1. COMPASSION FATIGUE Patricia Dunnigan MA ABS Traumatology Institute of Western Canada

3. My Plan  Offer information  Tell some stories  Provide tools  Have some fun

5. 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.

6. “I first called it a form of burnout, a kind of secondary victimization.” Charles Figley

7. 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.

8. 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 listening…NOT NECESSARILY A PROBLEM”  Adapted from Figley, 1995

9. 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.

10. 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.

11. 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?

12. Burnout Risk  36 or less = extremely low risk  37 – 50 = moderate risk  51 – 75 = high risk  76 – 85 = extremely high risk

14. Compassion Satisfaction  118 + = extremely high potential  100 – 117 = high potential  82 – 99 = good potential  64 – 81 = modest potential  Below 63 = low potential

15. Stages of Progression  The Zealot Phase  The Irritability Phase  The Withdrawal Phase  The Zombie Phase

16. Process Involved  Gradual exposure to job strain  Erosion of idealism  Void of achievement  Accumulation of intensive contact and experiences with people we serve

17. The Zealot - Idealist  We are committed, involved and available… ready to problem solve 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 I’ll do that!

18. Irritability 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. –We denigrate their efforts at wellness. –Our use of humor is sometimes strained. –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…

19. 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 as individuals rather they become irritants  Complaints may be made about our work  We are tired all the time……we 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 thicker……it blocks our pain and sadness.

20. 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 humour…and have no time for fun

21. Choice Point Pathology/Illness and Victimization Overwhelmed and Leaving the Profession Somatic illness Perpetuity of Symptoms OR Maturation and Renewal Hardiness Resiliency Transformation

22. PTSD STSD  Stressor  Reexperiencing traumatic event  Avoidance/Numbing of reminders  Persistent Arousal

23. 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

24. Post-traumatic stress disorder  Onset: cluster of symptoms lasting > 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

25. Secondary traumatic stress  A natural by-product of working with trauma –empathy –our own traumatic event –trauma may be evoked –children’s trauma

26. Secondary Traumatic Stress Disorder  Avoidance/ Numbing efforts to avoid thoughts/feelings avoidance of activities/situations diminished interest detachment from others diminished affect foreshortened future

27. Secondary Traumatic Stress Disorder  Arousal sleep disturbance irritability general anxiety hypervigilance physiological reactivity

28. That which is to give light That which is to give light ….must endure burning ….must endure burning Viktor Frankl (1963)

30. Difference Between Compassion 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

32. IMPACT ON QUALITY OF WORK IMPAIRMENT  Violates the sense of basic trust  Severs connection to community  Destroys meaning  Loss of sense of perspective  Can’t find a way out  Behaves within the patterns generated by the client – good/evil, ally/enemy, rescuer/rescuee

33. Treating PTSD Tri-Phasic Model 1.Safety and Stabilization 2.Remembrance and Mourning 3.Reconnection

34. 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

35. WHAT ORGANIZATIONS CAN DO  Educate  Inoculate  Create Trained Support Teams

36. 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

37. Compassion Fatigue The Water and Stone Consulting Group www.waterandstone.ca