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