Compassion Fatigue: Effects on Caregivers

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Compassion Fatigue Effects on Caregivers

• Gloria Collins, Psy.D.
• Behavioral Health Consultant
• Author Secondary Traumatic Stress Compassion
  Fatigue and Compassion Satisfaction on Caregivers

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Compassion Fatigue

• The notion that working with people in pain
  extracts a significant cost to the caregiver is
  not new.
• In recent years there has been a substantial
  effort to examine the effects on the caregiver of
  bearing witness to the effects of traumatic
  wounds inflicted by traumatic experiences.

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Trauma Research

• The study of the effects of trauma has promoted a
  better understanding of the negative effects of
  helping.
• Psychological effects of trauma over the past 100
  years as shell shock, combat neurosis, and
  combat fatigue mainly in reference to veterans.

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Posttraumatic Stress Research

• In 1980, the latest designation for these
  reactions, Posttraumatic Stress Disorder was
  formally recognized as an anxiety disorder in the
  Diagnostic and Statistical Manual Mental
  Disorders (DSM-III)
• Since that time research in the field of trauma
  has grown at an exponential rate.
• Initially, the research focused on veterans, then
  added other trauma populations.

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Emerging Secondary Trauma Literature

• As therapists and other helpers are increasingly
  called upon to assist survivors of violent crime,
  natural disasters, child abuse, domestic
  violence, and now terrorism, the effects on
  helpers is emerging.
• Helpers are exposed to primary (i.e., direct) and
  vicarious sources of traumatic stress.
• Helpers may feel a positive effect associated
  with their ability to help they may also feel
  negative, secondary effects.

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Emerging Research Findings

• McCann Pearlman (1990) introduced the concept
  of vicarious trauma and provided a theoretical
  framework for understanding the complex and
  distressing work on therapists as the
  transformation in the inner experience of the
  therapist that comes about as a result of
  empathic engagement with clients trauma
  material.

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Vicarious Trauma

• Vicarious traumatization refers to the
  transmission of traumatic stress through the
  observation and/or hearing others stories of
  traumatic events and the resultant
  shift/distortions that occur in the caregivers
  perceptual and meaning systems (McCann
  Pearlman, 1990).

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Secondary Trauma

• Secondary traumatic stress has been defined by
  Figley (1995) as the natural consequent
  behaviors and emotions resulting from knowing
  about a traumatizing event experienced by a
  significant otherthe stress resulting from
  helping or wanting to help a traumatized or
  suffering person.
• Secondary traumatic stress reactions can be
  considered inevitable in trauma workers and may
  occur regardless of race, age, gender or level of
  training.

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Trauma Terms

• The terms vicarious trauma, secondary trauma,
  and compassion fatigue, have all become
  cornerstones in the vernacular of describing the
  deleterious effects that helpers suffer when
  working with trauma survivors.
• The term compassion satisfaction is a new term
  that has been described (Collins, 2004) to
  document positive or protective factors in trauma
  workers.

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STS Meta-analysis

• Figley (1995) carried out a meta-analysis and
  found trauma workers experienced an array of
  reactions and categorized them into three areas
• Indicators of psychological distress
• Cognitive shifts
• Relational disturbances

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Indicators of Psychological Distress

• Distressing emotions, including sadness, grief,
  depression, anxiety, dread, horror, fear, rage,
  shame
• Intensive imagery of the clients trauma
  material, such as nightmares flashbacks
• Numbing or avoidance of efforts to elicit trauma
  material from the client
• Somatic complaints, sleep difficulty, headaches
• Addiction or compulsive behaviors
• Physiological arousal, such as hypervigilance
• Impairment of functioning in social personal
  roles, isolation, alienation, missed appointments

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Cognitive Shifts(in world view)

• Shifts in cognitive schemata include changes
  along the dimensions of
• Dependence/trust to reveal a chronic suspicion of
  others
• Safety to a heightened sense of vulnerability
• Power to an extreme sense of helplessness and
• Independence to a loss of personal control and
  freedom

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Relational Disturbances

• Detachment or distancing oneself emotionally from
  trauma survivors is used consciously or
  unconsciously to enable helpers to deal with
  feelings of vulnerability
• Use of the dynamic of detachment may also take
  the form of withdrawal from family, friends, and
  colleagues.
• Trauma workers sometimes use the relationship
  dynamic of over-identification with the client
• They may also take on excessive responsibility
  for the clients life, perhaps in an attempt to
  gain control over overwhelming situations.

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STS is a Natural Process

• Figley (1995) states that STS is a natural
  consequence of the dynamic of caring that happens
  between two people, one of whom has been
  initially traumatized and the other of whom is
  affected by the firsts traumatic experiences.
• Stamm (1998) noted that not all trauma workers
  succumb to the negative effects of STS and that
  there must be a protective mechanism that helps
  maintain their well-being.

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• The Process

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Compassion Satisfaction

• The motivation of trauma workers to help is
  shaped, in part, by the satisfaction derived from
  the work of helping others.
• Thus, compassion satisfaction plays a vital role
  in the equation of working in the human services.
  
• The paradox remains, however, that helping people
  who have been traumatized can have a deleterious
  effect on workers and can be viewed as an act of
  compassion.

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Symptoms
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Compassion Fatigue and Compassion Satisfaction

• Collins (2004) investigated the differences in
  rates of compassion fatigue and compassion
  satisfaction in a large sample (n 504) of trauma
  workers.
• The data focused on provider well-being
  specifically the interpersonal capacity and
  quality of life across sex (male, female), levels
  of training (Bachelors, Masters, Doctorate) and
  type of workplace environment.
• Males with doctoral degrees demonstrated the
  least risk for CF

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CF CS cont.

• Masters level providers were had a significantly
  higher risk of developing CF and Bachelors level
  providers were at a significantly lower risk of
  developing CF.
• Private practice providers had the lowest risk of
  CF and highest levels of CS
• Females overall had the highest levels of both CF
  and CS (one mitigated the other)
• Post hoc analyses showed male doctoral level
  providers had a significantly higher quality of
  life than the group.
• Female doctoral level and male masters level
  reported significantly lower quality of life.

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What are the Protective Factors?

• According to Kessler (1005) being exposed to a
  traumatic stressor is not a guarantee that
  individuals will develop prolonged difficulties.
• The original question deepens and changes to ask
  what is it that protects humans as they steer
  the path between helping people heal?
• King (1998) claimed that hardiness was
  characterized by feelings of control, commitment,
  and change as challenge.

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Protective Factors

• Stamm Pierce (1995) proposed that when helpers
  have positive collegial support systems the
  negative effects by receiving both structural and
  functional support
• Focus on self-awareness in training program
• Access to confidential counseling services
• Opportunities for consulting on trauma cases
• Clinical supervision that promotes both
  professional and personal development

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Organizational Protective Factors

• One of the most, if not the most important
  protective factor is an organizational culture
  that values staff and promotes their care should
  be cultivated where staff know that they are
  supported and feel comfortable in accessing
  services.
• Given time, all levels of staff might come to
  believe that it is a sign of strength, rather
  than a weakness, to know their own self and
  acknowledge and own their unique thoughts and
  feelings.

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For Additional Information

• Sidran Institute
• Traumatic Stress Education and Advocacy
• www.Sidran.org Sidran_at_Sidran.org
• Traumatic Stress Institute/Center for Adult
• Adolescent Psychotherapy
• www.tsicaap.com info_at_tsicaap.com
• Institute of Rural Health
• www.isu.edu/bhstamm www.isu.edu/irh