Pouring from an empty cup: self-care for care givers
By Jody Elford

Self-care has become a bit of a buzz-phrase and, just like most important things, it is something that many of us are sort of rubbish at. I want to share my thoughts on self-care, particularly the self-care undertaken by those of us in caring professions, looking after other people, or supporting people with mental illnesses. Many of us find ourselves “pouring from an empty cup.” This is a surefire route to compassion fatigue and our own emotional overload.

Pouring from an empty cup: self-care for care givers

Compassion

kəmˈpaʃ(ə)n/
noun
noun: compassion; plural noun: compassions
sympathetic pity and concern for the sufferings or misfortunes of others.

I’m of the opinion that this definition needs some tweaking. For a start, I disagree with the notion that to feel compassion is to experience pity. Pitying someone involves, in my view, a degree of condescension that is unhelpful and detrimental to the development and expression of empathy. Pity, to me, seems like a flimsy and unproductive mechanism by which one feels a benign superiority over someone else’s experience – you feel sorry for them, as opposed to feeling for them. Pity is, in my humble opinion, just a really decorative way of experiencing guilt and shame about our own entitlement or of being generally “better off” than someone else, and it is something that unhelpful helpers tend to do.

Compassion isn’t pity

Compassion isn’t flimsy. It isn’t a flaccid attempt at offering platitudes or big, sad eyes and asking those nauseating questions in that molten marshmallow voice: “Yeah, but, how are you doing?” In my experience, compassion is fierce. Experiencing it can be difficult, leave you vulnerable, and even isolate you to a social minority. I feel compassion for addicts, prisoners, aggressive animals and delinquent youths. I feel this compassion deeply, without shame, and often at the risk of my own injury or disappointment. It is, to me, simply part of being a humanist – to treat all with as much empathy and compassion that I can.

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Compassion can be present in all things, at all times

Secondly, I challenge the notion that we can only feel compassion in the light of suffering or misfortune. It can be present at all times. It can be an underpinning ethos of an action, of an individual person, a whole company or even a whole country. Compassion can be the basis of parenting methodology, of an approach to care work, the foundation on which governments can formulate legislations and legal frameworks.

Far from being simply something a person just feels and experiences, compassion can underpin social constructs and inform our approach to human interaction. Just take a look at compassionate farming and industry, the thankfully evolving approach to caring for care professionals and the compassion that is evident in the infrastructure of some parts of the world.

Compassion for ourselves

Thirdly, and most importantly to this post, who decided that we can only feel compassion for others? Demonstrating empathy and having compassion for people is, of course, important, but what about ourselves? Why are we surprised to have a generation of self-critical, over-analysing, anxious and neurotic youth when many of us were raised in a target-centered sort of way?

Even in my own childhood – happy and loving as it was – I remember agonising over future career options and choices as a tender-shooted teenager. I remember receiving house points for Bs and above, and not only that, but I remember us losing them for poor scores or failed tests. My formative years were a far cry from the days of corporal punishment in schools and few opportunities and options, vocationally speaking – thank goodness!

I do think, however, that the growing focus on playing to kids’ skills, levelling academic playing fields to be more inclusive, and sharpening the focus on life-skills and social studies is a move in the right direction. School shouldn’t just be about tests, grades, homework and getting told off. It should be about discovering your talents, honing your skills, finding your strengths and being allowed to pursue them.

We’re having to improve our self-talk and ingrained neuroses, and most of us are doing badly.
I digress.

We should teach compassion

What I’m really saying here is that there is more to be learned in schools, and at school age, than academia. Students need to learn about sex and consent, self-defense, gangs and radicalization, voting and politics, equality and diversity, drugs and alcohol, mental health and illness and compassion. A whole generation of us are having to learn how to improve our existing self-talk, to learn self-awareness and mindfulness, and we’re having to do this as adults. Adults with ingrained self-loathing, neuroses and results-driven aspirations. It’s hard, and most of us are doing a shoddy job.

Most of us, at some time or another, find ourselves caring for someone else. That might mean becoming a parent, or undertaking a career in healthcare. It might mean having an elderly relative to look after in their last days, or maybe supporting a partner through an illness. It’s important to say that most of us undertake these care-giving roles, especially for loved ones, unbegrudgingly and without question.

Pouring from an empty cup

Certainly, most of us fail to truly examine our own needs when faced with someone we love who needs looking after. Doing so, in fact, brings with it a sense of shame all by itself. This is what we mean when we say “pouring from an empty cup.” Many of us are so ready to give of ourselves, to share our resources, to leap in to catch our loved ones, that we forget to check first with ourselves: can I do this? Am I well enough? Will this injure me?

Whether you have a broken arm or not, when your frail, elderly relative stumbles, you’ll reach out to catch them. This is, of course, without question. It cannot be helped or changed, and the more ingrained in your nature self-sacrifice is, the more you risk suffering yourself.

Compassion in care work

I tried to care for people as though they were my own family.

My first job at the tender age of seventeen was as a community carer. This involved teaming up with other carers and delivering personal care, practical assistance and providing stimulation for the elderly and infirm in their own homes. A couple of years after that I moved into residential care work, working in two large local care homes.

I don’t feel conceited when I tell you that I was good at care work. I took delight and a great deal of pride in my work and I was well-liked by the residents in my care. Obliging, fast-working, dedicated and with a firm sense of integrity, I performed my duties to a high standard. I tried my best to pour tenderness and compassion into my work, trying to approach the people I looked after as though they were my own family.

The first home I worked in had serious staffing and care quality issues that began to eat away at staff morale like a dry rot. Standards began to slide, training became sloppy and the attitude towards the people living in the home began to change.

Maybe you’ve been one of the many people scowling in disgust at the evening news when care homes have failed inspections or care workers are exposed for being negligent or unpleasant to their charges. I can understand how that is abhorrent and I’m not sitting here trying to suggest that the neglect and abuse of service users is ever acceptable.

I want you to understand though, that more often than not, and in my personal experience, the systemic problems that exist in the healthcare sector eat away at even the best care-giving staff teams.

Compassion fatigue

Maybe you feel confident that you wouldn’t become a cog in a diseased machine. Perhaps you simply can’t imagine how someone with any common decency or ounce of compassion could find themselves failing people they have a responsibility to care for. I can understand how it might be difficult to imagine how anyone can, at best, be idle or complacent in the face of even the most low-level neglect or abuse.

Let me tell you – it’s not as simple as having integrity. When you have twenty dependent people you’re expected to have washed and dressed before breakfast, you rush. When your concerns and whistleblowing are met with cool disregard or complete invalidation by management, you quit trying. It is possible to reach a psychological overload whereby your capacities for processing emotion, experiencing empathy, and even for viewing people in your care as individuals become impaired.

From outside? You might seem lazy, even unkind. Inside? You’re so stressed and spread thin that you feel like your feet scarcely touch the floor. I was once expected by management to continue working despite having a migraine. I was so under the boot of the care system and so indoctrinated into the insidious culture that existed there that I did it. Pausing occasionally to be sick or have diarrhoea or take a seat until the vertigo passed, I finished my shift.

I worked through that migraine and what did it get me? Nothing. Just a visit to A&E later that evening. During that shift I absolutely did not care about my residents. They were to-do lists. They were in the way. Their needs, their requests, a pain in my arse.

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Burnout

Compassion fatigue and burnout can erode the integrity of even the best care workers.
The day I pretended not to see a lady trying to get my attention was the day I decided I had to leave. Every day she would visit the bathroom after lunch. She couldn’t do it alone. I had been told off for failing to finish my rounds before breakfast and criticised for taking too much time feeding people their breakfast. And I was experiencing what I now know was my first severe episode of depression.

I ignored that lady because I felt simply too exhausted, overloaded and checked out to take on one more single task. I watched as others did the same thing, and I took her to her room thirty minutes later because she was upset. She had wet herself. I felt like a monster. That poor woman…I had neglected her.

Sometimes, you just can’t

I’m telling you this because that day I learned something. It took me a while to learn it, and I’m only benefiting from the lesson now. I learned that it doesn’t matter how much you love something, or even someone. It doesn’t matter one bit whether you’re a good person, whether you’re willing to support someone, or whether you feel terribly guilty for being unable to. Sometimes, you just can’t.

Sometimes, even the best, most compassionate and robust of us can burn out and experience compassion fatigue. Your mental health (or, rather, lack of mental wellness) runs rampant and simply overrides your good nature. Trust me, if your brain decides that, nope, this is too much, it will take the wheel and wreak havoc with your emotions, possibly even turning them off altogether.

Compassion fatigue can happen to anybody, and I feel sure it’s a self-preservation mechanism. You’re overloaded, your reserves depleted, your cup empty, so you shut down. I’m no professional, but the signs of compassion fatigue I’m familiar with include:

Signs of compassion fatigue

Difficulty in prioritising and decision-making. Trivial or less important matters become a much bigger deal and you feel powerless when it comes to making big decisions.

Depression and fatigue.

Becoming uncharacteristically inattentive or not picking up opportunities to demonstrate care-giving.

Missing cues from people in your care, failing to seize opportunities for empathy and connection and not seeming to notice things.

Routine breakdown. Neglecting self-care or falling out of established routines, such as working out, rising & retiring times and regular meals.

Denial, or complacency facilitation. Maybe you keep insisting you’re fine, batting away suggestions that you’re struggling. Maybe you make excuses and find explanations for the way you feel or for expectations you’re struggling to meet.

Lack of enthusiasm and feigned emotion.

Defensiveness.

Resentment that you might not even realise is there or that you try to suppress. Perhaps this comes about because you’re trying to meet the increased needs of someone else, whilst feeling your own needs are being neglected, and perhaps becoming more pressing.

Disinterest and non-responsiveness to the difficulties or crises being experienced by others. Providing responses and reactions that are, overall, tepid. Failing to acknowledge the seriousness of a situation or disclosure made by someone. Providing inert, non-practical and inadequate support.

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“At least” thinking. For example, upon being told by a loved one that they are feeling suicidal, providing reasons they should not feel that way, “At least you have a loving family, what about my feelings? You’ve got so much to live for…” etc.

Poorly demonstrating your needs. Acting out or seeking attention in non-productive, even provocative or negative ways. You have needs that you might not even be acknowledging, let alone be meeting. The compassion-exhausted person expresses this poorly, by indulging in impulsive behaviour or becoming controlling over the person they’re caring for, for example. Sometimes this can seem like harmlessly “letting off steam,” but it tends to happen more frequently and with increasingly detrimental effects on your relationship with those in your care.

Snappiness and short-temperedness.

These are, of course, just the ones I have observed in others or experienced myself. It is by no means an exhaustive list. It’s important to understand what compassion fatigue is as a mechanism and how it comes about for you personally. Some can give and give and give of themselves with seemingly bottomless reserves. Another person can struggle to cope with any compassionate load whatsoever.

The good news is this: once you understand yourself a little better, learn to acknowledge the unique ways you become psychologically strained, and find ways to manage your mental reserves, the better your stamina and strength will be when handling compassionate loads, and thus the better your care-giving will be.

Ask yourself just a few questions

What makes me vulnerable?
In what ways are you sensitive? What upsets you when it comes to your care-giving role? What do you dwell on? These are the things that make you vulnerable to stress, mental exhaustion and burn out, and therefore the things that need managing.

What makes me robust?
We all have different strengths and abilities. Your unique character and outlook might provide aspects of vulnerability and fragility. But there will also be facets of your personality that are your biggest strengths. You’ll be surprised how often these traits might make both lists! What helps you cope when you’re feeling stressed? What is your coping style? Do you laugh things off? Does seeking support from others help you?

Am I looking after number one?
If you are not looking after yourself, you’re looking after nobody as well as you could be. You should be eating properly and regularly. Drinking lots of fluids. You should be indulging in at least a few hours a week just to yourself. With no thoughts, considerations or worries about anybody else. These moments might be hard to find, but you must. Never underestimate the healing power that lies in a day home alone with the radio on low, the telephone off, and just doing whatever pleases you most.

Do I need help?
Some of us need more support than others, and that’s absolutely fine. There’s nothing wrong with needing a little help when it comes to looking after others. Just because you’re someone’s parent, partner or best friend, that doesn’t automatically make you qualified and able to ‘fix’ them all by yourself, even if you desperately want to. Reach out.

What will help me?
What are your needs? Are you meeting them? How can you make sure you are? Do people know what your needs are? Have you been clear with your support network what you need and expect from them? Make sure you, and everyone around you, knows what to look for and how to help.

Compassion for one another

Compassion fatigue and burnout happen to the best of us. But with a little compassion for one another, and much more for ourselves, we can help one another be great! None of us can do all of this loving and caring alone. We should not feel that we must bear massive emotional loads by ourselves. None of us should feel troubled and brought down and endlessly ruminate about our compassionate work load. Work and caring for loved ones should not make you ill.

Replenish.
Recharge.
Look after yourself.

You can read more from Jody Elford on mentalbabble


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