COMPASSION FATIGUE

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COMPASSION FATIGUE

• Patricia Dunnigan MA ABS
• Traumatology Institute of Western Canada

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My Plan

• Offer information
• Tell some stories
• Provide tools
• Have some fun

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Instructions for Table Work

• What is the first word or phrase that comes to
  mind when you hear the term Compassion Fatigue?
• Go around the table one-by-one. Speak your word
  to your colleagues.
• Select one word to bring to the whole group.

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I first called it a form of burnout, a kind of
secondary victimization. Charles Figley
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Table Game Look at the picture in light of
empathy and Compassion Fatigue. Find a funny
title to describe what is happening to this
caregiver.
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Compassion Fatigue

• Trauma expressed by client and absorbed by helper
• A natural consequence of caring between two
  people one who has been traumatized the other
  affected by listeningNOT NECESSARILY A PROBLEM
• Adapted from Figley, 1995

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Compassion Fatigue

• A feeling of losing our sense of self to the
  people we serve
• Suffering that can eventually be linked to our
  work with trauma
• The greater the capacity for feeling and
  expressing empathy, the greater the tendency for
  compassion stress.

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Compassion Fatigue

• Compassion Satisfaction/Fatigue Self-Test for
  Helpers
• Complete the Self-Test in your handout package
  using answers from your last work week.
• Score the test carefully following the
  instructions on page 4.
• What does your score mean to you?
• The Silencing Response Scale for reference only.

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Score Interpretation

• Compassion Fatigue
• 26 or less extremely low risk
• 27-30 low risk
• 31-35 moderate risk
• 36-40 high risk
• 41 very high risk
• What is your score what does it mean to you?

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Burnout Risk

• 36 or less extremely low risk
• 37 50 moderate risk
• 51 75 high risk
• 76 85 extremely high risk

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Compassion Satisfaction

• 118 extremely high potential
• 100 117 high potential
• 82 99 good potential
• 64 81 modest potential
• Below 63 low potential

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Stages of Progression

• The Zealot Phase
• The Irritability Phase
• The Withdrawal Phase
• The Zombie Phase

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Process Involved

• Gradual exposure to job strain
• Erosion of idealism
• Void of achievement
• Accumulation of intensive contact and experiences
  with people we serve

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The Zealot - Idealist
Ill do that!

• We are committed, involved and
• available ready to problem solve
• ready to make a difference
• We willingly put in extra hours
• our enthusiasm overflows
• We volunteer
• We are willing to go the extra
• distance and often do so without prompting

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Irritability

• We begin to cut corners
• to avoid contact with the people we serve
• to mock our colleagues and people we serve
• We denigrate their efforts at wellness.  
• Our use of humor is sometimes strained. 
• We daydream or become distracted when the people
  we serve are speaking with us
• We make efforts to avoid conversations with the
  people we serve
• Oversights, mistakes, and lapses of concentration
  begin to occur
• We begin to distance ourselves from our friends
  and coworkers

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Withdrawal

• Our enthusiasm turns sour and our bubble bursts.
  
• The people we serve become a blur and run
• together we lose our ability to see them
• as individuals rather they become irritants
• Complaints may be made about our work
• We are tired all the timewe no longer wish to
  talk about work and may not even admit to what we
  do so as to avoid talking about our work.
• We neglect our family, our coworkers, the people
  we serve and ourselves.
• Our shield gets thicker and thickerit blocks
  our pain and sadness.
•  

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The Zombie

• Our hopelessness turns to rage  
• We begin to hate people
• Others become incompetent or ignorant in our eyes
  
•  We develop a disdain for the people we serve
•  
• We have no patience we lose our sense of
  humourand have no time for fun

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Choice Point

• Pathology/Illness and Victimization
• Overwhelmed and Leaving the Profession
• Somatic illness
• Perpetuity of Symptoms

• OR
• Maturation and Renewal
• Hardiness
• Resiliency
• Transformation

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PTSD STSD

• Stressor
• Reexperiencing traumatic event
• Avoidance/Numbing of reminders
• Persistent Arousal

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PTSD STSD

1. Stressor
2. Re-experiencing Traumatic Event
3. Avoidance/ Numbing Reminders
4. Persistent Arousal

1. Stressor
2. Re-experiencing Traumatic Event
3. Avoidance/ Numbing Reminders
4. Persistent Arousal

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Post-traumatic stress disorder

• Onset cluster of symptoms lasting gt 1 month
• Resulting from
• extreme traumatic stressor,
• direct personal experience of
• threatened death
• actual or threatened serious injury or
• witnessing an event that involves the above

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Secondary traumatic stress

• A natural by-product of working with trauma
• empathy
• our own traumatic event
• trauma may be evoked
• childrens trauma

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Secondary Traumatic Stress Disorder

• Avoidance/ Numbing
• efforts to avoid thoughts/feelings
• avoidance of activities/situations
• diminished interest
• detachment from others
• diminished affect
• foreshortened future

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Secondary Traumatic Stress Disorder

• Arousal
• sleep disturbance
• irritability
• general anxiety
• hypervigilance
• physiological reactivity

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That which is to give light .must endure
burning Viktor Frankl (1963)
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Difference BetweenCompassion Fatigue and Burnout

• Compassion Fatigue
• Can emerge suddenly
• Helplessness and Confusion
• Isolation from support systems
• Symptoms disconnected from primary causes
• Faster Recovery Rate

• Burnout
• Emerges gradually
• Reduced sense of personal accomplishment
• Problems perceived to outweigh resources
• Caught between advocacy for client and
  bureaucratic policies and structures
• Recovery can take up to 2 years

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IMPACT ON QUALITY OF WORKIMPAIRMENT

• Violates the sense of basic trust
• Severs connection to community
• Destroys meaning
• Loss of sense of perspective
• Cant find a way out
• Behaves within the patterns generated by the
  client good/evil, ally/enemy, rescuer/rescuee

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Treating PTSD

• Tri-Phasic Model
• Safety and Stabilization
• Remembrance and Mourning
• Reconnection

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Treating Compassion Fatigue

• Accelerated Recovery Program
• 5 sessions
• Assessment for appropriateness of treatment
• How our work attitudes can make us vulnerable
• Mission Statement
• Power of Story
• Stabilization techniques
• Pathways

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WHAT ORGANIZATIONS CAN DO

• Educate
• Inoculate
• Create Trained Support Teams

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• The greatest tragedy of our helping organizations
  is that the level of attention and care given to
  our clients is often so out of proportion to what
  the caregiver receives that we lose our most
  capable, enthusiastic and empathic front line
  workers to Compassion Fatigue and Burnout

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Compassion FatigueThe Water and Stone Consulting
Groupwww.waterandstone.ca