Episode Summary
In this insightful episode of Palliative Talks, Kath Murray and Françoise Mathieu explore the complex layers of stress and trauma faced by frontline caregivers, highlighting how secondary traumatic stress, system failures, and working conditions contribute to moral distress. They discuss the importance of psychological safety, the power of small “micro-movements” for self-care, and the value of setting healthy boundaries—even when it means disappointing others. Emphasizing a bifocal approach, they underline the shared responsibility between individuals and organizations to support well-being, while also acknowledging the unique challenges leaders face. Practical strategies and resources are shared to help caregivers cultivate resilience and advocate for positive change within their teams and workplaces.
Episode Guest
Françoise Mathieu is a Registered Psychotherapist and the Executive Director of TEND, specializing in supporting professionals in high-stress, trauma-exposed environments. With extensive experience in long-term and palliative care settings, Françoise is also a trained hospice volunteer who spent several years providing compassionate support to patients and families at end-of-life. Her approach is deeply informed by her hands-on experience, emphasizing empathy, practical tools, and sustainable strategies for managing complex, emotionally challenging work. A TEDx speaker, Françoise is a founding member of the Secondary Traumatic Stress Consortium, chair of the TEND CARE4YOU Conference, and the author of The Compassion Fatigue Workbook as well as several other publications. She lives in Kingston, Ontario.
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Transcript
[00:00:11] (Kath Murray): Hello. Hello, Françoise. How are you?
[00:00:15] (Françoise Mathieu): I’m great. I’m so happy to be spending some time with you.
[00:00:18] (Kath): And you. Let me start with an introduction. Françoise Mathieu is a registered psychotherapist in Ontario and the executive director of TEND, an organization that supports professionals in high stress and trauma exposed fields. And I just want to do a shout out for this great organization. The education you’re providing. The free webinar you do, or full day you do usually every June?
[00:00:45] (Françoise): Right. Our care free conference. That’s right.
[00:00:47] (Kath): And I think I attended that a number of years ago in person, maybe in Kingston?
[00:00:53] (Françoise): Are you talking about the time we had a giant bowl of blueberries?
[00:00:56] (Kath): Yeah. Yeah, yeah.
[00:00:57] I still remember it. I think if we’re going to talk about health and then feed everyone, you know, all the toxic stuff, I just, I think it was just so exciting to me to have somebody talk about health and then provide such healthy snacks. Yeah, the big the big bowl of blueberries, I’ll Remember it always. So TEND is an organization that supports professionals in high stress trauma exposed fields. She’s worked extensively with health care teams, first responders, and legal professionals to promote well-being and healthier ways of working in difficult environments. In addition to that professional role, I think Françoise has also trained as a palliative care volunteer, and spent several years supporting persons and families through Hospice Kingston, an experience that continues to shape her work. My name is Kath Murray. I’m a hospice palliative care nurse, educator and author, and co-founder of Life and Death Matters and I’m excited to welcome you to the Hospice Palliative Care Ontario podcast series, Palliative Talks.
[00:02:07] (Françoise): I’m very excited about this.
[00:02:09] (Kath): Okay, so in this particular part of the series, we are focusing on integrating a palliative approach in care. When I think about that, and I think of you, and the work you have done, and I think of the work you’ve done in the past five years, and I think of the things I have heard you talk about in the last couple of years. I wonder how on earth can we talk about providing and integrating a palliative approach if we have not fully addressed the trauma of that five letter word, “Covid?” So, I wonder if you can- if you want to just reflect on that, because I’m sure there’s people when I say that word, the five letter word, that just want to gag and shut down the podcast right now. So talk to me.
[00:03:00] (Françoise): Sure. I’m going to add a couple of other I don’t know if they’re actually all five letter words, but I’m going to add a couple of words that, are generating some strong feelings and that- I promise to our listeners, please stay with us because we’re not- you know, I’m going to talk about why it’s important to look back and process before we can move forward, first of all, and- you know, another five letter word is the the P word, which we call “pivot.” Which I know everyone was totally sick of hearing about. And I also think that the words “self-care” and “well-being” and finally “work life balance” are not actually generating the type of feelings that people want. So we can unpack that a little bit better. Yeah. So you’re right. I’ve had the pleasure and the honour of working in palliative care and with long term care facilities for many, many years prior to the pandemic. And one thing that I think the pandemic caused and created, I like to use a word, the term potentially traumatic as opposed to traumatic. Right. So that’s our- we like that, we call it, you know, potentially traumatic events, because I don’t want to make the assumption that everyone was impacted in the same way by the pandemic. Although I will talk in a minute about frank burnout and frank moral distress, which we definitely saw, particularly for folks who worked in long term care. But I also think it’s important for us not to assume what the experience was like. And- and an example I could give you really quickly, Kath, is I was working with a group, in fact, who worked in long term care, and one participant said to me, “don’t call this traumatic, you don’t know my story.” And he actually is someone who came to Canada as a refugee and had experienced incredibly traumatic events in his life. And he said, you know, “this is disruptive, it’s very upsetting, but I’m not traumatized.” And so I respect and acknowledge that some people were, and I know that, were traumatized by the pandemic and some were not. And it’s a whole continuum. But certainly what we started seeing is that we’ve all been through it. So I don’t need to- I don’t need to explain the pandemic impacts on everyone listening, but part of it is that we did not have a chance to catch our breath. We did not have a chance to recover and recalibrate. And also we have a lot of unfinished grief, you know, unresolved grief of ways in which we had to care for our patients and their families that did not in any way align with what we believe are best practices and compassionate care using that palliative care lens. We also, when we don’t have enough resources, you know, Kath. There’s a term called the poverty mentality, which means that when there isn’t enough to go around, sadly, sometimes we turn on one another as coworkers. Many of you are familiar with the term lateral violence, and that usually comes because there isn’t- there aren’t enough resources, there’s not enough time. And then we end up turning sometimes on each other as opposed to rallying, if that makes sense.
(Kath): Yeah. Yeah. And so here we are. Five years later. In that context, let’s talk about, this word that you also use, “dysregulation.” Then let’s talk about those great things, about self-care and, pedicures and, things like that. Let’s get real talk to me about dysregulation first.
[00:06:46] (Françoise): Wonderful. So, dysregulation and recalibration, and I’ll explain what I mean by that in a minute, I would say are my two favourite tools. So, I work with a lot of very busy front line folks. Right? They say to me, tell us what to do. Give us actionable tools. And dysregulation refers to- it really, it’s about our nervous system. And I’m sure everyone listening has experienced a time where they were beside themselves or they were, you know, dealing with a colleague or often a relative of a patient, or even a patient, who was- they were beside themselves. And what we mean by that is that we are no longer, it’s a framework called a zone of tolerance, and we are no longer in the zone. You know, the zone is like the sweet spot that just. Right. You know, where you can deal with things as they come. And what we know is that when we are stressed, exhausted, worried, all of those things, we become dysregulated, which means that our, our nervous system isn’t recalibrating the way that it would normally do. And so an example I often give is, I’m sure everyone listening has either ever been stuck in traffic many times, or I often talk about, you know, spilling milk all over inside your fridge. So that’s called hyper arousal, right? You’re no longer in your zone. You’re you flip your lid. What I don’t think we talk about often enough is hypo arousal, which is shut down. And a shut down, I’m sure we’ve all had it, is you know, I’m exaggerating here, but you are so done that you just lie in the puddle of milk on the floor of your kitchen making snow angels, you know what I mean? Like, you are just so overwhelmed that you shut down. And so my favourite strategy is inviting people to think about what helps you widen that zone of tolerance. So for some folks, it’s food. You know, I’m sure you know people Kath, who get hangry, like they just need a sandwich. Other people, it’s exercise, other people, it’s sleep. And finally, for some of us, and, as you listen to this, I want to invite you to think about whether you’re an introvert or an extrovert. Meaning, do you refuel through solitude or do you refuel through time alone- through- Sorry- Clearly, I’m an introvert. Solitude and time alone, or time with others. And what we know is that, that can also help widen our zone. So if you’re an introvert and you’ve had a very noisy, busy time, everyone’s talking to you. You might just find like you are getting that, you know, your wick is getting shorter. And so these are all tools that anyone can use. And it’s called a zone of tolerance.
[00:09:30] (Kath): So you talked about one, flip your lid. Two, the hypo. And three, reregulate.
[00:09:38] (Françoise): Yeah, the sweet spot, and the sweet spot is right in the middle.
[00:09:41] It’s this zone, we call it the zone of tolerance, and what’s interesting about the zone of tolerance is that, it- Yeah. I want to invite people to think about this band, you know, this this margin that can be very narrow, right? Like, it’s like you’re fine, but, like, one more thing. will. Or, it can be quite wide, which means you can have your daily ups and downs. And another way to think about it is. So I’ll give you the example of being stuck in traffic. If you are about to miss a bus or a train or whatever. If you’re about to miss an important appointment, you’re of course going to be more reactive right, than if you’re just on your way for a Sunday drive. So life, it’s not about never going up and down. It’s about being able to return to baseline more quickly. And this is where the the dirty word “self-care,” which I can’t stand, I- it’s not a word I use very often. I believe in it, by the way, just so we’re clear. But it’s not about that. It’s about what are day to day things that are within my control that I can do so I can deal with stuff as it’s getting thrown my way.
[00:10:47] (Kath): Yeah. Wonderful. So- so you’ve talked about then different ways so that we can find that sweet spot. So we can return to that sweet spot, that place where we can be tolerant of whatever chaos comes our way. You wrote an article once that was just such a great title. “Beyond Kale and pedicures, can we beat burnout and Compassion fatigue?” And tell us about that and about your Venn diagram?
[00:11:19] (Françoise): So I wrote Beyond Kale and Pedicures originally ten years ago. Actually, it got me a little bit in hot water with some groups, which I’ll talk about in a minute. The reason I wrote it is that a lot of well-meaning organizations were doing what we call spray and pray. And spray and pray is, you know, it’s just so we’re clear, there’s nothing wrong with workplace wellness initiatives. Just so we’re clear. But basically, a lot of workplaces were throwing wellness at staff, but not changing anything about their working conditions. And they were hoping, you know, if I give you a smile, cookie and a mindfulness lunch and learn, but I’m not going to have any, you know, I’m not going to change anything about your working conditions. Let’s hope that that makes a difference. And of course, we know it doesn’t. And so Beyond Kale and Pedicures is an article that explores what actually makes a difference. And what we also developed is what you just mentioned, which is our Venn diagram. And we’ll provide resources to- as a companion to this. But if you all go back to good old grade three, primary school math, which is probably where I stopped understanding math. But, you know, the Venn diagram is basically they’re overlapping circles. And what I know is that, I started resisting. Also, the use of the term burnout is the umbrella term for everything. You know, in health care, we hear a lot like physician burnout, nurse burnout, health care provider burnout. And I believe that burnouts real. But I over the years realize that is not the whole story. So the Venn diagram, is a series of overlapping circles that invite each person to assess what’s actually going on for you. So if we go back to my original story of this individual saying, you know, I’m a refugee, don’t call this trauma, he had a whole bunch of other things that were contributing to his stress right now. But sometimes, you know what’s going on is related to your working conditions. Sometimes what’s going on is related to. And it could be all of them, of course. It’s related to system failures. It’s related to you not being able to do the work the way that, you know, ethically and morally, you’d like to do it. Sometimes it’s related to unresolved grief. We all know that many of us, I mean, I cannot tell- I’m sure you as well, Kath, but how many folks I got to talk to in long term care who said, I’m actually going to get, like, a little, emotional here, but who said “we did not get to care for people at the end of their life in the way that we wanted to.” And also there was no ritual anymore. And the final one is thinking about two things. Our personal circumstances. Now, I’ve had the pleasure of meeting tens of thousands of people who work in long term care. And what I realized very early on is that many of them have their own caregiver duties outside of work. And so it might be that you’re, you know, maybe you’re supporting a loved one who I don’t know, has, you know, dementia. And you’re also having to go to work. Or your loved one is unemployed, and you have all those layers. And the final circle is social cultural. So what is going on in the world right now that is directly impacting your stress? Or even, maybe some people listening are experiencing discrimination or overt racism or other forms of isms at work that are having an impact. So it’s a lot more complicated than just saying it’s the workload which could absolutely be the issue. But it’s it’s really helpful to take a minute and go through this tool to try and say what’s actually contributing to my stressors right now, because then we can develop an action plan, if that makes sense.
[00:15:11] (Kath):
Let’s just review. If I took, if I made a bunch of circles, piece of paper, a bunch of circles, what are the names that I would put on those?
[00:15:20] (Françoise): Okay. So you’re going to start with personal circumstances.
[00:15:24] (Kath): Okay.
(Françoise): Then grief and loss. And, when I talk about grief and loss, I often say, you know, big G, little G. So we all know what big G grief is, but small, small grief could be, loss of rituals, as I said before, you know. A beloved colleague is fired, or retires, or, you know, those types of, like, so grief and loss. Then we have direct and indirect exposure to trauma. And what that means is direct exposure is you, you know, are physically threatened or assaulted on the job, which sadly, we know is more common than many people think. Or you are witness to a really terrible health care crisis right in front of you. So you’re literally on the floor and something terrible happens. Indirect trauma is you’re not there, but you hear all the details from someone else, which can lead to secondary traumatic stress. Then we have, system failures, which are all the ways in which the system is not working in the way that it should. And that can lead to moral distress. We have your working conditions, which means, you know, your hours, your pay, who you report to, the quality of your work experience. And finally, the social cultural context in which we are all living right now.
[00:16:53] (Kath): So and if I made all those circles up, and some might be almost empty and some might be really full, but it gives me a very much different way to look at the stressors that I’m dealing with. What are some of the small things that have a big impact? For example, cultivating a practice of advocating for influence versus control?
[00:17:17] (Françoise): Yes, I love that. So this is actually a concept that comes out of Stephen Covey. Who many of you may know, he was, he’s no longer with us, but he wrote a great book, years ago called Seven Habits of Highly Effective People. And he had these circles. They were called the Circles of Control and Influence. And so the way to think about this are, imagine three circles embedded in one another. I’m doing a lot of circles today, but the circle in the- the smallest circle is what I have control over. The middle circle is things I have influence over. And the outside circle are things I have no control over. So there are certain things I don’t have any control over, but I feel like there are things that many of us have influence over. And influence is day to day decisions, like, who I’m going to hang out with at my breaks, if I get a break, whether I’m going to be involved in just venting about work, which, by the way, I’m a big believer once in a while that feels good. But if I’m doing that every day, but I have no control over anything, what am I doing? And then I’m thinking about things I have direct control over, which depending on what’s going on in your life, may be, might be minimal. I’ll tell you right now, when I had two little babies and a child who never slept, my zone of control was very limited. Right? So what I think is this has to be individualized, because I think that sometimes, staff- folks go to a training that feels very tone deaf to the realities of having a complex caregiver role outside of work, not having the financial flexibility or means. The circles, really help you think about, what do I have control over? And then I’m going to build on that Kath, which is talking about micro movements, and micro movements are teeny tiny changes we can make, I literally mean like 1% changes within what’s what’s possible.
[00:19:24] (Kath): 1% change. The teeny tiny things. Give me some examples.
[00:19:30] (Françoise): So I know that a lot of people are doomscrolling and are being very dysregulated by newsfeeds or constant, you know, barrage of information. And so a micro mini strategy might be that I make a 1% change about the way that I’m going to consume information, you know, the news. 1% little change.
[00:19:52] (Kath): So I might not look at it right away, or I might not look at it till after breakfast, or I might only look at it once a day.
[00:20:00] (Françoise): Yeah. And- and, you know, there’s a lot that’s called- and I know some people do shift work so you can insert something different for you, but, it’s called protecting our morning resources. So how am I going to set the tone? Another one, if I may, that goes like this first minute, you just, identify by sounds around you. The second minute you just identify physical, you know, stuff like, you know, the chair on my back, my glasses on my nose, whatever. And the third minute, you just check out your breath without changing it. And again, and, you know, we worked with a group of long term care folks who did that in between patients. And again, it for three minutes is too long. It’s fine. Make it 30 seconds. But that’s what I mean by micro, teeny tiny things. And what we know is when we do those, you know, the first time it feels a little clunky. But research has shown that when you do that 21 days in a row, it becomes part of your brain pathway. And then, even as you visualize that three minute breathing space postcard, which I’ll provide you with, it’s just a downloadable image. It helps you stay grounded into the present.
[00:21:10] (Kath): So that’s something that I could get and put on my- on my wall.
[00:21:16] (Françoise): Yeah, yeah. Or in your car.
[00:21:17] (Kath): Or on your team wall so that we can all think about it.
[00:21:20] (Françoise): Yeah. Or if you commute to work by car, you know, I know someone who, she printed it and put it on her dashboard as a reminder before she goes in, let’s anchor. And then at the end of her shift, let’s just get myself back here. Not in the future. Not in the past, but just, like, right here, right now.
[00:21:39] (Kath): So what about teams? We get together at breaks. Maybe if we get breaks, we get together breaks. We get together and passing in the elevator, etc.. What- what does this- how does this relate to our conversations?
[00:21:56] (Françoise): Right. So, you know, I talked about venting earlier. I’m not trying to be all preachy here and say we should never, ever blow off steam. Of course, sometimes that feels good, but I certainly know when I work back at that university as a crisis counsellor, a much wiser colleague than myself, she said to me, you know, “I feel like you and your friends are kind of, you know, playing the same old, record over and over again, like, this sucks and more pissed off.” And she said, “I just want to invite you to think about the difference between venting and advocating for change. And also, again, focusing on what you can control.” And so my friend and I made a decision, that we were going to have a time limit to venting. And the rest of the time we were going to talk either about things that we could control or something else. And so what I started thinking about is were there are some, I call them strategic alliances. I just mean, were there some folks I could spend time with during those small moments where we were going to both agree that we were going to advocate for change when possible, but also not just get stuck in that.
[00:23:06] (Kath): Let’s just finish with some, two things. One is, is some tips for people working in teams. And you wrote another article which is delightful in the title. “Disappoint someone today.”
[00:23:23] (Françoise): Yes.
[00:23:24] (Kath): “An invitation to make space.” Tell us about that, and ideas for team.
[00:23:30] (Françoise): All right. So, I don’t know who’s listening, but I can tell you that a lot of people that I know who are in the helping professions have a background where they are and were often the primary caregivers in their family of origin. Right. I certainly know that I was a helper long before I was a professional, if that makes sense. Right? As a teenager. And, what I have found, and this is actually from my work as a therapist because I, you know, was a frontline therapist for a long time. A lot of people in our fields have an incredible fear of disappointing other people. And so this article explores this from a personal lens. I give examples of my own story and my brothers, and what I know is that setting the limits, you know, we talk about boundaries is hard, but what’s even harder is that sometimes you decide to set boundaries and it is not well received. And often what we do then is we’re like, oh, never mind, right? Because we’re afraid of that experience. And so that article explores boundary setting without necessarily being aggressive. You know, I’m not someone who enjoys conflict particularly, but reminding ourselves that, let’s say with a colleague, you can respectfully say something. They may not like it, but it doesn’t mean that- it’s a form of- of- of brave. Of being brave. Right? A form of like courage is being able to also say, be that as it may like respectfully, this is my boundary. So it’s kind of an exploration of that, that article.
(Kath): And- and the need to see our own warning signals, and learn our own responses.
[00:25:21] (Françoise): Yes, our warning signs. So warning signs are very robust. And what I mean by that, and this I speak very confidently because I’ve done this work for so long. I don’t know about you, Kath, but my warning signs like, let’s say the top three, I mean, I’m sure many of us have more than three, but physical, emotional, behavioural. My warning signs that I’m starting to head to the yellow or red zone are always the same. And what I find, so I have a friend who’s warning sign is she gets all sorts of GI issues, you know, like reflux and heartburn and all of that. And for years, what she would do, which many of us do, is ignore or medicate as opposed to slow down. Correct? So it’s like this thing’s showing up and we’re like, oh, here we go. Let’s take some meds or let’s, I don’t know. And eventually it caught up with her. She is fine. But she was basically ignoring, you know, this health issue. That was really a stress response. So for me, you know, if you think about the continuum, like green being like your 100% great red is that you’re on stress leave. What I like to do is think about that yellow, you know, kind of green, yellow, orange red. The yellow. Like how do I know it’s starting? And everyone listening knows the first sign of a cold, right? Everyone knows. And so noticing what those are. And I’ll give you a quick example, if I may. She’s passed now, but I had a neighbour, Kathy, she lived to 107. She was such a delightful, and I- like, she wore little white gloves, little hat. Oh, she was just. And she lived on her own, next door, till she was 103. So, I mean, I think we all agree, she’s fabulous. Who would not want to speak to this person? When I was in the Green Zone, her name was Margaret. When I was in the green zone, of course, I’d go spend time with Margaret. When I was in the yellow zone, I would start, you know, thinking, oh no, there she is, outside. Like I would run into my house to avoid talking to her because I was so spent. And I’m embarrassed to tell you all that when I was in the red zone, I would take, you know, my garbage recycling out in the cover of darkness so I didn’t have to see her. It wasn’t Margaret who was a problem. It was my depletion. Right?
(Kath): Oh, yeah. Yeah. Wonderful examples. How does an organization look now at, some of these ways to help people rest and recalibrate and repair, rebuild, reevaluate. Is that- is that just an organizational thing? How do they do it? Or is that something we’re all part of?
[00:28:06] (Françoise): It’s a great question. If I had a staff who is, you know, no disrespect, but if I had a staff who was staying up all night playing video games and then drinking Red bull to get through the day, no amount of organizational improvements going to address that, right? So a bifocal approach is individual responsibility and organizational responsibility. But I want to add something here that I- often gets missed. Is that often organizations are so concerned about supporting their frontline staff, which matters, that they forget that leaders at whatever level, supervisors, managers, directors, senior leaders, they are people too and they deserve support. Many of them are exhausted, and they deserve support, and the tools in order to do this work and work with their staff.
[00:28:58] (Kath): Françoise. Thank you.
[00:29:00] It’s been good to be here. We could carry on, and I hope let’s see if we can’t just have an opportunity to carry this on another day, another way. Thank you so much. As you know, this podcast is part of the Hospice Palliative Care Ontario Education programming. So we invite people to go to HPCO.ca, for a full range of educational offerings and resources. And, we will put your resources, those articles there, the- the card that you mentioned, we’ll put that there. And please continue to join us for other episodes of palliative talks. Françoise. Thank you.
[00:29:44] (Françoise): My pleasure.
[00:29:44] (Kath): Lovely always to see you.
[00:29:46] And thank you for being here. Thank you for helping HPCO address the needs of the caregivers, informal and formal, and throughout the system.
[00:29:59] (Françoise): Thank you.
