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Mental Health and Missions 2017Tim Friesen, Psychologist
COMPASSION FATIGUE: THE COST OF CARING FOR OTHERSHenri Nouwen in his book Compassion: “God is a compassionate God. This means, first of all, that he is a god who has chosen to be God-with-us. What really counts is that in moments of pain and suffering someone physically stays with us. More important than any particular action or word of advice is the simple presence of someone who cares. When someone says to us in the midst of crisis, “I do not know what to say or what to do, but I want you to realize that I am with you, that I will not leave you alone”, we have someone through whom we can find consolation and comfort. In a time filled with methods and techniques designed to change people, to influence their behavior, and to make them do new things and think new thoughts, we have lost the simple but difficult gift of being present to each other. We have lost this gift because we have been led to believe that presence must be useful. Simple being with someone is difficult because it asks of us that we share in the other’s vulnerability, enter with him or her into the experience of weakness and powerlessness, become part of uncertainty, and give up control and self-determination. And still, whenever this happens, new strength and new hope is being born. Those who offer us comfort and consolation by being and staying with us in moments of illness, mental anguish, or spiritual darkness often grow as close to us as those with whom we call family. They show their solidarity with us by willingly entering the dark, unchartered spaces of our lives. For this reason, they are the ones who bring new hope and help us discover new directions.”
Professional quality of life is the quality one feels in relation to their work as a helper. Both the positive and negative aspects of doing your work influence your professional quality of life. People who work helping others may respond to individual, community, national, and even international crises. They may be health care professionals, social service workers, teachers, attorneys, police officers, firefighters, clergy, transportation staff, disaster responders, and others. Understanding the positive and negative aspects of helping those who experience trauma and suffering can improve your ability to help them and your ability to keep your own balance. www.ProQOL.org
Primary Trauma: From our personal lives, our own past: e.g. car accident, witness the death of a child, let go from job, physically assaulted
DSM-V Criteria A for PTSD: The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence through direct exposure
Secondary Trauma: “Trauma reactions that involve the images shared by others or trauma stories” characterized by “panic, horror or helplessness in relation to the event” (Tikasz)
DSM V Criteria A for PTSD: The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence through: 1) Witnessing the trauma; 2) Learning that a relative or close friend was exposed to a trauma; 3) Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics).
Mental Health and Missions 2017Tim Friesen, Psychologist
COMPASSION FATIGUE
• A profound and gradual emotional and physical exhaustion that helping professionals and caregivers can develop over the course of their career.
• An erosion of all the things that keep us connected to others in our helper role: our empathy, our hope, our ability to tolerate strong emotions/difficult stories in others, and of course our compassion - not only for others but also for ourselves.
• Changes in our personal and professional lives: we become dispirited and increasingly bitter at work, contribute to a toxic work environment, more prone to errors, violate boundaries, lose a respectful stance with others, short-tempered with our loved ones, and feel constant guilt or resentment at the never ending demands on our personal time. (Mathieu)
Primary Traumatic Stress +/x (synergistic effect)
Secondary (Vicarious) Traumatic Stress +/x (synergistic effect)
Burnout = Compassion Fatigue
Gentry/Baranowsky (1997) Model of Compassion Fatigue
SECONDARY STRESS AND TRAUMA
INEVITABLE: Secondary traumatization is an occupational hazard for those who work with others who experience trauma (Munroe et al., 1995), and it reflects neither pathology in the trauma worker nor intentionality on the part of the traumatized person. (Pearlman & McIan, 1995)
CUMULATIVE: Secondary traumatization implies changes in the trauma workers enduring ways of experiencing self, others, and the world. The effects of secondary traumatization permeate the trauma worker's inner world and relationships. These effects do not arise solely from one trauma encounter; they are cumulative across time and helping relationships. (Pearlman & McIan, 1995)
INSIDIOUS: proceeding in a gradual, subtle way, but with potentially harmful effects
“There is a soul weariness that comes with caring. From daily doing business with the handiwork of fear. Sometimes it lives at the edges of one’s life, brushing against hope and barely making its presence known. At other times it comes crashing in, overtaking one with its vivid images of another’s terror with its profound demands for attention: nightmares, strange fears, and generalized hopelessness.” B. Hudnall Stamm PhD
Burnout
• 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
Mental Health and Missions 2017Tim Friesen, Psychologist
Commonalities of Burnout and Compassion Fatigue1. Emotional exhaustion2. Reduced sense of personal accomplishment or meaning in work3. Mental exhaustion4. Decreased interactions with others (isolation)5. Depersonalization (symptoms disconnected from real causes)6. Physical exhaustion7. Compassion fatigue has a more rapid onset while burnout emerges over time. Compassion
Fatigue has a faster recovery (less severe, if recognized and managed early).
Mental Health and Missions 2017Tim Friesen, Psychologist
ACTIVITY
Objective: make a drawing representing trauma, both primary and secondary, burnout and compassion fatigue using 3 circles.
1. Think about the size of each circle that represents your current situation related to primary trauma, secondary trauma and burnout.
2. Now make a Venn Diagram connecting your 3 circles (with the appropriate size) with overlap indicating how the 3 circle are related. For example, you might be struggling with burnout, but realize that it is minimally related to trauma. In this case your circle representing burnout might be larger than the other two and have minimal overlap with primary or secondary trauma.
3. Make your diagram so that the intersection of the 3 areas converges to become your representation of compassion fatigue.
Mental Health and Missions 2017Tim Friesen, Psychologist
MISCONCEPTIONS OF COMPASSION WORK
1. I will "fix" the problem… save the world...2. I am invincible.3. I am responsible for outcomes.4. If I care enough, everything will be okay.5. People will appreciate everything I do.6. I will have enough resources to fix things.7. I know what I'm getting into.8. Significant people in my life will support and approve my absence from our relationship while I invest in
this compassionate mission
Mental Health and Missions 2017Tim Friesen, Psychologist
9.
COMPASSION FATIGUE PHASES
1. Zealot Phase: keen. Highly committed, enthusiastic, long hours2. Irritability Phase: cut corners, avoid contact with others, mocking, daydream3. Withdrawal Phase: exhausted, neglect family, co-workers, clients, ourselves4. Zombie Phase: automatic pilot, distain for others, no compassion, impatient5. Pathological and Victimization versus Growth and Maturity: overwhelmed, ill, leaving profession versus
transformation and resilience
Mental Health and Missions 2017Tim Friesen, Psychologist
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
STRATEGIES TO REDUCE COMPASSION FATIGUE
1. Strong social support both at home and work2. Increased self-awareness3. Good self-care4. Better work/life balance5. Job satisfaction6. Rebalancing caseload and workload reduction7. Limiting trauma inputs8. Accessing coaching, counseling and good supervision as needed9. Attending regular professional development
STANDARDS OF SELF-CARE GUIDELINES
Green Cross Academy of Traumatology (Figley et al): “First, do no harm to yourself in the line of duty while helping/treating others. Second, attend to your physical, social, emotional, and spiritual needs as a way of ensuring high quality services for those who look to you for support.”
Ethical Principles of Self-Care in Humanitarian Work: These principles declare that it is unethical not to attend to your self-care as a humanitarian worker because sufficient self-care prevents harming those we serve.
1. Respect for the dignity and worth of self: A violation lowers your integrity and trust.2. Responsibility of self-care: Ultimately it is your responsibility to take care of yourself and no situation or
person can justify neglecting it.3. Self-care and duty to perform: There must be a recognition that the duty to perform as a worker cannot
be fulfilled if there is not, at the same time, a duty to self-care.
Mental Health and Missions 2017Tim Friesen, Psychologist
SELF AWARENESS
• Being aware of current feelings, actions and reactions• Gaining an understanding and an awareness of how we deal with anger, hurt and resentment• Being aware of the dynamics from our past that influence the everyday choices we make: Why did you
choose to go into this field and not another? Did you pick this profession because of a trauma or loss you experienced in your own life? Were you already a helper in your family of origin? Are you the go-to person in your personal life? Do you feel empty or unimportant unless you are in a helping role?
• Understanding how you childhood history affects your reactions to your clients’ stories (countertransference)
• Being in tune with your stress signals: Do you have a good sense of how your body communicates to you when it is overwhelmed? Do you get sick as soon as you go on vacation: fatigue, flu, cold, migraine? Many of us live in state of permanent overload and are dimly aware of it. What happens when you feel angry? Do you explode or do you swallow your rage? Where in your body do you feel your anger?
• Are you aware of the ways in which you sabotage your self-care? (by saying yes to requests you don’t have time for, by taking on more responsibilities, by drinking excessively…)
SELF COMPASSION
Not judging yourself or allowing other to judge you Not blaming yourself Getting to know and accepting yourself Forgiving yourself Loving yourself Helping yourself overcome insecurities Respecting yourself Protecting yourself
SELF
AWARENESS
SELF
CARE
SELF
COMPASSION
Mental Health and Missions 2017Tim Friesen, Psychologist
“Self-care is never a selfish act—it is simply good stewardship of the only gift I have, the gift I was put on earth to offer to others.” (Parker Palmer)
SELF-CARE FOR COMPASSION FATIGUE
AWARENESS Recognize and identify CF symptoms Monitor changes in symptoms over time Recognize and monitor changes in functionality
BALANCE Have a personal life apart from your work Attend to physical health Seek outside support (mentor, spiritual director, accountability group, counseling)
CONNECTION Make relationships with family and friends a priority Maintain connection with community Revitalize sense of life purpose and meaning
SELF-CARE REGULATION1. Empathy Regulation2. ANS and arousal regulation3. Clear Thinking
“All three are necessary for the worker to be fully in control of his/her own well-being even in the most distressing of situations.” (Rothschild)
EMPATHY• Empathy is the connective tissue of connecting to others in a meaningful way. It facilitates the
development of trust with others and allows us to meet them with our feelings as well as our thoughts. Empathy also hones our tools of insight and intuition, and complements our theoretical knowledge. But when the mechanisms of empathy are not in our awareness or under our control, we can find ourselves in real trouble. Without mastery of our own talents and tendencies toward empathy, it can mutate, twisting our compassion into compassion fatigue and our resonance into vicarious traumatization. (Rothschild, 2006)
• Automatic empathy has all the force of running or tumbling downhill, controlled empathy is as effortful as climbing up a mountainside. (Hodges & Wegner, 1997)
PSYCHOLOGICAL RESILIENCE• Bounce back and recovery from adversity• Having a "where there's a will, there's a way" attitude• Seeing problems as opportunities• Staying tough when things get difficult• Making and carrying out realistic plans• Having confidence in personal strengths and abilities• Managing strong feelings, emotions, and impulses• Having skills in problem solving and communication
Mental Health and Missions 2017Tim Friesen, Psychologist
• Having a positive or optimistic view of life• Having a deep-rooted faith in a system of meaning• Having a healthy social support network• Having a wide comfort zone• Being able to recover from panic-inducing or traumatic experiences
HOPE“We cannot continue to do the work we do or to survive as a people or a society without hope. Yet, we cannot be repeatedly exposed to trauma without building up defenses against the pain and sorrow of our work…We cannot afford to ignore Compassion Fatigue or to abandon hope at any level—personal, professional, or society. Understanding Compassion Fatigue then is essential to sustaining hope.” (Saakvitne & Pearlman)
“And we rejoice in the hope of the glory of God.Not only so, but we also rejoice in our sufferings, because we know that suffering produces perseverance;
perseverance, character;and character, hope.
And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us.” Romans 5:2b-5
REFERENCESFigley, Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the
Traumatized, Taylor & Francis, 1995Mathiew, The Compassion Fatigue Workbook, Taylor & Francis, 2012Nouwen, McNeill, Morrison, Compassion: A Reflection on the Christian Life, Doubleday, 1982Rothschild, Help for the Helper: Self-Care Strateiges for Managing Burnout and Stress, Norton, 2006Stamm (Editor), Secondary Traumatic Stress: Self-Care Issues for Clinicians, Researchers and Educators, Sidran Press, 1999