the heart of being human. As soon as we start choosing and judging people instead of welcoming them as they are– with their sometimes hidden beauty, as well as their more frequently visible weaknesses– we are reducing life, not fostering it. When we reveal to people our belief in them, their hidden beauty rises to the surface where it may be more clearly seen by all.” (Vanier, 1998, p. 23) Our clients, the children and families we serve, are people first. Each person’s birthright is their inheritance to claim love, time, respect and attention. Diagnoses and trauma may have influenced and shaped our clients’ identity but they do not define the totality of who they are. It is essential that people encounter their inherent dignity and worth during any interaction. We must be careful not to equate the value of a person with the nature of his or her behaviour. (Satir, 1988, p.337-338)

Human to human contact is paramount. “Belonging…is a school where we learn to open up to others and to the world around us, where each person…is important and respected. We discover who we are through our mutual dependency, in weakness, in learning through belonging.” (Vanier, 1998, p. 41) I believe that it is important that people can come away from any encounter and feel richer and inspired because of it. Virginia Satir, renowned family therapist describes her view of connecting with people. “My means of making contact is in my own congruent communication and the modelling that went with it. It was as though I saw through to the inner core of each being, seeing the shining light trapped in a thick black cylinder of limitation and self-rejection.” (1988, p. 340-341) “The way to promote healing is by reversing the condition of rejection. We must be present with all our experiences as they are, in a fresh, open-minded way.” (Welwood, 2000, p. 141)

“Being real works. When people disguise their true feelings, and reactions of the moment, they lose emotional contact with those around them. And when the contact goes, so does the ability to influence.” (Edgette 2002, p.14) A youth, named Carly, illustrates the impact of poor therapeutic contact. “I think a lot of therapists are fake. I hate it when they always have to talk about how you feeeeel…[a facial expression accompanies this sarcastic remark]. It’s so annoying and it really bugs me. Then when you do tell them about something that really sucks, they just say, “Oh, you must be sad.” “Well Duh? Whaddyah think I am? I write them off then and there!”). “Great therapists are those who are likely to be more interested in what they don’t know about their clients than what they do know. When therapists operate primarily from knowledge, they are more likely to be manipulative; when they operate from not-knowing, they are more likely to embody authentic presence. Letting themselves not know what to do next invites a deeper quality of attentiveness.” (Welwood, 2000, p. 143)

2. Be Present: “It is not enough to reveal to people their value, it is also to celebrate them. (Vanier, 1998, p. 26) It is important that people experience their needs as being the top priority in that particular moment. Being distracted and rushed is not ‘being present’. Josh, a 12 year old client, illustrates the importance of presence. “Like…the other day, I was seeing this person and he kept going through his papers. I don’t remember if he really looked at me…Like really… I think he answered the phone at least 3 times while I was in his office. I really didn’t think I should be there because he was so busy…Actually, I didn’t wanna be there. I thought I was just a waste of time!” “The most powerful healers or teachers [and therapists] are those who can model authentic presence and bring it into their work. Inviting and allowing another person to have his or her experience just as it is– this is perhaps the greatest gift anyone can offer.” (Welwood, 2000, p. 144

3. Reflect: It is essential in this field to make time and then take time for reflection. This may happen on the way to or from work, by debriefing with a colleague, journaling, meditating, gardening, walking during a break, shutting the door and breathing deeply for a moment etc. As social service providers, we have an accountability that we should not take lightly. We have the potential to have an indelible impact on our clients and our agency and this potential is enhanced when we pause and reflect upon our work. In doing so, we reduce the risk of making serious mistakes. Indeed, not being reflective practitioners in my opinion makes us liabilities to our profession. Additionally, I would propose that each of us consider finding a professional therapist to work with, so that we can become even more aware of any personal issues that may intersect with our professional life and to assist us in assessing and monitoring the impact of vicarious trauma. “As therapists, we must be willing to hang out with our own raw edges, or else when our clients activate these touchy areas, we will pull back, offer a quick fix, or try to steer the client in some other direction.” (Welwood, 2000, p.144). Certainly, some of this reflection can occur during supervision. The benefit is that the quality of our work improves when we have such preventative and supportive measures in place.

In conclusion, it is important that we make every interaction purposeful and make it count. This can be accomplished by a conscious decision to: foster human contact and connection, be present, and lastly to reflect upon our work. We can intentionally approach each human contact as though it was the first or potentially the last encounter we might have. “You are the difference. With every single choice, every day, all day long!” (Stinnett, 2004, p.8)

Bibliography

Edgette, Janet Sasson. (2002). Candor, Connection, and Enterprise in Adolescent Therapy. New York: W.W. Norton and Company.

Satir, Virginia. (1988). The New Peoplemaking. Mountain View, CA: Science and Behaviour Books, Inc.

Stinnett, Suzanna Beth. (2004). Little Shifts. Naperville, Il.: Sourcebooks Inc.

Vanier, Jean. (1998). Becoming Human. Toronto, ON : Anansi Press.

Welwood, John. (2000). Toward a Psychology of Awakening. Boston: Shambhala Publications, Inc.

Patricia Berendsen, M.T.S., RMFT maintains an active private practice in Individual, Couple and Family Therapy and Clinical Supervision in London, Ontario. Patricia also provides clinical services as a Clinician with the Clinical Supports Program at the Centre for Children and Families in the Justice System of the London Family Court Clinic. She can be contacted at patricia@patriciaberendsen.com

Abstract : Everyone experiences ‘being stuck’ with clients at one time or another. This article stresses the importance of dialogue as one of the key ways to move through this type of therapeutic impasse. The author highlights strategies that may assist helping professionals when they encounter stuck points in their work with clients.

Evaluating our ‘mistakes’ in therapy can be one of the richest resources we have for learning, yet it appears to be one the most underutilized tools we have at our disposal. We all know we make mistakes or struggle in therapeutic situations with our clients, so let’s talk about it!!

“When the teacher is ready the student will appear.”

I believe that it is our clients who will bring us to the place of openness. It seems that the severity of cases that are coming through our doors is the impetus for the necessity of dialogue. We need the collective wisdom gleaned from our personal and professional experiences. We require ‘all hands on deck’ to facilitate safe passage as we navigate the uncharted waters of the complexity of our cases. Now, more than ever, it is important for us to “check our egos at the door” and seek support and supervision from our colleagues.

Recently, I was one of several clinicians gathered to have a round table discussion about the experience of feeling stuck or being stuck in therapy. Most of us were comfortable sharing our successes amongst our esteemed peers. What made this discussion so significant and pivotal event was our willingness to risk and be vulnerable with one another and expose our perceived incompetence.

The level of experience ranged from those who were recent master’s level graduates to those with 30 years of clinical experience. Most of us were familiar with each other, yet we were embarking on a new frontier … having a conversation about being “stuck in therapy” in a group setting amongst our peers. After reinforcing the importance of group guidelines to achieve our goal of having a supportive discussion without judgment, we proceeded.

‘Getting Stuck’ Happens

We all get stuck sometimes. Even seasoned CYC’s and therapists! Newer staff members expressed relief because they thought their ‘stuckness’ was related to inexperience. Actually, ‘stuckness’ seemed less related to inexperience or having or using the right therapeutic knowledge, tools or technique. It appeared to reflect more about the therapeutic relationship or the isomorphic nature of the therapist, treatment team, or client’s life. Oftentimes, feeling stuck reflected our hope for the family and our wish for their situation to improve, whereas clients seemed satisfied with where they were at. At other times, it was an indicator that it was time for the client to move on and that therapy was drawing to a close. Occasionally, therapists experienced pressure to be as productive as possible within constraining timelines. This appeared to impact the time required to adequately process therapeutic impasses.

Self-awareness is the key

Most important in dealing with ‘stuckness’ is the helping professional’s self-awareness. It is essential to take the time to reflect upon one’s reactions: to clients, the content of therapy and one’s physical responses and attitudes. Often we can be stuck in therapy because we may be frustrated with a client or exasperated with the lack of progress. Perhaps we might be bored and feeling a lack of stimulation. We may even be angry with a client. ‘Stuckness’ may also indicate that we need to pay attention to a blind spot or a pattern of therapeutic behaviour that continues to lead us into the stuck place we find ourselves in.

Give permission to feel

We need to give ourselves and each other permission to feel our ‘stuckness’. Sometimes, even though we are in this helping profession, we resist feeling our ‘stuckness’ or our helplessness. Some of us may attempt to “keep it all together” when we are flailing and need assistance. We may rarely ask for help, perhaps living the fallacy that being strong means we can do it on our own. We keep telling ourselves, “that we ought to know what to do!”…that “if we asked for help we would really appear incompetent.”

Talk about it

We need the opportunity to express both our competence and our areas of growth with one another. If this opportunity does not exist I propose that we will not be doing the excellent work with clients that we are capable of. In fact, we may end up doing harm to our clients and to ourselves. Our collegial and supervisory relationships need to include being able to talk about our feelings, especially our shame about being stuck. If we do not have a supportive supervisory or collegial relationship I would suggest seeking someone out. It would also be important to highlight this issue with managers of the organization as they might be assuming that supervisory relationships are satisfactory to staff members.

Try something different

If we keep doing the same thing, we can expect the same results! The idea is to interrupt the cycle. It is important to take risks and do something different. It is up to us to take initiative in our workplace. If we are feeling stuck, request a reflective team or time with colleagues to present a case. We can seek assistance from our supervisor or a trusted co-worker to get a fresh perspective. Videotaping our work and reviewing it with our peers, asking for feedback can be helpful. It might be a useful exercise to create a “how to get unstuck list” with our colleagues. It may be essential to journal about our reactions to a client. We can ‘draw our frustrations’ using crayons and pastels or ‘finger paint our ‘stuckness’. Sometimes, shutting the door and doing some yoga or deep breathing can help ground us.

Go back to the basics

Sometimes our ‘stuckness’ is a symptom that we need to review the original goals we have collaboratively developed with a client. They are the compass for us when we feel lost or stuck. We can talk with our clients about what we are experiencing in our therapeutic relationship. Respecting the wisdom and choices that a client may make, even if it is not what we would perceive as the ‘right’ choice is essential. We can pay attention to our self-importance and when we take ourselves too seriously. We can continue to cultivate our sense of humour. “Being with” our clients, knowing that bearing witness to their pain and validating their ability to survive, is indeed a measure of success.

The round table discussion came to a close but not before several people noted how energized and lively the discussion had been. There was great enthusiasm for when our next courageous conversation could occur. We had crossed the threshold of our fear of being judged into the reality that we were not alone in our ‘stuckness’. Instead, we found understanding, compassion and encouragement. We were hungry for more!

Each of us wants excellence in our work. It is our personal and ethical responsibility to ensure that our clients get the highest quality of care that they deserve. We need to trust the therapeutic process, knowing that ‘stuckness turbulence’ is normal. Establishing a community of practice may help us achieve this goal.

Reading

Kottler, Jeffrey A. and Carlson, Jon. Bad Therapy- Master Therapists Share Their Worst Failures. New York: Brunner-Routledge.

Orbach, Susie. (2000). The Impossibility of Sex. New York: Scribner Publishing.

Stream, Dr. Herbert S. (1988). Behind the Couch- Revelations of a Psychoanalyst. Toronto: John Wiley and Sons.

Patricia Berendsen, M.T.S., RMFT maintains an active private practice in Individual, Couple and Family Therapy in London, Ontario. Additionally, Patricia provides clinical services as a Clinician with the Clinical Supports Program at the Centre for Children and Families in the Justice System of the London Family Court Clinic.  She can be reached at patricia@patriciaberendsen.com.

It Can Happen to You!
By Patricia Berendsen

Keeping the soul in our work is not as easy as it sounds. Most of us have heard the words burnout, secondary traumatic stress, compassion fatigue, and vicarious trauma. These terms are often used interchangeably (much to the chagrin of many professionals), in an attempt to describe the impact on helping professionals working in the area of trauma. No one engaging in working with traumatized clients is immune to or can avoid its effects. (Health Canada, 2001) We take care of others all the time! Surely we would be able to recognize our own issues related to wellness and self-care because this is our forte. We know this stuff! Besides, we have grown accustomed to the difficulty of our work and have been doing just fine. Unbeknownst to many of us, however, we have become numbed to the reality and hazards of our job descriptions. “Through the inevitable participation in traumatic reenactments in the therapy relationship, the therapist is vulnerable through his or her empathic openness to the emotional and spiritual effects of vicarious traumatization.” (Health Canada, 2001). The bottom line is- that when we are in the business of caring, we will be affected in some form or another.

Most of us begin our careers with a clear resolve to maintain personal and professional boundaries, passion for our work and hold fast to our conviction in earnest of being the best helping professionals ever! We might acknowledge that tiredness and fatigue could eventually happen down the road (likely to someone else)…but that we would be different! We would work on self-care and avoid what we have heard described by senior staff persons as the painful reality of burnout. “It may have happened to them”, we think, “but it won’t happen to me!”

Vicarious trauma may be described as, “the energy that comes from being in the presence of trauma and it is how our bodies and psyche react to the profound despair, rage and pain. Personal balance can be lost for a moment or for a long time. Waves of agony and pain bombard the spirit and seep in, draining strength, confidence, desire, friendship, calmness, laughter, and good health. Confusion, apathy, isolation, anxiety and illness are often the result.” (Health Canada, 2001). Often the personal impact of vicarious trauma is experienced in 6 areas: cognitve, emotional, behavioural, spiritual, interpersonal and physical. (Yassen, 1995). The effects are cumulative and permanent, and evident in both a therapist’s professional and personal life” (Figley, 1995).

The symptoms of vicarious trauma reveal themselves gradually with a missed lunch here and there, from taking some work to more work home, overextending ourselves for the client, the agency or the community, missing work out times at the gym, cancelling massage therapy appointments, and increased isolation from family and friends. Oftentimes, we might experience more physical difficulties such as: chronic constipation, stomach/digestive problems, ulcers, urinary tract infections, headaches, sleep disturbance, general aches and pains, a loss of libido, teeth grinding and jaw dysfunction, and an impaired immune system.

In keeping with the wisdom of Dr. Seuss, “I’m sorry to say so but, sadly, it’s true that Bang-ups and Hang-ups can happen to you. You can get all hung up in a prickle-ly perch. And your gang will fly on. You’ll be left in a Lurch.” Yes, it (stress, vicarious trauma, burnout or whatever you wish to call it) can happen to you…and more likely than not, it will happen to you!

Case Example

I am reminded of a gifted child and youth worker, who was revered by his coworkers. Joel, a recent graduate, was an obvious leader and role model and a positive influence on everyone around him. Joel was an initiator of new ideas and programs for the residential team of a children’s mental health center that he was a part of. His creativity knew no bounds and any involvement he had with clients were met with great reviews. Children were drawn to him and often wanted him to be their primary worker. Colleagues relied on him for support. When chaos ensued, Joel was grateful to be needed and was pleased to provide calm and comfort to his coworkers. Joel was proud of his accomplishments as a Child and Youth Worker and was living up to his expectations of what he thought a good CYC should be.

Gradually, Joel began to get behind in his paperwork. Almost every time he would attempt to begin a report, a colleague would interrupt him, needing to debrief about something that happened on a previous shift. Joel, valuing being a team player, set aside his report time to listen to the plight of his peer. Initially, Joel was grateful that his colleagues could depend on him for support. However, now after almost two years, he was beginning to feel somewhat resentful toward his peers. Joel felt that he was being taken advantage of and gradually found himself wanting to avoid his team members. It was noticed that Joel was often quieter and withdrawn.

Program initiatives previously enticing to Joel became more burdensome and less interesting. Joel was increasingly reluctant to be nominated or designated as the committee representative or to lead the new project. The lion’s share of the workload seemed to fall primarily on Joel’s shoulders. Joel’s co-workers noticed that he seemed less organized. Oftentimes he would forget that he had meetings or would need several reminders to follow through with details that he normally would have been on top of.
Joel’s stellar attendance record now included more sick days. Joel began to have more migraines and suffered longer than he previously did, with colds and flues. Joel noticed that he was regularly feeling sluggish and tired and began to drink more coffee relying on the extra ‘caffeine kick’ to make it through his day. “It’s just one of those weeks!” he would tell himself, and hoped that his feelings of dread and fatigue would somehow magically disappear. Except every week was becoming “one of those weeks!”

Joel’s relationships with his coworkers became strained. Joel’s hallmark of infectious humour slowly transformed itself into sarcasm whose edges were sharp, cutting and alienating. Joel was observed to be impatient with his clients and tended to be more punitive than understanding. “They are resistant and not workable. If they’d only do what I told them to, things would be fine!,” he would mutter under his breath.

Homelife? What homelife? Joel, single and looking, could only plop himself on the couch with a beer or two after work and escape from the stress by staring mindlessly at the reality shows on television. Joel’s previous routine of working out at the gym had gradually been replaced by working extra shifts and attending work-related meetings. He could see no way to fit exercise into his schedule. And he had no energy to go out with friends, even though he used to at least 2-3 times a week.

Nightimes were the worst. Joel struggled to get to sleep. When he finally fell asleep he would awaken suddenly with his heart racing and worrying whether he counted the meds correctly before leaving his shift. Joel also found himself dreaming about his clients or work situations. Joel, who used to sleep deeply and soundly, now, would wake in the morning feeling worn out due to a restless night’s sleep.

And so the cycle would continue…more sarcasm and resentment, less productivity, more coffee, forgetfulness, increased illness…

Stress is the result of personal investment in difficult situations. If no investment exists, there is no basis for stress (Johnson, 1989). The empathic response of helping professionals is at the core of the commitment to service. It is this empathy that creates the greatest risk and vulnerability to vicarious trauma (Health Canada, 2001). The stress inherent in helping professions and leading to vicarious trauma is a slippery slope. It is the insidious way that the experiences slip under the door, finding ways to permeate the counsellors’s life, accumulating in different ways, creating changes that are both subtle and pronounced (Health Canada, 2001).

I would suggest that our vulnerability to vicarious trauma is one of our blind spots. We can usually identify changes in our behaviour when we can connect it to a specific event. But the nature of stress and vicarious trauma is that it is cumulative. It often grows quietly and patiently and can develop very deep roots. In our minds we know that vicarious trauma is a very real and present danger, yet we remain in denial as our lives, especially our bodies, tell the real story.

So what can we do about it? Recovery takes time just as it took time to develop the symptoms. The simplest (which does not necessarily mean easiest) description I have seen is the ABC’s of addressing vicarious trauma from Transforming the Pain (Pearlman and Saakvitne, 1996). These components of Awareness, Balance and Connection are most effective when applied to the personal, professional and organizational realms of our lives. More specifically, the ABC’s refer to:
Awareness: being attuned to your needs, limits, emotions and resources.
Balance: maintaining balance between work, play and rest.
Connection: developing and maintaining connections to self, others and to something larger.

In general self awareness and self-care strategies are essentials in prevention and healing. For many of us, evaluating our personal and professional expectations of ourselves is required. We may need to learn to pace ourselves and live life moderately instead of at breakneck speed. Even batteries need to be re-charged! Getting honest feedback from a few good friends can be an eye-opening experience. Boundaries need to be re-evaluated and/or re-negotiated so that we can take a step back and detach from taking on too much or “overnurturing’ others. Personal therapy can also be invaluable as can collegial support and supervision.

On the physical end of things…it is important that we take care of our bodies by drinking water, breathing deeply, eating well and developing regular sleep habits. Incorporating physical activity that is enjoyable to you and that works with your lifestyle is critical. I have known several people who have unused or lapsed memberships at fitness clubs because it wasn’t really ‘their thing’. Another significant aspect of attending to physical health is by making and keeping medical and dental appointments. (adapted from Freudenberger and North, 1986)

Joel, in our case example was beginning to show signs of fatigue. I imagine that the challenge for Joel and those around him was the gradual nature of the changes in his personality and professional demeanour. It is an example that illustrates for us the importance of regular reflection, honest feedback from friends, family, coworkers and supervisors to help us stay true to ourselves and our initial conviction to be the best we can be in our field.

In closing, may I quote some wisdom from Oh the Places You’ll Go by Dr. Suess… “On and on you will hike, And I know you’ll hike far and face up to your problems whatever they are. You’ll get mixed up, of course as you already know. You’ll get mixed up with many strange birds as you go. So be sure when you step. Step with care and great tact and remember that Life’s a Great Balancing Act.”

Resources

Dr. Suess. 1990). Oh, the Places You’ll Go! New York: Random House.

Figley, Charles, R. (Ed.). (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York: Brunner/Mazel

Freudenberger, Dr. Herbert J and North, Gail (1986). Women’s Burnout-How to Spot It, How To Reverse It and How to Prevent It. New York: Viking Penguin Books

Health Canada (2001). Guidebook on Vicarious Trauma: Recommended Solutions for Anti-Violence Workers. Ottawa: National Clearinghouse of Family Violence

Johnson, Kendall Ph.D. (1989). Trauma in the Lives of Children. Alameda, CA: Hunter House.

Saakvitne Karen W. and Pearlman, Laurie Anne. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York: W.W. Norton and Company.

Stamm, B. Hudnall. (2002). Professional Quality of Life: Compassion Satisfaction and Fatigue subscales-III. http://www.isu.edu/~bhstamm. (This is a good questionnaire to use regularly as a means to self-monitor compassion fatigue)

Yassen, J. (1995). “Preventing secondary traumatic stress disorder.” in Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. C.R. Figley (ed.). New York: Brunner/Mazel.