Author Archives: mike

  1. Compassion Fatigue

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    One of the greatest strengths that you have to bring to your occupation- your capacity to develop a compassionate connection with your clients-is also your greatest vulnerability.

    Most of us became vets and nurses out of a love of animals and a desire to help them.

    But the love of humans was not listed as a prerequisite for our career choice. Sometimes we love them, sometimes we’re stressed by them, and sometimes we shut ourselves off from their emotions as an act of self-preservation.

    Nevertheless, the more we ‘love’ the people who are tethered to our patients, the more job satisfaction we are likely to have. This is particularly true when fixing fractures, obstructions of any system, and heart disease.

    If we can celebrate with the owners of our patients, then it’s all good right?

    The downside to having a close emotional bond with our clients is that, without good self-awareness and self-regulation, we can feel their emotions a bit too intensely. We can ‘become’ their emotions of fear when investigations are being discussed, and grief and sadness when things aren’t going well.

    This, in turn, saps our strength and leaves nothing in the tank for actually doing what the client wants us to do: diagnose and treat.

    Our capacity for compassion, on top of the insanely busy days, other emotional strains, even without a global pandemic added to the mix, can lead to emotional exhaustion and compassion fatigue.

     Unfairly perhaps, one of the greatest strengths that you have to bring to your occupation- your capacity to develop a compassionate connection with your clients-is also your greatest vulnerability.

    So, shutting off from others is the solution? No. This only serves to increase our vulnerability. This is because being a rock and an island is only ever a temporary ‘fix’. Humans need positive relationships to thrive.

    There is an abundance of literature showing that people who are socially integrated, and who experience more supportive and rewarding relationships with others have better mental health, higher levels of subjective well-being, and lower rates of morbidity and mortality compared to others. (1)

    Even more interestingly, a meta-analysis (2) shows that being socially integrated into a network of meaningful relationships predicts mortality more strongly than many lifestyle behaviors (e.g., smoking, physical activity) i.e. the better the relationships, the lower the mortality rate in middle age.

    What are the symptoms of compassion fatigue?

    Compassion fatigue and PTSD have many symptoms in common:

    Depersonalisation (isolation from others, feeling like a zombie or an onlooker onto your own life)

    Difficulty falling asleep or staying asleep.

    Feeling like you’re never refreshed when you wake up.

    Irritability

    Hopeless attitude towards your job.

    Feeling like you have to just ‘get through’ each day.

    Difficulty in leaving work at the end of the day.

    Thinking about cases when not at work.

    Dreaming about cases.

    Awfulising about cases (an irrational and dramatic thought pattern, characterized by the tendency to overestimate the potential bad outcomes of a case). Predicting the most catastrophic outcome.

    How do I prevent or recover from compassion fatigue?

    1. Awareness of the symptoms and early recognition are crucial.

    Using mindfulness to enhance self-awareness will alert us to the difference between having good empathy with a client and having ‘too much’ empathy with them.

    • Self-regulation. Knowing when the drain on your emotional resources is more than what is being replenished as it’s happening in the consulting room or on the phone.

    And being able to stop yourself from traveling down that emotional spiral with your distressed client to stay strong.

    • Taking time off doesn’t necessarily bring relief for many of us, either because we’re thinking about work and checking our emails while we’re off, or because we return to the workplace having done little to no self-care whilst away.

    A holiday can still be a holiday even if we’re getting the ‘chore’ of self-compassion done.

    Self-care and self-compassion ideally shouldn’t be at the bottom of our ‘to-do list’, only to be ignored when we’ve finished work because we’re exhausted.

    Making time for short mindful meditations every day provides a structure for psychological self-care. Make that 10 minutes or half-hour non-negotiable with your self-neglecting self.

    “My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humour, and some style. Surviving is important. Thriving is elegant.”

    – Maya Angelou

    • We all know that good nutrition, good sleep and exercise are helpful. I don’t know any vet or nurse who’s nailed this.

        Maybe this could be adjusted for each of us to make it realistic and achievable. E.g., slightly less than a bottle of wine, no screens just before bedtime, and walking some of the ways to work. Whatever plan you make, stick to it. Because if it’s your plan it’s a great deal more valid than a plan your therapist has made for you.

    • Invest in your positive relationships and nurture them with more than just text messages and Facebook posts. Spend time with these people who feed your soul and who genuinely care about you. Put your phone on silent somewhere else when you’re with them if you can.
    • Spend less time with the negative influences in your life.

    Unrecognized and untreated compassion fatigue causes vets and nurses to leave the profession, hit the bottle, or, in all too many cases become self-destructive or suicidal.

    Recognizing the symptoms in ourselves and our colleagues benefits everyone: those with emotional exhaustion, those trying to avoid it, and the clients we see.

    “Taking care of myself doesn’t mean ‘me first’ it means ‘me too’”

    – L. R. Knost.

    References:

    1.  Cohen & Syme, 1985Collins, Dunkel Schetter, Lobel, & Scrimshaw, 1993Kawachi & Berkman, 2001Lakey & Cronin, 2008Miller, Lachman, Chen, Gruenewald, Karlamangla, & Seeman, 2011Sarason, Sarason, & Gurung, 1997Seeman, 2000Uchino, 2009Uchino, Cacioppo, & Kiecolt-Glaser, 1996Vaux, 1988)
    2. Holt-Lunstad & Smith, 2012
  2. Empathic Concern. What is it?

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    Pain is inevitable. Suffering is optional.”

    After two years of a life-changing slog in full PPE, the practices that have looked on this time as an opportunity to change the way we manage our staff for the better, are the practices with the best retention, the lowest absence rates, and the greatest satisfaction-at-work ratings.

    The ads in the Veterinary publications have changed dramatically almost overnight because of the shortage of staff in the pool.

    Now we see generous “5 nights on, 10 nights off” Rota’s, increases in annual leave, birthdays off work, etc. It makes for interesting reading.

    Satisfaction at work, we know improves profitability (The Empathy-Profitability Link Magazine November 2018 ).

    The client feels it and sees it. They hear it in our tone of voice when we pick up the phone. They need us to keep it together because, just as we think that they forget that we are humans as well as vets, we often forget that they are more than just pet owners and have their own stuff going on in the background too. If the vet can’t cope, how on earth can the pet owner cope?

    Some managers may have lost sight of what it’s like to be a vet or nurse on the coal face. With an extra 3.2million pets in the UK since the pandemic started, it’s the stuff of nightmares.

    The number of vets seeking counseling has tripled. The nurses are burning out, the receptionists are in crisis with car park consulting and the teams are feeling unappreciated, taken for granted, and often trapped in the UK if they have come from abroad.

    The stark difference between the teams who have become closer because of the crisis and the teams who have fragmented due to weak leadership during the pandemic is jaw-dropping.

    In Magazine November 2017, I briefly described the three main types of empathy.

    Cognitive empathy: means “I understand what you are saying, and I can also understand what you are feeling but not saying.  I can communicate with you in a way you will clearly understand. We have a rapport”

    Emotional empathy means: “I feel your distress. Also, I feel your joy and other emotions without the need for you to verbalize them”

    Empathic concern: is an active kind of empathy. More like “When I see you are in distress, I have an overwhelming need to help you.”

    These are the people who not only understand others and feel with others, but they also take action.

    The best leaders have all three types of empathy running at the same time.

    The case for Empathic concern vs just Empathy alone.

    In Potential Project’s The Human Leader study, a bi-annual study of 5,000 companies across 100 countries, Leaders were asked if they were more likely to be in the Empathy class or the Empathic Concern class. The results were then correlated with both the leaders’ and employees’ experiences at work. 

    The study showed that leaders who rate themselves high on Empathic Concern report 63% lower burnout, 66% lower stress, and a staggering 200% lower intent to quit their organisation compared to leaders who rated themselves in the Empathy only group. They felt more confident in their ability to lead others and were less likely to experience personal distress or be overwhelmed by negative emotions.

    More specifically, the data shows that leaders with a less proactive Empathy preference have a 12% increased risk of burnout on average compared to their more proactive Empathic Concern counterparts.

    To put this into perspective, a 12% increase in risk for burnout translates directly into an 11% increase in mortality risk for leaders.

    The picture is similarly positive for employees being led by Proactive leaders. They are 25% more engaged in their jobs and 20% more committed to the organisation. Not surprisingly, they too have an 11% lower risk of burnout.

    Acceptance and proaction

    As mindfulness teachers, we often are teaching our clients to sit with difficult emotions. To name them, look them in the eye and accept them, versus avoidance which is often our normal reactive response.

    That doesn’t mean we can’t also take steps to alleviate the difficulties.

    Pain is inevitable. Suffering is optional. Although life’s difficulties are often beyond our control, suffering is to a large extent determined by how we react to these difficulties. Our reaction can be under our control. Such is the power of the mind.

    We can spend an hour sitting on the cushion deciding our emotional reaction to a given stimulus.

    We can also spend time being proactive about tackling difficult situations. It’s not contrary to the teaching of mindfulness teachers. It’s a true human reaction.

    When leaders and team members go the extra mile for others, the team becomes visibly and tangibly stronger and more intact.

    Empathy is when we see someone suffer, understand the suffering they experience, and sit together with them. This is a good, altruistic response. But Empathic Concern is different.

    Empathic Concern is to take a step back from empathy and ask ourselves what we can do to proactively support the person who is suffering while empathizing with them at the same time.

    So how do I do It?

    Wouldn’t it be great if our members were able to take care of their mental well-being? If only we could hand that responsibility onto them, with our support, of course, it would free up so much time for us as leaders? That would be Proactive Empathic Concern.

    As Psychotherapeutic counselors, we know that if a client designs their well-being program and meditation techniques, it is so much more valid than if it were all guided and determined by us the therapists.

    Being aware of the impact of the pandemic on each member of the team is a start. It’s surprisingly difficult and time consuming to do this.

    What’s not helpful

    1. Putting a poster on the toilet door with various phone numbers to phone if you’re in crisis is very common. It’s rarely helpful although it does tick a box on the list of health and safety requirements as an employer. It’s done with good intentions.

    The reality is that, once your employee is in crisis, they don’t have the will or the energy to make these phone calls. And even if they did, the waiting lists are months long.

    • You can plaster helpline adverts and posters the length of the most populated corridor in the practice. I know, because I have counselled hundreds of vets and nurses, that more needs to be done.
    • Webinars on how to look after your mental health is superb. If your staff logged on. But they don’t. I asked many of my patients why they don’t log on. It’s because the last thing they want to do after work is to log back on to work.

    What is helpful

    1. True Empathic Concern combined with proactive leadership means that the leader will organize seminars for the staff which they attend in real-time during work hours. The consultations are blanked out for the day, the venue is close to work, the phones are turned off, and lunch is provided.
    2. The seminar is not about how to make a consultation into a profitable procedure this time. It’s teaching your staff how to take care of their mental wellbeing so that they don’t need the phone numbers on the back of the toilet door.

    It’s about training them in techniques and giving them the tools to deal with crises and pandemics and life’s ups and downs.

    Happiness comes through our deeper humanistic experiences like doing purposeful work, caring for others, being generous, and making authentic connections. Isn’t this the description of being a vet?

     It’s the long-term state of experiencing a meaningful, purposeful, and positive life. This describes our job perfectly.

    Empathic Concern from leaders positively impacts organisational commitment, job performance, engagement, and decreases the incidence of burnout.

    When leaders approach difficult situations with Empathic Concern, they help to encourage genuine human interactions, lifting not just the business, but our inter-staff relationships and our people, too.

    Adapted from: Compassionate Leadership: How to do Hard Things in Human Way by Rasmus Hougaard and Jacqueline Carter. Published by Harvard Business Review Press, January 18, 2022

  3. Ukraine War and How It Affects Us

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    Just as we were getting over Covid…………………… Putin messes it all up.

    Most of us were affected emotionally at least on some level by the pandemic.

    So much has been written about the mental health impact of it, including here.

    And then, just as the world could look up, de-mask and breathe a sigh of relief filled with common humanity and the potential of connecting with our fellow humans around the globe in collective recovery………………….Putin ordered his troops into Ukraine.

    We don’t know what the orders were. Some say the Russian soldiers were told they were just in training exercises. In any case, there is now a new and horrible collective grief and horror at the suffering, death, and destruction caused by the war in Ukraine.

    Some of us thrived despite the Coronavirus Pandemic. Through huge efforts and work on our mental wellbeing, we quickly learned to accept that it was a reality. Acceptance, as I have written about here before, is a key part of having emotions while not suffering because of those emotions.

    So we learnt acceptance.

    Accepting our emotions and allowing them to just sit there within us instead of pushing them away or shoving them into our box of ‘never to be revisited feelings’ , is way more effective than resisting them.

    You know when you try not to feel something like anxiety or sadness, it just comes back bigger and stronger to get you.

    Even if you assume zombie, emotion-less mode through alcohol or drugs or even just through binge-watching Netflix, once the numbness wears off, it still hurts, and sometimes it hurts even more because we haven’t accepted any of the pain.

    This war is different on so many levels albeit it is still another global crisis.

    For one thing, this time there is a perpetrator.

    So while our minds have to deal with familiar emotions like anxiety, fear, and despair. We now have anger to add to the mix. Helplessness, hopelessness, and guilt are in there too.

    The Three circles of control

    There is a prayer called the Serenity Prayer which is by far one of the most famous prayers that were written in the 1800s by Reinhold Niebuhr (1892-1971).

    Its popularity grew even more in the 1940s when Alcoholics Anonymous took up using a shortened version for its recovery program.

    The Serenity Prayer

    God grant me the serenity

    To accept the things I cannot change;

    Courage to change the things I can;

    And wisdom to know the difference.

    Living one day at a time;

    Enjoying one moment at a time;

    In Counselling Psychology, there is a concept called circles of control, that helps us to understand and reflect on how close things that affect us are to our influence.

      The idea here is that some things – many things happen that are entirely beyond your influence, so your energy is better focused on things that you can influence. 

     In the central circle are things that we can control. Although it may take effort and instruction, we can make changes here for the better. This includes the most important thing of all: our mind.

    With good instruction, we can change our minds. Mindfulness can rapidly move our chaotic way of thinking and reflexive way of behaving into an easy and methodical way of thinking and a way of behaving which is reflective rather the reflexive. I.e. we decide our reactions to things.

    “Between every action and our reaction, there is a space. In that space lies our freedom to choose”.

    – Viktor Frankl

     The middle ring contains things over which we have a small amount of control. This will include many things: our friends, family, jobs, habits, and daily life. Through compassion, self-compassion, kindness, and purposeful actions, we can have an enormously beneficial effect on the people around us. Sometimes just giving off good vibes can be palpably calming for those around us. Other times, a change in our daily habits can turn our profound sadness into joy. I say this from the experience of experiencing horrific tragedy and soon afterward feeling blissful about tiny things surrounding me.

    The outer ring is made up of things we cannot control. 

    Vladimir Putin is going to pursue his military agenda whatever you or I think, do or say, so this sits in our outer circles, beyond any kind of control we might have.  

    So, how can we just accept it?

    We see the Ukrainian people resist and fight back with unfathomable resilience and bravery.

    The public awareness thanks to Zelensky keeping Ukraine in the forefront of the minds of everyone around the globe is phenomenal.

    We’re angry and want to se Putin accountable.

    Acceptance is not about sitting here like a blancmange doing nothing and saying “Que sera, sera”.

    It’s not about being complacent and ineffectual.

    Acceptance is about feeling that anger and maybe pure unadulterated hatred for the perpetrators of human tragedy, and accepting that we feel that way.

    So we can have all that anger within us, for obvious reasons, and still, be kind to those in our inner circle (ourselves) and our middle circle.

    We can donate cash with gift aid, we can drive a truckload of blankets to Poland, all the time allowing ourselves to feel anger, grief, and the excitement that comes with being proactive all at the same time.

    By accepting our plethora of emotions one by one, maybe we will be more effective and courageous in the long run in changing the things we can and being wise to the things we can’t.