CRSI Conference ‘2014 Dr Dermot Casey

1. Building Resilience in ourselves and the people that we work with. If all you do is work to fix problems…then by definition you are working to get people to zero…why not try to get them to plus-two, or plus-three - Daniel J. Tomasulo CRSI Conference ‘2014 Dr Dermot Casey

2. Key Messages Today. When everything seems to be going against you, remember that the airplane takes off against the wind, not with it. ~ Henry Ford Resilience is a Complex - Yet NormalProcess We are All Resilient but it is Dynamic. Building Resilience in others is what we all do each day In Our Work CRSI Conference ‘2014 Professional Caregivers can find it harder at times to build Resilience in themselves

3. Presentation is broken down into four key areas…… What is Resilience ? What current Research Tells us about it Exploring Resilience In Survivors of Irish Institutional Abuse Resilience Strengths Based Approach Positive Psychology Recovery & Thriving Salutogenetics Neuroplasticity PathologyPossibility CRSI Conference ‘2014 Why we as carers Can find it Difficult to build Resilience in Ourselves An Approach To Understanding and building Resilience

4. What is Resilience? Although the world is full of suffering, it is also full of the overcoming of it. ~Helen Keller CRSI Conference ‘2014

5. What is Resilience? You can’t stop the waves but you can learn how to surf. ~ Jon Kabit-Zinn Definition: The ability to adapt positively despite experiencing adversity. • It is always present – Dynamic – fluid- multi-dimensional Adversity - Coping One day resilient Domains - Adversities – Factors • Adaptive to Maladaptive(need fluidity and flexibility in adaptation, even to same adversity) • Vulnerable vs.InvulnerableWith Resilience – we do not maintain a steady state of competence Resilient people are not ‘Teflon” rather might be ‘struggling well’. • Resilience can (be operationalized) have different outcomes: Ongoing: an ability to cope and adapt (as best we can) to adversity. Post: the absence of long term pathology or impairment. Growth: the ability to move beyond pre-adversity levels of functioning.

6. Resilience Research In Different Contexts ? It is only possible to live happily ever after on a day to day basis. ~Margaret Bonnano • Pathogenic vs. Salutogenic Dis-ease ------------------------------ Health –ease (Antonovsky) • Positive Psychology Pathology------------------------------Possibility (Seligman) • Strengths – based Approaches Deficits------------------------------Strengths CRSI Conference ‘2014 • Neuroplasticity Remodelling – New Connections. Normal development and as an adaptive mechanism. Starting Point • RecoveryProcessGrowth Recovery Recovery

7. “Exploring How Survivors of Irish Institutional Abuse Experienced Resilience” Come to the edge, life said They said: We are afraid. Come to the edge life said. They came. It pushed them….. and they flew. - Guillaume Appollinaire CRSI Conference ‘2014

8. Life PeriodsChildhoodAdulthoodOlder Adults (In Institution) (Post Institution) (More Recent Times) Superordinate Themes Coming from Within Emergence of Self Reaching Out Sub- themesSurvival & Acceptance Identity Formation Psychotherapy (Services) Normalization & Suppression Escapism Past Experiences Adaptive Activities Imagery & Dissociation People & Relationships Hope Positive Attitude CRSI Conference ‘2014

9. An Approach To Understanding & Building Resilience If we can understand it better – we can support building it in ourselves and others. CRSI Conference ‘2014

10. For Resilience Building we need to start not with what’s missing but what we already have. Three Pillars that can influence the Resilience Process Adversities Domains Factors Resilience Risk Factors Protective Factors Influencing Variables CRSI Conference ‘2014

11. People are like stained-glass windows. They sparkle and shine when the sun is out but when the darkness sets in their beauty is revealed only if there is light from within ~Elizabeth Kubler-Ross Adversities influence our level of Resilience • Traumatic do not know how to process • Bereavement • Abuse • Accident/Witnessed. • Loss of Job • Loss of relationship. • Chronic ongoing stressor • Lower SES • Chronic Health Problems. • Out of Work cannot find work. • Bad relationships – work/personal. Influences our Level of Resilience • Single one off/infrequent • Moving home. • Have to go to Dentist. • Exam / Interview. • Lost my purse/wallet • Accumulation smaller stressors • Not speaking with my partner • My Electricity has been turned off. • I burned the dinner • I hate my job • The children are acting up. • The dog has gone missing again CRSI Conference ‘2014

12. "...more than education, experience, or training, an individuals level of resilience will determine who succeeds & who fails.” ~ Harvard Business Review, 2002 Domains Where we can access supports to influence our Resilience levels Engaging with the Community External Coping Internal Processes Self CRSI Conference ‘2014

13. Interplay of Domains In the depths of winter, I discovered in me an invincible summer. ~ Albert Camus Self Intrapersonal External Internal Resilience CRSI Conference ‘2014 Interpersonal Community & Services

14. Domains – Resilience Promotive Factors Intrapersonal • Emotion Regulation •Past Life Experiences • Awareness •Self-esteem • Cognitive Biases. •Traits. •Goals & Planning • Meaning Self (Who we are) Internal (Coping Processes) • Hope/Optimism •Locus of control •Stress Management •Attachment. •Sense of purpose • Normalization •Personality •Moral/Values • Re-appraisal •Age •Health • Escapism •Boundaries. •Identity • Flexibility •Biological • Intelligence •Self-concept • Acceptance •Culture •Attribution. •Schemas. • Post-traumatic growth • Humour •Memories • Dissociation Resilience •Previous Coping • Suppression •Family & Friends. • Psychological Supports CRSI Conference ‘2014 •Work/Career. • Religion –Spirituality. External (Coping Processes) Community (Engaging With) •Social Capital. • Belongingness. • Mentoring • Self - care • Education/Schools • Helping others • Autonomy • Goals/Planning •  Health • Sports • Family Roles • Support Groups. • Physical Activity • Services • Social Media • Technology •Environment • Hobbies & Sports • Communication • Romantic Relationships Interpersonal • Voluntary Work / Altruism

15. Factors – Influencing Variables that can influence our Resilience Process Our greatest glory is not in never falling, but in rising every time we fall. ~ Confucius Self-esteem Self-value. - Value for our children - We know what solution is right for us - When we fail we recover much quicker Flexibility In the way we think & Behave - Adversity - when it occurs in life-cycle - All coping domains / combination. - Acceptance / Proactive Impact on Our Resilience Levels CRSI Conference ‘2014 Context Significance to me - When it happens in life - age? - What significance does it hold? - Why it happened, natural v traumatic? - Have I access to other domains of coping? Awareness Of me - Adversities – context of same. - Strengths and weaknesses. - What is available coping (previously) - Self-awareness e.g. moods

16. Three Pillar Resilience Process – Conceptual Model FactorsSelf-esteem Flexibility Domains of Protective Factors Adversities Accumulation Internal Self Turning the Dial Resilience Single You Traumatic External Community Chronic FactorsContext Awareness

17. Our Resilience Level is Dynamic – e.g. Death of a Loved One . Self-esteem (low) Old Coping Strategies (inflexible) Adversities Domains of Protective Factors Accumulation Community Single Resilience Limited Self Internal Resilience Traumatic Chronic External Context (significant) Awareness (limited) CRSI Conference ‘2014

18. Resilience Cog. Dynamic Nature of the Resilience Process Resilience at correct levels CRSI Conference ‘2014

19. Professional Carers & Resilience All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship. (Hilfiker, 1985) CRSI Conference ‘2014

20. Barriers to self-care in supporting the Resilience Process • Must do it all to get ahead - expectation is that workaholism is rewarded. • May seem self-serving - peers may question my professional dedication • Lack of awareness of needs and it takes a lot of hard work and discipline. • Do not know how to do it. and the belief that our training insulates usfrom risk CRSI Conference ‘2014

21. Associated Professional Hazards (Adversities) Vicarious Traumatisation – Secondary Trauma – Compassion Fatigue – Burnout In the same way that paint splatters on the painters and dirt under the gardeners nails, working with peoples trauma / adversity leaves a mark on us as well. ….too often our work becomes our life. At the end of our working day, having given so much of ourselves we feel drained of the desire for more relationship. ~ Irvin Yalom • One-way intimacy nonreciprocal, ambiguous loss. •Empathetic Imagery– role of eye-witness – in the first person. •Utilizing the person of the professional as a therapeutic tool. • Insufficient feedback successes - might only be laying seeds. CRSI Conference ‘2014

22. I have always been better at caring for and looking after others than I have been at caring for myself. But in these later years, I have made progress ~ Carl Rogers, 1995 - Aged 75yrs Inhibitors (Of Resilience) for Professionals It may seem ironic that in caring for others you need to put yourself first………. • Trained to be externally focused(Focusing on ourselves is like driving in reverse) • All ‘cared out’ - emotionally depleted. (All Caregivers are high-intensity relaters) • Stereotypical professional image of caregiver– we are the strong ones. CRSI Conference ‘2014 • Paradoxical Skill - attach – yet distant– than separate – ambiguity. • Successes a lot of the time are intangible – and if tied to self-esteem. • Covert nature of the work - confidentiality, nature of the work.

23. Factors that can influence (Professional) Resilience. “Self-care is Healthcare” ~ Hannah Braine Awareness Benign self-observation Prelude to self regulation Self-esteem The Imperative of Valuing Yourself Flexibility The key to sustained happiness, health and longevity is flexibility – Duran Context For me context is the key – from that comes the understanding of everything - Noland •Professional Strengths / weaknesses. •Emotional Depletion Levels •Bringing the office home (How Much?). •Developmental wounds •Personal vs. Professional. •Reflective Practice. •Who I am? •Note our successes. CRSI Conference ‘2014 •Rigidity: Oak Tree vs. Grass •Several ways to climb a mountain •Variety in my work. •Peer Support / Supervision / Learning •Stage of life / Career • Current environment (Prof & Per). • Changing times…. • Acceptance

24. In conclusion…… Ring the Bells that still can ring Forget your perfect offering There is a crack in everything That’s how the light gets in. ~ Leonard Cohen I came to you with sight but you showed me how to see. - Client CRSI Conference ‘2014 I came to you with sight Resilience but you showed me how to see be Resilient

25. Contact Details E-mail:caseydermot@eircom.net I can confirm that there is no conflict of interest with any financial organization regarding the material discussed in this presentation.