COMPASSION FATIGUECOMPASSION FATIGUE

Patricia Dunnigan MA ABSPatricia Dunnigan MA ABS

Traumatology Institute of Western Traumatology Institute of Western CanadaCanada

My PlanMy Plan

Offer informationOffer information

Tell some storiesTell some stories

Provide toolsProvide tools

Have some funHave some fun

Instructions for Table WorkInstructions for Table Work

What is the first word or phrase that comes What is the first word or phrase that comes to mind when you hear the term to mind when you hear the term Compassion Fatigue?Compassion Fatigue?

Go around the table one-by-one. Speak Go around the table one-by-one. Speak your word to your colleagues.your word to your colleagues.

Select one word to bring to the whole group.Select one word to bring to the whole group.

“I first called it a form of burnout, a kind of secondary victimization.” Charles Figley

Table GameLook at the picture in light of empathy and Compassion Fatigue.

Find a funny title to describe what is happening to this caregiver.

Compassion FatigueCompassion Fatigue

Trauma expressed by client and absorbed Trauma expressed by client and absorbed by helperby helper

““A natural consequence of caring between A natural consequence of caring between two people one who has been traumatized two people one who has been traumatized the other affected by listening…NOT the other affected by listening…NOT NECESSARILY A PROBLEM”NECESSARILY A PROBLEM”

Adapted from Figley, 1995Adapted from Figley, 1995

Compassion FatigueCompassion Fatigue

A feeling of losing our sense of self to the A feeling of losing our sense of self to the people we servepeople we serve

Suffering that can eventually be linked to our Suffering that can eventually be linked to our work with traumawork with trauma

The greater the capacity for feeling and The greater the capacity for feeling and expressing empathy, the greater the expressing empathy, the greater the tendency for compassion stress.tendency for compassion stress.

Compassion FatigueCompassion Fatigue

Compassion Satisfaction/Fatigue Self-Test Compassion Satisfaction/Fatigue Self-Test for Helpersfor Helpers

Complete the Self-Test in your handout Complete the Self-Test in your handout package using answers from your last work package using answers from your last work week.week.

Score the test carefully following the Score the test carefully following the instructions on page 4.instructions on page 4.

What does your score mean to you? What does your score mean to you?

The Silencing Response Scale for reference The Silencing Response Scale for reference only.only.

Score InterpretationScore Interpretation

Compassion Fatigue:Compassion Fatigue:26 or less extremely low risk26 or less extremely low risk27-30 = low risk27-30 = low risk31-35 = moderate risk31-35 = moderate risk36-40 = high risk36-40 = high risk41 + = very high risk41 + = very high risk

What is your score … what What is your score … what does it mean to you?does it mean to you?

Burnout RiskBurnout Risk

36 or less = extremely low risk36 or less = extremely low risk 37 – 50 = moderate risk37 – 50 = moderate risk 51 – 75 = high risk51 – 75 = high risk 76 – 85 = extremely high risk76 – 85 = extremely high risk

Compassion SatisfactionCompassion Satisfaction

118 + = extremely high potential118 + = extremely high potential 100 – 117 = high potential100 – 117 = high potential 82 – 99 = good potential82 – 99 = good potential 64 – 81 = modest potential64 – 81 = modest potential Below 63 = low potentialBelow 63 = low potential

Stages of ProgressionStages of Progression

The Zealot PhaseThe Zealot Phase

The Irritability PhaseThe Irritability Phase

The Withdrawal PhaseThe Withdrawal Phase

The Zombie PhaseThe Zombie Phase

Process InvolvedProcess Involved

Gradual exposure to job strainGradual exposure to job strain

Erosion of idealismErosion of idealism

Void of achievementVoid of achievement

Accumulation of intensive contact and Accumulation of intensive contact and experiences with people we serveexperiences with people we serve

The Zealot - IdealistThe Zealot - IdealistThe Zealot - IdealistThe Zealot - Idealist

We are committed, involved andWe are committed, involved and available… ready to problem solveavailable… ready to problem solve……ready to make a difference…ready to make a difference…

We willingly put in extra hours…We willingly put in extra hours…our enthusiasm overflows…our enthusiasm overflows…

We volunteer…We volunteer…

We are willing to go the extra We are willing to go the extra distance and often do so without promptingdistance and often do so without prompting

I’ll do that!

IrritabilityIrritability IrritabilityIrritability

– We begin to cut corners…We begin to cut corners…– to avoid contact with the people we serveto avoid contact with the people we serve– to mock our colleagues and people we serveto mock our colleagues and people we serve– We denigrate their efforts at wellness.  We denigrate their efforts at wellness.  – Our use of humor is sometimes strained. Our use of humor is sometimes strained. – We daydream or become distracted when the We daydream or become distracted when the

people we serve are speaking with us…people we serve are speaking with us…– We make efforts to avoid conversations with the We make efforts to avoid conversations with the

people we servepeople we serve– Oversights, mistakes, and lapses of concentration Oversights, mistakes, and lapses of concentration

begin to occur…begin to occur…– We begin to distance ourselves from our friends We begin to distance ourselves from our friends

and coworkers…and coworkers…

WithdrawalWithdrawal

Our enthusiasm turns sour and our bubble bursts. Our enthusiasm turns sour and our bubble bursts.

The people we serve become a blur and run The people we serve become a blur and run together… we lose our ability to see themtogether… we lose our ability to see them as individuals rather they become irritantsas individuals rather they become irritants

Complaints may be made about our work Complaints may be made about our work

We are tired all the time……we no longer wish to talk We are tired all the time……we no longer wish to talk about work and may not even admit to what we do so as about work and may not even admit to what we do so as to avoid talking about our work. to avoid talking about our work.

We neglect our family, our coworkers, the people we We neglect our family, our coworkers, the people we serve and ourselves. serve and ourselves.

Our shield gets thicker and thicker……it blocks our pain Our shield gets thicker and thicker……it blocks our pain and sadness. and sadness.

  

The ZombieThe Zombie

Our hopelessness turns to rage  

We begin to hate people

Others become incompetent or ignorant in our eyes

 We develop a disdain for the people we serve  We have no patience… we lose our sense of

humour…and have no time for fun

Choice PointChoice Point

Pathology/Illness and Victimization

Overwhelmed and Leaving the Profession

Somatic illness

Perpetuity of Symptoms

OR

Maturation and Renewal

Hardiness

Resiliency

Transformation

PTSD STSDPTSD STSD

StressorStressor

Reexperiencing traumatic eventReexperiencing traumatic event

Avoidance/Numbing of remindersAvoidance/Numbing of reminders

Persistent ArousalPersistent Arousal

PTSD STSDPTSD STSD

1.1. StressorStressor

2.2. Re-experiencing Re-experiencing Traumatic EventTraumatic Event

3.3. Avoidance/ Numbing Avoidance/ Numbing RemindersReminders

4.4. Persistent ArousalPersistent Arousal

1.1. StressorStressor

2.2. Re-experiencing Re-experiencing Traumatic EventTraumatic Event

3.3. Avoidance/ Numbing Avoidance/ Numbing RemindersReminders

4.4. Persistent ArousalPersistent Arousal

Post-traumatic stress disorderPost-traumatic stress disorder

Onset: cluster of symptoms lasting > 1 Onset: cluster of symptoms lasting > 1 monthmonth

Resulting from:Resulting from:– extreme traumatic stressor,extreme traumatic stressor,– direct personal experience ofdirect personal experience of

threatened deaththreatened death actual or threatened serious injury or actual or threatened serious injury or

– witnessing an event that involves the abovewitnessing an event that involves the above

Secondary traumatic stressSecondary traumatic stress

A natural by-product of working with A natural by-product of working with traumatrauma– empathy empathy – our own traumatic event our own traumatic event – trauma may be evokedtrauma may be evoked– children’s traumachildren’s trauma

Secondary Traumatic Stress Secondary Traumatic Stress DisorderDisorder

Secondary Traumatic Stress Secondary Traumatic Stress DisorderDisorder

Avoidance/ NumbingAvoidance/ Numbing efforts to avoid thoughts/feelingsefforts to avoid thoughts/feelingsavoidance of activities/situationsavoidance of activities/situationsdiminished interestdiminished interestdetachment from othersdetachment from othersdiminished affectdiminished affectforeshortened futureforeshortened future

Secondary Traumatic Stress Secondary Traumatic Stress DisorderDisorder

ArousalArousal

sleep disturbancesleep disturbance

irritability irritability

general anxietygeneral anxiety

hypervigilancehypervigilance

physiological reactivityphysiological reactivity

That which is to give light That which is to give light …….must endure burning.must endure burning Viktor Frankl (1963)

Difference BetweenDifference BetweenCompassion Fatigue and Compassion Fatigue and

BurnoutBurnout Compassion FatigueCompassion Fatigue Can emerge suddenlyCan emerge suddenly Helplessness and Helplessness and

ConfusionConfusion Isolation from support Isolation from support

systemssystems Symptoms Symptoms

disconnected from disconnected from primary causesprimary causes

Faster Recovery RateFaster Recovery Rate

BurnoutBurnout Emerges graduallyEmerges gradually Reduced sense of Reduced sense of

personal personal accomplishmentaccomplishment

Problems “perceived” Problems “perceived” to outweigh resourcesto outweigh resources

Caught between Caught between advocacy for client and advocacy for client and bureaucratic policies bureaucratic policies and structuresand structures

Recovery can take up Recovery can take up to 2 yearsto 2 years

IMPACT ON QUALITY OF WORKIMPACT ON QUALITY OF WORKIMPAIRMENTIMPAIRMENT

Violates the sense of basic trustViolates the sense of basic trust Severs connection to communitySevers connection to community Destroys meaningDestroys meaning Loss of sense of perspectiveLoss of sense of perspective Can’t find a way outCan’t find a way out Behaves within the patterns generated Behaves within the patterns generated

by the client – good/evil, ally/enemy, by the client – good/evil, ally/enemy, rescuer/rescueerescuer/rescuee

Treating PTSDTreating PTSD

Tri-Phasic ModelTri-Phasic Model

1.1. Safety and StabilizationSafety and Stabilization

2.2. Remembrance and MourningRemembrance and Mourning

3.3. ReconnectionReconnection

Treating Compassion FatigueTreating Compassion Fatigue

Accelerated Recovery ProgramAccelerated Recovery Program

5 sessions5 sessions Assessment for appropriateness of treatmentAssessment for appropriateness of treatment How our work attitudes can make us vulnerableHow our work attitudes can make us vulnerable Mission StatementMission Statement Power of StoryPower of Story Stabilization techniquesStabilization techniques PathwaysPathways

WHAT ORGANIZATIONS CAN DOWHAT ORGANIZATIONS CAN DO

EducateEducate

InoculateInoculate

Create Trained Support TeamsCreate Trained Support Teams

The greatest tragedy of our helping The greatest tragedy of our helping organizations is that the level of organizations is that the level of

attention and care given to our clients attention and care given to our clients is often so out of proportion to what is often so out of proportion to what

the caregiver receives that we lose our the caregiver receives that we lose our most capable, enthusiastic and most capable, enthusiastic and empathic front line workers to empathic front line workers to

Compassion Fatigue and BurnoutCompassion Fatigue and Burnout

Compassion FatigueCompassion FatigueThe Water and Stone Consulting GroupThe Water and Stone Consulting Group

www.waterandstone.cawww.waterandstone.ca