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C Fconcepts.C Hpowerpoint

  1. 1. Compassion Fatigue: Protecting the Spirit of the Helper in the Real World. <ul><li>Tracy Wharton, M.Ed. </li></ul><ul><li>Adjunct Faculty, Cherry Hill Seminary </li></ul><ul><li>[email_address] </li></ul>
  2. 2. <ul><li>YES! </li></ul><ul><li>Here are some sample codes of ethics from various professions. Take some time this week to look up the code of conduct associated with your profession, and see if there is a similar mandate. </li></ul>Do we have an ethical obligation to teach this information?
  3. 3. <ul><li>Code of Ethics, National Assocation of Social Work: </li></ul><ul><li>4.05 (a) Social workers should not allow their own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility. </li></ul><ul><li>Code of Ethics, American Psychological Association: </li></ul><ul><li>2.06 (a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. </li></ul><ul><li>Code of Ethics, Nursing: </li></ul><ul><li>Provision 6.1 . Both virtues and excellences, as aspects of moral character, can be either nurtured by the environment in which the nurse practices or they can be diminished or thwarted. All nurses have a responsibility to create, maintain, and contribute to environments that support the growth of virtues and excellences and enable nurses to fulfill their ethical obligations. </li></ul><ul><li>Code of Professional Conduct, Unitarian Universalist Ministry: </li></ul><ul><li>Because the religious life is a growing life, I will respect and protect my own needs for spiritual growth, ethical integrity, and continuing education in order to deepen and strengthen myself and my ministry. I commit myself to honest work, believing that the honor of my profession begins with the honest use of my own mind and skills.Because the demands of others upon me will be many and unceasing, I will try to keep especially aware of the rights and needs of my family and my relation to them as spouse, parent and friend. </li></ul>
  4. 4. Some Jargon <ul><li>Compassion fatigue (CF) </li></ul><ul><li>Empathy exhaustion </li></ul><ul><li>Vicarious traumatization (VT) </li></ul><ul><li>Secondary traumatic stress (STS) </li></ul><ul><li>Secondary victimization </li></ul><ul><li>Secondary survivor </li></ul><ul><li>Emotional contagion </li></ul><ul><li>Proximity effects </li></ul><ul><li>Burnout </li></ul><ul><li>Compassion satisfaction (CS) </li></ul><ul><li>... and many more... </li></ul>
  5. 5. What is your Cognitive Schema?? The Way you See the World What does it all mean? How could this happen? Identity Worldview Spirituality Basic assumptions and beliefs Relationship with meaning & hope
  6. 6. Compassion Fatigue is made up of 3 areas. Together, they change your cognitive schema. Secondary Trauma Burnout Compassion Satisfaction Compassion Fatigue
  7. 7. Secondary Traumatic Stress (also sometimes called Vicarious Traumatization) <ul><li>Mir rors the symptom profile of PTSD </li></ul><ul><li>Secondary contact with traumatic experiences through contact with others </li></ul><ul><ul><li>For example: </li></ul></ul><ul><ul><ul><li>hearing people talk about their experiences with trauma; </li></ul></ul></ul><ul><ul><ul><li>seeing images of disasters or traumatizing events; </li></ul></ul></ul><ul><ul><ul><li>debriefing other service professionals and hearing about their stories. </li></ul></ul></ul><ul><li>Different from countertransference; this is a change in cognitive schema </li></ul>
  8. 8. Diagnostic criteria <ul><li>The American Psychological Association’s diagnostic criteria manual (DSM-IV) notes that PTSD is possible when one is directly traumatized (in harm’s way) or indirectly (as for a parent). </li></ul><ul><li>Indirect PTSD is called Secondary Traumatic Stress Disorder. </li></ul>
  9. 9. Burnout <ul><li>Cumulative stress </li></ul><ul><li>Related to structural issues </li></ul><ul><li>Job environment </li></ul><ul><li>Characterized by exhaustion </li></ul><ul><li>Inability to be effective </li></ul><ul><li>Confidential environment as a contributor to secondary traumatic stress </li></ul><ul><li>Social/cultural context of questioning the validity of issues </li></ul><ul><li>Usually caused by limited or lack of supportive structures in the work environment </li></ul>
  10. 10. Compassion Satisfaction <ul><li>Why do you keep going back, when it’s such a thankless job?? </li></ul><ul><li>Figley & Stamm noticed that there was a hidden dimension not accounted for in previous assessments. Scores showed people who should be leaving, but weren’t. There is little research yet on this construct, but seems to be related to cognitive schema. </li></ul><ul><li>May be related to feelings of efficacy and “fit” with personal or cultural belief systems. </li></ul><ul><li>*Sometimes traumatized people help others to avoid doing their own work: helping others feel good is “enough.” </li></ul>
  11. 11. Research shows… (we’re not talking about 1 or 2 people!) <ul><li>60% of social service personnel have personal history of trauma; In a sample of 350 american social workers, 98% had a history of trauma. </li></ul><ul><li>In a study of Georgia, USA, child protective workers, 77% had been assaulted or threatened while on the job. </li></ul><ul><li>In a study of Mississippi, USA, child protective workers, Burnout was the most significant predictor of STS. </li></ul><ul><li>Burnout is the greatest predictor of likelihood of leaving employment. </li></ul><ul><li>Studies of disaster responders has found that type of job and months of service are correlated with clinical range of distress symptoms. There is some difference between disaster response and “normal” frontline responders. </li></ul><ul><li>In a study of disaster responders to the Oklahoma City bombing, 64.7% exhibited degree of severity for STSD, and an additional 44.1% exhibited “caseness”; 76.5% were at moderate or high risk of burnout. </li></ul><ul><li>Counselors at the 1994 Northridge (CA) earthquake exhibited 60.5% degree severity for STSD. </li></ul>
  12. 12. Protective & Risk Factors <ul><li>Compassion Satisfaction </li></ul><ul><li>Spirituality (not to be confused with religion) </li></ul><ul><li>Empathy </li></ul><ul><li>Family of origin & Social Support </li></ul><ul><ul><li>Family of origin sets up your cognitive schema </li></ul></ul><ul><ul><li>Social supports as a protective factor </li></ul></ul><ul><li>Education, Job & length of exposure </li></ul><ul><ul><li>Correlation between new, younger, and/or less educated professionals and higher risks of CF. </li></ul></ul><ul><ul><li>Also correlation between long-term exposure and insidious traumatization (“getting jaded”). </li></ul></ul>
  13. 13. Implications <ul><li>Economic, Clinical, and Personal </li></ul><ul><ul><li>Burnout is a predictor of turnover at social service agencies. Training new people is expensive. </li></ul></ul><ul><ul><li>Lack of continuity in care is detrimental to clients and causes caseload management problems for agency administrators. </li></ul></ul><ul><ul><li>STS can wreak havoc with personal lives. Just because we are professionals does not mean that we are immune. How can we provide best care when we have impaired judgment? </li></ul></ul>
  14. 14. Personal <ul><li>STS often is masked by other problems: </li></ul><ul><ul><li>Substance abuse </li></ul></ul><ul><ul><li>Relationship problems, or difficulty </li></ul></ul><ul><ul><li>separating work from personal life </li></ul></ul><ul><ul><li>Risky behavior </li></ul></ul><ul><ul><li>Hyper-vigilance that may seem appropriate in some contexts </li></ul></ul><ul><ul><li>Hypersensitivity or lowered frustration tolerance </li></ul></ul><ul><ul><li>Increased physical discomfort or injuries on the job </li></ul></ul><ul><ul><li>Isolation and/or depression </li></ul></ul><ul><ul><li>Spiritual crises </li></ul></ul><ul><ul><li>Diminished sense of purpose/enjoyment with career </li></ul></ul>
  15. 15. Professional <ul><li>Diagnoses can be assigned incorrectly and be damaging to clients as a result of therapist anger, despair, or misunderstanding. </li></ul><ul><ul><li>Example: BPD diagnosis assigned to a trauma survivor or a physician overlooking critical symptoms </li></ul></ul><ul><li>Lack of self-awareness or control can lead to an inability to track the countertransference in a relationship. </li></ul><ul><li>Lack of continuity of care due to burnout or STS. </li></ul>
  16. 16. What are some things that help? <ul><li>Compassion Satisfaction & Fatigue Self Test (ProQOL) </li></ul><ul><li>Peer groups: develop a buddy system </li></ul><ul><li>Good supervision and support, esp. in high trauma or risk jobs </li></ul><ul><li>Humor & good self-care (eating, recreation, etc.) </li></ul><ul><li>Quiet, safe, and attractive workplaces </li></ul><ul><li>Manage the “Silencing Response” in clinical practice </li></ul><ul><li>The Accelerated Recovery Program (ARP) for compassion fatigue </li></ul><ul><ul><li>Designed for professional caregivers </li></ul></ul><ul><ul><li>Brief, multimodal (five-sessions) </li></ul></ul>
  17. 18. What do we do?? <ul><li>TEACH </li></ul><ul><ul><li>Require training programs to educate students about these issues. </li></ul></ul><ul><ul><li>Offer continuing education for professionals already in the field. </li></ul></ul><ul><li>Engage agencies and institutions to consider the economic and outcomes implications of not supporting their clinicians with healthy work environments. </li></ul><ul><li>Advocate for policy changes to require education, institutional support, and safe work environments. </li></ul><ul><li>Support each other! Peer support goes a long way in protecting & healing from these factors. </li></ul>
  18. 19. References <ul><li>AMA (2005) Making every moment count. Women Physician’s Congress. [Electronic source] Available at www.ama-assn.org/ama/pub/category/print/ 8257.html </li></ul><ul><li>APA (2006). Burnout harms workers’ physical health through many pathways. Monitor on Psychology , 37(6). </li></ul><ul><li>Figley, C.R. (2002). Treating Compassion Fatigue . New York: Brunner-Routledge. </li></ul><ul><li>McCann, I.L., & L.A. Pearlman. (1990). Psychological trauma and the adult survivor, theory, therapy and transformation . New York: Brunner/Mazel. </li></ul><ul><li>Meyers, T.W., & T.A. Cornille. (2002). The Trauma of Working with Traumatized Children. In C. R. Figley (Ed.), Treating Compassion Fatigue . New York: Brunner-Routledge. </li></ul><ul><li>Pryce, J., Shackleford, K., & D. Pryce. (2007). Traumatic Stress and Child Welfare . New York: Lyceum Press. </li></ul><ul><li>Saakvitne, K. & Pearlman, L. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization. New York: W.W. Norton & Company </li></ul><ul><li>Stamm, B.H. (2002). Measuring Compassion Satisfaction as Well as Fatigue: Developmental History of the Compassion Satisfaction and Fatigue Test. In C. R. Figley (Ed.), Treating Compassion Fatigue . New York: Brunner-Routledge. </li></ul>
  19. 20. Thank You!

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