COMPASSION FATIGUE IN SCHOOL COUNSELORSCaring for the Caregivers

Presented By:

Dr. Rosine DoughertyAssociate Professor

Argosy University- Sarasota Counseling Educator: School

CounselingDirector of Training

OUR REALITY AS PROFESSIONAL SCHOOL COUNSELORS

Nearly 1 in 10 high school students reported being threatened or injured with a weapon on school property.

1 in 3 high school students reported involvement in a physical fight.

(NCES 2013)

SCHOOL SURVEY ON CRIME & SAFETY 2010

In 2009–10, about 74 percent of public schools recorded one or more violent incidents, 16 percent recorded one or more serious violent incidents, and 44 percent recorded one or more thefts. Approximately 1 in 16 high school students reported carrying a weapon on school property. (NCES 2013)

During the 2009–10 school year, 85 percent of public schools recorded that one or more of these incidents of violence, theft, or other crimes had taken place, amounting to an estimated 1.9 million crimes.

This figure translates to a rate of approximately 40 crimes per 1,000 students enrolled in 2009–10. During the same year, 60 percent of schools reported one of the specified crimes to the police, amounting to about 689,000 crimes—or 15 crimes per 1,000 students enrolled.

U.S.Department of Education. (2011). Crime, Violence, Discipline, and Safety in U.S. Public Schools: Findings From the School Survey on Crime and Safety: 2009–10 First Look (NCES 2011-320).

Violence in our Schools

April 20, 1999, Columbine, 12 students, 1 teacher were killed and 24 others wounded

April 17, 2007, Virginia Tech mass shooting leaving 33 dead and 26 wounded

February 14, 2007, Northern Illinois University, 5 students were killed and 16 wounded

February 27, 2012, Chardon HS, in Ohio 3 students killed, 1 in wheelchair

April 2, 2012, Oikos University, Oakland, CA , 7 killed (3rd deadliest)

December 14, 2012, Sandy Hook Elementary, 26 killed

BUT…… THAT’S NOT ALL……

Millions of other occurrences happen in our schools yearly: student suicides, family deaths, and natural disasters.

Mass joblessness causing homelessness

Soldiers returning from war with PTSD: spouses and children of soldiers also developing PTSD

MY PERSONAL EXPERIENCE:CERRO GRANDE FIRE, Los Alamos, NM

May 6, 2000

School Counselors’ Roles

We are quite aware of the daily challenges we face as practicing PSCs, but when these duties are combined with long-term crisis response, these additional stressors are linked to work related dissatisfaction in the profession, burnout and compassion fatigue.

(Caro, 2007; Rayle, 2006)

SO LET’S DEFINE A FEW THINGS…..Burnout

Freudenberger first coined the term “burnout” in 1974; burnout has been identified in all professions. This widespread problem causes frustration, stress, reduced personal accomplishment, emotional exhaustion, depersonalization, personal dysfunction such as diminished mental and physical health.

(Belcastro, 1982; Collins & Long, 2003; Farber, 1991; Lowenstein, 1991; Maslach & Jackson, 1986; Morrissette, 2000; Pierson-Hubeny & Archambault, 1987; Pierce & Molloy, 1990)

Burnout

Burnout in school counselors has been well documented. As roles, student caseloads and duties have increased, school counselors have become stressed, emotionally overextended and drained. This exhaustion leads to burnout and impacts counselors’ effectiveness.

(Butcke, & McIann, 1984; Freeman & Coll, 1997; Kendrick, et.al., 1994; Lieberman, 2004; Morrissette, 2000; NCES, 2007; Rayle, 2006; Sears & Navin, 1983; Vail, 2005; Wilkerson & Bellini, 2006).

Lambie Study on Burnout with PSCs

Lambie (2007) identified several correlations when school counselors are working at low levels of burnout:

There is evidence that there is a negative correlation between burnout and ego functioning.

The higher the level of occupational support the lower degree of emotional exhaustion and depersonalization.

The number of years as a professional counselor, the ability to multi-task successfully, occupational support and one’s belief in personal accomplishment all were significant factors.

BUT BURNOUT IS NOT NECESSARILY TRAUMATIC

“According to the Diagnostic and Statistical Manual-IV-TR (DSM-IV) a traumatic event occurs when a person directly experiences an event or witnesses an event that involves

an actual or threatened death, serious injury, a threat to one’s physical integrity, the physical integrity of another person or the person learns about an unexpected or

violent death, serious harm, or threat of death or injury experienced by a family member of close friend”

(APA, 2000, cited in Caro, 2007, p.27).

Secondary Traumatic Stress or Secondary Traumatization orVicarious Traumatization

Secondary traumatic stress is defined as the “natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other; the stress resulting from helping or wanting to help a traumatized or suffering person.” (Figley, 1995, p.

7)

“Like primary trauma reactions, secondary trauma may disturb the worker’s ability to think clearly, to modulate emotions, to feel effective, or to maintain hope” (Figley, 1995, p. 416).

Posttraumatic Stress Disorder (PTSD)

“Posttraumatic Stress affects individuals differently but is identified by three categories of symptoms:

1) intrusive thoughts, images & sensations 2) avoidance of people, places, things and

experiences which elicit memories of the traumatic experience

3) negative arousal in the forms of hypervigilance, sleep disturbances, irritability an anxiety.”

(Gentry, Baranowsky & Dunning, 1997, para 7)

SO THEN WHAT IS COMPASSION FATIGUE?

“Compassion fatigue is a comprehensive term encompassing the concepts of secondary trauma, secondary traumatic stress, vicarious traumatization, and adding the components of cumulative stress, intrusion, avoidance and hypervigilance” (Figley, 2002; as cited in Caro, p. 44).

CONCEPTIONAL DIFFERENCES Compassion Fatigue vs Burnout

While both compassion fatigue and burnout are comprehensive terms that can affect many different professions, compassion fatigue seems to address helping professionals that work in the field of trauma or trauma-related situations.

(Abendroth & Flanery, 2006; Agulera, 1995; Agresta, 2006; Beavan & Stephens, 1999; Collins & Long, 2003; Figley, 2002; Frank & Karioth, 2006)

Burnout is not a natural consequence within a profession. It occurs when emotional resources are depleted, negative attitudes toward others build, the feeling of being unsuccessful increases. The counselor becomes unmotivated and detached.

CF can be a natural consequence within the helping professions.

Counselors with CF will still maintain a positive attitude about their work.

(McCann & Pearlman, 1990)

CERRO GRANDE FIREDoing What You Can…

Red Cross volunteer and victim, Judy Opsahl visits her devastated home in Los Alamos, NM

Associated Press Photo

WHILE THE EVENT MAY BE INSTANTANEOUS, THERE MAY BE NEED

FOR LONG TERM INTERVENTION

Even though the initial tragedy may be over, the need for long-term intervention may continue for days, months or years.

For school counselors, these interventions may not just be during the school year, but continue throughout the summer months and continue for years.

NOT A PROBLEM….. I CAN DEAL WITH IT….I AM

TRAINED! Denial is one of the most detrimental symptoms of Compassion Fatigue and Life Stress. It can easily hinder your ability to assess the level of fatigue and stress in your life as well as thwart your efforts to begin the healing process. (Smith, 2013)

A survey of emergency response personnel reported “86.9% symptoms of CF after exposure to highly distressing events with traumatized people” . . .

(Babbel, 2012 , Somatic Psychology)

SO…HOW DO WE KNOW?

“If counselors are taught to understand that CF symptoms sometimes result from counseling traumatized individuals, they will be more likely to prepare themselves for prevention of its symptoms” (para. 12).

“Additionally, if counselors are able to assess the development of compassion fatigue, they will be more apt to seek assistance and collaborate with peers and supervisors when in distress” (para. 13).

(Simpson & Starkey, 2006)

DANGERS OF HAVING CF

While PSCs are admired and honored for their enduring work, courage and dedication, they may put their students at special risk for harmfully or incorrectly applying counseling techniques or making poor decisions because of their exhaustion and inattentiveness due to CF.

Recognizing Symptoms of CF

Free Floating or misplaced anger Low self-esteem Increased irritability Insomnia Workaholism Depression Chronic tardiness Substance abuse (food, alcohol, drugs) Hypertension Frequent headaches Hypervigilance

STILL IN DENIAL? TAKE A TEST TO BE SURE

The following three tests were designed to help you recognize symptoms of Compassion Fatigue and Life Stress in your life. While they will never replace a qualified medical diagnosis, they may help you determine if you need to seek further assistance.

 (CFAP, http://www.compassionfatigue.org/index.html,2013)

Professional Quality of Life (ProQoL) Self-Test http://www.proqol.org/uploads/ProQOL_5_English.pdf Compassion Fatigue Self-Test: An Assessment http://www.compassionfatigue.org/pages/

cfassessment.html Life Stress Self-Test http://www.compassionfatigue.org/pages/lifestress.html

ADDITIONAL ASSESSMENTS FOR CF

Compassion Satisfaction/Fatigue Self Test (Stamm &

Figley, 1998) Trauma Recovery Scale (Gentry, 1998)

Silencing Response Scale (Baranowsky, 1998)

Global Check Set (GCS) (Baranowsky & Gentry, 1998)

Index of Clinical Stress (Abel, 1991)

Life Status Review Questionnaire ( Stamm & Rudolph, 1997)

Compassion Fatigue Scale –Revised (Figley, 1995; Baranowsky & Gentry, 1997)

Compassion Fatigue Self-Test (Figley, 1998)

Solution-Focused Trauma Recovery Scale (Gentry, 1997)

SO, HOW DO WE COPE? SELF-CARE STRATEGIES

FIRST: RECOGNIZE THE SYMPTOMS!

SECOND: ASK FOR AND ACCEPT HELP FROM OTHER PROFESSIONALS

Make time for quiet meditation, eat well and EXERCISE Increase social support Maintain task-focused behaviors – use problem-solving skills,

focus on tasks at hand, do not fixate on long-term implications Increase emotional distancing – protect from being

overwhelmed; block emotions during the event and utilize relaxation techniques; do not look at faces

Use cognitive self-talk – be mentally prepared, focus on positive aspects; prepare physically, take deep breaths, focus on staying in control

Feel better using altruism – Work for those who may not be as “strong” ; it feels good to help others; persevere and draw strength from adversity.

(Thompson, 2003)

HELPING OTHERS COPE WITH CF

Teachers, administrators and staff also suffer from workplace stress, burnout and even compassion fatigue when dealing with trauma within the school or community.

School counselors are on the “front lines” to be proactive to help school personnel. They have a daily school-wide perspective.

Counselors are expected to demonstrate and teach stress-reducing strategies in times of crisis.

(Moracco & McFadden, 1982)

HELPING OTHERS COPE WITH CF

Strategies for helping faculty & staff: (Thompson, 2003)

Routine visits by other mental health professionals Seek out families who may need assistance Be alert to misplaced anger – trivial events become

huge Give faculty & staff systematic public recognition for

important support they provide during the traumatic event

Debrief on a routine basis – reinforce they are having “normal reactions to an abnormal event”

Reassure there is no ideal way to handle a traumatic event

Promote counseling support groups

COMPASSION SATISFACTIONThe Silver Lining and Positive Effects of

CFSchauben and Frazier’s (1995) data revealed that

counselors identified 4 positive personal affirmations concerning compassion satisfaction:

1. The joy of watching clients change and grow. They liked being part of the positive process when their clients went from victim to survivor.

2. Counselors liked being part of the healing process. Helping their clients gave counselors a boost of satisfaction and impacted counselors positively.

3. Counselors enjoyed witnessing the resilience, strength and creativity of their clients.

4. Counselors found that their own personal growth and change was due to their clients’ challenges.

ORGANIZATIONS and TRAINING

Public Entity Risk Institute (PERI)

PERI provides training materials in cooperation with ASCA called The

Human Side of School Crises

Compassion Fatigue Awareness Project

http://www.compassionfatigue.org

CFAP is dedicated to educating caregivers about authentic, sustainable self-care and aiding organizations in their goal of providing healthy, compassionate care to those whom they serve.

Compassion Satisfaction: 50 steps to Healthy Caregiving

To Weep for a Stranger: Compassion Fatigue in Caregiving

both by Patricia Smith (Kindle)

HAVE THE COURAGE TO TAKE CARE OF YOU!The Power of Self-Compassion

Self-compassion is defined as having 3 main components, self-kindness, common humanity, and mindfulness.

Self-kindness refers to the tendency to be caring and understanding with oneself rather than being harshly critical or judgmental.

Common humanity involves recognizing that all humans are imperfect, fail and make mistakes.

Mindfulness involves being aware of one's painful feelings in a clear and balanced manner so that one neither ignores nor obsesses about disliked aspects of oneself or one's life

(Neff, 2011, The Power of Self-Compassion, http://www.psychologytoday.com/blog/the-power-self-compassion/201105/self-

compassion-caregivers)

“Life Begins on the Other Side of Despair”

Jean-Paul Sartre

REFERENCES

Abendroth, M., & Flannery, J. (2006). Predicting the risk of compassion fatigue: A study of hospice nurses. Journal of Hospice and Palliative Nursing, 8(6), 346-356. Aguilera, D.C. (1995). Crisis intervention: Theory and methodology. St. Louis, MO:      Mosby. Agresta, J. (2006). Job satisfaction among school social workers: The role of      interprofessional relationships and professional role discrepancy. Journal of Social      Service Research, 33(1), 47-52. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental      disorders (4th ed.). Washington, DC: Author. (Babbel, 2012 , Somatic Psychology) Baranowsky, A.B., Young, M., Johnson-Douglas, S., Williams-Keeler, L.,& McCarrey,      M. (1998). PTSD transmission: A review of secondary traumatization in holocaust      survivor families. Psychology, 39(4), 247-256. Baranowsky, A.B.  (2002). The silencing response in clinical practice: On the road to      dialogue. In C. R. Figley (Eds.), Treating compassion fatigue  (pp. 155-170). New      York: Brunner-Routledge. Belcastro, P. A. (1982). Burnout and its relationship to teachers’ somatic complaints

and      illnesses. Psychological Reports, 50, 1045-1046. Benevides-Pereira, A. M, &  Das Naves Laves, A. (2007). A study on burnout syndrome      in healthcare providers to people living with HIV. AIDS Care, 19(4), 565-571.

References, cont’d

Caro, T. Collins, S., & Long, A. (2003). Working with the psychological effects of trauma:      Consequences for mental health-care workers-a literature review. Journal of      Psychiatric and Mental health Nursing, 10, 417-424. Compassion Fatigue Awareness Project, http://www.compassionfatigue.org/ Farber, B. A. (1991). Crisis in education: Stress and burnout in the American teacher.       San Francisco: Jossey-Bass. Figely, C. R. (1995).  Compassion fatigue as a secondary traumatic stress disorder: An      overview. In C. R, Figely (Ed.), Compassion fatigue: Coping with secondary      traumatic stress disorder in those who treat the traumatized (pp. 1-20). New York:      Brunner- Routledge. Figley, C. R. (2002). Compassion fatigue: Psychotherapies’ chronic lack of self

care.      Psychotherapy in Practice, 58(11), 1433-1441. Figley, C. R., & Stamm, B.H. (1996). Psychometric review of the compassion fatigue self      test. In B.H. Stamm (Ed.), Measurement of stress, trauma and adaptation (pp. 127-      130). Lutherville: Sidran Press. Frank, D.I., & Karioth, S.O. (2006). Measuring compassion fatigue in public health      nurses providing assistance to hurricane victims. Southern Online Journal of Nursing      Research, 4(7), 2-13.

References, Cont’d

Freeman, B., & Coll, K. M. (1997). Factor structure of the role questionnaire (RQ): A      study of high school counselors. Measurement and Evaluation in Counseling and       Development, 30, 32-39. Gentry, J.E., Baranowsky, A. B., & Dunning, K. (2002). Diagnosis and treatment of      helper stresses,  traumas, and illnesses. In C. R. Figley (Eds.), Treating compassion      fatigue  (pp. 123-137). New York: Brunner-Routledge Greene, M. & Valesky, T. (1998). Elementary counselors and inclusion: A statewide      attitudinal survey. Professional School Counseling, 2(1), 68-76. Kendrick, R., Chandler, J. M., & Hatcher, W. (1994). Job demands, stressors, and the        school counselor. School Counselor, 41, 365-369. Lambie, G.W. (2007). The contribution of ego development level to burnout in school      counselors: implications for professional school counseling. American Counseling      Association, 85, 82-88. Lieberman, A. (2004). Confusion regarding school counselor functions: School       leadership impacts role clarity. Education, 124(3), 272-278. Maslach Burnout Inventory manual      (2nd ed.). Palo Alto, CA: Consulting Psychologists Press McCann, I. L. & Pearlman, L. A. (1990a). Psychological trauma in the adult survivor:      Theory, therapy, and transformation. New York: Brunner/Maze. Morrissette, P.J. (2000). School counselor well-being. Guidance & Counseling, 16(1), 2-      9.

References, Cont’d

National Center for Education Statistics (2007). High school guidance counseling.      Retrieved June 18, 2007 from      http://nces.ed.gov/surveys/frss/publications/2003015/index.asp

(Neff, 2011, The Power of Self-Compassion, http://www.psychologytoday.com/blog/the-power-self-compassion/201105/self-compassion-caregivers)

Pierce, M. C. & Molloy, G. N. (1990). Psychological and biographical differences       Between secondary school teachers experiencing high and low levels of

burnout.           British Journal of Educational Psychology, 60, 37-51. Pierson-Hubeny, D., & Archambault, F. (1987). Role stress and perceived intensity of      burnout among school psychologists. Psychology in the Schools, 19, 508-512. Rayle, A.D. (2006). Do school counselors matter? Mattering as a moderator between

job      stress and job satisfaction. Professional School Counseling, 9(3), 206-215. Schauben, L. J., & Frazier, P. A. (1995). Vicarious trauma: The effects on female      counselors of working with sexual violence survivors. Psychology of Women      Quarterly, 19, 49-64. Sears, S.J., & Navin, S.L. (1983). Stressors in school counseling. Education, 103, 333-      337.

References, Cont’d

Simpson, L. R. (2005). Level of spirituality as a predictor of the occurrence of compassion fatigue among counseling professionals in Mississippi. University of Mississippi.

Simpson, L.R. & Starkey, D. S. (2006). Secondary traumatic stress, compassion fatigue and counselor spirituality: Implications for counselors working with trauma. Retrieved October 30,2007, http://counselingoutfitters.com/Simpson.htm

Stamm, B. H. (1999). Secondary traumatic stress: Self-care issues for clinicians,        research and educators. Baltimore, MD: Sidran Press. Stamm, B.H.   (2002). Measuring compassion satisfaction as well as fatigue:       Developmental history of the compassion satisfaction and fatigue test. In C. R.

Figley      (Eds.), Treating compassion fatigue  (pp. 107-138). New York: Brunner-Routledge Thompson, R. (2003). Compassion fatigue: The professional liability for caring too

much. The Human Side of School Crises, Public Entity Risk Institute Symposium U.S.Department of Education. (2011).

Crime, Violence, Discipline, and Safety in U.S. Public Schools: Findings From the School Survey on Crime and Safety: 2009–10 First Look (NCES 2011-320).

Vail, K. (2005). What do counselors do? American School Board Journal, 24-27. Wilkerson, K., & Bellini, J. (2006). Intrapersonal and organizational factors

associated       with burnout among school counselors. Journal of Counseling & Development,

84,      440-450.