Compassion Fatigue

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Therapist and other direct service providers who work with trauma survivors may themselves be impacted. This is described as compassion fatigue, or secondary traumatic stress

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  • This is where I talk about Compassion Fatigue
  • Although the larger number of our clients are female, many men and boys are survivors of childhood abuse and trauma. Under-recognition of male survivors, combined with cultural gender bias has made it especially difficult for these men to get help. Because violence is everywhere in our culture and because the effects of violence and neglect are often dramatic and pervasive
  • Childhood trauma can cause the disruption of basic developmental tasks. Disruption of these tasks in childhood can result in adaptive behavior, which may be interpreted in the mental health system as "symptoms." For example : 
  • When helping others precipitates a compromise in our own well-being we are suffering from Compassion fatigue. CF- another term for secondary traumatic stress. (more user friendly) All familiar with post traumatic stress disorder (Psychological and emotional distress which develops following a stressful, traumatic event or series of events (war, rape, natural disaster).) that our clients experience. The idea here is that even secondary exposure to stressful and/or traumatic events can produce many of the same reactions. Our very compassion, empathic connection, the thing that makes us effective helpers, seems to be what puts us at risk. As many of us know, being around the pain and suffering of others can be "emotionally contagious". It's difficult to see and care deeply about the suffering of others without feeling some pain ourselves. Unlike burnout, The onset can be sudden. Burnout (term many may be more familiar with….the literature differentiates CF from burnout)- gradual, over time. emotional exhaustion resulting from the stress of interpersonal contact Burnout is when we doubt our ability to keep coping constructively Burnout is the development of a negative self-concept and negative attitude towards work, people involved in the work, life itself, and a severely hampered ability to cope with the work environment. (Pines and Aronson 1988) Untreated CF can get worse and lead to burnout
  • Like signs and symptoms of PTSD Sleepless, irritability, anxiety, emotional withdrawal, avoidance of certain tasks, isolation from coworkers, feelings of helplessness and inadequacy, and even flashbacks are among the symptoms.
  • Younger age-may be due to less exp, over involvement with client Anxiety/depression-pre-existing Negative att toward client- fear of contagion -----Several theories have been offered but none have been able to conclusively demonstrate the mechanism which accounts for the transmission of traumatic stress from one individual to another.  Figley (1995) hypothesizes that the caregiver’s empathy level with the traumatized individual plays a significant role in this transmission. Basically everyone!!!!
  • Individual- decreased health, job satisfaction, quality of life and psychological well being Workplace- has costs if this results in decreased performance, morale and ultimate higher turnover of staff. How many here have been doing this work for less than 5 years? 5-10? Over 10? CF/burnout can be one factor in high turnover is social service jobs
  • Professional Quality of Life Scale developed by Stamm, measures 3 factors Compassion satisfaction: pleasure you derive from being able to do your work well. Ex: feeling like what you do makes a difference, getting along with colleagues. Higher score = greater satisfaction. Ave = 37. Below 32 may indicate problems in work or just that ind finds satisfaction elsewhere Burnout: research is defining it as diff dealing with work or doing job effectively, asst feelings of hopelessness. Often gradual in onset. “my efforts make no difference” Higher scores = higher risk for burnout Ave score 23. above 28 cause for concern….if continues over time (may just reflect bad day) under 19----feell good about and able to be effective at work compassion fatigue/secondary trauma- work related secondary exposure to stressful or traumatic events. Often sudden onset. Ave score = 13. Above 17- examine what is happening, what is frightening at work
  • Awareness: Compassion Fatigue is a term, not a disease! It is simply a label to help us identify where we may benefit from healthy changes in our life. Having a high score may mean that there are a number of issues related to your stress that warrant your attention. There is no need for alarm, only awareness. Confirmation: Some people report that their scores simply confirm what they already know. Others are surprised. Many people did not previously know that certain symptoms they experience were related to the stress of their work. If this is the case for you, then the test was worth taking! The "surprises" can serve as alerts to what needs your attention. ???The scores don't matter. What matters are the items on the test which concern you. When you're done with all the scoring, go back through the items and look for the compassion fatigue items (the circled ones) which you rated a 4 or 5. These are issues which create stress for you. Use this information as a baseline, not to judge yourself, or to feel scared about, but just as information..
  • 1) Self-care: not always so good at practicing what we preach --Both for our patients and for each other, we as clinicians owe it to ourselves to acknowledge the importance of our own health, emotional balance, satisfaction, and well-being in order to be care providers . Basics: (refer to palm card) 10 things to do every day. Switching feeling on and off? Maybe more about detachment. Breathing key. 2) Time off two weeks consec? What works. me long weekend every month, flexible schedule, no work certain days 3) Peer support- formal groups, informal 4) We must also appreciate on a programmatic and institutional level that this is not "extra" but is rather an essential requirement for the long-term success and effectiveness of work with those impacted by trauma.
  • • Self-assessment : Ask yourself, "How am I doing?" What do I need? How have I changed? Discuss the questions and answers with a colleague, friend, or therapist. • Protect yourself: - Be aware of your vulnerability and the negative consequences of your work, - Strive for balance, and - Maintain connection with others. • Address the stress of your work: - Practice self-care, - Nurture yourself by focusing on sources of pleasure and joy, and - Allow yourself to escape when necessary. • Transform the negative impact of your work: - Focus on finding meaning in your work and day-to-day activities, - Challenge negativity, and - Participate in community building activities, joining with others around a common purpose or value. Connect with yourself and with others: - Pay attention to your inner experience, - Talk about it with others, - Do not work alone, and - Ask for support as well as offering it to others.
  • 1) Tell new or prospective employees what to expect. Normalize, predict, takes some of power away, don’t feel like something is wrong with me, make plans to cope "We recognize that compassion fatigue is probably inevitable in the work we do," she says. 2)Establish support systems. Giving employees opportunities to talk about the emotional aspects of their work -- and chances to blow off steam -- can help keep compassion fatigue from taking over. For counselors, the checks and balances provided by mandatory clinical supervision , can help them maintain perspective.(but may not always feel free to share everything) Support groups/peer groups (our senior staff mtg example) research shows can decrease staff turn over Informal support –break room, some org have time out rooms, yoga relaxation at the workplace Encourage workers to talk about their feelings. After a particularly traumatic event occurs at work, start a conversation about it. "People worry that if employees start showing their feelings, they'll just start breaking down all over the place and they won't do their jobs," says Ms. Brothers. "The truth is, when people can show their feelings, they do better work. They have more energy." 3) If a manager notices an employee's behavior has changed , he or she should take the initiative and gently bring it up , --would be good time to make use of CF test or other kind of self assessment. Provide referrals to outside therapy 4) In-service training- bring in outside resources -- programs in CF, secondary traumatic stress (like this) --ongoing support or consultation groups ( I did for work with dissoc disorders, also support group for therapists doing DD trauma work). -- Seek out stress-relieving activities outside of work, Mr. Bowers says, and consider bringing in speakers who can let employees know about local opportunities for the same, such as massage therapy or yoga. What Do Therapists Need? Options for Support • Work environments that acknowledge the reality of secondary or vicarious trauma and offer support for self-care and connection • Forums for discussions about the work and its stresses • A group with a focus on discussing and addressing vicarious traumatization • A buddy system (Identify a colleague with whom you will discuss the work and its challenges.) • Regular clinical consultation • Personal psychotherapy • Continuing education opportunities that address these topics • Emotional release (opportunities to express strong feelings of grief, fear, anger, gratitude) • Realistic expectations for selves
  • Compassion Fatigue

    1. 1. Compassion Fatigue: Secondary Traumatic Stress Kathleen Young, Psy.D.
    2. 2. Trauma- definition <ul><li>Psychological trauma is the unique individual experience of an event or enduring conditions, in which:
    3. 3. The individual's ability to integrate his/her emotional experience is overwhelmed, or
    4. 4. The individual experiences (subjectively) a threat to life, bodily integrity, or sanity. (Pearlman & Saakvitne, 1995, p. 60) </li></ul>
    5. 5. Types of Trauma <ul><li>Single Blow vs. Repeated Trauma
    6. 6. the traumatic experiences that result in the most serious mental health problems are prolonged and repeated, sometimes extending over years of a person's life. </li></ul>
    7. 7. Psychological effects are likely to be most severe if the trauma is: <ul><li>Human caused
    8. 8. Repeated
    9. 9. Unpredictable
    10. 10. Multifaceted
    11. 11. Sadistic
    12. 12. Undergone in childhood
    13. 13. And perpetrated by a caregiver </li></ul>
    14. 14. Who Are Trauma Survivors? <ul><li>survivors are all genders, all ages, all races, all classes, all sizes, all sexual orientations, all religions, and all nationalities
    15. 15. most clients/patients/recipients of services in the mental health system are trauma survivors </li></ul>
    16. 16. Developmental Impact <ul><li>self-soothing
    17. 17. seeing the world as a safe place
    18. 18. trusting others
    19. 19. organized thinking for decision-making
    20. 20. avoiding exploitation </li></ul>
    21. 21. Trauma related symptoms <ul><li>disrupted self-soothing can be labeled as agitation (or self injury)
    22. 22. the disrupted ability to see the world as a safe place looks like paranoia
    23. 23. distrust of others can be interpreted as paranoia
    24. 24. disruptions in organized thinking for decision-making appears as psychosis
    25. 25. avoiding/preempting exploitation is called self-sabotage </li></ul>
    26. 26. Definitions <ul><li>Compassion Fatigue: The natural consequence of stress resulting from caring for and helping traumatized or suffering people.
    27. 27. Burnout: The development of a negative self-concept and negative attitude towards work, people involved in the work, life itself, and a severely hampered ability to cope with the work environment. (Pines and Aronson 1988) </li></ul>
    28. 28. Signs and Symptoms <ul><li>Sleeplessness
    29. 29. Anxiety, irritability
    30. 30. Emotional withdrawal
    31. 31. Avoidance of certain tasks
    32. 32. Isolation from coworkers,
    33. 33. Feelings of helplessness and inadequacy
    34. 34. Flashbacks, nightmares
    35. 35. Feelings of therapeutic impotence or de-skilled with certain clients </li></ul>
    36. 36. Who Is at Risk? <ul><li>Younger age
    37. 37. Anxiety/depression
    38. 38. Negative attitude toward client
    39. 39. Perception that the work is difficult
    40. 40. Problems with colleagues, supervisor, administration
    41. 41. Inadequate support from family friends re HIV work
    42. 42. Therapist’s own exposure to trauma </li></ul>
    43. 43. Costs of Compassion Fatigue <ul><li>To individual
    44. 44. To workplace </li></ul>
    45. 45. Assessing for Compassion Fatigue <ul><li>Professional Quality of Life Scale (ProQOL R-IV)
    46. 46. Measures compassion satisfaction, burnout, compassion fatigue/secondary trauma
    47. 47. More information and scoring manual: http://www.isu.edu/~bhstamm/tests.htm </li></ul>
    48. 48. Making Use of Test Scores <ul><li>Awareness
    49. 49. Confirmation </li></ul>
    50. 50. Strategies for Coping With Compassion Fatigue <ul><li>Self-care
    51. 51. Time off
    52. 52. Peer support
    53. 53. Institutional support </li></ul>
    54. 54. CARING FOR YOURSELF IN THE FACE OF DIFFICULT WORK Our work can be overwhelming. Our challenge is to maintain our resilience so that we can keep doing the work with care, energy, and compassion. 10 things to do each day 1. Get enough sleep 2. Get enough to eat 3. Vary the work that you do 4. Do some light exercise 5. Do something pleasurable 6. Focus on what you did well 7. Learn from your mistakes 8. Share a private joke 9. Pray, meditate or relax 10. Support a colleague For More Information www.psychosocial.org or telida.isu.edu
    55. 55. Personal Plan To Prevent/Manage Compassion Fatigue <ul><li>What do you do that refreshes you?
    56. 56. Connections to others
    57. 57. Finding Meaning (why do I do what I do?) </li></ul>
    58. 58. Sample Self-care Plan <ul><li>Make the environment you are in everyday comfortable and pleasant by using pictures, plants, and music. Think about what you enjoy in your world and find creative ways to alter your &quot;life space&quot; to merge with your personality.
    59. 59. Set aside 15 minutes for private time, admiring nature, walking, swimming, biking, or reading a favorite novel. Taking time out consistently everyday is more important than the amount of time. Make a commitment to yourself to pamper yourself in a special way each day.
    60. 60. Use at least part of every weekend for enjoyable activities that are replenishing. Don't isolate yourself, have contact with others.
    61. 61. Exercise daily, for 10-30 minutes. Even a brisk walk around the block can provide a dramatic break and give refreshment to the spirit.
    62. 62. Listen to a favorite musician, and try unfamiliar music that may be interesting. </li></ul>
    63. 63. Administrative Prevention <ul><li>Educate new staff about what to expect
    64. 64. Establish support systems
    65. 65. Notice changes in staff behavior and address
    66. 66. In-service training programs </li></ul>
    67. 67. Additional Resources <ul><li>Lipsky, Laura van Dernoot, and Connie Burk. Trauma Stewardship. Seattle, WA: Las Olas Press, 2007.
    68. 68. Pearlman, Laurie Anne, and Karen W. Saakvitne. Trauma and the Therapist . New York: Norton, 1995. </li></ul>

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