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COMPASSION
FATIGUE & PROVIDER
RESILIENCE
Jaime W. Vinck MC, LPC, NCC
Chief Executive Officer
The expectation that we can be immersed in suffering and loss
daily and not be touched by it is as unrealistic as expecting to
be able to walk through water without getting wet. … we burn
out not because we don’t care but because we don’t grieve. We
burn out because we’ve allowed our hearts to become so filled
with loss that we have no room left to care.
Naomi Rachel Remen, Kitchen Table Wisdom
Agenda
Goals for Training
• How has our work impacted our lives?
• Understanding the elements of Compassion Fatigue
• Understanding provider resilience
• Ethics of self-care
• Developing a narrative
Statistics from the Field
Between 40% and 85% of
“helping professionals” develop
vicarious trauma, compassion
fatigue and/or high rates of
traumatic symptoms, according
to compassion fatigue expert
Francoise Mathieu.
(2012)
Statistics from the Field
Social Workers, MSW:
70% exhibited at least one
symptom of secondary
traumatic stress.
(Bride, 2007)
Statistics from the Field
Therapists, Sexual
Assault:
70% experienced
vicarious trauma
(Lobel, 1997)
Compassion Fatigue
Profound emotional and physical exhaustion that helping
professionals and caregivers can develop. Gradual erosion
of all things that keep us connected to others in our
caregiver role:
• Empathy
• Hope
• Compassion
- (Figley 1995)
Compassion Fatigue =
Secondary Traumatization + Burnout
Figley (1995)
Secondary Traumatic Stress
Secondary traumatic stress is the emotional duress that
results when an individual hears about the firsthand
trauma experiences of another. Its symptoms mimic those
of post-traumatic stress disorder (PTSD).
They include being afraid, having difficulty sleeping, having
images of stressful event, and avoidance.
Baransky & Gentry 2015
Vicarious Trauma
Vicarious trauma is the emotional residue of exposure that
counselors have from working with people as they are
hearing their trauma stories and become witnesses to the
pain, fear, and terror that trauma survivors have endured.
(American Counselors Association)
Vicarious Trauma
Vicarious Trauma
 Self Capacities – identity, relatedness, Connections self
esteem. Ability to tolerate and integrate
 Creating dysregulation and loss of ability to self soothe
 Increased self criticism
 Unable to respond to needs of others or seek support for
self
(Pearlman & Saakvitne 1995)
“Burnout is a psychological
syndrome of emotional
exhaustion,
depersonalization and
reduced personal
accomplishment”
(Maslach, 1982; Maslach & Goldberg 1996, Maslach & Leter 2003)
Burnout
“The Chronic condition of perceived
demands outweighing perceived
resources”
Gentry & Baranowsky, 1996
• Emotional Exhaustion – feeling depleted, overextended,
fatigued
• Depersonalization (cynicism) – negative and cynical
attitudes toward one’s consumers and work in general
• Reduced personal accomplishment – negative self-
evaluation of one’s work with consumers, decreased
occupational effectiveness
Maslach et al, 2001
Predictive factors of burnout
 Large case loads
 More work than can be accomplished
 Internal politics and bureaucracy
 Perception of a lack of control
 Preponderance of administrative duties
 Lack of specific training for assigned work
 Treatment of those with personality disorders or malingers
 Difficulty with work life balance
What are key differences?
 CF – Profound emotional and physical erosion when
we can’t refuel
 STS – Bearing witness to traumatic events which can
lead to PTSD symptoms
 VT – Transformation of worldview due to
CUMULATIVE exposure to traumatic images and
stories (may have many STS events)
 BURNOUT – stress and frustration caused by
workplace
Who is at greatest risk?
 Those who are the most empathetic
 Those who do not see self care as a priority
 Those with a personal history of trauma
Internal Source Factors
 People bring a past and a present to anything they do
 Their schemas and beliefs; their stigma beliefs
 Their social support systems (positive & negative)
 Their history of trauma and illness
 Their families and close others
 Their economic situation
Compassion fatigue
can be recognized on the
job by its effects on work
performance, morale,
behavior and relationships.
Identify Compassion Fatigue Markers
Healthcare providers must monitor themselves and coworkers
for the following markers. The more markers observed or felt,
the greater the risk of provider fatigue. The markers fall into
categories of cognitive, emotional, behavioral, spiritual,
somatic, and social.
Cognitive Markers
 Intrusive thoughts and disturbing memories
 Preoccupation with trauma
 Lowered concentration
 Disorientation
 Thoughts of self-harm or harm to others
 Reduced sense of safety
Emotional Markers
 Powerlessness
 Anxiety or fear
 Anger
 Survivor’s guilt
 Numbness or inability to feel emotions
 Sadness
 Emotional roller coaster
 Feelings of depletion, being run down or out of
steam
Behavioral Markers
 Impatience
 Being snappy or short tempered with others
 Poor sleep
 Nightmares
 Appetite changes, eating more or less than normal
 Being jumpy or on edge, startling easily
 Being accident prone
 Losing things
 Being rigid or inflexible, wanting to do everything the same
way
 Using ineffective or harmful self-care practices
Spiritual Markers
 Loss of hope
 Loss of purpose
 Anger at God
 Questioning prior religious beliefs
 Skepticism toward religion
 Reduced joy and sense of purpose with career
 Loss of compassion
Social Markers
 Decreased interests in emotional intimacy
 Mistrust and isolation
 Being overprotective as a parent or as a leader; not
allowing others to have normal activities
 Loneliness
 Increased interpersonal conflicts
 Trouble separating work from personal life
Somatic Markers
 Shock
 Rapid heartbeat and sweating
 Breathing difficulties
 Aches and pains
 Dizziness
 Impaired immune system: being more prone to illness
 Exhaustion
 Gastrointestinal problems and headaches
Effects on Work Performance
 Decreased quality
 Decreased quantity
 Low motivation
 Avoidance of tasks
 Increased mistakes
 Setting perfectionist standards
 Obsession about details
Effects on Morale
 Decrease in confidence
 Loss of interest
 Dissatisfaction
 Negative attitude
 Apathy
 Demoralization
 Lack of appreciation
 Detachment
 Feelings of incompleteness
Effects on Behavior
 Absenteeism
 Exhaustion
 Faulty judgment
 Irritability
 Tardiness
 Irresponsibility
 Frequent job changes
 Overwork
 Substance Use
Resiliency
“Persons inner ability to
face fear and adversity
with courage, and the
will to persevere and
overcome.”
Combat and operational stress control, chapter 4
Building our own Provider Resiliency
 Strength, not pathology
 Who is your resiliency role model?
 What are the qualities of people that inspire you?
How do we build Resiliency?
Self-Soothing
Self-Confronting
Enables
Simultaneously
In
Stressful Situation
Deliberately RELAX
• Breathing
• Meditation
• Orientation
• Grounding
Self-Sooth
Self-Confronting
Self-Confronting is the process of assessing one’s own anxiety
and examining what might be learned from the situation. Providers
should ask themselves questions such as…..
 Why am I anxious?
 What am I trying to prove?
 Whom am I trying to impress?
 What am I trying to fix?
 Am I depending on someone else to validate my
sense of worth?
 What is the growth potential in this situation?
Self Confronting
Self-Soothing = Avoidancy
• Withdrawing
• Being demanding or driven by emotion
• Overeating
• SUD
Self Sooth
Self-Confront = Negativity – Being stuck
• Failure to see growth opportunity
Building Provider Resilience
 Physical Renewal
 Mental Renewal
 Emotional Renewal
 Spiritual Renewal
PATIENT
WORK
SYSTEM
FELLOW
WORKERS
PROVIDER
TRAUMA
Focus on the provider is
essential to combating
provider fatigue.
Providers are affected
by their many
relationships with
patients and clients as
well as colleagues, in a
work environment with
exposure to various
types of trauma.
Pechacek, Bicknell, Landry, 2005
Compassion Satisfaction
May be related to
 Providing care to
the system
 Work with colleagues
 Beliefs about self
 Altruism
 Positive aspects of
helping
 Pleasure and
satisfaction derived
from working in
helping, care-giving
systems
ProQOL
Good
Psychometric
properties
3 Subscales
 Compassion Satisfaction
 Burnout
 Secondary Traumatic
Stress
Developed in 1998 in response to the Compassion
Fatigue Self Test (Figley, 1995)
Professional
Quality of Life
(Pro-QOL;Stamm, 1998,2009)
www.proqol.org
Provider Resilience Phone App
https://itunes.apple.com/ca/app/provider-resilience/id559806962?mt=8
Ethics of Self Care
Self care is an active, deliberate and
and creative approach to fulfilling
fulfilling ethical and legal
responsibilities
Self Care as a Defense
 Best defense is a good offense
 Instead of worrying about the ways of
getting in trouble, focus on how we can be
even better in our practice
 Part of self-care is to proactively manage
risk
Ethical Pitfalls
 Boundaries
 Multiple Relationships
 Dual Relationships
 Social Interactions
 Non-Sexual Touch
 Self Disclosure
 Competence
Professional Self Regulation
 Autonomy
 Beneficence
 Non-maleficence
 Justice
 Fidelity
 Veracity
Autonomy
Fostering the right
to control the
direction of one’s life
Beneficence
Working for the good of the
individual and society by
promotion mental health
and well being
Justice
Treating individuals equitably
and fostering fairness and
equality
Fidelity
Honoring commitments and
keeping promises, including
fulfilling one’s responsibilities
of trust in professional
relationships
Veracity
Dealing truthfully with
individuals with whom we
come into professional
contact
My Story of VT, and CF…
What is intruding
to your thoughts
and dreams?
Journal your
narrative
Looking at…
 Vicarious trauma
 Loss of innocence
 Anger and irritability
 Avoidance of meetings
 Predictability of client issues
 Avoiding difficult topics with clients
 Feeling discouraged about lack of options
 Failure to get a life
 Fatigue and exhaustion
Interventions
REAPER Model
Recognition of signs and symptoms
Education at all levels
Acceptance in the culture creating empathy
Permission to deal with symptoms openly
Exploration to identify resources
Referral sources when necessary
(Mitchell and Bray)
Take care
of yourselves,
and each other.
~ Jerry Springer
References
 Birnbaum, L. (2008). The use of mindfulness training to create an “accompanying
place” for social work students. Social Work Education, 27 (8), 837-852
 Bober, T. & Regehr C. (2005). Strategies for reducing or recognizing vicarious trauma:
Do they work? Brief Treatment and Crisis Intervention, 6 (1), 1-9
 Bourassa, D.B. & Clements, J. (2002). Supporting ourselves: Groupwork interventions
for compassion fatigue. Groupwork, 20 (2), 7-23
 Dane, B. & Chachkes, E. (2001). The cost of caring for patients with an illness. Social
Work in Healthcare, 33 (2), 31-51
 Figley, C.R. (1999). Compassion fatigue: Toward a new understanding of the costs of
caring. In B.H. Stamm (Ed.), Secondary traumatic stress: Self care issues for
clinicians, researchers, and educators (2nd ed., pp. 3-28). Lutherville, MD: Sidran.
References
 Figley, R.R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Psychotherapy in
Practice, 58 (11), 1433 – 1441.
 Michal Finklestein, Einat Stein, Talya Greene, Israel Bronstein, Zahava Solomon; Posttraumatic Stress
Disorder and Vicarious Trauma in Mental Health Professionals. Health Soc Work 2015; 40 (2): e25-e31.
doi: 10.1093/hsw/hlv026
 Laura K. Jones, Jenny L. Cureton, (2014) Trauma Redefined in the DSM-5: Rationale and Implications for
Counseling Practice. Retrieved from http: //tpcjournal.nbcc.org/trauma-redefined-in-the-dsm-5-rationale-
and-impliation-for –counseling-practice.
 Mathieu, Francoiese (2015) The Compassion Fatigue Workbook: Creative Tools for Transforming
Compassion Fatigue and Vicarious Traumatization (Psychosocial Stress Series).
 Pechacek, Bicknell and Landry, Provider Fatigue and Provider Resilience Training. 2005
THANK YOU
Jaime W. Vinck MC, LPC, NCC
Jaime.vinck@SierraTucson.com

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JAIME VINCK - COMPASSION FATIGUE AND PROVIDER RESILIENCE

  • 1. COMPASSION FATIGUE & PROVIDER RESILIENCE Jaime W. Vinck MC, LPC, NCC Chief Executive Officer
  • 2. The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. … we burn out not because we don’t care but because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care. Naomi Rachel Remen, Kitchen Table Wisdom
  • 3. Agenda Goals for Training • How has our work impacted our lives? • Understanding the elements of Compassion Fatigue • Understanding provider resilience • Ethics of self-care • Developing a narrative
  • 4. Statistics from the Field Between 40% and 85% of “helping professionals” develop vicarious trauma, compassion fatigue and/or high rates of traumatic symptoms, according to compassion fatigue expert Francoise Mathieu. (2012)
  • 5. Statistics from the Field Social Workers, MSW: 70% exhibited at least one symptom of secondary traumatic stress. (Bride, 2007)
  • 6. Statistics from the Field Therapists, Sexual Assault: 70% experienced vicarious trauma (Lobel, 1997)
  • 7. Compassion Fatigue Profound emotional and physical exhaustion that helping professionals and caregivers can develop. Gradual erosion of all things that keep us connected to others in our caregiver role: • Empathy • Hope • Compassion - (Figley 1995)
  • 8. Compassion Fatigue = Secondary Traumatization + Burnout Figley (1995)
  • 9. Secondary Traumatic Stress Secondary traumatic stress is the emotional duress that results when an individual hears about the firsthand trauma experiences of another. Its symptoms mimic those of post-traumatic stress disorder (PTSD). They include being afraid, having difficulty sleeping, having images of stressful event, and avoidance. Baransky & Gentry 2015
  • 10. Vicarious Trauma Vicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured. (American Counselors Association)
  • 12. Vicarious Trauma  Self Capacities – identity, relatedness, Connections self esteem. Ability to tolerate and integrate  Creating dysregulation and loss of ability to self soothe  Increased self criticism  Unable to respond to needs of others or seek support for self (Pearlman & Saakvitne 1995)
  • 13. “Burnout is a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment” (Maslach, 1982; Maslach & Goldberg 1996, Maslach & Leter 2003)
  • 14. Burnout “The Chronic condition of perceived demands outweighing perceived resources” Gentry & Baranowsky, 1996
  • 15. • Emotional Exhaustion – feeling depleted, overextended, fatigued • Depersonalization (cynicism) – negative and cynical attitudes toward one’s consumers and work in general • Reduced personal accomplishment – negative self- evaluation of one’s work with consumers, decreased occupational effectiveness Maslach et al, 2001
  • 16. Predictive factors of burnout  Large case loads  More work than can be accomplished  Internal politics and bureaucracy  Perception of a lack of control  Preponderance of administrative duties  Lack of specific training for assigned work  Treatment of those with personality disorders or malingers  Difficulty with work life balance
  • 17. What are key differences?  CF – Profound emotional and physical erosion when we can’t refuel  STS – Bearing witness to traumatic events which can lead to PTSD symptoms  VT – Transformation of worldview due to CUMULATIVE exposure to traumatic images and stories (may have many STS events)  BURNOUT – stress and frustration caused by workplace
  • 18. Who is at greatest risk?  Those who are the most empathetic  Those who do not see self care as a priority  Those with a personal history of trauma
  • 19. Internal Source Factors  People bring a past and a present to anything they do  Their schemas and beliefs; their stigma beliefs  Their social support systems (positive & negative)  Their history of trauma and illness  Their families and close others  Their economic situation
  • 20. Compassion fatigue can be recognized on the job by its effects on work performance, morale, behavior and relationships.
  • 21. Identify Compassion Fatigue Markers Healthcare providers must monitor themselves and coworkers for the following markers. The more markers observed or felt, the greater the risk of provider fatigue. The markers fall into categories of cognitive, emotional, behavioral, spiritual, somatic, and social.
  • 22. Cognitive Markers  Intrusive thoughts and disturbing memories  Preoccupation with trauma  Lowered concentration  Disorientation  Thoughts of self-harm or harm to others  Reduced sense of safety
  • 23. Emotional Markers  Powerlessness  Anxiety or fear  Anger  Survivor’s guilt  Numbness or inability to feel emotions  Sadness  Emotional roller coaster  Feelings of depletion, being run down or out of steam
  • 24. Behavioral Markers  Impatience  Being snappy or short tempered with others  Poor sleep  Nightmares  Appetite changes, eating more or less than normal  Being jumpy or on edge, startling easily  Being accident prone  Losing things  Being rigid or inflexible, wanting to do everything the same way  Using ineffective or harmful self-care practices
  • 25. Spiritual Markers  Loss of hope  Loss of purpose  Anger at God  Questioning prior religious beliefs  Skepticism toward religion  Reduced joy and sense of purpose with career  Loss of compassion
  • 26. Social Markers  Decreased interests in emotional intimacy  Mistrust and isolation  Being overprotective as a parent or as a leader; not allowing others to have normal activities  Loneliness  Increased interpersonal conflicts  Trouble separating work from personal life
  • 27. Somatic Markers  Shock  Rapid heartbeat and sweating  Breathing difficulties  Aches and pains  Dizziness  Impaired immune system: being more prone to illness  Exhaustion  Gastrointestinal problems and headaches
  • 28. Effects on Work Performance  Decreased quality  Decreased quantity  Low motivation  Avoidance of tasks  Increased mistakes  Setting perfectionist standards  Obsession about details
  • 29. Effects on Morale  Decrease in confidence  Loss of interest  Dissatisfaction  Negative attitude  Apathy  Demoralization  Lack of appreciation  Detachment  Feelings of incompleteness
  • 30. Effects on Behavior  Absenteeism  Exhaustion  Faulty judgment  Irritability  Tardiness  Irresponsibility  Frequent job changes  Overwork  Substance Use
  • 31. Resiliency “Persons inner ability to face fear and adversity with courage, and the will to persevere and overcome.” Combat and operational stress control, chapter 4
  • 32. Building our own Provider Resiliency  Strength, not pathology  Who is your resiliency role model?  What are the qualities of people that inspire you?
  • 33. How do we build Resiliency? Self-Soothing Self-Confronting Enables Simultaneously In Stressful Situation
  • 34. Deliberately RELAX • Breathing • Meditation • Orientation • Grounding Self-Sooth
  • 35. Self-Confronting Self-Confronting is the process of assessing one’s own anxiety and examining what might be learned from the situation. Providers should ask themselves questions such as…..  Why am I anxious?  What am I trying to prove?  Whom am I trying to impress?  What am I trying to fix?  Am I depending on someone else to validate my sense of worth?  What is the growth potential in this situation?
  • 36. Self Confronting Self-Soothing = Avoidancy • Withdrawing • Being demanding or driven by emotion • Overeating • SUD Self Sooth Self-Confront = Negativity – Being stuck • Failure to see growth opportunity
  • 37. Building Provider Resilience  Physical Renewal  Mental Renewal  Emotional Renewal  Spiritual Renewal
  • 38. PATIENT WORK SYSTEM FELLOW WORKERS PROVIDER TRAUMA Focus on the provider is essential to combating provider fatigue. Providers are affected by their many relationships with patients and clients as well as colleagues, in a work environment with exposure to various types of trauma. Pechacek, Bicknell, Landry, 2005
  • 39. Compassion Satisfaction May be related to  Providing care to the system  Work with colleagues  Beliefs about self  Altruism  Positive aspects of helping  Pleasure and satisfaction derived from working in helping, care-giving systems ProQOL
  • 40. Good Psychometric properties 3 Subscales  Compassion Satisfaction  Burnout  Secondary Traumatic Stress Developed in 1998 in response to the Compassion Fatigue Self Test (Figley, 1995)
  • 41. Professional Quality of Life (Pro-QOL;Stamm, 1998,2009) www.proqol.org
  • 42. Provider Resilience Phone App https://itunes.apple.com/ca/app/provider-resilience/id559806962?mt=8
  • 43. Ethics of Self Care Self care is an active, deliberate and and creative approach to fulfilling fulfilling ethical and legal responsibilities
  • 44. Self Care as a Defense  Best defense is a good offense  Instead of worrying about the ways of getting in trouble, focus on how we can be even better in our practice  Part of self-care is to proactively manage risk
  • 45. Ethical Pitfalls  Boundaries  Multiple Relationships  Dual Relationships  Social Interactions  Non-Sexual Touch  Self Disclosure  Competence
  • 46. Professional Self Regulation  Autonomy  Beneficence  Non-maleficence  Justice  Fidelity  Veracity
  • 47. Autonomy Fostering the right to control the direction of one’s life
  • 48. Beneficence Working for the good of the individual and society by promotion mental health and well being
  • 49. Justice Treating individuals equitably and fostering fairness and equality
  • 50. Fidelity Honoring commitments and keeping promises, including fulfilling one’s responsibilities of trust in professional relationships
  • 51. Veracity Dealing truthfully with individuals with whom we come into professional contact
  • 52. My Story of VT, and CF… What is intruding to your thoughts and dreams? Journal your narrative Looking at…  Vicarious trauma  Loss of innocence  Anger and irritability  Avoidance of meetings  Predictability of client issues  Avoiding difficult topics with clients  Feeling discouraged about lack of options  Failure to get a life  Fatigue and exhaustion
  • 53. Interventions REAPER Model Recognition of signs and symptoms Education at all levels Acceptance in the culture creating empathy Permission to deal with symptoms openly Exploration to identify resources Referral sources when necessary (Mitchell and Bray)
  • 54. Take care of yourselves, and each other. ~ Jerry Springer
  • 55. References  Birnbaum, L. (2008). The use of mindfulness training to create an “accompanying place” for social work students. Social Work Education, 27 (8), 837-852  Bober, T. & Regehr C. (2005). Strategies for reducing or recognizing vicarious trauma: Do they work? Brief Treatment and Crisis Intervention, 6 (1), 1-9  Bourassa, D.B. & Clements, J. (2002). Supporting ourselves: Groupwork interventions for compassion fatigue. Groupwork, 20 (2), 7-23  Dane, B. & Chachkes, E. (2001). The cost of caring for patients with an illness. Social Work in Healthcare, 33 (2), 31-51  Figley, C.R. (1999). Compassion fatigue: Toward a new understanding of the costs of caring. In B.H. Stamm (Ed.), Secondary traumatic stress: Self care issues for clinicians, researchers, and educators (2nd ed., pp. 3-28). Lutherville, MD: Sidran.
  • 56. References  Figley, R.R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Psychotherapy in Practice, 58 (11), 1433 – 1441.  Michal Finklestein, Einat Stein, Talya Greene, Israel Bronstein, Zahava Solomon; Posttraumatic Stress Disorder and Vicarious Trauma in Mental Health Professionals. Health Soc Work 2015; 40 (2): e25-e31. doi: 10.1093/hsw/hlv026  Laura K. Jones, Jenny L. Cureton, (2014) Trauma Redefined in the DSM-5: Rationale and Implications for Counseling Practice. Retrieved from http: //tpcjournal.nbcc.org/trauma-redefined-in-the-dsm-5-rationale- and-impliation-for –counseling-practice.  Mathieu, Francoiese (2015) The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization (Psychosocial Stress Series).  Pechacek, Bicknell and Landry, Provider Fatigue and Provider Resilience Training. 2005
  • 57. THANK YOU Jaime W. Vinck MC, LPC, NCC Jaime.vinck@SierraTucson.com

Editor's Notes

  1. Let’s start with an experiential - 3 ways that your work has negatively impacted your life
  2. Let’s start with an experiential - 3 ways that your work has negatively impacted your life
  3. Between 40-85% of helping professions develop CF, VT or STS For those who work with sexual assault 70% - compelling as how many of you work with addiction? How prevelant are these stories Stat was a wake up call
  4. Between 40-85% of helping professions develop CF, VT or STS For those who work with sexual assault 70% - compelling as how many of you work with addiction? How prevelant are these stories Stat was a wake up call
  5. Between 40-85% of helping professions develop CF, VT or STS For those who work with sexual assault 70% - compelling as how many of you work with addiction? How prevelant are these stories Stat was a wake up call
  6. Compassion fatigue is the normal physical and emotional reaction to hearing about another person’s trauma (Figley, 1995). It is broken down further into burnout and secondary traumatic stress/vicarious trauma. Burnout is a long-term stress reaction of helping professionals who work with people that is usually attributed to work-related factors (Noushadd, 2008; Stamm, 2010). Burnout is often more associated with professionals who have been working in the field longer. Secondary traumatic stress and vicarious trauma are related, with vicarious trauma being covert cognitive changes as a result of hearing about another’s trauma (Dane & Chachkes, 2003) and secondary traumatic stress being the physical and emotional stress of knowing about another’s trauma (Figley, 1999). The signs of secondary traumatic stress are often considered to be somewhat similar to Post-Traumatic Stress Disorder with avoidance, arousal and intrusion symptoms (Figley, 1999).
  7. These are rapid onset and associated with a particular event. Intrusive thoughts of clients, dreams, etc . Know your triggers – be mindful of sharing too many details when staffing - example – therapist who overshares every detail of the session YIKES Also – watch your language in terms of being trauma imformed – certain phrases can be traumatic to people “Committed Suicide” or mocking a gun shot Or my personal trigger – beating a dead you know what. Arizona is horse country – you want to see trauma responses say that. SET BOUNDARIES
  8. CUMULATIVE PROCESS!!!!! Not the worst story you have ever heard – it’s the impact of the 1000’s of stories you may not remember. The difference between secondary trauma and vicarious trauma is that secondary trauma can happen suddenly, in one session, while vicarious trauma is a response to an accumulation of exposure to the pain of others (Figley, 1995). Over time, VT creates covert cognitive changes that can impact your world view Frog in the kettle story
  9. FREEZE
  10. FREEZE
  11. Doesn’t have to be in a helping profession – your car guy or insurance salesperson can be burnt out
  12. Behavioral health – never
  13. Depersonalization – “the borderline down the hall” “why do we keep letting then back into treatment”
  14. Organizational burnout/trauma – sentinel events, high rates of turn-over, loss of key staff. Demoralization that comes with the predictive factors
  15. Terms are similar but different/complemtary and often used interchangeably and incorrectly. Can exist in several combinations depending on your history. For instance, I may be traumatized and disturbed by what I heard, and I may not want to watch tv, go to park, etc. (VC) I may still be able to be supportive to a friend and may not feel completed depleted by work collegues. Or I may be incredibly drained by my work, not able to give any more at home or at work, yet my world view is intact and I’m not having flashbacks. It matters because we need to know what tools to use. Are we treating symptoms (maladaptive coping strategies) or the construct of the being “I no longer trust)
  16. Irony – what makes us good therapists ? Our empathy and our pain - are we all doomed? Factors that contribute to the rise of compassion fatigue Talk about high SES
  17. Countertransference depends on the integration of our own life events – remember this isn’t linear. Ebbs and flows Be aware in your mind and body of what is going on The economic situation is interesting with high SES clients. Can create resentments when struggling financially ,………(chuck bankruptcy)
  18. These markers mirror our integrated or holistic model of care – mind, body, spirit. It is essential that we use these not to pathologize but to grow and support
  19. Worldview can change, covert cognitive changes
  20. Maladaptive Coping Strategies!!!
  21. Resonated – find myself uninterested in anyone not in the field. I’m an elitest – “they don’t get it “ I’m saving the world and they are not
  22. How does this impact us ?
  23. So are you all ready to go to work at Trader Joes? Not yet
  24. Went through Airforce leadership Training on resilience in December, Armed forces are highly focused on CF and PR. 80 Suicides in one year at the Base where I attended training – imagine the ST, VC ripple effect
  25. Another Label ? No. We are here because we want to leave the world a better place. Remember what brought you here – was it your pain your Wisdom, your empathy. You are here because you are a bad ass. ? Identify and describe role model
  26. BY creating the ability to self sooth simulataneously - self talk would be. . . . .
  27. Must I say yes ? To take this call, to take on another client. These take some guts . I’ll tell – in private practice if a former client calls I am seriously tempted drive the 2 hours in the coming weekend. I do this because I am the best therapist in all of America – the client can’t be referred to someone else or wait until I am back in town.
  28. Maladptive Coping skills – Victims 2. Do not grow – that one no one wants to be around – chronic stress
  29. How? Same model that we use for our clients. And the same way we identify our markers
  30. Focus on work system and fellow workers are equal players with the patient and our own trauma This is where we introduce a critical component to understanding resilience – compassion satisfaction.
  31. How do we feel about our teams? Friends? Co workers ? Can I count on theM?
  32. Directly from website: “The fast pace of military operations and frequent deployments affect the entire military community. For health care providers treating military personnel, the intense demands on their time and personal resources can lead to burnout, compassion fatigue, and secondary traumatic stress. Through psychoeducation and self-assessments, Provider Resilience gives frontline providers tools to keep themselves productive and emotionally healthy as they help our nation’s service members, veterans, and their families. Gets us into the solution and holds us accountable
  33. Good ethical practice is good risk management practice When BHP’s end up in an ethical quandary or board complaint, it is often because they unwittingly slid too far down “a slippery slope” Often as a result of ignorance of ethics, law or practice standard Boundary issues are common source of complaints to regulatory boards
  34. We are more vulnerable to these pitfalls when we are experiencing one of the VT, STS or CF
  35. Self Care is guided by a series of aspirational ethical virtues that are articulated through a variety of ethical codes
  36. Is this difficult in recovery?
  37. The belief that a person in power is attempting to improve the other’s siutation through the delivery of a professional service
  38. Should be evident wherever people are due benefits from others because of their particular circumstance
  39. Extends beyond responsibilities of business or contractual fulfillment to the creation of a relationship based on trust. Trust that we will always operate in their best interest
  40. What we are doing – set up heal the healer groups to process these stories, do self care surveys, use the APP What are wonderful ways that your work has impacted you?
  41. Office culture of collegiality, establish supervisory support, clean and enriching physical surroundings
  42. What we are doing – set up heal the healer groups to process these stories, do self care surveys, use the APP What are wonderful ways that your work has impacted you?