Vicarious Trauma & Compassion Fatigue Finalized May 31, 2017 Developed by: Mental Health & Addiction Services, Western Health

Compassion Fatigue Vicarious Trauma Burnout Often, these and many other terms are used interchangeably and there is even disagreement among scholars and practitioners about the definitions and overlap. We will take some time to separate and define the three concepts, to create a common understanding, for the purpose of this session. Keep in mind that these may be applied differently in different literature and it is important to determine the definition being used by an author or presenter each time you approach these subjects. Mathieu, Françoise (2012) www.compassionfatigue.ca

Vicarious Trauma (VT) The stress and trauma workers experience due to empathic engagement with patients and families who are experiencing grief and trauma Characteristics: stories we hear are transferred onto us in a way that we are secondarily traumatized and have difficulty ridding ourselves of the images or experiences fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material Normal Inevitable Cumulative The term vicarious trauma was first coined by Pearlman & Saakvitne (1995) to describe the profound shift in world view that occurs in helping professionals when they work with clients who have experienced trauma

Compassion Fatigue (CF) The profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate after vicariously experiencing the trauma of those they help Characteristics: pronounced change in helper’s ability to feel empathy for their patients/clients, loved ones, co-workers increased cynicism at work increased anger and irritability loss of enjoyment of career Dr. Charles Figley’s description of Compassion Fatigue as the “cost of caring” for others in emotional pain is the most commonly referenced (Figley, 1982)

Burnout Physical & emotional exhaustion as a result of prolonged stress and frustration Characteristics: 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 Vicarious trauma and compassion fatigue can lead to burnout but burnout can also happen for other non-traumatic physical and emotional stress within the workplace.

ABC’s of Addressing Vicarious Trauma & Preventing Compassion Fatigue Awareness Balance Connection

Assess your reactions and your needs Awareness Assess your reactions and your needs

Activity – Self-Assessment Handout: Burnout, Compassion Fatigue, and Vicarious Trauma Assessment * For a one-hour session – the assessment can be completed as a pre-requisite or given as a take-home handout

Warning Signs Continuum Headington Institute Document – Understanding & Addressing Vicarious Trauma (page 18-20) - may be helpful for more warning signs How am I doing today? How did my day rate on a scale of 1 – 5? What are my signs and symptoms?

Balance Take care of your physical health & nurture yourself through mini-escapes and pleasant activities during each day (even a deep breath helps) Create separation between work and home Treat yourself with compassion Transform negative perspectives (challenge your thinking, find meaning) Develop strategies to support your own needs and emotions when working with others’ trauma Need to maintain our ability to continue this work. Consider other professional and personal development on topics such as: Self-Care Relaxation Mindfulness Work-Life Balance Assertiveness / Developing Boundaries

Practice Self-Compassion Helpful when experiencing difficult or intense emotions Three Steps: Mindfulness — become aware of the emotions you are feeling, label and just notice them Identify feelings as normal human experience Treat yourself with loving kindness — be gentle and caring with yourself

Practice Extreme Self-care When you practice extreme self-care and put yourself first, you are then fully available to others without frustration, anger, or resentment People won’t always like it: “I will only be checking emails twice a day” “I have to say no because I have made a commitment to myself to reduce my workload” “Thanks for asking however this doesn’t fit with my current responsibilities (focus / workload / etc.), maybe you could ask…” “I’ve decided to take better care of myself so I’m not taking on any new projects right now”

Protective Activities While Helping Write notes Stretch or tense/release specific muscles Create a separation Change breathing Protecting ourselves from trauma content: To picture or not to picture? Shields up Grounding (wiggle your toes, rock in my pocket, drink H2O)

Connections Talk out your stress Process your thoughts and reactions with someone else at work or home Build a positive network that supports you, not fuels your stress It is okay to draw back our energy from those we love, when they are draining our capacity to care for ourselves.

Organizational Supports Supportive management: timely & effective supervision flexible manager who is open to regular workload assessments in order to reduce trauma exposure and create balance Debriefing Critical Incident Cumulative Informal - Low-Impact Disclosure Professional Development Teamwork Team Building Counselling / EAP supports Model and encourage balance and positive coping techniques For those working alone: Develop a peer supervision and debriefing network Collaborate when possible – share the workload and increase connection (double benefit!) Professional development cutbacks – try no-cost options – webinars/Ted Talks, reading, peer-led development (share our talents with each other)

Low Impact Disclosure (LID) or “Anti-Sliming Strategy” Formal vs. informal debriefing Steps: Increased self-awareness Fair warning Consent (Ask what need) Low impact disclosure Ask self: Is the listener aware that I am about to share graphic details and are they able to control the flow? How much detail do I need to share?

Activity – Personal Commitment Need to maintain our ability to continue this work.

Suggested Resources Francoise Mathieu Dr. Gabor Mate www.compassionfatigue.ca www.drgabormate.com Laura van DerNoot Lipsky Dr. Jon Kabat-Zinn www.traumastewardship.com www.mindfullnesscds.com Headington Institute http://www.headington-institute.org