Wednesday, January 29, 2014

Empathy, Compassion, and "Compassion Fatigue"

"All one here" collage by Lani, textures by FlyPaper.
Here's a little story about the possibly misnamed experience of "compassion fatigue".  Matthieu Ricard, the happiest man in the world, was a subject in some neuroscience research that Tania Singer of the University of Zurich was exploring.  With neuroimaging, Tania was trying to tease out the differences between empathy and compassion and what parts of the brain might be involved in these different experiences.  She asked Matthieu to simply feel empathy for the suffering of others, without transforming it into compassion, concern, or love.  It took her half a day to persuade him, and after a short while in the scanner he was begging her to please let him do his loving-kindness meditation, that experiencing the pain and suffering without doing his metta meditation was unbearable.  She found this experience really eye-opening.  She believes this may be the reason healthcare workers suffer burn out and fatigue, because we are overwhelmed by the suffering of others and are not taught to transform our empathy into compassion, concern, and love.  She thought that actually here in the west, we are more concerned with holding ourselves apart from those who suffer.  Suffering is an aversive feeling.  We are taught to fight, flee, or freeze when we come into contact with aversive feelings.  From an early age in our culture, we are taught to differentiate ourselves and others, to perhaps even to deny the possibility that one day we may suffer as well.  

The good news here is that there are folks out there working very hard to teach us what to do with our empathy for the suffering of others.  Joan Halifax is one of these individuals.  She has taught thousands of healthcare providers at the Upaya Zen Center in Santa Fe, N.M.  She believes that developing our capacity for compassion makes it possible for us to help others in a more skillful and effective way, and that recent research studies suggest that compassion plays a significant role in reducing physiological stress and promoting physical and emotional well-being, as well.  (Good news right?)  She kindly suggests a great collection of studies and articles on the benefits of compassion, which we can access from the Center for Compassion and Altruism Research and Education, based at Stanford University.

In response to the need for tools that can help prevent burnout and secondary trauma in clinicians, Joan developed the "G.R.A.C.E." model. This practice offers physicians, nurses, and others working in stressful situations a simple and efficient way to open to their patient's experience, to stay centered in the presence of suffering, and to develop the capacity to respond with compassion.

She believes it is quite possible to use "G.R.A.C.E." in our everyday interactions and allow it to help us cultivate more compassion in our own lives. Here's the abridged version.
The G.R.A.C.E. model has five elements:
1. Gathering attention: focus, grounding, balance
Here we should pause, breathe in, give ourselves time to get grounded. We can invite ourselves to be present and embodied by sensing into a place of stability within our bodies. We can focus our attention on the breath, (especially on the out-breath which activates the parasympathetic nervous system). We can also bring our attention to a phrase or an object. We can use this moment of gathering our attention to interrupt our assumptions and expectations (and our cultural training) and to allow ourselves to relax and be present.
2. Recalling intention: the resource of motivation
We can remember what our life is really about, that is to act with integrity and respect the integrity in all those whom we encounter.   We can remember that our intention is to help and serve others and to open our heart to the world. This "touch-in" can happen in a moment. Our motivation keeps us on track, morally grounded, and connected to our highest values.
3. Attuning to self/other: affective resonance
The first part of this is to notice what's going on in our own minds and bodies. Then, we can sense into the experience of the other; sense into what they are saying, listening for emotional cues: voice tone, body language. Sense without judgment. This is an active process of inquiry, first involving ourselves, then the other person. We can open a space in which the encounter can unfold, in which we are present for whatever may arise, in ourselves and in the other person. How we notice the other person, how we acknowledge the other person, how the other person notices us and acknowledges us, constitute a kind of mutual exchange. The richer we make this mutual exchange, the more there is the capacity for unfolding.
4. Considering: what will serve
As the encounter with the other person unfolds, we can notice what the other person might be offering in this moment. What are we sensing, seeing, learning? We can ask ourselves: What will really serve here? We can draw on our expertise, knowledge, and experience, and at the same time, be open to seeing things in a fresh way. This is a diagnostic step, and as well, the insights we have may fall outside of a predictable category. We shouldn't jump to conclusions too quickly.
5. Engaging: ethical enactment, then ending (this has two parts)
Part 1: Engage and enact. Joan believes that compassionate action emerges from the sense of openness, connectedness, and discernment that we have created. This action might be a recommendation, an open question about values, or a proposal for how to spend the remaining time with this person. We co-create with the other person a dynamic, morally grounded situation, characterized by mutuality, trust, and consistent with our values and ethics; we can draw on our expertise, intuition, and insight, and we can look for common ground that is consistent with our values and is supportive of mutual integrity. What emerges is principled compassion: mutual, respectful of all persons involved, and as well as practical and promoting action. Joan believes that these aspirations might not always be realized; there might be deeply-rooted conflicts in goals and values that would need to be addressed from this place of stability and discernment.
Part 2: End the interaction. Joan believes it is important to mark the end of the interaction with the other; release, let go, breathe out. She suggests we explicitly recognize internally when the encounter is over, so that we can move cleanly to the next interaction or task; this recognition can be marked by attention to our out-breath. While the next step might be more than we expected would be possible or even disappointingly small, we can notice that, acknowledge what transpired. Without acknowledgement of what unfolded, it will be difficult to let go of this encounter and move on.

Joan believes we live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well-being, resilience, and survival. Joan's G.R.A.C.E. model can help us to actualize compassion in our own lives and that the impact of this will ripple out to benefit the people with whom we interact each day.  Wonderful!  I think perhaps this G.R.A.C.E. model may just be the #31 out of a thousand ways to have a happy life.
Grace by Gretchen Miller
If you want more, do check out the Upaya Zen Center or this lovely video interview between Joan Halifax and Dr. James Doty.


Rebecca said...

Wow, Lani! Gioia directed me to this post--really appreciate what you've written here--both personally and professionally.

As always with admiration and appreciation, rebecca

Lani Gerity said...

I know, the material totally dovetails with what we are trying to do, right? I love that. And I love how you can "attend" great talks and conferences on YouTube!