Compassion Fatigue: What is it? What do I do about it?

Early On ConferenceNovember 5, 2009Ypsilanti, Michigan

Presenter: Janice FialkaSpecial Projects TrainerEOTTAruaw@aol.com

As a community, we can beginby acknowledging that compassion fatigue exists.

Breathe

Listen: Making of a Nurse by Tilda Shalof (2007)

What full blown case of ______________

have you or other’s caught?

All emotions can be contagious

Help for the Helper: Self-care strategies for managing burnout and stress by Babette Rothschild

All careers and jobs involve some kind of

labor

Emotional Labor-Arlie Hochschild “Managing the Heart”

Managing strong emotions while staying connected to the client/family

Learning outcomes

Define empathy, compassion fatigue, vicarious trauma, and burnout

Recognize common symptoms of compassion fatigue (c.f.)

~Second Half~ Identify strategies to deal with compassion

fatigue. Renew our commitment to self-care Feel a sense of resiliency.

What does resiliency look like?

Bibliography

The content of this workshop is based on:

Help for the Helper: Self-care strategies for managing

burnout and stress by Babette Rothschild (2006)

Francoise Mathieu, Certified Canadian Counsellor & Compassion Fatigue Specialist

www.compassionfatiguesolutions.com www.workshopsforthehelpingprofessions.ca

Empathy

…the action of understanding, being aware of, and vicariously experiencing the feelings & thoughts of another . . .

WITHOUT having the feelings & thoughts FULLY in an objective

explicit manner.-Babette Rothschild

Two components to empathy(Heinz Kohut, founder of the movement of self-psychology – 1970’s)

1. Having a sense of or an understanding of the feelings of another

AND2. Being able to demonstrate in accurate

verbal or non-verbal reflection the feelings of the another.

Resulting in that glorious experience “I feel understood!”

Watch “Lorenzo’s Oil”

Small groups of 4 people

1. Did you feel empathy with the mother? If yes, how do you know? What signs did you experience physically? emotionally? In other ways?

2. What are the benefits of empathy? What does it allow you to do in your work?

3. What are some of the potential downfalls for you/providers to empathy?

Neurology of empathyNeuro-physical component of empathy -Help for the Helper by Babette Rothschild

Mirror Neurons: brain cells that reflect the activity of another’s brain cells.

Researchers at Univ of Parma in 1996 (Gallese, Fadiga, Fogassi & Rizzolatti)

Investigating which individual neurons fired when a monkey reached out to grasp a raisin.

Used electrodes connected to a monitor.

Same neurons fired in both the action and the observation.

A connection between the sender and the receiver.

A strong somatic (body) connection. The feeling is there, even when there is not the action.

Compassion Fatigue- Francoise Mathieu, www.compassionfatiguesolutions.com

First used in an article in 1992 re: nurses In 1995, Charles Figley wrote “Compassion

Fatigue” “…is a natural outcome of working with

people who experience extreme stressful events.”

“cost of caring” An occupational hazard

“Chronic exposure to really tough circumstances…….”

-Dr. Doebbeling, Indiana School of Medicine

The expectation that we can be immersed in suffering or loss daily and

not be touched by it…. it is as unrealistic as

expecting to be able to walk through water without getting

wet.

- Rachel Naomi Remen, author of “Kitchen Table Wisdom”

We burn out NOT because we don’t care, but because we don’t grieve.We burn out because we allowed our heart to become so filled with lossthat we have no room left to care.

-Rachel Naomi Remen

Vicarious Trauma

Experience someone else’s trauma You are not the victim Your brain registers it as if you are the victim A profound shift in your world view of

something

Burnout

Exhaustion Low job satisfaction More about the work environment

Role conflict Role ambiguity

Hoffman, Palladino & Barnett

Signs of compassion fatigue Difficulty concentrating Intrusive imagery Loss of hope Exhaustion (tired in such a way that no

amount of sleep will help) Irritability Isolating self Cynical Excessive complaining Excessive blaming Anxiety Others?

Small group sharing

Which signs fit for you?

What other signs?

Strategies: You CAN do something!

THREE TYPES OF STRATEGIES to manage compassion fatigue

#1. With colleagues

#2. With the families (clients) we support

#3. With ourselves: (Self-care strategies)

#1. Strategies with colleagues while at work (not a complete list!!!)

Debriefing and/or reflective consultation

Formal

Informal

A specific strategy to use with colleaguescalled: Limited Disclosure or Limited impact disclosure

1. Be aware of the need to debrief

2. Offer a fair warning

3. Obtain consent

4. Disclose with intention

-Francoise Mathieu, www.compassionfatiguesolutions.com

Begin sharing at theparameters of the circle. Give fewerdetails. More like theheadlines of the story.

Event

Set the norm at your work site!

4. (cont) Disclose with intention and in phases. Check in: Is this okay?

#2. Strategies while supporting families: Unmirror the mirror

-Babette Rothschild

Know thyself (breathing, physical changes, heart beat, changes in skin, face, muscles, posture & triggers)

Soften the connection (empathy engagement not entanglement)

Tap (don’t slam) on the brakes: Feet on floor, cross legs, sip water, breathe slower.

Take yourself out of the movie and put yourself in the audience.

Use objects: A foot stool, a rug, a kleenex near the phone

# 3. Self-care strategies (partial list)

You KNOW the essential basics!!! Eat well, exercise regularly, sleep, spend time

Journaling Everyday do NOTHING for 5 minutes (Cheryl Richardson)

Every week do one NEW thing (Bill O’Hanlon)

Use of transition rituals from work to home with intention.

Intentional breathing (Nitric acid at the back of your nose.)

Sometimes we need to go IN THE BOX!

What would you put in the box?

Andrew Weil, M.D. founder and director of the Arizona Center for Integrative Medicine, ten million copies of his books have been sold

www.dr.weil.com

Relaxing Breath Exercise: 4-7-8 Exercise

We are born with the capacity . . . to experience what others experience and participate in their experience by virtue of the way we are grabbed by their nervous system.

One of the real questions is NOT, “How in the world does this happen.” We are beginning to have a really good idea (of how this happens.)

The real question is, “How do we stop it from happening so that we are not the prisoner of someone else’s nervous system all the time.” There have got to be a lot of brakes in the system……a very interesting area of research which has not been addressed so far. -Daniel Stern

Resources: Books & Articles Help for the Helper: Self-care strategies for

managing burnout and stress by Babette Rothschild The age of empathy by Frans De Waal Wherever you go there you are by Jon Kabat Zinn

“Compassion fatigue as a theoretical framework to help understand burnout among special education teachers” by S. Hoffman, J. Palladino & J. Barnett, in Journal of Ethnographic & Qualitative Research, 2007. Vol 2, p15-22.

Resources: Web sites

Francoise Mathieu, Certified Canadian Counsellor & Compassion Fatigue Specialist www.compassionfatiguesolutions.com www.workshopsforthehelpingprofessions.caOther great web sites

www.giftfromwithin.org www.compassionfatigue.org www.takingcharge.csh.umn.edu/activities/body-scan www.drweil.com****************************************I welcome your ideas, suggestions, resources, and feedback.Janice Fialka, Special Projects Trainer, EOTTA-CCRESAruaw@aol.com or 248-546-4870 or www.danceofpartnership.com