Is your empathy at risk?

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You entered into your profession as a health professional because you have a calling to help others using knowledge and skills in communication, healing, listening, physical manipulation, technical or clinical skills.
 
Helping takes many forms. Patients value health professionals who listen to them and communicate in ways that are easily understood. This shows an interest in connecting, respect and courtesy. It increases their trust and confidence in your ability to support them. To know how to really help someone requires empathy.

NB: What I’m about to share here is for 1:1 and 1: many therapeutic relationships, not in emergency situations that have specific protocols.

What is empathy?

Empathy is an innate quality and a learned skill that we access when we feel interested, curious and a desire to connect with others.
 
 Empathy:

  • is the ability to tune into the emotional frequency of another person
  • allows us to directly perceive the feelings of another person, realise their circumstances, learn how they feel about it and appreciate how they’re living with it.
  • is essential to establish and maintain relationships that vary in intimacy
  • is involved in the creation of groups and the formation & transmission of attitudes, values & group identities (i.e. groupthink or collective consciousness)

Each human quality or virtue exists on a spectrum. We can go too far into either extreme due to poor boundaries between Self and other. Too little empathy (fortress) is expressed as sympathy, pity, antipathy, cynicism or indifference. Too much empathy (broken or no fence) results in feeling overwhelmed, emotional and physical pain or mental distress, and other symptoms that highly sensitive people (HSP) also exhibit. Entering into a receptive state with another is a choice and maintaining connection with another is a skill.

The risks of empathy

The table below lists the pros and cons of empathy. Research tells us empathy is so important as it helps people feel at ease, validated, witnessed and safe to be vulnerable, honest and open.

Empathy is also a double-edged sword. It’s the workplace hazard needed to be effective in any therapeutic relationship.

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Extremes of empathy results in symptoms of compassion fatigue which ironically, is due to an absence of compassion.

Compassion and the wrongly termed compassion fatigue will have their own blog post shortly!
 
Some of the symptoms include
:

  • reduction to loss of empathy
  • cynicism
  • hopelessness
  • decreased pleasure
  • decreased libido
  • numbness
  • stress and anxiety
  • sleeplessness
  • pervasive negative attitude

This impacts on professional and personal satisfaction, productivity, focus, self-confidence and patient or client safety.

Some of these symptoms sound a lot like burnout. Burnout is a different beast that results from actions becoming out of sync with personal values and purpose, ignoring intuition and neglect of emotional needs rather than emotional over or underinvestment in therapeuetic relationships. These burnout-inducing actions are exacerbated in workplace settings that stifle creativity, agency, autonomy, safety and interconnectedness. These conditions also reduce empathic capacity as people verging on burnout operate in survival mode.

By now you might be thinking:

So let me get this straight — I’m here in service to my patients who I love to work with (on my good days) and I know I’m helping them, yet I’m feeling drained. This feels like an unfair exchange. How do I know that I’ve gone too far in either extreme?

Basically, empathic extremism can also be described as compromised empathy which occurs when you’re no longer able to be where the patient or client is at because you’re focused on Self and what the interaction is making you think and feel.

How empathy gets compromised within a therapeutic relationship

  • identifying with a client or patient experience because something similar happened to you, instead of remaining curious & objective with fresh eyes and ears
  • you’re drawn into the content of a patient’s story and you feel sorry for them (pity)
  • ruminating or worrying about them
  • believing that you know what a patient needs based on perceived familiarity with their issue (I’ve heard this before)
  • finishing their thoughts or sentences because ‘you know’ what they’re going to say
  • interrupting
  • responding based on assumptions instead of observation
  • feeling judgmental toward their lifestyle choices, behaviours, decisions and philosophies
  • belief that you know what a client needs because you’re the one with expertise/knowledge/experience, not them
  • guiding their healing process (trying to control outcomes)
  • allowing your client to dictate or drive the process (they’re trying to control outcomes)
  • fear-driven persuasion or influence on their decisions (coercive tactics to fulfil an agenda)
  • rushing through a consultation while thinking about the time and the queue of patients waiting
  • unconscious bias
  • unclear about your role, purpose and boundaries with patients
  • overconfidence in your approach, experience or methods (lacking humility)
  • following a protocol instead of what’s needed for their unique context
  • wondering if you’re actually helping
  • self-doubt
  • believing that the patient needs you
  • feeling/being disturbed by emotions triggered by client
  • lack of interest or curiosity about a patient’s experience
  • excessive emotional investment to provide specific results for clients
  • attachment to specific outcomes
  • using the therapeutic relationship to meet your emotional needs.

This list is not exhaustive yet highlights some of the ways working with others can be exhausting. Not only is (unintentional) interference with empathic connection tiring, it can hinder the ability to truly fulfil the purpose of the therapeutic relationship, which sucks for everyone.

Signs that your empathy is compromised:

  • you feel tired after seeing 1 to a few patients or clients
  • you feel drained at the end of your day
  • you feel a bit bored with your work
  • you feel irritated by some of your patient’s problems
  • you want to love your work but can’t

There are a few things happening that destabilise an existing therapeutic connection or that prevent empathic engagement in the first place.

  1. Shifting focus from being present and WITH the patient to being in your head, thinking about the next steps, your own problems and anything other than what’s being revealed in the moment.
  2. Investing too much of your own emotional energy or an agenda into your work instead of allowing a process to unfold together to fulfil a purpose
  3. Your own educational and training conditioning that reduces patients to a set of symptoms and problems that need solving.

There is a healthy empathic range where you remain anchored in your own Self and your emotional centre is not disturbed by what’s going on for your patient or their behaviour.

Many people think empathy is being in someone else’s shoes.

Nope.

Stay in your own shoes while taking a look into what’s going on in someone else’s world, while they remain in their own shoes. Empathy is maintaining an Other focus and the desire to be of benefit to them without getting lost in their world or wearing their shoes.

 Stay in your own shoes to maintain perspective while peering into someone else’s world. Courtesy of John Fluevog shoes that will soon be on my own feet.

Stay in your own shoes to maintain perspective while peering into someone else’s world. Courtesy of John Fluevog shoes that will soon be on my own feet.

If you recognise yourself in the descriptions above and you want to move out of the cycle of empathic disengagement that happens to EVERYONE (including me!), there are things you can do about it.

Hitting the empathy sweet spot

  • remain connected to your breath as often as possible
  • define your role(s) & responsibilities
  • remember your purpose
  • park your problems using meditation techniques and debrief via brain dump onto paper, voice recording or speaking to a trusted peer
  • exude warmth, openness and kindness, even when the patient is not showing you those qualities
  • avoid trying to do all the things or tricks with clients or patients — focus on what’s enough and what’s needed in that moment
  • define your boundaries of knowledge, experience & expertise. Knowing something isn’t the same as mastering something — be honest about where you’re at in your professional development.
  • know your triggers and learn strategies to comfort yourself in the moment
  • use pauses and silence as a strategy to feel, listen to your inner voice or intuitively perceive what’s going on for your patient beyond their words and body language
  • focus on the process of change/transformation/transition your client or patient is going through, not just the content of their story/problems
  • exercise compassion for yourself (you’re doing your best!) and others, not sympathy (aw that’s too bad) or pity (poor you)
  • let your patients know what they can expect from you and what you won’t be able to do for/with them
  • negotiate an agenda with your patient for what you will realistically cover in your time together
  • ask questions if you’re unsure of anything
  • be ok with doing enough
  • pray, ask for higher guidance, inspiration or connect with feelings of compassion before you start your day. As a healer, you’re more than your technical skills and knowledge. Your calm presence, empathy & desire to be of benefit transforms you into an instrument that can facilitate a healing process, whether a problem gets solved or not.
  • create space between one patient and the next through any ritual that makes a clean break between sessions and at the end of your work day
  • debrief with a professional empathic listener, journal about your experiences at the end of a work day and engage in group learning & reflective practice.
  • maintain perspective about your patient as they don’t exist in a vacuum but within an ecological context. Strive to discover what matters to them, what connections comfort them and hinder their wellbeing.
 Bronfenbrenner’s Ecological Model. This is a great tool to use to explore a patient’s life and world to discover what matters to them, the connections that can provide support to enhance skills and those that can help them grow and heal.

Bronfenbrenner’s Ecological Model. This is a great tool to use to explore a patient’s life and world to discover what matters to them, the connections that can provide support to enhance skills and those that can help them grow and heal.

 

Bronfenbrenner’s Ecological Model. This is a great tool to use to explore a patient’s life and world to discover what matters to them, the connections that can provide support to enhance skills and those that can help them grow and heal.

You might also want to increase the support you get for yourself to help you identify and understand any tendencies to disengage the empathic connection, what needs you’re trying to meet through your work, how you take on other people’s energy, emotions, stories and trauma, WHY you do it and WHAT to do to about it.

I also recommend any group learning activity — reflective practice, Balint groups, therapy groups or Schwartz rounds are excellent options to participate in on a regular basis.

Like anyone who wants to excel in their profession, everyone needs a coach to monitor and support skill development. We cannot deepen and master our capacity for empathy without understanding how our life experiences, beliefs, knowledge or ignorance can be barriers or helpers to developing and maintaining stable and effective therapeutic connections.

Healers need healers too.

I invite you to reflect on your own experience as a health professional or someone in a helping role to discover what you might be doing/not doing that’s interfering with your ability to more deeply connect with another for the purpose of helping or healing.

This is a pretty long article. If you’ve made it this far, I’d love to know if this resonated with you, what didn’t, what stands out and what you’d like to know more about.

NOTE: This content is a result of consulting, shadowing, observing and facilitating reflective practice & debriefing sessions with diverse health professionals for the last 7 years. This is intended to be a practical article of how our own natural tendencies, conditioning and an unruly mind hinders our ability to maintain empathic connections with others.

References:

Barrett, S., Komaromy, C., Robb, M., & Rogers, A. (Eds.). (2004). Communication, relationships and care: a reader. Routledge.

Charon, R. (2001). Narrative medicine: a model for empathy, reflection, profession, and trust. Jama, 286(15), 1897–1902.

Davis, H. & Day, C. (2010). Working in Partnership: The Family Partnership Model. London: Pearson (my bible).

Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs of caring.

Kelm, Z., Womer, J., Walter, J. K., & Feudtner, C. (2014). Interventions to cultivate physician empathy: a systematic review. BMC medical education14(1), 219.

Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., … & Scheffer, C. (2011). Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic medicine, 86(8), 996–1009.

Plack, M. M., & Greenberg, L. (2005). The reflective practitioner: reaching for excellence in practice. Pediatrics, 116(6), 1546–1552.

Rivera, Luis de. (2004). Empatia y Ecpatia. Psiquis, 25: 243–245.

Singer, T & Klimecki, O.M. (2014). Empathy and Compassion. Current Biology, 24(18), R875-R878.

Skovholt & Trotter-Mathison (2010). The Resilient Practitioner. p. 23.

de Zulueta PC (2015). Suffering, ethics and doing good medical ethics. J Med Ethics, 41, 87–90.

This article was first published on Safe Space Health. Please check it out and other resources.

Answering the call to heal the healers

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This is me in Sydney with my gorgeous friend 7 years ago today. You wouldn’t know it but behind my big dazzling smile lurked the Black Dog of depression.I didn't know I was depressed yet I did know that this was not my normal way of being and that somewhere between 2007 & 2011 I was slowly being consumed by a heaviness I couldn't shake regardless of the healthy eating, frequent exercise, active social life and stable family connections.

What this photo doesn’t show is that after it was taken I had a short nap that turned into a 5 hr sleep, and I still felt exhausted when I woke up. I was sinking slowly into darkness and gloom and sleeping it off wasn't a solution.

I hated where my life had taken me. My career path in health research was paved by unconscious bias & publish or perish incentives which created more distance between myself & those I wanted to help heal from their health crises. I was burned out by an institution who cared little for the wellbeing of their employees & enabled abusive behaviour to persist throughout. An institution that wanted innovative thinking only if it fit within the pre-existing models that were getting funded. It wasn’t just the institution - it’s a problem within the industry much like any other. I was no longer stimulated by that type of intellectual pursuit alongside the abuse I witnessed were deafening signs that I no longer belonged there and needed out of the Ivory Tower. But what’s a burned out scientist to do when it’s the only path I knew?

So rather than remain another day, I hung up my lab coat for good. Then I sank into the depths of darkness & depression.

It remained until I stood up and shouted to the heavens that I'd had enough of this life and demanded that the life I'm here for to show itself. I shook my fist repeatedly at invisible forces in the air making endless demands until a text message (from the beautiful woman on the right) made me stop. Within 24 hours I was with two physicians who took me to a meditation class that they facilitated. When I opened my eyes at the end of that class, the heaviness, density & exhaustion were gone, replaced by clarity, lightness, hope and a knowing that life part 2 had begun.

Nothing magical happened. I wasn’t cured, rather I woke up and found a different path that was waiting for me all along, I just didn’t listen or trust my intuition enough to see or pursue it any sooner. I know now that what I believed was depression might have also been a prolonged existential crisis that created a lot of suffering for me.

Having the veil of delusion lifted from my eyes meant that I became open to infinite possibilities for my career path. I wanted to learn about meditation, healing emotional & spiritual issues that influence physical & mental wellbeing, spiritual philosophies and ancient practices, discovering the characteristics of therapeutic relationships that facilitate healing for both practitioner and patient, and see where that would take me.

I would discover that my skills & qualities were needed to support physicians, other healthcare professionals & hospital administrative staff to recognise & get real about the toll their relationship with work, distress & human suffering was having on their satisfaction. I would shadow oncologists, surgeons, multidisciplinary teams, nurses, genetic counselors, scientists and hospital executives and discover the behaviours, assumptions & workplace conditions that were harming their wellbeing.

I would learn about Ballint groups, reflective practice and supervision, mentoring, coaching, group facilitation, public speaking, Schwartz rounds, designing workshops, qualitative research, best practice evidence, outcomes-based therapy, ethical practice and adult learning principles. I would learn how to help people rewrite the stories of themselves to include their strengths, triumphs, capabilities and power to continually learn from life, increase their ability to love & transform themselves.

Most importantly, I learned that I could help many many professionals in healthcare settings to become more free to be themselves and lift them out of the fog of their own existential crises so they too could see clearly & feel joy again.

Looking back on this photo of myself 7 years today, I'm reminded that we never know what's beyond the moment. We could be in darkest depths of our own hell and a request declaring readiness for a different reality along with the right action & support can be the catalyst to change the trajectory of life. I can chuckle now at how ignorant I was to the realities that exist beyond what we currently see as truth.

My message to you all who have read this far: keep going but don’t keep going in the same place in the same way expecting something different to happen. Try something different daily - a new route to work, a new topic to learn about, learn something handy you can’t yet do, create a community or join a community. Something, anything. Just do something else even if it means walking away from a career path to preserve your wellbeing. Don't do it alone. Arm yourself with solid and stable people who will escort you from your old way of seeing yourself across the chasm of the unknown into the new world that feels more right for you.

If this resonates with you and you've been entertaining thoughts about trying something new to get you out of a rut, I'm running a 31 day meditation experience using the style of meditation that pulled me out of my own personal hell.

10-20 minute guided, themed meditations that are easy to follow and participate in every single day for 31 days. You'll receive a new recording everyday along with tips on how to apply the principles into your daily life to create a new healthy habit.

Book in and discover what else is possible.

Blessings to you all for a peaceful & joyful life,

Nathalie

How to not set up clients, and yourself, to fail

As a scientist, communication coach and partnership-centred healing practitioner, I do my best to bridge the gifts of our left and right brain hemispheres. Intuition can partner beautifully with logic, and as we have these faculties we should be using them optimally.

Clients can have have amazing healing experiences with me that unfold for weeks and months and I always give each client homework in the form of a specific practice, communication skill or technique to use in between sessions.

BUT after doing my research, I discovered only a percentage follow through on using the strategies I gave them.

Why?

I was making an assumption that my clients could IMPLEMENT those strategies easily, even after we practiced them together.

The art and science of implementation is a missing ingredient in the many healthcare, coaching, therapeutic and healing services who aim to empower their clients or patients.

If you're a practitioner who provides a service to help anyone, the strategies you give your clients might be AWESOME, be grounded in research evidence, follow clinical guidelines or practice wisdom or sound GENIUS but unless they fit into the routine of your client's life and their bigger picture beyond their immediate need (besides emergency situations that require urgent medical attention), the homework won't get done and new healthy habits don't develop.

That's because once a strategy is suggested or even better, co-developed based on complementary expertise, it needs to be implemented. Implementation needs its own planning process.

Together, you'll want to discover what resources your client has to support the successful implementation of this strategy. You'd look at things like: when it will happen, what time of day, how often, who else needs to be involved, who can support this change, what can be removed to add it in and what are the risks of that. Etc. Like setting goals, implementation plans can benefit from being SMART (specific, measurable, achievable, relevant & time bound) so your client can report back on the results.

So how do you do that with your client?

Reality test it!

Role play with your client to discover the risks that could derail its execution aka playing devil's advocate until you have a SMART implementation plan to support your SMART strategy.

By walking through a process with your client to help them see how the plan looks in reality, the more likely the plan will succeed. And if it doesn't succeed, there will be some amazing learning and possibly other beneficial outcomes. Which is also why reviewing outcomes at the beginning of the next session is so important in order to learn together and course correct.

This is also why you can't create an implementation plan for your client. They need to be involved in the process. In fact, they should probably be involved in setting strategies and goals to ensure they're meaningful for them as it's the client who has to take action and experience the outcomes.

So rather than wondering why your clients aren't taking their prescription, not doing meditation at home, going to the gym, eating more healthy food or standing up for themselves when facing adversity, realise that perhaps the course of action was doomed from the start.  As helping practitioners, one of our roles is to help our clients try the new skills out & plan where to fit them in their full lives before we send them off on their own lives with blind optimism & assumption that they know what to do, why and how to do it.

If you're looking for a coach, healer or healthcare practitioner to help you change something significantly, ask them if they can help you implement the strategies they suggest from your consultations. If not, ask them for a referral to someone they work with closely who do that.

Educating people on what you think they need to know isn't enough. Being an effective practitioner who can facilitate meaningful change in someone's life requires that you take an interest in their life, their supports, barriers, cultural beliefs, strengths and problems before considering suggesting a course of action.

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This falls into the realm of coaching communication skills and personal qualities that are enhanced through programs that train people to unlearn from the expert model and discover the rewards of working as partners in care.

Working with clients in this way has helped me and them stay on track with supporting them to achieve the goals that take them closer to fulfilling their vision.

I teach practitioners how to unlearn and rediscover the power of uncertainty, not knowing, curiosity, wonder and awe in facilitating meaningful change for themselves and their clients. These qualities improve connection to intuitive and practical wisdom, enhance therapeutic partnerships with clients and prevent burnout and compassion fatigue. Contact me for more information.

Blessings,

Nats

A Reflective practitioner is an evolving practitioner

A Reflective practitioner is an evolving practitioner

Reflective practice is an essential tool for ALL healthcare workers. It helps us to look at what we're doing and honestly asking ourselves if we're achieving the desired effect that aligns with our vision, values and ethics for practice. It's not a one-off process and requires continuous practice, to prevent perpetuating practices and processes that are ineffective, harmful or less effective than we think.

Understanding uncomfortable emotions

Sorrow, grief, sadness, anger, jealousy, discomfort, fear and shame are all GORGEOUS emotions.

Yes, you read correctly.

They're part of the beautiful spectrum of existence and life. They have messages for each of us about our desires and where we'd like to be in our lives.

Resisting them, shaming others for feeling them, shaming ourselves for experiencing them after healings/inner work/positive thinking/insert any spiritual bypass tools here, avoiding them for fear they'll drop your vibration and negatively effect your business or relationships are ironically, what will drop your vibration and get you stuck.

We also get stuck when we're trying to understand the story behind the emotion. We ask 'why am I feeling like this?'. We need a reason! Why? Do we ask happiness for its reason? Joy? Contentment? Or are we more accepting of these and wish to feel them forever?

Negative emotions are no different and looking for a rationale to justify their presence or not allowing ourselves to experience the full depth of those emotions only prolongs their presence. This creates pain and suffering.

Don't give your power away to creating a story to justify that emotion.

Don't put your emotions in boxes labelled 'FEEL' 'DON'T FEEL'. They're big loads to keep carrying.

It's draining and pointless because there is no story. It's just a neutral & natural emotion that can feel great or feel like we're in the pit of hell. This is not failure - this is being human.

Who do you work for?

What if I were to tell you that your real job has nothing to do with what you do for income?

That the things you're striving for like success, material wealth, love, approval are getting in the way of doing your job?

Consider who you are underneath the veneer of professional labels and identities. What if your ability to perform in your job disappeared?

What if all your clients and work dried up, the requests to see you stopped coming- would you suddenly feel like you couldn't live purposefully or would you become free to be who you actually are?

My tip is to spend time off the radar doing nothing, no retreats, no studying, no human
contact, no FB scrolling and notice the emotions that emerge, the fear, anger, indifference, bliss.

I call this the achievement detox.

It's important to come back to yourself and remember why you matter - not for what you produce, but because you exist.

Overcoming Approval Addiction

Needing approval or external validation is one of the greatest sources of fatigue and energetic drain in health care workers, academics, researchers and private practitioners.

It's because APPROVAL is one of our basic needs, like love, security, sleep, acceptance and list of others.

Needing approval manifests as our inner critic and our external critics telling us that we're wrong, misguided, incompetent and never going to be good enough. And we believe it.

We can get so invested in doing and saying things that don't rock the boat and maintain status quo. We can follow rules and formulas of perceived success that go against our creative ideas and expression because we fear failure and disapproval from others.

Here's the thing -no amount of external validation, props, love and attention will ever quench that need for approval.

It's an inside job. WE are the only ones who can fulfill this need and doing so regularly when the critics get loud can save us from the exhaustion that accompanies this unfulfilled need.

You can do this by allowing your Inner Mentor to speak to the part of you that doesn't feel validated, heard or good enough. Validate yourself and remind yourself that your ideas are great, you're doing a great job, even if no one else thinks so. If you're scoffing at this idea, consider this an invitation to try something new for a few days and notice the effect.

If you feel you have to earn approval in order to receive it, you'll tire yourself out waiting for that evidence to appear. The more you approve of yourself because you're already enough, the less you care about what others think or expect of you. This is so freeing and attracts more approval and positivity in your life. When you trust that you're already doing your best and believe your best is good enough, you become a magnet for experiences that reinforce this belief, along with the energy you need to keep going.

It's your choice.

My best is good enough,

Nathalie

Judgement as a teacher

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We can get triggered by the way people relate to us or others -through what they say and do, when they do things so differently than how we would.

Behaviours like aggressive sales tactics or health care workers who don't listen can really get on our nerves once we've had the luxury of experiencing other ways of doing business or empathic approaches to care that are more aligned with our vision and how we might behave.

Personally, I would get annoyed when I notice healers, therapists, health professionals and spiritual types speaking and acting from their ego, expressing concrete beliefs as truth under the guise of guidance, cherry-picked evidence and spiritual wisdom. I have a good BS meter for this so when it goes off, I feel triggered.

But this is the thing: if we're triggered by those behaviours then it's OUR issue. There's something we're being shown about ourselves. Something we're judging harshly or disowning that no amount of positive thinking is placating.

Perhaps, once upon a time, it was a way we needed to conduct ourselves to build confidence and feel successful before we were ready to consider other methods. That approach or information was our truth at the time and it worked for us then.

Judging someone's method of relating is as ridiculous as the butterfly judging the larva, when the butterfly could not exist without having gone through its larval stages.

Next time you get triggered by whatever behaviour you judge as inappropriate or primitive:

DO have GRATITUDE for that person for showing you how much you've changed and that you no longer need to use those methods to achieve your goals.

DON'T go into superiority or believe that you're more evolved than that person. That keeps you in judgement, arrogance and blocks compassion.

DO revel in the fact that the person is showing you how much you've developed your virtues like: patience, wisdom, humility, self-love, acceptance and so on. These are the qualities of your soul that you've embodied.

DO send love to that old version of you for helping you get to where you are today.

Most importantly - the person is NOT the behaviour. We are each the sun with some dark spots. Zoom out of the dark spots to view the sun. As you do this for others, you're helping yourself and able to tap into compassion.

Blessings of self-love to you all,

Nathalie