Group A presentation - June 20

1. Compassion Fatigue Melanie Johnson Rosario Fernandes June 2011

2. Relevant quotes From physicians “All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship.” (Figley 2002) “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” (Rachel Remem, 1996) Charles Figley “The very act of being compassionate and empathic extracts a cost under most circumstances. In our effort to view the world from the perspective of the suffering, we suffer.”

4. describe an example of compassion fatigue in the context of their own practice

5. recognize signs/symptoms of compassion fatigue

7. Compassion fatigue (Figley 2002) A state of tension and preoccupation with the individual or cumulative trauma of clients as manifested in one or more ways: re-experiencing the traumatic events, avoidance/numbing of reminders of the traumatic event, persistent arousal combined with the added effects of cumulative stress (burnout)

8. Compassion fatigue The Gentry/Baranowsky (1997) Model of Compassion Fatigue PRIMARY TRAUMATIC STRESS +/x (synergistic effect) SECONDARY TRAUMATIC STRESS +/x (synergistic effect) BURNOUT ____________________________________ = COMPASSION FATIGUE

9. Compassion satisfaction-Compassion fatigue Model From: http://www.proqol.org/Customize_a_Presentation.html

11. Work-related hopelessness and feelings of inefficacy

12. Secondary traumatic stress (STS)

13. Work-related secondary exposure to extremely or traumatically stressful events

14. Both share negative affect

15. Burnout is about being worn out

16. STS is about being afraid© Beth Hudnall Stamm, 2009. Professional Quality of Life Scale (ProQOL). www.proqol.org. This test may be freely copied as long as (a) author is credited, (b) no changes are made without author authorization, and (c) it is not sold.

17. ProQOL measure Most commonly used measure of negative and positive affects of helping others who experience suffering and trauma Measure of compassion satisfaction and fatigue Free tool 30-item self-report Used for over 15 years Available in multiple languages Available at: http://www.proqol.org/ProQol_Test.html

18. Pre-inservice assignment: ProQOL scale discussion

19. What are signs and symptoms of compassion fatigue

20. Signs and symptoms of compassion fatigue (Gentry 1997) Intrusive symptoms Avoidance symptoms Arousal symptoms

21. Intrusive symptoms thoughts/images associated with client’s trauma obsessive/compulsive desire to help certain clients inability to let go of work-related matters thoughts/feelings inadequacy as a caregiver

22. Avoidance symptoms loss of enjoyment in activities/cessation of self care activities loss of hope/sense of dread working with certain clients loss of sense of competence/potency secretive self-medication/addiction

23. Arousal symptoms increased anxiety, impulsivity/reactivity increased frustration/anger sleep disturbance difficulty concentrating

24. Compassion fatigue trajectory Zealot phase Keen, committed, enthusiastic, extra hours Irritability phase Cut corners, avoid pt contact, mocking, daydream Withdrawal phase Exhausted, clients become irritants, neglect (family, coworkers, clients, ourselves) Zombie Phase Automatic pilot, distain for clients, no compassion, no patience Pathology and Victimization vs. Renewal and Maturation Overwhelmed, ill, leaving profession vs. transformation/resilience Initially from Jan Spilman 2010 inservice: Caring on empty: creative tools for compassion fatigue transformation and resilience

25. What characteristics do you think would put a person at risk?

26. Personal risk factors Unresolved personal trauma and loss Current life stressors Low levels of social support Low sense of control over life Lack of meaningful personal relationships Personality-based coping style Enneagram

27. Work-related risk factors Empathy Insufficient training of experience High frequency of exposure to traumatic material Caring for the most vulnerable in society Insufficient recovery time Poor or no supervision Isolation and systemic fragmentation Lack of systemic resources

28. What are tools you use to handle stress in yourlife?

29. Self Care Strategies1. Physical a. Care for your body – sufficient rest and respite, nutritious food, 30 minutes aerobic exercise 3 times per week. Regular medical, dental, and psychological check ups. Recharge/renew daily: exercise, prayer, meditation, mindfulness, good nutrition

30. 2. Psychological and/or Emotional Engage in personal therapy to resolve traumatic stress, past and present*** Be aware of YOUR compassion fatigue early warning signs and have a detailed response plan at hand. Use the Enneagram or other personality system to identify and develop your personality-based coping style** As Spillman says, Exercise your humour muscle! Laugh out loud! Try to soften critical self talk; replace with self-affirming language Assess and reduced your trauma inputs – use low impact disclosure and teach it to others*

31. 3. Spiritual Journaling Care for your spirit – develop and nurture a supportive spiritual life. Creating a daily mindfulness practice (meditation, awareness pauses, haiku) can be particularly helpful

32. 4. Professional and/or Workplace Maintain personal/professional life balance Delegate -- learn to say no; learn to ask for help at home and at work Have a transition ritual between work and home Get good, regular supervision or consultation Work at the level of your competence; attend workshops and professional training regularly Consider working partime! What is your ideal schedule?

33. Action plan: MY self-care ideas

34. AVOID these strategies Blame others Ignore the problem Make big decisions Complain to coworkers Work harder and longer Self-medicate Neglect your needs, interests and desires Reduce leisure activities Unrealistic expectations Look for easy answers

35. Suggestions on ways to use the information from this session… Start a self care idea collection, including activities for stress relief, stress reduction and stress resilience. START NOW: Pick 1 self-care technique that is new to you and try it out Periodically complete the ProQOL scale to monitor your compassion satisfaction and fatigue self-care techniques helping? additional support required? Other ways?