Post on 01-Jul-2015
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