Compassion Fatigue

An important component to providing Trauma Informed Care

Created by: Holly Hampton, MS, LPC, JFIS I &II and Lisa Basci, MA, LPC

Disclaimer• The information presented to you today is intended

to increase your understanding of compassion

fatigue.

• The information is not intended to replace medical

advice.

• If you are in need of medical advice, please

contact your physician.

• This information may cause strong emotions or

reactions from participants. Please feel free to take

breaks as needed.

Objectives

• Define and describe the five phases of compassion fatigue.

• Learn skills to apply in supervision to minimize the potential for compassion fatigue in employees.

• Review two assessment tools to understand personal levels of compassion satisfaction and compassion fatigue.

So… is this you or your staff?

Constantin, P. (2011, September 28). Battling the crisis [cartoon]. Retrieved from https://www.cartoonmovement.com/cartoon/3548

Job SatisfactionExposure

+ Stress/Burnout

[Digital Image]. Retrieved from http://clipart-work.net/clipart/simple-balance-scale-clipart.html

Compassion Satisfaction-

is this you?

Compassion Satisfaction is

• … positive aspects of working as a helper.

• … the “GOOD STUFF.”

• … what you may have felt when you started.

[Digital Image]. Retrieved from http://www.criticalcarevet.ca

Burnout

• inefficacy and feeling overwhelmed

• work related hopelessness

• feeling worn out

• It is the cumulative result of stress:– Stress is a state of “too much”

– Burnout is a state of “not enough”

Burnout

Central Features

• Emotional Exhaustion

• Depersonalization

• Lack of Self Efficacy

(Bianchi, R., Schonfeld, I.S., & Laurent, E. 2014)

Vicarious & Secondary Trauma

• Intrusive imagery

• Avoidance response

• Distressing emotions

• Functional impairments

Compassion Fatigue

“Compassion fatigue is characterized by a

gradual lessening of compassion over time,

resulting from a combination of burnout and

secondary traumatic stress related to vicarious

traumatization from repeated exposure to

traumatic material.”

(Wood et al, 2017)

Compassion Fatigue

“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”

(C. Figley, 1995)

Scotney, R. [Getting2Zero]. (2013, Nov 24). Compassion Fatigue [Video File]. Retrieved from https://www.youtube.com/watch?v=8QOZ96dObys

Trajectory of Compassion Fatigue• Zealot phase

• Irritability phase

• Withdrawal phase

• Zombie phase

• Pathology and Victimization vs. Maturation and Renewal

Gentry, J.E. Accelerated Recovery Program for Compassion Fatigue [PowerPoint slides]. Retrieved from

http://www.compassionunlimited.com/pdf/PowerPointPresentation.pdf

Zealot Phase

• Committed, involved, available

• Solving problems/making differences

• Willing to go “the extra mile”

• Excited about the work we do

• Volunteers without being asked

Irritability Phase

• Begin to cut corners

• Avoid clients/patients

• Use humor inappropriately

• Oversights, mistakes, lapse of concentration

• Distance self from friends/coworkers

Withdrawal Phase

• Loss of enthusiasm

• Clients become irritating

• Complain about work and personal life

• Tired all of the time – don’t want to talk about what we do

• Try to avoid our negative emotions

Zombie Phase

• Our hopelessness turns to rage

• Others appear incompetent or ignorant to us

• Begin to feel indifferent in relation to our clients

• We have no patience, no sense of humor, no time for fun

Pathology and Victimization vs.

Maturation and Renewal

• Overwhelmed and leave profession

vs.

• You notice the way you are being

impacted by your work and you take

action steps to build resiliency

So where does that leave me?

[lauralipsky]. (2009, Mar 15). Trauma Stewardship [Video File]. Retrieved from https:// www.youtube.com/watch?v=tAKPgNZi_as

What about ME? The good,

the bad and the ugly

• Isn’t it selfish to care about myself?

• I don’t get paid to care about myself.

• I should worry about others.

How can we care for others and

ourselves?

• Planned time off work

• Recognize signs in ourselves

and colleagues encouraging self-

care.

[Digital Image]. Retrieved from http://www.anchalblogs.com/mother-teresa-given-title-saint/

How does this fit with your

job? What might this look like

in your work?

Building Resiliency

• How can we protect ourselves from

compassion fatigue?

• What resources can we use as an

individual and an organization?

Protective factors

• Individual

• Organizational

• Supervisory

Supervision models

• Accelerated Recovery Program (ARP)– (Gentry, J.E. & Baranowsky, A.B. 2013)

• Adapted Emotionally Focused Therapy (EFT)– (Soloski, K. & Deitz, S. 2016)

• Components for enhancing clinician engagement and reducing trauma (CE-CERT) – (Miller, B. & Sprang, G. 2016)

Accelerated Recovery Program

Main components

• Connection between supervisee and supervisor that conveys respect

• Assessments

• Managing negative emotional reactions

• Writing their personal story

• Self-care

• Self-awareness

• Seeking out needed resources

(Gentry, J.E. & Baranowsky, A.B. 2013)

Adapted-Emotionally Focused Therapy

Main components

• Look for themes or patterns in expression of emotions

• Understand emotional impact of various influences on clinician

• Explore primary emotions

• Reframe cycle of emotions, clinician will increase self-awareness of engaging in this cycle

• Assist supervisee in understanding and recognizing their pattern of emotions as well as reaction to these emotions, and seek resources as needed

• Accept and allow emotions to occur related to clinical situations while minimizing the impact on work

(Soloski, K. & Deitz, S. 2016)

CE-CERT

Main components

• Experiential Engagement

• Reducing Rumination

• Conscious Narrative

• Reducing Emotional Labor

• Parasympathetic Recovery

(Miller, B. & Sprang, G. 2016, p.2)

Application

• Encourage self-care

• Assess work-life balance

• Utilize assessment measures quarterly

– ProQOL-5

– Self Assessment Tool: Self-Care

• Allow expression of emotions in supervision

Questions?Take Away?

Thank you for attending today!

References

• Bianchi, R., Schonfeld, I. S., & Laurent, E. (2014). Is burnout a depressive disorder? A reexamination with special focus on atypical depression. International Journal Of Stress Management, 21(4), 307-324. doi:10.1037/a0037906

• Center for Advancing Health Policy and Practice. (2009, April). Building blocks to peer success: A toolkit for training HIV-Positive peers [PDF file]. Retrieved from http://cahpp.org/wp-content/uploads/2016/05/HIV-peer-training-toolkit-guide.pdf

• Center for Advancing Health Policy and Practice. Self-Assessment tool: Self-Care [PDF file]. Retrieved from http://ucebt.com/images/pdfs-doc/SelfAssessmentToolSelfCare-PeerRole-Peer_Training.pdf

• Constantin, P. (2011, September 28). Battling the crisis [cartoon]. Retrieved from https://www.cartoonmovement.com/cartoon/3548

References• [Digital Image]. Retrieved from http://clipart-work.net/clipart/simple-balance-scale-

clipart.html

• Digital Image]. Retrieved from http://www.anchalblogs.com/mother-teresa-given-title-

saint/

• [Digital Image]. Retrieved from http://www.criticalcarevet.ca

• Figley, C. R. (1995). Compassion fatigue as secondary traumatic stress disorder: An

overview. In C. R. Figley, C. R. Figley (Eds.), Compassion fatigue: Coping with

secondary traumatic stress disorder in those who treat the traumatized (pp. 1-20).

Philadelphia, PA, US: Brunner/Mazel.

• Figley, C. R. (2002). Compassion fatigue: Psychotherapist's chronic lack of self

care. Journal Of Clinical Psychology, 58(11), 1433-1441. doi:10.1002/jclp.10090

References

• Gentry, J.E. Accelerated Recovery Program for Compassion Fatigue [PowerPoint slides]. Retrieved from http://www.compassionunlimited.com/pdf/PowerPointPresentation.pdf

• Gentry, J.E. & Baranowsky, A.B. (2013). Compassion fatigue resiliency- A New Attitude. Compassion Fatigue Treatment & Resiliency- Program with Legs: The ARP, CFST, & CF Resiliency Training. Retrieved from https://psychink.com/ti2012/wp-content/uploads/2013/10/Compassion-Resiliency-A-New-Attitude.pdf

• [lauralipsky]. (2009, Mar 15). Trauma Stewardship [Video File]. Retrieved from https://www.youtube.com/watch?v=tAKPgNZi_as

• Miller, B., & Sprang, G. (2016, January 28). A components-cased practice and supervision model for reducing compassion fatigue by affecting clinician experience. Traumatology. Advance online publication. http://dx.doi.org/10.1037/trm0000058

References

• Richard, C. (2013, June 3). Compassion Fatigue Scales: Clinician Wellness. (Web log comment). Retrieved from http://www.charlenerichardrsw.com/2013/06/compassion-fatigue-2/

• Sabo, B., (2011, Jan 31). Reflecting on the Concept of Compassion Fatigue. OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 1, doi:10.3912/OJIN.Vol16No01Man01

• Scotney, R. [Getting2Zero]. (2013, Nov 24). Compassion Fatigue [Video File]. Retrieved from https://www.youtube.com/watch?v=8QOZ96dObys

• Soloski, K.L., & Deitz, S.L. (2016, August 18). Managing emotional responses in therapy: An adapted EFT supervision approach. Contemporary Family Therapy: An International Journal, 38 (4), 361-372. http://dx.doi.org.ezproxy.messiah.edu/10.1007/s10591-016-9392-8

References

• Stamm, B. (2009). Professional quality of life: Compassion satisfaction and fatigue version 5 (ProQOL) [PDF document]. Retrieved from http://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf.

• The Advocacy Alliance. (2013). Compassion Fatigue [Power Point slides]. Retrieved from http://theadvocacyalliance.org.

• Tobias, C., Brown, K., Rajabun, S., Drainoni, M.L., & Young, S.R. (2005). A kaleidoscope of care for HIV-Infected substance users. Journal of HIV/AIDS & Social Services, 4(2), 27-43. doi: 10.1300/J187v04n02_04.

• Wood, A. E., Prins, A., Bush, N. E., Hsia, J. F., Bourn, L. E., Earley, M. D., … Ruzek, J. (2017). Reduction of burnout in mental health care providers using the provider resilience mobile application. Community Mental Health Journal, doi:10.1007/s10597-016-0076-5.