compassion fatigue how to avoid compassion fatigue and instead foster emotional resiliency

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Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

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Page 1: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Compassion Fatigue

How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Page 2: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Training Module

Page 3: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Resiliency

“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

Page 4: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Definitions

• Compassion :

Per Merriam Webster (2015) “sympathetic consciousness of others' distress together with a desire to alleviate it”.

• Per American Institute of Stress: Compassion Fatigue :Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burnout, but can coexist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Page 5: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Definitions continued…

• Burnout:

Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma related.

• Primary Traumatic Stress:

Primary stressors are those inherent in the extreme event, such as what was immediately experienced or witnessed, especially those things most contributing to a traumatic response.

Page 6: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

“Cost of Caring”

• Our primary task as helping professionals is first and foremost to meet the physical and/or emotional needs of our clients and patients. This can be an immensely rewarding experience, and the daily contact with patients is what keeps many of us working in this field. It is a calling, a highly specialized type of work that is unlike any other profession. However, this highly specialized rewarding profession can also look like this: Increasingly stressful work environments, heavy case loads and dwindling resources, cynicism and negativity from coworkers, low job satisfaction and, for some, the risk of being physically assaulted by patients. Compassion Fatigue has been described as the “cost of caring" for others in emotional and physical pain (Figley, 1995).

Page 7: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

It is characterized by deep physical and emotional

exhaustion and a pronounced change in the

helper’s ability to feel empathy for their patients, their loved ones and their

coworkers.

Page 8: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

It is marked by increased cynicism at work, a loss of enjoyment of our career, and eventually

can transform into depression, secondary traumatic

stress and stress relatedillnesses.

The most insidious aspect of compassion fatigue is that it attacks the very

core of what brought us into this work: our

empathy and compassion for others.

Page 9: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Who is affected by Compassion Fatigue?

Compassion fatigue is an occupational hazard, which means that almost everyone who cares about their patients/clients will eventually develop a certain amount of it, to varying degrees of severity. Statistics Canada recently published their first ever National Survey of the Work and Health of Nurses (2005) which found that “close to one-fifth of nurses reported that theirmental health had made their workload difficult to handle during the previous month.

Page 10: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Helping Professions

A study of Cancer Care Workers in Ontario carried out in 2000 also found high levels of burnout and stress among oncology workers and discovered that a significant number of them were considering leaving the field: 50% of physicians and 1/3 of other cancer care professionals had high levels of emotional exhaustion and low levels of personal accomplishment. (Grunfeld 2000) Similar findings have been found among other helping professionals such as child protection workers, law enforcement, counselors and prison guards. (Figley, 2006).

Page 11: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Is it Burn Out or Compassion Fatigue?

The Stages of Burnout have been identified as:

• Enthusiasm

• Stagnation

• Frustration

• Apathy

Commonalities of Burnout and Compassion Fatigue:

• Emotional exhaustion

• Reduced sense of personal accomplishment or meaning in work

• Mental exhaustion

• Decreased interactions with others (isolation)

• Depersonalization (symptoms disconnected from real causes)

• Physical exhaustion

Page 12: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Compassion Fatigue: The Process

“First, you should understand that it’s a process. It’s not a matter of one day, you’re living your life with a great deal of energy and enjoyment, and the next, you wake up exhausted and devoid of any energy; both physical and emotional. Compassion fatigue develops over time; taking weeks, sometimes years to surface. Basically, it’s a low level, chronic clouding of caring and concern for others in your life, whether you work in or outside the home. Over time, your ability to feel and care for others becomes eroded through overuse of your skills of compassion. You also might experience an emotional blunting ;whereby you react to situations differently than one would normally expect.” When Helping Hurts by F. Oshberg, MD (1995).

Compassion Fatigue has many symptoms and often parallel to the symptoms of the traumatized clients with whom caregivers are working. While compassion fatigue has been most often written about in the rubric of psychotherapy as emotional contagion passed from client to clinician, there is growing evidence to support the transgenerational and societal transmission of this condition (Danieli, 1985; Baranowsky, 1997; Bloom, 1997)

Page 13: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Symptoms of Compassion Fatigue

increased negative arousal intrusive thoughts/images of clients' situations/traumas (or clinicians' own historical traumas) difficulty separating work life from personal life lowered frustration tolerance/outbursts of anger or rage dread of working with certain clients marked or increasing transference/countertransference issues with certain clients depression perceptive/"assumptive world" disturbances (i.e., seeing the world of terms of victims and perpetrators, decrease in subjective sense of safety) increase in ineffective and/or self-destructive self-soothing behaviors hypervigilance feelings of therapeutic impotence or de-skilled with certain clients diminished sense of purpose/enjoyment with career diminished ego-functioning (time, identity, volition) decreased functioning in nonprofessional situations loss of hope

Page 14: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Mirroring

The symptoms of Compassion Fatigue are essentially the very same symptoms we see in our

population of children who have experienced trauma. When we

suffer from these symptoms, we mirror their own symptomology,

emotional challenges and behavioral concerns.

Page 15: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Compassion Fatigue can Change, Evolve or Heal Over Time.

Compassion Fatigue is fluid and ever-changing. Depending upon each individual’s personal resiliency, risk factors and

protective factors, they may suffer from Compassion Fatigue ranging on a wide spectrum. Furthermore, caregivers and

helping professionals may struggle with Compassion Fatigue, implement strategies aimed towards resilience and recover. Compassion Fatigue is not a diagnosis or static and can be

healed.

Page 16: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

The ABC’s of Prevention

• Awareness

• Balance

• Connection

Page 17: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Awareness

• What types of cases contribute to your stress level increasing your vulnerability to compassion fatigue?

• Think of events or situation that causes one to experience an unusually strong reaction and often overpowers one’s usual coping mechanisms.

• Are you aware of any of these issues or contributing factors in your workday? If so, you could be at risk of compassion fatigue.

• Is your ability to function interfered with or altered?

• Does “Compassion stress” impinge upon or breaks through normal boundaries?

• Do you regularly waking up tired in the morning and struggling to get to work?

• Feeling as if you are working harder but accomplishing less?

• Becoming frustrated/irritated easily?

• Losing compassion for some people while becoming over involved in others?

• Routinely feeling bored or disgusted?

• Experiencing illness, aches and pains?

It is critical to check in with yourself regularly. Be aware of your own behaviors, reactions,

emotions and thoughts. Be honest with yourself and others. There is

no shame in suffering from Compassion Fatigue- until

acknowledged and dealt with, Compassion Fatigue will only

continue to cloud personal and professional lives.

Page 18: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Balance

• Nurture yourself by putting activities in your schedule that are sources of pleasure, joy and diversion

• Allow yourself to take mini-escapes; these relieve the intensity of your work

• Transform the negative impact of your work (find meaning, challenge negativity, find gratitude)

• Get medical treatment if needed to relieve symptoms that interfere with daily functioning

• don’t use alcohol or drugs to self-medicate

• Get professional help when needed to get back on track; we all need coaches and consultants at times

• Practice excellent self-care

• Adequate sleep

• Healthy lifestyle

• Make time to feed your soul

• Indulge your passions

Balancing your life involves putting the things that we value and have

passion for in our schedule.

Page 19: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Balance (continued)…• List one thing that brings you joy

• Name 3 things you feel grateful for today

• Think of something that has brought you a sense of joy (Make your top ten list)

• Who do you love that you can reach out to today? (Call them!)

• What made you laugh today? (Share it!)

• Find your passion! When you identify the things that fuel you, the things that you have true passion for, your

fatigue will disappear.

• Have quiet alone time in a calm, beautiful

place

• Enjoy a safe retreat where you feel renewed

• Have an awareness of what restores and replenishes you.

• Find ways to acknowledge loss and grief

• Stay clear with commitment to career goals or your personal mission

• Know how to focus on what you can control

• Look at situations as entertaining challenges and opportunities, not problems or stresses

Page 20: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Connections

• Talk out your stress process; share your thoughts and reactions with someone else (coworker, therapist, clergy, friend, family,

supervisor)

• Build a positive support system that supports you, not fuels your stress

• Pets accept whatever affection you are able to give them without asking for more

—Pets are basically invulnerable to “provider burnout”–Blood pressure and

heart rate decrease when interacting with animals

Page 21: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Fostering Resiliency: What is Resiliency?

Resilience is the process of adapting well in the face of

adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship

problems, serious health problems or workplace and financial

stressors. It means "bouncing back" from difficult experiences.

Page 22: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Research has shown that resiliency is ordinary- not extraordinary.

People commonly demonstrate resilience. One example is the response of many Americans to the September 11, 2001 terrorist attacks and individuals' efforts to rebuild their lives. Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress.

Page 23: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Resilience is not a trait that people either have or do not have. It involves behaviors, thoughtsand actions that can be learned and developed in anyone.

Page 24: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Factors in Resilience

A combination of factors contributes to resilience. Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person's resilience.

Several additional factors are associated with resilience, including:

• The capacity to make realistic plans and take steps to carry them out.

• A positive view of yourself and confidence in your strengths and abilities.

• Skills in communication and problem solving.

• The capacity to manage strong feelings and impulses.

• All of these are factors that people can develop in themselves.

Page 25: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Strategies for Building Resilience

Developing resilience is a personal journey. People do not all react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies.

Some variation may reflect cultural differences. A person's culture might have an impact on how he or she communicates feelings and deals with adversity — for example, whether and how a person connects with significant others, including extended family members and community resources. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience. Some or many of the ways to build resilience in the following pages may be appropriate to consider in developing your personal strategy.

Page 26: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Learning from Our Past

Focusing on past experiences and sources of personal strength can help you learn about what strategies for building resilience might work for you. By exploring answers to the following questions about yourself and your reactions to challenging life events, you may discover how you can respond effectively to difficult situations in your life.

Page 27: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Points to Consider

• What kinds of events have been most stressful for me?

• How have those events typically affected me?

• Have I found it helpful to think of important people in my life when I am distressed?

• To whom have I reached out for support in working through a traumatic or stressful

• experience?

• What have I learned about myself and my interactions with others during difficult times?

• Has it been helpful for me to assist someone else going through a similar experience?

• Have I been able to overcome obstacles, and if so, how?

• What has helped make me feel more hopeful about the future?

Page 28: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Stay Flexible

• Resilience involves maintaining flexibility and balance in your life as you deal with stressful circumstances and traumatic events. This happens in several ways, including:

• Letting yourself experience strong emotions, and also realizing when you may need to avoid experiencing them at times in order to continue functioning.

• Stepping forward and taking action to deal with your problems and meet the demands of daily living, and also stepping back to rest and reenergize yourself.

• Spending time with loved ones to gain support and encouragement, and also nurturing yourself.

• Relying on others, and also relying on yourself.

Page 29: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Where to go for help?

• Self-help and support groups. Such community groups can aid people struggling with hardships such as the death of a loved one. By sharing information, ideas and emotions, group participants can assist one another and find comfort in knowing that they are not alone in experiencing difficulty.

• Books and other publications by people who have successfully managed adverse situations such as surviving cancer. These stories can motivate readers to find a strategy that might work for them personally.

• Online resources. Information on the web can be a helpful source of ideas, though the quality of information varies among sources.

For many people, using their own resources and the kinds of help listed above may be sufficient for building resilience. At times, however, an individual might get stuck or have difficulty making progress on the road to resilience.

Getting help when you need it is crucial in building

your resilience. Beyond caring family members and friends, people often find it

helpful to turn to:

Page 30: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Asking for help

A licensed mental health professional such as a psychologist can assist people in

developing an appropriate strategy for moving forward. It is important to get

professional help if you feel like you are unable to function or perform basic

activities of daily living as a result of a traumatic or other stressful life

experience. Different people tend to be comfortable with somewhat different

styles of interaction. A person should feel at ease and have good rapport in working

with a mental health professional or participating in a support group.

Page 31: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Compassion Fatigue CBT Toolkit

What would go in that toolkit? What are my warning signs – on a scale of 1 to 10, what is a 4 for me, what is a 9? Schedule a regular check in, every week – how am I doing? What things do I have control over? What things do I not have control over? What stress relief strategies do I enjoy? (taking a bath, sleeping well or going for a massage) What stress reduction strategies work for me? Stress reduction means cutting back on things in our lives that are stressful (switching to part time work, changing jobs, rejigging your caseload, etc.) What stress resiliency strategies can I use? Stress resiliency are relaxation methods that we develop and practice regularly, such as meditation, yoga or breathing exercises.

Page 32: Compassion Fatigue How to Avoid Compassion Fatigue and instead Foster Emotional Resiliency

Recommended Resources

Books:

Borysenko, J. (2003) Inner peace for busy people: 52 simple strategies for transforming your life.

Fanning, P. & Mitchener, H. (2001) The 50 best ways to simplify your life

Figgley, C (1995) When Helping Hurts: Sustaining Trauma Workers

Jeffers, S. (1987) Feel the fear and do it anyway.

O’Hanlon, B. (1999) Do one thing different: 10 simple ways to change your life.

Posen, D. (2003) Little book of stress relief.

Richardson, C. (1998) Take time for your life.

SARK, (2004) Making your creative dreams real: a plan for procrastinators, perfectionists, busy people, avoiders, and people who would rather sleep all day.

Van Dernoot Lipskey, L. and Burk, C. (2009). Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others

Online:

Dailystrength.com

http://www.apa.org/helpcenter/road-resilience.aspx

http://www.tir.org/research_pub/research/compassion_fatigue.html

giftfromwithin.org

stress.org

compassionfatigue.org

https://www.psychologytoday.com/basics/resilience