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uisibionsand Acquisitioriset raph'c Services services bbriogmphiques
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Compassionate Professionais 1
Running head: COMPASSIONATE PROFESSIONALS
NON-VOLITIONAL WAlRMENT AND RESILIENCE IN COMPASSIONATE PROFESSIONALS:
A MODEL
A THESIS ÇUBMIITED IN PARTIAL FULFKLMENT OF
THE REQUREMENE FOR THE DEGREE MASEROF ARTS
in
THE FACULlYOF GRADUATE SWDIES
GRADUATE COUNSEZlUNG PSYCHOLOGY P R O G W
August 21, 2000
The role of ttte professional "people-helw offers no guatantee to its
praditioners of personal immun@ h m the dimuptions of life, whether
inconvenientiy minor or completely devastating. Life events sudi as
bereavement, failing health, changing rehtionships, andlor financial diff idt ies
are liMy to occur in everyone's life eXpenence at some point. This thesis focuses
upon the experience of the "compassionate professional" encomtering life
events which are disnipave in the extreme - particuLarly conditions and
experiences that are best descriid as random, adverse, a d pemnally
catastrophic. C m t l y available professional impairment literahw indicates
that scant attention has been directed toward the realities of these non-volitional
stressors, and potential resolutions, espeoally among clergy and cou~lsellors.
This Uiesis synthesizes existing models of resource-congruent coping (Wong,
1993) and compassion fatigue (Figley, 1995), creating a theoretical hamework in
which to explore issues of the compassionate professional's +ence. The
mode1 includes: (1) speQfic culhial context (the unicpe influences shaping
professional subcultures pafticular to Christian minisbiy and pmfessional
caregiving); (2) integrated appraisal (a position focuseci on the hannonizing of
personal and professional d e s durhg the eXpenence of significant random Me
disruptions); and (3) the loas to growth spectnim rdecting directions of
po tential outcornes (threshold of stability / instability, compassion fatigue, and
compassion resilience). The focus of this thesis is upon the influence of non-
volitional disruptive events in both the private and vocational life of the
compassionate professional, with an emphasis upon global proases rather than
selecüve mechanisms m the sphere of the integrated appraisal and coping.
Table of Contents
Abstra ct .............................................................. i Table of Contents ..................................................... ii
Acknow1edgements and Dedication ..................................... v
Chapter One: SETTING THE CONTEXT ................................. 7
introduction ................................................... 7
Parallels Beîween Pastoral and Counseilor Roles .................... 8
The Wounding of the Healers ................................... -10
Distinctions Between Compassion Fatigue and Bumout ............. 12
Definhg the Compassionate Professional .......................... 15
Chapter Two: PROFEÇGIONAL IMP- ABRIEE: LITERATURE REVIEW ..................... 20
Introduction ................................................... 20 ................................... Impainnent Issues in Medicine 20
Impairment Issues in Nursing ................................... 23
The Perspedive of M a l Work .................................. 24
Pastoral Impairment Issues ...................................... 26
.......................... Impairment Risks Aaoss the Professions 30
Narrowing the Fanis of the Impairment Literature ............... -31
............................. Defming Non-Volitional Impairment 33
Nomvolitional Impairment and the Psychoanalytic PerSperave .... -33
Ernpincai Investigations of Non-Volitional Professional Impairment . . 36
Chapter EXIÇIWG MODELS .................................... 51
Compassion Fatigue: A Background ............................ -51
A Model of Compassion Stress and Compassion Fatigue ........... -53 .................................. A Mode1 of Congruent Coping 58
................. Case Applications of the Wong and Figiey Models -61
Chapter Four SOURCE MODELS BLENDED AND ElCïENûED ........... 68
Brief Rinaples of Theory Development ........................... 68
The Path of Theory Development Toward the Synthesized Mode1 .... 68
....................................... Redience Mefly ûefined 72
Wong and Figley Interpreted Through Case Materials ............. -75 Non-Volitional Impairment and Resllience in Cornpassionate
......................................... Professionals: A Model 80
.................................. SpeQnc Culturai Context 81
.......................... Congruent Resources Repertoire 83
Secondary Traumatic Stress. Prolongecl Exposute and .................................. Traumatic Recollections 84
........................... Non-Volitionai Life Disruption -86
............................ Revious DysfunctiOnaj Coping 89
..................................... Integrated A* 92
...................................... Inteptecl Coping -92
............................ Ineffective/ Inadequate Coping 94
Summary of the Mode1 .................................... 99
Chapter Five: CONCLUSIONS. WLICATIONS AND APPLICATIONS ................................... 102
A Brief Review .............................................. -102 nie Necessity of Practicai Applications ........................... 105
Identifymg Potentiai Appîïcations and Challenges ................. 106
A Final Word ................................................. 110
Figures ............................................................ -126
Figure 1 . Compassion Stress (Figley. 1995) ...................... 126 Figure 2 . Compassion Fatigue (Figley. 1995) .................... 127
Figure 3 . Resource-Congruent Effective Adaptation (Wong, 1993) . 128 Figure 4 . Non-Volitional Impairment and Resilience in
Compassionaie Rofessionals ........................ -129
Appendix .......................................................... 130
Case 1: Louisa. a Mental Health Theapist ........................ 130
Case 2: Pastor Craig, a Patish Pastor ............................. 134
Case 3: Richard. a Student Services Courrsellor .................... 138 Case 4: Katnona. a Private Fractitionet ......................... -143
Chapter One
SEl7lNG TIIE CONTEXT
Introduction
There is a certain irony in the realization that pastors and counseilors - people who provide care and support to others through some of life's most
intimate and painhil moments - are themselves often emotionally isobted
figures (Herlihy, 1996; Hickson, Gudz Q Hombuckie, 1995; McBurney, 1986;
Wamer Q Carter, 19û4; Morris & Blanton, 1994; Owen, 1993; Coster 6r Schwebel,
1997; Nouwen, lm). Pubiidy identifieà with images of ideal spiritual, emotional
and mental health, in private they are as M y as anyone to d e r h m the
blows and discouragements of human existence, including relationships that
confiict and cmmble, health that becornes fragile, addictions that grow, finances
that wither, aspirations that flounder, and deaths that t h dose to the heart. In
circumstances of such intense persona1 distress, members of these two related
"compassionate pfessiow" may nevertheless feel enormously pressureci to
maintain a stoic and seif-contained profesional posture, knowing full well that
private life Win be subject to public scrutiny.
Given the l ikelihd that any of these ernotionally weighty conditions
could affect the Me of any person, at any tirne, it is significant to note that the
existence and potential ramifications of such "non-volitional impairments"
remain an area relatively unexplored within the body of professional
mipainnent literature. It is the intention of thîs discussion to address some
Mted aspects of this void, particularly those concemed with the experiences of
counsellors and derics who enanmiter unavoidable cimunstances of peRonal
catastrophe and potential Unpairment.
Warner a . Carter (1984) discuss issues of tension between the public
persona and private reality in the pastoral experience, describing a commonly
held perception of dergy and th& famicies as "community caretakers,'' whose
every Life experience is subjed to dose inspection by the people to whom they
minister, for signs of success or failure. Wnhg hom a Roman Catholic
perspective, Hickson, Gudz and Hombuckle (1995, p. 35, c ihg Bowers, 1963)
comment that the pastoral &g has haditionally carrieci an "insurmountable
contrast between [the] very real humanity and the transcendent requirernents of
[the] symbolic representation [of] the @est." Kennedy, Eckhardt and Goldsmith
(1984, p. 17) offer a similar observation, noting that "...congregational members
expect their leaders to perform, respond, and act in a manner after which they
rnay pattern their own lives." In an empùical study whkh paralleis Kennedy et
al. (lm), Blackbitd and Wright (1985) report that the derical eXpenence is one in
which pastors feel th& vocation o h causes them to be "placed on a pedestal",
preventing them h m enjoying sponhneity of personal expression, behaviow
and relationships, regivdless of th& personai needs. Moms and Blanton (1994)
report a similar finding, noting that a fiquent companion to the pastoral role is
an içolating "celebnty-like status" for both the individual deric and his/ her
family, an extemai perception whidi mates challenges and diffidties in the
formation of intimate relatiomhips (e.g., Iriendships) outside the family W e .
The expectations held by other people conceming a cOUIISellor's approach
to the vicissitudes of life may be equally idealistic. 'Invincible", "invulne2abIe",
even "omnipotent" are among the qualities frequently ascribed to therapists in
the perceptions of their clients (Counseiman & Alonso, 1993; Gold, 1993; Daines,
Gask k Ushmood, 1997). S i l y I a sense of quasi- "Unm~rtality'~ may
v a d e the counsell~~-ciient relaticmship. According to Simon (1990, p. W), the
existence of the therapeutic union indudes a taat assumption that the coullseUor
will always preserve that d e , unaitezed by time or cimmstance and, without
question, will "outlive the treatment and continue to be avaüable indefinitely ." Most commonly, the therapist seems to be considered as a mode1 of what the
dient wishes to become in terms of adjushnent, coping, behaviour and
emotionai health (Schiachet, 1996). The counsellor's experience with personal
crisis carries critical weight, then, in the treahnent and progiess of the client,
since "the therapist's responses and reactions affect the psychotherapy
relationship and process. Both therapist and patient are unavoidably touched by
a signiticant ocamence in the therapisfs Me," (Sion, 1990, p. 590, emphasis
added). Pope and Tabadinick (1994) lend support to this observation, noting
that the psychoanalytic orientation has traditiohally aclcnowledged a concern
that the analysYs personal Me experiences, if unadàresseâ, may become
detrimental to the pfactice of effective therapy.
It is in this realm of tension, between a real and falliile human existence,
and the pedestall target occupid by the professional role, that the pastor and
therapist dwell. It is a problem that fresuently exists unnoticeci, unaddresseci,
and unresolved until the advent of a cri& in the congregation, counselling
pradice, or petsonal life of the individuaL professional. In some instances, this
crisis rnay become apparent in the exhaustion of "burn-out" (W~tmer & Yaung,
1996; Emerson 6r Matk~s, 1996), a disabling depliession (Emerson 8 Markos,
1996; Muse br Chase, 1993; Raybum, 1991), or serious issues of physical ill-health
%me ministem and counsellm, l i k many 0th- peoplef m o r t to dearly
dysfunctional stress reduction behaviours such as the abuse of alcohol or other
substances (Oisheski B Le& 19%; Emerson & Markf 19%), eating or
gambiing disordm (Hill & Baillie, 1993), inappropriate, risky and sometimes
criminal semai conduct (Alcom, 19%; Hopkins, 1991; McBmey, 1%;
McButneyf 1996; Steinke, 1989; von Shh, Mines B Anderson, 1995; Emerson &
Markos, 19%), or rigidly authoritative and othenvise exploitive power
relationships (Falbo, New 6r Gaines, 19û7; Emerson dr Markos, 19%). Several
researchers dkuss the complicated dyMmics of deception, of both the self and
others, Uiat becorne active when a member of the dergy maintains a dud life,
pu~lposefully engaging in such dysfunctionai behaviom (in theological temis,
those "volitional s i . ) that are in dear conflict with the pastoral role (Steinke,
1989; Fortune, 1989; von Stroh, Mines & Anderson, 1995). Commenthg from a
sedar perspective, Epstein, Simon and Kay (1 l982), and Webb (1997) offer
paralle1 observations regarding the influences of therapist self-awiueness and
self-deception in instances where the culmination of personal Srcumstances and
choice result in professional boundary violations against clients.
The Woundina of the Healers
For most members of these compassionate professions, however, the
greater burden of th& respecüve vocations is fou& not in the struggle to
maintain consistent authentiaty between public and private life, but in the
inherent expectation that they will provide a limitiess source of quality support
to o t k people dealing wïth M e demands; fiesses and addictions, deaths,
divorce, shattered d.amsf spintual searching and the myMd 0 t h prob1ems
defuiing the human condiaon. In a m e y of the extant literature regarding
pastoral hctioning and wd-be in~ Hall (1997, p. 240) broadly comments that
"there is neuer a thne when they are not on c d to fundion in their pastoral role"
(emphasis added). Kieren and Munro (1988) characterize the ministerkd d e as a
"greedy" one in the pastor's Me, demanding extremdy high rates of invatment
in tirne, emotion and other personal resources, o h to the detriment of
relationships with family and fnends. Morris and Blanton (1994) Lîkewise discuss
s e v d signiscant @lems encountered by detgy families, including excessive
tirne demands imposed by the ministry upon the derical member, fiequent
intrusions by the people and neeâs of the ministry into areas of the family's
privacy, and 0th- (albeit unintentional) boundq enaoachments. The research
ensemble Raybum, Richmond and Rogers (1988) offers much the same
condusion in a series of 17 brief shidies examinhg Levels of stress eXpenenced by
d e and female "rehgious pmfessionals", both mariid and single.
Commenting on the often poor definition of the role boundaries between "life"
and "work" for clergy members, Kunst (1993, p. 209) observes thak
unlike rnany professionals who are able to leave their
work at the office and maintain dear limits regardhg th&
private lives, artinisters are overly visii1e and available to
those whom they serve....their neighbours may be church
members, they kequently sociaiize with parishioners, and
their "days off are often intempted by emergency concerns.
P d e l observations have been made conceming the weariness that can
be inherent in the d e of the therapeutic professional. Figley (1995) identifies the
inaeasing oaYrrence among clinicians, particular1y those engaging in severe-
trauma work, of a phenornenon known as "compassion fatigue". Briere (19%)
makes simüar observationsp discussing at length eXpenences common to those
therapists who focus on healing work with SUNivors of sexuai abuse, induding
sociai and professiional isolation, prolongeci and repetitious exponve to homfic
materiai, and si@cant diçiuusionment with people and professionals in general.
Whether working with survivors of abuse or some 0 t h traumatic event, it
seems apparent that the very quality of ernpathy, whid\ is the C O U I ~ S ~ U O ~ ' ~ gift
and skill for this compassiortate vocation, can become the seed of his or her own
extreme distress. The danger, writes Figley, lies in the fact that "relief of the
emotional suffering of clients automatidy uidudes absorbing Uiformation that
is about dering. Often it includes absorbing that suffering itselfas weU" (1995,
p. 2, sic, emphasis added).
Dish'nctions Between Cornvassion Fatime and Buniout
Warranthg carehil attention at this point is a problem closely reiated to,
but distinct from compassion fatigue: that of therapist '%urnout!', as discussed by
several researchers (Ememn & Markos, 1996; Witmer & Young, 19%; Sowa,
May h Niles, 1994; Neukug & Williams, 1993; Reamer, 1992). Sowa, May and
Niles (1994, p. 19) write:
persans in occupations that involve providing Services
to others, such as c o d m , are especially vulnerable to
the accumulation of occupaticmai stress and subsequent
burnout The many dernands placed on c o d o r s ... and
the ethical dilemmas Uiheffnt in the counseling profession
... contribute to the occupational stress of counseling as a
profession.
While the concept of h o u t was first introduced in kterature specific to
public health and social service professions in the 197Vs (Hall, 1997; Witmer &
Young, 1996; Wamer & Carter, 19&), the term has become too frequently
misappptüited by the popuhr press, and mdiscnmina . . . M y applied in the
vernada.. A more accurate understanding may be gained from a bnef survey
of the multiple chical descriptors identitying bumout among professionai
caregivers. A function of the pressures involvecl in having too few resources
with whidi to meet too many demands, therapeutic bumout may be manifest in
any of the following:
a) a condition of chronic stress hom prolonged, demanding
and non-reciprocal interpersonal con tact (Hall, 1997);
b) an experience of "emotional exhaustion, negative
attitude shift, and sense of personal devaluation" (Patrick,
1981, p. 11, ated in Menningerf 19%);
C) ùicreasing Levels of intolerance for ambiguity, and
inflexicbility when confronthg new experierices (Owen, 1993);
d) a los of positive feelings regardhg the profession, and
a marked decrease in sympathy or respect for clients
(Witmer dr Young, 19%; Skorupa dr Agresti, 1993);
e) increasing physical or emotional efforts to "escapet' from
the therapeutic demands of the profession (for exarnple,
avoiding dient contacts or daydreaming in sessions) (Emerson
dt Markos, 19%);
f) severe procrastination and increased Cymcism, with a loss
of desire to help (Emerson & Markos, 19%);
g) inaeased physical arlments (Emerson & Markos, 19%);
h) substance abuse (Skompa 6 Agresti, 1993); and
i) contemplation or attempt of suicide (Pope 6r Tabadin*
1994; Reamer, 199î)J
Given that the current broad application of the tem bumout has
somewhat diminished its authentic diagnostic significance, Figiey (1995) takes
pains to delineate bumout h m the condition of secondary traumatic stress (STS,
also labellecl compassion stress), establishing them as qualitativdy diflerent
states, and not simply degrees of variation on a single distress spectrum.
According to Figley (1995), one of the differentiating factors is established by the
time Erame in which the two conditions develop. Hoff (1995) similar1y
dis~guïshes bumout from other aisis states, Q h g its chronic rather than acute
character as the measure of distinction. Bumout, then, is best d e s c n i as a
chronic condition, the end product of a slow erosion of emotional and other
tesou~ces, which is ody gradually manifest in the coping styles of the
compassionate professional. Converseiy, acute SE/compassion stress can
develop with little waming, in extremely qui& tirne, and in response to a
discrete event or series of events (Figley, 1995). Figley (1995) m e r notes that
SE/ compassion stress is characterized by a sense of imrnediate helplessness,
conhision and isolation not generally assOaated with the malaise inherent in
emotional bumout. Fïnally, according to Figleis (1995) assessment, bumout
1 It is beyond the scope of the piesent discussion to evaluate the psychological literature concerning suicide, and its reiation to bumout and other professional impairrnents. Howevet, given the recognition that contemplatedlattempted suicides greatly outnumber completeâ suicides in the general population, that contemplatedfattempted suicides are reported in relation to burnout syrnptoms, and that self-reporting of completed suicides is impossible, it may be reasonaçdy concluded that fully reaiized suicides are, at least oaasionally, the extreme outcome of the compassionate professional's bumout experience. For more speufii information, the intefested reaber shouid consutt the extensive suicide l i t m r e found in psychoiugy, medine, sciai mrrk, and oîher disciplines.
and 5TS/compassion stress are distinguished by the Pace of the recovery phase.
Typically8 compassionate pfessionals experiencing SE/ compassion stress
demonstrate a retum to previous leveis of well-functioning more swiftly than do
casualties of bumout (Figiey, 1995), an observation which pafalleis the sudden
onset of the trauma-related condition versus the slow deterioration of
developing burnout.
Definina the Comvassionate Professional
It seems apparent that by the very nature of th& roles within vocations
defined by compassion, pastors and counsellors bear a tremendous risk for
conditions of personal isolation and professional exhaustion. Understanding the
nature of the human phenornenon known as compassion is therefore essential to
understanding the professionai's experience with compassion fatigue. Nouwen,
McNeill and Morrison (1982, p. 4) write with simple clarity regarding the nature
of cornpassion in the human experience:
The word cmpmsion is derived from the Latin words pati
and mm, which together mean 'to d e r with.' Compassion
asks us to go where it hurts, to enter into places of pain, to
share in brokenness, fear, confusion, and anguish. Compas-
sion challenges us to cry out with those in misery, to moum
with those who are lonely, to weep with those in tears.
Compassion requires us to be weak with the weak, Yulner-
able with the vulnerable, and powerless with the powerless.
Compassion means full immersion in the condition of being
human. Whm we look at cmpadm this way, it becornes
or tenderheurtedness (emphasis added).
Cornnienhg on the dynamics of the counseiids acperience of
compassion, Owen (1993) considers the possiiility that many psychotherapists
ch- the profession, in part, seivching to hilfill unmet intinlilcy ne&, as a
reaction to Me-long ernotional isolation. Maeder (1989, ated in Milier, Wagner,
Britton 6t Gridley, 1998) o h a kmcired observation, stating that "the helping
professions, notably psychotherapy and the ministry, appear to attract more
than their share of the emotionally unstable wounded healers," (p. 37).
Roviding a balance to these somewhat negative perceptions is another portrait
of the "wounded healef' that emetges h m both the pastoral and therapeutic
literature (Gerson, 1996; Figley, 1995; Neukrug & Williams, 1993; Owen, 1993;
McBumqr, 1986; Nouwen, 19721 l979), whkh considers the güts of empathy and
insight bom of the professional's experiences with dfering. nie remainder of
the passage by Nouwen, McNeiU and Morrison (1982, p. 4) cauiters the opinions
of Owen (1993) and Maeder (1989, cited in Miller, e t al, 1998):
It is not surpriang U\at compassion, understood as suffering
with, often evokes in us a deep resistance and even protest.
We are inclineci to Say, ''This is self-flagellation, this is maso-
this is a morbid interest in pain, this is a si& desire."
It is important for ris to acknowledge this resistance and to
recognize that SUEfkring is not s r n e t h g we desire or to
which we are attracted. On the contrary, it is somelliing we
want to avoid at all cost. Wefore , compassion is not mnrmg
our tnost naturaf r We me pain-tmiders and we wnsider
anyonr whoférls atbacted to su@ig abnonnal, or at laast aery
unustuzf (emphasis addeci).
Finally, in language evocative of the existentialist miters, Miller e t al (1998, p.
125) offer a helpfd summary of the wounded heak concept:
The corisensus Mef is that the c d o r can b.anscend the
painful or tragic experiences of Me. This transcertdence allows
the counselor to bridge the conditions of mental health and
mental ihess, thereby bringing compassionate healing
to the therapeutic reiationship.
ui spite of this dose identification with the derings of others, there &ts
a profound imbaiance in the relational flow between compassionate
professionals and their clients or congegants, a pattern of 'W-intirnades"
(Kunst? 1993) that has received attention h m several researchers. Feelings of
lonelines, alienation and isolation are reportedy prevalent among reiigious
pfessionals of ail wallcs, inciudùig Roman Catholic priests and nuhs (Hickson,
Gudz & Hornbudde, 1995; Raybum, 1991). pastm amos a wide range of
Protestant denominations (Wamer C Carter? 1984), and women rabbis of the
Refonned movement (Raybum, Richmond & Rogers, 1988g dr 1988h). Hickson,
Gudz and Hornbztckle (1995, p. 37) hitther report that in the experience of many
Roman Cathoiic derics, "personal relationships with others are ordinarily distantf
highly stylized and often unrewarding."
Almost identical to KunsYs (1993) discussion of the half-intimacies in the
pastomte, Guy and Liaboe (1986) retum to the theme of imbaIanced
ielatimhips in th& description of the "me way intimacy" that is characteristic
of the traditional theapeutic alliance- Such a skewed pattern is not surpriPng in
a field where professional preparation and practice require the continual
examination of issues sumounding boundaries, non-disclœure,
countertransference, mnfidentiality, and appropriate pefsod/ professional
ethics. To paraphrase Kunst, (1993, p. 2û9), it seems evident that as praditioners
of the compassionate professicms, both dergy and therapists are expected to
engage in muitiple unidirectional relationships - wherein the participahg
"other" may disclose phenomdy personal feelings and needs - without
oppottunities for, or expectatiom of, 1Tecipmcal reveiatiorts by the pastoral
caregiver .
Sutnmal'~
In üght of such observations, it seems evident Uiat in the practice of these
distinctty "compassionate prokssions," certain conditions are consistent aaoss
the eXpenences of both counsellors and pastors. These observations may be
summarized by the following points: (1) that courtseilors and pastors occupy a
unique and highly presenued d e of trust and modehg in Society; (2) that they
are not immune to the experience of catastrophic or chronically debilitating
circumstances; (3) that poa judgment or delikate choices may significantiy
impact both petsonal and professional actions; and (4) that extrema of
emotional isolation are W y to occur over the course of the vocational Mespan/
often due to the expectations of the vocation. Given these realities, it is a matter
of fundamental importance to examine and understand the ability of the caring
professional to authentidy hindion in that d e while enduring his or her own
iïfe crisis (DeWaldB 1994; S i lm; Vamos, lm; Reamer, 11991; DiGiulio,
1997). An appropriate starting point for this sipifiant pursuit lies in the
exploratim of existing iiteratureB derived from various but compaable
professions, and patainllig to both broad and speQfic questions of compromised
pfessional functioning.
Introduction
Discussions of professional impainnent issues, incorporaporatug
circumstances and conditions, incidence and reporting rates, effects, treahnents,
and recidivism may be found in the îiterature of most disciplines of health care or
spintual leadership where the focus is upon "the care of persans," including
medicine and psychiatry, psychology, social work, nutSin& pastoral theology
and (most recently) counselling (Menninger, 19%; Olsheski & Leech, 19%;
Emerson & Markos, 1996; Re-, 1992; Kagel 6t Giebeihausen, 1992. Swenson 6t
Foster, 1995; Hoff, 1995; von Stroh, Mes 6t Anderson, 1995; McBumey, 19%;
Hazler & Kottler, 19%; Witmer & Young, 19%; Sheffieid, 1998). Whiie the
recognition of b o a actual and potential problerns of professional impairment is
lteQected in the ethical codes of rnust disciplines, working definitions of the
pmblem vary considerably (Kilburg, Nathan 6r Thomson, 1986; Emerson dr
Markos, 19%; Sherman, 1996; Sherman 6c Thelen, 1998; Sheffield, 1998).
Imvuhent Issues in Medicine
One of the earfiest efforts to defïne professional impairment in any field
appeafed in 1973, when the American Medical AsBodation's (AMA) Council on
Mental Health issueci its "si& doctor statutePm stating professional impainnent
was present when a physician was no longer able to practice "with reasonable
ski11 and safety due to ph* or mental disabilities Ulcluding deterimation
through the aging process or l o s of motor sk31 or abuse of dnxgs or alcohol,"
(Qted in von Stmh, Mines 6r Anderson, 1995, p. 7). By the late 19Ws, physicians
belonging to the AMA formally defined impaitnient in their Cield in the following
manner:
the Wity to deliver competent patient care r d t i n g
h m alcoholism, chernid dependency or mental lunes,
induchg h o u t or the sense of emotional depletion
which cornes h m stress, (Sbdler, Willing, Eberhage 6r
Ward, 1988, p. 258, cited in Emerson &c Markos, 1996).
6
Doctors in at least one Axnerican state presently adhere to an even more
stringent definition of physician impairment than the national standard
originating with the AMA. The North Carolina Physiaans Health Program,
legislatecl in that juridiction to identifjr and adcires incidents of professionaiiy
impaired practitioners, recognizes six spedic areas of concem: 1) alcoholism and
alcohol abuse, 2) 0th- dnig addictions, 3) sexual misconduct and harassment, 4)
psychiaûic disorders, 5) behaviowal disorders, and 6) conditions of dual
diagnosis (Sheffield, 1998). Eisewhere in the Literahw, BisseIl's (1983, cîted in
Sherman, 1996; and ated in Sheffield, 1998) consideration of chemidy
dependent doctors proposes a deat distinction tetween physicians who are
incompetent, those who are unethical, and those who are tnily "impaireci."
According to these guidelines, incompetency occurs where physich training
was inadeqpate andior continuing professional ducation is lacking; unethicd
professionai behaviout is dernonstrateci where the physicïan is dishonest, or
uncaringf negiectful of appropriate patient care; impaireci functioning ensues
where the doctor in question is ill, whether the condition is one of alcohoüsm,
mental ihess, or a disease h m which recovery is unlücely ( B M , 1983, Qted in
Shetman, 19%, and cited in Sheffield, 1998). Sherman (19%) points out that
Bissell's categories are "non-mutudy exdusive" and contain brwd degrees of
impairment. Such an observation concedes both the Likelihood that multiple,
complicated sources may contircbute to a professional's impaired condition, and
that the judgment of "impaimient" in any given situation is, frequently, a
subjective one. This recognition bears signifiant implications for issues of
intervention, treatment, and the ethical responsib'ities of colleagues when a
professional is suspecteci or found to be impaired.
A similar observation is advanced by the British Columbia College of
Physiaans and Surgeons. According to the Registrar of that body at the time of
this writing (PXebùecis, personal conununication via electronic mail, A N 2 7
1999), the mdtiplicity of potential sources of professional impairment predude
the utility of a singleI pr& dennition Instead, the CoUege focuses its efforts
upon educaüng its members and the puMic regarchg practitioner distressI
idenmg individuai cases of impairment, and the devebpment and
implementation of appropriate interventions, such as the Physician Support
Rogramme (P. Rebbeck, personal communicaticm via dectrwiic ma& April27,
1999). This approach se& to emphasize a partnership between the regulatuig
body and the physich-at-risk in the management and resoluticm of the
impairing arnimstances, before resorting to potentially invohntary (and
necessarily severe) interventions allowed for by provincial legislation. At this
date, the Colleges of Physicians and Surgeons in most Canadian provinces
e x h e a similar a p c h to problems of impairment within theV profession
(P. Rebbedc, personal communication via ele-ctmmîc mail, Apni 27,1999).
Registered, licensed and practicai nurses comprise a segment of the
medical establishment distinct hom, but dosely aligneci with the professional
commUNty of physicians and surgeons, resulting in a professional nursing
culture shaped by many of the same conditions and pressures. It follows, then,
that nurses are like1y candidates for impairments similar to those mentioned by
the AMA, and exp10red in relateci literature. Proof of this expedation is borne
out in the exisüng Merature's toais on addictions-related impairments within the
nursing profession (Hoff, 1995). Although precise enmerations of those
functionally impawd or "al-risk" nurses are unknown (Swenson & Foster, 1995),
Anderson (1994) reports that the incidence of chemical dependency among
nurses occurs at a rate of more than twice that found in the general population.
In the US., severai programmes currently emSt for the intervention, treatment
and support of nurses admitting to (or found to have) dru6 alcohol and other
substance abuse problems (Anderson, 1994). In a m e y of the complicated
structures of Arnerican xnalpractice insurance coverage as it Çpecificajly relates to
impairment within the nursing profession (Swehson & Foster, 1995), the
majority of the literature documenteci also indicates a focus in this field on issues
of mental illness, chernical dependency and other substance a h among
nurses.
Finally, related issues of impaved cornpetencies and abuses of power
within the nursing field must be consideted. It has been noted that both public
and professional awareness of "inappropriate nurse-client relatianships has
grown as an issue over the pst kw years" (Canadian Nuses Association, 1998).
A recent domment, jointly issued by the three nursing regulatory organizations
of British Columbia (Registered Nurses Assoaation of British Columbia,
Registered Psychiatnc Nurses Assoaation of British Columbia, k British
Columbia C o d of Licenceci Practid Nurses? 1995) addresses these issues with
the use of "plain-languaget' ethics, disamion-provoking scenarios, and
suggestions of proactive and preventative measures for use by nurses in self-
evaluation.
The Perspective of Social Wmk
in a discussion of the known impainnent and treahnent rates among
professional social workers, Reamer (1992) proposes three sources of impairing
"interference," deriveci fiom work by the research ensemble of Lamb, Ressert
Pfost, Baum, Jackson and Jarvis (1987):
a) an inabïLityI or disinchation, to acquUe and integrate
acceptable standards of behavi0u.r in the professional hction;
b) an inability, or disinclination, to develop professional skiUs
to an acceptable levei of competency; and
c) an Mbility, or disinclination, to manage elements of personal
Me (inciuding stress? psychologid dysfwicüon or extreme
emotional reactions) that may interfere with competent
professional functioning.2
The third b u e rdected in Remefs (1992) discusçim is ampLified in
DiGiuliors ((1995) brief study conceming workplace responses to M d welfare
worktm who experience sipficant emotional losses, either personal or
2 This third area of potentially impairing condiions described in FFeamer's (1992) anaiysis of social workefs, generalty describlng circumstances of extemal, adverse, signifïït and frequentty unavoidabk stressos. 's orie patimibrly relevant to the present examinatkn of random crises and non- w o W i inyminnent or resiliemt ammg c o ~ i o n a d e pr&?ssbnak.
Cornpassbnate Profession J s 35
professional. Reamer's (1992) discussion, dortunately, conveys the impression
that, in order for social wmkers to remain unimpaireà and hee of interferhg
emotions, distresshg personal events may (and shodd) be reduced to elements
simply in need of effective "management". However, DiGidio's (1995)
definition of these losses recognizes the profound depths of some human events,
and anticipates the present definition of potentially impairing nomvolitional
stressors among compassimate professionals. She writes:
For the purpose of this research, loss was defineci as the
ending of an important relationship because of death, divorce
or marital dissolution; [the] illness or disabüity of the M d
weifare worker, a family member, or a close fnend; and
the LMnad or emotional crisis of the diild weLfare worker,
@iGiuiio, 1995, p. 880).
Given this definition. it is interesthg to note that the majority (85%) of
DiGiulio's (1995) sample of 106 professional child welfare workers reported
telatively recent, and frequently multiple experiences of serious pefsonal Loss.
Two-thirds had sullered the death of a loved one, two-füths reporteci dealing
with serious illness or disability in family or aiends, and signiscant emotional
losses resuiting h m pe.rsonal experience with ïllness/injury were acknowledged
by more than a thid of the samp1e group (DiGiulio, 1995). The dissolution of
marriages or oher signiscant relatiomhips, financial crises, and undehed
emotional crises? while reporteci by fewer of the sociai workers inDiGiuiio's
(1995) study (between 16 and 26%), were also rmbstantial sources of respondent
distress. The implications of even this limiteci investigation are sobering.
Examinhg DiGiulio's (1995) definition and d t s in the context of Reamer's
(1992) framework for impairment suggests that at any given moment, a sizable
portion of compassionate pmfessionals may be undettaking significant
professional burdens, in spite of bearing enormous personal distress.
Commenting on the problems of impairment among members of the
dergy, studies by researchers sudi as Hall (1997), Kunst (1995), and von Stroh,
Mines and Anderson (1995) offer little in the way of a single comprehensive
definition, mming instead the potential of s e v d influencing factors, including
alcohol abuse, occupational ~tressois# confüctuig systems functions,
inappropriate semial behaviow, family conflicts, personal moral struggles, and
poverty of spirihial life. The majority of the dergy-impairment literature is
focused within the narrow confines of sexltal misconduct and the abuse of
pastoral power (Fortune, 1989; Steinke, 1989; von Stroh, Mines L Anderson,
1995; Hopkins, 1991; Muse ds Chase# 1993; Alcorn, 1996). Both Forhuie (1989)
and Steinlre (1989) offer pioneering work in the recognition and treatment of
pastoral sexual misconduct, discussing the characteristics common to male derics
Cornpassimate Professionais 27
who engage in extra-marital affairs3, and raising sllnilar issues examining the
factors contriiuting to (and the d t s of) such impairment, including poor
spintual heaith (Hall, 1997), fiawed emotional development, lack of seIf-
awareness? and a sense of narcissistic non-accountability in the offending pastor.
The inauence of work-relateci sttessors upon the perçonal and
professional fundionhg of dergy m e m b is the focus of a &segment of the
developing pastoral impairment iiterahire. Studies by several researdi teams,
including Morris and BLanton (1994a, 1994b, 1995), Hall (1997), K i m a d M m
(1988), Blackbird and Wright (1985), Benda and DiBlasio (1992), Hutduson and
Hutdiison (l979), and others, concentrate upon occupational stressors Speacically
associateci with the pastoral d e .
3 Upon first evafiiation, discussions of pastoral sexual misconduct such as those presented here (Fortune, 1989; Steinke, 1989) wuld appear lo be signifiintly skewed toward, if not exclusively focuseâ on, the benaviours and characteristics of male clergy. This does not suggest that some munen members of the pastorate migttt not also be inclined to abuse the tnst of that office by engaging in sexual or other rnisconâuct; nor doas it imgly that the majority of male cleiics do. lt is, however, a reflection of m i n g social patterns and resulting msearch findings. The informed reac¶er should recagnize that seveml factors rnay be of potmtial influence in this instance, inckrding:
the relative& recerit (late 20th ceritucy) entrance of women into fomally ordained ministry the extremely small permtage of women currently funcüoning in pastoral roles, when
cornparad to the total dethai ôoây the relative scarcity of pubiïiitied material conceming specitlc histoiical incidents, rnembers, or
indiïdual activiües of cwitemglatii cbïstereû, teaching, nursing, and social are rellgious Orders significantly bwer ratios of fernales to males i d e M i amng seraial MenderS in the genefal
population prevaihg sociallcutturai standards regarding acceptaMe ercpressions of indvidual semielity ptevailing expectatbns of, and toletance for, the betravioun of individual6 occupying positions
of go- ard trust the reœnt accentuation of generic proMems of 'male vüMence agaagainst wom' by the vdce of
a ferrjnist generation in media, mearch and po i i i in the iate 20th c8ntury. and an associated focus on issues of m-vlderd gmûer-baJed eKpioitat'i-
The interestet! reader is mferred to the vast (though not necessarily hannonized) litemture reetdity available in a number CH retated arm, such as: pastoral car8 & comseüing; sexW abuse ttieory & therapy; studies of organuatioml psychobgy & dynarnics; gerider situdies; Chutch & social histories; human wuMy; p6ychopathokgy; and professional et--
Cornpassionate Professionais aB
In a 1979 study, Hutdllson and Hutchison bmach a topic traditioMiiy
unheard of among ciergy, namely pastors' eXpenences of divorce, and its
subsequent impact upon th& opportunities for profesional advancement.
Reporting on a limiteci survey of American Presbyterian pastors (n = 331; 157
"ever-divorced", 174 "never-divorced"), Hutchison and Hutchiscm (1979)
identify a derids divorced status as a significant negative factot influencing
overall career development According to this and 0th- research, work-relateci
stressors iikely to increase for pastors as a result of their divorce eXpenence
indude:
higher levels of job insecunty (loss of present position or
future opp~rtunities~ increaseâ iikelihood and h.equency of
geographic relocations)
lower income ievels (direct job lm, dernotion to lower status)
increased Welihood of non-parish pastoral positions, and
(ultima tely ),
mandatory or voluntary departure h m professional
ministry (Hutdiison B Hutdiison, 1979; Morris & Blanton, 1995).
Framing th& investigation in the context of intact clergy familiesr Moms
and Blanton (1994b) discuss several potentially impairing work-related stressors
which appear disproporti~lliitely prominent in the ministerial experience. There
is some overlap between these and the earlier work of Hutchison and Hutchison
(1979); studies conducteci by other research teams support MamS and Blanton
(1994b) by the suggestion of simüar condusioz~s.
Accordhg to Morris and Blanton (1994b), the m a t signifiant work-
related stressors for this population indude: (1) fiequent relocations; (2) finanaal
"undercompensation"; (3) time demands; (4) ambiguous bounàdes; and (5) la&
of social supports. Generallyf clergy f d e s do not remain in the same
geographical area for more than a few consecutive yearsf with moves often
intemipting the family's early development and SOcialization. Negative effects
of this "mobrlity syndromef' (induding loss of support networksf marital
dysfunction, family disiuptionf loss of personal relationships and growth
opportunities) are likely to be expienceci by the ministerîai family (Morris &
Blanton, 1994af1994b; Mickeyf Wilson dr Ashmore, 1991; ûsttanderf Henry &
Hendrixf 1990). In addition, pastorai pfessionals are frequently underpaid,
coriddering both the demands of thei. work, and the educationai levels required
of them. This la& of h a a l resources is a major source of chronic individuai
and family stress (Morris & Blanton, 1994a, 1994b; Mickeyf Wilson k Ashmore,
1991; Benda & DiBlasiof 1992).
When the demanàs of ministry have exhausteci the professionai thne
available to the pastor, pardel resowes of personal and family tirne are
kequently impiriged upon. Confounding the problern is the fact that such
intrusive demands typically anu without waming, driven by emergencies
occwring in the lives of congregants or the communityf rather than as periods of
scheduled working overthe. The frequent eXpenence of sustained los of
private time cian mate negative effects such as the increasecl WLation, loneliness,
and disruptim of the derical family (Morris & Blanton, 1994a, 1994b; Wamer 6t
Carter, 1984; Kieren Q Munro, 1988; Benda & DiBlasioI 1992; Mickeyf Wilson &
Ashmoref 1991). The "fishbowl" effect common to the ministerial family (high
public profile combineci with a loss of protected personal time) often creates a
situation where other famüy boundaries become, or are at least peieeived to be,
permeable and optional ôoth by family meanbers and outsiders. nie
triangulation of congregants into the f d y system, and fragmentation of the
derical family are m u e n t reSuIts of this paaicular stressor (Morris & Blanton,
1994a, 1994b; Benda & DiBbsio, 1992; Ki- & Mumo, lm; Mickey, W b dr
Ashmore, 1991; Ostriander, Henry dr Hendrix, 1990).
Given the recognized rates of mobility and social isolation yiherent in the
pastoral de, dergy families are also W y to experience substantial àisruptions
in established mial networkç, and to encounter fewer oppottunities to constmct
extensive new ones. Frequent removals £rom extended family and community,
and the la& of readily accessible (long-term, stable) extemal relationships
impose additiod stressors upon the primary relationships of the ministerial
family. Finally, effective denominationally-based family support semices are
rare; those that do exist are kquently pmven inadequate for pastoal famüies in
need of them (Morris dr Blanton, 1994a, 1994b, 1995; Kieren B Munro, 1988;
Wamer & Carter, 19û4; Blackb'i & Wright, 1985; Benda & DiBiasio, 1992).
Imvaiment Risks Amss the Professions
Noted at the beginning of the present chapter, and demonstrateci
throughout this review is the recognition that no single standard currently exists
desning the term "professional impairment" (Sherman, 19%; Sheffield, 1998).
Rather, it appeivs to acquite differing emphases depending on the dixpline, the
era shaping the profession's development, and the conditions under which the
question of impairment is being considemd. One theme consistently addressed,
however, is the expectation that the compessionate professicmal must be able to
demonstrate competency in the attainment and maintenance of certain levels of
practice (Fortune, 1989; Lamb et. al, 19û7; Reamer? 1992; Sherman 8 Thelen,
1998). These aiteria are genedy held to include the ongoing pursuît of
professional training supervision, and personal development, in addition to
formally prescr i i educational programmes. If the hdividual practitioner
tolerates a defiat in, or an e d o n of these expectations of excellencef the risk is
high for encountering signihcant impairment in his or her professional
functioning .
NRnowin.~ the Focus of the Imvaimtent Literature
In the history of most disaplines, the bulk of the literature examining
impairment themes has been generated relatively recentiy? almost aU of it within
the past 25 years. In the instance of coumehg, this same thne period
approximates the emergence of the discliphe as a recognized profession, during
which the foundations of counsehg theory and skills have been estabiished as
distinct h m th& mots in academic psychology (Vance Peavy, 19%; Hazler dr
Kottler, 19%; Herlihy? 19%). Given this developmental stage, both scholarly and
anecdotal treatments of impaired coullseuor issues are SU relativeiy spafsef anà
the profession as a whole is only now turning its scmtiny upon this Achille# heel
(Olsheski & Leech, 19%; Hazler & Kottler, 19%; Sheffield, 1998). Several authors
speQndly comment on the relative scarcity of literatuile addressing the issues of
impairment in the couriselling pfession, including Olsheski and Leech (19%),
Vamos (1993)f Counselsnan a . Alonso (1993), Witmer and Young (19%), and
Sheffield (1998). A similar deficiency is noted in regard to clergy impairment
issues, as reporteci by M d and Bhton (1994b). The majority of the literature
which dœs &t in either field tends to concentrate on three general areas:
1) detection and recognition of various addictions-,
competency-, and ethically-based impaiimmts (Fortune,
1989; Epstein & Simon, 1990; Hopkins, 1991; Owen, 1993;
Menninger, 19%; Emerson & Markos, 1996; McLeod, 1992;
Sherman & Thelen, 1998);
2) assorteci mdeis for the intervention and treatment of
substance- or stress-induced impainnents (Hopkins, 1991;
Okheski k Leech, 19%; Witmer 8 Young, 1996); and
3) questions of ethics and action assoàated with the confront-
ation of colleagues who may be experienchg impairment of
any origin (Gd, Thoreson & Shaughnessy, 1999; Neukrug,
Healy dr Herühy, 1992; Hazier 6r Kottler, 19%; HeriihyI 1996;
Hohanf 1995; Gibson 6r Pope, 1993; von St& Mines &
Anderson, 1995).
A refreshingly positive approach to issues of professional impairnient is
one reflected by Witmer and Young (19%) in their emphasis on the necessity of
"preventative welhess,'' both in the progammes/methods of counsejlot
training, and in later-career clinical practices. According to this research team
(Witmer L Young, 19%), the bkehhood of a compassionate pfessional
succumbing to irnpairing conditions may be signiacantly reduced by the
dtivatim of proactive measures and activities in severd areas of life (e.g,
exerQPng creative problem-solving skillsf developing a saw of spinhiaüty,
maintainhg good physid health). Where the greater part of the professional
impairment literature is occupied with identïfying antecedents to an individual's
deterioration, or with "picking up the pieces" after the fact, Witmer and Young's
(1996) attention to the antecedents of professional wellness offers a balanced
peftpective to the disCuSmon. This position is consistent with cum?nt
developments in stress and coping theofy (Wong, 1993); a criticai bridge
between these two areas of investigation win be exploreci in further depth
elsewhere in the present work.
Definina Non-Volitional Imvuimient
Within the demonstrably limited body of evidence and conceptuaiization
conceming professional impairmertts, an even d e r duster of work examines
the question of "non-volitionai" stressors and impairment arnong therapists.
For the purposg of the present discussion, a "non-volitional stressor" is bneny
defined as any condition leading to pemonai distress (such as a sudden illness,
bereavement or other catastrophic chunstance) k i t may randomly,
unavoidably, si@can~y anci adversely affect the Me of one who works within
the compassionate professions. The term "non-volitionai impairment" is, by
extension, reflective of any personai distress directly resuiting frorn a non-
volitionai stressor. Under this definition, a distinction is made between the states
of professionai bumout and non-volitional impaiment. Where h o u t
develops as a function of the work and workîng conditions of the compassionate
professional, nomvolitional impainnent originates h m signifiant, random
shpssor events or conditions in the individual's personal Me, exaspeated by the
demands and experiences of the the compassionate profession.
Non-Volitional Itntlainnmt and the Psvchonncrlvfic Permeciive
The in£iuential power of the theirapist's Iife events upon the therapeutic
relatiOI\Ship is a hctor that has received scattered and inconsistent recognition in
the psychoanalytic tradition. According to one ment evaluation, Freud's
insistene that analysts paiodicaily assume the analysand role was based, in part,
on the belief that "therapists' personal problems may, if unidentifieci,
unexamined, and unaddtessed, interfere with the ability to conduct effective
Uie~aw (Pope 6r Tabachnick, 1994, p. 247). At the same the, in spite of his
previous assertion that "completely sound phytid health" (Freud, 1900, cited in
Schwartz dr Silver, 1990) was necessary for the execution of the andytic arts, the
impact u p n his ciinid work by Freud's own lengthly and debilitating struggle
with cancer is virtuaiiy ignored in his extensive writings, and those of his
biographers (Schwartz, 1990). In conhast, Cetson (19%) revisits Fromm-
Reidiman's advice to psychiahists (1950, ated in Gerson, 19%), urging them to
be cognizant of the influence thev own "intercurrent events" (e-g., marriage,
divorce, death, childbirth) have upon their therapeutic effectiveness. In a similar
vein, although writing from substantially different pezspectives, Gmebaurn
(1993), a Fteudian psychoanalyst, and Hicks (1993), a military diaplain, affirm
one another's foundational observation; namely that, without the capaaty to be
vulnerable in Ue, authentic experiences of empathy for the pain and suffering of
ano ther person are not possiile.
For the most part, however, the pfession~s awafeness of the individual
therapist's "personhd (Mitchell, 19%) in relation to the impact of Me events
upon professional hinctions has been ümited, transmitted through various
anecdotal accounts (Gnmebaum, 1993; Nadelson, 1993), and in the context of
discussions fe8arding transference/~~~~itertransferenœ issues relative to the
patient's progress (Gerson, 19%; Schwartz 6t Silver, 1990). In a statement whidi
could easily apply to professional colleagues m medicine, c o m d h g , or the
pastoate, one editorial team Wfites regarding the psychoanalysts:
We are intrigueci Uüit it has taken the profession a cenhuy
to adoiowledge directly the speafic effects of the morbidity
and rnorfality of its practitioners. ...As we becorne seasoned
pfessionals, we learn through the Me experiences of others
and o d v e s , to cope with out own ralamities, or so it is
assumeci. But if we were to hm@ guidance to our personal
fibruries, we mi@ t&f incretzsingly abne, seing hoPv cumpletely
the issue has been ignored, (Schwartz dr Silver, 1990, p. 3;
emphasis added).
While it is beyond the scope of the present discussion to pursue a
thorough investigation of even UUs limited dimension of the psychoanalytic
tradition, a bnef tally of some recent discussions regarding non-volitional
stressors and impairments is appropriate at this juncture. An eady exampie of
this material is Weinberg's (1988) discussion of the analysYs experience with an
intrusive illness in the course of therapeutic work with clients. LasYs (1990a)
contribution, "Catastrophic illness in the analyst and the analysYs ernotional
reactions to it," is another early effort to distinguish traditional issues of
therapeutic countertransference as secondary to the more hdamental
experiences of being a very ill person who must still function as the emotional
support of clients. The timing of Lasky's (1990a) article coinad& with the
emergence of a concentrated duster of related literatwle, appearing both in
jouniais (Simon, 1990; Counselman & Alonso, 1993; Varnos, 1993; Philip, 1993;
DeWald, 1994), and edited coUections such as ' T h e s in the analvst Im~licatiions
for the treatment relationshb (Schwartz & Silver, l990), "Bevond transference:
When the thera~ist's teal life intrudes" (Gold Q Nemiah, 1993), and "The
therapist as a a w r s o n : Life crises, iife choices, Me experiences, - and theV effects on
treatmenr (Gerson, 19%). These authors explore a spectnun of personally
catastrophic, and potentially impaving life events, induding the deaths of a chüd
(Chasen, 19%; Lazar, 1990), a parent (Warshaw, l%), and a spouse (Vamos,
1993; Morrison, 19%); life with a "terminai" or debilitating disease (Philïp, 1993;
Silver, 1990; DeWald, 1994; Momkm, 1990); the devastation of divorce
(Schlachet, 19%; Johansen, 1993); and othe~ traumatic acperiences (Stevens, 1996;
Morrison, 1996).
Predictably, the majority of this material is devoted to traditional Fmdian
analysis of such issues as tramference and countertransference, fantasy
constructions and hinctions (Woimart, 1990; Nemiah, 1993), " d y s t
enactments," "selfobject needs," and "seEstates" (Morrison, 19%). A few
authors, howwer, do venture into discussions of more concrete pfessionai
issues relateà to the intrusion of non-volitional stressors into the Me of the
therapist. %me of the topics touched upon in this subsection of the
psychoanalytic literature indude: practicing while eXpenenchg diminished
cognitive, physical and/or emotional capaaties; degrees of self-osure;
suspension of practice and related arrangements for notification or coverage;
and signiticant financial conœms due to interrupted practice (Counselman Q
Alonso, 1993; Philip, 1993; Vamos, 1993; Monbon, 19%; Civin dr Lombardi, 19%;
Lady, 199ûb; DeWald, 1994).
Ernvi&al Investikations of Non-Volitional Rofessional Irnvahent
Whüe much of the material deaüng with non-volitional impairments has
been generated by authors holding orientations of various psychoanalpic
schools, empincal evaluations are beginnuig to make th& mark upon the
fiterahire (Sherman & Thelen, 1998; Sowa, May & Niles, 1994; Pope dr
Tabachnick, 1994; Coster Q Schwebel, 1997; Mahoney, 1997; Schwebel & Coster,
199s).
Conducting a mdest investigation into the stressors inherent in the
counseiiing profession, Sowa, May and Niles (1994) report on a sample of
counsellors (n = 125) practicing in a variety of settings in the state of mrguiia.
The research questions framing this investigation (Sowa et. al., 1994) provide
important background to the present discussion conceming non-volitionai
impairments among clergy and counsellors:
do counsellors report markedly different leveis of work-
relateci stress, symptoms of personal stress, and coping
resources than reporteci nonns among other ptofessionals?
do valid measures of "personal strain" and coping resources
d e c t differences between counsellors reporthg high leveîs of
work-related stress, and those repotting low levels?
are counsellors' experiences with levels of work-related
stress, personal &stress and coping resources affected by
professional training?
Employing the Occupational Stress hventory (Osipow B Spokane, 1987,
cited in Sowa et. al., 1994), Sowa, May and Nies (1994) report mixeci hdmgs
h m ttreir limited samp1e. Fitstly, the researchers note that subjects did not
perceive themselves to be under a greater burden of stress than other
professionalS. Considefing th& second question, higher work-relateci stress
levels are associateci with lower levels of coping strategies in mas of self-care,
recreation and social support. However, no negaüve correlation is reporteci
between levels of stress and coping strategies of rational/ cognitive problem
solving. According to Sowa, May and Niles (1994, p. 7) " teaching rationai
problem-solving s W by ikelfdocs not trmslate into wunselm havïng th necessznj
reperfoire of coping skills to daal with stressfil mvironments" (emphasis added). This
observation is consistent with recent caUs within the profession for mater
attention to the development of proactive, multiple coping strategies (Wong,
1993).
Regardhg their two remaining questions, surrounding the effects of
professional preparations upon counsellors' circurnstances~ and perceptions of
work stressors, personal strain, and coping resources, Sowa et. al. (1994) report
that respondents with specinc training in stress management presented a greater
repertoire of self-care and recreational coping resources than did th& coileagues
who lackeù such proactive training. Of interest in this portion of the analysis is a
finding that (in the context of that study, at least) the sarne stress management
training did not appear to advantageously influence the development of the
coundlors' resources via &al supports (Sowa? May & Niles? 1994). While Sowa
and her assodates (1994) make no clalln to presenting "cutting edge" conclusions
through theV study, theV research nevertheles contributes positively to the
m e n t state of counsellor development literature? and solidly positions the
authors with others (Frame 6r Stevens-Smith, 1995; Witmer B Young, 19%;
Coster dr Schwebel, 1997; Schwebel6L Coster, 1998; Sherman & Thelen, 1998;
Baml, 1999; Sheffield, 1999) who voie a particuiar ConceZn regarding the
adequaaes and appropriateness of professional counselior training-
Another exploration of the link between issues of p e d distress a .
conditions of professional impairment, conducted against a background of
*'Mestyle, stress and coping theory,'' is off& in a ment enpirical investigation
by Sherman and Thelen (1998). Shidying the self-reported expexiences of a
sample of ciinicians (n = 513) drawn from the roster of the American
Psycholo Jcal Association (MA), the researchers (Shman 6r Thelen, 199û)
present an analysis of the quality and prevalence of distresshg life events
(ranghg lrom bereavement, to finanaal pressutes, to phase-of-life
developments), and subsequent expenences of professional impairment. As has
been noted arnong other authors and researchers, Sherman and Thelen (1998)
acknowledge the troublesome ladc of consensus within the profession regardhg
definitions of impairment. Differentiating "impairment" fKnn "distress" at the
outset of their study, they offer the foilowing helpful Cianfications:
[impairment is] the interference in ability to practice
therapy, which may be sparked by a variety of factors
and results in a dedine in therapeutic effectiveness,
(Sherman 6r Thelen, 1998, p. 79).
In conttast, "distress" is explaineci as:
a subjective eXpenence of discontent that may arise from
various fadom and that may be manifesteci in 'anxious or
depressed moods, somatic complaints, lowered self-esteem,
and feelings of confurnon and helplessness about their
problems', (Sherman 6r Thelen, lm, p. 79).
The primary assessrnent instrument employed in this m e y was
consûucted by the research team, based on pilot investigations using Sarason's
Life Experiences Scale (SLES; Sarason, Johnson Q Seigel, 1978, ated in Sherman B
Thelen, IM), adjusted and augmented spedically for Sherman and Thelen's
(1!39û) study. nie final fonn of the instrument addresses occupational factors
and non-volitional sttessors (e.g, bereavement, personal ïnjuq). An additional
instrument, the Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen &
Griflen, 1985, ated in Sherman & Thelen, 1998) provides an additional source of
data, tapping both persona1 and professional life domains.
Consistent with Figley (1995), Lamb et. al. (1987)' Pope and TabaIhnick
(lm), Gerson (19%), Sheffield (lm), Sherman (19%), Herlüiy (19%)'
Menninger (19%), Philip (1993), and Lasky (1990a), research partners Sherman
and Thelen (1998) find the existence of a positive correlation between distressing
conditions, both personal and occupationai, and the impairment of profesional
hctions in the respondent group. According to these researchers (Sherman L
Thelen, 1998), stressors here identifid as "non-~01iti0na1" in nature (e.g. major
iUness, relatimhip problems) create the greatest level of distress and
impairment in responding professionals.
Conceming gender differences, the researchers report that no signifiant
distinctions appear between men and women when considering the suznmed
totals of responses related to ''Me occurzences," 'We distress," or 'We
impairments" (Sherman 6t Thelen, 1998). They do, however, note some gender-
baseddisslmilan . . 'ties in the m e f s wosk-related factors. Women respondents
"reported experienQng a signincantly p a t e r number of stressfuf events than
men,. .. [and alsol reported signiticanüy more summed work distress" Uian did
the men (Sherman & Thelen, 1998, p. 81). A further gender spüt appears where
Sherman and Thelen (1998) report their findings conceming preventative
measures of self-cm: women respondents are noted as engaging in a
signiscantly higher number of proactive and prevention activities (e.g., regular
exercize, partiapatim in churdi/spintua.i activities, use of personal thetapy) than
are the men in this group (Sherman dr Thelen, 1998).
The kt of eighteen preventative strategies generated by this sample of
therapists appears balanceci between private and professicmai emphases. While
Sherman and Thelen's (1998) table presents these "prevention behavim"
according to the frquenaes and percentages by whkh they appear in the whole
group, categories created by focusing on either the occupational or personal
areas would also be appropriate. The proactive measures ciosely related to
professional adivities indude: periodic condtation and supenrision, scheduied
breaks and limiteci bookings of back-bback sessions, use of stress andior t h e
management skills, maintenance of a b c e d caseload at a realistic level, use of
professional network supports, and refusal to accept certain types of dients (the
recognition of limits of competency andior persona1 boundaries) (Sherman bt
Thelen, 19%). The personally oriented seif-care activities named in Sherman and
Thelen's (1998) study indude: participation in activities not relatecl to profession
or worksite, periodic holidays, reguiar exercize, active networks of social
support, engagement in church/spiritual life activities, personal therapy or
support groups, and other (undefined) efforts.
Although the issue of non-volitional stress and consequent impairment
among compassionate professionals is not the primary focus of Sherman and
Thelen's (1998) investigation, the problem does becorne evident in the Mer contact of the study. Of the significant and distressing W e events" detailed in
th& research (Sherman k Thelen, 1998), severai reûect a dimension of personal
catastrophe (e-g., bereavement, major illnessO nahua1 disaster) which is inherent
in the present definition of non-volitional stressors, but which is not a necessary
component of simple phase-of-life developments, or other sources of stress.
Preiiminary findings such as these reported by Sherman and Thelen (1998)
convey the necessîty of developing and clanfying an adequate concephial
framework addressing non-voütional stressors and subsequent impairment in
the experience of counsellors and dergy.
Issues of distressO impairment and "well-functioning" among professional
psychologists have received further investigation in cornpanion stuclies recently
conductecl by Coster and Schwebel(1997; Schwebel k Coster, 1998). Adopting a
position çimilar to Witmer and Young's (19%) emphasis on therapists' healthy
adaptations to occupational and personal stressors, Coster and Schwebel(1997)
be@n with the simple (perhaps obvious) asmmption that the normal state of
being for the professional is one of weil-functioning not dysfunction.4 Fmm this
position, they define impairment as "a dedine in quality of an individual's
professional hinctionllig that d t s in consistentiy subsbndard performance,"
4 There is parenthetical value in examining the authors' choice of the tenn WeH-functioning". The secondary purpose is simple deference to gramnatical p r o s c r i p ~ regardhg the doMe negatïve Wkh would be cmated by the construction 'unimpairment". More importantly, though, Coster and Schwebei (1997) that prdessionally inaâequate fucictianing may resuît from sources other than impairnient nameîy, i n c o ~ e n c e or pathobgical conbhhns. Mhile it b beyond the s- of the presecit discussion ta pursue an adeqmte expbratüm of the constituent causes and effets invohmd in these prdessbnai and personal hirûrances, both incornpetence and specrt~ psychopatnologies (e-g., ~ d C s o r d e r s , m o o d d i s o r d e c s , o r d e m e c i t i a s d o r g a n k o r i g i m ) ~ ~ q ~ a s ~ ~ impairment distinct ?rom %adibnal" problems of addictions (Coster & Schwebel, 1997; Pope & Tabacnriick, 1994; Pqm & Vasqwz, 1991 ; Rame & Steve~m-Smiai, 1995; Sherman, 1996; Swie ld , 1998; BisseJi, t 963, CM in bdh Sherman, 1996 and Shetfield, 1998; and On, 1997).
(Coster & Schwebel, 1997, p. 5). In the same context, "weii-functioning' is
described as an "enduring quality in one's professional functioning over time mid
in theface ofprofessional ami p m o ~ l stressms," (Coster & Schwebel, 1997, p. 5;
emphasis added).
The k t of the two articles (Coster (Ir Schwebel, 1997) presents a double
study. The initial investigation, focusuig on interviews with wd-functioning
psychologists who had been nominateci by professional pers, yields ten themes
which the investigators (Coster (k Schwebel, 1997) identify as "important
contriibuors" to the professional's well-Eunctioning. Ranked according to the
subjective impressions drawn by one of the authors during the interview process
(Coster Q Schwebel, 1997), these themes incorporate the foilowing proactive
measures:
1. peer support
3. supervision
5. graduate schooI experience
7. continuhg education
9. c a b / implications of impairment
2. stable petsonal relationships
4. a balanceci life
6. personal psychotherapy
8. family of origin
10. coping mechanisms
The second study p~esented in this investigation examines resuits hom a
sampIe of 339 New Jersey psychologists respcmding to a survey package
including three instruments: a general demographic questionnaire, the
Impairment Questionnaire o, and the Well-Functioning Questionnaire
(WFQ) (Coster & Schwebel, 1997). While the h p Q had been ernployed in
previous and related research, the WFQ was mnstructed SPeQfically for this
section of the shidy, drawn from results of the earlier in* discussed above
(Coster 6 Schwebel, 1997). Coster and Sdiwebel(1997) report on several
statisticai findings generated by this second study, including gender differences,
the signiscance ratine on several factors of wd-hctioning, and the analyses of
variance ewminllig states of impairment versus well-functioning. In general,
respondents endorsed strategies of seIf-care with an emphasis on personal
relationships and supports, in preference to academic training as the most
valuable sources of weU-functioning (Coster Q Schwebel, 1997). Overall? the
research generated in Coster and Schwebel's (1997) investigation supports the
work of other theorists and researchers (Wong, 1993; Sherman, 19%; Witmer dr
Young, 1996; Sherman & Thelen, 1998; Frame Ek Stevens-Smith, 1995; Pope L
Tabachnick, 1994) who advocate the profession's practice of preventative and
proactive efforts in relation to weii-hinctioning and the avoidance of
impairment.
Extending the previously c k u s s d research is Sdiwebel and Costefs
(1998) d a t e c i investigation, which considers issues of psychologis ts' well-
functioning as perceiveci by the professionals responsîîle for graduate
programmes and related training protocols. According to the authors (Schwebel
6r Coster,1998) a reasonable expectation exists that, in generai, progamme
heads (occupied as they are with matters of acadernic preparedness and
credentialling) may hold differing opinions about factors involveci in impairment
and well-functioning than do the career practitioners sampled in the previous
shidy (Coster & Schwebel, 1997). This is amsistent with positions presented in
the work of Wihner and Young (19%), Fame and Stevens-Smith (1995), and
Sowa, May and Niles (1994). Given this ohmation, it appeam evident that
specifdy ccmsuiting with programme heads as a distinct subpapulation of the
profession offers a balance not previously achieved in examinations of well-
hctioning versus impairment Issues.
Schwebel and Coster (1998) report on the r d t s generated by a survey of
107 respondents, heads of APA certifieci clinid, counseîling and school
psychology programmes. The unnameci survey instrument, speaficaily
designeci for the reseatchefs pmject, is an extension of the WFQ used in the
tearn's prior study of praditioners (Schwebel h Coster, 1998). S d a r to the
responses of the professionai psychologîsts in the k t investigation, the
programme heads in Schwebel and Costefs (1998) mixequent study endorsed
personal and existentid items (eg., self-awareness, personai values, f d y
relatiomhips) as criticai elements in maintainhg well-functioning s ta tes.
However, exhibithg a signiscant ciifference h m the practitioners surveyed in
the earlier shidy, the programme heads allocated Mirtually equal weights of
importance to those items tapping the "didactic, supemsOry, and experiential
aspects of the graduate school experience," (Çdiwebeldz Coster, 1998, p. 285).
Although distinctions are presented between the statbtical hdings of
these cornpanion investigations - findings not presented in detail here - the
overall implications of the second shidy (Schwebel & Coster, 1998) are consistent
in essence with the team's earlier work (Coster 6r Schwebel, 1997), in that both
studies support the necessity of exercizhg proactive measutes to enhance
professional well-Mg and functions, and to avert potentially impairing
conditions. That both groups, practitioners and academics, appear to emphasize
differing areas within that recognition is of secondq importance. In a lengthly
discussion of the implications and potential applications of th& tesearch me&,
Schwebel and Coster (1998) again focus on the necessary relationship betweai
training goals, career eXpenences, and the proactive coping skills of
compasionate professionals, stating:
what is paramount is not that every professional 't' is
aossed and 'i' is dotted in the knowleàge domain but t h t
the graduates emnge os well-jhnctioning individuals who m
as expert in self-cure as in caringfir the needs of 0 t h (p. 289;
emphasis added).
A further example of the inaeasing empincal evidence relateci to non-
volitional impairments is a recent, brief survey by Mahoney (1997) focushg on
patterns of the personal problems, seIf-care practices, and use of personal
U i e r a ~ arnong professional psychotherapists. Reporthg on a relatively srnail
(n = 55) nonrandom sample of practitioners, Mahoney (1997) notes that dusters
of "emotional exhaustion and fatigue" were the most kquently reporteci
personal problems, although by fewer than half of the respondents. Less
frecpent eruiorsements induded relational problems, emotional isolation,
professional h o u t symptoms (e.g, disillusionment, d o a d concems),
anxiety, depression, somatic concems, and substance abuses; findings that are
g e n d y consistent within the field (Pope &r Tabachnick, 1994; Sherman L
Thelen, 1998).
Mahoney's (1997) survey reflects a diverse ange of self- strategies
within this group of compassio~te professiods, including measures that may
be variously r e f d to as physicai (e-g, exercize, pfeventative hed-
practices), mental (e.g, "pleasure'' reading, hobbies, vacations, professional
supervision, culhval events), and spintual/e>ristentid (e.g, payer or meditation,
worship, volunteer comrnihnents, persmal therapy, journalling). According to
this study (Mahoney, lm), while no discemicble gender dikences appeared in
the pfessionals' perceptions qarding the value of personal therapy, women
therapists were signincantly more likely than men to engage in personal th-
as a method of self-support. A similar split is noted dong professional lines, in
that therapists holding nonaoctoal aedentials were more iikely to report
participahg in personal therapy than were theh doctoral-level colleagues
(Mahoney, 1997).
Mahoney's (1997) 6ndings regarding th& sample's spiritually~riented
self-care activities are noteworthy. While slightly iess than a third of the gtoup
were currently engageci in some form of psychotherapy, fuliy half of the
therapists responding daimed a personal practice of either prayer or meditation
(Mahoney, 1997). Similarly, wwhüe about forty percent of the respondaits
adcnowledged the value of chanty volunteer activities as part of th& self-cive, a
strong third of the p u p also endorsed participation in f o d worship activities
(eg, church Sennces) as integrai to rating weU for themselves. In the context of
proactive coping efforts (Wong, 1993), Woney's (1997) report conceming the
value these therapists place on attention to dimensions of personal spirituality is
espeaally saüent, given the present discussion of non-volitional stressors,
impairment, and d e n c e among pastoral and counsehg professionab.
A related study, one considerably more extensive than Mahoney's (lm,
is found in a sunrey of pmfess id psycholagists caiducted by Pope and
Tabachnick (1994). Ln this broad investigation, focused on pfessionals who
eXpenence the d e of patient thraugh the exploration of personal
psych~therapy~ the researchers (Pope dt Tabachnick, 1994) daim a kee-iold
intention:
1) to coUect arploratory data h m a sample of psychobgists
regarding beliefs about therapy, precipitating problems
leading to th& use of personai therapy, and their therapeutic
@ences;
2) to seek confirmation of fùidings deriveci h m ptevious
related studies in this area; and
3) to gather data for the consideration of a multipiiaty of
secondary questions (more than 9), including "what is the
major problern, distress, dyshction or issue addressed
in therapy" by the professional-as-patient?
A total of 476 practitioners of clinid psychology, comselhg psychology
and psychotherapy participated in th& research (Pope & Tabachnick, 1994).
Consistent with Mahoney (1997), and Sh- and Thelen (lm), Pope and
Tabachnick (1994) report that a sigdicantly greater proportion of women than
men in the sampIe pufsued thetapy in response to peftanal distress. They
further note that younger professionak (those unàer 40 years of age) were more
lïkeiy to engage in personal therapy? either current or past, than were their
colleagws of a pater age (Pope & Tabachnick, 1994).
Pope and Tabachnick's (1994) sample generates a considerable List of the
problems, distresses, dyshctions and issues which may compel professionals to
assume the patient role through th& own personal therapy. Of the 34 specifïc
categories (excluding "miscellaneous") tabled in this study (Pope & Tabachnidc,
1994, Table 3, p. 249), a large portion are consistent with issues contained in the
present denniaon of non-volitional stressors and impairments, includuig issues
reiated to abandonment and family-ofaigin, sexual assault and/ or abuse,
childhood abuse, grief, trauma and/ or pt-traumatic stress, medid conditions,
and personality disorders. Pope and TabachnicWs (1994) research also reveals a
bnef but critical list of distressuig circumstances whidi the anonymousiy
responding professionals acknowleàge they have kept (or would keep) secret
£rom others, refusing to disclose even in a therapeutic relationship. These
ciraunstances indude sexual issues, feelings regarding the therapist, personai
histories of abuse, active substance abuse, eating disorders, third party identities,
and unnamecl niiscellaneous problems. Additionally, accmding to Pope and
Tabachnick (1994), the occurrence of serious depression as a source of distress
was remarkably high in UUs goup of practitioners. Sity-one percent of the
respondents acknowledged having lived thugh at least one episode of d h i d y
defined depression, twenty-nine percent reporteci having experienced suiadal
feelings, and alrnost four percent Wosed surviving at least one &de attempt
('Pope & Tabachick, 1994).
The major focus of Pope and Tabachnick's (1994) investigation is an
analysis of the therapeutic experiences and beliefs of the therapist-as-patient.
However, their initial exploration conamhg the types of stressors and
impairment that may move cliniaans to seek personal therapy (Pope k
Tabachnick, 1994) is particulailly important, given the contat of the present
disassicm of non-volitiod ïmpainnents and compassionate pfessianals.
While Pope and Tabachriick (1994) caution readm Uiat theh study is subject to
several flaws inh-t in survey-based research (e.g., self-selecting samples,
responses infiuend by social conformity, inaccutacies of memq), and that
th& findings la& the confirmation of replication, they nevertheles conhcbute
information of substantial value concemirtg the "mal-Me" dishpsses of
professional psychologists; information that is consistent with the findings of
other recent researchers (Mahoney, 1997; Sheman 6r Thelen, 1998).
Cliapter lhree
EXlSllNG MODELS
Among the few investigations applicable to issues of non-volitional
impairment among compassionate professionais there is a notable, but limited
body of work rooted in the fi& of psychotraumatology, and mounding an
emerging phenornenon labelleci "secondary traumatic stress disorder" (STSD)
(Figley, 1995; Sherman, 19%). According to the most ment editim of the
Diagnostic and Statistid Manual of Mental Disorders (DSM-IV, 1994), there
exists a condition known as " posttraumatic stress disorder" (PISD), which is
diagnosed in the presence of:
the development of characteristic symptoms following
exposure to an extremely traumatic stressor involving
direct pemmaI expen'ence of an event that involves actual
or tfireatened death or serious injury, or other threat to
one's physical integrity; or witnessing an event that involves
death, injury, or a Uwat to the physical integrity of another
person; or leamhg about unexpected or violent h t h . &ous hm,
or thrmt of doath or injury expe~enced by a fanify member or 0 t h
close assuahte, @sM-IV, 1994, p. 424; emphasis added).
The referenced "characteristic symptorns" of RSD include a broad range of
affective? cognitive and physiologicai disturbances telated to amusal states, fear
responses, and subsequent psychol0ga.i disorganization @SM-IV, 1994). Much
the same description is applied to the positeci syndrome of secondary traumatic
stress disorder (STSD); however it has yet to aqyire the authoritative
endorsement of the DÇM-N or its supplements (Figley, 1995).
In a ment exaatination of mental health problems ptevdent among
psychotherapists, Sherman (19% p. 306 - 307) points to the risk of vicarious
traumatization, descriig "the stress reactions [ofj therapists who hem horrific
stones of intense suffering by s u ~ v o r s of some trauma." Figley (1995) and his
colleagues Wnte at length concffning the psychologid hazards inherent in the
function of trained helpers who are consistently exposed to the immediate
traumas and suwivorship of others. According to these researchers (Figley,
1995), SrSD may be especially common in a range of pmfessionals and
paraprofessionals, including crisis and emergency responders (police,
fire/rescue, parameâic and dispatch personnel), emergency rmm doctors and
nurses, mentai health therapists, and degy. Wriüng h m a unique perqwdive
connecting pastoral, therapeutic and military des , Hicks (1993) makes simüar
observations regarding the impact of secondary trauma upon compassionate
helpers, whether they are pmfessionals, disaster scene volunteers, or
happenstance witnesses.
A select group of other theorists and tesearchers (Jung, 1966; Farber, 1985;
Guy, 1987; Freudenberger, 19ûû; and Briere, 1992, a l l ated in Sherman, 19%;
McCann Q Peariman, 1989; Miller, Stiff 6r Ellis, 1988; Remer k Elliot, 19W; and
Harbough dr My=, 1985, al l cited in Figiey, 1995) similarly suggest the existence
of a corollary between extended or complicated trauma-work, and therapist
distress. Additiomlly, numerous labels appearing in the 1iterah.m of the last
decade point toward the reality of ûinical awateness concerning secondary
traumatic stress affecOng both family and pmfessionals, including the terms
"secondary victimization," "CO-vicümization," "secondary stuvivor," "emotional
contagion," "raperelated family crisis," "proximity effects," "gene~ationai effects
of trauma," "family toxification," "secondary catastrophic stress reactions," and
"sadour syndrome0' (Figiey, 1995). Clearly, these authors and labels represent
an accumdating body of evidence calling for the recognition and indexing of
ÇTSD as a valid clhicai syndrome among mental health and emergency workers;
a call for the acceptance of the disotder on par with PTSD (Figley, 1995), itseIf
ody recently admitted to the psychiatrie Iexicon (DSM-IIï, 19ûû).
A Mode1 o f Comtlussion Stress und Comvassion Fatirne
Considerd in Uùs hqer context, substantial justification &ts for the
examination of more speafic issues of non-volitional impairment arnong pastors
and counsellors. Partiakly appropriate to Ulis exploration is a provocative
mode1 of the transmission of STSD, presenting distinct but overlapping concepts
of "compasion stress" and "compassion fatigue" (Figiey, 1995; Figures 1 & 2).
Developed from extensive study of the experiences of both survivors of
catastrophic events (whether of the naturd world, or resuiting fnnn human
actions or technologies), and of the workers - often therapists - whose
speaalties engage them in intense exposure to these Sunnvors, Figley (1995, p. 9)
offers a model whkh graphicaily explains "the cost of caring for 0th- in
emotional pain"
The STSD Transmission Model (Fidey, 1995) is framed in two phases. The
first, "compassion stress," d e s c n i the concentrateci strain assoSated with an
individual's intimate exposure to another's Stlfferings. According to Figley (1995,
p. l), "the most effective therapists are most vulnerable to this mirroring or
contagion effect. Those who have enormous capacity for feeling and expressing
empathy tend to be more at risk of compassion stress." Preapitating and
sustaining this sensitive burden is a combination of factors (Figley, 1995) which
seem to draractetize the function of compassionate pfessionals: empathic
ability, emotional contagion, empathic cmcem, empathic response, aadevement,
and disengagement (Figure 1). Although Figley (1995) does not dkws the
minute definitions of these factors, it is esenoal that the basics are dearly
understood in th& individual contexts, and within that of the iarger
ÇIS/ compassion fatigue model.
The first dement, empathic ability, identifies a person's capacity to be
aware of the experience of pain in another king. Possession of this perceptive
characteristic would seem to be requisite for persans who hction in the
compassionate professions. This comrn~n~sense eXpeaation of empathic aWty
seems obvious, receiving endorsement by most counselling theorists, induding
Jennings and Skovholt (1999) in th& recent analysis of the chatacteristics
attri'buted to master therapists.
Close1y aligned with empathic ability is the second factor, that of
emotional contagion. According to Figley (1995), this is an emotional sense of
"being swept up" by close identification with the victim's feelings - just as if
they were one's own - by vittue of witnessing the person's experience of
trauma-induced stres. In Figiey's (1995, p. 252) tennuiology, emotional
conta* is "the uoy essence of thefiehg of c o m p ~ s s i i o n ~ umtW (emphasis
added).
Ernpathic concem is the third element contnhting to the composition of
compassion stress (Figley., 1995). Figley's description of this companent., also
closely aligned with empathic ability, is i s b r i e f : it addresses the helpefs motivation
to relieve the suffering observeci. It is possible, since this factor appears to
tepliesent traditional ideals of altmim, that the essence of empathic concem is
better caphued by more lyric descriptions of "a semant heart," "the quality of
mercy [that] is not strained," or "the greater love."
Figley's (1995) fourth elernent, empathic response, is the mannet in which
the previously identified abilities (to feei, to care and to fuid the motivation to
relieve another person's pain) are ttanslated into action. It is the point at which
these emotiond energies crystallize into concrete efforts âirected at supportrng
the victim/sunrivor in the t rama experience. Without some form of response,
whether material, organizatiod, therapeutic, spiritual or physid (Figley, 1995),
empathy - or more c o d y , sympathy - is of littie value in itsei€, anand dws not
extend beyond the potential helper.
A fifth factor contniuting to compassion stress lies in the professional's
own perceptions of success or failure when meeting the thetapeutic challenges of
anothefs traumatic eXpenence (Figiey, 1995). Compassion stress is l e s M y to
develop under conditions in which the caregiver derives some encouragement
(however slight) h m the fniits (howevet rare) of the supportive and heaüng
network.
According to Ergley's (1995) SISD transmission moàel, the sixth signiscant
compent determining either the grneration or resolution of compassion stress
lies in the professionai's abüity to disengage him- or herself h m the imediacy
of the victim's experience. Discussions of Uieapeutic disengagement and d t e d
uboundarks" issues by Baird (1999)' Alcom (1996), Pope and Vasquez, (1991),
Hoffman (1995), Webb (19971, Kunst (1993), Emerson and Markos (19%), Epstein
and Simon (1992), Owen (1997) and others, concur with Figley's (1995) theory on
this point all comment on the necessity of sustainhg a balance between
empathic involvement and dinical distance when functioning in the mle of a
compasionate intemenor.
The second phase of the SISD transmission mocieî, "compassion fatigue,"
(Figure 2) refers to a "state of exhaustion and dishuiction (sic) - biologicaily,
psychologidy, and socially - [ d t i n g bm] prolonged expute to
compassion stress and all that it evokes," (Figiey, 1995, p. 253). A condition of
impaued hctioning whidi is global and exûeme, compassion fatigue is l k l y to
occur when a combination of factors challenge, deplete, and evenhiaily
overwhelm the coping resources available to the professianal caregiver. Three
of the factors instrumental in the development of compassion fatigue
demonstrate the prinaple of the active transmission of trauma stress predicated
in the ÇTÇD mode1 (Figley, 1995); compassion stress, prolonged exposure and
traumatic recollections. Where compassion stress remains unadckssed,
unrelieved, and progressively inmasing over an extended period, Figley (1995)
contends that there is tremendous potential for the situation to becorne a catalyst
in the resurgence of the professicmai's own intense memones concerning
petsonal encounters with traumatic stress. Ln the event that these conditions
hanspire - regardes of the time elapsed since the originai experience of
pnimary trauma - the heiping pfessional is at substantial risk for develaping
Cornpassimate Professionais Y
constellations of impairing symptoms generaiiy associateci with diagnoses of
PTÇD, indudutg demon, hypenrigiiance, avoidance, or intrusive Uioughts
@SM-IV, 1994; Figley, 1995; Sherman, 1996).
F W y , Figiey's (1995) description of compassion fatigue acknowledges
the individual% "degree of life disniption" as the burth critical element
contributing to the condition, supporthg a growing realization that professional
functions are not performed in isolation h m the balance of the individual's life
(Figley, 1995; Lamb et. al., 1987; Anderson, 1992; Sowa, May & Niles, 1994; Pope
& Tabachnick, 1995; DiGiulio, 1995; Sherrnan, 1996; Sherman 6r Thelen, 1998;
Baird? 1999; Jennings (Ir Skovholt, 1999), and that such an artifid split shouid not
be imposed upon the practitioner. According to Figley (1995, p. W), where the
professionai helper experiences "an inordinate amount of Me disruption as a
function of illness or a diange in Mestyle, social status, or professional or
personal resp01lslWties~' in concert with those previous1y examineci impairing
innuences, it is inevitabie that critical conditions of compassion fatigue wül be the
result*
While Figlefs (1995) mode1 of SïSû transmission in cornpassionate
professionais does not Eocus s p e a S d y on issues of counsellor and pastoral
impainnent due to perçonally threatening or devastating life events? an
examination of the STSD hamework yields several concepts salient to the latter
discussim lnduded among theçe points are the following:
1) Uie uniqueness of the compassicmate professional role;
2) the incorporation of stress and coping theory with issues
of professional impairment; and
3) the identification of non-volitional stressors in conditions
of p f e s s j d impairment
A Moâel of Conment Cm*ng
Essential to an informed discussion of non-volitional impairxnent issues
within the compassionate pmfessions is an adequate understanding of the
current state of human stress and coping theory. To this end, Wong's (1993)
ment conceptualization of coping ski& and strategies ofkm a concise,
integrative perspective. Building on the foundaticm estabhhed by Lazarus and
his colleagues' influenoal explorations of cognitive and behaviourai coping
mechanimis (Lazanis & Launier, 1978; Lazarus & Folkman, 19û4), Wong's (1993)
resource-congruent mode1 of effective adaptation (Figure 3) concentrates on the
potentiai value of the personal resources (oc defiab) bmught by an individual to
any given instance of stress. In this context, "tesources" range from the non-
material factors residing within a person (problem solving abilities,
communication skills, charader traits), to relatiomhips with other people, to
tangible elements of the environment (hinds, available medical c m , d u c a t i d
opportunities). Extending tazMs and FoIkmads (1%) stress, appraisal and
coping patadigm (which de~~n'bes general elements of causal antecedents as
"personal variables" and "environmental variables"), Wong (1993) elucidates
existentid, preventative, mative asid collective coping stratepies - qualities of a
"uniqely human" adaptive capacity.
Offering a dinement of the traditional views of stress (riamely, the
tensions areated between an individual and the envionment by extemal
pressures), Wong (1993, p. 55) defines stress as my "problematic intemal or
extemal condition that creates tension1 upset in the individual and caUs for some
form of coping." Definhg the component of "effective" coping in the face of
these tensions, Wong (1993) descriibes both the long- and shott-terni benefits
inherent in the resource-cmpent appmach, Thete is, he writes, "efficiency in
tenw of expenditure of energy and reSOUTces; etficacy in achieving the d&ed
goal of removing stress and restoring balance; and personal growth in terms of
enhancing cornpetence, seIf-esteem and well-being," (Wong, 1993, p. 58). These
definitions allow the application of the present expandeci mode1 across a
specûum of life stages and situations, whether conhnting isolateci or multiple
stressorsf "garden varîety" problems of daily üving, or events of catastrophic
magnitude. FiFAy, Wong's (1993) resource-congmence mode1 adaiowledges
the signiscant inauence of cultural contexts and expectations upon an individual's
patterns of both appraisal and coping.
The function of the resource-congruence coping mode1 (Wong, 1993) is
best d e ~ ~ ~ c b e d in the context of a larger, continuous cycle of cognitive-relational
adaptations to stress (Cazanis & Foikrnan, 1%; Won6 1993). Upon each k h
encounter with a potentially stressful situation - whether the event is a novel
one, or a reauring eXpenence - the individual engages in a p e s s of primary
and secondary appraisals, evaluahg the degree of discemible ümat or present
opportunity, longevity or transience, persmai impact or detachment. At this
point, available resou~ces may be employed in the cycle's coping phase.
Given that coping is an active rather than rdective process, the
mrnpassionate professicmal experiencing inordinate stress might not make an
irnmediate and perfect match between streçsors and coping responses. Initial
coping eEorts/measures rnay, however, ' k y some tinte" for reflection and
reappaisal, while pfeparing for additionai, more effective long-tem coping. For
instance, when an unexpected and apparently mild illness occurs (e.g., "the 'flu"),
a therapist would MW/ make arrangements to rebook the weeYs clients into the
fouowing week, or to have a cdeague pmvide coverage. Either of these choices
would constitute a masonable coping plan in the event of quiring ody a couple
of sidc days away from work If, however, the duration or gravity of the ihess
causes the situation to develop pfoportions of a medical crisis, such a stop-gap
plan wouid cease to function as an overail effective coping strategy. Under this
contingency, successfui coping and comptent client care would demanci a .
accurate reappraisal of the impinging conditions, and the implementation of a
plan better matdied to a long-term absence from practice.
According to stress and coping theory, following each outcome or coping
attempt, the individuai achieves a position h m whidi to reappraise the now
alter4 conditions of stress. Depending on the nature and effectiveness of the
fesources enlisteci in the coping effort, an outcome may be judged as either
positive or negative (Wong, 1993). If stressful ciraunstances are resolved in
favour of reduceâ tensions, the person achieves a satisfactury (positive)
outcome, and Me carries on to meet the challenges of the next stressor; a proces
of growth. If, however, attempts to mach the adaptive equilt%rium fail to llessen
the stressors - or, perhaps, even e x a d t e them - an individual must rehun
to the initial phase of appraisal, and the cycle begins again.
One of the advanbges of Wong's (1993) mode1 of lesou~ce-con%fuent
CO- becornes apparent when considering the individuai's strategis for this
process of resource selection and implementation. If, through a la& of rational
analysis, an inappropriate match is made between stressor demands and the
supportive tesornes available, a personfs efforts to successfdly cope are likely
to be und-. Rather than tespnding thru,ugh skilled and infonned
strategies, coping is reduced to trial-anderor, %ope for the b e ~ r practices.
Accord@ to Wong (1993) the probability of exploiting coping skills congruent
with the challenges of the stress experience depends upon the variety and quaiity
of strategies assembled prior to the event. It is this emphasis upon the proactive
development of personal meaning (Wong, 1993) within a management
repertoire that distinguishes the resource-conpence mode1 (Wong, 1993) in the
field of stress and coping theory. Moreover, the proactive aspect of coping
presented in this model becomes paftidarly d e n t when considering issues of
the compassionate professional's respomcbility for self-care (Witmer & Young,
19%).
Case Amdications of the Won9 and Fipleu Models
Given that the value of any idea is tested and expresseâ through its
translation into concrete tenns and Wperiences, a seiection of case analyses
(Appendix, Cases #1- 4) are presented in or& to illustrate the unique application
of the models proposeci by Wong (1993) and Figley (1995) to issues of non-
voiitional impairment among compassicmate professionals.5
The case of Lorii9, a ammUTtity-based mental hedth therapist oCkrs a
c o m ~ portait concedng the development and nature of compassion
5 Illusbative case materiais presmted in the Appendix are composite profiles of several euaientic compasdonate plof8s8ionaIs. known to the author. Names, specspecific case de@ls. and other identifying information have been Jtered to protect the ptivacy of those individuais repr6s8nled.
fatigue (Figley, 1995). Louisa's &ce to sene in a field focused on wounded and
emoticmally ninerable childten presupposes her capacity to be touched by, and
act upon her concem for others,6 in spite of the o h negative environment in
which this is accomplished. The chrr,nidy stressful conditions shaping Louisa's
employment within the meneai health service are a product of both the nature of
her work, and the nature of the organization iWC Fbtly, Louisa absorbs
repeated exposures to victimized chrldren, and to families otherwise in need of
support, an activity which is a wearying task in itself (Hicks, 1993). Secondly, she
has intemaihed her identification with the public agency, which perceives and
experiences itself as undervalued, given the wueiieved inadquacies of funding
and staff required to meet the mandate for whidi it is responsiible. Like rnany of
her coiieagues, Louisa exhiits and is stniggüng to cope with several dassic
symptoms of professional bumout (Hall, 1997; Witmer dr Young, 19%; Emerson
6t Markos, 1996). Given these conditions, Louisa's work is n o d y conducted
under a considerable bwden of compassion stress (Figley, 1995).
According to Figley's (1995) dual-phased moàei, L o d s enduring
experience of compassion stress is a substantial but insuffiaent comportent in the
development of compassion fatigue. At this moment, however, Louisa has
become the recipient of secondary traumatic stress (Figley, 1995) in a manner
signincantiy more intense than her daily ccmtacts with traumatized ChiIdren,
There is usually a marked lape in thne bekween the occurrence of a chiid's
traumatizing event (or series of events), and Louisa's first contact with him or
her. That period of time is likely to ahrd Mdten and their parents severai
oppominities (whether formally or informally) to recount, review, reflect and,
6 For the purposes of this discussion. the choiœ by Louisa (and other mental haalth therapists) to work with emoüonally wounded childm and families will be regarded as evidence of positive motivations and weli-adjusted quaiities, and should not be considered as an opportunistic -vity aibwing preôatory or other patfio(oeical behaviours,
perhaps? distance themselves a bit from the events of th& stories (Hicks, 1993).
In this encounteq however, Louisa is immediately cast in the roles of both an
active partiapant and a witnes, since this diait family is in the throes of
absorbing its present reality - an horrifie, traumatic and grievous eXpenence
whichis sa UnfoldirLg.
Additionally, buisa carricarries in her own history a parallel experience of
traumatic assault Although she long ago redaimed a healthy adjustment to Me,
and demonstrates constructive resilience in the context of this assauit and other
diffidt life events, the present trauma of this family has a profound resonance
for her. Accordhg to Figley (1995), the disturt,ance of traumatic tecoUections
(experienced by Louisa in symptoms of both psychological and physiologicai
intrusions) is a critical element contn'buting to the development of compassion
fatigue.
Louisa's case does not identify the current details of her private iife.
However, several researchers and authors (Reamer? 1992; DiGiulio, 1995;
Gerson, 19%; Mahoney, 1997; Sherman 6t Thelen, 1998) estabiish the likelihood
that signifiant petsonal burdens may exist either simultaneously, or in recent
proximity, to the work-relatecl stcessoft eXpenenced by such compassionate
pro fe s s id as Louisa. Figley's (1995) mode1 acknowleâges, but does not
adequately explore this fourth aitical element as the "degree of lik disnption"
contnbuüng to the professional's risk for compassion fatigue.
According to the ciinicai descriptions offered by FigIey (1995), Emerson
and hrIarkos (1996), Wtrner and Young (1996) and &ers, Louisa is a d t y of
not one, but two identifiable and damaging syndromes: professional buniout
and compassion fatigue. The enduring, negative stresscm of her work Me,
coupled with her experience of present professiohal and historic personal trauma
have comlidatedf leaving Louisa depleted and waunded. in the wake of this
transmitted and d e d trauma, Louisa initially believes her only option for
coping - for Sunnving - is to abandon her job altogether.
Where Louisa's story illustrates Figley's (1995) specific model of secondary
traumatic stress transmission and the development of compassion fatigue in
professional helpers, the case of Pastor Craig affords some understanding of
certain aspects found in Wong's (1993) generd model of resource~~ongruent
coping. Prominent in this innovative synthesis (Wong, 1993) is the recognition
that an individual's socidturai context generates considerable influence upon
both the stressors experiend, and the efficacy of the person's coping resources
and choires. Although Wong's (1993) emphasis is primarily upon the influence
of traditional cultural elements (mmely, ethnicity, community and language), in
Pastor Craig's eqxrience the modei is applicable because his immersion in a
culture of professional Christian ministry infom and shapes the *ority of his
personal and professicmai envinnunents, induding role-congruent coping
options.
Gaig and Gnœ's personal beliefs support his vocational participation in
their faith-commUNtyf independent of the larger Society in whidi they live.
Sice the Church tends to regard its pastors as sojounneis, Caig's eXpenence
with employment placements by a process of calî7 is a major factor in the
famiy's vaned geographic and economic history. The worlr of several
mearchers (Morris & Blanton, 1994aI 1994b; Wamer & Carter, 19&; Kieren &
Munro, 19ûû; Mckey, Wilson B Ashmore, 1991; Benda k Diiiiasio, 1992) points to
this and other significant stressors eXpenenced by a majority of dergy and th&
families, in relation to the unique aniumstanœs of the ministerial lifestyle.
Aithough the demands of work frvently interfere with the enjoyment of th&
"normal" family Me, Pastor Craig's role also contributes to the network of
congregational and community supports he and Grace have developed for
themdves and th& chiîdren, in spite of (perhaps in response to) separatiom
from their extended family. According to the organization of Wong's (1993)
rnodel, Craig's pastoral experience may hction as either a resoufce or a
stressor in any given situation; moreover, its influence is Likely to operate in both
domains simultaneously.
In the context of Wong's (1993) model, emphasizing proactive coping and
the importance of spiritual/existential values in the human experience, the
consistency Craig maintains between his personal beliefs, a . his vocation as a
Christian pastor, is a signifiant factor in the deveiopment of an appropriate and
fundionai range of mphg strategies. Recent research by Fortune (1989), Steinke
(1989), Mahoney (1997), Sherman and Thelen (1998), and 0th- identifies the
7 Within the Christian community, the terni 'call" denotes both formal and informal understanding of personal vocation. tn its broadest sense, each person confesses Christ as Saviour is resgoiding to the call d the Ho(y Spirit, GIowtn in the Christian iïfe is eric~uraged as beHevers bear God's individual catl to devebp and exercize penonal talents and gitts - wnethet spiritual, physical, i~kectucil, mathm or emdiaml - for the futMerance d the Gospei, and taward the building up of other members m i n the Body of Christ. This recognition of the cal1 as a personai invitation, roated in Gob's diied invohmeM in an irdividual's Me and tnisting His putposes, is Vie mis by which some denominations exterid *ailm to include the f ~ ~ l i z e d processes of eritefing pastoral training, iMd/Or the arrangenient of the specüiic mtch between a ciefgy member and a mgregaüon for a period of rninistry.
"caretaking" of an individual's spirituai life as an element essential to wd-being.
ui Paçtor Craig's life, personal spvituaî caie takes shape in several related
plusuits, hciuding a committed p y e r and "devotional" lik, marital and family
bonds based on Bibliral prinaplesI and his authentic desire for continueci
participation in his faith-community and its coprate wmhip. Interpreted
according to Wong's (1993) resoutcesongruence model - and together with
various cognitive, physical, psychologid, social and financiai strengths - the ongoing spirituai focus of M g ' s îife enables h i . to daw upon a broad, creative
and appropriate range of proadive coping resowces when he is conf?onted with
either common or exceptional stressots.
Given the chronic and seldom-relieveà stressors attadied to parish
ministry, and its unavoidable intrusion into the normal sanctuaries of family NeI
Pastor Gaig has long been at risk for developing b o u t symptoms. Together
with these conditions, the tecent arisis into which he was drawn, and the
subsequent resurgence of mernories detaiüng his similar participation in his
father's cardiac emefgency have cornbind to mate conditions under which
Craig is now eXpenenchg secondary traumatic stress (Figley, 1995). Since, in
addition to a personal faith, Craig's effective coping repertoire indudes a
subshtial rneasure of intimate emotional support shared between himdf and
Grace, he has relieci heavily upon her strengths this past week
From the place of this already depleted emotional condition, Gaïg is now
confronteci with an addition& signi6cant crisis; a famüy bereavement bearing
echoes of previous expiences. According to Figley's (1995) confguration,
Pastot Craig is ripe fbr the impairment of compassion fatigue. hterpreted by
Wong's (1993) m d 4 the hkelihood that an individual may successfully
negotiate the challenges of a uisis is directly dependent upon the congruence
between person and resources, and betwem appropriate i.es0urces applied in
speafic circumstances. In this case, the histdcal strength of Craig's effective
coping has been moted in las active Christian faith, spousal support, extended
famdy and commtuiity. His presait circumstance of non-volitional stress is a
signifiant challenge and potential barrier to the present eficacy of those
resoufces*
Given the preceding brief introduction to the existing models of Tesource-
congruent coping Won& 1993) and compassion fatigue (Figley, 1995), it is usefd
now to focus attention on theh synthesis into a modei speafic to the experience
of the compassionate professional.
Chnpter Four
SOtlRCE MODEZSBLENDEDAND EXENDED
Brief ZWciples of niecm Dmeloment
The deveiopment of a theoretical concept or mode1 is by nature a slow
and dehkate process (SliEe Q Williams, 1995; Kuhn, 1970, ated in Figley, 1995).
It is an ongoing procedure which simultaneously seeks to interpret, challenge,
integrate, reoqanize and extend the assumptions of existing "knowledge" with
the innovative elements and applications proposeci by k h thinking and
observations. At the same time, sound theoretical developments range aaoss a
variety of abstract levels, £rom the broady philosophicai, to speafic models of
disaete functions or systems ( W e 6t Wiliiams, 1995).
The Path of Themu DaDelument Towurd the Sunthesized Mudel
A m e n t example of this theorydevelopment process may be obsemed
in the evolution of psychotrauma theory, recentîy described as a fieid "in a pre-
paradigm state" (Figley, 1995, p. 6). Although countless generations of humanity
have endureci (and surviveci) the traumas of war, naturai disasters and other
horrendous events, a cohesive portrait of such emotionally costly sunrivorship
has only recently been codifieci, and remains in the proass of rehement.
According to Figley (1995, p. 7):
the concept of PTÇD, developed through both scholarly
synthesis and the politics of the mentai health professions ... was inttoduced in the DSM:-Ili (APA, 198û) as the latest in a
of tmns to descncbe fk harmful tn'opsychosocial eficts of
ïraumatic ewnts (emphasis added).
By extension, it is apparent that the concepts detived from the primary f a y s of
psychotraumatology (inciuding those affiliateci concepts of secondary traumatic
stress, compassion fatigue, and treatment considerations or sûategies) should
aiso be approached as incomplete and developing, even as they are
cohstncüvely appiieâ in piesent ckcumstances.
Understanciuig the dynamic nature of theory is partiddy helphil when
considering the question of non-volitionai impaiirment and potential resiiience as
eqmienced by compassionate professionais. As has been demonstrated in
Chapter Two, several elements relateci to UUs issue appear in the context of other
iveas of concern, dispecsed among specialties addressing addictions, professional
competency and impairment, occupational health, stress and coping, counsellin&
trauma work and pastoral m e . However, the reviewed Iiterature yields iittle in
regard to the areas of common experience between pastors and counsellors, and
less sül l to the composition of professional impairnient as it may be conditioned
by signiscant, negative and unavoidable disniptions in the individual's private
lifè.
Also contained within the broad domain of human stress and coping, and
intersecting with concenis speofic tu both health-care and occupational stress
studies, is the concept of buniout among professional caregivers. As noted in a
prior segment of this discussion, the term "bumout" represents a range of
deterimathg conditions, extending h m work-dted malaise to the
contemp1ation/completim of suicide. Bumout develops gradually, as the
individual experiences chronic and unrelieved (intense, but not Me-btening)
demands relaied to the functions of professionai caregiving (Figiey? 1995; HaU,
1997). Recovery h m bumout is noted to be an equally slow process (Fidey?
1995). Considering the similar contexts in which the professional functions of
both clergy and counsellors are perfomied, the concept of h o u t as drawn
h m studies of occupational stress and coping, provides an important source for
the development of a model of non-volitional impairment and tesilience.
Also ckwsed in depth elsewhere is Figley's (1995) addition to the existing
dinical portrait of PED, a dual-phad malel dernomtrating the transmission of
secondary traumatic stress and the development of compassion fatigue in
professionals working with victims of ûauma. Figley's (1995) mode1 offers both
structure and content to the present consideration of the non-volitional
experiences spepfic to clerics and counsellors. His treatment of compassion
fatigue as a syndrome distinct from the spectrum of burnout is aitical to
unders tanding the qualitative, ra thet than qyntitative, nature of non-voli tional
impairment. Furthet, the model (Figley, 1995) Aows for the complexity of
arcUmStances in the compaseionate professions which may generate
syndironous, rather than exclusive, conditions of bumout and compassion
fatigue. In the context of non-volitional irnpaiments parti& to the @ence
of pastoral and CO- professi~nals~ one of the most signiscant components
of Figley's (1995) model is found in its (iimited) recognition of the influence of
"private Lik" disniptiom in the development of compassion fatigue.
Fuiailyf in d e r to adequately infoim a specific model of non-voliticmai
impairment in the compassicmate professions, it is necessary to examine the
current context of general professionai impainnent issues. As demonshated,
several definitions and considerations fiaming impairment concerris are
encountered in 0th- disciplines such as medicine, nursing, and social work A
review of ihis broad information reveals that the majority of material is occupied
with prob1ems of addictions, questions of professional competency, abuses of
power (usuaily semai behaviours), the detection and treatment of such
problems, and the accountability of colleagues in the aforementioned
Orcumstances. The same survey of available liteature is evidence of the scaraty
of comparable materials speafcally dealhg with c o d o r s and pastors.
FuiallyI aside from a few recent studies, the literature's treatment of professional
impairment due to unavoidable and distresshg circumstances in the individual's
private iife is almost wholly confined to authors of the psychdytic schools
(Schwartz & Silver, 1990; Gold & Nemiah, 1993; Gerson, 19%). This absence of
deveioped theory in the professional literature has been identifieci as an issue
tequiring carefd artaiysis and concephial synthesis, in order to geneate
construcüve applications for the %al world" experiertces of compassionate
The logid points of depamire to this present extension of the field were
derived h m the models proposeci by Figley (1995) and Wong (1993). These
models have functioned in parallel, but without putposetul and obvious
integration concerning the assessment of counseilors and pastors at risk for
impairment due to non-volitional factors. However, when evaluated in light of
Wong's (1993) emphasis on the value of "proactive versus reactive" copïng
strategies, and "effective v e ~ u s ineffective" adaptations, a minor but wful
extension of Figley's (1995) focus on the hazard of impairment generated by
compassion fatigue becomes apparent, Set in the contact of non-volitional
peftonai and professional impairment as it is eq~+rnced by c o m p a ~ m t e
proféssimfs, this augmentation of the combined models extends the element of
compassion fatigue (Figley, 1995) to recognize "compassion dence' ' as an
alternative and desirable outcorne in such an instance (Figure 4). It is an
extension consistent with Slaikeu's (1990) general discussion concenùng the
effects of crisis
we must rememk that h m the disorganization that
ensues, some sort of reorganization must eventudy begin.
This reorganization has potentiaî for moving the person... to
higher as well as lower levels of functioning. At first glance,
gowth resulting fimm something [traumatic]..siay seem
rather farfetched. However, since these events call for new
methods of coping and provide the occasion for examinina
and reworking umsoIved personal issues ftom the pst,
it is passile for an individuai to emerge h m the aisis
better equipped than before to face the hthue, (p. 65).
Resilience B r k t b Defined
Resilience, by definition, suggests the quality of enduring strength
Encountered in the naturd and physical sciences, resilience describes the ability
of an mganism, substance or system, subjected to extreme and/ or prolonged
stress, to retain, recover, or enhance its Onguiai form, once the sttessor
conditions ate lessened, removed or assimilateci. h some instances, this ability
to suMve may be the result of adaptive capaaties inherent m the original form:
the elastiaty exhibited by certain plant and animal tissues ofks a simple
example of this. In other cases, d e n c e is achieved through the unique
combinations of cm&tions created in the hision of particulat stressors and the
origmal forni. The simplet iîlustration of this principle is observeci in the na-
world where, under speafic stressor conditions of pressure, temperature and
time, akssed deposits of the element carbon are transformeci into the crystai
structure better known as diamond. Nothing of the pure elemenfs nature is lœt
in this transformation, but its potenoal applications are drastically altered, and its
new substance-Eonn acquires a brilliance, darity and strength not possessed
prior to the influences of the combineci stressors.
Explanations of individual human d e n c e have traditionally adopted
simüar illuskative models b m natural-worfd examples and parailels,
partidariy as the field has focused on explorations of personality traits that are
hardy and stress-resistant (Wong, 1993). However, where the physicai sciences
simpiy explain tesilience as the equilbrium (or "homeostasis") achieved through
the conservation of matter, or via systemic adaptations, the approach is one
increasingly recognized as insuffident to explain phenontena of psychological
CeSilience in people (Hoff, 1995). According to Hoffs (1995) dixYssion of aisis
theory, "several limitations [exis t] to the concept of homeostasis as applied in
psychology and psychiatry. For example, honieusthsis does not qp2y to processes of
grauth, &velopmuntr creatiott and the l~k,'' (p. 1 2 emphasis added).
Given this emphasis on the qualities of human transcendence - qualities
which pmvide Surpivors with something beyond the element of simple physical
continuance - it is not surpriPng that psychoiogical resilience is o h expresseci
in language refiectmg the Lheolopical, clinical and poetic. Thus, Frank1 (1959,
1962) discusses the endurance of the human spint in the face of inconceivable,
unbearable and dehumanking conditions. Wong (1991) writes of the higher
purpose fauid thmugh suffering, and (1993) of a "vasi guler m e " of
creative, spintual and psychoIogical resowces that support the individual in spite
of Me stresses. In a similarly spintual tone, Hicks (1993) points to the sustainhg
hope of trauma s ~ v o r s compeued to endure, if only for the sake of the
meaning investeci in their personal relationships. Biblicai passages speak
repeatedly of the spirit of enduranceI strength in the face of adversity,
perseverance, patience, and the building of a character of excellence in the
believer (Joshua 1.9; Proverbs 31.10; Romans 5.1-5; Coloesians 1.10-11; 1
C ~ t l l i t h h ~ 4.10-13 & 13.47; Psalm 46.1-3; 2 Corinthians 4; Phüippb 4.49; 2
Timothy 2.810 & 4.5-8; Titus 2.2; Hebrews 10.36; 1 Peter 2-19-23; 2 Peter 1.5-9;
James124 Q 1.12. New hternational Vexsïon). Less poetic, but equally
persuasive, is L,azanis and Foikman's (1984) reference to the existence of flemiie
cognitive styles which cm accommodate aberrant expiences in a human Me.
Although expressing the central W p l e in a variety of descriptors, each of
these wrîteis is in agreement with Hoff s (1995) position that the quality of
resilience is a dimension of the human experience that cannot be accounted for in
simple medranistic terms.
Considered within this trame, and as suggested by the present model, the
likelihd of movement by the compassionate professional toward either fatigue
and subsequmt impairment, or d e n c e and growth, is one sllIIttnarized in
Spedrhard's (1947) staternent:
Studies of the cornplex nature of trauma-reiated vulnerability
and resiliency have highlighted the fact that individuab respond
differently to potenüaiîy traumatic eXpenences depending
u p n previous eXpenence, context, and acpectations. In other
words, the meaning of any given Srpenence can vary 8featIy,
not only from one individual to wother, but significantly over
the duration of a given individual's Metirne. Thus, given the
appropriate context and the idiosyncratidy necessary
antecedent priming eqmience(s), vimially any experience
can have traumatic impact, even retrospectively as new
eXpenences d w g e the meanings that are assjgned to previ-
ousiy experienced events, (p. 68).
Wons & F i ' Intertrreted Z7t~oudz Case Materials
When assessed h m the combineci perspectives of Figley (1995) and
Wong (1993) (Figures 1 dr 2; Figure 3), the cases of Louisa, M g , Ridiard and
Katriona (Appendix) iUustrate the distinction of non-volitionai stressors and
impairment risks for compassionate professionais. Whüe it rnay be argueci that
no one of these instances presents an htration of "text-book perfection" in
which the criteria for compassion fatigue (Figley, 1995) are met in their entirety,
each case clearly indicates the severity of risk surrounding the piofessional
involved. For instance8 Louisa's situation rdects the highly volatile combination
of secondary traumatic s-, prolongeci exposure and traumatic recollection
that is the heart of Figley's (1995) compassion fatigue modd Additiody, she
pmsmts as a professional already eXpenencing the erosive effects of
occupationai bumout (Emerson & Markos, 19%; Witmer & Youn& 19%; Figiey,
1995; Sowa, May & Niles, 1994; Rearner, 1992). For the purposes of simpliaty in
this discussion, it may be assumecl that events in Louisa's personal life remain
relatively stable at this time; however, even without signin.cant disruptions in ttiis
area, the previous elements are more than SuffiCient to place her at risk for non-
volitional impairment,
In conhast, both Gaig and Katriona are encountered at the point of
eXpenencing extrerne Me disniptions, both interrupting and combining with
their mies as compassionate pfessionals. Bearing traditional burdens of
pastoral are, Craig also has ment and direct involvement in a critical event,
with the addition of pexs0nal.i~ traumatic mernories revived by it. An even more
signifiant event, a famiy lm, has subsequently oc~tllfed at a point where Craig
has not yet recovered h m the effecfs of the commUNty event. Even without
the presence of Figley's (1995) element of prolongeci exposure to others' tauma,
Craig's present constellation of events strongiy points to the developrnent of
conditions of compassion fatigue.
Similady, although Katriona's case does mt indicate an awareness of any
personaily traumatic recollectio~~~ compounding her di)fidties, she has a
personal history marked by prolongeci expomw to victims of trauma and the
eff& of their experiences. According to Figley's (1995) mode1 this viarious
eXpenence places her at considerable risk for the syndrome of secondary
traumatic stress. F l V f h m o ~ ~ the sudden intrusion of this siflcantly
distressing peftonal event, in the form of serious ill-health, exacerbates
Katriona's set of conditions beyond the maches of "simple" stress or bumout,
and moves her into the comp1exities of compassion fatigue.
Finally, aithough Richard's clinical experience lacks the accumulation of
"pure" secondary traumatic stress (since his campus-based practice is not
primarily comprised of trauma survivors), his present working conditions point
to the certain eventuality of burrpnit, compassion stress? or both Compounding
this is the ment death of dient D., an event encompassing both immediate and
past trauma for Richard. Memories of previous professional encouiters with
suicide, and his own si'bling's intentionai death are revived by this ptesent reaüty.
Viewed coUectively in the context of his ongoing work, and incongruent and
deficient coping chaices, the elements of Richard's experience also mate a profile
consistent with the path to compassion fatigue.
When a s s e 4 according to Wong's (1993) mode1 of effective coping, the
case materials continue to offer insights useful to understandmg the
development of compassion fatigue and non-volitional impairment, and
(equaüy), compassion d e n c e in compassionate professionals. Although
Louisa's case presents iiffle information regarding her speafic, personal
repertoire of coping skills, the elements of appaisal pn>cesses and resou~ce-
congruent choices emphasized in Wong's (1993) mode1 are dearly evident in the
supports recentiy estabLished in Louisa's extremely difficuit professional Me.
Similarly, Craig's situation is an example of personally and s i t u a t i d y
congruent coping resources, and of simple but effective coping choices. Wong's
(1993) element of cultural context is applicable to Craig's case where it recognizes
his participation in a very s-c su-ture of faith and profession, which in
tum influences his selection of copins skills (inciuding his family Ne, spintual
disciphes and social values).
Katriona's story iliustrates an extensive repertoire of balance a .
resources, including purposeful spintual stffngths and activities, a range of
physical and exnotional selfi.are measutes, creative outlets, and the continuhg
development of her profession and ethics. Additionally, Wong's (1993) element
of adturai context is relevant in the evaluation of Katriona's resources. Aside
from the influences of the iarger d e t y in which she lives' Katriona actively
identifies herseU with s e v d separate (but co-existirig) "su&culturesn. These
sources of potential assets include her Christian community, a professional
culture disthguished by compassion, a mal social comnunity, and a womens'
culture shapeâ by the gender-issues present in al l three of the previous pups .
In contrast, the application of Wong's (1993) model to Richard's situation
reveals significant defïats in a comprehensive strategy for aturce-congruent
coping. Although the details of Richard's style of selfare and professional
maintenance previous to this period are not Speaned, his disproportionate
reliance upon external and transient sources of support (busy schedule, physical
environment, student contacts) is apparent. Additionally, since learning of the
death of his dient, Richard's actions have been more demonstrative of
dysfunctionai and ultîmately ineffective reactions, than of purpoeehil appraisal
and responsive coping measUres. Rather than seeking and exeKiPng the
supportive measures he would recommend to a dient in similar circumstances
(e-g., debriefing the crisis srperience, peer support and self-care), Richard has
chosen isolation, rumination and dcohoi to deal with his emotional distress. The
outcome of the path of Richatd's present s<peiience is not likely to meet Wong's
(1993) criteria of positive stress resolution, namely, reduced stress, restored
balance and enhanced well-being.
Retuming to the case of Katriona, it is readily apparent that her current
personal crisis is inextricably linked with her characteristic appmach of proactive
pbiem-solving. However, her awareness of the ptob1em should not be
conhised with aeating the present crisis. It is Katriona's appraisal of recent
syrnptoms as a challenge worth adàressing that has prompted her to adjust her
plans for preventative health care to "sooner,'' rather than "later". By this
response she has leamecl of an existh& threatening, but previously
urtrecognized, pathogenic condition. The timing of this information, however
distressing and unwelcome, may achcally function as a resource in Katriona's
management of her moment of personal threat and crisis, and its potential
outcorne. In contrast, while his practice arnong University students certainly
requires him to coach others in the application of realistic appraisal and coping
skius, t h e is Little evidence to asmune h t Richard consistentiy functions h m a
position of congruent problem-sohing for himseü. In fact, he regards himself as
thriving on the overload of his professional activities, relying on the energy of
his youth and physical condition to sustain him, rather than mauttainhg
teasonable boundaries and expedations. For Richard, the la& of an intentiody
proactive orientation in bis professional life weighs as a signifiant negative in
the balance of his resource options.
According to the present synthesis and extension of the Wong (1993) and
Figiey (1995) models, a variety of potential outcornes, both positive and
negative, are likely in each of these cases. It is possible, but by no means certain,
that Lowsa's experience could conclude poeitively following the restorative and
supportive interventions proposeci by her superim. Ctaig's ability to manage
successive personai crises in the context of a ta>ang miniskry is severely
challengeci at this moment, since his primary supportive cesou~ces for coping
(faith and Emuly) are now fully enveloped in the same experience of crisis. In a
third situation, Katriona demonstrates strong potential for eventually atriving at
a place of compassion d e n c e , but this cannot be considemi a foregone
conclusion. By cornparison, Richard is a lücely candidate for professional (if not
global) impairment, given the conditions he has both encountered and
cansbucted.
In order to more completely understand the path to either fatigue (Figley,
1995) or resilience (Slaikeu, 1990; Speckhard, 1997) that lies before these and
other compassiortate profkssionals in distress, it is necessary to examine the
individual componaits and interactions in the synthesis and extension of the
models off& by Wong (1993) and Figiey (1995). Essential to this task is the
distinction between the levels of global ("wholepefton") trauma processes, and
discrete medianisms (or "seiective") trauma processes. This synthesis focuses
upon the former, adopüng an approach of integrateà appraisaî, rather than
examining individual strategies of coping.
Non-Volitional lmvahen t and Resilimce in Com~assionate Professionals:
A Mode1 - Figure 4 is a schematic presentation of the mode1 descriiing Non-
Volitional Impuiirnent and Resilience in Compussionatc Rofes s io~ l s . The
diagram coflsists of eleven interadhg segments. While the rnajority of these
have been àrawn h m Figley (1995) and Wong (lm), the principle elements
asnime narr0we.r definitions, and new functions or effects when integrated in
the present context As shown in the figure, the individual elements follow
dosely the configurations set forth by Wong (1993) and Figley (1995), inciuding:
1) SpeaScCLXltural context
2) congruent remmes repertoire
3) secondary traumatic stress
4) p l ~ g e ~ e x p o s ~
5) traumatic recoHection
6) non-volitional Me disniption
7) previous dysfunctiod copLig
8) integrated appraisal
9) integrated coping
10) ineffective/ inadqate mping
11) 1- to growth (compassion fatigue, threshold maintenance,
compassion d e n c e ) .
Svedfic Cultural Context
Foundational to this model is the segment labelleci Spe@ Cultural
Context (1). This k t element is a signifiant contriition from Wong's (1993)
work on resource-congruence in effective copuig. It is a g e n d designation for
the effects of s o c i o c u l ~ influences upon the individual, including situatiod
interpretations and expeaatiuns, communication methods, &al roles, and
ethnicity. Depending on the given ckumshnces, the individual's cultural
conditions and resources may have a -cial or detrimental fundion. As a
broad example, consider the event of an unplanned teen pre8naclcy. According
to the focus of Wong's (1993) cultural context, this lhchanging wmt is likeIy to
be a significantly difkrent eXpenence (in some respects, at least) in the
perception of a kt-generation female member of a ChineseCanadian family,
than for a fifth-generation female m e m k of an Anglo-Canadiian hmily. The
same situation will likely be difkrent again for a young woman daiming an
Aborigmai hentage, with its attendant m y system. In the first instance, where
Asian family culture is commonly dominateci by a collective and cross-
generational orientation, there is lücely to be tremendous emphasis on family
honour and filial okdience (Sue dt Sue, 1990). A First Nations family may
operate within a similarly communal petspective, but - occupying a distinctiy
different d e and status within the broader society than new Canadians usually
do, and possessing a Mering vision of spirituality - may hold sigriiticantly
different beliek concemirtg meaning and outcome(consequencesI t.esolutions) in
this situation. Young women h m Angle-Canadian families, dthough perhaps
also mind)ul of the value of advice hom elder family members, are less Likely to
feel the cmtraints of those elder members' wishes, since the general orientation
of most families of "Western" descent is decidedly more individualistic than is
found in o t k dtures.
A narrower interpretation of this basic definition of dtural mntext is
applied as the +fit culficral context in the present model, through the
recognition of unique professional and religious citcumstanœs in which
therapists and dergy encounter and meet the demands of theV vocations. As
noted elsewhere, counsellors and cl& both Scpenenœ, and are perceiveci by
others to operate within a rarefied environment, whem the blending of private
and professional lives is virtually inescapable, and expectations of performance
are kquentiy unreéîiistically high. u\ genetal, their colleagues who work in
professions which are equally compasionate, but more technidy- or
institutiOnaUy-oriented (e.g, medicine, nursing, emergency response work), are
less îikely to be subjected to constant "invasions" of the sanctuaries of private Me
by the demands of th& professional cultures.
Additionaily, as professional caregivers hurctionhg within communities
de- by the tenets of Christian faith, ptors a d cowselioss who engage in
"cive" ministries are likely to encounter distinctively SUWU expectations
regardhg behaviour, emotions and resources. Gemrally comidered as mms
within the "community of beiievem", these s<pertaticms are usually believed to
cany an even pater weight of morality than do those expectations simply
p m a i i i by good professional ethics. At the same the, sub-cuihual
comUNty expectations are ohen considerably narrower, and less flexible, than
are the accepted n o m of the l q e r Swety.
The appended examples of Couisa, Cr&& Ridiard ami Katriona illustrate
some facets of the subcultures, both religious and professional, in which pastors
and therapists function. In oder to comprehend the unicpe position of the
compassionate professional at risk for eWpenencing non-volitional impainnent, it
is essential to derstand this extendeà definition of the speciflc mftitral context,
since it bears on ai l subsqent elements and interactions in the synthesized
model.
The second dement of this model, also derived tram the murce-
conpence work (Wong, 1993), is the Congrumt Remurces RepPrtoire (2)
constructed by the individual, Won@ (1993, p. 58) description of personal
resoun:es as those "devices and means of supply that can be drawn on in times
of need," indudes the traditional physid and cognitive aspects descn'bed by
such researchers as Lazanis and Follmw (1984) and others, with the addition of
collective, creative, existeritid and SpLitual components. Accotduig to Wong
(1993), resources exist in community; the proactive development of them in that
context, rather than in isolation, can offer an individual tremendous strengtks
and options in coping with stresshil ciraanstances. Wong (1993) hirther attends
to the necessity of conpence between tesources and demands, emphasizing
the pmactive nature of resource development. The concentration of Wong's
(1993) model upon the individuai's spiritual resourcesI and efforts to discover the
meaning of existence and sufkring are particdar1y signiscant in the case of the
pastoral or counselling professi~nal~ aupenting and shaping that cmgruent
resourcps repertoire, plcesumeci to be developed through professionai and
continueci training peer nehnrorks, experience and personal resowces.
Secondm Traumatic Stress, Prololtzed Emoswe and Traumatic Recollections
The next three sections of the present synthesis, Secondary Traunatic Stress
(3), Prolonged Exponcre (4), and Traumatic Recollections (S), originate in the second
phase of Fiey's (1995) compassion fatigue model, and iargeiy retain the
definitions and funcüom applied in that source. Sewnàary hmcmatic stress tefers
to the compassicmate professional's vicarious experience of, and victimization by,
painhil or feathil events endured by othet people, when related by them in the
course of crisis intervention, therapy, or pastoral care. In the present mode1 as
in Figley's (1995) definition, SIS may be the effect of either a cumulative or
isolateci witnessing, and absorption, of such material.
The case of Louisa offas a simple example of SI'S in the mntext of the
couIlSellor's movement toward either compasion fatigue or resilience. Whereas
the desujibeâ encounter with a traumatized family could in itself constitute
suffident dtical acposure to pcecipitate SLS in Louisa. her multiple and long-
term exposures to si* case material hilfüls, for her, the a d d i t i d dimension
of prohged exposure, recognized by Figley (1995) and serving the same hinction
in the present modeL In simple terms, the sheer weight of repetitious contacts
with haumaüzed surPivors is a risk factor for the compassiortate professional. It
is the position of the present model that prolonged ~xposure wili resuit in similat
effects, whether those contacts take the form of:
* multiple short-term exposufes (as might be the case of a
commmity c o ~ m speaaliPng in work with SUrYivors
of wual assauit);
limited numbers of continuing-care clients who have
survivecl extrerne trauma (as might be the case of cou~lsellors
çpeaaüpng in work with refugees b m war andlm phticai
torture);
or a mixture of both short- and long-term trauma care
(as might be the case of pastoral and therapeutic caregivers
following a community trauma/dkster such as a tomado,
or an incident of mass violence).
The Eitth segment of the Non-Voliti-1 Intpaiment a d ResiIkco model,
Traumatic Rewilecton (51, is also extracteci h m Figley's (1995) innovative
paradigm, and is supported by SpeckhaFd's (1997) analysis. Depending upon the
resolution of earrier eXpenences, the compassionate professional's remembrance
of persmal encounter(s) with traumatic cjrcumstances and swvivotship may
exeKize considerable influence in the progression toward eîther htigue or
resilience. The deciding factor appears to reside in the contactual teference of the
traumatic rewUectim: namely, whether the past incident exists as a processed
(albeit painful) memory of past trauma, or whether it possesses qualities of a
presently active and intnisive event. Inadents of onpinai tauma which have not
been successfuily subsumeci into the kger balance of Me, h m whidi the
inunediacy of exnotional involvement lingers, or which have generated related
and enduring PISD symptoms, are likely to Uiterfere with, or at least negatively
influence, the processing of the unique realities involved in the current trauma.
The power of trmcmatic recollectrotls to shape perceptions of present reaüty, and
therefore both present and future coping patterns, is illustrateci by the cases of
Louisa, Gaig and Richard.
Non-Volitional Life Disrrrrrtion
An essenaal element of this mode1 emeges in the segment Non-Volitiotl~l
Lifé Dinuptia (6). It emphasizes a cornponent acknowledged, but accorded only
minor attention in Fidey's (1995) conceptualization. In his original context of
"degree of life disruption", Figley broadly contends that a professionai's plunge
into the impairment of compassion fatigue is vimially guar,anteed if, in addition
to conàitions of STS, prolongecl exposure and recoilected trauma, "the helper
experiences an inordinate amount of Me disniption as a function of Unes or a
change in lifestyle. social status, or professional or persanal respomi'bilities,"
(Figlq, 1995, p. 253). Research finidings by DiGiulio (1995), Mahoney (1997), and
Sherman and Thelen (1998), enurnerate quivalent categories of life events that
may either hinction as, or contnhte ta, sources of distress among clinicians*
These conditions indude (but are not limited to): bereavement and grief,
and emp10yment adjustments, trauma and post-traumatic stress? relationship
diffidties and divorce, legal prob1ems, and generai likcycle transitions.
Sheffield (1998) similarly identifies broad groupings of physical, mental and
situational factors as causative elernents in the development of coumeNor
impairment.
In the context of the model off& heie, the intefpfetation of a disruptive
life experience is made within a more limited focus than has been adopted by the
previou61y ated t h d t s and researchm. Within the parameters of the
compaasionate professionai's non-volitimial life dimption, the definition of
"disruption" is retained. consistent with its common meaning in the sense of
disorganization, &turbance, or "disequiliifium'' (Lazanis & FoIkman, 1984).
The terni "non-volitional" speci6cally conveys the nature of the life event(s) in
question as adverse and unavoidable, undesirable, outside the election and (at
least initially) beyond the conho1 or influence of the person in distress. Only
briefiy addresseci in Figley's (1995) compassion fatigue mode1, that theorisY s
definition of this critical degree of disniption is necessariiy vague, an ambiguous
measure of the "inotdinate amount" of personal distress bearing upon the
individual. Because quantifiable standards are unattainable at this stage of
concephialization, the present model is similariy lacking in precision: events of
n a - w l i t i o ~ l lifi dimptim belong to that category otherwise descr i ï as
"random", "significant", "catasûophic", "dwastating", "aitical", "damitous",
or "disastmusw. Under this purposefuily narrow definition, the case histories
presented in the Appendix ofkr dear illustrations of just a few of the vast array
of life events that could mnstitute a critical m-wfitimf lifi diwon in the
aCpenence of the compassicmate professional
Conversely, there are those dismptive events of historical impact (e.g.,
encounters with violence/abuser or serious personal rUness) that may be better
accounted for by other segments of the model, (der to Cagru~nt Resources
Repertoire (2), or Trmmtic Rewllectons (5)); therefme, the focus of this element is
upon circumstances in the context of the individuai's irnmediate or cecent
experience. The limited parameters describeci in the present synthesis
purposefully exclude several further potentid sources of Me àisrupticm
(spedically: transient phases of Me; &ai stahis; generd occupational stressors;
conditions of seif-comhuction or deconstruction; substance abuse and addictions,
and generai stresses of living), since they are topics more than adequately
addressed ekwhere in the literaturp.8
In conmete t e m , non-volitional lifé dimcptions which either contribute to
the composition of compassion fatigue, or become instrumental in the
development of its counterpoint compassion resilience, are seen in such random
events as:
death and bereavernent @iGiulioI 1995; Hoff, 1995; Slaikeu, 1990)
personal (or family) aperience of serious medical condition(s), not
otherwise accounted for (ûiGiulio, 1995; Çlaikeu, 1990; Philip? 1993)
cornrnunity- or other large-scaie disaster(s) (Hoff, 1995; Slaikeu, 1990)
personal encounter(s) with, or witness b, violence (Hoff, 1995; Figley,
1995; Slaikeu, 1990)
involvement in, or witness to, other traumatic circumstances (Figley,
1995; Hoff, 1995; Slaikeu? 1990).
The extension of Figiey's (1995) original "degree of life disniption" to the
8 Aîthougn psychiatrk Cnsocders, such as the dementias or pemnaTRy disorders, alço met the stated bigniri - adverse - unmMWe' criteria, they are ercckded from the pcaserit mode! for rees~cls
o O c o n p ~ i b e y o n d t t i e ~ o f t h i s u r o r l r -
problem of non-volitional impairment in compassionate professionals M e r
tecognizes and accommodates associateci issues of intensity and duoniCity active
within the disniptive circumstances. Singular non-volitional events or conditions
(which in and of themselves might not mate impairing levels of distress in a
pason's Me) may, by Wtue of chronic recurrence, la& of resoIution, escalaüng
dernands upon resources, or a combination of these, exceed the individuai's
threshold for tolerance, and contnïte to a SigniEicant disniption of normal
functioning. A comoniy recognized example of this int&ty/chronicity factor
ocrurs where serious (but not Me-threatening)), and/ or persistent heaith issues
intrude upon an individual's Me. In its initial stages, such a pmblem might be
experienced as a relatively minor, perhaps incidental, event. However,
CiKzUmstances may d a t e to aeate a signiticant life disniption when health
deteriorates swiftly, or if the= is a lengthiy continuance of the condition and its
attendant treatments. The appended cases of Gaig and Katriona iliustrate
slightly different aspects of this intensity / chronicity dynamic within non-mlitional
lifi dimptioas, in this model of the compassionate professionai's expience.
At this stage in the constniction of the synthesized model, it is necessary
to consider the effects of the individual's histonc patterns of coping. Whereas the
pteviously discussed segment, Congruent Rcsources &?peTt~*~e (2), focuses on the
positive employment of peftonally- and situationally-congruent resources and
developed skills, P T ~ O U S Dysfunctzhuf Copnig (7) recognkes isolated or
accumulateci prior choices which have had, or continue to have, effects that are at
best "non-constructive" and, ai worst, detrimental or destructive. Given these
parametter, this segment encompasses problems of substance abuse and
addiction; aggression, violence and abuses of power; eating disorders and related
patterns of seIf-harm; and other c h r o W y avoidant, escapist, or risk-taking
behaviours.9
The aitical point to understanding the present model lies in the
recognition that previms dysfinctional coping choices are distinctly different h m
the identifieci do& of non-v01iti~l I i f e disruptions. Where the synthesized
mode1 has defineci a non-volitional disniptor as an event, ciraunstance or
condition that is signifiant, adverse, unavoidable, undesirable and apart hrnn
the influence or control of the individual, the genesis of a dysfunctional coping
choice (tegardiess of the evenhial wverity of distress or disorder) is not a
andom influence, but resides in an historic act of volition, or dmice, and may
t hdo re be better described as a leanied or aasWated behavim. Uearly,
exisûng patterns of dyshction coping exert substantid influence upni
subsequmt coping choices, and must be coclsidered in any analysis of impaireci
professional behavim. in the context of this model, however, cydic dysfunctiun
is not a source of andom non-voiitionai distress among cou11sellors and clerics.
At the same the, it s W d not be discounteci that the events, choices and
behaviours which constitute this model's domain of prmious dysfudm1 roping
may, in fat , effectively contnite to the cmpent resources reprrtoire previously
identified. Howwer, this eff& does not usually axiur unol after the passage of a
sigdicant Hod of the, or until an effective waluaticm has been precipitated
9 ~ i t C s ~ e d t n a t s o m e p a t t s r n s d b e h a v i o u r ~ ~ m a y , infact,arisefram the speelfii and decCdedOy 'm- fadm d enduring psychiatrie or orgmically-bssed disordecs, it is beyond the scope of ttiis d l s c m to examine each iristarice d Èhi tikeiihood. Pubifshed bfaîure is only beginnlng to r q n i r e üte c a p M t y ad dualdia~mis issues, wtme paychhtric condiiiocrs (othef man addictions) coaM in the and funcaoris of mental balth practiaoners. At the point of the pmmt msearch and mode1 syntheb, paralid investiOatbrrs regaraing pastmi imQannent b y r e a s o n o f p e & W a û k P l l n e m s a r e ~ ~
by another crisis. A cornmon example of this process may be illustrateci by an
addicted individual's choiœ for sobriety and personal accountability for his / her
behaviour, following an event of critical pmportions which was direftly
predpitated by the volitional impairment For the mœt part, however, the
individual's selection of (or default toward) unhealthy, inadquate, and unhelphil
methods of coping is more ükely to contribute to unstable res01utior\s, a d the
eventuai repetition of similar choices, enacting a cyde of crisis, inadeqyate
a+ and dysfunction This simple cyde is deriveci from contemporary crisis
theory, parfjdarly as interpreted through Hoff's (1995) multi-faceted Crisis
Paradip. The fourth level of that model suggests that the resolutim of crisis
may be assessed as either a positive or negative outcorne, where the latter
encornpasses emotional or mental disturbances, violence against others, self-
destruction and addictions (Hoff, 1995). With the exception of psychiatrie
disturbances, this same taxonomy of negative tesolutions is presented in the
m e n t synthesis as the accumulation of questionable, and essenaally
detrimentai choices made by an individual prior to immediate ammistances of
hmntlttk recolkecttons, Iifi distuptions, or prdonged e x p m r e to secondllry traumatic
stress.
In the context of the presmt discussion conœming the development of
non-volitional compassion fatigue, the collective inauences of prEmous
dysfunctim1 cqing strategies are speafically acknowledged, in recognition that
prim choices may be instrumental in the development of current circumstances.
They are not, however, the primary focus of the present âhussion,
The next, pivotal, segment of the synthesized mode1 focuses on the
significant tasks of lntegrated App~aisrtl(8) which the compassionate professional
at risk must eventually consider. Whereas traditional models of stress and
coping (Peacodc & Won& 1989; Wong, 1993; L a z m & Follanan, 1984)
emphasize the seledive "mechanics" d such evaluative tasks (e-g., leveis of
primary and secondary appraisals, feedback loops, objective measures of stress),
the focus of the pteçent modeYs attention to iintegmted appraisal is upon the
bahce of personai and professionai perspectives of appaisal. The area of
personal appraisal refem to questions of individual meanhg and attribution
(Fr&, 19591 1962; Wong, 1991), the problem of pain (Grunebarn, 1993), the
recognition of growth oppomimties (Famsworth, 1998), and simiiar existentid
challenges created by sigiuficant Qrcumstances of non-volitional distress (Phiüp?
1993; Wyatt-Brown, 1995). Parailei to this, the range of professional appraisal
encompasses matters of accountability and ethia (Andexson, 1992; Skompa B
Agresti, 1993; Pope 8c Vasque, 1991; Gibson 6r Pope, 1993; Pope & Tabachnick,
1994; von Stroh, Mines & Anderson, 1995), clinical evaluation (Coster &
Schwebel, 1997; Webb, 1997), achievement or disengagement (Figiey, 1995), and
the professional's respomities for seif-care (Muse &z Chase, 1993; Pope 6r
Tabachnidc, 1994; Sperry, 1993; Witmer dr Young, 19%). It is in this emphasis of
perception and context, rather than speafic passes of appfaisal that the
segment integmted qprais112 fepfe~ents a critical point of consolidation of the
source models in thb synthesis.
with the material pnsmted in the pfevious segment, where the tasks of
integrutcd llpp~aisal are defined. In the compasgio~te professional's @ence of
the effects of a m-vditional lifC dimpfion, the process of integrated coping
repmsents a broad band of potential response areas, incorporatirtg a traditional
focus on a variety of c e g mmechanisms and strategies. The domain of
intwated coping d e ~ ~ l h e s multiple levels of response areas which, depending on
the individual in cpestion, may operate in isolation, seqyence, or unisoh
Personal and professional coping encompasses the individuai's efforts toward
seif-management; management of the events or conditions created by the
disniptive intrusion; antiapatory-proactive and precipitous-reactive coping
efforts; and immediate, ongoing, and long-tenn coping strategies. This macro-
perspective of whole person trauma processes (represented in the segments
integnted qpraiwl and integrated wping) prrsumes fluidity between the coping
activities identified here, and of the time progression involved in this segment of
the model. Altemating andior repetitious movements through the areas of
coping are to be expected, depenâing on the individual's ongoing assessments of
cfianging dmunstances and remmes. The possiwties within this phase of
integrated coping are further multiplieci when considemi accotding to Wong's
(1993) assertion that congruent coping indudes resources avaüable to, and from,
both the individual and the community. The pmcesses of integrated coping
whîch occur in this phase occupy a critical role in the continuance of the model, as
the compassionate professional moves toward the condition of either
compassion fatigue or compassion resïlience.
The multi-layd activities of integmfed coping are well illustrateci in the
case of Pastor Craig. In the period foîlowing the news of his father-in-lads
death, Craig is witnessed engaging in several simultaneous coping activities,
involving both personal and professional Me mas. M g ' s present coping
choices are dearfy identifiable as short-tenn tasks and activities: arrangements
for immediate and extended family, h v d p h . coverage for the parish
ministry in his absence. While his &ce of coping strategis for the
management of the long-tenn impact of thîs crisis are unknown at this point,
Pastor Craig demonstrates an ongoing mess of integrated qqwuisul. He
recognizes that he has not yet resolved the traumatic experiences of the
emergency he was recently involved in, nor the @or persona1 expiences that
event remmecteci for him. Gaig W e r recognizes that, in part. his abiiîty to
respond to this family crisis is king shaped by those lingering burdens. Findy,
Craig is acutely aware that of his two primary coping resoivces (namely, his
Christian faith and his M e ) , Grace's support is not avaihble to him in their
present situation, in the usual sehse of offerhg him strength, stabdity, reflection
and emoticmai refuge. At this point, Pastor Craig is functioning in simultaneous
procesres; m e y i n g the situation and his available resowces h m dual
petspeaives (integrated appraisal), and selecüng coping options that are (although
only short-terin) effective and congruent with his personal and professional
culture (integrated coping).
The tenth element, titled Ine@ctive/Inadequate Coping QO), oaupies a
minor position in the present model, simüar to that dacribed fur Preuims
Dysf.ndm1 Cq*ng. However, where the latter segment focuses on past
incidents or pattems of behaviour, the element titled itl~deqwte / I ~ ~ ~ u e Coping
accounts for choices and experiences of dysfunctional coping behaviour in the
immediate experience of the c0111passionate professional encountering
potenWy impairing conditions- While the critical procesees of integrated
uppraisaf and integnited cuping demand attention to both personal and
professional spheres of lik, there is no parantee that the individuai wiil rnake an
approPnate or helpful match between the Unmediate aisis and the coping
options available. In the event that the compassionate professional has not
attended to the development of a repertoire of proactive and personally
congruent resources, it is quite W y that coping choices wili be poorly made
(Wong, 1993), ocauring by defadt in the absence of a positive choice, or by
choosing a negative reaction which does not contain potenaal kefits.
The case of Richard, a student services cmnselîot Scpenencing
simultaneous conditions of b o u t and xcondav tmmat ic stress, clearly
identifies an instance of ineffective, and potentiaîiy damaging coping behaviours
that fit w i t h this segment. By his increasîng use of alcohol and self-imposed
isolation to manage his growing distress, Richard both obstructs his available
and proactive coping options, and increases the likelihood of developing an
enduring dysfunctional pattern. Katriana's story tefiects a similar default to
inegMiw coping in her binge activities of excessive spending. Udike Richard,
however, Katriona demonstrates an early recognition that this choice is
ineffective and potentially damaghg to her long-tenn interests. At this point,
Katriona moves out of an i n @ c h e / i d e p u t e cop~*ng process, and badc to the
tasks identified in the mdei as intepufad llpp~aisaf and integrated coping; Richard
demonstrates no such benefid insight
It shdd be mted at this point that another option &ts fot the
compassionate professional at risk - an option which teflects a coping
alternative that is, at the same time, both effective but imbaianced in tenns of the
personai and professional spheres. This altemative is observecl in the story of
Louisa, a chilàrens' mental health therapist, and her initial decision to leave the
profession entirely. When assessed h m a purely pragmatic position, the
individual% voluniary departure from the profession (whether pastoral or
therapeutic) may in fact, dfiaently deviate the risks, and contain the effects, of
both buniout and compassion fatigue. However, when asseased accordhg to
the m e n t moàel, the sarne decision reflects the i t t l l d e p q of this dioice when
compareci to a strategy of integnited coping. ResumabLy, leaving the profession
allows nei- the positive res01ution of redevelopment from a depleted
professional de, not the healthy integration (and probable healing) of the
person-as-professional. It is important to recognize that the intefpfetation of this
choice as an "effective but imbalanced" mode of coping applies only to those
instances in which the individual departs the profdon in the wake of
unresolved compassion stress and depleted/ incongruent resouzces. Where
career changes are made solely for reasons of life-stage dwelopments, health, or
prevailing market amditiom, such choices cwld easily refiect balanced, adequate
and positive coping.
Loss ta Groltoth
The fmal element contnbuüng to the wrent model's synthesis hames a
broad spectnun of potential outcomes for the ampssionate professional
challengecl by the uniqye stressors of non-volitional life disnipticm. It is a
spectrum well described as the individual's oppominity to either "rive, thrive, or
Mt survive". Smply labelled Loss to G m t h ( I I ) , this segment addresses issues
of threshold and stability whkh are crucial to the development of either
compassion fatigue, or compassion d e n c e . In the present model, loss to
grmuth repments both the distinct stage of decision/non-decision (with its
inevitable movement toward some form of tesoIution), and the threshold of a
larger life-context. It is the element of the mode1 where the cumulative effects of
all previous segments are moet dynamic*
If the compassionate pfessionai's background of trauma, recollection,
exposure, and prior ineffective coping outweigh resources Uiat are depleted or
inconpent, then the likelihood of compassion fatigue is extremely high. Such
an outcome is dearly a loss situation in its immediate context (e.g., loss of Me,
health, mental health, relatiomhips, occupation, stahis), and may, in fact, contain
the seeds of future and enduring impairment* The case of Richard contains
several indications that the W y outcome will be one of compassion fatigue and
sustained lm.
If, however, the individual rnanages to 'Wg on," in spite of the Çhaos
mought by combinations of b o u t , SE, criticai Me disniptiolis and other
elements, then it is W y that a survival mode has been achieved. The best
description of "survivai" as eXpenenced at fhis stage is the continuance of both
pasmal and professicmai functiom, but with a pfound depletion (and perhaps,
a WhLal absence) of mping resources. As a result, little tolerance remains for
additional complications, ambiguities, emqenaes, or exhausticm, leaving the
professional in a hi* vulnerable state. At kt, this phase in the spectnim of
loss to growth offers the individual a tenuous threshold, and a transitid state
m which it is impcmsible to remain for any extendeci period. Future encounters
with extiPme distress or mild but dvonic stress wiU inevitably destabilize this
middle "SUTVival" state, most likely toward the impairhg experience of
compassion fatigue and its attendant losses.
If, however/ the compassionate professionai fin& value, meaning, ot
purpose (Frankl, 1959,1%2; Nouwen, 1972,1979; Wong, 1991; Won& 1993;
Hicks, 1993; Figley, 1995; Wyatt-Brown, 1995) in the midst of the potentially
impairing experience, the Iikelihmod is great for re&g a state of compassion
tesilience. As noted earlier, recognition of the human capacity for d e n c e in
the face of a d v e t y is a subject consistent across religion, philosophy, fok-
wisdom, the arts and, lately, science. Katriona's story offers a simple illustration
of this " p w t h from loss" therne, wihressed in her decision that something
"useful" for o t k women ought to emerge h m her experience. Such a
conviction, although powerless to alter the amimstances of her present
condition, mobikes Katriona to activity that is beneficial on several levels.
Firstly, it asBists her with coping in the present moment (integrated copnig).
Secondy, it allows her to maintain a professional peftpective and identity in the
midst of enormous non-volitional personal disruption ( h t e p t e d ~ p p l a i s ~ l ) . A
third benefit is tealized in the mation of a future-focus towarci which Katriona
may order her resources and subsequent coping choices (proactive congrtient
resource repertoire). F M y , Katriona's focused activity strengthens her
inclination to pursue p w t h and pirpose, rather than becoming enveloped by
mental and spintual fatigue, or acœpting bare Survival as suffisent. Katriona's
story indicates a mow t o w d compassion resilience thn,ugh the influences of
an existentid coping orientation amsistent with her established values and
beliefs.
Summanr of the Mode2
The preceding chapters clearly document the dearth of resesvch and
theory regarding pmblems of dergy and counsellor impainnent speafically due
to combinations of si@cant, involuntary lik disruptions and the burdens of
their compassicmate vocations. This void may be attributed to severai causes.
Several researchers (Sherman dr Thelen, 1998; Sheffield, 1998; Baird, 1999)
comment on the relative recency of the counseiling profession's attention to
issues of impairment among its pracütioners: existing literature reflects this
attention as generally focused upon imphents due to addictions or power
differmtials, and appropriate interventions and coUegial responses. Similarly,
pastoral mearchers Fortune (1989)? Steinke (1989), McBumey (1986,1989) and
others represent a p w i n g movement in the professional ministry toward
respo~t~lily attendhg to impairment problems in the dergy experience. The
focus of this movement atso tends to be upon problems and interventions
relateci to substance use, sexual behaviours and other abuses of power.
Although writers of the psychoanalytic sdmols continue to generate anecdotal
and first-person accwnts of devastatïng events in the context of their therapeutic
effects, Figiey's (1995) development of a mode1 trachg the transmission of
secondary traumatic stress is the first theoretical acknowledgement (however
~sory) of the effects of persord iife disniptions in this sphere of professional
fwictioning. DiGiuiio's (1995) investigation of diüd welfare workers
a<penencÎng signi£icant pemmaî personal is a rare example of ment research
puisuuigUusrecognition.
Nowhere, howevet, is the a dear vision of the effecfs of specifidy non-
volitional Me disniptions - random, adverse, unavoidable, catastrophic events
- in the life of a compassicmate professional, when combining thejr influence
with the deleterious effects of a "drahing" professional Me. Further, when
assessed accordhg to the suggestions of recent work by Wong (1993) in the area
of congruent coping resources, the problem of non-volitionai professionai
impainnent naturaily raises cpestions of professional d e n c e - The present
modei, Non-Volitional Imwnnmt anà Resilimce in Compnssionate Proféssionals
(Figure 4), seeks to addresPl this void. This integration of existing models
achieves the extension and viable synthesis of both the profoumi professional
effects of personal disaster first intimateci in Figley's (1995) work on compassion
fatigue, and the value of rneaning-centreci, congruent coping propounded by
Wong's (1993) model.
The construction of this mode1 of m-ditional imwnnent out of s e v d
independent segments represents, at the same tirne, a series of dependent,
synchronous and m u W y inauential elements. As noted in the ptevious
disassion, the temporal pperties of the model are l e s rigid than a simple
"start-tefinish" progression, since (depending on the individual in question) the
development of either compassion fatigue or compassion resilience may indude
cyciic, altemating andlm simuitaneow pathways. There is, however, a general
fiow to the modei, illustrateci in F i p 4, which takes care to presenre the
integrity of the contributhg models (Wong, 1993, Figure 3; Figiey, 1995, Figures
1 k 2), while concentrathg upon the activities of Uiis unique combination.
S iar ly , certain ekments (e-g. culhual context, life disrupüons,
ineffective / inadequate coping) have acqukd slightly m m limited definitions in
the blendeci model than are found in the source md&. These narrower
definitions are employed for purposes of clarity, and to direct spea6c attention
to the experiences of counselling and pastoral pfessionals at risk
CONCLUSIONS, iMPUCAnONS AND APPLICATIONS
A BriefRePieto
The c d to care for others is not without a price. Professicmals who
engage in the compassionate vocations, induding counselling and pastoral amI
are espeaally susceptible to the emotional and psydiological costs attacheà to the
long-tenn witness of distress and d e r i n g as experienced by othe~s (Figley,
1995; Witmer dr Young. 19%; Emerson & Markos, 1996; MCBURWY~ 19û6;
Raybum, 1991; Sowa, May Q Niles, 1994). Neither are compassionate
professionais invulnaable to the occurrence of similar events and conditions in
their own lives. Signihcant personal crises are quite likely to be encountered
concurrent with the demands of their professional hctions: death and
bereavement? illness, broken telationships, violence, or amUnstances of disaster
may happen to any person, of any stahis, at any time. As demonstrated in the
literature conceming secondary traumatic stress, it is at the intersection of such
catastrophic personal crises? and the intense demanâs of the compessionate
profession that the practitioner is most at risk for expe&mcing the negative
efkts of depleted coping resoutces, exhlxted particulariy in the development of
compassion fatigue. One of the contributions of the synthesized mode1 is its
emphasis that the point of criticai convergenre between pfessionai burâens
and personal tragedy need not inevitab1y result in the lasses of compassion
fatigue? but can instead offer the individuai an opportunity for growth,
ultimately becoming a path ta compassion resilience.
Th- is nothing new in the recognition of this dual-directional
phenornenon. The language of folk-wisdom is strewn with fragments applicable
to the aitical threshold of human endurance: "the straw that breaks the camel's
back," "when the going gets tough, the tough get going," "benci, but never
break," "too little, too late," and more recently, "no pain. no gain." in a simple
and elquent intetpfetation of the philosopher Neitxhze's tirneles statement,iO
one n o v a t observes that "the world breaks evefyone, then some h m e
s b n g at the broken places" (Hemingway, ated in Hicks, 1995). Biblical wisdom
unicpeiy and consistenlly expresses the understanding that this universal
eXpenence may be embtaced as an opportunity to seek the presence of Gd, that
it is only in the W s t of human weakness and brokenness that the blessings of
Gd's grace and stcength can be most dedy reaiized (e.g., 2 Corinthians 12;
Hebravs 4.15; the Book of Job). In the context of the compassionate
professional's experience with si@cant lik disniptions and impaunients of
non-volitional origins, these traditional insights conkm the model's description
of movement toward either compassion fatigue or compassion resilience.
Prot,lems of profesional impairment created by incornpetence, substance
abuse, or o h responshiiity-bearing choices have been extensively identifieci
within the disciplines of medicine, nus@ and social work. The professiom of
counselling and pastoral ministry have been markedly slower to recognize and
address these same problems, although curent Iiterature reflects a positive trend
in that direction, Less weil acknowledged in any of these fields, however, are
impairment problems related to "unconttollable" sources such as general aging,
deteriorathg mental abüities, or circumstmces of extreme advemity.
Thete are multiple and compiicated issues sinmnuiding impaired or
1 O That Mich does not k l me, mkes me strongeï(cited in Fmnkl, 1962).
incompetent professional performance assoàated with advancing age, cognitive
or peftonality dis or der^, or other h i c d conditions (not related to an identifiable
addiction). The most obvious examples are witnessed in relation to the
involuntary temination of an affecteci individual's pmfessional activities, and the
related ethical challenges confronting informeci colleagues. Clearly, awareness
of these sensitive issues demanâs M e r exploration and undersbnding in the
distinct contexts of the professions involved. Demanhg both theoretid and
concrete investigations, research in the areas of medidy-, personality-, or
aging-based impairments should also attend to appmpriate methods of
intervention and support, and to the professionai's unique experience of the
affecting conditions. E q d y important, though iargely overlooked in theory
and research literature, are the issues of potentiai professional impairment
arising h m chronically adverse conditions, and kom profound a . unavoidable
disruptions in the peRonal life of the compassionate professional. The
integration and extension of Figley's (1995) notion of degree of life dimupüon,
and Wong's (1993) batment of congruent coping, into the framework Non-
Volitional lmwment a d Resilience in Compc~stiomte Projkssiott~k is an innovation
intendeci to focus attention upon, and rudimentarily address this void. Where
the suggested mode1 of impairment a . resilience among compassionate
professionals invites application auoss these and other situations, the narrow
definition of "non-volitional" adopted hem places the problems aeated by
aging, cognitive deterioration, or personality disordm outside the scope of the
present discussionl~
11 7 he mader intsrested in leaming more about problem of aging, pmonaîity dÎÎôereô, or cogniüvely impaireci compassionate prdessiortals shoulb consult S h m n (1996). Emeison and -05 (1996). Resrner (1992), Coster and Sch- (1997). and Sheffield (1998). and pursue s e d of the excellerit reler8ms contained in thcse sources-
combined efkcts. In the absence of an integrated vision of the PefSOn-as-
professional, the stability of "just swivuig" becornes a temporary state at best,
and one more than likely to serve only as a threshold toward further signihcant
1- in eventual compassion fatigue.
The fusion of progressive and pardel work by Wong (1993) and
Figley(1995) containeci in the structure of the mode1 b h - V o l i f i o ~ I Imwment mtd
Resilience in Comp~ssionate Profetioonals moves beyond the perspective of simple
professional &val. Considered in the context of Wong's themes of culture,
congruence and coping, Figley's conceni for the practitioner saturateci with the
trauma of others acquires an even sharper focus, examining the experience of
the carhg professional faced with extreme persona1 life dimptions of a non-
voütionai nature. The unique character of this harmonization finds its fullest
expression in the model's conduding segment, where, Muenceci by Wong's
emphasis on personal meaning, Figley's concept of the condition of 1- known
as compassion fatigue is extended to indude the potentially enrichhg experience
of compassion d e n c e .
Identif'vini~ Potentid Amlications and Challenms
The constnicüon of the plesent mode1 makes no claim to rephce or
supercede existing paradigms in the fields of stress and coping theoryf
professional development, or psychotraumatobgy. It is not a workbook plan
for the development of coping styles, nor an extensive kt of çelf-care strawes
for either the counselling or pastoral professional in distress. It is not a new
mode1 of resource-based coping. Neither is it an exploration of the role of
relational-, a--, ococpatidyyf or addicüoxwbased aises in the lives of
compassionate pfessionals, since ail of these are more than adequately
adckssed h u g h literahire and research in theV respective fiel&. Similarly, the
non-volitional moàel of compassion impairment and resilience makes no effort
to resolve the ongoing professional dialogue regarding the distinctions and
similanties between secondary tramatic stress and viarious traumatization. It
is not a new modeî of trauma-tesponse thmry. It is not an artifiaaiiy
"spiritualized" application of secular prinaples to the Christian professional's
experience; nor is it a completely developeâ integration between the counseuing
and pastorai vocations. Rather, this model se& to idenbfy a speciric important
area in the experience of the professional caregiver, one which has not been weil
conceptuaiized. At the same tirne? it seeks to establish a iikdy direction for
M e r investigation, both conceptuai and empincaî, in this domain.
Given this clear focus for the -nt model of compassion
fatigue/compassion resiliencer the possi'bilities for its application are broad.
Recent research findings demonstrate strong differences in emphasis between
practitioners and academics when considering issues of professicmai pfeparation
and subsequent weU-hcüoning among psychologists. Simiiarly,
denominational administrators' perceptions of pastoral fundionhg and the
support resomes available to clergy differ signifi~i~ntly fmm the perceptions of
the cl= themselves. Given these dispanties, it seems W y that desipers of
pastoral- and clinical-training programmes d d benefit from familiarity with
the propased model. The augmenteci modeYs foo i s upon both integrated
appraisai and intepted coping in the compassionate professicmai's eXpenence
suggests a nahial bridge between the differing perspeaives of the
admsiistrator/academic and the " r d life" practitioner.
Administrators and directors of counselling agenaes and mental health
clinics (whether community, campus or private), and persans in f o d positions
of church leadership would also do well to be aware of Uiis integrative model,
with its emphasis on the potential for growth as well as loss. This is equally tnie
for counding and pastoral pmfessionals who involve themselves in extended
work with trauma swvivors, and for those who respond to emergencyl trauma
events m e n t l y , or who hindion as primary responders in the intense phases
of the traumatic event. In these instances, an understanding of the loss to
growth spectrum following si@cant non-volitional life disruptions can be
usefui both for client care, coileague care, and for enhand seif-awareness of the
professional's own eXpenences.
Persans who provide the principal emotional supports for members of
the compassionate prokssiom (espeQally spouses, other f d y members, and
colleagues) muld also benefit greatly h m understanding the rnodel's contexhial
blending of personal and professional experience. This is partidarly tnie for
clergy families where, as dernonstrateci in earlier chapters, the lines between
work life and private life are frequently blurred by the demands of a lninistry
that m o t be confineci to office hours, and which &ts in the structure of the
unique cultural community surrounding Christian clergy.
The present model invites hvther research into the phenornena of
compassion fatîgue and compassion resilience, with vimially limitless
combinations of interest. Ernpirical investigations of secondary traurnatic stress,
coping resourres, sbbility thresholds, cultural influences, and dysfunctional
behavioural choices have weil-established histones, and continue to q a n d the
spedic and general knowledge bases of psych010gy. Using the context of the
aupented mdel's integrated peftpective, and speàficaily focusing on the
etkcts d distressing conditions created by non-volitional events, extensive
empirical exp10ratim of the issues pertaining to clergy anci counselling
pmfessionals could signüicantly enhance the direction of professional support
and development, both in these particuiar fields and in general. Additionally, the
present topic raises issues and questions eminently suited to the employment of
quantitative and qualitative research methods. inquiries into unique personal
eXpenences, the development and expression of personal meanin& and the
cMlenges of coping in the midst of distress offer perfect opporhinities for case
study and depth-interview reseaich W e the psychdytic schools have
generated a spate of first-person accounts moving in this direction, the
structured investigation (both quantitative and quaütative) of questions
surrounding non-voiitionai impairment and resilience among compassionate
pmfessionals is an m a clearly in need of advancement, and one which is primeci
for p w t h in the inunediate future.
F M y I the construction of the non-volitional impairment and resiiience
mode1 is most applicable to the direct experiences of the professiona.ls upon
whom it is focused. CouIlsellors and degy, pviding intimate and supportive
care to emotionally wounded people on a continuing basis, are themselves at
tremendous risk for distress when faced with a personal and uncantrollable
catastrophe in addition to the demnds of theV w& This is the heart of
understanding non-volitional impairment. Compassionate profesionals will
benefit from actpiring a dearer vision of the unicpe cultures of their professions,
the relatiomhips between personal and professionai distresses, the desirability of
developing a b d repettoire of feasiile and congruent coping tesomes, the
se& for personal meanin& and the spectnim of potential loss and purposefui
growth.
A Final Wwd
Thete is a price exacted in living out the vocational caii to care for others.
Compassionate professicmals kqyently pay that price in the coin of absorbed
trauma, private distresses, and ultimately, devastating personal and professional
impairmentS. The vision behind the present model is to assist pastors and
counsellors in developing a more complete understanding of the need to realize
th& personal and professional inkgration, and to prepare purpasefully for the
near- tuunbearable burdens created when their "mal Me'' colides with the
compassionate demands of wotk. To impart a similar vision of the potential for
enrichment and resilience beyond the losses of compassion fatigue is the
ultimate, extravagant, and sincere purpose of this harmonized model.
Akcom, R, (19%). Strategies to keep h m falling. Leadeishi~: A Practicai Joumal for ChUrch Leaders, 17 (3), 46 - 54.
Amerian Psychiatnc Association, (1980). Diagnosttcmrd statistiuzl munual of mmtol disorderr (3rd ed.). Washington, DC: Author.
American Psychiatrie Association, (1994). Duignostic mui statistiaf n r m d of mental disorders (4th ed.). Washington, DC: Author.
Andetson, D., (1992). A case for standards of counseling practice. J o u d of Counsehpt and Develovment, - 71 (l), 22 - 27.
Anderson, J. L, (1994). Treatment considerations for the addicteci nurse. Behavioral Health Management, 14 (S), 22 - 26.
Baird, B. N., (1999). Tlar internship, pmcticum, adfleld phcement handbook A guide jbr the helping pro#ssions, (2nd ed.). Upper Saddle River, NJ: Prentice Hall.
Benda, B. B., k Diilasio, F. A., (1992). Qeqy rnarriages: A multivariate mode1 of niarital adjustment. J o d of Psvcholoev and TheolomI 20 (4), 367 - 375.
Blackbird, T, Q Wright, P. H, (1985). Pastors' fnendships, Part E Rqect overview and an exploration of the pedestai effect. Journal of Psvcholoay_ and The01wI 13 (4), 274 282.
Briere, J., (1%). Therapy* adults molested as chr?d~m: Bcyad sumiual(2nd ed.). New York Springer Publishing.
Bmwn, C, k O'Brien, K. M.? (1998). Understanding stress and h o u t in shelter workers. Professicmal Psvcholm: Research and Ractice. 29 (4), 383 - 385.
Burish, T. G, 6r Bradley, L. A., (1983). Coping with b n i c disease: Definitions and issues. In T. G. Burish & L. A. Bradley, (Eds.)., CWng with chrmic disense: Rmwch and applications. New York: Academic Press.
Canadian Nurses Association, (1998). Cornpetencies@ the yem 2000: Nurse regis tration / licensure examination. Ottawa, ON: Author.
Carbond, J. L., dt Fi* C. R, (1996). When trauma hits home: Pemmd trauma and the famiiy therapist. JO& of Marital a d Familv T h e r a ~ v ~ 22 (l), 53 - 58. -
Chasen, B., (19%). Death of a p s y c h d y s Y s diild. In B. Gerson, (Ed.), The therapist as a pmon: L i ! crises, life choiccs, lifé experimces, und thpir eficts on heahmt. Hillsdale, NJ: Analytic Ress.
Civin, M. A., Q Lombardi, K. L., (1996). Chloe by the aftemoon: Relational configurations, identificatory processes, and the organization of ciinicaî experiences in unusual drcumstances. in B. Gerson, (Ed.), The therupist as a
p m n : L i ' m.ses, Iifi ciwices, Iife qmèncesI and Nvir e@& on traatment. Hillsdale, N J: Analytic Press.
Coison, D. B., (1995). An anaiyst's multiple losses: Countettransference and other reactions. C o n t e m ~ o m Psvchoanalvsis, 31 (3), 459 - 478.
Cmmdia Self-Shuiy Bible: New l n t e m t i m f VPmon (1%). St. Louis, MO: Concordia.
Coster, J. S., & Schwebel, M., (1997). Weil-functicming in professional psychologists. Professional Psvchology: Reseatch and Practice, 28 (l), 5 -
Couhseimai, E. F., & MO;CLSO, A., (1993). The ill therapist Therapists' mactions to
personal illness and its impact cm psychotherapy. herican Journal of P s v c h d ~ s i s , 47 (4), 591 - 603.
Daines, B., Gask L., 6t Usherwood, T., (1997). Medial a d psychintnc issues@ wunseIlms. London: Sage Publications.
DeWald, P. A., (1994). Countertransference issues when the therapist is ill or disabled. Arnerican loumal of Psvchothera~v, 48 (2), 221 - 231.
Diciulio, J. F., (1995). A more humane workplace: Responding to chüd welfare workers' personal losses. Child Welfare, 74 (4), 877 - 889.
Emerson, S., & Markos, P. A., (19%). Signs and symptoms of the imparied counselor. journal of Humanistic Education a d Develovment, 34 (3), 108
Epstein, R S., 6s Simon, R I., (19%). The Exploitation Index: An early wamhg inacator of bowidary violations in psychotherapy. Builetin of the Menninger Clinic, 54 (4), 40 - 466.
Epstein, R S., S ion , R. L, & Kay, G. G., (1992). Açûessing boundary violations in psydiotherapy: Survey redCs with the Exploitation Index. Bulletin of the MenNn~er Clhic, 56 (2), 150 - 167.
Falbo, T, New, B. L, Q Gaines, M., (1987). Perceptions of authority and power strategies used by clergymen. Joumal for the Scienüüc Studv of Reli~on. 26 (4,499 - 507. -
Farnsworth, K. E., (1998). Wmcndrd mh: Rewueritrg~om hcortache i~ the
workplace mui the church. Mukiiteo, WA: WinePress Publiçhùig.
Figley, C. R, (Ed.), (1995). C~1~p11ssimfitigue: Coping witk secondmy haimafic stress disrder in those who haPt the traumtafued. New York: Brunner/Mazel.
Figley, C. R, (July 23,1999. Persmal ~~~ll~~lunication via electroIiic maiL Permission to use elements of compassion stress/compassion fatigue
models.)
Figley, C. R, Bride, B. E., dr Mazza, N., (Eds.), (1997). Dmth a d tmuma: 7'he hmcmatology of g ~ i d n g . Washington, DC: Taylor dc Francis.
Fortune, M. M., (1989). k nothing sacred?: Whm sex imdes the p s t d relatimship. San Francisco: HarperCollins.
Frame, M. W./ & Stevens-Smith P., (1995). Out of harm's way: Enhandg . . monitoring and dismissal processes in counselor education programs.
C o d o r Education and SuDervision, 35 (2), 118 - 130.
Frankl, V. E., (1%2). Man's search fir menning: An introduction to Logotherapy (revised ed.), translation by 1. Lasch. New York Simon dr Schuster /Toudistone.
Gd, R, (1988). Colleagues in distress: 'Welping the helpers." Intemational Review of Pmchiatrv, 10 (3), 234 - 239.
Gerson, B., (Ed.), (1996). The therapist as a pmon: L i i Nos, life choices, lifi expenbencesf a d their effécs a heatnent. Hillsdale, NJ: Analytic Press.
Gibson, W. TV & Pope, K. S., (1993). The ethics of comlling: A national s w e y of certiûed counse1ors. Jounial of Counseline and Develo~ment~ 71 (3), 330 - 337.
Gold, J. H. dr Neahh, J. C, (Eds.), (1997). B e y d hmfiretlce: WhPn the themptist's rml Lfe intrudes. Washington, DC: Arnerican Psychiatrïc Ress.
G d , G. E, Thoresoc R W., & Shaughnessy, P., (1995). Substance use, confzontation of impaired colleagug, and psychologid functioning among coutiseling psychologists: A national survey. Counselinp:
PsYchoIloait. 23 (4), 703 - 722.
Grunebatun, H, (1993). The vulnerable therapist: On being ill or injuteci. In J. H. Gold Q J. C. Nemiah, (Eds.), & y o d ham~ence: W h the tkapist's r d lifi infrudes. Washington, DC: American Psychiatrie Press.
Guy, J. D., 6t Liaboe, G. P., (1986). The impact of conducting psychotherapy on the psychotherapist's interpersonai functioning. Professional Psvcholoe]~ Resemch a d Practiœ, 17, 111 - 114.
Hall, T. W., (1997). The personal functioning of pastors: A review of empirid researdi with implications for the are of pastors. and Theolonv, 25 (2), 240 - 253.
Hazler, R J., Kottler, J., (19%). Following thugh with the best of intentions: Helping impaired profesdonalS. 1ourna.i of Humanistic Education and Develo~ment 34 (3), 156 - 159.
Herlihy, B., (1996). When a coileagw is impaired: The individual counselof s ~esponse. Journal of Humanistic Education and ûevel01)ment~ M. (3), 118 - 128.
Hicks, R M., (1993). Tmum: Thc pin that stays. Grand Rapids, MI: Fleming ReveU.
Hickson, J. H., Gudz, G., k Horribude, D. R, (1995). Grnip work with Catholic priests who have exited the derical world. Counselinjz - and Values, 40 (l), 32 - 44.
Hill, E. W., dt W e , S., (1993). Coping with the s t r e s of pastoral counseiùig. J o d of Relinion and Heaîth, 32 (2), 121 - 130.
Hoff, L. A., (1995). People in crisis: UNimtrmding and hefping (4th ed.). San Francisco: Jossey-Bass.
Hoffman, R M., (1995). Sexuai dual relationships in cniiiseling: COnffonting the
issues. C0urtse.h~: and Values, 40 (l), 15 - 23.
Hopkins, N. M., (1991). Congregational intervention when the pastot has cornmitteci sexual misconduct. Pastoal Pwch01m, 39 (4), 247 - W.
Jennings, L., h Skovho1t, T. M., (1999). The cognitive, emotionai, and relational
Johansen, K. H, (1993). Countertransfmce and divorce of the therapist In J. H. Gold dr J. C . Nemiah (Eds.), Bqond bansfemce: Whnt the tkapist's real fifi inlnuks. Washington, DC: Arnerican Psychiatrie Press.
Kagel, J. D, & Giebeîhausen, P. N., (1994). Dual relationships and professional boundaries. Social Work, 39 (2), 213 - 221.
Kennedy, K. A., Eckhardt, B. N., & Goldsmith, W. M., (1984). Church membed expeaations of clergy personality. journal of Pastoral Counselins 3 (3), 9 - 18.
Kieren, D. K, 6r M m , B., (1988). Handling greedy dergy des: A dual de%y example. Pastoral Psvcho~ow, 36 (4), 239 - 248.
Kilburg, R R, Nathan, P. E., k Thoreson, R W., (Eds.), (1%). Proféssiomb in distress: Issws, syndromes, and solutiom in psychlogy. Washington, ûî: American PsychoIogicai Association.
Kunst, J. L., (1993). A system malfundion: Role conflict and the minister. JoumaI of psycho^^ and Chtistianitv, 12 (3), 205 - 213.
Lamb, D. A, Presser8 N. R, Pfost, K. S., Baum, M. C, Jackson, V. R, & Jarvis, P. A., (1987). Confronting professional impairment during the internship: IdentScation, due pc0cess8 and remediation, Professional Pmchol- Research and Practice, 18,597 - 603.
Lasky, R, (199ûa). Catastrophic illnes in the analyst and the anaLysYs emotional reactions to t International l d of Psvchwhalvsis, 71 (3), 455 - 473.
Lasky, R, (1990b). Keeping the analysis intact when the d y s t has d e r & a
catastrophic iUness= Clinical considerations In H, J. Schwartz & A. S. Silver, (Eds.), ZZlness in the annlyst: InrplicatimisfOr the bmtntent reiatiowhip. New York: International Univmities Fress.
taZar, S. G., (1990). Patients' resporesp to pltegnancy and miscarriage in the analyst. Tn H. J. Schwartz & A. S. Wver, (Eds.), Illncss ni the analyst: ImplicatonsJbr the trevlhnmt refutionship. New York Intemationai Universities Press.
Lazarus. R S., & Folkman, S., (1984). Stress, appraisal and coping. New York: Springer.
Lazants, R S., & LamierI R, (1978). Stress related transactions between persans and envVonmentI ated in L. A. Perwi & M. Lewis, (Eds.), Perspectives in interacfibnal psychology. New Y& Plenum Press. In T. G. Burish k L. A. Bradley, (Eds.), (1983). Coping with chronic disease: Researck and applimtim. New York: Acadernic Ress.
Mahoney, M. J, (1997). Psychotherapists' personal problems and seIf-care patterns. Professional Psycholonv: Research and RadieI 28 (l), 14 - 16.
McBumey, L., (1986). Counscling Christian Workers. Waco, TX Word Books.
McBumey, L., (19%). Why 1 resist accountability. Leadershim A Practical Journal for Church Leaders, 17 (3), 34 - 40.
M c L d , J., (1992). What do we know about how best to assess counsellor
Meminger, W. W., (19%). Paditioner, heal thy& Coping with sîress in &cal pctice. Bulletin of the Menninger Clinic. 60 (2), 197 - 206.
Mickey, P. A., Wilson, R L, & Ashmore, G. W., (1991). Denominationai variations on the mle of the ci- family. Pastoral Psvcho1wI -- 39 (S), 287 - 294.
Miller, G. A., Wagner, A., Britten, T. P., & Gridley, B. C, (1998). A framework for understanding the wounding of healers. CourzSelinp: and Values, 42 (2), 124 - 133.
Mitchell, S. A., (19%). Aftmord. In B. Gerson, (Ed.). Tho therapist as a person: Li' nises, life cbices, life eqmiences, ami k i r effrcts on treafment. Hillsdale, NJ: Analytic Press.
Morris, M. L, & Blanton, P. W., (1994a). ûenominational perceptions of sûess
and the provision of support services for dergy families. Pastoral P N d i o l o ~ . 42 (5), 345 - 364.
Momis, M. L, & Blanton, P. W., (1994b). The iduence of work-related stressors on cl- husbands and th& wives. Farnily Relations. 43 (2). 189 - 195.
Morris, M. L., & Blanton, P. W., (1995). The avdability and importance of denominational support SeMces as perceived by clergy husbands and rheV wives. Pastoral Psvcholonv, 44 (l), 29 - 4.
Morrison, A. L., (1990). Doing psycho108y while living with a Me-threatening illness. In H. J. Schwartz 6r A. S. Siver, (Eds.), nlness in the analyst:
Implicntimisfm the heatment process. New Y& International Universities Press.
M m h n , A. P., (19%). Tauma and disruption in the iife of the analyst: Enforred Woslve and disequüibnum in "The analytic urstrument". In B. Gerson, (Ed), nit therapkf as a p s m Lifi Ncs, fifi chices, fifi
expienas, and their eficfs on heutment. Hillsdale, NJ: Anaiytic Press.
Muse, S., B Chase, E., (1993). Healing the wounded healers: "Souln food for clergy. Joumai of PsychoImv and Christianitv, 12 (2), 141 - 150-
Nadelson, C. C, (1993). The therapist's absences. In J. H. Gold & J. C. Nemiah, (Eds.), B y o d trans&ence: Whni the thernpfsf's real lifé inhudff. Washington, DC: American Psychiatrie Press.
Nemiah, J. C., (1993). Concluciing dections. In J. H. Gold & J. C. Nemiah, (Eds.), Bey& b m ~ e n c e : Whon the therapist's raal lifi intmks. Washington, DC: American Psychiatnc Press.
Neuk~g, E. S., He*, MM, 6t Herlihy, B., (1992). Ethical practices of licensed professional counselors: An updated nirvey of state iicensing boards. C o d o r Education and SuDervision, 32 (2), 130 - 142.
Neukrug, E. S., Q Williams, G. T., (1993). Counsekng counse10rs: A survey of values. Counselinp: and Values, 38 (l), 51 - 62.
Nouwen, H. J. M., (1979). The wounded k l e r Ministry in wntetnpof~ty societtj.
New York: Image Books/ Doubleday.
Nouwen, H. J. M., McNei11, D. P., & Morrison, D. A., (1982). Compssim: A rEpectim on the Chrrstian IijE. New York Image Books/ Doubleday.
Olsheski, J , & Leech, L. L.. (19%). Rogrammatic intementions and treatment of impaired professionais. Journal of Humanistic Educaticm and ûevelo~rnent, 34 (3), 128 - 141.
On; P.? (1997). Psychobgy impaired? Proféssional Pwcho1ogy: Researdi and Practi~e, 28 (3), 293 - 2%.
Ostrandert D. L., Henry, C S., Q Hmdnx, C. C., (1990). The Stressors of C i e f g y
Children Snventoiy: Reliabilty and validity. PsvcholoPjcai Rewrts. 67, 787 - 794.
Owen, 1. R, (1993). On "The private life of the psychothetapisr and the
psychology of caring. CouIlSeUinp: Psvd io lq Ouarterlv, 6 (3), 251 - 265.
Owen, 1. R, (1997). Boundaries in the practice of humanistic CO-g. British Journal of Guidance and Counsellin~, 25 (2), 163 - 175.
Peacock, E. Jv 6r Wong, T. P. T., (1990). The Stress Appraisal Measme (SAM): A mdtidimensional approadi io cognitive appraisalc S h s s Medicine. 6,227 - 236,
Philip, C. E., (1993). ûilemmas of disclo~su~fe to patients and colleagues when a therapist faces lik-threatening illness. Heaith and Swal Work, 18 (l), 13 - 20.
Pope, K. S., & Tabachnick, B. G., (1994). Therapists as patients: A national suntey of psych01ogists' experiences, problems, and beiiefs. Professional PsvchoIm: Research and Pactice, 25 (3), 247 - 258.
Pope, K. Sv & Vaquez, M. J. T., (1991). Ethics in psychothprapy and wunseling: A pracfia1 guide* pychofogists. San Francisco.. Jossey-Bass.
Raybuni, C. A., (1991). Counseling depressed female religious professionals: Nuns and dergywomea Counseline and Values, 35,136 - 148.
Rayburn, C. A., Richmond, L. J , & Rogers, L, (1988a). Stress in singie and mamed deqy: 1. Ioumal of Pastoral COuIlSeljn~~, 23 (l), 31 - 33.
Kaybum, C. A, Richmond, L. Jv & Rogers, L, (198Bb). Stress in single d mamed cl-: 11. Joumal of Pastoral Counseîins 23 (l), 34 - 36.
Raybwn, C. A., Richmond, L. J., 6r Rogers, L, (lm). Stress in single and
married dergy: IU. J o d of Pastoral Counseling, 23 (l), 37 - 38.
Raybum, C. A., Richmond, L. J., 6t Rogers, L., (19ûûd). Uergy couples and stress: When dergy marry dergy. Journal of Pastoral Counselinpu 23 (l), 39 - 41.
Raybum, C. A., Richmond, L. J., 6r Rogers, L., (1988e). Clergymen, defgywomen, and their spouses: Stress in marrieci ciergy. Joumai of _Pasoral Couflselinn, 23 (l), 42 - 46.
Raybum, C. A., Richmond, L. J., & Rogers, L., (1988f). Stress, reiigion and marriage in women. Joumai of Pastoral Counseline 23 (l), 54 - 56.
Raybum, C. A., Richmond, L. J., & Rogers, L., (1988g). Fernale rabbis, ministers, and priests and the Religion and Stress Questionnaire. J o d of Pastod Counselinpv 23 (l), 61 - 63.
Ray& C. A., Richmond, L. J., 6r Rogers, L., (1988h). F d e rabbis, Protestant cle%ywomen and stress. Journai of Pastoral CouTlSelin% - 23 (l), 64 - 66.
Reamer, F., (1992). The impaired soaal worker. Soaal Work 37 (2), 165 - 171.
Registered Nurses Asswation of British Columbia, Registereà Psychiatrie Nurses Assoaation of British Columbia, dr British Columbia Council of ticensed Practid N u r ~ e ~ ? (1995). Nune - Climt reiationships: A discussion patm mt prprmtti~g abuse ofclients mzd expectatimfir profisional behapiour. Vananver, BC: Authors.
Richmond, L. J., Ray- C A., 6r Rogers, L., (1988). Stress within reiîgious leadership mies: What counselors need to how. Journal of Pastoral Coun~elinn, 23 (1). 67 - 71.
Rogers, Le, Raybum, C. A., & Richmond, L. J., (1988). Reiigion and stress: The male dergy and spouse, or the wife and her dergy husband. Joumal of Pastaai C- 23 (l), 47 - 53.
Schlachet, P. J., (19%). When the therapist divorces. In B. Gemon, (Ed.), The therapist as a perum: Lifi crises, lifé choims, fifi @enas, d tthri eficts on hentnimt. Hillsdae, NJ: Analyüc Press.
Schwartz, H. J., (19û7). nùress in the doctor: hplications for the psychoanalytic pmcess. In H. J. Schwartz 8 A. Siver, (Eds.), lhess in the analyst: Impliçatimjbr the treahnont refutimiship. New York Intemational Univdties Press.
Schwartz, H. J., 6r Silver, A, (Eds.), (1990). Illnas in the d y s t : InrpliartiotlsJw the
treatmoit relationship. New York: Intemational Universities Press.
Schwebei, M., & Coster, J., (1998). WeU-functioning in professional psychologists: As program heads see it. Professional Psvdioloey: Research and Practice, 29 (3), 284 - 292. -
Sheffield, D. S., (1998). Counseior impairment: Moving towarâ a CO&
definition and protocol. Journal of Humanistic Education and Develcmment, 37 (2), % - 107.
Sherman, M. D, (19%). Dishess and professional impairment due to mental heaith pmbiems among psychotherapists. M e w , 16 (4), 299 - 315.
Sherman, M. D., k Thelen, (1998)- Distress and pmfessional impairment among psychologists in clinical practice. Rof&ona.l Psvdtolm: - R e s e d and Practi~e. 29 (l), 79 - 85.
Silver, A. S., (1982). Resuming the work with a Me-threatening iîlness - and further rdecfions. In H. J. Schwartz dt k S. Silver, (Eds.), nlness in tfre mlysf: lnrplicatimjbr fhe herrtment relatimhip. New York International Universities Rress.
Simon, J. C., (1990). A patient-therapists reaction to her therapists serious illness. American J o d of fsvchothera~y, 44 (4), 590 - 59%.
Sko~pa, F, dr Agresti, A. A, (1993). Ethicai beliefs about bumout and continued professional practice. Professional Psvchology; Research and Practice, 24 (3). 281 - 285.
Slaüceu, K. A., (1990). Crins intpmention: A handbwk/or practice and reseylrch (2nd ed.). Boston: Ailyn and Bacon.
Sb, B. D., Q W i , R N. (1995). What's behinâ the reseatch?: Dismdng hiddPn assumptims in the bebimal sciences. Thousand Oaks, CA: Sage.
Sowa, C. J., May, K. M., 6r Ni, S. G, (1994). Occupational stress within the counseling profession: Implications for counselor training. Counselor Education and Supervision, 34 (l), 19 - 30.
Speckhatd, A., (1997). Traumatic death in pfe&nancy: The significance of meaning and attachment, In C. R Fi*, B. E. Bride, & N. Mazza, (Eds.), Dath a d trauma: The tmumatology of grieaing. Washington, DC. Taylor & Francis.
Stadler, H., Willing, K., Eberhage, M.. & Ward, W., (1988). Impairaienk Implications for the counseling profession. Journal of Counselin~ and Develcmment - 66,258 - 260.
Stamm? B. H, (Ed.), (1995). Secondary hmtmntic stress: Sel/-Me issuos for clinicumS, resaarhs anà edmztors. Luthde, MD: Sidran Press.
Steinke. P. L., (1989). Clergy &airs. Journal of Psvdiolopy and Christianit~, 8 (4), 56 - 62
Stevens, B. F, (19%). The effects of sexual trauma on the self in clinical work In B. Gerson, (Ed.), The therapist as a person: Lifé crises, lifi choices, lifr expen'ems, a d tkir eficts a traitment. M a l e , N J Analytic Press.
Strang, J , (1998). Missed pblems and missed opportunities for addicted doctors. British Medical Tournai, 316 (7129), 405 - 407.
Sue, D. W., dr Sue, D., (1990). Cmnseling the culturully di&ent: Throry and practice. New York Wiley.
Swenson, I. E., & Foster, B., (1995). Malpfactice coverage for health professionais with physical, mental or substance-abuse impainnents. Hamital Topics, 73 (3), 21 - 26. -
Varnos, M., (1993). The bereaved therapist and her patients. Amencan Journal of Pmchothera~v~ 47 (2), 2% - 306.
Vance Peavy, R, (19%). Counselling as a culture of heaüng. British loumal of Guidance and Counsebac 24 (l), 141 - 151.
von Stroh, S. P., Mines? R A., & Anderson, S. K., (1995). Impaired dergy: Appiications of ethical p~cip1es. Counsehp: and Values 40 (l), 6 - 14.
Wamer, J., & Carter, J. D., (19û4). Loneliness, marital adjustment and h o u t in pastorai and lay persons. Iournal of Psvcholonv -- and Theol- 12 (2), 125 - 131.
WmhawI S. C., (19%). The loss of my father in adolescence: Its impact on my work as a psychoanalyst. In B. Gerçon. (Ed.), The therqist as a person: Lifi cris, Iifi choiees, Iifr exprripnces, and t k r eficts on treutment Hillsdale, NJ: Analytic Press.
Webb, S. B., (1997). Training for maintaining appropriate boundaries in
counseuing. British T o d of Guidance and CounseIlYm, 25 (2), 175 - 189.
Weinberg, H, (1988). Illness and the worbg analyst W i Alanson White Psychoanalytic Society Symposium: Transitional issues in the iife cyde of the p s y c h d y s t (1987, Walker Valley, New York). Contemmrarv P~~chOanal~sis, 24, (3) 452 - 461.
Witmer, J. M., & Young, M. E., (19%). Preventing counselor impairment: A welines appmach. Ioumai of Humanistic Education and Develomnent, 34 (3), 141 - 156. -
Wo- T., (1990). Death of the psychoanaiyst as a form of termination of psychoanalysis. in H. J. Schwartz & A. S. Silver, (Eds.), Illness in the mfyst: ImplicatimfDr the haahnent relitionship. New York International Universities b.
Wong, P. T. P., (1991). Mstential vetms causai attributions: The swal perceiver as philosopher. In S. L. Zelen, (Ed.), New mudels, new extmions of attnktion thcoly. New York Springer-Verlag.
Wons P. T. P., (1993). Effective management of Me stress: The resource- congruence rnodel. Stress Medicine, 9,51- 60.
Wyatt-Brown, A. M., (1995). Creativity as a defense against death: Maintaining one's professional identity. Special issue: Geativity in the face of death: Ciaire Phdip's journals and poems. Journal of APjnn Shidies. 9 (4), 349 - 354.
Casr 1: Louisa. a Mmtal Heulth lkeram&
Louisa is a childrens' mental health therapist. She is a pvinciai
employee, w o r h g out of a community oface in a district with an urban and
rurai blend. Whiie the majority of Louiea's caseload are children who have
eXpenenceci m e form of semai abuse, she aiso sees children and families who
may be eXpenencing @lems unrelateci to sexual exlploitation. Lüce other
therapists across the provincep Louisa's office is s e v d y understaffed for the
popdation it m e s ; she is chronidy overbooked, works through her breaks?
and tiequently completes case notes and other paperwork on her own, unpaid
time.
Louisa loves ici&? and the creative things she's able to do to help them,
but she's been feeling less than enthused about this set- she has worked in for
so long. The pcditicized climate of the office and its pubk employer have a
grhding effect on Couisa and ha colleagues. In fact, she thinks some of thern
might have lost th& professional ideaüsa It's t h g to go into work, especially
in the days fdowing a fundingat announcement, or when the media focus on
a hi@-profile child-at-rik Louisa has, lately, found herseIf living for statutory
holidays. Ftequent and signincant staff dranges are becoming more of a
pmblem, too. Louisa sees many of her lcmg-time colleagws seeking transfers or
leaving the profession altogetherp and theK replacements - often only recently
trained - generally stay for only a short while. This instability is maLing it
for Loulsa to suetain reliable condting amtacts and at-work supports.
Louisa has both personal and professianal reasons for remainmg in her
job. She has invested s e v d yeam building her career and developing effective
methods to work with %et kids"; she likes the commUNty she iives in, and is
not willing to renew the fuiancial risks of starüng over; and she feeis a sense of
duty to the chiidren she m e s and those yet to corne..... "if not me, who?".
Louisa beiieves that wen a little bit of change d d help her pst this bumt out
feeling; pezhaps just one more permanent, expdenceci staffer, or a new
structure for flexible work hous. She hopes, but without much conviction.
Yesterday moining Louisa saw a new client family in an emqency
situation, a case that she kmws is going to be long and e m o t i d y costly to
c m . The children d v e d with theh mothei. Just two days ago, they
witnessed the violent death of th& father, as he tried to aid a woman who was
king assaulted. Her attackers turned their hiry upon him, kickhg him to death
in front of his family, then ran away as other witnesses called the police and
moved fmd to heip. The young famiiy had been out for a spedal night of
hamburgers and a movie; it h a p p d in the theatre parking lot
Reading through the !künd Senrices notes was hader than it usually is.
Louisa eXpenenced an ovewhelming pit-of-the-stomach feeling and found
herself battling sipificant shock symptoms. It took her several minutes to
compose heRelf before going intb the Quiet Room to be with this little family,
and hear their story.
Her su- later cunvinced her b book off the test of the day, as
Louisa seemed unwell following the session. Since then she has, in fact, been
experiencing buts of nausea, lœt concentration, confusion, a<treme jumpiness
and intntsve visual images. She feeis lüre she is king assauited aii ova again,
but she knows that it isn't really happening. niat was all over twelve years aga,
and she knows that she is d e at work, at hoaie. Really. But living through the
little farnily's story - and it is still unfo1ding for them - has taLen werything
out of her. Ifs "sent her right back there."
Louisa made a deasion k t night. She's going to quit her job.
This has been one of the longest weeks of Louisa's life. It's been fau days
since she decided to throw in the towel at the Ministry. So why is she bobking
clients into next month? Because her supervisot wouldn't accept her nesignaticm.
Because they talked it aii out Tuesday moniing, and Louisa stiU couidn't onvince
him why qui* was her best opnion. Because she feeis a little bit guilty over
the idea of abandoning ship in a crisis, when hurting kids don't have the same
choie. Because mat of the the, she beliwes in what she does. Because Dr.
Blacklock said he had some ideas about what's gohg on fm her right now, and
some plans about hav they can do some crisis management, and how to
support her thiough this. kause he made his own commitment to heip her
help this little famiiy. Because she thuught she was made of stronger stuff? and
hopes to be again.
So, she's staying. Tnie to his wod, Louisa's superpieor started with some
basics. Same of h m have nothing at all to do with clients. The fkst thmg was
to set a rekRal to set hes EAP in motion. He's not her therapist, ,Dr. Biacklock
said, but he's been around long enough to h w compassion fatigue when he
sees i t Louisa's always known about PTSD in her kids and familes, but she has
never thought of its d e in the context of her own helping pdession. She's SU
exhausteci, but tecogniPng just that mudi has producd an aiormous relief in
the iast couple of days.
As well, fhey've wmked out a Uree month half-the leave, with a plan to
teview it neai the end, in case Louisa needs an extension. With her resignation
letter back in hm own hand, Louisa realizes that she simp1y can't a f f d to quit
her job. She can't really afford an extended LOA, either. Twelve weelcs at half-
time soumieci wonderfd, but since she's never head of an anangement like
that, louisa wasn't convincd Pagonnel would ok it. Dr. Blacklock said that's his
pbtem, not hem, and besides ....... they'l be happy enough once the nwnbers
pmve m m favmable than another posting-search-6r-hire process. Anyway,
he'd rather help to hep a good therapist intact-
%, Couisa's scheduling into next month, spacing out her caseload, and
paesing on new intakes to support w o r h . She just might survive thtough all
ttnis.
Case 2. Cr& a Parjsh Pasta
Pastor Craig is in bis fourth year of arinistry with a small suburh parbh.
Before this, he spent six years as an assistant- and youth-pasta in a large
meûmpoiitan congregation. Craig began his W - t h e ministry fifteen years ago,
when he was d e d to serve a mdti-point d eh. Pastor Caig and Grace
have been marrieci far fourteen years and have three children, ages 13,lO and 6.
Grace carries out a lot of "unsung" ministry in the congregation, in addition to
c d worlr as a float nuise at the local hospital* The couple welcomes the extra
income her job provides, but between Caig's busy schedule and Grace's short
notice for shüts, they are often pnidied for family time, and regularly have to
juggle arrangements.
Although far h m all theh reiatives, Pastor Ciaig and Grace like the t o m
they are presently living in. Besides nndmg a 'hame" for themseives in the
chu& they have made fnends with s e v d families in th& neighbourhood, are
happy with the local sdtools, a d have their kids involveci in lots of community
and congegational activities. Craig and Graœ hope to be able to buy a home of
their own within the next year.
Like al l congregaticms, in spite of a grnuine de& to follow Quist, this
church has its problerrts. At the t h e of his arrivai, Pas- Craig found the parish
riwn with disagreements and Mties, both real and imagineci, so the major
portion of his enagies have been chcted t o w d couns&ng, building and
reconciiinp relationships. It has mpi& a huge motional investment fnnn
both Craig and Graœ, but in this f d year they are keling enamrageci by
iitüe s i p of pmgress.
Last week, at the monthly lunch meeting held between m e m b of the
community's ministerial, cme of Craig's colleagws sufkred a heart attack Craig
was diredly involvd as a h t responder? Ireeping CPR going with Fathet
PetireUi's Wp until the ambulance arriveci. AU the whiîe? mernories of that other
tirne he'd had b do the same thing - for his dad - kept flashing aaoss Craig's
minci.
He's been inQedl%ly tireci sine then. Grace ha9 been heipfd, but
everyone else seems to expect the same measure of Pasta Craig that he dways
gives. This morning when the phone rang More breakfast, he tned to just
ignore it. When he caught it on the fourth ring, it tmk a couple of minutes
before he ~alized it was his brother-in-law, ttelling him that Grace's dad died in
the night.
She's standing m the doaway now, asking Craig why he looks so ill.
Today feels a thousand years long. He's still not mdy over last we&s
crisis. Craig is tired of leaving phone messages? and thinking in details and
arrangementsI and then remembeMg why he's ha* to do it ail. S i this
moming's di fkm Dave, it kels like that all he's ôeen doing. That, and praying,
and wonrying about Graœ. She's doing ok, amsidering, but it is sort of hard to
tell with her. Eght now she's ok - the kids are with her, malring some cards
for th& Nanna. Craig'Ujoin themas sain as he finishes the notes for the
deaams.
After thqr heM one another thmu@ the absolute shock of Dave's news,
one of the fmt things Craig and Grace had to do was malce a tough deâsicm.
Therets no question they'd rather have the kids with them right now, but they
have to be realistic about time and money. Their firiances can't stretch to airfare
for ail five of them. And this ien't a holiday where they could camp the way
there a . badc again; it would mean mot& and restaurants for several days.
Besides, there isn't enough time, he doesnpt have enough energy to drive it, and
he wddn't want Grace to be stucL in that kind of limbo until they get to their
f d e s . He dK1 suggest to Gace that she should t& Poily with her, and he'd
stay home with the two y-er kids. He can't believe how muchbetter he
achially felt when she said no, she'd rather have him with her - what 14nd of a
dad is that?!? Then Dave called again. Gtace's mom thought she'd like to have
Craig take a part of the service.
So. Their night leaves b m m w rnoming at 10.00. The kids are taken
care of. As soon as the news started making its way through the church, Freddy
and Cade were there, annOUhQng thqr'd keep the kids at their place. What 's 3
more on top of the crew we've got? T h e 0 be ok ...out kids are already
drasgmS out the au-mattresses! We're so sorry about Grace's dad. Remember
we're keeping you ali in our praym." He's arrangecl with the deacons and
another local pastor to covet the church's needs for the week; they'U be badc by
nextsimday.
Craig's sure t h e ' s something else he's sripposed to arrange, but he can't
q i t e thmk of i t On top of eveqdùq else, he's banc-weary. It's been that way
since the day the emergency happened at the ci- lunch. He just hadn't
realized how mu& he's been relying on Cacm to be the strong one since then.
The problem is, he doesn't feel strong e w g h to camy hm through this.
Case 3: RidlRtd, a Shrderrt Scnrr9ces Counsellor
Richard has been on staff at the University Counselling Centre for six
years, having reœntly moved into a senior therapist position. Ifs a busy place ail
yen, servir\g bath students and the City where the University is located. Like
most 0th- branches of sWaG a d student-senrices? the Centre is having to do
more with lem; Richad is now respol\sible for 21 3 administration arsd a 31 5
caseîoad. He's done the math, and hows Uiat on paper ifs an equation for
ovedoad. But W s on paper. Ifs not going to be much of a problem for him in
real Me. Richard draws a lot of energy h m his contact with students, the
academic atmoephere, anà the physicai setting of the U. He fmds a hectic
schedule invigoraüng. He's in a g d marriage. He's fit, and considers himself
relativeiy young - he can SM see 30 - so Richard isn't really womed about the
extra load at wmk.
Today was the worst of bad days at work One of the students Richard
has ken wmking with for severai months, D., twk his own life during the
night. The constabies came to the Centre this moniing with the news, and the
questions. Ifs nut the first tirne Richard's had to ded with the after-effects of a
dient suicide, but thts one is the worst From the time of th& fUst session, D.
reaulnded him a lot of his own brother. They had gotten to h o w each other
reaUy wek and Richard has been seeing si- of impmvement and hope
beginning to grow in ttiis guy. He never expeaed at Uiis point that D. would do
the very same thhg Steve did. Once the investigatois Mt, Richard kept an
appointment with another fiagile dient, but Uien bailed out of a couple of
cornmittee meetings in order to 6ind =me tirne fw himself. He has spent the
aftemam second~essing his whole therapeutic history with D.
On the way home, Richard stoppeci into his &@bowhooci pub agaia
He needs something d i x ü n g . He knows a b Mt the greatest choiœ# but
itll do. Besides, it'll help him relax. H e l have one more. A k this one, he's
gohg to go home. For sure. Y œ œ œ œ ~ Y œ L I œ
Richard isn't sure who starteci last nighfs argument, but it wasn't pretty.
He was feeiing wrekhed by the t h e he got home. Trying to explain to Uargaret
what happened with D, he mentioned Steve. She said that was an excuse; it
happeneci so many y e m 40 , he should be mer it by now. She kept going on
about how she was womed because it was so late, and that he'd been drinlong
again, and that she was so tiied of this. He members thqr were yeliing at each
other. Richard feeis bad about dut, but at Least h doesn't have to feel guiity - nobody got hit. Wouldn't that have looked good on his iist of counseiling skilis.
The alarm didn't work this morning, making him too late for anything
but a drive-through coffee. He?l be sure to call Magaret from work, though,
when he gets some time today. He% incredi'bly tired this morning, but he'll pi&
up soon enough Being with people is always energidng.
Richard sorts Uirough the pile on his de&. Some policy changes he hasn't
hdd time to read y&; a blizzard of pink phone slips; diait files; a couple of
propoeals for the Centre, unfinished, but only a M e overâue; some riesouice
readhp. There's not much t h e to prep fot today's clients, but this couple are
practicaUydizect9ig UieP own sessions now, anyway. Hell be sure to have a few
resources ieady for them next week Then, there's still Do's 6îe to finish, and the
Student Services Director wants to meet with him sometime today. AU the
h o u d q h g s a that bis ta happen after somethjng like this. And the weekly
team meeüng is SU slated for this a&moon. Richard really meant to have that
new resounie binder on mens' issues finished for tday. He h o p the others
will understand and cut him some slak But at least the team meeüng will be a
bit of "ncmd", amsidering yestetday. ......... attet all, life goes on, ri@?
Richard is aware U t awful fit-of-theistamach feeling haen't left him since
yesterday moming. What he really wants nght now is to be anywhere but here.
Gulping a deep breath, Richard heads out to the dient waiang a .
L I I C I C I Y Y C Y Y I C I
Early evey moming, exœpt Friday, Richad iuns a qui& couple d mües.
On Fridays he does a long run after work. Ifs a Little titual he's carved out ovet
the y-, using the üme to do a mental review of his professionai weelr. then
dear it ali away and refcms on the weekend acfivities of his " o k life". Lately,
ifs been M e r to stick to his Friday nm, since work seerns to be spülllrs later
and later everyday. Today, Richard's got the the, but just doesn' t want to
bother. He's feeling wasted. The's got to be better ways of 6üüng that couple
of hows. Besides, it's been a lousy week since D!s death. ...... who wants to feplay
it? It's been so bad, he's even stivting to have nightimares about Steve ag&
Foiget the fitness plan. He'li sink into a good book, have a @et ber, and try to
get home about the same thne as Margaret does. C l œ ~ œ L I a œ - œ œ
Richard hasn't had a g d Iiight's sleep in the several weeks since D.'s
suicidee He can't relw; when he does anally fall asleep, it's only foi a liWe while,
since the nightmares are Whially nightly now. ThqN stop sooner or later, and
he'll get his balaire back AU it means right now is that he's had to malce a
couple of changes. For instance, as much as he misses it, the moniing nui is side-
tradd. But just for now. He needs to match that extra bit of sleep when he can.
Friday's nui is more of a hit-&mies thing, too, but at least he's doing fine
IUeeping up with the extra load at worlc And hds still "iight theren for his
clients, and working goad SM with them.
It has been a while since he met with any frimds or d e a g w s fa lunch - or even coffee. A couple of them have been in wondered when he's
phning to be "back to his old self," but Richard mally d0esn.t feel much like
socialiPng these days. And of came, Margaret doesn8t seem to miss a chance to
point out that he's dmpped into the pub a couple of times, erg0 that harpy-chant
"Richard, W s the third night this week Richard, you seem to be dnnking a lot
lately* Richard, is there something you want to tak about? Richard0 WWS
Wcmg with you?"
There's nothhg ~ o n g with him. He's a proiessional therapist; he'd
know if there was something going wrong, for God's sake* He's just doing what
he ne& to do, for himself, for a whüe. And thafs finding a way to telax. If
anybody really wants to ihpist he has a prob1em, they might want to amsider the
amditions he and bis team are eXpeaed to work under. Ot remember that he
deals with other peopW cappy shiff dl the tïme. Or ahwledge th& own
con~tio~lstothecirappystuffmhislik. Oramsiderthathe'stheonewho
found Steve. Even thinhg abait this stua is making Richard W, a d more
than a little angry. And deprmd. .........
After a i l these yem, is this ali there is?
Case 4: Klltdoll~ a Rivate Ractifjoner
It has long been Katricma's dteam to buüd a anuiselling practice focrrsed
on womens' issues, m the contact of a Christian ministry. In partnership with
her church and a talentecl deague, she has spent the last few years nurturing
Whole Heart Counselîing into a vibrant and effective professional entity. One
speciaîty that has emef8ed through Katriona's praCace is in the area of post-
abortion counselling. Her gif t for wmking with women and th& partnem in
this emotion-laden ciniuntance ia becomhg weil-knom Katriona is receiving
increasing numbers of &mals fran both pastoral and secuIar (often p m
abortion) sources.
Early in her career, Katnona committed herseIf b maintainhg a healthy
balance between her professicmal activities and her private Me. Although her
d - t o w n practice is a full and busy one, Katriona tries to pmted her persona1
and famiiy tirne away hom the anuieelling office. She imrolves herself in few
community activities, but chcmes thœe that are expressive and enrichhg she
has been involveci with amateur theatre, an arts guild, and the local photography
club. Katriana does what she can to stick to a healthy âiet, but in truth, chocolate
wins out a lot of the the. Mthough she hksn't the siightest interest in sports,
Katriona spends an hout working out in the pool wery moming, hating (but
surviving) each moment of it. Most importantly, Kaüiona attends to her
spintuai health and life For her, that means s t a . eomiected with the teaching,
miseion d fellowship of h &UT& and spendmg time in personal disciphes
of payer and study. Katriona also believes in, d e x e e s , a coxrunon serise
cOnnection between her Christian faith and prokssional ethics, reqnhhg that
each must be able to challenge and infam Uie 0 t . i ~~ .
Katriona M t been feeling quite as well as she wouM like for the last
little whiie, so she m w d her annd check-up ahead on her dendar. Th-
m e d to be an awful lot of tests and iab work this thne araind, but she diàn't
thinlr much of it. This moming she had a foliow-up appointment, just to "corne
in for a takm. She's sa not sure she hearà the doctor quite right.....everything
seems to be happening v q qUckiy.
Katriona doesn't lsnow why she's m g . After aii, she's seen lots of other
women thrnigh this. And, they say, the cure is getting dosez every day ..........
It's t a h Katriana the bettet part of the day to figure out what she needs
to do next. She's not convinceci it's a perfkt plan, but ifs wmkable right now.
She carRed through with her boom this alternoan - 2 individuai clients and
a small g m p - since she d M t thînk of a good enough teason, quickly
enough, to cancel. Hdes, she's never made a habit of bailllrg out on people at
the last moment, and doesn't intend to start now. Then again, she has a nagging
feeling that it might jtist have been her emotional autopilot, and not professicmai
mples, that kept her cm track at the office today. Katnona is acutely aware that
she wasn't reaiiy "with" her clients and coiieagws. She feeb exhausted at this
moment, but ifs hard to know if ifs an emotional reacticm to h a own stuff8 or
because she just didn't get a break between three back-bback appointmentsi.
After aU, Katriana m!mons8 r d life goes on. But she needs to think through
tomofiow and the mst of the week And everythhg. The pmblem is that, since
this momin%, everyUuns has been ail mashed tog* in her head, and thinlting
about one thing sets off another, and then she gets aU over the phce and
there. ........ it's happening again.
Katriona decides that one of the fiflt Uiuigs she neecls to do to deat the
confusio~istc,nndherspiritualbearings. ShererealizeçUiatsinceher
appointaient with the doctor this momins she has mt taLen any of her
customary stili moments of prayer about her dientsI her work with hem, or
wen her own needs. Drawing a deep breath, Katriona doses her eyes.
u œ œ - u œ œ œ œ - œ
Sinœ yesteiday, Katriona has been considering her worldoad thmugh the
next several weeks. Her k t impulse was to leave things just as they were, but a
gathering sense of reality has moved her to evaiuate it a little more dearly.
ClientsI gmups, woikshops, supervision and some coiîeague d t s have been
booked in advance, but with enmgh notice, there's always m m for adjushnent
Katriona decides that rescheduljng wything after the next two weeks should
count as reasonat,le notice. She also irreds to figue out what to dmp? anci what
to riearrange. Workshops pmbably arai't a big deal. She's most ccmcemed
about individual clients that she's seeing. some are doee to terminahg T a y ,
but so mwy 0th- are just begimnng theV work, or are in the middle of the
anihseIüng praiess. And what about her M c partner? And the church's
ministry goals? And how and when is she wen going to telï them about any of
this? Katriona doesn't want to just dump everythins and werybodyI but she's
afraid she won't be all that &le for the next little while.
After juggbg and -*&hg sevacal schemes, Katriona wondm if she's
maybe starüng at the wrong end of thinp. Maybe this isn't something she can
figure out on paper. Maybe this isn't something she can figure out done.......
Katriona ltnows she nieeds to be more than a little carefd with her
finances nght now, but that hawi't prevented her fnmi some *or spending in
the last ample of weeks. This moming it ocrurred to her that this is not stuff
she'd normally consider buying. None of it has the power to "W what she's
going through right now8 either. Katriona is stniggüng not to beat herseif up
over this, but spree shopping is not high on her kt of poeitive cophg choices.
Now that she's awme of what she's been doing, it!s t h e to thjnk thrr,ugh how
this e t look if it were a problem for a client8 and how she'd ûy to shape some
of her comme- to worbng on it. ~ œ a œ u # œ C I I ) œ
Ifs been more than a month sirace Katriona got the news about her
health; there's been a lot packed into that time. Her schedule has changed
completdy, not once, but several times. Some of the adjwtments were
purpoeeful, espegally the @&Onai ahes. Some of the changes have been
dictated by k new regimen of hedth-care appointments and therapies. And,
Katriona realizes, some Oiings have changed just because she isn't her own self
at the moment, W s even talring a break h m some of her creative p u b - that sort of fun shiff d d s energy she simply hasn't got right now. She's
pmised~iMIbeorreofUiefiistthingsshetedaimswhendthisisdone
with.
Katriona has also made some deQSim a h t who she is inviting to know
what is gohg on with her health, Of course, her family is a tremendous source
of support, but then, she's always been able to fount cm that niey're a dose
bunch Her partner in 'Whole Heart has been amazhg, too. Every now and thai
KatnoM worries that she's dumpeâ too much of the pracafe - she's not seeing
any clients8 and only spends about 8 hoitrs a weeic working on resourre
materiiils, or doing other odds and ends - but the two of them worked out this
p h together, and and counselling parûm assures her ifs more than ok that this
is what Katriona needs to do.
Kaüiana strusgied with what, and how much, to teli her clients about
whafs going cm for her. On the one hand, when chsasmg referrals or
terminations with her clients, disclosing taa much d d be distresshg for them
and not accompiish an- helphiL Besides, her privacy is important to k.
At the same tirne, she strongly believes that her faith and pf&sion demand
authenticity in her d e as a therapist. As well, Katriona lives in a small tom;
word gets arounâ, and people spedate on what Uiqr do not know. She finally
settled for le- her clients know that some health hues are requiring her to
talie a bmak form wark right MM, and le& it at that, Katriona's not positive it
was tkw best approach, but at least it wasn't damaging. ThinMg almg the same
hes, she chose to tell same of her dose aiends from the chu& what is
happening fw her, but from the rest of the mqpegation, Katriona has shply
askeù to be upheld in general prayer. Her M y and pastor support this
decision. çhe might change her mmd a little later, but not just yet
v c I I L . C I œ m - . L . L I
After a couple of weeks of feeling like she was just sitting around,
Katriona has decided she ne& to put some of this t h e away b m work to
bette use, so she's doing some tesearch on her illness. Not just magazine-of-
the-week stuffO but real diggiq - the kind she had to do in grad school. She's
nnally fi@ out which sorts of days are more productive foc W. T m W
days are the best for going aftez the material; 'tired" days are good for reading;
'nausean days am p t t y much a write-off, but they don't last forever. Katriona
came up with her plan one day while trying to think of h d as a client After
ail, her pfofessional penpective helped curb that spending riot, and she bught to
be able to pctice what she pfeaches.
The point of the se& isn't so much for her own information, dthough in
the initial days of h a diagnœis and decision-making, s k had to be quickîy and
thoroughly informecl. Ifs mare of an effort to pull toge- stuff that might be
useful for other women. Katnona found that the material her dators were
pvidhg her with was either too clinid, or too benign. (She loves that pun! At
least her sense of humout is etiU intact!!) At that time, she &y w d d have
welcorned the cluiicai fa&, qmken by a real person..... mt part of an ad by a
phannaceutid c ( 5 ~ t i o n , or Wtitten by some hennit pathologist in a dusty
texttiook It occurred to her that since she's spent the k t kw years putting
toge- usable w01:kshcp and mouras on othei tough issues0 she ought to be
able to do it on this, tao. The reseprdi isn't rnming at a fast paœ, and it doesn't
maice being si& any easier, but Katriona's fOund it does give her just a bit of
ccmttol over the âisease, instead of ahvays the other way around.
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