Managing Compassion Fatigue, Vicarious Trauma and Burnout

1. Managing Compassion Fatigue, Vicarious Trauma and Burnout

2. Exercise: Life / Work Balance • Were the areas in which you score high what you predicted they would be? • Are there things in your life draining you that you didn’t suspect or realize? • When is the last time you gave careful thought to specific things that drain you? • Do you engage in healthy self-care practices? • Do you practice self-validated caregiving? Is your self-care guilt-free?

3. “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.” Kitchen Table Wisdom (1996) Rachel Naomi Remen

4. Objectives • Develop a framework for understanding and differentiating between: • Moral Distress • Vicarious Trauma • Burnout • Compassion Fatigue • Normalize the “helper experience” • Self-Assessment / Awareness • Self-Care and Resilience Strategies • Have Fun!

5. First World Problems • https://www.youtube.com/watch?v=vN2WzQzxuoA

6. The Reality of Helping Professions • Compromised or inflexible systems (i.e. schedules, lack of staff, lack of training, poor work space/environment) • Systemic challenges and budget cuts • Difficult stories and situations of those you help • Losses • Disclaimer – own experiences

7. Moral Distress • An issue that affects all helping professions • “When policies or routines conflict…with beliefs…about patient care” (Mitchell 2000) • Involves a threat to one’s moral integrity – that sense of wholeness and self-worth that comes from having clearly defined values that are congruent with one’s perceptions and actions • A Helper may experience Moral Distress or Moral Injury multiple times per day or shift

8. Trauma • “Primary” trauma – A trauma experienced in the first-person. Professional or personal - Many people in the helping profession have experienced multiple personal traumas. It’s part of what makes us good at our jobs! • Secondary or “Vicarious” Trauma – A trauma that is experienced second-hand, in the re-telling of events, investigations, observations • Tertiary Trauma – Long-range effects of a traumatic incident or pervasive environmental conditions Which of these three is most damaging?

9. Vicarious Trauma (VT) • Occurs when the stories we hear from people transfer onto us in a way where we are secondarily traumatized and have difficulty ridding ourselves of the images and experiences they haveshared • The profound shift Helpers experience in their world view when they work with people who have experienced trauma • Fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material

10. Burnout • Does not mean our world view has been changed • Gradual onset of dissatisfaction and resentment with the work environment • The exhaustion and disconnect employees can experience when job satisfaction is low and they feel powerless and overwhelmed • Directly related to the work environment – hours, supervisors, training, etc. • Depleted ability to cope with work demands • Feel powerless to achieve goals • Specific to the work environment, Burnout is the easiest to fix

11. Conditions that Lead to Burnout • Long hours and/or working in agency settings • Working with clients with more severe problems or chronic mental illness • Absence of meaning/purpose • Supervision dissatisfaction • Often worse for those working in the public sector • Lack of evaluation/feedback on performance • Task ambiguity

12. Compassion Fatigue (CF) • Characterized by an emotional and physical exhaustion, a Helper can develop CF over the course of their career when they are unable to refuel and regenerate • A deep erosion of our compassion and our ability to tolerate the strong emotions and difficult stories of those with whom we work • Stems from absorbing the suffering of others (Figley, 2009)

13. The Compassionate Connection

14. Risk Factors for Compassion Fatigue • Intensity • Frequency • Severity • Proximity • Personal Factors • Previous trauma • Anxiety • Depression • Impulsive/High-risk behaviors • Substance use

15. Physical Symptoms • Shock / Disbelief • Sweating • Rapid heartbeat • Unexplained aches and pains • Dizziness • Impaired immune system • Restlessness • Sleep disturbance • Appetite disturbance

16. Impact on Professional Functioning Morale Decrease in confidence Loss of interest Dissatisfaction Negative attitude Apathy Lack of appreciation Detachment Feelings of incompleteness Interpersonal Withdrawal from colleagues Impatience Decrease in quality of relationships Poor communication Staff conflicts Performance Decrease in quality and quantity Low motivation Avoidance of job tasks Increased mistakes Setting perfectionist standards Obsessing about details

17. Impact on Personal Functioning • Withdrawal from others • Decreased interest in intimacy • Mistrust • Intolerance • Loneliness • Projection of anger or blame • Irritability

18. Spiritual Symptoms of Poor Self Care • Questioning the meaning of life • Loss of purpose • Lack of self-satisfaction • Pervasive hopelessness • Angry at higher power • Questioning prior beliefs

19. Do these symptoms leave you feeling like… … THIS??

20. Who fills your glass? Have you noticed a change in your world view or have you found that you give the best of yourself at work and have nothing left when you get home?

21. This is you…

22. This is you at your best…

23. Protective Factors • Support system • Part-time work or other tasks • Adequate training • Work-Life balance • Belief system • Current coping strategies • Implementation of self-care techniques • Ability to recognize warning signs

24. My Colleagues are Awful! • Many Helpers find the negativity of their colleagues to be a big challenge • Reframe this negativity and think of it as an organizational form of compassion fatigue, caused by the CF and VT that some of our most depleted colleagues are experiencing

25. What Does Your Dragon Look Like? • Danger • Caution • Warning Health

26. Meet the Dragons

27. Key Elements in Review • CF/VT can affect an individual or can contaminate an entire workplace as a whole • Not all workplaces are created equal! You could be experiencing burnout due to an unsupportive workplace in addition to CF/VT from the challenging work you do

28. ABC’s of Prevention and Maintenance • Awareness – Recognizing signs and symptoms • Balance – Taking personal responsibility • Connection – Seeking consultation and debriefing

29. Have you been slimed? Debriefing vs. Venting aka “sliming” Self-Awareness – Pay attention to how your sharing impacts others; avoid “sliming” Permission to come aboard Fair warning

30. Well, That’s Lovely. Now What? • Awareness is the first step • What is affecting you… CF? VT? Burnout? Moral Distress? A combination of two or more? • Understand your warning signs

31. Get Control of Yourself • BREATHE!!! • Identify the desired outcome • Steps for a desired outcome: • Ask yourself what you want • Identify areas in your life where you DO have control • Make a plan: • What’s in your Self Care First Aid Kit? (Your “person”, snacks, stress ball, comedy, music, exercise, etc.)

32. Self-Care Strategies • Accept feedback from identified support system • Set up, ahead of time, a contingency plan with peers should you notice you are in the yellow zone • Accept occasional “failures” in therapy • Find work that is congruent with who you are as a person • Find meaning in what you do: the activity is significant and important thus ameliorates the tediousness of repetition • Protect your “off” time: energy vampires

33. Self-Care Strategies Cont. • Regular vacations • Setting boundaries separating work and private life • Striving for a balance between work and “life” • Personal therapy (less burnout) • Give your brain a break • Laugh!!

34. 4 Domains of Control to Make a Change • Physical • Cognitive / Attitude • Existential / Meaning & Purpose • Relationships – “No” is not a four-letter word

35. Your Challenge • Your Challenge • Make a list • Set a goal • Pick one thing you believe (at 90% or more certainty) you will be able to sustain for three weeks • Do it! • Then pick another….

36. When to Seek Outside Help • An increase in self-destructive or high-risk behaviors (alcohol, food, drugs/medications, spending, etc.) • Missing work • Increased irritability • Lack of empathy towards everyone • Anxiety • Symptoms of depression • Sleep and/or appetite disturbance • Withdrawing • Anhedonia/Apathy

37. Healthy Detachment • What are you in this for? Are you making it about you? Are you wanting to help someone else to provide you with a sense of satisfaction? (e.g. “You’re OK… then I’m OK”) • “It doesn’t mean we don’t care. It means we learn to love, care and 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)

38. Stress Reduction Activity • BANG HEAD HERE Directions Place on firm, flat surface Follow directions on circle Repeat step 2 as necessary or until unconscious If unconscious, cease stress reduction activity

39. “I did the best I could with the light I had to see by” - Author Unknown