Professional caregivers choose that career because they have an intense, compassionate desire to help others. Unfortunately, burnout is a real issue for most professional caregivers, as they give and give without checking in with their own needs. If you are a caregiver, this article will help you identify what you need to do to fill your well before giving to others.
“You make it so much easier” she said, opening her eyes and looking right at me, and then my dying mother fell fast asleep once again. I was stunned.
She had been sleeping for days, edging ever closer, breath by labored breath, to the final sleep, the last breath, freedom from a broken, failing body. Over the few months since her terminal diagnosis of metastatic colon cancer, I had been both daughter and nurse, providing her care at home. Like all of us who sit vigil–like at the bedsides of dying loved ones, I had plenty of time to think, to pray, to daydream, to remember, to count ceiling tiles and repeating carpet patterns, and to experiment with energy and consciousness and healing. Yes, you heard right. Experiment with energy and consciousness and healing.
When my mother was diagnosed I had just completed a graduate program in nursing at New York University, during which I had taken an elective to learn an energy–healing modality called Therapeutic Touch. This modality is hypothesized to work via an interaction of human energy fields, understood to be inseparable from the universal/environmental energy field. Beginning the course as a total skeptic, I had finished it eager to continue practicing and learning, and would later do doctoral and post-doctoral research to advance our understanding of Therapeutic Touch. Little did I know that so soon I would have the opportunity to begin my research in the most innocent of ways.
One day, sitting sleepily in the club chair that I had pulled up next to my mother’s bed, I suddenly had an idea. Since Therapeutic Touch works with the human energy field, using the hands on or near the body with the intention to help or to heal, perhaps one doesn’t need to use one’s hands at all. I decided to experiment. Remaining motionless, I began by quieting my mind and centering myself in the present moment, invoking unconditional love and compassion, and making the intention to be an instrument for healing. I opened to my sense of connection to Source and infinite energy.
Still motionless, I imagined myself moving my hands from the top of my mother’s head to her feet in a gentle, smooth, sweeping motion. As I did, I allowed feelings of comfort and unconditional love to flow through me and radiate out towards my mother. I visualized a cobalt blue cocoon of healing energy being woven around her, holding her gently. In this cocoon, all fear and pain were gone and only peace remained. Here we dwelled together, embraced and held in the infinite heart.
I lost track of time, but in what seemed a very few minutes my mother suddenly awoke. Turning her head toward me she looked soft, relaxed. She normally awoke with a startle and as she looked for me she often seemed fearful, panicked almost. But at that moment, it was different. She looked at me so tenderly and then, with a small, soft smile, whispered the words I will never forget: “You make it so much easier.”
Making it easier for those in our care
Who wouldn’t want to hear from one in our care that we make whatever they’re going through “so much easier?” And really, everyone is in our care. It doesn’t matter whether our care–giving is as a healthcare professional or as a family member; a lover or a friend; a stranger in a chance airport encounter or an activist on the streets. There is something deep within most of us that responds to the vulnerability of others with a desire to help, to heal, to make a difference, to ease suffering. It is a sort of quickening of the heart in the presence of dis–ease that, unencumbered, moves us to act in service to the other, who is, the heart knows, not really other at all. But responding to the impulse is neither simple nor without risk.
We are complex beings, and the natural and highest impulses of the heart arise in and through the field of our unique personalities, lives and experience. Such impulses can be actualized in truly beautiful acts of unconditional love and compassion as witnessed, for example, in the aftermath of recent natural disasters. They can also be repressed, or distorted, or co–opted by the ego into codependency or power–plays or in building an identity, or simply acted on with genuine good–heartedness but without awareness, knowledge, and skill about how to actually help.
My experiences with my mother and with subsequent patients and clients over the years, confirmed for me what I had learned through both academic and spiritual study, and which you likely already know: the fundamental interconnectedness of all life and consciousness is “non–local,” that is, not bound in space and time [i]. I learned that we can be of genuine, discernible help to each other through centering in unconditional love and compassion and that by engaging from this contemplative presence we can care deeply and intimately without draining our resources. In fact, in the process of helping others we become more vital and whole ourselves.
This knowing has fueled many decades of my work with health care professionals around issues of burnout, self–care, and professional sustainability. To help address these concerns I developed a theoretical model and set of practical strategies that can help caregivers to maintain their own vitality in the very midst of their very challenging work. Part One of this article presents the framework of this model. In Part Two, I’ll share some practices and strategies to help us actualize our love for self and others in the world in (hopefully) more sustainable ways.
Responding to needs and demands as caregivers
For anyone working in the helping professions, or anyone who seeks to be of service in the world, every day brings an onslaught of demands for our time, our compassion, our skill, our knowledge, our care. We can imagine that as a living energy field, all of these demands are like hooks of various sizes being cast into the fabric of our fields, tugging on us relentlessly, evoking responses that for most of us remain almost completely unconscious. How we respond to these demands makes an enormous difference in how we feel at the end of the day and how available for caring we will be in the future.
The Defensive Mode
In my experience, many of us respond to the demands in one of two primary ways, or modes, as I have called them, which can be seen in Figure 1.
Figure 1. Responding to Needs and Demands
In the first mode, the Defensive Mode, the demands are experienced, consciously or unconsciously, as threats to maintaining limited energy/life–force and so create a subtle anxiety, triggering bodymindspirit contraction, defense mechanisms and habitual defensive behaviors. Examples of these are as varied as we are: avoidance; focusing on technology and procedures to the exclusion of the person; inappropriate levity; offering superficial reassurances; distracting ourselves; labeling and judging people so as to justify distance, and so on.
Without judging any of these behaviors, the question is whether or not this mode of responding fulfills its intent of protecting us from being/feeling drained in the course of our caring for others. The answer is typically no, because withdrawing, withholding, and maintaining defense mechanisms blocks free energy flow/exchange and consumes, rather than conserves energy. In addition, holding ourselves apart and disengaged is quite likely to conflict with our heart’s desire, our ideal of ourselves as loving and generous human beings/caregivers, and with internalized messages about what good caregivers/people “should” do. This unconscious conflict blocks and drains more energy and can also leave one feeling dry, numb, and guilty.
The end result of responding to the demands in the defensive mode is a sense of frustration. In experiential workshop sessions, health care professionals report that when they are in this mode, their breath gets shallow. They feel shut down, closed, contracted, angry, tight and tense in various parts of the body such as the jaw, the arms, the hands, the chest, etc. They report that while these are not comfortable feelings, they are very familiar to most healthcare professionals.
The Sympathetic Mode
In the second mode, the sympathetic mode, it’s as if the hook lands somewhere within us that for perhaps hidden, perhaps obvious reasons, elicits a profound sympathy response. Sympathy is characterized by feelings of sorrow or pity for the other or for the situation, and has been defined as the quality of being affected by the state of another with feelings correspondent in kind. Thus, in the moment of sympathy, we take on the other’s suffering, literally bringing the energetic pattern of their pain into our own bodymindspirit field. Simultaneously, sympathy opens the floodgates for an outpouring of raw, emotional energy that carries with it our own overwhelming need and desire to make things better; to help; to relieve the other’s suffering and vulnerability. We cannot stand not doing something.
In experiential exercises that allow people to notice what happens in the bodymindspirit when they are in this mode, they report feelings like tightness in the stomach; stomach turning or slight nausea; tearful eyes; heaviness and being weighed down; depression; contraction/lump in the throat; hopelessness and sadness, among others. Health care professionals further report that, while not comfortable, the feelings are very familiar.
Responding in this mode is so poignant and so human. But to return to the question of whether or not it helps or hurts caregivers to respond in this way, we can say it is so very draining, leading to emotional depletion, bodymindspirit exhaustion, and ultimately a profound sense of futility. It may indeed be futile, because no matter how much we suffer over someone or something, sympathy is of very little actual usefulness. We can only do what we can do, and often that doesn’t change the unfortunate situation. In addition, from the point of view of energy and vibration, we are surrounding this being or situation not with a cocoon of peace and love, but with our own suffering. It is a very useless energy, at best, to the one who is already suffering enough.
In sharing this model with nurses, I’ve learned that it is as if each mode is (unconsciously) designed to fulfill one of the two contradictory mandates that were received in nursing school: Don’t get emotionally involved with your patients, and make sure that you truly care about your patients. I can remember asking one of my professors how we were supposed to do both of those things simultaneously. The answer I got was that “every nurse figures that out for her/himself.” She wasn’t withholding the secrets in some Socratic ploy to get us to discover them for ourselves. She was telling the truth—she didn’t know. We were on our own. So out in practice, we alternate between the two, and then wonder why there is so much burnout.
Another way: The Centered Mode
The third mode of responding to the needs/demands for our energy, time, love, skill, and so forth is the Centered mode. As I practiced with my dying mother, Therapeutic Touch can be used in interior visualization practice. At the heart of that practice is the intention to be an instrument for healing, achieved by first using a learned process of centering, or what we might also call contemplative presencing. It is the invocation of a state of interior alert stillness, openness, and connectedness to something greater than the small, personal self—call it Self, Source, universal energy, Love, God, unitary field of unconditional love—it really doesn’t matter in this context.
The inner movement is to come back to center, to conscious awareness from unconscious reactivity, where new and healthier possibilities for how to respond to the needs in front of us may arise. In my experience, bringing centered, contemplative awareness into the service of the other in the present moment opens or deepens two capacities of the bodymindspirit that we are. The first is our capacity to discern exactly what is being asked for in this moment by this “other myself.” Through shared consciousness, discernment and right action can arise as response, replacing unconscious, automatic reactions. The second is the capacity to act on our discernment from and with love and compassion flowing through us, but not being generated by us. In experiencing this mode of responding, health care practitioners report feelings of aliveness, openness, lightness, flowing bubbling energy throughout the body, sense of radiating from the center of the chest, equanimity, and so on. They report that while very comfortable, these feelings are not nearly as familiar as those of the other two modes when they are at work.
This is the key: to remember to be an instrument and not the generator of this unconditional love and healing energy; to be the garden hose and not the reservoir; to be the jumper cables and not the battery—You get the idea! It is the withholding (defensive mode) or pouring out (sympathetic mode) of our own personal energy, love, caring, etc., as if we are a separate self trying to avoid or help another separate self, rather than allowing the infinite to overflow and radiate through us that results in exhaustion and depletion. Being an instrument fills us first, and from that fullness we give. In this state of consciousness, it is as if the hooks mentioned earlier simply fall out of the field as love flows outwardly.
Bringing our Contemplative Practice off the Pillow
As professional caregivers, or simply awake human beings attempting be of loving service, we deeply wish to make the way easier for all beings and for our most beautiful home, planet earth. There will always be interactions after which we discover ourselves to be depleted and in need of recovery; that is the risk we take through our full–hearted engagement with the world in all its need, and we willingly, even joyfully, take it. However, with practice, we can learn a way of responding to the demands for our time, energy, love and skill that can help us minimize this draining, at least some of the time, and perhaps recover more quickly from it when it inevitably happens. By bringing our contemplative practice off the pillow and into the very moments of our caring engagement, we can thrive in the midst of even the most challenging situations. Learning such skills is essential for anyone who wishes to walk in this world as a healing presence, in service to others, bringing ease where there is dis-ease. The world needs us, and it’s part of our sacred duty to keep ourselves whole so that we are able to continue to serve from aliveness, joy, and an abundance of love.
Stay tuned for Part Two of “Contemplative Presence as Self-Care for Caregivers,” where Dr. Quinn shares some specific practices for using this module.
[i] Dossey, Larry. A Conversation About the Future of Medicine. Accessed February 13, 2014, http://www.dosseydossey.com/larry/QnA.html