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					Being a Healer

                         Michael Kearney MD,
      Awakening the Imagination of Medicine,
    Saint Francis Hospital and Medical Center,
                   Monday, October, 26, 2009
Hippocratic      Asklepian

Clinician        Clinician helps
intervenes       to create
and does         circumstances
something to     which awaken
make the         the patient’s
patient better   innate power to
                 heal




                 Asklepios, Robert Pope
        Integrated Healthcare

Hippocratic                  Asklepian-Hy

         The therapeutic relationship

Intervene                    Awaken innate
therapeutically              healing potential

                  Who we are
   “We are the medicine”
                              Michael Balint
“The Doctor, his Patient and the Illness,” 1957
Chiron




         “The Wounded Healer”
The Dynamics of the Wounded Healer


Power and the helping professions
               Adolf Guggenbühl-Craig
              Spring Publications, 1971
                           “The new kind of hero lays down
                           his sword and allows nature to
                           happen to him.”


                           “The best way to experience
                           grace is to willingly surrender to
                           gravity.”



                           “Our mortality is an exquisite
                           way of experiencing our
                           immortality.”



John Moriarty, 1938-2007
Accepting This
… Ultimately,
we are small living things
awakened in the stream,
not gods who carve out rivers.
Like human fish,
we are asked to experience
meaning in the life that
moves through the gill of our heart.
There is nothing to do
and nowhere to go.
Accepting this,
we can do everything
and go anywhere.
                            Mark Nepo
“[Clinicians] have a choice ...


They can all be wounded-healers or petty tyrants. The
[clinician] can only work creatively if he bears in mind that,
despite all his knowledge and technique, in the final analysis
he must always strive to constellate the healing factor in the
patient. Without this he can accomplish nothing.

                                      Adolf Guggenbühl-Craig
The Rainmaker of Kiau Tchou
―[Clinician] heal thyself‖ would appear to be the axiom. For it’s an
Alice through the looking glass affair. When one sees a door
reflected in a mirror, to reach the actual door, one must first move
away from the mirror.
When you want to help a person towards healing you must, in some
way, retreat into yourself to the level from which the healing flows.


                                                  Sri Madhava Ashish
Self-care




            JAMA, March 18, 2009: 301(11); 1155-1164.
Clinician stress – 2 Syndromes
 Clinician stress – 2 Syndromes

• Burnout
• Compassion Fatigue
                 Burnout

Burnout results from stresses that arise from
the clinician’s interaction with the work
environment
                 Burnout

Burnout results from stresses that arise from
the clinician’s interaction with the work
environment

“The stuff that burns me out has nothing to do
with loss … it’s fighting insurance companies”
                                          Dr C
           Compassion Fatigue

―The cost of caring‖ for others in pain: AKA
―secondary traumatic stress.‖ Individual
suffers trauma symptoms resulting from
vicarious experiences of another’s suffering.
                 Empathy as Liability

• Empathic engagement in the trauma therapy
  relationship is a key causal factor and a liability in
  conceptualizations and definitions of compassion
  fatigue
                 Empathy as Liability

• Empathic engagement in the trauma therapy
  relationship is a key causal factor and a liability in
  conceptualizations and definitions of compassion
  fatigue

  “The [clinician’s] empathy level with the traumatized
  individual plays a significant role in this transmission”
                                                Figley, 1995
Is it possible to revision empathic engagement?
Is it possible to revision empathic engagement?



Preventing Vicarious Traumatization of Mental Health
    Therapists: Identifying Protective Processes

                        R.L. Harrison, and M.J. Westwood
       Psychotherapy: Theory, Research, Practice, Training.
                                       9(2); 203-219: 2009
Abstract:


    A qualitative study identified practices that mitigate risks of
    Vicarious Traumatization (VT) among mental health
    therapists. Peer nominated, exemplary trauma therapists who
    appeared to be thriving in their work.
Abstract:


    Participants responded to the question:
    “How do you manage to sustain your personal and
    professional well-being, given the challenges of your work
    with seriously traumatized clients?”
Abstract:


    Findings included 9 major themes salient across participants’
    narratives of protective practices…

    One of these was the practice of ―exquisite empathy‖.
Exquisite Empathy


  “Exquisite empathy is highly present, sensitively attuned, well-
  boundaried, heartfelt empathy for another who is suffering …
Exquisite Empathy


  “Exquisite empathy is highly present, sensitively attuned, well-
  boundaried, heartfelt empathy for another who is suffering …

  Therapists who engaged in exquisite empathy were invigorated
  rather than depleted by their intimate professional connections
  with traumatized clients.
Exquisite Empathy


  “Exquisite empathy is highly present, sensitively attuned, well-
  boundaried, heartfelt empathy for another who is suffering …

  Therapists who engaged in exquisite empathy were invigorated
  rather than depleted by their intimate professional connections
  with traumatized clients.

  The practice of exquisite empathy is facilitated by clinician self-
  awareness …”

                                      Harrison and Westwood, 2009
“I actually can find sustenance and nourishment in the
work itself, by being as present and connected with
the client as possible. I move in as opposed to move
away, and I feel that is a way I protect myself against
secondary traumatization. The connection is the part
that helps and that is an antidote to the horror of what I
might be hearing.”
Abstract:


    The novel finding that empathic engagement with traumatized
    clients appeared to be protective, challenges previous
    conceptualizations of Vicarious Traumatization.
What is “clinician self-awareness” and
      how can it be developed?
                Self-Awareness


Is taken here to mean self-knowledge and self-
empathy, and the development of dual-awareness
and contemplative awareness
   Self-Knowledge


“Clinician know thyself …”
                  Self-empathy


Self-empathy involves an awareness that you are
suffering and a genuine care and kindness for yourself
to end that suffering. This connection and care for
oneself is related to an understanding and care for
others. Self-empathy opens the way to interpersonal
empathy.

                                        Shapiro, 2005
                 Dual-Awareness


A cognitive stance that permits the clinician to
simultaneously attend to and monitor the needs of the
patient and/or the work environment and his or her
own subjective experience.
             Contemplative-Awareness


Awareness of how we as individuals are situated in a
bigger field of relationships; on ―deeper ground‖.
Martin Buber’s concept of ―I-Thou‖ speaks to a
spiritual underpinning of relating in a heartfelt way that
is rooted in contemplative awareness.
Clinician self-awareness - 2 Steps:


1. Raise self-awareness as on-going practice (self-
   knowledge, self-empathy, dual-awareness and
   contemplative awareness)

2. Practice these self-awareness skills in the clinical
   setting as ―exquisite empathy‖
Some practices for developing clinician self-awareness


•   Mindfulness meditation
•   Reflective writing
•   Supervision/Mentoring
•   Peer Group Support
•   Educational initiatives
•   Research initiatives
•   Psychotherapy
•   Spiritual direction
Some benefits of self-awareness based self-care


For the organization
• Increased staff retention/reduced absenteeism
• Increased employee morale/job satisfaction
• Reduced employee conflicts
• Employees who are present, empathic, effective
• Increased patient and family satisfaction
Some benefits of self-awareness based self-care


For the clinician
• Ability to remain present to another’s suffering
• Ability to recognize counter-transference (i.e. one’s
  own subjective response to patient/patient’s story)
• Ability to recognize when one is ―at one’s limits‖
• Ability to recognize when work is adversely affecting
  one’s health, and personal and professional
  relationships
• Ability to know what one needs to do to regenerate
  oneself
Some benefits of self-awareness based self-care


For the patient?
Some benefits of self-awareness based self-care


For the patient
• Clinicians who are present, empathic, and effective –
  wounded healers
The Peace of Wild Things

When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children's lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.

                                                — Wendell Berry

				
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