2. History
1982: Charles Figley defines SecondaryTraumatic
Stress as a phenomenon associated with the “cost of
caring”
1992: Nurse Joinson used term in Nursing Magazine to
describe feeling of “worn down”
1992: Jeffrey Kottler writes CompassionateTherapy to
emphasize importance of compassion when dealing with
difficult / resistant clients
1995: Figley redefines SecondaryTraumatic Stress to a
“more friendly term” - Compassion Fatigue
3. CF defined:
Those who work with the suffering
suffer themselves because of the work
“We absorb the traumatic stress
of those we help” (Beaton & Murphy, 1995)
4. AKA Secondary Trauma
or Secondary Post-Traumatic Stress
or Secondary Exposure
or SecondaryVictimization
orVicariousTraumatization
or Emotional Contagion
or Secondary Survivor
“Phenomenon associated with the
‘cost of caring’ for others in emotional pain”
(Figley, 1982)
9. The CF Process
1. Exposure to Suffering
2. Empathic Concern – motivation to respond to
those in need
3. Empathic Ability – aptitude for noticing the pain of
others
4. Empathic Response – helper makes an effort to
reduce the suffering of the sufferer
10. The CF Process
5. Compassion stress – compulsive demand for
action to relieve the suffering of others
6. Prolonged Exposure – on-going sense of
responsibility for the care of the suffering
7. Traumatic recollections – memories that trigger
the symptoms of PTSD
8. Demands of Life – unexpected changes in
schedule, routine, & managing life’s responsibilities that
demand attention
11. The CF Process
9. Compassion Fatigue – state of tension and
preoccupation with the traumatized by:
a. Re-experiencing the traumatic events
b. Avoidance/numbing reminders
c. Persistent arousal
9. CompassionTrap – inability to let go of the
thoughts, feelings and emotions useful in helping
another, long after they are useful
14. Contributing Factors
Intensity
Frequency
Severity
Proximity
Personal Factors
Sensory Information
– “Imprint of Horror”
(Learner, 2005)
Perceptions,
Belief system
Current coping
mechanisms
Implementation of
self-care techniques
Support system
15. Symptoms of Poor Self-Care
Cognitive
Diminished
concentration
Confusion
Loss of meaning
Decreased of
self-esteem
Apathy
Rigidity
Self-doubt
Perfectionism
Minimization
18. Symptoms of Poor Self-Care
Spiritual
Questioning the meaning of life
Loss of purpose
Lack of self-satisfaction
Pervasive hopelessness
Angry at God
Questioning prior beliefs
“Soul Sick” (Bill O’Hanlon)
19. Symptoms of Poor Self-Care
Interpersonal
Withdrawn
Decreased interest in intimacy
Mistrust
Intolerance
Loneliness
Projection of anger or blame
20. Symptoms of Poor Self-Care
Physical
Shock
Sweating
Rapid heartbeat
Aches and pains
Dizziness
Impaired immune system
Restlessness
21. Impact on Professional
Functioning
Performance of JobTasks
Decrease in quality & quantity
Low motivation
Avoidance of job tasks
Increased mistakes
Setting perfectionist standards
Obsession about details
22. Impact on Professional
Functioning
Morale
Decrease in confidence
Loss of interest
Dissatisfaction
Negative attitude
Apathy
Demoralization
Lack of appreciation
Detachment
Feelings of
incompleteness
23. Impact on Professional
Functioning
Interpersonal
Withdrawal from colleagues
Impatience
Decrease in quality of relationship
Poor communication
Staff conflicts
26. “When you discover you are
riding a dead horse,
the best strategy
is to dismount”
- Dakota Tribal Saying
27. ““Primum non nocere”Primum non nocere”
- Claudius Galen, born in 129 AD, chief physician
to the gladiator school in Pergamum
First Do No HarmFirst Do No Harm
28. ““First do no harmFirst do no harm
to Self”to Self”
- Gentry & Figley, 2007
Created adage after discovering correlation between
compassion fatigue and ethical violations
29. Self-Care may involve…
Re-evaluating an unhealthy relationship
Listening to your body & staying within your limits
Advocating for your rights
Commit more time to planning
Not assuming responsibility for others & their
problems
Lose “all-or-nothing” thinking; be more flexible
Not feeling compelled to “fix”/solve another
person’s problem
Not anticipate the needs of others
30. Self-Care may involve…
Re-think trying to please others; explore being
satisfied with self
Appreciate your mistakes – opportunity to learn &
grow
Not over-committing
Giving yourself plenty of time so you don’t feel
harried or pressured
Quit blaming and shaming self…then others
Stop taking things personally
31. Self-Care may involve…
Keeping up with dentist & doctors appts.
Taking restroom breaks when needed
Accepting myself for who I am
Not feeling the need to control; accept some
things are out of my control
Forgive yourself when you make a mistake
Quit trying to prove you’re good enough
Stop tolerating behaviors that you don’t want to
tolerate
Trust yourself
34. Back to the CF Process
Detachment (M. Beattie, 1992)
Opposite of attachment – excessively worried or
preoccupied w/ person or problem
It’s Not: Cold,Withdrawn, Hostile, Ignorant Bliss
Based on premise that “each person is responsible
for himself & we can’t solve problems that aren’t
our own & worrying doesn’t help”
35. Detachment cont.
“It doesn’t mean we don’t care. It means we
learn to love, care & be involved without
going crazy” (M. Beattie, 1992)
“When we allow people to be who they
are, then we stop trying to change things
we can’t.” (M. Beattie, 1992)
36. Sense of Satisfaction
“Shades of Gray” (D. Burns, 2005, Cognitive Motivational
Therapy)
“When things don’t work out as well as you’d
hoped, you can think of the experience as a partial
success or learning opportunity.
Question: Are you wanting your client to
provide for you a sense of satisfaction?
“You’re OK … then I’m OK”
37. Sense of Satisfaction cont.
Reframe the “Pay-Out”
Appreciation
Approval
Attention
Acceptance
Affiliation
Admiration
Acknowledgement
Affirmation
Accomplishment
Affection
38. Standards of Self-Care
1. Respect for dignity & worth of self
2. Responsible for self-care
3. Universal right to wellness
4. Physical rest, emotional rest & nourishment
5. Seek, find & remember appreciation from
supervisors & clients
6. Make it known that you wish to be
recognized for your service
Adapted from “Standards of Self Care for the Practitioner,” Green Cross Foundation, Inc., 2004
Editor's Notes
#7 …& associated reactions such as panic/anxiety & depression