Who helps the people in the helping professionals manage their stress?? This important workshop was presented at the LiveOn NY's 26th Annual Conference on "The Transformation of Aging". It covers the types of stress (physical and mental) encountered in the workplace. It gives specific assessment tools to help you see how "stressed out" you are, covers "compassion fatigue" and helps you see your personal risk factors contributing to your stress. But, don't fear - the presentation also focuses on self-care; what you can do for yourself to make things better. Bottom line - strengths to combat this stress come from identifying the stress and acting to manage it. And, it ends with extremely practical solutions on things you can do - even if you only have two minutes to relieve your stress!

1. Kara M. Dean-Assael, LMSW
Lydia Franco, LMSW

2. Agenda
 Welcome
 Overview of compassion fatigue, secondary trauma, and
burnout
 Self Care
 The importance of self-assessment
 Practical ways of coping:
 Personal techniques
 Friends/colleagues- relationships
 Caseload management
 Supervisory support
 Next steps

4. Types of Stress
There are at least three different types of stress,
all of which carry physical and mental health risks:
 Routine stress related to the pressures of work, family and other
daily responsibilities.
 Stress brought about by a sudden negative change, such as losing
a job, divorce, or illness.
 Traumatic stress, experienced in an event like a major accident,
war, assault, or a natural disaster where one may be seriously
hurt or in danger of being killed.
(NIMH, Fact Sheet on Stress. 2014)

5. Impact of Chronic Stress
 Most Americans report feeling moderate-to-high
stress levels
 70-80% of all visits to the doctor are for stress-related
and stress-induced illnesses
 Stress can play a part in problems such as headaches,
high blood pressure, heart problems, diabetes, skin
conditions, asthma, arthritis, depression, and anxiety.
(USDHHS: Healthy People; APA: Stress in America Survey;
Mayo Clinic: “Chronic stress puts your health at risk.“)

6. Work Stress
Please share an example of a way that job stress
has impacted you.

7. Helpers’ Reactions to Work in the Helping
Professions
• Compassion Satisfaction: Positive aspects of working
as a helper
• Compassion Fatigue: Negative aspects of working as a
helper
• Burnout
– Inefficacy and feeling overwhelmed
• Work-related traumatic stress
– Primary traumatic stress direct target of event
– Secondary traumatic exposure to event due to a
relationship with the primary person (Stamm , 2009)

9. Compassion Satisfaction
 The pleasure you derive from being able to
do your work.
 Feel satisfied and enjoy your work
 Feel positive towards clients
 Feel you actually are helping others (I make a
difference)
 Feel you are able to keep up with the work
(Stamm, 2012)

10. http://muttscomics.com/ June 4, 2007

11. Compassion Fatigue
“affects those who do their work well” (Figley, 1995)
 Shift in hope and optimism about the value of the work
 Deep physical, emotional and spiritual exhaustion
 Compassion fatigued practitioners continue to give
themselves fully to their clients, finding it difficult to
maintain a healthy balance of empathy and objectivity.
 Can be a typical response to work overload; can ebb and
flow depending on demands
(Mathieu, 2007;Pfifferling & Gilley, 2000)

12. Risk Factors
for
Compassion
Fatigue
Personal
History of
Trauma
Inexperience
Working
with Trauma
High Degree
of Empathy
Degree of
Exposure
Counter-
Transference

13. Burnout
 Feelings of hopelessness
 Feelings of being emotionally exhausted and
overextended by the work.
 Feelings of depersonalization which result in negative,
cynical attitudes toward clients.
 Diminished personal accomplishment, reflecting a
sense of lowered competence and a lack of successful
achievement in work with clients.
 Associated with high workloads and non- supportive
work environment
(Maslach & Jackson, 1986; Stamm, 2012)

14. Secondary Traumatic Stress,
Also Known as Vicarious Trauma.
 Secondary exposure to extremely stressful events
(exposure to others’ trauma or reexperiencing the
client’s trauma)
 Symptoms rapid in onset and specific to a
particular event
 Symptoms: Afraid, difficulty sleeping, images of
upsetting event, avoiding the client and reminders
of the event
(Figley, 1995, Stamm, 2012)

15. Brief Compassion Fatigue Self-Assessment
1. Personal concerns commonly intrude on my professional role.
2. My colleagues seem to lack understanding.
3. I find even small changes enormously draining.
4. I can't seem to recover quickly after association with trauma.
5. Association with trauma affects me very deeply.
6. My patients' stress affects me deeply.
7. I have lost my sense of hopefulness.
8. I feel vulnerable all the time.
9. I feel overwhelmed by unfinished personal business.
Exercise only – Non-validated tool: http://www.aafp.org/fpm/2000/0400/p39.html

16. How many of you answered….
 Yes to 1 item
 Yes to 2 items
 Yes to 3 items
 Yes to 4 or more
Yes to 4 or more could be possible indicators of
Compassion Fatigue.

17. What is the ?
Compassion
Fatigue
Compassion
Satisfaction
Self-Care!

19. Self-care
• How do you take care of your
self?
• Name one thing you do to take
care of yourself.
• Why is this important as a
helper?

20. Self-Care Assessment
Let’s Review the Personal Self-Care Checklist

21. Personal Self-Care
 We have stressful experiences everyday in our jobs
 People are different: What is stressful to you, may
not be stressful to others.
 Strengths comes in identifying the stress and
acting to manage it.
 Checking in about your stress levels on a daily basis
can help to make you more aware of what you and
your body are going through (e.g., stress
thermometer)
Volk, Guarino, Grandin, & Clervil, (2008)

22. Personal Self-Care
 Many of us come with issues that are unresolved and
can impact our lives and our work
 Do you have your own history of trauma?
 Very common
 What are your triggers?
 Are you getting help to help you cope?
Volk, Guarino, Grandin, & Clervil, (2008)

23. People Bring Themselves
• People bring a past and a present to anything they do
– Their schemas and beliefs
– Their stigma beliefs
– Their social support systems
• Positive support
• Negative support
– Their history of trauma and illness
– Their families and close others
– Their economic situation

24. Personal Self-Care
Key areas to examine:
 Sleep – How much sleep are you getting a day? Most people
are sleep deprived which makes you more vulnerable to
stress(6-8 hours a day is ideal)
 Exercise – Are you exercising? It’s helpful to exercise, even a
little bit helps- may also be helpful to do with a friend
 Diet – How is your diet?- it’s important to eat regularly and eat
healthy foods
 Unhealthy habits - Do you have unhealthy habits? Caffeine,
smoking, drinking excessively?
 Relationships-Are you maintaining positive relationships?
(Stamm, 2002)

25. If you
only
have a
few
minutes
…

26. Relationships Help
Personal Relationships
 Stress can impact and strain relationships
 Maintaining positive relationships helps to balance the stress
one is experiencing
 What are you doing to build relationships?
 Are you expanding your support networks?
 Do you have friends you can speak with about how work
affects you?
 Can you tell your friends and family not to expect you to solve
their problems since you are “so good at it”?
(Volk, Guarino, Grandin, & Clervil, 2008; Stamm ,2002)

27. If you
only
have a
few
minutes
…
Volk, Guarino, Grandin, & Clervil, (2008)

28. How do you ask for help?
How do you seek support from your colleagues
or supervisors?

29. Relationships Help
 Workplace Relationships
 Colleagues:
Colleagues can help listen and provide support
Colleagues can see you struggling and let you know
 Supervisors:
Support to process challenges and build coping
Do you feel comfortable with your supervisor? If not, can
you change supervisors or add an outside supervisor?
 You can also find non-workplace professional communities
Look for others in similar profession
Virtual support groups or professional networks
Remember confidentiality – share how you feel not your
client’s story (Stamm, 2002)

30. Managing Your Workload
 Can you see a variety of clients (e.g., mixing milder cases
with more intense cases)?
 Split seeing clients with administrative tasks
 Can you transition stagnant cases to other services?
 Plan pockets of time to complete administrative tasks during
your day so you can leave work on time.
 Have a transition time between seeing clients and going
home.
 At work, end your day with something positive.
 During commute, do something fun/enjoyable unrelated to work.
 At home, take a few minutes to breathe before transitioning to home
responsibilities (e.g., enjoy family time, listen to music, etc.).
 Switching on and off – See PocketCard
 Keep Hope Alive!
(Stamm , 2002)

32. If you
only
have a
few
minutes
…
Volk, Guarino, Grandin, & Clervil, (2008)

33. Organization-Wide Stress
 Warning signs:
 High rates of staff turn-over; High rates of absences or tardiness
 Lack of communication and frequent miscommunication between co-
workers and/or departments
 Increase in interpersonal conflicts between co-workers and/or between
various parts of the organization
 Missed deadlines
 Incomplete work; Poor quality of work or service delivery
 Increase in customer/client complaints
 A negative atmosphere/low morale
 Less energy and motivation to do “extra” or to take sufficient time to do
quality work as an organization
 A lack of emotional and/or physical safety in the organization
Volk, Guarino, Grandin, & Clervil, (2008)

34. The Professional Quality of Life Scale
(ProQOL)
 The ProQOL is free and available at www.proqol.org
 A 30 item self-report measure of the positive and
negative aspects of caring
 The ProQOL measures Compassion Satisfaction and
Compassion Fatigue
 Compassion Fatigue has two subscales
 Burnout
 Secondary Trauma
Stamm (2009)

36. Resiliency Planning
• Individual, personally
– The ProQOL can help you plan where to put your energy
to increase your resilience
• Organizational planning
– Can help organizations find ways to maximize the positive
aspects and reduce the negative aspects of helping
• Supportive Supervision
– The ProQOL can be used as information for discussions
Stamm (2009)

37. Do You Have Any
Questions for Us?

38. Kara Dean-Assael
kara.dean@nyu.edu
Lydia Franco
lydia.franco@nyu.edu
Please Contact Us…

39. Resources
 http://www.compassionfatigue.org
 http://www.stress.org/
 http://www.healthycaregiving.com/
 http://www.proqol.org/Home_Page.php
 Workbook for Those Who Work with Others:
 http://www.familyhomelessness.org/media/94.pdf
 Organizational and Personal Self-Care Checklists:
 http://www.familyhomelessness.org/media/95.pdf

40.  Figley, C.R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C.R. Figley (Ed.),
Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20). New
York: Brunner/Mazel.
 Figley, C.H. (2002). Treating Compassion Fatigue. New York: Routledge
 Maslach, C. and Jackson, SE (1986). Maslach Burnout Inventory Manual: Second Edition. Palo Alto: Consulting Psychologist
Press.
 Mathieu, F. (2007).Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 Self-Care Tips for Helpers.
Workshops for the Helping Professions.
 Pfifferling, J. H., & Gilley, K. (2000). Overcoming compassion fatigue. Family Practice Management, 7(4), 39-39.
 Stamm, B.H. (2002). Quick-guide suggestions prevention/intervention with the negative effects of caregiving.
http://www.proqol.org/Handouts.html
 Stamm, B.H. (2009-2012). The PROQOL: Professional quality of life scale: Compassion satisfaction burnout and fatigue
scale-Version V. Retrieved May 13, 2013, from http://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf
 Rothschild, B. & Rand, M. (2006). Help for the helper: The psychophysiology of compassion fatigue and vicarious trauma.
New York, NY: W. W. Norton & Company.
 Volk, Guarino, Grandin, & Clervil, (2008). What About You? Workbook for Those Who Work with Others. The National
Center on Family Homelessness.
 Bourassa, D. B. (2013). Compassion Fatigue Presentation, PA Behavioral Health and Aging Coalition
 Cunningham, M. (1999). The impact of sexual abuse treatment on the social work clinician. Child and Adolescent Social
Work Journal, 16(4), 277-290.
 Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social Work, 48(4), 451-459.
References

41. References Dane, B. & Chachkes, E. (2001). The cost of caring for patients with an illness: Contagion to the social worker. Social
Work in Health Care, 33(2), 31-51.
 Figley, C.R. (1995). Compassion fatigue as secondary traumatic stress disorder: An overview. In C.R. Figley (Ed.),
Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20).
New York: Brunner/Mazel.
 Figley, C.R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self care. Journal of Clinical Psychology,
58(11), 1433-1441.
 Jenkins, S.R. & Baird, S. (2002). Secondary traumatic stress and vicarious trauma: A validational study. Journal of
Traumatic Stress, 15(5), 423-432.
 Jacobson, J. M. (2004). Compassion fatigue among employee assistance program counselors. Unpublished doctoral
dissertation, University of Maryland at Baltimore, Baltimore, MD.
 Leon, A.M., Altholz, J.A.S., & Dziegielewski, S.F. (1999). Compassion fatigue: Considerations for working with the elderly.
Journal of Gerontological Social Work, 32(1), 43-62.
 Maslach, C. (1982). Burnout: The cost of caring. Englewood Cliffs, NJ: Prentice-Hall.
 Moran, C.C. (2002). Humor as a moderator of compassion fatigue. In C.R. Figley (Ed.), Treating compassion fatigue (pp.
139-154). New York: Brunner-Routledge.
 Myers, D. (1994). Disaster response and recovery: A handbook for mental health professionals. Rockville, MD: Center
for Mental Health Services. Retrieved May 25, 2010 from http://www.empowermentzone.com/disaster.txt
 Politsky, S. (2007). Revitalizing yourself: Making time 4u. Oncology Nursing Forum, 34(2), 494.