Compassion FatigueSecondary Trauma

What is it?

History 1982: Charles Figley defines Secondary

Traumatic 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 Compassionate Therapy to emphasize importance of compassion when dealing with difficult / resistant clients

1995: Figley redefines Secondary Traumatic Stress to a “more friendly term” - Compassion Fatigue

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)

AKA Secondary Trauma

or Secondary Post-Traumatic Stressor Secondary Exposure

or Secondary Victimizationor Vicarious Traumatization

or Emotional Contagionor Secondary

Survivor

“Phenomenon associated with the ‘cost of caring’ for others in emotional pain” (Figley, 1982)

Compassion FatigueSecondary Trauma

Do I have it?

CF “Possible” Solution…

Compassion FatigueSecondary Trauma

How did I get it?

The CF Process

Figley, 2001

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

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

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

10.Compassion Trap – inability to let go of the thoughts, feelings and emotions useful in helping another, long after they are useful

A Codependent Co-worker with Compassion Fatigue

Compassion FatigueSecondary Trauma

How bad is it?

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

Symptoms of Poor Self-Care

Cognitive Diminished

concentration Confusion Loss of meaning Decreased of

self-esteem

Apathy Rigidity Self-doubt Perfectionism Minimization

Symptoms of Poor Self-Care

Emotional Powerlessness Anxiety (Survivor) Guilt Anger/rage Numbness Fear Sadness

Helplessness Depression Hypersensitivity Overwhelmed Depleted

Symptoms of Poor Self-Care

Behavioral Impatient Withdrawn Moody Regression Sleep Disturbances Appetite changes

Elevated startled response

Hyper vigilance Use of unhealthy

coping skills Accident proneness Losing things Self-harm behaviors

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)

Symptoms of Poor Self-Care Interpersonal

Withdrawn Decreased interest in intimacy Mistrust Intolerance Loneliness Projection of anger or blame

Symptoms of Poor Self-Care Physical

Shock Sweating Rapid heartbeat Aches and pains Dizziness Impaired immune system Restlessness

Impact on Professional Functioning Performance of Job Tasks

Decrease in quality & quantity

Low motivation

Avoidance of job tasks

Increased mistakes

Setting perfectionist standards

Obsession about details

Impact on Professional Functioning Morale

Decrease in confidence

Loss of interest

Dissatisfaction

Negative attitude

Apathy

Demoralization Lack of appreciation Detachment Feelings of

incompleteness

Impact on Professional Functioning Interpersonal

Withdrawal from colleagues

Impatience

Decrease in quality of relationship

Poor communication

Staff conflicts

Impact on Professional Functioning Behavioral

Absenteeism

Exhaustion

Faulty judgment

Irritability

Tardiness

Irresponsibility

Overwork

Frequent job changes

Compassion FatigueSecondary Trauma

How do I get rid of it?

“When you discover you are riding a dead horse,

the best strategy is to dismount”

- Dakota Tribal Saying

““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

““First do no harm First do no harm to Self”to Self”

- Gentry & Figley, 2007 Created adage after discovering correlation between

compassion fatigue and ethical violations

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

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

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

Compassion FatigueSecondary Trauma

How do I keep it from coming back?

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”

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)

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”

Sense of Satisfaction cont. Reframe the “Pay-Out”

Appreciation Approval Attention Acceptance Affiliation

Admiration Acknowledgement Affirmation Accomplishment Affection

Standards of Self-Care

1. Respect for dignity & worth of self2. Responsible for self-care3. Universal right to wellness4. Physical rest, emotional rest &

nourishment5. Seek, find & remember appreciation

from supervisors & clients6. Make it known that you wish to be

recognized for your serviceAdapted from “Standards of Self Care for the Practitioner,” Green Cross Foundation, Inc., 2004