What do greeting the sunrise, taking a five-minute break and making light of a grave situation all have in common? These simple acts represent a crucial coping mechanism for folks who, in one way or another, find themselves acting as "pain professionals" -- people who have to feel the pain of others in the course of their daily work lives. And, whether they hear that pain from their therapeutic clients, manipulate it away on a massage table or listen intently through the confessional window, they all need to find ways to remain simultaneously empathic and detached.
"It's really about caregiving versus caretaking," says Kathleen G. Moore, a certified grief therapist and board member with the Association for Death Education and Counseling, a multidisciplinary professional organization for those working in death education, bereavement counseling and care of the dying.
Moore says that members of her organization, which includes an eclectic mix of pastoral counselors, educators, therapists, nurses and others, are "all subject to burnout.
"It's important to remain detached without abandoning the person," she says. The notion of boundaries is a critical element in the self-preservation of people who do this type of work.
"Don't do something that they can do for themselves. You've got to set limits, and keep them. You are there to assist them in finding their own way; you can't take away their grief -- it's their path to walk, and they have to walk it."
In addition to the facilitation of a client's recovery, Moore stresses the vital importance of counselors staying in touch with their own feelings. Self-review is one way to stay on track.
"You can't take care of others if you don't take care of yourself," says Moore. The "mental health" day, the mini-vacation, the chat with another professional -- these are all ways to relieve the stress.
"You've got to establish a self-care routine that includes exercise and eating right, as well as a social support system and some sort of spiritual definition that allows you to look within yourself. You've got to be willing to look at yourself and your own personality, examine your own losses. If you're not in tune, you can't help your clients," Moore says.
"I found where I belong," is how Joyce Torchinsky, funeral director at the Torchinsky Hebrew Funeral Home in Washington's Takoma neighborhood, describes how she feels about her job. "I wouldn't have it any other way; I know I'm in the right place."
Torchinsky says she started out wanting to be in another "helping profession" -- medicine. But she struggled with the idea that she might be forced to wonder whether she somehow caused another person's death. In her current capacity, she feels she can't do any harm, and she can do much good.
"I help the family have a clear head. I know what to do when everyone else around them doesn't," she says.
There is no doubt that she becomes intimately involved with her clients. Torchinsky admits, "By the time I finish with a family, I feel like I'm one of them. And, though I wish we met under different circumstances, I'm glad it's me helping them."
Torchinsky has shed her share of tears. "I cry at funerals of people I've never met -- I cry when [the families] cry," she says.
It's that sense of fulfillment and of having found her calling that carries her through. Plus, her constant exposure to fresh loss has made her appreciate each day that much more. "It makes you not put anything off; you learn what really matters. I'm in the business of caring, so my work is always in my mind, but I can go to a birthday party and enjoy myself, too. Life is for living."
Linda Goldman, a certified grief therapist and educator in Chevy Chase, admits, "I think there's a fine line between objectivity and compassion, and walking it is a delicate balance."
"I do 'feel' with my clients; I think it's perfectly okay to cry with a client. I'm deeply touched, but careful not to become enmeshed," she says. One of the best ways to do that is to be cognizant of what brought the person in to begin with.
"I have to remember that this person has come to see me with a crisis or problem which I had no creation in. I can help facilitate how to work through the experience and learn to live with it, but it's their [issue] to work out."
To maintain balance, Goldman also uses various forms of release -- constructively giving back out what she takes in, whether it's through writing books, such as "Breaking the Silence," or teaching others how to cope, as she does in the course she created at Johns Hopkins University.
After the death of her own child 20 years ago, Goldman knows what a long, deep and sad process such grief is for the parents. "I limit how many of these types of clients I take on because it is so energy-consuming," she says.
The Rev. Tom Moriarty, a priest from Floral Park, N.Y., finds his strength from a higher power. It is the spiritual aspect of his life and work that makes it possible for him to do it.
"There's no way I could do what I do without a constant prayer life," he says. And although he may believe God created man "in His own image," he doesn't believe he himself is Superman, a realization that made his job easier.
"Once you realize you can't save the world, it's better. I'll do as much as is humanly possible, but I'm not the Savior; that job is taken. I can work for Him, but I'm not Him," Moriarty says.
Regardless of his limitations, Moriarty ultimately finds his job extremely rewarding. "When you give your entire self to the community, what you get back is so much more," he says.
Working through spiritual and mental pain can take a lot out of you, but what about pain that's rooted in the physical world? Kate White, a licensed massage therapist who specializes in treating chronic pain, has firsthand experience in this area. "To stay pain-free, I follow my passion carefully. My work gives me energy and pleasure," she says.
White is careful about what she eats and she exercises regularly to stay strong. And, of course, she gets massages, too.
"It's best to get body work, especially when you first start out. Your hands ache; I get my forearms and hands done on a regular basis."
Firm boundaries make a difference, as well. "I don't carry around too much of what my clients are going through. I like to cleanse myself of negativity -- I greet the sunrise with prayer and song."
It's hard to imagine a pain greater than the death of a child. Beth Knox, whose daughter died seven years ago in an airbag accident, worked through her pain, and now helps others in similar circumstances. She founded Crossings, an educational resource organization dedicated to caring for our own at death.
"When a child dies, someone we cared for every waking moment, we should be able to escort them out of this world with the same love and dignity. We should be able to love and tend to them until they are put into the ground or taken to a crematory," Knox says.
The organization has enabled Knox to spend time with parents who find themselves in the same tragic circumstance she was in.
"When they see someone who has experienced the amazing pain that they're in, and who has survived and been transformed by it -- I'm a beacon of hope," she says.
Of course, getting to this point is part of a process.
"When it first happened, I thought I would retire from life and hate everyone who had a daughter," Knox says. "What got me to start this was that I was able to transform what happened by forming a new relationship to my daughter and to death. Then I knew I had something to offer. It's not all about me and my loss -- when I help others, I'm giving of my best self. Something else is carrying me at that point. I'm more of an instrument and less Beth Knox.
"When any of us find work where we truly have something to offer, it's transformative. Darkness becomes luminous," she says.
For Judith Sandelow, the executive director of the Children's Law Center, which specializes in criminal and juvenile defense work, laughter is the best medicine when it comes to stress.
"The number one way we handle it is humor," she says. "I guess we've developed a certain 'gallows humor' around here to relieve the stress."
Still, there's no doubt they are sometimes smiling through their tears.
"I have no doubt my colleagues feel deeply about their clients. They wake up and worry, they spend dollars out of their own pockets to make sure people have food on the table, or gifts at Christmas."
Another way Sandelow processes her emotions is to simply talk -- and talk and talk -- to people about her work.
"I discharge the energy by telling and retelling the story. The more upsetting it is, the more people I tell before getting it out of my system," she says.
In a job that can often be plagued with discouraging setbacks due to uncompromising bureaucracies, Sandelow takes comfort in the small victories along the way. Things may be hopeless, but sometimes she can still be helpful.
"I remember a client who was 13 years old, selling drugs to support his younger siblings. He had poor vision, so I bought him glasses," she recalls. His story, like so many, doesn't end happily.
"I never was really able to help him, but I encountered him at age 19, in jail, and he was still wearing those glasses. As much as you want to make a big difference, sometimes you just have to take pleasure in the small things you can do."