Why healthcare practitioners must learn to self-care

Sarah Parry is a senior lecturer in Clinical and Counselling Psychology at Manchester Metropolitan University. Her new book, ‘Effective Self-Care in Clinical Practice,’ explores how compassion can enable clinical practitioners to foster hope and resilience for themselves and their clients. We talked to Sarah about her motivations behind the book and why it’s so important for healthcare practitioners to learn how to effectively self-care. 

Effective Self-Care and Resilience in Clinical Practice is a collection of essays from different practitioners, that explore the need for compassion in therapeutic work. Where did the idea for the book originate from?

Developing a personal compassionate framework for self-care has been an on-going endeavour of mine for some years. When I started working in healthcare settings that could, at times, present multiple challenges to my own well-being, I became increasingly curious as to how to overcome these emotional hurdles. I am also a great believer in the power of stories, both in terms of helping us see through the eyes of another, as well as giving us a mirror to hold up to our own experiences, helping us develop a deeper knowledge of ourselves. My motivation for this book came from my own experiences of struggling with competing demands and a realisation that working harder and harder isn’t always the answer. I wanted to understand more about how people developed effective self-care strategies based on compassionate teachings and practices, to enhance their own well-being, resilience and ability to maintain a hopeful outlook. Consequently, I started talking to colleagues who I knew managed their self-care well, as well as people I didn’t know at all at that stage but whose writings inspired me and encouraged me to think about how well I was looking after myself.

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How to utilise rhythm and reflection in both therapeutic and educational settings – Q&A

faulkner-rythmntorecovery-c2wIn our recent release, Rhythm to Recovery, you can discover how to utilise rhythm and reflection in both therapeutic and educational settings to improve well-being. To celebrate the release of Rhythm to Recovery, we caught up with Simon Faulkner to talk all things music therapy and his new book!

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Author Q&A with Dr Monika Renz

Dr Monika Renz shares her perspective on optimal palliative care and talks to us about her most recently published title, Hope and Grace.

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Could you tell us a bit about your background? Where you grew up and whether there were any early influences in your decision to enter the palliative care field?

I grew up in Zurich. My father was a business leader; my mother was a psychologist. Since childhood, I have been interested in the human condition, particularly health and spirituality. I was first influenced by my father’s focus on efficiency, and as a psychotherapist, I began looking for efficient therapy methods.

A second early influence was music: My mother told me that I had begun singing before speaking! Since I was 5 years old, my hobby has been piano improvisation. Without reading notes, I played whatever I heard and as a child discovered the healing effect of music. When I was a teenager, research on intrauterine hearing had just come to the fore. I was fascinated and became interested
in music therapy.

At the University of Zurich, I studied educational psychology, psychopathology, and ethnomusicology. The deepest influences on my therapeutic work with dying patients came from several accidents and longer periods of personal illness. As a patient, I experienced what I later called a transformation of perception. I discovered two different states of being: In one, I suffered great pain, and in the other state, I had none. In the one state, I was present and in control, and in the other painless state, I was somehow far away from time and space but very clear. I looked deeper into this phenomenon when writing my doctoral dissertation on primordial trust and primordial fear under Professor Heinz Stefan Herzka. Years later, I studied theology to better understand patients’ spiritual distress. My theologic dissertation dealt with redemption from early behavioural imprinting. Continue reading

Who takes care of the caregiver?

Shake up your view of your demanding and relentless work so that you can start to put yourself at the centre of your caregiving work. Cheryl Rezek, author of Mindfulness for Carers, has written an incredibly honest blog on why it’s important to say ‘no’, putting yourself first, and being mindful of your emotions as a carer.

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Taking care of someone else = neglecting to take care of yourself.  Does this ring true for you?  A carer or caregiver is often prone to using all their time, energy and resources giving the person or persons the attention and support that is needed.  However, the danger that can arise is that the caring is only working in one direction.

This blog isn’t about patting you on the back, telling you that you really ought to get some rest or saying what a great job you are doing.  You know all these things already.  You should be patting yourself on the back for all that you do as well as making sure that you get enough sleep and keep your stress levels down.  The chances are you don’t do any of those things or the rest of the long list that could be tagged onto that one.  This blog is about shaking up your view of your demanding and relentless work so that you can start to put yourself at the centre of your caregiving work.

Possibly one of the most difficult issues with being a caregiver is setting boundaries.  To do this can set in motion a whole range of emotions and fears – I’m being selfish; I don’t need help; what if something happens when I’m resting or out?; how will the person manage without me?  These responses are common and, at times, come about for good reason.  To say No to someone, in any form, may seem like a mean, uncaring or unrealistic thing to do but this is not always the case.  On occasions, the caregiver’s anxieties and fears are greater than those coming from the person being cared for.  We often don’t want to admit, or even acknowledge, that our anxiety may be what is driving us to be overstretched rather than only the needs or demands of the situation.  Perhaps there are occasions when you could go out or ask someone else to take your place for a short time but you may be reluctant to do this.  Why?  What is the concern behind this?  Do you think you’ll be criticised?  Have you lost touch with so many of your friends that you don’t actually have anyone to go out with?  Is it easier being the round-the-clock caregiver than having to deal with some other issue in your life?  Does your position give you power in the family or at work that isn’t allowed to be questioned?  Does your role give you a strong sense of identity that you may not otherwise feel?  As a professional, are you needing to present in a certain way to your colleagues or do you perhaps enjoy the energy and status that may accompany the demands of the job?  These are important questions to ask yourself as without some answers you will struggle to find a place for yourself.  With all the good that is done by being the generous and attentive caregiver, it can also work against you.

Most carers don’t set out to be in that role, unless by choosing a career in it.  The vast majority of family carers are doing it because of circumstance, often thrust upon them in some harsh way.  The choices here are dramatically reduced but, in spite of that, you still have a choice about how you take care of yourself as well as the other person.

There are evident differences between being a family caregiver and a professional person who is in a helping profession.  Family carers or foster carers feel an enormous responsibility for the wellbeing, comfort and survival of their relative or foster child.  Needless to say, professional caregivers such as nurses, doctors, social workers, therapists and health assistant also feel such a sense of responsibility but there is an inevitable difference as the family ties, bonds and history aren’t there, and while loss may be felt, sometimes deeply, it is not felt in the same way or with the same level of intensity.  Professional carers go home at the end of the day, or shift, and if they don’t they ought to.

It is important to also raise the issue of being a family carer for someone with whom one does not have a good or loving relationship.  This situation is more common than most people would like to admit but the other person’s vulnerability makes it very difficult to say no or to set limits.  Caring out of a sense of duty or obligation can lead to resentment and distress.

Caregivers come in many shapes and forms and people are in those roles for as many different reasons – a parent to a sick or disabled child, a special education teacher, a hospice worker, an adult child of elderly or ill parents, a partner of chronically ill or terminal husband or wife, a young child of an ill parent, a foster carer, a medical doctor, a community nurse, a health assistant in a mental health unit, a social worker, a carer of younger siblings.  The list is endless but the demands and stress frequently similar.

The big question is how you take care of yourself and if you don’t, why not?  Burnout and fatigue can lead to physical and mental health issues.  These are damaging and you then run the risk of making mistakes, becoming unwell and, at worst, needing to be taken care of yourself.

Mindfulness is a gentle, accessible and nourishing way of reducing caregiver’s stress and increasing their wellbeing and attention.  Research has also shown how those being cared for by people using mindfulness benefit from their carers being more present and open to them.

We are human and no matter how resilient we believe we are, how physically strong we show ourselves to be or how psychologically grounded we say we are, we are still human and being human implies that we have thresholds of tolerance.  It’s not about breaking or collapsing in a heap but far more about recognising that as a caregiver you need to take care of yourself as well as the other person.

Dr Cheryl Rezek is a consultant clinical psychologist and mindfulness teacher who brings a fresh and novel approach to how mindfulness and psychological concepts can be integrated into everyone’s life as a way of managing it in the most helpful way.  She has a longstanding clinical and academic career as well as runs workshops and authors books.  You can find out more about Mindfulness for Carers, read reviews or order your copy here.

 

Call for Comic and Graphic novel submissions

Jessica Kingsley Publishers and Singing Dragon (an imprint of JKP) have recently started developing an exciting new line of comics and graphics novels and we are now open for submissions.

At JKP we are committed to publishing books that make a difference. Our range of subjects includes autism, dementia, social work, art therapies, mental health, counselling, palliative care and practical theology. Have a look on www.jkp.com for our full range of titles.

Singing Dragon publishes authoritative books on all aspects of Chinese medicine, yoga therapy, aromatherapy, massage, Qigong and complementary and alternative health more generally, as well as Oriental martial arts. Find out more on www.singingdragon.com

If you have an idea that you think would work well as a graphic book, or are an artist interested in working with us, here is what we are looking for:

Graphic novel or comic – Long form

We are looking for book proposals that are between 100 and 200 pages, black and white or colour, and explore the topics listed above or another subject that would fit into the JKP/Singing Dragon list. Specifically we are hoping to develop more personal autobiographical stories.

Here are the guidelines for submission:

  1. A one-page written synopsis detailing the plot/outline of the book, as well as short bios of all the creators involved.
  2. Character sketches of the main characters with descriptions.
  3. Solo artist/writers or writer and artist teams should submit 5 to 10 completed pages to allow us to get a sense of the pace, art style and writing.
  4. Solo writers will need to submit 10 to 20 pages of script as well as the one-page synopsis from point 1.

Comic – Short form

We have some shorter comic projects underway and are looking to expand the range of topics covered. These books can run from 20 to 40 pages, black and white or colour, with dimensions of 170x230mm. We are mainly looking for comics that provide ideas and information for both professionals and general readers.

For example, the first in this series, published by Singing Dragon, is a book exploring the latest developments in chronic pain research.

Here are the guidelines for submission:

  1. A one-page written synopsis detailing the narrative style and subject matter to be explored in the book. Also include short bios of all the creators involved.
  2. Solo artist/writers or writer and artist teams should submit 3 to 5 completed pages to allow us to get a sense of the pace, art style and writing.
  3. Solo writers will need to submit 5 to 10 pages of script as well as the one-page synopsis from point 1.

When submitting please provide low-res images and send them, along with everything else, to Mike Medaglia at mike.medaglia@jkp.com

If you have any other ideas that don’t directly relate to the subjects described above but you feel might still fit into the JKP or Singing Dragon list, please feel free to get in touch with ideas and enquiries on the email above.

On the value of writing with traumatised young people – with Marion Baraitser

Baraitser_Reading-and-Exp_978-1-84905-384-6_colourjpg-printMarion Baraitser demonstrates the power of writing with traumatised children and young people. Marion’s book ‘Reading and Expressive Writing with Traumatised Children, Young Refugees and Asylum Seekers: Unpack My Heart With Words’ is available now from the JKP website.

On the value of writing with traumatised young people:
When disturbed young people have read aloud together a strong text, talked about it with a practiced facilitator in a roomful of trusted community members, discussing characters and subjects that concern their own lives, and then written about it, it can transform their idea of themselves and of their future lives. They are better able to externalize self-hood so they can exist in the world, feeling that their internal being has connected to the outside world through books, in some profound way, a form of ‘being-in-development’, a process of growing and changing the many selves they can uncover by this process. The facilitator brings energy, optimism, warmth and responsiveness, even inspiration, or at least motivation or affirmation, to each session.
Here is Amina on the value of writing in helping her to heal:
Writing is helping me to put down memories, different perspectives, to try to find the line… Talking doesn’t do this. When I write I am having a relationship with my journal. Writing is like having a conversation with yourself. I tend to be more honest… pick up on things that lie deeper. I love myself, in writing… I am lucky to be here… I am lucky to be alive… You must keep going and finding yourself, at the same time staying true to yourself… even though you cannot forget where you started from.

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How reading great books together can change lives:
The Nigerian writer Ben Okri, who holds childhood memories of civil war in Nigeria, of his schooling in Lagos 400 miles from his family and of how, on reaching England, he lived rough, by his wits, homeless and miserable. He went to London because of Dickens and Shakespeare, but he also loved African writers like Chinua Achebe and Wole Soyinka. ‘Literature doesn’t have a country. Shakespeare is an African writer… Dickens’ characters are Nigerians.’ (Okri, 1992) As the young people read aloud in the company of a facilitator and a like-minded group, they become the writer, they are taken out of themselves, and if the writer is worth his salt, that encompasses a whole new set of dimensions that can change the way they regard life and their place in it.

Marion’s book ‘Reading and Expressive Writing with Traumatised Children, Young Refugees and Asylum Seekers: Unpack My Heart With Words’ is available now from the JKP website.

 

 

 

Vipassana Retreat – a brand new article from the author of Mindful Living with Asperger’s Syndrome

Woodland Sunrise

Vipassana Retreat

When trying to make sense of the social world as a person diagnosed with Asperger’s Syndrome I have often found myself learning social skills through observing those around me, especially non-verbal gestures such as facial expressions and eye contact. This can often leave little scope for exploring one’s own emotions and feelings, such as being able to notice how they arise and pass and where they take control over one’s actions. Stepping back from the flow on a ten-day Vipassana retreat enabled me to get in touch with this.

One of the purposes of ‘Vipassana’ (which means to ‘see things as they really are’ in the Pali language) is to help those who practice the technique to experience themselves as they are and experience sensations as they occur. By sensations I refer to anything experienced at the physical level, both those that arise from internal bodily feeling and those that arise from external factors, such as the surrounding temperature or the materials of the clothing one is wearing. A mixture of sensations occurs throughout the body constantly, but due to the many distractions around us we are often oblivious to them and how they can determine our thoughts and actions.

Observed in noble silence for ten days with no verbal communication, no non-verbal gestures or signals and no contact with the outside world, a Vipassana retreat provides a distraction-free environment in which one can get more in touch with oneself and be able to observe the comings and goings of thoughts and feelings, including different degrees of Asperger-related obsession with thoughts. As a person with Asperger’s Syndrome what I found so helpful about there being no non-verbal communication was that I find trying to interpret a lot of non-verbal gestures (including understanding how other people feel about me) very confusing, which can then become a source of worry and anxiety, especially if I feel someone is giving me the ‘silent’ treatment. But during the retreat, being aware of the absence of non-verbal communication helped reduce a great deal of this worry, thus giving me more freedom to explore and understand the workings of my own mind.

During the first four days of the retreat participants are instructed to focus on the breath coming in and out around a triangular area from the tip of the nose to the upper lip, one gradually begins to notice a range of physical sensations that arise and pass around this limited area. Participants are encouraged to observe different sensory experiences as they occur rather than create sensations that we find comforting, allowing each breath coming in and out to be as it is naturally and each physical sensation to arise and pass as naturally as possible. On the fourth day one is then instructed to gradually expand awareness throughout the body, scanning through the body slowly starting from the top of the head.

Participants practice this technique for up to ten hours a day throughout the retreat, including three hour-long sittings of serious determination where one shouldn’t make any major movements to their posture or open their eyes unless absolutely necessary. This is so that as well as noticing different sensations or any urges to move, (such as averse sensations around the knee joints when sitting) one is able to observe their response rather than acting on it and acknowledge that sensations, both pleasant and painful are impermanent and subject to change.

Where I find Asperger’s Syndrome can be a strength during practice is through applying attention to detail and being able to notice sensations very closely. Sometimes, due to sensory preferences, the mind can end up being controlled by sensations that can lead to one becoming controlled by obsessive thought. With continued practice and patience, I found  that I was able to exert more control over my mind, including Asperger-related tendencies and obsessions, rather than allowing them to control me. Thanks to this I noticed that each night I was going to sleep much quicker than normal. I felt I was able to notice sensations on a deeper level, including blood flow and vibrations throughout my body coming from my heart beating. Normally, my mind distracts me from going to sleep.

I came home from the retreat thinking that although our physical make-up takes up a limited physical space it has a huge degree of variation with regards to what it is made up of in both a spiritual sense (with the five elements, earth, water, wood, fire) and in a scientific sense. Atoms and particles (the source of most physical sensations) are a constant in our make-up and we are unaware of how much they are influencing our thoughts and actions and how they trigger habits and obsessions. With awareness developed from patience and practice one can eventually exert more control over the mind, and thus more freedom from mental constraint, including anxiety and depression.

On my return to the outside world I noticed just how dependent we can be on external factors for happiness and self-esteem because we aren’t often in tune with how we are within. Turning our mirror neurons towards us enables us to see who we are as we are in the present, rather than being constrained by the need for outside approval. In turn, being happy in this way reflects well on those around us.

 

Chris Mitchell is the author of Mindful Living with Asperger’s Syndrome and Asperger’s Syndrome and Mindfulness both published by Jessica Kingsley Publishers

Small steps – Mindful walking with robots

From using ancient techniques to cross inhospitable terrain to walking with a highly sophisticated robot,  Chris Mitchell, the author of Mindful Living with Asperger’s Syndrome reflects on the many kinds of mindful walking.Chris Mitchell with Robot photo Edited

When new to meditation and mindfulness practice, an initial image that we may have of meditation is of a figure sitting cross-legged with their eyes closed. Understandably, a person with Asperger’s Syndrome who engages in repetitive movement as a way of coping with anxiety and finds sitting still for an extended period of time difficult may be put off seeking mindfulness practice from this mindset. As well as sitting, the Buddha also taught three other meditation postures; standing, reclining and walking. Many people who have found sitting meditation difficult take surprisingly well to walking meditation.

Though we do a lot of walking in normal day-to-day life, we may forget that much of our walking is done on autopilot, within the routine of our comfort zone. When we step outside the routine of our comfort zone into different environments, including when stepping onto different surfaces, or when walking with someone, we notice how little attention we usually pay to sensations that come with each step when we walk on autopilot. This is especially brought to our attention when you are walking with someone who has very tiny footsteps!

At the 2014 NAS professionals Conference, as well as give a seminar on Mindfulness Techniques and Asperger’s Syndrome, including some of the exercises described in Mindful Living with Asperger’s Syndrome, I also got to practice mindfulness of walking with a new friend, Mickey the Robot. Designed to help children with autism in both special and mainstream schools to develop empathy and build on their social skills, NAO Robots, designed by Aldebaran Robotics, are able to respond to human speech and movements and even have the ability to laugh. The first thing that Mickey asks you is: ‘What do you want me to do?’ He then asked me if I would like to go for a walk with him!

Mickey shows he is able to interact in a tactile way when he puts his arm up for you to hold his hand and begins to walk. Noticing that you are walking with him, he then reminds you that he only has very tiny footsteps and that if he has to walk too quick he may fall over! Becoming aware of this, I began to pay more attention to the speed and sensations of my own footsteps, stepping as short and as slowly as I could. When walking with Mickey, as well as being more aware of my footsteps, I also felt I began to feel empathy with him, just by being conscious of his walking needs and not wanting him to fall over!Chris Mitchell Walking with Robots photo

After the conference, it was then my turn to fall over numerous times with a trip to Tromso in northern Norway, north of the Arctic Circle. Leaving behind mild weather in the UK, when I arrived north of the Arctic Circle, I noticed that I was in habitual walking mode when I slipped and fell on an icy surface. Walking on different surfaces, especially ice or snow, often require different techniques of walking to cross, not only when going up and down inclines but also on flat gradients. Though it helps having the appropriate footwear, one also has to be more aware not only of the sensations of their footsteps but also of their centre of gravity, which helps keep us upright, something which we are not normally aware of when walking habitually. In the Chinese legend Journey to the West (known as Monkey in most English-speaking countries), about the journey of the monk Xuan Zang from China to India to retrieve and translate Buddhist scriptures across mountainous terrain, part of his journey involves walking across clouds from one mountain to another. Though he is given special cloud-treading boots for this part of the journey, he has to be able to master their use before embarking on his endeavour. This involves being with each step and noticing where he places each step so that he doesn’t fall through the clouds.

Similarly, in Norway’s Lyngen Alps, I took to cross-country skiing to cross a snow-covered route. Unlike downhill skiing, cross-country skiing involves a lot more walking, with the boots being more flexible and only fastened to the skis at the front. The skis help one move across the snow, but one also has to get used to a different technique of walking than the habitual walking we do in day-to-day life, being aware for the first few yards in front of you, including the hardness of softness of the snow you are stepping on. When going uphill, one finds themselves more in tune with pressure from sensations from the strength required to go up the hill. When going downhill, because there is often a feeling of relief, one can find themselves in a false sense of security when it becomes difficult to control your speed, having to bend knees to slow down.Mindful Walking with Robots mountain pic edited

Just because I practice mindfulness, it doesn’t necessarily mean that I am mindful in each and every moment of my life. Like all human beings, I am just as capable slipping out of mindfulness into habitual thought and movement. Where in fact mindfulness is in noticing when your mind wanders and you fall into habitual movements, including on our walking, sitting, standing and reclining postures.

Mindful Living with Asperger’s Syndrome by Chris Mitchell was published by Jessica Kingsley Publishers in 2013.

How well do you know yourself?

Bolton_Writers-Key_978-1-84905-475-1_colourjpg-webWe make assumptions about ourselves all the time, but how much do we really know?

As Gillie Bolton says in the opening chapter of her new book The Writer’s Key, ‘The simple action of putting words on a page can begin to help us find out what we think, believe and know’.

This exercise taken from the book is a great way to begin to explore ourselves through writing; our worries, our fears, our hopes, and our aspirations.

All you need to have a go is a pen and a piece of paper. You might be surprised by what you discover!

Download the free writing exercise here