The Warrior Therapist: Building Resilience Against

Compassion Fatigue and Burnout - a training

for staff and supervisors

Matthew Lindberg, MA, LPCCJeremiah Schimp, PhD, CPRP

MACMHP Winter Supervision Series December 8, 2015

INTRODUCTIONS

Matt and Jeremiah introductions Introducing each other:

What is your current role and position? What made you decide to attend this training? What do you want to get out of this training?

LEARNING OBJECTIVES

By the end of this session, participants will be better able to: Define compassion fatigue and burnout Identify signs, symptoms, and personal

contributing factors Understand the stages of compassion fatigue and

burnout Identify compassion fatigue and burnout in

themselves and others Learn and implement best practices for prevention

and mitigation of compassion fatigue and burnout Understand and begin to build resilience against

compassion fatigue and burnout in themselves and their staff

COMPASSION FATIGUE

“A state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper”.

Figley (2002)

COMPASSION FATIGUE

“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We tire. We aren’t sick, but we aren’t ourselves.”

Figley (2002)

WHEN THE TOOL (YOU) STARTS TO WEAR OUT

BURNOUT

A employment-related syndrome that “represents an erosion in values, dignity, spirit, and will – an erosion of the human soul” (Maslach & Leiter, 1997, p. 17).

Maslach describes the construct as a “psychological syndrome that involves a prolonged response to stressors in the workplace” (Maslach, 2003, p. 189).

RESEARCH ON COMPASSION FATIGUE AND BURNOUT

-Rates of burnout in social workers and mental health workers is hard to measure-Younger workers exhibit more compassion fatigue and burnout (Lim et al., 2010)

-Social workers and psychiatrists are found to have higher levels of compassion fatigue (Rossi et al., 2012)

-Acknowledging compassion fatigue is helpful in coping with it (Newell & MacNeil, 2010)

-The attribute of hardiness may be a preventative factor for burnout in mental health workers (Schimp, 2015)

HOW COMPASSION FATIGUE IS DIFFERENT THAN BURNOUT

Burn out is a state of physical, mental and emotional exhaustion caused by long term involvement in demanding circumstances (Maslach & Leiter, 2008)

Burnout can involve a physical component

Burn out is a process, not a condition

Compassion fatigue is easier to recover from than burnout

Mostly affects those providing direct care

HOW COMPASSION FATIGUE AND BURNOUT ARE SIMILAR

Emotional exhaustion Reduced sense of personal

accomplishment or meaning in work

Mental exhaustion Decreased interactions with others

(isolation) Depersonalization (symptoms

disconnected from real causes) Physical exhaustion

COMPASSION FATIGUE

VULNERABILITY TO COMPASSION FATIGUE

Exposure - daily barrage of traumatic material (i.e. therapy, assessments)

Empathy - the greater your empathy the more effective the relationship and the greater the risk for Compassion Fatigue

Emotional state - current life stressors, relationship issues

Limited stress management skills - lack of outlets, hobbies, interests

Poor self care - poor nutrition, lack of exercise

Poor support - lack of connection with family and friends

WHO IS AFFECTED BY COMPASSION FATIGUE

Anyone who provides a service or listens to another person.Including, but not limited to:•therapists•social workers•physicians•nurses•counselors•nursing home employees•case managers•police officers

RECOGNIZE AND ACCEPT VICARIOUS TRAUMA (NOT NECESSARILY COMPASSION FATIGUE)

Occupational hazard in mental health Normal response to trauma and

relational work Just is/normalizing/being aware

Boscarino, Adams, & Figley (2010)

DO YOU KNOW OF SOMEONE AFFECTED BY COMPASSION FATIGUE? HAVE YOU BEEN

AFFECTED BY COMPASSION FATIGUE?

MYTHS RELATED TO CARING I can “fix” the situation I am a savior I am responsible for my client’s success or

failure The recipient will appreciate everything I do

for them I will have enough resources (time, money,

material, supervision, skills and training) to fix things

I can be absent from relationships and responsibilities because I am doing compassionate work

I can do this work without help If I’m trained enough, I can deal with the stress

of working with suffering people

RECOGNIZING THE SYMPTOMS OF COMPASSION

FATIGUE

SYMPTOMS OF COMPASSION FATIGUE (INTRUSIVE)

Intrusive thoughts of clients and their problems

Intrusive images of trauma described to you Taking work home with you Unhealthy or compulsive desire to help

certain recipients Work concerns take over your personal time

Florida Center for Public Health Preparedness (2004)

SYMPTOMS OF COMPASSION FATIGUE (DEPRESSIVE OR AVOIDANCE) Anhedonia Avoiding recipients and their concerns Less self-care activities (i.e. stop working

out) Loss of energy/development of fatigue Loss of hope Sense of dread when working with certain

clients Less feelings of competence Isolation from others Self-medication/addiction

Florida Center for Public Health Preparedness (2004)

SYMPTOMS OF COMPASSION FATIGUE (AROUSAL)

Anxiety Increased startle response Impulsivity Frustration Anger Sleep problems Eating more or less Concentration problems

Florida Center for Public Health Preparedness (2004)

SYMPTOMS OF COMPASSION FATIGUE (PHYSICAL)

Headaches GI symptoms Sleep problems Increased illness Fatigue Appetite disturbances

SYMPTOMS OF COMPASSION FATIGUE (PERSONAL)

Disturbances in perception Decrease in subjective sense of safety Self-isolation Difficulty separating work life from

personal life Diminished functioning in non-

professional circumstances Increases in ineffective or self-

destructive self-soothing behaviors

SYMPTOMS OF COMPASSION FATIGUE (WORK)

Avoidance of certain patients / clientsHypervigilant response to certain casesDiminished sense of purpose / enjoymentFeelings of therapeutic ineffectiveness

SYMPTOMS OF COMPASSION FATIGUE (SPIRITUAL OR METAPHYSICAL)

Questioning the meaning of life Questioning your prior religious beliefs Anger at God or higher power Increased skepticism Loss of hope or optimism

RISKS OF COMPASSION FATIGUE (AND BURNOUT) IN YOUR WORKFORCE

Sub-standard or low quality work Less effective client care Poor morale in the workplace Low job satisfaction Absenteeism Less client change

Mathieu (2007)

EXAMPLES OF COMPASSION FATIGUE • Kayla has been working with Mary, a

therapy client, for a little over a year. Mary struggles with depression, suicidal ideation, and has had several attempts. Mary also is the victim of domestic violence by her partner Tom, which she often details for Kayla in her sessions. Kayla is a compassionate therapist and wants to see Mary get better. Kayla has been struggling with thinking about Mary while not in the office, finds herself dreading Mary’s sessions, feeling less effective with her other clients, and wondering if she is a good therapist. Kayla’s boyfriend and mother are concerned that she does not have the same spark they are used to. Kayla has not seen her friends for a few weeks.

CONTRIBUTING FACTORS

What factors may have contributed to Kayla experiencing compassion fatigue?

What are some of her symptoms?

EXAMPLES OF COMPASSION FATIGUE

Richard is a dedicated in-home mental health practitioner. He is working with multiple clients who are struggling with suicidal ideation. Richard met with one client who was recently released from the hospital after an overdose and another client who cut her wrists and needed stitches. Richard found the last client at her home right after the suicide attempt and called 911. Richard has been going through relationship problems with his wife. He has stopped working out, which he usually enjoys. Richard is thinking his job may not be worth the stress, people just don’t seem to be getting better.

CONTRIBUTING FACTORS

What factors may have contributed to Richard experiencing compassion fatigue?

What are some of his symptoms?

RECOGNIZING THE STAGES OF COMPASSION FATIGUE

AMBITIOUS PHASE

Motivated by idealism Problem solver Making a difference Goes the “extra mile” High level of enthusiasm Actively engaged with clients Helps with extra tasks without being

asked

IRRITABILITY PHASE

Begin to avoid contact with recipients

Low view co-workers and recipients

Less socializing with co-workers and friends

Denigration of recipients Humor that is inappropriate Increased oversights,

mistakes and lapses of concentration

WITHDRAWAL PHASE

Becomes defensive Enthusiasm turns sour Recipients become irritants, instead of

persons Loss of hope for recipients Increased complaint about work and our

personal life Increased fatigue Don’t want to talk about our work Neglect family, clients, coworkers and

ourselves

ZOMBIE PHASE

We begin to hate people…any/all people Views others as incompetent or ignorant Dislike of recipients Less patience with co-workers and

recipients Less involvement in enjoyable activities Our hopelessness turns to rage

Florida Center for Public Health Preparedness (2004)

OVERWHELMED PHASE

Overwhelmed Somatic Illness Leaves the job or field

BURNOUT

BURNOUT AND BEING A SUPERVISOR

Burnout is based in part on the work environment, culture, function of the job, workload, buffering administrative “crap” for staff, turnover, scheduling, payroll, performance issues, communication expectations, lack of resources, staffing shortages, and on and on….

Meeting needs of staff individually and collectively

Balancing compassion for staff and being an administrator

Intensity differs by types of program… Type of staff, manager, supervisor…

Remember that your younger staff are more vulnerable

RECOGNIZING THE STAGES OF BURNOUT

Stage 1. Stress Arousal

Stage 2 . Energy Conservation

Stage 3. Exhaustion

STRESS AROUSAL

Persistent irritability Persistent anxiety Periods of high blood pressure Insomnia Forgetfulness Heart palpitations Unusual heart rhythms (skipped beats) Inability to concentrate Headaches

ENERGY CONSERVATION

Lateness for work Procrastination Persistent tiredness in the mornings Turning work in late Social withdrawal (from friends and/or family) Cynical attitudes Resentfulness Increased coffee/tea/cola consumption Increased alcohol consumption Apathy

EXHAUSTION

Chronic sadness or depression Chronic mental fatigue Chronic physical fatigue Chronic headaches The desire to "drop out" of society The desire to move away from friends, work,

and perhaps even family

BURNOUT IS:

Emotional Exhaustion

Depersonalization

Decreased Personal Accomplishment

EMOTIONAL EXHAUSTION

Feeling no longer able to meet psychological demands of the job or clients and feeling overextended emotionally by one’s work (Maslach, 1982; Maslach & Jackson, 1981).

DEPERSONALIZATION

Depersonalization is defined as viewing clients as less than human or in other negative, callous ways (Leiter & Maslach, 1988).

DECREASED PERSONAL ACCOMPLISHMENT

When staff feel poorly about their work quality and vocational accomplishments with a decreased belief in one’s personal accomplishments which can lead to low level of confidence in one’s ability to help others (Leiter & Maslach, 1988).

HEALING FROM COMPASSION FATIGUE

AND PREVENTING BURNOUT

WHAT ARE THE TOOLS YOU USE TO HANDLE STRESS IN YOUR

LIFE?

LIMIT EXPOSURE

Limit exposure to trauma material when possible

Limiting exposure during clinical intakes/assessments by focusing on other areas if possible

Don’t open up things you can’t close

SET LIMITS

Keep good boundaries with clients Do not mistake client’s needs for

mandates Watch number of work hours Take days off when needed, Encourage staff to take time off Seek help from co-workers or

supervisor

MAINTAIN PROFESSIONAL CONNECTION

Encourage teamwork Professional Education (CEUs) Support Groups Supervision and Consultation Working as a team/supporting each

other Consultation after supervision is over Getting to know others in the same line

of work Send staff to trainings for enrichment

CREATE BALANCE

Engage in non-clinical work at times (both at work and home)

Vary case load with different recipients, if possible

Furnishing workspace with personal objects

Make time between meetings: breathing, stretching, etc.

DISCONNECT AND UNPLUG

Don’t check work e-mail when not at work (or limit this)

Maintain a separate cell phone for work that you can turn off when not working

Depending on your job or role set clear guidelines of when you check and respond to messages

Screen your calls Communicate face-to-face when

possible Encourage staff to set their own

boundaries around technology

EFFECTIVELY MANAGING TIME

Limiting time with clients Knowing your time limits Making time for documentation Time for yourself between client

meetings/visits Teach your staff time management

skills

SEEK PERSONAL RENEWAL

Remember to find meaning in your work

Identify and celebrate successes with recipients

Renew hope in yourself and recipients

Maintain focus on larger purpose of the work you and your staff do

BREATHING AND YOGA POSTURES AT WORK

Breathing exercises Mindfulness Yoga postures

WELLNESS PLANNING

Personal psychotherapy, if needed Develop a personal self-care plan Manage physical health Seek out services that nurture your

physical wellness (YMCA, yoga, massage)

Use PTO Help staff with compassion fatigue

plan

MAKE CHANGES…

Different role at agency “Reinvent” your career What will challenge your staff Look at what your gifts are….

METHODOLOGY TO REDUCE THE RISK OF COMPASSION FATIGUE

Use of Motivational Interviewing to combat risk of Compassion

Fatigue

THE “SPIRIT” OF MOTIVATIONAL INTERVIEWING

Partnership Evocation Acceptance Compassion

HIGH SPIRIT SUPPORT

Accept that the client may not choose to change

Are invested in behavior change but don’t push it, in order to maintain therapeutic alliance

Reinforce that ultimately any behavior change is within the realm of the client

Elicits the client’s ideas about change

LOW SPIRIT SUPPORT

Counselors who struggle with clients choosing not the change

May demonstrate urgency in the session (example: death, jail or institutions)

Confronts clients Only counselor’s point of view is

“right” Rigid in their ideas and plans Try to persuade the client to change

“Righting Reflex in Action”

DANCING OR WRESTLING?

Roadblocks-Giving advice, making suggestions, or providing solutions

-Disagreeing, judging, criticizing, or blaming

Traps-Question-answer

trap-Expert trap-Confrontation-

denial trap

BUILDING RESILIENCE AGAINST COMPASSION FATIGUE AND BURNOUT

WHAT IS A RESILIENCE OR HARDINESS?

Hardy individuals actively engage in their pursuits and encounters, have a belief in their influence over situations versus feeling powerless, and have an understanding that change is inevitable and part of growth.

Commitment Control Challenge

(Kobasa, 1979)

HARDINESS

A theory espousing that there are reasons that some people are negatively impacted by stress and others are not (Kobasa, 1979).

Hardiness includes three personality components: commitment, control, and challenge. Commitment is the characteristic of being actively engaged in their pursuits and encounters. Control is a belief that one has influence over situations versus feeling powerless. Challenge is understanding that change is inevitable and part of growth (Kobasa, Maddi, & Kahn, 1982).

BUILDING RESILIENCE

“Building resilience does not happen by chance , but instead is based on active practice of decisions that lead to wellness and health. Many believe that the key to prevention of compassion fatigue is discovery and reinforcement of “compassion satisfaction,” those activities that yield a sense of satisfaction from working with clients” (Sadler-Gerhardt & Stevenson, 2011)

CHARACTERISTICS OF A RESILIENT STAFF OR SUPERVISOR Optimistic Open to change Belief that clients can recover Able to separate and contain client

distress Use social support networks Able to acknowledge limitations Recognition of skills and abilities of self

and staff Recognizes client autonomy and

responsibilities

HOW RESILIENCE IS FOSTERED

Through self-care and attention to your needs

Knowing your limits Changing your thinking Fostering Compassion Satisfaction Resilience is built and developed over

time

BUILDING YOUR RESILIENCE…..

Self-reflection Self-awareness Making small changes to care for

yourself

Maddi (2006); Hall (2012)

COMPASSION SATISFACTION

COMPASSION SATISFACTION

The opposite of compassion fatigue The good the you derive from helping or

caring for others The satisfaction may come from work

environment, the work itself, co-workers, self-efficacy, teamwork

Stamm (2009)

COMPASSION SATISFACTION QUESTIONS TO ASK YOUR STAFF

What do you like about your job? What satisfaction do you receive from

helping others? What do you like about caring for people? Why did you go into this field? What keeps you going?

COMBATTING BURNOUT AS A SUPERVISOR; QUESTIONS TO ASK YOURSELF

What keeps you going? What challenges you? What do you like your job? What do you like about being a supervisor or

manager? Why are you doing this work? What are you

getting out of it?

COMPASSION SATISFACTION

“One of the weapons we have against compassion fatigue is the satisfaction we get from our work” unknown author

ACTION PLAN FOR FIGHTING COMPASSION FATIGUE AND BUILDING

RESILIENCE AGAINST BURNOUT

HOW RESILIENT ARE YOU?

Do you keep a positive attitude during difficult situations?

Do you have skills to help you relax and manage stress?

Do you have a network of people who offer you support?

Do you take good care of yourself? Do you keep your eyes on the big picture

even in challenging situations?

RESILIENCY PLANo Individually• What changes will you make?• What does compassion satisfaction

mean to you?o Organizationally• What will you bring back to your

organization and staff?o Supervision• How will you provide supervision with

the information you obtained?

PARTING THOUGHTS TO SHARE WITH YOUR STAFF (AND REMEMBER YOURSELF)

o You’re not a Super Heroo The need in the mental health field will always

be greater than the resources availableo The suffering of your recipients in not yourso Look at how you measure “success” for

yourself, recipients, and your staffo Remember to care for yourself, you are the

instrument to help otherso Value small changes in recipientso Don’t take your clients home with you

“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.” -Dr. Seuss, The Lorax

“If your compassion does not include yourself, it is incomplete.”

-Buddha

Thank you and be well!