Nicole LeBlanc, LICSW David Stanley, LCSW

Transcription

1 NEIAS: Addressing Opioid Overdoes Crisis: Supporting Those on the Front Line Nicole LeBlanc, LICSW David Stanley, LCSW 6/8/16 10:00 am 5:15pm Healthrecovery.org 1

2 Objectives At the end of this training participants should be able to: 1. Describe the scope of the overdose epidemic 2. Define compassion fatigue / secondary trauma 3. Describe symptoms of secondary trauma 4. Identify ways of coping with secondary trauma 5. Identify strategies for developing resilience 3 Create a distance that feels safe for you. Institute for Health and Recovery 2

3 Exercise: Silent Witness Write down three (3) negative effects from your work as a caregiver on an index card. For two (2) minutes circulate about the group allowing others to see your card. 5 Introduction 6 3

4 Scope of the Problem: 2015 Stats 46,000 deaths each year from drug overdoses - More than Car Accidents or Gun violence. ½ are related to opioid abuse 78 people die everyday (SAMHSA, CDC, 2014) 1526 deaths in 2015 (Mass DPH) 1256 deaths in million people in national survey reported abuse of a Prescription Drug (Pain Killer) for 1 st time. 4 out of 5 heroin abusers started with pain killers 259 Million prescriptions written for pain killers 8 4

5 We are hardwired for connection to others. Without connection we cannot grow or survive. As a result, what affects one person can ripple through and affect those connected to them. 9 Secondary Trauma 10 5

6 Secondary Trauma A transformation of the helper s inner experience, resulting from empathic engagement with clients trauma material (Saakvitine & Pearlman, 1996, p. 40). 11 What is to give light must endure burning Viktor Frankl 12 6

7 Compassion Fatigue: deep emotional and physical wearing down that takes place when helping professionals are unable to refuel and renew (Figley, 1995) Vicarious Trauma: profound negative changes in our worldview due to the exposure to traumatic content of clients (Saakvitne & Pearlman, 1996) Secondary Trauma: witness to a traumatic event or series of events (Figley, 1995) Burnout: workplace - stress & frustration 13 Post Traumatic Growth: positive psychological change that occurs as the result of one s struggle with a highly challenging, stressful, and traumatic event. Compassion Satisfaction: The ability to receive gratification from the work you do helping others. 14 7

8 Resilience The ability to bounce back from adverse experiences. The relational capacity of individuals to both navigate and negotiate resources. A dynamic process that contributes to the subjective sense of how one s life is going. Resilience is a predictor for well- being. Appreciativeaction.com 15 Secondary Trauma Survey of 226 Substance Abuse Counselors 75% reported at least one trauma symptom 56% met criteria for major symptoms 19% met criteria for PTSD (Bride, et al 2009) 75% 16 8

9 Symptoms 1. Emotional 2. Cognitive 3. Physical 4. Behavioral 17 Symptoms: Emotional Feel overwhelmed, drained, exhausted, burnt out Feel angry and sad about client s victimization; these feelings linger Feel loss of pleasure, apathetic, depressed, despair Overly involved emotionally with the client Feel isolated, alienated, distant, detached, rejected Experience bystander guilt, shame, feelings of self- doubt 18 9

10 Symptoms: Cognitive Preoccupied with thoughts of clients outside of your work. Over- identification with the client. (Have horror and rescue fantasies.) Loss of hope, pessimism, cynicism, nihilism Question competence, self- worth, low job satisfaction Challenge basic beliefs of safety, trust, esteem, intimacy and control. Feel heightened sense of vulnerability and personal threats 19 Symptoms: Behavioral Distancing, numbing, detachment, cutting clients off, staying busy. Avoid listening to client's story of trauma May experience symptoms similar to those seen in clients Impact personal relationships and ability to experience intimacy High overall general distress level Overextend self and assimilate client s traumatic material Difficulty maintaining professional boundaries with the client 20 10

11 Symptoms: Physical Somatization Frequent unexplained illness Weight loss or gain Feeling fatigued It s the kind of tired that sleep cannot fix. Anonymous 21 Individual Risk Factors Difficulty of working with trauma survivors who have difficulty with trust in relationships Institutional barriers within legal and mental health systems Staff history of untreated trauma More time spent counselling clients with histories of trauma Age and experience levels Hearing the trauma story and experiencing the pain of survivors: Empathy 22 11

12 Case Examples What do you think is happening here? What steps could the counselor and the supervisor take to resolve job performance issues? What do you think might be helpful? 23 Empathy Key to establishing emotional safety and fostering healing from trauma. Provides us meaning and hope in helping others

13 So, What is Empathy? Empathy: the feeling that you understand and share another person's experiences and emotions and the ability to share someone else's feelings, attitudes, roles and perceptions and world of another. With Clients: The counselor understands the client's feeling and experiences within the client's frame of reference and communicates that understanding without judgment. 25 Empathy and Growth Resilience look for strengths vs. focus on deficits Attachment - profound loss / harm of childhood traumas leaves in it s wake. Healing promotes a sense of safety, healthy relationships, power of attunement, human connectedness for a thriving life Steele, Wm Trauma Informed Practices with children and adolescents

14 Empathy and Growth (cont.) Mind/body safe/empathic relationships promotes neural plasticity, therapeutic interventions help change neural pathways. Holistic (Ecology) wide lens / perspective family dynamics, institutional, environment and cultural concerns. Steele, Wm Trauma Informed Practices with children and adolescents. 27 Mirroring Neurons We are hard wired to perceive the mind of another being. - - Dan Siegel 28 14

15 Mirror Neurons - Empathy 29 Mirror Neurons - Empathy There is increasing research on the dynamics of empathy, in particular the mirroring of emotions and body movements. This is the capacity to unconsciously and automatically mirror the emotions of others. If we see someone yawn, we may also want to yawn. You might even have to yawn right now. Laughter also is also contagious. In our work, we may note that we are matching our clients/patients in emotions and body movement and vice versa. ( When Compassion Hurts, page 11.) 30 15

16 Mirroring Neurons System of cells in the brain that allows us to understand the minds of others. Brain s Inner Imitation (others) Social cognition our awareness and interpretation of social stimuli based on our knowledge of rules that govern social interaction within cultural context. (Iacoboni, 2009)l 31 Social engagement Fight or Flight Collapse Social engagement Fight or Flight Collapse 32 16

17 Social engagement Fight or Flight Collapse Failure to validate client feelings and experiences 33 Individual Risk Factors Social engagement Fight or Flight Collapse Validate client feelings and experiences 34 17

18 Life s roughest storms prove the strength of our anchors. 35 Finding your anchor. Short term Self Regulation Long term Self Care 36 18

19 Self Regulation Strategies Top down / begin with the mind Bottom up / begin in the body 37 Self Regulation Top down Cognitive Techniques Mindfulness 38 19

20 Self Regulation 39 Self Regulation Mindfulness Body (physical) Feelings (emotional) Thoughts (cognitive) Causes and conditions (relational/behavioral) Paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment

21 Self Regulation The only reason we don't open our hearts and minds to other people is that they trigger confusion in us that we don't feel brave enough or sane enough to deal with. To the degree that we look clearly and compassionately at ourselves, we feel confident and fearless about looking into someone else's eyes. Pema Chödrön 41 Self Regulation Bottom up Breathe Movement Touch 42 21

22 Self Regulation Bottom up Breathe Mindful breathing Yogic breathing Biofeedback Abdominal Breathing 43 Self Regulation Bottom up Movement Yoga Tai Chi Dance 44 22

23 Self Regulation Bottom up Touch Emotional Freedom Technique Massage Acupressure 45 Self Care Self-care is a priority and necessity, not a luxury, in the work that we do

24 GRIEF 47 The reality is that you will grieve forever. You will not get over the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to. Elisabeth Kübler-Ross 48 24

25 Grief: Why is it hard for us to talk about Socially Unacceptable to talk about? Death Feels Avoidable Unresolved Grief and loss Guilt what did I miss, Could the death have been preventable Sense of relief (a mother s narrative) Shame - My fault? Not doing enough to help, others blame me. I am bad Stigma & Isolation Accept the reality of the death part of grieving process 49 Grief Do not Grieve Alone Express your feelings Ask for help Spirituality and Self Care Tributes and rituals Gender differences Cultural differences Tasks of Mourning: Accept, work through the pain, new normal, emotional relocate the loss and move forward in life

26 Grief How to Help Listen Like a roller coaster / Comes in Waves Goal is not to forget, but to remember with less pain Re-invest emotions into life and living Develop new adaptive coping skills Find Meaning / Hope Social Supports Do not Grieve alone.. Resources (see handouts)?depression? With grief you know why your sad, with depression you may not know why your sad. 51 What if..situation.details 52 26

27 What to do and Good Samaritan Law General Law, Title IV, Chapter 258C, Section 13 No person who, in good faith, provides or obtains, or attempts to provide or obtain, assistance for a victim of a crime as defined in section one, shall be liable in a civil suit for damages as a result of any acts or omissions in providing or obtaining, or attempting to provide or obtain, such assistance unless such acts or omissions constitute willful, wanton or reckless conduct. 53 Overdose and Good Samaritan Law What to do. Check for signs of opioid overdose (gurgling, blue lips, clammy) Try to wake them up (knuckle rub) Call 9ll Start Rescue Breath Give Naloxone / get trained Stay with the person Encourage follow- up help & medical care 54 27

28 What to do when an overdose affects your organization Have notification process to ensure staff are informed Acknowledge the impact the event may have Offer staff support and normalize reactions Offer additional individual supervision to process Conduct critical incident debriefing when necessary Schedule time for staff to process together Schedule time for staff to engage in positive uplifting activity or to engage in community change 55 The ABC s of Self Care A = Awareness B = Balance C = Connections 56 28

29 Awareness Where we focus our time % Past Present - Future 57 Awareness What increase your stress levels? Events / Situations experience an unusually strong reaction Often overpowers your coping mechanisms Functioning is altered What triggers your trauma history? 58 29

30 Awareness What inspires you or reduces your stress level? What keeps you going in the face of adversity? What inspires you to do the work that you do? What lifts your spirits when you feel down or exhausted? 59 Awareness Know what you need to take care of yourself Self Care Checklist (see handout) Self Care Plan (see handout) 60 30

31 Balance Trauma throws us off balance: Physically Mentally Emotionally Relationally Professionally 61 Physical Balance Exercise Relaxing Breath / exercise Adequate sleep Nutrition / Hydration Medical / preventative care 62 31

32 Mental Balance Examine Your Negative Beliefs and Assumptions Reframe to Positive Opportunities and choices. 63 Mental Balance Always My work will always be discouraging Sometimes Sometimes I feel discouraged about my work. Other times I feel rewarded Never My work will never be rewarding 64 32

33 Emotional Balance Emotions are a signal that tell us when something is happening which may lead to feeling out of balance 65 Emotional Balance Respond rather than react Honor the reality of your emotions Introspection and compassion for oneself Practice gratitude Pain is inevidable, suffering is optional Haruki Murakami Touch base with that which inspires you 66 33

34 Emotional Balance Centering Exercise 67 Relational Balance Powerless Trusting Completely Sharing All Dependent Caring Only for Others Collaborative Balanced Trust Sharing Appropriately Interdependent Caring for Self and Others Powerful Not Trusting At All Sharing Nothing Independent Caring Only for Self 68 34

35 Relational Balance Caring for everyone else, but not ourselves. Caring for ourselves, so that we are able to care for others. Caring for ourselves, but no one else. 69 Professional Balance Balanced workload Variety in type of work Meaningful items in the workplace Schedule down time, time for reflection Have a ritual for marking transition from work to private life and vice versa Learn you employers policies on leave time 70 35

36 Connections Kisa and the mustard seed. Found healing through community connection. In the progress of personality, first comes a declaration of independence, then a recognition of interdependence. Henry Van Dyke 71 Connections Mutually growth fostering relationships Fun Activism Debrief and process difficult experiences Practical support during and after crises Peer or professional consultations, case conferences, treatment teams 72 36

37 Exercise: Part 2 On the back of the index card, write down three (3) things you have learned today that you will do to take care of yourself. 73 Thank You Thank you for being here. Thank you for doing the work you do. We work on ourselves in order to help others, but also we help others in order to work on ourselves. Pema Chodron 74 37