This fantastic podcast is brought to you by one of your fellow listeners! Sarah joins us because she sent in a question about Compassion Fatigue and Motivational Interviewing. We dive deep into answering this question for her and all of you!We discuss:Where Compassion Fatigue comes fromBeing “other” centeredAccurate EmpathyHealthy BoundariesSympathy, Empathy and Compassion-what’s the differenceand much more!Want a full Transcript? See below!Tami Calais: [Welcome to the conversation.John Gilbert: Hello everyone. Welcome to another podcast with the IFIOC team and we have a guest today. Sarah Cameron, if I’m saying it correctly, oh gosh, I thought when I, I thought that was what it would be, but then when I read it up top, I was like, I’m going to try it. Anyhow. Last year you spent in Spain, John.Literally. He has Sarah. Thank you so much for joining us here today. Um, [Motivational Interviewing I, sounds like as a, as a backdrop in there quite a bit. So you’ve been even more immersed in it. So it’s interesting to hear that perspective too, if you want to bring that in, um, whatever you would like to explore, it is completely, your field to do so with Casey and I.So with that in mind, Sarah, what, would you like to say, what are you curious about and what would you like to explore?Sarah Cameron: Well, first off, thank you so much for having me. I have become quite the Motivational Interviewing geek, and I look up to you all very highly. So, uh, this is like meeting with celebrities to me. Um, so I’m very [How does compassion fatigue fit in with Motivational Interviewing?Um, well, I come to you with questions that kind of come from a different webinar that I was watching actually two different webinars. And they had someone on who was talking about Motivational Interviewing, um, and they were talking about, Motivational Interviewing in the health coaching world? And someone brought up compassion, fatigue, And it really got me thinking, I wonder where compassion, fatigue actually fits in to Motivational Iinterviewing, um, and I kind of wondered if you’re truly, honoring autonomy and if you’re truly empathizing, how does compassion fatigue build?So that’s kind of my first question.Casey Jackson: Well, there’s at least an hour and a half conversation. That’s brilliant. [The first thing I always say is that there’s so many good, smart, Motivational Interviewing trainers out there and, you know, and all of us have kind of our own take on. And some of the, some of the kind of similar takes in different takes on things. One of the things that I had to a chance to talk to bill Miller about, I actually had a, um, I always say this, this is a social worker.I was so excited when he and Steven Rolnick were writing about compassion. And as a trainer, I’m going, why the heck are you writing about compassion? Like, it is hard enough for me to get people to really understand accurate empathy. And now we have metrics around that. Why are you introducing compassion?Is it necessary to, we really be talked to compassion if we have accurate empathy. And this kind of gets to your, a little bit of an answer to your question, what [But he’s a part of my concern is I can train a used car salesman to express accurate empathy that doesn’t make it motivational interviewing the used car salesman can understand who you are and what you’re about and what you want and not share anything about themselves and get completely worn into your reality and use that to, you know, make a sale and.He said that’s, that’s not motivational interviewing. So we have to look beyond that. He goes, and I don’t care if we can ever measure compassion, it needs to be part of the conversation. So what he said with compassion is compassion is that thing that gets us up in the morning. That makes us want to kind of, you know, improve our corner of the world.And when we see people that we just have that compassion, and this is where it started for me, it kind of came to an answer with what you just asked, [That well of compassion side of you should get filled up from things like spiritual pursuits and recreational activities and family and friends and, and things that just fill you up inside. And that’s what that keeps that compassion well full. But if that’s what you’re expecting to get from your clients, that kind of, that well of compassion filled up that’s I think what he’s alluding to is where compassion fatigue comes from..What I’m going to, what I’m going to take that part of that response. And that is something that struck me recently that I’ve been thinking about. I was in, an amazing conversation with, this woman, Theresa, first nation, um, individual out of Minnesota, actually. And I just worked with her this week.One of the things we’re talking about from a cross-cultural perspective. And when I was talking about empathy, because she was talking about, I’m [Empathy and compassion fatigueSo I love that. And so I think with compassion fatigue for me, what I think of from that angle is. Empathy is such an amazing skillset and something we can master. And the more we focus on our mirror neurons and really work on, we can get really high, accurate empathy from this compassionate perspective, but I don’t, I can get tired when I go on vacation and go to a different culture.But every day I wake up excited, ready to explore new things. And even at the end of the day of my feet are tired and I’m exhausted. And maybe the food isn’t sitting well with me because it is a different culture. I still wake up the next morning. I can’t wait to go. And so I think from that perspective with empathy, um, I don’t get exhausted [That’s just me. And so this is why I’m not going to project compassion fatigue on to anyone else and, and how it could be a natural part of Motivational Interviewing or not a natural part of Motivational Interviewing. But what I think of is, is discerning between those two constructs, I think is helpful and looking where the fatigue is coming from is helpful.I think sympathy is exhausting. Because sympathy can have a sense where we’re disempowered often, like, I don’t even know how, you know, I can’t even imagine how you feel. I can’t imagine what it would be like in your situation. I don’t, I’m not even sure what to say. It just, there’s almost this sense of helplessness to sympathy.And I think people can confuse sympathy and empathy or the energies around them. And I think constant states of being sympathetic can be exhausting emotionally for us. And for me, empathy can be so stimulating. So I think looking at those three constructs of sympathy, empathy, and compassion, I think it helps us get clearer.Where does the fatigue come from? And [I can’t do this anymore. It’s just draining me and, and healthy stretching of ourselves and growth that can be emotionally taxing. But there’s something incredibly growthful around it at the same time. So I’m just going to spit all of that out and just see what your thoughts or reactions to the context that you were listening to that.And so I don’t know if that’s helpful or not, but to kind of clean some of that.Sarah Cameron: Yeah. That’s, that’s very helpful. And it actually gets me thinking about, you kind of presented the idea that, it’s different for each individual and that’s how they work through, or maybe avoid compassion fatigue. Um, it also gets me thinking about there’s an article out there by, Roger neighbors.His name is, and he talks about a switch. And it’s an empathy [Casey Jackson: One of the basics that I, when we’re talking empathy and sympathy is just, I get people get really, really clear about being in the non-negative way, just self centered versus other centered. And when you think about it, you can’t sustain being other centered for vast periods of time.Because we have our own needs that we need to pay attention to. So we can’t be other centered exclusively at all times. There’s there’s times that we have to be self centered just with whatever we’re talking about with nourishment, whatever it is. So I think that. When we look at context, because I know, I know your brain well enough to go.It’s like, I just don’t want the pat answer or just kind of what the [It doesn’t mean we’re getting clear about who this other person is. It just means we’re reflecting words if we’re not going deeper into their experience. So I think that may be partly what he’s referencing to that it’s like, that’s just a space. And then, then when the person doesn’t feel heard and understood and we keep reflecting, then it’s just like, oh, that’s just an awkward place because it’s not self-centered and it’s not other centered.It’s just kind of this no man’s land that I think can be exhaustive as well. So, I don’t know if that fits from what you read or not, but that, that’s where my brain kind of goes as I deconstructed it.Sarah Cameron: Absolutely. I hadn’t thought about that toggle switch in that way, either that, if you’re in the middle as the whatever clinician, coach, psychologist, whatever you are,[Um, and you can’t like, you’re saying, if you’re not over to, on the empathy side of that switch, you can’t do complex affirmations that, kind of build, build that reflection, build your understanding of that person.Casey Jackson: What struck me when you were just talking about that too? Cause I’ve been obsessed with mirror neurons for the last chunk of time and, and just the source of empathy from that.And, you know, there’s controversy around and then there’s some, some strength around it as well too. But I think even that I would just struck me as we can get tired. I mean, we get tired of staring at a computer. You know, we can get tired and get, uh, you know, a writer’s cramp in our brain or in our hand, when we just focused on something, focusing on your mirror, neurons for long periods of time, if you’re not used to exercising, that can be exhaustive of just trying to be so focusing that concentrated part of your brain.Of course, there’s [You just feel weaker and weaker and weaker and more fatigued and more fatigued and more fatigued. So it’s just like, I think the, the general stereotype with compassion fatigue is it’s breaking me down. Like, I just can’t do this anymore, or I just need a break from this. And which I think is absolutely real for people, but I think understanding what it is and what is, where is it coming from? I think is very helpful. And I, I think that’s, that’s part of that. Self-assessment self-awareness as well too. And I think it’s just like this, I think there’s a semantics aspect of it too. Is what are we really talking about?Sarah Cameron: Yeah, you’re bringing up a really good point right now, too, but it’s been rolling through my head and I wanted to bring it up.Burnout, Trauma and compassion fatigueSo I’m glad you did that. There has to be a difference between burnout, [Casey Jackson: I think that was such a smart way to look at it. Because when you think about it, it there’s reasons why people write about those differently.But I think just like sometimes empathy, sympathy, or empathy and compassion tend to get a little bit smushed together and they kind of make an amalgam out of it. And it’s like, they are distinctly different. I think there is a Venn diagram there. But I think there are also distinctly different energies with that because you know, the secondary trauma things that we can experience, that that’s just a different thing that’s happening within us.Um, versus the just absolute burnout versus the compassion fatigue, because you don’t have to have compassion to get burnout. You know, you can be an accountant and get burned out. You can get, it can be any professional, get burned out, um, which is a distinctly different thing than the compassion fatigue. And, and it is because I think why this is so relevant.I mean, why, let me bring this up so relevant to Motivational Interviewing, because what we’re [It’s just, that’s, that’s, that’s a lot to manage. Um, it’s like, I, I can’t remember if I showed these pictures. When I, when I was doing the, the Motivational Interviewing Competency Assessment training. With you, but I, I showed these three pictures with equipoise. You know, there’s, there’s a woman who’s in this position where she’s just standing on her head, littered with her arms, to the side on her head only, you know, and it just think that weight support it on there.She’s a perfectly balanced. And though the guy who’s kind of squatting on one [It’s just because you’re strong and good at it and have mastered it doesn’t mean it doesn’t cause exhaustion in their body, um, or cost something in their body. And you have to get on, you have to shake it all out. Whenever you’re using muscles that concentrate, and this is John’s area of expertise, there’s going to be some wavering.There’s going to be some muscle exhaustion from that. And so I think that’s where you get into, is it a burnout thing? Is it a fatigue thing? Which is again, completely different than if we’re experiencing secondary trauma or, um, some of those things that can happen. You know, as we’re listening to people’s struggles, I know John wants your thought this the most quiet.Not heard you, so, uh, any thoughts John?John Gilbert: You’ve had a lot to share, so it’s like, and then Sarah’s our guests. So there’s a lot that she’s sharing. That’s very interesting. Um, there’s a million [What you just brought up is critical. What are we even talking about? Right. Like, there’s, I’m just completely humbled to anyone that’s listening. That’s there’s people that get their PhDs in what we’re talking about. Right. That go deep into things like what is compartmentalization and Casey, you’re talking about, where is there this, you know, boundary of sorts that I’m interpreting and where is there this working out of building that capacity?That well of compassion, right? These are things that go well beyond the professional world, into. How much do you feel compassion for other human beings at all? And what are we even talking about when we’re talking about that and what is burnout versus compassion fatigue?. I mean, I could take a guess from what I’ve looked into, but that is, I don’t know exactly in Motivational Interviewing.It’s that their agenda matters more than your agenda for them in [And it’s up to you to figure out a way to not build resentment around. And that’s really hard to do when you’re relying on the stability and security of a certain kind of a job. Um, and you know that world and you’re comfortable with that world. And or if you’re in a certain relationship or whatever it is, there’s a certain level of how do you care for another person while still caring for yourself that Brene’ brown and other people talk about, which is self compassion.So are we talking. Compassion, always for someone else in like an Motivational Interviewing thing. But then when you’re a real human to not build resentment, you got to build up a well of your own compassion. And when we have so much depression and antidepressive drugs and the amount of suicides we’re having, [There’s also, so that’s the working outside of it. That takes time and effort, which I totally have dropped off on doing that style of meditation. I started to keep up my other, that takes time and effort. So you’re asking someone to do time and effort when they’re already probably exhausted in some way.Now I’m supposed to make new friends or something else. Now I got to do this can’t I just get some relief and get some boundaries up. I think that’s where this conversation goes is to that like boundary isolation, when really it’s about compassion is about in my layman’s. [It’s loving and caring and, and that loving kindness book that Dr. William Miller wrote, who’s the, one of the main people in, Motivational Interviewing, that’s what it’s about. The context is going to matter. Your belief systems are going to matter, and I’m talking at a really way, zoomed out version, but all that is going to matter to how I see you and how I treat you.But to me, all of the, well, you were talking about building up that well. I think could get a lot more, uh, attention for exactly the sorts of things we’re seeing happening in the world right now to have more of that well, of caring and loving. And then from that place, how do we set up our own healthy boundaries for our limits of where we get whatever that is to stretch too thin?Like you were talking about Casey. And then last but not least, how do we create environments and practices with our people or our work environments around us that help us build that muscle that help us [I mean, the Jonathan, the guy that we had on from the social worker podcast has a great podcast on the difference between trauma and stress and, and recovery with post-traumatic growth, you know? So I’m wondering what you’ve [Sarah Cameron: Yeah, and I actually did some digging, um, and I did some well, yeah, I guess just sticking into different various. Definitions that people have of compassion fatigue. Some people just call it empathy overload, like you’ve just spent empathetic for way too long and it’s just built up over time. Um, and you’ve just kind of reached that limit.Um, whatever that limit might be for each person. But the definition that really troubled me as far as how it aligns with Motivational Interviewing, , I don’t know if I’m saying these names, right? Fegley and STAM. They say that empathy, or I’m sorry, that compassion fatigue is experience of deep empathy for a person’s suffering coupled with a desire to resolve their misfortune or remedy their, their plan. In my mind, I didn’t understand how that fits with Motivational Interviewing because if you’re truly being, [Casey Jackson: Yeah. Your desire is to help them resolve their stuff. That’s that’s the slight modification is just that, you know, the desire is to help them.Resolve their ambivalence in a way that aligns with their values and their goals and the target behaviors. I mean, that’s, that’s your best case scenario in a guiding situation? I don’t know if there’s, I think there might be something here. What hit me with the guiding. I was just thinking about one of our definitions we used in the Motivational Interviewing Competency Assessment in the, in some of the first iterations of it had to do with, um, kind of helping someone whose ship is off course or stuck or lost, or has no course.And traditionally what people tend to think of. And I, we really talked about this quite a bit is that our natural instinct as a helper is to kind of take the wheel, and [So why are you stepping in and taking their wheel? There’s a disempowerment from that that, that I know better than you or I can do better than you are here. Let me show you how to do it, which is a very egocentric perspective or self centered perspective. And what we talk about is to be an expert navigator.You have to be aware of how the captain thinks, but you also need to be aware of their destination and aware of the here and now of what’s going on with the tide and the weather and things like that, and not lose sight of where their treasure or their destination is. That can be exhausting, but you never go and take the wheel.And I think that, I don’t know if that gets to what you’re talking about or put some words around that construct to get a little bit clear about what are we trying to do, because some of these things do overlap. But in my mind, when I think of motivational and I’m training on it, there’s some of these things really need to be differentiated [How you embody that, or how do you try to operationalize that? And that, that will make a big difference. And especially when you’re thinking about things like the difference between burnout or trauma or, fatigue, or just, it was a good workout. I, the other thing you said that really struck me too. That kind of the chronic exposure to empathy, is what does make sense to me is even if I love to travel, if you know, I go on a, uh, a month long trip and get home and unpack my suitcase and pack it again and then leave the next day for another one month trip and they get home and come home for a month and unpack, like, if you don’t have a home base to just kind of just relax for a minute.Yeah. That would get exhausting, no matter how much you love to travel. But that shouldn’t be motivational interviewing either because what any of the, any of the great minds in Motivational Interviewing would say is not every conversation is or should be motivational interviewing. Not every conversation needs to be highly empathetic.It’s it’s we pull it out [ But then there’s just kind of our take on, or my take or John’s take on this is this kind of adaptation the way that I look at it from my experience and the way that I apply Motivational Interviewing.John Gilbert: Yeah, I’ll throw in here, Sarah too. I’m curious more of the research you’ve done. You’re looking at the notes, super prepared. It’s wonderful.Sarah Cameron: I’m telling you I’m nerdier than you can even imagine.John Gilbert: It’s a wonderful John do imagine a lot with dirtiness. Trust me. You can totally imagine. That’s the one thing with, with this too, that comes back to something like talked about a lot. Occupational therapy is bandwidth and that’s the well, that’s the whatever and different people are going to have that differently in some people, uh, you know, as kids you tell me are [It’s like, it’s so different and I don’t know. There’s people that could be listening to this. And I’m just recently reflecting on some, uh, with the organization we’re working with the amount of difficulty of the situations they’re facing of aggressive to passive aggressive, to just, it’s not even, you could say you could relate it to compassion, but you could relate it to empathy.It’s that? It’s this sense of being attacked and a belief around that that you can know it’s not about you, that you feel for the person. And yet I continue to get attacked day in and day out and should. To be the Dalai Lama or someone that could just be there and just feel those feelings. We could [Uh, the Dalai Lama talks a lot about compassion and yet he feels their feelings. When, you know, you could say maybe that’s tipping into. Sympathy at a certain point when he gets so sad, but I’m simply trying to highlight how difficult this is to like talk about what are we really talking about. And at what point does it become traumatizing?And is it like a bruise that you just keep hitting and yes, you might have stronger skin than someone else, or maybe you hit your shin a little less with that bruise because you know how to compartmentalize or. Um, whatever that is for you at a certain point, it just seems like there’s a certain amount of wear and tear to any human in any particular kind of situation.That’s easy for us to talk about versus be about day in and day out and then not have the support system. To re recharge in the ways like you were talking about Casey. So whatever that is, I think there’s a, there, there to [Um, and, or a support system around them to understand that, to have a well buildup of compassion. And then from there make a more informed choice. Is this really healthy for me, given my capacity, my bandwidth, to handle all this and that that would require change and that’s uncomfortable too. So which discomfort do I want to choose?And that brings me back to the very first thing you brought up, Sarah is to me where it relates to what you said. An Motivational Interviewing perspective of compassion is that ambivalence, especially when it’s amplified is suffering. That’s my definition that I’m putting out there that could be wrong, but it doesn’t feel good to sit on a fence.Hence thinking of sitting on a sharp, weird fence, it’s uncomfortable. And the more that becomes amplified, [And when someone feels that ambivalence, I don’t want them to feel that because I care for them to not feel suffering. That’s my closest thing that came to my mind when you were talking about that particular thing, which is why I aligned so much of the resolve of someone’s. Towards some kind of happier, healthier that Motivational Interviewing is about it’s that we don’t define what that happier healthier is about.So to me, there is some kind of alignment there. And then earlier, Casey, you said we don’t always use Motivational Interviewing conversations. That reminds me of that Terri Moyers thing, but we got to wrap up soon, but there’s a whole story you have related to even the greats we’ll say, Motivational Interviewing, there’s not always a time that you got to do.Motivational Interviewing. So anyhow, that’s, that’s some of the thoughts that I have related to what you brought up, Sarah, but if there’s anything [Maybe we can do another future one together. Just anything else you’d like to share?Sarah Cameron: Yeah, I think this conversation could go on for probably like three hours, but, I have so many more questions, so many more. I guess my, my thoughts. Thanks John, for saying, like I think what you’re, we’re tapping into that really kind of intrigued me was the idea of.Having a finger on your own pulse of your own kind of empathy tank as well. And you said it much better than I’ll say it now, but kind of like that. You have to understand what, what level your tank is at when it’s completely depleted only you as a practitioner, as a coach, as a psychologist, whoever can know that.Um, I guess my questions are like now, now that we’ve gotten to this point in the conversation, how, how do we use Motivational Interviewing [Casey Jackson: Well, I think there’s when people think they’re using Motivational Interviewing or getting used to trying to use the micro skills and really understanding the intention, the mindset behind it. And what I always think of is motivational interviewing and really should be an empowering conversation.No matter how it exists is that one of my favorite lines is ultimately you get to choose, this is your life. You get to choose that. And there’s something about that just cuts off the onus on my part because it is not my. And I think that’s the part of Motivational Interviewing that is such an empowerment model, which means that as if I’m doing that, that’s part of me taking care of myself.It’s not my life. It really is not, but you have to believe that embody that it’s not my life, but maybe between [Uh, in that process as well too. And I think those are the things that self assessment like you’re talking about. And I, I jumped on the same thing that John said with the bandwidth piece of it, I think is so critical because that is exactly where you’re going to be able to self assess. Am I stretching my bandwidth more?Or I just don’t have any bandwidth left with all the things that are going on in the world of what do you do if your tank is empty, how do you come back? And I think this is it. It’s that then it’s comes into the self love that John was talking about earlier. And in that relationship with and is this conversation meant to be an Motivational Interviewing based conversation.Am I trying to help someone to resolve their ambivalence so they can get their behavior to align with their values and their goals and the target behavior? I mean that, and if it’s not that kind of a conversation, you’re not trying to reduce tension or discord, we know it’s going to be less Motivational Interviewing based in that.It [And usually our intention, if we’re not mindful is to fix things. Whether you’re a health coach or a psychiatrist, whether you’re, you know, anything in behavior, we just tend to want to fix things. And it’s like, oh, that’s just, we’re talking about very complex organisms. You never know if you’re really fixing the right thing then.Cause there’s so many things that could be fixed. Is that their perspective? Is that their thinking? Is it that, you know, just, ah, I can go on forever and ever, but anyway, So, yeah, no, sir. We’re going to have to pick this conversation up because there’s no way we can end it right now. Uh, it’s just like, oh my God, there’s too many things.500 or the things that I want to talk about, which we do got at least another 500 things you want to talk. Right.John Gilbert: Well, thank you, Sarah, so much. Yeah. Cause [Um, but there’s still so much to discover around these topics. We’re talking about how to even put. Maybe measure them how to seek support systems for getting that sense of what your tank is and how to do that. Not in a calloused way, how to do it in a healthy way and all this sort of stuff. That’s easy to talk about versus be about.I think you bring up really, really critical things for the future of our society on many, many levels. So thank you very much for that genuinely and, uh, where, where can. Uh, find you or contact you, you said [Sarah Cameron: Yeah. Um, for sure if anyone wants to reach out and nerd out with me at all, uh, I’m always down for that. Uh, my email is Sarah with an H dot Cameron, C a M E R O. That Minnesota spelled out. You’re going to look that one [email protected]. So it’s [email protected].Definitely Marilyn. Yeah. Camaro. But yeah,Casey Jackson: I mean, I didn’t talk about this and tell him he does our marketing, so you can correct me after this, but Sarah, I don’t know if you know that we do a monthly kind of for Motivational Interviewing geeks. Uh, it’s a Friday, one Friday a month on, and it’s actually a week from this Friday. It’s when you’re part of the MI plus. And I [Um, I think we need to start to when we have guests on here that love, that might as much as we do that, we’re just going to give you, if you don’t have the membership, we can give you the membership. Um, just so if you want to, because we get to get in these conversations with people from all over the world.That get together once a month and just kinda geek out together. Um, if you don’t have it, we’ll make sure you get that. Um, The MI PLUS membership and just for being on here as a guest, I just, you definitely, I want to give you access to that and then join us on that, because that is where it’s just, it’s fascinating.It’s all MI geeks to get on it once a month to just talk about. Whatever comes up and it goes down some of the most fascinating rabbit holes. If you haven’t done that before. And I want to invite you to do that because it is, we have so much fun on that. Great. I try to engage people all the time and they are not MI geeks and they are just face, like I got your tribe.I’ve got to try for you to join.John Gilbert: So, no, and as we’re on that topic too, just for you Sarah, but [Right. There’s so many things you can get into with equipoise,. Who’s defining it in different ways. And so. Things like that. We also have our MI mini trainings once a month as well. So you have at least two things a month, uh, that you can geek out on with different people that want to join and then kind of resonate with how we approach MI hopefully in a still aligned way with the intentions as though, as the whole goal.So any, uh, Sarah, anything else you’d like to add before we sign off? No, this was lovely. Seeing you again. Yeah, great chatting. Super fun. Hopefully I get to do it again sometimes there, so. All right. Well take care and thank you so much. All right. Bye everyone.Tami Calais: Thank you for listening to the communication solution [As always, this podcast is all about you. So if you have questions, thoughts, topics, suggestions, ideas, please send them our [email protected]. That’s [email protected] for more resources, feel free to check out IFIOC.com. We also have a public Facebook group called motivational interviewing every day. We have an amazing blog and we have lots of communication tips on our website.In addition to all these amazing resources we do offer online public courses on our website on motivational interviewing and effective communication strategies. Thanks for listening to the communication solution by IFIOC.Want to join in the conversation?Send us topics, comments or questions by e-mailing [email protected]Want more?Check out this #MIminute on the difference between sympathy, empathy and compassion