Coping with Families/Keeping YourSense of Balance
Alex Chamberlain, M.Div., BCC Revised by Kelly Loy, M.Div., BCCSt. Luke’s 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, & MD’s Ours: clinical situation, staffing issues, time
constraints, moral distress, conflicts between disciplines
Theirs: Absence from work, presence of invasive technology, patient’s diagnosis, prognosis, pain, and unresponsiveness
So?? Timing can differ. We respond professionally to the family’s crisis, even if we see it differently or are experiencing our own stress.
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.
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.
Intact Families, Cont.
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:
ChaoticControlling
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.
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.
What doesn’t work: Reacting rather than responding Defending yourself, coworkers, St. Luke’s Yelling, stomping your foot! Questioning your calling to healthcare Wishing they would behave differently Complaining to those who can’t help Accepting, Accommodating, Avoiding
What works…sometimes: 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?
What works…Sometimes, Cont. Learn to respond rather than react. Notice: My reaction vs. others Attempt to reorient everyone’s energy toward
what is best for the patient. Count to ten…literally. Go to a break room and
“chill.” Temporarily getting some distance physically for self-care is not the same as avoiding someone or something.
Don’t try to change them: you are not their therapist!
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, “Let’s try to narrow it down to one or two key things and work on a solution together.”
What you might say…Cont.
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 YourselfHow are you thinking about your
professional role? Meaningful and Rewarding?
Difficult and Painful?
Right!
Stress / Compassion Fatigue / Burnout
Stress: “I don’t have the energy to do my job.”
Compassion Fatigue“It hurts too much to do my job.”
Burnout: “I don’t want to do my job.”
Compassion
A feeling of deep sympathy.
Com = with Passion = suffer Often accompanied by a strong desire
to alleviate another’s 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” “I’ll never be the same”
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
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 overwhelming
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 one’s humanity The use of humor Affirmations
Be attentive to yourself:
There is a difference between: Prevention (Resilience)
andKnowing when to get help after the fact
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
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