compassion fatigue/ secondary traumatic stress: caring for the caregivers
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Compassion Fatigue/ Secondary Traumatic Stress: Caring for the Caregivers. Together We Can April Naturale , MSW, Ph.D. Lafayette, LA October 6, 2010. Goals and Objectives. Goal: - PowerPoint PPT PresentationTRANSCRIPT
Compassion Fatigue/ Compassion Fatigue/ Secondary Traumatic Stress: Secondary Traumatic Stress: Caring for the Caregivers Caring for the Caregivers
Together We CanApril Naturale, MSW, Ph.D.
Lafayette, LAOctober 6, 2010
Goals and ObjectivesGoals and ObjectivesGoal:For staff working with abused and traumatized children to understand and address their risks and responses to Compassion Fatigue, Secondary Traumatic Stress and BurnoutObjectives: • To be able to identify the body and mind’s responses to stress• To learn ways mitigate and address these responses by implementing skills and self care• To monitor changes over time
Stress is a cognitive reaction that affects humans physiologically
Individuals from different backgrounds, cultures and geographic areas perceive
stress differently
CONCEPTS OF STRESS VARYCONCEPTS OF STRESS VARY
The Physiology of StressThe Physiology of Stress
Good Stress The good stress allows us to perform at a
higher level (fight or flight)
The production of cortisol improves memory and enhances immune function
Spikes in blood pressure flood our muscles and brain with oxygen
The Physiology of StressThe Physiology of Stress
Bad Stress-Overload
The allostatic system becomes charged too frequently with NO CHANCE TO VENT the build up of energy
Too much cortisol will damage memory, hurt or weaken your immune system and enlarge your stomach
Work StressWork Stress
Stress measured by increases in blood pressure is generally twice as high during the work day compared to when at home or time off.(Pickering, 2005)
Work Stress Work Stress
The worst work-related stress is caused by jobs where people have little
control over activities and the rate at which they have to address
them
Environmental EffectsEnvironmental Effects
Responsibility of caring for physically and/or emotionally abused, neglected children
Exposure to the fear, grief, pain, loss, separation, death of children
The community/social response (or lack of)
Additional FactorsAdditional Factors Depression-5-10% of the population (NIMH, 2005)
Race-genetics, family illnesses
Diet –high salt, high fat
Social Constructs-professional women, single parents with children
Children react to caregiver’s emotional responses
Child care workers put needs of children ahead of their own
Increased responsibility of caring for children increases the stress response
The Population of CareThe Population of Care
Compassion FatigueCompassion Fatigue
THE COST OF CARING
Secondary Traumatic Secondary Traumatic StressStress
The experience of trauma symptoms in the counselors as a result of
listening to the trauma material of clients
DifferentiationsDifferentiationsNot burnout, but can lead there (Figley, 2002)
Unlike countertransference (Green, 1992)
Differentiated from vicarious trauma (Pearlman &
Saakvitne, 1995; Figley, 1999)
Compassion fatigue and secondary traumatic stress are most similar in meaning (Stamm 1999)
Symptoms (Trauma Symptoms (Trauma Specific)Specific)
High adrenaline, physical euphoria, numbness-the endorphin effect disguises distress
Coupled with fatigue, cognition can change and create an inability to recognize poor judgment
Anger is a common defense against recognizing the problem
SymptomsSymptomsPosttraumatic stress disorder symptoms;
Symptoms that parallel those of client Monroe, 1999
Negative cognitive schemas Pearlman & Saakvitne, 1995)
Questioning beliefs; Sense of helplessness
Isolation; Depression; Increased substance use; Increased rates of physical illness
Lower staff morale and productivity; Higher turnover and errors Stamm, 1997
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Medicating or narcotizingOvereating, excessive drinkingExtramarital affairsSuicidal gestures
High Risk SymptomsHigh Risk Symptoms
Tiredness/weariness yet insomnia
Brooding, wistful, mournful-Depressive
Increasing demoralization
Intellectualizing/Religionizing the work
Grandiosity (I can handle this myself/don’t consider asking for help)
Long Term Exposure SymptomsLong Term Exposure Symptoms
Risk CategoriesRisk Categories Health, mental health, social services
providers
Staffs with clients who experience profound suffering
Highly exposed response staffs (media, clergy, caregivers)
Inhibited individuals in these groups (more likely to have dissociative responses)
Risk VariablesRisk VariablesLesser educated and lesser
experienced counselors
Greater length of assignment results in higher STS risk
Gender and ethnicity have been found to affect STS (women and minority status)
Child Care WorkersChild Care WorkersAre generally self sacrificing -many place themselves in danger -many will work ‘till it hurts -many will skip breaks -many will ignore/fight direction to rotate assignments, go off duty or take benefit time even when encouraged
Automatic ResponsesAutomatic Responses
Caregivers react to stressful situations by training- without the benefit of thought-they go right to caring for others
Concerns for family don’t disappear-We put our own emotions on hold
Cognitive reactions reinforce physical reactions (our thinking controls our actions)
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What Can You Do?What Can You Do?
LearnBe AwareMonitorThinkPracticeChangeManage
Prevention: StructuralPrevention: Structural
Vary caseload of trauma and non trauma cases
Utilize buddy system
Access supervision routinely
(Dugall, Herberman, Delahanty, Inslicht & Baum, 2000).
Supervisors-mandate case rotation and use of benefit time (Monroe, 1999)
• Expect, seek & accept peer
support
• Master controlled, limited
empathy• Define structure and boundaries
• Monitor overidentification
• Self assess-PRO QUAL-IV
• Commit to implementing self-care
Prevention: Professional PerspectivePrevention: Professional Perspective
Recognize when you are: Hungry Angry Lonely Tired Maintain support systems
Schedule personal time, engage in pleasurable activities
Maintain a balance
Practice Self Care
Prevention: PersonalPrevention: Personal
Prevention: Professional Prevention: Professional PerspectivePerspective
Be realistic
Commit to implementing self-care
Recognize that the world won’t fall apart without you
LET GO
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• Give yourselves permission to celebrate even in the midst enormous stress- play, laugh, experience joy
• Be together-don’t isolate
• Communicate, communicate, communicate (e.g. I need you to understand, we will get through this together, let’s stay connected)
• Plan for every day
As a UnitAs a Unit
Managers, Professionals and Front Line staff can mitigate compassion fatigue and burnout by using stress management techniques. Learn those personally effective ways of using relaxation: - focused breathing; - distraction; - seek support, comfort from loved ones - use positive self talk
Simple Stress ManagementSimple Stress Management
Breathing, Stretching, Walking
Healthy Diet-Avoid excesses
Body Work Body Work Body Work (Exercise, Yoga, Meditation, Guided Imagery, Self Hypnosis)
Meditation
Music
Physical ToolsPhysical Tools
Start with the Start with the 333 STOP333 STOP MethodMethod
STOP Where You Are3 Minutes3 Breaths
3 Times a day
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Graduate to the Relaxation Response
Cognitive ToolsCognitive Tools
• Interrupt the Automatic Response/Reduce the Reaction
• CBT (Messaging; Thought Stopping/Insertion)
• Emotion Regulation (Turn Down the Vibration)
• Reintroduce Routing-Return to Normal Activity
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AffirmationsAffirmations
Familiarize yourself with the action of affirmations both auditory and visual
Sample different expert’s work-choose voices and images that are pleasant to your eyes/ears
Schedule the use of these tools to obtain maximum benefit
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Leisure Tools Leisure Tools Try Acupuncture, Art, Awareness, Create,
Cook, Dance, Dream, Draw, Exercise, Enjoy, Explore, Go Home, Kick-Box, Laugh, Limit work, Loosen up, Listen to music, Massage, Meditate, Practice Yoga, Paint, Pet the Pet, Sing, Sit Quietly, Sleep, Start a Book, Stretch, Talk to Yourself, Family and Friends, Wade, Walk, Watch a bug, or a movie or the sunset, Whistle, Wish
Do Something other than WORK
Stay focused on answering the question that is being asked.
Read the introductory words and think for a moment how you will respond to the questions by starting with the introductory words.
1. What problem(s) do this work bring to your life? Begin
your response: “Being a child care worker brings ________________to
my life….” (e.g.: excessive worry ) 2. How has this problem affected your family life or other
relationships? Begin your response: “This problem, _________________, has affected my life
by…” 3. What have you done to cope with or address this
problem? Begin your response: “To cope with this problem, I have….”
Publications WebsitePublications Website
National Mental Health Information Ctr
www.mentalhealth.samhsa.gov/cmhs/katrina/pub_respond.aspNational Center for Posttraumatic
Stress Disorder www.ncptsd.org Compassion Satisfaction & Fatigue
Test www.isu.edu/~bhstamm/tests/satfat.htm