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Compassion Fatigue Compassion Fatigue and Vicarious Traumaand Vicarious Trauma

Cheryl Rizzo, Hospital Administrator, SWFVSCheryl Rizzo, Hospital Administrator, SWFVS

Certified Compassion Fatigue TrainerCertified Compassion Fatigue Trainer

The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.

Naomi Remen, 1996

A workbook on Vicarious

Traumatization

• 98% strategies we will discuss today are free

Goals: • increasing your self awareness

about what is going on in your life

• identifying what you can change and

• deciding where to begin

• You walk into the door of your house• What happens next? What do you see when you first

walk in the door? What do you do next? Are there dogs/children/relatives jumping all over you or is the house empty? Is it peaceful, lonely or hectic or something else?

• How are you feeling physically? Emotionally?• Do you even get home after work or are you at:• The bar/casino/shopping mall• The nursing home helping your aging parents• Driving 5 hungry kids to soccer/swimming AND fencing• Staying at work late to finish your paperwork• At the gym• In a coma sitting in your car somewhere in a parking lot

staring blankly…• What happens to the stories you hear at work?Where do they go at the end of our day, when we go

home?• What are your particular vulnerabilities?• How do you protect yourself while doing this very

challenging work?

The work that we do…

• Large volume of demand• Continually dwindling resources • Were you trained for this?

DefinitionsDefinitions

• Compassion Fatigue

• Vicarious Trauma

• We will look at burnout in a minute

What is important about these definitions for you today

Compassion fatigue &Compassion fatigue &Vicarious TraumaVicarious Trauma

Similarities:•A deep erosion of our compassion, of our ability to tolerate strong emotions/difficult stories

•Transformation of world view, sense of meaning, affect tolerance, beliefs

•Accumulate over time & across clients

•Evident in helpers’ professional and personal life

Compassion fatigue &Compassion fatigue &Vicarious TraumaVicarious Trauma

How they differ from each other (but are complementary):

• Vicarious trauma

• Compassion Fatigue

Recognizing Compassion Fatigue

• Compassion Fatigue symptoms are normal displays of stress resulting from the care giving work you perform on a regular basis. While the symptoms are often disruptive, depressive, and irritating, an awareness of the symptoms and their negative effect on your life can lead to positive change, personal transformation, and a new resiliency. Reaching a point where you have control over your own life choices will take time and hard work. There is no magic involved. There is only a commitment to make your life the best it can be.

Normal symptoms present in an individual include:

• Excessive blaming• Bottled up emotions• Isolation from others• Receives unusual amount of complaints from others• Voices excessive complaints about administrative

functions• Substance abuse used to mask feelings • Compulsive behaviors such as overspending, overeating,

gambling, sexual addictions• Poor self-care (i.e., hygiene, appearance)

» continued

Normal symptoms present in an individual include:

• Legal problems, indebtedness• Reoccurrence of nightmares and flashbacks to

traumatic event• Chronic physical ailments such as gastrointestinal

problems and recurrent colds• Apathy, sad, no longer finds activities pleasurable• Difficulty concentrating• Mentally and physically tired• Preoccupied• In denial about problems

• When Compassion Fatigue hits critical mass in the workplace, the organization itself suffers. Chronic absenteeism, spiraling Worker's Comp costs, high turnover rates, friction between employees, and friction between staff and management are among organizational symptoms that surface, creating additional stress on workers.

• Healing an organization takes time, patience, and most important, commitment. An awareness of Compassion Fatigue and its far reaching effects must be present at the highest level of management and work its way down to encompass line staff, as well as volunteers.

• Often, the mistrust that employees feel towards management is not unfounded. Since many care giving institutions are non-profit, they inherit additional challenges such as low wages, lack of space, high management turnover rate, and constantly shifting priorities.

Work Place CF

Organizational symptoms of Compassion Fatigue include:

• High absenteeism• Constant changes in co-workers relationships• Inability for teams to work well together• Desire among staff members to break company rules• Outbreaks of aggressive behaviors among staff• Inability of staff to complete assignments and tasks• Inability of staff to respect and meet deadlines• Lack of flexibility among staff members• Negativism towards management

• A human physician once said that “burnout results from the stresses that arise between the interactions of the clinician and the work environment whereas compassion fatigue evolves specifically from the relationship between the clinician and their patient” or in our case our clients. This is an important distinction, they way I look at it is if you have burnout you may be able to change your work environment by going to another practice with better hours, better pay, better MANAGEMENT, etc. which may help your burnout. However, compassion fatigue, because it has to do with something more internal it doesn’t have to do with where you work rather THE WORK THAT YOU DO as a caregiver. You cannot run form CF-it WILL follow you to your next job.

BurnoutBurnout

• “Physical & emotional exhaustion as a result of prolonged stress and frustration”

• Depleted ability to cope with work demands

• Sense of powerlessness to achieve goals

• Does not necessarily alter our view of the world, but our view of the workplace

• Can happen in any occupation

Consequences of overworking

• Compassion fatigue, burnout

• Heart disease, diabetes

• Alcoholism

• Marital stress

• Depleted parenting (“can we paint”?)

• Depleted friendships & family relationships

Strategy #1Strategy #1

• Low impact debriefing

(anti-sliming strategy)

Low Impact Debriefing

1) Increased Self Awareness

2) Fair Warning

3) Consent

4) Low Impact Disclosure

Questions to ask yourself before you share graphic details:

Is this conversation a:• Debriefing?• Case consultation?• Fireside chat?• Work lunch?• Parking lot chat?• Children’s soccer game (don’t laugh, it’s been done)• Xmas party?• Pillow talk?• Other…

Is the listener:• Aware that you are about to share graphic details?• Able to control the flow of what you are about to share

with them?

The problem•CF still not recognized as a problem by many

agencies/funders (this is changing - 2005 Survey on Nurses - CMHA Work/Life Wellness initiatives)

•Some eaps doing it well but many are doing it superficially - the benefits of having it be presented by Mental health counsellors vs HR MBAs

•? Safety of attending work sponsored workshops on CF

•Keeping it meaningful once you are gone from the workshop

Physical Signs of Physical Signs of Compassion FatigueCompassion Fatigue

• Exhaustion

• Insomnia

• Headaches

• Increased susceptibility to illness

• Somatization and hypochondria

Behavioral Signs and Behavioral Signs and SymptomsSymptoms

Increased use of alcohol and drugs

Anger and Irritability

Avoidance of clients

Absenteeism Impaired ability to make decisions

Problems in personal relationships

Attrition Compromised care for clients

Silencing Response

The Silencing Response

“ […] inability to attend to the stories/experiences of our clients and instead to redirect the material that is less distressing for the professional.

This occurs when client’s experiences/stories are overwhelming, Beyond our scope of comprehension and desire to know, or Simply spiraling past our sense of competency.”

(Baranowsky, 1997)

Examples of the Silencing Response

• changing the subject• avoiding the topic• providing pat answers• minimizing client distress• wishing or suggestion that the client would “just get over it”• boredom• angry or sarcastic with client• using humor to change or minimise the subject• faking interest or listening• blaming clients for their experiences• not believing clients• feeling numb or avoidant prior to or during sessions• constantly being reminded of personal traumatic experiences when working with certain clients.

Excerpted from pp 162-163 of Baranowsky in Figley (2002)

Psychological signs and Psychological signs and symptomssymptoms

• Emotional exhaustion• Distancing• Negative self image• Depression• Reduced ability to feel

sympathy and empathy• Cynicism• Resentment

• Dread of working with certain clients

• Feeling professional helplessness

• Diminished sense of enjoyment/career

• Depersonalization• Disruption of world view

Psychological signs and Psychological signs and symptoms Con’tsymptoms Con’t

• Inability to tolerate strong feelings

• Problems with Intimacy

• Intrusive imagery • Heightened anxiety or

irrational fears

• Hypersensitivity to emotionally charged stimuli

• Insensitivity to emotional material

• Increased sense of personal vulnerability

• Loss of hope• Difficulty separating personal

and professional lives

Sources Saakvitne, Figley, Gentry, Baranowsky & Dunning (1997).

Pro Quol Inventory

• Testing for CF, burnout and Compassion Satisfaction

“The Thingy”

Email for excel version: thingy@aweber.com

Why do we get CF/VT?

• Nature of the work (exposure to traumatic content, angry/upset clients…)

• Working conditions (workload, absence of referral resources)

• Your own vulnerabilities (trauma history, coping skills, current life situation)

• Cynical/negative colleagues

• Insufficient Training

• CF exists on a continuum throughout our career

How many helpers get CF?How many helpers get CF?

All studies come to the same conclusions:

• Affects the most caring • % of traumatic cases on caseload: the more

traumatic the work = higher incidence of VT• Full time vs part time (or 2 p/t jobs eg:

counselling + bookstore, couns + gardener)• Availability of social support is protective• Helper’s own history of abuse• Adequate training is protective

Addressing CF: StrategiesAddressing CF: Strategies

Transforming CF/VT

Review of Key elements of CF

•Compassion Fatigue can contaminate a workplace as a whole as well as its workers

•How might our workplaces be different from others who are not exposed to these kinds of challenges (the office)?

•Identifying your own yellow zone/red zone (you can find that you are slowly tipping into the red zone, or you can think you were in the green and all of a sudden something throws you right in the orange zone –we all likely have residual CF with us)

Now for the unfair news…

To stay CF-free, you may have to make some drastic Changes to your Work/Life balance

What has been found to help reduce CF?

Job Satisfaction Good self care Increased self awareness Low impact disclosure Better WL balance Limiting trauma inputs Rebalancing caseload & workload reduction Coaching/counselling Professional development

Addressing CF: Addressing CF: StrategiesStrategies

DebriefingTraining

Professional

Peer SupervisionAcknowledging CF

Organizational

Transition timeHobbies

Personal

You

What is your professional support network?

Who is in it?

How regular is it?

Do you feel that it could be improved upon and if so how?

What are some obstacles you face in having the ideal support system?

If you are in a relationship: How do you handle all of this with your partner? Does your partner understand the profound impact of your work on you as an individual?

(source Saakvitne and Pearlman: Transforming the Pain)

Your Support System

CF Strategies - The four steps

Step oneTake Stock of stressors at home and at work

Step threeDevelop CF resiliency

Step fourMake a commitment to

implement changes

Step two

Enhance self careat home and at work &

Improve Work/Life balance

The Four Steps of CF Strategies

Step One – Take Stock: Track your Stress (at home and at

work)

What’s on your plate?

What we say…bargaining with our lives

• “I’ll slow down when I retire…when the kids leave…when I have enough money…

• This is just a bad spell, it won’t be this crazy in a month…

Step Two: Enhancing Self Care and Improving work/life

balance

Self Care - What has been shown to work?

• Deceptively simple strategies• Abcs of basic self care: Sleep, rest,

proper diet, exercise, vacations• Renewal• Activities that replenish you• Working part time/life work balance• Nourishing activities every day• Debriefing process

Retooling your self careThe challenges, to my mind, are the following:

• Waiting too long before activating the self care strategies we do have in our toolbox

• Lack of a good repertoire of self care activities

• Failing to periodically reassess how effective/relevant the self care strategies that we do use are – are they still working for us? Getting in a rut

• Not feeling that we deserve to do self care, that it’s selfish/no time/not a priority.

1) Take Stock regularly- What is on your plate?2) Start a Self-Care Idea Collection - share ideas with peers3) Find time for yourself every day – Rebalance your workload4) Delegate - learn to ask for help at home and at work5) Have a transition from work to home6) Learn to say no (or yes) more often7) Assess your Trauma Inputs8) Learn strategies to ground yourself during trauma work9) Consider Joining a Supervision/Peer Support Group10) Attend Workshops/Professional Training Regularly11) Consider working part time (at this type of job)12) Physical Exercise

Top 12 Self-Care Tips for Helpers

Take Time for Your LifeCheryl Richardson

• The Ideal Schedule• If you only had to work

10 hours a week?• Dyads

50 Best Ways to Simplify Your life

by Patrick Fanning

Step Three:Developing CF resiliency

through relaxation training and stress reduction techniques

two important principles

(1) the development and maintenance of intentionality, through a non-anxious presence, in bothpersonal and professional spheres of life, and

(2) the development and maintenance ofself-validation, especially self-validated caregiving.”

Eric Gentry, Compassion Fatigue ScholarThe Crucible of Transformation, 2002

The importance of relaxation training

• Mark Berber “Creating Inner Calm”

CD can be purchased at Indigo (not amazon)

What works in CF therapy?

Now for the good news:

• CF is easily treatable

What works in CF therapy?5 treatment areas:1) Resiliency Skills: “rebounding from life and work

difficulties” - “strengthening areas of our lives to cushion the fall when the going gets rough”

2) Skills acquisition: What symptoms are being caused by areas of work where I do not have adequate training?

3) Self Care: “what symptoms are caused by the professional overextending themselves in their work or personal lives?” soothing skills, boundaries

4) Internal Conflicts: Unresolved personal issues, knowing what we need to do yet being unable to do it (eg physical exercise, proper eating etc)

5) Connection with others: “Developing a personal “therapeutic community” is mandatory in preventing CF, “develop underutilized resources for support, nurturance and enrichment.”

Baranowsky and Gentry, ARP training manual (1999)

Step Four: Making a Commitment to

Change

Where is your life out of balance?

•Your emotional health

•Your physical health

“What gets the majority of your timeAnd attention?”

Eg Moving closer to work freed up 15 hour a week

Volunteering at the school once a week or one hour a month

Source: Take Time for yourLife (1999)

Your Money or Your Life by Joe Dominguez

Calculating your true hourly wage

When Enough is enoughWhen Enough is enough

•Accessing Counselling

•Changing workload

•Making a career change

THANK YOU

• MY HAPPY PLACE