Exhaustion

Exhaustion can be a reality in the lives of both workers and clients. I have personally experienced exhaustion from work and, over the years, have had a number of clients present in a state of total fatigue. I found it more helpful to encourage these clients to do something about catching up on rest, before addressing any other counselling issues.

The sources and impacts of exhaustion

Exhaustion/ fatigue can be related to lack of sleep, worry, over-work, metal stress, depression and over-exertion as well as medical conditions and certain medications. It can be both physical and mental.

Mental fatigue tends to come on gradually and impacts on cognitive performance and our ability to challenge negative thinking or unhelpful thoughts, but it can also decrease our physical performance.

The need for rest

It is more beneficial to take regular breaks rather than only resting after exhaustion, as this allows the body and mind to replenish energy, and sleep is not the only way to rest.

The concepts of Circadian and Ultradian rhythms have been around for some time and are based on research. Circadian rhythms occur in 24 hour cycles (of sleep and wakefulness), whilst Ultradian rhythms are cycles that occur multiple times during the day (dream cycles of sleep, and performance of tasks in 90 minute cycles). Whilst there is some debate about the length of optimum time for the   activity/ rest cycles of Ultradian rhythms, there does seem to be some evidence that if we continue to push ourselves without breaks during the day we will become stressed (and may crave endless cups of coffee, smoking or sugar laden foods).

Some of the signals that tell us that we need to take a rest to allow for break to allow for renewal include hunger, difficulty concentrating, tasks taking longer, memory loss, making errors, moodiness, feeling frustrated and irritable, weariness/ loss of energy/ sleepiness  and muscular aches and pains.

The article below from Psychology Today gives a simple overview of both Circadian and Ultradian rhythms:

https://www.psychologytoday.com/articles/200404/biorhythms-get-in-step

Fatigue fighting tips

This article from the Better Health Channel gives a good overview of fatigue, and lists a diverse range of ways to combat it. These include preventative strategies with suggestions related to diet, sleep and lifestyles. Psychological issues are also covered, and some advice is provided on coping with the mid-afternoon energy slump.

However, in working with clients, we may need to be creative in exploring ways to fight fatigue that best fit their unique situations. In particular I am thinking of mothers with babies and young children, and clients who find sleep very difficult. Similarly, we may need to be creative in finding ways to implement these suggestions in a work environment. One size does not fit all.

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Fatigue_fighting_tips

Troubled pasts

Lately the books I have been reading and the interviews I have been listening to on the radio have left me reflecting the diverse ways that people have reacted to troubled pasts.

The impact of childhood trauma on the brain

Theorists like Bruce Perry, Frank Putman and Douglas Bremner have concluded from research studies that repeated trauma and violence decreases the size of the child’s developing brain and inhibits the development of the parts of the brain responsible for learning, managing behavioural and emotional reactions, social reasoning and social skill development, and that this in turn impacts on success at school, employment and relationships. This can result in an increased risk of anxiety, depression and difficulties forming attachments to others (and can link to subsequent mental disorders and substance abuse disorders).

On the other hand, most of what we know about the human brain is theory, and theory suggests that the human brain is also capable of healing and re-growth, and there are other factors that help develop resiliency.

Listening to people’s stories

Margaret Throsby’s midday interviews on ABC Classic FM engage with a diverse range of people who are well known in particular fields or who have studied the lives of other well-known people. In most interviews she asks about the interviewee’s childhood, and it is amazing how many of the people have experienced troubled pasts. Most have moved on from these pasts and have become very successful in their chosen specialities, but some of those who write about others talk about people becoming mass murders and/ or difficult personalities.

Two books led to me reflecting further – one a biography, and the other fiction.

The Tsunami Kids: Our Journey from Survival to Success by The Gandy Brothers (Michael O’Mara Books Ltd, London, 2014) is about four children who survived the 2004 Tsunami in Sri Lanka which killed their parents, but left them with horrific memories. Despite this the two oldest brothers subsequently set up a successful business making Gandy flip-flop shoes and a charity Orphans for Orphans.

A Week in Winter by Maeve Binchy (Orion Paperback, London, 2013) covers the backgrounds of a diverse range of people who are the first guests of a newly established hotel on the coast of Ireland. The troubled pasts of some have impacted in various ways – one is a social isolate who is unable to see any good in anything, one becomes a slave to his father’s business (but finds new freedom through music), one is a reformed delinquent, two are traumatised doctors (having  witnessed traumatic events related to patients) who take up country practice, but the one who has not had a troubled past becomes vulnerable to the charms and manipulation of a married man (leading to  inevitable distress  when the truth is revealed to her).

So what makes the difference?

I am left to ponder about the answer to this question. Is there any research occurring in this area, or is it too complicated, I wonder? I imagine that resilience is a factor, as is the individual’s world views. 

From my own childhood I have learnt how not to parent (learning from the mistakes of others). And I have learned from clients that those who are willing to engage in the process of healing do have more positive outcomes. I believe that any work we do with clients that frees them up from their past, or tilts them towards more positive outcomes, is worth-while.

What do you think?

Taking mini-vacations

I came across the concept of taking mini-vacations in Yvonne Dolan’s book Beyond Survival: Living Well is the Best Revenge (BT Press, Great Britain, 2000) and I loved the idea. When I was working full-time I often longed for times when I could take extended leave and travel, but this did not help me to get through challenging days or to make the best use of shorter breaks.

Yvonne describes mini-vacations as being about taking a few hours off from day-to-day occupations. She says that if we are feeling exhausted (which can be disguised as feeling lazy or depressed) we may need to take time off to do things we really enjoy doing, or just relax. However, if we have spent a lot of unstructured time, then we may need to use activity to self-renew.

Tuning into our needs

Most of us probably need a balance of rest, quiet and relaxation and being more active and/ or leaving for a few hours (or a day), but a full or part day out may allow for both. We need to tune into our needs at the time and allow for flexibility in our plans in case other demands arise.

 Relaxing/ doing things we enjoy

Here are some suggestions of ways to have this type of mini-vacation (maybe with the phone off the hook):

• Curling up with a movie/ watching TV and doing nothing
• Making a cuppa and sitting with a book or magazine
• Doing something to pamper ourselves
• Listening to a favourite music CD
• Finding a tranquil spot outside to sit
• Sitting and watching water
• Going fishing
• Doing relaxing crafts or hobbies

Being more active

And here are some ideas about how we might engage in this type of mini-vacation:

• Going for a drive to a place we love, whilst enjoying the scenery along the way
• Visiting friends
• Browsing through books at the local Library
• Going to new places to explore
• Bike-riding or bush-walking
• Cooking new recipes
• Window shopping or browsing in shops we love
• Going to the cinema or a concert (or a gallery of festival)
• Having a picnic, visiting a coffee shop or going out for a meal
• Gardening and/or engaging in more active crafts and hobbies

Doing the things we would usually do on vacations

If we reflect on the things we look forward to doing on vacations, this will give us appropriate ideas of what fits best for us on mini-vacations. We may need to do some of these things in different forms (e.g. if we love walking along beaches and live inland, we may need to consider the essence of the experience and try to replicate it walking elsewhere, for instance by a lake or river).

We can also re-live past vacations by looking at photos or re-reading travel diaries. I find that typing up hand written travel diaries at a later date helps me to re-live the experiences. I am still typing up our visit to the South Coast of NSW in February this year, but am finding that I need detective skills to discover where some of my photos were taken!

I have found that whatever I choose to do, being in the mindset of taking a mini-vacation helps me to relax and enjoy it more. I have also found that it is a useful concept to share with both clients and fellow workers.

I would love to hear about your ideas on how you would choose to spend mini-vacations.

But what if it is my swamp?

There are times when I have found myself struggling in my own swamp and, following the last entry on "The swamp metaphor", I began to reflect on how I had survived these times and how I had managed to remove myself from the swamp. Life will always give us swamps!

When I thought about reflecting and reflections  and considered photos that I could use to illustrate this post, I recalled our boat trip in Chamberlain Gorge at El Questro in the Kimberley, and as I thought further, this became the perfect metaphor for this post.

The nature of this "swamp"/ river

On a still day the reflections in the river are almost perfect and it can be tempting to focus on the beauty of the gorge and forget what lurks beneath the water. Estuarine crocodiles inhabit these waters and have been know to attack boats. There are also lots of Archer Fish who catch their prey by spitting a stream of water into the air. Shiny camera lenses are a guaranteed target.

The things that put me in the "swamp"

Experiencing traumatic events and being faced with unexpected challenges tends to put me into my "swamp", especially if these things have shattered my assumptive world. I can never anticipate what life will throw at me.

However the other things that can put me into my swamp are triggers to past traumas and challenges, and I liken these triggers to being spat at by the Archer Fish. These can hit unexpectedly, and when I try to focus on them or look more closely at them (e.g. metaphorically with my camera) they congregate and spit more, but also invite me to delve beneath the surface, where crocodiles (the memories of past traumas) lurk.

Surviving in the "swamp"

I have found that it is important to concentrate on staying on the surface of the water, to avoid further triggers if possible (not photograph the Archer Fish) and to seek ways to exit from the swamp. Mindfulness (likened to concentrating on the reflections in the water whilst still being aware of the danger of the hidden crocodiles) is a good strategy to use, as delving beneath the surface before I reach safe ground can lead to struggling more. I also find it useful to remind myself that trauma reactions usually ease after two weeks (the Gorge does not go on forever) and are more intense during the first week. Knowing that I won't feel like this forever is helpful, as is knowing that my reactions to the trauma are normal.

Experience has shown me that time takes me further down the "river", lays down new experiences and memories, and carries me to exit points from the "swamp".

Processing things

Once I am on safe ground I can begin to reflect and process my experiences in the "swamp". I see the crocodiles as each representing a past traumatic event. Every time I process an event this is like removing some teeth from that crocodile, so that the intensity of its "bite" is gradually reduced, as is the intensity of the impact of my memories. I think that whilst the crocodiles will always be there (we cannot change our past), as they lose their teeth, this is like traumatic events lurking in my memories but no longer having the power to acutely hurt me.

How about you? What is it like in your swamp, and what things help you to escape from it?

The swamp metaphor

I have used this metaphor personally and for clients who are being impacted by the issues of others. I found the concept it in a book on Art Therapy ( Interactive Art Therapy Linda L. Simmons, Haworth Press, 2006) and developed the diagram below from this.

 I have found that clients who are paddling (or even drowning) in the swamps of others readily grasp this metaphor and have commented that they have found it to be helpful. Personally, I have found it useful to regularly  remind myself that "it is not my swamp" when being enticed into other people's swamps.

Using the metaphor

The swamp represents the problems of others, and it is often easy for us to be invited into the swamp with them, either by their helplessness or our own feelings of compassion. However if we jump into the swamp to rescue them it is most likely that we will be sucked down as well (think quick-sand).

A better option is to stay on solid ground and to use our strengths and resources to offer the struggling person a plank. Then it is up to the struggling person to choose whether or not to grab hold of the plank (we can't make them do this). The choice of the right resources, to best fit the struggling person's situation and needs, will enhance the likelihood of them grabbing the plank.

If they refuse to grab hold of the plank, then it is still unhelpful to everyone for us to be tempted to jump into the swamp with them. This is the most difficult challenge. We could try offering other planks or to change the existing plank to make it more enticingly appropriate, or maybe the struggling person needs to be allowed space to manage their own struggle for a while.

The diagram

In our travels we have discovered that swamps often occur in really beautiful areas. Why is this, I wonder?

Power and responsibility

I have found that power and responsibility can either complement each other or be opposing forces, depending on the nature of relationships between people.

The imbalance of power and responsibility in domestic violence relationships

Chris Burke presented the diagram below in the ECAV Workshop Contexts and Connections and I have found it useful in dialogueing with women experiencing domestic violence. 

The client is asked to identify the level of power they feel in their relationship and plot this on the diagram, and then to do the same with the level of responsibility. After this they are asked to do the same in terms of the levels of power and responsibility they perceive their partner to have. Lines are respectively drawn between the two numbers allocated for power and the two numbers allocated for responsibility and these lines graphically portray any imbalances (usually with the woman carrying lots of responsibility whilst having little power, and her partner displaying lots of power but little responsibility). This opens up discussion about what this tells her about her relationship.

Power without responsibility

This can be quite dangerous and lead to exploitation, bullying and abuse. We have probably all been subjected to people who act this way and have had to carry the damage from the trauma of the experience.

Responsibility without power

This is also a very uncomfortable place to be in and can leave one feeling quite helpless but burdened. Workplaces sometimes put employees into this position, without recognising or understanding the impact it will have.

Power with vs. power over

"Power with" assumes that power and responsibility work together and balance each other by using co-operation, consultation and participation, and sharing, rather than imposing, power. Participants in the relationship balance each other's needs and personal power is not used in ways that diminish others. The Conflict Resolution Network portrays it diagrammatically as follows:

Whereas "power over" is about controlling, demanding and criticising, leaving others feeling excluded, alienated and controlled. This is how the Conflict Resolution Network portrays it:

Reference: Conflict resolution Trainer's Manual 12 Skills Handout Masters (2nd Edition):
http://www.crnhq.org/pub/CR%20Trainers%20Manual%202nd%20edition%20/CR%20Trainers%20Manual%202nd%20ed%20pdf%20files/T%20Handout%20Masters%202nd%20Ed%20web%20625kb.pdf

I don’t believe in just ordering people to do things. You have to sort of grab an oar and row with them.  HAROLD GREEN

My journey into retirement

It has been just over 1 month since my last day at work and I thought I would share some thoughts about the process so far. It did take a lot of courage to make the final decision against the tide of "what ifs" and unknowns about the future.

I have lived in "The losses and gains through change" (see this Post in April 2015) and in "Freedom from and freedom to" (see the Post on "Freedom" in February 2015).

Canola in flower in the front paddock

Losses

I was surprised to find that following the final farewell dinner, two weeks after I had finished work, I was unexpectedly overcome with a sense of loss. The next day I felt overwhelmed with sadness and I think this was because at this point I had finally walked into the change, and had time to stop and let my reactions catch up with me.

During my leave I had merely paddled in change and had not properly stepped into it. And the two major things I had not faced when on leave were the finality of ending a career, and cutting myself off from a good source of income. Now I was entering a new life stage -- the one that is seen as the least desirable by western society.

However I have also lost the yearning to regularly pack up the caravan and run away. The photos accompanying this post may partially explain why.

Early morning in the tree paddock next to the house

The passing of eras

I have lived and worked through a number of significant eras in Community Health. My first position as a new graduate was at Liverpool Community Health Centre in Sydney when Community Health was in its infancy during the Whitlam era, and sadly I have been witnessing its gradual demise (in terms of counselling services) in recent years.

Almost 40 years ago I was the first Community Health Social Worker in the town near which I live, and a Community Nurse and myself shared the kitchen of the local Baby Health Centre as our office. Back then we were employed as Commonwealth Public servants and were allowed to take our work cars home (and working hours were 9 am to 5 pm with an hour for lunch).

25 years ago when I returned to full-time work, Community Health had been moved to NSW Health and the numbers of staff employed had grown significantly. A few years later a new Community Health Centre was built in the grounds of the hospital and I used the same office there from then until I retired. However a new hospital and health service complex is being constructed on the southern edge of town, and staff will move into the new Ambulatory Care wing, where there will be work stations instead of offices, and the title "Community Health" will be lost. This major change was a large influence in prompting my decision to retire.

All of this adds to the poignancy of my sense of loss.

Sunset across a paddock

Terminology

I had never stopped and noticed the interesting terminology that is used when one is leaving a workplace.  Words that are used include “severance” and “termination”, giving the impression of being hacked off and gotten rid of, whilst one is playing a waiting game re: final payouts of leave, final payments into Superannuation funds (this is an interesting one since Super Pension Funds now need to be activated) and the accompanying paperwork. It is like dangling on a thread whilst being severed from the branch of a tree, and it prolongs the process of gaining freedom from.

This is in contrast to the message on my NSW Senior's card, which says: The holder is a valued member of our community. Please extend every courtesy and assistance. 

The view from our front verandah

Gains

The main gains have been flexibility, feeling less exhausted and being more available to spend time with people, like cousins passing through, attending gatherings and having grandchildren to stay. My 5 year old granddaughter, not understanding the term “retired” said that Gran has left work because she is “too tired” and now “she can stay home and play with me all day”. It is so freeing being able to make appointments any time and to have space around these to do other things.

I have begun to re-engage in hobbies and interests and have spent a lot of time clearing the jungle in the garden and designing a vegetable patch with raised beds.  I also enjoy being able to read in bed first thing and arise feeling rested. I am slowly edging back into “freedom to”.

I have discovered that my evenings and weekends have remained much the same (the times when I was not at work), although weekends are now much less busy as I no longer need to do the washing and other housework on Saturday, or cook meals for the week.

So that is how it has been so far -- an interesting journey!

Fledgling vegetable patch

Our house from the tree paddock

The importance of hearing stories

This is going back to basics, but is something I have had reinforced from experience. Any counselling is based on allowing the clients to fully tell their stories and on rapport building, and these build on each other. The metaphor of putting together a jigsaw puzzle is useful here.

Putting together the frame 

Initially we may gain an outline of the client's situation as we listen to the beginnings of their stories and we may then be tempted to begin to work with this framework. However the framework is usually about the situation and may not include the client's reactions to the situation and/ or the pain it is causing them. This is like putting all the outer edges of the puzzle together along with a few obvious inner pieces and then assuming we have the whole picture.

This was reinforced to me many years ago when I attended a workshop on Doing Justice and Respect  which was conducted by St Lukes. In a role play situation where I was the client I foolishly chose to share about a current situation that was causing me great distress and felt quite dismayed and unheard when the two participants who were role playing the counsellor pulled out Strengths cards and proceed to encourage me to use them. However this was an excellent learning opportunity for me about the importance of hearing the client's story and allowing it to be fully told before introducing tools for solutions.I also learnt not to role-play using stories of personal distress!

Filling in the pieces

We need to hear the pain. The power of listening and conveying empathy is often underestimated and the best tools to use here are reflective listening and open questions. This is like filling in the middle pieces of the puzzle.

Attending a workshop on Solution Focused Therapy by Michael Durrant, reinforced this for me when he played a video (this was also many years ago) of work with a real client on her second visit and lots of listening occurred before he even gave a hint of using any Solution Focussed tools (even although he was very passionate about the value of their use).

Missing pieces

Sometimes when a story has been told we have a sense that there is more that has not yet been shared. The pieces do not quite add up and we may feel a bit stuck. This is when we may need to search for missing pieces of the puzzle by asking additional questions based on any hypotheses we may have begun to form. The puzzle will not be complete until we find, and place in, the missing pieces.

Of course, no-one's life is static and new puzzles may emerge over the life of our work with the client. Thus listening and hearing stories does take up 80% to 90% of our work with clients.

The word 'listen' contains the same letters as the word 'silent'. Alfred Brendel