Compassion Fatigue & Self Care

Facilitator Toolkit
Resources for the 2022 Nutrition Services Plan Counseling Goal

Introduction
Every agency is experiencing work overload, compassion fatigue, burnout, and
sometimes vicarious trauma. Two years of COVID combined with fires, floods, and
other “typical” crises is a lot for everyone.
The first comment about an early
rendition of this toolkit was, “The
information about work overload and
overwhelm is overwhelming!”
We decided to re-think how we
presented it for your use.
This Facilitator Toolkit is just that: a
toolkit. It is intended to provide ideas
and tools for you to choose from to
use or modify to support staff. You
won’t use them all. There’s no one
way to explore these topics. We tried to bring together a collection of activities,
handouts, videos, and a presentation that you can use as a toolkit. If your agency has
tools and resources that work for you and your staff, feel free to use them alone or
in combination with some of the tools provided in this toolkit to meet this
counseling goal. Please feel free to modify the PowerPoint slides or handouts to
meet your needs.
Use what best fits your agency.

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Mindful facilitation
This topic is a tough one. No one’s life journey is the same. Two people can
experience the same moment and have completely different reactions to it based on
their lived experience. Which is why we created a toolkit rather than a guide or in-
service.
Be mindful of yourself
Be mindful of your own emotions. If a discussion about compassion fatigue is
something that brings on feelings of overwhelm and dread, consider a different way
to meet this goal. Some ideas include asking if your agency’s Employee Assistance
Program has someone who can help, finding someone in a different section of your
agency who is comfortable with compassion fatigue to lead the discussion or using a
different approach not mentioned in this toolkit.
Be mindful of your staff
Prepare them for the topic. Let them know the topic may bring up some emotions.
Tell them what they can do if they need to take a break from the activity. Create a
safe space. A safe space is one in which people feel comfortable having courageous
conversations. A good way to do this is to develop guidelines or agreements for the
discussion. Read more about creating safe spaces for courageous conversations here:
https://tinyurl.com/Create-Safe
Have your agency’s employee assistance program information available. Include this
information in any handouts or other resources you share. Try to make it as easy as
possible to use.
Be mindfully creative
Meeting this goal on the Nutrition Services Plan is not a one-size-fits-all process.
Local agencies are welcome to meet this goal through guest speakers or other
methods.
Coaching is available
If you have questions about how to use this toolkit please reach out to Joan Medlen
([email protected]) or Bonnie Ranno
([email protected]).

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Contents
Introduction .................................................................................................................. 1
Mindful facilitation ....................................................................................................... 2
Contents ........................................................................................................................ 3
Objectives ..................................................................................................................... 4
Details ........................................................................................................................... 4
How to use this toolkit.................................................................................................. 4
Discussion questions .................................................................................................... 5
Self-Assessment tools................................................................................................... 5
PowerPoint slide deck .................................................................................................. 6
Resources on compassion fatigue, resiliency, and self-care ........................................ 6
Handouts or activities ............................................................................................... 6
Articles...................................................................................................................... 7
Videos ....................................................................................................................... 7
Websites ................................................................................................................... 8
Books and printed magazines ................................................................................... 8
Stress-reducing and connection-building strategies .................................................... 9
From OWCA: ........................................................................................................... 9
Bingo Example courtesy of Deschutes County WIC ............................................. 11
PowerPoint Slide Notes .............................................................................................. 12

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Objectives
These objectives are listed in the 2022 Nutrition Service Plan. Please modify them
to fit your activity as needed.
• List signs of compassion fatigue, work overload, vicarious trauma, and burnout
in helping professionals, including WIC staff.
• Recognize signs of vicarious trauma or compassion fatigue in themselves.
• Develop personal resiliency and empathy skills, including methods of self-care.

Details
• Target audience: Appropriate for all staff members
• Facilitator: Local agency training supervisor
• Estimated length: 1+ hours
Will vary depending on content and discussion questions selected
• Complete by 12/30/2022

How to use this toolkit

This toolkit is filled with more tools than one can use in a single session. There’s
no need to try to use them all!
• Become familiar with the information in this packet and decide which
resources are most relevant to staff in your agency. Ask yourself these
questions when deciding which resources to use:
o Will this be done in person or remotely?
o How do staff learn best?
• Are they at their best when they are physically engaged?
• Do they like to share with each other?
o What tone will engage staff more? Light-hearted? Serious?
• Do the self-assessment for yourself. Which activities, if any, do you,
personally, find useful in creating a self-care plan?
o With this topic it will be important to have practiced some self-
discovery before leading the discussion.
• Send staff any resources they will need to view prior to the presentation.
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 o Links to the article(s) you plan to cover or that you want them to read
independently.
o Attach a blank copy of the self-assessment questionnaire to complete,
if using.
• Arrange for a computer and speakers, if needed, for the presentation.

Discussion questions
The questions below are suggestions. The best questions are ones that fit the people
working in your agency. Consider them as you review the tools in this toolkit.
1. What does compassion fatigue look like in our clinic?
2. How do you feel when you are feeling work overload?
3. What are some ways you “reset” when work or home is overwhelming?
4. How would you like others to check in with you at work?
5. What can we do for each other to influence positivity at work?

Self-Assessment tools
A key element to resilience is understanding what you are feeling. Many of the tools
in this toolkit focus on self-discovery and creating plans for support. Below are two
self-assessment tools designed to heighten personal awareness of burnout,
compassion fatigue, and vicarious trauma. These are not required. The intention is to
promote self-reflection. Do not collect the information.
These are best used early in the discussion.
• Professional Quality of Life Scale Version 5
This one-page tool focusses on a person’s compassion satisfaction and
compassion fatigue. It measures these feelings based on the past 30 days.

The tool offers information and insights for WIC Staff. Staff should not be
pressured or expected to share their score. However, the insight gleaned from the
tool can be helpful when considering where to focus a self-care plan.

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• Is your lifestyle causing you stress?
This is a one-page fillable form that is easy to understand. The user simply
answers yes or no to a list of lifestyle behaviors related to stress. There is no
scoring, and it contains personal behaviors only – no job-specific factors.

PowerPoint slide deck

The PowerPoint file is optional. The PowerPoint presentation is intended to provide
evidence-based information about compassion fatigue, burnout, role overload, and
vicarious trauma in our work and provide structure for an open discussion with staff
if desired. The slides are intended as a toolkit for the discussion facilitator. Tailor the
presentation to fit the personality of your staff and to your comfort level. There are
notes on each slide that provide suggested dialogue for the presenter. You are
welcome to change them to make them work for you.
One way to use the PowerPoint is to include one of the self-assessment tools at the
beginning of the discussion.

Resources on compassion fatigue, resiliency, and self-

care

Handouts or Activities
These handouts and activities are included as separate files for easier printing and
sharing.
• The 5-point Barometer.
This handout is a companion to an activity referenced in the PowerPoint
presentation. It can also be used as a standalone activity.
• The Feelings Wheel.
This handout is a companion to an activity referenced in the PowerPoint
presentation. It can also be used as a stand-alone activity.
• Create a Vision Board.
This is an activity that would take some time. A great activity for those who
enjoy creating things and crafts.

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• Start the day with Intention.
This activity is a mindfulness activity.
• Grateful log.
A one-page log to write down things for which the person is grateful.
• The Trauma Stewardship Institute’s Map for Managing one’s Day.
A graphic tool.
• The Trauma Stewardship Institute’s Tiny Survival Toolkit.
A graphic reminder of ways to promote resilience in one’s day.
• The Trauma Stewardship Institute’s graphic of what one may feel when
experiencing overwhelm.

Articles
• Healthy You Tip Sheets. These are available in English, Spanish and recording
(English). Here is a sample from the American Public Health Association
(APHA).
http://www.thenationshealth.org/page/healthyyou
• Canopywell.com is one of the state-contracted employee assistance programs.
They have a variety of articles that may be helpful. Here are two examples:
o Outcomes of Resiliency
https://canopywell.com/79
o Characteristics of Resiliency
https://canopywell.com/78
• A Trauma Informed Workforce: An introduction to workforce wellness. Trauma
Informed Oregon.

Videos
• Resilience and managing stress in the workplace. An illustrated video.
https://tinyurl.com/Resilience-in-healthcare (4:53)
• Choose Resilience: An illustrated video about resilience
https://tinyurl.com/choose-resilience (2:49)
• Brene Brown on Empathy
https://youtu.be/1Evwgu369Jw (2:53)

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 • How mindfulness empowers us
https://vimeo.com/152432001 (2:11)
• Validation – remember you are enough!
short version: https://youtu.be/Aks0bco7IQQ (8:58)
or
long version: https://www.youtube.com/watch?v=Cbk980jV7Ao (16:23)

Websites
• The Positivity Project:
Tools you can use in your own life and with your staff to encourage meaningful
positivity or happiness. www.Oregonpositivity.org The site also has many
activities that can be used for this goal in the toolkit section of the website.
• Self Care 101 – https://www.psychologytoday.com/us/blog/skinny-
revisited/201805/self-care-101
• Healthy You – https://www.thenationshealth.org/page/healthyyou
• Mindful.org – a website that is the home of the magazine, Mindful (also a nice
resource). The website has many tools for building resilience and understanding
compassion fatigue and burnout.
• Coloring is a popular way to manage stress. Here are free, printable mandalas
for those who like to color to relieve stress. https://www.color-a-
mandala.com/free-printable-coloring-pages/
• Animal in You – A fun personality site with some science behind it. Complete a
few questions and learn your animal personality. The site provides some fun
information about each animal personality. Another lens through which to learn
about yourself. http://Animialinyou.com

Books and printed magazines

The Compassion Fatigue Workbook: Creative Tools for Transforming
Compassion Fatigue and Vicarious Traumatization by Francoise Mathieu.
Routledge Taylor and Francis Group.

Trauma Stewardship: An Everyday Toolkit to Caring for Self while Caring for
Others by Laura van Dernoot Lipskey with Connie Burk. Berrett-Koehler
Publishers.

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 The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and
Self-Care Strategies for the Helping Professions, Third Edition, by Thomas M.
Skovholt and Michelle Trotter-Mathison. Routledge Taylor and Francis Group
Publishers.

Mindful Magazine, Centennial Publishing. published six times yearly.

Mindful.org

Take Time for Your Life: A Personal Coach’s 7-Step Program for Creating the
Life You Want by Cheryl Richardson. Harmony Publishers.

The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma, by
Bessel van der Kolk, MD. Penguin Publishing.

Set Boundaries, Find Peace: a toolkit to reclaiming yourself, by Nedra Glover

Tawwab, Tarcher Perigree/Penguin Random House.

Help for the Helper: Self-Care Strategies for Managing Burnout and Stress by
Babette Rothschild. W.W. Norton & Company.

Stress-reducing and connection-building strategies

From OWCA:
Thank you to everyone who contributed to this list after the February OWCA
meeting. The list was edited to remove duplicates. Thank you also to Laura
Spaulding for gathering them to share in this toolkit.
• Daily virtual huddles
o Set intentions, trouble shoot schedule/staffing issues
• Fun Friday Food Fact
o Share something specific about a food and then list possible answers and
everyone guesses. Includes trivia, pictures, recipes, origins of certain
foods—focus on culturally diverse foods
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• Celebrating fun “national days” like national sock day, national bow tie day,
national chocolate chip cookie day
• Birthday calendar and celebrations
• Valentine’s Day
o Virtual GIFs being sent over Teams; one clinic is celebrating “galentines”
with a dinner out
o Personalize this for different holiday
• Inspirational and/or funny quotes at the beginning of meetings, over Teams
messaging, etc.
• Staff highlights
o Highlighting one or more staff at each meeting and everyone shares what
they appreciate about them
• Send electronic cards for fun or special occasions that everyone can sign
• Sharing GIFs, quotes, funny memes
• 1:1 time with the boss
• Makes sure staff know it’s ok to just connect with one another sometimes on
work time to stay connected
• Sharing successes, work or personal.
• Reading appreciative emails from participants during meetings
• Having kids and animals join on Zoom meetings
• Getting outside as much as possible. Taking team walks.
• Attending inspiring trainings or webinars. Ensuring time is available to everyone
for this.
• Sending out “question of the day.”
o What was your best/worst vacation, dream vacation? Who would you want
to play you in a movie about your life? What was your favorite toy as a
child?
• Month (or two) long bingo (sample card attached) with prizes for staff who
participated
• Seeing everyone at our multiple monthly meetings
• Checking in with each other throughout the week via text/phone

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Bingo Example courtesy of Deschutes County WIC

WIC WINTER BINGO! Dec/Jan

Do something Take a nap Donate to a toy Do a snow Read/listen to A Christmas
EVERY (preferably not drive or buy a gift activity—ski, Carol or another holiday
SINGLE at work ☺) for someone who snowboard, themed book this month
DAY that you doesn’t usually get snowshoe,
enjoy! anything--or snowball fight,
donate time/food …etc
Show us your Do back/neck Make a Drink at least Show us a picture of a
oldest or stretches at gingerbread house 32oz of wintery scene – (hopefully
favorite least 1x/week or Christmas water/day for 5 we’ll get snow for all of
ornament or for both months cookies or other days straight these snow-based ones!) If
holiday Sally sent some holiday goodie no snow appears, a nice
decoration out!) outdoor scene works!
and tell us
about it
Walk or drive Tell us about a Stay off your cell Let’s all drink Take a couple hours on a
around and new year’s phone for two hot cocoa for weekend or evening to do
look at resolution or hours (sleep time our meeting on nothing
Christmas just about doesn’t count) the 16th! Or
lights or drive something you warm beverage
up and look at want to of choice
snow accomplish
next year
Celebrate a Go for a walk Show us a picture Wear a festive Write a card/letter or call
holiday during one of of your Christmas hat or antlers someone you haven’t talked
tradition from your breaks Tree or winter or sunglasses to in a while
a different each month--- decorations! or whatever at
culture and bring a our meeting
tell us about it coworker if you
can!
Get a pic of Make a snow Get some sort of Watch a Share your favorite holiday
yourself in angel or exercise every favorite or wintertime recipe with
your favorite snowman or week, for both holiday movie us!
(or ugliest) some other months, at least and tell us
holiday snow creation once a week; a about it or
sweater – walk, a hike, gym, watch one
wear it to a weights, cycling, you’ve never
meeting if anything! seen before
you want!

There will be prizes for those who complete the most boxes!

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PowerPoint slide notes
Slide Notes
Slide 1
Compassion fatigue seems to be a theme
these last two years, for everyone.
But for those of us in helping professions,
it’s often a theme all the time. We want to
provide some tools and resources for you
to use alongside your OARS counseling
skills, focused on YOU!!
One option is to ask people to complete the
self-assessment tools before you go any
further. Then wait to talk about it until
after the various terms are defined.

Slide 2:
Compassion fatigue. Role Overload.
Vicarious Trauma. Burnout.
As service providers in a health-oriented
field, these are commonly heard terms.
Though we often hear about a focus on
these from the angle of general workplace
self-care strategies to avoid burn out, we
also need to consider compassion fatigue.
And sometimes vicarious trauma.
This presentation introduces you to
outward signs of compassion fatigue, role
overload, and burnout. We hope this will
lead you to a level of self -awareness from
which you can begin to create your self-
care plan.
We hear these terms a lot. At times they
seem to be used interchangeably. While
each is unique, there are some similarities.
Let’s quickly define them so we are all on
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Slide Notes
the same page for the rest of the
discussion.
Slide 3
The term “role overload” is defined as
having too many competing demands and
too many roles. It’s a common situation in
healthcare related occupations/clinics. It’s
rampant now that clinics are impacted by
the demands of juggling COVID-related
work, too.
ASK What are the many thing you are
juggling at work at hime?
• Children at home (school or daycare
closed due to covid)
• Household chores staring at you
when working at home
• Filling in for absent co-workers
• Added tasks due to covid
responsibilities
ASK
What are some words or emotions you
associate with role overload?
Accept all answers there’s no right or
wrong.

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Slide Notes
Compassion fatigue describes the profound
emotional and physical exhaustion that
helping professionals and caregivers can
develop over the course of their career.
It’s a gradual erosion of all the things that
keep us connected to others as we share
our ability to provide care, empathy,
compassion and hope in our role.
Compassion fatigue is seen by some as
“the cost of caring” for others who are in
emotional or physical pain.
Compassion fatigue can ebb and flow. It’s
not a constant state.
ASK
What are some words or emotions you
associate with compassion fatigue?
Accept all answers there’s no right or
wrong.

Slide 4:
Vicarious traumatization is a term coined
by Lauri Anne Pearlman and Karen
Saakvitne to describe a profound shift
workers experience in their world view
when they work with people who have
experienced trauma.
When a person is experiencing Vicarious
Trauma, they notice a change in their
beliefs about the world – sometimes
damaged because of the trauma they have
been exposed to.
It happens when the stories we hear from
the people we serve transfer onto us in a
way that we too are traumatized by the
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Slide Notes
images and details, even though we did not
experience them.
It isn’t something participants do to us –
it’s the consequence of knowing, caring,
and facing the reality of trauma.
This too, is a cumulative process. One does
not develop Vicarious Trauma because of
the most difficult story they’ve
encountered. It’s the hundreds of stories of
trauma and pain that are the everyday story
– that you don’t remember or can’t recall.
ASK
What are some words or emotions you
think of related to vicarious trauma?
Accept all answers there’s no right or
wrong.

Slide 5:
You might be thinking, isn’t it all just
burnout?
No.
Here’s how they are different:
Compassion fatigue = profound emotional
and physical erosion that happens when
those in a helping profession, like you, are
unable to refuel and regenerate. You feel
“tired.”
Vicarious trauma = the transformation of
our view of the world due to the
cumulative exposure to traumatic images
and stories. The way you view and respond
to your work changes.

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Slide Notes
Burnout = Feeling that what you are doing
has stopped making a difference. the result
of the stress and frustration caused by the
workplace such as low pay, unrealistic
demands, heavy workload, heavy shifts,
poor management, and inadequate
supervision. Burnout can happen in any
profession, job, or role in your life. It just
doesn’t matter anymore.
Compassion Fatigue happens in helping
professions such as health care workers,
WIC staff, teachers, and law enforcement.
Vicarious Trauma happens in a profession
in which the worker is consistently and
frequently exposed to an individual who
has experienced trauma – for example, for
example families who have experienced
trauma related to food insecurity or
housing insecurity, victims of abuse, or
victims of crime.

Slide 7
This slide has animations. It works best
if you can plan audio. If you do not have
a audio available, delete the movie (top
layer image) and change font to black.
(do not change the slide arrangement)
Click through the slide.
Compassion fatigue, role overload,
vicarious trauma and burnout take time to
develop. Each of us responds differently to
situations that set the stage for them. Here
are some common physical signs of
fatigue, overload, and burnout.

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Slide Notes
This list of symptoms and those on the
following slides are long. They are
included to highlight the point that each
person experiences compassion fatigue and
burnout differently. People do not exhibit
all of these symptoms. Rather, these lists
help us see red flags for ourselves and
those around us.

Slide 8
“Other Addictions:” shopping,
workaholism, compulsive overeating
Silencing response: When a person
unknowingly silences participants because
the information the participant is sharing
with us is too distressing for us to bear.
This is more likely when experiencing
increased compassion fatigue.

Slide 9:
Review the list.
The list of psychological symptoms is very
long. (two slides)

They are all listed here to highlight the

point that each person experiences
compassion fatigue and burnout
differently. People do not exhibit all these
symptoms. Rather, this list helps us
identify red flags for ourselves and those
around us.

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Slide Notes
Slide 10:

Intrusive imagery: finding that your

participants stories are intruding on your
own thoughts and daily activities – having
a dream that does not belong to you,
having trouble getting rid of a disturbing
image shared with you or seen,

Slide 11:
Did you resonate with any of those signs
or symptoms?
The question usually is, what can I do
about it?
There’s no quick fix to burnout,
compassion fatigue, role overload or
vicarious trauma. It takes time and work.
The best thing you can do is to begin to
learn about yourself with all this in mind.
Slide 12:
There are many ways to develop some sort
of meter for yourself. IT’s a good way to
begin to identify when you can interrupt
the process of heading toward fatigue and
burnout.
One method is to use what is called the 5-
Degree Scale. It allows for more layers
than a “stop light” scale but is similar.
We’re modifying it a bit, so we’ll call it the
5-Poiint Barometer.
As a tool, we’ve all seen something like
this. And it makes perfect sense. But when
was the last time you really thought about
this scale for yourself? What do you do –
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Slide Notes
what behaviors begin to emerge – at each
stage? Obviously, these can be good, or
not so good.
--How are you feeling internally at each
stage?
If you are “Not Coping Well,” What helps
you calm so you can avoid becoming
completely overwhelmed? Start making a
list tangible things you can do that are truly
helpful to YOU.
When you’re in the green areas, what can
you do to help yourself avoid the orange
and red areas? Is there a preparatory
activity or tool that will help?
For example, sitting down to plan for the
next day’s meetings or tasks the day before
might make it easier to handle a bump in
the road the next day. Or if the day ended
and you weren’t coping well, what can you
do to reduce those feelings? Go for a walk?
Talk to a friend, Play with your children or
pet?
Last, consider ways your team or family
can help you. Share the behaviors you
exhibit when you are “Not coping well.”
What does that look like to them and what
can they do that will be supportive? What
should they NOT do?
The worksheet has some questions to help
you discover your emotions and feelings at
each stage.
Every tool takes some thought to work.
This one is no different. Take a look at the
handout with the Early Warning System on
it and begin to list what you feel,
physically, emotionally, and how you
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Slide Notes
behave when you are in each category. By
understanding these feelings better, you
can begin to recognize the stages.
Share the 5-Point Barometer Handout

Slide 13:
Sometimes it is hard to identify the
feelings you have and place them. WE all
create a “code” for our feelings.
Sometimes we’ve used the code for so
long, we’ve forgotten what the core
emotion is behind it all. This feelings chart
is one way to begin to explore those
emotions.
The Feelings Wheel, created by Gloria
Wilcox is a way to explore those feelings
with more depth. It might be useful with
the 5-point barometer.
The feelings wheel can also help you see
how to create a bridge from one emotion to
another – or recognize change.

Handout: The Feelings Wheel

Slide 14:
Two key elements to taking care of
yourself:
1. Learn about yourself.
• The most effective strategy is the
one that is tailored to you.
• Learn your warning signs.

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Slide Notes
• Share those with the people who
are in your circle of support.
2. Self-validated caregiving:
Self-care that is guilt-free and
prioritized as a means of remaining
healthy.
3. This is where those traditional Self-care
strategies come in to play!

Consider the various activities. Build in

something that speaks to what you are
feeling. Is it a gratitude journal? A
daily walk to re-focus thoughts and
feelings? Start considering how you can
change the trajectory of burnout by
taking care of yourself. Making many
small steps might be easier to maintain
that making a huge leap!
The goal is to develop and maintain
intentionality through a non-anxious
presence personally and professionally.
A non-anxious presence is the ability to
be in the room with a person’s pain and
suffering, being able to express empathy
and compassion without taking it on
yourself. It requires mindfulness,
When we get to this point, we are our most
effective at supporting our participants.

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Slide Notes
Slide 15
Enter your agency’s Employee Assistance
Program information and any other
appropriate support information for your
community.

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