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Professional Resilience and Self-Care

Professional Resilience and Self-Care. Towanda Garner Lawyer Assistance Program / PALS Steven D. Mullinix, PhD HRC Behavioral Health & Psychiatry, PA BarCares Program. Drug Court Works! – Evidence Based Practice Made Practical August 31, 2010. Acknowledgments:.

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Professional Resilience and Self-Care

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  1. Professional Resilience and Self-Care Towanda Garner Lawyer Assistance Program / PALS Steven D. Mullinix, PhD HRC Behavioral Health & Psychiatry, PA BarCares Program Drug Court Works! – Evidence Based Practice Made Practical August 31, 2010

  2. Acknowledgments: • N C State Bar Lawyer Assistance Program • N C Bar Association BarCares Program – Anne Arberg, Coordinator • NC Psychological Association, Colleague Assistance Committee • Judith Holder-Cooper, PhD Director, Duke Professional & Personal Development Program • J. Eric Gentry, PhD, LMHC CompassionUnlimited

  3. Objectives: • To increase awareness of the impact of Secondary Traumatic Stress on Drug Court team members • To identify self-care strategies to reduce stress and build resiliency thereby reducing the risk of alcohol or other substance abuse by team members • To introduce the Lawyer Assistance Program / PALS and the Bar Cares Program as professional and personal support resources Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind. -Bruce Lee

  4. Secondary Traumatic Stress • Also known as countertransference or vicarious traumatization • Natural consequence of behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant person • The stress resulting from helping, wanting to help or working closely with a traumatized or suffering person (Figley, 1995)

  5. Burnout • Burnout is a process (rather than fixed condition) and becomes progressively worse (Cherniss, 1980; Maslach, 1976, 1982) • This process includes : • gradual exposure to job strain • erosion of idealism • a sense of lack of achievement

  6. Compassion Fatigue • Secondary Traumatization + Burnout=Compassion Fatigue(Figley, 1995) • Mimics PTSD and other disorders of clients/patients • Event(e.g., witnessing or gaining knowledge of an event) • Intrusion(e.g., thoughts of clients, client’s imagery, dreams, etc.) • Avoidance or Numbing(e.g., detachment) • Arousal(e.g., sleep disturbance, irritability, general anxiety, physiological reactivity)

  7. Compassion Fatigue SymptomsGentry, 2008 • Intrusive Symptoms • Thoughts and images associated with client’s traumatic experience • Inability to “let go” of work-related matters • Avoidance Symptoms • Loss of sense of competency/potency, isolation • Secretive self-medication/abuse/addiction (alcohol, drugs, spending etc.) • Arousal Symptoms • Increased anxiety • Reactivity

  8. The “Type E” Professional • Professionals who do not heed the warning signs: • Poor judgment, e.g., boundary violations • Poor coping, e.g., alcohol or other substance abuse • Psychological distress, e.g., mood issues, vicarious traumatization, workaholism, impaired judgment • Physical impairment, e.g., sleep disturbance, changes in weight, ulcers, HBP Work importance correlates with burnout.

  9. Impairment is…. • It is an objective change in a person’s professional functioning. It may or may not be accompanied by the subjective experience of distress. • The change can be physical (substance abuse), psychological (depression), or interpersonal (separation). • The criterion for impairment is a reduction in performance, e.g., doing a poor job.

  10. Stages of Compassion Fatigue Trajectory • The Zealot Phase • The Irritability Phase • The Withdrawal Phase • The Zombie Phase • Pathology vs. Renewal/Maturation -Adapted from D. Fakkema by Eric Gentry (2008)

  11. Compassion Fatigue Phase I: The Zealot Phase - Idealistic • We are committed, involved, and available… • …ready to problem solve… • …ready to make a difference… • We willingly put in extra hours • …our enthusiasm overflows… •  We are willing to go the extra mile Adapted from J. Eric Gentry, PhD 2008

  12. Compassion Fatigue Phase Two: The Irritability Phase. • We daydream or become distracted when patients/clients are speaking with us in session… • Oversights, mistakes, and lapses of concentration begin to occur… • We begin to distance ourselves from our friends and coworkers… • We begin to mock our colleagues and patients/clients… • The use of humor is sometimes strained.  • We begin to cut corners… Adapted from J. Eric Gentry, PhD 2008

  13. Compassion Fatigue Phase Three: The Withdrawal Phase • Our enthusiasm turns sour….. • We are tired all the time……we no longer wish to talk about work. • Our patients/clients become a blur and run together…… • Complaints may be made about our work • We neglect our family, coworkers, patients/clients, and ourselves. • Our shield gets thicker and thicker……it blocks our pain andsadness. Adapted from J. Eric Gentry, PhD2008

  14. Compassion Fatigue Phase Four: The Zombie Phase • Others become incompetent or ignorant in our eyes. • Our hopelessness turns to rage.    • …we even hate our coworkers if they dare question us. • We develop a disdain for patients/clients.   • We have no patience… we lose our sense of humor…and have no time for fun. Adapted from J. Eric Gentry, PhD 2008

  15. Compassion Fatigue Resiliency Phase Five: Pathology and Victimization vs. Maturation and Renewal Overwhelmed and Leaving the Profession Somatic illness Perpetuity of Symptoms or Hardiness Resiliency Transformation Adapted from J. Eric Gentry, PhD 2008

  16. Summary • Compassion fatigue results from the combined effects of secondary trauma and burnout to produce painful symptoms in caregivers and staff. • Compassion fatigue can be prevented through the development and maintenance of a calming presence, self-validated care giving and other self-care skills • Compassion fatigue is very responsive to self-care strategies and/or treatment

  17. Self- Assessment What’s your risk?

  18. Self-Care Strategies

  19. Resilience • Researchers have found there are three (3) personality traits important to hardiness: • Commitment (to self, family, work, values) • Sense of personal control over one’s life • Ability to see change as a challenge to be mastered • Optimism is another factor that influences our responses to stress

  20. Board of Directors For Your Life . . . .

  21. Discussion What do you do to manage stress and recharge your batteries?

  22. Resilience Discussion • How do you handle distress so it never gets to the level of impairment? • What does resilience look like in your job?

  23. Strategies for Self-Care • Physical • Diaphragmatic breathing/ Muscle Relaxation • Hydration • Exercise • Diet/Nutrition • Monitor substance use/or other processes you may use for relaxation or entertainment (video games, movies, sleep) • Social • Spend time with friends • Volunteer • Playing with your pets • Take regular vacations • Collaboration (e.g., seek consultation when personally or professionally challenged)

  24. Strategies for Self-Care • Mental/ Emotional • Realistic expectations • Keep intellectually stimulated • Sense of humor • Journaling • Positive self-talk • Challenge your assumptions • Spiritual • Spiritual Reflection (prayer) • Mindfulness meditation • Affirmations • Guided Imagery

  25. Simple, healthful suggestions: • Change clothes when you get home • Have a transition from office such as walking or listening to something relaxing (not the news!) • Use the symbolic nature of water – e.g., showers as transition time, have a fountain in the your office, wash your hands between meetings

  26. WHAT IS THE NORTH CAROLINA LAWYER ASSISTANCE PROGRAM (LAP)? • The Lawyer Assistance Program (LAP) is a service of the North Carolina State Bar which provides confidential assistance to North Carolina’s judges, lawyers and law students to assist them in identifying and addressing issues regarding alcoholism, chemical dependency, other addictions and mental health concerns . The primary purpose of the LAP is to assist judges and lawyers before they deteriorate to the point of receiving client complaints or otherwise become involved in the discipline process.

  27. The LAWYER ASSISTANCE PROGRAM (LAP) • The LAP has no connection with the discipline function of the Bar, except in those cases referred to it by Grievance or DHC for monitoring.

  28. The LAWYER ASSISTANCE PROGRAM (LAP) The LAP has two components entitled Positive Action for Lawyers (PALS) and FRIENDS. The mission of PALS: • To assist judges, lawyers and law students who struggle with alcoholism, chemical dependency or other addictions. • To provide support for family members. • To provide educational outreach. • To provide volunteer development and training.

  29. The LAWYER ASSISTANCE PROGRAM (LAP) The mission of FRIENDS: • To assist judges, lawyers and law students who struggle with depression or other mental health concerns. • To provide support for family members. • To provide educational outreach. • To provide volunteer development training.

  30. CONFIDENTIALITY • The information received by PALS and FRIENDS is confidential. Under Rule 1.6 of the Revised Rules of Professional Conduct, the attorney-client privilege applies to communications between a lawyer seeking or needing assistance and the LAP. • The LAP is, by rule of the State Bar and approved by the North Carolina Supreme Court, entirely separate from any ethics or disciplinary committee of the State Bar.

  31. BarCares • Provides confidential counseling for lawyers, judges, paralegals, law students (and their families) for those counties and judicial districts that have “opted in”. • Up to 3 free visits are provided at no cost to you with funding provided by your bar group membership or law school – The NC Bar Association and Lawyers Insurance Agency fund administrative fees for the program. • BarCares is administered State wide by HRC Behavioral Health & Psychiatry, PA of Chapel Hill.

  32. BarCares • HRC credentials licensed counseling professionals across North Carolina to participate in the network. The network includes psychologists, psychiatrists, social workers, and marriage and family therapists. • HRC provides a personal referral to assist you with personal issues, family issues , or work related issues

  33. BarCares • Personal Issues: • Crisis intervention • Depression and anxiety • Substance abuse (alcohol or other drugs) • Financial concerns • Career counseling

  34. BarCares • Family issues: • Marriage or relationship issues • Children or adolescents • Parenting • Family conflict

  35. BarCares • Work related issues: • Professional stressors • Course and academic related stress • Conflict resolution

  36. BarCares -- Confidentiality • If you use the BarCares Program, no one will know but you, unless you choose to tell someone else. • The counselors who are part of the program are licensed professionals, bound by the confidentiality requirements of their profession.

  37. BarCares • To find out if the BarCares Program is available in your area or to make an appointment, contact the BarCares Coordinator -- Ms. Anne Arberg 1 – 800 – 640 – 0735 www.hrc-pa/barcares/ aarberg@aol.com

  38. Other Resources: • Friends and family members • Pastor, priest or rabbi • Private counselor or therapist • Your sponsor or 12 step group • Other . . .

  39. Finally…. • What’s your plan? • Make self-care a priority!

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