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Caring for the Caregivers
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Paula David, MSW, Coordinator, Holocaust Resource Project, Baycrest Centre

How to Deal with Stress and Potential Burnout

Providing Psychological Care
Listening to Holocaust-related narratives - and also silences about these events - can be at once challenging and rewarding for professional staff. Many Survivors respond well to caregivers who listen to their stores. This is a way for them to share their War-time experience and also to seek much-needed emotional support and empathy.

Listening with empathy and reacting appropriately can be difficult one who is giving professional care to an aging Survivor. Some clients and situations are so complex and upsetting that staff might wish to withdraw and not respond at all.

All staff who work Survivors should understand and recognize the impact of this phenomenon which is known as "counter transference." Witnessing the depth of pain, loss, fear and anger among Survivors and their adult children can be traumatic. It's not unusual for professional care providers to themselves feel helpless, angry, anxious, sad and even guilty. So long as these responses are recognized and appropriate supports are available, the burden should not become overwhelming.

The process of providing empathetic listening must be balanced with planned supportive team review and ongoing support, both from colleagues and ongoing professional development. All staff should have a colleague, supervisor or team member to provide opportunities for debriefing, support and collaboration. It is well documented that clinicians, in order to work effectively with victims of violence, torture and/or abuse, require ongoing professional development, smaller caseloads and collegial support. Holocaust Survivors belong in this category, and the professional staff must recognize the burden of their stories and the necessity for support in order to maintain clinical competence.
Providing Physical Care

Staff performing clinical examinations or procedures should know - in advance, if possible - whether a Survivor under their care experienced any abuse from "health care providers" during the War. Even if the person did not experience direct abuse, the threat was always present and real.

If attempts to provide medical or personal care are met with suspicion or resistance, staff should try to understand the source of such behaviour and avoid taking it personally. They should explain the nature of any procedure and also why it is being done. For example, if you are changing a dressing that might cause pain, let the person know what to expect. Discuss the need for this treatment and the anticipated outcome. Patients with some degree of cognitive impairment may need several reminders of this type during the course of each procedure. Be aware of the triggers that may present while you are with the patient - for example, your uniform, the need to ask personal questions, the need to remove the person's clothing an so on. A calm reassuring voice and language which helps the patient "remain in the present" can help ease the tension. Some patients may feel better if a family member or translator is present.

Families of Survivors: Emotional Impact

In many cases, adult children of Holocaust Survivors experience a transmission of their parents' early life trauma. The usual mixed feelings about changing care needs and the possibility that their parent will need to be placed in a long-term care facility is often exacerbated by the fact that they are children of Survivors. Any family would find it difficult to face a loved one's diagnosis of Alzheimer's Disease, but this may be particularly painful for Survivor families. Family members must be prepared to differentiate between long-standing traumas, recent traumas and how best to care for
Reminders: Tips for Stress Relief

The Canadian Mental Health Association and the Heart and Stroke Foundation say the following strategies can help people deal with stress:

Deep breathing exercises, exhalation breathing, progressive relaxation exercise, stretching exercises, walking, meditation, social diversions and spiritual activities

Other Ideas

Hobbies: Whether you enjoy photography, crafts, sports or some other hobby - DO IT! Build time into your schedule to enjoy these activities on a regular basis. Consider it "nourishment for the soul."

Gardening: Whether you have a back yard or live in an apartment, consider the soothing quality of tending indoor and/or outdoor plants and watching them grow. The results of your work are obvious and you can enjoy watching your flowers, plants and vegetables grow day-to-day over many years.

Giving to others: Helping others takes attention away from yourself which can reduce anxieties and relieve stress. Find an organization whose goals you support and then volunteer to do something you enjoy. Donating money to charities is very worthwhile, but you may benefit more through personal involvement.

Vacations: Taking a break, for a weekend or a month, can be refreshing, but be careful. Vacations can be stressful if they are poorly planned, too expensive for your budget or if you are under constant pressure to make decisions about where to travel, eat and stay. Plan ahead and don't try to pack too much into the time available.

Enjoy nature: Go for a drive in the country. If you live in the city, make regular use of parks and nature trails. Smell the flowers, enjoy the trees and the birds - get away from the noise of the city whenever you can.