Coping with Families/Keeping Your Sense of Balance Alex Chamberlain, M.Div., BCC Revised by Kelly Loy, M.Div., BCC St. Luke

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Coping with Families/Keeping YourSense of
BalanceAlex Chamberlain, M.Div., BCC Revised
by Kelly Loy, M.Div., BCCSt. Lukes Regional
Medical Center
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• As Victor Frankl writes,
• That which is to give light
• Must endure burning.

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Stress test
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• Reality
• is the leading cause
• of stress among those
• in touch with it.
• And families can push
• Our buttons like nothing else!

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Families include

• Birth parents
• Adoptive parents
• Siblings
• Stepfamily
• Significant Others / Spouses
• Ex spouse / Family
• Cousins, aunts, uncles
• Grandparents

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Hospitalization often evokes a crisis for family,
staff, MDs

• Ours clinical situation, staffing issues, time
  constraints, moral distress, conflicts between
  disciplines
• Theirs Absence from work, presence of invasive
  technology, patients diagnosis, prognosis, pain,
  and unresponsiveness
• So?? Timing can differ. We respond
  professionally to the familys crisis, even if we
  see it differently or are experiencing our own
  stress.

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Generally, we meet two kinds of families

• Intact Families
• Crazy-Making Families

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Intact Families

• Normally manage life well. Can handle finances,
  life transitions, employment, etc.
• Hospitalization of a loved one creates stress
  usual coping skills are stretched. Life gets out
  of alignment, where the usual sense of balance is
  temporarily lost.
• Anger, fear, unreasonable expectations (of self,
  family, patient, modern medicine), tears,
  withdrawal, and tensions among family members all
  occur to varying degrees.

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Intact Families, Cont.

• We can empathize with them, because we are them
  at times.
• They can partner with us to benefit the patient,
  expressing gratitude appropriately and validating
  our calling to health care.
• The Intact Family enters our world.

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Crazy-Making Families

• The Crazy-Making family brings us into their
  world - and we can inadvertently be sucked into
  their dynamics, dysfunction, and disarray
• Crazy-Making families broadly fall into two
  types
• Chaotic
• Controlling

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Chaotic Families

• May have less education, finances, family
  cohesiveness, or communication skills.
• Carry problems/dysfunction in ways that run from
  minor to major, and acute (recent struggles) to
  chronic (passed down from generation to
  generation.)
• Crisis is normal may not appear as distressed
  as the intact family. They are often
  self-absorbed and ask few questions.
• Can lead us to bond with the patient over/against
  family, as protector.

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Controlling Families

• May be professionals in their own field,
  financially secure, and are used to controlling
  their own destinies.
• Want to call the shots rather than roll with the
  punches.
• Can name a good lawyer, who happens to be a
  family friend. They not only ask questions, they
  question the meds, dosages, tests, cleanliness of
  the room, size of the room, etc.

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What doesnt work

• Reacting rather than responding
• Defending yourself, coworkers, St. Lukes
• Yelling, stomping your foot!
• Questioning your calling to healthcare
• Wishing they would behave differently
• Complaining to those who cant help
• Accepting, Accommodating, Avoiding

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What workssometimes

• Assessing Difficult person or Difficult
  situation?
• Is their behavior today out of character?
• Was there a particular incident that triggered
  their behavior?
• Will direct, open conversation help the situation
  or exacerbate it?
• Is there someone in the family who is coping well
  who can be the point person to whom we relate?

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What worksSometimes, Cont.

• Learn to respond rather than react.
• Notice My reaction vs. others
• Attempt to reorient everyones energy toward what
  is best for the patient.
• Count to tenliterally. Go to a break room and
  chill. Temporarily getting some distance
  physically for self-care is not the same as
  avoiding someone or something.
• Dont try to change them you are not their
  therapist!

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What you might say

• Ask open ended questions using I and We
  language. Avoid using You should or You need
  to
• Ask, I wonder what would help us get a fresh
  start? (Even if they list complaints, they are
  still providing information.)
• Say, Lets try to narrow it down to one or two
  key things and work on a solution together.

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What you might sayCont.

• Ask, I need some help understanding what your
  greatest concern is today.
• Or, As family, what do you need?
• Remember Timing is everything!
• Ask, When would be a good time for you so we can
  review how things are going?

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Enlist help from other disciplines

• Social work
• Chaplain
• Case Manager
• Ethics Committee
• Security
• Patient Relations

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When do you need help? Know Yourself

• How are you thinking about your professional
  role?
• Meaningful and Rewarding?
• Difficult and Painful?
• Right!

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Stress / Compassion Fatigue / Burnout

• Stress
• I dont have the energy to do my job.
• Compassion Fatigue
• It hurts too much to do my job.
• Burnout
• I dont want to do my job.

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Compassion

• A feeling of deep sympathy.
• Com with Passion suffer
• Often accompanied by a strong desire
• to alleviate anothers pain or remove its cause

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Compassion Vs. Over-Identification

• It moved me
• That family touched me
• I took them home with me (inwardly!)
• Vs.
• That blindsided me
• I felt overwhelmed
• Ill never be the same

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Compassion Fatigue

• State of tension and preoccupation with
  individual or cumulative trauma of
  patients/clients.
• Re-experiencing traumatic events
• Avoidance/numbing of reminders
• Figley, 1982

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Compassion Fatigue Indicators

• Insomnia
• Dizziness
• Aches and Pains
• Impaired Immune system
• Lowered concentration
• Decreased self esteem
• Apathy
• Anger/Rage
• Fear
• Sadness

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How are you coping?

• Chronically using alcohol, drugs, food, or other
  substances for comfort or avoidance
• Blaming, complaining, whining
• Looking for a new job, new car, new spouse when
  your situation is likely to be temporarily
  overwhelming

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Daily Coping Skills Practice!

• Boundaries
• Learn how to waste time
• Learn how to transition between work and home
  be intentional
• Make Connections Peers, Family, Friends

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Cultivating Resiliency

• Make connections
• Tolerate change
• Face fears
• Cognitive flexibility (be willing to reframe)
• Be realistic
• Accept ones humanity
• The use of humor
• Affirmations

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Be attentive to yourself

• There is a difference between Prevention
  (Resilience) and Knowing when to get help
  after the fact

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When to get help

• Others can provide reality check
• What is your canary in the coalmine?
• Have you lost the ability to play?
• When the symptoms of stress, compassion fatigue,
  or burnout are unrelenting
• When you wonder if you need help

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Remember

• To share often and much
• to know even one life
• has breathed easier
• because you have lived.
• This is to have succeeded.
• - Ralph Waldo Emerson