The Cost Of Caring

1. The Cost Of Caring Deneen Dryden, LCMFT

2. Case Study • It was the third time this month that Diane discovered an item had been stolen from the family home. The first time it was a gift for a family friend and the second time it was the new boots that she had bought her other daughter for Christmas. This time it was her grandmother’s wedding ring. She knew right away that she hadn’t been robbed by a stranger. Her daughter’s addiction to opioids had reached a new level of seriousness and she was stealing from the family. At first it had been simple things, like items around the house or the change out of her purse, but it had escalated as Kati’s addiction escalated. So had the sleepless nights waiting for Kati to come home and the fear of her never coming home. Diane knew if this had happened a year ago, she would have been devastated. Now all she felt was numb. What kind of mother was she? She had tried everything to help her daughter and nothing worked. What was wrong with her? She couldn’t shake this feeling of helplessness and hopelessness.

3. Case Study • James couldn’t believe his good fortune! He was only one of ten that landed the job they wanted straight out of law school. He had been a public defender for the last five years. At first, he thrived on the heavy case load and the thrill of entering the courtroom, defending those accused of crimes. He had always loved the constitution. When he was a boy, he had memorized the biographies of all of the founding fathers. Anymore he found himself not wanting to read one more report or hear one more word from his clients saying they had been set up. The reports were so graphic that he couldn’t get them out of his mind at night when he went home. He no longer really cared about his clients or what happened to them. Instead he found himself blaming them for getting themselves into these situations in the first place. After all, no one forced them to commit a crime. The only thing that seemed to help was drinking at the local bar after work every night where he and the lawyers he worked with swapped war stories. His wife had begin to accuse him of being an alcoholic and numbing out the pain.

4. James & Diane Are Not Alone • James and Diane are not alone in caring for those that are addicted to substances.

5. Addiction in America • Whether it’s a problem with alcohol, opioids, cocaine, or any other substance, addiction kills thousands of Americans every year and impacts millions of lives. Addiction is a disease which compels someone to repeatedly use substances or engage in behaviors even though they have harmful consequences. Addictions destroy marriages, friendships, and careers and threaten a person’s basic health and safety.

6. Statistics on Addiction in America • Almost 21 million Americans have at least one addiction, yet only 10% of them receive treatment. • Drug overdose deaths have more than tripled since 1990. • From 1999 to 2017, more than 700,000 Americans died from overdosing on a drug. • Alcohol and drug addiction cost the U.S. economy over $600 billion every year.

7. Statistics on Addiction in America • In 2017, 34.2 million Americans committed DUI, 21.4 million under the influence of alcohol and 12.8 million under the influence of drugs. • About 20% of Americans who have depression or an anxiety disorder also have a substance use disorder. • More than 90% of people who have an addiction started to drink alcohol or use drugs before they were 18 years old. • Americans between the ages of 18 and 25 are most likely to use addictive drugs.

8. Addiction Is On The Rise • As opioids continue to be in the news, the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 2014 National Survey on Drug Use and Health, has estimated that 21.5 million people aged 12 years and above had a substance use disorder, including drug and/or alcohol addictions. • Substance abuse and addiction exert a huge impact on the family life of countless individuals who suffer from the devastating effects of these addictions. Far too many of these people do not receive the help they need in order to overcome these problems in their daily lives and subsequently, their families suffer alongside them.

9. Addiction Devastates Families • When a family member has a drug or alcohol addiction, they have a disease that has the power to affect and hurt their entire family, including parents, children, brothers, sisters, grandparents, or any family member who is a part of their life. An addiction can cause tension, miscommunication, and more frequent arguments within a household, raising the stress levels and negativity off all who are within this unhealthy atmosphere leading to compassion fatigue toward the addict by all members of the household. .

10. What Is Wrong with James and Diane? • What James and Doreen don’t know is that they are suffering from compassion fatigue. • Colleen Breen, the author of Making Changes: A Guidebook for Managing Life’s Challenges, defines compassion fatigue as a “soul sadness.” • She says that caregivers, whether it be family, friends, or healthcare professionals forget to take care of themselves, because they become so overwhelmed by the needs of others. • They become spiritually, mentally, and physically bankrupt.

11. Compassion Fatigue • Webster Dictionary defines compassion fatigue as: • Medical: the physical and mental exhaustion and emotional withdrawal experience by those who care for sick or traumatized people over an extended period of time. • Apathy or indifference toward the suffering of others as the result of overexposure to tragic news stories and images and the subsequent appeals for assistance. • Compassion Fatigue has been described as the “cost of caring”; for others in emotional and physical pain. (Figley, 1982) It is characterized by deep physical and emotional exhaustion and a pronounced change in the helpers ability to feel empathy for their patients, their loved ones and their co-workers

12. Compassion Fatigue • Most of us learned in childhood it is more important to give than take care of ourselves. In childhood most of us learned; • Other Directedness; so when we try to take care of ourselves we would experience or have feelings of shame, self centered, or selfish. • Lack of strong Boundaries; we allow way too much in. We need to know what and when to allow in.

13. Compassion Fatigue • Unresolved past pain and trauma; Learn to let go of past pain and trauma. This can be done by rituals, spirituality and other ways. • What doesn’t go through us Defines us!!

14. Compassion Fatigue • Overdeveloped sense of Responsibility; parental drug and alcohol abuse, physical abuse, emotional/verbal abuse. We felt we were responsible for everything. • Impulse to rescue anyone in need. We all know people who have rescued MANY animals, when 1 dog and 1 cat would have done our part.

15. Types Of Compassion Fatigue • Primary Traumatic Stress: • Primary stressors are those inherent in the extreme event, such as what was immediately experiences or witnessed, especially those things most contributing to a traumatic response. • The case study of Diane is an example of primary traumatic stress. Diane is personally experiencing the impact of drug addiction on her self and her family. She has done all that she knows how to do to help her daughter yet the addiction continues.

16. Types of Compassion Fatigue • Secondary Traumatic Stress: • “vicarious traumatization” – the emotional residue or strain of exposure to working with those suffering from consequences of traumatic events. • James is experiencing compassion fatigue from secondary traumatization. He is constantly reading and rereading reports of secondary trauma. He is beginning to numb his feelings of resentment toward his clients. In fact, his wife thinks he’s an alcoholic.

17. Secondary Trauma • For those in the legal system, especially lawyers, they intersect with their clients because the worst has happened. • “Clients call for help because the worst has happened. Lawyers dealing with the aftermath can become a trauma of it’s own-leading to depression, anxiety, difficulty sleeping and concentration, personality shifts and substance abuse.”

18. Secondary Trauma • Lawyers are taught to not show weakness, to deny, defend and deflect vulnerability, while staying emotionally detached at all times. • Source: Understanding and Mitigating Compassion Fatigue for Legal Professionals. Linda Albert, LCSW CSAC, pg. 9; • www.wispd.org

19. Is Compassion Fatigue The Same Thing As Burnout? • Answer? No!

20. Burnout • The Webster Dictionary defines burnout as: • “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.

21. Burnout Vs. Compassion Fatigue • Burnout and Compassion Fatigue can co-exist but there are some differences: • Compassion Fatigue occurs due to exposure to a cumulative level of primary or secondary trauma. • Burnout is NOT trauma related. Burnout occurs due to exposure to an increase workload and institutional stress.

22. Symptoms of Compassion Fatigue • The American Institute of Stress identifies the following symptoms of Compassion Fatigue: • Affects many dimensions of your well being • Nervous system arousal (Sleep disturbance) • Emotional intensity increases • Cognitive ability decreases • Behavior and judgment impaired

23. Symptoms of Compassion Fatigue • Symptoms continued: • Isolation and loss of morale • Depression and PTSD (potentiate) • Loss of Self Worth and emotional modulation • Identity, world-view, and spirituality impacted • Beliefs and psychological needs safety, trust, esteem, intimacy and control • Loss of hope and meaning – existential despair • Anger toward perpetrators or causal events

24. Common Symptoms of Compassion Fatigue • Abusing drugs, alcohol or food • Anger • Blaming • Chronic lateness • Depression • Gambling • Diminished sense of personal accomplishment • Exhaustion (physical or emotional) • Frequent headaches/migraines • Nail biting • Constant thoughts about stressors

25. Common Symptoms of Compassion Fatigue • Gastrointestinal complaints • High self-expectations • Hopelessness • Hypertension • Inability to maintain balance of empathy and objectivity • Increased irritability • Less ability to feel joy • Low self-esteem • Sleep disturbances • Workaholism

26. Common Symptoms of Compassion Fatigue • Fatigue • Chest Pain • Muscle Pain and tension • Nausea • Increased sweating • Weakened immune system • Neck and back pain • Increased irritability • Sadness • Restlessness • Mood instability • Decreased sex drive

27. Commonalities Between Burnout And Compassion Fatigue • Emotional Exhaustion • Reduces sense of personal accomplishment or meaning in work • Mental exhaustion • Decreased interactions with others (isolation) • Depersonalization (symptoms disconnected from real causes) • Physical exhaustion

28. Differences Between Compassion Fatigue and Burnout • Professionals agree that there are clear differences between compassion fatigue and burnout. • The major difference between compassion fatigue and burnout is that compassion fatigue is trauma related and can occur more rapidly. Burnout occurs over time. Compassion Fatigue can be managed if caught in early onset and can have a faster recovery time.

29. When Helping Hurts • F. Oshberg, MD, author of When Helping Hurts stated it this way: • It’s not a matter of one day, you’re living your life with a great deal of energy and enjoyment, and the next, you wake up exhausted and devoid of any energy – both physical and emotional. Compassion fatigue develops over time, taking weeks, sometimes years to surface. Basically, it’s a low level chronic clouding of caring and concern for others in your life - whether you work in or outside the home. Over time, your ability to feel and care for others becomes eroded through overuse of your skills of compassion. You also might experience an emotional blunting whereby you react to situations differently than one would naturally expect.

30. Who Is At Risk? • EVERYONE that cares for an addict is exposed to primary and secondary trauma! • Those who are in a profession of caring. Therapists, Lawyers, Nurses, Working with special needs.

31. How Do You Identify Compassion Fatigue In Yourself? • A free assessment tool can be found at: • www.isu.edu/~bhstamm/tests.htm • CFST-Compassion Fatigue Self Test • ProQoOL-Professional Quality of Life • STSS-Secondary Traumatic Stress Scale

32. What If It’s Too Late? • What if the self-assessment tool above indicates you suffer from compassion fatigue?

33. What’s A Person To Do? • Preventing compassion fatigue can be done. It is easy for those who live with and try to help an addict put off taking care of themselves in an effort to help their loved one get and stay clean. • If compassion fatigue isn’t managed in the caregiver, it reduces their ability to care for the addict or anyone else.

34. Mother Teresa Understood Compassion Fatigue • She wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.

35. How To Manage Compassion Fatigue: Caring For The Caregivers • Be aware of changes in your level of compassion fatigue • Monitor your levels for stress and how you feel about caring for loved ones suffering with addition. Track your stress levels in a journal over time. This will help you track changes and identify when you need added self-care.

36. How To Manage Compassion Fatigue: Caring For The Caregivers • Make self-care a priority • Taking care of yourself isn’t an option. It is essential that you protect your mind and emotions from compassion fatigue. Although you may experience feelings of fear and anxiety about not being able to monitor your loved ones suffering from addiction 24/7, it is essential that you take time for yourself – even if it is only a few minutes a day.

37. How To Manage Compassion Fatigue: Caring For The Caregivers • Spend time away from the addict. • In order to prevent isolation, spend time away from the addict. Continue to spend time with other family and friends in your social circles. This can help ward off loneliness and depression.

38. How To Manage Compassion Fatigue: Caring For The Caregivers • Join caregiver support groups • Join a caregiver support group! If you don’t have one located in your community. Look online. There are many online support groups. Don’t forget Facebook- where there is a connection for everyone! • Support groups are a wonderful way to reinforce the feeling that you are not alone and share insight on how to deal with your emotions and practical aspects of caring for an addict.

39. How To Manage Compassion Fatigue: Caring For The Caregivers • Activities to cope with stress: • Write in a journal • Journaling has been shown to help caregivers process their thoughts and emotions while reducing stress. It can be done anywhere, anytime! • Take a walk, meditate, do a short workout, practice deep breathing, call/text/visit a friend, watch some funny video clips on YouTube, take a bath or shower, take up a new hobby

40. Speak With A Professional • If you feel that none of the above activities are helping and your compassion fatigue levels are increasing, seek professional help! Support groups are a great way to seek a referral for a counselor or therapist in your community that specializes in compassionate fatigue and addiction.

41. Treating Secondary Trauma And Compassion Fatigue In Professionals • Attorneys, judges, legal support staff, mental health professionals, and addiction counselors to name a few suffer from vicarious trauma when working with those suffering from addictions. Legal Professionals practicing criminal and family law are among the category with the highest potential to suffer compassion fatigue. Prosecutors of sex crimes and crimes against children are the most likely to suffer compassion fatigue

42. Treating Secondary Trauma And Compassion Fatigue In Professionals • Awareness • Debriefing: Talk about how you are feeling about the traumatic event or material that you are reviewing or experiencing. • How is it personally impacting you? • Balance or Self Care: Learn how to turn off your “fight or fight response” and turn on your relaxation response. • Be intentional • Professional Assistance

43. Stress Management Tips • Keep in mind stress is not a bad thing. Stress motivates us to work toward solving our problems. Reframing thoughts to view stress as an acceptable emotion, or as a tool, has been found to reduce many of the negative symptoms associated with it. The goal is to “manage” stress, not to eliminate it. • With Compassion Fatigue the stress has gone on for so long that we numb out and no longer care as we did.

44. Stress Management Tips • Talk about your problems, even if you feel it won’t be solved. • Talking about your stressors-even if you don’t solve them-releases hormones in your body that reduce the negative feelings associated with stress. Time spent talking with friends and loved ones is valuable, even when you have a lot on your plate.

45. Stress Management Tips • Prioritizeyour responsibilities. • Focus on completing a few quick tasks first. Gives you momentum to continue on with the “to-dos.” Quickly knocking out the small tasks will clear up your mind to focus on larger responsibilities.

46. Stress Management Tips • Focus on meeting your basic needs. • Stress can start a harmful cycle where basic needs are neglected. Make a point to focus on your basic needs, such as eating well, keeping a healthy sleep schedule, exercising, and other forms of self care.

47. Stress Management Tips • Don’t put all your eggs in one basket. • People who are overinvolved in one aspect of their life often struggle to deal with stress when that area is threatened. Balance your time and energy between several areas, such as your career, family, friendships, and personal hobbies.

48. Stress Management Tips • Set aside time for yourself. • Personal time usually gets moved to the bottom of the list when things get hectic. However, when personal time is neglected, everything else tends to suffer. Set aside time to relax and have fun every day, without interruptions.

49. Stress Management Tips • Keep things in perspective. • In the heat of the moment, little problems can feel bigger than they are. Take a step back, and think about how important your stressors are in a broader context. Will they matter in a week? In a year? Writing about your stressors will help you develop a healthier perspective.

50. Self-Care • Take regular vacations • Setting boundaries separating work and private life • Striving for a balance between work and “life” • Remember Progress not Perfection • Find work that is congruent with who you are as a person