Care for the Caregiver: Addressing Compassion Fatigue Marsha I. Wiggins, Ph.D. Licensed Marriage &...

Care for the Caregiver: Addressing Compassion Fatigue

Marsha I. Wiggins, Ph.D.Licensed Marriage & Family Therapist #

MT2567Kaleidoscope Counseling & Consulting, LLC

(561) 247-COPE (2673)West Palm Beach, FL

www.westpalmbeachcounselor.com

Objectives:

At the end of this workshop you will be able to:

1. Verbalize the Compassion Fatigue syndrome and the signs and symptoms of Compassion Fatigue.

2. Discuss ways of prevention and overcoming of Compassion Fatigue

Biblical Bases for Compassion

In the Hebrew scriptures the term, “hamal” means to have pity, to spare, to have compassion as with Pharoah’s daughter taking responsibility for baby Moses (Exodus 2:6)

“Raham” means to love deeply to have mercy


In the Christian Testament,

“Eleos” means mercy, an emotion aroused by contact with a person who is suffering, accompanied by giving help

Luke 6:36: “Be merciful, just as God is merciful.”


Oiktirmos—mercy or compassion, torn of heart at the sight of another’s suffering

The Lord is full of compassion and mercy (James 5:11) and believers are urged to put on a heart of compassion (Colossians 3:12-13)

(Richards, L. O. (1991). Expository Dictionary of Bible Words. Zondervan)

Application

To express compassion is to imitate God’s mercy and compassion (Luke 6:36)

To convey compassion is accomplished by reliance upon God as the branch draws energy from the vine (John 15:4-5)

Exactly What Is Compassion Fatigue?

Defined as “State of exhaustion and dysfunction (biologically, psychologically and socially, spiritually) as a result of prolonged exposure to secondary trauma or a single intensive event. (C.R. Figley, 1995)

Series of psychosocial and emotional factors caused by a specific event or events indirectly affecting helpers.Emotional fallout from delivering services to those who were primarily traumatized.

Compassion Fatigue In Many Forms

Healthcare ProfessionsPhysicians, Nursing, Social Services, Mental Health Providers

Other Helping ProfessionsTeachers, Clergy, Attorneys, Disaster Site Clean-up Crews, Animal Shelter staff etc.

Fire, EMS, Law EnforcementFamily Care GiversCharitable Giving workersAnimal rescue workers

(Philpot, Sue)

Menu of Misconceptions that Lead to Compassion Fatigue

“I will ‘fix’ the problem…make everything OK…save the world.”

“ I am responsible for outcomes.”

“If I care enough, everything will be OK.”

The hurting people I help will appreciate everything I do for them.”

More myths…

“I will have enough resources (time money, material, skills, training) to fix things.”

“Significant people in my life will support and approve my absence from this relationship while I invest in this compassionate mission.”

“I know what I’m getting into.”

And other myths…

“ I can do it alone.”

“If I’m spiritual enough, I can deal with the stress of working with suffering people.”

(Wood, Samuel)

The Compassion Fatigue Trajectory

Becoming a victim of Compassion Fatigue follows a predictable pattern of 5 phases:

1. ZEALOT PHASE

2. IRRITABILITY PHASE

3. WITHDRAWAL PHASE

4. ZOMBIE PHASE

5. VICTIMIZATION

ZEALOT PHASE

In the Zealot Phase caregivers…Committed, involved, available

Solving problems/making a difference

Willing to go the extra mile

High enthusiasm

Volunteers without being asked

IRRITABILITY PHASE

In the Irritability Phase caregivers…

Begin to cut corners

Begin to avoid clients

Begin to mock co-workers and clients

Begin to denigrate the people they serve

Use inappropriate humor

Make mistakes

Distance selves from friends & co-workers

ZOMBIE PHASE

In the Zombie Phase caregivers…

Hopelessness turns to rage

Begin to hate people…any/all people

Judge others as incompetent or ignorant

Develop a disdain for clients

Lose patience, sense of humor, time for fun

VICTIMIZATION

In this phase, caregivers…

Become overwhelmed and consider leaving their profession or volunteer posts

Experience physical illnesses

Have perpetual symptoms

(Wood, Samuel)

A Model of Stress & Coping

McCubbin & McCubbin (1989) found:

Resources + Pile Up of Demands + PerceptionsInfluences the way people respond to a major stressor.

Also, the level of adaptation to stress is also based on individuals’ resources ($, social/family support, spirituality etc.), Pile Up of Demands (a laundry list of other stressors) and Perceptions (how individuals view and make sense of their life circumstances)

The Process

Why Not “Burnout”

Defined as: “Exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration” (Merriam-Websters Collegiate Dictionary)

Gradually builds to a breaking point and the stress and frustration comes from all types of work-related stressors

Burnout

Usually takes longer

Compassion Fatigue may be a contributing factor

Frustrations such as Paper work and “red tape/bureaucratic issues”

The environment (home and work)

Colleagues

Pace and or grind of work

Burnout

Burnout is losing all satisfaction at work as a result of long hours, too much stress, & overwork.

Compassion Fatigue vs. Burnout

Compassion fatigue is a debilitating weariness brought about by repetitive, empathic response to pain and suffering. With compassion fatigue, you are absorbing the trauma through the eyes and ears of your clients.

The Difference?

Ask the Question:

“Do I Love My Job?”

Yes

Compassion

Fatigue

NO

Burnout(Philpot, Sue)

Who is More Likely to Develop Compassion Fatigue?

Anyone with the capacity for true compassion, empathy, concern and caring

We try to stay within professional boundaries and adhere to training guidelines

But the greatest strength (compassionate connection) is also greatest vulnerability

Not a characteristic to give up

Compassion Fatigue

Recognize the symptoms

Educate yourself

Recognize that:The more prolonged exposure

Working long hours

More personal demands

More isolated you allow yourself to become

Increases your vulnerability

Warning Signs and Symptoms

Symptoms similar to post-traumatic stress disorder (PTSD) but from secondary exposure

Additionally cynical, discouraged or hopeless attitude about work or career

Paradoxically you find it difficult to leave work at the end of the day

Have recurring thoughts about a particular case

Symptoms

Cognitive Emotional Behavioral Spiritual PersonalRelationships

Physical/Somatic

Work Performance

Loweredconcentration Decreasedself-esteem Apathy Rigidity Disorientation Perfectionism Minimization Preoccupationwith trauma Thoughts ofself-harm orharm toothers

Powerlessness

Anxiety Guilt Anger/rage Survivor guilt Shutdown Numbness Fear Helplessness Sadness Depression Emotionalroller coaster Depleted Overlysensitive

Impatient Irritable Withdrawn Moody Regression Sleep disturbance Nightmares Appetitechanges Hypervigilant ElevatedStartleresponse Accidentproneness Losing things

Questioningthe meaningof life Loss ofpurpose Lack of selfsatisfaction Pervasivehopelessness Anger at God Questioningof priorReligiousbeliefs Loss of faith in a higher power Greater skepticism about religion

Withdrawal Decreased interest in intimacy or sex Mistrust Isolation fromothers Over protection as a parent Projection of anger or blame Intolerance Loneliness Increased interpersonal conflicts

Shock Sweating Rapid heartbeat Breathing difficulties Aches and pains Dizziness Increased number and intensity of medical maladies SleepDisruption Other somatic complaints Impaired immune system

Low morale Low motivation Avoiding tasks Obsession about details Apathy Negativity Lack of appreciation Detachment Poor work Staff conflicts Absenteeism Exhaustion Irritability Withdrawal from colleagues

Prevention

Early Recognition and Awareness is Key!

Restore a healthy balance in your life including:

Good sleep, good nutrition and exercise

Take Time Off From Work (mini-vacations)

Enhancing Your Skills by Attending Stress Reduction Courses

Enhanced Self Care Skills

Don’t Wear This Button

Resiliency: The Ability to Keep On Going When the Going Gets Tough

Must be well restedResiliency sags when you are tiredUtilize your positive supportive connections to process your feelingsTake negatives and turn them into positivesResearch shows those who can “turn off thoughts about work” are more resilient during their careers

Stay Resilient

You need to have good support

You need to have the ability to talk about it

Be able to disconnect work and home

Strong connections with others

Overcoming Compassion Fatigue

PHYSICAL NEEDS:Get medical treatment for those symptoms that are interfering with your daily functioning;

Eat meals at a relaxed pace

Develop and stick to an exercise plan

Don’t self-medicate with alcohol or drugs

Take time off!

Take time off!

Overcoming Compassion FatiguePHYSICAL (cont)

Practice breathing exercises

Breathe deeply: inhale, exhale

Imagine: go to your quiet place

Feel: tension leave, relaxation, healing come


MENTAL NEEDS:Assess what’s on your plate. Make a list of your stressors to see what is making your plate too full.

Reduce or eliminate multi-tasking.

Identify stressful thinking (e.g. “always,” “never” “should” “ought”

Reframe failures as mistakes


MENTAL NEEDS (cont)Notice the connection between thoughts, feelings and behaviors


A PERSISTENT THOUGHT IS LIKE A DROP OF DYE IN A BOWL OF WATER: IT COLORS YOUR PERCEPTION OF THINGS!

(Endicott, Larry)


WORK:Rebalance your workload! Do you work through lunch? Spend weekends catching up?

Take mini-breaks

Do at least one nourishing activity a day

Ask for help

Have a transition from work to home


WORK (cont)Learn to say “no” more often.

Assess your trauma inputs and create a visualization or trauma filter to protect yourself from extraneous material.


WORK (cont)

Create and/or enforce time off policies in the workplace! A dry well cannot quench thirst!


RELATIONAL/EMOTIONALCreate a self-care idea collection such as a walk on the beach, massage, watching sports on TV)

Plan time to connect with family and friends

Keep a feeling journal

Have one good con-

versation a day


SPIRITUAL

“You are not made for the Sabbath; the Sabbath is made for you.” (Mark 2:27)

“Sabbath is not dependent upon our readiness to stop. We do not stop when we are finished. We stop because it is time to stop.” (Muller, p 82)


SPIRITUAL (cont)Prayer & Meditation

Walk the Labyrinth

Be still

Be silent

Listen to music

Read


“Just as speech without silence creates noise, charity without rest creates suffering.” (Muller, p. 159)

Overcoming Compassion FatigueFrom Isaiah 40: (paraphrase)

God, the Creator of the

ends of the earth does not

become weary or tired.

God gives strength to the weary and to whoever lacks might, God increases power.

All in allUnrecognized and Untreated Compassion Fatigue causes people to

Leave Their Professions

Self Treat with Drugs or Alcohol

Become Suicidal or Self Destructive

Therefore, remember…

You are not God.

The need will always be greater than the resources.

Use care in how your measure success

Who you are is as important to the mission as what you do.

And this…

Their pain is not your pain.

Don’t take them home with you.

Care for your spirit, emotions, and body so that there will be something left to give.

(Wood, Samuel)

Be Sabbath for One Another

We can make our minds so like still water that beings gather about us, that they may see their own images, and so live for a moment with a clearer, perhaps even a fiercer life, because of our quiet. (Yeats)

Questions?

References

Figley, C. (1995). Compassion Fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. London: Brunner-Routledge.

Muller, W. (1999). Sabbath: Restoring the sacred rhythm of rest. NY: Bantam.

Power point slides based on work by Larry Endicott, Sue Philpot, Samuel Wood)

Care for the Caregiver: Addressing Compassion Fatigue Marsha I. Wiggins, Ph.D. Licensed Marriage &...

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