Module 11: Compassion Resilience

Module Purpose

The purpose of this module is to:

  • Learn about secondary trauma and compassion fatigue.
  • Recognize our responses to ongoing and prolonged stress. 
  • Access tools and practice strategies to promote compassion resilience.
 

Mindful Moment

"We may not have been directly exposed to the trauma, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.” – C. Figley, 1995

Mindful Moment

Be mindful. Take a deep breath.
Take good care of yourself

Let's begin this module by taking a “mindful moment” to ground our intentions. 

Why are we exploring compassion fatigue and resilience? 

Statistically, many people doing this training have gone through some sort of trauma.  As you are going through this training please be mindful of your responses. Let's start by taking a deep breath. 

Here are some ideas for self-care you can use:

  1. Download a mandala for coloring using colored pencils and crayons. Coloring or doodling can help with focus and reduce stress.

  2. It is OK to stop anytime you want, take a break, stretch, walk around.

Click here to download a mandala

 

Secondary Trauma and Compassion Fatigue

Vicarious or secondary trauma refers to the cumulative physical, emotional, and psychological toll that can occur when we are exposed to the suffering, hardship, crisis, or trauma of others. It is the impact from exposure to traumatic stories or events when working in a helping capacity, combined with the strain and stress of everyday life. There is a toll individually, individually, organizationally, and societally. Other terms used include trauma exposure response, compassion fatigue, empathic strain, or trauma stewardship.

 Historical and cultural trauma can intensify the impact.

  • The events we experience, witness, remember and store in our body can impact our ability to cope.

  • Events can overwhelm the ordinary responses that give us a sense of control, connection and meaning.

  • We can be left feeling helpless and our world view may be impacted.

The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.
— Rachel Remen

Trauma exposure responses

Trauma exposure responses include our feelings and behaviors and are natural responses that flow from our humanity. The effects of secondary trauma are similar to those experienced by victims and survivors themselves (1). The following are potential warning signs of trauma exposure response.

Trauma Exposure Response

Trauma Stewardship

In this talk, Laura offers us a window into the cumulative toll that can occur when we are exposed to the suffering, hardship, crisis or trauma of humans, other living beings, or the planet itself. Held within a larger context of systematic oppression and liberation theory, we'll dive into what gets hard and how to work toward reconciling it both individually and collectively.

 “Trauma stewardship refers to how we come to do this work, how we are affected by it, and how we make sense of and learn from our experiences. When we talk about trauma in terms of stewardship, we remember that we are being entrusted with people’s stories and their very lives. As stewards, we create a space for and honor others’ hardship and suffering, and yet we don’t assume their pain as our own. We care for others to the best of our ability without taking on their paths as our paths. To participate in trauma stewardship is to always remember the privilege and sacredness of being called to help. It means maintaining our highest ethics, integrity, and responsibility every step of the way.” Laura van Dernoot Lipsky

Cultivating our capacity to be present

One of things Laura invites us to do individually and collectively is to “continue to strive to cultivate our capacity to be present. We remind ourselves with everything that is out of our control, one of the things remains in our control is our ability to bring our exquisite quality of presence to what you are doing and how we are being. From this place of presence it is possible to aspire to do no harm, to transform whatever trauma arises, and to continue to work to dismantle systems of oppression which is causing such a legacy of suffering (2).” 

Organizational responses

Organizations have the potential to either mitigate or exacerbate the effects of trauma exposure for all of their workers. When people perceive their organizations as supportive, they experience lower levels of vicarious trauma (3).

Here are some examples of prevention strategies organizations can incorporate to address secondary trauma :

  • Psychoeducation
  • Clinical supervision
  • Ongoing skills training
  • Workplace self care groups (yoga, meditation)
  • Flextime scheduling
  • Good health/nutrition

Multiplying Connections provides a useful resource on Reflective Supervision for providers faced with the traumas of the families they work with. Click here to download a white paper on Reflective Supervision from Multiplying Connections. 

  1. Yoder, Carolyn (2005) The Little Book of Trauma Healing: When Violence Strikes and Community Is Threatened (Little Books of Justice and Peacebuilding) Good Books
  2. van Dernoot Lipsky, Laura (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others. Berrett-Koehler Publishers
  3. Golie Jansen (2004) Vicarious Trauma and Its Impact on Advocates, Therapists, and Friends,”Research & Advocacy Digest 6, no. 2
  4. Van Berckelaer, Anje. Using Reflective Supervision to Support Trauma-Informed Systems for Children. Accessed at http://www.multiplyingconnections.org/sites/default/files/field_attachments/RS%20White%20Paper%20(2).pdf on April 13, 2018
 

Stress Response and Overwhelm

Our bodies response to stress

Our bodies respond to stress with physiological changes such as increased heart rate, blood pressure, and stress hormones, with a return to baseline when the stressor is removed. A positive stress response is a normal stress response. Positive stress responses are infrequent, short-lived, and mild. Tolerable stress responses are more severe, frequent or sustained. The body responds to a greater degree. Examples include divorce or the death of a loved one. Toxic stress that is severe or prolonged can result in an ongoing stress response with a failure to normalize (1). We experience repetitive shocks to the mind and body that occur under the radar of conscious awareness. Over time the body becomes habituated to chronic over- stimulation and simultaneous exhaustion. We become wired and tired.

Stress Response

Recognizing our reactions is the first step to compassion for ourselves (and others). From this place of understanding and self-compassion, we can begin to understand what is causing our overwhelm, ease the burden, and work to change what is within our control. 

Reflection

 Click to download body template.

Click to download body template.

  • Think of a specific time when you were impacted by the work you are doing.

  • Where were you? Who was there with you?

  • What words can you use to describe the emotions you were feeling?

  • Where did it show up in your body?

  • Draw on the body where it showed up. Click here for a body exercise template. 

Recognizing overwhelm

Paying attention to our sense of overwhelm will help us to ease the burden of overwhelm, restore our perspective, and take action (2).

  1. What does my OVERWHELM look like?
  2. What is currently CAUSING it?
  3. What are the perceived or actual BARRIERS for tending to my overwhelm?
  4. Make informed CHOICES

Sources

  1. Franke, H. A. (2014). Toxic Stress: Effects, Prevention and Treatment. Children1(3), 390–402. http://doi.org/10.3390/children1030390. Click here to download this resource. 
  2. The Trauma Stewardship Institute - http://traumastewardship.com/
 

Levels of Exposure to Trauma

When we think of trauma sensitivity, we understand that there reactions to trauma (trauma exposure) at three different levels (1): 

Levels of Exposure

Personal dynamics

Think of who are we as individuals and what’s our own history of trauma/pain. Our own history of trauma may help us identify with the population we are serving and connect in an intimate and knowing way. But it also heightens our vulnerabilities. If we are not careful to separate our own self from another’s experiences, we may increase responsibility to the point we feel anguish in a debilitating way. We can feel an overwhelm or loss of control. 

Organizational tendencies

Trauma exposure responses may manifest in our workplace in both a lack of accountability and unethical behavior.

Societal factors

Numerous forces contribute to the flow of trauma:

  • Social dynamics, struggles, environment, relationships

  • Systematic oppression- systems that perpetuate suffering for certain groups are created and maintained through use of force, authority or societal norms (structural violence) to keep them from satisfying their basic needs. Systemic oppression includes "isms" such as: racism, ethnocentrism, elitism, racism, sexism, ageism, nationalism, heterosexism.

  • Lifespans are reduced when people are socially, politically, or economically dominated or exploited.

  • We can see this happen through intergenerational patterns of family violence, racial violence, hate crimes, wars, terrorism, trafficking

The risk of behaviors that may magnify the pain and suffering of direct trauma is always present and can lead us to vicarious trauma.

Shifting attitudes and practices

We can sustain our work with trauma only if we combine our capacity for empathy with a dedication to personal insight and mindfulness (being present) so as to not cause harm but to edify (1).

First, we should have some awareness of what it means to be who we are (gender, race, career, relationships). Then, we can work to nurture workspaces that don’t replicate oppression we experience.

To accomplish lasting repair, we need shifts in attitudes and practices by ourselves, organizations, and infrastructures.

Sources

  1. Trauma Stewardship Institute - http://traumastewardship.com/
 

Compassion Resilience

Compassion resilience is the ability to maintain our physical, emotional, and mental well-being while responding compassionately to people who are suffering (1).

  • You - Start by taking care of yourself
  • You and others - Our relationships are a key piece of taking care of ourselves.
  • You and others and work – We need to create a team and workplace culture that values compassion resilience for individuals, teams, and the organization.

Higher levels of compassion = higher levels of resilience

“Love and compassion are necessities not luxuries. Without them, humanity cannot survive…. If you want others to be happy, practice compassion. If you want to be happy, practice compassion.”
— Dalai Lama

Spark Exercise

If we think of compassion as that spark inside of us that brings us hope and a sense of possibility in this work (world).

  • What fuels your spark?
  • How do we intentionally feed that spark?
  • How do we protect that spark?
  • What we need from each other to nurture our sparks?

Create a spark card for a daily practice of nurturing your spark.

Sources

  1. Wise Wisconsin - https://wisewisconsin.org/tag/compassion-resilience/
 

Tools for Resilience

We can help our body release the tension and hormones that accumulate with stress, or if it’s difficult for us to manage our feelings, stress, and anxiety.

listen to body

Body scan

A body scan helps us bring attention to where we’re holding tension in our body so we can help it relax.

Begin by bringing your attention into your body. You can close your eyes if that’s comfortable for you.

You can notice your body seated wherever you’re seated, feeling the weight of your body on the chair, on the floor.

Take a few deep breaths.

And as you take a deep breath, bring in more oxygen enlivening the body. And as you exhale, have a sense of relaxing more deeply.

You can notice your feet on the floor, notice the sensations of your feet touching the floor. The weight and pressure, vibration, heat.

You can notice your legs against the chair, pressure, pulsing, heaviness, lightness.

Notice your back against the chair.

Bring your attention into your stomach area. If your stomach is tense or tight, let it soften. Take a breath.

Notice your hands. Are your hands tense or tight. See if you can allow them to soften.

Notice your arms. Feel any sensation in your arms. Let your shoulders be soft.

Notice your neck and throat. Let them be soft. Relax.

Soften your jaw. Let your face and facial muscles be soft.

Then notice your whole body present. Take one more breath.

Be aware of your whole body as best you can. Take a breath. And then when you’re ready, you can open your eyes.

5-7-5 deep breathing

Breathing is a natural relaxation response that helps reduce cortisol (stress hormone) levels and pain in body.

To start, put one hand on your belly and the other on your chest as in the belly breathing exercise. You want to make sure that when you breathe in, your belly rises and falls.

Take a deep, slow breath from your belly, and silently count to 5 as you breathe in through your nose.

Hold your breath, and silently count from 1 to 7.

Breathe out completely through your mouth as you silently count from 1 to 5.

Progressive muscle relaxation

When we feel anxious, our muscles tense in response to thoughts; by intentionally becoming tense and then releasing, we help our muscles relax and block anxiety and stress as well as metabolize those stress hormones. It can also help reduce headaches, stomach aches, and improve sleep. There are exercises you can do where you combine playfulness and humor with relaxation:

Squeeze lemons (relax arms & hands; helps control anger): Pretend you’re squeezing a whole lemon in your left hand. Squeeze it hard! Try to squeeze all the juice out. Feel the tightness in your hand and arm as you squeeze. Now drop the lemon and relax. See how much better your hand and arm feel when they are relaxed. Repeat with the other hand.

Turtle (relax shoulder & neck): Pretend you’re a turtle. You’re sitting out on a rock by a nice, peaceful pond, just relaxing in the warm sun. It feels nice and warm and safe here. Oh-Oh! You sense danger. Pull your head into your shell and try to pull your shoulders up to your ears and your head down to your shoulders. Bend your arms and knees and bring them into your shell. Hold tight and hide in your shell. It isn’t easy to be a turtle in a shell. But you sense the danger is past now. You start slowly stretching your head and looking around to make sure the danger is past, then let your arms and legs slowly stretch out as well. You can come out into the warm sunshine and once again you can relax and feel the warm sunshine. But watch out! More danger! Hurry, pull your head and body back in and hold tight. Repeat.

Spaghetti: Pretend your an uncooked spaghetti, which is tense and rigid. Then pretend you’re being put into hot water and little by little, from your feet upwards, you begin to loosen up. Repeat as many times as necessary.

Trees: Pretend you’re a tree, your body is the trunk and your arms are the branches. You are stretching your arms towards the sun, reaching for the sun. You may move with the wind as well.

Shake out (ants in my pants): Mindfulness exercises: help you ground yourself and focus in the here & now, reducing anxiety.

Rocking chair/sway: Stand with feet apart (parallel to your shoulders) and push yourself a bit off the floor with your right foot, then your left. Continue to do so until you begin to sway. You may close your eyes and release you arms and let them flail as you sway.

Five senses exercise

A simple mindfulness exercise is to notice what you are experiencing right now through any or all of your five senses: sound, sight, touch, taste, and smell.

Take a few slow breaths and ask yourself:

  • What are five things I can see?
  • What are four things I can touch?
  • What are three things I can hear?
  • What are two things I can smell?
  • What is one thing I can taste?
 

Transforming Stress

It’s important to acknowledge what we’re feeling because our feelings serve a purpose in helping us process what we’re experiencing.

Ask:  “I’m having big feelings right now. What can I do to metabolize (transform into something less harmful) these feelings?”

If we don’t metabolize, we feel “saturated” and may begin to “hemorrhage out” into unhealthy/harmful behaviors or actions.

It’s important to have daily practices that help us metabolize.

Finger Holds

This is a light and practical exercise that you can do at any time for immediate self-care by using simple finger-holds to release extreme emotions.

  • Hold each finger with the opposite hand for two to five minutes until you feel a steady, rhythmic pulse. This will help move and drain blocked energy, and bring back a sense of balance and harmony to the body. You can work with either hand.
  • Deep breathing while holding each finger can also help to bring the body-mind-spirit to a state of peace and harmony.
  • As you hold each finger, breathe in deeply; recognize and acknowledge the strong or disturbing feelings or emotions you are experiencing. Breathe out slowly and let go. Imagine the feelings draining out your finger into the earth. Breathe in a sense of harmony, strength and healing. And breathe out slowly, releasing feelings and problems.  
  • As you hold each finger, you may feel a pulsing sensation as the energy and feelings move and become balanced.
Finger Holds

Click here to download a guide to finger holds. 

 

Self-Care Wheel

The self-care wheel is a helpful tool for self-care ideas in six areas of life:

 Click on the image to view. 

Click on the image to view. 

  • Physical
  • Psychological
  • Emotional
  • Spiritual
  • Personal
  • Professional

You may think of many other activities you could do in each area. This list is meant to be a starting point and an inspiration for you to find your own best self-care practices.

Click here to download a blank self-care wheel to fill in.