In our roles as Victim Advocates/Service Providers, we put other people's needs above our own in our working life, often times resulting in neglecting ourselves. Helping professionals may find themselves at risk of becoming overwhelmed with other's pain-possibly resulting in burn out or compassion fatigue. This workshop helped participants identify signs of burn out and compassion fatigue. Participants were provided tools to help transform stress and become relaxed and rejuvenated, resulting in better care of others as well as ourselves. The workshop included information on breathing, diet, self awareness and meditation, through movements associated with the ancient practice of Qigong.

1. Compassion Fatigue
When Helping Hurts

2. Jessica Heskin
California State University, Sacramento
heskin@csus.edu
Christine Ward
Crime Victims Assistance Network (iCAN)
Foundation
cward@ican-foundation.org
Your Facilitators

3. Ground Rules
 Please raise your hand when you have a
question
 What is shared in this room stays in this room
 All of us are important and special, please treat
each other as such
 No side conversations while the facilitators are
talking - please
 Let yourself go! Have fun – learn a little
 Please feel free to leave the room when needed

4. Compassion
 compassion
noun Definition: sympathy: sympathy for
the suffering of others, often including a
desire to help

5. Fatigue
 fa·tigue (noun)
Definition:
1. mental or physical exhaustion: extreme tiredness or weariness
resulting from physical or mental activity
weak with fatigue after the long march
2. inability to respond to situation: the temporary inability of
somebody to respond to a situation as a result of overexposure or
excessive activity ( often used in combination )
compassion fatigue
3. physiology inability to respond to stimulus: the temporary
inability of an organ or body part such as a muscle or nerve cell to
respond to a stimulus and function normally after continuous activity
or stimulation

6. Compassion Fatigue
 com·pas·sion fa·tigue
Definition: loss of sympathy: (noun) a
loss of sympathy for the suffering of others
experienced by donors or caregivers as a
result of the demands made of them

7. What causes compassion fatigue?
 Indirect chronic repeated exposure to
traumatic events
 Stress responses due to repeated
exposure

8. Burnout
Noun
1. Physical or emotional exhaustion, especially
as a result of long-term stress or dissipation.
2. One who is worn out physically or
emotionally, as from long-term stress.

9. Compassion Fatigue vs Burnout
Compassion Fatigue is NOT "burnout".
 Burnout is associated with stress and hassles involved in your work;
it is very cumulative, is relatively predictable and frequently a
vacation or change of job helps a great deal.
Compassion Fatigue is very different.
 Compassion Fatigue is a state of tension and preoccupation with
the individual or cumulative trauma of clients as manifested in one
or more ways including re-experiencing the traumatic event,
avoidance/numbing of reminders of the event, and persistent
arousal. Although similar to critical incident stress (being
traumatized by something you actually experience or see),with CF
you are absorbing the trauma through the eyes and ears of your
clients. It can be thought of as secondary post-traumatic stress.
(Ace Network www.ace-network.com)

10. Symptoms of Compassion Fatigue
Examples of Compassion Fatigue – Figley (Ed.) 1995;97
Cognitive
• Perfectionism
• Preoccupation with trauma
• Spacing out
• Loss of meaning
• Self-doubt
• Minimization
Emotional
• Powerlessness
• Anxiety
• Guilt
• Anger/rage
• Survivor guilt
• Hypersensitivity
• Emotional roller coaster
• Overwhelmed
• Depleted energy
Behavioral
•Impatient
•Withdrawn
•Irritable
•Sleep disturbances
•Hypervigilance
•Accident prone
•Losing things
Spiritual
•Questioning the
meaning of life
•Loss of purpose
•Lack of self-
satisfaction
•Question religious
beliefs
Personal
Relationships
•Withdrawal
•Mistrust
•Overprotective as a
spouse or parent
•Loneliness
Physical
•Shock
•Rapid heartbeat
•Joint and muscle
pains
•Dizziness and
disorientation
•Impaired immune
system

11. Impact of Compassion Fatigue
 Reduction in job performance
 Decrease in moral
 Deterioration of personal relationships
 Increase in psychological issues
 Increase in health problems

12. How Do We Get There?
It’s Hard Work Darn It!
 (in the beginning) I am here to help, to make things right – to save the world!
 I am responsible for the outcomes of those I help
 In order to really care and be committed to the cause, those I help must
come first
 The victim will appreciate everything I do for them
 If I am with a victim/client, my friends, doctors, personal trainers, teachers,
etc. will understand if I call last minute to cancel or just don’t show up
 Working in this field you have to be strong – I can handle anything that
comes my way
 I need to please everyone
 I need to be liked and respected by everyone
 I cannot make a mistake, I must be perfect
 I can do everything
 Success to me is …..

13. Compassion Fatigue Phases
 The Zealot Phase
 The Irritability Phase
 The Withdrawal Phase
 The Zombie Phase
 Pathology vs. Renewal/Maturation
Adopted from J. Baker, M.D. and J. Kane, M.D.

14. Zealot Phase
 Committed, involved, available
 Solving problems/making a difference
 Willingly go the “extra mile”
 High enthusiasm
 Volunteers without being asked
Adopted from J. Baker, M.D. and J. Kane, M.D.

15. The Irritability Phase
 Begin to cut corners
 Begin to avoid clients/patients
 Begin to mock co-workers and clients
 Begin to denigrate the people we serve
 Use of humor is inappropriate
 Oversights, mistakes and lapses of concentration
 Start distancing ourselves from friends and
coworkers
Adopted from J. Baker, M.D. and J. Kane, M.D.

16. The Withdrawal Phase
 Enthusiasm turns sour
 Clients become irritants, instead of persons
 We make complaints about our work life and our
personal life
 Tired all the time, don’t want to talk about what we
do
 We start to neglect our family, clients, coworkers
and ourselves
 We try to avoid our pain and sadness
Adopted from J. Baker, M.D. and J. Kane, M.D.

17. The Zombie Phase
 Our hopelessness turns to rage
 We begin to hate people…any/all people
 Others appear incompetent or ignorant to
us
 We develop a real distain for our clients
 We have…no patience…no sense of
humor…no time for fun
Adopted from J. Baker, M.D. and J. Kane, M.D.

18. Even Mother Theresa
…understood the need for self care.
Mother Theresa wrote in her plan to
superiors that it was mandatory for her nuns
to take an entire year off from their duties
every 4-5 years to allow them to heal from
the effects of their care-giving work.

19. How do we prevent this?
Organizational
– Have a clear purpose or goal
– Clearly defined roles
– Effective management structure and
leadership
– Team support
– Stress management plan

20. ABC
A=Awareness
B=Balance
C= Connections

21. Awareness
Issues and Contributing Factors
What in your work contributes to your
stress level increasing your vulnerability to
compassion fatigue?

22. B=Balance
keeping your life in balance
 And BOUNDRIES
 Self care
 Your “me” calendar
 Transform the negative impact of your
work (find meaning, practice gratitude,
avoid negativity)

23. B=Balance
 We are human and it’s ok to ask for help
– Get professional help if needed

24. C=Connections
 Talk it out
– Trusted friends/co-workers/clergy/therapist
– Build a strong support network that supports
your health, not fuels your stress
– Hang out with your pet
– Connect with yourself

25. What you can do
 Sleep as much as needed to feel refreshed and healthy during the following
day, but not more. Limiting the time in bed seems to solidify sleep, while
spending excessively long times in bed seems related to fragmented and
shallow sleep.
 Wake up at a regular and consistent time in the morning. This strengthens
sleep cycles and can help you fall asleep at similar times each night.
 A steady, daily amount of exercise may deepen sleep, but occasional
exercise does not necessarily improve sleep the following night. Also, do not
exercise right before bedtime.
 Occasional loud noises, such as traffic and airplanes, disturb sleep even in
people who are not awakened by noises and cannot remember them in the
morning. Playing white noise, using earplugs or sound-proofing bedrooms
may help those who must sleep close to noise.
 Although excessively warm rooms disturb sleep, there is no evidence that
an excessively cold room promotes sleep.

26. Things you can do continued
 Hunger may disturb sleep. Therefore a light snack may help you sleep. Some good
snacks include milk and cereal or a turkey sandwich, both of which have tryptophan,
an ingredient that helps you sleep.
 An occasional sleeping pill may be of some benefit, but the chronic use of sleeping
pills is ineffective for most insomniacs.
 Caffeine in the evening disturbs sleep, even in those who feel it does not. Therefore,
it is a good idea to avoid drinking caffeinated beverages in the evening.
 Alcohol helps tense people fall asleep more easily, but the resulting sleep is more
fragmented. We recommend avoiding alcohol before going to sleep.
 If you feel angry and frustrated because you can't sleep, you should not stay in bed.
Instead, get up, turn on the light and do something different, such as reading,
watching television or doing simple crafts. Once you are sleepy again, go back to
bed.
 Pajamas at bedtime only
 The chronic use of tobacco disturbs sleep. Promoting good sleep habits is another
reason to stop smoking.

27. Self Care
 To stay healthy
– Exercise
– Relax
– Sleep
– Eat well/hydrate
– See your doctor regularly

28. How to take care of me….
How to take care of my colleagues……

29. Get up and Move

30. Resources
Mindfulness meditation apps for phone:
Buddhify
Headspace—this one charges money but has progressive meditation
sequences
Insight timer
Calm
Chill
Mindshift
Website for guided meditations:
http://marc.ucla.edu/body.cfm?id=22
Sleep Hygiene Website:
http://www.cdc.gov/sleep/about_sleep/sleep_hygiene.htm

31. Resources
Energy Medicine
http://innersource.net
Qi Gong
http://www.sacramentoqigong.com/