My Path to Compassion: Learning About Being Rather than Doing

Professor Darcy Harris

King’s University College at Western University

When treatment isn't helpful

My undergraduate degree was in nursing. Shortly after graduation, I was offered a job in a busy outpatient adult neurology clinic. We worked in a primary care model, where I was assigned to work alongside one of the neurologists. We had our own roster of patients, and we got to know many of them quite well over time. 

My training as a nurse had prepared me to be able to assess patients’ symptoms and I learned the necessary skills that were part of this area of specialization. I enjoyed forming relationships with my patients and their families. I also felt gratified when patients responded well to treatment.

One thing that had not been included in my training was when patients did not respond to treatment, or when their diagnosis included a chronic, long-term trajectory that was often refractive to improvement with any interventions. There were patients with severe chronic back pain that prevented them from working or engaging in normal daily activities. Some patients were incapacitated with migraine headaches that made them hibernate in darkened bedrooms for days on end. Some diagnoses, like multiple sclerosis or painful neuropathies (nerve damage in the extremities) were lifelong, chronic degenerative conditions with countless debilitating symptoms—and we had very few effective treatments to relieve these symptoms. 

It often felt like we were failing these patients, unable to offer the relief that they were desperate to find. I can’t count the number of times a patient or family member would say, “Can’t you at least DO SOMETHING”? It was heartbreaking.

Compassion Focused Therapy

I noticed that when these patients or their family members contacted the clinic, their calls were returned by the doctors or nurses at the end of the day. Likewise, their appointments were often placed at the end of the day as well, knowing that these would often be time-consuming meetings that left us all feeling demoralized. I remember one of the neurologists saying to me that it was time for his “daily flogging” when he was about to go into the room with a patient whose chronic pain was unrelenting—and unresponsive to the myriad medications that he had prescribed. What was obvious is that we had all been taught that good care meant improvement, and we all wanted to help our patients feel better. This was a good thing, except that it was a model that was a setup for failure because we had not been taught how to “be” with suffering when it was impossible to relieve it. I don’t remember ever being told during my training that there would be times when it would be impossible to relieve my patients’ suffering. I felt like an imposter at the best of times, and like a failure on many days. I eventually burned out after working there for two years. I remember thinking that instead of relieving pain, I was just adding more pain—my own–to the mix. I left the clinic—and I almost left nursing completely. I took a six-month hiatus, tended my garden, read self-help books, and started riding horses to reconnect with myself. I finally entered therapy to address the feelings of shame and self-loathing that continually plagued me. It took a long time to heal.

The concept of Chronic Sorrow

Many years later, I completed my graduate training as a therapist. I attended a professional meeting where one of the presenters talked about clients with “chronic sorrow,” described as situations of ongoing pain and loss that had no ending in sight. This piqued my interest. I had never really come to terms with the loss of my caring capacity that occurred when I worked in the neurology clinic, and there was something about this description that gave words to what I had felt during that time. The topic became the basis of my doctoral research that focused on non-death loss and grief. As an academic, I was drawn to explore this topic as a subject of research inquiry. However, my interest was also personal, resulting from the need to make meaning from my earlier experiences with patients whose suffering I could not relieve—and the suffering that I experienced due to the shame and sense of failure I felt during that time.

Suffering and Compassion

Compassion Focused Therapy

A convergence of events led me to attend a session at a conference that was offered by a palliative care nurse researcher who had completed training through the Compassionate Mind Foundation. 

She presented the research that demonstrated the difference in brain processing found on functional MRI scans between individuals who had engaged in compassion training and those who had not when they were exposed to distressing images. Those who had engaged in compassion training were able to sustain their motivation to relieve suffering, even in the presence of very difficult and distressing scenarios. I remember thinking, “I want some of that.”

Shortly afterward, I attended the Being with Dying training at the Upaya Zen Centre in Santa Fe, New Mexico. I was introduced to compassion training as part of this intensive residential experience. It felt like the stars had aligned! I had a taste of what it was like to approach the suffering of others without an expectation of what the outcome should be; when I would feel overwhelmed, I could return to my breath, feeling grounded in my body, and focus on my intention to show up and be present without the mandate to “make it all better.”  There was freedom in this practice. I made a quip about all my previous training that emphasized the need to “do something,” and began stating to myself, “Don’t just do something…sit here.”

Gradually, I recognized how my shame at not feeling effective in “helping” people was based upon a narrow view of what “help” meant. In addition to my training as a nurse, I had been taught in my graduate training in therapy about the importance of the therapeutic relationship, and yet the primary focus was still on theories, techniques, processes, and skill development. When did we learn how to be present with others, to be able to approach those in pain without an expectation of what would happen afterward? And that became my practice, starting with cultivating self-compassion as I began to sit with myself, and then shifting that compassionate stance to those I journeyed alongside. I learned that while I may not be able to change a diagnosis or the person’s circumstances, I could still make a difference by being present— “showing up” to what was presenting itself to me instead of clinging to an expectation of a specific outcome. The compassion training at the Upaya Zen Centre (referred to as the GRACE model) asked us when confronted with suffering not to think of what we should “do,” but rather, to consider what might serve best in that situation. This requires the ability to exercise discernment and tap into deeper wisdom to guide our response (which can be cultivated through compassion training). Sometimes, what might serve best is sitting with someone when they are in pain rather than busily trying to “do” something that just leads to the useless expenditure of energy and ultimately, exhaustion. An image of the Tao came to me, where I realized that while yin energy may be more reflective and introspective, it is no less engaged than the more active yang energy. Both types of energy are necessary and the ability to consider many possible ways of responding is important so that we can maintain our sense of balance when we encounter suffering.

Compassion Focused Therapy

Balanced Minds, Compassion Focused Therapy & Self-Compassion

Eventually, I was able to engage in training with the Compassionate Mind Foundation on Compassion Focused Therapy (CFT). The pieces just kept falling into place. Similar to my work as a nurse in the neurological clinic, much of the work that I do now is with clients who experience non-death losses that they will live with for the rest of their lives, including chronic pain and degenerative conditions. I also work with clients who have lost loved ones and feel overwhelmed by their grief. 

While I know that I can’t bring back a loved one and I certainly can’t change what has happened in the lives of my clients, I am no longer afraid of being a failure, or of becoming depleted by working in the field that I have chosen. I continue to draw upon my professional training in every encounter that I have with my clients. But more importantly, I show up as a fellow human traveler and approach my clients’ suffering from a well of compassion that sustains me in the time that we share together.

Darcy

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