Musings, Wellness


The Four Aspects of Empathy


Social work is an emotionally demanding job. In fact, as high as seventy percent of social workers will experience at least one symptom of secondary traumatic stress (STS); working in the human services is a risk factor in and of itself for developing STS, burnout, and compassion fatigue (Wagaman, Geiger, Shockley, Segal,2011). The good news is that compassion fatigue can be mitigated by developing all four aspects of empathy (affective sharing, self-other, perspective-taking, and emotional regulation) which in turn will yield compassion satisfaction. I found the results of this research to be immediately applicable and relevant to my future career as a social worker as well as to my current career as a Massage therapist. A wide variety of helping professionals from any demographic could benefit from developing these skills. I will use the term case worker to include the vast variety of human service workers to which this research is pertinent.


Before launching into a discussion of the research provided by Wagaman et. al.  it is important to explore some definitions. Compassion satisfaction is the good feeling that comes from helping someone through a difficult time. On the flip side, compassion fatigue is feeling of despair and hopelessness from trying to help too many people with too many difficult problems. Burnout and secondary traumatic stress can exist alongside compassion fatigue: with the first the worker experiences overwhelming exhaustion and finds basic work tasks to be difficult, with the latter the caseworker has a physiological and emotional stress reaction to a trauma expressed by a client.

The four aspects of empathy are affective response, perspective taking, emotional regulation and self-other.  Affective response describes the way that the nervous systems of the client and caseworker will sync up; simply put, when one person yawns the other will too. More broadly speaking, the caseworker upon hearing about a traumatic event or disturbing experience from a client feels agitation, fatigue, and physical ailments (Wagaman et al.,2011) Affective responses can be both physiological and emotional.

Perspective taking is the classic idea of “walking in someone else’s shoes.” This is a cognitive process which requires some imagination. The person in the environment approach is an example of perspective taking. Anytime we say, “I see where you are coming from” we are perspective taking

 Emotional regulation is the ability to stay calm and collected when a person or situation is escalated. Segal et. Al. (2019, p166) calls it turning down the emotional dial. The case worker must use metacognition to track feelings as they arise to be objective and fully present for the client. They also need to learn more about their own emotional processes so as not to experience STS from a client interaction.

Self-Other is a way to counter the mirroring phenomenon of affective sharing. The idea is that while the caseworker experiences the feelings of the client they still keep a meta view on which feelings are not their own, which feelings are a reaction to the client’s feelings, and which feelings do not belong to the caseworker at all. Setting and maintaining boundaries is an essential component of self-other (Wagaman et al., 2011).

The Study

The researchers inquired into the relationship between empathy and compassion satisfaction, burnout, and secondary traumatic stress. The research was based on a survey of 173 social workers using the snowball method and multi-variable regression. This study found a strong correlation between compassion satisfaction and the ability of the caseworker to cultivate a strong sense of self-other as well as regulate emotions. Another finding was that therapists that had been in the profession for a long-time scored higher on the empathy assessment index.


Wegaman et al. (2011) addresses the power differential between social work supervisors and the social workers providing direct services to the clients. Resoundingly, those working directly with clients have a higher incident of burnout and compassion fatigue as opposed to those working in supervisory or administration positions. The supervisors must show empathy toward the supervisees to help them mitigate burnout and compassion fatigue.

Briefly touched on are strategies for strengthening emotional regulation and self-others; these included mindfulness techniques, boundary setting, and introspection to understand one’s feelings and triggers. Other strategies include self-talk, physically removing oneself from a situation, and practicing control of one’s physical or verbal reactions (Wagaman et al.,2011). The study also noted it was important for the therapist to share positive emotions like laughter with client. On the upside Wagaman et al, (2011) insists that empathy skills can be learned.

Is Empathy for Everyone?

I cannot think of a single reason why people of different genders, races, orientations etc. could not develop empathy skills. Afterall, a keystone of empathy is perspective taking and no matter one’s identity one can always try to understand those that are different than they are. It is worth mentioning that the study was very limited in its population sample; most the participants were White women with a master’s degree. Perspective taking is pertinent when working cross culturally

Some questions that came to mind. Could activating empathy be useful in anti-racism trainings? I posit that perspective taking is extra important for developing cultural competency.   It is important for the caseworker to be aware of their own privilege so that they can get a better perspective on their client? Furthermore, I am curious if caseworkers that have experienced more adverse traumatic experiences have a harder time with emotional regulation. A quick search through the library database shows that this is a well-researched topic with much to offer.

Another question that arose about this research regards the finding that social workers with more years in the profession scored higher on all aspects of empathy. I wonder if those professionals had long careers due to innate empathy skills, or if being in the job a long time helped them develop those skills?


Learning more about the four aspects of empathy is worthwhile as there is growing research that this approach increases compassion satisfaction while reducing compassion fatigue. The biggest indicator of longevity in the profession is an ability to develop self-regulation and a sense of self-other as a form of self-care. Even though the four aspects are a new concept for me, I will be able to apply these ideas immediately to my work as a massage therapist. My job is high on afferent response because we are directly touching people in distress. Developing a better sense of self-other will be helpful.


Segal, E.A., Gerdes, K.E. & Steiner, S. (2019). An introduction to the profession of social work (6th Ed.). Boston, MA: Cengage Learning ISBN 13: 978-1337567046

Wagaman, M.A., Geiger, J.M., Shockley, C., & Segal, E.A. (2015). The role of empathy in burnout, compassion satisfaction, and secondary traumatic stress among social workers. Social Work,3,201


Adventures in the Riviera Maya

Ubiquitous Mayan Culture

For this mystical adventurer, Playa Del Carmen offers many soul nurturing activities. For the second year in a row my family had the good fortune to visit Playa Del Carmen, Mexico. Traditional aspects of Mayan culture still abound in the Riviera Maya and without too much trouble can be found all over. For example, it’s not uncommon for the staff at resorts to speak Mayan. Most Spa services include some elements of traditional Mayan healing whether it be essential oils or energy balancing. In this blog I want to share a couple of my favorite stories from my trip.

As an aside, there are complex issues around labor issues involving indigenous culture and the tourist industry. I want to acknowledge that they exists and want to admit that I don’t have the answers or language to express the nuances of the ethics of visiting another country and participating in traditional cultural activities. The aim of this blog post is to tell you a story about my trip to Mexico.

Enduring Mayan Architecture

My daughters pose atop Mayan Ruins just outside Play Del Carmen

Just outside of town of Playa Del Carmen are the ancient ruins Xaman-Men Ha. Without any fanfare these humble ruins sit on the side of the road waiting for visitors to walk through them. These ruins sit near the main port where traveler’s would come to launch their pilgrimages to Cozumel; which usually involved prayers to a fertility goddess. Let’s face it-honeymooners still do the same!

Parque de los Fundadores showcases traditional ceremonies

A Mayan Dancer lights a ceremonial flame at Parque de los Fundadores, Playa Del Carmen, Mexico

There are daily traditional performances at the Parque de los Fundadores.  On this particular trip we caught a Mayan prayer dance. Mexican and International tourist alike stop to watch the performances. These athletic men dance in figures, blow on conch shells, drum, and light fires and incense under this magnificent sculpture. At the end they pass the hat for tips.

Looking for adventure

Once you get to the Riviera Maya, it can be hard to find adventures outside of those offered as packages through the tourist agents at the resorts. On this trip I wanted to swim in a Cenote, but didn’t want to go to a Wisconsin Dells style tourist destination. It pays to research ahead because once you get to Mexico the wi-fi can be spotty which makes planning and purchasing activities through your phone more challenging. Most activities in the Riviera Maya require planning ahead. There are very few places from which you can just decide to drive up and buy a ticket on the same day.

Chikin Ha here was come

After much searching I came across Chikin Ha (no there are no chickens here). Chikin Ha appealed to me because it came across as being more eco-friendly and less touristy than many of the other offerings. The entrance fee was reasonable and the cab for all 6 of us was about $100 USD round trip. Seeing as I speak Spanish, the conversations I had with the driver made the long cab rides worth the expense.

When we pulled into Chikin-Ha we drove about 2 miles down an unmarked gravel road through a forest.  We talked with the cab driver about all the animals. This felt like a good start to an adventure.

The entrance to Chikin-Ha was fairly humble.  Just a couple of huts set up for check-in.  

A glorious Cenote. On the other side of the pool our family descends for a dip.

Cenotes are naturally formed underground rivers leftover from the ice age.  Over time the cave roofs would crash in exposing spring fed swimming holes.  We were able to swim and snorkle at our leisure. Everyone once in a while fully equipped scuba divers would emerge or submerge to enjoy the extensive underground river system. In spite of the leaf debris, the spring fed water felt clean and pure.

The second cenote was more mysterious.  There are two open pools connected by a cave. A guide rope goes from one entrance to another to allow swimmers to find their way through the dark cavern.  It took us a minute to conjure up the courage to jump in as the pool was quite dark.  The water would go from rocky and shallow to quite deep. At one point we looked down and a light from deep below. It was a set of scuba divers coming out of a cave even lower down!!!!! We felt reborn from this cenote adventure and ready to move on.

Iguanas Everywhere!

We walked a forested path.  The smoke of Palo Santo filled the air as we noticed an ancient looking man managing the forest through controlled burning. We also delighted in the copious iguanas ambling over the paths and climbing the trees.

Taakbil Ha

At last we approached Taakbil Ha-the most sacred of cenotes. We scrambled down a steep staircase into the lower landing of this cenote. Clear water and majestic rocks dazzled our eyes. Through the hole in the upper ledge I could see the trees. Somehow we were inside, outside, up and down all at the same time.

Then I noticed a crude handrail leading into the dark recess of the cave. I couldn’t help it, I had to follow. I peered into the darkness and heard some rustling and wondered, “what could it be?”.  Then I saw a glimmer of light, and then another. With surprise, I realized that someone was quietly and systematically lighting candles in the cave.  Time stood still as the cave illuminated. We saw a man working, a bench and an altar. In a cauldron, he set incense on fire and the smoke escaped through a hole in the ceiling.  In spite of the kids telling me to stay out, I moved silently to the bench and watched as the man finished lighting the candles.

At first the cave was pitch black, but one by one the shaman lit the candles. I quietly walked in and took a seat. Notice the whole in the ceiling.

And then we talked quietly in the stillness. …..

I asked the man if I could sit and he acquiesced. We began to talk in Spanish. From him I learned that he was, indeed a Shaman and was setting up a ceremony for employees and tourists.  He learned the art of Shamanism from his Grandfather. He felt grateful that he could continue the practices at this site. We remarked on what a beautiful ceremony it is.

He told me about the ceremony, “First, I take a piece of Copal Resin and put it into the right hand.  The person makes a prayer or a wish. Then they put it into the cauldron so that the smoke can go out through the hole in the cave up to the gods.  They make an offering. The gods hear the prayer and purification comes back down.”

We could have paid to be part of the tourist group coming into be purified, but it felt more magical to witness the inception of this ceremony and have a soul to soul talk in Spanish with this Shaman. The lesson was clear to me-it’s better to walk into a dark cave than to avoid it.

For me the most magical part was the fluency with which I spoke to him. After almost 30 years of studying Spanish off and on I reached a level of fluency in this trip wherein I no longer translate in my mind. When I had this long complicated conversation with the man I felt like I had a true soul to soul connection that didn’t need translation.

On the way out, I purchased the purification ointment they sold at the entrance. In the vial was a mixture of Jojoba Oil, Grape seed Oil, Palo Santo, and Moon light.  You put a drop on your crown Chakra for daily purification. Up until this quarantine I had been putting a drop on my clients to calm the mind.

 Between the clean water, the talk with the Shaman and the oil, we all felt a keen sense of peace as we drove out of Chikin-Ha.

On the steps to the final Cenote Taakbil Ha
Massage, Musings, Shiatsu, Wellness

Massage and Anxiety


On a regular basis clients experiencing some sort of anxiety come into my office.   Anxiety shows up differently from person to person; for example, one client may have a general sense of stress and worry while another might already be under the care of a doctor or psychologist for a diagnosed condition. Some people feel it in a general sense of agitation while others might have headaches. Body work helps ameliorate the signs and symptoms of anxiety both on a mental and physical level.  

Bodywork calms down the nervous system

Basically, Massage therapists are wizards of the parasympathetic nervous system. The parasympathetic system is in charge of “rest and digest” and is when it is on the healing happens.  Part of what is at play with anxiety is a heightened flight or fight response which is hardwired into our sympathetic nervous systems.  We live our lives with our sympathetic nervous systems keyed up to handle what ever threats(real or imagined) are around the corner.  What we do as body-workers is provide an opportunity for your sympathetic nervous system to turn off and your parasympathetic nervous system to turn on. Signs that your body has switched to the parasympathetic nervous system are slower breathing, gurgling tummy, and a drop in body temperature. When you sit up and say, “wow, I can get on with my life” I know that I have done my job.

There is a method to the calmness of a Massage room as the soothing music, the aromatherapy, the heated stones all trigger the relaxation response.

The Physiology of Worry

Not only does body-work engage the parasympathetic nervous system, it actually causes changes in the endocrine system; the system in charge of hormone secretion.

For example, massage has been linked to elevated levels of dopamine and lower levels of cortisol, which provides evidence of reduced stress.”

Benjamin, Patricia J Tappan’s Handobook of Massage Therapy p.136

Dopamine and oxytocin are feel good hormones whereas cortisol is emitted during times of stress. Due to the relationship of the PNS and impact on hormones Massage also helps with the psychosomatic signs and symptoms like headaches, tight muscles and upset tummy through hands on application.  Regardless of the science behind Massage, caring human touch makes people feel good.

Emotional Release

Emotional release  is when a clients might have a deep sense of letting go of some intrinsic stress that has been held in the muscles and it usually involves a good cry during a bodywork session.   Our muscles store our memories and sometimes when we are touched in a safe environment our minds and muscles let go of some negative feelings that has been stored inside. Not to worry if this happens, crying is a normal way to shed stress and most people feel better afterward. 

It’s not the job of the Massage therapist to process the feelings like a talk therapist would, but rather to hold the space so that you can release deep tension.  I like to say that we listen with hands and heart.

The Practical Healer Full Body Approach

Whether you choose Massage or Shiatsu a full body approach is best.  For example; the scalp muscles can tense from making worry faces.   Also Abdominal massage is great if worry has your stomach tied in knots.  Rubbing out the shoulders is a way to take off the weight of the world.  Working on the feet helps bring the energy down from the head and is deeply relaxing.  Also, evening out the energy of the channels from an Asian bodywork perspective helps support the underlying condition.

Comfort and Safety are Key

The cornerstone of working with anxiety is good communication.  No two clients need the same thing.  I have anxious clients that prefer the deep pressure points of Shiatsu and others that prefer a soft Swedish Massage.  One thing that everyone has in common is a need to be comfortable and safe.  It’s not uncommon for those with anxiety to need adjustments to the bolsters, face cradle, music, lighting and so on.  A good Massage therapist is there to help and can make infinite adjustments.


As far as aromatherapy goes, Frankincense, Lavender and Ylang Ylang are notorious for calming the mind.  I can send you home with an aromatherapy inhaler which you use in times of stress.  It’s also great to use before you fall asleep.

Acupressure Points

There are many acupressure points that are associated with couple the mind. Below are a few examples. A therapist trained in Shiatsu can access these points to augment a treatment for someone struggling with excess worry.

Gently Pressing on Pericardium Six Reduces Nausea and Anxiety.


In conclusion bodywork is an effective tool for coping with anxiety-whatever form it takes.  On a personal note, I too can find myself taking a ride on the worry wagon.  Over the years I have learned that that talk therapy, medication, exercise and great body work are all helpful ways for me to deal with stress of anxiety. In particular bodywork helps with the psychosomatic manifestations like headache and stomach ache. I hope that you will find relief too so that you can continue to enjoy a vibrant life.

Massage, Musings

Lunch with Cadavers

I just finished a weekend of learning at the Northwestern Health Sciences Massage Symposium. A highlight of the symposium is an opportunity to spend 30 minutes in their prestigious cadaver lab over the lunch hour. So, yes it was billed as Lunch and Cadavers. Stop reading if you are easily grossed out.

Into the Cadaver Lab

Outside the lab I was informed by the experienced attendees that I might want to put some Vick’s VapoRub under my nose to keep out the smell of formaldehyde. Thankfully, I was at a massage symposium and there were samples of smelly unguents to be had around every corner. I chose a packet of China Balm to be my olfactory friend. The smell was nothing compared to the existential unease that came over me.

For the most part, the bodies were mid-dissection. The skin was mostly removed and the exposed muscles were dry to the point of looking like beef jerky. That was less problematic for me than the intact body parts that gave hints of the life once lived.

For example, while the size of the femoral artery was fascinating to see I couldn’t help but notice the chipped blue nail polish on the intact, but wrinkled, toes of the donor. My vivid imagination overtook my scientific mind. I began playing out my own personal morgue scene from one of those murder mystery shows I love so much. Surely, she must have painted those toes about three weeks prior to her death but never had a chance to remove or re-apply the nail polish. So sad.  

Deep breath, April. Stay focused on the anatomy!!!

We moved on to the second cadaver. While my colleagues were eagerly grabbing at the glutes to get a better look, I was focused on the short curly hair of the donor; not to mention its missing face. As everyone “oohed” and “aahed” over the the third cadaver I was mesmerized by its intact ears and hands. They looked like something out of a mad scientist’s lab in a classic horror film. The pacemaker cords sprouting out of another donor’s chest didn’t bother me as much as the detail of the coarse hairs growing out of his ears. I couldn’t not create stories in my mind about these people. After only ten minutes I was the first to leave the lab. 

The other attendees were mostly graduates of the Northwestern Health Sciences massage program so perhaps they were more accustomed to an academic morgue. The instructors in the lab were way more interested in teaching anatomy than helping me process my encounter with death. Perhaps she was putting on a brave face for me but my fellow therapist said bluntly, “It’s no big deal, you get used to it.” The more I write this I realize I was less put off by the lab but more so by the insensitivity of my fellow massage therapists.

Allow Me to Process

Sadly some of my former clients have passed away. I have experienced that strange feeling of knowing that someone who was once pulsing and alive under my hands is no longer with us. There is a certain intimacy between my clients and me. I have a great respect for the vulnerability they bring into my room. It is always sad when I hear that someone I once worked with is gone. Let me just take this moment to say “thank you” into the great beyond to all those who have shared sessions with me and have crossed over.

Maybe next year will be the year that I put my imagination aside and join the cult of dissecting the dead. But this was destined to be the year where I humbly observed the fragile mortality of my fellow human beings. For now I will appreciate learning through palpating living breathing humans!




Musings, Wellness

Breakfast and Healing in Maine

MaineRecently, I had a chance to travel to Maine with my spouse John. We stayed in the quaint twin towns of Saco/Biddeford-just a two hour train ride north of Boston.  This used to be a thriving mill town and cute old houses and brick buildings abound.  In the latter part of the 20th century the town lost its main industry and suffered a significant economic down turn.  It is now a rebounding tourist and industry town.  On Main Street one will see unique, independent shops.  The buildings in the town mostly have that weather worn look.  The town is full of well groomed hipsters, who migrated up from Brooklyn and beyond to seek their fortune.  Alongside these motivated young adults exist the old time meth addicts hanging out together sporting last decades fashion trends.


Here I am at the vintage and chic Tiny Diner.  It still only seats about 20 and the bathroom is located outside of the caboose.  Within is a well oiled breakfast machine. Although it serves traditional diner food everything was elevated to the next level.  My scrambled eggs were perfectly done with a little bit of cheese and chives scrambled in.  No industrial carton of egg puree here.  The breakfast potatoes were battered and fried.  The toast and jam were of good quality.  I stole more than a few bites of John’s corned beef hash.

Enough about breakfast-I want to tell you the  story of Flourish

Our first night we walked down to the Main Street with our hosts to eat a Thai dinner. As we headed to our next destination- I spied “Flourish” a little new age healing space and store.  There just happened to be a “healing salon” going on the following night.  It has been a good decade since I attended such an event so I knew I had to check it out and my host, Kate, was in for the adventure.

On a dark, cold, Thursday night Kate and I entered a cozy healing space.  Picture low lighting and a room with gigantic, beautiful mandala paintings on old brick walls.  A women was playing auto harp for all to hear.  There were various practitioners around the space and for a small fee one could get a sample session.

For example, for a fee the auto harpist would play the auto harp on your stomach.  With the addition of Reiki she would use sound healing to cure what ails thee. I still wish that I would have tried this one.  My friend Kate chose reflexology.  I chose to see Martha Fishback for flower essences and energy healing.

I was having a little pain in my right hip so I stated that as the main complaint.  Martha swung a pendulum over a chart to discern what the problem was and then to choose the correct flower essences to go with it.  Flower essences are the distilled essences of flowers.  A few drops are put into a cup of water and imbibed by the client.

After swinging a pendulum over a chart she decided that the root cause was emotional stress from work.  Although I wasn’t actively feeling that stressed about work I figured it was worth reflecting on. At this stage of my career I’m pretty good at managing my energy when working with clients.  Even so, I sometimes take on my client’s emotions without realizing it.   Also, there is always a certain stress that goes with the uncertainty of self employment.

She gave me my paper cup with a little water and flower essences.  Next, she invited me into a makeshift tent of colorful tapestries which housed a Massage table.  I lay down on the table face-up.  Without putting her hands on me she did about seven minutes of energy work over my head and about seven minutes over my feet.

I entered a very relaxed state.  Some very nice imagery came to me and I even shed a few happy tears.  It was nice to take a moment of calm in the middle of a vacation.  The auto harp music in the background was lovely.

My hip pain really didn’t abate, but I did have some emotional revelations.  More than anything, I was reminded how nice it is to have an energy practitioner give me full attention. While I really enjoyed the experience and felt some emotional relief, I ultimately needed more attention paid to the direct cause of the hip pain through Massage and Chiropractic.  Kate absolutely loved her reflexology session.

I see that they are hosting a medium in a few weeks.  If only I were in town to witness that!!