Compassion Fatigue: What

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Compassion Fatigue Whats New? What Works?

• Françoise Mathieu, M.Ed., CCC.
• Certified Canadian Counsellor Compassion
  Fatigue Specialist

www.compassionfatigue.ca
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• Background Robin Cameron

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www.compassionfatigue.ca
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My amazing team
Diana Tikasz, MSW RSW Hamilton
Rebecca Brown, MSW RSW London
Lori Tomalty-Nusca, ECE Burlington
Meaghan Welfare, BA Kingston
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Ten Years On

• Walking the Walk CF workshop has been offered to
  thousands of Canadians across the country
• Nurses, social workers, MH counsellors, PSWs,
  teachers, physicians, allied health
  professionals, victim service workers, court
  reporters, lawyers, judges, ministers, chaplains,
  police officers, paramedics, prison staff,
  alzheimers societies, palliative care
• Approx 300 CF Educators trained through Train
  the Trainer program
• Various organizations implementing CF education
  as part of their staff wellness plan (Peel
  Region, York Region, Bruyere Continuing Care,
  Yukon and NWT Victim Services, to name a few).
• Now more attention being given to
  organizational health and how agencies can help
  reduce/prevent CF-VT

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The Current Reality

• Deeply compromised system
• Ongoing challenges and cutbacks
• Difficult stories
• Increasingly complex cases (even in schools, end
  of life care)
• Big org health assessment interviewed all
  staff individually. What came out? Who coped well
  and who didnt?
• Those who struggled the most were those who did
  not have an external practice of some kind to
  manage their stress, people who were angry and
  resentful and held on to it.

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The Compassion Fatigue Workbook Published by
Routledge - December 2011
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• The expectation that we can be immersed in
  suffering and loss daily and not be touched by it
  is as unrealistic as expecting to be able to walk
  through water without getting wet.
• Remen, 1996

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Definitions

• Compassion Fatigue
• Vicarious Trauma
• Moral Distress
• Burnout
• Chronic stress

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Compassion Fatigue

• A profound and gradual emotional and physical
  exhaustion that helping professionals and
  caregivers can develop over the course of their
  career.
• An erosion of all the things that keep us
  connected to others in our caregiver role our
  empathy, our hope, our ability to tolerate strong
  emotions/difficult stories in others, and of
  course our compassion - not only for others but
  also for ourselves.
• Changes in our personal and professional lives
  we become dispirited and increasingly bitter at
  work, contribute to a toxic work environment,
  more prone to clinical errors, violate client
  boundaries, lose a respectful stance towards our
  clients. short-tempered with our loved ones and
  feel constant guilt or resentment at the never
  ending demands on our personal time.
• Can also happen to caregivers (caregiver
  fatigue)

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Vicarious Trauma An Occupational Hazard
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Laura Van Dernoot Lipsky
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Vicarious Trauma

• Repeated exposure to difficult stories changes
  our view of the world.
• Can cause nightmares, difficulty getting rid of
  certain images, an intense preoccupation with a
  particular story or event weve been exposed to.
• When external trauma becomes internal reality
• Lipsky 2009 Impacts the entire nervous system
• Can happen through work (stories we are told or
  stories we read) and through media exposure.
• Accumulates over time across clients.
• Both CF and VT are occupational Hazards

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• What happens to the stories you hear at work?
• What are your particular vulnerabilities?
• How do you protect yourself while doing this very
  challenging work?
• Were you trained for this?

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Primary vs Secondary Trauma

• Secondary Trauma Trauma reactions that
  involve others trauma imagery or trauma stories
  characterized by panic, horror or helplessness
  in relation to the event (Tikasz)
• Primary Trauma
• As a consequence of the work e.g. EMS car
• accidents, fatalities involving children
• From our personal lives, our own past
• Post Traumatic Stress Disorder (PTSD)

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(No Transcript)
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Moral Distress

• happens when there are inconsistencies
  between a helpers beliefs and his or her
  actions in practice (Baylis 2000)
• when policies or routines conflict with
  beliefs about patient care
• (Mitchell 2000)

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Burnout

• Physical emotional exhaustion as a result of
  prolonged stress and frustration
• Depleted ability to cope with work demands
• Sense of powerlessness to achieve goals
• Does not necessarily alter our view of the world,
  but our view of the workplace
• Can happen in any occupation

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Occupational Hazards

• We dont get CF/VT because we screwed up, we get
  it because we care
• Vicarious Trauma is a natural consequence of
  trauma exposure

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Primary Trauma
Compassion Fatigue
Vicarious Secondary Trauma
Burnout
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A workbook on Vicarious Traumatization
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(No Transcript)
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• Beth Stamm (1995)

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Current ResearchTerminology - A need for more
clarity

•  Beth Stamm "The controversy regarding secondary
  trauma is not its existence but what it should be
  called.
• Nadine Najjar et al 2009 review of all the
  research to date on compassion fatigue in
  cancer-care providers
• Conclusion there still exists "an ambiguous
  definition of compassion fatigue that fails to
  adequately differentiate it from related
  constructs (e.g. burnout, secondary traumatic
  stress)."
• We are working on getting a set of working
  definitions we all agree on, but we're not there
  yet.
• Stamm (1995)
• Najjar, Nadine et al (2009) Journal of Health
  Psychology, Vol 14(2) 267-277.

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Some recent data

• Depending on the studies, 40-85 of health care
  professionals were found to have CF and/or high
  rates of STS
• 57 of SW have been threatened, 16 physically
  assaulted
• 40 of nurses physically assaulted
• 52 military chaplains at medium to high risk
  for anxiety and depressive disorders - this is
  twice as high as the norm for CF members and
  higher than general population

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Some recent data

• 2009 AMA study of junior doctors
• 54 met the criteria for CF
• 69 met the criteria for burnout
• 71 had lower than average levels of job
  satisfaction
• Markwell Wainer, Doctors Health, MJA Vol 191,
  No 8, 19 Oct 2009

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Data cont

• 2005 survey of the health of nurses (Canada)
• 8/10 nurses had accessed their EAP which is over
  twice as high as the EAP use by the total
  employed population
• DV lawyers significantly higher levels of STS
  and burnout compared to other mental health
  providers
• 2011 study of US surgeons had thought about
  suicide 1.5-3 times more than the general
  population. Only 26 of them had sought
  psychological help for their SI.
• US immigration judges higher levels of burnout
  than hospital physicians and prison wardens
• 59 of MH professionals are willing to seek help
  vs 15 of law enforcement professionals

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Green Cross Standards of Self Care Guidelines

• First, do no harm to yourself in the line of duty
  when helping/treating others
• Second, attend to your physical, social,
  emotional and spiritual needs as a way of
  ensuring high quality services for those who look
  to you for support as a human being

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What Works?7 steps individuals (and
organizations) can take to reduce CF/VT
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What Works?

• 1) SOCIAL SUPPORT IN THE WORKPLACE
• "the most significant factor associated with
  compassion satisfaction (Killian 2008 study of
  trauma counsellors)
• 2) TRAINING ON SELF CARE AND SELF AWARENESS
• "... most of the therapists interviewed
  observed that they had not had any courses or
  specific training on professional self-care, and
  this was an important but neglected area in
  training. Killian 2008
• Killian recommends that self awareness and self
  care become integral parts of the curriculum for
  all helping professionals.

Killian, K.D. Helping Till it Hurts? A
Multimethod Study of Compassion Fatigue, Burnout,
and Self-Care in Clinicians Working With Trauma
Survivors in Traumatology, Vol 14, No 2, June
2008.
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Step Two Self Awareness
Psychoneuroimmunology Dr Gabor Maté
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• Step Two Self Awareness cont
• Long term effects of chronic stress
• Our immune system does not exist in isolation
  from daily experience. (Maté, 2003, p.6)

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Step Two Self Awareness cont

• Chronic stress chronically high cortisol levels
  destroy tissue. Chronically elevated adrenalin
  levels raise the blood pressure and damage the
  heart. (Maté, 2003 p.35)
• See p 35 for alzheimers disease eg.

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Step Two Self Awareness cont
The Gut Feeling

• we have lost touch with the gut feelings
  designed to be our warning system. We keep
  ourselves in physiologically stressful
  situations, with only a dim awareness of distress
  or no awareness at all.
• Maté, 2003 p36

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Self Awareness a Key Strategy for CF/VT

• Being aware of our current feelings, actions and
  reactions
• Gaining an understanding and an awareness of how
  we deal with anger, hurt and resentment
• Being aware of the dynamics from our past that
  influence the every day choices we make Why did
  you choose to go into this field and not another?
  Did you pick this profession because of a trauma
  or loss you experienced in your own life? Were
  you already a helper in your family of origin?
  Are you the go-to person in your personal life?
  Do you feel empty or unimportant unless you are
  in a helping role?
• Understanding how your own childhood history
  affects your reactions to your clients stories
  (countertransference) 
• Being in tune with your stress signals Do you
  have a good sense of how your body communicates
  to you when it is overwhelmed? Do you get sick as
  soon as you go on vacation, develop hives, get a
  migraine when you are stressed? Many of us live
  in state of permanent overload and are dimly
  aware of it. What happens when you feel angry? Do
  you explode or do you swallow your rage? Where in
  your body do you feel your anger?
•  Are you aware of the ways in which you sabotage
  your self care? (by saying yes to requests you
  dont have time for, by taking on more
  responsibilities, by drinking excessively, by
  cancelling a therapy appointment) 

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Jon Kabat Zinn Mindfulness Stress Reduction
Step Two Self Awareness cont

• Stress Reduction in 6 parts Video on Youtube

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Mindfulness-Based Stress Reduction

• Article on website www.compassionfatigue.ca
• Book Full Catastrophe Living by John Kabat-Zinn

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Mindfulness Stress Reduction
Research on the effectiveness of MBSR is highly
conclusive over 25 year of studies clearly
demonstrate that MBSR is helpful in reducing
emotional distress and managing severe physical
pain. MBSR has been used successfully with
patients suffering from chronic pain, depression,
sleep disorders, cancer-related pain and high
blood pressure. (Cohen-Katz et al, 2005) Based
at Toronto's CAMH, Zindel Segal has developed a
mindfulness-based cognitive therapy program for
treating depression that has shown to be highly
effective MBSR and Compassion Fatigue
www.compassionfatigue.ca
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3) Rebalancing Caseload Workload Reduction"To
combat compassion fatigue and burnout, agency
administrators and therapists may also wish to
ask themselves "How many cases are too many?
Killian, 2008
What works? Cont
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What works? Cont
4) Limiting Trauma Inputs Limiting media
exposure/traumatic stories
Low Impact Debriefing aka sliming see my
website for an article describing this process
www.compassionfatigue.ca resources
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Step Four cont - Limiting Trauma Inputs
Low Impact Debriefing

• Increased Self Awareness
• Fair Warning
• 3) Consent
• 4) Low Impact Disclosure

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5) Improved Work/Life Balance
What works? Cont

• 2009 Duxbury report on role overload in health
  care
• 3/5 health care workers suffering from role
  overload
• 36 report high levels of depressed mood
• 1 in 4 employee was planning on leaving their job
  at the hospital - not for higher pay, but for
  greater control over work hours and more
  respect

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Take Time for Your LifeCheryl Richardson
Step Five Cont

• The best Work-Life balance resource available

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RelationshipsEnvironment (clutter etc)Body,
mind and spiritWorkMoneyCheryl Richardson,
Take time for your Life (1999)
Step Five Cont Improved Work-Life Balance
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6) Developing CF resiliency through relaxation
training and stress reduction techniques
What Works?
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Step 6 Cont Developing Resiliency

• Help for the Helper the psychophysiology of
  compassion fatigue and vicarious trauma

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7) Accessing Coaching/Counselling/Clinical
Supervision as needed
What Works?
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Increased recognition that this is an
organizational health concern (CSST report Summer
2007, Mental Health at Works CMHA and
Desjardins)The bottom line high attrition,
poor retention, soaring costs of LTD and sick
leave
A changing landscape, for the better
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Managing workplace toxicity

• Feeling wronged bitter A sense of
  helplessness, of persecution
• We become convinced that others are responsible
  for our well-being and that we lack the personal
  agency to transform our circumstances Lipsky P93
• Laura van Dernoot Lipsky (2009) Trauma Stewardship

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Key Tools for Dealing with CF

• Knowing your big three
• Your warning signs physical, behavioural and
  psychological symptoms

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The Warning Signs Continuum
Talking to my neighbours
Hiding from neighbours
Avoiding neighbours
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ProQol Inventory

• Testing for CF, burnout and Compassion
  Satisfaction
• www.proqol.org

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The Four Steps of CF Strategies
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Upcoming events

• The Compassion Fatigue Conference June 2011,
  Kingston. www.cfconference.com
• Workshop for Managers on Organizational Health,
  June 2011, Kingston. www.compassionfatigue.ca

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• The heart must first pump blood to itself
• Shapiro

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Get in touch

• whp_at_cogeco.ca