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Compassion Fatigue Secondary Trauma What is it?

Compassion fatigue

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Page 1: Compassion fatigue

Compassion FatigueSecondary Trauma

What is it?

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History 1982: Charles Figley defines Secondary

Traumatic Stress as a phenomenon associated with the “cost of caring”

1992: Nurse Joinson used term in Nursing Magazine to describe feeling of “worn down”

1992: Jeffrey Kottler writes Compassionate Therapy to emphasize importance of compassion when dealing with difficult / resistant clients

1995: Figley redefines Secondary Traumatic Stress to a “more friendly term” - Compassion Fatigue

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CF defined:

Those who work with the suffering suffer themselves because of the work

“We absorb the traumatic stress of those we help” (Beaton & Murphy, 1995)

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AKA Secondary Trauma

or Secondary Post-Traumatic Stressor Secondary Exposure

or Secondary Victimizationor Vicarious Traumatization

or Emotional Contagionor Secondary

Survivor

“Phenomenon associated with the ‘cost of caring’ for others in emotional pain” (Figley, 1982)

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Compassion FatigueSecondary Trauma

Do I have it?

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CF “Possible” Solution…

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Compassion FatigueSecondary Trauma

How did I get it?

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The CF Process

Figley, 2001

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The CF Process

1. Exposure to Suffering

2. Empathic Concern – motivation to respond to those in need

3. Empathic Ability – aptitude for noticing the pain of others

4. Empathic Response – helper makes an effort to reduce the suffering of the sufferer

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The CF Process

5. Compassion stress – compulsive demand for action to relieve the suffering of others

6. Prolonged Exposure – on-going sense of responsibility for the care of the suffering

7. Traumatic recollections – memories that trigger the symptoms of PTSD

8. Demands of Life – unexpected changes in schedule, routine, & managing life’s responsibilities that demand attention

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The CF Process

9. Compassion Fatigue – state of tension and preoccupation with the traumatized by:

a. Re-experiencing the traumatic events

b. Avoidance/numbing reminders

c. Persistent arousal

10.Compassion Trap – inability to let go of the thoughts, feelings and emotions useful in helping another, long after they are useful

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A Codependent Co-worker with Compassion Fatigue

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Compassion FatigueSecondary Trauma

How bad is it?

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Contributing Factors

Intensity Frequency Severity Proximity Personal Factors Sensory

Information – “Imprint of Horror” (Learner, 2005)

Perceptions, Belief system

Current coping mechanisms

Implementation of self-care techniques

Support system

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Symptoms of Poor Self-Care

Cognitive Diminished

concentration Confusion Loss of meaning Decreased of

self-esteem

Apathy Rigidity Self-doubt Perfectionism Minimization

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Symptoms of Poor Self-Care

Emotional Powerlessness Anxiety (Survivor) Guilt Anger/rage Numbness Fear Sadness

Helplessness Depression Hypersensitivity Overwhelmed Depleted

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Symptoms of Poor Self-Care

Behavioral Impatient Withdrawn Moody Regression Sleep Disturbances Appetite changes

Elevated startled response

Hyper vigilance Use of unhealthy

coping skills Accident proneness Losing things Self-harm behaviors

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Symptoms of Poor Self-Care Spiritual

Questioning the meaning of life Loss of purpose Lack of self-satisfaction Pervasive hopelessness Angry at God Questioning prior beliefs “Soul Sick” (Bill O’Hanlon)

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Symptoms of Poor Self-Care Interpersonal

Withdrawn Decreased interest in intimacy Mistrust Intolerance Loneliness Projection of anger or blame

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Symptoms of Poor Self-Care Physical

Shock Sweating Rapid heartbeat Aches and pains Dizziness Impaired immune system Restlessness

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Impact on Professional Functioning Performance of Job Tasks

Decrease in quality & quantity

Low motivation

Avoidance of job tasks

Increased mistakes

Setting perfectionist standards

Obsession about details

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Impact on Professional Functioning Morale

Decrease in confidence

Loss of interest

Dissatisfaction

Negative attitude

Apathy

Demoralization Lack of appreciation Detachment Feelings of

incompleteness

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Impact on Professional Functioning Interpersonal

Withdrawal from colleagues

Impatience

Decrease in quality of relationship

Poor communication

Staff conflicts

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Impact on Professional Functioning Behavioral

Absenteeism

Exhaustion

Faulty judgment

Irritability

Tardiness

Irresponsibility

Overwork

Frequent job changes

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Compassion FatigueSecondary Trauma

How do I get rid of it?

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“When you discover you are riding a dead horse,

the best strategy is to dismount”

- Dakota Tribal Saying

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““Primum non nocere”Primum non nocere”

- Claudius Galen, born in 129 AD, chief physician

to the gladiator school in Pergamum

First Do No HarmFirst Do No Harm

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““First do no harm First do no harm to Self”to Self”

- Gentry & Figley, 2007 Created adage after discovering correlation between

compassion fatigue and ethical violations

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Self-Care may involve…

Re-evaluating an unhealthy relationship Listening to your body & staying within your

limits Advocating for your rights Commit more time to planning Not assuming responsibility for others & their

problems Lose “all-or-nothing” thinking; be more flexible Not feeling compelled to “fix”/solve another

person’s problem Not anticipate the needs of others

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Self-Care may involve…

Re-think trying to please others; explore being satisfied with self

Appreciate your mistakes – opportunity to learn & grow

Not over-committing Giving yourself plenty of time so you

don’t feel harried or pressured Quit blaming and shaming self…then

others Stop taking things personally

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Self-Care may involve…

Keeping up with dentist & doctors appts. Taking restroom breaks when needed Accepting myself for who I am Not feeling the need to control; accept

some things are out of my control Forgive yourself when you make a mistake Quit trying to prove you’re good enough Stop tolerating behaviors that you don’t

want to tolerate Trust yourself

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Compassion FatigueSecondary Trauma

How do I keep it from coming back?

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Back to the CF Process

Detachment (M. Beattie, 1992)

Opposite of attachment – excessively worried or preoccupied w/ person or problem

It’s Not: Cold, Withdrawn, Hostile, Ignorant Bliss

Based on premise that “each person is responsible for himself & we can’t solve problems that aren’t our own & worrying doesn’t help”

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Detachment cont.

“It doesn’t mean we don’t care. It means we learn to love, care & be involved without going crazy” (M. Beattie, 1992)

“When we allow people to be who they are, then we stop trying to change things we can’t.” (M. Beattie, 1992)

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Sense of Satisfaction

“Shades of Gray” (D. Burns, 2005, Cognitive Motivational Therapy)

“When things don’t work out as well as you’d hoped, you can think of the experience as a partial success or learning opportunity.

Question: Are you wanting your client to provide for you a sense of satisfaction? “You’re OK … then I’m OK”

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Sense of Satisfaction cont. Reframe the “Pay-Out”

Appreciation Approval Attention Acceptance Affiliation

Admiration Acknowledgement Affirmation Accomplishment Affection

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Standards of Self-Care

1. Respect for dignity & worth of self2. Responsible for self-care3. Universal right to wellness4. Physical rest, emotional rest &

nourishment5. Seek, find & remember appreciation

from supervisors & clients6. Make it known that you wish to be

recognized for your serviceAdapted from “Standards of Self Care for the Practitioner,” Green Cross Foundation, Inc., 2004