2. Independent Schools of New Zealand
Senior Leaders Forum
Auckland 2013
CARING FOR THE CARERS: Organisational Responsibilities
Peter Huggard
University of Auckland

3. You cant wipe
the tears from
someone’s face
without getting
your hands wet

4. As you do so, you
may recall some of
your own experiences
that have relevance
to you – think about
why these memories
have re-surfaced,
and the significance
of them for you.
Later, as we discuss
support, think of how
you access your own
support systems
Invitation to
engage in the process
as the discussion develops

5. This presentation: an invitation to explore the nature and management of compassion fatigue and vicarious traumatisation, and to consider organisational responsibilities
Describe the constructs of compassion fatigue, burnout, and compassion satisfaction
Experiences from working in health care
Approaches to managing these experiences
Prevention and support strategies, including organisational responsibilities, and combining these
understandings to look at both individual and organisational
resilience
Invite you to consider connections between ‘health’ and ‘education’

6. Compassion Fatigue Self-Test
. . . the natural consequent behaviours
and emotions resulting from knowing about a traumatizing event experienced by a significant other . . (Figley, 1995)
Charles Figley
Compassion Fatigue Self-Test
for Psychotherapists

7. Compassion Fatigue is composed
of two parts:
Burnout, being worn down and
overwhelmed by work
Secondary Traumatic Stress
– experiencing work-related fear
from traumatic stress exposure

8. PTSD intrusion avoidance hypervigilance CONSTANT STATE OF ALERTNESS
The person has been exposed to a traumatic event in which both of the following were present: 
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror
DSM IV-TR (2000)
PTSD
intrusion
avoidance
hypervigilance
CONSTANT STATE
OF ALERTNESS

9. “We view vicarious traumatization as an
occupational hazard, an inescapable effect
of trauma work. It is not something that
clients do to us; it is a human consequence
of knowing, caring, and facing the reality of
trauma” (p.25)
Laurie Anne Pearlman
Karen Saakvitne

10. Burnout The term burnout first used to describe the
emotional and physical exhaustion displayed by
some human service workers in health care
agencies.
Herbert Freudenberger (1975)
Multiple dimensional view (Maslach Burnout Inventory)
Emotional exhaustion
Depersonalisation
Reduced personal accomplishment
Christina Maslach (1981)
Burnout can lead to a deterioration in the quality
of services provided by the helping professional.
Ayala Pines (1981)

11. Burnout The term burnout first used to describe the
emotional and physical exhaustion displayed by
some human service workers in health care
agencies.
Herbert Freudenberger (1975)
Multiple dimensional view (Maslach Burnout Inventory)
Emotional exhaustion
Depersonalisation
Reduced personal accomplishment
Christina Maslach (1981)
Burnout can lead to a deterioration in the quality
of services provided by the helping professional.
Ayala Pines (1981)

12. Burning brightly . . Burning dimly . . . Burning out . . . .
Frank Lamendola (1996)

13. Compassion Satisfaction
. . . an expression of the positive aspects of
care-giving (Stamm, 2002, Treating Compassion Fatigue)
Beth Stamm

14. Compassion Fatigue (STS) Satisfaction Burnout
+ sig.
Resilience
Compassion
Fatigue
(STS)
Satisfaction
Burnout
Empathy
Spirituality
Emotionality
ProQOL

15. Compassion Fatigue (STS) Satisfaction Burnout
+ sig.
Resilience
Compassion
Fatigue
(STS)
Satisfaction
Burnout
- sig.
Empathy
Spirituality
Emotionality
ProQOL

16. Compassion Fatigue Satisfaction Burnout
+ sig.
Resilience
Compassion
Fatigue
Satisfaction
Burnout
Spiritual Beliefs
Relationship with
a Higher Power
+ sig.
Empathy
- sig.
Spirituality
Emotionality
ProQOL

17. Strongest association with compassion fatigue
Personal Strengths
Emotional Competence
These two subscales
were the most strongly,
and negatively,
associated with CF

18. Personal Strengths I can deal with whatever comes up
I believe that past success gives confidence
for new challenge
I see the humour side of things
I believe that coping with stress strengthens
I tend to bounce back after illness or hardship
I believe I give my best effort no matter what
I believe I should act on a hunch

19. Emotional Competence
I feel confident in my ability to care for patients
exhibiting strong emotional distress
I am aware of my emotions as I experience them
I feel confident in my ability to understand my own
emotional responses to my patients’ distress
I feel competent in my ability to understand the
reasons for my patient’s strong emotional distress
I feel confident in my ability to care for the
emotional as well as the physical needs of my patients
I feel able to initiate access to additional support,
if required, to help me to understand and manage
my emotions in relation to my patients

20. Emotional Competence
I feel confident in my ability to care for patients
exhibiting strong emotional distress
I am aware of my emotions as I experience them
I feel confident in my ability to understand my own
emotional responses to my patients’ distress
I feel competent in my ability to understand the
reasons for my patient’s strong emotional distress
I feel confident in my ability to care for the
emotional as well as the physical needs of my patients
I feel able to initiate access to additional support,
if required, to help me to understand and manage
my emotions in relation to my patients

21. Emotional Competence
I feel confident in my ability to care for patients
exhibiting strong emotional distress
I am aware of my emotions as I experience them
I feel confident in my ability to understand my own
emotional responses to my patients’ distress
I feel competent in my ability to understand the
reasons for my patient’s strong emotional distress
I feel confident in my ability to care for the
emotional as well as the physical needs of my patients
I feel able to initiate access to additional support,
if required, to help me to understand and manage
my emotions in relation to my patients
QUESTION:
Does my organisation make it easy for staff to
put their hand up and ask for help?

22. Signs & Symptoms of Compassion Fatigue
Physical
Exhaustion
Insomnia
Headaches
Increased susceptibility to illness
Somatization
Hypochondria

23. Signs & Symptoms of Compassion Fatigue
Behavioural
Increased in alcohol use (and other drugs)
Absenteeism
Anger and irritability
Avoidance of clients
Impaired ability to make decisions
Problems in personal relationships
Attrition
Compromised care for clients
The Silencing Response

24. Signs & Symptoms of Compassion Fatigue
Psychological
Emotional exhaustion
Distancing
Negative self image
Depression
Reduced ability to feel sympathy and empathy
Cynicism
Resentment
Dread of working with certain clients
Feeling professional helplessness
Diminished sense of enjoyment/career
Depersonalisation
Fear

25. Signs & Symptoms of Compassion Fatigue
Psychological
Disruption of world view/ Heightened anxiety
or irrational fears
Increased sense of personal vulnerability
Inability to tolerate strong feelings
Problems with intimacy
Intrusive imagery
Hypersensitivity to emotionally charged
stimuli
Insensitivity to emotional material
Loss of hope
Difficulty separating personal and
professional lives
Failure to nurture and develop non-work
related aspects of life

27. The Silencing Response
“Silencing” patients as a coping
mechanism – particularly with people
experiencing compassion fatigue
Can be through words or actions
Developed the “Silencing Response Scale”
Dr Anna Baranowsky
Toronto

28. 1 signifies rarely/never and 10 means very often/always
SILENCING RESPONSE SCALE
Chose the number that best reflects you experience (over the last 2 weeks)
1 signifies rarely/never and 10 means very often/always
Question
No.
Response 1
Are there times when you believe your client(s) is/are repeating
emotional issues you feel were already covered? 2
Do you get angry with your clients? 3
Are there times when you react with sarcasm towards your clients? 4
Are there times when you fake interest? 5
Do you feel that listening to certain experiences of your client(s)
will not help? 6
Do you feel that letting your clients talk about their trauma will hurt them? 7
Do you feel that listening to your clients’ talk about their
experiences will hurt you? 8
Are there times that you blame your clients for the bad things that
have happened to them?

29. 9
Are there times when you are unable to believe what your clients are telling you because what they are describing seems overly traumatic? 10
Are there times when you feel numb, avoidant or apathetic before meeting with certain clients? 11
Do you consistently support certain clients in avoiding important therapeutic material when time is not a constraint? 12
Are there times when sessions do not seem to be going well or the client’s treatment progress appears to be blocked? 13
Do you become anxiously aroused when a client is angry with you? 14
Are there times when you cannot remember what a client has just said? 15
Are there times when you cannot focus on what a client is saying?
Total Score

30. SUPPORT & SELF
CARE
STRATEGIES

31. A B C Awareness: of our needs limits of our physical and emotional
resources A B C
Balance:
between activities, work, play, and rest
Connection:
to oneself, others, and something larger
Saakvitne & Pearlman (1996)

32. Resilience building strategies
Building positive nurturing professional
relationships and networks
Maintaining positivity
Developing emotional insight
Achieving life balance and spirituality
Becoming more reflective
Jackson, D., Firtko, A. & Edenborough, M. (2007). Personal resilience as a strategy for surviving in the face of workplace adversity: a literature review. Journal of Advanced Nursing, 60(1), 1-9.

33. But these are general approaches towards having
a safe workplace, and are both individual and
organisational obligations
– what about legislation that provides for this?

34. Health and Safety in Employment Amendment Act 2002
7 New section 5 substituted
The principal Act is amended by repealing section 5, and substituting
the following section:
“5 Object of Act
The object of this Act is to promote the prevention of harm to all
persons at work and other persons in, or in the vicinity of, a place
of work by—
“(a) promoting excellence in health and safety management,
in particular through promoting the systematic management
of health and safety; and
“(b) defining hazards and harm in a comprehensive way so
that all hazards and harm are covered, including harm caused
by work-related stress and hazardous behaviour caused by
certain temporary conditions;

35. Organizational Processes
Top-down acknowledgement of
the ‘additional’ consequences of
being in a ‘carer’ role
Commitment to providing
processes that assist staff to
manage these consequences
Monitoring of staff workload and
assignments
EMOTIONAL SAFETY POLICY
CRUISIE JOBS

36. Jayne Huggard & Jan Nichols (2011)
Jayne Huggard & Jan Nichols (2011). Emotional Safety in the Workplace: one Hospice’s
response for effective support. International Journal of Palliative Nursing, 17(12),

39. Peer Group Processes The Guardian Angel “Peer monitoring”
“Belonging” processes
– collegiality, decreased
sense of isolation
Organizational culture of fun
Appropriate work load balance
The Guardian Angel
Group Support
Delilah Smith

40. The Separation of Sky and Water
Individual Processes
Strategies for
disengagement:
Effective professional
supervision
Defusing/debriefing
Boundary setting
Healthy work-life-home balance
The Separation of Sky and Water
Michelangelo

41. Achievement – Mark Huddleston
Individual Processes
Strategies for gaining a
sense of achievement:
Setting achievable goals
Being open to feedback
Focus on successes
Develop a tolerance for
setbacks
Positive self-statements
Use of rituals
Achievement – Mark Huddleston

44. Link to resilience, both individual and organisational – a guideline
Amy Stephenson, John Vargo, Erica Seville (2010). Measuring and
Comparing Organisational Resilience in Auckland. The Australian
Journal of Emergency Management, Volume 25(2)27 – 32
Resilient Organisations Research Group – Universities of Canterbury
and Auckland
Developed a measure of organisational resilience
Sampled 1009 Auckland organisations and established the validity
of the instrument

45. A new model of Organisational Resilience
Planning Dimension Adaptive Capacity Dimension
Planning Strategies Leadership
Participation in Exercises Staff Involvement
External Resources Situation Monitoring and Recovery Priorities Reporting Proactive Posture Minimisation of Silos
Internal Resources
Decision Making Innovation and Creativity Information and Knowledge

46. What is Organisational Resilience?
Resilient Organisations: University of Canterbury and
University of Auckland
• Leadership
• Staff Engagement
• Situation Awareness
• Decision Making
• Innovation and Creativity
• Effective Partnerships
• Leveraging Knowledge.
• Breaking Silos
• Internal Resources
• Unity of Purpose
• Proactive Posture
• Planning Strategies
• Stress Testing Plans

47. So, in conclusion; Thank you for your Attention