Preventing Compassion Fatigue and Promoting Compassion Satisfaction- Presentation at the American Psychological Association, 2011 ; A skill building workshop facilitated with Dr Ilene Serlin
2. Background Selah- The Israel Crisis Management Center Emergency and longer term support to immigrants in disaster situations Photographer : Edward Kaprov
4. Method: 3 studies on separate samples of volunteers (N=310) were conducted including a diary study and experimental design Compassion Fatigue & Satisfaction An Attachment Perspective :
5. Research Findings Factors associated with compassion satisfaction : Dispositional factors- Negative correlation with attachment avoidance Contextual factors Mediating factors : Emotional regulation Meaningfulness Hopefulness Study 3- The effect of security priming on anticipation of compassion fatigue & satisfaction
6. Security priming ( visualizing a supportive attachment figure, versus an acquaintance ) increased: -willingness to reach out (and cope with possible ambivalence, withdrawal or rejection of help). -positive appraisal of the recipients' strengths and ability to benefit from support . -anticipation that the caregiving experience will be rewarding . Additional Finding s: Discussion- Attachment security – dispositional or contextual – as a resource that may reduce susceptibility to burnout and secondary traumatic stress. The importance of examining intra-personal variance Research limitations & future directions
7. Key Factors: M eaning O pportunities V alidation I nvolvement N ature G roup Moving Encounters Photographer : Vladimir Godnik
11. Narrative & Appreciative Inquiry Themes Adapted from Krasner et al. (2009). Association of an Educational Program in Mindful Communication with burnout, empathy and attitudes among primary care physicians. JAMA . Vol. 302 (12) pp 1284-1293 Write or tell a brief story about… Topic A pleasant or an unpleasant experience during work and its effect on the relationship Awareness of pleasant and unpleasant sensations, feelings or thoughts An experience of noticing and responding to your own emotional exhaustion, depersonalization, and low sense of personal accomplishment Burnout An encounter that was meaningful to you; what made it meaningful, what personal capacities did you have that contributed to the meaning Meaning A time when you effectively said “No!” or set a clear boundary while maintaining a supportive relationship Boundaries or conflict management A time when you faced choices about balancing caring for yourself and caring for others Self-care An encounter involving being present to suffering: sadness, pain and uncertainty Being with suffering
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Hinweis der Redaktion
Background- The model that I plan to present was initially as part of SELAH (Israel Crisis Management Center) training and support programs for volunteers. What is Selah? SELAH is a NGO countrywide network of volunteers who are trained to provide outreach to immigrants in crisis situations to identify immediate needs and provide on-site emergency practical and emotional support - in the hospitals, morgues, or homes - to the bereaved as well as to the wounded and their families. You can see the volunteer finding his way through the ruins of a home after a bombing. Such volunteering entails extensive outreach including to “difficult to reach populations” The emergency support is followed by a longer term individual support by volunteers as well as group programs. - The volunteers come from a wide variety of professional backgrounds, including mental health professionals experienced in working in crisis intervention and trauma treatment. -Some of the people who suffered tragedy and were helped by SELAH volunteers, have themselves joined the Selah network as volunteers who reach out to support the newly wounded and the newly bereaved families They make a unique contribution. Helping others for them may be a survivor mission.
Isolation from family or friends are risk factors- Caregivers need to feel part of a caring community- The helpers' families involvement also play a significant role In predicting compassion satisfaction. One practical implication of this finding is that we can mobilize family support by joint sessions or activities. Creating and maintaining a sense of belonging, meaning, and purpose is essential both to preventing compassion fatigue and to enhancing compassion satisfaction. How is this implemented?
Study 1- Questionnaires were administered to 148 volunteers. Their scores on attachment anxiety and avoidance were measured, as well as perceived support and reports of burnout, secondary traumatization and compassion satisfaction (the three subscales of compassion fatigue). Study 2- A diary study design. 54 volunteers were requested to fill-in a questionnaire, following each encounter in their volunteering activities over a period of two months. They were requested to fill-in a questionnaire, following each encounter in their volunteering activities over a period of two months. They were asked to rate signs of burnout, secondary traumatization and compassion satisfaction. Study 3- We examined the effect of priming (through guided imagery) of attachment security on the responses of 108 volunteers to a hypothetical scenario of a person coping in the aftermath of traumatic loss, including anticipated signs of burnout, secondary traumatization and compassion satisfaction. In an additional study we used diary entries using the Pennebaker paradigm
The findings of the three studies support the hypothesis that mobilizing external or internal forms of felt security reduces the likelihood that the caregiver will develop symptoms of compassion fatigue (including burnout and secondary traumatic stress). Higher scores on the anxiety dimension were associated, in all the three studies, with reports of burnout and secondary traumatization. Attachment avoidance was not related to burnout or secondary traumatization, but was negatively associated with compassion satisfaction. A possible explanation is that avoidant people use strategies of deactivation and distancing that block access to emotions, including positive emotions which can contribute to compassion satisfaction. . These findings support previous research showing that attachment security or insecurity shapes a person’s responses to others in distress; secure individuals respond with greater empathy to expressions of need and vulnerability, feel more confident about their ability to deal with the needs of others while effectively regulating their own emotions and are more hopeful regarding the care-recipient’s strengths and capacity to benefit from support. .
Being secure with respect to attachment – whether secure due to the caregiver’s long-term personal relationship history or secure because of the induction of security in a particular context – acts not only as a protective shield against burnout and secondary traumatic stress, but is also associated with an increased likelihood that the caregiver will anticipate compassion satisfaction. While previous research has emphasized the stress responses of emergency workers, such as those involved in rescue teams and crisis interventions, the current findings point to the need for further research examining the unique challenges of providing longer term support with the more chronic cases of those in need
Programs for volunteer training and support- These are the six key factors that emerged from previous research (Pardess, 2010) as central sources of strength for the volunteers and are building blocks of our support programs.
Multimodality-The multifaceted nature of the caregiver experience calls for an integrative perspective The programs include -narrative practices and appreciative inquiry -The Pennebaker writing paradigm - -outdoor and nature-based experiential activities alongside verbal and non verbal expressive arts Compassion-focused strategies, Pennebaker, J. W., & Chung, C. K. (in press). Expressive writing and its links to mental and physical health. In H. S.Friedman (Ed.), Oxford handbook of health psychology .New York, NY: Oxford University Press.
The term movement represents a shift of the emphasis from the prevailing cognitive perspective toward a more comprehensive approach which includes attention to sensory and emotional aspects of Moving in relationship to oneself, others and the world Body Movement- Nature excursions, Grounding, stretching and Breathing exercises, dance therapy or martial art therapies The term Moving encounters also corresponds in a way to what Daniel Stern (2004) refers to as “ now moments ”- interactions that are full of potential for transformation. Such moments occur also outside of therapeutic settings. People often remember these moments, not the intellectual explanations of them, as turning points or transformative in their change process.
Asking questions to generate affirming and resourceful memories for future times Seeking out with caregivers the resources they can call on for handling the challenges that caregiving brings. An existential perspective- Pines, A. M., Aronson, E., & Kafry, D. (1981). Burnout: From tedium to personal growth. New York: Free Press .
This model suggests three interrelated ways of doing so: (1) increasing positive affect- Our experience provides support to the model of increasing PNR, and extends it by highlighting the importance of increasing tolerance to complex mixtures of emotions- The most difficult encounters can be the most rewarding ones. (2) increasing resources – 3) Self care- Treatment team meetings where individuals share both the peaks and valleys of the caregiving experience- give helpers the opportunity to share their difficult encounters as well as the rewarding aspects. There is need for evaluative research on the effectiveness of narrative, compassion focused, nature based and expressive arts in increasing PNR , resource building and self care/soul care Compassion stress can be used as an engine to growth.
“ Joy through the lens of a tear” - Opening up to pain, also opens us to experiencing positive emotions
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