Reviewing the Costs and Benefits of Compassion

April 20, 2010

by Jeanne Denney

A few years ago I did something crazy. At least some people thought so. I did a research project in which I had hospice volunteers simply sit with non-communicative hospice patients in self-defined states of compassionate presence. While they did that I measured both patient and “sitters” Heart Rate Variability (or HRV) using a biofeedback technology developed by the Heartmath Institute.

I had always felt that I developed relationship with non-communicative patients and that they responsed to my presence. Further, that patients in this state, far from insensitive, were actually accutely sensitive to people in their surroundings. I thought using Heartmath would be an interesting way to probe the vast abyss of silence at bedside of dying patients, a place I had come to know well as a vigil sitter and hospice worker to people in comatose states. The Heartmath Institute has done some intriguing research that shows a relationship between emotions and HRV. In addition, their research suggests that one person’s HRV (a measure of emotional state and well-being) influences another’s simply by being in proximity (something I think that we have all checked out experientially).

There was much that came out of that little research project (if any of you are interested in it you can read an article here (p. 11), and the full text on the Heartmath website itself The Effects of Compassionate Presence). There seemed to be fairly consistent evidence that sitters and patients had non-verbal conversations with each other and that things such as touch, prayer, meditative states and even possibly the thoughts of sitters exerted an influence on patients’ heart rate patterns. However the most uniquivocal and unexpected finding of this little project was the effect of the experience on sitters themselves.

The Myth of Separateness Debunked

Prior to starting this project, I tested sitters to make sure that they had the ability to maintain at least some heart coherence (or states of well being as seen by their HRV). As a result, I had a baseline of their ordinary states. However, out of 27 sittings with patients in institutional settings, there was not one in which the sitter’s state of well-being equalled their pre-project state of well-being (as measured by HRV). Not even close. Apparently either the setting or the activity itself exerted a strong, negative influence on sitters’ states of well-being. I suppose that this stands to reason. Many people avoid places like nursing homes, hospitals and institutions where people suffer and perhaps this is why: our very bodies register the experience and we may literally give up some of our well-being or “coherence” when we walk through the doors, at least temporarily.

What could this mean for staff who work and live with people who are sick or dying from day to day? And if one person’s suffering indeed exerts a physiological effect on another, what can it mean for patients to be grouped together in suffering to expedite caregiving? Might this outcome be at least one factor in the phenomenon of burnout that is rampant among caregivers in hospitals and nursing homes, as well as caregivers generally who work with trauma? Might it explain why most people want to die at home? I had lots of questions, and still do. Not the least of which was….

Is Compassion Safe?

We could conclude that sustaining strong empathic responses to suffering is a dangerous enterprise that perhaps will one day need OSHA regulation, something like exposure to environmental toxins. We could. Except for one thing. While it is commonplace in facilities such as the ones where I was working to see overworked staff members in institutional care that look as if they are about to either kill or collapse (certainly I experienced that myself as a hospice staff person), there are notable exceptions to this phenomenon and people who seem to defy burnout. Further, my experience in these situations as a volunteer was also often a very positive one. I often left feeling expanded and uplifted. I may have been affected in the moment, but my post-sitting experience seemed just fine. Part of that may have been my intrisitc motivation: I was there just to learn. I was there for myself and sitting with my own questions.

For the sitters that participated in the project, the report was mainly the same. It was sometimes tough to be with certain patients, but somehow most sitters processed it into good growth for themselves. Even though they had been challenged on many levels of their being, four of five reported that they would do it again because it had given them something on a personal level. This leads me to ask the quesiton: what makes the difference between some experiences, which seemed full of meaning and growth, and the apparent experiences of others who commonly seem overwhelmed and disengaged? Could the motivation of the caregiver, the context in which these experiences occur and what happens both before and after them have a lot to do with what our mind/bodies make of the experience?

Obviously the raw volume of exposure to pain and need, intense demands to “do” and document things in linear time as well as understaffing play large roles in burnout for care workers. My heart, at least, doesn’t seem to understand time pressure to care for people. True caring, in my experience, happens in a kind of time that is different than linear, chronological time. The Greek word for this synchronous or non-linear time is “Kairos” (hence the name of this endeavor). I have wondered if the lack of Kairos time to engage on a heart level itself plays a part in burnout. It certainly felt like that to me as a hospice chaplain exposed to an overload of patients in situations in which I could not possibly build meaningful relationship. When I have occasion, context and time in which to make a deeper connection with patients and families I generally feel nurtured and find a greater sense of meaning. I further have wondered about frozen and efficient attitudes that caregivers sometimes adopt, or even the sickly sweet ones. Could they offer short term protection from feelings and a certain efficiency, but could they also be factors in longer term exhaustion when the work itself is not allowed to penetrate to the level of personal meaning and growth? Research on burnout seems to support these observations, pointing to the need for flexibility, self-regulation and safe places to talk about and make sense of experiences.

Exploring the Possibilites of Growth through Compassion

Granted, these explorations were only a series of 30 minute experiences, not a series of 8 hour shifts stretching into eternity. It was intensive presence but relatively short. Still, these results may open a window of understanding on this issue yet another crack. There was something different about the sitters that I worked with. There was a sense of adventure that we shared, a sense of comraderie trying to crack the mysterious together. It felt meaningful even if it was crazy. Further, the sitters were supported by the constructs of the study, we were regulating our contact with the patient ourselves, and the short study included both surveys and interviews with the sitters about their experiences which forced self-reflection.

There are many in nursing, psychology and social work who have been working intently for years on the study of compassion fatigue and burnout. There is much that I still need to learn. But I am still crazy enough to extend this project, should I find another willing group of patients and families, and begin to explore some of the many questions it raised about the nature of our contact with others who may be dying, in pain or trauma. It seems likely to me that the ultimate effect of compassion on helpers is context dependent. Inadequately supported, effects can perhaps accumulate to be overwhelming and even physically debilitating, but when held in well-designed, supportive contexts in which we find our intrinsic motivation, the practice of compassion may be the very balm to help us heal with another into the best of ourselves in a win/win paradigm. That is one of my theories. If this is true, what might need to be in place so that caring does not become toxic to body and soul?

These are some of the questions Kairos was started to take on in concert with many others interested in these questions. In the next few blogs I will be taking up some of these questions further, and present offerings of hospice workers on their work. As always, I welcome your experiences, responses, objections, ideas and even….indeed, compassion.

Jeanne Denney is a therapist and hospice worker in Rockland County, NY. She directs the Rockland Institute for Mind/Body Education and Kairos, an organization for helping professionals.

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