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

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

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

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

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

Hospitalization often evokes a crisis for family,
staff, MDs
  • Ours clinical situation, staffing issues, time
    constraints, moral distress, conflicts between
  • 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

Generally, we meet two kinds of families
  • Intact Families
  • Crazy-Making Families

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.

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
  • Chaotic
  • Controlling

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
  • 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
  • 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

What workssometimes
  • Assessing Difficult person or Difficult
  • 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?

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

What you might say
  • Ask open ended questions using I and We
    language. Avoid using You should or You need
  • 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.

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?

Enlist help from other disciplines
  • Social work
  • Chaplain
  • Case Manager
  • Ethics Committee
  • Security
  • Patient Relations

When do you need help? Know Yourself
  • How are you thinking about your professional
  • Meaningful and Rewarding?
  • Difficult and Painful?
  • Right!

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.

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

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

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

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

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

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

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

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

  • 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
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