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Caring for the Caregiver

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By Madeleine Narvilas, Esq., LCSW

“Put your own oxygen mask on first before tending to your children and their masks!” How many times have we all heard this said by the flight attendants before take-off? It’s a familiar mantra, not even just for parents traveling with kids. I was recently on a flight from Florida to New York when one obviously well meaning member of the cabin crew singled me out for this instruction, coming to my row and demanding eye contact as she asked me “Do you understand? Your mask goes on first, then you help your daughter with hers.”

I became immediately nervous. Why the extra instructions? Were we going to need our oxygen masks? What about our flotation devices? They say they’re located under the seat but I’ve never seen one. How come they never talk about making sure you blow up your flotation device before trying to help those around you? Was I giving off co-dependent vibes? (I imagined a conversation between the flight attendants – “Yes – that one! The woman seated in row 22 – I bet she takes care of everyone before herself. Did you see her helping to stow carry-on luggage in the overhead bins for other passengers? She’s a regular caretaking nightmare!”)

Ok – so my mind went a little nuts. I was tired and it had been an exhausting few days. While in Florida for an event, I’d tried to find the time during a 48 hr period to meet individually with about 20 former patients as well as run the event, conduct groups, deal with crises and generally, look after the well-being of all concerned. This brings me to the point: Clinicians and individuals who work in addiction treatment hold an undeniably challenging but rewarding role. Without proper self-care, it is impossible to remain inspired, non-judgmental, passionate about the promise of a life in recovery, and able to stand as both a guide and witness to the process of change. Not all of our patients are inclined to find recovery and those that do often find it on timetables different than what we’ve scheduled for them. The chronic nature of the illness often leads to relapse, heartbreak and the need for multiple treatments, though we do our best to provide a foundation for life-long recovery, still to be lived only one day at a time.

So how do we make sure that we remain up to the task? By seeing that our own lives and journeys are manageable. This goes beyond just not working 12 hours a day and doing enough yoga and meditation. It has also to do with looking at our reactions to patients, our peers and to doing our own work. What does doing our own work look like? A different tableau for every individual but one that probably includes one’s own therapy, support network and those folks that have the nerve to call us on our less than Buddha-like behaviors: “What!

Me? Defensive? Just because I became sarcastic and called you a mongoose. Ah! That’s right! I still can’t spot self-deception by myself. ”

After many years of being a therapist, I’m convinced that the milieu of addiction treatment is about as “parallel process” as it gets. Clinician expectation, stemming from the collective health of the treatment team, is what creates an environment wherein healing takes place. In my experience, the team whose members are continually doing their own emotional health self-care is the team which can support:

* The promotion of the belief that motivation to change is elicited from within the patient, and not imposed from the outside.

* That patients be encouraged to express both sides of their ambivalence regarding use of addictive substances/processes.

* That treatment does not involve direct persuasion, aggressive confrontation or argument; rather a patient-centered, respective atmosphere which enables change.

* That any “resistance or denial” are seen as issues of counter-transference, in which the team member is encouraged to look at his or her expectations.

Of course, it’s also important to remember to do many of things that we tell our patients in early recovery to do: Eat well, get enough rest, share your feelings with other people, spend time with those around whom you feel lifted up and supported, develop a spiritual/inspirational practice, and start to see that there are a myriad little ways to be kind to yourself and others.

When I’m giving from a well that’s full, I can mindfully accept that you can bring a horse to water but you can’t make him drink. That said, I’ll have a greater chance of seeing a patient recover if I’ve consciously seen to my own thirst first. And as they say, there’s nothing a few down dogs won’t make better! Pass the oxygen mask…

Namaste,

Maddie