IRRCF: Managing for Increased Resilience and Reduced Compassion Fatigue Trish Thacker, MSW, LICSW Program Director Salvation Army Harbor Light Center,

IRRCF:Managing for Increased Resilience and Reduced Compassion Fatigue

IRRCF:Managing for Increased Resilience and Reduced Compassion Fatigue

Trish Thacker, MSW, LICSW Program Director

Salvation Army Harbor Light Center, Minneapolis

Salvation Army TSSC4/28/2015

Trish Thacker, MSW, LICSW Program Director

Salvation Army Harbor Light Center, Minneapolis

Salvation Army TSSC4/28/2015

IRRCF: Copyright: Trish Thacker MSW, LICSWFor more information or to schedule a training please contact: Trish Thacker [email protected]

Introductions• Trish Thacker, MSW, LICSW• Program Director, Salvation Army Harbor Light Center• Clinician for 17 years• Advanced training in: IPNB, trauma, EMDR, forensics,

narrative therapy, addictions, staff development, project management, program management, leadership development

• Interest in combining therapeutic understanding with staff development and support crystalized during work at the Harbor Light

• Who’ s here today?• What are you hoping to get out of today’s session?

Outline for today

• Interpersonal Neurobiology Primer• Trauma Informed Care• IRRCF• Begin Individualized Plans for

participants

Expectations for today

I encourage you to:1) Ask questionswrite down questions or raise hand

and ask…will also have q & a before break and before session ending

2) Take care of yourself…stand etc if needed

3) Drink water

Complexity DisclaimerThis is a simplified presentation,

whittled down to principles and core concepts.

What is presented today provides a basic structure.

A blueprint. A framework of understanding.

This presentation illuminates a process and is merely

a place to begin …

Hand Model of the Brain

Interpersonal Neurobiology Primer

DEFINITIONS

• Interpersonal: of or relating to relationships or communication

between people• Neurobiology: the anatomy and physiology of

the nervous system• The Nervous System: The system in the body

that controls internal functions of the body and

receives, interprets, and responds to stimuli


CONCEPTS• The Mind:

• the emergent, self-organizing process that shapes and directs how energy and information flow across time

• shaped by the interaction of experience and gene expression

• Represents a complex system• Characteristics of a healthy, complex system:• F - flexible• A - adaptive• C - coherent• E - energized• S - stable• Therefore, an individual with “good” mental health will

generally exhibit these characteristics


CONCEPTS• Mirror Neuron system:

• fires both when a person acts and when the person observes the same action performed by another

• Wiring which allows for attunement, empathy ,and connection

• Attunement:• to bring in to harmony; the feeling of being “at one” with

another human being• Shared emotional states• Powerfully influences others


CONCEPTS

• Attachment:• a deep and enduring emotional bond that connects

one person to another across time and space …”feeling felt”

• Defines and effects how we perceive people and the world

• Tends to be determined by the attachment style or strategy of the primary care giver• Every child grows up in a different family• Same parent can have different attachment

style with each child


CONCEPTS

• Types of Attachment:• Secure – earned secure• Insecure• anxious/ambivalent• dismissive/detached• disorganized/traumatic


CONCEPTS

Secure - earned secure attachment• Contingent communication • perceive cues• interpret accurately• respond appropriately• in a timely manner• most of the time

• Auxiliary containment – foundation for later integration

• When injury occurs, the repair is made


CONCEPTS

• Insecure – anxious/ambivalent attachment• Parent with “unfinished business” – past intrudes into

present• Available inconsistently

• Insecure – dismissive/detached • Relationships as tasks and people as roles – few

memories, • Unavailable

• Insecure - traumatic/disorganized• Biological conundrum – drive toward and away• Parent is a source of fear or pain


CONCEPTS• How does this work?

Mirror neurons

Attunement with other

Attachment style

Integration and containmentIntermittent integration/containment

Rigid/unavailable integration/containmentFragmented/sparse integration and intrusion/no

containment

World is good and I’m okWorld is unpredictable and I’m nervousWorld is cold/unhelpful and I’m separateWorld is scary and I’m unprotected

Influences perception and interpretation

Developing mind


CONCEPTS• What does this mean?

• We are influenced by, and we influence, people and environments

• Our minds will filter/define experience and perception based on our history to date (this is not static)

• We will act/react/respond in accordance with our self-defined experience and perception

• Our interaction with people and environments will effect which genes are turned on and which are turned off (gene expression)

• Our life experiences influence genetic coding and the wiring in our brains and bodies (epigenetics)


SIDEBAR

• Emerging field of Epigenetics• refers to external modifications to DNA that turn

genes "on" or "off” without changing the DNA sequence

• Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state.• Ex: childhood abuse and/or neglect leave

markers in the hippocampus that remain in the next generation and increase risk for mental illness and suicide

Why do we need to know all of that??

Understanding who we are and how we operate

will allow us to be more effective asmanagers and practitioners

As leaders and people within a system, we are responsible for what we bring into each

day and each interaction

Quick break to:

thinkbreathestandetc

IPNB and TraumaWhat is trauma?

• Individual trauma results from an event, series of events, or set of circumstances that is experienced or witnessed by an individual as physically or emotionally harmful or threatening

• Trauma overwhelms/surpasses our current ability to cope

• Trauma can be singular and/or cumulative

• Traumatic reactions occur when action is of no avail

IPNB and TraumaWhat happens in the brain and body

when trauma occurs?

IPNB and TraumaWhat can we expect from traumatized people and people groups?

• Flipped lid - Brown-out/black-out state• Triggered reactions vs considered responses• Can be physically reactive• Can be dissociated “loop” of conversation

• Disorganized/chaotic behavior (doesn’t make “sense”)

• Elaborate back-story explanations• Learned helplessness

IPNB and TraumaWhat can we expect from traumatized people and people groups (continued)?

• Unaware - ness of other people, ideas, causal relationships

• False dichotomies – black and white thinking• Rapid shifts in emotional state• Difficulty making decisions• All manner of presentation of fight-flight-freeze

behaviors• The “sprint” mentality (vs marathon) which

increases long-term suffering • Exercising control in counterproductive ways

(tardiness, etc)

IPNB and TraumaWhy does trauma matter to us as managers/leaders?

• Remember what trauma is:• Individual trauma results from an event, series of events,

or set of circumstances that is experienced or witnessed by an individual as physically or emotionally harmful or threatening

• Our staffs are working with increasingly traumatized people

• Complexity and acuity of difficulties• National sense of trauma• They are continually exposed to the psychological states

of traumatized people (IPNB and mirror neuron systems)• They are continually witnesses to trauma

• When we listen to a survivor, we become a witness ~Elie Wiesel

IPNB, Trauma and Compassion Fatigue

Compassion Fatigue:

• Also called “vicarious traumatization” or secondary traumatization (Figley, 1995).

• The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

How do we support/develop our staff,

and get the work done, in light of this information?

Trauma Informed Care

Trauma Informed Care = HOW services are delivered

not the service itself• Realizes the widespread impact of trauma and understands

potential paths for recovery• Connection • Respect, fairness – policies and procedures that make sense• Paths of support and recovery must exist for staff as well • Vicarious trauma• Staff stress unintentionally passed back and forth with clients

• Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;

• Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and

• Seeks to actively resist re-traumatization


Effective trauma informed care functions like:

• The insulation around an electrical cord• Noise canceling head-phones• lifeguarding on a beach: o talk through o guide outo throw a flotation deviceo go out and get

• It contains and off-sets the negative effects of trauma

• It increases Resilience and Reduces Compassion Fatigue


Effective trauma informed care takes into consideration the “contagion” effect of emotional states…

therefore

…trauma informed care must include care for the other AND care for self


Care of Self

• Intentionally do those things that fill me up in order to stay well ex: gratitude practice, exercise, meditation, safe people, alone time, etc

• Intentional boundary management (ex: playground)

• Do my own work • Apart from “work”• Anything that is unresolved in me will get triggered

in this environment• If I don’t, I risk working out my own issues at the

expense of clients


Care of Other

• Above all, do no harm• It’s all about who you are in the room• Eye contact - attunement• Listen to the story • ask if they feel heard vs proving you’ve heard• It’s not about what’s wrong, it’s about what happened• It’s not about the event. It’s about the experience of the event

• Consistency• Fairness• Professional transparency• In creating conditions of safety, the roadblock is often myself• The process is the product

That’s all well and good. But, again, you ask….

How do we support/develop our staff,

and get the work done, in light of this information?

Using the principles of trauma informed care as a spring board, we’ll begin combining principles of leadership and personnel management

But first, please…

Stand upTake a deep breath in and outMove around a bit

Here we go…

IRRCF

IRRCF - Self CareSelf Care means:• Doing what you need to do to un-flip your lid

• self-attunement• alignment with self and values• knowing clearly WHO you are

• Getting your emotional and significance needs met outside of work• work is not family and it’s not therapy. Work is work

• Making reality your friend• what you hate defines you as much as what you love• when I get clear on reality my next steps become clear as

well• Integrity is the courage to meet the demands of reality

~Henry Cloud

• Finding a coach or mentor

• Being willing to interpret yourself to other...over and over again

IRRCF - Self Awareness

IRRCF starts with YOU! • Relationships are multiplicative, not additive. Be as

close to whole as you possibly can• The leader sets the tone • Lead from a stance of intra-personal alignment with

your values• Be willing to pay attention to the tension, both

internally and externally

By going first, the leader furnishes confidence to those who follow ~Andy Stanley

IRRCF - Self Assessment

Get Honest and Clear

• Use tools for self assessment (Myers-Briggs, Enneagram, Strengths Finder)

• Identify your strengths and work within them• Quarantine your weaknesses• Know and be alert to your own signs of overwhelm

or helplessness• Remain an open system…seek feedback

IRRCF – Use of SelfYou are your most important tool!

• Know who you are and demonstrate who you are• when people know who you are, they will know what kinds of

decisions you will make• increases clarity and ability to set boundaries

• As an agent of culture change, you may feel quite alone at times

• Maintain a “big picture view” to bolster resilience and consistency. Trust is eroded through inconsistent effort

• You will likely apologize over and over and over again in order to model personal responsibility

• You will likely experience the same learned helplessness that your staff experiences. Use it as information, not a reason to stop

IRRCF – Staff Development

Begin with data collection:

Look at list of behaviors and consider your staff…

Flipped lid * Triggered reactions vs considered responses * Disorganized/chaotic behavior * Elaborate back-story explanations * Learned helplessness * Unawareness of other people, ideas, causal relationships * False dichotomies * black and white thinking * Rapid shifts in emotional state * Difficulty making decisions * fight-flight-freeze behaviors * “sprint” mentality * control in counterproductive ways (tardiness, etc)

• Are any individuals exhibiting these behavior patterns?

• Are there ongoing patterns that appear generalized to your staff as whole?

SIDEBAR… Some notes about shame…• Often, people who have experienced trauma also

experience shame• Shame is experiencing my “badness” outside of safe

relationship• Shame says, “If something is bad, someone must be

bad”• Shame assigns blame. It does not resolve problems• Shame is resolved in safe relationships (opposite of

bad isn’t good, it’s loved)• Shame produces an inflammatory chemical called IL-

6, which is stored in the fascia and connective tissue. This chemical is released through mindful movement (yoga, tai chi) and massage



• Identify individual and groups dynamics, assessing strengths and challenges

• What does your staff do really well?• EX: Pull together under pressure, highly skilled

• What does your staff struggle with regularly?• EX: Punctuality, consistency, accuracy

• What don’t you understand about your staff, or what puzzles you?• Ex: Why would people call and not leave

messages?


• Provide common, non-offensive language for understanding self and other• Personality type indicators• Myers Briggs• Enneagram• D-I-S-C• Strengths Finder• Personality color

• Find ways for staff to do what they love and are good at (doesn’t need to be a position change)

IRRCF– Goal Development

In light of:

• Congregate staff strengths and challenges• Individual staff strengths and challenges• My strengths and challenges

AndThe work and goals of the organization or department

What are my next steps?

IRRCF – Work the Plan

Remember:

• Start with yourself• The people are the plan• Reality is good

Great works are performed not by strength, but by perseverance. ~Samuel Johnson

IRRCF - Ongoing

• Keep these processes in front of you until they become habituated.

• Measure progress against the five characteristics of a healthy complex system:

flexible adaptive coherent energized stable

References Ainsworth, Mary. Patterns of Attachment: A Psychological Study of the Strange Situation.

Psychology Press. London, England. 1979 Bloom, Sandra. Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of

Care. Oxford Press. 2013. Bowlby, John. Attachment: Second Edition. Basic Books. New York, NY. 1983. Bowlby, John. Separation: Anxiety and Anger. Basic Books. New York, NY. 1976. Bowlby, John. A Secure Base. Routledge. New York, NY. Re-issue 2005. Bretherton, Inge. The Origins of Attachment Theory: John Bowlby and Mary Ainsworth.

Developmental Psychology (1992), 28, 759-775. Clark, Carrie. Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care. Routledge

Publishing. 2014. Cloud, Henry. Changes That Heal. Zondervan Publishing. Grand Rapids, MI. 1992. Cozolino, Louis. The Neuroscience of Psychotherapy: Healing the Social Brain. W.W. Norton and

Company. New York, NY. 2010. Evans, Amanda. Trauma-Informed Care: How neuroscience influences practice. Routledge Publishing.

2014. Levine, Peter. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North

Atlantic Books. 2010 Levine, Peter. Waking the Tiger. North Atlantic Books. 1997.

References

Main, Mary. Intergenerational Transmission of Attachment. PBS Series. 1995.

Main, Mary and Hess, Erik. Disorganized Infant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies. Journal of the American Psychoanalytic Association, 48:1097-1127. 2000

Scaer, Robert. The Body Bears the Burden. Routledge Publishing. 2014.

Siegel, Daniel. Mindsight: The New Science of Personal Transformation. Random House, NY, NY. 2010.

Siegel, Daniel. Pocket Guide to Interpersonal Neurobiology. Norton Publishing. NY, NY. 2012

Siegel, Daniel. The Neurobiology of "We": How Relationships, the Mind, and the Brain Interact to Shape Who We Are (Sounds True Audio Learning Course). 2010.

Siegel, Daniel. The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. W.W. Norton and Company. New York, NY.2007.

References Siegel, Daniel. The Developing Mind: How Relationships and the Brain

Interact to Shape Who We Are. The Guilford Press. New York, NY. 2001. Siegel, Daniel. The Mindsight Institute Conference on the IPNB of Attachment.

UCLA. Los Angeles, CA. 2010 Siegel, Daniel. Toward and Interpersonal Neurobiology of the Developing

Mind: Attachment Relationships, Mindsight, and Neural Integration. Infant Mental Health Journal Vol 221 (1-2), 87-94. 2001.

Siegel, Daniel and Hartzell, Mary. Parenting From the Inside Out. Tarcher Press. Los Angeles, CA. 2004

Sutherland, Carol. Inner Relationship Focusing: Strengthening Attachment and Interpersonal Neurobiological Integration. Focus Training. Cape Cod, MA. 2005.

Thompson, Curt. Anatomy of the Soul: Surprising Connections between Neuroscience and Spiritual Practices That Can Transform Your Life and Relationships. SaltRiver Publishing. New York, NW. 2010

Townsend, John and Cloud, Henry. How People Grow. Zondervan Publishing. Grand Rapids, MI. 2004

Van der Kolk, Bessel. The Body Keeps the Score. Viking Publishing. NY, NY. 2014

IRRCF: Managing for Increased Resilience and Reduced Compassion Fatigue Trish Thacker, MSW, LICSW Program Director Salvation Army Harbor Light Center,

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