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INTRODUCTION TO MINDFULNESS
Palliative Care Quality Network
Denise Hess, MDiv, BCC, MFTI
Providence Little Company of Mary Medical Center –Torrance
February 13, 2014
Listen to the following statements about your everyday experience. Using the scale below, please indicate how frequently or infrequently you currently have each experience. Please answer according to what really reflects your experience rather than what you think your experience should be. Please treat each item separately from every other item.
1: Almost always
2: Very frequently
3: Somewhat frequently
4: Somewhat infrequently
5: Very Infrequently
6: Almost never
SELF ASSESSMENT
• Habits
• Routines
• Automaticity
• Multi-tasking
• Depersonalization
• Judgment
“Compared to what we ought to be,
we are only half awake.”
William James
Mindlessness
• Attentiveness
• Genuine interest
• Curiosity
• Compassion
• Presence
“Simultaneous engrossment in a task or person
as well as a recognition of one’s own perspective.”
(Epstein, 2003)
Mindfulness
Context
Other Self
Mindfulness
Attention to and awareness of what is occurring
in the present moment in:
with a stance of open, non-judgmental curiosity
0 0 1 1 3 5 0 0 2 1 5 2 8 10 7 11 7 11 13 18 21 28 44 52
76 77
122
167
228
290
353
397
477
0
50
100
150
200
250
300
350
400
450
500
550
19
80
81
82
83
84
85
86
87
88
89
19
90
91
92
93
94
95
96
97
98
99
20
00
01
02
03
04
05
06
07
08
09
20
10
11
12
Nu
mb
er
of
Pu
blic
atio
ns
Year
Mindfulness publications by year, 1980 - 2012
Source: DS Black (2013). Mindfulness Research Guide. www.mindfulexperience.org
Research
• Anxiety, depression, stress, burnout (e.g., Cohen-Katz, Wiley, et al ., 2005; Ma & Teasdale, 2004; Teasdale, Segal, Williams, et al., 2000)
• Chronic pain (Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney, 1985)
• Substance abuse (Bowen, Witkiewitz, Dillworth, et al., 2006)
• Arthritis(Pradhan et al., 2007)
• Diabetes(Gregg, Callaghan, et al., 2007)
• Fibromyalgia(Sephton et al., 2007;Grossman, et al., 2007)
• Psoriasis (Kabat-Zinn et al., 1998)
Outcomes
VICARIOUS TRAUMA: similar emotional, physical and cognitive symptoms to that of traumatized patients
“Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a
career for their children.”
www.physiciansfoundation.org
Burnout, CF, & STS
A Hardening of Heart?
Newton, et al. Academic Medicine, Vol. 83/3, March 2008
PREVENTING VICARIOUS TRAUMATIZATION OF MENTALHEALTH THERAPISTS: IDENTIFYING PROTECTIVE PRACTICES
RICHARD L. HARRISON AND MARVIN J. WESTWOOD
University of British Columbia
This qualitative study identified protectivepractices that mitigate risks of vicarioustraumatization (VT) among mental healththerapists. The sample included six peer-nominated master therapists, who re-sponded to the question, “How do youmanage to sustain your personal andprofessional well-being, given the chal-lenges of your work with seriously trau-matized clients?” Data analysis wasbased upon Lieblich, Tuval-Mashiach,and Zilber’s (1998) typology of narrativeanalysis. Findings included nine majorthemes salient across clinicians’ narra-tives of protective practices: counteringisolation (in professional, personal andspiritual realms); developing mindful self-awareness; consciously expanding per-spective to embrace complexity; activeoptimism; holistic self-care; maintainingclear boundaries; exquisite empathy; pro-fessional satisfaction; and creating mean-ing. Findings confirm and extend previ-ous recommendations for amelioratingVT and underscore the ethical responsi-
bility shared by employers, educators,professional bodies, and individual prac-titioners to address this serious problem.The novel finding that empathic engage-ment with traumatized clients appeared tobe protective challenges previous concep-tualizations of VT and points to excitingnew directions for research, theory, train-ing, and practice.
Keywords: vicarious trauma, preven-tion, compassion fatigue, countertrans-ference, empathy
The risks of working directly with traumatizedindividuals on a regular basis are well docu-mented (Arvay, 2001; Buchanan, Anderson,Uhlemann, & Horwitz, 2006; Figley, 2002; Pearl-man & Mac Ian, 1995). McCann and Pearlman(1990) first identified the problem of vicarioustraumatization (VT), which they defined as thecumulative transformative effects upon therapistsresulting from empathic engagement with trau-matized clients. As part of their work, these cli-nicians must listen to graphically detailed de-scriptions of horrific events and bear witness tothe psychological (and sometimes physical) af-termath of acts of intense cruelty and/or violence.The cumulative experience of this kind of em-pathic engagement can have deleterious effectsupon clinicians, who may experience physical,emotional, and cognitive symptoms similar tothose of their traumatized clients (Pearlman &Saakvitne, 1995a, 1995b; Sexton, 1999). How-ever, there is consensus in the field that there isnot enough empirical literature on the definitivefactors that contribute to VT, nor the practicesthat may prevent or ameliorate its harmful effects(Arvay, 2001; Figley, 2004; Pearlman, 2004).
Although research and theory have begun toemerge about VT vulnerability and treatment(Figley, 1995, 2002; Saskvitne & Pearlman,
Richard L. Harrison and Marvin J. Westwood, Department
of Educational and Counseling Psychology, and Special Ed-
ucation, University of British Columbia.
This article was based on the doctoral dissertation research by
the principal author, which was generously funded by the Social
Sciences and Humanities Research Council of Canada and the
Michael Smith Foundation for Health Research in partnership
with WorkSafe BC (Worker’s Compensation Board of British
Columbia). The primary author wishes to thank his dissertation
committee (Drs. Marvin Westwood, Marla Buchanan, and Wil-
liam Borgen) for their insight, rigor, and warmhearted support.
Correspondence regarding this article should be addressed to
Richard L. Harrison, Vancouver Couple and Family Institute,
Suite 270, 828 W. 8th Ave, Vancouver, BC, Canada, V5Z 1E2.
E-mail: [email protected]
Psychotherapy Theory, Research, Practice, Training © 2009 American Psychological Association2009, Vol. 46, No. 2, 203–219 0033-3204/09/$12.00 DOI: 10.1037/a0016081
203
Preventing Vicarious Trauma
How do you manage to sustain your personal and professional well-being, given the challenges of your
work with seriously traumatized clients?
Peer nominated master clinicians:
• Countering isolation
• Holistic self-care
• Clear boundaries
• Embracing complexity
• Creating meaning
• Mindfulness
• Exquisite empathy
Themes
Wherever you are,
be all there…
Jim Elliot
When clinicians maintain clarity about interpersonal boundaries, when they are able to get very close without fusing or confusing the client’s story with their own, this exquisite kind of empathic attunement is nourishing for therapist and client alike.
Connection is protection
Circles of suffering
http://www.fammed.wisc.edu/mindfulness/pip/pause
Circles of suffering
Circles of suffering
The Mindful Clinician
Upbeat Relational Focused Efficient Satisfaction
The Mindful Clinician
Depression Anxiety Burnout Persisted one year later AND
• Attention- expected/unexpected, central/peripheral, biases & filters
• Curiosity- seeing what is as it is, allowing doubt, awareness of one’s own humanity
• Beginner’s mind- cultivated naïveté, holding contradictions, non-habitual thinking
• Presence- undistracted connection to self, other, context
Essential Components
– Non-religious
– Focused attention on breath
– Not mantra
– Not emptying your mind
– Not relaxation
– Notice what is:
• thoughts
• emotions
• sensations
Formal Practice: meditation
• Informal: mindful awareness in daily activities
– Eating
– Listening to music
– Reading
– Journaling
– Driving
– Walking
– Connecting
– Uni-tasking
Informal Practice
Practice, practice, practice
http://www.fammed.wisc.edu/mindfulness
The pause is an active, nimble, often intense state, as when an Olympic diver pauses at the end of the diving board until that precise hundredth of a second when
every muscle is tensed in harmony.
And at that instant he dives.
Rollo May, Freedom and Destiny
Pause
Presence
Be Still by Lao Tzu
Do you have the patience to wait till your mud settles and the water is clear?
Can you remain unmoving
till the right action arises by itself?
The master doesn't seek fulfillment,
but not seeking, not expecting, is present,
and can welcome all things.
Presence
Proceed
The rush and pressure of modern life are a form of violence. To allow oneself to be carried away by a multitude of
conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything, is to succumb to violence. The
frenzy neutralizes our work for peace. It destroys our own inner capacity for peace because it kills the root of inner
wisdom which makes work fruitful.
Thomas Merton
Open minded presence in the context of medical expertise is the skeleton key that opens many locks.
(Hutchinson, 6)
The Mindful Clinician
Whole Person (Clinician) Care
Flourishing
Compassion Satisfaction
Post-Traumatic Growth
Burnout
Compassion Fatigue
Post-Traumatic Stress
• Free:
– iTunes U “Mindful Meditations” by UCLA
– Smiling Mind http://smilingmind.com.au/
– University of Wisconsin: http://www.fammed.wisc.edu/mindfulness
• Books:
Resources