Therapeutic Alliance, Compassion Fatigue, and

It’s Impact On Crisis Work

By Sean Erreger, LCSW Peer Support Call by the National Association of Crisis Organization

Directors

September 15, 2015

Objectives

• Define Transference and Counter-Transference; Identifying its impact on crisis work

• Defining the Therapeutic relationship and it’s impact on crisis work

• Some helpful tools to help your organization problem solve problems within the therapeutic relationship, compassion fatigue and it’s impact on your workforce.

Transference

• …the clients resistance, the transference-feelings wishes, fears, and defenses that influence the clients perceptions of the therapist” (Strean, 1996).

• “the clients’ experience of the therapist that is shaped by his or her own psychological structures and past, and involves displacement onto the therapist, of feelings, attitudes and behaviors belonging rightfully to in earlier significant relationship.” (Gelso and Hayes, 1998)

Transference

• Can be positive • Your voice Sounds like my best friend

• Can be negative Your voice may be similar to the person that sexually assaulted

• How has transference effected your Crisis Work?

Counter-Transference

Counter-Transference

• “We have begun to consider the ‘counter transference’ which arises in the physician as a result of the patient’s influence on his unconscious feelings, and have nearly come to the point of requiring the physician to recognize and overcome this counter transference in himself… We have noticed that every analyst’s achievement is limited by what his own complexes and resistances permit.” (Freud ,1910/1959)

Counter-Transference (cont.)

• “Counter transference is the same dynamic phenomenon as transference except it refers to those unconscious wishes and defenses, which are always part of the perception and treatment of the client” (Strean, 1996).

• Hayes (2004) argues that the notion of the unconscious slowly evolved to include any emotional reaction by the therapist to a client’s words or actions

Emotional Reactions

• My Example:• How Does Emotional reactions effect you and your staff?

Therapeutic Alliance

Therapeutic Alliance

• Robert Hatcher (2010) defines Therapeutic Alliance as “a way of talking about the quality of collaborative work between the patient and therapist. Asking the critical question of a patient feeling like that they are working together toward goals of therapy in a single session, a month, or throughout therapy thus far”.

• Transference, Counter-transference, and therapeutic alliance taken together can have a significant impact on your crisis workforce.

Measuring Therapeutic Alliance

Examined 3 scales…• 1) Shared Goals• 2) Subjective feelings• 3) The process of therapy• 4) being mindful of the potential for a rupture/impasse in

the relationship.• Mainly focused on long term work…

Scales Relevant to Crisis Work

• Professional Quality of Life Scale (ProQOL,)• The Shared Traumatic and Professional Postraumatic

Growth Inventory (STPPG) (Tosone, Bauwens, and Glassman, 2014 )

Here is why I think they are helpful/useful tools for crisis directors..

Professional Quality of Life Scale (ProQOL)

• The ProQOL is free• A 30 item self report measure of the positive and negative aspects of

caring• The ProQOL measures Compassion Satisfaction and Compassion Fatigue • Compassion Fatigue has two subscales

• Burnout• Secondary Trauma

Available at http://www.proqol.org/ProQol_Test.html

Professional Quality of Life

Compassion Fatigue

Compassion Satisfaction (ProQOL CS)

Work Environment

Client Environment

Personal Environment

Traumatized by work

Secondary Exposure

(ProQOL STS)

Primary Exposure

Frustration Anger

Exhaustion Depressed by Work

Environment(ProQOL Burnout)

Some Sample Questions from ProQol

• 7. I find it difficult to separate my personal life from my life as a [helper].

• I am not as productive at work because I am losing sleep over traumatic experiences of a person I [help]

• 20. I have happy thoughts and feelings about those I [help] and how I could help them

• 25. As a result of my [helping], I have intrusive, frightening thoughts.

• 27. I have thoughts that I am a "success" as a [helper].

The Shared Trauma/Professional Growth Inventory (STPPG- Tosone, Bauwens and Glassman, 2014)

• 14 Item Likert scale inventory about how “true” their response was.

• Focus on Post-Traumatic Growth- How did the shared experience of trauma have an impact on your professional work?

• Assumption that crisis call is both potentially traumatic for the person calling and for the worker receiving the call.

• Specific measure was for shared experiences around Hurricane Katrina but questions can be a great tool for supervision for crisis directors..

Sample Questions for STPPG

• As a result of my personal experience with Hurricane Katrina, the boundaries with my clients changed after the event

• As a result of my personal experience with Hurricane Katrina, I’ve changed my practice orientation (e.g., theoretical or technical approach)

• As a result of my personal experience with Hurricane Katrina, I’m triggered by my clients’ traumatic reactions to the event

STPPG and Post-Traumatic Growth

• Brings up the notion of Post Traumatic Growth • First measured for professionals by (Tedeschi and

Calhoun, 1996)• Changes in Self, Changes in Relationships with others,

and changes in philosophy of life.

Post-Traumatic Growth InventoryTedeschi and Calhoun, 1996

Conclusions

• The concepts of Counter-transference and compassion fatigue have a significant impact on crisis work. Crisis Directors can address this using several tools.

• The impact does not always have to negative, we can focus on the notion of post traumatic growth and learning from shared experience.

Follow Up

• Would love to hear feedback if these tools helped or if your group is interested in more information…

Email: stuckonsw@yahoo.comBlog : www.stuckonsocialwork.wordpress.comTwitter: @StuckOnSW

References Freud, S. (1910) Future Prospects of Psychoanalytic Psychotherapy. In J. Stratchey (Ed. And Trans). The standard of the complete psychological works of Sigmund Freud Volume 11 pp. 139-151. London Hogarth press. Originally published in 1910.Gelso, C.J, and Hayes, J.A. (1998) The psychotherapy relationship, New York, NY: WileyProQol.org. Professional Quality of Life Scale (English) retrieved 8/15/15 at http://www.proqol.org/ProQol_Test.htmlCustomize a Presentation on Compassion Satisfaction, Compassion Fatigue & Secondary Traumatic Stress [Powerpoint Slides] retrieved 8/15/15 at http://www.proqol.org/Customize_a_Presentation.htmlStearn, H.S. (1996) Psychoanalytic Therapy and social work treatment. In F.J Turner. Social Work Treatment : Interlocking approaches.(4th Edition, pages 523-554) Free Press: New York Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of traumatic stress, 9(3), 455-471.Tosone, C., Bauwens, J., & Glassman, M. (2014). The Shared Traumatic and Professional Posttraumatic Growth Inventory. Research on Social Work Practice, 1049731514549814.