Caring for Self While Caring for Others 2015 to 2016

Welcome to our fourth year of Caring For Self While Caring For Others.

This year, I decided to step back and invite a new face into the series.  In a few weeks, Petrea Hansen-Adamidis, will be presenting on art therapy, with a focus on self-care.  I will be continuing to present this series, assisted by Irina Dumitrache, who will offer demos of different mind/body practices for self-care.  Irina will also be co-presenting the last talk on integrating a healthy nutritional plan into our self-care strategy.  Irina is currently enrolled in training at the Institute for Integrative Nutrition, and I’ve been watching some of her training videos.  It’s exciting to see a whole new frontier of wellness opening up before us.

If there is interest in more self-care presentations, please let me know.  I have lots more material, and the ability to repeat old talks.  I actually only made it through half my material for the first talk (How Burnout Looks to us in 2015) in October.  Sadly, there seems to be more and more to say about burnout in the helping professions, as our world goes through some very uncomfortable political changes and growing pains.

After your feedback last year, I have corresponded with Michael Kaufmann at the Ontario Medical Association Physician Health Program (PHP).  After last year’s guest talk given by Dr. Joy Albuquerque, some of you requested a talk on the physician in distress, for some guidelines for what we do and where we turn to for help when we feel we are at the brink.  These requests felt filled with an immediacy of emotional need.  So that’s the talk I asked for when I first initiated dialogue in September.  Dr. Kaufmann said he would discuss this with the PHP staff and get back to me.  I will let you know when he does.

I’m told that attendance is down for all the Ontario Medical Association presentations this year.  I hope you won’t pass up on these talks.  It is tempting to hunker down and minimize during hard times, but nothing is more precious than our own health and self-care.

I’m looking forward to seeing familiar faces this year.

October 7, 2015

How Burnout Looks At Us In 2015

Despite being inundated with evidence that the prevalence and severity of burnout is increasing in physicians and other human service workers, this condition remains poorly understood. There are as many myths as facts, and misconceptions abound.  Often burnout is confused with (and treated as) depression, when – in fact – these conditions are very different. As health care workers, we have an obligation to care for ourselves in order to be the best we can be for our patients. As Charles Figley, a pioneer in the field of compassion fatigue reminds us in the title of his book on physician wellness and stress resilience, we need first do no self-harm in order to best serve. How do we achieve this goal?  How do we begin to approach the tenacious condition of burnout that now threatens to erode away our happiness, our effectiveness and our sense of meaning?

In this presentation, participants will learn:

• To appreciate that many of the standard interventions recommended as treatment for burnout (diet, exercise, spending time with family, mindfulness meditation) have been shown to have minimal impact on outcomes.
• To better understand the impact of burnout (and secondary trauma) on subcortical brain structures and the HPA-G axis
• To gain a sense of which interventions do work best in addressing burnout
• To appreciate burnout as a systemic issue that requires systemic solutions
• To create a self-care plan informed by current understanding of Burnout and Secondary Trauma
• To practice a self-care tool aimed at regulating the autonomic nervous system

Suggested Reading: http://www.scottdmiller.com/wp-content/uploads/2012/11/Burnout-Reconsidered.pdf

November 18, 2015

Beyond Doodling, using art for self expression and self-care

Petrea Hansen-Adamidis, DTATI, RCAT

As psychotherapists and healers, we give our energy to those that seek our help in many ways that can drain us over time.  We listen to their stories, their narratives, ponder their experiences and hold the many tumultuous feelings that present themselves in sessions. We do our best to to keep this separate from our personal lives, but the truth is this is not always easy to practice.  Learn how art making can allow you to express yourself, release tensions and stress and debrief difficult sessions with clients.  Art making for self care can enrich your practice as a therapist and growth as an individual through deepening your connection to own feelings.

Petrea Hansen-Adamidis DTATI, RCAT, is a Registered Art Therapist with the Canadian Art Therapy Association working in the field of art therapy for over 20 years. She has worked for the past 13 years as an Expressive Arts Therapist at The Hincks-Dellcrest Centre on both the Birth to Six team and within the Specialized Therapy Unit.  A graduate of the Toronto Art Therapy Institute (TATI 1995), Petrea serves children, adolescents, parent child dyads, and families, specializing in trauma assessments and treatment. Petrea supervises art therapy practicum students and is an instructor for the Toronto Art Therapy Institute.

Learning objectives:

•         Learn ways to debrief using art after difficult sessions

•         Experience self care using simple art exercises

•         Develop a sustainable self-care practice using art expression

February 17, 2016

Expanding the Burnout and Stress Management Toolkit.

Recent literature stresses the importance of acquiring a set of short and long term skills as a means of addressing trauma and/or unremitting stress. These tools are frequently learned and then quickly forgotten. For instance, the efficacy of learning mindfulness meditation without making it part of a larger lifestyle is now being questioned. What tools work best and when? What is the range of tools available to us? What is the neurophysiologic “target” of these tools? How can we incorporate these tools into our lives in the most effective and lasting manner? How do we utilize these tools as a pathway to building resilience and new meaning in our lives?

Learning objectives:

•         To integrate a variety of stress management tools into their daily lives

•         To acquire a personalized set of both short-term and long-term stress management tools

•         New techniques to calm a dysregulated autonomic nervous system

•         Why some tools are best suited to health care workers including psychotherapists

There will be an opportunity to practice some new tools in a supportive and relaxed environment.

Suggested Reading: http://www.alternet.org/personal-health/how-fight-stress-and-burnout-when-you-cantgo-expensive-spa

March 16, 2016

Integrating a Healthy Nutritional Plan into Self-care Strategy

In this presentation, we will look at practical ways to integrate sound nutritional elements into an overall holistic lifestyle strategy. Rather than exploring diet in isolation, we will explore the interplay of the factors that nourish us every day; discover primary and secondary foods. There will be adequate time to reflect on our current approaches to diet and nutrition, and where the greatest opportunity for impactful transformation can be accessed. Is self-care a luxury? Or is it essential to our health and well-being? We will also get playful with a demonstration of home preparation of fermented foods, in our opinion the best source of probiotics.

In this presentation, participants will learn:

•         To integrate diet and nutrition with other key domains of self-care: work, relationships, exercise and spirituality

•         Myths and truths of dieting; why diets do not work

•         10 tips for self-care every day

•         Easy to follow guidelines for healthy eating

Harry will again be assisted by Irina Dumitrache. Irina has graduated from two yoga teacher training programs, at the Yoga Sanctuary in Toronto and at the Yoga Therapy Toronto. She is currently enrolled in the health coaching program through the Institute of Integrative Nutrition in New York City. Irina brings her avid interest in wellness and wellbeing to her teaching of self-care tools and her encouragement of healthy and balanced lifestyles.

The Main Speaker's Series 2015 to 2016

Sorry that this is arriving late.  As I mentioned in my last post, I’ve been behind in keeping up with the blog.  I think that’s about to change.

So this is our finalized schedule for the 2015-16 Main Speaker’s Series.  I hope that we have again covered a wide area, while remaining true to our vision of this program.

For more information on the philosophy of this series, please refer to my previous blog posting for the 2014-15 series.  Again, we’re hearing lots of you would love to have these small group experiences come to your city outside of Toronto.  I’ve been working hard, devoting mad amounts of time and energy to networking with other organizations (such as the Ontario College of Family Physicians, the Collaborative Mental Health Care Network, the Ontario Medical Association and the General Practice Psychotherapy Association).  Promises have been made, but none have yet come through.  I do want you to know that I am working on this, and hope that one day these talks can be more widely disseminated, while providing the community building and collegial interaction for which they were originally designed.

I hope to see some familiar faces between now and April.

And please add your comments.  This is your blog too, and your opportunity to share what’s important to you, and what’s true to your own calling and vision.

October 21, 2015

Déjà vu all over again: Understanding traumatic enactments and how to work with them

By definition, traumatic experiences overwhelm a survivor’s capacity to cope. To manage psychological trauma, aspects of the trauma are dissociated and not integrated in the survivor’s sense of self and personal narrative. Traumatic enactments are the inevitable consequence as the survivor unconsciously attempts to resolve the trauma. When enactments are played out with the health care provider they have the potential to derail treatment. However, when enactments are understood and appropriately addressed, they can be critical in laying a path for healing. This presentation will address traumatic enactments, including strategies for working effectively with those challenging encounters.

By the end of the session participants will be able to:

•               Provide a theoretical framework for understanding traumatic enactments.

•               Describe four types of enactments that are common among trauma survivors.

•               Describe basic strategies for helping a survivor work through a traumatic enactment.

Dr. Catherine Classen is a full professor in the Department of Psychiatry at the University of Toronto, director of the Mental Health Research Program at the Women’s College Research Institute at Women’s College Hospital, and the academic leader of the Trauma Therapy Program at Women’s College Hospital. She is a past president of the International Society for the Study of Trauma and Dissociation and past chair of the Traumatic Stress Section of the Canadian Psychological Association. Dr. Classen has been working in the field of psychological trauma for over 20 years as both a researcher and clinician. Her research interests include investigating psychotherapy interventions for trauma survivors and advancing trauma-informed care within the health care system. She has over 100 publications and recently co-authored the book, “Treating the trauma survivor: An essential guide to traumainformed care,” published by Routledge. She is also co-author of an online accredited CME course “Posttraumatic Stress Disorder: A Primer for Primary Care Physicians” sponsored by the Mood Disorders Society of Canada in collaboration with Faculty of Medicine, Memorial University, Newfoundland.

December 2, 2015

The Science of Yoga

Yoga and Meditation are becoming increasingly popular in the West for treatment of mental health and chronic illness. While often perceived as a mystical practice involving bends and twists, Yoga is actually an ancient secular philosophy describing how to cease or slow down the racings of the mind to achieve health and well-being.  This experiential workshop will clarify the misperceptions about this transformative mind-body practice, as well as present the scientific evidence for its neuroplastic and physiological effects. Through this workshop, participants will:

•         Understand key principles of the Philosophy and Psychology of Yoga and its common roots with Buddhism and other Eastern Practices
•          Understand the Neurological and Physiological effects of Yoga, and its benefits as an adjuvant therapy in Chronic Illness, Mental Health, and Trauma.
•          Appreciate the different styles of yoga, and which patient is suited for which practice.
•          Experience simple and accessible yogic practices, connecting, body, mind and spirit.

Dr. Shailla Vaidya practices Mind-Body Medicine for Stress Resilience in Toronto. She completed her MD at Dalhousie University, followed by a residency in Family and Emergency Medicine at the University of Ottawa. She went on to provide both Primary and Acute Emergency care to isolated First Nations communities, sub-urban immigrant populations and homeless, street involved youth. Gaining insights into what plagues our health and wanting to affect change, she went on to complete a Master’s in Public Health at the Harvard School of Public Health. Upon return, she lead teams of health care providers to improve efficiency, patient access, and safety. She also worked to implement medical group visits, improving social connection and peer-support for patients. She has served as a faculty member with the Departments of Family Medicine at McMaster University and the University of Toronto. Dr Vaidya is also trained as Yoga Teacher and Yoga Therapist, and has been incorporating scientifically sound Yoga techniques in her medical practice since 2005. Her clinical interests lie in how the social determinants of health, attachment, and disconnection lead to physiological stress and the development of chronic illness. Combining her knowledge, she applies an integrative, compassionate approach to help her patients restore health and build resilience. To learn more about her practice, please visit www.theYogaMD.ca

January 13, 2016

Understanding and Treating Chronic Shame

Chronic shame is a powerful and pervasive outcome of relational trauma, but it is usually hidden behind other symptoms of pathology.  If chronic shame is ignored, treatment of those symptoms will likely be effective only in the short term.  If we can recognize the presence of chronic shame in the symptomstories our patients present, and if we can imagine its particular formation and operation within each patient’s self-system, we will be in position to treat chronic shame directly and effectively.  Effective treatment is grounded in understanding that chronic shame is a problem with patients’ right-brain integration of affect, relationship, and self.  Treatment requires attuned, nonshaming engagement with our patients, the co-construction of narratives that integrate their sense of emotional/relational (right-brain) self, direct attention paid to their shame whenever possible, including shame-reduction strategies, and our own skillful, self-reflexive handling of the many ways shame becomes enacted within the therapeutic relationship.

Key Learning Points:

•               A definition of chronic shame as a relational and right-brain phenomenon

•               Assessment markers for chronic shame across symptomologies

•               How to make reparative right-brain connections possible with and for chronically shamed clients 

•               How to recognize and work through shame-disturbances in the therapy relationship

•               Strategies for life-time shame reduction

Pat DeYoung MSW, PhD is a psychotherapist and clinical supervisor in private practice in Toronto.  A founding faculty member of the Toronto Institute for Relational Psychotherapy, she has written Relational Psychotherapy, A Primer (Routledge, first edition, 2003, second edition, 2015) and Understanding and Treating Chronic Shame: A Relational/Neurobiological Approach (Routledge, 2015).

February 10, 2016

ACT in Practice

Acceptance and Commitment Therapy is gaining recognition as a mindfulness-based psychotherapy.  Its aim is to increase psychological flexibility through 6 ACT processes, including defusion, acceptance, present moment, self-as-context, values, and committed action. As it is a functional approach, it can be adapted for a wide variety of applications in both clinical and nonclinical settings. It can also be flexibly conducted in both individual and group format from single to multiple sessions. This presentation will review the core ACT processes and discuss how it may be potentially used in various contexts.

By the end of the seminar, participants will be able to

•               Describe the 6 core ACT processes

•               Identify potential applications of ACT

•               Discuss how it may be adapted to suit various clinical and non-clinical contexts

Dr. Kenneth Fung is a Staff Psychiatrist and Clinical Director of the Asian Initiative in Mental Health Program at the Toronto Western Hospital, University Health Network.  He is also Associate Professor with Equity, Gender, and Populations Division at the Department of Psychiatry, University of Toronto.  He completed a two-year fellowship in Cultural Psychiatry at the University of Toronto, and his Master thesis was on alexithymia among Chinese Canadians.  His primary research, teaching, and clinical interests include both cultural psychiatry and psychotherapy. He co-leads the Pillar 4 Dialogue of the Department of Psychiatry Strategic Plan, University of Toronto, which focuses on issues regarding equity, social justice, and social responsibility, and is the Block Co-coordinator of the Cultural Psychiatry Core Seminars for psychiatry residents.  He is the seminar co-lead and psychotherapy supervisor in Cognitive Behavioral Therapy (CBT) at the University Health Network, and teaches and conducts research in Acceptance and Commitment Therapy (ACT).  He has been involved in community-based research projects related to HIV, mental health stigma, and immigrant and refugee mental health.  He is psychiatric consultant to the Hong Fook Mental Health Association and is involved in various mental health promotion and education projects in the community.  He offers consultations at Mon Sheong Scarborough Long-Term Care Centre. He is the Vice-President (President-Elect) of the Society of the Study of Psychiatry and Culture.  He is the past Chair and current Historian of the Federation of Chinese American and Chinese Canadian Medical Societies.  He is the current Chair of the Ontario Chapter of the Association of Contextual Behavioral Science. He is enthusiastic about art, and dabbles in various expressions of art including sketching, painting, and piano playing. He is a supporter of the arts, and is a Board Member of the Little Pear Garden Dance Company.

March 2, 2016

Anxiety and the Gift of Imagination. A new clinical model for helping children understand and manage anxiety

According to the U.S. Dept of Health and Human Services, anxiety disorders are the most common mental health problem occurring during childhood and adolescence (2010).  In the U.S. 13% of children and adolescents experience some kind of anxiety disorder.  The Public Health Agency of Canada 2002 reports that in Canada 6% of children have an anxiety disorder serious enough to require treatment.  In spite of anxiety being a debilitating condition that can prevent a child from participating in many of the critical aspects of childhood, including school attendance as well as recreational activities, many children are not motivated to receive psychotherapeutic help, preferring instead to use avoidance as their main defense against uncomfortable anxiety states. From the adult perspective, this is not a viable solution and creates many secondary problems. Dr. Alter will focus on a therapeutic formulation of anxiety that has worked extremely well for hundreds of children in her private practice. She will explain her discovery of the link between imagination and anxiety, and how this new understanding can be used effectively for the treatment of anxiety. This new approach starts and ends with an enhancement of self-esteem and puts children in a place where they are motivated to use many of the tools and strategies that have been developed by others.  You will also learn how children’s anxiety is different from adults’.  As well you will learn how children’s thinking is different from adults’ which will assist you in helping children with many other problems besides anxiety. Key Learning Points:

•               Understand and appreciate the difference between children’s and adult’s thinking processes

•               Understand the differences between children’s and adult’s anxieties

•               Make the connection between anxiety and imagination

•               Implement a concrete step-by-step approach to applying this new understanding of anxiety

•               Incorporate some effective strategies into your clinical practice to manage children’s anxiety

•               Find a new way to work with children around anxiety that enhances their self-esteem and empowers and challenges them to face their problems and their fears

•               Discover why motivating children to make changes is key to effective  clinical practice and find new ways to increase their motivation for change

Dr. Robin Alter was born in New Jersey and received her undergraduate degree from Skidmore College, Saratoga Springs, New York. She received her Master’s and Doctoral degree from the University of Florida in Gainesville. She then moved to Toronto, Canada, where she has been working in children’s mental health since 1980.

She has been employed by two of the largest children’s mental health centre in the Toronto area for over 34 years— the Hincks-Dellcrest Children’s Centre and Blue Hills Child and Family Centre. She also works with Anishnawbe Health Toronto, providing fetal alcohol assessments for the people of the First Nations community. She has taught psychology at York University. She maintains a private practice with Alter Stuckler and Associates in Thornhill, Ontario. She is trustee with the Psychology Foundation of Canada. She gives many public lectures to parent groups, teachers and principals, and has been on numerous radio and television programs talking about children’s mental health issues.

Her second book, Taming the Anxiety Monster: A Workbook for Kids, will be published by New Harbinger in the fall of 2015. You can find out more about

Dr. Alter by visiting her website: http://www.docrobin.com/

April 6, 2016

Finding Familiarity in a New Frontier: Psychotherapy for Adults with Autism Spectrum Disorder

Despite the increased numbers of children and adults being diagnosed with Autism Spectrum Disorders (ASD) in Ontario, and the knowledge that at least 1% of the adult population has ASD, relatively little attention has been given to the provision of support and treatment to these individuals and their families. Individual, couple, group and family psychotherapy, core components of a lifespan approach to intervention, will be discussed in this session. Considering the presentation of ASDs, Dr. Stoddart will highlight the issues that ongoing psychotherapy that can be useful in addressing, and some of the challenges that are unique to this group, reflecting on his practice of 25 years. Key Learning Points:

•               Identify Ontario trends in youth and adult ASD diagnosis

•               Understand the psychosocial and mental health issues that can be addressed in the context of psychotherapy

•               Articulate the lifespan challenges common to youth and adults living with ASD, from entry into adulthood to aging with ASD

•               Increase knowledge of resources and interest in working with this group

Dr. Kevin Stoddart is Founding Director of The Redpath Centre and Adjunct Professor, Factor-Inwentash Faculty of Social Work, University of Toronto. Since the early 1990s, his clinical focus has been children, youth and adults with primarily Asperger Syndrome and the co-morbid social and mental health problems that affect them. His second book with Drs. Burke and King entitled “Asperger Syndrome in Adulthood: A Comprehensive Guide for Clinicians” was published by Norton Professional Books (2012). He is Co-Chair of the Ontario Working Group on Mental Health and Adults with ASD and the Ontario Partnership for Adults with Autism and Asperger.

Walk and Talk

It’s been a while.  And somewhere, in the interim, I’ve been thinking about ways of catching up; of re-acquaintance.

I’m sure I’ve heard the phrase ‘walk and talk’ many times over the years, but I’m thinking of it now along the lines of how it was mentioned in a recent self-care workshop.  I’ll be talking about the presenter, Françoise Mathieu, a little later in this post.

Walk and talk is something we can do when we’re stressed and faced with strong emotions or with a sense of the need to connect.  So, it’s a good resource to have in our self-care toolbox.  Sometimes, what I find is that the resources that work during the hard times work even better during the easier moments of life.  And that’s one of the reasons we are always being told to practice.  How many times have we said, or heard? Don’t wait until you’re really upset to practice your yoga breathing.

I don’t think there’s any really formal definition to walk and talk.  It’s pretty self-explanatory.  The urge or need arises and you recruit a friend or colleague to spend some time with you while you get both your bodies in motion – either burning excess adrenaline, or simply taking the opportunity to break away from the more sedentary aspects of the day.

We won’t actually be walking and talking here, but we can run a mental simulation.  So imagine we are connecting again after a bit of a hiatus.  Choose your favourite walking route.  Imagine written words as dialogue.  And if something comes, please add your comment down below.

I’m unsure why I stopped blogging for a while.  There were probably different causes.  Sometimes we bring all the things in life together, and they still don’t add up, or so it seems to me.  And even when they do, life is a process of ebbing and flowing.

So (as perhaps we pass by your favourite tree, or garden) I am thinking now about where the flow of life took me away from the blog, from helping attend to my mother, who was terminally ill with cancer, as well as to other clinical and teaching responsibilities.  For now, - this weekend at least – there are no outstanding insurance reports, or PowerPoint slides to complete, or other details of life screaming for attention.  There’s time to touch the inner background of myself.

*****

It took me a while to sense a starting place.  This morning, I reflected on the number of conferences and educational events I’d attended in the past six or seven months.  And I thought there was the possibility of building a bridge here.  I would not try and summarize more than a few of the moments that stood out for me.  What are those moments?  What necessary and important truths came my way, during a period that began peacefully, and is ending at a time when the very fabric of physician-delivered medical care is being painfully assaulted in my province and perhaps in a far more widespread geography as well.

*****

Ferenczi 2015: Subcortical Cries and Preverbal Cues

There is something powerful and reassuring about the current resurgence of interest in the early Hungarian psychoanalyst, Sándor Ferenczi.  His interest in addressing the unmet needs and traumas of earliest childhood, now backed by modern scientific discoveries, contains the seeds of a more humane and effective model of psychotherapy and of human relationships.

I won’t review Ferenczi’s life and work.  It’s of value to point out that he believed that it would require tenderness and care to repair the traumas of early childhood, and that – in a later work, Confusion of the Tongues Between the Adult and the Child – he explored the difference between the tenderness of childhood sensuality and the passion of adult sexuality.  Of course, in that, we see the potential harm of confusing the two in our patients.  I’d like to say that this occurred mainly in the realm of the conscious, but I’m pretty sure when it comes to this area of concern, we are actually oblivious to much of what we inadvertently say and do.

So for Ferenczi, the deadness in the adult comes not from a death instinct, but from early object-relational or attachment loss.  He describes patients we see frequently, who come to us in dissociated states, split off from their sense of alone-ness, their sense of being unlovable and unwanted, and from the hopelessness and disappointments of their childhoods.

How do we reach these unreachable patients?  How do we induce the will to live, to choose life in a world that is almost always challenging and sometimes inimical?

Is there really a kind of dead or deadened child beneath the present hatred or coldness or despair.  Can we attend to these deeply wounded aspects of self?  We cannot offer the love and care those “ghosts of the past” did not receive, but we can offer our presence and gaze.

At this juncture, I became captivated.  Some of the speakers were describing and capturing deep truths for me.  I was touched by such liberating and honest terminology and testimony.  I heard speakers describe their felt experience of some of the loneliest places we can share with our patients, places where our training offers no tools, no techniques, nor even a map; not even the validation that these places exist.

I listened with rapt attention to Judy K Eekhoff, a Washington State object-relations analyst speaking at the well-attended international conference, taking place at Victoria College in the University of Toronto.

There are patients, she noted, who challenge more than our minds to find them.  We must utilize the full breadth and depth (and bodies) of who we are, and we must be real.  Drawing on Ferenczi and Bion, she reminded us that in finding some of the most inaccessible and hard to reach places in our patients, we are afforded the opportunity to meet those same places in ourselves.

*****

United in Common Cause

This year, the annual conference of the International Society for the Study of Trauma and Dissociation took place in Florida, during early spring.  It’s not always easy working in the traditional medical world, which continues to turn a mostly blind eye – even at its own peril – to the effects of trauma and unremitting stress on our health.  So, for my week in Orlando, I felt filled with gratitude at being connected to a large group of clinicians who felt like-minded and courageous in their ability to face some of the harsher and more complex aspects of the human condition.

In a room close by, a Polish clinician enjoyed the chance to travel locally, as well as attend this conference entitled Mastering the Complexity of Trauma & Dissociation.  She seemed exquisitely pleased with herself for having rented a car and visited Cape Canaveral.  Others wandered closer afield from the conference site.  A colleague from Alberta, who I’d done some training with, and who had recently survived a rough patch in her personal life, shed tears of joy after finally getting her magic wand at Harry Potter World.  It was just the one she wanted, with a unicorn hair inside.

The moment that stands out for me as I write now, took place during the awards ceremony, when Steve Frankel spoke.  Steve is a well-known teacher in the mental health care field, and is credentialed as both a psychologist and attorney at law.  As he spoke, he described, with passion, why he chose to devote so much time and energy to the ISSTD.  In other fields, like psychology and law, he watched those around him maneuver and struggle to find wealth and the spotlight.  Here, this evening, he recognized a group of individuals – lawyers, social workers, addiction counsellours, psychiatrists, psychologists and therapists – who were devoted and selfless in their one common cause: to end child abuse and the mistreatment of children.

You don’t need awards when you are doing this kind of work, but it was good to see ISSTD handing some out anyway.

*****

Beyond Kale and Pedicures

One doesn’t have to be Canadian to know Françoise Mathieu.  An interest in compassion fatigue and self-care will bring you to her.  This Kingston psychologist has been in the field of burnout and stress for a long time, working with the military, with emergency service workers and with health care workers.  At ISSTD, I had the pleasure of spending most of a day learning from Laurie Anne Pearlman, one of the true and original pioneers in this field.  During her presentation, some attendees asked who else they could look to in their reading and the name of two fellow Canadians came up first: Françoise Mathieu and Anna Baranowsky.

I felt quite proud in that moment, since our teaching series has featured both of these speakers, who otherwise have been more or less denied exposure in our more insular medical world.  I hope that will be changing soon.  We are learning very quickly that we are not super-heroes and that we are not immune to compassion fatigue, to burnout and to secondary traumatization.

I attended Françoise Mathieu’s day long workshop at the Hincks-Dellcrest Centre (having previously attended a two-day workshop with her through Leading Edge Seminars) knowing that it was time for our own education series to face what is becoming increasingly well-recognized.  This is the knowledge that the standard interventions for physician burnout, so widely disseminated, do not actually work.  What does work is a far more complex question, and one that Françoise Mathieu has no difficulty tackling. 

I hope that the Caring for Self while Caring for Others series will continue to tackle this difficult and pressing contemporary challenge, without flinching, or hiding in the comfort of old, worn-out assumptions.

What does lie beyond kale and pedicures?  Let’s keep walking and finish up with one final moment of inspiration.

*****

My New Operating System – Two Days with John Briere

In my mind, there is nobody better to speak about mindfulness and trauma than John Briere.  John has been another shining light in our field, and he continues to contribute prolifically through his teaching, his writing and his clinical work.  This was not my first time seeing him in Toronto.  Having also seen him very early in my therapy career, I was able to reflect both on how much I’d changed, and – in many ways – on how John has changed as well.

There’s something about the work he does (which involves things like emergency psychological interventions with major burn victims) and his years of contemplation and mindfulness practice, that add up to both a vulnerable and utterly convincing presence.  John understands science, and writes quite scientifically.  But, at the same time, his reverence and respect for his own and for the direct experiences of others have led to a kind of wisdom that will always remain elusive and mostly out of our reach.

The work we do changes us, and those of us who currently, or in the past have worked in emergency services, recognize just how quickly a life can change.  “I see you with your everyday operating system and two hours later in an ER with a new operating system for desperation and terror.”  This is, in a way, what PTSD is.

And that’s hard for those of us who are still (seemingly, sometimes) intact to get. We bring in our own operating system, and whether it’s based mostly on our own good fortune, or to our own accommodations to old wounds, it may be very different from the one our current patient is utilizing.

So, what do we do with that?  What do we do with a gang member, with a lot of numbing and hypervigilance?  They’re stone cold and hard to treat.  You can knock on their door, but you’ll most likely get very little response.  We see numbed out perpetrators and we want to say: Wake up, get out of it, you’re not helping yourself.  And then we can ask: Should you die because of your attachment style?  When you see highly avoidant perpetrators who were never loved or cared for, and who are consequently mean, cruel, sadistic, what kind of conclusions are there to make?

Do we also expect the victims of trauma to contact their pain, when they may not have the room or ability to access the emotions necessary to do so?  And when they don’t, we might comment that they asked for it.

Do we really know mindfulness until we bring it to bear on these most painful aspects of life?  Do we really become what we are meant to be until we find compassion and the ability to accompany others in their pain, until we recognize that “I am them and they are me”?  And what is the prize?  Nothing but the process of who we are becoming.

As John reminds us, in his song, Sting is essentially right.  It’s a song I always loved, from the first time I heard it in Buenos Aires, backpacking in 1986.  (I would again see Sting perform it again on TV while sitting alone in a hotel room in Dallas, a few days after September 11^th, 2001, where I was attending an ER conference).  We are fragile.

It’s a good ending to this brief autumn walk.  We can look around mindfully, gaze at our surroundings, and gently break contact.  With the music acting as transition …

The work changes all of us.