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The Care Giving Character

CHAPTER 1: The Caregiving Character
Many survivors of childhood sexual abuse have developed heightened capacities to be attentive to the wants of others, to be outstanding caretakers, and simultaneously to know and not know. It's not surprising that children who have organized their lives around such functions may possibly become psychotherapists, a part in which they could continue patterns begun in their families of origin, and which permit a therapist to obtain recognition that may possibly happen to be missing. (p.175)
- Pearlman and Saakvitne: Trauma along with the Therapist
Introduction
Care providers are exclusive folks. We have the gift of being able to connect with other folks in ways that are challenging to explain and also more difficult for other folks to understand. Our unique ability to emotionally join with our customers that allows us a near first-hand experience of their inner planet is probably our greatest gift; it truly is also our greatest challenge.
I typically ask participants in my Compassion Fatigue workshop how many of them knew they had been going to be caregivers just before they reached college. Consistently about 50 60 percent in the participants raise their hands. When asked what percentage of healthcare providers who specialize in work with traumatized customers were exposed to childhood trauma is, most participants say they think it truly is between 75 and 90 %.
It really is truly no mystery that people who share specific traumatic life experiences would discover their way to making some optimistic use out of those experiences as skilled caregivers. It really is from these traumatic experiences that we find out the art of empathy the ability to experience heart to heart what one more particular person is feeling. It is precisely the same set of experiences that could render us more vulnerable to unconsciously absorbing and internalizing as secondary traumatic stress the freezing cold fear that our clientele knowledge in their own bodies and minds.
Character and Profession
Who taught you all this Doctor?
The reply came promptly:
Suffering.
Albert Camus: The Plague
Several of the character traits that attracted us to care providing as a profession are the quite same traits that may render us vulnerable to pressure, burnout and depression. For those of us who took the Strong-Campbell Vocational Interest Inventory (that lengthy, boring test that tells us what we are suppose to become when we develop up), will recognize it as a kind of personality test. Its validity is based upon years of trials that show a strong correlation among simple personality styles as well as the sorts of jobs these designs are drawn to.
As a care provider, it really is my encounter that the majority of us are drawn for the profession. We're drawn often by strong emotions and beliefs also as the want to become of service to other people. We're also often drawn in by the need to realize how and why men and women can believe, feel and behave the way that they have and do.
Take a moment and reflect for yourself. Why did you become a care provider? It surely wasnt for the cash! I dont know of an additional profession that draws the amount of very educated and qualified people who're routinely challenged with big caseloads, diminishing resources and expectations to produce benefits at a pay that may possibly not be equal with the process.
Dr. Paul Pearsall in his book The Hearts Code identifies a number of personality traits that he calls cardio-sensitive. He describes these traits as special to people who were more tuned in to the subtle energies on the heart. I believe care providers share several these traits including:
1. A feminine point of view
Nurses, social workers, case managers, counselors and psychologists are often the lions share of participants who attend my Compassion Fatigue seminars comprising about 85% females who, in line with analysis psychologist Carol Gilligan as reported in the Hearts Code, take on a far more collective orientation determined by caring connection (p.95). One of many core competencies these experts share is their ability to straight intuit other peoples feelings and experiences, to empathize.
Empathy has traditionally been viewed a feminine trait. It is the basis for interpersonal and intra-personal intelligence. The capability to intuit other peoples feelings and being aware of how you can creatively respond are essential skills in any helping profession. Dr. Daniel Goleman in his book Emotional Intelligence states: In tests with over seven thousand men and women inside the United states and eighteen other nations, the advantages of being able to read feelings from non-verbal cues incorporated becoming better adjusted emotionally, much more common, much more outgoing, and probably not surprisingly more sensitive. In general, women are far better than men at this sort of empathy (p. 97).
two. Open minded.
One of several actual pleasures in delivering workshops is the opportunity to interact with large numbers of healthcare specialists who I have found to be for one of the most element, open to new ideas, interested in the new research and really frequently will point me in directions I have never deemed.
Being open minded can also be a lot more than the need to examine new study and therapy methods; it really is the willingness to suspend judgment, to courageously step outside the (often) narrow parameters of our scientifically-culturally biased perceptions and look at ourselves from a new and fresh perspective. Genuine open mindedness demands the ability to take a look at ourselves together with the very same clarity and transparency we observe other individuals.
Dr. Pearsall (1998) writes that most cardio-sensitive folks he interviewed were accommodators rather than assimilators. Psychologist Jean Piaget described the method of accommodation as revising current schemata, our mental models of persons, objects, events and situations (p.95).
three. Body conscious
Body awareness may be the ability to place your focus inside the body and to sense and really feel the connection each and every part of your body has with each other part; it really is one of the core competencies of martial artists. It really is the basis of what Howard Gardner (1993) calls bodily-kinesthetic intelligence.
Care providers have a tendency to fall into two relatively distinct groups individuals who have carried out considerable operate on and in their bodies, and those who tend to be somewhat disconnected from their physical getting.
I usually uncover a considerable quantity of social workers, nurses and counselors who come to seminars on Compassion Fatigue are extremely experienced in some kind of physique oriented therapy, discipline or exercising. Even ahead of present investigation recommended the value of a mind/body method to functioning with trauma survivors, these survivor-helpers had been intuitively tuned to their body. I believe practically any truthful and persistent pursuit in self-healing will lead a survivor sooner or later, back to their physique.
Care providers who appear somewhat disconnected from their physical getting often have a curiosity or earlier encounter using a mind/body strategy but have not pursued or practiced their strategy because of how chaotic their function lives have gotten. It is specifically for this group that the FlowMotion? exercises described later inside the book have already been developed. They may be possibly the simplest, most direct strategy to develop body awareness.
four. Hugely inventive
When we really feel safe enough to discover new concepts, particularly in teams, healthcare providers are tremendously creative. Dr. Ellen Langer, Harvard Psychologist in her book Mindfulness (1989) believes creativity is an crucial top quality of Mindfulness. She states:
Many if not all, in the qualities that make up a mindful attitude are characteristic of inventive people. People who can totally free themselves of old mindsets, who can open themselves to new info and surprise, play with perspective and context, and focus on process as opposed to outcome are most likely to be inventive no matter whether they may be scientists, artists, or cooks. (p. 115).
Creativity is natural to children. Traumatic stress often results in physical and emotional constriction that's expressed emotionally as an almost deadly seriousness. Seriousness is the anticipation of discomfort.
Creativity is actually a situation from the Natural self. When you really feel safe enough and good enough within your physique as well as your environment, the Organic self will come out to play. The willingness to play with new ideas, perceptions and perspectives is the core of creativity.
five. Great visualization potential
Visualization is usually a double-edged sword; we are able to unconsciously visualize what we dont want (and generally do by default) also as begin to consciously type our experience by means of directed visualization.
The use of directed imagery in visualization has been studied and utilized extensively in sports psychology. From Applied Sport Psychology: Private Growth to Peak Efficiency, Jean M. Williams, editor 1986), contributing author Robin S. Vealey from Miami University in her chapter Imagery Education for Functionality Enhancement states: The proof supporting the good influence of imagery on sport overall performance is impressive. Each scientifically controlled research and experiential accounts in the use of imagery to improve performance report positive benefits.(p.209)
Visualization can also be far more than directed imaging; it involves the usage of memory fragments each implicit and explicit, body motion, emotional or affective charging and cognitive mapping. Visualization is inevitable; we either visualize with conscious intent, or unconsciously (and typically negatively) by default.
When conscious directed visualization is performed utilizing multi-sensory rehearsal the enhancement of overall performance and enjoyment is significant. When visualization is carried out by default, we most usually visualize that which we fear. It is exactly the same mechanism behind a self-fulfilling prophecy.
6. Compulsive/dependent/unresolved grief.
These personality traits are extremely consistent with compassion fatigue; they frequently create as a result in the traumatic experiences many care providers have experienced in their lives that also helped create heightened capacities for empathy.
Traumatic private experiences can be the wellspring of empathy and wisdom; they can also outcome in unresolved grief that is certainly often expressed as dependency and compulsive behavior.
A single frequent personality trait of care providers is our compulsiveness. That is in fact a valued trait sought out by managers and supervisors. As a former clinical director and plan manager, possessing workers who were somewhat rigid about finishing tasks and taking a higher degree of duty for their perform was hugely valued. It could also outcome in burnout, particularly when combined with emotional dependency and unresolved grief.
I think a high percentage of care providers have experienced important loss in their lives that may possibly still stay as unresolved grief. It really is no mystery that a surprising quantity of us have, do or will knowledge key depression that typically needs medication and therapy.
In regards to cardio-sensitive men and women, Dr. Pearsall (1998) states:
They had seasoned what they described and family members confirmed as a severe break inside a prior emotional bond. Many reported an specifically tough divorce or the premature loss of a parent, which nonetheless plagued them emotionally even following a number of years had passed. There seemed to be a chronic, mildly depressive nature often masked by self-depreciating humor (p.97).
Dependency is typically the outcome of unresolved grief. Unresolved grief can take root in the bodys thoughts as need-desire, a desire or want which is skilled with all the same intensity and tenacity as an unmet simple want. Dependency may be experienced as emotional hunger using the same intensity as physical hunger. It might draw our interest and intention inward towards its constantly aching emptiness.
As a single counselor who operates with battered women stated; I by no means imagined that unresolved grief could in fact impact how and where I would be drawn to find function. The truth is I'm most fulfilled when I'm in a position to consciously function on a few of my own dependency issues even though being of service to other females with equivalent issues.
7. Sensual/dreamer/flow-er
This last set of character traits speaks to our capacity to engage the organic self in spontaneous and playful creative flow. Flow may be the situation of alignment and synchrony amongst mind, physique and Energy in MOTION that outcomes in higher levels of enjoyment and functionality with every activity in which we consciously engage these traits.
Sensuality within this context refers to becoming in touch with your physical self from the inside out. It is the ability to delight in the expertise of physical touch at the same time as sense that sweet location where physical and emotional energies intertwine and circulate all through the body and thoughts. Sensuality dances within the heart in the All-natural self.
The dreamer is the playful, imaginative, child-like self that we usually tell to stand nevertheless and be quiet as we attend to our critical, critical, adult perform. The dreamer may be the flowing, unformed, creative impulse that's just under the surface of consciousness. It really is waiting, always ready to come out and play.
To flow would be to consciously engage the sensual dreamer in playful, inventive activity. Flow would be the outcome of surrendering towards the present moment and aligning who I am with what I am performing in spontaneous action.
Repeating and Remembering
Long ago Sigmund Freud stated, You will repeat as opposed to bear in mind. I think he was talking concerning the repetition compulsion, or the tendency in some customers to compulsively repeat patterns of behavior instead of remember their origins typically in an try to master the stimulus retrospectively.
Van der Kolk in Traumatic Pressure (1996) calls it compulsive re-exposure, and states: One set of behaviors that is certainly not talked about in the diagnostic criteria for PTSD would be the compulsive re-exposure of some traumatized men and women to scenarios reminiscent on the traumaIn this reenactment from the trauma, a person might play the function of either victimizer or victim. (p. ten).
In some approaches, care providers may compulsively expose themselves at work towards the quite same kind of trauma that they skilled at house earlier in their lives. One particular care provider at a recent workshop states: I didnt recognize it at the time, but the extremely very same situations of danger and unpredictability that characterized my childhood residence environment have been also a few of the same conditions as my last job.
The tendency to repeat patterns of trauma by means of compulsive re-exposure is one of the major psychological mechanisms at operate in compassion fatigue. The re-exposure may be inside the kind of functioning with survivors who knowledgeable related trauma as ours, and/or working in an emotionally toxic environment with unpredictable guidelines and relationships.
As a survivor therapist just out of graduate college, I was initially drawn to crisis intervention inside a really busy emergency area. As I look back on it now, I understand I was drawn towards the chaos, unpredictability and in some cases danger inside a job position that was brand new and not properly formulated with tiny definition or boundaries; an ideal repetition of my household of origin with all the dramatic relationships that would eventually play out.
Re-exposure to personal trauma by operating with clients who knowledgeable trauma equivalent to yours is one of the most direct approaches care providers can reactivate their own frozen-in-fear body memory also as absorb and internalize the feelings of their clientele.
Emotion really is Power in MOTION. As Gary Zukov (1989) writes in The Seat of the Soul: Emotions are currents of energy with diverse frequencies. Emotions that we think of as damaging, for example hatred, envy, disdain and worry possess a reduced frequency, and less energy, than emotions that we think of as constructive, for example affection, joy, enjoy and compassion. (p. 94)
As care providers empathically attune their receiving heart for the frequency of their clients sending heart that energy stamp is recorded inside the receivers heart and body. When the energy received is felt to become familiar in its tone and frequency, a sympathetic response might develop resulting in absorption and internalization of that energy.
The a lot more challenging to identify situation in which re-exposure to personal, person and collective trauma can manifest in functioning relationships with co-workers, supervisors and in organizations. As Pearlman and Saakvitne (1995): in their book, Trauma and the Therapist state:
Organizations possess a potent influence on therapists they employ and on the therapeutic relationships that exist inside the organization. Sensitivity around the portion of members, and especially leaders, from the organization to instances when organizational dynamics call for an external consultation will enable those involved to create a clearer sense from the dynamics and choices for adjust.(p. 379)
Individual and collective patterns of perception, reaction and inaction can and do kind because of this of individual psycho-dynamics that could be re-enacted in relationships at operate. It may be as simple as; consciously or unconsciously, with intent or with inertia, we bring who we are to what we do and who we do it with.
Empathy and Sympathy
The core competence for all care providers and all care providing is the capacity for, and the capability to create, empathy.
The Oxford American Dictionary defines empathy as: 1. The ability to identify oneself mentally with a person or things and so realize his feelings or its meaning. two. Do not confuse empathy with sympathy.
In his book Emotional Intelligence, Daniel Goleman states: Empathy builds on self-awareness; the a lot more open we're to our personal emotions, the more skilled we'll be in reading feelings(p. 96). In other words, our capability to connect with other individuals is closely tied to our capability to be open and honest about our own feelings. Self-honesty and transparency genuinely are some of the keys to individual growth and transformation. Empathy will be the capability to attune our own sense-perception towards the frequency of one more as even though we could actually choose up on yet another persons individual frequency.
Heinz Kohut, a Chicago psychoanalyst and author of the classic book, The Evaluation in the Self (1971), defines empathy as:a mode of cognition that is especially attuned for the perception of complex psychological configurations (p.300). Empathyor the ability to attune ourselves towards the inner workings of our clients experienceis at the heart of each care providers core competence. How do we attune ourselves to other individuals?
Once again, Dr. Goleman gives some clues. He states: For all rapport, the root of caring, stems from emotional attunement, in the capacity for empathy. The important to intuiting anothers feelings is inside the capability to study nonverbal channels (p.96).
Empathy will be the process of establishing rapport by way of emotional attunement, the capability to intuit an additional persons feelings and study non-verbal channels. In a way, empathy sets in motion the internal mental and emotional conditions essential to nonetheless your thoughts, suspend judgment and listen together with your heart and gut.
Empathy is really a fundamental therapeutic skill that allows you to become a participant/observer throughout the method of communicating together with your client.
The participant component of you your feeling-intuitive sidejoins along with your client by developing rapport and alignment with them. The observer part of you detaches without having disconnecting in the content of what's occurring and is in a position to clearly and objectively observe the process of the transactions along with your client as they unfold. The participant-observer is watching/feeling/experiencing from inside the physique at the same time as attending to what is transpiring outside as well.
The art of cultivating a helping relationship depends on the ability to join, intuit, move, and mirror one more persons emotion. This ability entails simultaneously hovering inside the transaction zone, even though you observe, approach, and respond to the unfolding of the interaction in between your self and your client. Its the dance of flow between care provider and client.
The Oxford American Dictionary defines sympathy as: 1. sharing or the ability to share an additional persons emotions or sensations. So what is the distinction amongst empathy and sympathy and how do you know which 1 you are feeling?
Firstly, there is no clear dividing line among the subtle energies of empathy and sympathy simply because we need to have a single to draw differences. Actually, I usually do not believe there's a clear dividing line amongst most concepts within the human service field; most divisions and separations are self-induced because we believe the division in our considering will offer a lot more clarity. The truth is, it produces far more confusion. It's almost certainly closer for the truth that we employ a diverse mix of empathy and sympathy to each and every particular person or scenario we concentrate our interest on.
There's nevertheless a valuable guideline in noticing when your empathy/sympathy mix might be out of balance.
Correct empathy is a basic ability and ability that lets you turn into a participant/observer even though you might be emotionally engaged along with your client. As one particular of my professors (several years ago) stated; Listen to the music and not only the words. The participant component of you that's open and receptive for the music of the client whilst the observer is also listening for the words. The observer will be the component of you that's detached (not disconnected) in the pull in the emotional interchange whilst clearly and objectively observing the content and approach of one's transactions as they unfold.
The emergence of an out of balance sympathetic response happens when your client (or coworker/supervisor) says something that draws your observing self in causing you to shed your connection with all the being inside the body. As an alternative to noticing how the emotion is experienced inside your body, you turn into the emotion. Instead of observing from a viewing point you're now engulfed and locked into your point of view. Getting appropriate starts to grow to be far more important that being clear.
In one particular of my very first seminars on Compassion Fatigue an insightful social worker who operates mainly with Borderline Personality Disorders mentioned; I know Ive taken the bait and gotten hooked by my client when the concentrate of my consideration, my central awareness abruptly alterations, from a wide angle flowing point of view to a tight, narrow, constricted beam. And usually, I start to tighten my neck and shoulders and restrict my breath.
Countertransference
Countertransference gives the therapist with invaluable info to inform and shape their clinical interventions. Therapists can gather essential diagnostic information through responses to unspoken, unconscious events inside the therapy connection. Our subjective expertise of confusion and disorientation throughout history-taking by way of example, frequently supplies early clues about a clients lack of access to fundamental information or about his discomfort as he tries to hold contradictory pieces of details simultaneously (p.25).
Pearlman and Saakvitne (1995) Trauma along with the Therapist
Countertransference is an frequently employed and misused term to describe a few of the sensations, feelings and feelings felt by the care giver in response to his/her empathic and/or sympathetic connection with the client. Exactly where the confusion often develops is when we're unable and/or unwilling to distinguish our personal, private sensations, feelings and emotions from previous personal trauma that have turn into re-activated as a result of our sympathetic connection together with the client from these sensations, feelings and emotions that are activated because the result of an empathic connection with all the client.
Within the context I'm utilizing here, countertransference refers in component to the description offered by Pearlman and Saakvitne (1995):
Our definition of countertransference consists of two components: (1) the affective, ideational, and physical response a therapist has to her client, his clinical material, transference, and reenactments, and (2) the therapists conscious and unconscious defenses against the impacts, intrapsychic conflicts, and associations aroused by the former (p.23)
The Care Providers Physical/Affective/Ideational Response to His or her Client
Its a great idea to have in touch together with your private sense of physical-emotional being, exactly where most of the action requires place. As you will find out within the chapter on Parallel Procedure, human beings are truly considerably much more connected than we prefer to think. One of many very best techniques for me to understand what's transpiring with my client is to listen with my personal felt-sense to what exactly is transpiring in my own physique, my feelings, thoughts, and pictures.
When we sit and listen to our customers we're receiving energy as well as information. It is inevitable. We are able to, will, and do absorb the emotions of our consumers.
Becoming body conscious makes you a lot more sensitive to your own internal movement of power, sensations, impacts, various tension levels, andmost importantlyof your breathing.
You're more in a position to identify which physical and emotional sensations are responding to what your client is describing to you. This understanding enables you to separate the client-caused reactions from these arising out of your personal private history.
Additionally to the body/emotional response to countertransference, there is certainly also the ideational and info processing response.
Ideational refers towards the content material of information becoming processed. This content material can present itself as thoughts or concepts, sounds, visual images, and memory fragments. Fear would be the emotion most frequently linked with such content. This gives most ideational content the energy to intrude upon the screen of our conscious mind or be projected unconsciously onto others.
The Therapists Conscious and Unconscious Defenses
What is our immediate, conscious physical and emotional response to another particular person with whom we have an empathic connection that is certainly experiencing fear and pain particularly if our personal body-mind is attuned to that certain type of discomfort and/or fear?
Usually we freeze up as well; even though it's one thing as subtle as holding or restricting your breath all through the session. How several instances have you come out of an intensive interview having a client gasping for air? The initial physical response to the experience of fearyours or that of your clientis to hold your breath.
Additionally to holding your breath, youll also feel a frozen-like acute or chronic muscle tensionusually inside the neck, shoulders, and back. This hardened tension results from consistently squeezing your shoulders up and in. That is the bodys frozen-in-fear-like-a-statue stance.
Countertransference also can be unconscious and is normally the result of projection.
Projection occurs in two approaches. A single would be the projection of the complete self, which is, the use of the client as a self-object, a mirror in the therapists self. Therefore, the survivor therapist could assume the clients experiences are just like her own, that the client felt the identical way, had the same conflicts, and coped within the exact same ways. The second way projection occurs is as a automobile for ridding the therapist of uncomfortable affects by attributing them for the client
- Pearlman and Saakvitne, 1995 (p.181).
Once you can, let your self to become as sincere and transparent as you possibly can, look out into the world from an extremely still and quiet spot inside the center of one's body/mind and notice what genuinely gives shape, type and color to what you see. A fantastic deal of what you truly physically perceive and the majority of what you notice or spend focus to has been given shape, form and colour by projecting or transferring your personal individual reality onto the screen of one's perception of other people and the world around.
Particular countertransference reactions is usually a form of projection that's normally unconscious and develops in between care provider and client that may outcome inside the provider perceiving the client as either a mirror in the providers idealized self, or as the paranoid object (devalued other).
Inside a mirroring countertransference, the client is mainly perceived by the care provider as an extension of the providers personal narcissistic self. Within this way, the client is perceived and valued for the extent that he/she is observed to share certain common experiences, values, preferences, coping styles, etc., with all the care giver. The caregiver can turn into very taken using the client personally and commence to shed the observer self as he/she participates far more fully in mirroring and becoming mirrored by, the client.
The flip side to a mirroring countertransference will be the devaluation on the client by depositing the unwanted unworthy, disowned components on the care providers self onto the screen in the client. The client becomes the receptacle for the caregivers persecutory self-representations, the paranoid object.
In each kinds of countertransference, the care provider is unconsciously attempting to sustain emotional balance and self-consolidation by over-identifying with what he/she perceives as good that's projected onto the individual of the client and splitting off and disowning what exactly is skilled to become negative or contaminated.
When Wanting Feels Like Needing
Need-desire is a want that is seasoned with the very same intensity and tenacity as a physical need to have. It really is a desire that feels like a need. The desire to be appropriate or to feel specific, for example, might be skilled using the same force and intensity as our physical and safety needs.
For care providers, our need-desire to be right or particular can trap us in the compulsion to give a lot more of ourselves to our clients, our function, and our co-workers than is healthful for us, or them. It could also lead to us to react stronglyand at instances without our conscious awarenesstowards our clientele or co-workers in approaches that support division and conflict rather than unity and cooperation.
A single of our strongest needs will be the want to become seen and heard. To be seen and heard and accurately empathized with is among the strongest wants infants have in their development. To be observed, heard, held, mirrored and protected is highly connected with the infants sense of physical and psychological survival. It's the basis for the development on the self.
It's interesting that whilst becoming seen, heard and appreciated by other folks is one of the strongest, human motivations, the fear of humiliation is one particular of our strongest counter-motivations. What we want/need the really most is what we're also most vulnerable to and dependent upon. We want to be observed but are also afraid of becoming observed. This is because the possibility of getting seen also brings the possibility of shame of appearing bad or incorrect.
The Need-Desire to be Right
If becoming proper is your objective,
you'll discover error inside the planet, and seek to appropriate it.
But don't anticipate reassurance.
If reassurance is your purpose,
seek out the errors in your beliefs and expectations.
Seek to change them, not the globe.
And be constantly prepared to be wrong.
Peter Russell: Waking Up in Time (p.95).
Some care providers are burdened with a self-image that demands other people to respond to them in ways that they count on will make them really feel proper, important, and specific. Such a burden can render opaque what would be transparent to a person much less burdened. The need to be correct might be experienced with all the very same or higher force and intensity than the must survive; several people are willing to become dead-right.
Eckhart Tolle (1999) in his current book: Practicing The Power of Now, states; Even such a seemingly trivial and normal issue because the compulsive need to be correct in an argument and make the other particular person wrong defending the mental position with which you might have identified is because of the fear of death. In the event you recognize with a mental position, then in case you are incorrect, your mind-based sense of self is seriously threatened with annihilation. So you as the ego can't be wrong(p.