1. Empathic Discernment: The Key to Preventing Compassion Fatigue Charles R. Figley, Ph.D. Professor and the Henry Kurzweg, MD Chair in Disaster Mental Health Tulane University School of Social Work, New Orleans, USA

2. Purpose: Recognize and avoid the Compassion Fatigue and promote resilience Caring as much for ourselves as we care for the traumatized Appreciate the importance of empathic discernment for both.

3. Objectives: Appreciate the various sources of stress among counselors including the demand to be compassionate with suffering clients – especially fellow survivors of Katrina. Define the critical concepts, including empathic discernment. Describe two useful models for predicting compassion fatigue and the role of empathic discernment. Note the various ways counselors cope with these demands – effectively and ineffectively. Be better prepared to prevent and be resilient in a post-Katrina work environment.

4. Working with the suffering requires compassion Compassion requires empathy, interest, and contact Exposure to clients’ distress can be distressing for the caregiver, particularly if the distress is associated with the counselor’s own experiences. 4 Basic Caregiver Resilience Assumptions

5. Basic Assumptions (cont.) Exposure can also be inspiring. The services provided generate a sense of pride and satisfaction. Most counselors have the ability to survive, be resilient, and thrive Resilience is the antidote to compassion fatigue. 5

6. Definitions of Critical Concepts Work-related stress: The demands of one’s job that are applied in the work setting but affect other settings as well. Caregiver Resilience: The tendency to cope with the work-related stress naturally or through the help of others (organization and or colleagues, friends, and family

7. Psychological Burnout: the experience of long-term exhaustion and diminished interest in one’s work that is most often corrected by changing work settings or clients (Altman & Jackson, 2005).

8. Compassion stress The perceived demands derived from experiencing the suffering of others and wanting to help relieve their suffering in some way (Figley, 1995; 2002)

9. Compassion Satisfaction The perceived joys derived from experiencing the suffering of others and succeeding in helping to relieve their suffering in some way (Figley, 2002)

10. Empathic Discernment Effectiveness in accurately selecting and using the best empathic response for both client and self (Radey & Figley, 2007)

11. Compassion Fatigue (CF) is the experience of short-term exhaustion and traumatic stress reactions associated with exposure to the suffering one’s clients(Boscarino, Figley & Adams, 2004).

12. Plain old job burnout stems from dissatisfaction with the work environment Vs compassion fatigue stems from absorbing the suffering of clients

13. Empathic Discernmentis the key ingredient for Avoiding both burnout and compassion fatigue A case example: Animal caregivers

14. Humane Society of the US Organization dedicated to helping and managing abused, neglected, and abandoned animals Members of the animal care community include those who rescue animals, care for their medical and psychological needs, or who must euthanize them. Here is a short film about compassion fatigue

15. Compassion Fatigue Research Example of the Animal Care Community research (2003-2006) Resulting in a book and a short film

16. National sample of animal care workers (Roop & Figley, 2006) (cont.) Compassion Fatigue risk 53.1% extremely high risk 12.4% high risk 11.9 %moderate risk Burnout risk 45.6% extremely low 35.9% moderate risk Compassion Satisfaction 43.0% good 21.4% high 3.9% extremely high

17. CF Theory: Based on more than 10 years of research The following 11-factor model identifies the major factors contributing to compassion stress, fatigue, and management.

18. The Compassion Fatigue Process:

19. Implications 1. Compassion fatigue hurts counselors of the suffering 2. Compassion fatigue blues can be avoided or stopped 3. The way to do it is focusing on EMPATHIC DISCERNMENT

20. Figure 1: Transformation to compassion fatigue or compassion satisfaction: ROLE OF POSITIVE AFFECT (Radey & Figley, 2007)

21. (Positive) Affect Provides essential foundation in meeting client needs (e.g., empathic response, therapeutic alliance) as well as the caregiver needs (e.g., joy of service and its appreciation by all).

22. Figure 2: Transformation to compassion fatigue or compassion satisfaction: SELF CARE!

23. Self-care Self-care involves Self-monitoring Social supportive monitoring Utilizing an individually-designed and updated self-care plan Following recognized standards of self-care

24. Self-care (cont.) The negative consequences of poor self-care: Harm to clients Lowered compassion satisfaction Harm to the caregiver’s health and relationships

25. Figure 2: Transformation to compassion fatigue or compassion satisfaction: Increasing RESOURCES (Radey & Figley, 2007)

26. Resources ARE IMPORTANT They include Intellectual, unit morale, effective leadership, and physical resources Intellectual resources includes helping and other practice skills

27. Resources (cont.) Physical Resources from Enhanced recreational resources Opportunities to exercise Good nutrition through the cafeteria Contact with nature Personal space and opportunities to use it

28. Figure 2: Transformation to compassion fatigue or compassion satisfaction: EMPATHIC DISCERNMENT (Radey & Figley, 2007)

29. Empathic Discernment Helps in balancing and increasing three independent factors in the process of human services with the suffering: Resources, Affect, and Self-care (RAS) It is the gateway to determining how much fatigue and satisfaction can be derived from the work of caregiving Thus, empathic discernment ultimate is a measure of caregiver resilience

30. Stress Management Strategies for Enhancing Empathic Discernment

31. Stress Management Resiliency In vivo (working with clients) Breath-work Self-talk Physical movement (walking, bikes, basketball, etc.)

32. Stress Management Resiliency (cont.) Between Clients at Work Breathing Meditation Prayer and Meditation Visualization (e.g., safe place) Dance and Other Kinesthetic Treatments

33. Stress Management Resiliency (cont.) Journaling Art Therapy Music Therapy Poetry Therapy All hobbies and absorbing activities Music and Other Creative Therapies

34. Treating Compassion Fatigue Caregivers deserve as good a treatment as they are providing. Most treatments of anxiety disorders are relevant for CF The challenge is establishing and maintaining a strong therapeutic alliance with the caregiver client

35. September 2008 35 Treatment Implications Focusing on Desensitization of the traumatized worker Assessment of currently available approaches

36. Conclusions 1. You deserve as good a treatment as you provide the traumatized 2. Caring for yourself results in being a more effective counselor, Family member and friend, and Human being

37. Questions, Answers, Discussion Contact information: CharlesFigley.Com Figley@tulane.edu