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1. Healers� Healing and Resiliency in the Aftermath of Disaster:Harnessing Our Resources across Individual, Family, and Social Systems Tai J. Mendenhall, Ph.D., LMFT, CTR University of Minnesota Medical School Family Medicine and Community Health

2. Why is attention to 1st responders� well-being important in Disaster-Preparedness and Response? First responders are oftentimes at-risk for burnout and compassion fatigue before they even deploy Fieldwork contexts are ready-made stages for burnout and compassion fatigue to evolve Preparing beforehand can buttress breaking down processes Healing and Resiliency are multi-systemic

3. Why are 1st responders at Risk? Common characteristics of Responders Do not tend to practice what they preach Reluctant/resistant to seeking help Under-report symptoms of hurting (broadly defined) High capacities for empathy are highly correlated with compassion fatigue Lives are already over-scheduled with self-imposed pressures Selves (and oftentimes family) are lower-priorities vis-�-vis work

4. Why are 1st responders at Risk? Common characteristics of Responding Unpredictable deployments Long-hours Few creature-comforts Unsafe (often) work and living conditions Institutional / Turf / Political battles Fieldwork vs. Day-job vs. Family obligations Physically-exhausting Emotionally-exhausting

5. When Healers Hurt Physical Psychological Institutional Social

6. Compassion Fatigue Common themes relate to breaking-down processes in which our physical, psychological, social, even spiritual resources are depleted Signs/Symptoms are extant across multiple systems levels Higher risk for ethical violations

7. Compassion Fatigue Physical Symptoms Exhaustion / Fatigue Insomnia Headaches GI distress Alcohol / Drug abuse Loss of Appetite

8. Compassion Fatigue Psychological Symptoms Irritability / Outbursts Spontaneous crying Poor concentration Depression / Anxiety / Panic Capacity for empathy isolates to fieldwork (i.e., deteriorates with family, friends) Overall capacity for empathy declines (? apathy)

9. Compassion Fatigue Institutional Symptoms Poor work performance Irritability with co-workers Social Systems Increase in family conflict or distance Social isolation

10. What do we do to Prevent or Repair Compassion Fatigue? Attention across multiple systems levels is essential Physical Psychological Institutional Social

11. Preparing / PreventingCompassion Fatigue Physical Be assertive about self-care Taking breaks by self and with others Eating and drinking (water, juice, etc.) Exercise Creature comforts Healthy strategies for sleep

12. Preparing / Preventing Psychological Recognize and honor your own humanness Recognize and honor normalcy of your own reactions to stress, traumatic stories, and disaster contexts Do not minimize or catastrophize your symptoms Do not play therapist or provider in your own personal relationships If you need help, seek it

13. Preparing / Preventing Institutional Discuss what to expect beforehand Encourage responders to talk about their feelings Daily defusings/group-processing sequences Deployments are generally = 2 weeks

14. Preparing / Preventing Institutional (con�t) Sequential teams sent to a single location overlap by a couple of days to effectively and smoothly transition one team to another While in the field, team members work for only 3-5 consecutive days � followed by 1-2 days of rest

15. Preparing / Preventing Social Establish support(ive) systems Be social with partners / family Be social with friends / colleagues Professional and lay organizations

16. Recovering from Compassion Fatigue: Healer�s Healing Physical Exercise (e.g., casual, intense) Relaxation (e.g., hot baths, stretching, massage) Meditation (e.g., music, art, special places/activities) Sleep (e.g., follow the sleep hygiene strategies that you tell your patients to do) Diet (e.g., decrease junk food, alcohol)

17. Healer�s Healing Psychological Self-time (e.g., have it � literally � on your �to do� list) Pursue interests outside of profession Again, if you need help � seek it

18. Healer�s Healing Social Couple-time with spouse/partner Family-time Seek out positive people Avoid negative people Support(ive) groups

19. Closing Thoughts Be intentional about your own health and well-being in the context(s) of attending to others� Remember the Starfish-Story

20. Resources Compassion Fatigue Self Tests http://www.traumatologyacademy.org/Training/2004/Blackmountain/CFTWorkbook_v2.pdf http://aafp.org/fpm/20000400/39over.html Further Readings Rothschild, B., & Rand, M. (2006). Help for the helper: The psychophysiology of compassion fatigue and vicarious trauma. NY: Norton & Co. Skovholt, T. (2000). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals. NY: Allan & Bacon.

21. Contact Information Tai J. Mendenhall, Ph.D., LMFT, CTR University of Minnesota Medical School Dept of Family Medicine & Community Health 717 Delaware St., Suite 422 Minneapolis, MN 55455 Office: 612-624-3138 Email: mend0009@umn.edu