The Demand for Carers
A number of societal issues mean that more people are living longer in different circumstances. An ageing population, the advent of the mobile phone (meaning emergency reporting is more rapid) and new and better health diagnostics and treatments, all contribute to more people living with some sort of illness or disability.
Many of these people require help with activities of daily living and increased geographical mobility and alterations in traditional family structure often mean that this care is not provided by family members but by paid carers. Paid carers may support individuals in their own homes through to providing full nursing support in residential settings.
In western society paid carers provide a great deal of the direct contact received by highly vulnerable people but carers themselves often have little support or training and their salaries are low. High turnover is common in these roles and this has been related to high stress, low job satisfaction and poorer client care. A number of highly publicised cases have demonstrated how abuses can occur in such environments.
How do we prevent harm and encourage well-being for paid carers or indeed unpaid family carers in the important role of looking after the most vulnerable people? This seems an important issue facing our society in the 21st Century.
Empathy and Compassion
Empathy is the ability to see and feel another’s world as if it was your own, regardless of whether these feelings are positive or negative. Empathy has been valued as an important attribute in caring professions. However, this issue is more complex than it seems. Those who work in healthcare are inevitably exposed to people dealing with the difficulties of illness. It seems that high empathy in those in the caring professions can be associated with stress and burnout. This empathic distress can result from emotional contagion or excessive sharing of suffering with a lack of sufficient separation between self and other.
An alternative response to this empathic challenge is compassion. Compassion is the response to suffering of others involving warmth, concern and the desire to alleviate the distress and improve the well-being of the other. Studies involving functional MRI scans have shown that compassion and empathy are associated with different neural network activations. The presence of distress in others can lead to negative feelings and withdrawal associated with empathic distress or positive caring feelings and prosocial motivation associated with a compassion response and these show different neurological correlates (Singer & Klimecki 2014). If one is subject to repeated empathic distress responses, this is likely to have negative consequences for long term health and this could underpin the relationship between high empathy and burnout in the caring professions. The good news is compassion, and the related neurological influences can be trained.
Compassion and Self Compassion Training
An important construct related to compassion is self compassion. This is simply the compassionate response directed at one’s own distress. However, the two don’t always go hand in hand. Even those good at showing compassion to others are not always good at being compassionate to themselves and I would suggest this is often seen in those who work in healthcare and the importance of these issues in this context has been highlighted (Egan, Mantzios & Jackson 2016). So is training in compassion and self compassion a possible solution to addressing burnout in healthcare workers?
Preliminary studies suggest that it could be. Kristen Neff and colleagues at The Center For Mindful Self Compassion (centerformsc.org) have developed a training program based on the Mindfulness Based Stress Reduction (MBSR) course adapted to specifically train SC skills. It is designed for use with clinical and general populations (Neff & Germer 2013) and has been found to be associated with positive well-being outcomes in student populations (Smeets, Neff, Alberts & Peters 2014), and health care professionals (Rabb 2014). I have recently completed this 8 week course and found it to be immensely useful at a personal level. I believe the Center For Mindful Self Compassion are beginning to trial adapted versions of this program with health care providers specifically aimed at the needs of this sector. This is good news.
But Will It Help Direct Carers?
My concern is that most of the literature I have seen in this area relates to trained nurses, therapists or other professionals rather than hands on carers. Are health care providers likely to invest the time and resources necessary to train compassion and self compassion in those who spend the most time with vulnerable clients but who are often seen as “replaceable” as they have little training? Of course the efficacy of any intervention needs to be demonstrated first and any compassion training in an organisation will hopefully have a knock on effect at other levels. However, this is as much a question about our values as a society as a challenge to us as positive psychologists to develop effective interventions that can be delivered efficiently to those who may need them most.
Egan, H., Mantzios, M. & Jackson, C. (2016). Health Practitioners and the Directive Towards Compassionate Healthcare in the UK: Exploring the Need to Educate Health Practitioners on How to be Self-Compassionate and Mindful Alongside Mandating Compassion Towards Patients. Health Professions Education (2016), http://dx.doi.org/10.1016/j.hpe.2016.09.002
Neff, K.D. & Germer, C.K. (2013). A pilot study and randomised controlled trial of the Mindful Self-Compassion Program. Journal of Clinical Psychology, 69(1), 28-44.
Raab, K. (2014). Mindfulness, Self-Compassion, and Empathy Among Health Care Professionals: A Review of the Literature. Journal of Health Care Chaplaincy, 20, 95-108.
Smeets, E., Neff, K., Alberts, H. & Peters, M. (2014). Meeting Suffering With Kindness: Effects of a Brief Self-Compassion Intervention for Female College Students. Journal of Clinical Psychology, 70(9), 794-807.
Singer, T. & Klimecki, O.M. (2014). Empathy and Compassion. Current Biology, 24(18), 875-878.
About the author: Sarah Monk is a student on the MAPP course at Buckinghamshire New University. She has a degree in psychology from Southampton University and an MSc in Clinical Psychology from the University of Surrey. She has voluntary roles with a number of charities and lives well with C.F.S.
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