3/26/14. Sarina Lyall, LCSW. Objectives. UT Vet Social Work: Mission. What is a Vet Social Worker?

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1 How to Best Support Broken Hearts Sarina Lyall, LCSW B.S. in Psychology MSSW in Social Work Certified Grief Recovery Specialist Sarina Lyall, LCSW Staff Social Worker Work 5 years as Staff Social Worker, Veterinary Social Work Teach communication & conflict management skills Individuals, Families & Couples Objectives Define grief, mourning, and bereavement Discuss and identify manifestations of grief Identify methods that can be helpful for healing after a loss Define compassion fatigue and related concepts Discuss and Identify compassion fatigue Identify ways to combat compassion fatigue UT Vet Social Work: Mission University of Tennessee Veterinary Social Work (UT VSW), founded in May of 2002, is a partnership between the University of Tennessee Colleges of Veterinary Medicine and Social Work and is designed to enhance, support, and inform both professions. What is a Vet Social Worker? The Veterinary Social Worker strives to promote and enhance HUMAN well-being and relationships. The Veterinary Social Worker does this through attending to human-animal relationships. The hopeful indirect by-product of this is more humane attitudes and practices toward animals. Why did you choose this profession? 1

2 What s The Difference? Grief Mourning Bereavement What is Grief? Grief is the normal and natural response to the loss of someone or something. Grief Grief is the complicated feelings caused by the end of or change in a familiar pattern of behavior. (James & Friedman, 1998, pg 3) Grief is the internal meaning given to the external event (Wolfelt, 1983, pg 26) Grief A reaction to loss Subjective and individual internal experiences A normal emotion, with significant differences to be expected from one culture to another (Averill and Nunley, Handbook of Bereavement) Mourning The public displays or outward expressions of grief Set of rituals or prescribed behaviors Shaped by one s cultural beliefs or practices Bereavement The entire process or experience of the loss Objective state The state of experiencing grief or the period of time following a death during which grieving occurs (Rosenblatt, Walsh & Jackson, Grief and Mourning in Cross-Cultural Perspective) The period after a loss when grief is experienced and mourning occurs 2

3 Loss Is Universal! Hospice/Health Care Provider Grief Manifestations of Grief Physical Manifestations of Grief Physical Intellectual Emotional Social Spiritual Crying Lump in throat Sleep disturbances Nausea (Lagoni, Butler & Hetts, 1994) Intellectual Manifestations of Grief Emotional Manifestations of Grief Denial Sadness Confusion Anger Preoccupation with loss Irritability Inability to concentrate Blaming others 3

4 Social Manifestations of Grief Withdrawing Isolating Reluctance to ask for help More dependant on others Spiritual Manifestations of Grief Anger with God or Higher Power Renewed or Shaken religious beliefs Search for a meaningful interpretation of death Bargaining with God or Higher Power Factors that can Complicate Grief Mourning Respite Limited or no social supports No experience with loss Recent loss Witnessing the death Cause for death unknown Traumatic death Societal norms trivialize or negate death After death anniversary and holidays Untimely deaths Insensitive comments from others Pre-existing mental health and/or emotional conditions Grief Recovery Method Myths of Grief Be strong Give it time Grieve alone Replace the loss Don t feel bad Keep busy Healing After a Loss Reviewing the relationship Recognizing what is lost and what may be unfinished Remembrances and Rituals Self care 4

5 Reviewing the Relationship Recognize What is Lost and Unfinished Tell the story Recognize the meaning of the relationship Identify the ups and downs Any things we wished were different, better, or more in the relationship If only I should have I wish Remembrance and Rituals Self Care May be culturally defined or individualistic Burials or cremation Ceremonies Memorials Poems or writings Connect with friends or social support Eat Go the doctor Sleep Allow time for grieving Helpful Hints Don t Say: Well at least you still have They are in a better place It was God s will I know how you feel Be strong It isn t that bad Do Say: I m sorry for your loss This must be so difficult for you I don t know what to say Tell me about how you are feeling Tell me your favorite thing about (pet s name) (Tousley, 1996) 5

6 STERBS Short Term Energy Relieving Cumulative Loss Shopping Eating Alcohol Exercise Work There is a cost to caring. Professionals who listen to clients stories of fear, pain, and suffering may feel similar fear, pain and suffering because they care. Sometimes we feel we are losing our sense of self to the clients we serve Those who have enormous capacity for feeling and expressing empathy tend to be more at risk of compassion fatigue. - Figley (1995) Behaviors Anger Compassion Fatigue Related Concepts Burnout What is it? Secondary Traumatic Stress Vicarious Traumatization Compassion Fatigue Burnout Burnout or Compassion Fatigue? Driven by organizational issues, policies, procedures and bureaucracy. Cumulative effect of stress in our daily lives (Figley, 1995) The chronic conditions of perceived demands outweighing perceived resources. (Gentry & Baranowsky, 1998) Burnout can contribute to compassion fatigue. Different but FEEL the same (Mitchener & Ogilvie, 2002) (Mitchener & Ogilvie, 2002) 6

7 Secondary Traumatic Stress Vicarious Traumatization stress resulting from helping or wanting to help a traumatized or suffering person (Figley, 1995, p.7) Almost meets PTSD criteria with exception that traumatic exposure is indirect: Avoidance Distressing emotions Cognitive changes Etc. Results from empathic attunement to patient s traumatic experiences Disruptions in: world view beliefs about self or others interpersonal relationships affect tolerance (Bride, Radey & Figley, 2007) (Bride, Radey & Figley, 2007) Compassion Fatigue Compassion Fatigue Indirect exposure to trauma which can lead to significant cognitive, emotional and behavioral changes Direct result of exposure to client suffering and complicated by a lack of support in the workplace and at home (Radey & Figley, 2007) A condition that is a result of a depletion of our internal resources. It impacts almost all aspects of a person s life. More user friendly term (Mitchener & Ogilvie, 2002) (Bride, Radey & Figley, 2007) Compassion Fatigue Four contributing factors: Poor self care Previous unresolved trauma Inability or refusal to control work stressors Lack of satisfaction for the work (Radey & Figley, 2007) Difficult Patients (and/or their families) Complaining Co-workers/Employees Not feeling appreciated Your own trauma/pain Health problems Family Demands/ Guilt Being highly empathic Other outside stressors (finances, etc.) 7

8 Compassion Fatigue Compassion Fatigue Trajectory The result of caring very much and working very hard AND Not recognizing and caring for your own needs Zealot Withdrawal Irritability Zombie Compassion Fatigue Adapted from D. Fakkema, Animal Sheltering, 2001 Compassion Fatigue is. the result of doing good work, not a weakness not pathology, instead can be viewed as that which is greatest in all of pushing us towards our growth and maximum capacity Treatable preventable through the development and maintenance of self-care skills Taken from Tracy Zaparanick, PhD, LCSW Compassion Fatigue Symptoms Compassion Fatigue Symptoms High self-expectations Hopelessness Hypertension Inability to maintain balance of empathy and objectivity Increased irritability Less ability to feel joy Low self-esteem Sleep disturbances Workaholism Abusing drugs, alcohol or food Anger Blaming Chronic lateness Depression Diminished sense of personal accomplishment Exhaustion (physical or emotional) Frequent headaches Gastrointestinal complaints (Pfifferling & Kay, 2000) (Pfifferling & Kay, 2000) 8

9 Compassion Fatigue Symptoms Self-destructive self-talk: If I don t do it no-one will. No one cares as much as me. No one can do it the right way. I am the only one that can take care of this. If I don t help every client, I failed. I don t want to burden others by taking time to care for myself. I can t believe he is taking off today. Clearly he doesn t care as much as me. How Can I Find Out? Professional Quality of Life Scale: "The time to relax is when you don't have time for it." Author Unkown Loving oneself is crucial. If we do not love ourselves, how can we love others? It seems that when some people talk of compassion, they have the notion that it entails a total disregard for one s interests a sacrificing of one s interests. This is not the case. In fact, genuine love should first be directed at oneself. - Dalai Lama Compassion Satisfaction Possible change in perception about how to use compassion stress As a way to flourish and cultivate compassion satisfaction Something that helps us function well, promotes resilience, and leaves us feeling fulfilled with our clients Reciprocal relationship between affect, resources, and self care Maximizing compassion satisfaction includes: Increasing positive affect Increasing resources Increasing self care Positivity ratio 3:1 Compassion Fatigue Recovery Don't: Blame others. Look for a new job, buy a new car, get a divorce or have an affair. Fall into the habit of complaining with your colleagues. Hire a lawyer. Work harder and longer. Self-medicate. (Radey & Figley, 2007) (Pfifferling & Kay, 2000) 9

10 Compassion Fatigue Recovery Do: Find someone to talk to. Understand that what you feel is normal. Start exercising and eating foods that nourish. Get enough sleep. Find a way to take some time off. Develop interests outside of your work. Identify what's important to you. Developing a Self-Care Plan Learn to identify what is needed and important Physical exercise, get enough sleep, eat properly Intellectual find fulfilling interests and hobbies outside of your job Emotional take time off, talk to a trusted person Social connect with others Spiritual attend to your spiritual needs (Pfifferling & Kay, 2000) (Pfifferling, J.-H.& Gilley, K. 2000) Life Balance Wheel Working With It A wheel runs most smoothly when well balanced Self assessment of 6 aspects of your life Using the assessment, create a self care plan Positive self-talk or stating one good thing I am doing a wonderful job! or My clients trust me. or Today the sun is shining! Write Journal LAUGH!! Gallows Humor Excessive humor or lack of humor can both be signs of distress Play Working With It Personal psychotherapy Supervision Set boundaries home and work Exercise: I must be careful about overextending myself so that I have energy left to help others. How do I say NO when the work is driving me beyond my limits? 10

11 Debriefing Used as an opportunity to talk about personal impressions of a recent experience Talk about each person s perspective of the event What went wrong What was done right (remember positivity ratio) What were you feeling Helps to build resilience Comes naturally when people reflect in relationship with each other (emotional co-regulation) Personal Debriefing Model Check that tasks are finished, and documentation completed. Deal with outstanding issues: Complete if essential, OR Delegate, OR Write it down to do tomorrow Remember what went well in the day, and what didn't, and, rather than dwell on the negatives, focus on the positive outcomes of the day. Acknowledge you did your best with the resources available to you Say your goodbyes, giving closure for now to both collegial and patient relationships. Personal Debriefing Model Take off your name badge or develop other personal rituals that signify that work is now completed. Make your journey home a separation between work and private life, even if you live on the premises. Try hard to not take work home, but if you must, create a specific space for your professional work and only use it for this purpose. (Huggard, 2008) Five Minute Share Ask someone you trust for 5 minutes The person speaking can say: I need to tell you something that happened to me today. Would you be willing to just listen? Describe the worst experience in the week/day and then one thing they will do to take care of themselves. The person listening just listens; they do not fix, advise, or interrupt. After the speaker is finished, the listener may say one sentence that is true, like: Thank you for sharing that. or That must have been very hard. Adopted by Dr. James Fogarty Relaxation Techniques Take a deep breath Progressive Muscle Relaxation Guided Imagery Body Scan Diaphragmatic Breathing Diaphragmatic breathing" VAGUS Nerve- The wandering nerve 11

12 I can be changed by what happens to me, but I refuse to be reduced by it. - Maya Angelou UT Veterinary Social Work (VSW) How to reach a Veterinary Social Worker: VSW Helpline (865) Questions? Comments? Thank you! 12