Maintaining Mental health and well being for those in the Caring Professions

1. Understanding and managing Compassion Fatigue Vicarious Trauma and Burnout Maintaining Mental health and well being for those in the Caring Professions

2. Martin J. SmithPhD • NOTTINGHAM TRENT UNIVERSITY

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” (Remen, 1996)

4. Some terminology and definitions • Secondary traumatic stress • Vicarious trauma • Compassion fatigue

5. Some terminology and definitions • Secondary traumatic stress • Defined as indirect exposure to trauma through a firsthand account or narrative of a traumatic event. • The vivid recounting of trauma by the survivor and the clinician's subsequent cognitive or emotional representation of that event may result in a set of symptoms and reactions that parallel PTSD.

6. Some terminology and definitions Secondary traumatisation is also referred to as compassion fatigue (Figley, 1995) and vicarious traumatisation (Pearlman and Saakvitne, 1995). . Learning to recognise one’s own symptoms of compassion fatigue has a two-fold purpose: Firstly, it can serve as an important “check-in” process for a helper who has been feeling unhappy and dissatisfied, but did not have the words to explain what was happening to them, and secondly, it can allow them to develop a warning system for themselves.

7. Compassion Fatigue Compassion Fatigue has been described as the “cost of caring" for others in emotional and physical pain. (Figley, 1982) It is characterised by deep physical and emotional exhaustion and a pronounced change in one’s ability to feel empathy for customers, loved ones and colleagues / co-workers.

8. Compassion Fatigue It is marked by increased cynicism at work, a loss of enjoyment of our career, and eventually can transform into depression, secondary traumatic stress and stress-related illnesses. The most insidious aspect of compassion fatigue is that it attacks the very core of what brought us into this work: our empathy and compassion for others.

9. Some other terminology and definitions • Compassion - A deep awareness of the suffering of another coupled with the wish to relieve it. • Compassionate mission - Any endeavour by individuals, groups of individuals or organisations to alleviate the suffering of others • Stress - The nonspecific response of the human organism to any demand placed upon it. • Suffering - A state of distress associated with events that threaten the person and their sense of self. • Burnout - A state associated with chronic stress and pressures in your vocation.

10. At a Behavioural level At an Interpersonal level Personal Values / Beliefs Job Performance Compassion Fatigue impacts many areas Fact Sheet Number 9 Vicarious Trauma - American Counselling Associations

11. Signs and Symptoms • Disruption to world view, Heightened anxiety or irrational fears • Intrusive imagery or dissociation • Hypersensitivity or Insensitivity to emotional material • Difficulty separating work life from personal life • Absenteeism – missing work, taking many sick days • Impaired ability to make decisions and care for customers needs • Problems with intimacy and in personal relationships

12. Signs and Symptoms of Compassion Fatigue and Burnout • Exhaustion • Reduced ability to feel sympathy and empathy • Anger and irritability • Increased use of alcohol and drugs • Dread of working with certain clients / patients • Diminished sense of enjoyment of career

13. Cognitive Signs and Symptoms With burnout and compassion fatigue many can notice some cognitive shifts that become problematic • Dependency / trust (suspicion of others) • Safety (feeling more vulnerable to danger) • Power (feeling helpless) • Independence (loss of control / freedom) • Esteem (being bitter or cynical about others) • Intimacy (alienation) • Frame of reference (blaming the victim / client)

14. Factors leading to Compassion Fatigue • The Messiah Complex I will “fix” the problem and make everything OK. I can save the World • The Lone Ranger Complex I know what I’m getting into, and I can handle it on my own • The Saint Complex • My faith and belief will carry my through, I can deal the stress of working with suffering people

15. Measuring impact - Positive and Negative

16. Professional Quality of Life Scale (PROQOL) One of the most commonly used measures of negative and positive affects of helping others who experience suffering and trauma A measure of compassion satisfaction and fatigue A free tool 30-item self-report Used for over 15 years Available in multiple languages Available at: http://www.proqol.org/ProQol_Test.html

17. Professional Quality of Life Scale (PROQOL) Compassion Satisfaction and Compassion Fatigue measure A well developed questionnaire that measures your current state in three key areas, these areas being: Compassion Satisfaction Burnout Secondary Traumatic Stress

18. Insufficient training Identification with the victim Insufficient support in the workplace Predictive aspects of Compassion Fatigue

19. Prevention of Compassion Fatigue and Burnout There are four suggested domains that are important to the prevention of Compassion Fatigue and Burnout in staff: Professional strategies, such as balancing caseloads and accessible supervision. Organisational strategies, such as sufficient release time and safe physical space. Personal strategies, such as respecting one's own limits and maintaining time for self-care activities. General coping strategies, such as self-nurturing and seeking connection. Pearlman and Saakvitne (1995)

20. Prevention of Compassion Fatigue and Burnout More specific help. A group of trauma therapists were asked what activities they found that were most helpful in balancing out compassion fatigue. These included:

21. Prevention of Compassion Fatigue The following percentage of those surveyed felt the following activities benefited them: • 85% Discussed cases with colleagues • 76% Attended CPD workshops • 70% Time spent with family and friends • 70% Travel, holidays, hobbies, leisure activities • 69% Talk with colleagues between sessions • 64% Active social life • 62% Exercise • 56% Limiting caseload • 44% Development of a spiritual life • 44% Regular supervision

22. Burnout As opposed to compassion fatigue or caregiver stress, burnout is usually related to administrative, organisational or political issues at work. The term was first introduced by Maslach (1982) to describe a collection of symptoms which can be described in three key aspects.

23. Three aspects of Burnout • Emotional Exhaustion - “I feel emotionally drained at work” • Depersonalisation - “I worry my job is hardening me emotionally” • Reduced personal accomplishment - “I am no longer positively influencing other people’s lives through my work” The Maslach Burnout Inventory

24. Contributory factors to Burnout • High workload and few rewards • Feelings of being unsupported • Inadequate training and supervision • Values and ethical conflicts • Burdensome policies / excessive bureaucracy

25. Contributory factors to Burnout • High expectations from managers • Tight deadlines • Little autonomy and independence • More work than time to do it • External locus of control

26. Compassion fatigue and Burnout is always a possibility. If you don’t take care of yourself, physically, mentally and spiritually, then eventually there will not be enough of you left to care for anyone else. Some important thoughts. • In order to do the job effectively you need “spare capacity”. • Compassion fatigue is not a character flaw or a weakness.

27. Thank you for your time Any further questions?

28. Martin J. SmithPhD • ITC CONSULTANCY • www.taking-control.co.uk • Telephone 07 973 410 010