What you don’t know CAN hurt you!

Compassion Fatigue

Definitions

What do you think it means?

I dunno. What do YOU think it means? Beats me!!

Vocabulary

• Compassion Satisfaction–Positive aspects of working as a helper

Compassion Satisfaction

• The positive aspects of helpingProviding careThe systemWork with colleaguesBeliefs about selfAltruism

Vocabulary

• Compassion Fatigue–Negative aspects of working as a

helper

Compassion FatigueAka as secondary traumatic stress disorder evidenced by:• hopelessness• a decrease in experiences of

pleasure, constant stress and anxiety • and a pervasive negative attitude

Compassion FatigueCF describes the emotional, physical, social and spiritual exhaustion that overtakes a person and causes a pervasive decline in his/her desire, ability and energy to feel and care for others.

CF results from the combined effects of primary trauma, secondary trauma, and burnout to produce painful symptoms in caregivers.

CF is the gradual loss of empathy for others over time due to emotional and physical overload.

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CF refers to the emotional and physical exhaustion that helpers (nurses, doctors, social workers, police officers, chaplains, caregivers, the list goes on and on) experience over time when working in these challenging and rewarding fields.

CF is a state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper.

Vocabulary• Burnout–Inefficacy and feeling overwhelmed

Burnout• Occupational burnout, characterized by

exhaustion, cynicism, and reduced professional efficacy within the workplace

• Frustration and exhaustion stemming from a highly stressful workload and/or a non-supportive work environment

• Stress that is cumulative, relatively predictable, and frequently can be helped through a respite or habit/life change.

Burnout and STS- Co Travelers

• Burnout–Work-related hopelessness and

feelings of inefficacy• Secondary Trauma Stress (STS)–Work-related secondary exposure to

extremely or traumatically stressful events

Vocabulary• Work-related traumatic stress–Secondary traumatic exposure to event

due to a relationship with the primary person (Vicarious trauma)

Secondary Trauma Stress

Secondary trauma stress is work-related, indirect exposure to extremely stressful events such as working with child abuse victims, treating war-related causalities and responding to disasters.

It often begins soon after exposure to another person’s specific traumatic event but it can also be cumulative with repeated exposure to others’ traumatic situation.

Karen Dickason, LCSW, CFAP

People Bring Themselves• Victim assistance workers include people

with all types of education, training and income• Some workers bring with them histories

of difficult lives that may include trauma• Some people have difficult family,

economic, or other personal situations

People Bring ThemselvesPeople bring a past and a present to anything they do– Their schemas and beliefs– Their social support systems• Positive support• Negative reactions

– Their history of trauma and illness– Their families and close others– Their economic situation

Stages and Symptoms

Compassion FatigueTrajectory

• The Zealot Phase• The Irritability Phase• The Withdrawal Phase• The Zombie Phase

Zealot Phase• Committed, involved, available• Solving problems/making a

difference• Willingly go the “extra mile”• High enthusiasm• Volunteers without being asked

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

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

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

Where are you?

•What phase do you think you are in right now?

Not me. I’m a trained

professional..Nope, not me

Me, either. I’m too mentally tough.

There must be something wrong with me. I think

I’m developing it.

WHO IS AT RISK?

EVERYONE

Symptoms• Can’t rid oneself of thoughts and images

of a client’s situation and pain• Compulsive desire to work with certain

clients• Client time leaches over into private time• You see the clients as fragile individuals

who “need” you

Symptoms• Avoidance behaviour especially of

certain clients or types of clients• Sleep disturbances which may

contribute to forgetting and loss of concentration• Feelings of inadequacy (you can

never do enough, be good enough)

Signs of CF

• Emotional Signs• Social• Physical• Intellectual• Spiritual• Professional

EMOTIONAL

• Feel depressed – may want to quit job

• Sudden outbursts of anger• Feel sad, tears just below the

surface• Feel cynical, numb, or hardened• Nightmares or flashbacks• High volatility of feelings

SOCIAL

Loss of interest in previously enjoyed activitiesAvoidance of certain patients / clientsHyper vigilant response to certain casesDiminished sense of purpose / enjoyment

• Difficulty separating work life from personal life• Diminished functioning in non-

professional circumstances• Increases in in-effective or self

destructive self soothing behaviours

PhysicalIntrusive thoughts / imagesHeadachesGI symptomsInsomnia / nightmares / sleep disruptionsDecreased immune responseLethargyBecoming more accident prone

Spiritual

• Questioning the meaning of life

• Questioning prior religious beliefs

• Increased scepticism • Loss of hope

PROFESSIONAL

• Difficulty separating work life from personal life

• Withdrawal from colleagues• Feelings of therapeutic

impotence• Diminished functioning in non-

professional circumstances

Solutions

PersonalOrganizational

Professional

Three Areas to Consider

ORGANIZATIONAL

Indications of Organizational Compassion Fatigue

• Increased absenteeism• Constant changes in co-worker

relationships• Staff sniping at one another• Negativity toward management and

clients

• Inability of staff to complete assignments and tasks; or to respect/meet deadlines• Lack of flexibility among staff• Inability for staff to believe change is

possible – “why bother?”

Organizational Strategies• Have established roles, clear policies

and protocols, supervision sessions, reasonable expectations

• Recognize the “banking analogy” – no withdrawal without a deposit

• Quality more important than quantity, or how fast you complete treatment

• Encourage team work rather than competition• Discourage over-time, excessive

client load

• Educate staff about what they might expect to experience• Hold in-service activities• Have managers be aware of changes

in behaviour of staff

PROFESSIONAL

Professional Strategies• Supervision – ask for it and use it• Be clear and aware of potential

Boundary violations• Self-awareness

Professional Strategies• Processing of events and emotions• Realize that not all cases are

treatable and you are not inadequate because you did not seem to be able to help.

PERSONAL

Personal Strategies• Be aware – know the symptoms of CF• Health Promotion- Take care of yourself first. You can’t feed the hungry from an empty soup kettle•Learn to “Roll with the punches” – not everything is equally important•Talk to yourself in a positive way

Personal StrategiesComplete this sentence five times, in five different ways: “I sometimes find it difficult to balance______ with ______.” (Hint, think about demands, responsibilities, and desires acrossdifferent people, roles, and situations in your life).

More Healthy Strategies

• Take some time to decompress after difficult sessions• Don’t think about work away from

work• Personal journals• Good nutrition

More Healthy Strategies• Breathing (deep)• Take vacations – don’t be a

martyr• Engage in exercise,

recreation and hobbies• Develop a strong support

system

REMEMBER

• You can only do what you can do• You are not God• There will always be more need than

resources• Their pain is not your pain

QUESTIONS????