© Dr. Angie Panos and Gift From Within
Being a care-giver takes courage, but there are no medals for your efforts. As you are there day-to-day helping your injured soldier heal, it may take a toll on you. “Compassion fatigue” is what we call the set of symptoms that care-givers can sometimes experience.
What are the symptoms of compassion fatigue?
* Feeling estranged or isolated from others (Having difficulty sharing or describing feelings with others)
* Difficulty falling or staying asleep.
* Outbursts of anger or irritability with little provocation.
* Startling easily.
* While helping your loved one thinking about violence or retribution against persons who hurt them. Anger toward others who put them in harms’ way.
* Flashbacks connected to the trauma my loved one went through.
* Feeling there is no one to talk with about highly stressful experiences.
* Working too hard and not able to care for myself.
* Frightened of things my injured soldier has said about their experience.
* Experience troubling dreams similar to what my injured soldier has.
* Experienced intrusive thoughts and worries about my injured loved one.
* Suddenly and involuntarily recalling a frightening experience.
* Preoccupied with my injured loved one.
* Losing sleep over my injured soldier.
* Feeling trapped by my role as a care-giver.
* Feeling a sense of hopelessness.
* Feeling weak, tired, or rundown.
* Feeling depressed as a result of my care-giving.
* Losing balance between caring for my loved one and having any time for myself.
* Feeling little compassion toward others
* Thoughts that I am not succeeding at achieving my life goals.
* A sense of worthlessness/disillusionment/resentment associated with my care-giving.
Prevention, Resiliency and Treatment
Early recognition and awareness is crucial in being able to be resilient to compassion fatigue. Compassion fatigue is treatable! Keeping your life in balance or getting it back in balance, by taking some time for yourself or enhancing your self-care are essential strategies. Keeping your body and your health in good shape is key to being strong through the distress. You are not going to be resilient if you are not well rested. You may need medical attention if the symptoms of compassion fatigue, such as sleep disturbance, start interfering with your ability to function. If you are eating poorly and not exercising you are more vulnerable physically and emotionally to the effects of distress. Therefore, keeping a healthy balance in your life is a requirement to prevent and treat compassion fatigue. Care-givers that have a structured schedule that allow them time to organize and do good self-care are more resilient (Panos, 2007).
Another essential factor to prevent and treat compassion fatigue is to have a good relationship with eithera friend, a counselor or a clergyman that you can safely and confidentially discuss the distresses you are experiencing. Isolation is a symptom of compassion fatigue and is ultimately dangerous. To be resilient you need to have good support and connections with others.
Many care-givers report that creative therapies such as writing in a journal, or expressing their feelings through music or art are helpful. Diversions and recreation that allow you to take mini-escapes from the intensity of care-giving is absolutely necessary.
What to do if you have symptoms of Compassion Fatigue:
* Have a recognition and awareness of the symptoms of compassion fatigue in yourself.
* Restore a healthy balance in your life, including good sleep, good nutrition and exercise.
* Get medical treatment for those symptoms that are interfering with your daily functioning.
* Utilize your positive supportive connections with others to process your feelings.
* Implement regular mini-escapes in your life, like recreation, creative therapies or other healthy diversions from the intensity of your work.
*Get respite care for your loved-one to give you a break from your role as a care-giver.
*See a counselor to assist you in dealing with the stress of your care-giving role.
* Don’t medicate yourself with drugs or alcohol! Don’t use other self-defeating addictions! Get professional help for yourself if needed to get back on track.
With a balanced approach that takes into consideration your own self-care plan, both you and your injured loved-one can heal. Compassion fatigue can be either prevented or treated early on before it takes a toll on you or your relationship.
References and Suggested Reading:
Figley, C.R. (1993a). Compassion Stress: Toward Its Measurement and Management. Family Therapy News, February, 1-2.
Figley, C.R. (1993b). Compassion Fatigue and Social Work Practice: Distinguishing Burnout from Secondary Traumatic Stress. Newsletter of the NASW Florida Chapter, June, 1-2.
Figley, C.R. (Ed.) (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. An Overview. 1-20. New York: Brunner/Mazel.
Panos, A (February, 2007). Promoting resiliency in trauma workers. Poster presented at the 9th World Congress on Stress, Trauma, and Coping, Baltimore, MD.
Pines, A. & Aronson, E. (1988). Career burnout: Causes and cures. New York: Free Press.
A-V Resources for Families:
Author's Bio
Angelea Panos, Ph.D. is a therapist who specializes in trauma and grief. She has 25 years of experience in helping survivors. Dr. Panos is a board member of Gift From Within, a non-profit organization serving PTSD clients and professionals.
© Dr. Angie Panos and Gift From Within
Is keeping a relationship healthy easy even in the best of situations? People in long lasting relationships report that it takes an investment of constant effort, like growing a beautiful garden to keep a relationship thriving. When your loved-one has a serious injury and you are in a care-giving role, it can take a toll on your relationship.
In order to keep your relationship strong, you need to evaluate honestly how you are doing.
This involves:
Discovering the true impact the illness has had on your relationship.
Forgiving each other (and yourself).
Recognizing what needs to improve.
Finding ways to create hope.
Creating balance and ways to meet both partner’s needs.
Learning new skills.
Knowing when to look for help and outside resources.
Everyone in the household is touched when their family member comes home with a serious injury. The injured partner may feel like they are bringing less to the relationship than their healthy partner. The injured partner may feel they are "holding back" the healthy partner from being fulfilled. Feelings of insecurity arise along with shame and guilt. The injured partner believes that their healthy partner must be resentful of what their life has become due to their injury. A vicious cycle develops with the feeling of inadequacy and the continual need to apologize.
A good marriage consists of shared activities, shared responsibility, common goals, along with healthy intimacy. Once one partner feels they are the reason for the disruption in the relationship they feel deep anxiety and sadness. The injured spouse becomes encumbered with self-doubt and wonders why their spouse stays in the marriage. Partners don’t feel free to ask for emotional support from each other.
Here are some helpful hints from couples who have worked through having an injured partner:
“ Don’t take things too personally. I knew my husband felt cranky because he was in pain. I was an easy target for his irritability at times. He would apologize later, and I would brush it off. If I had taken it personally, or resented him for it, we would have had a lot of conflict. “
“ I tried to put myself in his boots and realize it's not easy. So I don't feel badly if he appears to lash out at me at times.”
“When my wife would get mouthy and use foul language, I tried to turn up my compassion. I asked her what her pain level was. Inevitably her pain would correlate with her moods. I went with her to her doctor at the VA and explained what I was seeing. They got her into some physical therapy to help with the pain control. "
“We would have a weekly time to share our feelings and ask for the kinds of support we needed from each other. We would also try to have a date night and do something fun. These things helped us get through many months of rehabilitation.”
Talk Together and with the Doctor:
Discuss the injuries. A thorough understanding of the healing process and limitations is essential for the healthy partner.
Learn to explain symptoms in a measurable way. Saying “I'm tired” is not as effective as explaining that you feel as weak as you did when you had a bout of the flu.
Use a scale of 0-10 to describe severity of symptoms.
Be Helpful in Their Independence:
Find how to help without being overly helpful and annoying.
Too much can make the injured partner feel demeaned or powerless.
“I was trying to walk more after I got my leg prosthesis. My husband was hovering over me worried that I would fall. I could see that our goals clashed and we had to talk through how I needed him to give me some space to try out my new leg.”
Make Caring Mutual:
Deal with the ups and downs of the healing process. It takes ongoing communication and imagination to find ways to give and take and to acknowledge what each partner can do for each other. To avoid silent resentment, make direct requests when you need something. Don’t assume your partner knows what you need. Instead, give your partner the recipe for success. Do assume they care and want to give you what you need. Educate them on what they can do. Is it quality time and attention you need? Perhaps it is some type of physical affection they can offer you? Ask for the words or actions you are hoping to receive. This is new territory for you both. Coaching each other through it in a supportive way will lead you both to a healthy, happy relationship.
Intimate Needs:
Keep your spouse from feeling neglected. Health issues may suddenly throw sex out the window, but intimacy does not have to follow. An honest discussion is necessary even if the healthy partner is not complaining. Your well spouse may feel guilty or selfish for expressing their needs.
Deciding how you can best achieve a physical intimacy which affirms your feelings of love for each other. This requires talking very openly about how to do this and putting away unrealistic expectations about sex.
Prioritize Intimacy:
Arrange dates for intimacy, affection or sex so the injured person can prepare by taking pain medication, by not taking on too much during the day and by building a sense of desire. Time it for the best time of day (best energy, least pain, etc.) You need to make intimacy a priority and talk about it. Tell each other what feels sensual and what hurts.
Helpful hints:
–Learn to massage in a manner that relaxes your spouse.
–Talk to your healthcare provider about pain relief or therapeutic lotions for pain.
–Utilize lubrication or medications as needed.
–Sometimes a hot bath or shower before love-making is helpful.
Finding What Works for You
Physical limitations, emotional and physical fatigue, financial pressures, and lack of time can all affect intimacy and lovemaking.
Snuggling may replace sexual intercourse. Sometimes, even touching or holding is difficult. Many people with health challenges report that although sexual intercourse is limited or non-existent, emotional and spiritual closeness increases.
Look for new ways to express your love so that you can sustain a caring, growing relationship. Try alternative ways to experience sex and sensuality, from just hugging and gentle kissing to giving one another massages. Consider mutual or self stimulation while holding each other.
Orgasm, for most people, produces a natural high. Not surprisingly, this helps with pain control, much the same as a "runner's high."
Don’t feel rejected and don’t take their discomfort personally.
Ask questions to determine what might feel better.
Everyone needs touch and intimacy- go as far as it is comfortable for both of you.
Be willing to find alternative ways to satisfy each other, and don’t be afraid to discuss this with a therapist or doctor.
A Good Marriage Can Make You Healthier!
A close marriage not only makes life easier for the two of you, it could be a make-or-break factor in the health and healing of both the patient and the caregiver.
Learn to Meet Both of Your Needs
Managing the way an injury affects your marriage is just as important as keeping up with medications and doctor's appointments and treatments. Couples can build stronger, closer marriages or relationships despite the presence of illness or injuries. Many people are confused when thrust into the role of caregiver. It can be difficult for a person to separate her role as caregiver from her role as spouse, lover, friend, etc. Parent to child types of interactions or communication kill romance. Make sure your communication with your injured partner is adult to adult and respectful, empathic and allows the ill spouse their dignity.
It is time to get help!
Don’t blame each other when the reality is you are both overwhelmed. Get some help! Don’t be afraid to call friends, neighbors, and family members and tell them what you need. Solicit supportive services to help deal with negative feelings. Both caretaker and patient may carry heavy burdens and experience unproductive feelings of guilt and shame. These feelings may manifest as anger, bitterness or apathy. Talking is good medicine.
Couples need to:
Talk openly as problems arise, rather than withholding resentment and avoiding conflict.
Understand that anger is a natural response to the limitations illness or injury imposes on a marriage and needs to be expressed. Finally, realize that mature love comes with much effort and conscious desire to keep the marriage/relationship together.
Adjust to a New Reality:
Successfully adjust to life with your partner’s limitations by dealing with issues and developing a coping plan. Use pain control, music therapy, keeping a journal or blogs, and reading or listening to books on CD’s. Address symptoms of grief, anxiety or clinical depression as needed.
Coping Strategies for a Well Spouse:
Create balance between love and independence
Take time to pursue the things that renew you
Get away regularly
Create a life apart from the illness
Develop a strong support network
View the experience as a spiritual journey
Have your own good self-care plan that includes exercise
Keep Up Each Other’s Morale
You need to make an effort to keep up each other’s morale. For example, you might make appropriate plans for fun future activity. Having something fun to look forward to is important during the healing process. Learn to tell your ill partner about your day’s events and listen patiently to theirs. Contain complaining to 15 minutes or so (have other interests that can be discussed). You don’t want every conversation to be about the injury, pain medications, and so forth. Create positive memories together and reminisce about them. Find new ways to have fun.
Chronic injuries, pain and illness drain away much of the laughter in a relationship. Unrelenting sadness, irritability and strife are deadly enemies to many marriages. Try different forms of entertainment and hobbies both as a couple and individually. Laughter and fun may not come easily; but it is essential to find ways to break away from the suffering.
“If you can find humor in it, you can survive it.”--Bill Cosby
“A man without mirth is a like a wagon without springs. He is jolted disagreeably by every pebble in the road”.--Henry Ward Beecher
How Couples Put Gratitude and Joy in Each Day:
“Some of our most tender, loving moments were when he was very ill”
“We learned to enjoy looking at the sky together”
“We kept a gratitude journal that we wrote in each evening-it helped our morale”
“We made a list of things that bring us joy and tried to put them into each day”
Author's Bio
Angelea Panos, Ph.D. is a therapist who specializes in trauma and grief. She has 25 years of experience in helping survivors. Dr. Panos is a board member of Gift From Within.
For additional information on PTSD visit Gift From Within- a non-profit organization serving PTSD clients and professionals.
